The troponin threshold to predict cardiovascular events is lower for women due to the greater cardiac mass typically seen in men.
Since estradiol and testosterone were not thought to directly impact cardiac mass, researchers expected that troponin would remain similar to individuals’ assigned gender at birth.
However, they found the opposite to be true.
The clinical research team found that troponin levels shifted towards the affirmed gender after 12 months of hormone therapy.
Troponin decreased in transgender women to a level not statistically different from cisgender women, but which was 78% lower than in cisgender men.
and on the molecular level, estrogen changes the protein biomarkers:
“For transgender women, we found gender affirming hormone therapy alters the levels of many protein biomarkers,” Novakovic said, noting that this could impact risk assessments for things like autoimmune disease and heart conditions. Usually, these assessments factor in any number of variables, including sex as well as lifestyle or genetic components.
“Feminizing GAHT [gender-affirming hormone therapy] skews the plasma proteome toward a cis-female profile,” the study concluded. It should be noted that people of any sex or gender can exhibit a vast and evolving spectrum of these biomarkers—there is no “one size fits all” model for biodiversity.
so yeah, you don’t change your gender identity with hormones - but you definitely are changing the way your body functions and changing your biological sex (in most health-relevant ways, e.g. heart and stroke risks, drug metabolism, etc.), and so increasingly I’ve come to think trans women on estrogen are biologically female, and that’s probably true in multiple ways (if they weren’t in some way biologically female they wouldn’t have needed estrogen).
Since it seems like a gender identity in a body with the wrong hormones seems to make a lot of people suicidal, depressed, and anxious - having the right hormones seems to fix that (go figure! lol)
This honestly makes me so happy. Back before I cracked my egg and started learning about what hormonal transition really meant I thought that transitioning was purely cosmetic, like all the passing trans women just got really lucky with their body shape and put in a ton of work with cosmetic surgeries, makeup, hair removal, wearing clothes that made them look more feminine, etc. I thought they were still biologically men and nothing could change that, which looking back made me really sad and held me back from coming out to myself. After all, if there’s no hope of really being a woman what was the point? I’m so glad I got past that because learning how much changes with HRT is fucking awesome. I actually, biologically, get to be a woman, even if I never really pass to some people. I couldn’t be happier lol.
That is very mind-blowing. Is it like 100% conversion, or is there something left behind? Is it a morphology issue? Like, because they formed a bit the other way after leaving the womb, or would they turn out 100% the other gender if it was done early?
You can actually ask former member of the other gender what their lives are like, it’s mind-blowing @_@
I’m not sure what you mean by “100% conversion”, but no - there are developmental pathways that are irreversible, e.g. the fetal development of the genitals are not going to change by taking hormones later, and many changes during puberty are irreversible (like changes to the skeleton - length of bones, changes to the skull, angle of the hips, etc.).
In trans women, undergoing male puberty causes irreversible changes to the thickness of the vocal folds, and estrogen does not change or fix the voice (but for trans men, starting testosterone will cause the vocal folds to thicken, permanently masculinizing the voice).
Preventing the wrong puberty helps avoid a lot of distress for trans people, which is why it is so important those interventions are available to trans youth. It is no different than if a cis person were administered the wrong hormones and forced to live as the wrong gender - it causes distress and significantly increases likelihood of suicide.
But even for those who avoid the wrong puberty, there are sex differences that developed as a fetus that would require surgery to fix.
EDIT: in case it’s not clear, there is a huge variety in the ways bodies develop even just when looking at non-trans people, and so even though my body underwent male puberty and that resulted in permanent changes to my rib cages, skull, hip width, etc. - my body still more or less overlaps with other female bodies enough that nobody can really tell the difference.
Male and female genitals are actually homologous meaning they have the same structures - both men and women have a phallus, e.g. a penis is a large, spongy clit and women have a “prostate” (Skene’s gland) that like in men produces ejaculate, etc.
So with surgery, my genitals were able to largely be corrected and the various structures were simply altered to be like they would have been (scrotum is a fused labia, and with surgery is fashioned into labia).
So even my genitals would be “female” to most people (not that most people would see my vulva anyway).
