
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](https://transfemscience.org/), 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.

Choppy Waters

<p>As an update to <a href="/posts/choppy-waters">Choppy Waters</a>, Lindsey (who has way more experience doing stats stuff) and I have put together an <a href="https://hypothete.github.io/e2-patch-simulator/" target="_blank" rel="nofollow noreferrer noopener">Estradiol Patch Simulator</a> in order to figure out my dosage schedule. Like I said in the original post, my body is very sensitive to spikes and drops in estradiol, and so my first few days on patches hasn't gone great because the typical regimen is a bit spiky. I'm hoping also that I can get more out of my patches by using this model because it takes into account the actual long tail of patch efficacy. Lots of caveats around using this for your own HRT, neither of us are medical doctors, pharmacologists, or statisticians.</p>

Choppy Waters 2 - Patch Simulator


It’s been a rough month for me health-wise, and as such I haven’t been able to get much writing done. One of the other admins on the trans Discord I help with has been posting weekly writing prompts about the positive aspects of transition, and so I’ve been easing myself back in by working on responses. Here’s what I wrote about the aspects of transition I wasn’t expecting when I started.

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I had heard that transition would bring more emotional depth, but the unexpected breadth of emotions has proven to be more important for me. I’ve been able to better identify what I’m feeling rather than assign it to a limited palette. I was so frustrated about my inability to articulate what emotions I was experiencing pre-transition, and the only times I could bring them to the forefront before were occasionally when I was intoxicated. Now I can understand the nuance of my emotions more in my day-to-day and it’s massively eased my anger and anxiety. It’s not that I see the world in loud technicolor now, it’s that I can describe differences that weren’t apparent to me before.

I didn’t expect as much happiness about the changes HRT has brought to my body in transition. More than anything I wanted to see if starting hormones would change how my mind works. I felt weird about how many discussions on trans subreddits were like “when boobies,” as if that was the point, or as if that was what made someone a woman. But now that I’m here it’s apparent to me that parts of me were missing, and other parts not so much, and some parts of me have changed in terms of their importance to me. I didn’t realize how alienated I had been from my body as a whole.

Before transition I had searched for a long time for “my people.” I remember crying in my bedroom as a teenager, feeling isolated, unsure how to connect with anyone, and my mother telling me “\[deadname\], you have to find your people.” I felt like I made some headway in college pulling together a friend group (never mind that 99% of them turned out to be queer). After graduating I spent so much time looking for my people in meetups, chatrooms, hobby spaces, innovative startups, whatever. But things never seemed to stick. When I started transition and began attending trans spaces, I unexpectedly felt a pull and a sense of kinship for other trans folks so strong and so quick that I had never felt elsewhere. It was like being struck by lightning, and I’ve been charged ever since.

Human Kibble

Choppy Waters 2 - Patch Simulator

Choppy Waters

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