HRT

 

CW: Needles & My Butt

 

I thought it would be beneficial to provide my experience with Hormone Replacement Therapy (HRT); the commitment required, as well as basic info on my process for both cis people and those thinking about medical transition. First, I am not a medical professional. This is in NO WAY meant to be instructional in nature. Let me be clear that this is my regimen as prescribed by my physician. It is customized to me. This is not a one-size-fits-all solution. Nothing I do or say here should be taken as medical advice. Got it? Good.

Secondly, it’s important to know that not all trans women choose this route – or have the option for hormones due to a variety of factors – and that doesn’t make them ANY less trans. I’m fortunate. This is available to me.

So, I thought I’d provide a Saturday morning tour of the HRT realities in my weekly life. If you are squeamish about needles, stop now! First, a little bit of background on my HRT journey.

Every Saturday morning, I inject myself with Estradiol Valerate. It is a bioidentical form of estrogen, meaning it is a synthetic hormone nearly identical to hormones naturally produced by the body. This is the primary hormone treatment for trans feminine people. Injectable hormones increase risk for blood clots and stroke; with a higher risk for people who smoke (people like me).

Estrogen is typically administered in sublingual pill form at the onset of transition, along with a testosterone blocker (anti androgen) like spironolactone (more on Spiro later). It is then titrated up. Blood tests are done every 3 months in the first year of treatment to check levels. Then every six months to a year after that.

Treatment produces variable results including:

  • breast growth
  • softening of the skin
  • reduction and fining of body hair
  • change in body fat distribution
  • reduced muscle mass and strength in the upper body
  • emotional change
  • decline in libido
  • decreased spontaneous erections
  • testicular shrinkage and cessation of spermatogenesis.

 

I have experienced all of the above plus: 

  • absence of libido
  • blood in semen (minimal)
  • pain from erection (inconsistent)
  • abnormal erection (inconsistent)
  • complete lack of ability to climax (inconsistent)
  • changes in taste
  • improvements to digestion

The detail here is self explanatory to those who are trans; however, I include this level of detail for cis friends, so people get a better idea of the commitment required for this one element of transition. Why? Because I’m sick and fucking tired of seeing TERFs (Trans Exclusive Radical Feminists) posting stupid comments and stories about how a “man” may simply transition, win a gold medal in sports by participating in women’s events, and then “change” back. This is literally the dumbest fucking thing I’ve ever head and is a complete insult to the commitment required to transition.

At this point in my life, I will essentially have to do this for the rest of my life. My regimen may change based on age and additional surgeries, but there will likely never be a time in which I don’t have to intervene with medications and hormones.

Anti Androgens 

As an aside, I wanted to touch on anti androgens quickly. These are commonly know as testosterone blockers. While I am not a doctor, I can say without a doubt that Spironolactone was terrible for me. It caused a general fogginess, balance issues, general depression, anxiety increase, and I even began losing my vision. These were severe in me. After doing some of my own research I found a group on Facebook specifically about trans feminine HRT. It discusses the anecdotal and documented dangers of Spiro. I highly recommend that all trans women who are considering taking it, or taking it, read this articleThe Case Against Spironolactone. Furthermore, following the Dr. Will Powers method of transition, I found that I didn’t even need it. My experience has been that Spiro is not necessary at all for most trans women. A high enough dose of Estradiol will push down testosterone levels to where they should be. My blood work verifies that; in fact, my testosterone dropped with I began injections and ceased Spiro (currently < 10pg). I had to actively advocate for myself with my doctor to get off Spiro and move to injections. I have been off Spiro since my 6 month on HRT. I saw nothing but improvement in every way – physically, mentally, and emotionally – after ceasing Spiro. Obviously, this may not be the case for everyone and you should do your own research and make the best decision for yourself.

Estradiol Injection

Back to injections. I recorded this video to demonstrate what my Saturday injection routine looks like. Again, if you don’t like needles or don’t want to see my ass, you might not want to watch it.

There’s a common narrative within the media and literature that all trans folx knew they were trans from a very early age; that we all went to sleep each night praying to a god that we would magically wake up in the “right” body. This narrative is so pervasive that I think many trans people feel guilt, shame, or fear if they didn’t feel that way. I know I did. It created questions in mind as to whether or not I was actually trans! I suspect that some folx simply say that they did know, even when perhaps they didn’t; just so they don’t feel othered within the trans community or by cis-people who know only one book-club narrative.

