I know you already said this experience might not generalize to more neurotypical people, but for the record, my experience starting estrogen monotherapy was nothing like this. The physical changes were obvious, but I didn’t actually notice any psychological changes at all.
I actually find this post quite concerning. These sound like mild symptoms of HPPD, mania, and/or psychosis- and you yourself describe them as resembling schizophrenia. The neurological explanations you give as to why this is happening strike me as strange and implausible. My impression is that your experiences are likely caused by heavy use of psychedelics, such as the trip you went on right before you started E.
I’m glad you’re happier and experiencing less sensory overload, but I think you can do that while staying sane, and I really don’t think you should “lean into” schizotypy. I’ve watched people experience psychosis and it’s really quite frightening and sad.
I have also sat people through acute psychotic episodes a few times over the years, so I’m familiar with what that looks like. I also agree with you that it can be quite frightening and sad.
Schizotypy is not the same thing as schizophrenia or psychosis. I hoped that I was being careful enough with my language around this (and even lampshading colloquial use of the term “schizo” with scare quotes) that nobody would think I was conflating the mild increase in schizotypal traits I was experiencing with schizophrenia or psychosis. I’m not sure how I could convince someone of this through a comment field but having spent ample time around people with these traits I do not model myself as being prone to schizophrenia or psychosis.
I’m also familiar with what both inducing and resolving HPPD can be like. In my experience, HPPD tends to have visual characteristics similar to the psychedelics which induced it. For instance, for a few days after using 2C-B, I’ll tend to see strobing afterimages (if I look at my curtains, which have blue stripes, and then close my eyes, I’ll see a brief flash of yellow). Estrogen did not do anything at all like this.
I can’t access the paper by Andersen that you discuss, do you know if schizotypy as Andersen understands it would include the “schizoid” personality type or if he’d consider that distinct? Nancy McWilliams, who wrote an interesting piece about her impressions of schizoid personalities as a psychotherapist, commented on p. 199 of her textbook Psychoanalytic Diagnosis that “Our taxonomic categories remain arbitrary and overlapping, and acting as if there are discrete present-versus-absent differences between labels is not usually wise clinically … Perhaps schizoid psychology, especially in its high-functioning versions, can be reasonably viewed as at the healthy end of the autistic spectrum.” There also seems to be some support for the idea of a schizoid/high-functioning autism spectrum in this study, with “spectrum” here meaning shared common features that would be atypical for neurotypicals, rather than opposite ends of a broader spectrum that includes neurotypicals in the middle as with Andersen’s proposal.
Personally I find that I relate to a lot of the features of schizoid personalities in descriptions like McWilliams’ and also that I relate to a lot of the features of HFA thinking that are distinct from difficulties with reading people’s intentions/meaning, as described for example by the autistic writer Temple Grandin in her book Thinking in Pictures, so this makes it seem plausible to me that at least some subset of schizoid personalities might have a lot of mental overlap with HFA but without the same degree of mind-reading deficits. And some of those shared cognitive features of autistic/schizoid minds are ones that Andersen puts in the “schizotypal” pole that he thinks is opposite to the “autistic” one, which for me raises doubts about his theory as described. For example when it comes to “associative thinking”, on p. 9 of Thinking in Pictures Grandin talks about the highly associative nature of her own thought, which is compatible with her highly “systematizing” nature rather than being opposite to it (maybe one could make an analogy to an animal building up a mental map of a landscape through continual impulsive curiosity-driven exploration):
“If I let my mind wander, the video jumps in a kind of free association from fence construction to a particular welding shop where I’ve seen posts being cut and Old John, the welder, making gates. If I continue thinking about Old John welding a gate, the video image changes to a series of short scenes of building gates on several projects I’ve worked on. Each video memory triggers another in this associative fashion, and my daydreams may wander far from the design problem. … This process of association is a good example of how my mind can wander off the subject. People with more severe autism have difficulty stopping endless associations. I am able to stop them and get my mind back on track. … Interviews with autistic adults who have good speech and are able to articulate their thought processes indicate that most of them also think in visual images. More severely impaired people, who can speak but are unable to explain how they think, have highly associational thought patterns.”
