Two Steps Forward, Three Steps Back

2011, as I’ve mentioned, was a huge year for us. We’re more visible than ever before, in a good way, and people think we deserve discrimination protections. Hooray! Pop the corks! Being trans will never be a problem for anyone again! (Suicide rates not withstanding) Oh happy day!

Ah, but. Even as trans rights advance, it seems that legal protections for women are being rolled back across the board. I’m leaving the world of men just in time to relive the fun and excitement of the nineteen-fucking-fifties. Abortion rights have been eroded for years, so much so that now there are no more half measures, no more “reasonable restrictions” and “zoning code revisions.” Now they’re forcing you to get an ultrasound. Now they’re demanding waiting periods. Now they want you to carry your dead fetus, because even that is too close to an abortion for their comfort, and it’s not like a woman has a right to get rid of the fucking corpse she’s carrying. (And hey, cows and pigs pass dead fetuses all the time. It’s not like women are people.) They’re coming after contraception (but not Viagra). Expect a condom tax, soon. Or maybe only men will be able to buy them. Wouldn’t want him to become a father without his consent, now would we?

Reproductive rights are bodily autonomy rights. No trans woman should view this assault on our cis sisters as anything less but a dire threat to ourselves as well. We’re all under siege here. If they can enshrine it into law that old white men who are afraid to say vagina out loud should have the authority to tell you what you do with yours, then they can pass any law they want to about our bodies. They don’t want us to exist. They’d ban transitioning in a heartbeat if they could. We’re probably not even on their radar yet, but that’ll change.

More than that, it is wrong! It’s just fucking wrong! How can they demand that women met become mothers whether they like it or not? Do they think that’s going to make for a happy childhood? A productive citizen? No, it won’t, and they know it! It’s never been about the welfare of the child. If it was, they wouldn’t be slashing family planning services that make abortions less necessary, or social services that help young mothers provide for their families.

It’s about punishing women for having sex.

“You did the dirty, now suffer for 18 years, you worthless bitch! We have to control your terrifying pussy or else!”

Or else what?

“Or else sluts!”

They know they can’t stop abortion; it’s being going on in one form or another for thousands of years. They just want to make it dangerous and difficult, to punish women for taking control of their lives and their sexuality. There is no other explanation that fits the available data.

This is retrograde misogyny of the highest order, and it is a threat to everyone. Fight it tooth and claw. Do not buy their “both sides” bullshit. People who respect a woman’s right to have an abortion are fighting for civilization and equality. People who want to squash it are fighting for a world where half of the spices is enslaved to the other half as an infrastructure support system, providing sex, housing services, and new men (new girls are a tedious byproduct, but we can find a use for them in the kitchen) for the over class. This sounds like some serious second wave lunacy, but that’s where we’re at: the threshold of lunacy. People who expect to get elected are saying things in public that, in a civilized country in a civilized time would get them laughed out of office. It used to be commonly accepted that, fer instance, the Pill should be something women have a right to. We do not have that consensus anymore.

This will spill over. This can only spill over. It will infect and corrupt the lives and prosperity of women in every sphere of their lives. Once you establish that the value of a woman’s health is less than the right of a dead fetus to fester in her uterus, then you can do anything to her.

Even as I’m ‘allowed’ to be a woman, the conservative movement in this country seems to have dedicated itself to a concentrated push to make the lives of women worse.

Thank the invisible sky daddy that I live in the 21st century.

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Hormones, Round Two

So once upon a time I got a prescription for injectable hormones. The injections hurt, but the effects they had were worth it. My skin softened. My boobs appeared. My hair began growing back. My emotions unlocked, and I realized I’d been living a pale shadow of a life.

When I moved away from San Francisco, my endocrinologist neglected to come with me. I shall never forgive her for this unforgivable lapse; there was plenty of room in my suitcase. What I did bring was a bag full of needles and a bottle of hormones. I kept up the injections, no matter how much I loathed them. Their benefits were too good to lose.

And then I lost them. My skin became rough again. My boobs stopped growing. My hair’s rallying charge turned into a desultory retreat. Worst: the haze settled over my emotions and the world once again became a pale, dry place. My performance at work started to suffer as my irritability and impatience returned.

