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 article – The 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.