Natural Privilege

6mg micronized estradiol 17, sublingual

5mg finasteride

50mg cyproterone acetate

75mg methadone (in tang solution)

two inhalations salbutemol, every four hours as needed

Every day.

I depend on these medications. In literal senses as well as existential ones, I need them in order to survive. Who and what I am, as well as my continued existence, hinges on modern medicine. Had I been born a century or so earlier, I wouldn’t have even survived past infancy in order to experience the nightmares of gender dysphoria and opiate dependence. And in the event of a zombie apocalypse, I’m totally fucked. Unless I were to take to hunting female zombies and harvesting their ovaries.

Needless to say, the Naturalistic Fallacy ends up feeling a tad personal for me. I’m a naturally unnatural Natalie.

Yesterday on twitter I came across a woman calling herself Yeats Infection who decided to chastise the “decision” trans people make to become dependent on the “capitalist pharmaceutical industry” for the rest of our lives, framing us as having somehow been duped by the evil conspiracy of Big Pharma.

What an insulting, condescending, privileged, uncomprehending, self-righteous, patronizing infuriating, ignorant thing to say. Ugh. Just ugh. Well, no, not just ugh. Ugh and a heartfelt “fuck you” as well.

What it brought to mind for me, and made explicit, was the incredible degree of privilege and entitlement that often underlies the “natural medicine”, “alternative medicine”, “non-allopathic”, anti-“Big Pharma” attitude. That beneath the preference for these “natural” alternatives was the luxury of a normative physiology, and that to extrapolate from that luxury a prescriptive, paternalistic attitude towards the not-so-inconsequential choices others make about their health and bodies belies considerable classism, ableism and, yes, cissexism.

It’s really easy to talk about “natural medicine” and criticize pharmaceuticals when your life and identity aren’t dependent on your medicine actually working.

But not all of us have those same luxuries. Some of us don’t have normative bodies, don’t have perfectly “natural” physiologies, and need to rely on the tools of science rather than the empty comforts of placebos and “traditional”, “non-allopathic” care. Some of us need the disease to be treated, not “the person”. Some of us aren’t at liberty to treat our medications as a mere lifestyle choice, something you pick off a shelf because it presents the right cultural image and makes you feel cozy and enlightened. Some of us have more at stake than a vague sense of middle-class ennui or a case of the sniffles that will go away on its own regardless. Some of us need to survive.

It’s interesting in how she framed this in terms of us trans people having been deceived. It’s staggering the degree to which cis people simply refuse to accept the possibility that trans people are actually rational, capable, intelligent people who’ve thought things through and come to a decision about what we need to do (not unlike the republican idea that every woman who ever chose to terminate a pregnancy just didn’t think it through properly, and there should be laws forcing her to). Staggering how much they just don’t bother to consider the fact that maybe we’ve put a little thought into the question, and maybe did our homework, and maybe the five minutes they spent considering the question of gender variance might not be providing some unique, devastating, heretofore unconsidered truthbomb that none of us ever possibly could have considered before and that will totally blow apart the myths us poor deluded trans people have blindly stumbled into uncritically accepting.

I understand that this whole reluctance to consider us having real, genuine agency and education thing is mostly about the fact that accepting us as fully informed, aware, rational agents poses a giant threat to a whole lot of foundational cultural assumptions about gender and sex (“how could anyone in their right mind choose to be a woman?!”), and so there’s an enormous amount of cultural tug in the direction of dismissing, ridiculing and pathologizing us, as well as coming up with various reasons to believe we’re delusional or deceived (by the patriarchy, by the gender binary, by homophobia, by the gay agenda, by our own [insert unrelated co-morbid psychological condition here], by Satan, by the pharmaceutical companies, whatever), but still… the arrogance required to presume that a cursory examination of our existence by your mighty, unclouded cis minds will reveal these amazing facts we just plain don’t understand about “biological realities” or “only cosmetic” or “why not just be a butch lesbian?” or “unnatural” or “capitalism” is still something I can’t quite understand.

But it’s certainly largely about privilege. Privilege and entitlement. No cis person has ever been forced to consider gender in its multifaceted complications, or reconcile its contradictions and paradoxes, or weigh the relationship between sex and gender identity and gender expression and assignment and socially prescribed role and sexuality and everything, or have to hold on to that sense of selfhood against an immense cultural force baring down at all times from all sides, or “prove” the legitimacy of their gender against an endless procession of family, friends, teachers, therapists, doctors, bureaucrats, clerks, customs agents, security guards, human resources personnel, police officers, nurses, hiring managers, landlords, property managers, neighbours, roommates, whosoever happens to cross their path and is afforded at least some tiny scrap of power or authority. Cis people are not forced into the position of understanding how deep the ocean of gender’s complexities goes, and are therefore able to believe (though yes, Pending Whiny Angry Commenter, being able doesn’t mean all do) it’s as shallow a pool as their own shallow understanding. A five minute dip in to the bottom step of the kiddie pool (“Oh… but that means they have to take pills for their WHOLE LIVES? That’s kuh-razy!!!”) and they come back out thinking they’re the very first to discover the ocean floor.

Nevermind the other positions in which people end up “duped” by their health conditions into being dependent on pharmaceuticals. Like, say, heart transplant recipients or diabetics or people with severe pain management issues. No need to bother with that comparison, right? …Right? Gender, it seems, is something uniquely positioned to be considered understood by the ignorant, and gender dysphoria uniquely well positioned to be “just in one’s head”, because one who’s never experienced it can’t possibly grasp just how intensely real it is.

Actually, the pain comparison might be worth exploring. Try telling someone with irreparable nerve damage that it’s just in their head, and they’d be better off accepting themselves and learning to live with it rather than being tricked into dependence on the pharmaceutical industry.

Amazingly, in all this arrogant entitlement, those with the luxury of natural medicine, the class, able-bodied, cisgender privilege to eschew proven medicine, the thought never occurs to them that they might be the ones who have been duped. They never seem to think through long enough to remember that the purveyors of natural and alternative medicine and treatments are businesses too, with the same capitalist instincts, motives and biases. But way less controls and regulation.

And no evidence.

There are a few things I’d really like to clear up about this whole thing, before we find ourselves with a brand new means by which our identities can be invalidated though misconceptions and ignorance.

First of all,

Gender variance predates modern medical interventions designed to accommodate it.

Trans people have always existed, and trans people always will exist. Just like chemotherapy didn’t create cancer, exogenous hormones and genital surgery didn’t create transgenderism. They simply present options for care, for adapting to the condition, for attaining greater quality of life, greater happiness. We are not a creation. We are not an experiment. We are not Frankenstein’s monster. We are a fact of human nature, and of human gender.

