gendertreyf, revolution, Uncategorized

trans health care: a taxonomy of HRT access

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in the department of screaming into the wind, it seems useful (if perhaps optimistic) to try to be concrete about the different pathways that trans liberals and antitrans organizers alike try to conflate, as part of their shared commitment to Professional Expertise (a/k/a doctors; a/k/a gatekeeping). that’s especially visible right now, as they attempt to redefine “DIY” in the context of HRT, pushing to keep us all dependent on state-licensed gatekeepers for access to the drugs many of us use, need, and want.

in the u.s. there are four basic pathways for getting drugs that you can use to adjust your endocrine system. (the specific examples i use are going to be about estrogens, since the greater legal restrictions on testosterones have made the process of developing autonomous pathways slower and quieter – but the same structure applies.)

two are commercial:

(1) by prescription. you go to a state-licensed gatekeeper, persuade them that you meet one or another set of arbitrary criteria, and are then allowed to pay a pharmaceutical company (directly or through an insurance company) for one drug off a very short list of possibilities1, with a state-licensed pharmacy taking a cut off the top.

(2) from unlicensed pharmacies/dealers. you go to a website2, and pay them (often using one or another form of blockchain pseudo-currency) to send you however many drugs you want, off a longer list of possibilities. the drugs come from the same manufacturers that supply the pharmaceutical companies.

two are autonomous:

(3) from community-based compounding projects. you go to a table at an event, or some other distribution point, and are given one or more drugs from a very limited selection3 (which is often just a choice between injectable and transdermal preparations of the same drug). you may be asked to contribute a nominal amount to support the ongoing project, but are not refused drugs if you can’t pay. the drugs are compounded (put into usable form) by community members, with the raw drug coming from the plants that supply the manufacturers of the commercial versions.

(4) from community-based redistribution projects. you go to a distribution point and are given a choice of whatever drugs they have on hand, which mainly come from the limited options available by prescription. you may be asked to contribute a nominal amount to support the ongoing project, but are not refused drugs if you can’t pay. the drugs come from either the prescription pathway (#1) or the community compounding pathway (#3).

there is a third possible autonomous pathway. i’m separating it off because i don’t know whether there are any projects currently working on using it. i hope there are, and i hope that they’re being very careful who they talk with about it.

(*5) from community-based production projects. when this exists, you’ll go to a distribution point (likely one established for the community compounding (#3) pathway) and choose from a limited selection on a pay-what-you-can basis. the raw drugs will come from a community compounding project, using raw drugs synthesized by a community-based manufacturing project.

of these pathways, only #3 is “DIY” in any meaningful sense (and #5 will be once it exists). #1 and #2 are gatekept efforts – one by the doctors and pharmacists who control access to prescription drugs; one more impersonally, by the prices they charge; #4, though very useful as a way around doctors and pharmacists, is basically dependent on #1 rather than an alternative to it.

but the distinction that matters here is between commercial and autonomous pathways of access. #3 and #4 (and #5 once it exists) are pathways in which trans people are directly supplying trans people with drugs, without the gatekeeping presence of either Professional Expertise or the profit motive. within the autonomous zone, #4 is much more limited in its scope than #3, since its supply of drugs depends on donors who both can persude a doctor to give them a prescription and don’t need to actually use all of the drugs they’re prescribed.

importantly, #2 is neither “DIY” nor autonomous in any meaningful sense. it’s an alternative to getting drugs by prescription, but it is neither community-controlled nor based on providing the maximum access to as many people as possible. and given that the people most likely to be uninsured (and thus without access to prescription drugs made affordable by insurance coverage) are poor people, no commercial operation does much of anything to change the patterns of who can and can’t get access.

trans liberals and anti-trans organizers both participate in the demonization of what they call “DIY hormones”. they tend to focus on #2, using the legitimate reasons to be especially cautious about that pathway4 as a starting point for attempts to discredit any pathway that doesn’t run through state-controlled gatekeeping checkpoints – that is, anything but #1. their arguments are garbage, and i won’t even get into rebutting them here.

but it’s important that we not accept their redefinition of “DIY”. if it’s not community-based and community-controlled, with no barriers to access (economic, diagnostic, age-based, or otherwise), it’s not DIY. it may be good; it may be useful; it may not involve the state directly. but it’s not DIY if we aren’t doing it ourselves.

