I started on Testosterone Cypionate, which in Canada is branded as Depo-Testosterone (aka Depo) and made by Pfizer. In December 2008, there was a Depo shortage and my pharmacist substituted Testosterone Enanthate, aka Delatestryl, then made by Theramed. (Aside from custom compounds, Depo and Delatestryl are the only injectable testosterone preparations available in Canada.* We don’t have Sustanon, Reandron, Omnadren, Nebido et al.)

I wrote about the differences between Testosterone Cypionate and Enanthate here. Chemically speaking, they’re practically the same, with the main difference being the concentration of testosterone offered by each brand:

• Depo-Testosterone (cypionate): 100 mg / ml
• Delatestryl (enanthate): 200 mg / ml

The only payload of this is that when I’m using Depo, I have to inject twice the volume. Initially, a 2cc shot looked a little intimidating, but it’s really of no issue.

In August 2010, I picked up my Delatestryl at the pharmacy and… Surprise! The price had doubled. Nevertheless, I stayed on Delatestryl (for the smaller injections) and then in the summer of 2011, there was a shortage. My pharmacist had no information about this, so out of curiosity I called Theramed myself. They were less than helpful. I spoke with my dollars and switched back to Pfizer’s Depo-T rather than wait for Delatestryl to return to market, and was pleased to find out that Depo had actually had come down in price by a whopping $3. Win!

Fast forward just a few months and I started hearing about another Delatestryl shortage rearing its head at pharmacies across Canada in late November and December, 2011. That story got a bit bigger when Benjamin posted this video. I commented on it, offering up the straightforward solution: get your doctor to switch your prescription to Depo. Hassle over, plus pay half as much. However, by the time reporter Katie Toth picked up on Benjamin’s story and was quoting officials from Toronto’s  Sherbourne Health Centre advising trans men that “they can be switched to a different compound,” I’d found out while trying to get my prescription filled that there was now also a shortage of Depo. We weren’t just talking about a shortage of T, this was now a full outage.

Aside from the misinformation about access to Depo in Toth’s articles that appeared on Xtra.ca and Rabble.ca, I think Toth missed some other important points:

The articles failed to mention the without-warning price increase of Delatestryl.  (The Xtra article also has incorrect information about Delatestryl pricing… I don’t know anyone who goes through a vial of Delatestryl in a month.)

I spoke to my doctor about the testosterone shortage outage, and he said that he believes many drug shortages are “orchestrated” to drive up demand and prices. This leads me to wonder… Will Pfizer increase the price of Depo soon? My sister, who’s a doctor, mentioned that fertility drugs have recently gone up in cost as well. I don’t know much about the hormone protocols for trans women, and wonder if this has impacted Canadian trans women at all? Big Pharma knows hormones are Big Business. Is there some kind of legislation in place in Canada that prevents Valeant, Pfizer and friends from setting pricing to their whims?

Also, I think it’s important to note that testosterone shortages affect all men using therapeutic T, not just trans men. Here in my small community of about 1000, I’m the only trans man but I know there are several other men on T. I imagine being off it would affect us differently, but I don’t want to compare who has it worse. Suffice it to say that without our prescribed medication, we probably all feel off.

Testosterone Shortages Are More Common Than You Think

You’re less likely to feel the effects of a shortage if you live in an urban center. My pharmacist told me that as a controlled substance, a drug that not a huge number of people are on, and one that’s dispensed in amounts that last for several months, testosterone isn’t heavily stocked in pharmacies. This is especially true in small towns. Pharmacies rely on their distributor to have stock. When your pharmacy, their distributor and the manufacturer are all out of stock, that’s when YOU will experience a shortage.

This time around, my timing was off. I ran out of T on December 4. I got a smaller dose than normal and I haven’t been able to buy more since. I’ve now missed two shots, it will be three as of this Wednesday. (I inject every 2 weeks.) Word on the street is that Delatestryl may be back on the shelves this week, and I’ve heard mumblings that Depo is back in stock already, so I’ll check with my pharmacist.

