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Some Good Things

May16

I’ve been neglecting the blog here a bit, except for that political piece yesterday, for over a month. But I should mention several good things going on.

HRT under the new estrogen regimen is working much better than under the old. I’m seeing rapid changes now that I like. A year ago, I still had a fairly boney male ass. Today, I have a nice rear end back there! Breast development is accelerating finally. Body shape is changing. Overall weight is only down about 7 pounds since I began HRT 19 months ago but the body shape continues to change due to closely monitoring my diet and trying to engage in regular exercise (though I’ve been lax about that since Christmas). That body shape change has resulted in me dropping from size 14 jeans with no rear end to speak of to size 10 jeans with a rather attractive hiney. 🙂

Also, as the physical aspects of transition continue, it’s becoming harder and harder to pass as a male. A few weeks ago I went into the office (I work from home mostly) to pick up a new battery for the laptop. I tied my hair back in a ponytail and put on a cap, male polo shirt, and jeans (though they were women’s jeans) and headed to the office. I thought I had the “geeky guy” look going pretty well. People who knew me identified me as male but I got some odd looks that had me perplexed. Then on the way out the front door, a guy I’d never met from the second floor steps ahead of me, grabs the door handle, and says, “Let me get that for you, ma’am.” And suddenly I realized what the odd looks were for – people were looking at me, expecting male and thinking male but not seeing that.

That happened again that same evening, still dressed the same way going to dinner with my spouse. We were addressed as “you ladies” and I was addressed as “ma’am” multiple times even when not carrying a purse and trying to look male. I guess I’m hitting the “male fail” line now. 🙂

And I have another facial hair removal session in two weeks again in Dallas. The entire chin/lip area is getting very sensitive and while I can see a small overall reduction in total facial hair, it’s still pretty dense in those areas. I am hoping the fourth session in two weeks, and the fifth session in July will make a big dent in that.

My benefits coordinator at work continues to try to get a straight answer from our health insurance company about gender surgery. Nothing useful so far on that front. I do need to contact the other HR rep though, because I want to get moving on the official coming out meeting to my team mates. I don’t want to come in on a Friday, announce that I am trans and then show up on a Monday in a dress. I want them to have time to assimilate the idea, ask questions, and for it to become a non-issue. HR wants to bring in a third party coordinator for this but has not found someone they want to use yet so I may have to push a bit on that front.

Legal name and gender change (on driver’s license) is still on track for early fall. That’s been my plan and I am going to stick to that barring some financial catastrophe along the way. I can admit that I am already looking forward to seeing ‘Cara Elizabeth’ and ‘F’ on my driver’s license though.

So things are slowly progressing in the direction I want. I’m still probably 18 to 24 months out at least from GCS (or SRS as some call it). I’m holding off on voice surgery since my voice is now changing due to hormones alone, something that usually doesn’t happen on hormone therapy but can occur rarely. I think I will wait to see where my voice ends up before I decide on voice training versus voice surgery though if I had to pick today, the voice surgery would be my choice.

Anyway, life is generally ok. Not quite where I want it but not horrible either. My adult sons and their families continue to pretend I don’t exist but I can’t do anything about that. Their loss. My ancient 1998 Z-28 Camaro has required no serious repairs (yet) and looks ready to pass inspection for another year after a recent tuneup. I want a new car but I have other financial priorities at the moment so unless my hand is forced, the Z-28 is it for a few more years anyway.

And that’s where things are for the moment!

Medical Information about Transwomen in Sports

Mar9

The following was put together by Transadvocate, a trans advocacy website, on their Facebook page. In order to not lose track of it, I am putting it here. This is not my work! I am copying it for ease of reference! Thank you Transadvocate and Rehan! If I find another link to this, I will add it here for completeness as well.

In regards to the Crossift HQ refusal of Chloie Jonnson’s participation at the games here are some facts that should be considered before any sensationalistic claims are made without proper knowledge.

First of all the XY vs XX argument is invalid and not sufficient. There are well documented cases of XX males and XY females. The SRY gene region is normally found on the Y chromosome but is not a reliable method of testing since not only is not always found on the Y chromosome it also triggers a gene cascade not well understood by scientists yet that in turn affect other tissues during development which may lead to altered sexually dimoprhic traits in individuals, such as brain structure.