if the past decade has taught us nothing else, it should teach us that we cannot rely on the state to provide or protect trans people’s access to health care of any kind. what the state gives – grudgingly, belatedly, and stingily – can be taken away by that same state – rapidly and enthusiastically – always, and at any time. “legality” doesn’t come into it; the state, after all, is what decides whether a law will be ignored or enforced (that “discretion” is an inextricable element of the state as a structure, at the core of every state, whether a theocracy, a people’s democracy, or a parliamentary republic).

autonomous trans health infrastructure is the only way that we can actually maintain access to the drugs and the care we need. community-based compounding and redistribution projects are laying the foundations for the decentralized network that will save our lives – if we make those foundations strong and broad, and build on them!

  1. on the estrogen side, usually the only drugs that are available by prescription are estrodiol cypionate and estradiol valerate (which can come in injectable, tablet, or transdermal forms). these have a notably steep absorbtion curve, which means that the drug’s effects vary significantly over the time between doses (for injectable versions, often a week). ↩︎
  2. or potentially, for some forms of testosterone, a dealer catering to the gym-rat/body-building crowd. ↩︎
  3. most current community compounding projects are making estradiol enanthate, which has a flatter absorbtion curve than cypionate or valerate, meaning that its effects are less variable over the time between doses). ↩︎
  4. which have much more to do with past periods of trans health access than the present. in the past, many (if not most) unlicensed sources were charging high prices for low-quality drugs, and often drugs that had been replaced in the prescription sphere. and some were selling actively harmful drugs, or alleged drugs that didn’t actually do anything. that’s much less true today. that’s much less true now, because the push to drive pharmaceutical manufacturing into low-wage overseas factories has made it much easier to get access to the supply chain for “legitimate” drugs, at either as raw materials (#3) or fully-produced medications (#2). but the profit motive can still lead to dangerous cost-cutting measures that make the actual dosage not match the label, or use harmful materials in the compounding process. and as in past periods, that a commercial supplier is trans, or has trans people willing to vouch for them, does not make them any less motivated by profit. ↩︎
gay wrath, revolution

for the record…

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well, i went back to look at something i wrote in september 2018 about the then-upcoming midterm election. and while i may have overestimated the degree that the senior partner in the current bipartisan fascist regime had its shit together then, and thus gotten some details wrong, it holds up well enough as a description of this year’s midterm election for me to post it here unedited:

Continue reading for the record… →
criticism, gay wrath, longer writing, revolution, yiddish & jewish

Repair and RETVRN

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lies, shams, and “tikkun olam”

this is a slightly repetitive collage of various things i’ve written about “tikkun olam”/”tikn oylem”1 as a framing for jewish liberatory work, arranged according to the ACT-UP rubric for criticizing and rejecting supposedly helpful policies and programs: “it’s a lie, it’s a sham, and it won’t work”.

It’s A Lie

in the 1970s, a cluster of young liberal Zionist men entered jewish political and religious life (i’ll get to some of the key figures in the next section). they soon seized on a theological phrase to depict their politics as an outgrowth of their new role as rabbis: “tikkun olam.” the phrase had never had a social or political resonance before; it was about reincarnation, predestination, and the individual spiritual athletics of kabbalistic and Hasidic religious leaders who sought to bring about the apocalypse by gathering the fragments of divinity scattered in an irredeemably sinful world. that earlier history, however, has very strongly shaped how “tikkun olam” has functioned in the institutionalized jewish left over the past 50 years.

previously, the term’s only political deployment was in a few places in the Mishnah, where it designates small legalistic shifts that ease the conditions of the worst off, in order to ‘repair/maintain [tikkun] the existing social order [olam]’ without structural change.

