A lot of Testosterone

By, Theodora

I hadn’t had a period since the beginning of November when I went in to my local clinic to get checked out. After evaluating my symptoms and doing a lot of blood work, my nurse practitioner diagnosed me with Polycystic Ovarian Syndrome (PCOS). PCOS is a common condition that is prevalent in many different kinds of people. Although symptoms of PCOS vary from person to person, it is a hormonal imbalance that means that a person has a lot of androgens (“male hormones” including testosterone) in their body. Although the term “polycystic ovaries” means cysts, or lumps, inside the ovaries, not all people with PCOS have cysts. Common symptoms of PCOS include excessive hair growth all over the body (hirsutism), irregular (infrequent, absent, or frequent) menses, painful periods, obesity, and sometimes, infertility. People with PCOS are more at risk for diabetes and uterine cancer.[1]

There is also a small body of evidence that shows that PCOS is more common among transmen than among cisgender (having a gender that matches your body) women.[2,3] A more recent study showed that an excess of androgens was more common among FTMs than cisgender women, but that rates of PCOS were not significantly different.[4] However, hormone levels vary from person to person, and gender is not dependent on them.

As someone who is FTM transgender (female-bodied, but male), I was astounded to find out that I had a condition that involved me having too much testosterone. I was worried that doctors would want to treat my PCOS in a way that made my body more female. I was also worried they would try to “correct” my understanding of my gender or treat being transgender as a psychological disorder.

So here I am, a FTM transperson with a diagnosis of too much testosterone! You can see the dilemma – I want testosterone. So how do I separate the seriousness of the medical condition and its treatment, and my desire to keep my body as it is? As an FTM person, how do you treat the medical condition without unwanted effects on your body – or if transitioning, how do you balance treatment of PCOS with your transitioning process?

There are no easy answers. FTM transgender people with PCOS still face a number of barriers to information and treatment. But here are a few things to take note of:

  • Because of PCOS and other related health conditions, all FTM persons should consider having regular pelvic exams and following up on related concerns.
  • One of the main treatments for PCOS is to receive progesterone. Some FTM transpeople may not want to receive female hormones. It is important, if safe, to discuss all treatment options with your physician, and to balance these out in relation to the severity of the condition. Maybe your doctor can help you look at natural options.
  • If a FTM transperson is utilizing testosterone, hormonal imbalances can lead to metabolism alterations and heart disease. Inform your doctor.
  • Sometimes, it is advised to remove the uterus and ovaries. For FTMs, this is not always easy. If you are transitioning or cross-living, your insurance or doctor may not want to pay attention to your ‘female’ body parts. If you are female, and revealed your identity as FTM, doctors may not be culturally sensitive to your needs.
  • Remember: everyone’s PCOS looks different. Someone may have cysts, someone may just have a hormonal imbalance and infrequent and painful periods. Someone may have excessive hair. Some may be ashamed of their ‘male features.’ Some may be more affected by the symptoms of the disorder than the fact of the hormonal imbalance.
  • It is important in any medical situation to be as assertive as you possibly can. State your needs clearly. Push for solutions that are safe and acceptable to you.

It is obvious that we need trans-positive health care reform so that transgendered people can have hormonal imbalances treated without encountering transphobia or being told they have a mental disorder. Trans-inclusive PCOS healthcare would be beneficial to the treatment of PCOS in all people, because it would help treat symptoms, rather than misdirecting the treatment. Just like the chicken and the egg, or were you born gay or did you turn that way, the origins of PCOS are debatable. And treating the symptoms with excellent bedside manner is much more important than positing where all of this came from.

If you are FTM transgender, you may be more at risk for PCOS. Please take care of yourselves, go to your doctor or to Planned Parenthood or another clinic in your town to get checked out, and take as much control of your health care as you can. Your health may depend on it.

References:

  1. “Polycystic Ovary Syndrome – Topic Overview.” WebMd. Accessed from http://women.webmd.com/tc/polycystic-ovary-syndrome-pcos-topic-overview
  2. Vujovic S et al. “Transsexualism in Serbia: A Twenty-Year Follow-Up Study.” Journal of Sexuality and Medicine, 2008.
  3. Baba T et al. “Association between polycystic ovary syndrome and female-to-male transsexuality.” Human Reproduction, 2007.
  4. Mueller A et al. Prevalence of Polycystic Ovary Syndrome (PCOS) and Hyperandrogenemia in Female-to-Male Transsexuals. Journal of Clinical Endocrinology and Metabolism, 2008.