Estrogen causing Anxiety/Panic Attacks

[SelenaMendez]

Hey girls

i just wanted to take the time to share an experience of mine and hopefully get some feedback or advice on this. 2 1/2 years ago i began my journey through transition mtf. Everything was great guys!! i was happy as can be and every moment of it has been exciting. Ive reached a point where im passible and 99.9% of people see me as a natal female or just female for that matter. Anyway back in August of 2013 couple days after my last estrogen shot, i had my first full blown panic attack.. i had no idea it was even that all i remember is feeling really weak and dizzy and chest felt a little constricted. Went to the Er checked out great. Handed some Ativan for anxiety. Later that week i sat with my boyfriend to watch a horror film. Let me tell you. I Love Horror films but this time i noticed i felt so awkward watching this film and then i experienced my second panic attack. I ignored it and thought must be one of those days so i ignored it and went about my day. later that week i began to have horrible left side chest pain which led to more full blown panic anxiety and id go to the ER many times for 5 months. They ran blood tests, ekgs, mri's, saw a cardiologist everything turned out great. No sight of blood clots or strokes or anything. Just Anxiety. I went back to my Endocrine in San Francisco and told him how i felt. He handed me more hormones and added an anti depressant?? i thought what??!! are you kidding me?? i went home and i just remember starring at my bottles of antidepressants and anti anxiety and i just broke down.i couldnt believe i had somehow gotten to "that point." i refused to take em after massive research as i love to research what i put into my body n said heck no im not taking it..i changed my diet, i meditated, i exercised n just continued to take my noral dose of hormones. i cant help but think that everytime i ran across a friend  or  relative id share with them my feelings of anxiety and the first thing theyd say is " hun are u sure its not your hormones?" why is everyone telling me this i thought to myself and just disregarded them no way!! cuz i knew how important my transition is and no way in the world id stop. Anyway i researched and researched and i even went on youtube and all i ever saw was videos of successful transitionsand then their were the detransition videos hmmm?? all the sudden i ran across this individuals videos where she posted a timeline of videos. She shared how awesome n wonderful transition was going for her to the point where she shared it was time for that legal name change. Then all the sudden she posts a sad video. She had been hospitalized for anxiety and i thought well ok maybe shes just going through it but a month later she posted another final video where she explained she had to stop hormones because THEY WERE CAUSING HER ANXIETY!!?? my heart dropped. I thought omg someone else is going thru what i experienced!! Im so sad you guys. If what she says is true then why would my endocrine just hand me more hormones instead of saying LOOK THE HORMONES ARE CAUSING YOU TO HAVE ANXIETY AND YOU NEED TO TAKE A BREAK! But he didnt. Thats where im so comfused guys. Ive been to the doctors so many times and nobody seems to blame my hormones. Why? its the only thing i take and ive never had health issues little alone depression! Im so sad and i just wonder if its time for me to just stop hormones for some time and see if theres any change or what? im just seeing a therapist right now but i keep wondering what if its just the hormones and these people wanna medicate me thinking im really depressed and anxious for what they call a traumatic experience or what if the root cause is just estrogen? Any thoughts? advice anyone?

[Ltl89]

I can't claim to have any knowledge on whether or not hormones can induce anxiety; however, I imagine for most people it's unrelated to the hormones.  Most of us go through so much societal drama and inner self hate, that it's no wonder why many of us have anxiety problems.  Plus, anxiety issues are fairly common in the cis world, so it would make sense that it also applies to us.  Having said all that, I can't say that you aren't getting panic attacks from the hormones.  I don't know. 

In any case, I hope you will find a solution to this.  I used to get panic attacks all the time and it was horrible.  I constantly felt like I was going to pass out or have a heart attack.  It sucks.  Nowadays, I deal with more general anxiety which isn't quite as bad as it once was, but it is still debilitating in many ways.  So I feel you.  If you feel stopping the hormones will be best for your overall health, then I couldn't fault you for it. 

