HRT as a diagnostic

[Marleena]

I tried to adress this in another thread but it was ignored. You see my TS group leader and my endo told me I should feel better in 1 to 2 months time after starting HRT. When the third month rolled around and I didn't see a noticeable difference I started to look for answers. What I found out is that the endo had put me on low dose E by mistake. So he upped the E to the dosage I was suppose to be on and within about a months time I finally started to function a lot better as it helped with my GD. So far so good.

Yesterday I researched how HRT could be used as a diagnostic and how it should affect a TS person. Everything I've read states that it should help with GD if you are TS but would cause or increase anxiety in a non TS person. The hormones should also help with depression if you are experiencing it from the GD. However I can't find anything on interactions with antidepressants and HRT (I'm not on antidepressants) but was curious about it.

So I posted this so people can know what to look for if they're on HRT and it isn't helping as expected.

I'd like to hear if HRT helped you with your GD. Did your endo and/or therapist ask if it helped with your GD?

Should it be used more as diagnostic tool or do you think the gender therapist is convinced of the diagnosis already since they gave you the letter?

[Rianna Humble]

I was warned that the first two months would not seem to do much as I was on a low dose to allow them to monitor for possible reactions. I think there probably was a positive effect of just having started though.

On this side of the puddle, I don't think it is as common to use hormone therapy as a diagnostic tool, but my clinician did check how my Dysphoria was affected by the increasing doses of hormones I had over the first 6 months. I am now on a stable amount (I hope).

There are arguments for and against using such radical methods to diagnose, and I think the chances of consensus are probably as high as the chances of consensus between those who say "Tomaito" and those who say "Tomarto"

[Angela Campbell]

Should it be used more as diagnostic tool or do you think the gender therapist is convinced of the diagnosis already since they gave you the letter?

I would ask the therapist this question since they are the only on who will know. I guess I will find out soon as I am going to see a therapist very soon now. Today actually

[MarinaKirax]

Interesting, but in Canada, unfortunately not practical. Before any drug can be licensed it has to pass clinical trials, bazillions of them. It has to help the target patients, but do no harm to others. If a drug were being used to diagnose that you were not transgendered, Then your doctor would have to say "take this and if you are a cross dresser it will make you more anxious". Not ethical for doctors to do, and not ethical for companies to do studies with TG and CD subjects, when their working hypothesis is if it works the way they think it should, half the subjects will get sicker.

[Michelle.M]

The use of hormones as both a diagnostic tool and as treatment is well established for transgender therapy. Marleena, your experience is an example of how that's supposed to work. In my case, the positive effects were immediate. First, psychologically as I suddenly had a sense of well-being for finally being able to make a positive and decisive step forward, and very soon after physiological as my mood began to brighten and my daily functions evened out.

Never once have I regretted that decision to request and begin HRT.

[Kaitlyn Michele]

my "relief" from starting HRT was instant..

i know this was psychological...it was not euphoria...it was relief...putting those hormones in my body somehow caused me to immediately consider myself internally female...

like michelle , never once did i reconsider or doubt my decision..and soon after starting them, i was thinking through when to start living as a woman

as far as using it as a diagnostic tool...i saw tomarto

[Marleena]

@ Marina I am in no way advocating using HRT to diagnose if one is CD/TG or TS, that would be dangerous. That's why we have gender therapists to help diagnose patients before giving a referral. However not all therapists are created equal and some may slip through the cracks. This thread is more about knowing what to expect once HRT is prescribed. For someone that is self medicating or considering it I've posted the side effects to watch for also. Of course self medicating is dangerous and that goes without saying.

[TeresaL]

I'm the odd man/woman out. The good part is that I have no urge or compunction to dress or do makeup. Prior to HRT, I was driven and controlled almost against my will and beyond all practical limits to go out in public as just a another woman. Now I don't, and have to contemplate going out days before.

Secondly, I'm much calmer and can function without constantly feeling the nagging pull to "present" as a woman. I'm almost always in male clothes now and entertain myself in my wood workshop, model railroad, noodling on my musical instruments, or piddling around. I'm retired and home alone, and can stay dressed in long T and lounge pants.

Unexpected though, is that SRS is now a distant longing, although I sense the woman internally, and see her in my heart and mind as being present. There exists some slight sorrow for she is definitely attached to me. Yet the magnetism is not so strong that I'm bowled over in deep depression and angst. HRT provided the disconnect from my brain command center to not act on SRS and go with the current flow, whichever direction the residual TG leads. If that is a definition of GD being deminished, then maybe so, but SRS was my target intent, and momentum was in motion. However, I am not like some the rest of you and am not ready to commit suicide until I reach that target.

Yet the "CD" angst is gone, and I don't want it back. Never. Cross-dressing is possible, and does feel right, but it must premeditated. I'm free for now, and believe HRT saved me from the insidious grip of compulsive cross dressing.

