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destroyyourbinder · 5 years

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I want to thank Jacob for his enormous bravery in speaking out publicly about how the “puberty blocker” (GnRH agonist) protocol and the medicalization of his identity affected him as a struggling trans teenager.

I want to note before I share the article that stories like Jacob’s are being politicized by groups like Mermaids (the primary transgender child lobbying organization in the UK) to claim that while "blockers” are “safe” and “reversible” and ought to be immediately provided to trans children who are beginning puberty, that any problems with GnRH agonists indicates that clinicians should begin cross-sex hormone treatment early. Organizations such as Mermaids and various other groups in the US frequently claim that there ought to be no formal lower age bound for the initiation of cross-sex HRT (i.e. testosterone for female children, estrogen and an anti-androgen drug for male children) and Johanna Olson-Kennedy (a pediatric gender “expert” and head of the gender clinic at Children’s Hospital Los Angeles) advocates regularly for female children to receive testosterone at twelve and has possibly given children as young as 8 testosterone treatment. So in sharing this kid’s story, I want to be careful, since there is a real danger that exposing the harms of using GnRH agonists such as Lupron on gender-variant children will lead to a change in strategy where these children are merely dosed early with cross-sex hormones, a protocol that to my knowledge that we have zero long-term data on. (Children are given GnRH agonists as a means to halt precocious puberty, and in fact, these drugs are approved for this purpose, so we have some data on their effects already. As far as I know, there has been no previous medical reason to give female children testosterone or male children anti-androgens and estrogen.) The article is behind a paywall but I am transcribing it here: Puberty blocking drugs: ‘For the past four years I’ve been stuck as a child’ Jacob has just turned 16 and for the past four years the teenager’s body has been put on pause. He has been on hormone blockers to stop puberty while he decides how far he is willing to go to become a transgender man.

He claims that taking blockers was “the worst decision I’ve ever made”.

Jacob was born a girl but felt unhappy with his gender. “I always felt so weak and pathetic and inferior to the men.” He started using the male pronoun and imagined himself growing up and “dating a woman”.

When Jacob became one of thousands of young adolescents to be referred for puberty blockers by the NHS’s main gender clinic for children he was delighted. “It was sold to me as a miracle cure for being trans,” he claimed. He told another trans school friend about them, who started requesting blockers too.

Hormone blockers are only licensed in Britain to delay the onset of puberty for children suffering “precocious puberty” — that is, those who start developing abnormally early before the age of eight or nine.

However, their use is promoted by the transgender campaign group Mermaids as a way of giving young people “a pause button” while deciding whether to graduate to the irreversible, cross-sex hormones that will trigger the life-changing, fertility-reducing jump from one gender to another, once they reach 16. The vast majority of children who begin blockers go on to take that step.

Blockers are physically reversible, insofar as puberty will eventually restart once someone stops taking them. But no one — not even the directors of the country’s leading gender clinic, the Tavistock’s Gender Identity Development Service [GIDS] — knows their long-term impact, for example, on the teenage brain.

After just a few consultations at the Tavistock, Jacob was referred to the endocrinology clinic at University College London Hospitals [UCLH]. He claimed the clinic did not consider his background, such as the trauma of a sexual assault at primary school, or his parents’ difficult divorce. He and his mother were soon making regular visits to London from their small village in the west of England for the injections.

“They promise you that your breasts will disappear, that your voice will be deeper, that I would look and sound more like a boy. For me, that was the best thing that could have happened,” he said.

Only, Jacob found that wasn’t what happened at all. Far from becoming one of the lads, as he’d hoped, he felt even more alienated from them as their physiques changed and Jacob’s remained the same.

“At school, other people were maturing into adults. The guys I grew up with were growing hair and growing up. For someone who’s trying to fit in as a boy, that’s not what you want.” Jacob had always been the tallest among his friends. Now he was the shortest. When his little brother overtook him in height and strength, he found it too upsetting to be in the same room as him. “My little brother is 18 months younger and now he has completely outgrown me. I go to school and I feel like other people are developing and I still feel like a child,” he said. Jacob also claims he was not warned about the side-effects of the drugs. These have included insomnia, exhaustion, fatigue, low moods, rapid weight gain which caused his skin to become covered with angry, itchy stretch marks, and a reduction in bone density. “I’d never broken a bone before [taking puberty blockers],” he says. “I’ve since broken four bones.” “I stubbed my toe, it broke. I fell over, my wrist broke. Same with my elbow.” As he took the blockers, Jacob’s mother watched her child become even more introverted and body-conscious. “The blockers contributed more to the self-image problems that were already there,” she said. Jacob found it increasingly difficult to concentrate on schoolwork. If sitting GSCEs is hard enough with raging hormones, it’s even harder without them, he said. “I’m someone with the developing mind of a 12-year-old who’s doing exams designed for a 16-year-old.”

