Overdue Update, on Electrolysis, Surgery, Insurance, and Boobs

"The boob fairy never came for me
No the boob fairy never came for me
Look, I wasn't wanting melons, just a cute curvaceous "B"
But the boob fairy never came for me."

-- Deirdre Flint, The Boob Fairy

I know this is where I'm supposed to make some excuse about why I haven't been updating for the last three months, but I've got nothing. Well, I've got a few things, but they're empty excuses that don't really matter in the long run. It's probably best if we all just move on and pretend that nothing happened. =P

Electrolysis continues. I've now logged just over 8 hours on my face, and 15 down below (and spent about $1,200 on it). I saw my physician for a checkup back in August and finally asked for lidocane/prilocane numbing cream, which she was happy to prescribe. In general, the numbing helps a ton, especially on my upper lip, but there are certain areas I'm not so sure about.

The cream only numbs the top layers of skin, and in a few spots this has the strange effect of removing most of the pain, but not the itching. With the top layers numb, scratching does absolutely nothing, and I end up wanting to crawl out of my skin by the time she's done. At least without the cream, the pain from each successive zap helps relieve some of the itching from the previous stabs.

It helps my mental well-being to think about the time until surgery in terms of how many electrolysis sessions I'll have in the interim. Assuming that I continue with my current schedule of two weeks between sessions, and that I stop around four weeks in advance to allow the skin to fully heal, I only have six more sessions before surgery! Contrasted with the 17 sessions I've already endured, I think I just might make it with my sanity intact.

Yep. Surgery is less than four months away (if I haven't established, I'm definitely waiting for the official date of February 22nd), and once again it's all I can think about. Honestly, damn this wait!

For the longest time I racked my brains over whether or not I even wanted surgery, then whether or not I was ready, whether we could save the money, what surgeon to go to. It seems unfair that the seemingly interminable year-long wait could only happen after these decisions were made. At this point, I check the countdown calendar on the right side of my blog constantly. I'm ready to move on now... please? =P

Still, the year since scheduling is more than two-thirds over. I just hope the days fly by faster as the date approaches, and not slower.

Saving is going well, and I'm pretty sure we have the funds secured, but I've been stressing over money a lot lately. All I can think about is what else we could be spending $20k on, like truly starting our married life together. I've recently been having dreams that insurance pays for it, and suddenly we have enough to put a down payment on a house, buy furniture, take a vacation.

Erin is amazing for taking this all in stride. I also appreciate all my friends for putting up with me repeatedly doling out the same tired excuse: "I want to, but I can't. I'm saving for surgery." If you're sick of hearing it, believe me when I say that I'm sick of saying it, too. I think the fact that I've never had to pretend to be broke for this long is affecting me, though. I'm definitely a child of the consumer age, and I miss spending money on stuff.

On that note, I'm trying really hard not to count any chickens just yet, but it's looking like I probably will be able to get insurance through work that will cover my reassignment surgery. It's insanely exciting, and hopefully I'll have more details soon. Fingers and toes crossed!

Speaking of doctors and insurance, I also saw my endocrinologist not very long ago for a yearly renewal, and to discuss my pre- and post-surgery hormone regimens. Female hormone replacement pills are known for increasing the risk of thromboembolism (traveling blood clots), so most surgeons, including mine, require patients to reduce or stop taking hormones a few weeks before surgery. My endo suggested that I wean myself off slowly, to reduce the inevitable hot flashes and moodiness. Though I'll resume estrogen and progesterone after surgery (and for the rest of my life), I'm definitely looking forward to never needing to take testosterone-blockers again. =D

She also gave me the regular blood work, to check my hormone levels, but apparently she forgot my insurance situation and coded it under "psycho-sexual disorders". My insurance will have none of that, and denied the claim, so I recently got a bill for $400 worth of blood tests. =(

I've talked to the hospital and asked them to change the coding and try again, but I'm nervous that the damage has already been done. A friend of mine recently tried to claim her SRS through the same insurance (SelectHealth), and after denying her, they also decided to start denying anything and everything else that they could claim was related, whether it actually was or not. Hopefully the re-code on my blood work will pass through, and that's the last I'll hear of it, especially since I'm planning to switch insurance ASAP.

Last, but not least, I've been doing a lot of ruminating about possibly getting a breast augmentation. It's something that's been in my head for a long time, but something that, for a few reasons, I haven't really talked about. It's odd to me that I find it fairly easy to disclose all sorts of information about my transition and body, but not so easy to talk about this one thing.

To be honest, I have some self-esteem issues around my body. I still pad my bra, and though I know that's not that strange, I guess I just want to feel like I can have more confidence in my image, without having to think about it daily.

Even though putting it that way makes perfect sense to me, I still feel guilt around the subject. I suppose I view SRS as simply necessary, but implants have been socially drilled in to my brain as being purely superficial. Well, sure, they are superficial, but we live in a superficial world, and if that's what it takes to make me feel comfortable in my own skin, then I should probably stop feeling guilty and do it.

Letters to a Surgeon

Won't you please,
Please tell me what we've learned?
I know it sounds absurd;
But please tell me who I am.

-- Supertramp, The Logical Song

I can has two letters of recommendation for surgery! =D

As I wrote before, I was having a tough time finding someone for my second letter, as required by the WPATH Standards of Care (and more importantly, as required by my surgeon). I'd collected a couple of suggestions from trans friends and called a few psychologists, with no luck. Among those I'd called was one prospect, a Dr Beckstead, who was out of town. I waited until he got back in near the end of June to leave a message, which he promptly returned a few hours later. He said that he had experience working with trans clients and writing these letters, and that he'd be glad to meet with me. W00t!

I had an appointment with him on July 7th, and he was awesome! He was very courteous, kind, patient, and a great listener. For some reason, I'd expected a battery of dry evaluation tests, with ridiculous questions questions like, "How often are you angry?"

Instead, we sat and chatted casually for an hour about my transition, the ups and downs I've experienced, my emotional state during various stages in my life, etc. The hour flew by, and by the end of it, I'd rambled off my entire life as it relates to my gender. He told me he'd be happy to write a letter for me, and agreed to have it ready the following week. I picked it up on the 14th, and... wow.

