medical tomfoolery (WIP)

Shout Out to My Oomf, Emily Estradiol

I have been on hormones for five years. Honestly, it feels pretty wild to write that. I can still distinctly remember the part of my life where I didn't know what the difference between a "boy" and a "girl" was ('whatever those things were,' my innocent little homeschooled brain probably thought). I can also distinctly remember the part of my life where I thought I would never transition, because I'd been sold lies (oh how many lies) about how HRT works and how dysphoria was ever so rare. Yet all of that feels like the far distant past, even if some of that happened less than a decade ago. I have spent all of my 20s taking hormones, and these being the years in which I've actually really begun to live my life, it almost feels like I have been on them for my entire life, as if my life didn't really begin until I started HRT. Or, you know, it's the CPTSD fucking with my memory. That could be the case too.

At any rate, I've spent a lot of time on HRT, and somewhat predictably for anyone who has known me long enough to know that I am a very weird and sometimes obsessively curious person, I have become obsessed with the logic and workings behind the funny girl juice stuff I have to put into my body constantly to maintain my luscious hair and soft skin. Part of this is because I think it's very neat how one chemical can radically transform a human body, but part of this is also because I've been screwed over by doctors and refused dialogue with them plenty enough to know I should just take this particular thing into my own hands. I would trust a professional with brain surgery or breast augmentation, but not with my estradiol unless they knew to write up tests for FSH and LH. Not sorry.

Consided this page my account of some of my history with transness and a variety of experiences I've had with hormones. It's been a long road to settle on the regime I've settled on now, and I think there's been a lot of interesting bits along the way to get there.

Those Androgen Bastards Are Gonna Pay for Fucking Up My Puberty

Before my body decided to begin producing testosterone en masse, I was - I think - a pretty average looking if slightly chubby kid. I also had hardly a conception of what gender was, growing up as a homeschooled child with no access to the outside world (this was, somehow, quite legal under Washington state law). I used to think all girls had penises and the only difference between girls and boys was the clothing they put on. Kid me was pretty ahead of the time to be frank with you, but no one else thought this, and eventually (right around the age of 10) I was sternly reminded this was not the case: boys were different from girls in many ways, and that was final! Thus I had an awareness of this "innate" difference instilled in me right around the time I had begun going through puberty, about as convenient of a time as any even though puberty for me was a rather odd experience in that it wasn't much of one at all.

To say it was nothing would be a lie, because things did happen and I can't say I was fond of them. Most notably, I got facial and body hair, which nowadays I'm at peace with (even if I'd like to get full body laser) and my bits developed to a functional degree, but in comparison to my brother, puberty whizzed past me to little fanfare. But perhaps because of my anorexia and subsequent regular failures to give myself nutrition, I didn't bulk up and begin to look very manly, my voice refused to drop much at all, and in general, I ended up with basically the ideal of a little twink femboy body. Tiny, bony, light, frail, and forever stuck at 14 years old or so... except I'm 171cm.

The Twink to Anime Girl Pipeline

That, I suppose, is not a half-bad place to start puberty over again. At the age of 19, very well aware of what a gender is and deeply unsatisfied with the ways my body had already changed, I suffered a series of mental breakdowns that ultimately led to one in which I told myself outloud "I cannot do this anymore." That, combined with a certain episode of Star Trek The Next Generation, led me to be utterly certain that I needed to start on hormones before I actually followed through on killing myself at age 30 (I had figured, "well I'll live this out until I can't handle it anymore," and figured 30 was the cap for that). After quite a bit of talking with my parents, I was able to convince them to let me see a therapist to get a diagnosis, and then to the closest doctor who could take me in within the month.

I cannot remember who it was, to be honest with you. It was someone studying under someone else at a family residency in Bremerton, Washington (fun aside: searching for Bremerton now pulls up images of the absurdly hot Azur Lane character in addition to the city.) Both of them were very nice, which was great since at the time I was desperate for any medical care that I could possibly get and would have accepted far worse. Looking back though, I'm not sure how much I trust their authority and knowledge on HRT, because it seemed they were working with some very outdated ideas of trans care. I say this, because my starting dosage was 2mg of estradiol a day and 100mg of spironolactone to block my testosterone. Anyone who knows much about feminizing HRT will have alarm bells going off in their head right now, because all that dosage can accomplish is a pittance raising of estradiol and an exhuasting decrease in testosterone. For some it may even cause menopausal levels of hormones. Great fun!

