A query for the populace:

[EnglishPatient]

I apologize that this is my first post, and that it may seem that I only appear because I need help, but I'm a bit of a Nervous Nelson and quite a big lurker.
I've been looking around for a bit, and I've tried to find all that I could, on my own, but there is little information on how hormone treatments or vaginoplasty would interact with pre-existing conditions, and in a young lady with a pre-disposition for several autonomic and auto-immune disorders, as well as several outright diseases and maladies.

My darling girlfriend is in a bit of a pickle, being only seventeen, and ravaged by type one diabetes, cyclic vomiting syndrome, POTS (to do with the contractions of blood vessels), a mutation in the mitochondria that causes severe fatigue, autonomic disorders which keep the core temperature between 99 and 104 at all given times, and keep her from sweating enough to keep herself from overheating in warm environs, as well as predispositions for bipolar disorder and several more autonomic and autoimmune diseases and disorders. Considering that the both of us, myself being ftm, are still under wraps (although I am out to family and friends) and neither of us are allowed treatment for the time being, I'd like to know if any of you strapping ladies, gents, and other-gendered folk of good standing could give me some insight on what may be possible for my lovely little flower.
And even if blanks are drawn, perhaps you could consider accepting her into the community? She's even more frightened than I, I'm afraid, but she'd most likely come along to lurk, at the least, if she could be reassured by more than one voice.

I owe you all my greatest of thanks, in all cases, for allowing me the privilege of posting here, looking in on the goings-about, and posing this question to you, as a community. Thank you, and good luck, my dear acquaintances.  --Ludwig

[azSam]

Absolutely! Come and join us! There is no reason to be afraid. I do bite, but not very hard 

I sort of relate because I also suffer from CVS. I first got it around the same age, around 16 years old.

Anyone and Everyone is welcome here. There's no need to be shy, we are here to help. We all seek help, and we all give help. We don't discriminate and we don't have requirements. Being on HRT is not a requirement for posting here, transitioning is not required. Just having an open mind is all you need.

We have plenty of people who are non-op, or non-transition do to medical or personal reasons. We don't turn anyone away if you want help, or even if you want to just hang out.

So please, join us and don't be shy!



Now to address you other questions. What is possible, that's hard to say. Since being on HRT, I'll admit that the frequency of attacks from my CVS have actually increased, but I've learned to control them better. Since they say it's related to migraines, HRT can increase the frequency that you experience migraines.

I can't think of much to help. She is still young, and it would be very beneficial to get her on HRT before too much testosterone damage sets in. Best thing to do, if you feel you NEED to transition, and are willing to risk an increase of attacks from your CVS, then you should persist and try to get treated for your gender incongruency. Because GID (Gender Identity Disorder) is as much a condition that needs treating as anything else, and the treatment is to transition.

As for complications relating to the other conditions, I really can't say. It's all very complex, and changing your chemistry in such a way may cause harm. But this deserves to be treated just as much as anything else, so persist. Insist on treatment. The doctors are paid very well to figure out whether or not it's truly possible, and what complications it can cause. So make them work for that big fat paycheck!!!!

[A]

Of course, you both can join. Why not? This place is the one place on Earth where you can both be the least shy.

As for your questions, uhm, I know practically none of these illnesses, but GID can be just as deadly as any problem. Suicide hurts, kinda. That said, HRT could be dangerous in some situations, depending on the illnesses. But there are ways to go against this. For example, an early orchidectomy would allow her to skip anti-androgens and use a lower dose of hormones, putting less strain on herself. Also, transdermal HRT puts less pressure on her, compared to oral or even injectable hormones.

I am no medical expert, but I am still sure there has to be a safe - or at least relatively safe - way for her to transition. And even if there are risks, A. doing tests frequently, they should be minimized and B. any risk will probably have less chances of killing her than suicidary impulses from GID which have extremely high chances of appearing at some point if the issue is not dealt with. And there's no point in waiting whatsoever. Every month that passes poisons her more into becoming what she isn't. On top of this, the older she is, the higher any potential risks from interaction between her HRT and her conditions get. If she's going to transition one day, she should do it immediately.

But doctors are thickheaded, so she might face tall walls. The only weapons I can offer her are here.

