Thinking more clearly on HRT? You’re not imagining it

One commonly reported experience on trans support forums like Reddit’s AskTransgender is difficulty with focusing and concentration, with symptoms that are often described as a kind of cognitive fog or “brain fog”. Notably, many trans people have reported that these symptoms begin to abate after starting hormone therapy, and that they are able to think more clearly and focus more easily:

“…it felt like I took something like NyQuil, thoughts were slow to form, sometimes leaving during the middle of a sentence. Often times I’d wait for someone to finish their sentence, and forget a question I had been trying to memorize the whole time they were talking. Once I started hormones, I actually had hope for a future where I could be myself. I became more active, and my brain stopped losing focus all the time.” (1)

“You can’t fully think clearly, thoughts and feelings seem hazy and far away and difficult to grasp or define, trying to form a complete, concise train if thought can be harder than for most people because it literally feels like your thoughts are slipping through your fingers…” (2)

“…when I started hormones, it was like I had been walking around in a fog bank for over a decade (since puberty), and had completely forgotten there was such a thing as a place without fog. Starting hormones was like cresting a hill, and seeing the sun for the first time in a very, very long time… and it being so much clearer where I had been, and where I needed to go. Having the correct hormones does very good things for your cognitive functions.” (3)

“The mental fog I use to feel on my brain has vanished and I can think/write much more clearly and not feel as restricted or like something was missing like before.” (4)

“It’s like a fog’s been lifted and I can take in the world and my own thoughts more clearly.” (5)

“It felt like I was never clear headed, even after a good night’s sleep. The mental fog kind of felt like a very low grade headache from lack of sleep although it wasn’t quite the same feeling for me. I had trouble concentrating too. It felt like something was holding my mind back. After around a week of HRT, I noticed that my head and thoughts were incredibly clear, even when I only got 5 hours of sleep a night … My job requires a lot of thinking. My mind felt sharp like never before.” (6)

These experiences might be relegated to the realm of community lore: common and shared experiences reported by individual trans people, which have not yet been the subject of empirical study and confirmation. But what we do know about the psychiatric benefits of HRT, as well as the potential cognitive impact of conditions frequently comorbid with untreated gender dysphoria, provides several clues as to why many trans people experience cognitive difficulties which resolve during medical transition. ■