Ask Matt: Binding Blues and Peeing Problems

A reader writes: “I’m in high school (Junior), but am very open about my gender identity (cross dress, bind, etc). At this point there isn’t a whole lot I can do about hormonal treatment or surgery. So instead I try to do what I can, at my age. I bind, as mentioned, and use a commercially available binder.

“It has been fine, but lately I’ve gotten a lot of pain, difficulty breathing, and nasty bruising on my rib-cage. I wear it too often as it is (about 12 to 14 hours a day, nearly every day), so I know the best thing to do would be to just stop wearing it so much.

“Unfortunately, this is a problem for me as my gender dysphoria has also gotten much more severe as of late (and includes thoughts of self-harm and things we don’t need to get into). It’s a difficult trade-off for me to consider – wear it less and hopefully not end up with a serious injury in the hospital and cause my dysphoria to be that much worse (which, when paired with my depression, anxiety, and raging teenage hormones can be a serious and kind of terrifying problem), or continue doing what I can to suppress (no pun intended) my dysphoria and likely end up in the hospital.

“My mother doesn’t take my depression or dysphoria seriously (it took her witnessing one of my most violent panic attacks to convince her to let me see the school therapist), so advice from her doesn’t help (especially when she doesn’t offer any).

“So that’s problem one. My other problem, which is much less serious, is standing to pee. I really would love to be able to stand to take a pee, but the price of commercially available STP devices that also function as packers is insane! Not to mention the harnesses! The cheapest set I found would still set me back by $50 that I do not have (a lot of money for a jobless teen who’s worried about affording college, a car, gas for that eventual car, animals, etc). Do you have any ideas in this regard?”

Last question first – have you tried a coffee can lid? I never got the hang of it, but a lot of guys use a plastic coffee can lid with the edge or lip part cut off so that it’s just a flat circle. Then they roll it into a kind of tube and pee through it. You can also buy a sheet of thin plastic at the hardware store and cut a coffee-lid-sized circle out of it. It’s explained here on TransGuys.com, along with other suggestions, tips, and links for the Stand to Pee situation.

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Ask Matt: Gender-Neutral Pronouns and ‘Non-Transition SRS’

I’m catching up, but still behind. Today we have two short letters that I have some thoughts about, but that I am unable to answer with much certainty, so I hope that readers can give these writers some additional information.

A reader writes: “I found your website while googling around on gender-neutral pronouns. My question, in brief, is this: Is it just me, or are gender-neutral pronouns mostly sought by people who were assumed to be cis women at birth?

“I love the idea of genderqueer and have happily appropriated the parts that work for me and read a fair amount of queer theory over the years. It occurred to me today that most of the third-way writing I have read is by people who no longer want to use girl-pronouns after being assigned she/her at birth, where as trans women tend to love getting access to (and perhaps ideally only using) the girl pronouns versus seeking some third way.

“I googled a bit hoping to find some evidence to the contrary, but didn’t find much. Perhaps I’m insufficiently thorough. Thanks in advance for your reply, and also for your patience with my question and any parts I may have phrased inelegantly or insensitively.”

I don’t know whether or not this is true, but it appears to me, as well, that the majority of people who prefer gender-neutral pronouns are those who were assumed to be female at birth. I do know some genderqueer-identified people who were designated male at birth who use “they,” and I know some who use “he” and “she” interchangeably. But again, the majority of people who I have found to use “they” or “ze” were designated female at birth.

I’m not aware of any statistics on this, or whether or not any surveys or studies have been done (if anyone knows, please fill us in), so my answer is coming from personal experience.

If my personal experience transfers to the larger culture (and I don’t know if it does or not), and I had to give my thoughts on why this might be, I would say that I think that the “gendered” life experience is different for those who are designated female at birth and those who are designated male at birth, and this causes potentially different responses to any feelings of gender incongruity.

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Ask Matt: I Can’t Take Testosterone

We have two letters below regarding testosterone – first, from someone who can’t take it, and next, from someone who doesn’t want to. I hope readers will chime in with their suggestions and personal experiences.

A reader writes: “Though I have had top surgery, no doctor will prescribe me T because of my health problems, and I cannot find it through other channels. Add that to crippling bottom dysphoria, being five feet tall, and being universally misgendered, I am not a happy guy.

“I have a fantastic long-term boyfriend, a queer cis guy who sees me as I really am, but my own angst is magnified by the way the rest of the world treats us. Either I am treated as his ‘little lady,’ with waiters handing him the check when I give my credit card, gay men saying I’m a fag hag, being called a butch dyke, or being offered ‘makeovers’ to ‘look like the pretty girl stuck under the boy costume’ (oh, the irony).

