T's effects on mental illness?

[verkatzt]

I've been thinking about maybe trying the gel, as I have a mental illness (under control, mostly, with medication) and I'm worried that T might make my brain get weird.  Estrogen (birth control pills) upset my mental health quite a bit at various times, and I'm afraid T would do the same thing.  My psychiatrist says that it can make some people have psychotic episodes if they already have mental illness, and she wants me to do my research before I try anything.  Anyone have experience, or can point to some expert info online?  (She's going to do some research too.  She's awesome.)

[Kreuzfidel]

Well, none of us here can advise you on what may happen if you go on T, as you already know.  But that being said, there are several of us who have mental illnesses - from what I've seen and from my own experiences, T can greatly improve mental illness.  Whether it's due to an emotional release or to the hormone itself, I don't know - but as for psychotic episodes...I've had psychotic episodes off and on for a large part of my life, and T didn't make those worse at all.  In fact, quite the opposite.

But I can't say what "might" happen as I don't know you, your life circumstances, medical history, etc. Most of the research online pertains to the effects of T on mood (and on cismales).  I have tried, but can't find anything that seems of benefit as far as studies go.  Someone else may have better suggestions.

[Mr.X]

I'm with Kreuzfidel. Everybody has a different response.
But if you'd start reading on both the MtF and FtM forums, you'd see that the general trend is that E causes a bit of an emotional instability (as in, more moodswings), while T seems to make emotions more stable. Both hormones also seem to cause a calmness, though. As in, it feels right to finally have the right hormones. Will T make you more stable too? There's no saying.

If anything, the only way of finding out is trying. And in your case, starting with a very, very low dose and then gradually buidling it up seems like the way to go. As soon as you'd start feeling off, it'll be easy to slowly stop then. I'm no doctor, so discussing it with her/him would of course be best.

[Jill F]

My brain apparently malfunctioned for decades simply due to a lack of estrogen.  Turns out my brain is wired female.  Add estrogen, no more antidepressants, antianxieties or need to get wasted.

If your brain is wired male, I assume the reverse is true.  When cisguys are administered MTF HRT type things for prostate or testicular cancer they usually get depressed, angry, cranky and sometimes suicidal.  Transchicks dig it.  Go figure, our brains are not necessarily wired like our bodies.

[Edge]

I also agree with Kreuzfidel. Personally, it doesn't seem to have much of an effect on my mental illness(es) either way, but I am able to calm down after losing my temper which I couldn't do before.

[aleon515]

I have NEVER heard of psychotic break on T. Of course one could happen while someone was taking it, but I doubt that's even on the label. Now T use in athletes trying to improve their performance, maybe so. But that's entirely different. These are cisguys who take T (in high doses) plus a half dozen other substances some of which are illegal. The source of the concept of "roid rage".

Several people here have mental illness dxes who are on T (or E). I don't currently but I feel like T stabilizes my mood quite a lot. I agree with Jill on that one. There might be something to the cream or gel since the dose is the same, that is if your mood isn't stable. But you could go on weekly, every 10 day injections, and some people do fine like that.

I initially had trouble handling anger and had to relearn how to handle it.

--Jay

[verkatzt]

Thanks for the input, you all.  Next Thursday I see the HRT doctor and will ask her about her knowledge/experience.

[verkatzt]

Update: saw a doctor who specializes in HRT.  After talking to her, I realized that I don't want T enough to deal with the side effects (both mental and physical).  I was mostly interested because my wife says every trans person she knows has been mentally happier on HRT, but I'm kind of happy looking androgynous anyway.  and I'm mentally stable enough right now that it's not worth the risk.  Thanks for the input, everybody!

[Kreuzfidel]

Thanks for the update, verkatzt.  I'm glad you've found what makes you feel happy

[Bimmer Guy]

Hi, verkatzt.

I am glad to hear that you came to a comfortable decision for yourself.

I am very curious, though and hoping you will clarify something.

