The Biggest Decision I've Ever Made

"This is life,
What a f***ed up thing we do,

What a nightmare come true,

Or a playground if we choose,

And I choose."

 -- Offspring, I Choose

Transition has been one set of objectives after another... hair removal, various stages of coming out, therapy, hormones, bathroom issues, work. My life has turned in to a strange series of stepping stones, which I think the rest of the world calls "goals". I have no clue how "normal people" go about their lives like this; I have no idea how I've done it for the past year, but it has definitely improved things for me.

With the bulk of work transition successfully behind me, the next life steps I'm looking toward are marriage, and a legal name change, but I keep asking myself, "What's after that?"

I guess I don't know why there has to be a next step, but it feels like there should be, and I never really planned this far out. Suddenly the road forks in big ways, and I don't know which forks to take.

I hate decisions, especially big permanent decisions. When I was a kid, I came up with all sorts of rationalizations for why my decisions were not important, just to make it through the day without anxiety attacks. Some day I'll write several posts just about all the life "rules" that I came up with during my teenage years, and still use, but for now I'll spare you by sticking to the ones about decisions:

• If I can't decide between two or more options with a reasonable amount of information and time, then all options must be nearly equal, and I may as well just pick one.
• If time and space are infinite, then my decisions are infinitely unimportant.
• If a decision can be undone, and doesn't cause permanent harm, it's ok to try it just to try it.

Unfortunately, the decisions I need to make now are bigger than anything I've dealt with before. Especially with regards to "the" surgery. Rule C above doesn't apply, since it can't be undone. B isn't much comfort now that I'm emotionally invested in my own future (I know, what a weird concept, but it is surprisingly new to me). And A, well, it somehow doesn't seem appropriate to flip a coin or Rock-Paper-Scissors for this one.

Don't get me wrong; if Sexual Reassignment Surgery (SRS) were cheap, with safe and predictable results, I would do it in a heartbeat. Unfortunately, surgery is expensive (around $15,000-$20,000), and comes with many risks and possible complications. For a young and relatively healthy person such as myself, the risks are lessened, but extremely scary nonetheless. This is a major surgery, after all.

There's also the timing issue. Due to the Standards of Care, I can't have SRS until I've been living "in role" for at least a year. Shouldn't this make the decision less urgent? It would, except that $20,000 is not pocket change, and I've failed to save more than a few thousand in the last year. If I want to do this, I'm going to need to start saving aggressively, and even selling a lot of the nostalgic junk I've held on to over the years.

It would be nice if insurance covered any of the cost. The American Medical Association's House of Delegates passed several resolutions in 2008 asserting, among other things, that Gender Identity Disorder is a serious medical condition, that treatment is not "cosmetic" or "experimental" but is medically necessary, and that denying coverage is discriminatory. Most insurers however, go right on with their blanket policy exclusions, or statements that GID is a "pre-existing condition". Of course, I know that's not why most insurance companies don't cover GID. They don't cover it because they don't have to, even though its low prevalence means that paying these costs would likely be much less impacting to their bottom line than most seem to think.

Most reassignment surgeons are also booked anywhere from six months to a year out at any given time, which means I need to know whether or not I'll have all the money quite a while in advance of when I actually have the surgery.

I want the surgery. I know that it would make me feel a lot better about myself, despite the fact that it may only ever matter to me and one other person. In the end, I have to acknowledge that my fears are the biggest thing stopping me, and flying in the face of those fears has gotten me too far to stop now.

I decided a couple of weeks ago that I will definitely be getting the surgery, it's just a matter of when and how. As much as I hate to, I will probably eventually have to ask for some help. For now though, I'm going to see how far I can get on my own.

Work Transition: My Birthday Present to Me

"So if you think it's scary, if it's more than you can take,
Just blow out the candles, and have a piece of cake!
Happy Birthday! Happy Birthday to you!
Happy Birthday! Happy Birthday to you!"
 -- Weird Al Yankovic, Happy Birthday

Disclaimer: 
All opinions posted here are my own, and not necessarily representative of the company I work for

On Monday I transitioned at work. A few people have asked me what that means, and each time, I suddenly remember that this isn't all self-explanatory. Outside of work, I've been dressing how I like and going by my new name and female pronouns for a few months now. At work, however, none of these changes had happened yet.