This is evidenced by scientific literature cited

Male-to-Female Transsexuals Have Female Neuron Numbers in a Limbic Nucleus
http://press.endocrine.org/doi/abs/10.1210/jcem.85.5.6564

and

Sexual differentiation of the human brain: relevance for gender identity, transsexualism and sexual orientation

Read More: http://informahealthcare.com/doi/abs/10.1080/09513590400018231
http://informahealthcare.com/doi/abs/10.1080/09513590400018231

and

Sexual Differentiation of the Bed Nucleus of the Stria Terminalis in Humans May Extend into Adulthood
http://www.jneurosci.org/content/22/3/1027.short

and

A sex difference in the human brain and it’s relation to transsexuality.
http://depot.knaw.nl/821/1/15106_285_swaab.pdf

with subsequent study by Dr.Swaab et al. And Kruijver et al. showing differences in the Bed Nucleus of the Stria Terminalis, SDN, Hypothalamus and gray matter volume underlining the importance of brain physiology.

http://www.sciencedirect.com/science/article/pii/0165380688902313

http://www.sciencedirect.com/science/article/pii/S1053811909003176

http://www.tandfonline.com/doi/abs/10.1300/J082v28n03_07#.UxoCwRbPPFI

http://books.google.ca/books?hl=en&lr&id=JFpq6hYQRhQC&oi=fnd&pg=PA41&dq=brain+dissection+transgender+Dr.+Swaab&ots=FjtewJ28wz&sig=8F-QOG1Q5QCEIMe1oQwqlWNb9ko#v=onepage&q&f=false

http://www.hawaii.edu/PCSS/biblio/articles/2005to2009/2006-atypical-gender-development.html

Also studies showing it to be irreversible

http://aace.metapress.com/content/nm510264636815vk/

There is also an article linking hormone related genes to the atypical sexual dimoprhism. Genes CYP19 (Aromatase responsible for testosterone to estrogen conversion), AR (androgen receptor, the “key” hole for the cell that the testosterone “key” acts on to elicit it’s effects) and ESRB (Estrogen Receptor Beta which is responsible for the initiation of differentiating gene cascades in the fetal brain during fetal hormonal “washes”)

here

http://www.sciencedirect.com/science/article/pii/S0306453005000454

Continuing on the topic of performance and gender testing the IOC released a statement before the 2012 summer Olympics.

“The new rules state that a panel of independent medical experts will examine through a blood test the testosterone levels in a woman and will then make a recommendation about whether she could be eligible to compete.”

The IOC and NCAA have decided after extensive research (independently) that Hormone profile is the primary determining factor for gender qualification in sport.

The Olympics requires 2 years post surgery before being allowed to compete at an INTERNATIONAL event.

The NCAA requires only one year of HRT.

This was determined the minimum to not have any unfair advantage as evidenced by the quotes from respective authorities below.
“Requiring sex reassignment surgery before allowing participation for the high school or collegiate student athlete is medically unnecessary and not linked to competitive equity IOC regulations requiring surgery for Olympic transgender athletes have been controversial and it would be unreasonable to”make this requirement for high school and college students”
ERIC VILAIN M.D., PH.D., PROFESSOR, DIRECTOR OF THE CENTER FOR GENDER-BASED BIOLOGY AND CHIEF MEDICAL GENETICS DEPARTMENT OF PEDIATRICS, UCLA
“Research suggests that androgen deprivation and cross sex hormone treatment in male-to-female transsexuals reduces muscle mass; accordingly, one year of hormone therapy is an appropriate transitional time before a male-to- female student athlete competes on a women’s team
ERIC VILAIN: M.D., PH.D., PROFESSOR, DIRECTOR OF THE CENTER FOR GENDER-BASED BIOLOGY AND CHIEF MEDICAL GENETICS DEPARTMENT OF PEDIATRICS, UCLA
“Transgender student athletes fall within the spectrum of physical traits found in athletes of their transitioned gender, allowing them to compete fairly and equitably”
DR. NICK GORTON
AMERICAN BOARD OF EMERGENCY MEDICINE, MEDICAL LEGAL CONSULTANT, TRANS HEALTH CARE

