“The trans test”: self-medicating in the trans community

We have seen in previous posts that there is a push to “diagnose” people who question their gender as transgender, and there is a pervasive narrative that the only way to treat this condition is through transitioning. In the majority of cases, this means taking hormones: For females, testosterone; for males, some type of testosterone blocker plus estrogen. This is often referred to as “HRT”, “hormone replacement therapy”. For young people who have not finished puberty, it can also mean to take drugs that block their body’s natural hormones, so-called “blockers”.

In many online trans communities, starting to take hormones is seen as a way to decide whether you are transgender or not. The idea is that if you are really transgender, taking hormones should make you feel better. If you are not, it should presumably make you feel worse, or the same as before.

In this post, a 17 year old asks for advice regarding taking hormones, mentioning this idea of the “trial period”.

Im 17 pre-everything possible mtf.I have heard that for a lot of people hormones were the factor that made them sure of their gender identity and was wondering if a short-term small dose trial period of hrt for confused and questioning people was at all common practice. Im a minor so i still need parental approval but would a doctor even give me a referral?

The very first commenter shares their experiences, saying “I did HRT as a kind of confirmation”. Notice how the commenter admits to lying to their health care provider in order to get a prescription.

I did HRT as a kind of confirmation to what i thought i knew. There isn't really a trial dose that i know of, just whatever your doctor prescribes to start. For me it worked out just swimmingly, though im not sure how being a minor would work since ive no experience there. I will also add that i fudged the truth by saying i was in it for the long haul, as i didn't think showing reservations would factor very well into them giving me the go ahead. Know that if you do what i did, no one is forcing you to keep going if you dont want too.

There is discussion about which effects of HRT are permanent and which are reversible. The original poster, who is 17 years old and not even sure he is transgender, shrugs away the possibility of permanent infertility.

[–]PositivelyClueless probably XY, certainly confused 1 point 2 years ago  Correct me if I am wrong, but apart from breast growth, what are the permanent changes? My (limited) understanding is: Fat will redistribute to male proportions again, muscles will again be easy to build and skin and hair will become coarse again. permalinksaveparentgive gold [–]tossaby queen of swords 8 points 2 years ago  Infertility is the biggest one. permalinksaveparentgive gold [–]transjen [S] 2 points 2 years ago  small sacrifice if it is what is right. i just dont know how to tell

He gets encouraged to “do it” by another commenter, who also gives specific advice on which medication to take.

Do it. I did a similar thing by taking a strong phytoestrogen, but estradiol is probably safer.

More discussion of the “trans test” in this post, where a commenter admits that sometimes the commitment to do something about a condition can trigger a placebo effect. However, in the same post they claim that the effects from estrogen couldn’t have been placebo because they “surprise[d] me every single time i injected”.

Trans woman here. Drawing from my experiences, and starting orally with meds, I recall (this was about twenty years ago, so memory is fuzzy) the relief of just making the commitment to start meds was enough of a placebo effect to feel good about things. It was, however, about a year or two later when I was financially forced into not refilling my meds and having to leave them for a spell when I solidly grasped just how much of an impact that an estrogen and anti-androgen did for me — specifically, my brain. At times, I'd be able to return to one or the other until I was able to afford stuff again; during those times, when I'd be on estrogen only, my brain would feel less like an electrical storm than anti-androgen only or nothing at all). When I started IM injectables, much like the guys here, that's when I'd really notice the impact of estrogen arriving to my brain and body all at once. It was no placebo in that it would surprise me every single time I injected. For the remainder of the first day or two, I'd feel incredibly calm, randy and, inexplicably, attractive (n.b., I'm no looker). This would wane until the next injection. I returned to oral after taking care of gonadal removal. So I don't know. I wasn't being monitored with a portable EEG while all this was going on, but I do think that if the stria terminalis[1] in the brain's bed nucleus (BSTc) is what primarily responds to sex hormones, then for me at least, there is absolutely no question that the BSTc in my brain responded very poorly to testosterone and has consistently responded very well to estrogen. As to what estrogen did or did not do for my body, that came secondary (though an important secondary) to this. Hope this helps. tl;dr: To answer your question, I do think a trial of exogenous hormones are an indispensable metric for determining neurological suitability to hormones not produced by your body — especially when this is in doubt for a trans person just beginning their transition.

This commenter attributes a sudden liking of taking care of their hair and skin and being able to “feel colors” to hormones:

Lets see, after HRT: * I could cry for the first time since being a child * I could "feel" colors * I could smell new things * I had much more empathy * I needed to "be" with other people * I became much more comfortable with who I was * I wanted to talk a lot about what I was feeling * I was happy for the first time in my life on a daily basis * I started liking taking care of daily things like hair, skin, etc. * After a while on HRT my sex drive stopped controlling me. The changes from HRT are really profound.

