Tag: Medical

3 Types of Trans Healthcare That Everybody Should Know About

When we hear about trans people and healthcare, we mostly hear about hormones and surgery. But trans people are way more than just hormones and surgery.

As part of my current research, I am learning about the different types of barriers that trans people experience when accessing healthcare. To my surprise, the majority of the barriers discussed were in relation to accessing transition related care – ie hormones and surgery (among other things). I had to dig significantly deeper to find anything on the barriers that trans people face in accessing regular, every day health care.

What I realized was that this was a reflection on society’s view that trans people are one-dimensional – trans. As it turns out, trans people are more than just trans. They are parents and kids and employees and students and immigrants and homeless and artists and athletes. They are just as multi-faceted as cis people – maybe more so!

This goes for their healthcare needs as well. Sure, they need access to things that are specific to medical transition, but they also need access to basic health care. They break bones, get in accidents, have chronic conditions, and get sick just like cis people.

Since this concept seems to be difficult for the medical and research communities to grasp, I thought I would break it down into three categories to make it a bit more straightforward. Here goes.

TRANS SPECIFIC CARE

This category of health care needs is specific to being transgender. These are health care protocols, medications, and surgeries that are only accessed by and applied to trans people. Some of these were created specifically for trans people. Most were designed for cis people but have been adapted in ways that are now seen as separate protocols when used for transition purposes.

  • Hormone replacement therapy (HRT) for the sake of gender transition
  • Chest masculinization surgery (top surgery)
  • Vaginoplasty
  • Orchidectomy
  • Phalloplasty
  • Metoidioplasty
  • Facial feminization surgery (a collection of many different procedures including trachial shaving)
  • Gender dysphoria diagnosis
  • Psychological assistance with gender/sex incongruity
  • Voice masculinization/feminization therapy

TRANS ASSOCIATED CARE

This category of health care needs refer to services that are used by trans people in the course of medical transition but are also used in the same form by cis people.

  • Puberty blockers
  • Electrolysis
  • Hysterectomy/Salpingo-Oophorectomy
  • Breast augmentation
  • Breast reduction
  • Liposuction/sculpting
  • Scar/Skin graft care post gender affirming surgery
  • Hair transplant
  • Hair growth treatments
  • Treatment for conditions related to bottom surgery
    • Pelvic pain
    • Incontinence
    • Urethral stricture
    • Urethral fistula
    • Post-op infection
    • Dilation

TRANS SENSITIVE CARE

This category refers to all healthcare needs that are not related to medical transition. These are basic healthcare needs that may or may not interact with an aspect of medical transition. For these aspects of healthcare, being trans is not the reason for or the focus of treatment but is still an important aspect of the whole person and their experiences.

  • Diagnosis and management of chronic conditions
  • Cancer screening, diagnosis, treatment, and follow-up
  • Mental health support and psychiatric care
  • Disability related care
  • Fertility, pregnancy, birthing, postpartum, and lactation
  • Emergency care
  • Geriatric and end of life care
  • Stroke and traumatic brain injury
  • Addiction management
  • Physical Therapy and other rehabilitation services
  • Preventative healthcare and health promotion
  • etc

If you are a cis person, think of anything you have ever needed the health care system for, or anything any of your cis family and friends have needed the health care system for. Guess what? Trans people need that care too.

It is the responsibility of the health care professional to know whether any aspect of care within their scope of practice will interact with an aspect of medical transition. For example, drug interaction with HRT medications. Even if the care is irrelevant to any aspect of medical transition or their experiences as a trans person, they still need to be treated with respect, dignitiy, and compassion in order to receive the care they need and have a positive outcome related to that care.

Check out my post about how to be a trans inclusive health care professional and find other recommendations about how to be trans affirming in the related posts below. In the coming years, I will be working on guidelines for medical researchers on how to include trans people in clinical research.

Because really, trans people may be unique in many ways but they are also people with regular, every day health care needs who deserve to have equal access to appropriate, respectful care.

Note: Trans people are by no means the only group marginalized by the health care system. People with disabilities are often reduced to their disability. People with chronic pain are often labelled as drug seekers. People who are fat/obese are reduced to a BMI category or number on a scale. None of these types of stigma are acceptable. If you are a health care professional, I challenge you to learn more about the experiences of all of these marginalized groups (and others). But if you’re overwhelmed and need a place to start, you may as well start here, with trans inclusivity.

RELATED POSTS

Want to receive more information on trans inclusivity and gender related topics? Join my community! Receive new posts in your inbox so you don’t miss anything if you forget to check back. You can unsubscribe at any time.

Processing…
Success! You're on the list.

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.

RELATED POSTS

Receive new posts in your inbox!

Processing…
Success! You're on the list.

Reflections on Top Surgery, Part 2: 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, 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 booked my time off from work as well as flights for me and my spouse, Meaghan Ray.

Last Minute Researching

While I had been looking at post-op trans guys for a while, and reading their stories of heading into surgery, suddenly it was going to be me in that position! I refocused my searches on what other people had found useful after surgery.

While there weren’t a lot of medical sites with information regarding top surgery for trans people, there was loads of information for people recovering from breast cancer surgery. Some of it was not quite relevant (what to do while waiting for breast reconstruction), but a lot of the advice on recovering from a long incision across your chest was useful.

The things I found most useful were button down pyjamas and shirts, as well as a neck pillow. Other items that seemed like they would be helpful but then I didn’t use were dry shampoo, body/baby wipes, and stool softeners (though I REALLY wish I had).

Arriving In Toronto

Since we were staying with family, we arrived a few days before surgery for a visit. Similar to when I was travelling for archery competitions, arriving and settling into a new location a little early allowed me to start mentally progressing towards acceptance and excitement.

I did some journaling at the time to help get rid of all the bees buzzing around in my head. I knew that I was super excited for the surgery, but there was now also the return of the anxiety of wondering if I had made the right choice. Everything I did was the last time before having a flat chest, and it felt important to remember those things, mundane as a lot of them were. “This is the last time I’ll be flying with a round chest” “This is the last time going to a cafe with a round chest”. So journaling helped with clearing my head a bit and helping me feel less chaotic.

Pre-op Appointment

The day before surgery I attended the clinic to see where it was, meet the surgeon face to face, and ask any last questions. The staff were great with pronouns, and the clinic seemed modern and clean. However, my appointment time was more than 2 hours behind schedule, and no one bothered to let me know. The only good thing about that is my anxiety completely burned itself out, and was only left with mild annoyance.

Meeting the surgeon was good, he was very respectful but clearly he had his method of doing the surgery and didn’t seem to be interested in what my desires were (similar to the surgeon back home). Despite those nagging worries, I was happy with the pictures I had seen of his results, and I was far too excited for a flat chest to let that slow me down. We drove the 90 minutes back home and settled in for a long evening of no sleep.

