Speaker 1: Greetings listeners in the podcast verse, This is it could
Speaker 1: happen here the podcast about things falling apart and sometimes
Speaker 1: how we can put stuff back together. I'm Garrison Davis
Speaker 1: are Resident Gender mess In the past few weeks, we've
Speaker 1: been talking a lot here on the show about the
Speaker 1: escalating war on trans people and queer folks in general.
Speaker 1: There's been a wave of bills making any gender affirming
Speaker 1: healthcare of felony for people under the age of eighteen,
Speaker 1: which forcibly detransitions teenagers and multiple states, and we've had
Speaker 1: a lot of banning trans people from participating in sports
Speaker 1: and trying to ban books and discussion in schools about
Speaker 1: the just the existence of queer people at all. But
Speaker 1: today we're not really going to be talking about that.
Speaker 1: We've talked about that plenty for the past few weeks.
Speaker 1: It's good to have a little little bit of a break,
Speaker 1: but we'll still be talking about stuff around trans people.
Speaker 1: Because with all the discussion around gender affirming healthcare, I
Speaker 1: thought it would be a good idea to put something
Speaker 1: together talking about what HRT or hormone replacement therapy actually is,
Speaker 1: as since it's the most common form of trans healthcare
Speaker 1: and since many states are trying to or already have
Speaker 1: criminalized it, perhaps I can use the POD to point
Speaker 1: people towards alternative means of receiving care, you know, in
Speaker 1: the vein of the putting stuff back together side of
Speaker 1: the show. Now, I want to clarify upfront that we're
Speaker 1: not giving anyone medical advice, obviously. I'm just making observations
Speaker 1: and talking about things as they exist, um and talking
Speaker 1: about things that many trans people have been doing for
Speaker 1: a long time, and that includes d I Y HRT.
Speaker 1: My doctorate program is in parapsychology, not medical science, so
Speaker 1: just keep that in mind. First, I will quickly clarify
Speaker 1: what HRT or hormone replacement therapy actually is for specifically
Speaker 1: non CIS gender individuals, because HRT as a term is
Speaker 1: also used for CIS women to describe similar but different treatment.
Speaker 1: So HRT as a form of gender affirming treatment is
Speaker 1: when someone receives sex hormone medication that produces a number
Speaker 1: of desired secondary sex characteristics. There are two broad types
Speaker 1: of hormone therapy that one would receive, depending on what
Speaker 1: direction you want to go in gender of wise, there's
Speaker 1: feminizing hormones and masculinizing hormones. Feminizing hormones produce more typically
Speaker 1: feminine traits, right, big big shocker there. Uh. It usually
Speaker 1: consists of a form of estrogen, usually called estradial. There's
Speaker 1: different types of estradial, and also it can include anti
Speaker 1: androgen's aka a testosterone blockers. Masculinization therapy consists of taking
Speaker 1: to sasterone or androgen's and then also less commonly anti strogens,
Speaker 1: but usually just tinking to toss your own will suffice. Now,
Speaker 1: I'm no expert in hormones despite my weekly shot, but
Speaker 1: lucky enough I was able to sit down with an
Speaker 1: actual expert on hormones and talk over zoom. So what
Speaker 1: follows is segments from our conversation. I guess first, do
Speaker 1: you want to introduce yourself? Sure? I am the Reverend
Speaker 1: Dr Victoria Luna B. Grieve. I am an assistant professor
Speaker 1: at the University of Pittsburgh School of Pharmacy. My primary
Speaker 1: clinical focuses on gender affirming hormone therapy, other kind of advocacy,
Speaker 1: work in queer healthcare, and I do a lot of
Speaker 1: other stuff on the side. Heatigo g Ludac, instructional design,
Speaker 1: game design, just anything that strikes my fancy really fun
Speaker 1: fun stuff in with within kind of our our coverage
Speaker 1: of trend stuff the past few weeks and months, it's
Speaker 1: been mostly on like the bills and like the politics
Speaker 1: side of things. I definitely had some people like reach
Speaker 1: out and be like, okay, but how like why why treads? Gender?
