Fear of losing family and career at odds with hrt realities

[cdtraveler]

Well have been diagnosed as transgender and a candidate for hrt yet am struck by what I risk losing and pursuing this course of action. Have been diagnosed as severely depressed too and am not sure what kind of compromise there is. Sure wish there.was an "hrt lite" that could serve to lessen the neg feelings yet would hold off the boobs. Understand this is an impossibility yet believe once I started I would only crave a deeper integration. So.what th hell.to.do?!

[AllieSF]

As I understand it there is an HRT Lite, which is low dosage HRT, sometimes including a low dosage testosterone blocker like spironolactone and low dosage estrogen, sometimes only one of those. You really need to work with your gender therapist, hopefully they have adequate experience, and a transgender experienced endocrinologist. If your health permits it is not an impossibility. You just need the right experienced specialists working with you.

PS: Your physical results with low dose and even high dose HRT can vary a lot, giving you time to see if any of it helps you.

[Rianna Humble]

CDTraveler, based on what you write, you appear to value other things more highly that being congruent with your gender.

If that is correct, then starting transition would be a dangerous minefield for you.

There is no guarantee that you will lose everything, but unless you are prepared to do just that, then you will in all probability not be able to cope with the negative experiences that come with transition.

[Eemz]

I'm going to be fairly blunt: you don't really have a choice. I was depressed for years, so I'm saying this from a place of love and understanding, but if you have a chance to become a functioning human being again then you have to take it. The depression is telling you that it might make things worse. That's what it does. Depression tells you that every change makes things worse, so everything is pointless and hopeless. It's lying.

Staying severely depressed is not an option - you'll lose your family and career that way anyway. If starting HRT means you might start to function again then you have a chance. You might grow boobs. Big deal. You'll be alive and functioning which you're not now. Once your mind starts working again you'll be able to make real decisions about the future. The only decision you can make right now is to grab the lifeline.

[KymberlyOct]

I say this treading very lightly but IMHO humble being more emphasized than usual LOL.... anyway...

The concept of HRT lite doesn't seem like the way to go to me. I am sure I could be convinced in certain circumstances, but for the most part I think the real exploration needs to go on in your mind not a small change in the hormones in your body.

By the way starting on spirolactone really is basically HRT lite so if you really want to go that route spiro is an option.

But I think you are putting the cart before the horse. My suggestion would be to do the soul work first and the pharmaceutical work second.

[Kas]

I was in exactly the same situation as you. Had been on anti-depressants for about a year and things weren’t looking goodplus I have a fiancé and 2yo daughter too to make things just a little more complicated. My advice; Just do it. It’s easy to think of reasons why not too, but you can’t predict the future and you have no idea how things will turn out. Change is good and I recommend more people try it.

PS. Since I started HRT I no longer need my anti-depression meds and have felt better than ever before. If there are any problems down the track I will cross that bridge when I get to them.

[LeaP]

The very idea of “HRT Liteâ€� is based on wholesale misunderstanding of the roles hormones play in the body. Hormones are not Ã* la carte drugs whereby you can get a little of this and a little of that. You may or may not get a bit of this - or perhaps a lot of that - just as with full doses and on an unpredictable timeline. In the meantime, you are highly likely to screw up your system. (That’s a scientific term ...)

But that’s taking exogenous hormones. Solely taking down testosterone levels modestly can be often be done under medical supervision without risk. It may reduce gender-related issues in some. But then, so can a number of medications, when indicated, such as anti-depressants.

It can take years to appreciate the real effects of taking estradiol (as opposed to those from taking down testosterone). These effects should not be confused with those related to transitory mood effects, either - mood issues should not be confused with fundamental gender dysphoria. Some of these effects progress over long periods of time after becoming estrogen dominant and gene expression works its changes throughout the body.

If you want to guarantee against visible physical effects, don’t do anything to disrupt your natural hormone levels. Even the modest reduction of testosterone mentioned above may trigger some of them, including breast growth. Gynecomastia is a common condition.

[Jenny22]

By your post's heading, I gather that your family does not know of your being TG. Have you been TOLD by medicos that HRT WILL help to surpress your depression?? If you do begin HRT, your boobs will develop slowly. If your wife asks about same, it's GYNO to her. As many girls here use gaffes to hide their male parts, you can use compression shirts or Ace bandage wraps to flatten boobs when at work or as otherwise needed.

[kimdl93]

Ok, you have been labeled TG. And you have also been diagnosed with severe depression. The former may contribute to the latter, but it might be wise to address the depression first, through conventional medications and cognitive therapy before embarking on HRT.

