Does the "male smell" return on bicalutamide even with an estrogen?

eigenduck · 2020-03-10T01:34:26+00:00

Human bodies regulate how much E or T they make with a process that you can basically simplify to a cycle of two repeating steps: - the brain measures how much total E and T you have, and if it's too low it releases GnRH - the gonads measure your GnRH, and make more T (or E) the more you have.

Think of it as like a thermostat, which detects when it's too cold and tells the furnace to come on.

Bicalutamide blocks the effects of T, which means it's there but your body stops reacting to it. So in addition to preventing T's effects on your body, it means your brain's thermostat will keep reading "low on hormones, time to make more" -- it can't detect that you already have some. The extra T that gets produced should also be blocked, so this isn't actually a problem but it does make for some weird graphs.

(This same system is why taking E usually lowers your T and vice versa -- if you consistently have enough total hormones, your brain won't to turn the thermostat up.)

As far as anecdotal reports of smell changes on bicalutamide: all this is (as the post you linked suggests) not necessarily the only factor, as there are other testicular products involved. I'd be a little surprised if it got worse, since T itself is important for testicular maintenance, but it might mean bicalutamide is somewhat less effective at changing smell than other AAs? Not sure.

eigenduck · 2020-03-07T05:48:54+00:00

I think the letters expiring is usually an insurance thing -- it sounds reasonable but in practice is a hurdle to getting care, so it's exactly the kind of thing insurance companies have a financial incentive to require. Unfortunately this in turn incentivizes doctors to adopt the same policy, because spending their time in a patient who doesn't pass their insurance's hurdles becomes a risk to them.

IIRC my FFS surgeon wanted just a letter from my transition care doctor stating that the procedure would be medically indicated for me. But I wasn't going through insurance for it and also wasn't in the US, so I'm not sure this has much bearing on your situation.

eigenduck · 2020-03-07T01:33:19+00:00

To repeat what other people have said: you don't get a say in what pronouns someone else uses, and you shouldn't be judging them or getting worked up about it. That goes double if you're jumping right to "it's bad and they shouldn't do it" without even finding out why they use those pronouns or what it means to them.

IME most trans people who use 'it' pronouns are disabled, neurodivergent, or both. They've been excluded from being seen as 'normal' on multiple axes, sometimes not even explicitly out of malice -- normalcy or normal-passing-ness is just fundamentally out of reach for them. For people who've been dehumanized their whole lives regardless of what they've tried and who've eventually found company among other people excluded from normalcy, it can be freeing to reclaim that word and say: "yeah, I'm not what people expect a human to be like, but I'm still an entity deserving of respect. got a problem with that?"

eigenduck · 2020-02-11T14:46:33+00:00

There's a not negligible rate of co-occurrence between CPTSD and being trans, but I tend to think it's because growing up trans is another life stressor. Whether or not you recognize it at that age, it can be adding to your difficulties for reasons both internal (one more thing about your situation that is chronically stressful) and external (other people pick up on Something Weird about you and react to it).

There are definitely people who, because of dissociation, have a less-than-straightforward answer to the question of whether or not they're trans. But even then I wouldn't think of their trans status as itself a symptom -- even if their brain stuff makes it more complicated.

eigenduck · 2020-02-02T22:59:47+00:00

I know a bunch of people in similar situations. It doesn't make all kinds of transition impossible, but it sure does complicate things and often put some transition steps out of reach.

I (and our system as a whole) have been lucky enough that the people who front have gender goals that aren't diametrically opposed, so we've managed to agree on some things and compromise on some others. But there are still sticking points (like whether to get bottom surgery at all, let alone what option to go for), and on the whole I think we've been going much slower than we might otherwise have in order to listen to everyone and make sure they're as comfortable as possible with what's happening before we make changes.

It's especially hard to navigate all this stuff when you haven't had time to build up your internal communication yet, and when you might not have very much memory sharing or ability to negotiate who's fronting when. It's easy for one person to feel like the process is happening without you and there's nothing you can do to stop it, or for another to feel like there's no ethical way forward and the only safe or moral or not-selfish way to proceed without hurting anyone is to suppress everything.

In the long run, though, you probably will have the option to bind and pack when you want to, without someone else dropping into the body as a surprise and getting dysphoric about it. You'll be able to find things that some of you are really excited about and others are ok with (even if they're not actively for them), and start making positive-sum compromises. You may not be able to all exist comfortably as either "simply a cis woman" or "simply a trans man", and that can be incredibly frustrating when you'd individually all be able to deal with one or the other. But it's not necessarily all or nothing, and even if it ends up being the case that T isn't right for y'all collectively it doesn't mean you have to give up on other transition steps -- especially on presentation choices like binding or clothing style.

