The process of taking artificial hormones to counteract your body's natural sex-related hormones is called hormone replacement therapy, or HRT for short.
How It's Going
In short, the effects of HRT have been pretty much entirely positive for me. I am feeling more relaxed, more in control of myself, less angry... more like myself. There have been some down times, but I think they're mostly due to circumstances. I've always had mood swings; it's just easier to see what's going on internally, now, and to express it if I want.
The only down-side, as far is I can tell, is that I often find myself impatient with how slow the changes are, and how incomplete I know they will be. There's only so much a body can to do reverse 51 years of having the wrong hormones.
The most dramatic effect is that I have not had any of my chronic headaches since the first day of HRT. They always used to happen with an interval anywhere from a few days to a few months, and tended to be triggered by certain types of stress which I consequently learned to avoid – but now even those triggers don't seem to cause them. This was not on the list of expected effects (and actually, getting more headaches is listed as a possible side-effect of estradiol), but I'm definitely not complaining. I'm not sure which hormone is responsible, but if I had to guess it would be the spiro.
Another positive side-effect – which may be a direct effect of the hormones or may be due to just feeling better in general, which itself is largely due to the hormones – is that I have been able to get up several hours early most days in order to get focus-work done. This has had a very positive effect on my productivity and additional positive impact on my mood during the day if I feel like I actually accomplished something.
The HRT has not yet substantially hindered my ability to lift heavy objects as far as I can tell – but as of this writing I am only seven months into it, so that could still change.
What I'm Taking
Spironolactone (aka "spiro"), 125 mg/daydiscontinued after SRS
- Estradiol (sublingual tablets), 3 mg/day
(For details on the resulting hormone levels, see test results here: levels)
I gather this is a fairly standard regimen, though data is still coming in on what works best and some doctors deviate from this substantially. It may also depend on health factors.
I started out with a slightly lower regimen; after the first set of labs came in, my practitioner upped it to a slightly higher dose. After the next set of labs came back, they lowered it halfway back down to where it was in January, and then raised it back up again after the next set of labs showed slightly high testosterone. (All I can say is, the less testosterone the better... and whole pills are a lot easier to deal with than half-pills.)
The cost of both of these is somewhere between $20 and $40 at Costco for what is currently a 30-day (Spiro) and 36-day supply (Estradiol) – not a big deal at all.
This is a quick summary of the effects of sex hormones and HRT. In general, sex hormones affect how the skeleton grows (when it is still growing) and how fat is distributed in the body, and also affect mood and emotions.
The physiological effects also tend to be reduced somewhat the further you are past puberty.
My HRT regimen does these things, where still possible (some effects only happen while your skeleton is still growing).
- more subcutaneous fat: reversible
- This tends to make facial and body contours more "curvy" and lightens the skin tone in light-skinned people.
- chest protrusions: irreversible except by surgery
- slower burning of calories: reversible
- stops male-pattern baldness (but does not reverse it)
If I were still growing, it would also result in:
- wider hips
- This is the other part of what makes female bodies more "curvy".
- shorter stature (on average)
The HRT I'm taking tends to suppress or reverse these effects, though not all of them, as noted.
- darker/thicker body hair: reversible
- upper body muscles: reversible
- quicker burning of calories: reversible
- enables male-pattern baldness (effects vary widely)
- I have a little bit, but less than some cis women.
If I had not already developed these features, the spiro would also suppress:
- deeper voice: Not reversible by hormones; surgery is available but relatively new.
- facial hair: Not reversible by hormones
- Several methods of removal are available, but all are time-consuming and somewhat expensive.
- skull bump in the back of the head
- "Adam's apple": can be surgically reduced
- certain "masculine" facial skeletal features: can be surgically "feminized" (expensive)
- It turns out I'm perfectly healthy, which is something I was worried about before going in for my first appointment since I've never been much of an exerciser and I hadn't been able to afford regular checkups for at least a decade and a half. Actually, I may not have had a regular checkup since leaving Durham for the first time, in 1985; I really don't remember. Arranging things like checkups is really difficult when you have social anxiety and phone-phobia, and tends to get triaged off the do-list unless there's a really compelling reason (such as needing prescriptions for HRT).
- I initially went to CVS/Pharmacy; they were significantly more expensive there, but they do have a nice online renewal tool – so that can be a worthwhile trade-off when saving time is more important than saving money.