Do It Yourself Hormones: Is this a good idea?

I had a nice discussion with a lovely woman from Florida who came to my workshop at Southern Comfort two weeks ago. She had been on do it yourself hormones for awhile, stopped taking them and went back on them, but after she heard my comments, she changed her mind and was going to look into getting prescriptions and medical monitoring of her hormones.

I am someone who is not an advocate of doing it yourself, also sometimes known as D-I-Y. But I am also someone who has tried do it yourself, albeit a long time ago and it was only for about 3 or 4 months. I hope that this article will help people to reconsider the D-I-Y route and seek medical supervision.

My personal adventure with D-I-Y does not contain a horror story and I am not going to paint dire pictures of certain doom, illness or death, but there are potentially serious health complication that the D-I-Y person should be aware of and at least take some reasonable steps to minimize the potential for harm that exists with D-I-Y.

I have said before and I will say again, hormones are not playthings. Misuse of hormones can lead to heart, kidney and liver damage. They have the potential to raise blood pressure and cause heart attacks and strokes or fatal embolisms. Some people are not candidates for HRT because of other pre existing serious heart problems.

One of the most serious problems is that the pharmacies that one can obtain these hormones from do not require prescriptions. There is no guarantee that the drug you have purchased was manufactured with adequate standards to insure that the two milligram estradiol tablet actually contains 2 mg of estrogen. It may contain 2.5 mg or it might not even contain 1 full mg if estradiol. You just don't know what you are really getting. When you get a perscription filled, you are buying hormones that have been manufactured under rigorous standards and can feel safe that you are actually getting what you expect to be getting.

Many people who do it themselves ignore the need for regular blood testing every 6 months. This is important for many reasons. One reason is this is how physicians determine that your organs are not being negatively impacted by what you are taking. It confirms that you are getting proper amounts of hormones so that you can get the most benefit from taking them. You just might not be getting the serum levels of hormones up to where they should be in order to be most effective! It allows you to be aware of your cholesterol levels which can affect your heart and arteries and your liver. Adjustments can be made with other drugs, you don't necessarily have to cut back or eliminate HRT with this information if things aren't in balance.

One of the many reasons people don't go to their personal physician is because they continue to experience guilt and shame over experiencing gender dysphoria. That is something that occurs frequently and needs to be addressed, I've been there. I had literally had an old country doctor who was getting near retirement. My own guilt and shame at the time prevented me from going to him and telling him about myself. My solution was to ask my gynecologist to refer me to a female doctor as I'm not keen on having men seeing my body. So now I have a female primary care doctor who I can go to and talk to without feeling ashamed of myself. Whatever you have to do to get rid of the guilt and shame to have a health care provider you trust, please do it. You deserve nothing less than quality health care!

Another thing to consider is that you may be paying way over what you should for those black market hormones. Did you know that a prescription for 90 days of the maximum therapeutic dose of estradiol is $36.00 (U.S.) at Walmart, Kmart, Kroger or Martins for example of stores in my area? That's $12 dollars a month! That's dirt cheap. Most insurance companies' co pays would be higher than that. So isn't it worth dealing with your fears to find a competent practitioner you can trust? Then you know you are getting what you are supposed to be getting. How much is Spironolactone? $18.00 for 90 days at the recommended highest dose. Some of us take progesterone and there is some debate whether it is at all helpful or not in breast development. Generic progesterone is also inexpensive. My gynecologist prefers Prometrium because it is bioidentical to women's natural progesterone. It is expensive though. The maximum dose runs me a bit over $100.00 a month. In 6 more months I'll make a decision whether this is benefitting me or not in terms of breast development. If after 18 months on it and the results aren't that much, I'll likely discontinue it.

"Sherri, you don't get it, do you? I live in BFE (that is a remote place in Egypt). There is no doctor where I live who I can trust to go to or is willing  to prescribe HRT. I know this for a fact because I have called around."

Ok fair enough, not all health care professionals are as enlightened as I am or as enlightened as the ones who take care of me. I'll grant you that.

At least, go get your blood work done every six months, Please, please, PLEASE! get your liver and kidney functions tested and cholesterol too, even if you choose not to tell the doctor you are doing it on your own. We have a term for that. It's called HARM REDUCTION.

