Tag: FTM

Reflections on Top Surgery, Part 3 : Post Surgery

Gender affirming chest masculinization “top surgery” is one of the major defining moments for trans men. But getting from your existing chest to the one you want to have can be overwhelming from both the information overload and emotional point of view. Having had surgery 3 years ago, I wanted to share my thoughts on surgery in case it may help someone else in the same position. I’ve created a 3 part series on surgery : Pre-surgery, surgery itself, and post- surgery.

This will be mainly from my personal experience as a mostly binary trans man, but could easily be applied to non-binary/GNC people.

If you haven’t read Part 1: Pre-surgery and Part 2: Surgery, start there. To recap: I had a phone consultation with a privately funded top surgeon in Ontario, who gave me a surgery date 6 weeks later. I had my surgery, had my bandages removed, but still had to wear a compressive binder for a couple more weeks.

Initial recovery

Right after the disaster of visiting the clinic for the last time, we went to a nearby mall for some fast food self care. I went into the food court bathroom which was the first public washroom since surgery and I automatically felt 100 times safer. I felt like I belonged. I didn’t feel like an imposter that everyone would automatically clock and tell me that I was in the wrong bathroom. This bathroom euphoria wouldn’t last (more on this in a future post and other bathroom shenanigans here) but for now it was an amazing experience and I couldn’t wait to use another public bathroom!

Our flight home was uneventful. I was nervously waiting for a security officer to ask why I was walking so stiffly, or wonder why I was covered in bandages but nothing happened.

Once home I had another week off before returning to work, but my energy levels did not bounce back as quickly as I had hoped. I ended up taking an additional week off.

In those couple of weeks after surgery I was mostly numb across my whole chest and down my sides. Showering was weird since I could feel the water near my neck and on my belly, but not in between. I was also getting weird prickly sensations across my chest and I would itch but it didn’t help at all. Meaghan Ray said it was my nerves starting to boot back up, so I rubbed a rough cloth across my chest to help my skin remember what sensation was all about and stop freaking out which seemed to help. This technique is called desensitization. Leave a comment or send us an email for more info.

I wore the binder all day and night, and applied polysporin to my incisions and nipples. Slowly they closed up and started healing with more normal skin tones. There was a point in healing where the scabs on my nipples started coming off in small pieces, and since the healed skin underneath was so much lighter, it looked like my nipples had fallen off entirely! It was terrifying until more of the scabs came off and I could see that my nipple was still intact.

Getting back to normal life

When I returned to work after being gone for 3 weeks, people were happy to see me, but for them not much had changed. It was like I had gone for a vacation and come back. It was very frustrating because I had spent a bunch of money to have body parts removed in order to “pass” and meet society’s expectations of what I should look like, but people still couldn’t use the proper pronouns. It felt like I had a big incision and T-rex arms for nothing. My euphoria and confidence slowly drained.

Once I stopped wearing the binder and started feeling the shirt directly against my skin, my confidence began to return. I didn’t care as much about being misgendered because I could feel how flat I was and it was awesome.

I wanted to minimize scarring so I massaged my scars with oil at least once a day for several months. I also didn’t raise my arms above shoulder height for 6+ months which made getting back to working out consistently a struggle. Everyone heals differently so it’s hard to tell if it made any difference but protecting my scars was the thing I had control over and it feels like I did the right thing for me.

Post op Depression

One experience specific to top surgery is having to keep your elbows at your sides for months which limits your use of your arms and therefore your independence. I was a bit angsty with how weak and dependent I was and I am prone to depression so the first couple weeks were a bit rough for me. But having the support of Meaghan Ray and seeing how excited they were for me helped me find that excitement for myself.

Many people experience post-op depression after top surgery. If you google “post op depression” the autofill option for “after top surgery” is only 4 options below. It happens after many surgeries due to some metabolic and physiological reasons as well as having time to yourself while you recover to ponder your life choices. It can especially happen after top surgery or other gender confirmation surgeries because there is usually a long buildup from when you are starting to wonder if you are trans, to finally getting a result in the mirror you are looking for, usually years later. You are looking forward to having the surgery completed, but then there is physical recovery, there is pain, maybe there are complications which feels like it robs you of the excitement you were expecting. And now that the surgery is completed, there is a sense of not having something to look forward to anymore.

Another aspect is that while your brain is telling you what you want, the actual experience of being unconscious for 2 hours and having something removed that you were carrying for 15+ years, makes part of your brain go haywire. Something is suddenly no longer there. And while you were mentally picturing what it would look and feel like, you didn’t know exactly what that would be like. So there is an adjustment period while your brain catches up. And having to wait while your brain straightens itself out makes you doubt that you have made the right decision.

While I definitely experienced all these types of thoughts, they didn’t cause a spiral into depression which I am grateful for.

Where I’m at now, 3 years later

I am still a little self conscious when taking off my shirt around others. 31 years of social training will take a little while to fight against. I have gone swimming in pools and the ocean with no shirt which was empowering. Looking down while showering is great. Doing skin to skin contact on my chest with my newborn kid was thrilling.

Once I did get back to working out and doing other activity, not having the wobble of my chest was amazing. One of the first things I noticed after that wobble was gone was the jiggle from my belly! It was a weird sensation but I quickly adjusted.

Every once in a while after I wake up in the morning my brain will remind me to grab a bra from my dresser, but then I laugh to myself when I go to open the drawer. T-shirts and button up shirts fit so much better now.

There was a point where I was wondering if I wanted a revision for what we affectionately call “the crinkle” in the middle of my chest between my scars. It would be free and the clinic was more than willing to set it up, but when it came time to booking the appointment I never followed through. I had started accepting what my chest looked like, and then grew to love it. It will never be a cis male chest since I am not a cis male, and that is ok.

Having a flat chest has greatly increased my general gender euphoria, and decreased my chest dysphoria down to nearly zero. My social dysphoria was also decreasing as my voice deepened and I grew a scraggly mustache. About 3 months after top surgery when I was healed a decent amount and not struggling with day to day activities I did notice a shift in dysphoria. The very blatant dysphoria of “you have breasts, everyone thinks you’re a girl” was pretty much gone, but my discomfort with my lower area (which I didn’t have much of before surgery) started ramping up to noticeable levels. This is also very common in trans guys – once the seemingly obvious problem gets dealt with, the focus moves to a more personal but just as glaring difference between what you were born with and what you should have.

As trans or GNC people, our dysphoria will likely never go completely away. There will be sudden surprising moments of “I wish my hands were a better size, they completely give me away as trans” or having to explain a different name on a credit application. But hopefully as time goes on, our gender euphoria and comfort with our bodies (surgically altered or not) will increase and those moments of dysphoria will be so much less devastating than they were at the beginning of transition. Having top surgery was life changing for me and provides so much gender euphoria armour against dysphoria frustrations, and I am grateful that I had the opportunity to pursue it.

I hope you found this 3 part series on top surgery helpful! If you are contemplating top surgery and have questions leave them in the comments below, or send an email to letstalkgenderpodcast@gmail.com.

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Reflections on Top Surgery, Part 1 : Pre-surgery

Gender affirming chest masculinization “top surgery” is one of the major defining moments for trans men. But getting from your existing chest to the one you want to have can be overwhelming from both the information overload and emotional point of view. Having had surgery 3 years ago, I wanted to share my thoughts on surgery in case it may help someone else in the same position. I’ve created a 3 part series on surgery : Pre-surgery, surgery itself, and post- surgery.

This will be mainly from my personal experience as a mostly binary trans man, but could easily be applied to non-binary/GNC people.

Deciding to pursue surgery

Wanting to pursue top surgery can come before wanting/deciding to transition and be a driving force towards wanting to transition. AKA your chest dysphoria is so strong that any other steps towards transition (hormones, coming out) are secondary.

Or like in my case, my social dysphoria was my driving force to transition, and once I had started the process for getting hormones and coming out, top surgery was my next urgent priority.

