Transmen and hormones.
[There is a solid general article on FTM hormones, written by a physician,
targeted for other physicians. This article was written from Wisconsin-based
physician Kathleen Oriel in the Journal of Gay and Lesbian Medical Association,
in 2000. You can find the article, entitled, Medical Care of Transsexual
Patients at http://php.ucsf.edu/PatientEd/MedicalCareofTransexualpts.pdf]
Many medical providers are uncertain (and sometimes unwilling) how to treat a
transgender person. They may feel they don't know enough to prescribe hormones
at the "right" dose and/or have concerns about short and long term health
effects. Of the physicians that are interested and willing to treat (prescribe
hormones, in this case), most are "traditionalists" -- believing that e.g.
200mg/ml of injectable testosterone every 2 weeks is the "right" dose. They
determine what special legal release forms they may require their trans patients to sign before treatment. They may have a predetermined schedule of blood tests and expected results -- rather than running tests when a need arises. They may terminate hormone therapy if a patient does not continue in psychotherapy.
Basically, many physicians have a plan, which they may slightly modify for individual differences, but they don't deviate far from this
plan.
What do physicians do when a person comes in and states they want to start on a low dose of hormones (and stay at a low dose)? Or when they specify that they want to use patches rather than injections? Or they report that their body overall feels better on higher doses of hormones?
These and other questions/requests can be difficult for physicians. The line between where physicians vs. where the
consumer knows best might be quite blurred. Physicians may feel an obligation to "do no harm" -- thus assessing (assuming?) that low or high dose hormones may create harm or illness. The reality is, though, that LITTLE is known about "cross gender" hormone use -- and even less about "variations" from what has grown to be commonly accepted as the norm.
Some trans people may question the equality in proactive and personally tailored healthcare options for trans people vs. options that are available to others. For example, a 30 year old post-hysterectomy woman is often given the choice about hormone replacement. She could opt for no hormones at all, or predominantly estrogen-based replacement or a blend of estrogen-progesterone-testosterone. Obviously, some physicians may have a clear bias, but frequently the woman is presented with options from which she can choose.
Fortunately, some physicians who work with trans clients are becoming more open to the wide range of possibilities
they can present to their clients. Likewise, many physicians are recognizing that their clients have the potential to educate them and that the trans person's anecdotal experience may be more accurate than the limited medical literature!
visit www.transhealthcoordinators.org for info and resources!
targeted for other physicians. This article was written from Wisconsin-based
physician Kathleen Oriel in the Journal of Gay and Lesbian Medical Association,
in 2000. You can find the article, entitled, Medical Care of Transsexual
Patients at http://php.ucsf.edu/PatientEd/MedicalCareofTransexualpts.pdf]
Many medical providers are uncertain (and sometimes unwilling) how to treat a
transgender person. They may feel they don't know enough to prescribe hormones
at the "right" dose and/or have concerns about short and long term health
effects. Of the physicians that are interested and willing to treat (prescribe
hormones, in this case), most are "traditionalists" -- believing that e.g.
200mg/ml of injectable testosterone every 2 weeks is the "right" dose. They
determine what special legal release forms they may require their trans patients to sign before treatment. They may have a predetermined schedule of blood tests and expected results -- rather than running tests when a need arises. They may terminate hormone therapy if a patient does not continue in psychotherapy.
Basically, many physicians have a plan, which they may slightly modify for individual differences, but they don't deviate far from this
plan.
What do physicians do when a person comes in and states they want to start on a low dose of hormones (and stay at a low dose)? Or when they specify that they want to use patches rather than injections? Or they report that their body overall feels better on higher doses of hormones?
These and other questions/requests can be difficult for physicians. The line between where physicians vs. where the
consumer knows best might be quite blurred. Physicians may feel an obligation to "do no harm" -- thus assessing (assuming?) that low or high dose hormones may create harm or illness. The reality is, though, that LITTLE is known about "cross gender" hormone use -- and even less about "variations" from what has grown to be commonly accepted as the norm.
Some trans people may question the equality in proactive and personally tailored healthcare options for trans people vs. options that are available to others. For example, a 30 year old post-hysterectomy woman is often given the choice about hormone replacement. She could opt for no hormones at all, or predominantly estrogen-based replacement or a blend of estrogen-progesterone-testosterone. Obviously, some physicians may have a clear bias, but frequently the woman is presented with options from which she can choose.
Fortunately, some physicians who work with trans clients are becoming more open to the wide range of possibilities
they can present to their clients. Likewise, many physicians are recognizing that their clients have the potential to educate them and that the trans person's anecdotal experience may be more accurate than the limited medical literature!
visit www.transhealthcoordinators.org for info and resources!
