Queer Doc (they/themme): All right, everyone. Welcome back to part two of the queercini. Dosing deep dive podcast with my guest Dr. Upton. And we're just gonna jump right in since we introduced ourselves last episode, if you don't know who we are, Listen to the previous episode. And so we're on our third case, Dr. Upton. In this case, is a 42 year old singer who wants facial hair, bigger, muscles less complex emotional experience, less easily tearful bottom growth, worried about voice and first to wear of gender diversity at age, 10 found language for
Queer Doc (they/themme): Each 35 socially transitioned at age. 36 uses hemp pronouns past medical history, significant for type 1, diabetes and endometriosis currently medications include insulin and an ACE inhibitor. No known drug allergies pass surgical history, positive for a bilateral, top and goal forrectomy with hysterectomy, but does still have ovaries no cervix. A family history positive for type 1, diabetes. Guy in history, had menarca age 12, and monthly menses until the hysterectomy tonight is tobacco, nicotine alcohol and all substances. Okay, what stood out for you? In this case Doctor up
Steph Upton (they/them): Okie dokie. so I have to be honest here and say that when I look at Singer, my heart drops a little bit.
Steph Upton (they/them): What's that? Yeah, yeah,…
Queer Doc (they/themme): I said There's some panic.
Steph Upton (they/them): I get kind of worried. so that's the major thing that sticks out to me. Let's see other things, I would say would be the diabetes.
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Steph Upton (they/them): I mean really those are the things that are sticking out to me. What about you?
Queer Doc (they/themme): Yeah, definitely. I think the Balancing, the goals of facial hair, bigger, muscles less complex, emotional experiences. And bottom growth against.
Queer Doc (they/themme): This. C2 scene, access to vocal range. All the things in the Type 1 diabetes. And I feel like the type one diabetes is actually the easier thing to go over here for our listeners. So I might start with that one, which is just that, blood sugar control can be affected by hormonal status. And so we sometimes see people Needing less insulin or having lower blood sugars. Overall when we start or increase testosterone and kind of the opposite, when we have estrogen therapy started. And so the take-home point being, I advise anyone who has diabetes particularly who's using insulin and monitoring blood sugars regularly to pay extra close attention to their blood sugar status in their insulin needs.
Queer Doc (they/themme): When we're starting or adjusting hormonal doses. And I want to make sure that something right that they know how to do. And so for someone who's been living with type one diabetes for the song they're probably gonna be able to do this, pretty comfortably on their own. They don't necessarily, need to hold hands with their endocrinologist. But if this is someone who has a newer diagnosis of diabetes, or who's diabetes is actually just really challenging to Doing warm care, coordination and hands-offs, and touching base with the endocrinologist or primary care provider, who's managing the diabetes and insulin management. Does that kind of your thoughts about the diabetes as well?
Steph Upton (they/them): Yeah.
Steph Upton (they/them): Yeah.
Queer Doc (they/themme): And I would say maybe the other thing that maybe we didn't put in any of these cases, but the reason I look at gynecological history as far as Menarch and whether or not men's thesis happened monthly is I'm actually searching for concern for a DSD or, for instance, sex development general hyperplasia. And it's mild. Presentation is actually often miss diagnosed as PCOS, and we actually know that we have higher incidents of PCOS and probably and gender diverse folks. And so, if there was kind of any just irregularity and menstrual patterns,
Queer Doc (they/themme): Monarch I might think about getting baseline 17 hydroxy, progesterone and a patient like that looking for that chiagnosis and not pertinent to those case. But that's why I look at those and why I included them in case history, so, What,…
Steph Upton (they/them): Good point. Good point.
Queer Doc (they/themme): how do you approach? Singer?
Steph Upton (they/them): Yeah, so again, this is one of those. I feel like what was it the first case that we had where the person was concerned about bottom growth, but anytime that I have a potentially permanent Affect that someone is particularly concerned about, then I'm particularly concerned as well.
Steph Upton (they/them): Also one that can happen with very small doses of tea and very early on. So That's just baseline. and then they So are they a professional singer?
Steph Upton (they/them): Singer for fun, whatever. But they describe themselves as a singer and so it's important. Do there like core identity,…
Queer Doc (they/themme): Right.
Steph Upton (they/them): I'm guessing so
Steph Upton (they/them): talking just a lot about How tea can affect vocal range, pitch control, all of that, kind of stuff, and exploring, their feelings about that. I think would be vital in terms of dosing.
Queer Doc (they/themme): Okay.
Steph Upton (they/them): Just probably again generally the low and Very cautious and Stop or pause if you want to approach. I do think it's kind of Maybe ironic that, they desire less complex emotions and to be less easily, careful. and we're about to do something that good accomplish that. But then, if their voice changes then they're going to have lots of complex, emotions and possibly be careful.
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Steph Upton (they/them): Thinking about giving them early on. Resources.
Steph Upton (they/them): To work for their voice. Assuming they're not already plugged in with that professionally, but looking at some Trans Specific Training There. I think I would want them or maybe encourage them to get plugged in earlier rather than later.
Steph Upton (they/them): Renee Jackson springs to mind. Because I know they focus on singing quite a bit.
Queer Doc (they/themme): Yeah, there are a singer by training, right? And yeah I think.
Steph Upton (they/them): Mm-hmm
Queer Doc (they/themme): We spoke in the last episode. The first part of this about non-hormonal approaches, which is always something. To counsel around, right and for this person, maybe considering topical stuff for facial hair or micromedeling. which is kind of like microblading for eyebrows, but, it's more pinpoint for facial hair and exercise working with trainers for muscle growth and the emotional stuff is harder to affect bottom growth.
Queer Doc (they/themme): Transdermal, or quote unquote. Topical patients will call it. Topical testosterone for bottom growth. It's not topical. It's totally absorbed systemically and so it can still affect voice. but potentially, you could use lower doses because the testosterone is more concentrated at play of application. But there's still a risk to voice.
Steph Upton (they/them): Yeah.
Queer Doc (they/themme): But me, and we don't know if that risk is any less than with any other form of testosterone since they are all so much systemic, but it's something to consider.
Queer Doc (they/themme): And we kind of said we weren't gonna dive deep on those after that first case but just to review them for anyone who didn't listen to the first episode. Yes. Yes.
Steph Upton (they/them): Okay.
Queer Doc (they/themme): But I think the big thing for me when I work with a singer is really, I think you called it out. So it's part of this person's identity and it's like Which identity is more important to you, Is it singing or Is it your transness? And it's not that simple, right? It's not a black or white. This one's more important or this one isn't. But really exploring with the patient. How much have they explored that?
