Hormone Therapy Self-Care: Navigating Mood Swings, Fatigue & Euphoria (Beyond the Pamphlets)

Three months into estrogen, I sobbed because my toast burned. Not a graceful cry — a gasping meltdown. My therapist shrugged: ‘Hormones!’ But nobody told me how to SURVIVE the rollercoaster.

Hormone therapy (HRT) reshapes your body, mind, and soul. Medical guidelines cover dosages and blood tests, but rarely the day-to-day reality: the exhaustion that feels like lead blankets, the skin crawling at 3 AM, the euphoria when you finally recognize your reflection.

Whether you’re on testosterone, estrogen, or blockers — here’s what I’ve learned from 6+ years on HRT and supporting hundreds through transition:

Section 1: The Unspoken Side Effects (And Why They Happen)

Key Hormone Impacts (source)

Estrogen-Dominant	Testosterone-Dominant
• Emotional intensity (crying spells, rage)	• Rage → Calm whiplash (T’s "anger rep" is overblown)
• Fatigue deepens (esp. months 1-6)	• Hunger surges (metabolism spikes)
• Skin sensitivity (new allergies, "crawling" feelings)	• Skin oiliness/acne (pores reorganizing)

Why This Occurs:

“Hormones are neural reorganizers,” explains Dr. Ada Cheng (UCSF Trans Care Center). “Estrogen thickens the brain’s emotion-processing gray matter. Testosterone shifts fat distribution, altering energy storage. Your body is rewriting its OS—glitches are normal.”

For many trans people, hormone therapy brings on a second puberty. This can be a deeply affirming experience, but also one filled with questions and changes that aren’t always well explained by healthcare providers. You might find yourself navigating shifts in energy, mood, physical strength, or emotional expression that are deeply linked to the hormones you're taking.

Understanding the typical traits of each hormonal pathway can help you prepare for what’s ahead—and offer language for what you're experiencing.

Self-Care Strategies for Hormone Journeys

Whether you're navigating estrogen or testosterone, hormonal shifts can bring powerful physical and emotional waves. These strategies are designed to support you with practical, body-positive care tools rooted in real science and lived experience.

1. Riding the Emotional Waves

5-4-3-2-1 Grounding (HRT Edition): When emotions spike, try this body-affirming reset:

• 5 things you love about your changing body

• 4 textures you can feel (e.g., soft hoodie, cool metal ring)

• 3 HRT-related changes you’re grateful for

• 2 deep, calming breaths

• 1 mantra: “This is temporary. I am safe.”

Mood Swing Logging: Use a free app like Bearable to track emotional patterns. Example: “Day 14: Estrogen injection → Day 16: Weepy. Solution: Cancel plans, watch comedy.” Logging helps normalize the mood cycle and anticipate what your body needs.

2. Managing Bone-Deep Fatigue

Micro-Nap Protocol: Try a 15-minute nap followed by a small iced tea. Caffeine (in moderation) constricts blood vessels, which may ease hormone-induced headaches and sluggishness.

Iron-Boosting Snacks: Estrogen can impact iron levels. Pair pumpkin seeds with citrus—vitamin C boosts iron absorption and supports energy levels naturally.

3. Soothing Skin Sensitivity

Fabric Swap: Hormonal shifts can make skin feel extra sensitive or even "crawly." Choose breathable fabrics like bamboo or cotton and avoid synthetic blends.

Shower Reset Hack: Finish your shower with 30 seconds of cold water. It helps close pores, reduce histamine reactions, and calm inflammation flare-ups.

Celebrating the Euphoria

Lean Into the "Gender Highs":

• Create a "Euphoria Album": Selfies, voice notes, or journal entries from joyful moments (e.g., “Today, my reflection winked back!”). Revisit during low spells.

  
  

• HRT Anniversary Ritual: Year 1: Write a letter to your pre-HRT self. Year 2: Plant something that blooms yearly (symbolic of your growth).

You’re Not Crazy—You’re Changing

HRT is second puberty with adult consequences. You wouldn’t tell a 13-year-old to ‘just meditate’ through acne and rage — so don’t gaslight yourself.

Remember:

• Fatigue ≠ laziness. It takes energy to rebuild a body.

• Mood swings ≠ weakness. Your brain is literally rewiring.

• Asking for help ≠ failure. It’s survival.

If today feels impossible: Put the phone down. Wrap yourself in a weighted blanket. Whisper: ‘This is the tide pulling back before the wave brings you home' I’ve been there — the calm is coming.

Crisis Management (When Self-Care Isn’t Enough)

Red Flags Needing Medical Attention:

• Estrogen: Sharp chest pain (blood clot risk)

• Testosterone: Dark urine + nausea (liver stress)

• (Source: WPATH Standards of Care v8)

Mental Health Lifelines:

• Trans Lifeline: 877-565-8860 (U.S.) / 877-330-6366 (Canada)

• Trevor Project: Text START to 678-678

If you’re fantasizing about quitting HRT because the mood swings are too much—tell your doctor BEFORE you stop. A dose tweak could change everything.”— Kai Cheng Thom, Author of "Fierce Femmes and Notorious Liars.