Doctor question?

[cougar9q]

I just finished reading Miriam's thread about transsexuality, gender disorders and all. I got me thinking....or atleast asking..

What type of doctors do transsexuals see?
What type of doctors do spefic intersexuals see?
Do some doctors see both types ?

The reason I ask, is because I am totally oblivious to who sees who.

The word "doctor" seems too broad for me.

Also good point Miriam about medical changes coming from the doctors.

So are you saying that once they recognized the complexity of all of our issues, is that when that will slowly turn the wheels or views of society about us?

Thanx,

Monica

[Sophie338]

Hi cougar9q

Oh thats a complex question. well it is for me :) In the UK it can be pot luck basically. (Depending on your age and what you have)For intersex people there are two speicalist clinics, one in London (That is the one I attended for a while run by Dr Conway), I now see the local endo. And one in Leeds.

I mainly see endocrinologists and urologists. Transsexual people see medics, in the same cities from what I understand but in different departments or hospitals. Transsexual people go to a place called Charing Cross for psychiatric assesement. Surgery in both cases (When adult) is conducted in numerous places. It all runs to that basic remit until the odd occasion when someone who was assigned to the wrong sex as a child appears, and then it gets confusing, mainly because the loacal health authories have administrators who tend to get confused.

Children who are surgically mutilated are mutilated at Great Ormond street. (Or Great Ormerod Street as I sarcastically call it).

Children with Transsexual issues go to the Tavistock Clinic again in London I think.

Generally speaking, Intersex people see endocrinologists and various other involved medics. Transsexual people see psychiatrists and then surgeons.

There are specialist clinics for intersex and transsexual people that are seperate, but the health authorities tend to get mixed up from time to time.

That is how it is in the UK I cannot speak for the US or Europe.

I have had the misfortune to come face to face with "Gender shrinks" and I regard them generally with disdain. But then my issues were not to do with toy guns and dolls, but my endocrine system and bladder going wrong.

Hope it helps

All the best

Hugs

Sophie.

[cougar9q]

I also had an additional question....


Who gives one a specific intersexed diagnosis?
Does any doctor have the license to assign a specific intersexed condition?

My diagnosis was made well before I could walk, so who do I talk to get the an updated diagnosis.

For me it's not enough to know that my diagnosis is "Mixed Gonadal Dygenisis" MGD

I first want to know if that's a correct diagnosis.
Maybe it's hopefull thinking, thinking that a certain doctor out there get give me the whole truth about everything about my body and not a simple term.

In other words, I have high doubts in the doctors that I have seen in the past. I guess that I want the truth to be told straight to me....

I know that I am intersexed, but I don't know everything that has been done to my body. Since I don't know what was done to my body I don't know if I should be living my life differently.... ie like since I'm taking estrogens there is a risk of having a stroke, and I was born with a heart disease....... Even though the estrogens prevent osteoporuous (not spelled correctly) I don't want to be at risk of having a heart attack...

So, any more and all input will be greatly appreciated.....


Monica

[Dana Gold]

Monica,

Are you asking about general medical care for transsexual and/or intersexed people, as in who to see when you get an injury or illness (flu, for example) OR what doctors do transsexuals see specifically for transitioning; and what doctors do intersexed people see specifically for intersexed conditions?

I believe in either case, whether TS or IS, it is difficult to find ANY doctor, because general care and specific care may overlap, especially with IS.

However, in general, according to "Hairy Benny Stds of Care"
(HBSC), a transsexual wishing to transition must see a psychologist first to determine diagnosis of "Gender Identity Disorder"; wherein the next step is to see an endocrinologist for initial physical evaluation (body exam, blood tests etc.) and if there are no negative findings (diabetes, gonadal tumors etc) then estrogen or testostereone hormone therapy may begin.
That is the ideal; however many sidestep the HBSC and get hormones from the Internet and/or Mexico etc. For surgery; one must have two letters of recommmendation: a psychologist and endocrinologist (most surgeons follow HBSC). And there is the problem that some psychs and/or endo may be averse to seeing trans patients, whether out of fear (due to inexperience with such) or prejudice.

