TRANS WOMEN: HERE'S SOME SHIT YOUR DOCTOR WONT TELL YOU ABOUT HRT

1. Progesterone: not for everyone, but for many people it may increase sex drive and WILL make your boobs bigger. Also effects mood in ways that many find positive (but some find negative). Most doctors won’t prescribe this to you unless you ask. Most trans girls I know swear by it.

2. Injectible estrogen: is more effective than pill or patch form. Get on it if you can bear needles bc you will see more effects more quickly.

3. Estradiol Cypionate: There is currently a shortage of injectible estradiol valerate. There is no shortage of estradiol cypionate. Functionally they do the same shit.

4. Bicalutamide: This is an anti-androgen that has almost none of the side-effects of spironolactone or finasteride. The girls I know who are on it are evangelical about it.

@euryale-dreams

Are there HRT medications that don’t increase blood clot risk? I’m already at risk because of my blood pressure, and my doctor won’t prescribe HRT that increases clot risk while I’m on the medication - and I may never not be on the medication.

Absolutely.

The concerns surrounding venous thromboembolic events as a side-effect of hormone replacement therapy can mostly be traced back to one particular study known as the Women’s Health Initiative. This study was an enormous undertaking which, unfortunately, demonstrated significant adverse effects of the hormone therapies studied. As a result of this the use of hormone replacement therapy in postmenopausal cis women was dramatically reduced as the medical community began to question whether or not the therapy caused more harm than good.

Naturally, trans women have been suffering from this fall-out ever since.

What physicians seem to fail to recognize is that the study examined a very specific hormone regimen which was, arguably, outmoded at the time the study was conducted: It examined the use of conjugated equine estrogen (Premarin) with or without the use of medroxyprogesterone acetate. Neither of these drugs is regularly used for the treatment of transgender women.

The estrogen most commonly used to treat transgender women nowadays is 17β-estradiol either in pill form or in the form of a sticky patch that you apply to your skin. Esters of estrogen (e.g. estradiol valerate) are also sometimes used either in a pill form or as an intramuscular injection.

Transdermal estradiol patches are the gold standard when it comes to treating women who are at high risk of a venous thromboembolic event. It simply does not increase the risk of developing a venous thromboembolism. The only thing you should keep in mind is that patches are not always well tolerated because of the lifestyle changes required to keep them from falling off and the fact that they tend to irritate the skin.

Fortunately, oral 17β-estradiol appears to be safe, regardless of the increased risk. At least one large study has shown that the use of oral estradiol in trans women is not associated with venous thromboembolic events. An individual woman’s risk would need to be substantial in order to contraindicate the use of oral estradiol.

For those who have significant risk of venous thromboembolism because they have had a previous thromboembolic event, because they are paralyzed, or because of some other factor it is good to know the relative risk between oral and transdermal estrogen. The latest research indicates that the use of transdermal estrogen lowers your risk of a thromboembolism to 80% of what your risk would be using oral estrogens.

It’s difficult to find hard numbers regarding the relative risk of venous thromboembolic events with regards to hypertension. The best I could find after an hour or so of searching was this study regarding VTE in lung cancer patients. Hypertension increased the risk by a factor of 1.8.

However, to put that into perspective being of African descent increases your relative risk for deep vein thrombosis by a factor of 1.3 when compared to Europeans. Europeans are, themselves, at increased risk when compared to Asians and Pacific Islanders by a considerable margin: a four-fold increase.

I should point out that being ‘male’ is also a risk factor for developing a thromboembolism and hormones are likely to be a contributing factor. Also, menopause is another serious risk factor. Given this information it is likely that the use of transdermal estradiol will lower your risk of thromboembolic events significantly.

As far as the anti-androgen is concerned: The primary use for spironolactone for cisgender people is as an antihypertensive.

Even if the risk of thromboembolism was truly significant with modern hormone replacement therapy it wouldn’t justify what your doctor is doing to you. The fact is that mortality in the transgender community from suicide–caused in part due to the lack of access to hormone therapy–is substantial. The quality of life lost when a trans woman is denied hormone therapy is substantial. The fact that your doctor does not appear to be taking this into consideration when they weigh the risk of thromboembolism against not receiving necessary medical care is deeply concerning.