Speaker 1: Why why hormones? Like why are hormones actually important? Like
Speaker 1: could you actually explain like what, like you know, with
Speaker 1: all of these all these states banding hormones, let's I
Speaker 1: would like to kind of explain why it's such a
Speaker 1: big deal and like how much these things actually are
Speaker 1: like life saving medication for so many people. Yeah, so
Speaker 1: why are hormones? I love it because it's a question
Speaker 1: that as like a species, we've been we have known
Speaker 1: the answer to for like five thousand years. It's it's
Speaker 1: very funny, but um, hormones are. Okay. A big part
Speaker 1: of this requires to like acknowledge something that is very
Speaker 1: wrong in in like the medical literature. There's a lot
Speaker 1: of elements of healthcare that are coordinated between like male
Speaker 1: and female, and there's a kind of like obviously is
Speaker 1: a little so there's a lot of I mean like
Speaker 1: from like from people's I know, when trans people talking
Speaker 1: about interacting with the medical system, it's always like, oh, yes,
Speaker 1: we're gonna be doing this bullshit, Yes of course. Yeah, well,
Speaker 1: but it even goes to it like a really deep level,
Speaker 1: like if you're in the hospital and you get a
Speaker 1: CBC count, there's a male profile and a female profile
Speaker 1: of what your hematocrit should be on, like what the
Speaker 1: level of red blood cells are, and and the general
Speaker 1: understanding and like the health industry is that there's a
Speaker 1: biological anatomical difference between them. And for the longest time,
Speaker 1: certainly in this country, trans women would have would be
Speaker 1: compared against the male profiles. But but it's nonsense. It's
Speaker 1: actually should be thought of in form of hormone dominance,
Speaker 1: because the vast majority of medical differences are not anatomical,
Speaker 1: they're hormonal, and and that right there should should give
Speaker 1: the game away, which is really funny, which is why
Speaker 1: it's why I kind of hate the term biological woman
Speaker 1: whenever people start using that, because that's not really how
Speaker 1: biology works. Yeah, I mean that Oak is my my
Speaker 1: nesting partner. My fiancee wishes that she could be a robot,
Speaker 1: and then if she were to do that and upload
Speaker 1: her brain into an immortal robot body. She would no
Speaker 1: longer be a biological woman, but she would still be
Speaker 1: a woman. It's just cybernetic. Um. I hate that. It's
Speaker 1: like organic. Organic just means it has carbon in it. Like,
Speaker 1: give me a break. Yes, so yeah, hormones, what's what's
Speaker 1: what's the deal do they? Because I know all of
Speaker 1: people will be like, well, all of these trends, people
Speaker 1: sure do seem sad. I want that's how how how
Speaker 1: can we make things better? Does this thing actually work? Uh? Well,
Speaker 1: so it's somewhat multifactorial. I have a friend who does
Speaker 1: um sell imaging, and her like working theory, which I'm
Speaker 1: a little dubious of, is that like the brains of
Speaker 1: trans people like have receptors for hormones that the body
Speaker 1: doesn't make, and we should think of being transgender is
Speaker 1: having like a form of hypogonadism. Yeah, there's there's a
Speaker 1: lot of different trains of thought there in terms of
Speaker 1: the different theories of why trends people exist and how
Speaker 1: it's like you know, the girl's brain, boys body, blah
Speaker 1: blah blah blah blah, which all, if you dig deep enough,
Speaker 1: goes back to eugenic. So it's all, yeah, I've always
Speaker 1: not liked that model. I've always it's always I've always
Speaker 1: found it to be a little bit uncomfortable because I
Speaker 1: take hormones because I want to, And I don't think
Speaker 1: it's because my my my brain is like secretly looking
Speaker 1: for girl receptors or something like, right, I totally agree,
Speaker 1: Like it also requires a certain like extremely binary understanding
Speaker 1: of gender, which I also do not ascribe to. So
Speaker 1: it's a very like odd thought. But putting aside all
Speaker 1: of that, if you just wanted to look at the
Speaker 1: like why people want hormones, Because when a person who
Speaker 1: wants hormones gets the hormones they want, their suicidality goes down,
Speaker 1: their anxiety, depression goes down, gender dysphoria, if we wanted to,
Speaker 1: you know, talk about the problems with that, essentially like
Speaker 1: goes away, uh, and they get this to get treated
Speaker 1: like the way they want to be treated in society.
Speaker 1: So from the if if you want to look at it,
Speaker 1: not from like the causes, but from the results, giving
Speaker 1: gender affirming hormone therapy to a person who is requesting
Speaker 1: gender afforming hormone therapy has a success rate. The rate
Speaker 1: of regret from starting hormones is one percent or less,
Speaker 1: which is unbelievable in the health care field, like like
Speaker 1: having a child, like biologically giving birth has a seven
Speaker 1: percent regret rate, Like the idea of any therapy having
Speaker 1: that high of a rate of preventing death, anxiety, depression, bullying,
Speaker 1: like all of the different effects. Being that successful should
Speaker 1: be like a miracle. It should be looked at as
Speaker 1: the thing we in healthcare are like should do absolutely ethically.
Speaker 1: Uh and it it is is so much more complicated
Speaker 1: than that. So like hormones from the results obviously makes sense.
Speaker 1: It aligns your bodies shape and like fat fat deposits
Speaker 1: and the way that you feel, the way that you
Speaker 1: relate to your emotions. It all goes back to the
Speaker 1: way that hormones work on your body. And there's there's
Speaker 1: like the old saying that like assis person would never
Speaker 1: want to try gender forming homerone therapy, So like, if
Speaker 1: you have the in if you want to try it,
Speaker 1: you should be allowed to try it. I mean, like
Speaker 1: you're you're kind of a good example right here, Like yeah,
Speaker 1: but I'm sitting Yeah, if you're sitting around a bar
Speaker 1: with a bunch of like CIS guys and you're like, hey,
Speaker 1: who wants some estrogen? They would all like shrink away
Speaker 1: from it, Like no, absolutely, because yeah, it's definitely a thing.
