Archive for the ‘Legal’ Category

Question MarkBelow we have two letters having to do with transition issues. The first is about the effects of hormones on mood, and the second deals with changing names and gender markers on transcripts. Here we go:

A reader writes: “I started ‘T’ (testosterone cypionate) one week ago at 100 mg. every two weeks, then will go up to 200 in three months. I started feeling a bit more agitated and quick to anger two days ago. I also feel sort of flat emotionally and a tad depressed.

“The first two days after injecting I felt calm, more peaceful, and good (probably because I was starting the process). I’m older at 53. Do these feelings settle down after a while? It’s becoming sort of a drag.”

They should settle down. Hormones can cause rapid mood changes and other feelings that you are not used to. Testosterone and estrogen can both affect mood, emotion, and feelings of general well-being. Your body is not used to this hormone. It has to adjust.

Testosterone can make some people feel agitated and angry. Strong agitation and anger is what body builders who are on steroids mean when they refer to “roid rage.” Not every trans guy experiences this, but it is not uncommon, and it should either lessen over time or you will adjust over time. It also should fluctuate as your body cycles through each dose (if you are injecting).

I personally think that testosterone suppresses some emotions, which could be why you feel emotionally flat. I am not able to cry as easily on T, and it’s not because I think that guys shouldn’t cry. I know a few guys who have gone off of T just to have a good cry once in a while. I also know a trans women who became very confused about why she was bursting into tears at the smallest provocation, because she had never done that before in her life. She had recently started estrogen. Aha! (more…)


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Question MarkBelow 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. (more…)

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Question MarkA reader writes: “I’m an FTM, 18, and I came out to my mum about two years ago. She didn’t take it very well.

“She told me that she didn’t believe that I was transgender because I feel uncomfortable talking to her about sex (I’ve tried telling her multiple times this is normal and that my friends feel the same way with their parents, to no avail), and that I’m stuck in a phase that I just haven’t grown out of.

“Since I came out to her in 2011, thing have slowly gotten better and I’ve put in a lot of effort so that we could reach common ground. She is a lot less hostile about it, she’s fine with me wearing a binder, she tries to use gender neutral pronouns when she can, and I had a talk with her earlier on in the year about changing my name when I finished high school later in the year and she seemed all right with it.

“A few days ago, however, I was talking to her about my name change again, and she told me she thought changing my name would be a mistake, but that I’m an adult and she won’t try to stop me. As we continued talking I also discovered that she still thinks that I’m not transgender, and for the same reasons she told me when I first came out to her.

“While I do appreciate that she won’t try to stop me, my relationship with my mum is very important to me. I love her very much, and I just wish she would be supportive. I don’t want to try to move out, and when we’re not arguing about me being transgender, we get on very well. But I’m not coping well with the realisation that she still doesn’t think I’m transgender.

“I have a psychiatrist (so I can start medical transition) who is willing to approve me for testosterone. I asked my mum if she would be interested in meeting my psych, and she refused and was very negative about the whole thing. Not having her on board makes everything so much harder for me. There aren’t many things that I want more in my life at the moment than for my mum to see me as her son.

“So essentially, what I’m asking is do you know what else I can do to try to make my mum realise that I am transgender, and that the emotions and feelings I have because I’m transgender are real?”

I had to edit your letter a great deal for length, but from the entire letter, it sounds to me as if you’ve done just about everything you can to convince your mother that you are trans, including asking her to talk to your therapist and providing articles and information that she won’t read. She has chosen not to believe this and to dismiss any evidence to the contrary. This is a classic defense mechanism called denial, and she has decided to use this so she doesn’t have to deal with information that she doesn’t want to deal with. (more…)

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Question MarkI’m getting a little backed up again, and this week is my “holiday” week, so I put some short questions together with some short answers. For my many question-writers, thank you for your patience. I’m getting there!

I am also working on trying to make the blog a little easier to navigate (I hope) by adding some specific categories so that readers can more easily find old information and posts that might apply to their circumstances. I am trying to redo my Categories, and it’s taking some time, so again, thanks for your patience.

Here are this week’s questions:

A reader writes: “I’m an FTM transgender person. I’ve already picked out a first and a middle name, and I chose to stick with my last name. The problem is I like the first and middle names that I picked, but I also like the first name given to me at birth. I just can’t seem to find a way to add my birth name in there. I need a bit of help or advice.”

I answered a very similar question recently, so I am going to link to that post, Choosing a Middle Name, because I think it could be helpful. I would also recommend reading the comments. A reader suggested something that I didn’t even think of when I was answering the question, which is that the writer could have two middle names.

If you have a first and middle name picked out that you really like, but your birth name is special to you, use it as another middle name. You can even decide to go by one name in a professional setting and another in a personal setting. So don’t feel limited. Changing your name is an opportunity to have exactly the name that you want, so go for it!

A reader writes: “Do you know anything about the connection (or lack thereof) between testosterone and cancer? And any thoughts on how this might affect one’s decision to go on T?

“My second issue is, I am thinking about going on T to transition from female to male, but I have a really bad needle phobia. If I don’t miraculously overcome it, I won’t transition. The thought of giving myself shots for the rest of my life is too overwhelming. Do you have any advice or know anyone who has been in a similar situation?” (more…)

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Question MarkA reader writes: “My 17-year-old daughter wants to be my son. I fully support him in every way I know possible, and am currently looking into family therapy so that he can have a place to vent, receive validation, and navigate the difficulties of extended family and their varied reactions. I definitely need support as well, in that I want to understand and support what he’s going through.

