A bit late to the party but I wanted to add my experience to the pool: I also felt pretty tired at the start of HRT. For me, it started after 2-3 months and stopped at the 6 month mark, I think. During that period, I regularly had problems staying awake during afternoon lectures in uni, something I never had problems with before. I considered that my T was too low during that time but as the fatigue went away after a bit, I never changed anything about my medication. I think overall my energy levels now still might be a bit lower than before medical transition but I blame that on puberty and minority stress. And it’s not too much, maybe 10%.

More coffee helped. :)

I started HRT 11 months ago, and I have now been tired for 10 months. Around month 9 I stopped making a lot of plans I would have made otherwise. I don’t go out nearly as much now, because I don’t want to risk going to all the effort of going out just to find that I’m too tired to stand.

I have hope that things will turn around, but I’ve spent a lot of time this year searching for reassurance that others struggle with this past the initial few months. There are a lot of people who quickly got over their fatigue, and report feeling “more energetic than ever before” on E, which I found disheartening as that has not been my experience at all.

Here is my analysis of my energy troughs this year.

2 – 3 months: Initial reduction in testosterone after starting estrogen. It wasn’t a smooth start either. I was using patches at the time. Convinced that my dose was insufficient on the basis of some pretty bullshit reasoning, I self prescribed a second patch. To give me energy! Then I went a little crazy, and decided that the remedy was more estrogen, so I slapped on a third patch. I was basically incapable of sleeping for longer than an hour towards the end of this period, which can be expected of a person with very high estrogen. My endocrinologist eventually saw my insanely high E, I came clean, she told me off, and now I’m a good girl who follows her medical practitioners’ advice to the letter.

5 – 6 months: With the addition of cyproterone, my testosterone nosedived. I believe cyproterone on its own, anti–androgenic effects aside, is kind of a lot for the body to adjust to as well. I was getting up at 7 and going back to bed at 11 some days.

9 – 10 months: Cyproterone stopped working, as cyproterone has been known to do, and I had to increase my dose. So basically my T rose to somewhere between female and male range, then nosedived again. A few weeks later, I was going through the same adjustment as last time, but moreso. This was the point at which I started telling people that I’m staying home for all but the most important events.

11 months: Cyproterone is out because I was getting so upset by the fatigue. Started on progesterone instead and discovered that I am not one of the people who feels happier, less anxious and more rested after sleeping. Nope, I’m an anxious, depressed megabitch on progesterone. My dreams are terrifying, I wake up crying all the time, every sound puts me on edge, and I also weirdly feel emotionally numbed like I did on SSRIs. So we’ll see where this goes, but I feel like I’ve leapt backwards in my transition with this decision, and I am still SO TIRED!

As a bonus, I was diagnosed with POTS recently, which I know I’ve had since my teens, but which only became a problem in need of a solution in the absence of testosterone. This also impacts my sleep and energy.

One positive thing I take away from this is that I must really want this. 'Cause things really suck right now, but never have I ever considered slowing or pausing my transition. A year ago I was all “but what if I’m not really trans”, and now I think I’d sooner get a mobility scooter than stop HRT.

I hope things will be different for you, but I don’t want you to be discouraged if they aren’t, and I don’t want you to feel like something is wrong with you if things still suck 11 months in.

Well I think that’s part of your body doing the remodeling. Idk how much was HRT or getting older but I do have less energy than I used to.

About 6 weeks is about right. Your body is using energy to change. During the first 2-3 years I’d get really tired, then really hungry, then my tits would get really sore after a few days of it.

Early on it’s all the time, then it moves to the bursts I described, then it just slowly fades to happening maybe once a year in mild form.

To add to the other comments, what you’re describing is a symptom of reduced testosterone levels. As others have pointed out, It will take you some time to adjust, but it’s also possible that your T levels are simply too low. This is especially likely if you’re on a blocker like cypro.

Which is to say, if things don’t sort out, you should look at getting your bloods done so you can see what your T levels are, and adjust your blocker accordingly.

I started HRT in my early twenties and literally slept through my alarm for the first time in my life! If it lasts more than a few months I’d talk to the doctor about it, but your body is going through a lot of changes so it’s naturally going to be tiring.

Are you noticing significant changes from the HRT?

To be clear, I’m no expert in this area, but it seems to me that if your body is changing then the fatigue might be just due to that, but if you’re not noticing a lot of changes it’s probably something else.

Like, maybe your HRT meds are not dosed properly and your hormone levels are unhealthy. It’s probably worth having your hormone levels checked if you can, either way, to see if that’s the issue.

I think you might have it somewhat backwards at the very end there. I also felt tired early on, more drowsy and sleeping longer and stuff. I think for me a big part of it was Spiro.

But the noticeable sleepiness went away after a few months for me. Like idk if I just on the whole adjusted to feeling that way, or my brain chemistry acclimated to the new hormones. But either way I think it does go away for some people eventually, and I think its very pronounced early on.