The Nature and Properties of Hormones
My Very Unprofessional Guide
When you’re a trans person, it can feel impossible to avoid the constant debates over when and how people like you should have access to synthetic hormones and puberty blockers. This is doubly true if you’re politically engaged and find yourself spending a lot of time online, especially if you happen to write political essays for a small audience of readers on YouTube and Medium. You may even feel that your trans status and your most popular essay put you in a position where you’re almost obligated to talk about the subject. I’ve got a lot to say about the dubious things people believe about hormones, is the point.
I was inspired to write this now because of the recent swelling of controversy in the UK over puberty blockers, but it will almost certainly remain relevant for years into the future. It seems like just about everyone has a bad take on hormones, from the supposed dangers of blocking puberty and the frivolity of trans healthcare to the anecdotes and guesses so often passed off as authoritative data. In writing this, I seek to clear some of that confusion and provide a resource for both what hormones actually do and how to best think about them.
As ever, I’m no biology expert, and a lot of scientific research on these topics is gated off behind paywalls that I can’t consistently pass, so I’ll try not to make too many dubious factual claims. Also, as I am a trans woman, much of this article will center around that experience, because I’m not altogether qualified to talk about the experiences of transmasculine people and others who take testosterone. I will try to shine light on that aspect of things when it becomes relevant, though I may very easily miss things.
Part 1: What Are Hormones?
There are three main kinds of “Sex Hormones”: androgens, estrogens, and progestogens (which I will herein refer to as “progestins”, the term for synthetic progestogens, so I don’t have to keep saying “progestogens”). Androgens, such as testosterone, promote typically masculine-coded traits such as coarse body hair and deep voices. Estrogens, such as estradiol, promote typically feminine-coded traits like prominent boobs and soft skin. Progestins, such as progesterone, are a bit more complicated, but they generally manage reproductive matters like pregnancy, breastfeeding, and sperm production.
All three of these hormones exist in almost every human being, and they each play vital roles in our health. Among adults, estrogen levels tend to be higher in cis women, androgen levels tend to be higher in cis men, and progestins are roughly equal in everyone, spiking significantly during the second half of the menstrual cycle for people who have menstrual cycles. As for trans people, well … that’s the topic of this article, isn’t it?
Some trans people choose to leave their hormones as they are, for a variety of reasons. Their bodies will usually develop in a typical manner for their assigned gender, depending on what other medical interventions they choose to take. Other trans people, such as myself, take a regimen of synthetic hormones and hormone blockers which adjust our hormones towards a different range and thereby alter the development of our bodies. This process is called “Hormone Replacement Therapy” (HRT) and it is one of the most commonly misunderstood aspects of daily life for trans people.
I’m going to be extremely “Trans 101” about this, because I really want this article to be comprehensible to the kinds of people who think that transitioning is just a series of surgeries you get in a day or something. There are a few core principles I need to get on the table about how the physical effects of HRT work before we continue.
- Hormones are extremely variable. Everyone’s bodies will react differently to different medications and doses, because we are not all perfectly average human beings. The effects one person gets from a given regimen may be completely different from the effects someone else gets. There are general expectations you can go in with, but everyone will have different hormone goals, and it will often take different approaches to meet those goals for different people.
- HRT is sort of like puberty. Puberty is a process initiated in teenagers when their bodies are flooded by naturally produced hormones and start to develop in accordance with those hormones. HRT is synthetic and manual, but it mimics a lot of the same biological signals, and causes a lot of the same effects. Many trans people refer to taking hormones during their transition as a “second puberty” for this reason.
- DNA is just a blueprint, and hormones are just a signal. Everyone has biological processes programmed into their DNA for how to develop any biological trait that any human can develop. The main function of the Y-chromosome is to increase testosterone exposure in the womb and throughout puberty. The testosterone tells other cells in the body to do things like develop a penis or chest hair, but those cells themselves are what do the heavy lifting, and they know how to develop pretty much any human part.
- Hormones can build, but they can’t un-build. By changing the signals our cells receive, we can change the things they build. However, there’s nothing in our DNA about how to un-develop boobs, or how to un-deepen a voice, so these changes require other interventions if desired. When I took estradiol, my body was able to develop boobs, but a transmasculine person taking testosterone wouldn’t see their boobs disappear. The closest thing to un-building that HRT can do is allowing atrophy by suppressing certain hormones. Without as much testosterone, for instance, a trans woman might require more manual upkeep to avoid losing some muscle mass or *ahem* other things. Similarly, fat can be redistributed, because you’ll continue burning fat in the same pattern as before but new fat will go to different places.
