Rewriting the Script: An Autistic Trans Woman's Reflections on Her First Week of HRT
In the symphony of my life, the decision to start hormone replacement therapy (HRT) was a crescendo moment, a pivotal step in my journey as an autistic trans woman. After months of introspection, journaling, self-discovery, and embracing my authentic identity, I found myself ready to embark on this transformative path.
As I reflect on that first week of HRT, I am filled with a mix of emotions - excitement, trepidation, curiosity, and above all, a profound sense of rightness. I knew that this medical transition would be just one part of my ongoing narrative, but I also recognised its significance in aligning my physical self with my inner truth.
In today’s article, I want to share with you a sort-of day-by-day account of that inaugural week. Through a journal-style format, I’ll invite you into the intimate details of my experience - the physical changes, the emotional shifts, the social interactions, and the moments of revelation. As an autistic gestalt processor (aka, non-verbal), I’ll also explore how this transition intersected with my neurodivergent perspective, how not having the scripts for what I was going through affected things, and how it both challenged and affirmed my sense of self.
As a gestalt language processor (GLP), I found myself lacking the scripts and frameworks to navigate this new chapter of my journey. The decision to start HRT was one I had to construct from the ground up, piecing together fragments of information and experience without the guidance of a pre-existing narrative. In my preparatory research over the previous year, diving deep into the intersection of autism and gender identity, I struggled to find accounts that resonated with my specific background as an autistic GLP in my 50s. This absence of representation underscored the importance of sharing my own story.
Writing this article serves not only as a contribution to the broader tapestry of trans experiences but also as a crucial tool in my own language development. By documenting and reflecting on my journey, I am actively working to assign words to the complex emotions and experiences that arise. This process of articulation is a form of self-discovery, a way of constructing meaning and coherence in the midst of profound transformation. In sharing my story, I hope to create a resource that I wish I had access to - a narrative that speaks to the unique challenges and joys of navigating HRT as an autistic GLP.
So, dear reader, I invite you to step back in time with me, to that first week of HRT. Join me as I navigate the unknowns, celebrate the triumphs, and embrace the complexities of this transformative journey. Together, we’ll explore the profound impact of those seven days, and how they set the stage for the ongoing unfolding of my authentic self.
Day 1
The morning of my first HRT dose was filled with a palpable nervousness, a mix of anticipation and trepidation. With tired hands (I didn’t sleep well the night before as I was both excited and nervous for what was to come), I took my medication at 5 am, before setting off for my teaching job. As I went about my usual routine, I couldn’t help but wonder what changes, if any, I would notice in these early hours.
Around 11:30 am, as I was in the midst of my workday, I suddenly experienced a sensation that I can only describe as a profound shifting of my internal landscape. The constant noise that had been my lifelong companion - the sensory overload, the incessant buzzing of my mind - suddenly fell quiet. In its place was a tranquility I had never known, a peace that seemed to emanate from the very core of my being. It was as if someone had flipped a switch, muting the chaos and leaving behind a serene stillness.
This feeling persisted throughout the day, and even now, as I write this, I can still feel its echoes reverberating through me. As an autistic GLP, I have often struggled to find the precise words to capture my experiences, and this moment is no exception. The best way I can describe it is as a profound alignment, a sense that my gender journey and my autistic identity were intersecting in a way that brought unexpected ease and harmony. It was as if by embracing my truth as a trans woman, I was also unlocking a new way of being in my autistic body and mind.
The medical aspects of starting HRT had filled me with uncertainty, but this first day felt like a triumph, a validation of my decision to embark on this path. Whilst I know that not every day will bring such profound revelations, this initial experience has given me a glimmer of the transformative power of living authentically. I am filled with gratitude for this moment of grace, and with a renewed sense of hope for the journey ahead.
