ii wanna start with htr, but im kinda scared !

[nattyfan]

i really wanna do it, but im scared

[lesliecleves]

Sure it's all scary. I recommend first some quality sessions with a qualified therapist. Good dialog works in your favor. And time is on your side.

[LeaP]

Why?

So far, all anyone knows is that you are a bored crossdresser (post #1). Just for fun, let's assume that's true. That would make it… A. Really. Bad. Idea.

[DebbieL]

Good. It would be a bigger problem if you weren't. Normally, before the doctor starts you on HRT, they want you to have at least a year of living "full time" as a woman. This is called Real Life Training or RLT. This may be 24/7 or more like 120 hours/week, so all time excluding time at work. Furthermore, a therapist will usually want to make sure that you have structured your life to work during and after transition, this would include having your career or school arranged so that you can transition safely. For example, if you were in a boy's military school, that wouldn't work. Often, the therapist will encourage you to check your own company's diversity policies, and if they do not protect LGBT (all for letters) people, then they may encourage you to find a company that will. If you work in a man's field, such as unloading ships, you would have a harder time. But then again, would that really be a career choice for someone who wanted to be a woman the rest of their lives? Depending on what you have already done, how you have already organized your life, and how much RLT you have already had, you could start HRT in as little as 6 months after going "on record".

Even when you start HRT, the doctor will usually start slow and build up. Sometimes there will be an injection to stop your body from producing testosterone, as well as pills to be taken daily. Sometimes the doctor will wait a month before starting Estrogen to see how much Estrogen your own body produces once your testosterone is shut down. Some intersex males can produce quite a bit because they are actually part female. Then the doctor will start you on low dose estrogen, usually orally, to see how you tolerate that. He will check liver and kidney function as well as estrogen and testosterone levels as well as other proteins that will indicate whether you are reacting well to the pills. The dosage may be increased, and may be supplemented with injections on a monthly basis or just the oral, depending on the pace you want. There are limits. Too much oral estrogen can cause liver and kidney damage, so the doctor will switch you to patch or injections at the first sign of trouble. Often the estrogen will be combined with some form of progesterone.

Depending on your body, it may take anywhere from 3 to 6 months to start seeing any dramatic results. The first thing you will notice is unusual calmness. This is the antiandrogen stopping your body from producing testosterone. Budding starts around the first month, along with crying jags and mood swings. Within 3-6 months, it will no longer be possible to hide your breasts, and you would have to have surgery to return them to normal. By the time you get to a B-cup, you will already be living 24/7 including work, as a woman. You breasts can continue growing for 2 years or more, often frustratingly slow. You will also notice that you have to manage your diet and exercise more carefully, because it's easy to gain weight if you don't.

How much benefit you get depends on your age. If you are younger, you will find your natural hair getting thicker, finer, and longer. If you had a beard, you will need laser and/or electrolysis to get rid of it, but when you wax your arms, legs, and whatever needs waxing, you will find that very little grows back. Have a professional do it for you if you can afford it. Full legs are about $60 and full body is around $100, well worth the investment, since you will want to stop if you try to do it yourself. If you have a girl-friend who is helping you, then she may be willing to do it for you as well.

Keep in mind that at this point, the process is not reversible. If you decide that you want to go back to being a boy, it will take surgery for breast reduction.

The other thing you need to be prepared for is the changes in your boy parts. They will shrink - a LOT. You won't be able to have erections and won't be able to have intercourse or top. On the other hand, your breasts will be more sensitive and you may find that with the right stimulation, you can have multiple orgasms - even without erections. This is one of the reasons the doctor is likely to start you on the blockers first, then add the estrogen later. Most of us don't have much fondness for the things between our legs, especially since it has blocked us from being accepted as girls all these years.

You also lose a lot of your upper body strength, if you had much to begin with. You will find that you need to adjust for the change by how you lift things, and you will find that you do need help with heavier objects.

This is serious business, and the RLT is designed to help therapists and doctors distinguish between a cross-dresser who just thinks he wants breasts, someone who really needs to transition. When you have to wake up an hour earlier to get ready for work (make-up, wardrobe,...) and have to deal with the looks you get from guys you don't know, you will have moments when you start to think you really might be crazy, but then you have some nice looking man hold the door for you, or help you with your bag, or a really attractive man gives you a sweet smile that says you are beautiful to him, and you know - it's either very right, or very wrong.

I think the hardest thing to get used to was the reactions of women. As a male, and a pretty looking male, I would get lots of smiles and looks and flirts from women. As a woman, most women ignore me, some are even a bit hostile, other are friendly but more aloof. A few give me the flirts but in a very different and more subtle way. On the other hand, I gave lots of women friends, and we tend to hug more, laugh more, even cry more. I'm still married to my second wife, and we love each other more than ever. It was a good thing I told her about Debbie before our first date, because when I did decide to transition, after a short period of freaking out, she has been a wonderful ally and partner. She can see how much happier I am, how much more I want to please her, and we have structured things so that Debbie was accepted at work, by her family, and at church. In fact, a month before I went full time to include church, women were coming up to me saying "I can't wait to see you in a dress". Now, I still sing bass in the choir, and the robe covers my wardrobe, but I frequently get compliments on my hair and once I'm out of my robe, on my outfits. Most of the people in my life have completely accepted me as a woman, and I am happier than I ever could have imagined.

I'm glad I followed the WPATH guidelines. I was impatient when I first started to transition, and I wanted HRT immediately and breasts as fast as I could get them, but the more gradual approach gave me the time I needed to structure my life so that it worked more successfully. Ironically, the hardest time was the period when I was Debbie everywhere BUT work. I had gotten to the point where I was wearing nail gel, earrings, and had removed most of my facial and arm hair with waxings and laser. It was impossible to hide that I was in transition, and I was struggling to pass as a boy.

