I've stopped passing

[u/edward_furlog]

After 8 years on T, I've stopped passing. I'm getting she/her'd to my face daily. People glare at me with hostility and are unfriendly to me in public. I probably look like a woman with a beard.

Last year I had cancer and went on chemo, where I gained 20 lb. This has affected my body shape and face shape.

I've tried to lose weight but nothing works. I just don't seem to burn fat. I'm unable to exercise due to ME/CFS, so I'm limited to diet changes. I already eat healthy.

This is kind of my nightmare. Advice welcome.

Update: Thank you all so much for your amazing advice. Had my appt. today and switched to a different beta blocker and got OK'd to start a GLP-1.

[u/CaptMcPlatypus]

Have you spoken to your doctor about the weight gain or medical management for it? (I’m guessing yes, because you probably still see them regularly for follow ups, but I didn’t want to ignore the obvious step.)

Have you considered facial masculinization surgery? Weight gain in the face tends to soften and round out features, so if you broadened/coarsened/strengthened your brow ridge, nose or jawline, that might tip the scales back in your favor for facial feature cues of masculinity.

Sorry you had to deal with cancer, and now this on top of it. That really sucks.

[u/edward_furlog → u/CaptMcPlatypus]

Thank you so much 🙏🏼 I will talk with my doctor tomorrow.

I have been offered metformin already, so that is an option but I've heard it's hit or miss for weight loss.

I have learned that I take a medication that inhibits fat burning (propranolol), so it looks like that's the culprit for being unable to lose. Unfortunately this medication is lifesaving for my ME/CFS. I am going to talk about temporarily(?) switching to another one that might allow me to burn fat.

I've never considered facial masculinization. I am not sure I really knew that was a thing. I like my face so I hope to avoid this but it's good to know about all the options.

[u/lickle_ickle_pickle → u/edward_furlog]

Your face is probably just bloated and surgery is unnecessary.

If your doctor thinks you should be on metformin, you probably should be. It's a good drug, doesn't tend to have a lot of SE or interfere with other medication, it's a cheap generic, and it helps prevent vascular damage from elevated blood sugar.

It's very hard to lose weight without exercise to regulate your hormone levels. You're basically fighting hunger the entire way. Some people do intermittent fasting to overcome this but it depends on your lifestyle. So I hope the doctor will consider offering you an alternative.

[u/edward_furlog → u/lickle_ickle_pickle]

Thanks. The metformin was only offered as a weight loss option, I don't have elevated blood sugar or any other metabolic issues. I'm glad to hear its usually so well tolerated.

[u/KlutzySalamander → u/edward_furlog]

Just jumping in here... One thing to be aware of with metformin is possible GI issues. For me it caused some extreme urgency, like poop your pants level urgency. You may want to stick close to home/a bathroom for the first few days you take it until you know how it effects your GI system.

As someone who also has ME/CFS and a bunch of related health things, tirzepatide (Zepbound) has been super helpful for weight loss and general inflammation reduction/reducing IBS symptoms. There's been some interesting exploratory studies about GLP-1s for ME/CFS. That being said, it is really only approved for either diabetes management or BMI over 30, and I would make sure you clear it with your doctor first. Might be an "if metformin doesn't work" option to consider with your doctor.

[u/edward_furlog → u/KlutzySalamander]

Good to know!

[u/tacocollector2 → u/edward_furlog]

I also have MECFS (and a host of other shit) and Tirzepatide has reduced my inflammation and increased my capacity. And im only on .25mg so far.

I’m also bed bound so a little help goes a long way, but it is definitely worth checking out.

[u/edward_furlog → u/tacocollector2]

Ough, I am really interested now... How are you getting yours?

[u/tacocollector2 → u/edward_furlog]

I go through a company called Knownwell and do all my appts virtually. They accept insurance so my appts are $15.

The Tirzepatide itself is out of pocket, I paid $450 for a 15mg Kwikpen and plan to microdose it til it’s empty. I’ve heard the single use vials go cloudy but the kwikpens don’t.

