Steven Paul Novella (born July 29, 1964) is an American clinical neurologist and associate professor at Yale University School of Medicine. Novella is best known for his involvement in the skeptical movement as a host of The Skeptics' Guide to the Universe podcast and as the president of the New England Skeptical Society. He is a fellow of the Committee for Skeptical Inquiry (CSI).

Wikipedia

TLDR:

• Updating state documents and IDs
• Maintaining a supply of medication
• Changing your social security office gender marker
• Consider moving now, if you want to
• Make decisions around staying or going “stealth.”
• Relying on local community allies

What are your thoughts on getting your health records wiped? Yay/Nay?

My Therapist asked if I wanted my medical records wiped..... I was asked if I wanted my medical records scrubbed of any mention of being trans or gender dysphoria. She indicated I could ask the same from all of my doctors. It feels disgusting but some part of me says it's a good idea. I could just be a woman on Estrogen which isn't really unusual. I wanted to share with the community, this is a personal choice you should consider. permalink by Shadowfoxx757

I'm leaning more towards that they'll make it legal to "we retain the right to refuse service to", or your boss can fire you because you are trans, rather than poring through medical records to fuck people's lives up.

Notable comments in my opinion:

• Once your trans status has been wiped from medical records (I've not done so, but I'm seriously considering it), you can then tell doctors that you've had a hysterectomy, or that you happen to have a birth defect where your uterus never formed. This covers why certain things like PAP Smears don't apply to you, even though they apply to most women. ⏤ by lirannl
  • My medical record already seems to not say I'm trans, but it does have the line "congenital absent uterine cervix" ⏤ by Xunae
• Look, everyone should absolutely do what they feel is best for their safety, full stop, no questions asked. My own feeling though, is that A) I honestly don’t believe our worst fears are going to come to pass. Why? Do you remember Trump’s first term and what a chaotic mess it was, even from the GOP’s perspective? Remember when the GOP squandered their House majority on infighting? They are going to be so overeager with everyone trying to ram through their pet hate legislation and trying to kiss the ring, it will be like a traffic bottleneck when lanes close on the interstate during rush hour.B) even if our worst fears do come to pass, I have no energy left to hide who I am. I did it for 30+ years of my life, not only with this but with autism/ADHD as well, and I just will not go back. I cannot go back. The future is scary yes, but ultimately we do not know what will happen. I do know, however, what will happen if I go backwards and I am certain that place is as scary for me personally as anything they can do to me. ⏤ by Different-Yam-736

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Bird flu has been detected in a pig in the US. Why does that matter?

David MG/Shutterstock

C Raina MacIntyre, UNSW Sydney and Haley Stone, UNSW Sydney

The United States Department of Agriculture last week reported that a pig on a backyard farm in Oregon was infected with bird flu.

As the bird flu situation has evolved, we’ve heard about the A/H5N1 strain of the virus infecting a range of animals, including a variety of birds, wild animals and dairy cattle.

Fortunately, we haven’t seen any sustained spread between humans at this stage. But the detection of the virus in a pig marks a worrying development in the trajectory of this virus.

How did we get here?

The most concerning type of bird flu currently circulating is clade 2.3.4.4b of A/H5N1, a strain of influenza A.

Since 2020, A/H5N1 2.3.4.4b has spread to a vast range of birds, wild animals and farm animals that have never been infected with bird flu before.

While Europe is a hotspot for A/H5N1, attention is currently focused on the US. Dairy cattle were infected for the first time in 2024, with more than 400 herds affected across at least 14 US states.

Bird flu has enormous impacts on farming and commercial food production, because infected poultry flocks have to be culled, and infected cows can result in contaminated diary products. That said, pasteurisation should make milk safe to drink.

While farmers have suffered major losses due to H5N1 bird flu, it also has the potential to mutate to cause a human pandemic.

Birds and humans have different types of receptors in their respiratory tract that flu viruses attach to, like a lock (receptors) and key (virus). The attachment of the virus allows it to invade a cell and the body and cause illness. Avian flu viruses are adapted to birds, and spread easily among birds, but not in humans.

So far, human cases have mainly occurred in people who have been in close contact with infected farm animals or birds. In the US, most have been farm workers.

The concern is that the virus will mutate and adapt to humans. One of the key steps for this to happen would be a shift in the virus’ affinity from the bird receptors to those found in the human respiratory tract. In other words, if the virus’ “key” mutated to better fit with the human “lock”.

A recent study of a sample of A/H5N1 2.3.4.4b from an infected human had worrying findings, identifying mutations in the virus with the potential to increase transmission between human hosts.

Why are pigs a problem?

A human pandemic strain of influenza can arise in several ways. One involves close contact between humans and animals infected with their own specific flu viruses, creating opportunities for genetic mixing between avian and human viruses.

Pigs are the ideal genetic mixing vessel to generate a human pandemic influenza strain, because they have receptors in their respiratory tracts which both avian and human flu viruses can bind to.

This means pigs can be infected with a bird flu virus and a human flu virus at the same time. These viruses can exchange genetic material to mutate and become easily transmissible in humans.

The Conversation, CC BY-SA

Interestingly, in the past pigs were less susceptible to A/H5N1 viruses. However, the virus has recently mutated to infect pigs more readily.

In the recent case in Oregon, A/H5N1 was detected in a pig on a non-commercial farm after an outbreak occurred among the poultry housed on the same farm. This strain of A/H5N1 was from wild birds, not the one that is widespread in US dairy cows.

The infection of a pig is a warning. If the virus enters commercial piggeries, it would create a far greater level of risk of a pandemic, especially as the US goes into winter, when human seasonal flu starts to rise.

How can we mitigate the risk?

Surveillance is key to early detection of a possible pandemic. This includes comprehensive testing and reporting of infections in birds and animals, alongside financial compensation and support measures for farmers to encourage timely reporting.

Strengthening global influenza surveillance is crucial, as unusual spikes in pneumonia and severe respiratory illnesses could signal a human pandemic. Our EPIWATCH system looks for early warnings of such activity, which can speed up vaccine development.

If a cluster of human cases occurs, and influenza A is detected, further testing (called subtyping) is essential to ascertain whether it’s a seasonal strain, an avian strain from a spillover event, or a novel pandemic strain.

Early identification can prevent a pandemic. Any delay in identifying an emerging pandemic strain enables the virus to spread widely across international borders.

Australia’s first human case of A/H5N1 occurred in a child who acquired the infection while travelling in India, and was hospitalised with illness in March 2024. At the time, testing revealed Influenza A (which could be seasonal flu or avian flu), but subtyping to identify A/H5N1 was delayed.

This kind of delay can be costly if a human-transmissible A/H5N1 arises and is assumed to be seasonal flu because the test is positive for influenza A. Only about 5% of tests positive for influenza A are subtyped further in Australia and most countries.

In light of the current situation, there should be a low threshold for subtyping influenza A strains in humans. Rapid tests which can distinguish between seasonal and H5 influenza A are emerging, and should form part of governments’ pandemic preparedness.

A higher risk than ever before

The US Centers for Disease Control and Prevention states that the current risk posed by H5N1 to the general public remains low.

But with H5N1 now able to infect pigs, and showing worrying mutations for human adaptation, the level of risk has increased. Given the virus is so widespread in animals and birds, the statistical probability of a pandemic arising is higher than ever before.

The good news is, we are better prepared for an influenza pandemic than other pandemics, because vaccines can be made in the same way as seasonal flu vaccines. As soon as the genome of a pandemic influenza virus is known, the vaccines can be updated to match it.

Partially matched vaccines are already available, and some countries such as Finland are vaccinating high-risk farm workers.

