#'did you know they did a study with giving cis women more estrogen to help with menopause symptoms and they all got cancer'

[caspersscareschool]

oh i forgot to say this to u thousand something strangers yesterday when it happened but idk how to feel about my mom. dont reblog this

[tmitransitioning]

how will t be most likely to change my dietary needs? i used to have an eating disorder, and even now, i have trouble getting enough nutrients just because i have extremely limited access to food that i can hold down and still afford. also, ive heard t can cause some weight gain. im getting better about not obsessing over my weight, and i know its probably more muscle weight than fat, but im afraid ill relapse again anyway. are there ways beyond "just dont look" that i can deal with that better?

cw: disordered eating, calorie restriction, weight, generally talking about food and anxiety

So, I have been/am in a very similar position—long-running restrictive disordered eating patterns, low budget for groceries, and not a lot of food that I can physically eat (digestive problems). My ED started around natal puberty and has persisted since, but I’ve also never been formally treated, so the strategies and discussion here may not encompass that perspective.

Testosterone is... interesting, because it almost universally makes you hungry, kind of like a teenage cis dude, but a lot of the “oh my god if I don’t eat protein right now I’m gonna go feral” kind of hunger goes away after the first couple years. Cis women and cis men don’t really have that different of energy needs*, and while it’s true that your body needs energy to build muscle and grow hair and all of that, I think we sometimes accidentally give the impression that you’re constantly going to be eating three-course meat platters, which can make anxiety around food a lot worse to think about. It’s also kind of hard to figure out how much someone’s appetite increase is due solely to hormones and what is due to lifestyle changes—a lot of trans people on T hit the gym super hard and then wonder why they’re so hungry. (That’s a self-drag.) In general, once you’re past the bulk of the Second Puberty Changes, your appetite returns to about what it was.

The same goes for weight gain. Not everyone gains weight on testosterone**. In most people, T promotes muscle growth; you don’t get bodybuilder muscles without a ton of effort, but you will likely feel a bit stronger and might see physical muscle development in parts of your body that you use a lot (I got quads of steel; a lot of people get buff forearms and shoulders; your butt usually changes if you walk a lot; etc). HRT in general also doesn’t change how much body fat you have, because that is largely genetic. The shape that body fat takes will change, which can trigger emotions and anxiety about your body—I’ve had a hard time with this re: fat redistribution to my stomach. Knowing what effects something is having doesn’t necessarily turn the ED off, which is pretty frustrating; they’re irrational and based in fear and interact weirdly with dysphoria.

If you’re able to, I’ve found the most helpful thing is to straight-up build eating into a schedule every day. For example, I use paper lists on my desk a lot to keep track of things I have to do on days when I’m home, and I’ll incorporate “eat something” into those at specific intervals—”do dishes, clean desk, eat food, study, eat food, etc.”. It doesn’t have to be a meal, and it’s unrealistic to expect myself to do that. I also think that, since this isn’t a clinical setting, it is probably better to try and not track or care about the caloric or nutritional content, if possible. That is out of the question for a lot of people’s EDs, and I don’t know what form yours takes; I mention it because the anxiety produced around trying to hit a calorie goal can make it a lot harder to eat anything, and putting some fuel in is better than no fuel.

The trick to the repeated reminders thing is that you have to enforce it, or get something else to enforce it for you—I like phone alarms and timed reminders for this, where I can set them to snooze for five minutes but cannot dismiss them until I physically have an apple or whatever in my hand.

In terms of dealing with your actual thoughts about your weight: You’re right, “just don’t look” isn’t really a feasible solution. But it’s also hard to know how those thoughts will change on T, which makes them tough to anticipate and react to in advance. There’s a really, really weird intertwining of dysphoria and body image that tends to happen, where people will find that the body shape they settle into on hormones either doesn’t give them the same urge to control it that their pre-HRT body did or is easily separable from those feelings. I don’t want to tell you to wait and see but I do think that your overall ability to counter the anxiety you feel around food may get stronger when you feel more in control of/euphoric in your body. It’s weird, and takes some introspection to tease out, like, “okay I felt bad about my thighs previously because they made me dysphoric but now they’re shaped differently and I’m pretty sure that my remaining bad feelings are weight-based”. But it does, genuinely, surprisingly help a lot to ease dysphoria as a way of addressing weight and eating. EDs don’t disappear with hormonal transition, or with surgery, but they can get easier to manage when you are not constantly anxious about your body and gender. I hope some of this helps you; I’m sorry I can’t give you more of a handbook-style guide to it, I’m not sure anyone has it fully figured out.

