So I had an endoscopy done on Friday. Woke up from anesthesia and doctor was halfway explaining to my aunt who struggles hearing. The printed report with pictures has one item that has me nervous, with no picture: it says “single medium mucosal nodule with a localized distribution was found in the duodenal bulb. Biopsies were taken with a cold old forceps for histology.” I also had a few gastric polyps that were biopsied as well as a few places of mild erosions. I was having pain in my right upper abdomen which prompted the doctor to order the endoscopy. The Endo doc said resume diet next day, but I have been still having the same pain, sometimes with nausea. Very fatigued, lost 14 lbs in 14 days so far. Appetite is there, but afraid to eat unhealthy and too much that will damage my stomach further. Nervous because I am having constant crampy pain mostly dull, but distracting.

I had severe cystic acne that was triggered by my cycle and just generally a bunch of under-the-skin pimples that I was obsessed with picking bc of my ADHD. I started in Feb, don't have pictures unfortunately, but my skin has cleared up so much in the meantime it's wild. I am having severe depression as a side effect, but I know that if I make it through this, it'll go back to normal. The dry skin on your lips and mucosal membranes is no joke though, FixMySkin and aquaphor have been life savers.

I've noticed recently that despite following the MTHFR protocol that I assembled over half a year ago, that I've not been feeling the same equanimity and serenity that I initially felt.
At first, I chalked it up to acclimation: my improved state of mind became my default state of mind, and so it no longer felt 'special'. While there may be some of that, it didn't explain all of it, and a very busy/stressful recent couple of weeks at work especially magnified that something was not working as well as it had originally. As someone with slow COMT, chronic anxiety is always just a stone's throw away, and so I wanted to address it.
In trying to determine what may have changed, I recalled that when I first started this journey, I was using Citicoline (aka CDP choline) as my primary choline source, with meat and eggs secondary. (I forget the exact dosage I was using.) Once I found out that Citicoline is only 18.5% choline I switched to eggs as my primary choline source, with meat secondary. I then later incorporated TMG to reduce the egg requirement.
I still had some Citicoline onhand, so last week I took 900mg of Citicoline, without changing anything else. Within 30-60 minutes I had that sense of ease and serenity that I hadn't felt as deeply for many months. Since then I have been trying different doses (300, 600mg), and I seem to get a dose-dependent response.
It is not clear why Citicoline is having this effect. A few possibilities:

1. The Choline Calculator is underestimating my choline needs, perhaps due to additional SNPs not considered by the Calculator. Supplementing the Citicoline is getting me to my actual total choline need level.
   1. This seems unlikely, since even 900mg of Citicoline is providing only 167mg more choline. Also, I have had several days where I've had 8 eggs + 1-2 pound of meat + TMG and those days have never stood out mood-wise from others.
2. There are specific genetic issues in my CDP pathway which reduce production of Citicoline and therefore supplementing Citicoline resolves that shortage.
   1. This seems the most likely. More below.
3. There are component(s) in Citicoline which are somehow deficient, and which Citicoline provides.
   1. Also more below.

​

Kennedy Pathway

The Kennedy Pathway is a dual pathway:

1. CDP-ethanolamine pathway:
   1. Conversion of ethanolamine to phosphatidylethanolamine (PE). PE is used by PEMT to create PC.
2. CDP-choline pathway:
   1. Conversion of choline to phosphatidylcholine (PC).

In my case, I have a heterozygous rs7496 PEMT, which reduces conversion of PE to PC. This is accounted for in the Choline Calculator.
In the CDP-choline pathway, the enzymes are:

• Choline kinase (CK or CHK)
  • Output: phosphocholine
• Phosphocholine cytidylyltransferase (CCT)
  • Output: CDP choline
• Cholinephosphotransferase (CPT)
  • Output: PC

As it happens, I have a homozygous 'AA' variant in my rs10791957 CHKA (CHK-alpha) according to my Genetic Lifehacks report, which reduces PC production via this pathway.
Thus, I have reductions in both pathways of PC production.
​

Absorption Mechanisms

But if our primary source of choline is phosphatidylcholine (PC) from eggs, then don't we have more than enough PC already, and have minimal need for the Kennedy pathways?
As it turns out, absorption process of dietary PC largely breaks down PC, and then feeds those components into the Kennedy pathways for reconstitution (paper):

It was concluded that the dietary phosphatidylcholine is hydrolysed in the intestinal lumen by the pancreatic phospholipase A to 1-acylglycerylphosphorylcholine, which on entering the mucosal cell is partly reacylated to phosphatidylcholine, and the rest is further hydrolysed to glycerylphosphorylcholine, glycerophosphate, glycerol and Pi. The fatty acids and glycerophosphate are then reassembled to give triacylglycerols via the Kennedy (1961) pathway.

​
Therefore, there is still demand on the Kennedy pathways in order to produce sufficient PC.
So then, supplementing Citicoline is bypassing the CHKA defect and providing CDP choline directly to cholinephosphotransferase (CPT) for the production of PC, right?
However, like dietary PC, Citicoline is not absorbed intact. According to this Cognizin PDF:

Citicoline is degraded to uridine and choline during intestinal absorption. These two compounds then pass through the blood-brain barrier to reconstitute citicoline in the brain.

​
So then, the picture is a bit more complex. If the benefit I am seeing is from choline + uridine, and I believe I already have a sufficient intake of choline, then is the subjective benefit I experience from taking Citicoline due entirely to the uridine?
​

Uridine

As this paper notes:

In infants, when synaptogenesis is maximal, relatively large amounts of all three nutrients are provided in bioavailable forms (e.g., uridine in the UMP of mothers’ milk and infant formulas). However, in adults the uridine in foods, mostly present at RNA, is not bioavailable, and no food has ever been compelling demonstrated to elevate plasma uridine levels.

​
Uridine is produced de novo in the body, through a rather lengthy pathway (paper). But as this paper notes:

Evidence suggests that metabolic derangements associated with ageing and disease-related pathology can affect the body’s ability to generate and utilize nutrients. This is reflected in lower levels of nutrients measured in the plasma and brains of individuals with MCI and AD dementia, and progressive loss of cognitive performance. The uridine shortage cannot be corrected by normal diet, making uridine a conditionally essential nutrient in affected individuals.

​
Here they are discussing mild cognitive impairment (MCI) and Alzheimer's (AD). But, as I am in my 60's, I have to consider the possibility that the beneficial effect of this supplemental uridine via Citicoline is compensating for age-related decline in de novo uridine synthesis.
However, uridine is also used in the CDP-choline pathway. So, is extra uridine compensating somehow for the CHKA homozygous variant? This seems unlikely, since CHKA is at the beginning of the pathway, so its not clear how improving later steps would help.
​

Next Steps

At this point, it is still unclear why Citicoline provides this subjective benefit. I plan to try a uridine supplement to see if the benefit is tied specifically that metabolic component of Citicoline.
I just wanted to share this exploration, and also to hear any feedback from any of you who have tried uridine or Citicoline, as an add-on piece to your methylation treatment.
​
​

Hello, and welcome to my 1.5(ish) week update. It’s a bit later than I planned on posting, but I’m here to catch you all up, as promised. I'll be walking through my recovery progress from between 4 days post-op, until 11 days, which is when I had my follow-up appointment. (Warning: anatomical terms used ahead)
4 Days Post-Op
Alright, so it would have been on the 12th, that I noticed there was a rash spread out all around my torso. It didn’t seem super focused near the incisions, and it went as far down as my hips/thighs, and as far up as reaching my rib-cage.
It was only mildly itchy and didn’t feel warmer in any areas. I took some pictures, sent them to my gyno asking about whether it was a major concern, or if it could be an allergic reaction to the surgical glue. I waited about half a day, before finally calling into her office for a quicker response, and was told that yes, the glue was a likely culprit for the rash, and being four days out, the incisions are probably closed up by now, so it would be okay to try and peel the glue off using my fingers, and a warm rag, gently.
They also recommended that I use ice on the most irritating areas of the rash for relief. I had already started using a cold gel-pack to do cold-compresses on my abdomen, though. I highly recommend that you do the same if you’re dealing with an allergic reaction or rash. It provided me with the most instant relief out of everything I tried. (My itchiness never reached a very high level, but I’m sure that this would have been my main form of calming it, if it had)
They also called in for me a 6-day Medrol (methylprednisolone) dose-pack. I picked it up a few hours after it was called in, and just followed the pack instructions. I took 6 tabs between when I picked it up, and when I went to sleep. I was also given the okay to continue taking Benadryl before bed, as it would help to reduce the inflammation/itchiness.
There was a second concern, which I didn’t pick up on until later that night, but I noticed that my lower-legs/calves were swollen, particularly my left leg, and heavily toward my ankles. They felt a bit sore, too. This caused me to panic, so I ended up calling the emergency number, worried about dvt/clotting.
I was connected directly to my gyno, who told me that it was most likely water retention, and I should keep an eye on it, keep my legs/feet elevated when I lie down, keep up with taking short walks throughout the day, and to stay as hydrated as possible. Having her quell my worries was very helpful, and if you ever have any concerns following a procedure, don’t hesitate to contact your surgeon’s office, or the emergency line you’ve been given. They are there to answer your questions and 100%, you’re no bother to them whatsoever.
6 Days Post-op
I noticed that my on-q bag was looking flat this morning, so I verified it's emptiness by taking the medicine bag out. It was completely empty, and shaped like an apple core. All I could feel was the cylinder in the middle of it, so I knew I’d finally be removing my pump's catheter today.
I washed my hands, got myself into a comfortable position lying on my back, took the dressings off, took the taping over the catheter off, and gently pulled the catheter away from my body. I was told to stop if it started to pull, or wasn't coming out easily, but there was no problem. I barely felt it as I was taking it out, and the worst sensation was just an unusual tugging, but otherwise completely painless removal. It took about a minute for me to entirely pull it out. Once I saw the black tip at the end, I placed a band-aid over the insertion area, and was done.
I’ll include a short video I made, for anyone curious about how it looks to do this. Warning to those squeamish around medical procedures, I'll be pulling out a thin catheter inserted just above my groin in this video (no blood or discharge, but it may still be hard to stomach for some): https://www.youtube.com/watch?v=Ve9wa3sJduQ The audio is a bit low, so you also might want to bump up the volume. I added subtitles to make up for the quiet audio.
Oh, and I was told that seeing a pinkish-red colored discharge on the gauze taped over the catheter site is normal, and I will include a picture of what this looks like at the end of my post, so you can more easily recognize it. This is a harmless discharge, and if you see your dressings are turning red/pink, no need to panic, just take your dressing off and replace it with a fresh pad of gauze, or a sufficiently sized band-aid.
In good news, I wasn’t feeling much irritation or itchiness around my rash today, and any gas pains I had been experiencing in my neck, shoulders, or upper chest seemed to be mostly gone whenever I went to lie down/sit up.
I felt well enough to do some slow paced baking, so I made some valentines themed red-velvet glazed donuts for my family. (I may have been pushing it with this, so maybe hold off on baking or cooking for longer than I did, haha.)
7 Days Post-op
By this point I completely stopped using Ibuprofen, Tylenol, and the Gabapentin. I no longer felt like I needed it, as I didn’t feel any pain beyond soreness occasionally. The rash was my biggest irritant right now.
8 Days Post-op
I’ve been doing a lot of resting these last couple of days, I guess I must have been hit with that infamous post-surgical fatigue, haha. I’m happy to report my legs are no longer swollen, though. I also looked over the results of my pathology report today, and it turns out my ovaries were indeed riddled with cysts. I wonder how long I would have had before they started to grow larger, or before they began causing noticeable issues.
It makes me curious about if it would have become medically urgent to remove one, or both of them at some point regardless, especially seeing how my mother had to have her right ovary removed just this past year from cyst-induced ovarian torsion. It seems I was heading down that same route, although I couldn’t say how long it would have taken me :' )
9 Days Post-op
I finished my steroid dose-pack today, and then went out shopping for the first time since my operation. I was careful to walk at a slower pace than I usually would, and made sure not to pick up more than 5-7 lbs, and if I did pick something up, I was quick with it. I also had someone helping me to push a cart along, and wore my abdominal binder during this small excursion, which provided a lot of support.
I usually put my abdominal binder on whenever I’m doing something that requires a lot of walking/movement, or even if I just feel like I need the support it gives around my torso.
Aside from that, I’ve definitely been more tired than usual, and have been sleeping much more often, which I expected post-op, but it’s interesting that I almost felt more energetic for the first 2-5 days afterwards, and only now I feel the fatigue setting in. I guess it’s all a part of the healing process.
Two days ago, 11 Days Post-op
I had my post-op appointment today. Arrived thirty minutes early, and after getting checked in with the receptionist, I waited 5 or so minutes before being called in by a nurse. She got my weight and blood-pressure, then sat me down in an exam room to ask me some questions about how I was doing.
After answering her, she told me my gyno would be coming in to conduct a short internal exam to check on my cuff healing, so I’d need to unclothe from the waist down, and cover myself up (they provide a sort of thin white sheet you can drape over yourself for more privacy). I unclothed once she left, and waited for my gyno to come in.
When my gyno entered the room, she asked me how I’ve been doing since the procedure, and what my pain levels have been like. I told her that I never really had any pain afterwards, and that I stopped taking all my pain meds on a schedule, four days ago. I have just been using Ibuprofen/Tylenol for breakthrough soreness. She seemed very happy to hear that, and said she was glad I’ve had an unexpectedly easy, and pain-free recovery so far.
She asked me how my rash was faring, and I told her that it’s definitely been improving. There’s less redness/inflammation, not as much itchiness/tenderness, and it just overall looks, and feels much better. I mentioned that I finished the steroid dose-pack a couple days ago and have been taking a couple of Benadryl before bed each night since I began the dose-pack. I added that I‘ve kept up doing cold-compressions to relieve any discomfort from occasional itchiness or irritation.
She asked me to take my abdominal binder off, and to lift up my shirt so she could take a look at my torso, and she commented that she could definitely see where the rash had spread out, but that it looks to be improving, and my incisions themselves, were healing well.
I asked her if the rash meant I was allergic to the surgical glue/Dermabond, but she said it was actually more likely that the preparatory wash is what I had a reaction to, called Chloraprep, (which I’ll be keeping record of). The reason she gave, is because if it were a reaction to the surgical glue, the rash would have been much more focused around the incisions, instead of spreading so far out on my body.
I was directed by her to get into an ideal examination position, where I’d place my feet on foot-holds/supports. Knowing how unpleasant these exams tend to be, she distracted me through talking, and asking questions, while she quickly examined my lower region, and vaginal cuff. It was uncomfortable, but not painful. She inserted a speculum inside of me very briefly, and remarked that my internal stitches, and cuff appeared to be healing nicely too.
One question she asked was whether I’d noticed any hormonal differences with the removal of my ovaries, to which I answered not yet, aside from a handful of moments where I noticed myself suddenly feeling overheated/hot, and of course, the unusual tiredness I’ve been having (which is sort of expected after a surgery like this).
The exam ended within 5 or so minutes, and I think I felt more discomfort in my lower area after she finished when I sat myself up, than I did during it. She gave me some time to ask any follow-up questions I had, so I’ll put a shortened summary of this part of my appointment here,
Follow-up Q&A Portion
Q1. Did the partial vaginectomy remove any of the muscular layer or nerves? – A. No, no muscular layer was removed, the only kind of tissue that was taken out was mucosal tissue.
Q2. Would the partial vaginectomy effect pleasure sensation, or my ability to orgasm? – A. No, it should have no effect on that, as that would be connected to the clitoris.
Q3. Is vaginal penetration still possible? Would it be dangerous in any way or cause damage if it were attempted? – A. Yes, penetration is still possible, but you will have to wait a minimum of 8 weeks before having any sort of vaginal penetration. The cuff will be fragile at first but should be stable enough by eight weeks.
Q4. When would external stimulation be safe? – A. I’d advise you to wait 4 weeks, to resume external stimulation.
Q5. For how long do I have the 5-10 pound lifting restriction? – A. You should wait until 6 weeks before lifting heavier objects, or participating in more strenuous exercises.
Q6. Am I okay to go up and down stairs more than twice a day? – A. Yes, more than twice a day should be fine.
Q7. Any restrictions on bending? – A. No, so long as you’re not experiencing discomfort, bending is okay.
Q8. Would the estrogen cream you mentioned be a good idea to start using, to aid in the healing process? – A. It can be helpful to aid in healing when the patient has noticeable pain or bleeding from a thin and fragile vaginal lining, but if you’ve noticed no bleeding, and haven’t had any discomfort, it shouldn’t be necessary for you to start using it, yet. If you do start to notice bleeding/discomfort though, you can contact me and I’ll prescribe it for you.
Q9. When urinating, it feels different, and seems to come out in spurts, instead of a steady stream like it used to. I also notice I don’t have to urinate as often, despite drinking more? – A. This isn’t uncommon, you’ll want to wait until you reach around 6-8 weeks post-op to see your bladder and bowel movements return to completely normal function, and feeling.
And that was it, I finished asking my questions, and she said I shouldn’t need to come back for a second follow-up, unless I notice any issues. My post-op appointment was brought to a close, she left, and I was walked out by the nurse who initially took me in.
When I got back home, I did notice a little bit of spotting in my briefs (still using some of the disposable ones I got before leaving the hospital, so nothing was ruined 👍). I assume this was from the exam, but it’s the first time I’ve had spotting since I was freshly post-op. This was also the first time I’ve really needed to use any of the liners I purchased, pre-op.
Pre-op Checklist Update
I’ll just be going over what I’ve found to be the most essential items, out of all the pre-op stuff I purchased, up to this point.
· 1 Pack of Dulcolax tablets - These were used prior to surgery, and were necessary for the bowel-prep, but I never used any more of these afterwards. (verdict: essential for pre-op only)
· Fleet Saline Enema 2-pack - Was also only needed for the bowel-prep, and I did not need to use the second enema afterwards. (verdict: essential for pre-op only)
· 2 large bottles of MiraLAX - This was completely essential for having painless, and consistent bowel movements after surgery, I highly recommend using a gentle laxative like this one if you have an upcoming hysto. I would even suggest starting it a few days prior to surgery, as that is my only regret in terms of not preparing enough. I was a bit backed-up during the first 2-3 days post-op, but managed.) (verdict: strongly essential)
· Gas-x - I feel this was also very helpful, as I’m prone to bloating, even putting this whole procedure aside. (verdict: essential)
· Bottle of Tylenol 500s - I took one of these each time I took an ibuprofen, and although I didn’t really experience much pain, I am glad to have had these. I’m sure they contributed to my painlessness. (verdict: essential)
· Xl sized heating pad - 100% glad to have had this, it helped a ton with relieving discomfort in my neck, shoulders, and upper chest from internal gas-pains. These pains were especially noticeable when lying down, but draping this over myself helped far more than I anticipated it would. (verdict: strongly essential)
· Doughnut pillow - This was a must-have for me, it made sitting much more comfortable, especially since I had to take it easy, and stay off of my feet. I didn’t always want to stay in bed, so it was a gigantic aid in sitting-up afterwards. I think you could get away with using a pillow or cushion, though. (verdict: essential)
· Liners – I only used these during the first 5 or so days post-op, but had no spotting or bleeding following the first day anyways, so I didn’t really need them. I also used one after my follow-up appointment, but altogether, these weren’t essential for me. However, they might be for you, so I would still recommend having at least 1 box on hand, just in case. (verdict: non-essential) (but I do recommend having some just in-case you need them, during the first 6 or so weeks post-op)
· Wet wipes - Weren’t necessary, I didn’t need these. If you have sensitivity though, I’d recommend getting some for sure. (verdict: non-essential)
· Q-tips - Helpful for cleaning/drying my bellybutton incision, would recommend for this purpose, if you’re having laparoscopic surgery. (verdict: somewhat essential)
· Melatonin - I found that I had a decreased need for melatonin, especially once the post-surgical fatigue set in. Actually, sleeping has never come more easily, so you probably won’t find yourself needing a sleep-aid. (verdict: non-essential)
· Liquid anti-bacterial dial soap - Needed to use this prior to surgery, so yes, very much necessary, but I did keep using it afterwards as well. (verdict: essential)
· Some comfortable loose clothing - If you already have some loose shirts/sweatpants, you probably don’t need to buy more, but I am glad that I did. It was nice to have a fresh, and comfortable variety of clothing to wear coming home. (verdict: non-essential)
· Disposable underwear – Whether you get these by ordering them, buying them at a local store, or asking for some extras from your hospital before discharge, I’d 100% recommend having these on-hand. Disposable in case of bleeding, spotting, or discharge, and stretchable so as to not bother your incisions, or cause general irritation. (verdict: essential)
· Medication organizer - Generally helpful item to have while taking so many meds, but not completely necessary. (verdict: non-essential)
· A memory foam cluster pillow - Not necessary, but was grateful to have it afterwards, gives a lot of comfort, whether you’re holding it to your abdomen, or using it in bed. (verdict: non-essential)
· Incontinence pads - Was not at all necessary, but I wanted to be prepared, haha. You’ll probably be okay without these though, yeah. (verdict: non-essential)
· Husband pillows - This was essential for me, because I was unable to lie flatly on my back at all, for about the first full week. This was due to gas pain/discomfort in my neck, and shoulders, so I fully recommend having at least 1 of these. (verdict: strongly essential)
· Ice pack - Wasn’t sure I’d use this, but it turned out to be essential, as I broke out in a very irritating rash a few days post-op. Only this, could quickly alleviate the discomfort from that. (verdict: strongly essential)
Conclusion
I’m holding up decently so far, and hoping to keep it up, haha. Trying to remind myself often that I’m still less than two weeks out from this procedure right now, so that I don’t accidentally overdo it. Like with the last update, I’ll include some pictures I took along the way, just for you visuals lovers out there. 👍
Pictures of the on-q pump when completely empty: Imgur
Pic of the original gauze that went over my catheter: Imgur
Leg swelling: Imgur
Rash timeline: Imgur
Bonus pics including my room setup, to show how I’ve placed my stuff for convenience: Imgur
links to my first two posts:
https://www.reddit.com/FTMMen/comments/1an8w58/my_hysterectomy_journal_and_general_hysto_updates/
https://www.reddit.com/FTMMen/comments/1anu3u5/my_hysterectomy_journal_postop_edition/