I expected half page or so. This sucker is four pages long, and recounts nearly every detail I shared with him, but in a more cohesive, less rambly way. It's really interesting to see a summation of so much information about myself. Even though much of it is a direct interpretation of what I'd told him, being reworded and peppered with his observations makes it feel slightly surreal, like hearing a recording of your voice for the first time and wondering, "Is that really what I sound like to other people?" Even though none of the information is a secret, the letter feels very intimate, and makes me realize just how much I expose my naked thoughts and feelings to the world. I'll cherish it always. =)

My regular therapist told me long ago that she'd be happy to write a letter if/when I decide to have surgery, so I also set up a recent appointment with her to go over the details. I hadn't seen her for the better part of a year, but most everything I had to share was good news, so the session had the odd feeling of catching up with an old friend, then paying her for it. =P

She offered to mail her letter, and it arrived on Saturday. Her letter is much more what I expected, basically just an overview of our therapy and her recommendation:

Dear Dr. Bowers,

This letter is in regard to [Vivienne]. Vivienne is a male to female transsexual woman who I have been treating for Gender Identity Disorder (GID) since March of 2009. [Vivienne] has been on hormone replacement therapy since July of 2009; she has undergone a legal change of name and gender marker and has been living full time as female since April 2010.

I have spent many clinical hours with [Vivienne] addressing issues pertinent to her gender identity and transition. I am confident that she is psychologically and socially prepared to complete a surgical transition to female. [Vivienne] has considered all aspects of gender reassignment surgery and will continue to live a productive and emotionally healthy life as a woman. Therefore, it is my recommendation that she be considered for further medical or surgical procedures as she wishes.

For the sake of completeness, I've also included some of Dr. Beckstead's letter below. I've pared it down to around 1/2 the original length, but it's still pretty long, I wouldn't blame anyone for thinking it's TL;DR and skipping it. ;)

Dear Dr. Bowers,

This letter is to document my assessment of Vivienne and my recommendation that she is eligible and ready for male-to-female sex reassignment surgery (SRS). My evaluation is based on 1 individual evaluation on July 7, 2011. After this meeting, I was confident in making this recommendation. Vivienne has also met with another local therapist, who is highly competent in gender-identity issues, starting in March 2009 to the present. Regarding Vivienne, she is 29 years old, employed, and married, with no children. My overall impression of Vivienne is that she is intelligent, thoughtful, warm, sensitive, easy-to-get-along with, independent, practical, and confident about her choice of SRS.

History of Gender Dysphoria & Sexuality
[Vivienne] describes herself as an awkward, emotional child that never felt right being who she was... She was never into sports but also never interested in “girlie toys” but building toys. She would always play female characters in video games, not only preferring the identity but also being attracted to the character’s characteristics. She sees herself as always having feminine mannerisms and that people considered her to be homosexual or the “gayest straight boy,” which caused her to question and explore if she were gay. She relates that this focus on sexuality clouded her exploration and acceptance of being transgender.

She describes always feeling out of place in men’s locker rooms and bathrooms and never using the urinal. She hated gym class because she would be forced to change in front of people and would often leave her shirt on while swimming, always feeling awkward in her body but never understanding why.

She recalls that a pivotal time for self-acceptance and identity was when she worked in the Philippines for six weeks in 2008. Transgender issues were more prevalent, obvious, and accepted. This compelled her to do research for a couple of months on transgender issues, which helped her “put the pieces together” and realize that transitioning was worth the risks of social rejection. This process led to her talking with her then girlfriend, which Vivienne describes as emotional because her girlfriend was afraid of losing her. However, once her girlfriend realized the possibilities of staying together (her girlfriend is bisexual) and that Vivienne would be happier, both were okay with the decision and she has been supportive ever since. They married in September 2010.

Vivienne describes having slight “bi-tendencies,” open to the idea that she could be with a man if she met one with whom she fell in love; erotically and emotionally, however, she states that she has always preferred women and does consider herself a lesbian. She relates never being sexually aroused or interested in female clothing or going through a cross-dressing phase of buying and purging clothing. She describes herself as “not that girlie of a girl,” and typically wears jeans and a t-shirt. She has never been interested in wearing feminine-typical clothing because she believes women can wear what they want and still be a woman. She does relate how thinking of her body as female, especially being able to have sex and interact the way she wants as female, is arousing. In her words, “It’s never about the clothing but about the expression of myself through my body that is important.”

Overall, she describes feeling uncomfortable about her body, although less now because she appears female, but she feels “squeamish, weird, awkward” when she does think about her current genitalia and knows that she would be happier and excited with “the correct body” and wants “everything to match.” She is considering breast augmentation but wants to give hormones more time to have an effect. She is also determined to eat better and exercise more.

She states that making the decision for SRS has been difficult, mainly because of finances and her concerns about its effect on her wife and their relationship. She reports exploring and evaluating the risks of surgery, especially with concerns about having a good sex life and sexual sensation, but she states that she sees herself having more fun and pleasure with the correct body.

Social Support, and Current Life Stresses
She describes her relationship with her wife as equal, where both can discuss and resolve issues, and her transition has strengthened their relationship. They can lean on each other for support. Vivienne also states that she has not lost a single friend or family member’s support.

Current stresses for Vivienne include saving money for surgery and a house and managing any guilt about putting her wife under this pressure. Vivienne states that she also worries about body issues and what people think of her (e.g., has she offended someone).

Mental Health History and Status
Vivienne reports that she has suffered with anxiety and depression since childhood. Vivienne sees herself as independent and able to “deal with it” on her own. Vivienne describes having strong emotions but also strong logic that help her maintain balance.

She describes her anxiety as worrying too much about what people think and feel, trying to please them, and then blowing things out of proportion. Her depression was strongest when she first came out and feared its impact on others, which involved breakdowns of wondering if she was doing the right thing. Vivienne states that since her transition, her depression has gradually disappeared as she expresses who she is more: “Not needing to pretend has helped a lot.”

Overall, she states that her sense of independence and responsibility can become to extreme and turn in to anxiety. Vivienne considers that she will always be anxious but has learned to manage it better. Ways that help her to cope currently include expressing more with people who care, processing issues with her wife, and using reality as a check-and-balance.

