Article on Transsexualism in the New England Journal Of Medicine

This is a very quick post to say that there was a nice article on transsexualism in the New England Journal of Medicine this week. It’s advice on the hormonal treatment, mainly of MtFs, but a little on FtMs.

http://www.nejm.org/doi/full/10.1056/NEJMcp1008161?query=featured_home#t=article

It’s great to see transsexualism treated as just another medical condition..

Become a man, or change what it means to be a woman?

Bionic Baby Mamma recently dropped by to say:

I’d love to hear you talk more about your thoughts on transitioning vs. creating out a butcher version of femininity, as the tension there (please forgive ineloquence — new baby, no sleep. and now it turns out ineloquence isn’t a word.) is something I struggle with. I don’t mean to deny the existence of trans people or say people shouldn’t transition, but sometimes, as a fairly femme lesbian who still doesn’t like the “traditional” boundaries of womanhood all that much,  it can feel like being abandoned — particularly in the case of those who transition and seem to immediately get drunk on access to male privilege.  I don’t mean to say that it IS abandonment or that those people are wrong to follow what it in their hearts, mind you, only that it can feel that way.

I think that this is an interesting point. It’s a variation on the common question of ‘why not just act like a masculine woman’ which is something that trans people are asked a lot.  Society has roles set down for men and women to act in, the roles that say that women stay home and raise children and that men go out to work. But these days there is nothing at all stopping women going out to work,  and men stopping staying at home and raising children. There is nothing stopping men wearing women’s clothes, and women wearing men’s clothes.

My answer is that there’s a difference between what you do and what you are. When I was at woman at first I tried to act like other women, I wore skirts, and tried to do the things other women did, played rubbish games like netball instead of proper games like football. I quickly established that being a woman was shit and I didn’t like it. I realised that just because I had the misfortune to be a woman I didn’t actually have to do anything just because I was a woman. I made a conscious effort to act completely like a man, but still being a woman.So I stopped playing netball, I stopped wearing skirts and make-up, I got my hair cut in a man’s style, I started having sex with women.

In fact it got to a stage where every activity in my life was the same thing that a man would do, I would walk home through a dangerous area at 2am because that’s what a man would do. When I was 17, and rather drunk, a unfortunate boy offered to walk me home and I punched him in the face to prove that I didn’t need walking home,  he refused to hit me back, so I punched him again. He kept saying that he wouldn’t hit a woman, and I got more and more angry with him.  I forget how it ended, but I remember walking home with a group of straight girls who tried to explain to me that it wasn’t sexist to refuse to hit a woman. By the time I got home I was really really upset, and I cried and told my parents about something awful a boy had done to me,  no, not rape, but refusing to fight back because I was a girl.  When I was 18 I went travelling around Europe on my own, I remember my Dad saying ‘Well I would have thought I’d be really worried if my  daughter did that, but I’m fairly sure that if you got into any trouble you’d be able to get out of it physically’.

But once I was effectively doing everything that a man would do in life I was still miserable. I was miserable because blood kept dripping out of my body where it shouldn’t, I was miserable because I had weird lumps of flesh growing out of the front of my body. I was miserable because however masculine I looked people kept treating me as a woman. I was miserable because of the bizarre rollar coaster of hormones that is the menstrual cycle. Acting like a man didn’t make me happy about being a woman, in fact it almost made being a woman worse, because it drew attention to the way that I just couldn’t change.

Could I have stayed as a masculine woman? Yes, I could have done, would I have been miserable? Yes. Is by transitioning harming women? I see that many people who would have been masculine women in the past are now transitioning, that may mean that there are less I too worry that some of them are doing it too soon, without really exploring whether they could be comfortable as a masculine woman. That worries me a bit.

Would I want to be continually suicidal to keep other people happy? No.

Different Types of Testosterone

I’ve noticed that people often find my blog whilst looking for information about testosterone, so I thought I should post something about it. Because testosterone is broken down by the digestive process you can’t just take a tablet, you have to find a way of getting it into you and bypassing the liver. These are the ones that I have tried:

Sustanon

Injections of hormones every 2-3 weeks. This is the form of testosterone I started on, meandered off, and then came back to. It’s ok, not great, but it works for me. It’s got upsides, firstly it’s cheap which means that GPs are willing to prescribe it, also if I am caught out and need a private prescription it’s easier to organise. It’s licensed for treatment of transsexuals and a lot of GPs aren’t willing to use unlicensed products without hospital supervision.  The big upside for me is that I can inject myself, which is great, I couldn’t afford to take time off to go to a GPs to get a nurse to inject me. A lot of GPs haven’t been entirely happy with  me injecting myself, but once I point out that I can put a central line in they give up.

