Elliott
Elliott has had recurrent thrush for two years which has got worse since starting testosterone (T) therapy. Elliott has visited the GP to get antifungal medication but finds the thrush keeps coming back. They have been self-managing thrush, but are now considering re-engaging with healthcare and exploring a longer-term prescription of antifungal tablets, or adjusting their testosterone therapy.
Elliott (they/them) is a non-binary trans person. They work as a support services manager at a charity. Their background is white British. Interview clips are read by an actor.
More about me...
Elliott first experienced thrush in their early 20s, primarily linked to sexual encounters with cisgender men. They vividly recalled, “When I would have sex, I used to always then have thrush”. This issue, initially sporadic, turned into recurrent thrush over the last two years, especially after starting testosterone (T) therapy. Their symptoms included a change in discharge and itchiness which would keep them up at night.
Elliott discussed the connection between starting testosterone therapy and an increase in thrush episodes. However, Elliott noticed "as soon as I stopped taking T, I stopped having thrush”. This observation led to a challenging dilemma - whether to continue with T therapy, which was crucial for gender affirmation, or stop it to get rid of thrush.
Navigating the healthcare system presented multiple challenges which prompted Elliott to self-manage thrush. Elliott used online forums like Reddit to seek advice. They read about others experiencing a link between recurrent thrush and testosterone, but had not explored this with a doctor.
Despite feeling lucky that their GP practice was “very affirmative” and “trans-positive”, Elliott said "I don't think I’d probably feel comfortable talking to the GP” due to a lack of perceived knowledge about hormonal issues. Elliott was prescribed testosterone therapy from a private endocrinologist due to the long wait times at Gender Identity Clinics. Elliott had not told their endocrinologist or GP about the link between testosterone and thrush yet due to fear that they would stop the prescription. An appointment with the endocrinologist also cost £140 which was another barrier.
Elliott saw their GP to get thrush medication and advice, but due to not feeling comfortable, did not discuss gender affirming care. Within the last year, Elliott has been given three different prescriptions for recurrent thrush from their GP. This treatment included “a bunch of tablets to take every two days”. Other thrush self-management strategies have included not over washing and drying well after a shower. They have also tried pre-biotic supplements. Financially, Elliott said the cost of continuous treatments have added up and they would sometimes opt to order antifungal tablets and cream online where multipacks were available for a cheaper price.
Elliott felt it required “a lot of emotional resilience” to keep making appointments with the GP. Elliott had been tested for STIs multiple times which was “annoying” when they were not sleeping with people. They had been tested for thrush which came back positive.
Recurrent thrush was frustrating and embarrassing for Elliott, especially its impact on their sexual and personal life. Elliott said it felt “relentless”.
In terms of support, Elliott said there was varying degrees of openness and understanding in different social circles. Within trans-supportive environments and among friends, they find a greater degree of empathy and comprehension. However, in broader societal contexts, they often confront misconceptions and a lack of awareness about the intersectionality of their gender identity and health issues.
Looking forward, Elliott is considering taking a longer-term course of weekly antifungal medication that they read about on the NHS website and possibly re-engaging with healthcare providers.
To healthcare professionals, they recommend adopting a “zoomed-out” holistic, person-centred approach, especially in trans healthcare, to ensure that treatment plans align with patients' unique identities and experiences.
Testosterone triggered recurrent thrush for Elliott and this led them to consider the pros and cons of continuing gender affirming hormones (read by an actor)
Testosterone triggered recurrent thrush for Elliott and this led them to consider the pros and cons of continuing gender affirming hormones (read by an actor)
But then also because it drives me so... so crazy, at the moment I’m like I’m not take... I like stop... as soon as I stopped taking T (testosterone), I stopped having thrush, so then I was just like, ‘oh, maybe I’m just not going to bother because it’s... because I really can’t be bothered with all of like... these like hormonal changes, la-la-la,’ so I’m sort of... I’m on the fence at the... I mean I’ve got thrush at the moment, which is so annoying, so I’m on the fence, but I don’t really know... I haven’t really thought my game... I think because I’m in my own sort of like journey of like, ‘do I want to keep taking it, do I not, can I be bothered with these side effects, can I not?’ so it’s... yeah.