My breasts have developed naturally through hormones alone, and at this point I have no complaints about size, and they certainly are large enough that nobody questions that I’m a woman.
I’m beginning to lose sight of in what medical or biologically significant ways I’m not “female” at this point, even if there are still plenty of residual signs of my initial male puberty I’m very aware of, nobody else seems to notice them, and more importantly, my history as a “male” is no longer relevant to my physical health - the current evidence seems to support what I experience: my body is a female body.
This is not something I thought would ever happen, I didn’t think transition really makes you female or changes your sex, I always thought of it as more metaphorical or cosmetic. I underestimated the role hormones play in the body’s functioning and the way hormones seem to play a primary role in biological differences between men and women.
Oh I do have a question: how does it feel different to be a woman, if at all?
that’s a very complicated question with a very complicated answer, which makes it hard to answer
whatever answer I give will be misleading or insufficient, and that can be painful because it feels then like I’m causing harm (harm in the ways my answer might accidentally mislead other trans people who may be repressing or not aware they are trans, harm in the ways my answer might mislead cis people who don’t understand what it’s like to be trans, etc.).
You have to understand that because I’m trans, this has impacted my whole life, including my earliest experiences - I have really never known what it’s like to be a cis man or to be cis, etc. - but in another sense I obviously lived a life as a boy and a man, and a life as someone whose lived-gender matched their assigned sex - so I tend to think I lived “as a man”, and not just in social ways but also in the ways that testosterone can influence (e.g. I experienced the kind of urgent, visual, but superficial libido of a man, etc.). But it’s important to understand that along the way I felt off or weird about it all - even as a young child, I didn’t like changing in the locker room with the other boys, I didn’t like take off my shirt when I went swimming, and even when I was 5 years old I thought there was some cosmic mistake and I was supposed to be born a girl (I just didn’t know I actually was one already and needed to transition).
I’m also older, I grew up in an era where trans healthcare was not as accessible or common, and when the average person really didn’t know anything about trans people. The two main representations of trans people I had growing up were from Silence of the Lambs (the serial killer who killed women to make a suit so he could wear their skin to feel like a woman), and Ace Ventura (also a villain character who transitions from a man to live as a woman to evade the law; notably the scene when the villain is finally confronted and exposed, my family reacted to how extremely taboo that scene was by simply not allowing me to see it growing up - further confirming the stigma, wrongness, etc. of being trans).
I also grew up in a place and time when being gay was the same as being a pedophile.
So, I saw a lot of social change in my lifetime, and I didn’t have the tools to interpret my experience or to get the help I needed.
In some sense the answer to your question is that it feels no different at all - in many ways it feels completely the same. Even after bottom surgery my genitals it feels very same-y, to the point that this can be a point of distress because I have internalized and come to believe I’m male and a man, even believing that it’s manly or masculine to envy women or to want to be a woman. This is a twisted perspective caused by decades of repression and needing to cope and survive, and it feels like a life-long kind of mental wound that I am attempting just now to address and heal, and progress is slow.
But obviously things are very different, and there are plenty of ways it also feels different, in fact everything is different in a way. So it’s all the same and all different - that makes sense, right? 😄
When my body produced testosterone, I experienced what is called “anhedonia” but that’s just a fancy word that describes how it feels when you struggle to feel happiness or pleasure. A way this could look: I spent a lot of time and energy seeking pleasurable activities (things that made me feel happiness), and they had a muted effect in some ways. For example, a nice meal felt like survival to me - if I didn’t cook a delicious dinner every day, I would struggle to feel a will to live that was so bad I couldn’t get out of bed or get myself to engage in the necessary daily tasks I needed to get done. The pleasure from the meal was necessary, and for example if it was a stressful time and we decided to grab some frozen meals from the store or even something like a nice prepared meal from Trader Joe’s, those meals were not tasty enough or pleasurable enough, and I would experience worsening depression and would have to dig myself out of that hole in a sense. I didn’t know this wasn’t normal, it was just always what it felt like to be in my life. I was known for being grumpy, critical, and sharp. It’s maybe like living in pain all the time, I was really suffering but because it was normal to me, I didn’t realize I was even technically experiencing depression.
