Tag: Surgery

Trans Wisdom: Our Bodies Don’t Define Us

YOUR BODY DOESN’T DETERMINE YOUR GENDER. YOU DO.

Trans people learn very quickly that their body and all the assumptions that go along with it don’t define their gender. Whether the body they were born into feels wrong or not, their identity is separate.

If this is true for trans people, it is also true for cis people. Maybe you feel at home in your body and the gender you were assigned at birth. But is your experience of your gender based on your genitals? Is it solely made up of your secondary sex characteristics? Or is it more than that? Do you have an innate sense of being the gender you are? What aspects of your personality, behaviours, and presentation are related to your gender?

Once you learn how to think of your gender as more than various parts of your body, you also learn that you can choose how to express your gender. Do you wear the clothes you wear because they align with your gender and make you feel good or because it’s what society expects you to wear? Have you ever tried wearing clothes or jewelry that you think will make you uncomfortable? You never know! You might discover something you like even better than your original presentation.

YOUR BODY DOESN’T DETERMINE YOUR WORTH.

It goes beyond gender. Our bodies also don’t determine our worth. Regardless of your body type, ability, size, colour, or sex, we are all worthy of love and care. Society may not treat us that way, but we have to treat ourselves that way.

Trans people learn this throughout the difficult journey to self-acceptance. As we learn who we are and take steps to communicate it to others, we are faced with uncertainty, confusion, anger, fear, and even violence which are really easy to internalize. If we take steps to change our bodies to align more with our sense of who we are, we learn that though the change may alleviate some dysphoria and make it more comfortable to go about our daily lives, it does not automatically result in an increased sense of self-worth. This is something we have to consciously work on at every stage of our journey (and throughout life).

YOUR ABILITY TO REPRODUCE DOESN’T DEFINE YOUR GENDER.

The reproductive organs you possess and whether or not you are able to reproduce has no bearing on your gender. It may be a component of yourself and your experience that you choose to include as part of your gender identity but this does not mean that is true for everyone with a similar experience.

Trans men and nonbinary people who have uteruses can get pregnant and successfully birth a baby. Cis women who have had hysterectomies are no less women. Trans women who produce sperm are no less women. Cis men who do not produce sperm are no less men.

Your gender (and your worth) is not defined by the ways in which you can or cannot reproduce.

SOCIETY’S PERCEPTIONS DON’T HAVE TO BE YOUR PERCEPTIONS.

Trans people are assigned a gender by almost everyone they encounter. Often, this assumption is either entirely or partially incorrect. Having a trans identity is also perceived as wrong, unheard of, a burden, or inappropriately fascinating. It takes work to unlearn these perceptions and hold onto our own self-concept, even when we feel like no one else around us sees us for who we are.

Are you judged by society in a particular way because of an aspect of your body or appearance? How society perceives you does not have to dictate how you perceive yourself. It’s often hard to identify which perceptions we have internalized and constant work to fight against that perception internally but it is worth it.

SURGERY IS PART OF A PROCESS, NOT AN END GOAL.

Many trans people undergo one or more surgeries in their effort to align their body with their identity. Often, when they are looking forward to the upcoming surgery, they have the perception that once they have the surgery, everything will be better. They fall into a mode of waiting for the surgery and build high expectations of the positive impact of the results.

No matter what the surgery is, it is always a difficult experience. There is pain and healing. There are often activity restrictions and limitations, sometimes for months afterwards. Sometimes there are complications. And regardless of the outcome, it does not automatically change their self worth or self confidence. If they are lucky, there is a decrease in dysphoria but often, over time, the dysphoria will shift to another area of their body, or they will become more aware of the dysphoria once the other source has been relieved.

Trans people learn the hard way that surgery is part of the process, not an end goal. Whether you are undergoing surgery for cancer treatment, weight loss, pain relief, or transition, it is never the only component of the process and often isn’t even the component that makes the biggest difference. If there is something going on in your life that is big enough to require surgery, it is definitely big enough to have emotional components and other milestones that come before and after surgery. Try to keep it all in perspective while you work towards or recover from surgery. Don’t leave ‘the rest’, whatever that is, until after surgery. Work on everything else while you wait for surgery. You’ll be glad you did.

What are your experiences around how your body does or does not inform your gender or other aspects of your identity? What societal perceptions have you worked hard to unlearn? Leave a comment below with your story!

