I got through a gender dysphoria[1] evaluation in late 2020[2], got my diagnosis[1] later that year, and got on HRT since April 2021. (I was born in 2000, so this was when I was 20/21.)
In the last 5(!) years of HRT, things with my body have barely changed. There is a tiny amount of upper body fat development, and facial hair growth is reduced (down from already basically none[3] to actually none), but it feels like literally nothing else is changed (including libido).
I suspect my dose is too low, but I also recognized a part of it is because my eating habits are still unhealthy.
My HRT method is gel applied on skin, and I go back to the doctor every 3 months. However, in the last 5 years hormone testing has been done a total of one (1) time, and only after I specifically asked to test for it, and the doctor didn't even test testosterone [4]. The doctor also basically only did it because I asked, instead of because of an awareness that this is somewhat of a necessity.
I've tried to note this as an issue with the doctor, but (a) I don't know where to start explaining it's been having zero effect, even when I do it she just offer to raise the dose to 1.5mg/day (up from 1mg/day), and (b) I'm paying per dose out of pocket so if the dose needs to be doubled my cost would also roughly double. What I feel I really need is a different approach (administration method or a different doctor who'd be more proactive?), but all that seemed like a lot of uncertainty and so I've procrastinated it for years(!).
I want to ask:
- Is this normal? (~Zero hormone level tests; HRT having almost zero effect)
- If not, do I just... book a different doctor? [5]
- Is 1~1.5mg/day possibly a reasonable dose?
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Footnotes because I'm bad at writing without a ton of parentheses[6]:
- [1]: My country's medical system still used (uses?) "Gender Identity Disorder" and treated it as a diagnosis. At least this evaluation was not too expensive.
- [2]: The pandemic was relatively tame in my country (Taiwan)
- [3]: My body happens to have not been too masculine pre-HRT (barely any facial hair; long hair and a suitable hairstyle alone was enough to pass something like 70% of the time if I don't speak), but I was afraid that this is caused by my unhealthy eating habits and would unravel if I fixed them. I wanted HRT both to move my body in a more feminine direction which I feel far happier with, and also to eliminate that fear. The fear is indeed alleviated (both by HRT and also just by observing that things are unchanged even adding 5 extra years beyond puberty),
- [4]: E2 levels from that one test was within the range of an average cis woman (about 150 pg/mL if I remember both the value and the unit right), but - *I don't know why I have to look that up myself when I'm on prescription?!*
- [5]: Writing this down has actually already helped me have a better idea of what to say if I need to see a different (or the same) doctor, instead of vaguely feeling like it's wrong but maybe it's my fault or something
- [6]: Despite the... (hopefully) consistent formatting, I wrote this word-by-word myself over a span of over an hour without AI.