I was driving through rural Colorado when the call came.
I almost never answer the phone if I don’t know who’s on the other side— heck, I barely answer the phone when I do — but I had a feeling that this was the call I’d been waiting for all month. “Ms.…LaBelle?” I heard in a bored, feminine cadence. “I’m calling from Denver Health. You left us a message about starting hormone therapy?”
I pulled onto a patch of grass next to the road and tried to speak without a quiver in my voice. “Yes,” I said, before repeating myself in a slightly higher register. “I mean, I don’t have a primary care doctor yet, so I don’t know if I’d need a check-up first, but, um, yes. I’d like to speak to someone about HRT.”
“Not to worry,” she replied, as I heard her quickly typing in the background. “We can find you a doctor. Let’s set up an intake appointment, okay? How does the 29th of October work for you?”
“You must be excited,” my wife said, when I got home and told her that I’d be giving up testosterone for Halloween this year. “You’ve been talking about doing this all summer.”
“I am,” I said. “But I’m nervous, too. This is big.”
“Yeah,” she said. “It is.”
I could feel a pit forming in my stomach as I realized that this was finally happening. I’d self-accepted as a trans woman back in January, but my mind was still plagued with doubts about actually starting HRT. Even though I’d already come out to most of my friends and family members, hormone therapy felt like the first truly permanent step in the coming-out process. This was the line, and I finally had to cross it.
And even though I loved being Cassie…was that really who I was? And even if it was who I was, could I really live the rest of my life as a woman? And even if I could live the rest of my life as a woman, would the world actually see me that way? I hadn’t even dressed as myself yet — what if I looked ugly and gross in a dress? What if the hormones didn’t work? What if I didn’t like how I felt on estrogen? What if if HRT changed my body in ways I didn’t like?
What if I was making a huge mistake?
Hormone Replacement Therapy, or HRT, is the act of medically swapping your primary sex hormone for another. All people, regardless of sex or gender, have small amounts of both estrogen and testosterone in their system, but human bodies generally rely more on one hormone or the other depending on what your endocrine system is able to naturally produce. Bodies with testicles generally produce a lot more testosterone than estrogen, while bodies with ovaries tend to produce a lot more estrogen.
Since hormones are fairly easy to synthesize in a laboratory, HRT is simpler than you might think — at least in theory. For transgender men, it’s as easy as slapping on a testosterone patch or taking a shot every week or two. For transgender women, it’s a little more complex — we generally take one pill to block our testosterone, and then another pill (or patch, or shot) to fill our bodies with estrogen. That’s it. The human body is an infinitely complex machine, but you can hack it pretty easily if you’ve got the right mix of chemicals. And as far as we know, there are no major health risks associated with long-term HRT.
Before I self-accepted and started to learn more about my identity, I had no idea what HRT actually did. I’d heard of it, sure, but who has any idea what hormones actually do? I had a vague sense of the stereotype that testosterone made men horny and angry while estrogen made women weepy and compassionate, but that was about as far as my understanding went. I figured I’d probably try HRT at some point, but I had no idea what estrogen would actually do to my body — or if it would even work at age 34, long after puberty had given me size 12 feet and a heavy beard shadow. I worried that taking HRT would be like showing up to a high school rager as an adult, chugging all the beer, and then vomiting on the floor. I could technically do it, sure, but what would it accomplish?
As it turns out, HRT can accomplish a lot at any age. Transphobic people like to talk about “biological males” and “biological females,” and about how your X and Y chromosomes prove that sex and gender are both immutable. But transphobes are wrong about how gender works, and they might also be surprised to learn how much of what they consider to be part of “biological sex” can actually be changed by swapping out your sex hormones.
Believe it or not, hormones can actually change how your DNA is expressed. Think of your genes like 20,000 little locked doors, while estrogen and testosterone each have a different set of tiny keys. If you swap your T for E, the hormone will begin to interact with different parts of your genetic code. HRT will literally change how your body rebuilds and regenerates itself.
Unfortunately, taking HRT after puberty will not change everything. Your first puberty is a one-way trip for quite a few things; voice, height, and shoulder size for AMAB folks, breast and hip growth for AFAB people. But the number of things that can change with a Second Puberty on HRT is quite startling, no matter when you start replacing your hormones. While I wish I’d gotten on estrogen back when I was 11, I was unprepared for the depth and breadth of changes I’d feel at age 34.
With just weeks left before my appointment, I began fixating on the risks of taking HRT while I was in the shower each morning. I was giddy and excited, but I was also still nervous. I’m an anxious person by nature, and this felt like the biggest decision of my entire life. This anxiety compounded upon itself in a deadly sort of feedback loop. If I was really this nervous about starting HRT, wasn’t that a sign that I shouldn’t do it?