Hello, and welcome to my 1.5(ish) week update. It’s a bit later than I planned on posting, but I’m here to catch you all up, as promised. I'll be walking through my recovery progress from between 4 days post-op, until 11 days, which is when I had my follow-up appointment.
4 Days Post-Op
Alright, so it would have been on the 12th, that I noticed there was a rash spread out all around my torso. It didn’t seem super focused near the incisions, and it went as far down as my hips/thighs, and as far up as reaching my rib-cage.
It was only mildly itchy and didn’t feel warmer in any areas. I took some pictures, sent them to my gyno asking about whether it was a major concern, or if it could be an allergic reaction to the surgical glue. I waited about half a day, before finally calling into her office for a quicker response, and was told that yes, the glue was a likely culprit for the rash, and being four days out, the incisions are probably closed up by now, so it would be okay to try and peel the glue off using my fingers, and a warm rag, gently.
They also recommended that I use ice on the most irritating areas of the rash for relief. I had already started using a cold gel-pack to do cold-compresses on my abdomen, though. I highly recommend that you do the same if you’re dealing with an allergic reaction or rash. It provided me with the most instant relief out of everything I tried. (My itchiness never reached a very high level, but I’m sure that this would have been my main form of calming it, if it had)
They also called in for me a 6-day Medrol (methylprednisolone) dose-pack. I picked it up a few hours after it was called in, and just followed the pack instructions. I took 6 tabs between when I picked it up, and when I went to sleep. I was also given the okay to continue taking Benadryl before bed, as it would help to reduce the inflammation/itchiness.
There was a second concern, which I didn’t pick up on until later that night, but I noticed that my lower-legs/calves were swollen, particularly my left leg, and heavily toward my ankles. They felt a bit sore, too. This caused me to panic, so I ended up calling the emergency number, worried about dvt/clotting.
I was connected directly to my gyno, who told me that it was most likely water retention, and I should keep an eye on it, keep my legs/feet elevated when I lie down, keep up with taking short walks throughout the day, and to stay as hydrated as possible. Having her quell my worries was very helpful, and if you ever have any concerns following a procedure, don’t hesitate to contact your surgeon’s office, or the emergency line you’ve been given. They are there to answer your questions and 100%, you’re no bother to them whatsoever.
6 Days Post-op
I noticed that my on-q bag was looking flat this morning, so I verified it's emptiness by taking the medicine bag out. It was completely empty, and shaped like an apple core. All I could feel was the cylinder in the middle of it, so I knew I’d finally be removing my pump's catheter today.
I washed my hands, got myself into a comfortable position lying on my back, took the dressings off, took the taping over the catheter off, and gently pulled the catheter away from my body. I was told to stop if it started to pull, or wasn't coming out easily, but there was no problem. I barely felt it as I was taking it out, and the worst sensation was just an unusual tugging, but otherwise completely painless removal. It took about a minute for me to entirely pull it out. Once I saw the black tip at the end, I placed a band-aid over the insertion area, and was done.
I’ll include a short video I made, for anyone curious about how it looks to do this. Warning to those squeamish around medical procedures, I'll be pulling out a thin catheter inserted just above my groin in this video (no blood or discharge, but it may still be hard to stomach for some): https://www.youtube.com/watch?v=Ve9wa3sJduQ The audio is a bit low, so you also might want to bump up the volume. I added subtitles to make up for the quiet audio.
Oh, and I was told that seeing a pinkish-red colored discharge on the gauze taped over the catheter site is normal, and I will include a picture of what this looks like at the end of my post, so you can more easily recognize it. This is a harmless discharge, and if you see your dressings are turning red/pink, no need to panic, just take your dressing off and replace it with a fresh pad of gauze, or a sufficiently sized band-aid.
In good news, I wasn’t feeling much irritation or itchiness around my rash today, and any gas pains I had been experiencing in my neck, shoulders, or upper chest seemed to be mostly gone whenever I went to lie down/sit up.
I felt well enough to do some slow paced baking, so I made some valentines themed red-velvet glazed donuts for my family. (I may have been pushing it with this, so maybe hold off on baking or cooking for longer than I did, haha.)
7 Days Post-op
By this point I completely stopped using Ibuprofen, Tylenol, and the Gabapentin. I no longer felt like I needed it, as I didn’t feel any pain beyond soreness occasionally. The rash was my biggest irritant right now.
8 Days Post-op
I’ve been doing a lot of resting these last couple of days, I guess I must have been hit with that infamous post-surgical fatigue, haha. I’m happy to report my legs are no longer swollen, though. I also looked over the results of my pathology report today, and it turns out my ovaries were indeed riddled with cysts. I wonder how long I would have had before they started to grow larger, or before they began causing noticeable issues.
It makes me curious about if it would have become medically urgent to remove one, or both of them at some point regardless, especially seeing how my mother had to have her right ovary removed just this past year from cyst-induced ovarian torsion. It seems I was heading down that same route, although I couldn’t say how long it would have taken me :' )
9 Days Post-op
I finished my steroid dose-pack today, and then went out shopping for the first time since my operation. I was careful to walk at a slower pace than I usually would, and made sure not to pick up more than 5-7 lbs, and if I did pick something up, I was quick with it. I also had someone helping me to push a cart along, and wore my abdominal binder during this small excursion, which provided a lot of support.
I usually put my abdominal binder on whenever I’m doing something that requires a lot of walking/movement, or even if I just feel like I need the support it gives around my torso.
Aside from that, I’ve definitely been more tired than usual, and have been sleeping much more often, which I expected post-op, but it’s interesting that I almost felt more energetic for the first 2-5 days afterwards, and only now I feel the fatigue setting in. I guess it’s all a part of the healing process.
Two days ago, 11 Days Post-op
I had my post-op appointment today. Arrived thirty minutes early, and after getting checked in with the receptionist, I waited 5 or so minutes before being called in by a nurse. She got my weight and blood-pressure, then sat me down in an exam room to ask me some questions about how I was doing.
After answering her, she told me my gyno would be coming in to conduct a short internal exam to check on my cuff healing, so I’d need to unclothe from the waist down, and cover myself up (they provide a sort of thin white sheet you can drape over yourself for more privacy). I unclothed once she left, and waited for my gyno to come in.
When my gyno entered the room, she asked me how I’ve been doing since the procedure, and what my pain levels have been like. I told her that I never really had any pain afterwards, and that I stopped taking all my pain meds on a schedule, four days ago. I have just been using Ibuprofen/Tylenol for breakthrough soreness. She seemed very happy to hear that, and said she was glad I’ve had an unexpectedly easy, and pain-free recovery so far.
She asked me how my rash was faring, and I told her that it’s definitely been improving. There’s less redness/inflammation, not as much itchiness/tenderness, and it just overall looks, and feels much better. I mentioned that I finished the steroid dose-pack a couple days ago and have been taking a couple of Benadryl before bed each night since I began the dose-pack. I added that I‘ve kept up doing cold-compressions to relieve any discomfort from occasional itchiness or irritation.
She asked me to take my abdominal binder off, and to lift up my shirt so she could take a look at my torso, and she commented that she could definitely see where the rash had spread out, but that it looks to be improving, and my incisions themselves, were healing well.
I asked her if the rash meant I was allergic to the surgical glue/Dermabond, but she said it was actually more likely that the preparatory wash is what I had a reaction to, called Chloraprep, (which I’ll be keeping record of). The reason she gave, is because if it were a reaction to the surgical glue, the rash would have been much more focused around the incisions, instead of spreading so far out on my body.
I was directed by her to get into an ideal examination position, where I’d place my feet on foot-holds/supports. Knowing how unpleasant these exams tend to be, she distracted me through talking, and asking questions, while she quickly examined my lower region, and vaginal cuff. It was uncomfortable, but not painful. She inserted a speculum inside of me very briefly, and remarked that my internal stitches, and cuff appeared to be healing nicely too.
One question she asked was whether I’d noticed any hormonal differences with the removal of my ovaries, to which I answered not yet, aside from a handful of moments where I noticed myself suddenly feeling overheated/hot, and of course, the unusual tiredness I’ve been having (which is sort of expected after a surgery like this).
The exam ended within 5 or so minutes, and I think I felt more discomfort in my lower area after she finished when I sat myself up, than I did during it. She gave me some time to ask any follow-up questions I had, so I’ll put a shortened summary of this part of my appointment here,
Follow-up Q&A Portion
Q1. Did the partial vaginectomy remove any of the muscular layer or nerves? – A. No, no muscular layer was removed, the only kind of tissue that was taken out was mucosal tissue.
Q2. Would the partial vaginectomy effect pleasure sensation, or my ability to orgasm? – A. No, it should have no effect on that, as that would be connected to the clitoris.
Q3. Is vaginal penetration still possible? Would it be dangerous in any way or cause damage if it were attempted? – A. Yes, penetration is still possible, but you will have to wait a minimum of 8 weeks before having any sort of vaginal penetration. The cuff will be fragile at first but should be stable enough by eight weeks.
Q4. When would external stimulation be safe? – A. I’d advise you to wait 4 weeks, to resume external stimulation.
Q5. For how long do I have the 5-10 pound lifting restriction? – A. You should wait until 6 weeks before lifting heavier objects, or participating in more strenuous exercises.
Q6. Am I okay to go up and down stairs more than twice a day? – A. Yes, more than twice a day should be fine.
Q7. Any restrictions on bending? – A. No, so long as you’re not experiencing discomfort, bending is okay.
Q8. Would the estrogen cream you mentioned be a good idea to start using, to aid in the healing process? – A. It can be helpful to aid in healing when the patient has noticeable pain or bleeding from a thin and fragile vaginal lining, but if you’ve noticed no bleeding, and haven’t had any discomfort, it shouldn’t be necessary for you to start using it, yet. If you do start to notice bleeding/discomfort though, you can contact me and I’ll prescribe it for you.
Q9. When urinating, it feels different, and seems to come out in spurts, instead of a steady stream like it used to. I also notice I don’t have to urinate as often, despite drinking more? – A. This isn’t uncommon, you’ll want to wait until you reach around 6-8 weeks post-op to see your bladder and bowel movements return to completely normal function, and feeling.
And that was it, I finished asking my questions, and she said I shouldn’t need to come back for a second follow-up, unless I notice any issues. My post-op appointment was brought to a close, she left, and I was walked out by the nurse who initially took me in.
When I got back home, I did notice a little bit of spotting in my briefs (still using some of the disposable ones I got before leaving the hospital, so nothing was ruined 👍). I assume this was from the exam, but it’s the first time I’ve had spotting since I was freshly post-op. This was also the first time I’ve really needed to use any of the liners I purchased, pre-op.
Pre-op Checklist Update
I’ll just be going over what I’ve found to be the most essential items, out of all the pre-op stuff I purchased, up to this point.
· 1 Pack of Dulcolax tablets - These were used prior to surgery, and were necessary for the bowel-prep, but I never used any more of these afterwards. (verdict: essential for pre-op only)
· Fleet Saline Enema 2-pack - Was also only needed for the bowel-prep, and I did not need to use the second enema afterwards. (verdict: essential for pre-op only)
· 2 large bottles of MiraLAX - This was completely essential for having painless, and consistent bowel movements after surgery, I highly recommend using a gentle laxative like this one if you have an upcoming hysto. I would even suggest starting it a few days prior to surgery, as that is my only regret in terms of not preparing enough. I was a bit backed-up during the first 2-3 days post-op, but managed.) (verdict: strongly essential)
· Gas-x - I feel this was also very helpful, as I’m prone to bloating, even putting this whole procedure aside. (verdict: essential)
· Bottle of Tylenol 500s - I took one of these each time I took an ibuprofen, and although I didn’t really experience much pain, I am glad to have had these. I’m sure they contributed to my painlessness. (verdict: essential)
· Xl sized heating pad - 100% glad to have had this, it helped a ton with relieving discomfort in my neck, shoulders, and upper chest from internal gas-pains. These pains were especially noticeable when lying down, but draping this over myself helped far more than I anticipated it would. (verdict: strongly essential)
· Doughnut pillow - This was a must-have for me, it made sitting much more comfortable, especially since I had to take it easy, and stay off of my feet. I didn’t always want to stay in bed, so it was a gigantic aid in sitting-up afterwards. I think you could get away with using a pillow or cushion, though. (verdict: essential)
· Liners – I only used these during the first 5 or so days post-op, but had no spotting or bleeding following the first day anyways, so I didn’t really need them. I also used one after my follow-up appointment, but altogether, these weren’t essential for me. However, they might be for you, so I would still recommend having at least 1 box on hand, just in case. (verdict: non-essential) (but I do recommend having some just in-case you need them, during the first 6 or so weeks post-op)
· Wet wipes - Weren’t necessary, I didn’t need these. If you have sensitivity though, I’d recommend getting some for sure. (verdict: non-essential)
· Q-tips - Helpful for cleaning/drying my bellybutton incision, would recommend for this purpose, if you’re having laparoscopic surgery. (verdict: somewhat essential)
· Melatonin - I found that I had a decreased need for melatonin, especially once the post-surgical fatigue set in. Actually, sleeping has never come more easily, so you probably won’t find yourself needing a sleep-aid. (verdict: non-essential)
· Liquid anti-bacterial dial soap - Needed to use this prior to surgery, so yes, very much necessary, but I did keep using it afterwards as well. (verdict: essential)
· Some comfortable loose clothing - If you already have some loose shirts/sweatpants, you probably don’t need to buy more, but I am glad that I did. It was nice to have a fresh, and comfortable variety of clothing to wear coming home. (verdict: non-essential)
· Disposable underwear – Whether you get these by ordering them, buying them at a local store, or asking for some extras from your hospital before discharge, I’d 100% recommend having these on-hand. Disposable in case of bleeding, spotting, or discharge, and stretchable so as to not bother your incisions, or cause general irritation. (verdict: essential)
· Medication organizer - Generally helpful item to have while taking so many meds, but not completely necessary. (verdict: non-essential)
· A memory foam cluster pillow - Not necessary, but was grateful to have it afterwards, gives a lot of comfort, whether you’re holding it to your abdomen, or using it in bed. (verdict: non-essential)
· Incontinence pads - Was not at all necessary, but I wanted to be prepared, haha. You’ll probably be okay without these though, yeah. (verdict: non-essential)
· Husband pillows - This was essential for me, because I was unable to lie flatly on my back at all, for about the first full week. This was due to gas pain/discomfort in my neck, and shoulders, so I fully recommend having at least 1 of these. (verdict: strongly essential)
· Ice pack - Wasn’t sure I’d use this, but it turned out to be essential, as I broke out in a very irritating rash a few days post-op. Only this, could quickly alleviate the discomfort from that. (verdict: strongly essential)
Conclusion
I’m holding up decently so far, and hoping to keep it up, haha. Trying to remind myself often that I’m still less than two weeks out from this procedure right now, so that I don’t accidentally overdo it. Like with the last update, I’ll include some pictures I took along the way, just for you visuals lovers out there. 👍
Pictures of the on-q pump when completely empty: Imgur
Pic of the original gauze that went over my catheter: Imgur
Leg swelling: Imgur
Rash timeline: Imgur
Bonus pics including my room setup, to show how I’ve placed my stuff for convenience: Imgur
links to my first two posts:
https://www.reddit.com/FTMHysto/comments/1an8komy_hysterectomy_journal_and_general_hysto/
https://www.reddit.com/FTMHysto/comments/1antpay/my_hysterectomy_journal_postop_edition/

