Hormonally yours… A Transgender Person’s Adventures in Endocrinology

I have always been deeply suspicious of people who claim to be changing sex because they feel “like a woman trapped inside a man’s body” (or vice versa).  With a woefully underdeveloped concept of what it means to be a woman – or a man, for that matter – I have long been incapable of articulating what, precisely, are the emotional and psychological differences between the sexes, and, consequently, highly sceptical of anyone who claimed they ‘felt’ like a member of the gender to which they were not assigned at birth.  I was just… me, I thought, not a set of variables within a biologically determined category allotted a prescriptive set of parameters regarding how I should think and behave.  Transition, by implication, couldn’t possibly be a process of setting free one’s inner-male or inner-female, I reasoned, because it was more a question of redefining my social space, not my interior life; an endeavour to shape a male or female identity from the outside in, not the inside out.  After two months of taking the testosterone-inhibiting drug, Diphereline, however, I’m no longer as sure as I was about whether it is biology or environment that maketh man or woman…

 

I started taking oestrogen because of the minor cosmetic adjustments I had been assured it would trigger.  I was told I would notice some redistribution of fat – a tendency to gain weight on the hips rather than the belly, for example – and that I should look forward to enjoying a full head of hair for a good while longer than presaged by my father’s youthful baldness.  A couple of months in to the treatment, I was told that my face had changed; that my previous jowly plumpness had disappeared to expose my cheekbones.  Changes to the way hair grew on my body were also promised, but, as I was also following a strict regime of depilation, it was difficult to tell exactly how much of my tonsorial success could be attributed to the hormones I was on.

Before commencing the treatment, I was also cautioned to expect a significant change in my emotional state.  I would be prone to mood swings, I was warned, as well as a tendency to take criticism and slights to my character very personally.  I was highly sceptical of that prediction, however, and I still believe I was right to be so: I did not experience any shifts in the way I reacted to emotional stimuli that were conspicuous to me (apart, perhaps, from an irrational anxiety that oestrogen would be unavailable when it was time to stock up again).

From inside one’s own skin, it is rarely possible to be sensitive to the changes taking place on the surface.  I’ve never been one for staring at my reflection for hours, and, not being a Facebook narcissist, I haven’t compiled a meticulous photo-journal documenting my physical transition.  As a result, I’d be lying if I said I felt I had undergone a miraculous transformation as result of dosing myself regularly with feminising oestrogen.  I’m told the change is pronounced – that I’ve got hips now, and round, peachy buttocks – and that the old me has long since vanished, but I find it very difficult to trust the assurances of others.  I worry that people are only telling me what they think I want to hear, and I’m aware that the hormone medication I have been taking is not deigned to help male-to-female transsexuals to look and feel more feminine, but to ease the symptoms of the menopause.  That knowledge makes me dubious of the power of oestrogen to affect physical transfiguration, and I occasionally wonder whether I’ve been prescribed a placebo, intended to satisfy my need to feel as if I’m doing all I can to continue and maintain my transition, rather than a metamorphosing wonder-drug.  I never, for example, enjoyed the glorious burst of breast growth augured in internet chatrooms on the subject of hormone therapy.  For that, it was necessary to seek a surgical solution.

Frame Sweets
The obligatory photograph of some generic medication, which tradition dictates must accompany any article about prescription drugs

For these reasons, being prescribed feminising hormones seemed to me a symbolic, rather than a physiological, victory.  The reason I felt this way predated my application for medical assistance to continue my transition.  The cultural milieu of twenty-first century, western, capitalist life means that a person cannot simply decide to dress and behave in a way contrary to stereotypical expectations of gender and still expect to journey unmolested through everyday public and professional life.  When you finally pluck up the courage to make the switch, a number of significant social and bureaucratic barriers are immediately erected in your way.  There is the painstaking process of informing family, friends and colleagues, for a start, with all the diplomatic wrangling this entails.  Then there is the need to subject oneself to counselling before permission for any sort of surgery or medication can be considered – irrespective of whether one goes private, or joins the queue for NHS support.  Some of these obstacles, the individual can legislate for; others depend on the munificence of key medical, legal and professional gatekeepers.  For example, I can demand the agreement of my boss for me to attend work in my new gender role, but I cannot control the effect this may have on my prospects of promotion.

