Icon from a picrew by grgikau. Call me Tir or Julian. 37. He/They. Queer. Twitter: @tirlaeyn. ao3: tirlaeyn. 18+ Only. Star Trek. Sandman. IwtV. OMFD. Definitionless in this Strict Atmosphere.
Trans Missourians on HRT, call your doctor as soon as possible and get a 90-day supply or as much as they’ll give you.
Lots of us are going to have to relocate or go through costly and/or illegal channels to acquire HRT now.
I invite trans people in MO to add their payment links this post. We desperately need support. We need people to give a shit right now. This is life-or-death for many of us.
Trans Missourians on HRT, call your doctor as soon as possible and get a 90-day supply or as much as they’ll give you.
Lots of us are going to have to relocate or go through costly and/or illegal channels to acquire HRT now.
I invite trans people in MO to add their payment links this post. We desperately need support. We need people to give a shit right now. This is life-or-death for many of us.
[Image ID: A drawing of a fat person pulling up a sweater to show off top surgery scars. The sweater has a trans flag on it. He has short spiked hair, and stretch marks on his stomach and thighs. He wears boxers. There are wavy trans flags surrounding him, and the text to his right reads “Fat people deserve trans healthcare.” His facial expression is enthusiastic and happy. /.End ID]
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Please remember that fat trans folks experience increased medical discrimination and decreased access to life-saving medical transition.
It’s very common for surgeons to have upper weight limits measured by BMI (body mass index), an outdated and bigoted system that many healthcare professionals have spoken out against as flawed and medically inaccurate.
Doctors often cite potential weight gain as a reason to deny trans people HRT (hormone replacement therapy.)
It is also common for trans people to be asked to lose weight prior to surgery. This is dehumanizing and abusive to the patients.
Fat trans people are often silenced in discussions of their own health. They are exposed to higher rates of medical abuse, inappropriate medical conduct, and bigoted medicine practices.
Fat trans people are often unsafe and unable to advocate for themselves in medical settings.
Furthermore, finding medical professionals who will work with you instead of on you is time-consuming, draining, and costly, on top of the preexisting difficulties of transition.
Advocate for and protect your fat trans friends, particularly your fat trans friends of color, and help prevent medical abuse. Having an ally in a doctor’s appointment can be the difference between access to life-saving healthcare and a note to lose weight.
In short, remember to help fat queers where you can, and especially those in the medical field, challenge your colleagues when they reinforce fatphobia. It can be the difference between life and death for a patient.
Parents with fat children, speak up for them. You might not remember it, but your kids can recall each and every time their doctor noted their BMI and you didn’t say anything.
would people be interested in a post about DIY hrt from a harm reduction perspective
okay fabulous i love being trans and love harm reduction so this is great. usual disclaimer that this is not medical or legal advice. this is drawn from my own + community experiences plus internal resources from the org I work with.
DIY HRT and Harm reduction
Most important things to know: DIY HRT is one possible way to access hormones, and there are safer and riskier ways to DIY HRT. In the context of increasing transphobic legislation in the US, I think it’s important that people know their options and can discuss this without having to deal with our community putting moral judgments onto DIY HRT. I’m not going to spend a bunch of time getting into super specific information about dosage, methods of HRT, or where to find HRT, because a ton of that information is on this website which I highly recommend! Instead I’m going to be focusing on how to make informed decisions about DIY HRT and how to understand the risks.
Source Safety
When getting HRT without a prescription, it’s important to consider the reliability and safety of your source. When at all possible, finding a healthcare provider who will provide HRT under the table is a good way to ensure that what you’re getting is actually legitimate HRT. The next safest option is buying from a legitimate online pharmacy that provides pharmaceutical-grade hormones. This is where research + community knowledge comes in. Reading reviews, talking to other trans people, or buying from known sources in your community is a way to help reduce the risk of getting a product that is not legitimate HRT. When buying without a prescription, there is always some risk that what you are getting includes other chemicals, is for veterinary use, or has other contaminants. Checking your hormones before usage for anything odd, like bits floating in the liquid instead of pure liquid, for example, can be a good way to reduce risk. Overall, it’s important to know that there are some risks involved with how you source your hormones, which is why talking to community members, reading reviews, and learning about trusted sites + people can be an important step for safer sourcing.
Injection Safety
If injecting your hormones, it’s super important to know safe injection practices, especially if you have challenges accessing a consistent needle supply.
Do your shots in a clean, sanitized environment. Wash your hands and use alcohol swabs on your hormone vial, your injection site
Avoid sharing needles with anyone else. Sharing needles puts you at a higher risk of acquiring HIV, HEP C, and other bloodborne illnesses.
