Episode 62: The (Trans) Body in Space

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An image of the planet Jupiter in alternating blue and pink colors against a black backdrop.

Image: “Jupiter in Ultraviolet from Hubble” (Source: NASA)

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Transcript

This transcript has not been edited for accuracy or clarity; it will be updated shortly.

Charles 0:22
Hello, and welcome to assigned scientist at bachelors. I’m Charles and I’m an anthropologist, and I’m passing on I’m an astrobiologist. And today it’s just the two of us for the inaugural episode. And today, it’s just the two of us for the first of what we have deemed trans medicine March, the one month of the year where this podcast which is not normally about being trans, it’s just with trans people, is actually about being trans and specifically about the medical aspects, the history and science of medical transition. And today, I thought that we could start the month off on a lighthearted foot light, both in heartedness and because of microgravity.

Tessa 1:09
That’s right, we’re talking about trans people in space, we’re talking about trans people

Charles 1:13
in space. And specifically, what would it be like to be a trans person and specifically somebody who has medically transitioned. So to begin with, I thought that we could kind of talk about what we know about the effect of being in space and of spaceflight, on the human body. And I think, as a, as a just a note to kind of start off with is that we actually, there’s a lot, there’s a lot that we know, but a lot of what we know is also relatively difficult to generalize, right, small sample sizes. Yeah, the sample size of everyone who has ever been in space is smaller than, let’s say, most sample sizes in well regarded medical studies. I think a couple 100 people total have ever been in space, especially for any prolonged period of time.

Charles 2:29
One paper that I found, put it that space travel, that we’ve kind of identified five key threats to quote long duration space travel, which is distance from Earth isolation and confinement, hostile slash closed environments, gravity, or lack thereof, and radiation. And I think in particular, the great majority of information that we have about the effect of space on the human body at this point, has come from relatively long term stays that people have had, particularly on the International Space Station.

Tessa 3:03
It’s usually like, if you’re up there, you’re up there for six months or longer.

Charles 3:07
Yeah, although not longer than about a year, I think.

Tessa 3:12
Yeah, it’s been rare for I think the Russians had someone who was up there for like two years, a few times back when mirror was still around. But yeah, longer than two years very rare, in large

Charles 3:22
part, because of the health effects that have been well documented on people coming back from space, there are kind of two aspects of thinking about the effects of space on the human body, in terms of prospects for future space exploration. What is it the International Space Station is actually not all that far out there? I think one article I found, said that it would take about three and a half hours, if they had to emergency send somebody back to Earth, it would take about three and a half hours to do that. So it is in relatively low orbit. And it is relatively close to Earth, meaning that some of the problems associated with longer term space travel are not as relevant to people who are in the International Space Station, versus if somebody were going on a trip to Mars, right? A lot of what we know about being in space is also we don’t have empirical data on anybody who has been in space for three years at a stretch. So in terms of what that would actually be like, in very many cases, we just literally don’t know we have an idea. And we can speculate, but we don’t know versus what happens if you’re in relatively low orbit around Earth for six months. We do have a lot of data about that, relatively speaking. But in another way, we have very little data because very few people have been in space. There are kind of as far as I can tell. There are kind of two aspects of how space is different from being on earth that are the primary driving forces behind a large amount of The different physiological changes that we see and people who are in space and those being microgravity or zero gravity and ionizing radiation, does it? Can you explain to the people what we mean when we say microgravity?

Tessa 5:17
So microgravity is effectively weightlessness, it’s sometimes referred to as zero gravity, though, if you want to get technical about it, that’s not entirely accurate, because you would still feel the pull of Earth’s gravity in orbit. The reason you don’t is because when you’re in orbit, you’re effectively falling. And since the environment around you is falling at the same rate, it doesn’t feel like there’s gravity. But I mean, you do if if your orbital velocity all of a sudden stopped, you would very much feel Earth’s gravity. And eventually, if you do get outside of the Earth’s gravitational sphere of influence, you do get something closer to actual microgravity where you’re not being pulled anywhere strongly by a gravitational field. You as far as your body is concerned, you are in an environment that has no gravity pulling you down.

Charles 6:05
So And why can you tell us why microgravity does such weird stuff to the human body?

