Norethisterone V

It seems my choices are to take Oestradiol only, and completely lack energy so that if I do my washing in the morning I just want to slump in the afternoon, or to take synthetic progesterone, and have febrile energy manifesting in highs I don’t fully trust- I seem rational, but its my Norethisterone brain doing the judging- and crushing lows.

I phoned the Samaritans, wanting to explore this low, quite how bad everything is. I would go into the darkness, and start by saying “I am not suicidal” to reassure Helen (or me). Thinking of how to express that I realised, “I want to die”. I don’t trust myself to look after myself.

The low is deep but I know it will end. That is an improvement. The high on Tuesday was really good. Even low, I feel more energy and purpose. Georgia O’Keeffe wrote, I’ve been absolutely terrified every moment of my life – and I’ve never let it keep me from doing a single thing I wanted to do. Well, I have mostly suppressed my terror below consciousness, and it has stopped me doing things, or even knowing what I want to do. Her way is better. I don’t trust my rationality, but having more energy may be worth that cost. Feelings pass.

As a benefits adviser I dealt with a man who cared for his mentally ill sister. She would do things like wander off at 2am without shoes on, and he would try to keep her safe, that is, well-managed. She was getting DLA high care low mobility, the most she could get, but he wrote to the benefits office asking if she could get more. Rather than telling him “No” they sent him a review form, and decided she should get less. He was distressed by this. She was calm, well enough fed, irked by his control as walking off in the night is fairly harmless, really. He was constantly stressed.

We did the tribunal, he was stressed, picking up various bags and papers, shaking, and she whispered to me, “Help him, Mr Maxwell”. So I helped him with his bags, and she was quietly caring for him.

It feels I have a carer, looking after the Inner Child, because I do not trust that spontaneous being. I trust the carer to understand the world, but the carer understands no better, is as insane as it imagines the Child is, and does no better than the Child would. The Carer’s first ambition is to avoid the Child having painful feelings, rather than to keep me safe, and it does not manage that, just anticipating painful feelings and worrying about them, and avoiding action. It falsely imagines that is “keeping me safe”. The Catholic Meditations are on getting rid of the Carer, an emptying of all the contents of the ego-consciousness to become a void in which the light of God or the glory of God, the full radiation of the infinite reality of His Being and Love [or, perhaps, the Child] are manifested. It quotes Matthew 10.39, He who loses his life shall find it.

Before today’s low, I discussed all this with Tina. I could lose my income, yet then was sanguine. All I could do was monitor the situation: no point in worrying. Life is bearable, with the occasional pleasing sensation. It is only not bearable if I imagine that I cannot stand this, there is too much unpleasant emotion. I might think that my current existence, at home most of the time, is not enough. I can get more pleasing sensation by noticing more: if I go into that state of awareness of my surroundings, particularly outside, there is a great deal of beauty and the state itself feels lively and energised.

I don’t know if I want more experience. I judge that I ought to. I find what I want when I see what I do. I do what I do. I feel dissatisfaction. I do not want to put plans into practice, as the Carer anticipates defeat.

I see a need for Advance into Greater Spiritual Maturity, and I am working on that. I am coming to appreciate my own good qualities.

I don’t trust the benefits system. It claims to pay a very low income to people unfit for work, but does not keep that promise. If some people in a wheelchair might not qualify for ESA, its criteria are far too strict. And I think I have identified the Gotcha moment, the moment where I could not have known but she seems, now, to have decided I did not score particular points. I am frightened.

Tina asks, are there any human systems which don’t make promises and fail to live up to them? Well, in 1948 the benefits system was more honest. Now there are deliberate cuts, and intended holes in the safety net. And we never manage perfection, just imagine it- each person differently. What we achieve is good enough.

-What do you hope for?
No idea.
-You might get it then.
That is a good question, and I shall go away and consider it.

I have now been blogging for six years.

