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. ūüôā

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.

~~

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

Aug 272013
 

CC BY-NC 2.0 flickr user PhotoComiX

This post is a legacy page, and was part of an on-going series, Trans 101 for Trans People. It covers questions about medical transition, hormones, surgeries, or seeking health care for transgender people.

For the material that once lived on this page, please see this page.

Please update your links to the full Trans 101.

Feb 102013
 

CC BY-ND 2.0 - TjookAs a group non-heterosexual people have poorer mental health than heterosexuals do. LGB (lesbian, gay, bisexual) folk have higher rates of mood/anxiety disorders, suicidal ideation/attempts, and substance use. Why? The dominant theory is minority stress: simply being a minority is stressful, especially if one is a minority who faces discrimination. Higher levels of stress are associated with poorer mental health. For LGB folk, the fact that their minority status is invisible is an additional factor. Research is conflicted on whether “coming out” improves mental health or not. While coming out in a supportive environment may improve mental health, coming out in a discriminatory environment may do the opposite.

Before I jump into the actual study, a little background on stress. Stress that comes from a psychological or social source is called psychosocial stress. Like all stress, it isn’t just psychological. There’s a biological component too! In the laboratory, there are at least two different ways of measuring stress. The first, and easier, is through cortisol. Cortisol is a stress hormone made from cholesterol that is released by the adrenal glands. It’s a small, non-polar molecule, so it passes right cellular membranes into every cell in the body. Because of this, cortisol can be measured in saliva, making its collection easer, cheaper, and less riskier in research than other measures. Cortisol also has a cyclical pattern; it’s lowest in the morning but rises in concentration through the day. Cortisol measurement is not without its problems. Levels of cortisol, and the reactivity of cortisol concentration to stress, varies between men and women, and between women of varying menstrual cycles and oral contractive use. It’s also worth noting that cross-sex hormones may be a confounding variable for cortisol testing, which is why this study did not include transgender people.

Another way of measuring stress requires a blood sample and lots of blood tests. Stress affects many different body systems. Everything from sex hormones to triglycerides to insulin can be affected, so those levels can be used to help detect stress levels in participants. Non-blood tests such a blood pressure may also be used. These non-cortisol factors were referred to as “allostatic load” (AL) in this study. AL broadly refers to the cumulative biological effects of being ready for “fight or flight“, or in other words, stress.

So what about this study in particular? This study has two goals:

  1. Compare the stress levels of LGB people with heterosexual people
  2. Compare the stress levels of “closeted” LGB people with “out” LGB people.

Participants were 87 people, roughly evenly divided between lesbian/bisexual women, heterosexual women, gay/bisexual men, and heterosexual men.¬†The researchers measured a variety of demographics including age, race, sex, occupational status, socioeconomic status, physical and mental health, substance use, religion, and family. They measured sexual orientation with the¬†Klein scale, and asked about disclosure status (i.e., whether¬†participants were “out” or not). Psychiatric variables included perceived chronic stress, anxiety symptoms, depression symptoms, burnout symptoms, and conscientiousness. Conscientiousness is a personality trait that has been found to be a confounding variable in these kinds of studies. Biological variables were salivary cortisol, measured three times a day to track cortisol’s daily cycle, and allostatic load, as I described above.

And what did they find? There were few statistically significant differences between the groups; only sexual orientation and oral contraceptive use were different. That’s important! Any differences between groups would be a confounding variable. They also verified some expected results. For example, that anxiety symptoms are associated with depression and burnout symptoms, and that elevated cortisol levels were correlated with burnout.

First the researchers reported their results for comparing LGB folk to heterosexual folk (goal #1). They found that gay/bisexual male participants had more depression symptoms than the heterosexual male participants. In contrast, their lesbian/bisexual women participants had fewer depression symptoms than the heterosexual female participants. They also found that allostatic load levels were lower in gay/bisexual men than in heterosexual men. They found no other differences between their LGB participants and their heterosexual participants.