Estrogen and testosterone ARE “natural”.

Whether produced in a laboratory or produced in a testicle, testosterone is the exact same chemical. The hormones taken by trans people in the 21st century are the very same hormones that already occur in the human body. We simply adjust the levels, so as to produce physiological changes that are already encoded as potentials in our DNA.

Comparatively, phytoestrogens or premarin or whatever, despite not necessarily being produced in labs or factories, are substances that are alien to the human body.

These kinds of statements are not harmless.

Describing transition as “unnatural”, or framing it as being “tricked” into dependence on some kind of evil, hand-wringing, mustache-twirling, mwa-ha-ha-ing pharmaceutical cartel, is, as stupid as it may be, not quite so easily shrugged off by everyone. Trans people who are in early phases of questioning can easily be thrown off by this kind of thing.

When you factor in the tragedy of how often, how widely, and how consistently the medical establishment has failed to meet the needs of our community, how it talks down to us, asks us to jump through countless hoops, how it refuses (like everyone else) to accept the possibility of us being rational people in full possession of agency and the ability to make informed choices about our bodies and genders and health, how it often prioritizes the maintenance of archaic concepts of gender and sex over our well-being, how often its members are ignorant of us and our needs and our bodies and how to treat us, how often its members are ignorant of how to demonstrate basic respect and sensitivity, and how it treats us with as much paternalism and condescension as those who would “protect” us from them, and you have a situation where people are very, very, very vulnerable to the suggestion that their interests are best met outside the framework of established medicine.

But proper medical care is what we need. Improvement of that care is vitally necessary, but giving up on it, casting it aside as the “enemy”, is a recipe for disaster. The problem with medical care for trans people as it currently exists is not that this medical care is overly “scientific” or “western” or “capitalist” or whatever-the-fuck. The problem is that how doctors have researched, understood and treated trans people is damaged by decades of extremely poor science, a lack of empiricism.

And the last thing we need is yet another avenue through which we’re described as unnatural, wrong, deluded, shameful.

Lives can be lost to this kind of thing. And if it goes unchallenged, they will be.

“Natural” is often just a code word for “normative”.

When speaking of human beings, the word “natural” breaks down into incoherence and nonsense. “All-natural arsenic! No dangerous additives!”. There is no strict, concrete, tidy definition for “natural” vs. “unnatural”. What these words ultimately mean in the context of human beings, human traits, or human behaviours is simply a value judgment.

And this value judgment is based on what seems normal, comprehensible, recognizable, easily understood and embraced within the pre-existing scope an individual subject-position. “Natural” means “this seems like something normal and un-frightening that totally fits into what I understand about how the world works”. “Unnatural” means “Oh noes! I’m going to have to rethink and adjust my understanding, or frame of reference, or understanding of how things are, in order to reconcile this thing I’m being confronted with! And I’d really rather not!”. “Natural” fits into your (always limited) conception of the order of things. “Unnatural” does not.

More so, “unnatural” suggests an unwillingness to adapt one’s understanding. “Unnatural” suggests you don’t wish to reframe anything, or ask any new questions, or consider any new possibilities, by which this new thing could be understood to be a “natural” part of your world. To name it “unnatural” is to exclude it from the set of facts you’re willing to accept.

“Natural” poses a normativity, a set of things you already know how to handle and conceive, and necessarily constructs an “unnatural” Other of that you wish to banish from your understanding, that you refuse to allow to fit in to your world. “Natural” forgives your comprehension of how things are as the only way things ought ever be. “Natural” is all about limiting the range of what you’re willing to understand. “Natural” is a limited, threatened, frightened, closed-in little world. “Natural” is hiding in your shell with what you’re already comfortable dealing with, and pushing away everything else, everything new, everything different. “Natural” is a Dalek in his casing.

In that sense, I am proudly unnatural.


  1. EthicistDan says

    Way to end a Foucauldian argument with a Doctor Who reference! You just earned all of your nerd points for the year. That’s the best thing I’ve read in a while.

  2. leftwingfox says

    There are very few things that strip the gears of my brain faster than alt-med types claiming that Big Pharma is only in this for profits. Really? And alt-med isn’t? That “All natural” medication has been packaged, processed and sold with a massive markup to passionate defenders who don’t care whether or not it’s been proven to work, and probably would’t be able to tell the difference between herbs and horseshit at 20c dilutions.

    Not only are there no government regulations on much of these products, but the customers have so deeply drunk the kool-aid that they’d justify almost anything these companies do to them. I don’t “trust” Big Pharma, but that lack of trust translates directly to all the studies and clinical trials and safety regulations that they need to go through before releasing a product.

    • says

      The other point alties seem to miss is that while Big Pharma is in it for the money, they get that money by giving people things they want. Thus they selfishly do good (though I’m not denying they can do harm at times). Trying to apply zero-sum thinking to a modern economy is going to leave you getting things very wrong.

      • leftwingfox says

        I’m of the mind that a genuinely free market is amoral: profit is the primary consideration, morality is secondary. If a company can make a profit in a mutually beneficial manner, they will. If a profit can be made in an immoral way, someone will fill that niche. If that immoral action is profitable enough, then people will find ways to justify their actions for the sake of profit.

        I think it’s vital that the law sets the boundaries and limits of the market to prevent abuses.

        The drug companies especially need these boundaries, to ensure that the drugs they sell are significantly superior to a placebo in doing what they claim, to ensure the side effects are less severe than the illness they attempt to cure, that quality is consistent, and that prices are kept in line when the “free market choice” is to buy the medicine or face crippling illness or death.

        Alt-med regulations vary greatly between countries, and don’t have to prove their pills work the same way drug companies do. It’s a ripe field for abuse, and the natural habitat for the snake-oil salesmen to slither over to.

        • says

          It’s certainly true that properly function markets generally require some structure from the government, particularly in cases where information is as unevenly distributed as it is in medicine.

  3. natashayar-routh says

    Bravo! As a trans woman who takes 40mg of Pantoprazole a day to keep her stomach from trying to digest her esphogus I salut you.

    I tried the alt-med treatments for my acid reflux with the only result being enough damage to my esphogus that I had trouble swallowing. That cured me of that particular stupidity. It’s interesting how so many of the alt-med crusaders just so happen to have something to sell isn’t it.

    Thank you for yet again taking down the ‘poor deluded trans woman’ meme again. That particular undead zombie of an idea simply can not be beaten down often enough or hard enough. It has done far too much damage but just won’t die.

    Again bravo!