I strongly recommend that you seek a doctor who is more sensitive to your medical needs as a transgender woman.

Edit: Fixed a minor, but embarrassing, error.

oh wow this is so helpful & good info

Everyone who cares about transfem people please reblog this

this was really fucking helpful

I know a lot of trans women dont have acess to information like this and its very helpful.

Here’s some stuff I could have used being told when I started HRT:

If you do HRT, you are seizing control of and reconfiguring an aspect of your own metabolism, which is fucking cool and amazing, but despite what medical literature and community knowledge exists, you must always be your own advocate in the process (even if you think you have good doctors). As someone who deals with hypervigilance, I’m not going to tell anyone to be more vigilant, but HRT has myriad and subtle impacts on your body and mind (duh). Some of these you probably want, some of these you probably don’t, but telling the difference can be more tricky than you think.

Really watch yourself for side effects. I don’t mean relatively rare side effects like liver damage or blood clots, but simpler stuff that’s much easier to dismiss as just being transient or bearable, like nausea or mood swings. Such side effects are likely to be be small and easy to deal with in the beginning, easily borne, but if they become more serious over time they can do so so slowly that you don’t realize your quality of life is being reduced, especially if you’re loving many of the effects of HRT at the same time. Don’t accept any side effects of your meds as unavoidable, or akin to a price you have to pay for HRT’s benefits. Just adjusting the dosage of your meds, the times you take them, how you take them, and what you take them with can have a huge impact, but doctors can leave out that this is a process of experimentation, and that finding the right combinations of meds and dosages can take time.

Evangelical is not a word I ever thought I’d use for myself, and I’ve only been on bicalutamide for a week, but wow. If you are using spiro and experience any nausea or stomach pain while on HRT, even if you think it has other causes, or if you’re someone like me who carries their anxiety or fear in their stomach, I’d highly suggest at least trialing bicalutamide in place of spiro, just to make sure you know what’s causing that pain and/or nausea. I took 300 mg/day of spiro for about a year, and was waking up in pain and nausea every day without connecting the dots. Now that I’ve switched anti-androgens and tapered off spiro, in just a week I have twice the appetite and almost no stomach pain. What pain I do have dimishes every morning. So far, bica has been literally life-changing for me.

But I only found out about bica from another trans woman, here on tumblr ( @social-justice-cleric ) . My doctor insists he mentioned it as an alternative, more than a year ago, but frankly he stood by as my stomach pain became worse and worse, and only switched me to bica when I did my own research and asked him to. Don’t underestimate the importance of community and its accumulated knowledge- make sure you find other trans people you can talk about your transition without fear of judgment, especially including talking about any and all biomedical components of it. This is especially important for trans women who tend to socially isolate ourselves in response to stress or uncertainty (aka, me).

And as someone who really wanted results from HRT as quickly as possible, it’s ok if you end up wanting to step back your dosages, or if a medication doesn’t work out. This should seem obvious, but it doesn’t make you less of a woman to slow down or even stop doing HRT. Additionally, don’t assume that the speed at which your appearance changes is necessarily correlated to the amount of meds you take- there is for everyone a threshold of dosage past which there is no benefit (and instead just increased risk). For instance, I just finished a two month trial of progesterone- maybe my breasts developed a little more than they otherwise would have, but mostly I just had slight mood swings that trended slightly more to the negatives than the positive, so I’m not going to keep taking the stuff. And if spiro was the only anti-androgen out there, I might have stopped taking one entirely rather than stay on it. But decisions like these are hard, and intensely personal- your doctor can’t, or at least shouldn’t, make them for you.

Ultimately, all the biomedical means of transitioning are for is getting the changes you want to your body and/or mind. And despite the legal-functionary and regulatory components of biomedical transistion, these means do not make you into a woman. Regardless of whether or not you apply these biomedical technologies to your own transition, you are a woman. Some of us trans women come to accept increased medical risks, or endure physical discomfort, in pursuit of the self and life we want. In this, we are hardly alone among women. And, as is the case for any patient heading into a doctor’s office, what medical experts tell us must always be judged against our own embodied expertise.

