On Becoming

The five year anniversary of my beginning T passed without much fanfare. I casually noticed that this milestone had passed one morning while I was shaving. It's important to keep in mind that when I say shaving it is not a full beard growth that I am scraping away at each morning, but a few patchy whiskers that after a week just make me look sloppy. I thought after 5 years of hormones I'd have more to show for it, but I'm also determined to let my transition take whatever form it will take.

Then last week I went to the doctor for depression. I'd been on anti-depressants before and after a year long experiment of being med-free I decided it wasn't working. Since living in Philadelphia I've been going to the Mazzoni Center. The Mazzoni Center is a queer health center and although I'm glad it exists, compared to Callen-Lorde, I was always disappointed. Every time I went to the Mazzoni Center I saw a different doctor, nurse and once a Temple University Intern. I understand internships need to happen but he was more nervous than I was and ended any chance of me actually asking for what I needed. It began to feel more like shopping than medical care. I would make an appointment, say what I needed and get a prescription. I would occasionally be told that I needed to get blood work done but never heard anything about these results. I always assumed they would tell me if something was wrong. I shouldn't have.

This past visit I saw Dane Menkin. He asked me important and intelligent questions when I talked to him about my desire for anti-depressants. He told me when I didn't answer his questions--which means he was actually listening to the answers. He was able to say things like "I've had a lot of success with this with my other trans patients." He had other trans patients.

Then he did something that no one else at the Mazzoni Center has ever done--he looked at my blood work. My testosterone level was only two thirds of what it should be. More disturbingly, it probably had been since I moved back to Philly 4 years ago and started a new type of testosterone. Suddenly everything began to fall into place--my depression, my irritability, my lack of facial hair, my womanly metabolism, my fatigue. I felt like a man, but I wasn't sure I felt normal. I wasn't sure because I had no normal to compare it to.

I think sometimes we have trouble taking control of our own medical care. We are so grateful to be getting any sort of care that we don't want to rock the boat. Its also hard when everything is changing to know if everything is changing enough or in the right way. What is normal when everything about this feels so un-normal sometimes?

I've started Welbutrin and upped my dose of Testosterone every morning. Its too soon to feel an actual physical change, but mentally knowing that I have a doctor who is actually invested in my health and paying attention to my shortfalls has changed everything. I may never be happy without medication, grow a full beard or loose all my lady fat, but at least I'll know I only have genetics to blame.

WHAT WILL YOUR PARENTS SAY...

I've been blessed with parents who not only accepted my transition, but wanted to take this journey with me. I think sometimes we forget that for our parents it isn't just a matter of accepting but they are coming out as well. In my case it was telling everyone in the small town I grew up in that they now had a son when before they had two daughters. Its a complex road full of twists and turns that seem to sneak up on you when you least expect them.

My parents recently told their story in their church. My sister said that some people even stayed through he second service to hear it again. I asked them to send it to me and as long as they approve I will post that as well.

Note: Parts of this story may have been recycled into "Living my Legacy" which was also posted here so if pieces sound familiar, forgive me.


In May my mom came to New York. I would be visiting the doctor for the first time to investigate hormone replacement therapy and I wanted her to be there. It wasn’t anything as metaphoric as my mom being present at my birth as a girl and re-birth as a boy. Rather, she had been there when I broke my leg, she had been there when I got my first and second set of stitches, she was there for my first visit to the GYN appointment and it seemed only natural that she be here for this. She arrived at my house and we immediately opened a bottle of wine. What began as idle conversation had, by the third glass of wine, turned to tears. I didn’t know how to explain to my mom, who had tried to raise me to be a proud woman, that I had made the decision to become her son. She was supportive and respectful, but also sad. She cried for the childhood she felt I had lost and she cried for the woman I would never become. “Your dad and I are just mourning. It feels like a loss.” These words stayed with me long after they were uttered. I suppose I understood what they were feeling, but I didn’t want to acknowledge it. Doing so would have meant that a part of me was dying and for the first time I had begun to feel truly alive.