  4. Musical Atheist says

    I’m in total agreement about ‘natural’ being a value judgement that represents nothing but the preferred option of the person using the word. It’s so broadly applicable that it basically becomes meaningless. It’s used this way across many fields of endeavour, not just medicine. It’s frequently a term co-opted by people with a specific agenda, be it the subordination of women, the immutability of gender, any given ethical or political imperative or just an aesthetic preference, like the appropriate amount of vibrato to use when singing! It’s also so tied to the desire to preserve a status quo – whatever we’re used to is of course the natural thing – that it should probably automatically be considered a suspect move in an argument.

  5. says

    I find it particularly interesting how people decide what’s “natural”. Often you find that very unnatural things are not considered so at all, simply because people are used to them.

    Practical example: I wear glasses with a rather strong prescription. I see the world through a set of lenses every day. Without them, I wouldn’t be able to see the world at all. I’d just see a blur. By attaching a pair of carefully shaped lenses to my face, I can live normally with what would otherwise be a debilitating handicap.
    This is not natural by any reasonable definition of the term, but it’s quite normal and you rarely hear the nutbags whine about glasses (although I’m sure there are some). This despite the fact that I’m stuck wearing glasses for the rest of my life. I guess I just got suckered by Big Lense or something.

    What we perceive as natural is very much a subjective thing. I mean, take a look around your room right now. Can you see a single thing that hasn’t been processed or altered by human beings in some way? Do you own a single “natural” thing at all?

    This fact does present us with a bit of hope, however. Since the idea of what’s natural can be changed so much that we perceive the world we live in now as normal, surely there’s a chance that gender-reassignment surgery and hormone therapy might at some point be seen as just another, completely normal intervention.

    Of course, it might take a while.

    • says

      Damn, I got tricked by Big Lens too! Nefarious bastards…

      It’s so unnatural, but I hear that dripping searing hot lavender infused beeswax onto your corneas is excellent, and natural, way to restore perfect vision. I know it sounds completely counter-intuitive, but that’s why it works: it’s antipathetic medicine!

      Don’t be fooled by Big Lens, don’t buy another pair of glasses!

      • Erin W says

        Big Lens got to me early. Look at pictures of 4-year-old me and I’m already squinting at the camera. Hooked me young, I tell you, even before I was in primary school! Clearly, I should accept my uncorrected vision and learn to adapt the way blind folks do. Good thing there’s so much funding for occupational therapy in this country!

    • Happiestsadist says

      I’m also a helpless slave to Big Lens. I’ve just been duped into believing that these all-natural headaches and organic limited vision aren’t the way my body would prefer to be. I’m so enthralled to them that I’m even checking out new frames right now as my lens requirements have increased! and don’t get me started on how I’ve been fooled that I need sunglasses. Photosensitivity is natural! Blinding pain when I go out is just how my body works!

    • Kels says

      Big Lens victim here too, my prescription often shocks people with good vision (and even some with bad). But who knows, perhaps an eyedrop solution of basically water would be enough to cure me IF I ONLY GAVE IT A CHANCE!

      I’m also a victim of Big Clothing, Big Shoes, Big Transit, Big Housing, and a whole lot of other non-naturally-occurring things that make my life bearable. Naked and living in the woods, that’s how we were meant to be!

  6. says

    Personally, I find people who claim that it came from a plant therefor it must be good, as laughable. Just ask them why is the plant producing these chemicals? The answer is usually to fuck over anything trying to eat it. Peroxide, cyanide, and ricin are all natural chemicals.

  7. Movius says

    Salbutamol is good stuff. It’s helped me to not die many times. Do you use it for Asthma? No preventer medication?

  8. says

    The Discworld version of the naturalistic fallacy:

    ‘It’s, er, the other stuff, sah! Colon coughed nervously. ‘He makes them rubber wallies, sah.’
    ‘Ah. The preventatives.’
    ‘Lot of people don’t agree with that sort of thing, sah.’
    ‘So I understand.’
    Colon drew himself to attention again. ‘Not natural, in my view, sah. Not in favour of unnatural things.’
    Vetinari looked perplexed. ‘You mean, you eat your meat raw and sleep in a tree?’

    I agree with Natalie; the fetishization of “natural” this and “natural” that is bizarre and irrational. If we hadn’t relied on science and technology to enhance our quality of life, we’d still be hunting and gathering, living in caves, and – if fortunate enough to survive childbirth and infancy, which few people would be – we’d all be debilitated with painful osteoarthritis by our thirties. Not to mention falling prey to various communicable diseases, having mouths full of dental plaque because of the lack of oral hygiene, and so on. Personally, I’m quite glad to live in the modern world. (Not that modern life doesn’t come at a cost, of course – it comes at a huge cost to the environment and the planet’s depleted resources – but it’s still a hell of a lot better than the way most of our ancestors lived.)

    • Cynthia says

      Thanks you, thank you! I felt I might be the only Pratchett head on this site and now I know I was wrong.

      I love Discworld and look forward to more quotes from the other readers here. Pratchett so often puts it just the way I feel but can’t articulate.

      And if I didn’t have a cat sleeping on me right now, I’d go thumb through my books and find another quote for y’all….

      • says

        And if I didn’t have a cat sleeping on me right now, I’d go thumb through my books and find another quote for y’all

        Gotta have priorities. Few things are more important than a sleeping kitty.

      • embertine says

        Cynthia, I am ripping off an immaculate Sergeant Colon salute for you right now. You are certainly not the only Pratchett fan on this site.

        I do not currently have a cat on me, but if I did it might well be an enormous grey tomcat, fleabitten and scarred, with one white milky eye.

  9. says

    I need a button on my toolbar for “What Natalie said.” Push it and it syndicates to all my social network accounts.

    This is all dead on. I’m dependent on allopurinol to keep uric acid crystals from precipitating out of my blood into the soft tissues of my joints. Without it, I lose several days or weeks to excruciating, debilitating pain. You know? Allopurinol works. Watching my diet–some of my more woo-inclined friends suggested I become a vegan–did NOT work because I have a genetic predisposition for gout. I don’t drink or eat red meats or organ meats, which are the big no nos for gout, and I still had it. That genetic predisposition is “natural,” so they can bite me if they think taking a drug for the rest of my life is “unnatural.” I don’t know what they think of my hormone therapy, and I don’t want to know. They don’t know what they’re talking about.

    Also, in case of a zombie apocalypse or robot uprising (let’s be serious, the robot uprising is a LOT more likely), I’m going to be going from town to town with a pink AK-47 raiding every pharmacy I can find. Should keep me in hormones for a while, I hope.