Day 2
The morning after my first HRT dose brought an unexpected gift - a night of restful, uninterrupted sleep. As someone who has long struggled with insomnia and anxiety-induced wakefulness, the simple act of falling asleep without issue and waking up feeling refreshed was a revelation in itself. Given the stress and emotional turbulence leading up to the start of my medical transition, this newfound sense of tranquility was a welcome surprise.
With my second dose taken at 5am, I set off for work, still enveloped in the calming embrace that had characterised the previous day. However, during my commute, a realisation struck me - I had forgotten to upload a crucial report to my school’s system, a document essential for an upcoming IEP meeting at 8:30am. In the past, such an oversight would have sent me spiraling into panic and anxiety, my mind consumed by worst-case scenarios. Yet, in this moment, I found myself relatively composed. Concerned, certainly, but not overwhelmed by the weight of my mistake.
As I navigated this situation, I couldn’t help but wonder about the role of my HRT medication in this newfound emotional equilibrium. Without a clear point of reference, a firsthand account from an autistic adult like myself documenting their transition journey, I found myself craving insight into how much of my experience could be attributed to the hormonal shifts taking place within me. Later that day, I delved into research, hoping to find answers or parallels to my own journey. However, my search yielded little in the way of relatable narratives.
Alongside these emotional and psychological shifts, I also found myself grappling with the practical medical aspects of HRT. As someone who needs to stay well-hydrated, the 90-minute classes I teach posed a challenge, especially given the diuretic nature of one of my medications. Moreover, I couldn’t help but ponder the potential physical changes on the horizon. Having already lost 10 pounds since the start of my journey the previous year, I wondered how the combination of anti-androgens, muscle mass reduction, and water weight loss might further transform my body. Whilst weight loss was not a specific goal of mine, the unknown landscape of these physical shifts added an extra layer of complexity to an already profound journey.
As I reflect on this second day, I am struck by the interplay of my autistic identity and my trans experience. The calm that has settled over me feels like a gift, a respite from the constant sensory and emotional overload that has characterised so much of my life. Yet, I also find myself navigating uncharted territory, without the benefit of a roadmap or a preexisting script. It is a journey of self-discovery in every sense, one that I am learning to embrace one day at a time.
Day 3
I woke up this morning after another night of restful, restorative sleep. As I stretched and began my daily rituals, I couldn’t help but marvel at the profound sense of integration I was experiencing. It was as if, for the first time in my life, my mind and body were in harmony, no longer at odds with each other. The constant background noise of my brain trying to ‘figure out what’s wrong’ had been replaced by a newfound sense of peace and wholeness.
As I prepared my morning HRT doses, I realised that I had set a reminder in my iPhone’s Health app to ensure I wouldn’t forget this crucial part of my routine. However, I quickly discovered that such prompts were unnecessary. Unlike the vitamins I often neglected, taking my HRT medication had already become a joyful, eagerly anticipated ritual. The incentive to embrace this aspect of my transition was intrinsic, a powerful motivation that required no external reminders.
With this newfound enthusiasm, I found myself dedicating more time and attention to my morning grooming routine. As I navigated the unfamiliar terrain of feminine beauty standards, I realised that my getting-ready process had doubled in length. Far from being a burden, however, this extra time felt like a gift, an opportunity to explore and express my authentic self.
One particular area of focus quickly emerged - my eyebrows. As I studied my reflection, I couldn’t help but feel a sense of dissatisfaction with their current state. I knew that learning to shape and care for them would be a crucial part of my journey, a way of aligning my external appearance with my inner identity. I made a mental note to research techniques and products, to seek out guidance from those who had walked this path before me.
As I reflect on this third day of my HRT journey, I am struck by the profound shifts already taking place within me. The physical changes, barely noticeable at this point, are merely the outward manifestation of a deeper transformation. With each passing day, I feel more at home in my own skin, more aligned with my true self. The challenges of navigating a new social and cultural landscape - from beauty norms to gender expectations - are balanced by the profound joy of living authentically.
