Integrating Yin Yang Theory in Transgender Care

This article was originally published June, 2024

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“Instead of saying that all gender is this or all gender is that, let’s recognize that the word gender has scores of meanings built into it… Instead of saying that gender is any one single thing, let’s start describing it as a holistic experience.” –Kate Bornstein & S. Bear Bergman (Gender Outlaws)

Gender identity encompasses a multifaceted experience that defies rigid categorization. In the realm of traditional Chinese Medicine (TCM), the concepts of Yin and Yang similarly defy simplistic binaries, and in my view offer a nuanced perspective on gender that embraces diversity and fluidity. This article explores the application of Yin and Yang theory in transgender medicine, highlighting its significance in promoting inclusivity, respect, and empowerment. By examining adapted Yin-Yang principles and discussing the role of acupuncture and herbal remedies, this article elucidates how a holistic approach to transgender healthcare can honor the diverse experiences of transgender individuals and support their overall well-being.

Yin and Yang Theory in Transgender Medicine

The concept of Yin and Yang is commonly associated with female and male energies, leading to the misconception that this medical system is inherently binary and unsuitable for transgender healthcare. However, Yin and Yang transcends simplistic binaries and, traditionally, represents opposing yet complementary forces symbolizing balance and harmony. Masculinity (Yang) and femininity (Yin) are indeed perceived as opposites, but they exist in a constant state of transformation, with each containing elements of the other. This dynamic interplay underscores the mutual reliance and interconnectedness of masculine and feminine energies within individuals. Recognizing this fluidity is paramount in providing transgender individuals with holistic care that respects their identities and experiences. The classical and Taoist roots of Chinese Medicine embraced variations in sex, gender, and sexuality, a perspective that remains relevant in modern practice.

Adapted Principles of Yin/Femininity and Yang/Masculinity:

1. Masculinity and femininity are recognized as opposing yet complementary forces.
2. Both masculine and feminine energies coexist within all individuals.
3. Masculinity and femininity undergo continuous flux.

Through an examination of adapted principles, Yin and Yang theory provide a framework for understanding the complexity and fluidity of gender identities, emphasizing the interconnectedness of masculine and feminine energies. In the context of transgender medicine, Yin and Yang theory suggest that gender is a dynamic interplay of masculine (Yang) and feminine (Yin) energies within individuals, rather than a rigid binary. This perspective acknowledges the diverse experiences of transgender individuals and underscores the importance of embracing both masculine and feminine aspects of identity.

Furthermore, Yin and Yang theory emphasizes the need for balance and integration in transition-related care, promoting holistic well-being by addressing physical, emotional, and spiritual dimensions of patients' identities and health. Adapted principles of Yin and Yang for this work include the recognition of opposing yet complementary forces, the coexistence of masculine and feminine energies, and the continuous flux of masculinity and femininity. Ultimately, Yin and Yang theory in transgender medicine fosters inclusivity, respect, and empowerment, guiding practitioners in delivering affirming and holistic care to transgender patients.

Yin, Yang, and Hormones

In transgender healthcare, TCM adopts a holistic approach that addresses the physical, emotional, and spiritual aspects of transition. Treatment focuses on restoring balance and aligning with the patient's constitution, rather than conforming to external norms. Herbal remedies offer a gentle alternative for transitioning, complementing conventional hormone therapies while respecting the body's natural rhythms. Acupuncture plays a pivotal role in supporting transgender health, alleviating symptoms related to hormone therapy, managing pain associated with surgeries, and promoting emotional well-being throughout the transition process. By incorporating acupuncture into transgender medicine, practitioners can offer comprehensive and integrative care that supports the overall health and well-being of transgender individuals.

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.

The great thing about Chinese Medicine is that we always work from a constitutional root. In diagnosing hormone imbalances, acupuncture offers a constitutional lens, prioritizing individual constitutions over societal norms. Treatment focuses on tonifying Yin or Yang to restore balance, aligning with the patient's constitution rather than conforming to external expectations. Holistic medicine embraces the entirety of an individual's being, including their physical, emotional, mental, and spiritual aspects, which inherently supports patients' diverse identities. Holistic medicine tailors treatments to each patient's unique needs, preferences, and circumstances, and empowers patients to take an active role in their health and well-being. It encourages patients to explore and understand their own bodies, emotions, and lifestyles, fostering self-awareness, self-care, and self-advocacy regardless of their identities. By embracing a holistic approach to care, practitioners of holistic medicine support patients' diverse identities by honoring their whole selves, providing individualized and empowering care, and fostering healing and well-being in all dimensions of their lives.

Whether addressing testosterone or estrogen deficiencies, treatments aim to restore equilibrium and promote overall well-being. I see many trans men present as Yang (testosterone) deficient and many trans women 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. Think of it this way: 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.

Herbal interventions offer a versatile approach to various aspects of transitioning, encompassing the option of utilizing herbs as a standalone method, transitioning from synthetic hormones to herbal alternatives to maintain secondary sex characteristics, and employing herbs and nutrition to mitigate the side effects associated with synthetic hormone therapy. When collaborating with transgender patients who opt for herbal transition methods over prescription hormones, it is imperative to engage in comprehensive discussions regarding the gentler nature of herbal remedies, which work in harmony with the body's natural processes as opposed to synthetic hormones. As such, herbal interventions typically yield subtle rather than dramatic changes. Specific herbal formulations may induce minor physiological changes, such as slight breast growth or facial hair growth, and may mitigate 'male'-pattern balding. Additionally, some individuals may experience a heightened sense of femininity or masculinity following herbal treatment. It is essential to note that while certain herbs may lead to minor elevations in estrogen or testosterone levels, such fluctuations are typically not clinically significant.

