Testosterone: Day 377

This post has been a work-in-progress for over a week now. It’s more personal than previous posts because it’s more like storytime than trying to teach readers about transgender people and transition, though I’m sure it will help other FtM individuals and the people around them. So please, bear with me.

 

I started Testosterone on September 9th, 2013. I remember the day vividly. I was awake before my alarm was supposed to go off at 7am, I leaped out of bed and all but ran to take a shower, treating myself to a chance to use my “for special occasions only” body products. I shaved for the first time using a 2-blade ladies’ safety razor and conditioner in place of shaving cream, even though I had no real visible facial hair at the time. I carefully styled my hair in an attempt to look more manly, but ended up opting to wear my favourite wool flat cap (that I lovingly refer to as my “fancy dancey chuaffeur-pantsy hat” because it makes me feel like a dapper taxi driver when I wear it) instead because I couldn’t make my hair look the way I wanted it to. I put on my normal sports bra, followed by a slightly-too-small one, then my compression shirt, and finally my favourite black polo shirt on top. I pulled my packer strap up over my hips, carefully nestled my packer into it, stepped into my boxerbriefs and pulled them up into place, rearranging the packer carefully to make a natural-looking bulge instead of looking like I was “pitching a tent”. Grey tweed-patterned shorts on top, and my brown Hush Puppy sandals that I’d searched all over the city to find in my size (size 6, not a common size, most shoes seems to only go down to a 7, and youth seem to only go up to a 4 or 5). I carefully packed my vial of Depo-Testosterone (testosterone cypionate suspended in oil), a Scooby Doo bandaid for after the injection (I specifically looked though the box to find one that was Scooby’s dog tag because it made me smile the most and felt like a badge of honor to put on my thigh after the shot), and I headed out the door. I was well over half an hour early arriving at my appointment, but I waited quietly, albeit excitedly, in the waiting area for my name to be called. Not just my name, my preferred name. The endocrinologist was the first doctor to ever ask me what I go by, instead of assuming I identified with the name on my care card/ID.

“Shayne?” I nearly jumped out of my skin when I heard my name called. My wonderful endocrinologist (who will referred to as Dr V from here on out) greeted me with a smile and a wink, and I think I sprained my face with the grin that came next. We reached her office at the end of the hall and she asked if I was ready, and I choked back tears as I said “I was BORN ready!”. I hopped up on the table and pulled up the leg of my shorts while she explained how to do the shots. I didn’t really take much of it in because we had gone over it in our appointment the week before and I’d repeated it to myself over and over since. Heck, I had already versed my mother and best friend (who would be doing the shots for me as I knew I didn’t have the confidence to self-inject with such a large needle) in how to properly do it! My best friend has done most of my shots over the last year because she’s good at doing them painlessly; my mom, I think because I’m her kid, tends to make it partway into my leg and then has to push a second time to get it in properly and it always hurts and leaves a big bruise, but at least she’s willing to try! Anyways, I drew the Testosterone into the syringe, got the air out, prepped the injection site on my thigh with an alcohol swab, and then handed the needle to Dr V. By the time I realized she had jabbed me, she was done. Quick and painless, a far cry from every darn vaccination I’ve had to have (I always bruise really badly and have severe muscle pain wherever I get vaccinations done, so I was expecting similar with the hormone shot. Pleasant surprise for sure!!!)

As Dr V carefully put the bandaid I’d brought over the poke mark, I burst into tears. For a few minutes she simply hugged me while I sobbed some of the happiest tears I’ve ever shed. I finally felt like my life was on track!

That day, and every time I’ve seen her since, Dr V makes me feel absolutely wonderful about myself. I can have the worst day ever, but I go in to see her for a check-in, and I leave feeling like I’m on top of the world. I will never be able to express my appreciation for her and her kindness and respect for me as an individual. When I first met her and she performed a pre-hormone physical, she came across some old self-harm scars. I braced myself for criticism, as I’d experienced from other doctors previously, but she simply ran her fingers gently over them and said that she was sorry that I felt like that had been my only option. Then she hugged me and told me that if I need anything, to let her know. A year later I DID need something, a referral to a psychiatrist, and she gladly did that for me, even taking time from her busy day to call the psychiatrist I asked to be referred to while I was still in the room so that I could trust that she had actually done it (my family doctor is notorious for claiming to have made referrals for me and not actually doing it, hence my needing to ask Dr V to make the referral instead). I dropped off a card the next day to thank her for doing that for me.

