Transvox - Chloe from Sapphic Bison talks Blood

[00:00:07] Hello and welcome back to Transvox on a wet and windy, horrible, nasty January day. But my life is being uplifted by the sight of Chloe sitting in front of me. Chloe, not Jenny today, but Chloe from Sapphic Bison who's joining us to talk all things blood, to talk all things interesting and particularly around blood testing and all sorts of amazing stuff. So first of all, hi Chloe, how are you? I am fantastic.

[00:00:36] Wow, that's what I like to hear. And where in the world are you? I am in London right now, missing out the worst of the storm, which is pretty chill, but it's also just bleh. Yeah, it's a proper yucky day. This will go out probably in February, but we'll be able to think back in February. People will think back to the storm of January and what an odd event it was. And it was for the people that suffered, but we got away quite well with it, so that's not so bad. Look, tell us a bit about yourself, Chloe, and what it is that you do.

[00:01:04] So I wear a couple of hats. The one that's more relevant to this one is I'm a founder and one of the main people at Sapphic Bison, which is a blood testing nonprofit in the UK. In my other work that actually pays me, I do a bunch of things. I do a tiny bit of teaching. I do a cheeky bit of engineering. And then I also work in reproductive healthcare.

[00:01:31] Ooh, tell me a bit more about that. Reproductive healthcare. What do you mean by that? What does that involve? Oh, in two words, making babies, but it's typically like a lot more than that. So I work at a IBF clinic that does, yeah, a lot of baby making. Overall, it's a really interesting place to be, namely because there are, it's a really young field still. We're still like, like trying to reverse engineer how IBF even works.

[00:02:00] It's not really like other areas of biology where it's, oh, we're starting from the mechanisms going up. It's more in 1978, some absolute mad lad created life in a tube. And we're trying to reverse engineer that, number one. And number two, make it like actually work most of the time because success rates in general are quite abysmal. Are there really? Sorry, you've got me distracted out of our talk on blood in two talk on facilities. So what are the success rates for IBF?

[00:02:28] So typically the recommendation is three rounds of IBF for a 45% chance of taking home a baby. Is it still the case that you might take home 13 babies because of the way that the process works? That was the issue at the beginning, wasn't it? Yeah, I mean, it was the issue in the beginning because we didn't really know what we were doing. And as a result, we were just putting embryos into people.

[00:02:53] And obviously that way you end up with this like very fun little distribution of how many babies you're going to end up with. And unfortunately, a lot of people end up with a not small number of people, definitely more than the natural rate, ended up with multiple pregnancies. And as a result, people started developing more sensible ways of transferring embryos back into the patient. And these days, the official line in the UK, at least is one by one.

[00:03:20] Takes more time, but you're much less likely to require a fetal reduction. Or yeah, because multiple pregnancies really bad if it's anything more than two. Increases your risk of needing the cesarean, increases your risk of a whole raft of pregnancy complications. And yeah. Interesting. Let's talk blood because actually, Sapphic Bison. Tell us a bit about the company first of all. What does it do, or the organisation rather than the company? What is it?

[00:03:49] Whose idea is it? Why was it set up? Okay, so Sapphic Bison is very much a grassroots organisation set up by me and a bunch of trans friends who are... Low-key pissed off at the way that trans healthcare in the UK and more broadly is happening. It's a non-profit organisation, which is like the first important bit.

[00:04:12] Because to an extent, in the UK at least, for the international listeners, you're stuck either between the NHS, which is the state-funded thing, which is... But the real kicker is that the waiting lists are like... And even once you're on it, the standard of care doesn't seem to be the greatest. They only see you like once a year, if that. And they offload a lot of the stuff to your GP, which is also not great because GPs have an annoying tendency to say,

[00:04:42] this is outside of my competence, or I just disagree with this, piss off or go back to the GIC or whatever. The other side of it is the private healthcare settings, which for a lot of people are just like... out of reach, just because like... you're looking at ridiculously expensive healthcare. It's quite specialised and...