C Raina MacIntyre, Professor of Global Biosecurity, NHMRC L3 Research Fellow, Head, Biosecurity Program, Kirby Institute, UNSW Sydney and Haley Stone, Research Associate, Biosecurity Program, Kirby Institute & CRUISE lab, Computer Science and Engineering, UNSW Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

This article is republished from The Conversation under a Creative Commons license. Read the original article.

New Apostolic Reformation evangelicals see Trump as God’s warrior in their battle to win America from satanic forces and Christianize it

President-elect Donald Trump, joined by Melania Trump and Barron Trump, on Nov. 6, 2024, in West Palm Beach, Fla. AP Photo/Alex Brandon

Art Jipson, University of Dayton

A growing movement believes President-elect Donald Trump is fighting a spiritual war against demonic forces within the United States. Trump himself stated in his acceptance speech on Nov. 6, 2024, that the reason that “God spared my life” was to “restore America to greatness.”

I have studied various religious movements that seek to shape and control American society. One of these is the New Apostolic Reformation, or NAR, whose followers believe that they are waging a spiritual battle for control of the United States. NAR is an offshoot of Protestant Christian evangelicalism.

NAR advocates claim they receive divine guidance in reconstructing modern society based on Christian spiritual beliefs. In 2015, an estimated 3 million adult Americans attended churches that were openly part of NAR. Some scholars estimate that the number of active NAR adherents may be larger, as the movement may include members of Protestant Christian churches that are not directly aligned with the NAR movement.

The beginning of the movement

NAR emerged in the late 1990s when theologian C. Peter Wagner popularized the term “New Apostolic Reformation.” Wagner argued that God was creating modern-day apostles and prophets who would lead Christianity in remaking American society.

The roots of the New Apostolic Reformation can be traced to the broader charismatic movement that sees spiritual forces as an active part of everyday life.

This view does not separate sacred experience from regular everyday life. For the much larger network of charismatic Christians and Pentecostal movements that emphasize a personal relationship with God, the world is full of the active presence of the Holy Spirit, spiritual gifts and direct divine experiences.

Core beliefs

Central to NAR is the belief that Christian religious leaders should be the main source of cultural and political authority in America.

NAR proponents argue that select leaders receive direct revelation from God, guiding the direction of churches and fighting spiritual warfare against demonic influences, which they believe corrupt the behavior of individuals and nations.

NAR advocates for a hierarchical structure in which religious leaders and their political allies hold authority in society.

They believe in “The Seven Mountains Mandate,” a way to represent Christian control of society through a strategy that Christians should infiltrate, influence and eventually control seven key areas in society – business, government, media, arts and entertainment, education, family and religion – to bring about cultural transformation.

By doing so, NAR proponents believe they can establish a pure and true form of what they believe is a society ruled by divine guidance and strict adherence to biblical ideas.

Lance Wallnau, a prominent Christian author, speaker, social media influencer and consultant associated with NAR, has promoted the idea that such engagement where NAR Christian leaders hold authority through a government tied to divine will is essential for advancing societal transformation.

Wallnau has been a vocal supporter of Trump, viewing him as a significant figure in NAR’s vision.

Spiritual warfare

Followers of the NAR believe that they must engage in spiritual warfare, which includes prayers and actions aimed at combating perceived demonic influences in society.

Evangelist Lance Wallnau speaks during a September 2022 rally for Republican gubernatorial candidate Doug Mastriano in Chambersburg, Pa. Doug Kapustin/For The Washington Post via Getty Images

This practice often involves identifying “strongholds” of evil, around cultural issues, such as gay marriage, transgender rights and LGBTQ+ activism, and working to dismantle them. An example of this is a recent series of religious-based political rallies led by NAR leaders known as “The Courage Tour” that advocated directly for Trump’s second election.

The NAR emphasizes that Christians should expect to see miraculous signs, where extraordinary events, such as Trump’s survival of an assassination attempt, are interpreted to be explained only by divine or spiritual intervention.

The movement’s adherents also believe in faith-based healing and supernatural experiences, such as prophetic utterances and speech.

Trump as divinely ordained

Many NAR leaders and followers support Trump, viewing him as a divinely appointed figure who would facilitate NAR’s goals for societal reconstruction, believing he was chosen by God to fulfill a prophetic destiny.

They position Trump as a warrior against a so-called demonically controlled – and therefore corrupted – “deep state,” aligning with NAR’s emphasis on spiritual warfare and cultural dominion as outlined in the “Seven Mountains” mandate. NAR leaders followed Trump’s understanding of a corrupt government.

The NAR led a “Million Women” worship rally on Oct. 12, 2024, to Washington, D.C., in which the organizers sought to encourage 1 million women NAR adherents to come to pray, protest and support Trump’s campaign. The event was promoted as a “last stand moment” to save the nation by helping Trump win the election as a champion against dark, satanic forces.

Several prominent politicians, legislators and members of the judiciary, such as House Speaker Mike Johnson and Supreme Court Justice Samuel Alito, have flown the NAR-based “Appeal to Heaven” flag.

For NAR evangelicals, the presidential election is interpreted through a Christian apocalyptic rhetoric. In this rhetoric one candidate is a force for good, a warrior for God – Trump – and the other is led by demonic forces such as Harris. Trump’s 2024 win is seen as a critical moment of spiritual warfare where the forces of God defeat the forces of evil.

Criticism from many Christian denominations

Despite its growing popularity, NAR faces substantial criticism. Many mainstream Christian churches argue that the movement’s teachings deviate from traditional Christian orthodoxy.

Critics highlight abuse of authority by people who claim God is directing their actions and the potential for abuse of authority by those claiming apostolic roles. The embrace of Trump raises concerns about blending evangelical faith and political ambition.

Critics argue that the NAR’s support for Trump compromised the integrity of the gospel, prioritizing political power over spiritual integrity. The events surrounding the Jan. 6, 2021, attack on the U.S. Capitol further complicated this relationship, exposing the potential dangers of conflating religious beliefs with partisan politics.

Moreover, the NAR’s emphasis on spiritual warfare and the idea of taking control over society has raised other Christian groups’ concerns about its potential to foster an “us versus them” mentality, leading to increased polarization within society.

The New Apostolic Reformation represents a significant development, blending charismatic practices with a strong emphasis on politics and cultural transformation.

However, a large majority of Americans disagree that society should be remade based on religious theology. Thus, for now, the NAR movement’s fundamental views about religion and government are starkly at odds with most Americans.

Art Jipson, Associate Professor of Sociology, University of Dayton

This article is republished from The Conversation under a Creative Commons license. Read the original article.

This article is republished from The Conversation under a Creative Commons license. Read the original article.

What Trump can do to reverse US climate policy − and what he probably can’t change

Donald Trump tours a liquefied natural gas terminal under construction in Louisiana in 2019. AP Photo/Evan Vucci

Gautam Jain, Columbia University

As the U.S. prepares for another Trump administration, one area unambiguously in the incoming president’s crosshairs is climate policy.

Although he has not released an official climate agenda, Donald Trump’s playbook from his last stint in the Oval Office and his frequent complaints about clean energy offer some clues to what’s ahead.

Exiting the Paris climate agreement

Less than six months into his first presidency, Trump in 2017 formally announced that he was withdrawing the United States from the Paris climate accord – the 2015 international agreement signed by nearly every country as a pledge to work toward keeping rising temperatures and other impacts of climate change in check.

This time, a greater but underappreciated risk is that Trump will not stop at the Paris Agreement.

In addition to exiting the Paris Agreement again, Trump could try to withdraw the United States from the United Nations Framework Convention on Climate Change. The 1992 treaty is the foundation for international climate talks. A withdrawal from that treaty would make it nearly impossible for a future administration to reenter the UNFCCC treaty because doing so would require the consent of two-thirds of the Senate.

The reverberation of such a step would be felt around the world. While the Paris Agreement is not legally binding and is based on trust and leadership, the stance taken by the world’s largest economy affects what other countries are willing to do.