Avoid reusing your own needles if possible, as it increases infection risk.
If you must reuse or share needles and have no other options, clean needles with bleach first! Check out this handout for more info. To access free needles and syringes, check out this directory of harm reduction organizations that provide needle exchange services.
Legal Safety
Estrogen, spironolactone, and other anti-androgens are not controlled substances. They are legal to buy online in the United States.
Due to the absolute bullshit that is the Controlled Substances Act and the War on Drugs, Testosterone is considered a Schedule III substance. This means that it is illegal to buy and sell testosterone without a prescription in the United States. Realistically though, the risk of conviction for possession in a DIY HRT situation is currently incredibly low. A study following Anabolic Steroid Cases in US district courts from 2013-2017 found that there were only 63 cases in those 5 years, and that most cases were for selling steroids online or in the context of other criminalized substance convictions. (Decrim now for all drugs, including testosterone-check out this resource to learn more about decrim)
So, what that means is that the legal risk for buying DIY testosterone is relatively quite low, but it is still good practice to be intentional and considerate about what information you share publically, especially if you live in a state with gender-affirming care bans. To reduce risk, it can help to share information privately among trans circles, not admit DIY HRT use to any law enforcement, and not bring unprescribed testosterone through security checkpoints on planes, for example. We don’t really know how new transphobic laws are going to affect prosecution right now, so it’s good to be cautious without fearmongering or overexaggerating risk.
Miscellaneous
Regular blood testing is a good way to keep an eye out for any medical complications and also adjust dosage when needed. For intersex people, much of the available information online about DIY HRT is likely relevant to us, although we might have some additional needs or concerns. There isn’t any widely available data that really explores what gender-affirming HRT looks like for us, but anecdotal community evidence suggests that we usually get all the same effects, but will often experience a different timeline than dyadic trans people. Depending on our variation, we might need a lower dose than dyadic trans people because of our existing hormone levels. Blood tests can help track our levels and signify to us if our dosage is too high and our testosterone is converting to estrogen, for example. When doing DIY HRT as an intersex person, it can be important to research the other medications we might be on and understand the role they play. If we are already on an anti-androgen medication, that’s really important info to know before adding more HRT.
Overall I want to link this harm reduction guide specifically for HRT, and just affirm that DIY HRT has a long history in trans communities, and that this is something we have always done. HRT is absolutely not a necessity to be valid as a trans person and there are so many ways to exist as trans. However, it’s important for us to acknowledge that DIY HRT is a method of HRT that can sometimes be more accessible for us, and that it’s important for us to have access to accurate information that helps us make decisions about what’s right for us. hormones are fun and fabulous and i support trans people getting them in whatever way works for us!
reblogging so the actual post shows up in the notes even with the links :D
Trans pro tip: if a form asks for your sex assigned at birth, unless it is trying to determine when you next need a Pap smear or prostate exam, what it’s really asking is legal sex (what is listed on your ID or health insurance card).
Today if I had put female (my sex assigned at birth) on a form, my insurance would not have covered my flu shot (because as far as my insurance knows, I’m male).
I used to work in primary care- a form accurately asking for gender information will have 3 questions:
What was your sex assigned at birth? (Important to consider if lining up health maintenance such as Pap smears/prostate exam/mammograms, which they would need to at least ask about even if you’ve had these removed)
What gender do you identify as (or what pronouns do you use)? (Important for referring to you appropriate)
What is your current legal sex? (Important for billing and coding).
Reminder [UK]: your GP is REQUIRED to refer you onto a gender identity clinic if you ask them to. They may try to refuse a referral - but it is not up to them. They do not get to decide who is ‘trans enough’ to be referred. The system is broken enough as it is - do not let your GP refuse you at the first hurdle.
If your GP refuses a referral:
1) Ask them to officially note the refusal in your file so that they cannot deny that they refused a referral later.
2) Talk to the practice manager - point out that it is a requirement that they refer you.
3) Speak to PALS.
Finally, once they do agree to refer you - chase up on it. A reluctant GP may ‘lose’ or ‘forget’ your referral. Don’t sit for 6 months thinking that a referral has gone through when your GP hasn’t ‘gotten around’ to it yet. Chase weekly.Advocate for yourself. Sometimes being a (polite, but firm) nuisance is the only way to get things done.
I’d appreciate if you could share to make sure this gets seen by people who need to see it.