Speaking of harm reduction, being a member of WPATH, we strongly advocate harm reduction. What does that mean? It means that anyone who comes to see me on DIY hormones goes to the head of the class. I issue a letter of referral and give my patient the names of two, soon to be three doctors in my area who are willing to prescribe HRT for trans people. I give this letter on the second visit.  Harm reduction is the overriding principle and it is a principle supported by the WPATH standards of care. I want my patients to be safe!

Please consider these thoughts when you decide whether you decide to go see a doctor or do it yourself. You only get one shot at HRT and it has to be done right so that all we have to endure pays off on our journey to be who we truly are! What good is it, if one ruins her health on the journey?

Do the Gender Police Confront You?

Sheri Berenbaum led a thought-provoking discussion about the often-debated topic of gender differences. An inquisitive crowd kept Berenbaum on her toes as she answered questions concerning whether gender differences are innate or learned. Drawing on over 15 years of research on congenital gender disorders—and using props such as Legos and make-up kits to illustrate her points—Berenbaum challenged the audience to "think outside the box" about the mix of social and biological factors that make us male or female. Sheri can be found on the web and also at her University, Penn State.

The Gender Police have drawn hard lines on people of my experience. We have the extreme Right who would say our very existence is an abomination and we have the extreme left who insist that we must identify as some blend of gender that is neither wholly male or wholly female. I find one as constraining as the other.

I wonder where it came from that if we were free and perfectly healthy individuals that if we identify as women, we are not respected as women or if we identify as men, we are not respected as men. This is the problem of the extreme Right. We simply want to live our lives and be left alone to the right of privacy as any other American Citizen.

The other side of the equation exists from the extreme fringes of Feminism and is solely an extension of Womens' Studies professor Janice Raymond's ideology. Even today as she rewrote a foreward to her book The Transsexual Empire: The Making of the SheMale.  Even with her new forward, which is a rather shallow apology to transsexual women, she still sees us as victims of a patriarchy. She was unable to and continues to fail to recognize that we are woman who for many different reasons ended up at odds with our assigned gender. The majority of these do not involve obvious anatomical variations. For this reason being politically coerced into a continuum known as "Gender Spectrum" includes vastly different presentations because of vastly different etiologies, makes us pawns in a political struggle between Left and Right.

Interestingly, the most negative people about the realities of our lives both as individuals and in varying collectives include the extreme Right and the Extreme Left.

For one group, our very existence on the earth is anathamema. For the other group, our very right to a unified gender identity is sacriledge. I find both extremes both nullifying simultaneously.

At this time in our culture, very few who wish to fall under the umbrella  of transgender identify as gender queer. They have every right to that identity. It's not my identity. I do not consider them to have the same orientation of gender or have much in common with me other than a political desire to be left alone and become the best me I can be.

Similiarly people who feel a mix of their genders but have no burning urge to match their physical being to their identity, may be known as transgenders, crossdressers or by other labels that they define themselves by, have every right to be left alone and become the best people they can be.

Simply put, I am a woman. This is not a sociological statement, nor is it a political statement. It is who I am. There are more women who were correctly assigned at birth and individuals such as myself who were not, but sought to correct that error. I do not identify as a third gender or a fourth or a fifth. I'm just a woman.

This is a dual journey that I travel. I am the gender therapist and the gender patient, I bring my experience, professional and personal to the therapeutic alliance. All therapists do that. It is somewhat more unique for my patients as I am also someone who has been going through a legitimate process per the standards of care established by the World Professional Association of Transgender Health, a body of which I am proud to me a member.

As many of you know, I have been developing a comprehensive health care system for transgender people in the Shenandoah Valley of Virginia. I have been instrumental in initiating the Speech and Language Department of my health care system to offer voice and communication therapy for transsexuals in order to be able to communicate in a gendered manner that is congruent with our identity.

In announcement to a health care online network, this program was rebuked with a harsh and in my opinion, unwarrented attack. The author of this attack who is a faculty member of a large institution of higher learning, stated that she found it highly offensive that such a program would state that the therapy offered would improve the ability to communicate in a more masculine or feminine style, depending on the preference of the patient. She stated that because of this, she would not wish to refer anyone there for voice therapy.