- Mod Wolf

* The recommended-calorie diets are based on self-reported intakes; followup studies found that women were underreporting more than men were.

** And, conversely, not everyone loses weight on estrogen.

[qpocdoc-blog]

Dear Self, From M1 Me

Dear Self, So here's our typical end of the year letter to future!me in the hopes of documenting my hopes and trying to bring some memories in I might've forgotten. I really meant to be better at keeping this blog up to date with school, but school was so overwhelming and honestly I just forgot. So I guess goal number one for the future is to keep up with this blog a bit better. Onto the recap portion: This year has been long and it has been hard and it has been frustrating and exhausting, but it's also been fun. I gained a ton of weight (which is its own long post I don't want to get into) which I'm attributing to stress eating and not exercising. I also gained a ton of knowledge. It's kind of incredible how much information you can manage to cram into a brain, but it's equally incredible how much of it just falls right out. This year has truly been exhausting. School in and of itself was already exhausting. The exams felt never ending and I never felt like I had enough time to prepare the way I wanted to. And then on top of that was the never ending battle to just survive. My friend and fellow INFJ, whose codename shall henceforth be Pinky, disappeared off the face of the earth because of the harrassment by our classmates and so I spent the better half of the second year somewhat floundering alone. At least when it came to how awful the school is. I was lucky to find my study group, The Life's Squad, codenames henceforth Lion and Brian. Without them, I wouldn't have survived academically or emotionally. While they struggled all year just to use my pronouns, they're starting to get the hang of it and they helped me feel supported throughout the year. I'm glad we were able to become such good friends and I hope we keep being friends. I've actually put together a group of friends I don't hate (which for this school is about as good as it gets). In fact, I kind of like these people. There's codename Mastermind who keeps me amused during particularly boring lectures, codename Charlie who always wants to get hotpot, codename Phillipa whose kindness has been consistent and helpful, and codename Blue who was the first person outside of Pinky I heard use my pronouns correctly. They're not a perfect group by any means, but they're smart and kind and funny, and they help make me feel less alone. It's been a long year of fighting. After a year, there's still half my group of my Patient-Centered Medicine (PCM) class who don't use my pronouns. This includes my facilitator who I spoke to twice about this in the beginning of the year and just honestly can't take the energy to keep having that fight. PCM was a joke because the class is meant to teach us about working with marginalized populations but instead mostly was about how old white men felt about dealing with marginalized populations. The LGBT lecturer was so offensive, Pinky and I left in the middle of the lecture. I'm glad we did because apparently after we left the lecturer thought it would be appropriate to play "Let's Guess the Transgendereds". The administration refused to apologize for this. Despite many complaints about how offensive the lecture was, the course director sent out a follow-up email to the effect of "After looking at the evals, it looks like most of you enjoyed the class so it's too bad some of you super sensitive snowflakes didn't like it, but everyone else did" completely ignoring that the people who took offense to the lecture were all the LGBTQ students while those without a problem were generally straight people who, of course, had no idea what was wrong. While he tried to argue that it's better that we're moving toward talking about LGBT populations, I honestly think it does more harm than good to teach things incorrectly and horribly, horribly offensively. Still, he continued to defend the (white man) lecturer. On top of that there's been the year long refusal to own up to the transphobic/ cissexist language in the curriculum, consistently using woman to mean "person with a vagina and a uterus and XX chromosomes" and man to mean "person with a penis and XY chromosomes" while simultaneously teaching us it is possible to have XY chromosomes and have a vagina and uterus and XX chromosomes and have a penis. Additionally, it seemed an entirely absurd idea to them to teach us specifically what they meant. When they say "women are more likely" do they actually mean women? (no, they never do) Or do they mean people with a vagina? People with a uterus? People with higher levels of estrogen? People with a shorter urethra? People with two X chromosomes? People without a Y chromosome? Instead of actually teaching us the science, we play the "well obviously women have this" game which ultimately leaves us all with a poor medical understanding. While they seem to think we'll never have trans patients or that they'll be the exception to the rule, I'm hoping the vast majority of my future patients will be queer so there's a good chance many of them will be trans. Unfortunately this means I'll apparently be teaching half of my medical knowledge to myself as the school refuses to teach me the truth. At the beginning of the year Pinky and I were asked to write a letter to the curriculum committee about changes we'd like to see in the curriculum. When changing language was on our list, we were told, "No. We don't want to be progressive." I was flabbergasted. Oh, by the way, after sending this letter we got radio silence for six months. Then they decided they were making an "LGBT Task force" per