Comic about trans men in the health care system I made for
magazine Ottar last autumn! Please note that it presents a Swedish perspective unless stated otherwise, as it is mostly based on Swedish studies. I would however argue that it has implications on the state of healthcare for trans people in other places as well. Thank you so much Hedvig for translating this!
Anonymous:
Trans women who have had surgery still need to visit the urologist, not the gynecologist, because the former is familiar with our surgeries and the latter is not. You need to stop lying and spreading misinformation which could get someone killed.
Wow, everything you said is completely wrong. So it’s very funny that you think my ‘misinformation’ is going to 'get someone killed’. That hyperbole is fear mongering and also that’s just a really aggressive way to speak to a complete stranger. Especially to accuse me of 'lying’.
So let me clear up your misunderstandings.
Firstly, urologist specialize in the urinary system, which include the bladder and kidneys and also the uterus. They aren’t like the male version of gynecologists. For example, urologist treat organ prolapse, where the bladder, uterus, or colon “fall” into the vagina, or will treat fistulas, especially bladder fistulas. (Which is a hole connecting the bladder and vagina.)
Secondly, Vaginoplasties are preformed by reconstructivesurgeons not urologist or gynecologist in the vast, vast majority of cases. Also, vaginoplasties are not a trans specific surgery. Severe vaginal injuries, such as those caused by childbirth or disease, are also treated with a vaginoplasty.
It’s laughable any ol’ off the shelf urologist is “familiar” with the surgery. Plenty of doctors still refuse to preform even the simplest trans-specific healthcare 'because it’s not a usual part of their practice they are comfortable preforming’ let alone complex reconstructive surgery.
But my original comment wasn’t about vaginoplasties, it was about checking the cervix for cancer.
So, thirdly, trans women aren’t the only women with neo-cervixies. In addition to the above, people who have undergone hysterectomies of one kind or another often have a neo-cervix as well. Or, for example, if someone has cervical cancer, and needs their cervix removed, they give that person another cervix.
Because the cervix is a very important part of that set of anatomy. It keeps the uterus and other organs from prolapsing (just falling out) and is also something of a barrier that keeps junk out of the uterus. And if you don’t have a uterus, it keeps junk out of the abdominal cavity.
The procedure to check a cervix for cancer is the same regardless of if its a neo-cervix or a cervix-cervix.
Meaning, gynecologist are also familiar with the cervix aspect of a vaginoplasty. As well as the rest of the vaginoplasty. Because they treat people who’ve had vaginoplasties. So, you know, it’s perfectly normal to go see a gynecologist to have your vagina looked at.
A basic pap smear is actually simple enough it can be done with an at home kit (though if anything needs to be biopsied they’ll need you in the stirrups for that).
So uh, recommending you see a gynecologist for a vaginal specific issue isn’t horribly dangerous misinformation, it isn’t even misinformation. It’s a perfectly normal thing to do.
If a surgeon made you a vagina, that surgeon should tell you what vagina problems to look out for, what health screening you need, and what specialists you should have preform those tests for you. They’ll also likely be able to refer you to someone trans friendly if needed.
Getting an at home pap smear test from a general practitioner is not a big deal. There’s no need to see a urologist for that. If you need your neo-cervix biopsied there’s no reason not to go see a gynocologist since trans women aren’t the only ones with neo cervix.
And also most urologist offices aren’t going to have speculums and stirrups.
Trans health care is not some big secret only select medical disciplines are let in on.
A general practitioner can prescribe hormones and keep you up to date on the tests you need for that. A plastic surgeon with experience is going to preform the surgeries, MtF or FtM. A general practitioner can send you home with a pap smear kit, or preform one in the office, even. A gynecologist can look at your vagina, because it’s not a special or trans exclusive vagina. A urologist can look at a urinary tract or bladder infection or what have you.
Acting like trans health care is some super secret complicated thing is transphobic. That’s something transphobic doctors say as an excuse not to treat trans people.
A friend of mine had a complication develop after surgery and needed a local urologist to fix it. The long term fix was surgical, but the urologist could have drained the painful mass that developed while she traveled to see her surgeon. But he refused. So did the doctors at the Emergency Room.
So she got to enjoy a very painful very long very bumpy bus ride from her rural college to the city where her surgeon was so he could take care of it for her.
YOU’RE the one who needs to 'stop lying and spreading misinformation’ because your misinformation perpetuates the excuse transphobic doctors use to avoid treating trans people at all.
It is not a trans need to have a painful surgical complication corrected and it is not complicated to drain an abscess. But that doctor refused her, not because the abscess was caused by an unfamiliar surgery, but because she required that surgery because she was trans.
