Unfinished Business

Published / by rmaddy / Leave a Comment

Occasionally a patient or family member will call the ER to say that they are on their way in to see us.  Similarly, radio traffic alerts us to the dispatch of ambulances in the surrounding communities.  I refer to potential patients not yet within our walls as “lurkers”.  Thus, when asked if I am busy, I might respond, “3 here, 2 lurking.”  The lurking patient has already entered into my problem-solving calculus, and perhaps not in the manner you might expect:  lurkers count double.1

Why, you might ask, should this be the case?  Is not a bird in the hand worth two in the bush?  Quite the opposite, as far as I am concerned.  There are many words that might be used to describe what I do at work:  diagnostician, comforter, risk manager, explainer, and so forth.  In order for me to be an Emergency Physician, however, something else must be in the mix.  I am someone who finishes shit.  I meet people, enter into their dilemma and, to whatever extent possible, solve the problem.  At the very least, I figure out how it is going to be solved.  Quickly.  Perhaps you have a physician who knows you like a neighbor and who will walk with you through decades of sickness and health.  That’s not me.  I’m the one who checks out at 7:30.  I do as much as I can as well as I can, then I go home.  I am a specialist of the first hour, sifting through the problems of the day and always trying to be maximally prepared and available for the next bad thing that happens.  You need me to have such an outlook–the next disaster might befall you, and you will want my full attention at that time.

A lurker is a person I cannot yet help, a problem I can not yet solve.  If the lurker would kindly arrive, then we might make some progress together.  A job begun really is half done, as far as I am concerned.2  Until then, I have unfinished business.

I dislike unfinished business.  I paid off my 30 year mortgage in 12.  Don’t ask me to pledge x number of dollars for every mile you walk.  Tell me rather how much you want and how I can complete the transaction online right now.  No, I’m not interested in a wine-of-the-month club, and hell yeah–I belong to Amazon Prime.

By now you’ve guessed the segue, and if it sounds familiar, I think it is because I have riffed on it before:  transition is seemingly endless.  Whether it is actually endless, I cannot say.  I have met plenty of people that speak of completing transition in such and such a year, but the very fact that I have met them usually owes to their presence in transgender support groups.  Maybe they are Bodhisattvas, remaining among the transitioning to help us along our way.  Following that analogy, though, I wonder if transition, like enlightenment, is more something that you habitually do than a place you arrive.3  Use it or lose it.

But oh, how I hope it is a destination!  I even know what it would look like:  a state of happiness and coherence.  In this respect my goals are not much different than those of anybody else.  It doesn’t really matter how one gets there, so long as one gets there.  If the journey  itself is the reward, however, then I could end up nearly anywhere.  One can get in decent shape even by running after nothing, but in line with my introduction, I have always proceeded under the assumption that the point of a race is to break the tape at the end.

There you have it–a perfect recipe for my restlessness and a plausible explanation for why I intermittently flip out.  For me, there is not a reliable degree of joy in the journey, only the sense of not having arrived.  A friend of mine bears a tattoo stating, in oriental script, “Not all who wander are lost,”4 but I secretly suspect a healthy percentage actually are.  I certainly am.  This is hard…really hard, and I don’t know if I’ll ever, as the Scots say, “Get on wi’ ae.”

I believe people who say they have completed transition.  They own their stories, just as I own mine.  The sense I have gotten from speaking to several who have said so and from reading the blogs of others though is that they are referring very specifically to gender confirmation surgery (GCS), i.e. when they had their fun bits rearranged.  This is certainly understandable, since society in general thinks is what transition means.  Apparently, at least for some,  this really can be the end of the road.  The tricky part is that we are all on different roads and I don’t think we can infer too much from the experience of others.  The end of my road, you recall, is primarily defined by a mental state–happiness and coherence.  There doesn’t seem to be any guarantee that these things follow surgical transition.  The people I know post-GCS appear to fill a broad spectrum between happy and miserable.  Having major surgery because someone else said it helped them is flawed process.5

I experience transition as a mental phenomenon.  It is in my mind that I envision happiness/coherence and in my mind that I suffer its absence.  When you ask me how I feel, I think I can safely assume that you refer to my mental state, not my genitals.6  I publish my story largely to help me “think things through”–now there is a metaphor–hoping along the way to help the next transgender person do the same.  When I blew an emotional circuit breaker last month, I called my psychiatrist, not my endocrinologist.  It is in my mind where my demons lurk7, and it is there that I go to fight them.

I was raised this way, taught that my mind would “take me far.”  In some sense, it has, and yet I recognize that my religious upbringing thoroughly stigmatized “the flesh” as corrupt.  I often wish that I had recognized myself as transgender when I was younger, but I don’t see how that would have been possible.  I didn’t have the tools.  Speaking to another issue, but with great eloquence, my sister once remarked, “We were raised without bodies.”  She has since found hers back but I am still looking.

I have moved on, but I still tend to forget that the mind/body dichotomy is a metaphor.  It is often a useful metaphor, but metaphors have their limits.  We ought not to eat the menu.   Humans do not think, octopus-style, with their arms, but the brain is nevertheless thoroughly embodied.  When I deal with depression, I experience physical pain in my upper abdomen strong enough to wake me from sleep.  In my summary of a year on estrogen, I recounted what I was hoping it would do to my mind, and how surprised I was by how quickly it was messing with my body and that the things it was doing to my body were affecting my mind.  Well, duh…I need to stop being shocked by the obvious.  The term transgender would be meaningless if I had no body.

I have a body.  It’s that tall thing that glares at me from the other side of the mirror, every damned time I look.  It knows that I don’t like it and I can tell that the feeling is mutual.  Lately, just to piss me off further, it has been getting older.  Perhaps someday we will call a truce, but for now, we scowl at each other like old enemies, each demanding that the other surrender.

Unfinished business.

 

 

There are no happy endings.
Endings are the saddest part, 
So just give me a happy middle
And a very happy start.

Shel Silverstein, Every Thing on It

Footnotes

This or That?

Published / by rmaddy / Leave a Comment

My name is Renae Gage1 and I am a binary thinker.