The next day my girlfriend Anna arrived from Philadelphia and we all went to the doctor together. I stayed quiet during the visit and let my mom and Anna ask the questions. A form was passed around that listed possible side effects, everything from acne to death. They asked a few questions about the drug’s safety but not what was really on both of their minds. That was a question that the doctor could not answer. I knew they were thinking was, “Does he really have to do this?“
I tried to treat the rest of the day like a vacation for my mom, but this just wasn’t possible. The two women that care about me the most had spent the morning asking questions about whether or not testosterone would kill me. Suddenly becoming a tourist was out of the question. We ended the day with dinner in SoHo, not talking about what was on all of our minds. Anna was scared, my mom was concerned and I was exhausted. I knew they were thinking about the risks and whether it was worth it. Hormones had been my plan for months, but for them it had only been a reality for a few hours. I wouldn’t have been able to defend my choice if asked, I would have only begun crying. Thankfully, both these women knew me well enough not to ask. They allowed me the comfort of talking about books, school, art, and the food on our plates.

On Sunday my mom left, but told me she wanted my dad to come visit. She said that after twenty-five years I finally seemed comfortable in my own skin. She wanted my dad to see this. So, in August my dad flew from Michigan and I met him at my front door. He did a slight double take before hugging me explaining later that he expected to see me with a full beard after being on testosterone for only two months. I didn’t tell him I had run home expecting whiskers after only two hours. Clearly neither of us knew what to expect. The next day we boarded the subway and road to the West Village where we rode the elevator up eleven floors to see my therapist. I needed to say some things to him that I wasn‘t sure I could without the help of a mediator and the motivation of paying $100 an hour. All the effort I had made that summer to keep them updated on my progress seemed oddly unimportant to them. The weekly phone calls as my voice changed, the photos, the stories about my new support group, it all seemed so common to them. A daughter becoming a son is not an everyday occurrence. It’s hard to learn a new name when you worked so hard to choose the first one. It’s hard to know what to do with the memories of a daughter when he’s creating new memories as a son. Things felt like they were changing every moment of every day, and there they were all the way in Michigan. Why weren’t they struggling like I was? Why didn’t they feel as unbalanced and turned around and spit out as I did? “Well what would you like me to do?“ he asked. “I don’t want to question your decisions or make you think I don’t love you and respect what you are doing.” A loss of respect wasn’t what I was afraid of--it was loneliness. I needed them. I needed to feel confused and scared and excited with people who knew me and not just what I was becoming. Mom, him, my sister, and Anna were the only people close enough to me to really experience this transition the same way I was. I needed them to see me as I changed even if I was five states and 750 miles away.

Before he left I asked a favor of my dad which turned out to be the more difficult than any other part of my transition. I asked for a picture of his chest. I wanted my nipples to look like they would if I had been born his son. “Honey, I love you, but that’s a little too weird.” He could not forget the female chest in front of him. “I don’t think I can look at you with your shirt off and think ‘that’s where my nipples are,’” He paused and sighed. “I’ll think about it.” It wasn’t the changes in my body that concerned him as much as the relationship they suddenly had to his. I was beginning to inhabit a body like his. Eventually he would see me with my shirt off for the first time since puberty and seeing his body reflected in mine was maybe too much. Still, he would think about it. That was all I was asking for.
In November we all traveled to Washington to share the holiday with my mom’s family. Surrounded by extended family my dad turned to me, patted my hand and said, “Honey, it’s still a little weird for me, but if you want a picture of my nipples you can have that.” What began as a routine holiday dinner became a most intimate moment between father and son. Not only had he offered me his chest, he had done it in front of the entire family.

In December I asked my mom if she could take the picture of my dad’s chest and bring it with her to my surgery. She arrived in January two days before my consultation with the surgeon and told me he just couldn’t do it. “He tried, he really did, but it was just too weird for him.” That was ok. I would have to leave my nipples up to fate. Surgery would create a piece of me. I needed to accept the stitches and the scars however my body saw fit. This recreation was not something I could control. My parents had no control over the daughter they gave birth to, and in two days we would travel to Baltimore to create the son I always was.

Good News, at least for those of us with insurance

I always felt that you can't have it both ways. Gays went from mentally insane to cured in the 70's, The Pentagon decided they agreed in 2006, but trans people are still on the books. Gender Dysphoria is still a recognized medical condition and Gender Identity Disorder is still on the books. Thankfully the treatments have changed. People are no longer shuttled of to loony bins and made to feel even crazier like in The Last Time I Wore A Dress. Now, assuming we have a decent doctor we're prescribed hormones instead of Charm School. However, it's all out of your own pocket. Top surgery cost about $6000, the bottom is even more expensive and insurance won't help a bit.

