Down the Rabbit Hole: Cake or Potion (Testosterone or Estrogen)

Cam the Chameleon

Last week on Substack, I introduced myself with an essay that used Alice in Wonderland as a metaphor for gender ideology. I discussed regret, identity, and the often painful process of navigating life forward as a gay man who has gone through the process of detransition. In that spirit, I want to continue building on the metaphor—this time focusing on the confusing and often devastating medical aftermath of gender medicine.

A Trip Through Wonderland

In Lewis Carroll’s famous tale, Alice falls down the rabbit hole in pursuit of a rabbit — a symbol of curiosity, urgency, and perhaps, identity. She finds herself in a surreal world governed by strange rules. Early in her descent, Alice drinks a potion to shrink herself and eats a cake to grow. Each choice changes her body in unpredictable ways. One moment she’s too small to reach the key; the next, she’s too big to fit through the door.

This scene eerily mirrors the experience of trying to manage hormone replacement therapy after deciding to step away from a medical transition. The potion is estrogen. The cake is testosterone. Neither works as advertised when the body has been permanently altered by surgeries and prolonged use of cross-sex hormones. The fantasy of seamless transformation collapses, and what remains is a fight for survival—in a body that no longer follows natural rules.

Just a quiet longing to wake up from a dream that wasn’t supposed to last this long.

Maybe that’s the strange truth no one tells you: sometimes the potion works too well. Sometimes it changes you before you ever knew who you were.

The Potion is Too Sweet

Starting the transition process is far easier than leaving it—especially once hormones and surgery are involved. For those who begin young, with an underdeveloped brain and co-occurring mental health issues, it can be difficult to fully grasp the long-term consequences of medical intervention. Most are focused on the desired effects of hormones, while few truly understand the lasting impact these treatments can have on their lives.

Take infertility, for example—a common side effect. While some may technically understand what infertility means, do they really comprehend what it will cost to have children later in life? Politics aside, the financial burden of private adoption or surrogacy can range from $30,000 to $150,000. What child—or mentally unwell young adult—is capable of understanding that kind of future financial weight?

And yet, many have made these decisions, only to confront the consequences years down the road. Consider how many young adults are already in debt from college, car payments, or a mortgage. It’s a bitter lesson to learn—that permanent, life-altering decisions were made in the name of “help,” often for someone who was vulnerable, unstable, and unable to give truly informed consent.

Stuck Between Doors

Like Alice, I drank the potion before I realized what was required to leave the space I was in. I underwent bottom surgery fairly early in my medical transition, and the consequence is that my body no longer produces its own sex hormones. I am now dependent on exogenous hormones to function, but achieving hormonal balance—or homeostasis—through synthetic means is a maddening, imprecise science.

Too much hormone, and your mind spirals. Too little, and your body collapses. You try a pill. Then a patch. Then a gel. Nothing feels right. Each attempt to fix one issue creates a new one. It’s a chemical game of whack-a-mole where the stakes are your sanity, your metabolism, your ability to function. You feel pain. You feel nothing at all. You shrink. You grow. You’re too much. You’re not enough.

Before detransitioning, I was on a low-dose estradiol patch. My estrogen levels hovered just under 100 pg/mL—within the “safe” range, allegedly. But even that low dose came with a price: years of nausea, vomiting, facial twitches, and migraines so severe they left me bedridden for days. I had auras—blurry vision, dizziness, disorientation—that would precede the migraines like a cruel countdown. The migraines got worse as time went on, not better.

No doctor warned me that this could be caused by long-term use of estrogen.

Conflicting Advice, Confusing Choices

A year before detransitioning, I saw a neurologist. An MRI revealed I had temporomandibular disorder (TMD), but no brain abnormalities. I was prescribed medication that initially helped, but insurance would only cover 10 pills a month. I quickly ran out and was left defenseless for the next cycle of pain. Migraine medication is time-sensitive—you have to take it the moment the aura begins; otherwise, it doesn’t always work. It’s exhausting. You’re always chasing a cure that’s two steps ahead of you.

Even more alarming were the long-term complications: prediabetes and hypotension. I’m healthy. I eat well. I exercise. I wear a size four in women’s clothing. And yet, my body was breaking down under the weight of a medicine it couldn’t regulate. This wasn’t just about discomfort—it was about survival.

Then came the appointment that changed everything.

