#not that I was likely to get any changes to my HRT anyway cos WPATH is bullshit conservative

[dragonatthedinnertable]

Fuck's sake.

My current GP is on maternity leave, and for the last 6 months I've had an interrim doctor who has been proactive & responsive. She was just managing my prescriptions, blood tests, and referrals; I never actually met her, but I trusted her.

Today I finally worked up the courage to make an appointment (at the end of next month) to review my HRT (because I want another go at getting prog, and/or increasing my E). Only to be told that the previous doctor is leaving this week, and my new interrim GP is my old one.

The one who:

changed my antidepressants within 5 minutes of knowing me, on the assumption that it would fix my chronic fatigue;

only agreed to reduce my cypro dose on the assumption that it would fix my chronic fatigue;

only referred me to Gen Med for chronic fatigue because I had a nurse as my Support Person, and the nurse bullied her into it;

failed to prescribe me my antidepressants one time, right before the weekend, meaning I had to go to After Hours to get like 5 days' worth to cover me;

generally never listened to me at all.

The receptionist did offer me a chance to speak to the practice manager about it. But, like, I already did that 2 years ago, when I moved to my new GP (the one with a new baby). I shouldn't have to go through this again, and I certainly don't have the emotional budget for it.

[transgenderteensurvivalguide]

Can I take hormones if I’m on antidepressants?

Lee says:

Yes, it’s totally possible (and totally common) to be on antidepressants and hormones.

I’m not currently on antidepressants myself, but in the past I’ve been on two SSRIs (the generics for Lexapro and Celexa) while also being on testosterone, and both my psychiatrist and endocrinologist said there’s no issue with that.

You can use the Drug Interaction Checker to check whether the specific meds you’re on would have any interactions with your form of HRT, and you should also always talk to your doctor/psychiatrist/endocrinologist about all the medications you’re on to make sure there’s no negative interactions.

Some people experience mood swings with HRT, as it is your second puberty. You’re more likely to have mood swings if you’re taking HRT by injections that are 2 weeks apart or more since your hormone levels are fluctuating. Taking testosterone in gel or patch form should reduce mood swings because you have a more constant level of hormones in your body daily. 

From this link: 

“While hormones may contribute to mood disorders (such as in premenstrual dysphoric disorder or postpartum depression), these is no clear evidence that testosterone therapy is directly associated with the onset of or worsening of mental health conditions. 

In fact it has been found that transgender men experience improvements in social functioning and reduced anxiety and depression once testosterone therapy is begun. 

Mental health conditions in transgender men should be approached with a broad differential diagnosis as in any other patient, taking caution to avoid relating all symptoms directly to gender dysphoria or testosterone therapy. 

Consider using a non-injected medication form to avoid the potentially cyclic levels, which could bring about or worsen existing mood symptoms.”

Taking estrogen in gel, cream, pill, or patch form instead of injections is also recommended for many folks who have mood disorders, but estrogen isn’t as commonly prescribed as an injectable anyway.

All that being said, antidepressant medications shouldn’t have any interactions with testosterone or estrogen, and being on them doesn’t have anything to do with your ability or readiness to take hormones.

Since the antidepressants themselves don’t have major interactions with testosterone, it isn’t a pharmaceutical problem as much. So what matters more than if you’re taking meds is whether your doctors think that you’re stable and competent enough to consent to starting HRT. Some people with depression aren’t on antidepressants (for various reasons) but are still severely affected by their mental illness, and some people with a depressive disorder diagnosis and take medication are coping well and in recovery, so just saying you’re taking meds isn’t the equivalent of saying how stable your mental health is. 

I started T while I was on antidepressants and testosterone actually improved my depression because I became more comfortable in my body. It’s possible to start T while struggling with mental illness. It can be harder to get a prescription in the first place when you’re mentally ill, especially if you’re severely mentally ill or if you have stigmatized disorders like a schizo-spectrum diagnosis, but it isn’t impossible to do.

The WPATH guidelines say:

“Any co-existing psychological, medical, or social problems that could interfere with treatment (e.g., that may compromise treatment adherence) have been addressed, such that the adolescent’s situation and functioning are stable enough to start treatment"

“The presence of co-existing mental health concerns does not necessarily preclude possible changes in gender role or access to feminizing/masculinizing hormones or surgery; rather, these concerns need to be optimally managed prior to or concurrent with treatment of gender dysphoria. In addition, clients should be assessed for their ability to provide educated and informed consent for medical treatments.”

Six of the blogs mods (current & past mods) who are on T have had a mental illness diagnosis of some kind, and the rate of mental illness in the trans community is higher than with cisgender people because of minority stress, dysphoria, and family/friend rejection and social stigmatization among other things. That means a lot of trans people are depressed, and a lot of them are on hormones anyway.

Some people find that taking testosterone can negatively influence their mental health, like the blog post Medically Transitioning Is Not A Walk In The Park. (Sometimes, It Actually Sucks.) discussed.

However, the majority of trans people who take hormones finds it helps reduce their body dysphoria and increase how often they pass, which can help reduce their depression because it’s one less thing to deal with. Taking testosterone can’t ‘cure’ your mental illness, but feeling comfortable in your body can help get you to a place where you’re able to start focusing on addressing other issues.

Just make sure you’re connected with your treatment team (endocrinologist/testosterone prescriber, psychologist/therapist, and psychiatrist/medication prescriber) and your social supports (friends, family, community, etc) and keep on top of your mental health by reaching out if you notice a decline in the “Good days” you have or experience worsening or new symptoms.

So if you aren’t already in therapy, try to get a therapist so they can help you find new coping mechanisms if you do find that hormones affect your mood.

While HRT can affect mood, it’s usually possible to manage this by changing the form of testosterone/estrogen you’re on (gel, patches, pellets, etc), the frequency you take it, and the amount of that you’re taking. Sometimes you’ll have to tinker a bit to find the right dosage of HRT for you (which especially true with anti-androgens which can have some side-effects) so make sure you’re getting frequent blood work!

But yeah, while there are rare exceptions for complicated cases, people can be on HRT without having to stop their psychiatric medications like 99.99% of the time, just make sure your doctors are all aware of the various meds you’re taking!

More info:

Testosterone FAQ

Mental health page