Day Of Surgery

Due to my sleep apnea they moved by appointment up to first thing in the morning. Once we arrived I changed into a gown and had the two clinic surgeons as well as a visiting surgeon draw the anatomical lines that would make sure everything ended up straight and proportional. It was a little awkward but clinical (“this is the last time a stranger will see my female chest”).

Everything happened fast after that. They got an IV started and I was off to the surgery suite, and next thing I knew I was waking up crying inconsolably with a pressure on my chest. I don’t know why I was crying, just that I couldn’t stop.

The surgeon came by briefly, but otherwise I felt very alone and disoriented. I was discharged fairly soon afterwards, but with fumbles from the staff leaving me unattended to have a panic attack in the bathroom, and while discharging me out a back door with minimum instructions. This left the experience feeling less than excellent.

Eventually we got back into the car and Meaghan Ray drove us home. According to them, I was frighteningly pale and very nauseous the whole way home but I don’t remember much of that. I do remember the neck pillow came in handy to keep the seatbelt off my new incisions.

First Couple Post-op Days

I was firmly ensconced in the bedroom for several days. The pain was manageable with medications, though I was fairly drowsy so I slept lots and watched lots of movies in bed.

My main complaint was the post-op compression binder used to keep the bandages tight to the incisions. My surgery included liposuction along my armpits and sides to prevent the dog ears that the Edmonton surgeon had mentioned. While that would allow for a more masculine appearance, those areas were not as numb as the incisions and were very tender against the binder. Meaghan Ray helped to modify the binder so that it would be more comfortable. I was told I would need to wear it for 4 weeks! Guess I would need to continue to deal with a binder even though I no longer had breasts. Argh.

Post-op Reveal

The day before flying home, I had a post-op appointment at the clinic where they would remove all the bandages and tapes. There are many videos on YouTube of transmen seeing their new chest for the first time where they elatedly collapse in happy tears and emotion.

My appointment was not like that. I mostly felt relieved to be free of the bandages, continued tiredness from recovery and pain medication, and a touch of feeling surreal. Luckily Meaghan Ray was there to capture the moment and feel excited for me, even if I couldn’t stir up those feelings very well.

Again we fell through the cracks while waiting to be fully discharged. We waited a respectable amount of time, and another 15 minutes on top of that. We finally had to sneak out into the hall where someone finally went “oh, I didn’t know you guys were still here!”

Everyone else who had surgery with this surgeon had nothing but good things to say about their experiences with this clinic, so it appears my experience was an anomaly. I believe most of their private pay clients stay at the hotel adjacent to the clinic so perhaps they were thrown off by me staying 90 minutes away?

I was (and still am) very happy with my results, though the experience itself was far from ideal.

Up Next

Now I got to take my new flat chest back home! I couldn’t wait to finally experience that gender euphoria around my friends, family and colleagues, when they would stop misgendering me since I now had a flat chest! Right?

RELATED POSTS

Join our community! Receive new posts in your inbox so you don’t have to remember to check back! You can unsubscribe at any time so there’s no risk!

Processing…
Success! You're on the list.

How to Ask About Someone’s Gender

We always say that if you don’t know someone’s gender or pronouns, just ask. But how do you do that in a respectful way? As a stranger, we can use they/them pronouns and avoid gendered language for everyone we meet until they specify. But what if this is a new colleague or a friend of a friend? Or what if your partner or child just told you they are questioning their gender?

The closer you are to someone, the more impact your questions are going to have. You can ask questions to find out the basic information such as how they identify and what pronouns and name to use. Or you can ask deeper questions to get a better understanding of what their identity means to them, how they picture themself, and what their experience of gender is day to day. These deeper questions can help you form a more accurate mental image of the person as they see themself so that you are more likely to gender them correctly. They can also help the other person sort out some of their confusion around their gender (if need be).

THE BASICS

When asking questions about gender (or any other sensitive topic), I follow the principle of not asking any question I wouldn’t also be willing to answer. I also use the caveat that they never have to answer a question I ask, though I do appreciate knowing why they don’t want to answer so I avoid asking other questions that they don’t want to answer.

If you are ever uncomfortable about asking something, it’s a good bet the other person will have some discomfort in answering as well. Be honest about your discomfort but don’t let that stop you. Be aware of your surroundings and choose a place where both of you feel the most safe (likely a private space).

If you’re not sure how to phrase a question or what language to use, be honest about that too. Try to avoid saying ‘I don’t mean any disrespect, but…’. Instead, use a phrase like ‘I’m not sure how to word this question. Is it okay if I ask it anyway and you can tell me how I’m supposed to say it?’ Usually, there is a reason why a certain question is inappropriate. Either the word you chose is seen as offensive, how you used it was incorrect, or the subject matter isn’t appropriate to ask about. It is helpful if you can find out why the question was wrong so you avoid making the same mistake with other questions or in other circumstances.

Asking about basic information such as gender identity, pronouns, or name is pretty straightforward. Offer yours first, then ask. ‘Hi, I’m Wendy. I’m a cis woman and I use she/her pronouns. How do you identify and what pronouns do you use?’ Keep in mind that knowing how someone identifies isn’t usually necessary. Pronouns and name are enough to interact with them respectfully.

Always question yourself about why you want to know the information and what purpose it will serve for you. If you’re just curious, generally you should refrain from asking unless you have a close relationship with that person and you’re in a private space. But, if you feel that you do need to know more information, you’re going to need to know what questions to ask.

DEEPER QUESTIONS

As I said above, you can ask these more intense, specific, personal, and invasive questions to learn more about someone’s gender for your own understanding or to help them figure out their own gender. I have grouped these questions into categories to make it easier to follow. These are just examples – feel free to pick and choose from each list as needed rather than using every question. This list is by no means exhaustive.

Gender Identity

  • How do you identify with regards to gender at the moment?
  • Has your gender identity changed over time?
  • What labels do you use for your gender and how do you define them?
  • Does your gender always feel the same or does it fluctuate?
  • Does your gender influence your sexual orientation in any way?
  • Are you comfortable with your gender identity or is it a source of frustration?
  • Are you confident in your gender identity or do you still have some confusion?

Language

  • What pronouns feel best for you?
  • Do you always prefer those pronouns?
  • What name do you want me to use?
  • What other language feels best for you (guys, ladies, girl, ma’am, sir, bro, dude, etc)?
  • What familial terms feel best for you (sister/brother/sibling, son/daughter/child/offspring etc)?
  • Is there any way I can help you test out various names/pronouns/language?

