1 00:00:05,000 --> 00:00:09,360 Speaker 1: Greetings listeners in the podcast verse, This is it could 2 00:00:09,360 --> 00:00:13,760 Speaker 1: happen here the podcast about things falling apart and sometimes 3 00:00:13,840 --> 00:00:17,280 Speaker 1: how we can put stuff back together. I'm Garrison Davis 4 00:00:17,280 --> 00:00:22,080 Speaker 1: are Resident Gender mess In the past few weeks, we've 5 00:00:22,120 --> 00:00:25,079 Speaker 1: been talking a lot here on the show about the 6 00:00:25,280 --> 00:00:29,320 Speaker 1: escalating war on trans people and queer folks in general. 7 00:00:29,800 --> 00:00:32,639 Speaker 1: There's been a wave of bills making any gender affirming 8 00:00:32,640 --> 00:00:35,720 Speaker 1: healthcare of felony for people under the age of eighteen, 9 00:00:36,440 --> 00:00:40,519 Speaker 1: which forcibly detransitions teenagers and multiple states, and we've had 10 00:00:40,560 --> 00:00:43,840 Speaker 1: a lot of banning trans people from participating in sports 11 00:00:44,360 --> 00:00:47,200 Speaker 1: and trying to ban books and discussion in schools about 12 00:00:47,200 --> 00:00:50,159 Speaker 1: the just the existence of queer people at all. But 13 00:00:50,240 --> 00:00:52,519 Speaker 1: today we're not really going to be talking about that. 14 00:00:52,640 --> 00:00:55,080 Speaker 1: We've talked about that plenty for the past few weeks. 15 00:00:55,360 --> 00:00:57,080 Speaker 1: It's good to have a little little bit of a break, 16 00:00:57,360 --> 00:01:00,360 Speaker 1: but we'll still be talking about stuff around trans people. 17 00:01:00,440 --> 00:01:04,000 Speaker 1: Because with all the discussion around gender affirming healthcare, I 18 00:01:04,000 --> 00:01:05,600 Speaker 1: thought it would be a good idea to put something 19 00:01:05,600 --> 00:01:10,720 Speaker 1: together talking about what HRT or hormone replacement therapy actually is, 20 00:01:11,200 --> 00:01:14,160 Speaker 1: as since it's the most common form of trans healthcare 21 00:01:14,720 --> 00:01:18,000 Speaker 1: and since many states are trying to or already have 22 00:01:18,160 --> 00:01:21,839 Speaker 1: criminalized it, perhaps I can use the POD to point 23 00:01:21,880 --> 00:01:25,959 Speaker 1: people towards alternative means of receiving care, you know, in 24 00:01:26,000 --> 00:01:28,959 Speaker 1: the vein of the putting stuff back together side of 25 00:01:29,000 --> 00:01:32,959 Speaker 1: the show. Now, I want to clarify upfront that we're 26 00:01:32,959 --> 00:01:37,400 Speaker 1: not giving anyone medical advice, obviously. I'm just making observations 27 00:01:37,480 --> 00:01:41,360 Speaker 1: and talking about things as they exist, um and talking 28 00:01:41,360 --> 00:01:43,520 Speaker 1: about things that many trans people have been doing for 29 00:01:43,600 --> 00:01:46,199 Speaker 1: a long time, and that includes d I Y HRT. 30 00:01:46,800 --> 00:01:50,600 Speaker 1: My doctorate program is in parapsychology, not medical science, so 31 00:01:50,800 --> 00:01:54,640 Speaker 1: just keep that in mind. First, I will quickly clarify 32 00:01:54,680 --> 00:02:00,600 Speaker 1: what HRT or hormone replacement therapy actually is for specifically 33 00:02:00,720 --> 00:02:04,160 Speaker 1: non CIS gender individuals, because HRT as a term is 34 00:02:04,200 --> 00:02:08,880 Speaker 1: also used for CIS women to describe similar but different treatment. 35 00:02:09,240 --> 00:02:13,520 Speaker 1: So HRT as a form of gender affirming treatment is 36 00:02:13,600 --> 00:02:17,639 Speaker 1: when someone receives sex hormone medication that produces a number 37 00:02:17,680 --> 00:02:22,560 Speaker 1: of desired secondary sex characteristics. There are two broad types 38 00:02:22,639 --> 00:02:25,720 Speaker 1: of hormone therapy that one would receive, depending on what 39 00:02:25,919 --> 00:02:29,440 Speaker 1: direction you want to go in gender of wise, there's 40 00:02:29,680 --> 00:02:35,560 Speaker 1: feminizing hormones and masculinizing hormones. Feminizing hormones produce more typically 41 00:02:36,000 --> 00:02:40,480 Speaker 1: feminine traits, right, big big shocker there. Uh. It usually 42 00:02:40,720 --> 00:02:44,600 Speaker 1: consists of a form of estrogen, usually called estradial. There's 43 00:02:44,600 --> 00:02:48,520 Speaker 1: different types of estradial, and also it can include anti 44 00:02:48,560 --> 00:02:55,200 Speaker 1: androgen's aka a testosterone blockers. Masculinization therapy consists of taking 45 00:02:55,200 --> 00:03:00,480 Speaker 1: to sasterone or androgen's and then also less commonly anti strogens, 46 00:03:00,600 --> 00:03:04,440 Speaker 1: but usually just tinking to toss your own will suffice. Now, 47 00:03:05,200 --> 00:03:08,919 Speaker 1: I'm no expert in hormones despite my weekly shot, but 48 00:03:09,160 --> 00:03:11,600 Speaker 1: lucky enough I was able to sit down with an 49 00:03:11,600 --> 00:03:15,160 Speaker 1: actual expert on hormones and talk over zoom. So what 50 00:03:15,320 --> 00:03:19,600 Speaker 1: follows is segments from our conversation. I guess first, do 51 00:03:19,639 --> 00:03:24,440 Speaker 1: you want to introduce yourself? Sure? I am the Reverend 52 00:03:24,520 --> 00:03:27,800 Speaker 1: Dr Victoria Luna B. Grieve. I am an assistant professor 53 00:03:27,840 --> 00:03:30,919 Speaker 1: at the University of Pittsburgh School of Pharmacy. My primary 54 00:03:30,919 --> 00:03:36,520 Speaker 1: clinical focuses on gender affirming hormone therapy, other kind of advocacy, 55 00:03:36,560 --> 00:03:39,000 Speaker 1: work in queer healthcare, and I do a lot of 56 00:03:39,040 --> 00:03:42,360 Speaker 1: other stuff on the side. Heatigo g Ludac, instructional design, 57 00:03:42,440 --> 00:03:45,960 Speaker 1: game design, just anything that strikes my fancy really fun 58 00:03:46,120 --> 00:03:50,240 Speaker 1: fun stuff in with within kind of our our coverage 59 00:03:50,960 --> 00:03:54,200 Speaker 1: of trend stuff the past few weeks and months, it's 60 00:03:54,200 --> 00:03:56,680 Speaker 1: been mostly on like the bills and like the politics 61 00:03:56,800 --> 00:03:59,280 Speaker 1: side of things. I definitely had some people like reach 62 00:03:59,320 --> 00:04:04,440 Speaker 1: out and be like, okay, but how like why why treads? Gender? 63 00:04:04,560 --> 00:04:07,120 Speaker 1: Why why hormones? Like why are hormones actually important? Like 64 00:04:07,160 --> 00:04:10,240 Speaker 1: could you actually explain like what, like you know, with 65 00:04:10,280 --> 00:04:13,640 Speaker 1: all of these all these states banding hormones, let's I 66 00:04:13,640 --> 00:04:15,840 Speaker 1: would like to kind of explain why it's such a 67 00:04:15,880 --> 00:04:18,640 Speaker 1: big deal and like how much these things actually are 68 00:04:18,760 --> 00:04:23,599 Speaker 1: like life saving medication for so many people. Yeah, so 69 00:04:23,839 --> 00:04:28,800 Speaker 1: why are hormones? I love it because it's a question 70 00:04:28,839 --> 00:04:32,000 Speaker 1: that as like a species, we've been we have known 71 00:04:32,080 --> 00:04:34,960 Speaker 1: the answer to for like five thousand years. It's it's 72 00:04:35,120 --> 00:04:41,000 Speaker 1: very funny, but um, hormones are. Okay. A big part 73 00:04:41,080 --> 00:04:44,320 Speaker 1: of this requires to like acknowledge something that is very 74 00:04:44,360 --> 00:04:47,880 Speaker 1: wrong in in like the medical literature. There's a lot 75 00:04:47,880 --> 00:04:52,119 Speaker 1: of elements of healthcare that are coordinated between like male 76 00:04:52,240 --> 00:04:56,560 Speaker 1: and female, and there's a kind of like obviously is 77 00:04:56,680 --> 00:04:59,240 Speaker 1: a little so there's a lot of I mean like 78 00:04:59,360 --> 00:05:02,599 Speaker 1: from like from people's I know, when trans people talking 79 00:05:02,600 --> 00:05:05,039 Speaker 1: about interacting