If you are Transgender, will HRT or GCS Change your Sexual Orientation?
My thought is, “I suppose it’s possible.”
Someone in my trans women’s support group, the River City Gems, posted a survey this morning, asking the question that I have made into the title of this blog. My answer to the question is: “I suppose it’s possible, but I don’t think it happens very often”.
Before I begin, I should clarify the two abbreviations in the title: “HRT” is Hormone Replacement Therapy, typically Estrogen analogs like Estradiol Valerate or Estradiol Cypionate for trans women, and Testosterone Valerate or Cypionate for trans men. “GCS” is Gender Confirmation Surgery, a more trans-friendly and affirming version of “GRS” or Gender Reassignment Surgery. I personally prefer GCS, but they both refer to the same sets of surgical gender transition therapies.
To be specific here regarding my answer to the question, I know at least 50 trans women, and a couple of trans men, and only one of them has professed to me a significant change in orientation, and that was from, “Confirmed heterosexual male preferring women”, to, “As a trans woman, I might consider a relationship with a guy”. For myself, now having spent almost 6 years in a trans-lesbian relationship, I have come to realize that gender roles are much blurrier than I thought.
Look, I spent 59 years trying to be ‘a guy’, and my wife, Lynn, thought that I did a reasonably good job at it as her husband. On the day she died, she told me as much and thanked me for having been a good husband and life-partner for her. I’ll freely admit that my personality has not changed much, if at all, just because I no longer have testicles and I cruise on estradiol now instead of testosterone. And the same goes for my life-partner Pauline. Personality-wise, we both lived as men for decades, so what does that say about our relationship now? What does it imply about the possibility that I might have ended up in a happy relationship with a man, either cis or trans, instead of a trans woman?
I have come to realize that Kindness, Compassion, Companionship, Love, and a sense of joie de vivre, are not the exclusive purview of either women or men. Believe me, when you are 65 years old, you become uncomfortably aware of the fact that at least 75% of your life is now behind you. The final dissolution of everything you know and hold dear is just around the corner, and you begin to see the world, including human relationships, from a vastly different perspective than you did even at age 50.
In that segment of the transgender population that chooses to surgically transition through bottom surgery, most of us will experience radical changes in our hormone balance as a result of both the surgery itself and going on hormone replacement therapy (HRT). For trans women, it may be undergoing surgery to remove the testicles, either by orchiectomy, or full GCS with vaginoplasty. It is my understanding that for trans men, hysterectomy (removal of the uterus) is a fairly common surgical procedure, but that removal of the ovaries and fallopian tubes is not generally undertaken for GCS unless those organs were found to be compromised by some underlying disease, not necessarily connected to the gender transition.
The aftereffect of orchiectomy is that in most trans women, the level of testosterone measurable in their blood serum drops to less than 10 pg/ml, somewhere between 1%~3% of what it would normally be. That trace amount of testosterone remaining mostly comes from the pituitary and other small adrenal glands. Without surgery, the usual HRT regimen of spironolactone to suppress testosterone uptake, and estradiol to supplant the remaining testosterone, should result in a more-or-less stable blood level of 20~30 pg/ml of testosterone, and 150~250 pg/ml of estradiol. The endocrinologist will adjust dosages to optimal levels for each patient’s age and overall health and medical needs. The overall effect of this change in hormone balance for me personally, was that I felt less frustration, annoyance, and anger in stressful situations, and more able to put things in proper perspective when they don’t go exactly my way. It’s definitely a feeling of calm and peace-of-mind. It’s subtle, but I am definitely a more laid-back person on estradiol than I was on “T” in my youth.
But estradiol didn’t significantly change my sexual orientation; I’ve always felt more at ease around women, and far less threatened by them, even though I had a significant level of social anxiety in my teens and twenties. It is not easy to quantify how, or to what level, the hormones might have changed my sexual orientation; maybe I’ve always been pansexual to some degree and wasn’t consciously aware of it. Regarding gender transition and life-partnerships, it seems that if you are single when you transition or become so afterward, your pool of potential mates shrinks drastically, especially for us older people.
Not very many cisgender people can wrap their heads around the idea of even dating a transgender person, let alone marrying one, so whether you think about this dilemma consciously or not, you may feel on some level that going forward, if you don’t want to be alone the rest of your life, you are probably going to have to partner with another transgender person. Who else can really understand and accept you unquestioningly? If you are not going to have GCS surgery (and a lot of transgender people over age 50 never do because of the increased risk of serious medical complications and long recovery times ), it’s even more complicated and more difficult for most cisgender people to simply accept you as the gender you are transitioning into.
