Now this might seem like a perfectly reasonable question for a trans person to ask a trans man.  After all, that’s what some trans men do, right?  Some transsexuals take hormones.

Heck, we might even get together as a group and talk about it, or some folks will blog about it, or make videos on YouTube about it.  All this hormone business is out there in the trans-o-sphere and no one thinks twice about one trans person asking another whether they’re taking hormones?

But what if a non-trans person had asked a trans person that question?

If a non-trans person were to ask me personal questions about medical treatments, such as whether I was taking testosterone, I might put that question in a blog post, with a list of inappropriate things that non-trans people say to trans people.

Or if a non-trans person asked me whether I was taking testosterone and that person happened to be a dental hygienist, I might write a blog post about inappropriate ways that health care providers treat trans people.

But in this case, it was trans people who asked me whether I was taking hormones to medically transition.  And so now, I ask you —

Is it any more (or less) appropriate for a trans person, rather than a non-trans person, to pose these sorts of questions to someone about their medical treatments?

Is there a double standard?

Readers, what do you think?

With the information from that previous post in mind, we will now consider the functional aspects of the ovary, those being production of steroids and ovulation of a mature egg.

Steroidogenesis
In order to talk about steroid production by the ovary, we need to talk about the brain first. There are two parts of the brain responsible for control of reproduction, the pituitary gland and the hypothalamus.  The pituitary is a tri-lobed structure situated mid-brain at the base, nestled in a protective pocket in the bone of the skull.  The two main functional parts of the pituitary gland are the anterior and posterior lobes, with the intermediate lobe being non-functional in humans.

Cross section of the human brain showing the pituitary gland. From "Gray's Anatomy"

It is the hypothalamus of the brain that controls the pituitary gland via two different means for the two main lobes.  The posterior lobe of the pituitary is composed of neural tissue and is in communication with the hypothalamus via neurosecretory neurons that reside in the hypothalamus and send axons through the median eminence and pituitary stalk into the posterior lobe.

The communication of the brain with the anterior pituitary is by a capillary plexus, a blood portal system that delivers neuroendocrine signals from the hypothalamus through the median eminence and pituitary stalk directly to the endocrine (hormone-producing) tissue of the anterior lobe.

Hypothalamic-hypophyseal blood portal system. From Reeves, 1987.

I’m not going to go into a lot of detail about all of the hormones the pituitary gland produces and what bodily functions and mechanisms are controlled by this small yet very important endocrine gland; you can read that information here.

Instead, I’m going to focus on the hypothalamic/anterior pituitary/ovarian axis that orchestrates reproductive function in females, with the direct control of the anterior lobe by the hypothalamus being modified by hormones from the ovary in a feedback loop mechanism.  (The hypothalamus and anterior pituitary are also important for reproduction in males, which will not be covered in this post.)

Two glycoprotein hormones that are produced by the anterior lobe of the pituitary and important for ovarian function are  Follicle Stimulating Hormone (FSH) and Luteinizing Hormone (LH).  These are gonadotropic hormones in that they are trophic (stimulatory) to the gonads, specifically the ovary for the goals of the current discussion.  (FSH and LH also have actions in the testes of the male.)

The production and secretion of the gonadotropin hormones from the pituitary are under the control of Gonadotropin Releasing Hormone (GnRH) from the hypothalamus.  (As a side note, GnRH analogs are used as puberty blockers in trans children, but that’s a topic for another post.)

We’ve already heard a little bit about the stimulation of gonadotropin production by GnRH in the previous post about the ovary, the one dealing with folliculogenesis.  We also learned that FSH acts upon the granulosa cells of the follicles, stimulating them to proliferate and differentiate, pushing follicular development from secondary to tertiary and finally to Graafian follicles.  (Hence the name of the hormone.)  But what about LH, what does it do, and how do FSH and LH stimulate steroidogenesis in the follicles?

Well, both FSH and LH are required for ovarian steroidogenesis because estrogen production actually occurs in two different cell types, the theca interstitial cells and the granulosa cells, which are under control by the two different gonadotropins as part of the Two-Cell, Two-Gonadotropin Concept.  This is a bit simplified because other hormones and factors are involved (such as insulin, for example), but basically, LH stimulates the theca interstitial cells to produce androgen which is then converted to estrogen by the granulosa cells under the stimulation of FSH.

In order to see this in more detail, let’s first look at steroidogenesis in the ovarian follicle starting with the pathway in the thecal cells.

Androgen Biosynthesis, from Arici & Hochberg, 2002.

The pathway above requires several different enzymes that are located in the theca cells:  P450 side chain cleavage (P450scc, which converts cholesterol to the first steroid in the pathway), 3-beta-hydroxysteroid dehydrogenase/isomerase (3β-HSD/isom) and P450-c17-lyase (P450c17).

The expression of these enzymes in the theca cells begins when the follicle starts to develop an antrum during differentiation from the tertiary to the antral stage.  In conjunction with expression of these steroidogenic enzymes, the theca cells start to produce androgen, mainly in the form of androstenedione as mentioned in the figure legend above.