Applying for funding

In Canada there are two main paths to take in order to get top surgery – public and private.

The public funding model in Alberta involves being diagnosed with gender dysphoria by any psychiatrist who then submits for surgery funding on your behalf. When I was going through this process in 2017, there was one approved psychiatrist that had a long waiting list of his own. I was referred to the psychiatrist in September 2016, saw him in July of 2017, and I had a consultation with the surgeon in November 2017. At that time the waiting list for surgery was 1.5 – 2 years since dysphoria-eliminating surgery is not high on the list of priorities when those same surgeons are assisting cancer survivors.

In other provinces there are variations on how to go about getting funding, and the wait times vary.

Having to wait for surgery after coming out as male, attempting to “pass” as male with friends, family, colleagues, and strangers while still having a rounded chest was frustrating, tiring, and a safety risk. I decided to look into privately funded surgery.

In searching “top surgery in Canada” there was really only one option which was in Ontario, which was ok since my in-laws lived there. I submitted the documents the week after my consultation with the Alberta surgeon, and was set up for a phone consultation for March 2018.

Research while waiting

Part of my frustration with the Alberta surgeon besides the long wait time was that he didn’t seem interested in my goals for my chest. He asked me to take my shirt off, looked at me and told me what he would be doing. He told me that I would likely have a common complication called “dog-ears” where pockets of skin and fat remain along the sides, but also that Alberta wouldn’t cover the surgery to remove them, or the technique necessary to avoid creating them. So while I would have a drastically flatter chest, it would still be not quite ideal (in my eyes).

I started researching the different methods of masculinizing surgery and saw that the Ontario surgeon offered more than the one kind the Alberta surgeon offered me.

I spent lots of time on surgeon’s websites as well as different Facebook groups where I could see pre and post op chests and compare to what I thought I might want, and what my results were likely to be. In attending a PFLAG group in Edmonton I discovered that a couple other people had gone to the same Ontario surgeon and were happy with their decision. One person actually offered to show me their chest in person after the group which was great. I began to earnestly look forward to my consultation in March.

Private surgeon consultation

The consultation was similar to any other health professional, but since this surgeon was using the informed consent model as opposed to having mental health professionals vouch for me, I had to start at the beginning yet again and prove to another person that I was trans enough to get the surgery. Since this was a common occurrence at the beginning of my transition I had all the answers at the tip of my tongue, but it was still mentally exhausting. Its like the stress of a job interview every time, but instead of trying to land a job, you are trying to justify your ideas on why you are who you are. There are no certificates or diplomas, just defending the difference between your appearance and your thoughts.

While I had moderate chest dysphoria, I still felt like I had to exaggerate my feelings a bit in order to get the approval from the surgeon. What if he felt that I was a minor case and could wait? Maybe there were people out there who were suffering more than me.

I successfully “passed” that consultation and was given a surgery date for 6 weeks later! Suddenly I had to change from endlessly waiting to preparing for surgery.

Preparing for surgery

The physical components were easy to do and were a distraction from having to emotionally prepare for the surgery. I completed all the forms and bloodwork, submitted for time off from work and booked flights.

But when that was all completed, I had a relatively short amount of time to emotionally prepare. I had started questioning my identity in 2016 and had spent many hours in my own head up to that point, but admittedly I was fine with being stuck in the trans angst of “I have to wait so long, this sucks!”

Chest surgery was the next logical step for my happiness and safety, but I had a lot of conflicted feelings. My dysphoria was not overly bad. I enjoyed having nipple sensation. I was worried about surgery. I didn’t need to wear a binder very often. I was worried about what I was permanently doing to my body. In my anxiety I even started wondering if transitioning was the right thing to do. My therapist is highly regarded by many trans people in the city (read: long wait time) and I was not going to be able to see her before surgery.

To get through this mental hurdle I had to trick myself a little bit. I thought to myself “what would I say to someone in my exact circumstances?” “would I be jealous of someone else getting my 6 week date?” and “what would happen if I waited?”

The clinic did give me the option to postpone if I wanted, but after thinking about those questions, and endless talking about it with my spouse, I decided to go ahead with the surgery in 6 weeks.

Things I wish I had done differently to prepare

While I am happy with how things turned out, with the benefit of hindsight, I wish I had done a couple things differently.

I wish I had researched more surgeons – since I was paying out of pocket anyway, I could have chosen to go to a variety of surgeons.

I wish I had gone to see my therapist before going for surgery to try knock down some anxiety. Though I knew she had a long wait time, she always has space for emergencies. I didn’t even make a phone call to inquire, which I wish I had just mustered up some courage to ask for an appointment.

Up next

I’m getting on a plane heading to Ontario for surgery! The next post in this series is all about the few days prior, the surgery itself and the few days after.

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Let’s Talk Gender S1E8: Legal Transition

OVERVIEW

We start by talking about Meaghan Ray’s thoughts on top surgery because we didn’t have time in the previous episode. Then we talk about Jake’s process of changing his legal name and gender marker, Meaghan Ray’s role as his partner through that process, and Meaghan Ray’s thoughts on potentially changing their name and gender marker in the future.

This is the last episode in this series which has focused on the various stages of transition as we have experienced them so far. We will be taking a break and will return with a new series in the future.

SHOW NOTES

Meaghan Ray’s Thoughts on Top Surgery

  • Some NB people will get top surgery without testosterone, take testosterone but not have top surgery, or do both.
    • I have a harder time relating to the NBs that do both because I am genderfluid and have a significant female component to my gender
  • I don’t feel the need to wear a binder all the time
    • When I have top dysphoria it isn’t debilitating, just irritating
  • Having top surgery to have a flat chest doesn’t feel right for me at the moment but I would consider having a breast reduction
    • Enough that I wouldn’t need to wear a bra if I didn’t want to and could get the appearance of a flat chest fairly easily but could also wear a bra to have the appearance of breasts
  • Got lots of good info from a talk at the Trans Philly Wellness Conference on top surgery
    • To get a more NB look you can look at various factors separately to mix and match more female-typical and male-typical markers
      • Contour
      • Overhang
      • Nipple placement
      • Nipple size
      • Shape of scars
      • Placement of scars
    • If you know what look you want with relation to all these things you just have to find a surgeon who knows how to do it!

