Tag: Physical Health

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.

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How to be a Trans Inclusive Health Care Professional

THIS IS IMPORTANT AND YOU CAN HELP!

Trans people experience a wide range of barriers to health care including overt discrimination, uninformed health care professionals, systemic discrimination, and personal biases. As a result, trans people frequently have negative experiences in health care settings and often avoid accessing health care services even when it is necessary. Ultimately, this leads to significant health disparity. This is compounded by having intersectional identities and experiences that also experience health care bias (fatness, racial minorities, disabilities, neurodivergence, sex workers, previous incarceration, current or past drug use, etc.)

Trans people have a significantly higher risk of suicide, especially youth. The single biggest protective factor against this increased risk is having supportive people in their life that respect their name and pronouns. That’s all it takes (though the more support the better of course).

So as a health care professional, what can you do to help? Here are some suggestions.

DON’T ASSUME

Don’t assume you know someone’s gender. Not based on their legal gender marker, their presentation, their body shape, their voice, their experiences, or the clinical service they are accessing. Trans men can be pregnant, birth, and body feed their children. Trans women can have a low voice. Nonbinary people come in all shapes, sizes, and presentations. Not every trans person is able to or cares to change their gender marker.

Don’t assume someone’s pronouns or the language they prefer based on their gender (or any of the other above information). People can use any pronoun regardless of their global gender identity. Pronoun preference can shift day to day, depending on context, or depending on the people they’re with. Other gendered terms are separate from pronouns. People can prefer seemingly conflicting terms (such as preferring Mx., sir, guy, sister, and Mom) and this is perfectly fine.

Don’t assume a trans person’s transition trajectory. Don’t assume every trans person wants to transition in any way, what components they will want to include in their transition, or what order or length of time they will take to access and engage with the options available to them. There are not only two pathways for transitioning. There is no set end point to transitioning. It is a highly variable and individual process that spans many many years if not the rest of their life.

So if you’re not supposed to assume any of these things, how do you find them out so you can interact respectfully and provide the appropriate care? You use neutral language for everyone (not just the people you suspect of being trans) until they specify or until you confirm by asking specific questions. Knowing what questions to ask and how to ask them in a specific and respectful way comes with practice. It is your choice whether you want to practice on your own time (via accessing formal training opportunities or informally interacting with trans people on a personal level) or over the course of your professional career.

RESPECT NAMES, PRONOUNS, AND GENDER IDENTITIES

You don’t have to understand every gender identity in order to respect them.

When you get someone’s name or pronouns wrong (which you will, we all slip up sometimes), correct yourself and move on. Do not apologize, especially not repeatedly or profusely. By apologizing, you are putting the focus on you and the mistake you made and forcing the trans person into the socially conventional role of either thanking you for the apology or excusing the original mistake, neither of which is acceptable.

Repeating what you said with the correct pronouns, name, or other language is necessary to cement the correct version in your brain. The more you de-emphasize the mistake and emphasize the correct version, the faster your brain will adapt and stop making mistakes in the first place.

If someone else corrects you, say ‘thank you’ (not ‘sorry’), repeat it correctly, and move on.

If people around you are making mistakes, make sure to correct them if you feel it is safe to do so. It is often easier to hear when other people make mistakes than when we do it ourselves. The more you correct someone else, the more you are emphasizing the correct version to yourself and others. You can correct others by interrupting them and stating the correct pronoun/name/language, by repeating what they said but using the correct pronoun/name/language, or by continuing on with the conversation, ensuring to use the correct pronoun/name/language with added emphasis.

This goes for documentation and patient records as well. Find a way to include preferred names, pronouns, and other important language in your patient demographics tracking system. Document using the patient’s preferred name and pronouns. If these don’t match their legal information, start with a note that states that you will be referring to [legal name] as [preferred name] and using [preferred pronouns] for the remainder of the patient’s chart. If you have to do this at the beginning of every chart note, then do it. It’s important.

IT IS YOUR JOB AS A PROFESSIONAL TO BE OR BECOME INFORMED

It is not your patient’s job to educate you on the basics of trans identities, trans health care, trans bodies, or how to respectfully interact with them.

It is your job to know what aspects of trans experiences and medical care relate to your scope of practice. If you are a medical doctor and do not understand that trans men do not need prostate exams and trans women do not need pap smears, you have a significant amount of learning to do to be considered a competent medical professional (for anyone, not just trans people).

