T Minus Six Days…

Next week I have my first appointment with the good people at the Howard Brown Health Center.  Their transgender health program, THInC, is really great stuff.  It is based on informed consent, not lived experience or psychotherapy, and therefore very trans-friendly and empowering.

For those of you who don’t know, the Howard Brown health center has been serving the Chicagoland LGBT community for over three decades (previously it was part of the Center on Halsted) and has a serious track record of doing real good for us queer folks.

Basically, I will go in for an initial consult: in this first encounter they will preform a full physical, review all my medical records, and likely draw some blood for lab work concerning liver function and other “check under the hood” type stuff.  They want to make sure I am in good working order before we start messing about with my chemicals.  I am glad for their thorough approach.

I am excited, and scared, but mostly excited.  I am still pretty dang nervous about the long-term health risks of hormones, but for this first visit I am mostly excited to talk to a real expert, an actual doctor, with experience serving not just endocrine disorders, but the transgendered population specifically.  I have lots of questions, questions I am going to outline here for myself and for those of you thinking about testosterone for yourself.

Some myths and internet half-truths I would like dispelled or illuminated:

-Testosterone and cancer: what link (and likelihood, given my uterine cancer history) is there documented between ftm testosterone usage and cancer development?  If there is no documented data, what professional and educated inference can you make from your history of treating ftm transgendered patients?

-Testosterone and vital organ health: what link is there documented between ftm testosterone usage and the development of liver or other vital organ disease?

-Testosterone and appetite: it is my understanding that testosterone can increase one’s appetite.  Does it also increase one’s metabolism?

-Testosterone and red blood cell count: can you explain to me the damage ftm testosterone usage can cause to the circulatory system?  How likely is this damage to occur to someone in my current state of health?

-What long-term health risks have been documented with ftm testosterone usage?

-What special risk does keeping my ovaries pose?  How does testosterone affect my ovaries, and would an oophorectomy result in less health complications?

-What are my testosterone levels at pre-HRT*?  What are the testosterone levels of cis-gendered boys before puberty?  How long do they usually go through puberty, and what are their levels, typically, after the completion of puberty?

-Testosterone and cholesterol: What documented link is there between testosterone in ftm men and cholesterol?

-Does HRT put me at a special risk as a trans man, or are the risks associated with HRT similar to those of cis-gendered men with average levels of testosterone in their systems?

-Please tell me about the different kinds of testosterone delivery systems offered and your professional opinion of the pros and cons of each method.

Additional health-provider specific questions:

-What is your medical background? (Speciality, degree, years of experience treating the transgendered community, etc.)

-How many ftm patients have you treated?  Can you talk a little bit about the common health problems (as a result of testosterone usage) you have seen in ftm patients at Howard Brown?

***

Lastly, I would love to read any suggestions you readers already on T (or partners or loved ones of folks on T) have for me if I left something out.  I’m not looking for you guys to answer these questions, of course, I’m just looking for you to add to the list, or augment the wording or perspective.  I thank you in advance for any and all input you might have for me. 🙂

***

I could talk a little bit now about my fear: fear of making the wrong decision, fear of taking T for 2 years or 5 years and wanting to go off it but being stuck with certain undesirable side effects–I fear future indecision I have little inkling of now.  I could talk about the fear of entering a social group I have no intimate knowledge of being a member of: I will be shoved out onto stage on opening night with no rehearsal or prior knowledge of the script.  I will be asked to play the role of an adult male…a straight adult male, after having played the role of a gay woman my whole life.

That was the cart, here’s the horse: I am just going to a preliminary meeting with someone who can answer all my scary questions to the best of current medical science’s abilities.  And that is all the comfort I need for now.  This fear of the unknown I am experiencing currently is one like the fear I had before top surgery.  I question whether I really feel like a guy, whether I really want to go this far now, because now I can finally do something about it.  In the past (growing up) (my whole life) I wanted to be treated as and seen as male because I always thought of myself as male.  Now that I can get there, I panic.  But we all know action is scary.  There is a palisade in front of me–the adventure is hidden on the other side.