Jake’s Legal Transition

  • Jake started to live ‘full time’ in May 2017 which is when he also started HRT
  • Saw gender psychiatrist in July
    • Received generic form to certify that he is transitioning and said it would make sense to amend his sex on any ID
    • Also can be used to explain why he might look male when his ID still says female
    • This document counts as the ‘medical letter’ that was required to change provincial ID
      • No longer required!
  • Went into registries in August
    • Found out he had to get fingerprinting done to get his legal name change and needed to apply for a legal name change before
  • Got fingerprints done
  • Applied for legal name change in August
    • If he was born in Alberta, could have gotten birth certificate and marriage certificate done all at once but he wasn’t so the process was even more convoluted
    • Received certificate in the mail in October
    • Got a new driver’s license!
  • Had to apply for marriage certificate from Nova Scotia
    • Took two tries for them to get it right
  • Tried to submit for a new SIN card which eventually was returned saying that he needed to change his birth certificate first
  • Hardest part was birth certificate
    • New Brunswick hadn’t changed their laws yet – still required proof of ‘sex reassignment surgery’
    • Need an updated birth certificate to get updated passport
  • Was stuck in limbo with a drivers license that didn’t match his passport and a passport that didn’t match how he presented
    • Made it too unsafe for us to travel to the states and had to cancel a trip we had planned
  • Getting banking info was also convoluted and for some reason he still can’t order cheques without the wrong name coming up
  • His workplace wouldn’t update his name in their system until his SIN card had been changed (which required the birth certificate again)
  • Wrote a letter to an MLA in New Brunswick about how frustrated he was and how many problems this archaic law was causing (December 2017)
    • Heard back at the beginning of February that it was already in the works
    • They ended up emailing and calling him to tell him that the forms were up and how to apply
    • Was very lucky in his timing because if he had started any earlier he still would have waited for this law to change and would have spent even more time stuck with mismatched documents and old work ID
    • Finally got it back in March 2018
    • Allowed him to update his passport and SIN card which he received in May 2018 – one year after coming out
  • In the meantime, he had found a way around the issues at work
    • Concerns with payroll’s info not matching his banking info and a T4 being issued in the wrong name
    • Got in contact with an HR Diversity and Equity person who had all his work stuff changed over in two months (done in December 2017)
      • As random things kept coming up he would contact her again and she would fix it super quick
      • Had been out since May and had lots of co-workers wondering why they couldn’t find him in the system to send him an email and he kept having to tell them to look under the old name
        • Very long 8 months
  • Found several resources for recently married people with lists of documents you need to get changed once you change your name
    • Land title, mortgage documents, credit score, etc
    • Super helpful but often ran into problems where the forms or procedure for changing the document did not include either change of first name or change of gender marker
    • Felt like he had to tell his life story and out himself as trans in order to get the document changed (over and over)
  • Situations keep coming up
    • Recent election – two voter cards showed up, one under each name, tried to get it changed, just caused confusion
    • Now that he passes as male people are even more confused because they can’t compute that he ‘used to be a woman’
    • Still can’t order cheques at the bank – has given up on that one after going in person and calling on the phone many times
    • Had to contact the city because he was getting his old name coming up during a job application and in emails despite applying under his current name
      • Had a fast, positive response and got it fixed quickly
  • In general was he was burnt out and apprehensive from having to go back to the same places over and over, never knowing what response he would get, if he would get different info from the previous time
    • He was super strategic about which locations he went to and at what time of day because he knew it would take a while and didn’t want there to be a long line of other people behind him listening to him explain his life story
  • No overt transphobic experiences (hurray for Canada!)

Partner Experience During Legal Transition

  • Provided support and encouragement
  • Gave permission for him to take some time away from working through the long list
  • Would have gone with him as a buddy to all the various offices if our schedules allowed
    • Moral support
    • Safety
  • For parents: call ahead to medical offices to ensure they have the proper name and pronouns in their system before your kid arrives
    • Old information can keep popping up depending on when the last time was that you interacted with that particular medical office/hospital
  • Had to change Jake’s information on my benefits plan
    • The form had a list of reasons that did not include transition so I had to write it in
    • Did not have a space to indicate a change of gender marker
    • Had to call them multiple times to correct it as they returned various iterations

Meaghan Ray’s Plans for Legal Transition

  • Could change provincial documents to ‘Meaghan Ray’ and X
    • May do this some day but it’s a lot of work and not necessary for now
  • Could change national documents to ‘Meaghan Ray’ and X
    • Would be more dangerous to travel internationally to places that don’t recognize that as a gender marker
  • Potential incentive was to get it changed before having a kid because we can’t change parent’s names on your kid’s birth certificate
    • However, it’s only first and last names that appear on the birth certificate, no gender marker, and we can choose the parental labels that we use (mother, father, or parent for either or both of us)
  • So for now, the emotional cost of changing anything out-ways the benefit for me

This brings our series on transition to a close. We will be back sometime in the future with a new series and hopefully some guests! Stay tuned!

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Let’s Talk Gender S1E7: Medical Transition: Top Surgery

OVERVIEW

In this episode we talk about Jake’s path to top surgery and his experiences of the procedure and the recovery process. We also discuss the role of the partner and Meaghan Ray’s experience during each stage of this process.

SHOW NOTES

Jake’s Top Surgery Experience

  • Referral to gender psychiatrist September 2016
  • Saw gender psychiatrist July 2017
    • Referral to top surgery – likely a two month wait
    • No word, called back, finally heard from the surgeon two months later
  • Two surgeons in our area that rotate so one is taking consults then start working on the surgeries while the other one takes consults
    • Trans people are at the bottom of the list in terms of priority
    • A friend got in for a breast reduction after a year, Jake has been waiting two years and still hasn’t heard back from them
  • Initial consult was a fast twenty minute run through with minimal information
    • Didn’t know what questions to ask yet
    • Learned that he would likely end up with dog ears
    • Revision to get rid of dog ears is not covered by provincial health care
    • Liposuction to prevent dog ears was not covered or even discussed as an adjunct out of pocket
    • Offered double-incision method only
    • Left Jake feeling uncomfortable and frustrated
  • Started googling where else he could get surgery
    • Found McClean Clinic in Toronto where they do ‘Mascuplasty’ to create appearance of a male chest instead of just double mastectomy
      • Includes liposuction and revision
    • Called the clinic, filled out the application, and was put on the list for a phone consultation which happened 4 months later (8 months after original referral)
    • Likely wait was listed as 3-6 months after consultation
  • Phone consult in March 2018
    • Surgery is done under informed consent – don’t need a referral from psychologists or psychiatrists but instead have to pay out of pocket
    • Similar vetting process to the gender psychiatrist – what are your expectations for surgery, why do you feel you need this surgery, describe your dysphoria…
    • Feel like you have to explain how you feel in stereotypical ways in order to ‘qualify’ and get access to the medical treatment you need
  • Offered a date 6 weeks later!
    • Took a day to consider if this was what he wanted
    • Much less time to logistically and emotionally prepare
      • Good support from community, even people who had personal experience with the McClean Clinic who all had great experiences
      • One friend showed his results and provided a list that he had made of tips and tricks after his surgery
      • Did lots of research on facebook groups for trans guys and breast cancer survivors
  • Trip to Toronto for surgery!
    • Willing to pay for better results and less wait time
    • Able to stay with family
    • Second guessing at the last minute
      • Not a ton of physical dysphoria but lots of social dysphoria that was severely anxiety inducing especially in public washrooms
  • In-person consult the day before
    • Surgeon was 2 hrs late
    • Jake burned through all his anxiety during the long wait
    • Brief but thorough description of the surgery plan, results, and follow up
  • Day of surgery
    • Measurements and markings based on ratios
    • Awkward but done in a medical way
    • IV started
    • Went into surgery and came out crying for no reason
    • Very sore across the chest
      • Wearing a compression band over the bandages
    • Got up to the bathroom and was dropped off with no supervision, felt very panicky, light-headed and gross
    • Was rescued by a nurse who then asked about any history of anxiety
      • Maybe they should ask about this before surgery?
    • Eventually met up with MR and was escorted out to the back door in a wheelchair
      • Lots of difficulty finding the car, figuring out where they wanted him to be picked up, etc

Partner Experience of Top Surgery

  • Included in all the pre-op appointments
    • Helping remember information and nice to know what was going on
  • Day of surgery
    • Stayed for pre-op measurements etc
    • Kicked out when he went in for surgery
      • Told it would take about 2 hrs and they would phone when he was done
    • No word after 2 hrs so I checked in with the desk and was shooed away with no actual updated estimate
    • Waited another 45-60 mins with no word so I checked back in
      • They went to check with the nurses and this time gave me a spot to sit around the corner
        • Had all our winter gear and personal belongings and my entertainment to keep me occupied during the surgery piled around me
      • Eventually came back and told me he was just crying a bit and I could go back in a few minutes when he was feeling better
      • Would NOT let me go back to help him calm down/recover
        • Tried really hard not to get in the way but also mentioned that I am familiar with medical things and could probably help him
    • Eventually got to see him once he was back in the pre-op room (after the whole anxious bathroom experience)
      • Very pale, shaky, sweaty, nauseous and in pain
      • Got a wet cloth for his neck
      • Helped him eat crackers
  • Generally poor communication with me
  • Fiasco with getting him to the car was very frustrating
  • Drove home very carefully
    • He was already in lots of pain and getting very nauseous
    • Had to pull over a couple times to make sure he was doing ok
  • Got home, got him settled and took it easy for a few days