The downside is that that the injections themselves are fairly painful, and they sometimes mean that I walk with a limp for a day or so afterwards. If I’m actually sticking to my running training I have to time my injections so that I am on a rest day the day afterwards. It’s actually really difficult to stick a needle into yourself knowing that it will be painful, I have tried to persuade my wife to do it but she can’t really manage it.

The other downside was the fluctuations in hormone levels, before I had a hysterectomy I found that if I was low at a certain point in my cycle I would have a period. I was initially prescribed it every two weeks by Russell Reid which was ok, but then it was reduced to every three weeks by a NHS endocrinologist, which was the dose he used for hypogonadal biological males, and things turned into a rollar-coaster. This was annoying. Also my moods would go all over the place. Now I’ve had my ovaries removed (yahay) this isn’t an issue, and I can easily go for about 6 weeks between doses without noticing a problem. Other than the increasing risk of hip fracture that I get if I am low testosterone for that long.

Testogel

A clear colourless gel that you put on your skin. I tried this before I had my ovaries removed,  I was hoping it would surpress the menstrual bleeding that was happening on high does sustanon. It was great – with a dose every day the hormone levels were stable, and the mood swings were much better. There was one big downside: it made my wife’s hair fall out as she developed male pattern balding! Of course she wasn’t my wife then, she was the totally hot girl that I’d just started dating. Of course I should have made sure that I had a shower before I cuddled her skin to skin, but our relationship was in a very passionate stage and was just got carried away a little too often. Fortunately she wasn’t pregnant or this could have caused a miscarriage. A lot of FtMs who start on the gel report that the changes seem to be slower, though I can’t help wondering if there is an element of placebo effect here, as it’s well known that injections cause a greater placebo effect than tablets.

Buccal Testosterone:  ’Striant’

I can’t even remember what the brand name was for this, but google tells me that it was ‘Striant’. It was horrible. It was a small tablet that you had to put under  your top lip and suck gradually throughout the day, it tasted dreadful, and made food taste dreadful. Also I worried that if I kissed my then-girlfriend-now-wife she would get some more male pattern balding.

Andropatch

I nearly forgot about Andropatch! It was a patch that you put on your skin and it slowly released testostone throughout the day, or at least that was the plan. Usually it would fall off around lunchtime, my hormones would dip, and then if I was unlucky I would have a period, oh, and it made my skin really greasy, some people find that it makes their skin bleed. It’s not available anyone in the Uk anyway, which is a shame, because it wasn’t as bad as Striant.

Nebido

I may be the only trans man who has never taken Nebido, as it is rapidly becoming the most popular form of testosterone. It’s a an injection that you only have to take once every 12 weeks. That’s the up side, the downside is that you can’t inject it yourself, this doesn’t seem to bother most people but it does bother me, as I really value my independence with hormones. If I can’t make my own I can at least inject my own. I have had some limited successful experience with using it professionally and it seems to be ok, no not treating trans people, treating bio men who need hormones for other reasons.  The main downside is cost, I don’t think it’s ethical to use taxpayers money for the more expensive option when sustanon is so much cheaper. I know that the drug company that makes Nebido is trying to make ‘male androgen deficiency’ into some sort of hormonal disorder and I despise this  disease-mongering. Therefore I shall, on principle, refuse to be prescribed Nebido in an ineffective one man boycott.

I’m sure someone will take this post and use it as evidence of why artifical hormones are bad. So it’s worth taking a minute or two to consider the alternatives to artificial hormones.

Ostrogen and Progesteron

I did try living without any testosterone at all. Before I transitioned I tried coping just on female hormones. On the surface it seemed like quite a good solution, my body made the hormones itself so it didn’t require any prescriptions, and it was the ‘natural solution’. But it had some big disadvantages as they kept trying to turn me into a woman which was weird. Also instead of a consistent supply of hormones there was this strange ‘cycle’ thing, with a gap where there were no hormones at all, and where blood kept appearing out of places that blood really shouldn’t appear from, which made sex really messy for 1 week a month. If you have having sex with a woman that means that for 50% of the time sex is off the cards because one of you is bleeding. Some women, presumably finding this totally impossible, resort to having sex with men, but this carries a very big downside:  Pregnancy

Pregnancy is a truly awful business, in the days before modern medicine it used to kill about 1 in 5 women, which is actually quite a lot,( and my wife thinks that paragliding is a risky hobby). The worse thing about pregnancy is how it ends. Have you ever actually seen a child being born? No? I advise you not to.  That large baby is clearly not meant to fit through that small hole. If you like to have sex with men on a regular basis you could get pregnant about 12 times throughout your life. Maybe even more.

