Trans Healthcare - Blog Posts

So today I want to talk about puberty blockers for transgender kids, because despite being cisgender, this is a subject I’m actually well-versed in. Specifically, I want to talk about how far backwards things have gone.

This story starts almost 20 years ago, and it’s kind of long, but I think it’s important to give you the full history. At the time, I was working as an administrative assistant for a pediatric endocrinologist in a red state. Not a deep deep red state like Alabama, we had a little bit of a purple trend, but still very much red. (I don’t want to say the state at the risk of doxxing myself.) And I took a phone call from a woman who said, “My son is transgender. Does your doctor do hormone therapy?”

I said, “Good question! Let me find out.”

I went into the back and found the doctor playing Solitaire on his computer and said, “Do you do hormone therapy for transgender kids?” It had literally never come up before. He had opened his practice there in the early 2000s. This was roughly 2006, and the first time someone asked. Without looking up from his game of Solitaire, the doctor said, “I’ve never done it before, but I know how it works, so sure.”

I got back on the phone and told the mom, who was overjoyed, and scheduled an appointment for her son. He was the first transgender child we treated with puberty blockers. But not, by far, the first child we treated with puberty blockers, period. Because puberty blockers are used very commonly for children with precocious puberty (early-onset puberty). I would say about twenty percent of the kids our doctor treated were for precocious puberty and were on puberty blockers. They have been well studied and are widely used, safe, and effective.

Well. It turned out, the doctor I worked for was the only doctor in the state who was willing to do this. And word spread pretty fast in the tight-knit community of ‘parents of transgender children in a red state’. We started seeing more kids. A better drug came out. We saw some kids who were at the age where they were past puberty, and prescribed them estrogen or testosterone. Our doctor became, I’m fairly sure, a small folk hero to this community. 

Insurance coverage was a struggle. I remember copying articles and pages out of the Endocrine Society Manual to submit with prior authorization requests for the medications. Insurance coverage was a struggle for a lot of what we did, though. Growth hormone for kids with severe idiopathic short stature. Insulin pumps, which weren’t as common at the time, and then continuous glucose monitoring, when that came out. Insurance struggles were just part and parcel of the job.

I remember vividly when CVS Caremark, a pharmaceutical management company, changed their criteria and included gender dysphoria as a covered diagnosis for puberty blockers. I thought they had put the option on the questionnaire to trigger an automatic denial. But no - it triggered an approval. Medicaid started to cover it. I got so good at getting approvals with my by then tidy packet of articles and documentation that I actually had people in other states calling me to see what I was submitting (the pharmaceutical rep gave them my number because they wanted more people on their drug, which, shady, but sure. He did ask me if it was okay first).

And here’s the key point of this story:

At no point, during any of this, did it ever even occur to any of us that we might have to worry about whether or not what we were doing was legal.

It just never even came up. It was the medically recommended treatment so we did it. And seeing what’s happening in the UK and certain states in America is both terrifying and genuinely shocking to me, as someone who did this for almost fifteen years, without ever even wondering about the legality of it.

The doctor retired some years ago, at which point there were two other doctors in the state who were willing to prescribe the medications for transgender kids. I truly think that he would still be working if nobody else had been willing to take those kids on as patients. He was, by the way, a white cisgender heterosexual Boomer. I remember when he was introduced to the concept of ‘genderfluid’ because one of our patients on HRT wanted to go off. He said ‘that’s so interesting!’ and immediately went to Google to learn more about it. 

I watched these kids transform. I saw them come into the office the first time, sometimes anxious and uncertain, sometimes sullen and angry. I saw them come in the subsequent times, once they were on hormone therapy, how they gradually became happy and confident in themselves. I saw the smiles on their faces when I gave them a gender marker letter for the DMV. I heard them cheer when I called to tell them I’d gotten HRT approved by insurance and we were calling in a prescription. It was honestly amazing and I will always consider the work I did in that red state with those kids to be something I am incredibly proud of. I was honored to be a part of it.

When I see all this transgender backlash, it’s horrifying, because it was well on the way to become standard and accepted treatment. Insurances started to cover it. Other doctors were learning to prescribe it. And now … it’s fucking illegal? Like what the actual fuck. We have gone so far backwards that it makes me want to cry. I don’t know how to stop this slide. But I wrote this so people would understand exactly how steep the slide is.

