Informed Consent Model of HRT

HRT stands for Hormone Therapy Treatment.

If you remember from one of my previous posts, the transitioning journey for trans may include three major phases, (1) social transition (non-medical such as pronouns, clothing, hairstyle, or voice), (2) hormone therapy (which will be a life-long commitment), and (3) the optional (bottom) surgery (it is not only expensive but also dangerous, sometimes, life-threatening). (Note: bottom surgery can be done on 21+, so, for the moment, it is very much on the back burner and we do not even think much about it, other than struggling with finding the good panties - I may need to start a line of product one day!).

The legal requirements for adolescents to receive HRT vary from state to state since the federal government does not specify anything about hormone therapy or puberty blocker for adolescents, although the Biden administration has done a few things to promote access to health care and to prohibit discrimination in providing health care to the LGBTQA+ community. 

(Note: hormone therapy is done at later stage when teens already underwent their puberty years, most significantly, trans girls have already developed deep voices that could not be reverse with HRT; and puberty blocker is done at early stage, typically for pre-teens, so that trans girls do not have to deal with deep voice, among other things such as body hair and odor, wet dreams or erections, and trans boys do not have to deal with enlarged breasts).

https://www.kff.org/other/issue-brief/youth-access-to-gender-affirming-care-the-federal-and-state-policy-landscape/

Four states, including Arkansas, Texas, Arizona, and Alabama (in that chronological order), have recently in 2021/2022 enacted restrictions on limiting LGBTQA+ youths' access to HRT (gender-affirming health care). Fifteen other states are considering pieces of similar legislation. Some examples are: criminalizing or imposing professional disciplinary action, penalizing parents aiding, permitting individuals to file for damages against providers, and limiting insurance coverage or payment, among many other little things such as "the bathroom bills" or "don't say gay" bill.

Meanwhile, some states have adopted broad non-discrimination health protections based on gender identity and sexual orientation, including:

- Prohibitions on health insurance insurance discrimination based on sexual orientation, or

- Requirements that state Medical programs explicitly cover health services related to gender transition

The implication is that youth access to gender-affirming care boils down to state policies. In our particular case, we are stuck in a conundrum. I just quit a state-employed job in New York, where not only the access is great but the facilities are familiar with tons of youth transitions; I am now working a state-employed job in Texas, where I decided NOT to add my children to a family plan to avoid any legal issue towards me aiding my child (potentially considered child abuse); we are still living in New York where our base home is and we do not have a New York-sponsored medical plan; I decided to have my children added to their father's family plan which is based on a state-employed job in California, and while California is even more open and progressive than New York, my child has to either fly in to get in-state health care, or receive out-of-state health care, which is subject to a different set of rules.

Long story short, we have been very patient (while being somewhat frustrated) with months and months of waiting - waiting to figure out the process, for the next appointment with a doctor (or even a nurse practitioner from Gender Health Services under Adolescent Medicine), for the sorting out of insurance benefits and the upgrading to a better plan that would cover out-of-state health care, and finally, the jigsaw puzzle pieces fall a bit together. We now have three different options (note that there is a fourth):

(1) Kid could fly out to California, especially for the first appointment in-person (COVID allowed for many virtual setups but we are post-COVID now), and hopefully, depending on the physician, they may or may not allow subsequent visits to be done virtually (since the refills should not be a problem).

(2) Kid could receive the treatment from a local prestigious hospital, but the law in New York State would require months of consulting with a therapist (pediatric psychologist, basically) to talk about the emotional struggles, to make sure this is the right decision before getting a letter of support. 

(3) Kid could alternatively opt in for a newer approach called the "informed consent model" where we could cut off the months of therapy (where no DNA or blood test is done, just self-reported symptoms) and sign a consent form to acknowledge the potential risks that might come with receiving HRT.

(4) This scares me as a mom. My kid threatens to buy cheap hormone treatments off some dark website if she could not get HRT that she has been craving for. While I don't think HRT is the magic potion that will take her depression away overnight, my heart dropped she might actually do it.

Do some research, consider the so many plans you could possibly have, including flying/ driving to a different state, including alternative health care providers. It is a tough battle and I can't wait to finally have our very first HRT appointment tomorrow (under the "informed consent model").