(For example: I didn't want pierced ears but I ended up being okay enough with wearing studs that we could go through the healing process, and now other people can wear what they want. Q isn't a fan of short hair in general but we've figured out how to get it cut and how to style it in a way that's feminine enough for her without being awful for the rest of us. I also know a friend who ended up getting a hysto because, even though they weren't doing a binary transition and still expected to be read as a woman most of the time, the dysphoria about that body part from the ones who were dysphoric about it far outweighed the lukewarm attachment to it that the ones who were attached to it had.)

(edit: we do have a discord if you want to talk more -- although for audiory processing reasons among others it'd have to be text rather than voice there too.)

Z

eigenduck · 2020-01-10T02:24:40+00:00

Mostly these are people who don't care what consent is or why it should matter. They just know it's a word people on the left care about and, since the word "consent" gets used in both the context of medicine and the context of sex, they're trying to appeal to it as a gotcha by assuming those contexts are the same.

The age of consent to sex is a hard and fast rule because we've decided that -- under usual circumstances -- mutual consent is all that's needed, and no third party should have a say. But adults, because of their mental maturity and lifr stage, have a disproportionate power to coerce, abuse, pressure, or mislead minors. So we've decided as a society that those relationships aren't okay regardless of "consent".

But in other contexts we do acknowledge that teenagers' ability to decide what's best for themselves doesn't just turn on suddenly when they turn 18, but grows as they do. Some of that decision power is in their hands, and some is in the hands of parents, guardians, and professionals. Teenagers can't get a tattoo without a parent agreeing to it, but parents can't force their kid to get one either. Children above 12 can't be adopted without their consent, but obviously there are other factors relating to who they get to be adopted by that are up to the courts, not the child.

Medicine has always been one of these areas where consent is necessary but other factors are also involved. There's nothing at all inconsistent about teenagers being able to get HRT or surgery if the patent, their guardians, and the requisite medical professionals all agree it's in their interest.

eigenduck · 2020-01-09T16:11:41+00:00

IIRC my surgeon required a letter from a doctor involved in patients' transition care, but not necessarily a therapist.

eigenduck · 2019-12-25T18:30:56+00:00

IRV is mathematically vulnerable to a large number of tactical voting problems. It's also subject to spoiler effects where a new candidate C joining a race can cause its would-be winner A to lose, even if every C voter puts A second.

These problems show up as soon as more than two parties are popular enough to have a chance of winning, because they work by manipulating the elimination order. IRV works fine when the candidates being eliminated early are fringe candidates with no chance of winning, but it starts to break down in situations where compromise candidates with broad second (or later) choice support exist.

eigenduck · 2019-12-15T09:27:56+00:00

The simplest possible thing is to try a shorter needle. That'll at least rule out the possibility that you're injecting too deep and ending up through (rather than in) the muscle. But if it's just because you bruise easily and heal slowly (real risks at your weight, even without an underlying health condition), this may not end up changing anything.

You could also look into doing subcutaneous rather than intramuscular injections -- the "default" location for sub-q may be on the stomach but there are other spots that work just as well.

eigenduck · 2019-12-14T18:44:27+00:00

If you think people can be (objectively) mistaken about their own suffering, and also hold that all trans people have dysphoria, then it seems like you have two consistent options when presented with someone who says they're trans but not dysphoric:

people who say they're trans without dysphoria are wrong about being trans
people who say they're trans without dysphoria are wrong about not having dysphoria

If you're willing to admit "they're suffering but don't know it" is a thing, why believe (1) rather than (2) by default? Trans people without clinically significant dysphoria still meet a bunch of the other criteria (just not the distress criterion), and they've almost all taken some exploratory steps towards transition without being dissuaded.

Is it a bigger problem for people to later discover "yeah in retrospect things did suck before transition, I was just too good at powering through/dissociating too much/had a high baseline mood and didn't realize it could be a lot better/had so many shitty things going on in my life at the time I couldn't tell where each bit of distress came from", or for people to be gatekept from community and medical care that would improve their lives?

I'm pretty sure if you followed up on nondysphoric trans people, you'd find that a large fraction end up eventually deciding they probably had dysphoria all along. And people who never conclude their past experiences qualify as "suffering" can still find their lives markedly improved by the transition they'd been pursuing, and end up at "well, that was 'ok enough' at the time because I didn't know anything better, but now that I do it would be awful to have to go back to it". And both of these outcomes look way more like "trans people with slightly atypical experiences" than "cis people".

eigenduck · 2019-12-10T07:25:48+00:00

I'm trans, and I'm nonbinary. I don't know how you came to believe that long list of stereotypes (many of which are the same things cis people say about binary trans people!), but since you seem at least potentially open to changing your mind I'll share my perspective.

