Trans Advocates Warn Against Silicone Injections

For some transgender women, the desire for bigger breasts or curvier hips may lead them to consider something that may be dangerous - having someone inject silicone into their body.

One Bay Area woman died last year after receiving such injections, and a San Francisco doctor who regularly works with transgender patients had strong advice for anyone contemplating the procedure:

"Don't do it."

Dr. Dawn Harbatkin, executive and medical director of the nonprofit Lyon-Martin Health Services, said that's what she told a young woman who asked her about silicone injections last fall.

"I completely understand why she's interested," Harbatkin said, but the injections are "incredibly dangerous."

The death of Amelia Lopez Zaguilan, 22, appears to illustrate that point.

A friend said Zaguilan, who had been living in Oakland, died in a hospital near Sacramento last May after another trans woman injected her with silicone. The material eventually got into Zaguilan's bloodstream, clogging her heart, lungs, and other organs, said peer advocate Cinthya Herrera.

"All the girls know about the risks ... but sometimes we just want to be feminine and look good," said Herrera. "Sometimes, you think it's never going to happen to you."

Herrera, 33, who works at TransVision, a Fremont-based program for transgender women that had worked with Zaguilan, said Zaguilan died May 7. She said that her friend had gone to an unlicensed woman who lived in Citrus Heights, which is close to Sacramento, and who was practicing out of her house.

Sacramento County Coroner Kim Gin said her office is investigating the cause of Zaguilan's death.

Like Herrera, Lorena Martinez, 39, who also works at TransVision, said Zaguilan was popular, even though she had just moved to the Bay Area in recent years.

"She had many friends, more than me," said Martinez, and she was known for her "really delicious" Oaxacan tamales. Herrera said Zaguilan "would always make us laugh," and would "always try to make fun of herself."

Zaguilan "wasn't satisfied with her body," said Herrera, especially her "big shoulders." She said Zaguilan was tall and wanted to have "big boobs" and "a big ass."

Zaguilan got her first silicone injections to her butt from an unlicensed person in Oakland around November 2012, said Herrera, but she wasn't satisfied with the results. She took a few months to save some money and then, around the last week of April, she went to the woman in Citrus Heights to get more work done on her butt.

This time, "she was very happy," said Herrera. Zaguilan sent photos of the results and planned to buy new clothes.

Herrera said Zaguilan's first session with the woman included four shots for a total of $1,000, which Herrera said was "a very good deal."

About four days after the first round, Zaguilan returned to the woman for more shots, according to Herrera, who estimated the second round of injections was another $1,000.

Herrera said that afterword, Zaguilan told her, "I'm feeling bad."

The injector was giving Zaguilan medication, and Herrera asked her if she wanted her to pick her up and take her to the hospital. Zaguilan said, "No, I'm going to be okay," Herrera said.

"You need to take her to the hospital," Herrera said she warned the other woman. "If something bad happens, you're going to be in a lot of trouble."

The injector said she was afraid that if she took Zaguilan to the hospital "people were going to find out what she was doing" and "she was scared to get arrested," said Herrera. The woman, whom Herrera knew only as Alejandra and who was originally from Mexico, was in the process of getting asylum, she said.

Zaguilan told Herrera that she was starting to cough up blood.

"I think the girl called an ambulance," said Herrera, who stayed in contact with Zaguilan through text messages.

"Everything is going to be fine," Zaguilan told her. When she got to the hospital, she even remarked about a "cute" nurse.

When Herrera arrived at the hospital, there were "a lot of machines connected" to Zaguilan, she said. Zaguilan could talk, but she appeared heavily medicated.

A nurse told Herrera to call Zaguilan's mother, who also lives in Oakland, because she was "really, really sick."

The first night Zaguilan was in the hospital, staff medically induced a coma. Zaguilan's mother and other family members came to visit, as did many friends, over the next several days. Herrera was at the hospital with her friend almost the entire time.

One week after Zaguilan entered the hospital, she died.

"Her mom was devastated," said Herrera.

Herrera knew little about Alejandra, but she said many people think the woman has left the United States for Mexico.

Consequences

Health care providers cautioned against such silicone injections.

"There are really long-term negative consequences to silicone injection, and our hope is that people don't get injections," said Lyon-Martin's Harbatkin.

The silicone "doesn't stay where it's supposed to," she added.

"It can move around" and "create deformities," causing "painful" inflammation, Harbatkin explained.

Herrera and Martinez, who are both transgender, had the injections years ago and they're now causing pain, especially for Herrera, who said she gets "red patches" on her skin.

Harbatkin, an out lesbian who's been a physician since 1998, said it's "pretty common" for older transgender women "to have had silicone injections," and she still talks to patients about it, although people don't ask about it "as much as they used to."

"I completely can understand that people are trying to make their bodies look more feminine and that until very, very recently," options for surgical treatment, "especially, have been incredibly limited," and not covered by health insurance, she said.

But many treatments and procedures are covered now, and Harbatkin advises against getting the injections, "no matter who" does them, even if licensed practitioners do them.

Cassandra Hockenson, spokeswoman for the Medical Board of California, said the agency tracks complaints of physicians, but the agency wouldn't have anything as specific as data on complaints related to silicone injections.

Hockenson said there's nothing the agency can do if someone who performed such injections has fled the country, but if a complaint is filed against someone for performing silicone injections without a license, "we will work with authorities, because that's a crime."

She encourages anyone with questions or concerns to "notify us right away."

"We want to know if there's a problem," said Hockenson. "Even if someone is not 100 percent sure" a problem is reportable, "report it," she said. The medical board's website is http://www.mbc.ca.gov.

Harbatkin encourages anyone who has questions to contact a primary care provider or Lyon-Martin at http://lyon-martin.org or (415) 565-7667.

Melissa Jue, a spokeswoman for Dignity Health, which runs San Juan Medical Center, where Herrera said Zaguilan died, wasn't able to confirm information on Zaguilan because of privacy laws. Zaguilan's mother only speaks Spanish, and an interpreter wasn't available for this story.