Queer Doc (they/themme): And how long have they been thinking about this? What research have they already done? What do they already know about testosterone and its effects on voice? What kind of support have they thought out around this? Because I'm seeing and I know you do this already in your practice, but I put on the spot and a podcast, right? I don't want to be explaining things to them that they already know. Right. And also So finding out…
Steph Upton (they/them): Yeah.
Queer Doc (they/themme): how much they already know helps me Taylor my counseling and education to them. It also gives me a sense as a clinician This is a person who has been thinking about this for years, right in the decision,…
Steph Upton (they/them): Yeah.
Queer Doc (they/themme): to take testosterone, has come over years of considering this and thinking about this, and really putting a lot of time and energy into this decision. Versus this is a person who has never even thought about how testosterone might affect their voice, in which case, those two things would really change my approach, probably right and
Steph Upton (they/them): Yeah.
Queer Doc (they/themme): so, I think that really helps guide both my counseling and my approach. And I think when I'm working with singers, I would love to hear Do you have kind of your script that you use, when you're talking this through with a singer about testosterone effects on voice?
Steph Upton (they/them): I would say I don't have a script. I'm trying to think What are the things that I usually do? What are the components that are usually involved? I would say, Probably honestly this one I have to be a little bit careful about because I have some personal emotional responses that are, very present in this conversation. So I have to be a little bit careful about that. I'm not going to say over exaggerate but strongly emphasize the possibility for, just total desolation. Of your ability to sing the way you want to sing.
Steph Upton (they/them): Or it just a complete change, So it's a big deal. So I think I am. That's probably. the thing that is most commonly part of this conversation for me and…
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Queer Doc (they/themme): Yeah. Yeah,…
Steph Upton (they/them): exploring how they feel about that,
Queer Doc (they/themme): I think my script really starts off with We don't have as much information as we would like that right? we have very limited literature research and evidence on testosterone effects on singers and really what we have are kind of like individual case studies, an individual biographies and experiences and for some singers, no one maintains their range.
Queer Doc (they/themme): You will lose your upper range, There is one deep dive case, study of a singer who reaccessed pretty close to their range but with different vocal techniques, right? So they're going into a fault set of voice versus they had that as …
Steph Upton (they/them): but,
Queer Doc (they/themme): I think they call it head voice. Maybe I can't remember, I'm not let me be very clear. I am not a technically trained singer and all I know about singing comes from working with trans singers and…
Steph Upton (they/them): I can attest to this.
Queer Doc (they/themme): trying to help support them. and
Queer Doc (they/themme): Dr. Evans made me do karaoke and
Steph Upton (they/them): what was that podcast at that singer did or What was it a podcast or was what I'm talking about? There was a person who transitioned and they were professional singer and then they lost their voice for a while and they were some show.
Queer Doc (they/themme): I have some resources, I'll share And for the resources, I always like package out to my singing patience.
Steph Upton (they/them): Yeah.
Queer Doc (they/themme): And so there is two short.
Queer Doc (they/themme): Doctor by biopic documentary type things on YouTube.
Steph Upton (they/them): Yeah.
Queer Doc (they/themme): They're under 10 minutes, two different trans singers, who take testosterone, there's a website called Key of Tea Trans Singer. where he's just accumulated everything he can find about Transvoices and singing. And it's also his personal journey and story as a singer, and there's a four-part series from the Berlin Opera. That's like a master class for trans singers. It's all up on YouTube for free. The videos on YouTube or I think one to two hours each and so those are all resources. I share there is a short video on YouTube of a singer pre and post testosterone where they sing and duet with themselves. So, they recorded themselves prior to testosterone and after
Steph Upton (they/them): That's the one that's when I was. Yeah, yeah.
Queer Doc (they/themme): One of those short. Documentaries on YouTube that's under 10 minutes. Is a singer. who wrote and saying a song, I think it might be called my voice or something like this. That they wrote it and saying it and release it right before they started testosterone. And that's a song that they could only sing. for that couple of months and then very soon after they started testosterone, they can no longer seeing that song and they find a voice and a sound that fits for them and they still are singer and songwriter, but right, they can't Access the range that they needed for that song anymore.
Queer Doc (they/themme): And there's also Renee Oxen Yes, is a vocal transition coach, who has an online program and specifically Renee's training and background of local transition work is through singing and There is also a short article from another singer about his experience and famously There's a singer from the Philippines, who was featured in Glee, who transitioned and quit singing.
Queer Doc (they/themme): As well and had, I think Oprah called that person, like a voice of a generation, like that kind of thing.
Steph Upton (they/them): Yeah. Yeah.
Queer Doc (they/themme): And so there's definitely all these individual stories and the individual stories. And this is where I centered this conversation for my patients, right? I say we don't have the research, we don't have the literature, we have these individual stories. Some singers. With a lot of work in, a lot of training, are able to access a voice. And continue to sing. your range changes? And you have to understand that.
Queer Doc (they/themme): The voice that you have been singing with is that instrument? You have been practicing for however many years. You've been practicing this person's 482.
Steph Upton (they/them): Yeah.
Queer Doc (they/themme): Let's say they started singing. When they were 10. That's 32 years of practice and you suddenly have a new instrument that you have not practiced with at all. And so right, you have to put 32 years back into that and right and all those skills and techniques you learned in those 32 years will serve you. So it's not as great challenging…
Steph Upton (they/them): Yeah.
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Queer Doc (they/themme): but it's still a whole new instrument and so some singers. put I don't know when something lose their voice. And how much of it, they lose their voice because the testosterone has changed it in a way that they cannot access.
Queer Doc (they/themme): Singing because one of the accounts I read of someone really lost their power, obviously your range changes and They were still able to sing in tune and find notes but they can no longer project. They just really lost the power of their way and that they could never regain. right. So there are some things that maybe testosterone effect that no matter your training you can't regain. And then I think there are some people That. The loss is too painful to actually try the training, right? And so I don't know…
Steph Upton (they/them): Right.
Queer Doc (they/themme): If they could find a voice that they could sing in, if that loss wasn't painful, So you don't know. For some people who lose their voice is it's totally lost because the testosterone therapy or is it lost because the emotional experience is too traumatic and
Steph Upton (they/them): Or both. Yeah.
Queer Doc (they/themme): both yeah right and so I present it kind of in that context or my patients that some people that no matter what your range will change that some patients are able to continue to sing and professionally or someone professionally and in a capacity that works for them and that some patients do totally lose their capacity to sing. And that.