Further more, the difference need to be put into perspective when transgender women are compared with cisgender women they fall within a female range after the required time period (1 year NCAA, 2 years post-op IOC).
“Differences within the sexes are considerable and often times larger than differences between the sexes ”
DR. WALTER BOCKTING, PH.D.
PRESIDENT OF WPATH, ASSOCIATE PROFESSOR, UNIVERSITY OF MINNESOTA MEDICAL SCHOOL

These facts are presented based on scientific literature as cited
here
Elbers JM, Asscheman H, Seidell JC, et al. Effects of sex steroid hormones on regional fat depots as assessed.
here
Australian Sports Commission. Transgender in sport.www.ausport.gov.au/fulltext/2001/ascpub/women_transgender.asp (accessed 22 Mar 2005).

here
as contrasted between these two
↵ Stamm R, Veldre G, Stamm M, et al. Dependence of young female volleyballers’ performance on their body build, physical abilities, and psycho-physiological properties. J Sports Med Phys Fitness 2003;43:291–9. [Medline][Web of Science]
↵ Viitasalo JT. Anthropometric and physical performance characteristics of male volleyball players. Can J Appl Sport Sci1982;7:182–8. [Medline]
and here
Pilgrim J, Martin D, Binder W. Far from the finish line: transsexualism and athletic competition. Fordham Intellectual Property Media & Entertainment Law Journal2003;13:495–549.
And the rest of these studies

↵ Federation Internationale de Volleyball. Medical regulations, ed. 2004. http://www.cev.lu/mmp/online/website/main_menu/downloads/file_28430/fivb_med_regulations_-_revised_7.pdf (accessed 23 Mar 2005).
↵ Lausanne Declaration on Doping in Sport (adopted by the World Conference on Doping in Sport). 1999.www.sportunterricht.de/lksport/Declaration_e.html (accessed 23 Mar 2005).
↵ Ritchie I. Sex tested, gender verified: controlling female sexuality in the age of containment. Sport History Review2003;34:80–98.
↵ Batterham AM, Birch KM. Allometry of anaerobic performance: a gender comparison. Can J Appl Physiol1996;21:48–62. [Medline]
Thomas JR, French KE. Gender differences across age in motor performance: a meta-analysis. Psychol Bull1985;98:260–82. [CrossRef][Medline][Web of Science]
↵ Shepard RJ. Exercise and training in women. Part I. Influence of gender on exercise and training responses. Can J Appl Physiol2000;25:19–34. [Medline][Web of Science]
↵ Dickinson BD, Genel M, Robinowitz CB, et al. Gender verification of female Olympic athletes. Med Sci Sports Exerc 2002;34:1539–42. [CrossRef][Medline][Web of Science]
↵ Simpson JL, Ljungqvist A, de la Chapelle A, et al. Gender verification in competitive sports. Sports Med 1993;16:305–15. [Medline][Web of Science]
↵ Introducing the, uh, ladies. JAMA1966;198:1117–18.
↵ Doig P, Lloyd-Smith R, Prior JC, et al. Position statement. Sex testing (gender verification) in Sport. Canadian Academy of Sports Medicine. 1997. http://www.casm-acms.org/PositionStatements/GendereVerifEng.pdf (accessed 23 Mar 2005).

There is no “residual” advantage and often times transgender athletes are at a disadvantage due to severely lowered testosterone levels in comparison to native females. Cisgender women have a higher testosterone than transgender women who have had reassignment surgery and the related information.
http://transathletes.org/hormones.php

Other issues that arise in the form of practicality

1) Her numbers pale in comparison to other female athletes

Crossfit profile comparison between her and CLB:http://games.crossfit.com/compare/161983/8404

Back Squat: 225 lb Clean & Jerk: 165 lb Snatch: 125 lb Deadlift: 275 lb

These numbers pale in comparison to the top competitors as well as compared to many other regional athletes.

2) Let her compete, if she has an unfair advantage it will be very apparent and provide evidence for these as of yet unfounded claims of unfair advantage. There are yet to be any instances of a transgender athlete dominating competitions if this were to be so likely.

