I’ve been meaning to publish at least three blogposts I’ve had in drafts this month, but I ran into an unexpected transition roadblock that has, frankly, fucked up my headspace for writing. At the end of November I started on antibiotics to treat some really bad acne that showed up around the start of my transition. Usually dropping testosterone coincides with clearer skin, but that unfortunately wasn’t the case for me, and I spent several months trying increasingly strong topicals until finally I was referred to a dermatologist.
December seemed to start off fine - the antibiotics were helping my skin clear up a little - but after a couple of weeks I began to notice things. I was struggling with concentration at work, I was misgendering myself a lot in my head, and certain male physical responses that had gone away months ago began happening again like clockwork. But more than any other symptom I was experiencing, I was being a huge bitch. Just snippy and angry and unpleasant about everything.
Eventually I became conscious of my mental shift and started counting down the days until my next hormone labs, suspecting off-kilter hormones as the culprit. Then I woke up one morning with the thought in my head that I might be experiencing a drug interaction with the acne meds. My doctor had already put in for my labs even though our appointment was weeks away, so I held off on my pills that morning and popped in for a blood draw. Sure enough, my testosterone was no longer being suppressed via monotherapy, and my estradiol had dropped.
Digging into the literature a bit, there have been some connections made with doxycycline interfering with oral E2 via changes in metabolism - or changes to gut bacteria - it’s not really clear or well studied, and everything out there pertains to oral contraceptives. I know, shocking that trans healthcare is not well researched. I convinced my doctor to switch me to estradiol patches so I can stay on the antibiotics, and I’ve been trying out my first set over the past few days. It’s hard to tell if things are working yet, and I still have some logistical hurdles to clear (stupid insurance), but I at least was able to write this much!
I should be ending the antibiotic course in about a month, so if the patches don’t work out I can switch back to oral E2 no problem. You might be wondering, why not just do injections like most transfems on HRT? Well, I’m a woman who gets regular migraines (a migraineur, if you want to be fancy), and something I figured out early on in my HRT is that my brain is very sensitive to estrogen spikes, like most other women who suffer from migraines on their periods. This means that certain administration methods are unavailable to me: injections, sublingual, buccal. That leaves me with oral, transdermal, and pellets as possible administration methods. It’s a difficult constraint, but I’m glad that I have at least some wiggle room.
I want to close this post out with gratitude for the other transfems in my community who helped me figure out the problem and assisted with solutions. I’m lucky to have friends and acquaintances who read and collect papers on HRT, discuss dosages and treatment regimens, and share supplies with each other when the healthcare system fails at its responsibilities, as it so often does for trans people. We survive because we care for each other.