So Simple…

One of the things I see some of my friends and family struggle with when I disclose is how to relate to me. They can become so worried that they might offend me that their silence may come across as rejection. Maybe I am more sensitive to others emotional response or maybe it’s because I’m transitioning at an older age, but I know slip ups are going to happen. I know the wrong name or pronouns may be used. I know there will be questions. I also know they will never be able to truly understand what it is like for me in my head, heart and soul. Some seem shocked when I share with them that I don’t expect them to understand nor do I expect them to be perfect or to not have questions. The big thing is, are they respecting my need to transition? If they are respecting me and trying to get my new name and pronouns right…I can’t ask for more.

Yes, it really is that simple. Many of my family, I only see once or twice a year. I have a cousin who I haven’t seen in quite a while. My aunt, her mother, called her and her siblings this weekend to let them know about my transition. My cousin sent me an email the other night that had me in tears…good tears. I’m sharing it here but I have removed both of our names to protect her identity. I share this though to let you know it really is this simple…

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Repeat Labs

One of the frustrating aspects of transitioning is you really have little to no control over how things go.  There are so many factors that play into it all.  What age are you?  Where are you in your emotional and physical stages of development?  Will your body accept the hormones?  What about diet and exercise?  Every single on of these factors impacts how quickly the physical changes happen and how extensive they will be.  It is also a common misconception that you have this infinite amount of time for the changes to happen.  In reality, it is about three years, with the majority of the changes occurring from approximately the 6th-24th month after starting HRT.  Unfortunately, if certain things don’t go well and impact this timeline, the type of development we hope for may not happen.  Additionally…we really have no idea how we will look once the changes are done.  Talk about venturing into the unknown!

For me…I have had issues.  My journey has not gone smoothly for the past several months.  One check mark against me was that I am in my early 40’s.  That means I have a broader chest and broader shoulders than I would like.  But I also remind myself that there are women with broader chests and shoulders.  I’m not saying I look like a middle linebacker or anything…but my frame won’t fit the image of the cute, dainty woman.  Fortunately, I accepted that along time ago.

Sooooo…when I began my hormone therapy, things started off well.  I noticed my skin becoming much softer in the first 4 weeks.  At 8 weeks, I could notice some changes in my face.  At about 3 months, I could feel breast buds develop and the girls have hurt like hell ever since.  At my 6 month follow up, my endocrinologist said all of my development was exactly where it should be.  We increased my oral estrogen from 2mg to 4mg, labs looked good.  Not perfect, but good.  My estrogen was in the low 80’s (target: 100) and my testosterone had fallen into the mid 300’s (target, less than 100).  My doctor didn’t seemed too concerned.

After that appointment, I noticed that I wasn’t experiencing much in the way of changes and this is where the changes should be happening quicker.  While yes, I was a little concerned, I also reminded myself that everyone changes at a different pace and so I kept going through my days.  When I went in for my next appointment though, I was in for some shocking news.  While there had been some minor changes physically, my labs were NO WHERE NEAR where they needed to be.  At this follow up, my estrogen should have been at 150 and my testosterone under 100.  These labs had my estrogen at 40 and my testosterone in the upper 500’s.  No wonder I wasn’t experiencing much in the way of changes and I had been so moody!  And men…no smart ass comments on the moody statement, please…

So after these labs, my doctor increased my oral estrogen and told me to come back for labs in one month.  When I came back, my estrogen was up to 53 and my testosterone was in the upper 200’s.  We upped my dose of estrogen again and I was told to come back in another month.  Repeat labs were still off…estrogen at 59 and testosterone in the upper 100’s.  I was an emotional wreck at this point.

The worst part about that most set of labs was, as I was sitting in my internship office crying about my numbers and scared about what that would mean for my final appearance, ability to pass successfully and ultimately my own safety…I reached out to a friend for support.  As I said, I was going through tissues like you wouldn’t believe.  I ended up feeling kicked in the gut even more as my friend, who had been supportive up to that point, lashed out at me and told me I was being bitchy and just needed to be grateful for the changes that had occurred this far.  Needless to say…I don’t reach out to this friend for support anymore.  And thankfully, my sister and other friends listened and took the time to let me voice my concerns and fears.  Often times, when these poor lab results come in, we aren’t looking for anyone to fix anything.  We just need to talk to process what is happening.  Men…*hint, hint*…you don’t have to fix everything.  Just let us talk it out and process things as much as we know you hate doing that.