Steph Upton (they/them): Yeah.
Queer Doc (they/themme): Yeah, like you were saying Voice change is permanent and is ed interestingly enough, my patients who aren't vocally trained. A lot of times will not notice changes in their voice for three to six months.
Steph Upton (they/them): I was gonna say if I was going to put out a salient point to people who maybe don't do this all the time it is that this can happen early and one dose it can happen at low doses. So don't do not reassure people. there will be time for you to figure this out later on. No you need to be paying attention from the get-go.
Queer Doc (they/themme): And that's what I tell my vocally train patients. I say People who aren't vocally Average voice users will notice vocal change within about three to six months. My vocally trained patients.
Steph Upton (they/them): Yeah.
Queer Doc (they/themme): Will oftentimes notice vocal instability after the first dose of testosterone so it's not necessarily vocal change or their loss of range but they suddenly have less control of this finely tuned instrument and…
Steph Upton (they/them): Yeah.
Queer Doc (they/themme): so I like to make it clear that that can happen with one dose because I've had it happen more than once for our patient in that way.
Steph Upton (they/them): Yep.
Queer Doc (they/themme): And I completely agree with you if the person has thought this through and this is like
Queer Doc (they/themme): The choice that they feel is the right choice for them, really supporting them with all those resources, I just went over, I share all of those. I'm asking them, if they have a vocal coach, who has worked with transitioning voices before. What if, do they want to maintain their singing voice? Step one.
Steph Upton (they/them): Right. Right. Yeah.
Queer Doc (they/themme): And if they do, then plugging them. And with all these resources and asking them, if they have a vocal coach, who's worked with Transvoices, if not trying to connect them with one who has
Queer Doc (they/themme): Yeah, I think is really important. And then yeah, connecting them with other people who have transitioned their voice, because we're going back to our personal biases, right? And you have some personalities around this one.
Steph Upton (they/them): Right.
Queer Doc (they/themme): I have such a huge personal bias towards peer support groups, So I'm always trying to connect people with people with shared experiences because I think can be powerful,…
Steph Upton (they/them): Yeah. Yeah.
Queer Doc (they/themme): but that is a personal advice and not everyone.
Steph Upton (they/them): Just throwing this out there as well. I don't know if you had touched on this one but I believe trans vocal training, transvocaltraining.com. I feel like it's another Coaching resource that is available for folks. ging for trans singers specifically.
Queer Doc (they/themme): Yeah, and
Queer Doc (they/themme): I don't know if we have that one On our list of resources, and that list of resources. And that I just mentioned is in one of my queer. See me blogs. So, if you ever need that, I tend to use our blogs both at See me and queer Doc as a repository for all the things I have said, more than once to a patient. So I have built them just to be like my patient handouts. yeah, I don't think we were supposed to transferable training. I'll check them out. I do think I'm Maybe Seattle, voice lab as well, which is a
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Queer Doc (they/themme): They do trans voice support. I think they also have some singers there as well.
Steph Upton (they/them): do, they
Queer Doc (they/themme): Don't quote me on that, but I feel like I remember one of the coaches there. It has a singing background,
Queer Doc (they/themme): Right. Yeah.,
Steph Upton (they/them): I guess another thing that came up for me with this case that actually just came up while we were talking is, I'm now thinking maybe I should develop a script for this was intentionally because I feel some emotions when it comes up. Just so yeah, I think that I'm gonna put that on my to do list.
Queer Doc (they/themme): Yeah. Yeah, I think that's great. I'll just point that out to our audience. and I teach a lecture called The Therapy of Gender Ferment Care. The term meta therapy actually comes out of the speech language pathology field and it's a term that trace to encompass the specific phrasing and experience clinician uses to effectively and efficiently move through a clinical encounter and right and so I think Dr. E for Dr. Upton and I refer to that, as What's your script like What? Right. And we all experience clinicians. Develop these
Queer Doc (they/themme): I think about the first script I ever developed was doing the one I used doing pelvic exams, right? Right.
Steph Upton (they/them): Yeah.
Queer Doc (they/themme): The next thing you'll notice is my gloved hand and on the inside of your knee. The next thing you'll notice, Just the thing, I said, every time I did a pelvic exam as long as a patient wanted me to narrate, it was the same. and so,
Queer Doc (they/themme): We can use that same scripting in the actual history gathering and Dr. Upton's calling out that when we have personal bias or personal trauma and having a script that we rely on to help us, Maybe not push that comma and bias on to our patient, can be a really useful, skill and tool develop.
Steph Upton (they/them): Yeah.
Queer Doc (they/themme): And so I think that's Awesome. That you're At sharing the things you do to try to be a better clinician publicly and vulnerably and Nathan Morgan at Seattle, Voice Lab and has warmed on Broadway. Yeah and…
Steph Upton (they/them): yes.
Queer Doc (they/themme): so has a degree from the Manhattan School of Music and so Yeah, there's definitely some vocalists over at Seattle Voice Lab.
Queer Doc (they/themme): Yes.
Steph Upton (they/them): Stand up special out. We have to watch it. Just personal note, sorry.
Queer Doc (they/themme): Personal note to be, we derail this podcast to tell you about one of our favorite drag queens. And if you don't know who Jinx Monsoon is of Rupaul, fame, and Jinx is her dragon And Broadway theme.
Steph Upton (they/them): And Broadway, fame.
Queer Doc (they/themme): Out of Jinx out of drag uses They/them pronounced and identifies his non-binary trained at Cornish College in Seattle in And 11 years ago when I moved to Seattle, I saw Jinx perform.
Queer Doc (they/themme): Bohemian Rhapsody live upside down doing that headstand in a audience. Member's lap at a drag show immediately and in love and have followed their career for years and Dr. Upton. I saw them on Broadway. so yeah. If you like someone who is, Phenomenally talented artists and does some amazing advocacy and activism and work. Some of that and obviously into their highly recommend. okay, and so we've got some resources for trans singers. I think the most important thing is while we want to be really transparent about what we know and don't know about testosterone and voice and the potential effects and changes is that ultimately
Queer Doc (they/themme): Our patient is expert in their own body and their own experience and honoring their autonomy to make that decision. And Once they have the information, they need to have it beaten informed decision. And I think that's the big thing for me is that
Queer Doc (they/themme): removing paternalism from medicine is generally, where I think the field is trying to go as a whole, but I think this is one of those places where sometimes we can get tripped up as clinicians and be like, I don't know maybe I shouldn't prescribe this for you…
00:30:00
Steph Upton (they/them): Yeah. Yeah.
