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Are These Hormones Even Working?

The agony of waiting to see the effects of hormone replacement therapy in “The Weekly Rant” with Mila Madison.

Why does it feel like we are always waiting? As transgender people going through transition, it seems as though we have to wait in line for just about every step of our journey. Six months with a gender therapist just to get a letter to see an endocrinologist. Finally, you get the letter and have to wait even longer for the doctor’s next available appointment because they wouldn’t book you prior too having the letter. If you decide on any kind of surgery, it could be years before a good surgeon has an opening. Oh yeah, and you are going to need some more letters for that as well; that is if you have the money or the right insurance coverage.

There are a million hurdles and forms of gatekeeping that you have to go through in order to be who you are. I get it; there are standards of care. It would be easier to digest if they had such standards for cisgender people. A cisgender woman doesn’t need therapy and letters in order to have their breasts enhanced or have gastric bypass surgery. Believe me when I tell you that if there were a surgery available to make you “not transgender” the procedure would probably be available at your local Walmart, no therapy or letters required. But I digress.

I remember the day I finally met with the endocrinologist and I received that first shot of estrogen. All the waiting had led up to this moment. I was on my way. The experience in the office was strange; it was unlike any doctor’s appointments I had been to before. This doctor was supposed to be one of the more experienced endocrinologists in my area when it came to hormone replacement therapy for transgender patients. To be honest, the whole thing felt like we were doing something illegal, and I didn’t feel confident that this doctor really knew what they were doing. It would be something I would end up encountering every step of the way in my journey, but at this moment I was elated. I finally received my first shot.


It was probably in my own head, but within hours I felt different. I was euphoric, excited for all the possible changes that could occur that I had been hearing about. I took to estrogen like a fish to water. For the next three months, the changes were amazing. My face started to change, and my body started to shed some of those “masculine” traits that gave me so much dysphoria. Next came the chest pain, no I wasn’t having a heart attack, my breasts were beginning to grow. It was as if the person I suppressed for so many years was now bursting out of me. “Why didn’t I begin this journey earlier?” I thought to myself. Finally I was going to see “me” when I looked into the mirror. I was the happiest I had ever been. It was amazing, until one day when it all came to a screeching halt.

Nothing. Nada. Zilch. Zero. Here I was, three months in and nothing was going on. Suddenly, I found myself waiting again. I should have been grateful; many transgender people would later tell me their experience was the opposite. Many felt no changes at all in the beginning. Here I was doing so well, and it all seemed to just stop. I thought it had to be the endocrinologist, they didn’t have my levels right. I ended up changing doctors anyway after hearing some transphobic things they were doing at their office. The new one was nice, but she did not like shots, so it was pills from there. Those little blue green wonders. We would start with a new dosage and over the next six months to a year we would be modifying it with each blood test. Any increase in estrogen would have to be fought for on my part, and she was taking me on and off testosterone blockers as my levels seemed to never be right, either nonexistent, or a little too high for a woman. Still, the whole experience with the doctor had a backroom feel to it. I was again convinced that nobody really knew what they were doing.


I learned over time my experience would never be like those first three months. What I did learn was that the major changes would come in spurts. I now look forward to that chest pain when it does happen. In those moments, I know something is going on. The problem is that we see ourselves every day, and we often don’t notice our subtle evolution day in and day out. I guess that is why some people document their transition with daily, weekly, or monthly photos, just to see the changes. The same goes with people who you see every day. They may not notice the subtle changes. In reality, it does not mean that they are not happening, but I often find myself getting impatient.

There are many factors involved. Genetics, your hormone receptors, age, and so on; they all affect your results on hormones. I have learned to deal with the lulls that occur. Just when you think nothing is happening, you wake up one day noticing some changes. Nothing in life is a straight climb. I am now on my third endocrinologist, and I am still fighting to try and get the best care possible. It still feels like a backroom deal, and I often find myself having to educate the doctor. We argue about progesterone, which many transgender girls swear by, but I can’t find a doctor willing to prescribe it. I also find it strange that they often point out concerns about “male” bodied things such as prostate cancer and not breast cancer. There is still a stigma attached to the experience. I guess it will always feel like some sort of science experiment that I am going through. I will keep hoping to find a doctor that actually gets it.