“You’re thinking about it in black and white, like it’s all or nothing,” my best friend Emily said when I confessed to her how anxious I felt. “I had doubts too, but permanent changes don’t suddenly happen the day you start hormones. You’ve got at least three months before anything permanent, and even after that most things are reversible except a little bit of breast growth. Why don’t you go on HRT for three months and then see how you feel?”
I nodded to myself, which must have sounded like dead air on the phone. “That…makes sense to me. How did you feel after three months?”
“Oh, Cassie. After three months, I never wanted to go back.”
Talking to Emily made me feel a lot better. The more I started thinking of HRT as a thing I could stop if I wanted to, the more I realized that I would never be able to forgive myself if I didn’t at least try it. I told myself that if I didn’t like how estrogen felt after two or three months, I could stop taking it and my body would go back to normal. But the idea of never even trying HRT after coming this far in my gender journey…that was unacceptable. I’d experienced so much joy in discovering who I was as Cassie, and I had to know what the right hormones felt like, too.
I put “Cassie LaBelle” on my medical intake forms, but my health insurance was still under my deadname. The result was a two-line monstrosity that looked like “DEADNAME CASSIE LABELLE OLDLASTNAME.” When it was my turn to escape the waiting room and see the doctor, the nurse looked at her form for a solid five seconds before letting out a weak “…Casey?” Face slightly red, I raised my hand and quickly paced toward the back room, arms glued to my sides.
Denver Health prescribes HRT using an informed consent model, which means that you don’t need any sort of doctors’ note or formal psychiatric diagnosis to access hormone replacement therapy. As long as you tell them that you want HRT and prove that you know what you’re in for, they’ll give it to you. There are more informed consent clinics in the US than you might think, and you can use this handy map to see if there’s one operating near you.
It’s not an instantaneous process, though. The informed consent model involves a long conversation with a doctor as well as a comprehensive liability release waiver. The form acknowledges that the doctor has indeed discussed HRT’s various side effects with you, and that you promise not to hold the clinic accountable when HRT does its thing to your body. My form had two full pages of possible effects listed: everything from breast growth and softer skin (yes, this is the point!), to infertility, to an increased risk of breast cancer.
“Don’t worry too much about the cancer stuff,” my doctor said, perhaps noticing my trepidation as he was going over the forms with me. “Trans women who take estrogen have a higher risk of breast cancer than men, but it’s not nearly as high as the risk in cis women. It’s probably because your breasts are coming in later in life, so there’s less chance for cancer to develop.”
The fertility question was more pressing, and it was something I’d given a lot of thought before deciding to start HRT. Estrogen can make you permanently infertile if you take it long enough, though some trans women can temporarily stop taking their HRT in an attempt to temporarily re-gain their fertility. It’s far from a sure thing, though, so I chose to freeze some of my sperm in the months leading up to my doctors’ appointment in case I decide to have a biological child at some point in the future.
As I scrawled my deadname initials on line after line, I again wondered if I could actually go through with this. Having my friends call me Cassie was one thing, but rewriting my entire endocrine system? Seriously?
“Oh, you were born on Hobbit Day,” my doctor said, startling me out of my anxious thoughts.
He pointed to a date on my chart. “September 22nd. Hobbit Day. Bilbo and Frodo’s birthday. That’s my son’s birthday, too. I like to think it means that he was destined to go on a long journey. That seems to be true for you as well.”
I chuckled a little, surprised by his warmth. In the past, I’ve had a rather cold relationship with doctors, in large part because being reminded of my physicality in any way felt absolutely horrible. “Yeah,” I said. “I think it is.”
We talked for another half hour. Then he shook my hand and sent me to the blood lab for a full work-up. “Looks like we’re good to go,” he wrote me that night in the app that Denver Health uses for doctor/patient communication. “I’ve sent a prescription for Spironolactone and Estradiol to the pharmacy in your file. You can start right away, and we’ll check your levels again in a couple of weeks.”
And that was it. I picked up my pills the following morning, and took my first small yellow circle and tiny green oval around midday. That was October 30th, 2019 — the day my life began again.
Estrogen comes in three forms: a pill, a patch, and a shot.
The pills seem like the most straightforward option, but that’s not necessarily true. For one thing, estrogen taken in pill form has to be constantly metabolized by your liver, putting additional strain on the system. The pill is also the least efficient way to distribute estrogen into the body, and most pill-takers I know attempt to do so sublingually, letting the pill dissolve under their tongue before swallowing. Doing this allows more estrogen to enter your body — and faster, too.
My doctor also cautioned me that he doesn’t recommend people over a certain age take the pill, because it carries some long term medical risks that the other forms of estrogen do not. I don’t want to detail them here because I don’t have a firm enough grasp on the science, but it’s worth looking into if you’re planning to take estrogen pills for more than a couple of years.