Queer Doc (they/themme): because maybe you're gonna be upset with me later when you lose your voice and just really recognizing that. This is their voice and their body and they get to make those decisions. It's our job to give them the information to make an informed decision.
Steph Upton (they/them): I also throw out there. We have been talking a lot about the risks of key, but, one of the benefits is that they are gaining a new voice, So there are wonderful things to be had there.
Steph Upton (they/them): So yeah, I just want to call that out.
Queer Doc (they/themme): yeah, and all of the accounts I have read of trans singers, who take testosterone after voice change and
Queer Doc (they/themme): Some of them have Severely grieved, the loss of their voice. in that grief is real and palpable, but they haven't regretted their decision to take testosterone. That doesn't mean that someday someone won't have that experience.
Steph Upton (they/them): Yeah.
Queer Doc (they/themme): Someone probably will and someone probably has. But the accounts that I found published online and journals, Really.
Queer Doc (they/themme): People don't regret the decision to take testosterone, even if they've lost their voice and are creeping that loss. and then, yeah, a lot of those resources, I share with the YouTube videos and shorts and stuff, like that are singers, who cut the voice that they can sing in and they found a new sound that Is true to who they are and celebrate that and love that. So,
Queer Doc (they/themme): all right, next case.
Steph Upton (they/them): One other thing strain of mind. Sorry, the believer oiment. But, assuming this person was a professional singer and their livelihood was dependent on this. And they were like, Absolutely I'm taking tea, I want my voice to drop. I know it's going to affect my team. Blah blah. I'm plugged in with support Would you consider maybe going? Faster, to try to get things to just stabilize quicker so that this person get back to work.
Queer Doc (they/themme): Maybe. That's a really great question. the only published accounts I have of singers working with their voice and vocal transition are Low and flow. Coaches and…
Steph Upton (they/them): Yeah, same same.
Queer Doc (they/themme): so I would offer them that context, I guess.
Steph Upton (they/them): Yeah.
Queer Doc (they/themme): and I think, More importantly,…
Steph Upton (they/them): Yeah.
Queer Doc (they/themme): be like, how do you plan to support yourself? while your voice is in a place of retraining, how do you plan to support yourself? If you can't get your voice back to a place where you can earn a living off of it, Yeah, most of the singers, I have worked with our
Queer Doc (they/themme): It's not how they earn their living per se, or they earn their living through music education. And so, they're actually not going to lose the ability to do that work. So most of the singers, I've worked with, they do, make some money from it, but it's not their primary source of income. So
Queer Doc (they/themme): Yeah. Yeah.
Steph Upton (they/them): Something to think about.
Queer Doc (they/themme): okay, and then anything else that adds to this case before we move?
Steph Upton (they/them): I think we're good.
Queer Doc (they/themme): Okay, And so last case for our dosing deep down and I will say I think this is one of the most educational episodes of the podcasts that we've ever done and
Queer Doc (they/themme): And I really love case studies. So if any of our listeners have cases that they would deep dived on an episode of the podcast, please submit those, there's a contact form on queercini.com and, don't put any phi in it, please, it's an Internet contact form. It is not safer, protect health information. But yeah, if you want to listeners, want to share some cases, we'll do another one of these and a few months and in detrive again. last case. 51 year old attorney one, softer skin fuller hairline. Morehead hair, growth more complex emotions. Less frequent erections. No facial or body hair and no breasts.
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Queer Doc (they/themme): Firstware of gender diversity as long as she can remember, found the language for it when she was in her 30s and socially transitioned with a select group in her early 40s and worried about public transition, leading to the loss of her career. Uses. her pronouns past medical history significant for osteoarthritis.
Queer Doc (they/themme): Sleep apnea. Here. Remember…
Steph Upton (they/them): Hahaha objective.
Queer Doc (they/themme): what the stand for?
Queer Doc (they/themme): Obstructively having you, thank you. I was like central sleeping and hyperlipidemi and hypertension currently on naproxen stat and an ACE. Inhibitor known drug allergies past surgical history. Significant for a right knee replacement. we're gonna inventory positive for testes and prostate and family history of Hyperlipidemia, Antiti diabetes, tonight's background nicotine has two to three alcoholic beverages a month and tonight's other substances. Yeah, what stands out to you, in this case?
Steph Upton (they/them): Okey-dokey. So again, several things but number one, no breasts. Number two, let's frequent erections. Number three. Fuller hairline. No, facial robotic hair. I'm thinking more procedural. Things that we could talk about there.
Steph Upton (they/them): and then, just complex medical setting. And then I didn't know, I mean, it's not necessarily pertinent to this case but When I'm thinking about the right knee replacement, I thought, Do you want to talk about how we approach? people who are having maybe surgeries, where maybe the surgeon isn't quite Knowledgeable about the risks.
Queer Doc (they/themme): Done.
Steph Upton (they/them): Of estrogen. Yeah, so I think those are the things that stick out for me in this one. How about you?
Queer Doc (they/themme): Guys, so we have that and Last week when I walk erections and hair stuff, no breath Concern for loss of her career. And
Steph Upton (they/them): Yeah, Yeah. Did I miss myself? Of course.
Queer Doc (they/themme): And then he replacement and the complexities around vte risk and things like that area with surgeries. And yeah,…
Steph Upton (they/them): Yeah.
Queer Doc (they/themme): I think those are really the things that stand out for me and yeah, let's we just about some of the hair stuff because we kind of are focusing more on hormonal interventions in the deep dive dosing podcasts. But Yeah. What do you do hair stuff one. It doesn't want to different parts of the body.
Steph Upton (they/them): yeah. just thinking about laser and electrolysis and potentially transplant.
