There was an interview on RNZ’s Nine to Noon programme this morning about why transgender patients are turning to DIY HRT. They had one of the doctors who works on the New Zealand gender-affirming healthcare standards on and her answers were infuriating to say the least. The mental leaps to go “we don’t prescribe injected HRT, therefore we don’t know its safety, therefore we don’t prescribe it” is astonishing, and her lack of acknowledgement of overseas experience just iced the cake.
That said, I decided to write down why injected oestrogen is different to the currently available patches and pills. This post contains maths!
Why?
In a nutshell, bioavailability. This is the term for how much of a medicine you take actually makes it in to your body in an effective form. For example, paracetamol has a bioavailability of 63-89%1. Why the range? Everybody’s different, some people absorb more than others, and some people have a more efficient liver.
So lets look at bioavailability of oestrogen, and I’ll include maths on my levels.
As I’m a software developer I love edge cases… well, when I don’t have to deal with them anyway. Over the years I’ve learnt about the various types of business that exist in New Zealand. It’s a bit esoteric, but interesting to me so I’m going to write about it!
The most common businesses are sole traders - a person, partnerships - several people, and limited liability companies - a legal entity that pretends to be a person until you try to put it in jail. So here are some examples of none of the above!
After my last post I feel it’s a good idea to go over the dangers of doing DIY HRT. I’m sure most people are aware, but it’s one of the things that can’t be overstated. If you’re thinking about DIY then it pays to be aware.
The biggest risk is the product. Without proper certification you have no way of knowing what standards the product is made to, if the ingredients are pure, or if it’s safe to use at all. While they may be as good as licensed pharmaceutical companies you can’t be sure of this and they have no accountability for the product made. Despite what doctors here in New Zealand think, even compounding pharmacies have oversight.
If you have access to a commercial lab you can validate the products, and some people do this, but it’s an expensive option.
Secondly, if you’re taking medication without oversight from a medical professional they may unknowingly prescribe something with a bad interaction. This is unlikely with hormones but it’s definitely a risk.
And finally, it’s illegal, at least here in New Zealand. Possession of prescription medicines without a valid reason (eg a prescription for yourself or your dependant) is an offence, though I’ve never heard of anybody prosecuted for non-controlled substances. Same goes with importing them, though again if it’s not a controlled drug and it’s your first time it probably won’t be severe.
Of course if I do decide to get my own HRT I won’t write about it or where I get it from
Starting my transition journey was pretty easy everything considered, I started later in life and had no (recorded) mental health issues which eliminated a lot of the gate-keeping. It still took four months from telling my doctor I wanted to start HRT to getting it because of Process.
Living in Auckland the main clinic is Auckland Sexual Health Service (ASHS), and as most GPs are not familiar with transgender healthcare they often forward questions to ASHS. ASHS have a very particular view of what transitioning looks like, at least for transfeminine people - you will be binary transgender and aiming for gender-confirmation surgery (even though that’s essentially not available…). If you step outside that box the best you’ll get is “this is our recommended treatment” with no change, the worst is refusal to provide HRT.
Once I started HRT the problems started appearing. It was plain sailing for the first year, I didn’t encounter the problems I hear a lot. I started oestrogen and testosterone blockers at the same time - having no dominant sex hormone is a recipe for depression, and I stepped up to the full dose of oestrogen within a year. I even switched anti-androgens between cyproterone acetate and spironolactone a couple of times before settling on spironolactone without an issue.
I’m going to start a series of blog posts here, hopefully with contributors to show the extent of the problems faced for transgender people in New Zealand. It’s far from the worst place in the world to transition, but we could do so much better.
I intend to cover:
Lack of access to medications with low risk profiles such as bio-identical progesterone.
Refusal to consider injected oestrogen even in the face of shortage of oestrogen patches.
Incorrect dosing of medications with high risk profiles at inappropriate doses, like prescribing 100mg of cyproterone acetate for over a year.
Requiring people to go on extended periods with no sex hormones.
Gatekeeping transition with mental health requirements.
Dismissal of non-binary transition goals.
Extended wait times for consultations.
The lack of medical autonomy granted to transgender people.
After a lot of swearing, grumbling, trial and error this blog is now an activitypub publisher!
So far you can follow and get new post notifications, but replies and anything else aren’t processed (including un-follows…). Next on the list? Maybe. I also need to add an avatar.
When I get replies working I think I’ll integrate them in to the comments if the note is set as public. Non-public replies won’t be shown of course.
And I need to automate the publish runs, right now it’s all manually triggered… And switch to tokio instead of async-std.
Anyway, you can check out the source at https://github.com/sitharus/blog if you want to see how the fediverse works, though I’m sure I’m totally not spec compliant.
Medsafe is New Zealand’s medication regulatory authority. Except in a few cases all the medications on sale in New Zealand, and certainly any you see on shelves or advertised, have Medsafe approval.
This is a very important role - Medsafe ensures medicines meet the quality and efficacy the manufacturers claim, is safe to use in the way the manufacturer has specified, has appropriate guidance for patients and prescribers, and has a secure distribution network.
With the shortage of Estradot I’ve seen quite a few people wondering what all the different ways medication is described in New Zealand actually mean. What is an unapproved medication? What is a special authority? Hopefully I’ll answer that!
This isn’t an exhaustive list, just the ones you’re likely to see.
Yep that’s right! You can now comment and read the posts on mobile! Technology! And still no Javascript!
For those interested the code is on github. I might write some instructions on how to build it, because you need to build the migrations first since the SQL library checks the SQL at compile time.
And yes the resulting binary is 5MB on my x64 machine, but no dependencies! It still runs pretty fast as well.
Now back to writing posts about things other than the blog…