Apparently, today is my two year HRTiversary (anniversary of the day I started hormone replacement therapy). Who knew? I mean, I guess I did in the back of my head, but I completely forgot about it. I only even thought about it today because of a friend who reminded me this morning by wishing me happy HRTiversary.
Trigger warning for talking about suicide
As you can tell by the trigger warning, this post will touch on suicide a bit. I’ve written about this a few times before, but, while I know it won’t be the last time I write about it by any means, I’m always a little hesitant to write about it again. It always seems to raise concern with at least a few people. But, as I have written about before, being able to write about these kinds of things has always been helpful to me.
Two and a half months ago, I had my annual checkup with my doctor for my HRT (hormone replacement therapy). We went over my labs and discussed how things have progressed over my first year. One thing that came up, was my discontent with my breast development. I’ve hardly got anything going on. Since the main reason for transgender women to take progesterone is typically for breast development, I had planned on asking if it was even worth continuing with it, as it is likely partially to blame for my weight gain. Considering the plan was to only take it for a few years while things were developing, I wanted to know if maybe I should just stop taking it since I’m not getting anything out of it anyway. My doctor, instead, suggested doubling down. Literally. She suggested we try doubling my dose. She was confident it would help, but was very clear about the side effects of increased weight gain, depression, and possibly suicidal thoughts. I cautiously decided to at least give it a shot.
After a couple months on my increased dosage, the depression seems to be in full effect. I’ve been really struggling to deal with it at times and it’s around more often than it’s not now. The worst has been dealing with feeling suicidal much more than my normal baseline.
I’m no stranger to the feeling, it’s been a fairly constant background noise my whole life, but things had gotten a lot better for a while. Instead of it being a daily thing, it was maybe a couple times a week. I counted that as a huge win.
Unfortunately, it’s recently been back to every day and been triggered by the smallest things.
That’s sort of the thing about being someone who struggles with feeling suicidal, you really never can leave it completely behind you. Once you’ve been at a place where you’ve accepted it as a legitimate escape, there’s no reversing that. A few weeks back, I wrote a post on Tumblr, but never posted it. It’s been sitting in my drafts since then. This is what I wrote:
The thing most people don’t realize about suicide and feeling suicidal is that it’s rarely about the pain right now. The pain may suck, but, in many cases, you know you’ll get through today. You know tomorrow will be better and if it’s not then maybe next week will be better. You know what you’re feeling now isn’t going to be what you feel every moment of every day going forward. That’s not the problem. The problem is knowing relief from the pain is temporary. You know you’re always going to have to fight through something. You know the pain is immortal and, while it can be knocked down, it can’t be entirely defeated.
Sure, you can fight through today and you can fight through tomorrow, but you’re tired of fighting. Why do you always have to fight? Sometimes, you just want a break from fighting.
People tell you things will get better and they’re right, but things don’t stay better, they get bad again. It’s a cycle and you know all the stages. When you feel good, you know it’s only temporary. The good sometimes feels so fleeting that it often seems entirely pointless to even let yourself feel good at all.
The reason for not wanting to live isn’t what you feel, it’s knowing you’ll never escape what you feel. It’s feeling trapped. Suicide is escape from the trap. It’s freedom from ever feeling the pain again. It’s freedom from ever having to fight again.
It’s not the present that makes you not want to live. It’s the future.
Once this place has been created in your head, there’s no destroying it. It always exists. The worst is that it becomes easier and easier to access. Actually, that’s not even the best way to say it. It’s more like you exist closer and closer to it after each visit. Smaller things will take you there for another visit. A minor tiff with your significant other? Frustration with a coworker? A feel-super-ugly day? All of these things are more than enough.
This has been my reality since somewhere early in high school, so it’s sort of my normal. What’s changed now, though, is that it’s not just what’s in my head that’s taking me there. It’s being assisted by my meds. The very same meds that have freed me from so much other unhappiness in my life. This makes it so much worse. There was never a silver bullet for getting myself out of the darkness, but I had gotten good enough at surviving it until I felt better. Now, just surviving it is getting harder. Each time I’m in that dark place, it seems to be even darker and the way out is more poorly lit than the last time. Not to mention how much more easily I end up in that place now. It’s been multiple times a day. Every day.