What To Do When There’s a Testosterone Shortage

The best way to ward off the effects of a shortage is to not let yourself run out of T to begin with. It seems like an obvious and wise plan indeed to always keep a backup vial around. Given that I only go through four vials of T a year, keeping one spare around won’t raise any red flags with my doctor. The obstacle for me is that I don’t have convenient and regular access to a pharmacy. I live an hour from any pharmacy, and I combine chores into a single “town day” every couple of weeks. I can’t just pop in and pick up my T like I could if I lived in the city. It’s really just a matter of advance planning though.

Here are some of the suggestions that I’ve seen bandied around for averting this most recent Delatestryl shortage:

1. Switch to Depo. Normally this would be the ticket but the concurrent Depo shortage made this a moot point.
2. Get injectable T compounded. Only certain compounding pharmacies can do this, they need the right facilities (namely, a sterile hood.) This is probably a pretty good option if you have access to such a pharmacy and if you’re willing to spend a bit more.
3. Check with your local trans health clinic. If you have access to such a clinic, you may find that they keep their own stock of T on hand and can give you a shot. For example, Linc from TranArchy informed me that the Three Bridges Community Health Centre in Vancouver will do this (provided you have an existing Rx.)
4. Switch to Androgel. My understanding is that many trans men are not satisfied with the effects of T gel, but this could be a good stop gap solution provided getting a new Rx from your doctor isn’t a big hassle and you’re OK with the higher expense of gel.
5. Cross the border. Legally speaking, you can import testosterone into Canada as long as you have a valid prescription and physically carry it across the border. However, I don’t see this as a valid option given the expense of time and money.
6. Get T from a friend. I wouldn’t do this for legal reasons and because I think it could damage the trust that my doctor has in me.
7. Underground labs.This is a dumb idea, don’t do it. Not only is it illegal, and something your doctor would seriously frown upon, you’re likely to get something that’s cut or something that’s not T at all.  See:  Don’t Be Silly: A Public Service Announcement on HRT.
8. Patience.

I opted for the latter, patience. I’ve looked at this outage as a cleanse of sorts. Granted, I feel I have the luxury of this choice because I have a few years of T in me and I’ve had a hysterectomy. Were I earlier in transition, or pre-hysto, these shortages would cause me significant anxiety.

What It’s Like Being Off Testosterone

It’s been almost 6 weeks since my last (short) shot of T. I’m thoroughly surprised that my energy levels and mood seem unchanged. I haven’t been without symptoms of hormonal flux though:

Within a week of being late for a shot, my dick shriveled to about half its size. It doesn’t get hard and I have zero sex drive. I’m confident that this will all return to normal once I’m back on the juice but it’s another nail in the coffin for metoidioplasty for me. (More on this in another post.)

Hot flashes, oh my! They’ve consistently increased to the point where I’m having several an hour. I’m constantly taking off my shirt, or putting it back on.  In retrospect, I think I was having (much less frequent) hot flashes prior to running out of T and this makes me wonder if my dosage is correct.

I’m having more headaches, and I think it’s hormonal, but I can’t really be certain.

It’s been over a year since I’ve had blood work done so I plan on arranging that once I’ve been back on T for 8 weeks or so. As I mentioned earlier, I’m going through exactly four vials of T a year (a total expense of $625.79 since April 2008.) For most of 2011, I was on a reduced dose between 160-180 mg by choice, but given the incidence of hot flashes that I was having even before this recent shortage, I’m considering going back to 190 or 200mg. I like the idea of injecting as little as I can get away with, but without sacrificing health or well-being.

In the end, testosterone shortages are a problem for Canadian trans men, but luckily full outages aren’t that common. While I certainly prefer having an uninterrupted supply of my medication, it’s good to know how my body responds without testosterone and that I don’t fall into low energy and bad moods without it.

UPDATE, 01/16/12 – Related Links:

• Current Drug Shortages + Bulletin – Shows T. Cypionate returning to the US in early Feb 2012
• Worldwide testosterone shortage??? – Forum thread about recent Sustanon and Primoteston shortages

UPDATE, 01/18/12:

My local pharmacies still can’t get any injectable testosterone in for me. My headaches and hot flashes are increasing in frequency and intensity, and I’m feeling pretty weak (my workout this morning was lame.) I guess my limit for being off T is about 4 weeks. I considered calling the doctor and requesting a prescription for Androgel, but I just got a hold of a pharmacy in the next town over who happen to have a single 10ml vial of Sandoz-made Cypionate. YES!