Tessa 6:14
Well, it’s because our bodies have evolved in the presence of gravity for pretty much our entire existence. And a lot of our physiological systems as a result are dependent on gravity, the impact of our weight against the ground as we walk is one of the things that signals for our bones to strengthen up, our hearts have evolved to pump blood against the force of gravity. And in in its absence, it doesn’t really know what to do. And so you know, same thing like well, pretty much any fluid in our body is being routed around our body with the assumption that we are under the influence of gravity. And so weird things happen when gravity is not there to keep it going where it’s supposed to. So for example, people talk about like having a lot of fluid buildup in their sinuses or sometimes even in their eyes, not because there’s anything wrong with their sinuses of their eyes, but just be this gravity isn’t there to pull it down and into places where it should be

Charles 7:12
the quote, puffy face, bird leg phenomenon, where blood and other bodily fluids move to the upper body, swelling heads and quote, shrinking legs. And I was gonna make a great joke. I thought about this earlier. And by grade, I mean, yeah, it’s fine about women being overall better suited to astronaut life in terms of bird leg phenomenon, because they’re less likely to skip leg day. Thank you for laughing, because it’s not that good of a joke that Yes. So the the problems that we typically sort of associate maybe the most with the effects of microgravity are in bone density loss, and muscle atrophy. Right? Where it is well established that oftentimes astronauts have come down over time, with less bone, yeah, than they had going up. And actually, interestingly, because of that bone, D mineralization, like literally the loss of minerals from bones, kidney stones, increase in incidence,

Tessa 8:25
not surprising, all that calcium is gotta go somewhere. Yeah, they’re getting filtered out, and then they’re

Charles 8:29
becoming kidney stones. And then looking into it, it’s, if we know very little, if we have a very small sample size for the effects of space on the human body, we have an even smaller sample size for understanding overall sex differences and the effect of space on human bodies. Because I think one article which may or may not be the absolute most recent statistics on this, at least one article I saw said that only 11% of the people who have been in space have been women. And of course, as far as we all know, everybody who has been in space has been sis Yeah, I was thinking about this. I was thinking about this in the context of being trans. I mean, one thing that bunch of fear mongers love to bring up is the effect of puberty blockers on bone density when I mean, we did our blockers episode last year, which I will link in the show notes, but like, the evidence that we have over time is that while there is a temporary decrease in bone density on puberty blockers, almost universally people who then go on to have, quote, unquote, typical levels of estrogen or testosterone afterwards in basically getting back to like a normal level. So it’s a very temporary issue. So I was thinking about it. And I was thinking about whether there are observed sex differences in bone density of loss between men and women who have been in space there have been actually yes, and then also how that would interact with potentially being on a course of exogenous hormones and And the bad news is that nobody has made bad news. We don’t have data on it. Good news, no one has been Coercively Assigned HRT that they didn’t want. But we don’t you know, we don’t have we haven’t had any astronauts go up into space, and then start taking HRT that is out of step with what, you know, they’re naturally producing Yeah, but it wouldn’t thinking about bone problems and bone density loss, etc, etc, etc. We do know that that is one of those places where there is a marked difference in bone size, bone density, and the incidence of osteoporosis between sis men and sis women overall, where estrogen is known as a key regulator of bone health and estrogen deficiency plays a role in the rapid decline in bone mineral density, leading to osteoporosis in sis women alike. We’ve all seen those Sally Fields, commercials, from like 15 years ago, I think she was talking about a medication to prevent osteoporosis. And I hope Sally Fields bones are strong and hearty until the day that she dies. But in thinking about that, that we do know that is a point where a difference in sort of hormonal profiles can cause a marked difference in observed bone characteristics. And it is something where we know that spaceflight basically universally results in the loss of bone density, regardless of who you are. And I’m interested it has you interjected, just briefly to say that there have been noticed differences. Yeah, in bone density

Tessa 11:47
loss. Yeah, generally, it’s not huge, but and again, small sample size, but there does seem to be some evidence that men generally have had a somewhat increase. I’m actually looking at the paper right now, to see what the specific amount is. Okay, yeah, specifically, men tend to have more bone loss specifically in the areas they were looking at cortical and trabecular bone loss in the hip and spine. And the suspicion for this is based off the fact that estrogen promotes bone formation, essentially, and that men having less estrogen in their system potentially were more vulnerable to bone loss due to microgravity.

