I guess my biggest question is will low dose do anything to me at all?
Low doses of estrogen will have an effect, but you will need to keep your testosterone in check with adequate testosterone blockers. We aren't allowed to talk about dosages on here. Your therapist sounds smart and very responsible encouraging you to take low doses of hormones / anti-androgens. I know of one trans person your age who was encouraged by another trans person in her fifties online to take hormones ordering them from the black market and self-medicating, saying that hrt is 'a piece of cake'. I was privy to the online chat conversation, and was quite horrified by it, and later told her in private not to listen to our friend. Obviously she ignored my advice, because a month later I heard that the woman in her forties had to visit the emergency dept due to heart palpitations. I discovered that the dosages she was taking of spiro were quite high (not ridiculously so, but high for a person just starting), and that she wasn't monitoring her diet, and had failed to limit potassium-rich foods. Especially with spiro, it's important to start low, and slowly taper up.
It will take longer, but I think hormones are like running a marathon. Normal doses are like running / joggin, low doses are like walking. Overly high doses are like sprinting, and you will eventually burn-out. Average doses are like running at a steady pace, and chances are you'll reach the finish line. Walking will get you to the finish line, but at a much slower pace, than the already very long time it takes to run the marathon. God I can't believe I'm using sporting analogies!
But I'm wondering about other people's experiences with low dose "starter" therapy and it's initial effects.
I started on low dose estrofem and low dose spiro, probably similar to your regimen. In the first week I had extreme nipple pain, and one of my nipples started to bleed, which lasted for a couple of weeks. I don't know if this is typical or not. A month later I tapered up, and a month after that went to a full dose of both meds. I experienced no physical problems, although I was often paranoid about my health and heart, DVT etc. because it was all very new to me, and whenever my heart would beat too fast, I'd wonder if I was having physical issues from hrt. That was just my paranoia though. I started when I was 30 though, so still young and healthy. At 44 you have greater risks. I'm not calling you old or anything, I think 44 is still quite young in the scheme of things actually, but the biological fact is that you are more at risk to negative effects of any type of medication at that age.
I'm in my 4th year of hrt, and I don't expect much more to change. Most of my changes happened in the first three years, with the biggest changes in body shape showing in year three when I started to eat more. Diet and health has a lot to do with the changes you experience. My skin completely changed within the first six-months. I developed that glossy, soft appearance on my face, and the skin on my body became much softer. In year 2 I started to lactate intermittently, and after year 3 lactation became a daily thing. This is because I have prolactin levels that are in the high, but still safe range.
To be honest, I want the changes to be permanent. My other fear is that there will be no changes at all.
There WILL be changes. They may not be what you hope for, or they may be more than you hope for. It all depends on what you want. If you are happy having small breasts, and a more feminine bum, then this is a very realistic expectation. Spend long enough on hrt, and the effects will be permanent. Breast growth will not go away if you stop hrt. Your skin will become softer, and your fat may redistribute to more feminine areas, if you are lucky.
My boy side however is scared of what people will think. How soon will people notice? How long do I have to hide them?
Yes, many of us worry about that. Sometimes I have to mentally prepare myself to go out, because although I go out as male, people will gender me as male or female. It's very strange to have a man open a door for you smiling, somebody else will say 'is that really your name?' when they ask me for my male id, and then somebody else will talk to you like you're a boy saying 'hey dude, can i help you?'. As somebody else on here told me, a lot of it's about presentation though. I think if you want to hide the effects, you will be able to. Most people who know you may or may not really notice, because they will see what they want to see. Strangers may or may not notice. Ultimately what others think doesn't matter, but of course, we all have that desire to have people approve of us and love us.
Now What?
Wait and see what happens! Keep seeing your therapist. Monitor your health. Go out and live your life, enjoy the good, and try your best to cope with the bad. Your emotions will be magnified on hrt, and the bad may get worse, and the good may be even better than you've ever experienced on testosterone. Sometimes that can be overwhelming, and if you're like me, you may find them downright depressing, but at other times it can be wonderful.