If I was ever anything else, it was far away and long ago, lost even to memory.  Not 100% of the time of course.  It do hate peas and carrots more or less equally, and I observe that some folk really are a little bit country and a little bit rock and roll.  Nevertheless, binary thinking is my tragic flaw, the pit into which I regularly fall.  “As a dog returns to its vomit,” offers the scriptures, “so fools repeat their folly.”

Speaking of which, I blame religious indoctrination for this rut in my thinking.  I was raised on Heaven and Hell, good and evil, darkness and light, blessings and curses.  The stripe of Christianity which I was force-fed does not do nuance well.  Whether this only amplified some innate tendency within me or produced it out of whole cloth, my reflexes are honed to a razor’s edge.  Where others see similarity, I see difference.  My contrast knob 2 is dialed to the maximum.

The fact that I have rejected the crucible in which I was fired is of no consequence–the pattern is etched in my brain, and there isn’t a hell of a lot I can do about it.  In fact, the manner in which I extracted myself from religion looks just as binary–some people just file their faith on a dusty back shelf and ignore it.  I sent mine packing, barred the doors and secured a restraining order lest it ever contemplate a return.

Being a binary thinker is a serious bummer as a transgender person.  It has taken a Herculean effort for me to understand, for example, gender as a spectrum or, even more, as a social construction.  To be sure, I understand it up here, but not so much in here.   Note to self:  add head/heart to my list of artificial binaries.

It seems that the difficulty is primarily internal.  I have friends who reject gender completely and I think I am able to take their assertions at face value.  Nor would I think any less of another trans person who told me that they don’t fit neatly into the boy or the girl box.  I thoroughly accept that people are, so long as they are honest, exactly who they say they are.

For me, however, the binary tyrant lives.  I am unable to shrug at my variance.  Every day, I run into people who are ostensibly 100% male or 100% female with the singular exception of my morning encounter with the mirror.  I can opine until I am ROYGBIV3 in the face about gender as a spectrum, but waiting for me around every corner are two little boxes labeled “M” and “F”.

Nor is it just me, society.  I hear your “Good night, ladies.  Good night, Renae.”  I feel your hand-crushing handshakes and bro hugs.  I notice the angle of your lip when you stare at me in the checkout line.  Nevertheless, I recognize the steep discount I am getting.  In some places, the price is much, much higher.

I don’t believe in a world without gender.  I don’t feel genderless.  I feel feminine.  While the younger generations may be starting to chip away at the moulds, most of us were already hardened in them.  I’m told that I need to let go of the binary.  What if I can’t?  What if this also is simply something that is?

I’ve had the privilege of meeting more and more trans people.  Some are happy and others not so much.  Almost none of them are “embracing the broader gender continuum”.  To an individual, they all seem to be crawling into the “other box” and closing the lid.  The ones who fit in the box better seem to be happier.  Maybe that’s all you can do.  You can’t beat everybody.

Into the darkness

Published / by rmaddy / 6 Comments on Into the darkness

The first storm of winter is upon us.  The early indications predict that we will escape the heavy snow this time, but we have already been treated to gusting winds, steeply dropping temperatures and some sort of snow/sleet/hail thingie that didn’t do any damage, but produced an absolutely deafening roar on my windshield as I headed into work this morning.  Twas the witch of November come stealin’, as the prophet Gordon1 once intoned.

As much as I hate winter, I love a good storm.  Any storm.  I love “sheltering in place,” as they say, looking across the hills and fields out the back (southwest) windows of my home.  I don’t cower in the basement.  I grab a camera.  I step out of the front door to welcome the arrival of the new wind, to take in its measure and flavor.  In my formative years, I loved to go for a run during the height of a downpour, especially when the streetlights were knocked out.2  Like Lieutenant Dan, I climb to the top of the proverbial mast and taunt the sky:  “Is that all you’ve got?”

But not all storms are weather.

There are other kinds of storms which terrify me.  They paralyze–stunning me with a dizzying barrage of emotional lightening and pounding me with the thunder of confusion.  The very foundations of my life erode and I cascade downstream into Mare Crisium–the Sea of Crisis.3  It is there that, for the last several weeks, I have been treading water, at times with some success, but occasionally sinking beneath the waves of doubt.

Enough with the metaphor?  I suppose, but then again, you have never known me to be a particularly linear writer, and, as I have found myself saying more than once recently, I am not at my best.

I prefer to narrate the storm from the relative safety of its aftermath.  “Hey, things got bad, but look at all the nifty rainbows now!”4  I seem to be okay with vulnerability, but usual only with a certain degree of retrospect. I am not immune to shame.

I struggle to find a pathway into describing my whereabouts, but I think the storm is the best place to start.  I am prone to disruptions.  They strike without much warning and make a tangled mess of my thoughts and self-confidence.  If there are warning signs in advance, I am blind to them.  They are infrequent enough lull me into the delusion that they are done and gone.

Almost exactly three weeks ago, I was beset by crippling doubts about my identity.  True, there has always been a “female gravity” bending the trajectory of my life in the direction with which you have become familiar, but this crisis began with an overwhelming sense that, wherever I seem to be headed or feel I need to be, where I am isn’t identifiably feminine to most people, nor, during these dark hours, to me.

The disruption seems to be centered on two perceptions which still loom large in my present state of mind.  First, it is far more than the physical which separates me from other women.  I have been denied (or spared) the particular rhythms and discomforts of feminine physiology, but perhaps even more significantly, I have missed out on so many formative experiences:  I did not grow up in a world which devalued my gender.  I have not been groped or ogled by predatory men.  My size has conferred upon me a degree of protection from conflict.  I have been rewarded, not chastised, for “speaking out”.  I have made one dollar on the dollar.  I have not been asked on a date, nor spent any time worrying that this would never happen.  I have not spent a lifetime being conditioned to fret about my beauty.5  Not only did I get math (many women do, of course); I learned early that I must get math.  Though I have always made friends with women far more naturally than with men, have I ever truly convinced either them or myself that I am one of them?

I am unsurprised that this hit me so hard during the run up and run off of the election, whether or not this was actually the trigger.  Misogyny offends the hell out of me, but have I ever actually felt it?  As much as I desired the election of HRC, would it have produced any sense whatsoever of existential validation for me?  I was born into nearly every privilege imaginable.  What right do I have to see myself as a citizen of Pantsuit Nation?

