Disclaimer: I’m not a medical professional, but I’ve got familiar with the terms from them. I hope this will help others understand what medical professionals mean.
I’m going to cover two things in this post, what informed consent means in the broader medical context and what it means to transgender healthcare.
I’ve now heard from multiple people that their doctors or endocrinologists have told them laboratory tests for oestrogen levels are either inaccurate or cannot detect exogenous oestrogen, so there’s either no reason to test or no reason to take action based on test results. This always seems to be used to deny increase in hormone doses, but for decreases the blood levels are always trusted. Interesting that…
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!
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.
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:
And what ever else comes my way.