Tag: Privilege

The story began in Part 1: Exploration.

The story continued in Part 2: Social Transition.

And now, the conclusion.

Where do we start?

As soon as Jake knew he needed to transition we searched for any information about the medical process where we live. There was nothing online. The most reliable source of information came from Jake’s psychologist who is very involved with the trans community, including moderating a PFLAG group that we had been attending for several months. At this community support group we heard from others that were further along in their transition process how they had accessed medical care and got their legal documents changed.

Jake started by going to our family doctor who was allowed to prescribe hormones following a very clear algorithm in the WPATH guidelines but, having been to a seminar about the transition process ten years ago, our doctor felt like he knew the appropriate process (all referrals had to go through the psychiatrist) and refused to overstep his bounds. As you may have guessed, the medical management process has changed somewhat in those 10 years but very few family doctors are aware or feel competent enough to provide the treatment that trans people require. And although he was ‘aware of the correct procedure’ he didn’t know that the wait to see the psychiatrist was over a year long or believe us when we informed him of this repeatedly after talking to other trans people who had just gotten their first appointment and phoning the psychiatrist’s clinic.

Luckily, through the community, we learned of a family doctor who had prescribed Testosterone for another member of our group. Jake booked an appointment with him asap and was able to start T a week later. At the time I’m writing this Jake has been on T for 14 months.

Testosterone

The first change was his voice. He was starting a second puberty at the age of 30, complete with the cracking voice which led to much hilarity and some mild embarrassment. Until his voice had dropped enough to be more consistently recognized as male, I was the designated representative when interacting with strangers – ordering food, making phone calls, giving my name for contact info.

As his voice dropped mine started sounding higher by comparison to the point of sounding nasal and squeaky at times. I naturally found myself lowering my voice which in the end made me more comfortable due to my own gender identity (more on this in the posts from the ‘Personal’ category).

Jake then started growing facial hair, a sleazy mustache at first, then very slowly sideburns and a goatee. He got stronger, especially in the arms and shoulders. The slow nature of these changes gave me plenty of time to get used to them as they happened. I never had a moment of hesitation or question about whether I still found him attractive. The more his body changed the more confident and comfortable he became. Confidence is very attractive. My mental image of him had included a lower voice and facial hair for quite some time so as his physical body changed it simply fit my mental image more closely rather than being more and more at odds.

As he was read more as male this in turn made us read as a straight couple and put me squarely in the female category. All of this took away our visibility as a queer couple, something which we both continue to struggle with. It was also a trigger for my personal gender exploration – more on this here.

The struggle of Changing his ID

When it came to getting his documents changed Jake encountered too many barriers to list here. Forms that did not include options for his situation, systems that couldn’t accommodate a change in this information, customer service people who were not familiar with the process, conflicting answers that often required backup from unrelated documents that he was also struggling to get changed, all of which required a fee to be processed.

My personal experience with this was when I had to change his information on my health insurance through work. You can’t do this over the phone, you have to email them, they will send you the form, you fill out the form and fax it in, they will email you when it’s completed. The form has a section for changing your  dependent’s information and reasons why you need it to be changed including information is incorrect, marriage, divorce/separation, etc. There was no ‘transitioning’ category (which I wasn’t expecting) but there also wasn’t an ‘other – fill in the blank’ category. So I ticked off the ‘information incorrect’ and wrote beside it ‘transitioning from female to male’. When I got the email saying it had been processed I checked my account and found his name had been changed but he was still listed as female and ‘Mrs.’ So I emailed them back. A while later it got updated to Mrs. Jake, male. Another email, another wait, and eventually they got it right.

This whole time we weren’t sure what would happen if Jake tried to claim health expenses using his updated Alberta ID if his info in my account didn’t match. So he had been holding off on a couple of things until this went through. This was a needlessly frustrating process but still was much safer than many of the interactions he would go through to get ID changed – for example justifying himself in front of a line of waiting people to a clerk who then had to go get their manager to whom he had to explain himself again.

Getting his national documents changed was the biggest ordeal because he was born in New Brunswick, the one province or territory that had not yet passed legislature for people to change their gender marker on their birth certificates. And until your birth certificate is changed you can’t change your passport. And until your passport is changed it’s not safe to travel to a variety of places including the United States. So we had to cancel our planned vacation to go to Arizona in February at a time when we really could have used it.

Frustration levels rising

All I could do was try to support him, provide a sounding board for his frustration and provide positive outlets and distractions. Very few people could understand what this process was like. When voicing our frustration to others we would usually get the response of ‘oh yah, when I got married it was such a pain to change all my documents, it takes forever, but it’ll be done eventually’. Oh yah? Did the forms you had to fill out not have the option you needed to check off? Did the clerk never know how to process your request or require medical documents as proof? Did it take a huge amount of emotional resilience to walk into each office and out yourself every time? Just like coming out as gay and coming out as trans are not the same thing, changing your last name on all your documents after getting married or divorced and changing your first name and gender marker because you are transitioning is not the same thing. I know people were just trying to be supportive but the amount of educating we had to do to get people to understand the differences was exhausting.

The overall the frustration level rose considerably while he was on waitlists for surgery and endocrine, waiting for paperwork, and even waiting for laws to change so he could change his birth certificate. Frustration is a stagnant emotion that I learned leads to considerable burnout. Eventually I had to start paying more attention to my own mental health and I started a bullet journal including habit tracking, weekly debriefs which eventually lessened to monthly, daily journalling which tapered off quickly, and making sure I had emotional outlets that provided some sense of progress and connection with the queer community – for me this is creative writing and music. It took me five months of consistent personal work but I improved significantly and was pretty much back to normal.

