Congratulations you've started HRT, do you have a suicide prevention plan?

[Rowan Rue]

Wow, two days out from three months on E.  It seems as though I only started coming out to people yesterday, and at the same time, my pre-hormone self seems a lifetime past.
When I started this I knew that I should expect some mood swings.  Some ups and downs. I didn't know that in the space of just a few hours I could go from feeling fine to being suicidal.
I've experienced several major depressive episodes in my life.  They've typically lasted 3 to 6 months and were marked by a steady decline in mood and energy over that period, followed by a stay way down at the bottom and then a fairly quick return to normal (or as close as I've ever gotten).
I have a history of self harm and have been suicidal on a few occasions.
Monday of last week started off pretty good, but towards the evening I started feeling kinda down. 
What happened next was something I was completely unprepared for.
A comment was made to me and I (somewhat willfully) misinterpreted it, and then, I was at the bottom of a major depression. 
The next seventy two hours was, from an emotional perspective, like going through an full depressive episode at hyper speed.
Fortunately my wife (who's seen me acting suicidal before) and some friends were able to keep me from doing any thing more stupid than some quite elaborate carving on arm.
Then, as quick as the depression had come on, I had something of an epiphany and the clouds lifted.
Since then I've been feeling on top of the world but it really concerns me that I was able to loose all sense of perspective so suddenly and seemingly for no reason.
I've been talking with friends this week about what to look out for in my behavior, what to do to keep me safe, and basically doing what I can to have a plan if this happens again because I honestly feel pretty lucky to still be here.
So the reason I'm writing this post is to say,

Has anyone else experienced something similar?
And if my case is not so out of the ordinary, then why on earth aren't we taking more time to warn people just how serious the mood swings can be?
If I didn't have such a strong network of support I really think that I would have been a serious danger to myself, so I feel that I have some responsibility to talk about this and do whatever little I can to keep this from happening to others. 
Or at least make sure that people are aware of the (hopefully rare) possibility of this sort of thing happening.

P.s.  If anyone is curious as to more specifics of my experience I am happy to discuss them in this thread, I just didn't want to write War and Peace.

[Heather]

I haven't been suicidal but more like I'm ugly and nobody likes me thoughts! But I have had mood swings aplenty last week was the worst for mood swings I've had since being on hormones. The week started off great but by Thursday I could literally change moods from one moment to the next. One such mood swing I was leaving the gym feeling quite bad about myself but by the end of the trip I was smiling and singing along with the radio. These rapid mood swings continued through Sunday before I felt like my mood was normal. How I've learned to deal with mood swings is first you got to realize that your having a mood swing and these are not your real feelings. Then you just got to remind yourself over and over that this is just a mood swing it will pass. It does work most of the time. Then they are the other times were you just got to endure it. Its not easy but doable

[MaidofOrleans]

Cant say ive had a mood swing that intense on hormones.

While I had times where I wanted to die pre transition, ive never wanted to kill myself. The very concept of self termination is sickening to me and I could never concieve of doing it. Maybe its why I always seem to end up facing the darkness of my problems and conquering them in the end because while death is release it is not an option for me.

[Rachel85]

Only once did I ever feel that way about suicide and that was a long time ago, I consider myself very lucky. I told my mum how I felt and my feelings and it scared the absolute crap out of her and she was upset for days just at the mention of it. Since then I have never considered it how dark things were cos I felt that I couldn't do it to my friends and family and that helps in a horrible way.
I am a big fan of writing, particularly writing letters to yourself. We had to do it as a exercise in high school at the beginning of the year. I thought it was a joke to begin with but I stopped and took the time to pen my thoughts and feelings at the time. 9 months went by and I got this letter in the mail with my handwriting on it. I couldn't believe what I had written, it had been a really hard year (majority of school was) and it just hit me that all the things that I had said back then were so similar or different to now. I still keep that same letter in a drawer next to my bed.
Since then I still write letters but don't send them, I just keep them somewhere where I know that I can find it if I need it. It can be really self affirming to find something that you yourself have written. When your on a high take the time to write about your favourite qualities, about an occasion where you just felt fearless or were just plain happy!
Something about seeing it in your own handwriting too. It helps to remember where you were when you wrote it too.
That's my 2c, I hope that they're worth something

[EmmaS]

I've definitely considered suicide a few times even since starting hormones to be honest. I didn't make any attempts and I don't think I was at the point to try anything, but I let my psychologist know anyways to be safe.

