I recently had an injection that seemed to go wrong (CW: blood, I inject EV subq and I hit something like a capillary, there was a lot of blood and it bruised badly afterwards). Within a couple days I felt unusually dysphoric as a result of what I assume was a failure for the oil to depot and slowly release over time.
I get these “dysphoric thoughts” that maybe the estrogen is causing the problems, that I don’t have objective proof that I’m trans, etc. Lots of doubt, paranoia, and increasing amounts of anxiety and irrational fear (about transition, but also in general, e.g. thinking spiders are in my bed), and I start to experience depression and anhedonia (things aren’t as pleasurable, everything feels pretty flat emotionally, I just feel “bad”).
Of course when I inject again and it goes well, I feel much better and I forget about these problems.
I was just wondering if anyone has advice on how to deal with dysphoria when there are gaps in the HRT. Obviously in the long term, surgery will fix the hormone issue and I suspect that will fix this problem. Until then, though, I am stuck in a rather fragile place where I feel normal (even good, even amazing) when my estrogen levels are high and suppressing my testosterone. Any small slip in that and I barely function as a person.
Before HRT I would just do whatever I could to increase mental well-being:
- physical exertion (aerobic exercise, weightlifting, etc.)
- going outside and getting sunshine
- keeping up with hydration
- keeping good sleep hygiene (sleeping enough, going to sleep at the same times, etc.)
- meditation every day
But now it feels harder for me to “bootstrap” when there are gaps in HRT and my hormones aren’t right, it’s like I’m no longer used to how hard it was before.
Anyway - any tips or thoughts, would like to hear other’s experiences.
I haven’t had hrt yet and it sounds like you’re describing my life. I’m not functional at all, and I have no clue what to do to be functional. The only thing I can do is use discipline to play pretend, but then again that makes no sense because I don’t feel connected to my life. I just kinda manage a little at times because I don’t want to hurt the people around me.
Yeah, before HRT my life had two modes: stress and depressed. I preferred stress, it gave me agency and movement and made me feel alive. I think it’s part of why I became a workaholic, the stress of work became addictive and necessary to me.
I didn’t know how HRT would impact me, but I was shocked when I read about “biochemical dysphoria” in the Gender Dysphoria Bible. I became hopeful the HRT would help. The first two days after my first injection it wasn’t clear to me how I felt about estrogen, there were mixed feelings. By day 3 I think the testosterone was starting to get suppressed and I became euphoric and that’s the first time I would just lay there and feel delicious euphoria all over my body. I felt high, like I had taken drugs. It was delightful. I took that as a good sign.
I was surprised at how much estrogen changed my life. I have struggled to create stability with HRT, but in the periods where my hormones were right (I am guessing), I become much more able to handle everything. It suddenly became easy to do things that felt impossible before. I have a garage full of clutter that has built up to the point where I can barely get into my car anymore, and every time I need to drive out of the garage I have to move a bunch of items out of the way to make room. One day, just during breaks from my job (working from home), I was able to significantly clear out and organize the clutter. Something I wasn’t sure would ever happen.
I was suddenly finishing projects that I had sat on for years. It just became easier, more matter-of-fact, and less stressful. There was a kind of stress, but it didn’t take the same toll. Some when I would plan meals and go grocery shopping. Before HRT doing that would take up half of my day and would leave me completely drained afterwards, I would barely be able to put up groceries when I got home. Now with HRT I can feel the stress, but when I leave the store it doesn’t wreck me, I even have energy do other things after putting up the groceries.
Before HRT I could sleep 11 - 12 hours every night and still not feel that energetic. With HRT I sleep more like 6 - 8 hours and wake up rested and with more energy than before.
It is a huge change for me.
But my story shouldn’t set any expectations for anyone. I don’t think being trans is a monolith, and the causes of dysphoria which I believe are likely both social and biological in nature are probably multiple or quite complex. I have read a study which found a correlation between left interior parietal cortical thickness (Cth) and reported congruence with self and body (for both trans men and trans women, by the way - the Cth in cis controls different in the same ways from trans people regardless of whether they were trans men or women). The study compared baseline levels before HRT and after taking HRT, and what I found interesting was that some trans study participants after HRT actually had both thicker Cth and increased reported incongruence between self and body.
So while HRT is helpful in many, many cases, it’s not guaranteed that a person suffering from gender dysphoria will respond to HRT the same way as others. There might be more complicated mechanisms that explain this that we don’t understand yet. Some trans people don’t find HRT helpful and that’s OK. Some people try HRT and find it doesn’t make a big difference mentally, but they take it for the physical transformations.
My primary goal in taking HRT is to improve my mental health, above and beyond the transition.
I feel constant pressure to know whether the HRT is helping, to know whether I’m “really trans”, and so on - but ultimately even if the HRT didn’t work for me, that doesn’t necessarily invalidate my “transness”. So take my account with a grain of salt, it may or may not happen for others. Lots of people start HRT and experience more depression or anxiety (esp. if there are other things going on in your life that are creating stress or might cause that depression and anxiety, and transitioning is definitely a such an event for most people).
Whatever struggles you are having, I hope you find a way to cope and even overcome them! I ultimately transitioned and took transitioning seriously precisely because I was hurting the people around me by not doing so, I realized I needed to be more self-compassionate so that I could be a good person (whereas before I felt my welfare should come last, and I wasn’t sacrificing enough to be a good person). I can really relate to the struggle, and I’m so sorry you’re going through that.
Thanks for your story, I think I might show it to my gp in the hope of getting the signature I desperately need. Because it is exactly how I feel too.
Weeks ago I tried hrt from a friend for a month. It had a fundamental effect on my psyche. It was as if I was meditating but without any effort. From waking up to going to sleep, it was absolutely solid.