Jake’s Top Surgery Recovery

  • Returned to the clinic the next day to ensure everything was going ok
    • 15 minute appointment with lots of driving to get there and back
  • First few days were mostly sleeping, resting, watching movies, sleeping propped up
  • Became very itchy from the pain meds
  • Pain from the compression vest under his armpits where they had done liposuction
    • Sensation in areas of liposuction came back very quickly with lots of bruising
    • Tucked some towels over the edge to make it feel less sharp
    • Moved the vest down a bit and loosened it a bit
  • Went back for a follow up after 7 days where they took off all the bandages
    • Could already tell his chest was flatter but with no bandages or vest it felt very flat
    • Subdued reaction due to pain meds and that it matched his expectation so it didn’t feel surprising
    • Partner reaction was much stronger
      • Had spent so many months picturing him with a flat chest because that’s how he pictured himself that his chest area had blurred out and had become uncomfortable to really pay attention to
      • With the bandages off it was the first time that I could comfortably look at that part of him and have it look right
      • Also knew how awesome he would feel about it once his head was clear of the meds and he was feeling better
      • Took some pictures and video including the side view which was the greatest
  • Flew back to Alberta
  • Took an extra week off work in order to recover enough stamina
  • Was supposed to keep the compression vest on for 4 weeks but ended up taking it off after 3 because it was so uncomfortable to wear under work shirts
  • Kept nipple covers on to keep nipples moist
    • Nipples scabbed as they healed (normal)
      • Looked like two black nipples and felt like something was wrong (also very common)
    • Scabs started coming off and the nipple was so light that it looked like it wasn’t there but everything was fine
  • Sensation returned slowly
    • Lots of areas across the top of his chest that started to itch as sensation came back
    • Then down into armpit and across towards the nipples
    • Played games where we would test where his sensation had gotten to
    • Nipple sensation has returned part way, somewhat hypersensitive
    • One spot in the left incision where a nerve ending was exposed and caused serious stabbing pain each time it was touched
  • Traumatized by liposuction video
    • Makes sense why those areas were so numb
  • Scar care
    • Bio-oil
    • Scar massage
    • Really careful to not raise his arms
      • Found other ways to exercise by modifying activities to deal with the feeling of being cooped up
  • Mostly frustrated with the irritating symptoms as the sensation returned and changed constantly
    • Had to use numbing gel at times

Partner Experience During Recovery

  • Listen to what they are experiencing
  • Look up extra info such as scar care and desensitization strategies if needed
    • Your person is so irritated by those sensations and burntout from the whole experience
  • Had fun figuring out where the sensation had returned to
  • Helping out others in the community since

Looking Back On It

  • If you’re considering private options, take the time to look around, including international options
    • Worth pricing them out regardless of distance
    • Consider amount of post-op support from family/friends
    • Consider whether you will get the results you want and what medical follow up is offered
  • Most people have had positive experiences with McClean Clinic
    • Jake found a big difference between the high quality customer service at a distance vs less awesome experience in person

Next time: Legal Transition

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Let’s Talk Gender S1E6: Medical Transition: HRT

OVERVIEW

The changes with HRT are some of the most positive and euphoric aspects of transition. We talk about Jake’s experience with Testosterone and going through his second puberty. He talks about all the different physical changes and the emotional changes as well. We also discuss what it was like as his partner adapting to those changes.

SHOW NOTES

Jake’s Experience Taking Testosterone

  • Typical trans narrative is based on changes with HRT
    • External, obvious changes
    • Most socially acceptable aspect of transition to ask about
    • Lots of YouTube videos and picture timelines
      • Can be fascinating to show what the body does on HRT but also gives you an idea what to expect (though everyone is different)
  • So much variability
    • Will loosely end up similar to cis men that you are related to
    • Also depends on age, dosage, etc

Accessing Hormones

  • Referral from psychologist to gender psychiatrist
  • Previously required psychiatrist referral to endocrinology but very recently could get a referral from family doctor (most family docs were not aware or comfortable doing this)
  • Wanted to start HRT right away but had to wait to see gender psychiatrist
    • Came out to family doc who then refused to refer to endocrinolgy
      • Wasn’t up to date and wasn’t willing to trust our word enough to seek out more information
    • Found another family doctor who was recommended through the community who was prescribing hormones using informed consent
  • Started Testosterone!
    • Regular family doctor followed up with blood work and adjustments to dose
  • Waited another 6 months to see endocrinology (supposed to see them max 3 months after starting)

Physical Changes

  • Voice
    • Started a few weeks after starting T
    • Voice got a bit husky, thick, then started cracking, then eventually settled into the lower range
    • Voice recordings were helpful to hear the changes that happened really slowly
    • Vocal chords thicken but don’t change as much after you’re done growing
    • Made a big difference to being misgendered, especially over the phone
    • Generally done changing by about 18 months
    • Partner experience
      • Had a fun time with the voice change
      • Making fun of the cracking, drawing attention to something that was affirming
      • My voice started sounding higher in comparison (caused voice dysphoria for myself)
        • Worked on lowering my own range
  • Facial Hair
    • Very slow – mustache and side burns and under-chin hair first, very slowly filled in
    • Helps with passing from afar
    • Lots of euphoria
    • Lots of time spent staring up close in a mirror
    • Partner Experience
      • Enjoyed scruffing his beard, trying to encourage it to grow
      • Eventually had to encourage him to shave which he had a big resistance to
  • Body Hair
    • Lots more on thighs, forearm hair thickened, more on tummy
    • More fascinating than facial hair growth because it was less expected
    • Grew a lot at the beginning, then slowed down a lot but has continued
    • Partner Experience
      • Not much need to adapt to this as it wasn’t a huge change and has been fairly slow
  • Increased Temperature
    • Lots of overheating initially on T but has since improved
    • Especially when exercising which was very frustrating
      • Better after top surgery which meant he was comfortable exercising without a shirt on
    • Partner Experience
      • Used him as a heating pad
      • Wildly different environmental temperature requirements
      • Unable to exercise together for a while
  • Menstruation and Lower Changes
    • Periods stopped almost right away
      • Might be related to already having an IUD in
    • Other changes in downstairs anatomy that we did not discuss (go look them up if you’re interested/need to know)
  • Strength
    • Baseline strength increased without trying
      • Could suddenly lift tires more easily which felt weird
      • Didn’t need to workout to increase strength
    • Noticeable only when doing things, not all the time (like facial hair) so often took him by surprise
    • Partner Experience
      • Felt so much weaker by comparison!
      • Jealous of his strength and easy muscle gain when he was working out
      • Fun to see his confidence increase with his awareness of his strength
  • Body Shape
    • Very delayed and slow
    • Fat distribution changes – less on hips and thighs, more on belly
    • Changes within face – less in cheeks, more to jaw
      • Gives appearance of wider jaw even though bone structure isn’t changing

Emotional Changes

  • Concerns before taking hormones about becoming angry and raging
    • We were told that it augments emotions that are already present – if you’re an angry person, you might feel more angry but if you’re not, you won’t just suddenly become angry
  • Hormonal fluctuations definitely makes people generally more emotional just like typical puberty
    • As an adult there are adult expectations and responsibilities you have to manage while having mood swings
    • Hopefully have more coping skills as an adult
  • Less sadness, more channeled into frustration
  • Initially quire irritable but calmed down within a few months
  • Less emotional range and less nuance
    • Doesn’t feel wrong or repressed or stunted
    • Feels normal, the way his emotions should have been from the beginning
  • Less emotionally triggered, less emotionally invested
    • Maybe due to increased confidence
    • Seems more aloof but as a guy, people don’t particularly care (aloofness is somewhat expected)
  • Confidence increased which is difficult to measure as the person going through it
    • As a partner, this was easiest to see as compared to the rest of the emotional experience
      • Less social anxiety
      • More comfort in masculine clothes
      • Was very cool to see and very much offset any mild discomfort I had with the physical or emotional changes
  • Partner Role
    • Being a sounding board
    • Encouraging him to express the huge emotions when he wasn’t used to having them or having so much of them
    • Suggested a variety of positive outlets for emotions

Looking Back 2.5 Years on T

  • Lots of euphoria from HRT but at the time was painfully slow
    • Celebrated every little change we saw and made a big deal out of them
    • This was the good stuff during all the frustrations of accessing medical care and getting legal documents changed
  • Looking forward to more facial hair, body hair, and body shape changes
  • What will happened during the age of menopause/andropause? We have no idea!

