Community Conversation > Hormone replacement therapy

Everyone transitioning needs to be aware of our risk for thyroid disease!!!

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Dear everyone on Susans.

I would like everyone to be made aware of a very serious health problem that can happen to you when you go through SRS/orchi. This may or may not happen to you, but you should be aware of the symptoms so that you can get it treated in order to ensure a successful transition. I am talking about AUTOIMMUNE THYROID DISEASE, that is usually triggered by dramatic hormonal shifts/disruption of HPTA axis. So, it makes sense why myself and many other transpeople I know also experience this disease due to the disruption of HPTA axis after both SRS and Orchi. I have heard of it happening to one Tgirl I do not know personally after 3 years on hormones and no surgery, but my own experience is that SRS and Orchi have triggered it among both myself and other Tgirls I am close friends with in real life.

I have been posting on these forums for approximately 3 years now, but for the past 2 years I have been posting about how I have defeminized post op, regardless of how "optimal, low, or high" my estrogen levels have been. My breasts have diminished, I grew weird facial hairs I did not have before, developed depression and fatigue, and also developed serious brain fog. I never had any such symptoms or this feeling of "loss of my old self" before my SRS. My HRT blood tests would come back perfect And FINALLY I have figured out the problem!

Finally, after 2 years, I broke down in front of my teacher at school during her office hours and told her all of the problems I had been having (brain fog, hair loss, depression, no energy, never feeling tired, never feeling hungry, weight fluctuations, food intolerances) and I told her I had nothing to be depressed about but yet I was. She looked at me like it was an epiphany moment and told me the exact same thing happened to her after she gave birth to her second child. She told me giving birth the second time around triggered autoimmune hypothyroidism that went undiagnosed for 12 years before a doctor finally did the right tests and treated her for it. I told her all of my doctors tested my TSH and they always called me and said it was fine. I also told her that most doctors laughed at me when I asked if I was hypothyroid because they said only overweight people could have hypothyroidism. Surely, they said, someone who was a skinny girl like me could not possibly have it. One doctor even laughed at me and said "well you're skinny so you if you do have a thyroid problem, you're probably hyperthyroid and not hypo!" My teacher, flabbergasted, told me that the TSH is a pituitary hormone and can take many many years (in her case it took 12) before the TSH matched how low her actual thyroid hormone levels (free t3 and free t4) had been all along. She urged me to go get a bunch of tests done, and so I found an endocrinologist willing to do it. After visiting countless endocrinologists, I found one (who ironically goes to my church) to do all of the correct tests for my thyroid (a full thyroid panel, not just the TSH like most doctors).

Well, wouldn't you know it! At only 21 years old, my SRS for me triggered autoimmune thyroid disease. My thyroid labs came back, and my thyroid hormones (free t3 and free t4) were at the bottom of the range! Also, the explanation of how the thyroid goes through stages of hyper and hypo over a period of months to leaving one completely hypothyroid after a couple of years perfectly explained why every couple of months everything continued to worsen (weight fluctuations, hair loss, etc)! I also have read on another forum of another T-girl who went through exactly what I did, except she never had her surgery. She had simply been on hormones for three years, and something "changed" like it did for me after my surgery.

I am finally being treated for this condition, and I am on the path to feeling like my old self again! It takes a while for your body to readjust, but my depression is gone (yay!!) and already my body is looking back to its feminine self :D The reason I feel this is necessary to be made known to everyone is that I know of at least a couple of other T-girls in person who have the exact story as me as soon as they completed their SRS, and I am shocked at how common it is. The part of this all that irritates me is that most doctors will blame it on depression, especially if you are female and especially if you tell them that you're trans. It's simply assumed that depression is always the cause, but for me I knew it was a side effect of something else (not the cause)! I just know my body and I knew something was not right. I never thought something like this could happen to me at only 21 years old, but I am hoping that my story will urge others to go get their thyroid checked if they are experiencing the same symptoms after their SRS/orchi or having been on HRT for years. Now at age 23, it took me 2 years to finally put this mystery together, and I hope that everyone will be made aware of how autoimmune thyroid disease can really put the brakes on your transition no matter what stage you are in.

P.S. I forgot to mention that the "adrenal overdrive" that some people notice after SRS/orchi is likely due to the beginning stages of hypothyroidism, where the thyroid actually goes hyperthyroid. Hyperthyroidism triggers the adrenal glands to release higher cortisol/hormones in order to block excessive thyroid hormone levels from pooling in the blood. Some people are lucky, and the thyroid will regulate itself after this stage and function normally. However, others will be left with autoimmune hypothyroidism. Just some of my research I thought I would share :)

Kisses and hugs to all of my sisters :) xoxo

Sarah Louise:
Many things can affect your thyroid, not just estrogen.

Diabetics often have thyroid problems, I have been on thyroid meds for years and they work very well.  My spouse had half their thyroid removed and the meds replace what is needed. 

I have not heard of taking gender hormones increasing thyroid risks.

Testing for thyroid issues is very easy, the doctor feels your neck and does a blood test.

Hi Sarah! Sorry if it was unclear, but I mean that the main cause is usually after orchi/SRS. Taking hormones in itself is a rare trigger, but I have heard of it happen to one Tgirl. The four Tgirls I know of in person developed symptoms after their SRS/orchi. Also, I would be cautious about saying testing for thyroid disease is easy because countless people go undiagnosed for years due to doctors believing in the simplicity of its finding. This leaves many patients suffering for years, as my teacher in my story suffered for 12 before finally being diagnosed!

Catherine Sarah:
Thank you Jasmine,
For this award winning post. I've followed your story throughout your trials and have always wondered how it all finally worked out for you.

I'm just sooooooo pleased you are getting back to your old self after all this time. So good for you. You'll now be able to bask in the sunshine and glory of your transition.

Thank you once again


Ms. OBrien:
Jasmine, I am so happy you finally got your issues figured out.  Like Catherine, I have followed your trials with this.  I am going to keep this in mind and talk to my doctor about a full thyroid panel.


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