Transgender Health, Hormones, and Happiness

About 15 years ago I worked with this nice girl named Katy, and several weeks into our working relationship she one day asked if I wanted to hang out. I was immediately nervous that she was looking for a date. “Oh, uh. I’m gay,” I said, sheepishly.

“I know” she said with a smile. “I just want to be friends.”

I was thrilled, since I didn’t have many friends, even fewer female friends, and she seemed pretty amazing, with her purple-colored hair and no-fools-suffered attitude, and was a really good 3D artist as well.

We met at a sushi place and began getting to know each other. Eventually the conversation turned to dating, and I related my long, complicated history with men, then soon realized I had been talking about myself for too long. “What was your last date?” I asked.

“It’s complicated,” she said.
“I have time,” I said in jest.
“Well,” she reluctantly continued, “dating is really hard when you’re trans.”
“Trans?” I asked. “Who is trans?”
“I am,” she replied.
I was totally confused. “You’re trans? As in, transgender?”
She nodded. I was still confused. “As in, you used to be male?"
Again she nodded.

While I had been familiar with some famous transgender actors and activists I had never yet knowingly met someone who was actually trans, and here I was on a friend date with someone who was. “Wow,” I said. “I had absolutely no idea. That’s so cool.”

She smiled and said, “Thanks, sometimes I think I feel really obvious.”

I shook my head and laughed. “No, absolutely not.”

Over the last three decades my attention has largely been preoccupied by my own struggles with depression and metabolic illness, and I haven’t energetically engaged in many other causes orbiting our collective struggle as a society and family. But I have been aware of the deep and painful problems facing those who are transgender, and while I have not lived this experience I have some insight on hormones, health, and acceptance gleaned from my own struggles with wellness that would be valuable to those who are transgender, especially when it comes to hormones and mental health.

Passing as a particular gender is in no way an estimate of your value as a person or your own life experience, and there will be uncomfortable experiences with naive, ignorant, well-intentioned or even prejudiced people that will cause you sadness, stress, and sometimes feeling alone. Once even I, a staunch advocate of the entire LGBTQI+ community, totally accidentally misgendered someone while at dinner with lots of friends (and then greatly appreciated their kindness and patience when correcting me). All humans are given to callous, indifferent, obtuse, or even harsh behavior, so don’t let it deter you from being who you are and seeking your own happiness, whatever that may be. As humans we are also given to naturally pay more attention to unpleasant and negative experiences which can in turn prejudice our own experience to one which seems infected with more sadness than there really is. This is a natural protective mechanism we have for our own survival, because nice people and experiences are not a threat to our survival, so we must be more aware of those which are. But if ten people are in a room and one of them treats us poorly this means we tend to feel like the majority of the world is against us, even though nine of those didn’t act that way, and considering that other humans are more often just as timid, uncertain, and afraid as we are, even if those other nine didn’t stand up for you does not mean they didn’t feel the same revulsion and fear at the behavior of a smarmy antagonist. I used to feel so alone because so few of my friends and relatives failed to stand up for my rights and wellbeing as a gay man, but in writing both of my books and working with many hundreds of people I have come to learn that most people fail to do this because they are struggling with their own issues of depression, trauma, and survival, and not because they don’t care. They just don’t have the brain space to make room for it. Keeping this in mind as you progress along your journey can help take some of the sting out of it. Do not fill that silence with assumptions of negativity. It will only increase your stress and is in all likelihood not an accurate assessment of the world, even if it does sometimes seem overwhelming and depressing. I know from my own experience that there are far more loving and caring people in the world than may be obvious, because they are also by nature not so loud or obnoxious it can be difficult to see them, sometimes even requiring that we actively look for them.

There are basically two big problems often faced by those who are born transgender, and indeed those who are transgender are born as such just as the rest of us who are gay or cis or straight are also born that way too. It’s the great irony any time that conservative bigots cite “biological sex” and “science” to enforce their prejudices as if they know anything about either that yes, there is biological sex, but it’s not at all the way they frame it (if you don’t understand the biology behind gender and sexuality you can read my other article Why Transgender Women are Women and Transgender Men are Men). The first is that the apparent gender of the body can be mismatched from that of the brain, which is the greater determinant of sex and gender than the exterior sex organs, and this can cause stress to the transgender individual, especially since the way the world interacts with them is often based on their outward appearance. The other problem is that the society we are born into is one rife with bigotry, hatred, prejudice, fear of the Other, and environmental stresses which cause or contribute to depression, isolation, anxiety, PTSD, and loneliness. First I will briefly discuss depression as it is faced by those who are transgender, and later I will talk about hormones and how the transition experience can be improved, if it is so chosen.