with the medical system, it's always like, oh, yes, 80 00:05:05,160 --> 00:05:08,920 Speaker 1: we're gonna be doing this bullshit, Yes of course. Yeah, well, 81 00:05:09,000 --> 00:05:11,040 Speaker 1: but it even goes to it like a really deep level, 82 00:05:11,040 --> 00:05:12,479 Speaker 1: like if you're in the hospital and you get a 83 00:05:12,480 --> 00:05:16,279 Speaker 1: CBC count, there's a male profile and a female profile 84 00:05:16,279 --> 00:05:18,320 Speaker 1: of what your hematocrit should be on, like what the 85 00:05:18,400 --> 00:05:20,880 Speaker 1: level of red blood cells are, and and the general 86 00:05:20,960 --> 00:05:24,279 Speaker 1: understanding and like the health industry is that there's a 87 00:05:24,360 --> 00:05:28,160 Speaker 1: biological anatomical difference between them. And for the longest time, 88 00:05:28,279 --> 00:05:31,320 Speaker 1: certainly in this country, trans women would have would be 89 00:05:31,320 --> 00:05:35,280 Speaker 1: compared against the male profiles. But but it's nonsense. It's 90 00:05:35,320 --> 00:05:38,360 Speaker 1: actually should be thought of in form of hormone dominance, 91 00:05:38,360 --> 00:05:42,760 Speaker 1: because the vast majority of medical differences are not anatomical, 92 00:05:42,839 --> 00:05:46,400 Speaker 1: they're hormonal, and and that right there should should give 93 00:05:46,400 --> 00:05:49,040 Speaker 1: the game away, which is really funny, which is why 94 00:05:49,240 --> 00:05:51,880 Speaker 1: it's why I kind of hate the term biological woman 95 00:05:52,040 --> 00:05:54,920 Speaker 1: whenever people start using that, because that's not really how 96 00:05:55,000 --> 00:06:00,640 Speaker 1: biology works. Yeah, I mean that Oak is my my 97 00:06:00,680 --> 00:06:03,719 Speaker 1: nesting partner. My fiancee wishes that she could be a robot, 98 00:06:03,760 --> 00:06:05,839 Speaker 1: and then if she were to do that and upload 99 00:06:05,880 --> 00:06:07,919 Speaker 1: her brain into an immortal robot body. She would no 100 00:06:08,000 --> 00:06:10,400 Speaker 1: longer be a biological woman, but she would still be 101 00:06:10,440 --> 00:06:14,000 Speaker 1: a woman. It's just cybernetic. Um. I hate that. It's 102 00:06:14,000 --> 00:06:16,720 Speaker 1: like organic. Organic just means it has carbon in it. Like, 103 00:06:16,800 --> 00:06:23,719 Speaker 1: give me a break. Yes, so yeah, hormones, what's what's 104 00:06:23,839 --> 00:06:26,120 Speaker 1: what's the deal do they? Because I know all of 105 00:06:26,360 --> 00:06:28,760 Speaker 1: people will be like, well, all of these trends, people 106 00:06:28,800 --> 00:06:32,960 Speaker 1: sure do seem sad. I want that's how how how 107 00:06:33,000 --> 00:06:37,839 Speaker 1: can we make things better? Does this thing actually work? Uh? Well, 108 00:06:37,920 --> 00:06:41,240 Speaker 1: so it's somewhat multifactorial. I have a friend who does 109 00:06:41,520 --> 00:06:44,640 Speaker 1: um sell imaging, and her like working theory, which I'm 110 00:06:44,640 --> 00:06:47,039 Speaker 1: a little dubious of, is that like the brains of 111 00:06:47,080 --> 00:06:50,120 Speaker 1: trans people like have receptors for hormones that the body 112 00:06:50,160 --> 00:06:52,520 Speaker 1: doesn't make, and we should think of being transgender is 113 00:06:52,600 --> 00:06:56,159 Speaker 1: having like a form of hypogonadism. Yeah, there's there's a 114 00:06:56,160 --> 00:06:58,400 Speaker 1: lot of different trains of thought there in terms of 115 00:06:58,880 --> 00:07:01,719 Speaker 1: the different theories of why trends people exist and how 116 00:07:01,760 --> 00:07:04,719 Speaker 1: it's like you know, the girl's brain, boys body, blah 117 00:07:04,760 --> 00:07:07,320 Speaker 1: blah blah blah blah, which all, if you dig deep enough, 118 00:07:07,400 --> 00:07:11,280 Speaker 1: goes back to eugenic. So it's all, yeah, I've always 119 00:07:11,360 --> 00:07:14,640 Speaker 1: not liked that model. I've always it's always I've always 120 00:07:14,680 --> 00:07:17,040 Speaker 1: found it to be a little bit uncomfortable because I 121 00:07:17,680 --> 00:07:20,520 Speaker 1: take hormones because I want to, And I don't think 122 00:07:20,520 --> 00:07:24,200 Speaker 1: it's because my my my brain is like secretly looking 123 00:07:24,320 --> 00:07:28,920 Speaker 1: for girl receptors or something like, right, I totally agree, 124 00:07:29,000 --> 00:07:32,600 Speaker 1: Like it also requires a certain like extremely binary understanding 125 00:07:32,600 --> 00:07:34,880 Speaker 1: of gender, which I also do not ascribe to. So 126 00:07:35,000 --> 00:07:37,840 Speaker 1: it's a very like odd thought. But putting aside all 127 00:07:37,840 --> 00:07:39,280 Speaker 1: of that, if you just wanted to look at the 128 00:07:39,560 --> 00:07:45,160 Speaker 1: like why people want hormones, Because when a person who 129 00:07:45,200 --> 00:07:49,920 Speaker 1: wants hormones gets the hormones they want, their suicidality goes down, 130 00:07:49,960 --> 00:07:53,720 Speaker 1: their anxiety, depression goes down, gender dysphoria, if we wanted to, 131 00:07:53,760 --> 00:07:56,800 Speaker 1: you know, talk about the problems with that, essentially like 132 00:07:56,880 --> 00:08:00,720 Speaker 1: goes away, uh, and they get this to get treated 133 00:08:00,800 --> 00:08:03,520 Speaker 1: like the way they want to be treated in society. 134 00:08:03,600 --> 00:08:05,440 Speaker 1: So from the if if you want to look at it, 135 00:08:05,440 --> 00:08:08,960 Speaker 1: not from like the causes, but from the results, giving 136 00:08:09,120 --> 00:08:12,800 Speaker 1: gender affirming hormone therapy to a person who is requesting 137 00:08:12,840 --> 00:08:18,640 Speaker 1: gender afforming hormone therapy has a success rate. The rate 138 00:08:18,680 --> 00:08:22,800 Speaker 1: of regret from starting hormones is one percent or less, 139 00:08:23,080 --> 00:08:27,560 Speaker 1: which is unbelievable in the health care field, like like 140 00:08:27,800 --> 00:08:31,120 Speaker 1: having a child, like biologically giving birth has a seven 141 00:08:31,160 --> 00:08:35,760 Speaker 1: percent regret rate, Like the idea of any therapy having 142 00:08:35,920 --> 00:08:42,120 Speaker 1: that high of a rate of preventing death, anxiety, depression, bullying, 143 00:08:42,240 --> 00:08:45,480 Speaker 1: like all of the different effects. Being that successful should 144 00:08:45,559 --> 00:08:48,240 Speaker 1: be like a miracle. It should be looked at as 145 00:08:48,800 --> 00:08:53,959 Speaker 1: the thing we in healthcare are like should do absolutely ethically. 146 00:08:54,800 --> 00:08:57,439 Speaker 1: Uh and it it is is so much more complicated 147 00:08:57,440 --> 00:09:01,680 Speaker 1: than that. So like hormones from the results obviously makes sense. 148 00:09:01,840 --> 00:09:05,720 Speaker 1: It aligns your bodies shape and like fat fat deposits 149 00:09:05,720 --> 00:09:07,240 Speaker 1: and the way that you feel, the way that you 150 00:09:07,360 --> 00:09:11,520 Speaker 1: relate to your emotions. It all goes back to the 151 00:09:11,559 --> 00:09:15,640 Speaker 1: way that hormones work on your body. And there's there's 152 00:09:15,640 --> 00:09:18,360 Speaker 1: like the old saying that like assis person would never 153 00:09:18,400 --> 00:09:22,280 Speaker 1: want to try gender forming homerone therapy, So like, if 154 00:09:22,320 --> 00:09:24,360 Speaker 1: you have the in if you want to try it, 155 00:09:24,520 --> 00:09:26,440 Speaker 1: you should be allowed to try it. I mean, like 156 00:09:26,480 --> 00:09:29,160 Speaker 1: you're you're kind of a good example right here, Like yeah, 157 00:09:30,360 --> 00:09:32,679 Speaker 1: but I'm sitting Yeah, if you're sitting around a bar 158 00:09:32,720 --> 00:09:34,920 Speaker 1: with a bunch of like CIS guys and you're like, hey, 159 00:09:34,960 --> 00:09:38,080 Speaker 1: who wants some estrogen? They would all like shrink away 160 00:09:38,120 --> 00:09:42,480 Speaker 1: from it, Like no, absolutely, because yeah, it's definitely a thing. 