Elliott had STI tests taken multiple times when trying to treat thrush (read by an actor)
Elliott had STI tests taken multiple times when trying to treat thrush (read by an actor)
I remember I’ve had like... the only annoying thing with the GP is I’ve had so many like STI checks, like reoccurring, and it’s just like I know I don’t have an STI because like either I’m not sleeping with people, or other sort of things, but they always seem so determined and like thinking that you have an STI, and not that it mattered if I had an STI, but I’ve never had an STI, and I know around sexual health and, yes, so that’s really frustrating when GPs are just always like really just thinking like you’ve got... must have an STI, but not... but I mean I’ve done... I’ve... it’s difficult because I feel like I’ve always had to have so many swabs and so many different tests of things, but yeah, I don't know.
Despite repetitively getting prescribed thrush medication, Elliott said healthcare professionals did not frame it as recurrent (read by an actor)
Despite repetitively getting prescribed thrush medication, Elliott said healthcare professionals did not frame it as recurrent (read by an actor)
I also find that interesting from doing this, because even though they treated me... they’ve given me, what, I think in the last... less in the last 12 months, I definitely can remember they’ve given me three different on three different occasions, prescriptions for thrush, but they’ve never really framed it in a re-occurrent wording, even though I probably... I have gone back many times and even though I go for years and like had thrush medication, but no, that’s not ever been picked up as like a re-occurrent thing. It was only really so I saw your study and it was re-occurrent thrush and was like, ‘oh well, that’s me because I get it all the time.’
Elliott worried what friends would think about their hygiene after learning about recurrent thrush (read by an actor)
Elliott worried what friends would think about their hygiene after learning about recurrent thrush (read by an actor)
The only thing I’d say is like when it being re-occurrent then like sometimes like friends have been like you’re thinking as if like you’re like your habits down there, or whatever, must be like wrong, or something, or like you’re doing things... like something that you could be doing to you know cause it, when I know that I’m really on it and it’s not anything that is actually being caused by like that, does that make sense?
Elliott found that they needed more tablets over time (read by an actor)
Elliott found that they needed more tablets over time (read by an actor)
So, yeah, that one’s interesting because when it was happening in my early 20s I would just take a tablet, it would literally just sort it out and I would just use the cream and I’d just do it for like say the seven-day to 10‑day period, it wouldn’t be an issue. It’s only since starting the T (testosterone) where that’s not working, like it’s like it’s... it’s not responding to the medication in the same way, and then, yeah, so I’d say all of like... I would say only up until this last year, before I would just get it and just do the normal easier round and it’s only this time where it’s now like needing more than,— and yeah, and it’s staying.
Elliott advocated for a more “holistic” and “person-centred” view of recurrent thrush (read by an actor)
Elliott advocated for a more “holistic” and “person-centred” view of recurrent thrush (read by an actor)
Just I guess the same thing with them is like looking at it as a zoomed out, but also about the person and their lifestyle and, yeah, like the other sorts of things, like the other medications they’re on and if that interacts with it, and just always I think with the more holistic viewpoint is and about somebody and their life and who they are, and probably just always being nice to people around these things too, because I think when you speak to GPs and they’re a bit like standoffish, or cold, or... you’d probably get on and off... like on the phone and off the phone so quickly, so then you might like hold back information or not be like as honest or as open, so, yeah, if there’s like a way for GPs to be a bit like softer maybe and non-judgemental, and yeah, very person-centred, but I think obviously that health care’s just so hard and difficult, isn’t it, like GPs have to do so much and are up against it, so I just think that level of care’s like a lot harder to want to say give to somebody or able to give.