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Welcome to #TransTuesday ! This week we’re talking about something nearly every trans person has encountered, and I suspect it’s something most cis people have zero idea about. And it’s pretty messed up! It’s time to discuss ANECDOTAL TRANS HEALTHCARE.
12:05 PM - May 16, 2023
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The intersection of trans people and healthcare, if you didn’t already know, is pretty fraught. And not just because so many places are trying to make the vital, life-saving healthcare that we NEED illegal or impossible to access.
12:05 PM - May 16, 2023
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I’ve talked about various other ways that transness intersects with healthcare before. See the Trans Tuesday on how there’s NO ESCAPE (from my deadname and reminders that I’m trans) for some difficulty with it, and one way it went right.
https://twitter.com/TillyBridges/status/1379506428256284672
https://twitter.com/TillyBridges/status/1379506428256284672
12:05 PM - May 16, 2023
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See the Trans Tuesday on NO ESCAPE 2 for some really messed up ways it went very wrong, though it has a happy ending.
https://twitter.com/TillyBridges/status/1425149833388593154
https://twitter.com/TillyBridges/status/1425149833388593154
12:06 PM - May 16, 2023
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And you can see the Trans Tuesday on DISCRIMINATORY BUREAUCRACY on more ways that it’s just entirely messed up.
https://twitter.com/TillyBridges/status/1503772938931036163
https://twitter.com/TillyBridges/status/1503772938931036163
12:06 PM - May 16, 2023
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And for even more of an in-depth look at it, see COMPLETE TRANS HEALTHCARE OR THE LACK THEREOF.
https://twitter.com/TillyBridges/status/1442923779273883650
https://twitter.com/TillyBridges/status/1442923779273883650
12:06 PM - May 16, 2023
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Also! You should see the Trans Tuesday on TRANS KIDS and THE INTAKE EXAM to see how I had to PROVE my transness and womanhood to cis people in order to access the medical care I needed.
https://twitter.com/TillyBridges/status/1516451083412860931
https://twitter.com/TillyBridges/status/1516451083412860931
12:06 PM - May 16, 2023
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That leads right into me reminding you that cis people are largely the gatekeepers to trans healthcare. For most of us trans folks that means at some point, and likely multiple points, along the way, cis people had to agree that we needed the care and approve it for us.
12:07 PM - May 16, 2023
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As trans people are such a small part of the population, it’s not easy (and can be impossible for some of us) to find trans doctors to provide our transition care. I myself am limited to the doctors that work with my insurance and that are nearby. And none of them are trans.
12:07 PM - May 16, 2023
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And if you’re wondering how well cis doctors know and understand medical transition, let me tell you that it’s generally… not good. As far as I know, my primary care physician has zero experience with trans patients and doesn’t even know about most of what I want or need.
12:07 PM - May 16, 2023
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My endocrinologist has treated other trans patients before, but even STILL there were things that he just didn’t know, or wasn’t sure about. And this is sadly the norm for a WHOLE LOT of trans people.
12:07 PM - May 16, 2023
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I’ve mentioned before how, because we’re such a small part of the population, very few studies about trans healthcare have been done. A lot of our care is ANECDOTAL because rigorous, science-backed studies about us are few and far between.
12:08 PM - May 16, 2023
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This is not to say that puberty blockers and hormones are untested! They’ve been used safely for decades in both cis and trans patients! But so few doctors are at all familiar with their application to transition care.
12:08 PM - May 16, 2023
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And so we research online, we talk to each other and learn from each other. But it’s still difficult, because hormone replacement therapy works so very differently for every person, and requires trial and error and constant adjusting until you find the perfect balance.
12:08 PM - May 16, 2023
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If you need more information on the basics of HRT, there’s a Trans Tuesday on that, too.
https://twitter.com/TillyBridges/status/1356688203395125249
https://twitter.com/TillyBridges/status/1356688203395125249
12:08 PM - May 16, 2023
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One of the refrains you’ll hear a lot from the transphobes out there is how trans people are being “rushed” into transitioning, and that is THE MOST LAUGHABLE THING ON THE PLANET. Nothing NOTHING about transition is fast.
