Fearful I may need to come off HRT

[LindseyP]

I have a scheduled follow up with my Endo today.  One potential outcome has me deciding to come off HRT.  I really don't want to entertain that, but depending on the sum of the answers to all the questions, it is a possibility.  This scares the hell out of me. 

The problem lies with the fact that to be healthy, you need a dominant sex hormone.  Being too neutral is actually unhealthy.  But if I am to continue living "stealth", and it is my intention to do so, there comes a point where I could get too top heavy to pass - and that will create other issues.  My wife would be one of those issues.  I'd also prefer to not have to deal with coming out professionally.  And a host of other, I am sure rooted in privilege, issues. 

The biggest problems arise from why I even had to start dealing with my gender identity at the age I did.  I had some fatigue issues and among other things got diagnosed with low T.  So I got prescribed 2 squirts of Androgel a day.  Over a period of a year, I got lots of body hair and got increasingly depressed.  Until one day when I had a kind of a mini-breakdown.  I came back to my hotel after dinner (I was on the road for work) sat at the desk in my room, put my head in my hands and just started crying uncontrollably. 

I've been the way I am my whole life but managed somehow to cope with things enough to live.  But at that moment, every coping mechanism I had adopted over the years had all failed at once.  That was the night I called my Employee Assistance Plan and did an intake that ended me up with the gender therapist I currently have.  I eventually weaned off the testosterone, and tried low doses of HRT (starting Dec 2015).  They had to be increased over time as I wasn't getting the right mix to be healthy.  I'm at that mix now but because it has been an adjustment over the last two years, with the biggest jumps in the last 6 months, I can't rely on the 2 year rule for breast growth. 

So anyway, I have no idea how today's appointment will go, but the scariest potential outcome is the one where I not only come off HRT, but have to go back on T.  I just can't do that.  I do not want to go back to that place I was in. 

Three and a half years after I formally started dealing with "me", I have never felt happier with myself and being me.  I know HRT is not an exact science and I know there is no one that can make me any promises.  Which is why I know this needs to all be a conversation today.  I have other things on my list, but this is by far the biggest and most serious for my future. 

FWIW, I am amab, transfeminine, but you probably pulled most of that out of the above text. 

[KathyLauren]

Are you seeing a gender therapist?  Because these are things that you should be getting help with planning.

Since going back on T is not an option and going without sex hormones altogether is also not a healthy option, then going forward with HRT is the only option.  The only variable is the dosage.  As such, male fail is probably inevitable.

I take it you are not out to your wife?  As you suggest, at some point in the near future, that will be necessary.  You need to have a vision for where to go with it if that goes well, and a plan of what to do if it does not go well.

While there is no requirement to transition, you should be exploring in detail, with the help of a therapist, what barriers you have to transitioning, so that you can have plans in place to deal with them.

[LindseyP]

Are you seeing a gender therapist?  Because these are things that you should be getting help with planning.

Since going back on T is not an option and going without sex hormones altogether is also not a healthy option, then going forward with HRT is the only option.  The only variable is the dosage.  As such, male fail is probably inevitable.

I take it you are not out to your wife?  As you suggest, at some point in the near future, that will be necessary.  You need to have a vision for where to go with it if that goes well, and a plan of what to do if it does not go well.

While there is no requirement to transition, you should be exploring in detail, with the help of a therapist, what barriers you have to transitioning, so that you can have plans in place to deal with them.

Yes, seeing a gender therapist.  She has meant so much to me as I have been tiptoeing my way through everything the last 3.5 years.  Yes, I am out to my wife.  I have even had a couple of joint sessions with my wife and my therapist.
It was good for my wife to be able to get first hand confirmations to questions.  It was also useful as checkpoints in my therapy, as anyone can describe their situation, but meeting people involved lets a therapist confirm the accuracy of what they are being told. 

I do know if I decide to present full time, that will be the end of our romantic relationship.  I have periodically brought it up, and wife finally asked me earlier in the year to get her the name of a therapist and in the last few weeks she finally called.  She is only 2 appointments in, but this is a positive.  We are both committed to making things work.  She has met some of my trans friends and after hearing stories, she has told me she knows and appreciates that I go over and above to take her feelings into account.  Her words, not mine. 

She is not supportive in that I am not encouraged to transition, with her being by my side every step of the way.  She is supportive in that she will participate in certain things (we did a hike with some of my trans friends two weeks ago and went to a queer comedy show this past weekend), meet some of my friends, not complain about things in the budget like copays for my meds, my therapist, and the occasional electro session on my face.  She has no issues with my attending different support groups and knows this is helpful.  I had a negative situation with my family earlier in the Summer and she has been a rock to me.  I waited to come out to my daughter at my wife's request.  I am waiting until my son graduates High School in a year before I consider coming out to him at her request.  She is not big on disclosure among our friends so I generally stick to telling my friends where necessary and leave hers out of it for now.  I can live with that.  She has to transition as I transition, and I need to be equally supportive where I can.