A urogynecologist—someone who actually understands the consequences of MTF bottom surgery—looked me in the eye and said something devastating: continuing estrogen with the kind of migraines I experience puts me at serious risk of a brain aneurysm or blood clots. She told me that staying on estrogen was a choice between quality of life and quantity of life. Those words still play in my head.

I walked out of that office in tears. Not because I didn’t understand. But because I finally did. No one warned me when I started transitioning as a teenager that, despite building a life in deep stealth, I might have to medically detransition and be prepared for the repercussions. What will people think of me after learning my secret? My mother- and father-in-law? My friends? My neighbors? These questions consumed my mind.

Giving Up the Potion

That day, I quit estrogen. Cold turkey. The week that followed was filled with hot flashes, night sweats, and emotional instability. And yet—slowly—I began to recover.

The migraines lessened. My blood sugar normalized. After four months off the potion, I was no longer prediabetic. My doctors prescribed preventative migraine medication, and with the help of barre class, a high-protein diet, and quitting caffeine, I now experience migraines only once a week—not daily. I’m not cured. But I am alive. I am more stable. I am rebuilding.

Still, the mixed messages from doctors remain. My endocrinologist continues to deny that estrogen could cause any of this. My neurologist won’t commit to a cause. Only the urogynecologist dared to be blunt—to speak the kind of truth that medical gatekeepers often avoid. So who do you trust when experts contradict each other? I chose to trust myself.

The Cake is Bittersweet

When I first asked for testosterone, it was as easy as taking a bite of cake.

No questions, no long discussion—just a sweet, soft offering laid before me, marked Eat Me. I told my endocrinologist I wanted to try a low dose of testosterone gel. The prescription was ready that same day, like someone had been waiting for me to ask.

I rubbed the gel on my shoulders every three days. It felt harmless. At first, everything brightened. My energy surged. My thoughts sharpened. The fog that had quietly blanketed my mind for years began to lift. I didn’t realize I’d been dreaming until I started to wake up.

A few weeks in, something deeper shifted. I began noticing my husband in vivid, magnetic ways. I was transfixed by his facial hair—the way it grew, how it moved with his skin. I looked at him like it was the first time. My heart would race, the way your blood sugar spikes after eating too much sweetness at once. It was intoxicating. I hadn’t known this part of me was asleep.

And then came the sexual thoughts—intense, new, and unfamiliar. It was like someone had handed me a key to a room I didn’t know I’d locked. At first, I panicked. I thought I was hallucinating. But both my doctor and my husband reassured me: “This is normal.” And they were right—it was. But the relief was paired with something harder to admit: grief.

Because while the feelings made sense—finally—the body that held them no longer could. I had medicalized before I’d ever known what my sexuality actually was. I drank the potion before I knew what it would cost. And now, after surgery, that alignment between mind and body, between desire and function, felt broken. Irrevocably.

What disturbed me wasn’t the content of my desires, but that I had arrived at them too late—trapped in a body that no longer fit the hunger I had only just discovered. It was like sitting at the tea party with all the wrong cups, wondering if any of them were ever mine to begin with.

Then came the reverse dysphoria: a sharp, painful longing to undo everything—to go back, somehow, to a self that never got the chance to form. But how do you return to something that never was? I couldn’t find the path. The trail behind me had been eaten, one bite at a time.

In the quiet of that realization, I cried. “I want to go back. But what is back?” The mirror offered no answer. Only a reflection I didn’t recognize.

Eventually, I reduced my dose. I still use the gel, but less often now—just enough to keep the lights on, to hold onto the mental clarity and energy that had once tasted like salvation. The rest is numbed out. Carefully. Purposely.

Conclusion: Alice Never Left

Alice in Wonderland isn’t a story about magic. It’s a story about confusion. Disorientation. A girl who keeps changing sizes, unsure where she belongs or how to get home. That is what gender medicine can feel like after it’s done its damage—surreal, unmoored, irreversible.

Our bodies do not get a do-over. We are still down the rabbit hole, sorting through the broken potions and oversized cakes, trying to piece ourselves back together in a world that no longer claims us. It is an “impossible space” to be in, as described by Dr. Joseph Burgo.

I want to go home, but what is “home” when you haven’t experienced life as a gay man in society? What is “home” when you cannot relate to gay men because you are medicalized, and they cannot relate to you?

The real question isn’t cake or potion.

The real question is: What happens when the magic wears off, and you’re still too big or too small to fit back into your life?

For many of us, the answer is simple: you don’t get to go back. You just survive—and tell the truth for those still chasing rabbits.