Why? Well, for starters, you clearly need to be in a better place emotionally before undertaking a course of action that will have massive impacts upon your life and relationships.

[Aunt Kelly]

What Kim says is excellent advice. Sort out the depression first. That condition tends to color everything and is, in most cases, easily treated. When that's under control, you may well find it easier to sort out the gender issues.

I would not recommend HRT "lite", or HRT at all, until you are ready to pursue it for real. The notion that HRT has immediate psychotropic effects is a myth. That's not to say that the starting that journey doesn't have emotional benefits. Many report that it's just the act of taking that step that brightens one's outlook. Also, I wouldn't worry to much about obvious physical changes. They will come, but almost certainly in slow, small increments. With compression garments you will be able pass as male for a long time, to all but those who might see you without them.

[LeaP]

I also agree with Kim. Separately-treatable conditions (e.g., depression) should almost always be treated first. It’s not unusual for gender issues to subside or even disappear.

Kelly, psychotropic effects of estrogen are WELL-documented, including aspects of the underlying biology. (Like most things related to hormones, however, this is not a simple topic.)

I agree that simply starting hormones can have a powerful emotional effect, consisting of varying amounts of behavioral feedback and placebo effect.

[Jeri Ann]

Where are the psychotropic effects of estrogen WELL documented? I have searched and not found any documentation on the matter.

I often have found statements about the sense of well being and satisfaction that accompanies the initiation of HRT.

I also find well documented that estrogen may cause depression.

I really would like to see the documentation. If there is a preponderance, or even significant amount of documentation, I can't seem to find it.

[Lygophilia]

I'm on anti-depression pills and that's the first thing they've asked me if I had a history of depression so I can bring my pills and records from my behavioral health services in. If you have Rehabilitation Services in your area, then that's something you should look into. Mine in my state can re-open my case after I get out of therapy and get me jobs in my field that are transgender friendly. As for your family, I'd be prepared for the worse, if you know they will turn on you. Families are suppose to accept you unconditionally. For me, that wasn't the case, so it was easy for me to get rid of them. Fortunate that I don't have that kind of relationship with people.

[Rachael Leigh]

While I was not ever really at a point of depression once I began to take steps to do HRT I had to really consider what that
meant. I realized no I don’t need that to be myself. I’ve found a good place now being non binary and even though it’s
a bit of a hassle sometimes decided how I present myself at times I really think I’ve found a good balance. As far as my family I lost them anyway so I just move on

[LeaP]

A small sample, from multiple angles:


https://www.ncbi.nlm.nih.gov/pubmed/15094854
https://www.sciencedirect.com/science/article/pii/0149763486900291
https://www.ncbi.nlm.nih.gov/pubmed/4055718
https://www.karger.com/Article/Pdf/61372
http://www.anapsid.org/cnd/gender/genderdrug1.html
https://www.springer.com/us/book/9783211404850
https://en.m.wikipedia.org/wiki/Effects_of_estrogen_on_schizophrenia
http://file.scirp.org/Html/6-3900062_17723.htm
https://www.sciencedirect.com/science/article/pii/0378512279900215
http://www.jneurosci.org/content/31/14/5286
https://www.researchgate.net/publication/268034296_Clinical_psychotropic_effects_of_gonadal _hormone_medications_in_women
https://jnnp.bmj.com/content/74/7/837
http://www.smartcarebhcs.org/important-drug-interactions-between-psychotropic-medications-and-contraceptives/
https://ajp.psychiatryonline.org/doi/pdf/10.1176/appi.ajp.159.7.1225



Plus a sample of references re: estradiol and mood:



https://www.spandidos-publications.com/10.3892/mmr.2015.3942
https://link.springer.com/article/10.1007/BF02088099
http://journals.sagepub.com/doi/10.1177/1099800407305600
https://core.ac.uk/download/pdf/41240740.pdf
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3753111/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4330961/
https://www.ncbi.nlm.nih.gov/pubmed/17909167
https://openarchive.ki.se/xmlui/handle/10616/44290

[Jeri Ann]

Lea,

I had already read most of these studies. Did you? These well documented cases deal with post menopausal and post partum women, women with psychiatric disorders, mental patients and elderly people with dementia.

In fact, two of the studies conclude that estrogen inhibits the effectiveness of depression medications.

The pharmacology sheet that comes with my Estradiol says that Estradiol may cause depression.

None of these well documented cases pertain to MTF transsexuals experiencing psychotropic effects from estrogens.