    • says

      Also, in case of a zombie apocalypse or robot uprising (let’s be serious, the robot uprising is a LOT more likely), I’m going to be going from town to town with a pink AK-47 raiding every pharmacy I can find. Should keep me in hormones for a while, I hope.

      I’m thinking I should come up with a way of synthesizing estrogen in a really makeshift lab, since raiding pharmacies isn’t foolproof, and it pits you against other trans women, which kind of sucks, apocalypse or no… It can’t be that hard, can it?

      • Anders says

        Urine from pregnant mares contain estrogens, although you’d probably need to drink a couple of gallons a day to get an effect. Or you could become really, really fat because adipose tissue contains an enzyme that turns a precursor of testosterone to estradiol.

        And yeah, it could probably be done although how pure the product would be is anyone’s guess.

    • Lena says

      “I need a button on my toolbar for “What Natalie said.” Push it and it syndicates to all my social network accounts.”

      This so very much. 😛
      I can’t even keep count to how often I keep linking to Natalie’s articles recently.

  10. says

    In addition to the estradiol, medroxyprogesterone, dustasteride and spironolactone I have to take regularly just to feel (even somewhat) comfortable with myself, I have a crippling social phobia anxiety disorder that results in me being unable to go out in public without significant doses of valium… Sure, in time therapy could sort this out (and even then, being complicated by a high likelihood of clinical depression, some medication is going to be likely for the foreseeable future), but that could take years… so what should I do until then? Lock myself inside, or eat some dubious leaves, or apply burning hot stones to the soles of my feet, or some other idiocy? Way to delicately point out that life is super fun and easy for you, arseholes…

    And also, the idea about the duping of trans people by “big pharma”? Bollocks. The people claiming this should really learn about who they’re attacking before opening their mouths. The uses that trans people put the various medications we use to are not listed as indications for the products use by the manufacturers. These potential uses are not acknowledged by them at all. Funny how they’re duping us while pretending that we don’t even exist…

  11. chrisj says

    Try telling someone with irreparable nerve damage that it’s just in their head, and they’d be better off accepting themselves and learning to live with it rather than being tricked into dependence on the pharmaceutical industry.

    At least some of the “natural” morons are quite happy to do that. I’ve never really been tempted to punch any of them for it, because that would hurt me much more than them, but I have wondered about biting on one or two occasions. Biting’s excellent.

  12. Erin W says

    Too many friends and relatives are deep into woo medicine, and it depresses me. My counter has always been ‘When alt-med can give me a vagina, then we can talk.’ I tend to get a lot of stammering and backpedaling in response.

  13. TiG says

    Daleks aren’t in their “natural” state…Davros tricked them into letting him engineer those metal shells, and they have been genetically modified to where they would not be able to survive outside of the host.

      • TiG says

        Nope, I got it – but I was physically unable to let that Dalek remark go unchallenged.

        Naturopaths and Homeopaths and all of those who proclaim their veracity make my eyes twitch. What makes it so much worse is when they project their insanity onto those of us who depend on you know, actual sciency-medicine to survive.

        I can’t put myself into your shoes, but it’s reprehensible for anyone to attempt to de-legitimize trans issues by saying a trans person “hasn’t thought it through.”

  14. says

    I’ve had a few times in my life when I’ve been whimpering for industrial-strength, highly-unnatural painkiller. Camomile tea was not adequate.

    On the other hand, cobra venom is also 100% natural.

  15. says

    I live in San Francisco, where this is the most pervasive kind of woo, and it’s really frustrating. Personally, I save most pillls for when I need them (and I don’t need any daily pills yet), except for things where the chemicals are so basic that I actually understand what’s happening and am not worried about it, like Tums. But I get frustrated, because there is such a false dichotomy between pharmaceutical drugs and food such as coffee, or the plants that contain those drugs. When I’d rather find out about prevention and dietary sources, or mitigating long-term effects of ongoing medications, or how food will affect the absorption of medicines, and criticize the USA culture that regards “health” as “BMI” and posits pills as a magic fix-it…I don’t want to talk about unscientific “alternatives.”.

    • says

      I mean “when I really really need them.”. Because I am a bit afraid of pharmaceuticals and don’t trust the industry behind them, but not enough to ignore medicine when I need it.

      • Anders says

        A lot of Big Pharma are now moving into alt-med, because there are less regulations there. Better profits and there’s no need to do any research. The regulations are so much lighter that it’s extremely tempting.

  16. Happiestsadist says

    Major depression runs in my family, and I have a severe case, so antidepressants are sort of necessary. When told that it’s all in my head, my main response is “where the fuck else would it be?”. I have to take BC pills because otherwise I pretty much bleed forever and as I understand, blood is sort of important to have. And then the pain stuff, because I can either go with evil, unnatural science, or be in agony most days. Yes, it does sort of suck that I will likely need medicine of at least a couple types every day forever in the nuisancey sort of way. But it sucks a hell of a lot less than the alternative.

    Since the pain ratcheted up, I’ve had even less tolerance for those who enjoy the luxury of being “natural”.

  17. says

    People with depression probably get this even worse than trans people. Annoyingly, I have a friend who’s dependent on anti-seizure meds who complains that we are overpopulated because we are doing too much to keep people alive and we should just be letting people die instead of doing all this stuff to unnaturally inflate our numbers.

  18. says

    Hi Natalie,

    Interesting article, and I agree with most of what you say here. I do have a couple of quibbles that I hope we can discuss.

    I don’t think the paragraph where you state “No cis person has ever been forced to consider gender in its multifaceted complications” is entirely fair. I would definitely agree that the vast majority of cis people fit into what you’ve said there, but to say that universally no cis person has been forced to consider the complexity of gender is not true. Growing up cis but not normative definitely forced me to consider gender on a deeper level. Certainly I have not dealt with these things in the same way or to the same degree, but I think saying “no” instead of “most” is incorrect.

    Also, you say that trans people have always and will always exist, and I am not sure that I agree with this as stated. What do you mean by trans here? Trans as a category of identity emerged extremely recently and has not always existed (I am thinking of David Valentine’s Imagining Transgender, where he makes a convincing argument that discursive declarations of transgender as a category are productive rather than descriptive). Are you speaking more broadly of gender-variant people, or are you speaking specifically about trans people as categorized today?

    So does a person need to identify as trans to be considered trans? If I consider myself a cis man who is somewhat effeminate, does that mean I am trans even if I don’t identify that way? I guess my point is that I’m uncomfortable with slotting people into categories of identity that they themselves may not identify with because I think they are the only people who have the authority to make that decision for themselves.

    • says

      It wouldn’t be a problem to call people “trans”, if the word did not carry any stigma. Does one worry to this extent about whether or not to call someone a “child”?