161 00:09:42,520 --> 00:09:46,600 Speaker 1: Like I'm not the most dysphoric person, but I'm like, sure, 162 00:09:46,600 --> 00:09:50,040 Speaker 1: I'll take estrogen. That sounds fun. That's like, it's like that, 163 00:09:50,040 --> 00:09:52,520 Speaker 1: that sounds like a thing that I could enjoy watching 164 00:09:52,520 --> 00:09:55,360 Speaker 1: my body change. And I'm you know, it's it's I'm 165 00:09:55,400 --> 00:09:58,199 Speaker 1: happy that we're moving more towards that and not having 166 00:09:58,240 --> 00:10:02,360 Speaker 1: to deal with, oh, I'm so dysphoric, i want to die, 167 00:10:02,600 --> 00:10:04,720 Speaker 1: which is obviously they're a big thing for a lot 168 00:10:04,720 --> 00:10:07,800 Speaker 1: of people. I'm not I'm not minimizing that right um. 169 00:10:07,920 --> 00:10:09,600 Speaker 1: But also a lot of trans people have had more 170 00:10:09,640 --> 00:10:12,640 Speaker 1: kind of complicated feelings on gender, whether they're like gender queer, 171 00:10:12,760 --> 00:10:16,040 Speaker 1: non binary. Having the past had made it more difficult 172 00:10:16,080 --> 00:10:17,959 Speaker 1: to get gender firm in care because they don't fit 173 00:10:17,960 --> 00:10:23,280 Speaker 1: into those specific like male female boxes as easily. M Well, 174 00:10:23,400 --> 00:10:26,960 Speaker 1: and what you're talking about is really something that's relatively recent. 175 00:10:27,040 --> 00:10:29,920 Speaker 1: The idea of gender euphoria, like the idea that people 176 00:10:29,920 --> 00:10:34,480 Speaker 1: want to take because it gives them joy to like 177 00:10:34,679 --> 00:10:37,680 Speaker 1: dress or act or feel a certain way, and that 178 00:10:38,360 --> 00:10:40,480 Speaker 1: I mean, health care is all about, at least up 179 00:10:40,520 --> 00:10:44,560 Speaker 1: until well, the reality of health care is that it 180 00:10:44,640 --> 00:10:47,680 Speaker 1: is all about finding problems to solve and not really 181 00:10:47,679 --> 00:10:52,120 Speaker 1: looking at like your life just better in general. Yeah, exactly. 182 00:10:52,679 --> 00:10:55,080 Speaker 1: So you know, I know plenty of people who started 183 00:10:55,120 --> 00:10:58,440 Speaker 1: hormones of any type just because they felt it would 184 00:10:58,480 --> 00:11:00,679 Speaker 1: make them happier, and they were correct, And that gender 185 00:11:00,760 --> 00:11:03,199 Speaker 1: euphoria is just as good of a reason to take 186 00:11:03,240 --> 00:11:06,079 Speaker 1: it as the dysphoria. The problem ends up in how 187 00:11:06,120 --> 00:11:10,360 Speaker 1: the medical industry treats it, because dysphoria quote unquote is 188 00:11:10,400 --> 00:11:12,760 Speaker 1: something that's long. Oh my gosh, I could go into 189 00:11:12,800 --> 00:11:14,559 Speaker 1: the whole history of that if you wanted, but I'm 190 00:11:14,600 --> 00:11:16,319 Speaker 1: sure we could talk about the ds M four and 191 00:11:16,760 --> 00:11:19,200 Speaker 1: five for a long time. Oh it's so frustrating. I 192 00:11:19,240 --> 00:11:21,439 Speaker 1: spend I spend a two hour session in my Queer 193 00:11:21,440 --> 00:11:24,520 Speaker 1: healthcare class, specifically just dunking on the ds M five 194 00:11:25,200 --> 00:11:29,680 Speaker 1: definition of gender dysphoria. Um. But the real problem is, 195 00:11:29,720 --> 00:11:32,679 Speaker 1: like this focus on this negative quality and how that 196 00:11:32,720 --> 00:11:37,120 Speaker 1: actually damages a lot of the conversations around uh, gender 197 00:11:37,200 --> 00:11:40,640 Speaker 1: firming hormone therapy and trans people in general. Like, instead 198 00:11:40,640 --> 00:11:44,679 Speaker 1: of seeing it as like this manifestation of people like 199 00:11:44,800 --> 00:11:48,800 Speaker 1: truly taking control of their lives to become authentic in 200 00:11:49,040 --> 00:11:51,920 Speaker 1: like the truest way, Like you have never met a 201 00:11:52,000 --> 00:11:55,640 Speaker 1: more truly well uh self made man than a transman 202 00:11:55,800 --> 00:11:59,040 Speaker 1: who gets hormones. Like it's I mean it's and it's 203 00:11:59,080 --> 00:12:02,400 Speaker 1: still something where even we're not quite at the at 204 00:12:02,440 --> 00:12:05,880 Speaker 1: the gender utopia, I mean obviously because of all of 205 00:12:05,920 --> 00:12:08,880 Speaker 1: the anti tran stuff, but even even on like just 206 00:12:09,120 --> 00:12:12,800 Speaker 1: purely purely the medical side, like I even for for 207 00:12:12,880 --> 00:12:16,440 Speaker 1: informed consent, um, I still needed to get diagnosed with 208 00:12:16,480 --> 00:12:19,280 Speaker 1: gender dysphoria at the informed Consent clinic in order to 209 00:12:19,280 --> 00:12:22,280 Speaker 1: get hormones, which is in part like an insurance thing, 210 00:12:22,400 --> 00:12:24,199 Speaker 1: and you know it has has all of these all 211 00:12:24,200 --> 00:12:27,480 Speaker 1: of these bullshit reasons. Um, but that is that is 212 00:12:27,480 --> 00:12:30,880 Speaker 1: something we're still we're still definitely dealing with, Oh my goodness. Yeah. 213 00:12:30,880 --> 00:12:33,400 Speaker 1: And the better informed care clinics are the ones that 214 00:12:33,960 --> 00:12:36,400 Speaker 1: they realize it's just like an effort in box ticking. 215 00:12:36,520 --> 00:12:38,559 Speaker 1: So they're just like, Yep, sounds good. You came here 216 00:12:38,600 --> 00:12:40,800 Speaker 1: to this clinic and you asked about hormones. Sounds like 217 00:12:40,840 --> 00:12:43,640 Speaker 1: gender dysphoria to me, Like we'll sell your insurance whatever. 218 00:12:43,679 --> 00:12:56,120 Speaker 1: We gotta say. Yes, eventually we'll go into like hormone 219 00:12:56,120 --> 00:12:58,120 Speaker 1: blockers as well. UM. But I want to talk about 220 00:12:58,400 --> 00:13:01,559 Speaker 1: there's a lot of this. There's a lot of rhetoric 221 00:13:01,600 --> 00:13:04,360 Speaker 1: that's been we're growing for a long long time about 222 00:13:04,440 --> 00:13:11,760 Speaker 1: the extremely damaging, irreversible effects of of hormone replacement therapy um, 223 00:13:11,840 --> 00:13:14,480 Speaker 1: and how they're gonna permanently alter your biology. If you 224 00:13:14,520 --> 00:13:17,720 Speaker 1: give these two children and there's five year olds taking 225 00:13:17,760 --> 00:13:20,920 Speaker 1: testosterone and it's gonna like you're like, You're like, really 226 00:13:21,280 --> 00:13:25,200 Speaker 1: that sounds very scary. UM. So that's something I would 227 00:13:25,200 --> 00:13:27,000 Speaker 1: like to discuss. It's like because a lot of people 228 00:13:27,720 --> 00:13:29,679 Speaker 1: when we when we do we talk talk about hormones, 229 00:13:29,679 --> 00:13:32,360 Speaker 1: they think of it as this like big, extremely life 230 00:13:32,400 --> 00:13:37,000 Speaker 1: altering thing um that has like these you know, irreversible 231 00:13:37,000 --> 00:13:40,040 Speaker 1: effects on your your your bones are gonna get weak 232 00:13:40,080 --> 00:13:42,400 Speaker 1: and trivel to never and never get big again, and 233 00:13:42,640 --> 00:13:46,880 Speaker 1: all of all of this very scary stuff. Um. What's 234 00:13:46,960 --> 00:13:51,240 Speaker 1: up with that? I think a lot of it goes 235 00:13:51,280 --> 00:13:54,559 Speaker 1: back to that biological essentialism, because hormones, even for the 236 00:13:54,600 --> 00:13:59,600 Speaker 1: people who give them, are considered partially like reversible. Because 237 00:13:59,679 --> 00:14:02,680 Speaker 1: the mid majority of the things that happen one take 238 00:14:02,720 --> 00:14:05,960 Speaker 1: a long ass time, like you will know whether or not. 239 00:14:06,080 --> 00:14:08,400 Speaker 