Maisie × Estrogen

Preface

This is intended as a living (i.e., constantly updated) guide documenting all the changes, effects and feelings I’ve experience while undergoing hormone replacement therapy in the first few years of my medical transition. The guide is meant to present how I feel throughout as-is, and will try and reflect on other things that may have helped cause or enhance these effects.

I think in transfem circles, there’s often a big emphasis on how important estrogen is, its effects, and the timing of when to start using it; and I think that this can often be really problematic. And especially in certain circles (e.g. Reddit), estrogen is touted as a panacea that will make you feel absolutely wonderful and people who are unable or don’t want to access Hormone Replacement Therapy can feel left out or feel invalidated. Even for current users of HRT, they can feel like they aren’t getting the “full effects” of their medication or feel like they’re “behind”.

Personally, I’ve dealt with a lot of stress and anxiety about my own hormone regimen because of this. When I first started patches and didn’t feel euphoric or amazing straight away (and instead just felt very tired), I was worried they just weren’t working properly. And around the six month mark I fervently started comparing my changes with others who were also at their six month mark, and despairing that things weren’t moving along as fast as I’d hoped.

To this effect, I hope that this guide helps to provide an objective overview of my experience on estrogen for anyone curious. You shouldn’t use it as a benchmark or comparison. On each update, I’ll detail my thoughts and feelings (or at least try and remember how I’m feeling), as well as any significant life events or if anything had changed around that time.

This post does not constitute medical advice. Every person’s body is different, and will react to different regimens and methods of delivery, whether that be patches, gels, injections or pills. Some people use blockers, some do not. To reiterate this point, I will not provide any details of my doses or hormone levels, or who my endocrinologist is.

Effects and Feelings

0 months, June 2021

Day zero was absolutely terrifying. I’d just gone through a process to access a “bridging” prescription through the NHS and had to be brave and get my first ever blood tests. Having my first estrogen patch in my hand filled me with so much anxiety and doubt. All in all I think took me about three to four hours to put it on?

Once I was wearing the patch I definitely felt relief, this was absolutely from finally doing it and taking the leap of faith. I did not feel different at all or notice any changes for the first few weeks, although I was incredibly tired especially for the first two weeks. This is a recurrent effect that seems to come back whenever my hormone levels are changing, but I know this isn’t the case for a lot of people.

After coming out and before starting hormones, I had a lot of better days and my mood had improved so much presenting in a way that was more comfortable for me. In the first month or so after starting hormones, I noticed this was marginally improved, but also I had a tonne of mood swings. I definitely had more bad days than before, part of this was me fretting that nothing was happening.

1-2 months, July/August 2021

In July, I had my first appointment with my private endocrinologist, which means that I have a good account of how I felt things were going at the time.

She started hormone treatment 38 days ago with an [estrogen patch] twice weekly. She had dramatic mood swings initially and emotions heightened, her body odour has reduced and she has noticed some breast budding. Her longer term expectations of hormone treatment are for reduced facial/body hair growth, skin softening, fat redistribution.

The body odour change was really noticeable and continued to change as my testosterone levels continued to drop. Breast budding was a little earlier than expected, and started off with discomfort and soreness in that area. It seems to vary a lot for people, and TBH the guidelines from the GIC usually suggest these changes start between 3-6 months for most people, so I was very surprised.

I lost a relative around this time, which was really quite hard on me and meant I had a lot of emotions and feelings to deal with. This could have contributed to, and exacerbated, the mood swings and emotional changes.

I think around this time I mentioned that it felt like, “I could see the world in more colour, with more contrast”. I think this is tied a lot closer to my mental state than it is my hormone levels. I noticed later in the year when I had periods of low mood, that colour was definitely looking a lot less vibrant than before. There’s some research that seems to suggest that estrogen can increase the number of cones (colour receptors) in your eyes, but I don’t think that was the case here.

3-4 months, September 2021

At the end of August I had my first set of monitoring blood tests which showed results that, while not in my endocrinologist’s target ranges, were promising and on the right path. My GP responded by increasing my estrogen dosage. This did not have a noticeable effect for me.

I had noticed increased breast mass and some increased fat growth on my hips and thighs, but nothing too noticeable. I did not notice any facial changes but my skin felt softer, despite not looking it. At some point in September I did begin taking better care of my skin, using product with niacinimide, which seems to work well with my skin, and this absolutely made a positive contribution.

