To a lot of trans people, HRT is the ultimate goal. It’s the Holy Grail, with a Philosopher’s Stone inside, sat atop Excalibur. It’s talked about in the transgender community with almost legendary status. It’s a solution, it’s a goal and it’s the answer. But in reality, it’s complicated.
For those unaware, HRT stands for hormone replacement therapy. For trans folk who choose to pursue it, HRT is often the first, and sometimes only, medical intervention taken to combat gender dysphoria.
What sparked this essay was a culmination of things, but primarily it was reading a claim that HRT is powerless. A dismissive statement which said HRT’s effectiveness is a dangerous myth, that before beginning transition we trans people should expect nothing and even warn those seeking to transition to do the same. Elsewhere, I read a call to mock trans people who wanted HRT “early”, before they had come out to their social circle, the implication being that they were naive and putting hope where it didn’t belong. They had to “earn” it and run the gauntlet first.
As a trans person myself, I entirely reject that mindset.
HRT does not do everything, no. But saying it does nothing is irresponsible and wrong. Meanwhile, anybody who wants it deserves to have it. There is nothing justifiable about withholding healthcare from a consenting individual who is aware of the risks and effects.
However, the idea that HRT has a set of guaranteed changes for everybody, is not something I agree with either. HRT is very personal. Different doses and methods work on different people at different speeds with different outcomes.
There’s a stereotype in the community that before deciding to transition, binary trans people will scroll through HRT timelines, photo diaries of those who’ve gone through it already. These days you could even just browse the video library of your favourite trans vlogger, bouncing around their channel to look for how their appearance has changed. There is no shortage of before/after comparisons, often focused around HRT.
But comparing ourselves to others’ transitions is not a wise idea, tempting as it can be. Just like a random group of cis teenagers going through puberty, you can’t expect them to have the same results in the same timeframe just by virtue of having the same hormones. Genetic diversity dictates results more than anything else.
Claiming that everybody who goes through HRT with a “good” outcome must somehow be expertly deceptive or a liar, is just a ridiculous. There’s being cautious and then there’s being relentlessly pessimistic. Are we guaranteed to look attractive based on cisnormative beauty standards once on HRT? No. Is there a chance we will? Sure! If someone wants to transition, is it worth them starting HRT with no guarantees on how they’ll look? Yes, of course.
I’ve argued it before, but basing your transition hopes entirely on your appearance isn’t something I believe is a good idea, but I understand why some people do it. Gender dysphoria is deeply personal, but can often cruelly suggest that if you just looked better, then you’d feel better too.
HRT isn’t just about changing how you look. Transition is not the journey to look pretty. Its effects go beyond surface changes. There can be mental and emotional effects too, they can push people to feel better about themselves. Perhaps feel the best they’ve felt in years by treating the root cause of dysphoria, not just the external effect of it. This is also why I can never agree with the gatekeeping mentality that people must “earn” HRT. The mental effects alone of starting it can be hugely worthwhile, it can even give someone the confidence and peace of mind they need to socially transition.
Before starting HRT, I hated taking any photo of myself. Post-HRT, I take photos of myself weekly, for fun. I can consciously look at my own reflection for the first time in my life. For months after beginning HRT, whenever I walked by the tall glass building on my way to work I would glance at my reflection and smile. The fact that I was able to look at myself and actually feel anything other than numb dissatisfaction, is still something I consider groundbreaking.
Was that change from the subtle physical changes to my body and face? Or was that mental effects of HRT lessening dysphoria? Both? Honestly, I think it doesn’t matter. Regardless of the source, the result is that I am happier. It worked. HRT helped usher in a large and positive impact to my life within weeks.
Obviously, HRT is not the only reason I’m happier, no. It would be wrong to praise it as the sole force behind my life improving. But it is an important part of it. It helped me feel like I was making progress by hitting a significant milestone. Most of all, it gave me hope.
The transgender community is a vulnerable one. Hope is important, it is vital. Hope saves lives.