When your psychiatrist said "psychotic episode", am I correct in assuming she means true psychosis (hearing voices, seeing things that aren't there, delusions, paranoia, etc?)?  Additionally, you said she said this can occur in people who already have "mental illness".  Was she referring to people who specifically have had psychosis as part of their mental illness, or was saying a psychotic episode could happen to any person who has a form of a "mental ilnnes" (depression, for example)?

Interesting stuff.  I am curious to know if she is basing this solely on anecdotable evidence or if there is actual scientific evidence of this (academic articles).  I need to be honest and say that I am not confident in her statements as being scientifically based, or I think many of us would have heard about this.

[verkatzt]

am very curious, though and hoping you will clarify something.

When your psychiatrist said "psychotic episode", am I correct in assuming she means true psychosis (hearing voices, seeing things that aren't there, delusions, paranoia, etc?)?  Additionally, you said she said this can occur in people who already have "mental illness".  Was she referring to people who specifically have had psychosis as part of their mental illness, or was saying a psychotic episode could happen to any person who has a form of a "mental ilnnes" (depression, for example)?

I should have specified illnesses that either feature psychosis (like schizophrenia) or can have psychosis as an episodic symptom (like severe mania in bipolar disorder).  I already knew from personal experience that changes in hormone levels can cause psychosis.  My first psychotic break was caused by changing brands of birth control pills.  (I haven't had a break in many years, thankfully.)  I've also been so depressed from estrogen/progesterone changes that I was actively planning how to kill myself at one point.

There is some academic research into the effects of hormone changes on people with mental illness, but not related to being transgender.  Just stuff in relation to cis women with polycystic ovaries and the like.  I've been doing some research, and there are studies, but I don't know if the abstracts from APA's database of journal articles are publicly available.  (The articles themselves require a subscription to the database, and I get that through school.)  It's a subject that hasn't been explored much, but that's starting to change...

[james-felix]

It's impossible to say what will happen until you try. But yeah, definitely talk about it with your doctor. I had similar problems with estrogen, especially on birth control, but I'm happy to say that T has really evened out my mood. The only catch has been making sure I don't convert it to E, as my T levels skyrocketed on a really low dose - that happened for a short while and it really sucked.


I know that T can increase your chance of manic episodes. If you've ever experienced them, make sure to let your doc know.

[Bimmer Guy]

I should have specified illnesses that either feature psychosis (like schizophrenia) or can have psychosis as an episodic symptom (like severe mania in bipolar disorder).  I already knew from personal experience that changes in hormone levels can cause psychosis.  My first psychotic break was caused by changing brands of birth control pills.  (I haven't had a break in many years, thankfully.)  I've also been so depressed from estrogen/progesterone changes that I was actively planning how to kill myself at one point.

There is some academic research into the effects of hormone changes on people with mental illness, but not related to being transgender.  Just stuff in relation to cis women with polycystic ovaries and the like.  I've been doing some research, and there are studies, but I don't know if the abstracts from APA's database of journal articles are publicly available.  (The articles themselves require a subscription to the database, and I get that through school.)  It's a subject that hasn't been explored much, but that's starting to change...

Ok, this makes sense.  Thanks.

[Bombadil]

Glad you've figured out what is going to be right for you. We each have our own path. Be well on yours

[Tysilio]

The only catch has been making sure I don't convert it to E, as my T levels skyrocketed on a really low dose - that happened for a short while and it really sucked.

Not to hijack the thread (at least not much  ), but could you say more about this, james-felix? I have the same thing going on, and my doc is puzzled by it. I'm curious about when this happened relative to when you started T, how long it lasted, did your level come down on its own... I'd appreciate any info you have.

[Arch]

I know two guys with mental illness who transitioned. One needed gel to keep stable because the shots involved too many fluctuations; I don't know what his particular illness is, and I don't know how he is doing now. The other guy is bipolar. He ran into problems when the clinic accidentally prescribed him a lower concentration--half as much as before--without his realizing it. After months of spiraling, he wound up in the psych ward. He said that once he got his dosage sorted out, he felt much better.

