Tag: Transition

3 Types of Trans Healthcare That Everybody Should Know About

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

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

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

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

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

TRANS SPECIFIC CARE

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

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

TRANS ASSOCIATED CARE

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

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

TRANS SENSITIVE CARE

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

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

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

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

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

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

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

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My Hero’s Journey, So Far

Here is how my gender journey lines up with the Hero’s Journey. Missed my previous post about Gender Transition as a Hero’s Journey? Check that out first and then come back to read my story.

ORDINARY WORLD

When my husband started being identified as a man by strangers, their ingrained heteronormative views told them that I must be a woman. I started getting treated as more feminine when we were together and this didn’t sit right with me.

I had never been comfortable with the term lesbian, and instead had always called myself gay or queer.

In grade 10 I had a gender fluid experience where I would feel like a boy named Ray for a few days every few weeks, shifting back to feeling like a girl named Meaghan in between.

I grew up in a very liberal and supportive environment but at the inception of my gender journey I had moved away and was working in a more conservative and very hetero- and cis-normative environment.

CALL TO ADVENTURE

Part way through my husband’s transition, I realized that I was definitely experiencing dysphoria as well. We had been attending local PFLaG meetings and had been listening to people describe a range of identities and experiences. Some of these, especially the more androgenous, gender neutral, gender fluid, and nonbinary ones, really resonated with me.

REFUSAL OF THE CALL

However, my husband was still in the middle of navigating how to get top surgery, how to change all his legal documentation, and what to do about continually being misgendered at work, months after coming out. From witnessing his experiences and hearing about similar experiences from the community, I knew that exploring your gender and clarifying for yourself who you are and what you need to feel authentic can make not having those things feel a whole lot worse.

Knowing that my husband still needed a lot of my support and I was not working in an environment that would be condusive to coming out as nonbinary, I decided to put off all gender related self-discovery for the time being.

MEETING THE MENTOR

As soon as my husband felt fairly stable in his transition, he encouraged me to do my own gender exploration work. As a result of his transition, he finally felt ready to be a parent (being able to picture himself as a dad instead of a mom) but also did not want to be the one to be pregnant. This meant that, if possible, I would be the carrying and birthing parent.

There is so much unknown and out of your control in the process of trying to conceive, pregnancy, and birthing. I didn’t want gender related feelings to be one more. So I started to explore what felt not so great, what felt awesome, and how my gender felt on a daily basis.

CROSSING THE THRESHOLD

Turns out I am nonbinary. I discovered that I have both female and male genders which balance out to an overall experience that is a mix of the two or ‘somewhere in the middle’. I discovered that I do have some physical dysphoria during which times I feel better if I wear a binder (if my body can tolerate it). I discovered that I have significant social dysphoria and feel much better when referred to using they/them pronouns and neutral language.

The physical dysphoria I could manage pretty well with some practice. The social dysphoria was a whole other story, especially at work.

TESTS, ALLIES, AND ENEMIES

Partly as a result of constant social dysphoria, I started expriencing periods of burnout that would last 1-2 months and re-occur every 4-6 months.

I had a few new colleagues at work that were queer and super supportive and a few others that I slowly built friendships with and eventually came out to. These allies, especially at work, were a major help on bad dysphoria days.

I had a colleague who was also a friend come out as nonbinary. Unfortunately, the support from the management team was not in place and did not appear when they needed it. There were very few allies around them and they were continually misgendered, had repeated conflicts with coworkers, and ultimately moved to a different job. As an example of what it would be like for me to come out at work, it was a pretty clear one.

Navigating the world of fertility, pregnancy, and postpartum as a nonbinary person is extremely difficult. There were times I found community and resources and felt like I could belong. There were also times that were nauseating and traumatic that I will carry with me for life.

APPROACH TO THE INNERMOST CAVE

While I was on parental leave (for a whole year – go Canada!), and in the middle of a global pandemic, I had minimal interaction with the outside world unless I reached out for it. I had significantly less dysphoria and significantly less burnout, despite being a new parent in a pandemic. This told me that my burnout was indeed primarily dysphoria related and in order to feel more comfortable in my life, and have the emotional reserve I wanted and needed to support my child, I would need to make some changes. I would need to find spaces that I was comfortable being out in. And I would need to be out in as many spaces as I could.

This was especially true around family. I wanted my kid to grow up hearing people refer to me using the correct pronouns. This meant I would first have to explain my identity to everyone my kid would be interacting with regularly (namely family) and train everyone to use my pronouns and preferred language. This would take time and my kid was growing up at a steady pace. I had to come out to family before my kid started understanding what pronouns meant and remembering and repeating phrases from those around them.