Speaker 1: Like I'm not the most dysphoric person, but I'm like, sure,
Speaker 1: I'll take estrogen. That sounds fun. That's like, it's like that,
Speaker 1: that sounds like a thing that I could enjoy watching
Speaker 1: my body change. And I'm you know, it's it's I'm
Speaker 1: happy that we're moving more towards that and not having
Speaker 1: to deal with, oh, I'm so dysphoric, i want to die,
Speaker 1: which is obviously they're a big thing for a lot
Speaker 1: of people. I'm not I'm not minimizing that right um.
Speaker 1: But also a lot of trans people have had more
Speaker 1: kind of complicated feelings on gender, whether they're like gender queer,
Speaker 1: non binary. Having the past had made it more difficult
Speaker 1: to get gender firm in care because they don't fit
Speaker 1: into those specific like male female boxes as easily. M Well,
Speaker 1: and what you're talking about is really something that's relatively recent.
Speaker 1: The idea of gender euphoria, like the idea that people
Speaker 1: want to take because it gives them joy to like
Speaker 1: dress or act or feel a certain way, and that
Speaker 1: I mean, health care is all about, at least up
Speaker 1: until well, the reality of health care is that it
Speaker 1: is all about finding problems to solve and not really
Speaker 1: looking at like your life just better in general. Yeah, exactly.
Speaker 1: So you know, I know plenty of people who started
Speaker 1: hormones of any type just because they felt it would
Speaker 1: make them happier, and they were correct, And that gender
Speaker 1: euphoria is just as good of a reason to take
Speaker 1: it as the dysphoria. The problem ends up in how
Speaker 1: the medical industry treats it, because dysphoria quote unquote is
Speaker 1: something that's long. Oh my gosh, I could go into
Speaker 1: the whole history of that if you wanted, but I'm
Speaker 1: sure we could talk about the ds M four and
Speaker 1: five for a long time. Oh it's so frustrating. I
Speaker 1: spend I spend a two hour session in my Queer
Speaker 1: healthcare class, specifically just dunking on the ds M five
Speaker 1: definition of gender dysphoria. Um. But the real problem is,
Speaker 1: like this focus on this negative quality and how that
Speaker 1: actually damages a lot of the conversations around uh, gender
Speaker 1: firming hormone therapy and trans people in general. Like, instead
Speaker 1: of seeing it as like this manifestation of people like
Speaker 1: truly taking control of their lives to become authentic in
Speaker 1: like the truest way, Like you have never met a
Speaker 1: more truly well uh self made man than a transman
Speaker 1: who gets hormones. Like it's I mean it's and it's
Speaker 1: still something where even we're not quite at the at
Speaker 1: the gender utopia, I mean obviously because of all of
Speaker 1: the anti tran stuff, but even even on like just
Speaker 1: purely purely the medical side, like I even for for
Speaker 1: informed consent, um, I still needed to get diagnosed with
Speaker 1: gender dysphoria at the informed Consent clinic in order to
Speaker 1: get hormones, which is in part like an insurance thing,
Speaker 1: and you know it has has all of these all
Speaker 1: of these bullshit reasons. Um, but that is that is
Speaker 1: something we're still we're still definitely dealing with, Oh my goodness. Yeah.
Speaker 1: And the better informed care clinics are the ones that
Speaker 1: they realize it's just like an effort in box ticking.
Speaker 1: So they're just like, Yep, sounds good. You came here
Speaker 1: to this clinic and you asked about hormones. Sounds like
Speaker 1: gender dysphoria to me, Like we'll sell your insurance whatever.
Speaker 1: We gotta say. Yes, eventually we'll go into like hormone
Speaker 1: blockers as well. UM. But I want to talk about
Speaker 1: there's a lot of this. There's a lot of rhetoric
Speaker 1: that's been we're growing for a long long time about
Speaker 1: the extremely damaging, irreversible effects of of hormone replacement therapy um,
Speaker 1: and how they're gonna permanently alter your biology. If you
Speaker 1: give these two children and there's five year olds taking
Speaker 1: testosterone and it's gonna like you're like, You're like, really
Speaker 1: that sounds very scary. UM. So that's something I would
Speaker 1: like to discuss. It's like because a lot of people
Speaker 1: when we when we do we talk talk about hormones,
Speaker 1: they think of it as this like big, extremely life
Speaker 1: altering thing um that has like these you know, irreversible
Speaker 1: effects on your your your bones are gonna get weak
Speaker 1: and trivel to never and never get big again, and
Speaker 1: all of all of this very scary stuff. Um. What's
Speaker 1: up with that? I think a lot of it goes
Speaker 1: back to that biological essentialism, because hormones, even for the
Speaker 1: people who give them, are considered partially like reversible. Because
Speaker 1: the mid majority of the things that happen one take
Speaker 1: a long ass time, like you will know whether or not.
