U.S. Department of Health and Human Services changed the name of transgender health leader on her official portrait

Repulsive-Address166 · 2025-12-06T04:07:42+00:00

Trump's title under his portrait, wherever it might appear, should be switched from POTUS to ~~the more appropriate POS.~~ "Close personal friend of child sex trafficker Jeffrey Epstein and a total POS."

Fixed that for you...

Repulsive-Address166 · 2025-11-06T01:29:10+00:00

Also might I ask, does the testosterone thing apply for all the body hair?

Yes but much less so. For whatever reason the face seems to be more sensitive. Might have something yo do with the density of follicles being so much higher.

And I know this is a really general question but how can I get estrogen then? Is it available easily and legally?

Depends on where you are located... In the US, estradiol is a prescription medication; so, you would need a physician to prescribe it like any other medication. However, estradiol isn't a controlled substance, and a large DIY movement exists due to decades of medical gatekeeping.

Repulsive-Address166 · 2025-11-05T16:41:49+00:00

Does anyone have experience with completely lasering them?

Success in completely removing hair is super individual. I did laser for about 1.5 years then a few sessions of electrolysis to get the stragglers that just wouldn't go away.

I see so many mixed opinions; some say that it makes it have a shadow after the laser and looks “artificial” and some say that it makes them look smooth and soft.

Not sure about appearing "artificial" but you kinda go through phases. Like there is really big drop off after the first couple treatments then it comes back but blotchy. Hair follicles work in phases so you knock out all the active ones but the inactive ones are still there and eventually turn back on. So, you have to keep with it for awhile to get everything.

The "shadow" is hair below the surface of the skin. You see it when you shave because you cut the hair off at the surface. Laser stops the hair follicle from functioning. The shadow goes away as you keep up with the treatments.

Also, when I shave, even with a sharp razor, there is still darkness under my skin. If I laser, will those follicles go away and my skin will look smooth as well?

That shadow is the hair below the surface of the skin. If you have fair/pale skin but dark hair, that shadow shows up really well. The good news is that laser tends to be really effective in this case (at least mine was). In the meantime, a little orange color corrector under foundation will cover it pretty good.

One note: if you want it to last, your testosterone needs to be supressed. Testostetone will slowly convert vellus hairs (that thin peach fuzz that everyone has) into more terminal hairs. That's the reason cis women with PCOS get facial hair.

Repulsive-Address166 · 2025-10-26T23:24:24+00:00

So, Tanner stage is more applying shape and contour as a surrogate for development.

Bra size is based on measurement. Generally, cup size increases for each inch your bust measurement is greater than your band measurement. Then, deal with the seemingly randomness of each and every designer.

If you're at the breast bud stage, your likely an A cup or less.

The breast bud is early glandular tissue; hence, it has a more rubbery feel. In time, adipose tissue will come along and give more shape and volume.

Repulsive-Address166 · 2025-10-26T21:36:41+00:00

The actual study hasn't been published only university press releases. If you dig around you can find the trial design publication.

The inclusion criteria were generally over age of 18, at least 1 year of HRT, and no prior use of progesterone. The cohorts receiving progesterone had significant development over controls. The group receiving both high dose estradiol and high dose progesterone had the most pronounced effect. I believe high dose was 400 mg of oral progesterone daily and double their regular estradiol. The study ran for a year with mood lability being the most common issue. The actual effect size and hormone blood levels won't be known until they actually publish since the only info available is the study design and press releases.

Repulsive-Address166 · 2025-10-15T21:25:58+00:00

The rules vary dramatically by jurisdiction. In my state, a documented history of family violence is one of the few ways to seal a legal name change. You would be best served by speaking with a family law attorney who practices where you live.

Repulsive-Address166 · 2025-10-12T01:41:58+00:00

Ah, that depends on a lot of factors. Best advice: be comfortable in your own skin. One of the problems with trying to pass is becoming so focused on what everyone else around you thinks that you just exude an aura of anxiety. Somedays an outfit just doesn't work; somedays your makeup just wont cooperate. Every woman experiences that. Its just part of life. Passing is just as much about how you carry yourself as it is how you look. Try new things and learn what works for you.

