17-Year-Old Me’s Journey with Hormone Replacement Therapy: A Personal Account
Discover the untold details of my experiences with hormone replacement therapy (HRT) as a transgender individual in early 2017. After coming out to my family nearly a year prior, I eagerly awaited the start of my medical transition. However, navigating insurance companies, delayed bloodwork, and lengthy wait times proved to be more challenging than expected. It took two additional months before I could self-administer my first testosterone injection.
In today’s discussions on gender-affirming care, seldom are these intricate details shared. Instead, sensationalized stories of young trans kids being manipulated or filled with regret dominate the narrative. These stories have motivated Republican lawmakers in over 20 U.S. states to pass legislation restricting or even banning essential healthcare services for transgender individuals under 18. In Missouri and Oklahoma, some conservative legislators have even proposed raising the age restrictions to 25 or 26.
As a result, the Human Rights Campaign estimates that more than half of transgender youth aged 13 to 17 in the U.S. are at risk of losing access to evidence-based, best-practice care. It was this very care that I, as a 17-year-old, first introduced to my parents in the spring of 2016, shortly after coming out as trans. I explained to them the significance of hormone replacement therapy and top surgery, a procedure that removes breast tissue and creates a flat, more masculine chest.
Initially, my parents had reservations about irreversible medical interventions. While they supported my exploration of new names, pronouns, hairstyles, and clothing, they hesitated to approve nonreversible gender affirmation treatments. Surprisingly, I became the one advocating for these healthcare options, utilizing YouTube videos and detailed pros and cons lists to convince the adults in my life.
When my parents finally agreed to schedule a visit with my pediatrician in January 2017, we encountered a setback. The pediatrician was unfamiliar with the current guidelines for treating transgender patients. Fortunately, I had conducted prior research and discovered a gender health program at our local children’s hospital. With my pediatrician’s referral, we set an appointment.
Approximately one month later, my mother and I attended our first appointment at the hospital. The visit commenced like any other doctor’s appointment, with measurements of my weight, height, temperature, and blood pressure. A doctor then joined us to conduct an initial evaluation and discuss any necessary gender-affirming services. We delved into my family, medical, and mental health history, including my journey of gender identity development from childhood.
Reflecting on my childhood in the early 2000s, I realized that I lacked the language to identify as transgender until I hit puberty. Despite exhibiting masculine traits and expressing discomfort with being perceived as a girl from a young age, the limited resources and awareness on gender diversity during my early years hindered my self-discovery. It wasn’t until I learned more about LGBTQ+ identities during puberty that I found the right words to describe the incongruity between my mind, body, and social role.
During the appointment, we not only discussed my past but also explored my future goals for medical transition. I reiterated my desire for testosterone and top surgery, highlighting the anticipated physical changes such as a deeper voice, increased body and facial hair, cessation of menstrual cycles, redistribution of fat, muscle growth, and a flat chest. According to the World Professional Association for Transgender Health’s standards of care, a phased approach to gender-affirming treatments was recommended, necessitating a minimum of 12 months of hormone therapy before considering top surgery. While this news was somewhat disappointing, I understood that local surgeons and insurance companies were unlikely to approve the surgery before I turned 18.
We also engaged in conversations about my expectations and concerns regarding testosterone. Topics included the duration of my interest in starting the medication, expected changes, and any changes I wished to avoid. As testosterone’s impact on fertility is challenging to predict, my doctor inquired about my desire for future biological children and my opinion on fertility preservation services like cryopreservation. Knowing individuals who had become pregnant after starting testosterone, I decided not to pursue additional fertility counseling or preservation services.
Following the clinical interview and educational session, a brief physical exam confirmed that I was in good health and developmentally ready to commence hormone therapy. At 17 years old, I had already undergone most of my natal puberty, rendering puberty blockers unnecessary.
With the initial assessment complete and having thoroughly discussed the benefits and risks of hormone therapy with my parents, therapist, and multiple doctors, we unanimously agreed that commencing testosterone would be the next logical step. Consequently, my mom and I signed the consent forms and provided a copy for my father to do the same. We then scheduled a follow-up appointment to undergo baseline bloodwork at the hospital lab and receive professional guidance on self-injection techniques.
Finally, on April 24, 2017, I received my first prescription for testosterone, and my journey became a reality. Overwhelmed with hope and excitement, I collected my injection supplies from the pharmacy and eagerly enlisted my mother, a seasoned medical professional, to…
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