Charles 12:32
And the good news is that it seems like the more modern exercise regimen that astronauts specifically have to do, has it demonstrably been very effective in lessening Yes, amount of bone loss.

Tessa 12:49
And the other thing that has helped has been, unsurprisingly, a lot of drugs that are used for osteoporosis have also shown a lot of

Charles 12:56
them make sense. Yeah, one paper I read specifically said, Thus, the current exercise protocols literally bringing crew members home in better general physical shape than when they launched. And I think that that might be an overstatement, because they were just in space. But yeah, the idea being that the exercise regimen that they are on is, in fact, very effective, which also it because it’s interesting, and the point that I was kind of trying to make with puberty blockers and I’ll, it seems like and I’m, listen, I’m just a humble entomologist, it’s my best friend who’s in medical school, but it seems like loss of bone density, demineralization, etc, are problems that can occur in response to a variety of situations, say puberty blockers or being in space for six months. But we also have very real ways of counteracting that, and of encouraging re mineralization because we see the loss of bone density in astronauts who are up in space. But once they’re back on Earth, and exercising and experiencing Earth, typical gravity again, they then kind of regained the density that they have lost. And also interestingly, and in the context of trans people, I don’t do a lot of very specific exhaustive research, but based on the overall trends that we’ve seen in the research that is available, it seems like trans men who go on testosterone, but notably pre refract to me so without the loss, the attendant loss of ovaries overall don’t seem to like the loss of estrogen is sort of the predominant, quote unquote sex hormone in their system does not actually lead to their bones becoming shriveled and dried up and weak. It seems like they, they pretty much stay in the same place and trans women who go on estrogen. There’s kind of more data and therefore more confusion in the overall conclusions. But it seems like y’all are also doing pretty okay. Good to hear. So it seems like bone D mineralization is a problem. But it’s a problem that we have known about for a long time, and that we actually do have fairly effective methods to counteract and which seems to be overall temporary, and not something that is going to cause long term health problems. I mean, it’s it’s difficult to say that definitively because not a lot of people have gone into space, and then had time afterwards to become old people. Does that make sense? Like most of Yeah, we don’t? Yeah, yeah. Most of the people who have overall been in space are still not particularly old. So knowing how that experience would, for instance, impact, bone weakening, and senescence is still kind of up in the air, because we just have very few examples of people who have done that, ever. So the other thing that microgravity seems to have an immediate obvious effect on is muscle atrophy. And that largely seems to have a pretty straightforward explanation of like, without normal Earth gravity, it is easier to move things. Yep, including your own body. And as a result, you don’t need those muscles. Get out of here.

Tessa 16:39
I mean, it’s everything if you just spend all your time on your couch.

Charles 16:41
But yeah, so that’s kind of microgravity. That’s kind of the issues of microgravity. And I think there’s potentially, other than my very good joke about not skipping leg day, it seems like the effect of being trans on that aspect of it would be overall fairly minor. We’ve all got bones and our bones are largely the same stuff in there. But something where being trans might be more relevant, potentially, is in the effect of radiation. And our radiation. Ionizing radiation is bad for everybody. Actually tests I would love it if you could tell us why ionizing radiation is

Tessa 17:27
basically ionizing radiation, high energy particles, especially like chunks of atomic nuclei that are floating out around in space, they may have been attracted by the sun or by distant stellar explosions, any number of sources really, and they are bad because they fly in with such velocity that if they hit an object like st you, it can damage the machinery of your cells, and specifically your DNA, which is why being around ionizing radiation raises your cancer risk. And it just not great in general, I know astronauts, especially those who did the Apollo missions, like have a slightly higher rate of cataracts for the same reason.

Charles 18:07
We’ll see that didn’t come up to me and I thought you were gonna go one way and then you pivoted and now I’m fascinated on this cataracts topic, but it’s not. So ionizing radiation is kind of bad news bears for everybody. Regardless of what specific organs you’ve got in your body, it’s kind of all bad. But one point that was brought up in a variety of articles that I read was speculation on the effect of ionizing radiation on particularly reproductive anatomy, and especially, gonads are apparently particularly sensitive to ionizing radiation,

Tessa 18:45
which is surprising because you’ve got a lot of like, gametes in there.

