Episode 7: Hormones and Hormone Replacement Therapy
In this episode we talk about Hormones, Hormone Replacement Therapy (HRT), who takes them, and some huge surprises I had on HRT.
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Hello and welcome to another episode of Valentine’s Voice, the educational and hopefully entertaining show hosted by me, Valentine Valcourt. Apologies for the delay in getting this out, finals for this semester were especially trying and it is definitely the cause for me getting behind writing and recording this episode. As promised in the last episode, we will be discussing hormones today! For this episode I would encourage you to comment below if you have any questions about hormones or if you are transgender and have had any crazy HRT surprises!
Hormones are chemical messengers that coordinate different functions in your body. While Hormone Replacement Therapy, or HRT, generally refers to sexual hormones, it’s important to realize that there are a LOT of medications that help us regulate our hormones. Examples of other hormones that we have medications for are: dopamine, serotonin, adrenaline, insulin, and cortisol. They help people with conditions like depression, anxiety, obesity, diabetes, thyroid disease, and PMDD. If you don’t have a problem with those conditions being treated, and do have a problem with transgender people getting their hormones, then to quote Uncle Iroh, “It’s Time To Look Inward And Start Asking Yourself The Big Questions.“
When we talk about HRT for transgender people, we are talking about estrogen and testosterone. The estrogen and testosterone that transgender people take are bio-identical to what cisgender people produce. Transgender people also aren’t the only people who take estrogen or testosterone as part of an HRT regimen. Cis women who go into menopause early and cis men who have experience testicular cancer are just two other times estrogen or testosterone HRT are used, but pretty much anything that messes up hormone production in a cis person can also require HRT.
For transgender women, the goal is to reduce testosterone production or block the receptors for testosterone and to add enough estrogen that our blood levels are within the cisgender range. This is generally accomplished with a pair of medications, estrogen, obviously, and a class of medications called antiandrogens. For me personally and for most transgender women in the US, this is spironolactone, more commonly called spiro. For transgender men, testosterone blocks estrogen production enough that they don’t need to take any kind of estrogen blocker. Non-binary people take whatever combination of these medications they need to sync their physical characteristics to their mental identity.
While the testosterone blockers are all pills, there are a variety of delivery methods for hormones. There are pills, lozenges and troches, gels, patches, injections, and most recently subcutaneous pellets. There are wide ranging and intense debates over which way is best. I would urge you to do whatever works for you. I do injections because I don’t do well remembering to take daily meds. In some places injections aren’t available and some people are scared of needles. Just like with any other condition and its accompanying treatments, there is no one size fits all solution.
Concerning what these hormones actually do, I’m only going to talk about transgender women, I’ll save non-binary people and transgender men for their specific episodes because I have no personal experience there.
Just to remind you, we’re talking about someone taking two or three pills a day or doing an injection every week or two. It seems like such a minor change, but the changes are major, and I’m not just talking about the physical stuff. Prior to starting HRT, I was full of angst and anxiety. Within a couple weeks of starting, I was happier and more at peace with myself than I had ever been in my life. I had people passive aggressively reminding me that I could be permanently changing myself, and all I could respond with is ‘well I hope so!’
The physical changes take longer, but are just as dramatic. The most dramatic change sounds the most mundane. Fat redistribution. It sounds like something that a bad exercise machine ad would promise. Target belly fat these three easy ways! What it really means though, is hips, butt, and boobs. The shape of the whole body changes! My silhouette prior to transitioning was something akin to a rectangle. It is now a much more satisfying hourglass. There was also a super cool change that no one told me about that I’ll get into later. Your skin also softens, body hair thins and its growth slows. I also went from having super oily skin to moderately dry skin. This is all due to the actual composition of your body changing. Due to this body decomposition you will also lose muscle mass. I was a gym rat prior to transitioning, and I can tell you that the change in strength is dramatic. Anyone who thinks trans women have some massive edge in sports just needs to watch me try to get the lid off of the pickle jar. Libido definitely dropped off for me somewhat. Some trans women counter this by adding progesterone into their HRT mix. Progesterone also helps some women accelerate the fat redistribution phase and increase breast size. Hormones are crazy things.
I’m not gonna get super into genital changes here, I might do a write up or maybe throw that into a Patreon video whenever I get around to actually putting extra stuff into my Patreon. The short and kid friendly version is that everything slowly shrank. There were a ton of changes that no one told me about prior to transitioning, and while some of it seems obvious in hindsight, in the moment I promise it was mind blowing to me.
The first big change that felt like it came out of nowhere was that how my body smelled changed dramatically. I went from smelling like a dude to smelling extremely feminine within a week or so. Right after that I had another change that I hadn’t anticipated: I was cold, all the time. I went from being able to wear a light jacket through all but the coldest of days to not being able to take off my hoodie unless it was a really hot day. For anyone that take spironolactone, this definitely applies to you. You get to experience the double whammy of having to pee much more frequently and craving sodium. Especially pickles. Transgender women craving pickles is definitely a meme due to spiro. I had bottom surgery about a year and a half ago and I the whole pickle craving thing just disappeared entirely. Related to this, my sense of smell and taste has definitely changed. I went from hating spicy food to needing at least some spice in virtually everything I eat. I got COVID during the pandemic and lost a lot of my sense of smell, but prior to that I get like I smelled Everything, sometimes I wondered if I smelled things that weren’t ever there. While I was experimenting with these new tastes I also noticed that it was a lot easier to gain weight and a lot harder to lose it. Which was profoundly annoying. Another annoying change was that my fingernails went from being virtually unbreakable to thinner and more fragile. Even the idea of breaking fingernails freaks me out, and it definitely happened a couple times. Ugh. About a year in, I realized that my shoe size had dropped dramatically. I went from an 11 in men’s to an 11 in women’s. Shortly after that I went to the doctors office and was informed that I was about an inch and a half shorter. Apparently both of these were part of body re-composition. About two years into transitioning I was making a collage to celebrate how much I had changed when my wife pointed out that the shape of my eyes had changed. A lot. This due to fat redistribution, which is something I never would have linked together. Lastly, the during my time trying progesterone I had another couple side effects that were downright shocking. The first one is that I lactated, enough that I had to be sure to wear a bra that was thick enough to absorb anything that came out. Now, lactation isn’t unique to women, but I definitely had never done That before. The other mind blowing side effect was the incredibly strange and vivid dreams that I experienced virtually every night I was on progesterone. They were never nightmares, I never felt afraid or anything, but it became a fun game for my wife and I to try to guess what insane stuff I was going to dream about before we went to bed.
Now to dive into what hormone don’t do for transgender women. Right off the bat, as you can tell from the sound of my voice, the hormones alone don’t change a transgender woman’s voice if they have already gone through testosterone puberty. In that same vein, they also don’t eliminate any facial hair that is growing due to testosterone puberty and they won’t rotate the pelvis either. All of this can be changed through other methods, but hormones alone won’t accomplish it. This is the reason I’m a big fan of teens being able to go on blockers until they are old enough to be sure what direction they want to go. Nothing wrong with hitting pause long enough to figure things out.
At any rate, I hope that you have found this short rundown of transgender hormones, especially for transgender women, helpful. I have an interview with a non-binary friend lined up, so next week’s episode will feature a discussion with them! If you are a transgender man, or know one, who would like to be interviewed, please email me at val@vvalcourt.com! Thank you so much for watching and I’ll see you next week!
Sources
https://transcare.ucsf.edu/guidelines/feminizing-hormone-therapy
https://my.clevelandclinic.org/health/articles/22464-hormones