Speaker 1: This is a good idea for the majority of people
Speaker 1: well before the physical manifestations occur. Uh. And and considering
Speaker 1: like one of the biggest problems we have with certain formulations,
Speaker 1: like in the once a week or once every other
Speaker 1: week injectable version of estrogen, By the time you get
Speaker 1: to right before your next dose, your estrogen is so
Speaker 1: low you're feeling it and it's starting to like reverse
Speaker 1: some of those So like, if you're feeling it after
Speaker 1: two weeks, how irreversible could it be? Uh? And some
Speaker 1: of it depends on like eight timing, because if we're
Speaker 1: talking about a person who has say, already gone through
Speaker 1: a testosterone mediated puberty, then some of the things are
Speaker 1: just not going to be affected. You can't change like
Speaker 1: bone size, height or anything like that. There's some interesting
Speaker 1: things about like hip uh, like flexation and and and
Speaker 1: and pivoting and yeah actually yeah and and and even
Speaker 1: like shoe sizes can can change because of the way
Speaker 1: the ligaments work on hormones. But like the bones aren't
Speaker 1: going to change once they're done growing. But that's sort
Speaker 1: of where the puberty blockers come in that we can
Speaker 1: we'll talk about later. Um. But for the for the
Speaker 1: majority of people, if you are going through if you
Speaker 1: have gone through a puberty that you did not want,
Speaker 1: you can take hormones to go through puberty you do
Speaker 1: want and get the effects that you do want. And
Speaker 1: some of the elements sure, like you know, growing breasts
Speaker 1: uh guna coomastia as we would call it, an assist man,
Speaker 1: which is another whole nonsense. Um, is not irreversible, Like
Speaker 1: you can have them removed if you decided that you
Speaker 1: needed to, like de transition, which is a whole another story.
Speaker 1: But even then it takes like five years to see
Speaker 1: their final breast size. Like if you if you're on
Speaker 1: hormones for five years and you're worried about the irreversible
Speaker 1: quote unquote effects, like what are we doing here? I mean?
Speaker 1: And even I've heard from a lot of my elder
Speaker 1: trans friends that whenever they go off hormones sometimes their
Speaker 1: breasts just kind of go away because they're not massive
Speaker 1: to begin with. Like if it's generally generally generally you
Speaker 1: don't get the massive, massive honkers immediately. Um. I know,
Speaker 1: I know we're trying, um, but a lot of a
Speaker 1: lot a lot of even the you know, that was
Speaker 1: one of the big things that informed content thing was like,
Speaker 1: you know, a lot of these changes are reversible except
Speaker 1: for breasts. These are these are these are these are
Speaker 1: permanent change. Be careful and all my transferends are like
Speaker 1: a little bit. But I like, your nipples won't shrink,
Speaker 1: Like your nipples will definitely be bigger, and that that
Speaker 1: won't change. But a lot of like the size actually
Speaker 1: does fluctuate, and I can even tell that on like
Speaker 1: depending on if I like missidos or something, being like
Speaker 1: oh yeah, like there is a lot of a lot
Speaker 1: of fluctuation even like on like you know, like temperature
Speaker 1: and stuff. How cold will determine how how how how
Speaker 1: how my chest looks it is? It is, uh, it's
Speaker 1: pretty fun. I mean, I am I just like the
Speaker 1: bio hacking thing in general. It is like the cyberpunk
Speaker 1: and me um. But yeah, I guess I guess we
Speaker 1: could talk about hormone hormone blockers as well, because this
Speaker 1: is the other kind of thing you hear a lot
Speaker 1: about when conservatives are very scared about transpeople. The idea
Speaker 1: of hormone blockers like making people infertile or making permanent
Speaker 1: changes to children's health or something. Blah blah blah blah blah. Gosh.
Speaker 1: That's the thing that is like really really frustrating for me,
Speaker 1: specifically because puberty blockers, the ganada trope in the g
Speaker 1: n r H antagonist and agonists, which have been around
Speaker 1: for like long time, but like ever for for I
Speaker 1: want to say it was like a hundred years, but
Speaker 1: I might be misquoting something that I'm half remembering, but
Speaker 1: they've been around for like a really long time to
Speaker 1: the point where we have generics and in the in
Speaker 1: the pharmaceutical industry, that means that it's been like decades
Speaker 1: at the very least, something that had rigorous testing that
Speaker 1: has an indication with the FDA for precocious puberty, which
Speaker 1: just means a person who is usually SIS who for
Speaker 1: whatever reason, has puberty at a very young age. With
Speaker 1: some of the some of the specific cases that I've
Speaker 1: seen that I've that I've looked into, um involved giving
Speaker 1: puberty blockers to like a three or four year old
Speaker 1: because their body is trying to undergo puberty. So even
Speaker 1: the idea of like, oh, well, I don't know this
Speaker 1: twelve year old being on a puberty blocker for three years.