As an autistic GLP, I am acutely aware of the learning curve ahead of me. The scripts and routines I must master are complex and multifaceted, requiring a level of adaptation and flexibility that has not always come easily to me. Yet, I am also aware of the unique gifts my neurodivergent perspective brings to this journey. My ability to deeply analyse and reflect, to approach each new challenge with a fresh perspective, feels like a powerful asset in this process of self-discovery.
Day by day, I am learning to embrace the complexity and beauty of my intersectional identity. As an autistic trans woman (it just feels so incredible to say that), I am charting my own course, crafting a narrative that is uniquely my own. With each small triumph - from a good night’s sleep to a soon to be well-groomed brow line - I am reminded of the transformative power of living authentically. And whilst the path ahead may be uncertain, I am filled with a sense of hope and determination, knowing that each step brings me closer to the person I am meant to be."
Day 4
As I moved into the fourth day of my HRT journey, I found myself noticing some interesting changes in how my body was responding to temperature and physical activity. When I stepped outside for my morning walk to sign in at the main school office, I was struck by how acutely I felt the chill in the air. Despite the temperature being relatively mild, I found myself shivering and wishing for an extra layer. It was as if my body’s thermostat had been recalibrated, making me more sensitive to the slightest hint of cold.
This heightened sensitivity to temperature made me wonder about the potential impact of HRT on my erythromelalgia. As someone who has long struggled with this condition, I am well-acquainted with the painful flare-ups that can be triggered by changes in temperature. However, over the past few days, I have noticed a marked reduction in these episodes. It's almost as if the estrogen is acting as a balm, soothing the inflammation and regulating my body’s response to heat and cold.
Later in the day, I decided to engage in my regular workout routine. As I moved through my exercises, I couldn’t help but notice a difference in how my muscles were responding. Movements that had once felt fluid and easy now seemed to require more effort, leaving me feeling fatigued more quickly than usual. As I finished my routine, I braced myself for the familiar post-workout soreness, knowing that it would likely be more pronounced than in the past.
Sure enough, as the hours passed, I could feel a deep ache settling into my muscles. It was a sensation I had experienced before, but never with quite this intensity. I found myself wondering about the role of HRT in this increased soreness. Were the hormonal changes affecting my muscle composition, making me more susceptible to micro-tears and inflammation? Or was it a result of my body adjusting to a new metabolic baseline, one that required more energy and effort to maintain?
As I reflected on these changes, I couldn’t help but feel a sense of awe at the profound impact that HRT was having on my body so soon. From the way I experienced temperature to the way my muscles responded to exercise, it was as if I was being introduced to a whole new version of myself. As an autistic person, I have always been acutely aware of my body’s sensations and responses. Now, with the added layer of my trans identity, I was discovering a new depth to this embodied experience.
Of course, navigating these changes is not without its challenges. As someone who thrives on routine and predictability, the idea of adjusting my workout regimen or accommodating new temperature sensitivities can feel daunting. But I am also reminded of the incredible resilience and adaptability of the human body, and of my own capacity for growth and change.
In checking in with myself, I know that there will be many more discoveries and adjustments ahead. But I also know that each of these changes is a reflection of my authentic self, a testament to the power of living in alignment with one’s true identity. And so, even on the days when the chills bite a little deeper or the soreness lingers a little longer, I am filled with gratitude for the opportunity to inhabit this body, this life, in all its complex and beautiful reality.
Day 5
I woke up this morning (a Saturday) feeling the weight of exhaustion deep in my bones, despite having slept well the night before. As I dragged myself out of bed, I couldn’t help but wonder about the cause of this pervasive fatigue. It was as if my body was working overtime, expending vast amounts of energy on some invisible task. As I contemplated this, a realisation struck me - could this be a symptom of testosterone withdrawal?
A quick dive into the research confirmed my suspicions. As my body adjusts to the new hormonal landscape created by HRT, it’s not uncommon to experience a period of withdrawal from the testosterone that once dominated my system. This process, while necessary and ultimately beneficial, can take a toll on one’s energy levels, leaving you feeling drained and exhausted.