Hello, and welcome to my 1.5(ish) week update. It’s a bit later than I planned on posting, but I’m here to catch you all up, as promised. I'll be walking through my recovery progress from between 4 days post-op, until 11 days, which is when I had my follow-up appointment.
4 Days Post-Op
Alright, so it would have been on the 12th, that I noticed there was a rash spread out all around my torso. It didn’t seem super focused near the incisions, and it went as far down as my hips/thighs, and as far up as reaching my rib-cage.
It was only mildly itchy and didn’t feel warmer in any areas. I took some pictures, sent them to my gyno asking about whether it was a major concern, or if it could be an allergic reaction to the surgical glue. I waited about half a day, before finally calling into her office for a quicker response, and was told that yes, the glue was a likely culprit for the rash, and being four days out, the incisions are probably closed up by now, so it would be okay to try and peel the glue off using my fingers, and a warm rag, gently.
They also recommended that I use ice on the most irritating areas of the rash for relief. I had already started using a cold gel-pack to do cold-compresses on my abdomen, though. I highly recommend that you do the same if you’re dealing with an allergic reaction or rash. It provided me with the most instant relief out of everything I tried. (My itchiness never reached a very high level, but I’m sure that this would have been my main form of calming it, if it had)
They also called in for me a 6-day Medrol (methylprednisolone) dose-pack. I picked it up a few hours after it was called in, and just followed the pack instructions. I took 6 tabs between when I picked it up, and when I went to sleep. I was also given the okay to continue taking Benadryl before bed, as it would help to reduce the inflammation/itchiness.
There was a second concern, which I didn’t pick up on until later that night, but I noticed that my lower-legs/calves were swollen, particularly my left leg, and heavily toward my ankles. They felt a bit sore, too. This caused me to panic, so I ended up calling the emergency number, worried about dvt/clotting.
I was connected directly to my gyno, who told me that it was most likely water retention, and I should keep an eye on it, keep my legs/feet elevated when I lie down, keep up with taking short walks throughout the day, and to stay as hydrated as possible. Having her quell my worries was very helpful, and if you ever have any concerns following a procedure, don’t hesitate to contact your surgeon’s office, or the emergency line you’ve been given. They are there to answer your questions and 100%, you’re no bother to them whatsoever.
6 Days Post-op
I noticed that my on-q bag was looking flat this morning, so I verified it's emptiness by taking the medicine bag out. It was completely empty, and shaped like an apple core. All I could feel was the cylinder in the middle of it, so I knew I’d finally be removing my pump's catheter today.
I washed my hands, got myself into a comfortable position lying on my back, took the dressings off, took the taping over the catheter off, and gently pulled the catheter away from my body. I was told to stop if it started to pull, or wasn't coming out easily, but there was no problem. I barely felt it as I was taking it out, and the worst sensation was just an unusual tugging, but otherwise completely painless removal. It took about a minute for me to entirely pull it out. Once I saw the black tip at the end, I placed a band-aid over the insertion area, and was done.
I’ll include a short video I made, for anyone curious about how it looks to do this. Warning to those squeamish around medical procedures, I'll be pulling out a thin catheter inserted just above my groin in this video (no blood or discharge, but it may still be hard to stomach for some): https://www.youtube.com/watch?v=Ve9wa3sJduQ The audio is a bit low, so you also might want to bump up the volume. I added subtitles to make up for the quiet audio.
Oh, and I was told that seeing a pinkish-red colored discharge on the gauze taped over the catheter site is normal, and I will include a picture of what this looks like at the end of my post, so you can more easily recognize it. This is a harmless discharge, and if you see your dressings are turning red/pink, no need to panic, just take your dressing off and replace it with a fresh pad of gauze, or a sufficiently sized band-aid.
In good news, I wasn’t feeling much irritation or itchiness around my rash today, and any gas pains I had been experiencing in my neck, shoulders, or upper chest seemed to be mostly gone whenever I went to lie down/sit up.
I felt well enough to do some slow paced baking, so I made some valentines themed red-velvet glazed donuts for my family. (I may have been pushing it with this, so maybe hold off on baking or cooking for longer than I did, haha.)
7 Days Post-op
By this point I completely stopped using Ibuprofen, Tylenol, and the Gabapentin. I no longer felt like I needed it, as I didn’t feel any pain beyond soreness occasionally. The rash was my biggest irritant right now.
8 Days Post-op
I’ve been doing a lot of resting these last couple of days, I guess I must have been hit with that infamous post-surgical fatigue, haha. I’m happy to report my legs are no longer swollen, though. I also looked over the results of my pathology report today, and it turns out my ovaries were indeed riddled with cysts. I wonder how long I would have had before they started to grow larger, or before they began causing noticeable issues.
It makes me curious about if it would have become medically urgent to remove one, or both of them at some point regardless, especially seeing how my mother had to have her right ovary removed just this past year from cyst-induced ovarian torsion. It seems I was heading down that same route, although I couldn’t say how long it would have taken me :' )
9 Days Post-op
I finished my steroid dose-pack today, and then went out shopping for the first time since my operation. I was careful to walk at a slower pace than I usually would, and made sure not to pick up more than 5-7 lbs, and if I did pick something up, I was quick with it. I also had someone helping me to push a cart along, and wore my abdominal binder during this small excursion, which provided a lot of support.
I usually put my abdominal binder on whenever I’m doing something that requires a lot of walking/movement, or even if I just feel like I need the support it gives around my torso.
Aside from that, I’ve definitely been more tired than usual, and have been sleeping much more often, which I expected post-op, but it’s interesting that I almost felt more energetic for the first 2-5 days afterwards, and only now I feel the fatigue setting in. I guess it’s all a part of the healing process.
Two days ago, 11 Days Post-op
I had my post-op appointment today. Arrived thirty minutes early, and after getting checked in with the receptionist, I waited 5 or so minutes before being called in by a nurse. She got my weight and blood-pressure, then sat me down in an exam room to ask me some questions about how I was doing.
After answering her, she told me my gyno would be coming in to conduct a short internal exam to check on my cuff healing, so I’d need to unclothe from the waist down, and cover myself up (they provide a sort of thin white sheet you can drape over yourself for more privacy). I unclothed once she left, and waited for my gyno to come in.
When my gyno entered the room, she asked me how I’ve been doing since the procedure, and what my pain levels have been like. I told her that I never really had any pain afterwards, and that I stopped taking all my pain meds on a schedule, four days ago. I have just been using Ibuprofen/Tylenol for breakthrough soreness. She seemed very happy to hear that, and said she was glad I’ve had an unexpectedly easy, and pain-free recovery so far.
She asked me how my rash was faring, and I told her that it’s definitely been improving. There’s less redness/inflammation, not as much itchiness/tenderness, and it just overall looks, and feels much better. I mentioned that I finished the steroid dose-pack a couple days ago and have been taking a couple of Benadryl before bed each night since I began the dose-pack. I added that I‘ve kept up doing cold-compressions to relieve any discomfort from occasional itchiness or irritation.
She asked me to take my abdominal binder off, and to lift up my shirt so she could take a look at my torso, and she commented that she could definitely see where the rash had spread out, but that it looks to be improving, and my incisions themselves, were healing well.
I asked her if the rash meant I was allergic to the surgical glue/Dermabond, but she said it was actually more likely that the preparatory wash is what I had a reaction to, called Chloraprep, (which I’ll be keeping record of). The reason she gave, is because if it were a reaction to the surgical glue, the rash would have been much more focused around the incisions, instead of spreading so far out on my body.
I was directed by her to get into an ideal examination position, where I’d place my feet on foot-holds/supports. Knowing how unpleasant these exams tend to be, she distracted me through talking, and asking questions, while she quickly examined my lower region, and vaginal cuff. It was uncomfortable, but not painful. She inserted a speculum inside of me very briefly, and remarked that my internal stitches, and cuff appeared to be healing nicely too.
One question she asked was whether I’d noticed any hormonal differences with the removal of my ovaries, to which I answered not yet, aside from a handful of moments where I noticed myself suddenly feeling overheated/hot, and of course, the unusual tiredness I’ve been having (which is sort of expected after a surgery like this).
The exam ended within 5 or so minutes, and I think I felt more discomfort in my lower area after she finished when I sat myself up, than I did during it. She gave me some time to ask any follow-up questions I had, so I’ll put a shortened summary of this part of my appointment here,
Follow-up Q&A Portion
Q1. Did the partial vaginectomy remove any of the muscular layer or nerves? – A. No, no muscular layer was removed, the only kind of tissue that was taken out was mucosal tissue.
Q2. Would the partial vaginectomy effect pleasure sensation, or my ability to orgasm? – A. No, it should have no effect on that, as that would be connected to the clitoris.
Q3. Is vaginal penetration still possible? Would it be dangerous in any way or cause damage if it were attempted? – A. Yes, penetration is still possible, but you will have to wait a minimum of 8 weeks before having any sort of vaginal penetration. The cuff will be fragile at first but should be stable enough by eight weeks.
Q4. When would external stimulation be safe? – A. I’d advise you to wait 4 weeks, to resume external stimulation.
Q5. For how long do I have the 5-10 pound lifting restriction? – A. You should wait until 6 weeks before lifting heavier objects, or participating in more strenuous exercises.
Q6. Am I okay to go up and down stairs more than twice a day? – A. Yes, more than twice a day should be fine.
Q7. Any restrictions on bending? – A. No, so long as you’re not experiencing discomfort, bending is okay.
Q8. Would the estrogen cream you mentioned be a good idea to start using, to aid in the healing process? – A. It can be helpful to aid in healing when the patient has noticeable pain or bleeding from a thin and fragile vaginal lining, but if you’ve noticed no bleeding, and haven’t had any discomfort, it shouldn’t be necessary for you to start using it, yet. If you do start to notice bleeding/discomfort though, you can contact me and I’ll prescribe it for you.
Q9. When urinating, it feels different, and seems to come out in spurts, instead of a steady stream like it used to. I also notice I don’t have to urinate as often, despite drinking more? – A. This isn’t uncommon, you’ll want to wait until you reach around 6-8 weeks post-op to see your bladder and bowel movements return to completely normal function, and feeling.
And that was it, I finished asking my questions, and she said I shouldn’t need to come back for a second follow-up, unless I notice any issues. My post-op appointment was brought to a close, she left, and I was walked out by the nurse who initially took me in.
When I got back home, I did notice a little bit of spotting in my briefs (still using some of the disposable ones I got before leaving the hospital, so nothing was ruined 👍). I assume this was from the exam, but it’s the first time I’ve had spotting since I was freshly post-op. This was also the first time I’ve really needed to use any of the liners I purchased, pre-op.
Pre-op Checklist Update
I’ll just be going over what I’ve found to be the most essential items, out of all the pre-op stuff I purchased, up to this point.
· 1 Pack of Dulcolax tablets - These were used prior to surgery, and were necessary for the bowel-prep, but I never used any more of these afterwards. (verdict: essential for pre-op only)
· Fleet Saline Enema 2-pack - Was also only needed for the bowel-prep, and I did not need to use the second enema afterwards. (verdict: essential for pre-op only)
· 2 large bottles of MiraLAX - This was completely essential for having painless, and consistent bowel movements after surgery, I highly recommend using a gentle laxative like this one if you have an upcoming hysto. I would even suggest starting it a few days prior to surgery, as that is my only regret in terms of not preparing enough. I was a bit backed-up during the first 2-3 days post-op, but managed.) (verdict: strongly essential)
· Gas-x - I feel this was also very helpful, as I’m prone to bloating, even putting this whole procedure aside. (verdict: essential)
· Bottle of Tylenol 500s - I took one of these each time I took an ibuprofen, and although I didn’t really experience much pain, I am glad to have had these. I’m sure they contributed to my painlessness. (verdict: essential)
· Xl sized heating pad - 100% glad to have had this, it helped a ton with relieving discomfort in my neck, shoulders, and upper chest from internal gas-pains. These pains were especially noticeable when lying down, but draping this over myself helped far more than I anticipated it would. (verdict: strongly essential)
· Doughnut pillow - This was a must-have for me, it made sitting much more comfortable, especially since I had to take it easy, and stay off of my feet. I didn’t always want to stay in bed, so it was a gigantic aid in sitting-up afterwards. I think you could get away with using a pillow or cushion, though. (verdict: essential)
· Liners – I only used these during the first 5 or so days post-op, but had no spotting or bleeding following the first day anyways, so I didn’t really need them. I also used one after my follow-up appointment, but altogether, these weren’t essential for me. However, they might be for you, so I would still recommend having at least 1 box on hand, just in case. (verdict: non-essential) (but I do recommend having some just in-case you need them, during the first 6 or so weeks post-op)
· Wet wipes - Weren’t necessary, I didn’t need these. If you have sensitivity though, I’d recommend getting some for sure. (verdict: non-essential)
· Q-tips - Helpful for cleaning/drying my bellybutton incision, would recommend for this purpose, if you’re having laparoscopic surgery. (verdict: somewhat essential)
· Melatonin - I found that I had a decreased need for melatonin, especially once the post-surgical fatigue set in. Actually, sleeping has never come more easily, so you probably won’t find yourself needing a sleep-aid. (verdict: non-essential)
· Liquid anti-bacterial dial soap - Needed to use this prior to surgery, so yes, very much necessary, but I did keep using it afterwards as well. (verdict: essential)
· Some comfortable loose clothing - If you already have some loose shirts/sweatpants, you probably don’t need to buy more, but I am glad that I did. It was nice to have a fresh, and comfortable variety of clothing to wear coming home. (verdict: non-essential)
· Disposable underwear – Whether you get these by ordering them, buying them at a local store, or asking for some extras from your hospital before discharge, I’d 100% recommend having these on-hand. Disposable in case of bleeding, spotting, or discharge, and stretchable so as to not bother your incisions, or cause general irritation. (verdict: essential)
· Medication organizer - Generally helpful item to have while taking so many meds, but not completely necessary. (verdict: non-essential)
· A memory foam cluster pillow - Not necessary, but was grateful to have it afterwards, gives a lot of comfort, whether you’re holding it to your abdomen, or using it in bed. (verdict: non-essential)
· Incontinence pads - Was not at all necessary, but I wanted to be prepared, haha. You’ll probably be okay without these though, yeah. (verdict: non-essential)
· Husband pillows - This was essential for me, because I was unable to lie flatly on my back at all, for about the first full week. This was due to gas pain/discomfort in my neck, and shoulders, so I fully recommend having at least 1 of these. (verdict: strongly essential)
· Ice pack - Wasn’t sure I’d use this, but it turned out to be essential, as I broke out in a very irritating rash a few days post-op. Only this, could quickly alleviate the discomfort from that. (verdict: strongly essential)
Conclusion
I’m holding up decently so far, and hoping to keep it up, haha. Trying to remind myself often that I’m still less than two weeks out from this procedure right now, so that I don’t accidentally overdo it. Like with the last update, I’ll include some pictures I took along the way, just for you visuals lovers out there. 👍
Pictures of the on-q pump when completely empty: Imgur
Pic of the original gauze that went over my catheter: Imgur
Leg swelling: Imgur
Rash timeline: Imgur
Bonus pics including my room setup, to show how I’ve placed my stuff for convenience: Imgur
links to my first two posts:
https://www.reddit.com/hysterectomy/comments/1an7uat/my_hysterectomy_journal_and_general_hysto_updates/
https://www.reddit.com/hysterectomy/comments/1anr7au/my_hysterectomy_journal_the_sequel_edition/

Hello, and welcome to my ‘hysterectomy journal’, where I’ll be jotting down my experience as a ftm, transgender individual, seeking a total hysterectomy as my first stage in preparing for future prospective bottom surgery (genital reconstruction). DYSPHORIA WARNING: ANATOMICAL TERMS USED AHEAD
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Beware this is going to be an exceptionally lengthy, and detailed chronicle of my journey through this stage of my life. Feel free to skim through, and read whichever parts interest or apply to you the most, I don't mind at all. Just happy to provide my perspective, and maybe help a couple of people along the way, if they need some extra information. Also, there will be multiple changes in points of view, as some of this was written during, and some was written in past-tense.
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As you may have noticed from the title, I am seeking out a gender-affirming hysterectomy, and will be noting down my experience in obtaining this surgery from the perspective of a transgender-man.
From the very beginning, this has always been a procedure I’ve wanted done to relieve the dysphoria from my menstrual cycles, but I have also always felt that I need a total hysterectomy to feel whole with myself, both physically, and mentally. Having a uterus inside of me, and knowing it is there, has always been dysphoria-inducing to me, even putting the menstrual cycles aside.
I had hit puberty early, so those aforementioned cycles started when I was around 10 or 11 years old. You could say things were off to an abnormal start, haha. My cycles were never regular. They would often show up out of nowhere, would last varying durations of time when they did occur, and it was always excruciatingly painful, and accompanied by heavy bleeding. Then they would typically disappear for 2-3 months at a time, with absolutely nothing, not so much as a cramp.
Eventually due to the extreme amounts of dysphoria my early-puberty induced, I was taken to a children’s hospital to see their gender-treatment team, and although puberty blockers weren’t given as an option, depo-provera was, which being my only option to stop my cycles, I gladly took. In the form of an injection to my shoulder every three months, which I had a total of 2-3 times, so for 6-9 months before I finally started testosterone-replacement therapy when I was a bit past my 15th birthday.
I will mention that when I went to that clinic, I was also diagnosed with pcos, and hyper-androgyny, likely caused by the pcos, which meant my natural testosterone-levels were already higher than normal. It certainly explained how I was able to grow facial-hair even off of testosterone, but I digress.
My mother also has pcos, and had her right ovary removed last year, after a very large cyst was identified as the cause of her abdominal pain, causing ovarian torsion. Pcos would seem likely to be genetically passed down to me, from her.
The initial referral
So, I had been seeing my gender therapist since I was about 13, started medical intervention for dysphoria a bit past my 14th birthday, and a year-ish later began testosterone replacement therapy after my 15th birthday. I am now 19 years of age, but have always been strongly certain of what treatments would be necessary to alleviate my dysphoria, and have sought them out relentlessly, without rest. I’m sure there are many who can relate.
I was first referred to a trans-friendly gynecologist through my therapist, who I will refer to as T, when I was 17. However, due to a loss of insurance, I was unable to follow-through with that appointment.
…Here I am now, two years later. The way I got ‘back in’ so to speak, was through my primary care doctor. Who I was also initially referred to through T, my therapist, to begin hrt. However, she has been my pcp ever since, and I couldn’t be happier to have her as my doctor.
In any case, I made a call to the office asking if she could send a new referral out for the gynecologist/hysterectomy consultation, and she did so without the need to meet me in person. My new consultation date was set for about a month and a half later.
The Hysterectomy Consultation
After what felt like a very long wait, my appointment day came, on January 8th. I was extremely nervous, having never been to a gynecologist before. I wasn’t sure whether to expect a pelvic exam, or whether anything similar would take place. I was also a bit nervous to go to this appointment, just due to not being the typical women’s health patient, but despite my fears, I made my way out to it.
Fortunately, the staff was very accommodating, and friendly towards me. It quickly became clear that they had dealt with many other trans patients before me, which made me feel very reassured. There were zero incidents of mis-gendering which I appreciated.
I waited twenty minutes, then was called in to speak with the nurse. We just did a brief medical history, and went over my reason for being there, and that was that. She left, and mentioned there would be a little extra wait until I’d be seeing my gynecologist, who for the sake of convenience, I’ll refer to as G.
We discussed my transition, what I was looking for in this procedure, whether I’d like to keep my ovaries, and so on. We went over risks, options for egg-freezing (not something that I was interested in, nor could hope to afford quickly enough, even if I were interested) but I appreciated that she suggested it. I proceeded to ask all of my questions. Also, I never felt I had to prove my identity to her in any way, and I never felt as though I was being judged for my decisions. She didn’t rush me, and made sure to take her time to answer every question I had for her.
If you’d like a quick run-down of how that conversation went, I will give one shortly, otherwise feel free to skip ahead a bit, haha.
Q&A Portion
Q1. Would a total hysterectomy with salpingo-oophorectomy be possible vaginally/laparoscopically? – A. Yes, in fact she mentioned that she almost exclusively performs robotically-assisted vaginal laparoscopic hysterectomies with the Da Vinci.
Essentially, they make three or so incisions in which tools are inserted to free the uterus from the surrounding tissue, they then make a cut into the vagina where they pull it all out through the vaginal canal.
Apparently being on testosterone for so long will also have likely shrunk the uterus down in size, which makes it even easier to do. This procedure is abbreviated to ‘RATLH, BSO’ (robotically assisted total laparoscopic hysterectomy, with bilateral salpingo-oophorectomy.
Since I am seeking bottom surgery in the future, she added that she would also be willing to perform a partial vaginectomy, which I was very enthused to hear. This will leave enough mucosal tissue to be used in the possible urethral hook-up. All in all, this was great news to hear.
Q2. Is there a particularly high risk of bladdevaginal/rectal prolapse? – A. This is highly unlikely without having ever been pregnant or previously given birth. It’s typically only a major concern when the pelvic floor has gone through previous trauma and has been weakened.
Q3. I assume that with ovary removal I’ll need to stay on testosterone for the rest of my life, or some form of hrt? - A. This is correct, and staying on testosterone will reduce/eliminate the risk of osteoporosis.
Q4. Will this procedure cause any form of menopause, or surgical menopause? – A. Yes, but since you are currently, and have been on testosterone, it will be unnoticeable to you.
Q5. How long have you been working with transgender patients, and with my doctor? – A. I have been working with your doctor, and performing hysterectomies on transgender patients since 2012.
Q6. What does the recovery look like? – A. You will be recovering for a minimum of 2-4 weeks, and expect to hold off from any strenuous activity for around 6-8 weeks.
Q7. What are the greatest risks to look out for, following this procedure? – A. There is general risk of bleeding, infection, anesthesia complications, intraoperative injury to surrounding organs/bowels, and possible post-op complications. This is still a relatively low-risk procedure, and the above happens in less than 1 in 1000 patients.
She mentioned that to combat risk of infection, I’ll be started on antibiotics before the day of surgery to prevent it ahead of time.
Q8. Will I need a catheter? – A. Yes, but it will be inserted only once you are unconscious, and will be removed before you wake up.
Q9. Does staying on testosterone and keeping your uterus/ovaries increase the risk of developing cancer? – A. There has not been a notable increase in risk of cancer caused by staying on hrt, based on current available statistics. She did mention that there is a 70 percent risk reduction for ovarian cancer solely from the removal of the fallopian tubes, though. This is a question I asked, just to appease my own curiosity.
Q10. Will there be bleeding afterwards? – A. Some bleeding is to be expected, and an estrogen cream may be prescribed for a couple of weeks to help.
Q11. Where will this procedure take place, and who will be performing the surgery? – A. She answered one of two hospitals, which I had the choice between, and that she would be performing the surgery herself using the Da Vinci, along with an assistant.
Q12. Can I immediately return home? – A. You will likely be able to return home within the first 24 hours.
Q13. When will I need to follow-up? – A. There will be a two-week follow-up appointment.
Q14. What is the first thing to do in case of a complication? – A. You will be given an instruction packet at the pre-op appointment going over this in detail.
Q15. How will the insurance coverage work, as I have Medicaid? – A. I will need two letters, one of them can come from your pcp, and the other should come from your therapist.
Q16. Will an examination need to take place beforehand? – A. Yes, we will need to do a pelvic transabdominal, and transvaginal ultrasound before this procedure.
After she took her time to answer all my questions, we parted ways, and I was walked into her scheduler’s office to get the dates sorted. I asked for the soonest date I could get in for, which was February 8th. My insurance has a 30-day consideration period before approving any non-emergent hysterectomy procedures. Not that this was an issue, as I needed time to get the required letters anyways.
We also scheduled for my pre-admission testing, and I was given the option to have my pre-op appointment directly afterwards, at their office, so I also had them go ahead and schedule both of those for the 22nd of January. The exact times were yet to be determined, but I asked for something in the afternoon, if possible.
Oh, and I can’t remember if I left it out, but she brought up egg-freezing as an option, and I declined, although it was certainly a green flag to me that she suggested it.
While I’m interested in becoming a father one day, I personally don’t feel the need to be biologically connected to my future children. From my own experience, family extends way farther than blood-relations anyways, haha. My own father for example, has never been biologically related to me, but he’s always been my dad 100%, through the rocky times, and through the smooth ones as well.
Nevertheless, I was confirmed for January 8th, and the general time-frame that it would occur, would be early in the morning, between 6:00 am to 7:00 am. Feeling very encouraged, I returned home. It was finally sinking in that this would really be happening.
The Hospital Pre-Admission, and Pre-Op Appointments
Within the following two weeks, I was given an exact time for the pre-admission appointment, at 1:30 pm on the 22nd of January. The pre-op would be back at my gynecologist’s office, directly after leaving the hospital.
A nurse from the hospital also shortly gave me a call on the 18th of January to go over, and confirm my medical history ahead of time, as well as to give me directions for the testing location. She added that no fasting would be required for this appointment.
They also scheduled my first future post-op, at just a bit before the 2 week mark. on February 19th, at 2:00 pm.
All that was left was to give my doctor a call asking for her to write and send out that letter, and to ask my therapist for the same during our next visit.
Obtaining The Aforementioned Letters
Very smooth and easy process on my end. I gave my doctor’s office a call asking if my pcp could write a letter for my insurance, to approve the upcoming gender-affirming hysto, and the receptionist notified her the same day. I was wondering if there would be any hassle, or a need to come see my doctor in person first, but not at all. She wrote it out the same day I called, on January 9th, and it was in my gynecologist’s hands in a snap. Or rather, in a fax.
I scheduled to meet with my therapist on the 18th of January where we would discuss all the recent events, and of course, he very happily wrote out that second letter, no problem. I received it through email the following day, and quickly forwarded that to my gynecologist’s office by the 23rd.
Hospital Pre-Admission Testing
I arrived to the hospital nearly an hour early. After a bit of a wait, I was called in to confirm my basic information, emergency contacts, get registered at the hospital, and I then signed a consent form. I was given a wristband, and was directed to go back to the waiting room until I was called on again.
About 15 minutes later, I was brought back to an examination room by a nurse. We went over my personal information again, current meds, and I was given their general surgery preparation pamphlet. The nurse told me someone else would come in to examine me and take some blood, then left when we were finished going over everything.
A little bit later, a nurse practitioner entered the room, and did a very brief physical where she checked my lymph nodes, took my blood pressure, pulse, and listened to my breathing. Then she drew blood from my right arm. It was very quick, and she only took two tubes worth. One to determine my blood type, in case I needed a transfusion, and a smaller one for a full cbc panel.
To my surprise that was the end of my testing. No chest x-ray or ekg. The original nurse came back in with my discharge papers, and went over which meds I could keep taking, and which ones to stop. As far as otc meds go, I was told to stop taking aspirin and ibuprofen on the first of February, but everything else could be taken up to the surgery day. He did say no energy drinks the day of surgery though, haha (I'm a tad addicted to them). I was also given the okay to take my 10mg paxil the morning of surgery. Didn’t need to stop my testosterone at all.
In any case, I left the hospital with my discharge papers, and hurried to my gynecologist’s office to get to my pre-op appointment. Small note: I'll be including some pictures of my papers, for those who are curious.
Pre-Op
I didn’t meet with my gynecologist during this appointment, but with a nurse who took me into an office, going over all the grittier details.
Essentially, she went over all of my pre-op instructions, and allowed me to ask a few more questions which I had prepared.
Although, the packet with my pre-op instructions answered much of what I was worried about, so that helped to speed things up.
I’ll quickly go through the questions and answers. Feel free to skip ahead if you're not interested in the q&a
Q1. What is the pain management plan? – A. You will be prescribed Percocet, Ibuprofen 800, and 100 mg of gabapentin. The percs and Ibuprofen can be taken every 6 hours, and up to 300 mgs of gabapentin every 8 hours. Recommended that I stagger these meds, so for example, take a Percocet at 12, then an ibuprofen at 3, and so on, instead of taking them at the same time every 6 hours, to more closely manage the pain.
They also use something called the ON-Q Pain pump, which is basically a local anesthetic dispenser. It has a bag of numbing medication, of which you control the rate of distribution to your nerves, with a dial. It’s connected by a very thin cathetewire that goes right below the bellybutton/above the groin, and should help to reduce the need for narcotics, and keep you more comfortable for 2-5 days, depending on how quickly the medication is dispensed. (If you would like to know more about how that works, and what it looks like, here is a link to get a better idea (https://avanospainmanagement.com/product-catalog/acute-pain/pumps-accessories/elastomeric-pumps-and-accessories/on-q-pump-with-select-a-flow/ )
Q2. Will there be anything I can do to more quickly mitigate the gas pain? – A. Yes, moving around, and walking more frequently is the best thing you can do to get rid of this pain. A heating pad over the shoulder and neck area is highly recommended for this, too.
Q3. I wanted to ask for clarification about the antibiotic used for this procedure. Would it be started prior to surgery? – A. She rarely needs to prescribe an antibiotic before the procedure, the type you will be getting is run through the iv during the surgery.
Q4. I’ve heard that tap blacks are sometimes used to decrease pain, and reduce the need for narcotics immediately afterwards? - A. We don’t typically find it necessary to use a nerve block for this.
Q5. Will I be given pictures after? – A. One of her favorite things is showing her patients the pictures afterwards. That’s something we can do, yes.
Q6. I think she mentioned she’ll be having an assistant with her. Do you know who that will be? – A. I cannot confirm who exactly will be assisting her, but yes, she will be having an assistant with her during the procedure.
Q7. Do you know when I’ll meet the anesthesiologist? – A. Prior to the procedure, the day of surgery.
Q8. Afterwards will I need to use laxatives? Would Miralax work? – A. Yes, you will either be taking Colace twice a day, or taking Miralax once a day as needed. Whichever one you prefer is okay.
Q9. Do you think I could have something prescribed to make sleeping afterwards easier? – A. The meds you’ll be getting for pain management will likely have an effect of making you drowsy, but I will make note to ask her about prescribing you something.
Q10. Is there a particular way I should dress? – A. Comfortably, and in loose clothing.
Q11. How much bleeding would be abnormal? – A. Anything more than light-bleeding or spotting is a reason to be concerned.
Q12. What is a safe activity level? And what are the lifting restrictions? – A. Lift no more than 5-10 lbs before your 11-day follow-up, and no strenuous activity for six weeks. I recommend trying to take a short walk around your house every couple of hours.
Q13. Is cooking okay? – A. It should be safe, as long as you’re not lifting things very often.
Q14. When can I shower? – A. Right away, and make sure you pat the areas around the incisions dry, don’t rub them. No submerging yourself in water, or bathing, and try to keep your back to the water instead of facing your incisions towards the showerhead.
Q15. What color of discharge would warrant concern? – A. A pink, creamy or brown discharge would be normal, mostly look out for a foul odor, or green colored discharge.
Q16. Will stitches or glue be used for the incisions? – A. She uses both. She likes to put stitches beneath the skin and uses glue on the surface to hold the incisions together, as it allows for better scarring.
Q17. She mentioned that she might prescribe an estrogen cream, could you tell me a bit more about that? – A. She will likely wait a couple of weeks into your recovery before prescribing that, since estrogen can increase blood clot risk, but it should help with vaginal pain afterwards, and promote better healing. When you use it, discard the applicator, and apply a pearl-sized dollop on your finger, and use your finger to apply it shallowly before bed.
Q18. Will I need to do a bowel prep? – A. Yes, you will need to begin your bowel prep two days prior to the surgery date. On the first evening, you will take 2 Dulcolax tablets with a glass of water.
On the day prior to surgery, you will take 2 Dulcolax tablets with a light breakfast, and maintain a clear liquid diet throughout the rest of the day. (Examples include fat free/low sodium broth, clear juices, jell-o, sport drinks like Gatorade/Powerade, clear sodas, lemonade, popsicles (excluding sherbets and fruit bars), and plenty of water.) No restrictions on colors of electrolyte drinks/popsicles/jell-o.
Between 2-4:00 pm, insert 1 adult fleet enema rectally. And at bedtime before surgery, drink 20oz of an electrolyte sports drink, no later than 3 hours prior to surgery.
Q19. When do I have to stop eating? – A. Ideally by 10 am the day before. (I negotiated this to 11 am in my case :’ ), thank you pre-op nurse)
Q20. Will it be outpatient, or will I have to stay overnight? – A. Most likely it will be outpatient, and you will receive the exact time of surgery the day before.
Q21. What number should I call if I have additional non-emergent questions? Does mychart work well enough for that? – A. You can call our office’s number, but you might get an answer more quickly through mychart.
Q22. What happens if you come across something unexpected? – A. We will contact the family member who accompanied you.
Q23. Will stairs be an issue afterwards? We also have a chairlift, I assume it would be a good idea to use that? – A. Yes, using a chairlift will be fine, and no climbing stairs more than twice in a day.
Q24. Is it safe to use a heating pad afterwards, as well as moist heating? – A. Yes, it should be perfectly safe, and it would be especially useful for the gas-related pain in your shoulders and neck.
After going over the rest of the pre-op preparations with the nurse, I was sent home with the in-depth pre-op and post-op instructions on paper, which included an emergency number I could use to directly talk with their on-call physician, should I suspect serious complications. And that would conclude my pre-op appointment.
She also mentioned that I should make a note for remembering to bring home the abdominal binder they send with you at discharge, as that could help with keeping me more comfortable when I'm moving around afterwards. Apparently, the nurses sometimes forget to give it to you before you leave, so it is a good idea to make a note of it.
My gynecologist/surgeon also prescribed my post-op meds for early pick-up, to make sure I had no trouble directly afterwards with accessing them. I picked them up on the 25th.
If you’re wondering what exactly I was prescribed, I received scripts for 800mg Ibuprofen, Gabapentin, and Percocet, and 4mg Zofran for post-op nausea.
fin
This will be where I conclude the first part of my journaling, just for the sake of being concise. I will be shortly posting a second part to this though, so no worries if there are things you're still curious about, this isn't the end. :)
tldr; trans man seeks a gender-affirming hysterectomy
Accompanying photos:
pre-op instructions: https://gyazo.com/4e6cf767ad884412c401b1580edddcb0 , https://gyazo.com/7872e45b2f43e04f794fd3db6a262018
post-op instructions: https://gyazo.com/dc074e8cb4967d73ccd22ef4c83cba16 , https://gyazo.com/851e9e9668dbfaa93eafc70d30a0af32 , https://gyazo.com/f40c2c04934a12709cc3b0bb55c40a0e
meds to stop/continue: https://gyazo.com/cb37dbe214d446eb5f030d545849bfc8 , https://gyazo.com/449b1e9a0e05b10f73ab5253e66914fc , https://gyazo.com/763ccfa781b3da631391e629fff77f5a
signs of post-op complications: https://gyazo.com/df5242f328a68565d321c58eee6d3a1f