Norethisterone IV

My dear friend Richard explained to me that I transitioned because I misunderstand what femininity is. Well, of course I do, but I feel he simplifies it worse. My father, a pansy, found a virago, and they were married for 33 years. Then 18 months after she died he found another, who is now his widow. He was happy.

We had some difficulty on finding the right word. I want to be- dominated? No, no, yuck, the connotations of leather, pvc, whips and chains revolt me. Subordinated, perhaps. Ruled, even. Those words will do. He says this is inauthentic, a cop-out from the existential duty Sartre called all human beings to. Yeah, right- so tell me again why Sartre had a fifty year relationship with a woman who was cleverer than he was.

I said that if I were a woman seeking a man, wanting to be dominated would be unremarkable, and at that he said no, only equality is acceptable within a relationship. Why should my father not be happy? Or I? He insisted, and then said I misunderstood femininity. He accepted it was cultural. Women are strong. I agree equality is a good model for a relationship, yet feel “Wives be subject to your husbands as you are to the Lord” is OK if that fits the people involved- and the other way round, too, for some couples.

What would a gay man know about it anyway, I wondered. Possibly he was projecting, but as we were getting a little heated we agreed to change the subject, and went onto politics.

I have enough norethisterone to have ten nine-day sessions of it, at the dose I had been on. I find that it makes my emotions more intense, so came off it, and the endocrinologist said I should not take it, but I wanted to experiment. At times, more intense emotions could be fun or a learning experience. This is day three.

I arrived a little early, and phoned his house in case he had not left yet. When we had poured the tea, I noticed a tedious chord progression in the background music- I V VI IV repeated, eight semiquavers to each- so unimaginative- and complained about it. “That sounds like Batman”, he said, Nananana nananana… I put my hand up to stop him, embarrassed and peremptory. Ah. Possibly that’s the norethisterone. Its purpose with HRT is to prevent endometriosis, and as I have no uterus, it has no value. My needs and desires have greater immediacy, and then I find myself apologising and explaining.

Sartrean authenticity may be impossible.

Testosterone overdose

Men in the US increasingly take testosterone supplements. This can lead to impulsive decision making. Hypo-gonadism, causing low T levels, can make a man fatigued, and uninterested in sex, which can be cured with T; but men with ordinary T levels are taking T. What is the effect?

Men and women were given the Cognitive Reflection test, which is a series of maths or logic puzzles with an intuitive, wrong answer and a need to think carefully to get the right answer. Eg, a bat and ball cost $1.10, the bat costs $1 more than the ball. How much does the ball cost? Not 10c.

Men and women given a testosterone boost are less likely to analyse carefully. They care less about what other people would think. They are more likely to think they outperform others. In simulated asset trading, they were more likely to overprice assets, and slower to recognise that prices were falling.

I got all that from the NYT, and recall a factlet from something I read some time- after watching a football match, fans of the winning team had increased T levels, and fans of the losing team had decreased T levels.

More impulsive decision making could be worthwhile in a leader. Where are the mammoths we need to hunt? If our best way of working it out is magic with mammoth bones, it’s better to just guess. We need a decision and it almost does not matter what that decision is. Other people will be grateful for leadership.

In the more complex modern world, good decision making takes account of a wide variety of expertise, and a testosterone-inspired random plumping may be sub-optimal. The problem is, only the women notice.

If high-T males rampage through life damaging things, and women trail in their wake, fixing the mess, the man might never realise he had made any false steps. However the research does not prove that high-T is a bad thing, just that a sudden change in hormone levels can discombobulate a person. I knew that already.

The effects of hormones

Taking oestrogen reduces your blood pressure. Or not.

There was a study published in 2015 of 23 trans women and 34 trans men commencing hormone treatment, measuring blood pressure, BMI, lipids and sex hormone levels at the start of treatment and six months after. Trans men continued menstruating throughout the time. The trans women’s blood pressure reduced from 130 to 120.

