The Effects of HRT (pt3)

Welcome back to Queering the Narrative!

Over the last couple of weeks we’ve talked about the effects of HRT for both masculinizing and feminizing therapies. But what about those who identify outside the gender binary, who might not want treatments that fully (and in some ways irrevocably) feminize or masculinize their appearance?

Many non-binary individuals pursue hormone replacement therapy as a way to achieve a more androgynous or ambiguous appearance. Some go on a fully binary regiment of hormones first and then stop, while others utilize smaller doses or different combinations of medications in order to gradually achieve changes, stopping a medication or reaching a stable maintenance dosage after they have achieved their desired effects.

As under-studied as pretty much all trans healthcare is at this point, these sorts of changes are particularly poorly documented and it isn’t as easy to find information about how to achieve particular results, or what these intermediate methods may ultimately result in.

As I’ve mentioned previously: you can’t actually choose the effects you get from HRT. By carefully monitoring doses and effects as they emerge, some people have had success in achieving only the effects of HRT that they desire, but it’s not always a guarantee.

That being said, this is a part of the trans community, and something that I think more people should understand if they’re going to write about our community. So, I’m going to walk through some of the basics.

Achieving “Intermediate” Effects of HRT

As I mentioned, there isn’t a ton of science around this. However, there are some methods that folx have employed which have anecdotally been found to be only “moderately” masculinizing or feminizing.

Low-Dose T

For afab (assigned female at birth) folx, Low-Dose T refers to utilizing lower or less frequent doses than a standard testosterone regiment. As full-dose testosterone can work quickly and irrevocably, especially on the vocal cords and body/facial hair, some prefer this as a way to attenuate their changes and make it easier to stop if they desire.

However, the effects of testosterone tend to be cumulative, so people who are on low-dose T will eventually start to experience the same changes they would on higher doses, just more slowly. And, because you can’t pick the order things come in, it’s difficult to know for certain whether desired changes will come before undesired ones. 

There is, however, such a thing as too low a dose, as testosterone will be converted to estrogen in the body. At too low a dose, the medication won’t have any masculinizing effects.

Though testosterone injections are the most common form of testosterone HRT, some who want to pursue more intermediate effects prefer alternative forms, such as gels, creams, or patches, which are sometimes considered easier to attenuate the dosages of (and don’t involve needles!)

Spironalactone is the most common antiandrogen used in the USA.

T-Blockers

As I discussed previously, testosterone blockers or “T-blockers” are a part of standard care for trans women. These medications block the effects of endogenous testosterone. Even without exogenous estrogen, these medications can have mildly feminizing effects

Estrogen only

Estrogen without T-blockers can also be used to achieve more feminizing results. At high enough doses, estrogen can act as a testosterone blocker on its own, or it can simply attenuate the effects of endogenous testosterone. As with testosterone, though, bear in mind that estrogen can be converted to testosterone if the dose is too negligible.

Note also that, before the introduction of T-blockers, estrogen-only (at much higher doses) was the standard of care for trans women, and so not everyone who is on only estrogen is seeking a nonbinary transition!

Intermediate Effects of HRT

For afab folx looking to go on low-dose T, they can often expect more gradual or moderate changes than a more aggressive testosterone regiment.

The first effects, which are also irreversible, are likely to be a deepening of the voice and bottom growth. Low-dose T can also cause body and facial hair to grow and thicken -- another irreversible change.

Low-dose T will also promote muscle growth and redistribute fat for a less “curvy” body shape. This usually takes longer on low-dose T, and is less overall dramatic. For more information on the effects of low-dose T, I recommend checking out this website.

For amab folx, both T-blockers and estrogen can have similar effects in the long run.

Generally speaking, T-blockers will do more to stop the effects of endogenous testosterone while estrogen will do more to achieve feminizing results. Both will eventually cause thinning and slowing of hair growth, cessation of male-pattern balding, fat and muscle redistribution, and breast development.

T-blockers alone will more quickly stop things, like hair growth or balding, but won’t promote as much breast development, and actual redistribution of fat may proceed more slowly or not at all. Estrogen alone, taken at sufficiently high doses, can promote more dramatic breast growth and muscle/fat redistribution, but will have a less noticeable effect on hair growth.

The difference between these paths is subtle, but most of the research -- anecdotal and otherwise -- points folx towards using T-blockers if they want “intermediate” effects of HRT, as those can lead to a “softening” of masculine features without dramatically feminizing the body.

Disclaimers

Everyone’s body uses HRT differently, and everyone sees the effects at different rates. Again, you cannot pick and choose effects -- your body will do what it wants with the resources you give it. This can be especially true with testosterone.

There isn’t a wealth of medical knowledge on the effects of HRT, and even less so on these non-binary or intermediate approaches. So, while anecdotal accounts (like this one) can be helpful for understanding some of the lingo and motivations that surround this sort of HRT, nothing here is a guarantee.

Conclusion

That’s it for this week! I’ll be back next week with another post but until then stay safe, stay healthy, and keep writing!