We’re writing a book

Kristin Tynski, a fellow trans woman on YouTube, has graciously invited me to contribute to her upcoming e-book, Hacking Transition. It’s an in-depth guide to the mental, physical, social and legal processes of transitioning, for trans women, by trans women. In addition to a comprehensive exploration of the science, medicine and raw mechanics of transition, we also focus on the personal and experiential aspects of living as a trans woman. Our book is as much about how to figure out whether you’re trans – often a rather significant stumbling block – as it is about what to do once you’ve decided you want to transition.

Topics covered include, in no particular order: problematic media images of trans women, maintaining your self-esteem, the true prevalence of transsexualism, legal protections, emerging treatments, resources for support, “is it normal to feel this way”, trans-friendly religions, coming out in any context, sex advice, relationship advice, disclosure, dealing with transphobia, choosing a name, style tips, “why am I still a guy in my dreams”, thought experiments and practical experiments for exploring identity, effects of HRT, “why doesn’t it work anymore and how can I get it to work again”, early transition and later-in-life transition, repression and hypermasculinity, nonsense autogynephilia theories, dysphoria or the absence thereof, “can I still be trans if…”, finding good therapists and doctors, fertility, “natural transition” scams, exercise regimens, recommended surgeons, and pretty much anything else that belongs in what’s basically “Being Trans: The Book”.

We’re aiming for a release date in May. If you’d like to sign up for updates on our progress, just go here. Questions, comments and recommendations are welcomed!

MetaMed: The best second opinion

There’s a pretty cool new company I’ve been working for lately. It’s called MetaMed Research, and it’s a concierge medicine service that researches treatment options for unresolved health problems. When someone has already seen several doctors, tried all the common treatments, and nobody knows why they’re still suffering, what can they do now? Is that the end of the line? It shouldn’t be. This is the role that MetaMed seeks to fill: finding possible solutions for unanswered questions. Not everyone has the resources to start a biotech company just to develop a treatment for their dying children, but we think we can provide people with the same kind of opportunity through personalized medicine and comprehensive research.

In addressing a client’s needs, we tackle multiple problems that come to bear on their health issues: giving them personal attention that takes into account their individual biological variations, separating relevant and valid literature from useless and poor-quality studies, and rationally evaluating the strengths and weaknesses of all of the available evidence. These are a lot of words to say that we do our best to figure out what’s true, what’s false, and how this can help someone with a particular condition.

Why is this necessary? First, people can miss things, even things that they really should not miss. When patients diagnosed with breast cancer were referred to a board of specialists, 52% had their surgical recommendations changed. 45% received a new interpretation of their imaging results – in some cases, second cancers were identified that had been missed the first time. For 29%, their test results were interpreted differently by pathologists, affecting the staging of their cancer. How many of these patients would have had improper or inadequate treatment if it weren’t for this second opinion? How many patients are getting the wrong treatment every day, when errors in diagnosis are this common even for deadly diseases like cancer? We believe that teams of specialists can similarly apply their expertise to a variety of health conditions and make better diagnoses that may have been missed.

Second, scientific studies aren’t necessarily reliable merely because they’re scientific studies. In 2010, a psychologist designed an experiment based on the idea that there would be an evolutionary advantage to being able to perceive the future possibility of sex – essentially, precognitive detection of sexually available partners would aid in successful reproduction, and thus select for itself. In the experiment, study participants were asked to select which of two concealed images they believed would contain “erotic stimuli”. Said stimuli was placed randomly, after a participant made their selection. The original study found that they were able to select the correct image – “predicting” events that had not yet happened – with slightly better accuracy than would be expected from chance alone. This was widely reported as evidence of human precognitive ability. However, even when numerous replications showed negative results, the original journal refused to publish them, simply because they were replications. It would seem that while “Porn Travels Backward Through Time” was an appealing headline for the Journal of Personality and Social Psychology, “Porn Does Not Travel Backward Through Time” was not quite so attention-grabbing. This isn’t just a one-off, anomalous disgrace. A majority of published research findings may actually be false, and it’s crucial to evaluate a study’s strength instead of taking it at face value. MetaMed weighs studies according to how well-supporting their findings are, taking into account any flaws or biases that would compromise their results.

Third, not all relevant information is taken into account when treating patients. Why do some drugs work only for some people and not others? It’s because there are vast individual differences in how people metabolize those drugs, and most medical treatment fails to recognize those variations. Patients are often treated with one-size-fits-all regimens, and their unique genetic and metabolic features aren’t taken into account. Doctors also don’t have the time to research every patient’s case individually, and there’s no way for one person to keep up with the volume of published literature that could be relevant to each patient. MetaMed can offer them a kind of support team, focusing on the details of a patient’s disease process and searching medical literature to find potential interventions.

It’s a pretty simple idea: more evidence, better evidence, better answers. Yet this kind of highly personalized medical practice is rare enough that there’s a niche for MetaMed to fill. That’s the service we offer, and I think we’ve got a decent shot at this.

Guess who just got engaged?

An engagement ring

For those of you who don’t know, my partner Heather and I have been together for almost two years now. It’s been a long and amazing and awesome journey so far, and last night, she decided to pop the question! It was just about the sweetest thing ever, and we agreed to upgrade from partners to fiancées. Seriously, I’m a fiancée. Wow. Obviously we’re both really excited, and we’ll keep you all updated on any new developments.