Hello, and welcome to my ‘hysterectomy journal’, where I’ll be jotting down my experience as a ftm, transgender individual, seeking a total hysterectomy as my first stage in preparing for future prospective bottom surgery (genital reconstruction).
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Beware this is going to be an exceptionally lengthy, and detailed chronicle of my journey through this stage of my life. Feel free to skim through, and read whichever parts interest or apply to you the most, I don't mind at all. Just happy to provide my perspective, and maybe help a couple of people along the way, if they need some extra information. Also, there will be multiple changes in points of view, as some of this was written during, and some was written in past-tense.
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As you may have noticed from the title, I am seeking out a gender-affirming hysterectomy, and will be noting down my experience in obtaining this surgery from the perspective of a transgender-man.
From the very beginning, this has always been a procedure I’ve wanted done to relieve the dysphoria from my menstrual cycles, but I have also always felt that I need a total hysterectomy to feel whole with myself, both physically, and mentally. Having a uterus inside of me, and knowing it is there, has always been dysphoria-inducing to me, even putting the menstrual cycles aside.
I had hit puberty early, so those aforementioned cycles started when I was around 10 or 11 years old. You could say things were off to an abnormal start, haha. My cycles were never regular. They would often show up out of nowhere, would last varying durations of time when they did occur, and it was always excruciatingly painful, and accompanied by heavy bleeding. Then they would typically disappear for 2-3 months at a time, with absolutely nothing, not so much as a cramp.
Eventually due to the extreme amounts of dysphoria my early-puberty induced, I was taken to a children’s hospital to see their gender-treatment team, and although puberty blockers weren’t given as an option, depo-provera was, which being my only option to stop my cycles, I gladly took. In the form of an injection to my shoulder every three months, which I had a total of 2-3 times, so for 6-9 months before I finally started testosterone-replacement therapy when I was a bit past my 15th birthday.
I will mention that when I went to that clinic, I was also diagnosed with pcos, and hyper-androgyny, likely caused by the pcos, which meant my natural testosterone-levels were already higher than normal. It certainly explained how I was able to grow facial-hair even off of testosterone, but I digress.
My mother also has pcos, and had her right ovary removed last year, after a very large cyst was identified as the cause of her abdominal pain, causing ovarian torsion. Pcos would seem likely to be genetically passed down to me, from her.
The initial referral
So, I had been seeing my gender therapist since I was about 13, started medical intervention for dysphoria a bit past my 14th birthday, and a year-ish later began testosterone replacement therapy after my 15th birthday. I am now 19 years of age, but have always been strongly certain of what treatments would be necessary to alleviate my dysphoria, and have sought them out relentlessly, without rest. I’m sure there are many who can relate.
I was first referred to a trans-friendly gynecologist through my therapist, who I will refer to as T, when I was 17. However, due to a loss of insurance, I was unable to follow-through with that appointment.
…Here I am now, two years later. The way I got ‘back in’ so to speak, was through my primary care doctor. Who I was also initially referred to through T, my therapist, to begin hrt. However, she has been my pcp ever since, and I couldn’t be happier to have her as my doctor.
In any case, I made a call to the office asking if she could send a new referral out for the gynecologist/hysterectomy consultation, and she did so without the need to meet me in person. My new consultation date was set for about a month and a half later.
The Hysterectomy Consultation
After what felt like a very long wait, my appointment day came, on January 8th. I was extremely nervous, having never been to a gynecologist before. I wasn’t sure whether to expect a pelvic exam, or whether anything similar would take place. I was also a bit nervous to go to this appointment, just due to not being the typical women’s health patient, but despite my fears, I made my way out to it.
Fortunately, the staff was very accommodating, and friendly towards me. It quickly became clear that they had dealt with many other trans patients before me, which made me feel very reassured. There were zero incidents of mis-gendering which I appreciated.
I waited twenty minutes, then was called in to speak with the nurse. We just did a brief medical history, and went over my reason for being there, and that was that. She left, and mentioned there would be a little extra wait until I’d be seeing my gynecologist, who for the sake of convenience, I’ll refer to as G.
We discussed my transition, what I was looking for in this procedure, whether I’d like to keep my ovaries, and so on. We went over risks, options for egg-freezing (not something that I was interested in, nor could hope to afford quickly enough, even if I were interested) but I appreciated that she suggested it. I proceeded to ask all of my questions. Also, I never felt I had to prove my identity to her in any way, and I never felt as though I was being judged for my decisions. She didn’t rush me, and made sure to take her time to answer every question I had for her.
If you’d like a quick run-down of how that conversation went, I will give one shortly, otherwise feel free to skip ahead a bit, haha.
Q&A Portion
Q1. Would a total hysterectomy with salpingo-oophorectomy be possible vaginally/laparoscopically? – A. Yes, in fact she mentioned that she almost exclusively performs robotically-assisted vaginal laparoscopic hysterectomies with the Da Vinci.
Essentially, they make three or so incisions in which tools are inserted to free the uterus from the surrounding tissue, they then make a cut into the vagina where they pull it all out through the vaginal canal.
Apparently being on testosterone for so long will also have likely shrunk the uterus down in size, which makes it even easier to do. This procedure is abbreviated to ‘RATLH, BSO’ (robotically assisted total laparoscopic hysterectomy, with bilateral salpingo-oophorectomy.
Since I am seeking bottom surgery in the future, she added that she would also be willing to perform a partial vaginectomy, which I was very enthused to hear. This will leave enough mucosal tissue to be used in the possible urethral hook-up. All in all, this was great news to hear.
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Q2. Is there a particularly high risk of bladdevaginal/rectal prolapse? – A. This is highly unlikely without having ever been pregnant or previously given birth. It’s typically only a major concern when the pelvic floor has gone through previous trauma and has been weakened.
​
Q3. I assume that with ovary removal I’ll need to stay on testosterone for the rest of my life, or some form of hrt? - A. This is correct, and staying on testosterone will reduce/eliminate the risk of osteoporosis.
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Q4. Will this procedure cause any form of menopause, or surgical menopause? – A. Yes, but since you are currently, and have been on testosterone, it will be unnoticeable to you.
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Q5. How long have you been working with transgender patients, and with my doctor? – A. I have been working with your doctor, and performing hysterectomies on transgender patients since 2012.
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Q6. What does the recovery look like? – A. You will be recovering for a minimum of 2-4 weeks, and expect to hold off from any strenuous activity for around 6-8 weeks.
​
Q7. What are the greatest risks to look out for, following this procedure? – A. There is general risk of bleeding, infection, anesthesia complications, intraoperative injury to surrounding organs/bowels, and possible post-op complications. This is still a relatively low-risk procedure, and the above happens in less than 1 in 1000 patients.
She mentioned that to combat risk of infection, I’ll be started on antibiotics before the day of surgery to prevent it ahead of time.
​
Q8. Will I need a catheter? – A. Yes, but it will be inserted only once you are unconscious, and will be removed before you wake up.
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Q9. Does staying on testosterone and keeping your uterus/ovaries increase the risk of developing cancer? – A. There has not been a notable increase in risk of cancer caused by staying on hrt, based on current available statistics. She did mention that there is a 70 percent risk reduction for ovarian cancer solely from the removal of the fallopian tubes, though. This is a question I asked, just to appease my own curiosity.
​
Q10. Will there be bleeding afterwards? – A. Some bleeding is to be expected, and an estrogen cream may be prescribed for a couple of weeks to help.
​
Q11. Where will this procedure take place, and who will be performing the surgery? – A. She answered one of two hospitals, which I had the choice between, and that she would be performing the surgery herself using the Da Vinci, along with an assistant.
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Q12. Can I immediately return home? – A. You will likely be able to return home within the first 24 hours.
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Q13. When will I need to follow-up? – A. There will be a two-week follow-up appointment.
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Q14. What is the first thing to do in case of a complication? – A. You will be given an instruction packet at the pre-op appointment going over this in detail.
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Q15. How will the insurance coverage work, as I have Medicaid? – A. I will need two letters, one of them can come from your pcp, and the other should come from your therapist.
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Q16. Will an examination need to take place beforehand? – A. Yes, we will need to do a pelvic transabdominal, and transvaginal ultrasound before this procedure.
​
After she took her time to answer all my questions, we parted ways, and I was walked into her scheduler’s office to get the dates sorted. I asked for the soonest date I could get in for, which was February 8th. My insurance has a 30-day consideration period before approving any non-emergent hysterectomy procedures. Not that this was an issue, as I needed time to get the required letters anyways.
We also scheduled for my pre-admission testing, and I was given the option to have my pre-op appointment directly afterwards, at their office, so I also had them go ahead and schedule both of those for the 22nd of January. The exact times were yet to be determined, but I asked for something in the afternoon, if possible.
Oh, and I can’t remember if I left it out, but she brought up egg-freezing as an option, and I declined, although it was certainly a green flag to me that she suggested it.
While I’m interested in becoming a father one day, I personally don’t feel the need to be biologically connected to my future children. From my own experience, family extends way farther than blood-relations anyways, haha. My own father for example, has never been biologically related to me, but he’s always been my dad 100%, through the rocky times, and through the smooth ones as well.
Nevertheless, I was confirmed for January 8th, and the general time-frame that it would occur, would be early in the morning, between 6:00 am to 7:00 am. Feeling very encouraged, I returned home. It was finally sinking in that this would really be happening.
The Hospital Pre-Admission, and Pre-Op Appointments
Within the following two weeks, I was given an exact time for the pre-admission appointment, at 1:30 pm on the 22nd of January. The pre-op would be back at my gynecologist’s office, directly after leaving the hospital.
A nurse from the hospital also shortly gave me a call on the 18th of January to go over, and confirm my medical history ahead of time, as well as to give me directions for the testing location. She added that no fasting would be required for this appointment.
They also scheduled my first future post-op, at just a bit before the 2 week mark. on February 19th, at 2:00 pm.
All that was left was to give my doctor a call asking for her to write and send out that letter, and to ask my therapist for the same during our next visit.
Obtaining The Aforementioned Letters
Very smooth and easy process on my end. I gave my doctor’s office a call asking if my pcp could write a letter for my insurance, to approve the upcoming gender-affirming hysto, and the receptionist notified her the same day. I was wondering if there would be any hassle, or a need to come see my doctor in person first, but not at all. She wrote it out the same day I called, on January 9th, and it was in my gynecologist’s hands in a snap. Or rather, in a fax.
I scheduled to meet with my therapist on the 18th of January where we would discuss all the recent events, and of course, he very happily wrote out that second letter, no problem. I received it through email the following day, and quickly forwarded that to my gynecologist’s office by the 23rd.
Hospital Pre-Admission Testing
I arrived to the hospital nearly an hour early. After a bit of a wait, I was called in to confirm my basic information, emergency contacts, get registered at the hospital, and I then signed a consent form. I was given a wristband, and was directed to go back to the waiting room until I was called on again.
About 15 minutes later, I was brought back to an examination room by a nurse. We went over my personal information again, current meds, and I was given their general surgery preparation pamphlet. The nurse told me someone else would come in to examine me and take some blood, then left when we were finished going over everything.
A little bit later, a nurse practitioner entered the room, and did a very brief physical where she checked my lymph nodes, took my blood pressure, pulse, and listened to my breathing. Then she drew blood from my right arm. It was very quick, and she only took two tubes worth. One to determine my blood type, in case I needed a transfusion, and a smaller one for a full cbc panel.
To my surprise that was the end of my testing. No chest x-ray or ekg. The original nurse came back in with my discharge papers, and went over which meds I could keep taking, and which ones to stop. As far as otc meds go, I was told to stop taking aspirin and ibuprofen on the first of February, but everything else could be taken up to the surgery day. He did say no energy drinks the day of surgery though, haha (I'm a tad addicted to them). I was also given the okay to take my 10mg paxil the morning of surgery. Didn’t need to stop my testosterone at all.
In any case, I left the hospital with my discharge papers, and hurried to my gynecologist’s office to get to my pre-op appointment. Small note: I'll be including some pictures of my papers, for those who are curious.
Pre-Op
I didn’t meet with my gynecologist during this appointment, but with a nurse who took me into an office, going over all the grittier details.
Essentially, she went over all of my pre-op instructions, and allowed me to ask a few more questions which I had prepared.
Although, the packet with my pre-op instructions answered much of what I was worried about, so that helped to speed things up.
I’ll quickly go through the questions and answers. Feel free to skip ahead if you're not interested in the q&a
Q1. What is the pain management plan? – A. You will be prescribed Percocet, Ibuprofen 800, and 100 mg of gabapentin. The percs and Ibuprofen can be taken every 6 hours, and up to 300 mgs of gabapentin every 8 hours. Recommended that I stagger these meds, so for example, take a Percocet at 12, then an ibuprofen at 3, and so on, instead of taking them at the same time every 6 hours, to more closely manage the pain.
They also use something called the ON-Q Pain pump, which is basically a local anesthetic dispenser. It has a bag of numbing medication, of which you control the rate of distribution to your nerves, with a dial. It’s connected by a very thin cathetewire that goes right below the bellybutton/above the groin, and should help to reduce the need for narcotics, and keep you more comfortable for 2-5 days, depending on how quickly the medication is dispensed. (If you would like to know more about how that works, and what it looks like, here is a link to get a better idea (https://avanospainmanagement.com/product-catalog/acute-pain/pumps-accessories/elastomeric-pumps-and-accessories/on-q-pump-with-select-a-flow/ )
​
Q2. Will there be anything I can do to more quickly mitigate the gas pain? – A. Yes, moving around, and walking more frequently is the best thing you can do to get rid of this pain. A heating pad over the shoulder and neck area is highly recommended for this, too.
​
Q3. I wanted to ask for clarification about the antibiotic used for this procedure. Would it be started prior to surgery? – A. She rarely needs to prescribe an antibiotic before the procedure, the type you will be getting is run through the iv during the surgery.
​
Q4. I’ve heard that tap blacks are sometimes used to decrease pain, and reduce the need for narcotics immediately afterwards? - A. We don’t typically find it necessary to use a nerve block for this.
​
Q5. Will I be given pictures after? – A. One of her favorite things is showing her patients the pictures afterwards. That’s something we can do, yes.
​
Q6. I think she mentioned she’ll be having an assistant with her. Do you know who that will be? – A. I cannot confirm who exactly will be assisting her, but yes, she will be having an assistant with her during the procedure.
​
Q7. Do you know when I’ll meet the anesthesiologist? – A. Prior to the procedure, the day of surgery.
​
Q8. Afterwards will I need to use laxatives? Would Miralax work? – A. Yes, you will either be taking Colace twice a day, or taking Miralax once a day as needed. Whichever one you prefer is okay.
​
Q9. Do you think I could have something prescribed to make sleeping afterwards easier? – A. The meds you’ll be getting for pain management will likely have an effect of making you drowsy, but I will make note to ask her about prescribing you something.
​
Q10. Is there a particular way I should dress? – A. Comfortably, and in loose clothing.
​
Q11. How much bleeding would be abnormal? – A. Anything more than light-bleeding or spotting is a reason to be concerned.
​
Q12. What is a safe activity level? And what are the lifting restrictions? – A. Lift no more than 5-10 lbs before your 11-day follow-up, and no strenuous activity for six weeks. I recommend trying to take a short walk around your house every couple of hours.
​
Q13. Is cooking okay? – A. It should be safe, as long as you’re not lifting things very often.
​
Q14. When can I shower? – A. Right away, and make sure you pat the areas around the incisions dry, don’t rub them. No submerging yourself in water, or bathing, and try to keep your back to the water instead of facing your incisions towards the showerhead.
​
Q15. What color of discharge would warrant concern? – A. A pink, creamy or brown discharge would be normal, mostly look out for a foul odor, or green colored discharge.
​
Q16. Will stitches or glue be used for the incisions? – A. She uses both. She likes to put stitches beneath the skin and uses glue on the surface to hold the incisions together, as it allows for better scarring.
​
Q17. She mentioned that she might prescribe an estrogen cream, could you tell me a bit more about that? – A. She will likely wait a couple of weeks into your recovery before prescribing that, since estrogen can increase blood clot risk, but it should help with vaginal pain afterwards, and promote better healing. When you use it, discard the applicator, and apply a pearl-sized dollop on your finger, and use your finger to apply it shallowly before bed.
​
Q18. Will I need to do a bowel prep? – A. Yes, you will need to begin your bowel prep two days prior to the surgery date. On the first evening, you will take 2 Dulcolax tablets with a glass of water.
On the day prior to surgery, you will take 2 Dulcolax tablets with a light breakfast, and maintain a clear liquid diet throughout the rest of the day. (Examples include fat free/low sodium broth, clear juices, jell-o, sport drinks like Gatorade/Powerade, clear sodas, lemonade, popsicles (excluding sherbets and fruit bars), and plenty of water.) No restrictions on colors of electrolyte drinks/popsicles/jell-o.
Between 2-4:00 pm, insert 1 adult fleet enema rectally. And at bedtime before surgery, drink 20oz of an electrolyte sports drink, no later than 3 hours prior to surgery.
​
Q19. When do I have to stop eating? – A. Ideally by 10 am the day before. (I negotiated this to 11 am in my case :’ ), thank you pre-op nurse)
​
Q20. Will it be outpatient, or will I have to stay overnight? – A. Most likely it will be outpatient, and you will receive the exact time of surgery the day before.
​
Q21. What number should I call if I have additional non-emergent questions? Does mychart work well enough for that? – A. You can call our office’s number, but you might get an answer more quickly through mychart.
​
Q22. What happens if you come across something unexpected? – A. We will contact the family member who accompanied you.
​
Q23. Will stairs be an issue afterwards? We also have a chairlift, I assume it would be a good idea to use that? – A. Yes, using a chairlift will be fine, and no climbing stairs more than twice in a day.
​
Q24. Is it safe to use a heating pad afterwards, as well as moist heating? – A. Yes, it should be perfectly safe, and it would be especially useful for the gas-related pain in your shoulders and neck.
​
After going over the rest of the pre-op preparations with the nurse, I was sent home with the in-depth pre-op and post-op instructions on paper, which included an emergency number I could use to directly talk with their on-call physician, should I suspect serious complications. And that would conclude my pre-op appointment.
She also mentioned that I should make a note for remembering to bring home the abdominal binder they send with you at discharge, as that could help with keeping me more comfortable when I'm moving around afterwards. Apparently, the nurses sometimes forget to give it to you before you leave, so it is a good idea to make a note of it.
My gynecologist/surgeon also prescribed my post-op meds for early pick-up, to make sure I had no trouble directly afterwards with accessing them. I picked them up on the 25th.
If you’re wondering what exactly I was prescribed, I received scripts for 800mg Ibuprofen, Gabapentin, and Percocet, and 4mg Zofran for post-op nausea.
fin
This will be where I conclude the first part of my journaling, just for the sake of being concise. I will be shortly posting a second part to this though, so no worries if there are things you're still curious about, this isn't the end. :)
tldr; trans man seeks a gender-affirming hysterectomy
Accompanying photos:
pre-op instructions: https://gyazo.com/4e6cf767ad884412c401b1580edddcb0 , https://gyazo.com/7872e45b2f43e04f794fd3db6a262018
post-op instructions: https://gyazo.com/dc074e8cb4967d73ccd22ef4c83cba16 , https://gyazo.com/851e9e9668dbfaa93eafc70d30a0af32 , https://gyazo.com/f40c2c04934a12709cc3b0bb55c40a0e
meds to stop/continue: https://gyazo.com/cb37dbe214d446eb5f030d545849bfc8 , https://gyazo.com/449b1e9a0e05b10f73ab5253e66914fc , https://gyazo.com/763ccfa781b3da631391e629fff77f5a
signs of post-op complications: https://gyazo.com/df5242f328a68565d321c58eee6d3a1f

