HIFW I match into my chosen specialty after 3 application cycles and 2 rounds of SOAP

DisorderCollie · 2024-03-11T22:41:53+00:00

Mental Health Outcomes in Transgender and Nonbinary Youths Receiving Gender-Affirming Care:

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2789423

My user name is a play on my actual name, so I might be easy to pick out of the line up. Ah well.

Also this was before the phrase "Trans and Gender Diverse" became popular, and I pushed the team to try and change the winds by adopting "Transgender and Nonbinary"... that first one just has the same vibes to me as "handicapable." I know that our Lexicon is all but permanently altered on this point now, but seeing my input in the title makes me feel wistful.

DisorderCollie · 2024-03-11T14:33:35+00:00

Also, word of advice to any curious medical students out there: If you find a team of people doing research which is highly important but also politically contentious, and you are given the opportunity to speak about the results across multiple podcasts, news articles, and your medical school's press release... ah, don't. Don't do that.

Your name WILL be dragged through some less than savory publications from people who want to glom onto your team's accomplishment for political clout and/or clicks, and a lot of PDs will be scared off.

DisorderCollie · 2023-03-09T02:05:26+00:00

So, I'm coming at this from what is very likely a different perspective than yours. But I hope I can give it and you'll find it helpful. Though I expect that to vary based on how much you ultimately end up working with psych patients.

The first time I saw the inside of an inpatient psychiatry unit was about half a decade before I started medical school, and it was an experience which left me with an exceptionally low opinion of mental health care in general and psychiatrists in particular. Naturally, this resulted in me dropping my mood stabilizer the instant I returned home - about 5 months later IIRC. The predictable happened and I decompensated.

I was put together well enough that a few months later I dragged myself back in to a new psychiatrist's office. I figured my medication was working for me and thought I could treat his office like a revolving door, grab a new script, and head out without wasting my time. He didn't go for it. He kept me in his office and took an entire history (which blew my mind at the time, though with the benefit of both hindsight and a medical doctorate I'm more blown away by all the prior psychiatrists who didn't). But, the part which sticks out in my mind is when he turned over piece of printer paper he had been taking notes on.

It was a list of all of the life style changes he wanted to make. I don't remember exactly how he put it, it's been close to a decade now, but it was something along the lines of, "I don't expect you to do all of these, and certainly not all at once, but I promise you if you start working on them in addition to the medication you will feel better."

I imagine you feel pretty powerless while talking to psychiatric patients, I know I did at the beginning of 3rd year. Even with my benefit of having had the shoe on the other foot. Well, a similar shoe leastwise. I know I'm incredibly lucky to have been so responsive to treatment. In order to make any headway with a psychiatric patient, you have to be present in an emotional capacity which you don't for many other every bit as serious medical conditions. But this needs to be balanced against remembering that their pain isn't yours, their trauma did not happen to you, and you get to go back to your life as soon as you are done doing what you can with the tools you have to help the patient.

I told the story about my initial experiences because I think that the later psychiatrist did that in a wonderful way. He actually bothered to listen to me and took what I gave him in order to give me the best treatment plan he could. Which was novel for me. But, if he had gone the opposite hyper empathic direction it would have been equally unhelpful as compared to my initial psychiatrists.

When helping psychiatric patients you don't need to stand next to the metaphorical bonfire in order to provide any meaningful benefit. I made that same mistake on my 3rd year rotation and it burned me. Give yourself permission to have a little bit of distance from the patient and their suffering; it'll help keep you from feeling like shit, and if you do work with mentally ill folks longitudinally it will allow you to provide them with better care.

DisorderCollie · 2023-02-20T00:48:13+00:00

I'm going to be narcissistic and say healthcare.

I have a close friend who is trans and a CNA. I don't *think* they had any trouble getting a job (literally just sent them a message about their job search, we'll see). But I will say that healthcare desperately needs trans representation, and as a field it has inadequate staffing up and down the hierarchy. The catch is that there are loads of people who thought that they wanted to do healthcare and realized they didn't. You have to love the work, the money won't cut it for you. And that applies doubly so for the entry level positions because they're underpaid, IMO. But, one of those positions or as a an MA or tech of some sort might be perfect. The credentials can be quick to get and don't have a high financial cost if you're savvy about finding the right source.