Summary
Vivienne demonstrates the capacity to understand anticipated physical, emotional, and social changes and drawbacks associated with SRS. She is realistic about the changes that can and cannot occur through SRS. I consider her eligible and ready for SRS because she has consolidated her gender identity in the last 2.5 years during her use of hormonal therapy and full-time, real-life experience. She is highly supported by her spouse, family, friends, and job. Her mental health is stable and she does not suffer from any self-abuse, psychotic thought patterns, severe psychological or personality symptoms, or impaired decision-making skills.

These are letters #4 and #5 that I've had to acquire throughout my transition, the first to start hormones, and the second and third for changing my legal name and gender, which shows the kind of crazy hoops we trans folk have to jump through. =/

Anywho, everything's coming together nicely. Now I just wish I didn't have six more months to wait! ><

Updates on Electrolysis, Surgery Prep, and the HRC CEI

"Easy now, hush, love, hush;
Don't distress yourself, what's your rush?
Keep your thoughts nice and lush;
Wait.
Hush, love, hush, think it through;
Once it bubbles, then, what's to do?
Watch it close, let it brew;
Wait."

-- Wait, Helena Bonham Carter as Mrs. Lovett (Stephen Sondheim's Sweeney Todd)

The updates are slow(er than usual), because life is simple and relatively routine. That's probably a good thing.

Another two hours of electrolysis down. I've started doing sessions every two weeks, instead of one, to allow some time for the dormant hair to cycle back in. We're still doing about 30m at the beginning of each session to re-clear my face, and the rest of the time on the lower area. So far I've logged just under 5 hours on my face, and about 6 hours down below. My electrologist still leaves the room while I change in to the towel skirt thingy, but it seems like a silly ritual at this point. All other pretense is gone, and she doesn't even pretend to keep me covered any more. =P

My insurance won't cover a physician checkup until August, so I'm still managing the pain with just an Ibuprofen or two, but I'm considering calling to ask if my doc will prescribe some EMLA (numbing cream) over the phone. Some electrolysis sessions, I feel like I can take about anything, and I almost fall asleep while she's working. Other days, the pain consumes me, and I start getting visions of that one Fight Club scene ("I tried not to think of the words 'searing', and 'flesh'." "Stop it! This is your pain."). =P

Speaking of surgery prep, I've still got a lot to do in the next few months. Besides electrolysis, I need a psychological evaluation and two letters of recommendation from therapists (one being a PhD/MD), I need to get HIV testing, and I need to work with my endocrinologist regarding my pre- and post-op changes to my hormone regimen.

The most pressing of these is probably the letters. My primary therapist has agreed to write the first, but I'm having a hard time finding someone with a degree and familiarity with GID to write the second letter. I've been calling various people suggested by trans friends, with no luck so far. I'm sure I'll find someone to write it; it's just another thing I want to get out of the way. =)

As I mentioned before, my set SRS date is in February 2012, but I'm on a cancellation list for November. When I scheduled, there were a lot of personal advantages to having my surgery done in November, but those pros are slowly being overwhelmed by the possible advantages of waiting until the scheduled date in February.

The Human Rights Campaign (HRC), a major organization focused on the advocacy of BLTG rights (you've probably seen their bumper sticker logo: a blue square with a yellow "=" sign), releases a Corporate Equality Index each year. Basically, companies volunteer to send in a survey and information about their TGBL-related policies, and HRC scores each company on a 100-point scale. My employer has consistently gotten 100 points each year that they've participated (2009, 2010, and 2011).

As of 2012 however, HRC is changing the criteria by assigning 10 points for having trans-inclusive benefits-- health insurance that covers GID therapy, hormones, surgery, etc. Since my company seems pretty proud of their CEI rating, I've informed the powers-that-be that we are in danger of losing our 100, unless they add an inclusive insurance option by the end of this year. They definitely listened, but I probably won't find out what they've decided until around November. It's an off-chance, which is why we've been saving and planning for paying for it ourselves. But as the date approaches, waiting three more months for even a small possibility of saving twenty-thousand dollars is sounding more and more worthwhile.

We've also found out that Erin isn't eligible for family medical leave through her work until she's been there for a year, which will occur in January. She gets 40 hours of PTO a year, and at the moment, she has to save every minute of it to be able to go to Cali with me in November, which really isn't fair to her. Finally, waiting until February means the date is no longer uncertain, and gives us that much more time to settle the funds.

I was really looking forward to November, but logic dictates otherwise, and I think (hope) I can deal with waiting just a little longer.

By the way, if you want to see the CEI ratings, here are the 2011 results (ratings start on page 38):
http://www.hrc.org/documents/HRC-CEI-2011-Final.pdf

And a few previous years:
http://www.hrc.org/documents/HRC_Corporate_Equality_Index_2010.pdf
http://www.hrc.org/documents/HRC_Corporate_Equality_Index_2009.pdf
http://www.hrc.org/documents/HRC_Corporate_Equality_Index_2008.pdf

Does your company participate? What's their rating?

My First Electrolysis Session

"After all this has passed,
I still will remain;
After I've cried my last,
There'll be beauty from pain."
-- Superchick, Beauty From Pain

On Saturday I had my first electrolysis session.

Not. fun.

I haven't done much in the way of hair removal thus far, mostly because I've never been very hairy, even before hormones. The hair on my arms is pretty light, I've never had any back or chest hair to speak of, and I can deal with shaving my legs on the rare occasion that I actually wear a skirt.

I have, however, been getting laser hair removal on my face for almost two-and-a-half years now. It was actually the very first step I took towards physical transition, and I started just a couple of weeks after coming out to Erin. I wasn't sure at the time if I'd end up transitioning or not, but I knew that I hated my facial hair enough to get rid of it regardless.

I spent more on it than I probably should have, but on the plus side, they gave me a two year guarantee, so I've been going back once a month since then without paying anything more. Laser has eliminated 95% of the hair on my face, but there are a few hairs it just hasn't cleared. Still, I don't regret starting with laser versus electrolysis, because it has saved me a lot of time and pain, while costing about the same in the long run. Laser was also enough to get rid of the beard shadow on my face, which helped me dramatically in passing as female.

I've now started electrolysis for two main reasons, to clear up what's left on my face, and to start genital electrolysis in preparation for surgery. To put it simply, in sex reassignment surgery, some of the outside skin gets moved to become inside skin, and I need to get any hair removed from those areas before then.

