Transition Update - Step One
Well, now that I’ve gotten the deep thinking out of the way (only temporarily - trust me!), I’m going to actually toss up this second post (two in one week, is that even legal?) just to catch up anyone who’s curious on what’s been happening in my transition process (rather than just in my head) during this unexpected break in communications.
Because my big news, transition-wise, is that in mid-January I finally, finally, FINALLY started on testosterone. (!!!!!!!!)
When the moment actually came, after SO many setbacks and false starts, I found that I was suddenly reluctant to immediately share that information with too many people. To be honest, I was still sure that SOMETHING would find a way to go wrong. I’d end up being horribly allergic to the preparation that had been prescribed, or I’d have some dreadful side effect - or, heavens forfend, cardiac symptom - that would force a re-evaluation, and start the whole roller-coaster all over again...
But no. I have never been so grateful for the lack of drama surrounding a medical treatment!
So for anyone who’s curious, here’s the low-down.
While most transmen take “T” by intramuscular injection - usually in the form of a complex mix of testosterone esters that enter the bloodstream at different rates, creating a sort of “time-release” effect over the course of several weeks - my situation is a little different, both because of my existing health issues, and because of my concerns about preserving my vocal quality as a singer. So when the question of hormone therapy for transition was first discussed, my doctor and I agreed that slow and gentle would be the way to proceed.
With this in mind, the aim was to use a topical product that could be dosed at very low levels, adjusted slowly, and immediately discontinued if any adverse effect presented. After consultation with an endocrinologist and investigation of the options, I was finally prescribed Androgel 1.62%, a testosterone gel dispensed by metered pump. It’s applied daily to skin in an area that is easily covered by normal clothing, thus preventing anyone but the person for whom it’s prescribed from being exposed to it.
The smallest metered dose of Androgel seems to be equivalent to about 1/7 of a “full” dose at the level that’s widely considered standard for transguys, so this mode of delivery allows for appropriately slow regulated increases over time - significantly more gradual than the 1/4-to-1/2-to-full progression that usually comprises a “gradual start” by injection. It also makes for more stable levels of testosterone in the blood, unlike injections which, despite the best efforts of creative pharmaceutical compilers, inevitably cause ups and downs.
Of course, while part of me was envisioning horrific side effects, another part of me was wondering if I’d feel nothing at all from such a small starting dose. (Which, I admit, would have been a bit disappointing!) The actual effects, now that I’ve begun, are a little hard to describe. Clearly there’s something in my body that’s reacting, saying, “Hey, wait a minute, are we supposed to be getting that stuff? Was that on the schedule for today?” - but it doesn’t seem overly upset, just a little... surprised.
There was a vague inkling of “possible incipient headache” at first, but it dissipated quickly. And a slight feeling of, well, maybe “buzz” is a good word to describe it, in both my physical and mental state... a wee bit like taking caffeine on an empty stomach if you’re not used to caffeine, but not nearly as dramatic. It’s maybe a little like the difference in vibration when you rev the engine of a parked car. The car isn’t acting any differently, it’s still just sitting there, but it FEELS different.
Contrary to popular expectations, which tend to equate testosterone with rage and negative emotions, most transguys starting on T report that they experience a feeling of increased calm and well-being. I’m happy to report that I am no exception to that... and I am certainly happy to be experiencing it!
Of course, it’s hard to tell how much of that feeling is due to the hormone itself, and how much is due to simply having finally taken that step, crossed the river at last. It’s one thing to do the preparatory work, all the introspection and the questioning and the decision-making, all the revealing and explaining... and it’s another thing entirely to take the step that begins the irrevocable change, that starts this One-Way-Only magic working in your body.
It’s an absolutely amazing moment.
How long before there is any externally perceptible change? I don’t know. On the one hand, the dosage is very low, which should slow all changes. On the other hand, my body seems unusually receptive to androgens - which is apparently why, at the extremely low (“female normal”) levels at which my body already produces them, I could grow a significant amount of facial hair before starting on T. This is my doctor’s opinion after checking me for abnormally high testosterone levels, PCOS, and other possible explanations; some people’s bodies are just more sensitive to certain hormones.