I came out to all my coworkers in November, but so far, I had decided that I wasn't quite comfortable enough with the new me to make the transition leap at work. I continued wearing a sports bra, baggy t-shirts, androgynous earrings, no makeup, and talking in my old voice. About a month ago I decided I was finally ready, and that pretending to be male was getting a little bit too awkward.

I informed my supervisor and started meeting with HR and management to plan it all. We created different communication plans for my local teammates (one meeting a few days beforehand to prepare them), the local center (a top-down communication to all leadership, so they can be prepared if any rumors or concerns surface), and the various other teams and people I work with globally (basic communication from their leadership). We planned for a new name tag, badge, preferred name in the system, etc. When it came to the bathroom issue, I told them that I was worried about it because I know it can be a very sensitive issue for a lot of people, but they reassured me that it was no problem and that I would probably just use the women's.

A couple of weeks before transition, the HR rep met with me and told me she would be meeting with legal the next day to review the plan. She wanted to get a clear idea of my thoughts on the bathroom issue so she could represent them properly while discussing it with the powers that be, so she asked, "What if, for some legal reason, they say you have to use the men's room?"

Anxiety set in. After a pause I choked out, "I guess... I wouldn't transition at work."

"Then how would you continue your whole process?"
The tears started, "I guess... I would have to leave the company."
"Wouldn't you have to face this kind of thing at any company you work for?"
"...Yep."

We talked some more and she reassured me that she just wanted to clarify my feelings-- that nothing had actually been decided yet. I tried desperately to calm myself down. I felt pretty stupid, but she was really sweet about it, and asked me to come talk to her first thing the next day since she was meeting with them earlier in the morning.

Thankfully, the next day, she told me that the meeting had gone well and that I would be using the women's restroom. They decided that there would be more questions/complaints/awkwardness if I were using the men's room, than if I were using the women's. Yeah, I could've told you that. =P

Day 1 (Monday)
On Monday, April 5th, I went in to the office as myself for the first time. I met up with the HR rep, who sat me in a meeting room to give me time to breathe and make sure I was ok. I think I was shaking. When I was ready, we went to the security office and got a new badge printed out, complete with new name and picture.

When I got to my desk everyone was very natural and easygoing about it, which helped a lot. One of my awesome female coworkers gave me a necklace, because "Every woman needs a black necklace that can go with anything."  So. Sweet. =3

There were a few slip-ups with the name, but I never got a chance to correct anyone before they did it themselves. I was still terrified of the bathrooms and avoided going for most of the day. At around 5 hours into my shift, I finally decided that it wasn't worth a bladder infection and convinced myself that I'd have to get over my fear eventually. I decided to use the upstairs bathrooms, to hopefully avoid seeing anyone I know. I actually didn't end up seeing anyone at all. On the way out I decided that I looked pretty good, and that I should've gone a long time ago just to see myself and boost my confidence.

Day 2 (Tuesday)
On Tuesday, the internal systems finally updated with my "preferred name" and new picture, so that people can look me up or email me using Vivi. Partway into the day my boss's boss called a random meeting and brought in Birthday cake for me and my supe, whose birthday was on the 4th.

"Happy Birthday Michelle and D  Vivi"

LOL

I was worried about my voice for most of the day, so I kept talking really quietly, and trying not to cough. The bathrooms got easier to use, especially since there was never anyone else in the ones upstairs.

Day 3 (Wednesday)
We had a team meeting early Wednesday morning, which I decided to call in to from the comfort of my pajamas. The whole meeting, I kept thinking about how much I hate my voice, and how the more afraid I am, the worse it sounds. On the drive in to work, I used my phone to repeatedly record and playback my voice, to reassure myself that I don't sound that stupid. Shortly after getting in, a co-worker randomly told me that my voice sounded good, and that he didn't recognize me on the call at first, which made me feel a lot better.

A few of the women on my team sometimes take breaks together to go on walks or over to the gym, and they invited me. A social activity and forcing myself to work out? Sweet!

I used the bathroom a couple of times without too much anxiety, but I know I'll tense up the moment I finally see someone. Everything else is already starting to settle back into normalcy. My boss's boss commented on how it was as if everything had changed, and yet nothing was different. I couldn't agree more.