Next, the androstenedione goes to the granulosa cells and is aromatized by P450-aromatase enzyme (P450arom) to estrone which is then converted to estradiol by the enzyme 17-beta-hydroxysteroid dehydrogenase (17β-HSD).

Conversion of androgen to estrogen in the granulosa cells, from Arici & Hochberg, 2002.

Expression of 17β-HSD in granulosa cells appears to be constitutive (automatic) in follicles from the primary stage all the way to preovulatory Graafian follicles.  It’s the expression of aromatase, stimulated by FSH in the putative dominant follicle when it is approximately 1 mm in diameter, that results in the production of estradiol.  And so, with the growth of the dominant follicle, there is an increase in steroid production.

Follicle Growth, Steroid Production and Gonadotropins, from Erickson, 2002.

Ovulation
And so now that we understand all the players – the gonadotropins FSH and LH from the pituitary, steroids from the ovary and the process of folliculogenesis – how do these all work together to result in ovulation?

We know from our discussion of folliculogenesis that cohorts of follicles are growing all the time in the ovary, but only one follicle will become dominant during each menstrual cycle, with others in its cohort becoming atretic and regressing.

During folliculogenesis, FSH from the pituitary is increasing to stimulate follicular growth.  Once the dominant follicle is selected, estradiol production begins to increase as the follicle grows (as shown above).  In the human, this period is called the Follicular Phase and occurs during the first 14 days of the 28-day menstrual cycle.  As estradiol produced by the follicle increases, it feeds back to the pituitary to decrease FSH release, causing all antral follicles except the dominant one to become atretic due to lack of sufficient support by FSH.

Follicle recruitment, selection & atresia. From McGee & Hsueh, 2000.

Also during the Follicular Phase of the cycle, GnRH from the hypothalamus stimulates LH release from the pituitary in a pulsatile fashion which induces androgen production by thecal cells as mentioned above.  As the dominant follicle grows and its production of estradiol increases, the estradiol reaches peak concentrations at mid-cycle and, in a positive feedback loop, stimulates a huge surge in gonadotropin release by the pituitary.  It is the gonadotropin surge that is responsible for a number of well-coordinated biological processes at this time.

→  FSH stimulates the final morphological changes in the pre-ovulatory follicle.  It grows to its largest size and protrudes from the ovarian surface while enzymes are produced within the follicle that digest the stigma, point where the egg will be released at ovulation.
→ FSH acts on the cells of the cumulus oophorus, the special granulosa cells that surround the oocyte/egg and causes the entire complex of cells to expand.
→ FSH and estradiol both act on the granulosa cells to induce expression of LH receptors.
→ LH induces changes in the steroidogenic machinery of the follicle, inhibiting androgen production (and thereby cutting estrogen production as well), which results in the production of progesterone.
→ LH acts on the oocyte, which has been locked in early meiosis since birth, and stimulates it to undergo the first meiotic division, thereby rendering it ready for fertilization.
→ LH stimulates rupture of the stigma and release (ovulation) of the cumulus cell mass containing the oocyte from the follicle into the oviduct.
→ LH induces a complete morphological change of the ruptured follicle to a new structure called the corpus luteum (CL), which is Latin for “yellow body,” and stimulates it to produce progesterone.  (A CL can be seen in cross-section of the ovary shown in the micrograph at the top of this post.)

Plasma concentrations of steroid hormones and gonadotropins during the menstrual cycle. From Groome et al., 1996.

So what then is the ultimate goal for all of these biological processes?  To deliver a mature egg to the oviduct, the site of fertilization.

If the egg is fertilized (by a sperm cell), the resulting embryo makes its way down the oviduct to the uterus which has already been prepared to accept it.  The estradiol that was produced by the follicle during the Follicular Phase induced a buildup of the endometrium, the lining of the uterus, so that it becomes a receptive and supportive environment for the embryo to implant.

After the gonadotropin surge, the progesterone from the CL maintains the endometrium in its pregnancy-ready state during the second half of the menstrual cycle, the Luteal Phase.  If an embryo arrives and implants into the uterine endometrium, it sends signals back to the ovary to maintain the CL and its production of progesterone during pregnancy.  If no embryo implants, the CL regresses and progesterone production falls, thereby removing support for the endometrial lining which is subsequently sloughed during the process of menstruation and the cycle starts over again.

Cycle of the uterine endometrium (shown in the upper panel in cross-section) and hormones. From Shepperson & Vernon, 2002.

Next Posts
With the material covered in this post and the previous post about folliculogenesis, we now have a foundation of information that we can use to consider the next topic in this series, Polycystic Ovary Syndrome (PCOS).  The discussion on PCOS will then be a prelude to the discussion about PCOS in trans men.

–ATM

References – The information provided above was taken from the following references and the references therein:

Arici A & Hochberg RB, 2002, Steroidogenesis. In:  Gynecology and Obstetrics, Sciarra JJ, ed, Vol 5, Chapter 1.

Erickson GF, 2002, Follicle Growth and Development.  In:  Gynecology and Obstetrics, Sciarra JJ, ed, Vol 5, Chapter 12.