For me, I consider ‘transition’ to occur in three stages.
The first is Social Transition, where you change your name and maybe your gender identity marker (perhaps you take the route of legal transition by way of petition in a State Superior Court if your country so requires it) and begin presenting as your chosen gender by way of clothing, hairstyle, and other social cues. Social Transition is generally reversible if you later decide that this isn’t the path you should be on.
The Second stage is where you begin Medical Transition: Hormone Replacement Therapy. Spironolactone and Estradiol for trans women, and Testosterone for trans men. The medical effects of HRT involve both your body, and your mental state, and they can’t easily be quantified in an exact manner since every human being’s biology is unique. Typically though, for trans women, exposure to estradiol will likely have the following effects:
- It shrinks your prostate gland and your testicles. The cells with the testes that produce sperm will begin to die off and within 90 to 180 days you will be rendered sterile. This is usually permanent and irreversible, so a decision to start HRT is not to be taken lightly.
- It causes changes in mammary tissue that you can feel. Starting about 6 months into estradiol therapy, your nipples might get very sensitive for several weeks, and over 3 or 4 years, your breasts will develop, at least a little, in most people. The younger you are, the more you get, usually, but there are no guarantees. I’ve known trans women who started HRT at age 45 and had a D cup in 2 years, and I’ve known 25-year-olds who had almost no breast development at all. ‘YMMV’ (Your Mileage May Vary), sadly applies to both car purchases and HRT.
- Estradiol slows your metabolism. Trans women often have difficulty keeping their weight under control. This is a serious problem not only for overall health. It can be disastrous if your weight gain results in you being told by a surgeon that you can’t get your bottom surgery because your body mass index is above the safe limit.
I don’t know as much about the effects of testosterone on trans men, but none of the few that I do know are struggling with obesity, so I assume that T doesn’t cause weight gain, or at least, not as much as estradiol often seems to. As for the long-term effects of testosterone on a trans man’s reproductive systems — my understanding is that exposure to testosterone does not damage their ovaries as much or as quickly as estradiol damages testicles in us trans women, so if a trans man goes off HRT, he may still be able to conceive even if he’s been on T for years.
The Third stage is Surgical Transition, and this is a lifetime commitment: Gender Confirmation Surgery is a permanent thing. It’s not like you can ask the surgeon to store whatever pieces and parts were removed from you in the freezer, then sew them back on if you change your mind at some point. The key point here is that after any gender confirming surgery in which the testicles or ovaries were removed, the transgender person must remain on HRT for the rest of their life to prevent osteoporosis (bone density loss) which can lead to an increased risk of fractures of the spinal vertebrae and hip bones and possibly life-threatening complications. Prior to surgical transition, HRT can be stopped at any time.
Post-surgical HRT and sexuality
So, you have undergone surgical transition, and are now on HRT permanently. What might change about your social and sexual attractions at this point? As far as I’m aware, there is a very small percentage of all transgender people who report that their orientation, post-surgical transition, changed to some degree. But it’s very hard to pinpoint that change to a specific cause. It could be the HRT, or perhaps that person was always latently bi-sexual or pan-sexual? It’s not like your doctor can hook you to a brain scan machine before and after giving you a hormone injection, and point out something like, “Ah, ha! I see the estradiol hitting your Amygdala and Hippocampus, and cranking your orientation from female to male attraction!”
Maybe just getting older has an influence.
No one knows for sure. Most likely there are many small contributing factors. But my personal belief is that we are all born with certain traits and tendencies that will lead us towards a specific gender identity and sexual orientation, and it’s our society’s aversion to, and suppression of, LGBTQAI+ people that forces children into whatever mold their parents want them to conform to. Who can say what 20, 30, or 40 years of being forced to live in the wrong gender, or be married to someone that you secretly wish was the other gender, does to the psyche of a closeted queer person? That’s got to have an enormous impact on that person’s true state of being regarding gender, orientation, happiness, and quality of life.
Dialing in on Gender and Sexuality
Before I go further though, I want to emphasize that when I say, “certain traits and tendencies that will lead us toward a specific gender identity and sexual orientation”, I am not talking about anything that’s hard and fast. I like to use thermostat dials as a metaphor for both gender identity and sexual orientation: They have a range of temperatures from hot to cold, depending on which way you turn the dial, right? In this analogy, imagine that you have a couple of these thermostats in your brain somewhere, and one of them is for Gender Identity, with 100% Male being the clockwise stop, and 100% Female being the counter-clockwise stop. On the other dial, for sexual orientation, the clockwise stop is 100% Heterosexual and the counter-clockwise stop is 100% Homosexual, and somewhere around the halfway point of this dial’s range is where Bi-Sexual/Pan-Sexual are defined.