In other news, today is my birthday! After 28 years, I'm finally free to be myself. Oh well, better late than never I suppose. =)

Telling Erin's Family

"Breathe, keep breathing,
Don't lose, your nerve.

Breathe, keep breathing,

I can't do this, alone."

 -- Radiohead, Exit Music (For a Film)

*sigh*

I've been meaning to write for quite a while, as usual. For the same reasons that I really want to write, it's also been hard to find the time.

Between coming out to Erin's dad two weeks ago, planning our wedding, voice classes, planning work transition, and hanging out with old and new friends and family more in the past three months than in the whole previous year, sometimes I'm surprised I find time to breathe. It's good, but it's scary; I'm not used to my life being like this, and I always feel like I'm forgetting something really obvious.

I like to be aware of things. As long as I'm aware of everything, especially my own faults, then I can correct them or decide not to feel stupid about them ahead of time. The current pressure makes me worry that I'm losing awareness of details, like I could have something horrible on my face all day, and not notice. *sigh* C'est la vie.

Where was I? Oh yeah-- Erin's dad and stepmom took the news really well! Erin really loves her dad, so I think keeping this secret has been hard on her. That she loves him is also exactly why we were afraid to tell him. I was so scared that he was going to take it badly, and that I would blame myself.

We went to visit them with the intent to get it over with. When we got there, we skirted around it for a while, trying to find the right situation, which never comes. Suddenly, they started searching around the internets, and saying they wanted to see our FaceySpace profiles.

Me: *sinking feeling, tugging on Erin's arm* "Say something!"
Erin: "So... we came here to tell you something... [my old name] is transgender."
Dad-in-Law: "Ok, so? Why does that matter?"
Me: "It doesn't really matter, but it was still important that we tell you."
Dad-in-Law: "That makes sense... Listen, I may not agree with it, but as long as Erin's ok with it, it's fine."

The "I may not agree with it" caveat is always weird, but that's for another time. With the way they were going after our FB profiles, I'm pretty sure they knew ahead of time. I find that parents are often more clever than their children give them credit for.

They asked a few questions about it, which is always a good sign of acceptance. With the air cleared, we decided to stay and play a few rounds of Rummikub. Erin slipped back into calling me "she," and by mid-game, her dad picked up on it and started using female pronouns as well. At one point, Erin left the table to use the restroom, and he told me "You know, you can call me Dad." =3

I'm surprised I didn't write about it before, but the rest of Erin's family has been similarly accepting. Her brother was one of the first people we told, and he was actually excited for me. We told her sister last summer, and her mom, stepdad, and other brother in December. The last three even took us out to dinner to celebrate our engagement.

I thought people were supposed to hate their in-laws? If this is a dream, please, don't pinch me.

On Toys and Stereotypes

"When I grow up,
I'll be stable.
When I grow up,
I'll turn the tables."
 -- Garbage, When I Grow Up

The video in the previous post got me thinking about my own childhood.

Listening to other trans women's stories, there are a lot of themes that come up time and time again. One of those is that many knew from a very young age that they were female. That they always wanted to play with dolls. That they hated their genitalia. That they just... knew.

To some extent, I envy those people, because I had no idea.

Some of my earliest memories are of toys, but not dolls. Oh sure, we had a Teddy Ruxpin. I had a stuffed rabbit pillow that I took everywhere for a while. My sisters had gobs of stuffed animals, My Little Ponies, and Cabbage Patch dolls, which were certainly interesting, but I was drawn to something else completely.

I liked Domino Rally, Legos, K'Nex, and Lincoln Logs. I liked to make things, I liked to invent. I liked Intellivisions and computers and Game Boys. I taught myself to program text adventures in qbasic when I was 9, a dot matrix printer is one of my favorite sounds, and I still ask for Lego sets for Christmas and Birthdays.

It took me a long time to realize and accept it, but these things do not mean that I must be male. Sure, for many women-- trans or not-- playing with dolls was an expression of their girlhood, but many other women played with Legos. And they are still women.

I've always had gender issues swirling around in my brain, but as a little kid, I don't think I fully grasped the meanings and consequences of gender, let alone how it would affect me in the years ahead. As I started to realize the implications of the box I'd been placed in, my gut reaction was to prove to myself, and to others, that the boxes didn't exist.