Queer Doc (they/themme): Yeah, yeah and we have a really great here, blog on the Queer DOC website. the Queer Doc website is kind of more of our facing education and resources. And so that blog is for here, patient community members. And it really is like getting rid of and keeping here at focuses on kind of both. So it goes over a lot of the options there, right? And I always feel patience any hair follicles on their head that they have lost in the past 12 months. We might actually be able to revive with just walking testosterone, estrogen be therapy and maybe some of the topical transdermal stuff but if the hair follicle has been gone for longer than 12 months is usually
Queer Doc (they/themme): Eight, possibly 18 months, but usually 12 months. it's not typically saveable right? We can't wake it back up. It has had its apoptosis or whatever we want to call it. and so, To help set realistic, expectations about how much hair we can get back. And whether or not we really need to be thinking about things like microneedling, hair transplants, prostheses. And I think one of the important things I always, like, to point out to clinicians, you don't do this work. As often is prostheses, so wigs, packers, binders? All of those things, and you can write a letter of medical necessity for people and depending on their plan, may or may not cover it, but if nothing else, they can use HSA or FSA funds for it once you've written a letter of medical necessity or it can be right off of bullet, expense right. If
00:40:00
Queer Doc (they/themme): If they spend enough on there,'s what I think it's is it seven and a half percent. You have to spend on healthcare in a year to be able to claim it as deductible. Ask your tax person. I think it's somewhere between seven and 10% of your income has to be spent on health care for it to be something that you can actually claim on your tax return for a trans people. It's depending on your income obviously, but it's pretty easy to get to that number for a lot of trans people, you can get packers for 30 dollars and you can get packers for three thousand dollars. And so, I think it's just Allied clinicians. I think don't always realize how quickly it adds up being trans how much tax we pay the world. And so anything you can do to help
Queer Doc (they/themme): insurance coverage, or Making it pre-tax dollars, Is really beneficial. And Talked about hair stuff.
Steph Upton (they/them): Yeah.
Queer Doc (they/themme): Right. Let's talk about last frequent erections and…
Steph Upton (they/them): Yeah.
Queer Doc (they/themme): no breath development.
Steph Upton (they/them): So kind of initial thoughts when I see breast development and word about loss of career, I really want to talk about are those things related?
Steph Upton (they/them): and what are you concerned about tipping off the loss of your career? How long do you want to be in your career?
Steph Upton (they/them): thinking about things like, Do we need to delay hormones? Could we do some other stuff first while we get the career thing? Kind of settled a little bit would be one route that you could go.
Steph Upton (they/them): Possibly thinking about maybe just starting with five alpha reductase inhibitor to accomplish some of these things. And then adding in the hormone Slater,…
Queer Doc (they/themme): Okay.
Steph Upton (they/them): when things are more career stable
Steph Upton (they/them): Of course, I think about relaxation. talking about possibly using that if we are going to do some estrogen,
Steph Upton (they/them): Answers are kind of major things about you.
Queer Doc (they/themme): Yeah, I think all of those same things, Is the loss of career is that fear around? visibility as a trans person which this is directly out of great these cases. None of these cases are one patients that I've had. They're all conglomerations of patients that I've had, Of just things. I know are important and trans health care. So I tweaked it into the story but I always like to point out because one of the lectures they always want me to give is non-binary treatment options, right? And,…
Steph Upton (they/them): Yeah.
Queer Doc (they/themme): my pet pvr, treatment options, don't have genders, right? We said this last episode, your gender is an internal sense of who you are.
Queer Doc (they/themme): Medications don't have an internal sense of who they are. only humans do that. We're aware of I have about dolphins and orcas So I find it so interesting because people want to lecture on non-binary treatment options And my first several patients who were interested in relaxfin, which is what people often think of in that category how to binary gender identity. And who really didn't want breast development, because he wanted to still be able to move through society, perceived as assist meal and for the first few patients that I did relax within with it was very focused on maintaining career and the ability to continue to support themselves and their families.
Queer Doc (they/themme): And so those people were not non-binary and so to give a lecture on non-binary, treatment options is misundering. My patients. And significantly.
Steph Upton (they/them): Yeah.
Queer Doc (they/themme): But yeah.
Queer Doc (they/themme): Definitely have had.
Queer Doc (they/themme): That conversation in this patient? I would actually think about something. That almost never comes up with my adult patients because of costs. Really think about Lupron.
00:45:00
Steph Upton (they/them): Yeah.
Queer Doc (they/themme): And so Dupont is one of the most effective at stopping erection. So someone really wanted all their erections gone. And we said less frequent in the case notes. So honestly like that, I need to clarify with a patient. Is that no erections? We're only erections when you want them,…
Steph Upton (they/them): Yeah.
Queer Doc (they/themme): but on a patient who really wants erections gone. And doesn't want breast development. I would really think about Lupron because spiral finasteride,…
Steph Upton (they/them): Yeah.
Queer Doc (they/themme): detasterated by glutamide, all carry the risk of breast development, independent of hydrogen therapies and so
Queer Doc (they/themme): I would. Think more about trying to access that Fqhc's, places 403b is a retirement plan. There's A 305 farm. There's some fancy number for pharmacies that get and special pricing. And I've heard that LeBron through those pharmacies can actually be $150 in injection, which is very different than the 5,000 that you'd have to pay on a retail pharmacy, and that might make it more in a situation like this, or potentially doing a prior authorization,
Queer Doc (they/themme): But Luke Bryan tends to stop erections for most people and wouldn't necessarily bring about breast development. And would lead to other, a softer skin, less head hair loss and
Queer Doc (they/themme): maybe some slowing of growth of facial and body hair and so it might help achieve some of the other goals kind of similar to how you were saying an anti-androgen might help achieve some of those goals. And then really exploring How much does this person want to explore medically, supported transition prior to retirement? When are they thinking about retiring,
Queer Doc (they/themme): once they were tired is breast something they want you…
Steph Upton (they/them): Yeah.
Queer Doc (they/themme): I'm really kind of navigating those things and then maybe this is a person who really wants to try a really low dose of estrogen just to Know that they're working somewhat towards their goals and maybe keeping that dose 0.5 milligrams or…
Steph Upton (they/them): Yeah.
Queer Doc (they/themme): else a day for the next few years until, you…
Steph Upton (they/them): Yeah.
Queer Doc (they/themme): they're retired, or they've had more time to think about it and doing that in combination with relaxed, then, potentially.
Queer Doc (they/themme): It in my clinical experience. Luxman doesn't fully prevent breast development. We're kind of assuming it's minimizing it. And they do, traditional dosing, 60 milligrams po a day. I do go up to 120. And Council, you just got to cancel around increase risk for VTE, and having slightly less safety data. But I think it was steady up to 300 milligrams, I'm pretty seen to be pretty safe and so definitely think about that for them.
Queer Doc (they/themme): As And then I've also worked with patients, who.
Queer Doc (they/themme): Less true for this patient maybe a little bit older than this patient with slightly more medical fragility. Overall, who really pursue? non-hormonal interventions.
Steph Upton (they/them): Right. Yeah.
Queer Doc (they/themme): They do hair transplants, they do breast augmentation.
Queer Doc (they/themme): and do a lot more with gender presentation with makeup styling and things like that because they didn't feel comfortable with the risk of hormone base therapies and who also again, they want to be able to move in and out of society, presenting in different ways and some industries and fields that Traditionally don't respond it's you women of any ilk or…
Steph Upton (they/them): Yeah.
