I don't feel like a woman

[Aly Cat]

My endo put me on Spiro with all the other HRT drugs. I can't imagine Spiro by itself going good for the body because it suppresses testosterone, but if you don't have the other drugs to go with it, then you are hosed. Your body doesn't naturally produce estrogen as a male so if you reduce the testosterone, then your system is simply out of sack. Hormonal imbalances are no joke. They can not only mess with your mental state, but affect physical parts of your body like your thyroid and other important glands and organs. Hopefully you were not self medicating. I know quite a few people who do, and it is so dangerous. If you are on anti-androgyns, make sure you are replacing what the Spiro is blocking. Do lots of research. It is well worth seeing an endocrinologist to make sure doses are right. Every person is different and requires different doses. Play it safe, your life is literally on the line.

[LeaP]

It common to start HRT with an anti-androgen (AA) alone. I did and am glad I did, because it let me distinguish among the effects of lowering testosterone vs. mood effects of estrogen vs. long-term estrogen effects. [edit - Aly is correct on risk with AAs alone. Your body REQUIRES sex hormones. AAs alone are sustainable for most for only a few months.]

I had quick relief from lowering T. That took off the aggressive and reactive edge, the feeling of always being pressured by T, which I compare to being drugged (or "on crack", or poisoning when I'm making a dramatic point). I did NOT experience a loss of energy from starting AAs. Mine increased. The relief was HUGE. But - big but - this doesn't necessarily mean that T is not for you!

Although not classed as a psychotropic drug, E does affect mood, aspects of which are usually positive in both men and women, and is often an important consideration in prescribing E for women. I experienced positive mood effects in short order when I started E. Very nice indeed.

The long-term psychological effects of E result from the expression of your genetic potential. As the estrogen receptors in your brain activate and your testosterone receptors inactivate, your brain will slowly change. (Contrary to popular thinking, brains cells do change and regenerate. Your brain is also continually changing neuron connection patterns.) My first indications of this were perhaps 6-8 months in, and became definitive only after about 18 months.

IMHO, it is really important to assess yourself regularly, because it is the long-term effects that matter the most. The world is full of people who started hormones, felt absolutely wonderful, but ultimately stopped. Put aside those who experience and dislike a drop in energy from lowering T, as well as those who dislike the emotional and mood changes of the early E experience. Those taking cross-sex hormones who are fundamentally unsuited will experience a growing unease in their very sense of self over time. In fact, this is exactly the same as a MTF transsexual living on T pre-transition. I.e., lack of congruence.

There is real risk in taking hormones as a result. Not from the long-term psychological changes. As far as I know those will reverse themselves over time if hormones are stopped. But from incurring permanent physical changes because of the length of time it takes to get to that point. It is also possible for someone to move further down the path prematurely because they are taken in by the earlier effects. Sometimes this is phrased as hormones creating momentum toward transition. And again, the world is full of people who start hormones and a few months later are making announcements … only to stop transition later. My transition is stalled the moment for reasons which are irrelevant here. One of the benefits, however, has been experiencing the long-term changes prior to taking further steps. I had planned on several of those steps well before this happened. As it happens, that would have been okay. But in truth, I didn't really know – and that is now evident only in hindsight. Two things need very serious consideration before starting hormones: your willingness to actually complete transition, and your willingness to live with permanent physical change if you don't.

[sandra-leigh]

Your body doesn't naturally produce estrogen as a male so if you reduce the testosterone, then your system is simply out of sack.

Male bodies require some estrogen. A fraction of the free (unbound) testosterone in the blood gets naturally converted to estrogen which is then used. If the testosterone levels increase or if the testosterone binding rate decreases then there becomes more unbound testosterone in the blood (in absolute terms) and when the relatively fixed fraction gets converted to estrogen, that would lead to higher estrogen levels (in absolute terms), which can then act on the male body to feminize it. As males approach andropause, the absolute testosterone production falls, but the binding rate often falls faster, leading to more free in the blood, leading to more estrogen converted. This is why a lot of men (estimates range from 1/3 to 54%) get gynecomastia ("women breasts") in later life.

