Much like Dr. Jekyll and Mr. Hyde, hormone "replacement" therapy (HRT) has two major identities.

The best-known form of HRT is the increasingly controversial use of Premarin and such to alleviate menopause symptoms and the potential health risks (like osteoporosis associated with menopause. However, in the transgendered community, HRT is used to refer to doses of either estrogen or testosterone (depending on one's birth sex and desired gender presentation) which are used in transitioning.

There are many ways in which HRT used this way is different:

As is noted in transsexual hormone therapy, this "HRT" is sometimes alternatively known as Hormone Reassignment Therapy, or as Hormonal Sex Reassignment. Ironically, however, the term "hormone replacement therapy" is sometimes appropriate in this case, since from the transsexual perspective the purpose of undergoing HRT is to as nearly as possible replace the body's usual hormone balance with that of another sex - and FTMs at least get to take hormones which are not derived from horse urine. Regardless, it is so often referred to as just HRT that the two acronyms have essentially become synonymous.

While there are many risks now associated with taking HRT as a menopausal woman, there are far fewer associated with the trans form of HRT. Unfortunately, this may be for the same reason that it took so long to understand the risks of menopausal HRT: the medical community does not study us.

Even in these presumably feminist times, many studies are conducted solely on men. This does decrease the number of variables in a study, but it means that the findings from many medical studies conducted on men are just assumed to be true for women. On top of that, issues that are specific to women's health get less funding and fewer grants than more obviously commercial studies. And many women still find that their medical complaints are written off as stress - the modern-day version of "It's all in your head, dear." Thus, it took a long time for the risks of HRT to be noticed in post-menopausal women.

The same factors are present in the transgender community. Doctors are, if possible, even less respectful of transgendered patients/consumers, particularly since they are placed in a position of so much power over us that they are actually allowed to decide what our physical sex should be and what we would have to do to change it. Medical researchers generally have a very difficult time getting grants to study anything related to this relatively small community, at least in the United States.

Fortunately, there are countries where this is less true. For example, researchers in the Netherlands completed a study on "Mortality and morbidity in transsexual subjects treated with cross-sex hormones" in 1997. They studied both transmen and transwomen and found that "total mortality was not higher than in the general population and, largely, the observed mortality could not be related to hormone treatment." We can only hope that this finding is duplicated by future studies.


  • has genderal... I mean general... links about this and other trans health issues.
  • has good information on HRT for transwomen, although they make the common mistake of using "transsexual" to refer solely to MTFs;
  • provides FTMs with health information including HRT and SRS info, as well as articles on personal and social issues; they have an abstract of the above-mentioned study on mortality and morbidity at;

After a long absence due to a sudden upswing in the translation business, classes, and moving into a new home, I have finally found the time to node this writeup, months in the making...

Hormone replacement therapy has a number of applications, ranging from the administration of oestrogen in menopausal women to the medical reversal of hormonal polarity in patients with various hormonal abnormalities (e.g. excessive testosterone and insufficient oestrogen and progesterone in a female patient) or those who are transitioning from one gender role into another. This writeup will centre on this reversal of hormonal polarity, drawing largely on my own experience.

Some Basics

We don't know terribly much about how the mind and brain work. While we've certainly made quite a bit of progress in recent years, brain research is still nowhere near where we are in understanding, say, the colon. The effects of cross-gender hormone replacement (i.e. giving testosterone to a patient who has oestrogen as the predominant reproductive hormone or vice versa.) on the brain have not been studied very extensively, but there are a few things that have been found in the work that has been done. First, it's important to keep in mind that reproductive hormones are one of the few truly nonselective substances in the human body. Many biochemical substances select for one or other type of tissue or receptor. Oestrogen, testosterone et al., on the other hand, are generalists; they affect whatever tissue they touch: skin, muscle, fat, brain. Some studies have shown that cross-gender hormone replacement changes brainwave patterns, as seen on EEG, to match those of the gender with which the new predominant hormones are associated.

Thus, a male patient (or other patient in which testosterone is the predominant reproductive hormone) who takes antiandrogens to suppress testosterone along with oestrogens will show EEG patterns consistent with normal female brain activity (and vice versa). Similarly, positron-emission tomography (PET) scans have shown cross-gender HRT patients to have brain metabolic patterns matching the gender associated with the hormones being administered. Other studies have also noted shifts in skill profiles — biologically female patients taking testosterone performed on skill tests closer to biologically male subjects after testosterone than before.