Top Surgery

Jake had waited 4 months for his consult for top surgery with a local surgeon which would be covered by health care. The consult was not particularly encouraging, suggesting that he would likely need a revision a couple years later which would not be covered. It would also be 1.5-2+ years wait before he would be having surgery (because of the waitlist). So he had booked a consult with a private clinic in Toronto which he waited another 4 months for.

In prep for this consult we had to take topless pictures for the surgeon and take measurements which was a very uncomfortable experience for both of us as neither of us pictured him with a female shaped chest at this point. Any time he saw himself in a mirror it would cause dysphoria. My image of him had a blurred out section at his chest. Since he overheats easily and has asthma he couldn’t really wear a binder comfortably so instead he had been wearing baggier clothes and adopted a slightly hunched and rounded posture which was causing upper back and neck pain.

This consult went very well and, as it turned out, they had a cancellation and could do the surgery a month later. We had a brief scramble to make sure we could both get time off from work, see how much flights would cost, make sure my parents didn’t have other visitors staying at that time, and then confirm everything.

Just before leaving for top surgery he received his final national documents in the mail – a huge milestone and a huge relief for both of us.

Getting him through surgery

The days leading up to surgery were filled with excitement and nervousness. After the pre-op appointment the day before surgery this went to a whole other level and all I could do was help him manage anxiety about surgery and self-doubt about whether this was right for him or not.

While he was in surgery I waited and waited and waited. I checked in with the clinic at the time when they said he’d likely be done, was sent away, returned an hour later to be told he was in recovery but that they wouldn’t let me in. I came back 45 minutes later to be told he was a little teary but was doing ok (What does a bit teary even mean? Why was he teary? Wouldn’t I be the best person to support him if he was upset?). Not having access to him in recovery to help with the immediate symptoms was even more frustrating because I work in a hospital and I’m very familiar with how to deal with people who are coming out of anesthetic and dealing with post-op pain.

Half an hour later I finally got to see him. He was super pale, sweaty, and shaky. But even with the post-op binder on his chest was flat! I asked him about the tears. Turns out it was just an endorphin response when coming out of the anesthetic, not an emotional response to the surgery or his chest like they had made it seem. I helped him change out of the gown into his clothes, grateful that we had been told by friends to wear a button up shirt. Eventually he was feeling good enough to go home but they insisted on escorting him to the car in a wheelchair. As far as I’m concerned they’re either ready to release him or not but whatever. This caused more hassle than necessary because I had to go get the car and figure out how to get back to where they were waiting. I tried to stay calm because Jake didn’t need any more stress than necessary but was ready to scream or burst into tears by the time we were finally in the car and driving away.

We spent the next few days resting in bed. I visited with my family while Jake was taking naps. I helped him manage the binder, adjust it as needed, and folded face cloths to wrap over the edges of it where it was digging in under his arms. I helped him stay cool or warm, got food and water, made sure he had entertainment when he was up for it so he didn’t get antsy, got him different meds when he got itchy or nauseous from the narcotics, and put arnica on the bruises (very gently). His energy slowly came back and the pain decreased enough to wean from narcotics but the binder was still digging in under his arms in the most painful bruised areas where they had done liposuction so he couldn’t use his arms much as a result. T-rex Jake.

Post-op reveal and return to normal life

We went back to the clinic about a week after surgery for removal of the bandages and to see how the nipple grafts were doing. I’ve seen incisions before so it didn’t make me queasy or concerned. His nipples looked really dark but this apparently is normal and the surgeon was pleased which was a good sign. It was a very interesting experience to see his chest flat for the first time. I was finally able to look at that part of his body and not have what I was seeing conflict with what he looked like in my head. Over time the blurry part where his chest was in my mental image cleared to match what his chest looks like now.

Once we were home he struggled with the binder for another few weeks but eventually gave up and stopped wearing it. He was instantly more comfortable using men’s washrooms which in turn decreased my own anxiety about him being at risk in public washrooms. He slowly started wearing the clothes that he hadn’t been able to for a while because they had been too fitted across the chest. Now they fit perfectly. I don’t think he had realized how much stress he had been dealing with whenever he was putting clothes on to go out until he was able to put on whatever he wanted and not worry about it getting him misgendered. It’s an amazing experience to see your person finally be at ease with themselves and gain the confidence they had been searching for for so long.

The end?

So in the span of about a month we went from huge amounts of frustration and burnout to all legal documents changed and top surgery complete. It took a while for the stress to dissipate and the relief to settle in but man, did it feel good. Not everyone has the opportunity to pay for private surgery and get it in a timely fashion. Not everyone has support from family when they’re going through these medical procedures or transition in general. We are extremely fortunate in both these areas. And yet, even with all that support and stability it was still a very difficult, stressful, emotional process that was very hard to explain to the people around us. Spending time with each other and other trans people and finding online resources that related to our experiences were the things that kept us going. It is not a surprise to me at all that approximately 50% of trans people attempt suicide at least once in their lifetime (reference).

There is no specific end point to transitioning. Jake may have other surgeries in the future and will continue to have slow changes from Testosterone. But in our experience, after being on T for year, having completed top surgery, and having all his documents changed he has been able to pass consistently as male and has considerably less daily struggle with being trans. When we go through future transition related experiences I will make separate posts about those so stay tuned.

I hope you found this account interesting and helpful. Leave a comment if you have had similar or different experiences or if you’d like to hear more about any particular aspect.