So, on estrogen, I just feel happy most of the time - my base level happiness is much greater, and I don’t rely on fancy meals to have a will to live or get out of bed. This can actually make life a little more boring in some ways because life is now pretty normal feeling, there isn’t the same extreme struggle that also led to me living in extreme ways (like, I admit my cooking was better before I started estrogen because the necessity to cook really great meals was much stronger).
Before on testosterone, I might go grocery shopping and not have the mental endurance to do much more than that once a week. On estrogen, I can go grocery shopping and then have social plans and do several busy things during the week and still feel fine. I might even be tired, busy, and running an errand and just feel happy in ways I never experienced before.
So being a woman feels like becoming a normal person, becoming a human being. Living as a man felt like living as a subhuman animal. As a woman I take care of my hair, my skin, my teeth, etc. like a normal person. Before transition, my hair knotted into neglect dreads and I washed it every day with hot water and bar soap and I shaved my head once or twice a year out of convenience (even though I hated it). I didn’t brush my teeth, I didn’t take care of body odor, I wore the same outfit every single day. I was really mentally ill, looking back - I couldn’t feel motivated by anything like self-care, it was just so entirely pointless and even immoral and wasteful in my mind. I judged other people for taking care of themselves, for the vanity and the waste of self-care.
So, it’s hard because I don’t think normal men live this way - I lived in extreme and awful ways before I transitioned, I was really a broken person who was hurting. Being a woman felt salvational to me, I thought anyone would want to be a woman and it’s just the obvious, rational, and moral choice if there was a choice. But I also believed that no-one can really become a woman (I even felt resentment against trans women for violating this, for pretending to be women, even as I strongly felt that trans rights were important and that trans people are valid - there was a part of me that needed to deny myself that path, and so being around trans people or exposed to media with trans people was simultaneously alluring and disturbing to me - so much cognitive dissonance arose, but I was also inexplicably drawn to trans women like a moth to a flame).
So yeah, it feels very different even if I’m still just “me” and I also feel like I’m the same. Hopefully that makes more sense now, but feel free to ask any follow-up questions or ways in which you are wondering how it feels different. Phenomenology can be hard to describe - but I would say some things really do feel different while other things really do feel the same. I think most people just feel the same before vs after, tbh - so that’s the most common answer you’ll probably find.
I think the emerging evidence is that HRT changes your sex, though - biological sex seems to be much more plastic than people realized
there was that recent study that found within 12 months on HRT, heart mass changed and matched the trans person’s gender:
https://www.medicalrepublic.com.au/gender-affirming-hormone-therapy-changes-the-heart/120596
and on the molecular level, estrogen changes the protein biomarkers:
https://www.nature.com/articles/s41591-025-04023-9
https://www.erininthemorning.com/p/study-finds-trans-womens-blood-proteins
so yeah, you don’t change your gender identity with hormones - but you definitely are changing the way your body functions and changing your biological sex (in most health-relevant ways, e.g. heart and stroke risks, drug metabolism, etc.), and so increasingly I’ve come to think trans women on estrogen are biologically female, and that’s probably true in multiple ways (if they weren’t in some way biologically female they wouldn’t have needed estrogen).
Since it seems like a gender identity in a body with the wrong hormones seems to make a lot of people suicidal, depressed, and anxious - having the right hormones seems to fix that (go figure! lol)
This honestly makes me so happy. Back before I cracked my egg and started learning about what hormonal transition really meant I thought that transitioning was purely cosmetic, like all the passing trans women just got really lucky with their body shape and put in a ton of work with cosmetic surgeries, makeup, hair removal, wearing clothes that made them look more feminine, etc. I thought they were still biologically men and nothing could change that, which looking back made me really sad and held me back from coming out to myself. After all, if there’s no hope of really being a woman what was the point? I’m so glad I got past that because learning how much changes with HRT is fucking awesome. I actually, biologically, get to be a woman, even if I never really pass to some people. I couldn’t be happier lol.
That is very mind-blowing. Is it like 100% conversion, or is there something left behind? Is it a morphology issue? Like, because they formed a bit the other way after leaving the womb, or would they turn out 100% the other gender if it was done early?