The second perception was that my identity seems to be largely aspirational.  Am I female or do I simply experience intense conviction hat I ought to be?  I was trained to believe the unbelievable–is this simply the latest version?  Yes, masculinity took effort for me, but does femininity take less?  Without imaging that other women sail from moment to moment free of self-doubt, I observe that they never have to spend a moment convincing anyone else, let alone themselves, of their gender.  I do not think that this is merely to say that I don’t pass in society.  The question is whether I even pass to myself.  I fit the typical profile of a late transitioning transsexual–white, XY socialized male, melancholic, above average intelligence6.  Is there any sense in which transphobic critics, who see my identity as a sustained delusion, have a point?

Suffice it to say, the last several weeks have sucked mightily.  For the first 4-5 days, I was back to being a squirrel in the road, unsure which direction to run and consequently immobilized in front of the approaching headlights.

“Forward?  I can’t go forward!  Back?  I can’t go back!  Oh God, I definitely can’t stay here…”

My brain flip-flopped rapidly, wanting desperately to decide or better, to do something, and yet I knew there was nothing to do.  I just wanted to go back to bed so I could shut it out for a bit.

Fast forwarding a couple of weeks, the intensity has dialed down a little, but I’m still “dazed and confused”, and worse, worried that I won’t ever be able to un-think some of the thoughts of the last couple weeks.  And there is no resolution, no personal victory to report.  I still feel the wind and hear the thunder.

More ominously, this is the first time I have gone through this post-hormonal therapy.  There is certainly a lot more to the sense of calm and general well-being I have tried to convey beyond freedom from crisis, but until now, I really did have freedom from crisis.  For 18 months.  Even more, it had the feeling of resolution.  Peace was the benefit of therapy that justified the various downsides.  What now?

I don’t really know, and I don’t know when I will find out.  Sorry, there is no moral to this story.  Sometimes there isn’t.

 

 

Notes:

Out of the Woodwork

Published / by rmaddy / Leave a Comment

Minnesota…ever a blue state.

We’ve doubled, it seems.  In 2011, the William Institute (UCLA School of Law) estimated that 3 out of every 1000 Americans–a total of 700,000–identified as transgender.  Now, their most recent study suggests that the actual figure is twice as high.  1.4 million, or 0.6%, of Americans identify as transgender.  The vivid blue color of my home state, above, indicates that Minnesota has the highest proportion of transgender residents in the midwest.1

I see this as very, very good news.  At this rate, we will take over the world in less than 40 years, well ahead of schedule.  Long live the transgender agenda!  Chill the champagne and check to see if Lady Gaga is busy in the summer of 2055…

Of course, it might just be possible that the doubled estimate has nothing whatsoever to do with an increase in transgender people.  More mice crawling out of the woodwork could owe to a bumper crop of pinkies,2 but it might also mean that the cat has gone on vacation.  Translation:  it is likely that more transgender people are being identified because they are less afraid to be out.


Being transgender in a small town can be a lonely business, but not everything is as it seems.  Before I came out (somewhat before the 2011) survey, I could have never imagined that there were 20 other trans people in my little hamlet.  If this were the case, why wouldn’t I have already met some?  Such is the ironic reasoning of the closeted individual.  Invisible at the time myself, I wondered that others were not more apparent.

Eventually3 I realized that I hadn’t met other transgender people because I had never tried, and I really wasn’t paying much attention.  Further, I came to grips with the fact that I was afraid to meet others like me.  What if I didn’t like them?

I got out more.  I tried a couple of support groups.  Most of all, I stepped out into the open myself.  There is simply no better way to meet transgender people than to be openly transgender4  Fairly quickly I discovered that belonged to a largish cohort of people that I had never even noticed before.

Additionally, I found that the skill of noticing gets better with practice.  Walking through my town festival last week, I spotted several transgender people in the crowd.  There is sort of a secret nod that increasingly happens.  In my medical practice, I meet upwards of 1000 people every year.  I suppose that my social interactions add a few hundred more.  The current research suggests that about 1 out of every 170 are trans.  I do directly experience that proportion, but I no longer doubt that it is the case.  Not everyone who is trans is noticeably so.  Some are not out at all and are performing their expected gender.  Others have the privilege of passing,5.  And, if I’m honest, most of the time I’m still not paying attention.

I still feel like a zebra among horses, but there really is a degree of strength in numbers.  Besides, one could do far worse than to be a zebra.

Vote Trans 2016

Published / by rmaddy / 1 Comment on Vote Trans 2016

What a difference a year makes.  At this point last fall, I predicted that anti-transgender bills would continue to proliferate (as they did in 2015) and that transgender rights would remain a contentious issue in state and national politics.  Instead, 2016 has become a referendum on economic and racial grievance as well as an increasingly nauseating contest of personalities.  Yippee!  We’re off of the hot seat, at least for the time being.

I’m sure that your political views, like mine are a conglomeration of a variety of opinions to which you give degrees of weight as you approach election day.  Trans issues, as you might expect, are weighted rather strongly in my calculus.  That you are reading this at all leads me to expect that you assign some importance to transgender politics, but what, if anything, does that mean in a practical sense as one enters the voting booth?  In other words, what might it look like to “vote trans” in November if nothing else mattered to you?

Presidential

Four candidates remain for the Presidency.  Reading “from left to right”, their positions on transgender issues are as follows:

Jill Stein–thoroughly on record in favor of LGBT rights, she also states explicitly that transgender rights fall under the heading of existing protections against discrimination based on sexual identity (similar to the declaration in the Minnesota Human Rights Act of 1993, which defines transgender identity as a sexual orientation).  Some trans advocates chafe at this designation.1  Nevertheless, this approach works has resulted in durable human rights protection for trans people wherever it has been enacted.  In other words, there is a semantic quibble, but no broad concern on policy direction.

Hillary Clinton–consistently supportive of transgender rights and inclusive of trans people within her circle of advisors.  As Secretary of State she changed changed the internal policies to prevent anti-trans discrimination and re-wrote the procedures for issuance of a passport such that trans people do not need to prove a history of genital surgery prior to changing their gender marker.