Estrogen patches don’t seem to have that problem, but you do have to have a patch on your skin semi-permanently that you switch out on a weekly or biweekly basis. This is fine, but it wasn’t my first choice.
The shot is the newest method of estrogen distribution, and it seems to be the best. I switched from pills to shots about 3 months into my HRT regimen, and I definitely noticed an immediate change in efficacy. This method bypasses the liver, and it allows your body to access estrogen more quickly and efficiently.
The shot is intramuscular, which means that you can do it yourself at home since you’re not trying to find a vein — you’re just trying to form a small pocket of estrogen gel within one of your muscle layers. I didn’t think I would be able to handle shooting myself with a needle every week, but it does get easier with time. It helps that HRT still feels like something I want to do instead of something that I have to do. Every time I inject myself with estrogen, it feels like an affirmation of my identity.
Most HRT regimens include a testosterone blocker in addition to estrogen, though some doctors are starting to advocate for estrogen-only (monotherapy) treatments. The idea behind this is to give trans women so much estrogen that it overwhelms your natural testosterone. There seems to be some legitimate research indicating that this is the best approach, especially when it comes to stimulating breast growth, but it’s still considered somewhat radical since it requires dosing people with several times as much estrogen as you’d find in most cis women. It’s possible that this significantly increases your risk of breast cancer, though advocates of estrogen-only treatments claim that this is a holdover from the nineties, when synthetic estrogen wasn’t as good as it is now. You can ask your doctor about this if you want. Mine is firmly on the side of using testosterone blockers, so that’s what I’m doing.
As for the anti-androgen, what you get will probably be determined by where you live. In the US we use spironolactone (spiro), while Europe uses cyproterone acetate (cypro). Both of these are pills, and both have their proponents and detractors.
Some people experience brain fog on spiro, and if you spend enough time reading about HRT on Reddit you can find a lot of stories from people who dislike the drug, but the vast majority of people who take it don’t have any serious side effects at all. It’s a diuretic, though, which means that it forces trans women to pee more often than they would have without it. I used to be able to make it through the night without having to use the bathroom, but now I rarely do. This is also a particularly cruel piece of irony, considering how many anti-trans laws here in the US are designed to keep us out of public restrooms. I also drink a lot more water now, and I crave a lot more salt in my diet thanks to the spiro. Have you ever heard the stereotype about trans women and our love for pickles? That’s in part due to the spiro, which makes us crave salty and vinegar-laden foods.
Some trans women also choose to add another hormone — progesterone — to the mix. This usually happens at some point in your second year on HRT, often depending on how conservative your doctor is. There’s even less science about the benefits or possible side effects of trans women taking progesterone than there is about estrogen — a running theme here, sadly — so it’s hard to say what it will or will not do. That said, several of my trans friends have reported increased libido, increased breast growth, and an easier time sleeping once they started progesterone. This study also seems to indicate that progesterone should be a part of more of our HRT regimens.
But we’re getting ahead of ourselves.
In truth, I didn’t feel anything during my first two weeks on estrogen. My libido went down to zero by the end of the second day — more on that later — but that was the only change I noticed for quite some time. By the middle of the third week, I was getting nervous that HRT was a dud.
Then I woke up one morning with a major bout of brain fog, and suddenly I became nervous that HRT wasn’t a dud — it just hated me. No matter what I did, I couldn’t concentrate. I had to keep blinking and shaking my head as a drove to and front the post office to drop off a bundle of packages. “I’m really scared,” I told Emily that night. “I don’t think my body likes this.”
“Be patient,” she said. “Your body has spent 33 years running on testosterone. Now it has to get used to estrogen. It’s a big change. Big changes take time.”
The brain fog lifted after 36 hours, and by the end of my third week on HRT, I began to feel better. By the end of my fourth week, I began to feel legitimately good. At the end of my fifth week, my doctor checked my levels and doubled my dosages. By the end of my sixth week, it felt like a lightbulb had switched on in my brain.
By the end of two months, I knew that I never wanted to go back. Not then, not now, not ever.
I’m going to use the rest of this article to chronicle all of the changes I’ve noticed in myself during my first year on HRT. I want to be clear, though — this is just one girl’s story, and it should not be taken as evidence of what HRT does for everyone. I’ve shared parts of my story with many of my trans friends, and they’ve shared parts of their stories with me. Often, there are as many differences between our experiences as there are similarities.
One thing that comes up a lot when discussing HRT are the mental changes that some trans women (including myself) have experienced on estrogen. These are even harder to predict than the physical changes, and I know several trans women who haven’t experienced any mental changes at all on HRT. Your experience might mirror mine, or it may not.