Second the researchers reported their results for comparing out LGB folk to closeted LGB folk (goal #2). In this case, they did not separate by sex or orientation. Out LGB people had fewer anxiety symptoms, depression symptoms, burnout symptoms, and lower cortisol levels than closeted LGB folk did. No other differences were detected.

Every study has its limitations. This study was no different. Limitations and potential confounds included:

  • Combining homosexuals and bisexuals into one group for analysis. While some issues overlap, bisexuals can face different stressors than homosexuals do (e.g., bisexual folk report facing discrimination from both the gay and straight communities where gay folk don’t; ).
  • Relatively small sample size may have made accurately detecting statistical significance difficult.
  • Their sample was from the Mont√©al area, an area that has been called “one of the most gay-friendly places on Earth.” Results may have been different in a less tolerant area. This means that results from this study¬†can’t necessarily be applied to people in other areas (e.g., Uganda, the American South).
  • Both age and conscientiousness were found to be confounding variables.
  • Variables like gender presentation (e.g., butch vs femme lesbians) were not considered. They could affect how much active discrimination an individual faces and thus might affect their stress load.¬†Other variables, such a family acceptance, were also not considered.

All of this is interesting, but what does this mean?¬†If we interpret these results as true, then there are some interesting dynamics at play. LGB people who are out of the closet have better psychiatric health than closeted LGB people. However, closeted LGB people don’t seem to be at a disadvantage when it comes to the physical effects of stress. As for comparing heterosexuals with non-heterosexuals, gay/bisexual men seem to have poorer mental health than heterosexuals, who have poorer mental health than lesbian/bisexual women. Coming from an American viewpoint, it seems to me that that might be explained by the cultural acceptance of lesbian/bisexual women and rejection of gay/bisexual men. I don’t know how true that is in Canada, though.¬†Do the results support the minority stress hypothesis? Somewhat, but only for the out/closeted comparison. The heterosexual/LGB comparison results partially support minority stress and partially don’t.

I think these results should be interpreted with a large grain of salt. I don’t think it’s justifiable to make conclusions about all LGB people from this one study. These results are curious, certainly. There are factors at play which bear greater examination (e.g., why don’t closeted LGB people show higher cortisol and AL levels?). I’m curious to see what a study replication in a different area and more participants would show.

Abstract. Full text (PDF).

Jan 102013
 

CC BY-NC-SA 2.0 - Zuhair AhmadDespite the general lack of studies, it is known that there are differences in the mental health of bisexual and gay men. Bisexual men are more likely to have poorer mental health, even though gay men are more likely to report discrimination, rejection, and experiences of victimization.¬†This new study looked at patterns of concealment and disclosure of same-sex sexual behavior for an explanation. Concealment refers to the active hiding of one’s behavior, whereas disclosure is explicitly teling others about one’s behavior.

Participants were roughly 200 men who did not identify as gay, and who had sex with both men and women. The sample was diverse in age, race, education and income. None of the participants had disclosed to their female partners that they had sex with men. Nearly 38% of the participants did not disclose to anyone that they had sex with men. 51% felt that their sexual behavior was too embarrassing to disclose, and 63% indicated they would lie if asked.

The researchers found that concealment of same-sex sexual behavior was associated with depressive and anxious symptoms.¬†However, disclosure was not significantly associated with mental health. In other words, “coming out” may not improve the mental health of bisexual men. They also found that concealment was indirectly associated with internalized homophobia. Perhaps reducing¬†internalized¬†homophobia is a better psychotherapeutic treatment than encouraging disclosure?

I look at this study from the public health perspective as well; if 38% of bisexual men aren’t disclosing, do they disclose to their doctors? Do they protect themselves from STDs/STIs? Do they get screenings? What health risks are they at simply by not disclosing? I don’t know, but I think it’s important to find out.

The study’s abstract is publicly available. As always, if you want some of the details from the study, just ask!