Donald Trump–apparently personally disinterested in LGBT rights as a political issue.  There is no evidence that he discriminates against LGBT employees in his business.  His only public comment on trans rights during the current campaign indicated a belief that transgender people should be allowed to use the bathroom facilities with which they felt comfortable.  Due to a reaction from his party, he subsequently walked this back, saying that he would “leave it up to the states.”

Despite managing to insult nearly everyone during this campaign, he has not made any truly inflammatory remarks against trans people.  He somewhat famously said that if Caitlyn Jenner came to his hotel, she could use the women’s room.  During primary season, his relatively easy-going attitude about the LGBT community stood in stark contrast to the nearly daily anti-trans pronouncements of his closest Republican rival, Ted Cruz.

That said, trans people have some cause to be wary of Trump’s candidacy, if not his personal opinions.  First, trans people aren’t generally comfortable with dealing with transgender rights at the state level.  During a recent business trip, my stopover was changed from Phoenix to Dallas/Ft Worth.  On landing, I could not recollect whether using the women’s room was illegal, and I believed (with some cause) that the local culture in which I found myself was substantially more hostile than the Land of 10,000 Lakes.  When, in the past, we have left civil rights up to the states, the end result has tended to look like a historical re-enactment of the Confederate succession.

Second, Trump nominated Mike Pence to serve as VP.  Pence was the pioneer of so-called “religious freedom laws” at the state level (as governor of Indiana) which were written in such a way as to open the door for sanctioned discrimination against LGBT people.  True, he ended up walking back this stance after threats of a national boycott, but he established the template that North Carolina, Mississippi  and others would subsequently follow.  The media have tended to interpret the appointment of Pence steadiness to counterbalance Trump’s erratic nature.  LGBT people see Pence as a dog whistle to culture warriors.

Third, Trump’s publish list of potential judicial appointments (which was lifted wholesale from a pre-existing RNC list), includes a number of justices who have already voiced opposition to gay and transgender rights.  Whatever Trump’s personal tolerance toward LGBT people, he shows no reluctance whatsoever to throw us under the bus to appease his base.

Gary Johnson–supports LGBT rights in general, stating a libertarian desire to “keep government out of the bedroom.”  Although he has not said much about transgender rights, he was early, at least among conservatives, to support marriage equality.

In summary, a voter prioritizing candidate stances on transgender rights above all else would have most cause to trust Clinton, but might comfortably end up backing Johnson or Klein as well.  Trump the man doesn’t seem to harbor any personal animus against trans people,2 but Trump the candidate has taken on associates and policies far more hostile to the advancement of LGBT rights in calculated moves on the pathway toward his election.

In the grand scheme of things, however, the trans-conscious voter probably would not sweat the Presidential election too much, if at all.  The reason for this you have already guessed:  the battle lines in the battle for transequality are drawn not so much in Washington DC as in the state houses, city councils and school boards.

As I mentioned, the wave of specifically anti-trans legislation (mainly bathroom bills) we saw last year seems to be losing a bit of energy.  There are a few reasons for this.  First and foremost, the corporate response to such legislation was swift and unambiguous.  Companies will halt expansion or worse in states that pass bigoted laws.  Transphobia, like homophobia is bad for business.

Second, in anything beyond the reddest of states, voter backlash is a real problem for those facing election.  I have previously written about the 2012 Republican implosion in Minnesota after their bigoted crusade of 2010.  More recently, Governor McCrory, the architect of North Carolina’s anti-trans bathroom law is poised to lose his re-election campaign, and there is concern within that state’s GOP that the backlash against McCrory might spill over into the Presidential election, essentially blocking Trump from any chance of victory.  If McCrory loses, which seems increasingly likely, his political career is over.

Finally, state and federal courts are ruling against such laws.  There is a growing sense that the issue of transgender equality will be resolved much in the same way that marriage equality was in 2015.  Both pro- and anti-equality advocates suspect that a game-changing ruling is coming, making expenditure of political capital on what will likely prove to be temporary legislation does not make sense.  Instead, each side is nationalizing the fight, hoping for a more favorable court.  Meanwhile, trans-conscious voters can become more savvy voters by carefully listening for the dog whistles within the broader campaigns.

The most shrill is that religious freedom is under attack.3  Of what does this attack consist?  If the “corrective” legislation is any indication, the threat is that it is becoming more difficult to discriminate against others with impunity.  In addition to anti-trans proposals, there are growing movements to favor “European”4 and Christian immigration despite the fact that the most severely oppressed refugees are brown and Muslim.  Churches still pay no taxes, enjoy broad protections to discriminate in their hiring/firing practices even when it violates federal law, and polls regularly demonstrate that Republicans would sooner vote for Democrats and vice versa far more readily than either would vote for an atheist.

Lately, an even louder chorus is booming: we must protect our children.  Not from poverty, inadequate education, measles, air pollution, racism or school shootings.  No–our children are threatened by transgender kids, who are willing to subject themselves to anxiety, social ostracism and daily abuse in hopes of seeing your kid partially naked before gym class.  Be afraid.  Be very afraid.


At the beginning of this post, I enjoined you into a thought experiment in which you would vote based on transgender issues alone.  Let us put that thinking aside once again.  I do not advocate one-issue voting.  Nevertheless, if someone you know is transgender, or if trans people simply matter to you in general, elections are a time of great angst and greater opportunity.  I would ask you simply to factor our concerns into your electoral calculus.  Whatever your political assumptions, please do not leave your voting decisions until the afternoon of November 8.  Read.  Ask.  Contact.  Consider.

Vote.

Puberty–The Sequel

Published / by rmaddy / 1 Comment on Puberty–The Sequel

Time flies when one is sitting on one’s ass, soaking up the scents and sounds of summer and not writing a blog post before its time.  Tempus fugit…it’s time.  I spin for you today a medical odyssey, about why I decided to revisit the biochemical shitstorm of adolescence, what I gained and lost along the way and my best guesses about what lies ahead.