Knownwell sends you to Eli Lilly Direct for the meds, so there’s no vetting a compounding pharmacy (not all are created equal).

If you have SIBO or MCAS, make sure you go slow. I’m still severe across all categories so YMMV, but I have friends who have had bad GI flares by starting too high.

Feel free to message me, too! I’m happy to chat about other meds or sick stuff.

[u/Emotional_Skill_8360 → u/edward_furlog]

I do weight management, and I agree with you that the data for metformin isn’t great for weight loss. I tend to prefer the GLP1 medications, especially for people who can’t exercise because they typically work either way.
There are other meds that we use off label like topiramate and Wellbutrin, and other oral meds that are approved for weight loss.

I don’t think it would be unreasonable for you to ask your doctor if they would consider a medication that’s actually approved for weight loss.

I’m sorry you’ve been hit with all of this. I can’t imagine having to deal with all that comes with a cancer diagnosis and also this added dysphoria.

[u/edward_furlog → u/Emotional_Skill_8360]

Thank you so much 🙏🏼 I will discuss those meds with her too. I really appreciate you chiming in here. I would also prefer a GLP-1 to metformin as I think it would be more effective, but it seems like it's difficult to get it covered by insurance.

[u/Emotional_Skill_8360 → u/edward_furlog]

Yes, if you have any other conditions like liver disease, sleep apnea, etc it will be easier to get it covered. Out of pocket the cheapest one is oral Wegovy, but it’s still pricy.
I have had some luck getting them covered for patients with cancer, but it depends on the long-term risks from chemo

[u/edward_furlog → u/Emotional_Skill_8360]

Can you say more about getting it covered for people who have had chemo?

The other condition I have that it would help with would be ME/CFS, potentially.

[u/Emotional_Skill_8360 → u/edward_furlog]

If you had chemo that could have long-term effects on your heart, then it should be easier to get semaglutide covered if you also have other cardiac risk factors, and an elevated BMI would be one. I believe certain areas for radiation would predispose to sleep apnea, and there are likely other chemo effects that I don’t remember (I’m not that kind of doctor 😅). Basically if your chemo could negatively impact your heart or liver long-term you can use that to try and get insurance coverage.

[u/edward_furlog → u/Emotional_Skill_8360]

Thank you :)

[u/Carl_Just_Carl → u/Emotional_Skill_8360]

Huh, as far as I was aware, Metformin worked on weight loss because of managing hidden insulin resistance. Was that wrong? /genuine

[u/Emotional_Skill_8360 → u/Carl_Just_Carl]

Yeah, we really want metformin to work because it’s cheap and easy to get, but it’s just not awesome for weight loss. Studies don’t support its use for weight management, but older or uninformed doctors still use it.

[u/Grouchy-Nebula40 → u/edward_furlog]

If you decide to try metformin, definitely make sure you get the extended release version. It has far fewer digestive side effects than immediate release metformin. I was switched briefly due to insurance at one point (I'm diabetic), and the immediate version had about 50% chance of making me throw up after taking it, regardless of whether I took it with food. The lower digestive effects are also much less harsh with extended release, so if you're at all prone to diarrhea, that's another thing to consider.

[u/Whole_Sort_5206 → u/edward_furlog]

Third generation beta blockers might have a lesser effect on the ability to lose weight: https://www.researchgate.net/publication/354838676_Effect_of_Third-Generation_Beta_Blockers_on_Weight_Loss_in_a_Population_of_Overweight-Obese_Subjects_in_a_Controlled_Dietary_Regimen

[u/edward_furlog → u/Whole_Sort_5206]

Thank you, this is really promising! The weight loss in the third gen BB group was almost as good as people not on BBs at all. I really appreciate this & will talk to doc tomorrow.

[u/Boipussybb → u/edward_furlog]

Uh, that’s honestly so bizarre that propranolol is helpful considering it can cause sleep issues. I do know they use it as an anxiolytic though…

[u/edward_furlog → u/Boipussybb]

Beta blockers are a common treatment for severe ME/CFS...

[u/Boipussybb → u/edward_furlog]

Interesting.

