There is a dearth of clinical knowledge and expertise in the slowly yet surely evolving field of Transgender Medicine as only lately most practicing physicians have honestly  acknowledged that they know little or next to nothing about Transitioning for these patients. But many enthusiastic and honest professionals are starting to study the clinical challenges posed by these patients and trying some specific, practical steps.

Considering that Transgender people are usually receiving treatment with exogenous hormones that alter their metabolism, the established treatment protocols might not be entirely appropriate and they must be adjusted. Moreover since the hormonal schedules are often changed in composition and dosage, the treatment of chronic ailments must be adjusted accordingly.

The use of Testosterone in the female to male transitioning schedule could worsen a previously existing endometrial neoplasia. The use of estrogens in the male to female transitioning schedule can stimulate the appearance of blood clots. The use of hormones can affect chronic neurological diseases like Epilepsy. Some studies have suggested that there is negative interaction of Estrogen with antiepileptic drugs but its extent has not been established. The control of seizures becomes more difficult as new hormones are added.Transgender people have a higher rate of HIV infections and use retro-viral medication, which can interact with the hormones in still unforeseen ways.

Sadly one of the commonest reactions of clinicians who encounter treatment difficulties in their Transgender patients is that they must immediately stop the use of hormones until further notice. The subconscious in their minds still resists the idea that Transgender people are different and they need their hormonal treatments to become fully identified with their gender of choice. The only way to surpass this obstacle is to maintain good communications between the clinicians and the experts managing the hormonal treatments. Trans patients occasionally complain that some drugs are promoting a faster metabolic degradation of the hormones in their livers, for which they cannot benefit from their full metabolic effects in their Transitioning protocols. Instead of just dismissing those complaints, physicians should find solutions.

What do you think? Please tell us.

Don’t leave me alone.

13 thoughts on “Clinical challenges in Transitioning

  1. Hi Dr. Sahib, this is a very interesting article to read. Glad that you chose to write about this topic, as the transgender community (in my opinion) seem to need greater support as compared to other communities in the LGBT group, especially the FTM population.
    I am not a medical expert, but I do know some biology, so I will be using whatever knowledge I have to suggest.
    For the use of estrogen, I wonder if it could be possible to use blood thinners to reduce the side effects – blood clots, since blood thinners are used by patients having high cholesterol.
    Regarding the part where doctors stop the patient’s use of exogenic hormones, I feel that such an action may worsen a patient’s psychology, bringing about mood swings and maybe even depression, from the deprivation of transitioning into who they really feel they are.
    All in all, I feel that dismissing issues or patient’s claims is not a solution, but rather, a detriment to the transgenders who were given hopes of transitioning through the starting of the hormonal treatment.
    Thinkthoughtstaught 🙂
    P.s. decided to follow you as well. Hope to learn a great deal from your posts! 😀 Thanks!

    1. Dear TTT: good evening and thanks for your comprehensive commentary. Using Coumadin to counter the clotting side effects of estrogens is a risky proposition that might need further studies. Remember that it is a toxic substance that might further complicate the hormonal treatment.We fully agree that the knee-jerk reaction of stopping their hormonal schedules at the first sign of complications is a grave mistake. I noticed that you are based in Singapore. What is the general attitude of the medical establishment of such a highly regimented city-state towards the Trans people? If you liked this blog please check a previous one I did with the title ” The Trans also exist” listed under the “Health Care Justice” series. Thank you for following me. Buona notte!

      1. Dear Dr. Sahib, Singapore is still rather closed and traditional about such issues in my opinion, especially for MTF individuals. Although Singapore does have medical professionals that give such transitioning treatments, these issues and the answers are mostly hidden under.
        Okay! Will read your previous posts as well! Thanks for your recommendation! 😀

  2. Dr. Sahib, we writers generally write about the condition transgender but hardly want to know or delve about Transgender Medicines about which there is very little information or if it is available, it is not being given, due to less publicity including the dosage for proper treatment.
    I am really impressed by the know-how about the adverse affect that Testosterone could bring about. This could bring about awareness about its use by the transgender. The likely adverse effects mentioned in the blog is really wonderfully explained. But I think, more research is called for HIV infections, as these hapless people are generally found to be inflicted with. The use of hormones, as given on the blog, should be restricted to the extent possible. Care ought to be exercised that the medicines which give rise to metabolic degeneration should not be used. I feel, more research is called for so that proper medicare is done for these people amongst us. A great job in fact.

    1. Good morning and thank you for the focused and comprehensive commentary. You’re absolutely right in pointing out that more research is needed and that’s exactly what all the physicians involved in Transgender Medicine like myself, are doing. You’re also right that we do not exactly know the real incidence of AIDS in this population and that is due to two factors. One is the inequity of access to needed health care services forvthis population. Secondly, the ” gender identity” is not properly considered and measured in Public Health population studies, masking their real presence, which skews the data. Sahib, please keep reading and commenting my articles.

      1. The Yeoman’s service the doctors associated with you are doing is obviously laudable. This segment of society need the due attention. They too are our fellow brethren and deserve to be cared. Laudable indeed. Thanks.

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