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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: “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: (more…)

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Question MarkI have two letters with relatively short answers (for me!), so even though they’re not related, I put them together into one post. And here we have them:

A reader writes: “I’m a queer cis femme, and I have a number of close friends who, over the past few years, have come out as trans (FtM). I consider myself a strong ally, and I have had no problem adjusting to their preferred names or pronouns, but there is one issue that I am unsure about.

“In many cases, these friends and I share mutual friends and/or acquaintances who may or may not know of a trans friend’s past. When telling stories about various adventures or experiences with a trans friend who, at the time, did not identify as trans, which pronoun should I use?

“I don’t want to accidentally ‘out’ them to people who don’t know (or don’t need to know) the whole story, but I also want to stay true to my friend and true to the story. If we did something together – let’s say, went camping – then should I say, ‘She and I went camping last summer’ or ‘He and I went camping last summer’?”

The best thing to do, particularly if you are talking about relating stories about this person when he is not present, is to ask the person. You will need to ask each one of your friends, individually and privately, what he prefers if you happen to be talking about him to others when he is not present, particularly when those people don’t know that he has transitioned.

However, as a general rule when talking about a trans person’s past, whether he or she is present or not, the following two things apply:

1. Always use the pronoun that the person currently uses, even if everyone in the room knows that he or she is trans. For example, when referring to a trans man friend, you would say, “He and I went camping last year,” “He and I grew up together,” or “I’ve known him since he was five.” The same rule applies with trans women. You would always use “she,” regardless of the time period you are talking about. If the person uses a pronoun other than “he” or “she,” then use that one.

There’s nothing more aggravating than reading a news story about a trans person and seeing that the writer uses both pronouns to refer to the person, as if the writer’s sole purpose was to confuse the public: “She was a nuclear physicist prior to her transition from female to male, and then he became an astronaut.” Huh? No, he was a nuclear physicist prior to his transition from female to male, and then he became an astronaut. (more…)

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Question MarkToday we have three letters on various changes regarding gender/sex markers and names. So without further ado, let’s get started.

A reader writes: “I’ve heard that you shouldn’t change your gender marker on your insurance if you haven’t had a hysterectomy yet. What I’m wondering is what to do if you have never been on insurance, but will be in the future (hopefully around August or so). I’m planning on getting a court order to legally change my name and gender marker in a week or two.

“What if I need a hysterectomy years down the road after being legally male for years? When I get on insurance, can I just avoid gender, since they can’t legally require you to disclose (along with race/ethnicity)? And waiting isn’t an option (until after I get a job and insurance). I’ve waited seven years for this. I’m finally in a position where I can, so I’m taking this chance while I have it.”

Insurance is such a slippery slope. Insurance companies pretty much do what they want to do. I no longer have insurance, but when I did, and my employer switched to a new plan, I tried not putting any gender down. They looked at my name and put one down for me in their records – male. So even if you have never had insurance before, if you put nothing down, they will likely decide for you.

I didn’t know that insurance companies could not require you to disclose. The problem that you might run into, even if you put down nothing and they don’t choose for you, is that, if they agree to pay for “male” things, like hormones (if your doctor codes it as “low testosterone” or something), then they won’t pay for “female” things, like a hysterectomy or pelvic exams. If they agree to pay for pelvic exams, then they won’t pay for testosterone replacement. At least they will try not to.

Even before my insurance company chose my gender for me (based on my name, I’m assuming), I had insurance with another company where I did list myself as male. Every year, they denied my PAP test and pelvic exam claim, and every year, I appealed and won. I worded my appeal like this (or something similar): “I understand that you cover this procedure for people who have a particular set of organs, and I have those organs.”

It always worked, and I recommended it to my friend, who had a different insurance carrier, and it worked for him as well. So I would suggest either leaving the gender part blank and letting them figure it out, or putting down “Male.” That way, if you are male at your job, you won’t have to out yourself if you don’t want to, and even if you are out to human resources, you won’t have to be out to anyone in the organization who has access to your file. (more…)

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Question MarkWelcome to a special Thursday edition of Tranifesto, with more Ask Matt questions. I’m hoping to catch up on my backlog of questions, and, as always, I’m hoping that readers will supply their wisdom in the Comments section. Today’s questions are:

A reader writes: “I have a pretty scary question. I’m a trans man, and pretty early in everything, so I used to like looking accomplished trans men up online to have some celebrities to feel some sort of connection to.

“But then I noticed than trans men seem to die pretty young – at least the ones mentioned in ‘famous trans men’ lists all around. So many died before they were even fifty or sixty. And now I just saw another memorial post on Facebook for a guy who died, also before his 50th birthday.

“I know that it’s probably a coincidence, and that all the trans men who live long, happy lives are probably never heard of. But I just have this nagging fear inside that it might have something to do with medical conditions that aren’t being noticed because of bias in the medical system, or something to do with testosterone or … you get the picture.

