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Finding freedom in change: Hormone Replacement Therapy in the Philippines

Amid the colorful backdrop of the local LGBTQ+ community are members of the transgender community who strive to achieve their true selves, seeking to create consistency between who they are and who they believe themselves to be.

Transitioning refers to methods of changing one’s gender presentation or sexual characteristics to match their gender identity. It is not limited to transitioning through medical procedures, such as undergoing Hormone Replacement Therapy (HRT) or surgery. People can transition socially as well, with individuals dressing and behaving according to their gender identity and freely using their preferred pronouns.

The many forms of transitioning can cause some confusion to arise, and sometimes this confusion aggravates the discrimination the transgender community faces from society, reinforcing the negative stereotypes the public has of them.

Sam*, a trans male student studying Mechanical Engineering at the University of the Philippines Diliman, is familiar with the negative connotations attached to transgender peoples’ image. “Some people are just embarrassed to be affiliated with a transgender person,” he says, citing instances where transgender people are often painted as jokes in the modern social climate. “I think in the end that also affects how people see us; I think they don’t consider us ‘people’ as well, just because of what we want or decide to do.” This stigma surrounding the community can deeply affect those who choose to transition, especially those who undergo HRT.

Due to the sensitive nature of discussions surrounding HRT, the interviewees for the article have requested anonymity. Those transitioning face danger every day due to the stigma surrounding HRT, and for their safety, The LaSallian respects their decision to keep their identities private.

In transit

HRT is a process which involves administering female or male sex hormones into the body. With regular and prescribed intake of these hormones, the body will undergo a series of physical changes at a rate that depends on one’s general health.

The University of California San Francisco (UCSF) Transgender Care website provides an in-depth explanation of what one may experience while undergoing HRT. There, Dr. Maddie Deutsch, director of Clinical Services at the UCSF Center of Excellence for Transgender Health, likens HRT to a form of “second puberty”, in that it takes time for the effects to fully manifest or become observable.

On the USCF Transgender Care website, Deutsch further describes the physical changes that would eventually become noticeable in one’s skin, weight, and hair. For trans women undergoing HRT, hair will grow at a slower pace and will be much thinner than those taking testosterone, which promotes hair growth and thickness.

Despite the availability of medical sources like that of the UCSF website, finding someone to talk extensively to regarding HRT, particularly in the Philippines, proves to be a challenge. Sam believes that the conversation surrounding HRT is one that is difficult to have with most people due to generally poor public perception of the transgender community. He further discloses that he “couldn’t really ask anyone” about HRT, because aside from his desire to keep his personal matters private, the people he has chosen to confide in usually “[don’t] know about [the topic] as well.”

“I feel like not everyone in the Philippines is as aware of what HRT and transitioning truly [are],” shares Lexi* (Grade 12, ABM), who believes that the difficulty of talking about HRT stems from people’s confusion and misconceptions surrounding the topic.

Experience of undergoing HRT

Acquiring the necessary medication in order to proceed with HRT comes with varying degrees of difficulty. Lexi is fortunate enough to be able to purchase her hormone pills in local pharmacies through doctor’s prescriptions. “Things like testosterone pills and birth control pills work, as all HRT really needs to do is increase the count of the hormone that corresponds to the gender you wish to transition to,” says Lexi.

However, the monetary costs associated with transitioning can be very high, with injectables and patches having to be ordered overseas. A study by Campbell, Heru, and Padula in 2016 reveals that the cost of HRT amounts to USD 4,350, with further surgery costs amounting to up to USD 22,000 depending on gender—the prices reach a point where it may prohibit some people who want to transition from doing so. “It’s just not very accessible here,” Sam states.

Beyond the acquisition of medication, transitioning is entangled with complexity, both in the physical and mental sense. Sam, who has been transitioning for about a month, has not seen much physical change yet. “I haven’t felt too different, and when I look in the mirror, I don’t see too much of a difference either,” he shares, noting that by the time the changes do become evident, the journey will only become more difficult. “Any physical changes I take on will be difficult to hide, which still kind of scares me, but I have to face the music eventually.”

In contrast to Sam’s experience, Lexi has begun noticing that her face has started to become clearer, and her breasts have started to develop. “As of the moment, it’s not that crazy,” Lexi comments on the bodily changes. “The effects are still somewhat minimal, having only taken HRT for three months.”

Regardless of the degree to which their appearances have changed, the two similarly feel pleased with their ongoing transition. Prior to transitioning, Sam was under a lot of stress. He had always wanted to transition, but his fear and uncertainty prevented him from doing so for the longest time. He now feels more relaxed after choosing to be true to his identity, looking forward to the changes his body will be experiencing.

Like Sam, the years prior to Lexi’s transition were unkind to her mental health, but when she started transitioning, she felt a significant change. “Personally, I feel like it’s slowly pushing my mental health back to a more positive state,” she shares.

Beyond the transition

The process of undergoing HRT also brings with it effects that manifest outside of one’s own self. Discussions regarding transgender people are often volatile—met with resistance or distaste—and the news that a family member or friend is undergoing HRT isn’t something that is well-received for many.

For Lexi, the worst of it came from the people she was closest to, people whom she felt would have been most supportive of her. Revealing that some friends and relatives have refused to accept who she is and what she’s doing, she adds, “I personally try not to let these bother me…I simply cut [out] anyone who dislikes me for who I am out of my life.”

Similarly, Sam acknowledges that while he receives support from his mom and friends, there are people in his life who don’t share that same outlook. “I’ve had friends who cut ties with me [upon] learning about my decision, some of whom I was really close to,” he recounts how after being shunned by some of his friends, he found himself spending more time alone. “My mom’s also had to defend me against the [words] of some relatives who talk [behind my back].”

Given their experiences, Lexi and Sam both understand the pain faced by those undergoing HRT. However, in their eyes, the desire to change far outweighs the struggle they have to go through. “I am the type of person who cannot go a day without expressing themselves,” Lexi says, indicating that the desire to express who she is outweighs the difficulties she faced in her journey.

The unique process that is HRT will continue to serve as a way for some people to become the individuals they desire to be. Many respond with malice and apathy to those who undergo the process, and treat people like Sam and Lexi as less than human. Yet in spite of the difficulties and doubts they may have encountered—and may continue to encounter—the journey is one that these brave people undertake in hopes of being comfortable in their own skin and finding freedom in being who they truly wish to be.

*Names with asterisks (*) are pseudonyms

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