      Respecting people’s identities here and now is all well and good. But using this as a game to detract from the power of statements like “trans people have always existed”, is not.

      There is a really interesting book called “Queer (In)justice,” which has a lot to say about how white European colonizers imposed rigid expectations of sex and gender on indigenous peoples when they arrived, and indeed used any “deviance” as a tool to paint such people as more “animals” than people.

      To quote near the beginning:
      “At times modern lesbian and gay scholars appear to have adopted the notion that peoples Indigenous to the Americas are somehow inherently, culturally, or traditionally “queer”, and claimed Native Americans to be members of “homosexual” cultures destroyed by wrong-minded colonists. But traditional Indigenous cultures cannot be understood by pacing them into existing templates of homosexuality, transgender identity, or inflexible definitions of gender…”

      Yet, the book goes on to talk about gender policing, and does an excellent job of talking about how people society would /now/ label as ”queer” were victimized by European societies for centuries before we got the word.

      If you’re looking at older history and further in the future, people may never *need* to words like “trans” to describe themselves. That doesn’t prevent them from existing, and having a life that is recognizable as a trans person’s life. By this I mean, that if you take a person from our time and culture, and introduce them to any other time and culture, they will probably meet people they would call “women”, meet people they would call “men”, and they would also decide who was and wasn’t “trans” among them. The word “trans” is a product of our culture; the people it usually refers to, are not. Same goes for “queer”.

      • says

        I disagree. It is a problem to use terms to refer to people’s identities that they do not use for themselves. You risk erasing their experiences by trying to slot them into categories that they don’t feel are appropriate for their lived experiences. The ethnography I mentioned in my previous post gives good examples of people who identify as gay (and sometimes “fem queen” or drag queen), but they reject trans as a label for themselves even though they were labeled by social service workers as transgender. You think this is not a problem? They are trans even if they don’t identify? Whose right is it to place that identity on them?

        People can dislike identities applied to them even if the identity is not stigmatized. Certainly plenty of people could be taken for an ethnicity and reject being labeled that way not because of stigma, but because it’s not how they identify (e.g., someone I know was called white recently and she corrected the person that she wasn’t white, but Lebanese).

        To say I’m detracting from the power of Natalie’s statement is a bit odd because I think it’s a false statement and I think there are better ways of saying what I think she is saying without the universalist language, which is why I bring it up. I think it would be more powerful if it weren’t overreaching.

        I also don’t agree that it’s only the word that is cultural. Read the ethnography I cited above if you want to get into the details, but I already explained the basic premise (that the discursive category is not merely descriptive but productive). To say that someone can “live a trans person’s life” implies that there’s some sort of idealized, unenculturated version of a trans life that we could use as a litmus test to determine if a person is living a “trans life” or a “cis life.”

        • says

          Will, I believe I already did address your point. As an identity, “trans” depends on cultural context, and there is no absolute litmus test as you say. The point is that there have always been people in the past who, if they grew up in this culture, would ID as trans. We may not say exactly who they are, or how they would do this; the assertion is valid nevertheless.

          I think you are still being blinded by treating “trans” as an identity more special than other identities. For example, consider the assertion “children have always existed”. If there is a culture that doesn’t consider a category of “children” as a separate class of human beings, or draws the lines differently than we do, does that invalidate this assertion?

    • Sas says

      Similarly, homosexual people have not always existed, because that word was coined around 1890, and there were no gay people before the 1950s.

        • Sas says

          Sure, but if “trans” is so complicated and modern a concept that we aren’t allowed to assert our historical existence for fear of misrepresenting people, then the same surely goes for other identities. Who’s to say those men fucking men prior to 1890 even considered it fucking? Maybe it was just very low-competition wrestling, or a sort of interpretive dance. We mustn’t impose our modern ideas onto them. The only responsible stance to take is that “trans” and “gay” spontaneously began at the moment those words were coined.

          • says

            My years dealing with the post-structuralist crowd are causing me some serious Poe problems here.

            But yeah… REALLY interesting point about the value of historicity. Honestly, I don’t give a damn if I accidentally “mislabel” pre-modern trans identities. I’m NOT going to allow the narrative of trans people as “invention of modern medicine” to go unchallenged. We are a fact of humanity, and WE HAVE A HISTORY.

          • says

            I actually agree that homosexuality as an identity has not always existed, so I’m not sure if you were trying to do a “gotcha!” on me or something, but I don’t disagree.

            And, again, I’m not trying to erase trans history. I’m saying that it’s problematic to appropriate other people’s history as trans history, just as it’s problematic to appropriate other people’s history for gay history. If you don’t care, that’s certainly your prerogative. I just feel that for people who believe in social justice to “not give a damn” about other people’s histories is a major problem.

            I totally agree that there are trans histories, and that they are not entirely tied to modern medicine. In fact, I think much of trans history has been erased from American gay and lesbian history (I’m thinking specifically of Sylvia Rivera, who has been nearly completely erased from Stonewall and queer liberation).

            I would hope you know me well enough, Natalie, to know that I am not trying to erase trans people’s experiences or histories. Quite the contrary. But I am interested in preserving other people’s histories, too, and that means being respectful of their categories and identities and not appropriating their histories. If we expect people to be respectful of our identities and our histories, don’t we owe others the same?

        • Sas says

          Your Poe senses were right on, Natalie, I was being super-sarcastic even though I didn’t telegraph it well. I think it’s totally ridiculous to pretend that “trans”, “gay”, and such didn’t exist in history just because they weren’t called that or involved a different cultural context.

    • says

      What we call it changes, but what it is was always there and will always remain. Categories shift, conceptions shift, cultural accommodations shift, medical options shift, but the fact that gender identities don’t always match prescribed roles and morphology is a fact of human gender. Words carve up the world, and modify our perceptions of it, but they certainly don’t create it.

      And partly we need to figure out what sense of “trans” we mean. The larger umbrella term “transgender” is heavily dependent on cultural context, in that it’s defined by being non-normative to cultural concepts of gender. But many of the etiologies covered under that umbrella term, such as transsexuality, are etiologies that exist independent of the terms or pathologies or concepts we use to describe (prescribe?) them.

      • says

        I’m not denying that there is gender variation, please don’t misunderstand me. It seems like you’re trying to have it both ways. You said trans was always there and will always be there and when questioned on whether trans is really the appropriate term, you say “what we call it changes, but what it is was always there and will always remain.” What is it? What, exactly, will always be there and always remain?

        As far as words not creating the world, I think that depends on what you mean by “the world.” 😉 Certainly many social theorists would beg to differ that important aspects of human life are not discursively produced.

