Top surgery consultation #2

Content warning:  discussion of self-injury.

On Monday, I traveled to consult with Dr. Rumer, and the appointment went well.  In stark contrast, I had a terrible consultation with a local surgeon, at a cancer center, yesterday.  She mainly works with breast cancer patients, and the mail / paperwork I received in advance reflected this.  (The center could easily draft up non-cancer related documents for trans-clients!)

I was there for a total of an hour and 45 minutes – lots of waiting!  When I got there, I filled out paperwork about my breast cancer diagnosis.  I just put N/A for a lot of it.  Here’s a sampling of questions I was prompted to answer:

– What do you know about your diagnosis?
– Previous breast history?- Some cancers are more prevalent in persons of different racial and ethnic backgrounds.  The following information will help us to better understand your potential risk in developing certain types of cancers and to understand your prognosis.  [Followed by questions about ethnicity.]
– What percentage of waking hours do you spend up and about?
– more than 50%
– less thank 50% – I am confined to a bed or chair
– I am completely disabled, totally confined to a bed or chair

On the phone, when I scheduled the appointment, the woman was sensitive to the reason I was coming in, and to the fact I hadn’t legally changed my name yet.  Regardless, that didn’t translate over to the present day, and I was called by my birth name and even, “Mrs. [last name].”  I don’t think I’ve ever before been called “Mrs. [last name].”

I finally was brought up to the breast cancer suite and my vitals were taken.  I waited in an exam room and a nurse came in and went over some of the questions with me.  She left for a while and came back, saying, “let’s fill out this paperwork.”  This one WAS relevant to why I was there.  I asked her, “Why was I filling out papers for breast cancer patients?”  She replied, “Oh, well, they just gave you the wrong one down stairs.”  No big deal… ???

She left and a doctor with an intern student came in.  The doctor asked if it was OK if the student was present, and introduced her.  She then asked, “Are you so-and-so?”  I said no I’m not.  She said, “oops, sorry, wrong room.”  I sat there waiting a while longer and finally the surgeon came in with TWO student interns.  At no point did she ask for my consent for them to be present.  They introduced themselves and we got started.  She started by putting words in my mouth – “So you’ve felt this way since you were a teenager.  That’s when you started feeling different…”  I just let her roll with that.  She asked about mental health, suicidal thoughts, and even self-injury.  I’m not sure why.  She asked very little about gender identity.  I answered her questions honestly, including that I’ve had vague suicidal thoughts, and I used to use self-injury as a coping mechanism.

She then said they were going to leave the room and prompted me to put the robe on.  They were gone a very long time.  They all came back, rubbing hand sanitizer into their hands.  I had a flash fear thought – are all these people going to be touching me?!!!  Fortunately only the surgeon touched me, but the presence of all these people was enough for me to check out for this part of the appointment.  A few things that registered:

– She commented on my tattoo, asking if that was magic marker – it looked like marker.  ???
– She talked a lot while I was sitting there half exposed.  She described the procedure she would do, and manipulated my breast in her hand to demonstrate it.  I looked down briefly, and seeing her grabbing my breast was totally surreal.  She was talking at my chest, and not to my face.  I was poked and prodded a lot more than seemed necessary.
– She actually said to me, “This scar, is this from cutting?”  I could not believe I was being asked this.  I was in shock.
– I was aware of interns in the background, watching this whole thing.  They were fuzzy.
– I said to her, “I’m just in the consultation phase, and I have some questions for you.”  This changed the dynamic and she wrapped up the part where I was sitting there, vulnerable.

When this part was finally over, they left and I got dressed.  I waited a very long time again.  When they came back, I went through my list of questions.  She has a year and a half of experience working with trans-patients (really?!!), and does chest masculinizing surgeries a couple times per month.  She requires patients to be off T one week before and one week after surgery.  50% of patients will immediately retain nipple sensation, and 80% will eventually over time regain sensation.  She could not show me any examples of her work that would be related to my surgery type.  She could not tell me how much it would cost, not even a ballpark estimate.

Before leaving, I gave her feedback.  I told her how I had been misgendered by the staff.  She conceded that they needed to work on that.  I also, in front of the students, said, “As someone who is transgender, I have gender dysphoria around my naked body.  These may not be the best types of appointments to have students present.  It felt like I had an audience, and I didn’t feel comfortable being partially exposed.”  She responded, “Thank you for that feedback.”  I understand she might not have control over when she has interns with her, but she could CERTAINLY ask for consent, or ask that the interns not be present for the naked part.  I wanted to give her more personal feedback, such as, “It’s not appropriate to comment on my body,” but in the end I didn’t go there.  I just couldn’t right then.