The truth? Not everyone knows at 6 years old or 20 years old or, even, 50 years old. Not everyone prayed to be transformed over night. Certainly there are those who experienced early recognition – common narratives exist for a reason – and, in many ways, I suppose I’m envious of their clarity at such an early age. However, I didn’t have that language or awareness early in my life. In fact, I’m still gaining clarity. After I had already begun this post, I read an incredible article that gave much clarity to my experience – Gender Desire vs Gender Identity by Amanda Roman. As she so eloquently states, “I, like so many other trans people, grew up experiencing gender not as an identity so much as a desire.”

Growing up, I idolized womanhood. I viewed it as far superior to being a man. Women had all the good stuff, the things I coveted so deeply: conversation, sisterhood, emotiveness, whimsy, sexuality, expression, fashion, creation, power, presence, culture, maturity, empathy, intelligence, mother spirit, depth. I longed for that experience so deeply; to be on the inner circle of what I perceived to be the “better” experience in life. I stood as a witness, an outsider looking in on a world I desperately longed to live in.

Being from the Deep South, and from an incredibly patriarchal, Christian extended family dynamic, gender roles were rigid. Holiday gatherings spotlighted this separation of duties clearly. Women did women things. Men did men things. The woman prepared the food. The men waited. I generally preferred to be in the kitchen with my mother, grandmother, and aunts fretting over the best food layout and who needed iced tea over hanging out with the men who were idle. My grandfather and uncles would take a napkin or scrap of paper and meticulously draw out small mechanical designs, discuss the changing architectural landscape in our small town, or stand over a new table saw, unhuhing and ahahing at each small detail. It was excruciating. I avoided it when possible. The energy I needed was in the kitchen. It wasn’t about the food prep or traditional roles. It was about the energy; it just felt…right. This continued throughout my adolescence.

It’s no coincidence that before I ever applied makeup, I already had a good idea of how to do it, as well as how to file and paint my nails. Without it being a conscious decision, I watched my mother closely for years, each morning. She would sit on the floor in front of the couch with a cup of coffee next to her and a small mirror between her knees, all of those fascinating potions and powders in a little bag next to her. I can still see the exact sequence and motion she’d use to apply her foundation. She used her hands (not this girl!), beginning at her cheeks, moving to her chin and upper lip before finishing at her forehead. I had watched other women, too. I paid close attention, because it was important to me.

It never dawned on me that I was Trans. In 1985, at 10 years old, I had never even heard the term Transgender. In fact, it would probably be another 15 years before I did. I had no idea that it was even possible. Plus, I lived life without a lot of thought as to why; I just did what felt right. While I knew it was “wrong” and socially unacceptable to want to do feminine things and look feminine, it didn’t stop me. More importantly, I didn’t feel any guilt about it. I knew well enough, however, not to get caught and to toe the line carefully.

As I aged, this desire grew stronger, or perhaps just expanded as my experience of the world expanded. I found outlets for it; these were not conscious thoughts, but rather my heart gravitating toward what it needed to survive. As a teen, I was a metalhead. Growing my hair out and piercing my ear – singular, it was the 80s – was acceptable; frowned upon but acceptable. I loved and wrote poetry as a teen. I always had friends that were female. I hid in plain sight. I swooned over Prince, as well as each and every beautifully feminine or androgynous musician. I was migrating toward all things traditionally feminine, and, honestly, only in my forties did I see that clearly. Then, I was just being me. I didn’t stop to think about my gender identity; that phrase was non-existent in my vocabulary.

When I was 19 I moved to a larger city, eagerly leaving behind the insulated, narrow view of small-town Southern life for something better. I would find more of my tribe. I openly identified as bi-sexual. I found myself experimenting more with cross-dressing and uncovering myself and my voice. I met people who didn’t reject me because of my femininity, but rather embraced me – not all, but enough. I still didn’t have formal thoughts of being trans. But! I did know that trans women existed by this point, sadly through porn only, and I was obsessed. This was the early, early days of the internet, and identification began to open up to me. I looked on in awe and envy. Ironically, though, I still didn’t know. In hindsight, I don’t think my brain was ready for that realization. My psyche was protecting me from a truth that, at that time of my life, I may not have survived.

I hit a point in my early 20s where I needed more, and I wasn’t completely trusting of my spouse at the time. So, I turned to more private behaviors to explore my sexuality and my gender identity. I was not informed enough at the time to understand the separation of gender and sexuality. I suspect this is common. Sex is a safer space to explore gender. It’s “kinky,” and, therefore, more acceptable. But, in usual fashion, my inner needs went beyond what even an open mind considered acceptable. I had a deep itch that had to be scratched. So, I looked for fulfillment elsewhere. I began sneaking around and dressing up when I was alone. My mental health was volatile at best, but none of this was on my emotional radar. Alas, I found IRC chatrooms and started putting myself in risky situations, but the more I experienced, the stronger my truth grew.