When a doctor takes my blood pressure I become tense, and they tell me this may give a falsely high result. Trans women beginning treatment are likely to relax. They are on their way, so their stress will reduce. So blood pressure reduces. These people are undergoing such an extreme life change that it is impossible to isolate one possible cause of change of blood pressure. “The study had insufficient power to detect other associations,” the summary says, and I wonder, decades after doctors started giving us hormones, that so little has been done to find what they do to us.

I wanted to read the article Priorities for Transgender Medical and Health Care Research, but it will be published on 1 April.

From 2007, there is an NHS leaflet, addressed to both trans men and women. The aim of hormone therapy is to make you feel more at ease with yourself, both physically and psychologically. That is, the fact of taking hormones, whatever effect they have physically, affirms your transition so makes you feel better. Some people find that they get sufficient relief from taking hormones so that they do not need to change their gender role or have surgery. I had decided to transition: I am transsexual, therefore I will transition to expressing female. A more fluid way of proceeding, trying things out, would have been better. I railroaded myself.

Hormones will affect your appearance, but you need to be realistic (the leaflet says). Fat may be redistributed, hair loss may reduce though probably not significantly reverse, facial hair may be easier to electrolyse, you may grow breasts though that might take years- ten years, in my case. You may have blood clots in brain, heart or veins: a woman I met in Thailand had a stroke a few months later. You should stop smoking, which increases risk: I was told you could not have hormones until you stopped.

If you start to feel better this is a good sign that you are having the right treatment. However, I railroaded myself. I committed to the whole thing. Moving forward on that track made me feel better, because I thought I had the solution, waiting at the end of the track.

You may find erection and orgasm harder to achieve. You may become infertile: it is not known when. You may become less interested in sex. This was a good thing for me, as I was so thoroughly ashamed of it, but I might have found better ways of living with it.

It is unethical and impossible to conduct a study comparing transition with other modes of treatment. People wait for years to see an NHS psychiatrist, and have definite ideas of what treatment we want. From Lili Elbe onwards, doctors have seemed delighted to have a subject they could try things out on, rather than merely wanting to find the best way to help, which might be to do nothing.

“You will need to take hormones for the rest of your life.” I was told I had to, to avoid the risk of osteoporosis.

Study: Effects of Cross-Sex Hormone Treatment on Transgender Women and Men.

Patient leaflet– A guide to hormone therapy for trans people, pdf.

norah-neilson-gray-self-portrait-1918

Gender psychiatrist

I am one person. This is not immediately obvious.

Penny Lenihan, at Charing Cross, is my eighth psychiatrist. I liked her practical manner, and she shook me up, so that I don’t want to go where I am going this weekend. Cos it ain’t competent me that is going, but shit me, shit me who does fuck all and whom I despise. She observed me communicating calmly and well, and me weeping in anger frustration and sadness, and said “You compartmentalize”.

And I think that’s a bad thing, and I should stop, and I don’t even know what she means by it, particularly. One of my thoughts was that this is a good experience, because however unsettled I feel now I might get to better ways of coping. And now I think that I might bring things to consciousness: see what I am doing, see I have choices.

I got a different view of Serra Pitts. Dr Lenihan has some familiarity with my case, because she has been supervising Serra, who was a trainee and is no longer working with the clinic. I was unaware Serra was a trainee. It is “contrary to protocols” that trainees work with patients privately after sessions at the clinic end. Dr Lenihan will see that the new trainees are aware of the protocols, she says drily. And now I see, yes, that is appropriate; and Serra just not turning up for work does not mean Serra having great difficulty but Serra doing something any employer would object to.

We started by discussing what hormones I was on. She saw no reason for me to be on norethisterone, and did not think my emotional issues were anything to do with hormone doses, though she did want me to see the endocrinologist.. This morning I have been entirely miserable about that: so much of what I have done over the last four years to get my head together has been at best useless. So we were off to a bad start: I thought I would be discharged. She asked if I had been offered group therapy. Well, no; I would be willing to attend but needed it sold to me: what might I gain? So the offer of groups appeared rescinded, because I was insufficiently enthusiastic, and I was confused.