Biomedically transitioning shouldn’t be seen as a necessary stage of one’s gender transition- it should be an opportunity available to all of us, but not one we all must take, or need to take, to be happy. Since we live in such a cissexist and transphobic society, biomedically transitioning is for many of us a desperately needed means of survival. And at the same time, and in equal measure, it is also for many of us a source of incredible joy. Listen to your doctor, listen to the community, listen especially to your body and to your own heart, and see what works for you.

Also, as a trans woman who has a chronic liver disease, bicalutamide can be hepatotoxic (damaging to the liver) and so far Spiro is the safest antiandrogen if you are a trans woman or AMAB nb in a similar situation as me. However, bicalutimide has not been tested in hrt doses, which are much smaller than the doses bicalutimide was originally for. Feminization begins as low as 12.5mg and the doses tested were 150mg.

estradiol depot is good replacement for valerate as well. 2nding the injections over pills. you can get so much more estrogen into your system SAFELY when it doesn’t have to be processed by your liver (which is what pills have to do).

It seems like a lot of this advice would be useful to anyone considering or taking HRT -- man, woman, or enby. And absolutely, always be your own advocate. Your health is ultimately in *your* hands, not those of your doctor.

Today we mourn, honor, and remember the transgender people who were murdered because of their gender identity or expression.

Gender and pleasure

So much of the Euro-American understanding of being trans (or anything other than 100% constantly identified with your assigned gender) focuses on discomfort. 

Some people take this idea to an extreme and claim you can’t be trans unless you hate your body and want every surgery available to you. As many other writers have said before, that’s not true. It’s perfectly possible to be trans with only mild dysphoria or none at all. It’s perfectly possible to be trans and have a mental map of your body that looks just like the one you already have. 

But I’d like to push even harder against the idea that trans=discomfort. I’d like to offer this: sometimes the exploration of one’s gender can be motivated by pleasure rather than discomfort. 

Let me give an example. Let’s say there’s a person named Cal. Most people think of Cal as a boy, and Cal’s all right with that. So far as Cal’s concerned, a boy isn’t a bad thing to be. But sometimes, Cal likes to imagine being a girl and being treated as a girl. Those fantasies are always accompanied by feelings of pleasure, satisfaction, anticipation, and warmth. Eventually, having had these thoughts for years, Cal asks people to use ‘she’ pronouns in private and to refer to her as a girl. Cal does this for another year before claiming the label “trans”. 

Some people would say a person like Cal can’t be trans because there’s no dysphoria, self-hatred, distress, or even discomfort. There’s just a pleasure-based preference. But why is distress necessary? Why are trans people supposed to be defined solely by our pain and self-hatred?

It’s my opinion that defining trans people solely by discomfort is an aspect of transphobia. The idea behind trans=discomfort is that being anything other than 100% cis is so awful that no one would do it unless the alternative were unlivable. Think about that: defining trans people solely by their experiences of discomfort means believing that being trans is so awful that only misery could drive us to it. And to me, that sounds like the thinking of someone who really hates trans people.

So I’ll come out and say it: sometimes transition or self-exploration of gender is not just about lessening discomfort, but is about improving and deepening the pleasure we take in our lives. 

“Think about that: defining trans people solely by their experiences of discomfort means believing that being trans is so awful that only misery could drive us to it.”

The number of times lately I've seen people try to exclude trans and non-binary people from the "lesbian" label in particular has dismayed me. Trans women are women. Non-binary people can define themselves as women (demigirls and gender-fluid folk are two examples).

Excluding trans people makes you look like ignorant bigots, and plays right into the hands of the conservatives who want LGBT people stripped of their rights. After the trans people come the bi folks, and guess what, lesbians - you're next.

AlecZander, Ohio

I #WontBeErased. As an 18 year old, non-binary, queer person of color, I REFUSE to be told that in order to avoid harassment, I should conform to the sex stereotypes of America today. I refuse to be told that in order for my government to acknowledge my existence, I must be a cisgender, straight, white american. I will not erase my own identity by conforming. We will not erase our identities by conforming. The transgender community is over 1.4 million people strong and we will not simply disappear just because the Trump Administration wants to define us out of existence.