 

I began to feel some of the effects of the Testosterone within the day. About an hour after my injection, I felt amped-up, like I had energy to burn and the only thing that would make the feeling go away was to go do something physical, so I went out and worked with my pony.

A few weeks into it, I realized that injecting every other week as originally prescribed led to severe mood swings at the beginning and end of the period. I called Dr V and she said to half the dose and inject weekly instead, and it made a huge difference in the mood swings. I still found that I had restlessness in my muscles, so she also suggested to take a combination calcium/magnesium supplement, and that also helped! I still take the supplement daily to be safe, but if I miss a day here and there (if I run out of the pills and can’t get to Costco to buy more right away, usually) I don’t feel like I’m crawling out of my skin.

My voice started dropping around Christmastime, and as I felt things starting to rumble when I’d speak, I also developed a bit of a cough. It lasted about a month but has since gone away for the most part. The cough did come back recently when there was a sudden drop in my voice again, and my throat feels scratchy when I talk. Dr V says it’s due to my vocal chords thickening. Week 53 I noticed that I have a slight adam’s apple forming as well. People started noticing the voice change in early February.

I started getting hairy thighs about 2 months into the hormones. My mom (who had to assist me in getting in and out of the shower after I trashed my ankle in October) started laughing when one day in December she noticed I had “a hairy butt crack” (she then proceeded to inform me that I get that from my dad. Gotta love my family’s openness about things like that! Haha!). Shortly after Christmas I started getting a “treasure trail” (trail of hair down my stomach leading to my pubic area) and since then it has gotten darker/thicker. Over the summer I started growing chest hair, and at the moment it’s localized to my cleavage, apart from a few stray hairs elsewhere on my chest.

Facial hair started coming in sometime in May. I only had to shave once a week for the first while, but now I find myself having to shave every few days. The hair is darkest/thickest around my jawline, but I have a light mustache starting, and random hairs coming in on my throat. The hair on my throat and under my chin is itchy if I’m sitting in bed reading, and I tend to use that as the signal for when I need to shave again. I currently use a Gillette Mach 5 razor with same brand sensitive skin shave foam. I think I’d like to switch to shaving soap and badger brush instead of the canned foam though, because I find it really dries out my skin. I also have a bit of a thing for old fashioned safety razors and am thinking of asking for one for Christmas. Part of the reasoning behind this is that the replacement blades are CHEAP, especially compared to the replacement cartridges for the Mach 5, and the design allows for an even closer shave when shaving with the grain which means less ingrown hairs (something that my father and I are both prone to, but he says he doesn’t have a steady enough hand to use the safety razor, so he alternates between the Mach 5 and an electric razor). There’s also something about old fashioned safety razors, bars of shave soap, and badger hair brushes that feels really sexy!

 

I’ve also noticed a dramatic change in my body shape. The fat around my middle is shifting and has started to smooth out my female curves, making my torso look straighter rather than slightly hourglass. My butt has flattened slightly and my pants are fitting me better in the butt/thigh area, but are now too big in the waist. I still need a slightly larger waist size to make pants fit my rear, but I’ve lost about 4″ around my waist.

My breasts have “deflated” and are about half the size they were pre-hormones. On the flip side, they now sag more! But this has proven to be a positive thing for me; the “deflated” shape has made them a lot easier to arrange in my compression shirt and have them look natural and masculine. I’m less confident without my compression shirt on, but I’m far more confident when I’m wearing it and feel that I “pass” easier.

I have gained a fair amount of muscle and have lost some fat as well. I have noticed that I am stronger than I was, but I tire more easily because while I have improved strength I lack endurance. I am sitting at approximately 220lbs and while some of it IS fat, the majority is muscle. Most of my fat in around my middle and is partly caused by PCOS (poly cystic ovarian syndrome). The goal is to have a hysterectomy and oophrectomy (remove my uterus and ovaries) at approximately the same time (if not at the same time) as my top surgery.

