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.
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.
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.
No way he's a tumblrina. The idea of him using reddit is funny, but I don't buy it. Can you imagine him using twitter, though? Losing his shit over people's shitposts because he takes everything too seriously, responding to everyone in the comment section of some obscure posts. Making tweets responding to all the Burachovsky allegations?
two of the transfems youre friends with have been talking to you about the clinic they got their bottom surgery done at. apparently its dirt cheap, and the surgeon - despite some oddities and, your friends admit, poor hygiene - is incredibly talented. theyre more than happy to give you her phone number when you ask, and while it sounds simultaneously incredibly sketchy and way too good to be true, at this point youre just so broke, desperate, and tired of gatekeepers that you're willing to give it a shot.
you call on a thursday afternoon, and the call is picked up on the fourth ring, when youre just gearing up to hear an answering machine. the voice on the other end sounds like a middle-aged woman with a smoking habit trying to sound like a cheery, bubbly young girl, and mostly succeeding. hiiiii! what can i do for you? she asks. you say er im looking for a surgical clinic is this the right number? she says mhm! thats me. you say okay, i just have a few questions. she says shoot. you say do you take patients who arent referred to you? she says nobody refers patients to me so yes. then she giggles. youve never heard somebody pull off a giggle in real life. you ask okay, so ive been looking for a place to get my metoidoplasty done, can you do that here? she says i dont know what that is give me like five seconds. then the line goes silent. you can hear her typing on a mechanical keyboard and humming to herself as she reads. youre now convinced that this is not in any way a legitimate medical institution.
youre about to hang up when she comes back on the line. OH you need a dick she says. sure i can do that! does tuesday afternoon work for you? i have that morning free too but i HATE getting up in the mornings so id rather not schedule it if i have to. you say tuesday afternoon is fine, how long should i expect the visit to be? she says i dont know like seven hours? you say seven hours? she says yeah give or take a few, every person is different so i dont know what itll be like until ive got your cunt opened up. honestly probably best to take the whole day off just in case it turns out to be a tough operation. you dont respond to that immediately. she says oh shoot should i not use the word cunt, is that too gendered? sorry. you say no its fine. you say i thought i was just going in for a consult? she says i mean yeah if youd rather. i dont mind doing same-day but some people like having more time to think about their options. do you have somewhere to be tuesday night or something? you say no its just... no tuesday afternoon should be fine. she says okay great!
she gives you her address. she says knock three times so i know its you and not my parole officer. parole officer you ask? she says im being good i promise but i still hate talking to him hes boring. you say if you dont mind me asking what were you imprisoned for? she says the ones i plead guilty to at the trial were a hundred and ninety-two counts of first-degree murder with a parahuman ability, two hundred and fifty-six counts of physical and emotional torture with a parahuman ability, five hundred and six counts of intentional infliction of emotional distress with a parahuman ability, four hundred ninety-eight counts of aggravated assault and battery with a parahuman ability, four hundred twenty five counts of domestic terrorism with a parahuman ability and two hundred and twelve counts without, three counts of arson, two hundred forty two counts of burglary with a parahuman ability, three hundred eight four counts of robbery with a parahuman ability, four hundred twenty seven counts of abduction with a parahuman ability, a hundred eighty six counts of human trafficking with a parahuman ability, three hundred ninety counts of destruction of public property with a parahuman ability, eighty counts of possession of a controlled substance, more than three thousand conspiracy and complicity charges in various felonies, eighteen violations of the Geneva Conventions, and the unauthorized practice of medicine. i plead not guilty to the larceny, sexual assault, contempt of court, corporate espionage, and identity theft charges and the prosecutor didnt really try to fight it since i had already earned seventy life sentences from the other stuff so im technically innocent of those.
you dont say anything to that.
after three seconds of silence she says sooooooooo i'll see you tuesday? you say tuesday, yeah. what was your name again? Riley, she says. Riley Grace Davis. you say thanks again and then hang up.