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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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How to Ask About Someone’s Gender

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

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

THE BASICS

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

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

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

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

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

DEEPER QUESTIONS

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

Gender Identity

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

Language

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

Body Dysphoria and Euphoria

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

Medical Transition

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

Legal Transition

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

Practical Concerns

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

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

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

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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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Prioritizing Together Time

Whether you are in a relationship or have a close friend or family member that you rely on for support, prioritizing time with them is especially important if you are questioning your gender or transitioning.

Any exploration or change in our gender identity and presentation is a big change that very much affects the people around us. Close relationships only remain close if we keep communicating to understand how each person is changing and growing so we can support or adjust as needed.

From my experience during my husband’s transition and my own gender exploration, I discovered there are a few different types of quality time that serve different purposes. We were not always good at using out together time to the best advantage but we definitely got better at it over time out of necessity. Hopefully, by sharing our experience, I can help you skip the muddling through process and keep your relationships strong right from the start.

TALKING TIME

Setting aside time to share how each of you is doing or discuss new thoughts and emotions is the most important. These conversations can take a lot of energy but they are the core of what will maintain your mutual understanding and support.

These conversations can be intense, draining, and difficult. Here are some ideas you can try that might make them easier:

  • Schedule a regular check-in time that includes self care strategies before and/or after (journaling, exercise, creative expression, time in nature, etc).
  • Have these talks in a safe and isolated environment such as the bedroom (ie pillow talk), the car, or when you’re out for a walk together.
  • Write down some notes in advance if you get easily emotionally overwhelmed and have difficulty expressing yourself or staying present in the conversation.
  • Request a conversation to give the other person some warning. If this is helpful but also makes them anxious with wondering what it’s about, you can use a shorthand to define the parameters – Is it a you thing, me thing, or us thing? What is the general topic? Is it a big thing, a medium thing, or a small thing?
  • Try NOT to think of these conversations as a one-off for any topic. It’s important that you have a chance to come back to anything you have discussed previously to delve deeper, clarify or adjust how you explained yourself or how you understood each other, or to have another opportunity to explore, express, or process the same emotions or situation.

ACTIVITY TIME

Spending time doing something that you mutually enjoy is also really important. This is a way to take a break from the gender based conversations and maintain your bond based on previous activities. You can choose activities that are not inherently gender based or dysphoria inducing or agree to not discuss gender based topics during the course of a particular activity or day.

These activities may need to be adjusted somewhat if they trigger dysphoria. Be self-aware and honest about this. Sacrificing your well-being and hiding your discomfort defeats the purpose of doing something you both enjoy to strengthen the relationship. Finding new ways to enjoy the things you bonded over will initially take a bit of effort, communication, and time, but the pay-off is well worth it.

EXPLORATION TIME

Maybe you are exploring your gender and need a sounding board, someone to go shopping with, or someone to be your safety buddy when trying out a new presentation in public for the first time. Maybe you have started hormones or are having surgery and your body and emotions are changing and your partner or close support person needs time to explore these changes with you so they can get used to them.

These moments of exploration can happen spontaneously or be part of a planned activity. They are particularly important for intimate relationships but are also helpful for other close relationships.

Some examples of this are when I would feel my husband’s facial hair as it grew in or ran my hands down his chest when he was wearing a binder or post top surgery to get used to the change, or when we took a vacation trip where we explored different names and pronouns for him.

The exploration time is mutually beneficial. It can help the transitioning person be more confident in exploring something new or doing something scary. It can also be euphoric for the transitioning person and help them see their partner/support person being curious and making the effort to adjust. And of course, it includes the partner/support person in the transition process, helps them adjust their mental image of the transitioning person, and adjust to new changes.

SHARING SPACE

Sometimes all you need is to be in the same space together. You can be doing completely different things and not talking to each other at all, but just feeling the other person’s presence can be a balm against the irritation, frustration, and exhaustion from interacting with the rest of the world and navigating transition.

Acknowledging each other’s presence in small ways helps strengthen the value of this time. Whether it’s staying within view, checking in with each other with a look, a touch, or a few words, or sharing some aspect of the space while you’re doing different things (ie listening to the same music or watching the same TV show), this helps turn two people doing separate activities into quality time.

I hope these descriptions of different types and purposes of together time help you be more purposeful and effective with maintaining strong relationships during transition or other big life changes.

If you have other suggestions for together time, please leave a comment below! I’d love to hear from you.