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spread this shit the fuck around

spread this shit the fuck around

spread this shit the fuck around

its like they keep forgetting the fact that its possible for us to get pregnant. like i know this is a hard topic for many trans men as it causes dysphoria but its also something that needs to be discussed.

they keep forgetting that the laws that are put in place about abortion rights, reproductive care, etc also affects trans men but they never fucking mention it probably because they dont fucking care to.

if i were living in the a different state, one that has made abortions illegal, and i were to be attacked as a trans man, my rights to abortion would be the exact same as a cisgender woman. we are equally in danger.

because fun fact not all trans men get rid of their eggs. not all trans men want to get that surgery. some trans men actually WANT kids that are made using their eggs. IM one of them. why as a trans man is it expected of me to have that surgery? why do people assume that i want to? why are we never mentioned when it comes to healthcare the same way others are? why are they even BEING gendered? if it were like something someone with a certain sex organ should have then *sure, whatever, but that’s not whats happening here.

nothing should be specified to a gender as people who ARENT WOMEN can get pregnant and do not have access to abortions. people who ARENT MEN can get other people pregnant. lets go back to using gender neutral terms.

*(i also think its weird to have classes based on sex organs alone i personally think that everyone should learn about each organ and how to properly protect yourself and your loved one no matter what organ you have)

why are we always forgotten? excluded? especially when it comes to topics about protecting ourselves?

Holy fuck? That’s actually insane what.

There is so much more I could say about this, but there is not enough room. Remember to check with reality rather than believing conspiracy theories promoted, supported, and funded by white nationalist hate groups.

Missouri is proposing 20% of the nation’s anti-trans legislation this session. Gender-affirming care for young folks is on the edge of being criminalized (so much love to trans friends in states where that has already happened).

Please keep up with the anti-trans legislation in your state and combat it. There are lives at stake.

Transphobes do not touch this post.

Image ID: a 10-image cartoon comic featuring Joey, a boy with short hair.

Image 1: Joey, upset, gesticulates towards an open laptop. Text reads: The reality of St. Louis trans kids. Last week, a former (non-medical) employee of Washington University’s Pediatric Transgender Center was featured in a viral article about how the clinic was “rushing” kids into medical care and “mutilating” us. Every single thing she said was a lie, but the media loves it. Footnote reads: I wouldn’t give any more attention to this, but it is immediately endangering the lives of trans people. Missouri has launched a state investigation and is actively attempting to criminalize gender-affirming care based on conspiracy theories.

Image 2: Joey points to a map of the United States where Missouri is singled out, and a map of Missouri where St. Louis is indicated with a star. The text reads: The Transgender Center, located in St. Louis, Missouri, has been the target of hateful attacks from the far-right state legislature for years. It is part of Washington University Hospital, a branch of a prestigious private university.

Image 3: A younger Joey injects his T shot in his leg while someone takes a photo. Text reads: I can tell you that everything in the article is false because I received care at the Transgender Center beginning at 16 years old. My medical transition has brought me nothing but joy. What a gift it is to be trans!

Image 4: A younger Joey sits on a couch and stims with a tangle fidget toy. Text reads: No one is “rushed”. I sat on many waitlists, had to have 6 months of specialized gender therapy and a diagnosis of gender dysphoria before even being referred to the Center, and I was denied as “not ready enough” by an endocrinologist the first time I finally got an appointment. Footnote reads: If you’re curious about what it looks like to be a trans kid, I did another piece on that! Check out tinyurl.com/transkidscomictumblr.

Image 5: A colorful map of the United States shows how many states have a Negative Gender Identity Policy Tally and how many states have criminalized gender affirming care. Joey holds a credit card. Text reads: St. Louis’ Pediatric Transgender Center is the only one in the region, meaning the waitlists are extremely long. Plus, no one in the only industrialized country without free healthcare is getting medical care for fun. Many American trans folks have to fundraise for our care.

Image 6: Joey, distressed, sits on a couch while talking on the phone. The person on the other end says: “That’s me!” Text reads: This former employee spoke about specific cases, and patients have been able to identify themselves. She shared our private medical info and called us horrifying.

