@euryale-dreams

Are there HRT medications that don’t increase blood clot risk? I’m already at risk because of my blood pressure, and my doctor won’t prescribe HRT that increases clot risk while I’m on the medication - and I may never not be on the medication.

Absolutely.

The concerns surrounding venous thromboembolic events as a side-effect of hormone replacement therapy can mostly be traced back to one particular study known as the Women’s Health Initiative. This study was an enormous undertaking which, unfortunately, demonstrated significant adverse effects of the hormone therapies studied. As a result of this the use of hormone replacement therapy in postmenopausal cis women was dramatically reduced as the medical community began to question whether or not the therapy caused more harm than good.

Naturally, trans women have been suffering from this fall-out ever since.

What physicians seem to fail to recognize is that the study examined a very specific hormone regimen which was, arguably, outmoded at the time the study was conducted: It examined the use of conjugated equine estrogen (Premarin) with or without the use of medroxyprogesterone acetate. Neither of these drugs is regularly used for the treatment of transgender women.

The estrogen most commonly used to treat transgender women nowadays is 17β-estradiol either in pill form or in the form of a sticky patch that you apply to your skin. Esters of estrogen (e.g. estradiol valerate) are also sometimes used either in a pill form or as an intramuscular injection.

Transdermal estradiol patches are the gold standard when it comes to treating women who are at high risk of a venous thromboembolic event. It simply does not increase the risk of developing a venous thromboembolism. The only thing you should keep in mind is that patches are not always well tolerated because of the lifestyle changes required to keep them from falling off and the fact that they tend to irritate the skin.

Fortunately, oral 17β-estradiol appears to be safe, regardless of the increased risk. At least one large study has shown that the use of oral estradiol in trans women is not associated with venous thromboembolic events. An individual woman’s risk would need to be substantial in order to contraindicate the use of oral estradiol.

For those who have significant risk of venous thromboembolism because they have had a previous thromboembolic event, because they are paralyzed, or because of some other factor it is good to know the relative risk between oral and transdermal estrogen. The latest research indicates that the use of transdermal estrogen lowers your risk of a thromboembolism to 80% of what your risk would be using oral estrogens.

It’s difficult to find hard numbers regarding the relative risk of venous thromboembolic events with regards to hypertension. The best I could find after an hour or so of searching was this study regarding VTE in lung cancer patients. Hypertension increased the risk by a factor of 1.8.

However, to put that into perspective being of African descent increases your relative risk for deep vein thrombosis by a factor of 1.3 when compared to Europeans. Europeans are, themselves, at increased risk when compared to Asians and Pacific Islanders by a considerable margin: a four-fold increase.

I should point out that being ‘male’ is also a risk factor for developing a thromboembolism and hormones are likely to be a contributing factor. Also, menopause is another serious risk factor. Given this information it is likely that the use of transdermal estradiol will lower your risk of thromboembolic events significantly.

As far as the anti-androgen is concerned: The primary use for spironolactone for cisgender people is as an antihypertensive.

Even if the risk of thromboembolism was truly significant with modern hormone replacement therapy it wouldn’t justify what your doctor is doing to you. The fact is that mortality in the transgender community from suicide–caused in part due to the lack of access to hormone therapy–is substantial. The quality of life lost when a trans woman is denied hormone therapy is substantial. The fact that your doctor does not appear to be taking this into consideration when they weigh the risk of thromboembolism against not receiving necessary medical care is deeply concerning.

I strongly recommend that you seek a doctor who is more sensitive to your medical needs as a transgender woman.

Edit: Fixed a minor, but embarrassing, error.

oh wow this is so helpful & good info

Everyone who cares about transfem people please reblog this

this was really fucking helpful

I know a lot of trans women dont have acess to information like this and its very helpful.

I made this post two years ago, and nothing has so meaningfully improved my life as “treat yourself like a senior citizen and schedule some enrichment.” I have an honest-to-god enrichment calendar now. It exists specifically as a place to put all the stuff that I might want to do on a random evening or weekend. And I read local papers a lot more, searching for things to do, smaller events that are more up my alley or offbeat street fests that I wouldn’t know about otherwise. (Side benefit—I know a lot more about local reporting too.) It doesn’t matter that I put plenty of events on the enrichment calendar that—because it’s on a Wednesday, because I’m tired, because the planets are in the wrong position—I don’t go to! The point is not create an unbending obligation that will haunt me to my grave; the point is to pay more attention to the world, and leave my apartment to join it sometimes.