‘I was never taught that in school’ is never a good reason not to know something. All regulated medical professions have an expectation of continued learning and keeping up with medical advances and new research. Would you prescribe someone the same medication now that you did twenty years ago even if it was no longer recommended and newer medications that are cheaper, more effective, and with fewer side effects had since been developed? No? Then don’t treat a trans person according to twenty year old ‘best practice’ guidelines. Those are no longer best practice. The world of trans care is changing rapidly. It is your job as a professional to stay up to date.

YOU DON’T NEED TO KNOW EVERYTHING TO BE A GOOD HEALTH CARE PROFESSIONAL

Even if you are doing your best to stay informed, there will be times when you’re not sure whether you’re missing something or whether their experiences as a trans person simply aren’t relevant. You don’t need to know everything. But…

You need to be willing to admit when you don’t know something.

You need to do the work to learn what you need to know when you identify a gap in your understanding or knowledge.

And you need to be able to find the information you need and assess whether the source is reputable, scientifically based, and whether it holds bias (hint: there is always some bias if it is a scientific source so it’s important to be aware of it).

TRUST THE PATIENT

Trans people’s experiences are incredibly nuanced, intersectional, and often very internal. You cannot judge what a trans person (or anyone, really) is struggling with internally by looking at them. Therefore, you cannot judge what care would be best without first understanding and accepting what they are telling you about their experiences, struggles, joys, and desires.

It is your patient’s job to be as honest with you as they think is safe and necessary in order access the care they need. Sometimes this involves misrepresenting their identity or hiding parts of their medical history. The more informed you are and the more respectful you are, the more likely your patient will trust you, the more honest they are likely to be with you, and the better the care you can provide.

Don’t question their lived experience because it is outside your area of experience or expectation. Trans people are not exaggerating when they describe the systemic barriers they face such as long wait times, repetitive updates and submissions of forms, lack of appropriate processes for changing legal documentation, etc. You can be shocked and disgusted that that is the way the system is but unless you have your own lived experience of navigating these barriers with a trans person and have found a way around or through them, you have no right to argue against them, suggest that they are doing something wrong, or simply haven’t tried hard enough.

TRANS PATIENTS ARE STILL PATIENTS

At the end of the day, trans patients are still patients. If you’re not sure how to proceed, draw on your clinical knowledge and treat the patient in front of you, not the trans patient you are assuming they are.

Don’t know whether the testosterone that a trans patient is taking may be relevant to the reason you are seeing them? Go back to the basics. What affects does testosterone have on a human body? What body systems might it affect? Are these relevant to your patient’s current concerns? You can follow a similar thought process for any component of trans experience or medical care.

If you think something might be relevant, explain your reasoning to the patient in terms they would understand and ask some clarifying questions. If you’re still not sure, make a note of it and move on to the next part of your assessment. Then, before you see the patient for their next visit, learn more about it.

As with any patient, consider the whole health of the patient, mental health included. If there is a component of their trans identity or trans specific medical care that you are worried is causing concern for other aspects of their health, consider ALL the consequences of interrupting that behaviour or medical care before making a recommendation.

Often, trans people have to compromise their physical health and wellbeing in order to protect or maintain their mental health and wellbeing enough to function in society. If you then suggest that they change their behaviour in order to protect or improve their physical health, that change could cause significant damage to their mental and emotional health (which is much harder to get help with and recover from). So, before making any recommendations, ensure that you understand the patient’s reasons for engaging in that behaviour or pursuing that avenue of medical care. You may not be seeing the big picture, or your version of the big picture might be different from your patient’s.

WHERE TO GO FROM HERE

I hope this has helped clarify a few things and point you in the right direction. Simply by reading this, you are already showing you are a better health professional to trans people than the majority. That is how low the bar is. Please help raise it.

Below you will find recommended resources. These are a place to start, not a sum total of what you need to know. If these links are outdated or broken, please let me know. I will try to keep it up to date. But again, if you are a health professional, you have the skills to find these resources on your own.

Beyond these links, how are you supposed to learn more about trans people (or other minority groups that differ from your experience)? Here are a few options:

  • Talk to a trusted friend or family member who is trans (or other minority) outside of a professional-patient relationship
  • Read descriptions of trans experiences written by trans people (such as this blog)
  • Attend a lecture or other learning opportunity presented by a trans person
  • Pay a trans person to provide education to you and your staff or assess your clinic/practice on the basis of trans inclusion

Reach out if you are struggling to find specific resources. If you are a trans person and would like to add suggestions to this post for how health professionals can be trans inclusive, please leave a comment!! The more experiences and voices the better.