“My boyfriend and I try to explain endlessly about me being a trans guy, and we get met with reactions ranging from puzzlement (‘I know a trans guy who really looks like a guy, but you don’t, and I can only think of you as a butch girl’) to laughter (‘You’re joking’) to hostility (‘You’re a crazy bitch and he’s a closeted fag’). I wish I could let all this misgendering go, because obviously our explanations aren’t making it better, but I just can’t.

“So, my question is twofold. Firstly, when I came out in 1999, we needed therapist letters (which I had for my surgery) to get treatment. Now, there are informed consent clinics to give you hormones even without letters, but they do require blood tests. Do you think in the future they will waive this requirement, too, or at least let people like me get hormones if we sign an affidavit indemnifying them from liability? There is no guarantee that hormones will worsen my physical issues, but my gender angst has gotten worse over the last 15 years to the point where I don’t know how much longer I can stand it.

“Secondly, do you have any tips to make going out in the public eye easier for the constantly misgendered trans man and his boyfriend, who himself is tired and hurt by the way his love for me, and also his own identity and motivations, are misconstrued? Am I being delusional in the first place to expect anyone to respect my gender identity when, despite my teenage goatee, big muscles, low voice, flat chest, and boyish style/haircut, I am still very short and not on T?”

In response to your first question, I think it is unlikely that even informed consent clinics will change their policy on blood tests, because there is just too much liability involved. Even if you sign a paper releasing them from all responsibility, that might not hold up in court. We have become a lawsuit-happy country.

We sue tobacco companies (and win), even though we choose to smoke. We sue McDonald’s (and win), even though we choose to eat junk food. So even though it is obvious that we are making our own choices, we can still assign blame and win in court. Doctors and clinics are aware of this. Even when a person’s blood tests come out fine, that person still has to sign something saying that he/she/ze understands the risks of hormones. If medical risks are obvious, as determined by blood tests, regardless of what you’ve signed, medical malpractice might be an issue.

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Ask Matt: Gender Identity/Sexual Orientation Confusions

In these two letters, we look at the confusion around, and intersections of, sexual orientation and gender identity. Here we go:

A reader writes: “I’m dating a trans man now and it’s been amazing. I’m still slightly confused as I have always considered myself as a straight female and have always seen him as male, but at the same time I’ve accepted that for the moment he is still female and am willing to do stuff with him (obviously, haha).

“I know labels are not the best way to go about things, but I’m not sure of how else I can understand what I am feeling? I hope this doesn’t come across as naive or stupid. I’m just a little bit confused.”

It’s not uncommon for those who are dating trans people to become confused about their own sexual orientation. For you, it seems pretty straight-forward – you’re a straight woman dating a trans guy, so you’re a straight woman … because he’s a guy.

I would argue that he is not “still female.” I think what you mean is that he has not had any type of genital surgery. Maybe you even mean that he is not taking hormones. But if he’s living as a man, then he’s not female. And if you see him as male, then he’s not female to you, either.

Just because he has a different body type from what you might be used to doesn’t negate any of that. If you’ve been with several men in your life, you know that their body types vary widely, even though they all might have come closer to the particular prototype or representation that we have of a “standard” male body than your current lover’s body does. No matter. He’s a man, you’re a woman, and the label for that type of relationship in Western culture is “straight.”

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Ask Matt: Inappropriate Family Responses to Coming Out

A reader writes: I’ve never felt like I fit in until I started to dress as a male at University a few year ago. Before I left University, I threw away my small collection of male clothes because I was scared of what my parents would say/think.

“When I was 16, I was forced by my sister, in particular, to wear a dress. I did tell my sister at the time (who is three years older than me) that I didn’t feel right in a dress, but she said, ‘You’re a woman, so act like one.’ Now I’m settled in a job I really enjoy, I feel it’s time to start to transition, but I’m scared of my parents’ reaction.

“A few years ago, they found out I self-harm, and my Mum didn’t know what to say, but one morning my Dad suddenly wrestled me to the ground and shouted and spat at me, saying, ‘Do you want someone to talk all simple to you? Do you want a straight jacket? Just stop it.’

“I never sought professional help, because I felt like I needed my parents’ support. I stopped self-harming a couple of years later. I want to start to wear male clothes again, to begin the transition, but I’m scared that my parents won’t support me, especially after their reaction to the self-harm.

“I try to dress as androgynous as I can, and I’m being read as a male a fair bit already. Dad keeps on lifting my top up to see how many layers I’ve got on. I feel humiliated, but if I tell him to stop, he still does it.

“My other worry is work. If I suddenly wear male clothing, people may ask questions. Would it be better to make an announcement before I dress as male, so everyone knows what’s happening?”