More praise for hormones:

With many of the mental changes I've experienced, I don't know if they're a result of the hormones or a result of feeling so much better about myself by being myself and not letting other people hold me back. It does make a world of difference, for sure, to be taking these pills. I cry more freely (I was always frustrated at being unable to cry pre-hormones) but that's the only mental/emotional change I can pinpoint as almost certainly hormone-related. That being said, my mood has improved enormously and I absolutely place those changes starting at when I began taking hormones.

We see the idea rehashed again and again that taking HRT is a way of confirming your trans-ness, together with the constant praise of how great hormones can make you feel. In fact, the people in these communities are often quite quick to suggest hormones to young questioners.

This poster asks: “am I trans?”

I’m a 17 year old gay human of the male variety. That is, I’ve got a schlong. And that’s where my maleness stops. My behaviour as a child could be seen as a gender identity issue, or just plain old gayness. I used to play with my sister’s toys and dress up in her clothes. I’ve never identified with guys, I hate most male related activities. (Sports, cars, etc.) Through my preteen years I constantly dressed up, always assuming female roles in play. As a teenager, I have dressed in female clothes a few times, and it felt much more natural to me. I’m fairly “straight acting” in that I don’t flap about much when I talk and I’m not too sassy, I’m not like the gay stereotype. Around close friends however I am extremely flamboyant. Anyway, back to the question, am I trans? Reasons why I think I am: •I feel more comfortable in female clothes. •When I visualise my future, I see myself as a female. •I feel like I identify more with females.

Reasons why I don’t think I’m trans: •I don’t have the stereotypical hatred for my male body, sure I have had issues withwith self confidence etc but I’ve never felt like my junk was alien. •These feelings don’t overwhelm my brain. They’re subtle, niggling at the back of my mind.

This is a gay male who is extremely preoccupied with stereotypical gender roles. What do people suggest to him?

Try hormones!

Go to an informed consent clinic, get your blood tested for hormone levels, demonstrate reasonable knowledge of the effects of HRT, get a prescription.

Try hormones!

Then if you're uncertain, maybe seek out a therapist who can help you figure things out. If you're sure, then maybe look into informed consent. MTF hormones don't immediately cause permanent changes, so you can try them out for a couple weeks or a month to decide if they're the right choice.

The problem with using any kind of medication as a diagnostic tool is that there is no way of knowing how much of the effect is due to placebo. And especially problematic is the tendency for online trans communities to advice people to start taking hormones completely on their own, without medical supervision. Since you usually can’t “just try” prescription medications, they give each other advice on how to circumvent the medical practitioners and obtain the medications on their own.

Watch as they tell a suicidal 15 year old how to obtain hormones without his parents knowledge and without medical supervision:

I was in a similar situation when I was 16, and I ended up getting a PO box (and also trying to castrate myself, but I wouldn't recommend it - you'll want that material for GRS, if you plan on having that). I had a friend drive me after school - I think it was $42 a year, and I had to show two forms of ID (school ID counts). A signature is required to pick up the meds, so they'll place a notice in your box telling you to go to the counter (I saw you asking about it). No, they don't know what's in there, and no, they don't care.

They tell him to omit mentioning his suicidal thoughts to counselors:

I cannot say for sure because I have not ordered from inhousepharmacy before. If I had to guess I would say x-small or small. i would think that the canisters are about the size of a canister of ibuprofen. You bring up a good point about the counselors. you might be able to find a gender therapist who will work with youth without the knowledge of their parents. you don't have to tell counselors you're suicidal either. But i think what your parents are doing is very harmful for you and they need someone to make them realize that.

When a 14 year old posts wanting advice on becoming more feminine, this is the advice they get:

Start hormones, grow your hair out, thin your brows, wear makeup, etc... the usuals.

(note to readers: we are not linking directly to this post to protect the poster’s privacy).

“If you really want them there are ways of getting them”:

you have a very feminine face. order your hormones in the mail, if you really want them there are ways of getting them.

They get told they’ll pass once they start “DIY” (do it yourself) hormones:

omg you're adorable To be honest you'd probably pass with a wig + less bushy eyebrows + more girly clothing. Once you get to DIY, you'll look cis in, like...months, unless you can't DIY for several years for some reason.

In another post, the same kid gets told to “DIY secretly”, by befriending an adult transgender person in their area. Just DIY secretly. Make friends with a transgender who lives near your area and ask them to help you get hormones. Even if you can't find any, I'm sure you can find someone who has a credit or debit card, then you can get it online which costs less than $1/day. Your allowance should definitely be able to cover that.