I also began laser hair removal on my lower face in early September. This sparked a strong feeling of dysphoria while the burned follicles were enflamed, then a good deal of euphoria when they fell out and my face looked great for a week. Laser hair removal, for me, has been the biggest contributor to my euphoria. This is mainly because of how strongly my facial hair contributed to my dysphoric feelings, so seeing it go has been fantastic, despite it being a long and difficult process. I think that it actually has helped me more than estrogen itself!

Throughout this period I continued to have breast tenderness and soreness as the buds continued to expand and grow. As I have a rather wide rib cage, the appearance of this was rather deceiving and it made it look like less change was happening than there was. But also it is still early days at this point.

~6 months, November/December 2021

I was sent for another blood test at the end of November and the results seemed to show no progress despite the higher dose, which made my emotions spiral downwards really significantly for about a week. Until this point, I felt like things were going pretty well and was enjoying the changes, but this felt like a punch to the gut.

The endocrinologist explained that the test should have happened a day earlier and this was something for me to keep in mind when booking my next blood test. Based on my progress that I shared, he was not too concerned and recommended increasing my estrogen dose again and seeing how I got on. I also requested hormone blockers which he then recommended on his report.

I had a private follow up consultation with Maisie. She is doing fine. She has been on hormones now for almost 200 days and she has had some breast growth – roughly an A cup, her skin feels softer, more fat over hips and buttocks and subtle change in facial fat. She has noticed some change in her body odour. There has been no change in body hair. Her libido is much reduced, no longer having spontaneous [REDACTED]. She definitely feels less dysphoric.
Maisie mentioned that her sleep is a bit worse and occasionally feels a bit warmer.

I was also struggling with Seasonal Affective Disorder around this time which did not help with emotional state. The sleep problems can be attributed to not having enough hormones in my body but there’s no clear link, this could also be anxiety or stress related.

~7-8 months, January 2022

During this month I noticed the very subtle changes in my face, it seems a little bit rounded out and fuller than it did before.

Mentally I’ve not been doing so well thanks to extenuating circumstances which I haven’t contributed to estrogen.

My dose was raised once more on new years’ eve, and I instantly got very tired and emotional for the next few days. I wasn’t anxious or excited about this dose change, so again I believe this was due to hormone levels increasing in my body. I’ve noticed continual slow but gradual breast growth, although soreness is less common than before. It’s very common that this will start and stop as it does for many other trans femmes.

In mid January I received my first injection of Triptorelin, a long-lasting medication that acts like Gonadotropin-Releasing Hormone (GnRH). This works by overstimulating the pituitary gland, which secretes Lutenising Hormone (LH) and Follicle Stimulating Hormone, until it stops producing either. LH is responsible for stimulating production of testosterone, and FSH is responsible for stimulating production of sperm. Therefore the medicine will almost completely halt testosterone production in the body. That overstimulation does causes an initial surge in testosterone production for a couple of weeks, and without extra antiandrogen medication, you can be in for a rough time. Guess who did not have any extra medication to take...?

The first week has brought incredible tiredness, anger and irritability, gigantic mood swings, my hair and face is noticeably greasier, and I’ve noticed my body odour has returned to how it was before starting estrogen. Thankfully it will only last a short while, but the experience has not been great.

8 Months, February 2022

The Decapeptyl-triggered testosterone spike wore off towards the end of January 2022, which I noticed while out for a walk in the afternoon. It was an incredibly wonderful feeling, I think both being outside and having fresh air to help with my depressive spell, as well as the weather being great and me buying bubble tea, coincided with the t-spike lifting and enhancing how it felt. Although anecdotal reports from other people on the same class of medicine (GnRH agonists) match up with this.

It felt like a sudden wave of calmness washing over me, and even though I sat down on a bench with a transphobic sticker on it, it just didn’t seem to phase me. At the same time, I had noticed the masculine scent had dissipated and I did not feel quite as irritable or grouchy.

During February, I contracted COVID-19, which meant that mentally I was not in the best place, so it’s unclear whether the decapeptyl has had an effect here specifically. But I have noticed I’ve had multiple depressive spells. I shall keep an eye on these and see if they persist or if they’re a product of my current circumstances, as I’m currently dealing with a wide range of life events.