Hello, and welcome to my ‘hysterectomy journal’, where I’ll be jotting down my experience as a ftm, transgender individual, seeking a total hysterectomy as my first stage in preparing for future prospective bottom surgery (genital reconstruction).

Beware this is going to be an exceptionally lengthy, and detailed chronicle of my journey through this stage of my life. Feel free to skim through, and read whichever parts interest or apply to you the most, I don't mind at all. Just happy to provide my perspective, and maybe help a couple of people along the way, if they need some extra information. Also, there will be multiple changes in points of view, as some of this was written during, and some was written in past-tense.

As you may have noticed from the title, I am seeking out a gender-affirming hysterectomy, and will be noting down my experience in obtaining this surgery from the perspective of a transgender-man.
From the very beginning, this has always been a procedure I’ve wanted done to relieve the dysphoria from my menstrual cycles, but I have also always felt that I need a total hysterectomy to feel whole with myself, both physically, and mentally. Having a uterus inside of me, and knowing it is there, has always been dysphoria-inducing to me, even putting the menstrual cycles aside.
I had hit puberty early, so those aforementioned cycles started when I was around 10 or 11 years old. You could say things were off to an abnormal start, haha. My cycles were never regular. They would often show up out of nowhere, would last varying durations of time when they did occur, and it was always excruciatingly painful, and accompanied by heavy bleeding. Then they would typically disappear for 2-3 months at a time, with absolutely nothing, not so much as a cramp.
Eventually due to the extreme amounts of dysphoria my early-puberty induced, I was taken to a children’s hospital to see their gender-treatment team, and although puberty blockers weren’t given as an option, depo-provera was, which being my only option to stop my cycles, I gladly took. In the form of an injection to my shoulder every three months, which I had a total of 2-3 times, so for 6-9 months before I finally started testosterone-replacement therapy when I was a bit past my 15th birthday.
I will mention that when I went to that clinic, I was also diagnosed with pcos, and hyper-androgyny, likely caused by the pcos, which meant my natural testosterone-levels were already higher than normal. It certainly explained how I was able to grow facial-hair even off of testosterone, but I digress.
My mother also has pcos, and had her right ovary removed last year, after a very large cyst was identified as the cause of her abdominal pain, causing ovarian torsion. Pcos would seem likely to be genetically passed down to me, from her.
The initial referral
So, I had been seeing my gender therapist since I was about 13, started medical intervention for dysphoria a bit past my 14th birthday, and a year-ish later began testosterone replacement therapy after my 15th birthday. I am now 19 years of age, but have always been strongly certain of what treatments would be necessary to alleviate my dysphoria, and have sought them out relentlessly, without rest. I’m sure there are many who can relate.
I was first referred to a trans-friendly gynecologist through my therapist, who I will refer to as T, when I was 17. However, due to a loss of insurance, I was unable to follow-through with that appointment.
…Here I am now, two years later. The way I got ‘back in’ so to speak, was through my primary care doctor. Who I was also initially referred to through T, my therapist, to begin hrt. However, she has been my pcp ever since, and I couldn’t be happier to have her as my doctor.
In any case, I made a call to the office asking if she could send a new referral out for the gynecologist/hysterectomy consultation, and she did so without the need to meet me in person. My new consultation date was set for about a month and a half later.
The Hysterectomy Consultation
After what felt like a very long wait, my appointment day came, on January 8th. I was extremely nervous, having never been to a gynecologist before. I wasn’t sure whether to expect a pelvic exam, or whether anything similar would take place. I was also a bit nervous to go to this appointment, just due to not being the typical women’s health patient, but despite my fears, I made my way out to it.
Fortunately, the staff was very accommodating, and friendly towards me. It quickly became clear that they had dealt with many other trans patients before me, which made me feel very reassured. There were zero incidents of mis-gendering which I appreciated.
I waited twenty minutes, then was called in to speak with the nurse. We just did a brief medical history, and went over my reason for being there, and that was that. She left, and mentioned there would be a little extra wait until I’d be seeing my gynecologist, who for the sake of convenience, I’ll refer to as G.
We discussed my transition, what I was looking for in this procedure, whether I’d like to keep my ovaries, and so on. We went over risks, options for egg-freezing (not something that I was interested in, nor could hope to afford quickly enough, even if I were interested) but I appreciated that she suggested it. I proceeded to ask all of my questions. Also, I never felt I had to prove my identity to her in any way, and I never felt as though I was being judged for my decisions. She didn’t rush me, and made sure to take her time to answer every question I had for her.
If you’d like a quick run-down of how that conversation went, I will give one shortly, otherwise feel free to skip ahead a bit, haha.
Q&A Portion
Q1. Would a total hysterectomy with salpingo-oophorectomy be possible vaginally/laparoscopically? – A. Yes, in fact she mentioned that she almost exclusively performs robotically-assisted vaginal laparoscopic hysterectomies with the Da Vinci.
Essentially, they make three or so incisions in which tools are inserted to free the uterus from the surrounding tissue, they then make a cut into the vagina where they pull it all out through the vaginal canal.
Apparently being on testosterone for so long will also have likely shrunk the uterus down in size, which makes it even easier to do. This procedure is abbreviated to ‘RATLH, BSO’ (robotically assisted total laparoscopic hysterectomy, with bilateral salpingo-oopherectomy.
Since I am seeking bottom surgery in the future, she added that she would also be willing to perform a partial vaginectomy, which I was very enthused to hear. This will leave enough mucosal tissue to be used in the possible urethral hook-up. All in all, this was great news to hear.
Q2. Is there a particularly high risk of bladdevaginal/rectal prolapse? – A. This is highly unlikely without having ever been pregnant or previously given birth. It’s typically only a major concern when the pelvic floor has gone through previous trauma and has been weakened.
Q3. I assume that with ovary removal I’ll need to stay on testosterone for the rest of my life, or some form of hrt? - A. This is correct, and staying on testosterone will reduce/eliminate the risk of osteoporosis.
Q4. Will this procedure cause any form of menopause, or surgical menopause? – A. Yes, but since you are currently, and have been on testosterone, it will be unnoticeable to you.
Q5. How long have you been working with transgender patients, and with my doctor? – A. I have been working with your doctor, and performing hysterectomies on transgender patients since 2012.
Q6. What does the recovery look like? – A. You will be recovering for a minimum of 2-4 weeks, and expect to hold off from any strenuous activity for around 6-8 weeks.
Q7. What are the greatest risks to look out for, following this procedure? – A. There is general risk of bleeding, infection, anesthesia complications, intraoperative injury to surrounding organs/bowels, and possible post-op complications. This is still a relatively low-risk procedure, and the above happens in less than 1 in 1000 patients.
She mentioned that to combat risk of infection, I’ll be started on antibiotics before the day of surgery to prevent it ahead of time.
Q8. Will I need a catheter? – A. Yes, but it will be inserted only once you are unconscious, and will be removed before you wake up.
Q9. Does staying on testosterone and keeping your uterus/ovaries increase the risk of developing cancer? – A. There has not been a notable increase in risk of cancer caused by staying on hrt, based on current available statistics. She did mention that there is a 70 percent risk reduction for ovarian cancer solely from the removal of the fallopian tubes, though. This is a question I asked, just to appease my own curiosity.
Q10. Will there be bleeding afterwards? – A. Some bleeding is to be expected, and an estrogen cream may be prescribed for a couple of weeks to help.
Q11. Where will this procedure take place, and who will be performing the surgery? – A. She answered one of two hospitals, which I had the choice between, and that she would be performing the surgery herself using the Da Vinci, along with an assistant.
Q12. Can I immediately return home? – A. You will likely be able to return home within the first 24 hours.
Q13. When will I need to follow-up? – A. There will be a two-week follow-up appointment.
Q14. What is the first thing to do in case of a complication? – A. You will be given an instruction packet at the pre-op appointment going over this in detail.
Q15. How will the insurance coverage work, as I have Medicaid? – A. I will need two letters, one of them can come from your pcp, and the other should come from your therapist.
Q16. Will an examination need to take place beforehand? – A. Yes, we will need to do a pelvic transabdominal, and transvaginal ultrasound before this procedure.
After she took her time to answer all my questions, we parted ways, and I was walked into her scheduler’s office to get the dates sorted. I asked for the soonest date I could get in for, which was February 8th. My insurance has a 30-day consideration period before approving any non-emergent hysterectomy procedures. Not that this was an issue, as I needed time to get the required letters anyways.
We also scheduled for my pre-admission testing, and I was given the option to have my pre-op appointment directly afterwards, at their office, so I also had them go ahead and schedule both of those for the 22nd of January. The exact times were yet to be determined, but I asked for something in the afternoon, if possible.
Oh, and I can’t remember if I left it out, but she brought up egg-freezing as an option, and I declined, although it was certainly a green flag to me that she suggested it.
While I’m interested in becoming a father one day, I personally don’t feel the need to be biologically connected to my future children. From my own experience, family extends way farther than blood-relations anyways, haha. My own father for example, has never been biologically related to me, but he’s always been my dad 100%, through the rocky times, and through the smooth ones as well.
Nevertheless, I was confirmed for January 8th, and the general time-frame that it would occur, would be early in the morning, between 6:00 am to 7:00 am. Feeling very encouraged, I returned home. It was finally sinking in that this would really be happening.
The Hospital Pre-Admission, and Pre-Op Appointments
Within the following two weeks, I was given an exact time for the pre-admission appointment, at 1:30 pm on the 22nd of January. The pre-op would be back at my gynecologist’s office, directly after leaving the hospital.
A nurse from the hospital also shortly gave me a call on the 18th of January to go over, and confirm my medical history ahead of time, as well as to give me directions for the testing location. She added that no fasting would be required for this appointment.
They also scheduled my first future post-op, at just a bit before the 2 week mark. on February 19th, at 2:00 pm.
All that was left was to give my doctor a call asking for her to write and send out that letter, and to ask my therapist for the same during our next visit.
Obtaining The Aforementioned Letters
Very smooth and easy process on my end. I gave my doctor’s office a call asking if my pcp could write a letter for my insurance, to approve the upcoming gender-affirming hysto, and the receptionist notified her the same day. I was wondering if there would be any hassle, or a need to come see my doctor in person first, but not at all. She wrote it out the same day I called, on January 9th, and it was in my gynecologist’s hands in a snap. Or rather, in a fax.
I scheduled to meet with my therapist on the 18th of January where we would discuss all the recent events, and of course, he very happily wrote out that second letter, no problem. I received it through email the following day, and quickly forwarded that to my gynecologist’s office by the 23rd.
Hospital Pre-Admission Testing
I arrived to the hospital nearly an hour early. After a bit of a wait, I was called in to confirm my basic information, emergency contacts, get registered at the hospital, and I then signed a consent form. I was given a wristband, and was directed to go back to the waiting room until I was called on again.
About 15 minutes later, I was brought back to an examination room by a nurse. We went over my personal information again, current meds, and I was given their general surgery preparation pamphlet. The nurse told me someone else would come in to examine me and take some blood, then left when we were finished going over everything.
A little bit later, a nurse practitioner entered the room, and did a very brief physical where she checked my lymph nodes, took my blood pressure, pulse, and listened to my breathing. Then she drew blood from my right arm. It was very quick, and she only took two tubes worth. One to determine my blood type, in case I needed a transfusion, and a smaller one for a full cbc panel.
To my surprise that was the end of my testing. No chest x-ray or ekg. The original nurse came back in with my discharge papers, and went over which meds I could keep taking, and which ones to stop. As far as otc meds go, I was told to stop taking aspirin and ibuprofen on the first of February, but everything else could be taken up to the surgery day. He did say no energy drinks the day of surgery though, haha (I'm a tad addicted to them). I was also given the okay to take my 10mg paxil the morning of surgery. Didn’t need to stop my testosterone at all.
In any case, I left the hospital with my discharge papers, and hurried to my gynecologist’s office to get to my pre-op appointment. Small note: I'll be including some pictures of my papers, for those who are curious.
Pre-Op
I didn’t meet with my gynecologist during this appointment, but with a nurse who took me into an office, going over all the grittier details.
Essentially, she went over all of my pre-op instructions, and allowed me to ask a few more questions which I had prepared.
Although, the packet with my pre-op instructions answered much of what I was worried about, so that helped to speed things up.
I’ll quickly go through the questions and answers. Feel free to skip ahead if you're not interested in the q&a
Q1. What is the pain management plan? – A. You will be prescribed Percocet, Ibuprofen 800, and 100 mg of gabapentin. The percs and Ibuprofen can be taken every 6 hours, and up to 300 mgs of gabapentin every 8 hours. Recommended that I stagger these meds, so for example, take a Percocet at 12, then an ibuprofen at 3, and so on, instead of taking them at the same time every 6 hours, to more closely manage the pain.
They also use something called the ON-Q Pain pump, which is basically a local anesthetic dispenser. It has a bag of numbing medication, of which you control the rate of distribution to your nerves, with a dial. It’s connected by a very thin cathetewire that goes right below the bellybutton/above the groin, and should help to reduce the need for narcotics, and keep you more comfortable for 2-5 days, depending on how quickly the medication is dispensed. (If you would like to know more about how that works, and what it looks like, here is a link to get a better idea (https://avanospainmanagement.com/product-catalog/acute-pain/pumps-accessories/elastomeric-pumps-and-accessories/on-q-pump-with-select-a-flow/ )
Q2. Will there be anything I can do to more quickly mitigate the gas pain? – A. Yes, moving around, and walking more frequently is the best thing you can do to get rid of this pain. A heating pad over the shoulder and neck area is highly recommended for this, too.
Q3. I wanted to ask for clarification about the antibiotic used for this procedure. Would it be started prior to surgery? – A. She rarely needs to prescribe an antibiotic before the procedure, the type you will be getting is run through the iv during the surgery.
Q4. I’ve heard that tap blacks are sometimes used to decrease pain, and reduce the need for narcotics immediately afterwards? - A. We don’t typically find it necessary to use a nerve block for this.
Q5. Will I be given pictures after? – A. One of her favorite things is showing her patients the pictures afterwards. That’s something we can do, yes.
Q6. I think she mentioned she’ll be having an assistant with her. Do you know who that will be? – A. I cannot confirm who exactly will be assisting her, but yes, she will be having an assistant with her during the procedure.
Q7. Do you know when I’ll meet the anesthesiologist? – A. Prior to the procedure, the day of surgery.
Q8. Afterwards will I need to use laxatives? Would Miralax work? – A. Yes, you will either be taking Colace twice a day, or taking Miralax once a day as needed. Whichever one you prefer is okay.
Q9. Do you think I could have something prescribed to make sleeping afterwards easier? – A. The meds you’ll be getting for pain management will likely have an effect of making you drowsy, but I will make note to ask her about prescribing you something.
Q10. Is there a particular way I should dress? – A. Comfortably, and in loose clothing.
Q11. How much bleeding would be abnormal? – A. Anything more than light-bleeding or spotting is a reason to be concerned.
Q12. What is a safe activity level? And what are the lifting restrictions? – A. Lift no more than 5-10 lbs before your 11-day follow-up, and no strenuous activity for six weeks. I recommend trying to take a short walk around your house every couple of hours.
Q13. Is cooking okay? – A. It should be safe, as long as you’re not lifting things very often.
Q14. When can I shower? – A. Right away, and make sure you pat the areas around the incisions dry, don’t rub them. No submerging yourself in water, or bathing, and try to keep your back to the water instead of facing your incisions towards the showerhead.
Q15. What color of discharge would warrant concern? – A. A pink, creamy or brown discharge would be normal, mostly look out for a foul odor, or green colored discharge.
Q16. Will stitches or glue be used for the incisions? – A. She uses both. She likes to put stitches beneath the skin and uses glue on the surface to hold the incisions together, as it allows for better scarring.
Q17. She mentioned that she might prescribe an estrogen cream, could you tell me a bit more about that? – A. She will likely wait a couple of weeks into your recovery before prescribing that, since estrogen can increase blood clot risk, but it should help with vaginal pain afterwards, and promote better healing. When you use it, discard the applicator, and apply a pearl-sized dollop on your finger, and use your finger to apply it shallowly before bed.
Q18. Will I need to do a bowel prep? – A. Yes, you will need to begin your bowel prep two days prior to the surgery date. On the first evening, you will take 2 Dulcolax tablets with a glass of water.
On the day prior to surgery, you will take 2 Dulcolax tablets with a light breakfast, and maintain a clear liquid diet throughout the rest of the day. (Examples include fat free/low sodium broth, clear juices, jell-o, sport drinks like Gatorade/Powerade, clear sodas, lemonade, popsicles (excluding sherbets and fruit bars), and plenty of water.) No restrictions on colors of electrolyte drinks/popsicles/jell-o.
Between 2-4:00 pm, insert 1 adult fleet enema rectally. And at bedtime before surgery, drink 20oz of an electrolyte sports drink, no later than 3 hours prior to surgery.
Q19. When do I have to stop eating? – A. Ideally by 10 am the day before. (I negotiated this to 11 am in my case :’ ), thank you pre-op nurse)
Q20. Will it be outpatient, or will I have to stay overnight? – A. Most likely it will be outpatient, and you will receive the exact time of surgery the day before.
Q21. What number should I call if I have additional non-emergent questions? Does mychart work well enough for that? – A. You can call our office’s number, but you might get an answer more quickly through mychart.
Q22. What happens if you come across something unexpected? – A. We will contact the family member who accompanied you.
Q23. Will stairs be an issue afterwards? We also have a chairlift, I assume it would be a good idea to use that? – A. Yes, using a chairlift will be fine, and no climbing stairs more than twice in a day.
Q24. Is it safe to use a heating pad afterwards, as well as moist heating? – A. Yes, it should be perfectly safe, and it would be especially useful for the gas-related pain in your shoulders and neck.
After going over the rest of the pre-op preparations with the nurse, I was sent home with the in-depth pre-op and post-op instructions on paper, which included an emergency number I could use to directly talk with their on-call physician, should I suspect serious complications. And that would conclude my pre-op appointment.
She also mentioned that I should make a note for remembering to bring home the abdominal binder they send with you at discharge, as that could help with keeping me more comfortable when I'm moving around afterwards. Apparently, the nurses sometimes forget to give it to you before you leave, so it is a good idea to make a note of it.
My gynecologist/surgeon also prescribed my post-op meds for early pick-up, to make sure I had no trouble directly afterwards with accessing them. I picked them up on the 25th.
If you’re wondering what exactly I was prescribed, I received scripts for 800mg Ibuprofen, Gabapentin, and Percocet, and 4mg Zofran for post-op nausea.
fin
This will be where I conclude the first part of my journaling, just for the sake of being concise. I will be shortly posting a second part to this though, so no worries if there are things you're still curious about, this isn't the end. :)
tldr; trans man seeks a gender-affirming hysterectomy
Accompanying photos:
pre-op instructions: https://gyazo.com/4e6cf767ad884412c401b1580edddcb0 , https://gyazo.com/7872e45b2f43e04f794fd3db6a262018
post-op instructions: https://gyazo.com/dc074e8cb4967d73ccd22ef4c83cba16 , https://gyazo.com/851e9e9668dbfaa93eafc70d30a0af32 , https://gyazo.com/f40c2c04934a12709cc3b0bb55c40a0e
meds to stop/continue: https://gyazo.com/cb37dbe214d446eb5f030d545849bfc8 , https://gyazo.com/449b1e9a0e05b10f73ab5253e66914fc , https://gyazo.com/763ccfa781b3da631391e629fff77f5a
signs of post-op complications: https://gyazo.com/df5242f328a68565d321c58eee6d3a1f