Thankfully, I did not feel horrendously ill during the first month or two of HRT. I was actually pretty euphoric to be on it at all, and when I prodded my doctors a month in for a dosage increase after reading something somewhere online about that combo being terrible, they provided it. They also told me to take it sublingually, which - if you're unaware - is the best way to take estradiol pills, because it means you absorb the estradiol directly and it doesn't have to pass through your liver. Not only is it harsh on your liver, but it also destroys most of the estradiol and creates the far less potent estrone instead. Soo... okay, cool, on to 4mg of sublingual estradiol and 200mg of spironolactone I was, which gave the minimum healthy levels of estradiol and low testosterone... and a whole ton of terrible side effects.

Spironolactone? More Like... Spir-OH NO-Lactone!

Here's my quick tip to all of you aspiring trans girlies out there: SPIRONOLACTONE FUCKING SUCKS. DON'T USE IT. While it seems quite well known now just how awful it is within trans spaces (and especially the DIY community), I was not aware, and furthermore, my doctors in Washington did not have any interest in any alternatives. This only got worse when I moved to Ohio (oh what a saga that was), and Cleveland Clinic categorically refused anything BUT spironolactone as a testosterone blocker. Cyproterone acetate has not been used in the US for ages so that was out the door, and bicalutamide - widely regarded as far safer, more effective, and generally better - was not allowed because of liver malfunction concerns. That would be fair if the concerns were not extremely rare, and CC actually gave two shits about liver function elsewhere, because they kept me on 200mg of spiro (which is not nice to your liver) and demanded I take my estradiol orally rather than sublingually (which is also pretty mean to your liver).

This resulted in some fun things. For example, my blood tests while taking sublingual showed great levels all around, but my ones on oral didn't (and I was reprimanded if I didn't take them orally!). I also started developing serious lightheadedness and general problems with my stamnia thanks to the 200mg spiro dosage, which resulted in me getting sent to the ER because I couldn't breathe properly or stand for three hours straight. It took a general care practitioner I was assigned after the episode (not my endocrinologists!!!) to point out that 200mg of spiro is actually really bad for you and because your levels look good maybe you should just do 100mg.

I did 100mg and my symptoms mostly vanished.

Well, okay, not entirely. I did not realize until this year, when I quit spiro entirely after starting injections, just how much it was fucking up my body. My LDL cholesterol had been raising over time despite my diet improving; my stamina was severely damped by spiro; spiro made me get light-headed quite easily; spiro made me exhausted; etc. It's a death by a thousand cuts, a ton of tiny things adding up to feeling sickly overall. And the worst part? Spiro isn't even a good anti-androgen. All of this bullshit when I could have been doing fine on bicalutamide.

Really, the only good things my doctors in Ohio did was give me progesterone, and increase my estradiol dosage to 6mg per day. Boofing progesterone every night has definitely helped my sleep and helped my breasts (even if I got a strongly worded email not to boof it, but, fuck you, I've put worse up my butt than a hormone that absorbs perfectly down there), and the 6mg of estradiol daily gave me more energy and general wellness than 4mg did. I just wish they were nicer to me throughout it, because I was very respectful of everything they told me up until the moment it made me actively feel worse. I was a good patient, I tried!

Last fun story I want to mention before I close out this little segment. I had actually tried to switch to injections with Cleveland Clinic, and I got the runaround of a life time. At first they were cooperative about it, and said they'd write me a script for estradiol... but they didn't really specify which, and that's important because there's two common commercial formulations: valerate and cypionate. Valerate is cheaper but has to be injected twice weekly, cypionate is more expensive but can be injected weekly. After some prodding, I got the script for cypionate and some injection supplies... but no advice on how to inject. Of course I was offered to drive an hour north into Lakewood for an injection course that my insurance may or may not cover, but actual advice? No no, you can figure that out yourself. Also, the supplies they gave me were not in-stock ANYWHERE. In the end I had a dinky bottle of estradiol cypionate, a bunch of syringes and needles that weren't compatible with each other, and no advice on how to do injections. You can imagine how well that all went.

Did I mention they bounced me around six separate doctors because they kept losing staff? And that they kept testing me for STDs even though I wasn't very sexually active, so my bi-monthly test costs shot up to USD$250 with insurance? And I couldn't refuse tests because then I'd lose my meds? What a fucking racket. I could seriously keep going on about this all forever, but I don't want this page to be depressing.