        I think this is really important because it seems to me that you’re trying to universalize experiences by placing people into categories that they may or may not approve of for themselves. People don’t even agree on the etiologies or that trans is a pathology, so it is hard for me to accept that we can so easily place people into this category when it is unclear what the category even means. I think it’s best to steer clear of universalist language when it comes to identities.

        • says

          Gender variance is the “IT” that was always there. And “transgenderism” is a key term we use to articulate gender variance. As an umbrella, it would encompass the prior articulations and etiologies of it. I don’t see any real point here, Will. I see an irrelevant, self-referential language game.

    • Paws in a Box says

      “So does a person need to identify as trans to be considered trans? If I consider myself a cis man who is somewhat effeminate, does that mean I am trans even if I don’t identify that way?”

      A male-bodied person (for instance) could be the most objectively masculine person in the whole entire world and still be a trans woman. Or ey could be the most objectively feminine person in the whole entire world and still be a cis man. Being “somewhat effeminate” affects your *gender identity* in this many ways: 0.

      You get to decide what your gender identity is based on a feeling in you that tells you. If your feelings are telling you that your gender is x, no one can tell you that you’re not x; it’s *your* identity and *your* feelings, not theirs.

      If you’re not noticing any disconnect with being called your assigned gender, you’re probably not trans*!

      Agreed on this, though:

      “It wouldn’t be a problem to call people “trans”, if the word did not carry any stigma. Does one worry to this extent about whether or not to call someone a “child”?”

      Children don’t stop being children just because they’ve decided “child” is a word they don’t like! The problem in your example of gay people getting called transgender is that that’s a completely incorrect usage. Like if I called you a child (presumably you’re not!) it would just be plain incorrect. Or if I called you a cookie! Or a desk. But if you were a desk and I called you a desk, that would be fine.

      Transgender means a certain thing, so if someone just *is* the certain thing, surely they’re transgender? If someone’s legitimately uncomfortable with being called that (‘legitimately’ meaning some real meaningful reason, not because of a misconception or cissexism or something), I guess it’s not very nice to call them that, but surely it wouldn’t stop being accurate?

      You personally don’t have to get called transgender, so I’m not sure why you’re really scared of someone calling you it. Are you getting “by the way you identify as transgender now; I know your personal identity better than you do live with it” mixed up with “the word for the feeling you are experiencing is ‘transgender'”? You know like there’s a difference between looking at a blue sky and saying “That sky is red” and looking at a *red* sky and saying “That sky is red”.

      • says

        Well you can’t say that the sky was blue before people decided that “blue” was a different color from “red”! And what if the sky could be considered violet, then you shouldn’t call it blue, amirite?

        • Sas says

          For another example, the color called “aoi” in Japanese is normally what English speakers would call “blue”, but it can also include pale green. That does not mean we cannot translate uses of the word “aoi” into English as “blue” (or pale green, depending on the object), just because the concept is subtley different!

      • Paws in a Box says

        (Um, pretend “male-bodied” was written “male-assigned”! Some people have expressed discomfort with their body being called “male” or “female” because it’s not a male or female body it’s *their* body – which makes lots of sense! – and while I’ve seen them ask for ‘male-bodied’ and ‘female-bodied’ to be used instead I think lots are probably uncomfortable with those as well.)

  19. Alex says

    While probably a topic for another article, I was thinking recently about how similar pro-“nature” “medicine” and woo gets bounced around trans masculine* communities. Specifically, I’ve seen a lot “natural medicine” suggestions for increasing testosterone, homeopathic shit to reduce hair loss and fuck knows what else [I see “homeopathic”, I stop reading], and particularly the popularity of “natural transitioning” [both the trade-marked version and variations thereon].

    Anytime I hear some guy talking about how he’s “naturally transitioning”, I pretty much want to punch him in the face. [Someone at Skepchik did a review of the program, which I thought was really interesting – ]

    I don’t know how much of it is just failure of science education, how much is opportunistic snake-oil salesmen, and how much is fueled by desperation of a community with historically limited/gatekeepered/non-existent access to real health care.

    *I wouldn’t be surprised if it happens in trans feminine communities, too, but not being well-acquainted with your side of community thoughts on medicine, I shan’t extrapolate.

  20. katie says

    Thanks for your honest and interesting perspective–I never thought of people promoting natural health stuff as being cissexist (but of course, in hindsight, it makes sense). I’ve often been frustrated with these people since they never seemed to get that not everyone has the privilege of getting to use natural products only (like my health concerns that CANNOT be treated by “natural” products only). But I never thought of it as a human rights issue until now.

    Just for interest’s sake I looked up how much estradiol my BC delivers daily–less than 1/300th of what you’re taking. Holy crap, hormones are interesting. I tell ya, if I had to do it all again, I’d be an endocrinologist.

  21. Cara says

    Aside from being miserably unhappy without EEI, I’m pretty sure I’d never have existed because my mother had appendicitis while she was pregnant with me. And that’s not counting all the diseases I didn’t get because of vaccines and sanitation. Three cheers for modern medicine, and fuck natural: smallpox, transsexuality, and cancer are all natural and all horrible.

  22. Louis says

    It’s really easy to talk about “natural medicine” and criticize pharmaceuticals when your life and identity aren’t dependent on your medicine actually working.

    This. This post is possibly the best critique of the “natural medicine” movement I’ve ever seen.

    I don’t choose to take hormone adjustment medication. I take it because if I don’t, my body doesn’t function correctly. And that’s before we begin to discuss my psychological well-being. My physiology is non-standard. If one of the alt-med woo merchants could borrow my body for a month or so, would they choose to accept a substantially reduced quality of life just because they hate Big Pharma? Somehow, I think not. Of course, we all make choices and people can choose to use homeopathy if they want to, but how dare they presume to make my choice for me. The arrogance is sickening.

    Regarding the psychological issues, I’m going to go with the chronic pain comparison. It is like that, really, but of course so many alt-med idiots also claim that chronic pain can be cured by happy thoughts and regular application of dandelion leaves or whatever, that I think that comparison may go over their heads.

    On a completely different topic, many happy returns Natalie. I hope you had an awesome birthday.

  23. Eris says

    I have various mental disorders/disabilities/illnesses/whatever you want to call them; I take various medications to control these so that I can do productive things like work, go to school, get out of bed, shower, and not jump out of window. I also have a sister who believes that Big Pharma is evil, and that the pills I’m taking are CAUSING my symptoms, not alleviating them. Oh, she believes that they surely made me feel better at first, but she views me taking them kind of like a med student taking meth to sleep less: a very bad idea.