- You never stop taking hormones. Because it’s a common myth, I want to make it clear that hormones aren’t something that you take and then forget about once you’re “done” transitioning. Transition is a process that you live with forever, and hormones are a part of that, especially if you decide to remove the parts of your body that produce your original hormones. Don’t get me wrong, it’s entirely possible to go off hormones, but it will result in an HRT-esque process happening in reverse. Nothing will be un-built, but some things will be built back to where they were.
Now that we have a baseline understanding of what hormones generally do, I want to go over some of the medications that are actually used in therapeutically replacing hormones. This is where things enter an extremely anecdotal territory, because there isn’t a lot of great research about the precise effects and risks of many of these medications with respect to trans people, and I’m not that great at researching. Most lists of side effects you can find online focus on how these medications might “accidentally” cause you to grow boobs or something. So, you know, take what I say with a grain of salt.
The most obvious place to start is with the “sex hormones” themselves — synthetic estradiol, testosterone, and progesterone. Estradiol can be found in pill form relatively cheaply and commonly due to the fact that it is also used to manage menopause symptoms in cis women (my actual mom had to take estradiol for a few years after her reproductive system was removed due to endometriosis). Of course, estradiol helps your body develop breasts, move fat towards the hips, and soften your skin. It’s also sometimes capable of blocking testosterone all on its own, though a lot of trans women need to take separate blockers for that.
Progesterone is sometimes prescribed to trans women as well, it can be taken mostly in the same ways as estrogen, and it’s similarly pretty cheap. It normally plays a role in breast development during puberty, though its effects on trans women post-puberty are not well understood, as it hasn’t been tested for that purpose particularly thoroughly. Still, trans women who take it pretty consistently report an increase in breast development and sex drive, and it’s presumably required for breastfeeding.
Finally, Testosterone is commonly administered through injection. This is because it has a very short biological half-life, meaning pills have to be administered very often and they’re a lot more finicky. It brings with it all the expected physical effects — thicker and darker body hair, deeper voice, and increased muscle mass, among others. I can’t say much else about the drugs themselves, as I’ve never taken anything like them.
Of course, every yin must have its yang. While medications that boost one hormone sometimes have the effect of blocking another, this isn’t universally the case. Some trans people opt to make use of Hormone Blockers, which limit the body’s production or absorption of hormones in various ways. This is much more common for transfeminine people than transmasculine people, because testosterone can be fairly overpowering on its own when administered properly.
The most common blocker for trans people in the US, and the one I take, is called Spironolactone (or spiro for short). It was originally developed as a blood thinner, but it was later found to be much more effective at suppressing androgen production. Still, it is a potassium-sparing diuretic, which basically means that it makes you produce more urine and that that urine doesn’t take as much potassium out of your body as it normally would. Our bodies need a special balance of potassium and sodium, so when you don’t lose as much potassium as normal, you may start to crave sodium to balance it out — This is where the stereotype of trans girls liking pickles and salt comes from. Additionally, blood thinning can sometimes cause problems with dizziness or depression. As ever these effects are extremely variable.
Spiro isn’t the only androgen blocker, though — there are plenty of others! Cyproterone acetate (cypro) is common around the world, but isn’t approved for use in the US for reasons I could not honestly tell you. I think the one company that was developing it just kind of stopped in 2008? I don’t fully understand how that process works and I’m not paying $50 to Barr Laboratories™ to find out. Either way, cypro both decreases androgen production and blocks androgen receptors. It generally has less common but more severe side effects compared to something like spiro. It won’t make you crave salt or anything, and it’s very unobtrusive for most people, but it might cause depression symptoms if you’re unlucky.
I’m going to have to run through some of the other common hormone blockers pretty quickly or we’ll be here all day. Finasteride was created for preventing hair loss in cis men. It does this by decreasing dihydro-testosterone levels, so it’s useful for HRT, if limited by its specificity. Bicalutamide was developed for treating prostate cancer, but it can also be useful for HRT. It blocks access to androgen receptors without actually decreasing androgen levels, which can cause androgens to be converted into estrogens, depending on your body.
Finally, we have Gonadotropin-releasing hormone agonists, or GnRH agonists. These circumvent the process of blocking hormones entirely and instead act on the pituitary gland to prevent the release of gonadotropin, which essentially prevents the signals that tell your gonads to produce hormones in the first place. This functionality has been used for a long time to delay early puberty in cis kids, so GnRH agonists have also become popular for delaying puberty in trans kids. It almost seems like the kind of topic you might bring up if you wanted to segue into the part of your article where you talk about trans kids! Oh, also these get administered via injection, implants and nasal sprays
Part 2: Trans Kids and the Right to Choose
With all that legwork done, we can finally get to the reason that I decided to write this article when I did. The question of whether trans kids and teenagers should have access to hormones and puberty blockers has become a perennial issue in recent years. The idea of “giving drugs to kids” is very easy to fearmonger about. It’s second only to the specter of the male predator pretending to be trans in its utility for driving a wedge between trans people and the political blocs that normally support us. It would be really damning, too, if it represented anything that happened in the real world.