He added: “The worst part was probably the depression. There were moments when I wanted everything to stop. Weight gain and depression — for someone who is already self-conscious about their body, that’s a lethal combination.” Clinicians who resigned from GIDS for ethical reasons said one of their main concerns was that young people were being sent down a medical pathway without proper exploration of the possibility they may simply be gay. Jacob is no closer to understanding who he may be attracted to at 16 as he was at 12. “My friends are all talking about having sex and girlfriends, and going to prom... but I’ve never had a crush. I’ve never felt sexual attraction to anyone. I feel so out of place.” In hindsight, Jacob finds it surprising how little his background — and the reasons why he didn’t want to be a girl — were discussed before being referred for treatment. “They didn’t even look at my history or trauma,” claimed Jacob. “They sent a child whose circumstances and feelings they didn’t understand [for hormone treatment].” Jacob is speaking out about his experience to warn other transgender youngsters to think twice before starting blockers. “I was sold a miracle cure. They promised happiness with little evidence behind it. Then four years in, you realise, oh my God, I’ve no idea about the long-term effects.“

“They asked a 12-year-old to make a decision an adult would struggle with.” “It was like, ‘here are the drugs’ and off we went. It’s a ridiculous process. It’s not gone the way they told me it was going to go.”

Mermaids, the transgender lobby group, claims that puberty blockers are safe and “completely reversible” and that not giving them to youngsters who request them can be more damaging than prescribing them.

Gendered Intelligence, another trans campaign group, claims on its website that hormone blockers give children “breathing space to ensure that they are sure about the permanent effects of cross-sex hormones, without the adverse effects of an incorrect puberty.” Jacob is scathing about such claims. “Breathing space! It really isn’t. I’ve not had any space to breathe the last four years.“

“They sell it to you as a break from feeling like a girl, and that’s fine for the first few months but as soon as everyone else around you starts developing it becomes ‘spot the transgender kid’, which is so easy because you’re stuck as a child.“

“If anything, I’ve been more depressed than before. My thyroid is messed up. I’m hungry all the time. I have no idea how my breast tissue will develop.” He claimed: “They push and push you on to this one-way train you’re not allowed off.” Asked whether it was misleading to promote puberty blockers as a “pause button”, a spokesman for Mermaids said: “Mermaids cannot comment on clinical cases as we are not involved in any individuals’ medical pathways.” “We offer young people and their families information, support and access to others in similar circumstances.” Gendered Intelligence declined to respond. Jacob claims the main focus of his treatment at the Tavistock was on the milestones of transition — “how far you’re willing to go” — rather than discussion of the consequences.

He claims: “My Tavistock worker was saying to me, ‘once you have the testosterone, you’ll be a boy’. “But it shouldn’t be about milestones. Being trans is how you think; it should not be about how far down the line you’re will to go.” A spokesman for Tavistock said: “All young people considering the puberty blocker or cross-sex hormones are repeatedly made aware of the known potential impacts of these medical interventions... as well as the areas of impact that remain to some extent unknown.“

“The information that we give patients about the blockers makes it clear that they may get tired and experience low mood. We explain to young people that hormones give us energy and drive, not just our sex drive but our overall ‘get up and go’. “We also emphasised to them routinely that while on the blocker they would stay early puberty whilst their peers developed. This is a routine part of the discussion.“

“In the end the decision to go on blockers is a balancing act weighing up these factors against the perceived distress of undergoing puberty in the ‘wrong’ gender and developing unwanted and potential hard to change secondary sexual characteristics.” Jacob decided to come off the drugs on turning 16. He began to feel the benefits almost overnight. “I grew taller, I lost weight, I felt livelier. It was like getting the poison out of my system,” he said. He will now wait until reaching 18 before making any big decisions.“I’m just fed up with all of it. I’ve felt like a guinea pig from day one. [Blockers] only made my life more complicated and it was pretty complicated already.” He added: “I’ll be 18 in two years, but for the past four years I’ve been stuck as a child. Blockers took away the chance I had to grow up with other kids. Now I want to give my body a break.”