Nonbinary Identities and HRT

  • Can take low dose to have fewer and slower changes
    • ‘Micro-dosing’
    • Can stop after the voice change but before much hair growth
  • I have minimal consistent physical dysphoria, no particular desire for facial or body hair changes, minimal voice dysphoria which I dealt with by working on my range
    • Also trying to get pregnant so would not be able to be on T currently
  • Open to it in the future if I ever felt like I needed it

Next episode: Top surgery!

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Let’s Talk Gender S1E5: Social Transition: Coming Out At Work

OVERVIEW

Jake has now been out at work for nearly two years. We discuss his process for coming out at work from the preparation, through coming out, and all the frustrations that happened afterwards including HR struggles, bathrooms, mysogeny, and misgendering.

Meaghan Ray talks about what it was like to be in the role of the partner during this part of the transition process including having to come out to their co-workers about Jake’s transition.

We discuss Meaghan Ray’s process for coming out at work as non-binary so far and Jake’s experience of having a non-binary spouse when he’s talking to co-workers.

SHOW NOTES

Jake’s process for coming out at work

Preparation

  • Talking to community, online friends to learn from other people’s experiences
  • Talking to team lead and other coworkers in a hypothetical context
    • They didn’t really apply the conversation to real life or think about it practically
  • Should have gone to HR in advance though he wouldn’t have necessarily known what to bring up as a potential concern until he encountered them

Tipping Point

  • Eventually dysphoria was bad enough that he could not do his job so it was either come out or quit
  • Told team lead in advance
  • Had written an email
  • Pulled aside immediate co-workers to tell individually
    • Generally supportive
  • Sent email to whole department
    • Much more generic than discussion with immediate co-workers
  • Told other higher-ups
    • One person in particular had immediately helpful comments such as “Which bathroom are you going to be using” and “How do we get your name changed in the computer system” ie considering the practical aspects
    • Some were confused as to why Jake’s transition would be affecting anyone and why he needed to tell everyone when it’s a personal/private issue (ie thinking of it as the same thing as coming out as gay)

Challenges

  • Old name on emails and inter-office messaging until his name change document came in
  • Then was told he had to get his birth certificate changed first as well as a new SIN card (even though others who are changing their name due to marriage etc do not require all of this extra documentation and there was no good explanation as to why he did)
  • Eventually discovered that HR had a diversity and inclusion rep that helped a lot
    • Met with her in person and discussed all the concerns with things that had been happening and unnecessary hoops that he was being forced to jump through
    • She was super feisty and got things changed really fast which was amazing

Bathrooms

  • Started out by going to the farther away women’s washroom
  • Then used the men’s washroom in the same farther away area but was terrifying, especially prior to top surgery
  • Found a single use bathroom a couple floors up in an abandoned area that was under renovation
    • Felt safe but isolating and cumbersome
  • Found out later that some of the management had been talking behind his back about what bathroom he should be using in order to decrease the discomfort of others
  • Decided he wasn’t going to hide anymore and went back to using the men’s washroom closer to the work area
  • Had emailed facilities management to ask about bathrooms and they connected him to the diversity rep at HR

Looking Back

  • Felt like it took forever, in reality was about a year
  • Fighting on all fronts
  • Exhausting and circular and convoluted

Did People Adapt?

  • Took a really long time, no trigger event like we had with the family (see Episode 4)
  • An ally helped by correcting others on Jake’s behalf
  • Still getting misgendered 5-10 times per shift by immediate co-workers one year later
    • Now, another year later, still getting misgendered 1-2 times per shift
  • People now know him longer as Jake than anything else and he still has a hard time correcting people
  • Newer co-workers don’t know he’s trans and never knew him prior to transition
    • Others who misgender him get a completely confused reaction rather than people realizing he’s trans – people just don’t think of that
    • Now that he passes, being misgendered doesn’t bother him as much because they end up looking like idiots

Other Interesting Situations

  • Suddenly being included in mysogenistic ‘bro’ language and conversation in an attempt to show acceptance
    • Difficult to counteract the mysogeny without losing the acceptance
  • People tried to teach him how to be a guy as though he had never been exposed to masculinity

Partner Experience

  • Could only be a cheerleader
  • Wasn’t able to help with any of it in the ways I was able to help during other phases
  • Having to come out to MY coworkers for Jake so I could talk about my husband instead of my wife
    • Made a little presentation which my immediate team responded to really well
    • Hoped that it would get around via gossip but it really didn’t so I had to tell everyone separately, often more than once
    • Lots of disjointed conversations where I had to stop mid conversation to explain why I was referring to my husband
    • Most common question was “Does that make you straight?”
  • Had a hard time getting support from co-workers because no one had enough context for how the process was affecting me, what type of support to give me, and why I was getting burned out
    • Tried to explain but ended up spending more energy than I got back in support
    • More recently I have had more co-workers who have trans experiences
  • Educating co-workers was still important to me because I work in a health care setting and I want as many people who work with patients to understand how to be respectful towards trans people
  • Once I was no longer talking about my wife, I lost my ability to come out as queer off-handedly in a conversation
    • Made my own identity feel a lot more invisible
  • Had a few difficult situations in my workplace where I witnessed transphobia or had co-workers misgender trans patients which were very triggering for me (and still are though I deal with them slightly better now)

Meaghan Ray’s experience of coming out at work

  • Most dysphoria at work, mostly social dysphoria
  • Half the people I interact with are strangers
  • Rather than a goal of not getting misgendered (not feasible), set the goal of minimizing discomfort
    • Most uncomfortable with other female language (ma’am, ladies, girl)
  • Instead of “I’m non-binary, use they/them pronouns, call me Meaghan Ray,” I’ve chosen to instead say “I’m non-binary, this is what that feels like, please avoid these types of gendered terms and instead use these neutral ones”
  • Very choosy with who I have these conversations with
  • I still have a hard time correcting people when they use female terms but I tend to groan, squint, flinch, go silent, or say “Nope!” and they eventually get the idea and self-correct

Jake’s experience as a partner

  • Couple of co-workers that know about Meaghan Ray’s non-binary identity and are generally good at using they/them pronouns
  • Refers to Meaghan Ray as his partner or spouse
  • Generally less gossipy/social work environment so it comes up less

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Let’s Talk Gender S1E4: Social Transition: Coming Out To Family

OVERVIEW

Coming out to friends and family is a long process that involves lots of uncertainty, strategy, and a bit of luck. We discuss Jake’s process of coming out as a trans man and Meaghan Ray’s experience of that process as his partner, including how this process went for us, what methods we used to come out to people, what emotions we experienced, and what responses we got.

We also discuss Meaghan Ray’s experiences of coming out as non-binary so far (still early on in the process), Jake’s experience of being their partner, and how their two experiences are similar or different.

You can find the audio for the episode at the bottom of the page or subscribe to Let’s Talk Gender in your favourite podcast app.

SHOW NOTES

The following is Jake’s coming out process and Meaghan Ray’s experience as his partner.

Who to come out to first?

