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| Author | Topic: Acne in FTM transsexuals |
| Ganesh 06-03-2003 08:19 PM | Perhaps it's because I'm just back from five days in Amsterdam (beautiful weather this past weekend, no?) but, when one of my patients approached me with the following problem, I thought of you guys. If you can help even slightly with this, I'll be extremely grateful. One aspect of my work involves assessing and monitoring transsexual people as they undergo gender transition - initially by changing their social role, then through taking high-dose sex hormones, and finally reassignment surgery. One of my patients, a transman (female-to-male transsexual) recently started taking testosterone supplements - intramuscular Sustanon 250, which he injects into thigh or buttock every three weeks - and has developed bad acne, particularly on his back and neck, around the hairline. He's firmly committed to transition, so stopping the Sustanon is not an option; in fact, as his menstruation has not yet been suppressed, it's likely that he'll require fortnightly doses. He's stoical but would, I'm pretty sure, like his skin to be clearer if at all possible. I inquired very briefly about his diet. He's vegetarian by default (he can't afford to eat meat), says he eats lots of fruit and vegetables, doesn't consume much milk and eats bread. Didn't have time on this occasion to get much more detail. Any suggestions? |
| moydodyr 06-03-2003 11:04 PM | quote:Ugh... reassignment surgery?? You mean you can actually attach testicles and a penis to a woman and make her into a man?? ![[Eek!]](../eek.gif) How does it work? |
| Ganesh 06-04-2003 03:48 AM | My purpose in starting this thread wasn't particularly to explain transsexualism, but if you insist... Firstly, gender doesn't necessarily equal genitalia; it's not a case of penis = man, no penis = woman. Much more relevant is whether society accepts an individual as male - and that tends to hinge on a variety of other 'signifiers' such as body build, hair style, facial hair, vocal pitch, presence of absence of visible breasts, behaviour and mannerisms, name, etc., etc. So no, it's not a simple case of "attach testicles and penis to a woman and make her into a man". Reassignment surgery, in FTMs, involves the creation of a penis (phalloplasty), usually from a rolled tube of tissue from the arm or abdomen. In practice, most transmen get their breasts removed first (mastectomy) as this impacts upon their lives to a greater extent. Testicles cannot be attached or created, hence the need for testosterone supplements - and the common side-effect of acne. I'm wondering whether Wai's diet might help in this admittedly rather atypical situation. |
| Wai 06-06-2003 12:00 PM | Ganesh, a short intro: in our view, someone is prone to acne when both much sebum is produced (1) and water is retained in the true skin (2). (1) is determined by the condition of the skin (the more the skin is dehydrated, the more sebum will be produced to counteract dehydration) and, by hormones, such as progesterone and testosterone in particular (2) is determined by (again) hormones (sex-hormones as well as hormones such as ADH), by stress (stress hormones evoke the breakdown of cell-protein into lots of smaller protein moilecules, which, in total, atract more water), bad sleep (less water attracting protein is totally cleaned up) and... diet: salt and hard-to-totally-digest protein may end up in the true skin, attracking more water, and the resulting increased water pressure may pinch oof the sebum canals too much (if also much sebum is produced) . a transition as desired by your patient, can only be triggered by overpowering his natural (female) hormone metabolism. this means that the testosterone level will be elevated in ratio to the amount of testosterone receptors in his body, at least temporarily this means that the influence of testosterone may have a overwhelming impact on both the secretion of sebum and water metabolism and since the combination of these 2 is enough to cause acne, acne may be unavoidably connected with the transition for him (its individually different) but... maybe not maybe the influence of testosterone is not too dominant maybe the influence of his testosterone level only affects the production of sebum, and not retention of water in that case, a change of diet will help but, this would require a radical change (see the "sample diet") and can he do that? (isnt that a bit too much in this already difficult stage?) quote:he can eat fresh raw egg yolks, eggs arent that expensive fruits and egg yolks combined already supply one with all essential nutrients (nutrient calculator the bread wand milk (all dairy) would have to go (which would require a much greater intake of fruits / juices to compensate for the loss of energy = much more expensive) regarding energy intake, it would be cheaper to drink lots of OJ with oil and sugar added PS; following a less than 100% strict sample diet (initially) usually leads to poor results |
| Ganesh 06-06-2003 01:11 PM | Thankyou, Wai. I've hesitated to recommend your diet to him because, as you suggest, I think he's already going through some pretty radical changes, and he seems more or less happy to accept a certain amount of acneiform change as a side-effect of the large amounts of testosterone which are necessary for his transition. I did wonder whether a less-than-100% adherence to your diet might, in some ways, be worse than disregarding it altogether. I think I'll wait a few months to see whether his acne stabilises of its own accord; if it doesn't I'll give him the URL for your acne book, and suggest he gives the diet a go. |
| Wai 06-06-2003 02:03 PM | quote:yes, absolutely not only because water retention in the true skin has to do with osmosis, and what way the osmosis goes is determined by a very delicate balance, so that you easily swing the wrong way (that is why the acne sample diet is so strict), but also because of likely 'failure' and 'disappointment' this diet is more for those who are desperate and have only 1 thing on their mind: getting rid of their acne, no matter what it takes quote:probably, the number of testosterone receptors (and/or their sensitivity to the stimulating influence of testosterone) in the sebaceous glands will decrease strongly within the next few months; a natural negative feedback response to the elevated blood-testosterone level this would lead to normalisation of the production of sebum, and therefore diminish / eliminate his acne |
| Ganesh 06-06-2003 04:27 PM | That makes sense. If the acne doesn't stabilise, I'll suggest your diet. |