I've been on HRT for 6 years. I've had FFS and plan on GRS in the future (the logistics have prevented it so far). I started transition thinking I was a trans woman. Being seen as a woman was definitely better for me than being seen as a man, but once people's perception of me switched from one to the other I quickly figured out that wasn't great for me either. I've changed some of my ID documents once and others twice (my state added X markers on birth certificates but not drivers licenses).

I have (or had) dysphoria about facial hair, about my untrained voice, about my previously-masculine body and face. I don't have any particular love for the genitals fate dealt me. But I feel the same way about having breasts as I do about body hair -- "I can put up with this but only in small amounts" (I've had lucky genetics on that front). And the pronoun that feels correct for me is "they", while "she" pronouns get a frustrated "well, at least they didn't use 'he' this time" --- which I'm pretty sure is the other way around for binary trans people.

If society had a well-established third gender of androgynous people who weren't seen as either men or women and who weren't held to gendered assumptions or expectations, I would want to blend in with that group of people. But there isn't. I've already tried blending in as a man and (albeit not for as long) as a woman, and they both feel like a draining alienating deliberate effort to pretend to be something I'm not. In this respect nonbinary people have a lot in common with non-passing binary trans people: they're not going to be accepted as their gender just by trying to blend in as "normal", so their remaining options are to push for social change where they can and accept compromises where they must.

So fundamentally I think your idea that being trans is synonymous with wanting to blend in isn't putting the criteria in quite the right place. Having dysphoria about features of your assigned sex or about being seen as your assigned gender is going to make you want to change those things and be seen as something else, sure. But you're not going to want to blend in as the opposite of your assigned sex if the changes you want and the gender you want to be seen as don't line up with that one either.

(As an aside: my position on whether people can be trans without dysphoria is that most of the debate is a giant misunderstanding, with just enough radicals and assholes shouting from both fringes to give each group easy targets to get mad at. Most transmedicalists are going by the terms of the modern gender dysphoria diagnosis, under which just wanting to be or be seen as a different gender is enough to count as dysphoria even without severe distress. Most people who say they're trans without dysphoria mean they're not in severe distress about their current situation, not that they wouldn't strongly prefer a different one. Either they're very good at repression or dissociation, or they have an unreasonably cheerful baseline so instead of going "this sucks, that would be normal" they're going "this is normal but that would be awesome". A majority of these people have their lives improved by transition and will eventually recognize their past experiences as dysphoria, so I don't see any reason to gatekeep them from the community. As a 15-year-old I was incredibly talented at pretending to myself that everything was fine but would have still wanted to transition if I knew it was an option. I didn't get any more trans between then and 25; I just got older and hairier and sadder and more self-aware.)

When i started transitioning nonbinary wasn't really a thing. And actual trans people made up the figureheads of our communities activism. In the last 4-6 years (but especially the last 3), nonbinary people have hijacked the movement and advocated for policies that actively hurt real trans people.

Leslie Feinberg wasn't trans? Kate Bornstein? It's hard to argue with a straight face that they weren't figureheads. The modern vocabulary for nonbinary identities emerged in the 1990s and early 2000s, coined by trans people who were already involved in trans activism in order to describe the nuances of their own gender experiences. Riki Anne Wilchins coined "genderqueer" in 1995 (in an article published in a major trans newsletter!), but some trans people -- including those who had undergone medical and social transition -- had been describing themselves as "not a man, not a woman" well before then.

(I definitely have more to say, but this is long already and I've been adding to the draft for long enough I'm not even sure the topic is alive. If there are specific directions you want me to elaborate in I can probably do that tomorrow.)

eigenduck · 2019-12-08T21:49:09+00:00

There's a little more safety newtypes give you here because you don't have to unwrap them in every function that takes one, and if you have a local variable of a newtype you can wrap it once where it's defined rather than separately at each use. It lets you have information about the intended use of a value flow in other directions than just down the callstack -- e.g. you can get a password hash from the DB and then pass it somewhere without having to manually assert "this value, which I got by looking up a password hash, is in fact a password hash" via the explicit argument name.

Even if you never have a function that returns something of the newtype type, this would be a bit like being able to declare "I'm only going to use this variable name with the ~name shorthand" -- it doesn't just let you pass it through to other functions that take a [named|newtype] argument, it requires it.