Fast forward to 29 years old. I was divorced from my first wife. I was deep into my drug/alcohol addiction and self harm, and one day I met a wonderful soul. She and I fell in love. My life had been filled with moments of awakening leading up to the day I met her, times when I knew I needed to get clean. Perhaps she was the proverbial straw on the camels back. I knew I could no longer go on if I didn’t get clean. So, I did. Somehow. I found recovery. I managed to stay clean and stop engaging in self-harm.

I felt more open with her, or ,perhaps, I was determined to be more open; to try and avoid past secrecies. My gender self-knowledge was still infantile and unformed. She would paint my toenails and fingernails black, if I was feeling especially confident. Around this time, I heard the term metrosexual. “Yes! That’s what I am. I am metrosexual.” I felt comfortable dressing up for her on occasion, again always in sexual situations. She didn’t reject me. It was still framed as a kink and not my identity, and I gained such a sense of euphoria and excitement each time.

Over time I incorporated elements of this into more frequent practice. I had “gothy” skirts, and, when we attended an event where it was possible, I’d wear eyeliner, mascara, and one of my gender-bending skirts – straddling the line of gender presentation, leaning as far to the femme side as I could while still sitting in the comfort zone of rebellious male. I was comfortable there for a while. My spirit got the fix it needed.

Sometime in my late 30s, a parade of new humans began marching into my life. They were queer and confident. They were open and brave. They brought new perspectives, acceptance, and love into my life. They were infectious, and I was ready for it. I began to find identification. Little by little the light began to shine on the dark secret, tucked away so deep that its shape was obscured even to me.

There are so many people and events that contributed to the unearthing of my gender identity. Some know, many do not. It would take a book to recount them all – big moments, small interactions, happenstance, endless pieces of the puzzle. There’s that one moment, though, when it really formulated in my brain and heart. I heard that truth find her voice. It was January of 2016. She was gentle with me. She led me in baby steps, knowing what I needed. First, she said maybe your gender fluid, and I said “Yes! I’m gender fluid.” This was comfortable for a short time. But, more and more I leaned further to the femme side. I had no use for masculinity anymore. It pained me to live that way now that there was a small light inside.

It would take me 2 1/2 more years to come out as a trans woman. I was 43-years-old. Forty-three years of working up to that moment. I do my best not to live in the “what ifs.” What if I’d know when I was a teenager? Imagine how much my body would’ve changed with hormones. What if I’d know in my twenties? I could have experienced so much that I may never experience now. However, I didn’t know until I was in my 40s, and that’s okay. I regret nothing about my life. I have the most beautiful, brilliant son ever. I have a wife who is also my best friend, and a life so fulfilling that, at times, it brings me to my knees with gratitude. Had I realized earlier, the life I have today would not exist. It makes no difference to me what that alternate life would’ve been. I wouldn’t trade it for what I have today. More importantly, I can’t.

What I can do, however, is move forward; revel in the complicated bliss of living the life as the woman I am. Do my best to take it all in. All the firsts. All the euphoria. All the sighs. All the pain. All the struggles and the love… the love. More often today life falls on me like the sun. I turn my face up toward it, feel its grandeur, let it soak in, warming me in the comfort of rightness. A feeling that only someone who’s waited 43 years can understand.

raising brooklyn

I had been hunched over my mental script for a long time – a couple of years actually. Writing, editing, rewriting the outcome; planning for every single possibility. In hindsight, it’s not surprising that my first thought after I’m trans was will my mom accept me?

It’s rare for me to remember dreams, or be affected by nightmares. However, for a year or more, I found myself startled awake by dreams of coming out to my Mom – short of breath and sweating. There I was, night after night, upright in bed, panting, the image of her face quickly fading from view; that disorienting and sickening feeling that something had just occurred against my will. The type of dream where you have to touch something to ground yourself, and, even then, it took a moment to convince yourself that it was only a dream. It was a clear how deep my fear ran, and it was clear that I had to tell her. I couldn’t live in fear forever; it was destroying me.

