Oestrogen, my old friend — Call to action for trans medical research
Sometime around this time of year twenty three years ago I slapped on my first E patch. It was such an innocuous thing, a tiny square of possibility that held such promise. Unlike now there was little information for trans girls about the impact of oestrogen on our bodies, especially if we had not finished puberty, so to start this journey was both intriguing and a leap into the unknown. Over those 23 years I have gone through many physical changes, never regretting for a second the decision I made. Yet, there remains a central issue to trans health that often goes unremarked, there are no longitudinal studies of trans female healthcare that signpost what impact oestrogen has on the aging trans body.
For all those just starting out, or who have been on E for a few years, a question mark hangs over the speed at which oestrogen works on the body. Many of the cosmetic surgeries open to trans women and trans feminine folk attempt to reshape the body to conform to a version of womanhood that those who have oestrogen from early teens develop over a decade or more. For me it took more than 15 years for E to finish with me, though even then it took Covid lockdown to take my breasts from a C to an E cup. Bodies are inherently individual and just a bit weird, so while I can tell you about the impacts of E on me, the likelihood is that it effects each person differently.
This is why it is essential that more research is carried out on trans women as they age through the process. Much of the medical discourse is focused on early-stage HRT, and even menopausal HRT is recommended for ten years maximum. This means that for trans women there is little to no medical evidence for us to make judgement calls about our health. I can tell you my anecdotes, as can any trans woman, but these are not medically verifiable. Hard evidence, quantifiable evidence, is necessary. Yet, given the low levels of trust and high levels of stealth and fading into the background by trans women once they get passed the two to four year transition mark, it is difficult to get enough participants to make such research viable. In addition, getting funding for such a study would proof complicated, as would ethical approval, country of study etc.
When we talk of transphobia and blindness to trans issues, trans healthcare is high on the list because the reactions of healthcare professionals towards trans folk. Yet, I would argue that much like women’s healthcare in general, the lack of longitudinal studies is a symptom of baked in reticence by the scientific community to deal with trans issues at large. It is not transphobic not to want to do medical research about trans women, but it becomes problematic when those prescribing medication to trans people have little to no research from which to draw their decisions. Even informed consent runs into issues because while it is all well and good saying that you as a patient consent to take the medication, if you do not know the life-long implications of your medication you cannot fully consent to taking the medication for the rest of your life.
Within the trans community we see oestrogen as a life-saving medication, life affirming in its effects on our bodies. I am not advocating for anyone to be denied or to stop taking E due to the lack of long-term research, but at the same time without these studies, without scientific research on the intersectional nature of oestrogen on the broad range of ethnicities and socio-economic backgrounds, we are reliant on anecdotal evidence. The simplest solution would be to get an organisation such as the British NHS to do a publicly funded research project, yet due to the levels of distrust on both sides of the community in the UK this is potentially a non-starter. The harder route would be for healthcare providers to mend the burnt bridges, and reach out to trans patients to do a meaningful piece of work as an initial step to something broader.
Does it matter if this research is not conducted, and trans women are left to experience hormones in an aging body? Yes, I would argue it does. If our bodies are left to develop without evidence backed research we are at the mercy of medical practitioners who themselves do not understand the impact of oestrogen on XX chromosomal bodies. In some respects E works on trans women much the same way as XY chromosomal bodies, but without the research it is impossible to say that those differences are negligible. There are intersex women who were born XY androgen insensitive, so there is some research on their bodies and lives that overlap with ours. Yet, simply overlocking their bodies with trans women risks being reductive and harmful.
I have no regrets in the decisions I have made with respects to my body, and I have had 23 years of good hormonal health. I made a conscious decision in May 2023 to take part in longitudinal research because I believe it is critical someone kickstart the process. While this may not be for everyone, I would ask those trans women who have been on E for a decade or more to potentially do the same, as without the evidence we are all at risk of complications and healthcare professionals ignorance. Oestrogen is an old friend to me, but without the evidence it may not always be one in the future.