It would also hand the climate leadership mantle to China.

U.S. funding to help other countries scale up clean energy and adapt to climate change rose significantly during the Biden administration. The first U.S. International Climate Finance Plan provided US$11 billion in 2024 to help emerging and developing economies. And commitments from the U.S. International Development Finance Corporation surged to almost $14 billion in the first two years of Biden’s presidency, versus $12 billion during the four years of Trump. Biden also pledged $3 billion to the United Nations’ Green Climate Fund.

Under President Trump, all these efforts will likely be scaled back again.

Targeting clean energy might not be so simple

In other areas, however, Trump may be less successful.

He has been vocal about rolling back clean energy policies. However, it may be harder for him to eliminate the Biden administration’s massive investments in clean energy, which are interwoven with much-needed investments in infrastructure and manufacturing in the Infrastructure Investment and Jobs Act and the Inflation Reduction Act.

Since both are laws that Congress passed, Trump would need majorities in both Houses to repeal them.

Even if Republicans end up with a trifecta – controlling both houses of Congress and the White House – repealing these laws will be challenging. That’s because the laws’ benefits are flowing heavily to red states. Trump’s allies in the oil and gas industry also benefit from the law’s tax credits for carbon capture, advanced biofuels and hydrogen.

However, while the Inflation Reduction Act may not be repealed, it will almost certainly be tweaked. The tax credit to consumers who buy electric vehicles is likely on the chopping block, as is the EPA regulation tightening tailpipe pollution standards, making battery-powered cars uneconomical for many.

Trump may also slow the work of the Department of Energy’s Loan Program Office, which has helped boost several clean energy industries. Again, this is not a surprise – he did it in the first term – except that the impact would be greater given that the office’s lending capacity has since skyrocketed to over $200 billion, thanks to the Inflation Reduction Act. So far, only about a quarter of the total has been doled out, so there is a rush to ramp up the pace before the new administration starts in January.

Drill, baby, drill?

Trump also talks about increasing fossil fuel production, and he almost certainly will take steps to boost the industry via deregulation and opening up more federal lands for drilling. But prospects of massively ramping up oil and gas production seem dim.

The United States is already producing more crude oil than any country ever. Oil and gas companies are buying back stocks and paying dividends to shareholders at a record pace, which they wouldn’t do if they saw better investment opportunities.

The futures curve indicates lower oil prices ahead, which could be further weighed down by slowing demand from any resulting economic weakness if Trump follows through on his threat to impose tariffs on all imports, leading to the risk of lower profitability.

Trump will likely try to roll back climate policies related to fossil fuels and emissions, which are the leading source of climate change, as he did with dozens of policies in his first administration.

That includes eliminating a new federal charge for methane emissions from certain facilities – the first attempt by the U.S. government to impose a fee or tax on greenhouse gas emissions. Methane is the primary component of natural gas and a potent greenhouse gas.

Trump has also promised to support approvals of new liquefied natural gas, or LNG, export terminals, which the Biden administration tried to pause and is still working to slow down.

The markets have a say in clean energy’s future

One clean energy source that Trump is likely to rally behind is nuclear energy.

And despite his criticism of wind and solar power, investments in renewable energy will likely continue rising because of market dynamics, especially with onshore wind and utility-scale solar projects becoming more cost effective than coal or gas.

Nevertheless, a U.S. withdrawal from the Paris Agreement and the regulatory and policy uncertainty under Trump would likely slow the pace of investments. The expected inflationary impact of his economic policies is likely to negate the benefits of lower cost of capital that were expected to flow through with central banks lowering interest rates this year. It’s an outcome that the warming planet can ill afford.

Gautam Jain, Senior Research Scholar in Financing the Energy Transition, Columbia University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Not Original Poster. But thought that you'd like to learn more about a hair removal device if laser salon visit prices are too high

My Experience as a male using the Braun Silk-Expert Pro 5 IPL device: what you won’t find in most reviews

by /u/Rantakemisti Saturday, October 19, 2024 at 6:08:50 AM GMT

I’ve been using the Braun Silk-Expert Pro 5 IPL for over two years now, and as a guy, I've noticed that most of the reviews are written by women, focusing on areas like the face, legs, or bikini line. But what about the areas men want to treat? The pubic region, penis, balls, butt, and armpits. Before I bought the device, I couldn’t find any reviews or other helpful info from men, especially about treating those areas down there. That’s why I want to share my personal experience and everything I wish someone had told me when I first started out.

This isn’t a product review going over the device’s features—you can find that anywhere. This post is about my personal journey toward hairlessness and everything I’ve learned over two and a half years of consistent IPL use, especially in those areas most reviews don’t focus on, like the pubic region, scrotum, penis, and armpits. I’ll talk about the results I’ve seen, how to approach those tricky areas, and what kind of maintenance you’ll need. Along the way, I’ve discovered a few tips, like using powder on darker skin to get better results, and I’ll show you close-up photos of my progress so you can see exactly what’s possible. I hope this helps you avoid the trial and error I went through and gives you realistic expectations based on my experience.

What this review covers:

• Results after two and a half years of use: How long it took to see results, the kind of hair reduction I experienced, and what maintenance looks like now.
• Close-up photos after two years of IPL treatment:: Detailed visual examples of treated areas, including the pubic region and armpits.
• Tips and Tricks for treating male-specific areas: Practical advice on using IPL on the pubic region, the shaft of the penis, the scrotum, and the area around the butt crack.
• Important note for using IPL on genitals: Manufacturer warnings and my personal experience after using the device in sensitive areas for over two years.
• What affects IPL effectiveness? (and why it doesn’t work for everyone): Factors such as hair density, thickness, skin tone, and device settings that influence how well IPL works for different people.
• Are the results permanent?: My thoughts on permanence, regrowth, and how individual factors may influence results.
• Final thoughts and overall value: Was it worth it? My honest conclusion after long-term use, including comparisons to professional treatments.

First off, I want to clarify that I have no connection to Braun or the beauty industry, and I didn’t receive this product for free. I bought it with my own money, and at the time, Braun had a campaign offering a money-back guarantee if the device didn’t deliver results. I’m not sure how difficult it would have been to go through that process, but it made me feel more confident about purchasing. Fortunately, I never had to think about returning it because the results were fantastic.

When I was doing my research, I noticed that many people recommended laser treatments and suggested that IPL devices like this one were scams. Despite those opinions, I chose the Braun IPL, and I’m glad I did. Professional laser treatments in Finland can cost over 450 euros per session for areas like "the bikini line", and multiple sessions are needed. Besides the cost, I wasn’t comfortable with the idea of someone else treating my intimate areas. The Braun IPL cost me around 299 euros on sale (though it’s currently priced closer to 500 euros), but it has been an excellent long-term investment, and the results have been well worth it. The exact model I bought was Braun SilkExpert IPL PRO 5 PL5237, and it came with a normal head, a precision head, a wider head, a Venus razor, and a pouch (there are many model numbers, but the difference is usually in accessories).

Now, I’ve been using the Braun Silk-Expert Pro 5 for about two and half years. I’ve treated areas like my armpits, the entire pubic region (including the typical "bikini line area"), the base and shaft of the penis, the skin near my butt, and the scrotum. These areas are now almost entirely hairless, except for a small pubic landing strip I left intentionally. The few hairs that grow back are incredibly fine and barely noticeable transparent – I can literally count them on one hand! Even though I’ve achieved great results, I still shave and use the device once a month for maintenance, treating any new fine hairs that come back in that time period.

Results and how long it took

It took about two to three months of weekly treatments before I noticed a significant reduction in hair. My armpits responded quickly, becoming hairless fairly early in the process, while the genital area—especially the pubic region and the base of the penis—took longer due to the dense, thicker and coarser hair in those areas. Additionally, the skin in the genital region is darker, which likely affected the device’s ability to operate at full power in those spots. The area near the butt crack also required more time, but the results have been excellent.