Ferin M, 2002, The Hypothalamic-Hypophyseal-Ovarian Axis and the Menstrual Cycle.  In:  Gynecology and Obstetrics, Sciarra JJ, ed, Vol 5, Chapter 6.

Images:

Arici A & Hochberg RB, 2002, Steroidogenesis. In:  Gynecology and Obstetrics, Sciarra JJ, ed, Vol 5, Chapter 1.

Erickson, GF, 1986.  Analysis of follicle development and ovum maturation.  Semin Reprod Endocrinol 4:233.

Erickson, GF, 1987. The ovary: Basic principles and concepts. In: Endocrinology and Metabolism, 3rd edition, Felig P, Baxter JD, Broadus AE, Frohman LA, eds., New York: McGraw Hill.

Gray H, 1901, Gray’s Anatomy, The Classic Collector’s Edition, Pick TP & Howden R, eds, Bounty Books, New York, p 660.

Groome NP, Illingworth PJ, O’Brien M et al., 1996, Measurement of dimeric inhibin B throughout the human menstrual cycle.  J Clin Endocrinol Metab 81:1401.

McGee EA & Hsueh AJ, 2000, Initial and cyclic recruitment of ovarian follicles. Endocr Rev 21:200.

Reeves JJ, 1987, Endocrinology of Reproduction.  In:  Reproduction in Farm Animals, 5th Edition, Hafez ESE, ed, Lea & Febiger, Philadelphia, pp 89.

Shepperson D & Vernon M, 2002.  In: Endometriosis: A Key to Healing Through Nutrition, Harper Collins, pp 370.

Here’s an excerpt:

The concert hall at the Syndey Opera House holds 2,700 people. This blog was viewed about 26,000 times in 2011. If it were a concert at Sydney Opera House, it would take about 10 sold-out performances for that many people to see it.

Click here to see the complete report.

Happy New Year everyone!
–ATM

Times Square

I had the chance to go to New York City last weekend and I took advantage of the opportunity by checking out the holiday lights, mainly at Rockefeller Center.

To say that I was blown away would be an understatement. Not only were the lights and decorations absolutely stunningly beautiful, so were the people!

There were lots of them!, entire families, parents and children, from all over the world.  And they were happy and enjoying themselves, and laughing and talking and smiling and taking photographs, and handing their cameras to complete strangers (like me) and asking them to take photos of their families.  There were no arguments or snippy remarks or people losing their patience. People didn’t even seem to notice that it was a cold 29°F.

Radio City Music Hall - Home of the Rockettes!

The entire atmosphere was so pleasant, that I cannot adequately put it into words. Even the cops were in a good mood!

And so for my holiday greetings this year, I will post some mediocre photos I snapped with my Blackberry in Manhattan and wish you all the happiest of holidays in whatever way you celebrate them and a healthy and prosperous New Year.

–ATM

Atlas - at Rockefeller Center

The statue of Atlas in front of Rockefeller Center, taken from St. Patrick's Cathedral, across 5th Avenue

Rockefeller Plaza from W. 50th Street

The huge Christmas tree and ice rink at Rockefeller Plaza

Angels at Rockefeller Plaza

I don’t want to reinvent the wheel here; however, some of the things that people have said to me recently have me wanting to inform the uninformed what not to say to a trans person when they meet one for the first time.  Or even the second or third time.

But then I considered the possibility, however small, that something I might suggest not to say to trans people might be the very thing that another trans person might want to hear. (It’s not likely, but I can’t rule it out 100%.)

So with that in mind, I decided to address this from a more personal perspective and changed the title of this post from, “What Not to Say to a Trans Person,” to what you have already read above, “What Not to Say to This Trans Person.”  I will frame my comments in the form of a letter…

Dear Non-Trans Person Who Doesn’t Know Me Yet,

When you meet me and find out I am trans, you might be surprised or curious about trans people and want to ask questions.

That’s perfectly alright with me and even understandable, but please keep in mind that my being a transsexual does not make me any less deserving of the respect that you would extend toward any other human being with regard to personal questions.  If you wouldn’t pose a certain question to your grandmother, minister, dentist or mechanic, then you shouldn’t pose it to me either.

If you’re still not sure what I’m referring to, please allow me to provide some real-life examples of questions that people have asked me, but shouldn’t have:

1. What are you going to do? Are you going to take hormones and have surgeries?  (Hormonal and surgical steps are part of a medical treatment for transsexuality and should be regarded as just as private as any other medical information that you wouldn’t ask anyone about.)

2.  So, uh, what are your plans?  Are you thinking of going “all the way”?  You know… for the, ah,  — “full monty”?

3.  What exactly are you, anyway?

4.  What’s your story?

5.  Are you attracted to men or women?  (This might seem at first like an innocuous question, but think about it — to how many people in your life would you really pose this question?) 

6.  It’s okay to be a masculine woman, you know. 
(Okay, that’s not really a question, but it’s  still annoying.  Of course I know it’s okay to be a masculine woman – my hat is off to all masculine women. I just don’t happen to be a masculine woman, or any other kind of woman for that matter.)

