Worried about getting turned away by doctors because they are under 21, some young Singaporeans have been buying hormonal medication online.

They self-medicate in the hopes of feminising or masculating their bodies so they can soon look like the gender they identify with.

Ms Cassandra Thng, 19, started ordering hormones online in June and took a cocktail of four pills a day.

“This is because you need to be 21 and above to get hormones without parental consent. My parents wouldn’t consent. But I felt I couldn’t wait until I turned 21,” she told The Straits Times.

She is not alone. Her friend Jolene Tan, 19, did so for a year.

On discussion website Reddit, a local transgender woman in her 20s told of starting her hormone replacement therapy (HRT) journey at 14.

All said they self-medicated because they heard from friends that they had to be 21 to get prescription hormones from a doctor unless they had parental consent.

The usual route for a person looking to transition is to see a psychiatrist for evaluation.

Only when diagnosed with gender dysphoria can the individual be given hormonal therapy, usually by an endocrinologist who will carry out blood tests and recommend dosages tailored for the individual.

Doctors said such self-medication is worrying because of side effects and the questionable authenticity of the products.

Dr Vivien Lim, president of the Endocrine and Metabolic Society Singapore, said: “You’ve no experience on what to look out for. Advice from friends is just anecdotal.”

Psychologist K.C. Lee added: “There isn’t one pill for every transman or transwoman.”

Potential side effects in the long term include deep vein thrombosis, weight gain, migraines, changes in moods and behaviour and osteoporosis. But the greater concern is authenticity of the pills.

Said Dr Lim: “Who knows what is inside? There could be mercury and you could have issues with major organ damage.”

In its response to queries from The Straits Times, the Ministry of Health advised against buying such products off the Internet “as it is difficult to authenticate the safety and quality of products sold online”.

“Products sold online could also potentially be counterfeits or adulterated with undeclared potent ingredients,” it added.

Doctors also said the emotional and psychological support offered by a psychiatrist are critical for someone who is transitioning.

Dr Lee said: “There can be very awkward stages because transitioning does not happen overnight. Some families are not supportive, so there are risks of anxiety, depression and even around daily functioning: How do you go to work? When you go to the mall, which bathroom do you use?”

Asked if she was confident her online research on dosages was reliable, Ms Thng said: “It was more like desperation, I needed to get something done or it will drive me insane. So long-term health complications aren’t really an issue.”

As for Ms Tan, she wanted to prevent further masculation of her features.

It is unclear if there is an age requirement to getting HRT.

Endocrinologist Abel Soh said there is, but Dr Lim is not aware of such guidelines although she said it was a “grey area”.

“They are not even allowed to watch R21 films, how am I going to give them hormones to change their bodies?” she said.

The Singapore Medical Council’s ethical code says that while it is standard practice for consent for minors to be taken from parents, “you must give consideration to the opinions of minors who are able to understand and decide for themselves”.

The Ministry of Health said “young persons who have questions or uncertainty about their sexual orientation or identity should seek professional support”.

To discourage self-medication, better services for transgender people and guidelines for doctors are needed, said professionals.

Dr Keng Shian-Ling, assistant professor at the department of psychology at the National University of Singapore, said: “More transgender-affirmative psychological and medical services should be made available to the transgender community so that they will feel more comfortable seeking out professional help.”

If there was an age limit, Ms Thng thinks it is important for that to be lowered. “For transwomen who have to do national service, getting hormones earlier is probably something that’s quite important.”

kxinghui@sph.com.sg

This article was first published on Jan 16, 2017.
Get a copy of The Straits Times or go to straitstimes.com for more stories.

Shortly after Chinese New Year last year, Ms Jen Wang, 33, was pregnant with her second child, and had just moved into her new Build-To-Order HDB flat in MacPherson with her family.

Life seemed good.

However, a few months later, she found out she had stage 4 cancer – rare for a pregnant woman, not just in Singapore but other countries, too.

In May last year, while 17 weeks pregnant, she was battling colon cancer, and worried for her and her baby’s life.

She was also thinking about her son and husband’s future without her, and in a dilemma about making a decision about her course of treatment.

Dr Benjamin Chuah, an oncologist from Mount Elizabeth Novena Medical Centre, did not mince his words when he spoke to her.

“You have three options. Each choice is a cup of poison and you have to choose one,” he told her.

She could go for “radical surgery” to take out the tumour, but mother and baby could both die.

The second option was to undergo chemotherapy, but there was a chance the cancer may not respond to it.