    I love her, but I sometimes I want to shake her. The fact that I am taking pills to deal with a mental issue rather than a physical issue doesn’t mean my issues aren’t real. Yes, I may end up on these pills for my whole life (and I don’t want to), but “for my whole life” is better than “and I died.”

    Ah well.

  24. Cynthia says

    I, too, take meds on a daily basis to keep living in a healthy way. I finally started taking anti-depressants when one of my babies was only a few months old. I saw the need for some Big Pharma help with my depression when I realized I was planning how to die in a car wreck but not injure my children. Yeah, it was serious.

    And a well-meaning, clueless IDIOT asked me why I didn’t take St Johns Wort instead – ’cause it was NATURAL.

    I didn’t scream at her, but I did emphatically say “Because I don’t have 6 weeks to see if something might work, because SJW has been shown not to work in controlled studies, because there is no guarantee of the quality of the SJW in capsules you buy, because natural doesn’t mean GOOD. Arsenic is natural!”

    She was never anything but supportive of my meds after that. At least to my face. But I still meet these people. They think homeopathic stuff works better than the double blind trial stuff. That lavender oil and arnica are better for stitched wounds than antibiotic ointment. That debilitating pain can be fixed by pushing the right points on the body. The myth of Big Pharma is almost as pervasive in my area as the myth of god. It’s appalling. And you know what? This post made me realize that most of the ‘natural’ crowd are fairly well off. They are majority white, middle class and female. And they’re wrong because they can afford to be.

    I’d say it was depressing, but I have meds for that!

    • embertine says

      To be fair, St John’s Wort has been shown to be as effective against an active placebo as modern SSRIs but without many of the side effects. (Check Cochrane Review for results)

      I’m planning on going on it for my despression because I can guarantee the quality of the tablets I buy and I’m not happy about the long-term side effects of SSRIs. I’m certainly not going on it because it’s “natural” and therefore better.

      I also take valerian, because it freaks my doctor out less than prescribing me Valium does, even though it’s exactly the same drug.

      Even medical professionals can be weird about this stuff.

      • Anders says

        That’s great but two caveats –

        a) check out so you don’t have a medium or severe depression, because SSRI does zippo against those. Although your doctor will probably still try them first.

        b) check out so St. John’s Wort doesn’t interact with any other medication. Especially troubling is warfarin, but other substances are affected as well. Of special interest for this blog is the interaction with birth control. If it interacts with that it should theoretically interfere with trans woman HRT as well.

        Also, valeriana does not contain Valium, but it contains substances that work the same way. I don’t think we know exactly what is responsible for the sedative effect.

        Oh, I’m a pharmacologist so while I won’t guarantee this is the truth, it’s probably more accurate than something on a random website. 🙂

        • embertine says

          Thanks Anders, it’s really useful to hear from someone who works in the industry. I did do a bit of research before making my decision (not from the University of google, thank you Jenny McCarthy!) and it seems like the right fit for me.

          I am on prog-only birth control but I’m not using it for contraception, and wouldn’t as it’s not AIDS-proof. I’m not on any of the other classes of drugs that have a contraindication.

          I know what you mean about the valerian – I was being a bit flip by saying it was the same as Valium. What I should have said is that it is the same class of drug, not the exact same drug.

          • Anders says

            Yeah, I know. It’s something for us connoisseurs… 🙂

            Progesterone is not affected as far as I can see from a quick Google-search. Indeed, there’s a study saying it’s not affected.

  25. says

    Yup, those of us who are on meds for anything that isn’t, like, an infection or cancer or some OMG-so-tragic condition, we’re CHOOSING to be on mind- and sometimes body-altering drugs. There’s either “nothing really wrong” with us, or we’re “looking for attention”, or we can “just cheer up” or some-such nonsense that involves ditching the meds and just applying a little willpower.


    (No, I can’t speak to the transgender part of this, but people with mental illness get a lot of the same shit. “Why can’t you just be happy?”)

  26. Anders says

    When people ask me if I just can’t stop taking my medicine I tend to go the direct route and say “Yes. I would be dead within a month but I could stop taking them. It’s like taking insulin from a diabetic.”

  27. embertine says

    Natural vs. unnatural is total bollocks. Natural is infanticide, intestinal worms and dying of typhoid at the age of eleven.

    And I might be cis but I’m not a “natural woman” (sorry Aretha). I take progesterone, I dye my hair, I shave my legs and I’m wearing some kickass green eyeshadow right now. Natural schmatural.

  28. katie says

    The thing that gets me about paranoia about Big Pharma is that it seems really ridiculous when you know people who work in that field. My partner is a grad student studying new cancer drug candidates (that he designed and synthesized!) at a university here in Canada. If everything the “medical establishment” tells us about cancer is wrong, his experiments wouldn’t work in a predictable way. He’s a grad student, and trust me, if he could show that the things we know about cancer biology are wrong, he could publish his results in Nature and make his career on it. There’s no financial incentive to hide that kind of thing for him.

  29. lexy says

    In my opinion, Big Pharmas are angels. They don’t misgender me, they don’t mistreat me, they don’t ask questions. They *do* supply the sweet elixir that allows me to live as a free human being and not a prisoner.

  30. dollypop says

    Body modification is body modification. Meh, deal with it, is my first reaction.

    What would actually happen in the zombie/robot/Smurf apocalypse where you were unable to access the drugs which keep you trans? Forget the asthma meds, the psychoactive meds, all of those; we all would have to deal with similar problems. Would you be in particularly ill health if you couldn’t access them?

    • says

      To start with, hormones don’t “keep me trans”… as if I could stop and I’d suddenly be cis, since that would been I was cis to begin with, and HRT was the cause of my transness… It makes so little sense, I have a headache now…

      Secondly, you asked if we’d be in particularly ill health? And you list psychoactive meds as something that would be missing, and hence a problem. I’m sure you can put two and two together here. My psychological and emotional wellbeing hinges on my access to female hormones. Without them, my body, and brain chemistry, would revert to something that feels utterly wrong and alien, on every level, which ultimately would lead to crushing depression and complete apathy. So yeah, I think I would be be in particularly ill health without access to them.

    • says

      Also, transition /= body modification. They are completely different things, with completely different causes and motivations. It’s more than a little offensive to have them equated that way. (which in no way is meant as disrespect to those who pursue body mods. The issue is that one is truly a lifestyle choice, and the other is a medically indicated necessity)

    • Sas says

      As a trans woman who also enjoys body modification, I want to tell you that you’re completely wrong. Body mods are fun and feel good and many people find great meaning and passion in them … but they’re not a fraction of the necessity that transition is for a trans person. When I found out I can’t ever get my tongue pierced because of the shape of it, I didn’t walk out of the parlor and into the path of an oncoming bus. I’ve had to give up some piercings and cover up a tattoo for employment, but it didn’t send me into a downward spiral of depression and loss of will to live, which is what loss of transition care would do to me.