It’s also impossible to say how many of these mental changes are truly hormonal, and how many of them are simply a result of my transition in general. Is my increased sense of peace and comfort in my skin due to a better hormonal balance, or because I’m more comfortable dressing as myself and presenting as a woman? The answer to almost all questions of nature vs. nurture ends up being “both matter, silly!” and I think the same is true of transitioning. HRT has helped a lot, but so have all the other steps I’ve taken to claim my identity.
I also want to be clear that the point of this essay isn’t “estrogen good, testosterone bad.” The correct hormones for your particular body and brain are good, while the incorrect hormones are bad. Even though testosterone made me an angrier person while estrogen allowed me a greater depth of emotion, that’s not because testosterone makes people angry. In fact, several of my transmasculine friends have told me that they had anger issues before starting HRT and they have better control over the emotions now that they’re living in a testosterone-driven body. The important thing is to find a hormonal path that works for you.
Lastly, I just want to say that I am not a doctor and I have no medical training. If you are considering HRT, you should do additional research and read at least a couple of pieces written by medical professionals before making that step. I’ve written this essay because there are very few comprehensive articles out there about what taking HRT is actually like, and in the absence of data, I’m hoping that my anecdotes will prove illuminating.
Softer skin. This is pretty self-explanatory. A few months in, my skin just started…getting softer. It’s very nice. Sometimes I’ll just rub my fingers up and down my arm. It feels quite affirming. I’ve always wanted to be soft, and now I am.
Less body odor. Testosterone is what gives people that “locker room funk” that I still associate with trying to avoid the gaze of every boy in my middle school as I quickly tried to slip out of my trousers and into my gym shorts. I never quite came to grips with the fact that I also smelled that way, and now I don’t anymore. My sweat still has an odor, but it’s a lot fainter and less putrid.
Boobs, boobs, boobs! Okay, so this is a big one.
Yes — HRT will give you breasts. How big will they be? Nobody really knows. There has been exactly one study done about this, and it claims that 48.7% of trans women on HRT will have less than an AAA cup after a year. This simply isn’t true, though. I remember reading at least one Twitter thread (that I can’t find right now — please send it along if you know where it is!) showing how this study completely dropped the ball on how cup sizes are actually measured, thereby negating their conclusions. Either way, literally all of the trans women I know who have been on HRT for at least a year have more breast growth than an AAA cup would imply.
Regardless, there are loads of different factors that play into your potential breast growth. Genetics is the biggest one: if the women in your family have larger breasts, you will probably grow them bigger and faster yourself. Spironolactone has been suspected of stunting breast growth, and it’s possible that trans women on estrogen monotherapy will experience more growth. Supplementing your estrogen with progesterone has been known to help as well.
Regardless, breast growth is one of those things that usually takes several years, and some trans women I know experienced far more growth in years two, three, or four of HRT than in year one. You will probably not grow breasts as large you’d have had as a cis woman if you start HRT well after puberty, but medium to somewhat large cup sizes aren’t unheard of. You might still need augmentation at some point if you have a larger frame and want the breasts to match, though.
As for me, I had kind of a head start. I’m overweight, and I’ve always had somewhat obvious “man boobs.” This was a source of intense shame for me as a kid, but I’m happy I gutted it out. A year in, I definitely have noticeable breasts that can’t really be hidden by a t-shirt. I wear b-cup bras without padding, and would probably fill them entirely if I had a smaller frame. My growth has been fairly consistent throughout the first year, and I would like one more cup size over the next 12–18 months if possible.
My nipples changed. A lot. This was the first massive physical change that happened to me. About a month after starting HRT, my nipples became incredibly sensitive and would chafe in all but the loosest shirts. My chest also felt sore some of the time — a dull sort of ache. I would also go through periods of pleasurable sensitivity as the nerves in my chest reworked themselves.
It was…very weird.
At about the three month mark, my nipple soreness stopped and I was left with a chest that would instantly get me flagged on Tumblr. My nipples are a lot bigger now and I have noticeable areola. My nipples are also pleasurable in a way that they never were before. The physical difference is striking, though — as long as I’ve shaved my chest, I’m pretty confident I could post a picture of one of my breasts and nobody would know it didn’t belong to a cis woman.
More brittle fingernails. I don’t know why estrogen makes fingernails more brittle, and it’s quite possible that my constant use of nail polish (and nail polish remover!) has something to do with this, but other trans gals have reported this phenomenon, so I assume it’s at least somewhat hormonal. You can take biotin to improve your fingernail and hair strength on HRT, but be careful — I’ve heard that it can mess with estrogen levels in blood tests. If you do take biotin, I’d suggest not taking it for at least 14 days before you get any HRT-related bloodwork done.
My face shape changed. It’s not a lot — and not nearly as much as I was hoping for — but my face is noticeably different now. Here’s a side-by-side picture of my face pre-HRT and my face now:
I wish I could lose more of the jawline, and a lot of the work here is just presentation changes and laser hair removal, but there has been some fat redistribution around my cheeks, pushing them up a little higher. And I’ve got to be honest, it’s getting really hard to recognize the person in the “before” picture as “me” in any meaningful sense.