7.  Why would anyone take testosterone if they are going to go bald?
(Right. I see millions of men deciding to have their testicles removed and live as women so they can avoid the horrors of baldness.)

8.  Don’t you know it’s a pain to have to shave every day? 
(As though the only reason I would ever consider a medical transition is so I can have facial hair.  Let’s forget about living an authentic life, as my true self, to be seen in the world as the man that I am.  I can’t understand why someone would think shaving out-trumps any of that.)

9.  Shouldn’t you be somewhere else? (Usually asked in a public restroom.)

10.  Transgender people get married?  To who?

11.  Do you know Chaz Bono?

12.  I’m assuming there have been some surgeries involved? (Do you sense a theme here?)

13.  As a man, are you…  well…  “fully established”?

There are probably more I could add, but instead, while we’re at it, let’s also talk about certain behaviors that some people exhibit once they find out I’m trans.  One of them is what a friend of mine, a trans guy, calls the “crotch watch.”

To those who feel that they have to shoot repeated glances at my crotch, whether you’ve just met me or have known me for some time  — do you look at the ‘package’ of other people you meet or see?  Honestly, what do you plan to do with that information anyway?

People who exhibit this behavior don’t even consider that they are so obvious that I (and everyone else!) can see them doing it.

And so, to anyone out there who has the urge to inspect my genitals simply because you know I am trans, grow up already and KNOCK IT OFF!  Sheesh.

But hey, don’t take my word for any of this that I’ve written about here.  There are other trans folks out there (including Matt Kailey, whom I mentioned above) who have expressed their frustrations over the inappropriate questions they receive.

One would be L. Weingarten who has a photographic project entitled, “A Series of Questions” that provides a powerful visual statement on this subject.

Another would be Calpernia Addams, who has a video, “Questions Never to Ask a Transsexual Person” that, although amusing, is also shocking in its list of inappropriate questions that have been posed to her.

I could go on, but I think I’ve gotten my point across.  If there is even one reader out there who, however well-meaning, has already asked similar questions or would consider posing questions like these to trans people and, after reading my rant, will now think twice and refrain, then this post was worthwhile.

Happy Holidays everyone!

–ATM

Well, time flies like an arrow but fruit flies like a banana…

(By the way, that doesn’t look like a fruit fly on the right.  To me, it looks like a common house fly. But I digress.)

Seems like just last week when I wrote a post about the embryonic differentiation and development of ovaries and testes, the genes that control these processes and what happens when the genetics go awry.  But actually, it was almost a year ago.

Now, it’s finally time to talk about normative functioning of the human ovary which is, hopefully, a prelude to a discussion about Polycystic Ovary Syndrome (PCOS) in trans men.

So what does the human ovary look like?  According to Gray’s Anatomy – The Classic Collector’s Edition:

The ovaries are of a grayish-pink color, and present either a smooth or puckered, uneven surface. They are each about an inch and a half in length, three-quarters of an inch in width, and about a third of an inch thick, and weigh from one to two drachms.

Wait, what’s a drachm?

Anyway, in the photomicrograph below you can see the cross-section of an ovary from an adult primate, which is very similar to a human ovary.  You can see two “zones” of the organ:  an outer cortex where the follicles are mainly located and an inner medulla made up of mostly stroma.  The hilum, the structure that anchors the ovary, is where the blood and lymph vessels and nerves enter the organ.

As you can see in the photomicrograph, the follicles, which contain the eggs, are in different stages of development in the adult.  As a refresher on these structures, here is a description of their embryonic development from a previous post:

By approximately 28 weeks in the fetal stage, most of the follicles are present and are no longer organized in cords.  The follicles form when somatic cells (i.e. cells that are not germ cells) aggregate in a single layer around the oocytes in the embryonic ovaries.  At this stage, they’re known as “primordial follicles” and they reside in mostly the cortex, although some can be found deeper in the embryonic ovary, closer to the medulla which has grown and become even more vascularized with blood vessels.  In this phase of development, the layer of cells around the oocytes differentiate into granulosa cells which communicate with the oocytes and stop meiosis in the immature eggs.

By the late fetal stage, the human ovary is stocked with 5 to 6 million oocytes that are arrested partway through meiosis and reside in primordial follicles that are made up of a single cell envelope of granulosa cells.  By the time of birth, the number of oocytes has dropped to approximately 2 million.

And so at birth, the ovarian cortex contains oocytes (immature eggs) that are arrested part way through meiosis and are encased in primordial follicles.  How do the primordial follicles get to the different stages that we see in the photomicrograph above, and why is this important?

To answer that, I hope you don’t mind that I skip over puberty and just talk about the different stages of follicle development in the adult ovary, called folliculogenesis, where the ultimate goal is the ovulation of a mature ovum (egg) at the proper time in the menstrual cycle and in the proper hormonal milieu.  To quote Gregory F. Erickson (2002):

The follicles in the cortex are present in a wide range of sizes representing various stages of folliculogenesis.  The goal of folliculogenesis is to produce a single dominant follicle from a pool of growing follicles. There are four major regulatory events involved in this process: recruitment, preantral follicle development, selection and atresia [i.e. regression and death].

