It’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. 🙂