Queer Doc (they/themme): or Non-assessment and just in general. So yeah, I don't know that trick or…
Steph Upton (they/them): Yeah. A couple things,…
Queer Doc (they/themme): anything for you.
Steph Upton (they/them): one talking about getting back to relax And this person. Yeah, my big question is, Do you just not want boobs now? Or do you not want them ever? Do you think because if they're like, Yeah, I just need to hold off for another four years until I, leave this job or whatever which I had exactly that person and we ended up doing a milligram of estradiol a day for a while until they left that job and moved away. And then we really kicked it into gear. But if they do want it later, I do think about relaxing and counseling on potentially Limiting that development later. We don't,…
00:50:00
Queer Doc (they/themme): Yeah.
Steph Upton (they/them): and the general lack of evidence that we have about any of this stuff. so that's one thing that I kind of thought of this second thing, I actually had a question because in my mind, what I'm thinking about Anti-androgens, In my mind, I have it, That the father of a reductase inhibitors, have a somewhat less chance of gynecomastia / breast development, but maybe I'm wrong about that. do you happen info?
Queer Doc (they/themme): My favorite starts always is up to date and I will let's pull it up and see what the statistics on and capacity is for My general census, finasteride has higher side, effect profile than do tasks, right? Which is kind of interesting because we think of Detached right as more effective.
Steph Upton (they/them): Stronger. Yeah.
Queer Doc (they/themme): Yeah, since it blocks both Diamond eye camera. Exactly. The word don't judge me Internet. but yeah, let's see. Gynecomasty, breast development, one to two percent for people on finasteride and you do think My previous understanding particularly the sexual side effects of finasteride of they are pretty dose dependent, right? Because now started, we can take anywhere from half a milligram to five milligrams at a time.
Steph Upton (they/them): So we got and dutasteride gynecomastia less than 1%.
Queer Doc (they/themme): Yeah, yeah. so less risk there than with Spyro or by Glutamine, where we definitely have
Queer Doc (they/themme): Some rest.
Steph Upton (they/them): Yeah. I'm looking up the Spyro. there we…
Queer Doc (they/themme): Okay, by glutamine.
Steph Upton (they/them): up to 52 percent in patients, receiving high doses for spiral Okay,…
Queer Doc (they/themme): Yeah. and…
Steph Upton (they/them): so I was on the right.
Queer Doc (they/themme): 38 to 73 percent and by clutamine monotherapy but that's 150 milligrams a day which is more than we use in gender care So yeah you're totally spot on there.
Steph Upton (they/them): Yeah. Yeah.
Queer Doc (they/themme): Finasteride has the highest rate of erectile dysfunction outside effect. so,
Steph Upton (they/them): So that's, kind of why I always leaning towards this. And when I'm thinking about detached right, in finasteride, that's something we haven't talked about yet, maybe you do or don't
Steph Upton (they/them): Always get kind of weirded out by the risk of severe suicidal depression. that doesn't go away when you stop the ication. very rare, but super important thing to think about
Steph Upton (they/them): Yeah, what is your counseling around that one?
Queer Doc (they/themme): Yeah, I tend to think of it more significantly for people who have a past history of depression or suicidal, ideation or suicide attempts. it's a post-marketing side effect it's seen in less than 1% of people. So yeah that's pretty s***** side effect but
Queer Doc (they/themme): less than 1% is The best you're gonna get on any side effect.
Steph Upton (they/them): Yeah.
Steph Upton (they/them): Okay, true.
Queer Doc (they/themme): Rate. So I tend
Queer Doc (they/themme): If they have had a history, depression or suicidal, ideation, or suicide attempt. I tend to want to use it less,…
Steph Upton (they/them): Yeah.
Queer Doc (they/themme): but whereas if they haven't had that history, I feel like a little more
Steph Upton (they/them): Exactly. I think I would say I'm the same,…
Queer Doc (they/themme): Yeah.
Steph Upton (they/them): I counsel everybody about it but with people with a history I'm like, and I'm super cautious about using it in folks with a history of this. And, I think of being killed by a shark, right? So, I know. the risk is so small that I would be killed by a shark if I went in the ocean, but if it happened I would just be so pissed
Queer Doc (they/themme): Here. Understandable, I think it's always like,…
Steph Upton (they/them): yeah.
Queer Doc (they/themme): how we present things wait. We just talked about how I think every person in my I interact with his bodily autonomy, Obviously there's a certain component of making sure that person has capacity to make informed decisions that were responsible for as clinicians. But let's Assuming we're talking to people who have capacity ily. Autonomy is so important and I think my job is as an educator and then people get to make decisions with that information. But yes, how I present things and how much my bias is against that. It is really going to affect someone's informed decision because, what I don't do is sit down and say,
00:55:00
Queer Doc (they/themme): What am I gonna say is I'm less interested in using this with patients with the history of depression or suicidal ideation because of That's risk. I don't just say there's a less than 1% chance that you will experience depressed mood and…
Steph Upton (they/them):
Queer Doc (they/themme): considers suicide and they will not stop once we stop the medication. Those have very different flavors and…
Steph Upton (they/them): Yeah.
Queer Doc (they/themme): suggestive power to the patient. And so I think It's something for all to explore and…
Steph Upton (they/them): Now.
Steph Upton (they/them): Yeah.
Queer Doc (they/themme): consider as clinicians and there isn't necessarily a right or…
Steph Upton (they/them): Yes.
Queer Doc (they/themme): wrong answer to it that I have for anyone.
Steph Upton (they/them): Yeah, I just go out and say, you might get depression that you might want to kill yourself forever and it doesn't get better but I'm the person who won't go in the ocean, So I think, if I was that person, that's how I would want it propose to me, but, probably could use some work on now.
Queer Doc (they/themme): I mean I'm on Accutane right now, I said Turn that. No. And I swear all, I got a medical degree and there's I think a less than 1% chance I would become suicidal on that as well, And it's like, I get asked about it at every monthly follow-up.
Steph Upton (they/them): Yeah, that it doesn't go away thing, though. That's the part about it.
Queer Doc (they/themme): All right.
Steph Upton (they/them): That makes me concerned. that I think is Worth letting people know what the risk is, right? Just in very simple terms. Yeah.
Queer Doc (they/themme): Yeah. yeah, anything it's yeah, I think all of these things are really pertinent and relevant and I think, yeah, it's like This is where I can't tell you the dosing that I would use with this patient based off of this case, because ultimately, what I would do is present all of these options to her and…
Steph Upton (they/them): Yeah. Yeah.