Back when I started laser, I did a lot of research on the differences between laser and electrolysis. The only thing I learned with any certainty should probably be obvious: never trust an electrologist or laser tech to tell you which method works better. Both fields are chock-full of the kind of propaganda and superstition that's spread around so often, even the pros believe it. The truth, as far as I can tell, is that both methods work, and both have many pros and cons.

As far as effectiveness, laser is more like lobbing grenades, where electrolysis is more like sending in a sniper. The grenades are quicker and easier, but you have to be more careful not to damage the scenery, and there's a lot more luck involved. (Yes, I'm a dork, but it's a good metaphor. =P) Electrolysis also seems to be more dependent on the skill of the technician, for better or worse, while laser is more dependent on the area being treated, the skin type, and how dark the hair is.

Technically speaking, most laser hair removal devices don't actually involve any lasers, but use xenon flashbulbs, which flash high-intensity light at the skin. The skin itself lets most of the light pass through, but the hair's melanin (pigment) absorbs the light. The hair briefly heats up, effectively frying and killing the follicle around it. The hair is then left to eventually fall out on its own.

An average session of laser hair removal for me involves lying down, and being given goggles to protect my eyes from any errant flashes. They then spread clear goo on my face to keep the skin cool. Next, the tech dials in the intensity for my skin type and progress, and presses the small flasher part against my cheek. The machine beeps, I feel a sting, the tech moves the flasher gun about a centimeter, and then repeats.

The pain is semi-intense, but manageable, though I usually forget to breathe until they stop, and it always makes my eyes water when they go over my upper lip. Each monthly session only takes about 15 minutes. When they're finished, they clean the goo off my face, apply lotion, and give me an ice-pack to go. After each of the first few sessions, the room smelled like burning hair, and my face was red and tender for a couple of hours.

Electrolysis, on the other hand, uses a tiny needle-like electrode. The tech inserts the electrode in to each follicle, next to the hair, and zaps it at the root with an electrical current. They then grab the hair with tweezers and pluck it out.

At my first session on Saturday, my electrolysis tech began by joking about how every trans person she's talked to says that electrolysis is the worst part of transition, which got me nice and psyched. =P

She wore medical gloves, and glasses with little telescope-y magnifiers attached. She also dialed in the intensity, starting low to see what I could handle, then raising it a few times as she worked. Though I couldn't see exactly what she was doing, it seems like inserting the electrode stings, but is bearable, since it's being inserted where there's already an opening in the skin. The zapping and plucking hurts much worse. The pain was pretty manageable at first, but as she slowly moved across my face, my skin became more sore, and the stinging became more intense. The only things I can compare it to are laser hair removal, and getting a tattoo on my back, but it easily beats both.

My upper lip has the most hair left, mostly because the laser techs were afraid to zap too close to my lips. While the electrologist progressed across my upper lip, my eyes were watering like crazy; If you've ever plucked your nose hair, it's like that, but more hurty. Thankfully, Erin came with, and at this point I asked to hold her hand. I also had to ask the tech to stop a couple of times, so that I could sneeze and blow my nose.

The session lasted a little over an hour, and she cleared most of the remaining facial hair. Hair grows in cycles, with one set of follicles being dormant while another set grows, so I'll have to have my face done at least a couple more times to clear everything.

Once she was done, she had me hold a metal rod with a cord sticking out, and I started wondering why she wanted to electrocute me. She applied what smelled like VapoRub to my face, then pressed a metal roller to my skin, and I could feel a very mild current as she rolled it around. Apparently this is called cataphoresis or electrophoresis, which reduces redness by causing pores and blood vessels to constrict, and helps transfer medicinal substances into the tissue. Who knew?

She asked me not to touch my face or wear any makeup for a couple of days, to avoid infection. Most of the redness went away after a couple of hours, but my face was sore for the rest of the day, and there are still some tiny red spots and slightly tender areas four days later.

I definitely plan on taking some pain meds before my next appointment on the 18th. Since I normally avoid meds, they're pretty effective when I do take them. That should be enough to get me through the rest of my face work, but I don't know what to do for the genital electrolysis. Some people go as far as using numbing cream, or even local anesthesia. I'm really not looking forward to it. =/

After just one face-clearing session, I wouldn't say that electrolysis is the worst part of my transition, but we'll see if I feel differently about it after the surgery prep work. *knock on wood*

Video: Documenting my Voice(s)

"And if you're still within the sound of my voice, watching this video,
I just want you to know that it always made me rejoice,
Just to have you so near, there's a place for you here,
If you're still within the sound of my voice."
-- Linda Ronstadt, Still Within the Sound of my Voice

Video documentation, ZOMG!

I wanted to show the progress that I've made on my voice over the last year, and the only way to really do that is to record it, so voilà! Just a heads up, I switch in to my old voice-- or at least, as close as I can get to my old voice-- which may look/sound a little weird. ;)

Something else that really helped in figuring out my new voice is the fact that I've always done a lot of impressions. It took me about three months of reading and watching videos about the human voice to get the basics of it down, but about seven or eight months before I stopped having to think about my voice every time I spoke. I also took a vocal feminization class, which ended up not helping me in the slightest. These days, the new voice is habit; it's the way I talk when I wake up, and it's the voice my internal monologue uses. =)

New Doc, New Meds, New Prescription Madness

"You kn-kn-know what I want!
Gimme more. Gimme more.
Pretty please, a prescription!"
-- Mindless Self Indulgence, Prescription

I usually avoid talking very specifically about my body, but this is pretty limiting in a transition blog. Physical changes are a huge part of my transition, and if any place should be safe to talk about them, it should be here... I just worry that I'll make other people uncomfortable. Since I've really got to stop worrying so much about other people, I'm just gonna give you a heads up: I will talk about my boobs. There, I've said it. Whether you know me or not, if you think you might be uncomfortable with me talking about anatomy, nobody will blame you for ducking out. =P

As usual, I've waited far too long to talk about what's going on in my life, and I've got quite a backlog, so let's catch up on hormones. =)

My first endocrinologist sucked, so about four months ago, a month before my hormone prescription ran out, I decided to look for a new doc. I had three goals in mind: find someone who cares, is in my insurance, and prescribes *progesterone. I got a big list of endos and ratings of said endos from various trans friends, then narrowed it down by insurance, and started making calls. The only one within my plan that was taking new patients however, was only accepting referrals from a primary care physician. The good news was that there was a PCP in the same office that works closely with the endo. The bad news? The physician was booked about a month out, and the endo three months. =/

*(Progesterone is a primarily female hormone often prescribed as part of both post-menopausal and transsexual hormone replacement, but many docs are afraid of it, because some synthetics have been known for nasty side-effects, and its full effects on development aren't well known. Progesterone is key in breast development, among other things, but there is still a lot of disagreement as to how much is gained, and which meds, if any, benefit trans-women the most. Part of the problem is that most of the data comes from post-menopausal women, and broad testing with trans-women is virtually non-existent.)

