Jan 042015

8787343055_a2a6eb06bf_mIt’s a new year here at Open Minded Health. I hope you all had a safe, fabulous, and fun new years celebration. Here at OMH it’s time for the yearly questions and answers post.

For the unfamiliar — once a year I take a deep look at all the search queries that bring people here. Often, they’re questions that I didn’t completely answer or that need answering. So in case anyone else has these questions — there are answers here now that Google can find. The questions are anonymous and I reword them to further anonymize them.

This year is all questions about transgender health issues. There’s been a lot published and a lot in the news about trans health issues lately. This next year I’ll try to find other articles to post about too, though. 🙂


What are the healthier estrogens that a transgender woman can take?

In order from least risk to most risk: estrogen patch, estrogen injection sublingual/oral estradiol, oral ethinyl estradiol, oral premarin.

But note that that’s an incomplete picture. The estrogen patch isn’t the best for initial transition and is very expensive. Injectable estrogen means sticking yourself with a needle every 1-2 weeks and needing a special letter to fly with medications. By far the cheapest of these options is oral estradiol.

Ethinyl estradiol is the form of estrogen used in birth control. Premarin is conjugated equine estrogens, meaning they’re the estrogens from a pregnant horse. Neither should be the first choice for transition. They’re both higher risk than estradiol.

For transgender women, how long does it take to see the benefits of taking spironolactone?

The rule of thumb is 3 months before changes on hormone therapy.

Where is the incision placed in an orchiectomy for transgender women?

That depends on the surgeon. But I’m know you can find images and personal stories on /r/transhealth and transbucket.

Does a trans man have to stop taking hormones to give birth?

Yes. Trans men and others who can become pregnant who are taking testosterone must stop testosterone treatment before becoming pregnant. Testosterone can cross the placenta and cause serious problems for the fetus. Once the child is delivered and no longer breast feeding testosterone can be resumed.

Once you’re on female hormones, how long does it take to get hair down to your shoulders?

My understanding is that the speed that hair grows doesn’t change. It grows at roughly 1/2 an inch a month. Expect growing it out to shoulder length to take 2-3 years.

As a trans woman on estrogen, are there foods I should avoid?

If you’re on estrogen only, there are no foods you should avoid. Instead eat a healthy varied diet.

If you’re on spironolactone you may need to avoid foods that are high in potassium. Potato skins, sweet potatoes, bananas, and sports supplements are foods you may need to limit or avoid. Ask your physician if you need to avoid these foods.

Is there a special diet that can help me transition?

In general, no. Any effect that food may have is, in general, too subtle to make a difference. The possible exception is foods that are very high in phytoestrogens — like soy. Phytoestrogens are chemicals in plants that act a little like estrogen in the body. There are a few case reports in the medical literature of people developing breasts when they eat a lot (and I do mean a lot) of soy. But they’re unusual. Ask your physician before you make radical changes in your diet. In general — just eat a healthy, varied diet.

I’m a trans guy taking testosterone and having shortness of breath. Do I need to worry?

See a physician as soon as you can. Shortness of breath may be a sign of something serious. Taking testosterone raises your risk for polycythemia (too many red blood cells in the blood), which can manifest as shortness of breath.

How often do trans women get injections of estrogen?

Most women have their injection every week to two weeks.

Can I still masturbate while I’m on estrogen?

Yes. Many trans women have difficulty getting or maintaining an erection though.

Can I get a vaginoplasty before coming out as transgender or transitioning?

Generally speaking, no. Surgeons follow the WPATH standards of care which require hormone therapy and letters of recommendation from physicians and therapists before vaginoplasty.

Are there risks to having deep penetrative sex if you’re a trans woman?

I’m assuming you’re referring to vaginal sex post-vaginoplasty. The vagina after a vaginoplasty is not as stretchy or as sturdy as most cis vaginas. It’s possible to cause some tearing if the sex is vigorous or if there are sharp edges (e.g., a piercing or rough fingernails).

Things you can do that might help prevent injury: Make sure you’re well healed after surgery. Dilate regularly as recommended by your surgeon. Use lots of lubrication, and try to go gently at first. Topical estrogen creams may also be helpful for lubrication and flexibility.

Is it safe to be on trans hormone therapy if you have a high red blood count?

Depends. If you’re a trans man looking for testosterone, you may need treatment first to control the high red blood cell count. Testosterone encourages the body to make more red blood cells, which would make the problem worse.

What kinds of injection-free hormone therapy are available to trans men?

Topical testosterone is available for trans men. It’s a slower transition and it’s expensive, but it exists and it works. Oral testosterone should never be used because of the risk of liver damage.

What can cause cloudy vision in trans women on hormone therapy?