Like many group patients, I like to imagine I am better than the people I would meet in the group; and perhaps fear opening up to them.

Serra told me that the clinic is under great pressure to put patients through, and achieve desired outcomes. I should come knowing what I wanted to get out of it.

So because my emotional issues are not particularly related to transsexuality, she will refer me to my local CMHT. Yes, I do know that means Community Mental Health Trust. I know what they will say: “Sorry, we have no funding”. Well, I am not a risk of killing someone, and if I were they could always leave me to the prison system.

So I gave myself permission not to go to the AM clerks’ conference, and considered the possibility that I would be still tearful, there, and actually disrupt it, rather than merely gain nothing and give nothing to it; and decided that the risk was worth it, and that I could get there without undue difficulty, and would just go.

Antoine Caron, The Triumph of Winter

Norethisterone III

How does synthetic progesterone, Norethisterone, affect my mood? I can only find out by varying what I take.

My retired doctor friend said an option would be to take norethisterone all the time. When my levels change, then my moods will. I could cut it out, continue on the current regime of twelve days in every four weeks, or take it all the time. The GP was happy to prescribe norethisterone: it is oestradiol which causes the elevation in risk of deep vein thrombosis and so heart attack, stroke, pulmonary embolism etc. I can do what I like with norethisterone.

The norethisterone I take is licensed as a contraceptive. I did not think my risk of pregnancy was that high, but there you go. It is a dose a third of what I was taking, so I have to take three pills: I heard that contraceptives had far higher doses of hormones than HRT, which is not true of these pills: you have to go into these things in great depth or just do what feels right, and trust. I don’t know that an in depth understanding of current endocrine theory would help me make better decisions. I also see that norethisterone is used to delay bleeds or mitigate heavy periods, which might seem to contradict what I had heard, that it is used in HRT to precipitate a bleed; but different doses may have different effects in different situations.

The first thing I decided to do was take it all the time. I wanted greater control; and I wanted to see what effects altering what I take might have; but I am not sure I want to reduce my emotional lability. When it’s good, it’s really good. My friend said that menopause was a relief, as she got her analytic mind back. During her period, it left.

I want the intensity of feeling, because it feels good, and may help me understand my desires. I find myself swayed by attraction and aversion rather than calm analytic thought, and that feels like me making the decisions.

And on Sunday night I sent off an email. I reacted rather than responding. I did not improve the situation, and may have made it worse. I made a politic decision: rather than saying “I am angry” I wrote “I am distressed”, because that gets more sympathy, even though as I read on facebook “Angry is Sad’s bodyguard” and my choice of word was calculated- analytic enough. The communication I had received was badly expressed, but it was a lot less offensive when it was explained to me than it had seemed. That is, there are risks; however my feeling angry sad or fearful is usually a good thing, and not to be feared.

Rousseau, Jungle at the Equator

Letting off steam

Trouble with hormones. Man cycling on the pavement of Midland Road, which has little vehicular or pedestrian traffic, a wide pavement and low kerb so you can fairly easily move on and off the pavement on a bicycle. Being in an arsey sort of mood, I think to myself “It’s a road vehicle,” and walk so as to force him to the edge of the pavement. He wobbles on the edge, passes me, and shouts abuse: “Slut!” he shouts. “Slut! Slut!” Quotidian human interaction…

Here am I on the green pills, which may or may not cause emotional lability, and my emotional reaction shows in my face and actions. Sometimes I am upset, and I start to cry (Oh God, I think, why can I not get this sentence out? Such frustration!) and sometimes I get angry. There is a rational basis, an explicable factual stimulation behind both responses, the world is not as I want it to be, do you want it to change too, can we make it better? The crying produces “there there” noises and offers of help and sympathy- still frustrated, I think No! Under this I am sensible- and the anger produces an equal and opposite reaction, or sometimes expressions of hurt from others which get sympathy and I am the Bad Person.