1: This is a good idea for the majority of people 240 00:14:08,720 --> 00:14:14,000 Speaker 1: well before the physical manifestations occur. Uh. And and considering 241 00:14:14,080 --> 00:14:17,200 Speaker 1: like one of the biggest problems we have with certain formulations, 242 00:14:17,240 --> 00:14:19,320 Speaker 1: like in the once a week or once every other 243 00:14:19,360 --> 00:14:22,360 Speaker 1: week injectable version of estrogen, By the time you get 244 00:14:22,400 --> 00:14:25,160 Speaker 1: to right before your next dose, your estrogen is so 245 00:14:25,280 --> 00:14:28,440 Speaker 1: low you're feeling it and it's starting to like reverse 246 00:14:28,520 --> 00:14:31,200 Speaker 1: some of those So like, if you're feeling it after 247 00:14:31,320 --> 00:14:36,840 Speaker 1: two weeks, how irreversible could it be? Uh? And some 248 00:14:36,920 --> 00:14:40,320 Speaker 1: of it depends on like eight timing, because if we're 249 00:14:40,320 --> 00:14:43,080 Speaker 1: talking about a person who has say, already gone through 250 00:14:43,080 --> 00:14:47,240 Speaker 1: a testosterone mediated puberty, then some of the things are 251 00:14:47,320 --> 00:14:49,480 Speaker 1: just not going to be affected. You can't change like 252 00:14:49,600 --> 00:14:53,160 Speaker 1: bone size, height or anything like that. There's some interesting 253 00:14:53,200 --> 00:14:56,960 Speaker 1: things about like hip uh, like flexation and and and 254 00:14:56,960 --> 00:15:01,120 Speaker 1: and pivoting and yeah actually yeah and and and even 255 00:15:01,200 --> 00:15:03,240 Speaker 1: like shoe sizes can can change because of the way 256 00:15:03,240 --> 00:15:06,560 Speaker 1: the ligaments work on hormones. But like the bones aren't 257 00:15:06,560 --> 00:15:09,520 Speaker 1: going to change once they're done growing. But that's sort 258 00:15:09,520 --> 00:15:11,000 Speaker 1: of where the puberty blockers come in that we can 259 00:15:11,000 --> 00:15:13,480 Speaker 1: we'll talk about later. Um. But for the for the 260 00:15:13,520 --> 00:15:16,560 Speaker 1: majority of people, if you are going through if you 261 00:15:16,600 --> 00:15:18,960 Speaker 1: have gone through a puberty that you did not want, 262 00:15:19,360 --> 00:15:22,080 Speaker 1: you can take hormones to go through puberty you do 263 00:15:22,160 --> 00:15:24,880 Speaker 1: want and get the effects that you do want. And 264 00:15:25,000 --> 00:15:28,440 Speaker 1: some of the elements sure, like you know, growing breasts 265 00:15:28,960 --> 00:15:32,120 Speaker 1: uh guna coomastia as we would call it, an assist man, 266 00:15:32,160 --> 00:15:38,280 Speaker 1: which is another whole nonsense. Um, is not irreversible, Like 267 00:15:38,440 --> 00:15:40,760 Speaker 1: you can have them removed if you decided that you 268 00:15:40,800 --> 00:15:44,400 Speaker 1: needed to, like de transition, which is a whole another story. 269 00:15:44,440 --> 00:15:48,240 Speaker 1: But even then it takes like five years to see 270 00:15:48,280 --> 00:15:51,080 Speaker 1: their final breast size. Like if you if you're on 271 00:15:51,160 --> 00:15:55,600 Speaker 1: hormones for five years and you're worried about the irreversible 272 00:15:55,680 --> 00:15:58,400 Speaker 1: quote unquote effects, like what are we doing here? I mean? 273 00:15:58,440 --> 00:16:00,760 Speaker 1: And even I've heard from a lot of my elder 274 00:16:00,960 --> 00:16:04,200 Speaker 1: trans friends that whenever they go off hormones sometimes their 275 00:16:04,240 --> 00:16:06,800 Speaker 1: breasts just kind of go away because they're not massive 276 00:16:06,840 --> 00:16:11,200 Speaker 1: to begin with. Like if it's generally generally generally you 277 00:16:11,200 --> 00:16:17,280 Speaker 1: don't get the massive, massive honkers immediately. Um. I know, 278 00:16:17,440 --> 00:16:20,280 Speaker 1: I know we're trying, um, but a lot of a 279 00:16:20,280 --> 00:16:21,960 Speaker 1: lot a lot of even the you know, that was 280 00:16:22,000 --> 00:16:24,640 Speaker 1: one of the big things that informed content thing was like, 281 00:16:25,360 --> 00:16:27,760 Speaker 1: you know, a lot of these changes are reversible except 282 00:16:27,800 --> 00:16:29,840 Speaker 1: for breasts. These are these are these are these are 283 00:16:29,880 --> 00:16:32,640 Speaker 1: permanent change. Be careful and all my transferends are like 284 00:16:35,600 --> 00:16:39,160 Speaker 1: a little bit. But I like, your nipples won't shrink, 285 00:16:39,360 --> 00:16:42,040 Speaker 1: Like your nipples will definitely be bigger, and that that 286 00:16:42,080 --> 00:16:44,440 Speaker 1: won't change. But a lot of like the size actually 287 00:16:44,440 --> 00:16:47,760 Speaker 1: does fluctuate, and I can even tell that on like 288 00:16:47,880 --> 00:16:50,080 Speaker 1: depending on if I like missidos or something, being like 289 00:16:50,160 --> 00:16:52,280 Speaker 1: oh yeah, like there is a lot of a lot 290 00:16:52,320 --> 00:16:54,960 Speaker 1: of fluctuation even like on like you know, like temperature 291 00:16:54,960 --> 00:16:59,360 Speaker 1: and stuff. How cold will determine how how how how 292 00:16:59,600 --> 00:17:02,320 Speaker 1: how my chest looks it is? It is, uh, it's 293 00:17:02,360 --> 00:17:05,240 Speaker 1: pretty fun. I mean, I am I just like the 294 00:17:05,359 --> 00:17:08,280 Speaker 1: bio hacking thing in general. It is like the cyberpunk 295 00:17:08,320 --> 00:17:11,320 Speaker 1: and me um. But yeah, I guess I guess we 296 00:17:11,320 --> 00:17:15,760 Speaker 1: could talk about hormone hormone blockers as well, because this 297 00:17:15,840 --> 00:17:17,080 Speaker 1: is the other kind of thing you hear a lot 298 00:17:17,080 --> 00:17:20,720 Speaker 1: about when conservatives are very scared about transpeople. The idea 299 00:17:20,720 --> 00:17:26,440 Speaker 1: of hormone blockers like making people infertile or making permanent 300 00:17:26,520 --> 00:17:31,960 Speaker 1: changes to children's health or something. Blah blah blah blah blah. Gosh. 301 00:17:32,040 --> 00:17:36,000 Speaker 1: That's the thing that is like really really frustrating for me, 302 00:17:36,840 --> 00:17:41,800 Speaker 1: specifically because puberty blockers, the ganada trope in the g 303 00:17:42,000 --> 00:17:45,639 Speaker 1: n r H antagonist and agonists, which have been around 304 00:17:45,720 --> 00:17:49,480 Speaker 1: for like long time, but like ever for for I 305 00:17:49,480 --> 00:17:51,000 Speaker 1: want to say it was like a hundred years, but 306 00:17:51,080 --> 00:17:54,560 Speaker 1: I might be misquoting something that I'm half remembering, but 307 00:17:54,680 --> 00:17:56,480 Speaker 1: they've been around for like a really long time to 308 00:17:56,520 --> 00:17:58,560 Speaker 1: the point where we have generics and in the in 309 00:17:58,640 --> 00:18:01,720 Speaker 1: the pharmaceutical industry, that means that it's been like decades 310 00:18:01,800 --> 00:18:05,399 Speaker 1: at the very least, something that had rigorous testing that 311 00:18:05,480 --> 00:18:09,800 Speaker 1: has an indication with the FDA for precocious puberty, which 312 00:18:09,840 --> 00:18:13,119 Speaker 1: just means a person who is usually SIS who for 313 00:18:13,200 --> 00:18:17,160 Speaker 1: whatever reason, has puberty at a very young age. With 314 00:18:17,320 --> 00:18:19,840 Speaker 1: some of the some of the specific cases that I've 315 00:18:19,880 --> 00:18:22,840 Speaker 1: seen that I've that I've looked into, um involved giving 316 00:18:22,840 --> 00:18:25,000 Speaker 1: puberty blockers to like a three or four year old 317 00:18:25,040 --> 00:18:27,960 Speaker 1: because their body is trying to undergo puberty. So even 318 00:18:28,000 --> 00:18:29,879 Speaker 1: the idea of like, oh, well, I don't know this 319 00:18:30,040 --> 00:18:33,200 Speaker 1: twelve year old being on a puberty blocker for three years. 