Queer Doc (they/themme): ask what she was most interested in. but I think Dr. Epson's point Of finasteride alone. And my point of Lupron
Steph Upton (they/them): Let's talk about that a little bit, I feel like Lupron is something that I do not think about Or that's not true.
Steph Upton (they/them): You can't ever get it. But, You can get it. It's several hundred dollars a month with goodrx. And, not that I ever. Recommend doing this but there's other GnRH blockers that you can get in other countries that some people use. And if you are using that and you're my patient, I do want to be able to talk about that with you.
Queer Doc (they/themme): And we don't recommend, I will say what we actually say. I'm Dr. Austin's doing great job of making sure we have no liability.
Steph Upton (they/them):
Queer Doc (they/themme): And, I tell patients all the time if they're interested in ordering medications internationally if they're interested in Supercaringastate or if they're interested in generate Agnes I think we're selling is maybe the one that is internationally available and affordable and said an easel story. I want to say and I let them know that I have much less experience working with these medications that I can look at the literature but I don't have clinical expertise to guide us but that I am happy to do my best to help to support them doing these things, as safely as possible. And this is again people get to put whatever the f*** they want in their body.
Steph Upton (they/them): Okay.
Queer Doc (they/themme): And I want to be very clear about where I stand on that and if you own a uterus, please think about what and bodily autonomy right and the reality is our patients are gonna do whatever they want. Once we're done with their appointment anyways.
Steph Upton (they/them): Yeah.
Queer Doc (they/themme): And so I'd much rather create an environment where it feels safe for my patient to really come to me and…
Steph Upton (they/them): Yeah.
Queer Doc (they/themme): ask for the information. They need to try to make those decisions as safely as possible for themselves. And so I sat in the last episode, how much my work in general? Affirming care is informed by my work and addiction medicine and harm reduction is such a core principle and Of that, I think of it in the same terms here. And so, I will
Queer Doc (they/themme): be transparent with patients about what I can and cannot support them how I can and cannot support them, but that I will do all my best to get the education knowledge and make recommendations. But that I can't guarantee sourcing or safety of what they buy on from international pharmacies but we have a blog up about how to vet an international pharmacy and the HRT DIY Wiki has great sourcing information as well and so yeah. I'll be a little more, Dr. Upton has a lovely completely legal practice as do I quote? Unquote and Yeah. Yeah, and
01:00:00
Steph Upton (they/them): No, I would say my approaches the same. Yeah.
Steph Upton (they/them): But yeah it's something that I think about more often now than I did but still not very frequently at all and I think it's a good thing to consider and put back in my more standard repertoire.
Queer Doc (they/themme): Yeah, I think The.
Queer Doc (they/themme): Interesting thing about this too if you did like Luke Bryan, or is it Gracel? And I want to say another generation and a really low dose of estrogen for a couple years that is like that. We might staff jokes about this. They call it the deal. The BL method, right there is some theories that if we could turn testosterone off incredibly effectively and someone's body and then replicate At the pubertal process more closely to what happens in bodies with ovaries during puberty. So a low dose of estrogen over a longer period of time and
Queer Doc (they/themme): And pull basically putting someone's body through one tan or two Tanner three wiltena, Tutana three chain of four, right? And would we maybe see better or more physical expression or changes, And this is to the point that you're like, we don't know for locks of an effects future breath development. And the way I counsel around that is like, we don't know. and what?
Queer Doc (they/themme): What seems to be true for most people? Taking estrogen? Is that breast development? is generally smaller, right? I think the average breast development is a cup. I always also explain a cup sizing because that can be really confusing, So in a cup with a 32 band, is smaller than a cup on a brawl with a 42 band, so cup, size increases with band size. So, part of why transgender diverse people have quote unquote, smaller cup size is because they tend to have larger band size, So kind of putting that into perspective but that ultimately, A breast size development is
Queer Doc (they/themme): Oftentimes on the smaller side overall and we don't know if that's because of some loss of potential because of an endogenous puberty with testosterone first or is it because we don't have a super great way to replicate a functioning over you going through puberty and someone's body and we don't really know these things and this would be a really interesting case study to get to do that in right? If you had a patient who wanted to do a really low dose of astrodial for a year and GnRH Agnes, it really lets you kind of if they were down. To be a guinea…
Steph Upton (they/them): Yeah.
Queer Doc (they/themme): Unless you really try that and
Queer Doc (they/themme): Approach and you have no way to control it so you don't know if they get better unquote outcomes than they would have if they'd done in a more traditional approach or…
Steph Upton (they/them): Yeah. Brings up a related…
Queer Doc (they/themme): not, but yeah.
Steph Upton (they/them): but maybe not related to this case question. Maybe we want to talk about which is cyclic dosing both in terms of progesterone and in terms of estrogen, if you have a good blocker a good Say maybe either by glutamide or a GnRH agonist?
Steph Upton (they/them): I will say, I haven't or, status post or key or something like that. I will say I've cyclically most progesterone That's true.
Queer Doc (they/themme): Or he would be a great option for this patient too. We didn't even Yes.
Steph Upton (they/them): I mean to be honest, I feel like we're kind of talking about everything about the dosing here. This whole podcast, I feel like both episodes are somewhat missing.
Queer Doc (they/themme): Sorry.
Steph Upton (they/them): but these are the things that I'm thinking about, I guess one dose is zero, right? So yes.
Queer Doc (they/themme): Yeah, yeah, and and we'll talk about cyclic piercing a second. if we're using Lupron, or if they're trying to get an implant dosing is pretty fixed in that. monthly lupron dosing is wheat beast. The three months, it's 22.5 milligrams. solid doseing there's alegard all those have six months. I have dosing in the blockers lecture for all of those and then for finasteride I usually have people start on a milligram and take that for a week and then increase by milligram each week basically as tolerated and to a fact up to five milligrams at a time in a day and detox, right?
01:05:00
Queer Doc (they/themme): It's just 0.5, that's it easy relaxed.
Steph Upton (they/them): Easy peasy.
Queer Doc (they/themme): When I start with 60 if we're not getting enough effective blockade a breast tissue development, I go to 120 if they're interested in doing that and then don't use tamoxifen for that. Typically there is some literature on relax and intoxicant tamoxifen for gynecomastia and relaxfin was actually more effective. So Maxim's also just not as well tolerated. If I'm trying to shrink breaths to do, that has already developed and we're removing the estrogen influence. I actually started 120. So I start higher and then work my way down over a period of couple months and
Queer Doc (they/themme): so, estrogen dosing for this person, though, I would really think about 0.5 milligrams. A day, If I would Or something will oral shuffling will either options fine there.