… Recognition that only a few follicles become dominant beautifully demonstrates the fundamental principle that folliculogenesis in mammals is a highly selective process …  In women, the process is long, requiring almost one year for a primordial follicle to grow and develop to the ovulatory stage.

The cartoon below illustrates the different stages of folliculogenesis in the human.  At the beginning is the primordial follicle which we have already discussed, a couple million of which are present in the ovarian cortex at birth.

To go from primordial to primary stage, the follicle must undergo the first major regulatory event, recruitment, which sends the quiescent follicles into a pool of growing follicles.  In the transition from primordial to primary follicle, the single layer of flattened, squamous granulosa cells surrounding the oocyte divide and differentiate into a single layer of cuboidal-shaped granulosa cells.  These cells send processes into the oocyte so that they are connected and can communicate with each other, forming a “metabolically and electrically coupled unit” (Erickson, 2002).  The oocyte grows and differentiates and forms an outer “shell” called the zona pellucida.  This process constitutes the second major regulatory event, preantral follicle development.

The development from primary to secondary follicle involves division of the granulosa cells so that they form between two and ten layers of stratified epithelium around the oocyte.  A basement laminae forms around the outer layer of granulosa cells, which is like a collagen capsule of sorts.

Two important events occur during the growth of a secondary follicle.  One is the development of the theca cells, the theca interna (inner layer) and theca externa (outer layer) around the basal laminae.  The second, which occurs in parallel, is the formation of small blood vessels which, for the first time, bring blood to the developing follicle, and in so doing, deliver nutrients, remove waste products and expose it to hormones.

The delivery of hormones to the follicle at this stage is important for continued development.  To quote Erickson (2002) again:

At the endocrine level, folliculogenesis is regulated by a central nervous system, anterior pituitary, and ovary cascade mechanism.  Specialized hypothalamic [a part of the brain] neurons secrete pulses of gonadotropin-releasing hormone (GnRH) into the portal blood vessels [of the pituitary], which acts on the gonadotrophs [cells in the anterior pituitary] to cause a pulsatile release of follicle-stimulating hormone (FSH) and luteinizing hormone (LH), which act on ovarian follicle cells to control folliculogenesis.  Although GnRH, FSH, and LH are critically important in regulating folliculogenesis, hormones and growth factors, which are themselves products of the follicle, can act locally to modulate (amplify or attenuate) FSH and LH action.

It’s the delivery of the gonadotropins to the follicle, in part, that cause it to differentiate further and become steroidogenic.  (More on that later, in the next post.)

At this point, the follicle has a basement laminae, theca interna and externa layers, and a stratified epithelium of granulosa cells surrounding a zona-encapsulated, fully grown oocyte.  It moves to the tertiary stage of folliculogenesis by developing a cavity called an antrum in a process called cavitation.

In the early tertiary follicle, fluid begins to accumulate among the granulosa cells near one “pole” of the oocyte.  The fluid-filled cavity is called an antrum, and the follicle is, at this point, known as an antral follicle or graafian follicle.

As the follicular fluid in the graafian follicle accumulates, the antrum expands and the follicle grows and is arbitrarily classified based on size:

Small graafian follicle: 1-6 mm
Medium graafian follicle:  7-11 mm
Large graafian follicle:  12-17 mm
Preovulatory graafian follicle:  18-23 mm

Also during this process, the next major regulatory event occurs, that of selection, where the graafian follicle either develops down the path to ovulation as a healthy, dominant follicle, or it becomes atretic and eventually degenerates through the process of atresia.

If a graafian follicle is selected to become a dominant follicle, the granulosa and theca cells continue to divide via mitosis as the follicular fluid accumulates.  If a graafian follicle is atretic, mitosis of the granulosa cells and accumulation of follicular fluid both cease. The atretic graafian follicle may grow from the small to medium stage but cannot increase in size beyond that because cellular division and fluid production are no longer occurring.

In a healthy, dominant graafian follicle, the granulosa cells undergo proliferation and differentiation that are dependent upon their position within the follicle.  (Click on the image to enlarge it.)

This graafian architecture as described by Erickson (2002):

In the graafian follicle, the granulosa cells and oocyte exist as a mass of precisely shaped and precisely positioned cells.  The spatial variation creates at least four different granulosa cell layers or domains:  the outermost domain is the membrana granulosa, the inner most domain is the periantral, the intermediate domain is the cumulus oophorus, and the domain juxtaposed to the oocyte is the corona radiata.  A characteristic histologic property of the membrana domain is that it is composed of a pseudostratified epithelium of tall columnar granulosa cells, all of which are anchored to the basal lamina.

The location and differentiation of the different granulosa cells will become important when we talk about ovulation in the next post.

