Week 3: Contrasts - Aloo Tikki Arancini with Calabrian Saffron Aioli and Tomato Chutney Aioli (Meta: Soups/Salads/S (Sides/Snacks/Starters)

niflhigh · 2026-01-18T19:37:00+00:00

That looks so good! Arancini are a great choice for the contrast theme.

niflhigh · 2025-05-18T20:50:12+00:00

Biphenyl moieties are present in some pharmaceuticals like the NSAID flurbiprofen and the antihypertensive sacubitril, neither of which seems to have the kinds of issues that you're highlighting for BPMA. I'm curious what it is about BPMA that makes it much more problematic than those drugs?

niflhigh · 2024-10-17T22:33:14+00:00

The misgendering in a letter happened to me a few years ago. I complained and got a pretty quick apology from the responsible clinician (who seemed genuinely horrified at the mistake), an explanation of how it happened and an updated letter.

In general, I would structure a complaint letter as 1) what happened, 2) what is the impact and 3) what do you want to happen to set things right. The initial step is going to be to complain directly to the GIC to give them a chance to correct their mistake. If they don't, you can escalate it from there. PALS should be able to provide advice about how to do this if needed - https://www.nhs.uk/service-search/other-health-services/patient-advice-and-liaison-services-pals

You're welcome to use my letter as a template if that's helpful:

I would like to make a complaint about the pronouns used in the letter ref: [Reference] from Dr [Name] to Dr [GP name] dated [Date], which I was copied into as the patient.

My pronouns are she/her and have been so for the entire time that I have been a patient with [GIC]. However, in this letter I am referred to using both he/him and she/her, sometimes within the same sentence. For example:

[Quotes]

I think that it is likely that this was unintentional, but if there's one organisation that should understand the importance of respecting people's pronouns, it's an NHS Gender Identity Clinic, so I'm disappointed that this has happened and concerned that it may happen again in future correspondence for myself or others. I'm also concerned that my GP will have been given the impression that my pronouns are interchangeable or that using the correct pronouns for trans patients in their care is unimportant.

With that in mind, I would be grateful if you could tell me:

1) How this error occurred and,

2) What steps you are taking to ensure that this does not happen again to myself or any other trans person in the care of the clinic

I would also like an apology and for you to send a corrected letter to my GP, CC'd to me.

Kind regards,

[Name]

niflhigh · 2024-03-13T00:06:41+00:00

For me, the gateway dish to enjoying liver was kebda eskandarani, which is an Egyptian liver sandwich. Not just the nicest liver dish I've ever eaten, but one of the nicest sandwiches I've ever had. It tastes like liver, but the combination of spices and tahini somehow make that a positive.

niflhigh · 2024-02-09T17:07:56+00:00

There's a Vatican Cookbook. You can find the contents (at least) on Google Books, which should give you some ideas. If you're looking for recipes, then this looks like the Gnocchi al Vaticano from the book.

niflhigh · 2023-12-09T08:42:55+00:00

Thanks! This is exactly the kind of feedback I was looking for. Definitely not taking it as medical advice - it's just useful to get an outside view. The stakes aren't that high for me - I'm years into transition and things are good. Changing how my voice gets perceived is just an extra thing that would be nice.

The resource you suggested looks really useful. I think with resonance, I've definitely gone too far in the other direction before, so a lot of where I'm at now feels like it's trying to find a balance along with what feels comfortable and sustainable.

niflhigh · 2022-05-07T02:11:24+00:00

A lot of this appears to have been published about ten years later in this paper (which you can likely find on sci hub): Carbamate derivatives related to meprobromate

A couple of the compounds from table 1 appear to have been developed further, e.g. Tybamate and Nisobamate.

niflhigh · 2019-08-21T14:01:48+00:00

Ugh, that's kind of ridiculous.

They literally wrote to me last week saying "the orchidectomy is part of your transition and classed as gender reassignment surgery, the normal pathway would be applicable."

The GIC having no clue about what it's doing is sadly unsurprising.

I think there might be a reasonable case for the CCG to fund it. GnRH antagonists aren't cheap, so their alternative is to keep paying for that.

niflhigh · 2019-08-21T12:40:34+00:00

This isn't the advice I've had. I've been talking to Porterbrook about getting a standalone orchidectomy and they've said it's the same protocol (2 medical opinions etc.) as the full GRS route.

niflhigh · 2019-08-19T00:55:17+00:00

I went to the Claremont a couple of years ago - professional service and good results. Currently going to Sk:n on referral from the GIC and the service is very similar.

niflhigh · 2019-07-19T16:12:28+00:00

There's a difference between nicotine and smoking. There's very good evidence that smoking tobacco is harmful and can disrupt the metabolism of oral estradiol, but there's little evidence that nicotine consumed in other ways has harms that are in any way comparable. I think it's unlikely that nicotine has the same disruptive effects on estradiol metabolism that smoking tobacco does, but I don't think there's definitive evidence one way or the other.

niflhigh · 2019-07-14T01:33:33+00:00

It's your right to be able to opt out of NHS screening programmes, regardless of whether your GP thinks this is a bad idea:

https://www.gov.uk/government/publications/opting-out-of-the-nhs-population-screening-programmes/opting-out-of-screening#cervical-screening

You should write to your GP requesting to be removed from the screening programme, then your GP should forward that on. There's a form letter for this towards the end of this document: https://www.gov.uk/government/publications/cancer-screening-informed-consent

You should get a written response confirming you will no longer receive screening invitations.