But maybe all that is changing. The American Medical Association, at it's annual conference in Chicago, called on insurers to start coughing up some dough. Resolutions 114, 115 and 122 were passed by the AMA's House of Delegates noting that Gender Identity Disorder is an internationally recognized medical condition. Delegates highlighted the need to combat the emotional pain and physical incongruity and downright awkwardness associated with gender dysphoria with proper access to mental health services, hormone treatments, and surgical procedures. I personally have parental support that boarders on crazy. They paid for my surgery and even flew in from Michigan to enjoy the ride. I had great friends who helped me raise $500 for my stay in extended care, but not all of us are that lucky. After seeing women self-inject silicone under their skin to gain some curves, or seeing the deflated chest and crushed lungs of a man who's been binding for years I'm happy to say that maybe some physical and mental pain can be avoided.

Like I said, you can't have it both ways. If I'm sick help me pay for my treatment. If my care is cosmetic, take GID off the books.

Resolution 114: Removing Barriers to Care for Transgender Patients
Resolution 115: Removing Insurance Barriers to Care for Transgender Patients
Resolution 122: Removing Financial Barriers to Care for Transgender Patients

“IT’S A FEEL GOOD SURGERY”

Anna and I sat silently in the brightly lit exam room. Neither of us knew what to talk about so I uncomfortably looked around the room. Where there were normally posters encouraging you to quit smoking or practice safer sex, instead were advertisements for Botox. Posters which exclaimed “I can look years younger” replaced those I normally saw declaring “Silence=Death.” Health and safety were replaced by opulent vanity. Pictures of Dr. Bev with her show dogs littered the counter by the stainless steel sink. These were not the surroundings I expected for such a life changing surgery to take place. I wanted to talk to Anna; tell her everything I was feeling but one of the office nurses was in the room with us. This woman’s life seemed so far from my own that I couldn‘t bring myself to open my mouth. Finally Anna broke the silence. “ Do you perform this surgery often?” she asked.

“Oh yeah,” the nurse replied. “One week it was the only surgery we did, the whole week straight.”

“Wow,” Anna exclaimed, “That is a lot. Do people come from all over?”

“Sure. We get people from all over the country and Canada. Once we even had someone from England.”

“That’s quite a trip. He must have really wanted it done right away,” I chimed in.

“So the doctor is pretty good then?” Anna said, hoping for anything to calm her fear that the tomorrow I would die on the operating table.

“Oh she’s the best,” the nurse gushed. “It’s really a great surgery, you know. It’s a feel good surgery. You guys are just so appreciative and happy when it’s done, like a huge weight has been lifted off your chest.” Anna and I looked over at each other, struggling not to laugh. “We just love you guys.”

The surgical nurse entered just in time to save this particular guy from losing his composure. Betty was all business and not one for idle chit chat. My mom was brought into the room and immediately the explanation began. Nurse Betty pulled from her pocket a clear rubber grenade shaped object with a tube attached to it, saying these would be sucking fluid from my body following surgery. My mom and Anna simultaneously cringed at the thought of anything being sucked from my body. Betty showed them how to dump the fluid, clear any tissue and clots that might block the tubes, and replace the suction. For the first time during this experience, someone else would be taking care of me. Knowing that I didn’t have to listen as if my life depended on it freed me to watch everyone else’s reactions rather than controlling my own.

“Once you dump the fluid and tissue in the toilet, record the amount on this piece of paper. Once you’re down to 25cc on each side for a full 24 hours the tubes can be removed.” My girlfriend and mom maintained their disgusted look while she explained how either they or my doctor at home would pull the tubes from my body and clean up the holes left behind. Rather than begin to worry about who would do this procedure when I was home, I forced myself to completely stop listening.