[00:05:09] you're going to have to take out a lot of insurance given the political climate. So yeah, it's like that. And then... I... let me actually answer the question. So yeah, long story short, the sapphic bison approach is two-pronged. The first one, the first prong basically be in direct action. Let's offer these services not at... we can't do it for free because we don't have money.

[00:05:32] We also aren't going to mark things up by like a factor of three or like doubling the price of blood tests just because. So we're basically offering our blood tests at cost, but also at the same time approaching, creating systemic change from a more researchy perspective.

[00:05:50] So basically publishing, creating the medical evidence that apparently we need to basically make decisions and stuff in policy and all matter of fun stuff surrounding that. Yeah. And making sure that all of this is done by trans people and trans-led because at the minute we've got this situation around trans healthcare where it's a lot of it...

[00:06:17] a decent bit of it is written by trans people, but also a hell of a lot of it is written by cis people. And yeah, I read... to give this example of this Chinese text whenever I, whenever I give like talks to VF units or whatever surrounding like specifically these topics where it's like, they'll always ask, oh, is there recommended reading? And I'm like, yes, there is recommended reading, but first let me read this to you.

[00:06:45] And it's like this old Chinese text about the Chinese, when the Chinese people first, when the Chinese explorers first interacted with the Roman empire. Mm-hmm . And basically wrote about like how the Romans are like really tall people who breathe fire. And they wrote about... They write about democracy actually, which is quite cool. And they're basically like the kings are temporary. And if there's a misfortune, then they get rid of the king and he's unceremoniously replaced.

[00:07:12] And it's basically this Chinese-ified interpretation of what the Roman empire looked like. Mm-hmm . And it's similar to, or at least I like to draw the parallel between behind, take it with a pinch of salt, how a lot of these medical texts especially are written. Yeah. The thing is, a lot of the academic literature is built on quite shaky foundations. So what we're constantly doing is quoting and sourcing weak evidence.

[00:07:40] And never mind political evidence has been politically sourced or contrived. But I do think that's part of the problem here, isn't it? Transgender medicine is medical research is quite new in a way, isn't it? Mm-hmm . But the roots of it go back quite a long way because they come out of some weird stuff from the States and such. And it's all very odd when you go back to the beginning. The Q tests are great until you see the background. And transgender medical stuff is tricky. So I guess we should, let's, should we start with hormones? Should we?

[00:08:08] Oh, before we do though, because easily, I'm very easily distracted. The name, Safak Bison. I know what Safak means and I know where a bison is, but why are the two things put together? We had a bunch of random names actually. And a lot of them had the word trans in it, but there are just so many trans slash queer organizations with the words trans and queer in their name that they kind of, yeah, trans box. That, yes, for the people who are not watching that it just becomes quite difficult to actually remember which is which.

[00:08:36] I personally have difficulty because a lot of them blend into one. That said, it's, yeah, it's, it's literally just something memorable. A story that I do like to tell people is what did the, what did the guy say to his trans daughter after she comes out to him? And the answer is bison. That is a bad joke. That is proper. That's my level.

[00:09:05] That I'm going to be using a lot. Yeah. That's great. All right then. So you set up this, actually, a blood testing organization on the back of the very obvious need. And we talk a lot on this, on this podcast, as all trans people do about the state of healthcare. So what is your solution? I'm guessing it's a blood testing kit, is it? Yeah. Yeah. So we're basically just offering the at home blood test kits that are now flooding the market increasingly without the markup.

[00:09:34] And specifically with like trans panels. Typically, if you're like some random schmuck on the street who may or may not be like cis or trans, what you're going to be interested in is general health. If you're like trying to have a baby, you're going to buy a reproductive health panel. And that's going to come with like all sorts of fun little markers like FSH, LH, and which are like, yeah, they can be useful. There is some intersection with what you need as a trans person to stay safe.