320 00:18:33,240 --> 00:18:36,720 Speaker 1: That sounds very dangerous when we have a person over 321 00:18:36,760 --> 00:18:40,320 Speaker 1: here who was on it for fifteen years with no 322 00:18:40,440 --> 00:18:43,840 Speaker 1: ill effects, like like no long lasting ill effects. Um 323 00:18:43,880 --> 00:18:47,080 Speaker 1: that the idea of anybody describing it as like experimental 324 00:18:47,320 --> 00:18:52,359 Speaker 1: is absolutely a historic outside of the realm of reality. Yeah, 325 00:18:52,359 --> 00:18:56,240 Speaker 1: there's it's it's basic anti anti intellectualism, because yeah, we've 326 00:18:56,280 --> 00:18:59,680 Speaker 1: been giving sis children hormone blockers for a long time 327 00:18:59,760 --> 00:19:03,440 Speaker 1: for early onset puberty, and it turns out they work 328 00:19:03,480 --> 00:19:06,280 Speaker 1: and they're pretty safe. So yeah, maybe we should give 329 00:19:06,280 --> 00:19:09,000 Speaker 1: those two trans kids too if they want them. Uh, 330 00:19:09,200 --> 00:19:10,960 Speaker 1: it seems like something we could at least try and 331 00:19:11,000 --> 00:19:13,960 Speaker 1: see if it improves mental health. And then it's it's 332 00:19:13,960 --> 00:19:15,200 Speaker 1: not even a matter that we have to try it. 333 00:19:15,359 --> 00:19:18,600 Speaker 1: We've been doing it for like almost ten years. Like 334 00:19:18,640 --> 00:19:21,200 Speaker 1: the it was first I think it was like two 335 00:19:21,240 --> 00:19:23,679 Speaker 1: thousand thirteen. There's a there's a ted talk I use 336 00:19:23,760 --> 00:19:25,760 Speaker 1: in my class of a of a physician who like 337 00:19:25,880 --> 00:19:29,640 Speaker 1: pioneered the use of puberty blockers in trans kids and 338 00:19:29,720 --> 00:19:32,840 Speaker 1: showed that any trans kid who got puberty blockers and 339 00:19:32,840 --> 00:19:35,200 Speaker 1: then was allowed to undergo the puberty that they desired 340 00:19:35,240 --> 00:19:38,560 Speaker 1: at an appropriate age, which is actually like fourteen fifteen 341 00:19:38,600 --> 00:19:41,199 Speaker 1: at the same time as their peers. UM. But even 342 00:19:41,240 --> 00:19:44,680 Speaker 1: if they had to wait till eighteen, the psychological effects 343 00:19:44,800 --> 00:19:49,440 Speaker 1: of having an in appropriate puberty are essentially nullified. They 344 00:19:49,440 --> 00:19:53,680 Speaker 1: are otherwise psychologically and physically like identical to their their 345 00:19:53,680 --> 00:19:57,719 Speaker 1: CIS gender peers. So it's like we have actual evidence 346 00:19:58,359 --> 00:20:02,760 Speaker 1: that it is extre really beneficial and extremely worthwhile. And 347 00:20:02,800 --> 00:20:05,879 Speaker 1: like the one kind of long term side effect is 348 00:20:06,200 --> 00:20:08,719 Speaker 1: you might be up to an inch shorter than you 349 00:20:08,800 --> 00:20:12,959 Speaker 1: otherwise be, which is a wildly like problematic like study 350 00:20:13,080 --> 00:20:14,960 Speaker 1: that was done because like we don't have time machines 351 00:20:15,040 --> 00:20:16,720 Speaker 1: to know whether or not that work, Like what would 352 00:20:16,760 --> 00:20:21,120 Speaker 1: your control group be? UM, And it's just wild. It's 353 00:20:21,240 --> 00:20:24,040 Speaker 1: very bothersome to me because a lot of the gender 354 00:20:24,040 --> 00:20:26,920 Speaker 1: affirming hormone therapy, the evidence is all over the place 355 00:20:26,960 --> 00:20:30,160 Speaker 1: for a variety of political reasons and and historical reasons. 356 00:20:30,160 --> 00:20:36,119 Speaker 1: But for hormone blockers, or for puberty blockers specifically, the 357 00:20:36,160 --> 00:20:42,800 Speaker 1: evidence is like really solid, really strong. And this is 358 00:20:42,800 --> 00:20:45,119 Speaker 1: the question I actually have because I'm actually unfamiliar with 359 00:20:45,160 --> 00:20:47,879 Speaker 1: this specific thing. But yeah, if you give like um, 360 00:20:48,080 --> 00:20:52,760 Speaker 1: hormone blockers to like a kid who's tend they still 361 00:20:52,880 --> 00:20:56,399 Speaker 1: kind of like grow at the same rate as a 362 00:20:56,400 --> 00:20:59,960 Speaker 1: lot of as a lot of their peers. And then 363 00:21:00,040 --> 00:21:02,439 Speaker 1: is that it just it's it's this specifically like the 364 00:21:02,480 --> 00:21:08,119 Speaker 1: secondary sex characteristic changes that get put on pause. Um, 365 00:21:08,160 --> 00:21:10,960 Speaker 1: but there's just so much Yeah, there's just so much 366 00:21:11,040 --> 00:21:14,080 Speaker 1: fear around the whole. Even even just the hormone blocker 367 00:21:14,119 --> 00:21:17,560 Speaker 1: thing right when we're getting you know, just like prescribing 368 00:21:17,680 --> 00:21:20,680 Speaker 1: hormone blockers being like a felony offense in multiple states. 369 00:21:20,680 --> 00:21:24,720 Speaker 1: Now you're like, it's like, it's it is just an 370 00:21:24,720 --> 00:21:29,000 Speaker 1: extreme degree of anti anti intellectualism, just like just like 371 00:21:29,240 --> 00:21:37,040 Speaker 1: purposeful like ignorance, um and just extreme hatred and uh bigotry, 372 00:21:37,119 --> 00:21:40,480 Speaker 1: and it's it is uh, I mean yeah, it's a 373 00:21:41,600 --> 00:21:45,359 Speaker 1: I'm kind of speaking to the choir here, but but 374 00:21:45,359 --> 00:21:47,159 Speaker 1: but but that's the trick. And and even like the 375 00:21:47,200 --> 00:21:49,600 Speaker 1: purity blocker thing, like you were saying, your body will 376 00:21:49,600 --> 00:21:52,960 Speaker 1: still make human growth hormone, you will still grow, it's 377 00:21:53,000 --> 00:21:56,200 Speaker 1: just that the modulation of that with say testosterone, which 378 00:21:56,240 --> 00:22:00,600 Speaker 1: would increase the overall growth like just doesn't there. And 379 00:22:01,160 --> 00:22:04,399 Speaker 1: people say make a lot of you know, talk a 380 00:22:04,400 --> 00:22:08,160 Speaker 1: lot about the idea of um bone mineral density because 381 00:22:08,200 --> 00:22:12,200 Speaker 1: you don't have testosterone or estrogen, which are both necessary 382 00:22:12,320 --> 00:22:15,040 Speaker 1: one or the other necessary for your like bone mineral 383 00:22:15,080 --> 00:22:18,679 Speaker 1: density to not like have like easily fractured bones, but 384 00:22:18,760 --> 00:22:20,960 Speaker 1: like you don't even have that until you go through puberty. 385 00:22:21,000 --> 00:22:24,640 Speaker 1: If you're just like preventing one puberty, the endogenous puberty, 386 00:22:24,680 --> 00:22:28,960 Speaker 1: and then providing the hormones for an exogenous puberty, they're fine, 387 00:22:29,160 --> 00:22:32,600 Speaker 1: Like they have the hormones they need, their bones are happy. 388 00:22:32,720 --> 00:22:46,359 Speaker 1: Uh So, yeah, I look to talk about I guess 389 00:22:46,560 --> 00:22:50,679 Speaker 1: kind of access to hormones and in like the like 390 00:22:50,720 --> 00:22:54,119 Speaker 1: the different models of of obviously we're not giving up 391 00:22:54,280 --> 00:22:57,919 Speaker 1: medical advice, but like this access to hormones and the 392 00:22:57,960 --> 00:23:01,400 Speaker 1: different ways that people can go about that now through doctors, 393 00:23:01,400 --> 00:23:04,760 Speaker 1: through informed consent um and all of all and all 394 00:23:04,800 --> 00:23:10,240 Speaker 1: of that jazz. Yeah. So the informed consent model is 395 00:23:10,280 --> 00:23:14,320 Speaker 1: a much more recent option, and it's not available everywhere. 