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criticism, yiddish & jewish

“Ceci tuera cela”

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[written october/november 2021]

i was poking around in an anthology the other day, and found something about one of my favorite poets’ work that kinda blew me away. i saw in the table of contents that among celia dropkin’s poems was one called “tsu lutsifer / to lucifer”. that wasn’t surprising; part of why i adore her work is its gothy edge. the surprise came when i turned to it and found not a single poem but a triptych: a first section addressed (as promised) to lucifer, and then two poems i know quite well. they’ve been printed under a few titles; their first lines are “ikh hob dikh nokh nit gezen / i still haven’t seen you” and “du kvelst, ikh kvel / you rejoice, i rejoice”.

both are intense and erotic: in “ikh hob dikh nokh nit gezen”, dropkin declares “i want to see how you sleep / when you lose your power / over yourself, over me / … / i want to see you / helpless… / i want to see you / dead.” in “du kvelst, ikh kvel”, she demands “burn me up, be burnt up / take up all my desire”. but seen as parts of a larger piece, especially one dedicated to the light-bringing fallen angel, they take on a whole new dimension.

i’ll put the triptych below, in yiddish and english – you might want to skip down to read it now.

the three parts move from a cold, compelling, dominating object of desire to a fantasy of a lover stripped of all power to an image of sanctified purgation through excess. so far, so wonderfully goth: creepy, hot, disturbing, cosmic.

but what gets my head spinning in interesting ways is that all of this is done with specifically christian occult imagery. there’s not a jewish reference point to be found, and, as in a great deal of yiddish poetry by women, there’s barely a word from the hebrew/aramaic side of the language, which bears liturgical resonances as well as everyday meanings (to be precise, there’s one: “תל / tel” [ruin]).

Continue reading “Ceci tuera cela” →
longer writing, revolution, yiddish & jewish

is this the feast that we desire?

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on adar and genocide warrants

or, how many massacres will it take until you’re ready to stop telling the fucking esther/mordekhai story already?

i wrote a piece about the month of adar, and carnival, and how we celebrate purim, for the 5785 edition of the wonderful Dreaming the World to Come planner (you can still get this year’s edition, and you should!).

i just made a slightly remixed version, because as the israeli and u.s. governments again wage war on iran, the use of the Megila as a justifying reference point has already begun.

you can read it here.

and on iran and solidarity in the face of this new war, i think some of the best writing to think with is from the Raha Iranian Feminist Collective. their article “Solidarity and Its Discontents” is from 2009, but is still perfectly applicable to the new crops of useful idiots – both the dithering sanctions-fan liberals and the enemy-of-my-enemy leftist apologists for the iranian theocracy (now often using a rhetoric of “multipolarity” to justify their embrace of murderous regimes). and their 2011 “Essential Readings” remains an excellent starting point.

there is also a long history of revolutionary organizing in iran, in opposition to both local oppressive regimes (whether theocratic or monarchist) and imperialist interventions. here is a brief 2022 interview with members of one of the current iranian anarchist groups; and here is a much longer 2005 interview with the editor of an iranian anarchist magazine (including an account of the theocratic counter-revolution that installed the current regime).

gay wrath, revolution

files and conspiracies

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(1)

so: the core module of u.s. conspiracist thinking is the one it inherited from the european christian intelligentsia, whose history norman cohn traced brilliantly in Europe’s Inner Demons (if a little dryly, especially if you’re not an archive-rat like me). it goes back to ancient roman political maneuvering – in sallust’s account of the “catiline conspiracy”, from the last century before the christian era, for instance – and perhaps even further1, but consolidated itself through anti-jewish and anti-christian attacks over the first few hundred years of the christian era.

that module says:

there is a hidden group of people who seek power for themselves and control over our society; they gather in secret and hold perverse sexual rites, abusing children (and also adults – willing or unwilling – often incestuously); they ritually kill humans (often children, specificially) and drink their blood or eat their flesh; their ultimate goal is to undermine the political and social systems that we live within.

i won’t go into the history of that module (i’d only be summarizing cohn, and you should just read him instead) but it moves essentially unchanged from roman anti-christian polemic through christian anti-heresy and anti-witchcraft polemics and the anti-jewish blood libel, inspiring and excusing a massive number of murders and massacres along the way. almost all of those deaths, importantly, were carried out by the state (whichever one, of whatever form), or with the explicit or implicit support of the state.

we’ve seen a very classical version of this module emerge and grow over the past decade: the ongoing Pizzagate/QAnon movement.

and we’ve seen an equally classical mobilization of it in a more open-ended form over a slightly longer period: the ongoing anti-trans campaigns centered in the u.k. and u.s.

and we have also, over more or less the same years, seen more and more detailed evidence of something else:

the actual involvement of an impressive number of public figures with someone they knew was actively involved with the sexual exploitation of both children and adults on a very large scale, which many of them directly participated in or saw happening.