After that round of blood work, my doctor placed me on transdermal patches for estrogen.  That has been working much better.  In 4 weeks and on 0.1mg of estrogen per day, my estrogen level finally increased back to 78.  While not perfect, my doctor was much happier with that result and they have increased my dosage to 0.2mg per day.  I have to have labs drawn AGAIN in another 10 days.  Their hope is my estrogen levels will be up in the 130-150 range.  If that happens, my doctor will consider me right where I need to be until they increase my dosage again.  Fortunately, I am noticing physical changes again, which has given me a great deal of peace.

I’m hoping this works with the patch.  My emotions are all over the place some days because of both the hormone levels and stress.  Additionally, neither my doctor nor I have any real idea how this will impact my final appearance.  No one can really say that the months I have lost with my levels being off will be lost so far as development or if my body will kind of pick up where it left off when my estrogen levels fell so much.  I also hope my poor arms will forgive me for all of the needle sticks recently.  I’m tired of getting poked for blood work…

lab-work

Understanding It All

One of the things I struggle with, especially in light of events from this past week, is how to explain who I am to others.  I determined a while ago that explaining sexual identity is much easier.  But how do you explain this constant dysphoria with your own body?  Unfortunately, too many people confuse gender identity and sexual identity.  I am not even going to discuss my own sexual identity here because right now, that is one thing I really want to keep to myself.  The people who know me best know my sexual identity and that is enough for me.  I do think discussing sexual identity for the transgender population is important though.

So let’s start with sexual identity.  While some people may still struggle understanding someone being attracted to someone of the same sex from the WHY perspective, I witnessed a homosexual friend of mine try to explain to someone else how he thought.  He was explaining to another male friend and the conversation went like this…

Gay Male:  Ok…do you see that dark haired woman sitting over at the table? *points in the general direction*

Straight Male:  The one reading her iPad?  Yes.

Gay Male:  Yes.  That one.  What do you think about her?

Straight Male:  She’s beautiful.  If I wasn’t dating ****, I might consider going over and flirting with her.

Gay Male:  Ok…so you see the blond guy with the beard and glasses to your left?

Straight Male:  Yes.

Gay Male:  That’s how I feel about him.

By breaking it down in this manner, my gay male friend was able to provide insight into his sexual identity that my straight friend could comprehend.  He gave a real world example that provided a smack of reality and personalization.  It truly was a simple conversation but it finally opened our mutual friend’s eyes to how sexual identity works.

So how does that relate to gender identity?  Honestly…It doesn’t!  Unfortunately though, too many people tie the two together.  Transgenders identify as homosexual, bisexual and heterosexual.  how that breaks down, we will get to in a minute.  So what is it about a transgender, or even a gender fluid person, that drives their gender identity?  I will be honest and say that I cannot break it down into easy to understand terms or phrases.  so I will try to explain the things the let me know I was struggling with my gender identity.

  1. Do you ever look in the mirror and hate what you see?  I am not talking about hating the fact you put on extra weight, your hairline is receding or graying or those wrinkles are starting to appear.  I am talking about you look at yourself in the mirror and you feel as though every single thing about you is wrong.  You imagine having breasts when you don’t or you would give anything to have them removed and have that boyish flat chest.  You imagine having a vagina in place of a penis or vice versa.  You wish your body hair was like that of the opposite sex.  You wish your voice resembled that of the opposite sex.  You dream of having the body shape of the opposite sex.  These are the some of the very thoughts that have gone through my mind for years.
  2. When you look in your drawers or closet, do you feel disappointment or disgust at the clothes you are choosing from?  For my entire life, I looked in my closet at male clothing: polos, khakis, suits, oxfords…and I wanted to wear anything BUT these clothes.  As much as wearing a bra sucks at times (and yes…I rip mine off the moment I walk in the door from a long day), I wanted to see bras, cammis and the like in my drawers.  Opening the closet, I wanted to see cute sandals, heels, wedges and boots, dresses, skirts, boat neck and v-neck tops and things of that nature.  I wanted bright colors for every season.  I would look at my ties and all I wanted to was to replace them all with necklaces, bracelets and earrings.
  3. Activities are difficult to use as a means of measuring sexual identity.  I have always loved some of the traditional male activities.  I love college basketball and football.  I love to grill.  I love working on my house.  But I also adore distinctly feminine activities.  I love getting my nails done.  I love fragrances.  I love to entertain and cook for others.  I love relaxing in a bubble bath with candles burning and music playing.  I was always the one in my previous relationships that, when entertaining, would pull out the family silver and serving platters.  In one of my previous relationships, the woman I was dating at the time looked at me and said, “You realize you would make a better wife than me, right?”  She has no idea how right she was in that statement.
  4. Is your mind in chaos?  Do you find yourself thinking and processing things differently than peers of your genetic gender?  I spent my entire life with my mind like some constantly swirling tornado or hurricane while all of my peers talked about how as they reached their mid-20’s and their minds and thought process, as a whole, stabilized more.  Mine never did that until I began hormone replacement therapy and my testosterone levels decreased significantly.  That brought an enormous amount of peace to my mind, heart and soul.  While I have had some struggles with my estrogen levels being where they should be, as those have increased, despite getting used to the changes, I truly do not have the mental turmoil I used to have every single day.  But yes…for the record…I can cry at the drop of a hat and can be a totally flighty ditz at times now.