I've spent so much time and energy throughout my life trying to break down stereotypes, trying to show people that gender is not what they think it is, that I couldn't see the forest for the trees. The truth is that nobody fits into the boxes of "male," "female," or "in-between," but that doesn't stop the average person from staking a claim wherever they damn well please. It wasn't until I finally admitted to myself that the boxes do exist, and that I had a right to stake my own claim wherever I wanted, that I saw where I fit in, and where I would be happiest.

Maybe if I had wanted to play with dolls, or wear dresses when I was little, I would've figured it out earlier. In the end though, I think I'm glad that I didn't. I certainly wish I had the opportunity to undo my first puberty, but I know that I would not have been ready to handle this any time before now, and I don't think I would love and appreciate being a woman nearly as much as I do today.

So now I'm curious; what were your favorite toys when you were little?

Transgender Children on the Dr Oz Show

The Dr. Oz Show recently aired this segment about trans kids. Thanks for the link, Mel!


(If you're interested, Part 2 is here.)

I'd never heard of Dr. Oz before this, but the show was surprisingly respectful and well done. I usually watch these programs and wince, for fear that the host will make the trans folks look like a sideshow.

What do you think? Is it okay to delay puberty until the child can make a more educated decision? At what age is a child old enough to start irreversible surgeries?

Engaged!

"But there never seems to be enough time,
To do the things you want to do,
Once you find them.
I've looked around enough to know,
That you're the one I want to go
Through time with."
-- Jim Croce, Time in a Bottle

Today, Erin and I are officially engaged.

I haven't talked much about Erin here in the past, mostly because I didn't feel comfortable putting her on the spot. That sort of thinking is honestly silly, since she agreed without hesitation to stay with me through transition, and has never been ashamed of me. I just tend to feel like she doesn't know what she's gotten herself into, like I have to protect her from the prejudices of the real world, and sometimes I forget that all too often she's the one protecting me.

Four years ago, I saw Erin's profile on MySpace, and was attracted by three things: her gorgeous picture, her nerdiness, and the word "androgyny." I told our mutual friend that I thought Erin was cute, we began talking, and the rest is history.

I won't lie and say that we haven't fought from time to time, or that our relationship has never been rocky, but I believe one major thing has held it together: trust. I have never in my life felt as though I could trust another human as much as I trust her. She has integrity, of a type that I never thought I would find.

Erin was the first person I came out to, about 14 months ago, and though it was hard for her to accept at first, she has always supported me. We've talked about marriage many times over the last few years, but I have a major fear of permanence, and knew that we didn't communicate as well as we should. Over the last year, we've been forced to work together and support eachother in entirely new ways; out of necessity, our communication skills have grown, and we have become closer than ever.

With our relationship becoming stronger every day, I realized that the only excuse I had left was my fear. If there is one thing that my transition has taught me, it's that the things I'm most afraid of can also be the most worthwhile, as long as I'm willing to give them all the effort and energy they deserve.

This realization, along with the fact that we won't be able to legally marry after I change my legal gender, placed an urgency on the subject. A few weeks ago, we again started talking about marriage, about who would propose to who, about how we should go about it. Last week, we made plans to go to the jewelry store together. Later, I found out that Erin had been preparing a romantic proposal with a Ring Pop, to be replaced at a later date, and I almost wish she would have gone through with it; I would've bawled. ;)

Last Saturday, we picked out matching solitaire diamond rings, then held our breath for the next five days, as we waited for them to be assembled. Today, the rings were finally finished, and we "made it official."

As an aside, the person that helped us at Shane Co. was great. Being a transgender woman, in a "lesbian" relationship, with a low budget, and living in Salt Lake City can be a scary combination sometimes, but he was completely professional. He listened to what we wanted, he gave us options without trying to upsell us, and he never once acted like anything was abnormal or out of place.

The rings are beautiful, simple, and effective. The glint catches my eye from time to time, and makes me smile uncontrollably. We haven't set a date for the wedding yet, but we're discussing it, and it probably won't be that far off. Thanks to everyone who has congratulated us so far, it means a lot to have the support of so many friends and family!

Most of all, thanks Erin, for loving me unconditionally, and wanting to grow old with me as badly as I want to grow old with you.

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.