I don’t know how old you are or whether or not you still live with your parents, but it sounds as if you might be out on your own. You have graduated and you have a good job. If you’re not out on your own, you might consider saving the money to do that fairly soon, if that’s possible.

You do not need your parents’ support to start therapy if you are able to pay for it yourself or have some kind of health coverage that will pay for it. I suggest you start therapy, regardless of what you decide to do. Even though you say you stopped self-harming two years ago, there is a possibility that this could start again as you become more stressed, and some professional support might be able to prevent a setback.

A therapist can also help you make decisions about how to come out at work and what to do about your parents, as well as helping you deal with any negative repercussions that might come from coming out or transitioning in any way, if that’s what you decide to do.

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Ask Matt Briefs: Short Questions, Short Answers

Here are some short questions and short answers. I (and I’m sure the writers) would love to get reader input on any or all:

A reader writes: “When someone says they are a transsexual man, does that mean that they are a woman contemplating their sex identity or a man contemplating their sex identity? Pardon me if this was offensive, it was purely out of curiosity so I don’t mess up in the future.”

No offense taken. It’s a legitimate question. (Here’s a link to some vocabulary terms that might also help: Trans-lations.)

In most cases, when a person says that he is a transsexual man, what he means is that he has transitioned in some way from female to male. In other words, he was assigned female at birth, and now lives as a man. When someone says that she is a transsexual woman, she means that she was assigned male at birth and has transitioned in some way to female.

This is particularly confusing when the press refers to a “transgender man” when they actually mean a “trans woman,” and vice versa. I could go into a long diatribe about the whole “transgender” and language thing, but I won’t (because nobody wants to hear it again).

Suffice it to say that when people refer to themselves as a man or a woman and any form of “trans” is in front of that, they will generally mean that they are living in a sex and gender that were not assigned to them by the outside world at birth.

A reader writes: “I’ve always felt like I was male from being a young child, and now I feel ready to begin my journey. My question is: I understand there is no guarantee with hormones, but do people who are younger when they begin hormones see results sooner?”

Hmm. That depends on the person. I don’t think there is any research behind this. In my experience, it seems to me that people who are younger when they begin often have “better” results. By that, I mean that I have seen young people masculinize relatively quickly when compared to older people (but “quickly” is just a matter of a few months), and it seems to me that they generally get better facial hair and muscle tone.

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Ask Matt: Do My Spouse’s Feelings About Hormones Matter?

A reader writes: “I was inspired to write by a question you posted recently from a parent asking about their genderqueer teenager. I felt like that teenager could have been me if I was born a couple of decades later.

“I started to have issues with my assigned birth gender at about age 13, but the message I got from so many people was that I was just going through a normal adolescent phase and I would grow up to feel comfortable being a woman. I spent some years thinking I must be a trans man, but that didn’t really fit either. By the time I was 19, I was pretty sure I wanted to change my body to create something androgynous and knew that meant taking hormones.

“But this was the 1990s and everything I read and heard about transition was that it was only open to binary-identified people who could complete a ‘real life test.’ My brief experiences with therapy where I tried to bring up gender issues did not go well – my therapists took the ‘normal adolescent phase’ tack I was hearing everywhere else. So I did my best to push my issues aside and accept living in the body I was born with, because I didn’t think I had another choice.

“Fast forward to the past couple of years. I started hearing about non-binary and genderqueer folks who were pursuing partial transitions to achieve androgynous bodies. They were finding therapists and gender specialists who were supportive of this, even managing to get their transitions covered by insurance. I’m re-evaluating my decision not to seek transition in light of this.

“I’m really wishing I could go back and tell my 19-year-old self this was an option, but of course the past is the past. I have to deal with the present, and the present I live in is one in which I know I could have hormones if I decide I want them, but in which I have the weight of nearly two decades of convincing myself I didn’t need that weighing down on me (I’m 37 now). So I guess the question is, if I’ve lived without T for the better part of two decades, do I really need it?

“On the other hand, if I’ve lived without it all this time, but the feeling of wanting it never went away, maybe that means I really do. Complicating this decision is the fact that I am married. My spouse identifies as agender, but to him that means he just expresses himself however he wants and if other people project gender onto him that’s their problem and not his.

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Ask Matt: Trans Disclosure in Medical Emergencies

A reader writes: “My first close contact with a transgender individual was following a car wreck where the victim was later discovered to be transgender.

“Besides taking care of the patient’s physical/medical needs during transport, which, following a trauma, always includes exposing the majority of the body to examine for bruising, swelling, etc., I learned a lot about all the additional issues this person had going on. Things got a little complicated pretty fast.

“Fortunately, I was the only paramedic in the back, so was able to eventually establish how the lady wanted to be referred to, her new name, and the other issues involved, including being homeless at that time. I was able to become an advocate for her (with the other personnel).