I speak, of course, about cross gender hormone therapy, which I will hereafter abbreviate as HRT.1  You have likely gathered that I am not especially reluctant to make personal disclosures2 about my gender identity.  In fact, in this case, I find it preferable.  After the experience of being closeted, I dislike secrets in general, and speaking about my medical choices openly not only spares me the nuisance of potentially having other people speculate about them privately, but also provides some comfort those who might otherwise might misinterpret some of the physical changes discussed below as illness.

I made the decision to start HRT in hopes of feeling better.  Specifically, despite good I made the decision to start HRT in hopes of feeling bettersocial support, regular counseling and antidepressants I continued to experience fairly crippling gender dysphoria.3  Over the years I did my best to put a brave face on, but those closer to me tended to notice that I was anxious as hell and at best “getting by”.  Short of hormonal therapy, I felt that I had done everything else I could to address my daily distress.  Unfortunately, they didn’t solve my actual problem–the unrelenting sense that I was living the wrong life.  Case in point:

I recall roughly 18 months ago, sitting in Dairy Queen with my son and his girlfriend.  I was so strung out on antidepressants that I was falling asleep in my french fries.  He grabbed my hand in almost a parental way and said, “Dad, why are you taking medicine when it only makes you feel worse?”  I was just alert enough to realize that this was a damn good question.  Not every day was such an exercise in misery, but I certainly got the sense, over the long haul, that I was painting over the cobwebs, caught in a downward spiral and unable to break my fall.4

Improved mental health was therefore my primary goal..  Still it is undeniable that I recognized that I would potentially be given a tantalizing opportunity to see life through different eyes.  Regular readers might be thinking, “Wait! You have tended to dismiss most accounts of male/female brain differences as not only greatly overstated, but also carrying significant potential for justifying sexism.”  Quite so.  Still, the distinction I make is that while both men and women have versatile brains with amazing and essentially equal capabilities, it still might feel better for a brain which continues to recycle thoughts of being the opposite gender might feel better with the hormones associated with that gender.5  Well, along comes a chance to discover whether this opinion would hold up under the weight of personal experience.

Therefore I decided to keep, for my own edification and that of any other 50-ish transwoman6 who might be considering the same course, a symptom diary chronicling any changes I encountered as they happened.

Soon I learned that this was madness.  The timescale of hormonally-influenced change does not lend itself well to real-time reporting.  Within a couple of days, I realized that what I was doing was akin to watching the moon track from one horizon to the other.  Sure, you can stare at it from east to west, but most of the time it looks like it’s just hanging there, and you might be better off taking a nap and coming back to check its progress later.  It has now been a year–nap time is over.  Here is what I noticed, roughly in order:

My nipples hurt.  As in really hurt…starting within a week.  For several days I assumed this was my imagination.  Until, that is, I ended up clumsily juggling a box as I was carrying a load of junk into the garage.  It bumped against my chest and produced an instantaneous stream of tears which clarified the situation.  Something was already happening in my breasts.

My first thought was, “WTF.”  Then, “One week?  WTF?”  Recall that my primary goal for HRT was improved mental health.  Of course I knew that physical changes were just as likely, but my research had led me to believe that as a Way-Post-Adolescent patient, not much was going to happen in the mammary department.  That much is probably still true, but I had more or less expected that I would be able to figure out whether estrogen was good for my brain long before it had much effect on my body.  This, indeed, was my brilliant plan.

With that delusion safely in the wastebasket, I immediately had to reconsider under what conditions I would remain on HRT.  I had not made a lasting and permanent decision to take estrogen.  Now that I knew that physical changes were definitely going to proceed mental, I deftly reframed the “experiment” of therapy. I would give HRT a “reasonable amount of time” to work on my psyche, then decide whether or not to continue.  “Reasonable amount of time”, in this context, now meant “Damned if I know”.  Farewell, Caution, my dear friend.

Fortunately, I suppose, nipple-itis was the only thing that happened for quite some time.  It also settled down to a dull roar after about 3 month.  Although HRT produced more of a “flip of a switch” change in my hormonal balance than adolescent females likely experience, I assume that they experience something similar.  Let’s just say that I overlooked this morsel of information the first time around and never got around to reading the memo.  At any rate, I had re-entered puberty with reckless abandon.  What could possibly be more quintessentially adolescent than awkward body changes followed by a big, fat juicy helping of nothing in particular?  “Here you go, my child.  I grant you proof that your body is changing and equally compelling evidence that it is not.  Enjoy.”

During the next few months my discoveries were few.  I alluded to one of them in the preamble.  I discovered that I was overthinking the issue.  It was neither useful nor healthy to pick my brain for signs of new ways of thinking than it was to measure my chest regularly.  This did not, of course, stop me from doing either, but I put the “symptom journal” away, thereby saving me a colossal waste of time7

The second came in a eureka moment while exercising.  I did not smell like festering, putrid death.  My spouse reports that she sometimes gets grossed out by her body odor after a workout, but in terms of acrid, buzzard-gagging funk, she has never been my equal.  Rather abruptly, my sweat chemistry seemed to have changed.  I do not sweat any less–at least I think I don’t8–but I clearly sweat differently.  It was subtle, but undeniable.  I now had two clear changes to report, and the second, like the first, was physical.  Mostly physical, anyway.  I took pleasure in the change in my scent.  It felt distinctly positive.

I suppose by this time I was about 2 to 2 1/2 months into therapy.  Everything else was business as usual.  I continued seeing my counselor, thus affording an opportunities to reflect on the latest answer to the question, “What’s new?”  I tried to exercise regularly, although I didn’t really keep up.  I kept blogging.  I wondered if HRT would ever be something I would want to disclose.  I watched the leaves of summer turn to gold.  I waited.  And waited.  And waited.

Perhaps waiting is too strong of a word.  It would be closer to the truth to say that I forgot, at least to the extent that it is possible to forget something that involved giving oneself a weekly injection in the leg and taking a pill every morning and night9 which more or less guaranteed that the nights would involve quality time in the bathroom.  Enter emotional observation #2.  After several weeks of learning to get over the crazy-overblown fear of needles, I started to look forward to Wednesday mornings.  As much as I hated the shot (it’s not bad–estrogen is a bit syrupy, but doesn’t sting), it felt worthwhile to do it.  I’m not exactly sure why.  Perhaps it was ritualism.10  I speculated at the time that perhaps I was patting myself on the back for the small potatoes bravery of doing something mildly uncomfortable for purposes of feeling better, even though I didn’t feel better yet.

