When first deciding whether or not to go on hormones, you're often left with more questions than answers. We've gathered up the top 9 myths you've heard about estrogen HRT, so you can know what's what.
Despite the fact that gender-affirming HRT has been around for nearly 100 years, there are still many misconceptions about the effects of hormone therapy for trans people. When you realize most of what the general public (and the medical profession) knows about trans people comes from the media—be that sensational headlines or offensive cinematic portrayals of our lives and struggles—it’s no wonder that we often know more about our own bodies than most medical providers do. We’ve all seen the scene in the movie where some girl misses one dose of estrogen and is suddenly half a beard away from becoming a complete hormonal wreck. The fear of trans people medically transitioning runs deep.
One of our brand ambassadors, Luna Lovebad, spoke to us about her apprehension before starting HRT. “I really was afraid for the longest time to come out. I did a lot of my own research prior, but I didn’t feel as if I had the proper information. One of the biggest misconceptions I had before starting estrogen was that it is an irreversible process.” Luckily it’s 2021. So before you get lost in the trenches of Discord or ridiculous misrepresentation of estrogen HRT, we’ve worked with our vetted clinicians to compile a list of the top 9 myths that are out there about E. We want to make sure that you are empowered with the real information on estrogen and what you can and can’t expect to change if you take it.
As if the sexist tropes of a cisgender woman on her period weren’t enough to make you cringe, there is this idea out there that estrogen is some hysteria-inducing force that will make any trans femme break down over a parking ticket. And while some people do experience changes in their emotional landscape, these hyperbolic stereotypes usually come from a deep place that views women (and femininity) as emotionally unhinged.
While hormonal fluctuations can cause mood changes in some people, research studies consistently show that gender-affirming hormones improve mood and mental health for trans people.
It’s natural to be worried about how and if your emotional experience of the world will change. But one of our FOLX clinicians, Dr. Kameryn Lee, who has practiced gynecology for 17 years and thus spent her whole career discussing estrogen, weighed in on this one.“Every cisgender woman and trans person on estrogen would be incredibly insulted by the notion that estrogen makes people they are hysterical. While hormonal fluctuations can cause mood changes in some people, research studies consistently show that gender-affirming hormones improve mood and mental health for trans people.” For many, taking estrogen allows them for the first time to actually feel their feelings, perhaps emotions that were always there but remained buried. This is often a welcome change from the numbness that many trans femmes report feeling before going on hormones.
To be honest, sex drive is a highly individualized and relative thing. There is no one truth that applies to the connection between libido and HRT. You might experience changes in your sexual drive, but this is more likely due to decreased testosterone levels due to blockers. Everyone has a different response to hormones, so it’s important to know that your desires or what gets you off might change as a result of taking estrogen, the same way these things might shift and change due to other circumstantial factors in our lives. No matter what, you should be able to talk to your provider if you have concerns to figure out what is best for you.
This is a common misconception that many people have before starting HRT. It’s important to know that hormone therapy is not an effective form of birth control and you can still get people pregnant, even while on E! So keep yourself protected unless you’re going for a baby mama vibe anytime soon.
The effects of hormone therapy on fertility are largely unknown and unpredictable. The truth is, the medical community doesn’t have any real data on the long-term effects of HRT on the fertility of transgender people due to the lack of any meaningful research. Courtney Rawls, one of our nurse practitioners says, “I have heard cases where people on HRT go on to conceive after being on hormones for some time. I like to advise members that hormone use could potentially impact their ability to conceive using your own genetic material, but there are ways to preserve sperm prior to starting estrogen.” If this is something you’re interested in, talk to your provider.
This is a big one that our clinical team hears often from people who want to medically transition via HRT but are worried about the risks. A recent study found that while the rate of blood clots for transgender women on estrogen was higher than the general population, they are lower than the estimated rate in premenopausal cisgender women taking oral contraceptives. In short, estrogen HRT increases the risk of blood clots but no more than birth control pills do. While the chance of developing a blood clot or having a stroke is low, some people are at an increased risk (such as people who smoke or have a history or heart disease or blood clotting disorders, to name a few).
Estrogen will change many things, but unfortunately, vocal cords aren’t one of them. If you were assigned male at birth and weren’t on hormone blockers as a teenager, testosterone would have thickened your vocal cords, which deepened your voice. There are some hormonal effects that are permanent such as testosterone thickening vocal cords or estrogen stimulating chest development. But if altering your voice is important to you, voice therapy or surgery can help, entirely dependent on which Whitney Houston song you want to nail in karaoke.
This is another one that you see lurking out there on those deep web forums. Bone structure is also something that cements during our first puberty so, unless you took hormone-blockers as a young person, taking estrogen later in life won’t change things like height or shoe size. The same goes for things such as facial and body hair, although the texture and thickness might reduce, estrogen will not eliminate hair growth.
Slow down babe, don’t get ahead of yourself. Many trans femmes and non-binary people put off starting to take estrogen because they aren’t ready to come out to the world. There is this belief that once you start hormones, somehow everyone will suddenly know. People may notice something different about you, but often they can’t put their finger on it. The reality is that HRT is a gradual process that changes things slowly, day by day. You don’t have to tell anyone that you are on hormones until you are ready to. In other words, you do you.
It’s common to get caught up in the fears behind starting hormone therapy, and it can be hard to disentangle what is internalized transphobia vs. what is genuinely the right decision for you. Luna told us, “I just wish I would have started sooner and not let fear stop me. It’s a slow and gradual process and you'll be much happier if it is something you truly want.”
The most important thing to remember is that you are in control of your relationship with your body. Some people take a low dose forever while others take a higher dose for a while and then stop. It’s also important to note that hormones are just one part of some people’s transition. It’s your gender and ultimately your decision for what path your transition takes. It’s always best to talk with your provider to understand which effects are more permanent and which are reversible, but either way, just know it’s in your hands.
Illustrations by Rory Midhani