unto zero and beyond

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.

i think they were very careful up until the point that both of them could get it taken care of permanently adkdjdj

I was trained in the dark arts of the cover letter by my mother, who is a hiring manager. And her training has paid off: I've been consistently told my cover letters are excellent. Let me pass on the wisdom.

The job of a cover letter is to give a prospective employer strictly more information than is on the resume. This is where you take the resume contents and put them into context. You look at the job requirements (you are looking at the job requirements before applying, right?) and look at your resume and ask the question (in your head) "why would a person think this candidate would be good for this job?" and your cover letter is the answer to that question. If you don't answer that question, the hiring manager is going to have to do it themselves, and you have way more information to work with than they do.

This is especially important if you're moving from one industry to another, because then the relevant connections aren't obvious. It's also very important if you're overqualified, because then you can use the letter to say "I know it looks like this job would be too entry-level for me, but I'm interested to pursue it for reasons x, y, and z". You can also use this space to explain away something that might otherwise be disqualifying, like job-hopping or a long break in employment. The tone to strike here is always matter-of-fact and constrained to topic - don't go into detail about health stuff or personal tragedy, just tell them what they need to hear: that this period of your resume was affected by [bad thing] but that it's now in the past and you're looking forward to the next chapter. Remember, one of the things they're trying to learn is whether you'd be content in this role, or whether you'd be miserable and leave after 2 months, which would force them to do all the work of hiring again. You're trying to establish that you will fit right in and not cause problems. Knowing what drew you to this job in particular (and don't just say 'money', that's true for everyone) helps with that.

Barbarossa in a tarot card commission

Thought it would be cool to have a visual reversal of the lightning striking the tower on most classic tarot card designs, to it being a siege cannon/apocalypse rail being fired (the tower itself wreaking calamity rather than calamity being wreaked upon the tower).