The irony is that I eventually found out that I never really passed as a boy. After transition, I went to my high school reunion as Debbie, and girls who had known me since second grade were coming up to me and saying "we always thought of you as one of the girls". Some of the boys who knew me that long said "We called you a Sissy because you were so girly, but you really were a girl even then, weren't you?". Even people from the church I grew up in remembered me being such a feminine boy that they figured it wouldn't take hardly anything for me to be a girl. All those years, I thought I had kept my secret so well, and yet about the only person who didn't know they knew, was me.

I've had a good life as a male, but I'm having an even better life as a woman. I don't have to struggle to maintain the mask of Rex anymore, I can be silly, but I can share real feelings of happiness, sadness, joy, love, and grief. I don't have to hide anymore. For me, HRT was well worth the effort, and I would rather die than go back.

[Aprilrain]

Don't be such a wet blanket Lea, what could possibly go wrong? I say go for it!

[Karolyn]

Debbie, thanks for your long and detailed post. Even if I already know a large part of it thanks to this forum and people's experiences, having such a nice summary of your experience was great and giving me confidence. I should get the HRT prescription sometimes next week.

nattyfan, if you are scared, just go to a gender therapist. I had a great experience with mine, and if you find the right person (not a standard psychiatrist, you need a gender specialist), they will be able to analyze why you are scared. I was scared of some parts, and I needed to know if it was really what I wanted, and her help was priceless, I have most of my fears gone thanks to those sessions, and she ultimately wrote the HRT letter. Definitely a good starting point.

(and April, I did read the entirety of Debbie's post, it is a very good read when you are close to starting HRT)

[Rianna Humble]

You are right to be scared. HRT is not some kind of designer drug that you take to alleviate the boredom that you spoke about in your other thread.

Before you even consider taking this kind of medication, you need to be very sure about who you are. So far the only information you have given anyone on these forums is that you are a bored crossdresser who wants (for reasons not disclosed) to start HRT. This makes it very hard to offer you the right level of support.

[I Am Paula]

DebbieL- Where does a Dr. require RLE before starting HRT? I thought that was last century, in very unenlightened places.

[Karolyn]

From the info I have, the RLE was required by the DSM-4, and that requirement was removed in the DSM-5, published in 2013.

[LeaP]

DebbieL- Where does a Dr. require RLE before starting HRT? I

There is no such requirement. Not even any current standard of care and not in practice. This gets posted and reposted and reposted despite having been thoroughly discredited. WPATH's SOC 6 had discussion points on one – repeat, one – possible eligibility criteria for hormones being real life experience, but it allowed for therapy to substitute for it. If you don't read the entire text, it is easy to come to the conclusion that RLE was required.

Natty, I see your first post is gone! I'm not sure … Some revisionism, perhaps?

April – you're right. Just like popping aspirin. Everyone knows how simple body chemistry is!

[Jorja]

Good I am glad to hear you are scared about taking HRT. The body chemistry is nothing to play with. It is serious and can make permanent irreversible changes to your body. However, if you are certain this is a course you need to take, be sure you are monitored by a doctor. As to the RLE requirement, it has been eliminated. I personally feel this is a mistake but I am not a doctor or a psychologist.

[Zooey]

While I'm happy that the RLE requirement for HRT has been dropped, as I would prefer not to transition at work before certain changes have started to take effect, I have to agree with Jorja a bit here. I'm VERY happy that I've transitioned in my life outside of work prior to beginning HRT, for a few reasons.

First and most simply, living the important half of my life as myself has reaffirmed my desire to move forward despite the consequences. It's also brought those consequences into stark relief, and forced me to consider them deeply. I deal with most of them every day - I think it'd be too easy for me to ignore them if I wasn't in that situation.

Second and (in some ways) more importantly, it's given me a perspective on HRT that I really appreciate. I'm comfortable living my life outside of work as a woman at this point. I'm not expecting HRT to help me pass - I'm expecting it to help make me a bit more comfortable with a few issues I have. Chiefly, that I dislike not having any sort of natural chest. Breast forms and enhancers feel costumey to me, and I hate feeling like I'm wearing a costume. I ditched wigs as soon as I could, and I'll ditch those little silicone *******s at the first reasonable opportunity.

Everybody takes their own path, and I'm really not judging AT ALL, but I do worry sometimes that people who start hormones before getting comfortable with living as their proper gender are putting too much faith in them to do things that they'll never do. So while I don't think a full-time RLE should be required for hormones, I do think there's a lot of value in learning to be comfortable with living your life as yourself as early as humanly possible in the process.

[LeaP]

RLE was dropped as a hormones requirement because it was considered cruel to compel someone to socially transition without the benefits hormones bring. This reasoning resonates strongly with me. I can't overstate enough how much my thinking clarified. (I'm not talking about emotionality here. Also I do recognize that this took months.)

RLE itself may be on its way out even for surgery. There have always been some exceptions, particularly for those whose cultures do not allow social transition prior to surgery. It is not unusual for therapists and doctors to clear patients for surgery with less than our year when they are older. Finally, it seems there is no evidence for RLE's efficacy. I will admit to having concerns over its potential disappearance, but that may be because I've invested too much in what amounts to an urban myth. (Albeit one with a history.)

[celeste26]

At some point RLE is important prior to making completely irreversible changes like surgery. There is no point at all offering surgery unless a person can live in the other gender. There might be rare exceptions so the rule must not be too tightly drawn but lets face it most candidates want that experience for the rest of their lives anyway and giving it a 'tryout' is not some horrible thing just to make sure. For someone who has literally hidden in a closet for most of their life, it can be traumatic.