“It takes a lot of courage for some transgender folks to discuss things with a perfect stranger, especially when in a serious medical situation. However, it would have made things much faster for the secondary care issues, and protecting the modesty of the patient even more, if the patient had given me just a little warning initially.

“Perhaps this could be a discussion on your blog sometime.”

I’m glad that you were able to have this discussion with this individual during this time of crisis. In many cases, people are not able to speak up at all about their situation or their needs – they might be unconscious or injured to the point where communication is impossible. Or they just might be too traumatized or in too much pain to communicate much.

This is a tough one, because I know that medical personnel need as much information as possible about a patient, particularly in an emergency, so that they know the proper ways to treat that patient – and even, as you say, to protect that patient’s modesty or privacy.

And even in an emergency situation – actually, especially in an emergency situation – using the correct name and pronouns with a trans person is extremely important. It’s scary enough to be in that type of situation without experiencing any kind of prejudice or misgendering. It’s also very comforting to have an advocate, so thank you.

But sometimes, even when a person has the capability of speaking up, that person might not feel comfortable disclosing a lot of information – or might not even think about it. Here are some reasons why a trans person might not disclose personal information about his/her/hir body in an emergency situation:

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Ask Matt: My Genderqueer Child Wants to Use Testosterone

A reader writes: “I have a question about how to support my teen daughter. She is 19 and decided this past year that she identifies as genderqueer, which she describes as ‘being neither male nor female, but only herself as an individual.’

“Until she was 18, we saw no sign of this; for example, she used to wear very long hair and dresses at 17, but now is dressing and wearing her hair ‘butch,’ to use her words. She did not express discontent to us with her gender when growing up. She also identifies as bisexual, which we have been aware of and supportive of since she was in high school.

“She says that she has great discomfort with her biologically female body so has decided to go onto testosterone hormones in order to have a more gender ambiguous body, ie, to look and sound less female. She is not interested in transitioning to becoming male. However, she does want to drop her voice to sound like a man and hopes to change her facial structure.

“Her father and I support her feelings about her gender identity – at least we think we do – but we are very concerned that she is apparently being given medical permission to go onto male hormones so quickly. We would like for her to slow the process down and take more time to decide.

“One reason is that she is struggling with other mental health issues, such as depression and ADD, with which she was just diagnosed this past year and still has not yet found the right combination of therapy and medication to treat either one. We’d like to see those under control before she adds any hormones at all to the mix. She seems OK with this part of our objection and says she will give it two months.

“A second concern is that she seems to have identified so recently as genderqueer that we wonder whether she can really know whether this is a deep-seated identity issue that must play out with hormonal therapy for her to feel comfortable in her body, or if it is part of normal exploration of what gender means to her in a culture that has pretty rigid and narrow expectations of what it means to be female. She also has never dated or kissed anyone (either male or female) and seems to fear vulnerability of her body within the context of a romantic or sexual relationship, and we wonder if that is also relevant.

“When we expressed these latter concerns to her, she told us we were being ‘transphobic.’ We think there is a difference between being transphobic and telling your child that we think she needs more time to discern.

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Ask Matt: ‘I Can’t Transition Right Now’ Problems

Below we have three letters with a common theme: a desire to medically transition, the inability to do so, and the problems that can create. Each is a little different, so I’m hoping that readers will have some thoughts about one or more of these situations.

A reader writes: “I’m writing because I went to my Kaiser trans specialist yesterday. She said that they now offer SRS and breast implants to trans women who work for certain companies. I replied that it was fine, and I’d happily take a genital reworking once my company was among the fold.

“However, to meet the requirements of WPATH, I would need (and want!) to live full-time for a year prior. To facilitate that, I asked, could I get electrolysis and/or facial changes that would enable me to live comfortably as a woman. She said that Kaiser won’t cover those procedures. My PCP added that she remembers when they didn’t offer ANY trans surgery.

“So I feel caught in a Catch-22. I can get bigger boobs, but not a chance to live comfortably in my skin, relatively free from harassment. And I should be grateful. Argh! I have a small income and no savings. What do you think? I just feel frustrated.”

It is frustrating, because some of the very basic procedures that trans people need – sometimes more than extensive surgery itself – are not considered medically necessary. Things such as electrolysis and facial surgery are considered “cosmetic,” although they can be the foundation of living socially in the gender that matches a person’s identity.

And social presentation can be just as important – and sometimes more so – than parts of our physical body that are generally private. How we are seen by others, and how others interact with us, can be essential to how we see ourselves.

In my opinion, the things that allow for appropriate and successful social adjustment in transition should be considered just as necessary as any larger medical procedures that trans people might need. However, my opinion has yet to be taken into consideration by the powers who make these decisions.

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