396 00:23:14,440 --> 00:23:16,520 Speaker 1: I have a friend in Texas we had to find 397 00:23:16,560 --> 00:23:18,400 Speaker 1: a clinic that was like two hours away to get 398 00:23:18,400 --> 00:23:20,760 Speaker 1: her hormones. But here where I live, we actually have 399 00:23:20,800 --> 00:23:23,720 Speaker 1: to informed consent clinics. So it's pretty convenient, but it 400 00:23:23,840 --> 00:23:27,280 Speaker 1: varies wildly by by region. Uh And the informed carre 401 00:23:27,359 --> 00:23:29,520 Speaker 1: clinics are great. It means you come in, they say, 402 00:23:29,560 --> 00:23:31,160 Speaker 1: this is what's going to happen. Do you still want 403 00:23:31,200 --> 00:23:33,560 Speaker 1: to do it? You say yes, They take some blood, 404 00:23:33,680 --> 00:23:35,560 Speaker 1: they run some tests, you come back in two weeks, 405 00:23:35,760 --> 00:23:38,800 Speaker 1: and they go here. You go like that. That's they 406 00:23:38,840 --> 00:23:42,280 Speaker 1: work really well, depending on the clinic, I guess. And uh, 407 00:23:42,320 --> 00:23:45,399 Speaker 1: but the more traditional quote unquote standard model would be 408 00:23:45,400 --> 00:23:48,320 Speaker 1: going to your PCP or or whoever and saying that 409 00:23:48,359 --> 00:23:50,960 Speaker 1: you want to do this, which makes most of them 410 00:23:51,080 --> 00:23:56,120 Speaker 1: very concerned because most physicians, pharmacist, nurses, they don't get 411 00:23:56,160 --> 00:23:59,840 Speaker 1: taught anything about trans people, are caring for trans people, 412 00:23:59,840 --> 00:24:03,080 Speaker 1: are gender affirming hormon therapy in their school like, so 413 00:24:03,160 --> 00:24:06,520 Speaker 1: they have nothing to fall back on. Uh. So that 414 00:24:06,560 --> 00:24:09,800 Speaker 1: makes them very nervous to do it. And then UH, 415 00:24:09,880 --> 00:24:12,439 Speaker 1: if you if you look at gosh, I really want 416 00:24:12,480 --> 00:24:14,960 Speaker 1: to tell you about the guideline stuff at some point 417 00:24:14,960 --> 00:24:18,760 Speaker 1: here because it is bucked wild um as to why 418 00:24:18,800 --> 00:24:20,840 Speaker 1: that would be a concern. But another part of it 419 00:24:20,920 --> 00:24:24,200 Speaker 1: is is also the insurance. You know, America's original sin 420 00:24:24,280 --> 00:24:29,680 Speaker 1: in our healthcare dystopia, if you will. Uh, the insurances 421 00:24:29,760 --> 00:24:32,240 Speaker 1: historically have required and and part of this is also 422 00:24:32,280 --> 00:24:36,040 Speaker 1: from antiquated guidelines that has been somewhat like just grandfathered 423 00:24:36,040 --> 00:24:38,760 Speaker 1: in to excuse the term. Uh, this idea of like 424 00:24:38,800 --> 00:24:40,040 Speaker 1: we you have to go to a therapist. You can 425 00:24:40,080 --> 00:24:41,800 Speaker 1: go to a psychologist and they have to say that 426 00:24:41,800 --> 00:24:43,480 Speaker 1: you have gender dystoria, that's why it's in the d 427 00:24:43,640 --> 00:24:46,959 Speaker 1: s M. And then after you do that, some places 428 00:24:47,000 --> 00:24:51,200 Speaker 1: require you to socially transition before getting hormones or anything, 429 00:24:51,240 --> 00:24:55,040 Speaker 1: which can be extremely problematic for some individuals. That just 430 00:24:55,320 --> 00:24:58,960 Speaker 1: increases like visibility and bullying and and such in a 431 00:24:59,000 --> 00:25:02,000 Speaker 1: way that it makes drive people. It's it's sort of 432 00:25:02,200 --> 00:25:05,320 Speaker 1: was intentionally required back in the day to drive people 433 00:25:05,440 --> 00:25:08,960 Speaker 1: to not want hormones anymore. And it's all of these 434 00:25:09,000 --> 00:25:11,720 Speaker 1: gate keeping steps. And it's even worse if you wanted 435 00:25:11,720 --> 00:25:14,840 Speaker 1: to get a surgery later on, where you have to 436 00:25:15,320 --> 00:25:17,640 Speaker 1: have been on hormones for a certain length of time, 437 00:25:17,680 --> 00:25:21,920 Speaker 1: you have to have two different generally like susgender right. 438 00:25:22,240 --> 00:25:25,520 Speaker 1: Health care practitioners who don't necessarily understand like the full 439 00:25:25,680 --> 00:25:28,199 Speaker 1: like everything that's going on, write you letters before. The 440 00:25:28,680 --> 00:25:32,399 Speaker 1: most insurances up until recently wouldn't even cover it. So 441 00:25:32,760 --> 00:25:35,560 Speaker 1: it's just gate keeping step after gate keeping step. Because 442 00:25:35,600 --> 00:25:38,359 Speaker 1: even the Big Guidelines, which is w PATH, which is 443 00:25:38,359 --> 00:25:41,359 Speaker 1: about to put out their so gate guidelines. Um, there's 444 00:25:41,359 --> 00:25:44,280 Speaker 1: a guidelines out of San Francisco, and the Endocrine Society 445 00:25:44,320 --> 00:25:48,080 Speaker 1: has guidelines from two seventeen that are but all of 446 00:25:48,160 --> 00:25:52,520 Speaker 1: those are made by cisgender people, usually with the intent 447 00:25:52,640 --> 00:25:56,159 Speaker 1: to gate keep this care because it's either they're uncomfortable 448 00:25:56,160 --> 00:25:58,200 Speaker 1: with it, because they're unfamiliar with it, they have some 449 00:25:58,320 --> 00:26:02,640 Speaker 1: kind of ideological reasons to be against it, or whatever 450 00:26:03,440 --> 00:26:05,800 Speaker 1: whatever else. There's a survey that I often quote to 451 00:26:05,800 --> 00:26:09,400 Speaker 1: my students in class that, Um, they surveyed a whole 452 00:26:09,440 --> 00:26:13,679 Speaker 1: bunch of trans individuals trying to get care from their physicians, 453 00:26:14,119 --> 00:26:17,960 Speaker 1: and it was nearly a quarter of them said that 454 00:26:18,040 --> 00:26:22,320 Speaker 1: they avoided healthcare because of discrimination, and half of them 455 00:26:22,800 --> 00:26:25,840 Speaker 1: reported having to teach their health care practitioner how to 456 00:26:25,960 --> 00:26:30,439 Speaker 1: care for them, which is wild. Like, imagine going to 457 00:26:30,480 --> 00:26:33,239 Speaker 1: the hospital with like heart failure and having to like 458 00:26:33,359 --> 00:26:36,560 Speaker 1: talk your physician through how to care for you. Can 459 00:26:36,600 --> 00:26:39,000 Speaker 1: you can you live for two years with heart failure? First? 460 00:26:39,080 --> 00:26:43,919 Speaker 1: Before we go, Oh my gosh, could you imagine if 461 00:26:43,960 --> 00:26:45,800 Speaker 1: we treated other things this way? I'd be like, well, 462 00:26:45,880 --> 00:26:48,840 Speaker 1: are you sure that you have diabetes? Are you sure 463 00:26:48,960 --> 00:26:52,200 Speaker 1: that you're like, well, we can't treat your diabetes you're 464 00:26:52,240 --> 00:26:55,040 Speaker 1: too fat. Well your b m I is too high, 465 00:26:55,040 --> 00:26:58,000 Speaker 1: so we can't give you the insulin. Like, give me 466 00:26:58,040 --> 00:27:03,120 Speaker 1: a break. What is happening? Uh it seems like Uh, 467 00:27:03,400 --> 00:27:05,959 Speaker 1: basically what you're saying is that we've got a good system. 468 00:27:06,080 --> 00:27:08,560 Speaker 1: We gotta oh, we gotta figure it out. Absolutely no 469 00:27:08,680 --> 00:27:12,639 Speaker 1: notes dent perfect in every way. Well that doesn't for 470 00:27:12,720 --> 00:27:19,760 Speaker 1: us today here. Uh well, specifically if I could, Um, 471 00:27:19,800 --> 00:27:23,360 Speaker 1: it's really interesting from like the healthcare perspective, because from 472 00:27:23,400 --> 00:27:26,600 Speaker 1: you know, the practitioner's perspective, because there's essentially two kinds 473 00:27:26,840 --> 00:27:30,200 Speaker 1: of like treatment. There's guideline based medicine and evidence based medicine, 474 00:27:30,560 --> 00:27:32,639 Speaker 1: and a lot of schools, like my school teaches a 475 00:27:32,720 --> 00:27:35,600 Speaker 1: lot of guideline based medicine, which is for something like 476 00:27:35,680 --> 00:27:39,800 Speaker 1: hypertension or diabetes, is put out by like large organizations 477 00:27:39,840 --> 00:27:43,040 Speaker 1: with a ton of evidence. It is actually like pretty reasonable. 