We asked trans and gender-nonconforming members of the BuzzFeed Community what they wish they had known before beginning hormone replacement therapy, which can be a wild and confusing ride.
Hormone Replacement Therapy, or HRT, is the process of taking hormones either orally or by injection. The act of replacing hormones that your body is no longer producing sufficiently, or adding hormones that your body does not produce at all, is a treatment used for many medical issues (most commonly, for treating menopause in older women).
For trans and gender-nonconforming people, it's often the first medical step to affirming one's gender identity. The supplementing of sex hormones — like estrogen, anti-androgens, or testosterone — allows an individual to develop physical characteristics that better match the gender they identify as.
For this post, Buzzfeed LGBT got some extra input from Dr. Meera Shah of the Callen-Lorde Community Health Center and Dr. Asa Radix, MPH, senior director of research and education at Callen-Lorde.
Let's talk about testosterone therapy (we'll cover feminizing hormones over here). Testosterone, often referred to as simply "T", increases muscle mass, facial hair, and deepens your voice.
According to Shah, the full effects of testosterone usually take one or two years to develop. "While HRT may not be part of everyone's transition, for those who include it, it is considered medically necessary," She adds.
Here's what BuzzFeed Community members had to say about starting T:
1. Not everyone who goes on T has the same goal for how "masculine" they want to look.
"After starting testosterone, I tried to be extremely masculine. I stopped wearing makeup, dyed my hair a dark color, and started wearing baggy boy clothes. All I did was make myself a different kind of miserable. Clothing and makeup do not have a gender. I'm still valid in anything I want to put on. I look and feel best when I'm just me."
— Jess Winter, Facebook (pictured above)
2. Testosterone can also affect your mood and temperament.
"A lot of people think the hormones will only bring fun things like facial hair, fat redistribution, self-confidence, etc — but it can also disrupt the peace in your own head and surroundings. I wish I could have better prepared my girlfriend, and myself, for this shift in my behavior and personality."
— Kelsey Lagman, Facebook
According to Radix, starting on hormone therapy induces the same physical and emotional changes that go along with puberty — so mood swings can be fairly common. One way to fight the highs and lows of T levels is to try transdermal testosterone (topical gels) which are less likely to cause such exaggerated mood swings.
"Another option is to have your medical provider prescribe a lower dose of the injectable testosterone weekly instead of every two weeks to keep the T levels more stable," says Radix.
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3. There is no universal transition timeline. Your body may not change as quickly as someone else's, so try not to get discouraged by constant comparison.
"I had friends whose voices dropped after a few days on testosterone, and for me, it took roughly 5-6 months for my voice to drop. I started to get more body hair in the first few weeks, and for most of my friends it took several months. There really is no timeline to go off of."
— Jude Ezra Goodman, Facebook
“It’s easy to look at others and compare how far you’ve progressed but it’s not a race to become the ultimate trans man. It’s about what makes you happy — finding that piece of authentic happiness inside and holding onto it."
– Jaek Avants, Facebook
"Everyone's journey is unique, so don't be discouraged if changes seem to take longer than expected," Radix says. "If you have questions, about hormone effects or dosing, you should bring them up with your provider — chances are that other people have had the same concerns."
4. Voice changes can be a painful up and down — literally.
"I wish someone would have told me that voice changing could be painful. I knew hormones would cause the vocal transition, but I kept trying to reach a higher tone by instinct and got killer sore throats. For months I kept losing my voice and getting really painful coughs."
— Gabriel Davies, Facebook
"When you start testosterone it causes the larynx to grow," explains Radix. "When this happens you might notice a sore throat intermittently before the voice deepens. This can come and go over several months to a year. Luckily the soreness eventually goes away."
5. Getting that right dosage can be a bit of trial and error, so listen to your body and be patient.
"I wish someone had properly explained to me what being low-T feels like. Doctors all describe it as being 'a bit tired' but that is the worst understatement possible. Being low-T feels like what I imagine being 80 years old feels like — your bones ache, you can't think straight, and you constantly feel tired. It took months for my doctor to get me on the right dose so I would stop feeling like this at the end of my shot cycle."
— Jake Hammel, Facebook
Both over and under-dosing can be a problem, after all everyone is a different size and will need a different amount of hormones.
"It is important to have your T levels checked and dose adjusted," says Radix.
6. It's OK to be a little (or a lot) intimidated by self-injections.
"I wish I would had known how huge the needle was going to be. When I first started testosterone, I went with injections because shots never bothered me before so I figured it would be no biggie. I was wrong. It was a biggie, it was very biggie."
"Self injection is scary for a lot of guys," assures Radix. "Testosterone can be given subcutaneously (just under the skin) instead of the muscle. This is less painful and much easier to do."
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7. On T your sex drive will, well, thrive.
"I probably could have been having sex three times a day and still be horny as hell. Thankfully, that did die down with time."
8. And you'll probably want to eat all the foods.
"I wish I had known how hungry I'd be the days after each shot. For two or three days after my shot I'm starving almost all the time and can eat almost an entire pizza and an hour later be hungry."
— Chevy Whitson, Facebook
9. FYI: Growing facial hair is itchy AF.
"As far as body stuff, I wish I would have known that beards are way itchier than my brothers made them seem. I also wasn't prepared for my smells and sweat consistency to change."
— Noah Rosvall, Facebook
10. Your dysphoria may change as you change.
“I wish someone had told me that my dysphoria would shift. It would go from being brought on externally (being misgendered, people confusing my age, clothes not fitting) to internal. I now find I am the root of all my dysphoria."
— Elliot Michael Snyder, Facebook
You can read more about dealing with gender dysphoria here.
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11. Don't be afraid to ask questions! Ask your doctor if you notice anything unusual, they'll know what's cause for concern and what's not.
"I'm a trans man, and I wish I had known about breakthrough bleeding. It's like a period all over again — except it lasts for weeks and it's more painful."
— Marcosias Harland
According to Radix, breakthrough bleeding for guys is something that needs to be evaluated by a medical provider.
"Infections and uterine problems need to be ruled out. Sometimes it is just due to variations in hormone levels and the T dose might need to be adjusted or given at shorter intervals," says Radix.
12. Hormone replacement therapy isn't a "cure all or fix all" treatment.
"In a lot of instances, medically transitioning can improve a person’s mental health because they’re able to physically become the person they’ve always been on the inside, but it’s definitely not a 'cure all, fix all' treatment. If you go in expecting HRT to solve all your problems, you will be disappointed."
13. Sometimes talking it out with a therapist is the best medicine.
"HRT is not meant to replace psychological treatment. Seeing a counselor and or psychologistfor support in ANY life transition that can be difficult, is ALWAYS a good idea. It may not be something you need long term, depending on your situation and mental health history, but it is always a good idea to have someone to talk to to help you figure out how to cope with varying levels of stress in your life."
14. And, always and most importantly, try to love yourself just as you are.
"I wish I would have known a lot, but the thing about being a trans person, at least for me is, it’s going to take a long time, and it’s going to be hard, but the journey is all part of who I am and who I am becoming and I don’t regret any of it."
