Jul 042016
 

On June 17, 2016 The Lancet, one of the UK’s most prestigious medical journals, published an entire series dedicated to global transgender health.

The World Professional Association for Transgender Health biennial conference happened over the weekend of June 17-21. I wasn’t able to go this time around, so I can’t report on it directly. But! It looks like it was a fabulous conference. Topics ranged from surgical techniques to cancer prevention to health and psychological care for transgender youth. You can see the schedule yourself.

The Pentagon has announced that it will begin allowing transgender people to openly serve in the US military next month. No details on what that means for veterans or formal military who were dismissed from service because of that status have yet been revealed. Source.

President Obama has declared Stonewall a national monument.

Jan 182016
 

There’s been a cluster of publications and news recently that I won’t be able to dig fully into and write a full article on, but still needs mentioned. So this week’s post is a quick summary of a bunch of them!

Several articles came out pointing out that various health care professionals have a role to play in gender/sexual minority health. Articles like this are important in helping the wider medical community understand why learning about gender and sexual minority health issues is important. The articles include…

  • Obstetricians can help screen fetuses for being intersex and help to manage the medical aspect of intersex medical conditions. Gynecologists can help adult intersex people with both medical and social issues associated with being intersex. See the article.
  • Pharmacists can help with the care of trans people above and beyond just filling a prescription. They can help make sure that certain laboratory calculations are done correctly, based on the hormonal status of the patient. They can counsel on the various forms of hormones (e.g., pill vs patch vs injection). See the article.
  • Dermatologists may be able to assist in medical transition by providing hair removal and other noninvasive, aesthetic procedures. See the article.

Asking about sexual orientation and gender identity and recording it in the electronic health record is now a required part of all electronic health records by Medicare/Medicaid. This is part of “meaningful use”, and is part of the larger goal of having electronic health records that actually cooperate with each other and record the same things. Here’s a quick abstract discussing this. This is really the beginning of a change in health care around the United States — there’s now a financial incentive to screen for sexual orientation and gender identity and to handle patients who aren’t cisgender and straight. It’s good stuff.

A study of examined the effectiveness of therapy intended to change same sex sexual attraction as performed within the Church of Jesus Christ of Latter-day Saints. Less than 4% of those surveyed experienced a change. 42% reported that it wasn’t effective, and 37% found it to be moderately to severely harmful. Those who seek to modify their sexual orientation should keep this in mind — therapy intended to change sexual orientation is far more likely to do harm than good. For context, if this therapy was a new drug the FDA would never allow it into the marketplace. It would never get past early clinical trials. In contrast, acceptance therapy (i.e., therapy meant to help one be accepting of one’s orientation) in this study was found not only to reduce depression and improve self esteem but also improved relationships with family. See the abstract.

It’s well known that lesbian, gay, and bisexual cisgender people are at higher risk of suicide than the general public. A study recently clarified some of that risk, finding that bisexual cis women are at nearly 6 times higher risk of suicide than straight cis women (roughly 4-9% of the women). Gay men were 7 times more likely to attempt than straight men (roughly 3.5-13% of gay men). Lesbian and bisexual women were also more likely to attempt suicide at a younger age than straight women — roughly 16 years old vs 19 years old. Sad news. See the abstract.

Gay and bisexual men may be more likely to rely on chosen family for social and economic support than lesbian and bisexual women and heterosexuals, who may rely more on blood relatives. See the abstract.

And very exciting — the FDA has changed their blood donation policy for men who have sex with men! Instead of an “indefinite deferral”, people who quality as “men who have had sex with men” need to wait 12 months after the last sexual encounter to donate. This brings the guidelines for sex who have sex with men roughly equivalent to the guidelines for others who are at higher risk for HIV.

