The low down on low dose T

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I’ve had a lot of questions recently about the mental and emotional effects of low dose testosterone. I had a bit of a difficult experience because I had a massive exacerbation of untreated mental illness while in the early months of being on low dose T but it’s wasn’t due to me being on T alone.

I was on 50mg depo testosterone every 2 weeks and I got impatient and upped it to every week because I wanted to see changes quicker but around the same time I had 3 major crises happen in my life that ended up putting me into a depressive spiral and I wasn’t coping with all the stress/depression and puberty at the same time so I stopped T for a while. I’m hoping to go back on HRT soon.

I really loved the way T made me feel. The way I can describe it is that I had a slight invisible buffer between me and my emotions.  I had to actually consciously be emotionally engaged rather than previously when I felt wrapped up in emotions that were global. I liked the bit of emotional distance, it was a welcome change to me, however I did find that I tended to be less empathetic to my spouse and more likely to fob their emotions of as less important/relevant which would be something I’d have to work on when I go back on T. I wouldn’t describe it as being less emotionally available but rather more like a half second delay in emotional response that gives you the opportunity to decide how you want to react to it.

I did get irritable and snappy and I know some of that was T and some was because of the extreme stress I was under and not getting the opportunity to go through puberty and learn my own emotional landscape before having to deal with crises. A friend of mine warned me that in his experience and the experience with other trans men starting T that 50mg every 2 weeks makes people very moody, this is apparently the starting dose that some Drs prescribe and it does cause the most fluctuation in mood. In the future I would be interested in trying 25mg weekly rather than 50mg every 2 weeks. I am also considering moving over to Nebido (long acting T with more stable hormone levels) which I would stagger a shot every 6 to 8 weeks rather than doing a weekly T shot. I’ve also been told that the moodiness does ease up after about 8 months or so.

I couldn’t cry. I’m not usually a crier and I’m more likely to cry out of anger or frustration than I am out of sadness. On T… no tears… niks… nada… fokol. One situation did make me cry but it really took a lot to override the T-tearlessness. I mean I did feel sad, I did feel frustrated, I did get angry, it just didn’t result in me ever crying.

I was finding that I wasn’t taking my shot as regularly as I should have because if I took my shot too late in the day or at night I wouldn’t sleep that night, and it wasn’t always possible to do my shot in the mornings due to life demands. I have long standing insomnia and my psychiatrist gave me a prescription for sleeping pills which means that getting my shot in the evening when it is more convenient for me becomes an option again.

I was in the process of having to relearn my emotionality and reactions within my relationships because my way of navigating emotions did change. Any sort of HRT and hormonal transition is difficult on both partners in a relationship as you have to be prepared to relearn how to relate to each other. It can often end up highlighting existing issues that you haven’t dealt with. My spouse was struggling with what they perceived as an emotional distance between us, I think this was directly related to me not having had a chance to figure out how to be consciously present in our time together as my natural reaction in crisis is to dissociate. Being dissociated was very easy on T, and considering it was an existing stress reaction, having that become even more default became obviously problematic.

If you’re considering going on low dose T but are still unsure

The whole going onto HRT is a pretty serious decision. My own personal experience is that once you’re thinking about going on T the things stopping you tend to be social/family/external pressures. If you think you can live with the physical changes within yourself then going onto low dose T would give you a good idea of whether T is for you far sooner than any physical changes will happen. If you go on T and feel that it isn’t right for you, you can always stop.

 

 Here is a bit about my experience with regards to what changes to expect

The voice changes, facial hair, hair thinning and clitoral enlargement are permanent. Facial hair can always be plucked/lasered if it bothers you. The growth of facial hair is gradual. Facial hair that grows in the first couple months of T will mostly fall out if it hasn’t had a chance to become “terminal hair” so most of the fuzz disappears when you stop T and only the thick darker hairs remain. I don’t think I have more than 3 or 4 chin hairs left and all the fluff on my cheeks is gone.

Hair thinning is entirely genetic so if your male family members have receding hairlines you might have hair thinning too, however again this reverses to a certain extent when you stop T.

Low dose T won’t result in massive virilisation so even after 6 months on low dose T I didn’t even vaguely pass as male.

The emotional changes as well as the body fat redistribution are both reversible changes. The body fat redistribution and muscle bulking happened really quickly for me but those effects disappeared almost as quickly.

My voice lowered a bit in the first couple months and one of my biggest motivators to increase my dose was to have my voice change more as I have serious voice dysphoria. A friend noted yesterday that my voice has gotten a bit higher since I stopped T too. The voice change has been my favourite change so far.

Also, unless you’re on antideps which suppress your libido, the 14 year old libido is wild! Though my one friend who is ace didn’t find much boost in libido at all so I guess it is person specific. With this, I got a bit annoyingly inappropriate at times with regards to just blurting out whatever thought was in my head but this is just an unfortunate intersection of testosterone puberty meeting ADD and my never ending struggle not to blurt out my every random thought in every situation anyway.

Other info

Some people have asked if you can skip T and just go on blockers. Everywhere I have researched says no. You can’t really go onto blockers alone, there haven’t been any studies on the effects on living with no T or E and even post-menopausal people still have low levels of various hormones. Added to this, your body needs either oestrogen or testosterone for metabolic functions. Not having sex hormones can increase your risk of chronic conditions like osteoporosis, heart disease and some cancers.

