Reproductive Health of the Transgendered: One Man’s Story
Not many men visit the gynecologist's office: E. Danielle Maroon shares his personal experience with reproductive health and the challenges for female-to-male (FTM) trans people to maintain good health.
It's quiet in the reception area when I get there; the click-clacking of the lone receptionist filling in electronic patient forms is the only noise in the room. There are several already paged-through copies of Redbook, Ladies' Home Journal, and Saveur on end tables ready to be put in the magazine holders for tomorrow morning. Apparently it was a busy day in this practice, and by intention, I missed most of it.
The receptionist looks up at me and knows who I am, and why I'm here late, for surely there aren't many men who come to the gynecologist's office. It's roughly six o'clock. I sign in and don't even have to sit down before the nurse is at the door, ready to do my intake. She smiles and I walk behind her to the small examination room, pictures of faraway beaches in my sight, hanging on the wall across from the cushy exam table.
She takes my history—current age, why I'm here today, how long I've been taking testosterone, what changes I've had since I started hormone therapy. I'm grateful that she's obviously educated about talking to transgender patients, but I'm also a customer with expectations that the people delivering health care services have some sensitivity and proper training in our care. We do the usual weigh-in and blood pressure check, and she leaves so that I can change into the paper gown. I hate the paper gown.
I'm a female-to-male transsexual, also known as an FTM. I have a counselor to help me through transition, and she has been invaluable. I have an endocrinologist who prescribes my testosterone, monitors my hormone levels and makes sure my liver and other body chemistry ranges are normal. I have the usual primary care physician for my yearly physical, but I see a gynecologist who has some experience with FTMs and can look out for our specific issues. Not all doctors and nurses are sensitive to my needs, but I've found that by asking friends and people who work with transgender patients, I can find health care practitioners who know how to support me. I found my GYN from talking to my therapist, for example.
Testosterone shuts down the ovaries of pre-menopausal, female-bodied people, stopping menses and putting them into a kind of menopause. I dealt with the hot flashes and the night sweats, yes, as a precursor to my second puberty. It breaks down breast tissue, as does binding one's chest. But although these female organs may shrink or change, they're still present until and unless one has them surgically removed. And according to my gynecologist and endocrinologist, as long as I have these organs, I need to continue to have them evaluated. Yearly PAP smears need to continue, as do regular breast exams. Without any long-term study of the effects of taking testosterone on female organs, I've decided to err on the side of caution. They may not be organs I'm fond of having, but I've learned to manage their care like I manage other things in my life. I'm on the lookout for things like occasional spotting or any lumps on my chest. These would need to be reported to my doctor so that she can follow up.
Some doctors say that within five years of starting hormones, FTMs should plan to have hysterectomies and/or mastectomies, because these organs are no longer good for doing anything other than becoming cancerous. Other doctors aren't so sure, but people I've talked to have all agreed that no matter when one opts for surgery, regular visits to the doctor are essential for maintaining good health. It's just not helpful to avoid going to the doctor because of one's dysphoria (that feeling that one's body is wrong for them), as challenging as it may be. My strategy is to go at the very tail end of the day, see the doctor after regular hours, or to see an internist who sees male and female patients so that I'm not so obviously out of place. And when I need to, I talk to my counselor about how much I hate that PAP smear. And she totally understands.