Fluid Gender

I recently read a blog posted by an online friend which included another post-op trans woman’s regrets of transitioning and having GRS.  She had described how her feelings to transition and being a woman were more sexually motivated, and that after surgery she could not have that satisfaction.  She mentioned that she misunderstood the drop-off of sexual desire due to hormones as a sign that she was doing the right thing.

My first reaction and thought was how it was a good example of why the real life test or real life experience is important.  I assume the person lived as the gender she wanted to be before having the surgery, based on the comment of her “following the rules”.  If she had, then I wondered if she truly did the necessary soul searching — the second-guessing and what-ifs playing in her mind over and over.  When it comes down to it, the physical aspects of transition are not as important as the emotional aspects.  Being emotionally ready for the changes is very critical to anyone’s successful transition.

I started my transition almost two years ago, and if I had had the money, was single, and could have had the operation sooner, I probably would have jumped in head first and had GRS.  But with my therapist’s guidance, I slowed down, following her suggestions to explore my femininity and get out in society presenting as a female.  I also wanted to do the changes in steps, where I could evaluate each step to see if it was enough for me.  First, I had facial and body hair removal, as it was one thing that always seemed to bother me (and guys have it done, so no harm there).  Then I attended several transgender conferences to “live” as a woman 24×7 for one full week.  I went out to public places in the daylight, such as a shopping mall and busy restaurants.  I wanted to get a feel for how I would be treated and how any negative reactions would make me feel.  Would I feel more like a “man in a dress”, or would I feel like a woman, regardless of how people treated me?  These exercises are very important, as they can let us know that if we are uncomfortable as a part-time woman, then we’re not ready to be full-time.

My soul searching has been going on now for quite awhile.  There are days when I think I just need to stop stalling and move forward with it all.  But I am very cautious, as there is much at risk.  I question myself over and over about what is right.  Am I that uncomfortable living as a man?  Can I just keep hiding this for the rest of my life?  Would cross-dressing periodically be enough, especially since my wife would be accepting of it (as long as I do it discretely)?  Would being on hormones but continuing to live as a man with no surgery be good enough?  Twenty years from now, would I be happier living as an older man or as an older woman?  These are just some of the questions I have asked myself over and over.  For me, I need to be as sure as I can that the distress and discomfort I experience is impacting my life enough to move forward with transition to full-time and eventual surgeries.

In my honest opinion, I think that gender is fluid and NOT binary.  I think there are many who are on one end of the spectrum, where the difference between body sex and gender identity are so polar that they absolutely know that they are “in the wrong body”.  Then there are others who are somewhere close to the middle, with just enough feminine-mindedness that they experience some discomfort and have a notion that something is out of whack, but can otherwise function in society as a man.  There are days when I think I fall into that category.  I had an acquaintance recently tell me that you should know you are a woman inside if you are truly transsexual.  I have to disagree with that, as that may be true with some but not all.  I think we all have within us, both natal male and female, a degree of masculine and feminine nature (and when I say nature, I mean born with it and not learned).  Those balances are different in each of us, and could even change based on how much we suppress or allow those natural tendencies.  It comes down to really understanding ourselves, to find the “true self”.  Once that is done, then the surgeries and other aspects become window dressing.

I hope we all take the time to fully understand ourselves, as that is the true journey.

Tiana 🙂

The UK NHS Postcode Lottery

I am Stephanie Butterfield, and I am transitioning on the UK PCT-led NHS system. Whilst i feel fortunate to have had my trachea shave/vocal cord surgery and facial hair removal already, with my GRS also guaranteed when the time comes, I do however feel very frustrated at the UK postcode lottery, not just for me, but for others too.

The PCT’s (Primary Care Trusts), often treat transsexual procedures as unnecessary, or simply cosmetic, not thinking beyond their small mindedness and thinking about the TS patients’ quality of life.

The postcode lottery works like this – one PCT will fund a girl’s breast augmentation and facial hair removal, whereas another PCT will not. How, you may ask?  If it is the NHS (National Health Service), we should get even and equal access to funded treatments and operations available on the NHS.

However, each PCT has the right to decide funding at a local level; it’s this which allows the postcode lottery to thrive, leaving many transgirls and transguys frustrated at the unfairness of it all.

Another irritating feature of the NHS transition route is the waiting one has to do, from GP (general practitioner) to GIC (gender identity center), from 1st opinion to 2nd opinion, from 2nd opinion to the operation itself.