Again, I am open, but still have not seen any reputable studies that have reported that estrogen has a mood altering effect on transwomen.

[Laura912]

Lea, your references are scientific sources but not applicable directly to the psychotropic effects of estrogen. Some extrapolation is required to connect the dots. That is my humble academic opinion.

[LeaP]

I have read some of these, but by no means all. I’ve read many others.

I never mentioned transwomen. The fact that there has been little to no focus on trans people should surprise no-one, least of all you. The articles on menopause, dementia, schizophrenia, etc. are to support my comment on the complexity of the topic, e.g., by touching on topics like progestin interactions, level changes, and related systems. Yes, estrogen can cause depression as well as treat it! Both are illustrations of psychotropic effect.

Regardless, the point of the multiple cites is that psychotropic effects are abundantly documented, studied, and frankly, obvious. A revolution in ER research started in the 80’s and 90’s as different types and locales of E receptors in the brain have been discovered and estrogen is known to affect a variety of neurotransmitters, including serotonin and dopamine, both of which affect mood. ERbeta research has focused on non-reproductive behavior effects. Finally, estrogen plays a role in mediating neuroplasticity - and in the areas of the brain (such as the amygdala) known to be affected by cross-sex hormone administration. And, of course, sexual dimorphism in the brain IS due to sex hormones not only in development, but throughout life.

In closing, I should mention that not only trans-women rarely studied for anything, but much hormones-related research is animal-based. For estrogen research, a lot of that is in female rats and mice! Nonetheless, I’ve come across the odd reference to cross-sex splice experiments and mutant study in animal populations, too. I’ll post them when and if I come across them again.

Laura, estrogens are not psychotropic drugs in the current classification scheme. For commentary on classification issues, see: https://europepmc.org/articles/pmc4919951 While the classification of psychotropic medications is restrictive, the definition of psychotropic itself is exceedingly broad: “Capable of affecting the mind, emotions, and behavior” (MediLexicon). In short, a given drug may be psychotropic but not classified as such. No dot connecting required.

[elizabethamy]

After a handful of months on HRT (not lite), one thing I know is that lowering the T level (I'm down from the mid-400s to a little over 100) can, among other things, make you super tired. My E levels are still low, so functionally I'm like one of those guys in the ads for the Low T clinic. If spiro alone is the trans woman idea of "HRT Lite," I submit that it's a terrible plan. Like many others here I have had depression and taken pills for it for a long time. Transitioning is making me less depressed, but everyone's different, and I wouldn't discontinue any meds or any treatment until you know that you don't need it and that the causes have been addressed.

Having said all that, and wanting more E and higher levels, I'm liking the subtle facial changes, the growing hair on my head, and the softness of the skin...none of it is pure magic but taken together it's like a slow-moving miracle, for which I waited years, and I would caution anyone to not wait that long, but do take your time to get it right for yourself!

[Aunt Kelly]

Laura, estrogens are not psychotropic drugs in the current classification scheme. For commentary on classification issues, see: https://europepmc.org/articles/pmc4919951 While the classification of psychotropic medications is restrictive, the definition of psychotropic itself is exceedingly broad: “Capable of affecting the mind, emotions, and behavior” (MediLexicon). In short, a given drug may be psychotropic but not classified as such. No dot connecting required.

I should have stipulated that we were talking about transwomen, because, as we all agree, the literature on that is far from conclusive. Even so, (and feel free to jump in here, Laura) extrapolating that the effects documented in your citations (several of which are far from conclusive themselves) translate directly to MtF transsexuals is quite a stretch. In at least one case, the literature documents physical changes and attempts to correlate that with subjective findings, vis a vis emotions. While that's an interesting finding, it is not at all the same as a psychotropic effect, which typically has a prompt effect on brain chemistry. IIRC, more than one source (including the very first one listed) states unequivocally that estrogen alone (again, in post or peri menopausal women) not an effective antidepressant. The next article discusses some interesting effects on the basal ganglia, but seems to be focused on the study of the efficacy of using estrogen to treat extrapyramidal disorders. Again, interesting reading, but related to the MtF poplulation in only the most tangential ways.
I could go on, but I've no desire to shoot holes in your case. I just want it understood that there is not any compelling body of research on the supposed psychotropic effects of HRT in the the MtF trans population. Furthermore, I do not dispute what many of my sisters here have experienced, but such evidence is anecdotal and does not carry any of the credibility that a proper clinical study would.