You can actually ask former member of the other gender what their lives are like, it’s mind-blowing @_@
I’m not sure what you mean by “100% conversion”, but no - there are developmental pathways that are irreversible, e.g. the fetal development of the genitals are not going to change by taking hormones later, and many changes during puberty are irreversible (like changes to the skeleton - length of bones, changes to the skull, angle of the hips, etc.).
In trans women, undergoing male puberty causes irreversible changes to the thickness of the vocal folds, and estrogen does not change or fix the voice (but for trans men, starting testosterone will cause the vocal folds to thicken, permanently masculinizing the voice).
Preventing the wrong puberty helps avoid a lot of distress for trans people, which is why it is so important those interventions are available to trans youth. It is no different than if a cis person were administered the wrong hormones and forced to live as the wrong gender - it causes distress and significantly increases likelihood of suicide.
But even for those who avoid the wrong puberty, there are sex differences that developed as a fetus that would require surgery to fix.
EDIT: in case it’s not clear, there is a huge variety in the ways bodies develop even just when looking at non-trans people, and so even though my body underwent male puberty and that resulted in permanent changes to my rib cages, skull, hip width, etc. - my body still more or less overlaps with other female bodies enough that nobody can really tell the difference.
Male and female genitals are actually homologous meaning they have the same structures - both men and women have a phallus, e.g. a penis is a large, spongy clit and women have a “prostate” (Skene’s gland) that like in men produces ejaculate, etc.
So with surgery, my genitals were able to largely be corrected and the various structures were simply altered to be like they would have been (scrotum is a fused labia, and with surgery is fashioned into labia).
So even my genitals would be “female” to most people (not that most people would see my vulva anyway).
My breasts have developed naturally through hormones alone, and at this point I have no complaints about size, and they certainly are large enough that nobody questions that I’m a woman.
I’m beginning to lose sight of in what medical or biologically significant ways I’m not “female” at this point, even if there are still plenty of residual signs of my initial male puberty I’m very aware of, nobody else seems to notice them, and more importantly, my history as a “male” is no longer relevant to my physical health - the current evidence seems to support what I experience: my body is a female body.
This is not something I thought would ever happen, I didn’t think transition really makes you female or changes your sex, I always thought of it as more metaphorical or cosmetic. I underestimated the role hormones play in the body’s functioning and the way hormones seem to play a primary role in biological differences between men and women.
Happy it worked out well for you! (and unhappy I can’t write a whole article to match yours).
EDIT: Oh I do have a question: how does it feel different to be a woman, if at all?
that’s a very complicated question with a very complicated answer, which makes it hard to answer
whatever answer I give will be misleading or insufficient, and that can be painful because it feels then like I’m causing harm (harm in the ways my answer might accidentally mislead other trans people who may be repressing or not aware they are trans, harm in the ways my answer might mislead cis people who don’t understand what it’s like to be trans, etc.).
You have to understand that because I’m trans, this has impacted my whole life, including my earliest experiences - I have really never known what it’s like to be a cis man or to be cis, etc. - but in another sense I obviously lived a life as a boy and a man, and a life as someone whose lived-gender matched their assigned sex - so I tend to think I lived “as a man”, and not just in social ways but also in the ways that testosterone can influence (e.g. I experienced the kind of urgent, visual, but superficial libido of a man, etc.). But it’s important to understand that along the way I felt off or weird about it all - even as a young child, I didn’t like changing in the locker room with the other boys, I didn’t like take off my shirt when I went swimming, and even when I was 5 years old I thought there was some cosmic mistake and I was supposed to be born a girl (I just didn’t know I actually was one already and needed to transition).
I’m also older, I grew up in an era where trans healthcare was not as accessible or common, and when the average person really didn’t know anything about trans people. The two main representations of trans people I had growing up were from Silence of the Lambs (the serial killer who killed women to make a suit so he could wear their skin to feel like a woman), and Ace Ventura (also a villain character who transitions from a man to live as a woman to evade the law; notably the scene when the villain is finally confronted and exposed, my family reacted to how extremely taboo that scene was by simply not allowing me to see it growing up - further confirming the stigma, wrongness, etc. of being trans).
