Sure, knee pain was fucked up. Then came the hand pain. But then I learned with back pain. But now having dominant wrist pain? Constantly unlocking new levels of existential horror via the failure of critical joints.
Today at work, I finally got an MRI safety training that I have literally been asking to take for years. I learned that these parts of the hospital that I frequently go to are way more dangerous than I or any of my department knew about. The MRI manager who led the training asked if we had any questions. I said “yeah, uhh… we have a guy in our department who goes into these spaces a lot and he has a pacemaker.” She was silent for a very long time and then said that she was “deeply concerned.” One of the things that I learned was that all individuals are supposed to be screened before they are allowed to enter that space, including submitting a medical form; the manager also did not like it when I informed her “yeah, I was not aware of any of that, normally we just pick up the phone outside of the MRI department and someone buzzes us in.” She said “they should not be doing that.”
Earlier this week, I got to notify my entire department’s management team “hey, I just learned from an online module that we’re supposed to be garbing up to do this routine task? I explicitly asked multiple people about this when this task got assigned and was told there was nothing special I needed to know. I polled around on first and second shift and everybody said we don’t need to garb up. Who is in charge of this training and when do we receive it? Also we don’t even keep the PPE in the place where we do this. This shit causes cancer.” My shift lead helpfully sent out an email saying “hey wear garb, reach out if you feel like you don’t know how to garb.”
Genuinely feels like I live in a meat grinder world where my body is quite literally just fodder for the cogs of a massive machine.
There’s a fascinating phenomenon that isn’t unique to tumblr, but which I have certainly seen here a lot, which I’m going to call the Default Assumption of Incompetence. It’s when somebody has the baffling habit of always starting from the assumption that other people do not know anything about anything, or at least that having more knowledge than the assumer is extremely rare and statistically unlikely. To do this, they will frequently go out of their way to ignore context clues that indicate otherwise, or in some cases the assumer simply doesn’t know enough about the subject at hand to be able to estimate whether or not this person knows what they are doing.
The assumer will see a social media post about someone’s mushroom harvest, which clearly only contains exactly two distinct kinds of mushrooms, which the poster has identified and correctly named in the post itself, and the assumer will feel compelled to warn the forager to be careful out there! Some mushrooms are poisonous and they should be very careful to only pick ones they can identify! The assumer, who has ignored the fact that the poster did identify both of the mushroom species they had picked, and can most likely be trusted to do so in the future as well, has naturally assumed that the person showing off the results of their latest mushroom haul must have been obliviously picking them at random like an unsupervised toddler who is lucky to be alive.
If someone makes a post talking about how they just got a new job as a bus driver, the assumer might swoop in to warn them that driving a bus is extremely dangerous! It’s so dangerous that it’s literally illegal to do that unless you have a specific special training for doing that! Even a normal driver’s license isn’t good enough, you need a special license for it! And when the person who just got hired as a bus driver verifies that yes, they know that, they do have the license to drive a bus, and that they wouldn’t have even hired someone who doesn’t. The first question of the job interview was about making sure that they have a valid license for driving this type of vehicle.
“Well how was I supposed to know that?” is the assumer’s standard answer to being corrected. Not embarrassed or apologetic, only defensive and insulted, as if the other person here is the one being unreasonably rude for implying that it was stupid of the assumer to assume that someone who just got a job driving a bus might not know how to drive a bus.
Its awesome how many studies about trans men are like “>70% of trans men interviewed continue to experience menstrual-like cramping while on testosterone therapy even though menstruation has stopped” and the three conclusions drawn are either “this is probably something we should look into to see if we need to change something about how we do HRT for trans men to make it better for them,” (which gets ignored by the medical community) “I need research funding to prove that HRT is mutilating and killing our poor teenage girls,” or “if its over 70% its probably fiiiine lmao”
The person I reblogged this from brought up pelvic floor tightness in the tags, and I just want to second that there’s more movement from trans informed medical professionals that the cramping is most likely caused from pelvic floor tightness.
I’ve made great progress on my own pelvic tightness, there’s exercises you can look up online to loosen your pelvic floor. There’s also this sex toy specifically designed for people with tight pelvic floors. It’s done wonders to loosen mine.
Back before there was more people in the medical community flagging the pelvic floor as the culprit, and it still happens sometimes with less informed medical professionals, any hint that a trans man was getting cramping was chalked up to “uterine atrophy.” And trans men would be sent to get a hysterectomy, sometimes without even an ultrasound first, or a second opinion. Which disturbs the fuck out of me, for a number of reasons.
A trans dude on a local transmasc Facebook group posted a while back, about how he’s been getting cramping and his doctor wanted him to get a hysterectomy just based on his descriptions of symptoms alone. I don’t even think his doc even did a physical exam, and he definitely didn’t send him to a [trans friendly] gynecologist, or to get an ultrasound.
So I relied being like, “woah. It sounds like your doctor isn’t informed around current health care for trans men. Recommending a hysterectomy without doing a full exam, or sending you to a specialist, or at least ordering an ultrasound, is a huge red flag to me. I use to have your exact symptoms and mine ended up being my pelvic floor. Please ask your doctor for a referral to a trans informed gynecologist.”
And they were really grateful because the idea of going in for a surgery just like that was scary.
So ya, if you’re a trans dude with bad cramping even though you don’t get your period, or if you’re sexually active/use toys on yourself but find certain positions/certain angles of penetration intolerably painful, look into pelvic floor tightness. Oh, also, another symptom of mine that not everyone gets, but if you find you can’t pee everything at once.