(If you didn’t already know this, toss it in your Trivia Box as a Fun Fact for today: every normal human body produces both estrogen and testosterone; it’s merely the ratios of the two that differ between men and women.)
I think I’ve moved past my fears about the vocal changes. (A note to my treasured handful of transmale acquaintances: I’d still like to pick your brains about that experience, guys, when you have leisure for such conversation - but no rush!)
I believe I’ve taken every precaution I can to preserve my singing voice. It will change, eventually, but hopefully those changes will happen in as gentle, controlled, and positive a way as can be managed. I intend to keep singing through the entire process, actively work through whatever kinks may occur, and leave a written record of my progress for others. (There is still very little information out there about FtM vocal changes, and a lot of it is extremely discouraging.)
And until those changes actually start to happen - which could realistically take a very long time, at such low dosages - I’m simply not going to worry about it.
Some lifestyle changes are necessitated by this step. I’m trying hard to make sure I get some form of exercise every day, even if only a little, because taking testosterone and not exercising is a recipe for disaster. Taking “T” will cause me to either build more fat or more muscle - and since I’ve already got plenty of fat, I think I’ll choose the latter. And hey, if this is the push I need to finally work more consistently toward getting healthier... I’ll take it! Gods know I need it.
And of course I’ve potentially let myself in for many other fun things as well - from acne (remember, this is a second puberty) to male pattern baldness (which I’m pretty sure will be a reality for me, considering that I’ve already had thinning hair since my first puberty). It could take forever for any of this to occur, or it could sneak up on me sooner than expected. There’s simply no knowing.
It’s kind of exciting. :)
And although I’d wondered whether, when the moment finally came to take this step, I’d perhaps feel the need to pause and think, make sure I felt right about this decision... when it did come, there was simply no question in my mind or heart at all. I’ve done the work, I’ve made the choice, I’ve come through the fire. Now let the magic begin.
So mote it be.
Because my big news, transition-wise, is that in mid-January I finally, finally, FINALLY started on testosterone. (!!!!!!!!)
When the moment actually came, after SO many setbacks and false starts, I found that I was suddenly reluctant to immediately share that information with too many people. To be honest, I was still sure that SOMETHING would find a way to go wrong. I’d end up being horribly allergic to the preparation that had been prescribed, or I’d have some dreadful side effect - or, heavens forfend, cardiac symptom - that would force a re-evaluation, and start the whole roller-coaster all over again...
But no. I have never been so grateful for the lack of drama surrounding a medical treatment!
So for anyone who’s curious, here’s the low-down.
While most transmen take “T” by intramuscular injection - usually in the form of a complex mix of testosterone esters that enter the bloodstream at different rates, creating a sort of “time-release” effect over the course of several weeks - my situation is a little different, both because of my existing health issues, and because of my concerns about preserving my vocal quality as a singer. So when the question of hormone therapy for transition was first discussed, my doctor and I agreed that slow and gentle would be the way to proceed.
With this in mind, the aim was to use a topical product that could be dosed at very low levels, adjusted slowly, and immediately discontinued if any adverse effect presented. After consultation with an endocrinologist and investigation of the options, I was finally prescribed Androgel 1.62%, a testosterone gel dispensed by metered pump. It’s applied daily to skin in an area that is easily covered by normal clothing, thus preventing anyone but the person for whom it’s prescribed from being exposed to it.
The smallest metered dose of Androgel seems to be equivalent to about 1/7 of a “full” dose at the level that’s widely considered standard for transguys, so this mode of delivery allows for appropriately slow regulated increases over time - significantly more gradual than the 1/4-to-1/2-to-full progression that usually comprises a “gradual start” by injection. It also makes for more stable levels of testosterone in the blood, unlike injections which, despite the best efforts of creative pharmaceutical compilers, inevitably cause ups and downs.
