How HRT Can Affect Sleep and What to do About It.

How HRT Can Affect Sleep and What to do About It.

How HRT Can Affect Sleep and What to do About It.

A representative from the Mattress Nerd company (Mattress Nerd) contacted us to offer their resource information on the link between HRT and sleep problems (Mattress Nerd Sleep and HRT) along with some potential simple remedies. We summarized this article below along with a bit of wisdom from the transgender community.

Just a reminder to contact your health care provider if you are having ongoing problems with sleep that are not addressed by simple solutions, relaxation techniques or meditation.

Undergoing hormone replacement therapy (HRT) means making a lot of physical and emotional changes, and those changes can lead to sleep issues you may not have had before. In this section, we will go through all of the physical and potentially emotional changes associated with estrogen and testosterone therapy and explain how these changes could lead to increased sleep problems.

Testosterone Hormone Therapy

Physical Effects 

Increased Sweating:
A common effect of testosterone therapy is increased sweating, which could interfere with your sleep at first. Thankfully, there are several simple ways to cope with this change. Try using lower thread-count sheets that are more breathable or lowering your thermostat a few degrees before going to bed and that should help.

Painful Acne:
Acne is another side effect of increased testosterone. Typically, acne doesn’t disrupt sleep, but if you develop painful cyst-like acne, certain sleeping positions might become uncomfortable.

Acne generally improves after a year of testosterone therapy, but if you need faster solutions, you can talk to your doctor about acne medications that won’t interfere with your hormone therapy. If you’re comfortable, you can also discuss lowering your testosterone dosage to an amount that will still be effective in your transition, but won’t cause so much skin trouble.

Throat Pain as Voice Drops:
Testosterone therapy causes the vocal cords to thicken and the voice to drop, and in the process, your throat might feel scratchy or sore. Pain typically makes sleep more difficult, so this could impact your sleep in the beginning, but this stage passes relatively quickly.  In the meantime common pain relievers or hot beverages with honey which stage performers use to lubricate their throats.

Weight Gain or Loss:
After a few weeks on testosterone therapy, you may start to notice your muscle mass increasing, especially if you work out. This could lead to weight gain or weight loss, depending on your lifestyle and genetics, and you may find that your mattress is no longer as comfortable as it was at your previous weight. It might be a good idea to get a new mattress that will be comfortable and supportive at any weight. 

Obstructive Sleep Apnea:
So far, we’ve been talking about how physical changes caused by testosterone therapy can have a tangential effect on sleep. But recent research suggests that testosterone therapy in transgender men is directly related to an increased chance of obstructive sleep apnea (OSA).

OSA is a sleep disorder where the sleeper periodically stops breathing throughout the night because of a minor collapse of the airway. This can cause poor sleep quality and if it gets too severe, can be dangerous for your health. If you tend to wake up feeling tired or if your partner notices that you stop breathing in your sleep, you should talk to your doctor.

Emotional Effects 

Mood Changes:
When you first start testosterone therapy, you may notice that you have more mood swings than you used to. This is to be expected as your body adjusts to differing amounts of hormones.

After the initial mood swings, you may notice you are less emotional than you used to be, feel your emotions differently or interact with others in a different way. Some studies have found that after several months of testosterone therapy, transgender men notice feeling more anger, but they also report feeling more in control of their anger than before transition.


Estrogen Hormone Therapy

Physical Effects

 Changes to Skin/Skin Sensitivity:
As your body adjusts to increased estrogen, your skin may start to feel more sensitive. For some people this is a minor annoyance, but for others it is a difficult adjustment. Increased sensitivity may make it more difficult to fall asleep, especially if you find that your sheets feel rougher than usual. Choosing softer fabrics may help alleviate this concern.

Painful/Uncomfortable Breast Tissue on the Chest:
Developing new breast tissue can be painful, especially if you’re used to sleeping on your stomach. Pain and sleep usually don’t play well together. Being in pain can make it much harder to fall asleep and stay asleep, and trying to adjust your sleeping position to reduce the pain can keep you awake as well.

More Prone to Bruises and Cuts:
When your body is still adjusting to increased amounts of estrogen, it may bruise and cut more easily. These minor injuries could keep you up more at night because of the discomfort.

Weight Gain or Loss:
Many people who start estrogen therapy experience a loss of muscle mass and a redistribution of weight throughout the body. Some people may lose weight while others may gain weight, but either way, your weight will probably fluctuate in some way. This could make your mattress a lot less comfortable. We recommend looking at a new pillow top mattress that will provide comfort and support regardless of weight.

High blood pressure:
One of the risks associated with estrogen hormone therapy is high blood pressure. Although this isn’t a desired result, it can happen, and some studies have found a link between high blood pressure and poor sleep. Researchers aren’t sure whether one causes the other, or if another factor is at play, but there is a chance that high blood pressure could make it more difficult for you to sleep.


Emotional Effects

Mood changes:

Everyone reacts to hormone therapy differently. Some people notice that for a while after starting estrogen therapy, they are more emotional, they experience new emotions, or they find themselves relating to others differently than they used to.

As we said before, undergoing hormone replacement therapy is a lot like experiencing a second puberty and it may come with some uncomfortable mood swings. The severity of the swings should settle down after a while, but at first, it may be overwhelming and could disrupt your sleep.

Sleep Tips and Treatment Options

Poor sleep can lead to poor overall health, and it can definitely add to the stress of your transition process. But if you’re having sleep issues because of HRT, there are plenty of solutions that can help you sleep easier and better.

Here are a few relaxation techniques, sleep hygiene changes and natural sleep aids that might work for you.

