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Question MarkWe 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. (more…)

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Question MarkA reader writes: “I turned 33 and for all my life, I’ve always tended to dress and act in a manly way. I don’t like the traces of femininity on my body but I learned to live with it. The last nine years I identified as a lesbian and was quite content, although I always felt something isn’t right.

“Half a year ago I realized that there is something as ‘transgender’ and it felt like the solution to my discomfort. I went to therapists and got my paper to start testosterone. I told few friends. First they were like, ‘No problem, that’s cool,’ but now when it turns serious, they tell me that they don’t see me as a man and that I’m doing a big mistake, I would mutilate a perfect body now and still not be a real man.

“I had myself a breakdown thinking about a new male name – everything felt ‘ridiculous.’ I know I have to know what is right for me, but some of the points my friend told me are torturing me. I am biologically a woman now. I am perhaps the outsider in look and behavior, but completely accepted among my female friends. In fact, I have only female close friends.

“I feel at ease around men, but they look at me as a woman and so I still don’t belong to them, which discomforts me again. I was socialized for 33 years as a woman and was always trying to fit in as best – I can’t cut out this part and I don’t want to lose my female friends.

“How was this transition for you? As I understand you had the bigger change from ‘girly girl’ to man. Did you never doubt you were on the right track? Did you lose your friends? How did you cope emotionally?”

While I think there are many people who have no doubts whatsoever about transition, having doubts is not uncommon. It can be a very scary thing. Many of the changes that come with testosterone are permanent, and changing a body that might not fit you, but that you have lived with for a long time, is a big deal.

But I honestly think that the body can be the least complicated issue for many people (and correcting a body that is absolutely not right is not mutilation, by the way). The social aspects of any transition can sometimes the most difficult. (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 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 having issues determining my sexual identity since transition from female to male. Dating and having a relationship are things I consciously took off the table while I was in the early stages of transition. It is now three years into transition and the idea of having someone in my life is sounding pretty good.

“Although I am attracted to the male physique and enjoy the visual of a handsome, sexually attractive man, I just don’t picture myself in a sexual relationship with a man, but I wouldn’t take it off the table. I am attracted to women, especially lesbian women. But I am not so interested in overly masculine lesbians. If she is more masculine than I am, I feel feminine and that makes me uncomfortable.

“But the thought of having my face in close proximity of a vagina just makes me uncomfortable, and I don’t know if that is an act I could perform. I am not sure if that distaste has to do with the fact that even though I have had some surprisingly impressive changes, I still consider myself to have a vagina and I don’t like it at all and I am looking forward to the day I have lower surgery.

“I don’t really care about labels, but my brain wants desperately to find a category to place my sexually identity in. So what defines sexual identity? Is it attraction to femininity or masculinity, a particular type of genitalia or what? I like to believe my sexual attraction revolves around the individual as a whole and not just particular body parts. I am so confused. What are your words of wisdom on the topic of sexual identity?”

Once again, we run into the problem and the necessity of labels. We are a label-making, category-making species, and because of this, labels can be both friends and enemies. They help us define ourselves, but they also limit our choices. The problem with definitions, which evolve from labels, is that many people have many definitions for one label. You asked for mine, so here goes: (more…)

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