A long and mighty struggle ensued. I did battle with the forces of OHSU, who politely but firmly declined to provide me with an endocrinologist because “we don’t have anyone who does that here.” They were willing to provide me with a list of unvetted alt-med bullshit artists they found on the Q Center’s website. I’m sure they felt quite generous.

On the recommendation of a friend (thanks, Kate!) I tried Legacy Good Samaritan. I was initially concerned about going to a hospital with such a religiously aligned name, but it turns out that they kick a simply amazing amount of ass on a daily basis over there. These people are fucking medical ninjas. Two phone calls later I had an appointment with a new endocrinologist who, upon seeing my prior medical history, simply asked me to do a couple of blood tests and then she’d prescribe whatever I wanted, pending test results. One test that same day, which happened to be injection day, before my injection. So call that the trough. The second a week later, then average those out to get a picture.

The first results show up in my mailbox with a handwritten note appended. “Estrogen levels a little high. Please come see me.”

The second results show up in my mailbox with a handwritten note appended. “Estrogen levels very high. Please come see me!”

I get to my ass back over there. (It doesn’t jiggle the way it used to. I am sad.) The doctor says that my test results for the first test, the trough, where my estrogen levels were about as low as they’d go, were a bit high. 640. Out of a scale of what, I ask.

“Well we’re shooting for 60,” she says. It gets better: the second week’s tests put me at about 1240. (I now have medical proof that I am 2000% woman!) I had so much estrogen in me that my body essentially said “fuckit, we’re done with with this shit until you quit flooding us out.” So it turns out that it’s okay that I’d stopped giving myself injections after that last one; I just couldn’t face them anymore.

We switched to pills. I’d wanted patches, but my new GP (yet another ninjadoc from Legacy Good Samaritan) has a lot of experience with transfolk and says that patches make it hard to get enough. I might have had to use two of them at a time. So now I take a pill and a half every day and it is glorious. My hair is returning again, my skin is softer again, my emotions are better again. I’m less irritable at work, and my performance is coming back up. Best: I don’t have to stab myself anymore!

I feel alive again, and I’m going to have regular appointments with my team of ninjadocs to keep this from happening again. Progress feels good. Literally feels good.

I feel lucky.

How to Choose a Therapist

So I’ve found a therapist to support me through my transition. Even better, she suggested that she might be willing to write me a note next time I see her. I’ve learned to be cautious so I’m trying not to get my hopes up on that score, but it’s difficult to keep them down. If she doesn’t write it for me next week, then hopefully she’ll do it soon after.

Here is what I learned about finding a therapist from my experiences so far with navigating bullshit gatekeeper drama.

1. Get a list of names from some place other than Google. Google will tell you were every single therapist they know of works, and in a dense city like San Francisco, it’ll be in the hundreds or thousands. Such a list is simply too long to sort through. I suggest calling up your health insurance, if you have any, and asking them to provide you with a list of therapists that they cover and who have experience or interest in gender identity issues. Some therapists inform the insurance companies what their specialties are so that the clients that get referred to them by the insurer will better match their practice. If you don’t have insurance, go to your local queer center, if there is one, and ask around. If that fails, then find a hospital and ask their psych ward for referrals. The point is to get a list of prospective therapists that is short enough to be manageable, and that have been referred to you by a reputable source. If you simply pick 5 random names off of Google, you have no idea what kind of quality you’re getting. Yelp! and other such services can help, as well.

2. If possible, talk to the therapists over the phone before you commit to an appointment. Get a feel for them, ask them any questions you have. You’re not making hard decisions here, you’re just looking for obvious red flags, things that if they came up in an appointment would make you walk out of the room. Remember that someone’s phone manner and their office manner may be different, so give them a chase even if you don’t click over the phone, but conversely don’t assume that because you like them during a brief phone chat that they will be right for you. If you get the feeling that something is deeply wrong with them, or that they are worryingly ignorant on the subject of gender identities, trust that feeling.

3. Make several appointments at once. Rather than making an appointment for next week, going to it, realizing you don’t like the doctor, making another appointment, waiting another week, and so on and so on, it’s best to make several appointments within the space of a week or two. Tell each therapist that you will be seeing others; it’s the polite thing to do.