In the beginning, I used the IPL device once a week. After reaching a state of “hairlessness,” I switched to using it about once a month or whenever I noticed hair starting to regrow. The regrowth was much slower, and the few hair that came back was very fine and soft - more like baby hair. Initially, each session took about 15 minutes, but as the hair thinned out, the treatments became much shorter—often less than 5 minutes now. Larger areas, like the legs, could take up to an hour, even though Braun’s marketing suggests faster results. Consistency was key for achieving smooth skin within a few months, and now I only need occasional touch-ups to maintain those results.

In terms of discomfort, the first few treatments were a bit painful, especially due to my dark, thick hair, but the pain decreased significantly as the hair thinned. Now, during my monthly maintenance sessions, there’s no pain at all. I should also note that despite using the device on the genital area, against the manufacturer’s recommendations, I haven’t experienced any burning, irritation, or side effects in over two years of use. That said, every body, skin, and hair type is different. Especially if you have dense and thicker hair and dark skin, I recommend starting at a lower intensity and increasing it gradually as the hair reduces.

While I can’t say for sure if the results will be permanent, the reduction has been significant and long-lasting. It’s possible that the hair may never return to its original state, or if it does, it could take years and come back finer and sparser. If I continue treatments for many more years, I don’t know if I’ll eventually achieve full hairlessness. I want to be open about the fact that I can’t promise anything that I haven't experienced, but so far, I’m very happy with the results and the ease it’s brought to my routine.

Close-up photos after two years of IPL treatment

To give a clearer idea of my progress, I’ve included two close-up images taken today (22. Oct 2024), a month after my last shave and IPL treatment, which was at the end of September. These areas have been treated regularly—first every week and now just once a month for maintenance. The images show the results after two and a half years of consistent use. Remember that these are macro shots, revealing details beyond what the naked eye can see. Even I can't see those hair follicles, but they are clearly visible in a macro image.

Pubic Mound Image: This close-up photo shows the right side of my pubic mound, right next to the landing strip of hair I intentionally left. The upper right corner shows the pubic hair I kept, while the lower right direction is towards my genitals (not visible in the image), and my abdomen is towards the upper left corner. My hip is towards the lower left. In simple terms, the treated area is the lower section of the image that was previously full of hair. It gives a clear contrast between the untreated and treated areas. Remember that this is a macro shot, so you can see more detail than you would with the naked eye. In everyday life, the treated skin looks completely smooth and hair-free. It’s been about a month since I last shaved and treated this area with IPL.

This close-up photo shows the right side of the pubic mound, right next to the landing strip of hair I intentionally left. The treated area is the bottom half of the image, and the photo was taken a month after the last shaving and IPL treatment.

Armpit Image: This close-up of my armpit shows the results after two years of treatment. I’ve been a bit lazier with armpit treatments compared to the pubic area. Again, the image is zoomed in to show the details of the skin, but in reality, my armpit feels smooth and hairless to the touch. Like the pubic area, it’s been about a month since I last shaved and treated this spot with IPL. The armpit is mostly hair-free, with only a few very fine, light hairs that are barely noticeable.

Close-up of the armpit. The photo was taken about a month after last session.

These images help show how far I've come since starting IPL treatments. Even though they’re highly magnified, the areas are almost entirely smooth in real life, and the monthly treatments keep the regrowth minimal.

Tips and Tricks: How I treated male-specific areas

If you’re thinking about using IPL for the pubic region, the base and shaft of the penis, the area around the butt crack, or the scrotum, the device worked really well, but there are a few tips that can help make the process easier and more effective:

Tip 1. Stretch the skin for better contact:

For areas like the scrotum or the base and shaft of the penis, gently stretching the skin can help the device make better contact. This ensures the hair is properly targeted.

Tip 2. Use baby powder or corn starch for darker skin areas:

If you’re treating darker areas, like the skin near the scrotum or the butt crack, applying baby powder or corn starch beforehand helps lighten the skin slightly. Without this trick, I found it required a lot of adjusting and positioning to get the device to even work on the scrotum, as many parts of that area were too dark for the device to activate. The powder allows the device to operate at a higher intensity and makes the process much smoother. Make sure the area is dry before applying the IPL.

Caution: Manufacturers recommend using clean and dry skin without any products. The warning is likely about liability and ensuring the device is used safely. Excessive powder use could affect the device’s cooling fan, so take it easy with the powder and use common sense.

Tip 3. Reduce friction and control moisture with powder

Powder also helps reduce friction, making it easier to drag the IPL device, especially when using the burst fire feature. Additionally, if your skin is damp, moist, or sweaty, the device can struggle to read the skin color correctly, leading to decreased power. Applying powder keeps the skin dry and helps the device maintain its intensity, even for light-skinned users.

Tip 4. Move the testicles aside when treating the scrotum

When treating the scrotum, move the testicles aside to avoid directly zapping them. Focus on the skin around the testicles, and be patient with the process. I don't know if it's unsafe to treat testicles, but my common sense said that it won't be a good idea.

Tip 5. Flexibility helps for hard to reach areas

For difficult-to-reach areas like the butt, back of the thighs, or similar spots, positioning can make a big difference. Use a hand mirror to improve visibility and help with alignment. Elevating one leg on a stool or bathtub edge can stabilize you and improve your reach. For even more control, a low squat can offer stability and better angles. Sometimes lying on your back with knees bent or even twisting slightly can help access awkward spots. Experiment with these positions to ensure full contact and thorough coverage.

Tip 6. Choose a wider head for larger areas

If you’re considering getting this device, I highly recommend purchasing the version that comes with a wider treatment head. It covers larger areas more quickly, saving a lot of time, especially when treating regions like the lower abdomen or general pubic area.

Tip 7. Avoid missing spots with proper IPL head positioning

The flash area of the Braun Silk-Expert Pro 5 is smaller than the treatment head due to the surrounding borders and sensors. This can lead to missed spots if the device isn’t aligned correctly. To ensure complete coverage, position the flash window directly over the area you want to treat rather than relying on the width of the treatment head. Move in small, overlapping sections to prevent untreated spots, ensuring consistent results, especially in hard-to-reach areas.

Tip 8. Evening treatments for reduced redness

I found it helpful to do the treatments in the evening. This allows any potential redness or irritation to calm down overnight, so your skin looks and feels better by the morning.

Tip 9. Let the skin cool between zaps

I’ve found that treating some spots twice, like around the scrotum, helps because the darker skin there causes the device to lower its intensity automatically. However, I always give the skin time to cool down before zapping again to avoid any burning or discomfort.

Tip 10. Shave closely before IPL for better results

Always shave closely before using IPL. This allows the light energy from the IPL device to target the hair root beneath the skin effectively. Remember, don’t wax or pluck, as this removes the root and reduces the effectiveness of IPL. Also, hair in areas like the pubic region can have deeper follicles, so don’t be discouraged if it takes longer to see results in those spots. Consistency and patience are key for getting the best outcomes.

Tip 11. Start small and break it into manageable sessions

Results take time and regular use, so I recommend starting with smaller areas like your armpits or the genital area. When I first started, I tried to treat everything at once—armpits, genitals, butt, and legs—and it quickly became overwhelming. I ended up dropping leg treatments because I didn’t want to spend over an hour each week on shaving and IPL. The process became much more manageable by breaking it down into shorter sessions with smaller goals.

Tip 12. Less is more: Focus on session quality over quantity

Based on my experience, treating once a week has been effective, and I find it hard to say if more frequent sessions would yield better results. Pushing for too many treatments could lead to fatigue or frustration if progress doesn’t meet expectations. Many manufacturers recommend waiting a week or longer between treatments to align with the hair growth cycle. I prefer focusing on the quality of each session, even revisiting tricky areas, rather than increasing the number of sessions. As results improve, consider extending the intervals between treatments.