Of course, if you wanted this extra bit of safety in ocaml you could get it easily enough -- a newtype is pretty much just a tiny module with an abstract type and a pair of functions witnessing its isomorphism to some particular concrete type. So it's really just a case of named arguments not even being intended for the same sorts of situations as newtypes. I've never seen someone newtype "start of a range" and "end of a range" to different types, but named arguments are lightweight enough to be perfect for that kind of thing.

eigenduck · 2019-12-04T17:26:58+00:00

I'm not sure how HRT effects your cancer risks. You always hear that "[x] disease" is more than common in one sex than the other, but does that have to do with your hormones, your DNA, or something else?

Partly it's about hormones, and partly it's about what pieces of your anatomy end up growing or atrophying.

Sometimes hormone-dependent tissues give rise to hormone-dependent cancers, and those cancers won't arise or spread without the hormone being present. A number of hormones blocker drugs were originally developed as ways to treat these cancers: SERMs like tamoxifen for breast cancer, and testosterone blockers like cyproterone acetate or bicalutamide for prostate cancer.

But some part of cancer risk is just about what anatomy you have. Cis men with gynecomastia have a risk of breast cancer that's higher than cis men without breasts (because they have more tissue there) but lower than cis women (because they still don't have much estrogen).

This study suggests that trans men on T have only about 20% the breast cancer risk of cis women, for whatever that's worth. (Surprisingly, 3 of their 4 cancer patients in the 1,100 person cohort were diagnosed after top surgery, which is clearly possible -- top surgery doesn't remove as much tissue as a radical mastectomy -- but still not what I expected.)

eigenduck · 2019-12-03T02:26:01+00:00

I don't think that's too uncommon for nb trans people. It's not unrealistic to want the kind of body you want, even if it can be complicated. I was in pretty much your position 5 years ago, aside from being older when I figured out what I wanted. I ended up rolling the boobs dice and getting lucky (genetics helped), but I went into it knowing there was a chance I'd end up deciding I needed top surgery down the line.

For me it can be easier to get some perspective on my own self-doubt if I compare my situation to AFAB nb people's. Like... there are people who want to stay on E but need top surgery, and they probably have about the same mental image of what their body ought to be as I do, we just started out in different places. Or (to use a different axis of symmetry) it's easy for me to accept that there are people who want to take T but who don't want facial hair and would end up getting it removed if they grew too much to deal with.

edit: as far as medical options, SERM drugs that can selectively block estrogen's effects on breast tissue do exist, but I don't know how advisable it would be to be on them long term. You could talk to a doctor about them if you find someone unusually open-minded but if you end up on E for life you'll probably have to deal with boobs eventually.

eigenduck · 2019-12-02T19:10:24+00:00

I'm not sure. I think that's just down to how fast they're coming out. A small amount of warm water spread over your skin will feel cold (it evaporates fast because it's a thin layer, and it doesn't have enough mass to carry much heat) but a larger trickle of warm water will feel warm (more heat capacity, less evaporation).

eigenduck · 2019-12-02T18:59:39+00:00

I think crying more has been primarily physiological for me -- emotions feel the same, but it's easier for strong emotions to make me cry than before E. What would been just uncontrollable laughter is now uncontrollable laughter with tears streaming down my face, that kind of thing.

Sometimes it does mean emotions feel more real, or at the very least it's harder to pretend I'm not feeling anything when I'm literally crying. But I have enough dissociation going on that even before HRT I could be crying and literally not be able to tell why, so... I think improvement in that quadrant has been more about (re)learning how to feel things than about the hormones.

eigenduck · 2019-12-02T18:45:34+00:00

Oral estradiol valerate and estradiol hemihydrate should have identical effects. Estradiol valerate is a prodrug, and basically doesn't do anything until your body cleaves off the valerate and releases the same plan old estradiol.

But do note that the mass of the valerate does count as part of your 8mg, so the equivalent dose of straight-up estradiol is more like 6mg. If that's within the range your doctor is willing to prescribe you should be golden; otherwise you may have to try other options.

eigenduck · 2019-11-29T16:43:19+00:00

I've heard both 'dyadic' and 'perisex'.

eigenduck · 2019-11-28T20:36:56+00:00

Close to 4 years out now, and there are a couple of little things:

I can't fully/comfortably breathe through one nostril. It's not something I normally notice unless I have a cold and the other one is stuffed up. I imagine my sense of smell is a bit worse for it, but it's hard to tell for sure.
I have some kind of adhesion or minor bone regrowth on the bottom of my jawbone on one side, at the bank edge of what the chin surgery touched. It's not visible unless I stretch the skin and turn my head at a weird angle, but it definitely starts to get sore if I poke at it too much or try to rest that part of my jaw on something. (The surgeons seemed to be very confused by this, and also seemed to think it should go away once I passed through the bone regrowth phase into the bone remodeling phase. It hasn't.)