Going back to the first image above, we can see that the adult human ovary has a collection of follicles at different stages in the pool of growing follicles. I have not discussed the known mechanisms that orchestrate the recruitment, development, selection and atresia of multiple follicles that are ongoing at any one time.  Many mechanisms driving these processes are not currently known, but they are regulated such that at the time of ovulation, there is only one dominant follicle that is ready to ovulate (except in the case of fraternal twins, when there are two dominant follicles that ovulate, three in the case of fraternal triplets, and so on).

As mentioned above, the entire process, from primordial to preovulatory dominant follicle, takes almost one year in the human, with the greatest amount of time being needed in the preantral stages, as outlined in the following figure.  (Click the image to enlarge it.)

In this post, we have had a relatively high-level overview of the anatomy of the human ovary and the process of folliculogenesis.  In the next post, we will consider steroid production and ovulation to wrap up the discussion about normative ovarian function as a prelude to looking at ovarian function in trans men.

–ATM

Reference:
Erickson GF, 2002. “Follicle Growth and Development.”  In:  Gynecology and Obstetrics, Sciarra JJ, ed, Vol 5, Chapter 12 (and references and images therein).

Images:
Bloom W, Fawcett DW, 1975.  A Textbook of Histology.  WB Saunders, Philadelphia.

Erickson, GF, 1987. The ovary: Basic principles and concepts. In: Endocrinology and Metabolism, 3rd edition, Felig P, Baxter JD, Broadus AE, Frohman LA, eds., New York: McGraw Hill.

Erickson, GF, 1995. The ovary: Basic principles and concepts. In: Endocrinology and Metabolism, Felig P, Baxter JD, Frohman L, eds., New York: McGraw Hill.

Gougeon A, 1986. Dynamics of follicular growth in the human: a model from preliminary results. Hum Reprod 1986 1:81-87.

I had a post all written about disrespectful and/or annoying questions that people have asked me when they’ve learned that I am trans.  But just before I posted it, I remembered the Thanksgiving holiday that is upon us and my cranky rant just didn’t seem appropriate.

And so let’s work with the cliché — what am I thankful for?

I am thankful for many things, but one of the biggies has to be the ability to finally live as my true, authentic self.  Stuck in that female persona for over four decades …  the word “prison” comes to mind.

Well, sure, that experience helped to make me what I am today, but I would not — could not — go back.  The genie is out of the bottle and he’s damn glad about it.

And so, in being thankful about being out, I thought that rather than windge about some of the negatives, I would focus on the positives and tell you about some of the best reactions I have seen, heard or received in writing when I have come out to people as trans.

The Dentist
I dedicated an entire blog post to recounting the annoying behavior that dental hygienists displayed during a routine teeth cleaning I had six months after coming out to everyone in the dentist’s office.  What I didn’t tell you about, however, was the reaction of the dentist himself.

When I came out at the dentist’s, I didn’t say anything like, “Hello, I’m trans and I’m transitioning my gender.”  I only gave the receptionist my new dental insurance card and told her about my new name.  She took care of the rest with efficiency and professionalism, changing the name on my records file and informing the hygienist who was to work on me that day and, apparently, also informing the dentist.

I’ve been seeing my dentist since 2001.  I chose him on a recommendation, but meeting him for the first time sealed the deal. He’s a grandfatherly type, and even has the same first name as my maternal grandfather.  I like him.

I liked him even more when he walked into the room that day, shook my hand as I was sitting in the chair and said, “Congratulations on this big step that you’ve taken.  I think this is a courageous thing you’re doing.  You must be relieved.  How do you feel?”

Me thinks my dentist has a trans person in his life. Or maybe he’s just knowledgeable and caring.  Whatever was behind his greeting, it was pretty awesome.

Coworkers
I came out at work a little over a year ago, with full support from Human Resources and upper management, to about 400 coworkers, vendors and academic colleagues across the U.S. and in three other countries. Within minutes of sending out my email announcement, the replies started rolling in and they continued for two days. Each message was supportive, sincere and heartfelt.

The best response, in my opinion anyway, was delivered in person by a colleague I had worked with for about eight years.  He was flying in from Europe for a meeting at our Boston site and wanted to have dinner with me to discuss a new project.  This was only days after I had sent out my little coming out announcement.

When I picked him up at his hotel, he greeted me in his usual fashion and launched right into the topic at hand as I drove us to the restaurant.  I hadn’t received an email reply from him when I had sent out my announcement, and he wasn’t mentioning it upon seeing me in person, so I thought perhaps he hadn’t received the coming out message I had sent.

He began, “Thanks for meeting with me.  What I wanted to talk to you about…” but I broke him off by saying, “Before we get deeper into this conversation, I would like to first just check in with you and see if you received the email announcement I sent out the other day.”  His expression didn’t change as he looked at me and replied, “Yes, I received it.”

His response was so matter of fact, I was caught off-guard.  I said, “Oh. Okay. I just wanted to make sure that we were on the same page.”  “We’re on the same page,” he replied.