Seek medical care. It could be unrelated, but changes to vision are not a good sign.


And that’s it for this year! Next week we’ll be back to normal posts. 🙂

Mar 282011

Today’s post is a first in a series on prevention. Let’s start with self-examinations – specifically, breast self-exams (BSEs).

Benefits/limitations of BSEs:

  • They are optional (unless your doctor says otherwise) for detecting breast cancer. Some recent meta-analyses have found there to be no reduction in breast cancer mortality from self-exams. So BSEs are only one small part of prevention. They can not and should not be used as the only means of detecting problems. Mammograms and clinical exams are more effective.
  • They’re a great way to get to know your body! You’re better able to catch any changes, which you can then discuss with your doctor. Also, they can be positive for your love play! Partner(s) can also be involved in exams, which can help keep them from getting boring.
  • They can lead to false positives (thinking that there’s something seriously wrong when there isn’t), which can be stressful and costly, and false negatives (thinking there’s nothing wrong when there is), which can be fatal.

Who can do them? Almost anyone! The American Cancer Society says that women over the age of 20 should consider doing BSEs. Men can also do BSEs (I would assume with the same age caveat), as can transwomen and transmen. Personally, I think it’s an especially good idea to self-examine (even casually) if you’re doing any kind of sex that’s rough on the breast or nipple….not to detect cancer (trauma to the breast does not cause cancer – Source) but to be better able to detect injury.

When should you self-examine?

  • Menstruating people (that’s most genetic women of childbearing age, folks!) should self-exam right after a period finishes. Breast tissue changes with hormone fluctuations, and right after a period is the best time to detect lumps. Those with very irregular periods should ask their doctor about timing.
  • Men and anyone else who does not menstruate can self-exam at any time during the month. Pick a day!
  • Transwomen and transmen should consult their doctor. There are no studies yet on the incidence of breast cancer for trans folks.

How do you do a BSE? The full instructions can be found at cancer.org and webMD. Here’s the CliffsNotes version:

  • Look at the breast! Check especially for odd dimples or wrinkles in the skin. Move the breast around – both with your hands and by moving your arms and flexing your chest muscles.
  • Pull on the nipple (gently) – does it produce odd discharge? Bloody or clear discharge can be a warning sign.
  • Now comes the fun part! Ideally using your 2nd, 3rd and 4th fingers, feel for changes in the breast tissue. This should be done with dime-sized circular motions, in a vertical pattern (check the ACS website for diagrams). Do this both standing and lying down, and with light, medium and heavy pressure. Here, you’re looking for unusual lumps and/or texture changes.
  • Your physician can confirm your technique. Please consult him or her if you feel any changes (especially new lumps!) from last month’s exam.

What are you feeling?

  • These diagrams may help: Wikimedia, Mount Nittany, Beth Israel Medical Center, and Vulva University (note: these are female breasts. Male breasts are different).
  • At birth and during childhood, male and female breasts are the same. Female breasts change at puberty in response to changing hormones.  These changes can be induced later in life with hormones, as many transwomen already know.
  • Random fact of the day: The glands that produce milk are actually modified sweat glands – so milk is modified sweat!
  • The apparent visible anatomy is the nipple and the areola (the colored area around the nipple). The nipple is where milk flows (through “lactiferous tubules”), and it’s also got a lot of nerve endings. It can become erect with stimulation, sexual excitement, or cold. Both the nipple and the areola differ in size, shape and color depending on the person, stage of life, and reproductive history.
  • Breasts are mostly fat and connective tissue. In women, the connective tissue includes Cooper’s suspensory ligaments of the breast (named after Sir Astley Cooper, who first identified them). They’re not true ligaments – true ligaments connect bone to bone – but they do help support the breast. They sit right underneath the skin, and they may contract around tumors, potentially producing a wrinkled appearance in the skin. Men generally do not possess these ligaments.
  • Female breasts contain glands (glandular lobules) which drain into ducts, which connect to tubules at the base of the nipple. Men generally lack the glands, but still have the ducts and tubules – which is part of the reason they can also get breast cancer. In fact, while men are less likely to get breast cancer, they’re also much more likely to die from it because it’s detected later in men than in women (Source).
  • I’ve had a really difficult time figuring out what changes in the breast when a transwoman starts hormones (e.g., does she develop Cooper’s ligaments?). If anyone knows these little anatomical details, please let me know!

So, in summary: First, talk to your doctor about doing BSEs. She or he can advise you on whether or not it’s right for you to do BSEs, based on your health and family history. Second, get to know your body! BSEs are one way of doing that.

Finally, try out these videos:

How to perform a breast self exam Contains female nudity. The best instructional video I’ve seen so far.

Partner breast exam Funny! Heterosexual-oriented