On the other listed characteristics of Andersen’s schizotypal pole which he thinks are opposite to the autistic one, I would guess people on a HFA/schizoid might be more likely then neurotypicals to enjoy a kind of “magical thinking” as a form of imaginative play, even if they are not as likely as “schizotypal” people to literally believe it. (As an example consider H. P. Lovecraft, who in his real life was a hardheaded materialist but had a great fascination with weird fiction that evoked nebulous feelings of transcending ordinary reality, as in his comment in one letter that ‘The true function of phantasy is to give the imagination a ground for limitless expansion, and to satisfy aesthetically the sincere and burning curiosity and sense of awe which a sensitive minority of mankind feel toward the alluring and provocative abysses of unplumbed space and unguessed entity which press in upon the known world from unknown infinities and in unknown relationships of time, space, matter, force, dimensionality, and consciousness.’) And the comment about “Decreased systematising and attention to detail, for instance with tedious matters like finances” may be misleading in treating these two as intrinsically connected, it’s possible to be highly systematizing about subjects that one finds interesting but bad with details of subjects that seem tedious (think of the absent-minded professor stereotype, which fits pretty well with real famous scientists like Einstein who might be part of such a spectrum/cluster). Ozy’s piece discussing intuitive observations of a cluster of mental traits dubbed “plasticbrains” (who are also said to be more likely to be trans) also fits this pattern of being highly systematizing in some areas and bad about keeping track of details in others, with the comment “Plasticbrains people typically have difficulties with executive function. However, their difficulties span a wide range. Some may have relatively ordinary problems, such as procrastination, difficulty planning how long tasks will take, constantly forgetting why they walked into this room, and never knowing where they left their cell phone.”
The physical changes were obvious, but I didn’t actually notice any psychological changes at all
Thanks for this report; I alsodidn’t notice psych effects from my five-month HRT experiment besides decreased libido. I wondered if “maybe I’m not very self-aware” was the real explanation, but if so, at least I’m not alone in that??
Yep, I guess “no changes” is an exaggeration; l experienced lowered libido as well. I think it might affect my mood in a non-obvious way but tracking that stuff is hard.
but I didn’t actually notice any psychological changes at all.
People experience significant psychological changes from like, listening to music, or eating different food than usual, or exercising differently, so I’m going to guess that if you’re reporting nothing after a hormone replacement you’re probably mostly just not as attentive to these kinds of changes as cube_flipper is, which is pretty likely a-priori given that noticing that kind of change is cube_flipper’s main occupation. Cube_flipper is like, a wine connoisseur but instead of wine it’s perceptual shifts. Their language may sometimes sound odd or exaggerated, until you try the wine again while bearing it in mind, and then you’ll see what they were getting at.
It’s surprisingly easy to overlook this kind of shift, too. I can absolutely imagine a person getting this unflatness sensation and then just never finding the language to describe it before they totally forget how strangely flat the world used to feel.
i experienced a psychotic break that ended about 8 months before i started HRT, and i did notice some psychological changes after i started estrogen/spiro (not any psychotic symptoms though, which i am much more familiar with personally than i’d like to be). in particular my ability for self-care drastically improved (taking a shower every day became significantly easier after about 1.3 months on HRT) and my emotional regulation improved to the point that i became capable of holding a job. granted, the changes could have been primarily related to my brain continuing to recover from psychosis, but i guess i’m curious if you really had zero psychological changes. did you not feel slightly less anxious, or did you not sleep better once you started?
i guess i’m just curious because one would think that if trans women had brains closer to cis women than cis men do, that pre-HRT trans women would experience similar psychological symptoms that cis women with elevated testosterone do.
I didn’t rigorously track things like mood and sleep. What I really meant is that I had no clear changes in my moment-to-moment experience.
