As I mentioned in my first post - and the entire reason it's taken me so long to start testosterone hormone therapy - I'm a bit of a prematurely aged safety nut. I've never tried alcohol (unless NyQuil counts). I've never tried recreational drugs. I'm vegan. I bicycle as my main form of transportation year-round. I try to work out every day. I weaning off sugar and soda pop.
Moral of the story being, now that I have started hormone therapy, I've been very concerned about the immediate and long-term future here in regards to my uterus and ovaries. Despite having my transition plan that entails taking T for a max of 5 years, I'm anxious about increasing any long-term risks of liver damage or cancer of my completely unnecessary and obnoxious reproductive organs (uterus/endometrium, cervix, and/or ovaries). Hopefully I'm just being too cautious and there really isn't anything to worry about. Still, I am who I am, and this is what I do.
The reality is that us "female-to-male" (FTM) folk haven't been around for too long or studied in a large enough sample size over enough time to determine the actual, long-term risks of cancer associated with testosterone therapy. I hear a lot of mixed messages. My hormone doctor is really blunt and tells me the above. Other transmasculine individuals who are on hormone therapy tell me not to worry. Others say that an increased risk for such cancers is a myth. Then I hear of a documentary called 'Southern Comfort', which is specifically about a man of transgender experience who died from cancer in his female reproductive organs (however, he lived in the south and also had a history of not seeing doctors regularly for check ups, had doctors who refused to treat him due to being trans-phobic, etc). And it's already known and documented polycystic ovarian syndrome is linked to endometrial hyperplasia (where the lining of the uterus grows too much), which ... anyway, so on and so forth.
My period hasn't stopped yet, but, it's likely that it will due to the regular feedback patterns that control estrogen, progesterone, menstrual flow, etc., being altered. Most transmen I've heard of get a hysterectomy as soon as possible so that the testosterone therapy doesn't have to "compete" with the estrogen/progesterone hormonal production and feedback that is present in those with active ovaries, AND because this is strongly advised health-wise. But I'm not planning to have a hysterectomy.
I'm torn, in a lot of ways.
I know that those few, precious years after my top surgery and during hormone therapy are going to be THE BEST I've ever experienced connection-wise. I'm concerned that, when I experience this and how entirely connected and mentally sound I'll feel, it's going to be incredibly difficult to gradually stop testosterone therapy.
I'm promising myself that I'm going to stop though because, once I have some irreversible male secondary sex characteristics (more information about what's reversible/irreversible here), I can do my best to keep my body fat low. Not to mention that if this didn't work for me I will always have the option to continue testosterone therapy again in the future, and, in that case, I would definitely have a hysterectomy.
For now, I'm going to ask my hormone doctor in a few months (we're meeting every 6 months, unless something happens that requires meeting sooner) about potentially using a progesterone-based hormone therapy to induce menstrual periods during the first year or two in order to shed any buildup of the endometrial lining. This may help prevent spot bleeding as well as potentially decrease the risk of uterine cancer,.. or, at least, I can ask her, and get her feedback on this line of thought.
My hormone doctor, by the way, is pretty amazing. I was surprised to find her, seeing as it's Utah. She's blunt, honest, and spends a lot of time with her patients. My very first visit with her wasn't to start hormone therapy (I didn't have a letter from my therapist yet), but to "test the waters", see if I felt comfortable with her, and to get a routine checkup.
During this routine checkup, she asked me, "When was your last pap smear?"
Gulp.
I replied, "Well, there have been two unsuccessful attempts. Afterward I was told by both doctors that, due to my history, I didn't need them and I'm incredibly low risk." (This may be true, actually. Those two doctors told me this, but I've also read it on various health sites. For example: Pap smear: Do I Need One?). She then replies, while staring straight into my eyes, "How would you like to have your first successful one today?"
I was on the spot. There was silence. I squirmed. She continued to stare. I replied, "How about I make an appointment for it later on, so I can mentally prepare beforehand?" She called my bluff. There was no escape. And, despite the fact that I most likely don't need them, but since I'm a prematurely aged preventative safety nut, I consented. Reluctantly. She knew what she was doing and has obviously worked with a lot of transmen before.
She leaves the room, I put on a little gown. Next thing I know she returns with a syringe full of some kind of muscle relaxant, which she tells me she was injected with prior to delivering her first baby. She shoots an entire dose into my left shoulder. We wait for me to relax, chit chat. When it doesn't happen, she leaves the room, comes in with another dose of this stuff and shoots it into my right shoulder. Despite being completely hopped up on muscle relaxants, it took a while for it to happen. She was incredibly patient, understanding, responsive, slow, and careful. I started crying at some point. It was traumatic and awful to all hell, but, I did end up getting my first successful pap smear. I'll wait 2 years to ever have that done again, and I'm NOT looking forward to the day.