[00:10:01] But at the same time, you're buying a lot of stuff that you don't really need. And it's marked up because obviously the consumer there is middle class slash wealthy women who can't be bothered with the NHS. And that's the situation. So basically, the idea is number one, create trans specific blood panels. So for example, just hormones and sex hormones at that.

[00:10:26] We're introducing a couple things, progesterone prolactin because that's been requested and it's actually quite interesting when we get requested to add things. And like the decisions that we have to like make on when we roll them out, how do we roll them out? Because there's a lot of stuff to consider beyond just logistics. But yeah, it's basically like sex hormones plus liver function is one of our test skin kits.

[00:10:51] We offer it at 35 quid, which is way cheaper than basically anywhere else on the market. I think that like even some of the trans like specific, like I guess clinics are offering things at a good couple multiple of the price. Okay, so let's dig into that a bit. So I'm guessing you're doing the, so you mentioned you're doing progesterone, which is a great thing for trans women. But obviously testosterone and estrogen, I'm guessing, are there.

[00:11:19] So it's trans men and trans women. So that's fine. So why would we, or why should we be interested in liver function? Liver function, it's mostly just because if you're taking any sort of drug that is metabolized through the liver, you probably need to check your liver function. It's more relevant for people taking blockers because that goes through the liver.

[00:11:41] But yeah, that's the main thing because taking any sort of medication for the most part will put some sort of stress on your liver. In most cases, it's okay. In most cases, your alcohol habits will probably have a bigger impact on it than your HRT. But it's something that is one of the obvious things that you can do to stay safe. And that's why it's recommended by the NHS and by basically everyone. Okay.

[00:12:11] I'm someone who has private medicine through one of the usual providers, usual suspects out there. And I have to have three monthly blood tests. So you know which one it is now straight away. And so I have to send a huge long list of things in, which RamDocs I currently do, which is quite expensive. I go in person. Is there a... My thing is I'm always a bit cautious about doing my own blood tests. For some people, they don't want to have blood tests arriving on the front doormat because that raises all sorts of questions.

[00:12:37] For some people, they can't prod themselves or whatever, however it is to get the blood out. And for some people, they just want something that's simpler. So I'm guessing at the moment you're just based with the kits. Is that right? So how does that kit process work at the moment? So the way that the kits work is they're quite discreetly delivered. I actually have one. This was not a prop, but this is the packaging. Okay. It's like literally just a gray envelope. So that's pretty chill.

[00:13:05] But yeah, the way that it currently works is the kits come with a bunch of lancets. You poke your finger, bleed into it. It actually takes quite a bit of effort to bleed if you're like new to it. Some people find it a lot easier than others. It's not great if you have a poor circulation, but there are some really good tips on how to do it, which we're like trying to compile into something like a useful resource at some point to be released.

[00:13:31] But there are some contraindications, obviously, as to like when you shouldn't be using it. One of them basically if you're on gels. And this is one of those annoying things because the gels basically stay in the fat right underneath your skin. Yes. And that basically means that your results end up really messy and high off the really high levels because you've got these ridiculously big concentrations of the hormone under your skin.

[00:14:01] Even under your fingers? Yeah, under your fingers. Wow. So the official guidance from a couple of places, not naming names, is that, okay, actually you can just, you can just like literally just put some gloves on, apply it a couple times for three days. And then you're fine or two weeks. I think most guidance is three days. What we found is that three days is definitely not enough. It stays under your skin for a lot longer and messes with your results a lot longer.

[00:14:30] And this also does affect, this also does affect your blood draws if you're doing it like venously. And that's mostly if you've also contaminated your lower forearm or whatever, or upper forearms with, which one is upper? Yeah, yeah, yeah. Yeah, that's basically like the sorts of situation where it's not great. So basically if you're using any blood test kit from any provider, you need to wear gloves for a few days, at least three or four, before you start doing the blood tests. If you're in your finger.