At the conclusion of the demonstration we left the bright lights of the exam room and were ushered across the hall to look at some before and after pictures. Nurse Betty opened the door and escorted us into a dimly lit room that seemed more fitting of a brothel than a doctor’s office. There were waist high, faux granite pillars, and a painting of a nude female graced the wall above a red velvet Victorian love seat. We were left alone to page through a notebook of “feel good surgeries,” forcing me to face my expectations. I knew I would be left with scars, but I was more worried about the placement of my nipples. I had seen some of the doctor’s earlier work where they seemed to almost be in the armpit. Displayed in our laps were high nipples, low nipples, nipples that looked like pieces of chewed gum, and even some that were missing altogether. I noticed the results got progressively better with each surgery she performed. Aside from an occasional nipple complication the finished products looked pretty good. More importantly, however, this was a book full of men who had had gone before me. Anna could see that they had not died, my mom could see that they weren’t mutilated, and I could just look without having to face a million questions that I could not answer. What I saw was not perfection, but a natural variation. Mine would not be the chest of a “man” but that of a trans man. I stood up feeling a little more content about what tomorrow might bring.

Our minds racing with information, we left the room and asked the receptionist where we should visit on our first trip to Baltimore. On her recommendation, we climbed in the car and headed for the waterfront, a final outing for my female chest. At the aquarium we imagined postcards of my breasts posing with the dolphins. For the first time I was able to laugh about the presence of my chest, knowing that tomorrow it would be gone. We all returned to the hotel room that night sensing the gravity of the next day, but knowing there was nothing more to say. The appointment was set, the balance on the surgery paid, and tomorrow night I was going to fall asleep in a body forever changed.

As I laid down, an instinctual fear began welling up inside me. I wanted to be comforted, told everything was going to be all right, but I couldn’t admit that to anyone. They were just as scared as I was. I had made this decision. Admitting my fear would only make the situation worse.

We arrived back at the office bright and early the next morning. I was ushered into the exam room with Anna and told to take off all my clothes except my boxer shorts. Once I had stripped I sat in silence while Anna held my hand. Our palms were sweating and our fingers freezing cold. My nipples hardened, unaware they’d soon be sitting in a bowl of ice two feet from the rest of my body. Dr. Bev and Nurse Betty entered with a flurry of tape measure and purple marker. Their cold fingers moved rapidly to measure and mark my chest.

“This is really the worst part,” Dr. Bev assured me. I expected the upcoming pain of having a part of my body removed to surpass the pain of that particular moment, but I wasn‘t going to argue. I pulled a surgical gown over my chest and my mom was invited in. She and Anna were given a refresher coarse on my drains and bandages. Once they felt certain they could perform their nurse-like duties they both kissed me and wished me good luck. I slid off the exam table and shuffled down to the operating room in nothing but a loose fitting gown and my boxer shorts.
White Christmas crooned from the stereo as I entered the operating room and lay down on the table. Apparently the snowman underwear I had haphazardly chosen that morning inspired one more day of Holiday music. The anesthesiologist explained what was going to be happening while Nurse Betty hooked up blood pressure monitors to my legs and right arm. She mechanically rubbed my hand with the affection of someone who sees this everyday. The anesthesia gradually overtook me, and I fell asleep listening to hollow talk of her new Buick.

Four hours later I jolted awake in a small dark room, freezing cold and about to throw up. Instead I forced myself to speak. “Tell Anna I didn’t die.” A woman I couldn’t recognize smiled and said ok, while another nurse covered me with a blanket and turned on a vent that blew hot air up my shorts. As my body temperature slowly returned to normal I remembered to look down at my body and began to smile. Anna appeared at the door asking gently how I was while she rubbed my head and fed me ice chips. After no more than five minutes Nurse Betty entered with my clothes. She wrapped my shirt around me, leaving the buttons to Anna, while she held out my pants for me to climb into. I wanted to point out that I’d just woken up and perhaps should stay a while, but one look at her face told me to get dressed.

“You might want to think about flip flops next time,” scolded Nurse Betty. My shoes, which this morning had slipped on quite easily, were now impossible.

Knowing there’d never be a next time I stood and resolutely shoved my feet in. Proud of this small accomplishment, I began to shuffle towards the door.

“Stand up straight,” I heard behind me. “You can do that. You don’t have breasts anymore.” Although Nurse Betty had never witnessed me trying to hide a chest that didn‘t belong, her words echoed the fact that there was nothing left to hide. I grabbed Anna’s arm for support, cautiously put my shoulders back, and made my way to the waiting car.

pre surgery post

There's been a lot going on since the last time I wrote. I suppose I got so overwhelmed with the general act of living life that I didn't quite have time to relay the information. So here in a nutshell is everything that's happening.

