Interview between our own covergirl
Danielle Foxxx and Endocrine Specialist
John O’Dea, MD
Precision Hormone Therapy
SO JOHN, LET’S FACE IT, IT’S BEEN YEARS SINCE I FIRST CONVINCED YOU TO WRITE AN ARTICLE ON HORMONE THERAPY FOR TRANSFORMATION MAGAZINE, IN FACT YOU WERE THE FIRST DOCTOR WITH THE GUTS TO PLACE AN ADVERT IN ANY POPULAR TRANSGENDER MAGAZINE, WHEN YOUR COLLEAGUES WERE BIASED AGAINST IT, TRUE?
Yes Danielle, I believe you’re right. I remember my initial advertisement was positioned right beside a bondage ad. I remember thinking my mother must be rolling in her grave but of course over the years we became experts in the field of transgender medicine and whatever fears we had either of transsexuality in general or of shemales in particular, even those involved in the porn industry, quickly evaporated. In fact over the years I have found my trans-patients to be the most appreciative and easy to deal with. They have an IQ around 30 points above the average and most of the ones I met were pretty darned nice.
Hormones Especially Designed for the Trans-Woman
THESE DAYS YOUR LOS ANGELES OFFICE IS LOCATED IN MARINA DEL REY. THAT’S ABOUT TEN MINUTES NORTH OF LAX, RIGHT ON THE WATER BUT YOU ALSO REGULARLY TREAT PATIENTS IN SAN FRANCISCO, SAN JOSE AND LAS VEGAS. SO BRIEFLY DOC, WHAT WAS YOUR MESSAGE BACK THAN ABOUT HORMONES, WHEN YOU STARTED TREATING TRANSWOMEN, AND HOW HAS IT CHANGED OVER THE YEARS?
It seemed to me that hormone therapy for the trans-woman back then was quite primitive. It involved copying the way women were treated for menopause, usually involving tablets of horse estrogen with or without oral MPA (medroxyprogesterone acetate) and multiplying the doses of these highly unnatural drugs times three or four. And it involved getting clearance from a psychologist before you could even take hormones, as if the transgender drive were psychological, what nonsense? The whole process made no sense to me so I designed a new approach starting from the ground up, based on a novel set of principles. The first was that one should never take hormones by mouth. The use of oral hormones maximized risks and minimized benefits. By passing first through the liver, estrogen increased the risk of clots, weight gain and fluid retention. At the same time feminization was slowed and limited because oral estrogen increased the levels of binding proteins, whose presence prevents estrogens from working. Instead of using oral hormones I focused on estradiol pellet implants, which by bypassing the liver pretty much eliminate clotting risks and problems with binding proteins. These hormones worked wonderfully in women whose uterus and ovaries had been removed, where all other hormonal treatment systems had failed them miserably, so why not use them in transgendered patients as well? I believe I was the first doctor to do this for the trans-patient, and the only one for at least fifteen years. But if imitation is the highest form of flattery, over the last ten years some other physicians have slowly began to copy me, though they often give what I would consider the wrong doses. Hormone therapy is not a simple matter; it requires endocrine training and lots of expertise. Using the right doses of pellets I was able to minimize mood swings, bypass the liver and keep testosterone under wraps all the time. I also supplemented pellet treatments with injections of estrogen and progesterone and developed my own forms of long-acting progestin injections.
SO WHAT DID YOU DO WITH THE SHE-MALES? THEY OFTEN AVOID HORMONE THERAPY AND DEPEND ON BREAST IMPLANTS AND SILICONE INJECTIONS TO SIMULATE FEMININITY; FOR FEAR THAT A DROP IN TESTOSTERONE WILL KILL THEIR ERECTIONS.
