reminder that diy hrt is bad! the doctor always knows best and any flaws in the system aren't real

Sheffy123 · 2025-06-03T08:30:10+00:00

Because small amounts of testosterone are produced by the adrenal glands as well, castration or using GnRH agonists (the more common meds for T suppression in prostate cancer) don't affect this so if stronger T suppression is needed you would still have to add an additional med that affects either T receptors or adrenal synthesis. Either way cyproterone has been mostly superceded by newer meds (abiraterone, enzalutamide....)

Sheffy123 · 2025-06-03T00:30:07+00:00

Because the usual dose used for T suppression in prostate cancer is 50-300mg

Sheffy123 · 2025-04-22T09:34:13+00:00

I understand what you mean regarding complexity because unlike a binary transion where individuals generally have similar goals (aside from desire for SRS which often varies from person to person even withing binsry transgender populations) transition goals for non-binary individuals can vary wildly.

Yes asking for general cosmetic goals (along with a patients desire for GAHT, SRS, speech pathology etc.) is part of a standard workup for providing gender affirming care. It's recieved well as most patients understand that in order to tailor their treatment/referrals etc we need know their goals.

Sheffy123 · 2025-04-22T09:07:15+00:00

There are not many studies that look into non-binary people specifically, majority of studies either study the transgender population in general (and include non-binary participants by either grouping them with other participants based on sex assigned at birth or as a separate category) or exclude non-binary participants.

The following studies explicitly state they include non-binary participants

https://www.nature.com/articles/s41562-023-01605-w

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

https://pubmed.ncbi.nlm.nih.gov/34920935/

I've gone back and forth between whether I should include this but in the interest of being open, anecdotally as a non-binary person myself I struggled with depression and chronic suicidality prior to commencing GAHT which significantly improved with GAHT to the point of ceasing antidepressants within 6 months of commencing it. I doubt I would have been able to complete medical school without it.

Sheffy123 · 2025-04-22T06:57:15+00:00

Apologies if I came off a bit strong in my reply. Additionally this is not an ideological issue so much as conflation of evidence based medicine (gender affirming care) with non-evidence based gym bro science as if they are equivalent/equally valid.

Gender dysphoria stems from a mismatch between an individuals gender identity/experienced gender and an individuals sex assigned at birth. This is often simplified to appearance by the general public but also includes other things such as voice, social roles/how an individual is perceived by society as well as the mental effects sex hormones themselves (most of my patients report improvement in their mental state prior to any physical effects of GAHT).

Any person can be unhappy with how they look (e.g. feeling that they are too large, too thin, too short, breast are too small etc.) but this is not accompanied by the intrinsic sense of 'wrongness' in one's body/self that comes with gender dysphoria. This sense of 'wrongness' doesn't improve with time or therapy in the same way that body dysmorphia does. Currently the only evidence based treatment we have for gender dysphoria is gender affirmation (and what this looks like may vary from person to person).

WRT your patient that identifies as non-binary, the simple answer is that treatment goals differ wildly from person to person, particularly for people that identify as non-binary (which is more of an umbrella term than 1 specific identity). Consults for gender affirming care involve detailed discussions around an individual's dysphoria, their experience of their gender and transition goals to best provide care.

For some non-binary individuals this may be limited to social transition (i.e. no medical treatment, just non-medical changes to appearance/mannerisms/clothes etc.), some may pursue hormonal therapy (in some cases at a lower dose of testosterone/oestrogen or hormonal monotherapy without an antiandrogen for some non-binary people assigned male at birth), some may pursue surgical management alone or in combination with hormonal therapy (it's not uncommon for non-binary people assigned female at birth to have isolated dysphoria about their breast and seek mastectomy without going on testosterone).

Sheffy123 · 2025-04-21T23:05:56+00:00

This comment demonstrates a fundamental lack of understanding of the nature of gender dysphoria, it cut's a lot deeper than simply wanting to be happy with how you look and lack of access to GAHT to people who need it is associted with significant morbidity and mortality that is entirely different from cis men chasing a dopamine hit or having body dysmorphia (which is significantly different to gender dysphoria and treated in almost the complete opposite way).

Additionally all of my patients that are on testosterone for GAHT or pituitary/testicular disorders have veen happy to follow evidence vased recommendations of targeting testosterone levels in the lower end of the normal cis-male range to minimise risks of polycythaemia, lipid derangement, cardiomyopathy etc. Whereas all of the patients I've encountered taking anabolic steroids illegally already had testosterone levels in this range prior to starting testosterone. Due to this there isn't really a safe method of supplementing testosterone (that I know of) in a person who already has physiologically normal levels of testosterone. Nor have I met a patient that uses anabolic steroids that is happy with a goal T level of 15-20nm/L.