[Eva Marie]

I had wild mood swings when i started on low dose HRT - one minute giddy and happy, the next minute weeping and thinking of days to end it all. Luckily the moods evened out after a few months, but it's not totally even - just yesterday after two years of HRT i was weepy and tearing up at work for no apparent reason. I had to remind myself that it was just the hormones doing their thing, and it is nice to have emotions now. I was an emotional brick before HRT.

You may find that your emotional landscape evens out some after a few weeks or months on HRT.

[Carrie Liz]

Yeah, I too have been having some really nasty mood swings. I seem to just constantly go back and forth from "OMG, this is the best thing ever! Smooth skin! Mental Calmness! Boobs! I've never been so happy!" And then later in the same day I'll be curled up into a ball on my bed, crying about "This is NEVER going to work! I've got too far to go! I'm NEVER going to look good! I'm NEVER going to truly be myself! Waah, waah, whine, whine, complain, complain, mope, mope, mope."

I've never gotten to the point of seriously feeling suicidal though, even in high school when my gender dysphoria was at its absolute worst. And it's not that the thought has never entered my mind at all, it's just that as soon as it even enters my head my superego kicks in and says "NO!!! Don't you dare let me catch you thinking like that ever again! You have too damn much to live for, too many people that you can still help, too much good that you can do for the world, too much talent and too many stories to tell to just throw it all away because you feel crappy. Get over it!" And that always works. There's just too much that I still want to do in life. I really want to do some good for this world before I leave it.

[MadelineB]

Means of administration, and exact chemical composition, of your HRT regimen can affect the intensity, speed, and recurrence of mood swings:
1. Any progesterone, or combination birth control pills containing a progesterone, are famous for causing mood swings in ciswomen as well as in transwomen. My endo has been treating trans women for decades, and herself transitioned 10 years ago, and categorically refuses to prescribe even micronized progesterone, which seems to have the best side effect profile, to women without uteruses. It is essential however for any woman taking estrogen who has a uterus or endometrial tissue.
2. If mood swings seem to occur in synch with the schedule you take your estrogen, discuss with your endo taking the estrogen closer together, or switching to a longer acting means of administration, or modifying the dosage, or all three. Every woman is different in how quickly her body metabolizes each drug, and so you can end up putting yourself through a mini-menopause that you can't handle. Ideal for me is something that has a high peak estrogen, for stimulating body changes, and a longer period of lower levels, with the cycle recurring before it gets too low.

HRT specifics aside:
Estrogen, or transitioning itself, can open you up to feeling things you kept buried, so you may need to go to therapy, or learn new coping mechanisms, because the old mental gymnastics you used to make bad thoughts go away, aren't working in a newly wired brain.

I had suffered from a lifetime of bouts of depression, and it runs strongly in my family, so I absolutely needed a good therapist to help me handle all the emotional (and for me, trauma) stuff that I finally had the emotional tools to reach and deal with whether I wanted to or not.

[tomthom]

I've never considered suicide an option for myself, but I totally understand the appeal for other people... at times.

I can't say I know enough about you or your past to firmly give you much advice on the matter, but we're here for ya.

[Noah]

It sounds like the hormonal flux in mood that accompanies HRT is compounded with your body's natural inclination toward depression. Of course, that is a laypersons observation and carries no weight. From my experience, the mood swings are very real: I went on a date two months ago that went really well. The guy asked me out for a second date, it was very romantic...we kissed a lot. A few days later when it was time for our second date...he ignored me calls/texts. He completely stood me up and I never talked to him again. I freaked the ->-bleeped-<- out...I had a high drama melt down in which I was wailing in my studio apartment incapable of moving, and streaming tears and hating myself and all of life. I literally collapsed on the floor in the middle of my room and laid there for hours in torture.

The next day I felt totally fine and was like...whatever! But that experience was contingent on two things - 1. Hormonal changes that amplified my emotions at any given time. and 2. My history with men and their relation to my self worth. I have not had anything like that happen since, nd now the emotional ups and downs are typically less dramatic. But they happen all the time...I just feel my feelings more, and it can seem like I am crazy sometimes.

I definitely think people need to have a good resource for mental health available if they are starting HRT. We don't know what it is like to have a body and mind that operates on Estrogen (or Testosterone for ftm), and though we may need and love the experience of inducting that change into our lives, there are definitely some changes that we may not be prepared for - or that are even clearly linked to HRT.

Thanks for the post, and good luck in the future.

