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Saturday, December 24, 2011

To Your Health!

One of the more important things that I am both personally and professionally concerned with is the status of our overall well being. It worries me that we don't pay enough attention to our general health and worry most about getting HRT and the surgeries that we want to feel complete. Many of us ignore our health towards this goal by obtaining black market hormones off the street or from pharmacies that sell on line that don't even require a prescription. We don't really know what we are getting from these sources, but the imperative to move our bodies towards a better fit with our minds allows us to take risks risks with our health we would never consider doing otherwise regarding the rest of our health care. It is not entirely our fault, but we share some of the responsibility for this conundrum.

It has been notoriously difficult to find therapists, physicians and other health care providers to provide the care we need, yet more and more health care professionals are willing to treat us and more and more insurance companies are willing to pay for some, if not all of our health care needs on a parity to that comparable with other diagnoses. Many health care systems offer financial assistance based on income. There are also free clinics in many communities that offer health care to those who work, have no insurance and are of limited income. 

When I began working with transsexuals, way before I ever considered that it would be possible for me to transition, I was the only therapist who provided transgender care for the greater part of Virginia. I had one resource for a physician who provided HRT for my male to female patients. I had no resources for my female to male patients, but I had never encountered one until the last 4 years and I was able to find a doctor willing to provide his care.

Today I have developed resources for my patients that include the psychotherapy I provide, substance abuse treatment, treatment for co occurring mental health problems and second letter evaluations (psychiatry), primary care, endocrinology, aesthetic dermatology and voice therapy. Generally, we think of male to female people benefiting from voice therapy, but female to male people can benefit from this service as well. That is because communication within our gender identity does not only include the pitch, tone and inflection, of our voices, but it also includes non verbal communication such as gestures and body movement.

For whatever reason, even if you decide to go the DIYS (do it yourself) HRT route, there are some things that are absolutely necessary and should not be neglected.Please do these to maintain your good health!

1. Blood work: We need to have some blood work done twice a year when first beginning hormone reassignment therapy and after full induction, at least once a year. These tests include a metabolic panel to check the functioning of your organs. The liver and kidneys are particularly stressed by hormone therapy. Having a lipid panel is important as well because hormones can elevate cholesterol and raise the risk of coronary artery disease.

2. Depression, anxiety and substance abuse: These problems are epidemic in our community and we have an overall suicide rate of 41% of those who have attempted suicide at least once. People of color have a much higher rate of attempted suicide than that reported overall.

3. Substance abuse is a particularly severe problem for us and exacerbates depression and anxiety and is often a huge factor in attempted suicides. It has been difficult for us to find substance abuse treatment that is sensitive to us as individuals, but this has been an emphasised area for improvement among substance abuse treatment professionals. This problem is taking too many good brothers and sisters away from us. It is so unnecessary too. There are 12 step programs available. They work for more people than anything else. Check out Alcoholics Anonymous   or Narcotics Anonymous

   . Click on these links to find a meeting near you! or . Some of the groups in some localities are for GLBT people specifically, if you don't feel comfortable with another type of meeting, but if there aren't any of those type meetings available in your area, please don't make that the excuse to not get the help you need. It is truly a matter of life and death.

4. Don't forget your annual mammography! While we generally have a lower rate of breast cancer than genetic women, we are at higher risk with family histories of our moms, sisters and aunts having had breast cancer, especially if they had one of the mutations that cause the more aggressive breast cancers. It is really a painless procedure and will be a life saver. Then there are a couple of tests that we hate as a reminder of having a body we felt was wrong for us. We still have to have the digital examination of our prostate glands. While the risk is reduced, we still are at risk for prostate cancer as we age, even though estrogen and progesterone are treatments used to slow the growth of prostate cancer. We also need to have the PSA blood test done on a yearly basis.

For the guys, it is important to continue to get that pelvic regularly along with a pap smear, and even if you have had a hysterectomy and oopherectomy, you will still need that done periodically, perhaps not as often.

5. See your dermatologist once a year, especially if you have had heavy sun exposure or have a history of skin cancer in your family. It is imperative that you do this yearly if you have has any relatives who had malignant melanoma. This is an extremely dangerous skin cancer and it is too often the case that when it is finally found, it is often too advanced to be successfully treated.

6. See your dentist twice a year! People who are able to keep their own teeth are healthier and live longer. Poor dental health can often lead to heart disease.