As for what doctors see intersex patients, I believe the problem is compounded (especially if the person wants to transition sex) by gross inexperience and the , perhaps, subconscious urge by some doctors to treat intersex conditions as a disease (which, of course, there are some medical "problems) in and by itself requiring "standard correction modalities" ..all resulting in a general scarcity of qualified medical personnell to see most intersex patients. As for psychological issues unique to intersexed, well, the available psychs able to deal with those may be like a desert....Perhaps I'm wrong, but I do know that just being able to find a regular doc, a psych, an endo etc was difficult for me because of transphobia and some doctors just not knowing how to deal with my hypergonadotropic hypogonadism and the accompanying osteoporosis PLUS estrogen administration. I think a lot of doctors are just afraid of some intersex conditions due to lack of experience; it is as one person put it "uncharted territory"


In my opinion , both transsexual and intersexed people have to go "on a hunt": to find a general practitioner (PCP as in HMO), a qualified psychologist (NOT just for transition by either TS or IS, but for , like me, anxiety, depression, panic, insomnia etc.) and an endocrinologist..AND if transitioning or in need of surgery for a internal problem: the same holds true...ALL who are NOT averse or afraid to see both or either. Sadly, whether IS or TS, both cannot just go to the clinic and see ANY medical personnel. One very bad thing, though, is that if an intersexed person decides to transition back to original sex, then the HBSC may be more of an impediment than help, and the insurance companies won't pay for psych, endo, and surgeon at all. Before starting hormones, I finally found a regular doc, who said the HMO would be more than happy (coverage) to "reduce my breasts" and make my penis bigger and start me up on some testosterone....until, ooops":eek: I told them no, that's not what I wanted...and so I paid for everything, whereas in the latter, the HMO would have paid.....ironic, huh:confused:

Anyway, BLO's home page (click on our logo to get there) has a list of IS friendly medical personnell. If you are not satified with your current docs then consider a change.....do some research and then call up each of "prospectives" offices and ask to have a brief talk with doctor....that's what I did.

I've gott to go to a meeting now (I'm at work)....bye!!.....good luck and take care.!!

Dana:D

[Dana Gold]

Just now saw, your most recet reply, Monica, after aklready posting mine....anyway here's something that may be of some help inre hormones

http://www.bodieslikeours.org/forums/showthread.php?s=&threadid=714

Bye!

[Sophie338]

Hi Monica :)

You Said..


"Who gives one a specific intersexed diagnosis?
Does any doctor have the license to assign a specific intersexed condition?

My diagnosis was made well before I could walk, so who do I talk to get the an updated diagnosis.

For me it's not enough to know that my diagnosis is "Mixed Gonadal Dygenisis" MGD

I first want to know if that's a correct diagnosis.
Maybe it's hopefull thinking, thinking that a certain doctor out there get give me the whole truth about everything about my body and not a simple term."

Unless you are in the UK I dont know who to reccomend. But I do understand what you are saying. I myself had to go through a lot of hoops in order to get a hint of any diagnosis, and it was only when I had tests done privately and saw an endo who specialised in this stuff that I had the diagnosis, and then some of the documentation. Originally it said "Testicular Femnisation" (This was in the 1960's when originally diagnosed hence the clumsy terminology, it is actually AIS) which while a different condition would be consistent with 5arD as this is similar to AIS in some respects. Not only that my situation is atypical so that made getting to the truth difficult.

I would suggest perhaps doing something similar to that. Find a good MD/GP/Doctor you can trust, and get whatever tests you can that would give some indication of what is going on. From that point you can get to see someone who is a specialist.

If you find it hard to trust medics I do understand that, I had a lot of pain when having to discuss this stuff at the beginning. For me it wasnt as if they could simply deny it because the IGM I had as a kid was really messy. But it is worth finding someone who you can trust to tell you the truth, and getting whatever tests you can to be given a more accurate description of what condition you have.

I hope I am being of some help :)

All the best

Hugs :)

Sophie.

[cougar9q]

I wanted to see if there is a connection between the medical treatment of transsexuals and intersexuals.

I have heard of stories of intersexuals that continue to see doctors and others that shy away totally from doctors.

I see it, as a paradox that from what I read about transexuals is that they have "faith" in doctors to "fix them." It's almost a uniform faith in them.

I am not encouraging intersexuals to go out there and get operations, but what I am encouraging or suggesting is for people like us to get information about their bodies.

It is when you understand what has been done to you is when you start to see the bigger picture.

If we want to paint those doctors that "screwed us up" then we get understand what they knew at that time and now to know how to approach them to influence them to make choices that are beneficial to the individual to conform to what's inside them and not to what society expects of them.

I am asking for doctors to step down as a social "de facto" enforcer as a social healer.

