Hormones

Even the best, most supportive of families can also worry about the health or safety of their loved one. While there are no easy answers to assuage their concerns, several strategies can be used -- quite successfully -- to help family members become more comfortable with the steps the trans person may want to take.

• Realize that trans people may have thought about their trans issues for years (often since childhood). Family members often learn this information after the trans person has made some tentative (or firm) decisions. It’s important to give family members a bit of time to catch up and process the information, before they can get up to speed.
• Family members may only see the risks of hormones/surgery and not recognize the risks if the trans person doesn’t transition (but wants to). It may mean increased stress, high blood pressure, depression and anxiety -- all of which can compromise health, and may even be fatal.
• If there is a family history of heart disease or diabetes, it’s harder to comfort family members that taking testosterone won’t negatively impact those health conditions. Fortunately, many conditions that are passed from one generation to the next can be aggressively addressed through lifestyle changes/maintenance -- getting regular exercise, eating a healthy diet, going for routine check-ups, consistently taking prescribed medications, etc.
• Everyone can use support. Invite family members to participate in support groups, therapy, reading and discussing of trans books, and getting connected to listserves.

  For in-person support for parents (in northern Illinois), contact:

  Ellie Altman
  EllieAlt@aol.com
  847-564-9496
  [Ellie is the parent of an FTM who transitioned nearly 10 years ago. She organizes support groups for parents (and family members) of trans people. If not in the Chicago area, Ellie will gladly talk with parents -- or others -- by phone.]
  

One of the controversies within the trans community (and within the pool of providers that serve trans people) is the role of the Harry Benjamin Standards of Care (SOC). While the SOC were developed to help both providers and trans people work better together and assure safety for everyone, some providers mis-use their power by using these GUIDELINES as hard, fast, and unbendable rules. The SOC can provide a structure that enables both trans people and providers to move smoothly through transition; but many believe that the SOC dis-empowers trans people and prohibits us from making the choices we feel are best for us -- on our own timetable, in our own unique way.

You can read the Harry Benjamin International Gender Dysphoria Association’s (HBIGDA) Standards of Care and other information about HBIGDA at: http://www.hbigda.org/

The following articles highlight some of the controversies surrounding the SOC:

a.
Dallas Denny on the Standards of Care
Some Notes on Access to Medical Treatment: A Position Paper
by Dallas Denny, M.A.
Dallas Denny is a prolific writer and trans-historian. Her position paper offers some brief history and some of the mis-uses of the Standards of Care.
http://my.execpc.com/~dmmunson/dallasdennnySOC.htm

b.
Origins of the Real-Life Test
By Just
A brief historical discussion, including the downsides of the “real-life test.”
http://www.trans-health.com/displayarticle.php?aid=80

c.
The SOC Era
&
A More Current Conceptualization of Gender Dissonance
By Reid Vanderburgh, MA
Articles by an FTM therapist who has some sensitive comments on the Standards of Care and client-driven therapy.
http://www.transtherapist.com/writings/thesissocera.html
http://www.transtherapist.com/writings/thesismorecurrent.html

We each run our own gauntlet, with unique obstacles placed before us. No one’s path is effortless, even if it looks like your peer hasn’t faced the challenges you have. It’s easy to find all the reasons why it’s harder for you than for others, but the reality is that we all are “put through our paces” and need to move through each step of our journey in our own unique ways. Some may feel their path has an unusually high number of barriers or that some particular aspect of their journey is unfair. Just like the old fairy tale, though, slow and steady can be a highly successful way to reach your goal.

It’s hard not to be discouraged, but keep your eye on the target!

Tripping the Light Fantastic
Staying Sane and Whole While in Transition
Dallas Denny
http://www.genderweb.org/general/gpsy5.html

 

This is not a complete list, but this document contains many of the Milwaukee/Illinois providers who serve trans people and SOFFAs:
http://www.forge-forward.org/handouts/Milwaukee_Resources.pdf

FORGE’s basic Testosterone 101 handout gives a broad overview on what types of testosterone are available, desired effects, “negative” effects, and health maintenance.
http://www.forge-forward.org/handouts/Hormones.pdf

A common question asked about testosterone is if and how it may affect mood and/or personality. While everyone’s experience is different, the majority of people report experiencing a CALMING, stabilizing, less moody effect when starting on testosterone rather than the hyped-up reports of increased aggression, anger and rage.

The belief that testosterone causes aggression or anger is highly over-reported. Many FTM+s and SOFFAs find that the introduction of testosterone results in moods stabilizing, the person becoming easier to be around, more able to socially relate to others, and many other positive characteristics.

