Thoughts on getting a diagnosis

Posted: November 6, 2014 | Author: | Filed under: coming out | Tags: , , , , , , , , , , , , , | 25 Comments

Last week in therapy, I talked briefly about planning ahead for top surgery one day.  I said that I might want to do this, maybe as early as this coming summer.  That’s the most concrete thing I’ve ever said about the subject.  She asked what some first steps would be, and I replied, “look into whether it would be covered by my insurance.”  That’s kinda something that would really help frame it in my mind, the answer to that…  She asked me how I’d do that, and I really floundered with the actual words I would use if I were for real making a phone call to insurance people.

It’s too sensitive and too hypothetical in my mind still, and I could barely even say, “female to male chest reconstruction surgery” out loud, just to her.  She got it and said, “what you could do is find out the code for that type of surgery, and when you make the call, you can just ask about the code as opposed to using the words.”  I said, ok, yes, I think I could do that.  She said she would look it up for me and email me the code.

She ended up finding out a ton more info than just the code, on her own.  She said certain info led to more questions and she ended up just calling.  Basically, she got all the information for me, for which I am so grateful because it would have felt too emotional for me to do on my own, at this time.  It is NOT covered by insurance.  I’m not surprised.  I told her that doesn’t change much – I’m still considering it.

We briefly talked about it again this week, and about gender identity in general.  She said that some surgeons require a diagnosis of gender dysphoria for X amount of time in advance (glad she is doing the relevant research!), and should she be diagnosing me with that?  This turned into a heated discussion (on my end), with the conclusion that I do not care about that, but I am OK with that, if it’s in order to help along a process.  And that, again, I don’t really care to know what she is doing in that regard.

The idea of being diagnosed with a mental health label is contentious in my mind, and she knows this.  She gets it.  I’ll be writing about this further in my next blog post, probably next week.  A teaser for what is to come:  I was misdiagnosed with bipolar disorder at the age of 17, and held onto that belief strongly for about 6 or so years.  That’s a heavy duty label to be grappling with, unnecessarily.

My therapist is not a gender therapist, but she is doing right by me more than any other therapist I’ve ever had (and some have been gender therapists).  There was a time where I thought – we both thought – I would need to go to a different therapist in order to progress with any medical transition steps (I did this in order to access testosterone, kinda unnecessarily in the end).  I don’t think that anymore.  Why can’t she be that person?  I think she is getting on board with, she can be that person.  We concluded recently that a big goal for therapy is to make some progress with transgender-related issues and decisions, and I said I would send her some more general information to get her started.  I sent her the following resources:

Genderqueers, Gender Rebels, and OtherWise in the National Transgender Discrimination Survey

Trans Research Blog – a compilation of what is out there

Trans Bodies, Trans Selves – a great book to have on hand

Anyone have other essential resources?

More than once, she has said, where is the data?  Where is the research that says this and this and this are best practices?  And I just keep responding, There needs to be more research.  And I just keep shrugging.  IT DOES NOT EXIST.  (Yet.)  I don’t know whether she believed me initially, but she may be starting to realize it by now.  It’s maddening how little is out there.

Do I think that I have gender dysphoria?  Whoa.  That is going to take way too long to pull apart right now.  That’s probably for a future post!  Do I mind being diagnosed with that for the purposes of having a wider selection of surgeons to choose from if I do decide to move forward with top surgery?  Not at all!  It’s close enough.  (Although I do strongly, strongly wish more surgeons would get on board with the informed consent model.)

Edit:  Now that I think about it, I’m sure I’ve already been diagnosed with gender dysphoria by my primary care physician (for my testosterone prescription) and probably at least one other therapist.  To me, it all feels so arbitrary.

From whimsical musings to invasive ruminations on transitioning

Posted: September 17, 2013 | Author: | Filed under: Testosterone | Tags: , , , , , , , , , , , , , , , | Leave a comment

For over a decade, I had been going back and forth hundreds (thousands?) of times in my head about whether transitioning was right for me or not.  Or if not every aspect of it, what about this but not that?  Will I ever move forward with some aspect maybe?  At some point not that long ago, I seemed to come to the conclusion that no, I wasn’t going to move forward because if I were, I would have done something about it by now.  And I haven’t, so I’m not.  I must be lacking some internal drive, so it must not be something that I need to do.  I settled on identifying as genderqueer and trans* but not planning on medically transitioning in any way.  And I seemed satisfied with that.  (?)  But not quite, or, no, not at all actually.  Because it was still on my mind.  Sometimes just as whimsical musings in the back of my brain.  Other times as pervasive/invasive body-dysphoric consistent ruminations.

I guess I always thought that if I did move forward with something, it would be top surgery, and not HRT.  Because I never want to consistently pass as male.  I want to continue looking androgynous forever.  Top surgery could help with that (although I’m fortunate in that I can get away without surgery, and without binding, in hiding what I have).  Taking testosterone would be going further than I want to go.  So I thought.

I thought it had to be all or nothing.  I thought I had to have a case ready about how I need to transition, in order to access testosterone.  And I don’t need to transiton, and I really don’t like to lie.  I thought I would need a letter from a therapist, and to jump through all these hoops, to access testosterone.  And I wasn’t even sure I wanted it!  Eventually I reached a point where I just knew that I needed to try it, at some point, just so that I could know.  So that at the very least, I could think about it differently or think about it less often, as it relates to a decision about something I should or should not do.

I have this awesome therapist.  She doesn’t know much about trans* identities.  I’m fairly certain she had not previously had a trans* client before, although I could be wrong.  I’d been talking to her about this stuff, and she’d been following along, more or less, in stride.  When I would say I need to try this out, she would say, “then why not!”  I asked her if she’d write me a letter if need be, and she said she wouldn’t be comfortable doing that; she doesn’t have enough knowledge about it.  Still operating under the assumption that I would need a letter, I started also seeing another therapist, basically for the purpose of getting a letter.

This second therapist gave me the name of a doctor during our first session.  Turns out that, apparently, I didn’t need a letter!  Turns out I didn’t need to convince anyone at any point that I wanted to transition medically.  I never once had to lie to get my hands on testosterone.  And once I did get my hands on it, I was given the freedom to experiment with the dosing, basically use as much or as little as I wanted.  Turns out I want to use as little as possible.  Turns out I might be able to stay on it for the rest of my life without looking any more masculine than I currently do (this has yet to be proven, but it’s been 6 months now, and so far, so good).  And the internal effects, with this super low dose, are significant and pretty much better than I could have even hoped for.

Basically, for all those years of wondering and second-guessing and processing and feeling anxious and obsessing and daydreaming and doubting myself and ultimately sort of concluding by default that I wouldn’t take any steps forward, actually doing something about it has been one of the best decisions I’ve ever made.

And in retrospect, it isn’t like there’s no turning back, to some extent.  Testosterone is a slow-moving substance in terms of long-term changes… I’m really enjoying the internal forward momentum though.

chest piece

Posted: August 6, 2013 | Author: | Filed under: Uncategorized | Tags: , , , , , , | Leave a comment

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:

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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…

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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.

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