TransMed
Informed Choices Towards Better Health Care Management
By Sheila Kirk, M.D.
Our community needs to have information but it also needs the education and sense of judgment to process that information. Of late more than ever before, information is available in our literature and particularly on the Net. But our readers don't always have the knowledge to assist their sense of judgment. I often hesitate to use the word "ignorance" it has a derogatory connotation. When one looks for definition, however, ignorance does not mean lack of ability to understand or a lowered intelligence-it means being without information so as to make proper judgement or decision. Now what am I saying? I've just told you that more information is available than ever before and then I say that our community is without information. What I want you to know is that often, too often, my sisters and brothers don't have the correct information. They don't have accuracy. They don't give real balance when difficult facts and findings are presented particularly in matters of health.
Science and particularly medical research is complex. In many instances experimental results are confusing even to those medically trained. Good research is very often in conflict with bad research and clinicians and researchers must reflect and weigh carefully what they learn in the medical literature. They must call upon their experience in the areas of their expertise to make judgements about what is reported. So they have trouble, too.
Where does that leave you? Most of you don't know where to find the medical literature much less how to read and interpret it. How much comfort can you find in the reports made to you not only by untrained individuals but even by professionals who make statements that can mislead and misinform? I offer some wisdom and some clear thinking aided by facts - facts other researchers and clinicians in medicine offer in creditable work and reporting. Add what I report to your fund of information and use it with your logical thought, your sense of personal safety, and your ability to make good judgment and add to it your just plain good common sense!
Take these examples for starters:
Free Silcone Injections
Death In A Third of Cases
A very concerning problem has to do with the use of injection of free silicone - a practice sought after by a considerable number in our community who want instant body and face contouring and who encourage others to do the same. Even worse, there are professionals uncaring enough to accede to their requests.
There is no way to report to you just how many in our community take such an approach to breast enlargement as well as hip and leg modeling. Hence, no one can report an accurate incidence of complication. None the less, just one disastrous complication can be development of a chemical pneumonia. When patients present to a doctor or an emergency facility with this disease, the mortality rate is about 35%.
Think of it, one out of three with this highly serious lung disease will die. In studies reported in the medical literature (but not disseminated in our own literature), these individuals have very often, previous experience with injections of free silicone but no untold effect. This is an encouragement to use this method once again to accomplish physical changes but it is falsely reassuring. The problem, an immensely serious one, can occur with no warning and no hint of impending danger. Should you be deeply worried about this? You should be. Very much so!
Hormones: No Questions Asked?
Occasionally, individuals are urged to purchase hormones from mail order houses in various parts of the world. They are given names of firms and their addresses that will supply them with "mones." Just send in the money; get your "Mones" no questions asked.
This directive sponsors the self-medication attitude and implies that it is safe to bypass the monitoring of one's health by a capable and experienced physician. If our community is not advised to obtain ongoing monitoring at the same time they are being told of mail order meds, they are being misled. To obtain those meds at less expensive prices is NOT arguable. I support that vigorously. But to suggest purchasing them with no advice or supervision is to foster the idea that you can do it by yourself. And to condone the idea that the mail order user is in charge of his or her own medical decisions and care is decidedly dangerous.
To use contragender hormone therapy is to actually tamper with genetically programmed biologic systems in place for years. To do it without guidance is setting one up for potential serious complications that may not be reversible.
To support and encourage this method as some do who are trained (but mostly non-trained) in the complexities of endocrinology is not only unethical but shows little care and regard for your health and well-being.
I pose this one simple question to you. Would you feel comfortable with encouraging a loved one of yours (partner, parent, child, sibling or friend) to purchase and consume a potentially dangerous medication without medical supervision? If your answer is no, then please practice the same love and concern for yourself that you do towards those that you love when considering self-medication and medical care.
If you want to purchase your medications through mail-order make sure you are receiving what you think you are. And please make sure you have a physician who knows what you take, provides you with the safest and most effective dosages and tests you regularly to be sure you're not inducing changes and harm that is damaging to you and potentially fatal.