THE ORDEAL

The first step I took was to apply to a graduate school program using my preferred name, pronouns, and gender identity. I was open with my supervisor from the beginning and made it clear in my application that my identity and lived experience was a big part of why I wanted to do research work. This meant that in September, when I started school, I had the foundation and backup to expect that everyone refer to me correctly. When they don’t, I have significantly more confidence to correct them than I ever have in other environments.

When my kid was about ten months old, I bit the bullet and came out to my in-laws (who live near us) and my parents (who live across the country but were coming for a month-long visit). I did this via email with the hope of some reply, either of support or questions or concerns that I could respond to. Mostly, there was silence and confusion. I had a brief follow up conversation with my in-laws and, after a period of awkwardnes and tension, saw some awereness and progress. My sister had many follow up conversations with my parents on my behalf but I had minimal expectation that they would be able to/willing to follow through and change their use of pronouns for me during their visit.

However, their visit happened to coincide with work I was doing to develop inclusive training material for a health professions college. They were curious about my work which gave me an opening to talk about many of the issues trans people face in health care settings (mostly related to ignorance and being misgendered). The materials I was developing included a ‘bad’ version of a health care interaction and a ‘good’ version. I sent them both versions and we had a few conversations about why the ‘bad’ version was ‘bad’ and why it was important to interact in ways that were depicted in the ‘good’ version. They were able to grasp these concepts significantly better than the information my sister had attempted to explain, perhaps because it wasn’t directly about them and thus did not make them feel as defensive. They almost immediately started making an effort to use my correct pronouns. While they weren’t great at it, and they will likely back-slide between in-person visits, this was more progress than I expected and I took it as a positive sign.

REWARD

It’s an increadible feeling, being seen. It’s even better when you don’t have to fight for it first. I now have numerous allys who actively step in to do the educating and, if necessary, fighting, on my behalf. I am better at advocating for myself (or getting better at it slowly), and better at identifying situations where having an ally would be useful and then recruiting one.

Confidence, euphoria, authenticity, and visibility are pretty good rewards. Do I wish I didn’t have to fight for them? Sure. But it’s still worth the fight.

THE ROAD BACK

I now spend the majority of my time working in an inclusive environment with my name and pronouns displayed correctly on my zoom screen during ‘meetings’. I have more bandwidth to apply to my work and family. I have not had a period of burnout in over a year despite having a baby during a pandemic. I am able to exercise despite the accompanying dysphoria because, for the majority of the time, I experience more euphoria than dysphoria. I can recover easily from the few days I spend in my previous work environment where I am still not out (and likely will never be).

I am using my unique experiences and perspective to help others make their work more inclusive. I am being recognized for the value of my experiences and identity rather than ‘supported’ or ‘accommodated’.

I am thinking about the future and what I might want for myself in my transition. Are there ‘next steps’? I have a long road to recovery from pregnancy related body changes and have chosen to focus on this prior to pursuing anything further related to transition. Though, likely, at some unknown point in the future, I would like to have some form of top surgery. Will this be my ‘Ressurection’? Who knows! If you stay tuned, you’ll likely find out when I do!

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Gender Transition as a Hero’s Journey

The heroes in our favourite stories all start out as ordinary people. Their journeys often follow a similar pattern as they face trials and tribulations, discover their inner strength, and return triumphant. Joseph Campbell orginally described this story arc using 17 stages (and fairly problematic language). It has since been revised into 12 stages, most recently by Christopher Vogler.

As it turns out, these stages match the emotional stages of a gender transition pretty closely. Which means trans people are all heroes or heroes-in-training!

Here’s how it looks:

There are three parts: Departure (the beginning), Initiation (the middle), and Return (the end). These are broken down into the 12 stages.

The journey starts with the hero in the ordinary world living in a harsh and unforgiving external light in a state of unhappiness, stress, ignorance, and/or confusion.

They move to a new, extraordinary, or special world during the Initiation phase. Here they move through darkness as they struggle to discover their own internal source of light.

They then return to the ordinary world in a state of triumph and rebirth, having learned how to shine brightly from withinwith. They now have a new perspective, skill, or, in our case, identity.

As I was thinking about the steps in the Hero’s Journey and lining them up with the experience of gender transition, it was interesting how easy it was to see. Some of the original wording even makes sense without changing much except the context.

Let’s break it down and look at each of the twelve steps:

Stage 1: Ordinary World

Classic: The hero is uneasy, uncomfortable or unaware. They are living a life at the mercy of their enviornment, heredity, and personal history. The hero feels pulled in different directions and is stressed by the dilemma.

