Jan 202014

Some readers find their way to Open Minded Health through search terms. Sometimes I have access to those search terms, and sometimes those terms are a question (or half-formed question) that I haven’t answered. Sometimes I feel like those questions needs answers. So as a belated year-end wrap up, here is a Q&A session of the questions that floated in over 2013…

Do I have to wait until I’m 18 for cross-sex or transgender hormone therapy?

That depends on where you are, how accepting your legal guardians are, who your local medical providers are, and which protocols they or their organizations subscribe to. Some organizations do restrict to age 18. If your guardians are not accepting and don’t support hormone therapy then you will probably need to wait until age 18 (unless you qualify to become an emancipated minor). Many organizations, however, subscribe to the Dutch protocols. These allow for cross-sex hormone therapy (estrogens and anti-androgens for trans women, testosterone for trans men) at age 16.

How common is breast cancer in transsexual men?

No more common than it is for cisgender men, statistically speaking.

How do I get cross-sex hormones?

Call your physician. In the United States at least, they are available by prescription only. It’s of questionable legality and even more questionable safety to acquire them in any other way in the United States.

How will the Affordable Care Act affect trans care?

Honestly? Not sure. And I’m not sure anybody knows. There’s a lot of hope it’ll lead to better health care coverage but I haven’t heard anything definitive on how. The ACA does mean that you can’t be denied coverage for pre-existing conditions, and that does include “gender identity disorder”. The Advocate has some thoughts on the matter.

What about transitioning from male to female using birth control pills?

No! Birth control pills are the wrong form of estrogen. They contain ethinyl estradiol which has significantly high risks associated with it. Please do review the Trans 101 here for more information on why birth control pills are not a good idea.

Can a transgender person be cured of their transgenderism?

Not in the sense you’re thinking of. To my knowledge no attempt to change a transgender person’s gender has ever been successful. Like reparative therapy for gay people, all that seems to come out of such attempts is pain, misery, depression, and suicidality. The only ethical treatment for transgender people at present is transition. Every trans person is different, so the “amount” of transition needed is different. Some may need genital surgery, others are fine with hormones, still others choose not to have either. But transition is the only thing that I’ve see in the literature that has been shown to alleviate gender dysphoria.

How do I ask my doctor about hormones?

That’ll depend on your relationship with your physician. Here’s what I would say: “Hi Dr. X. I’ve been struggling with this for a while. I’m transgender. I would really like to start hormone therapy. Can you help me with hormones, or refer me to someone who can?” Remember that not all physicians are comfortable or fell competent with hormones, so asking for referral might be the best way to go. It can also be helpful to disclose how long you’ve identified as trans, whether you’ve had therapy (or have a letter), and whether you’re out and/or have the support of your family/community/friends or not.

Can I transition to male without injections?

Yes. Testosterone creams are available, but the dose is more uncertain and transition may be slower. Creams are also more expensive and messy. Be careful not to expose others, especially pregnant women, to the cream!

Why is top surgery so scarring? (Trans men)

Because there is cutting involved. Surgery cuts through skin and fat and sometimes muscle and nerve. Those cuts produce scars. It’s part of how the body heals. Also note that scars fade with time, and not everybody scars the same. Also remember that not all scars heal the same. Heck – I got a scar recently that decided to heal as a raised scar, but most of my other scars aren’t raised. Consider bearing all your scars with pride – you survived and healed and you’re able to tell the tale!

Is urethral sounding safe?

As compared to what? Strictly speaking, it’s not. Neither is sex in general. Or breathing for that matter. What you need to decide is whether it’s something you feel comfortable doing, and to what degree you want to minimize your risks. The biggest risk for urethral sounding is tearing or irritating the urethra and then having an infection. A urinary tract infection can become a kidney infection – not a good thing. Using an object other than a urethral sound is riskier than using a urethral sound. To minimize risk, only use urethral sounds (please, no forks. Or glue bottles), remember to sterilize all tools, use sterile lubricant, and go slow and gentle.

Why does urethral sounding feel good? Does it feel good?

I assume it does feel good, otherwise people wouldn’t do it. Urethral sounding is one of the most popular topics here on Open Minded Health. While I don’t know for certain why it might feel good, I have some ideas. The urethra is right next to bits that feel good to stimulate. The stretching of the urethra might feel good in and of itself. And the psychological knowledge of doing something forbidden might add some excitement too. For whatever reason… if you enjoy it, remember to enjoy it as safely as possible.

Does the vagina expand during foreplay?

Yes. (Link NSFW)

Can I get a labia piercing if I have HPV?

BMEzine has a great exploration of this.


And that’s it for this week. See you next week!