My eyes appear larger. You can see that in this picture too! This is apparently a real thing that happens due to fat redistribution on your face — it’s not just wishful thinking, or an illusion caused by using way more eyeliner now. I think I would rock some big anime girl eyes, but I’ll take this.
Loss of muscle. Muscles actually form differently depending on whether your body is estrogen-driven or testosterone-driven, and testosterone-havers enjoy a much greater amount of passive strength than estrogen-havers. I’ve never really worked out much, but I always had a certain amount of latent strength that I took for granted. Not anymore. Heavier things feel heavier, and I’ve definitely asked my wife to open a pickle jar for me — an act that must be the punchline of SOME trans joke out there.
Honestly, this only comes up every couple of weeks for me, but I’d imagine it would be harder for someone who works with their body a lot. At any rate, you may have to start working out a little more if you value your strength.
A harder time warming up. I was hoping that my body would run a bit colder — I’ve always run hot, likely due to being overweight— but that hasn’t really happened. I don’t have an easier time with hot weather now than I did before transitioning.
Instead, my body has simply gotten worse at warming me up on incredibly cold days. Beforehand, it felt like testosterone would simply light a bunch of calories on fire and then I’d be relatively okay, even on very cold days. Now, I’m pretty screwed unless I’ve brought layers.
My body hair has thinned out a lot. Before starting HRT, I had to shave my arms and chest in the shower at least three times a week. If I didn’t, I’d get thick black stubble popping up everywhere. While my fastidious shaving regimen was something of an outlier among the trans folks I know, body/facial hair is one of my biggest dysphoria triggers. If I didn’t shave it all off every few days, it was hard to look at myself in the mirror and see anything other than a gross, hairy, masculine mess.
A year into HRT, I only shave my arms, chest, and stomach every few weeks. My body hair isn’t entirely gone, but it’s much thinner and less obtrusive. There are fewer actual hairs, and the hairs that do show up are much smaller and less bold. I’d have to shave my legs and armpits more often than that if I wanted to remain totally body-hair free, but hair in those locations doesn’t bother me as much because cis women have plenty of hair there, too.
HRT also helped thin out my facial hair, but it’s impossible to tell how much of that was hormonal vs. the laser hair removal treatments I’ve had done. Even if you take HRT, you will need laser hair removal (and possibly electrolysis as well, depending on several factors including hair color) to completely eliminate your facial hair. It’s definitely possible to go from a heavy beard shadow to a totally smooth and shadowless face, but it’s a multi-step process. I’m not even there myself because the pandemic has temporarily derailed my ability to receive laser treatments.
The hair on my head has grown thicker and more vibrant. I’ve always had fairly good hair, but I was starting to notice my hairline receding a little bit and the top of my head was starting to get somewhat thin. Not anymore. The effect was somewhat similar to watering a plant that had begun to wilt. I also can’t overstate the mental health benefits of knowing that I’m not going to go bald now.
My body fat has begun to somewhat redistribute itself. Testosterone-driven bodies tend to consolidate fat in the stomach area (the classic “beer belly” look), while estrogen-driven bodies store more fat in the hips and butt. While I still have narrow hips and not much of an ass to speak off, estrogen has definitely done some work down there. Hopefully more is coming.
This is definitely one of those things that changes more the earlier you start taking HRT. Hip and pelvis bone development, especially, can be significant if you start taking estrogen before your mid-twenties. I wish I knew enough about who I was to start earlier, but there are still noticeable changes for me in this area, and I’ll take it.
I am physically weaker. Testosterone and estrogen create different chemical bonds in your muscular structure, and the bonds that utilize testosterone are passively stronger. The result of one year on feminizing HRT? Opening jars is harder, and so is carrying heavy objects. It’s certainly not awful, and I really don’t notice most of the time, but in D&D terms, it feels like I just took -1 to my strength. I could re-gain this strength by working out and starting a fitness regime, but I haven’t done so yet.
I cry way more often. I’ve cried more since mid-July than I did during the entire decade before I began taking HRT.
This may not seem like a big deal to many of you, but I felt a level of emotional constipating before starting HRT that I don’t have anymore. Crying is an essential part of how I process tough situations, so it was a lot harder to process tough situations without the ability to cry. I would bury my feelings instead, even if I didn’t quite mean to. That made it a lot harder to move on. These days, I can cry it out for a few hours and then work toward recovery.
I feel a much deeper and richer sense of joy. Do you remember the character Joy from the Pixar film Inside Out? She’s the little blue-haired girl played by Amy Poehler. One of the things I remember most about her performance is how incredibly kinetic it was — she’s constantly moving around, bouncing off walls, getting excited about things.
