3 Mental Changes on HRT, from a Minneapolis Gender Therapist

Starting gender-affirming hormone therapy (HRT) is a big milestone for many trans and nonbinary folks. It often feels like a mixture of nerves and excitement. As a gender therapist in Minneapolis I’ve celebrated this moment with a lot of my clients.

Physical benefits of HRT and its potential to decrease dysphoria are well known. What’s less discussed are the mental changes. Here are three common mental shifts I’ve noticed come up for my trans clients after starting HRT:

• Feeling more embodied.

• Feeling less worried about “passing.”

• Feeling more pressure to come out to people as the physical effects of HRT become more visible.

Let’s look at each of these in more detail…

Feeling more embodied.

As a gender therapist in Minneapolis, I’ve talked with many trans clients about how they feel more at home in their bodies through HRT. One thing I hear time and time again is how they feel much more connected to their body. For instance, after starting HRT, trans folks might describe:

“I feel less numb overall.”

“I feel more motivated to go running and move my body.”

“I [lovingly] touch my body more than I did before.”

“I feel my emotions more.”

HRT lets trans folks experience greater congruence between their body’s appearance and their gender, but it can also facilitate a healthier relationship with their body. It allows you to go from feeling disconnected and numb to feeling more present and attuned to your body.

This in turn helps you live a more fulfilling life because you’re becoming more present in life. More present with how you treat your body, how you show love to your body, and how your body experiences emotions.

Less emphasis on “passing.”

Because of transphobia and anti-trans violence, passing as cisgender brings safety and privacy for a trans person. In my practice offering gender therapy in Minnesota, I’ve seen how the pressure and hope to pass weighs heavily on someone, especially at the start of their coming out journey. There can be a lot of internalized transphobia that plays out in thoughts like “You’ll never pass so why bother coming out?”

HRT helps your body become more feminine or masculine and may help you get closer to passing. Something I hear from many of my trans clients though is that after starting HRT, the pressure they put on themselves to pass lessens. Passing is for safety and survival, instead of something used to self-validate their gender. They become more focused on redefining what masculinity or femininity means for them outside of White, cisgender beauty norms.

Ticking clock with coming out to others.

One of the biggest mental struggles with starting HRT is the timeline it can put on when you come out to family and friends. Each month on HRT results in becoming more and more visible in your gender expression. At a certain point it becomes difficult to hide the physical changes.

Clients and I often talk about this in therapy as the ‘ticking clock’ that starts once you begin HRT. As the physical changes of HRT begin, you feel more pressure to come out to family and friends before they directly comment on the observable changes.

Working with a gender therapist can help you process how and when you want to come out to others. They can help you sort through coming out on your own terms even after starting HRT.

Closing Thoughts

Some trans and nonbinary people need HRT in order to affirm themselves, while others don’t. All trans and nonbinary folks deserve the autonomy to decide whether or not gender-affirming HRT is right for them.

It’s so important to have access to trans-affirming, informed medical providers when deciding whether or not to start HRT. Given the mental changes that can come from starting HRT, it also helps to have a trans-affirming therapist. A therapist who is knowledgable about trans mental health makes all the difference.

If you're beginning or continuing gender-affirming HRT and want emotional support that understands your identity, I’m here for you. As a queer and trans-affirming gender therapist in Minneapolis, I offer LGBTQ+ therapy that validates you and supports your mental health. Reach out today to begin.