7. Don't smoke! It is the most difficult of all addictions to overcome, but it can be done! Smoking is a deceptive addiction, because it doesn't kill you as quickly as some other addictions, but the long term health consequences are devastating and are well known.

8. If you use alcohol, please use it in moderation. Alcohol in any quantity has negative effects on every tissue and organ in the body and is one of the more deadly addictions. Alcohol causes many ruined relationships and injuries due to accidents as well as fatalities. Know when you have had too much and don't be too proud to ask for someone else to drive or take you home. There is no shame in that and it may save some one's life if not your very own life.

9. Get some exercise daily! Even if you can just take 30 minutes and go for a brisk walk, it will improve your overall health as well as cardiac health. It will help you with weight control as well.

10. Be sure to laugh every day! Enjoying humor has been known to benefit general health and one's outlook. Cultivate a positive attitude. It is part of being healthy and attracting positive people. It will be part of being successful and happy in your own life. Smile! positive people are attracted to people who smile and are interested in their well being too.

11. Do something for someone else. It is good for one's outlook and overall attitude to do something nice for someone else. It doesn't have to be anything big, just look for that little opportunity to do something special to help someone else. The return will be ten times what it took to do that little helpful or kind thing!

I hope that you all have a happy and healthy 2012!


  1. Very good advise - Im a big believer in exercise - I dont always feel up to it, but it works well in many areas including warding off "Depression" / My tool of choice - the eliptical cycle - 45 minutes - 4 to 5 times daily - Burns 367 calories per secession.....
    Humor is hard to come by, when you are alone, and live a lonely life - I guess there are no answers for that one !!
    All the best - Shirley

  2. Sherri, I keep seeing the words - "We don't really know what we are getting from these sources, but the imperative to move our bodies towards a better fit with our minds allows us to take risks risks with our health we would never consider doing otherwise regarding the rest of our health care" - associated with both black market purchases as well as online pharmacies. Has anyone looked at the efficacy of the spiro and estradiol which can be obtained from online pharmacies.

    I won't mention which pharmacy I use, but it is one of the most popular and fairly priced sites. The meds they send come from a consistent source that seems to be legitimate. Based on the type and quantity of meds sold on this site, I must assume the TS people are not the only customers. Why would a prescription make my meds more safe or effective. And if it would, why is it that only doctors can write a script and most refuse to do so?

    I've talked about my experience with the pre-op doctor when I got my cataract removed. I was quite up front with him about the purpose of the only two drugs I consume and that they are self prescribed. He judged my intelligence and confidence, then ask me, "What is your diagnosis?" Now, I know that is a question that can imply my participation or not, but the way he said it, with respect and with genuine curiosity, I took it as Doctor to doctor. I told him that I was a transsexual woman, and that satisfied him. He finished his standard questions, said everything looked fine and walked away. Five minutes later he was back. He asked me one more question - Do you feel depressed or anxious? He must have done some quick research on my diagnosis. I told him, no, and he was satisfied, if not a little confused.

    Now, I know I am not a doctor, but I did stay at a Holiday Inn Express lately. I am going to find a gatekeeper soon, just to make things official, and perhaps be able to obtain US based meds at a bit lower price. I also want to be able to say that a professional agrees with my own diagnosis, so it eases the minds of those around me, and validates what I say in my book. However, some people, though intelligent and confident, cannot obtain this additional level of validation.

    What I am saying is that medical doctors should be trained, or at least have easy access to self training, in the treatment of the transsexual patient and be intelligent and confident enough to confirm their patient's own diagnosis. It's the only way we will ever make a dent into my dangerous behavior.

    BTW, did you here the one about . . .

    Hugs, my precious friend

  3. Hi Nikki! Happy New Year! Thanks for posting this, you bring up a lot of things worthy of discussion. There is a lot of research that has been done with online pharmacies. Some are legitimate and require prescriptions. Some sell authentic legitimate meds without a prescription and most who do not require a prescription do not sell manufactured medications that meet the standards of legitimacy for a couple of different reasons. They may not be standardized in dosage, they may have a lot of chemical waste in them from the process of making them, and some are just counterfeit. Unless you have the knowlege, skills and abilities to perform qualititative and quantitative chemical analysis, you really can't be sure.