you debate constantly during the intervening days whether you should go on tuesday. youre grateful your friend group is so slutty; it means youve already seen with your own eyes that this surgery is real and not just a lure to murder you. still, you have some reservations, which you think is perfectly understandable.
you call one of your friends whos been there already. she picks up and you say if this is a joke its only sort of funny. she says if whats a joke? you say the clinic. you say you DID give me the actual number to the place where you actually had your bottom surgery done right? she says yeah, dont worry the surgeons so sweet. you say she admitted to doing two hundred murders when she was on the phone. she says i dont know anything about that but i trust her. you say if i end up dead, kidnapped, or mutilated, its your fault. she says dont worry about it.
tuesday comes. you never agreed to an exact time so you show up as early as you can and still have it be "afternoon" in your mind - 12:30. you climb the rusted fire escape to the third floor door and knock three times. the door is answered by a woman six feet tall in casual but very nice clothes with frizzy brown hair and an expression you cant read. you say er, riley? she says nope. another girl pushes past her, exasperated. she's maybe five foot two and her wavy blonde hair is worn down, with a red bow in it. she's wearing torn jeans - naturally torn, not the sort that you buy with holes in them that youve always hated but the kind that were once normal jeans and now have worn through much of the fabric on the knees. her tshirt is faded and has stains that you cant quite place on it, but youre pretty sure it was once Eidolon merchandise.
she says damnit amy let me answer the door next time. the taller woman, amy apparently, shrugs and steps aside to let you in riley claps her hands together once youre inside and the door is shut. introductions! she shouts. amy, this is, er... I never actually got your name? you tell them your name. she says right! hes one of my clients. and this is Amy, my sister. dont worry about her, shes just a little awkward. amy says can you PLEASE not introduce me as your sister. riley says make me. then she grabs amys shirt and pulls her down, standing on her tiptoes at the same time. they kiss in a very un-sisterly way. you clear your throat politely.
riley breaks away and says right, yeah, sorry! i get distracted easy. youre here to get a dick right. you splutter a bit, both at the bluntness of the question and the fact that amy is still standing right there. riley follows your gaze. she says oh dont worry about her! sorry, i wouldve run her off earlier, i thought you wouldnt come by for another few hours. you say sorry. she says dont worry, its her fault. amy says you didnt tell me you had a client. riley says you didnt ASK. you clear your throat politely again. you say er yes, i did come in for metoidoplasty. she bites her lip and furrows her brow. she says metoido... oh right. well i dont really do that here but i can give you a dick. you say uh im not really interested in phalloplasty. she says whats phalloplasty? amy says its the construction of a penis, usually via tissue flap taken from another part of the body, often followed by the insertion of prosthetics to allow the constructed penis to achieve erection. riley says oh, huh. yeah i dont do that either. i can give you a dick though. she takes a second then puts on an exaggerated scowl. who would want that she asks? amy says lots of people prefer it to metoido for aesthetic reasons or because they dont think theyll be large enough for penetrative sex with metoido. riley says but it wouldnt feel like a dick! man, some surgeons are talentless hacks.
you clear your throat again. you say so if youre- riley says youre clearing your throat a lot, are you okay? you say im fine, its just- she says oh duh were being so rude! why are we all standing around here. come sit down in the living room, do you want anything to drink? she leads you into the living room. it has the unmistakable air of a room thats been cleaned recently, with vacuuming marks present in the carpet and the unmistakable scent of air freshener. the sofa that you're gestured to sit on is, by contrast, unbelievably filthy. stains of every sort are visible on it - some of them are obvious, like the patches of blood and vomit or the ring of a coffee mug. others take you a second to place, like the crusty streak along one cushion that you realize all at once is semen, or the sticky yellow parts that you hope to god are honey. some of them, like the muddy green handprint along one arm of the sofa or the deep black smudge along a seat, are completely foreign to you. you can smell it from several feet away.