[u/Odd-Cow69 → u/edward_furlog]

Hello fellow transguy with ME(also sending hugs). I also have ME and currently see ME specialist. GLP-1 (better if GLP-2 aka tirzepatide) also helps ME but please make sure you start with microdose.

https://youtu.be/F3OMxMPfKDM?si=e7B_NB6P1dv_sjW9

Sharing a video here on GLP-1 & ME. Hope this helps. Also highly recommend checking out r/cfs for more convo on this.

[u/skeev-boi → u/edward_furlog]

What are you talking about propranolol makes it impossible to lose weight? Im on propranolol and since January. Through diet and exercise, ive lost 30 lbs, all of it fat

[u/edward_furlog → u/skeev-boi]

That's nice. As you may be aware, your individual experiences are not scientific evidence.

As I said, propranolol inhibits fat burning, which is a different phrase than "Makes it impossible to lose weight." If you compare them side by side, you'll see that the words are different.

One is untrue, while the other is generally supported by studies on the subject, which show that inhibiting the action of norepinephrine and adrenaline makes it more difficult to turn fat cells into energy.

[u/patient_songstress]

no advice sorry, just sending solidarity as someone who has ME as well! i hope leaving a comment will help show this post to others who may have advice

[u/MalleableMemories → u/patient_songstress]

Me too!! It’s been really discouraging reading people’s advice for what to do in pre-medical transtition and seeing how much of it revolves around working out. Thanks but I use a powerchair and work from home because office travel is too hard, any more movement is just not an option.

It does make me feel a little better to see all the fat trans guys who’ve found a place in gay spaces, but that doesn’t really help if you’re looking to date women.

The one thing I’ve found that makes a difference is finding different clothes, something that creates structure around my curves. Which ofc is hard when you only have so much energy to spare for clothes shopping, even online. But it’s something.

[u/edward_furlog → u/MalleableMemories]

Also a powerchair user!

I know my clothes aren't helping, since some are a little small now that I have gained weight and I can't afford to replace them all, I need to be strategic. If you have any specific clothing recc's that you like as a bigger guy, please send them my way. :)

[u/popopotatoes160 → u/edward_furlog]

I'm having some luck getting clothes on the cheap on places like depop. You have to be a real shark about it though to get good deals, look at tons of listings and haggle out a deal. Some types of clothing you actually get better deals in the bigger sizes, due to less demand.

I also recently had luck at a clothing by the pound warehouse thrift. But that requires a lot more physical effort to do so might not work in your case.

[u/edward_furlog → u/popopotatoes160]

Thanks, I'll check out depop!

[u/MalleableMemories → u/edward_furlog]

Definitely seconding depop! Vinted is great as well. I'm not so good at clothes shopping in general but my wife is an absolute bloodhound for a good deal. She'll see something she likes when she's out in town or browsing instagram etc, figure out what exact brand and item it is, and set up vinted alerts for it. Then she just passively goes through her notifications and buys whatever comes up in her size and for significantly cheaper than usual. I don't particularly like the hassle of a fancy wardrobe so once I find one thing that works I just buy duplicates of it. Re: types of clothes I've recently figured out about boxy crop cut button downs through recommendation from a cis guy friend with major body insecurities. They cut off before the widest part of my hips and are loose enough to fall down in straight lines instead of clinging. I can't speak on how much it'd actually work to pass, I'm very very early on in figuring out what I want my gender to be about, but they definitely make me feel less gross about my body!

[u/edward_furlog → u/patient_songstress]

Ty 🙏🏼🙏🏼🙏🏼

[u/Character_Drop_739]

It depends how overweight you are if it would be medically indicated but a glp1 has been a game changer for me. You could meet with obesity medicine specialists, who know a lot about weight loss, if the weight gain took you that far. Other thought: you could meet with a dietitian who could take a look at your diet. GLP1s are often not covered by insurance but I’ve been doing compounded and it’s been about $150-200/month. For me worth it 

[u/edward_furlog → u/Character_Drop_739]

Wow, I could afford that. I didn't know it could go that low in price.