Body Dysphoria and Euphoria

  • Are there parts of your body that feel wrong or bring discomfort?
  • Are there parts of your body that feel good?
  • How do you picture your body should look?
  • Do you do anything to make your body feel more authentic for yourself?
  • Do you do anything to modify how your body appears to others?
  • Are there specific ways you would like me to refer to or interact with certain parts of your body?
  • Is there any way I can help you test out various presentations?

Medical Transition

  • Are you planning to/have you already started hormones?
  • How do you feel about the idea of/changes from taking hormones?
  • Are there any challenges you are facing with accessing hormones?
  • Are you planning to/have you already have any gender affirming procedures/surgeries?
  • How do you feel about the idea of/changes from [procedure/surgery]?
  • Are there any challenges you are facing with getting [procedure/surgery] done?
  • Have you ever encountered transphobia in a medical setting?
  • Is there anything I can do to support you with accessing basic or trans-specific medical care?

Legal Transition

  • Are you planning to/have you already changed your legal name?
  • Are you planning to/have you already changed your gender marker?
  • What documents have you changed so far?
  • What institutions have you informed of this change?
  • What documents/institutions do you still need to change/inform?
  • Is there any way I can help you with making these changes or support you during this process?
  • If we are in a situation where I need to disclose your legal name/gender, what would you like me to say? (hospital, banking, insurance, police, etc)

Practical Concerns

  • Who are you out to?
  • How would you like me to refer to you around people you are out to?
  • How would you like me to refer to you around people you are not out to but who know you and who you also interact with?
  • How would you like me to refer to you around people you are not out to but who you have no interaction with?
  • Have you encountered any transphobia?
  • Is there anything I can do to provide support?
  • Is there anything I have been doing or saying that is uncomfortable? What would you like me to do/say instead?

I hope this list of suggested questions helps guide your discussions of gender with anyone you interact with. Remember to think about how you would answer these questions before asking them of someone else. These questions are designed to guide a discussion that would be a follow up to the basic learning I talked about in How to Be a Trans Ally so don’t forget to start there.

Let me know how your discussions about gender are going! Or, let me know if you have other questions that you have found helpful in your discussions and I will add them to the list above. Leave a comment on this post or send me an email! Looking forward to hearing from you.

RELATED POSTS

Receive new blog posts and podcast episodes in your inbox! You can unsubscribe at any time so why not?

Processing…
Success! You're on the list.

How to be a Trans Ally

ALLYSHIP 101

Being an ally for any minority takes more than being accepting of a friend or acquaintance from that identity. Not being a biggot is not the same thing as being an ally. Being an ally isn’t a perspective, a state of mind, or even a level of understanding. It requires ongoing action that at first can be a challenge but eventually becomes automatic.

As someone who is part of a majority group, it is not for you to say that you are an ally. If you take actions that show to members of the minority group that you are safe to be around, understanding, supportive, affirming, and uplifting, they will label you as an ally.

Being an ally takes work, requires an open mind, and most of all, a willingness to feel uncomfortable. At some point, someone from a minority group will tell you that what you’re doing isn’t helping or may actually be causing more harm than good. Being an ally means listening to this perspective, asking questions to understand it further and what you can do differently, then acting on what you’ve learned.

Being an ally for one minority does not mean you are an ally for all minorities or even all the identities encompassed by that minority. Being an ally at one time does not guarantee you are an ally forever or in all circumstances.

But don’t let this discourage you! We need more allies!! Below are a number of ideas for what it means to be an ally to trans people. Please leave a comment below or get in touch with me if you have questions or other things to add to this list!

PRONOUNS

Put your pronouns in your email signature, your social media profiles, your video chat name, and on name tags. As a cis person, you likely have never had your pronouns questioned, never felt uncomfortable with the pronoun people assume you use, and never had to justify your use of that pronoun. Trans people have to do this every day or deal with the discomfort of being misgendered. So please, normalize the expression of pronouns by including yours.

Along the same lines, when you are introducing yourself to someone (anyone, not just someone you guess or know to be trans), introduce yourself with your pronouns. “Hi, my name is _____ and I use ______ pronouns.” You may get some funny looks or confusion from cis people who are not trans aware and you may feel awkward the first few times but just like anything else, it gets easier with practice. If you give up the first time it is uncomfortable, you really aren’t understanding how uncomfortable, scary, and often painful it is for trans people to be in a similar situation. And they don’t have the choice to just walk away, pretend it doesn’t exist, or avoid the discomfort.

Learn how to use a variety of pronouns. No, she/her and he/him are not the only singular pronouns out there. They/them is fairly common. There are also neopronouns such as per, xir or zir, and aer. Learn how these pronouns sound, how to use them in a sentence, how to switch between different pronouns, how to use pronouns that seem counter to your perception of someone’s gender, and how to avoid using pronouns altogether. Often, in English anyway, it is easy enough to rearrange a sentence to remove pronouns or substitute the person’s name.

KNOWLEDGE

Understand what it means to be trans. Understand the difference between sex, gender, sexual orientation, and gender presentation. Learn about some of the various identities that fall under the trans umbrella. Learn about the different steps someone might take to transition. You don’t need to know all the ins and outs of all the medical procedures or medication options (unless you are a healthcare worker and this is relevant to your field) but a general understanding is required.

Understand some of the challenges faced by the trans community in your area. This may be systemic barriers such as access to medications and medical procedures, cost of changing ID, wait times for medical procedures and documentation changes, lack of inclusive forms at medical clinics, banks, and workplaces, and difficulty accessing employment and housing. Or it could be interpersonal barriers due to transphobia that increase the risk of physical and emotional harm. Or personal challenges such as dysphoria, lack of social support, or struggles with mental health or addictions.

Some of this knowledge can be gained through online resources (such as this blog) but you will also have to engage with your local trans support networks and advocacy organizations. You may be tempted to simply ask your trans friend a slew of questions to learn about all these things. DO NOT do this. Trans people have to educate almost everyone they come in contact with. As an ally, you do not want to be another one of those people. If you have looked up everything you can online and joined the mail lists of your local organizations to learn more and still have some specific or personal questions to clarify a couple things, ask your friend if it’s okay with them if you ask them and when a good time would be. They are not obligated to answer. If you see this refusal as a lack of their friendship you really don’t understand what it means to be trans.

CHECK YOUR ASSUMPTIONS

Avoid making assumptions about someone’s gender based on their sex, presentation, physical characteristics, or mannerisms. Keep your language neutral by referring to everyone using they/them pronouns and neutral language until they have disclosed their gender to you. Yes, everyone. Not just people who fall outside the ‘norm’ of gender presentation or someone you think might be trans. You can’t tell someone’s gender from the outside. Being an ally means creating a safe place for trans people that you haven’t met yet. The only way to do that is to consider that anyone could be trans and act accordingly.