REFERENCES AND RECOMMENDED RESOURCES

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How Dysphoria Contributes to Burnout and What You Can Do About It

WHAT IS BURNOUT?

I have struggled with cycles of burnout for many years now. For a long time I felt like I was making it up, or being lazy, or finding an excuse to avoid the mundane but challenging parts of everyday life. Very little of what I was feeling matched the symptoms of depression but that was the closest I felt like I could come. Until I heard about burnout.

When I’m in a state of burnout, the thought that keeps going through my mind is ‘I just don’t care’. I know I should, and usually do, but I can’t muster up the emotional energy to engage with almost all aspects of life. This is not me. In this state, I don’t feel like myself. And because I don’t have the energy to care, it is very hard to make myself do the things that will help me get out of the state of burnout.

I feel numb, heavy, and drawn to escapism. It feels like the world is happening around me and I’m just going through the motions. I don’t keep up with house chores, I eat less and more poorly, I socialize less, I exercise less (usually not at all), I am often late, and my productivity at work decreases.

If this sounds like you or someone you know, I highly recommend the book ‘Burnout’ by Emily and Amelia Nagoski. Not all of it resonated with me but the parts that did have been very helpful by giving me language to discuss my experiences of burnout with others, different ways of thinking about and noticing how I’m functioning, and practical strategies to prevent and recover from burnout.

HOW DYSPHORIA CONTRIBUTES TO BURNOUT

I have found that dysphoria is a large contributor to my burnout. There are three reasons for this:

  1. It takes a lot of mental effort to ignore the buzz of dysphoria in order to focus on what I’m supposed to be doing. It takes mental effort to check in with myself, identify what aspects of dysphoria I’m feeling, and use appropriate management strategies. It takes mental effort to identify and avoid situations that trigger my dysphoria (as much as possible). And it takes mental effort to reframe the dysphoria or fight it’s effects by using positive self talk and affirmation. So yah, lots of mental effort.
  2. Dysphoria is constant. It goes up and down depending on the day, my emotional state, my physical state, who I’m around, and what situation I’m in, but even at it’s lowest it’s still there. So lots of constant mental effort.
  3. Generally, there is a lack of understanding from others about what dysphoria is and how it affects me (or how it can affect people). The situations where my dysphoria is triggered the most and which are unavoidable are also the situations where I’m surrounded by and interacting with people who do not understand dysphoria. So lots of constant mental effort that is invisible to or misunderstood by the people around me.

WHAT BURNOUT FROM DYSPHORIA FEELS LIKE

For me, certain symptoms of burnout are specific to dysphoria. Three main ones are:

  1. Decreased attention/focus. So much of my attention is taken up by ignoring, managing, avoiding, and fighting the effects of dysphoria that I have less mental space to spend on other things. It is harder to stay on task, perform multiple step activities without getting derailed, maintain momentum on a task, block out distractions, and remember details.
  2. Irritability/easily frustrated. Dysphoria is an internal irritant that is constant and unavoidable. No matter how good I am at managing it, it will never be zero. So I already have a baseline irritation that I am working to ignore. That means that I have less patience for other sources of irritation. Less patience leads to more frustration. The more dysphoria I have, the more easily frustrated and irritable I am.
  3. Physical, mental, and emotional fatigue. The constant mental effort I talked about above is exhausting. The feeling of being misunderstood and invisible and at odds with myself or how people see me is emotionally exhausting. We feel our emotions in our bodies so I end up with a feeling of heaviness and lethargy that means I don’t feel like I have the physical energy to exercise or do any extra tasks (even though that is what would often help me the most).

WHAT YOU CAN DO ABOUT IT

Over the last few years I have developed a number of different strategies to help manage my burnout. After reading the book I recommended above, I have some more language to explain it and some practical strategies to suggest.

Prevention

Identify the sources of dysphoria for you. Develop strategies to decrease as much of the dysphoria as you can (more posts on this in the Related Posts list below). Where possible, avoid situations that trigger high amounts of dysphoria or repetitive situations that trigger even small amounts of dysphoria (such as getting dressed in a room that doesn’t have a mirror).