You’re so right. The she-male patient doesn’t know that she can have her cake and eat it too. Many girls try to put on femininity like an overcoat. We believe that femininity should start on the inside and work its way naturally outward. We call this “fractal femininity”. One of my patients put it perfectly. She said “my essence should be thoroughly feminine, and not just my outer shape”. She knew that the she-male who doesn’t get adequate estrogen but depends instead on plastic surgery for her feminization simply isn’t convincing and too often looks like a caricature. Hormones offer us a better way. Using the right blend of hormones we can soften up the body, make it naturally feminine, and yet keep that vital organ working perfectly, if the individual girl wants to keep it. Of course it takes a lot of expertise to work out the right hormonal blends so that a girl can look truly beautiful while continuing to have erectile function, but it can be done. And if the organ starts shrinking too much, that too can be regulated; all you have to do is ask. In addition we designed special erection pills just for the T girl, to help her further.
SO DOCTOR, NOW THAT YOU’VE SPENT ALL THESE YEARS DESIGNING HORMONAL THERAPIES FOR TRANS-WOMEN, IS THE PROBLEM SOLVED? IS THERE SOME SIMPLE PROTOCOL YOU JUST PLUG INTO THE COMPUTER SO THAT SURGEONS, GPS AND EVEN PSYCHIATRISTS AND DERMATOLOGISTS COULD EFFECTIVELY DO THE SAME JOB?
Danielle, you get what you pay for. If you buy hormones over the internet, don’t be surprised if you end up with major mental problems. And if you get your hormones from somebody lacking in hormonal knowledge, experience and expertise, don’t be surprised if you end up facing major physical and mental complications such as depression, diabetes and weight gain. Also remember when you first begin hormone therapy that even the best doctor isn’t psychic. At the beginning of treatment there has to be some trial and error, so as to discover your unique blend. It’s important that you return for an adjustment relating to your very own response to a given hormonal combination. Not all trans-women are the same and they cannot be treated with some standard protocol, some rigid approach, some one-size-fits-all form of treatment. For a long time I have said that “we don’t treat transsexuals, we treat people” and I stand by that approach. The real objective with the trans-woman is to deliver natural, effective feminization without putting the patient at great risk or causing a lot of side effects. At the same time, trans-women may suffer from other medical conditions that complicate their treatments, such as insulin resistance. If insulin resistance is present, it alters our transforming formula. Another of my sayings is this; “if you want to have a truly feminine body, don’t try to put on femininity like a superficial overcoat, develop your femininity naturally, from the inside out, through the immense power of hormones.” Plastic surgery can give you breasts, but it cannot give you the hourglass figure and the narrow waist you really need. Hormone therapy surely can.
New Developements From The Cutting Edge
OKAY JOHN, NOW THAT WE KNOW ABOUT THE EXPERT’S APPROACH, WHAT NEW AND EXCITING PRODUCTS DO YOU HAVE IN THE WORKS? I KNOW YOU DON’T REST UPON YOUR LAURELS.
Well yes, we have continued to be innovative and we have come up with a new delivery system that allows me to be more flexible and precise in my treatments. Pellets are still the best way to deliver estradiol and the long acting progestin complex is my favorite way to deliver progestins but now I have personally designed an array of hormone gels that can be tailored to our different types of trans woman, both pre-operative and post-operative and those better suited by a progestin-heavy or an estrogen-heavy combination. The gels can be potent or mild or in between, depending on the blend we need, and involve different concentrations of estrogens, progestins and androgens. I call this concept Precision Hormone Therapy (PHT).
SO YOU KEEP ON MOVING FORWARD, DOC?
Yes Danielle, it’s called progress, and it depends on real expertise, knowing what you are doing, and having the mindset to be innovative, in contrast to the mindlessness of cookbook medicine. It’s what America is and always has been about, moving forward flexibly and refusing to worship or remain bogged down in mindless tradition. I hope we never lose it. John O’Dea, MD is an endocrinologist who has been treating transgendered patients and hormonally disrupted pre and postmenopausal genetic women for years. A major interest of his is the impact of sex hormones on brain and mind. His Los Angeles area location is situated in Marina Del Rey, about ten minutes north of LAX and he also provides services in the San Francisco, San Jose and Las Vegas areas.
John O’Dea, MD
4560 Admiralty Way, Suite 112
Marina Del Rey, California, 90292
(310) 482 3530
This article was originally published in Transformation 77 December 2011