Can you Get PTSD from Going Full Time/RLE

[Stella Sophia]

Hi Ladies,

I have been pondering this for a while, but I went full time August last year and started going out in public in girl mode as early as May of last year (When I started HRT) At the time I wasn't having much struggle dealing with people who harassed me or all of the different forms of mistreatment and abuse I had gone through. I lived in Idaho during this time which was not the type of place that was accepting of trans people, but for some reason none of their words or abuse or mistreatment seemed to phase me at the time.

Now recently, as in the last month I have been having some issues with flashbacks if you will? I will think about different places or different people and remember someone saying something rude to me, or having someone threaten my life or even a guy that pushed me down in public. I keep feeling these come up when I drive by these certain places. Words trigger it like if I hear "man" or "sir" even if not directed at me but generally if they are within my direction (like a guy shouting past me or something along those lines)

I have been struggling with this and I am not sure what to do. The feelings I get are fear, helplessness, shame, guilt, and anger and loneliness. These feelings are getting more and more severe and are beginning to make me go from being completely happy and content to just totally shutting me down and causing my moods to become depressing and dark and it will cause me to cry. I feel like I must have blocked these feelings out while I was going through my first several months of transitioning and now they are all just catching up to me. I think it may be PTSD but I don't know if that could actually happen due to living full time or going through RLE.

Anybody else experiencing this or have any ideas?

Thanks ladies,

Stella

[Cindy]

Hi Honey,

That certainly sounds an extremely stressful series of events and you are sounding a bit depressed. I think this really does need to be discussed with your therapist as you need methods to protect you from such abuse.

PTSD can arise from any series of events that impact on your life and general well being and being insulted in the way you describe could certainly cause severe stress.

Do try and talk through this with your therapists very soon rather than letting it get worse.

Oh and you are welcome to come to Adelaide, no one worries about transgender people here!

[Ms Grace]

It certainly sounds like stress and depression and anxiety have mushed together into something that is causing you to struggle. As Cindy says, talking to someone about it before it gets worse is the best course of action. I don't know if it was directly linked to going full time but I can easily see how it could be. Take care.

[Stella Sophia]

Thanks Cindy,

I don't know what's going on I just was reading through some other topics about some of us girls talking about passing and other RLE and it started giving me flashbacks and causing anxiety. This is getting pretty bad.

[Cindy]

You can pour your heart out here Hon. Sometimes just talking about it helps.

[Stella Sophia]

Thanks but no thanks, I will probably just do another video on it at some point. I am mostly looking for others that are experiencing this.

[marssu]

I feel you girl.

I was experiencing this kind of negative mixed feelings the first months when I started RLE. It was specially bad when I was walking alone through group of people or in a shopping mall. I sometimes got panic attacks even. It was the worst! Now after 1 year on hormones things got much more better. I dont get panic attacks anymore since I feel more passable and people treat me good. Hang in there! Talking with someone helps too

[KyleeKrow]

Sounds like PTSD to me. I have it myself. I find meditation has helped me a lot. Sometimes I use little tricks like counting objects of a certain color that I can see, holes in the ceiling, etc. Would of course recommend a therapist to learn ways to cope with it. I use art a lot to get some of that stuff out as well. Writing has helped as well.

[itsApril]

. . . I went full time August last year and started going out in public in girl mode as early as May of last year (When I started HRT) At the time I wasn't having much struggle dealing with people who harassed me or all of the different forms of mistreatment and abuse I had gone through. I lived in Idaho during this time which was not the type of place that was accepting of trans people, but for some reason none of their words or abuse or mistreatment seemed to phase me at the time.

Now recently, as in the last month I have been having some issues with flashbacks if you will? I will think about different places or different people and remember someone saying something rude to me, or having someone threaten my life or even a guy that pushed me down in public. I keep feeling these come up when I drive by these certain places. Words trigger it like if I hear "man" or "sir" even if not directed at me but generally if they are within my direction (like a guy shouting past me or something along those lines)
. . . I think it may be PTSD but I don't know if that could actually happen due to living full time or going through RLE.

Well, not exactly PTSD as strictly defined.  Here's some info from the American Psychiatric Association on how PTSD has been defined:

"The diagnostic criteria for the manual's next edition [DSM-5, adopted in 2013] identify the trigger to PTSD as exposure to actual or threatened death, serious injury or sexual violation. The exposure must result from one or more of the following scenarios, in which the individual:
• directly experiences the traumatic event;
• witnesses the traumatic event in person;
• learns that the traumatic event occurred to a close family member or close friend (with the actual or threatened death being either violent or accidental); or
• experiences first-hand repeated or extreme exposure to aversive details of the traumatic event (not through media, pictures, television or movies unless work-related)."

