A common question which many trans women ask, is what their estrogen levels should ideally be. They have often asked for a higher dose from their prescribing doctor, and been told no, there are too many risks, and that their current level is within the normal ranges. The maximum pmol/L cited by doctors is often 200 or 250. However, this is against best practise.
If an adult is on a dose resulting in a lower pmol/L than the above, they should be given a higher dose if desired, unless there are sound medical reasons to keep their dose lower.
A sound medical reason may include hormone sensitive cancers or other medical conditions that are not well controlled. If liver and kidney concerns are the reason, these can be minimised by switching from oral estrogen to patches, gel, or cream, as these bypass the liver and kidneys. It is also possible for your prescribing doctor to advocate for estrogen implants (such as those available in Australia) to be made available in NZ through Pharmac.
If a patient is being told no repeatedly without what they consider to be a legitimate medical reason, they have the right ask in writing:
“I am not seeing results and would like to increase my estrogen dose. Please tell me if this is possible, and if not; what is the medical reason?”
They may also wish to add that the national guidelines recommend up to 500 pmol/L, and the endocrinology society guidelines recommend between 367.09 and 734.19 pmol/L.
If there are sound medical reasons for keeping the patients dose lower, the clinician then has the opportunity to write these down in a way that the patient can understand. It also gives them the opportunity to make sure they understand the risks and best practise, before writing it down, to ensure they won’t be found to be wrong later.
GMA would like to acknowledge the enormous amount of work being done by trans people, advocates, and healthcare workers to bring gender affirming healthcare in Aotearoa up to standard. We also wish to acknowledge that there is still bias, negligence, and malpractice from some healthcare providers, and that this can have a devastating impact on their patients’ lives. If you are a trans person struggling to navigate the healthcare system, please get in touch with us as we may be able to assist you in finding out what your options are.
The Office of Ethnic Communities in Auckland wants to reach out to trans and rainbow people, and is holding a hui tomorrow (Thursday 4th Feb 2021). Below is an invitation from them.
Tēnā koe, नमस्ते, Ni Sa Bula Vinaka, こんにちは, 你好, As-Salam-u-Alaikum, Ram Ram. The Office of Ethnic Communities (OEC) invites you to attend our Community Connection Hui for Rainbow and Ethnic Communities.
This is an opportunity for OEC to build our relationship with people in the queer and ethnic community and introduce the work that we do. OEC currently does not have a significant connection with queer ethnic communities, and we want to change that. We will also take this opportunity to introduce the Ethnic Community Development Fund, a 4.2 million dollar fund available for our mandated communities.
Event details are as follows: Community Connection Hui for Rainbow and Ethnic Communities Thursday 4 February 2021 Studio One – Toi Tū, 1 Ponsonby Road, Grey Lynn, Auckland 1011 7:00 pm – 8.30 pm RSVP – Please let us know if you are able to attend by contacting firstname.lastname@example.org by Tuesday 2 February 2021. (they sent it to us today so there’s still time for late RSVP we imagine) Refreshments will be provided.
We hope you are able to attend and we look forward to seeing you there. Please note, RSVP is essential due to number restrictions at the venue. The location is accessible by public transport. Alternatively, street parking may be available in the vicinity, and a few paid parking buildings are located at a few minutes’ walk.
Do you have time to help improve how data is collected about our communities?
Stats NZ is looking for trans (including non-binary) and intersex people to help test possible sex and gender questions that could be used in surveys. It will take about an hour, either in person (in Wellington or Christchurch) or online / via video. You need to be 15 or older and available this month (February 2021). Stats NZ are offering a supermarket or petrol voucher for your time.
There is also a very short online form to get extra feedback about a transgender status question. That online form is open until 19 February.
Information from Stats NZ about helping to test the sex and gender questions (1):
What we are looking to do?
Stats NZ are testing a range of sex and gender questions as per the consultation paper to help determine the guidance we give for collection of these concepts in a range of different surveys of people and the households they live in.
We aim to include both online and paper-based survey forms. Note that you need to be at least 15 years old to participate.
What is involved?
Our testing involves completing a draft form, in the presence of an interviewer (in person or video call) who will ask for your feedback on the parts we’re looking to improve e.g. wording. We’re also checking that the design and layout enables people to work through the survey easily from start to finish.
When and where?
Testing will be taking place in over the month of February, with Christchurch and Wellington office based tests. There will also be online/video options.
As a thank you, we will you give a supermarket voucher or MTA (petrol) voucher for your time and effort.
Information from Stats NZ about the online form (2):
To complement the cognitive testing process, we have developed an online form to get additional targeted feedback from transgender and nonbinary New Zealanders on wording variations for a transgender status question and guide notes to support the standard. This will be live till 19th Feb. This may be a more accessible way for people to engage if they do not have capacity to be involved in the cognitive test process. It may also allow us to get further insight from minority groups that may not have been feasible with general participant recruitment.
The feedback form is not for the purpose of re-consulting on the proposed changes to the existing standards, but rather a means to refine the question formats and guidance that will be included for a question on transgender status specifically.
