The Dangers of Peer Advice Regarding Sex Hormone Use
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
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.
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.
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
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.
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
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
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.
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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