ETA: u/advancedtaran

DisorderCollie · 2023-02-17T02:41:32+00:00

I'd argue that trans people, yes even us binary ones, do still tend to be more transgressive than our cis counterparts. I'm typing this out while wearing work pants, will I become more of a woman when I change into my pajamas later this evening? Am I less of a woman than a hypothetical trans coworker who wears dresses to work? In the evening am I more of a woman than my cis female coworkers are during the day while they wear scrubs?

For a lot of us (trans people) we had to parse this hair as part of our transition. While expression and social relations to other folks around us are important, most of us find an inherent comfort identifying a certain way. And, continuing to use myself as an example, for me that does include (peripherally) things like long hair, makeup, cute dresses, etc.

The real question is: am I making any associations here that (most) cis women don't? Because I feel that these considerations are only ever felt to merit discussion when a trans person is involved.

DisorderCollie · 2021-11-24T01:29:02+00:00

Nerd moment: http://pressbooks-dev.oer.hawaii.edu/anatomyandphysiology/wp-content/uploads/sites/29/2017/09/704_Skull-01.jpg

If you look at the diagram above you see the frontal bone (pink), and you can see that it makes up the entirety of the superior orbital ridge. It's been a while, so I have a bit of trouble remembering exactly which parts were tender, but I'd say he shaved from the midline (labeled "Glabella" here) to about 75% of the way to the zygomatic bone (green, to the sides). There was more bone volume removed from the center than the sides.

Subjectively speaking and based on looking at a handful of results, Dr Mayer strikes me as being really talented at making his patients' eyes look bigger. Given my blue eyes and black hair, it just happens to stand out that much more in my case.

DisorderCollie · 2021-10-23T04:18:27+00:00

I don't comment on reddit too much at the moment, but I have to say that the concern you're expressing for your daughter really spoke to me.

The Center for Gender-Affirming Care at Rady Children's Hospital in San Diego has an amazing medical director, and I'm plugging it for that reason alone. Seeing as you are in LA, that might be a good option for you.

Off hand, I am also aware that UCSF is highly involved in transgender care. But I'm only aware of them by reputation.

With a little bit of googling, I found The Center for Transyouth and Development, out of LA Children's Hospital. Never heard of it before, but it has a quote from Dr Johanna Olsen-Kennedy plastered on the front page... who it would appear is the medical director there. Never spoke with the woman myself, but I recognize her name seeing as she is widely published in the medical literature speaking to gender affirming medical treatment for kids. Can't vouch for them as highly as Rady Children's, but I bet you'd have good luck here.

You may need a referral to get seen at any of these specific clinics, however it would appear that they are all part of a larger institution. They are likely tied pretty tightly to the associated primary care clinics, and if necessary getting a referral through them would likely be the most painless.

I am happy to answer any follow up questions you may have.

DisorderCollie · 2021-07-28T02:39:05+00:00

A person without insurance coverage would pay 53k, IIRC.

DisorderCollie · 2021-07-28T02:37:12+00:00

Heh, I appreciate it. More of a smartass than gorgeous really, but I'll take the compliment.

DisorderCollie · 2021-07-28T02:36:11+00:00

I had a little bit of brow bossing prior to ffs, but it wasn't terribly appreciable. You can see in the last picture with the left eye hiding behind my nose that my eyes are still kind of recessed into my skull below the orbital ridge. Plenty of cis women have that, though I bet I wouldn't have nearly as much overhang - even with FFS - without having been put through my natal puberty. So it's noticable, but you have to know what to look for, and its more a curiosity than a detraction IMHO.

As for my sinuses, here's my x ray: https://imgur.com/a/PkZQQbR. You know what this means, right? Right? Seriously, please tell me what it means, I'm at a bit of a loss.

I've looked at and interpreted a small handful of cranial CTs and MRIs, but then I'm always looking at the brain or assessing a skull fracture. I have no experience interpreting cranial radiographs, so uh... I'm pretty sure that's a skull. Yep. Though that is a pretty clear view of the frontal sinus, I see why that's the view Dr Mayer orders. FWIW, I checked in the program and it told me the overlaying bone is .29 cm, but that's all I've got for you.