amy notices your hesitancy. she says i keep telling her to throw that thing out. riley says and i keep telling HER that its a relic from earth bet! its an antique and itll be worth millions soon. it just needs a good deep cleaning. amy says what that sofa needs is a bullet, not a deep clean. you sit down. drink? riley asks. you say er what do you have? she says water, diet coke, vodka, coffee. no more beer though, SOMEBODY drank the last one. amy says you never said they were off limits! riley says they arent, im just teasing. you say waters fine. riley says aaaaaaaaaamyyyyyyy, could you pleeeeeeaaaaaaaase go get our guest a glass of water and me a diet coke? oh and can you grab the pill bottle on the second shelf of the spice cabinet. amy says sure, i'll be right back.
riley sits down next to you. she says sooooooo what do you want for your dick? you say sorry, if youre not doing phallo or metoido then what exactly are you offering? she says no offense but it would take like literally eight years to give you enough background info for you to understand my explanation, and i dont have that kind of time. im not getting any younger. except for when i am. she laughs louder than you thought a human could. you have no idea how to describe the sound of her laughter. she says just tell me about your dream dick and ill give it to you. trust me, im a doctor.
except that youre not, amy says, returning with glasses and pills in hand. she sets the water down in front of you and you immediately take large gulps, feeling very much lost right now. riley says am TOO, accepting the pill bottle and diet coke from amy. she frowns. why is it can diet coke, she asks? she says glass bottle is so much better. she says why did i even BUY can. amy says they are literally the same liquid, what do you mean its better. riley says theyre not the same, stop deluding yourself. amy says which of us is the REAL doctor? riley says both of us! the PRT finally issued me an equivalency. youre talking to doctor riley davis, MED. amy says oh really? congrats she says. riley beams. then she unscrews the lid of the unlabeled, dark brown glass bottle, grabs three pills, and pops them into her mouth.
what is that you ask. ectasy she says. you want some? you say no thanks. she says you sure? you say i probably shouldnt take drugs before an operation, what if it interacts with the anesthetic? riley says dont worry, i made my own anesthetic that has zero drug-drug interactions. amy says except with sudafed. riley says ok YEAH except with sudafed, how was i supposed to know? she glances at you. you dont take sudafed do you she asks. you say no. she says good. it was such a bitch cleaning the pus off the ceiling she says. you say huh? she says dont worry about it, you dont take sudafed. she says are you sure you dont want any ecstasy? i promise its pure. you say i dont want to get addicted. she says i can surgically remove the addiction pathway from your brain if that would help. amy says riley, no means no. riley says fine. do you want any ecstasy babe? she says no thanks. riley frowns. she says you guys are a bunch of squares. she pops a fourth one and starts chugging diet coke.
she slams the can down after drinking what must be half of it, wipes her mouth with her arm and grins. sorry, we keep getting distracted! she says. she says im getting into the start of a manic episode and that always makes me roll right over people in conversation. what do you want for your dick? you say um. i hadnt really thought about it. its not normally a choice beyond the type of surgery, you sort of just end up with whatever the doctors are able to make work? thats lame she says. why are normal doctors all so lame she says. ok, rude amy says. OBVIOUSLY im not talking about you babe riley says. and stop distracting me from my client! amy holds up her hands in mock surrender, an easy smile on her face.
you didnt bring a toy with you did you, riley asks. you say huh. she says sometimes people bring a toy that they want me to model it after and that makes everything a lot easier. you say no you didn't. you say i hadn't really thought about my preferences, can we go dealer's choice on this? amy pipes up. she says you REALLY dont want riley to go dealers choice. riley says shut up and get me another diet coke, i just finished this one. amy says yes princess. you honestly cant read whether it was meant to be mocking or endearing. riley turns back to you. ok, she says, lets start with basics. primate? canid? equine? suine? dolphin? i could give you a hyena pseudopenis but i dont know if that would be offensive. you say human is fine. she says please dont tell me you're gonna just be boring this whole time. you say define boring. she sighs deeply and starts massaging her temples. amy, having stepped into the room in time to hear the last bit of conversation, tousles rileys hair. she says sorry babe, customer's always right.
