Transing Drugs: HRT, Medicine, and Other Things

I peel the backing of the transdermal sticker off with abandon. Three months ago I would have done it with the delicacy that one handles a loose diamond they can’t afford. I wrinkle it and attempt to flatten it back out, hastily affixing it to my upper right thigh. My lack of care comes from the fact that I am double dipping. I am 36 hours away from my injection, the patch is just to smooth out the PMS like symptoms that hit me around 24 hours before I shoot up again.

Three months ago things were different. I treated each patch with extreme care as they were the only form of estrogen I was getting. I was forced into using the dreaded things. They are option number one in the Netherlands. Injections are not allowed. I was coming down to the last three months of injections I had imported with me from Korea, via Canada, and the UK. And I didn’t know if I would be in the Netherlands after the summer. I wanted to have time to smooth out the patch while I had access to healthcare as it was the HRT system it seemed I would end up with, even if I left. So I submitted to the inevitable switch. Wow, what a fucking unsmooth process. The day before I left for The North (UK) to see my in-laws, I got my first blood work back from the patch, bad. I spent most of the three week Xmas holiday in a state of panic. Things didn’t get better when I got back, my levels, which had been good for so long on my injections, where now cis-dude level — only with almost no testosterone. There are probably a number of reasons for this, the most likely being SSRI induced hyperhidrosis. But, as this is a common side effect of antidepressants, and us trans people are big-time consumers of said meds, then the imperative to push an HRT delivery method that doesn’t work well with sweating bodies seems reckless at best, and dangerous at worst.

Beyond this unfortunate grim fact, my sense of embodiment had immediately felt off when switching to the patch. Where injections of estradiol and antiandrogen pills seemed like an alchemical mix shot right into the body — the product of a modern Prometheus. The patch felt like an explicit technological mediation. I mean both are, but one felt like a whimsical transmutation, the other, a constant reminder that my gender and sex are determined by an affixed coaster-sized sticker. The injections mimic something of a desired natural hormone cycle, skyrocketing estrogen high, followed by a slow tapering and then PMS like mood instability as my levels crash: wash and repeat. The patch — which is advertised as a more desirably stable delivery system — gives the person it is stuck on to a steady drip of estrogen. It felt regulated and always there. And it didn’t work with my sweaty body.

I decided to buck the system that has so far given me little. After my last blood test, I picked up my remaining Korean bought, Swiss made estradiol — a global traveler like me. Popping the head off the old-fashioned glass ampule, I injected 10mg into my buttock. I immediately felt two months of stress melt away. The feeling almost paralleled the euphoria of that first sudden injection in a drab, temporary clinic in Gangnam. I had achieved somatic wholeness again, and all it took was changing how my drugs entered my body. Of course, I only have a limited supply of estrogen in this form, and I will have to switch to the pill in May. But it’s worth it.

I find the Dutch government’s directive that prevents me from modifying my body on my own terms oppressive and senseless. It’s not like these drugs are being used for the purpose they were synthesized for. Also, due to a lack of funding for trans medical studies, there is little general knowledge of how they affect the body longterm. So why be such a prohibitionist? Injections are something of a standard option in many countries. I am not sure what the Dutch medical system (VUmc) is getting at. I’ll be sure to ask if they ever agree to see me. But, if I am going to be a slave to global pharmaceutical capitalism, I want to go against the grain, do it on my own terms. That’s why I occasionally double-dip, augmenting my injections with my leftover stash of patches. It also gives me a little “fuck you” feeling. I like that.

I’ve long been a captive of the pharmaceutical industry: SSRIs at nine, antipsychotics at 13, and benzos for insomnia from at least ten years-old. By the time of my first institutionalization in a mental hospital, I felt my body had been totally violated by medicines and my parents/doctors who pushed/prescribed them (sorry mom). So, at the first stirring of agency, as a teen, I started to throw up my SSRIs. My parents found out and I was institutionalized to regulate them. But now, as an adult of sorts, I microdose them and use them off-label to deal with neurological damage. I can’t take benzos after my bought of the bends — having relied on them as anti-vertigo agents for a year left my body dependent. But I used to use them with red wine to knock me out, or in lieu of a better high. Then there was weed to deal with the night terrors from the SSRIs. There were dalliances with oxycodone to deal with my sense of existential dread. Hallucinogens to overhaul my overworked synapses. And amphetamines for fun and to make me skinny again after the antidepressants made me fat. My gender, brain, sex, and body are an assemblage of medical interventions. So who is the VUmc to say I can’t inject my estrogen? But, such is life. I am beholden to the system — perhaps created by it. But I am going to continue to be creatively maladjusted in my approach to medicine. It’s the only way I can make sense of a body that is so far from natural that it is practically synthetic on the molecular level. And that’s good, I’d rather be a cyborg than a goddess. I just want to be an autonomous agent and not a drone.

I’m trans, a grad student in gender studies, and a legal researcher.

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