* I’m a bit surprised by this because I didn’t know we could get Sandoz brand T in Canada. The pharmacist noted that Sandoz is also out of stock so she can’t order more if it. She put my name on the bottle, my doc’s calling my prescription in tonight, and I can pick it up on Friday. Just a couple more uncomfortable days…

I also tend to ignore public opinion. When I polled readers at the end of No Shave November 2010, only 6% of you thought I should continue to let my beard grow wild.

On New Year’s Day 2011, I gave in and went for a clean shaven look. I regretted it quickly. I’ve never liked the shape of my chin (probably somewhat rooted in the childhood memory of my orthodontist pointing out flaws in the shape and orientation of my chin and jawline.) Plus, my skin is a bit sensitive and I developed a wicked case of razor burn by January 2.

By the time this year’s No Shave November kicked off, I already had a 3 month razor-free head start with no plans to shave come Dec. 1.

This morning, I seriously contemplated a shave: tidy up the neck line, trim down the cheeks, even things out. I hopped onto Beards.org for inspiration but wound up inspired to NOT shave. Ha! I don’t think I’ll have any trouble being crowned a MaBeGroMo Champion. The hammer’s dropped, the beard stays. (For now, at least.)

How I Care For My Beard

I almost never comb my hair, but I comb my beard several times a day. It gets tangled fast and it feels good to get at my face under that fur.

I wash it every day or two with a gentle liquid soap in the shower, and once a week I wash it more thoroughly with a KnottyBoy shampoo bar. (I’d like to find some emu oil, I hear it’s a great beard conditioner.)

I style tame it with Knotty Boy dreadlock wax. Love the stuff!

I scissor trim whenever straggler whiskers visibly exceed the length of their brothers, and I trim my (still very blond) mustache weekly.

The Ramifications of Having a Bushy Beard

I’ve noticed on a few occasions that strangers seem to react to me a little differently with a bushy beard. For example, at a grocery store recently an elderly woman looked downright terrified of  me as she hurried past me in the aisle. Another (more friendly) example: other men with big beards give me the Bearded Brother Nod. Amazingly, I still occasionally get ID’d buying liquor, but less than BTB (Before the Beard.) I sometimes get food in my beard, or bits of Kleenex in it when I blow my nose. This is kind of gross, but it’s part of the package.

My Beard Goals

Transition requires so much patience! I look forward to my mustache becoming fuller and filling in down to each side of my chin. I’m still not able to grow much in the middle of my chin and up to my bottom lip but have lots of growth at the bottom of my chin on each side. (I could rock a French Fork.) Otherwise, I don’t really have any specific style or goal in mind, aside from low maintenance, though I seem to be subscribing to the notion of bigger is better.

If my GF has any say it in, I’ll wind up with a very big beard indeed. And this is kind of a shocker as I recall telling my psychologist in my initial surgery/hormone assessment that one of the reasons I was unsure about going on T was because I didn’t think my GF would like my facial hair. Looking back, I know I came up with all kinds of reasons why I couldn’t medically transition and I can now label that: Fear.

Do you have any beard goals? What about favorite beard or shaving products or beard websites? And lastly, would you be brave enough to sport a Monkey Tail?

UPDATE, 01/28/12: No, I still haven’t shaved. My beard and I are lending support to Tarald in his mission to end discriminatory policies in Norway against transgender people. Inspired by the first Norwegian king, Harald Fairhair, Tarald is growing his beard as a statement of protest, symbolizing the discrimination transgender people face, and our fight for basic human rights. I had the chance to meet Tarald in Seattle at the 2009 Gender Odyssey conference and am proud to support him in this. “What happens to my ovaries will probably have consequences for other trans people as well.” In solidarity!