More info here:
http://www.dsm5.org/Documents/PTSD%20Fact%20Sheet.pdf

People use the term PTSD pretty loosely in casual conversation, but as a medical/psychiatric diagnosis it's much more restricted.  Typically docs think of PTSD in connection with exposure to very extreme threats or violence (soldiers in combat, people injured in auto accidents, people held at gunpoint or severely beaten in criminal attacks, survivors of rape or sexual assault, etc.).  Offensive remarks or harassing behavior don't do it.  Of the instances you mentioned, the only one that seems close would be being pushed down by a guy.  But as you said, even those events didn't trouble you greatly at the time.

Whether or not what you're talking about is PTSD is beside the point.  Lots of stuff trans people have to deal with is acutely stressful and painful, and can give rise to long-standing emotional problems.  Depression and anxiety disorders are not uncommon among trans folks, particularly related to the period of active gender transition.

I agree with the people who say you should take this up with your therapist.  Trans folks often fall into the habit of thinking about therapy only in connection with gender issues.  But all kinds of people go to therapists for all kinds of reasons.  If you're experiencing generalized fear, or unwarranted guilt or shame, or panic attacks, those are excellent reasons for seeking therapeutic help.  Don't try to tough it out by yourself.  Life's too short!

[SonadoraXVX]

Sounds like PTSD to me. Discuss it with a therapist and he/she/they may concur. You maybe experiencing a delayed form of it. It's definitely related to the stress response.

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[starting_anew]

That does sound like PTSD to me, but can't say definitively - only a therapist would be able to clarify that for you following a few sessions.  I practiced as a clinical social worker for close to five years before being a student again, and I can tell you it's very common for people with trauma to detach themselves from the traumatic experience(s) they've undergone, and then later experience the trauma as flashbacks or as feelings of anxiety/depression/helplessness, or any combination thereof (among other symptoms). 

The good news is that these feelings are very manageable with access to a skilled therapist.  For now, the best thing that you can do is to think of all the situations in which you are triggered, and do a "grounding exercise" you may be comfortable with to bring you down from immediate sensations of distress when these triggers come up.  Here are some examples of grounding exercises, but there are many online that people find helpful: http://www.livingwell.org.au/well-being/grounding-exercises/

Keep in mind that this is just a bandaid, and that there really is no substitute for speaking to a therapist.  Grounding exercises are more like an emergency kit, and the work of a therapist is like treatment to help you truly recover and sustain yourself so that you no longer require professional support.

[KristyWalker]

I also recommend talking to a therapist I have used them on multiple occasions in my life from the death of mother when i was 12 and father when I was 18 to when I had an obsessive crush on a girl in college and I see one now to help me with coming out as transgender and how I want to express myself. They do help big time! 

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[Stella Sophia]

I haven't spoken to my therapist for several months now.

[stephaniec]

I've been developing severe anxiety issues for a while . I know the cause and it's a little too complicated to discuss , but my therapist has suggested going on anti anxiety medication which at first I balked at , but I realize she's right so I'm going to try to start it.

[DiamondBladee]

I haven't spoken to my therapist for several months now.

I'd try to speak to one if you're really having concerns and/or struggles.  It can't really hurt, right?

[Carrie Liz]

I worried about this exact same thing very soon after going full-time about 2 years ago, because I had a bunch of issues where I was getting negative comments from people, being scoffed at, having people take pictures of me, an old guy telling me "if my kids went out dressed like that I'd slap them," etc. These constant negatives were unnerving me just like they were unnerving you, and I was dwelling on them and having a hard time getting them out of my head every single time I went outside. I was constantly terrified that it was going to happen again, and I was reliving those moments in my head, etc.

Time heals everything.

Seriously, no, even though I worried about it giving me PTSD or something just like you describe, that worry/fear/PTSD-ish thing slowly went away the longer I was full-time. Once you reach the point where you're just living life, and you're you, you really don't worry about things like that anymore.

So yeah, just give it time. Everything will settle, your mind will settle, the fear will subside, the hurts of your early-transition will fade to becoming a distant memory, and you just have to have confidence that it will get better. Because it will.

