One of the things I want to do with my blog is to give some personal updates on how my transition is going, both in terms of how it affects my running but also more generally. I’ve read a lot on how hormone therapy can affect more elite runners, but not a whole lot about how it affects more casual runners. Hopefully this is helpful to other runners out there like myself! This is my first post in this style, so it will also be a brief how get here too. Please feel free to leave questions and I can expand. To get a little more background about me personally, check out my introduction here.
The start
I first started hormone therapy in August 2020. I took a more gentle approach to the start rather than jumping straight in. For me, this meant that I started with only taking a small amount of estradiol orally and no anti-androgens. At this point, the hormone therapy probably had little to no effect on either my physical performance, or much in terms of transitioning generally.
I wanted to start slowly though for a few reasons. First off, from reading other people’s experiences, I knew that transitioning could hit hard in terms of feeling physically unwell and just being tough emotionally. I wanted to do what I could to ease into it. Secondly, there is some thought that a more rapid transition may lead to less overall breast development (which is something that is important to me). From what I’ve read, the concern is that breast bud fusion could occur prematurely, and that a main cause may be the use of spironolactone. However, the amount of research and evidence regarding this is limited (like a lot of transcare unfortunately), but fortunately my provider was fully on board with what I want my transition to look like.
For reference on how this has affected my running, at this time my 5k PR was 21:04 from a couple years prior, and I had just ran a winding corn maze 5k in 24:17 (so I probably wasn’t terribly far off my PR pace given twisty and muddy the run was).
Anti-Androgens
After about 6 weeks of only taking a low dose of estradiol, I started taking dutasteride as my anti-androgen. My decision here was based off my concerns regarding spironolactone. This was partially due to the breast development concern, but also the fact that it’s a diuretic and I already pee frequently. I have considered at each step the potential benefits of spironolactone since high blood pressure runs in the family, but my thought has been that I would delay it as long as possible if the impacts to breast development are real.
With the dutasteride and the low dose of estradiol, I did start to notice some mild changes. On the running side, I had improving and getting back towards my PR pace, but my improvement seemed to flatten out. As I ran, I started feeling more emotionally giddy, almost as if there was more of an emotion to running. Otherwise I didn’t notice any significant impact to my performance.
On the other parts of transition, I did start to notice some very mild changes. This included breast tenderness and some more emotional sensitivity. As far as actual measured lab values for estradiol and testosterone levels, they did start changing. Testosterone down and estradiol up, but they were still in the male physiologic range. This was something I definitely wanted to work on more.
Increasing Estrogen
After another 6 weeks being on the oral estradiol and dutasteride, I switched to an estradiol patch. The goal here was to increase my estrogen levels further. At the same time, the increasing estrogen levels may help bring the testosterone down along with the continued use of the dutasteride. And both of these effects did happen, although still within the male physiological range.
Now one tricky thing about dutasteride is that it blocks the conversion of testosterone to dihydrotestosterone, so while the testosterone is still present, I still had some feminizing effects, including breast development. At one point though I did reach out to my provider over the concern that it felt like my breast development was stalling. This was causing me a lot of emotional anxiety. At that point, since my estradiol levels were still at the high end for the male physiological range, we added oral estrogen on top of the patches. This was at about the six month mark in March 2021.
At this point I ran a Strava estimated 5k PR of 20:43. I had a really good feeling day and just went for it around my area. While I was able to run a 5k PR, it was also around this time that running up hills also began to feel significantly harder (my 5k course was relatively flat with only about 100ft of cumulative climb). Trail running got really difficult because of these uphill challenges. On the other hand, I just felt a lot happier while running which helps with the suffering feelings of trying to run hard.
Today
Which brings me into my actual update! My estrogen levels are now in the typical female physiological range, but my testosterone has been slowly dropping and is now at the low end of the male physiological range. After discussing with my provider, I switched to bicalutamide for my anti-androgen. My hope is that this will bring the testosterone levels down into the female physiological range, which will help continue with my transition. At this point, I feel absolutely great about things have gone. I have definitely had some physical development, as well as emotional.
When I speak of emotional development, I think that my providers description of testosterone as being a bit like a firewall that blocks or blunts emotions is good, as I have definitely felt them more, which is great! The first two weeks on the bicalutamide have been a challenge emotionally, which may be an effect of the dropping testosterone. It’s hard to differentiate what is just the stresses of life vs. the changes I’m feeling from the hormones. It has felt frequently like I’m on the edge of crying without very much reason which is tough. After getting some cathartic cries out yesterday though, I’m feeling a lot better today.
With the recent heat, I haven’t done a hard run recently to get a good comparison. I’m definitely running a bit slower, but it’s hard to say by how much. Without putting in a full effort, I ran my 5k(ish) loop at a pace that would equate to a 22:35 (the loop is a bit longer). I just started a 5k plan with a goal of setting a new PR, so I’ll write another update on how that is going to give you all some more insight though. On the first observation, my first run at what should be my “easy” pace was not very easy.