Charles 18:49
I mean, I guess the I think that I mean, that feels like an explanation for severity of effect, and like, why it is a problem that they would be particularly sensitive, but not necessarily why, like why a gonad versus an organ immediately next to it. Oh, yeah, that’s true. You know what I mean? And I didn’t see an explanation for that in particular, but and not quite the same thing as gonads but there is a slightly elevated rate of the incidence of prostate cancer in men who have been in space although I did find one study you know, looking at incidences, apparently an increase in incidence, but not necessarily an increase in severity. And as when I brought up the topic of this episode to you as a potential topic for trans medicine merge one of the reasons that you brought up why you would be a great choice to go up into space is the absence of gonads

Tessa 19:43
Yep. Yeah, I’ve thought about that. So you know, don’t have to worry about like scrambling any future children because all my gametes are going to be safely stowed back on Earth and cryobank and Spokane Washington, are they actually they are actually yeah. Northwest cryobank.

Charles 20:00
A shout out. Yeah.

Tessa 20:03
So that is one reason. The other reason I would say I would be a particularly good candidate is going back to bone density loss. Well, that’s not a huge issue, it is still something they worry about for like, say missions to Mars where you might be in microgravity for a really long time. And then you get down to Mars. And you just, you know, if you get if you return to Earth, like if you have problems with your bones, you can just go to a hospital or just take it easy for a couple days on Mars, there’s no hospital, you are the hospital. And there is some studies, however, that show that the presence of estrogen, as we alluded to earlier may make you less likely to lose bone density due to weightlessness, to the point that there have been suggestions of like giving people HRT, especially women. Problem with that, though, is for sis women, that can raise your risk of cancer, specifically, estrogen without progesterone and raises your risk of uterine and ovarian cancer, I believe where and the progesterone then turns around and raises your risk of breast cancer. And also your lifetime exposure to estrogen can also raise your risk of breast cancer. So ideally, what you’d want to send if you’re going to use this treatment is someone who doesn’t have a uterus or ovaries, and, you know, maybe has had had breasts for a shorter period of time than the average cyst woman, if you want to minimize your cancer risk. The other thing there is unfortunately very much in the literature about this is that periodically, NASA will kind of freak out because they realize if they’re sending people like into space for like three or four years at a time, like you would for a Mars mission. If it’s a mixed gender crew, they might like start getting frisky with each other, which could then lead

Charles 21:48
Well, I’d listen to the people who listen to this podcast are probably the exact kind of nerds who would be like Well, wait a moment, MCs gender Cruz does not necessarily increase the risk of friskiness. But it does increase the risk of pregnancy resulting from it

Tessa 22:04
also true, which is not something NASA really wants to experiment with just yet. And they you know, they’ve talked about sending you know, all female crews, which got, you know, periodically circulates on the internet as a meme because, you know, they apparently forgot lesbians exist, or, you know, talking about pharmaceutically, giving astronauts medication that will deliberately lower their sex drives. I imagine a lot of people, men especially but a lot of people in general might be skittish about taking medication that lowers their sex drive, but not trans women.

Charles 22:40
I mean, this is not my experience. But I will say that periodically, I will see trans women, usually on Twitter, talking about the idea that going on estrogen like going on HRT lowers libido, and a lot of God bless them. Horny trans women are like, that was not my experience. Yeah,

Tessa 23:01
it’s not universal by any means. But it can, you know, it is still something that they warn us about. So like it is something we are aware of going in

Charles 23:11
that Yeah. And I will say if you have a random human individual, and you’re trying to turn the horny knob up or down, and you’re only two tools available, or giving them exogenous estrogen or exogenous testosterone, if you wanted to tip that to the down position, nine times out of 10, giving them exogenous testosterone is not going to be the most effective way of doing that is maybe a more exhaustively pedantically scientific way of putting it. And if we aren’t here to be exhaustively pedantic, what’s the point of this podcast? But yeah, so what better person to not have to worry about their gonads than somebody who just literally doesn’t have them? Yeah, exactly. I mean, I will say, bottom surgery is overall, a minority of trans people, even trans people who medically transition undergo any form of, I would say a loose minority if we’re having a very broad idea of what bottom surgery includes, which I’m willing to do in not just specifically genital reconstruction, but gender affirming activities, hysterectomy, or oophorectomy, orky ectomy, as well as various forms of general reconstruction. So ionizing radiation is bad overall. But it also is particularly talked about in the context of reproductive organs and the reproductive system in terms of how gonads are highly sensitive to radiation exposure as well as an increased rate of prostate cancer and potentially other forms of cancer. Answer, although, again, our sample size is so low that it is is hard to make any overall conclusions because of like, this is a made up number if five women go to space, and then two of them have a specific medical outcome. Does does that actually tell us that going into space? Was the contributing factor there? Or what getting into kind of more speculative area as you’ve already brought up Tesla, NASA claims that nobody has had sex and space? Allegedly? Yes. Allegedly. Now, there have been a variety of CO Ed, space submissions at this point. And also, listen, you don’t need a man and a woman to have salsa true.