Since I wouldn't see the new endo for a while, I called my old doc to ask for an extension on my prescription, and she told me that she would grant it, but never followed up. Fortunately, my appointment with the new PCP was just a few days after my prescription expired.

The new physician was awesome! She listened, she answered, she genuinely cared. I know, weird, right? She even chatted with me excitedly about my (then) upcoming wedding, and gave me a three month extension to last until I could see the endo. About a month later, when I went through my legal name/gender change, she was also nice enough to write up a letter of recommendation for me to present to the judge.

When I finally saw my new endocrinologist, she was just as cool. She was extremely enthusiastic in getting to know me and explaining things to me in detail. Before I could even bring up the progesterone, she asked, "How's your breast growth?" I explained that I'd had some growth spurts in the beginning, but nothing much since then, and she immediately followed up with "We should get you on progesterone!" =D

Of course, there's always a hitch. To save myself from having to go in at different times for different prescriptions, I waited for my other two to run out before filling the progesterone. When I did, the pharmacy informed me that I could now get three months of the spironolactone and estradiol, but that my insurance would only let me get one month to start on the progesterone. That seemed reasonable, but when I got home, I realized that they only gave me half my normal dose of spiro. It turned out that the new endo had accidentally prescribed it wrong. =/

Unlike with my old endo though, I was actually able to get a hold of one of the new doctor's staff, and they immediately sent a correction. The pharmacy then told me that I should just take the spiro at the correct dosage, and that they'd get it corrected at the 45-day marker when my supply is gone.

Last night, I called in a refill on the progesterone, but when I picked it up, they said they only had enough for 5 days, and that they'll call me in the next few days when the rest is available. I also asked them about the spiro, and they told me that they'll probably just refill for three more months when I run out.

So now, even though I'm getting meds for three months at a time, I had to go in yesterday for the progesterone, I'll have to go back in a few days for more progesterone, then back in two weeks for the spiro, again 45 days later for the estradiol, and repeat. Despite my efforts, my three prescriptions will never be on the same schedule again. *sigh*

Anywho, I've now been on progesterone for one month, and I've definitely noticed a few effects. Like with my first hormone post, I'll just present the evidence, and let you decide what's unrelated/psychosomatic and what's not. =P

• My breasts have been tender and itchy almost constantly for the last month, which indicates growth to me. This is basically what it felt like off-and-on when I first started hormones. Their shape has also rounded out a bit, and they look more natural.
• I've noticed some skin changes, and the weirdest thing, the tattoo on my back sometimes "raises", and I can feel bumps where the lines are; when this happens, it's also itchy.
• My skin is a little more oily, and I've gotten a few more zits than usual.
• My anxiety is back, which is odd, because progesterone is supposed to be calming. Of course, this could easily be due to a lot of other things going on, too. =P

I really haven't experienced any extreme side effects so far; the acne is a little annoying, but hopefully that will fade after a few months, as it did when I first started on hormones. Otherwise, med-related things are going pretty hunky-dory, and still far better than when I had to deal with my old endo. =)

1 Year on Hormones

"Every year is getting shorter,
Never seem to find the time.
Plans that either come to naught,
Or half a page of scribbled lines."
-- Pink Floyd, Time

It's been just over a year since I started on hormones! W00t!

I actually took my first couple of doses in late-July of 2009, but then decided to hold off for a couple of weeks so that I could bank some *ahem* genetic material (testosterone regulates sperm production). I don't know whether that means my "official" E-day is in July or in August; either way, the year has really flown by.

I posted regarding the effects of hormones last December, and most of it still holds true. The physical changes have slowed down considerably, but haven't stopped by any means.

I've taken tons of pictures of myself over the last year (not every day, but still), which I hope to turn in to a slideshow at some point, but since that will take more time and motivation than I'm willing to devote for now, here are some before and after pics.

Before hormones/laser/transition:

And recently, after hormones/laser/transition:

Utah Pride, 2010

"Won't explain, or say I'm sorry.
I'm unashamed, I'm gonna show my scar.

Give a cheer, for all the broken,
Listen here, because it's only..."
 -- My Chemical Romance, Welcome to the Black Parade

This last weekend was the Utah Pride Festival.

This was only my second year attending Pride. Last year, I watched the parade and wandered the festival with friends; this year I was much more active and involved.

On Saturday, Erin and I attended Utah's first ever Transgender March, which was awesome. Apparently we had around 100 people, which is much more than most of the people I talked to had predicted. Hopefully they'll do it again next year, as I'm sure it will only grow from here. They held the Dyke rally and Trans rally at the same time, which made me sad, but I have to go first and foremost with the T. The great part about the way it was done is that the two marches were able to join forces at a mid-point, along with the Interfaith Pride March, and then head down State Street in droves. George also met up with us at the mid-point, and was even sweet enough to hold a sign that said "Trans Fabulous" high and proud for me.

I wish I'd planned a little better, but by the time the marches ended, I only had about half an hour until my shift in the eBay booth, and I was 9 city blocks away from my car, which had the eBay shirt I needed to wear in it. I took off towards my car while George and Erin headed for Trax to get home. I only ended up being about 10 minutes late, but the heat and the huge hill our capitol building is on just about killed me.

I'm very much a nighttime person, and I've never done well with the heat. Add to this that hormones have killed my internal temperature regulation, and that I haven't had my hair this long in years, and it isn't hard to conclude that I probably shouldn't even leave the house on a hot summer day.