Until I did.  When it comes right down to it, I can’t put my finger on when precisely I noticed.  My best guess is November, roughly four months in.  Partially, this is because I had developed a recent ritual of going bat-shit crazy in November and this year I didn’t.  Instead, I asked my psychiatrist if he had any objection to me tapering off my anti-depressants.  When he asked my why, I said that I didn’t feel like I needed them any more.

I would beg the reader not to see this as a euphoric salvation story.  I still struggle with my mental health rather fiercely.  I am at least as prone to anxiety as before, for example.  I’m just feel better overall.

Mission accomplished, as far as I am concerned.  Barring some major development that forces me to reconsider, I intend to stay on HRT indefinitely.  Physical changes ended up being fairly minimal, at least so far.  They may or may not continue, but these were never the objective.  The way I saw it, changing my body would be of no value whatsoever if it did not change my brain.  In ways that are too vague to describe and too striking to ignore, my brain is changing–barely…I think.  I described it to my friend thusly:  “It’s still my same old brain, but now it’s marinating in the right sauce.”

That’s it, for the most part.  I keep waiting for some biochemical shoe to drop.  Supposedly, my body fat will redistribute.  Ironically, I’ve lost a shit-ton of weight recently, and I just look a bit more gaunt.11  There is nothing to redistribute.  This brings me back to boobs.  Very little followed the initial discomfort.  I transiently gained, but subsequently lost, about an inch on my “first measurement”.  If it looks like my bust line has changed, it’s mostly that I have figured out how to dress.

I would be remiss if I did not add that for every action, there is indeed an equal and opposite reaction.  Taking estrogen does’t make one’s penis fall off exactly, but let’s just say it’s not growth serum either.  Needing to draw a curtain of privacy somewhere, I’ll not say more other than that decreased male sexual expression neither caught me by surprise nor bothered me much.  Why would it?  I’m transgender.

I remain curious.  Will my second adolescence leave me feeling more at home in my skin than the first?  Will I wake up some day having forgotten male privilege?  Alas…these remain works in progress.  Meanwhile, I wait.  I reflect.  I measure.  But I should not look so often.  The moon makes its way, ever so slowly toward the western horizon.

Transgender Parenting

Published / by rmaddy / 4 Comments on Transgender Parenting

I take it as as sign of remarkable progress that no one wished me a Happy Mother’s Day this year.  Earlier on, this happened fairly often…certainly understandable given my gender transition.  There are no published data, but I suspect most transgender parents switch parental titles right along with their names and pronouns.  The fact that I didn’t do so probably makes me a bit of an outlier.  1The absence of maternally-themed well wishes therefore reflects a nuanced understanding of my story which was not evident in earlier years and which I greatly appreciate.

Of course I found myself secretly wishing this morning that I wouldn’t be wished Happy Father’s Day, either.  I welcome the sentiment, but mismatched gender cues sting the ears even when clearly offered with the finest of intentions.  It’s all a bit messy, isn’t it?  Sorry.2

To my kids, though, I am still “Dad”.  This reflects a number of different things particular to my own personal thinking and circumstance, and not necessarily representative of the trans community in general.  First, I have watched my spouse take up and embody the fullness and beauty of motherhood in an an intuitive way that I have never experienced.   I would personally think it hubris, if not sacrilege to see myself as her equal.  Read this with a generous helping of “in my experience”.  Many other trans people negotiate their family dynamics in other equally valid ways based on their own personal understandings.  Perhaps my late transition is part of what makes motherhood inconceivable for me personally.

Second, “Dad” is not nearly so much a gendered word for me as the description of a role that I continue to play and refine.  Though parents of either gender may do so, the blend of qualities I bring to the table–provider, planner, rough-houser-in-chief, clown, person-who-puts-things-on-the-high-shelf, law-giver, rascal and repairman are still somewhat more associated in my consciousness, if not the collective American social consciousness, with male parenting.  At some point along the way, I had to ask my children to re-imagine me in light of transition.  This was difficult enough without depriving them of the contributions which they had come to expect from me and for which I continue to have some degree of aptitude.

Finally, and unsurprisingly to those of you regularly reading my ramblings, I simply haven’t figured out a better solution yet.  I wade into the water.  My son and I especially have had several conversations over the last year about the potential risks of being called “Dad” in public.  Not all attention is positive attention, and though I don’t expect I pass to observant folk, neither do I think it is wise to attract unnecessary scrutiny.  Further, the fact that I have given him no better alternative label to use means that way he refers to me in my absence reinforces masculine expectations about me among his friends and associates in a way that is potentially awkward later on.  It might not be ideal, but frankly, it was hard enough for us all to adapt to “Renae”.  One of our friends, through a incident too convoluted to relate, has taken to calling my son “Evil”, and she suggested that perhaps I should be accordingly referred to as The Progenitor of Evil.  Works for me…if only it rolled a little more quickly off the tongue.

 

Outlawing Trans

Published / by rmaddy / 1 Comment on Outlawing Trans

Enough already.

North Carolina is not an outlier.  More than 30 anti-transgender bathroom bills have been proposed since the first of the year, and this week the shameless carnival came to my not-so-red state of Minnesota.  Locally, the proposal stands little chance of passing the legislature and none of escaping the Governor’s veto, but such pragmatic considerations were insufficient to prevent high-profile hearings, during which Republican sponsors publicly equated transgender women with voyeurs, pedophiles and rapists.  As is often the case in election years, the viability of legislative proposals is beside the point.  Of course they are delighted when a bill succeeds, but the viral proliferation of anti-trans proposals is more about messaging:

Fear not, culture warriors.  Stick with us through one more election.  Marriage equality was a setback, not a loss.  The front may have shifted, but the larger campaign goes on.  

2016 is open season on transgender Americans.