Here are some more info/stat on calcified vas.
I copied below the abstract of the most interesting paper I found on Medline (see below)
The prevalence of calcified vas would be quite common according to this 2020 Brazilian study based on abdominal CT examinations. 1.6% of men would have one or both vasa calcified! This would mean that we would encounter calcified vas in 1 or 2 patients per 100! This is obviously not what we are observing in vasectomized men.
I thus read the article and found that only 2 patients had both pelvic and inguinal calcifications. This would decrease the “interesting” prevalence for vasectomists to 0.1% (2/1915). Hum…. 1/1000 ? This seemed still a little high.
I then reviewed all vasectomies we did at Vasectomie Québec from January 1 2005 to December 31 2023 (19 years) searching the surgical notes for calcified vas. Here are the results:
Table 1. Proportion of men vasectomized for the first time at Vasectomie Québec between January 2005 and December 31 2023 (19 years) and in whom the surgeon noted one or both calcified vas.
Surgeon
Vasectomies
Vasectomies with one of both calcified vas
% (95% CI)
1
29520
8
0.03 (0.01-0.05)
2
6657
2
0.03 (0.00-0.11)
Sub Total 1+2
36177
10
0.03 (0.01-0.05)
3
6861
0
-
4
2661
0
-
5
91
0
-
Total 1+2+3+4+5
45790
10
0.02 (0.01-0.04)
Surgeon #3 and #4 did not have any surgical notes about calcified vas. It may be that effectively they did not encountered any ( the 95% confidence interval shows that it could be possible…) but my impression is that that they might not have mentioned it in the surgical note. It would be surprising that surgeon #3 did not encountered any…
To be conservative, let’s the prevalence in our practice is be approximately 0.02% to 0.03% (2 or 3 cases/10000 vasectomies or about 1 out of 3,000 to 5,0000 vasectomies), but I would expect that 1/3000 is probably more correct. Surgeon #2 observed one in January 2024 that is not included in the case series. That would bring the prevalence to 0.03% flush!
Among the 10 cases, 5 were bilateral, 3 on right side , and 2 on left side. Two had type 2 diabetes. The mean age was 45.5±5.9 years old. All had children except one. All had usual vasectomy with mucosal cautery and FI except on in whom “superficial cautery” was noted on his unilateral right side calcification. Among the 7 who did a PVSA , all were sterile.
I attached pictures of the vas of one patient for those who had never seen this, rather rare, “problem” in vasectomy. You will not miss it. It like cutting through a tube full of sand…
​
Prevalence of Vas Deferens Calcifications on Abdominal CT Examinations and Association With Systemic Conditions
William T Haddad Jr 1 , Otavio Takashi Moritsugu 1 , Vitor Rodrigues Fornazari 1 , Carlos Alberto Ferreira Coelho Neto 1 , Yoram Balderrama da Frota 1 , Carlos Augusto Fernandes Molina 2 , Jorge Elias Jr 3 , Antonio Pazin-Filho 4 , Valdair Francisco Muglia 3
Affiliations

• PMID: 33021834
• DOI: 10.2214/AJR.19.22672

Abstract
OBJECTIVE. The purpose of this study was to describe the prevalence of vas deferens (VD) calcifications on abdominal CT examinations and the associations between VD calcifications and several systemic conditions. MATERIALS AND METHODS. The CT examinations of male patients from January 2010 to December 2011 were retrospectively reviewed. After exclusions, the records of 1915 consecutively identified patients were analyzed. Five readers, 3rd- and 4th-year radiology residents, recorded the presence and laterality of VD calcifications and of vascular calcifications presumed due to atherosclerosis. A sixth reader parsed the patient records for diagnoses of type 2 diabetes mellitus (DM) and chronic kidney disease (CKD). RESULTS. The mean age of the entire sample population was 52.9 ± 18.9 years (range, 1-93 years). The mean age of patients with VD calcifications was 59.3 ± 12.0 (SD) years and of the group without VD calcifications was 52.9 ± 19.1 years (p = 0.17). The prevalence of VD calcification was 1.61% (31 patients): 21 (67.7%) of the patients had bilateral calcification; seven (22.6%), right-sided only; and three, (9.7%) left-sided. The frequency of DM was 28.8% (551/1915), of CKD was 7.58% (150/1915), and of atherosclerosis, 60.4% (1156/1915). The mean caliber of calcified VDs was 5.31 ± 1.29 mm versus 3.63 ± 0.63 mm for patients without calcification or any chronic condition (p < 0.0001). Among age, atherosclerosis, DM, and CKD in univariate regression analysis, only DM was associated with VD calcification (p = 0.006). However, because age (p = 0.063) and atherosclerosis (p = 0.057) were close to significant, they were included in the multivariate analysis, which also showed only DM associated with VD calcification (odds ratio, 2.14 ± 0.85). CONCLUSION. In the large cohort in this study, the prevalence of VD calcification was 1.61%. VD calcification was strongly associated with DM. The pathologic implications of VD calcification remain unclear and warrant further investigation in prospective longitudinal studies.

Hi,
I had a fall recently, it's coming up to almost 7 weeks and I'm yet to see any light at the end of the tunnel, I'm hoping for some words of advice or something to keep me from losing my head (I feel like I want to die).
My main symptoms are headaches, dizziness and issues with my vision.
The Headaches are constant, I haven't had a day without a headache. At best it's a constant dull ache in the crown of my head and at worst it's akin to an intense migraine.
The Dizziness, I would describe it like the dizziness you would have when jumping out of bed in the morning and strolling to the bathroom after a long drinking session the day before.
The Vision, It feels like my eyes are taking the pictures but my brain is not processing them It feels like I'm looking at a draft version. This had made the past 7 weeks feel like a nightmare that I'm just waiting to wake up from.
The Fall itself was very minor, was tripped and landed on my back. I did not lose consciousness. The Dizziness and Vision issues I described came on immedaitely, the headaches came on while I was trying to sleep that night or atleast that's when I noticed it.
So Far I've had an MRI to confirm there's no brain bleed, the MRI did not conclude any reason for my Symptoms.
The report did mention I had Mucosal thickening in the ethmoid air cells in keeping of minor sinusitis and left frontal sinus sinusitis. (I'm not sure what to make of these findings, if anything?).
I believe the problem might be due to a underlying Neck issue, I've been trying to do neck exercises daily to address this but it doesn't seem to be helping?
I don't know where to go from here, can I expect to be stuck in the conciousness forever now until I can undo what damage has been done?