Last Friday was probably the darkest it’s been in a very long time. I was at work and a couple things were frustrating me, then I was reminded about a few things that were causing me a lot of dysphoria earlier in the week and how crappily running has been going lately. Somehow, these things all really spiraled out of control and I was in bad shape. All will to live was completely taken from me. It wasn’t that I wanted to die, I didn’t, but I just REALLY didn’t want to live anymore. As I’ve mentioned, this is sort of normal for me, but things got to a level much worse than I normally deal with. The point that scared me the most was when I, while sitting at work, opened an incognito Chrome window and Googled “least painful ways to kill yourself.” I’ve never done this before. I even started thinking very seriously about what to write in a suicide note. I started drafting it in my head, but I didn’t quite get to a point where I actually started writing it down.
In the end, what snapped me out of it was my willingness to allow myself to be snapped out of it. It was actually my reply to a tweet that made me giggle to myself. That smile was just enough to calm myself and I felt everything just melt away.
@ZJemptv I once found my sex in my armpit. I was like "what the hell are you doing over there?!"
— Amelia Gapin (@EntirelyAmelia) July 11, 2014
Without this tweet, I don’t know what would have snapped me out of it. Something would have, but who knows what it would have been. And, this may be the scariest thing from Friday, it took something entirely unrelated and random. What if nothing happened that did the trick? What if the situation was different and I was at home and alone? How dark would things have gotten? What else might I have done?
Sitting here, typing this, I’m completely into the idea of not being dead. I’m in an entirely different headspace. A headspace I prefer a lot more! Typically, I wouldn’t even think twice about a single episode of suicidalness, but Friday was particularly intense and it came on really quick. The one thing that makes me feel okay about it is knowing it almost definitely wouldn’t have happened if not for my increased progesterone dosage. I don’t know how long it’ll be until I reduce my dosage or even stop taking it, but I know this dosage is for a finite timeframe. And, if this happens again, I can choose to stop and things should go back to the way they were.
PS: As I mentioned at the top, this topic often causes people to get worried and stuff. As much as it may seem really bad, I don’t want to worry anyone. My actually posting this should serve as evidence that everything is fine.
When I look back over the past year, it’s almost hard to believe it’s been a year already, but so much has happened and changed that it really does feel like a lifetime. It also took me almost a year after accepting transition before I started hormones so, when it finally happened, it felt like a long time coming.
The changes have been unbelievable. I’ve seen my face develop softer features and more prominent cheekbones. I’ve seen new growth along my hairline. I still hate my hairline, but it’s better than it was. I’ve also noticed my hair strands are slightly thicker. My body hair growth has slowed and almost entirely stopped on my back. I never had oily skin, but it’s definitely even drier than it used to be and I no longer get even the occasional pimple anymore. Obviously, I’ve got boobs now, but they haven’t grown nearly as much as I hoped they would have. They’re still barely there. Though, I have developed a slight bit of a waist. It’s not huge since bone structure doesn’t change, but you can tell it’s there. And finally, one of the most noticeable physical changes has been the reduction in strength and how much of a slower runner I am now.
Taken together, it’s pretty impressive. I look in the mirror now and see the woman I always felt I should see staring back at me. On good days, I even feel pretty.
Most importantly, though, have been the mental changes. Where I used to just feel “off,” like an engine running on the wrong type of fuel, I feel “right” now. My head feels much clearer and 95% of my dysphoria is gone. I feel how I always thought I was supposed to, how everyone else feels.
There have also been a lot of other random changes that I didn’t expect. I started liking most of the foods I used to hate and I fall asleep quicker at night. I’d never heard of either of these things happening before, but I’m not complaining!
The only real negative aspect of HRT I’ve experienced has been my weight. I’m really struggling to keep under control. At first, I lost about five pounds and was nice and steady there. After five months of taking estradiol as a cream I decided to switch to injection. Since making that change, I’ve gained those five pounds back, plus another four. I try to keep better tabs on how much I eat, but it never seems to be enough. It’s a constant worry.
Overall, I don’t think there’s much else to say that I haven’t said already. Transition is a life-changer and hormones are no joke. Next month will be six months live as Me 2.0 (full time out as Amelia), I’ll have more to say specifically about that then. I just felt like this was an occasion I should mark in some way.
I’ve don’t think I’ve given an update on my overall cost of transition in a while, so here’s where it currently stands after 22.5 months since accepting it…
- Hormones: $2,208.73. This includes all my hormones, labs, and doctor’s visits. My doctor simply charges $400/year to cover everything you do though them. My payment for my second year is included in this amount. My Spironolactone (testosterone blocker), Avodart (Dutasteride), and progesterone cost $60/month and my estradiol and syringes cost about $50 for three months.