My parents have offered to loan me the money for my top surgery and I will be paying them back gradually through various fundraising events. Thanks to all who have contributed so far. I have raised over $400 dollars, which is enough to cover my stay in extended care. I scheduled my surgery sometime in September with Dr. Fisher and have the date set for January 11, 2005. My mom and girlfriend will be traveling down to Baltimore and staying for about a week. After that I will return to Brooklyn and continue my recovery there.

In other news, I've been on hormones for about six months. My voice has dropped to a point where I have no trouble passing on the phone. I've hit a point where I never know how people are reading me when I'm in public. Perhaps they aren't so sure either because I rarely get called ma'am or sir. I have a few whiskers but nothing substantial. I do have a bit of a furry belly. However, the most notable feature change right now is my unbelievable acne problem. I've been told that it just looks like my skin is looking a bit more ruddy and masculine and thank you Meg for trying to make me feel better, but fact is I really look like a pimply faced teenage boy. What can you do, though? Going through puberty the right way this time makes up for some of the bad side effects.

Anna is still as beautiful and amazing as ever. Her jewelry donation raised $100 for my surgery but more important is her support and presence through all of this. It's by no means easy, but were doing our best to keep talking about everything.

Getting the Go-Ahead

My Visit to the Callen-Lorde Counseler:
Last week I had my appointment with the counselor at Callen-Lorde. I was admittedly nervous. I wasn't sure what I was going to be expected to do or say there. Would I be explaining myself and be expected to prove that I knew what I was doing or simply prove that I wasn't crazy? After 25 years of trying to explain it to myself I doubt my ability to find a convincing explanation in one appointment.

Thankfully every concern was put to rest immediately after I sat down. I was told I was simply there so that he could make sure I was getting all the services and support I needed. I was given a mental health seal of approval and can start hormones on June 6. After that I was sent to the Gay and Lesbian Community Center to join one of their support groups.

At my initial interview I was asked what gender I identified as? I thought this was a strange question to ask someone at a place called the Gender Identity Project. I answered Male, no trans identifiers, for the first time and it occurred to me what I was really doing. I wasn't crossing gender boundaries to exist on the other side, I was crossing so I could make my home on the border. Until I know what it's like to live as a man I can never know what it's like to live as both or neither. Sometimes you have to travel beyond yourself to know who you really are.

Begining Hormones

My first trip to the doctor: 7 May, 2004

I made my first concrete medical step towards beginning my transition this past Thursday. I went to Callen-Lorde heath clinic in Manhattan with my mom and my girlfriend. It was an interesting experience I must say. The doctor was helpful and very matter of fact. I was just happy that my mom came along. They did a health history and took blood for some general health tests. Next week I meet with one of their gender counselors and then in a month I see the doctor again. If all goes according to plan I can begin T that day.

I didn't realize it would be so fast. I thought getting to a point of being able to start injecting would take longer and involve more red tape. Its kind of scary. I know I have a very supportive family and girlfriend, but they are just as confused and concerned as I am, probably more. I'm scared. I'm scared also that if I let my fears be known people will question my decision to do this. When I think about the practical issues I do begin to wonder. I think that's normal. I would like to have kids, but I'd have to freeze and store my eggs and I doubt I can afford that. I am scared of any personality shifts I may experience. I know that's my girlfriends greatest fear as well. I don't want to be a different person. I like who I am. She doesn't want me to be a different person and I understand that. The hardest part for me about this whole thing is that I don't live in a bubble. This is affecting so many people around me that I love and care about. It makes you wonder how far you can stretch people before they snap. My mom doesn't want to see me get hurt. I don't want to see her hurt. Everyone is kind of mourning. I understand that. I'm mourning too.

However, the other side of all these fears is excitement. When I don't think about the unknown, about the bad things that could maybe happen, when I don't think at all I'm excited. I'm excited to look the way I will. I'm excited to feel more at home in my body. I'm excited to feel like I know who I am. This whole process reminds me of when I first told my family I was queer. I stepped so gingerly. I wanted to make sure I wouldn't one day decide I like boys again and have to take it all back. The funny thing is looking at me now you'd never even think I would question it. The truth is you can never know how well something will fit until you try it on for size. You can only be so sure before you just do it. I've done everything I can to lead up to this moment. It's time to just do it.