Our last drop in day for 2020 is Thursday December 17th (10.30am to 5.30pm). We will have limited office hours for the rest of the year. Our first drop in for 2021 is Wednesday January 13th, and after that we’re back to normal – office hours 10am to 6pm weekdays, with drop in times 10.30am to 5.30pm every Wednesday and Thursday.
Aunty Dana’s Op Shop
Aunty Dana’s Op Shop will be closed on December 24th and 25th, then again on December 31st and January 1st. Otherwise normal hours 10am – 6pm weekdays and Saturdays, 10am to 2pm Sundays. Aunty Dana’s is accepting donations of good quality homewares and nic-nacs but no clothing at the moment.
Showing at Penthouse Cinema 22 Nov 2020, the film ”Ambisexuality: Seeing More Colour in the Rainbow” was advertised to include a panel discussion by GMA National Coordinator Ahi Wi-Hongi, Dame Catherine Healy DNZM, Georgina Beyer MNZM, and director James Watson.
Gender Minorities Aotearoa explains it’s position on the concepts the film discusses, and why Ahi did not speak at this event.
Content Warning: Film trailer contains transmisogynist slurs. Article discusses genitalia using medical terminology.
”There are more colours to the rainbow than you might realise. While awareness, acceptance and inclusion around sexual orientation has been increasing, there is one expression that is virtually unknown: ambisexuality. To fill this gap in the spectrum, director James Watson spent more than 20 years undertaking doctoral studies and writing a book which focuses on the men who love and admire non-operative trans women. – Film Advertising
As you may have guessed, the topic is cis men who are attracted to trans women, but specifically only if the trans woman is ”non-op”, meaning that she has a penis. According to the write up:
”Ambisexual people have not been recognised by the LGBT or straight communities and they experience extreme prejudice and marginalisation.
It’s ok to stop and take a breath.
We recognise that it is in fact trans women who this prejudice is being directed toward, and that men who will only have sexual relationships with trans women in secret, are – at the very least – complicit in this prejudicial treatment.
There is no shame in being a coward. But it does have it’s price. Those who want to have a very specific sexual experience with a trans woman in secret will often have to visit a sex worker and pay for her services.
Broadly speaking, most men and almost all clients of sex workers who are attracted to trans women identify as heterosexual, though some may identify as bisexual, pansexual, or transamorous, etc. When men are predominantly attracted to trans women only on the condition that the trans woman has a penis, they are generally referred to as a ”chaser”. Our Trans 101 Glossary defines a chaser as:
”A person who sees trans people (usually trans women) as inherently sexual, and sexually objectifies them. As opposed to someone who simply is predominantly attracted to trans women; a chaser does not view trans women respectfully as whole people with humanity and agency, but rather as players in a sexual fantasy.”
We are not opposed to the existence of chasers, as trans sex workers need clients and chasers are their bread and butter. However trans women are not interested in being valued only for their penis outside of a work relationship. Even within work relationships, many trans women prefer clients who don’t fetishise their penis excessively.
As ”recreational” relationship partners, chasers are more likely to only value trans women for the sex acts they can do with their penis, to keep the relationship a secret, and to be abusive partners in other ways.
The effect of promoting chasers as having a legitimate sexual orientation is that it supports the thinking behind common coercive relationship practices. Examples include when partners of trans women pressure them to not-have genital reconstruction surgeries (GRS), or pressure them to use their penis to have sex in ways that they do not want to.
Written by the director, the book “Ambisexuality: The Anatomy of Transerotic Desire” coins the concept of the ‘Elective vs Extant’ typology, which was defined as choosing to “appropriate some female sex and gender attributes but not others” vs “complete their transformation”. One of the reasons we find this extremely offensive are that this ‘choosing’ is framed as ‘choosing to stay masculine’, which we reject.
There are many issues around access to healthcare, including the enormous cost of surgeries which are severely under-funded and difficult to access. Most trans women can’t think about planning GRS as their healthcare is uniquely undervalued in NZ society. Trans women’s experiences include a huge diversity of embodiments, given the massive range of procedures and practices that exist. Thus, there is no meaningful divide between trans women who have or have not taken steps toward different surgeries or medical treatments.
Beyond issues of access and diversity, we reject that a woman’s penis is masculine – if a woman is ‘feminine’ and has a penis, then her penis is part of her feminine self. We support that women should not have to change their bodies to be considered feminine, complete, or “extant.”
We had (and have) a genuine interest in seeing the film and discussing the nuances and differing perspectives on a seldom-made-public topic. We offered the above feedback to the director, and let him know that Ahi is not a trans woman so another member of GMA staff would speak instead. We also had a request:
“Many trans people and our supporters may attend if we publicise the event, but they will likely also bring criticisms about legitimising chasers via the term ‘ambisexual’, and potentially also bring lifetimes of trauma about sexual partners and wider society obsessing over their genitals. In light of this, we would like to see a copy of the book or e-book, and a copy of the film beforehand, so our promo can be accurate and include a nuanced content warning.
Unfortunately, as we were invited a little over a week before the event and provided our feedback and request just 4 days prior, the director was unable to provide us with a copy of the film, book, or e-book.
We would love to hear your thoughts, and are hoping to hold a community workshop on sex and sexuality for trans people at the upcoming Wellington PRIDE Festival 2021.