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Let’s Talk Gender S1E2: Transition Timelines

OVERVIEW

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

SHOW NOTES

General Thoughts on Transitioning

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

Jake’s transition process:

Personal Transition

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

Social Transition

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

Medical Transition

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

Legal Transition

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

Transition is never completely finished

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

Meaghan Ray’s Process:

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

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How to be Respectful Towards a Trans Person

Most of the people I talk to about my husband’s transition are open-minded and accepting but generally ignorant. They want to treat trans people respectfully but don’t know how. They want to learn more about my husband’s transition and my experience as his partner but don’t know how to ask the questions in a respectful way. So I thought I’d give you some suggestions or guidelines depending on your relationship with the trans person.

STRANGERS AND ACQUAINTANCES

Use the correct name and pronouns by which I mean use the name and pronouns that they ask you to use regardless of how they present at the time. If they don’t specify their pronouns you can ask or use the pronouns that is your best guess based on their presentation until they correct you. If they use other gendered terms to identify themselves then you should reflect their language back to them and use the corresponding pronouns unless they have specified otherwise.

You should not be asking anything about their transition including the name they were born with, whether they’ve had surgery (especially don’t ask if they’ve had ‘the’ surgery), whether their family is supportive, how old they were when they realized they were trans, or how long they’ve been on hormones.

Phrases to Avoid:

  • Are you a guy or a girl?
  • You look so good! I never would have known you were trans.
  • I have so many questions!

Phrases to Use:

  • My pronouns are ___. What pronouns do you use?
  • …blah blah blah… [incorrect pronoun]… sorry…. [correct pronoun]…. blah blah….

FRIENDS, COWORKERS, AND EXTENDED FAMILY

If this is the level of your relationship, the trans person may have shared more about their transition process with you. This may include frustrations and struggles, medical components such as starting hormone therapy or having surgery, and legal components such as completing their official name change on various documents.

The most important thing you can do remains using the correct name and pronouns. Even better, correct the people around you if you hear them get it wrong. Not only will this help you and others adjust more quickly but it will also show the trans person they have your support and establish an expectation for everyone that it is not acceptable to misgender someone. Correcting people’s pronouns is exhausting for the trans person especially when they have to correct the same person repeatedly. To help you adjust, change their name in your phone/contact info and put their pronouns in brackets next to it. Each time you think of that person, repeat their name and pronouns in your head five times. Don’t worry about sounding awkward and hesitating if that’s what it takes to use the correct name and pronouns. If you make a mistake, apologize and move on. Don’t derail the conversation and make it all about the trans person and their pronouns every time someone makes a mistake.

It is a long process with lots of barriers and frustrations. Drawing attention to how long the process is taking makes it harder for the trans person to deal with. Transition is not a step by step process or a recipe that people follow and does not always have a specific end point. Everyone’s transition process is different. Not everyone will be transitioning to male or female (they may identify as non-binary). Not everyone will take hormones. Not everyone will have top surgery or bottom surgery but some people might. The length of time between parts of their transition vary wildly. It is not your place to ask about this unless the trans person offers the information first. If they confide in you, it is not acceptable to share that information with anyone else without their permission.

Do not compare your frustrations with changing your last name after getting married to the trans person’s experience with changing their first name and gender. Forms that have categories for getting married do not have options for first name and gender changes. People that process name change paperwork are familiar with the process of last name change with marriage status but not first name change with gender. Talking about your name change with marriage does not put you at risk for discrimination or having people question your identity the way it does for a trans person. This example applies to almost any aspect of transition including hormone replacement, surgery, or other types of coming out experiences.

Try not to treat the person any differently once they transition or once you learn about their status as a trans person. Do not try to educate the trans person on ‘how to be’ their new gender. Do not second guess the trans person’s identity, even if their presentation or interests are not stereotypical of their stated gender. They have second guessed their identity enough, long before you became aware that they were trans.

Phrases to Avoid:

  • Why does your ID still have your old name?
  • When are you getting the surgery?
  • And your spouse/S.O. is ok with this?
  • I can get your name right but I just need a little more time to get your pronouns, you understand right?
  • You’re still not done yet? You’ve been working on this for a while!
  • I knew you as [birth name] for so long, it’s going to take a while to adjust
  • What bathroom are you using?

Phrases to Use:

  • I want to learn more about your experience. Do you have any resources I could look at?
  • Is there anything I can do to help support you?
  • …blah blah blah… [incorrect pronoun]… sorry…. [correct pronoun]…. blah blah….