[JennX]

My plan: I love myself too much to ever consider it. Sorry. I know HRT can increase/decrease such feelings, and I would discuss it with my therapist ASAP.

[natastic]

When I started this I knew that I should expect some mood swings.  Some ups and downs. I didn't know that in the space of just a few hours I could go from feeling fine to being suicidal.

I have experienced this, although I should qualify it by saying that I've experienced intense swings like this before and after starting HRT.

I have a history of self harm and have been suicidal on a few occasions.

I can relate.  I started HRT in October of last year, but all throughout 2012 I struggled with extreme depression, bouts of self harm, and two suicide attempts in the Spring.

The next seventy two hours was, from an emotional perspective, like going through an full depressive episode at hyper speed.

Since starting HRT, I have experienced this kind of "compression" of depressive episodes -- things got really wacky after two months on hormones, in December.  Things are starting to get a bit smoother now that I'm about four months in.

Since then I've been feeling on top of the world but it really concerns me that I was able to loose all sense of perspective so suddenly and seemingly for no reason.

This this this this THIS.  And I really don't have a good response, beyond that I share the same concern, and all we can do is what you appear to have done and reach out to the people we trust.

I have a really good therapist who I see multiple times a week, who is aware of everything I've discussed here.  We both wondered if it was a bottom-line "good idea" for me to start hormones when I did, but honestly as things have shaken out, I've found that despite ongoing mood swings, self-hatred, self-doubt, and feelings of isolation and loss, I'm actually LESS depressed and suicidal now.

I guess you can say I really hit a wall in my life last year, and I knew it had everything to do with fully transitioning.  I have a long way to go, but life is better today, infinitely, than it was last year.

P.s.  If anyone is curious as to more specifics of my experience I am happy to discuss them in this thread, I just didn't want to write War and Peace.

I'll take it offline and get the novel version in hardcopy.  Or spoken word

Cliff Notes:  Long struggles with depression and suicidal feelings/suicide attempts pre-HRT; continuing and perhaps crazier mood swings after starting HRT but overall less desire to off myself and starting to find some appreciation for myself and for life now that I'm transitioning.

P.S. ROWAN YOO ARE RAD LADY KEEP ON ROCKIN GURRRRLLLLLL

[victoria n]

please nobody off themselves it's not worth it.
If the hormones make you feel better go for it.
if the hormones make you feel crappy why take them. If you were not suicidal before mones and are now that should tell you something.
GID and depression seem to go hand in hand but GID doesn't seem to cause  depression. at least in my case.
Also add this line, congratulations You've had SRS, do you have a suicide prevention plan



Edited for profanity

[Robert Scott]

Although, I am not taking E but T ... my therapist and I did discuss when I started taking hormones that there is a marked increase in suicide in the trans community at that time as well as just after surgery.  So, part of writing my letters for surgery and hormones required a walk though of folks I could turn too if I felt suicidal.  She also requested a one month follow up after each event just for a check in (didn't require it).

[Hideyoshi]

I've never self harmed, but I do get vivid and scary suicidal thoughts.

Usually a mild dysphoric event is what triggers it, and I spiral downwards in the matter of an hour. I get vivid thoughts to the point where I start to cry. This can be at work or anywhere. I usually snap out of it within two hours. I get episodes like that once a month or two.

[EmmaS]

Is there anything you can do besides calling a hotline if you get severe thoughts? Just wondering for future reference, thank you!

[MadelineB]

Is there anything you can do besides calling a hotline if you get severe thoughts? Just wondering for future reference, thank you!