It is so frustrating! If only I could choose: calm, rational explanation; turn on the waterworks to elicit, “Oh! How can we help? What can we do?” Anger just at the right moment…

Arse excelled himself. (Quakers do not know whom I mean.) Now, when exactly the same circumstances are about to arise, I think, surely he will not do it again? Fearing that he will, I find anger and irritation rising, and wonder if I will be able to resist the sarky remarks which he just might take as a challenge. I know a soft answer turneth away wrath, and it is oestrogen I am on, and still.

Or, total bore whose topics of conversation with me, when I fail to avoid her, are what a wonderful Ally she is and what right-on opinions she has about LGBT (which I feel is my topic, and I don’t want to talk about it except when I do) and ghastly sympathy about how awful it must be to wear a wig, be unemployed etc. Actually, wearing a wig is like having your own hair: sometimes I love it, sometimes I think Oh God I look like a man! It looks like a wig! I look terrible! To which the appropriate answer- most women understand this- is “You look beautiful. Of course I mean that. I would not say it if I didn’t mean it…”

So I shouted at her, making my aim about which I was really stressed less likely to be achieved, making me less able to contribute to achieving it, and making me the bad person. Yes, I know I upset people. Sometimes I regret that, and sometimes I just regret the results.

Feuerbach, Medea

Norethisterone II

I am on my period. Sort of, anyway…

For some years a trans woman I met put a rubber bladder inside her knickers for five days each month, filled with a red concoction of the consistency of menstrual blood, which would leak out into a sanitary towel. I thought this entirely bizarre, but she wanted to have part of the experience of menstruating. Of course, her period was generally in her control.

I seem to have greater emotional lability when on Norethisterone acetate, twelve days in 28. The moments which most embarrass me over the last three months have taken place on the green pills. But then I started them on Tuesday last week, and have felt good. Planning my trip to Luton from Richmond was a pain: will I find three separate entrances to public transport, in streets I do not know, in five minutes? Will any of them be late so that I have less time? Even on the bus, I was stressed.

I keep thinking of an archetypal human conflict with the woman on the bus. She sat beside me holding the bar in front, so I had to ask her to let me out, twice. When I got off she caught my eye, standing in the street- she got off, she had time, I had no need to get up so quickly. Or, I have a right to get up early if it makes me feel better. Each irritated the other, and she caught my eye and pulled a face at me. Of such minor triumphs good morale is made.

Meeting a friend. She texted, don’t be angry that I am late. Oh, Darling, I thought, I expected you to be late, I am quite mellow. The food was poor: edible but dry and boring, in small quantities. Now, I have a letter about my last meeting with Stuart Lorimer of Charing Cross GIC, and I am not reading it. I glance at it, read a sentence, get worked up about what it says, leave it. Perhaps I will sit down with it, it says nothing I do not know, though the differences between his understanding and mine irk me.

Flirting with the woman at the station ticket office. I have noticed her, either butch lesbian or possibly a woman who likes to “wear the trousers” with sissy men; and on Friday she said “That’s £9.60, Honey”. Ooh. Yesterday she admired my necklace, so I took off a matching earring to show her.

With that friend, I got to the theatre just before the lights went down: not bad seats, actually, and quite on time.

So I do need to manage stress, or I could be a stress monster. But the risk of shouting at someone might be worth it, if I could enjoy the heightened sensibility the rest of the time.

Ingres, Venus Diomede

Norethisterone

Should I be taking norethisterone? It is synthetic progesterone, and (if the difference between the green pills and the white pills means what I think it means) I take it twelve days in every 28. Why should a trans woman take hormones, anyway? What good do they do?