Tessa 25:47
And I would note specifically that there has been at least one couple that had their honeymoon in space, because they got married and secret and didn’t tell NASA until it was too late for them to change the mission roster.

Charles 26:00
Yeah. Was it it was a year before they went into space, which to me, sometimes people are getting very loose, people are getting very loose and free with the definition of a honeymoon. I’ll tell you what, it because if it’s a year later, is it a honeymoon? Or is it just a trip that you’ve taken? Yeah,

Tessa 26:15
yeah, I got that. Although I don’t know, I feel like if you’re going into space, you might be able to petition for a special exception. But yes, I’m with you permanently.

Charles 26:24
The prospect of sex and space opens up a couple of different variably serious cans of worms, from my perspective. And now I’m not working at NASA. So full, full statement. But more and less serious problems with people as you put it getting frisky up in space. One is the interpersonal aspect, which is if it’s awkward to know that two of your roommates are having sex on Earth, where you can go to the park. Imagine how terrible if you were literally all in one small space, can’t go on a walk, because then you’ll get exposed to truly dangerous levels of ionizing radiation. Right. Right. Right, and only stay outside the spacecraft for a very short period of time. Plus, if your life support options fail, you’re dying in the vacuum of space. Yeah. And who wants that to happen? All because you felt awkward about hearing your roommates? Bone. Right, exactly. So that’s one problem. And then maybe most seriously, is the prospect of somebody becoming pregnant. If space is bad, for fully developed, healthy adult bodies, it cannot possibly be good for a developing embryo, and pregnancy. And this always absolutely blows my mind whenever I have to actually think about it. The gestational period for humans is arguably uncomfortably long, but in the course of a lifetime, happens pretty quickly. A relatively average astronaut could get their partner pregnant on Earth, go to space, come back home, you now have a baby. And people don’t stay in space that long. And so it’s kind of an ethical quandary, right of like, if you are pregnant in space, it is arguably morally wrong to not end up terminating that pregnancy because of the completely unknown effects of being in space on the development of that embryo, like the likelihood that that embryo would end up non viable is, and this is largely me speculating. But like, it cannot be a low probability of non vital Yeah,

Tessa 28:49
right? We simply don’t know. But like, given how delicate domestication can be on for humans on Earth, who even knows for space?

Charles 28:57
And so it’s, it is just an intrinsic risk of like, if you are going to have people who can impregnate and then also people who can become impregnated? I, you know, I don’t I don’t think it serves anybody to over exaggerate the risk, because we’ve had those people on space missions together for decades now, and nobody has ended up having a non viable space baby. So clearly, you know, adults who can go through the rigor of becoming astronauts and getting sent into space can apparently control themselves adequately, particularly because we do have data on sis women who have gone into space and then come back and then successfully had children. So we know that there are people who can have children, right, right, right, who have been in space, and they didn’t have any, they didn’t have any children’s base. So that’s another problem. And contrary to many transphobic talking points, medically, transitioning does not produce sterility, necessary. really where many, many people who go on HRT either literally there we have many examples of people who go on HRT, and then go off HRT and then either become pregnant, or help somebody else get pregnant, and then become biological parents. Yeah. Including many, many, many trans men and other trans masculine people who go on testosterone go off testosterone get pregnant, give birth to a baby, go back on testosterone. I, I don’t know for a fact that there are individuals who have gone on to the saucer and gone off drugs, testosterone, had a baby gone on testosterone got off testosterone had another baby. I don’t, I’m sure that there is at least somebody, but I don’t have that data point. Right. But that’s just saying, let’s say that surgically enforced sterility is I would imagine higher proportionally among trans people who medically transition than the general population. And in particular, as we discussed in the sampler platter episode that began 2023. You have a 100% success rate, right? visa vie contraception. Exactly.