Before HRT, I didn’t realize just how literal this metaphor actually was. I felt joy before transitioning, of course — I hope everybody has, at least a few times in their life — but it feels so much, richer, closer, more present, more vibrant, and more bubbly now. I understand how the character of Joy relates to the actual emotion in a way that I didn’t really get before. And I really like it.
My “am I trans enough?” doubts lessened considerably. Before HRT, I was still worried about whether or not transitioning was the right thing to do. My therapist likes to say that asking “am I trans enough?” is so common that it’s practically a symptom of being trans, but that still didn’t stop the anxious, protective voice in the back of my head from expressing its dissent sometimes.
I don’t really feel that way anymore, at least not very often. Not only has the fact that I like being on HRT so much helped affirm that transitioning was right for me, but that anxious voice just…doesn’t show up as much anymore, as a general rule. It’s really nice.
My palate has changed. It’s unclear how much of this is due to spiro-related salt cravings and how much is related to estrogen, but I’ve definitely noticed a difference in the foods I crave — and the foods I don’t.
Things I like a lot more now include balsamic vinegar (and really all vinegar-based things), ranch dressing, pickles, olives, and chips. I also legitimately enjoy salads and vegetables more now, and I have a better sense of how angry my body gets when I don’t have enough of them. I still like most of the other carby/fatty foods that I liked pre-transition, and I’m still not as big a fan of sweets as most people are.
On the other hand, I’ve gone from being a huge craft beer fan to someone who barely drinks beer at all. A large part of this is that beer has always been a social thing for me, and socialization has been impossible due to the pandemic, but there’s more to it than that. After years of getting comfortable with incredibly bitter and hoppy brews, they just…don’t do it for me now. Most of the beers I’ve had since transitioning have begun to feel like a chore to get through by the halfway point, and the ones I really loved before now just taste merely okay.
I am more capable of “living in the moment.” Some of this change is likely due to finally being seen as myself instead of having to constantly pretend to be someone I’m not, but there definitely seems to be a hormonal aspect as well. Before transitioning, it was really hard for me to spend any time just existing, without having one mental foot in the past and the other in the future. I still have issues with this, but living in the moment is possible for me in a way that it wasn’t before. I can just…be, sometimes. It’s nice.
I am an extrovert now?? Granted, introverts and extroverts exist on a spectrum, and I don’t really subscribe to the introvert/extrovert binary (or any binaries, really), but I’ve definitely moved several notches toward extroversion in transition.
Socialization before transition took a massive amount of external energy that I wasn’t fully aware I was spending. I loved spending time with friends, but I sometimes needed days to recover from that — a cost that I assumed was just part of my extreme introversion.
Nope. As it turns out, socializing is a lot harder when you have to spend the entire time pretending to be someone you’re not (even inadvertently), and not being seen correctly by the people you love most in the world. I am now much more of a people person, and I love that about me.
I have a much better sense of what I’m passionate about. Believe it or not, I really didn’t know what “drove me” until starting HRT. Everybody always assumed I was a really passionate and driven person because I went to film school and got my MFA in creative writing, but a lot of that was due to externally-driven feedback. People told me what I was good at, so I did those things because I assumed that’s what true passion was.
I still love writing, and I’ve always loved movies, but after taking HRT I began to actually feel passionate about things. It was like a light switching on inside myself. I probably wouldn’t have switched careers so many times if I’d been on the right hormones from the start, but at least now I know what I want to spend the rest of my life doing.
I’m more mentally resilient and less driven by safety and security. Before transitioning, I built a life around keeping myself as safe and insulated from catastrophe as possible. Being trans and in the closet meant that things were pretty bad a lot of the time, so I tried to build a life that would minimize harm. That’s what I needed to do to survive, but in the process I created a cage for myself where it was difficult to actually thrive. A lot of the risks that you need to take in a meaningful life were simply off the table for me.
These days, I feel much more capable of taking risks. Even on social media, I’ll post personal or risky things that I wouldn’t have dreamed of sharing before transitioning. I’m a lot more comfortable with ambiguity and uncertainty in general, and I actually feel like I’m doing well facing down a lot of the biggest challenges of transition that seemed insurmountable before.
Honestly, this is one of the biggest realizations that I want newly-hatched trans ladies to take away from this article. If you’re staring at a bunch of transition-related things and saying to yourself, “there’s no way I can handle this, I’m not strong enough,” well, I was right there with you. As luck would have it, transitioning has given me the mental strength I needed right when I needed it most. The same might happen for you, too.