[00:15:00] It's apparently at least three or four. What we found in like a internal study is that, yeah, no, it's not three or four. We've spoken to a bunch of actually menopause clinics because menopause clinics are doing similar things. Yeah. And they basically say, yeah, no, their advice is to apply your gels using like your wrist. So apply it onto the wrist and rub it like that still leads to contamination. And it's just these gels seem to get everywhere.

[00:15:28] It seems to be like something on the bottle or something. And yeah, it's not really mentioned in the leaflets or anything like that. So, yeah. I was just going to have a look at the bottle. Because actually, if you think about it, if you're living with someone, if you're living with a cis woman and you're spreading oestrogen around from a gel, it's going to get everywhere, isn't it?

[00:15:57] Because I've noticed this after using the bottle. Your hands are, then you're making a, touching a kettle or something after it. I just wonder how much actually does transfer onto that bit of care. No clue. I have no idea how it's quite, no clue on the quantification of that. It would be very funny if menopause women and trans women were like just slowly estrogenizing the London Underground or whatever by holding the poles. Can you imagine how cis men would be thinking about that? There'd be absolute hysterics.

[00:16:26] Forget the toilets and the bathrooms. It's all about don't have anyone touching anything. We'd have to walk around in suits. Yeah. Okay, so we get this discreet package. The thing arrives. We have to look after our clinic list to make sure that's all sorted. We stab ourselves a few times. We get a load of blood. Eek. And then we send it back to you. And then what happens then? Oh, and then it gets analyzed. Results go through. And we basically just forward the results from the lab because technically we're not supposed to be given medical advice.

[00:16:56] We're not like insured or even licensed for that. All we are doing is we're working with a laboratory that is licensed for to-do testing. And quite unfortunately, we just have to like, if we see something that's ooh, we basically just say, yeah, you need to talk to a healthcare professional about that. We can't really do anything because, yeah. And that's reassuring because I think there's a lot of people out there who play at being doctors, don't they?

[00:17:21] And whilst you do see a lot of results, it's actually more concerning if you said you were giving advice. Yeah. Just going back to that issue about stuff on the fingers, because you've really alerted me to this now. I've really never thought about it. Does that affect trans men as well? Oh, yeah. On testosterone gels, yeah. We tried it with, so in our internal experiments, we tried it on both trans men and trans women on gels. And actually, yeah, there wasn't that much of a difference in terms of like how long it stays in the skin.

[00:17:48] We found that, yeah, if you are like religious and like literally imagine like you're handling, I don't know, some like nerve agent. And you don't even touch the bottle ungloved and all of that stuff. Then you might be able to get away with it after give it two, three weeks, which is definitely longer than two, three days. And yeah, you can avoid contamination in that way.

[00:18:12] But for a lot of people, especially if you've got ADHD or whatever, it's just not particularly tenable. What happens? People like myself, I don't like needles and stuff. Is it like a stabby needle where you have to get a grip? Yeah. And stabby yourself. No. It's one of those little hidden ones. It looks like, yeah. Yeah. So basically what it looks like is it looks like a quotation mark is the best way that I can put it. Okay. The needle is hidden in there. You basically just press it against your skin.

[00:18:42] And once you apply enough pressure, it just deploys the needle, gets pulled back in. That basically reduces the chance that you're going to stab yourself by accident, which is very good if you're deploying something to people who actually have to do things by themselves without medical oversight. Yes. And I guess if you have other medical conditions like you shake or you've got short of sight or whatever it might be, that's really important, isn't it? That's a sensible process.

[00:19:17] Yeah. Yeah. Yeah. Because it's like, if you're super needle phobic, don't do it first off. But if you are just mildly needle phobic and you also have like a bunch of, or if you're just scared of like actually doing the needle, like even I'm sometimes a bit scared of doing the needle or poking myself, someone can help with that, especially if you trust them. And then another side of that is also just like milking the finger because you have to like, you'll get a couple drops just out of the finger,

[00:19:47] but you do have to do a bit of milking. Okay. Yeah. That's a strange expression. All right then. So we've got that going on and we get the results back. And what sort of, so say on a trans woman's test, you're going to have, what sort of words are going to be on that piece of paper when it comes back? Ah, yes. So we just go with, so our reference ranges are basically just, it's literally just like we give all of the reference ranges and leave it to you.