Personally, I’m skeptical of neurochemical explanations of gender dysphoria, and I suspect a lot of the emotional benefits of HRT are due to the positive experience of affirming your identity.
But haven’t you read about the BSTc findings? It’s a sexually dimorphic region in the lizard brain and trans women’s BSTc regions were similar to cis women’s while trans men’s were similar to cis men’s. This was controlled for HRT as well.
There’s no solid proof for it yet, but the idea that something went wrong during fetal development where the body masculinized but the brain feminized or vice versa makes the most sense to me.
I suspect that the reason it works might not be the reason we think it works. E.g. there is some neurochemical benefit to HRT, but whatever is happening is not having the wrong sex brain for your body.
I noticed a few psychological changes myself, but nothing major.
I’m more curious, I think, but perhaps my environment simply coincidentally became more interesting by my existing interest function? Hard to say. I’m on average happier, though not by much. I experience and express emotions more easily, from less intense triggering experiences than I had previously required.
Some of my lower-level sensory perceptions shifted, too. I was almost red-green colorblind before, and I now distinguish red and green slightly better. I can see the red shining though most browns now. Indeed, browns and pure reds are much more vibrant, in a way entirely nonoverlapping with my entire previous experience. Also chocolate used to have a hint of an “earthy” taste, and now instead has a hint of “fruity”.
I also have reason to believe my color perception is pretty abnormal, both before and after estradiol supplementation. Thus, not having heard of [anything relating to my vision] with relation to estradiol should perhaps not be considered surprising. My eye doctors have labelled it as “mild protanomaly”, though both offices remarked that the label doesn’t quite fit.
Well, maybe the original poster here ought to check in with a psychiatrist in case this is the onset of schizophrenia.
Trans peoples reports of the effects of HRT do seem to have a lot of variation, but there are unusual things in this report that might be symptoms of something else.
I know you already said this experience might not generalize to more neurotypical people, but for the record, my experience starting estrogen monotherapy was nothing like this. The physical changes were obvious, but I didn’t actually notice any psychological changes at all.
I actually find this post quite concerning. These sound like mild symptoms of HPPD, mania, and/or psychosis- and you yourself describe them as resembling schizophrenia. The neurological explanations you give as to why this is happening strike me as strange and implausible. My impression is that your experiences are likely caused by heavy use of psychedelics, such as the trip you went on right before you started E.
I’m glad you’re happier and experiencing less sensory overload, but I think you can do that while staying sane, and I really don’t think you should “lean into” schizotypy. I’ve watched people experience psychosis and it’s really quite frightening and sad.
I have also sat people through acute psychotic episodes a few times over the years, so I’m familiar with what that looks like. I also agree with you that it can be quite frightening and sad.
Schizotypy is not the same thing as schizophrenia or psychosis. I hoped that I was being careful enough with my language around this (and even lampshading colloquial use of the term “schizo” with scare quotes) that nobody would think I was conflating the mild increase in schizotypal traits I was experiencing with schizophrenia or psychosis. I’m not sure how I could convince someone of this through a comment field but having spent ample time around people with these traits I do not model myself as being prone to schizophrenia or psychosis.
I’m also familiar with what both inducing and resolving HPPD can be like. In my experience, HPPD tends to have visual characteristics similar to the psychedelics which induced it. For instance, for a few days after using 2C-B, I’ll tend to see strobing afterimages (if I look at my curtains, which have blue stripes, and then close my eyes, I’ll see a brief flash of yellow). Estrogen did not do anything at all like this.
I also wouldn’t conflate ketamine with psychedelics, and neither would Robin Carhart-Harris! It’s a dissociative!
