TransMed

T-Community Research:
What We Don't Know
Could Kill Us


by Sheila Kirk, M.D.


he backbone, muscle and cardiac function of science is research.

In the Human Genome Project, investigators who are experts in an incredibly complicated science called genetics, are looking at the genes that occupy positions on each and every chromosome in the millions upon millions of cells in our bodies. There are genes that determine a Mozart , an Einstein, a John Kennedy-a Mahatma Gandi! There are genes that make some of us liable to elevated blood pressure , to cholesterol aberrations, to skeletal deformities, to breast and colon cancers.

As you know, it is very strongly believed that there is genetic reason for the Gay/Lesbian individual. Have you thought ever that there may be genetic reason for the Transgendered person as well? The Human Genome Project could tell us that. It could add fantastic support to what is observed clinically by post mortum studies such as reported by Professor Louis Gooren from the Free University Hospital in Amsterdam wherein the brains of deceased MTF Transsexuals were examined and found to have special and unique changes in the hypothalamic areas, that are identical to that of genetic females.

Think of it-when they get around to it, the Human Genome researchers will find---I predict it without reservation---a gene or several genes that are distinctly related to why we, the transgendered are what and why we are. They will discover biologic cause for why some of us are CDs and some of us are Transsexual and why the subtle and even gradually developing progression from one to another takes place. Scientific investigation, and research, will take a firm and indisputable stand to justify us as the unique and special population that we know we are.

Actually, I have a problem with what I just wrote-we don't need to justify-we need only to explain!! But the research needed to look at the Transgendered with accuracy and assistance is overwhelming. We need studies that deal with psychologic processes in us all, no matter where we are on the spectrum.

What We Don't Know About Hormones Could Kill Us

We need studies that investigate and report the effects of contra-hormonal therapy in both the M-F and the F-M person-the effects on health and the potential for disease not suspected. Let me give you some ideas. We don't know at all the long term effects of feminizing hormones on the breasts of the genetic male.

Is the incidence of malignant disease -- cancer -- in any way different for transgendered males using estrogen than for those that are not. We know the incidence of breast cancer in males with no estrogen use is very low, not at all in the same incidence as with genetic women.

We don't know however, what family history of breast cancer can mean for males using estrogen. We have no current studies that tell us of risk relative to dosage or to duration of use. In fact, we know nothing-except for the increased incidence of breast cancer in males who have a chromosomal alteration called Kleinfelter's Syndrome. They are 47XXY as opposed to the normal chromosomal count of 46XY and their risk for breast cancer maybe even greater than genetic females. Some of those individuals are Transgendered. Should they take estrogen? Are they at increased risk over and above being at the level of risk they are if they use estrogen?

We don't know!

Let's look at female to male individuals. When they take testosterone they respond to it in a very maximal way. The changes in their appearance and in the various physiologic systems that react as they do, is very striking.

We know from recent studies that without the positive effect of estrogen on the various parts of the Lipid profile (i.e. cholesterol), and in fact with the superimposed influence of testosterone on those parts of the lipid profile, we suspect strongly in reported medical literature that cardiovascular risk can be increased for these genetic females.

Have we currently any studies supporting this suspicion to prove or disapprove it? Unfortunately-No!

While eventually we will learn what the true picture is, in the meanwhile, we have physicians who don't obtain baseline cardiovascular evaluations for their F-M patients on testosterone and their on-going monitoring is not oriented to observing possible heart accident potentials and even more-- they don't stress the problems that smoking, overweight and hypertension add to the risk of developing heart disease to their patients.

Does estrogen protect the prostate in the male using estrogen from the intense discomforts of benign hypertrophy and even more important the ravages of prostate cancer--the second most common cancer in the genetic male? We don't know! We suspect it does but we don't know! There are no controlled well-planned studies.

Mental Health Issues Abound Too

In the area of mental health the questions abound. We know nothing whatever about the psychologic differences between the male crossdresser who knows he is male and lives thinks and functions as a male, and the male to female transsexual who knows she is female and strives all her life to accomplish conformity in mind and body. We know so little about sexual orientation and its variations, and its changeability in the mind and behavior of the Transgendered, both male to female and female to male. We know so little about the psycho-social mechanisms that function and transpire in the Transsexual Male to female and Female to Male after their surgery. We know next to nothing about Transgendered youth and how to help them in the process of learning about themselves and how to live comfortably with that knowledge.

Our approach to the very complex problem of the management of the intersexual person is primitive, rudimentary and actually heartless in the way these individuals are cared for. The problems are many and complex and I've only given you a small insight into what we need to learn. But here is perhaps a more profound area to look at.

Can we count on our professionals to help us in gathering this knowledge and then applying it in the proper ways? To some extent, Yes! But many in my knowledge, particularly, the front line therapist and medical physician only treat -- sometimes not very well -- and never gather information that can contribute to the fund of knowledge developing ever so slowly.

What can we do? How do we stimulate the researchers to do more? To learn more? To report more about us? And to do so with accuracy and responsibility.

We can learn ourselves from what we can read in the literature, written about ourselves. We can become knowledgeable about our community and what needs to be said and done. We can give our talents and abilities to various endeavors that help the community to grow, to mature, to become strong and cooperative. We can take our resources and put them to work for groups and projects in the Transgendered Community that we believe in our hearts to be important and of value. We can speak out through those who want to use their voices on our behalf.

We can support our own transgendered researchers and investigators in whatever way we are capable-- with finance, with talents, with all efforts that are possible. We can assist them to go forward and to learn-- not only for ourselves but for the society around us that knows so little of our value and our worth. And my dear sisters and brothers-we do have value and worth.

Come to the happy realization, if you haven't already, that we are valuable and unique to the world. We are silent too much-we have been hidden too long! I ask you to look hard at the value of yourselves and those who work to show that value to the world.


Sheila Kirk, MD is a Transgender Medicine Specialist, board-certified in Obstetrics and Gynecology and in practice in Pittsburgh, PA. She is a well-known author and leading authority on transgendered medical care and research. Dr. Kirk provides international and national consultations and referrals to the TG community and health care professionals who assist in their care.

She can be reached the following ways:

    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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