You are telling trans people that our medical needs are complex and overwhelming and scary. That’s discouraging. And it’s just not true.
Urologist don’t have exclusive rights to vaginoplasties. Urologist aren’t extra familiar with trans women’s health needs. The cervix isn’t part of the Urologist’s specialty.
Calm down. Going to see a gynecologist for a pap smear isn’t going to kill anyone. And the gynecology field as a whole is making an effort to be more welcoming to trans women because it’s perfectly normal for trans women to see a gynecologist.
Please also note (for trans people who aren’t in the USA, and therefore aren’t dealing with the USA’s nonsensical “see specialists for every single thing” system) in many countries Pap smears are able to be performed by General Practitioners (GPs) - or in other words, the normal doctor you go to for all your other routine health checks.
If you have questions about your healthcare as a transgender person, probably the best person to start talking with is your regular GP.
your primary care doctor can do a lot of basic maintenance here in the US, too. My PCP handles almost all the routine stuff - my HRT, annual or quarterly testing for various maintenance things… I go to the dermatologist for an annual check-in, I go to the hospital for a mammogram since I’m over 40, but pretty much everything else is my primary care provider.
Y’all in the notes please be mindful when you say stuff like “it’s time to kill the British.” The people suffering the most from British transphobia are….British trans people.
^^^^^ for serious. British trans folks rarely get to transition at all, and when they don’t they’re often denied any social transition period. TERFs in the UK aren’t here to start laws against people in America, they’re trying and succeeding to kill off trans people in the UK. This really isn’t the situation to cram on the brits to look and feel better about yourself… the trans body count is tremendous over there. Please have some respect for the people actually effected.
Please do keep this in mind. As much as I find the anti-British memes funny, this is a genuine issue in the UK.
I’m a trans man in the UK, I’ve been on the waiting list to be diagnosed for just over 2 years now, and am expected to wait around another 2 years before I get my first appointment (if the wait time doesn’t increase). I will then wait around 2 more years (at the very least) for my second appointment, and if I’m very lucky and am diagnosed in that appointment (which is not guaranteed in the slightest), I’ll enter another waiting list to access healthcare. The service I’m in is considered around average. There are people waiting 6 years for their first appointment in other services, so I am incredibly lucky with my supportive family (in that I haven’t been kicked out or abused, parents still don’t respect pronouns or name) and I have good friends who respect me, as well as only waiting 4 years for a first appointment.
Maybe you could go private if you had the money, right? Go a similar route to trans people in the US? A diagnosis from a private practice can be rejected by your General Practitioner, and any referral you get for hormones or surgery can be completely dismissed, because you weren’t diagnosed by an NHS practice. You would likely have to go entirely private, which is not possible for thousands of trans people who rely on the NHS. This is an issue within the NHS and a completely lack of funding and training for trans healthcare, resulting in horrifically long wait time and difficult to access help, especially given doctors and surgeons have and are having their practices shut down because they aren’t considered proper by the NHS, despite being one of very very few who commit to this kind of work.
The transphobia in the UK runs far deeper than just tweets, and combining the aggressively transphobic attitude of a large portion of the population with the lack of healthcare due to wait times and difficulties with funding, you set up an incredibly difficult and dangerous position for trans people. Maybe this sounds like a bunch of complaints and nothing to people in the US, but people here are dying as a result of this. Please do keep this in mind when making anti-UK memes surrounding specifically transphobia.
also, our wait times for HRT have gone up to 6 years through the NHS.
^ a clarification, the state of trans healthcare is far more down to how the process is set up than funding. I had an entire appointment where they only asked me about my dead dads. I’ve had another being interrogated on my hobbies. One appointment was an hour of me being told to get a job.
Aside from totally wasting resources, clinics are also required to make trans people jump through unnecessary hoops and frequently add their own restrictions like “making nb people wait an additional 6 months” or “not allowing parents to transition”. Looking like you havent medically transitioned will also get you turned down for medically transitioning, as will making any attempt to medically transition without their approval. Some clinics require you to be in work, some require you to not have sex or relationships, some require you to have sex and relationships. I went to one clinic where the fact that I wore clothes from the men’s section was used as evidence that I am not transmasc. And god forbid you be ok with the fact that T will give you body hair, that just means you arent taling it seriously.
Honestly I have little doubt saying that their IS enough funding if the NHS moved to an informed consent model and that wait lists would drop to a few months. As it is people are just wasting time and money to be told no and then we jump on to the next waiting list so everyone else just starting out has to wait longer.
This has never been about money, it is about hurting and controlling us.