The Trump Administration’s proposal for redefining ‘gender’ is blatantly transphobic. The proposed definition of gender results in the erasure of transgender and gender-nonconforming people in Title IX’s anti-discriminatory law. This definition would define sex as unchangeable. This proposition would require that the gender of a person be determined by the genitals that a person is born with. If this proposed definition is adopted, it allows the federal government to ignore all issues relating to transgender discrimination under Title IX. When questioned about cases in which transgender students faced discrimination in school, the Education Department’s office for Civil Rights stated that they will continue to investigate cases as “unwelcome conduct based on a student’s sex” or “harassing conduct based on a student’s failure to conform to sex stereotypes.” rather than simply investigating them as what they are, transgender discrimination cases. This proves to the transgender community that our government not only wants to erase our existence, but expects us to conform to stereotypes that our society has placed on us.

18 years ago when I was coming out, y’all made the word “bisexual” so dirty that for years the only word I felt was accessible to me was “queer”, if I had any chance at having a community. 

Queer was widely used at that point among LGBT+ people to refer to ourselves and our community, and while you’d look askance at a straight person using that word, it was most definitely acceptable to call another LGBT+ person queer.

And now y’all are telling me “Queer” isn’t an acceptable umbrella term to use and it just feels like another way you’re using subtle language policing to tell me that really the only people you want in your community are gold-star LG folks. 

Those of us who like the word queer because it accurately reflects our misfit status are basically being told that this self-identifier is dirty and wrong, this is no longer the “queer community”, and the message yet again is that we don’t really belong.

I get it if someone doesn’t want to be called queer, and I would never call another person queer against their will but holy hell please stop acting like it’s common knowledge that queer can’t be used as an umbrella term for our community when it was for DECADES

“q-slur” is a very new concept, kids.

This is something that’s completely overlooked, by the same people who fling the word “ahistorical” at every viewpoint they disagree with.

When I first started participating in any kind of LGBTQ+ stuff online (so, 10 years ago), “queer” was by far the most common descriptor. It was pretty much agreed it had been reclaimed enough to be safe (I mean, show me an active slur that has academic disciplines named after it?) and people seemed much more keen to explore the ambiguity the term offers, rather than sticking with predefined categories. By “q-slur” logic, we should’ve been much less accepting of it back then if we simultaneously believe that LGBTQ+ rights are advancing over time, but the opposite is true.

So I would say that the current stigmatization of queer is based on two things: 1) reactionary essentialism (seeing “queer” as too dangerous for the more clear-cut categories), and 2) respectability politics.

Now by taking away “queer”, we don’t have any other term that’s both catchy (no version of the abbreviation is) and broad enough to actually be inclusive. Gay is not an umbrella term. It always has a default connotation that’s very specific. It only reminds me of all the time I wasted on bad gay-only discourse when I was first questioning my own identity, and for this reason it took ages to arrive at the conclusion that I’m just attracted to multiple genders and also trans without dysphoria (because the other bullshit I had to contend with was the truscum narrative of transness). So, gay is not a safe term for me. It doesn’t describe me and if I used it, it would actually misgender my own relationship. I’m not doing that for any of you, sorry.

Do you know who the majority of the people who still use “queer” are? Trans and MGA. Yet again, we have a political line that privileges cis LG people who are fine with binary categories over the most routinely erased parts of the community. Of course.

This, I imagine, is also why so many bi/pan and trans/nonbinary people aren’t against aces being included. Chances are most of us, at least those who are 25+ or so, have experiences like this, with either being actively policed out or just unable to find the right identifiers for ages because of the stigma and general ignorance surrounding them.

And now you’re telling us we HAVE TO use gay, which isn’t a functional umbrella term, because queer suddenly isn’t acceptable based on this new logic? Do you even hear yourselves?

–

“But!” I can already hear the gatekeepers protest, “This all relies on a bunch of personal anecdotes!”

In which case, buddy, I have bad news for you about the vast majority of all modern LGBTQ+ history.

I first came upon Queer as both an umbrella term and a field of academic study. This was in the early 90s. There were queer studies, queer histories, “queering” of the text, queer theory…

And Queer, more so than other words, felt inclusive of people who, at the time, referred to themselves as “genderqueer” as well as people outside the binary, as well as bisexuals, who couldn’t claim gay or lesbian.

It was, at the time, being reclaimed at a time when all the words were being used as slurs, so there was a real reason to reclaim them.

I’ve problem with using words that people are comfortable using, but not at the cost of erasing parts of our history.

I guess now is the time we’re hitting New Essentialism and Respectability Politics 2.0 from people who aren’t old enough to remember any of this.