The Mental Health issue of Connectivity contains an in-depth look at mental health issues and how they intersect with transness (from a trans person’s or SOFFA’s perspective). We collected data from 96 individuals who participated in an open survey. The analysis of this survey is lengthy, but contains highly relevant information on the types of mental health services people used, reasons people sought therapy, common diagnoses, SOFFA therapy about trans+ issues, psychotropic drug use, the practical impact of mental illness, how or if mental illness is attributed to being trans+/SOFFA, letter requests denied due to mental illness, experiences with mental health professionals, involuntary treatment, suicide attempts, mental health and hormones, mental health techniques, insurance coverage, and more. You can read the mental health survey results in Connectivity online at: http://www.forge-forward.org/newsletters/v07i02/MHsurveyresults.html

A significant number of people who use supplemental testosterone may develop polycythemia -- a blood disorder in which there is an excess of red blood cells.

Past FORGE follow-up resources have detailed information about polycythemia.
http://www.forge-forward.org/socialsupport/limitlessgender.html#polycythemia
http://www.forge-forward.org/socialsupport/hormones-april2004.html

Your healthcare provider can easily diagnose if you have polycythemia through a simple bloodtest. When your health care provider runs your hematocrit blood level, remember that different labs use different scales. Many times, you will need to have the same test run more than once to get an accurate reading.

The liver is a highly-worked organ that detoxifies blood. Testosterone (as well as other medications, alcohol, and family history) can cause the liver to function less efficiently.

A simple and often very effective way to help keep your liver healthy is by supplementing your diet with Milk Thistle extract. Milk thistle is an herb that can be taken in capsule, pill, infusion or tincture format. Most pharmacies or discount department stores (Walmart, Target) that carry vitamins generally stock Milk Thistle.

As with any supplement, consult with your physician before beginning any over-the-counter therapy.

Many people are interested in non-injectable forms of testosterone. Pellets are one option. They are surgically implanted under the skin (much like Norplant).

You can read about one FTMs use of pellets at: http://www.msu.edu/~omalley2/pellet.htm

In addition to this webpage, Kev also wrote:

“the come-down/crash was awful. nasty hot flashes, very tired all the time, really moody and irritable. it's like a cross between pms and what i hear from folks in menopause. it's also alot like what i hear from folks who miss a shot or two, only a bit more intense. i think it's more intense because a) i'd had such blissfully level hormone levels for 3 full months (whereas with shots the peaks and lows were so frequent it just seemed normal, and i didn't notice it) b) we didn't put new pellets in right at the recommended 3month mark. we wanted to see how long i could go before replacing them, for cost purposes. i think we'll stick to 3.5-4months before implanting them again.

“the goal now is to keep the levels level on an ongoing basis. Ie replace the pellets before the levels get too low again, and to use fewer pellets so they don't get quite so high.

“also, when he put them in this time, he went a little deeper, injected them further away from the incision, and put one small disposable stitch in the incision. this time i haven't had any problems with the wound closing. everything's like clockwork.”

He has returned to using gel for the past 4 years.

There is no conclusive evidence that there are any significant changes in bone density when going from an estrogenated system to one dominated by testosterone. Jamie Feldman M.D., Ph.D., and Walter Bockting, Ph.D. note in their article, “Transgender Health” (Published monthly by the Minnesota Medical Association, July 2003/Volume 86 -- http://www.mnmed.org/publications/MNMed2003/July/Feldman.html) that if testosterone regimens are not maintained, there is a chance of bone density loss. They recommend calcium supplementation for those who are not using testosterone (and who have had a hysterectomy), and for those using low doses of testosterone. They also suggest a calcium rich diet, as well as weight-bearing exercise.

One article that specifically addresses bone density is:

“Effects of Testosterone Therapy on Bone Mineral Density in the FTM Patient”
TANGPRICHA, VIN U.S.A.
Co-authors: Adrian Turner, Alan Malabanan & Michael Holick (U.S.A.)
E-mail: vin@bu.edu

http://www.symposion.com/ijt/hbigda/2001/39_tangpricha.htm
XVII Harry Benjamin International Gender Dysphoria Association Symposium
31 October - 4 November 2001, Galveston, Texas, U.S.A.

Background: The effects of androgens on the female to male transsexual skeleton are not clearly defined. There are limited studies investigating the effects of testosterone on bone mineral density (BMD) in these patients. One previous study in 19 female to male transsexual patients revealed a statistically significant decrease of 4.5% over 3.5 years in bone mineral density at the lumbar spine after treatment with testosterone and after total hysterectomy. The objective of this study is to determine the effects of testosterone on BMD and markers of bone turnover in FTM transsexual patients. We obtained approval for the study from our institutional review board (IRB). Patients were informed about the study by their endocrinologists. We started recruitment of subjects in July 2000. We obtained written informed consent from each patient. All female to male transsexual patients were eligible for the study, including those who had already initiated testosterone therapy. Baseline urine N-telopeptide and bone mineral density (BMD) were obtained at the femoral neck and lumbar spine. Bone mineral density will be determined annually and serum studies will be determined semi-annually for 2 years.