12:08 PM - May 16, 2023
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See my ONE YEAR RETROSPECTIVE to see what changes I’d experienced from HRT.
https://twitter.com/TillyBridges/status/1427693258738528258
https://twitter.com/TillyBridges/status/1427693258738528258
12:09 PM - May 16, 2023
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You can also see my TWO YEAR RETROSPECTIVE to see further changes I’d experienced from HRT.
https://twitter.com/TillyBridges/status/1356688203395125249
https://twitter.com/TillyBridges/status/1356688203395125249
12:09 PM - May 16, 2023
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In fact it took me ONE THOUSAND DAYS OF HRT to get up to a B-cup bra. I mean, I knew i needed a bigger cup size when I ordered this, but it arrived and I tried it on and found it fit perfectly on day 1000, so that’s when it was confirmed.
12:09 PM - May 16, 2023
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Surgeries can take even longer, as there aren’t that many doctors who perform gender confirmation surgery, and so their waitlists are long. Sometimes YEARS long. Some require multiple notes from psychiatrists or psychologists stating that you NEED the surgery.
12:09 PM - May 16, 2023
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And it also takes a lot of research to find the doctor that you think is best for you and can give you what you’re looking for. Some of us just have to go with whoever our insurance covers, if our insurance covers it at all. Some people have to fly to other states or countries!
12:10 PM - May 16, 2023
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Here are the parts of my OWN healthcare that I had to learn from other trans people and by researching on my own. This will not be the same for every trans person, but here’s a look at what *I* had to deal with just in terms of my own HRT.
12:10 PM - May 16, 2023
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I’m on estrogen pills, which my doctor and the label on the bottle says to take orally. But when you do, it’s hard on your liver AND your liver destroys most of it. You end up getting very little estrogen from it (compared to how much is in the pills).
12:10 PM - May 16, 2023
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But if you take it sublingually, by placing it under the tongue and letting it dissolve, it bypasses your liver and more of it goes directly into the bloodstream. Thus you get more of what you want and your liver doesn’t have to work as hard. It’s win-win.
12:10 PM - May 16, 2023
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But also it seems to be that taking it sublingually MAY affect your lipids, and cause levels of LDL to rise. I don’t know if that’s true for everyone. It has been for some people. It MAY be for me. On my recent labs my lipid panel got markedly worse, and my diet hasn’t changed.
12:10 PM - May 16, 2023
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My exercise level hasn’t really changed either. So now I’m back to swallowing the pills to see if that helps my lipids on my next labs. I dunno! Again, THERE IS SO LITTLE INFORMATION ON THIS OUT THERE.
12:11 PM - May 16, 2023
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I had to ask my doctor about adding progesterone into my HRT, it wasn’t something he even mentioned me possibly taking. And when I asked about adding it, he said (I KID YOU NOT), “Well… it’s anecdotal.” AND IT IS.
12:11 PM - May 16, 2023
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Because again, SO LITTLE INFORMATION IS OUT THERE. There’s not a lot of scientific studies done on the effects of progesterone in trans women, but nearly EVERY trans woman I talked to raved about how much it helped them.
12:11 PM - May 16, 2023
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So my endo agreed we could try it, and at first I saw some nice results, but then it seemed to stall out and nothing was happening. And it was then, in talking to other trans women, I discovered THERE ARE TWO DIFFERENT KINDS OF PROGESTERONE.
12:11 PM - May 16, 2023
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And for whatever reason, my endo had put me on the synthetic version (without mentioning there was any other option). A while back I had him switch me to micronized progesterone… and THEN I GOT TO THE BIGGER CUP SIZE. And I AM STARTING TO GET HIPS!
12:11 PM - May 16, 2023
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HIIIIIIPS! I have been waiting years. Every time I see them, I could fly up to the moon, it makes me so damned happy. This is the super lovely best thing in the world, GENDER EUPHORIA. Yes, there’s a Trans Tuesday about it.
https://twitter.com/TillyBridges/status/1430239296464691203
https://twitter.com/TillyBridges/status/1430239296464691203
12:12 PM - May 16, 2023
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I’ve also learned about an alternate method of taking both progesterone and estrogen, which the community has termed “boofing,” which is taking them as suppositories. Many trans women say they get much better results that way, but that doesn’t seem to work for me.