By the time I approached my GP to request a course of oestrogen (and later, for approval for breast augmentation that I was paying for myself), I had already started living in female role in every area of my life except one (work); dabbled in private health care as far as my budget would allow; and applied to change the name in my passport.  Consequently, I was able to smile, look my doctor confidently in the eye, and ask as casually as if I needed help sleeping for them to put me on oestrogen patches.  To my immense relief (I felt much less sure of myself than I was able to pretend), the doctor simply shrugged and sent me away with a prescription.

I would say that I was lucky in finding a GP willing to prescribe HRT so blithely, but the pattern has repeated itself often enough now – and in more than one country – that I have started to take much of my own credit for the ease with which I have found help to transition.  I think that the reason I have been able to obtain what I want from medical professionals with only a minimum of fuss and the most token amount of jumping through hoops lies in the way I have conducted myself during key gatekeeping meetings.  With the sole exception of my first appointment at the Charing Cross Gender Identity Clinic in Hammersmith, I have appeared calm, measured, courteous, rational, and, above all, sure of what I want.  In turn, the doctors I have met have treated me exactly as they should: as a person in full possession of their faculties who is merely exercising their right to put in, stick on, cut off, and turn inside out whatever they like of their own body.  We are able to claim ownership of very little in our lives, but if we can rightly claim that something (anything!) truly does belong to us, it is the meat that hangs from our bones.  It is an outrage that a transgender person requires the permission of a psychologist before they can exercise that right, and heart-breaking that some transsexuals are so afraid of rejection by medical professionals that they resort to the dangerous on-line black-market of untested and unverified substances.

Frame Meat
We are able to claim ownership of very little in our lives, but if we can rightly claim that anything truly does belong to us, then it is the meat that hangs from our bones

An individual’s ability to get what they want depends on patience, doggedness, and, ultimately, on being in the right place at the right time.  Through just such serendipity, I have recently been taken on as a science project by a family doctor who lives in the same apartment block as me in a south-west suburb of Bucharest.  As luck would have it, that doctor’s specialism is endocrinology.  She was stunned to learn that I was relying solely on oestrogen patches to tinker with my hormones.  This, she said, was like subjecting myself to the emotional rollercoaster of permanent menstrual tension; that having oestrogen swimming around my system as freely as testosterone was positively sadomasochistic, and was leaving my brain utterly bewildered as to which set of emotional precepts should be allowed to dominate.  My brain, in short, was both male and female, and probably didn’t know if it was coming or going.

Accordingly, my doctor/neighbour wrote me a prescription for the intravenous testosterone-blocker, Diphereline, and I have now been taking it – in conjunction with a reduced dose of oestrogen – for three months.  And, suddenly and unexpectedly, I find myself revising my original conviction that what differentiates feeling like a man and feeling like a woman is spurious and unknowable.  I now cry at the drop of hat – and sober up just as instantly.  I have become hopeless in an argument: whereas I once prided myself on my patient, smart-alecky ability to listen humbly to someone else’s point of view before demolishing it completely with a poetic tirade of perspicacious verbiage, I now crumple before the determination of other people to assert themselves, and can do nothing but whine and sulk during a row because I’m not getting my way.

The most alarming change to my emotional and psychological state, however, has occurred in the bedroom.  Whilst I remain sexually attracted to women (at least, I assume, for the time being), the sort of treatment I want between the sheets has altered.  I want to be held, I realise; wrapped in the protective arms of someone bigger and more powerful than me.  I want to be clubbed over the head and dragged into the boudoir by my hair, and then have things done to me whilst I meekly submit to a more dominant partner.  I have become simultaneously very demanding and very lazy when it comes to having my physical desires satiated, and I have become almost incapable of successfully initiating a bout of horizontal gymnastics.  The trouble is, of course, that that is precisely how (with only a handful of exceptions) heterosexual women wish to be treated in the bedroom department, and so finding a compatible playmate is proving very difficult indeed.

Man!  I feel like a woman!  Shania: I think I know what you mean; it’s made me a gibbering wreck, and I wouldn’t change it for worlds.