But no one seems to have done any serious work on the really interesting stuff.

The Really Interesting Stuff

The really interesting thing about cross-gender hormone replacement therapy (at least to many of those undergoing it) isn't the physical changes: the migration of fat tissue, the increase or reduction in muscle mass, the (resumed) growth or atrophy of breast tissue, etc. What is really fascinating, indeed truly mesmerising about cross-gender HRT is what it does on a very deep level to how one's mind works.

Having recently begun correcting my own hormonal polarity (going from predominant testosterone to predominant oestrogen and progesterone), this is a subject that I have had some time to ponder. Thinking back over the past five months, it appears that the first thing I noticed was a substantial reduction in sex drive. Testosterone, as I'm sure anyone who has taken testosterone or been around teenaged boys can easily confirm, has the tendency to make one horny. I had grown quite accustomed to a loud, intrusive, in-your-face sex drive that somehow managed to prevent me from thinking about whatever I was actually trying to do every once in a while (read: once or twice a week at least). The change was so sudden and complete that I didn't even notice it immediately, until it occurred to me that I had not thought about sex on any level in weeks. Equally striking was the qualitative change in the libido that did surface every now and then. Instead of being ready to go at a moment's notice, it became more elusive, picking its moments according to criteria that I still haven't entirely figured out. And the feeling was so different I had to be told what it was by a friend. Instead of the raw, carnal, Beavis and Butthead-esque feeling of urgency, the feeling I first noticed one day a few months ago was more a sudden hypersensitivity of the entire body to touch, combined with an overwhelming desire to be close to someone.

Emotional changes also abound. First of all, there are more of them. A friend of mine has described the experience as "one-tenth the sex drive, ten times the emotional depth, intensity, and range." That certainly has rung true in my experience. In my first five months of having an oestrogen level within normal limits, I have cried more than in the preceding fifteen years. Indeed, I managed to cry more in the first five weeks of HRT than in the preceding fifteen years. Not that it was a difficult record to break in either case: though I can't be entirely sure, I think I cried something like 2 times in the fifteen years before HRT. In any case, it can't have been more than five times. Deaths, disappointments, small heartbreaks were not in short supply, but I just couldn't cry over them. Even when I tried to, nothing happened. No matter how much I wanted to, I just couldn't cry.

HRT certainly put an end to that. Probably two weeks after starting, I cried for the first time in ages. Even more remarkable than the fact that I'd cried at all was the reason I cried. As far as I can tell, it was a song that did it. Víctor Jara's rendition of the Chilean peasant song Despedimiento del angelito (Little Angel's Farewell) came up on my shuffle pattern, and I found myself unable to contain it. The simple poignance of the song started it building up. But it was the combination of that sweet, sad melody with the man who sang it that finally got the tears flowing. It wasn't just the fact that the man who was singing that song, and had written so many other beautiful and inspiring songs had been murdered by the Chilean junta — but the fact that he was so brutally killed because he wrote such beautiful songs. Even now I cry a little when I think about it.

Even more amazing is the fact that I now cry for joy. I had always assumed that people only cried for joy in Hallmark Hall of Fame movies and cheesy romance novels. Crying no longer seems to be a specialised thing. Pretty much any strong emotion does it. After years of hardly feeling anything, actually being overcome by sheer emotion, of whatever kind, is a high. There is something irresistible about the feeling of release, catharsis, and, sometimes, satisfaction that comes from just surrendering, and allowing whatever is inside to come out. It's practically orgasmic

Similarly, I've always been known as the most utterly unsentimental person in any circle of acquaintances I'm in. I have long been known as the one who snarks about some continuity glitch or sloppy writing at the part of the movie where everyone else is making ample use of the Kleenex. With that track record, I'm sure that you can imagine my surprise when I find myself getting misty-eyed while watching the Adam Sandler vehicle Fifty First Dates. Cuteness suddenly also has an effect on me. Where I used to nod in faux understanding when a friend would point out some adorable puppy or baby, now I get an unmistakable physical reaction — a pervasive feeling of warmth and the generally irresistible urge to ooh and ahh over whatever it might happen to be.

