Sep 212015
 

This week’s post is a reader request! Ricki B asked for more information on gender dysphoria before and after transition. While I can’t speak from personal experience, I can dive into the literature and answer the question that way. Luckily there’s a summary article that talks about this very topic!

Gender dysphoria is a term that refers to the distress associated with having a mismatch between gender identity and physical sex. It’s a hallmark of being transgender or transsexual. People with gender dysphoria are often in intense distress. Some (but not all) individuals try to commit suicide, self-castrate, or self harm because of their distress.

This summary was published in 2010. The authors looked at studies that examined dysphoria and other psychological factors before and after medical transition (hormones or surgery or both).

Across all the studied the authors looked at, this is what they found:

  • 80% of the individuals found relief from their gender dysphoria by transitioning — some even to the point that they had no dysphoria at all.
  • 78% had relief from other psychiatric disorders, such as anxiety and depression. They also had relief from psychiatric symptoms that had not been diagnosed as a disorder. Suicide attempts also dropped, though they were still above that of the general population.
  • 80% had a significant increase in their quality of life. At least 2/3rds found that they had an improvement in concrete factors in their life. Their relationships improved. Their job prospects improved. They were generally happier.
  • More than half were satisfied with their sexual life after transition.

While life did not improve for everyone on hormone therapy or after surgery, it was a strongly positive influence in the vast majority.

This particular summary article did not go deep into potential differences in the benefits of surgery and hormones, though individuals studies do. The current consensus is that both are beneficial for the alleviation of suffering.

If you’re looking for a more personal account of how dysphoria improved with treatment, I highly recommend visiting the transgender communities on reddit, or picking up one of the many books written by trans people.

Aug 172015
 

715px-715px-Sunbedoff_largeA new study finds that gay and bisexual men use tanning beds more frequently than straight men. The use of tanning beds is strongly associated with skin cancers, especially melanoma (the most dead form of skin cancers).

Campaigns to dissuade people from using tanning beds usually target straight women, as they’ve been the most frequent users of tanning beds. These new data show that gay and bisexual men use tanning beds just as frequently as straight women. Lesbian and bisexual women were less likely than straight women to use tanning beds.

Tanning beds should not be used for cosmetic reasons. While many perceive a tan as “healthy” or enjoy the experience of tanning, tanning damages the skin and raises the risk of skin cancer.

Want to read the study for yourself? It’s publicly available!

Jun 262015
 

800px-Phaedriel's-orchidVaginoplasties for transgender women have been performed for a little over 80 years. The first known surgery was in 1931. Those early surgeries (link includes surgical images) were a little crude by modern standards. The patients in question already had penectomy (removal of the penis) and orchiectomy (removal of the testes) performed so most erogenous sensation was lost. No labia were formed as far as I can tell, and the vagina was made of skin from the inner thigh.

In the 80-some-odd years that have followed those first surgeries, the techniques have improved tremendously. However there’s little evidence to suggest which techniques are the best. Studies have been small and inconsistent in the factors they examine. Study results may be inaccurate. Without more data, and more consistent measures, nothing can be said for certain. Still, a recent meta analysis pulled what data we do have together into one document. And today I’ll translate and summarize their summary.

There are three basic techniques for vaginoplasty for trans women:

  • Penile inversion. The tissue of the penis itself is used to line the vagina and labia. Parts of the scrotum and/or urethra may also be used.
  • Intestinal graft, either from the ileum (part of the small intestine) or rectosigmoid region (end of the large intestine). This is less common among US surgeons than among non-US surgeons.
  • Non-penile skin graft. This is an older technique, primarily used before 2000. Grafts were often taken from the inner thigh or abdomen.

Penile inversion is the most common technique in the United States today. It’s also the most well researched. In contrast, intestinal grafts are rarely performed by surgeons who specialized in transgender vaginoplasty in the United States today. Intestinal grafts are more commonly performed by non-US surgeons or for individuals who do not have a penis to invert. Lastly, the non-penile skin graft is an older technique that does not appear to be used much anymore.

All three techniques appears to produce overall satisfactory results. The average depth was around 10cm to 13.5 cm, and the vast majority of trans women were satisfied with their depth. The majority of women were also able to have vaginal intercourse (75%) and obtain orgasm (70%+). A majority were also aesthetically pleased by their results (90%) and had an improvement in their quality of life.

All techniques had their own levels of complications. Overall the most common complication was narrowing of the vagina (anywhere from 12%-43% of patients depending on technique). Urine stream changes and increases in risk of urethral infection were also fairly common, affecting 1 in 3 women. Rare serious complications included tissue death, rectal injuries, fistulas, deep vein thrombosis, and pulmonary embolism.