As much as possible, make these dysphoria prevention, management, and avoidance strategies automatic. Restructure your environment, schedule, or routine so that you don’t have to spend mental energy on remembering to do things in a different way. The goal is to decrease your baseline mental workload, not increase it.

Protection

In psychology they talk about protective experiences that may be completely unrelated to the harmful experience but help build resilience and emotional capacity or offset or heal some of the negative effects. There are a few protective experiences that I have found to be important in decreasing the burnout caused by dysphoria.

  1. Euphoria. Notice moments of gender euphoria and seek them out. Avoiding dysphoria is helpful to tell you what doesn’t work for you but moving towards euphoria tells you what you should do. Moments of euphoria can pass us by or be overshadowed by dysphoria unless we notice them, focus on them, and celebrate them. In this way, they can be a beacon of light to look forward to and to remember when we feel overwhelmed by dysphoria.
  2. Support. Whether through therapy, social support groups, online groups, friends, or family, support from people who understand what you are experiencing and can give you a sounding board to process and strategize with is important. Your support person/people can also help bring your attention to the symptoms of burnout you are experiencing and provide some external motivation to socialize, exercise, or engage in whatever other activities are necessary for you to recover.
  3. Affirmation. Dysphoria is constantly telling us that something is wrong, that we don’t fit in our body or in society, that we don’t look the way we should, and that maybe we’re making this whole gender identity thing up. Finding sources of affirmation, whether from your support network, from positive social media influences, or a personal journaling, self-talk, or meditation practice can be extremely helpful in offsetting the negative thoughts and feelings associated with dysphoria. The more the affirmation comes from an outside source, the less mental work we have to do to provide the same level of protection and, often, the more likely we are to believe it.
  4. Activities and Interests. Part of burnout, for me anyway, is a lack of interest in things that I would usually enjoy. The frustrating thing is that engaging in things I enjoy makes me feel better. The trick is to find activities and interests that do not trigger any dysphoria. This allows you to engage in your activity or interest with less mental effort so that it doesn’t make the burnout worse which results in a net gain of positive emotion and energy.

Process the Stress

This concept is directly from the book I recommended earlier. The gist is that we experience our emotions in our bodies as a chemical and neurological process. When we are under constant stress (as with dysphoria), our bodies are constantly in ‘fight, flight, or freeze’ mode. Even if we get a burst of euphoria or a period of relief from dysphoria, our bodies still have to complete the chemical reaction or neurological pattern that was triggered by the stress. If we don’t engage in activities that encourage this completion to happen, our bodies remain in the stress state which only gets stronger the next time we experience stress (five minutes later).

So while we can’t necessarily get rid of the stressor (dysphoria) and stop it from triggering a stress response in our bodies, we can do various things to move through the stress response in our bodies, complete it, hit the reset button, so that the responses to this continual stress don’t compound as much. For me, the most useful activities are physical activity of any kind, breathing, affection, positive social engagement, and creativity (writing, painting, and crocheting). With so many options, it is easy to engage in at least one per day, usually more.

One of the tricks to making this as effective as possible for me is to do these activities mindfully. To focus on the calming effect it is having on my body, mind, and emotions. Or, if there was a specific situation that was stressful that I am ruminating on (because my body is still stuck in that stress cycle), I focus on that situation at the beginning of the activity, think through it, feel the emotions that I felt at the time (or didn’t allow myself to feel at the time), and continue the activity until the emotions and the associated physiological response dissipate. The amount of relief this brings in a very short span of time is pretty incredible.

Tl;dr

Burnout sucks and makes us feel numb, exhausted, and irritable. Dysphoria can lead to burnout due to the constant mental effort that is invisible to or misunderstood by the people around us. You can help yourself avoid repeated cycles of burnout by preventing as much dysphoria as possible, protecting yourself against the negative effects of dysphoria, and processing the physiological stress triggered by dysphoria (and any other sources of stress).

I hope this helps you. It is what I needed to hear five years ago. Leave a comment below or send me an email with your thoughts and experiences of burnout. Maybe your experiences are similar to mine and maybe they are very different. Either way, your experiences have value and I would love to hear about them.