[00:20:12] It will say like male reference range is this much, female reference range is this much. If it's estradiol, then you'll also get all of the different phases in the menstrual cycle. And yeah, that's basically it. Okay. And you send it off to your medical provider, you take it to your doctor and they work their magic and they give you more. They're lovely hormones or they do something else or change. Yeah, absolutely.

[00:20:38] And it is important to get you because it is a faff, but it is really important to get your blood tested, isn't it? Because you're, it seems obvious, but let's say why it is important to get a blood test. First one, but there are two main reasons. The first one is basically, are you on the right dose? Are you getting enough estrogen, testosterone, whatever into your body? Yes or no. You might need to up your dose, down your dose or see what else is going on.

[00:21:04] If you've maxed out your dose on a certain form of medication. Then your second bit is safety. So HRT can lead to a couple of potentially nasty side effects. First one, as mentioned before, liver issues, pretty rare. Another one is, especially for trans men or people taking testosterone, is basically the body producing too many red blood cells.

[00:21:31] Which is not great because they can get stuck in places. And yeah. And a bunch of other things. There are some, a couple reports of brain tumor things going through. And that's like why we take prolactin tests as well. Because obviously it's something that's super, super rare. But if it does happen, you probably want to know about it.

[00:21:57] That said, we don't want to, we've been like umming and aaring about deploying the prolactin test because you're going to have a lot of people getting false positives. Simply because one of the big things is it could be a brain tumor, but it could also be just because you're taking antidepressants. Oh, okay. And obviously if you go onto Google and search and ask Dr. Google, oh my God, my prolactin's really high. It's going to say, oh dear, oh dear, you've got cancer or whatever.

[00:22:27] Which is why we were like thinking, we're going to be putting out some sort of like little explainer. On it, basically to say, don't panic. Because if we just deployed, if we just gave out that, if we just deployed like prolactin testing willy nilly, people could be panicking. Yeah. Yeah. So it's not the best. Yeah.

[00:22:52] So we, there is like a lot of thoughts that has to go into if we're given the, if we're giving out these tests, if we're deploying these tests, especially to people who are like, for example, DIYing or self-medicating. And don't readily have access to a GP or like other healthcare professional who can help them interpret these bloods. And they are, and they are going to interpret these bloods themselves with testosterone estradiol. There is plenty of stuff on the internet about it.

[00:23:20] And it's also, if they're like slightly out of whack, it's not the worst thing in the world. Whereas with other things like liver function, for example, if we tell someone that their liver's failing, we need to like, or like just in trouble. We need to like be pretty sure that they'd be able to like act on it and all of that stuff. So there is like a kind of safeguarding aspect there. Yeah. Do you ever have plans to do clinics of your own and have people coming in and have blood tests taken?

[00:23:50] I know we've chatted in the past about that, if there's a demand. Yeah. So it's perfectly doable. The main issue basically being we want to have trans-friendly trained staff. And we also want to have this not centralized because I could quite easily open a couple clinics dotted around London if I wanted to take in venous blood samples or whatever. And it would only cost 10, 15 quid extra per test to do it.

[00:24:18] The only issue with that is that we have London, for example, has clinic here. It has Dean Street's really great services. However, a lot of our people are like coming in from random bits of North England, random bits of Scotland, random bits of, yeah. Come to us. Random bits of like South England and stuff, like Southwest.

[00:24:45] And in those situations, it's impossible to like really get that. Or at least for now, it's not possible for us to get that demand to set up something. And then secondly, even if we had the demand, would we make people like travel in? I know that the buses in, even just heading up to Northampton or something, aren't the beautiful system that we have in London. Yeah.

