Matt Kailey

Welcome to a special Thursday edition of Tranifesto, with more Ask Matt questions. I’m hoping to catch up on my backlog of questions, and, as always, I’m hoping that readers will supply their wisdom in the Comments section. Today’s questions are:

A reader writes: “I have a pretty scary question. I’m a trans man, and pretty early in everything, so I used to like looking accomplished trans men up online to have some celebrities to feel some sort of connection to.

“But then I noticed than trans men seem to die pretty young – at least the ones mentioned in ‘famous trans men’ lists all around. So many died before they were even fifty or sixty. And now I just saw another memorial post on Facebook for a guy who died, also before his 50th birthday.

“I know that it’s probably a coincidence, and that all the trans men who live long, happy lives are probably never heard of. But I just have this nagging fear inside that it might have something to do with medical conditions that aren’t being noticed because of bias in the medical system, or something to do with testosterone or … you get the picture.

“My doctor doesn’t know anything about anything, so now I ask you. Maybe you and your readers know something. Do you know if there is any kind of medical study of how trans men in general do medically after transitioning?”

The one thing I do know is that you will never get out of this life alive. I’m not trying to be snarky. You will die of something, and my philosophy has always been that I would rather die after having lived a full and authentic life than after having lived as someone I am not.

There are some health risks associated with testosterone, but for most people, these can be mitigated. From what I have read, trans men overall have the same life expectancy as non-trans men, which is slightly shorter than for women.

Some of the guys who you have read about have committed suicide. Lou Sullivan, a very famous trans man who is probably on many of those lists, died from complications related to AIDS. Robert Eads, another very well-known trans man, died from ovarian cancer. Both of these deaths were quite likely complicated by bias in the medical system.

Many of the guys you have probably read about would have died whether they transitioned or not. They might have had some overlooked or undiscovered health problem that would have killed them regardless. They might have developed a terminal illness that had nothing to do with testosterone. The only reason you know about them is because they were trans.

I will turn 58 in March. I know that Jamison Green, one of the most famous trans men in the world, is a hair older than I am. My very best trans-guy friend will retire this year at 62. Both James and my friend have been on testosterone longer than I have, and I have been on it for 15 years.

There are honestly a ton of trans guys over 50 out there. Some of us might not be as visible because we have assimilated into the mainstream and are not visible as trans men, or because we are not as Internet savvy (or as interested) as the younger guys who grew up with technology.

So don’t freak out about dying young. I can’t guarantee that you won’t, but I can guarantee that you will hear more about people who die than you will about people who are living, because death is almost always a shock, and when someone dies, people will talk about it. People also tend to elevate dead people to a higher plane out of respect, which draws more attention to them.

Here’s what you can do to mitigate any health concerns associated with T:

1. Get your cholesterol, blood pressure, red blood cell levels, and liver functioning checked regularly. I take cholesterol medication. My friend takes medication for high blood pressure. Both of these conditions can be exacerbated by testosterone, but we’re both fine as long as we’re on our meds.

2. Don’t smoke (this, not T, is what is going to kill me), exercise regularly, try to maintain a weight that’s right for you, and try to eat as healthy as possible. This is good advice for anyone, but one thing that T can do is cause fat redistribution around your middle, which is the most dangerous place to carry fat. It puts you at higher risk of heart attack and stroke, so try to keep it away from there.

3. If T has increased your anger or hostility levels (for some guys, it does, and for some guys, it doesn’t), try some regular meditation or anger management techniques. Research has shown that the thing that kills Type A personalities (hardworking, competitive, time sensitive, quick to anger) early is heart disease, and the heart disease tends to stem from anger.

4. Get regular PAP tests and pelvic exams if you still have your original reproductive organs.

5. Find someone who will act as your advocate if you become too sick to advocate for yourself. Even if you develop some illness that is not related to testosterone, there is always the possibility that you will experience bias in the medical system because you are trans. If you have someone to monitor your care and treatment, that person can hopefully prevent some of this from happening.

I would also suggest referring your doc to some helpful sites like Hudson’s FTM Resource Guide and The Transitional Male, as well as the publication Medical Therapy and Health Maintenance for Transgender Men: A Guide For Health Care Providers, for some good information.

But my advice is not to sweat it. Testosterone has its dangers, but so does estrogen – even when your own body is manufacturing it. If you had been born male, you would be dealing with the dangers of testosterone, just like every other guy. Take care of yourself and you will live the life span that you are intended to live. None of us knows what that is. So we just have to keep on going and hope for the best.

Readers, what do you think?

A reader writes: “I read that you had some luck with Anthem Blue Cross Blue Shield. My fiancé is a trans guy living in San Francisco who has been off of T for 1.5 years or so (by choice). We just got a new insurance policy under Blue Cross Blue Shield and are looking for trans- and queer-friendly docs affiliated with them. Do you have any specific recommendations?”

I haven’t had health insurance for so long, I can’t even remember what it was like. But I did have some luck with both Anthem and Kaiser when I had them with regard to being trans friendly and having some trans-friendly docs under their auspices. And if anyplace would have trans- and queer-friendly doctors, it ought to be San Francisco.

The problem is that I don’t know any general practitioners at all in that city. I’m hoping that readers who live out there can help, so I am opening this up to my readers by the Bay.