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Self administration of oestrogens
As promised, in my recent initial lblog recommending only to commence medication under Medical Supervision/ Monitoring.
In the event of a decision to by-pass the unacceptably long wait for an initial appointment in the Gender Identity Clinic (2-3 years as opposed to the Governments insistence that there be no more than 18 weeks wait), girls may, understandably, feel pressurised, and to see no alternative but to order Oestrogens via the internet; and, to commence then their own medication, unsupervised.
Internet:
there is no guarantee of quality or dosage control, nor that the drug is in reality as claimed.
Vehicle, Preparation and side effects:
Oral (tablets); Skin(absorption) as patches or gel; sub-dermal implants require local anaesthesia, and are consequently not available.
Preparation: Blood pressure check is vital: no therapy should commence until it is stable and fully controlled.
History: self administration should be with-held in the presence of a history of Cerebro-vascular accident (stroke): 'blood clots': Liver disorders: heart disease.
Side effects: In the presence of such problems (Fluid retention, Depression, Headaches, leg-cramps, sore breasts, indegestion. bloating, etc) one can a) switch to an alternative form of Oestrogen b)change the dose c) tail off (Not suddenly stop) medication d) seek medical advice.
relief may be achieved by taking oral therapy with food. Breast tenderness can be eased by a low fat, high carbs diet. Exercise/stretching can reduce leg cramps.
INSURMOUNTABLE OBJECTIONS:
1) Obligatory, initial, medical history and examination is absent. A repeat examination at 6 months is also absent.
2) No baseline serological tests have been taken (essential for performance monitoring)
3) dose titration, adjusted by repeat sex hormone analysis after 8 weeks of initial treatment, is unavailable.
4) Oestroden and Testosterone Levels: targeting is absent, as an essential base for titration management, dose adjustment and potential additional medication.
5) no regular assessment of Liver Function Tests (oral therapy's serious risk factor) is undertaken, either prior to of during therapy.
COMMENT:
Desperation (particularly for Orthopaedic proceedures) occurs in the UK, as a result of inadequate funding across all sectors of the NHS. However, the same NHS have always maintained a particularly high level of denial and chronic under-funding with regard to Gender Services. Their forward planning is in respect of less than 1% of the population with Trans status. Epidemiological studies (ignored or repudiated) indicate it is more like 2.75%! This, unacceptable situation is compounded by staffing difficulties with respect to Doctors with the necessary training (blame the EU for the lost 3000 hours of training per doctor); and, I have found presonally as a Professor of Surgery, a most surprising and worrying level of Transphobia in a Nursing Profession, otherwise dedicated to the general well-being of patients - hence another source of difficulty in attracting quality staff to the service.
DISCLAIMER:
I make absolutely no criticism of those of my community who follow the above route: "presonal choice" is enshrined in the modern NHS, and has always been the keystone of my professional life. I merely wish to make my sisters aware of all the risks, before they make their own personal INFORMED decision.
PERSONAL VIEW (Conclusion):
I would not drive completely blindfolded ( in my old-fashioned non self-driving vehicle) up the motorway system from my grand child's home near Lausanne to see my other grandson in Zurich. So, why would I have any desire to do the same with my health and hormones?