#medical47 #risks01

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destroyyourbinder · 5 years

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dealing with binding damage/pain

I had a reader ask this question a month or two back and I just realized I never answered it! Since I've been on the topic lately I wanted to give them a response:

So I came to terms with my sexuality after identifying as ftm, and binding for three years due to internalized homophobia (luckily didn't change my body more than that because my parents are extremely conservative). Any advice with dealing with chest pain/tissue damage when no longer binding?

Hey there-- I'm really glad to hear that you've come to terms with being a lesbian; it's a long journey for a lot of us, and although it's definitely not over once you recognize you're "just gay" after all, it often opens your life up to possibilities you thought were forever closed. Once you've settled in, in my experience at least I've found it to be a big fucking relief in a lot of ways.

The advice I'd give you is really contingent on what kind of damage you suffered, where the pain is currently and what in particular exacerbates it, what you're currently doing with regards to wearing garments on your upper body, whether you also have posture changes due to slouching/binding, and how far out you are from when you've stopped binding. I'm going to write to a general audience both because I don't actually know what you're experiencing, because you might be unsure yourself or not realize something you're experiencing is related to binding-related (or dysphoria-related) issues, and because I think a lot of female people could benefit from this discussion. One of the resources I want to link you to is a 2017 study that I think I've reblogged a couple times now, called "Health impact of chest binding among transgender adults: a community-engaged, cross-sectional study" which is I think the only research piece that we have to have systematically examined negative health outcomes of breast/chest binding practices. I'd advise anybody binding or with a history of binding to look through this study to educate themselves on the risks and prevalence rates of a number of health issues commonly caused by or associated with binding. Not everyone knows or is willing to admit that certain issues they are experiencing could be binding-related so just simply having this information is a good start. You can find the study linked here for free: https://transfigurations.org.uk/filestore/binding-project-postprint.pdf I also want to preface this with the plea to please take seriously anything you're experiencing; I know it's a chronic myth in the trans community and in gender non-conforming female circles where people might bind that there is a level of binding that is "safe" or at least significantly "safer". Although your problems can escalate the more time you spend binding (whether measured in hours per day, the frequency with which you bind, or how much time total you've spent doing binding practice) or with certain binding practices (like using ace bandages or duct tape, "double binding", or using too much compression) binding can cause certain problems near-immediately, such as muscle aches or other musculoskeletal related pain, shortness of breath, and skin issues. Serious binding-related problems, like rib movement or decrease in lung capacity, can occasionally happen very quickly, i.e. within a few months of beginning binding regularly, even following generally well-regarded harm-reduction practices for binding. I sometimes read of people who doubt that binding could have hurt them because they "only" bound for such-and-such a period of time or "only" with a commercial binder, and who seem to refer to some mythical lumberjack trans man who wears his binder 12 hours a day in the timberlands and has no problems, or at least just bears them through his beard with no complaint, as the gold standard for binding. I know for many female people bearing the pain and body issues that come with binding is considered a hallmark of masculine identity and that your right to name your distress as gender dysphoria is often in question if you decide that the costs of binding are too high for you. There is a very nasty arms race to the bottom in trans community sometimes about who is the absolutely most dysphoric and the absolute manliest, and if you don't think that any horrible level of nihilistic self-destruction is worth it to ward off the prospect of Really Being a Girl then you run the risk of losing this terrible game. I want to begin my discussion of binding risks and known problems with this because most of us struggle with this mentality in some form, at some point, and choosing to prioritize taking care of our bodies in a very basic way over doing what our dysphoria tells us is necessary to make it go away can be extremely difficult, to the point we may deny that we have anything happening with us that we need to take care of at all. Listening to your body will take a lot of time when all you could hear at one point was how gross, humiliating, disturbing, and wrong it was. It's a lot like learning to communicate with a species of animal you've never had to interact with intimately and that maybe you're repulsed by, like a rat (which are perfectly wonderful creatures, by the way). That all out of the way, the first question I want to ask is this: are you having any problems with breathing, your lungs, or general respiratory problems you suspect are related to binding? This is probably one of the most serious problems some people have with binding and is not something I feel comfortable advising on given that it can be extremely medically serious and life-limiting. Problems frequently cited are general shortness of breath, chronic wheezing or coughing, feeling deprived of oxygen especially when exercising, and feeling like you have fluid in the lungs. These may be more serious if you smoke, are being exposed to environmental allergens, or have a pre-existing respiratory issue like asthma. I did not experience this but would definitely direct you to seek advice from a medical professional if you are having lingering issues of this nature.