I am currently at the waiting for my 2nd opinion stage, an 8 and a half month wait as I write, and my latest frustration is being blocked from seeing an endocrinologist.

Stephanie

Review – “BBC America Reveals: Sex Change Soldier”

I was a little apprehensive going into the latest episode of “BBC America Reveals” – titling it “Sex Change Soldier” made it sound like a tawdry tabloid exposé rather than a serious documentary on one person’s journey from male to female. But I knew they’d done previous respectful treatments of a young transman and three partners of transvestites, so I approached it with an open mind.

Captain Ian HamiltonThe format was a little different in that the female documentary-maker (unnamed, and unseen) gave a narration that showed she became a true friend to Jan Hamilton during the filming. Apart from a few interactions that Jan has with people in her life, we don’t get to see or hear from others during the hour-long show. From the start, when we see footage of “Captain Ian Hamilton” of the Elite Parachute Regiment hiking through the jungle, Jan is on-camera almost all the time.

We are introduced to Jan, who tells us that she is a 42-year-old woman trapped in a man’s body. The narrator informs us that Jan will be the first officer in the (presumably British) armed forces to “undergo a sex change” – transition. She continues on to say that during the making of the documentary, she came to fully understand the price that Jan must pay to go through this.

Jan takes us through her daily routine of voice exercises, putting on makeup, tucking, and – after she shows us her thinning hair – putting on her wig. “I’m still Ian when I wake up.” Each morning she jogs four miles, in an effort go from 224 lbs and 14″ biceps, down to 154 lbs. Despite only having dressed in public for four months, Jan is ready to go to Thailand for FFS, “to have my face rebuilt to make me look like a woman”.

Jan Hamilton“I hid behind this big wall of being a paratrooper … I hated myself and I hated the world and I hated being in the world.” Jan had an overpowering sense of the wrong person, the wrong body.

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MSNBC’s ‘Born in the Wrong Body: A Change of Heart’

[Update to the review: Josef has contributed to the discussion forum on the show here. Worth a read. ]

I knew that I wanted to write a post about ‘Born in the Wrong Body: A Change of Heart’ before it even aired, especially so because many of my friends told me they were reluctant or nervous about watching it for themselves. As someone who has not made a gender transition even once (let alone twice, or even three times!) I felt I could view it dispassionately and objectively.

However, after seeing it, I found myself affected in quite unexpected ways. The aspects that I expected to feel negatively about were just not there, and my overall reaction was very mixed – finding both positive and negative emotions rolling together leaving me … somewhat neutral. I have decided simply to write a synopsis of what we were shown, and leave it up to the reader to come to their own conclusions. I’m sure if this spurs you to watch the show, you can find it on YouTube, or coming up in MSNBC’s frequent re-run schedule.

I’m going to use the pronouns that (mostly) match the current gender presentation of the two people shown in the documentary. (If this offends you, I’m sorry – in a case like this, there simply is no “right way”.) Without further ado, here’s what we learn:

It was stressed up front that of all those who transition, only a very, very tiny proportion ever “go back”. In fact, I suspect the two subjects we follow were the only ones who could be identified and were willing to have their stories told. Most similar documentary programs feature three or more subjects to give a wider experience.
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Transgender Access to Health Care

I want to start off by just apologizing for being a little haphazard in my posting here. I am hoping to get on a more regular posting schedule. I have had a lot of different things going on, and I have had a lot that I have wanted to write about but little time to do it. I do appreciate those who have stopped by to see what is going on here, and I look forward to writing more and engaging in some discussions of the topics and issues.

I just got off the Town-Hall conference call with Donna Rose, Jamison Green, and Becky Allison. I thought it was a good start, and I hope there can be more opportunities for our community to come together like this. I think one of the major benefits of calls like this is the breaking down of economic barriers. Today’s topic was essentially health care, and underlying the need for coverage is the need to break down economic barriers. Far too many in our community are unemployed or underemployed. For many, making the journey to a conference may not be possible for economic reasons. Calls such as this will help those members of the community to be able to reach out and interact with the Transgender community at large. I think this will also be of value to those who may live where there is no trans community to speak of. 

