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Transfem @lemmy.blahaj.zone
dandelion @lemmy.blahaj.zone

how to cope mentally during gaps in HRT

I recently had an injection that seemed to go wrong (CW: blood, I inject EV subq and I hit something like a capillary, there was a lot of blood and it bruised badly afterwards). Within a couple days I felt unusually dysphoric as a result of what I assume was a failure for the oil to depot and slowly release over time.

I get these "dysphoric thoughts" that maybe the estrogen is causing the problems, that I don't have objective proof that I'm trans, etc. Lots of doubt, paranoia, and increasing amounts of anxiety and irrational fear (about transition, but also in general, e.g. thinking spiders are in my bed), and I start to experience depression and anhedonia (things aren't as pleasurable, everything feels pretty flat emotionally, I just feel "bad").

Of course when I inject again and it goes well, I feel much better and I forget about these problems.

I was just wondering if anyone has advice on how to deal with dysphoria when there are gaps in the HRT. Obviously in the long term, surgery will fix the hormone issue and I suspect that will fix this problem. Until then, though, I am stuck in a rather fragile place where I feel normal (even good, even amazing) when my estrogen levels are high and suppressing my testosterone. Any small slip in that and I barely function as a person.

Before HRT I would just do whatever I could to increase mental well-being:

  • physical exertion (aerobic exercise, weightlifting, etc.)
  • going outside and getting sunshine
  • keeping up with hydration
  • keeping good sleep hygiene (sleeping enough, going to sleep at the same times, etc.)
  • meditation every day

But now it feels harder for me to "bootstrap" when there are gaps in HRT and my hormones aren't right, it's like I'm no longer used to how hard it was before.

Anyway - any tips or thoughts, would like to hear other's experiences.

21 comments

  • I used to have really bad mood swings that included lots of dysphoria. I made the soonest appointment with my doctor and brought this up to them. They changed the frequency of my injections to be closer together. This worked for me really well.

    Alternatives could be different delivery methods like the patch or pills to help reduce the fluctuations in estradiol levels.

    Stay strong girl friend 💜

    • Ah, that's definitely a good idea. My endo initially told me to inject 5 mg estradiol valerate every 10 days (I chose to inject subcutaneously). I couldn't last longer than 8 days, the dysphoria got so bad (I started to wonder how I possibly survived without HRT for so long, it really seems insane to me how I used to live).

      I changed to every 5 days with 5 mg, but I kept lowering my dose (I was afraid of my endo forcing me onto a lower dose if my blood work showed too high E levels). I tried lower doses more frequently. All in all, lower doses were a mistake, I kept having a few days of horrible-ness in the trough. Eventually I went back to 5 mg every 5 days, and found around day 4 I started to feel weird, so to avoid issues I started injecting 5 mg every 4 days.

      I know the half life is supposedly every 3.5 days, and I'm essentially relying on the estrogen to act as the anti-androgen (bicalutamide didn't seem to have any effect on my mood, positive or negative, so I stopped using it), so I'm intending such a high dose, I'm just not sure what those upper limits are or when I might be taking too much.

      On the one hand, more frequent but a lower dose (even 4.6 mg) seems to have less of that anti-androgen effect that 5 mg has, and it feels less euphoric (mentally, I mean - estrogen sometimes feels like a recreational drug). On the other hand, less frequent doses means unevenness and potential troughs where things get dicey. I think as long as my injections don't fail (like when I injected into a vein or capillary), it seems like this dose / frequency works well enough for me. Still, it's a bit concerning that my basic functioning is so fragile, I wish I had better coping strategies.

      For example, I wonder if anyone uses gel in conjunction with injections, or if anyone injects a partial dose when it seems like something didn't go right. I get the impression this just isn't as frequent of a problem, I've never heard that hitting a capillary caused such dysphoria as a result.

      Another factor: I started HRT three months ago, so it could be that my body more easily slides back to testosterone right now and I just need to get over this initial transition to a new hormone regime.