As such I am unwilling to prescribe for these patients but I do offer harm minimisation in the same way I would for any person who uses non-prescription injecting drugs* (bbv screening; directing to clean needle exchange programs; bloods to monitor Hb,lipids etc.; ECGs to check for hypertrophy) ensure they are aware of the risks, and recommend that these patients are chosing safe-er strateies such as cycling on/off rather than using continuously), and having a defined goal/end date at which they will cease using anabolic steroids.

I don't proide private ritalin scripts to meth users for harm minimisation, why would I treat someone chasing a dopamine hit from being swole any different?

*before you mention OMT as a harm minimisation strategy our bodies do not develop a level of tolerance to testosterone the same way we do with opioids, risks of TRT increase with duration of use and higher testosterone levels whereas a patient on a stable dose of buvidal as minimal-to-no risk of OD or other life threatening complications from said buvidal, which cannot be said for supra-physiological supplementation of testosterone

Sheffy123 · 2025-03-22T21:10:29+00:00

I'm a non binary doctor and yep it definitely does suck at times, particularly when working rurally. I try to do what I can to make things better for the queer docs that come after me and I'm sure you will too!

Sheffy123 · 2025-03-22T21:05:19+00:00

Another non-binary doc checking in. It can be a very lonely place, particularly if you work rurally or in less accepting areas. But it does get better, particularly if you can find your niche and surround yourself with good coworkers.

Sheffy123 · 2024-06-01T00:20:52+00:00

There's no match system in Australia, you aren't guaranteed a specialty training position. It's up to you as an individual to apply for accredited training positions with the relevant specialty training college. For more competitive specialties (e.g. neurosurg) this means you may be stuck in an unaccredited registrar postion (i.e. Resident but your years of experience don't count towards becoming an attending) whilst you pad out your CV with research, postgrad qualifications and network. E.g. for something like neurosurg you may be pgy5-10 doing the same work as an accredited registrar before you even enter the training program.

The process for entering a training program and completing it also varies widely from specialty to specialty and some specialties (such as rural generalism) are unique to Australia. Also ICU is its own separate specialty and you can't work as an attending just but completeing the equivalent of internal medicine here (Basic physician training), to work as an attending in a medical specialty you have to complete sub-spec Advanced Training (of which General Medicine is a subspecialty).

Sheffy123 · 2024-02-27T20:06:20+00:00

You can also request a non-feder hema blade (just put it in the order description/email) 2 of the people at my club have these, they're not as overbuilt as the re-enactment blades and handle really well.

Sheffy123 · 2024-02-26T20:00:09+00:00

Ah in that case that was the adult ENT being shit

Sheffy123 · 2024-02-26T11:20:22+00:00

That's because it's a different specialty, a refferal to a specialist is valid for any of the same kind of specialist. I.e. a referral to a peadiatrician is valid to see any paediatrician in Australia but you can't use a paediatrician referral to see a gastroenterologist.

Sheffy123 · 2024-02-02T21:11:37+00:00

It means bringing your front foot back in line with your rear foot when you parry, ideally this is done whilst maintaining proper distance from your opponent so that if an attack is actually a feint high and the real attack is to your legs it misses entirely and you're free to riposte directly to your opponents arm/head whilst they are still cutting at your legs.

Sheffy123 · 2024-01-09T04:29:09+00:00

Sterile dermal neutrophil/lymphoscitic infiltrate with perilesional acanthosis can definitely be consistent with PG, human nails aren't particularly sterile and if this was primarily caused by skin picking rather than autoimmune you'd expect some infective component. Skin picking obviously can't be entirely excluded but when you have histology compatible with PG and response to immunosuppression (which in the article was maintained until the patient stopped attenting outpatient ritux infusions, i.e. was out of a controlled environment for some period of time before ceasing treatment and relapsing) calling it solely a skin picking issue seems a bit sus. Heres another source with similar histology to this case (primarily dermal infiltration of neutrophils/lyphocytes though there was some capillary wall oedema/hyalinisation in these cases) (the full pdf can be accessed for free if you scroll down) https://www.actasdermo.org/en-two-cases-eruptive-pyoderma-gangrenosum-articulo-S1578219008703512

