Hormone supplementation can be a very helpful tool for some transgender people to live full and authentic lives. There is also a great deal of fear-mongering about the side effects of hormones, usually from non-transgender doctors. While more long-range study is needed, a large-scale recent long-term trial found no elevated risk for mortality, either broadly or specifically, for transgender people taking hormones. (1)
Care providers who try to scare trans people away from hormones are not standing on firm evidence in doing so.
That being said, the lack of mortal danger does not mean that there are never annoying or difficult side effects from hormones. Any medication, taken over a long period, can cause some unwanted experiences to occur. In the next two articles in this series, I’m going to break down some of the most common side effects of testosterone and estrogen supplementation, and explain how Chinese Medicine can help resolve them.
Testosterone, as we’ve discussed in the past, is primarily a hot and yang substance. What this means in practice is that it makes this growth, move faster, and makes people feel warmer. What it can also mean is that it can cause some people to get too hot, and develop unpleasant symptoms as a result. In Chinese Medical thinking, the yin of the body, or the cooling and moistening substances, need to be able to balance out the yang.
Over time if the yin is taxed by something, whether it’s a stressful life event or something we are consuming, the heat can overwhelm the system.
Some signs that this may be happening include; night sweats, anxiety, heart palpitations, changes in hunger, hot flashes, acne and pain in the legs. These are mostly symptoms that are associated with puberty or menopause, and there is a very good reason for that: people who are taking testosterone are inducing puberty and menopause, concurrently. This is not a bad thing; it’s just a life process.
But it can be a lot for the body to deal with.
In addition to heat, sometimes testosterone can lead to reduced blood flow in the lower abdomen, or what we call “blood stagnation” in Chinese Medicine. Blood stagnation can manifest as frank tissue changes, like polyps or tumors, but most often it shows up as pain from impaired microcirculation.
This can result from muscular changes in the pelvis bowl (particularly that pesky psoas muscle), the cessation of menses, or from the surgical removal of reproductive organs. Some trans people who take testosterone find that they develop mysterious wandering pain in the lower abdomen after several years on testosterone.
The fact that some people experience these unpleasant effects can feed back into the medical world’s desire to pathologize transgender people and say that taking hormones is just bad and dangerous.
This is rarely said, of course, for most other medications. Very few people say “metformin can cause diarrhea in some people, so no one should ever take it”, because it is seen as a life-saving drug. Hormones are also life-saving, and deserve the same medical care and respect as therapies. The correct way to think about this situation is not to say that testosterone is bad, but rather that we need to help the body integrate the changes from hormone supplementation in a more efficient way.
Acupuncture and Chinese herbs to do this, along with dietary changes in some cases.
The body is intelligent, and can learn how to self-regulate under new conditions. We can help it to vent excess heat, supplement yin, move blood, and adapt. Acne can be treated, night sweats disappear, hunger cues return to normal, and the body changes in a normal and healthy way. Instead of yelling at people about the “dangers” of the medications they take, we can work with people and make their experience be the smoothest it can possibly be.
Note: Not all people will have unpleasant side effects from testosterone, and not all side effects will look like what is described above. Each person in unique, both in their constitution and in their life experiences and circumstances.
If you are taking hormones and experiencing any difficulties, feel free to schedule an appointment with me so we can talk through what classical Chinese medicine might be able to do for you.
(1) Largest Study to Date: Transgender Hormone Treatment Safe. Kathleen Louden. July 02, 2017 http://www.medscape.com/viewarticle/827713
It’s a dilemma that trans-masculine people know all too well: the need to reduce the painful experience of dysphoria on the one hand, and concerns about longterm health on the other. At first, the decision is easy; we strap down our breast tissue somehow some way, whether with ace bangs, commercially-made binders or compression shirts. The internal alarm bell that goes off when we look into the mirror or down at ourselves quiets, and we finally get some relief. All seems well for weeks, maybe months.
Unavoidably though, a new problem arises: pain.
Where the pain resides exactly depends on the person and the binding method, but it will arise. Compression of our rib case, and the soft tissues beneath, can lead to a wide variety of problems. Rib pain, shortness of breath, dizziness, and even scary chest pain can all becomes staples of daily life during binding.