[LeaP]

All estrogenic activity in the brain is chemical and limiting the meaning of psychotropic to affect only is misleading at best. Many drugs firmly in the psychotropic sphere take time to take effect (some weeks or months) and for a variety of reasons. No-one disputes the psychotropic effects of SSRIs, which are classified as psychotropic drugs, and they typically take 30-60 days to take full effect. Serotonin reuptake is inhibited, more is available, depression lifted (for those with that specific issue). Consider also that the exact mechanism by which reuptake is inhibited isn’t known and that SSRIs are no better than placebo with mild depression. None of which invalidates SSRIs as psychotropic. Segueing to hormones, E2 has a major role in the regulation of serotonin.

What I’m reading is researcher after researcher, paper after paper, study after study on the effects of estrogens on mind, mood, cognition, memory, and behavior as well as uses in psychiatry for the treatment of illnesses including depression and schizophrenia. Virtually all acknowledge the complexity of estrogens’ roles in the brain and that there aren’t the 1-1 cause and effect relationships that I believe you are seeking.

Some objections, such as those regarding estrogen causing depression as well as alleviating it in some circumstances, speak as much to misunderstandings and lack of knowledge regarding the etiology of depression as they do anything else. Yet that estrogens play a role is clear, even if it’s not knows under exactly which combinations of circumstances, co-morbidities, interactions, etc.

For a good overview article on a host of related topics (specifically including complexity issues mentioned above), see: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3753111/

I fully acknowledge the lack of materials regarding cross-sex hormones administration. Unfortunately, that’s par for the trans course. I also acknowledge that most research is focused on menopause, the elderly female, and specific illnesses in women. That’s also par for the course as most medical research centers on change, disruption, illness, mutation, etc. as they give clues as to mechanisms, besides attracting funding and generating political benefit.

Alas, trans people haven’t the numbers, the money, or the support. While I would expect that not all existing female-based research would be relevant to the masculinized brain, whether or not cross-sex hormone administration is involved, to term any and all such possible relevancies a stretch is well, a stretch. Huge forest. Lots of trees ...

[EDIT - On Topic]

There is an on-topic item in all this, and that’s the role that estrogen appears to play in fear conditioning and learning. There is a specific gene involved - HDAC4 - that, when compromised genetically or by low E, compromises the ability to recover from trauma, including PTSD. Again, all female-based research!

Fear, of course, as well as the learned behaviors and co-morbidities such as personality disorders and social issues that many trans people experience, is one of the largest sources of dicussion in our little world, including the OP. And it’s interesting that fear so noticeably subsides in so many after starting hormones. Is the research applicable? Who knows. No information is no information ... not a confirmation of the lack of applicability.

Jeri, all my commentary is in the context of transsexuals. Discussion of the limits, problems, methods, conclusions, and applicability of research between populations are all fair game. I think this has been a really interesting discussion. If nothing else, it should alert some here who think otherwise that taking hormones is a life-changing decision not to be taken lightly. Just as I agree with the consensus that hormones have psychotropic effects, I also agree that there MUST be issues of difference and applicability in a cross-sex context. When you take cross-sex hormones, you are entering the void.

Or, as we like to say here - YMMV.

[pamela7]

erm, anyone who has been a teenage boy going through puberty, anyone who has raised teenage boys knows the T has a considerable effect/shift in the mindset, with lovely young playful things turning into dangerous drivers with no thought for others. And the hormones on girls too has effects in puberty, for sure.

So, the psychotropic effect of hormones is there to be seen. Then you take away the T, and of course there is the complementary effect on the formerly male body. It does not need studies by academics or medics for us to know this to be true.

If the depression is a consequence of dysphoria, then treating it first is pointless, and if the depression goes as a result of hrt then great. I'd suggest hormones less dangerous than anti-depressants anyway.

Anti-t only would suppress the T, maybe help the depression and not grow boobs, as that then requires the E. Is this not worth a try for the OP?

[LeaP]

Well, Pamela, perhaps that depends on how you define dangerous. Even if hormones are less dangerous - and I don’t know that that is the case - physical danger from taking a drug is only one dimension. There are risks and issues with NOT taking them also.

Your closing statement is a little ambiguous. If you are saying that simply lowering T will not risk breast growth, you are wrong. You are correct in saying that E is required, but the male body has sufficient in the face of lowered T to trigger breast growth. Gynecomastia is a listed (possible) side effect of anti-androgens. In fact, gynecomastia from hormone balance issues can happen from so many causes that 1 in 4 males over 50 have it, according to the Mayo Clinic.

[Rianna Humble]

OK folks, we have got about as far away from the OP as possible. I have tried to let the thread take its own course, but now it is time to say night night to the thread.