2023 will be a better year for sure! 

Ref: https://journals.sagepub.com/doi/abs/10.1177/0022167817745217?journalCode=jhpa

 

Hormone Replacement Therapy

https://idea.unt.edu/hormone-replacement-therapy

 

National Coming Out Day - October 11

National Coming Out Day (NCOD) 

https://en.wikipedia.org/wiki/National_Coming_Out_Day 

This is an annual awareness day that is observed on October 11 to support any LGBT+ member "coming out" of the closet, whether it be to their significant other, their family, their smaller circle of friends, colleagues, or the whole world.

The first NCOD in the United States was in 1988 (marking its 35th anniversary in 2022).  

NCOD Observance is also done in Ireland, Switzerland, the Netherlands, and United Kingdom. 

In the United States, NCOD is sponsored by the Human Rights Campaign with annual themes.

At the very beginning, it was grounded in the feminist and gay/ lesbian liberation spirit and the most basic form of activism being living life as an openly lesbian or gay person. The psychology behind this is that homophobia thrives in an atmosphere of silence and ignorance. People who know they are loved by their family, friends, and colleagues, even after coming out, are far less likely to maintain homophobic or oppressive views.

I do not personally care too much about that psychological explanation. I don't believe all gays and lesbians, and other LGBT+ members, suffer from homophobia. At least my simple child does not, other than some non-believing jokes about moving to Texas with me and being shot in the parking lot (however, for that valid phobia, I am willing to allow her to live with her father in California in her senior year of high school, so that she could have her peace of mind). I also don't believe by coming out, homophobia will go away overnight. It is more complicated than that.

But, as someone who is somewhat free spirited, someone who wants to treat others the way she wants to be treated, I want to be my truest self, I want to hold up my value system (which may overlap but not necessarily identical to other value systems such as the law, culture, or religions). I want the freedom to make my own conscious decisions and take full responsibilities for the consequences, while at the same time making sure I am a contributing member of the society and I am here to marginally make the world a better place.

One of the biggest social transitions we did early on after my kid came out to me was to take her to our local Pride Fest. I was up close and cheering and whistling and waving. I was wearing rainbow all over me. I was a strong ally, basically. But, I was not a member. I knew the euphoria I got was coming from being a good and supportive person, not from being accepted or belonging like the real LGBT+ members feel. My child, shy and worried, hid behind a tree peeking out most of the time, she did not want to be associated with a crazy and loud mom, but, I saw the beaming light in her eyes and the blush cheeks on her face. She was clearly excited, and I, in that moment, knew for sure I must accompany her on this long journey to happiness, and I will fight if I have to.

 

LGBT+ History Month - October

This is not to be confused with LGBT+ Pride Month, which is usually June.

https://en.wikipedia.org/wiki/LGBT_History_Month

In the United States, Canada, and Australia, it is celebrated in October. In Hungary and the United Kingdom it is observed during February (in the UK this coincides with a major celebration of the 2003 abolition of Section 28). In Berlin, the capital of Germany, it is in May (known as Queer History Month). 

In the United States, October was chosen as the month for the celebration because the first and second LGBT Marches on Washington, in 1979 and 1987, were in October; National Coming Out Day (NCOD) is on October 11 to mark the date of the Second March on Washington for Lesbian and Gay Rights in 1987, and October is within the academic calendar year.  

LGBT History Month is intended to encourage honesty and openness about being LGBT. While it was first known as Lesbian and Gay History Month, it has become known as LGBTQ+ History Month.

Medical Terms

I am just a mom that is doing her own homework and taking notes of things she learns along the way.

Some of the things I jot down might be common knowledge for some of you, but we are all different and I am sure there are also people like me who start from zero. 

As an educator, I now follow this approach in teaching - never assume students already knew something, always assume they knew nothing in the background.

* Specialists *

"It takes a whole village to raise a child." Similarly, transitioning is a team work.

Therapist

Psychologist

Psychotherapist

Psychiatrist

Social worker

* Medications *

It is critically important to know what we put into our (child's) body and the short-term and long-term side effects, many of which are yet known due to the first generations of teen trans have not reached their 50s-60s.