As I went about my morning routine, I noticed another change - my skin, once relatively trouble-free, was now feeling dry and tight (cue autistic sensory problems). This was a new sensation for me, one that I hadn't had to contend with in the past. Once again, a brief exploration of the topic revealed that dry skin is a common side effect of HRT, as the shift in hormones can affect the skin’s moisture levels and elasticity. Time to find new shower products … and a skin moisturiser.
Whilst these physical changes were certainly notable, my mind was also preoccupied with more practical concerns. With the summer break approaching, I began to think about updating my work wardrobe to better reflect my evolving identity. However, as I contemplated this, I couldn’t help but feel a sense of trepidation about the issue of footwear. My size US 15 / EU 49 feet, long since ravaged by the effects of erythromelalgia, felt like a significant obstacle in my quest for more feminine shoes.
As I grappled with these challenges, I couldn’t help but find a moment of levity in an unexpected place - my iPhone. It seems that my device has been quietly observing my recent searches and conversations, and has taken it upon itself to populate my Instagram feed with ads for nail polish and lipstick. Whilst the algorithms may be a bit presumptuous, I couldn’t help but chuckle at this digital reflection of my journey.
As I reflect on this fifth day of HRT, I am struck by the complex interplay of physical, emotional, and practical considerations that comprise this experience. From the fatigue of hormonal shifts to the challenges of finding gender-affirming footwear, each day brings new puzzles to solve and obstacles to overcome.
Yet, even in the midst of these challenges, I find myself filled with a sense of determination and purpose. As an autistic person, I am no stranger to navigating a world that isn’t always designed with my needs in mind. And as a trans woman, I am learning to embrace the unique joys and struggles of crafting an authentic identity in a society that often seeks to constrain and define us.
In the face of fatigue, dry skin, and limited shoe options, I choose to focus on the bigger picture - the profound gift of aligning my outer reality with my inner truth. Each physical discomfort, each practical hurdle, is a small price to pay for the opportunity to live as my full, authentic self.
And so, as I move forward in this journey, I do so with a sense of gratitude and resolve. I am thankful for the body that carries me through these changes, for the mind that seeks to understand and adapt, and for the spirit that refuses to be confined by the expectations of others. Day by day, challenge by challenge, I am becoming more fully myself - and that is a victory worth celebrating.
Day 6
Last night, as I drifted off to sleep, I found myself slipping into a world of vivid dreams - a realm I had not visited in quite some time. These dreams were not the alarming, disruptive kind that I had experienced in the past, but rather a vibrant, immersive tapestry of images and sensations. It was as if my subconscious mind, freed from the constraints of waking life, was taking the opportunity to explore and express itself in new and creative ways.
Upon waking, in that liminal space, I found myself marveling at the intricacy and detail of these dreams. As someone who has often struggled with sleep, the return of such vivid dreaming felt like a gift - a sign, perhaps, of my body and mind adjusting to the new hormonal landscape created by HRT. Whilst the content of the dreams themselves may not have been particularly significant, their presence alone felt like a marker of some deeper shift taking place within me.
However, as I emerged from the cocoon of sleep and began to face the day ahead, I found myself confronted with a profound sense of exhaustion. It was as if all the energy I had managed to gather during the night had been drained away, leaving me feeling depleted and drained. Even the simplest of tasks - getting out of bed, making breakfast, attending to my morning routine - felt like monumental challenges, requiring far more effort and determination than usual.
As the day wore on (Sunday), I found myself succumbing to the fatigue, my body demanding rest and respite. I spent hours on the couch, feet propped up, drifting in and out of a hazy, half-waking state. It was a strange sensation, this pervasive tiredness - not the satisfying exhaustion that comes after a day of productive work, but a bone-deep weariness that seemed to permeate every cell of my being.