See, transition for a minor doesn’t generally work the same way as transition for an adult, because minors are at a different stage in their lives. HRT is sort of like puberty, so transition for minors is generally focused on trying to avoid and replace their first puberty over triggering a second one. For older teenagers, this point is pretty much moot, but it’s a big difference for younger people. If you’re on the verge of going through puberty, you can use GnRH agonists to stop puberty from starting on its own while you decide whether to take hormones. If you’re prepubescent, transition isn’t much more than changing your name, pronouns, and clothes. Boys and girls don’t actually look that different when they’re kids, if you hadn’t noticed.
In stark contrast, transitioning for minors is often portrayed by opponents as if any 8-year-old who expresses feeling weird about their gender is just instantly carted off to the hospital to be given the scary Gender Procedures. I hope by now you know enough about how transitioning actually works to understand that this isn’t even a little bit true. It’s not even an issue of me not being radical enough to want that, there’s just literally no reason for a prepubescent child to undergo HRT. Similarly, there’s no real rush on anything to do with genitals, because the damage has already been done in that regard, so to speak. With the ability to control puberty, though, we have a unique opportunity to prevent serious and irreversible harm from coming to trans kids, if only we let them control their own bodies.
At this point, even ardent supporters of absolute bodily autonomy may be getting concerned. “Sure,” a critic might say, “people should be able to do what they want with their bodies, but kids can’t consent to things like that. You can’t let kids make such a big decision, they’re not ready.” This argument seems convincing, but falls apart when you understand what we’re actually talking about. A trans minor deciding whether to take hormones is not deciding between hormones and no hormones, they are deciding between the hormones they can take and the hormones their body will naturally produce if they don’t take anything. That is to say, it’s a choice between two puberties.
Is a 12-year old too young to choose to transition? Maybe. But if they’re too young to choose to transition, then they must also be too young to choose not to transition. It’s the exact same thing as 10 years ago when reactionaries were claiming that kids aren’t old enough to know if they’re gay; there’s absolutely no reason why we should treat straight or cis as the null hypothesis in these cases. This is a very big decision which should be taken seriously, and that’s exactly why people like me advocate for kids to have access to puberty blockers so they can be sure to make the right choice.
Besides, as I’ve mentioned in the past, this concern over the ability of a child to consent is notably absent when it comes to intersex people. Bills that ban medical transition for minors usually come with an exception for cases where a baby is intersex and their parents want to give them “corrective” surgeries to make their genitals look right. These procedures often leave physical and mental scars which last a lifetime, but I guess it’s fine to give irreversible and potentially damaging surgeries to infants without consent if you’re making them look more cis. That’s definitely not messed up at all.
Some may resolve this contradiction by arguing that we’re operating on the consent of the parent, not the consent of the child. I would simply ask those people if they really believe that. Sure, it’s easy to say it should be up to the parent when the parent is forcing their child to be cis, but something tells me the same would not be accepted if a parent forced their child to transition. I know this because of the case of Luna Younger, who you may remember as the young trans girl whose father was so unwilling to accept her that he accused her mom of forcing her to be trans and got the story picked up by the entire right-wing blogosphere. If a fake story of a kid being forced to transition gets that kind of exposure, we can’t say this begins and ends at parental consent.
I think that’s the crux of this whole thing. That feeling of disgust you have at a kid being forced to transition? That’s how it feels for people like me when we see a kid forced not to transition. Remember, Hormones can build, but they can’t un-build. Most trans people have features that we feel intense dysphoria over and will never be able to change, and most of these features would’ve never developed if we had been presented with the option to do literally anything about it. If I had grown up in a world where children were allowed and expected to decide for themselves how their bodies would develop, my voice probably would’ve never dropped. I would have narrower shoulders. My whole body would be shaped differently. I wouldn’t be plagued by this constant feeling of dysphoric inadequacy.
There’s a clear double-standard at play here. We fear babies being carted off for surgeries because of the supposed trans cult while the very real suffering caused by “corrective” surgeries on intersex babies is met with indifference. We say that kids can’t choose to transition, but that they can choose to go through puberty. We say that parents should step in and decide what their child will do, but only so long as they are doing so to maintain the child’s assigned gender. Time and time again, I find that transphobes are willing to sacrifice the health and well-being of every trans person on earth if it will protect a single cis person from making the wrong choice. Trans people are seen as irrational, degenerate, and undesirable. Our existence is to be avoided at all costs.
I think we need to move past that. I want to create a world where preteens are trusted with some level of autonomy, where children are allowed to be who they want to be while they learn who they are. I would hope that with what you know now, dear reader, you feel the same way. If you still have concerns, though, then that’s okay! We’ve still got half the article left to go.