3) Saying this will open the door for other males to “become” transgender and dominate is very short sighted. Firstly they would have to adhere to the strict protocol involving Hormone Replacement Therapy which would remove that advantage. Secondly transgender people face a MASSIVE amount of discrimination not to mention the amount of money and physical pain of procedures that need to be endured to complete the requirements. The transgender suicide rate is 41%, forcing someone to live as the opposite identity is devastating psychologically and would also be true of someone trying to “fake” it. (Remember once the surgery is done it is a PERMANENT change, is winning crossfit that important?)

4) Having larger bone structure and lowered muscle mass constitutes a disadvantage.

5) Furthermore there is no consistent testing policy in crossfit for PED’s. A cis-female using AA has a much larger and much more distinct advantage which could be considered universally as an “unfair advantage”.

The most shocking thing is the completely deplorable and inappropriate reply from Crossfit HQ, who seem to be the ones lacking in understanding of the human genome and biology.

Why Transition is the Overwhelming Treatment of Choice

Mar2

Recently, at a forum where I am involved, a poster asked about evidence for non-transitioning therapies for transsexuals. Now on that forum are a tiny number who consistently pound an anti-transition drum. But as I demonstrated in my reply, their position is not congruent with the position of the medical community today. Here is what I wrote, with minor edits to make it more appropriate for this blog.

__________________________________________________

The AMA is now overwhelmingly on board with fundamental brain differences being the root cause of transsexuality. And the APA (both of them) both state that the most effective therapy statistically for transsexuals is transition.

One of the most important of these is brain differences concerns the BST in the hypothalamus. “In the hypothalamus, the bed nucleus of the stria terminalis (BST) is thought to be important for gender identity. One study showed that male-to-female transsexuals had decreased BST staining identical to that for genetic XX female subjects (8). In contrast, genetic XY male subjects had significantly increased BST staining. BST staining was not influenced by sexual orientation or sex hormone levels.”

These differences can be seen below:

MTF_Brain_Scan_differences

In addition, further brain structure differences are being identified as well that impact transsexuals.

This NIH document references the study (by van Kesteren PJ, Gooren LJ, Megens JA. An epidemio-logical and demographic study of transsexuals in The Netherlands. Arch Sex Behav. 1996;25:589–600) that sex reassignment as overwhelmingly statistically successful in addressing the needs of the transsexual community. Given the size of the TS community the size of the study is significant. If the rates of transsexuality are as high as 1 in 600 as has been suggested by various studies, and if 1 in 2500 actually undergo SRS which have been suggested by direct analysis of number of surgeries in the US per year, then the size of the study in question was almost 25% of the SRS population of the Netherlands and 3% of the overall Netherlands TS population. If the rates of transsexuality are lower, then the size of the study is even more significant because it represents an even larger cross section of the TS population!

Here is the NIH position:

Quote

__________________________________________________

Treatment options for patients with gender identity at variance with physical appearance can be evaluated in the order of extent of invasiveness. The least invasive intervention would be counseling such patients to accept the circumstance. As already noted, however, no available data support the success of such therapy. The next least invasive approach might be a targeted treatment of the underlying problem. The medical community, however, has little knowledge about the brain region associated with gender identity, and even less is known about techniques for manipulating it.
Although current transgender treatment is relatively invasive and does not address the problem completely, it is the most successful intervention available. Studies report very high transgender patient satisfaction with sexual reassignment. Thus far, the largest evaluation has been a survey of Dutch transgender patients (10). Among the 1,285 patients surveyed, 1,280 were satisfied.

__________________________________________________

As noted, “no available data support the success” of counseling patients to simply accept their circumstances. The second discussed option, manipulating the brain to become more accepting of the body, is not currently possible because the “medical community, however, has little knowledge about the brain region associated with gender identity, and even less is known about techniques for manipulating it“.

This leaves transitioning as the primary therapy for dealing with GID. As has been noted in the past here, there are people who do manage to live out their lives without transitioning to live in a new gender role. Good for them. But they are also the statistical minority among patients suffering from significant GID. For that category of patients, the number one therapy of choice today is transitioning (aside from suicide and I think we all agree that suicide is a bad option, yes?).

