Editor's note: This article is not medical advice. Consult a healthcare professional regarding questions about diagnoses and treatment.

I started hormone replacement therapy in April, the same day Arkansas passed the first trans medical ban in the United States, barring trans youth from accessing gender-affirming care.

With the heaviness of the wave of anti-trans legislation on my mind, I felt fortunate to have access to an endocrinologist after nearly a year of back-and-forth with insurance and several attempts with less trans-competent doctors.

I wanted to start testosterone-based HRT to treat my lifelong gender dysphoria, or extreme distress related to my body and gender, that has affected me as a transmasculine nonbinary person. I started testosterone therapy to deepen my voice, make myself a little more muscular, and overall become more comfortable in my body.

As someone who has insurance that covers gender-affirming care and lives in a major city, I am incredibly privileged.

I microdose HRT, meaning I take a smaller amount of testosterone for more gradual changes over a longer period of time. When I told my endocrinologist in New York City that I wanted to stay on a microdose long-term, he said he could write me the prescription but had to be transparent about the lack of research available on it. When I asked him what changes I could expect for my body, he told me he didn't know, even after I pressed for more information.

The only place I've been able to turn to for concrete answers on how to achieve the results I wanted like a deeper voice and larger muscles was online platforms like Reddit.

Hormone replacement therapy as a form of treatment for the gender dysphoria that trans people experience has been around since the 1920s. But treatment protocols have been slow to shift.

Because of a lack of research on the effects of different HRT options, even trans-competent medical providers are left with few concrete studies to cite when patients ask questions, and physicians receive few hours of LGBTQ+-specific training.

One of the first questions I asked my doctor was which kind of injection I should opt for to get the most dramatic effects, which for me included a deeper voice, more muscle definition, and fat redistribution.

While small studies have suggested that subcutaneous injections (injection into the fat) could help retain testosterone in the body for longer between shots, my doctor told me there wasn't enough conclusive data to confirm this. I ended up opting for intramuscular injections and was dissatisfied with how long it took to see physical changes.

In the first month of taking HRT, the skin around my jaw thickened. When I went back to the doctor and asked how long it would take for my jawline to reemerge, he told me there wasn't enough research out there for him to give me a timeline.

Puffy-faced and feeling lost, I turned to the internet for understanding.

My friends who had started HRT before me recommended going on Reddit to find specific answers about where I should inject my T for the most effective results.

There I found several subreddits, like r/FTM and r/genderqueer, where people shared similar concerns and got their questions answered by a community of trans people who had taken testosterone. That's how I found out about the small study suggesting subcutaneous injections could keep testosterone in your system longer than intramuscular injections. So I switched, and I am much happier with the results.

My only sense of understanding about my body during this process came from other trans people willing to share their experiences with HRT.

Even close friends who have been on testosterone have been more helpful in some ways to my transition than my doctor.

One of my friends has a more radical endocrinologist willing to talk about experimental treatments that have anecdotally worked on patients, so I often chat with them about what they've learned so I can take questions back to my own doctor. My other friend lives on the internet and can name trans subreddits at the drop of a hat, so they offer their knowledge.

My friends and I doctor one another in many ways, trading information like playing cards.

Trans Reddit forums became a haven of support for me when so many of my medical concerns went unanswered through official channels. While I can only take the experiences of others with a grain of salt, they have been a huge comfort during a nerve-wracking process.

Continued here:
I'm trans and take testosterone. Reddit helps more than my doctor. - Insider

Before starting hormone-replacement therapy, Simon Moore, 27, thought hard about what effects they wanted to get from testosterone.

While they had always wanted a deeper voice, they didn't want all the added muscle and hair growth that sometimes comes with a full, longer-term dose of testosterone-based HRT. Like a growing number of nonbinary people, they decided a microdose would offer a slower transition.

"There is less emotional roller coaster. The vocal cords thicken slower and more gradually," Moore said.

Moore, who is nonbinary and trans, grew up in Moscow and moved to the US with their partner in 2019. They were able to access HRT for the first time in January through Plume, an online transgender-health service, they said.

It's been seven months since Moore started testosterone (commonly referred to as "T"), and they have decided to wean off it.

"I'm not really a 'trans man.' I never really wanted to be full-on masc, like go to the gym, get ripped, and get the whole beard," Moore told Insider. "I wanted something in between. I wanted to be comfortable."

Transition is often portrayed as a linear journey that has a clear beginning and end.