Trans: You are living with confusion and discomfort, just trying to get by with no language or understanding of why you feel different, that there is a way to relieve your distress, or what path your life is going to take.

Stage 2: Call to Adventure

Classic: Something shakes up the situation, either from external pressures or from something rising up from deep within, so the hero must face the beginnings of change.

Trans: You discover that your discomfort might be gender related by meeting a trans person, seeing a trans person represented in media, or learning about language, labels, or experiences that feel right for you.

Stage 3: Refusal of the Call

Classic: The hero feels the fear of the unknown and tries to turn away from the adventure, however briefly. This uncertainty may be voiced by someone else rather than the hero themself.

Trans: You have immense fear about the enormity of what this would mean for your life. This fear takes over and you ignore what you have just learned, bury the knowledge deep down, convince yourself that you don’t need to transition or don’t need to think about this. You try as hard as you can to fit in with what is expected of you or numb/ignore this awareness.

Stage 4: Meeting the Mentor

Classic: The hero comes across a seasoned traveler of the worlds who gives them training, equipment, or advice that will help on the journey. Or the hero reaches within to a mentor from their past or an internal source of courage and wisdom.

Trans: You meet someone who sees you for who you are and encourages you to delve into yourself. This could be a trans or queer person from the community who is living their best life and provides the experience and support you need, a therapist that starts helping you unpack your gender identity and dysphoria, or a close friend or family member who is no longer willing to let you hide from your truth.

Stage 5: Crossing the Threshold

Classic: The hero commits to leaving the ordinary world and entering a new region or condition with unfamiliar rules and values.

Trans: You come out to yourself, accepting yourself for who you are, accepting your true authentic gender identity. You are flooded by understanding, fear, excitement, confusion, discomfort, and determination.

Stage 6: Tests, Allies, Enemies

Classic: The hero is tested and sorts out allegiances in the new, special world.

Trans: You now know why you’ve felt uncomfortable your whole life and being able to point to and name dysphoria makes it so much bigger, louder, and more constant. You search the internet for trans information and find a huge community on social media platforms and many local and national organizations that offer support. At the same time, you start recognizing all the transphobic and cisnormative language around you and feel like no one in your life will accept you for who you are.

Stage 7: Approach to the Innermost Cave

Classic: The hero and newfound allies prepare for the major challenge in the special world.

Trans: You collect information from allies about coming out and navigating transition which helps you clarify for yourself what you want/need. This intensifies the dysphoria which gets harder and harder to deal with, especially when you haven’t told anyone yet. The internal pressure of knowing what you want, who you are, and how you want to be seen builds, pushing against the confines of the closet until…

Stage 8: Ordeal

Classic: The hero enters a central space in the special world and confronts death or faces their greatest fear. Out of this moment of ‘death’ comes a new life.

Trans: You decide that coming out is worth the risk, worth the loss of those that don’t support you, worth the potential harm in order to be who you are. You take the first steps to telling others who you are, breaking down that wall one brick at a time, or by driving a bulldozer straight through it and coming out to everyone at once.

Stage 9: Reward (Seizing the Sword)

Classic: The hero takes possession of the treasure they won by facing death. There may be celebration, but there is also danger of losing the treasure again.

Trans: Some people you come out to start using your correct name and pronouns and you have your first real taste of gender euphoria and what it could feel like to live as the person you are. Not everyone is supportive or consistent and dysphoria continues to fight it’s way in. You fight to hold onto your confidence in who you are and your resolve to seek what you need, using the bursts of gender euphoria as your guiding light.

Stage 10: The Road Back

Classic: The hero is driven to complete the adventure, leaving the special world to be sure the treasure is brought home. Often a chase scene signals the urgency and danger of the mission.

Trans: You learn how to integrate your new trans identity with your life at work, home, and school, with friends and family, and in social activities, hobbies, and sports. You struggle to navigate and access the medical care and legal services you want/need in order to be safe and feel authentic in your body and identity. You are desperate for the changes and progress yet they happen at a maddeningly slow pace.

Stage 11: Resurrection

Classic: The hero is tested once more on the threshold of home. They are pruified by a last sacrifice, another moment of death and rebirth, but on a higher and more complete level. By the hero’s action, the polarities that were in conflict at the beginning are finally resolved.

Trans: You start to recognize the person in the mirror, be recognized correctly by people around you more often than not, and feel more comfortable in your body. You come up to and cross a milestone of significance for you in your transition (starting hormones, top surgery, changing your gender marker, bottom surgery, etc) with all the doubt, fear, excitement, relief, pain, re-learning, and celebrating that comes with it.