Yes.
1. Observe as well as feel. (Ask yourself, if someone I care about was going through what I'm going through right now, what would I say to her about this? about these feelings? about these thoughts?) Just letting your better self rise above your crisis to put you into human perspective, can be a life saver.
2. Express yourself. (Write in a journal, talk to a friend, vent on Susan's). It helps.
3. Know that these things happen, they can be an expected part of life, and they are NOT the end of the world. It is just a mood storm. If you've been through one before, you know "THIS WILL PASS". If you haven't, take my word for it, "THIS WILL PASS".
4. Make yourself as safe as you can be. Avoid two things: triggers (thoughts/places/people/images/words/alcohol/drugs which make it worse) and deathtraps (cars, bridges, guns, knives, pills, police).
5. a) Listen to yourself, as compassionately as you can, as you would your child or your best friend. b) And when you hear "I" statements in those thoughts, gently correct, and replace them with "FEEL" statements.
So:
"I am a piece of sh*t and I deserve to die." should be corrected, and replaced with:
"I really feel like a piece of sh*t and I feel like I deserve to die".
c) And then respond lovingly and sensibly if you can, to the new FEEL statement:
"The things that happened that make you feel like you are a piece of sh*t happened."
"The things that make you feel like you deserve to die happened to you."
"Even though you feel that way now, you are a valuable and unique human being. You are NOT a piece of sh*t. Far far from it."
"If you let yourself live, you will have the chance to see the good things that come to people who get through feelings like this."
"You have as much right to live as any one who was ever born. Life is for making mistakes, for learning how to be your best person. You have had so many challenges, and it is going to take time, but you are going to get there. As long as it takes, I will be here for you."
6. Replace negative triggers with positive triggers. These are COMFORTS, the words/images/music/films/foods/beverages/friends/people/places/activities that always make you feel better and feel better than yourself.
I have my ballerina bear and my dollie to cuddle with, my playlist for the down times, my strawberry cheesecake ice cream, my spaghetti, my favorite books, my favorite poems, and a couple of people that are proven in the fire, to always lift me up when my feelings are most dire. Before I could transition, I used to grab my dogs, put on my cutest female exercise outfit, and after dark go jogging and let the saliva (theirs) and perspiration (mine) fly until we were all exhausted and feeling better.

[Rowan Rue]

Thanks everyone for your concern about my wellbeing and for your insights as well.

Madeline, those are excellent suggestions and get to the heart f what I wanted to talk about.
Namely, having a coping strategy in place before things get bad.
One of the things I had neglected to do for myself was prepare a safety blanket in which to comfortably hide from the world until I felt better.

Things I've noticed.
It's impossible to rationalize your way out of feeling like crap, but you sure can rationalize your way into feeling worse.  This is because emotion precedes rational thought, and we systematically seek to justify the way we feel with reason.  It's far better to not think about it and just let the emotions pass.  They always do.

To answer various concerns.

Yes I have a therapist and have been talking over these issues with them.
Since I started HRT I've been much much happier than I used to be 95% of the time.  But when I'm down, I can be sooo low down.  I was prepared for that in theory, but last week was just much worse than I'd expected.  I also feel that it was necessary for new growth.  An emotional forrest fire if you will.
In fact that's a pretty good analogy because we all know how when fires are a natural and necessary part of a forest ecosystem, but if they are prevented from happening for to long, they become wild fires and rage out of control.
Hopefully much of what needed to be burned of from my soul is now gone, and the next fire will be less destructive.

Lastly, what I've noticed is that what makes depressed and hate myself is when I make excuses for other people.  In this case What I mean is that I keep deciding I'm not allowed to feel bad when someone says something I find upsetting. 
The logic is usually
"this person is actually trying to be suportive, they just phrased that poorly so it's not fair to get upset at them "
The mistake I make here is thinking that my being upset must be causally linked to someone else's intention.  It's essentially my giving a higher value to the other persons intentions than to my own emotions. 
If intention isn't an excuse for ironic racism/sexism, then it's not an excuse for me to be crappy to myself either.

[MadelineB]

Things I've noticed.
It's impossible to rationalize your way out of feeling like crap, but you sure can rationalize your way into feeling worse. 
....
Lastly, what I've noticed is that what makes depressed and hate myself is when I make excuses for other people.  In this case What I mean is that I keep deciding I'm not allowed to feel bad when someone says something I find upsetting. 
The logic is usually
"this person is actually trying to be suportive, they just phrased that poorly so it's not fair to get upset at them "
The mistake I make here is thinking that my being upset must be causally linked to someone else's intention.  It's essentially my giving a higher value to the other persons intentions than to my own emotions. 

That's right, Ms. Rue! That's right!
Your feelings are legitimate. Period. Embrace them as messages from your self, and listen to what they can tell you, about what you do not deserve and will no longer put up with.
When we take the place of our abusers/neglecters/haven'tgotacluers and endeavor to shut up the crying child inside us, we do ourselves and the world a disservice. The world needs the unique whole person that we are and can be. We need to listen to that hurt child and change things so she doesn't have to hurt like that any more.

[Servalan]

I've always had suicidal thoughts, irrespective of whether I'm on or off hormones. I know it's so passé, but I have a very nihilistic outlook. One day, whether you've lived 80-years or 80-seconds, it will be like we never existed, so what's the point of all this nonsense we call life?

Why haven't I ended it all? Well, because I'm also a coward and that razor blade looks really sharp.