Relaxation Techniques:

One of the biggest reasons people have trouble sleeping is because they get stressed about the fact that they’re having trouble sleeping. When we don’t fall asleep right away, we start watching the clock, counting down the minutes until our alarm goes off and we have to face the day, exhausted. This stress only makes it harder to fall asleep, but you can combat this stress with relaxation techniques.

If you consistently have trouble falling or staying asleep, you might want to try a relaxation technique that can help you long-term, like acupuncture or yoga. If you’re just looking for something to relax you in case you start to get stressed at night, then breathing exercises and meditation could be very helpful.

  • Acupuncture/Acupressure
    • Acupuncture and acupressure are both treatments from Traditional Chinese Medicine (TCM). They involve stimulating points on the body, called acupoints, with either needles (acupuncture) or pressure (acupressure). This stimulation helps energy flow through the body, releasing tension and promoting relaxation. Studies show that it really can help reduce insomnia and relieve stress over time.
  • Breathing exercises
    • If you’re looking for a relaxation technique you can use without an appointment, then breathing exercises may be more useful to you than acupuncture. You can practice breathing exercises anywhere, even in bed at 3am if you’re struggling to fall asleep. research shows that deep breathing exercises can stimulate the part of the nervous system that calms us down, called the parasympathetic nervous system. This helps reduce our heart rate, slow our breathing and put our bodies in a better state for sleep.
  • Meditation
    • Meditation is another great relaxation technique you can do any time, any place, and studies show that it can significantly reduce stress. Meditation is all about bringing your awareness to the present moment, grounding yourself and allowing your thoughts and feelings to flow around you without getting swept up in them. This awareness to the present moment helps reduce stress because it keeps us from reliving the past or worrying about the future. Instead, we breathe through the now and trust that is enough.
  • Yoga
    • Yoga is sort of a combination of meditation, breathing exercise and regular exercise. Something about the combo must work, because literature reviews of the various studies done on yoga have found that yoga can both reduce stress and promote better sleep. It’s more effective to practice yoga regularly rather than only doing yoga when you already feel stressed out, but even occasional yoga sessions can do your mind some good. There are plenty of good yoga apps out there, and there are even some YouTube videos on yoga you can do while still in bed.
  • Sleep Hygiene and Routine:
    • Another way to improve your sleep is to work on your sleep hygiene. Sleep hygiene is all about setting up your habits and environment to help you get the best sleep you can. Here are a few sleep hygiene tips that have been proven to help you sleep faster, easier or better.
  • Come up with a soothing bedtime routine.
    • One of the best ways you can help yourself get a good night’s rest is by putting yourself in the right mindset for sleep. Take time at the end of your day to do something relaxing that will signal to your brain that it’s time to shut down for a while. The National Institutes of Health recommends taking a hot bath, listening to relaxing music and keeping your bedroom cool.
  • Avoid screens for at least half an hour before bed.
    • We know it’s tempting to lie in bed for an hour or two, scrolling through your phone or reading something on your e-reader, but it’s just not good for your sleep hygiene. According to Harvard, screens emit blue light, which can delay melatonin production, the hormone that causes us to feel sleepy. The longer we expose ourselves to blue light, the longer we delay melatonin and the harder we make it for ourselves to fall asleep.
  • Keep your sleep schedule consistent.
    • Going to bed around the same time each night and waking up around the same time each day, even on the weekends, is a great way to get better sleep. Our bodies run on circadian rhythms, which are basically our internal clocks, and when we change up our sleep schedule every five days, our circadian rhythms get thrown out of whack. Studies show that a consistent sleep schedule trains our brain to fall asleep around the same time each night, significantly reducing the time it takes to fall asleep.


Natural Sleep Aids:

If lifestyle changes aren’t helping you get the rest you need, then it may be time to try sleep aids.

Many prescription sleep aids run the risk of dependence, so before you get a prescription, you should talk to your doctor about natural sleep aids. There are a variety of safe, effective options out there, but you should always check with your doctor first to make sure they’re safe for you.

Below, we’ve outlined some of the most popular natural sleep aid options.

  • Melatonin
    • Melatonin is a hormone that our body naturally produces that makes us feel sleepy. Typically, melatonin production starts when it gets dark, but thanks to our modern, well-lit lifestyle, this means we don’t even start producing our sleepy hormone until we’re already in bed. Since melatonin takes a while to take effect, this can lead to tossing and turning. Instead, try taking a melatonin supplement an hour or so before bed. The National Center for Complementary and Integrative Health says that melatonin can help people fall asleep faster and sleep more soundly in some situations. If your doctor thinks it could work for you, melatonin canb be a great natural sleep aid.
  • Camomille
    • Camomile is a daisy-like plant that has been used to brew bedtime tea for centuries. Today, you can drink it as tea or take it as an oral supplement for better sleep.  Research suggests that camomile works by breaking down gamma-aminobutyric acid (GABA), which is a neurotransmitter that promotes feelings of calmness. However, if you are undergoing testosterone therapy, camomile may not be right for you. According to Penn State Medical Center, camomile can act like estrogen, which could cause issues with your transition. Talk to your doctor before using camomile for sleep.

Final Thoughts

More research needs to be done on how HRT affects sleep for transgender people, but for now it’s safe to say that the physical and emotional changes caused by HRT could cause some frustrating sleep problems.

It’s important to remember that HRT is different for everyone, and even if you run into unexpected troubles, there are solutions that can help. A good doctor can make all the difference in navigating these issues as they come up, but we know not everyone is that lucky.

If you’re struggling with your transition, please reach out to the Trans Lifeline online or call at 877-565-8860.