This surgeon and the staff could benefit from some trans-related training, particularly to the sensitivities trans-people may feel about their naked bodies, specifically chests.  Make it short and sweet!


Getting slammed by visions of violence

Trigger warning:  violent imagery (as the title suggests).

Last week, I was in high stress mode.  It’s due to an annual drastic change in my work schedule (and really no other reasons, as far as I know about.  I mean, I have other stressors going on, but nothing I can’t usually handle.)  This happens every single year, and it really affects how I engage with summer.  I can always predict it; simultaneously, I always conveniently forget how extreme it gets.

I wrote what follows last week, when I was in the thick of it.  And then I just sat on it, because I wasn’t sure if I really wanted to post it.  Partially because it’s a departure from what I usually write about.  Now that I’m feeling better, I find that, yes, I’ll post it.  So, here’s what I wrote, only slightly edited:

My mind’s reaction to long-term stress is terrifying to me.  I continue to wonder if this is really just how it is. (Why can’t I just grow out of this???).  Some people get stress-induced migraines or upset stomachs or struggle with insomnia.  Anything like that is, without a doubt, difficult to deal with.  In a big way, I am glad I am not afflicted with those stress-responses.  In some way though, a part of me wishes for something like that instead,  but only because it’s relate-able and I’d probably feel like I could talk about it with others.  “My stomach is in knots thinking about what I have to do.”  Or, “I’m losing sleep over this.”  These phrases are super common.

When I get stressed out for long enough, it feels like my brain is rotting away.  I lose brain functioning (not a figure of speech – my cognitive abilities actually suffer in some big ways.)  But more than this:  It feels as if my brain has turned against me; I am bombarded by visions – images of violence being inflicted upon me.  I do not know what I can do.  I can distract myself.  I can try stress reduction techniques.  I can (and do) follow through with inflicting pain on myself in an attempt to stop the visions.  None of these things have ever worked too well when I’m actually in it.  When I was younger, I was “in it” on-and-off for years and years and years.  It would become intolerable.  It’d be beyond intolerable, but, of course, I had to keep waking up and living it, over and over again because there’s no getting away from your own mind.

Often, my brain would feel so rotten that I couldn’t read, I couldn’t make sense of things on TV or in movies.  I couldn’t talk to people or follow a conversation.  Eventually I couldn’t do any schoolwork at all.  (And it wasn’t about concentration, which is a common issue with people who are depressed.  It was specifically that synapses seemingly disintegrated.)  I made it through because luckily I had a therapist at home and a therapist at school, and they helped advocate for me to get accommodations I needed to not flunk or drop out of college.  I felt like dropping out.  I “got by” with very high grades, because I couldn’t have lived with myself with anything less.  ???  Does this make any sense at all?  I was barely functioning, yet I somehow ended up with very high marks.  If my grades had ended up slipping, I would have been even more abusive to myself.  Maybe the people around me could sense that.

Somehow, I could still write, surprisingly eloquently.  Although, it was limited to journal-style writing, not academic-style writing.  Like what I’m doing right now.  When I can’t seem to do anything else.

I get barraged with images spanning from mild (such as my face being slapped or my skin being cut) to morbid (such as being hacked away at with an axe.  Or my head being whacked repeatedly with a 2×4.  Or falling and hitting my head so hard that I pass out.  Or my neck being held down as I am whipped over and over and over again.)  These images are never sexual.  They are disturbing and unwanted.  I seem to have no control over them.

I have heard of some people struggling with urges to actively do something they do not actually want to do.  Like inflicting pain onto someone else.  Or stepping off the subway platform in front of a subway.  Or driving their car off the road and down a steep ravine.  There is an excellent graphic novel I would highly recommend that is largely about this compulsion.  It’s called The Nao of Brown.  What I’m talking about is so similar, yet strikingly different.  I am never the one in control.  I’m not harming anyone else or actively harming myself.  It is always an anonymous person outside the visual frame, inflicting violence on me.  I’m the object; I’m looking at myself.

Last week I told my therapist, “whoever made brains needs to try again.”

