Counseling (heavily edited for clarity)
I just wrapped up a session with my health coach, and since we talked about gender things a lot, I wanted to write something here before I forgot everything (though I did take notes, as always). Obviously things are a lot more complicated than what I said in our brief phone conversation, but it was more than I'd gotten to say with my therapist over the last month, and I feel like it was a good start in the sense that I can now tell my therapist, "Hey, I got help from a health coach in these ways, and here's how it was useful, can we talk like that, too?"
Therapy has been going really slowly, and I find that immensely frustrating. I initially said that what I wanted to get out of gender therapy was a decision about what aspects of transition were right for me, but upon taking that apart a bit, I think what I really want is more certainty about what parts I've pretty much already decided to pursue in the nebulous, distant future. I think I already know what I want, but I want to be confident that I'm doing what I need to, not just indulging something optional or something that I could regret. And I feel like I really need to decide soon, so that it's easier to just be Ilan, not Ilan who used to be [birth name] when ey registered here, when I head off to grad school in June.
We talked about what changes I want from T. I really, really want my voice to be lower and for my face to look more masculine. I'd also like the changes to face, body, and head hair (though I worry I might regret those later on). Ease of gaining muscle and body fat redistribution would be fantastic, but I'm not sure if I'm even thinking about being on T long enough for that. And we talked about changes I'm less enthusiastic about, too. I don't know if I want downstairs growth. What if I can't ignore things as well then and spend more time being dysphoric about my crotch? I'm also concerned about my hormonal acne worsening.
I got to talk a little about why I've waited so long to get started on medical transition. I felt so comfortable at school where everyone important knew I was genderqueer that the issue wasn't really forced. Dysphoria regarding my crotch was mostly isolated to one week a month, and as long as I didn't have to wear a bra, my chest didn't bother me because I rarely left campus. I talked about wanting facial hair and a deeper voice, but I didn't feel like I couldn't live without it. . . now that I'm not surrounded by supportive people who will take my word for it regarding my gender, I feel like I can't be perceived the way I should be without changes from T. The health coach asked if I wanted to pass, and I said I wasn't sure, because it just seems so impossible and far away. If I really wanted to pass, I should have already done a bunch of things like cutting my hair, right? It was another one of those things that just wasn't an issue when I was in college and has been painful on a daily basis since I graduated and moved away, but I haven't done anything to fix it yet.
I also opened up about questioning my motives for transition -- am I just a misogynist? am I doing this for me or for other people? -- and its effect on my health given my other problems. I'm concerned about being on T for the rest of my life. I don't like being on medications, and I'm on several that will probably be life-long commitments due to chronic illnesses. It seems counterproductive to sign up for more of that if less is an option. But I can't see myself continuing to let my body be dominated by regularly fluctuating female hormones for much longer, and there doesn't seem to be an option to not have sex hormones. I really don't know if starting T soon will help me resolve this.
I got some useful medical-type information, too. Though genes control a lot of the hair distribution type stuff (face, head, and body), apparently voice isn't quite like that, because I won't be getting voice changes like a cisguy would during puberty, which makse sense because I know my voice has "matured" in some ways since I hit puberty the first time around. This means that while I can probably count on not being able to grow a beard, my voice is not doomed to be the same as my father's bizzarely high voice. It's also possible that my hormonal acne could improve on T, that I might have problems because my hormone levels are currently between the femle and male ranges, and my skin might stop rebelling if given the correct dose for either sex. Obviously some testing is in order, but it's an option I wasn't really aware of before.
However, there was a lot that I didn't talk about that I would want to discuss further with a counselor. One of the changes I'd really like from T is an end to the monthly reminder that I have female reproductive organs. I feel bad about this because there are other ways to stop it that are perceived as "less drastic," and I've never pursued any of those for what seem like weak reasons, plus I might want to be on a low dose that only makes things wonkier. I'd also be overjoyed to see my chest shrink further, so maybe I could get surgery by a method that's less likely to result in loss of sensation. (EDIT: I just spent the afternoon looking at Transbucket, and I think I've got a real shot at peri if I ended up going for surgery at all, moreso if I get just a bit more shrinkage.) One of my unsaid fears about starting T is that the changes will make my long-term partner stop being attracted to me. He's not making any promises, but knowing that he's trying not to have to break a promise that our feelings will never change doesn't make me feel any more confident in possibly putting our relationship at risk.
I also didn't go into my non-binary identity at all, which is a bigger deal than I generally let on. I want people close to me to see me as Ilan, who isn't a woman or a man, but I want those not close to me to just see another guy, because if I have to choose, and I very much feel that I do, I need to be perceived as not-female, which means transitioning to male, at least on the surface. I guess I didn't mention it explicitly to the health coach because I see him as being part of the not-close category, and I guess that makes sense since we've only met once and talked on the phone three times, but I feel like this is something I should be able to talk about more in counseling. And because we didn't go into my non-binary identity, we didn't talk about my alternatives to T, namely more exercise, voice coaching, and other things I can do to be read as male and feel more comfortable with my body.
Anyway, we talked a bit about what I can do about getting T if therapy moves too slowly and I end up having to move before starting T. I think that was really important to consider and not something that would have come up with my therapist. I'm going to be making an appointment for shortly before I move with one of the sliding-scale informed consent clinics here in the Bay Area. If I get a "T letter" (probably just a referral to an endocrinologist?) before the appointment, I'll cancel and someone with an emergency will get my slot. But if therapy never gets off the ground and I feel like I need to get going before introducing myself to my new department, I can still make it happen. (EDIT: I called the Lyon-Martin Clinic but got lost in a maze of automated voicemail subroutines. I'll try again tomorrow with a script for what my message will say and a stimulant to back me up when it comes to following the instructions.)