  • Friends, then close family, then work, then extended /more questionable family, then strangers
  • Everyone’s process will be different
    • Start with the people that will be most likely to be supportive and work your way up to the least supportive people

Partner Experience during closeted and early coming out phase

  • Various pronouns depending on the situation and who was present – female, male, neutral, avoiding pronouns altogether
  • Still trying to get used to his new identity so using female pronouns made that harder
  • Lasted about 4 months
  • Didn’t realize the toll that this took until about 8 months later (caused fairly severe burnout)
  • Got used to doing a quick check in before each social situation of who’s going to be there, who are you out to, is it worth going out, which name and pronouns are we using?

Coming out to family

  • Thought it would be similar to coming out as gay but it really wasn’t
    • Being trans is about who you are and requires them to do a lot more work – change how they think of you and how they refer to you
  • Started with the first few people who were most likely to have a positive to neutral response and who had less direct impact
    • Didn’t judge all of those correctly but overall it went ok
    • Be open to any response they have
    • Keep safety in mind
  • First part felt like it went really slow
    • Few people know and if they’re hanging out with people who don’t know it gets very stressful
    • Asking people to hold back on gendering you correctly which slows down their process of coming to terms with it
  • Eventually there is a tipping point where it’s easier just to have everyone know

Coming out to partner’s family/long distance family

  • Multiple conversations
  • Expecting close family to come out to other members of the family for you does not work – you end up having to do it yourself
  • Mostly done through email with generally positive, supportive responses
  • Follow up conversations at face-to-face gatherings
  • Took them longer to adjust but generally had less impact on us
  • Partner can do more of the work, especially with the follow up conversations

Methods for coming out

  • Face-to-face is the hardest, tended to avoid that if possible
  • Sent lots of emails in the early stages
  • Wrote a letter and read it out face-to-face
  • Sent lots of shorter emails to the more extended family
  • Facebook/social media for general public, past friends, far extended family

Responses to coming out conversations

  • Told close family early on that he was thinking about it/working on it as a warning that transition might be coming
  • Told them a while later that he for sure was trans but they didn’t seem to understand that there was much difference from the first convo
  • No change in pronouns or name
  • Had a family wedding coming up that necessitated telling Jake’s brother
    • First person to appropriately change pronouns, name, and referents (brother) and introduced him that way at the wedding
  • His family realized that they were the only ones referring to him with female name and pronouns and suddenly was making it more unsafe for him
    • Kick started their use of proper name and pronouns in an unexpected way
    • Positive effect of strangers getting name/pronouns correct around family that is getting it incorrect
  • Was a high risk, high reward situation
  • Realized afterwards that family had been reluctant to change likely out of fear for his safety (when he wasn’t passing yet)
    • What they didn’t realize (and what we didn’t understand early enough to explain to them) was that the toll on his psychological safety was worse than the physical safety risk that they perceived

Partner experience during early stages of being out to family

  • At the beginning, tried to hang out with them and refer to Jake in third person as much as possible to set a good example
    • Complete opposite from previous stage where we tried to use second person or no pronouns as much as possible
  • Really enjoyed being able to refer to Jake correctly, felt good about setting a good example and trying to help
  • When they were not getting it at all, it got very difficult to hang out with them
    • Jake wanted them to figure it out at their own pace and didn’t want to correct them
    • Started getting angry with them too easily and had to not hang out with them as much (until they suddenly figured it out at the wedding)
  • Once they figured it out, it was much easier to hang out with them again
    • Started correcting themselves, correcting each other

Correcting others when you get misgendered

  • Often happens in larger groups or in the middle of a conversation
  • Don’t want to derail a conversation or become the center of attention
  • Will remind them via text message later if they do it repeatedly without correcting themselves
  • Much better if someone else corrects them for you because you automatically have an ally and don’t have to make yourself vulnerable in order to stand up for yourself
  • Always takes emotional energy so it’s a balance of how much pain it’s causing you vs how much energy you have to spend to correct them

Emotions during coming out to family

  • Transition from questioning stage to coming out stage was the hardest
  • Fear, nervousness, what if someone becomes vengeful, actively negative
  • Questions about which family would chose to never talk to me again
  • Can’t base people’s reactions to you being trans on how they reacted to you being gay
  • Eventually reached a tipping point of it is more difficult to live in the closet than the fear of how people would react
  • Realization of how many people you actually have in your family
    • Exhaustion, frustration, unending
  • False urgency to tell everyone as soon as he started hormones because changes would be happening and people would notice
    • Didn’t happen nearly as fast as he felt like it would
    • Wanted changes to happen faster to help people have an external reference for changing name and pronouns

Mental vs physical image and adjusting to new identity

  • Lots of detailed conversations between us where Jake explained how he saw himself and would feel most comfortable which helped Meaghan Ray change their mental image of him earlier than anyone else would be able to
    • Made it easy for me to use correct pronouns well before any physical changes
  • Other people don’t get to have those detailed conversations and therefore can’t change their mental image because they don’t know what to change it to
    • Often do much better after physical changes start happening
  • Family have known you longest and will have the strongest mental image of you pre-transition
  • 5% rule: people will take up to 5% of the time they have known you to get used to new name and pronouns

Partner emotions during coming out to family

  • Fear, mostly for psychological well-being as he was having lots of difficult conversations
    • Kept my phone on me at all times
  • Tried to provide lots of validation and support so he had at least one positive influence
  • Offered to go with him when he would be having those conversations
  • Still didn’t really understand how hard those conversations were and how things were going
    • Had to ask really specific questions in order to find out because he didn’t want to make it harder for me and did not have any more energy to spend on another gender based conversation

Burnout lasts a long time

  • Still nervous about talking about gender and transition because there is a conditioned response that those conversations will lead to something huge and exhausting
  • Reviewing past experiences is much easier than talking about current ones
  • If you are the second person to transition in your immediate family or even within your relationship, those around you might have a hard time as a result of the residual burnout from past experiences with it

Meaghan Ray’s experience of coming out as non-binary

  • Even harder than coming out as binary trans
    • The person you are coming out to already has an idea of what you mean by ‘male’ or ‘female’
    • Most people do not have that reference for ‘nonbinary’
    • Requires a lot more sex and gender 101 education to work up to getting them to understand which puts them in information overload
  • Really, all I’d be asking is for them to use they/them pronouns and maybe a different name and even that seems to be extremely hard for people to do
    • We use they/them automatically all the time but when people are asked to do it consciously, apparently it messes with their brain and they can’t do it
  • Takes so much energy that I haven’t done a lot of coming out to family yet
    • Something else always seems more important to talk about when visiting with family
    • Sent an email with an explanation but haven’t talked about it since
    • Good sibling support, will likely help my family come around but want to have those conversations with my parents first
  • Will likely have those conversations with close family once I’m pregnant/having a kid and have more extended visits with them and potentially more gender-based discomfort

Jake’s experience as Meaghan Ray’s partner

  • Trying to avoid pronouns at all costs
    • Awkward pauses, reorganizing sentences
  • Being supportive while Meaghan Ray is slowly working up to coming out
    • Spending a long time in limbo
  • Can’t be fully invested because limbo causes burnout and limbo will last much longer

The coming out equation

  • Deciding when you’re ready to come out will be different for everyone
  • How uncomfortable it is to be misgendered vs how hard it will be to come out and how much benefit you will get
    • Very different answers to this equation for each of us

Every coming out process is different and personal but inevitably affects and involves the people around you.

Join us next week when we talk about coming out at work.

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Let’s Talk Gender S1E3: Personal Transition: Gender Exploration

OVERVIEW

The first stage of transition is the personal exploration of your gender. We discuss what the process of exploring your gender feels like, how each of us figured it out in different ways, and what it’s like to be the partner of someone going through the gender exploration process.

Sorry for the variable sound quality. We are still trying out different set ups to find something that works for us.