I am reminded of Dante: “Heaven wheels above you, displaying to you her eternal glories, and still your eyes are on the ground.”  Guess I better look up and get going.  Virgil would have never abandoned his traveller in Purgatorio.

Be nice to yourselves,
Your Pal Eli

*HRT: Hormone replacement therapy

Converse

I went to a wake today.

Yeah, another one.

This one was for a friend, D.E., a work buddy, and a guy that also died too young.  As I sat listening to his family eulogize him, and do a damn fine job of it, really illustrating the complexity of his character, respecting his struggles and highlighting his triumphs, I was reminded again of the limited amount of time we have on this little rock circling the sun.

I am sure I want to start hormone therapy.  I don’t want to wait around for a level of security that can never be obtained.  I am aware of, but not really concerned about, the health risks.  I believe them to be minimal.  Assuming my blood work does not illustrate a high probability of death (which it won’t; that’s not the kind of news you get from that type of blood work), I see no reason other than fear to not transition hormonally.

And let’s bottom line it here: we all die of something, don’t we?  And I would rather die from an authentic life than live another hundred years pretending to be someone I am not.

If there is an afterlife, I don’t want to tip-toe up to those gates in pristine condition and whisper a plea for entrance.

I want to careen in sideways, hubcaps flying, with a busted headlight, kick open the door and say, “Wow, what a ride!”

I respect this body enough to give it what it needs to manifest itself fully.  I respect this life, this one chance at it, enough to try the scary stuff.  D.E. might not have lived long, but he sure, as one eulogizer put it, “crammed a lot into his life.”

I wanna pack mine full.  So let’s try this “being the dude I was born to be” thing.

Fuck it.  I only live once, right?

Be nice to yourselves,
Your Pal Eli

So long, D.E.  We’ll kick it up at IML this year in your honor.

6 Month Surgery Update! [NSFW]

Well gang, here we are: 6 months post-op.

Still pale and skinny, still rockin’ crooked nipples.

Physical Update I have regained most of the sensation in my chest, but still lack erotic sensation in my nipples.  This I may regain someday, or I may not, but, for now, I’m just glad to have most of the feeling back.  My right side still has some intermittent aches and pains, mostly due to the drain that was in that side.  When I lay in bed on my left side and my right arm is resting on my right side, it’s quite painful.  Also, when I wake up in the morning, my chest feels tight, around my armpits and above the incision lines, but just moving my arms around a bit dissipates this tension.  Nonetheless, it is tension that was not there before the surgery.  Yoga obviously helps out quite a bit in this area. My nipples are staying, I think, for the long term.  They still expunge a stitch now and then (as do the incision lines), and in those moments I get a bit of blood, but the spot heals up very quickly, like a popped zit.  The nipple color is still a bit splotchy, but they are continuing to heal and settle and I think they will even out over the years.  I seem to have some scar tissue on my left side that pulls the symmetry out of whack a bit, but that is not something I am concerned with. I have regained full range of motion at this point, and this month, have gone back to regular workouts.  Cardio I keep at 20-30 minutes a day, 5-6 days a week, weights I rotate upper and lower body every other day, 5 days a week.  Upper body weights, just this week, are starting to reach and surpass pre-surgery limits.  For example, I’m doing 55 lbs. on the bicep machine, whereas pre-surgery I was only up to 50.  And I am up to 45 lbs. on my pecs, the same as pre-surgery. I’ve stopped wearing the silicone strips, many months ago, basically because I was so over wearing a sports bra.  And while they might have reduced the level of scarring, I am still happy with the results.  I am planning on getting a rather large chest tattoo, say six months or so from now, but the specifics of that are still TBD.  I do lather on a good amount of shea butter at least twice a day, as the scars tend to dry out rather easily, and it keeps loose the skin in my upper chest, which I think also helps with minimizing scar tissue.  No matter the benefit of it otherwise, rubbing lotion on my chest just feels good. Emotional/Psychological Update I love my new chest.  Just love it.  Of course, it will be nice to see some more definition as I continue to work the pecs and in the event that I start T, but even without, I dig it, how it looks and how it feels, both when I touch it and when it is touched by one sweet K. What does hurt is when little miss Violet steps on me when I’m laying down.  She manages every time to find the incision lines and basically gives me an impromptu deep tissue massage.  It is good for breaking up the scar tissue, though. Having a flat chest, has, not surprisingly, but still disappointingly, accentuated my hips.  Before, my tits sort of evened things out.  Now, without more muscle in my upper body, I think my hips appear slightly wider than they are.  This is probably mostly in my head, but when I look in the mirror, I don’t like those proportions.  Continuing the gym routine will undoubtedly move that ratio in the right direction. Overall, I know I have some more healing to do, but I am very happy with my six month progress. Let’s end with some more pics:

Right side profile: teenage boy.

and the left:

Flat-chested never looked better.

Some nipple and incision close-ups:

Right side

and the left:

You can see a bit of that scar tissue swelling on the outer side of the scar here, not a big deal, but something to be aware of if you’re weighing the pros and cons of the surgery.

And one more for the adoring fans:

I’m sorry ladies, I have a girlfriend.

Be nice to yourselves, Your Pal Eli

Dr. Miller and the Floppy Receptionist: A Hormonal Love Story

Comfortable?  Good.  This is going to take a minute to get the full picture:

This past Wednesday I had an appointment with Dr. Miller, endocrinologist.  I came across his name on a trans resource website for folks in or near Chicago.  I wanted to have some reassurance he would actually talk to a trans person, as not all endocrinologists treat folks like me.  So, I googled “trans friendly endocrinologists in Chicago” and came across this rather colorful website, and there I found Dr. Miller’s name and contact information.

I made an appointment with him for a consult, and double checked with the receptionist that he served the transgendered population.  Her accent was rather thick, so thick* that I questioned the doctor’s decision to make her the first voice potential clients would encounter.  I wondered what kind of a doctor would hire a receptionist for whom english didn’t seem to be a second language, but rather a fourth or fifth, one whose importance seemed to be somewhere down the line behind rude hand gestures and pig latin.

K went with me on Wednesday, and when we entered the tiny office on Michigan Avenue, a thoroughfare that is know for its trendiness and contemporary sensibilities, a street in Chicago synonymous for the very best of the best, I felt like I had left the world I knew and trusted as reality and stood below a dingy awning in one of the streets in Empire of the Sun.  Dr. Miller’s office was in the only building on that stretch that hadn’t been remodeled since the 70’s.   There were far too many mirrors in the hallways, floor to ceiling, for the comfort of Mies van der Rohe.  There were too many floor to ceiling mirrors for the comfort of a porn director.

Oh, but then we got to the actual office.

I am going to play a game with you now, one I play with my students, but we will modify it since you are reading this, not hearing it as they would.

I am going to give you a description, and I want you, after reading this, to close your eyes and imagine it.

OK?

Here we go.

The office: small as a prison cell, a huge mirror behind the receptionist desk so overwhelming that for the first 20 minutes I thought there was another room and desk behind her, until she turned around and the chair in the mirror turned in time and revealed her face to me.  Objects in our immediate space: a full kimono hung in display fashion over a running indoor fountain so loud no one on this earthly plane would find it relaxing.  Stacks of appointment books and paperwork crowd the receptionist, who is using a Dell computer.  It might as well been a telegraph machine.  There is a Viagra clock on the wall. There is a row of five chairs for visitors, K and I take the two closest to the door (which has a buzzer for one to be buzzed in to the office), and a particularly-antsy woman in her 50s sits, or bolts out of, or jitters on, the chair closest to the doorway with no door on it (this door-hole leads presumably to the examining rooms, or maybe some other mismatched shit like an antique roadshow or a fat lady in a tube top).  Something was distinctively Lynchian about that office: nothing was particularly menacing about the atmosphere, but I couldn’t imagine anything else in the place of all this weird stuff.  And the receptionist?  A mousy girl of Asian decent, wearing all clothes that were too big for her: a billowy silk-ish shirt**, some kind of MC Hammer pants, and shoes whose heels hit the ground with a thud every step she took.