Once you learn someone’s gender, don’t make an assumption about what pronouns they use, what steps they have taken or plan to take in terms of transitioning, or what their experiences are with dysphoria. Every trans person’s identity, journey, and experience is different. You don’t have to understand all the different possible experiences to be an ally but you do have to keep an open mind and understand that there is no one way to be trans.

KNOW HOW TO ASK QUESTIONS

You may not be able to learn everything you want to without asking a trans person some questions. And if you’re not supposed to make assumptions about anyone’s gender, you may have to ask someone questions to learn more about their experiences. Knowing what questions to ask, how to ask them, and when/where it is appropriate to ask them is part of being an ally. This, too, takes practice.

The knowledge you have gained about terminology will help you with appropriate wording. Knowing what challenges trans people face will help you be aware of the context and choose an appropriate time and place. Beyond that, honesty is the best policy. If you’re not sure if the question is appropriate, or you’re not sure how to word it, make sure you’re in a safe and private environment before asking and then be honest about your lack of knowledge. Ask for feedback and be open to it when it’s given, solicited or not.

Keep in mind that just because one trans person was comfortable answering a particular question does not mean every trans person will be. Some people are open, some people are private. This is true for trans people as well.

ADVOCATE AND AUGMENT!

As an ally, your main roles are to set a good example for other cis people and to create a safe environment for trans people. This means correcting yourself when you make a mistake with pronouns or other gender references and correcting those around you if they misgender someone (regardless of whether the person is present or not). If you’re not sure whether the trans person wants you to correct other people on their behalf, ask them!

If someone asks you to speak about trans experiences and issues or asks you to review a policy or resource to ensure it is trans inclusive, defer to a trans person, especially if it is a paying opportunity. It is not your job to speak for trans people but to give trans people the support, space, and opportunity they need to speak for themselves. You can also share social media posts from trans accounts and spread news stories that talk about trans people in positive ways.

On a smaller scale, you can offer to be a buddy for a trans person in your life, especially if they have limited social supports. Whether it’s going to the public washroom with them for safety, going with them to medical appointments or registry offices for document changes, or being a caregiver after surgery, there are lots of ways you can help support a trans friend when other people who aren’t allies wouldn’t realize they would need extra support or when the trans person wouldn’t feel comfortable asking for support from non-allies.

I hope this helps give you some ideas of how to be a trans ally. If you are a trans person, feel free to share this with people in your life. We need more allies! Please leave a comment below if you have any questions or if you have suggestions for other ways to be a good ally.

RELATED POSTS

Receive new posts in your inbox!

Processing…
Success! You're on the list.

Let’s Talk Gender S2E8: Nonbinary Pregnancy and Parenting

Podcast: Play in new window | Download

Hi everyone. Welcome back to Let’s Talk Gender.

This episode is about pregnancy and parenting as a nonbinary person including navigating the incredibly gendered world of fertility and pregnancy, the physical experience of being pregnant, and my thoughts as I look ahead to parenting.

FERTILITY AND TRYING TO CONCEIVE

Over the course of four years, my husband and I tried as many methods of getting pregnant as we could access. This included home insemination, known donor, IUI, and eventually IVF. I have heard many stories from folks who have gotten pregnant after only a couple tries of these earlier methods but, for no discernible medical reason, this was not the case for us. 

The IUI (intrauterine insemination) trials were done at a fertility clinic. Their language was generally inclusive of gay couples (referring to the partner as ‘partner’ instead of husband) but all the references to patient were female. We also ran into a few situations where, once my partner was identified as a man, people were confused as to why we were using donor sperm. Most notably, the psychologist we had to see to get the go-ahead to use donor sperm (which seemed strange to begin with) wanted to talk about if there was any guilt or shame on my husband’s part about not being able to provide viable sperm and when he stated he was trans she became very interested and curious, wanting to ask a bunch of irrelevant questions about his transness, and nearly derailed the appointment multiple times. You can bet I provided feedback about that encounter. 

The fertility clinic itself also did not have a gender neutral bathroom option and I had to empty my bladder immediately before each procedure. So that was fun. I did end up finding a single use bathroom in one of the medical areas during the IVF but it required a staff member to use a swipe card to get there so not actually for public use. 

I never came out to the fertility clinic, doctor, or nurses as nonbinary. With all the emotional ups and downs of trying to conceive, I didn’t have enough energy to educate or correct any misgendering that would happen afterwards. It was easier to let them assume I was female and deal with the dysphoria as best I could. 

Honestly, I didn’t find the IUI attempts to be that difficult. The procedures were fast with just me and Jake and a nurse in the suite, no high tech stuff. And it was only one procedure every two months. We decided early on that we needed to take a month off between trials to reset and breathe emotionally. Otherwise we would be required to order the next round of donor sperm before finding out if the previous trial had worked which felt a bit like having bad karma by assuming it wouldn’t. 

The IVF process was much more invasive and dysphoria inducing at times. They had to do an internal ultrasound as a baseline, after one week, and then every other day or every day thereafter for about five more visits before the actual procedure was scheduled. The ultrasound wand is much bigger than an insemination catheter and they had to move it around and dig it in to get good images of both ovaries. If my gender happened to be more female aligned on that day, this was mostly just physically uncomfortable. But there were a couple times when my gender was particularly male aligned and let me tell you, the dysphoria during the procedures on those days was a hell of a lot more uncomfortable than the physical part. I think I death gripped my husband’s hand to keep from crying at one point. Oh, and did I mention that these all had to take place first thing in the morning before I went to work? Where I’m also not out to most people and have a decent amount of dysphoria? Those were not good days. But hey, at the time of this recording I am 37 weeks pregnant and by the time this airs we will hopefully have been parents for a couple months so as far as I’m concerned, it was all worth it. 

PREGNANCY, MISCARRIAGE, AND GENDER

Being pregnant comes with its own slew of gendery things. One of those IUI attempts actually did work though it turned out that the egg that was inseminated was empty. I didn’t know this was something that could happen but apparently it’s very common. Usually these types of pregnancies end in miscarriage before the person even knows they’re pregnant. But my body was so ready to be pregnant it did a really good job of implantation and building a gestational sac despite the fact that nothing was growing inside it. So I experienced all the symptoms of early pregnancy until 10 weeks. 

During this first pregnancy, my gender shifted early on to the far end of my female range (which is still only about halfway from neutral) and stayed there. At first I was grateful. I had so much less dysphoria, both social and physical, and without the gender shifts I didn’t have to pay attention to my gender as much or worry about dysphoria taking me by surprise. But after a few weeks I started to feel like a part of myself, that I had only recently gotten to know, was missing. The male half of me that I knew was still there felt like a ghost, something I couldn’t quite touch, feel, or embody. The times I was interacting with queer friends who knew me as Ray felt dysphoric in a way they hadn’t before. I didn’t feel like Ray at all. It was very strange and disconcerting. 