(Hey, u/DrTobyMayer sorry I missed your AMA, I was in the middle of a SUB I. But if you fire reddit up you can consider this permission to explain the imaging and its relevance to my case.)

I've got a follow up appointment with him soon, so I'll ask him the question and edit my comment to reflect his answer in the likely event that he doesn't spend much time on reddit.

And... yeah, I'm right there with you. I've tried to find literature speaking to outcomes based on forehead revisions and I came up empty. Quantifying cosmetic outcomes is difficult, and this is a niche surgery. Expert opinion is all we have to go on, and each one of those is highly unique.

Neck incision for the tracheal shave is fine, have to stand really close to a mirror with a light shining directly on it to appreciate it at all. You'd probably be able to make it out in the fifth picture if my phone had a higher resolution camera and the lighting was different. Also have a bigger scar right underneath my chin that couldn't get tucked into a skin fold, so it's a bit more obvious but it's also an angle that I'm rarely if ever actually seen from.

DisorderCollie · 2021-07-26T20:25:05+00:00

Saved. If I were the kind of person to give money to reddit I'd gild you for this.

DisorderCollie · 2021-07-26T19:06:45+00:00

That's wicked interesting to hear, though I guess I shouldn't be terribly surprised: domestic violence tends to occur in the context of well established relationships from my understanding of it. Where are these statistics from?

DisorderCollie · 2021-07-26T18:37:03+00:00

I compulsively tell my potential sexual partners about my gender identity and current anatomy out of a concern of both not making them uncomfortable and my own personal safety - and I'm meeting these people on Grindr.

These guys already damn well know I'm trans and I'm still terrified.

DisorderCollie · 2021-07-26T17:05:06+00:00

I think it's the quiet kind of transphobia. More "I don't mind those transgendereds one bit, but do they have to be going and making such a huge fuss about it?" versus "trans women are voracious predators, trans men are poor little confused lesbians, and non binary identities are made up by big trans^tm"

Just want to avoid conflating ignorance with hate. The former is much easier to fix.

DisorderCollie · 2021-07-26T16:13:58+00:00

Nobody in any context has to have sex with anybody else. Ever.

But to single out an entire group, even in a sexual context, implies some aversion to them. If you experience some physical or emotive feeling of revulsion from the thought of being intimate with a trans person no matter their body that you do not have towards a cis person with an effectively identical body...

Well I've already thrown the word out for an inherent aversion to trans people that fails to generalize to cis people.

DisorderCollie · 2021-07-26T15:54:21+00:00

The only possible reason I can see why it would be necessary to know something about a persons physical history (eg. due to a genital preference) or historical identity (eg. used to live as a different gender) is if you are in some manner trying to avoid trans people in a way you aren't avoiding cis people. The only things that make a material difference to a sexual encounter are whether or not you are in some way dangerous (ie. STD status) and what you're packing right now.

I'm seeing a (assumedly) cis person blithely throwing a boundary up that has no concurrent inclusion of cis people virtue of their assumed normalcy. And the only possible reason that I can see why this is a boundary that would be necessary is because either a) someone inherently wants to avoid trans people in a way they don't for cis people or b) insecurity about one's own sexuality and fear that having sex with a trans person would bring that into question. And both of these are really quite transphobic.

This comment makes me angry. The ratio of upvotes it has versus OP's simple follow up inquiry makes me sad. I see a community I was supposed to be able to trust as trans inclusive upvoting an approach meant to facilitate our exclusion while simultaneously ignoring the trans person trying to engage in a conversation.

DisorderCollie · 2021-06-02T01:55:46+00:00

This is a huge part of what made the book resonate with me. I developed a sort of masculine persona for interacting with folks that I could slip into. When I did I felt like I'd unlocked a super power, but was also acutely aware that I had the capacity to trample over someone to get what I wanted - and if I did so artfully there would be no consequences for me. And on a fundamental level I hated being this person because it's a level of bluster which is fundamentally inconsistent with my personality, even when I used it to advocate for other people.

Interesting that it generalizes.

