TransMed

Q & A:
A Selection

by Sheila Kirk, M.D.
Surfing the net, it has become very clear that those in the Transgendered world want information.

They want to know what pathways they can take and where the pitfalls and obstructions are. They question each other in chat rooms and give of their personal experience or what they have learned from other resources. I want to add my thoughts from time to time. I want to answer questions and give information and generate discussion. I want to help.

Occasionally when writing for the Forum, I will put out a batch of questions that have been posed to me or I have gathered from my occasion "net-surfing" and then answer them as accurately as I can. If you think, that this method of exchange is helpful, tell my colleagues who are in charge of Transgender Forum and I will continue to write in this way now and again.

Q: If I develop phlebitis (inflammation and blood clots in my leg veins) while on estrogen-why is it stopped and can I ever go back to using estrogen again?

Estrogen can, for a percentage of users, change our clotting mechanism so that inflammation takes place in the vein walls and especially in the deep system of our leg and lower abdomen veins, blood clots form. A physiologic process that is usually a benefit in our body, is now a villainous and dangerous situation. The estrogen must be stopped and in the view of many physicians, cannot be used again.

Recent research indicates that after appropriate time has elapsed, with proper and effective treatment-the individual could go back to estrogen use by way of the patch (Transdermal delivery). The studies indicate that these individuals can again benefit from the contrahormonal therapy and do not develop the phlebitis again. In my view, if the studies hold up, it's a wonderful thing to be able to continue the feminizing process with no threat where once before the regimen was totally sidetracked.

Please be clear about one thing: doses of ANY estrogen in excess can lead to phlebitis and it is when individuals misuse their medications or are unsupervised that they run that risk. But occasionally even appropriate estrogen dosage can cause this problem Hence your doctor should give you instruction about the development of the disorder and teach you some of the basics of early diagnosis and awareness.

Q: There is so much said about surgeons who do SRS and cosmetic procedures and so much comment about good results and bad ones. Why do they go in and out of favor so much?

It's unfortunate that there are so few surgeons in the world who are skilled and empathetic to the individual who wants genital and cosmetic reassignment. Hopefully, in time more will take interest and take part. Those that do work regularly to help our population do an excellent job.

They want good results as much as the individual who comes to them. They want excellent function and appearance in every procedure they do and in fact that happens about 90% of the time. But we don't hear about those successes, we hear most of the time about the failures-especially the disasters.

Let's look realistically at a few things. While these skilled surgeons quite accurately make use of many of the human body's physiologic systems to produce remarkable results, some things are out of their control.

  • The human body will always revert to its former functions and configuration-or it will try to. Its' built-in protective and reparative processes will always kick in when they are able and to the best they are able. Hence, a vagina or a penis constructed and placed where it was not intended to be by our genetic make-up will sometimes do only what the doctor does not intend. The vagina will close or undergo stenosis. It will shorten or even fall out of its surgically placed position. The new penis can become infected and sloughs or the urethral connection between the native urethra and the newly constructed penile urethra can break down and a fistula results. These things happen uncommonly but they happen. The surgeon does not intend it and is not negligent. It happens and his reputation will suffer for it.
  • Rule #2-Many surgeons are presented with circumstances that make a difficult task even more difficult. For instance, a patient presents with a short penis but wants a long vagina. She doesn't want grafts and when post-operative she has a shallow vagina which tends to grow shorter and is painful when she has intercourse. What a picture for discontent. Should that patient consent to grafts or even consider colovaginoplasty? These are important options but they cost more and the risks increase as does the cost. Who is to blame-the surgeon?
  • And what of factors that are always difficult to control in any type of surgery. Infection and poor tissue healing because of arterial loss or because the patient smokes or has diabetes. Many times unknown and subliminal factors deter good healing and bad results are the experience. I know I sound like the defending angel-- an M.D. protecting an M.D. In truth, I guess I am but I ask you to believe that the surgeons we know to be doing the best work are really doing the best work. Their accomplishments are not often made known, yet their failures are headlines in our community's grapevine.

Do we need more surgeons? Absolutely! Do the doctors we have need to reappraise their work periodically and improve their techniques when exchanging with colleagues. Absolutely! Do these doctors need to put their success and failures before us, their patients, by keeping accurate data and reporting it-perhaps on an annual basis. Absolutely! Would all this improve the level of excellence? Indeed, yes! But all the while, keep in mimd, there is no one on earth in any endeavor who is 100% successful 100% of the time. Do your homework. Have trust in your judgment.

If you have further questions on transgender medical care or would like to learn of an experienced health care professional in your area, please feel free to contact me.

    E-mail: SheilaKirk@aol.com
    Phone: (412) 781-1092 Fax: (412) 781-1096
    mailing address: Sheila Kirk, P.O. Box 38114, Blawnox, Pa 15238-8114

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