After the miscarriage I was worried that my gender would suddenly shift to the male side and I would be swamped with dysphoria. But the hormonal confusion that I went through either masked that or overrode it completely. By the time my hormones stabilized and I felt more like myself, my gender was back to normal, feeling mostly neutral with a gentle fluctuation to either side. Still, it took some conscious work to re-learn how to use my dysphoria management strategies that I had developed before this weird female pregnancy experience. 

PREGNANCY (AGAIN)

Then I got pregnant again, after the IVF procedure. I was expecting a similar experience and had tried to think of strategies I could use to help with that ghostly feeling of losing contact with my male side for nine months. But as it turned out, my gender has stayed pretty consistently neutral. If anything, the only change is that it fluctuates less, if at all. 

This means that I have experienced dysphoria with this pregnancy. In the first trimester, before many people knew I was pregnant, it was mostly chest dysphoria as my breasts increased by multiple cup sizes. My chest was too sore to be able to wear a binder right from the beginning. I did use tape a couple times but even that was uncomfortable.

In the second trimester, the breast growth slowed down but my binder no longer fit. Once we announced the pregnancy I was slammed with social dysphoria as everyone started using more female language for me and asking about the gender of the baby. I continued to struggle with chest dysphoria until my belly started to grow. As my belly got bigger, my chest looked and felt smaller and smaller in comparison. In the third trimester, my belly was big enough that most regular t-shirts created a tenting effect that nearly completely hid my chest. I’m sure it looks funny to other people but it feels great to me. 

Throughout the pregnancy process I have been trying to consume as much information as I can about pregnancy, birth, and baby care though apps, websites, books, podcasts, and medical care providers. The majority of this information is female centric. The pregnant person is always referred to as mom or mom-to-be, is always assumed to be a woman, and dysphoria is never mentioned as one of the potential symptoms of being pregnant. 

We were lucky enough to find a midwife team in our area that is LGBT inclusive who we were upfront with about both my husband being trans and me being nonbinary from the start. This was hugely helpful for me. I don’t have to brace myself to go to every pregnancy related appointment like I had to during the fertility/trying to conceive process. If you are trans or nonbinary and trying to get pregnant, I highly recommend finding a trans inclusive care provider if you can. If none exist in your area or you don’t have a choice of who you go to, I recommend finding a trans inclusive doula to add to your support team who will advocate on your behalf throughout the process. You will have enough to deal with without having to do all the advocacy and education related to your gender identity on your own. 

At some point mid-pregnancy, I had an aha moment based on something someone posted on one of the facebook groups I’m in. They explained how they had re–framed their pregnancy as a nonbinary experience in a nonbinary body because they identify as nonbinary. When it was put like that, it seemed so simple. Of course if I identify as nonbinary, my body is a nonbinary body, and anything it can do, including getting pregnant and growing a baby, is a nonbinary experience. This mantra has helped a lot on days when my social dysphoria is getting the better of me or when I am trying to consume information that is highly gendered. 

INCLUSIVE TERMINOLOGY MATTERS

I have been able to find some resources that are trans inclusive. The Birth Partner, 5th edition is the best one. I included links to trans doula practices that also provide inclusive resources in Related Posts and Resources at the end of the show notes. 

The prenatal classes we attended were advertised as being LGBT inclusive and did a good job of being LGB inclusive, referring to partners instead of husbands, but they didn’t have much awareness of the trans component. They didn’t introduce themselves with their pronouns, so naturally I didn’t either. They almost exclusively referred to the birthing person as a woman or mom using female language. And when they were talking about feeding the baby they only ever talked about breastfeeding and used that terminology.

Particularly during the class on feeding, I had so much dysphoria that I became claustrophobic and had to pace in order to be able to stay in the room to get the information I needed. One of the perks of being in a pandemic was that these classes were all run over Zoom so I was able to be off screen and still listen in. Otherwise I probably would have had to speak up or leave the class entirely. I also provided the instructors of this class feedback (a couple weeks later once my dysphoria had calmed down) which was well received. 

When I’m trying to absorb information that will likely be helpful in navigating pregnancy, birth, or postpartum and caring for the baby and the information is presented in a gendered way that triggers my dysphoria, it’s very hard to tell if I am dysphoric because I just happen to be feeling more male and have more dysphoria that day, if the language used in the resource is triggering dysphoria that otherwise wouldn’t be there, or if the situation I am learning about will be dysphoria inducing when I’m experiencing it and I should prepare for that. This is why inclusive language is so important. 

If I feel dysphoric when picturing myself in a situation as I read an inclusive resource, it seems much more likely that I might struggle with that experience when the time comes. Since that very uncomfortable prenatal class, I have re-read the section on chestfeeding in The Birth Partner and watched videos by trans doulas on chest and body feeding and the dysphoria I feel when picturing myself doing this has decreased significantly. After this episode airs I will write an update on my blog and let you know how it’s going in real life. 

After the experience with the prenatal class and comparing it to reading The Birth Partner, I wrote a blog post with a list of inclusive pregnancy, birthing, and feeding terminology. This includes using gestating or pregnant person instead of mom, birthing person instead of woman, and chest or body feeding in addition to breastfeeding.

NONBINARY PARENTING

Of course the pregnancy journey doesn’t just stop relating to gender after the baby is born. It turns into a parenting journey. As I am not quite yet a parent, I can only speak to what I have been wondering about and talking to others about in preparation for this next step. 

First of all, there’s what the baby will call me. There are lots of nonbinary parental terms that people use and lots of nonbinary parents that are comfortable with either mom or dad. I honestly don’t know where I will go with this yet. I feel ok with mom but less ok with mommy or momma. I’m considering the name Mur based on my initials M.R. Or there’s something different like Ren or Renny from paRENt, or Mapa which seems highly accurate to my experience but doesn’t have any particular emotional connection for me. I guess we’ll see what sticks once we test them out. 

Then there’s deciding whether to gender your child based on their assumed sex or whether to raise them as gender neutral until or unless they specify otherwise. We have decided to gender our child but raise them in a gender inclusive, gender expansive way. For me, fighting for our child to be recognized as nonbinary when it is likely that they will identify as cis is not worth the effort and would be extremely dysphoria inducing for myself. We will of course be open about our own identities with our child and ask them often about their identity and adjust our use of language as often as they wish. 

This brings up another point. If we are open about our identities with our child, that necessitates being open with anyone the child interacts with – family, medical systems, school systems, playgroups. My husband is fairly open about being trans so this won’t be a huge shift for him. But I have only just started coming out to co-workers and family so this will likely be a steep coming out curve for me. I guess that is a pretty solid way of shifting the ‘need’ factor up in the coming out equation I talked about in Episode 5. 