The tiktok account has posted two more parts of this interview, I'll upload them both today

Unfortunately it appears you have a garden that is growing several important pollinator food sources you will be seeing wasps sometimes. You want us to spray your flowers? That’ll stop the wasps but only because your flowers will be Dead

I just think everyone would benefit from living in the woods for a week and having their bug tolerance forcibly increased by being forced to share a showerstall with a wolf spider the size of a half dollar everyday

(Life hack: if you consistently put out safe water sources for bees, the wasps will see you and they WILL eventually recognize you. And once you become The Bringer Of Water, they will become your own little goon squad. I used to get stung if I startled them by my compost bin, but now I have banged doors open just to realize a wasp was chilling right on the lintel, but all it does is wave its antennae at me. They see me carrying watering cans to my flowers and follow me. When I go to other places, the wasps there will also be friendly. Wasps are fucking amazing yall.)

I really hate how culture normalizes fear of bugs and reinforces and fuels insect phobias until they make it impossible to coexist with nature

I would never dismiss someone’s phobia. I know what kind of hell on earth that shit is. And I don’t mock people for being scared of wasps or bees because some people have allergies that can kill them and it’s kinda dumb to be rude to someone who is afraid of something that might kill them. But it’s done people such a disservice that culture tells people it’s reasonable to be afraid of all bugs and that most bugs will hurt you or your house or your pets.

I see so many comments and tags on posts about nature saying things like “I would love to spend time outside but I can’t handle being around bugs” as if it’s normal! If you can’t sit on grass or go on a hike because of your fear of bugs, that’s like…clinically significant highly disabling stuff. It’s locking you away from so many experiences.

Fears like this often get reinforced by witnessing other people’s responses to a stimulus. We are social creatures and if you watch the people around you show disgust and fear in response to bugs, you will learn to respond that way too. If you hear on the internet and TV and elsewhere that most bugs are dangerous and want to hurt you or will give you diseases, it will be reinforced even more.

The fact is, bugs are just guys. We depend on them for almost every part of our lives. Our planet is teeming with so many wondrous life forms, and many of them are insects. They come in every color and every form of iridescence, they glow and sparkle and they are fuzzy and striped and spotted. They are not “gross” or dirty.

Insects worldwide are now dropping in number, and it could mean disaster for us and every life form on earth. Most flowering plants (80% or so) have a symbiotic partnership with insects where they are dependent on insect pollination to fertilize their flowers. Wasps, bees, flies, butterflies, and even ants and beetles are all important pollinators, and each plant’s flowers are designed to be pollinated by a different group of insects. Without these insects, the majority of flowering plant species would not be able to exist. They would go extinct. That includes most of the plants we eat. No wasps, bees, flies and other pollinators= no apples, no berries, no peaches, no plums, no anything. That’s a simplified summary but it expresses just how important they are.

A big reason for it is the use of insecticides that are highly toxic to a wide variety of non-target insects. For instance, carbaryl, typically known as Sevin in the US, was for a long time sold in every garden center in a powdery dust form, to put on garden plants that had holes in their leaves.

Carbaryl dust is incredibly toxic to bees and can be picked up by them in the same way as pollen, and in that way it can be carried back to the hive and kill the whole hive.

Many of these insecticides are also highly dangerous to humans, and using them in and around your home exposes you to poisonous and/or potentially cancer-causing substances. The residues of these insecticides linger basically forever inside homes. There have been studies done that found insecticides that have been banned for a long time still lingering in people’s carpets and floors.

So it’s not good that so many people are terrified of insects. And the best antidote is to learn. Learn about bugs and their diversity and unique beauty and intelligence. If videos are no good, look at books with pictures; if you don’t want to look at pictures, books without pictures or podcasts might help. Maybe start with bugs that seem less frightening and move on to learning about others from there.

Learn about their ways and behaviors and how they are similar to animals you are more familiar with, such as birds or cats. Learn the ways in which they are similar to you—you will find that you share many important qualities, like “enjoy fruit” and “would defend friends and family.” Join bug identification groups online. Learn from people who keep bugs as pets.

It is so, so rewarding and important.

i saw a post the other day about treating spiders in your apartment like employees. like yeah, that spider over there is steven, hes the in-home exterminator. best not to destroy his hard work or else who’s gonna keep control of the ants? bees, even. betty stopping by your garden for some pollen so she can make honey for her hive. leave her alone she’ll be on her way soon.

personify them, and realize they’re just trying to exist like everyone else. the main reason any insect would act aggressive toward you is out of fear. like, imagine if you finally found a place to rest and some giant flesh creature decided to forcibly evict you. that would be terrifying.

I’ve stopped being afraid of the kind of wasps around my house now that I know they are hardworking single moms and don’t want to mess with me any more than I want to mess with them.

#dated three years ago is really what makes this one#sorry op if you still have notifications on for this one#but hoo-wee did you hit on the sentiment of the decade

I do have notifications still on for this post because I love the sense of community it gives me. We're all just staring at each other blankly and occasionally screaming.

Also for the people who have post dates turned on and just go JESUS CHRIST FOUR YEARS AGO?!