The ostensible justification for banning transgender people from restrooms corresponding to their identity is the privacy and protection of women and children.  Opening the bathroom door to transfolk will, we are told, unleash salivating hordes of predators and peeping toms upon unsuspecting innocents.  To be sure, protecting the vulnerable whenever possible is certainly a right and proper function of government; it simply has nothing whatsoever to do with the bills in question.  Transwomen have been using women’s restrooms all along.  There have been no reports of either transwomen harassing others in the privy, nor of non-transgender predators posing as transwomen to gain access to the Ladies’.  Where was the public safety crisis in 2010?  2005?  2000?

Further, every danger imagined by opponents of transgender bathroom access is already a crime.  Harassment, indecent exposure, assault, invasions of privacy, rape–all are fully prosecutable under existing statutes, and a transgender person committing such acts would face the same consequences as anyone else committing such an act.  Creepy behavior in a public restroom is illegal because it is creepy behavior, not because of who does it.

The implication of anti-transgender bills is that transgender people enter public restrooms as predators.  There is simply no evidence for this. We go to pee, and the facilities already equipped with private stalls, in which the chances of seeing anyone else in a state of undress is essentially zero.1 We do not go to to make a sociopolitical statement, but rather to relieve ourselves so that we can get back to what we are doing as soon as possible.  We are not–I must stress–not, “men in the ladies’ room,” because we are not men.  The genitals that we were born with demonstrably do not prevent us from acting in a civilized manner toward others, and whether or not we have left them surgically unaltered is frankly none of anyone’s business.  They are called private parts for a reason.

All of you, both men and women, have shared public facilities with transgender people many times in the past.  Most of the time you probably didn’t notice, and in any case you were done no harm.  Nevertheless much harm can come to transgender people and others when they are forced, as the bills prescribe, to use the bathroom associated with the sex on their original birth certificate.  It was not only because I was being ridiculed and occasionally threatened in the men’s room that I switched.  Some men who encountered me would visibly panic when I walked in, whether they were sure I was in the wrong place or worried that they were.  The nicest confrontation I recall was a guy who was walking out as I was walking in.  As he saw me, he froze, checked himself, then said.  “Miss?  You’re in the wrong room.”2

I quite agree.  However, what seemed obvious to both that poor guy and me is lost on an increasing number of conservative politicians.  They are not seeking to protect the privacy of women,3 but rather to make it legally difficult for us to function socially or professionally.  Their seething, absurdist rhetoric casts little doubt that they see us as delusional sociopaths.  Don’t be misled by them, my friends.  Dehumanizing transgender people does not make anyone else safer.  It just makes us feel like shit.

I am NOT Cait.

Published / by rmaddy / 4 Comments on I am NOT Cait.

I love medical students.  They’re just crazy enough to do what I did 25 years ago, but haven’t yet had the idealism beaten out of them.  They are young, driven, and honestly, a hell of a lot smarter than I was at the time, let alone now.  Meeting with them, I see their stars rising as mine slowly sets, and yet they afford me opportunity to feel on top of a social situation.   “You know that thing you want to do?  That you are betting your entire future on?  That you think about, dream about and obsess about until you can nearly taste it?  I’ve been there.  Done that.”1

So, when my psychiatrist asked if he could interview me in front of his medical students, who were studying gender and sexuality, I allowed as how it sounded like a lot of fun.   I was expecting a handful of students, but ended up with the entire first year class–50 or so–a much better number for me.  I am substantially more comfortable in front of a crowd than I am within an intimate circle, and I was definitely going to need to get comfortable.  I understood going in that I was a rara avis to be dissected, and that their scientific curiosity would express itself in some very personal, intimate questions.

The hour did not disappoint.  One student’s brilliant question2 gave me early occasion to point out that, contrary to worn cliché, there is such a thing as a stupid question.  Without further clarification on my part, the students artfully avoided the most cringeworthy ones.  Still, this was a psychiatry class, and they did ask tough, personal questions.  When did I know?  Were there earlier inklings?  How had my sex life been affected?  How did we manage to stay together as a family?  Was I having problems at work?  And what do I think about Caitlyn Jenner…

Just as in 2016 all Americans are expected to have an opinion on Donald Trump, so also must all trans-people be ready with an opinion about Cait Jenner.  I tell you now what I related to them then–that coming out is hard, and that coming out in front of a billion or more people must be harder still; that I recognize that she is a shameless self-promoter, but that I am old enough to know that this has been part of her DNA since at least 1976; that trans people don’t undergo personality transplants.  We work out gender shift within the context of who we already are.  I think she has made some missteps, but that so have we all, and I wouldn’t call her out.

Until this headline…

Caitlyn Jenner Wants to Be ‘Trans Ambassador’ for Ted Cruz

WTF.  I mean seriously…what the fucking fuck?

Being Ted Cruz’s transgender ambassador would be roughly equivalent to being the Teletubby ambassador to Mordor.  Cruz regularly equates transgender people with sexual predators.  He makes appearances and receives support from pastors who are not just anti-gay, but thoroughly on record as wanting to rid the nation of LGBT people.  He devotes particular political energy to railing against protections for transgender children.  That his five year old “knows there is a difference between boys and girls” is a regular punch line in his smarmy stump speeches.  Some people are beyond persuasion.  The best thing one can do regarding Cruz on transgender issues is to fight like hell to make sure he never gets elected.

I empathize with Cait as a fellow sojourner…a late-transitioning MTF transsexual who managed for a long season to bear the unwelcome burdens of masculine expectation, always longing for a different one to carry.  I understand that she needs to be her own person and follow her own beliefs. Nevertheless, I cringe when she has four minute conversations with notoriously bigoted pastors, then acts as if some major breakthrough has occurred.  Or when she visits with urban underclass women facing pressures she could never imagine, helpfully suggesting that maybe they should just “get a job.”  Now she expresses her immense admiration for Ted Cruz and wants to help him on transgender issues.

There are good reasons why transgender people are wary of the GOP.  Without a single exception, proposals to limit transgender rights have arisen from Republican legislatures or executives.  We understand the codes.  “Protecting our children” means kicking trans kids out of sports, clubs or bathrooms.  “Defending the family” means legally invalidating trans or gay partnerships.  “Defending religious liberty” means enacting laws which allow people to justify discrimination against LGBT people on the basis of their beliefs.3These things are not just coming from the far right fringes.  They are mainstream Republican policies.  They want judges who will “strictly interpret the Constitution,” by which they mean bolstering the 2nd Amendment (guns) and gutting the 14th (equal protection under the law for all citizens).  Candidates for major office actually promote their hostility to transgender rights as positives, egged on by their rank and file.  I’m sure just as many trans people come from conservative backgrounds as from progressive, but it’s damned hard to stay there if you are paying attention.  Cait clearly is not.