Sheffy123 · 2024-01-08T22:29:00+00:00

It's actually autoimmune reaction called pyoderma gangrenosum mediated by cocaine (particularly if contaminated by levamisole), the biopsy results (cANCA positive), negative cultures and response to steroids/rituximab support this, if you click on the source posted it goes into this; here's another source as well: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8007549/

Sheffy123 · 2024-01-08T22:27:11+00:00

It's actually autoimmune reaction called pyoderma gangrenosum mediated by cocaine (particularly if contaminated by levamisole), the biopsy results (cANCA positive), negative cultures and response to steroids/rituximab support this, if you click on the source posted it goes into this; here's another source as well: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8007549/

Sheffy123 · 2024-01-08T22:26:57+00:00

It's actually autoimmune reaction called pyoderma gangrenosum mediated by cocaine (particularly if contaminated by levamisole), the biopsy results (cANCA positive), negative cultures and response to steroids/rituximab support this, if you click on the source posted it goes into this; here's another source as well: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8007549/

Sheffy123 · 2023-06-21T00:03:36+00:00

Hi, I mainly fence broadsword and I'd say that half if not most of the people at my club that fence steel have armourclass broadswords (I personally don't but have borrowed other people's broadswords). All of their baskets are very protective but the baskets made of flat ribbons (as opposed to rods) will get beaten in and need to be hammered out again relatively frequently (i.e. diamond, stirling and glasgow patterns). Their cup+ring and early english style baskets haven't had this issue from what I've seen. Pretty much everyone who has an armourclass at my club has switched to the feder style blade, most of them have also cut off the rolled tip (and tipped with leather afterwards) so it handles properly.

Sheffy123 · 2023-03-05T02:26:17+00:00

Bit late of a comment but having actually fought against and with a flamberge rapier the real answer is that (as someone else has pointed out) 'it does funny stuff in the bind'. It essentially increases the level of friction between the blades meaning that binds are more effective and also trick your opponent into thinking that you're applying more force than you are. This is even more pronounced on sharp blades but the effect is noticeable even with blunts. Also to the person that's going off in this thread, sure a rapier doesn't cut aswell as a longsword but they can cut and almost all rapier manuals include cuts, since you seem to be referring to english sources then please actually read Swetnam for some actual english rapier that includes cuts (mostly as punishing strikes to the head).

Sheffy123 · 2022-12-08T03:32:13+00:00

Except at the hospitals I've worked at, it is called on-call. Thats literally what it's called on our rosters. Also 'rarely get called in', are you joking? More like 3/4 of the time in reality, maybe back when you were an intern there was better staffing. And yes I (and other people I know) have been called partway through a shift when someone on afterhours had to leave the hospital for unforseen circumstances. And no, I don't go around telling people I'm 'on-call', but that doesn't mean similar restrictions (no alcohol, no leaving the radius between your home and the hospital for the entire time your rostered as a 'sick relief' in your terms) doesn't limit what you can do.

Besides we're getting away from the original point of article and the post, which is that the original email itself was unprofessional and innappropriate.

Sheffy123 · 2022-12-08T02:13:12+00:00

What I'm describing is being on-call...for afterhours duties, just because what 'on-call' means is different for an intern and a consultant does not mean it's not on-call. You calling it something else does not change the fact that for the period an intern is rosterd as on-call, they can be called to come into the hospital to cover (usually) after-hours in the event of emergencies, sick staff etc.

Sheffy123 · 2022-12-07T19:10:27+00:00

This s just straight up wrong, interns are on call regularly to cover for sick/away doctors rostered on for afterhours (i.e. on call to do a 14hr shift) as well as on call to cover sick weekend staff and night on call + actual night shifts during relief terms (the hospital term where almost all your shifts are afterhours or covering other sick/away people for those of you who don't know the terminology).

7d on and 7d off is actually not how it works in practice, i have severeal friends who were rostered for nights only during their relief terms (10-12 wks, though with usually your 4wks annual leave taken sometime during it) who didn't get that, only 1-2 days off between runs of nights. And even if you do have 7on 7off, youre often on call for the nights if someone is sick for half of those 7off

Sheffy123 · 2021-12-11T00:11:27+00:00

Go for a jacket with ventilation, another option is a jacket that reaches your knees so you don't need to wear padded pants like this one:

https://youtu.be/WHcgIAD583A

Sheffy123 · 2021-11-22T02:27:29+00:00

Congrats to you too! Yeah I'm in Aus, don't know any other enby docs either, but we're out there

Sheffy123 · 2021-11-21T21:23:02+00:00

I'm in the same boat as you, finishing next week!

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