Speaker 1: That sounds very dangerous when we have a person over
Speaker 1: here who was on it for fifteen years with no
Speaker 1: ill effects, like like no long lasting ill effects. Um
Speaker 1: that the idea of anybody describing it as like experimental
Speaker 1: is absolutely a historic outside of the realm of reality. Yeah,
Speaker 1: there's it's it's basic anti anti intellectualism, because yeah, we've
Speaker 1: been giving sis children hormone blockers for a long time
Speaker 1: for early onset puberty, and it turns out they work
Speaker 1: and they're pretty safe. So yeah, maybe we should give
Speaker 1: those two trans kids too if they want them. Uh,
Speaker 1: it seems like something we could at least try and
Speaker 1: see if it improves mental health. And then it's it's
Speaker 1: not even a matter that we have to try it.
Speaker 1: We've been doing it for like almost ten years. Like
Speaker 1: the it was first I think it was like two
Speaker 1: thousand thirteen. There's a there's a ted talk I use
Speaker 1: in my class of a of a physician who like
Speaker 1: pioneered the use of puberty blockers in trans kids and
Speaker 1: showed that any trans kid who got puberty blockers and
Speaker 1: then was allowed to undergo the puberty that they desired
Speaker 1: at an appropriate age, which is actually like fourteen fifteen
Speaker 1: at the same time as their peers. UM. But even
Speaker 1: if they had to wait till eighteen, the psychological effects
Speaker 1: of having an in appropriate puberty are essentially nullified. They
Speaker 1: are otherwise psychologically and physically like identical to their their
Speaker 1: CIS gender peers. So it's like we have actual evidence
Speaker 1: that it is extre really beneficial and extremely worthwhile. And
Speaker 1: like the one kind of long term side effect is
Speaker 1: you might be up to an inch shorter than you
Speaker 1: otherwise be, which is a wildly like problematic like study
Speaker 1: that was done because like we don't have time machines
Speaker 1: to know whether or not that work, Like what would
Speaker 1: your control group be? UM, And it's just wild. It's
Speaker 1: very bothersome to me because a lot of the gender
Speaker 1: affirming hormone therapy, the evidence is all over the place
Speaker 1: for a variety of political reasons and and historical reasons.
Speaker 1: But for hormone blockers, or for puberty blockers specifically, the
Speaker 1: evidence is like really solid, really strong. And this is
Speaker 1: the question I actually have because I'm actually unfamiliar with
Speaker 1: this specific thing. But yeah, if you give like um,
Speaker 1: hormone blockers to like a kid who's tend they still
Speaker 1: kind of like grow at the same rate as a
Speaker 1: lot of as a lot of their peers. And then
Speaker 1: is that it just it's it's this specifically like the
Speaker 1: secondary sex characteristic changes that get put on pause. Um,
Speaker 1: but there's just so much Yeah, there's just so much
Speaker 1: fear around the whole. Even even just the hormone blocker
Speaker 1: thing right when we're getting you know, just like prescribing
Speaker 1: hormone blockers being like a felony offense in multiple states.
Speaker 1: Now you're like, it's like, it's it is just an
Speaker 1: extreme degree of anti anti intellectualism, just like just like
Speaker 1: purposeful like ignorance, um and just extreme hatred and uh bigotry,
Speaker 1: and it's it is uh, I mean yeah, it's a
Speaker 1: I'm kind of speaking to the choir here, but but
Speaker 1: but but that's the trick. And and even like the
Speaker 1: purity blocker thing, like you were saying, your body will
Speaker 1: still make human growth hormone, you will still grow, it's
Speaker 1: just that the modulation of that with say testosterone, which
Speaker 1: would increase the overall growth like just doesn't there. And
Speaker 1: people say make a lot of you know, talk a
Speaker 1: lot about the idea of um bone mineral density because
Speaker 1: you don't have testosterone or estrogen, which are both necessary
Speaker 1: one or the other necessary for your like bone mineral
Speaker 1: density to not like have like easily fractured bones, but
Speaker 1: like you don't even have that until you go through puberty.
Speaker 1: If you're just like preventing one puberty, the endogenous puberty,
Speaker 1: and then providing the hormones for an exogenous puberty, they're fine,
Speaker 1: Like they have the hormones they need, their bones are happy.
Speaker 1: Uh So, yeah, I look to talk about I guess
Speaker 1: kind of access to hormones and in like the like
Speaker 1: the different models of of obviously we're not giving up
Speaker 1: medical advice, but like this access to hormones and the
Speaker 1: different ways that people can go about that now through doctors,
Speaker 1: through informed consent um and all of all and all
Speaker 1: of that jazz. Yeah. So the informed consent model is
Speaker 1: a much more recent option, and it's not available everywhere.