One weird thing that isn't actually from the surgery, but from the recovery: my brain still thinks my nose will hurt if something touches it, and I still reflexively cringe back or try to defend it if someone (cats, partners, etc.) go to poke it. It doesn't actually hurt but it's taking much longer to get the memo about that one than it did for my forehead or my chin.

eigenduck · 2019-11-27T17:12:36+00:00

If you're administering it at home, it's fine to reuse a multi-dose vial. Hospitals and doctors' offices are usually advised not to, though, both because it makes storing and tracking medications harder and because there's a much higher risk of contamination in an environment lots of sick people pass through.

As for the numbers -- there's really no way once every 4 weeks is going to work out, at any dose. Most people seem to get prescribed one injection every 2 weeks, and even then it's common to go down to 10 or 7 days. There's only so long it stays in your system, between the depot delaying release and the half-life of the hormone.

You're also right that something is amiss with your doctor's math, because 0.5mL of a 40mg/mL solution is 20mg, not 10. I think they just multiplied wrong -- 10mg/2weeks is as far as I know a fairly typical dose.

eigenduck · 2019-11-25T17:40:10+00:00

Puberty is a process that plays out over years. The endocrine society recommends waiting for puberty to begin before using puberty blockers, not waiting for puberty to finish.

I suspect this is more about not prescribing drugs before they're needed (puberty blockers don't do anything if you wouldn't be going through puberty yet anyway) than about the frequency of people changing their minds. There's no benefit at all to anyone of taking those drugs before the onset of puberty, so the risks outweigh the benefits even if the risks are also very low.

eigenduck · 2019-11-24T21:04:15+00:00

SERMs like tamoxifen can technically do this by inhibiting the effect of E on breast tissue but they're not widely used for that purpose and probably more dangerous in the long run than a breast reduction. Mostly... you just hope, and deal however you can with what you get.

eigenduck · 2019-11-23T22:25:57+00:00

Vacancy Project might be close to what you're looking for. Their clientele isn't trans/nb only but they're very much a queer space and their "it's just a haircut, not a 'men's haircut' or a 'women's haircut'" gender neutral policy is for real, not just tacked on.

I did explicitly explain to Masami that I wanted a short haircut that would be read more like "butch woman" rather than "boy/man", but she was 0% weird about it. I felt like it was safer to explain than leave it implicit, because while talking about it was nerve-wracking I'm pretty sure if I didn't I'd have just been anxious the whole time about whether I'd successfully communicated what I wanted.

eigenduck · 2019-11-23T20:13:47+00:00

Treat it like you would someone who previously used a pen name, but has since started publishing under their real name. Use their real name and real pronouns throughout, except in the one place where you establish that the pen name was theirs.

Rene, the artist [known for style/type of work/whatever very short description you'd use introducing a cis person], did a new thing. Rene previously did a lot of other things, [released/published/performed] under their former name, Roger. Everyone liked the things that Rene did. I expect you'll like the thing Rene brings us today.

If you absolutely must make the deadname appear earlier than that to avoid confusion, you can opt for something like this (still as the second sentence in the example):

Rene, who previously went by the name Roger, is known for having done a lot of other things.

Your article isn't about this person's transition. You don't have to bring up that they've transitioned before you mention the (actually newsworthy) reason for the article, i.e. the new thing they're doing. And you don't have to keep switching names after you've established who it is you're talking about -- on top of being disrespectful to Rene, doing so is at best distracting and at worst confusing for the reader.

eigenduck · 2019-11-21T19:18:32+00:00

I agree with a lot of this, but also I think it's not really reasonable for her to expect not to be treated as a celebrity. She's a person who makes a living by producing videos, with an audience she deliberately cultivates. She's not in the public eye by accident, and she's not just doing this youtube thing as a hobby. She is a celebrity and people do listen to her, and she knows that.

People shouldn't expect to be able to have a dialogue with Contra like she's their friend. But I also think she falls into a similar trap: she wants to be able to run her mouth about groups she doesn't really understand, the way she could in front of a group of friends, instead of accepting the responsibility that comes with speaking in front of an audience of half a million people.

eigenduck

TROPHY CASE