However, it is crucial to emphasize that herbs alone are incapable of inducing drastic physiological alterations. Furthermore, for individuals who do not produce hormones endogenously, such as those who have undergone orchiectomy or oophorectomy, it is imperative to continue hormone therapy, as the absence of hormones poses significant health risks. In such cases, herbs do not serve as a safe alternative.

Chinese Medicine and Transgender Youth

Traditional Chinese Medicine (TCM) offers a supportive environment for children and adolescents to explore their gender identities and commence the transition process in a gentle and natural manner, affording parents the necessary time to adapt to these changes. Numerous studies underscore the importance of allowing transgender youth to express their identities, as it significantly diminishes their risk of suicide and enhances their long-term mental and physical well-being. However, parents often face challenges in navigating these circumstances, particularly considering the irreversible effects associated with conventional hormone therapies.

Herbal remedies within TCM can elicit a sensation of hormonal change in the body, providing relief from dysphoria for some individuals. Acupuncture and herbal treatments can contribute to enhanced comfort in one's body and identity while mitigating the overall risks and enduring effects commonly associated with traditional medical interventions. Additionally, these modalities have been observed to alleviate anxiety related to menstrual cycles, mitigate symptoms such as heavy flow, cramping, and premenstrual syndrome (PMS), and ameliorate psychological distress, ultimately contributing to improved academic engagement and attendance rates.

Furthermore, acupuncture and herbs have demonstrated efficacy in reducing physical discomfort arising from binding and gaffing practices, including compression pain, back pain, chest tightness, and skin lesions. By incorporating TCM approaches into the care of transgender youth, practitioners can provide comprehensive support that addresses both the physiological and psychological aspects of transition, fostering a more positive and empowering experience for individuals and their families.

Chinese Medicine to Support Transition

In my practice, I frequently employ a combination of herbal remedies, acupuncture, and nutritional interventions to support individuals undergoing Western medical transitions and mitigate associated side effects. Drawing from the rich history of Chinese herbal medicine and acupuncture, which spans thousands of years, I leverage these modalities to address common symptoms such as hot flashes, vaginal dryness, menstrual irregularities, and hair loss.

Furthermore, many of the treatments within traditional Chinese medicine (TCM) can be adapted to provide supportive care for transgender individuals undergoing hormone therapy and surgical procedures. Acupuncture plays a significant role in reducing discomfort related to binding, gaffing, and post-surgical recovery. Its holistic benefits extend beyond pain management to encompass scar management, emotional well-being, and overall postoperative healing. Acupuncture techniques can effectively minimize the appearance of scars, including keloid scars, enhance circulation to reduce the risk of blood clots and edema, and regulate blood pressure. Moreover, acupuncture has been shown to alleviate post-surgical numbness and neuropathy, contributing to improved functionality and sensation at surgical sites. It can help alleviate symptoms related to hormone therapy, such as hot flashes, mood swings, and fatigue, by regulating the body's energy flow and promoting hormone balance. It can support mental health and emotional well-being throughout the transition process by reducing stress, anxiety, and depression, and promoting relaxation and resilience.

Incorporating These Treatment Methods Into Your Practice

Overall, acupuncture offers a safe, gentle, and effective therapeutic modality that supports transgender health and well-being throughout all stages of transition. By addressing both the physical and emotional aspects of transition, acupuncture plays a valuable role in promoting holistic health and empowering transgender individuals on their journey towards self-discovery and self-actualization. Using acupuncture, herbal medicine, dietary therapy, and lifestyle recommendations, Chinese medicine can help transgender individuals feel more grounded, resilient, and balanced as they navigate their transition journey.

When integrating transgender healthcare into clinical practice, it is imperative to foster trauma-informed competence and establish gender-affirming environments that recognize and respect the diverse identities and experiences of transgender patients. This involves employing inclusive language, honoring chosen names and pronouns, and acknowledging the unique healthcare requirements of transgender individuals. By prioritizing the cultivation of trust, adherence to boundaries, and the implementation of culturally competent communication strategies, healthcare providers can deliver sensitive and empowering care that acknowledges the holistic nature of transgender patients' experiences. Transparency and collaboration with patients are foundational, to ensure they are fully informed and actively engaged in their healthcare journey. It is essential to articulate the procedural details to new patients, providing clarity regarding the appointment process, such as the pulse-taking procedure, the common anatomical areas involved in acupuncture, anticipated resting durations, and offering options for communicating preferences or discomfort during treatment. This approach facilitates patient understanding and autonomy, fostering a supportive and respectful healthcare environment.

As acupuncture practitioners, our commitment to holistic care extends to all individuals, including transgender patients. By embracing the principles of Yin and Yang and integrating tailored treatment approaches, we can provide compassionate and effective care that respects the diverse needs and experiences of transgender individuals. Together, let us foster inclusivity and empower our patients on their journey towards health and wellness.

References

• https://us.singingdragon.com/products/gender-and-sexuality-in-chinese-medicine
• Daoist approaches to sexual vitality from the Su Nu, interpreted by Dr. Nishanga Bliss, https://prismlearning.learnworlds.com/course?courseid=sexual-health-acupuncture