These are just some examples of things I experienced in my mind for most of my life.  As I have said before about other things…these reflect only me and my feelings.  Everyone is unique and different.  But hopefully this gives you some idea of what may be going through the mind of someone who identifies as transgender.

Both fortunately and unfortunately, there is no diagnostic test to determine whether someone is struggling with their gender identity.  In a world where diagnostic tests like the Beck’s Depression Inventory and others provide clinicians and clients a clear path to determine what is going on, questioning one’s gender cannot be done in this manner.  It requires a great deal of thought and discussion between the person questioning their gender with family members, friends and/or a licensed counselor who specializes in gender identity.

So now…to a topic that always gets me more than a bit fired up…sexual identity in transgender individuals.  As a couple of my friends have found out (in not so pleasant fashion), the gender I identify with has absolutely nothing to do with who I want to sleep with.  The range of sexual identities within the transgender population is no different than within the congruent in sex (cis) population.  I will break this down very simply…

  1. If a transgender person is attracted to the sex opposite the sex they identify with, they are heterosexual.  So…If I am attracted to men, then I am heterosexual because I identify as a woman.
  2. If a transgender person is attracted to the sex of the same gender they identify with, they are homosexual.  So…If I am attracted to women, then I am homosexual because I identify as a woman.
  3. If a transgender person is attracted to both sexes…yep!  You got it!  Bisexual just like the rest of those attracted to both. 🙂

An important thing to remember when talking with someone who is transitioning, especially when they first disclose to you…Don’t ask who they are sexually attracted to in the first one or two conversations.  Despite what many think, transitioning can really screw with your sense of sexuality.  Some know who they are attracted to and it all remains the same through transitioning.  Some are attracted to one gender in the birth gender and it changes as they transition.  Some people are still struggling to figure out who they are attracted to before transitioning.  It is just important to know one identity does not define the other.

For those who may have questions, I hope this helps.  If not…you can always ask me.

Oh!  I am sorry this is so late.  Happy Easter!

The Numbers

Sometimes I wish that identity wasn’t so complex.  I honestly believe that the older we get, the less we think about our “identity” and what that means to us.  As teenagers and young adults, we spend so much of our time focusing on our identity and who we are.  But as we get older, as we become settled into our identity, we think about it less and less until a life change such as marriage, birth of children, divorce or that scary empty nest stage hits.  We just go about life living our gender, sexual, professional and personal identity with little thought.  I’m not saying people who are comfortable with themselves don’t struggle with their identity some on a daily basis but I do believe its different based on conversations I have had with my sister and a few friends.

For me and many of those I know who are transgender, the concept of identity and figuring out who we are is a constant battle.  For starters, many of us spend years and an enormous amount of emotional energy just figuring out who we are.   This is especially true if we have a family that many see as traditional or conservative.  And fears of discrimination in social settings, the work place, housing, health care, etc. only make this worse.  Many transgenders spend YEARS denying who we are and trying to come to grips with the constant fear, depression and anxiety we feel every day as we struggle to survive.  To understand the depth of this, let me share some statistics from the National Alliance on Mental Illness (https://www.nami.org/find-support/lgbtq) …