[kiteless]

hi, i have ptsd that stems from a non-gender related issue. ptsd is like the worst thing you can have. you have all of these weird visual and audial effects that make places and people seem sinister, like your vision darkening out or a sudden sense of doom for no particular reason. the flashbacks are the worst, it's like you smell a smell or see something that reminds you of a traumatic event, and all of the sudden it's like your heart got sucked out and replaced with a gaping hole of nothingness, you feel like you will never be happy again. if you are familiar with harry potter, it's like when the dementors attack, visually and emotionally. only the dementors are the things in your head you can never erase.

i have had issues like this for a very long time, so i don't really remember what it is like to be "normal" and come down with it over a period of time. you should definitely visit a therapist or a psychiatrist if it's impacting your life.

[KayXo]

my therapist has suggested going on anti anxiety medication which at first I balked at , but I realize she's right so I'm going to try to start it.

Progesterone is naturally anxiolytic due to the actions of its metabolite, allopregnanolone, a sedative, especially high when taken orally. Anxiolytics work the same way by enhancing GABA action.

Experimental and Clinical Psychopharmacology 2007, Vol. 15, No. 5, 427–444
Progesterone: Review of Safety for Clinical Studies

"in a placebo-controlled study, patients with premenstrual mood disorder did report drowsiness but reported improvements in anxiety, depression, and stress"

J Womens Health Gend Based Med. 2000 May;9(4):381-7.

"women using micronized progesterone-containing HRT
experienced significant improvement in vasomotor symptoms, somatic
complaints, and anxiety and depressive symptoms."

Prog Neurobiol. 2014 Feb;113:79-87.

"Reduced levels of allopregnanolone in the peripheral blood or cerebrospinal fluid were found to be associated with major depression, anxiety disorders, premenstrual dysphoric disorder, negative symptoms in schizophrenia, or impulsive aggression. The importance of allopregnanolone for the regulation of emotion and its therapeutical use in depression and anxiety may not only involve GABAergic mechanisms, but probably also includes enhancement of neurogenesis, myelination, neuroprotection, and regulatory effects on HPA axis function."

Obstet Gynecol. 1997 Nov;90(5):709-14.

"To evaluate the anxiolytic 3alpha-5alpha-reduced progesterone metabolite allopregnanolone in the luteal phase of the menstrual cycle in women with premenstrual syndrome (PMS) and controls."

"Subjects with PMS manifested lower levels of the anxiolytic metabolite allopregnanolone in the luteal phase when compared with controls. Diminished concentrations of allopregnanolone in women with PMS may lead to an inability to enhance gamma aminobutyric acid-mediated inhibition during states of altered central nervous system excitability, such as ovulation or physiologic or psychological stress. The lowered metabolite levels could contribute to the genesis of various mood symptoms of the disorder, such as anxiety, tension, and depression."

Neuroscience & Biobehavioral Reviews
Volume 46, Part 3, October 2014, Pages 465–471

"Panic disorder is twice a common in women than in men. In women, susceptibility to panic increases during the late luteal (premenstrual) phase of the menstrual cycle, when progesterone secretion is in rapid decline."

"We show in females how a rapid fall in progesterone secretion, such as occurs during the late dioestrus phase of the ovarian cycle in rats (similar to the late luteal phase in women), triggers a neuronal withdrawal response during which the excitability of the midbrain panic circuitry increases as a result of upregulation of extrasynaptic GABAA receptors on inhibitory interneurones in the PAG. The withdrawal effect is due not to the native hormone but to its neuroactive metabolite allopregnanolone."

Progesterone is also used in women with post-partum depression (i.e. post-pregnancy).

Finasteride/dutasteride reduce allopregnanolone concentrations in the brain and may increase anxiety.

J Steroid Biochem Mol Biol. 2015 Feb;146:74-9.

"Observations performed in a subset of patients treated for male pattern hair loss indicate that persistent sexual side effects as well as anxious/depressive symptomatology have been reported even after discontinuation of finasteride treatment."

"Although severity of the anxious/depressive symptoms was quite variable in their frequency, overall all the subjects had a fairly complex and constant neuropsychiatric pattern. Assessment of neuroactive steroid levels in CSF showed a decrease of PROG and its metabolites"

PROG =  progesterone

Paradoxically, in some, high levels of allopregnanolone increase anxiety, irritability (or perhaps, it is the fluctuation?).

Neuropsychopharmacology. 2016 Mar;41(4):1093-102.

"we stabilized neurosteroid levels by administering the 5α-reductase inhibitor dutasteride to block conversion of progesterone to its neurosteroid metabolite allopregnanolone in women with premenstrual dysphoric disorder (PMDD) and in asymptomatic control women."

"Stabilization of allopregnanolone levels from the follicular to the luteal phase of the menstrual cycle by blocking the conversion of progesterone to its 5α-reduced neurosteroid metabolite mitigates symptoms in PMDD."