 

As far as surgery goes, Dr V made the referral (and wrote the letter required) to Dr Cameron Bowman in Vancouver so I can have my top surgery. I am VERY lucky to live in BC because BC Medical pays for top surgery for FtMs! All I have to pay for is the travel to/from Vancouver, the post-surgery compression vest, and any medications I am prescribed pre/post surgery. Depending on Dr Bowman’s schedule, I’m looking at 3-9 months before I get to go over for a consultation, and then 6-12 months after the consultation before I have surgery. I REALLY hope to be able to go for surgery by this time next year, but I won’t know until I hear from his office.

At this time I am NOT looking at having bottom surgery (genital reconstruction) but AM looking at hysterectomy/oophrectomy. Surgical procedures for FtMs aren’t the best right now, and the outcome isn’t what I’m looking for. I would prefer to keep my working-but-not-aesthetically-pleasing genitalia and be able to strap on whatever equipment I or my future partner prefers, rather than go through a REALLY intense surgery and have equipment that’s flesh-and-blood but doesn’t necessarily work the greatest. I would gladly have bottom surgery in the future if the outcomes look better, but for now it’s not something I am interested in pursuing.

Gender Dysphoria

According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), Gender Dysphoria is the “official diagnosis” for people whose gender at birth is contrary to the one they identify with. In order to be diagnosed as such, however, not only must the individual identify with another gender, but there must be significant distress caused by not being the gender they most closely relate to, and the distress must last for longer than 6 consecutive months. In children, the desire must be present and the child must verbalize such.

Gender Dysphoria is manifested in various way, including but not limited to: strong desires to be treated as the opposite sex or be rid of their current sex characteristics (ie genitalia and/or breasts or lack thereof), or the existence of a strong conviction that one displays feelings and/or reactions that are typical of the sex with which they identify.

The biggest improvement to the DSM-5 from previous editions is the change in phrasing from “Gender Identity Disorder” which suggests that it is unnatural or makes one ill/crazy to be transgender. Calling it a dysphoria (defined as a profound state of uneasiness or dissatisfaction) validates it as a legitimate feeling or way to identify as opposed to an illness that needs to be “cured”.

Transition – What’s the Process?

(I live in British Columbia, Canada, so the process for a BC resident differs from the process others may have to go through, so please don’t take this as the only way it’s done. The hoops I need to jump through are different from the hoops an Ontario resident needs to jump through, or someone from the US. Because I am unfamiliar with the process in other areas, I will only be talking about my own process here in BC.)

 

Let’s talk a little about what transition means. In the most basic way, it is the process that a person goes through when changing their gender identity. What comes to mind for most people when they hear about transition, or gender reassignment is the process of changing one’s physical body to match their true selves. The most common way of doing this is by doing hormone replacement therapy (HRT) or having gender reassignment surgery. But surgery and hormones aren’t necessary parts of transition, and there are many transpeople who choose not to transition and still feel whole in their gender identity without the permanent body alteration. Others don’t feel whole unless they have been on hormones for a long period of time, and have had all of their surgeries, and even then there are some who never truly feel whole at all.

Before someone is able to start their transition medically (in other words, begin HRT or have surgery) here in BC, they are required to go through a psychological evaluation with a psychologist or other mental health professional who is sanctioned by the province to perform said evaluation. In Victoria, we are lucky to have several fantastic psychologists who are not only knowledgeable about transgender health, but they are also huge advocates for the LGBT community as a whole. An individual is required to meet with one of these sanctioned professionals a minimum of 3 times, with 30 days between appointments. This is to determine that the individual is acting rationally, and not seeking transition as an impulsive change, because it is incredibly drastic and a lot of the changes are irreversible. If, for some reason, the professional believes there to be reason for more assessments before they approve transition, then the individual will be required to return for additional appointments, but this is on a case-by-case basis.

At the end of the assessments, if the professional feels that you are of sound mind and are truly “born wrong”, then they will write a letter stating that you are formally diagnosed with gender dysphoria – the medical journal’s name for the alleged mental illness or condition that causes a person to be transgender. That being said, very few trans* individuals or trans* advocates will agree that there is any sort of illness or underlying condition that causes one to be transgender, it is simply the way a person is born. However, in the province of British Columbia, because trans* related expenses and procedures are covered by the provincial medical insurance plan, it can be assumed that in order to rationalize why it should be paid for by BC Medical, there needs to be an officially diagnosed medical condition that requires treatment. At least that’s how I have come to understand it over the course of my transition thus far.