On Sunday, Erin and I marched with the eBay folks in the Pride Parade, which was a hoot. We blasted Weird Al's "eBay", and handed out eBay temporary tattoos to everyone and anyone.

Erin and I, waiting for the Parade to start.

The eBay parade crew.

The back of the "I AM" shirts say "eBay", but the front seems to imply other meanings on its own. ;) 

Handing out free stuff to the crowd.

Fortunately, I gave myself plenty of time before my booth shift this time, so after we were done with the parade, Wifey and I wandered over to Beans and Brews and zoned out on their comfy air-conditioned chairs while sipping iced mocha and iced chai for about an hour.

Next, we decided to wander the festival. The festival is great fun, and it's so nice to be in a place with so many people who don't care who you're holding hands with, but it's also pretty commercialized. Half the booths are selling jewelry or shirts or potpourri or who knows what, and most of the others are promoting a cause. We ended up skimming past most of the booths, and only lingered at a few of the more interesting ones, such as the "Gender Zone", where they had a great timeline of the history of gender variance.

This time, the Erinkins decided to just hang out with me while I helped out at the booth. We had silent auctions, with the proceeds going to charity, and for the most part I just helped people who wanted to bid and kept an eye on the goods, which at least kept me out of the sun. Unfortunately, I think it also kept me out of the occasional breeze. Even though my shift was only a couple of hours, by the end of it, I was zapped.

George met up with us again, and we went out to dinner, where I got to feel sweaty, gross, and stupid at a nice Japanese restaurant.

I'm very grateful to my love for tagging along and supporting me. Overall, I had a lot of fun, met some great people, and had a lot of good experiences where people were surprised to find out that I'm not a genetic female, but I ended up very emotionally and physically drained. Next year, I will definitely pick my battles more carefully, and try to hit up more shows, parties, celebrations, and other things I can passively enjoy. ;)

Voice Classes

"Cause sometimes,
I said sometimes, I hear my voice

And it's been here,

Silent all these years."

 -- Tori Amos, Silent All These Years

Egads! Has it really been a month since I've posted? And did I really just type "Egads!"? Bleh. I guess I should talk about the voice classes I recently finished while it's still semi-fresh in my mind, as much as it annoys me.

When I was still early in transition, voice classes were one of the things "on the list" that I definitely wanted to do, since hormones don't change the voice for male-to-female transpeople. Back then, I researched it the way I research everything: with the interwebs, but I couldn't find any. I know there are at least a few local speech/voice therapist/coaches, but I don't know if any of them work specifically with trans people. At the time, I was still afraid to tell even complete strangers that I was trans, which stopped me from ever calling and asking.

After a while, I put off the idea in favor of other things, and just practiced here and there on my own. I also did a lot of research; I read and watched how-tos, I learned about speech-patterns, pitch, resonance, vocal chords, and so on. I have a lot of the technical knowledge, but even with all that, it can be difficult to put it to use without someone to tell me if I'm doing it correctly.

A few months ago, I got an email on the Pride Center mailing list which said that a licensed speech therapist would be doing voice classes specifically for MtF trans people in March/April/May. I excitedly emailed the teacher to find out more about it, and she quickly replied to tell me that the class was $70 per person, and that we would work on expanding vocal range, flexibility, expression, pitch, resonance, intonation, "feminine" language choices, non-verbal communication, etc., via modified Fitzmaurice voicework, which is apparently something originally designed for actors. It sounded perfect, so I mailed a check.

A few days later, she emailed me to let me know that she received the check, when and where the first class was, and to bring workout clothes, a yoga mat, and water. Wait, what? Eh, apparently she incorporates yoga techniques... I wish I'd been informed of that earlier, but oh well, I decided to go anyway.

The class was only eight people, and I already knew a couple of them from elsewhere, which was nice. The first class ended up being mostly strange yoga-type positions, trying to find a "tremor", which was supposed to "shake up the voice". It was odd, but I figured that it was groundwork, and that I couldn't really judge its effectiveness until after the rest of the technique was revealed.

A few weeks/classes later, and we were still doing the same thing. What's worse, she never definitively tied these exercises in with the voice. Sometimes she would go back to vaguely explaining something about loosening up the voice, or show us a picture of the various tendons in the human body that run between the feet and the throat, still without giving us a definitive tie-in.

Eventually we moved in to learning about the muscles that control breathing, and how to be aware of them, which at least felt a little more relevant. It wasn't until around class 5 that we started learning some exercises for expanding vocal range, and experimenting with tone and such, yet we were still spending around 2/3 of each class doing stretches. By the end of class 6, I wasn't sure if I wanted to come back, though I kept reasoning that perhaps I'd learn something big in the last couple of classes that would make it all worthwhile. From class 7 on, we finally stopped doing any of the yoga stuff, and it suddenly felt like she was struggling to catch up.

To make things worse, there were supposed to be 10 classes, but she wasn't sure if we would have the venue for the final class or not. We were supposed to find out at class 9, but I forgot to go that day, and realized afterward that I didn't feel badly about it, so I didn't bother finding out about the last week.

Maybe I'm being a bit harsh... I'm only semi-pissed about the money, as it's a lesson learned, but I feel like it was the time I spent there that was the big loss. Oh well, some would say I have too much time on my hands already. ;) I hope the other people in the class felt better than I did about it. A few people had to rearrange their schedules and even bus to get there each week.

I think I've gotten my voice to a fairly androgynous place through my own practice. My current voice is usually enough to be passable in person, but my main concern is on the phone and online video games, where my voice has to represent me without the visual reinforcing. In games is the only place that I don't tell everyone about my past, mostly because I don't feel like constantly explaining, and because people online can be extremely cruel.

A friend recently asked if I'm afraid that I'll sound fake. I do worry about that (to be fair I worry about everything), but I know that practice will help make it sound less fake, and people can just deal with it in the mean time. I do get a lot of compliments on my voice, so I must be doing something right. Erin also says that it "freaks her out" when I accidentally switch to my old boy voice. I guess it's just going to take time. At least now that I'm fully socially transitioned, I practice every day, whether I like it or not. ;)

The Standard Process and Substandard Care

"One pill makes you larger,
And one pill makes you small,
And the ones that Mother gives you,
Don't do anything at all."
-- Jefferson Airplane, White Rabbit

I've been on hormones for a bit over six months now (wooh-hooh!), and you aren't taking them away from me. Ever. Unless I run out, and my dumb doctor and pharmacy can't coordinate to save their lives. Ugh.