Binding is also known to cause permanent rib changes-- serious and/or chronic chest or back pain should probably warrant a trip to the doctor. Broken and cracked bones are possible from binding practices, or from becoming injured while binding. If you're experiencing intense or odd pain you may have also pushed your ribs out of alignment to hit an internal organ or compress a nerve. Some symptoms, including ones like gastrointestinal issues, can indicate that you have altered the position or function of organs contained inside your rib cage or that compression is affecting their ability to work properly. If you suspect this is going on I also don't feel comfortable advising you to do anything else but seek medical advice.

Costochondritis is a common symptom that people who bind experience. It is an inflammation of the cartilage that connects your ribs to your sternum (the center bone in your chest) and is something that I experienced even when just wearing tight/multiple sports bras. I had it off and on the entire time I wore bras or used a binder and it ranged in painfulness from mild to so-intense-I-had-trouble-breathing. It is usually a temporary condition, but it can reoccur continually over time to various degrees of intensity. I usually waited out the times it occurred more mildly, but if it's severe you may need a course of steroids to decrease inflammation (as I did twice in my late teens/early twenties). You can usually tell that you have it instead of some sort of more medically serious chest pain if you poke your ribs towards the center of your chest and the pain feels both external and shoots up dramatically. If you aren't sure whether the pain is located in your ribs or elsewhere, you should probably get things checked out to make sure you don't have a heart or lung issue from binding or otherwise. Another thing I want to mention is that you can very easily sprain or pull muscles from getting in and out of binders or moving around in them, especially if you're moving around vigorously or exercising. This should also generally be temporary and can be treated in the same way you usually would treat any muscle injury (rest, heat/cold, gentle stretching and movement) but even if you stop binding, look out for continuing symptoms from any serious pulls or strains you might have incurred while binding. Wrenching your neck in particular can result in lingering issues. It might make you feel stupid to admit or think about, but "dumb" injuries like pulling your shoulder while getting a stuck binder off are mechanically the same as any other injury, so keep an eye out. A lot of pain you might experience while binding or even years after binding has to do with your muscles-- this can be from binding directly from the way a binder/bra exerts force on your chest and shoulders, from range of motion issues from being constricted in a binder or from compensating for binding pain, or from chronic posture issues from hiding your breasts. I also want to note, because they're so common in trans and gender non-conforming female people, that autism in particular but other neurodevelopmental disorders can change your posture in weird ways, and your sensory feedback is likely atypical or not fully integrated so you might have odd ways of moving that aren't necessarily mechanically optimal. All these things together can lead to chronic pain throughout your body-- obviously most people talk about pain in the upper back, chest, shoulders, and neck-- but chronic jaw pain or headaches are a potential issue from tightness or referred pain from lower down, and compensating for upper body tension, motion issues, or pain can lead to changes in the position or motion of the lower back, hips, or legs which can lead to tightness and pain. I unfortunately have both lingering issues in my chest, shoulders, and back and a host of posture-related pain issues even over two years after stopping binding, due to ways that I compensated for wearing compression constantly on my chest (I would wear sports bras even to bed) and ways I changed my body posture to prevent "looking female". I have a slouch about as bad as what’s-her-face, as most trans men I have met also do regardless of whether or not they're post-mastectomy, and although it’s gotten better with mindful practice and lack-of-binder I am still totally not where I want to be. There are many physical therapy resources out there that are now publicly available online-- on resource websites as well as YouTube-- and regularly stretching using these strategies has basically held my body together this whole time through several physically intense jobs. I personally use a set of stretches for headaches, and a number of sciatica stretches, calf stretches, and trapezius-focused stretches that I found all over the internet. There is also a tumblr thread here (not all of which is posted on my blog, please check the notes) where another woman who experienced binding damage solicits advice and many people offer suggestions for binding-pain related stretches and exercises. I also made a DIY foam roller out of a 2-ish foot stretch of 3 inch PVC pipe and some squishy shelf liner that I glued around the outside, and I have a DIY rice bag I pop in the microwave for use as a heating pad. I have also found that regularly taking omega-3 oils helps mitigate the level of inflammation and pain my muscles can reach; I take algae-based oils because I am vegetarian but if you eat fish, regular fish oil pills will work just as well. If you are still wearing a supportive bra or have chosen to deal with stopping binding by stopping everything your muscles will not have learned to support your chest yet, especially if it's large. If you quit all chest-supporting garments cold turkey or go to only very minimal chest support after binding you might have a lot of pain initially. My