Part 3: Concerning Very Reasonable Health Concerns
A common avenue used to justify interference with bodily autonomy, especially the bodily autonomy of children, is concern trolling over the threat of various nebulous mental and physical health risks. Much has been made of how dangerous hormones are, how scary and untested they are, and how little is known about them. Of course, the presented solution is then to just ban hormones or something, as if that will make them safer. I believe in a very different approach, and for that I might be accused of trying to hide or minimize the risks of these medications in service of some nefarious agenda.
That very much isn’t my plan, though. As a proponent of informed consent, I would never want to mislead anyone about what they might risk by starting HRT. While there are plenty of fake or exaggerated concerns peddled by transphobes to try and make these medications seem a lot scarier than they actually are, there are also very real concerns to be had, and I personally had an awful time early in my transition stewing in anxiety over what those concerns might entail. It won’t ward off the accusations of coercion, but I’d like to share some of what I’ve learned over the past two and a half years.
So, let’s begin. I’m not sure if this is a comprehensive list, but it covers many of the common worries surrounding hormones and their health effects. I’d implore you to do your own research if you want to learn more.
- Hormones are partly irreversible, but not to the degree that some people claim. For one thing, they act very slowly. The only changes you usually notice early on are subtle things like skin texture and physical sensitivity. Like with puberty, it takes a while to develop the kinds of entirely new body parts that won’t decay if you stop hormones. However, after a few years of HRT, there will be changes that can never be un-built without external interventions. Of course, since HRT is sort of like puberty, these changes generally can’t exceed those normally brought on by puberty, even when HRT is taken in place of puberty.
- Hormones can sterilize you. HRT replaces the hormones that activate sperm and egg production. Naturally, then, it will prevent your body from producing either due to the absence of a reproductive system which can handle your new hormones. If you go off HRT, you may see your sterility return, but this isn’t always the case. And, of course, if you get your ovaries or testes fully removed, you will be permanently sterile, at least until some means exists to give you a new reproductive system. This is important to understand going in, but it’s a pretty easy thing to wrap your head around.
- Your bones need hormones, eventually. This is why you can’t stay on puberty blockers forever. You need some form of puberty and subsequent hormonal maturity to maintain bone density. Fortunately, bone density takes years to decay, giving you plenty of time to decide what hormones you’d like to use. Your bones will also recover once you’ve started taking hormones, so there’s not much to worry about in terms of permanence.
- Hormones increase the likelihood of diseases. This is true in the same way that the statement “cooking spaghetti reduces its shelf life” is true. If you use hormones to develop breasts, you will face an increased risk of breast cancer, surprisingly enough. It doesn’t go much farther than that — your risk factors for certain ailments will fall relatively in line with the risk factors of other people on the same hormones as you.
- Hormones are an imperfect match. Basically none of the medication trans people use for HRT was actually developed with us in mind, so it’s not exactly a perfect replacement for your body’s endocrine system. Medication can’t be quite as subtle or bespoke as the hormones your body generates, nor can it be administered as evenly. All a doctor can do is test your blood and try to get your dosage within the right range. However, medical science is improving all the time, and the things we can do with our current understanding are already very impressive. Ultimately, I don’t think it matters that much whether hormones are perfect, so long as they’re having the effects you want.
- Medications have their own side effects. Every HRT medication has possible negative effects. Spiro can cause general drowsiness and dizziness, in addition to the potential for potassium overdose. Cypro sometimes leads to depression. Testosterone could contribute to heart disease. The thing is, though, that you could say this sort of thing about almost any medication. You should absolutely be aware of your medication’s possible risks before taking it, but we always take medication expecting the positive effects to outweigh them.
Bodily autonomy is an incredibly charged political topic in the modern world, so absolutely anything negative associated with a medical intervention a lot of people oppose will inevitably be made into a point of contention. As I said, I’m all for the sober, measured detailing of health risks, but too often transphobes forgo treating these medications like any other and replace the healthy pursuit of knowlege with an endlessly escalating game of telephone.
“HRT makes you infertile” becomes “the TRANS CULT is CASTRATING our CHILDREN.” “Puberty blockers will cause osteoporosis if used for too long” becomes “UNTESTED drugs are BREAKING our daughters’ BONES.” This isn’t even to mention the double-standards I was talking about earlier — rest assured, transphobes also love to fearmonger about risks that HRT and puberty have in common.
All this fear transphobes stir into the air enables a lot of awful things. For example, many insurance companies will try to create exemptions in their policies for “transition-related care.” That may seem relatively sensible to you if you believe that things like hormones and surgeries are a frivolous pursuit, but the implications get a lot worse than that.