My anxiety levels dropped considerably (pre-pandemic). Anxiety has been the dominant emotion of my entire life, and that’s still mostly true. That said, the early days of 2020 (between when HRT had finally kicked in and the start of the pandemic) were some of the happiest and least anxious of my entire life. My anxiety wasn’t totally gone — in fact, estrogen can increase cortisol levels, and some people experience increased anxiety on estrogen — but my baseline level of anxiousness dropped from a 5 to about a 3, with drops into the 0–1 range for the first time in recorded memory. That’s huge!
Of course, the rest of 2020 happened after that, and I’ve been an anxious mess ever since mid-March. I think we can blame that on other things, though.
I lose fewer days to brain fog. Did you know that estrogen is a neurotransmitter? I sure didn’t until this year. I haven’t looked into the science enough to know what this actually means, or how much the estrogen in my brain has been affected by the estradiol entering my body via injection, but I definitely feel sharper and more focused now. In fact, there seems to be a pretty clear correlation between my sharpest days and how high the estrogen level is in my body.
My moods are incredibly cyclical now. When I first started injections, I was put on a biweekly cycle. I did an injection every two weeks, and oh boy did my mental health suffer in the day or two leading up to my injection. I was foggier, more depressed, and far more anxious. Then I’d give myself some estrogen, and bam — about six hours later, I’d feel like myself again.
I’ve switched from biweekly shots to weekly shots, but the same thing still happens to me, in miniature. The day before my shot is usually my toughest mental health day of the week, and I usually feel great the evening after I’ve done my shot. Other trans women I’ve talked to also feel a similar boost after taking their spiro, but I’ve never noticed anything like that myself.
These cycles are also worth thinking about for anyone who takes estrogen pills. I have several friends that were told by their doctors to take all of their estrogen first thing in the morning, and many of them experienced daily emotional crashes in the evening because of it. Many of these girls reported a massive quality of life upgrade simply by spreading out their pills a bit more.
Believe it or not, trans women can also get periods on HRT! It often presents itself as a monthly bloating/cramping feeling along with some heightened emotional reactions, much like with cis women. I’m not sure if I’ve experienced this or not, because it’s hard to tell what might be a period and what might just be a normal reaction to the hell year of 2020. Here’s hoping I’ll be able to figure it out one way or another during my second year on hormones.
I’ve uncovered a part of myself that has been buried since adolescence. This is where I’m really going to get into the weeds with stuff that’s hard to explain. I’ll do my best, but I’m not sure I would have understood any of this before starting to transition myself.
The best way I can describe this mental change is to say that a part of myself was lost during puberty. I like to use the metaphor of a young girl getting frozen in ice at the core of myself, put into cryo-sleep like an astronaut on the way to Jupiter. There were times between age 13 and age 33 that I could kind of hear her voice, but it was faint, and I rarely listened.
HRT (and transitioning in general) thawed that ice. It wasn’t long before I could hear this long-lost voice in my head (not really a voice — more like a train of thought) and I finally began listening to her.
Then I put her in charge.
The past year has been a period of re-integration. The longer I progress into my transition, the less I feel like she’s a separate person and the more I feel like she’s just…me. She was a key part of me — perhaps the biggest part of me — and now I’m her, and she’s me, and life makes so much more sense now.
One of the weirdest things about this is how different everything feels now, despite the fact that I haven’t actually changed in a lot of ways. I still have the same goofy sense of humor, the same strong sense of morality, and most of the same likes and dislikes. But because this significant part of my personality wasn’t integrated into my personality for so long, I often feel like I didn’t actually exist for…most of my life. This is impossible to describe, because clearly I have existed for all of those years, but I will occasionally break down in tears at the knowledge that I didn’t get to be myself as a teenager. And it’s not even that I wish I’d had different experiences — I had plenty of good teen experiences. It’s just that the most important part of myself wasn’t actually there for any of them.
It’s a brutal loss that cuts extremely deep. God, I wish I’d transitioned earlier.
I wanted to give sexual changes their own section because they exist at the intersection of the physical and the mental. I also want to talk about this stuff as frankly and openly as possible, which I know some people aren’t as comfortable with. I believe that sexuality should be a lot less taboo, but if you want to dip out, now’s the time.
Spiro nuked my sex drive on day one. It took 7–8 months to start coming back. I had no idea just how hormone-driven my sex drive was before starting HRT, but the answer is: very. Sexual release felt a little like a compulsion before transitioning, and if I didn’t give in one way or another at least 3–4 times a week, my entire mood would feel tainted, somehow. I was also used to using masturbation as a way to regulate my hormones. Not only was sexual fantasy a great way to dissociate from my body and escape feelings of dysphoria, but I knew that if I went too long without relieving myself I’d just keep getting more anxious and irritable.
Then I started taking a testosterone blocker, and WHAM. My sexual desire just disappeared. I could still get erect if I wanted to, but I didn’t really want to most of the time. I had always felt kind of low-energy and irritable immediately following a masturbation session because of the drop in hormones, and my life kind of felt like that all the time between when I started taking spiro and when the estrogen began to kick in. My body definitely prefers testosterone to “no sex hormone,” and I hate that some endocrinologists make trans ladies take spiro for several weeks or even months before adding estrogen.
