Ten things I wish someone told me when I started HRT:
You can get hormone therapy in the United States without undergoing a long evaluation period or undergoing a ‘real life test’ if you seek out an ‘informed consent’ doctor or clinic. I waited over a year before seeking hormones because I did not want to place myself at the mercy of a mental health professional and I did not want a doctor ‘diagnosing’ my gender. Which brings me to…
They’re going to diagnose you anyway because they need an ICD code to bill your insurance company. I was furious when I found the diagnosis on my medical chart. It would have helped a lot if the doctor had asked my permission or explained that it was for insurance billing purposes only but he didn’t.
Hormone therapy drugs bought from overseas pharmacies are safe and will not cause ‘legitimate’ clinics to refuse treatment should you later decide to switch to a prescription. At the time the information I was able to find talked a lot about how trans women who use ‘black market’ hormones are not to be trusted and that a trans woman who uses such medications should be denied care until they can prove themselves ‘trustworthy,’ somehow. It is a lie.
There is absolutely zero evidence that injectable estrogens are more effective than oral estrogens. The fact is that the ‘advantage’ attributed to injectable estrogens is almost certainly placebo (and injectable placebo is known to be much more powerful than one administered orally). I could have saved myself a lot of discomfort and a serious leg injury caused by an improperly prepared injection.
Properly dosed, there is no reason that sublingual estradiol should be more effective than oral estradiol. The only thing that matters is that enough estradiol enters into your bloodstream and that is something that will be reflected in your labs.
Transdermal estradiol patches are itchy, smelly affairs that cost quite a lot of money and refuse to stay on. Knowing what I know now I would have avoided them entirely.
When I started hormone therapy my endocrinologist gave me conjugated equine estrogen because it came in smaller doses than 17β-estradiol. I was kept on conjugated estrogen for some time under the pretense that he was making sure I didn’t have any bad reactions to being on estrogen. Knowing what I know now I would have been able to argue that conjugated equine estrogen has a much worse side-effect profile than 17β-estradiol and that placing me on this drug unnecessarily endangered my body and my transition. Furthermore, the smallest doses available were far below a healthy dose needed to maintain bone and emotional well-being. Done again I would have insisted that I be started on a reasonable dose of 17β-estradiol.
Low progesterone is implicated in poor emotional health in women. Micronized progesterone is valuable to trans women for maintaining a healthy level of progesterone. I’ve personally benefited a lot, emotionally, from having it and I just wish I started using it sooner.
I wish someone had encouraged me to seek out other trans people as friends. At the time I first came out I didn’t really know there were other people out there that could really help me. The only thing I knew about being trans was what I was able to read online and in books and most of that firmly emphasized the idea that you should transition until you’ve had surgery and ‘pass’ and then disappear and that the people who ‘hung around’ the community were somehow failures. I know that’s not the truth, now, but it really messed me up early in my transition.
I wish someone told me to be cautious. I wish I was told that doctors and mental health professionals aren’t the last word and that if one decides that you’re a ‘failure’ or ‘actually a man’ it’s them that is wrong and not my own instincts regarding who I am. I also wish someone had given me a gentle nudge that some of the people I would meet in the trans community are not to be trusted and do not have my well being at heart. I feel that knowing those two things coming into that experience would have saved me a lot of grief.