SHOW NOTES

  • Exposure to a concept or identity that resonated with us
    • Looking up other people’s experiences on YouTube
    • Being fascinated by people’s experiences without knowing why until later
  • Finding language to express ourselves and define our identities
    • Other people’s labels don’t necessary feel right for you
    • The labels that feel right shift throughout the exploration process
    • The trans label comes with a lot of weight
    • Takes a while to find your own meanings for labels that fit
  • Exploration is often driven by the feeling of not fitting with the gender you were assigned at birth and how people relate to you as a result (dysphoria)
    • Trying to minimize it guides us in a direction towards our actual gender
    • Often have been experiencing dysphoria for a while but didn’t know what it was called and once we have the word for it it feels huge and way more painful than it did before
    • Physical dysphoria, social dysphoria, mental dysphoria
    • Fairly easy to tell what you are dyphoric about
  • Sometimes we encounter gender euphoria and exploration is driven by finding that experience again
    • Trying on different clothes when playing dress-up or secretly raiding a family member’s closet

Jake’s Experience

  • Minimal physical dysphoria, mostly social dysphoria
  • Voice causing people to gender him as female
  • Explorations
    • Cutting hair short
    • Wearing a binder
    • Trying a packer
    • More masculine style
  • Very nervous that people would notice immediately
  • Very scared of what the implications were of this feeling good, progressed very slowly
  • Looking for a new name
    • Flipping through baby books
    • Making a short list
    • Ordering different things online with a different name each time
    • Kept coming back to Jake and eventually it stuck
  • Eventually decided that he definitely did not feel comfortable being female
    • Even if he didn’t do any medical transition, he still felt more male than anything else
  • Exploration doesn’t end
    • Now that he is more comfortable in his maleness he is exploring some of the female things that he would never have done before
      • Longer hair
      • Nail polish
      • Earings back in

Meaghan Ray’s Experience

  • Exploration was a lot easier because they already new their identity but needed strategies to manage dysphoria, especially at work
    • Similar strategies as Jake
  • Had a very clear gender related experience in Grade 10 where they were a boy named Ray for a few days, then back to Meaghan, then back to Ray
    • Kept up for 2-3 months
    • Was very confusing and frustrating and destabilizing
    • Ended up making a list of personality traits for Meaghan and a list of personality traits for Ray, drew lines between the ones that matched, and from then on lived as that person
    • Buried the whole experience very deep until Jake started talking about gender and they found language and space to explore it in a positive way
  • Needed something more concrete to follow for exploration than Jake
    • You and Your Gender Identity: A Guide to Discovery by Dara Hoffman-Fox
    • Created a gender tracker to see how much their gender fluctuated between male and female for both physical and social sense of gender
    • Learned that their period affects their gender and that their physical and social sense of gender can shift separately which they will use different strategies to manage
  • Trying on a dress privately
    • Thought it would feel wrong but it felt like a non-binary person wearing a dress
    • It did not erase their sense of identity which was encouraging
  • At the end of exploration, they now have many more strategies that help and a much better understanding of who they are and how to express it to people

Partner Experience

  • Seeing Jake with a flat chest in a binder helped change Meaghan Ray’s mental image of him
  • If the partner is cis it can be very difficult to understand what’s happening
    • Some trans people are not willing to include the partner in their exploration process and just show up as their new self which is very threatening and sudden for the partner
    • Instead, Jake included Meaghan Ray in the process and they helped look stuff up, break things down into smaller steps so it was less scary, tested things out during a camping trip, provide encouragement and support
  • Your experience is your own
  • Need to find your own sources of support as a partner
  • Don’t know how to talk about it yet because everyone is still just figuring it out
  • The more open we are with each other the easier it is to keep our relationship strong
  • We happen to both be AFAB and heading in the male direction
    • Some strategies worked very well for both of us
    • Some things worked very differently for each of us
    • Some things worked for one of us but not at all for the other

Resources

  • FTM
    • YouTube Channels: Chase Ross at uppercasechase1, Ty Turner, Jammiedodger
    • Books: This One Looks Like a Boy
  • NB
    • Podcasts: Gender Rebels, They/Them/Theirs
    • YouTube Channels: Ashley Wilde, Ash Hardell
    • Instagram hashtags to create a community for yourself

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Let’s Talk Gender S1E2: Transition Timelines

OVERVIEW

Transitioning is a slow, often frustrating, ongoing process. It can roughly be broken down into four phases: personal, social, medical, and legal. We discuss the general timeline of each phase and how they overlapped for Jake’s transition from female to male. At the end, Meaghan Ray shares what their transition has included so far.

SHOW NOTES

General Thoughts on Transitioning

  • Typical FTM trans narrative
    • Binary transition from one to the other
    • Medical system sees it as a treatment to change from one to the other
  • In reality, it’s a slow frustrating process
    • No sudden tipping point or specific end point
  • Non-binary transition is even more vague
    • Often have to fake a binary identity to get the medical care you need
    • Wide variety of social, medical, and legal changes
  • Generally made up of four stages
    • Personal transition: an exploration of your own identity
    • Social transition: the coming out process
    • Medical transition: any medical interventions that help ease dysphoria or increase gender euphoria (HRT, surgery, electrolysis, voice therapy)
    • Legal transition: changing name and gender marker on legal documents and with various institutions
  • Stages can overlap or blend into each other
  • Trans people do not need to go through all of these stages in order to transition or be considered trans.

Jake’s transition process:

Personal Transition

  • Longest stage
  • Began in 2015 until late 2016
  • Self-questioning, self-doubt, internal conflict
  • Talking to friends, looking things up on youtube
  • Found a therapist that was trans friendly that was familiar with the referral process
    • Referral to gender psychiatrist
  • Felt like the therapist and Meaghan Ray were much more convinced that it made sense and he would be going through with it than he was
  • Finally determined that he would be more comfortable living as a man
  • Personal exploration continues throughout transition
    • Getting used to body changes
    • Learning how to communicate your identity
    • Learning how to navigate new social status and changes in privilege

Social Transition

  • Came out to parents with a message of ‘I’ve been thinking about this, I’m exploring this’
  • Different approaches to coming out
    • Emails, letters, face to face
  • You realize how many people you have in your life
    • Very overwhelming and exhausting
  • Started with the people who would be most likely to be supportive
    • Didn’t always work out as planned but generally helped build support
  • We were hoping that some people we told would pass on the information to others but it never actually worked out
    • Ended up having to tell them ourselves
  • Reactions
    • Some people changed name and pronouns right away
    • Some people needed to be told multiple times and are still misgendering Jake (in late 2019)

Medical Transition

  • Lots of gatekeepers
  • Gender psychologist – referral to gender psychiatrist in summer 2016
  • Gender psychiatrist in summer 2017 on a cancellation
    • Referrals for endocrine and surgery consult
  • Family doctor who was willing to write prescriptions for HRT – started Testosterone in May 2017
    • Turned out to be an easy process once he built up the courage to ask the affirming doctor
  • Top surgery consult in fall 2017, didn’t feel good about the two year wait or the type of surgery offered
  • Had top surgery done at a private clinic (paying out of pocket) in April 2018
  • Hysterectomy in October 2018
  • Potential for bottom surgery in future – would require another visit to gender psychiatrist to get referrals to surgery and separate referral for funding
  • Got most of the information about who is allowed to make referrals, who is willing to make referrals, who is accepting referrals, and what the wait times are through the trans community
    • Connections to community are very important

Legal Transition

  • Different process in each province or local area
  • First item was a piece of paper stating that [previous legal name] is transitioning from F to M that officially explains why you don’t look like the picture on your ID
    • Important during the stage when you’re already on hormones and presenting differently but haven’t yet changed any ID
  • Name and gender marker change document that requires fingerprinting
    • Submitted in Aug 2017, received it in October 2017
  • Immediately got driver’s license changed
    • Felt safer in general but now had conflicting documentation with national documents
  • So many different documents that needed changing
    • SIN card
    • Banking information, loans, mortgages, credit score
    • Marriage certificate
    • School records, work ID, email addresses
  • National documents were the hardest
    • Birth certificate took the longest due to waiting for laws to change – finally done in summer 2018
  • Took over a year
    • No international travel
    • Lots of stress, confusion, frustration

Transition is never completely finished

  • Will always be people to come out to or correct, medical history to explain, and documents that pop up that don’t match

Meaghan Ray’s Process:

  • No medical or legal transition yet
  • Personal transition started with a genderqueer experience back in grade 10
    • Ignored it, put it away until Jake’s transition provided more language, strategies, and community to give myself space to explore it
  • Tracked my gender and explored it for a bit
  • Have just started coming out to friends and family and coworkers one at a time, very carefully
    • Limited understanding of what non-binary means so coming out requires a lot of educating
  • Will be an even longer, slower, more careful process than Jake’s
  • May be interested in some form of top surgery or legal gender marker or name change in the future

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Wearing a Binder: Recommendations and Exercises

If you haven’t read it yet, check out Wearing a Binder: Physiological Effects. I will refer to the same areas of the body and some of those effects in this post.