It feels like breast growth has accelerated since the last month, but again I will keep an eye on it as I don’t have any concrete proof of this. My skin feels a lot softer and more sensitive, and I notice that I’ve been bruising and getting cuts easier. Other than this, I have not noticed any significant changes to fat redistribution in this short amount of time. Libido seems to have increased unexpectedly, I am unsure whether this is because of the increased estrogen dose or whether it is circumstantial.

Face and hair greasiness has possibly decreased but I’m not sure. My hair can go an extra day without needing shampooing, but I have also modified my hair care routine a little bit which may have contributed.

I shall continue tracking my changes now that I have mostly recovered from COVID.

11 months, May 2022

As of early May 2022, I have been on continuous Estrogen medication for eleven months, and I have been on a full testosterone blocker for four months, and had received my second blocker injection in April.

Changes seem to be less obvious to me at this point, other than reduced energy and a calmer mood, although prevailing life events and talking therapy have caused significant difficulties and bad mood spells. I feel less angry than I used to, for sure, and while I may be sad, I feel a lot more in tune with actually what emotions I’m going through and feel more able to communicate them to my partner and friends.

Other than that, I don’t feel like I notice much difference physically in the last few months, but I’m sure comparing photos things are a bit more apparent. Breast growth seems to have accelerated somewhat since beginning blocker injections, but I am an impatient being! Fat redistribution is slower, but will absolutely take time.

During March I was struggling with some random mood swings, body temperature/hot flushes, and abdominal cramping, which through blood testing me and my GP realised my blood estrogen level was still too low, which when combined with non-existent testosterone, meant that I was experiencing an almost-menopausal effect. My patch dose has been increased and these symptoms have eased. Next round of bloods are due later in May 2022.

2 years, June 2023

CW: Talk about depression/SI

I haven’t done one of these updates in a very long time, so apologies! A lot has happened in the last year.

In late August 2022, I stopped taking my hormones in preparation for bottom surgery. At this point, I was noticing chest growth and facial fat changes.

In October 2022, I had surgery and resumed taking estrogen and progesterone (no more need for a hormone blocker!). My estrogen was in the range recommended by my endocrinologist, and my testosterone was in the very low range (pretty much just the amount that’s secreted by the adrenal gland). I struggled a lot with chest shrinkage and feeling like things were going backwards, but a lot of this I attributed to post-surgery body weirdness and weight loss. Major surgery like that takes a huge toll on the body and I wasn’t looking after myself properly.

In February 2023, I stopped taking progesterone as it was causing me to experience very strong PMDD (premenstrual dysphoria disorder) once a month, resulting in strong stomach cramping, depression, body dysphoria, and ideation. It was a real struggle and felt like it was getting worse each time. As a result, I paused taking progesterone for a bit to see if it would resolve. These symptoms still persist, but are no longer cyclical, leading me to understand that there are other causes (which I’m now being medicated for).

The next month, in March 2023, I switched from estrogen patches to weekly estradiol injections. My levels on patches were fine, but I was experiencing some skin reactions and supply issues, both of which would be mitigated by switching to injections (a vial lasts for many months). It also meant only needing to inject myself weekly, versus dealing with swapping patches twice a week and dealing with residue etc. I had also heard good things anecdotally about breast growth, but since the estradiol reaches the blood stream in the same way as with patches and gel, theoretically this shouldn’t make a difference.

However… it does seem to have made a positive impact on me. In the next couple of months I have noticed some more chest growth (whether this is coincidental or not, I don’t know), as well as body fat distribution changing, and a noticeable softening of my skin which I hadn’t noticed before. People have noticed a change in my face, however it’s not something I’ve personally noticed, but I do generally feel less dysphoric.

I am on a relatively low dose of estradiol injections compared to many (I don’t need to suppress testosterone), so there may not be as extreme a difference to other methods of administration, but my levels should be relatively stable across the week which is never a bad thing. My last blood test revealed a lowest estradiol level that was towards the lower end of the GIC guidelines, which is perfectly fine for me. Importantly, the vibe feels good.

I’ve also restarted progesterone therapy, on a lower dose, working with my GP. This has not yet had a strong negative effect on my mood but I will keep an eye on it.