Jun 122015
 

450px-Bone_density_scannerOne of the worries about hormone therapy for transgender people is over bone density. Cis women are at higher risk of osteoporosis (brittle bones) than cis men are. Sex hormones are needed for good bone health. Specifically — estrogen is known to encourage bone health. The loss of estrogen during menopause is what’s thought to cause osteoporosis in cis women. Does the change in sex hormones involved in hormone therapy change bone density?

We have a little more data on that now, thanks to a study out of Europe. This was the same data set as a previous study on weight. So we’ll skip the study details for now.

The question this part of the study asked can be summarized as: After 1 year of hormone therapy, with no surgery, was there a change in the bone density of adult trans women and trans men?

And the answer? For trans women: Yes. Trans women gained bone density after a year of hormone therapy. They gained as much as 4.5%, depending on the measurement location. For trans men?: No. There was basically no change in their bone density.

Promising news, in either case. There was no loss over one year on hormone therapy.

If you’re concerned about your bone density, talk with your doctor! Making sure that you eat enough calcium (in food form, not supplements) is also helpful. Most important of all, make sure you get good weight bearing exercise like walking, running, and jumping.

As a final note: this was a European study. The hormones used in Europe are different than the ones used in the United States. The results may not be applicable in the United States.

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

Jun 052015
 

ZAYİFLAMA-İP-UCLARİHormone therapy for trans people has long been known to change body shape and body fat percentage. But by how much? And how much can be expected in the first year? A European study of 77 trans women and 73 trans men found out!

On average over the first year of hormones…

  • Both trans women and trans men gained weight overall. On average they gained around 4-6 pounds (2-3 kg). Both groups started with a BMI around 24 (just barely between normal weight and overweight). For trans men, this weight gain tipped them into the “overweight” category. Trans women stayed in the “normal” weight category.
  • Trans women gained body fat and lost muscle mass. Their body fat went up from 24% to 28%. They lost a kilogram (2.2 pounds) of muscle mass.
  • Trans men lost body fat and gained muscle mass. Their body fat went down from 34% to 30%. They gained 5 kilograms (11 pounds) of muscle mass.
  • There wasn’t much of a significant different in waist sizes.

It may be helpful to remember body fat percentage numbers. For cis women, 21-31% is considered a fit or normal range. For cis men, 14-25% is the fit or normal range. So the trans women in this study started out at an average body fat percentage and stayed there. The trans men in this study started off with too much body fat and stayed there.

During the first year of hormones it seems that around a 4% change in body fat can be expected. Trans men can gain quite a bit of muscle. Trans women will lose some muscle.

As a final note: this was a European study. The hormones used in Europe are different than the ones used in the United States. The results may not be applicable in the United States.

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

Mar 162015
 

170px-Rod_of_Asclepius2.svgBeing a gender or sexual minority (GSM) is not only difficulty and tricky for patients — it can also be a challenge for medical providers. Medicine can be a particularly conservative field, depending on location and specialty. Lives are, after all, often at stake.

Despite recent advances it appears that some 40% of lesbian, gay and bisexual medical students are hiding their sexual minority status in medical school. Among transgender medical students, 70% were hiding their identity. All because of fear of discrimination.

That fear has been, and still is, warranted. From medical providers transitioning and losing their practices, to medical students losing their residency slots, to LGBT health student organizations fighting to exist, LGBT providers face similar discrimination as our patients.  Similar happens for other gender and sexual minority health care providers, though we lack statistics. At a meeting of kink-identified mental health care providers, one attendee noted a high level of vulnerability for the clinicians. Being “outed” could lose them their jobs or even trigger legal action.

To some extent, discretion among health care providers is warranted. Most people don’t want to know about their clinician’s (or coworker’s) personal lives. And most GSM providers don’t actually want to share those most intimate details. It’s where the line is that can be distressing — how much information is too much? Can I discuss my wife when other women clinicians are discussing their husbands? How exactly do you notify your fellow clinicians or patients about a change in gender pronouns or name? How can a clinician use information gained from intimate encounters to help patients, without revealing too much? It’s a balance we constantly seek. Sometimes mentors are there and can help. Other times we figure it out as we go along.

Yet we bring a lot to the table, as minorities. Like many racial and ethnic minorities, there are pressures and issues that affect GSM people more than the majorities. We bring that knowledge with us to the research we choose to perform, the communities we participate in, and each and every patient encounter.

We as clinicians and future clinicians need to have the support in order to be appropriately open about our gender and sexual minority status. Our patients and clients must know they can be safe and honest with us so they can receive the most complete and respectful care possible.

Some progress has been made already. There’s an association for LGBT medical professionals. There’s an association for kink psychological research. There’s an association for transgender health. All of which allow student members and provide mentoring. Many other organizations exist too. Some US medical schools are working with their students to provide a safe and welcoming environment where these issues can be explored. The American Association of Medical Colleges recently launched a program to enhance education surrounding LGBT and intersex health care. The American Medical Association also has an LGBT Advisory committee.

I’m proud to say that my medical school has been accepting and supportive of its gender and sexual minority patients, and that clinics in the area of my medical school are seeking to expand their care to be more inclusive of LGBT patients. Support exists for both those seeking medical care, and those seeking to provide that care. It’s only the beginning.

Jan 092015
 

This is the start of a new series of posts here on Open Minded Health: Quickies! I often run into items in the medical literature that are too short to do a fully post on, but for whatever reason I think it’s worth covering it anyway.

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This week’s quickie is a case report, which was presented as a poster at a medical conference.

7170317810_f25026d624_mA trans woman in her thirties showed up at the emergency room with gastrointestinal problems. She had nausea, pain, and bleeding. No significant medical history was noted in the report, and she was on a normal dose of hormone therapy.

When they took her blood to run some lab tests, the sample appeared “as white and turbid as milk.”

Her lab work revealed a triglyceride level of 30,000 mg/dl. For reference, a normal triglyceride level is less than 150. Above 500 is considered “very high.”

She was immediately transferred to the intensive care unit for treatment. Triglycerides that high can cause inflammation of the pancreas. Thankfully all her pancreatic lab values were normal. After a week of treatment, which managed to get her triglycerides down to 3,000, she was sent home. She was instructed to stop estrogen treatment, take new prescribed triglyceride-lowering medications, and to follow up with her physician.

Why did the hospital physicians recommend that this patient stop her estrogen? Because estrogen treatment is known to increase triglyceride levels. Triglyceride levels that high are extremely rare. A much more mild version can, however, happen to anyone who has high estrogen levels. It can happen to cis women in pregnancy or receiving hormone replacement therapy for menopause. It can also happen to trans women on estrogen treatment.

High triglyceride levels are usually “silent” — there are no symptoms. That’s part of the reason it’s important to see a physician regularly for screening, especially if you’re at higher risk. High triglyceride levels are more likely if you…

  • are overweight
  • don’t exercise
  • eat a high-carbohydrate, high-fat diet
  • have other cardiovascular issues
  • are on certain medications
  • or if it runs in your family

Mild elevations in triglyceride levels may be controllable with diet, exercise, and weight control. If those don’t help, your physician may prescribe medications to lower your triglycerides.

For more information on triglycerides, including what they are, normal levels, and how to control them…check out this article by WebMD or ask your primary care provider.

The case report inspiring this post was “Hypertriglyceridemia up to thirty thousand due to estrogen: Conservative Management” and was published in Critical Care Medicine.