I can’t access the paper by Andersen that you discuss, do you know if schizotypy as Andersen understands it would include the “schizoid” personality type or if he’d consider that distinct? Nancy McWilliams, who wrote an interesting piece about her impressions of schizoid personalities as a psychotherapist, commented on p. 199 of her textbook Psychoanalytic Diagnosis that “Our taxonomic categories remain arbitrary and overlapping, and acting as if there are discrete present-versus-absent differences between labels is not usually wise clinically … Perhaps schizoid psychology, especially in its high-functioning versions, can be reasonably viewed as at the healthy end of the autistic spectrum.” There also seems to be some support for the idea of a schizoid/high-functioning autism spectrum in this study, with “spectrum” here meaning shared common features that would be atypical for neurotypicals, rather than opposite ends of a broader spectrum that includes neurotypicals in the middle as with Andersen’s proposal.
Personally I find that I relate to a lot of the features of schizoid personalities in descriptions like McWilliams’ and also that I relate to a lot of the features of HFA thinking that are distinct from difficulties with reading people’s intentions/meaning, as described for example by the autistic writer Temple Grandin in her book Thinking in Pictures, so this makes it seem plausible to me that at least some subset of schizoid personalities might have a lot of mental overlap with HFA but without the same degree of mind-reading deficits. And some of those shared cognitive features of autistic/schizoid minds are ones that Andersen puts in the “schizotypal” pole that he thinks is opposite to the “autistic” one, which for me raises doubts about his theory as described. For example when it comes to “associative thinking”, on p. 9 of Thinking in Pictures Grandin talks about the highly associative nature of her own thought, which is compatible with her highly “systematizing” nature rather than being opposite to it (maybe one could make an analogy to an animal building up a mental map of a landscape through continual impulsive curiosity-driven exploration):
“If I let my mind wander, the video jumps in a kind of free association from fence construction to a particular welding shop where I’ve seen posts being cut and Old John, the welder, making gates. If I continue thinking about Old John welding a gate, the video image changes to a series of short scenes of building gates on several projects I’ve worked on. Each video memory triggers another in this associative fashion, and my daydreams may wander far from the design problem. … This process of association is a good example of how my mind can wander off the subject. People with more severe autism have difficulty stopping endless associations. I am able to stop them and get my mind back on track. … Interviews with autistic adults who have good speech and are able to articulate their thought processes indicate that most of them also think in visual images. More severely impaired people, who can speak but are unable to explain how they think, have highly associational thought patterns.”
On the other listed characteristics of Andersen’s schizotypal pole which he thinks are opposite to the autistic one, I would guess people on a HFA/schizoid might be more likely then neurotypicals to enjoy a kind of “magical thinking” as a form of imaginative play, even if they are not as likely as “schizotypal” people to literally believe it. (As an example consider H. P. Lovecraft, who in his real life was a hardheaded materialist but had a great fascination with weird fiction that evoked nebulous feelings of transcending ordinary reality, as in his comment in one letter that ‘The true function of phantasy is to give the imagination a ground for limitless expansion, and to satisfy aesthetically the sincere and burning curiosity and sense of awe which a sensitive minority of mankind feel toward the alluring and provocative abysses of unplumbed space and unguessed entity which press in upon the known world from unknown infinities and in unknown relationships of time, space, matter, force, dimensionality, and consciousness.’) And the comment about “Decreased systematising and attention to detail, for instance with tedious matters like finances” may be misleading in treating these two as intrinsically connected, it’s possible to be highly systematizing about subjects that one finds interesting but bad with details of subjects that seem tedious (think of the absent-minded professor stereotype, which fits pretty well with real famous scientists like Einstein who might be part of such a spectrum/cluster). Ozy’s piece discussing intuitive observations of a cluster of mental traits dubbed “plasticbrains” (who are also said to be more likely to be trans) also fits this pattern of being highly systematizing in some areas and bad about keeping track of details in others, with the comment “Plasticbrains people typically have difficulties with executive function. However, their difficulties span a wide range. Some may have relatively ordinary problems, such as procrastination, difficulty planning how long tasks will take, constantly forgetting why they walked into this room, and never knowing where they left their cell phone.”
There’s a preprint of the paper available here.