“My question is about the actual transition. Ben would love to start college as a male, but knowing that it will most likely take more than a year, and lots of money, neither of which we’ll have before college, I just don’t think it’s going to happen. Where do we begin? Does insurance cover any of it? I have lots of other questions, but I’ve already downloaded your Kindle books, so chances are, I’ll find some of my answers there.”

First of all, thanks for being such a supportive parent (and thanks for buying my books). Now, let’s start by looking at some things that might be involved in a transition. I say “might” because everyone’s transition is different, and what each person desires and/or needs to survive is different. Here are some possibilities:

Legal: Name change; gender marker change on driver’s license, ID, other paperwork; change of birth certificate; change of school records/transcripts/diplomas; sex/gender change with Social Security; passport change

Mental Health: Evaluation and/or individual therapy; family therapy; “official” diagnosis

Medical: “Opposite-sex” hormones; chest surgery (implants, reduction, or chest reconstruction); hysterectomy/oophorectomy; genital surgery of some type; vocal cord surgery (generally for male-to-female transition); facial feminization or masculinization surgery; electrolysis; other body modifications as necessary/desired

Social: Coming out; adopting new gender expression/presentation, including clothing, hairstyle, mannerisms, and behaviors; restroom change; entering new gendered spaces and other social spaces; losing/gaining friends; family issues; workplace/school issues

Checking out family therapy is a good start. I would also recommend individual therapy for Ben, for a couple of reasons: If he is considering medical transition, which it sounds as if he might be, most doctors still require a letter from a therapist in order to prescribe hormones (ask your family physician what he/she requires in order to prescribe hormones for transition). In addition, therapy can be very helpful in planning and setting time frames, as well as in navigating some of the social difficulties that can occur, such as entering “men’s spaces,” coming out, and dealing with friends and loved ones. (more…)

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Question MarkA reader writes: “I am a 17-year-old FTM. I know my first and last name choices to change, but I am having a hard time on a middle name. I wanted to know how you decided on yours, and do you have any suggestions for me?”

Middle names are interesting, and they can be just as important as first names, depending on how you intend to use them. I chose my middle name (and my first name) based solely on what my parents were going to name me if I had been born a boy. But there are plenty of other ways to choose a middle name.

If you have one name that you absolutely love, then go with it. But you sent me a list of several that you were considering, which I’m not printing because it could identify you. However, here are some things I would suggest thinking about when choosing a middle name:

1. Preference: When you give your friends a list of the names you are considering, is there one that you secretly hope they will not choose? If so, eliminate that one, then give them the list of remaining names. Is there another one that you secretly hope that they will not choose? Then eliminate that one, and so on. If there is always one name that you secretly hope they will choose, then there’s your middle name.

2. Timelessness: Will your middle name stand the test of time? For example, Kanye West is huge right now, and maybe he is your favorite artist. But in twenty years, will you still want the middle name of Kanye? (Kanye will likely be happy with his name for the rest of his life, but he is Kanye West.) Think about how your name will stand up in twenty, thirty, or fifty years. Of course, your tastes will probably change, and you don’t know right now what they might be, but try to project yourself into the future. What name might you want? I would recommend avoiding “fads.” (more…)

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Question MarkA reader writes: “I am legally and anatomically female and 43 years old. I have presented as fairly gender-neutral for most of my life, and have always been bisexual in orientation, but relatively recently realized that I am really dissatisfied with my birth sex and gender.

“After extensive research on available options, I’ve decided I’m very unlikely to undergo surgery or hormone treatment, especially as I identify more as gender-neutral or possibly transmasculine than male. (I do intend to consult a therapist who specializes in trans issues for guidance in this area.)

“I am currently trying to figure out if it’s possible to have a viable gender-neutral identity. Fortunately I live in San Francisco, where all manner of gender expression is tolerated and even celebrated, but in some ways that makes it harder to show people that I don’t consider myself female; dressing more like a man will likely cause me to read as a butch dyke. As I’m much more sexually attracted to men, particularly bi and gay men, than women, that reading is problematic for me.

“In any event, I’ve decided that whatever form my gender expression ultimately takes, I do want to change my birth name, both first and last, to one that is gender-neutral and personally meaningful. I want to do this legally rather than just adopt a nickname, as my given first name is clearly feminine and I’ve had issues with my last name for years. I am 99% decided on what my new name will be, but I’ve run it by only my spouse so far as I want to be sure.

“I am struggling with how best to go about the announcement and process of my name change. I think it might be confusing to tell only a few close friends to call me by this name first, and then tell others later. I would rather do it all at once. But how to go about it? I’ve never had to reveal something of this magnitude before. When I came out as bisexual, and later as polyamorous, it was hardly a big deal, considering my social circles. This, however, is a momentous change, and that’s before even considering the legal aspects, with all the documents that must be changed and the associated expense. Any advice?”

First of all, yes, it’s possible to have a viable gender-neutral identity. You will probably run into the occasional “Thank you, ma’am, I mean sir, I mean ma’am” kind of thing, but if you have a strong self-concept and good self-esteem, you should be able to weather that. You will no doubt also run into some pronoun confusion, where sometimes you’re referred to as “he” and sometimes as “she,” but since you have presented as gender neutral for a while, you have possibly already experienced this. (more…)

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