A fourteen year old kid befriending adults for favors. What could  possibly go wrong? Taking prescription medication without medical supervision, what could possibly happen?

HRT is seen as not only necessary treatment for transgender feelings, but it is also a diagnostic tool, and one that people are encouraged to try out on their own. What happens when HRT does not make someone feel better though?  Does that mean the person wasn’t really trans?

This poster reports feeling worse since they started taking hormones:

Before I started I felt dysphoria but now it’s in overdrive. 

Apparently this is normal according to the replies they get. “The further you get in your transition the more dysphoria you feel”.

So, it's not unlikely that the further you get in your transition the more dysphoria you feel. Way I see it is that transitioning is partially about discovering how deep your dysphoria goes and then solving it in a positive, self-affirming way. Well, that and a fresh start, happiness and pretty clothing ;) You can pretty much bet that you'll hit a point where the dysphoria goes away, though. Stick with it, you'll be fiiiiine!!

It gets harder before it gets easier:

 started HRT a year and a half ago. I promise you like anything, it's going to get harder before it gets easier. My good friend is right about where you are now, and her dysphoria has gotten much worse. Just hang in there.

Another poster who feels worse after starting HRT

Feeling like total shit after starting HRT 

I feel almost as bad as ever:

I’m a couple of months into HRT, and I’m feeling almost worse than I did before I started. I look terrible, I hate everything about myself. People keep telling me that I look good, or that they love my eyes, or my hair, or whatever the fuck else, and I don’t believe them, and not believing them makes me feel worse than if they said nothing.

It gets better, right? I’ll stop crying and snapping at my friends? I’ll feel good about myself maybe at some point?

At no point does anyone suggest to any of these posters that maybe they are actually not trans and that maybe HRT is the wrong choice for them. It’s always “wait”, “try more”, “change your dose”, “hang in there”.

The answer is very probably yes to this, at some point you'll feel more balanced and better and be less snappy. I'm only about 8 months in but I recall the first few being kind of emotional times and then I felt a lot more chilled out and less emotionally volatile after about 4 months or so once my body had adjusted a bit better and gotten used to having way less T and much more E (although I was still tweaking the dosage up then). The only advice I've got is do your best to take compliments about the little thing and specific features, and get used to saying sorry to friends of yours, I find people are forgiving for a good few months at least, going through this kind of thing is kind of a big deal really. Good luck with it, hope things even out for you soon.

This is the huge problem with using a medication as a diagnostic tool without medical supervision, and it’s a recipe for disaster. First you create a narrative where any sort of questioning of your feelings about gender roles or your body means that you are trans. Then you plant the idea that being trans is something that needs a specific type of medical treatment, and you actively encourage people to experiment with this medical treatment to “see if it’s right for them”. If you’re truly trans it will make you feel awesome! Then when people feel worse instead of better, suddenly that’s not proof of not being trans at all, it’s just proof that they need to take HRT longer or adjust their dose.

4 thoughts on ““The trans test”: self-medicating in the trans community

  1. I identify as a transgender person. I have been researching hrt for months and this has not been my experience at all. All the top forums have strong rules against giving specific instructions for self medicating and almost everyone advises against it. Granted there are people who argue for it but you will always have fools, and fools who fallow them.
    But even in the anti-self medication majority there is an understanding that not everyone has access to knowledgeable therapists and doctors. Many trans people reach a point where they are so unhappy about their gender and feel so uncomfortable in their bodies that they feel life isn’t worth living if they don’t move forward, and for most people relocating is beyond their means. At that point the person may feel that a potential stroke is less dangerous than an inevitable bullet. after all if you’re facing death even a few more years is an improvement. Under those circumstances you’re always going to have people who self medicate, so anyone who says they have chosen to self med in spite of the risks are advised to educate themselves about warning signs of complications and at least get blood testing done through private means and preferably see a general practitioner and inform them you’re self medicating so you can have your blood tests reviewed by a doctor.

    I also haven’t found that people are pushing hormones as a test or filter to decide who is and isn’t trans. It’s generally accepted that trans people are all individuals and some take hormones but never have surgery or socially transition, some fully transition without ever wanting hormones and there’s a million variations in between. The idea that if you don’t transition or take hrt than you’re not trans is an old theory that pre-dates most of the neurologic research about GID.

    The only thing trying hormones can tell you is if hrt is right for you. It’s true that hrt can be tough at times and it takes some willpower to adapt but if the psychological changes feel right then the hormones work for you. If hrt makes you feel anxious or uncomfortable then it’s fine to stop and transition without them.

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