Thanks for this report; I also didn’t notice psych effects from my five-month HRT experiment besides decreased libido. I wondered if “maybe I’m not very self-aware” was the real explanation, but if so, at least I’m not alone in that??
Yep, I guess “no changes” is an exaggeration; l experienced lowered libido as well. I think it might affect my mood in a non-obvious way but tracking that stuff is hard.
People experience significant psychological changes from like, listening to music, or eating different food than usual, or exercising differently, so I’m going to guess that if you’re reporting nothing after a hormone replacement you’re probably mostly just not as attentive to these kinds of changes as cube_flipper is, which is pretty likely a-priori given that noticing that kind of change is cube_flipper’s main occupation. Cube_flipper is like, a wine connoisseur but instead of wine it’s perceptual shifts. Their language may sometimes sound odd or exaggerated, until you try the wine again while bearing it in mind, and then you’ll see what they were getting at.
It’s surprisingly easy to overlook this kind of shift, too. I can absolutely imagine a person getting this unflatness sensation and then just never finding the language to describe it before they totally forget how strangely flat the world used to feel.
i experienced a psychotic break that ended about 8 months before i started HRT, and i did notice some psychological changes after i started estrogen/spiro (not any psychotic symptoms though, which i am much more familiar with personally than i’d like to be). in particular my ability for self-care drastically improved (taking a shower every day became significantly easier after about 1.3 months on HRT) and my emotional regulation improved to the point that i became capable of holding a job. granted, the changes could have been primarily related to my brain continuing to recover from psychosis, but i guess i’m curious if you really had zero psychological changes. did you not feel slightly less anxious, or did you not sleep better once you started?
i guess i’m just curious because one would think that if trans women had brains closer to cis women than cis men do, that pre-HRT trans women would experience similar psychological symptoms that cis women with elevated testosterone do.
I didn’t rigorously track things like mood and sleep. What I really meant is that I had no clear changes in my moment-to-moment experience.
Personally, I’m skeptical of neurochemical explanations of gender dysphoria, and I suspect a lot of the emotional benefits of HRT are due to the positive experience of affirming your identity.
But haven’t you read about the BSTc findings? It’s a sexually dimorphic region in the lizard brain and trans women’s BSTc regions were similar to cis women’s while trans men’s were similar to cis men’s. This was controlled for HRT as well.
There’s no solid proof for it yet, but the idea that something went wrong during fetal development where the body masculinized but the brain feminized or vice versa makes the most sense to me.
I suspect that the reason it works might not be the reason we think it works. E.g. there is some neurochemical benefit to HRT, but whatever is happening is not having the wrong sex brain for your body.
I noticed a few psychological changes myself, but nothing major.
I’m more curious, I think, but perhaps my environment simply coincidentally became more interesting by my existing interest function? Hard to say. I’m on average happier, though not by much. I experience and express emotions more easily, from less intense triggering experiences than I had previously required.
Some of my lower-level sensory perceptions shifted, too. I was almost red-green colorblind before, and I now distinguish red and green slightly better. I can see the red shining though most browns now. Indeed, browns and pure reds are much more vibrant, in a way entirely nonoverlapping with my entire previous experience. Also chocolate used to have a hint of an “earthy” taste, and now instead has a hint of “fruity”.
wow, those changes in color perception are really interesting! I haven’t heard of that before.
I also have reason to believe my color perception is pretty abnormal, both before and after estradiol supplementation. Thus, not having heard of [anything relating to my vision] with relation to estradiol should perhaps not be considered surprising. My eye doctors have labelled it as “mild protanomaly”, though both offices remarked that the label doesn’t quite fit.
If still interested in more detail, see: https://www.lesswrong.com/posts/NyiFLzSrkfkDW4S7o/?commentId=tQaoxSgMteZnaWWee
Well, maybe the original poster here ought to check in with a psychiatrist in case this is the onset of schizophrenia.
Trans peoples reports of the effects of HRT do seem to have a lot of variation, but there are unusual things in this report that might be symptoms of something else.