- Clothes: $3,095.89. This is my entire wardrobe including running clothes and shoes, but not including most accessories. Things purchased with gift cards are included here, but not all gifts I’ve received are (some items my wife purchased for me are, some are not).
- Therapy: $3,083. This is 20 months of therapy at an out-of-network therapist. My last session was in January so this is not currently an ongoing expense. If my count is correct, this is for 27 sessions.
- Laser hair removal: $734 (face) + $448.25 (other). I’ve had 16 laser sessions done on my face and have probably reached the extent of what laser can do there. The rest of the money is for three sessions each on my chest and stomach.
- Freezing and storing sperm: $1535. We’re rather sure we don’t want kids, but just in case we thought it would be a good to make sure we still can. This includes the process of collecting and freezing sperm and two years of storage.
- Legal: $528.03. This is my name change, driver’s license, and new passport (which I needed to pay to be rushed).
- Other: $1,687.76. Everything else. Things like makeup, purses, and accessories, as well as all new snowboarding equipment (board, bindings, jacket, and pants) which I felt like I needed.
I’ve written about a lot of this over the course of the last few months, but a few people have requested a post dedicated to how I’ve changed as a runner because of transition. Since I’ve read two articles about transgender athletes in the past few days, I figured it was finally time to write about it myself. While my experience has been in line with the experiences of other trans women I’ve spoken to regarding the topic, I do want it to be noted that this is very specifically about my experience and it may not be universal to all transgender (women) runners.
When I decided to transition, I knew things would change for me as a runner and this was something I was going to have to come to terms with. I tried to research it as much as I could, but I was only able to find two articles which specifically discussed effects on runners. I knew to expect to be slower, but I didn’t know by how much.
When I finally started on hormone replacement therapy (HRT) which consists of estradiol, progesterone, and testosterone blockers, I realized this was no joke. Within just a few weeks, I was already noticing that building and maintaining muscle mass and strength was much, much more difficult. I used to have huge calves, but I watched as they quickly downsized. I lost five pounds within the first couple months, all of it was muscle, as far as I could tell. I was glad to have the testosterone out of my body, but this wasn’t a side-effect I was too thrilled with.
As I started gearing up for my Richmond Marathon training cycle, I was having a lot of difficulty mentally adjusting to the physical changes in my running. Despite knowing ahead of time things were going to change, I struggled to fully accept it. I still had no idea where to set my expectations and I felt like I didn’t know my body anymore. I didn’t know how or when to push it anymore. I generally only run by feel and perceived effort level, I don’t look at a watch to pace myself. I used to be able to guess my pace within +/- 10 seconds reasonably reliably, but I could no longer do this. I had no idea what pace I was running anymore. I also didn’t even know what paces to be shooting for either. Setting expectations for myself is where I struggled the most. I didn’t know what goals I should have or what paces to aim for while training and I didn’t know how to measure my progress towards any goals anymore.
Prior to starting HRT, I ran a 3:08 marathon which breaks down to a 7:12 minute/mile pace. Unfortunately, I don’t have a recent 5k pace from just before transition since I don’t run a lot of them. My all-time 5k PR is 20:29, a 6:36 pace, but leading up to the 2012 Chicago Marathon, I was doing 10-milers at around 6:50. So, realistically, I should have been able to do something like a 19:15-19:30 5k.
Now, after almost nine months on HRT, I can’t even dream of hitting these paces again. My current 5k pace is just slightly faster than my old marathon pace and my new marathon pace is 83 seconds slower than it used to be (a 3:44:55 finish). And the thing about my new marathon time is I ran about 20% more miles during my training cycle. I upped my running from five days per week to six. I broke my weekly and monthly personal distance records. And I still ran 36 minutes slower than I used to.
In the past, I would run really easy runs and recovery runs with my wife when she would be out for a tempo or mid-intensity run. These would be very easy for me and she’d help me keep my pace slow when I needed that (a recovery run should be about as slow as you can possibly go). Now, it’s become the opposite, she runs her easy and mid-intensity runs with me, but leaves me in the dust on her harder runs. (As a side-note, I’m actually not bothered by this at all! I’m excited to see her growing as a runner and getting faster and faster. Seriously, she’s getting out of control and accidentally PRs races now!)