Early on in my transition, I had a chat with the local Traditional Chinese Medicine (TCM) doctor about hormone therapy. He casually suggested that I take “ostrich testosterone,” something he sometimes gives to cisgender men with low T, and indicated that I could perhaps reduce my injected T dose if I took it. I wasn’t about to start messing with my dose but I let the information percolate in my mind a bit.

Jin Tuo Yang: Gold Ostrich Masculine

I asked a few other TCM docs about ostrich T but none of them had heard of it. I went online and found a single brand of ostrich pills available from a website based in Singapore: Jin Tuo Yang, aka Gold Ostrich Masculine. The website makes some outlandish sounding claims about this “male biological treasure” and I skeptically set the whole idea aside.

Fast forward to this past fall when I developed a case of shingles: I went to see the TCM doc for treatment, and as I was leaving he handed me a small blue box containing one Jin Tuo Yang pill and suggested I try it out sometime, free of charge. (It costs $25-30 per pill.) I thanked him, then dropped it onto a shelf when I got home and forgot about it.

When I did my last shot, I ran out of T and got 120mg instead of my regular 180mg. I decided I’d inject a small amount the following week if I was feeling off at all. Then I remembered the ostrich pill! If it was something that could give me a T boost, wouldn’t this be the right time to try it out? It may have been the right time for a T boost, but I won’t be taking ostrich pills again, and here’s why:

1. Well, what is Jin Tuo Yang, really?

The ingredients listed are: “Ostrich Penis, Lycium Barbarum, Oycium, etc.” Lycium Barbarum is goji berry, aka wolfberry. I can’t find a reference to “oycium” online, but Google thinks I’m searching for “lycium.” Maybe oycium is a variant name for goji? Or maybe it’s just a spelling error. Goji plants are green with red berries. Presumably ostrich penis isn’t bright blue. I guess “etc” is bright blue? The leaflet specifically states that it “contains no any western medicine composition” but I thought to myself, Viagra’s bright blue… (In retrospect, I wish I’d cut the pill open to see if it was blue all the way through or just blue-coated.)

According to the website, “domestic and foreign biologists and pharmaceutical experts succeeded in extracting DHLA substance from genitals, kidney and testis of ostrich.” (Kidney and testicles are “etc” then?) Dihydrolipoic acid (DHLA), the King of antioxidants, is claimed to be the source of the ostrich’s ability to maintain “vigor, strength and endurance,” and is the “governing drug” in Jin Tuo Yang. Also known as Alpha-dihydrolipoic acid, DHLA is the reduced form of alpha-lipoic acid (ALA), a bodybuilding supplement for muscle growth. DHLA has been found to increase the uptake of cysteine, leading to increased glutathione synthesis. According to Paul Adcock, author of Jungle King Secrets, DHLA is the only known antioxidant supplement capable of quenching every known free radical in living cells.

The biologically active polysaccharide (LPB) from goji berries is used as an “adjuvant” in Jin Tuo Yang. Published studies have reported possible medicinal benefits of goji, likely due to antioxidant properties.

It sounds like Jin Tuo Yang is a straight up antioxidant supplement.

2. It’s not clear how ostrich penis boosts testosterone, especially in a trans guy.

In TCM, Jin Tuo Yang is used to support healthy kidney Qi, treating impotence, spermatorrhea (excessive, involuntary ejaculation), and prospermia (premature ejaculation). (See repairs, characteristics and effects.) According to the website, “it is the effect of DHLA that… secretes a large amount of testosterone.” I’m not a biochemist, but I’ve had trouble finding information that indicates that DHLA is a testosterone building block or precursor, or plays some other role in increasing bio-available T.

In China, it’s believed that consuming animal penis enhances sexual vitality. Penises of yak, water buffalo, deer, antelope, goat, bull, and snake (they have two!) are all served up at specialty penis and testicle restaurants:

• Several varieties of steamed, roasted and boiled penis at Beijing’s quirkiest diner
• Beijing’s penis emporium
• Penis Buffet – Chinese Style [video] (His face at 2:20 is priceless.)