Tip 13. Treat IPL like a long-term commitment, not a quick fix

Think of IPL as a fitness journey—achieving lasting results can take months or even over a year, depending on factors like hair type, skin tone, and the area being treated. IPL isn’t a quick fix; it's a gradual process that requires patience and consistent effort. Since everyone’s experience can differ, maintaining a regular treatment schedule and realistic expectations is essential. While results can be rewarding, they may vary significantly from person to person.

Important note for using IPL on genitals

Braun advises against using the device on mucosal areas (like the labia minora, vagina, or anus) and recommends avoiding the genital region due to potential discomfort from darker skin and denser hair, which absorb more light. That said, I’ve been using it on the pubic region and scrotum for over two years without any burning, irritation, or side effects. Every body, skin type, and hair type is different, so if you decide to treat sensitive areas, proceed at your own risk with caution and common sense.

What affects IPL effectiveness? (and why it doesn’t work for everyone)

When considering an IPL device, it’s important to understand that its success isn’t just about skin tone and hair color. While the contrast between light skin and dark hair is often highlighted as a key factor, there are many other variables that can influence how effective the treatment is for each individual. From the thickness and density of hair to the depth of the follicles and even the settings on your device, several factors come into play that can impact the overall results.

1. Hair Density, Thickness, and Follicle Depth

Areas with thicker, denser hair or deeper follicles tend to require more treatments. For example, in my own experience, my armpits responded faster than areas like the pubic region or scrotum, where the hair is coarser and more stubborn. Hair thickness can slow down the process, meaning you might need more patience for regions where the hair is stronger or rooted deeper.

2. Device Power and Settings

The power level of the IPL device also makes a difference. Devices like the Braun Silk-Expert Pro 5 have different intensity levels, and if the device automatically lowers its power due to darker skin, the results might take longer to appear. I found that in certain areas, adjusting the angle of the device or using tricks like applying powder to lighten the skin helped improve contact and deliver stronger results.

3. Skin Tone and Hair Color

IPL works best for those with a clear contrast between their skin and hair—light skin and dark hair give the best results. To help explain, Braun provides a skin tone chart from 1 to 7, which you can also find in the product manual and I attached it after this paragraph. My skin tone falls between 5 and 6, with some areas, particularly down there, reaching a 7—the darkest shade where the device doesn’t work effectively. My pubic hair was the darkest shade on the chart, and it still remains so in untreated areas like the pubic mound. Other visible body hair is closer to the second-darkest shade, while I also have some white or transparent baby hair.

As I mentioned earlier, I’ve experienced difficulty using the device in areas where the skin is darker, like the scrotum. However, by adjusting the angle of the device and applying powder to lighten the skin slightly, I’ve been able to get better results. If you have darker skin in certain areas, this may be a helpful tip to consider.

Braun's skin and hair tone chart.

4. Hormonal and Biological Factors

Other factors like hormones or individual hair growth cycles can influence results. To be honest, I’m not entirely sure how hormones affect the process, but I wouldn’t be surprised if things like testosterone levels play a role in regrowth speed. I can only speak from my experience, and I’ve seen varying results even within my own body—some areas clear up quickly, while others need more attention.

5. Variability in Results by Area

Even with the same routine, I’ve noticed that different areas of my body respond differently. For example, my armpits, which I left untreated for months this year, experienced minimal regrowth. On the other hand, areas like the butt needs more consistent treatments to stay hair-free. This shows that IPL results can vary not only between individuals but also across different parts of the same body.

6. IPL Isn’t Suitable for Everyone

While IPL has been highly effective for me, it doesn’t work for everyone. If you have very light hair (blonde, grey, or red) or very dark skin, the device might not work as well or at all. Additionally, IPL doesn’t work on tattoos and can even damage tattooed skin. It’s important to check your skin and hair type against the skin and hair tone chart and be aware that results can vary significantly from person to person.

Are the results permanent?

The question of permanence is a big one when it comes to IPL, and it’s something I’ve reflected on a lot in the comments and I feel it's almost like a philosophical discussion point. What does “permanent” actually mean when it comes to hair removal? For some, it might mean never seeing any hair again after a few months of treatment. For others, it could simply mean significant reduction, where the hair grows back much more slowly, or is so fine and sparse that it’s hardly noticeable. In my experience, the reality lies somewhere in between, and what permanence means depends on each person’s expectations, body and how consistently they maintain treatments.

After two and a half years of regular IPL use, I can say that the areas I’ve treated are almost hairless. Any hair that does grow back is fine, soft, and very sparse—almost like baby hair. But to be honest, I still do monthly touch-ups. This has made me wonder: am I doing this out of necessity, or more out of habit? There’s such minimal regrowth that it’s hard to tell whether I need the treatments to maintain the results, or if I could stop completely and still stay mostly hairless.

For example, I left my armpits untreated for several months earlier this year, and there was very little regrowth during that time. The hair that did come back was fine and sparse, almost unnoticeable unless I looked closely. While I’ve recently started treating my armpits again about once a month, it’s mostly because I’ve gotten back into a routine. In contrast, areas like my scrotum and butt still seem to require more regular maintenance, and I haven’t felt comfortable stopping treatments there yet. These varying results have made me curious about stopping treatments on other areas, like my pubic mound, where the results have been excellent (see the earlier posted photo). I plan to experiment with this and will update my post as I learn more.

However, it’s important to understand that permanence can vary greatly between people. If someone expects to never see a single hair again after a few months, they might be disappointed. I can’t say for sure if all the hair would eventually grow back if I stopped treatments entirely. It’s possible that over time—months, or even years—some of the hair might return. Or maybe it wouldn’t. To be completely transparent, I don’t have enough long-term data to say what will happen if I stop treatments completely. Will my body eventually start growing hair like before, or will the results hold up permanently? I honestly don’t know, and that’s something I think about when considering how I talk about IPL.

While this has been my personal experience, I’ve seen comments and heard from others that their results can vary significantly, with some experiencing near-permanent hair removal and others needing more frequent touch-ups depending on individual factors like hair type, skin tone, and how consistently they follow the treatment schedule.

In summary, while I can’t say for certain that IPL will provide permanent, lifelong results, the reduction I’ve experienced has been significant, and the regrowth minimal. It’s possible that some hair could return over time, but it’s also possible that I might remain nearly hairless in the treated areas for the rest of my life—even if I stop treatments completely. It’s hard to predict with absolute certainty how my body will respond in the long term. For now, I’m satisfied with the ease of quick monthly touch-ups, and I plan to continue experimenting, especially by pausing treatments on my pubic mound to see how well the results hold up. I’ll share more updates as I go, but overall, I’m very happy with the results so far.

Final thoughts: Was it worth it?

In the end, I’m really happy with the results. As a guy, I no longer have to shave regularly or deal with irritation in sensitive areas. The device may have been pricey upfront, but compared to the cost of professional treatments, I feel like it paid for itself relatively quickly. When you shave, you get that smooth, dolphin-like skin for a day or two, but soon after, the hair grows back and the skin becomes prickly, almost like a hedgehog. Now, after owning the Braun for almost two years, I’m completely hairless in the treated areas. It’s enough to shave and use the device about once a month. The feeling of being hair-free and not having to deal with stubble, especially in the genital and butt regions, is truly priceless.

One of the best parts of using IPL is how easy the maintenance has become. After a few months of weekly treatments, I reached a point where I only need to treat the areas once a month. My sessions now last just a few minutes—far from the initial 15 minutes they used to take, and definitely a far cry from the constant shaving I had to do before IPL. It’s been such an easy part of my routine that I hardly even think about it anymore. The occasional fine hair that grows back is so light and soft, it’s barely noticeable and doesn’t feel uncomfortable like before.