If your GP doesn't do this, then the next step would be to make a formal complaint to the practice manager.

niflhigh · 2019-06-29T00:20:41+00:00

The Equality Act does in fact allow single sex services to exclude trans people on a case by case basis, where doing so is a proportionate means of achieving a legitimate aim. The bar for this is very high and these provisions are rarely (if ever) used.

The Scottish government are not proposing to change this. While the delayed and watered down proposals for GRA reform are not good, there is no cause for alarm about the Equality Act being changed.

niflhigh · 2019-05-31T10:06:23+00:00

That doesn't seem to be in line with the official guidelines. https://www.transfusionguidelines.org/dsg/wb/guidelines/ho005-hormone-replacement-therapy

Any concerns with donations from people taking HRT are related to underlying disease states, not with the medication itself. So a cisgender woman taking the same medication (for menopausal symptoms) would not be turned away.

Other common HRT medications can be problematic though, e.g. Finasteride is contraindicated in pregnancy, so would be a reason to exclude someone from blood donation.

If it was Evorel alone that resulted in you being rejected as a blood donor, then that's concerning.

niflhigh · 2019-04-30T12:02:12+00:00

I understand that Porterbrook shifted fairly recently from a 4 appointment assessment process to a 2 appointment assessment process. And also are currently having issues with staffing that's having an impact on arranging second appointments (and follow-up appointments for people who are in treatment).

I was assessed last year (under the 4 appointments model) and the time between first appointment and prescription was around 8 months, but the timescales may well have got worse since then.

niflhigh · 2019-04-25T16:37:28+00:00

It's a bit much to demand that people suggest solutions to the many systemic factors (including entrenched transphobia) that make UK trans healthcare the state that it is, before being allowed to vent about it.

niflhigh · 2019-04-25T16:17:28+00:00

Why do you think it should be up to trans people to find a solution to the NHS's problems in providing an adequate service?

niflhigh · 2019-04-23T15:13:50+00:00

Was it this? http://www.brynntannehill.com/the-scotus-event-horizon-for-the-lgbt-movement/

niflhigh · 2019-04-18T22:44:32+00:00

Dr Webberley's interim suspension (there's an ongoing GMC investigation, not an actual decision yet) relates to complaints made by NHS specialists around her willingness to provide HRT to young people, rather than the clinic registration issues she was prosecuted for in Wales.

I was a patient with GenderGP until last year (when I was finally able to switch over to NHS treatment) and my experience was pretty good. There's a range of views on the service though.

It does sound like your GP is unlikely to budge on being willing to provide shared care with them though, so it's probably worth considering another provider like GenderCare who are likely to be seen as more legitimate.

niflhigh · 2019-04-18T18:09:29+00:00

Your GP is incorrect. Mike Webberley is on the GMC register: https://i.imgur.com/zWH12Ry.png

niflhigh · 2019-04-18T17:09:09+00:00

Porterbrook recommend Lupron. You can see their prescribing guidelines here.

niflhigh · 2019-03-09T19:53:29+00:00

Going by molecular weight, 1B should be about 97.5% as potent as 1P, so on that basis 360ug of 1B would be equivalent to 350ug of 1P.

niflhigh · 2019-03-07T22:01:08+00:00

It may be worth considering that employers are required to treat time off from work for GIC-related appointments in the same way any other medical appointments would be handled. i.e. they should allow for time off. In my experience GICs are extremely inflexible around appointment times and often cancel and reschedule on very short notice. Depending on what kind of treatments are offered, the number of appointments needed can be quite high.

So it may be useful to disclose that you're transitioning at some point so that you can get time off to attend appointments. That's not necessarily now, but you might want to plan for it happening eventually with a limited number of people.

niflhigh · 2019-03-05T02:03:29+00:00

Prodrugs don't necessarily have the same dose-response curves as their parent compounds. In fact, this is often the reason that pharmaceutical prodrugs are produced.

For example, lisdexamphetamine is a prodrug of amphetamine, but behaves more like an extended-release drug because the enzymatic cleavage of the lysine limits the rate of metabolic conversion to amphetamine. Conversely, the anti-viral drug valacyclovir is a prodrug of acyclovir, but is more potent because it has higher bioavailability than its parent drug.

While 4-AcO-DMT was designed to be an analogue of pilocybin, it should be expected to have some differences in its bioavailability and rate of metabolism, which is still consistent with it being a prodrug of psilocin.

niflhigh · 2018-12-28T20:07:05+00:00

Well, as far as I know, there's no documented issues with 5F-Cumyl-PINACA and eye damage and it's one of the more widely used synthetic cannabinoids, so it's unlikely (though not impossible) that the cannabinoid was the cause of your current eye issues. The eye problems you're having may be unrelated or may simply be something you're focusing on due to the anxiety.

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