Personal disclaimer: I was involved in the initiative to develop these services, provided a number of training resources and linked them with other Speech and Language therapy professionals who are members of the World Professional Association of Transgender Health in their field who could be of further help in developing the program that we offer. In my opinion, they have developed a quality program that I myself have participated in and am so more than just comfortable in referring my patients who are interested in these types of services.

What I find to be most outrageous of this experience is the lack of forethought in the reckless condemnation of a service that person has no personal knowlege of, just a blind conviction of an ideology leading to  the same type of rigid results that the extreme right can be accused of (and rightfully so at times).

This is why I always say that I have found as much as bigotry, prejudice and hatred on the far right and the far left.

The issue at hand that I object to is that this person made a judgement that this person knows better for you than you do, therefore would not even grant you the opportunity to decide if this service would be helpful to you or not. Considering the philosophical orientation of this person, I find as much patriarchy in the Third Wave Feminist theory as they railed against in the Second Wave of Feminism. Each wants to control you, just to a different end, but neither will be the one of your own determination.

A pity, isn't it? I've seen absolutely no growth since Janice Raymond. 

Practicing What I Preach: My Life With the WPATH SOC

I'm sure that some people must imagine that because I am a therapist that I can scoot around the Standards of Care and get what I want using my professional connections with other professionals who work with trans people, but I don't believe that would be in my best interest for my own health care. So I abide with the Standards of Care in my own life. Would you want to have open heart surgery by a doctor who didn't have a standard of care for that procedure?

I have been an advocate for the Standards of Care long before I became a member of WPATH. I know that some people deeply resent the existence of a standard of care and being required to follow a process. Consider this though; The National Center For Transgender Equality (Transequality.org)  and The National Gay and Lesbian Task Force commissioned a survey that reported a number of terribly sad statistics of what many of us have experienced, some things I have personally experienced over the years. 41% of trans people who were surveyed had attempted suicide at least once as opposed to the general public whose rate of attempted suicide is only 1.6%. For those of us who are unemployed, lost a job due to discrimination, or have been forced into sex work, the rates are much higher and for people of color the attempted suicide is 49%. I find these rates appalling and unacceptable.

Addiction and substance abuse are also terrible problems for us. 70% of the survey reported current problems with substances overall. 3% have been denied access to substance abuse treatment programs and 4% have experienced mistreatment while participating in substance abuse treatment programs. As a professional who also has spent a significant part of my practice in substance abuse treatment, I recognize that it can be absolutely crucial to catch a person at the moment they are willing to get into treatment or that moment will be lost and not come around for quite a long time, if ever. If you miss that opportunity, it could literally be fatal. 25% experienced either denial of care or being treated poorly by doctors' offices or hospitals and 16% were denied help or were mistreated in emergency rooms. 12% reported denial of help or were mistreated in mental health clinics. Simply unacceptable.

Another reason to seek out healthcare professionals who use the framework of the Standards of Care is because of the discrimination we face from healthcare professionals which bothers me quite a bit both personally and especially as a health care professional.  Professionals who use the standards to guide practice will likely have a network of local health care providers who can be sure that you have equal access and are treated with the dignity any person is due.

Half of us report we have had to educate health care professionals on our needs and how to treat us. Fortunately, there is a national effort directed by the National Institutes of care to educate the health care community to provide us with competent care. Having WPATH's Standard of Care, provides health care professionals a quick way to get up to speed on how to work with trans people.

One of the pitfalls that some health care professionals fall into is solely relying on the standards and not tailoring them to the needs of the individual. The SOC clearly state that they are not to be rigidly used and state they are a guide to practice. They were not meant to be followed by rote with each patient. Often in the beginning of the learning curve, a professional will tend to rely on them more often ver batim, but as experience is gained the professional often feels more comfortable in relying on their own clinical judgement. I think that I would prefer a practioner who followed them as written rather than practicing in ignorance and possibly making a serious mistake in my own care.

SO all in all, I think having the WPATH SOC benefits us and that is why I use them personally and professionally.