There is one more very notable consideration we must all be aware of and we must not make light of it. It's called thromophlebitis and its potential counterpart embolism or blood clot to the lungs (when the phlebitis is in the deep system of veins in the legs or lower abdomen and the blood is draining into the right side of the heart.) This is a real potential. The condition is reported in the medical literature in transgendered individuals using estrogen. It is noted after traumatic incidents, after surgery and occurring quite spontaneously unassociated with either of those occurrences. It is known now and has been for some time that estrogen can disturb the very complex series of reactions that are in place to stimulate clotting when it is needed. When vein inflammation and clot formation occur and principally because of the estrogen regimen in use, the individual can be in grave danger because the clot formed can break off from the vein wall and travel to the right side of the heart then through its chambers to the pulmonary artery and into one or both lungs. If the clots are small and many, they will block blood supply to various portions of the lungs. If the clot is large, it can block the pulmonary artery at its divisions going to both right and left lungs and death will be imminent or sudden. This is known as a saddle block embolus. The individual has to be near to astute and experienced physicians to make diagnosis and institute treatment or all is lost.
I know of several physicians who speak lightly of this very serious complication stating they have never seen a case of it or heard of death as a consequence. Recently, a physician stated on the Net that it was quite unusual and suggested that estrogen and a blood thinner called Coumadin or Warfarin can be used together with no concern. Frankly, I don't know the experience of this physician in treating our community; nor do I know of their training or the discipline of medicine in which they hold their medical degree. But from what they state, I do know they are incorrect in being so casual.
The condition of phlebitis and embolism is the fear of all surgeons who have operated patients in older age groups or with leg or pelvic diseases. Safeguards are many to avoid this complication and if it occurs treatment is sometimes difficult and even lifelong. Does it happen "out of the blue" to those of us who use estrogen? Yes, it certainly does and in the experience of some investigators reporting to the medical literature it occurs in up to 8% of patients under a number of different circumstances. In T persons, it occurs more often in those 40 years and over and with estrogen use under one year. I don't think that incidence should be regarded as "unusual occurrence" and I question strongly the casual statement that treatment for the disorder can be given along with the offending and causative medication with little consideration.
This isn't to say individuals once experiencing deep phlebitis with or without clot to the lungs can never use estrogen again.
The Gender Team at the Free University Hospital of Amsterdam does treat with estrogen by the topical route of administration but after complete recovery and when studies show that the individual is as free from reoccurrence or residual as can be determined. This is not a condition to be taken lightly and because of the dangers most surgeons performing GRS require that patients stop estrogen therapy about 4 weeks before the operation. The legs are wrapped to compress the veins during and after the surgery, early ambulation is instituted, even light anti-coagulation using Heparin is given during surgery by some and for a time afterward in selected patients.
Just recently an obviously unknowing writer stated that all of this - including interruption of estrogen before surgery - is unnecessary. To support her argument the writer stated that genetic women with functioning ovaries aren't castrated when they undergo surgery. No, they aren't but two very important pieces of information should be made known to you. First, with corrections for the kinds of surgery performed in genetic women and the somewhat greater number of women having pelvic and abdominal surgery in comparison with men, genetic women with functioning ovaries have a higher incidence of deep vein and abdominal phlebitis with or without embolism. It should be noted that hormonal therapy in genetic women is interrupted prior to many surgical procedures. We believe that while other causative factors are in place the estrogen they produce is decidedly involved as well. In addition, they are making physiologic amounts of the hormone. That means the amounts of estrogen in their blood streams in infinitely smaller than the pharmaclogoic doses taken by Trans women.
The potential for vein inflammation and clot formation is higher in the Trans person on these doses. It's a wonder the incidence is only 8%. No, castration is not necessary or even possible for genetic women having leg and abdominal surgical procedures but the incidence for them is significant and it is significant for the Trans person also. Cessation of hormone used for the T patient for several weeks before is not a comfortable thought for many of you both emotionally and physically but several weeks of annoyance is better than a potentially fatal consequence.
I ask you earnestly to seek qualified, experienced physicians and surgeons to help you on your personal gender journey. I also urge you as you read and examine the information from others who teach and inform that you will use careful judgment before you use the provided information as a basis for altering physical change. In virtually all cases, all of us, trained and non-trained whether Transgendered or not, mean well. But not all information relayed is good and caution should be taken regarding your care. Remember, treat yourself with the same love, respect and concern as you do those that you love. You'll be happier and healthier and your loved ones will thank you for it!
Sheila Kirk, MD recently has made Trans-history by forming the first
Transgender Surgical & Medical Center (TSMC Center) developed and directed by
a Trans surgeon. In addition, Dr Kirk is the first Trans-surgeon performing
MTF GRS and related surgeries as well FTM top surgeries, hysterectomies, etc.
for her community. You can receive more information about the TSMC Center or
ask Dr. Kirk questions on your treatment and care, by contacting her at
TSMC@aol.com, by phone (412) 781-1092, fax (412) 781-1096 or snail mail:
TSMC P.O. Box 38366, Blawnox, PA 15238.
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