One of the weird things about bodies is that so very many people seem to have them, and yet not all of them are the same! This is something relatively recently discovered by such luminaries as NASA rocket scientists:
525,600 tampons. How do you measure a trip into space?
The details and implications of this knowledge are still being debated. But one interesting thing that happened along the way is that, according to The Atlantic, doctors started to realize that the questions that they asked FtM folk when they began therapy that artificially changed their hormone levels were not at all the same questions that they asked cis women going through spontaneous hormone changes at menopause.
Marci Bowers thought she understood menopause. Whenever she saw a patient in her 40s or 50s, she knew to ask about things such as hot flashes, vaginal dryness, mood swings, and memory problems. And no matter what a patient’s concern was, Bowers almost always ended up prescribing the same thing. “Our answer was always estrogen,” she told me.
Then in the mid-2000s, Bowers took over a gender-affirmation surgical practice in Colorado. In her new role, she began consultations by asking each patient what they wanted from their body—a question she’d never been trained to ask menopausal women. Over time, she grew comfortable bringing up tricky topics such as pleasure, desire, and sexuality, and prescribing testosterone as well as estrogen. That’s when she realized: Women in menopause were getting short shrift.
Menopause, for the uninitiated, is not merely relief from monthly bleeding. It’s a whole damn thing affecting more organs than you knew you had. And the transition from a stable adult menstrual cycle to a stable post-menopausal body state can be long and chaotic and affect far more than anyone has bothered to research. Kind of like menstruation itself! And while it’s caused to some significant degree by changes in estrogen, neither is that the only cause nor is replacing estrogen the only cure.
Bodies are highly individual things, almost like each person has their own version and it’s not the same as any other. Mind you, this has caused some distress for the medical profession, which has a history of very much wanting to square humans’ pegs and holes, regardless of the harm this might do. Recently, it seems, doctors have even become aware that hacking at the bodies of others in order to maintain binary illusions of an oppressive society may, in fact, be somewhat less than the ethical best practice.
As a result of all this exposure to radical trans antifa, BLM-HRT, police-defunding, highway- and puberty-blocking activists, a few doctors have been questioning a binary or two their own selves.
Although clinicians lack high-quality research on the role of testosterone in women over age 65, they know that in premenopausal women, it plays a role in bone density, heart health, metabolism, cognition, and the function of the ovaries and bladder. A 2022 review concluded, “Testosterone is a vital hormone in women in maintaining sexual health and function” after menopause.
Yet for decades, standard menopause care mostly would mostly pass over androgens. Interest in testosterone therapy has only begun rising—and rapidly—within the last 10 to 15 years. (Nota bene: the lack of research on testosterone use by perimenopausal women was not cited by the NHS as a reason to shut down such “experimental” prescriptions. This is our shocked face.)
There are more barriers than lack of research, however. It turns out that getting cis women comfortable with taking testosterone is not always easy even when it would be medically helpful, for they sometimes think the doctors are calling them trans for the temerity of ceasing menstruation:
[Cis women] have to get used to the idea of taking a hormone they’ve been told all their lives is for men, at just the time when their femininity can feel most tenuous […but…] taking testosterone wouldn’t change a menopause patient’s gender identity.
And patients are not the only ones struggling with holistic care for bodies that produce lots of hormones to varying degrees. Pharmacists, too, have a hard time believing leavening estrogen therapies with a bit of testosterone is kosher:
Some of [Dr. Kelly] Casperson’s female patients have had their testosterone prescription withheld by pharmacists; one was asked if she was undergoing gender transition.
While rapid-onset vaginal dryness has been observed as a side effect of even small doses of Ben Shapiro, the Cooties Hypothesis asserting social transmission of perimenopausal sexual symptoms seems unlikely to go viral, and there is as yet no movement to withhold testosterone from 52-year-old cis women for Baby Jesus and Western Civilization.
It means that trans people fighting for the medical establishment to take their care seriously has knock-up effects for cis health, and thus the more doctors get comfortable with trans lives, the better cis women’s care. Queer cis women, too, have benefited straight cis women’s care by challenging assumptions that what women want is too obvious to bother actually asking women. After centuries ignoring women’s desire, The Atlantic reports doctors are beginning conversations with
“Tell me about your sexuality. Tell me, are you happy with that? How long does it take you to orgasm? Do you masturbate? What do you use?”
And the benefits go both ways: trans men who experience menopause as a result of hormone therapy can now benefit from topical vaginal estrogen cremes originally developed to relieve dryness and vaginal pain during straight, menopausal women’s penetrative sex. (Though given the historical lack of conversation about cis women’s desire, it’s likely that these cremes were developed more with an eye towards the benefits to cis het men who didn’t like being turned down.)
This isn’t the only benefit either. Doctors have recently been studying menstruation and fertility in FtM folks taking testosterone, and to the surprise of many a third still ovulated. This should not have been news as testosterone isn’t birth control. Indeed it was tried decades ago to poor effect. And yet this was news in trans communities.
Part of the problem is that society insists on treating different communities as entirely separate, even when that’s radically inappropriate. And society does this in ways more hypocritic than hippocratic. For decades drug manufacturers would only include cis men in clinical trials of medicines because female bodies were considered a confound and male-bodied trans people were considered to have a confounding illness, even though there was no reason to think that a medicine would know your gender identity and function differently because of that. Yet after trials, manufacturers wanted their drugs prescribed to everyone as if they had been found safe and effective for every body. Even today the safety of many drugs for fetuses or pregnancies or female fertility has gone unstudied, yet the drugs are still prescribed for people who are or may become pregnant, with barely (and not always) an “ask your doctor if” warning.
But they’ve taken the opposite approach when the benefits might flow to patients instead of investors: anti-trans fuckfaces continually insist that puberty blockers have not been proven safe for trans children going through puberty. Yet these are old and well-tested drugs. And yet, the Cass Review is right there, insisting that bone density development during the years of postponed puberty must be studied before puberty blockers can be considered safe for adolescents diagnosed with gender dysphoria. Scotland has even decided to ban the use of puberty blockers until the age of 18, which Yr Wonkette thinks we can all agree misses the point of “puberty blocker” by rather a large margin.
We have said before that trans rights are reproductive rights, and that we are all in this together, and we are not the only ones to notice. Sad Brown Girl writes, “Despite the ongoing rhetorical battles over how trans people should be included in discussions of abortion, the link is unambiguous for those seeking the end of both: as goes abortion, so too transition, and vice versa.”
The Pope agrees, throwing in surrogacy for good measure.
The Vatican on Monday declared gender-affirming surgery and surrogacy as grave violations of human dignity, putting them on par with abortion and euthanasia as practices that it said reject God’s plan for human life. […]
[Pope Francis] has also denounced “gender theory” as the “worst danger” facing humanity today.
Yr Wonkette does not pretend to know whether asking someone what name they prefer is worse than climate change burning Canada to death and choking New York City on the ash, but we do know that the Pope is unlikely to be factoring in the benefits to straight cis women’s sex lives that accrue when all of us, regardless of gender, are treated as whole, complex people who deserve healthy bodies and happy lives.
[Atlantic]