Throughout this review, I’ve shared plenty of tips, especially for treating male-specific areas like the scrotum and penis. Especially, using powder to lighten darker areas has been a game-changer for me, especially where the skin is more sensitive. I’ve shared these tips so others can get as much value from the device as I have and avoid the trial-and-error I went through.

I don’t know if my results will be permanent, but the reduction has been significant and long-lasting in my case. It’s possible that with continued use, the remaining hair might stop growing entirely. I can’t say for sure if the hair would ever fully grow back if I stopped using the device, but based on what I’ve experienced so far, it would probably take a long time, and the regrowth would be much finer and sparser. Since I’m writing this review based on my own experiences, I want to be transparent about what I’ve observed and what I haven’t yet encountered.

If you’re a man considering IPL, I hope my experience helps. The reviews out there often focus on areas that women are more concerned about, but for men, this device works really well on the areas we care about. Don’t be discouraged by the lack of male reviews – this device has worked wonderfully for me.

Feel free to ask me any questions if you’re thinking about getting one!

permalink by Rantakemisti (↑ 304/ ↓ 0)

Comments

+1 for powder, it changed the game even for me specially if you're gonna drag the IPL it speeds up the time and lightens the area which results in higher intensity ⏤ by sushigotpussy (↑ 33/ ↓ 0)

├─ It's a great point that it reduces friction and makes it easier to use the burst fire feature simply by dragging the device.  I’ve also learned that when the skin is damp, moist, sweaty, or otherwise reflective, the device struggles to read the skin color correctly, which results in decreased power. Using powder can definitely help in this situation, even for light-skinned users who do not need to hack their skin color  ⏤ by Rantakemisti (↑ 24/ ↓ 0) ├── Using powder is a bit of genius. Thanks for the write-up. ⏤ by MyLastAdventure (↑ 11/ ↓ 0) ├─── Yes, it's definitely one of the greatest tricks. I just wish I had learned it much earlier. It would have saved a lot of time, struggle, and made the process less painful. ⏤ by Rantakemisti (↑ 3/ ↓ 0) └────

/user/Head_Juggernaut_6582/ Saturday, April 24, 2021 at 3:06:27 AM EDT

3 year update

This is my update after 3 years of medical transition and FFS. I’m mid to late 30s, and I’m a doctor.

The very personal part of this update is going to be brief, because I feel I can’t offer anything super unique there. It’s been a struggle to fit transition related tasks around family/professional life, but I somehow did it. My partner and I are still together and making plans for the near, medium, and distant future. It all feels very settled. I still have bad days, but I’m post-FFS and all my facial hair is gone so I’m just kind of being myself these days.

What I can offer you is my unique perspective as a doctor going through this process. I can also give you some of the fruits of my personal research and opinions on how to optimize a transition. So here are my thoughts, in no particular order:

Hormones

I think there is something to starting slow. I started with sublingual, 2 then 4 mg, then transitioned to EV 20mg/ml at 0.5 ml/week for a total of 10mg/week. Results with fat redistribution have been good. I had big mood swings early on, but it’s levelled out. I like the convenience of not having to let a pill dissolve under my tongue as well.

I know there is some controversy about hormone cycling in the community. I have done this by doing half an injection one week and 1.5x an injection the next, followed by two weeks of regular injection, and I did feel more breast sensitivity at points. There are no studies around cycling HRT in trans women or trans men that I can find, but the fact is, receptor downregulation happens. Almost every hormone in the human body has downregulation of its receptors as a feature. It was assumed for a long time, and has been shown to happen in mice and some human tissue. Do with this information what you will, and know if you choose to cycle hormones there is at least some science behind it and it’s not just some “trying to replicate periods” thing.

Edit: I should explain what receptor downregulation is. Your body has estrogen receptors on and in its cells -- on the surface, but more importantly on the surface of the nucleus inside the cell. This is where the estrogen you take attaches to, which then instructs the cell to make more or less of specific proteins, ultimately resulting in things like breast tissue growth, softer skin etc.

Your body strives for homeostasis in pretty much all things, which is a state of very little change. It's kind of a default setting for safety reasons. If a particular hormone gets too high in the blood, your body reduces the number of receptors expressed on and in the cells so that you don't get some kind of runaway overreaction from rising hormone levels. This is in fact how GnRH agonists work -- they blast the pituitary gland with so much of something that looks like GnRH that they become desensitized to it. So theoretically, having super high E all the time can reduce the number of receptors available to bind to, which means making less of desirable proteins etc. What is the effect of this on transition as a whole is unknown. I'd have to do some more research to find out how quickly the number of available receptors rebounds.

Breast growth

I honestly don’t believe that breast tissue growth stops at 1 or 2 years. Those who stick around the community sometimes report a growth spurt 3, 4, or 5 years in. My cis friends tell me their breasts didn’t really fill out until they were in their mid to late 20s, so give it time. Weight gain is a factor here too, which I’ll discuss later. Breasts are mostly fat.

Hips/fat redistribution.

Hips are fat. Hips are fat. Hips are fat. I can’t say that enough. The pelvic bone width difference between those who underwent puberty on T vs E is about two finger widths, on average. It’s noticeable but it’s not all the difference.

Going to get a little judgey here… I came across a site from a trans woman who had transitioned long ago and who I guess is rather famous in the community? Her advice was that you won’t get hip growth, and fat redistribution was way overblown, so just live with it. Thing is, she had less body fat as a trans woman than I have ever had living as a guy. I would have killed for that muscle definition in my gym-going days. So of course she isn’t going to get hips from fat redistribution, because there is no fat. If being that lean is your thing then go for it, but I feel like it’s kind of a classic transition mistake. Cis women are like 20-30% body fat, not 10%. I know you want your shoulders to shrink, but that takes time or possibly clavicle shortening. So you’re better off increasing your body fat to grow hips.

Here is one cis woman’s before and after from intermittent fasting:

https://i.imgur.com/0btKc0F.jpg

Starts with hips wider than shoulders, ends with shoulders much wider than hips. Of course this an extreme, but it shows my point: hips are fat. Look at any skinny model on a clothing site. No fat, no hips. Look at a very overweight cis woman. No, her hip width isn’t bone -- a human being with a pelvic width of 30” would not be capable of bipedal motion. It’s all fat. It’s kind of astonishing that this is still a debate. Hips. Are. Fat.

So why can’t some of us get hips? On to the next point.

Fat storage: hypertrophy vs hyperplasia

Hypertrophy refers to the growth of existing cells. Hyperplasia is the creation of new cells. You might have heard hypertrophy in relation to muscle growth. It’s generally thought that we have X number of cells in our muscles, and working them out increases the size of those cells. Some research indicates there may be a tiny bit of hyperplasia, but it’s overwhelmingly hypertrophy causing the growth.

So what about fat? If you have extra calories, your body stores it as fat. If you have existing fat cells, it’s much more efficient to stuff it there causing hypertrophy of those existing cells than it is to make new cells. If you run out of room in your existing cells, that’s when your body turns to hyperplasia and starts making new fat cells. If you gain weight on T it’s going to store it on your tummy, potentially making new cells there if it needs to. When you lose weight, those existing cells simply shrink, but don’t die. This is all a bit hand wavey, as there will be overlap in these processes and any number of variables that are difficult to track (does speed of fat gain influence hypertrophy vs hyperplasia etc.) How hormonal transition affects the balance between hypertrophy and hyperplasia is unknown. It may be slightly more preferential to create new fat cells on your hips even if there is room on your tummy, once you’re under E. What is this mix? 70% hypertrophy and 30% hyperplasia? More or less of one or the other? Nobody knows even with cis people, so it's a complete mystery with trans people. Point is, to gain hips you may need to exceed the existing fat storage capacity of your body to some degree in order to form new fat cells on your hips, and you need to do this with good E levels.