Image 7: This is split into two panels. In the first, Joey holds up a box of condoms and a packet of birth control pills. Texts reads: She especially hated trans men such as myself, saying that trans ideology was destroying “girls”. She lamented about hormones making us “sterile”, which is a complete lie. We trans mascs have to actively prevent pregnancy. In panel two stands a doctor. Text reads: Every time I had an appointment at the Center, doctors reminded me: Remember: testosterone is not a contraceptive! Footnote reads: The wonderful Erin Reed wrote a breakdown debunking all the lies in the article. See tinyurl.com/erinreedmissouri.

Image 8: Joey, masked, sits at a circular table with his brother, an unmasked boy with fluffy short hair. Joey’s brother is showing him his phone. Text reads: Major newspapers continue to platform these complete lies because they bring in engagement and money. The Washington Post tracked down my little brother’s personal cell phone number to try to get in contact with our mom – the president of an organization supporting trans kids in Missouri. Freaky, right?

Image 9: Joey, looking disgusted, leans against a door frame while talking on a cell phone. Text reads: But no one wants to talk with me, the adult who medically transitioned at this clinic as a minor and has not “desisted” in six years. The Washington Post reporter, who didn’t know anything about trans people, talked with me for 20 minutes and used a sentence of mine in an article about “both sides of the debate”. She didn’t mention that this former employee is being legally represented by a recognized anti-LGBT hate group, nor that all of her claims are unsupported by reality or science.

Image 10: Joey looks angry and gesticulates. Beside the drawing are two photos of Joey, one of him happy in front of a trans flag, and the other of him drawing up testosterone to take his first T shot. Text reads: There is no debate. There are trans people, and there are people who want us dead. There is truth and there are conspiracy theories. Where is my viral article in a major paper?

Published Feb 16, 2023. End ID.

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Bloodwork came back positive for GAD65 antibodies. So now my rheumatologist is assuming not just neuropsychiatric lupus, but also Stiff Person Syndrome and GAD65 autoimmune encephalitis, based on my imaging and other test results.

I guess we’re just collecting neuroimmune disorders like trading cards now. Got brain fog? Muscle spasms? Random hallucinations? Congratulations, you might qualify for the rare holographic edition.

At this point, it feels less like getting answers and more like unlocking increasingly cursed DLC. The collector’s set is not supposed to be this complete.

i got the copper iud today!

honestly, it wasnt as bad as i thought it would be, but it was still pretty awful. the insertion was painful but i wasnt nauseous, didnt pass out, i was kinda thirsty and tired afterwards tho. 

my nurse was also a trans guy too!! his name was pete and he was so nice and made me a million times more comfortable.

around an hour or so after the insertion was when i started getting really really bad cramps. typically, my period cramps are like a 5 or 6 but these were like an 8 in my opinion. the only thing thats helped so far has been tylenol (cant take ibuprofen for medical reasons) and heating pads--cant stress that enough: heating pads were the only things that helped. a couple hours after the insertion the pain was too much for me so i took so melatonin and slept it off. 

biggest piece of advice, drink water and eat something beforehand, bring some water and a stuffed animal with you for support, and have the doctor talk you through the procedure. afterwards make sure you have a heating pad, some tylenol or advil, and if you can, sleep it off. call some friends to take your mind off the pain as well.

Reblogging with a link for my commision chart!

pomagam.pl/mastectomyforelian Hii, I'm Elian and i need your help

I'm trans and i need to raise money to be able to get top surgery soon. If you can't donate - reblog, make this post visible! I'll be eternally grateful.

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pomagam.pl/mastectomyforelian Hii, I'm Elian and i need your help

I'm trans and i need to raise money to be able to get top surgery soon. If you can't donate - reblog, make this post visible! I'll be eternally grateful.

I'm also opening commissions if you want to support me and get an art at the same time!

Here's more details and examples🏳️‍⚧️🙌

I'll happily make for you portraits/OC's/Fanart of any kind My work for example:

I'll add that Pomagam.pl takes secure international payments!

Dolars/euros makes four times the impact due to currency conversion! Aand you can use PayPal here too :>

tumblr staff doesn’t want you to know this, but a great way to treat small amounts of granulation tissue to prevent it from becoming hypergranulation inside the canal of your neovagina is to make a hypersaline solution (more in tense version of regular saline) and soak a tampon in it, and then insert that tampon into your vaginal canal