In the end, hormone replacement had a profound effect on my transition, even if the process could have been managed better. With each day, I see more of myself in the mirror. Over time, I still see parts of my body change, and that is a good thing. I still go through the lulls as well. Looking at old pictures, I can see how much my face has changed, even my nose. I have more curves in the right places and way less body hair. I am two inches shorter than I used to be, though they say it is actually due to changes in the muscles and spine. My feet are even smaller. My stomach, which I thought would always look masculine, is now even starting to look more feminine in shape. None of these changes happened overnight, but I am glad they happened. So if you find yourself wondering, “Are these hormones even working?” I am sure in many ways they are.

We all experience different results. Some of us have to fight with doctors to get it right. Some of us use informed consent and go it alone, but I recommend using caution if deciding to do so. Not having the right levels could be dangerous. Make sure you do your own homework when it comes to your own transition regardless of how you go about it. Either way, we will often find ourselves waiting in some shape or form, and often wondering what will come next. It is all part of the journey.


“Are These Hormones Even Working?”

LOL, looking at the first picture, the hormones are working.

Gender euphoria. We've made the decision and now we want it all. And not tomorrow, today. Coming down off that high can be almost as debilitating as dysphoria.

The lulls are the most painful but the benefits are so much greater, I feel and think better each day even with set backs and delays. The one thing I could not agree more with is the cis gender section "... their breasts enhanced or have gastric bypass surgery...". I cannot believe that ICATH does not have more traction than WPATH, especially given how the FTM are treated the same as MTF when the experience is so wildly different in this culture for the MTF. Like you said, it is part of the journey, I am sure the journey is better now than it was and will be better for those that follow us as well.

I started transition at 56 so I was never going to change much and what change there is will slow and minimal. But I did change and I am still changing. I have found that good skin care, using face creams, cleansing well and a good diet all go towards a softer and more feminine face. I did a lot of weight training and adventure sports when I was younger so my body will always be athletic (muscular) but at least I have well shaped legs. :)

@LeeAnne I agree with you. It can be just as debilitating. Euphoria to dysphoria sometimes seems like a daily back and forth for me.

@meenow it is never too late to be who you are. I am glad to hear you are having positive effects from it. One thing I can say about estrogen is that it keeps us well preserved lol.

I agree... I am an older woman l started late. First few months it felt just incredible. I kind of laughed at the whole fish to water in HRT mode part... so true. But now I feel I struggle that is taking so long. I realize my breasts are going very slow but I also realize my breasts are coming from all the way from the sides under my arms and I can see they're going to be huge. This makes me very excited and more patience because I feel it takes a long time if they're going to be this big. I know it's not the right thing to say because everyone transitions at a different speed and time. But sometimes I become so frustrated because I look at my friends and I see the amazing changes and then I look at myself and I'm wondering is it going to start? It's been 30 months and for the longest time I felt like that not much was changing. But life has been changing and every now and then I catch myself in the mirror and I just stand there and smile and grin from ear-to-ear and think to myself.... you go girl! Because for that fleeting moment I'm actually starting to see change and I'm pretty happy about that. My first 30 months of breast growth was not spectacular I'll agree. But I am seeing changes now so maybe I'll just believe that I'm a late bloomer!

I have a doctor that's great so I don't have a complaint there. She takes the time to explain things to me and we have a great relationship. I probably take far more estrogen than most girls but my body loves it and I never really have had any issues with it. I take a lot of blockers compared to most as well but my numbers are extremely low almost non-existent and this makes me very happy. With SRS coming in the upcoming months I know it's going to get even better.

I love who I have become!! I wouldn't change it for anything! I'm the happiest I've ever been. I only wish I would have done it sooner!