It’s not clear to me how consuming animal penis is supposed to increase testosterone, especially in someone born female bodied, without much testosterone production to stimulate. The TCM doc and I communicate in different ways and I find it difficult to extract relevant information from him sometimes. I wonder why he thinks Jin Tuo Yang would do anything for me?

3. It gave me a massive headache!

I felt the effects of the bright blue ostrich pill within about 2 hours—in the form of a monumental headache. I don’t often get headaches and this one was mammoth. I took a couple of aspirin and it faded somewhat but I could still feel a dull ache in my skull the next morning. (The most common side effect of Viagra is headache.)

I’m always up for learning more about alternative therapies that help support my testosterone maintenance, but my experiment with Jin Tuo Yang was enough to guarantee that animal penises won’t be a part of my trans health regimen.

I first got into working out when I was about 21. My lifestyle as a working bar musician meant that I ate a lot of free pub food and drank a lot of free beer, and this led to my heaviest weight of 160 lbs. I got into cycling, then got a YMCA membership and started training under the guidance future Mr. Canada, Erik Alstrup. That winter, I dropped 40lbs and added a good deal of muscle to my small frame. I could press 450 lbs with my legs and I raced against cars on my bike down the main drag coming home from the gym. I was pumped and loving it!

When I started transition, I renewed my dedication to working out because I wanted to have as little estrogen-storing body fat as possible, and also wanted to help ensure good results with my top surgery. Since then, I’ve gone on and off exercise, due to additional surgeries, a surgery complication, a car accident and injury or illness. Through periods of wellness I’ve worked out, but then another life event would come along and derail me for a bit. Well, I’m recovered from my recent bout with shingles and ready to take aim once again!

I don’t have very defined goals, I just know that I want to drop the 10 lbs I’ve put on since the shingles and add about 20 lbs of muscle to my upper body. Dropping the weight shouldn’t be too hard because I have a killer diet technique that always works for me: no alcohol. I’ll be abstaining until my birthday in March and will re-evaluate then.

I got out of the habit of doing my daily 5km walk because my dog hasn’t been able to walk that distance for about a year now. I started doing it daily again, 4-5 times a week, beginning last month. There are some days when I can’t get the walk in for one reason or another, so I’ve found a handful of 15 minute cardio workouts to mix it up and keep me focused.

I start my workouts with some Yamuna body rolling and stretching. Next, I do 400 ab crunches (200 twist style), push ups (currently 3×40) and reverse pulls ups (currently 3×10.) 4 days a week I work out with barbells, focusing on two different muscle groups a day (ie. chest/biceps, biceps/triceps, back/shoulders, etc.)

I pay close attention to my diet and once I’ve lost the 10 lbs, I’ll amp up my eating to 6 meals a day of 30-40 grams of protein each.

Here are my starting photos, 2 years and 9 months on T, weighing in at 145 lbs. (If you compare these with my 22 months on T photos, you can see that I’ve put that extra 10 lbs on around my waist.)

Has the New Year inspired you to refocus on fitness too? What are your goals, and what are your biggest challenges in achieving them?

ps. Yes, I shaved on New Year’s Day, leaving just my ‘burns and faint ‘stache. It was fun, but it feels weird and I’m looking forward to it growing back!

Before

After

My mustache is still blond and thin, but you can see it better when I do this:

Am I right, or am I right?

Yes, my beard got a little wild this November, but I saw fewer than 10 people through the month, so I wasn’t scaring anyone. And though some people would find this wooly¹ look quite unacceptable, you know what? Growing up, I would have killed for a quarter of the face fur I have now. People always used to comment about how I stroked my bare chin. I still do this, especially while in thought, and the wiry fur I have there now feels very familiar.

What Should I Do With My Bounty?

No Shave November calls for no shaving of any kind, so I absolutely need to do some trimming and tidying. (I have mustache hairs getting in my mouth!) I’m rather proud of my sideburns and have never shaved them off. I don’t think I’m about to start now. I’m thinking, chops: shave my chin, do some shaping on my neck and cheeks. Beyond this, I’m open to suggestions. Bear in mind however that my GF has veto, particularly with regards to my mustache (re: whisker burn.)