Let’s say you’re a trans woman and you break your leg. You go to the emergency room to get it treated, and they have to operate. The doctor arrives to discuss the matter of payment, and you discover that your insurance has inexplicably refused to cover any of your medical expenses. See, everyone knows that hormone blockers have been linked with osteoporosis (no need to consider why that is) and estradiol decreases your muscle mass. That means you’d have never broken your leg if you weren’t on all those scary medications, probably, and so there’s no reason the insurer should be obligated to pay for your frivolous little gender surgeries.
This is called Trans Broken Leg Syndrome, and it’s a problem even in places with single-payer healthcare. Because transphobes perpetuate this ideological fear surrounding hormones and all the terrible risks they probably have, people all over the medical establishment have the perfect excuse to justify blatant acts of discrimination and transphobia. Insurers trying to get out of paying isn’t even the worst of it — a lot of doctors have been known to respond to unknown health problems in their trans patients by just assuming the problem is caused by hormones and telling the patient to stop taking them, potentially ignoring far more serious issues.
Here’s a fun anecdote: A friend of mine has Crohn’s disease, and she had to switch to a new GI recently. He was going to just give her medication, but her parents insisted on running tests first. Now, she’s an adult, but her parents are very controlling, and when she came out as trans they’d made sure to give her an earful about the Very Reasonable Heath Concerns they’d seen on a webpage somewhere about hormones. When the tests unexpectedly didn’t show any signs of Crohn’s, the doctor told her to stop taking hormones. There’s no particular link between HRT and Crohn’s, but her parents were very Concerned and there was literally any ambiguity about her health — that’s all it takes. Needless to say, she later went to a different GI, who discovered that she just has a fairly dormant case of Crohn’s disease.
That’s all it is, at the end of the day. You don’t need any particular evidence, research, or understanding of how hormones work — as long as you have Concerns, you can just bully people into doing whatever you want. As long as hormones remain Concerning, doctors can blame them instead of actually doing their jobs. And as long as transition is nebulously Bad For You, the double-standard between cis and trans puberties can be excused.
But this fear isn’t actually helping anyone. It’s not making anyone more likely to make the right choice, because this level of ambiguity is only ever going to lead to kids either fearing transition until it’s too late or going in without considering the risks at all. It’s not doing anything to get us better treatments that are actually designed for trans people, because anyone who even suggests trying to do that gets pilloried by an increasingly influential faction of terrified transphobes. It’s not even helping us exercise more caution about how we use hormones — to the contrary, it puts trans people under a lot of pressure to just pretend there are no risks and it often prevents us from even learning about them due to all the ideological baggage.
This is why I’ve had to constantly use the word “anecdotal” throughout this article. The atmosphere surrounding hormones is a hazy fog of generalities that’s nearly impossible to navigate even for people with formal training on the subject. It can be exhausting and infuriating to look into, and that leads to the substitution of competing generalized narratives in place of actual understanding. We all deserve better.
And it’s a real shame, too, because …
Part 4: Hormones (might) Change Your Life
I think I’ve said just about all there is to say about the physical effects of hormones, what they can and can’t do, and the frustrating dearth of information that leads to mass speculation. However, I’ve been kind of glossing over the other side of things. There is another side of mass speculation, and there is another side of hormonal effects.
In this spirit, I’m going to introduce the secret sixth principle of hormones which I hide from unworthy eyes. You, dear reader, have been chosen to learn and understand this secret:
- There can be emotional effects, but they are very personal. A lot of testimonials from trans people about the effects of HRT talk about their opinions, feelings, sexualities, and so on completely changing as a result of HRT. Others may talk about having a fog lifted, or being able to smell roses for the first time. These things can happen, but they are deeply personal, and it’s near- impossible to separate the psychological impact of starting hormones from the physiological impact of taking 2 mg of estradiol by mouth twice daily.
I’m sure it’s unsurprising that I’m emphasizing the variability of hormones yet again, but it’s really crucial to understand when it comes to the way hormones can influence your emotional state. The fact that hormones have emotional effects at all signals to some people that they can immediately revert to the worst of gender essentialism, where every interest, thought, or feeling stereotypical of a binary gender is immediately assumed to be the product of hormonal processes and nothing else. Then, it is further assumed that HRT will completely change who a trans person is, rendering trans women fragile and perpetually confused and making trans men into dumb rage monsters.
This isn’t even the only problem that wild assumptions about emotional effects can cause. Because sex hormones are associated with several processes in the brain, there’s a common idea amongst trans people that taking HRT will give your brain the hormones it was always supposed to have and therefore quickly and drastically improve your mental health. This then proves that you’re really trans, because your “brain sex” lines up with your new hormones.