you work out the appearance of your soon-to-exist cock this way. riley asks questions about length, girth, hair, amount of semen generated, percentage growth when erect, and you try to give what you think are average answers every time. amy watches, bemused, the whole time. halfway through she leaves to get the bottle of vodka. she drinks five shots in fifteen minutes. you say i didnt think the human body had that much capacity for alcohol resistance. she says it doesnt. riley swats playfully at her arm.
eventually, riley grabs a set of crayons and a cocktail napkin. she says ok, i think we got it, scribbling furiously. she shows you a crayon drawing of a dick. this look good she asks? you squint at it. there are no measurements given and the medium does not allow you to make out any fine detail. you say yeah thats fine. amy tries and fails to hide a smile. riley chucks the napkin aside and rubs her hands together. boring parts done! she says. time to get messy she says. amy pours a sixth shot of vodka. she says dont forget the anesthetic first. riley rolls her eyes. she says OBVIOUSLY i didnt forget the anesthetic. she says ill be right back. as soon as she leaves the room, amy knocks back her shot. she turns to you. she says you mind if i stay and watch? she says i dont want to make you uncomfortable, but i like watching her work. shes cute when shes working. you say at this point youre not sure you would mind anything at all. you say at this point you dont think you would be fazed if she came back with a fully-formed dick wriggling around in her hand like a fish and sewed it onto me. she says dont tempt fate.
riley comes back with a black bag the size of her head, which she sets on the coffee table with a thunk. she points at you and says okay, clothes off. or pants off i guess. you can leave the shirt on. or take it off. i dont care. you take it off. she tells you to lie down and starts pulling things out of the bag. amy stands up from the sofa to give you the space to stretch out and sits on the coffee table instead, one leg pulled up to her chest with her chin resting on her knee.
riley pulls out a syringe from the bag, filled with pitch-black fluid. she says okay this will hurt for a second but only for a second. you say huh? she flips you over onto your belly and jabs the needle against your lower back, into your spinal column. it hurts like a bitch for all of two seconds and then you stop feeling anything at all in your lower body. you also cant move your legs, you realize. what just happened you ask, as she flips you onto your back again. she says i just killed all the cells in the nerves in your lower spine. she says its the easiest way to make sure none of the pain signals slip through, and she'll just replace them with living ones when she's done. you don't know how to respond to that.
she pulls more things out of the bag. a cartoonish array of different cutting implements come out. most of them are various sizes of medical scalpel, ring cutter, or saw, but you also see a pair of chunky pink safety scissors, a pizza cutter, a serrated bread knife, an x-acto, a drill with a comically long bit, a pair of wire cutters, gardening shears, and an awl. she says okay im gonna start operating so look away if you dont wanna see how your crotch looks while its being rearranged. especially if you think you might puke, i hate having to stop to clean up puke in the middle of surgery. you look away. you notice amy is watching transfixed.
for a couple of hours things go on like that. amy and riley make light conversation, with riley filling any silence by humming a wordless tune you dont know. the sounds and smells youre getting are enough to make you slightly sick; you continue not looking.
in the middle of hour two, riley stops. oh goddamnit, she says. what amy asks? riley says she forgot that shed need extra meat. amy says you started a surgery to give somebody a whole new organ and forgot youd need more tissue to do it? riley says shut up, im dumb. amy says no youre not babe. riley says ughhhhh now what. amy says just get his stem cells to grow the tissue you need. riley says nooooooo thatll take forever, and i have places to BE tomorrow, and if i stop putting pressure on him here hes going to bleed out through his cunt. you say wait, what? amy says well i dont know what you want me to do about this situation, i gave you my solution. riley says baaaaaaaaaaabe. amy says whaaaaaaaaaaaat. riley says i think we have some bacon in the fridge, will you pretty please with sprinkles on top go get it? amy says and what do i get in return? riley says a kiss. amy says id get that anyway. riley says my undying love and affection. amy says i have that already. riley says not making me angry at you so you can sleep under my roof without having to worry that ill turn your sweat glands into acid glands in the middle of the night. amy says that, plus i get to top tonight. riley says fiiiiiiiiine, just go get the bacon. amy gets up.