Depression in all humans has long been misunderstood, most of all by the medical profession, and while there are some helpful medications that can be used to restrain serious mental health problems they are largely based on the idea that the hormone serotonin is that which is responsible for our happiness or depression. This in turn is based on flawed studies which showed that regulating serotonin produced somewhat desirable effects in restraining the manic/depressive behavior in some subjects, producing more subdued and restrained responses. This actually occurs because serotonin is a hormone of torpor, which means to slow things down, and so it produces an effect of lethargy upon the person who is subjected to the kinds of medications which regulate serotonin which is in turn mistaken as therapeutic to the condition of depression. This is why so many pharmaceutical products which focus on depression also come with side effects as increased risk of suicide, which on the face of it should be enough for anyone to call their efficacy into question. Depression is instead a deficiency of dopamine which results from enduring serious stresses to our mental and physical wellbeing which unbalance the pathways which produce dopamine. Most consequential to this process is that adrenaline is derived directly from dopamine, and that the greatest adrenaline stimulants in our existence is actually other humans, and so one route by which depression originates is the constant fight-or-flight reflex being engaged when growing up as a vulnerable minority, for instance those who are transgender (or gay or other sexual/gender minority) who live in constant fear of their safety, because the chronic and high expression of adrenaline then drains and depletes dopamine. Depression can be directly dealt with through accessible nutritional and environmental changes to support the dopamine pathways and restrain excessive adrenaline production. But because this is a rather long and involved process it cannot be done entirely in this article alone, but which is further discussed in my video on depression, Six Easy Ways To Interrupt Depression, Why You Feel So Goddamned Depressed Right Now, or get a copy of my book. I also am aware that many people who are transgender also struggle economically, so if you are transgender and struggle with depression please contact me and I will gladly give you a copy of it (I rely on it for my income though, so if you can afford a copy please purchase one instead, but don’t hesitate to ask if you need help as I would rather help you).

While the act of transitioning is not what makes a person transgender, part of the cause of depression for transgender people is not having a body which aligns with their gender identity, and achieving one which does can bring great relief for those who are transgender. But when it comes to hormones the medical community is also greatly mistaken as to the effect of certain important hormones which promote gender characteristics. Have you ever noticed that in terms of physical health and wellness transitions from female to male seem to be more successful than the male to female? Not in terms of gender characteristics but the quality of healthy skin, hair, energy, etc.? This occurs because there is very little problem with supplementing testosterone in a healthy body. It typically helps build muscle and promotes increased metabolic rate. In an unhealthy body (i.e. slow metabolism) Testosterone can, however, aromatize into estrogen. Ironically this aromatization occurs at a higher rate in the testicles, because they are so far from the lungs, heart, and detoxification organs they can easily become stressed and hypoxic when a person is metabolically ill, and in that state testosterone readily aromatizes into estrogen. This can result in cis-gender males developing feminine breasts and gaining weight. But female to male transition is often marked by success in mood, energy, skin and hair quality, etc., ironically because transgender men do not actually possess testicles in which testosterone can aromatize. The active form of testosterone, dihydrotestosterone (DHT) does not aromatize into estrogen, and it also increases metabolic function and is more responsible for the specific androgenic features of men such as hairy, larger forearms and facial hair, so using DHT can actively promote male health and maleness regardless of physical condition (the aromatization of testosterone into estrogen in testicles is why using illicit steroids such as for body building often results in unwanted side effects like shrunken testicles, skull enlargement, navel protrusion, and even liver damage).