Now on to the topic. I think most of us have heard about the AMA resolution in June and the WPATH statement in July. These were both significant statements. I would like to start with the AMA statement, which was actually three statements related to removing barriers to careremoving insurance barriers, and removing financial barriers. The one thing that struck me was the repeated use of GID throughout the statements. They did, however, reference GID as a medical condition, and referenced not only the DSM but also the ICD. Now, I was not familiar with the ICD until this evening. I would appreciate information about it if anyone knows a little more about it, and how GID is treated in the ICD. I think that it is positive that the AMA referred to GID as a medical condition as opposed to a mental disorder. I am curious about how this statement in conjunction with the WPATH statement and other papers could serve to help legitimize our need for treatment if GID were removed from the DSM.

I am behind Kelley Winters’ efforts, my only concern being that we have another avenue by which can can continue to gain the medical treatments necessary to transition. I know some have argued that they do not want to be medicalized. To those I would argue, how can one justify medical treatment in the absence of a medical condition. I want to be medicalized, I just don’t want to be pathologized. I believe that part of our process towards equal health coverage is strengthening the medical need and the recognition of GID in the medical community as a medical condition.

I rather liked the fact the the WPATH statement included things such as chest reconstruction and FFS. As Jamison mentioned, chest reconstruction is the only surgery that many FTM’s want at this time, and for many of them, this surgery is very validating for their gender presentation. The WPATH statement acknowledges that the path to transition is about more than GRS. There are other surgeries and procedures, which some consider cosmetic, that go a long way towards helping to affirm ones gender identity and help make a transition more successful and less emotionally painful (I think anyone who has been through laser or electrolysis knows these don’t reduce physical pain!). 

I think one of the most powerful things in this statement was the AMA’s statement of dispelling the myth that treatments, procedures, and surgeries for trans people are cosmetic or experimental. For us, these procedures are necessary for us to be able to live a life that is more genuine and more true to who we really are. These procedures reduce the emotional stress that can cause so many other health problems. When it comes to insurance companies arguing about cost, I have a few examples of my own situation. Prior to coming out and beginning transition, I smoked almost a pack of cigarettes a day and I was borderline high cholesterol. Within days of coming out, I quit smoking. I stopped cold turkey, now that I was on the road to being me, I didn’t need that crutch. I also changed my eating habits and reduced my stress levels significantly. I was no longer eating the bad foods we eat when we stress eat, fast food, high fat foods, high cholesterol food, you know that stuff that tastes so good but is horrible for you. Since then, my cholesterol is half of what it was before. Not smoking and reduced stress are also significant. Essentially, I likely saved my insurance company easily hundreds of thousands of dollars by transitioning. I greatly reduced my risk of heart attack and stroke, reduced my need for cholesterol and blood pressure reducing medications, slashed my cancer risk each year that goes by, and greatly reduced the potential costs if depression were to lead to suicide or suicide attempts and the related hospitalizations. You tell me, which is better. I think I would take the road of paying for therapy for a few years, GRS and a few other procedures, and HRT. Over my lifetime I bet that it will cost them a lot less then the bypasses and other procedures I was headed towards! 

Another thing I did take away from this was the need for education. Educating our employers, the insurance companies, and the insurance brokers that our companies deal with. There were several stories of brokers discouraging Trans benefits, or pricing them too high to be affordable. I worked in the insurance industry for a brief period of time, and when you are a smaller company, you have little or no ground to negotiate when it comes to benefits. It all comes down to what can I and my employees afford, and what do we have to give up this year. The education has to start with the insurance companies and the larger companies that have the negotiating power. If every company listed in the Fortune 500 index said we want full coverage for out trans employees, I am sure that the insurance companies would take notice.

I find it interesting that many insurance companies offer full benefits to their trans employees, and yet make it difficult and expensive for other companies to provide the same benefits. I wonder about the concept of creating an index that would measure and rate insurance companies not only on the benefits they provide their own employees, but also on how they make the same benefits available to subscribers. Imagine being self employed and having to shop for health insurance with trans benefits, I am sure that is impossible, and if possible prohibitively expensive. 

We need insurance companies to recognize trans benefits as a fundamental part of any group or individual plan. Spread over a sizable group, the costs are negligible. I believe one study showed that it was pennies per premium. I will find that presentation and post it later, I think it was from an Out & Equal conference. If this is part of every policy, cost would not be an issue, and we would finally have equal access to health insurance and the procedures that we need. 

I look forward to future calls, and the discussions and actions that they will generate. There are a few things out there that are dividing some of us, we need to concentrate on many of the things that bring us together. We will always have differing opinions on how to tackle a particular issue, but I think we need to respect the diversity of opinions in this community. We are an educated community, and we need to realize that there is more than one way to approach an issue. Good night to everyone, and hope to talk about some of this more.