 


Blog writing shows promise for… future blog writing

Just for fun, I decided to go back to an old online diary and see what I had written (if anything) ten years ago today.  And there was one dated 2/13/04!  At this time, I was a senior in college, I had no plans, and I was trying to rebuild my sense of self after a destructively devastating depressive episode.

I had been in a screenwriting class the previous semester, and had had some difficulty with the class and the professor.  We’d had a few miscommunications.  For example, I disclosed to him some of my struggles (such as issues with self-injury) in an attempt to get him to understand why I needed to take an incomplete, going to class and doing the work later.  As a result, he decided to show the movie Secretary for the class, letting me know somehow (I don’t remember how) that this was his way of connecting with me.  But actually, I felt mortified by this.

So what I wrote exactly ten years ago was this:

___________________________________
[The professor} emailed me today, saying he had been reading my “blog,” [which he must have found by Googling his name] and in my head, I was like FUCK, WHAT SORT OF SHIT DID I SAY ABOUT HIM? Oh man. But it turns out I didn’t really say any shit about him, just wrote about a conversation the class had in which I was excluded from the female POV. And I was like, awesome! but in the journal, it sort of sounded like I felt sligted, because I call myself “other.” He didn’t realize I love “other,” so he wrote to me in the email that it is easy to recall times when one has been slighted, but one must also remember times when one’s unique humanity is recognized. (ex. showing Secretary in class.) So I just had to write back that I didn’t feel slighted – I was pleased, rather, to be excluded from being able to speak from a female’s POV. Yeah, I don’t know if this makes much sense, but, he wrote back saying thanks for the clarification, and he also said to keep writing.  “Your blog writing shows promise.”

Promise for what?
__________________________________

Even though I was still a long way off from using the words non-binary, genderqueer, or trans* to describe myself (apparently preferring “other” haha), it’s awesome to see I was thinking about it and writing about it.

With this guy, it’ll be just my luck that he’ll find this post somehow and strike up a long-lost conversation with me, haha.  College was weird.


I’m becoming pussified* by testosterone

*I made up this word, I think (actually I just looked it up, and I totally did not make this word up), but that doesn’t mean some people don’t like it.  Let me know if you don’t like it; I’ll think more about it.  The root word is “pussy,” which I don’t mean to use in a derogatory way.  More like it has a certain ring to it; it is an accurate descriptor for what I mean to say.  I’m writing about becoming a pussy when it comes to pain, basically.

Also, trigger warning: self-injury

Before I started taking testosterone (about 9 months ago), I had a peculiar, but not really uncommon, relationship to pain.  In many cases, I derived pleasure from pain.  I would create sensations of pain, within my control, in an effort to calm myself.  Also, when I’d hurt myself accidentally like for example, hit my arm on a doorway, I would feel alarm, followed by an adrenaline rush, followed by a pleasant soothing wave.  I think in retrospect, I had a lot of potential to really get into BDSM, except for the fact that before taking testosterone, my sex drive was pretty close to non-existent, so none of that was all that appealing in a sexual context.

Now?  If I hurt myself, it hurts!  If I accidentally ran into a doorway, it would not be pleasant in any way, shape, or form.  I remember the first few times I got hurt in little ways, in the first couple of months of being on testosterone; I was so surprised by how much pain was coursing through my body.  I just felt like, aaaaaah!  I’ve been swearing under my breath and feeling unnerved by how much stuff hurts.

When I’ve been feeling particularly upset or depressed, I will still have the urge or flash-image to self-injure myself, but there is no real desire to follow through with it whatsoever.

I haven’t self injured since last winter, which is so incredible to me.  I hated that it was such an effective coping strategy.  Probably my most effective coping strategy, for about 13 years or so.  I’ve had such a long, complex relationship to self-injury, both as a concept and as it relates to my body.  And I’m so glad to see it changing.

Is pain tolerance a gendered thing?  I’m sure the way people experience pain is all over the map, but are there generalities between genders?  Such as, females have a higher threshold for tolerating pain.  I have no idea, but I’m really curious about it.

And seriously, how cool is it to be living through such a transformation on so many different levels?  Like when I started testosterone, it never occurred to me that I might feel differently about pain and be cured (so far at least) of my self- injuring tendencies!


five months on T without physical changes

I’m happy to report that outward changes continue to be extremely minimal!  I’m going to focus on the most noticeable internal-experience changes, now that it’s been a good chunk of time and it feels like these changes are here to stay.