[AMDERS]

I can say from personal experience that most of my panic attacks have been caused by hormones. BUT! It's not from the hormones themselves, but rather from the anxiety caused by not seeing as many changes as you'd like. For me, no matter how fast the hormones were working, it still felt too slow. This was causing me a lot of stress and leading to some panic attacks. I just had to realize that I needed to calm down and just let the changes happen as time went on. For me, it was this feeling of hopelessness that I would never reach the point of fully transitioning, as well as external stressors such as school as well as other things. Estrogen heightens emotional responses and you have to be ready for that. For me, it came in like a wrecking ball (damn it). You just need to take a nice deep breath and relax with the knowledge that everything takes time and before you know it, you'll feel great.

[SelenaMendez]

thank you so much for your response. Im so thankful for this website, i really am. i totally understand that hormones can heighten our emotions and in my case at a physical level     i suppose i just have to find peace within myself, relax and try to calm down. its such a debilitating illness  friends i noticed you mentioned you somehow suffered from it. Did you ever take meds for it? it freaks me out to take something like an anti depressant like a pill that thinks for me. thanks friends i really appreciate this

[Jenna Marie]

I know at least one other trans woman who started having panic attacks after she went on HRT, and several cis women who find that their hormonal cycle triggers anxiety/panic attacks.

I wonder if the endo suggested treating the symptom b/c MANY trans women would refuse to stop HRT, though. Maybe he was trying to be considerate, and *not* suggest you quit hormones.

[AMDERS]

thank you so much for your response. Im so thankful for this website, i really am. i totally understand that hormones can heighten our emotions and in my case at a physical level     i suppose i just have to find peace within myself, relax and try to calm down. its such a debilitating illness  friends i noticed you mentioned you somehow suffered from it. Did you ever take meds for it? it freaks me out to take something like an anti depressant like a pill that thinks for me. thanks friends i really appreciate this

I've been prescribed a mood stabilizer before, but I don't take it anymore. The secret to dealing with anxiety and panic attacks for me was to take a second to think about the universe and how inconsequential we are relatively speaking. If you look at your problems from a top down perspective, you may begin to realize that these things that you are worrying about, whether they be appearance or whatever else, are so insignificant that they aren't worth worrying about. Just relax and enjoy the ride. Do what you can to be happy knowing that you are free to be who you want to be and do what you want to do.

[Ms Grace]

My endo suggested to me that injections were more likely to cause a roller coaster ride. That was my experience during my first attempt at transition when I was having injections of E and was up and down and all over the place, and it was not a great way to be! This time I have a pellet under the skin and things couldn't be more different, no anxiety, no roller coaster. So yes, the E could cause it, but it can also sometimes be related to the delivery method.

[SelenaMendez]

i totally get the rollercoaster ride ughhh no bueno i suppose thats what makes this interesting. hmmm mood stabilizer havent heard maybe il have to ask him. I stopped taking the injections last august and was switched to the estrodial blue pill since. kinda gave myself breaks in between but i didnt notice much of a difference. Im sure if i stopped cold turkey my moods would go all over the place right?
all i know is im happy to how far ive come in this transition. ive been living with my loving boyfriend for a year and a half now. Hes everything a girl would want in a man. Hes been through the ups and downs with me and i know he put up with alot of BS. Lol till this day i sometimes think damn ive been a hormonal b@#ch at times but for the most part we enjoy our company very much. ive been blessed with a transition where even doctors and nurses still ask me "when was your last period?" ummm period of goin hormonal on someone? hmmm? lol  i began my transition  late 22-23 years old i am now 25. i remember looking online for what changes to expect on hormones hehe... i realized later in time hormones can do different things to diff girls. After all, women come in diff shapes n sizes right? i do remember i used to worry alot about how i looked and if i was presentable. kinda isolated myself for a while until i felt "passable enough" then i met my bf and he kinda forced me to go out and explore the world. i begn to notice people werent even making comments or gestures if anything i was complimented. Met his family they had no clue and one day he tells me i want to tell my parents!!! oh no big mistake they stopped talking to us for a month and finally he recieves a call from his mom appologizing and that she and his dad love and support our relationship very much. "just dont tell the rest of the family ok, they dont need to know." LOL.I do remember taking alot of things said at a personal level that would "ruin my day" and id stay home n cry over it. i used to be so self conscious about how i looked and id always push myself to look "better." I know that caused alot of stress for me cuz i was very indecisive and good wasnt good enough and obsessed over it. NOT GOOD. i was one of those that went through a phase of i dont feel pretty enough i want to be liker her. Maybe if i change my hair color, wait maybe if i change this ughhh!!! talk about stress. what im trying to say girls is that maybe having going through anxiety allowed me to reassess and realise look stop worrying about how u look, how passable you may be and just live your life!! be happy, you only live once and if their are haters let them talk..just be you.. this is what you wanted and your living it. Love yourself..i kinda changed the subject guys im srry but i felt like sharing a lil behind the scenes of my timeline. Didnt want this topic to be a total downer :-)