Oestradiol pill - a gender-affirming hormone in the form of pills

Sprionolactone - a testosterone suppression medication

Estriol - a sex steroids that would make the penis shrink

Lupron - NO!!!

Puberty blockers - controversial treatment from state to state

* Surgeries *

Except for the chest or breast removal (FtM without puberty blockers), most are *bottom* surgeries. Not all trans choose to have surgeries due to various reason, including affordability and internal desire.

For trans girls (MtF)

Penile inversion - note that only male-born that did not go through circumcision could do this

Testicles removal (disposal)

Erectile tissue removal (disposal)

Orchiectomy (same as vaginoplasty)

Phalloplasty (not functional)

Scrotectomy (scrotal tissue removal) 

Vulvoplasty (zero-depth vagina and vulva construction using the scrotal and penil tissue)

Vaginoplasty (vagina construction)

Medioplasty

Urethra cut short (and placed in female position)

Uterus (ovalry transplant) - this is the future of health care which may allow trans girls to be pregnant

For trans boys (FtM) - including top and bottom surgeries

Bilateral masectomy (chest reconstruction) - by far the most common

Hysterectomy (removing reproductive organs, required for some other surgeries)

Oophorectomy (same as hysterectomy)

Metoidioplasty (clitory release)

Scrotoplasty (crotum construction)

Uretheroplasty (urethral canal creation)

Vaginectomy (vaginal tissue removal to close the opening)

Phalloplasty (phallus/ penis-alike construction using a graft from another part of the body)

* Others *

Last but definitely not least, there are other things that are optional but could help significantly in emotional behavior.

Electrolysis (laser hair removal using electric needle) - for trans girls

Breast augmentation (silicone or silibreast implants) - for trans girls

Facial feminization (face bone contouring) - for trans girls

Fertility preservation (cryo preservation) - for both

(which could cost $1,000 in the first year and $150-300 for the subsequent years' preservation).

LGBT Rights in the United States

LGBT rights progress - in the United States

https://en.wikipedia.org/wiki/LGBT_rights_in_the_United_States

* Same-gender sex *

It is hard to believe that not too long ago, in 1962, all 50 states criminalized same-gender sexual activities!!!

By 2003 all remaining laws against same-sex sexual activity were invalidated with the last one in Lawrence v. Texas. 

* Marriage *

The movement to obtain civil marriage rights and benefits for same-sex couples in the United States began in the 1970s but remained unsuccessful for over forty years. 

On May 17, 2004, Massachusetts became the first U.S. state and the sixth jurisdiction in the world to legalize same-sex marriage following the Supreme Judicial Court's decision six months earlier.

Before nationwide legalization, same-sex marriage became legal in 36 states; twenty-four states by court order, nine by legislative action, and three by referendum. Some states had legalized same-sex marriage by more than one of the three actions.

On June 26, 2015, the Supreme Court ruled in Obergefell v. Hodges that states must license and recognize same-sex marriages. Consequently, same-sex marriage is legal in all 50 states, the District of Columbia, Puerto Rico, Guam, U.S. Virgin Islands, and Northern Mariana Islands.

Currently, same-sex marriages are neither licensed nor recognized in American Samoe, due to its unique constitutional status. 

The legal status of same-sex marriage also varies in Native American tribal nations, as their reservations are considered sovereign entities and were not affected by the Supreme Court's legalization in 2015.

* Anti-discrimination laws *

U.S. federal law does not explicitly include protections against discrimination on the basis of sexual orientation or gender identity. 

In June 2020, the U.S. Supreme Court ruled that sexual orientation and gender identity are included under "sex" as a prohibited ground of employment discrimination in the Civil Rights Act of 1964. The ruling may impact other federal civil rights barring sex discrimination in education, health care, housing, and financial credit.

Explicit and comprehensive anti-discrimination protections based on sexual orientation and gender identity are considered by the United States Congress under the Equality Act (May 17, 2019). As of July 27, 2020, the bill remains in the Senate.

* Employment *

There is no federal statute explicitly addressing employment discrimination based on sexual orientation or gender identity. 

However, in June 2020, the U.S. Supreme Court ruled that sexual orientation and gender identity are included under "sex" as a prohibited ground of employment discrimination in the Civil Rights Act of 1964. This effectively means that in the U.S., no employer can fire an employee on the basis of sexual orientation or gender identity.