  • Between 38-65% of those who identify as transgender will experience suicidal ideation.
  • Those who are rejected by their families and lack that family support are 8 times more likely to have attempted suicide.
  • 25% of LGBT individuals have a substance abuse disorder, compared to 5-10% of the general population.
  • LGBTQ teens are 6 times more likely to suffer from depression than the general population due to discrimination, lack of resources and lack of general support.
  • LGBTQ individuals are less likely to seek out health care, even emergency health care, due to fears of discrimination, difficulty with access of services, doctors not having adequate knowledge of health care needs and/or inability to pay.  I am working on a project for my internship addressing cultural competency in health care and while I may be off on my numbers (and I feel bad I don’t have the reference on hand), I believe approximately 40% of LGBTQ individuals will delay health care, even in emergencies, for these reasons.

As you can see, the impact of coming to grips with who we are can be incredibly difficult.  While this may be scary for some to read, and is a bit difficult for me to share, I think it is important to put this out there.  How does my own mental health experience compare?

  • I have been actively suicidal 5 times in my life.
  • On one occasion, due to a lack of people who could stay with me to ensure my safety, I was hospitalized in an inpatient treatment unit for 5 days.
  • I was on antidepressants almost non-stop from the age of 22 to the age of 43.
  • Until I had been on hormone replacement therapy for 6 months, I had never spent more than 6 months off of antidepressants.  I have now been off of medications for depression and anxiety for 1 year.
  • I avoided telling my mental health providers about my gender identity concerns unless they, themselves were part of the LGBTQ community until 2 years ago.
  • My PCP, who I adore, acknowledges he had absolutely no training on transgender health in medical school or residency.  What he learned, he learned because another doctor in his residency program transitioned during residency.  Many doctors who do not know about transgender health make guesses on proper treatment, hormone levels, medication doses, bully patients or end up relying on the patient to educate them…none of which is safe.  My PCP actually informs me when he doesn’t know or understand something and asks my permission to reach out to others for information.  I am extremely fortunate but yet my PCP doesn’t know due to lack of education.

Now…it is important for me to say this is information on MY journey compared to the national averages.  My depression and anxiety also need to be considered in context with my life.  There were multiple other circumstances that impacted my mental health over the years: the deaths of multiple key family members, an unhealthy marriage and the divorce that followed and nearly being fired from work twice when bosses questioned my gender identity. Of course, while I had these other factors, there is also the question of how well would I have coped with them had I been able to freely express myself at those times?  Every individuals journey and experiences are different. I want to say this…my journey is also no better or worse than anyone else’s.  It is just my journey.

Why do I share all this?  *pointing up* Identity.  How do we define ourselves?  How does society define us?  How do we integrate the two?  What parts of our identity are most important to us?  Again, for some people this is easy.  For some of us, we spend a significant amount of our lives putting up a this front because we fear for our homes, safety, jobs and families.

As I disclose my gender transition to people, I often hear, “I never would have guessed you were transgender!”  Like many people struggling with mental illness, substance abuse, family struggles and so forth…we become very skilled at presenting the front everyone tells us we should present.  And people wonder why we are so exhausted when we disclose?Shadows

Highs and Lows

I am not sure who will read this and out of those who read this, who I have shared this with or not.  I am currently finishing up my Master in Professional Counseling.  Counseling is what I have always wanted to do and I am LOVING my internship.  Along with the amazing clients I get to work with, I also work with an amazing team.  One of the neat things we get to do as interns is facilitate a group counseling session every week.  In my group, we use what we call the high/low discussion.  What is that?  Everyone reports one high since last session and one low.  It helps get conversations going and allows each participant to be heard before delving into deeper issues.

I originally created this site about a year ago and I have done NOTHING with it since.  There have been a lot of highs and lows in that time period.  Lately some of the negatives have been a lot to carry and I fully admit, I am starting to feel guilty for unloading to a small group of people.  Also, as scary as it is to share some of these experiences, fears and failures, along with the positives…these pieces of information need to be shared to help create discussion on the topic and end the stigmatization of those who are transitioning or who choose to live a gender fluid life.

To finally get this thing going, I think some discussions about the highs and lows might be a good place to start.  Transitioning is a roller coaster ride to say the least!  And in case you are wondering about the title of my blog…I must give full credit to Lauren Alaina because her song “Road Less Traveled” has become a bit of a theme song for me.  I hope she won’t mind that I took that song title as a title for this blog.