      Thanks for reading my post and for the suggestions! 🥰

      • I changed to every 5 days with 5 mg, but I kept lowering my dose (I was afraid of my endo forcing me onto a lower dose if my blood work showed too high E levels).

        Something to think about in terms of your estradiol results is how long it's been since your last injection. I've had several providers tell me they don't care how long it's been since my last injection, they just want to see. I push back that and only let them draw when it's a true trough sample (e.g. I inject every 7 days, so I have blood drawn on that 7th day before I inject). This will give you (and your endo) a truer value to base your dosages/frequency on.

        (bicalutamide didn't seem to have any effect on my mood, positive or negative, so I stopped using it)

        I had a similar experience to bicalutamide, but I kept taking it up until my orchiectomy. I tried spironolactone, but I didn't like the results. If you're not in the US, ask your doctor about cyproterone acetate. That stuff made me feel levelheaded; sadly because I was self medicating I had to stop when I began seeing a professional.

        Another factor: I started HRT three months ago, so it could be that my body more easily slides back to testosterone right now and I just need to get over this initial transition to a new hormone regime.

        This definitely sounds true. Based on my experiences, the first several months had ups and downs (hormone-wise). When those lows hit you, talk to a therapist, hangout with a friend, do a mini-fashion show in your room, go for a hike. The lows will pass; things definitely get easier. 💜

  • Whenever I get dysphoric thoughts, I counteract them with euphoric thoughts, such as how happy I was when I started HRT or when I changed my name. I take pills and I still have days where I feel dysphoric and shitty although they are getting rarer.

    I do get the dysphoric thoughts too about not being trans and that I'm actually just a man pretending to be a woman, but for me I think that's part of religious trauma I have from being put in a sex separated catholic school program for most of my childhood. I think that understanding why you have dysphoric thoughts is a key part to figuring out how to conquer them. Society is very cisheteronormative, especially in rural and religious areas, which makes it easy to feel like there is something wrong with us being trans, when really there isn't.

    Idk how long it takes to work through those feelings of shame, doubt, and anxiety about who I am. I've been working at for years and I feel like I've made decent progress but sometimes bad old memories resurface and then dysphoria comes and hits me like a truck. I always use my technique of thinking of euphoric memories, which does help, although I don't know how to make the dysphoric thoughts stop entirely.

    I hope that you feel better soon! Dysphoria sucks ass.

    Edit: I noticed that you recently started HRT and sometimes your brain adjusting to the new hormones can cause depression and such. I had issues like that as well until I reached about 6 months. Before that point I had a few days where I could hardly function and even exercise didn't help.

    • Yes, I do think because I'm still only on month 3 of starting HRT that it seems like I slip back into testosterone production easily, and that seems to correlate with the mood issues. I have been careful and conservative with my estrogen doses until recently (I consider 5 mg EV injected every 4 days a rather large dose for that frequency).

      I do live in an extremely conservative place, and I live in a city surrounded by rural areas and lots of people here come to the city to work their jobs but live in a rural place. I was raised here, and I have internalized a lot of transphobia. My father was also maybe repressed or closeted, we don't know, but for whatever reason he was rather fragile about his masculinity and used violence to keep me from even doing normal gender exploring as a young child.

      I think the dysphoria I feel in these gap periods seem to make it hard to connect with gender-euphoric thoughts, but I think it's a good idea - maybe I can journal about all the times people have given me compliments or all the times I have been affirmed by people when I least expected it. The reality is that most people have been extremely supportive of me.

      Thanks for the help!

  • I haven't had hrt yet and it sounds like you're describing my life. I'm not functional at all, and I have no clue what to do to be functional. The only thing I can do is use discipline to play pretend, but then again that makes no sense because I don't feel connected to my life. I just kinda manage a little at times because I don't want to hurt the people around me.

    • Yeah, before HRT my life had two modes: stress and depressed. I preferred stress, it gave me agency and movement and made me feel alive. I think it's part of why I became a workaholic, the stress of work became addictive and necessary to me.