Twenty-four states, the District of Columbia, Puerto Rico, Guam, and over 140 cities and counties have enacted bans on discrimination based on sexual orientation and/or sexual identity. 

Additionally, some states have laws or regulations that ban discrimination based on gender identity and/or sexual orientation in public employment only. 

At the start of 2010, the Obama Administration included gender identity among the classes protected against discrimination under the authority of the Equal Employment Opportunity Commission (EEOC). 

In 2012, the EEOC ruled that Title VII of the Civil Rights Act of 1964 does not allow gender identity-based employment discrimination because it is a form of sexual discrimination.

On July 21, 2014, President Obama signed Executive Order 13672, adding "gender identity" to the categories protected against discrimination in hiring in the federal civilian workforce, and both "sexual orientation" and "gender identity" to the categories protected against discrimination in hiring and employment on the part of federal government contractors and sub-contractors.

President Obama's related Executive Order 13673 required federal contractors to prove their compliance with labor laws, but President Trump revoked this requirement on March 27, 2017.

* Housing *

In 2012, the United States Department of Housing and Urban Development's Office of Fair Housing and Equal Opportunity issued a regulation called "Equal Access" to prohibit LGBT discrimination in federally-assisted housing programs.

It ensures that the Department's core housing programs are open to all eligible persons, regardless of sexual orientation or gender identity. In 2019, however, there was an attempt to weaken the regulation.

Transgender Athletes

https://www.hrc.org/resources/get-the-facts-about-transgender-non-binary-athletes

Article by the Human Rights Campaign (HRC).

*** Twenty states, the IOC, and the NCAA have allowed trans athletes to play sports for decades, with no problems ***

The alternative way to look at the flip-side of the coin is, nearly thirty states and many sports associations have some form of restrictions towards trans athletes, and it is very discouraging.

My child does not play super manly/ boyish team sports like the typical American kids (football, baseball, soccer, basketball...) or other individual competitive varsity sports (swimming, wrestling, tennis, you name it!). My child does/ did get exposed to some uncommon individual activities (table tennis, fencing, curling, sailing, soon, rowing) and the thing she expresses an interest to continue to pursue at college level is fencing. 

However, due to the way sports are always organized by gender (practice, competitions, rankings, coaching, or the locker room per se), the severe gender dysphoria (with the aid of COVID) made her gradually withdraw from fencing completely. Currently a junior, I do hope she will pick up fencing again, that is, if her future college has it. One of the fair concerns as we assume she would have her name and pronouns legally changed by then, but not her gender, and we do not know how it will affect her access to sport teams. (Note: it should be a topic of another post but, she must change her gender in the state where she was born, unfortunately, it was Texas, and Texas would not allow gender change until bottom surgeries are done, which might never happen to some trans due to the high costs and high risks).

To sum up the situation: (mostly directly targeting transgender girls and women in sports)

2015 used to be the worst year for LGBTQA+ community.

2021 surpassed it as the new worst year, with 250+ anti-LGBTQA+ bills enacted, 35+ towards trans girl athletes.

2022 continued the trend, with at least 55 new anti-LGBTQA+ bills under consideration across states.

What could you do? What could we do? What could I do?

Fact #1: some particular trans girls might have physical advantages that help them in sports of their choices (height in volleyball, for example).

Fact #2: natural variation of such physical attributes is a part of sports, any sport, especially at younger age and they are not always advantages.

Fact #3: not all trans girls have the so-called physical advantages, just like any youth, they have varying physical attributes and interests in sports.    

Fact #4: kids should be allowed to play sports that they enjoy, because playing sports has known benefits emotionally, socially, and mentally.

In conclusion, this is not just adding more discrimination to a minority group that is already marginalized in many social contexts, particularly school, but also a poor practice of inclusion.

My girl, for example, is currently about 5' 5" or 5' 6" and maybe 120 lbs which is considered on the smaller size even for biologically born girls. She also prays every day that she stops growing taller or bolder because she really wants to have the feminine look. Physically, she is not that much stronger than me, who is a 42-year-young female after two pregnancies.