Now that I’ve completed a serious marathon training cycle while on HRT, I’ve been able to figure out where my expectations should be a bit more. I know I’ll never get close to those old times I used to run, but I’m starting to feel as though I know where I’ll likely be able to get to. Right now, I generally can expect to run 60-90 seconds slower than I used to at any given effort level. I’m also finally able to feel things out more while I’m running. I’m able to estimate my pace, though with a little less accuracy than before, and know when to push it. I’m still lacking a lot of confidence in my body’s ability to do what I want it to when I’m pushing it on a longer run, but I’m hoping that will come given more time.
What all of this leads to, I guess, is…do I have an advantage over cisgender (not transgender) women? Is it wrong for me to be competing as a woman? Everyone is going to have their own opinion on this and there is a serious lack of scientific research on the topic, but I do feel being a transgender athlete gives me a little bit of credibility to discuss this here.
My honest answer is no, I don’t have an advantage and, yes, I should be competing as a woman.
Yes, I was able to train at a certain level before, but even prior to HRT, I was still well within the realm of what non-elite women my age are capable of running (I was still very much slower than even sub-elite women). Being that running is my hobby—okay, it’s practically my life—I never even came close to approaching a level of training that would have been able to take advantage of my testosterone driven puberty 1.0. I was able to build more muscle mass and strength, but all that is long gone now. When I started HRT, I was actually in the middle of a seven week break from running thanks to hip tendinitis so I wasn’t even in shape anymore when I started. Beginning running again after my injury and with HRT felt like starting from scratch. I hated running for months and I wanted to quit so badly. It wasn’t until around the fifth month that I finally started to feel like my old runner-self and liked running again. I was slower, but it felt the same.
Currently, my testosterone level is at the very bottom of the normal female range and closely monitored via regular lab tests. So the reality is the vast majority of women actually have more testosterone than I do and, therefore, are likely to have a slightly greater ability to build and maintain muscle mass (speaking from a general sense, of course). Coupled with my lower testosterone is my larger skeletal frame and higher bone density compared to cisgender women my age, height, and weight. This means with all other things being equal, I’m carrying around more dead weight in my bones than a comparable ciswoman who may make up the weight difference with additional muscle. While bone density may be a debatable topic for contact sports, when it comes to running, heavier bones just means more weight to carry around. The only advantage here is the decreased risk of bone-related injuries, such as stress fractures. However, my running has been far from injury prone in other departments. I’m just as likely overall to get injured.
One advantage I have over my former self is that I’m much better at handling running in warmer weather than I used to be. However, this is a documented advantage that women have over men, so if anything, it strictly puts me at the same level as cisgender women.
There are lots of little things as well that probably go in both directions. I have larger lungs and previously had a higher capacity for oxygen consumption, but having been out of running for almost two months zapped most of my increased aerobic threshold before I even started HRT and it hasn’t seemed to come back at all. Plus, I have no idea how to breathe with a sports bra on! These things are really constricting! There’s also the fact that my hips are shaped more like a typical man’s hips so I should have an advantage in that department, but my battles with hip and ankle tendinitis would indicate that I maybe I don’t. I don’t really know how this one plays out, to be honest.
In the end, taking all of these things in account, I truly feel as though I’m on equal footing as cisgender women. If you look at my real-world performance, I put in more work to run much slower than I used to. While there are many factors involved (course, weather, training, current fitness level, size of field, etc) so it’s not a foolproof way to measure this, but, a year ago, I finished in the top 6% of men at the Chicago Marathon and, this year, I finished in the top 10% of women at the Richmond Marathon (again, with much more training). I used to be within four minutes of the male qualifying for Boston. Now, I’m ten minutes away from the female qualifying time. Taking a look at the numbers (and I will gladly share more race results and information to anyone who wants it), I compete at roughly the same level compared to other women as I used to compared to men before I started hormone replacement therapy.
What’s your take on this? If you’re s cisgender woman, do you have a problem with me running as a woman?
Are you a transgender athlete? What’s your experience been like?
There are just 29 days until the Richmond Marathon and I’m officially in that stage of training where I’m looking at the calendar, looking at my legs, and then looking back at the calendar again saying “there’s no way I’m going to be ready for this thing! AAAHH!!” I don’t know why I feel this way, but it happens to me before every marathon. You’d think that with this being my fifth one, I’d know by now to trust my training. Last year, I was an emotional wreck in the last three weeks before Chicago right up until the race started. I didn’t feel like I was ready at all, but I went on to rock that race. I had much more reason to be nervous before that race, it was just my third marathon, I was making a real attempt to qualify for Boston (which at the time I was required to do under the men’s qualification time), and I missed almost two weeks of training due to an amazing European vacation.