[FrancisAnn]

None for me, everything seems smooth. I use patches.

[crowcrow223]

Even though panic attacks/anxiety are definitely not something I want you to be going through, I am so happy and relieved you've received so much help and love from both your boyfriend, family, friends and doctors, so happy for it!

I can definitely say that after starting HRT I've started suffering from anxiety, I still don't enjoy going out, and once in a while I do get the occasional mental breakdown. I remember, last week, a friend of mine from work whom I've asked to give me lift home, dropped me right before the city centre, instead of where I thought he would which was further from city centre i.e. closer to where I live, which basically meant I had to go through the middle of the uber-crowded city centre, with LOADS of people, and unprepared mentally!

Whenever I go out, I have to prepare myself mentally, like I have to prepare myself few days prior to going out, and that day I wasn't expecting that... I literally went through the crowds whilst having my eyes closed. After I came home I felt like crying but just sat there feeling awful.

I am so happy you've got someone with you, as it definitely helps!!
x

[Ltl89]

thank you so much for your response. Im so thankful for this website, i really am. i totally understand that hormones can heighten our emotions and in my case at a physical level     i suppose i just have to find peace within myself, relax and try to calm down. its such a debilitating illness  friends i noticed you mentioned you somehow suffered from it. Did you ever take meds for it? it freaks me out to take something like an anti depressant like a pill that thinks for me. thanks friends i really appreciate this

Yes, I got medicinal help for it, though it took a lot for me to get there.  What really made me go in for help is when I started to get anxiety behind the wheel of my car.  This is going to sound so weird, but I used to get mini panic attacks while driving.  Whenever I'd be at a red light, I would start tearing up, lose my breath and feel like passing out.  The idea of all those eyes being on me while in my car.  What they were thinking about me and how I looked like.  Having anxiety that is debilitating and hurtful to myself is one thing, but I couldn't ignore the fact that this wasn't a safe way to be on the road.  I was originally prescribed lexapro and some xanax.  Honestly, xanax probably saved my life.  For about half of a year, I took it twice a day and it helped me cope with things I couldn't handle.  Now I don't take xanax as I hate the idea of being dependent on a benzo, but it really was a miracle for me at the time.  Just don't abuse it.  I hate when people treat these meds like a get high drug because it creates a stigma for meds that some people really need.  But it was really helpful for me at the time while I was still learning to cope with who I am and my life.  It allowed somebody so weak have the ability to hold college review sessions and cover the rare lecture as a TA, ability to make my college graduation speach, and work in a very interactive and socially inclined role on a big political campaign.  And most of these things happened after starting cymbalta and learning to cope without xanax.  I came really far.  However, my gender dysphoria was still a major anxiety provoking issue.  It led me to take drastic measures and throw away all of the progress and accomplishments that I had because I just didn't want to live.  I've come to this realization that medication is helpful, but you can't ignore who you are and what you want out of life.  Burying that in substances and other things is not a good thing.  You can't hide from yourself.  And that will eventually take it's toll. Therefore, I think medications anti-depressants and benzos can be amazing and a gift for people, but they also have to find the things that trigger them.  Find out the source of your anxiety and why it plagues you.  The feelings do need to be dealt with or else the anxiety will always exist, so please don't expect medications to be a fix it all.  Transitioning is a way for me to take on my own fears and triggers, but at the same time it's anxiety inducing to even confront it all.   Sometimes I just don't know.  I guess I'm still trying to learn about my anxiety and how to overcome it all.