Unsurprisingly, this has all had a major effect on my relationships. For example, Karen and I have been friends for about a year and a half. We go to the same university and generally would see each other outside for a cigarette at least once every couple of days. We've always enjoyed each other a lot. For the past several months, we have quite suddenly becoming much closer. The first time we saw each other since I started on oestrogen and progesterone was about a month or so after I'd started. We were meeting to talk, have drinks, and work on her website, much as we often enjoy doing. However, this time, I randomly, spontaneously told her that I felt she was probably one of my best friends at the university, and she said she felt the same way (qualifiers have since been omitted). Since then, we have continually become closer. Before, our conversations were almost always about politics, the university, work, or griping about excessive coursework. Engaging, but rather impersonal. That has changed completely. We have established a level of emotional intimacy that I have never had with any friend before in my life. I had previously never been able to tell anyone (except in some exceedingly rare cases) how I felt about them. In fact, I don't think I could have actually even expressed how I felt about most people. Now, it's second nature.

The funny thing about having your entire cognitive, perceptual, and emotional apparatus reforming itself around you is that you don't really notice what's going on at the time. You do, say, and think things, and they all seem perfectly natural, as if you've always done things that way. Other people might notice, but to you, you haven't done anything out of character at all. If you do pick up on it, it's often quite a while later. A few hours, or a few days, later, you suddenly realise that you did or thought something that you had never previously even come close to doing. At the start of the aforementioned upswing in my translation and editing business, which coincided almost perfectly with the start of HRT, I began thinking about getting myself a new place. I began visualising it in great detail (something I'd never been able to do), and considering how it would be furnished and decorated. Surprisingly, I really got into the idea of creating this space for myself, and thinking about what it would need to really be a home for me. A few hours after these musings, it occurred to me that I'd had a thought process I'd never had before. Instead of thinking about specific items that I wanted to have present, I was looking at it in terms of the specific feelings I wanted the place to evoke.

Other times, you realise you're doing something out of the ordinary while it's happening. Sometimes the new behaviours are so jarringly different from the old, accustomed ones that you find yourself inwardly (and sometimes outwardly) stunned, thinking "Did I seriously just do that?" Such was the case during that first post-HRT visit with Karen, when I — a confirmed, some would say militant lesbian — found myself unable to take my eyes off of a really cute guy who had just walked into the coffee house. You sit there for a moment, utterly dumbfounded at what you just caught yourself doing, saying, "Omigod, I did not just do that!" There have certainly been plenty of shockers — suddenly having interest in men, going from detesting shopping to considering it a recreational activity, actually getting seriously into the process of choosing flatware, table settings, table linen, furniture, and cute little accents, finding myself reading as much Sophie Kinsella, Jennifer Weiner, and Helen Fielding as Noam Chomsky, Howard Zinn, and Christian Parenti, for starters — but my basic philosophy, which is as at odds with my previous way of life as it is sanity-preserving, is to explore and enjoy all these new aspects of my life and myself as I find them. The weirder, the more unexpected, the mushier, the better.

Of course, this could go on ad nauseam (assuming, of course, that it hasn't already), and, at five months, this is just the beginning. Normally, it takes years for all the changes to work themselves through and settle a bit. Right now, I essentially have the hormonal makeup (and, I have been told more than once, the temperament) of a 15-year-old girl; so much of the weirdness of adolescence is, after all, due to the brain having to cope with large quantities of substances it hasn't the slightest idea what to do with. So, incomplete as it is, I will content myself with this brief listing.

And Just What Does It All Mean?

I honestly couldn't say what it all means, and I don't think anyone claims to be able to should be taken overly seriously. We're only beginning to glimpse how the human brain and mind work. I do, however, have a few thoughts on the subject. For one thing, it hardly seems plausible that hormones, which do clearly have a significant effect on brain metabolism, can be without any effect on our behaviour. Certainly the sheer magnitude of the behavioural changes I've experienced coinciding with a total shift in hormonal balance suggests that. For another, I feel that this experience gives a great deal of insight into the nature of personality. Having experienced all of this, I think it's reasonable to believe that the core aspects of personality are set in one way or another, much like the parameters of universal grammar. Like the language faculty, that core setting is a default, filled with potentials that can either be realised or suppressed. Hormones, like environmental factors and life experience, through their interaction with the brain, unlock certain of these potentials by directing resources to certain areas of the brain rather than others. When one changes one's hormonal balance, suddenly new potentials begin to realise themselves and to supplement or supplant old ones.

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