Yeah, that’s something a lot of folks in the younger generation don’t get.

When you campaign against words like “queer”, to those of us in the older generations, what it looks like you’re doing is trying to roll the nomenclature back to the bad old days when cisgender gay men were treated as the only “real” members of the community, and everybody else was lumped together as this peripheral pack of weirdos who were expected to be slobberingly grateful to their betters just to be acknowledged at all.

Hell, I clearly recall a time when the leaders of mainstream gay rights activism would routinely castigate even lesbians as parasites and invaders - and be applauded for doing so. It’s difficult to overstate just how deep it went.

And, like, that wasn’t all that long ago - I’m only 33 and I’m old enough to remember that horseshit.

Remember when the acronym was GLBT?  No?  Then please do some reading before yelling about the “q-slur”.

Yes, there have been (and still are) some areas where “queer” is a real pejorative.  People who grew up and had it thrown at them are wary of applying it to themselves.  But that’s what reclaiming slurs is all about.  We make the word ours.  We throw it right back at them, and we make it something to be proud of, until college professors use it in class listings and people write real, serious, supportive books that have “Queer” in the title.  Until the New York Times uses it as a descriptor rather than an insult.  That is where we are now.

The people who are outside binary sexuality and gender, who are outside rigid gender roles, who are outside labels and convenient boxes, have a word now.  It may make the cis white gay men squirm -- too bad, it isn’t for them.  It may make the trans-exclusionary white feminist lesbians squirm -- too bad, they settled down nice and content once the gay contingent threw them the sop of putting “L” first in the four-letter acronym.  Adding more letters to it?  We don’t need that, sweetie, things are fine as they are.

Q is for the bisexuals who never felt like they fit in bi culture -- if they ever had a way in at all.  Q is for the trans people who want to go beyond transitioning, and break down the rigid walls of gender roles and narrow sexual preferences.  Q is for the people who are outside the binary; the people who have always been erased when the “adults” (L and G) were talking; the people who feel like society does not fit their needs and need an identity and a flag and a label of their own.  Q is for the misfits, because goddammit we’re going to rise up and be proud right along with the photogenic gays and lesbians.

Because make no mistake: society hates ambiguity and blurred lines and third options, and there is a contingent under the LGBT umbrella that hates it just as much as “the straights” do.  Using “queer” is pushing back against all of those who want to push us out from under that umbrella.  If you don’t understand the power struggle that’s been going on for these thirty years and more, you might not want to wade straight into the middle of it.

Some trans guy tips from your dad

@shyguyshiloh @kuchenkat

Spread the word, especially for the board shorts thing!!!!!! They do WONDERS for making hips appear slimmer!!!!!

@cloudstreamer

for my masculine children :-*

Adding a couple things. 

-Patience is a virtue you need to come to terms with. Even on T, things take time. My voice dropped immediately, but my cycle continued for 6 months. We’re all different. 

-In the summer, HYDRATE YOURSELF. A binder is an extra layer, and mine have always been very warm. 

-When its not too hot, layers are your friend. You’d be surprised what even simply an undershirt can do to smooth out your look. 

-You are going to get misgendered. This is a fact, and it sucks. Learn to politely correct people. Remember you might be the first (openly) trans person they meet, so be a good ambassador. 

-When you start T, your smell will change. You will sweat like you’ve never sweat before, and it WILL STINK. Adjust your bathing habits accordingly. 

*coughs in direction of my trans friendos*

If you have a really large chest you might do better with Underworks binders. They aren’t pretty, they’re not soft, but they do a good job and were the first on the market for a very long time. I couldn’t stand gc2b so if you’re like me, try Underworks.

Don’t double bind.

DON’T USE DUCK TAPE. I still have scars from a dumb decision I made as a teen and I’m 31 now.

When the time comes for top surgery, shop around. Find someone who will tailor your chest to your needs. Look at their portfolio. Compare surgeons. See if you can find someone who will work with your health insurance if you have it.

Be safe. Be healthy. Take your time. It’s not a race or a competition.