In any event, I wanted to share because there is no reason for you to feel ashamed about getting help for anxiety/depression.  It doesn't make you a bad or weird person even though there is stigma around it.  Many of us face this.  If it's hurting you, then getting treatment isn't a bad thing.  Just please realize that the medications, while sometimes life saving, are not a fix it all.  Don't make my mistake and think that the meds can fix everything without facing what we have to face.  I made some efforts to overcome my social fears and did really grow as a person but I did everything to deny my gender issues.  It led to a horrible rude awakening that I'm still learning how to overcome all of this.  I regret the fact that I've tried ignoring why I felt this way rather than trying to burry it or make improvements around the real improvements.  It's like having an infected tooth and taking pain pills without healing the problem.  It can make things better and more tolerable, but eventually you have to deal with the infection (or in anxieties case, the feelings that are leading to it). Therefore, I feel meds are helpful, but please don't expect them to solve everything.  Likely, they won't open the doors for you but they may help pick the lock for it to be possible.

Having said all that, everyone's situation is different.  I think most people have anxiety for a mixture of things, but some people may purely have some chemical imbalence or the anxiety is a reaction to something.  I think the best way is for you to talk to your doctor.  If you feel the hormones are the root of it all, and not certain social fears and/or a chemical imbalence, then your treatment may have to be revised in some form. 

Good luck and keep your head up!

P.S.  Anyone like my corny analogies, lol. 

[crowcrow223]

What is xanax and what did it do for you i.e. how you felt before taking it and after. I'd like to know a bit more, thanks learningtolive

[Ltl89]

Xanax is a benzodiazepine which is a class of anxiety medications.  Essentially, it makes you much more calm and less anxious.  It works differently for people, so I can only suggest reading up on it online.  Keep in mind, however, that xanax is a controlled substance that has a high addiction rate and the withdrawls can be horrendous for some.  For me, it was a life saving med during a time I was in need, but for others it is not so.  It's one of those meds that are heavily abused and can create future problems.  It's not the answer for everyone.  Personally, I don't like depending on controlled substances on a long term basis, so I don't use it anymore, though I've considered going back on temporarily for when I start full time.  Like any med, it has it's pros and cons and should be used as prescribed.  This is not one of those meds you would want to mess with or take recreationally as the addiction level is pretty high. 

[paxi1334]

I would like to chime in and share my own experience on this issue:

Before starting E, I did not have problems with anxiety/panic attacks - however, I did experience this sort of never ending, residual, treatment resistant depression that was due to my gender dysphoria.  I went for physical and mental health treatment at the same clinic and they were wise enough to realize that dysphoria was causing depression and that that had to be dealt with through transition.  When I first began transition, I was very euphoric - but after several months on oral E, WHAM, I began to be hit with all kinds of anxiety and anxiety-related symptoms... panic, agoraphobia, etc.  And to be honest, no one really knew how to respond to it and I was like in perpetual what-the-heck mode... it was overwhelming to the point where if I could have been happy by de-transitioning, I would have - but I couldn't and I knew I couldn't because of the overwhelming depression, but I truly spent months trying to figure it out, and simply could not make sense of it.  It got so bad to the point where I stopped driving and then eventually was hospitalized.  I did a trial of Ativan which, as has been said, can be a great short term method of stopping a panic attack but is simply unwise to use long term.  Further problems came when they tried to find a good longterm medication.  I started with Celexa and ended up having a manic reaction and then the search was on for a good "mood stabilizer" which is a long story but suffice to say that a lot of them, i.e. Lamictal, actually messed with my hormones and caused MORE problems.  Eventually with a lot of research and a lot of introspection, I've reached the finally conclusions...

*Living with life long gender dysphoria is traumatic.  Trauma - especially trauma early on life - changes brain chemistry and makes the brain more vulnerable to anxiety and mood disorders in the first place.  Since I have a family history of Bipolar, it just makes sense that I would suffer from depression that also has Bipolarish traits. 

*As has been said, Estrogen can make us more in touch with our feelings - its like before transition, I had this pervasive depression which under E essentially "converted" into overt anxiety/panic. 