“My doctor doesn’t know anything about anything, so now I ask you. Maybe you and your readers know something. Do you know if there is any kind of medical study of how trans men in general do medically after transitioning?”

The one thing I do know is that you will never get out of this life alive. I’m not trying to be snarky. You will die of something, and my philosophy has always been that I would rather die after having lived a full and authentic life than after having lived as someone I am not.

There are some health risks associated with testosterone, but for most people, these can be mitigated. From what I have read, trans men overall have the same life expectancy as non-trans men, which is slightly shorter than for women.

Some of the guys who you have read about have committed suicide. Lou Sullivan, a very famous trans man who is probably on many of those lists, died from complications related to AIDS. Robert Eads, another very well-known trans man, died from ovarian cancer. Both of these deaths were quite likely complicated by bias in the medical system.

Many of the guys you have probably read about would have died whether they transitioned or not. They might have had some overlooked or undiscovered health problem that would have killed them regardless. They might have developed a terminal illness that had nothing to do with testosterone. The only reason you know about them is because they were trans. (more…)

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Question MarkToday we have two short questions from readers regarding the effects of testosterone:

A reader writes: “So I am dating a guy ten years older than me, and I notice I have more energy. And then I read in a newspaper that cis guys’ T-level drops as they age. Ours won’t, of course, unless we become unable to shoot ourselves up. I can envisage that this might lead to an increasing gap in sexual energy and desire (this adolescence, now four years on for me, does not seem to stop). Has anyone ever commented on this one?”

The Mayo Clinic says that testosterone levels in non-trans men decline by about 1 percent a year after the age of thirty, and that lower testosterone levels can cause reduced sexual desire and less energy. But I have been on T for fifteen years and still have relatively high levels, and I definitely do not have the energy level or the level of intense sexual desire that I had during the first few years of transition. I think that is just a result of aging.

That doesn’t mean that older people don’t have energy. I know octogenarians who have more energy than I do (and a higher sex drive and more sexual activity). But I think aging does sometimes slow people down. I don’t know how old you and your partner are, but it’s possible that his lower energy levels could be due to decreased testosterone, general aging, or both. Your excess energy could be due to higher levels of T, youth, or both.

Ten years isn’t that big of an age gap, though, so I would think that, as you both age together, your energy levels might even out. For example, if you are now in your late thirties and your partner is in his late forties, that energy difference might be quite noticeable, but once you hit your late forties and your partner hits his late fifties, it might even out again.

And, as you said yourself, you are still in that “adolescent” stage of transition. Once that dies down, your sex drive will probably level out and you won’t feel as “deprived” (if you do) by your partner’s less-enthusiastic sexual desires. (more…)

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Question MarkI have several Ask Matt short questions, from voter laws to pronouns to sex drive, that have relatively short answers, so I am putting them together in an Ask Matt Potpourri, and am hoping that readers can help out as well. So here we go:

A reader writes: “I am coming out late in my life. I am 65. I am on phytoestrogens. I am an avid shopper for feminine clothes and such. I am totally happy, but money is a big issue. Any suggestions you could give me would be a big help.”

I turn to my trans women readers for some shopping suggestions, but I always recommend thrift stores, such as Goodwill or ARC, for clothing needs, particularly in the early stages of transition. Money is often tight for trans people, and many of these second-hand stores have fantastic clothes as bargain prices. They also have sale days or senior discount days, where prices are reduced even more.

And even if money was no object, I would still recommend thrift stores for both men and women just beginning transition. Hormones change the shape of the body, redistributing fat and increasing or decreasing muscle mass, so it’s almost counterproductive to spend a lot of money on a new wardrobe when you don’t know what your body will look like in a year or two. That great dress, shirt, or pair of jeans that fits now might not in a few months. Your tastes might also change as you move through your transition. So don’t make a major investment up front, and go where the bargains are.

A reader writes: “I’m a teen FTM and I’ve recently switched to male pronouns (my friends and family on board, of course). Although whenever someone is talking about me with ‘he’ and such, I often forget that they’re talking about me at all! I’m so used to ‘she’ that I haven’t really connected with ‘he’ yet, even though I want to. Is that a normal feeling for a new trans person? If so, how do I get used to my new pronouns?”

I think this is very normal, because “she” is all you’ve ever known. When I started transition, I sometimes even referred to myself as “she,” and I often turned my head when people said “Jennifer,” even though they were talking about someone else. I also turned around when people said “Ma’am,” even though I knew they weren’t talking to me. That one actually took a couple of years to go away entirely.

As a teenager, your brain is still developing, which is actually a positive thing for you, because it might make it easier to form those associations with regard to your new pronouns. But it’s still going to take time. The more you hear them, the more familiar they will become, and the more they will seem like you. You will “grow into” them.

Be patient. The brain is extremely adaptable, but it also needs time to adjust. Give yourself at least a few months, and soon you won’t even acknowledge female pronouns, because they won’t seem like “you” anymore. (more…)

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