how to cope mentally during gaps in HRT

Ah, that's definitely a good idea. My endo initially told me to inject 5 mg estradiol valerate every 10 days (I chose to inject subcutaneously). I couldn't last longer than 8 days, the dysphoria got so bad (I started to wonder how I possibly survived without HRT for so long, it really seems insane to me how I used to live).

I changed to every 5 days with 5 mg, but I kept lowering my dose (I was afraid of my endo forcing me onto a lower dose if my blood work showed too high E levels). I tried lower doses more frequently. All in all, lower doses were a mistake, I kept having a few days of horrible-ness in the trough. Eventually I went back to 5 mg every 5 days, and found around day 4 I started to feel weird, so to avoid issues I started injecting 5 mg every 4 days.

I know the half life is supposedly every 3.5 days, and I'm essentially relying on the estrogen to act as the anti-androgen (bicalutamide didn't seem to have any effect on my mood, positive or negative, so I stopped using it), so I'm intending such a high dose, I'm just not sure what those upper limits are or when I might be taking too much.

On the one hand, more frequent but a lower dose (even 4.6 mg) seems to have less of that anti-androgen effect that 5 mg has, and it feels less euphoric (mentally, I mean - estrogen sometimes feels like a recreational drug). On the other hand, less frequent doses means unevenness and potential troughs where things get dicey. I think as long as my injections don't fail (like when I injected into a vein or capillary), it seems like this dose / frequency works well enough for me. Still, it's a bit concerning that my basic functioning is so fragile, I wish I had better coping strategies.

For example, I wonder if anyone uses gel in conjunction with injections, or if anyone injects a partial dose when it seems like something didn't go right. I get the impression this just isn't as frequent of a problem, I've never heard that hitting a capillary caused such dysphoria as a result.

Another factor: I started HRT three months ago, so it could be that my body more easily slides back to testosterone right now and I just need to get over this initial transition to a new hormone regime.

Thanks for reading my post and for the suggestions! 🥰

Yeah, before HRT my life had two modes: stress and depressed. I preferred stress, it gave me agency and movement and made me feel alive. I think it's part of why I became a workaholic, the stress of work became addictive and necessary to me.

I didn't know how HRT would impact me, but I was shocked when I read about "biochemical dysphoria" in the Gender Dysphoria Bible. I became hopeful the HRT would help. The first two days after my first injection it wasn't clear to me how I felt about estrogen, there were mixed feelings. By day 3 I think the testosterone was starting to get suppressed and I became euphoric and that's the first time I would just lay there and feel delicious euphoria all over my body. I felt high, like I had taken drugs. It was delightful. I took that as a good sign.

I was surprised at how much estrogen changed my life. I have struggled to create stability with HRT, but in the periods where my hormones were right (I am guessing), I become much more able to handle everything. It suddenly became easy to do things that felt impossible before. I have a garage full of clutter that has built up to the point where I can barely get into my car anymore, and every time I need to drive out of the garage I have to move a bunch of items out of the way to make room. One day, just during breaks from my job (working from home), I was able to significantly clear out and organize the clutter. Something I wasn't sure would ever happen.

I was suddenly finishing projects that I had sat on for years. It just became easier, more matter-of-fact, and less stressful. There was a kind of stress, but it didn't take the same toll. Some when I would plan meals and go grocery shopping. Before HRT doing that would take up half of my day and would leave me completely drained afterwards, I would barely be able to put up groceries when I got home. Now with HRT I can feel the stress, but when I leave the store it doesn't wreck me, I even have energy do other things after putting up the groceries.

Before HRT I could sleep 11 - 12 hours every night and still not feel that energetic. With HRT I sleep more like 6 - 8 hours and wake up rested and with more energy than before.

It is a huge change for me.

