After a year and half on HRT I felt like this was the right time to discuss some advice around starting HRT focusing on those things that are noticeable in the first 12 months or so. Now, I expect that anyone reading this has hopefully done some research and realistically knows the changes that HRT brings. Things like fat redistribution especially developing breasts, emotional changes, loss of muscle mass, loss of male libido, softer skin and change to body hair growth are exactly what you want. However, there are a few things we need to manage and despite these negatives in my own experience HRT is completely worth it however it pays to be prepared and ready to manage some of these impacts. So, considering this I wanted to look at a couple of lesser-known effects and implications so that people are more prepared and can manage things a bit better.

1 – Fatigue

This can hit hard, especially in those early days when you’re just starting out. It is often the case that blockers, whether that is Spiro, Crypo, or something else that often act fast to cut testosterone levels. In contrast, estrogen takes a little while to build up and replace it to give you back anything near the same level of energy. It means that in the first month or two, you will have times where it is a real struggle.

This balances out a bit, but there are times due way estrogen works in your body where your energy levels really drop. It’s almost like you have a monthly cycle. For me, it is noticeable after lunch at work on those days, and it can be a real battle to get going again. However, it is also worth considering that you’re going through a second puberty, so your body also needs more energy to help with all that development we want, so be kind and prioritise your beauty sleep.

2 – Weight management

This can be a bit tricky as realistically we want to gain weight so hormones can work their magic and give us the hips and bust we want. However, the decreasing muscle mass and energy with our drop in testosterone as well as the impact of estrogen means we can easily pack on the kilos if we have been used to eating a lot. Obviously, this has the potential to become an issue, especially if you are overly concerned about the prospect of weight gain.

I am not an advocate for trying to slim down to fit any unrealistic society standards. However, as body image can be a serious issue that plays on people’s minds, the thought of noticeable weight gain can be problematic for many. If this is a real potential trigger, it might be wise to make some simple changes as part of starting HRT. This may include developing a workout or excise routine and making small adjustments to diet. As with all the effects of HRT, being aware beforehand is always important as it is best if you don’t get caught out and panic, which hopefully prevents some bad reactions.

3 – Stomach cramps

This will impact people differently but will once again be noticeable when you first start your HRT. In addition, I found that starting progesterone to the mix after my first year of HRT also gave me some bad cramps as I adjusted. It is a new experience and not something we can really relate to as it is different from the nausea you may experience when you’re sick, although you might get some of that too. The only thing for it is really to ride it out and may some of those remedies for period cramps.

It can be a bit of a contested issue amongst the trans community whether those of us on HRT experience ‘periods’ or not. However, hormones do affect us all a little differently, and there are enough of us that get cramps periodically, so regardless of what you call it, it’s a thing. It can be oddly affirming as dealing with cramps and any other period-like symptoms is part of womanhood. It was strangely something I hoped for when starting HRT to help feel valid. We can be a weird bunch sometimes.

4 – Muscle and joint pain

I feel like this is under discussed in the trans community, especially if you’re starting in your 30s and beyond. If it wasn’t for meeting another transwoman at the GYM before starting HRT, I would have been completely unprepared. The truth is we are changing our body in a significant way with fat distribution, posture, and muscle mass, so that can have a significant impact on joint pain.

In my case, I have always had some issues with my knees and back. This is one of the reasons why I have tried for a long time to maintain a rigorous workout regime with plenty of strength and conditioning. However, with HRT, I have found some new issues with my hip, including developing bursitis. This is more common with women, especially around menopause so I think it is safe to say it is hormone related. So, my advice here is to be prepared, especially if you have an existing history of joint problems, be proactive with exercise, and find a good osteo / physio for treatment if needed.

5 – Skin changes

It’s common knowledge that HRT increases skin softness, but it goes beyond that. We also become more sensitive, and our body reacts to a to being touched in a different way. This can be amazing if a tender and loving partner sends a sort of electricity through your body. Unfortunately, it does mean on the other extreme that you’re going to bruise easier, but there is always a trade-off. The other part of this to be aware of is that your skin will be dryer, and moisturising becomes a bit more of a priority. It can be a steep learning curve, but skin care is important, especially if you want to capitalise on those HRT changes in this area.

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My advice is to always make sure that you are informed on all the available medical information when deciding on pursuing HRT and to regularly have your levels checked to make sure things are in the desired range. However, it is worthwhile to build those links to the trans community, look at forums and the posts from trans content creators. This is because a lot of our experiences and the observed impact of HRT isn’t part of medical research and tend to effect people differently, so these sources are great for asking questions and learning from other trans women. sources are great for asking questions and learning from other trans women.