The Dangers of Peer Advice Regarding Sex Hormone Use




Introduction
Like most transsexual (TS) people I employ sex hormones to change my body to match my gender identity. Having been born without ovaries, I take estrogens to reach and maintain a female hormonal balance. Sex hormones can be dangerous if used in high doses, with or without proper medical monitoring, yet there are some TS women who reject doctor supervision of hormone replacement therapy (HRT). They also encourage others to reject medical supervision. And even though they're not licensed to practice medicine or have formal medical schooling, some of them even prescribe hormone regimens to women they've never even met, let alone examined. This practice can have drastic health consequences.



Hormones and Healthcare
The proponents of rejecting medical supervision correctly point out that TS women do not face all of the same risks of HRT that women with a uterus do. They may even be correct that some doctors under-prescribe HRT, thus not producing enough of a feminizing effect for a TS woman. However, even though most doctors experienced in treating TS women do understand our special needs, the most militantly anti-doctor TS women still go it alone and encourage others to do the same.

My suggestion to any TS person on HRT: if your physician is not familiar with treating transsexual people via HRT, then work with and try to help educate her or him, or search for a doctor willing to do so. There are resources for educating doctors about HRT from transsexual people. Most importantly, get regular Liver Function Tests (LFTs), which are also called liver panels or metabolic panels, and have them evalulated by someone with a medical degree. If you or your family has a history of liver, cholesterol, blood pressure or other internal disorders, lab tests can help protect you from potentially serious side effects from HRT.

While I cannot even begin to scratch the surface of laboratory work to safeguard the liver and other bodily systems, nor can I cover in depth the health risks that HRT presents to the liver, Wikipedia has some useful, comprehensible information on both liver tests and also HRT effects on transsexual people. I advocate learning as much as possible and then working with your doctor to reach a satisfactory course of treatment.



Resources
It is not my intent to attempt to provide a detailed listing of resources, but rather a few starting points for locating both information and providers. More of these can also be found on my LINKS page in my Transition section.
Andrea James' TS roadmap offers links to both information and providers.
Dr. Anne Lawrence is a TS woman who is a licensed physician in Seattle, WA. Her website contains handouts for medical providers who want to provide HRT for transsexual people.
GenderLife Information Exchange is an open forum for transsexual women where open, honest discussion is encouraged. Most of the TS women there are knowledgeable, friendly and happy to help. They can point the way to other resources.



My Experience
Due to a Hepatitis C (HCV) infection I was forced to stop taking estrogens in 1991. To prevent my testicles from reverting me back to a testosterone-intense body chemistry and the undesired physical and mental effects of that, I had a bilateral orchiectomy (castration). In 2002 a transsexual woman I encountered online made specific HRT dosage recommendations after hearing my full history. She also directed me to the Yahoo group Crone, a discussion for for transsexual HRT.

In 2004 I was cured of Hep-C and resumed HRT, finally settling on an intramuscular injection of estradiol valerate. For two months I followed my doctor's recommended dose and my liver enzymes stayed normal. I then considered adding a small dose of testosterone to counteract my very low libido. I joined the Yahoo group Crone and was again advised that my estrogen dose was way too low. It was also told that my doctor, a man with years of experience treating TS women, could not be trusted.

Foolishly heeding the advice I got in 2002 from a transsexual woman who'd never even been to medical school, I experimented with raising my own estrogen dose. Within two weeks I began to notice ill symptoms and a month later laboratory work confirmed my liver enzymes were back up to unhealthy, potentially dangerous levels.

While it is possible my liver is oversensitive as a result of fighting off Hep-C, of the chemo I underwent to cure the HCV, and/or of my decades of drug and alcohol use, that is a side issue. The real problem was taking medical advice from an untrained person who hasn't examined me or my lab results. Fortunately my liver enzymes returned to normal within a month after I resumed my prescribed dosage.



Questionable Peer Advice
Many transsexual women complain that most doctors have no experience in treating transsexual people with HRT. While this is true to a large degree, it is no excuse for not seeking out a doctor who has such knowledge, or helping educate your own doctor or finding one willing to be educated. Yet some of the most ardent and vociferous critics argue that virtually all doctors are not to be trusted, and that we are better off treating ourselves. This is a potentially dangerous suggestion to heed.

