First Person: How hormone replacement therapy has affected me psychologically

Estrogen patches. (Photo: Wikimedia Commons)
Estrogen patches. (Photo: Belinda Hankins Miller/Wikimedia Commons)

By Brettany Renée Blatchley
LGBT Perspectives contributor

Brettany Renée Blatchley
Brettany Renée Blatchley

ASHEVILLE, North Carolina — Sometimes people have asked me how hormones have affected the way I think and feel, and that is what I hope to answer here:

At the time of this writing, I have been on hormone replacement therapy for three and a half years.

My first experience with female hormones was during my “questioning” phase at 37 years of age. I had gone into therapy for clinical depression and as it became safe to “unpack” my “stuff,” my gender issues rushed out like a flash flood. In this time, I had begun to transition without realizing that was what I was doing. As part of this, near the end of a year of healing and changes, I decided that I needed to know how female hormones would affect me, so I conducted a weeks-long experiment on myself. After researching hormonal effects, the types of hormones, dosages and availability, I set up my experiment and carefully monitored my physical and psychological condition. While there were (temporary) physical changes, the psychological ones were most striking to me, and the best way to summarize that is to say that concluding the experiment was one of saddest and most difficult things I have ever had to do.

Female hormones make me feel right. They don’t make me feel good or euphoric or “high,” rather my body feels like it has stopped competing against me and is now cooperating with me. Psychologists would call this “egosyntonic” — there was a profound sense that my body was in harmony with myself. I’m thinking here of that separation of body and mind (or soul), and I am likening my body to be a vehicle, even a “rolling home” for my mind or soul or simply my “self.” In this sense, when my body was dominated by testosterone, I always felt the “check engine light” was “on.” Actually, it was worse: I felt the “push” of testosterone driving my body and feelings in ways that were profoundly uncomfortable or “wrong” for me. “Driving” my body, I felt a rough ride where the steering pulled in awkward and scary ways, even to the point where I had to struggle to maintain control. Like an auto with bad shocks, bad tires, bad brakes and loose steering AND bad fuel … well, you can imagine how difficult that made my life’s journey!

Female hormones, made the “check engine light” go “off.” The ride became smooth; the tires stopped making ominous noises, the auto easily went where I steered it. My body was cooperating with me instead of competing against me. I am more “congruent” on female hormones, where congruence for me means that my body, soul and spirit are matched to each other.

I have spoken with many other trans people, gals, guys and genderqueer, and they seem to share this sense of their body now cooperating where it hadn’t previously.

Metaphor aside, one specific area of change had to do with my libido. With testosterone, I had a near constant “push” in the area of my sexuality. I found the pressure deeply disturbing and mostly unpleasant, urgent and very “male.” Now testosterone is great for men, but it felt awful and icky for me. My sexuality is far more as other women describe theirs, with a qualitative and quantitative difference in our desires and the way our sexuality affects our overall lives (outside the bedroom). Though I could not always articulate this, I now understand myself (my gender identity) to be essentially female, and this female person was being pushed around with testosterone — too much** testosterone. I felt my light, gentle, “flowing” sexuality being goosed and bullied into male-ish patterns.

** (Everyone, has both estrogen and testosterone: depending on sex, one hormone is often 10 times the amount of the other.)

Here is something I never expected: HRT supercharged my transition. Before hormones, I wondered if I would ever actually fully transition … could I do that? After a short while on hormones, I knew I had to fully transition. It wasn’t a question any longer — it became an inevitability.

Similarly, HRT was an enormous confidence booster. There were times, like switching bathrooms, where I simply said: “I am woman enough now; I’m running on estrogen!!” and THAT would encourage me through difficult “firsts.”

To summarize most of my HRT experience, I would say that female hormones have not changed me so much as they have supported me. They have not changed me from a man into a woman; I was never a boy or a man: I was already a female person, but hormones have helped me develop my female-ness into my present expression of womanhood.

AND THAT is what I have been telling people for much of my journey, BUT I have noticed other things as I have progressed through my transition, especially when my estrogen levels moved more comfortably into the normal female ranges. Some of these are:

  • I feel even more deeply than I have before, and I am much freer in my emotional expression. I can easily giggle at the start of a sentence, get teary midway through and be laughing at the conclusion. My emotional dynamic range is way beyond what it used to be, and as a “special sort of man” I was very sensitive.
  • I was already deeply empathic, and now I am even more so.
  • Mutitasking comes easier — I was already good at this before, and now I multitask with the best of them.
  • My spatial reasoning (my ability to imagine and mentally manipulate 3-D images) has diminished. Once I was reasonably good with things like parallel parking, but now I have to really concentrate on them (and I have scrapes & dents in our car to attest to this).
  • I was already quite intuitive, and it seems that I have traded some of my logical-rational ability for more intuition.
  • I find that I care much more about relationships than I did before. I did care before, but now I CARE.
  • I communicate much more than I used to, and as much as I used to write, goodness, I write reams now!
  • Okay, this is harder for me … very difficult, in fact: I have long thought of myself as “asexual.” (Yes, before the term was coined!) I have never felt the “hots” for anyone, male or female. I don’t have what is termed “primary sexual attraction” — that is, there’s no “chemistry” love-at-first-sight kind of thing with me. Pornography does nothing for me; I never dated, never thought I would marry, didn’t “get” flirting. Oddly enough, I am deeply sensual and other than the “attraction” bit, I’m very sexual (in the everyday-outside-of-bed way that sex affects us all — AND this bit is clearly female-flavored in me).