The hormones needed for effeminate physiology, estrogen and progesterone, are in their use and application for both transgender women and cis-gender hormone replacement therapy generally flipped by common medical treatment when it comes to the importance of either, and this causes a lot of health problems both for transgender women and cis-gender women including accelerated aging and even cancer. Estrogen has been mistaken in modern medicine to be the primary female hormone, and while it is intimately involved in the female body and does play a role in feminine development it is not actually the protective hormone for a woman’s health. The hormone responsible for health in women is progesterone, but because estrogen has been mistaken to be the primary female hormone it is often given in excess, or even alone, and taking estrogen without the protective effect of progesterone is very dangerous. Estrogen is in reality a hormone of growth, which is why it rises during pregnancy to help grow a fetus, where progesterone protects the adult body against the growth promoting effects of high estrogen. When excess estrogen is given or without progesterone it induces problems like weight gain, sluggish metabolism, hair loss or thinning, rapid skin aging, and in the long term even breast cancer. When more progesterone is used than estrogen this instead results in a more youthful and healthy metabolism, healthy skin, hair, etc., and since progesterone in higher doses than what males have also antagonizes androgens (yes, men have progesterone too) it is progesterone, not estrogen, which can more strongly suppress male characteristics and promote those of the feminine.

Hormones are not especially concerned with gender, but instead perform specific biological functions. Rather than considering estrogen as a female hormone it is more accurate to understand it as a hormone of growth. Estrogen is even involved in men’s health too and is responsible for the masculinization of the male brain during gestation. A young, healthy male will have as much circulating progesterone as a young woman not on her cycle, but he will also (can) have such high androgens that it overcomes the feminizing effect of progesterone. While some estrogen is needed to grow breasts, progesterone specifically amplifies and promotes breast enlargement, and small breasts (clinically, not aesthetically) are often an indicator of low progesterone production (most commonly resulting from dieting and starvation behaviors). Any harmful effects of progesterone comes from synthetic forms, and it is far better to take progesterone which is derived from a natural source in the first place anyway (wild yam is usually the source, but wild yam is not the same as progesterone, which is instead enzymatically treated to become progesterone).

Natural progesterone is available without a prescription, and can be taken safely in high doses, even in those who cannot afford to do medically assisted transitioning, and typically doesn’t cost very much compared to pharmaceuticals, and will effectively and strongly diminish maleness in those who use it, even if the male gonads are still present while also promoting general metabolic wellness (it will actually shrink the penis and testicles if used in higher doses for longer periods of time). There are a few “side-effects” of progesterone to be aware of. The biggest is that progesterone is also the hormone of empathy, so taking high doses will make a person highly sensitive and emotional (this is what women experience during a menstrual cycle, and is a natural effect of progesterone). This can sometimes be mistaken for increased depression or sadness if you have those feelings but in reality is just an intensification of any feelings you may have and should be expected from using progesterone. Because progesterone is generally healthful for the body, and also involved in protecting men’s health albeit in smaller amounts, it persists in the body for a long period of time (one dose can last for several days), so once supplementation is begun it is easy to sustain effective levels with lower, consistent doses. Progesterone can be taken orally or mixed with a very small amount of good fat such as coconut oil or olive oil and applied to skin or mucosal tissues and will absorb very rapidly. Progesterone in very high doses also makes the internal organs more malleable (this allows for organs like the stomach to be pushed aside by the womb enlarging with a baby) and while this effect is not harmful, it can in turn cause nausea. Experiencing this effect is a sign of excess dosage, and there is a dose between that effect and not enough to suppress maleness in which both can be achieved comfortably, and skin application can also reduce this effect. Natural progesterone products can often contain soy, which is harmful for our health, and as such it’s best to use a 100% natural progesterone without any soy derived products. If the ingredients do not indicate that they are not from soy, it is likely derived from soy and you should find another product which states that it is not. Ranging from $30-45 a bottle, natural progesterone can also be very cost effective and accessible for those with limited economic resources (one product I like: https://shop.forefronthealth.com/products/molecular-progesterone-supplement).