Bem-Vinda ao Brasil, Temos Hormônios Aqui

After way too long of this god awful status quo, taking 6mg estradiol and 100mg spiro daily while lying to my doctors about taking my pills sublingually, I got a chance to start things over fresh. Not just my hormones, but really my entire life, as I left my horrific living situation in the US to stay with my boyfriend in Brazil... which turned into marriage, and permanant residency. Now, before my first visit, my husband and I had already weighed options for continuing my HRT there. Neither of us knew anyone who was out as trans and on hormones there, so it was up to us to look through every option available at the pharmacies in our state. We went through what injections were available, we went through all of the different pills, we looked at gels, and so forth, and ultimately decided that the best choice would be... to continue the treatment I was already on, at least for a time.

See, in Brazil, there's a surprisingly vast amount of options available for estradiol over-the-counter, but the efficacy of them is all over the place. Estradiol valerate pills are pretty common in the trans community here, but they tend to produce sub-par levels of estradiol in the body. Estradiol gel and patches are available, but those can be difficult to produce good levels with, and I have skin disorders that make me weary of trying such a thing in the first place. Estradiol injections are available, but two of them (cypionate and valerate) are combined with very questionable progestogens, and one of them (enanthate) is generally well regarded but is bundled with a progestogen that can cause side effects for people in the high dosages necessary for getting sufficient estradiol. This, for me - as someone afraid of intramuscular injections, with a skin disorder, and weary of valerate pils - left me with a single option: Natifa.

Natifa is the brand name for estradiol hemihydrate pills here, and it is the only choice for estradiol hemihydrate here as no generics are being manufactured. It also costs R$60 for 30 pills at 1mg each. At my dosage, that works out to R$360 a month, which is seriously stretching it in terms of medication costs even as someone earning what amounts to a middle-class wage here. I was willing to do it, but after around a year of taking Natifa, I decided - in March 2025 - that I was going to switch to injections.

And this time, I was going DIY.

Grow Your Own Boobs, Just $79.95!

I was afraid of doing DIY for a pretty long time, mostly because I hated needles. I passed out the first time I had my blood drawn at 19 years old, I passed out from every single injection I did at home thanks to a lack of guidance from Cleveland Clinic, and I dreaded getting antibiotic shots or blood draws at clinics here in Brazil whenever I got a bit sickly. However, I also hated paying R$360 a month for pills, when just around that much could get me a year and a half worth of injectable estradiol, and that frustration with expenditures won out against my fear of needles. So, after a series of mental breakdowns following an extremely tragic event in my life where I found out a bunch of people I considered friends were actually fake personas made up by one guy who might have just really wanted to fuck me and see me nude (long story), I resolved to take agency over myself again by getting my ears pierced, starting meds to induce lactation, and getting DIY HRT.

Despite these all being decisions made in a debateably horrendous headspace, every single one of them has turned out to be awesome and positive for my life, and DIY HRT might just be the most beneficial of them all. I decided go for estradiol enanthate thanks to its incredible stability and weekly dosing schedule, and I could not be happier with the results. My mental health has been more stable compared to pills, my blood tests have come out very healthily, my monthly medication costs have plummeted, and maybe best of all for my well-being, I got to quit spironolactone and immediately realized just what a number it was doing on my body. I became significantly less fatigued, my head has gotten clearer, and weirdly enough, my skin has gotten better. I also don't get light-headed and faint anymore, which works.

Injections themselves also have not been as terrifying as I presumed they may be. I was initially using 25g syringes to draw and 27g needles to inject, but after finding out I was losing a significant amount of medication to them, I decided to switch to 30g fixed insulin needle/syringe combos, which work great and are more comfortable than the 27g needles. Which I guess is faint praise, because the 27g felt like a little pinch and left no discomfort after injection, but sometimes I can't even feel the 30g going in. It's absolutely wonderful, and I have now become one of those potentially annoying trans women who prostelytizes about the wonders of insulin needles and DIY HRT to everyone around me. Sorry not sorry.

Em Fim

Ultimately, I'm happy with where my transition has gone, even if there's some things I still wish I could do. One of these days I'd like to at least get an orchiectomy, because I have no attachment to my spheres and they're completely useless now anyways after years of atrophy. Most preferably I'd like to get phallus-preserving vaginoplasty, but I don't think this is going to happen any time soon, because all the surgeons are in the USA and I refuse to step foot there. I also don't have US health insurance anymore, and I don't want to enter combat with my insurance here over international converage. I don't even think they PROVIDE international coverage...

Regardless, for now, I have breasts and I look cute, and that's all I could ever really ask for.