Did you know that medical providers are beginning to wonder if Spironolactone, an androgen blocker, should always be prescribed with Estrodial for feminizing Hormone Replacement Therapy (HRT)?
There are more and more studies and women reporting negative mild to severe side effects of Spironolactone, including brain fogginess, muscle atrophy, increased cortisol, weight gain, decreased sex drive, and even decreased breast tissue growth. You can read more about the history of Spironolactone and the many possible contraindications in Beverly Cosgrove's "The Case Against Spironolactone" (2019) here: https://moderntranshormones.com/2018/01/01/whats-wrong-with-spironolactone/
Did you know that you can adjust your HRT treatment?
When I first started HRT years ago, I assumed my medical provider knew what dosage was best for me. She was kind and supportive of my transition, which was more than I had dreamed of. I did not connect my mood swings and fatigue with my HRT cycle at all. It was not until I was exploring a transgender online forum that someone mentioned that they shortened their HRT cycle from 7 days to 5 days because they were feeling depressed at the end of their cycle did I begin wondering if I wasn't on my optimal HRT regiment. Since then, I have monitored mood and physical symptoms in comparison with my HRT cycle, worked with my medical provider and adjusted my HRT dosage several times. After almost 4 years, I am very grateful to say that it feels like I am finally at my ideal HRT regiment.
Most medical provider refer to a range of what is considered "normal" or "acceptable" levels of Testosterone and Estrodial to guide their HRT prescriptions. What this means is that medical providers need our input to ensure that we are on our optimal regimen, otherwise they will just be following a standardized table. For example, because a "standard" level of Testosterone in an adult male ranges from 300 - 1,000 ng/dl, a medical provider with all of the good intentions may continue prescribing a particular dose of Testosterone Cypionate to someone who is testing within that range, regardless of the individual's body type, size, gender identity, transition goals and mental health history. There are more and more medical providers that are sharing about improving gender-affirming practices to be more patient-centered and inclusive of genderqueer, non-binary and gender fluid folks. Check out Dr. Madeline Deutsch's Guidelines for Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People: https://transcare.ucsf.edu/guidelines
If you are on HRT or considering starting, I recommend doing Hormone Check-In's with yourself.
Try different check-in's and see what feels best. For starters, you can try these three:
1. When did I get my labs last?
Did you know that labs are recommended every 3 months for the first year, and every 6-12 months after that?
If you are thinking about starting HRT, be prepared to get labs done to establish a baseline to work with.
If you have been on HRT, make sure that you are getting your labs done to ensure that you may not be experiencing unintended or unwanted symptoms of HRT. For example, because our bodies naturally try to maintain balance, it may create more of the hormone that triggers gender dysphoria (let's say estrogen) for you if your HRT (let's say testosterone) levels are too high. This happens often with folks that are taking HRT without access to medical support.
2. What do I notice the day I take my HRT? The day after?
Do I notice any emotional symptoms, like feeling depressed? Am I angry or crying suddenly?
Do I notice any physical symptoms, like feeling energetic or tired? Do I have brain fog or racing thoughts?
3. What do I notice the day before my HRT?
Do I notice any emotional symptoms?
Do I notice any physical symptoms?
Try journaling for 1 week or 1 month. Check out if there are any patterns that may be connected to your HRT cycle.
"Best Practices" evolve over time with practice experience, patient report, and research. As you can imagine, this process takes time. Often, those that are harmed by oversight or malpractice during this practice are those that are already marginalized. HRT best practices are based on the archaic Harry Benjamin ideas that focus on transition outcome, and not necessarily our quality of life as we medically transition or our identities. There are many things that we have normalized within our communities, such as the "T rage" or loss of libido, which may actually be influenced by HRT regiments that aren't optimal for the person.
You don't have the suffer in silence, or alone.
We all deserve care catered to our specific needs and with the right medical provider, we can get that.
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