And lastly, I have heard from many nonbinary parents that the world of parenting is, if possible, even more forcibly gendered than the world of fertility and pregnancy. I’m sure that is something you learn to deal with as it happens. But it’s probably good to have low expectations in order to be prepared and maybe occasionally pleasantly surprised instead of constantly irritated and defensive. 

REACH OUT!

If you are struggling through the process of trying to conceive, currently pregnant, or a nonbinary parent and want to reach out, please email me at letstalkgenderpodcast@gmail.com. You are not alone. 

That’s it for Season 2 of Let’s Talk Gender.

The music for this podcast is by Jamie Price. You can find them at Must Be Tuesday or on iTunes. 

As this season is airing, I will hopefully be at home with my husband and newborn baby, learning what it means to be a parent. If you subscribe to my blog, you will continue to get regular updates on our parenting journey and how it relates to gender as well as any other gender related thoughts and experiences such as updates on coming out as nonbinary or any medical or legal transition steps I take in the future. 

I hope you have found this podcast helpful. Please reach out by commenting below or emailing me at letstalkgenderpodcast@gmail.com. I’d love to hear your reactions, thoughts, experiences, and suggestions for future seasons.

Bye for now. 

RELATED POSTS AND RESOURCES

Receive new podcast episodes, show notes, and blog posts in your inbox! You can unsubscribe at any time.

Processing…
Success! You're on the list.

Let’s Talk Gender S2E5: Coming Out as Nonbinary

Podcast: Play in new window | Download

Hi everyone. Welcome back to Let’s Talk Gender.

This episode is about coming out as nonbinary, why it is so darn hard, how to figure out whether it’s the right time and place to do it (again), and how to respond to inappropriate questions and ignorance. 

TO COME OUT OR NOT TO COME OUT…

I look at coming out as an equation between pros and cons. On the pro side, I have need and benefit. How much do I need to come out? This often comes down to how much I’m struggling with not being out. As someone who is somewhat genderfluid and about 50% of the time is comfortable being identified as female, most of the time my need to come out is pretty low. If I’ve been experiencing a lot of dysphoria or been through a triggering situation, the need definitely goes up. 

How much will coming out benefit me? And how likely am I to receive those benefits? The benefit to me of everyone I come out to accepting me 100% as a nonbinary person is very high but the likelihood of that happening is very low, much lower than for binary trans people. This is simply due to society’s reliance on the gender binary and the lack of understanding of nonbinary identities. 

On the con side, there’s cost and risk. What is the emotional cost required to receive the benefit? I.e. how much emotional labour will I have to do to get someone to the point where they understand my identity or at least understand how to be supportive and are consistently following through on that? This varies but is generally on the high end. Also included in cost is the emotional cost of being misgendered. In mine and my husband’s experience, being misgendered by someone you have come out to hurts a lot more than being misgendered by someone you haven’t come out to yet. And if it’s going to be a struggle for people to understand my identity and gender me correctly, I am likely to get misgendered more often than correctly gendered. So this definitely puts the cost at the high end. 

I think of risk as what I might lose by coming out. Is there a risk to my physical wellbeing either due to safety or stability (job, housing, etc) by coming out? In my case, I have a lot of privilege and support in this area and have very low risk to my safety and security. 

So if the need and benefit of coming out are both low and the cost is high, why have I come out to anyone? Well, certain things can shift this equation in favour of coming out. As I said, the need goes up when I’m having a particularly difficult day, a longer period of more intense dysphoria, or experience a triggering situation. The cost can also go down significantly if I am talking to someone who is queer, someone who openly expresses awareness of trans issues or, even better, nonbinary identities and pronouns, or if I am in a position of power in relation to the person or people I am coming out to. 

The longer I have identified as nonbinary and the more times I’ve come out to people, the better I get at recognizing these low cost situations and capitalizing on them or the higher need situations and making sure I get the support I need without traumatizing myself further by having a high cost conversation with someone just based on proximity. 

COMING OUT CONSIDERATIONS

So what are some of the things you should think about when you’re deciding to come out to someone?

The first thing should be safety. This includes both emotional and physical safety. What views has the person expressed? How much risk is there to your wellbeing if the conversation isn’t received well? Coming out is always a scary process. I don’t think I have ever come out as nonbinary to someone without at least a small amount of fear. So it definitely can be a challenge to figure out if this fear is your natural anxiety about doing something big or if there is a legitimate risk to your safety. Take precautions, have a back up plan in case it doesn’t go well, find outside sources of support and stability as much as possible, and trust your gut. 

The next thing to do is figure out what your expectations are. What outcome are you expecting from this particular coming out conversation? How much might you lose? How hard to you think the conversation (or conversations) will be? This will help you figure out if it’s worth the cost. 

And lastly, consider the context. Who are you coming out to? If they are someone that is very close to you and has a high impact on your safety and stability, the emotional cost and risk will be higher, but also so will the need and benefit. Are they likely to talk to anyone else, either because they tend to spread news or because they will need to have someone to discuss it with in order to process? Are you ok with that or is this something you want to explicitly discuss during the conversation? Who else is around you at the time you are having this conversation? Are there others that might overhear who you don’t want to be coming out to, or who you would like to overhear so they know without you having to explicitly tell them? What medium are you using to come out? Up until now I have discussed it as though it is a face to face conversation but this doesn’t have to be the case. Both my husband and I have found a written format, usually via email, to be the easiest. But that only works for the planned, thought about in advance type of coming out conversations, not the ones where you capitalize on a low cost or high need situation. And lastly, consider your ability to care for yourself in that context. Will you have time alone soon after? Will you have access to your most effective self-care tools or support networks? How can you adjust the context so you do have access to those things?

This can seem like a lot of questions to ask yourself in a split second between someone calling you by a binary term and you deciding to correct them or not. But some of these questions will be more important to you than others. Some of them are make or break. Those are the ones you want to focus on. 

EXPLAINING YOUR IDENTITY TO CIS PEOPLE

So let’s say the equation tips in favour of coming out. Coming out as nonbinary, or any queer identity for that matter, requires using language that is not necessarily understood in the same way or understood at all by the person you are coming out to. When we find labels that work for us, they help us understand ourselves and often help us connect with others who share our experiences. But when we are going to use them as a communication tool such as in the coming out process, we have to remember that words are used to represent abstract concepts and not everyone has the same understanding of those concepts as we do. 

There are lots of aspects of queer identity and culture that are not understood, or misunderstood, by mainstream culture. This is because the majority of exposure to queer culture is via the media which is notorious for picking stories that are sensational, that are the most shocking or the most palatable to the mainstream, and that are the most visible or common. This leaves many queer experiences misinterpreted or not represented at all. So when we use language that connects to concepts built by the media, it can take a lot of energy to counteract those concepts in order for the person we are trying to come out to to accurately understand our experience and identity. 