general chest and breast pain has substantially decreased after 2+ years of being without a bra or binder, so it's worth a shot or two to learn to do this, but you will have increased pain initially until your body adjusts. It was both my actual chest muscles, wall, and ribs that hurt as well as my breasts (something that might be obscured by dysphoric-friendly language about "chests") but once my chest and shoulders became sufficiently built, my breasts "sagged" appropriately to hang where they were comfortable, and I adjusted to the sensory input of feeling the weight on my chest, I was ultimately more physically comfortable than I ever had been in bras or binders. The pain was not easy to get through-- it was sometimes excruciating-- but now I can do anything I could do previously with a bra or binder without one, including run. If you are in this position I recommend upper body exercise or introducing regular upper body work into your daily life; this will help you build muscles appropriately and learn to move your body in a mechanically optimal way. It does simply just take time if you are attempting to adjust to minimal or no compression on your chest, and stepping down more gradually can help (such as by wearing athletic compression wear, which I have a guide about here). But it took me probably about a full year before I no longer had this sort of pain, and about another year or so before it felt fully "normal". I talked more about the process of stopping wearing bras and what it felt like in this thread, if anyone is interested in knowing more. On the topic of changes to skin and tissue: sores, infections, skin damage, and so on are common from binding, especially if you are large-chested. I still have some mild issues with this in the summer, as many people do, when I sweat a lot and various fungal and bacterial microorganisms can easily proliferate. This should resolve itself over time if you wash regularly with a gentle antibacterial soap or cleanser, keep the area between and under your breasts dry, change your clothes daily, and try to wear loose-fitting clothing. But as always, anything that won't go away for weeks, or that is resulting in skin breakage, swelling, or sores, should be addressed by a doctor. My breast tissue did change from binding with a binder, and my breasts became more "floppy" and "soft". I gained more stretch marks than I had already had. I suspect I am more prone to breast pain than I was previously, and my nipples and breast skin have little conscious registry of sensation, but I don't know if that came from binding, either with a binder or bras. But to my knowledge most changes to your breasts from binding are largely "cosmetic". I have not heard word from anyone that this damages your breast as an organ, but then again most people who bind usually do not breastfeed. Stories by trans men who kept their breasts and became pregnant indicate that their breastfeeding is relatively normal, but we simply do not have the data to know how binding might affect breast function. I do not know either if you're more likely to do something to the breast tissue by binding which could increase the likelihood of any medical issue in particular or create the opportunity for pain. Mine are definitely "saggier" to some extent and have gotten even "worse" post-binding, but as I've noted this has not been a bad thing, because I do not wear a bra any longer and my breast tissue now hangs in a way that allows me to move without pain. Finally, I just want to mention there are a lot of emotions that you might feel from having binding damage in a similar way that anyone who did something to themselves in the name of transition or dis-identification might. I sometimes personally feel extremely stupid for having done what I did, and that makes it even harder to deal with pain or other physical issues, even though it was understandable that I reached for binding to cope with my feelings at the time. I also feel extremely stupid and conflicted about my values a lot of the time given that I still have impulses to go back to binding even though I know that it hurt me and I don't actually want to begin again. I feel really angry about how my body was sexualized at a young age and how my family and doctors dealt with my early puberty, about how my family chose to humiliate me for being neurotically "modest" instead of supporting me through something difficult. Sometimes I feel really bad about quitting binding or for having to quit because of pain because I feel like I was "proving" right people who criticized it or my impulse to hide my breasts for the wrong reasons, or even that they are right because I "deserve" the pain I feel as a result of trying to avoid my body. I feel exposed and ashamed a lot about my breasts, and it's been hard to cope with the effects of binding damage realistically in a way that values my not-being-in-pain when I'm also trying to manage dysphoric feelings. I feel messed up that I felt "validated" about having and using a binder and that I tried to ignore how much pain it put me through in favor of hoping that it would facilitate me some day achieving some ultimate male-like body state where basically I couldn't suffer anymore. These are all varieties of normal feelings to feel, and I just want others to know that it makes sense if you feel stuff like this. Re-centering on taking care of yourself and your body takes time if the feelings are really intense, but it's worth getting back to focusing on what you actually value-- your health, your functioning, and so on-- even if it takes a while, and you don't have to immediately ignore or push past what you feel to "get better".

#binding20 #responses #qanda #writings #risks01 #science30 #dysphoriacoping26 #whatsitlike106 #alts101 #chest12

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