MTF Transition in Prison: Hope Us Understand
April 6, 2016 8:08 AM   Subscribe

Looking for reliable information (and anecdata) about how to read blood tests and understand hormone levels for MTF gender transition, particularly for someone currently in prison.

Person in question (a close relative) is in prison, and is concerned that the information being given about hormone therapy is incorrect and incomplete. We are looking for information about the usual process and dosage of medication for MTF gender transition; from the limited information we have about hormone levels, it seems that the level currently prescribed is just enough for chemical castration (which we have been told is permanent). The person is around 6'1, and 160 lbs (down from 220 lbs - also has some undiagnosed issues surrounding digestion and has lost all that weight in the last few months).

Said relative is in prison for life, and has been for the last decade. We only became aware of the gender transition in the last few months, and this is not something the extended family knows. The intention is to keep it that way until the person in question chooses to reveal information personally. That's the reason this is anonymous.

SO...this is a "Talk to me like I'm 5" situation. The family is largely unfamiliar with gender identity, MTF transition in general, and the medical part of transitioning in particular. This has not been a process they welcomed, but they have and will continue to offer support and are dealing with remarkably well. We all just want this person to be happy - at least as much as possible given the situation.

Good, concise online resources are welcome, but we would also like anecdata and a sense of what to expect from this process. If you have information about transitioning MTF in prison, that would also be really helpful. Reliable information is hard to come by about transitioning in prison, though we are told it is incredibly common. If it matters, this is a California prison.

More than anything though, we need a way of explaining the medical part to someone who doesn't have access to the internet. All of this will also be filtered through relatives unfamiliar with the terminology. Relatives can print out pages to send/bring into the prison, but there is a page limit.

Thank you to everyone in advance, and please forgive any mistakes I've made. I purposely avoided pronouns because the person in question has not stated a preference for pronouns.
posted by anonymous to Health & Fitness (6 answers total) 3 users marked this as a favorite

The TGI Justice Project has resources online: Prison Resource Guide; Surviving Prison in California: Advice By and For Transgender Women. They are a fantastic organization, and if you contact them directly they can probably set you up with more resources.
posted by rtha at 8:42 AM on April 6, 2016

The Gender Identity Center of Colorado's quarterly Transgenders in Prison Journal (T.I.P. Journal) is free to any inmate who requests it. Your relative can write to the Gender Identity Center at: 1151 South Huron St., Denver, CO 80223.

The monthly Black & Pink newspaper is published by Black & Pink, a Massachusetts-based group of LGBTQ inmates from around the U.S. and their advocates and allies on the outside. "Each issue is full of submissions from our incarcerated members, along with relevant news, history, and opinions from the free world." Inmates can sign up for a pen pal program and other services through the newspaper.

For a free subscription, your relative can write to Black & Pink, 614 Columbia Road, Dorchester, MA 02125. Or you could buy a print subscription to the paper for yourself and your relative for $12 a year; click on the organization's website and scroll down to the PayPal link in the lower right-hand corner.

For downloading and printing by you and/or other family members who might be visting, the current issue and Black & Pink archives are available via here and here, and the archived editions are also available here as PDFs.
posted by virago at 9:04 AM on April 6, 2016

I can sorta speak to the hormone portions of your question, but honestly a lot of it should be handled by a competent medical provider who is monitoring labs and prescribing meds in response. I say this as someone deeply unsettled with the medicalization of trans people.

Couple fundamental things; typical HRT is going to include oral spironolactone at sufficient dosages to suppress testosterone, and oral estradiol to raise estradiol levels closer to those of a cis woman. The dosages are highly dependent on who's providing the care (e.g., how familiar they are with this stuff at all, and most providers are not), the person's response to the meds, and interpretation of lab work.

Though the goal above might sound simple to achieve, a couple things are worth noting: First, the testing accuracy of blood estradiol levels is actually terrible. Meaning, you're gonna get lab values that seem to offer a level of exactness that simply isn't scientifically supported. You therefore shouldn't freak out about "low" estradiol values having much meaning at all. Dosing regimens based on qualitative perceived effects over time are a more reasonable approach than trying to tune based on blood levels, which really should only be used to avoid extremely high levels of estradiol (this is highly unlikely, though, given typical dosages of estradiol prescribed). Some docs are concerned about prescribing higher doses of estradiol for literally no scientific reason. The ranges of estradiol levels in cis women actually go pretty high, and there's no evidence that "ramping" estradiol from tiny dosages is useful or necessary.

Second, docs are gonna prescribe oral estradiol, but it's best to dissolve it under the tongue to avoid it passing through the kidneys.

Finally, for the spiro, this can be accurately dosed based on the testosterone blood levels. Higher dosages of spiro do pose medical concerns which can be managed, but starting with a low dose is low risk assuming no contraindications.

Tl;dr: The doc should prescribe a 2-6mg daily estradiol and 100mg daily spiro, request bloodwork for months 1, 3, and 6 to establish and ramp to the lowest effective spiro dose (testosterone fully suppressed), and attempt to bump the estradiol up as well, and then set up a long term dosing plan based on those values.
posted by odinsdream at 10:12 AM on April 6, 2016 [1 favorite]

it seems that the level currently prescribed is just enough for chemical castration (which we have been told is permanent)

Either your relative's doctor is confused, or someone has misquoted them.

"Chemical castration" usually refers to loss of libido, which is a thing that happens when someone takes antiandrogens (such as spironolactone) or otherwise does things that reduce their testosterone levels. It is definitely not permanent. It is also highly subjective: how little sex drive counts as "no sex drive"? And it is basically unrelated to the question of whether a trans woman's T levels have been adequately suppressed. Some of us find that we still have a sex drive even with basically no testosterone in our system. Others of us find that even the slightest reduction in testosterone makes our sex drive tank. So if all you know is that someone is taking "enough for chemical castration," you have no idea if that's enough for the sort of feminizing effect your relative is hoping for.

Your relative's doctor should be testing her blood testosterone levels and checking that they are within the normal range for cis women. If her T levels are not that low, her spironolactone dosage should be increased.

As odinsdream says, estrogen level testing is complicated and unreliable. Probably best not to worry too much there, as long as she's being given an adequate dose. (2-6mg/day is normal.) But if she's worried she's getting too little spiro, push for her T levels to be tested.

(This is the advice I'd be giving a friend who wasn't in prison. I'm afraid I have no idea what is feasible in prison as far as demanding blood tests, unfortunately. It may be that she's stuck with the dosage they're giving her.)
posted by nebulawindphone at 12:23 PM on April 8, 2016

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