 

 

Please treat my depression and not my orange hair

TW mental illness, depression, suicidal ideation.

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It seems appropriate that today is the International Day Against Homophobia, Transphobia and Biphobia and the theme of many of the global discussions focus on mental health and well being. This morning I finally went to my appointment with a trans affirming psychiatrist and will hopefully be getting a bit of support navigating the desolate place that has been mental landscape for far too long.

The following is somewhat of a stream of consciousness and hasn’t been proof read or edited so please bare with my ramblings as I try to get the stuff out of my head before I lose my nerve.

I have hinted at the fact that I’ve been in a bad place recently. Frankly, I’ve been too scared to even begin trying to access psychiatric care because of a really bad experience I had about 2 years ago.

I went to a psychiatrist because post partum depression had turned into a major depressive episode and that combined with a massive trauma had left me suicidal and hopeless. I waited an awfully long time to get to see a psychiatrist who had been recommended as queer friendly by a cisgay psychologist friend.

The fact that there was a TV showing the Kardashians screaming at each other at an uncomfortable volume in the waiting area should have been the first clue that this was not the right doctor for me. I was desperate enough to need to see a doctor and I just couldn’t wait any longer so I stuck it out through the hour and forty five minutes that he was running behind schedule. Finally he calls me in and I am struck by his casual appearance and that his outfit would not look out of place at a trendy club or in an R&B video. He asked me why I was there and I replied detailing my struggles with post partum depression. And this, dear reader, is where everything unravelled disastrously.

Within the space of 15min he had diagnosed me as having Borderline Personality Disorder had shamed me for being depressed and invalidated every aspect of my experience. The way he made his diagnosis by his own words is that he “reads people.”

Want to know what his diagnostic criteria were?
Blue hair – impulsive and rebellious
Deaf – self harm via music (actually degenerative calcification of the tiny bones in my ears)
Unusual gender presentation – rebellious
Tattoos – rebellious
Complained about the TV being too loud to hear the receptionist over the phone – oppositional
Experimented with drugs in my youth (15 odd years ago) – impulsive
Abusive parents – well this is the one thing that actually does fit as an aetiology.

He actually told me that my suicidal depression was irrelevant and that it would sort itself out if we treated the real problems. The real problems being my non normative presentation.

I honestly can’t decided if the issue was homo/transphobia or garden variety misogyny but this doctor had taken one look at me and made assumptions about my mental illness and then looked for things to confirm his gut feel, rather than base his diagnosis on clinical case taking or history.

I left the appointment broken and confused. I sat and cried for almost an hour before I was able to drive home. Looking back, if I hadn’t had the supportive spouse to go home to, and psychiatrist friends, who upon hearing recount of my experience, insisted that his behaviour was malpractice and negligent, I would have probably not survived that experience. I was left unmedicated and unsupported by the very person I had entrusted myself with at my most vulnerable.

Two years…
It has taken me 2 years to work up the courage to go see a psychiatrist again. Two years of battling through depression alone. Two years of clawing my self out of the dark. Two years of falling back in to the pit unexpectedly.

The last 6 months have been hard. We have had major crisis after major crisis. A failed business, financial troubles, freak accidents with our kids, my car being vandalised, a massive betrayal of trust from someone we let into our home, a terrifying health scare, and then the separation from my parents. All of this while I was going through second puberty on T. It all got too much. I stopped T to try cope slightly better with my emotional coping mechanisms no longer turbulent with hormonal changes, but by that point I was so deep and far gone in the grip of mental illness that nothing was helping anymore. Too little, too late.

In the last 2 months, my mind has been a constant litany of “you’re worthless” “you’re a burden” “your family would be better off without you” “just kill yourself” “your function in this family could be filled by a competent au pair” “do it now before your kids are old enough to remember you” “you’re invisible”

“Do it”
“DO IT!”
“WHAT ARE YOU FUCKING WAITING FOR? DO IT!”

And then new words added to that familiar dialogue.

“It’s because you’re trans” “there is no space in this world for people like you” “you’ll never make a living because you’re too weird” ” you’ll never be accepted, look not even you parents can accept a freak like you”

That constant stream of negative thought, toxic internal dialogue and internalised transphobia had me struggling to cope day to day, barely surviving at all in fact.

Finally I reached the level of desperation that was necessary to disregard my fear of psychiatry and I made an appointment.

It has been a couple days of swallowing the fear and nausea lodged firmly in my throat, days of trying to breathe past the panic and calm my racing heart. This morning I managed to walk into the doctor’s rooms, suppressed the urge to run screaming and greeted the Dr with a babbling apology about being nervous and shed a fair few tears within seconds of walking through the door.

She was nice. She used gender neutral language for my spouse and I. She listened intently, asked sensitive and well considered questions, and then after 45min sent me on my way with Wellbutrin, sleeping pills, her mobile number written on a piece of paper in case of aggravations or side effects and a glimmer of hope.

So begins my medication roller coaster. These things are never straight forward, but I hope this time I have someone in my corner to whom I can hand over some of the weight of my mental illness and who’ll carry it for a bit until I’m stronger again.

Now I’m going to nap and hope some of the panic and tention will dissipate.

Wish me luck.