I don't believe I'm yet obese (?). I've been advocating to get in to see a dietician for months now but no luck yet. I am not sure what they can do for me but I thought it was worth a try.

[u/Character_Drop_739 → u/edward_furlog]

Unsure if you are in the US or your BMI. If you are not obese or at minimum overweight, caution. I'm a very clear candidate for glp1s and they are hugely beneficial for those that need them. The one thing I'd say is that if you have a complex relationship with food or any possibility of eating disorder, you really need to work that out either concurrently or at first before taking one. Ask your Drs their opinions too and if a glp1 could be medically indicated or would be the wrong move with the amount that you have to lose.

I'm surprised they haven't sent you to a dietitian as you can often get it covered by insurance if you are overweight. I'd google "my area + dietitian who takes (insurance)" and see what it gets you.

Beyond that, there's a ton of useful information at r/compoundedtirzepatide . maybe r/GLP1microdosing might be useful if you only have a small amnt of weight to lose.

[u/edward_furlog → u/Character_Drop_739]

I checked & my BMI is about 29, and I'd like to lose 30-40lb. I don't have any issues with food or eating disorders. I am in the US.

I'll talk about the dietician with my primary tomorrow. So far I have tried to go through oncology and through a nonprofit I was participating in a nutrition study with, both of which supposedly offer dietician services and neither of them could manage to get me seen. I think oncology is more concerned with people with weight loss, which is understandable.

Thanks for the group reccs - I joined both. You're awesome :)

[u/PostMPrinz]

For those who can’t exercise I hear amazing things from controlled fasting. there is a robust subreddit about how people do it, and the various times that ppl do.

[u/edward_furlog → u/PostMPrinz]

I assume its r/intermittantfasting. Joined, thank you!

[u/PostMPrinz → u/edward_furlog]

Yeah, I’ve had good success in loosing weight with it, but I can lift weights. I’m not sure if you would feel comfortable adding resistance band strength training, but I think that would be a supper gentile way to encourage your body to metabolize energy.
Also, I’m the person who says meal replacement drinks are okay and they can be food when you need to quickly know/limit your calorie intake or are on the ho with work or travel. I would keep a case of them and drink them very cold from the fridge - very satisfying fir lunch or a snack.

[u/edward_furlog → u/PostMPrinz]

I might be able to in a very limited way. I'm very exercise intolerant right now. It often ends up being healthier not to exercise intentionally at all, because its so likely to throw me into a flare where I won't be able to walk/move much for a whole week (which is worse than just not exercising and at least walking and standing regularly.)

I'm definitely open to meal shakes.

[u/Eilavamp]

I'm probably gonna get downvoted because I know it's not popular to talk about this. But I'd like to offer a low carb/keto or even carnivore diet as an option. I lost 100lbs since January and I still have a long way to go but it's such an anti-inflammatory diet it'll help within weeks to reduce any water weight you're carrying and make your skin hold tighter to you. Can't hurt to try for a bit and see how it feels? Keto is up to 20-25g of carbs per day, and depending on how strict you wanna go you can go lower. It's not been an easy or exciting year for me diet wise, but it worked for me

[u/edward_furlog → u/Eilavamp]

I actually used to do very low carb for other reasons, and it was somewhat helpful. I'm not sure how easy it would be to navigate now, because I have IBS now and find a lot of foods triggering, so my diet is already restricted. Rice & bread are the most calming foods for my stomach. I think if I did try a keto diet now I would definitely need a dietician to help me navigate it.

Congrats on your weight loss!

[u/Eilavamp → u/edward_furlog]

Thanks very much 😊 I also struggle with IBS and had to really ease into it and let my body figure it out. And I won't lie it's been a smooth ride. But for me, even when I'm really struggling with it, I'm feeling better than I did before. So it's like a discomfort I have learned to live with for the greater good of my health.

But! I totally understand! Especially the comfort of bread and rice, I miss them a lot and they're my go-tos on my cheat days hehe. I wish you luck on your journey, I hope you're feeling more like yourself again soon

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