Health / Informational / Reference

Disposable Body Parts, A Refutation

My top surgery is about 2 months away. Not surprisingly, I’m a little nervous about it, and have been doing research into various aspects of the recovery. The one I’m worrying the most about it pain management and recovery of daily activities. I’m a professional dancer, and being out six weeks is a bit of a problem for me. So, I went looking for advice.

Unfortunately, I fell afoul of a particular blog that had some very bad advice (and, to my horror, it was at the top of the search result list). When I went digging further, I found out it was a TERF (trans-exclusionary radical feminist) blog, but one that may not be all that obvious (or maybe that’s just me, Mx. Oblivious). I won’t directly link it, because the site doesn’t need the traffic, but this is the blog I found (TW: transphobia, transmisogyny).

The inaccuracies in the information in this blog are dangerous. Not just the transphobia, but the scientific/medical advice that is wildly inaccurate or inaccurately presented. A word of caution: never take the advice of a blog over the advice of your doctor. Including this one. It’s also an old blog, so I’ll give it that. But it still ranks first in some searches. That’s not okay.

However, I feel I am (possibly more) qualified to poke holes in the dangerous misinformation this blog is handing out over FTM surgery. I am a scientist, and have worked in breast cancer research for almost 10 years. I am not a doctor, but I certainly know how to interpret results from medical studies. The author of that other blog post clearly does not (or has an anti-trans agenda coated in concern trolling).

Unlike the other blog, I will actually give sources for my facts, not just vague scare tactics with nothing to support them.

TL;DR: That blog post is from a TERF blog and is filled with inaccuracies and misinformation meant to scare you into continuing to suffer from gender dysphoria. Read at your own risk.

Post-Mastectomy Pain Syndrome Claim

The first claim is that 20 to 60% of patients who have mastectomy experience Post-Mastectomy Pain Syndrome (PMPS), and therefore trans men should not get mastectomies because of this possible outcome. While that is an accurate figure (though dubious due to its huge range), what is not said is that this figure is from women with breast cancer, not tran men/trans masculine people undergoing top surgery. There is a distinct difference that may be missed by those who are unfamiliar with breast cancer. Most people may think, “Hey, it’s the same surgery, so shouldn’t the figure be the same?” Nope.

That’s not how science works. While we would like it to be that way, when something is studied in one population, the research is only of limited use for other populations.

What makes the difference is the lymphatic system. The claim that the breast is part of the lymph system is technically incorrect. We do have lymph vessels that go throughout the body, including the breast, but the breast itself is not part of the system. There are, however, lymph nodes in the armpits that are very important to those who have been diagnosed with breast cancer.

Here’s the deal: breast cancer itself is not deadly. We don’t need our breasts to function. Breast cancer is deadly because it spreads, and it spreads first (usually) to the armpit (axillary) lymph nodes. From there, it can go to the brain, the lungs, or the spine (or elsewhere, but those are the most common). Obviously, you need your brain, your lungs, and your spine to function.

In breast cancer patients, the lymph nodes (or some of them) in the armpit are generally removed (or biopsied), causing problems like lymphedema (collection of lymph in the tissues, causing swelling) and pain due to the invasive surgery. For trans men/trans masculine people, there is no need to remove the lymph nodes, and so the risk of the various side effects studied in breast cancer patients may not be applicable.

In one article I was able to find, they specifically state that the rates of PMPS are for women in the breast cancer population. This does not apply to the trans male population.

All surgery carries a risk of nerve damage and chronic pain, but most sources agree that the risk is higher with surgery that involves removal of the lymph nodes.

Can trans men get PMPS? Probably, but there aren’t any studies. This same blog, in another entry, claims that studies aren’t being done, even when procedures are being done on trans people, and implied that this was horrible. There is a specific reason for that. Human subjects research is heavily regulated. A doctor can’t just up and decide to start taking data from patients to put into a study. That can actually get the doctor in trouble enough to have their medical license revoked and is illegal in the US. For studies to be done on human subjects, doctors and scientists must submit grants to fund the research, have their procedures approved by an Institutional Review Board (IRB) that oversees human subjects research, and then actively consent patients, meaning the patient must give explicit permission for their samples or responses to be used and for what reason. They have the option to decline or withdraw from the study at any time. So the reason why there isn’t much research on the trans population isn’t because doctors are evil and they don’t care to study the trans population due to some horrible transphobic drive. It’s just that there aren’t many trans people undergoing these procedures. Take into account that a small percentage of those people will consent to being studied, and you then have a problem with any of the science that comes out of those types of studies. Also, trans people are considered a small, vulnerable population, and studies that target them specifically are going to be even more heavily regulated (i.e. difficult to fund and get approval from an IRB due to the increased possibility of ethics violations).

While this doesn’t mean that no trans man will ever experience extended pain after mastectomy, it means that there isn’t any research that supports it either way. Don’t let this fearmongering scare you.

Estrogen in Men Claim

The blog then rambles on about how women need estrogen and that if a person has an oophorectomy they can no longer make estrogen.