Losing Human Users, Facebook Releasing Chatbots for Lonely to Talk To https://futurism.com/the-byte/facebook-chatbots-lonely
However, the data could not confidently exclude thinner atmospheres, such as those composed of pure water, carbon dioxide, or methane, nor an atmosphere similar to that of Titan, a moon of Saturn and the only moon in the Solar System with its own atmosphere.
These results are generally consistent with previous (photometric, and not spectroscopic) JWST observations of TRAPPIST-1 b with the MIRI instrument. The new study also proves that Canada’s NIRISS instrument is a highly performing, sensitive tool able to probe for atmospheres on Earth-sized exoplanets at impressive levels.
Atmospheric Reconnaissance of TRAPPIST-1 b with JWST/NIRISS: Evidence for Strong Stellar Contamination in the Transmission Spectra, The Astrophysical Journal Letters (open access) https://astrobiology.com/2023/09/jwst-insights-into-the-atmosphere-of-exoplanet-trappist-1-b-and-the-star-trappist-1.html
Ocean acidification makes ecologically important seaweed species fragile September 25, 2023Ocean acidification will likely almost triple by the end of the century -- a drastic environmental change that could impact important marine species like fleshy seaweeds, algae that grow vertically and promote biodiversity in more than a third of the world's coastline. https://www.sciencedaily.com/releases/2023/09/230925124745.htm
New research from Northwestern University and the University of Wisconsin, however, is pointing to bacterial pneumonia as the cause of many severe COVID deaths. Deceased COVID patients studied were not shown to have experienced inflammation at all. Instead, the researchers, using machine learning to analyze data, found that half of the severely ill COVID patients who required a ventilator had bacterial pneumonia as a secondary infection. They did not find evidence of a cytokine storm in these patients; instead of dying from organ damage or failure due to COVID, they died of pneumonia. https://www.webmd.com/covid/news/20230925/is-pneumonia-the-true-cause-of-severe-covid?src=RSS_PUBLIC
Recent models predict Earth's greenhouse gas effect could reach a tipping point that renders most of the planet "uninhabitable to mammalian life" when the next supercontinent – a landmass some call Pangea Ultima – forms in the coming 250 million years or so.
"The formation and decay of Pangea Ultima will limit and… ultimately end terrestrial mammalian habitability on Earth by exceeding their warm thermal tolerances, billions of years earlier than previously hypothesized," the researchers behind the model write. https://www.sciencealert.com/the-next-supercontinent-formation-could-wipe-out-most-mammal-life
Multiple evolutions? Is this the first time life on Earth appeared? https://geneticliteracyproject.org/2023/09/25/multiple-evolutions-is-this-the-first-time-life-on-earth-appeared/
Compared to control interventions, plant-based protein interventions prevent declining body strength and function in older adults. The vitamins, fibers, minerals, antioxidants, and antioxidants in plant proteins impact muscle health by decreasing inflammation and mitigating the adverse effects of reactive oxygen species on muscle tissue, ultimately improving muscle strength and function. https://www.news-medical.net/news/20230924/Plant-based-proteins-boost-muscle-mass-and-cut-fat-in-older-adults.aspx
Fossil results indicate polar bears survived last global warming deglaciation in Siberian and Canadian refugia https://phys.org/news/2023-09-fossil-results-polar-survived-global.html
Identifying suitable new habitats will soon become a matter of life or death for some California native species, according to Lawren Sack, a UCLA professor of ecology and evolutionary biology. But if those trees could talk, where would they tell scientists they wanted to live?
In a new study, a team led by Sack and other UCLA biologists deciphered a secret language in leaves and woody stems that points to the species' optimal habitats. https://www.sciencedaily.com/releases/2023/09/230927003448.htm
A new study by researchers at Queen Mary University of London, Imperial College London and The University of Melbourne has found that people can learn to use supernumerary robotic arms as effectively as working with a partner in just one hour of training. https://www.sciencedaily.com/releases/2023/09/230927003048.htm
Climate change: Six young people take 32 countries to court https://www.bbc.com/news/world-europe-66923590
One known standard is that the ratio between galaxies and their heavy elements has held constant in the local Universe through the last 12 billion years of history, or about 5/6 of the age of the Universe.
But with JWST, astronomers are now seeing that the youngest galaxies look different. https://www.sciencealert.com/jwst-detects-earliest-galaxies-to-date-and-they-dont-look-the-way-we-expected
Many social media users have shared videos on how to fall asleep faster by conjuring up "fake scenarios", such as a romance storyline where you're the main character.
But what does the research say? Does what we think about before bed influence how we sleep?
How you think in bed affects how you sleep
It turns out people who sleep well and those who sleep poorly have different kinds of thoughts before bed. https://medicalxpress.com/news/2023-09-studies-show-that-what-you.html
Enforcement is one of the biggest challenges to international cooperation on mitigating climate change in the Paris Agreement. The agreement has no formal enforcement mechanism; instead, it is designed to be transparent so countries that fail to meet their obligations will be named and thus shamed into changing behavior. A new study shows that this naming-and-shaming mechanism can be an effective incentive for many countries to uphold their pledges to reduce emissions. https://www.sciencedaily.com/releases/2023/09/230925153739.htm
According to a report from the Business Development Bank of Canada, almost half of Canadian entrepreneurs are experiencing mental health challenges, mostly related to stress and finances. https://phys.org/news/2023-09-entrepreneurs-mental-health-crisis.html
Now a presidential distinguished professor and the director of the Penn Center for Science, Sustainability and the Media at the University of Pennsylvania, Mann has just published his sixth book, “Our Fragile Moment: How Lessons from Earth’s Past Can Help Us Survive the Climate Crisis.” Yale Climate Connections discussed the book with Mann over Zoom.
This interview has been edited for brevity and clarity. Where helpful, further details have been provided in parentheses. https://yaleclimateconnections.org/2023/09/renowned-climate-scientist-michael-e-mann-on-what-doomers-get-wrong/
For one of the simulations, the chamber was set to about 116° F and 15% humidity to emulate the conditions of the 2018 Los Angeles heatwave. The other was set to about 106° F and 40% humidity to emulate the 1995 Chicago heatwave.
While the older adults had similar skin blood flow and sweat rates as the younger group, they also had “an approximately twofold greater increase” in core body temperature. Accounting for this greater change in core temperature reveals that the older adults’ sweat and skin blood flow responses did not respond adequately to maintain a healthy body temperature.
This method of mimicking daily life during a heatwave “resulted in greater thermal strain than what has been previously reported in the literature during similar heat exposures,” researchers report. https://www.newswise.com/articles/older-adults-show-greater-increase-in-body-temperature-in-simulated-heatwave-than-previously-reported
The chameleon’s guide to making buildings green
In a bid to one-up white paint, researchers devised a new coating that keeps buildings cool in summer and warm in winter by changing color based on ambient temperature. No energy required. https://www.anthropocenemagazine.org/2023/09/the-chameleons-guide-to-green-buildings/
Images from the James Webb Space Telescope have confirmed that the universe appears to be expanding significantly faster than it should be, researchers report in a study accepted in the Astrophysical Journal. The observation is in conflict with an esteemed theory, the standard model of cosmology, that describes how the universe has evolved since the first moments after the Big Bang. https://www.sciencenews.org/article/jwst-images-cosmos-universe-hubble-constant-tension
But upon closer inspection, you'll notice two tiny cameras hidden in the arms that let wearers snap photos and videos on the sly.
The £299 glasses are the latest wearable from Meta, which unveiled them during the Meta Connect 2023 conference last night.
They feature new AI capabilities, meaning they can identify places and objects that people are seeing, as well as perform language translation in real-time.
'Smart glasses are the ideal form factor for you to let AI assistants see what you're seeing and hear what you're hearing,' Mark Zuckerberg said. https://www.dailymail.co.uk/sciencetech/article-12570217/Meta-launches-299-smart-glasses-Ray-Ban-featuring-two-hidden-cameras-Mark-Zuckerberg-desperately-tries-maintain-metaverse.html
In a study conducted in zebrafish, the team discovered that heart cells start beating suddenly and all at once as calcium levels and electrical signals increase. Moreover, each heart cell has the ability to beat on its own, without a pacemaker, and the heartbeat can start in different places, the researchers discovered. https://scienceblog.com/539794/heart-cells-start-beating-suddenly-and-all-at-once/
journal Nature Communications, scientists from the US calculated the importance of earthworms for food cultivation worldwide. Their findings highlight the need to manage agriculture sustainably and invest more in agroecological policies promoting food security while protecting soil health and biodiversity. https://www.news-medical.net/news/20230927/Earthworms-boost-global-crop-production-by-140-million-tons.aspx
In a recent study published in Plant Biotechnology Journal, researchers in Spain used a cisgenic approach to metabolically engineer tomatoes and fortify them further with flavonoids and branched-chain amino acids (BCAAs). The fortified fruits showed a multifold increase in amino acids such as valine, leucine, and isoleucine, as well as flavonoids, including kaempferol and quercetin, compared to wild-type tomatoes https://www.news-medical.net/news/20230927/Supercharged-tomatoes-Scientists-engineer-fruits-packed-with-amino-acids-and-flavonoids.aspx
Inflammatory bowel disease (IBD), which includes ulcerative colitis (UC) and Crohn’s disease (CD), is associated with mucosal inflammation that arises due to abnormal immune cell activation. A new study in Nature Medicine traces the sources of this type of inflammation to yeast cells. https://www.news-medical.net/news/20230927/Yeast-in-the-gut-linked-to-Crohns-disease-inflammation-opening-new-doors-for-treatment.aspx
But he does agree with the paper's authors that humans often underestimate crocodiles' cognition.
Murray knows of instances of crocodilians using sticks to lure birds to land on them and engaging in communal feeding, helping other members of a group get food. He's also seen crocodilians seem to learn from past experiences.
"I think some of those things are predominantly anecdotal, obviously, and I have some of those anecdotes for myself," Murray said. "So I think that their cognitive ability – of assessing what's around and their memory – is far better than I think we give them credit for," he said. https://www.sciencealert.com/crocodiles-seen-guiding-dog-to-safety-in-india-and-scientists-dont-know-why
Fasting is also an important factor that can considerably influence the gut microbiota composition. Fasting is defined as voluntary food deprivation for therapeutic, cultural, or political reasons. Ramadan intermittent fasting is a time-restricted feeding pattern in which food and liquid consumption is restricted from dawn to sunset during the entire month of Ramadan, https://www.news-medical.net/news/20230927/Ramadan-fasting-reshapes-gut-microbiome.aspx
A study has found that antimatter is affected by gravity in the same way as matter
CERN
View 1 Images
Antimatter has intrigued and confounded physicists for almost a century, and the effect of gravity on antimatter has been a point of disagreement. New research may have settled the debate by finding that antihydrogen atoms, the antimatter counterpart of hydrogen, are affected by gravity in the same way as their matter equivalents, ruling out the existence of repulsive 'antigravity.' https://newatlas.com/physics/antigravity-disproved-antimatter-responds-t0-gravity-like-matte
Weird, Fleshy Plant Parasite Has One of The Weirdest Genomes to Date https://www.sciencealert.com/weird-fleshy-plant-parasite-has-one-of-the-weirdest-genomes-to-date
The Department of Agriculture has spent at least $59 billion in subsidies for livestock and seafood producers since 1995, according to a new EWG analysis.
By contrast, USDA has allocated a mere $124 million since 2001 to support plant-based proteins and other alternatives to animal proteins. https://www.ewg.org/news-insights/news/2023/08/usda-livestock-subsidies-top-59-billion
As for the nighttime Moon, it's cold, so you were right about that. It’s as cold as we all imagine and maybe colder. NASA measured one bit of crater to be 410 degrees below zero Fahrenheit, and we’re not even going to bother converting that to Celsius because neither scale means anything to you when it gets that low. Let’s just note that it’s the lowest temperature officially recorded anywhere in the solar system. https://www.cracked.com/article_39671_5-ways-the-moon-is-different-from-how-you-picture-it.html
But before Microsoft can start relying on nuclear power to train its AIs, it'll have plenty of other hurdles to overcome.
For one, it'll have to source a working SMR design. Then, it'll have to figure out how to get its hands on a highly enriched uranium fuel that these small reactors typically require, as The Verge points out. Finally, it'll need to figure out a way to store all of that nuclear waste long term.
Microsoft founder Bill Gates also started an incubator for SMR designs called TerraPower. However, TerraPower "does not currently have any agreements to sell reactors to Microsoft," according to a statement to CNBC.
Other than nuclear fission, Microsoft is also investing in nuclear fusion, a far more ambitious endeavor, given the many decades of research that have yet to lead to a practical power system. https://futurism.com/the-byte/microsoft-power-train-ai-small-nuclear-reactors
I'm a dog expert and this is how long you can REALLY leave your pet alone - and it all comes down to a pet's age and breed https://www.dailymail.co.uk/sciencetech/article-12565901/Im-dog-expert-long-REALLY-leave-pet-comes-pets-age-breed.html
The future of quantum mechanics: Unraveling entanglement's secrets
A physicist explains the complexities of quantum entanglement and why scientists are so keen to understand and control this elusive phenomenon. https://engineering.stanford.edu/magazine/future-quantum-mechanics-unraveling-entanglements-secrets
Wooden mallet and esparto sandals from Cueva de los Murciélagos in Spain dated to the Neolithic period, 6,200 years ago. https://arstechnica.com/science/2023/09/behold-the-worlds-oldest-sandals-buried-in-a-bat-cave-over-6000-years-ago/
It is important to note that the researchers observed no association of average cognitive effects from psychological well-being at a population level, so without this more granular analysis, the potentially adverse effects of life satisfaction would have been overlooked.
It was impressive to observe how a relationship with no associations on population average showed underlying differences based on sociodemographic factors, physical health, and psychosocial elements." https://www.news-medical.net/news/20230929/Life-satisfaction-may-not-be-a-one-size-fits-all-solution-for-cognitive-health.aspx
The study, published Wednesday in the BMJ, shows “the quality of the carbohydrates in a person’s diet is much more important than the amount,” said its senior author, Walter Willett, a professor of epidemiology and nutrition at the Harvard T.H. Chan School of Public Health. “You want to increase whole grains and limit starchy vegetables.” https://www.nbcnews.com/health/health-news/preventing-weight-gain-switching-carbohydrates-study-rcna117496
Highest-energy observation of entanglement 29 September 2023 A report from the ATLAS experiment. https://cerncourier.com/a/highest-energy-observation-of-entanglement/
Chatbot Confabulations Are Not Hallucinations
Rami Hatem, BS1; Brianna Simmons, BS1; Joseph E. Thornton, MD1
Author Affiliations
JAMA Intern Med. 2023;183(10):1177. doi:10.1001/jamainternmed.2023.4231 https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2808091
Chatbot Confabulations Are Not Hallucinations—Reply
Teva D. Brender, MD1
Author Affiliations
JAMA Intern Med. 2023;183(10):1177-1178. doi:10.1001/jamainternmed.2023.3875 https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2808090
Collectively, the results presented in this report show that exposure to even traces of salad leaf juice may contribute to the persistence of Salmonella on salad leaves as well as priming it for establishing an infection in the consumer. https://journals.asm.org/doi/10.1128/aem.02416-16
A sufficiently powerful quantum computer could render our leading cryptographic schemes worthless. While the mathematical puzzles underpinning them are virtually unsolvable by classical computers, they would be entirely tractable for a large enough quantum computer. That’s a problem because these schemes secure most of our information online.
The saving grace has been that today’s quantum processors are a long way from the kind of scale required. But according to a report in Science, New York University computer scientist Oded Regev has discovered a new algorithm that could reduce the number of qubits required substantially. https://singularityhub.com/2023/10/02/quantum-computers-could-crack-encryption-sooner-than-expected-with-new-algorithm/
With millions of users relying on social media as a source of news and entertainment and as a mode of communication, addressing social media fatigue and its consequences is imperative, said the researchers.
While many societies underscore the importance of reduced social media usage for improved physical and mental health, relatively little attention has been paid to the detrimental impact of social media usage on the information ecosystem. https://phys.org/news/2023-10-social-media-fatigue-narcissism-linked.html
Although you thought her demands were exaggerated, it turns out that your grandmother was correct. Scrubbing between the toes and behind the ears helps keep the skin in those regions healthy, according to a new study https://m.jpost.com/health-and-wellness/article-761204
Cinnamon as a Useful Preventive Substance for the Care of Human and Plant Health https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8433798/
Actor Tom Hanks warns fans against trusting AI-generated video promoting dental insurance as video begins circulating online https://www.abc.net.au/news/2023-10-02/ai-tom-hanks-dental-plan-ad-scam/102924118
Federal law requires the EPA to review the pollution standards every five years and improve them as needed to ensure they protect public health. Today’s lawsuit, filed in U.S. District Court in Oakland, says the agency has not reviewed the standards since May 2018 and has not updated them since 2010, despite new scientific evidence showing greater harms from nitrogen pollution than were previously realized.
“It’s unacceptable that the EPA is flouting the Clean Air Act and endangering public health and the environment,” said Ryan Maher, an environmental health attorney at the Center for Biological Diversity. https://alankandel.scienceblog.com/2023/10/01/epas-failure-to-address-dangerous-oxides-of-nitrogen-pollution-prompts-lawsuit/
New research suggests that sleeping in on the weekends could be making us age prematurely.
The study, published in the journal Sleep Health, found that adults who slept more on weekends than during the week had shorter telomeres which are protective caps on the ends of chromosomes.
Telomere shortening is a marker of biological ageing. https://www.samaa.tv/208731894-long-sleep-on-weekends-has-astonishing-health-effects
Monica Lewinsky has launched an emotional new PSA encouraging us to stand up to the biggest bully we rarely confront: Ourselves.
Social activist, producer (15 Minutes of Shame; American Crime Story: Impeachment), public speaker and Vanity Fair contributing editor, Ms. Lewinsky is inviting people to stand up to themselves this October, Bullying Prevention Month, as new data reveals 74% of adults agree they are their own worst critic, with the majority admitting negative thoughts get in the way of succeeding in life. https://www.prnewswire.com/news-releases/monica-lewinskys-new-emotional-psa-shines-light-on-our-biggest-bully-301945668.html
Researchers have succeeded in printing uniformly sized droplets with a diameter of approximately 100 µm using a liquid film of fluorescent ink. This ink, with a viscosity roughly 100 times that of water, was irradiated with an optical vortex, resulting in prints of exceptional positional accuracy at the micrometer scale. https://www.sciencedaily.com/releases/2023/10/231002124405.htm
The first cup of tea can often feel like a lifesaver in the morning.
Now research suggests that this ritual is good for your health – slashing the chances of developing type 2 diabetes by 28 per cent.
Experts believe tea has potent antioxidant and anti-inflammatory effects which improve insulin sensitivity.
The effects were particularly strong in dark tea dark, an ancient tea which involves microbial fermentation in the manufacturing process. https://www.dailymail.co.uk/health/article-12584361/A-cup-tea-day-diabetes-away-experts-say-biggest-benefits-come-one-particular-type.html
"We know now that to the question: Do mortality risks change after floods in the general population? The answer is yes, and this needs to be factored into policy responses to flooding events," he said.
According to Monash University's Professor Li, a co-lead author on the paper, "our study suggests that all-causes, cardiovascular, and respiratory mortality risks reach a peak at around 25 days and last for up to 60 days after exposure to floods," she said.
In the aftermath of a flood, deaths from natural causes may be triggered by contamination of food and water, exposure to pathogens (i.e., fungi, bacteria, and virus), impaired access to health services, and psychological impairment. https://medicalxpress.com/news/2023-10-sobering-global-decade-long.html
New internet addiction spectrum: Where are you on the scale? October 2, 2023University of Surrey https://www.sciencedaily.com/releases/2023/10/231002124352.htm
She notes that the complexity of the climate and its effects on a large system like the Southern Ocean mean an exact prognosis isn’t possible. But it still doesn’t look good for Antarctica’s sea ice.
Robinson highlights 5 ways in which Antarctic sea ice is important for the global climate: https://cosmosmagazine.com/earth/climate/antarctic-sea-ice-emergency-summit/
The study shows that the risk of Alzheimer's disease was more than twice as high in patients with chronic stress and in patients with depression as it was in patients without either condition; in patients with both chronic stress and depression it was up to four times as high.
The risk of developing cognitive impairment was elevated about as much. A patient is deemed to be suffering chronic stress when he or she has been under stress with no opportunity for recuperation for at least six months.
"The risk is still very small and the causality is unknown," says the study's last author Axel C. Carlsson, docent at the Department of Neurobiology, Care Sciences and Society, Karolinska Institutet. "That said, the finding is important in that it enables us to improve preventative efforts and understand links with the other risk factors for dementia." https://www.sciencedaily.com/releases/2023/10/231002124415.htm
Mmmmmmmmmmmmmmmmmm . Dr. Dietrich Rau, Director of the German Institute in Cairo, said: “The excavation work in the tomb also succeeded in revealing new historical information about the life of Merit-Neith and the period of her reign.”
The team found tablets inside the tomb with inscriptions that describe Merit-Neith being responsible for central government offices, further supporting the belief that Merit-Neith ruled with the position of pharaoh.
. . Satellite television company Dish Network has been hit with a $150,000 fine for failing to properly dispose of one of its satellites, marking the first time federal regulators have issued such a penalty.
The Federal Communications Commission, which authorizes space-based telecom services, announced Monday that it settled an investigation into Dish, resulting in the fine and an “admission of liability” from the company.
“This marks a first in space debris enforcement by the Commission, which has stepped up its satellite policy efforts,” the FCC said in a news release.
Dish responded in a statement, saying the satellite at issue was “an older spacecraft (launched in 2002) that had been explicitly exempted from the FCC’s rule requiring a minimum disposal orbit.” https://us.cnn.com/2023/10/02/world/space-debris-fine-dish-fcc-scn/index.html
A team of researchers has discovered that dormant tumor cells surviving chemotherapy can be targeted through the inhibition of a specific protein called P-glycoprotein (P-gp). This discovery opens up new possibilities for delaying relapse and is particularly relevant for aggressive triple-negative breast cancer (TNBC), for which there are currently few effective treatments. https://www.sciencedaily.com/releases/2023/10/231002124400.htm
Mysterious Dark Shadows Observed Across Orion NebulaThe features are not visible in any other wavelengths and have not been seen before. https://www.iflscience.com/mysterious-dark-shadows-observed-across-orion-nebula-70942
VATICAN CITY (AP) — Pope Francis shamed and challenged world leaders on Wednesday to commit to binding targets to slow climate change before it’s too late, warning that God’s increasingly warming creation is fast reaching a “point of no return.”
In an unusually bleak update to his landmark 2015 encyclical on the environment, Francis heightened the alarm about the “irreversible” harm to people and planet already under way and lamented that once again, the world’s poor and most vulnerable are paying the highest price.
“We are now unable to halt the enormous damage we have caused. We barely have time to prevent even more tragic damage,” Francis warned. https://www.pbs.org/newshouworld/pope-francis-urges-world-leaders-to-act-on-climate-change-as-planet-nears-point-of-no-return
A team of astrophysicists says they may have found evidence for "cosmic strings", long-hypothesized defects in the universe left over from its early in its expansion. https://www.iflscience.com/cracks-in-the-universe-astrophysicists-may-have-found-evidence-of-cosmic-strings-70955
The team quantified how frequently the software was able to detect the face in the video, and evaluated how often the humans and the software agreed on facial expressions.
Finally, they used machine learning to predict human judgements based on the computers decisions.
Romana said: “Deploying automated facial analysis in the parents’ home environment could change how we detect early signs of mood or mental health disorders, such as postnatal depression.
“For instance, we might expect parents with depression to show more sad expressions and less happy facial expressions. https://www.newswise.com/articles/software-can-detect-hidden-and-complex-emotions-in-parents
"As they are molecular-based, our new sensors can be used to detect other chemicals or biomolecules like proteins and enzymes, which could be game-changing for detecting diseases."
Dr Fallon said the new piezoresistor was made from a single bullvalene molecule that when mechanically strained reacts to form a new molecule of different shape, altering electricity flow by changing resistance.
"The different chemical forms are known as isomers, and this is the first time that reactions between them have been used to develop piezoresistors," Dr Fallon said. https://www.sciencedaily.com/releases/2023/10/231003104800.htm
Paris has a bed bug issue. How can travelers avoid bringing them home?
Travelers and Parisians are spreading word of a bed bug infestation in Paris. Here's how to keep yourself safe. https://scrippsnews.com/stories/paris-has-a-bed-bug-issue-how-can-travelers-avoid-bringing-them-home/
FACULTY Q&A
As artificial intelligence apps such as ChatGPT have proliferated, so have chatbots with a religious bent. People facing a moral or ethical dilemma can submit their questions to these chatbots, which then provide an answer based on the religious texts fed to them or crowd-sourced data. Webb Keane, University of Michigan professor of anthropology, recently co-wrote an op-ed about what he and his co-author call “godbots,” and the danger of giving moral authority to artificial intelligence. https://news.umich.edu/are-you-there-ai-its-me-god/
High Dietary Phosphorus Is Associated with Increased Breast Cancer Risk in a U.S. Cohort of Middle-Aged Women https://www.mdpi.com/2072-6643/15/17/3735
Nearly half of women claim poor sleep caused by menopause has had a negative impact on their relationship, with over two thirds saying symptoms regularly result in arguments with their partner. According to the experts, fluctuations in progesterone and oestrogen levels during menopause can directly impact sleep, causing hot flashes and restlessness. https://www.hulldailymail.co.uk/news/health/menopause-means-key-bedroom-change-8803694
Fluorescence is widespread in mammals, including the domestic species of cat (Felis catus), report experts at Curtin University in Perth, Australia (file photo) https://www.dailymail.co.uk/sciencetech/article-12592191/Feline-bright-Cats-glow-dark-surprising-study-reveals.html
Having previously observed menthol inhalation boosting the immune response of mice, here the team showed that it could also improve the animals' cognitive abilities, as observed in a series of practical tests in the lab.
In mice with Alzheimer's, the course of menthol for a six-month-long period was enough to stop the cognitive abilities and memory capabilities of the mice from deteriorating. In addition, it appears menthol pushed the IL-1β protein back to safe levels in the brain.
When researchers artificially reduced the number of T regulatory (Treg) cells – known to help keep the immune system in check – some of the same effects were observed, opening a possible route that future treatments could take. https://www.sciencealert.com/mouse-study-reveals-unexpected-connection-between-menthol-and-alzheimers
But per Bloomberg, Walmart promises its data is anonymized, or stripped of identifying details that could be tied back to specific patients.
Unfortunately, the idea that huge, complex datasets can be meaningfully “anonymous” is largely a polite fiction. (Absent more detail from Walmart, it’s also not clear what kind of patient consent might have been given for the Ozempic research.) “Even anonymized prescription details can reveal a lot about individuals,” says Sklar. “Details like medication, dosage, timing, prescriber, pharmacy, etc. can be very unique to an individual, which makes it easier to re-identify someone.” The more widely this information is released, the greater the odds that it could be used in ways it’s not intended, and that people could see private details of their lives exposed. https://www.theverge.com/2023/10/9/23909581/walmart-ozempic-food-pharmacy-market-research-privacy
A new method for scanning telescope images for the faintest signs of rock far beyond Pluto has uncovered evidence that our Solar System's disc of material extends far further into interstellar space than we thought. https://www.sciencealert.com/distant-objects-show-solar-system-extends-further-than-we-knew
The federal government’s reef protection plan says sediment and nutrient pollution from agricultural run-off, and to a lesser extent urban and industrial activities, are the main sources of poor water quality.
The plan is central to Australia’s efforts to prevent the reef from being listed as a World Heritage site in danger.
The World Heritage Committee in September gave Australia more time to demonstrate it is addressing major threats, with the government due to provide a progress report in early 2024. https://www.australiangeographic.com.au/news/2023/10/new-major-threat-to-reef-discovered-by-scientists/
Analytical Discussion
The groundbreaking revelation that the midbody remnant is not simply cellular waste but a transporter of pivotal genetic information, capable of influencing cell communication and potentially triggering cancerous transformations, is monumental. The RNA within midbody remnants serves not merely as a schematic for cell division processes but also for proteins that direct a cell’s purpose, including its potential to differentiate into various cell types and form cancerous growths. This discovery not only challenges existing scientific paradigms but also inaugurates new pathways for comprehending cell communication, cell fate determination, and cancer metastasis. https://www.gilmorehealth.com/hidden-danger-tiny-cell-parts-once-thought-harmless-may-unexpectedly-spread-cance/
"The 2023 ozone hole got off to an early start and has grown rapidly since mid-August," Antje Inness, a researcher at the European Center for Medium-Range Weather Forecasts, said in the statement. It is "one of the biggest ozone holes on record," she added.
The enormous gap could be attributed to the eruption of the Hunga Tonga-Hunga Ha'apai volcano, which exploded with the force of more than 100 Hiroshima bombs and created the tallest-ever recorded eruption plume when it popped its top in January 2022, researchers said. https://www.livescience.com/planet-earth/weatheone-of-the-biggest-on-record-ozone-hole-bigger-than-north-america-opens-above-antarctica
While the study has limitations, such as a small sample size and recruitment from specific centers in Taiwan, it underscores the importance of promoting MAE interventions, such as walking, in older populations with OA.
Even minimal exercise, when performed regularly, can enhance joint health and cognitive well-being, making it a valuable strategy for preventing dementia in this demographic. https://www.news-medical.net/news/20231005/Exercise-prevents-the-incidence-of-dementia-in-older-people-with-osteoarthritis.aspx
“We need to echo our voices so that our bodies-territory are present in all spaces and places of decision-making and power,” says Daniele Guajajara, communicator at ANMIGA.
The first March of Indigenous Women in 2019, and its second edition in 2021, together with the creation of ANMIGA, boosted the empowerment and protagonism of Indigenous women in the fight for the rights of original peoples, leading to the emergence of numerous organizations or departments in historical entities of the Indigenous movement to represent them, reaching more than 90 organizations present in all Brazilian biomes. https://news.mongabay.com/2023/10/brazils-indigenous-women-march-again-for-the-rights-of-their-people-and-lives/
expert reaction to bedbug situation in Paris https://www.sciencemediacentre.org/expert-reaction-to-bedbug-situation-in-paris/
Over the course of many years, many studies have been conducted to understand how the characteristics of the Amazon River basin work together to maintain such a large rainforest. Such studies have shown that regional water cycling along with moisture exaltation from the plants, together with sunlight and even dust blown over from Africa, all contribute to the unique ecosystem, the largest rainforest in the world.
Such work has also suggested that disruptions to parts of the system, such as cutting down trees, could result in major changes to the ecosystem. And if such changes were to occur, other studies have suggested the region would change from a rainforest to one that featured a vast savanna-like climate.
Such a possible change is of major concern to climate scientists https://phys.org/news/2023-10-amazonian-forest-degradation-monsoon-circulation.html
China’s youth unemployment problem has become a crisis we can no longer ignore
Published: October 8, 2023 3.27pm EDT https://theconversation.com/chinas-youth-unemployment-problem-has-become-a-crisis-we-can-no-longer-ignore-213751
Resting metabolic rate is increased after a series of whole body vibration in young men https://www.nature.com/articles/s41598-023-44543-3
“Many chronic diseases and mental health disorders in adolescents and young adults have increased over the last two decades worldwide, and exposure to neurotoxic contaminants in the environment could explain a part of this increase,” said senior author Jose Ricardo Suarez, M.D., Ph.D., M.P.H., associate professor in the Herbert Wertheim School of Public Health.
Among the findings:
Glyphosate, a nonselective herbicide used in many crops, including corn and soy, and for vegetation control in residential settings, was detected in 98 percent of participants.2,4-D, a broadleaf herbicide used on lawns, aquatic sites, and agricultural crops, was detected in 66 percent of participants. https://www.newswise.com/articles/commonly-used-herbicide-is-harmful-to-adolescent-brain-function
California has become the first U.S. state to outlaw the use of four potentially harmful food and drink additives that have been linked to an array of diseases, including cancer, and are already banned in dozens of countries.
The California Food Safety Act prohibits the manufacturing, distribution and sale of food and beverages that contain brominated vegetable oil, potassium bromate, propylparaben and red dye 3 — which can be found in candy, fruit juices, cookies and more. https://www.npr.org/2023/10/10/1204839281/california-ban-food-additives-red-dye-3-propylparaben-candy