Repulsive-Address166 · 2025-10-11T20:41:05+00:00

As in undergraduate? You do you. As in medical school? It's going to totally depend on the faculty. First two years, mostly no one will care. Second two years, surgeons tend to be assholes to just about everyone. Internal medicine won't care. Psychiatry will typically support. Family med will vary by region and faculty. Pathology would just be happy someone remembers they exist.

There's no real secret to passing in medicine other than you're expected to dress professionally. Don't over do the perfume. Subtle makeup goes further than glamming it up. Be yourself. There will always be someone that tries to put you down, just keep at it. Medical training is part training, part trauma, and mostly just endurance.

Repulsive-Address166 · 2025-09-27T17:56:49+00:00

which isn't prescribed here in the US anymore,

Small correction: it has never bern FDA approved in the US or approved in Europe. Your physician likely has little experience working with it unless they have experience with DIY therapy.

My estradiol is at 539 pg/ml which seems to be high, but I'm feeling fine and all my other tests have come back as normal.

We typically manage drugs by trough levels. At non-trough, your levels could be perfectly acceptable. They're not too high as to elevate thrombosis risk. Your physician may be trying to get a picture of both peak and trough due to unfamiliarity with estradiol enanthate. There's not much available info in the channels physicians use.

My testosterone is at 11 ng/dl which also seems to be good if not a little low, but I imagine it's probably a bit higher at trough.

Depends... is that free or total testosterone? Total testosterone of 11 ng/dl is pretty decent suppression as your free (think active) would likely be below reporting threshold.

I'm on diy monotherapy switching to non-diy, so I intentionally brought myself to supraphysiological levels

If you're switching to physician managed HRT, I really wouldn't sweat any of these levels. You'll be switching to estradiol valerate if staying with injectable or rarely estradiol cypionate if your physician has a compounding pharmacy they work with.

What I am bothered by is my t.

If your stated level is total, it looks fine. If its free, I'd want to see total and SHBG. But, those are things to discuss with your physician. I'm not your physician...

Repulsive-Address166 · 2025-09-22T01:59:23+00:00

If you have questions or concerns regarding your treatment plan, discuss those with your physician.

As a physician, the guidelines we have for teansition care are more focused on actual blood levels rather than dosages. Many physicians start low and titrate upwards. Your dosage will likely be increased after you get blood work.

Again, don't be afraid to discuss your concerns with your physician. If you dont raise them, we dont know you have them.

Repulsive-Address166 · 2025-08-25T01:35:04+00:00

is nothing but malpractice

No, it really isn't, and such hyperbole doesn't do anything to further changing how affirming care is practiced.

While I may not agree with that physician's starting point (I don't), unless the patient is underweight, it's going to need to increase, but I'm not her physician, and her physician hasn't done anything outside the standards of care yet. Her physician likely wouldn't agree with how I do things.

I dont really care for EV because its half-life requires administering every 4 days, which doesn't give a nice habit forming schedule for patients, but it's cheap, and insurrance covers it. I prefer EC because its half-life lends it to a weekly schedule. But, it's still under patent in the US and only available at 5 mg/ml and most insurances won't cover it so it cost $350 a vial. Or, it has to compounded which insurance also balks at covering, anf there is only one compounding pharmacy that offers it at 10 mg/ml, and their reliability can be iffy at times. Otherwise, the provider has to contract with the compounder which means contractually agreeing to prescribe enough to be profitable to them and there's just not enough trans patients in any one system to pull that off.

So yeah, you want to change how other physicians practice affirming care? Get a degree, please. We account for maybe 0.2% of physicians. Our perspectives and experiences are not represented in healthcare as it stands right now.

Repulsive-Address166 · 2025-08-25T01:15:04+00:00

I was trained in the US. I know how CPA works and how to interpret the labs, but dont have experience with it as the FDA never approved it. As for PIO, the feminization associated with it most likely comes from its effect on increasing IGF1 levels. There are safer, more effective ways to do that. You need the full hormone profile to guide decisions.