And once the end of the meds was in sight, I knew what was ahead of me. To get back in the cage and to forget the feeling of life. I remember it in an abstract way now, but sometimes I lose hope.
I just feel utterly dissociated, even worse than before, if that’s even possible. All I can do is wait and trust.
I wonder why your GP wouldn’t prescribe HRT … If you are in the U.S., you should be able to use informed consent and go to any Planned Parenthood to get HRT. I think it’s possible a therapist can also refer you to an endrocrinologist, though that’s less common these days (and I don’t know the details, whether the psychologist can refer you directly to the endo, or if it somehow still routes through your primary care, I don’t know).
Have you read the Gender Dysphoria Bible? It’s full of information and anecdotes like mine. Either way, you shouldn’t be in a position of arguing with your GP or pleading your case with testimonies like mine. Contemporary doctors should know better and will refer you to an endo based on self-reporting. It’s not that different than if you have depression and need anti-depressants, there is no test, and ultimately the doctor has to take seriously your self-reporting. Obviously transphobia throws a wrench in this theoretical case, but if you’re trans you should want to find a doctor that isn’t transphobic anyway, since you will need unbiased care during and after your transition as well.
If you really wanted evidence to present to your GP that trans care is effective, here are collected research findings published by Cornell which provides a summary and many, many studies which overwhelmingly conclude that gender affirming care is effective. Still, I don’t think you should be in a position of arguing or pleading this case with your doctor. I got a referral to my endo by calling my doctor’s office, speaking with the nurse and telling her I think I have gender dysphoria and want to see an endocrinologist. She spoke with the doctor and he agreed to refer me to the endo. I am his first trans-feminine patient, and the first trans patient he has referred to an endo, but I learned he has some trans-masculine patients that transitioned before seeing him.
Sometimes there are directories to find trans-friendly providers in your area. That’s how I found my endo, there was a guide where he was listed. If there is any local LGBTQ+ organization, connect with that community and even if there is no official directory, someone might be able to tell you which doctors are safe.
Good luck out there, I’m rooting for you! <3
Thanks for your support.
Unfortunately in this case I live in the Netherlands and we don’t have informed consent here. I’m required to see a psychologist and it can take 1 or 2 years before you even meet one, and it takes longer to actually get it. I personally know someone who has been waiting for 2 years now.
I don’t let it stop me. I’ve socially transitioned for well over a year now. And eventhough I am a responsible person I have a plan B which involves getting DIY hrt. I just hope this GP sees reason and allows me a safer way.
What bothers me most at the moment is that my depression has regressed back to non functional, and I am unsure about the future. All I can do is wait and not lose faith.
Ah, I don’t know much about the laws and the way healthcare works in the Netherlands. I’m in the States, and after the doctor referred me to the endo, my first appointment with the endo was scheduled two to three months away. It felt like a long time, and in that time having socially transitioned but having no HRT I suffered much more than before. It was like I was giving up all of my repression and previous coping strategies, and that left me rather exposed to the dysphoria, to the point of having strong suicidal ideation.
In retrospect, knowing how I responded to HRT, I regretted waiting and not trying DIY first. It was easy before seeing the endo to rationalize not taking the DIY route, as I wouldn’t have baseline blood tests showing my hormone levels before HRT. I also didn’t want to come across as non-cooperative or acting in bad faith with my doctors. But I sacrificed my well-being for that, in ways that makes no sense.
In the U.S. estradiol is not a controlled substance, even though you generally need a prescription to acquire it. You can order it online and have it shipped to your house, and the quality of some of the estradiol on the market is the same as what you get at the pharmacy here (obviously not all sources are equal). The issue is really money for most people.
I don’t know how you might react to HRT, or what situation trying DIY might put you in. However, I would completely understand taking the DIY route, and I wish I had taken my well-being more seriously. I know in the UK people often turn to DIY because it can shorten the timeline for getting HRT through the clinics there, I guess the clinic feels a pressure to engage in “harm reduction” and will waive some of the transphobic policies that require waiting arbitrarily long times before being given HRT.
Much luck to you, sister. I hope you are able to find a way to help yourself and feel better. <3
Thanks, that makes me feel a lot better.
Being a goody two shoes can definitely be detrimental. I’m gonna try to get her to at least give me the blood tests. Otherwise I’ll have to go the private way and it’s gonna be expensive. And I’m already drying up my friends enough.
Looks like people are saying the greymarket medication is more expensive in the UK than through official means (just like in the U.S. where insurance should bring down the cost of the medication), but private (which I assume means still going to a clinic and paying out of pocket) might be more expensive than greymarket DIY, just a thought if financial resources are tight. Basically this would mean just not seeing a doctor or getting blood tests privately, just sourcing the medication on the greymarket. Then when you do finally get access to the public healthcare you will have been self-medicating and they will be motivated to fast-track getting you the medication through official means (as a form of harm reduction). At least this is what I have heard can happen.
If you haven’t already, you might find Yes, You Are Trans Enough by Mia Violet interesting, it’s a memoir but she’s in the UK and talks about what it was like navigating the UK healthcare system. I found the book important at the very beginning of my transition to help me come to terms with being trans and accepting that.
Well I can tell you that in the NL the official route is way more expensive, less predictable, slower, harder, dehumanizing and traumatizing. Even when it drove me to the point of suicide, they wouldn’t let me stay in the hospital. I’d recommend against going this route to anybody.
DIY is the status quo, simple, convenient, respectful, cheap, and you get a whole year’s worth. The only thing that really costs anything is the bloodwork. Learning how to be responsible with it costs less time and energy than all the paperwork.
For the official route, if I add up all costs, I am currently at well over 1500 usd, and I haven’t seen a single blood test or pill yet.
Thanks for the book, but right now I just need to get my medication in order.