GENERAL RECOMMENDATIONS

  • Try to wear it as short a time as possible. Most recommendations state no longer than 8 hours but if you work 8 or 10 or 12 hour days, that just isn’t possible. Just know that the longer you wear it, the worse the above effects will be.
  • Try to wear it as few days as possible. If you have severe dysphoria and can’t leave the house without a binder on, try to have one day a week where you stick close to home so you can stay binder free. Or try other slightly less compressive options as many days of the week as possible.
  • Avoid exercise while wearing a binder. Your lungs cannot expand the way they need to during exercise which forces your heart rate to go up significantly more to compensate. Also, you will have poor spinal and shoulder mobility, causing stress and damage to other joints, muscles, and tendons.
  • Do not bind while sleeping. When we sleep we are not aware of discomfort. You could be causing damage and not know about it. Also, while you are unconscious and thus not aware of dysphoria, this is the ideal time to take a break from binding.
  • Never bind with ace bandages. The tension in the wrap can shift over time causing one layer to loosen and another to tighten beyond what is safe.

EXERCISES

Deep breathing

Benefits lungs, ribs, and pelvic floor.

For the following exercises:

  • Best done in a seated position but can be done lying on your back.
  • If you start to get light-headed, breathe normally until it clears.
  • If you have COPD, skip the first exercise and focus on breathing all your air out between each deep breath in.

Active Breathing Cycle

  • Take a deep breath
  • Hold it in for 2-3 seconds
  • Let all the air out by compressing the lungs until they are empty
  • Take a full deep breath, then breathe normally for 5 breaths
  • Repeat 3-5 times

Diaphragmatic breathing

  • Place a hand on your upper belly, just below your breastbone
  • On each breath in, take a deep breath, pushing your tummy out into your hand
  • Try to minimize the rise or widening of your chest
  • Try to only move your tummy to breathe
  • Cycle of 5 belly breaths and 3 regular breaths
  • Repeat 3-5 times

Lateral Costal Breathing

  • This one is a little harder and may take some practice
  • Place your hands on the sides of your ribs (either by bending your elbows or giving yourself a hug)
  • On each breath in, take a deep breath, trying to make your chest as wide as possible and pushing your ribs out into your hands
  • Try to minimize the rise of your chest and the expansion of your belly
  • Cycle 5 wide breaths and 3 regular breaths
  • Repeat 3-5 times

Spine and rib movements

Restores general mobility to the spine and ribs.

Thoracic Side Bending

  • In a seated position, hold on hand on your ribs at the side.
  • Bend towards that hand, bringing the other arm up and over your head.
  • Hold stretch for 10-20 seconds while breathing deeply.
  • Repeat to the other side.
  • Repeat each side 3-5 times.

Thoracic Rotation

  • In a seated position, cross your arms high on your chest so you’re grasping your shoulders.
  • Gently rotate as far as you can one way, and then slowly as far as you can the other way.
  • As you go, you should feel less resistance and be able to rotate a bit further without pain or muscle cramping.
  • Repeat 15-20 times.

Flexion and Extension

  • In a seated position, reach forward, curling your neck, shoulders, and upper back as you breathe out.
  • Take a deep breath in, opening your arms, pulling your shoulders back, and arching your upper back.
  • Complete 5 repetitions, take a break to breathe normally for 3-5 breaths, then repeat 2 more times.

Spinal Twist

  • Lie on your back on a carpet or mat with your knees bent up and your arms spread out on the floor.
  • Keeping your shoulders flat on the floor, let your knees, hips, and lower back rotate down to one side.
  • Take a deep breath in and out, then pull your knees up and rotate them the opposite direction.
  • Alternately, you can start by lying on one side and, keeping your knees on the floor, lift the top arm and rotate your shoulders across to try and get them flat on the mat and then repeat on the opposite side.
  • Repeat 5-10 times.

Neck Range of Motion

  • Tip your ear to your shoulder, roll your head down to the middle, then the opposite ear to your shoulder, and back up to the middle.
  • Breathe slowly and evenly throughout.
  • Pay attention to where you feel muscle pull. Don’t force the stretch in these areas but pause in the circle to take a full breath in and out in these areas.
  • Repeat 5-10 times, alternating direction.

Chin Tuck and Neck Extension

  • Without looking down or bending your neck forward, tilt your head to tuck your chin in (like you’re trying to create a double chin).
  • With one or both hands, grasp the back of your head and gently pull up. You should feel a stretch right at the base of your skull.
  • You can also add a bit of sideways pull.
  • Hold the stretch for 5-10 seconds. Repeat 3-5 times.

Spine mobilization

Targets the thoracic (mid) spine and posterior ribs to decrease stiffness and stretch the ligaments.

For the following exercises:

  • You will need a foam roller
  • You will be lying on your back on a carpet or mat with your knees bent up and your feet on the floor with the foam roller horizontal under your spine.
  • Only put pressure on the spine where the ribs connect to the spine, not down on the lower back or up on the neck.

Spine Rolling

  • Lift your hips of the mat so the only place of contact is your feet and the roll.
  • With your hands behind your head or crossed over your chest, gently roll up and down the roll by walking your feet along the floor while breathing deeply.
  • Spend more time in areas that feel stiff or sore.
  • Repeat 10-15 times.

Foam Roller Extension

  • Place the roll just above your bottom ribs.
  • Take a deep breath in, then slowly arch back over the roll as you breathe out. Only go as far as you are comfortable.
  • In the arched position, take a full deep breath in and arch a bit more when you breathe out.
  • Return to the start position and move the roll slightly higher on your spine. Repeat.
  • It should take 4-6 repetitions in different spots to cover your spine up to the shoulder blades.
  • Repeat the whole spine 3-5 times.

Shoulder mobility and mechanics

Shoulder and Arm Circles

  • Roll your shoulders forward, up, back, and down. Repeat 10 times.
  • Picture a clock face on your shoulder where 12 is up, 3 is forward, 9 is back, and 6 is down. Pull your shoulders into the 10:30 position. Hold them there while you raise your arms up to the sides.
  • With your shoulders stable and your thumbs pointing up, move your arms in circles from big to small and back to big. Change direction and go big to small to big again. Repeat 3-5 times.

Protraction and Retraction

  • Give yourself a hug, grasping your shoulders and pulling them forward to stretch your back. Take a deep breath in and out.
  • Pull your arms back and squeeze your shoulder blades together, stretching your chest. Take a deep breath in and out.
  • Repeat 5-10 times.

Overhead Reach with Scapular Rotation

  • Raise one arm out to the side and overhead.
  • Focus on rotating your shoulder blade so the point of your shoulder moves towards your ear.
  • Place your other hand just below your armpit. You should feel the edge of your shoulder blade push into your hand.
  • Repeat 5-10 times each side.

Don’t feel like you have to do all of these every day. Pick a few and do what is manageable. Focus on the ones that treat the area that is causing the most pain for you. The more you do them, the better.

If you have any questions, please leave me a comment and I will clarify or provide modifications. If you have any other exercises that you have found helpful, please also share those in the comments!

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