Chinese Medicine, Natural Transition, and the Gender Binary [interview with Katrina Hanson]

CS: reflected in title, this is an article for transgender folks- Chinese Medicine, Natural Transition (using plant-medicines to alter hormones or ease hormone therapy symptoms/post-surgery symptoms), and the Gender Binary

Do yin and yang make Chinese Medicine binary?

Yin and yang are often associated with female and male energy respectively, which leads to the misconception that Chinese Medicine is inherently binary and therefore inappropriate for trans medicine. It is true that most diagnoses in Chinese medicine refer to the interaction between opposites: hot and cold, internal and external, excess and deficient, yin and yang, among others. However, yin and yang, though often associated with male and female energy, are more accurately represented by masculine and feminine.

Masculinity (yang) and femininity (yin) are indeed seen as opposites, but they are also in a constant state of transformation from one into the other, and at each stage yang contains yin, and yin contains yang within itself. It is actually their opposite nature that allows each of them to exist. Think of it this way: if heat did not exist, how would we know what cold was? If sadness did not exist, how would we recognize happiness? In this way, yin and yang create each other and one cannot exist without the other. Neither is stronger or more important than the other.

Basic Principles of Yin and Yang/Masculinity and Femininity:

1. Masculinity and femininity are opposites.
2. Masculinity and femininity are interdependent: there is always masculinity within femininity and femininity within masculinity.
3. Masculinity and femininity are mutually consuming and in a constant state of transformation of one into the other.

In this way, neither masculinity nor femininity can exist without both opposing each other and containing a piece of the other. Most people, in discussing yin and yang theory today, only focus on the first principle, which alone can be used to reinforce our culture’s thinking of gender as binary. However, traditionally this medicine was much more inclusive of sex, gender, and sexuality variations, and still can be applied this way today!

Yin and yang in diagnosis

In the case of hormone imbalances, it is common to have a diagnosis of yin or yang deficiency. The treatment would be to tonify yin or yang to bring them back into balance. Within the context of trans health, this is often interpreted as meaning that the yang deficient patient needs more testosterone and the yin deficient patient needs more estrogen. This comes from the western medicine framework that reduces masculinity and femininity to hormones and assumes that hormones should be one way for males and another way for females.

Constitution-based healing as a radical form of healthcare

The great thing about Chinese Medicine is that we always work from a constitutional root. We look at the person’s tongue and feel their pulse to identify the root of a person’s pattern and work on that as well as the symptoms. The goal is always to bring the patient into alignment with their constitution, not to change them based on societal expectations of their sex and what their hormone profile will look like.

I see many trans men pre-testosterone present as yang (testosterone) deficient and many trans women pre-estrogen present as yin (estrogen/progesterone) deficient. Treatment in this case affirms their identity and assists their transition. Once folks have been on hormones for a while, sometimes testosterone depletes yin and spironolactone (a testosterone-blocker) depletes yang. In this case, it is appropriate to tonify the depleted energy to bring the person back into balance. This does not in any way counteract their transition, it gently balances and keeps them healthy and aligned with their constitutions. Similarly, an intersex person with yin deficiency would be treated differently than an intersex person with yang deficiency, regardless of their chromosomes or type of intersex diagnosis.

*Picture of Katrina working away!

Can you actually use herbs for natural transition?

Herbs can be used for many aspects of transitioning: transitioning with herbs alone, switching from synthetic hormones to herbs to maintain secondary sex characteristics, and supporting the body with herbs and nutrition to counteract side effects of synthetic hormones.

Herbs are a desired alternative to prescription hormones for many people who wish to experience only mild changes, rather than the more drastic effects of prescription hormones. I work with trans patients who want to use herbs and not prescription hormones to transition. I always have a conversation with them about how herbs are much milder and work with your body rather than against your body like prescription hormones. Because of this, they don’t cause dramatic changes, just subtle ones.

Some herbs may cause slight breast growth. Some can cause facial hair growth, and some can slow or stop ‘male’-pattern balding. They can also make some people ‘feel’ more feminine or masculine, and for some people this is enough. They can even in some cases cause slight elevations in estrogen or testosterone, but generally not enough to be clinically significant. It is not possible to have dramatic changes with herbs alone. If you do not produce hormones on your own (for example if you’ve had an orchiectomy or oophorectomy), you do need to keep taking hormones as it’s dangerous to not have any hormones in your body. Herbs are not a safe alternative in this case.

My work

Generally I’m using herbs, acupuncture, and nutrition to support western transition and reduce side effects. Herbs are great at reducing side effects of prescriptions hormones, like hot flashes, acne, hair loss, vaginal dryness, blood pressure imbalance, edema and bloating, and many other effects. They can also be used to reduce hair loss, ease pain from binding and gaffing, and much more.

Acupuncture is most well known for its effects of reducing pain and speeding healing. It is in fact great for reducing chest tightness, back pain, and skin lesions from binding and gaffing, as well as reducing pain and swelling and speeding healing after surgeries. Acupuncture can also be used to reduce the appearance of scars, including keloid scars, improve circulation to reduce the chance of blood clots and edema, and regulate blood pressure. It can help with post-surgical numbness and neuropathy. It also soothes anxiety and depression, improves sleep and digestion, and generally aids your overall well-being.

By increasing or decreasing estrogenic foods in your diet, as well as by eating a balanced diet aimed at encouraging detox and flushing out of other hormones, nutrition can be an important part of your transition plan too.

Katrina Hanson LAc

I am a California licensed and nationally certified acupuncturist. I received my training through the Acupuncture and Integrative Medicine College (AIMC)’s rigorous four-year Master of Science program, and interned at UCSF Benioff’s Mission Bay Children’s Hospital and the San Francisco Homeless Prenatal Program, as well as at AIMC’s teaching clinic.

I went into the program with the intention of focusing in LGBTQ medicine, and this continues to be a driving focus of my practice. I specialize in transgender medicine, hormone regulation for every body, pre-post-surgical care, scars, neuropathy, and hair loss. I love guiding patients through times of hormonal upheaval, allowing them to stay grounded despite the emotional turmoil that often accompanies times of illness. My favorite part of my job is watching people regain ownership of their healing process, reconnect with their bodies, and make positive changes in their lives.

In addition to maintaining a private practice, I teach at Bay Area acupuncture schools–instructing students on gender vocabulary and pronouns, western and eastern transgender medicine, and approaches for creating an LGBTQI-inclusive practice. In my spare time, you can find me hiking or camping with my partner and our dogs

All information in this blog is for educational uses only. Always consult your doctor before taking any herbs or supplements, or changing or discontinuing your medications.