Steph Upton (they/them): Sublingual.
Queer Doc (they/themme): If I was going to do a patch, I'd probably only do a 100 microgram patch to point one. Maybe even a point zero five.
Steph Upton (they/them): it has a maybe,…
Steph Upton (they/them): maybe less
Queer Doc (they/themme): Yeah, you…
Queer Doc (they/themme): I might 2.1 since they cut it in half and patches can be cut in half, so that's totally fine and get some more for their money. And then
Queer Doc (they/themme): Inductible, this is a person. I wouldn't be super keen on using Valerie because, I have a really hard time getting Valerie. This is low enough for someone. We're trying to do a low approach and if you check this yellow children's dinner dosing protocols, you'll see that it was really funny because they had recommendations on Valerie in there and they asked me to review it and I was like, I don't use salary in kids that are young. I don't use it in Littles, I'll use it in older adolescents And let me be clearer to the haters on the Internet I only treat adolescents right? Only treat people in puberty. I don't treat children with medications but
Queer Doc (they/themme): And earlier adolescents earlier puberty and I don't reach for Valerie because the serum levels are so high with it. And so, unless you could get the hundred or the 10 milligram per ml concentration, I would do sabini if we were doing injectable for this person and I would probably do point one. Or 0.2.
Queer Doc (they/themme): Once a week. so, Okay, we specifically talked about dosing now. Cycling, estrogen and progesterone. What do…
Steph Upton (they/them): Yeah. Yeah.
Queer Doc (they/themme): What do you share about it? What do you think about it?
Steph Upton (they/them): So I will say, I've As of yet, actually only cyclically dosed progesterone. And typically, people have just done the zero for a week, a for a week, hundred for a week.
Steph Upton (they/them): I know, there are other No one's elected. Those. so I've done that for folks but the estrogen I haven't had anyone who we weren't using the estrogen to drive down the tea. and so, I'm less inclined cyclically to us estrogen yeah, but I know that you use a lot of
Queer Doc (they/themme): Micah.
Steph Upton (they/them): Generate agonist and Bika I was wondering, if you said quickly, dosed estrogen as well.
Queer Doc (they/themme): I've had one patient ask about it and so I will say my clinical experiences, we haven't. I've done it once. and we they're on injectables and then we would add oral Or sublingual, right? and
Queer Doc (they/themme): Ultimately all I'm trying to do is recreate the pattern of menstruation and this is a time I pull up those luteal phase and…
01:10:00
Steph Upton (they/them): Yeah, the little Lulu. Yeah.
Queer Doc (they/themme): Yeah, I look at the graphs, I'm looking at the lab I'm using. I'm looking at their values for those phases and administratings this woman. And so I'm just adding
Queer Doc (they/themme): Like the oral or something will estrogen on their base dose of estrogen and a way that replicates that pattern or curve to the best of my ability and…
Steph Upton (they/them): Yeah.
Queer Doc (they/themme): and usually, To be clear. I want to know what my patient wants out of that experience and…
Steph Upton (they/them): Exactly. Yeah.
Queer Doc (they/themme): what are we hoping for What are our goals? because Then it's like, Are we achieving them with this or Do we need to be doing something else and how is this making you feel? And so For one of my patients, it was just my patient who chose to do it who actually just do it and it was flat out like this is necessary for me to feel affirmed in my gender in my body. this is the experience I need and that's what we did and progesterone with that patient. We did the pattern where you
Queer Doc (they/themme): I think we were doing.
Queer Doc (they/themme): You might have been 400 and 200. And then 100. So number zero, But yeah. And so, if a patient's interested in cycling estrogen or progesterone, I let that be a patient driven option is never and…
Steph Upton (they/them): Yeah.
Queer Doc (they/themme): I never presented as an option when I'm presenting. Estrogener progesterone dosing overall to patients. And maybe I should reconsider that. But typically, that's something a patient, brings to me that they're interested in and then I clarify what they're hoping to achieve by it. and I talk about the fact that I have no information, no cover designs.
Steph Upton (they/them): Yeah.
Queer Doc (they/themme): No evidence-based icine. Nothing Other than what I know about, how ovaries work and…
Steph Upton (they/them): Right.
Queer Doc (they/themme): and there's one published article on replicating, a functioning ovary and
Queer Doc (they/themme): And And so that I'm making my best educated, guess it was a very expensive education, it's very educated. That is what it is.
Steph Upton (they/them): You're still paying for that education, you might as well use it.
Queer Doc (they/themme): And I'm all trying to just understand that we were walking down a road together that neither one of us. Know very well with that.
Steph Upton (they/them): Yeah.
Queer Doc (they/themme): I'm happy to hold their hand on that road. and that's what I've done.
Steph Upton (they/them): this is usually something that people bring to me, but I will say that I've kind of been working in the progesterone cyclic dosing as an option.
Steph Upton (they/them): More recently and…
Queer Doc (they/themme): Yeah.
Steph Upton (they/them): not very many people. Do but some people are like, yeah, that sounds great.
Queer Doc (they/themme): yeah, It's funny. I went the opposite direction. It used to be part of one equipment production, I would present the dosing options and I think the patients I have, who have done it
Queer Doc (they/themme): On average. The ones I presented to don't stick with it. The ones you wanted. It are the ones you stick with it, And so I probably let that kind of color…
Steph Upton (they/them): Yeah.
Queer Doc (they/themme): how I counsel on that one and
Steph Upton (they/them): Also interesting to kind of related, I would say of my people who came to me, wanting relaxation who also are taking estrogen
Steph Upton (they/them): All but one of them have come back and said, Yeah, I don't want that anymore. I want boobs now.
Queer Doc (they/themme): Yeah, I will say that is most of my experiences that eventually people just continue your locks of fun as well. I will say historically I could say the same thing but I'm at a point now where I do have a couple people have stayed on it. yeah. And I'm gonna wrap this up…
Steph Upton (they/them): All right.
Queer Doc (they/themme): because I really way over time for my next meeting. And hopefully, everyone got some really fascinating, educational learning, thank you so much, Doctor often for your time and expertise and…
Steph Upton (they/them): Thank you for helping me.
Queer Doc (they/themme): your vulnerability.
Queer Doc (they/themme): Okay,…
Steph Upton (they/them): Thanks for having me.
Steph Upton (they/them): It was fun.