For those who are seeking to transition to male there are not many great natural options, since estrogen is a dominant hormone of life it is ubiquitous and powerful, and even some supplemental products like Saw Palmetto which claim to promote things like prostate and hormone health in men are actually testosterone antagonists (meaning they actually promote estrogen, but plant estrogens are also not the same as human estrogens and can have negative effects even in women). Worse of all too are prescription hair loss medications which also block active testosterone. But ironically, the use of prescription testosterone isn’t typically too much of a problem if you don’t have actual testicles, because taking testosterone while also having testicles downregulates natural testosterone production and promotes aromatization of testosterone to estrogen in the testicles, a problem conveniently avoided by simply being a transgender man. One supplement which can be useful to transgender men is DHEA, which is available as a supplement and quite affordable and is a weak androgen, if used in moderately high doses (don’t use excess) can promote masculine features. In women with polycystic ovary syndrome DHEA is elevated which then causes body and facial hair growth, but DHEA is not the harmful agent in PCOS which is instead caused by dietary and environmental deficiencies such as excess exercise or under-eating, while the elevation in DHEA inhibits pregnancy the damage to the ovaries is caused by dietary stress. So DHEA as a supplement can replicate this masculinization on purpose if used correctly. If metabolic health isn’t sufficiently robust due to excessive dieting and exercise behaviors then testosterone will likely aromatize right back into estrogen in anyone, so we require a healthy metabolic rate to inhibit aromatization (being skinny is not healthy, and dieting will always lower the metabolic rate, as discussed in my book). While testosterone promotes muscle bulk, dihydrotestosterone is also the most active form of testosterone which promotes more maleness traits like coarser and more body hair and deeper voice. Sorghum is a grain which can promote testosterone and be eaten as hot cereal or other meals. It’s really delicious and helps prevents aromatization (sorghum should always be organic as non-organic versions are harvested using glyphosate, which can be very toxic to our gut microbiota). Pine Pollen is one of the few nutritional sources of natural androgens. It is not strong enough to replace prescription testosterone, but may provide some helpful androgenic properties, is widely available, easy to supplement, and also potent in the hormones it does deliver (specifically androsterone, and it also tastes pretty good). Other supposedly “testosterone” promoting herbs like nettle accomplish this by actually lowering production of DHT, the active form of testosterone, since DHT is made from testosterone, but since DHT is the active form of testosterone this then actually reduces maleness even though testosterone rises, as testosterone is anabolic (growth promoting) but not necessarily androgenic (maleness). Herbs and supplements are often promoted as doing the opposite of what they do in reality, and are often not at all harmless, and much caution should be weighed when evaluating claims of such products, especially ones which are promoted as treating depression like 5-HTP and melatonin, which in reality actively lower the metabolic rate and promote depression, and melatonin actively suppresses sex hormones altogether and supplementation melatonin can result in anhedonia and erectile and arousal dysfunction.

Lastly, physical scarring can be a side effect of surgeries to remove gender-specific body parts. Some people rightly love their scars as they are a sign of triumph and a badge of their struggle and courage, and there is nothing wrong with physical scars even if they may make us feel insecure, which is okay. But scarring can also be mitigated by keeping fresh wounds moistened with coconut oil and keeping them tightly covered with plastic wrap the same way a fresh tattoo is treated by an air-tight covering. Coconut oil is high in saturated fats which in turn keeps skin moisturized and pliable to facilitate stem cell migration to the injury site and regenerate scarless tissue, and slightly antibiotic to keep out bacteria which inhibit the healing process. An air-tight wrap holds CO2 against the skin and CO2 elevation increases rate of healing—on that same note, though post-surgery may also be painful, and NSAIDS like tylenol and ibuprofen actually slow down or even outright impair tissue regeneration because they too powerfully inhibit inflammation, which is needed for tissue to actually regenerate, so try to get off those as quickly as possible (never take them if you absolutely do not need to). Aspirin actually improves healing, and though it is not as powerful a pain inhibitor will make regeneration faster and thus the duration of post-surgery pain far, far less (always follow your doctor’s advice, though).

This world can be cruel, but there is much beauty in it too—for example, you. As a gay man who grew up in a homophobic and conservative community I long believed that God didn’t love me and that I was defective because of the way I was. I eventually learned that my prayers were always being answered—they just weren’t the answer for which I was searching (or more accurately the ones I was told to search for). If you need help you can always reach out to me for it, and don’t hesitate to ask for a book if you can’t afford one. The story of my struggle with depression and how I overcame it and metabolic insults will help empower you to do the same, and the trauma therapies in the chapter on spirituality can help you shed the burdens of pain and trauma associated with our struggles, to emerge the stronger, wiser, and more compassionate on the other side—compassionate not for other people, though that will come too, but towards yourself.

Many of us in the LGBTQI+ community suffer from alcoholism and addiction due to the stress of growing up in harmful communities, but this too can be addressed easily and accessibly as discussed in this excerpt from my book The Cure For Alcoholism and Addiction or follow this Six-step Program for Recovery. Reliance on substances does not need to control your life, and can be relieved through some simple adjustments to your diet and environment which resolve the underlying neurological problems that cause it.