This knowledge gap can be very frustrating and can often take you by surprise. What do you mean you’ve never heard the term nonbinary? What do you mean you’ve never heard of anyone using they/them pronouns? When we have been so immersed in this world and information as we try to figure ourselves out, it can be a shock to realize how far behind everyone else is. 

When you are coming out, you can ignore this knowledge gap and expect people to look up the terms you used that they don’t understand (and even provide them resources) but what if they don’t even understand that it is important enough an issue that they need to do this work? If you can find a key person or two in each group of people you are coming out to (family, co-workers, friends) and spend the time and energy to bring them up to speed, they can hopefully then help bring others along or at least be a good example of how to refer to you. 

The first step to bringing someone up to speed is noticing when there is a knowledge gap and identifying how big it is. If they have looks of confusion or ask vague awkward questions like ‘So when did this start’ or ‘Why are you telling me all this’ or even ‘What, what do you mean, nonbinary,’ these are good indicators that they do not have the background knowledge required to understand what you are telling them. 

The next step is to connect the dots. I tend to use a working backwards approach. If they’re confused about nonbinary, I suggest that gender isn’t just male and female. If they relate my gender to my body, I talk about gender and sex being separate concepts. If they want to know my life history and make everything about gender or are looking for some kind of trigger, I talk about identity as an ever evolving thing that was there from the start even if I didn’t have the words to understand or express it. If they have a strong, especially negative, reaction to a label I use, I ask them what comes to mind when they hear that label. If it’s a new label to them, they might just not like the feeling of being confused. Or, they may have a bad or incorrect association with it from media representation that I would then have to correct or find a different label to use (which is why I like knowing a few different ones that work for me). From there, I work my way back up to the understanding of my identity that I wanted them to have in the first place. 

The last step is to leave them with a clear takeaway message. For me, this is usually a combination of ‘You don’t have to fully understand my identity in order to support me’ and ‘I would like you to avoid female gendered language and use these terms and they/them pronouns instead’ or whatever my expectations are for that individual or group. Check out the post on bridging the gap between mainstream and queer and trans culture for more tips and useful phrases.

EXPLAINING DYSPHORIA TO CIS PEOPLE

Another aspect of coming out is often having to explain why you don’t feel like the gender you were assigned at birth. Typically this includes a description of the types of dysphoria you feel. Most cis people don’t know about the concept of dysphoria let alone understand what it feels like. So I find it helpful to relate it to something they might have experienced. Some of the phrases I’ve used include wearing an ill fitting piece of clothing that you can’t take off, having pins and needles that range from annoying to distracting to painful that you can’t do anything about, or not recognizing yourself when you look in the mirror. 

Even more important than explaining what dysphoria feels like is explaining what the impact is on you. For this, I describe how exhausting it can be to have part of your mental and emotional space taken up by the effort to ignore those sensations of pins and needles, or how it feels like being pinched every time you’re misgendered by someone who doesn’t know any better (someone you’re not out to) and punched when you’re misgendered by someone you are out to, or how you feel like the parts of you that feel comfortable are invisible and the parts everyone can see are the ones that feel wrong. 

I hope you find these phrases helpful in your coming out process. 

THEY/THEM PRONOUNS

If you are someone who uses they/them or neopronouns and will be asking people you come out to to adopt these pronouns, these conversations are all about shifting the other person’s mental image of you. This takes practice and most people have never had to do this until someone they know comes out as trans. So naturally, the more clarity you can give them on who you are, why your old identity doesn’t fit, and why the identity you are telling them about feels authentic and important to you, the easier time they will have in adopting the pronouns and name you are asking them to use. Take a listen to Season 2 Episode 4 for more ideas on names, pronouns, and other gendered language. 

EXPLAINING FLUID GENDER IDENTITIES

If you are someone who has a fluid gender identity, coming out often requires an explanation of your total gender experience and a shorter version of how you feel in the moment and how you want to be referred to that you would repeat at each interaction or when your gender has shifted. I’ll talk more about this in Episode 6. 

KNOWING YOUR BOUNDARIES

As you will have noticed from what I’ve talked about so far, and likely experienced yourself, coming out involves a lot of educating others. Often, especially at the beginning of this process (that goes on for the rest of our lives), we engage in conversations that are more exhausting than they are worth or reveal more personal information than was necessary for that individual or situation. In short, we cross our personal boundaries before we realize. 

People will ask invasive and inappropriate questions without knowing that’s what they’re doing. And sometimes, you will answer them without realizing that you don’t owe them that information. This can make you feel exposed, defensive, or antagonistic either in response to the question or at the next encounter with this person. This has definitely happened to me and is never a good place to be. The other person may be surprised when your demeanor suddenly changes or may become antagonistic themself. The relationship that you valued enough to want to come out can become a source of pain or even a safety risk. 

So how do you figure out where your boundaries are before you or someone else crosses them by accident? Here are a few questions you can ask yourself that might help. 

With regards to general information, are you comfortable…

  • Disclosing your birth name?
  • Explaining why you prefer the pronouns you use?
  • Talking about your experiences of dysphoria?
  • Talking about specific strategies you use to change your appearance  or presentation (binding, packing, tucking, padding, etc)?
  • Talking about how supportive your family, significant other, or other people in your life are?
  • Talking about what support groups you attend/are a part of?
  • Talking about wait times, difficulties finding a trans friendly family doctor, and other systemic barriers?

With regards to medical and legal information, are you comfortable…

  • Talking about medication you are on related to transitioning?
  • Talking about changes you are experiencing as a result of these medications?
  • Disclosing what surgeries/surgery you are interested in having/have had?
  • Talking about legal documentation changes?
  • Discussing transphobic policies and politics?

Answering yes or no to each of these questions is a good start. You may want to do this a few times based on who you are talking to or what context you are in. For example, you may answer differently if you are talking to a co-worker, a close family member, a trans person, or your medical doctor. 

So what if someone asks about one of those things that you aren’t comfortable disclosing that information but you don’t want to discourage them or shut down the conversation completely? Here are a few different options. 

Try explaining why that’s not something that is appropriate to ask or why this is not an appropriate context to ask it in. This response still provides education and helps them be better informed and a better ally and keeps a positive relationship and rapport between you but without crossing your personal boundaries. 

Have resources ready to recommend so they can look up general information on the topic they are asking about. Usually acquaintances, co-workers, or friends are asking you specifically because you are the first trans or nonbinary person they have been exposed to and you happen to be there when the question occurs to them. They don’t necessarily want to know your specific story even if that’s how they phrase the question.