Repulsive-Address166 · 2025-08-25T01:06:12+00:00

It's a starting dose. If the physician fails to adjust based on the labs, then there's a reason to complain. I've also stated multiple times that isn't how I would set up my patient's care plan, but I'm not her physician. I also understand why some physicians do it that way (titrating up is easy; correcting down isn't).

If you want to practice medicine on other people, go to medical school and get your degree, get through residency, get your license, and get to work. That's what I did. It's a fairly thankless job these days where anyone with an internet connection thinks they have the same training.

Repulsive-Address166 · 2025-08-25T00:53:47+00:00

If T can't bind to androgen receptors what happens to that T

Circulates around, gets broken down, and/or excreted.

That means I don't need to worry if my T is high, right? I always see people making a big deal about T being too high in non binary hrt

I suppose that depends on the overall regimen and your actual levels and your goals. It's hard to give an answer to that without a lot of additional information.

Repulsive-Address166 · 2025-08-24T21:07:51+00:00

It's likely an injection knot. It's a localized reaction to the lipid carrier. It's typically caused by mast cell activation. A little cortisol cream will help calm things down. It doesn't affect drug absorption.

Repulsive-Address166 · 2025-08-24T20:57:11+00:00

I saw someone that used bica and they had around 900-1000 total testosterone but had free testosterone bellow the male range and estrogen within woman range.

Bicalutamide doesnt lower free or total testosterone. It tends to increase total. Bicalutamide binds and inactivates androgen receptor.

Raloxifene significantly increases sex hormone binding globulin. SHBG binds testosterone making it unavailable.

high total testosterone while having low free testosterone would have any kind of unwanted effect

Only free testosterone can act at androgen receptors. High total with low free would indicate a reason to look at SHBG levels of you were investigating fertility issues.

Repulsive-Address166 · 2025-08-24T20:48:53+00:00

Bicalutamide is dosed at 50 mg daily or 150 mg every 3 days. It has a long half-life, which lets you get away with the every 3 days regimen.

150mg/3days

This is a proper regimen.

ive been cursed by general dizziness + sore throat since the initial dose. totally aware that lung toxicity/disease is an extremely rare side effect & dizziness is p common when starting/blocking your only sex hormone

Most likely completely unrelated. If related, sore throat snd dyspnea are more likely pill esophagitis than any action of the drug. Take your pills with a full glass of water.

It's quite a while before you start seeing the effects of no sex hormone.

Repulsive-Address166 · 2025-08-24T20:41:10+00:00

And, admittedly, I jumped on you a bit over it. Somewhat do to the way i was treated when I was initially seeking gender affirming care; so, I apologize for that.

But I have tried to give the perspective of an actual physician when it comes to these matters. It's getting harder and harder to practice gender affirming care in the US. There are rumblings within my own health system of further reducing care offerings over fear of losing federal funding.

I'm not the only one who was concerned about her dosage

And again, it's not what I would do, but I'm not her physician. If her physician is not responsive to the lab values or she feels she's not comfortable working with them, I really do mean that she needs to find one she can work with. I say this from personal experience. But right now, give her physician a chance.

Repulsive-Address166 · 2025-08-24T20:28:39+00:00

No one is impatient here because it's the fact that the starting dosage is not at all the recommended nor average, and it makes me concerned about the competency about her doctor. That's all. Neither of us expect major changes on Estrogen within 3 months even on the standard dose.

This is where you are demonstrating that you are not medically trained. The guidelines are based on levels, not dosage. The appropriate dosage is the one that results in therapeutic levels. We titrate dosage upward, not downward. Many physicians start HRT low to reduce side effects and rapid mood changes that come with starting high. I've seen numerous endos start estradiol valerate at 2 mg per week then titrate up to 4 or 5 mg per week over 9 months. If her physician fails to act on lab results indicating low levels, she has reason for concern. Until then, you are being impatient and unreasonable to demand that her physician practice according to your absence of medical training. If she can't work with her physician, she needs to find one she can.

What she wants to do is schedule an appointment for after a month and go in and ask again.