Take Our Poll

1. “wooly”, Carson, Dec 1 2010

About Transgender Day of Remembrance:

The Transgender Day of Remembrance was set aside to memorialize those who were killed due to anti-transgender hatred or prejudice. The event is held in November to honor Rita Hester, whose murder on November 28th, 1998 kicked off the “Remembering Our Dead” web project and a San Francisco candlelight vigil in 1999. Rita Hester’s murder — like most anti-transgender murder cases — has yet to be solved.

The Transgender Day of Remembrance serves several purposes. It raises public awareness of hate crimes against transgendered people, an action that current media doesn’t perform. Day of Remembrance publicly mourns and honors the lives of our brothers and sisters who might otherwise be forgotten. Through the vigil, we express love and respect for our people in the face of national indifference and hatred. Day of Remembrance reminds non-transgendered people that we are their sons, daughters, parents, friends and lovers. Day of Remembrance gives our allies a chance to step forward with us and stand in vigil, memorializing those of us who’ve died by anti-transgender violence.

Source: gender.org

UPDATE, 11/21/10: The Transrespect versus Transphobia Worldwide (TvT) Research Project produces maps each year that graphically display the results of the Trans Murder Monitoring project. They also map the events of International Transgender Day of Remembrance.

Shingles is an odd ailment. Can we start with the name? Shingles. I have yet to come across an explanation for this creepy moniker. It’s also referred to as herpes zoster and zona. While shingles is caused by a member of the herpes family of viruses, it’s distinct:

• Herpes Simplex Type 1 -  Cold Sores
• Herpes Simplex Type 2 -  Genital Herpes
• Herpes Zoster -  Chickenpox, Shingles

There are also several additional types of herpes viruses. That’s one kick ass family of viruses, isn’t it?!

At first, I thought the rash was just hives, perhaps caused by a reaction to some red wine I recently had (which I normally don’t drink due to a mild allergic reaction to histamines in red grapes.) But these were no normal hives. They persisted too long. They burned in a way that I haven’t experience with hives. The rash can be relatively pain free, then in an instant cause searing pain, like a match has been raised to your skin. The most identifiable aspect of the rash was the fact that it was only on one side of the body. A shingles rash will never cross your mid line and affect both sides of the body. Rather odd, isn’t it? Not surprisingly, the rash is on my left side—the side of my body that almost always gets the brunt of an injury or illness.

If the payload of shingles was just the rash, painful as it is, I could handle it. But shingles can cause a number of other symptoms, including intense fatigue and weakness, both of which I have. The one that’s really whipping me though is body pain. What I thought was a return of a nagging back/hip injury is actually pain caused by shingles. The pain radiates from my lower right back (the opposite side of where the rash is), around my torso, through my abdomen, and down into my hip. The abdominal pain is weird and disconcerting. It feels like my organs hurt. I can sit and stand with only moderate pain, but laying down and trying to sleep is another story. I have a lot more pain at night and I can’t get comfortable. Sleep is sporadic.

Once I pieced together that I was suffering from shingles, I called my doctor’s office and relayed my symptoms. The doctor felt confident in my diagnosis and advised me to call back if the symptoms had not eased by 3 weeks. If I’d called in within 72 hours of the rash’s appearance, then they may have prescribed an antiviral. I’m glad we didn’t have that chance because I’m wary of pharmaceutical antivirals and vaccines. I did start taking a daily dose of oil of oregano though, a natural antiviral.

1 week and 3 days after symptoms appeared I went to see a TCM doctor. He’s seen lots of cases of shingles, and said they’re on the rise, especially in younger people. Based on his observations, he didn’t think stress was the culprit. Despite calling myself “stressed out,” he said I didn’t show the physiological markers of stress. He also didn’t see any indication that I have unwellness that would compromise my immunity, and said that I appeared to be in very good health. He called my case of shingles “an anomaly.”

Does Testosterone Lower Immunity and Cause Shingles?

No one really knows for certain why herpes zoster stays dormant and what causes it to re-activate, but lowered immunity is certain to play a role. Immuno suppression can be caused by stress. Another cause of reduced immunity is long term use of steroids, such as… testosterone.