Tessa 31:10
No longer having gonads means i It is not physically possible for me to impregnate someone else.

Charles 31:15
Exactly. Plus noticeably lacking an organ that could do the job true.

Tessa 31:22
I mean, it wouldn’t be impossible, it would just be way more difficult.

Charles 31:25
Well, I mean, the thing about it is, if you’re if you’re getting genital reconstruction surgery towards valvuloplasty, vaginal plasti, there is kind of necessarily also the removal of testicles, because otherwise they would I mean, get in the way. Yeah, exactly. Because the thing is, for people who are going through transmasculine bottom surgery, there is a wide range of people who don’t get either ovary removed, who get one ovary removed, or who get both ovaries removed. Because it’s, you know, it’s fully internal. So it doesn’t affect the appearance at all. So just right now, I’m trying to think through the possibility of getting like trans femme bottom surgery, but maintaining the test.

Tessa 32:10
I feel like I heard like there’s been one case where that happened, but I don’t know any specifics. Like I well, I don’t know how it work.

Charles 32:19
I know that I saw one person who got non virgin vaginal plasti. And then just didn’t get anything removed. But if you were specifically were using, like penile inversion, if there would be a way to keep the testicles in such a way that you could then still inject sperm. I mean, I guess it’s possible. I don’t really know how urethroplasty happens in vaginal plasti.

Tessa 32:47
Um, they mostly just remove the penile urethra and use it as lining for the new vagina.

Charles 32:53
Right. But is there a repositioning of the urethral opening?

Tessa 32:57
Um, I would imagine, but not like, massively. So

Charles 33:02
yeah, because it is, it is sort of more anterior, because that’s part of what happens in urethral, lengthening in phalloplasty, and Matoi. Do plasti is that often the urethral opening is not anterior enough. Anyway, basically, what we’re saying is NASA sin, Tessa up into space, because her bones are good, as far as we know. Yeah. And she, she wants to give like day, because she’s, you know, gotta get the glutes, ya know, it’s better to hit on women. And she doesn’t have any gonads.

Tessa 33:35
So, you know, so I

Charles 33:36
think they can’t get affected. Yeah. Because what good is the other idea is the idea of ionizing radiation, even if it doesn’t necessarily have an acute effect on you, the individual, like, you go up into space, and you come back down and you like, don’t get testicular cancer, you don’t get prostate cancer, et cetera. But the possibility, as you talked about, of radiation changing, of being a mutagenic factor, right, of causing mutations in DNA, and then those mutations being heritable, where, potentially, your time and space doesn’t like acutely affect, like your experience of your own body, but it might cause changes in your gametes and in your DNA, that thing get inherited by your children and then might have effects on them. But as as noted, if that couldn’t, that’s not going to happen to your sperms because they’re in Washington, yep. And not on your person. I figured that we could also end by thinking about practical issues that might be particular to being a trans person who has medically transitioned and then being put into space. The first thing that kind of two major things come to my mind, and we can kind of see if you if they have other problems that are maybe particular to the train sexual experience. We’re number one is, I mean, good news, you have exogenous hormones, which then means that you can regulate your hormone levels in a way that says people often do not, or cannot, without risking them causing problems. But on the other hand, you are reliant on exogenous hormones, which is less of a problem if you are on the International Space Station, which is in relatively low orbit around the Earth. But on a long haul mission, there is the problem of both limited space for materials because, you know, it’s not going to be a millionaire’s Yeah, yeah. And of experience, probably. And then also just like expiration dates,

Tessa 35:47
right. And I mean, that’s going to be an issue for like, any medication in general, some obviously have longer, like half lives than others. So it’s less of an issue, but still the burning issue. And in fact, like, not just hormones, so fun fact, I actually applied late last year to be on one of those, like, astronaut analog missions, where like, they put you in a small building that’s supposed to be your spaceship in the middle of nowhere, and you just live in it for like, 90 days or whatever, right?