I hope this encourages you all to get pap smears!
It's difficult to explain WHY it's so traumatic, even to myself. I don't have another experience that I can use as an analogy to explain it. It's not like it's literally, physically painful to such an extreme extent that warrants crying and gritting my teeth. It's not embarrassing or emotionally hurtful. It's not like I'm thinking anything that's causing me to tense up or cry. I wasn't sexually abused and I don't feel upset about my body. It's literally due to something like a completely foreign, disconnected experience. It's like my mind is in shock from this sensation that isn't meant to be, because it isn't mapped for that kind of experience. Maybe a good analogy would be if some guy had a speculum shoved into his perineum, assuming it didn't have skin to tear apart to get up there. Or, at least, that's the best analogy I can think of, but still an extremely poor one. It's something, at least! A for effort.
Oh, after all of those muscle relaxants, an hour after my appointment (which was at noon) I fell asleep at home. I vaguely remember being woken up around 7pm, and toted over to Jay's for a Nip/Tuck marathon. I slept through that, too. Then I slept in the next day and got to work an hour late. I drooled a lot. And, when the relaxants wore off, I was all moody and plummeted in to a wonky place emotionally, then slept again. ALL OF THAT FOR A PAP SMEAR! My golly!
On another note, wunderbar atheist stuff going on in the world:
"Imagine No Religion" Billboards Go Up in San Francisco
and
The atheist bus journey
Moral of the story being, now that I have started hormone therapy, I've been very concerned about the immediate and long-term future here in regards to my uterus and ovaries. Despite having my transition plan that entails taking T for a max of 5 years, I'm anxious about increasing any long-term risks of liver damage or cancer of my completely unnecessary and obnoxious reproductive organs (uterus/endometrium, cervix, and/or ovaries). Hopefully I'm just being too cautious and there really isn't anything to worry about. Still, I am who I am, and this is what I do.
The reality is that us "female-to-male" (FTM) folk haven't been around for too long or studied in a large enough sample size over enough time to determine the actual, long-term risks of cancer associated with testosterone therapy. I hear a lot of mixed messages. My hormone doctor is really blunt and tells me the above. Other transmasculine individuals who are on hormone therapy tell me not to worry. Others say that an increased risk for such cancers is a myth. Then I hear of a documentary called 'Southern Comfort', which is specifically about a man of transgender experience who died from cancer in his female reproductive organs (however, he lived in the south and also had a history of not seeing doctors regularly for check ups, had doctors who refused to treat him due to being trans-phobic, etc). And it's already known and documented polycystic ovarian syndrome is linked to endometrial hyperplasia (where the lining of the uterus grows too much), which ... anyway, so on and so forth.
My period hasn't stopped yet, but, it's likely that it will due to the regular feedback patterns that control estrogen, progesterone, menstrual flow, etc., being altered. Most transmen I've heard of get a hysterectomy as soon as possible so that the testosterone therapy doesn't have to "compete" with the estrogen/progesterone hormonal production and feedback that is present in those with active ovaries, AND because this is strongly advised health-wise. But I'm not planning to have a hysterectomy.
I'm torn, in a lot of ways.
I know that those few, precious years after my top surgery and during hormone therapy are going to be THE BEST I've ever experienced connection-wise. I'm concerned that, when I experience this and how entirely connected and mentally sound I'll feel, it's going to be incredibly difficult to gradually stop testosterone therapy.
I'm promising myself that I'm going to stop though because, once I have some irreversible male secondary sex characteristics (more information about what's reversible/irreversible here), I can do my best to keep my body fat low. Not to mention that if this didn't work for me I will always have the option to continue testosterone therapy again in the future, and, in that case, I would definitely have a hysterectomy.
For now, I'm going to ask my hormone doctor in a few months (we're meeting every 6 months, unless something happens that requires meeting sooner) about potentially using a progesterone-based hormone therapy to induce menstrual periods during the first year or two in order to shed any buildup of the endometrial lining. This may help prevent spot bleeding as well as potentially decrease the risk of uterine cancer,.. or, at least, I can ask her, and get her feedback on this line of thought.
My hormone doctor, by the way, is pretty amazing. I was surprised to find her, seeing as it's Utah. She's blunt, honest, and spends a lot of time with her patients. My very first visit with her wasn't to start hormone therapy (I didn't have a letter from my therapist yet), but to "test the waters", see if I felt comfortable with her, and to get a routine checkup.
During this routine checkup, she asked me, "When was your last pap smear?"
Gulp.
I replied, "Well, there have been two unsuccessful attempts. Afterward I was told by both doctors that, due to my history, I didn't need them and I'm incredibly low risk." (This may be true, actually. Those two doctors told me this, but I've also read it on various health sites. For example: Pap smear: Do I Need One?). She then replies, while staring straight into my eyes, "How would you like to have your first successful one today?"