    Okay, to muddy things further, I have come to realize that I’m probably much more like a demisexual person: IF I am emotionally close enough to a person, THEN I might POSSIBLY feel sexual attraction for them. AND this is how it works in my marriage. I don’t know if I’m this way innately (as a sexual orientation) or whether my childhood rapes have “turned off” my primary sexual attraction.

    HOWEVER, I have noticed in the last year, as my estrogen levels have risen, I am having “twinges” of attraction to others, and I am now starting to “get” flirting. It’s a little scary for me to find both men and women to be “cute” in a somewhat-sexual way. I was scared out of my skin to experience a “crush” (my first ever-ever) on a close male friend over the last few years and in my fright and confusion, I put emotional distance between us. For someone who has not experienced ordinary sexual attraction to/with others, this is a shock, and I think that hormones are changing me even in this way. In the end, I don’t think hormones will have changed my sexual orientation as much as they will have freed, or maybe “amplified” what was already there. Time will tell.

  • I think it is also true to say that I am experiencing a bit of adolescence again as part of my second puberty. This involves trying to “find myself,” the inevitable existential angst, the narcissism, emotional storms and the all-consuming-ness of it all. AND THAT along with my mature adult way of looking at things and behaving — quite a mixture! I have a button in my collection that says “Puberty is more amusing the second time.” AND is that ever the truth for me! AND like other storms, this, too, is passing.

So, despite my insistence that HRT has not changed my essential person, I have to admit that it is changing me in essential ways. And these are ways that I want to be changed, that is, I am aware of the changes and I am comfortable with them: they feel right. Most of these changes seem to be more a matter of “degree” rather than “kind,” though the question of where my sexuality is going still seems to be an open one.

Comparing notes with many other transgender women on hormones, I have found a great number of similarities, yet each of us are different as well. Increased congruence, changes in emotional capacity and expression, a reduction (or loss) of male libido seem to be common among us. Less common is a greater awareness of a gentle female libido and increased awareness of and freedom with our sexuality including apparent shifts in our sexual attraction in degree (as with me) or in direction: attraction to males, females, anyone, no one.

As a final note, I should mention that HRT for trans women has two main components: female hormones and anti-androgens. The goal is to suppress testosterone and boost female hormones (especially estrogen). For the first two years of my therapy, my HRT comprised of transdermal estradiol patches (for estrogen) and spironolactone tablets to suppress testosterone production. My estradiol level (E2) was seldom above the lower end of the normal female range, and my testosterone was reduced to unmeasurable quantities. (I supplemented this with progesterone for its affect on my breast development and other physical effects.) Then at the two-year mark, I decided I wanted my E2 level to be well into the normal female range because I was never really “feeling” the estrogen — instead, I was feeling the absence of testosterone: this was a good feeling, but from my former experiment I very much know what estrogen feels like, in its profoundly wonderful way (almost like moving from mono to stereo music or B&W to color vision). So, I switched to injected estradiol, which is more efficient and could be administered in higher doses. Ah!!! THAT did the trick!! And having normal female levels of estrogen also told my XY endocrine system to naturally turn-off testosterone production — and so I could drop my anti-androgen from my HRT regime.

Well, dear reader, I hope that I have satisfied your curiosity, at least somewhat! Again, I am only speaking for myself (except when I noted otherwise).

Postscript: Three months ago, I had my inguinal orchidectomy — that is, I had my testes surgically removed. My body is no longer capable of producing testosterone (or even, apparently estrogen — my adrenals don’t seem to produce androgen precursors). For more than eight weeks after my surgery, I went without estrogen, and by the end of that time, my gender identity said “female,” but the rest of my body said “meh” (I felt genderless, body-wise). So, I have experienced life with one, the other, both and neither sex hormone dominating. It has been quite interesting, and I have a far greater appreciation of how hormones affect us, especially with regard to our sexual drives.


One thought on “First Person: How hormone replacement therapy has affected me psychologically”

  1. I am a transgender woman, too, though I’m not particularly girly, more of a tomboy. For me, starting estrogen was like taking the hand-brake off, and giving the old run-down car a badly needed service, new alternator and battery, an engine tune and new spark plugs!!

    An automotive analogy seems appropriate here, though I’m not that much into cars! 🙂

    All my life, it was like driving a car with the hand-brake on all the time. Even very simple things involved an excessive effort, and cruising just didn’t happen. When I stopped push-push-pushing, my life didn’t cruise, it just ground to a halt. That’s what having the wrong hormones (testosterone) felt like for me.

    In the 4½ years prior to my starting estrogen, things got much worse, and continuing the analogy of my life being like driving a car, my car started to stall regularly, in addition to having the hand brake on all the time.

    Then added to the stalling, there was alternator and battery trouble. Bad combination. Who would want to drive a car like that!

    Taking estrogen HRT is my first experience of normal life flowing instead of pushing, cruising instead of stalling. Simple tasks are starting to look simple again. It’s not just psychological. I FEEL the difference when my estrogen levels are high or low, big time!


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