This week I want to turn to a topic that is rarely discussed in any medical forum, eastern or western: hormonal transition. Hormonal transition can really refer to several experiences: puberty, menopause, andropause, and health-related hormonal shifts are all normal processes that bodies go through. Puberty for transgender people is also normal; it just happens to be medically-assisted.
There are many myths and misunderstandings about this process, and Chinese medicine can help us to see our way through them and towards a more comprehensive view.
Before we dive in, a general disclaimer: hormonal transition is a process that some, but not all, transgender people go through. Efforts to withhold access to hormonal transition over the last hundred-ish years have created very bizarre gate-keeping systems around who can access this kind of care, and although this is changing there continue to be people in the world who want to hormonally transition but have not yet been able to. Being on hormones does not make someone “more” trans or more “real”; it is simply a decision that some trans people make, in consultation with their healthcare practitioners.
Almost every body contains some mixture of estrogen and testosterone.
These hormones are responsible for a wide range of processes throughout the body, but they are best know 
for their roles in secondary-sex characteristics such as hair texture and pattern, body composition, skin texture and muscle mass. They both move in cycles, although the testosterone cycle is not accompanied by blood, so it tends to fly under the radar.
Yin and Yang are not concepts that map perfectly onto estrogen and testosterone, but they have a history of being framed that way. Though there can be conceptual problems with a 1:1 comparison, there is some utility to using them. To do so well, though, we have to keep a few things in mind.
First, yin is not “bad” and yang is not “good”.
Yin processes are generally cooler, slower, and more physical, while yang processes are hotter, faster and more about energy. Both are equally required for life to occur. Similarly, estrogen and testosterone exist within relationship to one another in healthy human bodies, and though the mix is different from person to person, it is that relationship that creates physiological balance.
Second, yin is not “weaker” than yang, and estrogen is not “weaker” than testosterone.
There is a strong desire to map sexist notions onto these concepts and molecules, and while I understand where that comes from, it’s misleading at best. Yin is required for life; without rest and darkness we would die. Estrogen is an extraordinarily powerful hormone that influences just as many physiological processes around the body as testosterone, including libido. Estrogens have powerful regulatory effect on bone density, metabolism and protein synthesis that people don’t often know about, because these functions are often thought of as being “masculine”.
All of these misconceptions feed into the way that people understand medical hormonal transition, even for medical providers.
This is a topic too big for this essay, but it suffices to say that people who transition to estrogen-dominance are often saddled with the dumb sexist tropes that already get hung around estrogen, yin, and femininity in general. There is more medical scrutiny, more concern (trolling), and sometimes even more monitoring. Folks who transition to testosterone dominance get the shiny things that sexism awards to men, but also sometimes experience a weird form of medical negligence that assumes that men don’t need care and that minimal monitoring is fine.
It is important to frame hormonal transition correctly: it’s puberty.
Puberty is a normal process that people go through, some earlier in life and some later. Like pregnancy, itis not an illness or a disease process, but it is wise to have a medical provider around when it’s happening. Like any puberty process, it involves a massive shift in the chemical soup of the body, in myriad ways. Appetite changes, sex drive changes in both its level and quality, and the appearance of the body also shifts. What can complicate this process for trans people who did not have access to care as young people is that one hormonal process has to be shut off, and another has to begin, simultaneously.
For people who are transitioning to testosterone dominance, this means that they are going through menopause (declining estrogen levels) and masculine puberty at the same time. For those who are transitioning to estrogen dominance, there is a simultaneous andropause (decline of testosterone) and feminine puberty.
These two processes can be a bit taxing for any body on their own, and together they can sometimes be challenging.
This is where Chinese medicine comes in. Our medicine is all about the balance of yin and yang in the body, and these hormonal shifts are just another manifestation of that process. When we treat any kind of symptom, it is within the context of thinking “is this a yin symptom or a yang symptom?”. We treat menopausal symptoms quite often, usually seen as Kidney Yin deficiency and Liver blood deficiency, and similar symptoms can appear with testosterone supplementation. Andropause can cause coldness, lethargy and sadness, which we usually see as Kidney or Spleen yang deficiency, and we sometimes see similar patterns in people who are supplementing estrogen.
None of these symptoms are terrible, and they usually disappear over time, but we can get them to resolve much more quickly by treating them.
Transgender people have been informed, either explicitly or implicitly, that our healthcare is a burden and that we should just be grateful for whatever we get, regardless of quality. The time for accepting this message is rapidly coming to an end. People can transition without any help with side effects, and we have been doing so for decades, but we don’t need to. We can have an even better and more fulfilling experience of transition with a little bit of extra help from a medicine whose entire raison d’etre is balancing yin and yang.
I’ve helped many people through this process already, and I’m excited to work with you. Please get in touch if you have questions – otherwise you can just get on my schedule.