Speaker 1: I have a friend in Texas we had to find
Speaker 1: a clinic that was like two hours away to get
Speaker 1: her hormones. But here where I live, we actually have
Speaker 1: to informed consent clinics. So it's pretty convenient, but it
Speaker 1: varies wildly by by region. Uh And the informed carre
Speaker 1: clinics are great. It means you come in, they say,
Speaker 1: this is what's going to happen. Do you still want
Speaker 1: to do it? You say yes, They take some blood,
Speaker 1: they run some tests, you come back in two weeks,
Speaker 1: and they go here. You go like that. That's they
Speaker 1: work really well, depending on the clinic, I guess. And uh,
Speaker 1: but the more traditional quote unquote standard model would be
Speaker 1: going to your PCP or or whoever and saying that
Speaker 1: you want to do this, which makes most of them
Speaker 1: very concerned because most physicians, pharmacist, nurses, they don't get
Speaker 1: taught anything about trans people, are caring for trans people,
Speaker 1: are gender affirming hormon therapy in their school like, so
Speaker 1: they have nothing to fall back on. Uh. So that
Speaker 1: makes them very nervous to do it. And then UH,
Speaker 1: if you if you look at gosh, I really want
Speaker 1: to tell you about the guideline stuff at some point
Speaker 1: here because it is bucked wild um as to why
Speaker 1: that would be a concern. But another part of it
Speaker 1: is is also the insurance. You know, America's original sin
Speaker 1: in our healthcare dystopia, if you will. Uh, the insurances
Speaker 1: historically have required and and part of this is also
Speaker 1: from antiquated guidelines that has been somewhat like just grandfathered
Speaker 1: in to excuse the term. Uh, this idea of like
Speaker 1: we you have to go to a therapist. You can
Speaker 1: go to a psychologist and they have to say that
Speaker 1: you have gender dystoria, that's why it's in the d
Speaker 1: s M. And then after you do that, some places
Speaker 1: require you to socially transition before getting hormones or anything,
Speaker 1: which can be extremely problematic for some individuals. That just
Speaker 1: increases like visibility and bullying and and such in a
Speaker 1: way that it makes drive people. It's it's sort of
Speaker 1: was intentionally required back in the day to drive people
Speaker 1: to not want hormones anymore. And it's all of these
Speaker 1: gate keeping steps. And it's even worse if you wanted
Speaker 1: to get a surgery later on, where you have to
Speaker 1: have been on hormones for a certain length of time,
Speaker 1: you have to have two different generally like susgender right.
Speaker 1: Health care practitioners who don't necessarily understand like the full
Speaker 1: like everything that's going on, write you letters before. The
Speaker 1: most insurances up until recently wouldn't even cover it. So
Speaker 1: it's just gate keeping step after gate keeping step. Because
Speaker 1: even the Big Guidelines, which is w PATH, which is
Speaker 1: about to put out their so gate guidelines. Um, there's
Speaker 1: a guidelines out of San Francisco, and the Endocrine Society
Speaker 1: has guidelines from two seventeen that are but all of
Speaker 1: those are made by cisgender people, usually with the intent
Speaker 1: to gate keep this care because it's either they're uncomfortable
Speaker 1: with it, because they're unfamiliar with it, they have some
Speaker 1: kind of ideological reasons to be against it, or whatever
Speaker 1: whatever else. There's a survey that I often quote to
Speaker 1: my students in class that, Um, they surveyed a whole
Speaker 1: bunch of trans individuals trying to get care from their physicians,
Speaker 1: and it was nearly a quarter of them said that
Speaker 1: they avoided healthcare because of discrimination, and half of them
Speaker 1: reported having to teach their health care practitioner how to
Speaker 1: care for them, which is wild. Like, imagine going to
Speaker 1: the hospital with like heart failure and having to like
Speaker 1: talk your physician through how to care for you. Can
Speaker 1: you can you live for two years with heart failure? First?
Speaker 1: Before we go, Oh my gosh, could you imagine if
Speaker 1: we treated other things this way? I'd be like, well,
Speaker 1: are you sure that you have diabetes? Are you sure
Speaker 1: that you're like, well, we can't treat your diabetes you're
Speaker 1: too fat. Well your b m I is too high,
Speaker 1: so we can't give you the insulin. Like, give me
Speaker 1: a break. What is happening? Uh it seems like Uh,
Speaker 1: basically what you're saying is that we've got a good system.
Speaker 1: We gotta oh, we gotta figure it out. Absolutely no
Speaker 1: notes dent perfect in every way. Well that doesn't for
Speaker 1: us today here. Uh well, specifically if I could, Um,
Speaker 1: it's really interesting from like the healthcare perspective, because from
Speaker 1: you know, the practitioner's perspective, because there's essentially two kinds
Speaker 1: of like treatment. There's guideline based medicine and evidence based medicine,
Speaker 1: and a lot of schools, like my school teaches a
Speaker 1: lot of guideline based medicine, which is for something like
Speaker 1: hypertension or diabetes, is put out by like large organizations
Speaker 1: with a ton of evidence. It is actually like pretty reasonable.
