the horrors persist, yet i remain Silly

1. Progesterone: not for everyone, but for many people it may increase sex drive and WILL make your boobs bigger. Also effects mood in ways that many find positive (but some find negative). Most doctors won’t prescribe this to you unless you ask. Most trans girls I know swear by it.

2. Injectible estrogen: is more effective than pill or patch form. Get on it if you can bear needles bc you will see more effects more quickly.

3. Estradiol Cypionate: There is currently a shortage of injectible estradiol valerate. There is no shortage of estradiol cypionate. Functionally they do the same shit.

The concerns surrounding venous thromboembolic events as a side-effect of hormone replacement therapy can mostly be traced back to one particular study known as the Women’s Health Initiative. This study was an enormous undertaking which, unfortunately, demonstrated significant adverse effects of the hormone therapies studied. As a result of this the use of hormone replacement therapy in postmenopausal cis women was dramatically reduced as the medical community began to question whether or not the therapy caused more harm than good.

Naturally, trans women have been suffering from this fall-out ever since.

What physicians seem to fail to recognize is that the study examined a very specific hormone regimen which was, arguably, outmoded at the time the study was conducted: It examined the use of conjugated equine estrogen (Premarin) with or without the use of medroxyprogesterone acetate. Neither of these drugs is regularly used for the treatment of transgender women.

The estrogen most commonly used to treat transgender women nowadays is 17β-estradiol either in pill form or in the form of a sticky patch that you apply to your skin. Esters of estrogen (e.g. estradiol valerate) are also sometimes used either in a pill form or as an intramuscular injection.

Transdermal estradiol patches are the gold standard when it comes to treating women who are at high risk of a venous thromboembolic event. It simply does not increase the risk of developing a venous thromboembolism. The only thing you should keep in mind is that patches are not always well tolerated because of the lifestyle changes required to keep them from falling off and the fact that they tend to irritate the skin.

Fortunately, oral 17β-estradiol appears to be safe, regardless of the increased risk. At least one large study has shown that the use of oral estradiol in trans women is not associated with venous thromboembolic events. An individual woman’s risk would need to be substantial in order to contraindicate the use of oral estradiol.

For those who have significant risk of venous thromboembolism because they have had a previous thromboembolic event, because they are paralyzed, or because of some other factor it is good to know the relative risk between oral and transdermal estrogen. The latest research indicates that the use of transdermal estrogen lowers your risk of a thromboembolism to 80% of what your risk would be using oral estrogens.

It’s difficult to find hard numbers regarding the relative risk of venous thromboembolic events with regards to hypertension. The best I could find after an hour or so of searching was this study regarding VTE in lung cancer patients. Hypertension increased the risk by a factor of 1.8.

However, to put that into perspective being of African descent increases your relative risk for deep vein thrombosis by a factor of 1.3 when compared to Europeans. Europeans are, themselves, at increased risk when compared to Asians and Pacific Islanders by a considerable margin: a four-fold increase.

I should point out that being ‘male’ is also a risk factor for developing a thromboembolism and hormones are likely to be a contributing factor. Also, menopause is another serious risk factor. Given this information it is likely that the use of transdermal estradiol will lower your risk of thromboembolic events significantly.

As far as the anti-androgen is concerned: The primary use for spironolactone for cisgender people is as an antihypertensive.

Even if the risk of thromboembolism was truly significant with modern hormone replacement therapy it wouldn’t justify what your doctor is doing to you. The fact is that mortality in the transgender community from suicide–caused in part due to the lack of access to hormone therapy–is substantial. The quality of life lost when a trans woman is denied hormone therapy is substantial. The fact that your doctor does not appear to be taking this into consideration when they weigh the risk of thromboembolism against not receiving necessary medical care is deeply concerning.

I strongly recommend that you seek a doctor who is more sensitive to your medical needs as a transgender woman.

are you a teenager? do you wish you had the space & resources & organization to do a thing, whether that's an anime club or a movie night or a big craft workshop or creative writing group or literally whatever? would you like to do your thing totally for free? yes?

okay, then bring it up to a librarian

seriously, teenagers are the absolute hardest group to engage at most libraries & we'll often organize programs that absolutely no one will show up to & it sucks. if you go up to a public librarian & say "hey, some friends & i want to do this thing. does that sound like a feasible teen program for the library?" most people will move heaven & earth to pull it off for you because we know there's an interest in our community. we will go balls to the freaking wall to make it happen

Equiping an armor tutorial

First: THIS RECALL IS NOT STATE SPECIFIC. IT IS NATIONWIDE.

here are the specific products and dates:

FDA page on this:

This past month, Parks & Rec has been doing a lot of work on the field adjacent to my school. They have trucks with flatbeds, mowing/tree-cutting/postholing machinery, etc. And when they arrived, I (campus monitor) was told I would need to herd the kids away from the trucks/machinery and basically prevent them from creating a dangerous situation.

So when recess came around and the kids stampeded out the door I held them up and I said (being funny but at the same time serious, you know how it is, kids listen better if you're funny)

"Okay, I know that you're all smart AND mature, right? And talented and good looking? Definitely the smartest and most talented class in this school? (I say this to every class, they're all 'my favorites'.) And because you're SO intelligent and mature, I don't need to actually TELL you that these guys have vehicles and machinery that you need to stay clear of, right? Because I know you figured that out already, and I also know that YOU know how sad I would be if any of you were run over, or squashed, or had a pole fall on you. I would be SO SAD, like, I would probably have to lie down on the floor and cry. So you're not going to make me cry, right? I can trust you to stay away from the trucks and machines no matter where they are on the field? Because you're wonderful and amazing? My favorites? My inspiration?"

And they're laughing at me of course, because I'm being so dramatic. Some of them are "Yes, and-"ing my dramatics and inventing more involved mourning processes I should undertake if any of them get run over. Some of them are yelling at me that they are NOT mature yet and they are VERY STUPID and I should know this.

It's been three weeks. We had one conversation about it. None of them have gone anywhere near the trucks. This is actually in excess of the typical elementary-schooler's working memory and I'm very proud of them. I haven't had to blow the whistle at ONE person for getting too close even when the trucks were literally 40 feet from the actual playground.