Charles 36:13
Like being in space without going to space. Not only did they not

Tessa 36:17
choose me, I never heard back from them. And I think the major reason is, is that one of the questions they asked was, do you have ADHD? And if so, are you on a stimulant medication for it. And as it happens, I am and I think the reason they did that was because by law, you can only get a 30 day prescription for ADHD meds that are stimulants at one time, which would kind of you know, it would kind of like break the simulation for you to go out of your spaceship, walk down to Walgreens and get your next months of supply. And obviously, I’m assuming NASA could probably work their way around it if you’re actually going into space, but it’s still going to be an issue, something that they’re gonna have to account for is if anyone’s on like a maintenance medication like that.

Charles 36:57
So maintenance medication and the particular aspects of HRT, which are not necessarily all that different from other forms of medication, although most people who are on exogenous testosterone are on injectable testosterone and needles add a whole additional level of complexity to the administration. I thought about that the amount Yeah, of medication, in potentially more serious things. The other thing that came to my mind is, given how trans bodies and specifically bodies that have undergone some form of medical transition are often regarded as kind of medical curiosities. And a lot of what we know about things that exhibit a sex difference in symptoms or an incidence are almost exclusively based on sis men versus sis women. And we don’t really have a good answer for like, if this looks different in men versus women, what does it actually look like? And a trans man who’s been on testosterone for 20 years, right? Like, we don’t have answers to a lot of those questions. And then in thinking about being in space, you have to have a real like an extreme medical emergency to justify going back down to earth, right. And so thinking about the reality of being in a space, where you are reliant on your crewmates to administer any medical care, the complexity and awkwardness and potential harm that could come from being somebody whose body fundamentally exists in kind of a medical gray zone, in terms of what we actually know, about people’s bodies, has this ever occurred to you?

Tessa 38:44
No, but you know, it does sound like a concern is that you would not have much literature or previous medical knowledge to rely on necessarily,

Charles 38:51
yeah, I was just thinking about, I am somebody who likes to plan for the worst, which is why I will never be in space, because it’s only the worst up there. But in thinking about this, thinking about I was like, what, what do they do if there’s like a medical problem on board? And the reality is that you have to, like you can call back down to earth to be like, is this a problem that I need to be worried about? But then in terms of anybody administering anything? It’s just the other people on board?

Tessa 39:18
Yeah, you have to hope they know, you know, that they, you have to hope they know what they’re doing. You

Charles 39:23
have to hope that they know what they’re doing. And the thing is, I think even with people who are very well informed, and like not even like I’m not even thinking about like transphobic people who would deliberately mess up your medical care, because that’s a darker space that I want to get into. But even just thinking about, like, you know, we talked about last year, and we’ve talked about various times of like, you going to a gynecologist, but a lot of people with even robust gynecological knowledge would potentially think, well, it’s I don’t know if what I know about this stuff is actually relevant to you You as the patient because we just don’t have a lot of information. We just don’t have a lot of information. Right? So that’s another anxiety, the lock in your brain bank. But of the two of us, I think I have more anxiety disorders, which is probably part of why you’re the one who was interested in going to space. And I’m interested in not even being on a boat on the open seas.

Charles 40:28
Hopefully this was an interesting episode. I think the other episodes that we’re going to do for trans medicine March are going to be more specifically empirically based. But I think it’s I think it’s an interesting topic to explore. And particularly if nothing else, again, we’re reaching out to NASA put tests in space don’t put me in space. I won’t go but test is Yeah, I’m good to go. Well, just if if the people want to find you Where should they want theoretically

Tessa 40:58
on Twitter at spacer mace SP ACR NSC? I don’t know if I’d recommend going on

Charles 41:04
Twitter, particularly though a finally went down the other day. Yeah,

Tessa 41:07
I keep on hoping they’ll stay down. But no such luck yet. And also, like Tessa fisher.com.

Charles 41:14
The podcast is as yet still on Twitter at ASAP pod, or at our website where we post show notes and transcripts for every episode ASAP. podcast.com. On our podcasts, or in the show notes, you can also find a link to a Google forum. If you are a trans and or non binary person in science, and you would like to come on and be a guest on the show. You can fill out that form. Or you can contact us at ASAP pod@gmail.com I will say I don’t check the email very often. So if it takes me a little while to respond to you, it is not disinterest. It is probably just anxiety, or forgetfulness. But thank you to Nicole Petrovich for our intro music friend of the pod and former guest and if you liked the podcast, please tell people about it. If you think they would like it also, word of mouth is the number one way that podcasts grow. And until

Tessa 42:07
next time, keep on science and

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