Friday, September 9, 2016

Testosterone Cessation: Introduction and Injection Anxiety

For several months now (finalizing in the end of July) I've been mulling over the thought of going off of testosterone replacement therapy, which I've been on for about four and a half years as part of a gender transition program.  This is not, I feel the need to insist, because I have any plans to "detransition" back to being a woman.  I'm very happy being a man, and without my rounds and rounds of hormone therapy I would not be as comfortable in my skin or as confident as I am.  I went on hormones after many years of socially transitioning without them, and the difference is staggering and overwhelmingly positive.  I got health problems from it, but many of these were probably going to happen anyway (like hypertension, which I have had since I was a teenager) or easy to treat (like secondary polycythaemia).  These are frustrating and definitely were part of my decision, but if it were just a matter of these I would probably still continue.  That said, my reasons for stopping are a mix of philosophical, medical, spiritual, financial, and mental-health reasons.

A warning that this next paragraph has some detailed descriptions of awful injection experiences.  Giving myself injections is a chore that I absolutely dread.  The only thing that motivates me to inject myself at all is putting it on the game Habitica, which I play with my best friends, and it becomes less and less of a motivator as time goes by.  One thing that transgender men such as myself don't talk about so much is the fact that administering hormones tends to get much, much worse over time.  The first shot is often very easy... it slides through the skin like a hot knife through butter.  You marvel over how easy it is, how painless it is, and think "Yeah, I could do this forever."  Then the physical changes start coming.  Your skin gets tougher.  Your muscle gets more dense.  Suddenly you have to make actual effort to stick the needle through that top layer of skin.  Getting it through the muscle starts feeling like cutting steak with a dull knife.  You start injecting in the same place more often than you should, trying to find reliable areas to shoot that don't leave you frustrated and anxious, leading to hard spots within the muscle it's impossible for the needle to get through.  You have a panic attack thinking you injected into an artery because blood spurts out when you remove the needle one time.  You bruise.  Maybe you get an infection at some point.  It doesn't always hurt, but the expectation of "will it or will it not hurt terribly today" makes giving yourself a shot a nightmare.  You start putting it off.  You say "oh gosh, it's so late in the night, I'll just do it tomorrow."  You put off refilling a prescription just because it gives you an excuse to avoid sticking yourself for another couple days.  And while I'm certainly not saying all trans men go through this, quite a large number of us do.  This is one of the reasons subcutaneous injections (which involve smaller needles and much less depth) are so popular now.

So I chugged through that because although the injections sucked, the physical transformation itself is awesome.  In a little under five years I've managed to grow a great beard and handlebar moustache and my voice is in a male-read range.  These are the two physical effects that matter to me, and they are unlikely to go away.  Everything else--the fat redistribution, the lack of menstruation, the extra muscle, a number of emotional side effects--do not mean very much to me, and in the latter case are a large burden.  And every time I sit there with a needle contemplating sticking it in my leg, I re-affirm to myself that testosterone was worth it for the amount of time I've been on it, but is not worth continuing.

There has been a huge hit on my health.  I gained a lot of weight that can't be explained by muscle growth, and a lot of fat in the belly rather than less-harmful areas.  I have secondary polycythaemia, meaning my body makes too many red blood cells, putting me at risk for heart attack and stroke.  My high blood pressure has shot up to the point of needing to take medications.  The secondary polycythaemia, in particular, is difficult for me to manage as a queer person, since the treatment is to go donate blood, something I am often ineligible for.

One thing I'm curious about is whether or not testosterone will bring back any anxiety.  There's a very commonly held idea in the trans community that being estrogen-dependent as a man or testosterone-dependent as a woman is inherently anxiety-inducing, which has been used as ammunition against people who consider hormone therapy unnecessary or cosmetic.  But is it, really?  I have had some extreme spots of anxiety after hormones, mostly due to financial stress.  How much of my pre-testosterone anxiety was merely due to not being read as a man?  I won't know the whole truth here until I'm an estrogen-dependent man again, but I suspect that the answer is "a lot."  When I do dwell on this sort of thing, I just remind myself that I can always start testosterone again, as many trans men have done.

This is the first part in a series regarding my current cessation from testosterone, what that means culturally for me, and what my plans are for it.  In the coming weeks (and longer) I'll be talking about the following subjects:

  • Whether or not transsexualism as we know it is a medical phenomenon and whether that's a bad thing as well as other cultural stuff about the trans community.
  • Plans for dealing with the pitfalls and quirks of living in an estrogen-dependent body with a functioning uterus.
  • Why I'm not moving toward "natural transition."
  • What physical and emotional effects I'm going through as they happen.
  • Whatever else I happen to feel like writing about.
Until then, happy trails,
--Setkheni-itw