References for ‘Shit Doctors Say’

Here are the numbered [1–10] references, sources and notes for the story
Shit Doctors Say. Find the original story here.

References

I recommend UCSF’s Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People as an excellent source for guidance of every aspect of care for trans people, including nonbinary, and those who want to have children. Open access. http://transhealth.ucsf.edu/protocols

[1] ‘New guidelines urge later, less frequent mammograms’, STAT, 2015.10.20,https://www.statnews.com/2015/10/20/new-guidelines-urge-later-less-frequent-mammograms/

[2] ‘Millions of women undergo pelvic exams with no proven benefit, US panel concludes’, STAT, 2016.06.28, https://www.statnews.com/2016/06/28/pelvic-exams-no-benefit/

[3] ‘Complications of MTF Vaginoplasty’, Allison S. Glass and Marci L. Bowers, 17.1.3 ‘Blood Loss’, in Chapter 17, in Management of Gender Dysphoria: A Multidisciplinary Approach 2015 Edition, Carlo Trombetta (Editor), Giovanni Liguori (Editor), Michele Bertolotto (Editor), ISBN-13: 978–8847056954

Discusses how easily blood loss becomes an issue in MtF GRS. Warning: graphic surgical descriptions and images.

[4] ‘Overview of feminizing hormone therapy’, Madeline B. Deutsch, MD, MPH, in Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender-Nonconforming People; 2nd edition. Deutsch MB, ed, UCSF. June 2016.http://transhealth.ucsf.edu/trans?page=guidelines-feminizing-therapy

A very current and thorough general overview of hormone treatment for trans women. Includes the following, which transitional trans women and their doctors should consider carefully:

‘Many patients are eager to begin maximal feminizing hormone therapy and are opposed to the idea of a slow upward titration. Weak evidence suggests that initiation of estrogen therapy at lower doses and titrating up over time may result in enhanced breast development in transgender women. The estrogen receptor agonist activity of spironolactone may play a role in reduced breast development due to premature breast bud fusion. As such an escalating regimen beginning with low dose estrogen only, and titrating up over several months, and then adding spironolactone may be an alternative approach, consistent with management practices in children with delayed pubertal onset (Grading: T O W). Upward titration of spironolactone can also help minimize side effects such as orthostasis or polyuria. It is recommended that providers discuss these considerations with patients before initiation of hormones in order to make an informed decision.’

This could account for the somewhat unsatisfactory breast development I experienced.

[5] Smith, K. P., Madison, C. M. and Milne, N. M. (2014), Gonadal Suppressive and Cross-Sex Hormone Therapy for Gender Dysphoria in Adolescents and Adults. Pharmacotherapy, 34: 1282–1297. doi: 10.1002/phar.1487

This paper disagrees with my statement that ‘…much higher levels of oestradiol are needed to counteract the effects of testosterone…’, which was the view of my endocrinologist in 1989, stating instead that ‘Physical appearance is not well correlated with target hormone concentrations, but practice guidelines recommend target CSHT doses that are associated with serum hormone concentrations in the adult ranges for the desired sex.’ This is at odds with my personal experience, as are other findings mentioned (e.g., with respect to changes in hair growth patterns), but then I am only n=1, and an anecdote at that.

[6] ‘Cancer risk in the transgender community’, Editorial, The Lancet Oncology, Vol 16 September 2015http://www.thelancet.com/pdfs/journals/lanonc/PIIS1470-2045(15)00249-1.pdf

No primary sources were found that specifically address the issue of pap smears for trans women with vaginoplasty. Kindly contact me if you know of any.

[7] ‘Vaginoplasty procedures, complications and aftercare’, Toby Meltzer, MD, in Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender-Nonconforming People; 2nd edition. Deutsch MB, ed, UCSF. June 2016.http://transhealth.ucsf.edu/trans?page=guidelines-vaginoplasty

A very current and thorough general overview of all phases of vaginoplasty procedures and care.

[8] ‘Gender reassignment surgery: an overview’, Selvaggi, G. & Bellringer, Nature Reviews Urology 8, 274–282 (May 2011) | doi:10.1038/nrurol.2011.46http://www.nature.com/nrurol/journal/v8/n5/full/nrurol.2011.46.html

A dated (5 years old at this writing) but complete description of both MtF and FtM procedures. Warning: graphic and detailed descriptions of surgical procedures.

[9] ‘Perioperative and postoperative care for feminizing augmentation mammaplasty’, Eric D. Wang, MD; Esther A. Kim, MD, in Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender-Nonconforming People; 2nd edition. Deutsch MB, ed, UCSF. June 2016.http://transhealth.ucsf.edu/trans?page=guidelines-chest-surgery-feminizing

[10] No primary sources were found that specifically support my claim. Anecdotally, there seems to be a general view that the larger rib cages and sometimes atypical hormonal breast development seen in trans women indicate using a surgeon with specialised experience in allowing for these factors.

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