An article on the Mayo Clinic website tipped me off to the fact that prolonged use of steroids can weaken the immune system and cause shingles. Is 2 ½ years of testosterone therapy considered “prolonged” steroid use? Could testosterone have contributed to my lowered immunity, and ultimately be the cause of my shingles?

From the looks of it, there’s enough literature out there to suggest that stress and testosterone negatively affect immunity:

Testosterone may impede immunity (November, 2004)
Decreasing testosterone boosts immunity because testosterone helps control T-lymphocytes, the attack cells of the immune system, according to Mayo Clinic-led research in laboratory animals.

This theory is not without opposition though:

Testosterone, Stress May Not Suppress Immune System After All (October, 1999)
“…Braude came across a new body of research — about a dozen studies in all over the past five years — that questions the whole idea of immunosuppression and suggests that, instead of suppressing the immune system, testosterone and other steroids play a key role in what’s called immunoredistribution.”

Out of curiosity, I pulled out my blood work lab reports just to see if they could offer up any clues. In particular, I looked at the hematology numbers for WBC (white blood cells) and lymphocytes. My WBC is perfectly normal throughout all the reports, while my lymphocytes are low across the board, but still in range. (A low normal to low absolute lymphocyte concentration is associated with increased rates of infection after surgery or trauma. Indeed, my lymphocyte count over the past few years was at its lowest after my hysterectomy when I was dealing with the VVF complication. I did manage to avoid post-op infections though.)

My TCM doctor performed some acupuncture to help lessen my body pain. He put about 10 needles in around the hot spots of the rash. “Surrounding the Dragon,” he called it. He also prescribed Banlangen tablets, a Chinese antiviral formulation that’s ideal for clearing “toxic heat.” Coming from humble folk origins, Banlangen is a combination of Radix Isatidis root, Herba Violae, and Herba taraxaci (Dandelion.) It’s become one of the most popular herbal beverages in China—a staple in every household—due to renewed concerns about immunity stemming from the SARS outbreak. I’m taking 6 Banlangen tablets three times a day. They have that intense earth/root scent of medicinal herbs, mixed with a flowery aroma. Distinctively non-Western.

In addition to the Banlangen, I’m taking 6-8 ibuprofen a day for pain, a small dose of oil of oregano daily, and have more acupuncture scheduled for Tuesday. I may look into getting some Lysine. Apparently, it prevents the absorption of arginine which the shingles-causing virus needs to stay active, and can produce almost immediate improvement of symptoms.

Preventing Shingles

Unlike chickenpox, shingles can come back. The key to preventing their return is keeping your immunity up. It’s unclear whether or not testosterone has anything to do with my lowered immunity, but it makes sense for me to look into supplements that can boost my immune system. There are a number of adaptogenic herbs and fungi that fit the bill:

• He Shou Wu
• Eleuthro (Siberian Ginseng)
• Panax Ginseng
• Ashwagandha
• Maca Root
• Reishi mushrooms
• Cordyceps

Of these, He Shou Wu and Eleuthro are recommended tonics for trans guys. Other supplements to boost immunity are vitamin D, which modulates immune function, and Zinc, which stimulates the synthesis of white blood cells and directly supports T-lymphocytes. Also, I can always eat more broccoli! It’s one of my favourite vegetables, and it contains Indole-3-Carbinol (I3C), which protects against the herpes family of viruses.

There is a shingles vaccine. However, it’s not recommended for people on steroid therapy, it’s about 50% effective and lasts about 6 years, and… remember what I said about vaccines? I’m wary. Vaccines themselves can suppress the immune system.

I’m curious about whether other trans men on testosterone have experienced shingles and/or have otherwise noticed decreased immunity? Please leave your comments below.

From November 1 – 30, participants aren’t permitted to shave any facial or body hair. And no-shave means ”no plucking, waxing, lasering, buzzing, or any other form of hair removal.” The idea is to see what you can grow in one month.

So, I shaved on October 30, just a tidying up of borders. As you can see below, I’m currently sporting a beard with a faint blond mustache. Left completely untended, this should get pretty unruly, particularly my neck! I’ll post result pics at the end of the month.