Therapists will assist a patient in trying to meet their personal goals but a transsexual suffering from significant GID ought to be prepared to discover that non-transitioning treatments are very likely to fail to bring them to a level of comfort with themselves that allows them to live a full and fruitful life. Certainly there will be those cases that do succeed at this, but as the NIH document notes, the medical community’s primary treatment therapy today is transition, including HRT, and optionally including surgeries to further assist the body to conform to the expectations of the mind.

Therefore, in answer to the original poster’s question – you are unlikely to find any large scale answer to your question of non-transitioning treatments that work. In almost every case where that does occur, the patient has developed their own unique regimen for coping with their GID that is specific to that patient. The single treatment option that does work and which is medically and statistically supported at this time by the medical and psychiatric and psychological communities is transition.

To the original poster, if you choose to not transition, it’s pretty much you and your therapist in uncharted waters. It’s possible you will succeed. Good luck if you choose that path. I will not dissuade you from taking whatever path you choose but I will stand by the statements in this post that transition is the proven most effective treatment for transsexuals suffering from severe GID.

P.S. This is the reason that there is so-called “cheerleading” for transition in the community – because it works. And because it is overwhelmingly statistically successful. Those are facts.

__________________________________________________

The above was the body of my response in that discussion thread.

Testosterone Toxicity Implicated in Male-To-Female Transsexuals? Some thoughts.

Oct31

I found the following article about Testosterone Toxicity in MTF transsexuals to be thought provoking. It’s from 2009 so probably too recent for much formal research to have been done, and it is anecdotal so conclusions shouldn’t necessarily be reached from this alone. However, the fact that this therapist and other therapists have seen the same thing frequently does give rise to the question she asks.

People have accused me of wanting to “justify” my transsexuality. I don’t see it that way. I’m trans, I know this, and I accept this and would go forward with my transition no matter what I find medically.

But I’m also curious and I’ve been curious about science my entire life. This is no different, hence my interest in the biological causes behind being transgender, which, incidentally, actually fits into my own life rather well so far.

Enjoy the article. I found it thought provoking.

A Pleasant Surprise in October

Oct9

I’m moving through my transition at a nice slow pace, which has been deliberate for a number of reasons. I’m still targeting next summer to go fulltime, partly because of all the wackiness my endo and I have been through with my t-levels, partly due to finances, and partly for other various reasons. So I’m happy at the progress I am making, slow though it may be at times. And I simply was not seeing myself as female on some days though on others, I definitely get that feeling.

Anyway, my spouse and I went to lunch at this tiny Italian place. I was wearing a compression shirt that is beginning to fail at the task assigned to it, a very loose t-shirt, a pair of women’s jeans, my favorite feminine black cap, and of course earrings that aren’t too loudly female. My hair is shoulder length and tied back in a pony tale and the cap hides the male pattern baldness problem on top when I’m not wearing a wig. I’ve taken to shaving with a new razor lately, a three bladed razor instead of the old dual and it really has been giving me a nice close shave so the beard is less visible plus I think the higher estrogen dosage my endo prescribed last month is having a small effect on the facial hair too. (E3000 appointment in 2 more months!)

So there we are in the Italian restaurant. I admit it was a wee bit dark and after the waiter takes my spouse’s order, I get “And you, ma’am?” I don’t blink but instead I place my order. I’ve been working on using my voice with male resonance minimized, which raises the pitch a bit, though not sufficiently for my taste, due to that darned paralyzed vocal cord, and he doesn’t bat an eye. He walks off and I grin. My spouse looks at me funny, and I say, “I think I just mis-heard the waiter.” She says, “No you didn’t. He said ma’am when talking to you.” He comes back, brings our iced teas, and says, “Your orders will be out shortly, ladies.”

Needless to say, I was grinning ear to ear. I did not expect that quite yet! Even being rationally fully aware that I need to be accepting of myself first and foremost, there’s a small sense of satisfaction when someone else sees you as you wish to be seen.

As a side note for seeing what we want to see, my youngest son, despite knowing that I am trans, upon seeing my hair back in a ponytail and the earrings said I should “grow a goatee” to complete the “biker” look. It’s interesting to see how expectations form opinions versus the absence thereof. Exact same visual image – my son sees a male “biker” and a waiter who doesn’t know me sees a woman. Overcoming first impressions can take more work than making good first impressions. Food for thought. 🙂