I was on the spot. There was silence. I squirmed. She continued to stare. I replied, "How about I make an appointment for it later on, so I can mentally prepare beforehand?" She called my bluff. There was no escape. And, despite the fact that I most likely don't need them, but since I'm a prematurely aged preventative safety nut, I consented. Reluctantly. She knew what she was doing and has obviously worked with a lot of transmen before.
She leaves the room, I put on a little gown. Next thing I know she returns with a syringe full of some kind of muscle relaxant, which she tells me she was injected with prior to delivering her first baby. She shoots an entire dose into my left shoulder. We wait for me to relax, chit chat. When it doesn't happen, she leaves the room, comes in with another dose of this stuff and shoots it into my right shoulder. Despite being completely hopped up on muscle relaxants, it took a while for it to happen. She was incredibly patient, understanding, responsive, slow, and careful. I started crying at some point. It was traumatic and awful to all hell, but, I did end up getting my first successful pap smear. I'll wait 2 years to ever have that done again, and I'm NOT looking forward to the day.
I hope this encourages you all to get pap smears!
It's difficult to explain WHY it's so traumatic, even to myself. I don't have another experience that I can use as an analogy to explain it. It's not like it's literally, physically painful to such an extreme extent that warrants crying and gritting my teeth. It's not embarrassing or emotionally hurtful. It's not like I'm thinking anything that's causing me to tense up or cry. I wasn't sexually abused and I don't feel upset about my body. It's literally due to something like a completely foreign, disconnected experience. It's like my mind is in shock from this sensation that isn't meant to be, because it isn't mapped for that kind of experience. Maybe a good analogy would be if some guy had a speculum shoved into his perineum, assuming it didn't have skin to tear apart to get up there. Or, at least, that's the best analogy I can think of, but still an extremely poor one. It's something, at least! A for effort.
Oh, after all of those muscle relaxants, an hour after my appointment (which was at noon) I fell asleep at home. I vaguely remember being woken up around 7pm, and toted over to Jay's for a Nip/Tuck marathon. I slept through that, too. Then I slept in the next day and got to work an hour late. I drooled a lot. And, when the relaxants wore off, I was all moody and plummeted in to a wonky place emotionally, then slept again. ALL OF THAT FOR A PAP SMEAR! My golly!
On another note, wunderbar atheist stuff going on in the world:
"Imagine No Religion" Billboards Go Up in San Francisco
and
The atheist bus journey
For testosterone I had to sign a waver that included the following risks:
ReplyDeleteIncreased weight
Edema (swelling)
Acne
Erythrocytosis (elevation in red blood cell count)
Liver enzyme elevations
Decrease in the HDL faction of cholesterol
Increased risk of cardiovascular disease
Coarsening of skin
Headache
Emotional changes, increased aggressiveness
Redistribution of body fat into an android (apple) shape
Male pattern baldness
Increased risk of breast cancer
Hypertension (high blood pressure)
Thrombophlebitis (blood clots in the veins)
I signed it immediately without hesitation. I think the benefits of transition outweigh the risks. I'd die for this...
In the long run, if you wish to transition, it is safer to have your ovaries removed.
I personally don't feel pain when I am examined, but it is a foreign experience. Instead of feeling pain, I am lacking in sensation. It seems as though my brain is completely disconnected from my insides. A pap smear is only a traumatic experience for me because I'm opening my legs to be examined like a woman... Instead of them checking my penis they're digging around in some hole that I don't even think is supposed to be there. I don't cry or anything, but I do tend to tense up. I always do. I've always wanted that hole to close up.
As for your "guy had a speculum shoved into his perineum," analogy, this is actually an analogy I've used to describe my pain and confusion for years. I believed when I was younger that this very thing is exactly what happened to me. I believed that my penis and scrotum were cut off and replaced with this hole. That something was shoved inside of me, stretching the skin like fabric and creating this foreign tunnel.
Thanks for your input, Dan! I entirely agree that it's worth the risks - however, I'm trying to do my best to transition in a way that reduces those risks as much as possible, under the belief that there are many ways to do this and that my body, despite the fact that it released estrogen instead of testosterone, isn't at fault for what happened. Instead of divide and conquer, I'm coming at this with a whole notion of compromise. Somehow. Which may or may not work.
ReplyDeleteEither way, if I do decide to do testosterone therapy long-term, I will DEFINITELY have a hysterectomy at that point.
We live once and entirely deserve to experience connecting, to whatever degree possible, however that's accomplished. :]
p.s. not to mention that, unlike biological guys, most of us were born with a functioning female reproductive system, which entails some... special consideration on how to go about it. Woo hoo!
ReplyDeleteI wish I could be a father... a normal father, who's had a child the way all fathers do. I can't stand the idea of being a mother.
ReplyDelete