The drugs would also be toxic to the body, and there was the risk of losing the baby.

The final option was to do nothing but this meant the cancer would grow aggressively and compete for space with the baby.

Ms Wang was in a dilemma. Should a pregnant woman who is diagnosed with cancer begin treatment before the child is born? Some studies show most chemotherapy drugs can pass to the baby via the placenta.

She prayed and made a decision. “I decided to start chemotherapy immediately and went ahead without thinking too much,” said Ms Wang, whose son is two years old.

Before this, she decided to keep the baby, despite the urging of her concerned family members to go for an abortion, so that she could focus on fighting for her own life.

She and her husband, legal counsel Jeremy Goh, 35, have been married for four years.

Said Mr Goh: “I considered abortion because her life was in danger and the doctors said treatment options could be limited because of the baby. We talked about it and I decided to support her decision.

“I prepared myself mentally to care for the children should anything happen to her, and even if the baby is born with disabilities.”

By then, Ms Wang was 21 weeks into the pregnancy. The cancer had spread to an area near her right kidney and was pressing on the common iliac artery – a large artery that also supplies blood to her womb.

According to doctors, people suffering from stage 4 colon cancer have a median timeframe of two years to live. For Ms Wang, the prognosis was worse because she was pregnant.

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Younger people getting diagnosed with colorectal cancer

Source: Facebook/NinaLangley, TNP, Choo Mei Sze

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Pregnancy lowers a person’s immunity and may delay treatment.

She started her first round of chemotherapy last June, when she was 21 weeks pregnant.

Every two weeks, she would go through another three-day cycle of chemotherapy. Besides suffering from severe nausea and fatigue, she was in so much pain sometimes that she forgot to breathe, and she hyperventilated.

After the fourth cycle of chemotherapy, when she was 27 weeks pregnant, the doctor decided to stop treatment and wait. Five weeks later, her haemoglobin levels dipped and she became feverish.

That week, a caesarean section was done to get the baby out.

Said Ms Wang: “She was perfect. She had so much hair, more than her brother, despite me having gone through chemotherapy and losing my hair.

“I asked if the baby was okay and they said she was okay, and everyone was laughing.”

Ms Wang and her premature baby were then separated.

The baby girl, called Jill, was sent to the intensive care unit and Ms Wang resumed chemotherapy two weeks after the delivery. She also started on immunotherapy, a new form of treatment that was undergoing clinical trials at the time.

Also read: Cancers on the rise in pregnant women: Study

But before long, there were more problems.

Two weeks later, Ms Wang’s colon ruptured and doctors told her family members to rush down to the medical centre – patients have died from having a ruptured colon.

But the emergency surgery was a turning point.

“The operation was a miracle. Doctors not only managed to take out about 50cm of my colon, but they also removed parts of the tumour around the kidneys,” said Ms Wang, who was formerly an executive with the Singapore Cancer Society (SCS).

Last month, she underwent a scan and there was no evidence of the cancer.

The recurrence rate for cancer is about 70 per cent.

For now, Ms Wang and her family are celebrating.

The baby is four months old now, and healthy. Ms Wang said she hopes to fight on for her children.

“Facing mortality has showed me how to live. I used to be paiseh, but now, I will not wait to tell my loved ones how I feel about them,” said Ms Wang.

She added that she hopes to continue working or volunteering with the SCS.

Ms Wang will be among those taking part in an SCS fund-raising walk called Relay for Life at Bukit Gombak Stadium next month.

Participants will walk or run together to convey the message that no cancer patient needs to go through the illness alone.

The event aims to show solidarity with cancer survivors and honour them and their caregivers, while raising funds and awareness.

Said Ms Wang: “I want to share my story with others, about how my struggles have helped to strengthen my faith.”

To register for Relay for Life, visit www.singaporecancersociety. org.sg/relay.

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Pregnant women with cancer choosing babies’ lives over their own

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Cancer during pregnancy rare in Singapore

It is rare to find a pregnant woman having cancer in Singapore.

The largest hospital for women and children here – KK Women’s and Children’s Hospital – has managed only a few such cases over the last few years.

These cases involve gynaecological and breast cancers.

Globally, pregnancy-associated cancer cases occur in about 1 in 1,000 pregnancies.

For colon cancer, as in the case of Ms Jen Wang, women have a one in 13,000 chance of being diagnosed with it while pregnant.

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16 must-knows for colorectal cancer prevention

Source: Merck Serono, Reuters, AFP, Shutterstock.com

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The rate of such pregnancy-associated cancer is considered to be on the rise as more women have children older, according to Cooper University Health Care.

