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.

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. 🙂

Questions!

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.

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

Jul 022013
 

CC BY-NC-ND 2.0 by flickr user aling_

Time for the last month’s news. Hope you all are having fun out there. This month’s image is the theoretical flower for the month: the rose.

Gender-related news…

  • A preliminary report presented at the Endocrine Society meeting in June appears to confirm that cross-sex hormone therapy is safe in the short term (12 months). Summary.
  • Finasteride, a commonly used anti-androgen used to prevent hair loss in both cisgender men and transgender women, has now been reported to reduce alcohol consumption. Summary.
  • GnRH agonists, also called “puberty blockers”, have been shown to be safe in one study. The prime concern for years has been about bone health. Previous studies had shown a drop in bone density while on the medication. This new study confirms that bone density returns to normal after going off GnRH agonists. Summary. This study will be covered more thoroughly in a later blog post.
  • The folks at Skepchick did a wonderful piece on a recent news article on an intersex person. Check it out!

Sexuality

  • In high doses, testosterone appears to help cisgender women retain their sex drive after hysterectomy/oophorectomy. The rub? Testosterone should be given either through the skin (creams, patches, etc) or by intramuscular injection. Summary.
  • Many cisgender men are now being treated for “low testosterone levels”… when their testosterone levels were never checked. This could be very risky. Summary.
  • Exodus International has apologized to gay people and closed down. Exodus was well known for its promotion of reparative therapy for gay people. Summary.
  • The American Medical Association has come forward arguing that the ban against blood donation by men who have had sex with men (the “gay blood ban”) should be lifted. Summary. The FDA recently reviewed their policy, but decided that the ban should stay. Currently in the United States, any man (male-bodied) who has had sex with a man since 1977 is ineligible to give blood. Additionally, any woman (female-bodied) who has sex with a man who had sex with a man since 1977 is ineligible to donate for the next 12 months. The FDA’s policy on trans folk is unclear, but some trans folk report being turned away because of their gender identity.
  • A case report of “foot orgasm syndrome” was reported in the literature. A woman reported having orgasms whenever her feet were stimulated. Summary.
  • A study found that people who practice BDSM (bondage, dominance/submission, sadomasochism) are not psychologically “sick”. Summary. I’ll be covering this study in a later post. It’s interesting and need a lot of breaking down.
  • A study by Durex reports that the vast majority of people enjoy sex most when they are emotionally attached to their partner(s). Summary. Because a sex study conducted by a condom maker is totally not biased.

And the biggest item of news? The US Supreme Court declared that Section 3 of the Defense of Marriage Act was unconstitutional. Federal and state governments are currently scrambling to figure out all the ramifications. And Proposition 8, here in California, was effectively reversed. Marriage equality now exists in my home state. Yipee!

Did I miss a piece of news? Let me know in the comments!

Jun 212013
 

Image © Kristy Peet. Used under creative commons license: CC BY 2.0A third case report of a meningioma in a trans woman has just been published.

A meningioma is a tumor of the meninges, the tissues between the skull and the brain. Most meningiomas come from the arachnoid mater, through which the cerebrospinal fluid sluggishly flows. Meningiomas are mostly (90%) benign, meaning they are not cancerous and will not spread throughout the body. Current treatment is surgery to remove the tumor, with radiation available if surgery is not possible.

There is some thought that sex hormones are a factor in the growth of meningiomas. Women are more likely to develop a meningioma than men. Like some breast tumors, meningiomas have also been found to be sensitive to estrogen and/or progesterone. Sensitivity refers to the tumor cells having receptors for certain hormones, and responding to those hormones. In the case of some estrogen-sensitive breast cancers, the estrogen increases the growth of the tumor.

This case was in Australia. The patient had been on estrogen and an anti androgen (cyproterone acetate), and had had genital surgery years before. Her tumor was benign, though sensitive to progesterone and estrogen, and was surgically removed. Unusually, her tumor came back and was removed again. She underwent radiation treatment. She is reported to have chosen to stop hormones and has made a full recovery.

Whether hormone therapy influences the growth of meningiomas is unknown. So far, the data are mixed and there is no consensus in the medical community. The other two case reports continued hormone therapy with no recurrence of the tumor. To stay on the safe side, however, the authors recommend that hormone therapy be discontinued upon diagnosis of a meningioma. They also suggest that a history of meningioma may be a contraindication for starting hormone therapy.

All individuals, trans or cis, should seek medical advice if they have any neurological symptoms. This includes symptoms associated with meningiomas such as headaches, seizures, blurred vision, double vision, weakness in arms or legs, numbness, or speech problems.

This case report was published in International Journal of Transgenderism. The abstract is publicly available.

Feb 252011
 

(UPDATED 3/30/11 – take a look at the bottom of the post)

A case report showed up in my feed recently. A woman and her partner were using a glue container in her urethra and it got lodged in her urinary bladder. They couldn’t remove it, so they went to the emergency department, where it was removed. She was discharged after a few hours of observation.

I thought this would be a good opportunity to talk about urethral sounding. Urethral sounding (usually just called “sounding” in the kink community) is when a cylindrical object is inserted into the urethra. Most of the resources I found were aimed at men, but women can do this also (Note: the urethra in men and women are different lengths and shapes! Knowing anatomy is helpful here).

Sounds should be made out of stainless steel, hardened rubber, or a similar material. They should not have ANY cracks or deformities. Glass, although traditional, is a bad idea because it can break within the urethra. Sounds need to be sterilized before and after use! Lubrication should be water-based and glycerin-free (Source). Glycerin (aka glycerol) is a sugar, and thus can serve as food for bacteria. Yickes! I’ve seen at least one guide recommend using individual lube packets to prevent contamination.

Risks include urinary tract infections (UTIs), from poor sanitation or scratching the urethra. UTIs can lead to bladder infections and kidney infections if not treated. Cranberry juice or pills can be taken to help prevent UTIs, but should NOT replace proper hygiene.

Please talk with your doctor regarding sounding and your own health history if you plan to play with it.

Other resources (may be seriously NSFW):

Medicaltoys.com Library

Sin Central Forums

 

UPDATE 3/30/11:

Hey folks! Thanks for all the interest in this post. If you want to know more about urethral sounding (especially female sounding), check out Mistress160’s excellent informational page on her blog (warning: site contains very graphic images). If you have further questions, feel free to ask here, on Fetlife, or contact your local BDSM organization(s) and/or dungeons.