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Reflections on Top Surgery, Part 3 : Post Surgery

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

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

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

Initial recovery

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

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

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

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

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

Getting back to normal life

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

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

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

Post op Depression

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

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

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

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

Where I’m at now, 3 years later

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

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

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

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

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

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

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

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Reflections on Top Surgery, Part 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?

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Reflections on Top Surgery, Part 1 : Pre-surgery

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

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

Deciding to pursue surgery

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

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

Applying for funding

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

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

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

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

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

Research while waiting

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

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

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

Private surgeon consultation

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

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

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

Preparing for surgery

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

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

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

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

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

Things I wish I had done differently to prepare

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

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

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

Up next

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

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Postpartum Update: 5 Months

We’ve all seen the representations of postpartum people in media who are frustrated with not being able to lose ‘those last five pounds’ when they’re five weeks postpartum. Let me tell you now, this is not reality. At least not for me.

My body did a whole lot more during pregnancy and birth than just put on a few pounds. Therefore, my body finding it’s way to a new, stable normal is not all about losing weight. Maybe I’ll get back to my pre-pregnancy weight, maybe I won’t. But more importantly, what is my body capable of doing and how does it feel?

PHYSICAL ENDURANCE AND MOBILITY

If you followed along with my pregnancy journey, you’ll know that I had severe pelvic and back pain that meant I was using a walker for mobility by week 14. Immediately postpartum I was able to start taking my regular medication and the pain improved quickly. But the impact of six months of limited mobility doesn’t go away over night.

I had a lot of joint stiffness and residual associated pain. I had significant muscle weakness in certain muscle groups (and still do to some extent). And I had extremely limited cardiovascular and muscular endurance.

I have been working on all of these as much as I can (giving the limited extra energy when caring for a baby). Initially I was mostly doing slow easy stretching and gentle movement and short walks. More recently I have done cardio exercise in the form of climbing the stairs while wearing the baby, using my rowing machine, and going for fast paced walks, strengthening exercise while playing with the baby on the floor or using the baby as a weight, and endurance exercise in the form of longer walks at normal pace. I even went skating for the first time today!

Each time I try another activity or try to push myself I come up against a very sudden limit in strength or endurance. I’m going along enjoying the feel of my body moving when suddenly I have no power. My muscles turn to water and my joints cease. I slow down or take a break to stretch, and try to continue. Often I can get a bit more out of my body but at much lower intensity or poorer quality. And that’s ok. That’s just where I’m at. Every bit counts.

Even if I wasn’t trying to improve my strength and endurance, just the act of moving my body and expending positive energy makes me feel less antsy, more patient, happier, and more connected with myself in a positive way.

HORMONE FLUCTUATIONS

At around two and half months postpartum I started having similar symptoms to when I was taking fertility drugs and when I was immediately postpartum. Wooziness, light headed, foggy, weepy, laughter easily becoming hysterics. Yes, apparently this is normal.

There is a hormone shift at 2.5-3.5 months postpartum and again somewhere between 6 and 9 months postpartum. My hormones were taking the next step in leveling out. Ugh. Not looking forward to going through that again but hopefully the next wave of this will be the last.

OTHER SYMPTOMS

  • All birthing trauma has healed (I had nothing severe and no C-section).
  • Despite having low milk supply initially and now decreasing lactation, my period has not yet returned (yay!).
  • I had some increase in hair loss around the time of the hormone shift but nothing extreme and it seems to have leveled out.
  • My belly is still round in a more pregnancy like shape than my typical body shape but is down to about my early second trimester size.
  • I had many many stretch marks that have somewhat faded into a soft, saggy, pouch of excess skin below my belly.

EMOTIONAL EFFECTS

As I am now trying to figure out what being a parent means and often exhausted from caring for my baby, I am definitely not in the same place emotionally as I was pre-pregnancy and never will be and that’s fine. Becoming a parent changes you and I am embracing and navigating that change.

But there are emotional effects from the experience of being pregnant and giving birth that stuck with me for a while. A few weeks postpartum, when the extreme fatigue had worn off a bit, I started having mild panic attacks when I was lying in my bed trying to go to sleep because I would be transported to the moments when I was waiting for another contraction to happen. That lasted for a few nights but, with the help of my husband talking me through it, wore off and hasn’t returned.

Looking back on being pregnant, remembering how it felt, is extremely surreal. Even when I see pictures of myself when I was pregnant. I know that it happened to me, I can remember that it happened, but I have a very hard time actually feeling what it felt like at the time. My body just felt so different than it ever had before and than it does now.