My friend is a retired doctor, as is her husband. I wanted to discuss my emotional lability, and the possibility of a hormonal effect on that, with a friend before the psychiatrist in November. She thought her husband would be more up to date on endocrinology. I thought, oh, do I have to? Telling a friend is one thing, telling yet another person that I have never met-

I cycled by country roads, luckily picking the right private farm road, and entered their beautiful house. The garden is glorious. I meet this man, and really do not want to. We shake hands. Over lunch I admire the art work- this 4′ high fish is welded together of bicycle parts- and having sensed my discomfort she suggests he go out of the room, she could consult him if she really needs to: yet such was his gentle charm that now I would like him present.

The whole problem is life passing me by (does everyone think that, or only most of the people most of the time?) while I sit at home with little motivation and no felt ability to earn money to support myself. And I feel so lonely yet want to hide away. But the smaller problem, which might be addressed by hormone adjustment, is my emotional lability. I would like to discuss this with you without bursting into tears. I would like to discuss Quaker problems with an overseer without crying or getting angry.

He says, there is not always a medical solution, and one of the GP’s roles is to protect patients from specialists. An endocrinologist will seek a hormonal solution, a psychiatrist a psychiatric one. Mmm, sometimes leave well alone is the best answer. I started the norethisterone after the endocrinologist saw blood results, and after the psychiatrist suggested testosterone for motivation.

Godward, an Offering to VenusHe says, the point of norethisterone in HRT is that oestradiol alone risks cancer of the lining of the womb, and norethisterone clears it out reducing that risk. So there should be no need in me. Now, I wonder, what of motivation, did the specialist know something he did not? Or not? One of his patients on norethisterone had been quite unreasonable emotionally- he happened to see it, she admitted it- and on this sample size of one he was wary of it. Though proper peer reviewed studies may be no more reliable.

There you go. One possible thing worth trying. Not an answer, even though hormones affect mood: premenstrual syndrome is not merely a male chauvinist myth, and I feel, well, premenstrual. I could try and see if I felt more labile when taking the green pills.

We discussed my wider issues. On defences, he noticed that when I seemed to be coming to an important point, I would digress into a long story.

I feel valued. I feel cared for. It was lovely, talking of my stuff to sympathetic hearers for two hours.

 

Oestradiol

Why should I be taking hormones? Dr Lorimer’s answer was, to prevent osteoporosis. Now, I have no wish to have a break as easily as I now have a bruise, but don’t think that is a huge risk. What Dr Lorimer said makes no sense to me, and is inconsistent with what he said before: I said I was lacking in energy, and he proposed testosterone. I said I would agree, if it would get me more motivated. His endocrinologist colleague proposed instead norethisterone, synthetic progesterone. It is indicated for heavy periods, not something I have suffered from.

Yet it could be that the only reason to take oestradiol indicated by studies sufficient to back licensing a preparation, is to avoid osteoporosis.

Oestrogen is so important to the culture. The name comes from Eastre, Germanic Goddess of Spring and fertility, from which we get the word Easter. The suffix is from the Greek for Begetter. Women have strong feelings about HRT, not all related to peer-reviewed double blind large-scale studies, and doctors’ recommendations for it seem to change by fashion as much as rational prognosis.

I could, I suppose, find out about the differences between oestradiol and oestrogen, norethisterone and progesterone; normal levels in pre- and post-menopausal women; and documented effects on such things as felt energy levels, emotional lability, and motivation. The problem is that I don’t believe finding these things out will give me any more control over those things.

I don’t know whether they affect the softness of my skin or levels of facial or body hair. I have grown breasts because I take hormones, but I don’t think they are growing now.

I like to think I would like a rational reason for taking, or ceasing to take, my pills. In cis women, they increase the risk of breast cancer and stroke. Yet I don’t look for one, perhaps because I do not believe it. It felt like I became hugely labile when I came off them suddenly, but I was stressed at the time and going back on did not seem to change things. I can’t be certain of anything.

So I keep taking the tablets. Perhaps they are a symbol of my femaleness, a link to womanhood. I feel my feminine character is more important. I like to think I don’t need a symbol.

Ostara, Johannes Gehrts