It was last week when I finally got around to seeing an OBGYN in a year and I had a different doctor at the same clinic. The one I had had left or something, but I didn't discuss intersexual issues with her. But with this last doctor I told here that I had a gonadectomy, clitorectomy, and a heart VSD operation, and her face turned white. It's as if she were talking to me in an ER, or even a freak or weirdo. I told her that I was born with ambious gentelia, and had been taking estrogens. She told me to follow up and to meet with her after I take a Dexa test (bone test) and send all of my records to her. I am hoping that she can give me some answers. But to tell you the truth I don't want to take estrogens anymore. I want to take something else (I have been taking them since the age of 12) Before I took these estrogens I was skinny, and now I am fat and my energy level is quite nonexistant.. So I am hoping that she can give me someother hormone to take, maybe a progesterone or whatever else there is that has fewer side effects. Back to my research.. thanx

Monica

[cougar9q]

Note:I speak only for myself, and when I do attempt to speak for other groups, I am not trying to generalize them, I am trying to fluidly get a point across.

I am asking for doctors to step down as a social "de facto" enforcer to a social healer.

If we want to paint [change] those doctors that "screwed us up" then we got to understand what they knew at that time and now to know how to approach them to influence them to make choices that are beneficial to the individual to conform to what's inside them and not to what society expects of them.

As from what I see, science seems to many people to be written in stone.

Whether they realize it or not doctors hold our lives in their hands.

They diagnose you if you're sick, and give you medicine.

Twenty years ago if one was born intersexed then they would do some tests to see what you are and what is wrong with you.

We can't give them all of the blame, yet not to justify what they have done.

They were merely reinforcing what society had ingrained into them.

As social leaders they have the power to change societies outlook on us.

Yes it is most important that we know that we are normal, yet we need a force of great power to change the way our society thinks about us.

It's about having a joint-coalition in this struggle for our equality.

Let's make the shame and secracy of being intersexed a thing of the past.

Yes this is optimism coming from a pessimist...


Monica

[Dana Gold]

Monica,

For some of us the truth (all of it) of what was done will never be completely known. Having been born in Germany, and then adopted by American soldier; all dependant (i.e. children) army archival med records have long been destroyed as general protocol. I only have my memory; which unfortunately; is somewhat like Swiss cheese....there are "holes" in some places in my past, where things get murky, especially the first few months upon arriving in the USA.

My previous post related some of the complexities of the questions you presented. And the feeling I meant to communicate was that a lot of doctors have this aversion to anything that relates to GENITALS in anybody deemed abnormal.
Being IS is compounded by lack of medical background history, records and secrecy from those involved with us as children (whether meds or parents). most TS do not have this problem. BUT there are some doctors that dislike TS regardless and when meeting an IS patient regard that person with the same feeling they have toward a TS.....genito-phobia. My diagnosis is not even a real diagnosis since primary testicular failure is the "effect" of a up to this time unknown "cause". Your MGD is an effect of a unknown cause.....when that "cause" is found out for us, then both the docs and (most importantly WE can begin to understand ourselves and our health status and what to watch out for. Also of the most appropriate treatment for internal anatomy/physiology and/or hormonal issues. We have to be very proactive in our care with a doctor who talks WITH us , not TO us. I told my doctors about my many broken bones, even after many doctors who saw my lab test results and finally diagnosed a form of hypogonadism NEVER considered osteoporosis even though it is common medical knowledge, until I TOLD them . WHY? Because it is like something they hope will go away on its own, resolve itself? Or is it as one doctor who saw me: fear of dealing with an "unknown", mixed with a quasi-disgust.

Because I bear the brand of TS with the med community I will never know the exact cause of why and what I have been and am now. ... and my mother's mouth is zipper-locked and any document and majority of familial ties to Germany are dead/non-existent and forgotten.

The connection between IS and TS med Tx is as I told you and it would be better if the two were treated as separate issues, but they overlap, especially if an IS will be transitioning......in either case the TS has it better (although not entirely good, either) The IS gets the "double-whammy" dealing with not only phobics within the med community, but also ignorant and sometimes erroneous medical protocol within a framework of "curing the disease" (intersexed condition) resulting in mistrust and a schism between patient and doctor and physical and psychological complications and trauma. To this day I do not totally trust my doctors, but I don't mistrust them as much as before, because I took control: NO I don't want that horse-piss Premarin; NO I am right about my osteoporosis, NO you people are not going to deny me a certain procedure; My doctor ordered pelvic ultrasound!, you will not deny it to me because "we don't do them for men"....I will fight you, legally if necessary. AND you will not be disrespectful to me anymore Dr and tell me to"drop my drawers" because I don't pay you out-of-pocket expenses just so you can make snide comments for your entertainment about me and simulataneously not seriously consider med/body issues about me because such things are not usually found in a man's body! Be a COUGAR with these idiots, Monica....snarl at them and don't let them put you in a mental cage with their rudeness and ignorance and any other crap they serve you.