But many trans people go on and off hormones for a number of reasons, such as access to care, a desire to get pregnant, medical complications, or contentment with the results of HRT they already received.

Insider spoke with three trans people who have gone on and off HRT at various points for medical or personal reasons.

A popular misconception perpetuated by TV shows, films, and general misinformation is that being trans means someone needs to "medically transition," or get gender-affirming medical procedures, to be seen as valid.

The idea that gender-affirming care is one size fits all and people stop HRT only because they regret their decision is often used as a political argument to justify anti-trans medical bills that suppress access to medical care for trans people.

There is a small and vocal group of peoplewho have "detransitioned" and actively say they are no longer trans. But research suggests a majority of people who stop HRT do so for other reasons. Some trans people never take hormones at all.

"Nobody needs to be on hormone therapy. Nobody needs to undergo any medical, surgical, or other procedure, or even therapy despite what people have told us for many years to be trans," Dr. Jerrica Kirkley, the medical director for Plume, told Insider.

Stopping treatment doesn't make a person not trans, Kirkley said.

Like many young trans people who grew up with little trans visibility, Moore as a teen relied on YouTube videos on female-to-male transition to get information about gender-affirming care.

But Moore decided they wanted their care to look a little different.

On their YouTube channel, Moore blogged their personal HRT journey.

Rather than taking the standard 0.5 milligrams of testosterone every week indefinitely, Moore decided to microdose 0.3 mG of testosterone a week for just seven months.

Moore then stopped microdosing once they got a deeper voice. (Certain effects of testosterone, like facial hair and a deeper voice, are permanent, while others, like building more muscle, are not and require consistent doses of T over time.)

Moore is happy with their results. They told Insider that while they were stopping, they were open to the idea that what their future desires could differ.

"I think a lot of people kind of want you to pick a label, stick to it, pick a journey, stick to it," Moore said. "I don't need to."

Tuck Woodstock, a 29-year-old journalist, host of the "Gender Reveal" podcast, and cofounder of Sylveon Consulting, started testosterone in July 2020, four years after he came out as nonbinary to close friends and family.

As a gender educator, Woodstock knew testosterone was a resource for years before they made the decision to go on it.

"The reason that it took four years for me to start testosterone is because it took four years for me to want to start testosterone," Woodstock said. "It was very much, for me, an incremental journey where the way that I thought about my own gender inched very slowly away from womanhood."

Woodstock added: "Because that process was gradual, it took several years before I was interested in physical or medical transition, which I recognize is very different than most people I know who came out as trans nonbinary, trans men, and immediately started testosterone. That was not my experience at all."

In the past year and a half, Woodstock has stopped and restarted testosterone three times. This is partially because of being a podcaster and musician who relies on their voice heavily.

"When I hit a certain level of testosterone in me personally, it changes my voice so rapidly that it becomes harder to sing at all," Woodstock said.

In addition to giving their voice a break, Woodstock also wants to take time to relish the changes his body is going through while on testosterone and likes to take breaks.

"I think it's nice to take a moment and regroup because these changes often are at least semipermanent," Woodstock said. "And I like to make sure that I have a moment to spend in this version of my body before I progress on to a later version. It's not so much that I don't want them to actualize but that I want to enjoy every single moment of this journey individually."

Kayden Coleman, a 35-year-old trans medical advocate and educator, started taking testosterone in 2009.

While he was really excited about the changes that happened in his first year on T, he said the weekly shot became more of a hassle, especially once certain changes, like hair growth and voice deepening, plateaued.

A post shared by Kayden X Coleman (He/Him) (@kaydenxofficial)

Coleman stopped taking testosterone twice. The first time was after a surgeon told him to before he underwent top surgery in 2013, though he has since learned that may not have been medically necessary. The second time was in 2019, when he moved states, briefly lost medical coverage, and became pregnant.

"With testosterone, that first year is like, you cannot wait to take your shot because all these changes. Then, you kind of get to where you are, and you're like, 'OK, I'll take it next week,'" Coleman said. "Or like me, you'll get needle anxiety and really put it off."

When he stopped taking testosterone, he said he didn't experience many negative effects. Because Coleman already had a full beard and low voice, which are permanent effects of testosterone, he said going off it didn't change many things physically.

But he said he felt a lot more emotional going off T.

"When I'm not on testosterone, I'm like all over the place," Coleman said. "Testosterone kind of keeps me at a more level headspace."