What was my experience with this? I did get some fat on my thighs and my butt under T, but I never stored fat on my hips under T, so I likely didn’t have that many fat cells hanging out there. I used to poke my thumb into the side of my hip just over the trochanter to see how far it would sink in. When I started HRT, it was pretty much just skin there. Now it sinks in a good inch. I took measurements throughout transition to track this as well, though not as often as I should have. I measured hip circumference as well as hip width by putting my butt against the wall and using pencils to carefully mark the maximum width point, kind of in the saddle bag area.

• Time: 152lbs Start to Now 178lbs
• Chest: 36" to 39"
• Waist: 29.5" to 32.5"
• Hip Circumference: 36" to 41.5"
• Standing Hip Width: 13.125" to 15.5"
• Waist to Hip Ratio: 0.82 to 0.78

That last standing hip width measurement is the same as my biacromial distance, that is, the distance between the lateral edge of the acromion process of the shoulder. I definitely did not have miracle bone growth in my hips, as I measured the distance between my anterior superior iliac spines (ASIS) and it did not change at all.

To get this growth, I had to fill the fat storage capacity of my butt, thighs, and some of my tummy. I would describe myself as “chubby” right now, and would like to lose some weight. But, I have no muscle definition, and my hips are pretty wide. We’ll see how much of it I retain in each area when I start losing.

So anyway, you want that waist to hip ratio of 0.75 or lower for that typically feminine look. I believe 0.7 is considered the “most attractive” WHR for women. Without more fat on your hips you’ll never approach that. You have to get it there somehow, then optimize your WHR. Once you start losing weight you should lose more from your tummy, just by virtue of hormonal distribution. If you want to take a more extreme route, CoolSculpting can apparently destroy fat cells, so that is an option you can try if you’re unhappy with distribution after gaining weight. No experience with this myself though.

Some general info on hypertrophy vs hyperplasia https://link.springer.com/article/10.1007/s00125-018-4732-x

Evidence of fat cell hyperplasia continuing into adulthood (previously this was disputed) https://www.pnas.org/content/107/42/18226

Muscle loss: you can botox any muscle in the human body

Here’s something I’ve never seen anyone else talk about: you can botox and shrink any muscle in the human body. More on this later, just trying to pique your interest.

I lost a lot of muscle early on in transition. I was never huge, but after about 8 months I tried on some old guy clothes with structure (a couple of jackets) and they were hanging off my shoulders. Muscle loss continues at a very slow pace, and I’m told it can even increase after orchiectomy/bottom surgery, even with complete suppression of T otherwise.

My biceps and triceps have remained stubborn, mostly in shape rather than overall size. I still had a big ball of bicep when I flexed my arm from hours in the gym. I thought surely there’s a better way, so I started doing some research after learning about botox treatments for jaw slimming. Why could that not be applied to other muscles in the body, I thought?

I found that botox is starting to be used for the trapezius, and in some places, for the deltoids and triceps. Google “barbie arms botox” to get an idea of what people are doing. The results aren’t super dramatic in cis women, but I think that depends on how hypertrophied the treated muscle is, and under what circumstances it got that way. Think of it like this: a masseter muscle is under a load of 1.0, just your regular load of chewing food and talking. Whatever 1.0 is for you. Once the botox wears off, the muscle rebounds slightly under this load. Similarly if you’re treating a cis woman’s arms who just wants them smaller, but has never really worked out. Think of it like if an average person broke their arm -- there’s quite a bit of atrophy after 6 weeks in a cast, but it builds back up rather quickly under normal use.

Now consider what happens if you were a bodybuilder and you broke your arm. The load on your arms is probably 2.0 or 3.0 or more of what a regular person does, with your heavy gym routine. So if you break it, it atrophies, but it’s never going to build back up to where it was unless you go back to the gym and put it under load of 2.0 or 3.0. If you gave up bodybuilding at that point and only had a load of 1.0, you’ll likely end up with a normal looking arm.

So, with that in mind, I started messaging places that do botox asking if they could do this. I found one, and started with my biceps. It was 4 injection points of 10 units in each bicep, for a total of 40 units per arm. Within a couple of days my bicep was just floppy tissue. It’s been about 3 months, and it was enormously effective in shrinking it. My best flex is just flat across the bicep. It is still regaining a little mobility but I don’t expect it will come back to where it was. I’ll update you as time passes. I’ve lost about 1” on each arm so far. As a side note, the arms are a key fat storage location for women. Your muscles might shrink but the measurement can stay the same as fat piles up on your tricep and round the whole arm. I can definitely pinch a good amount of fat there now. Here is an MRI of a healthy young man and young woman's arm compared. Size difference is there, but composition is the major difference.

Some things to know: do this with a doctor. It’s not common, and a knowledge of anatomy is required. Infiltrate too deep and you can hit some major arteries or nerves. This also isn’t cheap. Botox is $10/unit where I am. Might be less or more where you are. You might have trouble finding someone to do it. I emailed several botox places and was told it’s not something they do. Finally found one who would do it, but I had to get my hands on a copy of the bible of botox injection, available here:

https://www.amazon.ca/Pictorial-Atlas-Botulinum-Toxin-Injection/dp/1850971757

And I brought this with me to show them what to do. It’s possible that they were more willing to listen to me based on my medical knowledge so your mileage may vary.

You have to be careful about what you treat at one time. I think the safe maximum dose is 400 units in any 3 month period, so don’t go thinking you’ll just treat your whole upper body at once. Also realize that you need to be functional. Treating the biceps muscle and completely paralysing it is fine, because you have residual function by the brachialis muscle. If you were to, say, treat the long head of your tricep, your posterior deltoid, and maybe your trapezius all at once, you might find you cannot lift your arm over your head.

Also note I mentioned heads of the tricep. Many muscles have multiple heads (tricep has 3, deltoid has 3) and these can be treated individually depending on your needs.

This made a huge difference for me, dysphoria wise. And the nice thing about it is that it’s not like FFS where you have to pay it all at once. You can do just one muscle, and maybe even just one side at a time if you really want to. You can also start low on units and come back in a week if you don’t have the desired effect. Once you have a baseline of how much it took for effect on one muscle, you can use this research on the relative sizes of muscles in the upper body to ballpark the next set of injections.

Edit: I've had my deltoids done as well, 10 units in each head. I think I might need a little more for the effect so I'll be going back for a few more units in each head. After that, long head of the triceps, then lats/pecs.

Edit 2: Went back for another 10 units in each head for a total of 60 units per side. The deltoid has shrunk tremendously and my triceps are now the part that sticks out furthest from my body.

Be aware that there are risks associated with botox use.

Here’s a link to part of a book a chapter called Body Contouring with Botulinum Toxin in the book Botulinum Toxin for Asians. To give you an idea of efficacy, 75 units in the deltoid resulted in a 31.4% decrease in size on MRI in a cis woman. I would expect it to be a greater drop in a muscle with acquired (not congenital) hypertrophy, as they state here:

The effects of BoNT-A in body contouring begin to appear 2 weeks after the injection, become prominent after 1 month, and approach the maximum level after 2–3 months. After 6 months the muscle volume begins to redevelop partially and completely recover to the original state after 9–12 months. However, minimizing the use of the corresponding muscles can slow down the recovery process. Conversely, excessive use of the corresponding muscles can cause the muscle volume to recover more quickly as if undergoing rehabilitation physical therapy. If the muscle volume is large congenitally, the muscle volume recovers more easily due to homeostasis.

However, acquired form of muscle hypertrophy through exercise does not easily recover to the original state as long as exercise for the corresponding muscles is avoided.