I’m dedicating my No Shave November to Brian Wilson and the SF Giants, who might just win the World Series tonight. Fear the Beard!

I’m a big fan of OP and the men behind the mag, Amos and Rocco, so I definitely wanted to submit a piece for Issue 04, Workin’ Stiff. It wasn’t without some trepidation though: I’m used to writing for the web, which is a little more forgiving than print. I’m a compulsive editor, and my words in print are immutable, out of my control. But my piece came out well, and I’d like to thank Original Plumbing’s editors for the changes they suggested—they really improved the flow of the piece.

“Telecommuting and Transitioning” is about some of the surprise difficulties I’ve faced as a telecommuting worker through my gender transition, and how those circumstances have influenced my business and business relationships.

My submission is sandwiched between innumerable pages of trans male awesomeness (literally, they’re unnumbered.) Every article is interesting and well-written, Amos’ photography is excellent, and the textured cover is a nice touch (for those who appreciate the fine details.) A highlight for me was being published in the same issue as Dylan, who was an early Gender Outlaw commentator and friend (and the producer, editor and star of the Trans MD documentary.) His article about smooth transitions at work puts a nice positive twist on what can be a really trying situation for many trans guys.

I’d also like to note that Original Plumbing’s done a fine job on CanCon, with Canadian contributors in at least half the issues so far, plus a web-only spotlight on Alberta’s Abner, and a party at this year’s Toronto Pride. Is Vancouver next, OP?

You can buy copies of Issue 04 and subscriptions to Original Plumbing online.

In Canada, there’s only one company that I’m aware of that markets a 200mg/ml injectable testosterone: Theramed Corporation. This past summer, Theramed doubled the price of Delatestryl (Testosterone Enanthate). I’m now paying about $60 CAD for 5 ml instead of 10 ml. I can still opt for Depo-Testosterone (Testosterone Cypionate) instead—at roughly half the price of Delatestryl—but Pfizer only sells a 100mg/ml concentration. This means I could get T at half price if I’m willing to inject twice the volume or switch to a weekly injection. Neither of these are appealing to me though, so I opted for the pricier Delatestryl last time I stocked. I think my preferred pharmacy still has some Delatestryl available at the old price, and I’ll check soon. I also want to ask the pharmacist if there’s any access to Watson’s Testosterone Enanthate and/or Cypionate in Canada (or, maybe Theramed has exclusive rights here?)

Related: Testosterone Cypionate vs. Enanthate

I lowered my testosterone dose after my hysterectomy because I knew my hormones would be out of whack for a bit while my body adjusted to being post-hysto. Additionally, I  started using topical DHT cream on April 29, 2009, about 6 weeks after the hysterectomy. There have been mixed results in DHT studies regarding how T levels are affected by supplemental DHT, and I wanted to err on the side of caution. My T levels dropped by almost half, but then remained steady and within normal male range. However, I wanted them in the higher end of the range, mostly because I’d only been on T for a year and had only had a few full shots of 200mg. I was still looking for significantly more virilization.

I lowered my T dose from 200mg to 180 mg from March 17, 2010 to April 28, 2010 because of the high T levels coming back in my blood work. But then I didn’t feel great: I was tired and more emotional than normal. I went back to 200mg 6 weeks later. I didn’t really give it very long, I suppose. I stayed on 200mg until July 21 when I ran out of T with 160mg in the barrel. My lab reports were still showing high T, and I felt fine in the couple of weeks that followed, so when I did my next shot I drew up 180mg instead of going back up to 200. I’m going to try staying on this dose for a few months and re-evaluate. So far it feels fine, not like earlier this year.

Because the use of testosterone can affect the health of the liver, I plan to start taking milk thistle for liver support soon. It’s important to be cautious about what you take for liver support because some herbs can cause unwanted metabolic changes to hormones, limiting the effectiveness of HRT. Milk thistle is recommended though. I should be able to source a wild crafted tincture from the local herbalist, but milk thistle tincture is widely available in health food stores and online.

Lastly, for my your enjoyment, I made this fancy chart that shows how my T levels and dosage have changed over 2 ½ years.