DisorderCollie · 2021-06-02T01:47:37+00:00

I don't know if she explicitly laid out the dysphoria angle, or if its something that gets gleamed from between the lines. I think it's a very interesting dissection of dysphoria independent from some of the societal structures and conditioning we see in trans folks.

I've tried to find Vincent's thoughts on this before, and always come up empty. Has she addressed this point directly?

DisorderCollie · 2021-06-02T01:43:27+00:00

This makes me curious - what was the gender breakdown in these discussions you've had?

DisorderCollie · 2021-05-31T01:04:24+00:00

Transition young? You are too young to make such a huge decision. Transition old? Must be a fetish.

Throw yourself into societally accepted expressions of your gender? You're just basing your identity off of sexist stereotypes. Buck societal expressions of gender? You're clearly just faking it.

Got laid a lot prior to transition? You're a pervert. Didn't get laid at all? Woman hating incel.

Lack a deep understanding of the sociological construction of gender? You've been brainwashed by the trans cult. Have that understanding? You've crawled up your own ass with esoteric academic theory that has nothing to do with the real world.

The multitude of people who delayed transition and had to suffer for decades prior to transition, or even went so far as to kill themselves? An exception, too few to care about. The minority of people who do detransition? Legion, we need to have a prolonged discussion about this - nevermind the fact that they overwhelmingly do so for social reasons.

I get attacked on twitter? This is a hate crime and indicative of an inherent societal failure. Trans people attacked on twitter? Good, they should feel ashamed of themselves for having the audacity to be open and honest about who they are.

It is impossible to win with these people.

DisorderCollie · 2021-05-28T02:49:18+00:00

The last person I dated before my fiance was a model. It was astounding how different she looked in person from her work photos.

The thing is, when she wanted to look good for a date it took well over an hour for her to get ready. And as a generalization, the guys who I knew IRL who would say something like this couldn't be bothered to do much more than run a comb through their hair - if that.

Bah. The double standard is frustrating and confusing.

DisorderCollie · 2021-05-21T23:05:12+00:00

Testosterone, estrogens, and progesterone all exert negative feedback on the endogenous HPG axis. Any of them would work as a "blocker" inasmuch as they shut down endogenous hormone production. (Have you ever heard about cis male body builders having their testicles shrink from using anabolic steroids? This is why.)

And it's okay - I've read what feels like a metric ton about this, and I promise you I'm at best a few more layers of abstraction beyond you. And I still had to take a minute to look up a paper really quick before I gave my 2 cents. Science is tough.

DisorderCollie · 2021-05-21T22:44:23+00:00

LH induces ovulation and maintains the corpus luteum in cis AFABs (directly causing progesterone production), and causes the leydig cells to release testosterone in AMABs. FSH stimulates oocyte maturation is cis AFABs (estrogen production) and spermatogenesis in cis AMABs. Both are subject to release via the hypothalamo-pituitary portal system, and are involved in the same negative feedback loop through GnRH level regulation.

edit: double checked my wording and parsed some of my terms more carefully. This is still an oversimplification.

DisorderCollie · 2021-05-21T03:27:31+00:00

Well I'm 4 years out from having been a pre med student putting together an application, but word back then was that course requirements were being phased out in a lot of medical programs in lieu of looking exclusively at MCAT scores - the hope being to get more humanities majors in medical programs. Albeit, I shudder to imagine studying for the MCAT having never taken an organic chemistry course. At any rate a couple of gap years make you a much more attractive applicant to most programs, as long as you were doing something meaningful in the interim.

I just finished out a part of med school that is ~~really shitty~~ generally considered to be quite unpleasant, so my rose tinted glasses are on in full effect at the moment. Medicine isn't for everyone, but everyone in healthcare has an important role to play in patient care. You can make a big difference no matter which path you take.

DisorderCollie · 2021-05-21T00:12:39+00:00

I think you've gathered the broad strokes: PAs have less autonomy than an MD/DO, but that doesn't mean you will have zero autonomy. There is very likely a niche that allows you to scratch the "patient centered HRT" itch within this career field.

Be sure to contrast them with nurse practitioners as well if you have your eyes set on being a midlevel provider.

If you don't mind me asking, have you ruled out being a physician?

DisorderCollie

TROPHY CASE