First report of trans man having successful fertility preservation without interrupting HRT

Zinnia JonesSuccessive studies have worked to pin down how testosterone used in masculinizing HRT can affect fertility in trans men and transmasculine people who still have a uterus and ovaries. Despite popular misconceptions, HRT as part of medical transition generally does not have a permanently sterilizing effect. Instead, reductions in fertility may be temporary or reversible – or even nonexistent. Trans men may seek to preserve their fertility prior to gonadectomy (surgery that includes removal of the ovaries) using ovarian stimulation and cryopreservation, in which oocytes are released, extracted, and frozen. Crucially, this can be performed even after starting masculinizing HRT. Continue reading

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Proxalutamide, a new antiandrogen, improves COVID-19 outcomes in trials of men and women

Disclaimer: I am not a medical professional and this is not medical advice. The COVID-19 pandemic continues to be a rapidly evolving situation, and this information may be superseded by later findings. This article was last updated on February 28, 2021.

Zinnia JonesSince the worldwide outbreak of pandemic coronavirus last year, sex-specific patterns of infection and severity have offered tantalizing hints about the disease process and possible treatments. With those assigned male being significantly more likely than those assigned female to experience severe COVID-19 and death (Peckham et al., 2020), an explanation was sought. The cause of this bias appears to be multifactorial: two X chromosomes can code for a broader array of immune responses than only one, higher estrogen levels boost immune response to infection, and androgens such as testosterone can suppress immune function. This suggested the possibility of treating COVID-19 using estrogen, antiandrogens, or both. Continue reading

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Trans men and transmasculine people can get effective vocal pitch surgery too

Zinnia JonesI’ve previously posted about studies of vocal deepening among trans men and transmasculine people on testosterone and the range of results that are achieved. Voice pitch deepening under the effects of testosterone is a one-way process – testosterone deprivation or administration of estrogen cannot physically reverse it, and trans women seeking to raise their vocal pitch therefore need to rely on vocal training or vocal cord surgery.

However, a portion of trans men on testosterone still do not experience a satisfactory deepening of pitch. A meta-analysis of 520 trans men taking testosterone found that after a year of treatment, 21% still did not have a fundamental frequency in the typical range of less than 131 Hz for cisgender men (Ziegler et al., 2018). Along with Nygren et al. (2016), these authors recommended that trans men with unsatisfactory voice changes from testosterone should receive specialized voice therapy and training to develop a more masculine voice. Continue reading

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Put it under your tongue? Typical hormone levels for trans women on HRT, and differing effects of oral and parenteral estradiol

Zinnia JonesLast year, I covered the results of a study of trans men and transmasculine people who had been on masculinizing HRT for at least a year, which were used to establish reference intervals empirically and determine which range of testosterone levels encompasses the middle 95% of trans men on HRT. These reference ranges for laboratory blood tests determine whether a given measurement for a patient is “normal”, or within two standard deviations of the population average.

In the previous study, the reference interval for testosterone found among trans men on HRT spanned a much wider range than the guideline of 400-700 ng/dL that the Endocrine Society most recently recommended as a target range for testosterone treatment. Instead, only about the middle 50% of trans men had testosterone levels measured within that range. The authors noted that this may not be an issue requiring dose adjustment, as the wide variations in timing between the blood draw and the injection of intramuscular T – which can be given every week, every two weeks, or even every three months – can significantly influence the measured levels even when these men may still have levels in the guideline target range at most times. Continue reading

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The Gender Analysis word of the year is: resentment

Zinnia JonesWhen I think about the concept of resentment, I primarily think about it in the context of relationships: causes for anger or offense that aren’t voiced aloud and handled productively, but left unaddressed, piling up into an accumulation that ruptures, poisons, slowly forces a wedge between what should be a bond. Nor is it a transient matter – it is anger that comes with a supply chain, anger that never has a chance to fade or go out, anger stoked and fed from a coal hopper. Resentment, without remediation and without a moment to cool, is the best word I can find to describe how I feel about the circumstances of my 2020. Continue reading

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