Of course, while part of me was envisioning horrific side effects, another part of me was wondering if I’d feel nothing at all from such a small starting dose. (Which, I admit, would have been a bit disappointing!) The actual effects, now that I’ve begun, are a little hard to describe. Clearly there’s something in my body that’s reacting, saying, “Hey, wait a minute, are we supposed to be getting that stuff? Was that on the schedule for today?” - but it doesn’t seem overly upset, just a little... surprised.
There was a vague inkling of “possible incipient headache” at first, but it dissipated quickly. And a slight feeling of, well, maybe “buzz” is a good word to describe it, in both my physical and mental state... a wee bit like taking caffeine on an empty stomach if you’re not used to caffeine, but not nearly as dramatic. It’s maybe a little like the difference in vibration when you rev the engine of a parked car. The car isn’t acting any differently, it’s still just sitting there, but it FEELS different.
Contrary to popular expectations, which tend to equate testosterone with rage and negative emotions, most transguys starting on T report that they experience a feeling of increased calm and well-being. I’m happy to report that I am no exception to that... and I am certainly happy to be experiencing it!
Of course, it’s hard to tell how much of that feeling is due to the hormone itself, and how much is due to simply having finally taken that step, crossed the river at last. It’s one thing to do the preparatory work, all the introspection and the questioning and the decision-making, all the revealing and explaining... and it’s another thing entirely to take the step that begins the irrevocable change, that starts this One-Way-Only magic working in your body.
It’s an absolutely amazing moment.
How long before there is any externally perceptible change? I don’t know. On the one hand, the dosage is very low, which should slow all changes. On the other hand, my body seems unusually receptive to androgens - which is apparently why, at the extremely low (“female normal”) levels at which my body already produces them, I could grow a significant amount of facial hair before starting on T. This is my doctor’s opinion after checking me for abnormally high testosterone levels, PCOS, and other possible explanations; some people’s bodies are just more sensitive to certain hormones.
(If you didn’t already know this, toss it in your Trivia Box as a Fun Fact for today: every normal human body produces both estrogen and testosterone; it’s merely the ratios of the two that differ between men and women.)
I think I’ve moved past my fears about the vocal changes. (A note to my treasured handful of transmale acquaintances: I’d still like to pick your brains about that experience, guys, when you have leisure for such conversation - but no rush!)
I believe I’ve taken every precaution I can to preserve my singing voice. It will change, eventually, but hopefully those changes will happen in as gentle, controlled, and positive a way as can be managed. I intend to keep singing through the entire process, actively work through whatever kinks may occur, and leave a written record of my progress for others. (There is still very little information out there about FtM vocal changes, and a lot of it is extremely discouraging.)
And until those changes actually start to happen - which could realistically take a very long time, at such low dosages - I’m simply not going to worry about it.
Some lifestyle changes are necessitated by this step. I’m trying hard to make sure I get some form of exercise every day, even if only a little, because taking testosterone and not exercising is a recipe for disaster. Taking “T” will cause me to either build more fat or more muscle - and since I’ve already got plenty of fat, I think I’ll choose the latter. And hey, if this is the push I need to finally work more consistently toward getting healthier... I’ll take it! Gods know I need it.
And of course I’ve potentially let myself in for many other fun things as well - from acne (remember, this is a second puberty) to male pattern baldness (which I’m pretty sure will be a reality for me, considering that I’ve already had thinning hair since my first puberty). It could take forever for any of this to occur, or it could sneak up on me sooner than expected. There’s simply no knowing.
It’s kind of exciting. :)
And although I’d wondered whether, when the moment finally came to take this step, I’d perhaps feel the need to pause and think, make sure I felt right about this decision... when it did come, there was simply no question in my mind or heart at all. I’ve done the work, I’ve made the choice, I’ve come through the fire. Now let the magic begin.
So mote it be.
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