      I didn't know how HRT would impact me, but I was shocked when I read about "biochemical dysphoria" in the Gender Dysphoria Bible. I became hopeful the HRT would help. The first two days after my first injection it wasn't clear to me how I felt about estrogen, there were mixed feelings. By day 3 I think the testosterone was starting to get suppressed and I became euphoric and that's the first time I would just lay there and feel delicious euphoria all over my body. I felt high, like I had taken drugs. It was delightful. I took that as a good sign.

      I was surprised at how much estrogen changed my life. I have struggled to create stability with HRT, but in the periods where my hormones were right (I am guessing), I become much more able to handle everything. It suddenly became easy to do things that felt impossible before. I have a garage full of clutter that has built up to the point where I can barely get into my car anymore, and every time I need to drive out of the garage I have to move a bunch of items out of the way to make room. One day, just during breaks from my job (working from home), I was able to significantly clear out and organize the clutter. Something I wasn't sure would ever happen.

      I was suddenly finishing projects that I had sat on for years. It just became easier, more matter-of-fact, and less stressful. There was a kind of stress, but it didn't take the same toll. Some when I would plan meals and go grocery shopping. Before HRT doing that would take up half of my day and would leave me completely drained afterwards, I would barely be able to put up groceries when I got home. Now with HRT I can feel the stress, but when I leave the store it doesn't wreck me, I even have energy do other things after putting up the groceries.

      Before HRT I could sleep 11 - 12 hours every night and still not feel that energetic. With HRT I sleep more like 6 - 8 hours and wake up rested and with more energy than before.

      It is a huge change for me.

      But my story shouldn't set any expectations for anyone. I don't think being trans is a monolith, and the causes of dysphoria which I believe are likely both social and biological in nature are probably multiple or quite complex. I have read a study which found a correlation between left interior parietal cortical thickness (Cth) and reported congruence with self and body (for both trans men and trans women, by the way - the Cth in cis controls different in the same ways from trans people regardless of whether they were trans men or women). The study compared baseline levels before HRT and after taking HRT, and what I found interesting was that some trans study participants after HRT actually had both thicker Cth and increased reported incongruence between self and body.

      So while HRT is helpful in many, many cases, it's not guaranteed that a person suffering from gender dysphoria will respond to HRT the same way as others. There might be more complicated mechanisms that explain this that we don't understand yet. Some trans people don't find HRT helpful and that's OK. Some people try HRT and find it doesn't make a big difference mentally, but they take it for the physical transformations.

      My primary goal in taking HRT is to improve my mental health, above and beyond the transition.

      I feel constant pressure to know whether the HRT is helping, to know whether I'm "really trans", and so on - but ultimately even if the HRT didn't work for me, that doesn't necessarily invalidate my "transness". So take my account with a grain of salt, it may or may not happen for others. Lots of people start HRT and experience more depression or anxiety (esp. if there are other things going on in your life that are creating stress or might cause that depression and anxiety, and transitioning is definitely a such an event for most people).

      Whatever struggles you are having, I hope you find a way to cope and even overcome them! I ultimately transitioned and took transitioning seriously precisely because I was hurting the people around me by not doing so, I realized I needed to be more self-compassionate so that I could be a good person (whereas before I felt my welfare should come last, and I wasn't sacrificing enough to be a good person). I can really relate to the struggle, and I'm so sorry you're going through that.

      • Thanks for your story, I think I might show it to my gp in the hope of getting the signature I desperately need. Because it is exactly how I feel too.

        Weeks ago I tried hrt from a friend for a month. It had a fundamental effect on my psyche. It was as if I was meditating but without any effort. From waking up to going to sleep, it was absolutely solid.

        And once the end of the meds was in sight, I knew what was ahead of me. To get back in the cage and to forget the feeling of life. I remember it in an abstract way now, but sometimes I lose hope.

        I just feel utterly dissociated, even worse than before, if that's even possible. All I can do is wait and trust.

21 comments