For those that don't know the process, maybe I should start with the basics. Transsexualism is interesting in that it has both psychological and physical sides to it, maybe we'll get in to that more at another time. Decades ago, many tried "curing" it psychologically, which usually turned out badly. Nowadays, it's generally accepted that it's much more healthy to treat the body to match the mind, rather than the other way 'round. Sure, you run a few minor health risks, but a lot less people are killing themselves.

Eventually, the medical community adopted a semi-standard set of treatment guidelines, which are called the WPATH-SOC (World Professional Association for Transgender Heath - Standards of Care), formerly the HBIGDA-SOC (Harry Benjamin International Gender Dysphoria Association - Standards of Care, after a German doctor who did a lot of work to help transsexuals in San Francisco in the 50s and 60s).

The SOC has a lot of good information in it, but the main effect it has is to limit most physical treatment to those who have gone through psychological counseling and received a letter of recommendation for treatment. For hormones, usually a therapist will require three months of counseling before giving you "the letter," and for major surgeries, a year of being "full time" (living as your preferred gender socially, usually including work and/or school).

This makes sense on some levels, because it limits treatment to those who are serious and ready, but it also causes a lot of problems. Some people don't have money for therapy, especially since most insurance companies have specific exclusions for Gender Identity Disorder in their policies. Some people are perfectly well adjusted, and feel they shouldn't be forced to undergo mental therapy for something they've already figured out. Finally, some therapists are just bad, and either ignore the SOC completely, or get a gatekeeper complex and go on power trips, withholding letters and making trans people jump through unnecessary hoops.

Without the SOC, support from the medical community would probably be a lot harder to find, so I think of the Standards as a necessary evil, though it would be great for us to work out a more ideal solution some day.

Personally, I didn't mind starting with some therapy. The cost thing sucks, but my therapist is awesome. Since I am relatively well adjusted, I only went in every couple of weeks until the three month marker, when she gave me the hormones letter, and now once a month.

I took the letter to the endocrinologist she recommended, who first requested blood tests to make sure giving me hormones was safe. She then gave me a prescription for six months, with a plan to do follow up work before renewing at six months.

A couple of weeks before the six month marker, I had an appointment with my doctor, who gave me instructions to:
1. - Get new blood work done.
B. - Leave a message on her answering machine, telling her when to call me so that we could discuss the results.
Three. - Have my pharmacy fax a prescription refill request to her.

By the way, she also mistook me for a FtM at first, asked if I'd had a pap smear done, and received confused looks in response. I'm still not sure what to take away from this one besides a good laugh.

I went to IHC to get my labs done, so that I could at least have that covered by insurance. The next week, I left a message giving the doc a few days of wide open time in which to call back. No call.

I asked my pharmacy to send the refill request, and I left another message with another wide open time frame. No call.

I ran out of pills, so I called my pharmacy to check on the status of the request, to which they replied, "She declined it, because she wants to discuss your labs." SO DO I!

I left a third message, and a few days later she finally called me back, but I missed the call because I'd gotten sick. She leaves a message that says "Have the pharmacy fax over another request, and here's my pager number."

I have the pharmacy send it again, and leave a message on the pager. Two days later, on Saturday of all days, she calls me again. "Your labs look fine, I'll approve the fax request, but I haven't received it." Ok, ok, ok, I know you probably couldn't tell me about the labs in a message because of patient confidentiality and all that, but couldn't you approve the request, and then mail the results to me? That is, if you can't be bothered to do your job and call me.

And what's this about not receiving the fax? I confirm with the pharmacy that they have the right number, they send it a third time, and finally get a response. My spiro is renewed for five months, and my estradiol for one month. Wait, what!? The pharmacy says they'll call the doc to work it out. "Good luck with that!" I say, but by some miracle, they fixed it that evening, and both are now for five months.

I'm still confused as to why five, instead of six, but I don't care anymore. Once this is up, I'm likely finding a new doctor anyway.

The Magic of Hormones

"And if rain brings winds of change,
Let it rain on us forever.
I have no doubts from what I've seen,
That I have never wanted more."
-- VNV Nation, Solitary

I've been on hormone reassignment therapy (HRT) for about five months now, and I finally decided that I should share what I've experienced as a result. While there are a lot of things hormones can't change, I'm constantly amazed at all the things they can and do change. I currently take two medications, once a day: estrogen, and an anti-androgen, which dramatically slows the effects of testosterone.

Quick and generalized biology lesson:

During the first few weeks of fetal development, humans essentially have the potential to develop as either male or female. Usually, the chromosomes will determine gonad differentiation, which causes hormone differentiation, and the presence or lack of *androgens determines the other primary sex characteristics. (*Andro is a Greek prefix meaning "male" or "masculine"; androgens are "masculine" hormones, including testosterone.) Secondary sex characteristics are mostly caused by estrogens and androgens, respectively, during puberty. HRT mainly only affects the secondary sex characteristics, especially those involving skin, fat deposits, and hair, since these are always changing anyway.

Keep in mind that this is from the perspective of a MTF (Male-to-Female). First, let's start with the things HRT won't do:

• HRT won't dramatically change bone structure. Most of the skeletal differences are developed during puberty, though some bones will continue to very slowly change shape or definition over the course of years.
• HRT won't change the voice for MTFs (Male-to-Females). Once a voice is "broken", it can't be "unbroken". For FTMs, taking testosterone causes the voice to break, but MTFs simply have to practice their voices, or learn to live with them.
• HRT won't significantly affect already developed facial hair; laser hair removal or electrolysis are required for that.