Challenge them based on the phrasing of the question. If they ask ‘Are you having the surgery?’ you can respond ‘What surgery?’ If they can’t answer with a more specific informed question, they don’t deserve your personal response. 

Provide a general response instead of a personal one regardless of how they ask the question. For example ‘I’m not comfortable answering that for myself but from what I’ve heard from other trans people, some do [example A for these reasons] and some do [example B for these reasons]’. 

Remember, hindsight is 20/20. There will definitely be times when you disclose more than you meant to or realize later that there was no reason why you had to answer their question. This can lead to a lot of guilt and regret about not standing up for yourself or protecting your privacy when you had the right to. Try to be kind to yourself. We’ve all done that and all you can do is learn as much as you can from others about how to have the conversations in advance and explore where your boundaries are before they are crossed. 

SEXUAL ORIENTATION AND GENDER

Another aspect of coming out in terms of gender is how it impacts your sexuality. When my husband came out at trans one of the most common questions I got was whether that made me straight. I haven’t gotten nearly as many questions about my sexuality when I have come out as nonbinary but I also haven’t come out to nearly as many people. However, I definitely questioned my own sexuality and how to describe it to others when I came out to myself as nonbinary. Also consider that coming out to your partner may cause them to question their own sexuality (which they may or may not feel prepared to do). I’ll talk more about all these intersections of gender and sexual orientation in Episode 6 as well. 

GUIDELINES FOR CIS PEOPLE

One of the other posts on my blog I recommend checking out is called How to Be Respectful Towards a Trans Person. This is a resource written for cis people as a guideline of how to respond when someone in their life comes out to them as trans. It has different sections depending on the nature of the relationship to the trans person. You can read through this yourself to get a better understanding of how people should and should not respond to you when you come out or you can include it in your resources that you recommend or give to people when you come out.

REACH OUT!

Coming out is an intense, scary, repetitive, exhausting, but often rewarding experience. If you are struggling with this process and want to reach out, you can email me at letstalkgenderpodcast@gmail.com. Remember, you are not alone. 

That’s it for Episode 5 of Season 2 of Let’s Talk Gender.

The music for this podcast is by Jamie Price. You can find them at Must Be Tuesday or on iTunes.

Coming up in Episode 6 I will be talking about some of the more complex aspects of being nonbinary such as genderfluid identities, how physical and social aspects of gender can feel at odds with each other, and how nonbinary genders interact with sexual orientation.

Talk to you soon.

RELATED POSTS

Receive new podcast episodes, show notes, and blog posts in your inbox! You can unsubscribe at any time.

Processing…
Success! You're on the list.

Non-binary and Pregnant (Again)

That’s right! I am in my second trimester of pregnancy!

HOW WE GOT HERE

After the miscarriage (see Pregnancy, Miscarriage, and Gender), we continued with IUI for two more cycles (taking a month off between each as before). When that didn’t work, we tried a medicated IUI cycle where I took a follicle stimulating drug. The goal was to force my body to produce and release multiple eggs.

The drugs gave me hot flashes, dizzy spells, racing heart, and decreased appetite. We decided that if this cycle didn’t work, we would take a longer break to build up some money and prepare for IVF. The two week wait was particularly intense and when it came back negative, it took extra time and energy to recover from.

IVF

We calculated that it would take about eight months to build up the money needed for IVF but with the help of both of our families, we were able to start much sooner.

The IVF process involved a lot of hormone injections, abdominal discomfort from enlarged ovaries, many internal ultrasounds, an egg harvesting procedure, daily embryo updates, and eventually an embryo implantation.

What with all the hormones in my system and the aching ovaries, I had no idea if I was pregnant or not until the blood test. Which came back positive!!

PREGNANT AGAIN

This time, we knew for sure that the egg had properly developing genetic material inside so we had already avoided the cause of my previous miscarriage. Over the next few weeks I slowly developed the typical first trimester symptoms – fatigue, nausea (luckily not too bad), and increased hunger and thirst. The aching in my ovaries slowly faded and resolved by about week six.

We had our first ultrasound at week 7. There it was, a little bean, floating in a pool in my womb. Better yet, there was a little fluttering spot in the bean that showed a heartbeat!

My pregnancy symptoms continued to worsen until week nine when the nausea suddenly disappeared. My appetite and thirst increased even more. Around week six I started to have increasing joint pain. I have chronic SI joint problems and low level body inflammation and often take naproxen to manage pain. It is a wonder drug for me but unfortunately, you can’t take naproxen or anything like it while pregnant. So, over time my SI pain has gotten worse and I have had to use a cane, wear an SI belt, and be careful what I do at work.

THE GENDERY STUFF

The IVF process had a lot of ups and downs with regards to gender. There were times when I felt like I fit right in and felt affirmed as a woman, in awe of what my body was doing. Then there were times when I felt very out of place, at odds and uncomfortable with being identified as a woman. At those times, using the women’s bathroom and signing many documents that identified me as a woman were particularly difficult.

I was forced to be aware of and interact with my ‘female parts’ in invasive and unavoidable ways. I had many transvaginal ultrasounds throughout the IVF process, one of which fell on a particularly dysphoric day, after which I immediately had to go to work, and took me hours to recover from. All procedures since then have been slightly more difficult regardless of dysphoria just because of the memory of that experience.

During the pregnancy so far I have been floating around the female side of neutral, much closer to the middle of my typical gender bandwidth than the last time I was pregnant (see Pregnancy, Miscarriage, and Gender). Is this because I have had more time to become comfortable and confident in my gender or because the hormone balance is different this time around? Who knows. Regardless, this means I have had more balance but slightly more dysphoria than last time.

LOOKING AHEAD

As I move into the second trimester and start to show more and tell people, I’m expecting my social dysphoria, and eventually my physical dysphoria, to get worse. Hopefully I’ll be able to manage this ok with the support that I have and a lessening of the first trimester fatigue.

I will try to post more frequent updates on how things are going and what being pregnant is like as a non-binary person.

If you or someone close to you is going through the IVF process and you would like more details on my experience or someone to talk to I am happy to share in a more private setting. Feel free to email me or leaving your contact info in the comments.

Receive new posts in your inbox!
Use the unsubscribe link in those emails to opt out at any time.

Processing…
Success! You're on the list.

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

RELATED POSTS

Join our community! Get new blog posts and podcast show notes directly to your inbox!

You can unsubscribe at any time but we hope that you stay!

Processing…
Success! You're on the list.

Podcast: Play in new window | Download

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!

RELATED POSTS

Join our community! Get new blog posts and podcast show notes directly to your inbox!

You can unsubscribe at any time but we hope that you stay!

Processing…
Success! You're on the list.

Podcast: Play in new window | Download