Emphasize that GID's bad effects, including a potential for suicide in the future WITHOUT actually saying she could want to die right now, because then they'll say she (or rather they'll say "he") is depressed and, like children, will become deaf to anything they don't wanna hear - namely, GID - when they have some mental issues, even minor ones they would send other patients home or to a psychologist for, they could treat.

The key is showing them that the risks from HRT are unsignificant compared to the mental harm of not undergoing it whilst still showing understanding of them.

Appear as mentally healthy as possible. The key is for her to show them that she is functional so that they cannot accuse any other problem of her feelings - AND THEY SURE LOVE TO DO THAT - or claim her unready for any reason - AND THEY LOVE TO DO THAT EVEN MORE. But she must still show that she cannot function well at all or be truly happy in relationships, etc. without transition. This is a hard balance to reach, I know.

Be very prepared and know where to go. She must be very confident in front of doctors and look like she almost knows the subject better than them. She should have an approximate financial and school plan ready.

Be out to the most important people. Some doctors will require her to be out to everyone she is close to and will eventually HAVE to know, including her close family. But this can be skipped if she suspects a violent reaction.

Useful links

Standards of care - what most doctors will follow. She should definitely read this if she wants to understand the professionals: http://www.wpath.org/documents2/socv6.pdf

Essential quote

Eligibility Criteria. The administration of hormones is not to be lightly undertaken because of
their medical and social risks. Three criteria exist.
1. Age 18 years; smart physicians should definitely be okay with 17 too
2. Demonstrable knowledge of what hormones medically can and cannot do and their social
benefits and risks;
3. Either:
a. A documented real-life experience of at least three months prior to the administration
of hormones; or
b. A period of psychotherapy of a duration specified by the mental health professional
after the initial evaluation (usually a minimum of three months).

Readiness Criteria. Three criteria exist:
1. The patient has had further consolidation of gender identity during the real-life
experience or psychotherapy;
2. The patient has made some progress in mastering other identified problems leading to
improving or continuing stable mental health (this implies satisfactory control of
problems such as sociopathy, substance abuse, psychosis and suicidality; I don't know about others, but my psychiatrist more or less interprets "some progress in mastering other identified problems" as "very significant progress in mastering all aspects of every other identified problem". If hers is even a little like mine, I cannot emphasize enough the importance of convincing that person of her mental health.
3. The patient is likely to take hormones in a responsible manner.

Transsexual Road Map - a nicely done, though a little outdated in some aspects and written by an older woman (so the views on some aspects seem strange to younger people). Nevertheless, it is an excellent thing for her to read: http://www.tsroadmap.com/index.html

Now, an important point is that she must know, before she seriously requests transition from a health professional, a lot about her complex medical conditions and their interactions with hormones, because I think there is a rather high probability they will refuse without seriously looking into it, simply because "many illnesses = probably risky to do agressive treatment [not that HRT was ever an "agressive treatment", but...] = not worth it for something secondary [olol I'd want to see them in it] like transsexualism", so she will have to be the one to put sheets on the table and say what risks HRT with her illnesses carries, what risks are there but not worsened by her condition, and how HRT could actually indirectly help with her illnesses (I am no expert, but a first thing I'd see is that female hormones tend to lower the body temperature), whilst being realistic about them and showing acceptance towards them without excessive optimism.

To know how HRT could interact with her conditions, she should do a lot of research. Her situation looks really complex.

She should first get some thick information on HRT medications, their intended effects, side effects, biochemical effects and interactions. The following links may be useful: http://en.wikipedia.org/ - http://www.rxlist.com/ - http://www.drugs.com/ ---- Medications to look up in bulk: estrogens (Estigyn, Estraderm, Premarin), micronized progesterone (Prometrium), anti-androgens (cyproterone acetate [Androcur], spironolactone [Aldactone]).

She should also get information on her various illnesses and look for side-effects similar to hormones' (for example, thrombosis and liver failure), organs weakened by the disease that could suffer from HRT (for example, liver and kidneys), symptoms of her illnesses that are "worse on women", sensitive to hormones or similar to an hormone effect, etc.

She will have to do a lot of research, I think. In the UK, I think you have an "health information" service like we do in Québec here, with even the possibility to email a doctor with questions. You could call or send an email requesting information.

I hope I was helpful.

And in any case... Welcome to you two!