Estrogen Coronavirus Transgender Women

Golden Sikorka/Shutterstock Ana Valens

Why using estrogen to fight coronavirus raises alarms for trans women

What happens if COVID-19 patients get gender dysphoria?

Apr 28, 2020, 7:21 pm*

IRL

Ana Valens 

Ana Valens

Opinion

First, President Donald Trump suggested drinking bleach. Now, the New York Times has a breakthrough in the fight against the coronavirus pandemic: force-feminizing cisgender men. Scientists in Los Angeles and Long Island, New York, theorize that administering progesterone and estrogen in cisgender men could help them fight COVID-19.

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The idea comes as a solution to a curious gender gap in coronavirus care. Women are much more likely to recover from the coronavirus or only experience mild cases, while men are more likely to die from the disease. Some have theorized that (cis) men are at risk because COVID-19 is stored in the balls. Now, interest turns to whether feminizing hormones could be the real key to preventing men from dying.

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Estrogen is a hormone, which means it binds to cells to direct their behavior. Estrogen doesn't so much cause feminization as it replaces the instructions sent by testosterone in the body, thereby changing cell behavior. In trans women awaiting hormone replacement therapy (HRT), testosterone is predominant in the body, so it sends instructions to cells that lead to masculine, not feminine, characteristics. This is why trans women undergo a shift in their physical build and appearance as they continue their HRT regimen: The proper instructions result in feminine facial features or breast growth, so long as testosterone remains suppressed, and estrogen becomes the predominant hormone.

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This is great if you're a trans woman. Exposing a cisgender man to estrogen, however, could lead to some unintended side effects.

No better example exists than Dr. Will Powers, an LGBTQ care physician. On his official subreddit, Powers talks about a special facial moisturizing formula where he microdoses around 2mg to 4mg of estrogen per week to help improve his skin. Powers, a professional in trans care, relies on these specific numbers to assure his testosterone and estrogen levels remain baseline for a cisgender man. Its application means his skin looks as young as ever, but any other impact on his body is minimal.

By mistake, Powers wrote himself a 100mg prescription for estradiol, which is used for patients undergoing feminizing HRT. He slathered .2 grams worth of estrogen on his face over two days, and he had a deeply disturbing nightmare followed by chest pain. After he noticed one of his nipples was "hard as a rock and insanely painful," he caught the mistake: He had given himself 200mg of estrogen in just two days.

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"Dysphoria crashed over me like a literal wave as I was scrambling to think how I could undo my screw up. Thankfully, two days later, all went back to normal," he wrote. "However, during those two days when my estrogen was like stupidly high, I could not stop thinking about how awful it was and how much I didn't want those changes to happen to my body... It literally dominated my thoughts for 2 days and I had nightmares about it."

It's unclear how much estrogen and progesterone doctors plan to prescribe COVID-19 patients. But the Times warns COVID-19 patients undergoing feminizing hormones may experience "tenderness in the breast and hot flashes." If doctors plan to provide sustained feminizing hormone access to cisgender men over an extended period of time, they could find their COVID-19 patients sick with gender dysphoria.

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Trans women have since joked about this study by comparing it to force-feminization porn stories, but this isn't out of condescension. It's out of shock. Reprioritizing feminizing hormones for cisgender men could potentially burn through estradiol supplies and further strain medications' supply chains. Trans women in the U.K. are already experiencing limited access to refills, and under-the-table online retailers have seen noticeable shortages, Dazed reports.

Not to mention, sudden accessibility to estradiol and progesterone equally stings trans women who fought for months, if not years, just to access hormone therapy. When a cis person's life is in danger, red tape comes down. But when a trans person needs a life-saving medication to prevent further mental anguish or suicide, their safety is deprioritized.

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Health risks, collateral damage, supply chain issues, and double standards are all afoot if researchers decide estrogen is the COVID-19 miracle drug of choice. Research into trans men and women diagnosed with COVID-19 would provide far more data regarding whether estrogen and testosterone help fight the coronavirus. But if none of these arguments convince cis people to start looking into other solutions, then the Times has one key insight into fighting the coronavirus: Menopausal women are still outliving their male counterparts.

"Older men are still disproportionately affected, and that suggests to me it’s got to be something genetic, or something else, that’s not just hormonal," Dr. Sabra Klein told the Times. "Estrogen has immune modulatory properties — don’t get me wrong. You could get a beneficial effect in both men and women. But if women are better at recovery at 93 years old, I doubt it’s hormones."

So if estrogen plays a role, it might only be a small part of a much larger jigsaw puzzle. And this piece is one that trans people know much more about than their cisgender counterparts.

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*First Published: Apr 28, 2020, 3:19 pm