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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