I don’t need to tell you that these are both wildly overstated ideas. Not only are hormones extremely variable, the kinds of absurd and essentialist experiences I described aren’t a part of pretty much anyone’s transition. Your emotions and interests don’t tend to change beyond small tweaks, those effects which match stereotypes are generally slight, and HRT doesn’t cure anyone’s depression on its own. Plus, it’s basically impossible to separate the effects of hormones from both random coincidence and the more general emotional growth that inherently comes with transitioning.
Now, it’d be one thing if the only problem here was some pervasive myths about hormones doing more than they actually will. Unfortunately, these ideas can do a lot more harm than just misinforming people. Imagine you’re an adult, questioning whether you’re trans, and trying to decide if you want to take hormones. You’ve recently learned that hormones are much cheaper and lower-commitment than you thought they were, but you’re not 100% sure if you want all the changes they might bring. You’re kind of happy with your life as it is now, and you’re scared that hormones will contort who you are to fit some platonic gender ideal and make you think you like it. Also, you’re still not all that sure if you want tits or not.
Then you find out that, as it turns out, you might be feeling awful because your brain is getting the wrong hormones. Suddenly it hits you — you don’t have to make this decision at all! You can just try starting hormones and see if they make you feel better. If they don’t, it’s no big deal, you can stop before they do anything big. If they do, well, that’ll mean you’re allowed to be trans, and that you want to. Maybe it’ll turn out that all your mental health problems were just Wrong Hormone Disease the whole time.
So, what happens if you start hormones and it isn’t overwhelmingly amazing? What if they don’t cure your depression or your anxiety? Does that mean you’re just … not allowed to be trans? How do you even know that you aren’t just feeling bad for other reasons? Maybe this was wrong. You should go back. But … you don’t want to go back. Do you? Nothing is giving you an answer. Everything is vague. Your sex drive goes away. You liked your sex drive! Sure, it’s probably just that the new hormones haven’t kicked in yet, but what if they do and then it’s wrong? What if they do and they take away emotions and thoughts and feelings that mean a lot to you? Are you ruining yourself?
The summer of 2018 was, uh, not a great time for me, to say the least. Not that that hypothetical was at all autobiographical. It was very definitely not something I experienced.
There are other ways these ideas can harm people too, and they mostly boil down to the fear that your hormones aren’t doing enough good to justify the nebulous and existential bad they’re going to do. It’s a lot easier not to be crushed by that stuff after being on hormones for two and a half years (I mean if hormones were going to make me an emotional wreck who loves touching things they’d have done it already), but it’s still a very real problem that can impact anyone. The fear that you’ve made the wrong decision and the subsequent need for some validation with a veneer of objectivity is a very real thing for a lot of new trans people.
Trans people are only very recently being accepted in any mainstream capacity, and even when we are accepted, it’s often in a very confused and vaguely concerned way. Medical research all but ignores us, support from doctors is an extremely mixed bag, and we as trans people are constantly put upon to demonstrate, beyond a shadow of a doubt, why we should be allowed to transition. Not only are we met with gatekeeping and fear from cis people, we also have to prove to ourselves, to the internalized transphobes in our heads, that transitioning will be the right move. In this climate of fear, confusion, and desperation, we see the emergence of Trans Folklore.
This is a complicated subject. A lot of trans folklore is just a result of the benign tendency for trans people to share their experiences and what research they’ve seen with others as they attempt to patch together a quilt of helpful information. I’m essentially doing that right now. Unfortunately, this lacks a lot of the scientific rigor necessary for creating a strong knowledge base, meaning that lots of dubious information gets mixed in. Besides that, a lot of experiences which are common but hardly universal, like feeling suddenly and noticeably less depressed, get shaped into universalized narratives which everyone comes to expect from themselves.
This is hardly the fault of trans communities, of course. If we actually had a significant amount of decent research on our bodies, we wouldn’t have to rely so heavily on anecdotal nonsense. We’ve spent years as a community pestered about trying to find a basis for our existence, so of course there would be a lot of jumping to conclusions. It wasn’t long ago that the consensus in trans communities was that you were made trans only by the size of some brain gland, and that your “brain sex” could be measured by asking you how good you are at rotating cubes or how empathetic you are. There’s an obvious incentive to embrace really essentialized interpretations of gender and rely on the vague “sex differences” studies I’ve criticized in the past, because we’re being asked to do so much and we have so little to go on.
You always have a sense that you’re not being told something as you transition (because you often aren’t) and that’s a perfect environment for the spread of random twitter posts that purport to have the secret HRT trick your doctor won’t tell you about. Often these posts go so far as to say that if you haven’t been doing x or y your health is at serious risk and you’re going to ruin your transition forever. And, if you’re not satisfied with some element of your transition, this kind of thing can really spark anxiety and cause you a lot of pain, regardless of if you’re actually doing anything wrong.