Stage 12: Return with the Elixir

Classic: The hero returns home or continues the journey, bearing some element of the treasure that has the power to transform the world as the hero has been transformed.

Trans: You reach a sense of completion related to your transition or have found confidence and peace in the sense of an ongoing and lifelong gender discovery and evolution. You are living authentically, supporting others who are questioning their gender or know someone who is, expanding your society’s view of gender and authenticity, and maybe even advocating for trans rights. Huzzah!

What an epic journey! Can you see yourself, or the trans person you love, as a hero? What stage of your Hero’s Journey are you at?

I know everyone’s transition is different. Are there stages that line up differently based on your experience?

If you add in specific details that match your own experience, what story does it tell? Who were the mentor, allies, and enemies? What tests did you face? What treasure do you carry with you to this day? What final milestone did you face and overcome during your stage of resurrection?

What was the timeline of each stage, and the journey as a whole? Did it progress in a linear fashion the way it sounds like it would here?

Share your story in the comments or send it to me in an email! If you’re willing to share it, I’ll publish it here as a post! The more stories the better. We need more variety of trans experiences and we need more trans heroes!

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How to be a Trans Inclusive Health Care Professional

THIS IS IMPORTANT AND YOU CAN HELP!

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

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

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

DON’T ASSUME

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

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

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

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

RESPECT NAMES, PRONOUNS, AND GENDER IDENTITIES

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

TRUST THE PATIENT

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

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

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

TRANS PATIENTS ARE STILL PATIENTS

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

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

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

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

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

WHERE TO GO FROM HERE

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

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

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

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

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

REFERENCES AND RECOMMENDED RESOURCES

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Trans Affirmations

I am important. 
My voice matters. 

My experience is real.
My experience, my identity, and my life have value. 
I deserve to take up space.

I am important. 
My voice matters. 

I do not owe anyone an explanation of my gender. 
I have control over my own identity. 
I have a right to any label that feels right for me.

I am important. 
My voice matters. 

I do not owe anyone an explanation of my transition process.
There is no 'right way' to be trans.
My transition is my own process and I don't need to compare to anyone else. 
I am proud of who I am and who I am becoming. 

I am important. 
My voice matters. 

While I am trying to avoid dysphoria, I will seek out gender euphoria.
I will seek out what feels right. 
I will do what makes me feel whole. 

I am important. 
My voice matters. 

I love my body for being my vessel in this world. 
My body belongs to me and no one else. 
My body is capable of amazing things. 

I am important. 
My voice matters. 

I am strong.
I am beautiful.
I am worthy of love.
I am enough.

I am important. 
My voice matters. 

I can do this. 
One step at a time. 
I will go at my own pace. 

I am important. 
My voice matters. 

I am allowed to be scared. 
I am allowed to let people assume I am cis.
Doing this does not make me a coward. 
Doing this does not make me less trans. 

I am important. 
My voice matters. 

There is a community out there that understands and supports me.
When I have the energy, I will advocate for myself and my community.
When I do not, I will find ways to protect, care for, and be kind to myself.

Because I am important. 
And my voice matters.

What words do you find affirming? What do you remind yourself of in the face of transphobic politics, family members, and workplaces? Add your words of strength, encouragement, and assurance to mine by leaving a comment.

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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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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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How Being Trans Prepared Us for Parenting a Newborn

On August 27, 2020, a new member of the family was born. Our little one has a full head of hair and is doing well, as are we. But parenting a newborn, especially your first child, is not easy. There are many fears, frustrations, and sleepless nights. Of course, there are also the successes, excitement, and pleasant surprises.

The first three months are said to be the hardest. The baby is the most dependent and only able to communicate via crying. Initially, they only go three hours between needing to eat which leads to very little time for anything beyond basic baby care – feed, change the diaper, rock them to sleep, then two hours later, repeat. Their digestive system is predominantly inactive when they are born and has a steep curve which causes lots of gas pains and therefore screaming. During these gassy periods there is almost nothing you can do as a parent to help beyond be a calming, reassuring presence.

Needless to say, the first three months, and most especially the first six weeks, are extremely difficult. I can’t imagine how single parents or those with minimal support network do it. Even with two of us, and support from our parents on both sides, it felt extremely challenging at times.