12:12 PM - May 16, 2023
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Again, every body is different, and not only do our bodies respond differently to different hormones, our bodies are better or worse at processing things different ways. It involves experimentation, because again: SO FEW STUDIES ARE DONE.
12:12 PM - May 16, 2023
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And I will remind you again that ALL of HRT for trans people is DRUGS THAT WERE DEVELOPED FOR CIS PEOPLE. Some, like estrogen and progesterone, were developed for post-menopausal cis women.
12:12 PM - May 16, 2023
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Others, like testosterone blockers, are taken because we want what are considered SIDE EFFECTS of those drugs, most of which were developed to help cis men (with hair loss, enlarged prostates, etc).
12:12 PM - May 16, 2023
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NONE of them were developed FOR us. Because we’re such a small percentage of the population there’s not a lot of money in it for the pharmaceutical companies.
12:12 PM - May 16, 2023
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There’s not an OUNCE of truth to people saying transition HRT is “forced” on people so doctors and drug companies can make money. It’s LAUGHABLE how untrue it is.
12:12 PM - May 16, 2023
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I’d also heard from other trans women on HRT that it could cause PMS. I was so stymied! How? It’s not that I disbelieved them, I was just confused. And then, maybe six months ago, reader… IT HAPPENED TO ME.
12:13 PM - May 16, 2023
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What is this intense pain in my lower abdomen? Oh god why does it hurt so bad?? Why am I so emotional this week??? WHY AM I SUDDENLY CRAVING CHOCOLATE AND NOTHING ELSE WILL DO????
12:13 PM - May 16, 2023
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Like it’s such a cliche, but it’s somehow true. I’ve never been a huge fan of chocolate. I mean it’s fine, whatever. Vanilla is more my jam. But when the PMS symptoms hit I NEED it, and it somehow actually helps alleviate some of the symptoms! It makes me feel better!
12:13 PM - May 16, 2023
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It’s so, so bizarre. Even though trans women don’t have a uterus, we have the same muscles (in the same place) that cis women have, and those same muscles can cramp up and the same hormone-induced emotional changes can happen.
12:13 PM - May 16, 2023
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My primary doc suggested I take biotin to strengthen my nails, but didn’t mention at ALL that it could interfere with blood tests, PARTICULARLY THOSE RELATING TO HORMONE LEVELS. I need to stop it a week before blood tests if I want any kind of accurate reading.
12:13 PM - May 16, 2023
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One anecdotal thing I’ve discovered on my own is that sometimes I get just RAVENOUSLY hungry, and I wouldn’t know why. Nothing major had changed in my diet or exercise levels, but there would be days when I just COULD NOT EAT ENOUGH FOOD.
12:13 PM - May 16, 2023
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And then I discovered it happened on days when my boobs hurt the most, because they were having a growth spurt! And when I mentioned this, guess what? Other trans women went OH HEY THAT HAPPENS TO ME TOO.
12:14 PM - May 16, 2023
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If it surprises you that this much of my own healthcare was learned on my own, and were things my own doctors either didn’t know or didn’t bother to tell me, you’re starting to catch on.
12:14 PM - May 16, 2023
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To prep for this essay, a few weeks back I asked trans people to tell me what parts of their healthcare they had to learn on their own. I asked on every social media platform I’m on, and got so many replies, DMs, and emails about it.
12:14 PM - May 16, 2023
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I’m not going to quote people directly, because I wasn’t asking for permission to do that, but I will speak in generalities. And yes, this is ANECDOTAL, because I’m one person and don’t have the time or resources (or let’s face it, knowledge) to do a true scientific study.
12:14 PM - May 16, 2023
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So many people, SO MANY PEOPLE, told me they learned EVERYTHING about their transition related healthcare from other trans people or their own research.