We get our first glace of the good doctor 20 minutes into our wait: he is very thin, elderly man thin.  He is wearing a white button up dress shirt and grey dress pants that were too big around for his frail frame but the right length, so what do you do?  You wear billowy clothes too when you’re frail but still man-tall.  Oh yeah, and he is also wearing a beige leather multi-compartment fanny pack.  No shit.

45 minutes into the wait, the jittery woman goes into the secret hallway, comes out soon after that, and it’s our turn.  I am giddy with nerves, partly because I am going to talk to a doctor about the pros and cons of hormone replacement therapy, but now, and mostly, I am nervous because I find Dr. Miller to be potentially insane.  In the creative writing biz, he has the appearance of what I would refer to as “an unreliable narrator.”

He leads us to a small examination room, where there is still a patient’s file on the examination table, Joseph so-and -so***, and it occurs to me that the jittery woman who just left must have been born Joseph.  She was waiting for her shot.  Indeed, we lurk among the cisgendered people, because I would have never guessed that woman to have not been female her whole life.   I thought she was a drug addict, not a trans woman.

Dr. Miller comes back into the room, shut the door behind himself, clears his throat.  He says to no one in particular, and while looking at the floor, “That last patient got on my last damn nerve, and when I get mad I yell, and when I yell I lose my voice, and that’s why I sound the way I do now.  (Another pause, another cleared throat.) Then he looks around the room and says, “You sure you wanna be here?”  And he gives a sidelong glance at me and a slow smile spreads across his face.

I warm to him immediately.

There is a pause, and then he finally looks at me directly and says, “So, what is it exactly you think I can do for you today?”

And I say, “Well, I’m trans and I see a lot of information about hormone therapy on the internet, but I wanted to talk directly to a doctor about the pros and cons of it.”

And he says, “There’s a lot of bullshit on the internet.”

He gets no argument there.

And then he takes another long pause, and tells me a story about when he first started practicing medicine, how he wanted to publish a controversial paper, the topic of which he alluded to but never fully revealed, and that the medical community never warmed to that idea.  I think he was trying to get across the point that treating transgendered patients with hormone therapy is now a controversial course of action, but, well, he thinks it’s the right one, so fuck what the establishment has to say.  There was a lot of cussing coming out of him at this appointment.  It didn’t feel inflammatory to me, just conversational and sincere.

I asked him about the link between the hormones that ovaries produce and heart health (more bullshit, according to Miller, “women don’t die from heart disease like men do,” and science attributes it to the ovaries, but he finds this a dubious claim, or I am translating it as such.)

I asked him about the potential for damage to my liver (“No no no, there is no damage to the liver because I do a blood test every three months to insure your testosterone stays within the acceptable levels, not too low, not too high, and if it shoots outside of those levels we adjust accordingly.”)

He said, “I’m fucking 83 years old and I can’t do this shit forever; I’m going to die someday.  But I do enjoy my work, and so I will keep doing it for now.”

He said, “I don’t know where the spirit comes from, whether it’s God or nature or what, but if you follow your spirit, and you try to be a man with a male spirit, or a woman with a female spirit, you will have an easier life, it doesn’t matter what body you are born into.”

He told me I would (potentially) get very hairy.  He told me I would get more aggressive, and my sex drive would increase.  He told me God is a woman.  He told me not to worry about acting like a man, not to fall prey to the stereotype, and that if I thought about more than fucking, eating, and the score of last night’s game, that it doesn’t make me less of a man.

I don’t know if he will be my endocrinologist.  But I certainly appreciated his perspective.