*incoherent screaming* MY TRANS MEN/ TRANS MASCULINE FOLLOWERS, L O O K👀👀👀👀👀👀👀👀👀👀👀👀

OP is right about amazon binders but they didnt stress it enough or give the right reasons.

any cheap/offbrand binder is BAD, but not just,because of shipping or sizing or discomfort. binding with cheap binders or other methods is potentially fatal. I know I’m preaching to the choir and most of you know this but i ALWAYS emphasize that point in case i happen to reach that one person who doesn’t know and is binding improperly or considering it.

Bad binding can break ribs, puncture or crush your lungs, damage your trachea and esophagus, and cause long lasting scarring, muscular issues, spinal issues, and respiratory dysfunction. It can also kill you, and fuck up your ability to get top surgery in the future.

NEVER EVER:

-use binders from anywhere but major, reputable companies like GC2B and Underworks. Bonus if the company specifically markets towards trans folks. Stick to those two companies unless they’re unavailable in your country or something and research any other company REALLY thoroughly.

-double bind!!! Once binder at a time, period. Nothing else. You should never wear a bra of any sort with it either.

-bind with multiple sports bras, this is as dangerous as anything else. One good quality, properly sized sports bra is a good alternative until you can get a proper binder, but using a too small one or more than one is dangerous.

-use a too small binder. Equally dangerous and I’ve also been told it sometimes has poorer results on how you look anyway.

-bind with other materials. Common ones are duct tape or ace bandages. These are about the most dangerous ways to bind out there. NEVER do it. Yes, some people have done it for years with minimal issues. Others have died from one day of it. Do not try it, even just for an hour or two.

To any trans women and transfeminine followers of mine, did you know there’s a pretty huge Etsy store which does gaff underwear and swimsuits specifically designed for trans people amongst its products? They go in a pretty decent range of sizes, including sizes for young girls, and while I do not personally know anyone who has used them, there’s a fuckton of positive reviews on the Etsy store. They have a ton of colours to choose from, different fabric choices, the works.

And for once they’re not marked “for crossdressers” too, they actually under “transgender”, so that’s (depressingly) unusual.

I’m mostly posting this because I’ve seen a lot of younger people recently in particular saying they never knew what gaffs were… a lot of people find them WAY MORE comfortable and convenient than tucking, so I would recommend looking into them if you’ve never done so before!

And even if you yourself don’t use or need this stuff, do pass this kind of info on to any friends of yours that might, guys! There’s always like a million more PSAs about transmasc stuff as opposed to transfem stuf tbh…

This is so wrong bc no matter what the civil law is a medical/mental health professional cannot ethically do that.   

it’s not even limited to therapists, the bill concerns every governmental agent (ie. teachers!!!!) and it affects trans children and gnc children (anyone that show signs of gender non conformity and dysphoria). if the law’s approved, it would be considered illegal for such agents to help out a transgender child by providing them material or mental support. not only that but the law would also protect parents from loosing their child’s custody in cases where the parents refuse their child’s transness (in the bill they talk about transition and hormones)

Confirmed by Time magazine. WTAF, Ohio?

“The graph shows significant increases in left handedness over the past 100 years. Because people are no longer punished for being left handed. The apparent increase in numbers of trans young people is because there is more support for trans people to be themselves.”

Source: @TransActualUK

My mother was left handed.  She was born in 1915.  She had teachers who smacked her hand with a ruler so she wouldn’t use her left hand.  She also had her left hand tied behind her back to force her to write with her right hand.  I’m left handed and never suffered from what she went through.  That said, since EVERYTHING is designed for right handed people, I’ve learned to do several things “right-handed.”  Let me just say, the word RIGHT holds negative connotations for me.

My mother, born in 1944, experienced not-quite-as-aggressive but nevertheless abusive and punishing “incentives” not to use her left hand.  She was smacked for it, other people made fun of her or called her “evil” because of it.

She did anyway, and was a gifted artist.

So this bias against left-handed people lingered for a long, long time (and still exists in some places in the USA, no lie) and it has been a very long climb.

I suspect we will see the same with numbers of trans and nb people.  I believe there are a LOT more than current numbers suggest.  A LOT.

I know if I’d known more about it when I was younger, and had been in a supportive environment, I would have begun questioning my gender much sooner, and would have all this shit out of the way by now.

I came out at 38.  Would I have come out sooner if I had known “non-binary gender” was even a thing?  You’re damn right.

This is not an epidemic.  This is a revelation.