The only way to make being a woman vaguely bearable is artificial hormones,  you have to take artificial female hormones to stop you randomly bleeding the entire time, and having 12 babies. Given that you’re going to have to take artificial hormones anyway you  might as well take testosterone which has all of those benefits and more  as you get admission to the land of male privilege where can to oppress women all day long.

Being born with XY chromosomes

Ideally I would have chosen this option, none of the awful pregnancy / bleeding / random hormone rollar-coaster, and all the cool things about testosterone without having to actually inject it. For some reason this just isn’t an option. XY guys, you really don’t know how lucky you are, you think standing to pee is the coolest thing? You’re so wrong.

Should Doctors be the gatekeepers of Gender?

Doctors are in the semi-artifical role of ‘gatekeeper to your new gender‘. Transsexualism is a disorder, and it needs to be diagnosed by a doctor, who then prescribes some treatment. When the treatment goes wrong then you have  a legal action, as it was the doctors responsibility to make sure that that the patient didn’t regret the treatment. Most transsexuals don’t like this model, they want to be able to choose what treatment they want and when, some want to go faster and some want to go slower.

Sometimes I wonder whether we should dispense with this model of transsexualism being a ‘disorder’ that requires ‘treatment‘ and instead make it a that we make a free choice whether to have hormones or surgery or not. There would still need to be some medical professionals involved, hormones need to be prescribed and monitored by someone competent and medically qualified, surgery  requires both a surgeon and an anaesthetist. I also think that there would need to be some form of screening to check that you were of ‘sound mind’ or something and were capable of understanding the consequences of your actions.

Of course this would have a lot of downsides. Firstly it would mean that if you regretted treatment it would be your own fault, and you would have no one to sue, you would have to take responsibility for the consequences of your decisions about medical treatment. I don’t think patients really get this concept, in general most people don’t understand balancing risks and benefits and like to have someone to blame if things go wrong.

In the UK  treatment is sometimes available on the NHS to transition, but it is not available for cosmetic surgery, because that’s a ‘choice’. So if it was thought of that gender reassignment treatment was a choice in that way then there would be no chance of funding being available. So their would be no chance of free treatment.

In the UK we have pretty effective legal protection against discrimination, this is based on the fact that we have a disorder that we cannot change. If I got a facial tattoo I could legally get fired from work, if I had a sex change I do not get fired from work, if that happens I can sue my employer. If it was seen to be a choice then people would be able to fire us if we changed sex.

All in all I think that transsexuals benefit quite a lot from the current model, and it should really remain that way. What do my readers think?

A whole new school of FtM haters

I’ve just come across a bizarre blog, ‘Dirty White Boi’ is an American woman who believes that FtMs are women oppressed by society into  becoming men because society has told them to hate their own body. She seems to be a butch lesbian who feels threatened by FtMs because their are less butch lesbians around. She sees young FtMs choosing testosterone and  surgery over being butch lesbians and sees that they are mutilating healthy bodies.

The way she makes her point is downright ‘nasty’ and generally unethical. She subscribes to ‘trans only’ groups, where people publish information they think will remain confidential, and then takes posts out of context and puts them on her blog. This is a horrible violation of what felt like a safe safe (she says that as MtFs go into women only spaces and violate them, then it’s ok). She takes videos of kids transitioning on you tube and mocks them. Oh and the comments… she deletes the ones that she disagrees with, I know because two of my carefully crafted ones were deleted.

Annoyingly Dirt has a point, not one I agree with, but one that’s certainly worth thinking of. I actually urge anyone who is thinking of transitioning to read her blog throughly. If you are thinking of transitioning, you should be really sure that you have fully explored the option of being a masculine woman, and decided that it isn’t for you. If you are a young girl who isn’t comfortable with being a woman, in the way that you see your mothers and sisters being then you should really make sure you have explored all other ways of being a woman before deciding that you’re actually a man. If you have done this, and you have come to the conclusion that you are a man, then by all means transition.

But transitioning will involve hormones and surgery, and these have their downsides. You will be on regular medication for the rest of your life, and if you inject it is a bit painful, surgery has side effects which include death, long term infection, disability. If you feel that the only way towards happiness is to take the risk of death – then go for it! But do make sure you’ve explored all options, and don’t just jump on the bandwagon. Not that there are enough FtMs to form a ‘bandwagon’ anywhere I’ve ever been.