478 00:27:43,440 --> 00:27:45,480 Speaker 1: But that means that if you're going along with what 479 00:27:45,520 --> 00:27:48,240 Speaker 1: they say, that means that you believe that they read 480 00:27:48,280 --> 00:27:53,119 Speaker 1: those studies correctly and that their interpretation is in no 481 00:27:53,200 --> 00:27:57,880 Speaker 1: way compromised by like sources of their income, say, and 482 00:27:58,160 --> 00:28:01,560 Speaker 1: that those guideline is actually match your patients. So it's 483 00:28:01,560 --> 00:28:03,800 Speaker 1: a lot of assumptions that you're making, which can be 484 00:28:03,840 --> 00:28:07,080 Speaker 1: extremely problematic. And evidence based is where you dive into 485 00:28:07,119 --> 00:28:09,000 Speaker 1: literature and you figured it out yourself, which is very 486 00:28:09,000 --> 00:28:13,160 Speaker 1: time consuming and requires an awful lot of like professional uh, 487 00:28:13,280 --> 00:28:16,680 Speaker 1: like you know, criticism in a way. Uh, but when 488 00:28:16,720 --> 00:28:19,639 Speaker 1: you look at it for for trans care, for for 489 00:28:19,720 --> 00:28:24,639 Speaker 1: gender affirming hormone therapy, those guidelines are unbelievably compromised. To 490 00:28:24,680 --> 00:28:29,760 Speaker 1: give you an example, a hotly contested issue in feminizing 491 00:28:29,800 --> 00:28:34,679 Speaker 1: therapy is the use of micronized progesterone in feminizing care. Uh. 492 00:28:34,800 --> 00:28:36,520 Speaker 1: It's kind of like all over the place. There's a 493 00:28:36,560 --> 00:28:40,680 Speaker 1: long history of it, of of this controversy. In the 494 00:28:40,800 --> 00:28:45,280 Speaker 1: upcoming w path socate guidelines that I had like a 495 00:28:45,320 --> 00:28:49,600 Speaker 1: preliminary copy to to provide notes on there, there's a 496 00:28:49,640 --> 00:28:53,840 Speaker 1: single statement that just says that there's a controversy that 497 00:28:53,920 --> 00:28:57,520 Speaker 1: exists and you should not use micronized progesterone and transfeminine care. 498 00:28:57,720 --> 00:29:01,000 Speaker 1: And they list a study. Okay, if you pull up 499 00:29:01,040 --> 00:29:05,080 Speaker 1: that study, the title of it is progesterone is important 500 00:29:05,160 --> 00:29:09,800 Speaker 1: for transgender women's therapy. Applying evidence for the benefits of 501 00:29:09,840 --> 00:29:14,880 Speaker 1: progesterone insists women, and it is like a pretty long 502 00:29:15,000 --> 00:29:18,640 Speaker 1: document that concludes that it is like an ethical imperative 503 00:29:18,840 --> 00:29:21,160 Speaker 1: to offer it. So the idea that the people who 504 00:29:21,160 --> 00:29:23,920 Speaker 1: are writing the w path guidelines read this article, read 505 00:29:23,960 --> 00:29:27,240 Speaker 1: this this like meta analysis and went, yeah, I don't 506 00:29:27,280 --> 00:29:29,400 Speaker 1: really agree with any of that. I'm just gonna say no, 507 00:29:30,560 --> 00:29:34,600 Speaker 1: is just so infuriating. Again, that seems like we've got 508 00:29:34,600 --> 00:29:38,120 Speaker 1: a good system going here. Yeah, no, notes, I guess 509 00:29:38,200 --> 00:29:40,440 Speaker 1: on that note, let's I want to discuss some of 510 00:29:40,480 --> 00:29:42,080 Speaker 1: the some things that are talking about as much as 511 00:29:42,120 --> 00:29:47,280 Speaker 1: like um antiandrogen's, uh, progesterone, spiro and what all kind 512 00:29:47,320 --> 00:29:49,400 Speaker 1: of those do and how they can kind of supplement 513 00:29:49,440 --> 00:29:57,160 Speaker 1: a regular estradial regiment regiment. Yes, that sounds that sounds fancy. Sure, sure, 514 00:29:57,320 --> 00:30:01,160 Speaker 1: So generally speaking, if you're maybe you give a baseline 515 00:30:01,200 --> 00:30:03,480 Speaker 1: for for folks who are unaware. The way that we 516 00:30:03,520 --> 00:30:07,200 Speaker 1: do feminizing therapy is we offer estra dial, which is 517 00:30:07,280 --> 00:30:10,920 Speaker 1: a bioequivalent version of E two, because there's like three 518 00:30:10,960 --> 00:30:14,840 Speaker 1: different versions of estro of estrogen UM and an antiandrogen 519 00:30:14,880 --> 00:30:18,080 Speaker 1: because testosterone tends to be somewhat of an overriding hormone. 520 00:30:18,120 --> 00:30:20,800 Speaker 1: The presence of testosterone will override the effects of estrogen 521 00:30:20,840 --> 00:30:23,080 Speaker 1: to a certain extent depending on doses and stuff like that, 522 00:30:23,560 --> 00:30:27,960 Speaker 1: which is for the transmasculine individuals, why we just give testosterone. 523 00:30:28,000 --> 00:30:30,200 Speaker 1: It just does the job. You don't need to block 524 00:30:30,280 --> 00:30:34,840 Speaker 1: the estrogen. Uh So there's a you know, there's a 525 00:30:34,840 --> 00:30:38,040 Speaker 1: lot of history in just those hormones as well that 526 00:30:38,080 --> 00:30:41,479 Speaker 1: we could talk about, like conjugated estrogens versus estra dial 527 00:30:41,720 --> 00:30:43,720 Speaker 1: and and all the different other stuff. But for the 528 00:30:43,760 --> 00:30:46,840 Speaker 1: antiandrogens that we give historically in this country, we give 529 00:30:46,840 --> 00:30:51,200 Speaker 1: spiron lactone, which is a mineral corticoid. It's a potassium 530 00:30:51,240 --> 00:30:54,200 Speaker 1: sparing diuretic, and it's just really good. At higher levels. 531 00:30:54,520 --> 00:30:57,120 Speaker 1: We usually use it in like cardio issues like it 532 00:30:57,320 --> 00:31:01,120 Speaker 1: can be used for like hypertensions and other things. Um, 533 00:31:01,160 --> 00:31:05,160 Speaker 1: I believe it makes you pee a lot, So it's 534 00:31:05,160 --> 00:31:08,000 Speaker 1: a diuretic meaning that it makes you urinate and awful lot. 535 00:31:08,040 --> 00:31:10,640 Speaker 1: And it's a potassium sparing because it prevents your body 536 00:31:10,680 --> 00:31:17,720 Speaker 1: from eliminating potassium. So uh well, so that is that's 537 00:31:17,840 --> 00:31:20,160 Speaker 1: the thing that I think is really really wild because 538 00:31:20,160 --> 00:31:22,520 Speaker 1: you're using these high levels of it, it is preventing 539 00:31:23,040 --> 00:31:28,080 Speaker 1: your production of your endogenous production of testosterone and making 540 00:31:28,080 --> 00:31:31,720 Speaker 1: you pee all of the time, which spoilers estradial also 541 00:31:31,800 --> 00:31:33,880 Speaker 1: makes you pay more often, So like that's a real 542 00:31:33,960 --> 00:31:37,600 Speaker 1: fun combination. But then physicians, if they don't know what 543 00:31:37,640 --> 00:31:40,040 Speaker 1: the heck they're doing, they might say something like, well, 544 00:31:40,080 --> 00:31:43,840 Speaker 1: you can't eat any bananas, and like, historically the people 545 00:31:43,880 --> 00:31:47,120 Speaker 1: who are on feminizing therapy are healthy enough that their 546 00:31:47,120 --> 00:31:51,640 Speaker 1: body just accommodates for it. And if you have hyper keelmo, 547 00:31:51,720 --> 00:31:54,440 Speaker 1: which is like too much potassium, you're gonna know, like 548 00:31:54,480 --> 00:31:56,360 Speaker 1: your muscles are gonna ache and there's gonna be a 549 00:31:56,400 --> 00:31:59,440 Speaker 1: lot of like telltale side effects. Usually it's only a 550 00:31:59,480 --> 00:32:03,520 Speaker 1: problem if you are like only consuming a like salt 551 00:32:03,600 --> 00:32:08,320 Speaker 1: alternative that has potassium instead of sodium, which is not 552 00:32:08,400 --> 00:32:12,560 Speaker 1: super common not super common, or if you have some 553 00:32:12,600 --> 00:32:16,840 Speaker 1: other reason why your body is like holding onto potassium. Um, 554 00:32:16,880 --> 00:32:20,200 Speaker 1: So it's not usually an issue. Uh, it's an inspiral 555 00:32:20,280 --> 00:32:23,080 Speaker 1: actrone isn't sufficient for everyone. There's plenty of people who 556 00:32:23,160 --> 00:32:25,840 Speaker 1: have like refractory testosterone after some time, and there's some 557 00:32:25,880 --> 00:32:29,680 Speaker 1: other options. Uh, there's kind of a weird controversy about 558 00:32:29,680 --> 00:32:33,000 Speaker 1: it that is sort of heralded by the San Francisco Guidelines. 