The way gender-affirming care is framed as a journey with a clear beginning and end point, Coleman said, harms trans people because it makes it seem like care needs to look the same for everyone.

"Trans people should feel free enough to start and stop hormones as a form of self-care," Coleman said.

"If I want to try for a baby, I should be able to," he added. "If I just don't feel like sticking myself in the thigh or butt cheek or arm or stomach with a needle for the next few weeks, I should just be able to not."

Read the rest here:
You don't have to constantly take hormones to be trans - Insider

Source: |Updated: Nov 05, 2021, 08:40 PM IST

It is a misconception that menopause affects only women. Globally, men are also victims of this hormonal disorder. After a man reaches the age of 30 years, his testosterone levels gradually decrease, falling an average of one per cent each year. But in India, unlike women, men suffering from menopause take it as stigma and shame on their manhood and do not seek medical help to overcome it.

While in advancing age, women fear menopause and consider it as a normal hormonal change that takes away their womanhood. In western countries, some women opt for Hormone Replacement Therapy (HRT). Hence, HRT is seen as one treatment option for men menopause too. However, experts recommend raising awareness on lifestyle modification to overcome men menopause and suggest avoiding rushing to HRT.

Dr Kishore Pandit, IVF & Fertility Specialist says, Like women, men also undergo menopause, called-Andropause. Medically, we describe it as ageing-related hormone changes in men. When a mans testosterone levels decline on average about 1% a year after age 40, it leads to menopause among men. It is considered a stigma and shameful so men avoid treatment. Hence, we have to increase awareness about the same.

Experts do consider HRT as an option for treatment for menopause both in women and men. The fertility of men is affected by menopause. However, the experts do not believe that the natural, age-related drop in testosterone levels is to blame for male menopause symptoms. There isn't enough data to classify male menopause as a diagnosable medical illness. Hot flushes, impatience, fat build-up around the abdomen and chest, loss of muscle mass, dry, thin skin, and excessive sweating are all possible symptoms. The most prevalent symptoms of male menopause, according to a study published in the New England Journal of Medicine (NEJM), are decreased libido, a lower frequency of morning erections, and erectile dysfunction. As a result of the decrease in male hormone levels, depression and weariness may develop.

According to Dr Archana Dhawan Bajaj, Gynaecologist, Obstetrician and IVF Expert, menopause is a progressive event. It may be visible at the age of 50 and affects people individually depending upon their health conditions. Menopause in men does not manifest in the same way that it does in women. On the other hand, it can have an impact on fertility. Hormone replacement therapy can be explored as a treatment option if testosterone levels are dangerously low, adds Dr Bajaj.

Experts say that fertility in men is influenced by several other factors such as low self-esteem, lack of sexual drive, a sense of incompetence or being old. Hence, it is very important to make men aware of it.

Dr Kishore recommends taking good, regular, long walks, training gently but regularly with weights, eating a low-carb, high protein diet, getting a good eight hours of sleep every night, avoiding stress and overcoming addictions- like alcohol and smoking.

Overall, lifestyle modification and dietary changes can make this transition easygoing. The role of Hormone Replacement Therapy in this is still uncertain, he emphasizes.

The experts also emphasize that one should always consult a well experienced and qualified expert before opting for any treatment options including HRT. According to them, menopause poses a health threat to men and it should be taken seriously so that men get the support they need.

Original post:
Male Menopause: Know what it is and how it affects male fertility - DNA India

Weve never been more open about menopause. High profile women from Davina McCall to Mariella Frostrup are making books, films and podcasts, and campaigning to improve life for women at this stage of life.

Last week saw a bill before Parliament seeking to make hormone replacement therapy (HRT) more affordable. The move has been welcomed by women and doctors up and down the country, many of whom say HRT, for so long a dirty word, is a life-changing treatment that should be more widely available. But should everyone take HRT and what do you need to know if youre considering it?

The menopause defined as happening one year after your last period occurs on average at the age of 51 in the UK. But the peri or pre-menopause, when youre still having periods but are no longer likely to get pregnant, can also bring weird symptoms that accompany major hormonal shifts.

Im 49, and for the past couple of years, my usual mildly annoying PMS has ramped up from a couple of grumpy days a month to at least a week of sobbing, yelling and generally feeling that life is a wasteland of despair.

Last winter, I finally called my GP to ask whether I could be prescribed HRT. The first doctor I spoke to (male) suggested a coil, which I didnt want (I assure you, its the sensible option, he said, testily.) Then I spoke to a nurse who was a somewhat better listener, and suggested a combination of oestrogen gel and 2 weeks a month of progesterone pills.