    To answer you first question, it isn't the prescription per se that makes hrt safer. Kit's the doctor who provides your health care and the legitimate pharmacy that fills that prescription. I'm willing to wager that you don't know what your estradiol levels are or your free testosterone level. I'm guessing from what you wrote that you don't feel able to tell your primary care doctor about yourself. To me that tells me that you need a new primary care doctor or you need to find a practioner who will provide ypu with the proper health care. I would further wager that if you called around to the endocrinologists or the gynecologists in your area that you would find someone who would take care of you.

    You also have the advantage over many of our sisters of having a scientific background and are well educated. Many of our sisters have not had the advantages of educational opportunities we had(not that having higher education is the end all or be all). There need to be safeguards in place to protect people from unscrupulous preditors. We hear of people preying on us all the time.

    You mention the problem of gatekeeping. This comes about for two reasons. Strict adherance to the SOC which clearly state they are guidelines and are not chipped in stone and pratitioners who haven't had a lot of "reps" and tend to rely to the letter of the law of the WPATH SOC. Whether we like it or not, we are a rare occurrance in most medical professionals' experience unless we actively seek out to specialize in gender care.

    If someone such as yourself presented to me at the outset and I determined there was no mental health issue, and you understood what hrt would, would not do and what the risks and benefits of that medical treatment are, my policy would be to approve you in fairly short order. I won't cite a specific number of sessions, but it would be a lot less than the 12 sessions averaged over three months before I provided a referral. the reason I won't state a specific number of sessions is because I believe everyone is an individual and those decisions are made on the individual's situation. Most people come to me already knowing they are transsexual. I have a patient currently who is unsure and a longer period of assessment is in order for her. ultimately she will know when and if she is ready and at that time I wioll refer her. I can't remember the last time a patient who wasn't very sure presented herself to me.

    At this time, I would argue that you don't need to see a mental health professional, unless you have some things you would like to sort out. Instead, the issue for you is harm reduction. When someone such as yourself comes to me, my position is that I want you to have the proper medical care and I refer immediately to a physician. No other treatment decision is an option, other than to offer therapy. Often the patient who presents to me in that situation is more interested in moving forward with transition or has a social environment or relationship problem and that is something I can be of help with. Otherwise my job is done when I connect her to the physician.

    I hope that this clarifies your concerns! hugs,Sherri

  4. Sherri, The pills I take are as follows:

    Estrofem 2mg
    Blue tablets each 2 mg oestradiol as hemihydrate
    In a sealed 28 day dispensor
    With an expiry date and batch number
    Labelled on the box as...
    Made in Denmark for:
    Novo Nordisk Pharmaceuticals Pty Ltd
    Level 3, 21 Solent Circuit
    Baulkham Hills NSW 2153

    Novo Nordisk Pharmaceuticals Ltd
    Auckland, New Zealand

    ...and on the dispensor as:
    Novo Nordisk A/S
    Bagsvaerd, Denmark

    Spirotone 100
    Spironlactone 100 mg
    In a sealed bottle of 100 tablets
    With an expiry data and batch number
    Labelled as:
    Mylan New Zealand Limited
    Auckland, NZ

    Both of these companies seem to be legitimate, so the only question is whether they would sell their seconds and allow them to be labeled with their own name and brand. I know of no reputable company that would do that. Of course packaging and even size, shape and markings on pills can be forged.

    Once a year I get full blood screening done, including testosterone, free testosterone, estradiol, estriol and estrone. I can give my dosages and latest test results if you would like.

    My primary care physician is aware of my transsexual status, and orders these tests for me. She admits that she has little knowledge of the transsexual transition process, but is willing to learn. Last March, she told me that she had just gotten a new patient who had just realize that she was a trans woman - by listening to Oprah or something. This year I plan to discuss with her whether she would be willing to prescribe my meds, so I could be "safe", not have to worry about my shipments being seized by customs and save a little denaro too.

    So pay up, little sister :-)

    As for seeing a counselor, at this time, I want to do it for two reasons: 1) To help my physician feel comfortable about helping me; and 2) To validate, to all those around me, and for those who will someday read my book, that I am indeed, who I know I am. I would also like to have someone for my wife to talk to as we slog through this thing together.

    Happy birthday, young lady.

  5. slog..... I like that description!! Thanks for the birthdat wishes! xoxo lil' sis