Then he paused, looking at me with a look as though he couldn’t understand why this had come up, and then he went right back to the conversation, saying, “So what I wanted to talk to you about…”

Now that, my friends, may be the perfect professional response to a coming out message, at least in my opinion.  My being trans, my name change, my gender transition, was an incredible non-issue for this guy.  Some people might say that he should have at least acknowledged my announcement and I can understand that point of view.  On the other hand, I thought he had acknowledged it in his own way.  He adjusted with the pronouns and my new name without fanfare and we moved on as coworkers.  Seamless.

Family
If anyone in my family had an issue with my coming out as trans, they pretty much kept it to themselves.  Compared to the negative reactions that coming out can sometimes engender (pun intended) in a trans person’s family, I was pretty lucky in that regard.

There’s only one grandkid in my immediate family – my nephew.  I wanted to come out to him in person, so when I was back home, I drove down to the small Midwestern university where he was in the middle of his freshman year and I picked him up so we could go for a little drive and talk.  We pulled into a park and were sitting in the car overlooking a grassy field. The sun was out and it was a pleasant fall day.

When I broke the news to him, he gave it a moment’s thought, turned to look me in the eye and said, “This doesn’t change anything for me. It’s not going to affect my relationship with you.”

As that tender response was warming my heart, he seemed to reflect on it a little more and then raised his voice to announce, “I don’t think people should judge other people just by the way they look!”  I was proud of him to have this sentiment, although it wasn’t a complete surprise to hear it coming from someone sporting tattoos, big plugs in his ear lobes and a gold ring in his lip.

Then, he seemed to come to some sort of realization. With  his eyes opening wide, he lifted the copy of True Selves that I had given him as information.  As he held it out in front of him with both hands, he exclaimed, “Hey!  I have to write a paper on diversity!”

Glad I could help.

Friends
I don’t want to give anyone the idea that every single person I have come out to has responded in a positive and supportive manner.  To be sure, I have lost people along the way, and a few coworkers who must deal with me on a regular basis clearly have some sort of issue with who I am.

That’s pretty obvious when they see me coming from the opposite end of a long hallway and blatantly and almost frantically search for a side door to duck into so they don’t have to walk past me.  And if they can’t find that convenient side door, I always give them a very friendly greeting, maybe even ask them how their weekend was, any kind of small talk that forces them to interact with me. (Hah!  Take that!)

But overall, I have been fortunate in that most people in my life have responded positively to my true self.

When I was in the process of coming out, however, I didn’t know it would all turn out this well.  I was convinced that the reactions of some people in my life would be anything but positive. I was expecting rejection, maybe even hostility or anger.  Fortunately, I was wrong in all but a few cases, and I realized that what other trans people had been telling me was absolutely true:  You cannot predict how a person is going to react when you tell them you are trans.

There were a number of friends whose reactions defied my expectations in very good ways, one of which I would like to mention here.

He’s a Midwestern guy who works in the trades.  He’s solid, well-built, middle-aged, weathered from working outdoors all his life, blond and blue-eyed, active in sports, married with grown children, someone I would call a man’s man. I was sure he would hear my story and question how someone he had seen as female for two decades could possibly be a man.

To be honest, the conversation started out a bit shaky.  He did question me, he pushed back and resisted what I was telling him.  And so I just talked and told the story of my life backwards, from the recent realization that I was trans to the struggles I had as an adult, to the hell of adolescence, all the way back to the beginning — to kindergarten when I repeatedly got in trouble at school for going into the men’s restroom with the other boys, to when I named myself Andy at four years of age.

Fortunately, he listened.  As I talked, he asked questions here and there, and eventually, the challenges to my narrative turned to silence and reflection, and then to occasional brief comments of commiseration.  Our conversation lasted over an hour.

When I reached the end of my tale, we were in the kitchen, me leaning against the cabinets and he sitting on a wooden stool.  Watching him closely as he processed the information, I tried to read his potential reaction through the look on his face but he really didn’t show any emotions at that point.  When I said, “That’s about it – the whole story,” he looked down for a little while and seemed to digest everything I had told him.  I waited nervously, thinking that at any moment, he was going to ask me to leave his house.

Finally, he looked up and said, “There’s one thing that I hope you’ll do.  Don’t be afraid to be you.  Just be you.”

I looked at him, stunned, and he said again, “Just be you.”

I was speechless, and it must have shown on my face.  He walked over and clapped his muscular arm across my shoulders and said, “What? Were you expecting a bad reaction?”

“Well, to be honest, yes I was,” I replied.

“C’mon!” he said, giving me a little rough shake with the arm that was across my shoulders, like one man would give another, and added, “It’s me.”

Yes, my friend, you were right.  It was you.

Of the hundreds of people I have come out to — acquaintances, coworkers, family members and friends — he has been the only one who has given me his explicit expectation that I should be myself.

And so, kind readers, wherever you are and whatever you are doing today, I hope that you have something to be thankful for and are surrounded by good people who love and care about you.  Happy Thanksgiving!

–ATM

Each year, the community mourns the death of gender variant people and their loved ones across the world who were murdered because they were being themselves.  You can find more information about TDOR and the victims here.

