Apr14
So when I first tried to go on T the Endocrinologist wouldn’t let me and then Joe raised money for me to go privately. I have a bunch of feelings about access to hormones, fat phobia within the medical system, and power and privilege – but, that is for another day. Today’s comics is about Pies!
…. The endo I was seeing most recently (whom I am no longer seeing) sold Girl Scout cookies in her office.
It STILL boggles my mind. Diabetic people come to you regularly and you sell GIRL SCOUT COOKIES?! I understand supporting your child, but good god, y’all. And yes, she did tell me I needed to lose weight. (I do, to be healthier, but hearing it from her was not at all … Credible.)
My mother has informed me since that endocrinologists, as a type of doctor, are just… Weird. They’re just weird people. I’m sorry you’ve had to deal with their nonsense so much. =/
Um as a diabetic I hope you know, we CAN have stuff like girlscout cookies, I don’t know so much about type 2 in honestly, but me and other type ones, as long as we take the insulin for it we can eat whatever we want (as long as we’re not allergic to it)
Sorry, I didn’t mean to fall into labeling people. I was more indignant about this doctor being one whom people that struggle with weight issues come to would be selling cookies in her office. I know for myself that a helpful way to eat more responsibly (if I’m struggling to control urges to eat from boredom or stress-eat) is to not have the tempting foods in the house. So it basically felt like this doctor was selling temptation in her waiting room, which I felt was unfair.
Hi there,
I am sorry you had to go through that. It certainly doesn’t seem like that was a necessary thing for you to do.
My husband had to lose weight before he could safely start on Testosterone. We knew that before we even saw his specialist. We live in Toronto and his doctor was wonderfully supportive of the whole process so we were lucky. We worked together at his weight loss and it was a positive experience for us.
Having said that, I understand that many MDs have bad bedside manners and many more are transphobic and treat trans individuals with disrespect. However, as a healthcare practitioner myself, I’d like to share that it is much healthier to start hormones when the body is under least amount of stress and extra weight does add stress to our bodies. I am definitely not a Barbie (nor do I wish to be one) and my husband is wonderfully fluffy still and I love him as he is. However, while how one looks is not a good reason to lose weight, I wanted to add that losing weight to be healthier (assuming there is extra weight to lose, BMIs are even not always an accurate way of determining that), is valid and ok. I know that it’s extremely difficult to hear from a healthcare giver that you have to lose weight and in your case, again it seems like it was not needed. However, I know people who have been very unhappy with their doctors for similar reasons where the doctor was only doing their best to make certain that their transition happened in the safest way possible.
Thank you for your wonderful comic 🙂
Thanks Ash! Yeh, it’s totally important to be healthy, and doing what you can to do regular exercise and eat healthily is always good. I like my chubbiness – and I do eat pretty well, and exercise – I just like being big. I also work really hard to have a good relationship with my body, which, ya know was pretty hard before getting on T (and still is, sometimes). This particular endo used the BMI in a super problematic way – and was doing it in a ‘prove to me you’re really interested in getting T’ way, which was just gross. And he was really gross and disrespectful in a number of other ways too, so the weight loss stuff stung even more. But, some folk have really loved it when their doc has encouraged them around healthy eating and exercise – so it’s not automatically bad news when a medical practitioner talks about this stuff, of course.
I’d like to hear your thoughts on “far phobia” within the medical system. It seems to be a very responsible thing for a doctor to do by refusing T to a person who they had deemed unfit for its use?
Oh – sheesh, there’s heaps to say about it, really… But the crux of it is that there isn’t as strong a correlation between body weight and health as some people claim, plus the usage of problematic tools like the BMI (which is scientifically incredibly flawed) leaves health consumers at a disadvantaged situation of having to argue with health professionals for treatment that they know they need. When you add in the fact that a trans person is probably experiencing some sort of body issues, denying them a course of treatment that would help them feel better about their body seems really messed up. For most other health care treatments doctors work on an informed consent model, which is ultimately much more helpful and empowering for the consumer than a gatekeeping method – trans people are all ready in an incredibly vulnerable position, it seems really gross to further that within a health context.
I dont want to pull the “I’m nutritionist card”, but I will, I’m a nutritionist. BMI is inaccurate for a very small portion of society, unless you are extremely muscular or in rare rare cases, BMI is more than likely applicable. The number of health conditions associated with obesity is terrifying. People are literally killing themselves, and a doctors recommendation should be taken very seriously. I deal with people every day that claim to “eat healthy” and don’t understand why they are overweight, and question the work that I do at every step of the process and think they know more than me, and these are the people that end up getting diabetes or worse. When we get to the point when we are questioning health professionals, and think we know more, we get things like the anti-vaccine movement, and everyone loses :/
If you are happy with being chubby, awesome, all the power to you and I support it, but I view it the same way as smoking cigarettes. If you want to do it, great, but it will catch up with you.