4. Be honest with your therapists. Yes, they are gatekeepers. Yes, gatekeepers are often the enemy. But remember they’re pretty good at telling if someone is lying to them, and if you seem deceptive they probably won’t help you. If you do feel you must lie, about your thoughts on black market hormones for example, then try to use half-truths. Especially do not lie about anything they could check up on and confirm for themselves.

5. Be prepared to answer Trans 101 questions, and to stick up for your identity. Even therapists who claim (or are reputed to have claimed) to have an interest or specialty in the area often don’t know what the standards of care are, or the currently accepted nomenclature, or even basic facts about the trans experience. It helps to be able to clearly articulate why having a penis doesn’t automatically mean you’re a man, or having a vagina doesn’t automatically make you a woman. If you don’t think you can make this case forcefully (but tactfully!) under pressure, type it up ahead of time and bring it with you. It’s even okay to quote someone else and say that they can describe your feelings better than you can. One way or another, it is essential that you be able to explain what being trans means to you, and why you need to transition. Make it clear that you are seeking a letter of recommendation for hormone treatment, and that you want it now. It might help convince them to write a note sooner if you agree to remain in therapy for the duration of your transition (which is a good idea on its own merits, as well).

6. Do not make a decision until you’ve seen all the therapists you have made appointments with. I’ve seen three, out of four that I originally called. I’m pretty sure I’ve made my decision, hell I was pretty sure before I left the last therapist’s office, but I’m going to sit on it for at least the rest of the day and think about it before I call them back and ask for another appointment. A few hours deliberation now can save you weeks of cleanup on a bad decision later.

7. Most importantly,  trust your gut. A therapist is useless if you’re not comfortable talking to her, and even if the reason you’re uncomfortable isn’t rational or even anything you can put your finger on, the discomfort and unease will still hinder your ability to work with her. This might convince her that you’re not “ready” for hormones, and cause even further delays while you decide if you want to try and convince her or move on to another. If you have several appointments, then trusting your gut becomes easier because you don’t lose any time when you decide to go look for another.

Wrestling With Jafar

I had a therapist’s appointment today. I had the appointment because at my last endocrinologist appointment, I was told that my bloodwork was fine, that there’s really no medical reason not to begin treatment immediately, but that I need a permission slip from a therapist. I was disappointed and deflated when I heard the news, and the rage only hit a few hours later.

So now I’ve got three therapist appointments with three different therapists in one week. I’m going to take the pick of the litter, and hopefully get a note quickly. If I don’t get one, I’m going to try to convince my doctor that I’ve been living full time for 3 months (I consider this to be true) and so meet the standards of care requirement for the begining of HRT.

The therapist appointment today was intensely frustrating. I was recommended to her by my insurance company as a gender specialist, but she was nothing of the sort. Severely ignorant questions, invasive probing of an unnecessary sort, so on and so on. Very frustrating. I’ve got two other shrinks lined up. I hope one of them will be okay.

If this post is more scattershot than normal, that’s because my depression has returned and I find it difficult to focus or maintain interest. In anything.

The Size of It

I had an endocrinologist appointment this passed Wednesday. She was amazing, didn’t ask for proof that I was trans, didn’t freak out when I eventually fessed up to having been suicidal in the past, encouraged me to find a therapist but didn’t make treatment contingent upon that, helped me figure out a way to deal with two other doctor’s offices that appeared to be giving me trouble because I was trans, and so on and so forth. A couple hours later my blood and urine samples had been taken, and now I’ve got another appointment with her this coming Wednesday.

And now it’s hit me how big this is. How drastic. Transitioning is real now. It’s big and it’s scary. The part of me that is always afraid of change is louder now, shouting that I don’t have to do this after all, that maybe I can just change my name and live half way.

I know it’s not an option. I know it’s just insecurity. I’m afraid of change. I’m afraid of getting what I want. I’m afraid of trusting myself with this kind of decision. Transitioning is the right thing to do.

But the size of it!

Head in the Sand

It occurs to me that in all of my efforts to acquire hormone therapy, I haven’t given much thought to how I’d pay for it. I’ve only got the strength to deal with one headache at a time right now, and I’ve got two to deal with already. The AMA’s guidelines for treatment of the transgendered are to transition, hopefully in a stable, supportive environment. My insurance’s written policy on prescriptions is that it covers “all medically necessary” prescriptions.

Surely that means they’d cover me, right?

Right?