Speaker 1: But that means that if you're going along with what
Speaker 1: they say, that means that you believe that they read
Speaker 1: those studies correctly and that their interpretation is in no
Speaker 1: way compromised by like sources of their income, say, and
Speaker 1: that those guideline is actually match your patients. So it's
Speaker 1: a lot of assumptions that you're making, which can be
Speaker 1: extremely problematic. And evidence based is where you dive into
Speaker 1: literature and you figured it out yourself, which is very
Speaker 1: time consuming and requires an awful lot of like professional uh,
Speaker 1: like you know, criticism in a way. Uh, but when
Speaker 1: you look at it for for trans care, for for
Speaker 1: gender affirming hormone therapy, those guidelines are unbelievably compromised. To
Speaker 1: give you an example, a hotly contested issue in feminizing
Speaker 1: therapy is the use of micronized progesterone in feminizing care. Uh.
Speaker 1: It's kind of like all over the place. There's a
Speaker 1: long history of it, of of this controversy. In the
Speaker 1: upcoming w path socate guidelines that I had like a
Speaker 1: preliminary copy to to provide notes on there, there's a
Speaker 1: single statement that just says that there's a controversy that
Speaker 1: exists and you should not use micronized progesterone and transfeminine care.
Speaker 1: And they list a study. Okay, if you pull up
Speaker 1: that study, the title of it is progesterone is important
Speaker 1: for transgender women's therapy. Applying evidence for the benefits of
Speaker 1: progesterone insists women, and it is like a pretty long
Speaker 1: document that concludes that it is like an ethical imperative
Speaker 1: to offer it. So the idea that the people who
Speaker 1: are writing the w path guidelines read this article, read
Speaker 1: this this like meta analysis and went, yeah, I don't
Speaker 1: really agree with any of that. I'm just gonna say no,
Speaker 1: is just so infuriating. Again, that seems like we've got
Speaker 1: a good system going here. Yeah, no, notes, I guess
Speaker 1: on that note, let's I want to discuss some of
Speaker 1: the some things that are talking about as much as
Speaker 1: like um antiandrogen's, uh, progesterone, spiro and what all kind
Speaker 1: of those do and how they can kind of supplement
Speaker 1: a regular estradial regiment regiment. Yes, that sounds that sounds fancy. Sure, sure,
Speaker 1: So generally speaking, if you're maybe you give a baseline
Speaker 1: for for folks who are unaware. The way that we
Speaker 1: do feminizing therapy is we offer estra dial, which is
Speaker 1: a bioequivalent version of E two, because there's like three
Speaker 1: different versions of estro of estrogen UM and an antiandrogen
Speaker 1: because testosterone tends to be somewhat of an overriding hormone.
Speaker 1: The presence of testosterone will override the effects of estrogen
Speaker 1: to a certain extent depending on doses and stuff like that,
Speaker 1: which is for the transmasculine individuals, why we just give testosterone.
Speaker 1: It just does the job. You don't need to block
Speaker 1: the estrogen. Uh So there's a you know, there's a
Speaker 1: lot of history in just those hormones as well that
Speaker 1: we could talk about, like conjugated estrogens versus estra dial
Speaker 1: and and all the different other stuff. But for the
Speaker 1: antiandrogens that we give historically in this country, we give
Speaker 1: spiron lactone, which is a mineral corticoid. It's a potassium
Speaker 1: sparing diuretic, and it's just really good. At higher levels.
Speaker 1: We usually use it in like cardio issues like it
Speaker 1: can be used for like hypertensions and other things. Um,
Speaker 1: I believe it makes you pee a lot, So it's
Speaker 1: a diuretic meaning that it makes you urinate and awful lot.
Speaker 1: And it's a potassium sparing because it prevents your body
Speaker 1: from eliminating potassium. So uh well, so that is that's
Speaker 1: the thing that I think is really really wild because
Speaker 1: you're using these high levels of it, it is preventing
Speaker 1: your production of your endogenous production of testosterone and making
Speaker 1: you pee all of the time, which spoilers estradial also
Speaker 1: makes you pay more often, So like that's a real
Speaker 1: fun combination. But then physicians, if they don't know what
Speaker 1: the heck they're doing, they might say something like, well,
Speaker 1: you can't eat any bananas, and like, historically the people
Speaker 1: who are on feminizing therapy are healthy enough that their
Speaker 1: body just accommodates for it. And if you have hyper keelmo,
Speaker 1: which is like too much potassium, you're gonna know, like
Speaker 1: your muscles are gonna ache and there's gonna be a
Speaker 1: lot of like telltale side effects. Usually it's only a
Speaker 1: problem if you are like only consuming a like salt
Speaker 1: alternative that has potassium instead of sodium, which is not
Speaker 1: super common not super common, or if you have some
Speaker 1: other reason why your body is like holding onto potassium. Um,
Speaker 1: So it's not usually an issue. Uh, it's an inspiral
Speaker 1: actrone isn't sufficient for everyone. There's plenty of people who
Speaker 1: have like refractory testosterone after some time, and there's some
Speaker 1: other options. Uh, there's kind of a weird controversy about
Speaker 1: it that is sort of heralded by the San Francisco Guidelines.