Therapy has been going really slowly, and I find that immensely frustrating. I initially said that what I wanted to get out of gender therapy was a decision about what aspects of transition were right for me, but upon taking that apart a bit, I think what I really want is more certainty about what parts I've pretty much already decided to pursue in the nebulous, distant future. I think I already know what I want, but I want to be confident that I'm doing what I need to, not just indulging something optional or something that I could regret. And I feel like I really need to decide soon, so that it's easier to just be Ilan, not Ilan who used to be [birth name] when ey registered here, when I head off to grad school in June.
We talked about what changes I want from T. I really, really want my voice to be lower and for my face to look more masculine. I'd also like the changes to face, body, and head hair (though I worry I might regret those later on). Ease of gaining muscle and body fat redistribution would be fantastic, but I'm not sure if I'm even thinking about being on T long enough for that. And we talked about changes I'm less enthusiastic about, too. I don't know if I want downstairs growth. What if I can't ignore things as well then and spend more time being dysphoric about my crotch? I'm also concerned about my hormonal acne worsening.
I got to talk a little about why I've waited so long to get started on medical transition. I felt so comfortable at school where everyone important knew I was genderqueer that the issue wasn't really forced. Dysphoria regarding my crotch was mostly isolated to one week a month, and as long as I didn't have to wear a bra, my chest didn't bother me because I rarely left campus. I talked about wanting facial hair and a deeper voice, but I didn't feel like I couldn't live without it. . . now that I'm not surrounded by supportive people who will take my word for it regarding my gender, I feel like I can't be perceived the way I should be without changes from T. The health coach asked if I wanted to pass, and I said I wasn't sure, because it just seems so impossible and far away. If I really wanted to pass, I should have already done a bunch of things like cutting my hair, right? It was another one of those things that just wasn't an issue when I was in college and has been painful on a daily basis since I graduated and moved away, but I haven't done anything to fix it yet.
I also opened up about questioning my motives for transition -- am I just a misogynist? am I doing this for me or for other people? -- and its effect on my health given my other problems. I'm concerned about being on T for the rest of my life. I don't like being on medications, and I'm on several that will probably be life-long commitments due to chronic illnesses. It seems counterproductive to sign up for more of that if less is an option. But I can't see myself continuing to let my body be dominated by regularly fluctuating female hormones for much longer, and there doesn't seem to be an option to not have sex hormones. I really don't know if starting T soon will help me resolve this.
I got some useful medical-type information, too. Though genes control a lot of the hair distribution type stuff (face, head, and body), apparently voice isn't quite like that, because I won't be getting voice changes like a cisguy would during puberty, which makse sense because I know my voice has "matured" in some ways since I hit puberty the first time around. This means that while I can probably count on not being able to grow a beard, my voice is not doomed to be the same as my father's bizzarely high voice. It's also possible that my hormonal acne could improve on T, that I might have problems because my hormone levels are currently between the femle and male ranges, and my skin might stop rebelling if given the correct dose for either sex. Obviously some testing is in order, but it's an option I wasn't really aware of before.
However, there was a lot that I didn't talk about that I would want to discuss further with a counselor. One of the changes I'd really like from T is an end to the monthly reminder that I have female reproductive organs. I feel bad about this because there are other ways to stop it that are perceived as "less drastic," and I've never pursued any of those for what seem like weak reasons, plus I might want to be on a low dose that only makes things wonkier. I'd also be overjoyed to see my chest shrink further, so maybe I could get surgery by a method that's less likely to result in loss of sensation. (EDIT: I just spent the afternoon looking at Transbucket, and I think I've got a real shot at peri if I ended up going for surgery at all, moreso if I get just a bit more shrinkage.) One of my unsaid fears about starting T is that the changes will make my long-term partner stop being attracted to me. He's not making any promises, but knowing that he's trying not to have to break a promise that our feelings will never change doesn't make me feel any more confident in possibly putting our relationship at risk.
I also didn't go into my non-binary identity at all, which is a bigger deal than I generally let on. I want people close to me to see me as Ilan, who isn't a woman or a man, but I want those not close to me to just see another guy, because if I have to choose, and I very much feel that I do, I need to be perceived as not-female, which means transitioning to male, at least on the surface. I guess I didn't mention it explicitly to the health coach because I see him as being part of the not-close category, and I guess that makes sense since we've only met once and talked on the phone three times, but I feel like this is something I should be able to talk about more in counseling. And because we didn't go into my non-binary identity, we didn't talk about my alternatives to T, namely more exercise, voice coaching, and other things I can do to be read as male and feel more comfortable with my body.
Anyway, we talked a bit about what I can do about getting T if therapy moves too slowly and I end up having to move before starting T. I think that was really important to consider and not something that would have come up with my therapist. I'm going to be making an appointment for shortly before I move with one of the sliding-scale informed consent clinics here in the Bay Area. If I get a "T letter" (probably just a referral to an endocrinologist?) before the appointment, I'll cancel and someone with an emergency will get my slot. But if therapy never gets off the ground and I feel like I need to get going before introducing myself to my new department, I can still make it happen. (EDIT: I called the Lyon-Martin Clinic but got lost in a maze of automated voicemail subroutines. I'll try again tomorrow with a script for what my message will say and a stimulant to back me up when it comes to following the instructions.)