I can remember little things, like what it felt like when my baby had hiccups, what different stages of contractions felt like, and what my baby helping along my contractions felt like. But the overall experience of being pregnant? What it felt like to move around? It is very vague and very surreal. And maybe that’s ok.

So have I ‘recovered’ from being pregnant? No. I don’t even know what that means. Pregnancy doesn’t feel like something I need to recover from. I’m not trying to re-create my pre-pregnancy body. And as debilitating as my pregnancy was, it wasn’t a negative experience.

I am five months postpartum and very happy with what my body is capable of doing these days. I will continue to be curious and fascinated by all the changes just as I was during pregnancy. It is a continuation of the process that began with pregnancy. It did not end at my baby’s birth and will not have reached a conclusion for many months yet. So here’s to the journey.

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Goal Setting 2021

If the year 2020 taught us anything, it was that anything can happen and we need to be flexible in order to survive. One of the ways I failed in this was when I set my goals for 2020.

Every year in December I set up my bullet journal for the next year. This includes writing down my goals and deciding how I’m going to track them. Having goals that work for me helps me keep my sense of progress and growth. The act of goal setting forces me to decide what I feel is most important to focus on. And having a way to track my goals and a timeline for when I’ll check back keeps me accountable and shows me concretely how I’m doing.

Last year I picked five goals for the year and broke them down into four parts, one for each quarter of the year. I planned to update the tracker at each quarter to see how I’m doing but life got in the way in a big way. Three out of five of my goals were no longer feasible after the first quarter and another by the end of the second quarter.

So this year I’m picking three goals and only writing them out for the first quarter. At the end of the quarter I’ll revisit my goals and if they’re still accurate, I’ll write them out again for the next quarter which will reinforce my commitment. If not, I have space to adjust the intensity of the goal or pick an entirely new goal.

I’ve tried a number of different goal setting strategies and found one that I like the best. It includes five sections: topic, goal, why, how, and tracking. Here’s what goes into each section:

Topic

This the area of your life that the goal relates to. Ideally, each goal should relate to a different area of your life so that if one area is greatly affected or changed, you won’t lose all your goals; the goals from the other areas of your life sill hopefully still work for you. Examples: Health, Creativity, Work, House, Money, School, Fitness, Sport, Relationship.

Goal

What exactly do you want to accomplish? Is it a finite goal (finish something, achieve a certain level or score) or habitual (complete an activity a certain number of times each day, week, or month)? State the goal and the target. Chose things that you have control over. Examples of finite goals: Finish my novel, run 5K without stopping, save $12,000. Examples of habitual goals: Exercise 3 times/week, write in my journal every day, vacuum the house every week.

Why

Why is the goal important to you? What will you gain by having it as your focus? What benefit will you notice from completing it regularly? Write a list of the top 3-5 benefits that are most important or the strongest motivators for you. Examples: More energy, less stress, clearer mind, financial stability.

How

How will you accomplish this goal? How will you keep up your motivation or find the time you need? Who will you need to coordinate with? If you respond well to rewards, how will you reward yourself? What other habits will support this goal? Examples: Get dressed in running clothes before breakfast, write for 30 minutes before work, plan housework into weekly schedule.

Tracking

How will you measure your ongoing progress? Will you keep track on a calendar, a spreadsheet, or right next to where you’re writing out your goals? Will you use stickers, check marks, or colouring something in? Is the completion of each milestone a yes/no or are there levels in between? For finite goals, I like to break them down into weekly targets but if biweekly or monthly works better for you, use that. Habitual goals are easier – if it’s daily, track daily, if its weekly, track weekly, etc.

I can’t stress how important it is to track your progress towards a goal on a regular basis. Seeing good progress can be motivating. Being aware of poor progress quickly allows you to adjust your strategy, build in new habits, or redouble your commitment to your goal. There’s nothing worse than getting to the end of the goal period and having to do a bunch of work to find out if you have accomplished your goal only to realize you didn’t keep track of some key information.

I hope this helps you set motivating goals that are important to you and help you maintain a sense of progress and growth in your life. Share your goals in the comments below! Or if you have a completely different goal setting strategy that works for you, I’d love to hear it. Send me an email or share it in the comments!

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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.

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Let’s Talk Gender S2E8: Nonbinary Pregnancy and Parenting

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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. 

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