But after several months of this combination, I found myself feeling much more stressed and depressed than usual. It seemed to me to coincide with the weeks when I took progesterone, and online research suggested a possible link.

Studies show progesterone can trigger the amygdala the threat system in the brain, which releases stress hormones. Experts say HRT, and especially progesterone, can sometimes have an effect on mood though the causes can be complicated.

There is certainly a significant minority of women who find their mood is negatively impacted by progesterone, says Dr Hannah Short, a GP and specialist in menopause and premenstrual disorders. Either their own, released during the post-ovulation phase of the menstrual cycle, or by the progestogenic component of HRT.

If a woman is sensitive to the synthetic progestogens in some hormonal medication then these symptoms can be experienced whenever she is taking them, with low mood, depression, anxiety, rage, tearfulness and in severe cases suicidal thoughts, she explains.

Experts say that side-effects such as mood changes are more likely when a woman is given a synthetic version of progesterone, rather than a body identical or natural type, which is chemically identical to the hormone your body produces naturally. Both types can be prescribed on the NHS.

When women are on conventional HRT, which contains a synthetic progestogen, it can cause mood changes, high cholesterol and depression, says Dr Jan Toledano of The London Hormone Clinic.

The real hormone is recommended by the British Menopause Society, and has exactly the opposite effect to synthetic progesterone, she says. Its actually the bodys happy hormone. Its anti-anxiety, helps you sleep, and protects breast tissue from abnormal changes.

Tania Adib, consultant gynaecologist and head of The Menopause Clinic at The Lister Hospital, agrees that side-effects of HRT are usually caused by synthetic progestens. The structure of the hormone is not exactly the same as the kind the body produces, so its associated with a greater number of side-effects, she explains.

Some women react with bloating, weight gain, headaches and depression, she adds. Using a combination of bioidentical oestrogen, progesterone, testosterone and DHEA, I can usually find a combination which suits the patient.

I was not taking synthetic progesterone, however so what was making me feel depressed? According to Toledano, in my case it may have been the oestrogen. She says if youre still having regular periods, youre still producing enough oestrogen and probably dont need it though many perimenopausal women are wrongly offered it.

Unless youre actually menopausal, you may only need natural progesterone, she says.

I am indeed feeling better since stopping taking the oestrogen, though for some women, the hormonal havoc proves too much and quitting seems easier than experimenting further.

I was prescribed norethisterone (a synthetic progestogen) several times between 2018 and 2019 to stem my constant periods, one of which was so bad I took myself to A&E, says Lucy Sweet, 48, a writer from Glasgow. It made me feel terrible tearful, depressed, highly anxious and at one point, during a holiday in Spain last summer, I started having thoughts that everybody would be better off without me.

Not surprisingly, Sweet stopped taking it and has since discovered her heavy periods were due to a polyp. But she would not be tempted to try HRT again, she adds. There are still very few treatments for women in menopause that are suitable for everyone, and synthetic hormones are the absolute worst.

Short recommends speaking to your GP before stopping HRT or changing the dose. It can also be worth discussing your earlier hormone history, she adds. Any experience you had with the pill can be relevant, or whether you have had premenstrual syndrome or the more serious premenstrual dysphoric disorder. If you had symptoms of post-natal depression, that can mean HRT may have more negative symptoms.

But, she points out, that doesnt mean you cant be helped. I have found that there is a very tiny handful of women who cant get on with any type of HRT; about five per cent or so.

Amid the current debate about improving treatments for the menopause, some women who missed out on early HRT may be wondering if they are too old to try it now.

There are more benefits to starting younger and slightly increased risks if you start later in life, says Short. But there is no hard and fast rule. All HRT should be on a case-by-case basis; I have patients who started in their 70s; one doctor told a menopause conference that they have a woman of 104 still taking HRT.

That also clears up confusion about how long you can take HRT for. There used to be a guideline of no longer than five years, but now its down to individuals; as long as benefits outweigh risks, there is no reason to stop ever.

The menopause revolution and the liberation of HRT is something to be celebrated, but its important to remember that were all very different and with HRT, one size does not fit all.

Says Adib: Every woman is unique, with a different experience of the menopause, and requires an individual approach.

Here is the original post:
HRT made me depressed here's what you need to know before you start taking it - Telegraph.co.uk