I also grew up in a place and time when being gay was the same as being a pedophile.
So, I saw a lot of social change in my lifetime, and I didn’t have the tools to interpret my experience or to get the help I needed.
In some sense the answer to your question is that it feels no different at all - in many ways it feels completely the same. Even after bottom surgery my genitals it feels very same-y, to the point that this can be a point of distress because I have internalized and come to believe I’m male and a man, even believing that it’s manly or masculine to envy women or to want to be a woman. This is a twisted perspective caused by decades of repression and needing to cope and survive, and it feels like a life-long kind of mental wound that I am attempting just now to address and heal, and progress is slow.
But obviously things are very different, and there are plenty of ways it also feels different, in fact everything is different in a way. So it’s all the same and all different - that makes sense, right? 😄
When my body produced testosterone, I experienced what is called “anhedonia” but that’s just a fancy word that describes how it feels when you struggle to feel happiness or pleasure. A way this could look: I spent a lot of time and energy seeking pleasurable activities (things that made me feel happiness), and they had a muted effect in some ways. For example, a nice meal felt like survival to me - if I didn’t cook a delicious dinner every day, I would struggle to feel a will to live that was so bad I couldn’t get out of bed or get myself to engage in the necessary daily tasks I needed to get done. The pleasure from the meal was necessary, and for example if it was a stressful time and we decided to grab some frozen meals from the store or even something like a nice prepared meal from Trader Joe’s, those meals were not tasty enough or pleasurable enough, and I would experience worsening depression and would have to dig myself out of that hole in a sense. I didn’t know this wasn’t normal, it was just always what it felt like to be in my life. I was known for being grumpy, critical, and sharp. It’s maybe like living in pain all the time, I was really suffering but because it was normal to me, I didn’t realize I was even technically experiencing depression.
So, on estrogen, I just feel happy most of the time - my base level happiness is much greater, and I don’t rely on fancy meals to have a will to live or get out of bed. This can actually make life a little more boring in some ways because life is now pretty normal feeling, there isn’t the same extreme struggle that also led to me living in extreme ways (like, I admit my cooking was better before I started estrogen because the necessity to cook really great meals was much stronger).
Before on testosterone, I might go grocery shopping and not have the mental endurance to do much more than that once a week. On estrogen, I can go grocery shopping and then have social plans and do several busy things during the week and still feel fine. I might even be tired, busy, and running an errand and just feel happy in ways I never experienced before.
So being a woman feels like becoming a normal person, becoming a human being. Living as a man felt like living as a subhuman animal. As a woman I take care of my hair, my skin, my teeth, etc. like a normal person. Before transition, my hair knotted into neglect dreads and I washed it every day with hot water and bar soap and I shaved my head once or twice a year out of convenience (even though I hated it). I didn’t brush my teeth, I didn’t take care of body odor, I wore the same outfit every single day. I was really mentally ill, looking back - I couldn’t feel motivated by anything like self-care, it was just so entirely pointless and even immoral and wasteful in my mind. I judged other people for taking care of themselves, for the vanity and the waste of self-care.
So, it’s hard because I don’t think normal men live this way - I lived in extreme and awful ways before I transitioned, I was really a broken person who was hurting. Being a woman felt salvational to me, I thought anyone would want to be a woman and it’s just the obvious, rational, and moral choice if there was a choice. But I also believed that no-one can really become a woman (I even felt resentment against trans women for violating this, for pretending to be women, even as I strongly felt that trans rights were important and that trans people are valid - there was a part of me that needed to deny myself that path, and so being around trans people or exposed to media with trans people was simultaneously alluring and disturbing to me - so much cognitive dissonance arose, but I was also inexplicably drawn to trans women like a moth to a flame).
So yeah, it feels very different even if I’m still just “me” and I also feel like I’m the same. Hopefully that makes more sense now, but feel free to ask any follow-up questions or ways in which you are wondering how it feels different. Phenomenology can be hard to describe - but I would say some things really do feel different while other things really do feel the same. I think most people just feel the same before vs after, tbh - so that’s the most common answer you’ll probably find.