  31. Esteleth, Who is Totally Not a Dog or Ferret says

    Oh, this post wins. Totally.

    I run into woo-meisters a lot. I oscillate between wanting to pummel them and cheerfully poking holes in their assertions.

    Let’s see:
    1) Five years ago, my severely malfunctioning thyroid was removed. Modern medicine gave me a trained surgeon to carefully slit my throat and cut the bugger out, another doctor to feed me the radioiodine that modern physics enabled to production of, and the synthetic thyroid hormone that I will take for the balance of my life.

    2) Many years ago, I had surgery to correct a congenital abnormality. Minus modern medicine, I would not have had this surgery, and would thus have a serious impairment – modern medicine thus normalized my abnormal body. Minus correction, I was prone to serious infections (which modern medicine helped control pre-op).

    3) My first few weeks of life were spent in a NICU. Do I really need to expand on this?

    4) My mother’s pregnancy and delivery with me was difficult and high-risk. Not all that long ago, this would have ended with either maternal death and/or a miscarriage. My mother is alive and well, as am I and my younger sibling, due to modern medicine and Big Pharma.

    5) My mother became pregnant with me after years of suffering from PCOS. Big Pharma and modern medicine treated her PCOS, saving her health (and fertility!) and helping her to conceive.

    So, in summary: modern medicine and big pharma got me conceived, born, to my first birthday, and to a healthy twenty-seventh birthday.

    I’ve actually checked – woo and homeopathy can do nothing for the aforementioned issues.

  32. Sarah says

    This, very much this. Awesome post.

    My mom just got in remission from cancer yesterday. Modern medicine is pretty damn valuable.

  33. Anders says

    Hmm… here’s my list

    75 mg chlomipramine twice a day

    42 mg lithium sulphate, three in the morning and two in the evening

    300 mg bupropion, mornings

    75 micrograms levothyroxine (because Lithium Ate My Thyroid Gland)

  34. says

    Natalie, your daily intake significantly worries me that I’m not getting sufficient quantities for my own transition.

    For the first 3 months, my regime was transdermal estradiol – two patches containing 6.4mg each per week (at a release rate of 100 micrograms per 24 hours! Not both patches together for each week, but each one for half a week) + 20mg cyproterone acetate per day.
    It’s been raised to two sets of 9.6mg estradiol per week (at a release rate of 150 micrograms per 24 hours) last week when I asked my endocrinologist for it to be raised, since there were no counter indications, and my cyproterone acetate regime remained the same.

    The way I understand it, my dosage of estradiol was 100micrograms per day and is now 150micrograms per day; compared to your 6mg per day, I’m deeply concerned that my dosage could be insufficient.

    On the other hand, my most recent blood test results showed Estradiol levels of 421.0 pmo/L on a scale of 40-161, FSH of 0.1 miU/mL (on a scale of 0.95-11.95), LH of 0.01 miU/mL (on a scale of 0.57-12.07), Prolactin levels of 789.4 miU/L (on a scale of 54-380), and Testosterone levels of 1.32 nmol/L (on a scale of 6-29.2); results, which needless to say, I felt extreme bliss to witness.

    Subjectively, I’m seeing/feeling the changes I would have liked, but gradually – from all my reading prior to starting transition, I expected it all to be slow and gradual (perhaps even slower than they are occurring for me now), but I’m concerned that it might be gradual *because* of my dosages, rather than as an inherent fact of transition.

    Am I misunderstanding something about the difference in delivery systems (transdermal vs sublingual)? Am I getting ‘enough’?

    On an unrelated note, another part of my regime is 12 micrograms of formoterol fumarate per day, which addresses my asthma. I love that particular drug, as it works for me *instantly*, like magic. When presented with an asthma attack, I can either do my best to not panic, then do breathing exercises for a few hours… or inhale those 12 micrograms and have it fixed in seconds.

    Post scriptum: Do I have to register here if I want my comments to have an avatar?

    • says

      Dosage and intake for transdermal estradiol really isn’t comparable to sublingual estradiol. The delivery systems and metabolizaton are VERY different. But what ultimately counts isn’t dose, it’s your serum estradiol levels (which are higher than my own) and, more importantly, whether or not you’re happy with your results.

      Those prolactin levels are high, though. That’s not really a good thing. It increases chances of breast cancer, doesn’t play too much of a role in breast growth and nipple development, and I’m fairly confident you’re not nursing.

      To get an avatar, just go to, and associate an avatar with whatever e-mail address you use to post here.

      • says

        Many thanks Natalie and Anders. 🙂

        My prolactin levels were equally high on the first time it was sampled too, prior to HRT, and investigating whether it stays high with two more blood tests (it didn’t) + investigating why it was high in the first place (no discernible reason) added another month of medical hoops for me to jump through on my way to getting the HRT started. If that value stays high on my next blood test in 3 months those investigations will probably start afresh, I just hope that it won’t put my treatment on pause – nightmarish notion.

        I am happy with my results, but I’d be happier if those results would develop faster. :p

        And hopefully I should have an avatar now, yay!

    • Anders says

      Ciswomen produce between 100 and 200 micrograms per day, which is about what you’re getting. The bioavailability (how much of the drug in one dose reaches the bloodstream) of a sublingual preparation is pretty low – most of the estrogen will exit Natalie without ever leaving the intestine. I don’t know why you’d prescribe a sublingual tablet rather than a pill but I assume the doctor knows what ze’s doing.

      • Anders says

        My cat turned the computer off, but I managed to send my message… 🙂

        Anyway, the important thing is that your bloodstream levels are normal. If you want to contrast and compare with another trans woman (or a cis woman for that matter), that’s the levels that are important.

        I’m happy to defer to Natalie when it comes to prolactin – but the sources I consulted gave the following ranges:

        80-400 males
        90-520 females: reproductive years
        80-280 females: post-menopausal

        These are so-called reference ranges and when something is outside those ranges it’s worth noticing. It’s not necessarily something wrong or dangerous, but ask about it.

      • says

        The sweet, candy-tasting sublingual tablets can either be taken orally or sublingually, as it does get absorbed through mucous membranes. Sublingual doses cause a higher peak in the bloodstream but end up metabolizing away faster. Nonetheless, staggered sublingual doses throughout the day creates a higher average concentration in the blood than do oral doses.


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