If you are transgender, the guidelines are still unclear. Transgender women who had ever had sex with a man (unclear if cis or trans) used to count as “men who have sex with men” in the FDA’s eyes. Now the FDA advises that transgender people should self report their gender. What this seems to say is that trans women should be counted as women and trans men should be counted as men regardless of hormonal/surgical status. So according to the guidelines, this should be the logic…

  • If you are a cis/trans man who has had sex with another cis/trans man once since 1977, but over 12 months ago: You may donate blood.
  • If you are a cis/trans man who has had sex with another cis/trans man within the past 12 months: Wait until 12 months after that sexual encounter to donate, whether you used a condom/barrier or not.
  • If you are a cis/trans woman who has had sex with a cis/trans man in the past year, and that cis/trans man has had sex with a cis/trans man in the past year: Wait until 12 months after your sexual encounter to donate, whether you used a condom/barrier or not.
  • If you are a cis/trans woman who has not had sex with a cis/trans man in the past year: You may donate blood.
  • If you are a cis/trans woman who has had sex with a cis/trans man in the past year, but that cis/trans man has not had sex with a cis/trans man in the past year: You may donate blood.

Confusing enough? I hope that still helped. Keep in mind that all of the guidelines I attempted to simplify assumes that you’re not HIV+ (no one who is HIV+ may donate). If you’re confused still, take a look at the new guidelines or reach out to your local blood donation center.

And that’s it for this week! I hope this was fun, interesting, and helpful! Have a wonderful week.

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.

~~

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

Jul 282014
 

Some news months are very quiet. But as it’s said, “It never rains but it pours”. These last two months flooded my inbox. Whew!

Alexandrite for June

Alexandrite for June news

Sexual orientation (LGB) news

  • A meta-analysis of women who identify as lesbian found that roughly 48% had experienced domestic violence of some sort in their lifetimes. 15% of lesbians surveyed were currently experiencing domestic violence. Most of the violence experienced was emotional (43% of lesbians). Source.
  • Even after a cancer diagnosis, gay men report poorer health habits than their heterosexual peers. Such habits include tobacco use, infrequent exercise, high levels of psychological stress, and substance use. Any difference between gay and straight men with regards to cancer diagnosis may be a result of different levels of HIV infection. Source.
  • Women who have sex with women are at higher risk for suicide than heterosexual women. The same was not seen for men. Non-heterosexual men and women did not appear to be at higher risk for death in general than their het peers. Source.
  • Gay and bisexual men appear to be underestimating their chances of acquiring HIV and may be missing out on preventative treatment. Source.
  • A study of ex-ex-gay men found that realizing that sexual orientation change was not possible was the reason for abandoning reparative therapy. Reparative therapy itself resulted in negative mental health and shame for these men. Source.
  • Rates of syphilis are going up among men who have sex with men. Remember to use protection and get tested! Source.

Transgender, gender identity, intersex news

  • A paper was published acknowledging that research on transgender youth was limited at best. This paper advocated for early identification and treatment for the health of the youth. Source.
  • A study of young trans men using subcutaneous testosterone found that subcutaneous testosterone is effective and safe in short-term use. Monthly bleeding stopped within 3 months and most men in the study reached cis male testosterone levels within 6 months. Source.
  • A list of clinics providing care for gender non-conforming and transgender children and youth was published. Source (PDF).
  • A summary article was published summarizing the current state of challenges facing transgender youth within medicine. Source. Another similar article, intended to familiarize a pediatrician with cross-sex hormone treatments, was published. Source.
  • In-person survey results may differ significantly from online survey results within the trans population. An analysis of data from the National Transgender Discrimination Study found that people who took the survey in person were more likely to be young, relatively poorer, trans women who also were more likely to report being HIV positive and use substances. Data from in-person vs online studies should be interpreted accordingly. Source.
  • An open access article was published exploring the lives of several waria, trans feminine people from Indonesia. Most felt that any potential risk in risky transition-related behaviors (e.g., taking hormonal contraception pills, silicone injection) was worth it. Source.
  • Quality of life for intersex people seems to vary widely, depending partially on where they received medical care as children. Source.
  • A review of the care of intersex children concluded that it “requires acceptance of the fact that deviation from the traditional definitions of gender is not necessarily pathologic”. The review also advocated integrated peer support for intersex individuals and the development of skilled and trained teams of professionals to assist families. Source.
  • A case report of a trans woman with BRCA1 was described. BRCA1 is one of the gene mutations that results in a high risk of breast cancer. This woman chose to have medical care as usual, and did not opt for a preventative mastectomy. BRCA1 presents a challenge for all women, but the combination of a BRCA1 gene and estrogen may accelerate a possible breast cancer. Source.
  • A case report of a trans woman developing psychosis when abruptly stopping hormone therapy was reported. Her psychosis resolved when she started hormone therapy again. Source.
  • For relationships between trans women and cis men, both partners may be at risk for increased psychosocial stress because of transphobia. Source.
  • A comparison of rural vs nonrural trans people was published, confirming that rural trans people need medical and mental health services too. Source (full text!)
  • Roughly 16% of trans women in the San Francisco Bay Area were found to have used fillers such as silicone. Please don’t do this! It can, and does, cause death. Source.
Ruby for July