This may all read like a bit of an about-face to many of my readers.  I have spent more than one entry writing about the reasons I didn’t want to go on T.  But there also, in those same entries, have been outlined the reasons I would like to go on T.  So here I am: I want to go on hormone therapy, I want someday to pass as male, to be rounded to boy for good.  I am more male than female, and I think the part of me that feels female is the part that was put there because of my genitals at birth, not because I have some bond or link with feeling feminine.  Truth be told, when I think about being female I feel deeply uncomfortable, and I have always felt deeply uncomfortable being thought of as female.  I have tried, very hard (3 decades worth in fact) to be happy enough with checking that F.  But I can’t keep lying to myself just because I am used to it, because it is easier, because it is easier for the people around me.

So, I am going to go see one more endocrinologist, and if I have a similar chat with him, that the risks are minimal, that there is no record of trans folks dying in large swaths strictly from HRT, well, then my mind is made up.  I do want to spend some time, however, saying good-bye to the comforts of femininity.  It might have been a house too pink, but it was home for 34 years, and I want to give it some proper farewell and respect before I move out.

At this point, I would love to hear from you guys on T: what do your daily/weekly/monthly regiments look like; how has T changed your life (aside from the physical and emotional changes) in a practical way?

Be nice to yourselves,
Your Pal Eli

*This isn’t some veiled racism on my part.  Her trouble with english was so pervasive she was having a hard time understanding the numbers I was saying over the phone, and was confusing many of the letters of my name with other letters.

**K points out to me that in many Asian cultures the flow-y too big look is fashionable.  So, perhaps, her clothes were not too big for her, but rather she was being fashionable in a way that this guy just didn’t get.

***All names are changed to protect the innocent, but the file did indeed have a male first name on it, and a birth year that would have matched the approximate age of the woman in that waiting room.

Matt Kailey on Michelle Kosilek

Agreed, and well-stated:

Matt Kailey's Tranifesto

Our community seems sharply divided on the recent decision by U.S. District Judge Mark Wolf to allow convicted killer Michelle Kosilek to undergo transition surgery while in prison, paid for by the state of Massachusetts.

I understand the anger and frustration of those who have worked three jobs, sold their possessions, and still can’t afford to pay for this surgery. They think, “I have been a law-abiding citizen all my life and I can’t afford to have surgery, but a convicted murderer can get it for free? How fair is that?”

Probably not all that fair, actually. But, in my opinion, the Michelle Kosilek decision is about far more than one person – one murderer, even – getting her transition surgery covered by the state. I think there are some points that we have to look at with regard to this decision, all of which take Kosilek out of the…

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A Quick Update

Not much has been happening as far as gender-related issues in my life go.  I am still going through the awkward process of getting my friends and family and co-workers using the right pronouns.  It’s hard for them, and hard for me, and to be honest, I chicken out more than I ought to and don’t correct them when they mess up (often, but not always).   With the co-workers at least, part of the problem is that they do it in front of customers, and I just can’t deal with airing my private gender shit in front of strangers, and lots of them.  As for everyone else, I have no excuse other than my yellow belly.

And so, I ignore my blog too, because then I have to go on there and fess up to being a coward.

In related news, now that the election is over I am going full steam ahead on the legal name change.  I wanted to vote first, to avoid any potential for confusion.  And now that the right guy won, I can move confidently forward with legal recognition of my new name.

I found a great website that helps you generate the documents necessary to change your name legally.  It’s so informative, in fact, that it told me I can’t change my name until I have lived in Illinois for 6 months.

So, despite the fact that I was born here, and lived here for over 20 years, I have to wait until February 1st to mail in my forms.  I filled out the document, and tomorrow will contact the State to explain my predicament.  They may not give a fuck, as K suggests.  And the wording is ambiguous: do I have to have been a resident here for the most recent and consecutive 6 months, or just six months total, out of my life?  Guess I’ll find out tomorrow.

Be nice to yourselves,
Your Pal Eli