It’s my belief that at least 20% of the entire human population were born with, and are living with, one or both of their dials not cranked all the way over to 100% on either end of the scale. Their dials are floating around somewhere in between the extremes, at points of travel that are not only different for every individual at birth, but with some possibility of gradually drifting to other settings during that person’s lifetime, which might exceed 9 decades. And I don’t believe this is unnatural or a bad thing. It’s our uniqueness that makes human beings so wonderful. Life would be awfully boring if we were all as uniform as the contents of a bucket of golf balls, all of the same brand, color, and production lot, and all with exactly the same number of dimples on our surface.
“Life would be awfully boring if we were all as uniform as the contents of a bucket of golf balls…”
I was married to a cisgender woman for 27 years and was supremely happy to be her husband. Now, I’m a widow, a trans woman, and in a committed same-sex life partnership with Pauline, another trans woman. Any way you look at it, Pauline and I are in a gay relationship. We both lived many decades “as guys”, married to cisgender women. Does that mean we were both latently bi or pan-sexual from birth, or did the post-transition HRT loosen up and blur our (presumed) heterosexuality, causing our Sexuality Thermostat dials to drift off whatever positions they were formerly set at while we were married, and trying to be good husbands to our wives? Or are we just too old, too tired, and feeling too isolated as trans women to risk maybe spending the rest of our lives searching for new relationships with cisgender women? Searches that are all too likely to end in failure for even much younger and more attractive-looking trans women than the worn-out lard-ass I am at age 65.
Post-surgical HRT changes
My HRT has had obvious effects on both my physical body and my mental health and personality; the estradiol has slowed my metabolism making it even harder than it was to keep my weight under control. I’ve lost a lot of muscle strength, although at my age that was probably inevitable. The changes in my personality include patience — I am much more laid back and patient than I was as a youth in my twenties and thirties and I am far less likely to feel severe negative emotions like frustration, anger, irritability, and annoyance. I find it easier to think through a problem and make at least some kind of well-reasoned-out plan to ‘fix it’, rather than jump in haphazardly and flail about like the proverbial male bovine in the porcelain store.
I am far more tolerant of crying babies in my vicinity, especially in restaurants. This used to annoy the hell out of me and now my impulse is to try to comfort a crying child. Sadly, my HRT has apparently not induced, or brought to the surface, any instinctual knowledge of how to change a baby’s diaper. According to my daughter, my attempts to help her with my grandkid’s diapers have proven to her that I’m still about as incompetent at that today at 65, as I would have been at 15, had I ever been a teenage babysitter. But has post-surgical HRT changed my sexual orientation? I don’t think so. I’ve always been attracted to female persons of about my age, and been more or less nervous around, and sometimes felt threatened by most males, at least strangers. I can’t say that HRT significantly changed any of my emotional responses to other people based on what I perceived their gender to be.
For whatever it’s worth, my feelings for Pauline aren’t significantly different than my feelings for Lynn were. She’s a wonderful, loving companion, and in many ways, I have a lot more in common with Pauline than I did with Lynn, at least in life experiences that we can share conversations about. Maybe none of it means anything anymore; I’m retired, I’ll never be raising another kid, and my contributions to society are now of almost no significance in the ‘big picture’. I’m just an observer for the most part, now. I am still sometimes trying to suss out why I am here, whether I should have done more with my life, and if I owe it to anyone to try and be more than what I am. But I am now finally old and wise enough to understand that humankind, either as individuals or as a species, is less significant than individual water molecules in the Pacific Ocean when viewed against the immensity of the Cosmos.
But to each other, our interpersonal relationships are the sum total of why we are here. When I am with my family and friends, and we exchange a hug and a happy smile, my life has all the meaning it needs, and that’s a comfort. Love knows no gender, and if two people are enriching each other’s lives, and their love for each other shines like a beacon in the darkness, what does it matter to their kids (if they have any), whether it’s “Mom and Dad”, “Mom and Mom”, or “Dad and Dad”? And if their kids are happy and healthy, they will grow into good and happy adults and parents in their own right, regardless of whether their parents were a straight or gay couple.
“Love knows no gender…”