There are anti-androgens that reduce testosterone production without affecting the binding rate. When used, the leftover free testosterone in the blood falls, leading to less estrogen converted from testosterone. If reduced sufficiently far without introducing estrogen, body trouble can result. Oesteoperosis is often mentioned; a source told me that the real oesteo danger occurs if you have low levels of estrogen and low levels of testosterone. The anti-androgen doses typically used for MTF are, I gather, not typically sufficient to get to that particular danger, but biochemistry is variable and some bodies do not need much spiro to lower testosterone levels to the danger point; while other people end up having to go for high doses of anti-androgens because their body fights to keep testosterone levels high.

There are also anti-androgens that block testosterone binding without reducing testosterone production levels. When used, the unbound testosterone levels in the blood rise, the absolute amount available for conversion increases, and so estrogen production increases in the body.

Some bodies will need anti-androgens until the testes are removed, either via an orchi or SRS. For others, once the testosterone levels fall "far enough", sufficient estrogen alone is enough to tell the testes to go quiet and the testosterone levels will stay low-ish by themselves. That is the case for me: I haven't had anti-androgens for a year, but my testosterone level is only 6 to 10 with 3.4-ish being "normal for female" and 60-100 being "normal" for males (numbers are from memory.)

Some people notice withing hours if they don't get their estrogen dose on time; it takes me a good month without additional estrogen to notice anything. That indicates that my body has pretty much switched to a more female biochemistry mode, which will happen to some people and not to others. Medical monitoring is important! You won't know how your body will react until you try.

[LeaP]

Great response, Sandra. Just a couple of things: There are indications that serum E levels decline, not rise in older men. (See mainstream press article here: http://www.nytimes.com/2013/09/12/sc...anted=all&_r=0) And I haven't seen anything to support your comment about MTF AA administration and osteoporosis - but I'm unsure of whether or not you meant AAs alone. I find it hard to believe that reducing T to well below female-typical levels, or even close to zero, which are the usual results of MTF AA dosages, would not incur that risk.

[Starling]

LeaP, a serious question, because I might have misunderstood you: if only long-term changes with HRT are truly telling, and every phenotypic male (not only MTF) should feel better in the short term with lower testosterone and higher estrogen, why do some simply feel totally "wrong" shortly after starting HRT?

Lallie

[Dianne S]

No, I would never self-medicate. My therapist always puts people on Spiro alone for a few months first before starting HRT. Apparently, it has happened in the past that people have stopped at the Spiro stage. So she treats it as an additional test people have to pass before she recommends HRT.

At this point, I'm in stasis. I still dress quite a bit and present as a woman sometimes in public, but I'm not moving forward with irreversible body changes until sort out what's in my head...

[LeaP]

The only thing I stressed in early estradiol (not HRT) effects was mood - usually that's positive, but not always.

There are a whole lot of reasons why a man might react badly to HRT, either E alone, the AAs, or the combination. Some experience the E mood effects as emotional flooding. I did not (it was stabilizing and validating emotionally), but my therapist mentioned cases of that in her experience. Often, however, it's a bad reaction to lowering T. That's the source of the energy loss for many, and is clearly the source for loss of libido and/or sexual function, which I had not mentioned). Some find the earliest (within weeks or a few months) indications of physical changes profoundly disturbing. Some people find themselves confused on HRT, have lost their edge, disturbs their sleep, etc.

My note was primarily a caution about the potential for over-validation arising from early HRT responses. Well, it IS validating - but only goes so far. So often we talk about reality vs fantasy when it comes to actually living with changes, particularly pre-transition. What gets short shrift is the long-term psychological effects. These can be significant and affect you and those around you in ways you cannot predict.

[Marleena]

Bryn I think there was a lengthy thread here on what it feels like to be a woman. I'm not sure if there was a definitive answer though. Some of the (TS) women know what's going on early in life and that they are female. Many more MTF's seem to struggle with WTH is going on with them instead. It can be a feeling of being on the outside looking in like it was for me. I always felt like I was hiding and overcompensating as a male. I think some of us just keep busy so we don't have to deal with it until the GD increases and bites us in the a$$.

The questions and thoughts you have in your first post would be best directed to your gender therapist for peace of mind IMO.