Whew!:rolleyes: ...get me going about the schwein:D:mad:

Take care, please

Dana:)

[Dana Gold]

quote:

They were merely reinforcing what society had ingrained into them.


It is a 2-way affair; society may reinforce them, but they in turn do the same by reinforcing the accumulation of what bullshit has been amassed by both up to that point....a vicious circle....remember the concept of correct and control; both society and doctors exercise it

Do what's right for yourself and break the chain of "control" and take control of the "reins" of "correct"...refer to my last post.....snarl! don't whimper, lest they abuse you further

Ta-ta, dear:)

[Sophie338]

Hi Dana :)

Well Said :)

Hugs

Sophie

[Sofie]

Hi Monica

.....though the estrogens prevent osteoporuous.....Before I took these estrogens I was skinny, and now I am fat and my energy level is quite nonexistant......

Have you tried to reduce estrogen?

I've read about new medication against osteoporosis that doesn't contain any hormons. I don't remember any details though.

Sofie

[Dana Gold]

This is not just for Monica, but all who are taking hormones, especially estrogens. Firstly, have your doctors do blood tests for all sex hormones: estradiol, estrone (unfortunately here in US no test for estriol), progesterone, testosterone, prolactin, DHEA initially....the purpose of any hormone Tx should be to provide an adjunct therapy to maintain a BALANCE of the above mentioned constituents. That's why I referred Monica to my links from a previous thread. doctors will tell you: Oh! your estrogen is low.....WHICH estrogen is low, doc?? If estradiol, then maybe estrone may be high, because in such a case taking oral estradiol or Premarin (YECCCH:mad: ) will metabolize directly into estrone first...and then you will still be low on estradiol and way too high on estrone!! Oral estradiol will provide only 1-2% of estradiol to the body, the rest = estrone. Progesterone is VERY important....but NOT medroxyprogesterone acetate. Low dose estradiol (sublingually or by patch) and a natural form of progesterone compliment each other and provide a healthy balance. Many doctors just throw Premarin or MenEst at you and think you will be alright and wonder what the heck when you, who are taking it, aren't feeling well. Balance.....emphasize this concept to your doctors....MAKE them listem....if they won't .....get one who does....it's a big hassle, but one's health and proper treatment of is well worth it. Lastly, estrogen (particularly estrone!) overload and progesterone deficiency will lower metabolism = low energy levels and weight gain and "lovely " mood swings, depression. Progesterone deficiency may accelerate osteoporosis. You need a low level of testosterone, 0 is no good.
Inre osteoporosis:

Drugs and types of drugs available for the treatment of osteoporosis are : calcitonin, bisphosphonates, hormone replacement therapy, calcium/Vitamin D, Fosamax and Raloxifene. The new drug, alendronate sodium or Fosamax (brand name), has caused quite a bit of excitement because it is the first drug to reverse the bone loss of osteoporosis in post-menopausal women.

http://www.healthology.com/focus_index.asp?b=rxlist

click on osteoporosis on the left-hand scroll-down menu

On Progesterone:

http://www.medical-library.net/sites/framer.html?/sites/_progesterone_and_osteoporsis.html

Excerpt from an article:

Recent studies have shown that 100mg of micronized progesterone (Prometrium®) twice a day for 14 days or daily for 28 days is adequate for menopause management. There is some data to suggest that this form might have fewer side effects such as depression, bloating, and weight gain than synthetic progestins. Recent clinical trials (HERS), WHI) have suggested that the use of medroxyprogesterone (Provera) may increase the risk of heart disease. There is some evidence to suggest that so called "natural progesterone" has less of these effects than some synthetic progesterones.
One can purchase progesterone creams and gels in health food stores. . If you are thinking about using topical hormones, it is important to let your health provider know, so attention can be paid to a trusted brand and efficacious concentration and purity and your own current blood levels of it.

Dana