Oh yeah that was me, I sent an ask to @nothorses when he copied my tags but I’ll expand here as well:
The current view from medical providers I’ve talked to is that the relationship between atrophy and cramps is more complex than just “cramps = uterus atrophy, take it out”. For example, vaginal atrophy might change the stability of the pelvic floor and make other muscles engage more to compensate. So just getting a hysto might not fully treat it.
Also, cramps aren’t necessarily a result of things like endometriosis like some doctors think. A retrospective study of gender-affirming hysterectomy patients [1] found that chronic/cyclical pelvic pain was NOT a reliable endo symptom, because it had a high incidence in patients who didn’t have endo. (The reliable indicator of endo was abnormal bleeding). This is important because sometimes gynaecologists can get really focussed on endo or other reproductive health conditions and might not consider pelvic muscle dysfunction as a cause of cramps.
The pelvic floor muscles mainly start at the front of the pelvis and run all the way back to the tailbone. This means that as well as trouble peeing, trouble pooing can also be a symptom of pelvic floor dysfunction (also ✨butthole cramps✨), especially if you don’t have any other conditions that could be causing it or you can feel stool getting “trapped” in there. You can get a vicious cycle where straining on the toilet makes the muscles tighten up more. Definitely talk to a pelvic physiotherapist if this is a problem for you; a “squatty potty” footstool may also help.
One catch with looking up info online is that a lot of it suggests Kegel exercises, which are a strengthening move that may not help for cramps and tightness issues. My physio specifically banned me from them. Based on discussions with physios and doctors, my understanding is that the increased muscle bulking from T also applies to the pelvic floor, leaving a lot of trans people with pelvic muscles that are strong but too tight (it’s possible for them to be weak and too tight). This can create new issues, or worsen existing ones; some patients don’t realise they have an overtight pelvic floor until the bulking from T starts making it painful.
Other things that I tried out were:
Botox injections into the pelvic floor. I got mine done under general anesthetic but you can also get it as an outpatient procedure. Best for if you’re getting pain throughout the entire pelvic floor, since they get put in the middle and it can break up “chain reactions” with muscles setting each other off.
Biofeedback. Kind of a subset of physiotherapy, you get given a machine or toy that connects to an app and shows you how your muscles are activating. I have a hard time connecting to the “feeling” of them, so this helps me actively relax them.
Medical cannabis (if you can get it). I used a low-dose 1:1 THC:CBD edible. This worked better than most other pain relief both because it’s a muscle relaxant, and because my doctor was comfortable with me taking it as soon as I felt any indication of a flare (rather than waiting until I was “sure I needed it”), so it was easier to do good pain control.
Swimming (if you can) and walking. Some of the muscles in the pelvic floor start at the lower back, run down through the hips, and out the front (hip flexors). These can get super tight if you spend all day sitting. Walking and swimming (esp. front crawl and backstroke) help stretch these out.
Treating my other “unconnected” medical problems. Getting sleep apnea surgery made a HUGE difference to my pain levels even though it wasn’t the “cause” of the pain. Turns out that when your body is struggling on a day-to-day basis, that can make your pain conditions worse. Wild.
Yeah! So when your muscles contract, they give off electrical signals. (Electrical signals can also force them to contract, as demonstrated by this youtuber shocking his muscles to force himself to dab [1]). Biofeedback devices measure these signals and translate them into a feedback form that’s easier for the patient to interpret. This can be a screen with a game where the character moves based on muscle contractions, audio tones that tell you when you’re contracting the muscles the right amount, etc. This helps people get better at noticing when they’re holding tension in their muscles, and improve their ability to consciously relax them (at my first physio appointments I literally could not tell when my pelvic floor was tense or relaxed).
For pelvic pain, this requires a device that either has a part that gets inserted into the vagina or anus, or insertable probes that attach to an external device. I personally went for one with probes because the software for the all-in-one devices talked mostly about strengthening, whereas the device with the probes is a more general biofeedback device that can do strengthening and relaxation equally well (biofeedback is used as a treatment for all sorts of things).
Evidence-wise, biofeedback has been well established as a treatment for anorectal pain (✨butthole cramps✨), and there’s positive evidence for it improving other kinds of chronic pelvic pain too [2]. These devices can sometimes be loaned out by physiotherapists who offer biofeedback treatment, especially if they’re like the type I bought where you can get the probes separately for pretty cheap.
(Keeping all the info, cause v v important, but ai want to touch on the actual physical treatment-)
When it comes to pelvic floor treatments- THIS SHOULD INCLUDE TREATING ALL MUSCLES THAT ATTACH TO YOUR HIPS. This means all your thigh muscles, half your back muscles, and all of your abdominals. That means that a *regular massage* and ESPECIALLY a Myofascial Massage can actually help!! Especially abdominal massage.
If any muscles on your hips are injured, atrophied, tight, etc. It ends up affecting ALL of them.
(Im a trans guy who is a massage therapist and I worked at a pelvic floor therapy place for a while and I specialize in Myofascial massage specifically due to my own muscular pain.)
Someone at an old job asked why I wanted to write up the meeting minutes for our team and I said ‘i wanna control the narrative’ and they were like 'what’ and I pointed out that no one was gonna remember what we said in six months and so my interpretation of the meeting would dictate the assumed reality of what happened
“none of you ever send corrections when I offer the draft so y'all have consented to my version”
“we don’t read that shit”
“you must trust me implicitly to create our shared reality that’s so sweet”
That’s how several coworkers decided I was a supervillain and how I learned several coworkers didn’t understand record keeping as like a CONCEPT
ALT