Pain:  I was in quite a bit of constant physical pain, mainly joint pain in my hands and arms, probably from repetitive motions at work and/or not eating enough.  Instantly, that was gone.  In addition, I’m just kind of suddenly getting a little bit stronger and work is way easier.  Also, I’m experiencing sensations of pain a lot differently than before.  Like, it’s unpleasant!  Whereas before, the constant joint pain was unpleasant, but certain types of pain (basically, self-inflicted) were pleasant and/or comforting.  I’m not going to say I’ll never self-injure again, but it does feel so far away from where I’m at right now.  That is so amazing to me.  I hated that I did that, even very recently, quite a lot.

Hunger:  Hasn’t ended up being sustainable unfortunately, but seems worth noting.  I felt hungrier for about one week, early on.  I thought eating was a worthwhile thing to do.  Briefly, I had chemical signals connecting food with pleasure centers in my brain; It was awesome!  Like, I would think about and look forward to getting to eat.  I would prefer certain things over other things, by a lot.  That quickly dwindled back to my normal feelings and attitudes about food, which are not very exciting.  Not at all.  Sometimes eating is a real chore, in fact.  The one thing that feels different now is that if I skip eating at a time I usually eat at, I will feel more motivated to catch up.  In that way, I will feel hungrier if I don’t eat.  That wasn’t really true before.  Also, I’ve gained 5 or 6 pounds, which manifests in the one externally noticeable physical change going on – muscle growth, mainly in my arms, shoulders, pecs, and abs.  Really psyched about this.  Can’t go wrong with more muscles!

Warm and Fuzzy:  I just feel cuddly and cozy.  I feel connected to my body in a way I never have before.  It’s really hard to describe, but I’m sure people can relate.  Like, my clothes feel soft on my skin.  Like, I’m walking on pillows and clouds, yet paradoxically, I feel totally grounded.  Like, I had no idea how jagged and disconnected I was before; I had nothing to compare it to.  These sensations have been dwindling over time – I think I’ve been getting used to them.  Like the clouds are not quite as soft and pillowy as they were at first.

Sex Drive:  Having a sex drive I can relate to is awesome.  Being able to have sexual thoughts and have that be connected to a body sensation.  My body responding to sexual stimuli.  Having totally different sensations everywhere on my body than I used to, in a good way.  Clitoral growth, which means actually being able to feel and experience erectile tissue sensations.  Previously, junk was so small and sensitive in a bad way, it wasn’t all that fun.

Anxiety:  The biggest, most drastic change, is anxiety:  totally gone!  Like general anxiety just disappeared into thin air.  I still totally over-think things and mentally worry way too much, but the fact that those thoughts aren’t connected to physical anxiety responses is a huge relief.  I was exerting so much energy on things that don’t matter!  I was feeling so drained and limited by these feelings that I couldn’t get away from before!  It’s a lot of work avoiding things that might trigger unpleasant internal responses; now I don’t do that nearly so much!  It is totally a brain chemistry shift – I don’t know how or why, but it’s not something I’m worrying about haha.  Also, emotionality overall hasn’t changed much.  I still have been experiencing the same range and types of emotions, which I’m happy for.  If anything, there might be a slight capacity to acknowledge anger and frustration now, which seems positive.  I’ll have to see how that plays into my life.

I’ve been on Androgel, 1%, 1 pump (1.25g) per day.  I started with 1.62% for about 2 months, but I started to see some changes that freaked me out (voice dropping and body hair growth), so I asked to switch to 1%.  Which I did for 2 months (voice went back to where it was, body hair growth stopped).  Then recently I started alternating between the two every other day.  Which has been working out so far, and I like.  I just hope I can continue to alternate my prescriptions.  I might be questioned on that…

I have had some other slight physical changes that seem common:  I feel warmer, body temperature-wise.  I’ve had some pimples pop up, particularly in places I wouldn’t normally get pimples – thighs, butt, armpit(?)  I’ve been slightly sweatier (my partner would say significantly sweatier, haha).