In recognition of TDOR this year, I would like to call attention to a November 16th article in The Huffington Post by Pete Subkoviak entitled, “LGBT Leadership: Split Hairs and Burnt Bodies” –

When Matthew Shepard was beaten bloody, tied to a fence, and left to die alone in agony, a call was heard around the United States for tolerance toward differing sexual orientations. The lesbian, gay, bisexual and transgender (LGBT) community banded together, mourned and got to work to pass the Matthew Shepard and James Byrd, Jr. Hate Crimes Prevention Act, a law that expands the definition of a hate crime to sexual orientation and gender identity. Thankfully, we’ve come to a better place and time where gays and lesbians can focus on marriage issues, Don’t Ask, Don’t Tell and employment discrimination. These are all extremely important issues, so naturally some other stuff is going to have to wait. Things like, say, burning bodies.

It is not surprising to me that virtually no one is familiar with the name Shelley Hilliard. Shelley’s body was just found on the side of a busy highway in Detroit last week, burned to death. Shelley’s mother, who had reported to police that her much-beloved teen was missing, had to visit the medical examiner’s office to identify her child’s torso — all that remained.

Shelley was part of a much-disparaged group whose high rates of HIV, physical and sexual abuse and murders go largely unnoticed by the LGBT community, both in terms of consciousness and in terms of programming and funding. I’m talking about transgender individuals — especially young transwomen of color. Nov. 20 is the International Transgender Day of Remembrance (TDOR), which memorializes all individuals who were murdered because of their gender identity over the past year.

In marking this TDOR, it is time for leaders in the LGB communities to admit that they need to do more. Transgender individuals are a small minority of the LGBT community but are also the ones who need the most support this day and age. I ask you to imagine being a transwoman walking down the street and how many hateful epithets you would have to tolerate in order to pick up a gallon of milk or visit a doctor’s office. …

You can read the rest of the article here.

–ATM

Transgender Equal Rights Now a Reality in Massachusetts

November 16th, 2011

The Massachusetts Transgender Political Coalition (MTPC) is proud to announce the passing of the Transgender Equal Rights Bill in the House and the Senate extending civil rights and hate crimes protections to the state’s transgender residents.

Last night, just before 9:00 PM, the Massachusetts House of Representatives passed the Transgender Equal Rights bill without any amendments. This morning by 10:30 AM, the bill passed in the Massachusetts Senate. The bill must still be approved once more in Senate the Governor can sign it. As we wait for Governor Deval Patrick to officially sign this bill into law, we can celebrate the impact this will have on our transgender youth, adults, and families across the Commonwealth.

MTPC thanks our legislative lead sponsors Representative Carl Sciortino, Representative Byron Rushing, Senator Ben Downing, and Senator Sonia Chang-Diaz; all of the House and Senate co-sponsors, and the leadership of House Speaker Robert DeLeo and Senate President Therese Murray for providing vital protections for approximately 33,000 transgender residents here in Massachusetts.

This bill will give transgender people equal protections when seeking employment, housing, credit, and education.The bill also expands the state’s hate crimes protections to now include transgender people; a community that experiences alarmingly disproportionate levels of harassment and violence.

The final version of the Transgender Equal Rights Bill passed by the legislature unfortunately does not include protections within public accommodations. MTPC and our coalition partners fought hard to try to get public accommodations restored in the Senate version of the bill, and were unsuccessful in doing so. Although this bill does not include public accommodations, this is a historic and important victory in the fight for achieving transgender equality in Massachusetts.

“This is not the end of our fight, and MTPC is committed to getting public accommodations protections for our transgender youth, adults, and families. MTPC plans on introducing a bill for the 2013 legislative session for those public accommodations protections,” said Gunner Scott, Executive Director of MTPC. “For now, let’s be proud of the difference this bill will make in the daily lives of thousands of people across the state who need jobs, a safe place to live and access to education.”

MTPC expresses our deepest gratitude to our community members, who have spent countless hours educating their legislators and the general public about the issues transgender people face. “It is because of the courage of our community members to come forward and tell their personal stories about themselves, their family members, and their friends that we have accomplished this milestone,” said Nancy Nangeroni, Steering Committee Chair of MTPC.

MTPC thanks the members of the Transgender Equal Rights Coalition including MassEquality, Gay & Lesbian Advocates & Defenders (GLAD), National Association of Social Workers (NASW), ACLU of Massachusetts, MassNOW, Massachusetts Gay and Lesbian Political Caucus, Massachusetts LGBTQ Bar Association, Jobs with Justice, and Interfaith Coalition for Transgender Equality for their tireless work on behalf of transgender equal rights.

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Founded in 2001, the Massachusetts Transgender Political Coalition (MTPC) is a 501(c) 3 that works to end discrimination on the basis of gender identity and gender expression. MTPC educates the public, advocates with state, local, and federal government, engages in political activism, and encourages empowerment of community members through collective action.

“I dressed as a woman for 48 years.  I’m all done wearing costumes.”

But that’s me. What about you?

Whatever your plans are for Halloween, I hope that you have a safe, fun and happy time.