I had been out to my wife and son for at least a year when we made the trip to Mississippi. I don’t recall the reasoning I gave my mother for coming to visit, but I suspect it was just simply “we haven’t see you in a while.” It was relatively last minute, which was out of character for us. Fortunately, I’m a skillful liar. My mother had a high intuition. In order to out-maneuver her as a particularly defiant teenager, I had to match her intuition with my deception. Each day leading up to our departure I grew more anxious and excited. It’s difficult to portray the equal amounts of fear and joyful anticipation that coexisted during that time period; the aching desire to just be out and the paralyzing fear that those you love most will turn away. A fear not at all unfounded for trans people. Nonetheless, it was time to face that possibility.

A few days later we arrived in Mississippi. The reality of the situation immediately began to settle in. I knew I had to do it. Waiting was only going to make it worse. Besides, there was no going back. The truth was present in me always, and I wouldn’t change it even if I could.

So, there I sat in a musty, nicotine soaked recliner, my heart in my stomach, hanging my feet over a precipice of atomic change – a place we’ve all visited – looking for a reason not to jump. Stand up, Erica. Walk toward her. That’s all you have to do. So, I did just that. I took a deep breath and stood up.

My mother was directly behind me in the kitchen getting coffee, perhaps 10 feet away. Coffee was her water equivalent. There was always a pot of coffee made, no matter the time of day, and she was always refilling her cup. My siblings and I had multiple names for it – dark water, muddy water, and, even once, a crime against coffee. But, more generally, it was just Pat coffee. She was finishing pouring a cup as I rounded the corner of the kitchen. She looked up and gave me a smile. I walked toward her and the reality of it all finally conquered me. My heart knew I was about to be free and a tsunami of tears, which had been collecting inside for years, moved up through my body. With every step they neared the surface, and she could see it. She could always see it. Her face changed. I could see the worst thoughts forming. I didn’t make it to her before the tears breached the surface. Through a trembling voice and a well of tears I managed, “Mom, I need to talk to you. Can we go to your bedroom?” Followed up with a quick reassurance that everything was okay with my son and wife. “Of course, honey, of course,” she said. She lived for crisis. She was a counselor by profession. So, she walked me through the dining room toward the hallway rather than having to walk through everyone in the living room.

We reached her bedroom at the end of the hall. Her room was exactly what you’d expect of a counselor. A haven. A safe space. A purple couch, lamp light, knick knacks, journals and pens everywhere. We took a seat on the couch. The tears increased their flow. I don’t know that I’ve ever felt such a shock of emotion as I did that day. She looked at me, “What’s going on?”

“I have something I need to tell you. Nothing is wrong with [my wife] or [son]. I’m okay. I’m sure you’ve noticed that I’ve been changing lately.” The tsunami made landfall at the point. My mom moved in closer to me. She put her arm around me and said it was okay. The tears flowed even harder. “I’m transgender, Mom.” And, there it was. I had learned already from previous experience to just get to the point. I had rehearsed it over and over. A deafening silence set in. Every atom in my body held its breath while I waited on her response.

“I know, honey.”
“It’s okay.”
“I love you.”
That was what she said. To describe how I felt in that moment is simply not possible. Like all monumental moments in life, only the participants can know. It defies words. It simply has to be experienced. We sat there for a while, her arms wrapped around me while I cried, not from sadness but from relief and comfort. The comfort that only a mother can provide her daughter. She said so many other wonderful things. She said that she raised me to myself, and that this was right. She said she wasn’t surprised because I was raised by a strong woman. She said all the right things and then some. And as I sit here, barely able to see through my tears, writing this, I wish with all my heart that I could remember every word of it.

I began hormone replacement therapy just a couple of weeks later. She was admitted to the hospital three days after that. We learned that she had lung cancer. And, three months later, in October, she passed away. Every single day I’m grateful for all that she did for me, but that moment on her couch is the one I go back to most often. I wish my coming out experience could be what every trans person experiences. Sadly, it is not. My experience was unique. If I had just one more moment with my Mom, I would hug her and tell her just how much that day meant to me; how I am the person I am today because of her.

raising-brooklyn

Cis Women are often full of encouragement about what trans women don’t need in order to be a woman. It’s all well-meaning, kind, and, on the surface, sounds legitimate and empowering. But, how do you experience womanhood without, well, experience? People – their perceptions, beliefs, coping mechanisms, behavior, personalities – are largely made up of millions of daily experiences; experiences that are rooted in their perceived gender. Cis woman are, in large part, who they are based on a continuous and incredibly complex series of interactions with the world around them – good, neutral, and bad. Those interactions begin with the perceived notion that they are a “woman,” based on their physical features and mannerisms; mannerisms and character traits that were largely learned.

