Five things I wish I knew before starting hormones as a trans person
Jude Guaitamacchi described the leaked NHS guidance as “creating more barriers and complexities” for young trans people. (Getty)
Hormone Replacement Therapy (HRT) is, for many trans and non-binary people, a huge step in transitioning, but the process can be complex and confusing.
While the goal of HRT is to help a person feel more comfortable in their body and help them express their true gender identity, the treatment can have lots of subtle side effects that might not be immediately apparent.
Speaking as a trans woman on hormones, the first few weeks can feel incredible but also like emotional whiplash. Hormones change the way you can handle certain emotions or feelings and fundamentally shift your perspective in interesting ways.
Here are just a few of the things I wish I had known before I started hormone replacement therapy.
HRT is a process
If you’ve ever taken any long-term medication, you’ll know that it isn’t as simple as a one-time prescription, but involves plenty of follow-up sessions and frequent shifts in your dosage.
Hormones are no different. An integral part of HRT is keeping tabs on your hormone levels and seeing how your body responds. This is especially important to help prevent any internal liver damage.
The early stage of hormone treatment involves taking a low-level dose and gradually moving to a more appropriate prescription. It may sound frustrating, but these things take time.
Learning how to measure your hormone levels once you receive your blood test results is also helpful – particularly while under private healthcare – since having a better understanding of your levels can help inform you about the next steps.
Is it cold or is it just me?
Despite what the internet may tell you, the real key to a trans woman’s heart isn’t a Swedish shark plushie or a jar of gherkins – it’s a coat to handle how chilly it feels all the time!
As it turns out, hormone therapy actually changes how the body regulates cold. While the level at which temperature affects you – as with many changes from HRT – may vary from person to person, estrogen augments the way the body stores heat because of the way it affects the skin.
According to research published in the Autonomic Neuroscience Basic and Clinical Journal, estrogen will cause lower body temperatures because it directly affects blood flow and dilates blood vessels, meaning that the body is less able to store heat for longer amounts of time.
This is completely natural and is a byproduct of the feminising effects of estrogen, though it may come as a surprise to those who weren’t aware of the changes. Your first winter on HRT will be a doozy, so be sure to wrap up warm.
Trans fems have periods too!
It’s true! Many trans-feminine people on estrogen experience menstrual cycles similar to that of people with uteruses due to gender-affirming treatment.
Because of the shift in hormones, several trans people on feminising doses have reported that they experience hormonal cycles consistent with premenstrual syndrome.
Symptoms have been noted to include feelings of anxiety, changes in appetite, mood swings, cramps, fatigue, and more. Bleeding is not part of the cycle for those assigned male at birth (AMAB).
And for any TERFs still reading – no, just because trans-feminine individuals don’t bleed doesn’t invalidate the factual things that are happening to their bodies.
Patience is key
One of the most common things you’ll hear among trans people is how shocked they are at the effectiveness of HRT in how it feminises the body.
The kicker here is that, while emotional changes kick in surprisingly fast, physical changes can take longer to notice – your body needs time to change, after all!
Effects like body fat redistribution and skin softening can take several months to kick in and, even then, their effectiveness can vary from person to person.
According to Gender GP, physical changes such as breast growth, decreased testicular volume, decreased muscle mass and facial hair thinning can take anywhere from 3-6 months to fully get going, while their maximum effect can take years.
Once these changes kick in, they’re very noticeable and can be some of the most euphoric changes HRT offers, they just take time. Keep at it and, before you know it, you’ll notice the difference.
You’re more than your hormones
For some, hormones are an incredibly vital step in their transition and can be seen as the beginning of their journey – I would know, because I felt that way for a long time.
But it’s incredibly important to remember that, despite the amazingly affirming effects that hormones have for some, they are not a criteria for transitioning, nor are they an indicator of how well your transition is going.
Despite wanting to go on hormones since coming out as trans, the truth is that I socially transitioned for years before taking my first dose. I was as valid then as I am now, and the same is true with anyone who decides whether or not hormones are right for them.
This is also just as true if you decide that hormones are not for you. Your decision in what you want to do with your body does not make you more or less valid in your gender identity, and hormones are not an inherent part of everybody’s journey as a trans person.