I’m not sure that endocrinologists are trained on how to appropriately deal with Trans people. To be perfectly honest I didn’t know Trans people existed before my flatmate told me he was transitioning, hence why I’ve come across your comics which are awesome. I can understand Trans people being in a vulnerable position but I can also understand that asking a doctor to chose between giving a patient treatment that will potentially improve their mental health at the cost of their physical is a real sophie’s choice!
The issue isn’t even that the BMI is “inaccurate”, it flat out doesn’t have a good link to overall health, which is how it’s used “predictively” by doctors and other professionals. It was designed by a mathematician to measure population trends, not individual health. Being overweight is actually healthier than being underweight or even “normal” for many people, leading to longer live, and sometimes weight-loss can be a sign of illness not health, but these facts get subsumed in the simplicity of a simple numeric value placed on weight/height ratio which doesn’t take into account fat distribution, muscle mass, or bone density.
Here are several articles on the issue:
Top 10 Reasons Why The BMI Is Bogus (NPR) – http://www.npr.org/templates/story/story.php?storyId=106268439
BMI Not a Good Measure of Healthy Body Weight, Researchers Argue – http://www.livescience.com/39097-bmi-not-accurate-health-measure.html
Being Overweight Is Linked to Lower Risk of Mortality (Time) – http://healthland.time.com/2013/01/02/being-overweight-is-linked-to-lower-risk-of-mortality/
The big fat truth – http://www.nature.com/news/the-big-fat-truth-1.13039
Beyond BMI: Why doctors won’t stop using an outdated measure for obesity – http://www.slate.com/articles/health_and_science/science/2009/07/beyond_bmi.html
The history of BMI and why we still use it – http://the-f-word.org/blog/index.php/2009/07/22/the-history-of-bmi-and-why-we-still-use-it/
Do You Believe in Fairies, Unicorns, or the BMI? – https://www.maa.org/external_archive/devlin/devlin_05_09.html
Endos are freaking weird. And definitely anti – fat. Like when I lost a lot of weight and I wanted my endo to check my thyroid function and he wouldn’t because “you’re the healthiest person I’ve seen all day” – never mind that I’d lost 10kg and was so thin I had to buy clothes made for children. Got my GP to test me instead and what do you know! My thyroid was massively overactive. But no, course I was halthy, I was thin. *eyeroll*
I understand that being overweight is not helpful to your health or your self image, but is there a medical reason why Testosterone should be withheld because you are overweight? It may be that administering testosterone in such circumstances could be dangerous. In that case you would need to consider the doctor’s position. He could be held responsible or negligent in the event of any adverse reactions.
That’s why I went privately to get a second opinion – the second endocrinologist said that he saw no health issues in my case for prescribing T – he said it would be like telling cisgender men that they had to take testosterone blockers if they were overweight – which obviously medical professionals don’t do.
Being “overweight” is only unhelpful to your health and self-image because of the massive stigmatization and fatphobia that is prevalent the world over. Maybe if fat people weren’t bullied so much they’d be healthier? HMMMM.
Highly recommend Dances With Fat and the Fat Nutritionist for some great content relating to this stuff.
You eat pie for breakfast?!?!
haha, I know, it’s pretty disgusting, but also awesome.
You want to live in Wigan in England (couple of towns over from me.) Pies are the staple diet there!Pies for breakfast, pies for lunch, pies for tea (or dinner if you are posh…) pies for supper and if you want a snack… tha’s can go wrong with pie, lad!
Well I’ve clearly been doing breakfast wrong 😉
Ugh, an Endo in Texas and I went rounds. Not for hormones, but for my immune system issues (which have been decided to be related to anemia and stress long after this lady). I’m 162 cm/5’3″. I’ve been overweight even when I looked nice and proportionate and even when I LOOKED underweight at one point (horrible time when I was a teen due to my meals being limited) I was still considered overweight by the bloody BMI. I’m built like my dad with wide shoulders and wide hips (also from his side) but I have my mom’s height. I can be 15 lbs overweight according to the BMI and you can see my hip bones. Enjoy your pie, good sir! I know I don’t regret a meal these days :p