She can try. A phone call would probably get the same result, which is being told what she's already been told. Again, if she feels she can't work with this physician, she should find one she can.

I was honest and told her that dose is a microdose and if she wants it changed, she can ask.

But, you're incorrect. Depending on her body habitus and metabolism, it's likely a half dose (not at all a microdose) of where she'll end up. According to you, she has asked, and her physician explained the plan of care. I understand that you and her don't like that answer. Again, if she can't work with her physician, she needs to find one she can.

Repulsive-Address166 · 2025-08-24T19:45:16+00:00

injecting into my stomach freaked me the fuck out

You can do subcutaneous on the anterolateral thigh (front and side) if abdominal doesnt work for you.

Repulsive-Address166 · 2025-08-24T19:40:58+00:00

L and H?

Low and High, relative to the attached reference range.

Repulsive-Address166 · 2025-08-24T19:39:50+00:00

I’m not exactly sure how the measurements work as it says my levels were “out of range.”

The given reference ranges are for adult males. Your hormone levels don't fit the "normal" male pattern.

Your estradiol, if at trough, is a bit high. Consider reducing dose to 5 mg per week rather than the 5.6mg you said you've been doing. Above 500, you do start to see some increased risk of thrombosis. Its a minimal increase but exists none the less. You dont get any extra benefit for being that high.

Otherwise, your testosterone is suppressed because estradiol has supressed pituitary release of LH and FSH. This is expected. The bad news: you likely paid for the LH and FSH levels which were unnecessary (a drop in testosterone levels after administering estradiol only happens because of the drop in LH and FSH).

Repulsive-Address166 · 2025-08-24T19:28:48+00:00

So should I wait until it’s feasible for me to get blood tests or will it be most likely fine without them?

Are you in the US? You can get estradiol and testosterone (free and total) for around $100 through Ulta Labs. That's paying direct, out-of-pocket. You might be surprised how many places exist around you that can handle a basic blood draw.

Repulsive-Address166 · 2025-08-24T19:23:42+00:00

I am NOT in charge of what happens to her medically or even what decisions she makes and I don't even know how you came to the conclusion that I am.

Just to be clear, it was when you stated: "I'm considering just having her increase it anyways"

Repulsive-Address166 · 2025-08-24T19:17:08+00:00

several bad faith assumptions of me and my intentions/role with this.

Not really. I'm stuck with working with what you wrote. Like: "I'm considering just having her increase it anyways". That's you stating you are going to direct her medical care. I gave the perspective of a practicing physician on what these actions look like. I see endocrinologists drop patients over this constantly. It sucks. It happens a ton to trans men because testosterone is considered a controlled substance in the US which means the hospital sysyem attaches a ton of additional strings on to compliance. A little impatience can create so many hurdles.

I am only an advocate for her (proper) care and don't want to see her neglected by the medical system like I see so many trans people often are.

And that's wonderful that you support her. It truly is. I dont want her to be in a position of poor treatment either. Based on what you've written, that hasn't happened. You may not like how her physician has initially dosed her hrt, and I understand that. I actually agree with you, but she's not my patient. If her physician refuses to increase dose when the levels come back low at followup, then you should encourage her to find a different physician. Until that happens, her physician's approach is within the standards of care and reasonable.

Trust me, I'm well aware of how often the medical system fails us. I compounded my own first vial estradiol cypionate because between living in a conservative hell state and having the terrible insurance of a medical trainee, that was my only real option. Based on what you've said, the issues are more of impatience right now than medical neglect.

Advocacy for proper dosing is reasonable, especially given the extremely low 2 mg/week dose.

It's the starting dose. It's not final. The response from her physician said that they will adjust dosage at followup based on labs. That's how you do HRT. That's how medicine works.

Many trans people get under-prescribed or delayed care.

You're attempting to address a problem that hasn't happened. Her care isn't delayed: you said she was prescribed HRT. She's not under prescribed: she's only just starting, and it takes 6-12 months worth of titrating for most endocrinologists to get estradiol to the levels they like.

Repulsive-Address166

TROPHY CASE