Comparisons between techniques was difficult because the details of each technique differed and the outcome measurements differed too. It does seem that, as far as the researchers could tell, there were fewer complications for intestinal graft vaginoplasties than for penile inversion vaginoplasties.However abdominal discomfort and “foul” vaginal secretions during intercourse have been reported for intestinal graft vaginoplasties, largely with rectosigmoid vaginoplasty. For penile inversion vaginoplasties, using urethral or scrotal skin in addition to penile skin was associated with more complications as well.

More research in general, and more standardized research, is crucial to understanding the best surgical techniques. Patients deserve the best results and the safest surgeries possible. Surgeons have already made great strides. Time to make more!

Want to read the study for yourself? The abstract is publicly available!

Jun 222015
 
Fruit made of marzipan

Fruit made of marzipan

If you find yourself feeling confused by the many and contradictory messages about food and diet and supplements, you’re not alone. It’s a maze!

Believe it or not, medical students do get training in nutrition. Here are some general guidelines to help you figure out the weird and wacky world of food and supplements today!

1. Eat as broad a variety as you can. Include as many vegetables and fruit as you can. It doesn’t need to be fresh vegetables. They can be frozen or canned, or even processed. But the variety helps you get vitamins and minerals, and is tasty too.

2. Don’t bother with organic. There’s no nutritional difference or health benefit. You’re better off saving the money and using it to buy more vegetables.

3. Be reasonable with salt and fat. Don’t go on a very low salt/fat or very high salt/fat diet. Your body needs both, but too much of either may increase your risk of heart disease.

4. Unless you’ve been told otherwise by your doctor, don’t take multivitamins, vitamins, or supplements. Not even antioxidants! They don’t do healthy people much if any good, and may cause harm. Exceptions to this rule include calcium for women who don’t get enough calcium in their diet and iron/folic supplements for pregnant women to prevent anemia and birth defects.

5. Eat less and move more. You don’t need to run a marathon unless you want to. But moderate exercise is definitely good. So is being a “normal” (not overweight, obese, or underweight) weight.

6. Try eating less meat. Eating lots of meat is associated with cardiac disease. Try eating a little less and getting your protein from lentils, beans, tofu, nuts, dairy, or plain ol’ whole wheat. Besides, meat is expensive.

7. Ignore fads. Yes, this includes low-carb, high-carb, low-fat, high-fat, no-gluten, many food intolerances…and the list goes on!

8. Tell your doctor about your nutrition and if you take any supplements, including herbs. Some foods may interact with your medications (grapefruit is notorious for this). If you’re trying to change a habit for the better, consider mentioning it to them. They may know some resources that would help.

Got any more? Let me know your thoughts in the comments!!

Jun 152015
 

Mortier_PillonTestosterone replacement therapy has become nearly common place recently. Marketing of testosterone creams is everywhere. In addition to the big pharmaceutical companies, compounding pharmacies are now making and selling testosterone creams too. Compounding pharmacies are typically small local pharmacies where the medications are made and mixed on site. A compounded medication can be helpful to someone who, for example, is allergic to a filler used in a commercial product. Compounded products are often cheaper than commercial non-generic products. Compounded products are supposed to be standardized just like commercial products are. But are they?

The Federal Food and Drug Administration (United States) produced a report back in 2006 that showed that somewhere around 33% of compounding pharmacies were not making or selling standardized products.

Now a Canadian study confirms that compounding pharmacies may not be well standardized either. The researches took samples at two different times from ten randomly selected compounding pharmacies in Toronto. The samples were then analyzed and compared to two different commercial forms.

The commercial forms were consistently within 20% of the prescribed dose. Only 50% of the compounded forms in the first batch were within those limits. Worse, only 30%  of the second compounded batch were within that limit. Yikes! One pharmacy even had no testosterone in its product at all. The consistency within a pharmacy’s products also varied wildly. One pharmacy had 91% of the of the testosterone it was supposed to have in one sample, and only 8% in another sample.

The compounded testosterone was generally cheaper than the commercial testosterone. Compounded testosterone ranged from $57-161 for a 30-day supply, averaging around $105. The commercial stuff was $140-150 for 30-days.

This has very serious concerns for patients. Wild swings in testosterone level are not safe. For their safety and health, a patient should receive the dose that was prescribed. Not “half the dose one month” and “double the dose the next”. The lower price of the compounded products could easily lure a lower income patient into purchasing the compound instead of the commercial.

What can you do as a patient? Make sure that you get your prescriptions from a non-compounding pharmacy. If cost is an issue, talk with your pharmacist about using a generic. Generics are held to the same standards are brand-name drugs and are often made by the same company. Alternatively, consider discussing medication options with your physician and/or pharmacist.

Want to read the study for yourself? The abstract is publicly available!