The core thing to understand here is that there is no right way to transition, and there is no right set of effects. Spironolactone, for example, isn’t an ideal hormone blocker due to the side effects caused by its blood thinning properties. However, it’s not as resoundingly awful as some say it is, for some people it’s the only blocker that works, and the dominance it has here in the US means a lot of people don’t have better options. Blockers in general aren’t always necessary, and it’s usually best not to use them if you don’t need to, but they can be a big help for some people. We can’t expect one treatment regimen to fit everyone.
This goes for hormone administration methods as well. It’s common for trans people to push for one method over another, convinced that what works for them needs to be adopted by the community at large. Estradiol pills are normally taken by swallowing, but dissolving them under the tongue is often pushed as superior, along with other methods like injections and patches. Doctors will usually tell you there’s no difference, but doctors will also tell you that you only broke your leg because of HRT, so that’s kind of hard to trust.
I will say that the meaningful difference between different administration methods is not, generally speaking, the degree of physical or emotional changes. HRT is calibrated by taking blood tests and checking to see that your hormone levels are in the expected range of a typical cis man or cis woman, and those groups have plenty of variability in and of themselves. If your levels are where they’re supposed to be, then introducing more hormones isn’t going to make your transition any faster or more effective, for the same reason that I can’t take my entire bottle of Adderall in order to become a Brain God.
The more relevant differences between methods are in differing impacts on the rest of your body. Non-oral administration is going to be easier on your liver, but pills are cheap and sublingual (under-tongue) administration isn’t ideal for everyone. If you can spend more, other methods may be able to get you the same effects with less medication entering your body, but that’s going to vary on a person-by-person basis. Depending on your biology, you could even find that one method or another is just totally inadequate for transition or poses a serious health risk — your doctor may know how to work with you in these cases, but your doctor might be completely clueless, too.
See, this is a difficult spot for me to be in. I hate the way that universalized anecdotes about hormones spread and I want to tamp down on it, but the fact of the matter is that a lot of it is the best we have. Even though I’ve been personally hurt and known people who were hurt by a lot of these ideas, I only ended up in that position because the entire medical establishment is useless when it comes to trans people. The effects of progesterone are technically unsubstantiated, for instance, but only because no one has bothered to substantiate them. Some trans people report experiencing periods (Though I haven’t, despite how afraid I was of the possibility). This is completely untested, and yet no one cares to even begin to research it. The doctors barely know more than the rest of us, so they usually either prescribe stuff that they’ve personally seen work well enough or they refuse to do anything that isn’t attached to a pile of studies that no one is bothering to write.
So, you know, of course you have trans people claiming that because estrogen is a neurotransmitter it will fix your brain forever. Of course dubious ideas about estrone ratios and premature bud fusion get so popular. We’re scared and confused and all the researchers are busy studying differences based on “sex” instead of telling us how our bodies actually work. There’s basically nothing we can really trust, and in the absence of reassurance, all we can do is try and fill in the gaps ourselves.
My main advice here is to be careful with your trust. Exercise caution when looking online, and when talking to your doctor, and your parents, and anyone else. The only things you can trust, at the end of the day, are your experiences, your wants and your needs. You can’t let yourself get caught up in the baggage of expecting (or fearing) the things hormones might do. Everyone has a personal journey when it comes to transition, and you owe it to yourself to make yours based as much as possible on self-trust and growth, instead of just following random advice on the internet.
Now that’s quite a line for me to say when I am currently, right now, giving you random advice on the internet. I guess it’s complicated. There’s a lot of good information you can get from your doctor, and there’s plenty of good stuff you can learn from trans folklore. In this dearth of extensive research, anecdotal is hardly a synonym for incorrect. I’d like to think I’ve said some important things with this article that would’ve helped me a lot a few years ago, but I’m an engineer — what the hell would I know about hormones?
For now, all I can do is encourage doctors and scientists to push harder for research on these topics and help other trans people sort through it all. While we don’t have the scope of knowledge I want concerning hormones, if we exercise a little skepticism and calm when talking about the subject, keeping in mind the personal nature of transition, we have to potential to create a trans folklore we can be proud of. In any case, if you relate to the things I experienced, just try to keep in mind: hormones might change your life, for better or for worse, but they’ll never make you into something you’re not.
Part 5: The Future
Back in late 2018, Andrea Long Chu wrote an opinion piece in the New York Times called My New Vagina Won’t Make Me Happy. It sparked quite a lot of furor in online trans spaces, much of which I think was justified. It’s needlessly miserable at times and its attempt to reject happiness-focused narratives of transition results in the embrace of a different and more exploitable narrative about how estradiol makes you cry all the time and trans people can never truly feel real. However, there’s an important point there that was often glossed over in online discussion. As the article’s subtitle reads: It shouldn’t have to.
