Jun 272016
 

Welcome back to Open Minded Health Promotion! This week is all about how cisgender women who have sex with women, including lesbian and bisexual women, can maximize their health. As a reminder — these are all in addition to health promotion activities that apply to most people, like colon cancer screening at age 50.

Woman-and-woman-icon.svgAll cisgender women who have sex with women should consider…

  • Talk with their physician about their physical and mental health
  • Practice safer sex where possible to prevent pregnancy and sexually transmitted infections. Some sexually transmitted infections can be passed between women. If sexual toys are shared, consider using barriers or cleaning them between uses.
  • If under the age of 26, get the HPV vaccine. This will reduce the chance for cervical, vaginal, anal, and oral cancers.
  • Avoid tobacco, limit alcohol, and limit/avoid other drugs. If you choose to use substances and are unwilling to stop, consider using them in the safest ways possible. For example, consider vaporizing marijuana instead of smoking, or participate in a clean needle program.
  • Maintain a healthy weight. Women who have sex with women are more likely to be overweight than their heterosexual peers. Being overweight is associated with heart disease and a lower quality of life.
  • Exercise regularly. Weight bearing exercise, like walking and running, is best for bone health. But anything that gets your heart rate up and gets you moving is good for your body and mind!
  • Seek help if you’re struggling with self injury, anorexia, or bulimia. These issues are much more common in women than in men, and can be particularly challenging to deal with.
  • Consider taking folic acid supplements if pregnancy is a possibility. Folic acid prevents some birth defects.
  • Discuss their family’s cancer history with their physician.

Your physician may wish to do other tests, including…

  • Cervical cancer screening/Pap smear. All women with a cervix, starting at age 21, should get a pap smear every 3-5 years at minimum. Human papilloma virus (HPV) testing may also be included. More frequent pap smears may be recommended if one comes back positive or abnormal.
  • Pregnancy testing, even if you have not had contact with semen. Emergency situations are where testing is most likely to be urged. Physicians are, to some extent, trained to assume a cisgender woman is pregnant until proven otherwise. If you feel strongly that you do not want to get tested, please discuss this with your physician.
  • BRCA screening to determine your breast cancer risk, if breast cancer runs in your family. They may wish to perform other genetic testing as well, and may refer you to a geneticist.
  • If you’re between the ages of 50 and 74, mammography every other year is recommended. Mammography is a screening test for breast cancer. Breast self exams are no longer recommended.

One note on sexually transmitted infections… some lesbian and bisexual women may feel that they are not at risk for sexually transmitted infections because they don’t have contact with men. This is simply not true. The specific STIs are different, but there are still serious infections that can be spread from cis woman to cis woman. Infections that cis lesbians and bisexual women are at risk for include: chlamydia, herpes, HPV, pubic lice, trichomoniasis, and bacterial vaginosis (Source). Other infections such as gonorrhea, HIV, and syphilis are less likely but could still be spread. Please play safe and seek treatment if you are exposed or having symptoms.

Want more information? You can read more from the CDC, Gay and Lesbian Medical Association, and the United States Preventative Services Task Force.

Feb 152016
 

Welcome back! This week we continue talking about health promotion and preventive health. We start by continuing to answer the question…

What can I do on a daily or weekly basis to promote my own health?

  • Brush your teeth: No, really. I mean it. It’s not just about having good breath! The bacteria in your mouth can cause serious health problems if they go unchecked. To find out more, talk with your dentist or dental hygienist, or visit the NIH webpage.
  • Mental health: Your emotions and thinking are just as important as your bodily health. Your own mental health is going to be different and need different kinds of care than another person’s. Cultivate stress reduction techniques, from the Mayo Clinic’s 4 A’s to activities like running, knitting, or massage. Try different things. But if the common suggestions aren’t enough or you are thinking of suicide, professional help can and does help.
  • Sexuality: Play fun and play safe. Use barriers (condoms, dental dams, gloves) to prevent the spread of sexually transmitted infections. If you do not desire pregnancy and are having sex that could lead to pregnancy, use contraception. If you prefer kinky sex, consider playing under the “Safe, Sane and Consensual” or “Risk Aware Consensual Kink” principles. For more information on (vanilla) sex, the CDC has good information.
  • Sleep: Sleep is absolutely crucial to good health. If only it was easy to consistently get good quality sleep. If you have trouble, consider trying sleep hygiene tips like keeping your bedroom dark and cool, avoiding looking at screens before bed, and avoiding tobacco/caffeine/alcohol before bed. If you’ve tried a lot of different things and you still can’t sleep well or you don’t feel rested, talk with your doctor. There could be a medical reason for your sleep difficulties. As always, the CDC has more information.
  • Vitamin/mineral supplements: Put down that multivitamin! Unless your doctor has told you otherwise, most people don’t need supplements. You might need them if you don’t eat a balanced or varied diet, are vegan (B12), are looking to get pregnant (folic acid/folate), or are concerned about your bone health (calcium). For everyone else, they don’t help and they may even do harm. Recent studies have found that antioxidants (like vitamin E) may actually raise the cancer risks.
  • Alternative medicines: There are little to no benefits from alternative medicine and there’s definitely evidence of harm. Ayurvedic supplements have been found to have heavy metals in them. Traditional Chinese medicine is a significant contributor to the loss of important species like the tiger and rhino. Acupuncture is a placebo effect that has spread blood borne illnesses. Chiropractic manipulations are associated with stroke. And homeopathy? It’s just very expensive water. If you have a medical condition or concern, please visit your physician.