[00:25:09] And are we going to make, is it particularly just to make people have to take that long ass bus journey to the nearest city centre? Or whatever. But if there was, if for example, if there's a trans charity out there, you have an onsite nurse or someone who can, who's a nurse practitioner or something, you could provide the kits for that person to deploy with people. But I guess then, because, or would they just do their own?

[00:25:35] Because I guess for a lot of people, you can have nurse practitioners or nurses who can take blood samples, but they can't get, they can't send them away to labs, can they? Yeah. I mean, phlebotomy training is, you can literally get trained like quite easily. It's no, it's not that difficult. You just need to like, then go to a clinic, draw a couple of bloods, get signed off. I guess that the main issue there is the insurance piece, which is, and registration piece, which is, you can be like a mobile phlebotomist.

[00:26:05] So someone who takes, who goes around taking blood, no fixed address or no fixed address of work. You can go into a patient's house and take their blood. But then you have to be registered with the CQC that costs money. You also have to have decent professional insurance and all of that stuff.

[00:26:24] Same with like charities, if they want to like start, if they have a nurse practitioner on staff, then they're going to have to like, and they want to start like drawing blood and stuff, then they're going to have to also figure that out. And yeah, it's just a lot of paperwork and money. And I forgot the actual phrasing, but the CQC does require that the person in charge is of, I think the word was like something along the lines of good character.

[00:26:54] Well, yes, yes. So they are going to be like looking at your CV and like being like, oh, is this person responsible? And I am mixing up like the CQC and HFEA lingo here. There's many of them. Yeah. That's great. So if people want to order some tests, how do they do it? Oh, wow. This really is turning into an advert. Yeah. It's sapphicbison.org. You type that in.

[00:27:19] That's sapphic, S-A-P-P-H-I-C, bison, B-I-S-O-N, dot org. Yeah. We love all the links in the show notes as well. So that's not a problem. And your lovely blue site with a bison on it, all very straightforward. And there's some good FAQs on there as well. So that's actually quite useful as well. Good. Look, Chloe, it's absolutely a joy to talk to you. And I wish you tons of luck. Obviously, anybody in our space, we want to help and promote and such. Good luck with it all.

[00:27:46] And hopefully you'll get a flood of people storming to your door having their blood press tests done. Because actually, even if it's the same price, as far as I'm concerned, it's better to support a trans-led charity than it is to be going to one of these huge medical monoliths who are just there for the money, really, isn't it? Yeah. Disclaimer, we're not a charity. We are just a non-profit. Charity registration is just a bit of a ball ache, to be honest. Yeah.

[00:28:15] So, yeah, it's actually just, yeah, at the minute we're just doing non-profit. The legal structure for those interested is limited by guarantee. Yeah. So it's just one of those. I think you're still qualified. It's been called a charity. It's a limited... Anyway, let's talk about this. Yeah, yeah, yeah. That's the thing. Yeah. Look, brilliant. Chloe, you've been a joy to chat to. Really good luck with everything you're doing. I think it's absolutely fantastic. And sapphicbason.org is the website.

[00:28:45] And thank you very much for joining us today. Cool. Thanks for having me. Thanks for listening to this episode of Transvox. It's been a joy to have you with us. If you want to make contact with us, you can contact us at gillian at transvox.co.uk. And all of our money goes to our nominated charity. And Jen, you've chosen the charity for the next number of episodes. Which one have you chosen?

[00:29:12] Our charity is called Beyond Reflections, which is a charity that provides support and counselling to trans people, non-binary people and their friends and their families across the UK. An amazing charity doing some amazing work. Really important. So please, if you can, give. Great. And if you want to go and have a look at Beyond Reflections, it's beyond-reflections.org.uk. But as I say, if you'd like to make a contribution to what we're doing, because we love to help the people who help us.

[00:29:40] Again, if you've got ideas for the show, things you'd like to ask us, questions, comments, applause, or brickbats, feel free to send it all in to gillian at transvox.co.uk. Until the next time, goodbye. Bye-bye.