This is so real. I felt exactly the same as the OP before I started fellowship; I truly understand how frustrating it is to see the obviously dying patient and feel like you are the first to have a hard conversation with them. I decided early on that I would never be "that oncologist" and I make a very, very deliberate point of discussing (and documenting!) treatment intent and prognosis early and often using simple language.

Despite this, I have still had patients look at me with bewildered eyes when I told them that their cancer had progressed through 3L chemotherapy and that I did not feel that I could safely offer them more treatment. It is a bit crazy-making! I am so sure that those patient's PCPs / hospitalists / ED doctors, etc., think that I am a total scumbag, lol.

That said, some oncologists really do shy away from tough conversations, I know. And it sucks. It always sucks. It sucks when the oncologist DID have the conversation, too! Sorry that you experienced this phenomenon, OP.

Okay, so, this is "hot off the presses" - I am a hematologist (doctor that specializes in blood disorders) and I am currently doing a study looking at how starting testosterone impacts iron levels. I have a theory that it causes iron deficiency (because it causes our bone marrow to make more RBCs, which eat up our iron stores). This theory is based on trends that my colleagues and I have seen in our clinics. But my research is still in progress so I can't say that this is definitely "real." Right now, the official answer is that there is no known link between starting T and developing iron deficiency anemia.

Hey! My wife got testing done as part of our fertility counselling and I had the same question. I talked to a genetic counsellor friend, and she strongly advised me to do the Natera test (or equivalent); she said that 23andMe really can't give you the detail that you need to feel confident about your carrier status. It doesn't test for enough variants, and it is not as reliable as testing through a group like Natera. We ended up doing the full genetic testing and that's what I would suggest for you as well.

Sending care. I'm a trans man married to a cis woman; we can relate to how you feel. While I am so, genuinely excited to start our family using donor sperm, it would be disingenuous of me to pretend that I don't have moments where it all feels terribly unfair. I would love to be able to just... make a baby, you know? Just me and her. But it is what it is. To be honest, I think it is even harder on my wife than it is on me because I've had a decade to come to terms with all this.

All this to say that you are not alone.

This is a totally appropriate place to ask this question, but FYI, I just found r/Queerfamilies and I wonder if that might be a good resource for y'all as well. Congratulations and best of luck!

Not stupid but consider driving to OR or WA for care. Out of pocket costs for injectable T are quite reasonable with GoodRx these days.

Hopefully, someone else here can give you some specific names of surgeons! Best of luck to you.

Is CalOptima one of the public healthcare plans in CA? If so, your surgeries should be covered even if there's no one in network. You'll have to request an out-of-network exemption, but this should be granted since these are medically necessary procedures.

HRT is not required for top surgery these days. You may run into more trouble with bottom surgery, although if you were on T for 2+ years before you stopped, it might be fine.

Ugh, I'm sorry, man. This sounds incredibly frustrating. I went through something similar when I was first transitioning (but with friends rather than a parent) and I'm not gonna lie, it hurt my feelings. Like some of the others, I find myself feeling a little skeptical that a resource or explanation will be a fix for this problem; I suspect that you've already done a really good job talking this out!

That said, and operating under the assumption that your mom is approaching this in good faith and out of a place of love, I think that you could probably go in one of two directions here:

1.) Instead of trying to explain the "validity" of your binary identity, try to explain the emotions that you feel when she misgenders you. Like, "Mom, it really hurts when you say that I should be NB/third gender. That's not how I see myself and it feels just as wrong to me as when people say that I'm a girl. I am a boy, plain and simple. Can you please try to think of me this way? It is extremely important to me." Be direct so that there is no confusion about how you feel and what you are asking.

2.) Just medically transition. It will be hard for your mom to see you as NB/third gender when everyone else in the world sees you as male.

What? Girl, you need a CT of your chest. This has nothing to do with spironolactone.

Yes, and it's baaaaad. I think we're coming to the end of it but WOOF.

Maybe a nickname derived from his first name? Like "bobo" for a dad named Bobby.

Awesome advice. As an aside, I also really like Cancer Care Ontario's website for protocol stuff. They have good patient handouts as well.

Welcome!! I'm a 3rd year fellow and one of the chiefs at my program.

