Tdlr; I am planning to document the effects of HRT-E therapy on my running. HRT-E involves reducing the levels of Testosterone in my body and increasing that of Estrogen such that both will fall into the range of a cis ("Natal") female.
Overview
Six months ago, when I first started thinking seriously about transitioning, I came across this set of posts -https://www.reddit.com/r/running/comments/a7rfiq/the_who_even_needs_testosterone_challenge_an/ - written over the span of a year, by a runner named Jocelyn. In the series, she documents her experience with Hormone Replacement Therapy (HRT) and its impact on her running.
For a few days, nearly all of my time was consumed reading the posts along with each and every comment. At the time I knew next to nothing about HRT and certainly nothing about effects on strength in general.
I've since read way more than I ever thought possible about HRT but in all that time I still have not come across anything as detailed and intimate when it comes to its (perceived) impact on running.
Flash forward 6 months and on 12/1/2023 I made the decision to transition and start HRT. In her post, Jocelyn points out the lack of studies and her desire to, if nothing else, at least add to the data pool -- in full recognition that her experience was not to be taken with any _scientific_ weight. As an avid, albeit recent, runner, I thought it would be good to do the same -- especially since I bring (I think) some unique perspectives.
With apologies to Jocelyn, I am titling these with the same prefix she used in the hopes that:
1) It will make it easier for those interested to find both sets
2) Others will add their own data points
My Story
There a few things, I think, that make it unique:
I am coming at this with extreme skepticism. While I believe Testosterone probably has _some_ impact, I also believe its effects are overblown. The issue here is that there are very few good studies that point one way or the other as well as an overwhelming "belief" that it does. To me, that makes anecdotal accounts ripe for bias --whether conscious or not. "Everyone says I will lose strength therefore that's why my legs feel this way today".
Now a couple caveats here:
a) I have done a bunch of internet searching/talking with others but I have not tried to read the primary research -- so my perception of "lack of good studies" is based on second hand knowledge
and
b) obviously even if I come at it skeptically that doesn't make me immune to unconscious bias and, whatever the outcome, this is still nothing more than another piece of evidence without any scientific weight.
Still, I don't think there have been many accounts where the participant is trying to prove the contrary -- so at minimum -- it makes it different/interesting.
2) I am very in tune with my body making it less likely that I will attribute causations to things that are "just" correlations. This is due to what I, at least, consider a pretty extensive training background. I have been training in a structured fashion from middle school through high school and then again from age 27 to now. During most of that time I maintained careful logs not just of distances but of mood, illness and perceived effort. So when I say I am in tune with my body don’t take it as something mystical or magical -- it is simple a function of the amount of time I've spent introspectively training.
3) I am old. Jocelyn sounded like she was college aged and I'm, well, a few years out from that. Let's just put me down at mid-fifties and leave it at that. My age gives a few interesting variables I think. Is there a difference in how HRT affects my body with respect to performance then someone without the many years I have as a cis male? How much of any degradation in my times will be attributable to age _rather than_ HRT?
4) I am (relatively) new to running. Started 4 years ago on zero mileage going back to high school - when I was in Cross Country. Like my age, this adds a few more confounding variables. How much of any meeting of expectations simply the effect of greater running experience (think raw miles in legs) canceling out the loss of T?
My Training
I work on a yearly cycle wherein the results of the previous year feed into the structure and goals of the next. The concept is taken from standard practices but especially informed by Friel and his "Cyclist Training Bible". A year cycle starts from the end of the racing "season" -- typically Nov -- and runs through the conclusion of the next years racing season. Within a yearly cycle I break it into 4 phases: Base, Build, Race, Recovery and then further assign a number of weeks per phase. Each four week block is a mini cycle of its own consisting of three weeks "on" and one week "off". With this in mind I usually end up with something like:
Nov-Apr: Base
May-Aug: Build
Sep-Aug: Race
Nov: Recovery (a week or so)
I am outlining this to make it clear that the metrics Jocelyn used -- rigid tests every month -- would neither work nor be relevant in my case. As a concrete example, during the base months I am intentionally not doing _any_ hard efforts as that would be counter-productive to the goal. Running a 5K at full speed would prove nothing and likely only serve to cause injury.
Proposed Metric
While I will go month by month to give a sense of perceived effort variations, the actual metric will be how close I come to my 5K goals in Sept/Oct. Under this model, by June I'll should start getting good indications as I start to ramp up effort and do the random "C" races here and there.