So, don't hit the upper body weight hard and the reduction should be permanent. I suspect that after some time and in the absence of testosterone, you can even go back to upper body weights without much risk of becoming too bulky again. Honestly that is something I'd like to do, because lifting weights is so good for your overall health.

Don't expect overnight results from botox! If you google onset time, you'll find a lot of things about how fast it works for wrinkles in the face. That means that paralysis or partial paralysis has taken effect, resulting in the cosmetic improvement of skin texture, but it does not mean atrophy is happening. For larger muscles the onset time is slower. One reference I found said 1-2 weeks for muscle weakness to start, with improvement in appearance at 2-3 months. This is about what I saw with my biceps -- immediate weakening, but longer until the muscle actually shrank.

The other classic way to lose muscle is to do a caloric deficit, tonnes of cardio, and low protein. This worked for me somewhat, but didn’t change the contour of muscles the way botox did. I also had another problem with my hair because of this…

Hair

Take care of your hair. My hair story is pretty dramatic. It was quite thin on top with a badly receded hairline. I tried minoxidil for 2.5 years pre-HRT and got no response. I was also on Finasteride for over a year of that time, and dutasteride for about 5 months. After HRT I had dramatic regrowth on top, almost completely filling in. Hairline improved a little but did not move down. When I had FFS, I had a hairline advance, which helped, but I’ll still need transplants. I thought post surgery was a good time to give up on minoxidil because it didn’t appear to do anything, and I didn’t want to worry about getting around sutures. Following that, I had massive hair shedding, to the point where it was very thin on top. What happened? Some obvious possibilities:

• A scalp advance involves dissecting back on the scalp almost to the crown. This disturbs blood supply, and can cause something called anagen effluvium, which is an immediate shed of shocked hair in that area. This can be an effect of scalp surgeries and I think this happened to me.
• Separately from anagen effluvium, telogen effluvium is a shedding process that starts generally 6 weeks to 3 months after a major shock like starting some medications, surgery, or anesthesia for long periods. I had 2 of those risk factors.
• It’s possible that minoxidil magically started working after 2 years and I lost what I did because I quit minoxidil. I haven’t restarted, because honestly I hate applying it every day and it takes 2 hours to dry. If I don’t get good regrowth I’ll consider switching to oral minoxidil instead.

Ferritin and hair

One other possibility is this, connected to that low protein muscle losing diet… my post-surgery blood work revealed a ferritin of 7. What is ferritin? It’s a measure of the amount of iron that your body has in storage. Low ferritin means low iron. This can happen from losses, which is generally caused by menstruation, GI, or surgical blood loss, or it can be from reduced intake. I didn’t lose enough in surgery to account for this, so I think I screwed myself with my low protein (and very unintentionally by extension) low iron diet for many months, sometimes with a great caloric deficit. And low iron is also a trigger for telogen effluvium, and regrowth from this often only starts 6 months after coming back to good ferritin levels. What is a good level? A GP will probably tell you something like 20 to 200. Some derms will tell you 50 to stop shedding and 70 or 100 for good regrowth. I can tell you that below a ferritin of 50, there is a 50% chance that your bone marrow contains no stored iron, which is like, bad.

Iron is used for many things in the body. Generally a GP will only think about your hemoglobin, and tell you you’re fine if you’re not anemic. Anemia is a late finding of iron deficiency, and there are many other processes in the body that may be shut down/restricted when iron is low. Hair is one of those things. Iron deficiency without anemia just happens to be a thing many GPs don’t know about. Here is some good info from an internist who knows all about it.

Anyway, if you have some hair loss, iron probably isn’t your issue -- but optimizing it is part of making sure you get the most of any regrowth you’re going to experience under HRT. I think whatever else happened with anagen or telogen effluvium, the low ferritin made it worse or stunted regrowth. My ferritin is now at a good level so I’m just going to have to wait another 4-6 months for the hair to cycle and see if it grows back like it did before, or if minoxidil really did start working for me and I need to go back on that. That was long, but I think it’s worth mentioning, because I know a lot of trans women go vegan or very low protein in transition in order to maximize muscle loss. It’s possible to do that safely but few ever do. So be careful, and if you find yourself falling asleep from fatigue at 8 pm every night, maybe get that ferritin checked.

FFS

FFS is great. I had pretty much the works: hairline, brow, nose, lip lift, chin/jaw, and tracheal shave. I think I will need some revisions, but those were included in the cost. It’s made a huge difference for me. After a couple of years of HRT I was passing without makeup but I wanted it to be a no-effort foolproof thing. I think I’ve done that.

FFS is not a one day surgery. It is a 1 year long surgery. Your results early on are so different than what you end up with. Tissue has to be a bit overcorrected to account for sagging. My lip lift was unnaturally high for months, but drops over time to where it should be. A good surgeon knows this. Swelling also persists for a very long time.

So expect to hate the results. Initially I thought, "My god, I've ruined my face." And my wife later admitted to me that her first thought was, "My god, you've ruined your face." lol. So be prepared for that. It takes along time for swelling to come down.

Voice

Voice is hard. Work at it every day. Don’t go falsetto, that doesn’t work and doesn’t sound right. Pitch is important but not the main thing -- listen to some celebs with lower voices. Reducing chest resonance is key. I spent a lot of time with my hand on my chest or on the bony part of my nose, trying to discern where I was producing sound. If you can get some sessions with an SLP who works with trans women, this is useful. I pass on the phone all the time, people assume I have a husband and/or ask about my pregnancy status for things. Still thinking about voice surgery though, because I’m a low-maintenance gal and I just don’t want to have to think about it ever.

Mannerisms/walking

Something else I thought of. Your mannerisms are important. Generally women keep limbs closer to their bodies. Elbows tucked in at your sides while you're sipping coffee, things like that. The best tip I have heard for walking is don't think about swaying your hips, think about keeping your shoulders still, and the rest follows.

I would add that I think muscle loss assists in all of this. Having just treated my deltoids with botox, my arms naturally come in more. Before, it was easy to drink a cup of coffee with my elbow poking out. Now it's exhausting. Same with my biceps -- treating them made my arms more relaxed and swingy at my sides, rather than slightly flexed.

Hair removal

Laser hair removal is permanent. The only reason people think it isn't is when cis women have it done, they have increasing T later in life that activates new follicles, leading people to think it's not permanent. It's not the same follicles coming back to life, it's new ones being activated. We've probably activated every single follicle on our faces already, so once they get blasted, they're gone. I found that Diode Laser really effective, Alexandrite super effective, and that IPL was very painful and a waste of money. Research shows they're all equally effective, but it probably depends on skin type.

Electrolysis is good to clean it up but takes a lot of time. Skill really varies here. I had a local place that was nice, but slow, and relatively cheap. I found one in another city that was about 3 times the price but honestly about 6 times faster. If you're in Canada, I've had luck with Jade Electrolysis They have done my whole face in about 3 hours, and less time each time. They are good about applying the numbing cream and covering it with saran wrap, then only exposing the part they're working on. They also have the option of having a nurse inject lidocaine, but I haven't found that necessary. Also they can even do nose hair! Just something else to take care of.

Start your hair removal early. It makes a huge difference, just by itself.

Summary

That’s all I’ve got for now. If you have any questions I’ll do my best to answer them. Also I should say that I've kind of moved away from trans spaces, like a lot of trans people do later in transition. Life takes over. I thought I should pop back in because I had something unique to contribute, and I encourage you all to do the same thing when you are further along in transition.

Edit: added some details on receptor downregulation, mannerisms, FFS recovery, hair removal.

By cross post I mean I took it from a super detailed post I saw online. I am not the original OP.

Is it possible for somebody to achieve testosterone suppression through sublingual Estradiol tablets? I know that in theory you should be able to just take several tablets a day but I was wondering if anybody else had chosen this route?