I suffered from depression for decades and have improved significantly on T. I wasn't quite sure how much might be due to hormones and how much due to transition itself. But when the clinic asked me to cut back to a maintenance dose, I tried a gradual reduction and noticed that I felt "off" past a certain point. I'm at a higher dose than they like, but my moods are quite stable. I'm still working on the winter depression, but even that has improved markedly.

I'm glad you have come to a decision. If you ever change your mind, you might ask your doctor about a very low dose of gel and just take it one step at a time.

[Hex]

I can only talk about what I've experienced but since starting on T in February, my bi-polar, anxiety, stress have all lowered a ton. I'm the same with female bc. I actually haven't used any since 09 because it would send my bi-polar moods on the fritz and I was everywhere and drove not only me, but my husband up the wall.
I also had pretty severe social anxiety where it would send me into panic attacks at least 5-7 times a week and not just heart fluttering either. Full blown, almost pass out, I feel like I'm going to get sick ones.

I too had worries that getting on T would send my bi-polar especially through the roof but I have been so calm, level headed, and anxiety almost free since starting and it's been wonderful.

I stressed to my dr about my worries and she started me on a low dose shot for my first month to make sure I wasn't going to have any reactions ect. If anything, speak to your dr about trying something like that and just be aware for those first 2 weeks to make sure you don't notice anything out of the ordinary.

[Felix]

I have ptsd and have had that diagnosis since long before starting testosterone. I did delay starting for years because I was afraid of getting too angry or otherwise imbalanced. My experience was that I calmed down dramatically and I feel healthier on T. I am convinced that there is too much scaremongering and exaggeration, and that if you were a cismale with serious mental illness, no one would ever consider attempting to lower your testosterone levels. They would treat any mood disorder or mental disturbance with medication, and forcing your hormonal state to be more female would be seen as radical and cruel.

That said, your own healthcare is personal. If taking hormones makes it difficult for you to feel okay, or if you have to adjust the dose, or whatever, being healthy is way more important than social norms or physical changes or anyone's opinion.

[Tysilio]

I'd been on anti-depressants for a bit over a year before starting T, after a major bout of depression in which I became seriously suicidal, and I'm still on them. Just (finally!) owning my gender ID made a huge difference to my mood, and seems to have made me generally a nicer person, but since starting (not quite 3 months ago), I've noticed that I'm a lot more energetic and alert, and I need a bit less sleep.

My clinic, a very good one, does a lot of psychological testing as well as therapy before starting anyone on T, and they're not that worried about mental illness as such, as long as it's being adequately treated.  The only thing they really worry about is any tendency to overt aggression. Plain old anger, not so much -- they seem to grasp that some of us have had a good bit to be angry about. I go to a transmasculine group there, and one of the guys has borderline personality disorder, and one of them is bipolar -- non-issues in terms of their starting T.

[james-felix]

Not to hijack the thread (at least not much  ), but could you say more about this, james-felix? I have the same thing going on, and my doc is puzzled by it. I'm curious about when this happened relative to when you started T, how long it lasted, did your level come down on its own... I'd appreciate any info you have.

I had a really bad reaction to nuva ring, which was a pretty terrible experience given that the doctor I talked to vehemently denied that it can make mood disorders worse. But after doing a google search and hearing other people's horror stories, I quickly took the thing out and felt better a few hours later. Before that, I went on birth control pills as a teenager and experienced some depression, although at the time I chalked it up to just regular teenager stuff.

My mood didn't suffer on my starting dose of T, but when my dose went up this month my depression definitely came back. I won't get my blood work results back until tomorrow but I do suspect that's what's happening. We're not supposed to talk about doses, but my T levels shot well into typical cis range on a starter dose, which my doc said is pretty unusual, so I was anxious about doubling my dose this month.