E-V-E-R-Y-T-H-I-N-G
E-V-E-R-Y-T-H-I-N-G
12:15 PM - May 16, 2023
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Many said they had to learn about different options of hormones they could take (progesterone came up a LOT) from sources other than their doctors. Many also said they got no context from their doctors for what hormone levels were good or bad from their blood tests.
12:15 PM - May 16, 2023
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Some said their doctors didn’t even know all the different forms of HRT that are available, be they pills, injections, patches, etc. A few said they weren’t even shown how to properly administer their hormone shots to themselves.
12:15 PM - May 16, 2023
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Almost all who have had (or looked into) transition-related surgeries learned about how to find the right doctor for them from other trans people.
Some said being honest about their mental health would be a barrier to them getting the transition care they needed.
Some said being honest about their mental health would be a barrier to them getting the transition care they needed.
12:15 PM - May 16, 2023
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A few said their doctors knew so little they actually gave them bad (or no) advice for surgery after-care, which caused (or made worse) complications from surgery. Some said their doctors didn’t even know, or neglected to mention, there would be recovery time at all.
12:15 PM - May 16, 2023
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Some said their doctors weren’t even aware of anything beyond hormones or bottom surgery. Things like voice therapy/training, facial feminization (or masculinization) surgery, vocal cord procedures, electrolysis, etc. were things they weren’t even aware of.
12:15 PM - May 16, 2023
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Some said their doctors didn’t even know of the multiple different versions of bottom surgery that are available, or what all the options are. Some said their doctors didn’t even know about side-effects of HRT or what to watch out for.
12:16 PM - May 16, 2023
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Some said their doctors had no idea that things like PMS or emotional changes could accompany HRT. Some said doctors told them (trans women) that HRT would feminize their voice (it absolutely DOES NOT).
12:16 PM - May 16, 2023
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Many said their doctors were also unaware how simply being on the right hormones can help improve mental health in a lot of ways.
12:16 PM - May 16, 2023
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MANY said their doctors determined on their own what hormone levels were “enough” and refused to increase dosages or change medications to help the patient find the right combo that actually worked for them.
12:16 PM - May 16, 2023
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And one (ONLY ONE) person out of all respondents said that every doctor they’ve dealt with for all transition related care was helpful and well-educated on the topic.
ONE PERSON.
ONE PERSON.
12:16 PM - May 16, 2023
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I’d love to know who that person is and where that magical land exists, though. Every trans person would book a trip there RIGHT NOW.
12:16 PM - May 16, 2023
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And sure, there’s always a responsibility for all of us, cis and trans, to be knowledgeable about and involved in our own healthcare, to ask questions and be sure we’re getting what we need. But this is EGREGIOUS.
12:17 PM - May 16, 2023
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What we need is for cis people to not be the gatekeepers of trans healthcare, but I also don’t see HOW that will ever be possible. There aren’t enough of us, much less enough of us who are doctors, to make that happen.
12:17 PM - May 16, 2023
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So again we find a situation that comes down to cis people. CIS PEOPLE NEED TO DO BETTER. Trying to get the medical care we need SHOULD NOT BE THIS DIFFICULT.
12:17 PM - May 16, 2023
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Again, cis doctors already know how to use a lot of this for cis patients, and plenty of cis doctors know how to use it for trans patients too. But a whole lot don’t, and it’s causing unnecessary barriers and complications to us getting the care we need.
12:17 PM - May 16, 2023
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Cis doctors NEED to make understanding trans healthcare a priority. We shouldn’t know more about our own healthcare than our doctors do. We shouldn’t have to do it ourselves, or for each other.
12:17 PM - May 16, 2023
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But until the magical day that cis doctors step up for us… WE ABSOLUTELY WILL.
We don’t have any other choice.
Tilly Bridges, end transmission.
tillystranstuesdays.com
We don’t have any other choice.
Tilly Bridges, end transmission.
tillystranstuesdays.com
12:17 PM - May 16, 2023
You have created a strange association that I will always make when watching Star Wars going forward. "It has seen the end of Kenobi and it will soon see the end of wearing an A-cup."
In response to Tilly Bridges.
01:57 AM - May 17, 2023
