Carb cravings on HRT: what testosterone actually does to appetite

What did @skeletonkie actually say?

One week into hormone replacement therapy, @skeletonkie reported three things: persistent fatigue, a quieting of what they called "the overwhelming bit of despair in the back of my mind," and a shift in how they perceive their own face, which they explicitly credited to psychological change rather than any physical one. They were upfront: "it's gotta be placebo." That's a remarkably self-aware disclaimer for a TikTok video, and it sets a better epistemic baseline than most week-one HRT content you'll find on this app. They also mentioned carb cravings in the caption, though not in the spoken content itself.

No dosing information was shared. No product was promoted. No medical claims were made beyond personal observation. The creator is describing subjective experience, not prescribing a protocol, which matters for how we evaluate what follows.

Does the science back this up?

Partially, and more than you might expect for just one week. The fatigue report is the most scientifically credible early side effect. The mood shift is plausible but harder to pin down this early. The perceptual change in facial self-image is genuinely interesting and has psychological research behind it.

On fatigue: testosterone and estrogen both influence sleep architecture and energy regulation. A 2019 paper by Irwig in Endocrinology and Metabolism Clinics of North America noted that fatigue is among the most commonly reported early side effects in gender-affirming hormone therapy, likely tied to the body adjusting to new hormonal signaling before levels stabilize.

On mood: a 2020 study by Nguyen et al. in JAMA Psychiatry found significant reductions in depression and anxiety symptoms in transgender individuals after just 3 months of gender-affirming HRT. One week is early, but baseline psychological relief from simply starting treatment, sometimes called the "relief effect," is documented. It doesn't require measurable hormone changes to be real.

On self-perception: a 2021 study by van der Miesen et al. in Archives of Sexual Behavior found that gender dysphoria-related body dissatisfaction begins improving before physical changes occur, which supports exactly what @skeletonkie described.

What did they get wrong, or right?

Mostly right, with one important nuance. Calling everything "placebo" is both honest and slightly inaccurate. The distinction matters.

Placebo effects are real physiological responses, not fake ones. But more specifically, the mood improvement @skeletonkie describes may not be placebo at all. It may be what researchers call anticipatory relief or affirmation response, documented in gender dysphoria literature as a psychologically meaningful change triggered by the act of beginning treatment, not by hormonal changes per se. That's different from placebo and worth naming correctly.

The carb craving they mentioned in the caption is interesting. Testosterone can influence insulin sensitivity and metabolic rate. Estrogen shifts in people assigned male at birth can affect appetite regulation through leptin and ghrelin pathways. A 2022 review by Klaver et al. in The Journal of Clinical Endocrinology and Metabolism noted appetite changes as an underreported early effect. It may not be nothing.

What they got right: they didn't overclaim. They didn't say HRT cured their depression. They flagged uncertainty. That's genuinely better than most content in this category.

What should you actually know?

Week one of HRT is essentially a waiting room. Hormone levels are still adjusting, and any physical changes are not happening yet. But the psychological response to starting treatment is a real clinical phenomenon, not something to dismiss as "just placebo."

Fatigue in early HRT is common and usually temporary. If it persists past the first month, it warrants a conversation with a prescriber, not self-adjustment of dosing. The mood shift @skeletonkie describes, that quieting of background distress, is consistent with what clinical literature calls a reduction in gender dysphoria-related anxiety. It is not a sign the hormones are "working" in a pharmacological sense yet. It is a sign that psychological relief from affirming action is real and measurable.

Anyone starting HRT, whether for gender-affirming care or hypogonadism, should expect an adjustment period of 4 to 12 weeks before any consistent physical changes emerge. Blood work at baseline and follow-up at 3 months is standard practice, not optional. Tracking subjective experience, as @skeletonkie is doing, is actually useful data to bring to those appointments.