CLOSE FRIENDS AND IMMEDIATE FAMILY

Everything from the previous section applies to you as well, especially the part about name and pronouns. In addition, you may be one of the first people the trans person is coming out to. Your support is the most important factor in helping the trans person get through their transition. Literally. The suicide rate for trans people is extremely high. The number one factor that prevents suicide among trans people is family support. So learn as much as you can about the transition process and let them know they have your support, even if you are struggling to accept or understand their new identity. Let them know that they should tell you if you do something or say something wrong or upsetting. Make sure you spend time with them doing things that you both enjoy that have nothing to do with their transition. It is a good way to stay in contact and get used to changes as they happen but not make everything about being trans.

If there are aspects of their transition that you are struggling with, let them know and tell them you are working on it. Find other people to talk to about it. Unless they have given you permission to tell other people, this will likely be a therapist. If they know that you are struggling and need to talk to someone and you ask if you can tell a specific friend or one other family member, they may be open to it. Never tell someone that this person is trans without their permission. Once they start telling people, you may become a conduit for information for the rest of the family or group of friends. Talk to the trans person about how they want you to answer typical questions and how much information they are comfortable with you disclosing. This type of conversation will happen repeatedly as the group of people they have come out to grows.

Offer to go with them to medical appointments and other difficult tasks even if they seem trivial to you. It often takes a lot of courage to get those steps done and having backup definitely can help. If they ask you to, try to be willing to attend therapy or support group sessions with them.

Phrases to Avoid:

  • You’re not going to get surgery though, are you?
  • These changes are permanent! What if you change your mind?
  • You really should tell [specific person]. They deserve to know.
  • You don’t really need to get the surgery, since you’re married. If you were single it would be a different story.
  • You can come over for dinner, as long as you don’t talk about your transition.

Phrases to Use:

  • Would you like some company when you’re going to… (eg: HR, passport office, fingerprinting, registry for name change)?
  • I support you and your decision to transition but it will take me some time to adjust. Is there anyone you would be comfortable with me talking to about this so I can work through my own feelings faster and not put them on you?
  • Let me know when you are ready to start telling other people and I will help you with that in whatever way I can.
  • What can I do to affirm your identity? You have told me what not to do, but are things I can do that feel positive for you?

MEDICAL AND HEALTH PROFESSIONALS

If a patient enters your practice seeking treatment from you and you are either aware of their trans status or become aware of their trans status during the interaction, the first thing to do is confirm that you are using the correct name and pronouns and then stick to those. Make sure your patient database on your computer system reflects the correct name and pronouns. If you are unable to change them in your system for legal/billing reasons until the person has completed their legal name and gender marker change, find a way to indicate in your system what name and pronouns the patient uses so that all the staff in your clinic identify the patient correctly.

As a health professional it is your job to know what aspects of the patient’s status as a trans person are relevant to your medical field and which are not. Learn how to ask questions about the relevant areas in a respectful, straightforward way that makes it clear why it is relevant.

You should not be asking any questions related to any aspect of their transition or experience as a trans person that is not relevant to your area of practice. If you want to learn more you can ask the patient for resources they would recommend, but, better than that, you can do your own research just like you are expected to do when a patient has a history of a medical condition you are not familiar with. It cannot always be up to the patient to educate the professionals. It is not only exhausting for the patient but unprofessional.

Keep in mind that trans people will have had many unpleasant, inappropriate, transphobic experiences with other health professionals before you. They are coming into this interaction with their walls up expecting a negative experience. It only takes one misstep to confirm their expectations that this interaction will be like all the rest. If you realize you have made a misstep, apologize for it taking full responsibility and move on. Stay focused on why they are there to see you and only what is relevant to that condition/concern/complaint.

Phrases to Avoid:

  • Oh! You’re trans? That’s so interesting! I’d love to talk to you more about that.
  • Have you had the surgery?
  • When will your transition be complete?
  • Anything irrelevant to your profession or the reason they are there.

Phrases to Use:

  • I admit I have very little experience with trans patients so if I say something inappropriate please tell me right away or if you think there is something relevant that I haven’t asked about, please feel free to mention it if you feel comfortable doing so.
  • I’ve been trying to find information on trans people’s experiences with this condition. Are there any resources you would recommend?
  • I understand from your history that you are trans. Have we been using the correct name and pronouns for you? If yes, let us know anytime if that changes. If no, what name and pronouns would you prefer?

I hope this information helps you feel more confident that you will be able to treat trans people in a way that conveys your respect for them. Did you find any of this surprising? If there are areas you want to know more about, take a look at the Resources Page or search for other similar posts under the Partner tab.

If you are trans and reading this, what other suggestions do you have? What is your reaction when someone uses one of the phrases that I recommend people avoid?

My Husband’s Transition – A Partner’s Perspective (Part 3: Medical and Legal Transition)

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.