Let’s talk about Being Transgender – Part 2

 

In my previous post, I told a few personal stories and talked about being transgender in broad strokes. I want to take this post to talk about something a little more specific, medical transition. There is a lot of misinformation and mystery behind this. Those of us who go through this see things every day telling us how it works and not always considering what we are experiencing.

For those of us who medically transition, we live every day with potential risks. For transgender individuals on hormone replacement therapy, medical risks like blood clots and stroke increase. However, while people who want to ban medical transition try to talk about how dangerous it is, these risks are not simply limited to gender affirming care. Hundreds of different medications on the market have side effects of stroke or other cardiac events and yet, these medications don’t get a peep out of anyone, especially law makers.

Medical transition usually begins with doctor’s appointments. In most cases, doctors follow strict guidelines when prescribing the medications and procedures for a medical transition. While opponents of gender affirming care will point out examples where doctors were “handing out hormones like candy”, these situations are actually not normal and don’t represent the process as a whole. Most of the time, this process includes multiple doctors who are trained in these procedures, medications, and conditions. Therapists, surgeons, primary care physicians, endocrinologists, pharmacists, the list goes on and on of those who are all involved in these processes and discussions about medical transition with a patient.

Sometimes, it can seem like transgender people are making impulsive decision about this process and simply jumping into transition. This isn’t the case. These decisions are ones we have discussed with ourselves thousands of times. For transgender kids, yes they exist, these conversations are also held with parents.

The most common point for beginning a medical transition is starting low doses of medications for hormone replacement therapy. What is prescribed is done so by the doctor after discussions and usually bloodwork is completed. This is because each person is different. A prime example is that while I am a transgender woman, I am also a parent of a transgender daughter. Our medications are similar yet different. I am on both an androgen and estrogen while my daughter was only prescribed estrogen but at a higher dosage than my own. Her doctor discussed all of this with her and with me and we both trust that this is the right path for her.

The goal of this form of therapy is to begin to suppress the unwanted hormone and replace it with the desired one. Every person produces both estrogen and testosterone in their bodies. The difference is how much is produced and how the body processes it. This is why we always see stories around the times of the Olympic games about women who have high testosterone. As the balance of the hormones in a transgender person begin to shift we see changes to our bodies.

These changes are some the root of some of the biggest myths and misinformation out there. Testosterone is the hormone in every person that helps in the building of muscle. Transmen see an increase in muscle and body mass when they begin taking it. Transwomen, on the other hand, see a loss of muscle and body mass when their testosterone level begins to go down. I know this from experience.

Some people argue that transwomen have an advantage in sports because of this when the exact opposite is true. There has been no definitive study done showing that transwomen do have this advantage. In order to maintain the same level of fitness as they previously had, transwomen have to work 10 times harder. The placement of fat cells and muscle tissue is also affected by these treatments along with overall muscle shape.

Something else that is affected by these treatments is bone density. Now, many opponents of transgender individuals will argue that taking hormones won’t change your bone structure. While this is mostly true, it can change your bone density making them weaker than they were before. Also, a lot of transwomen report a loss in height wish is again, contributed to changes to bone density. So, to simply discount these things when others are reporting them happening, it’s just not a fair and complete picture of the issue.

Hormone therapy also leads to changes such as breast growth in transwomen along with having a fuller amount of hair on their head and the increased growth of facial and body hair along with a lowering of the vocal ranges in transmen. Needless to say, what transgender people go through during this therapy is vast and results differ greatly from person to person.

Something not as often talked about but always weaponized is gender affirming surgery. This is what most people refer to when they say the phrase “sex change”. Now, if you listen to the gender criticals and the uninformed, you will think that transwomen go and simply have their genitals “cut off”. Those now surgically removed genitals are then given to transmen who want male genitalia by simply sewing them on like some bizarre Frankenstein type of procedure. This couldn’t be further from the truth.

I am not going to get into the gory details on these procedures, but I will say they are way more complicated than that. Transwomen don’t simply get something cut off and that’s the end of it. No. The entire genital region is painstakingly reconstructed using the tissue of that region and other regions to create something that more accurately matches the gender identity of the patient. The procedure itself is an interesting mix of medical science and art. Similarly trans men go through a process, if they desire to, that takes donor tissue from their body to help build genitalia that is more inline with their identity as well.

The point I am trying to make with all this is that it is not as cut and dry or as simple as opponents of transgender rights want it to make seem. All of it is complicated. However, what most don’t realize is that there is science behind it. Many scream about biology but those who do barely have an 8^th grade level understanding of it. Science evolves, like we do. It changes and our understanding grows. I will acknowledge, there is a point in history where research on transgender medical care kind of stopped. People got uncomfortable with the idea of people changing their gender. Why? I don’t know, blame society if you are so inclined. It’s only been in recent years that there have been new studies taking place.

In the meantime, while science evolves, transgender people watch as our healthcare and rights come under attack by individuals you believe themselves morally righteous or more intelligent than everyone else. They deal with constant attacks and abuse. They deal with hatred and growing legislation designed to segregate and rule their lives due to other people’s beliefs. Now more than ever it feels like this tiny little community is out in the cold. I will get to that in part 3. 

-Robin Alura