The Internet has proven a great boon to transsexual people, allowing us to network, offer emotional support and share information. While the Internet may be a good place to start obtaining information about hormones, it should not be the principle source for information or discussion. If you do go to an online group, be certain it is a place where information and experience are not censored by those in charge of the group.

Most of the time the online forums permit open discussion, but on some forums members are silenced if they present unpopular views no matter logically or politely they are presented. The Yahoo group Crone does not encourage free discussion and it permits potentially harmful suggestions and misinformation to go unchallenged. In 2005 I joined this group and was swayed by the sense of authority one of the senior posters there, Lena. Yet when I reported my bad experience it was not only discounted by Lena, all of my followup posts were censored by the list owner.


Detailed Documentation
To see proof I have not made baseless charges against members of the Crone yahoogroup, one only needs to join it and read the thread I initiated on December 2nd, 2005: "No method 100% safe ". However, since the group is by invitation only and membership is screened, I have encapsulated the incident. These include a short history behind the debate, the actual thread, the censorship and my attempts to iron out the situation with the group's "list owner", Anna, most of which were ignored.

Frankly, this string of postings looks as childish and petty as two attorneys in a courtroom pissing match, tossing out the minutiae in an effort to make their case. I became disgusted as I assembled this string of emails from the Sent and Inbox folders of my email client. However, given that censorship is a serious allegation, and because I believe it to be a valid one, I opted for rigorous documentation.

Note: I have edited out the email addresses to prevent any of the parties being nailed by a spambot, thought I wouldn't lose much sleep if one of the parties were bedeviled with Viagra and penis-enlargement spam for the rest of her life.

Post: May 20th, 2002
In May of 2002 I joined the "postop" Yahoo group to get information about my upcoming sex reassigment surgery. I raised the topic of postop HRT in this group. It was then I was first exposed to the misinformation of Crone's most vocal and venerated member, Lena.

Post: December 2nd, 2005
In August of 2005 I doubled my estrogen dose based on Lena's past advice. A month later my liver enzymes had shot up to near Hepatitis-C levels. Nothing else diet, medication, lifestyle, etc. had changed. When I reduced the estrogens, my liver recovered within four weeks. While convalesced from my facial surgery I posted this message on Crone, warning the members of the potential dangers of hormone overdose.

Post: December 3rd, 2005
Several Crone members asked for clarification and elaboration on my previous post, so I included more details that suggested to me that the increased HRT dosage was the cause of my liver problems.

Post 1: December 4th, 2005
Unsurprisingly, Lena's response was not only defensive and patronizing, I was essentially accused of lying. Though angrily sarcastic in places, my response was designed to continue the debate. The list owner, Anna, prevented it from posting to the group.

Email: December 4th, 2005
In a length, scolding email, Anna not only sided with Lena but also took her own swipes at my post.

Post 2: December 4th, 2005
Meanwhile my replies were still being ripped apart by other members. Again, I attempted to rebut the misinformation and misinterpretation I saw. Of course, it was never allowed to post.

Emails: December 7th and 8th, 2005
Not only did I try to dialogue with Anna but also with the list founder, Jennifer. At least Jennifer responded to my email and initiated a dialogue.

Email: December 8th, 2005
I made an offer: allow one reasonable post to refute the misinformation, address the errant speculations and offer my perspective on experimenting with hormones.

Email: December 12th, 2005
Still attempting to get Jennifer's help in mediating it.

Post and emails: December 17-18th, 2005
Lena continues her onesided debate, I'm still censored. This time I email both Jennifer and Anna.

Email: December 19th, 2005
Anna finally responds to not only editorialize my posting but also to essentially rewrite it for me and tell me it won't be posted unless I consent to her editing it.

Email: December 21st, 2005
Even after I tone down my posting even further, Anna responded with even more editorializing and directions on how to edit the post to suit her opinions. After a few more ignored attempts to dialogue, I give up.


Postscript
When I posted my preliminary warning about Crone on this website back in January, 2006, my Crone membership was "mysteriously" cancelled. If you are a Crone member and care about open, frank discussion of HRT, you might consider posting on Crone a link to this page. Warning: doing just that may likely get you moderated or flat-out banned from membership on Crone. (That may not be such a bad thing.)


Copyright 2006 by Christine Beatty, all rights reserved


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