First off, it's a crime in many places around the world to give someone under age 18 a permanent ink tattoo. Go figure, getting your body inked is better protected than your genitalia unfortunately hacked up. When getting a tattoo it's almost always better to let a professional do it, but if you're like me, asking for a dick tattoo isn't an average request. By the way I'm not seeing if anyone would like to get this done as well, but has potential to speed up the progress of elimination for what works and doesn't in penile skin expansion if a few restorers were to get tattoo dots. I don't mind this being a solo project either.
Anyway, that be my first tattoo, on my dick as a direct cause of circumcision long ago, to figure out the quickest way to get my hood back. I got myself a stick n' poke tattoo pen and quality ink on Amazon and marked three small dots on my penile skin. I guess it goes well with the circumcision scar line.
Before anyone says why don't I use pictures or measure how it shows on the TLC website with FEC. Well I did try, and to be honest doesn't seem accurate enough to my liking. I needed a system that can utilize a scale and produce the same measurement every time without variation from being erect and an uncalibrated manual tug. I accomplished this with the Tattoo Dot & Tape Calibration(TDTC). Calibration because of the calipers and scale utilized; the Tape hooks onto the scale pulled to 1.5 pounds. With other ways I measured it felt like trying to break my old record where my current measurement felt like I was going backward at times.
This is not instruction on how to tattoo yourself. One must do a lot of research on how to do Tattoo Stick n Poke before committing. Watching multiple videos and reading online articles is what I did. There are a lot of instructions I'm skipping on how I went and did my tattoo dots. Please do your own research, or better yet consult a pro. Also these dots aren't very pleasing to look at. Maybe if I did a color instead of black it would be less noticeable. I make no guarantee if someone else will be able to measure accurately using the method described here.
The placement of all three dots align on the dorsal side top and centered. I don't think it matters much if it's a little off centered because it's a matter of measuring between the dots with calipers. A surgical marker can help with this center placement. Placement #1: at the base towards the scrotum on the dorsal side. I left enough room so I could grab a pinch of skin. As I was trying to figure how to get precise measurements this pinch of skin became the solving factor. I did think of this before I set my first tattoo. Note, the skin was thicker here and more difficult to get the ink to set in compared to the next two dots. Dot #1 was frustrating and kinda painful as the skin felt very elastic and difficult to puncture. Be gentle first then increase force if needed, check often. Placement #2: below where the T-tape wraps around, closer to the scrotum not the glans. This is the middle dot. I actually made a mistake here thinking it would be similar to how the first went. I went heavy on the ink and the needle went in a lot easier this time. It's called a blowout when the needle pierces too deep. Still it's a good dot that I can measure from. Just be more careful with dots 2 & 3, be light and not heavy on the ink. Placement #3: Near the glans on the mucosal skin. Same with #1 there should be enough room for a pinch of skin between glans and dot. When measuring between #2 & 3 there should be enough room to place the index finger under the corona ridge to help stretch the skin. Out of the three dots #3 isn't as needed, because it's difficult figuring how to attach a scale. Maybe with a PeniMaster Pro or something to help grab onto the glans. But I think by spreading the skin tight while erect with the thumb and index finger should do the trick. Not to be measured with T-tape on. Mucosal skin is thinner yet and luckily it came out perfect. #1 came out good too but was a bit of a pain for me.
Side note: A 1/3 section of T-tape applied to the dorsal side can be used instead of a full wrap. This might be ideal for testing results with tapeless devices and/or manual.
Progress: With that out of the way, I wanted to let you guys know how my measurements are going! Last month I gained 1mm between dots 1 & 2. I just took my first measurement between dot 2 & 3, 60.3mm but I had T-tape on and wasn't fully erect, so I don't think I'll count it as a perfect measurement. I'm not sure if I'll ever get an accurate measurement between dots 2 & 3. I guess I gained .5mm if it grew at the same rate as dots 1 & 2. Between 1 & 2 measures 115mm. My calipers break at 127mm, my new goal, haha to get new calipers.
I'll be taking measurements more often. I'm thinking every fresh T-tape I'll measure again. I want to see how fast I can gain 1 mm between dots 1 & 2. That interval timer that I posted about should help as well with the statistics. I have a journal to help log exactly what I'm doing in case I need to look at the past for what I did and methods used.
Methods I used to gain this 1 mm between dots 1 & 2: T-tape with badge reel and Gel Sleeve Klutch method. Also included exercise and intermediate tugging like this: Manual T-tape for 3 minutes, exercise with only a retaining cone on for 40 minutes. Tug with T-tape, badge reel, and gel sleeve for 2 hours and repeat. Most nights I was able to tug with T-tape on. Some days I was busy and couldn't keep to the interval, so that's why I'm starting to record time under tension. The interval app will calculate everything separately which should make it a breeze.
New this month: experimental tugging and rest cycles with a bullet vibrator. Tension level increases to high around 1.5 lb, so no more badge reels. I'm still using the Gel Sleeve Klutch method with T-tape. Also switching sides which leg I tug from every 3 - 4 hours.
Exercise 40 min interval: vibration first, put retaining cone on, no tugging, do 1.5 laps on the elliptical machine. For the rest of the time I clean house and do invisible jump rope here and there. There's this other exercise I like doing that really gets the heart rate up. I did the same before but without the vibration.
Stay hydrated. Water and add in your own minerals. Not too much water during and after a meal. But throughout the day, especially while exercising. Research more about water, is what skin is mostly made of. Protein too. I like to try organ meat soon.
A while back I still had my tattoo dots but I kept measuring the same 113mm for a few months. This makes me believe that if you're not feeling growth come in, that very well might be the case. Perhaps change things up a bit and if you find something that works, stick to it. For me I think that be manual. I wasn't doing any manual during that period of zero gains. It's only when I apply some manual in my routine that I get results. Maybe my manual methods are OP; I do twists, bends, combos, manual mm3 pressing with push rod and plate. Or could it be that I need to increase the tension while doing T-tape because with manual I'm doing a much higher tension. Much more experiments to come! Even before the zero gain measurements I struggled with figuring how to go about measuring.
Tools needed: Rapala 50 lb fishing scale with can opener, quick adjusting C clamp to hold the scale to the desk, small silicone Griffiti Band, *actually* cross off these first three items, wall pulley, rope, 1.5 lb weight, cheap set of calipers, a flat desk that is even with the hips, pacifier clip with loop end, T-tape materials. Still, this scale is quite nice when measuring the weight of an elastic strap or cord. -minus: scale, c clamp, and silicone band.
Measuring: Only clip the top half of the T-tape aligned with dot #2, leave the ventral half of the Ttape unclipped, at base below dot #1 grab a pinch of shaft skin and keep it held to pelvic bone, with wall pulley attached to desk attach rope with weight, make sure weight doesn't swing, measure with calipers between dot 1&2. Measure a few times like this till able to get the same measurement. Desk height is important too, keep it at the same height for every measurement. Try to replicated the process for each measurement.
Hopefully this will help uncover how to get faster results, ideal weight, to rest and when, etc. Yes I know it won't be practical for many, but who wouldn't like to perform the most effective routine minute per minute from time to time? Even the turtle can sprint here and there.
*There will be a new episode(ep) that includes a spreadsheet for time under tension(TUT). Measurements for TDTC and FEC. I'll have it set that anyone with the link can add comments which will allow me to add in the data manually without someone coming along and messing it all up. Every episode will include a new potential discovery.
More Progress: I know, super long post already. I grew another mm, now 116 between dots 1&2! I think this happened recently after one application of high tension T-tape that lasted 5 days. I'll try to see if I can replicate the results, then write up a new episode post along with a spreadsheet I have going. If my calculations are correct, this be about 9mm per month! Lets go...

Hi! I am on the verge of giving up, no doctor so far has been able to help me. Everyone just brushes me off.
About me: I am 30yo female, BMI 19, diagnosed with Hashimoto's thyroiditis and PCOS, depression but are well controlled (except worsening depression due to unresolved health issues). Thyroid hormone levels are good, estrogen&progresteron optimal. I test them frequently. Vitamin D is optimal. Taking no medicine atm, vitamin C&D every now and then.
It all started 15 months ago. Joint pain suddenly started all over body and was worsened especially after eating and waking up. At around the same time, vaginal itching started (thought it was yeast infection due to the discharge and tried treating it with Canesten). Soon after that I got a hemorrhagic cystitis that was treated with antibiotic fosfomycin (two doses of 3 grams, 1 month apart). Urine culture was clear of bacteria (it was never tested which bacteria) after a month. However, swollen and painful lymph nodes that came with the infection in groin remained (and are still present) – the most "reacting" one was biopsied for lymphoma but was negative.
I did urine culture multiple times, always negative.
After a few months, I started having endometriosis-like pain, back pain and general fatigue. Groin lymph node pain was so bad I was limping. Lymph nodes at the neck, armpits started swelling and hurting as well. Thyroid started to feel swollen as well and my thyroid antibodies (anti-TPO) went way up.
I did cystoscopy once and there was nothing seen. A healthy bladder wall.
I was tested for fresh Epstein-Barr infection, HIV, toxoplasmosis, hepatitic B&C, Bartonella, syphillis, bacterial vaginois, thrush - all negative.
I did MRI (without contrast) and all they saw was reactive lymph nodes.
After a few months I started having even worse vulvar pain (but especially on mons pubis and prepuce) in addition to vaginal burning&itching and white discharge. I was so far treated with multiple rounds of fluconazole (multiple rounds of 10 days fluconazole 100mg) and 150mg at the start of every period. Even though the swab showed no Candida despite a lot of white discnarge. So, the medicine hasn't helped at all. Over months, it progressed to the point where I have problems walking due to the terrible pain down there. I cannot touch it, I cannot wear underwear or even pants. It hurts to even wash it with water. The mucosal skin is red and swollen. Dermatologist diagnosed me with lichen sclerosis and gave me a super potent corticosteroid cream (which hasn't helped much tbh). Five other gynecologists and 1 other dermatologist said it doesn't look like lichen sclerosus and that swollen lymph nodes don't fall into the picture, neither does the discharge.
Recently, I paid for PCR testing (Microgen) of urine and a vaginal swab. The results showed that my urine has medium-high copy number of E.coli and that my vagina has 100% of Lactobacillus.
What could be possible wrong with me? My doctor refuses to test me any further. I have no hope anymore to get a solution for this and just accepted it's the autoimmune problem that will just keep destroying my life.

I was diagnosed on Wednesday with a thoracic cartilage infection and "a virus" (non specified) which i could potentially be incubating. Thus, i was prescribed with Azithromycin (finished taking it two days ago) Pectox Lisina (mucolytic, carbocisteine) and dexketofren (antiinflamatory). On Thursday/early Friday I felt a massive headache better detailed on this post but TLDR, center right, was worse then but it still kinda hurts sometimes, specially at night) and after laying down i felt a massive amount of phlegm flow down my throat. The headache has persisted ever since (though much mildly now) and, while i still get some phlegm (yesterday i got some flowing down my throat as a matter of fact, though i also cried a lot for reasons unrelated to the pain so yeah lol) it is in much lesser quantity and from the looks of it it looks normal, completely transparent without any weird colored mucosity on it. However, I'm still worried, since this is clearly (or almost certainly ) sinusitis but most of my symptoms (other than the headache, shared with sphenoid sinusitis) just aren't present:
-No facial swelling -Headache is on top of head -No eye swelling -Some coughing but not much anymore -Mild fever (highest temperature was 37 Celsius or 98'6 Farenheit, usually around 36'5 Celsius/97'7 Farenheit) -No ulcers -Mild tinnitus -No visual disturbances -Been really nervous lately (maybe a azithromycin side effect?) -Headache has already been detailed, sometimes rougher but overall mild, it kinda comes and goes -Throat dryness -Sweet taste in throat which likely implies something affecting the nostrils -No nosebleeds (though i had two veins on my nostrils cauterized so maybe that's related) -No nasal discharge (above is a picture of a piece of my mucus, upper part is more compact, lower is gooey, pretty sure i've had mucus like this [or at least very similar] in multiple occasions. Most nasal mucosity seems solid and even so there's not that many) nor congestion nor a runny nose -Ears are kinda clogged with mucus i assume, but i can still hear no problem -Nose is not swollen from the looks of it -Cheeks and forehead don't hurt to the touch -Initial facial numbness seems to have recovered, likely the antibiotics -No skin color changes -Mind is kinda foggy lately, i have trouble to remember some simple words (i also haven't been sleeping well lately) -Breath seems fine -Vaccinated against influenza and pneumococcus (heard these vaccines can help with this) -Neck pain that comes and goes, was much worse before, had it when i first got diagnosed at the hospital -No ptosis (or at least i'm pretty sure) -Some of my eyelid muscles also felt kinda weak but, again, it was also something that kinda came and went -Teeth feel "nervous" or hypersensitive sometimes -Right nostril kinda whistles sometimes -Mild dizziness/felt kinda nauseous early on nauseous but not anymore -Sometimes i taste blood on my throat but apparently that's also an antibiotic side effect so yeah -Muscle stiffness (again, likely the antibiotics + sedentarist behavior i had lately)
An user in the post i've linked initially suggested this might be a milder case of sphenoid sinusitis that's already being taken care of by the antibiotics i've taken. I'm going to the doctor tomorrow and i'm really nervous. If this is sphenoid sinusitis, is it treatable with antibiotics or do i have to get surgery? Is not fungal, is it? Can i ask for an urgent TC scan there? Is it too late for treatment or am i going on time? Is it just a normal sinusitis alongside the side effects of my antibiotics?
Sorry for the post but i'm really nervous since it's been a few days since it started to hurt and, while milder now, it doesn't seem to go away

One of the most challenging obstacles to educating United States Americans on male genital anatomy is that many of them somehow are not even aware that half of the prepuce is mucosal. In my experience, some even defend the conception that the inner layer of the prepuce is skin, or that infant circumcision doesn't remove the inner layer.
Due to the misconception that the preputial mucosa doesn't exist, they cannot comprehend the concept of it being highly innervated. I think this warrants the use of histological photographs. I'd like to combine histological images of the surfaces of the epidermis and the preputial mucosa side-by-side, but, I haven't had any luck finding any of the preputial mucosa after spending about an hour searching the internet.
Which leads me to... have any microscope photos ever been taken of it?
I'm sure I just don't know where to look. But if I'm wrong and there really are no pictures of it, ambitious as it is, maybe I'll go take some photos myself. I have a decent camera and a garbage microscope at home, only thing I'm missing to do this is, well... an intact inner mucosa to photograph. :(

Hi! I am 24M. I have had trouble breathing when I sleep for a couple of years now where I wake up a couple times at night and when I do, I go to the bathroom to urinate. It lead me to think I had prostate issues at 23 but I got it checked and my prostate was normal. Recently, being last couple of years, I started to get random hives that began one day when I went to the gym. I don't know what triggered it, but it went away and would come up out of no where sometimes. Once, my blood pressure dropped to 72/25. I got allergy testing almost a year ago and turns out I am allergic to a ton of various environmental factors, nothing food wise. I had deviated septum surgery once during the first year of covid and when I came out of it, I couldn't believe how open my nose was, I was able to breathe clearly finally and smell everything. That lasted for about a couple of hours. I had trouble breathing again and never thought it was allergies because this kind of stuff never happened before. My doctor at Mt. Sinai performed a turbinate reduction surgery this time to help and still I had trouble breathing. He gave up after the surgery and told me he doesn't know what could be the cause and good luck with everything, I thought it was empty nose syndrome at the time but looking back I think it had to do with my severe allergies. I to this day still don't know what is causing me hives because it is so random. My allergy testing said I was allergic to cats, dogs, dust mites, cockroaches, tress, weeds, pollen, etc, but no allergy to mold or candida. I tried flonase, azelastine, triamcinolone, in the past and they didn't really help. But maybe I have been using them wrong.
I have done MRIs before due to a pituitary tumor and my reports were

1. "mild/moderate right sphenoid sinus mucosal disease is present. There is no evidence of acute sinusitis."
2. "Overview scans of the whole brain demonstrate persistent mucous membrane thickening to the maxillary and ethmoid air cells. Mild sphenoid sinus mucous membrane thickening is also identified. Persistent sinus inflammatory disease with mucous membrane inflammatory change of the maxillary antra bilaterally and ethmoid air cells."

I have tried sudafed but I don't have congestion where it is a runny nose or post nasal drip. It's mainly just stuffy like inflamed. Recently I have started taking Spirullina and Allegra once a day and that seems to have helped a little bit but in the morning I notice the stuffy nose and it wakes me up. I am thinking thats because the Allegra wore out. So I am thinking of trying out Zyrtec at night instead of Allegra? Loratidine did not work at all for me, I step outside and my left eye always starts tearing down my face. Spirullina has worked amazing so far these last two days.
My hormonal levels are also not very adequate as my free testosterone is borderline normal and I am thinking that my hormonal irregularities are due to the interruption of sleep at night.
I also do not have the best diet. I have a problem of mostly focusing on proteins and then I snack. I do not have regular bowel movements at all, leading me to think that I have digestive issues. I am not lactose intolerant either. I defecate maybe once every 3-4 days. I went on a trip recently where I didn't have a normal bowel movement in 14 days. I went once or twice in that time frame but the stool came out in hard round clumps, and was not a decent amount of it either. I felt like I had so much more left in me.
I had thought this picture I am attaching was due to xerostomia from my nasal congestion and fixing that would help with my tongue but I don't know anymore. Do you think it could be from digestive issues? I started a probiotic today to help maybe and within an hour of taking it I defecated. I do also burp a lot, can't control it.
My tongue has been this way for two years now and some days its better and some days it worse. At one point last year I drank coffee and my tongue bled on the side. It looks very bad and looks like I have thrush. My PCP gave me fluconazole at one point, nystatin swish and spit, peridex and none of that did anything, but also I didn't really take them as intended because I never thought I had a fungal infection. One ENT dr told me it can be geographic tongue but I don't think so as I haven't had this for my whole life nor do I feel pain from it anymore. It just looks really bad and sometimes hurts. Do you think it is from the digestive issues or form the allergies? Anything I can do to help it?
I am going to start immunotherapy with my shots soon and plan on asking my doctor for a prescription for zyrtec. The spirullina seems to be helping a lot actually so I will continue that. The probiotic I think I will continue unless anyone thinks thats not going to help with anything.
Thank you all for your time reading this lengthy post. I have been to multiple doctors and no one has been able to help me so far. I appreciate your inputs!
https://imgur.com/a/P0MYUUJ