Did a woman decide to do the things she does? To cock her head that way, or place her hand just-so on her hip, to inflect her voice in that subtle way, or did she begin learning that from the first moment light hit her pupils? We all know the answer to this. Certainly there is some level of nature, but a tsunami of nurture. I suspect it’s beyond comprehension – how we become who and what we are. We know that if feminine behavior was modeled differently, by and large, women would behave differently. Simply look to other cultures and see how easily that’s proven. Yet, so many cheer from the sidelines with the conviction of infallible answers; seemingly as though they are above the subtle, cunning manipulations of the world around them. In fact, they are not. No one wakes up at point “z.” They had to walk to get there. Their programming has been so slow for so long – a glacier of psychic imprints rolling over them their whole life – they can’t even perceive it. Certainly, our essence, that beautiful lamp that lights us from the core, is less malleable. It is the beacon that tells us so clearly who we are. How that lights shines, though, its intensity and direction, its temperature, are all influenced by the world around us. We are, after all, social creatures. Our existence is one life-long attempt to fully communicate with others our essence; an essence that is forever shapeshifting.

So, when I hear, you don’t need men’s validation or desire to be a woman. You don’t need the acceptance of others. You don’t need pronoun validation. You don’t need sex. You don’t need makeup or hairstyles. You don’t need hips to be a woman, or tits to be a woman. I hear the sentiment behind it, and agree with the premise. I hear the spirit of this encouragement and advice. However, the truth is I do need social experience to explore, understand, shape, and grow into my womanhood. It’s easier to speak from a place of having. When you’ve had those experiences, learned your own lessons, perhaps it’s harder to see their significance. We learn through interaction. We learn what we like and don’t like. We learn what makes us feel confident and what makes us feel small; what we’re attracted to and what we’re not attracted to; how to have good sex, from having bad sex. We learn how to stand after falling. We grow. We evolve. We become. An important figure in my life once said to me, “Allowing people to make their own mistakes is a gift. Don’t take that from them.” I’ve arrived at a more personal understanding of that truth.

Today, I long for things that perhaps I shouldn’t – achingly so at times. They feel necessary; they feel shallow; they feel atomic. I need a lived female identifying experience to unlock the parts of myself that only experience can unlock. So, cis female allies – the wonderful humans that often make trans life bearable – encourage us, love us, and hug us. Feed us your experience and understanding, but don’t diminish. Build us up without robbing us of the gift of our own mistakes and understanding. I am trans. I will always be trans. Ultimately, my experience will be the trans woman experience. It is an honor; something so unique that only a small portion of the world will ever truly understand it. I also know I am a woman of trans experience who often wants to be a trans woman of cis experience. I want to know for myself. I want to fit through experience; give me that gift.

I started Raising Brooklyn for two primary reasons. First, there is almost no information on the lived trans-feminine experience online, or the lived trans-feminine experience outside the typical narrative. Often, it’s difficult to find stories, or information, about the nuances and daily realities of trans-life, and, while there is more information these days regarding topics such as health care and support, it’s often contradictory, out-dated, or unreliable. There are many more topics that are either non-existent or sparse. Important things like: details of coming out to family, co-workers, clients, and friends; what to expect from HRT; different approaches to HRT; advocating for health care; how to fucking shop and find clothes (hopefully my trial and error will help someone else); navigating relationships in a completely new way; straight talk on sex; misgendering yourself internally; walking into a nail salon for the first time; or being on dating sites as a trans woman and all the complexities that lie therein. I hope this site can help other trans feminine folx navigate these waters and find identification – and just maybe provide intelligent, honest, and eye-opening information for cis people.

Second, I wanted a place to make sense of my ever changing self, body, life, thoughts, and perceptions; a quiet place to record my journey and reflect on who I’ve been, who I am, and who I want to be. One thing I can say with certainty is that whatever I say today is likely subject to revision. The “I definitely feel this way” mentality was a mistake recognized in hindsight, which I have worked to remedy. This is my experience. This is not every trans woman’s experience. All I claim is my exploration is honest and sincere, based on my self awareness at the moment. I don’t have all the answers; I don’t have a magic formula. I do, however, have strong opinions on some things and a lot to talk about. But, at the end of the day, all I offer is honest, sincere entries of my life.

So, welcome to Raising Brooklyn – one middle-aged trans woman’s journey to finding myself, living through it, and reveling in all the beauty therein – unapologetically.