That’ll be it for this week! The next post in this series will address health screenings and immunizations.

Jun 222015
 
Fruit made of marzipan

Fruit made of marzipan

If you find yourself feeling confused by the many and contradictory messages about food and diet and supplements, you’re not alone. It’s a maze!

Believe it or not, medical students do get training in nutrition. Here are some general guidelines to help you figure out the weird and wacky world of food and supplements today!

1. Eat as broad a variety as you can. Include as many vegetables and fruit as you can. It doesn’t need to be fresh vegetables. They can be frozen or canned, or even processed. But the variety helps you get vitamins and minerals, and is tasty too.

2. Don’t bother with organic. There’s no nutritional difference or health benefit. You’re better off saving the money and using it to buy more vegetables.

3. Be reasonable with salt and fat. Don’t go on a very low salt/fat or very high salt/fat diet. Your body needs both, but too much of either may increase your risk of heart disease.

4. Unless you’ve been told otherwise by your doctor, don’t take multivitamins, vitamins, or supplements. Not even antioxidants! They don’t do healthy people much if any good, and may cause harm. Exceptions to this rule include calcium for women who don’t get enough calcium in their diet and iron/folic supplements for pregnant women to prevent anemia and birth defects.

5. Eat less and move more. You don’t need to run a marathon unless you want to. But moderate exercise is definitely good. So is being a “normal” (not overweight, obese, or underweight) weight.

6. Try eating less meat. Eating lots of meat is associated with cardiac disease. Try eating a little less and getting your protein from lentils, beans, tofu, nuts, dairy, or plain ol’ whole wheat. Besides, meat is expensive.

7. Ignore fads. Yes, this includes low-carb, high-carb, low-fat, high-fat, no-gluten, many food intolerances…and the list goes on!

8. Tell your doctor about your nutrition and if you take any supplements, including herbs. Some foods may interact with your medications (grapefruit is notorious for this). If you’re trying to change a habit for the better, consider mentioning it to them. They may know some resources that would help.

Got any more? Let me know your thoughts in the comments!!

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. 🙂

Nov 052013
 

News for the month of October - CC BY 2.0 - flickr user  cygnus921It’s that time of month again! No, not when we try to take over the world… it’s time for the monthly news! In no particular order, then, here we go:

  • Analysis of herbal supplements finds that many are contaminated with species not listed in the ingredients label. Herbs are typically classified as supplements in the United States, and are not regulated by the Food and Drug Administration the way medications are. The FDA website has more on the regulation of herbsSource.
  • One dose of Gardasil may be enough to protect against cervical cancer (but please remember to follow your physician’s instructions about vaccines!). Source. At the same time, the HPV vaccines may be less effective for people of African heritage than for people of European heritage. Source.
  • More evidence that monthly changes in sex hormones in cisgender women are associated with changes in sex drive. Source.
  • Germany’s “indeterminate” birth certificate sex designation law comes into effect. The “Indeterminate” marker is, from what I understand, intended to denote intersex babies, not transgender people. The BBC did a fairly good summary of some community reactions. Source.
  • Low prolactin levels in cisgender men as they age has been correlated with reduced sexuality and sexual functioning. Low prolactin levels were also correlated with general unwellness. Prolactin is a hormone most well known for being involved with lactation in breast-feeding parents, but has other effects too. Source.
  • A new study examining sexual satisfaction in women with complete androgen insensitivity syndrome (CAIS) or Mayer-Rokitansky-Küster-Hauser Syndrome (MRKH Syndrome, aka Müllerian agenesis). Women with CAIS reported less sexual satisfaction and confidence than women with MRKH Syndrome, who mostly reported being satisfied with their sex life. The abstract on this paper is fairly scarce so I’ll try to grab a copy for better examination. Source.
  • A study in Ontario, Canada found that 1/3 of trans people needed emergency medical services in 2012, but only 71% were actually able to receive it. 1/4th of those in the survey reported avoiding the emergency room because they are trans, and just over half needed to educate their provider. Source.
  • Another study has found a decrease in psychopathology (i.e., symptoms of mental illness, such as depression or anxiety) when trans people transition. The biggest drop was just after starting hormone therapy. Source.
  • A study on the changes in sexual desire/activity in trans people was published. In a nutshell, sex drive went down for trans women with hormone therapy but recovered a bit after surgery (compared with those who wanted/planned surgery but hadn’t had it yet). In contrast, trans men generally had their sex drive go up with hormones/surgery. Source.