Now that we are at week 9, things have settled into a routine and life is more predictable. Looking back, a lot of the skills and strategies we used to help us through the first part of our little one’s life were honed throughout my husband’s transition. It feels like that experience, though it was a huge trial in itself, taught us how to navigate new parenthood. No, we didn’t learn how to feed a baby or change a diaper during his transition, but those more concrete things are easier to pick up. It’s the squishy stuff that is much more challenging.

As I mentioned above, having a new baby can be exhausting and frustrating. You don’t always know what to do or have the emotional reserve to repeat the same actions every three hours. The repetition is exhausting to the point that when you do have a free moment, you no longer have the energy to do any of the things you have be wishing you had the time to do. You are in a constant state of boredom, restlessness, and exhaustion all while feeling like you’re supposed to be enjoying every moment.

Transition is also exhausting and frustrating. You have to repeat your personal story and defend yourself to acquaintances, service providers, friends, and family multiple times a day. You feel worn down but still have to deal with the next interaction that comes along. There are systemic barriers and long wait times that are overwhelmingly frustrating. And the whole time, you just want to be happy and excited that you are slowly becoming the person you want to be.

Learning how to deal with this long, slow burn type of frustration and function despite emotional exhaustion prepared us for new parenthood. The strategy we use is to recognize the emotion of frustration for what it is – a reaction to a situation that you feel you have no control over – and find ways to regain control either within that situation or by completing other tasks.

Another part of the strategy is to focus on the little things that are positive, small signs of progress, and keep the long term picture in mind. With a little baby who can only communicate by crying and who has minimal vision and no control over their limbs, it can be exhausting to sink all your positive emotions into this being and receive only fussing and crying in return. Sure, there are also the times when they are sleeping like an angel and are so sweet you just want to cuddle them and squish them but you don’t dare touch them for fear of waking them. But at the beginning, it can feel like the frustration outweighs the positive feedback. So any sign of development, that they will eventually grow out of this stage, is cause for celebration.

My husband’s transition taught us something similar. Transition is a long, slow process and at times can feel like despite all the fighting, frustration, and effort, you haven’t made any progress. But then you look at your pre-transition photos or compare a voice recording and you realize you have made progress. Keeping up with his transition as his partner required me to recognize and celebrate the little things with him – each crack of his voice as it dropped, each new whisker in his beard, each piece of ID that came back with his correct name and gender marker. We learned how important it was to pay attention to and celebrate the little things and applied the same strategy with our newborn.

Through both gender transition and new parenthood, being aware of your own mental health and being able to communicate how you’re doing with your support network (be it your partner, parent, or medical professional) is extremely important. Through his transition we each learned how to track our own emotional state, how to recognize the signs of depression, burnout, fatigue, or distress in each other, and how to express our own needs as well as raise the issue if we had a concern about the other person.

During his transition, this tracking of our mental and emotional states was up to us. There was no professional checking in, no tracking app with mental health questionnaires and resource articles, and minimal community going through something similar. Since becoming parents, we have had way more support in this area, though we found that both of us have been doing quite well. And when we have a bad day, or a few days of minimal sleep in a row which puts us in a state of burnout, we recognize it quickly and work together to figure out how to regain our positive, stable outlook and look for ways to avoid the same thing in the future.

My husbands transition and my experience supporting him through it didn’t teach us how to be parents. But it did give us the mental health and relationship skills to weather a stressful, exhausting, frustrating, and overwhelming time and turn it into something amazing, fulfilling, enjoyable, and a means of strengthening our bond.

Maybe you haven’t been through a gender transition yourself, or with someone you are close to. But maybe you have been through other trying experiences. If you can look back on those experiences and see what skills you developed or what your learned about yourself that helped you through, maybe you’ll be better prepared for whatever life throws at you. Or maybe you or someone you love is going through a gender transition now. If you are a parent and can remember back to the first six weeks of your child’s life, the skills you developed to get through those six weeks will serve you well over the next 3+ years of navigating transition.

If you are trans and have been told that this means you will never be a good parent, I would argue that the opposite is true. We have felt like, by being trans and navigating transition together, we have superpowers that have already served us well on this new, crazy, and exciting chapter of our lives.

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Let’s Talk Gender S1E8: Legal Transition

OVERVIEW

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

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

SHOW NOTES

Meaghan Ray’s Thoughts on Top Surgery

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

Jake’s Legal Transition

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

Partner Experience During Legal Transition

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

Meaghan Ray’s Plans for Legal Transition

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

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

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

OVERVIEW

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

SHOW NOTES

Jake’s Top Surgery Experience

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

Partner Experience of Top Surgery

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

Jake’s Top Surgery Recovery

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

Partner Experience During Recovery

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

Looking Back On It

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

Next time: Legal Transition

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