This time around, my training was more consistent, I didn’t miss out on two weeks of it because of travel. I also bumped up my mileage this time around and got more weekly runs in (six vs five). I’m a much slower runner than I was last year before I had started hormones, but I’m running consistently and I feel good. I had a rough week right before the Disneyland Dumbo Double Dare, but the last five or six weeks of training has been amazing, I’ve really found my groove and have been kicking ass. I’ve fallen back in love with running again after having a mostly off relationship with it for all of 2013. My only major hiccup was a minor cold I had last week which caused me to have to skip a mid-week nine-mile run, but I finished the week only down eight miles from what was on the calendar. I bounced back in time for my 17-mile long run over the weekend and I’ve been feeling great so far this week.
I think the problem I’m facing seems to be less about actual training and more simply a confidence thing. I’ve been completely unable to trust my body since starting hormones. I knew to expect a big loss in strength, but I’m still trying to place where my expectations should be. Even though I really surprised myself a few weeks ago at the Sean Hanna Foundation 5k, that doesn’t seem to be enough. I never feel confident to push my legs like I used to. I’m always afraid they’re not going to be able to keep up with what I’m asking of them. Even if I nail the last four weeks of training, I don’t see myself feeling ready for this race.
Do you ever feel ready for a marathon in the weeks leading up to it?
I almost didn’t even realize that today is exactly three months on hormones! Yay! I would have liked to write up a bit more than this for it, but I’m running out of time on the day. So instead, I’ll just share some of the changes I’ve already noticed:
- My chest hair grows back much slower and thinner.
- Two weeks ago I started to feel some tenderness under my nipples. Last week I noticed that my breast development is just barely getting under way. I’m like an AAAAAAAAAA cup.
- My skin is a little softer. It is also drier, but in a different way than it is in the winter.
- I’m already a much slower runner than I used to be and trying to improve and build back some strength is very difficult.
- My taste in food has changed a lot. I still like everything I used to like, but now there are a lot of things I like that I used to hate and refuse to eat. To name a few: mushrooms, asparagus, aioli and other mayo-based sauces (but not plain mayo), olives, and Brussels spouts.
- I fall asleep a little quicker after getting in bed.
- I haven’t really felt much in the way of the emotional changes everyone talks about. This has kind of worried me a bit. I find that I want to feel sad more now when I should, but I don’t quite feel as sad as I feel like I should and I still don’t get to a crying point.
- My reflexes feel a little faster which doesn’t make sense. I’ve always had pretty quick reflexes, but now I kind of feel like Spiderman.
- I’m overall much happier with myself and my life.
- I’m less lazy and feel more motivated to just get up off the couch and get things done.
- My sex drive is practically zero. This happened pretty quickly. I can still get aroused, but I’m much more in control of it. It used to be sex, sex, sex all the time, but now I don’t really think about it except for when I want to. Instead of my sex drive controlling me, I’m now the one in control. This has left me with a lot more free brain power.
- My dysphoria has decreased a bit, but it’s still there.
- I lost 3 pounds.
Transition isn’t cheap and when it comes to keeping track of how much I’m spending, I’ve been quite meticulous. I made the official decision to transition in May/June 2012, but I didn’t start HRT until three months ago.
Below is a rough breakdown of what I’ve spent to date while living in New Jersey and having health insurance:
- $2287 – Therapy. Twenty sessions since last May. My therapist is out-of-network so I have to pay out of pocket, but she is very experienced with LGBT people, especially the T so I willingly pay to visit her rather than going to a covered therapist.
- $461 – Laser hair removal for my face. Nine sessions so far, pre-paid for three more.
- $1235 – Freezing sperm. This included the at home collection kit and a year of storage.
- $420 – Hormones. This is the cost for almost five months worth.
- $613 – All the lab work and doctor’s visits so far. This includes the yearly fee to be under the Papillon Wellness Center’s care for HRT.
- $327 – Clothes so far. This does not include clothes that were given to me as gifts, but does include some that were paid for with gift cards.
Total: $5363.25 (eeeeeek!)