Trans 101: The ‘Mones
(reposted from Facebook, originally posted January 28, 2017)
Let’s talk about hormones.
Hormone Replacement Therapy (HRT) is one of the most fascinating and least-understood parts of being transgender. Not all trans people take them, but many do, and the effects are sometimes magical, often varied, and always mysterious.
Most of you probably know that there are two primary sex hormones: testosterone for males, and estrogen for females. It’s actually a bit more complicated than that — there are three primary types of estrogen, and testosterone is just one of four important male sex hormones — but we won’t overcomplicate this. The type of estrogen we’re mainly talking about here is called estradiol, but we’ll just say “estrogen” for simplicity’s sake.
Sex hormones are responsible for all sorts of things in the body, but we mainly think of them in terms of sex characteristics. Boys have T and girls have E, right? Well, no. Actually everybody has some of both, but the predominance of one or the other is a big part of being biologically male or biologically female. Because women and men are so different, estrogen and testosterone must be really different things, right? Wrong. They are very similar. They are both steroidal hormones consisting of four carbon rings with other little chemical doodads attached. In fact, most of the estrogen in your body is MADE FROM TESTOSTERONE.
A lot of transgender people, like me, use HRT to help their gender transition. Trans men take testosterone, and trans women take both estrogen and a testosterone blocker. The net result is that the T levels in trans men becomes very high, while it sinks to near zero in trans women. Meanwhile, the estrogen level is raised in trans women to be somewhere in the middle of a premenopausal adult women’s cycle.
There are three ways you can take estrogen: orally, via injection, or witha patch. I take the pills because that’s what they usually start people out on, but a lot of people seem to prefer the injections. I also take a drug called Spironolactone, which is the testosterone blocker. It is primarily prescribed, however, as a diuretic, and it does an admirable job of it, too. You know how trans women just LOVE to use public bathrooms? Imagine how scary that is, and then imagine that twice a day you take a drug that makes you have to pee. Every part of being transgender is a double-edged sword.
Okay, great. But what, you ask, do these hormones actually DO? There are two categories of effects from HRT: physical and mental. We’ll start with the physical ones because those are the ones that people seem more interested in, although I find the mental effects more interesting, and in some unexpected ways.
The physical changes are a big part of gender transition because they can significantly reduce dysphoria, and they can help a person be perceived as their identified gender. Someone with a beard, for instance, is more likely to be pegged as male. Someone with boobs, on the other hand, is more likely to be figured for female. Except me, for some reason. Even when I’m wearing the paddiest of padded bras, people still call me “sir” sometimes.
Testosterone is a HELL of a drug. When someone assigned female at birth starts taking testosterone, a lot of amazing things happen. The reason for this is that adding that stuff to a female body essentially induces male puberty: body hair, facial hair, more upper body muscle. Most trans men can grow beards, and their vocal cords elongage, giving them deeper voices. It’s possible that you’ve met and known numerous trans men and had no idea they were trans.
Estrogen is less harsh than her male counterpart, but just as amazing. Taking it (and removing testosterone) makes skin and hair softer. It changes the way a person smells: my sweat smells completely different now. It causes muscle loss, especially in the upper body, but also in other places, like the feet. It’s not uncommon for trans women to lose as much as two shoe sizes’ worth of foot. Estrogen also retools your body’s fat storage priorities, so fat is no longer placed around the middle but instead is stored in the thighs and ass. The fat in the face is redistributed as well, which is huge for trans women, because that redistribution can make a huge difference in being gendered properly.
And yes, it grows boobs. And yes, I am growing boobs, because I know you’re wondering. It is not particularly noticeable yet, but it is painful and hard to believe and pretty freakin’ awesome. But mostly painful.
Unfortunately, what estrogen CANNOt accomplish is to undo the effects of male puberty. Your facial hair doesn’t change. You will have to keep shaving forever unless you get it removed via laser or electrolysis, which are both extremely painful and costly, and trans women line up to do it because it’s a damn beard and it’s the last thing we want.
The other thing that doesn’t change is your voice. Estrogen can’t un-lengthen your vocal cords. This is a source of a lot of upset for many trans women. There are ways that you can alter your voice in order to make it sound (remarkably) feminine, but these methods take a lot of practice and effort. I can’t seem to be bothered to do it, but pitch and intonation are only two aspect of voice. When you pay attention to how women talk, you’ll notice that they do several things differently from men. Men tend to speak in a monotone; women’s voices rise and fall in pitch as they speak. Women tend to enunciate more, on the whole, and they also tend to speak more slowly. For me, it was a challenge to NOT talk this way. I had to work to keep my voice in that male monotone and not the female lilt that felt much more natural to me, and which is now just my voice.
So that’s the physical changes. What about the mental ones?
I don’t really know what it’s like for trans dudes. I assume that testosterone makes you want to explain things to women that they already know, but other than that, I’m not sure. (I kid the trans dudes.)
The most noticeable, for me, is my relationship with my emotions. Many trans women find that they have never really experienced emotions fully until they start taking hormones. Not so for me; anyone who knows me knows that I was already pretty emotional. Estrogen has made me a little more emotional, but more than that it’s changed the colors of them, made them brighter and a bit more saturated. I feel whatever I’m feeling more deeply, and it’s much harder for me to shut my emotions off, or compartmentalize them.
It’s also reduced my gender dysphoria in a subtle way that’s hard to explain. My brain parts feel more… womanly. I don’t know how else to say it. It’s very difficult to separate out what the hormones are doing from the effects of simply being free to be myself. But something about me is more — I hate to say it but it’s true — more tender, more empathetic, and more caring.
The question that seems to be on everyone’s mind in this regard is: Does taking estrogen affect your sexuality? That’s a question that nobody really knows the answer to. It’s not uncommon for trans women on hormones to find their sexualities shifting in unexpected ways. But is that the hormones, or just the freedom that comes from being trans? I mean, after you’ve told everyone you’re TRANSGENDER, coming out as bisexual or whatever just seems like small potatoes. If you want to know more about this for me personally, you either need to be another trans person or you need to get me fairly drunk.
Overall, HRT is an amazing gift. It doesn’t just make beards and boobs grow; it gives your brain something it needs to thrive. Brain scans of transgender people have shown that in some ways our brains are likely to be more like those of our preferred gender. This makes a certain amount of sense; you don’t just DECIDE to be trans one day; it’s baked into you at a deep level. It’s so deeply affirming on every level to look at my blood work and see my estradiol level well in the range of a healthy adult woman, while my T-levels are taking a nosedive.
HRT also gives trans people the rarest and most magical of opportunities, which is to experience the world from two very different perspectives. It’s a bit skewed because a) I was NOT your average guy when I identified as male, by a long shot; and b) my experience as female has a couple of major asterisks. I don’t know if what I feel like is what a cisgender woman feels like. There’s no way of knowing. But the more I exist in the world, the more I’m treated like a woman by other people, my experience of my inner mental world and of my outer experience tend to converge on something that just feels “right.” Whether it’s joking around with the lady who does my brows, or sitting with a girlfriend who’s feeling sad, I FEEL like a woman, and that means everything to me.
I’ll end this with a very strange experience I had a couple of weeks ago that I never could have imagined, and was not prepared for. I was in my favorite coffee shop, and a woman walked by holding the most adorable baby you ever saw in your life. The baby looked at me and smiled and I very clearly and with deep certainty, thought, “I NEED TO HAVE A BABY.” A hundredth of a second later, I remembered that I don’t have the biological equipment for that, and it was the most bizarre and surreal sense of mental double-vision I’ve ever experienced, like I was living in two different universes at once.
I guess, in a way, I was.