As I lay there, I couldn’t help but reflect on the paradox of this experience. On the one hand, the return of my vivid dreams felt like a positive development - a sign of my mind and body adapting to the changes brought on by HRT. Yet, on the other hand, the overwhelming fatigue I was experiencing felt like a reminder of just how taxing this process of transformation can be.
As an autistic person, I am no stranger to the challenges of navigating a world that is not always designed with my needs in mind. And as a trans woman, I am learning to embrace the unique joys and struggles of crafting an authentic identity in a society that often seeks to constrain and define us. But on days like this, when the exhaustion feels all-consuming, it can be difficult to hold onto the bigger picture - the profound importance of living in alignment with one’s true self.
And yet, even in the midst of this fatigue, I find myself filled with a sense of gratitude and determination. I am thankful for the vivid dreams that remind me of the resilience and creativity of my own mind. I am grateful for the body that carries me through these changes, even when it feels heavy and tired. And I am resolved to keep moving forward, one day at a time, knowing that each moment of rest and each step forward is a part of the larger journey of becoming my authentic self.
As I look ahead to the days and weeks to come, I know that there will be more challenges and more moments of exhaustion. But I also know that there will be more moments of joy, more instances of profound self-discovery and self-acceptance. And so, I choose to embrace it all - the dreams and the fatigue, the challenges and the triumphs - as part of the beautiful, complex tapestry of my own unique journey.
Day 7
As I stepped into my closet this morning, preparing for another workweek, I found myself confronted with a stark reality - the continued inadequacy of my current wardrobe. The button-down shirts and stiff trousers, once the staples of my professional attire, now felt like relics from a past life - a costume I had outgrown, but was still forced to wear.
With each garment I donned, I could feel the weight of decades-long cosplay bearing down on me. The fabric felt foreign against my skin, the cuts and styles a poor match for the woman I knew myself to be. It was as if I was stepping into a role that no longer fit, a character I had long since abandoned.
The frustration was palpable as I looked at my reflection in the mirror. The disconnect between my outer presentation and my inner identity had never felt so stark, so unbridgeable. I longed for the day when my wardrobe would reflect the truth of who I am - when I could step into the world each morning feeling aligned and authentic, from the inside out.
As I moved through my workday, I found my mind drifting to the upcoming summer break - a time of rest, rejuvenation, and, most importantly, creation. With each passing hour, my excitement grew at the prospect of finally having the time and space to craft a wardrobe that truly reflected my identity.
I envisioned myself at the sewing machine, bringing to life the designs that had long been percolating in my mind. Skirts and dresses, blouses and blazers - each garment a loving expression of my femininity, a tangible manifestation of my authentic self. I could almost feel the soft fabrics beneath my fingers, see the colours and patterns coming together in perfect harmony.
For me, the act of crafting and creating has always been more than just a hobby - it is a form of self-expression, a way of bringing my inner world into the outer realm. As an autistic individual, I have often found solace and comfort in the repetitive motions and precise details of the creative process. And as a trans woman, I am discovering the profound power of fashion to affirm and celebrate my identity.
As the day drew to a close and I prepared to shed my “boy clothes” once again, I found myself filled with a renewed sense of purpose and determination. Each day in this ill-fitting wardrobe was a reminder of how far I had come, and how far I still had to go. But it was also a testament to my own resilience and strength - the unwavering spirit that had carried me through countless challenges and would continue to guide me forward.
And so, as I looked ahead to the summer months and the creative projects that awaited me, I felt a sense of hope and excitement rising within me. I knew that the journey ahead would not be easy - that there would be moments of doubt and frustration, setbacks and obstacles to overcome. But I also knew that each stitch, each carefully crafted garment, would be a step closer to living as my true, authentic self.
In the end, this is what the journey of transition is all about - the slow, steady work of unmaking and remaking, of shedding the layers that no longer serve us and crafting a life that reflects the truth of who we are. And as I move forward in this process, one day at a time, I am filled with gratitude for the opportunity to undertake this sacred work - to create not just a wardrobe, but a life, that is a perfect fit for the woman I know myself to be.