I was really more trying to express my fears in my original post than to look for clinical help.   I am guessing I am not the only person that has ever stressed about "going too far" or "getting yanked off (HRT)". 

I have just got back from my appointment.  I went through my/my wife's questions and concerns.  I got answers that I know in some cases are best guesses and not warranties.  It needed to be done.  People probably should not run away from exploring the potential downsides of HRT, in order to make the best, informed choices.  In my case, we reviewed my labs, left the Spiro alone, and actually upped the Estradiol.  I had options to go in other directions, but this seemed to make the most sense based on the totality of my circumstances.  There are no guarantees, and only time will tell.   

[KathyLauren]

Thank you for the clarification, and sorry for my misunderstanding.  It sounds like you are progressing forward.  Congrats on that!

[LindseyP]

Thank you for the clarification, and sorry for my misunderstanding.  It sounds like you are progressing forward.  Congrats on that!

A lot of the same questions I'd probably ask someone.  They are good ones to not assume.  I appreciate your caring.   <3 

[JoanneB]

So just what sort of dosing of E are you on? Sounds like perhaps low dose HRT?  Some endos are very very conservative in general. I have to suspect more so for older patients.

I've been on/off low dose several times during my life for the much needed Brain-Reset. That was always followed up with the sheer force of will to keep up the "Male" life.  Low T, I doubt was ever my problem. Not when I towered over everyone in H/S and was the only one balding at 14.

Eight years ago the GD got to be too much again. Low dose worked... kinda sort of. Low in time became full feminizing and worked even better. As far as the fatigue goes.... I'm an old dinosaur. I've been on E before. Most times without an AA. One time I did do an AA. This time I had a kick ass AA. The drop in T levels first hit with not stinking like a guy, then followed by some loss of the little strength I have. To counter that, and to drop a few pounds, I started walking, a lot. Being outside in the fresh air surrounded by nature not only lifted my mood and helped some with the physical stamina.

Fatigue may also be a symptom of depression. Like you I am also doing my best to balance the male aspects and female needs of my life. My doing a full social transition is not something my wife wants to see. Well TBH, neither was a husband dropping the T-Bomb or having nicer boobs then hers. We both do our best to balance all our needs and wants. We both also have our darker periods.

[LindseyP]

So just what sort of dosing of E are you on? Sounds like perhaps low dose HRT?  Some endos are very very conservative in general. I have to suspect more so for older patients.

I've been on/off low dose several times during my life for the much needed Brain-Reset. That was always followed up with the sheer force of will to keep up the "Male" life.  Low T, I doubt was ever my problem. Not when I towered over everyone in H/S and was the only one balding at 14.

Eight years ago the GD got to be too much again. Low dose worked... kinda sort of. Low in time became full feminizing and worked even better. As far as the fatigue goes.... I'm an old dinosaur. I've been on E before. Most times without an AA. One time I did do an AA. This time I had a kick ass AA. The drop in T levels first hit with not stinking like a guy, then followed by some loss of the little strength I have. To counter that, and to drop a few pounds, I started walking, a lot. Being outside in the fresh air surrounded by nature not only lifted my mood and helped some with the physical stamina.

Fatigue may also be a symptom of depression. Like you I am also doing my best to balance the male aspects and female needs of my life. My doing a full social transition is not something my wife wants to see. Well TBH, neither was a husband dropping the T-Bomb or having nicer boobs then hers. We both do our best to balance all our needs and wants. We both also have our darker periods.

My original fatigue was just regular fatigue.  Besides the prescription for T, I was also diagnosed with sleep apnea.  The combination of the two treatments solved the fatigue.  And eventually the T landed me on the couch of a gender therapist.  I mentioned in the OP - I do not want to go back to using T.  I can't.  But I also acknowledge to be healthy, you need a dominant sex hormone.  The source of my fear was the depression generated by the T.  The fatigue was not a symptom of depression.  It was a result of low hormones and lack of quality sleep.   

I think I am in a good place (now that I have had my appt.) and I am happy with the professionals I am working with.  I just switched Endos in February.  My other was was good enough, but their office was not run very professionally, they did not take my insurance, and it was twice as far away as my current one.  The Endo I am seeing now has been highly recommended by others in my local community and she is everything they say she is. 

You need to have certain levels of hormones or you put the health of your bones at risk in the long run.  My E levels were bumped this last visit due to those concerns.  I could have opted to stay lower.  I want to be happy but I also want to be healthy.  I got the "little blue pill" this time, which also addressed some of my wife's other concerns.  I'm a work in progress.  But a relatively happy work.