But my story shouldn't set any expectations for anyone. I don't think being trans is a monolith, and the causes of dysphoria which I believe are likely both social and biological in nature are probably multiple or quite complex. I have read a study which found a correlation between left interior parietal cortical thickness (Cth) and reported congruence with self and body (for both trans men and trans women, by the way - the Cth in cis controls different in the same ways from trans people regardless of whether they were trans men or women). The study compared baseline levels before HRT and after taking HRT, and what I found interesting was that some trans study participants after HRT actually had both thicker Cth and increased reported incongruence between self and body.

So while HRT is helpful in many, many cases, it's not guaranteed that a person suffering from gender dysphoria will respond to HRT the same way as others. There might be more complicated mechanisms that explain this that we don't understand yet. Some trans people don't find HRT helpful and that's OK. Some people try HRT and find it doesn't make a big difference mentally, but they take it for the physical transformations.

My primary goal in taking HRT is to improve my mental health, above and beyond the transition.

I feel constant pressure to know whether the HRT is helping, to know whether I'm "really trans", and so on - but ultimately even if the HRT didn't work for me, that doesn't necessarily invalidate my "transness". So take my account with a grain of salt, it may or may not happen for others. Lots of people start HRT and experience more depression or anxiety (esp. if there are other things going on in your life that are creating stress or might cause that depression and anxiety, and transitioning is definitely a such an event for most people).

Whatever struggles you are having, I hope you find a way to cope and even overcome them! I ultimately transitioned and took transitioning seriously precisely because I was hurting the people around me by not doing so, I realized I needed to be more self-compassionate so that I could be a good person (whereas before I felt my welfare should come last, and I wasn't sacrificing enough to be a good person). I can really relate to the struggle, and I'm so sorry you're going through that.

Yes, I do think because I'm still only on month 3 of starting HRT that it seems like I slip back into testosterone production easily, and that seems to correlate with the mood issues. I have been careful and conservative with my estrogen doses until recently (I consider 5 mg EV injected every 4 days a rather large dose for that frequency).

I do live in an extremely conservative place, and I live in a city surrounded by rural areas and lots of people here come to the city to work their jobs but live in a rural place. I was raised here, and I have internalized a lot of transphobia. My father was also maybe repressed or closeted, we don't know, but for whatever reason he was rather fragile about his masculinity and used violence to keep me from even doing normal gender exploring as a young child.

I think the dysphoria I feel in these gap periods seem to make it hard to connect with gender-euphoric thoughts, but I think it's a good idea - maybe I can journal about all the times people have given me compliments or all the times I have been affirmed by people when I least expected it. The reality is that most people have been extremely supportive of me.

Thanks for the help!

I used a 1/2" needle at 90 degrees into my thigh. I think my thigh has been maybe losing fat? I injected for a couple months without much issue in my thighs, suddenly I've hit some kind of blood supply twice now in the past week or two, this time it bled significantly more and more forcefully, enough that I had to use my hands to prevent the blood from getting on everything, the blood covered my hands and I had to use a rag to clean it all up (the other time there was more like a few drips of blood, but not as forceful or copious).

I inject 5 mg EV every 4 days currently. I consider this dose / frequency enough normally, I've had a couple weeks of it working well for me. I do see an endo, but he is giving me a lot of autonomy to control my dose. I have had blood work twice, once before HRT and once after 2 months or so (before I started this new dose regimen).

Thanks for the semen tip, that is helpful. I have noticed much less semen, even no semen sometimes (esp. before this semi-failed injection). My bad mood seemed to correlate with semen coming back. There are other physiological signs along with the mental symptoms, like erections when I wake up in the morning, or body odor changes (my armpits smell spicier / worse).

It does seem like the depression is correlated with too little estrogen, but I haven't had an issue until this recent injection where the E didn't depot properly (maybe some of it ended up in the blood supply, maybe some of it ended up not in the muscle or fat, but in the skin layer, I don't know why it changed anything, I don't see any explanation as to why it would mess up the depot effect).

shoutout to the mods for removing that <3