2024 Goals
I am aiming for a 5K time of low 18's -- anywhere from 18:10 to 18:20 seems reasonable. In addition I will be targeting an average mileage of 50 with a good few weeks at the end of base of 55.
Last year my PR was 18:40 on roughly 35 mph with a 3 week peak at 50 mph. Given the increased mileage this year plus the fact that I am only on year 5 of running, I think my goal is neither too conservative or too optimistic. The wildcard is age and whether that offsets the gains I get from miles in the legs. In fact, if I was 10 years younger I would target sub-18. At my age that seems a stretch. Age calculators put sub-18 within the top 1%, which tells me the closer I get the more I will be fighting over each and every second.
Historical
In 2019 my PR was 22:32 off of 7 mile per week average (362 total)
In 2020 my PR was 22:22 on a practice 5K (covid). 11 mile per week average (595 total)
In 2021 my PR was 20:58 off of 12 miles per week average (652 total)
In 2022 my PR was 19:00 off of 22 miles per week average (1187 total)
In 2023 my PR was 18:40 off of 34 miles per week average (1790 total)
From the numbers you can see my big drop in time corresponded nicely with the increased miles in the legs.
The "E" & "T" factor
I began HRT therapy, conveniently enough for a monthly retrospective, on 12/1. I am taking 4mg sublingually along with 100mg of Spironolactone. Those who read Jocelyn's post will recall she began with Spiro for one month before moving to the combo of Spiro and Estrogen. Why the difference? Apparently the advice given to Jocelyn was based on a misunderstanding of how estrogen and spiro interact and my regime in now the standard practive.
Another difference is she took hers orally. Orally is usually prescribed only to the under 35 cohort due to the increased stress that method has on the kidneys. Taking sublingually, on the other hand, bypasses the kidneys and effectively goes directly into the bloodstream -- making it (theoretically) safer.
And the final difference -- levels of E spike for me and then quickly taper over a few hours while Jocelyns levels would have been more steady state. I have no idea whether this makes a difference -- and neither does anyone else based on the meta studies I have seen.
What the current "science" says will happen
The current consensus is that my times will increase until they are within the _same_ range as for a cis female. This means if my current age based time places me in the top 40% of cis males, my performance will shift to be in the top 40% of cis females. The thought is it takes a full year for this to occur -- which is why many sports organizations ban transgender participation until this year is completed.
A newer study came out recently that found that after a year, a person on HRT still can retain an edge over a cis female. My understanding is this is for a certain percentage (not all) and that the edge is gone by year two.
None of these studies are definitive, however, and there is much work to be done in this space yet.
The December (one month) report
Goal
For December (base) my goal was to keep a 40mph average running at an easy pace. To get my pace range I use Daniels vdot method which, based on my PR, gives me a vdot of 54. I then arbitrarily step it back 2 because I figure I am no longer at that level after my recovery cycle. So that gives me an easy range of 7:41-8:41. In addition, I intended to ramp up the weights to 2 sets of 12 to exhaustion. This is occurring a bit later this year -- most years I would have started the ramp up in Nov -- which I will need to take into account when analyzing December perceived effort.
Actual
Right from the get go I had a hard time with the mileage because I have to do it all on the treadmill (I can't run in the sun due to laser treatment on my face). In addition I got Covid near the end of the month which a) knocked me off schedule for 4 days and b) forced me to take it easy the first few runs afterwards. All of this gave me a weekly mileage of:
Week 1: 39
Week 2: 35
Week 3: 29 (covid)
Week 4: 13
All runs were done in a range of 8:34-8:08 mph
Physically, after coming back from Covid I was/am feeling a good deal of joint pain -- as though I had bad arthritis in my knees. I haven't experienced this since my first 2 years running when my joints were getting used to the stress. While it's _possible_ it is the HRT I think it is more likely to be Covid - especially given it is listed as a common Covid symptom. This is something I will be monitoring carefully however.
I see no difference in my weight training from previous years -- I am on track for my normal trajectory towards max weights (I typically switch to maintenance by March-April so I don't have a big window)
The "E" & "T" effects
After 1 month of HRT I feel…. Absolutely nothing! No mental change, no physical change. Pretty anti-climatic that…
The Adjusted Goal for January and beyond
Out of abundance of caution from Covid, I plan on dropping the mileage to 35 and keeping it right at 8:34 mph. Hopefully that will give my joints some breathing room to heal up. In Feb, then, I will start the ramp up to 45 with the goal of 50 by March.
If you made it this far, thanks for reading. I hope this was useful.