559 00:32:33,040 --> 00:32:37,480 Speaker 1: I mentioned earlier that spironal actone uh leads to Okay, well, 560 00:32:37,520 --> 00:32:38,920 Speaker 1: I want to make sure I get the wording right. 561 00:32:39,000 --> 00:32:42,880 Speaker 1: It's leads to premature fusing of the breast bud uh 562 00:32:42,920 --> 00:32:48,120 Speaker 1: and overall smaller breast size, which the document that they 563 00:32:48,120 --> 00:32:51,720 Speaker 1: cite for that is a real weird retrospective study from 564 00:32:51,760 --> 00:32:54,080 Speaker 1: like a bunch of years ago on the rate of 565 00:32:54,160 --> 00:32:57,440 Speaker 1: trans women getting breast augmentation, and it found that the 566 00:32:57,520 --> 00:33:00,000 Speaker 1: vast majority of trans women who are on spironal act 567 00:33:00,040 --> 00:33:04,480 Speaker 1: tone got breast agmented getting breast But the problem is, 568 00:33:05,200 --> 00:33:09,080 Speaker 1: like of their sample group of like to people, almost 569 00:33:09,160 --> 00:33:11,840 Speaker 1: all of the moron spur on a lactone. Like there's 570 00:33:11,880 --> 00:33:16,760 Speaker 1: like a sampling error, Like it's not it's very silly. Um. 571 00:33:16,800 --> 00:33:19,520 Speaker 1: And also even like that premature fusing in the breastbed, 572 00:33:19,520 --> 00:33:24,240 Speaker 1: I have never been able to find anything that suggests 573 00:33:24,240 --> 00:33:26,520 Speaker 1: that that's a thing or even like a way to 574 00:33:26,680 --> 00:33:32,360 Speaker 1: explain what that statement even means. But the San Francisco guidelines, 575 00:33:32,440 --> 00:33:34,960 Speaker 1: to go back to the my guideline thing actually says 576 00:33:35,200 --> 00:33:37,680 Speaker 1: has some like maybe don't use spar on lactone even 577 00:33:37,680 --> 00:33:40,440 Speaker 1: though it's something we've been using since literally like the 578 00:33:40,440 --> 00:33:44,160 Speaker 1: fifties or sixties for this purpose. In other countries, you'll 579 00:33:44,240 --> 00:33:48,240 Speaker 1: use what's called cyprotorone, which is a synthetic progesterone, but 580 00:33:48,280 --> 00:33:51,560 Speaker 1: it's not actually approved in the States because it has 581 00:33:51,600 --> 00:33:54,200 Speaker 1: a like there is actually some evidence that it causes 582 00:33:54,280 --> 00:33:57,240 Speaker 1: increase in certain specific cancers, but it's like a pretty 583 00:33:57,320 --> 00:34:00,360 Speaker 1: limited overall risk, Like it's not like something like you know, 584 00:34:00,560 --> 00:34:03,120 Speaker 1: going outside increases your risk of cancer. It's it's not 585 00:34:03,200 --> 00:34:05,400 Speaker 1: like a huge deal, but it was enough that they 586 00:34:05,400 --> 00:34:07,160 Speaker 1: don't it's not approved in the States, but in a 587 00:34:07,160 --> 00:34:10,320 Speaker 1: lot of other countries you'll you might get syprotarone, which 588 00:34:10,680 --> 00:34:13,160 Speaker 1: there's a lot of you know, controversy around that too 589 00:34:13,200 --> 00:34:16,400 Speaker 1: for those reasons. UM Here, the other option that we 590 00:34:16,480 --> 00:34:20,800 Speaker 1: usually see is finasteride, which is a five alpha reductation 591 00:34:20,840 --> 00:34:24,160 Speaker 1: inhibitor that essentially is preventing testosterone from being turned into 592 00:34:24,200 --> 00:34:30,200 Speaker 1: dihydro testosterone, which we use normally for UM to prevent 593 00:34:30,280 --> 00:34:33,960 Speaker 1: quote unquote male pattern boldness and in higher doses for 594 00:34:34,120 --> 00:34:37,920 Speaker 1: prostate cancer because it's real good at because it like 595 00:34:38,040 --> 00:34:43,680 Speaker 1: reverses some of the feedback loops just reducing product testosterone production. UM, 596 00:34:43,719 --> 00:34:46,600 Speaker 1: so it's just fine, like that one has like very 597 00:34:46,640 --> 00:34:50,240 Speaker 1: limited side effects, but it might not have as substantial 598 00:34:50,560 --> 00:34:56,399 Speaker 1: of a UM reduction of testosterone that spiral lactone does. UH. 599 00:34:56,440 --> 00:34:58,920 Speaker 1: And then the kind of third one that we really 600 00:34:59,320 --> 00:35:00,960 Speaker 1: we don't see our often, but there's a lot of 601 00:35:00,960 --> 00:35:05,120 Speaker 1: interesting evidence about is called by cooludamide. It's also a 602 00:35:05,160 --> 00:35:08,480 Speaker 1: prostate cancer medication. It actually blocks all of the receptors 603 00:35:08,520 --> 00:35:12,080 Speaker 1: of testosterone in your body while not reducing the production 604 00:35:12,120 --> 00:35:14,239 Speaker 1: of it. So you'll see a person who has like 605 00:35:14,840 --> 00:35:17,960 Speaker 1: you know, they have like seven hundred their their testosterone 606 00:35:17,960 --> 00:35:21,239 Speaker 1: comes back is like seven six D whatever, but they're 607 00:35:21,360 --> 00:35:24,399 Speaker 1: entirely feminized because none of it has anywhere to work. UM. 608 00:35:24,400 --> 00:35:26,439 Speaker 1: But the problem with that is by colutamide being an 609 00:35:26,440 --> 00:35:31,120 Speaker 1: anti cancer med UH primarily is ridiculously expensive. I think 610 00:35:31,120 --> 00:35:34,680 Speaker 1: it's like fifty bucks a dose or something like here, 611 00:35:35,080 --> 00:35:39,320 Speaker 1: it's so great, uh, I will say, And and for 612 00:35:39,560 --> 00:35:42,920 Speaker 1: my genderqueers out there or anyone anyone else. So we 613 00:35:42,960 --> 00:35:46,120 Speaker 1: can also just take estrogen without any without any blockers UM, 614 00:35:46,200 --> 00:35:48,840 Speaker 1: and you still get results as I can, as I 615 00:35:48,880 --> 00:35:52,360 Speaker 1: can confirm UM, and for a subset of the population, 616 00:35:52,600 --> 00:35:56,359 Speaker 1: just taking estrogen at sufficient dosages will also reduce your 617 00:35:56,440 --> 00:36:01,080 Speaker 1: levels of progester of testosterone, like, it's your body knows 618 00:36:01,120 --> 00:36:04,640 Speaker 1: what it's doing. Is it is? It is? It is 619 00:36:04,640 --> 00:36:09,000 Speaker 1: pretty cool. How but you can just change things up 620 00:36:09,040 --> 00:36:11,160 Speaker 1: in your body is like, oh, we're doing this now, Okay, 621 00:36:11,280 --> 00:36:14,360 Speaker 1: got it great? I have all these mechanisms. It's wonderful. 622 00:36:17,200 --> 00:36:19,480 Speaker 1: And with that, that wraps up part one of our 623 00:36:19,520 --> 00:36:24,640 Speaker 1: little two part series of episodes talking about hormone replacement therapy. Tomorrow, 624 00:36:24,680 --> 00:36:27,799 Speaker 1: I'll talk more about access to gender affirming treatment and 625 00:36:27,840 --> 00:36:31,360 Speaker 1: touch on d I y h R T special thanks 626 00:36:31,400 --> 00:36:35,560 Speaker 1: to Dr Victoria Luna Brennan Grieve for chatting with me 627 00:36:35,640 --> 00:36:39,480 Speaker 1: about gender affirming hormonal treatment. You'll get to hear more 628 00:36:39,480 --> 00:36:43,200 Speaker 1: of my discussion with her tomorrow as well, including a 629 00:36:43,239 --> 00:36:46,279 Speaker 1: brief tangent about the Scythian priestesses, which I was it 630 00:36:46,320 --> 00:36:49,319 Speaker 1: was very, very very excited to talk about, but that 631 00:36:49,400 --> 00:36:51,600 Speaker 1: doesn't for us today. You can follow this show at 632 00:36:51,640 --> 00:36:54,200 Speaker 1: Happen to Hear pod and Cool Zone Media on Twitter 633 00:36:54,280 --> 00:36:57,319 Speaker 1: and Instagram, and you can look at my late night 634 00:36:57,360 --> 00:37:01,120 Speaker 1: gender tweets at Hungry about Ie on or dot com. 635 00:37:01,160 --> 00:37:11,480 Speaker 1: So see you all on the other side.