Speaker 1: I mentioned earlier that spironal actone uh leads to Okay, well,
Speaker 1: I want to make sure I get the wording right.
Speaker 1: It's leads to premature fusing of the breast bud uh
Speaker 1: and overall smaller breast size, which the document that they
Speaker 1: cite for that is a real weird retrospective study from
Speaker 1: like a bunch of years ago on the rate of
Speaker 1: trans women getting breast augmentation, and it found that the
Speaker 1: vast majority of trans women who are on spironal act
Speaker 1: tone got breast agmented getting breast But the problem is,
Speaker 1: like of their sample group of like to people, almost
Speaker 1: all of the moron spur on a lactone. Like there's
Speaker 1: like a sampling error, Like it's not it's very silly. Um.
Speaker 1: And also even like that premature fusing in the breastbed,
Speaker 1: I have never been able to find anything that suggests
Speaker 1: that that's a thing or even like a way to
Speaker 1: explain what that statement even means. But the San Francisco guidelines,
Speaker 1: to go back to the my guideline thing actually says
Speaker 1: has some like maybe don't use spar on lactone even
Speaker 1: though it's something we've been using since literally like the
Speaker 1: fifties or sixties for this purpose. In other countries, you'll
Speaker 1: use what's called cyprotorone, which is a synthetic progesterone, but
Speaker 1: it's not actually approved in the States because it has
Speaker 1: a like there is actually some evidence that it causes
Speaker 1: increase in certain specific cancers, but it's like a pretty
Speaker 1: limited overall risk, Like it's not like something like you know,
Speaker 1: going outside increases your risk of cancer. It's it's not
Speaker 1: like a huge deal, but it was enough that they
Speaker 1: don't it's not approved in the States, but in a
Speaker 1: lot of other countries you'll you might get syprotarone, which
Speaker 1: there's a lot of you know, controversy around that too
Speaker 1: for those reasons. UM Here, the other option that we
Speaker 1: usually see is finasteride, which is a five alpha reductation
Speaker 1: inhibitor that essentially is preventing testosterone from being turned into
Speaker 1: dihydro testosterone, which we use normally for UM to prevent
Speaker 1: quote unquote male pattern boldness and in higher doses for
Speaker 1: prostate cancer because it's real good at because it like
Speaker 1: reverses some of the feedback loops just reducing product testosterone production. UM,
Speaker 1: so it's just fine, like that one has like very
Speaker 1: limited side effects, but it might not have as substantial
Speaker 1: of a UM reduction of testosterone that spiral lactone does. UH.
Speaker 1: And then the kind of third one that we really
Speaker 1: we don't see our often, but there's a lot of
Speaker 1: interesting evidence about is called by cooludamide. It's also a
Speaker 1: prostate cancer medication. It actually blocks all of the receptors
Speaker 1: of testosterone in your body while not reducing the production
Speaker 1: of it. So you'll see a person who has like
Speaker 1: you know, they have like seven hundred their their testosterone
Speaker 1: comes back is like seven six D whatever, but they're
Speaker 1: entirely feminized because none of it has anywhere to work. UM.
Speaker 1: But the problem with that is by colutamide being an
Speaker 1: anti cancer med UH primarily is ridiculously expensive. I think
Speaker 1: it's like fifty bucks a dose or something like here,
Speaker 1: it's so great, uh, I will say, And and for
Speaker 1: my genderqueers out there or anyone anyone else. So we
Speaker 1: can also just take estrogen without any without any blockers UM,
Speaker 1: and you still get results as I can, as I
Speaker 1: can confirm UM, and for a subset of the population,
Speaker 1: just taking estrogen at sufficient dosages will also reduce your
Speaker 1: levels of progester of testosterone, like, it's your body knows
Speaker 1: what it's doing. Is it is? It is? It is
Speaker 1: pretty cool. How but you can just change things up
Speaker 1: in your body is like, oh, we're doing this now, Okay,
Speaker 1: got it great? I have all these mechanisms. It's wonderful.
Speaker 1: And with that, that wraps up part one of our
Speaker 1: little two part series of episodes talking about hormone replacement therapy. Tomorrow,
Speaker 1: I'll talk more about access to gender affirming treatment and
Speaker 1: touch on d I y h R T special thanks
Speaker 1: to Dr Victoria Luna Brennan Grieve for chatting with me
Speaker 1: about gender affirming hormonal treatment. You'll get to hear more
Speaker 1: of my discussion with her tomorrow as well, including a
Speaker 1: brief tangent about the Scythian priestesses, which I was it
Speaker 1: was very, very very excited to talk about, but that
Speaker 1: doesn't for us today. You can follow this show at
Speaker 1: Happen to Hear pod and Cool Zone Media on Twitter
Speaker 1: and Instagram, and you can look at my late night
Speaker 1: gender tweets at Hungry about Ie on or dot com.
Speaker 1: So see you all on the other side.