I think I’ve made it clear how much I believe in bodily autonomy and how much I dislike the idea that hormones are a cure-all, so I really appreciate this sentiment. While the kind of misery Long Chu describes isn’t altogether very common, I think it’s really powerful to say that even if hormones are an active detriment to our lives we should still be allowed to use them. Ultimately, it shouldn’t be up to a medical board, or a therapist, or the state, because none of those people have the right or the power to encroach on our basic ability as people to decide who we are and what we want to be. There’s never going to be any “objective” assessment that can determine our deepest desires for us, as much as many of us may crave that.
Transition, like everything else in life, has to be a personal journey. You’re the only you in the universe, the foremost source on what you want, and as such anything you do will be a unique experience only you can have. We can hand wring about the potential for regret or the risks of this or that side effect, but at the end of the day, all any of us can do is make the best decisions we can with what we know at the time and trust that everyone else is doing the same. It’s the best and worst thing about being alive.
As I alluded to before, I wrote this article because many of these things have caused me pain in the past. I was vaguely aware that trans people existed when I was younger, but it was just this weird queer thing that other people did. I wasn’t made aware that I could do anything about puberty, just flatly told about what it was going to do to me. I was a boy, so I was just going to be a man, and like sportsball, and have anger issues, and work at the steel mill. Even once I learned about trans people, I thought being a trans woman meant loving makeup, and staring at mirrors, and hating myself. I never really comprehended the things I’d never be able to change about myself until it was too late, because the society I grew up in saw transition as, at best, an unfortunate necessity for some particularly deranged souls.
I’ve never been good at trusting myself, so when 2018 came around and I finally admitted I was a girl, I wanted some website or scientist that could tell me I was objectively trans more than anything. I wasn’t sure what I wanted out of hormones — I only started because I thought they would be the thing to prove it to me. I was wrong about that, of course, but even when I was as depressed as ever and overflowing with anxiety, I never stopped for more than a week. Was that because I always knew I wanted them deep down, or was it just a facile and stubborn commitment to a treatment that wasn’t helping? I don’t know. Does it matter?
All I can say now is that I like the way I look. I don’t feel great, but I’m also kind of unemployed in the middle of a pandemic so I don’t think hormones are coming into it that much. I’m still the same person, I’m just a little more in touch with myself, I guess. I don’t think about my gender that much anymore, but sometimes I think about how nice it would’ve been if I’d never had to “transition,” if I’d just been left without the baggage of a birth assignment and trusted to be the person I always wanted to be. I can’t help but wonder how much of my traumas could’ve been avoided.
The reason I bring all this up is because this topic is very personal to a lot of trans people. The most infuriating thing about debating with transphobes is that for them, all of these deeply impactful and euphoric and traumatizing and confusing things are just some political issue. For me, this is my entire life. I’m still a nonbinary trans woman even when I’m not in your field of vision, and I’m going to continue being trans for the rest of my life once you’re done reading this. As I come to terms with my past, all I want is to build a future where I can be at peace and the things I went through don’t have to happen to anyone else.
That means trusting everyone, young and old, with their informed, consenting decisions. That’s the only way they’ll ever be able to trust themselves. And make no mistake, there isn’t even close to a complete body of information about the effects and risks of HRT (and hormones more generally) because wonky constructs like biological sex deeply limit mainstream understanding of trans bodies. If writing this has taught me anything, it’s that there needs to be a lot more research conducted on actual trans people so that the future can bring us better treatment administered by doctors we can actually trust. Contrary to popular belief, spreading fear and devaluing hormones isn’t going to do anything to get us there.
If we want a future we can be proud of, it needs to be powered by self-expression, acceptance, and trust. We need to ditch the speculative fear and paternalistic gatekeeping in favor of allowing people to take their own journeys and arrive at their own destinations. It’s not always going to be perfect, nor will it make everyone happy all the time, but the suffocating assumptions we’re placed under from birth are not good for anyone. I don’t want to convince anyone to take or not take hormones — I just want to create a future where nobody has to go through the things I’ve been through and everybody understands, in their own way, what all of this means to people like me. I only hope that I’ve brought that a little closer for all of us.
Thank you for reading! I’d like to quickly shout out the people who support me on Patreon and help to make my writing possible. That includes: VixenVVitch; Vanessa Argodale; Upscale Furry Trash; Sonja Marie; Niels Abildgaard; Mizake Da Mizan; Mahan Harirsaz; Leonidas; Julia Pseudo; Honestlyarchon; Gender_Thief; Bran; betty, your friendly neighborhood anarchist; and Abigail Nail. I really deeply appreciate the support from you all. If you’re reading this and you want to support me, I have a Patreon and Ko-fi page. Plus, if you enjoyed the article, I have a video version you can watch on my Youtube channel.That’s all for now, I hope you have a nice day!