Ruby for July news

Sexuality, minority sexual behavior news

  • A pair of case reports of urethral sounding came out, this time from Korea. As a reminder: electrical cables and magnets do not make for good sounding instruments. No matter how embarrassing, remember to get medical care when you need it! Thankfully for these two men the objects were removed, though one removal did require surgery. Source (NSFW images).
  • A review of changes to the paraphilia section of the DSM-V found that some of the changes make it more likely that someone will be falsely diagnosed with a paraphilia. Source.
  • Another study on personality traits of people diagnosable with paraphilias was published. The abstract isn’t really detailed enough to really see what the results were, but this is one to keep an eye on… Source.
  • An exploration of the psychological and sexual sides to apotemnophilia (desire to have an amputation of a healthy limb) was published. Source.
  • Comparison of self-identified swingers and self-identified polyamorous people found that both groups were more likely to seek psychological care when they needed it than the general population. Poly folk and swingers were also more likely to report that they were satisfied with life. Source (full text!).
  • Debates continue on the definition of paraphilias, and their inclusion in the DSM. Source.
  • A study of some in the Adult Baby/Diaper Love communities found that few in those communities have problems with their interests. Source.
  • A case of inability to urinate was presented. The cause? A sex toy that had been accidentally left in her vagina 10 years previously. Retained objects like that can cause fistulas (holes – either between the rectum and the vagina or the bladder and the vagina). The woman in the case had surgery. Source.
  • Among opposite-sex couples vasectomy was found to increase sexual satisfaction for both partners. Source.

Miscellaneous and general news

  • A number of Hispanic medical organizations came out in support of LGBT health. Source.
  • Almost half of LGBT people living in Nebraska had considered suicide in their lifetime. Source.
  • Some 80% of German medical students express interest in learning about human sexuality. Despite efforts to increase education for decades, only half of those students were able to correctly answer questions on human sexuality. Source.
Jun 032014
 

6763959_10420a4b6a_mThe biggest news for May of 2014 is really that Medicare lifted the blanket ban on covering genital surgeries for trans people. The National Center for Transgender Equality has a good summary (PDF) of what the decision actually means. If you’re trans and interested in surgery and are a Medicare recipient, I recommend calling the physician who’s prescribing your hormones and consulting with them about next steps. The news was covered in multiple outlets including the NY Times and CNN.

The other piece of news I spotted that is not getting as much traction as I’d like is this: Urine is NOT sterile! For a long time it’s been believed that urine produced by healthy people is sterile – at least until it passes through the urethra. Turns out not to be the case. Something to keep in mind if you have contact with urine. Source

Interested in the other news? Read on!

  • Work continues on the possibility of three-parent babies. While much of the research and reporting talks about preventing mitochondrial diseases, I still think it opens a wonderful door for three-parent poly households. The latest news is fairly political, but supportive.
  • Another study out of Europe indicates that transgender hormone therapy is safe. This was a 1-year study of both men and women, just over 100 people total No deaths or serious adverse reactions were reported. Highly recommend you skim the abstract for yourself! For US readers, please do note though that the hormones used in the study were different formulations than those used in the US. Source.
  • A published case study reminds us that not all “odd” physical things during medical transition are related to transition. This was a case of a trans man who had undiagnosed acromegaly from a benign brain tumor. Eek! He was correctly diagnosed and treated, thankfully. Source.
  • A Swedish review of transgender-related records found a transition regret rate of 2.2%. Other prevalence data, including the usual male:female ratios, are included. Source.
  • A study of gay men found that they have worse outcomes from prostate cancer treatments than straight men. Source.