How the cancer is managed and treated will depend on the stage of the cancer, the type of cancer, the trimester the cancer is diagnosed, as well as the wishes of the pregnant woman, said Dr Timothy Lim, head of the department of gynaecological oncology at KKH.

“Termination of pregnancy may be an option in the first two trimesters if the patient is diagnosed with cancer in its advanced stages and needs treatment urgently,” he said.

Also read: 26-year-old woman delays cancer treatment to deliver baby

Chemotherapy can be given from the second trimester if the mother decides to keep the baby. After the baby is born, the mother can then opt for surgery, chemotherapy or radiotherapy.

Patients are always counselled extensively by a team of doctors, said Dr Lim.

“We have had patients who have refused any treatment such as chemotherapy during pregnancy. Patients are well aware there is a risk of progression of cancer and risk of death in pregnancy.

“No matter which route our patients choose, we always respect their informed decision and support them in whatever way we can.”

About cases in Singapore, Ms Wang said: “One oncologist told me most mothers choose to abort the baby, and in one case where the lady went ahead with chemotherapy, the baby self- aborted later due to the effects of the drugs.”

This article was first published on Jan 16, 2017.
Get a copy of The Straits Times or go to straitstimes.com for more stories.

SINGAPORE – Over half a million dollars have been raised for charity, in conjunction with the recent launch of former senior bureaucrat Philip Yeo’s biography, Neither Civil Nor Servant.

The funds collected by the Economic Development Innovations Singapore (EDIS) – which Mr Yeo is the chairman of – will go towards helping underprivileged children, via the company’s corporate social responsibility arm, EDIS Cares.

The monies, raised through private donations and pre-launch book sales, will enable EDIS Cares to expand its programmes in Singapore to reach a targeted 300 children over the next three years, EDIS said on Sunday (Jan 15).

The EDIS Cares fund is administered by the Community Foundation of Singapore.

Neither Civil Nor Servant – The Philip Yeo Story, published by Straits Times Press, was written by author Peh Shing Huei and captures the half-a-century career of the former Economic Development Board chairman.

Mr Yeo, 70, said he was pleased that the book was a “catalyst for many generous donations” to the EDIS Cares Fund.

“The book dealt at length with human capital so it is good that it helped to create opportunities for the underprivileged in our next generation of talent,” he added.

Neither Civil Nor Servant has been well received, topping The Sunday Times’ non-fiction best seller list since its launch on November 11 last year.

It has also occupied the number one spot on the top seller list in most bookstore chains across Singapore since.

The book went into first reprint a month after its debut and is expected to hit the 10,000 copy sales mark soon.

A book signing session was held on Sunday at the Kinokuniya store in Ngee Ann City with Mr Yeo and Mr Peh sitting down to discuss reactions they have received to the book.

adrianl@sph.com.sg

This article was first published on Jan 15, 2017.
Get a copy of The Straits Times or go to straitstimes.com for more stories.

SINGAPORE – The family of three really loved their cats, all 45 of them.

For the sake of the felines, they moved to another flat for more space.

They even hired a maid to help take care of the cats.

The family – made up of a woman in her late 50s and her two adult children – have been keeping the cats for the last 18 years.

Last month, they received an e-mail from the landlord of the Woodlands flat that they were renting, threatening to evict them if they kept the cats.

One of the children, a 37-year-old who declined to be named, told The New Paper that they were devastated.

“We lived in our Woodlands home for three years and never had problems before.

“Then suddenly, we got an e-mail saying we had to take the cats away or pest control will take them,” he said.

While the family decided to move out, the son realised things had to change. He said he did not want his life to revolve around the cats.

Before finding a new place in Punggol, he sought help from the Cat Welfare Society (CWS) to re-home the cats.

Of the 45 cats – all of which have names – 30 are now at a cat shelter and five have been fostered out.

The family still have 10 cats, although they intend to put more of them up for adoption.

The CWS is sterilising all the cats and volunteers have also connected the family with fosterers.

CWS spokesman Veron Lau said it was not advisable to own a large number of cats unless the owner is educated on cat care and is diligent in hygiene.

“Living with a large number of cats without the right knowledge leads to health and aggression issues,” she said.

“We hope the owner in this case is able to keep up with payments to the shelter for the upkeep of the cats until they are adopted or die.

“There are very few options for them otherwise.”

The fee at the shelter comes up to $2,000 a month.

Paying a high price for their cats is something the family is used to.