And here are the changes I've noticed since being on hormones:

• Within the first few weeks, I got mild hot flashes (mild meaning they weren't painful, but still very strange and obvious). Apparently hot flashes can happen any time there's a quick change of hormones in the body, and some women get them throughout their lives as their natural hormone levels rise and fall. Mine only lasted for a few days, and I haven't noticed any since.
• Also within the first few weeks, I noticed that my skin was much softer and more sensitive to the touch. My skin was already pretty sensitive before, but now, Erin loves to run her hands down my back and watch me writhe.
• My skin is somewhat thinner and lighter in color, especially on my face. Combined with subtle differences in the fat deposits in my face and cheeks, my face looks a lot more feminine now.
• The fat stores on my body have been rearranging themselves. My butt is nearly twice as big as it used to be, I swear.
• Within the first month, I was already noticing some chest growth. This has continued slowly, though sometimes in small growth spurts.
• Within the first two months, I noticed tiny hairs around the corners of my forehead. Since then, even more dormant follicles have been sprouting all over my head, causing annoying fuzzies that are only about an inch or two long. They stick up all over through the rest of my hair, and I can't do anything with them (though my hair stylist was pretty fascinated).
• Body hair growth has slowed down considerably. Some body hair has become lighter and more sparse.
• After a couple of weeks, I started getting noticeable headaches off and on. For the most part these have gone away, but I still get mild headaches slightly more than I used to (which was almost never).
• My finger nails have become a bit more dry and brittle, though they're still stronger than the nails of a lot of girls I know.
• Temperature changes around me are much more noticeable now, both hot and cold. When it's cold, my hands and feet turn into ice sculptures.
• Erin says I now "smell sweeter and more feminine", even without any added scents.
• Recently I've noticed that when I drink alcohol, I feel the effects more and faster. I've always been a "light weight" drinker, which I've been happy with, because drinks are expensive. =P Unfortunately I also seem to sober up more quickly.
• What little upper body strength I had is being slowly but noticeably sapped. I could probably get it back to where it was with a little working out, if I were worried about it.

The psychological effects are harder to define, or pin down as being specifically caused by the HRT, mostly because my mind is already reeling from all the other things going on in my life right now. I'm a skeptic, so I think that most of these can be chalked up to placebo effects, but the below are the mental effects which could be related to HRT. I'll let you make up your own mind:

• I seem to move from one emotion to another more quickly, though the range and intensity of my emotions is about the same.
• I cry a lot more recently. I think this is mostly because I've been under a lot of stress, and because I've been allowing myself to. I used to cry a lot when I was younger.
• If I forget to take my hormones, shortly after the 24 hour mark I get moody, and usually depressed if I'm alone. This happened a few times before I made the connection, but now if I get moody in the evening, it serves as a reminder. This part especially annoys me, because of my control issues.
• Extremely cute things sometimes get to me more. A couple of weeks ago, I giggled uncontrollably at a kitten video on YouTube for about 10 minutes. I've always liked cute things, but what really startled me was the intensity of this experience.
• Sometimes I feel more "cuddly", with a similar intensity. This one's also tough to describe, but when it really hits me, all I want to do is be as near to Erin as possible.

Trans people report a huge variety of other psychological effects, but the above are really all I've noticed. Whether or not these are mostly caused by the hormones, it's likely that genetics and a predisposed mindset play a pretty big role in shaping those effects.

All of the physical effects I've listed are pretty standard, but I feel lucky to experience them all to some degree so quickly. Judging from what I know of other trans peoples' experiences, I'm responding to the hormones really well. It's especially exciting, because the full effects are supposed to take years, meaning I still have plenty to look forward to. =)

Self Deprecation: A Daily Routine

"I can't handle this but I can't handle anything else,
It's my own mistake, it's based on me and not on my groin.
It's the little things in my pants that we're all living for,
I never really knew what that thing down there was used for."
 -- Mindless Self Indulgence, Kill the Rock

I've been meaning to write again for a while. I have so many subjects swirling around in my head, but it's so much easier to procrastinate. =P Just a warning: this is a pretty long entry.

A few days ago, I came home after an average day, when suddenly a wave of pressure hit me like a ton of bricks. I remember bawling to Erin for half an hour, all the while repeatedly asking "What am I doing? I feel so crazy. I can't do this! What am I doing?"

Despite the fact that I'd woken her up, she was as sweet as ever, and stayed up to comfort me until I fell asleep sobbing. The last anxiety attack I can remember before this was at least five years ago, back when I was with Bitchface. I sort of thought I'd grown out of them. Turns out I've just had it easy for the last few years. My life honestly isn't that hard right now. I have a lot of great friends, a great job, a wonderful girlfriend, so what hit me so hard that night?

I did.

I try so hard to be strong outwardly, because I want people to be happy for me. I want people to see that this is right for me. I don't want them to see how much self-doubt I always have, or how afraid I am, but I am, and I need to stop bottling so much of that up. I'm not sure how to convey the kind of punishment I put myself through, other than to simply expose my daily thought process, so here goes.

Telling Mom

"I can’t say that you’re losing me,
But I must be that which I am,
Though I know where this could take me,
No tears, no sympathy."
   -- VNV Nation, Epicentre

I've been talking a lot about wanting to come out to my family, and I'm happy to say that I've finally done something about it!

A month or two ago, I found out about National Coming Out Day, which is October 11th. I tend to procrastinate a lot, so I decided that setting that day as my goal was a reasonable way to pressure myself to do what I want to do, and tell more people.

Funerals and Family

"Some of us fall by the wayside,
And some of us soar to the stars,
And some of us sail through our troubles,
And some have to live with the scars"
   -- Elton John, Circle of Life

My grandma died last week, and yesterday I went to her funeral.

I've always sort of wondered how well I'll deal with death. My dad's parents both died when I was very young - I barely remember his mother. I think the last funeral I went to before this was for my dad's brother Bill, and that was... almost twenty years ago.

It's odd, because I'm such a mix of both strong emotion and strong logic, plus the fact that I've recently started on hormones, which I'm still getting used to; For the most part I've noticed that my range of emotions is similar to pre-HRT (Hormone Replacement/Reassignment Therapy), but I think I snap from one emotion to another more quickly.

The Story so Far

"When everything is going wrong,
And you can't see the point in going on,
Nothing in life is set in stone,
There's nothing that can't be turned around."
-- Garbage, Androgyny

Hi! I'm 27 years old, I live in Utah, my favorite color is blue, and I am transgender.

To give you the basics, I was born physically male, and while I don't think that I truly identify with either "traditional" gender role, I feel more female than male internally. I will not ask you to agree with this. All I ask is that you keep an open mind and make as few assumptions as possible, and I will gladly answer any questions you have. Questions, as I've really learned in the past few months, can be a great sign that people care.