Let’s examine how to think about this situation using the tools & science of Chinese Medicine. In this way of thinking, the trunk of the body is divided into three compartments, or Jiao. The upper Jiao contains the lungs, heart and pericardium. The middle houses in the liver, gallbladder, stomach and spleen, while the lower is the home of the kidney, bladder and both intestines. The final organ, the Sanjiao or Triple Burner, is a network of water passages that connects all three for the purposes of transport and communication.
In addition to the organs, we also have meridians or Chanels associated with each organs, as well as larger channels that connect all twelve.
The most-often-used metaphor for this system is a watershed that runs through the deepest parts of our bodies, which then consolidates and emerges into broad rivers between the muscles and fascia, finally concluding as small streams at our surface. What a nice metaphor – and it has broad utility. This network, according to Chinese medical theory, carries information, regulates water metabolism, and ensures that homeostasis (the balance inside our body that enables health) is maintained by subtly responding to all of the weird things that happen us throughout our lives.
Given this system’s intricate levels of communication through different kinds of tissues, imagine what might happen if we took the entire thing in the upper and middle Jiao, and squeezed. Not just once, but constantly, every day, during every waking hour and sometimes sleeping hours as well. One can imagine that all sorts of processes could be negatively impacted!
Here are a few of the potential consequences, on this view:
Blood flow: blood is hugely important process that our bodies use to transport nutrients, gasses and yang (life force) from place to place, and its functions are especially associated with the heart, pericardium and liver. If blood flow is impeded, these organs can become either too full of blood (stagnation) or have their blood supply be subtly reduced (deficiency).
Symptoms can include chest pain, pain in the ribs and abdomen, anxiety and depression.
Water metabolism: The spleen, lung and kidney are all important organs that ensure the proper flow of moisture around the body. The kidney is said to seam water up into the upper Jiao, the spleen to transform and transport it from food and drink into the other organs, and the lung to accumulate moisture and then rain it back down to the rest of the body. If the lung becomes physically compressed, moisture can accumulate and build up as phlegm.
Over time, the heat of the body can cook this immobilized phlegm into a hot goo that results in chronic congestion, hot chest pain, cough and anxiety.
Qi transformation: the work of the organs is done around the body by their associated channels, through a process called Qi Hua or Qi transformation. To give one example; the stomach channel carries the hot and drying Qi of the stomach organ up the front of the body to assist with digestion, heat distribution and immune functions.
Cutting down the size of its pathway through the chest can impede its flow, resulting in stomach organ issues like reflux, nausea or vomiting. It can also have implications for our immune systems.
All of the issues that can arise from binding can be treated through acupuncture, herbs, bodywork, and targeted exercise, but their cause is the practice itself. I want to be careful here not to engage in victim-blaming. Many healthcare providers think about this issue and say “yes, my patients should certainly stop binding if it’s causing so many problems!” But that ignores the entire reason that we do it in the first place. Dysphoria is a very real health problem with severe mental health implications.
Binding is often a life-saving act of harm reduction that allows us to life our lives without the constant mental anguish that dysphoria creates.
Surveys of people who bind find that the vast majority of people are doing it while they await the ability to access a surgical solution. Until very recently, top surgery was not covered by insurance and was only available to those who could pay out of pocket. This has begun to change in some states, but remains the case for most people. Therefore we should remember that binding is a self-preserving response to a societally-imposed scarcity of medically-necessary healthcare.
While we engage in the activism needed to change this, here are some harm reduction strategies to consider:
- Stretch it out: engage in stretching poses that open the chest and ribs, for at least five minutes a day
- Build strength: strengthening the muscles of the back and chest may help hold the body of your ribcage in place and protect them from the longterm effects of compression
- Move your body: qi and blood move when we do, and exercise of any kind helps prevent stagnation. Depending on how you bind, running may not be a great plan, but walking is wonderful for both our bodies and our moods.
- Get some acupuncture: we can reduce stagnation and pain by unblocking channels and moving qi and blood in targeted ways
- Take some herbs: chest stagnation and digestive issue in particular respond well to Chinese herbals formulas
- Listen to your body: only you can know what is right for you in terms of when to bind, how to move, and how to balance all of the considerations in your life.
Above all, be gentle with yourself as you navigate the complexities of trans experience. If you want support in your journey, schedule an appointment and let's see how we can work together.