They bought their first cat in 1998 when living in Tampines. They then started adopting more cats and taking in strays.

Only 20 of the 45 cats were neutered.

At its peak, the cats cost $1,500 a month to maintain.

The son said: “My mother did not want to let go of any cat. If my sister and I threatened to give some of them up, she would not come home. Then, the number started to increase, and it became hard to give them up.

“We should have agreed to put them up for adoption a long time ago.”

He finally convinced his mother to let go of the cats as he was adamant things had to change after receiving the e-mail from the landlord.

The son used to wake up at 5.30am every day to feed the cats, groom them and clean their litter trays before leaving for work two hours later.

Now that they have only 10 cats, he feels a void.

He said: “It just feels so weird not having them around because my daily tasks revolved around so many of them.”

His mother said: “I love my cats like my own life. (Now that so many are gone,) I feel like I have lost half of my soul.”

This article was first published on Jan 15, 2017.
Get a copy of The Straits Times or go to straitstimes.com for more stories.

On his maiden trip to Singapore last October, Mr Ade Iskandar Roni bought a $51 Adidas T-shirt as a present for his best friend.

That thoughtful purchase has helped him win a cool $1 million.

Mr Ade, a procurement personnel who lives in South Jakarta, was on Sunday (Jan 15) crowned the new Changi Millionaire.

He beat seven other finalists in three rounds of games – including picking pre-packed luggages at random and putting them through a scanner to see if items were packed correctly.

“I’m very happy and nervous, my whole body is shaking. I don’t believe this,” said Mr Ade, 39.

His prize money works out to 9.3 billion Indonesian rupiah – a sizable sum when the country’s GDP per capita is 46 million rupiah as of 2013.

“I want to bring my whole family to Mecca, maybe buy a new house, a new car,” he said.

Mr Ade is married with five children and intends to take his extended family of 30 to 40 people on the Muslim pilgrimage to Mecca in Saudi Arabia.

The other seven finalists – from India, Australia, United Arab Emirates, Malaysia, Indonesia and Singapore – left with $5,000 each.

Changi Airport flew the foreigners in with a three-night hotel stay for the event.

This is Changi Airport Group’s seventh million dollar draw since its launch in 2010 to promote retail at the airport. There were 1.2 million entries from 225 nationalities from May to October last year.

To qualify for a chance at the draw, participants had to shop or dine at Changi Airport with a minimum spend of $50 in a single receipt.

On Sunday, Changi Airport Group announced that it had $2.3 billion in retail sales last year, a five per cent increase compared to 2015 sales, which was a record high of $2.2 billion.

The airport saw more than 50 million transactions last year, with Chinese shoppers making up 30 per cent of sales, followed by Singaporeans at 20 per cent. Other top shoppers were from Indonesia, India and Australia.

Perfumes and cosmetics, and liquor and tobacco were the two most popular product categories at Changi Airport, followed by luxury goods.

For Mr Ade, the Adidas shirt have become his best buy so far.

He said: “I still can’t imagine right now what $1 million is in Indonesia.”

This article was first published on Jan 15, 2017.
Get a copy of The Straits Times or go to straitstimes.com for more stories.

SINGAPORE – A driver was arrested in Woodlands on Saturday for driving against traffic – the latest in string of similar cases that have taken place in the past month.

Police said they were alerted to an incident at the junction of Woodlands Avenue 1 and Woodlands Avenue 2 at 7.06am on Saturday (Jan 14).

It reportedly started with a driver falling asleep at the wheel.

An eye-witness, Mr Ong, told Lianhe Wanbao that a BMW was parked at a traffic junction on Woodlands Avenue 2.

And though the light changed several times and other cars sounded their horns repeatedly, it did not move.

He told Wanbao he saw that the driver’s eyes were closed, and he tapped on the window to try to wake him up.

The driver did not respond, and so Mr Ong called the police.

When the police arrived, one of the officers knocked loudly on the car window, finally rousing the driver.

Startled, the driver stepped on the accelerator and drove onto the wrong side of the road. Mr Ong said that a police officer tried to stop the car by blocking it, and was nearly hit.

The car finally stopped and police said a 29-year-old man was arrested for suspected drink driving.

“I admire her ( the police officers’) courage, but I want to tell her to put her own safety first, as her family will be worried,” he said.

Traffic Police received reports of seven cases of driving against traffic between Dec 28 and Jan 7.

chuimin@sph.com.sg

This article was first published on Jan 15, 2017.
Get a copy of The Straits Times or go to straitstimes.com for more stories.