The letter is accompanied by a referral to an endocrinologist, a doctor who works with hormones. I can’t speak for other endocrinologists as I have only ever dealt with my own, but I will say that I genuinely look forward to my appointments with her. She is VERY trans-friendly, cares deeply for every one of her patients, and I always leave her office feeling wonderful about myself. My first appointment with her, on September 9th of 2013, was about an hour long and consisted of questions regarding my medical history, what my preferred name and pronouns are, what I expect from hormone therapy, a physical, and I left with a prescription for my first vial of Testosterone (in the form of intramuscularly injectable testosterone cypionate), a requisition for bloodwork (that I have to repeat every other month), and a list of the equipment I would need in order to inject the hormone solution (3ml syringes, 18g 1.5″ needles to draw up the thick solution into the syringe, and 22g 1.5″ needles to inject the medication into my thigh muscles). Because I have family history of poly-cystic ovarian syndrome (PCOS), I was also sent for a pelvic ultrasound to ensure that there was nothing wrong with my reproductive organs that might lead to issues with my body accepting and properly utilizing the testosterone. It was discovered that I suffer from PCOS as well, which explains why I have never had proper periods, even before starting hormones (I was lucky if I had one in a 12 month span, but averaged one period per 18 months since hitting puberty the first time around), but also helps with my testosterone levels because my ovaries won’t be able to convert the testosterone to estrogen before the testosterone is fully utilized.

I returned to my endocrinologist a week after my ultrasound to go over the results (neither of us were surprised, and she was not concerned), and for her to give me my first dose of testosterone!!! Most transpeople I know choose to start hormones as the first step of medical transition because it is the least likely to lead to any time missed from work or regular daily life. While technically speaking, hormones are less invasive than surgery in the sense that they don’t require hospitalization or recovery time afterwards, but they ARE responsible for the most changes! (More on what hormones control/change, and what changes I have experienced in my transition so far later.)

The next steps are different for every individual. For me, it’s top surgery (double mastectomy with chest recontouring, to be exact, but most transmen refer to it simply as top surgery). When this happens depends not only on the individual, but on the endocrinologist or other physician’s practices. In my case, my endocrinologist doesn’t make referrals for surgery until the patient has been on hormones for a year. This is because, from my understanding, it gives the body a chance to acclimate to the hormone-caused changes and gives them time to “turn back” if for some reason they decide that transition isn’t for them. I see my endocrinologist for my “1-year” appointment on September 17th, at which time she will go over the changes I have experienced, check that my levels are appropriate for the point in transition that I am at, and then put in the referral to the surgeon. Her in BC, only one surgeon, Dr Cameron Bowman in Vancouver, is covered by BC Medical and as long as a transperson goes through the proper procedures, their surgery is free to them – they simply have to cover their travel expenses. From what I’ve heard, from referral date to when you get in for a consultation with Dr Bowman, it’s about 6-9 months’ wait. Then another 6-12 months from consultation to surgery date. This may not be the most up-to-date information so I will update with new info as I can get it.

Bottom surgery (genital reconstruction) is a really complicated subject that I will leave to its own post at some point. At this time I do not plan on having bottom surgery in the foreseeable future and I do not know enough about the different options available to transmen at the moment to be comfortable talking about it. I don’t want to provide false information, so for now I will continue my research and revisit the subject when I am better able to provide correct information!

I am VERY excited for my appointment on the 17th and hope to have some helpful information to post afterwards!

So What IS “Transgender” Anyway?

For someone who IS transgender, one might think it would be easy for me to explain what it is to be transgender, and yet I still find it incredibly difficult even after identifying with the term for so long. So let me break it down:

 

In the most basic (and by basic I really do mean basic) of senses, “Transgender” is just that – the transition from one gender to another. Someone who is transgender is someone who identifies as a gender that does not match their biological sex.