Will this wear off and will I move forward into transitioning? I don't know the answer to that because I'm alone now. Not much information exists for my scenario.

I'm neither a cross dresser or TS.

My postings are slowly diminishing because I'm different and don't fit in with the TG camaraderie and support, other than as a peripheral observer.

"Ur Not Alone" no longer applies. It's gone, I truly feel alone in this TG continuum.

[arbon]

I really liked the effects hormones when I started what it was doing to my body and all of it.

But the benefits that it was having were somewhat clouded because of everything that was going on in my life. There was 2 1/2 years between the time I started HRT and went full time and during period I was going to work as a man ( originally my boss had indicated support for my transition he changed his mind which put me in a difficult situation) and then trying to be a woman the rest of the time and that going back and forth was extremely hard on me, it was insane - I felt like it was ripping me apart and my GD was absolutely horrible at times. And plus there were so many stressful things going on during that period - being demoted and loss of income at work which sunk me financially and was leading to loosing my house and BR, all the threats at work from my boss, all the issues with my wife, daughter, mom, brother, dad, all the gossip and getting laughed at around town - I mean all that stress overwhelmed whatever benefits I might have been getting from the HRT .

When I legally changed my name in May last year and started living full time is when I really started feeling significant decrease in gender dysphoria, and really started feeling betting. So I think the HRT could only do so much for me, but mostly my well being depended a lot on getting to a place in my life where I could just be myself.

[PaulaAnn]

I started HRT Friday(5th April),after the Doctor and I had a long chat .I'm prepared physically and mentally for this next step in my transition.The waiting for the medical go ahead was like forever and it was with utter relief and joy that it has happened. I've only been on the hormone for some four days ,but I feel 100% better in everyway. I just feel good;the stress is over ,I'm moving forward with my dream ....this was a 50 year struggle to reach this moment.....I'm savouring every minute of it.
PaulaAnn

[LeaP]

Lots of themes and questions in the OP, Marleena.

"Diagnostic tool" is a bit of misnomer. One's reaction to HRT is an indication, perhaps a confirmation for some, but it is only one indication nonetheless. I think it is better viewed as a negative confirmation than a positive confirmation, however. I.e., you should really go back to square one with a negative reaction, but a positive reaction may not be indicative.

The drugs used in HRT aren't anti-depressants. The brain sex theory attributes the calming effect to eliminating the conflict over what the brain expects vs. what it has been getting. Ok - maybe. Taking down T levels is going to calm a lot of people down anyway, though. Whether or not they like or want that is another thing entirely. I find the effects of estradiol subtle but pervasive. Rather than enhancing mood, though, I would say it enhances my presence, which in turn affects my mood. I have read that Spiro can interfere with antidepressants.

Regarding "low" dosages, mileage varies. I'm on a dosage that is considered low by most people, but my resulting E levels are actually slightly above target. More isn't necessarily better, as the male body can aromatize estrogen into testosterone as well as the reverse. Whether this happens, or to what extent, is going to depend 100% on individual body chemistry, such as how much aromatase you produce, whether or not you are estrogen dominant, how well suppressed your T is (not exactly the same as the last item), etc.

My own experience includes the initial psychological boost, the elimination of many of the secondary effects of dysphoria (anxiety, depression, dissociation, etc.), clarity regarding dysphoria itself, and a sense of being myself again after many years. I have no sense at all of an induced well-being such as you get from mood-altering drugs. In fact, the clearest thing I can say is how ordinary and normal I feel.

In my opinion, there should never be a letter without a diagnosis. Any subsequent confirmation (positive or negative) should be treated as a separate event or issue.

[melissaK]

Well I started HRT without any letters. But I had a long history of counseling over gender issues and have always known my TS issues. I just had a huge problem with self acceptance and huge fear of transitioning. So I thought since HRT gives some relief from GD which was destroying me at the time, I ordered from off shore pharmacies. It helped mentally as it was a step toward transition. It helped more when therapeutic dosages took hold. I have never looked back.

I did try to go off them, because you feel so good I thought my GD would be manageable. That experiment didn't go well. GD comes back. And then I tinkered with my dosage taking only enough to keep GD at bay. Miserable life. But it kept sex performance possible. And it reduces desire to CD. (This is a well known side effect Teresa, you are not odd in that regard).

And after awhile GD catches up and I increased all HRT drugs to high ends of reasonable and bought more time to not transition. But this kills your ability to have sex. And you grow breasts. I mean I grew B cups. And my wife confronted me and my life went upside down and all that.

And what you realize is that HRT isn't enough. That you really want to be perceived as a woman. You really want your body to match. You realize that if just HRT was a cure, very veryfew would still pursue risky SRS.

And so I have 5-6 years of experience being on HRT, and I've had to grow my self acceptance, and grow my self confidence, and risk all the stuff that goes with transitioning.

And no, I'll never go off HRT. It's the right thing for me.