Wow is that completely wrong.

First of all, cis men (who have no ovaries) make estrogen just fine. They need it, too. Women need testosterone as well. It’s a good thing that the liver (and muscles and fat) can convert testosterone into estrogen. So a trans man who has his ovaries removed is at no risk for low estrogen (and the associated problems listed in the blog post) unless he stops taking testosterone.

While it is true that hormone balance may be affected by taking testosterone shots…that’s actually the whole point. The amount of estrogen will decrease, though will never go away, and testosterone will increase, causing the changes in body chemistry and features desired by trans men. The body will self-regulate the amount of hormone it needs by converting testosterone into estrogen.

Besides, oophorectomy may be beneficial to trans men who may be at risk for ovarian cancer. No ovaries = no ovarian cancer.

The claim that oophorectomy before age 45 is associated with an increase in cardiovascular death is also not entirely accurate. One study did find this, but again, this was done on women who then may not have received estrogen treatment. Some of them did, and the effects were less. Nothing is said about trans men getting an oophorectomy and proceeding with testosterone treatment, so the inclusion of this claim is merely a scare tactic.

And, let’s all say this together: correlation is not causation. Nowhere in the study does it claim that an oophorectomy causes cardiovascular death. Besides, a more recent study has been done and found that this link doesn’t really exist. And another besides, testosterone has been shown to be beneficial to heart health.

We must all remember to take these sorts of studies with a grain of salt. None of these studies were done on trans men, so their applicability is in question. A trans man is not the same as a cis woman, biochemically speaking, after beginning testosterone treatment, so any research done on cis women will have little application to trans men.

I’d also like to see a source for the claim of male pattern baldness progressing faster in trans men than in cis men. I have not been able to find such information anywhere. And no, it’s not a lack of estrogen that causes it, but an increase in testosterone. Only the men (cis or trans) who have the genetics for male pattern baldness will get it. When women with male pattern baldness genes hit menopause, they often go bald, too. But most people will go slightly bald (or have thinner hair) as they age, regardless of gender or sex. So this, too, is merely a scare tactic meant to dissuade you from getting the treatment you and your doctor have agreed is necessary.

The rest of the claims are basically nonsense. As long as a trans man still takes testosterone, regardless of oophorectomy status, there will still be enough estrogen to prevent any problems. Progesterone may promote fat breakdown, but so does testosterone (why do you think trans men lose body fat when they start T? And why older men, who tend to have higher estrogen, get more belly fat?)

The Hysterectomy Scare

There is a brief mention of hysterectomy, and the blog post lists a couple of side effects as scare tactics. While some of them are true, the risk of these complications is small. There is no mention in that blog post about the differences in the types of hysterectomy and the differences in side effects and complications. Considering that hysterectomies are common, there are a lot of options based on the health and history of the man undergoing the surgery. If there is no reason to remove the cervix, it doesn’t need to be removed, thus having no impact on any possible sexual side effects.

There is a mention of the hysterectomy causing vaginal prolapse, which is a possibility. But considering that some trans men also undergo a vaginectomy (which is actually a surgical intervention to cure vaginal prolapse) this isn’t much of a concern.

And let’s all say it again…the studies done on the side effects of hysterectomy are primarily done on cis women, often older women, who may be at risk for urinary incontinence, vaginal prolapse, and sexual dysfunction anyway.

There is some controversy about hysterectomies, and I do want to admit that, because there is concern that they are done in too many women. This is definitely a surgery that should be carefully considered, with a qualified doctor’s input. Many trans men opt not to have this surgery, though some may find that it becomes necessary as they transition. You shouldn’t be scared into not having a surgery that becomes necessary for your own health and well-being by a TERF concern trolling you.

Other weird claims

There are some other pieces of irrelevant information in that post. It doesn’t matter what hormones and hormone byproducts are discovered in the future. Estrogen and testosterone are the main sex hormones and will be the ones used for transition.

The other claim that injections cause peaks and drops is true. Anyone who has had a simple biology class on human reproduction should know that hormones – all of them – follow cycles. Cis men have a 24 hour cycle, cis women have a 28 day cycle. But putting women on hormones (birth control) doesn’t negatively affect them, even when taken out of their cycle (TMI: I didn’t have a period for 5 years because of the hormonal treatment for my endometriosis and have had no ill effects – quite the opposite!). Injections of testosterone will cause a weekly (or biweekly) cycle but have a steady release of hormone over a period of days, with the peak release between day 2 and 5 of the shot. Daily testosterone (topical) mimics cis men’s daily fluctuation (if applied in the morning) so this claim is irrelevant.

While it is true that ovaries, breasts, and other organs are useful to women, they really aren’t necessary for trans men, as long as he is healthy and willing to maintain hormone therapy. While there are always risks in surgery, that should be discussed with a doctor. Every person is different, and will have different risks during transition. That TERF blog post does what would horrify any real feminist: tries to take away choice and intervene in the relationship between a person’s body and their doctor. So ignore it, and ask your doctor about the long term health effects of transition.

 

Image credit: solidermediacenter

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