Gender and sex are the same, you say? Absolutely not! Sex is all biological and is determined based on chromosomes. Whether someone transitions or not, their sex doesn’t change. This can be a cause for dysphoria and is NOT something that should be brought up in polite conversation with someone who is transgender. (More on polite conversation in a later post.) Gender, on the other hand, is a fluid idea, and there are countless genders and gender identities on the spectrum. Think of it as a rainbow (as cliche as that sounds) – on one end is male-identified born-as-male (cismale/cisman) and at the other end is female-identified born-as-female (cisfemale/ciswoman). In between those two extremes you’ll find female-born male-identified (FtM transman) and male-born female-identified (MtF transwoman), genderfluid (identifies as multiple genders or no gender and presents as various genders as they please), gender non-conforming (does not identify as part of the “gender binary” of male-or-female, sometimes not identifying as any gender), two-spirit (the First Nations/Indigenous North American word to describe not only transgender individuals but others who are on more central parts of the gender spectrum), to name a few. A person’s gender is determined by the individual; nobody can tell a person how to identify.

“Can someone identify as transgender even if they haven’t transitioned yet, or aren’t planning to transition surgically?” Of course! If someone feels that “transgender” is what best describes themselves, then all the power to them! But even if someone decides to transition, that doesn’t mean they have to identify as transgender. If they identify differently, that’s their choice, and we have to respect that. We can’t force labels on people that they don’t identify with, it’s not our place to decide what people are, or who they are.

“How did you know you were transgender?” This is where things get hard to explain. I always knew I was different, but it wasn’t until I was in my late teens that I learned that what I was feeling was normal, and that there were others like me. I’ve always been uncomfortable in my own body. As I got older, I started to wear more boys’ clothes, and it made me feel a little better. I cut my hair short again, chose men’s glasses. Then I started wrapping my breasts when I’d get to school, starting in mid grade 11. I started using things like tensor bandages, multi-layering my sports bras. I tried duct tape once and ripped so much skin off when I removed it that I had a hard time showering for more than a week. Needless to say I never used duct tape again! Then, after graduation, I learned about special shirts they made for men with gynecomastia, and how other transmen wore them to bind their breasts too, so that’s when I ordered my first one. It was great! While it didn’t hide them completely, it did give me a much flatter look, and putting that shirt on instantly made me happier and more confident. I started wearing a softpack (soft rubber penis with scrotum that is worn either in one’s underwear or on a harness strap under pants to give the look and feel of having a real “package”) after that and felt even better, and when I’d get called “Sir” or “young man”, well, no words can describe how it made me feel. It was around that time that I met other transpeople, men and women like myself who felt like they had been born wrong, that something had been mixed up during development. That’s when I learned what it meant to be transgender, that I wasn’t weird or crazy or a freak. There is nothing weird or wrong about being transgender, just like there is nothing wrong with being queer, or from a different background. We are all human, and that’s all that truly matters.

“So you identify as transgender. What’s next” Stay tuned, I’ll cover that next time 😉

Bear’s Hello

Hello world!

Allow me to introduce myself! The name’s Shayne, but you can call me Bear! I’m a 20 year old guy, or at least that’s how I identify. See, for all intents and purposes, I was born the wrong gender, I was raised as a girl, and while it took me a good 18 years to learn the word for it, I always knew I wasn’t what I was meant to be. Somewhere along the lines the wires got crossed and I just came out wrong. But that’s okay!

On top of my transition and gender identity, I’m also facing issues with Borderline Personality Disorder and Bipolar Disorder. Typically, individuals who wish to transition, who also have mental or psychological disorders, have a more difficult time getting diagnosed with Gender Identity Dysphoria (which all transitioning individuals must be diagnosed with before they can begin their transition), and I can back that up completely! I struggled with convincing psychiatrists that I was of sound and stable mind to make the decision to transition, but I eventually won (more about that later)!

I came out as Trans* to friends in 2008, my parents in 2013, and my extended family earlier this year. Many received the news well, or already saw it coming, but others (mostly extended family, but some friends too) took it negatively and have since disowned me. While it’s unfortunate that some chose to walk out of my life, my coming out went infinitely better than some people in the world, and for that I am grateful.

I’m hoping that this will be an educational resource for people who are transitioning, friends and family of transpeople, and anyone who is simply curious about what “transgender” is and transitioning involves. I am very open to questions and comments, so please don’t hesitate to leave me a note!