(2)

one response to that has been “the conspiracy theorists were right”.

it’s a tempting throw-away line, and i can understand why i’m seeing it so often from people in my circles.

but it’s also both untrue and dangerous.

Continue reading files and conspiracies →
criticism, gay wrath, yiddish & jewish

sex, lies, and primeval matriarchy

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or, how i learned to stop worrying and hate fake history written by fascists

or, you can’t fool me, it’s enemy feminisms all the way down


i’ve been thinking about this for a while, and picking up pieces of the story here and there, but i haven’t had the time (or, to be real about it, the languages) to do the deep dive it needs. so here’s what i know, in hopes that others will run further with it.

one of the most lastingly popular narratives to come out of the cultural feminist sphere1 is the idea of an ancient matriarchal culture, suppressed by later patriarchal oppressors. this currently appears in all kinds of forms: contemporary “noble savage” depictions of indigenous cultures of turtle island; historically dubious accounts of the medieval and early modern european/euro-colonial anti-“witchcraft” moral panics2; and, above all, grand presentations of the prehistory of europe and west asia, or/and of “indo-european cultures”.

that last one is not only central to a widely popularized cultural feminist “common sense”, but central to most contemporary paganisms. at its core, it holds that prehistoric goddess-worshiping societies were supplanted by patriarchal invaders (either physical or ideological) who brought with them monotheism as well as misogyny.

leaving aside the straightforward critiques of the basically laughable idea that there was a common culture across the vast geography involved in these claims – and that it would be reconstructable if there were3 – this simply doesn’t hold up to any detailed scrutiny. but that’s not what i’m interested in here; and neither is the narrative’s transparent recapitulation of the christian myth of the Fall from Eden. where i’m headed is towards the history of that narrative, the history of the fantasy itself. this is all still preamble.

frequently, but not invariably, this narrative of indo-european prehistory turns explicitly anti-jewish. take, for example, the version presented by z budapest, founder of Dianic Wicca and one of the most influential figures in the history of feminist paganism. at a 1976 Women’s Spirituality Conference in boston, she declared “the Jewish religion began as a backlash to the goddess religion”.4 another presenter at the same conference, mary daly, a post-Catholic theologian who played a similarly central role in women’s spiritual movements outside the pagan sphere, held a similar position.

if that sounds like a feminist version of the openly anti-jewish strains of “reconstruction”-oriented paganism – from slavic “native faith” groups to U.S. Odinism; often though not always aligned with neo-Nazi politics – it ought to, because that’s exactly what it is. and that’s what this piece is about.

Continue reading sex, lies, and primeval matriarchy →
criticism, revolution

half a pardes

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a critique of a book i liked a lot

i adore ruthanna emrys’ writing.

i first fell into it through her Innsmouth Legacy series (two novels and a novella so far), which reshapes h.p. lovecraft’s world in ways that i hope he would have appreciated, after his definitive late-life turn towards antifascism – and that i certainly do, for the changes she plays on the first and second red scares, on the many faces of u.s. fascism (and the pervasive xenophobia and eugenics that feed it) past and present, on the pleasures and dangers of closed communities and port cities. and her “the word of flesh and soul” made me fall even harder for the lovely and chilling things it does with the entanglement of words and bodies, sex and scholarship, archives and autonomy.

i’ve just finished emrys’ latest novel, “a half-built garden”, which is a first-contact story, a trans/queer/poly story, a climate-apocalypse story, a jewish diasporist futurist story, and even, in its subtle way, a monsterfucker story – and, according to its acknowledgements, has been (accurately) accused of being a “diaperpunk” story. it’s sweet, and tense, and very satisfyingly balanced between familiar and new. i enjoyed the hell out of reading it, and slowed down to draw out the pleasure.

i’m writing about it here because part of its power, to me, is as a very specific kind of cautionary tale – but in a way that i don’t think the novel itself sees. whether emrys does or not isn’t particularly important to me; i know very well from my own work that what i understand about and intend with a piece and what the piece understands and does have only a tenuous relationship.

Continue reading half a pardes →

ראָזעלע זושוק האַלעװי