Trans patient

[Giuliana Hazelwood]

Hello all!

I have a patient who had been taking testosterone for two years because they were transitioning, then decided to stop taking T and identify as nonbinary.

They’ve been off T for two years and it took about a year to get their period back, and now their cycle is long (35-38 days), and mostly regular but they are constantly warding off BV and yeast infections and have a dull, pressing feeling on their lower abdomen pretty much all the time. Rarely do the infections flare up in full, but they feel like they’re “one wrong move” from getting a full infection. They also recently had an abnormal pap smear which confirmed non-active HPV.

They don’t have any other major health complaints – and no major heat or dryness signs. I’m wondering how to approach this case given their history and current presentation. With any case of gender identity, my mind goes to one of the Chong trajectories, but part of me is wondering about emptying the Du luo to release some of the excess yang that might be left in their system post-HRT.

Would love any thoughts!

xxx

[Rm]

Hi Giuliana, The chong comes to mind in reading your post, and I like your idea of balancing in some way the du and/or ren.

I happen to be listening to Jeffrey’s lecture on Bladder primary channel (via ACCM, Dublin) and he talks about the important role certain BL primary channel points play in rectifying qi. He says rectification of BL helps with a patient who is struggling with their identity – could be gender, sexual identity, preferences.

Jeffrey shared that if someone isn’t comfortable being who they are because society judges them, that is where BL primary comes in. Are the desires that they have in life ones that they were told were inappropriate; have they been closeted about those desires? That can make someone feel ashamed, guilty which takes its toll on the body. The points for rectifying qi along the BL trajectory according to Jeffrey are: BL 14, BL16, BL17, BL25, BL44, BL45, BL47, BL50, BL30, BL32, BL67.

He flagged that the first 3 points in particular, BL14, BL16 and BL17 are key: BL14 (Jue Yin / PC shu point) the PC shields us from having to expose ourselves, so by treating it what you are doing in a way is exposing the PC, you are “freeing the skeletons from the closet” by treating it. He also mentioned in the lecture that BL14 isn’t just the PC shu, but that it is classically the jue yin shu, so also regulates LR. BL16 – the shu point for Du channel, gives the patient courage, the back bone to stick up for their rights and beliefs in who they are. And all he said about BL17 was that we are subjected to influence of blood regulated by BL17 (the IP for blood). And then the distal point included here, BL67, is the metal point in water and metal is about rectification. It is about letting it all go. Your point about “one wrong move” made me think that there may be a lot of metal, judgment.

I hope you find this helpful or at least interesting! Rene

[Erica Moffet]

Hi all,
An interesting discussion!
I know from a biomed perspective, testosterone supplementation (and esteogen fluctuatation) can lead to an increase in infections. Has your patient been experiencing these symptoms for a few years?

I also wonder, do they seem to be struggling with their gender identity at this point? If not, some simple support to clear dampness and stagnation from the lower jiao may be all that’s needed to halt the cycle they are in, now that their hormones are stabilizing. How’s their diet—-does it include a lot of cold and damp foods/ drinks? Does their menstrual blood give any indication of dampness or other stagnation? And their pulses-—does it feel like excess dampness? Cold? And/ or yang xu? I haven’t worked with anyone coming off of T, but I wouldn’t be surprised if the body flipped from seeming yang excess to a deficiency in response and that can play into leukorrhea and abdominal pressure, along with dampness.

And a last thought—-gender non-conforming people can experience a lot of trauma trying to survive/ thrive in much of current culture. If their pulses do indicate EV-level treatment, perhaps the Dai Mai is involved? Draining Dai is an obvious thought with the infections, but I would also think about consolidation first, if the person is struggling with feeling safe in the world.

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