It is a bit tricky to comment on the health issues facing transmen, as we’re not always very good subjects for studies. Firstly, there’s not all that many of us, and many of us are not the ‘signing up for research’ type. Secondly, whilst people have been transitioning for decades, it is still hard for researchers to be able to put together enough statistics to be reliable. In short, they don’t really know what’s going to happen to us in the long-term.

That said, there is enough evidence to be able to make some broad statements about the effects of transitioning through hormone use. I will do my best to talk about a few of them, but please bear in mind that I am not medically trained, and if you’re worried about any of this, you should go to the doctor for a more educated picture of what’s what.

Taking testosterone (“T”) can have some interesting effects on our bodies. T increases the number of red blood cells swimming around your system. This has two main effects – in a minority of people this can lead to Polycythemia, or excess thickening of the blood, which can cause potential health problems. On the scary side, it can lead to thrombosis, haemorrhage or heart failure. Less scarily, this can be dealt with by looking at your testosterone dosage. I believe immediate problems can be sorted by drawing some blood off, which sounds a touch mediaeval, but hey, if it works…

The other thing caused by all these extra red blood cells is higher blood pressure. Mine was always pretty low, so increasing it hasn’t affected me (other than being a bit red in the face!) Again, scarily, this can lead to strokes or coronary heart disease, but just as not every man with naturally occurring testosterone is about to die horribly, neither is your average transguy. A healthy lifestyle and regular medical checks is all you really need to do to keep on top of most of this stuff.

T also destroys ‘good’ cholesterol and increases ‘bad’ cholesterol. This can lead to similar problems to those outlined in my last paragraph, but again, with sense and medical supervision, there’s no reason why your average trans-Joe should have to worry too much.

Testosterone can increase the body’s resistance to insulin, and also has been documented as causing liver problems and a potential increased risk of some cancers. The trouble is with this ‘documentation’ is that (as mentioned earlier) we are a very small group of people, even internationally, and also it is often the case that factors such as previously existing conditions, and lack of access to healthcare have not been taken into consideration. A lot of studies take place in the US, where healthcare is largely expensive to access. It is also the case that a lot of transpeople fear to seek help because of discrimination (both perceived and very real – both lead to a fear of seeking care, and cannot be discounted). This is not to say that the studies are therefore worthless, but you need to be sensible before taking them as gospel.

Now here’s a quick biology lesson, which may also explain ‘Bodybuilder Moobs’ to you. As transmen, we take testosterone, but also have some oestrogen swishing around in our bodies. This is generally ok. However, if we take too much T, it turns into oestrogen. Who’d’ve thought it? That’s why bodybuilders who take very large quantities of testosterone indeed, in the hope of becoming very manly, can end up with quite large amounts of oestrogen in them. And moobs.

So where is this going? It is thought by a lot of medical types that excess oestrogen can increase the risk of a number of cancers: endometrial, ovarian, vaginal, uterine, cervical, to name but a few. This is why it is SO important to get your testosterone levels checked regularly. Quite apart from not wanting to slow down masculinisation, nobody wants to increase their risk of cancer when it could be avoided. Transguys, if you’re not masculinising as fast as you’d like, don’t be tempted to increase your T dose. Not worth it.

Speaking of moobs, even after chest surgery, breast-tissue cancer is still a risk. After all, it’s not just women who get it, so keep checking for lumps, bumps, crinkles and changes.

Another vitally important thing is to keep getting cervical smears while you still have a cervix. Believe me, it’s cripplingly embarrassing to try to book in a smear at the doctor’s surgery when the system has you down as male. It’s scary as hell having to reveal your testosterone enhanced ‘bits’ to a nurse. Being penetrated by a speculum when the last thing you want to do is identify with any femaleness ‘down there’ is awful. But while you still have the equipment, you need to get it checked.

This hasn’t turned out to be a very positive post, has it? However, I believe in honesty and being informed, and I really believe that by knowing what we’re doing to our bodies, and looking after them as best we can, we have the best prospects for a healthy future. Eat well, drink sensibly, pleeeease don’t smoke! Exercise, have regular blood tests, talk to the doctor about this stuff. The average GP in the UK (I can’t speak for elsewhere) knows next to nothing about the health of transpeople, so knowing yourself what risks you face will help you keep up a useful dialogue with your doctor.

I don’t mean to preach. I do want to be healthy, though, and enjoy my new life as long as I can. Which brings me to longevity. We all know that men tend not to live as long as women, and whilst studies on trans mortality rates aren’t that advanced, most medical authorities acknowledge that a transguy will probably live around 5 fewer years than he would had he not transitioned. I’ll take that.

I won’t go into a lot of detail here about hysterectomies, as it’s something I want to cover in much more detail further down the line. Many doctors do recommend that after a few years on T, transguys consider having a hysterectomy, with one idea behind this being that this will remove some of the organs at risk of cancer. Another aim would be to reduce naturally occurring oestrogen, amongst other things reducing the need for as much testosterone. Other doctors argue that this isn’t necessary. It’s a tricky one, and a question that I will be considering very carefully before deciding how to proceed.

I have written at length about transhealth today. However, I am also currently involved in “Movember”, a month-long charity event raising money and awareness of prostate and testicular cancer. Not conditions I will ever have, but a charity worth supporting nonetheless. A close family member had testicular cancer recently. He has survived, but he and his family went through hell in the process. Movember is a light-hearted way of raising money for research and support, with men across the country growing moustaches for money. However much testosterone I may be on, my top lip is not yet up to that challenge, but as you can see, I have taken an alternative approach to growing my ‘Mo’. Crochet rules. For non-Norwich supporters, yellow and green are my local team’s colours.

To support my fund-raising efforts, please consider donating to my support of the Mo at http://www.movember.com/m/1481124.

Whether we are transgender men, cisgender men, or their families or lovers, we all deserve to have the best health possible.

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