I cannot stress that last part enough. Hope is the most valuable and precious thing we can pass on to the younger generation, they need it.
It’s not even about age either. I spoke to a trans woman recently who’s my age, she wants to transition but is scared her life will be too difficult and complicated if she does. But she’s miserable not transitioning. She’s trapped in a middle-zone, suffering from her own brand of dysphoria and unable to see a happy future.
I used to be in the exact same position, I delayed transitioning for years and years, thinking I couldn’t find happiness. My life was a sad shell. I assumed transitioning meant a difficult and terrifying life, while I knew not transitioning meant emptiness and regret.
The only thing that got me out of that slump was the hope that things just might work out okay. I dared to wonder, what if transition went well? What if HRT made me feel better about myself? What if I found acceptance?
It’s important that we spread that hope and show success. People need to see that you can be trans and happy. We have to fight the sensationalist media perception that trans people are spectacles for others, that we’re all miserable and crawling through life with nothing.
I reject the message that all trans people are miserable and ugly, that HRT is some fallacy. I reject that because I know it’s lethal to some of us to believe it, it’s dangerous to spread it. I also reject it because it’s bullshit.
My life is infinitely better for starting transition. Is it easy? No. But it’s sure as hell been worth it.
I don’t “pass”, I look trans, if I never look any more feminine than this? Fine. I still have no regrets. I will still take HRT. It allowed me to be a better, more confident, happier me. It helped me realise I don’t have to look or act a certain way, that my gender dysphoria was as much about what was going on in my head as what my body looked like.
Ultimately: HRT is personal. It won’t do everything on its own, you have to work on your own wellbeing too, but it can help, a lot.
As a community we should be realistic with what it does, but I believe we should also fight pessimism and cultivate hope. We should do that for the sake of the most vulnerable of us, who are only still here because of the hope that they can one day be happy. To some trans people HRT is nothing, but to others it’s a goal to keep fighting for, a reason to hold on, it’s everything.
I agree. HRT is part of the deal … it comes with the meal, so to speak. It’s what almost every female gets a dose of. It is the pink color that fills in the coloring book of our bodies. Transmen? They get the blue crayon.
It’s also a quick acid test, though let me be quick to point out not 100% of the time and not in every case. Some years back I knew a person, J., a possible MTF who loved women in a very positive way and women who knew J. declared J. an “honorary woman,” to the point where J. considered transitioning. After seeing a shrink for a couple months, J. went in HRT and HATED it. “I don’t like how it makes me feel,” said J. Me/ I LOVED the way it made me feel when I take HRT.
I messed around with E- when I was in college. A bit later, I got into a gender program and after a couple months I tried I. M. estradiol valerate prescribed by an M.D. associated with the clinic. That was 43 years ago and I have never looked back.I posted about the never version, cypionate, which is what I use to this very day. http://virginiahall.net/post/150040812037/long-live-injectable-estrogen-the-feeling-of
Right after GCS from Biber, I went on estinyl. I took the pills for about 20 years and dropped progesterone as it had bad reviews, possibly leading to breast cancer. Through the International Women’s Grapevine (LOL) I heard that some people of transition went back to injectables. My above blog post mentions some of the advantages. It turned out in my case that all of the advantages were true. Softer skin and such. I know no other way to put it. I felt such peace!
After a while, under doctor’s care, He was in Mexico, I upped the E- to pregnancy levels for about nine months. Again, speaking only for myself, the E- not only affected the body, it washed through my brain. After GCS and with virtually no T- in my body, the E- went to work on brain receptors “unopposed.” and the higher doses I felt a shift in sexuality. This is anecdotal, of course, but there are a couple other long-term post-ops who did the same and reported the same. Is it possible the “girl parts” of our brain were metaphorically smothered by T- and knocked off line? Is is possible the high E- kicked them into motion? (Now we’re really getting into sci-fi.) The mechanism I postulate may be rank quackery, but the result was what it was. I found myself (after 20 years of being an all-out lesbian and dating in that community) sliding into bisexuality and then on into heterosexuality. Some will say it was inevitable, E- or not, but whatever the case, it happened.