I want to be able to use testosterone for the rest of my life, but to not change much, physically speaking, over time, if possible.  So far, it does seem possible.  The internal shifts are too good, I couldn’t have even imagined, or dreamed them up, in advance.  I’m still just hanging out, revelling in it all.  One of the best decisions I’ve ever made.


chest piece

A few years ago, I answered a call out for submissions for a new zine about about the trans/gender variant community and our relationships to our chests.  I wrote a piece and never heard back about the project.  I bugged them 2 or 3 times about it and still got no reply.  At the time, this was really difficult for me because the piece was coming from such a vulnerable place.  It’s just been sitting as a computer file since then, but I’m pretty sure it belongs here:

_______________________________________________

Slowly dissociating from my breasts.  I used to have a love/hate relationship with them, but now I feel deeply disconnected and don’t think about them much.  Unless I think they’re visible under my clothing, in which case I feel really uncomfortable and fixate on hoping no one notices.  I’m lucky they’re so small.  I can get away without binding if I wear the right layers.  So I do that – limit my clothing options to save myself from tense back pain.  I don’t take that for granted, the fact that I do not have to bind. 

I used to cope with stress and frustration, fear and anger by cutting my skin.  I often ended up focusing on my chest.  A lot of times when I was alone, I’d be topless and fizzing with frantic energy.  I’d envision their gory, bloody removal and bask in that thought.  But I also loved them.  It felt good when they were touched; they fit perfectly and comfortably in the palm of each hand.  They seemed like they were a part of me / not a part of me … a part of me … not a part of me.

FROM 5/15/04: I was just wanting something intense to happen. Just by myself, here at the apartment. In addition, I have been obsessing about the removal of my breasts again. There was quite a while when I was ok with them, but I’m not anymore. So I had to pretend like I was going to cut them off. I used that knife and dragged it in sections to form a circle around both. Not deep. It hurt. No blood, but it’ll leave red marks. Like 2 bull’s-eyes. I kind of liked it, but now I look at them and what I did is fucking scary. No emotions to match these actions.

Now though, I don’t act out toward my breasts or dwell on the fact that they’re there. It’s sort of like I don’t really know them. Although sometimes I squeeze my nipples because it feels good, no one else can touch me anywhere near there, or oftentimes, anywhere on my skin at all.  That chest is not a part of me.

I got my first tattoo this past fall.  The image is a scratchy line drawing, a symbol I came up with to express my connection to a deconstructed gender identity.  It’s on my chest, below my right clavicle – to the right of my sternum.  I thought a lot beforehand, while thinking about placement, about whether to incorporate some pretty prominent scars… whether to see if the tattoo could hide them… whether to accentuate the scar lines with the tattoo…  In the end, I wore a tank top that would hide the scars from the tattoo artist, and had the tattoo placed near them but not with them.  Too much shame still surrounds them; they are too personal.  The experience itself was exhilarating and euphoric; I was zoning, reaching a blissed-out state.  And also pushing thoughts of self-mutilation from my mind with every pulse of the tattoo machine.  Hours later, I was out to dinner with my person (who had also gotten a tattoo that afternoon), and emotions unexpectedly flooded in.  Tearing up and unable to dissociate from the parallels between cutting my chest myself and someone else inflicting pain there.  I talked about self-injury and she looked worried.  She knows that was in my past, but I had never really talked about it with her.  I wasn’t regretting the tattoo; I was realizing that the experience had been triggering, no matter how tough I seemed and how good it felt.

I’d like to get more tattoos on my chest.  I fantasize about swimming, being shirt-less, with a sweet chest piece on display.  I am pre-testosterone and pre-surgery (or am I no-hormone and non operative?  I have yet to know).  For now I continue this non-relating to my breasts/chest.  Maybe someday that could change.  Maybe someday I will have the chest I envision (flat and muscular, a male chest).  Although I don’t feel completely male, I don’t feel completely here, in this body, either…

____________________________________________________

I wrote this in 2010.  I’ve been feeling differently about my chest within the past few months, which is exciting.  I had been increasingly wanting to get top surgery, for sure, at some point.  But since being on this low-dose of testosterone, I’m not so concerned about it!  It feels good to be touched there.  Also, my pecs have gotten a little more prominent / maybe my chest is even smaller than before.  For now, I can live with it!  (We’ll see what the future holds.)

Also a quick rant:  If you are collecting submissions for a project, a rejection letter / email is 100X better than no email at all.  Or, if you end up just dropping the ball on your project, please let people who submitted know the status.  I was wondering for a long time what happened after submitting my piece.