But even as my body began to start running on estrogen and my energy levels perked back up, my sexual desire remained absent for a long time. I wasn’t disgusted by sex or anything, I just…wasn’t motivated. I was never “in the mood,” so to speak. It’s normal for a lot of trans ladies to wonder if they’re asexual during this period, and I definitely felt some of that myself.
My sex drive is back, and it’s totally different now. I don’t really know what to say other than, “I’m a woman now.” Like, I was always a woman, and I never felt comfortable filling any of the classically male roles during sex, but now my body responds in the way that my mind has always wanted it to. I have more varied erogenous zones, and I’m way less focused on climax than I was when my body was driven by testosterone. And at this point, orgasming is very much a “yeah, that would be nice, but it’s not strictly necessary” sort of thing. Instead, the activities that most men would consider strictly foreplay are now the bulk of what I am into, sexually. Even then, I feel more driven to build close connection with an intimate partner than I do to physically have sex with them.
Arousal also feels much different now. I could go from 0 to 60 on a dime before, and all I needed was a few well-timed kisses to really get going. Nowadays, I need to feel comfortable and safe and sexy before I can even think about getting aroused, and sex has to be a slow build-up. If things go too fast, I’ll shut down — a thing that was never really possible for me before. Arousal also now feels like a full-body flushing feeling — a heat — that I really really enjoy.
Things are also just…different down there. My penis has lost a little bit of length and girth, and it doesn’t get quite as erect. It’s just a lot softer, much like the rest of my skin. I also simply cannot reach orgasm using any of my old methods. I use a vibrator instead, and it works wonders. (Note to trans ladies: the Magic Wand is worth the cost.) I also don’t produce nearly as much fluid, and sometimes there’s none at all. I can still have some form of penetrative sex from time to time, but there’s no real way for me to have “sex as a man” anymore. My body just doesn’t work that way, and forcing myself into that role has gone from uncomfortable to impossible.
Lastly, my orgasmic function has changed. Depending on how I’m stimulated, I can have “boy orgasms” (shorter, more genital-focused) or “girl orgasms” (longer, more full-bodied). The boy orgasms aren’t as good as they used to be, but the girl orgasms blow anything I’ve ever felt before out of the water.
I also no longer feel tired and somewhat grumpy after climax. Instead, I feel warm and content.
I have a stronger grip on my sexuality. Some trans people talk about their sexuality “flipping” after starting HRT, going from (say) being attracted to almost exclusively women to being attracted to almost exclusively men. This is a scary thing for a lot of people who are considering hormone replacement, and I know a couple of trans ladies who were scared to try HRT because they didn’t want to have to date boys.
I don’t think HRT can change your sexual orientation, but it can bring your sexual orientation into focus for the first time. Most of the trans women I know who went from being attracted to women to being attracted to men weren’t actually attracted to women at all. Instead, they wanted to be close to femininity and enjoy female friendships, which they confused with sexual attraction, much the same way I confused encouragement for passion in my search for a meaningful career. In these cases, HRT didn’t so much flip their sexuality as it allowed them to finally experience a sexual attraction to men that had been hidden under layers of dysphoric trauma and incorrect brain chemistry.
As for me, I wasn’t attracted to men before HRT and I’m still not attracted to men now. I’m definitely attracted to more trans ladies and queer people in general, but that has more to do with my social group changing than anything hormonal. I know I would have had difficulty being sexual with someone who had a testosterone-driven endocrine system before HRT, and that’s still true for me now.
What I have learned on HRT is that I am demisexual. I do experience sexual attraction, and it can be intense, but that attraction can only form once I’ve built a bond and a kinship with that person. Beforehand…I mean, I know what attractive people look like and all, but the idea of having a “celebrity crush” is baffling to me.
Is this just a part of my new estrogen-driven body? Maybe, but I honestly think it was true for me beforehand, as well. I just never knew how to express it, and it was hidden under the frenetic anxiety and daily compulsions of my testosterone-driven sexuality. Estrogen hasn’t changed this part of myself, I don’t think, but it did cast it into sharper relief. I now have a better idea of who I am and how my mind works.
Whew — that was long.
But we’re finally done! I hope this was helpful, and I’d love to talk more about this stuff with anyone who is interested. You should follow my Twitter account (@CassieCeleste) and I’m happy to answer anonymous questions on my Curious Cat.
Lastly, be sure to check out my article on gender dysphoria if you haven’t seen it yet. It’s helped a lot of people figure themselves out, and if you’re reading this essay because you have a lot of mental energy around the idea of maybe possibly being trans, that’s a good next step for you.