I transition, also, as a 20-something and if you do the math and add 43+ years of HRT, you can probably guess that i have a few white hairs growing in by now. I was started to get depressed. Was it that I was aging? I found I had insomnia and yet felt like I needed to nap–caught in a terrible cycle of insomnia and wanting to sleep in between. (Hang on, this has something to do with hormones.) I have a lot of trauma that even at my age that I am still dealing with–long dead parents who were anything but supportive of their daughter. I went to a therapist and in passing mentioned my sleep cycle and the therapist suggested prometrium (the “good” progesterone) as something that could help. No LIE! It worked!
My sleep cycles are good and my energy level, which is an issue for everyone my age, suddenly had a sharp uptick. I did not feel like I did even in my forties, but . . . ya . . . my fifties? Yes.My new doc (the doc in Mexico is no longer in the picture) gave me 100mg oral daily.
I cannot say enough good things about estrogen. If I could go back in a time machine and give my teen self advice, I would say to find an M.D. ASAP and get on E-, ASAP, and if I was young enough, on blockers like GnRHa, if they would work as late as the late teens.
It is never too early and it is never too late to transition. It is never too early (save for pre-puberty) and it is never too late to go on E-.
I was on E- for about a year while I cleared my face and arranged my life to leave “him” behind. On E- things did not go smoothly, though. I would dress no differently and act no differently and suddenly people in cars (I lived in a working class rough neighborhood) would toll down their windows and yell “fag!” Nothing changed except the E-, so be careful. I went to letting my facial hair grow out–helped the electrologist a lot–and in damped down the catcalls, but people were seeing it, the male clothes and all, but there was something feminine that was ringing alarm bells in their head.
But then the hair was cleared. I had GCS. I wore appropriate clothing for being a lesbian. Now the cat calls were, “dyke!'” and “lesbie friends!” (Let’s be friends.) But I was passing and this was without any facial surgeries or top work–all natural, although it took about 10 years to get into a B cup and have female shape, not “man boobies.”
The hormones did not help voice, but feeling more feminine, did. But that’s another story.
All I can say is the HRT is a tool in the transition toolbox that should not be abused, but when handled correctly yields great results, at least that’s what I think.
Thanks for commenting! I appreciate you sharing your experience <3
As one who is still awaiting the ‘holy grail’, I can identify with so much of what you write, Mia. Do I have expectations? Of course I do – who wouldn’t? – but they’re much more about feeling right than looking right, if that makes sense. What frustrates me is the conditionality placed on being prescribed HRT, and having to prove (socially and otherwise) that one is worthy of receiving treatment. I can’t think of any other medical condition or treatment where this is necessary. One thing I’ve learned is that if someone thinks they’re transgender to the extent they’re prepared to seek medical advice, then chances are that they are. I concede that dysphoria can manifest itself in many ways, but if a person is sound in mind and body then why the hell can’t a GP prescribe HRT, with the support of an everyday endocrinologist? Goodness knows it’d relieve the pressure on the GIS clinics.
Also, I love Viriginia’s ‘colouring-book’ analogy above – sums it up perfectly!
There are clinics that are friendly to T people and then . . . well, it goes downhill from there. It does not take an endo to give a script for HRT. Family Medicine doctors do it all the time. We don’t have many GPs in the States. The key is to find a doctor familiar with HRT for T people. Are you in the States? Are you near an urban area. Chances are there is a doc within driving distance–might be a long drive–who can provide an Rx. I would be remiss if I did not suggest seeing a QUALIFIED gender therapist. From the spelling you use, I assume you are not in the States and have a different medical system.
Yeah that’s exactly it, what other service is there that treats people like this? 1-3 year wait lists and then a lengthy assessment period all before receiving treatment. It’s incredibly unsuitable and I really hope the system is shaken up before long.