[Marleena]

Thanks for the great replies so far.

I have not had a therapist since the start of HRT. Once he gave me the referral he said I no longer needed him. He seemed pleased that I was comfortable with what I was doing and no more sessions were required. He did leave the door open for future visits though. That placed the onus on me to deal with it on my own from that point on. So far so good other than the dosage issue and knowing the expectations.

[PaulaAnn]

Hi Marleena: I'm in a similar position...I never had the need to visit a therapist;any issues I had (and there were a couple)were dealt with either by myself and/or really good mates who knew what they were doing.Besides I never had the dosh to lay out on therapists anyway.I put my progress and success in my journey to my present state by my military background. Determination,self confidance,belief in my worth and the desire to make it happen.Many ups and downs,but despite the hurts ,I never lost sight of my goal and never gave up ....I just had to do this,as I have said ,it's taken me 50 years to get to this point in time.
My family Doctors in Sask. and Alberta did such a great job of guiding me ,educating me and sometimes kicking my butt so I could stay on the path,and the two support groups I belong to were simply awesome.
After a long natter with my Dr., he gave me the go ahead to start HRT....5th April '13 is my new birthday.
PaulaAnn

[CharleneT]

I'll be honest and too blunt, the idea of using HRT as a diagnostic tool for GD frightens me. Any physician or therapist who did so is just plain crazy. The diagnosis needs to be made prior to any hormonal therapy. Those involved need to be absolutely sure before moving onto a step like cross-gender hormonal therapy.

[noeleena]

Hi.

Im not a T S & H R T did not have any effect on myself from a Psychologicall , Mental or Emotionall point of view, regardless of type or dose rate, Sprolactin. was no more than a drink of water, like quite a few other meds my body just rejects them,

reason being , being interesex seems to run it's own course my own hormones worked better for what i was going through & any changes that took place were from them. .

The other point would be & i cant test it is because of being female how would they work H R T, or would it just be only the physical part of my body.only as to maintain my body.

As i have done some study on women in a test some 1000 women by a G P & there was nothing said about changes in the womens minds only how it helped in the lose of
Progesterone as women aged & went into menopause or the change of life,they needed H R t. to stablise there body's. & because of my age as well.

...noeleena...

[pose007]

From what I have read a well known Dr. in the UK, at Charing Cross, uses hormones as a diagnostic tool, but as far as I understand its more of a negative indicator. Meaning, that if you take hormones and you are not TS you will HATE the effect.
For me the effect was immediately positive. I stopped a couple of times because I got scared as in WTF am I doing. However, no way I could imagine life without them now. My system runs way better on them than off.

[Rianna Humble]

Not quite sure where you read that. I write from first hand knowledge and Charing Cross Gender Clinic will not even refer you to the Endo until two doctors have confirmed a diagnosis of transsexuality

[CharleneT]

Not quite sure where you read that. I write from first hand knowledge and Charing Cross Gender Clinic will not even refer you to the Endo until two doctors have confirmed a diagnosis of transsexuality

That is exactly what the docs in my area wanted as well.

[Kathryn Martin]

I think that cross sex hormone therapy is used for diagnostic purposes much more in North America than in other places in the world. I agree with Charlene that the idea is somewhat frightening. It is an outflow of so called gender therapists. Diagnosis is truly important even if the patient knows who they are.

[Tammy V]

In my case, I began using Spiro DIY for a couple months, because I got my hands on some right after I started therapy. Just the lower dose of Spiro alone had enough of an effect that I was able to quit an anti anxiety drug I had been on for years. The phsychological effects of full HRT, when I started, were magnifient and I even experienced a euphoric high for a couple months, before settling into a more relaxed and content person. Three months into HRT I quit smoking marijuana and I had been using that daily for about 31 years. So I have had a really good effect from the meds in the first 11 months and after 7 months on HRT I went full time, earlier than I was planning to. Living full time as myself and not faking any aspect of my life anymore had made me much more happy and content than just the effects of HRT alone.

I do think that therapists and doctors use the effects of HRT as a diagnostic tool and also use the experience of RLT as a diagnostic tool for GRS candidates. This would make it tough in a place like England, where you have to be full time before even being given meds. I guess that that scenario weeds out some people who would not be good candidates for HRT/transition but it makes it harder to get treatment.

[Marleena]

After a long natter with my Dr., he gave me the go ahead to start HRT....5th April '13 is my new birthday.
PaulaAnn

Congrats PaulaAnn! A good support group is a big help for sure.

This has been a good discussion so far.

[PaulaAnn]

Hi Marleena;Thankyou. I wish to say although I had to split from my wife and we both agonized over the decision ,it was the best solution for both of us.I started to live my new life as PaulaAnn 24/7/365 from that point in time.For me ,it was the right thing to do and made me feel like I now had found my place in life.It wasn't and will not be without setbacks,but I'm prepared......so I live and enjoy.
PaulaAnn