our recommendations (which, by the way, we recommended a task force to evaluate the needs of the curriculum based on a wide variety of marginalized communities, not specifically the LGBTQ community alone, but okay) and neither of us were tapped for the task force because we were "biased" for writing the letter that they asked us to write. Also, it's particularly strange to me I wasn't tapped being that I'm the only out QTPOC at the school. Especially since both the people tapped for the task force are white people. Especially because we didn't even know this was happening until one of the white people tapped (henceforth codename Poet) asked us if we'd been tapped because he was afraid he was only being asked because he's a "quiet" queer who doesn't make waves. He probably was. This was the point at which we sent yet another email to the curriculum committee and finally got a response for a meeting. Back to the story. Yes, at this meeting we were told our school does not want to be ahead of the curve. We simply want to catch up. "Our school," we were told, "Is five to ten years behind in some categories and we just want to catch up to convention. We don't want to be ahead of it." My jaw hit the ground. After I found the energy to pick it back up, I asked why. Her response? "Because we wouldn't want our students to not be able to talk with their peers." Because, as we all know, if you don't learn cissexist ideas and use cissexist language when your attending asks you about a woman, meaning a cis woman, you will be flabbergasted and confused after apparently living your whole life without being innundated by our society and so have no idea what this idea of woman according to your attending is. Also, because it is apparently preferrable for us to use outdated and potentially harmful language with our peers than to be at the forefront of giving better medical care. Excuse me while I roll my eyes so hard they fall right out of my head. Pinky and I are running two orgs together next year. We have our LGBTQ group and we're running a group with Lion based around human rights and social justice. We brought in a lecturer to talk about water quality in our community. I'm excited for the work we can potentially do, but am realizing much of the brunt of it may end up on my shoulders as Pinky is avoiding the school as much as possible for her own health. It's entirely understandable, but it is tiring to know I am our main presence on campus and on the internet and that, for the most part, I am alone. Still, that's been the theme of this whole year. As much as I've made friends I care about and have had support, I still consistently feel I am alone. I am the only out QTPOC at this school. Now that Pinky isn't around, I'm the only one who shares most of my politics. I am alone and I am tired of it. The last post I made on this blog was before my suicide attempt at the beginning of the year. I've been lucky to be keeping up with my antidepressants and have been dealing with my depression and anxiety at a much better rate, but still. I continue to grapple with feeling alone, and I'm not really sure how to make it better. I'm still missing my old home with my old community and the feeling that I was surrounded by care for every part of me. I'm back to being here where there are only parts of me that are held. Where I feel like I have to cut myself into pieces so I can be palatable. Where I know there are only certain parts of me that can and will be cared for. I'm still working out how I take care of the rest of me. At least I passed M1. I'm 25% of the way to being a doctor and I'm exhausted. This year has reminded me why you don't see a plethora of QTPOC doctors. They try really fucking hard to keep you out, and when you get in, they try really fucking hard to kill you and make you feel alone. They've done a pretty good job with me, but I'm going to try and survive out of spite. I will be a cockroach. I will survive on nothing and thrive on it. That, or I'll die trying. Future Goals: I hope through the next year I can better maintain this blog. I want to record more thoughts for the future. The time flies by in school and I want to document it how I can. I hope to maintain my friendships. I hope to find the time to keep up with my friends outside of school while still having time for my school friends. I hope to keep my chin up and feel like I'm doing something more than survive. We'll see if I can. Lessons learned: I know now I can survive quite a bit. I can push through quite a bit. Compassion is always important and kindness goes a long way. I know they will try and squash it out of me, but I hope I can hold on to that compassion and that kindness. Advice to future me? Be kind. I hope you've stayed in touch with your roommate, codename Red. I hope you've stayed in touch with everyone mentioned here. I hope you stay hopeful, even when they try to kill you. I know it's tiring and I know I'm coming from the perspective of someone who is now on break and doesn't need to be fighting every second, but I hope you do fight. I hope you keep following your dreams. I hope you are courageous when you can and compassionate when you can. As always, follow Dad's advice: Bend your legs when you have to, but stretch them out when you can. Be a cockroach and survive. If you can do it, I think the world does need you. I think we can do something amazing. I just hope we can get there. Anyways, I don't know when you'll be reading this, but I hope every time you do you remember that you are resilient. They have tried to kill you in every way they can, but you are here. I may not always like you, but I do love you. It's taken a long journey to learn that, but we'll keep spiraling up. Take care of yourself. Best, The QPOC Doc