My 2c: First year is a total "drinking from the fire house" situation -- much more so than anything I experienced in medical school or IM residency. I felt totally lost and on the brink for the first half of the year. That said, I survived and so will you. I really don't think that you need to look stuff up in advance. The truth is that you will feel incompetent... and that's okay, because that's just what being a first year is like, haha. It's all very "internship part II."

My sincere advice is to just enjoy the last week of your vacation. Cramming for a week will just stress you tf out. Show up rested and ready to go instead.

Absolutely nothing will happen brief 1x contact. Don’t worry too much about this.

Totally anecdotal, but I did not personally encounter any issues with my surgery (meta with UL, scrotoplasty, v-ectomy) despite having severe atrophy noted on my operative report. 🤷🏻‍♂️

Agreed - I would double check on this. The counselling we had was explicitly about the use of donor gametes; I don’t think our clinic would have required this had we been using all our own eggs and sperm.

BFFs: Goldens, labs, shepherds, malinois, any puppy around 6 months
Nemeses: Corgis, french bulldogs, chihuahuas, tiny white dogs

She is totally disinterested in other cattle dogs, sadly. :(

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Aw, nuts. That blows. And presumably, you have "no evidence of disease" so there is no additional tissue to test...

I wish I could tell you the "right" answer. I am an oncologist, so, of course, I am over here like, "She's so young! Her doctors should do everything possible to protect her from cancer recurrence!" but I truly do understand that endocrine therapy has had a negative impact on your health/wellbeing and that the actual gains from extending your treatment are likely to be small. I am afraid that you might just have to let your doctors fight it out and decide what is highest risk FOR YOU. Wishing you the best of luck.

Hi friend. This is not a forum where we can answer personal medical questions, sorry. Speaking generally, there is a lot of debate about the 5 year vs 10 year thing; there is some good evidence to suggest that 10 years > 5 years, but obviously, that is a very big ask for patients, especially young ones like you. I understand your hestitance. Hope you get answers/thoughts from the breast cancer sub.

Another nonspecific suggestion: Can you consider asking your oncologist about BCI testing? (www.breastcancerindex.com) This can help guide treatment plans when doctors are deciding between 5 and 10 years.

HNSCC is kind of my clinical niche, so I think it's very interesting, haha. I care for adult patients, but I would be flabbergasted to see a patient that young in my (medical oncology) clinic, so I do think it is worth presenting this case. That said, it can be easy to get into the weeds with these oncology cases. Who are you presenting to? Other interns?

Yeah, it’s super overwhelming and it can feel isolating at times, but you are not alone! Not worth stressing about at the moment, but know that you will have resources and community when you need it. :)

I’m so sorry you got that reaction from your MIL; that would have made me wince so hard. Family building can be really fraught for LGBTQ+ folks and I truly wish people would just shut their mouths instead of blurting out these kinds of insensitive comments.

Anyway, I think that using a known, related donor sounds really lovely. My wife and I would have seriously considered this if we had had the chance. We have elected to go with a “known at 18” donor from a bank because don’t have any cis men in our lives who could serve as a good donor, but a lot of donor conceived folks feel that using a brother or relative, like you are considering, is the best option. But of course, there is more than one way to skin a cat and it is hard to go wrong when you approach this with thoughtfulness and love, as you clearly are! When you guys are getting closer to actually trying to conceive, checkout the /r/queerception subreddit - I have found it to be really useful and supportive.

Congrats on getting married, btw! (Edited for typo.)

I can understand this. Your parent loves you. They love your hands, your face, your voice, your shape, your spirit. The thought of waking up one day and never seeing you as you currently are can feel like a loss. That last part, your spirit, is the most important thing and that’s what makes transition so important — all the other superficial things can change as long as the essence of You remains and thrives. But some people still feel a deep ache when they think about losing the you-as-you-are and they worry that they will miss those parts of you profoundly.

At the end of the day, I have found that for most supportive folks, this is an anticipatory grief more than anything. My own mom was devastated at the thought of never hearing her “daughter’s” “sweet, feminine voice” again. But when my voice actually dropped, she adjusted quickly, because at the end of the day, it was still MY voice and that’s what mattered most. I truly don’t think she gives a fuck these days.