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Harm reduction
– This is a philosophy that accepts certain behaviors or conditions and attempts to Dispelling myths about transgender care - Many physicians are uncomfortable managing transgender patients for a number of reasons. There has been alot of concern about issues such as blood clots, strokes, or effects on organs such as the liver or cholesterol levels. Many of these concerns are either overblown or not based in evidence. For example, the well-known (and flawed) Women's Health Initiative Study showed that women on post-menopausal hormone therapy have a 50% increased risk of stroke over those who do not. But if you look closely at the numbers, 32 out of 10,000 women without hormones had strokes, and 48 women with hormones had strokes. So while there is a 50% increased risk, your risk goes from .032% to .048%, which is still a remarkably low number and really should not persuade anyone to avoid hormone therapy. Another argument is the effect of testosterone therapy on cholesterol levels. It is entirely likely that long term testosterone therapy will cause an increased risk of heart disease, stroke, and therefore possibly even a shorter life span. In other words, it makes your overall risk profile just like that of a genetic male. Just as an unfortunate consequence of being a woman is that you are exposed to concerns such as violence or descrimination, an unfortunate consequence of being a man is that you have a higher risk of heart disease and a slightly shorter average lifespan. No one would ever deny a male to female transition based on an increased risk of violence, so why deny a female to male transition, if (after informed consent) the individual agrees to accept this risk profile in exchange for acheiving their true gender identity? Self-directed care – In the old days, doctors told patients what to do and the patients listened. In the modern, internet-enabled era patients are often well-informed and at times more informed than their physicians on some topics. Often there is more than one way to approach a medical problem. Patients may have questions and deserve to have them answered in a non-judgmental way. Some patients may want to hear about alternative or non-western treatment options. Others may want to hear the pros and cons of several different approaches and make decisions for themselves or after discussion with friends or family, or perhaps conduct their own research. I can even help teach you how to do this research on your own. Still other patients may say, “Well Dr. Maddie, I just don’t know – you decide for me”.
Transgender care – I believe that transgendered patients on hormone therapy should have a solid understanding of what they can expect and knowledge about the various treatments they are receiving. They should understand the pros and cons of issues such as cycling, the use of progesterone or Androcur, oral vs. injectable vs. transdermal medication as well as the risks (and benefits) of hormone therapy in both the short and long term. Furthermore, transgender medical care does not end with hormone prescriptions. Preventive care, focus on diet and weight management, cholesterol, preventive health and screening, as well as holistic and emotional wellness and all other health issues that are relevant to non-transgendered people are all cornerstones of a successful comprehensive care plan, FTM or MTF. The "De-medicalization" and "De-profitization" of cross gender hormone therapy - Some physicians require that patients return for weekly injections, and charge a fee for each visit. Some physicians refuse to prescribe hormones or even disclose to their patients exactly what hormones are being administered. Transgender care has become big business. No one should profit unfairly from the treatment of transgendered people or anyone else for that matter. I constantly wonder, "Why is transgender care so 'medicalized'?" Diabetics inject themselves several times a day with insulin, frequently adjusting the dose on their own after becoming educated about their condition. Without insulin, some diabetics could literally die within days. My own grandmother gives herself weekly Epogen shots for her severe anemia. So it is puzzling as to why a healthy, young transperson can not be educated about their therapy and inject themselves, only coming to the office for periodic checkups and adjustments as needed. Preserving the reproductive future of transgendered patients - I firmly believe that prior to beginning cross gender hormone therapy, all patients should receive counseling regarding therapy's effects on their reproductive future, and steps that can be taken to preserve that future. Typically this involves cryopreservation (sperm or egg banking). I will discuss these matters with you prior to beginning your therapy so that you may make informed decisions about your reproductive future. The WPATH/HBIGDA Transgender Standards of Care - These are guidelines. They are well written, relevant and in many cases appropriate. However, as with everything else in life, nothing is cut and dry. I subscribe to the Standards of Care and respect their importance. That said I am comfortable deviating from the standards of care if circumstances support doing so.
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