*Estrogen, especially when its levels change, can cause mood / anxiety problems for anyone.  I felt totally like I was alone in a black hole, in some other dimension, not like successful transitioners but also not like those who "regret" - until I began spending a lot of time reading the experiences of women who had undergone full hysterectomies and their experiences of HRT.  It was then that I realized that it IS the hormones.  Our bodies are all so unique and respond differently to hormones, that the levels, the amounts, type of delivery, etc. has to be tailored to everyone based on how she feels.  Some providers get this - some are clueless.

*I found that, for me, I'm caught between a rock and a hard place.  On the one hand, Oral E does the best job at creating changes that I want in my body - on the other, transdermal E stays at a more consistent level and I feel a lot more mentally / emotionally balanced.  So what do I do?  Having done Oral E for years, I sticking with transdermal for the time being.

In any case, what works is unique to each person.  This is a tough issue to navigate, but you are not the only one, and I wish you the best.

[warlockmaker]

I guess I am lucky. This has been a wonderful experience mostly. My hormones has made me less tolerant to alchol and social drugs and that excess has triggered anxiety attacks. apart from that I'm just feeling great and happy.

[SelenaMendez]

this is why i think its time for me to take a break from hormones :-(  i somehow think we are all hit at some point in our transition. some of us early and others later. I could be wrong and it could just be like some said, we go through so much during transition, socially and what not that we internalize everything and with all the estrogen eventually are nervous system erupts and we start to feel anxious and full of fear. It just seems so odd how everything is great for so long and then boom i get hit to the point where imrunning to the ER many times thinking im having a heart attack and its just anxiety. it got so bad id stay in bed for days curled up cuz id feel like my chest was constricted and these waves of fear running through my body and mind. Such a scary feeling i dont wish on my worst enemy my best friend mentioned she used to take birth control and started feeling really nervous and panicky so she stopped..i dunno you guys this is so confusing and frusterating. im the last person to feel even slightly down or sad little alone anxious almost everyday to the point i break down and curl up in bed to cry all day. im gona put myself to the test n take a break from the estrogen and see if anything changes. i had my first panic attack in august 2013 and it was hell in the beginning and over a couple months its calmed to an extent but still have those days where i feel like im dying.i have an appt with my therapist and doc tomorrow for hormones...il discuss my concerns and see what they say..it seems like alot of us are dealing with this "anxiety" during consumption of hormones over time and we focus too much on the "gender disphoric" being the reason but what if it really is the meds :-(  only time will tell..I love Scary movies and now when i watch them with my bf i get a full blown panic attack wth!!!??? lol coincidence or not il have to get to the bottom of this. Its hard enough i have to deal with my up n down moods. 

[Jennygirl]

Pellets +1

I would seriously consider talking to your endo about pellets. Surges in hormonal levels are gonna affect a person somehow, and pellets completely diminish that effect. Sometimes you can feel a ramp for the first week  but it is so minimal. I've had e booster shots and pellets are nothing like it.

I have had every-day debilitating panic attacks before, so I COMPLETELY understand the severity of the feeling. But going on a high dose of pellets has given me zero anxiety. Smooth sailing the whole time. Granted, I haven't been on e for as long as you!

[SelenaMendez]

Thank you so much jennygirl!! the last thing i want is to detransition :-( 
hmmmm pellets??? il ask him...but what is that?? Did your endo give you that when you felt anxiety??

[Jennygirl]

You are welcome Selena. As a person who has cured their panic attacks, I made a vow to help as many people as I can.

The pellets referred to here probably all come from this pharmacy, and they have a handy PDF info sheet:
http://www.collegepharmacy.com/images/download/PelletFAQ.pdf

I know my endo gets them from here, and I know of a few others in Australia doing the same. Quite a lot of doctors know how to use them The problem is that most doctors just have experience treating cis ladies with pellets, and don't have much experience using them with transgender patients- so they may be a bit reluctant at first.

They are about $75 a pellet from my endo... They need to be replaced every 3-6 months depending on your dosage (my endo has people on higher doses come back at 3 month intervals and some of the docs in Australia do 6 months). It should be pretty much up to you how much you want depending on the dosage (less if after SRS). Cost is another consideration, because at higher doses it becomes expensive.

It might be worth a shot talking to your endo about it, and perhaps it could help with the roller coaster effect you've had trying other methods. I can say from my own experience that I never feel a spike in levels, and they last so long I nearly forget I am on HRT altogether.