you say look uh i know you said not to question what youre doing but i kind of dont want a dick made of bacon, not to sound ungrateful. also did you say something about me bleeding out? riley says dont worry, if you bleed out ill put the blood back in, im a professional. you say thats not as reassuring as she thinks it is. riley says whos the doctor, mister? you say technically both of us. i have a phd in social sciences you say. she says wow, theyre just giving out doctorates for anything these days, huh? you say hey, rude. she says only teasing. you say anyway, uh, you didnt address the bacon dick thing? she says oh dont worry about it, my amys amazing, youll see.
amy comes back in with the package of bacon. do you need this in any particular shape she asks. riley says nah just give me a good amount of it. and make sure its spongy, so when he gets hard the blood can- amy cuts her off. she says dont worry, ive given you enough penises at this point that i think i know what penile tissue is like at this point. you say given her enough penises? what the hell does that mean? riley says hey, dont kinkshame! she sounds legitimately offended. you say sorry. amy pulls the bacon out of the package, holding it aloft in her left hand. you watch as the familiar look of a half-pound of bacon shifts and warps into a strange lump of fatty, spongy tissue of a waxy color. she hands it to riley. riley says thanks sis youre the best, love you! amy says no problem. riley says id kiss you if i wasnt elbow deep in this guys cunt right now. amy says kiss me after the surgerys done.
another two hours go by. the sounds of flesh being chopped, sawed, and stitched underscore riley and amys meaningless conversation about whether they HAVE to attend their acquaintance lisa's birthday party. riley says lisa probably wouldn't throw a birthday party if there wasn't some sort of scheme going on. amy agrees but says that doesnt indicate whether they should get involved with the scheme or not. you wonder dimly if you will ever feel your lower body again. you wonder if this is purgatory, an endless afternoon of lesbians bickering affectionately while one of them does surgery on you. you turn your head enough to look at the clock. its 5:26pm. where the fuck did the time go?
another hour passes. riley stands up. she is soaked up to her elbow in various bodily fluids - mostly blood, but youre not looking too closely. she says finally! she says just need to regrow your nerve cells now. you say is that going to take long? she says like twenty minutes maybe as she flips you over. you say ok. she jams a different needle into the same spot, injecting a strange yellow paste into your spine. she then flips you onto your back again. you feel brave enough to finally look at your crotch.
there is a completely normal human penis of average size there. you reach a hand down and touch it. you dont have any sensation in it yet since your nerves are all still dead, but it feels warm and soft under your hands. you smile, feeling tears come to your eyes. its over.
rileys talking. she says i followed your specifications except i had to cheat a bit on the nerves, you actually didnt have very many in your clit for whatever reason so your glans has maybe eight thousand fewer nerves than you wanted, sorry about that. she says i gave you balls in your scrotum for shape but since you said you didnt want kids they dont produce sperm. let me know if you want that changed she says. she says it should be fully functional in every respect, but if you notice any erectile dysfunction, incontinence, discoloration in urine or semen, priapism, or any other issue come back and we'll sort it out. if you notice it bleeding in ANY capacity, call me immediately. if im not answering call Amy, ill give you her number. if SHES not answering either then you can start seeing normal doctors, not that those idiots will know how to help you probably. if you want any changes to it call me and ill pencil you in to get it adjusted. get all that she asks. you nod. she says cool. she says itll be like $200, no rush if youre not able to pay right now. you say it might be a bit since youre still trying to pay interest on your student loan debt. wait, she says, they have student loans again? you nod. she says the world ended like thirty years ago, when did they set up student loans again? fuck, how much do you owe? you say a little under eighty thousand. she says jesus fuck, nevermind, its free. goddamn. you say thank you so much. she says yeah of course. do you want us to dress you or do you want to wait until you can move and do it yourself?