Through no fault of her own4, the general public sees Cait as a leader if not the leader of the American trans community.  Well, I’m not Cait, and many within the trans community are becoming frustrated with the extent to which she does not seem to grasp the issues which bear on us most acutely.

Why should she?  This is all new for her.  Coming out for Jenner has brought social promotion, positive attention and a resurgence of financial potential.  It usually does the opposite.  She is totally unconstrained by the often prohibitive costs of medical care.  Although I certainly recognize her courage, no other trans person I know has ever received an award for it.  For most of us, being trans isn’t a series of road trips and adventures with our posse in The Mystery Machine.

My best guess is that her path is horrible.  From time to time I wish she’d spend a bit more time figuring herself out before she opines to the press.  Then I remember that the only difference between her microphone and my blog is the number of people paying attention.  She relishes the spotlight, but I doubt she could escape it either.  I take a breath, continue to wish her well and give her due props for enduring transition under the microscope.  Still, I can’t sit quietly when she backs a smug, ill-tempered, transphobic bigot for our nation’s highest office.  Even from a sister, this is unforgivable.

Well, almost.

 

Men are from Mars. Women are from…

Published / by rmaddy / 2 Comments on Men are from Mars. Women are from…

…Mars, apparently.  Or, at the very least the two appear to come from roughly the same general location rather than from separate planets 199 to 316 thousand miles apart.1

Surprised?  Of course you are.  For years you have been told that men’s and women’s brains simply could not be more different.  How we love to think this is the case, and how the popular press/trash-science/book tour/lecture circuit reinforces the meme.  Does not the Internet Itself tell us that it is true?  Nor will most transgender blogs2 disagree.  Indeed, this is the most common explanation for that condition which afflicteth me.  Girl brain in boy body.  Makes sense, right?

The Word for the Day is specious3–superficially plausible but actually false.

It turns out that that there is nothing in the universe quite so much like the brain of a woman as the brain of a man.  Sure, some degree of variance exists, but with substantial overlap.  Further, the differences that do exist often involve areas where better non-sexual explanations apply (e.g. the sensorimotor cortex is larger, on average, in men because their bodies, on average are larger), or MRI studies which measure regional blood flow, which may or may not have much to do with what is going on in terms of global function.  Now, even that evidence seems to be tilting against the male brain/female brain hypothesis.4

Take a look at this nifty graphic, from the footnoted study:

Whether I ask you “Don’t they look alike?” or “Don’t they look different?”, you will probably think “yes”, unless of course you are rather contrary5, in which case you will likely answer them both “no”.  Either way, if I remove the captions and show them to you in ten minutes, I guarantee that you won’t be able to tell which is which.  Don’t feel bad–neither can a neuroscientist, at least not with any degree of confidence or consistency.

Add to this the fact that we are now finding loads of evidence indicating that the brain is not some rigid entity fixed at birth, but rather a complex, moldable structure which develops in response to use.6.  The various characteristics (post-mortem brain measurements, blood flow on MRI) which were once used to argue for differences between male and female brains are strongly, in some cases chiefly, due to lived experience.  Mathematicians acquire capacity to do math over time and through practice, changing their brain structure and connectivity in the process. Developed changes will show up on the old brain MRI just as much as the supposed male/female distinctions.

So why do men and women seem to act so differently?  Well, again, largely because of what they have experienced.  Subtle and not-so-subtle social cues press on them from the moment of birth.  Before the moment of birth.  A boy who articulates his opinions clearly is a leader.  A girl who does the same thing is a bitch.  A crying toddler is told either, “Let it out” or “That’s enough now” depending on whether they is7 wearing pink or blue, which was also chosen for them.  You tell your nieces–but not your nephews–“Oh…you are so pretty!” so often that many of them grow up with paralyzing insecurities about their bodies.  The fact that my then-girlfriend-now-wife grew up thinking it was improper to call me on the phone almost resulted in us failing to connect.  I have endured soul-sucking shitty jobs at various points rather than to shirk my well-conditioned responsibility to provide.  A young girl learns that someday her prince will come–and that this is what will make her life complete–at the same time that boys are learning that cars can turn into robots and blow up lots of shit.

It will take time and effort to unpack what is helpful and harmful about the way we currently gender children.  First though, we need to stop seeing innate difference where it does not exist.  Boys are not born to build things.  Girls aren’t born more empathetic.  The fact that they eventually show differences in these areas is just as likely to owe to nurture as nature.   We should also start asking the question, “If not brain structure, then what?”  Personally, I think that some of the dots are rather easily connected.  Obsess about the physical beauty of little girls, and eventually they’ll do it too.  Give one kid a toy lawnmower and the other a toy tea set, and they might just develop different interests as time goes on.  As Aristotle said, “We are what we repeatedly do.”  Or have done to us.  Food for thought next time we plan a princess party for our BFF’s little angel or tell a timid adolescent male to grow a pair.

Which brings me at long last back to gender dysphoria.8  If male brains and female brains really aren’t much different, why do trans folk say that they have the wrong brain, or that they were born in the wrong body?  Two reasons.  First, we’ve been bathed in that same myth, and are no less drawn to its elegant, but unfortunately bullshit, simplicity.  Second, we are, as a group, rather prone to feeling shut out, judged and shamed.  We tell the stories that work, that convey the very real turmoil we experience in the manner least likely to produce a hostile response.  You know, the same thing you do when you explain why you are 10 minutes late to work.

“All things are relative,”  said Einstein.  Never, actually.9  Every narrative has a narrator, and most truth is personal truth.  It might be metaphorically useful to speak of mismatched brains and bodies, but that’s about it.  Brain function is incredibly complex and poorly understood.  We were foolish to think that firm conclusions could be drawn from the small variances in the way a brain looks on a scan or an autopsy table.

And, of course, we can’t really swap out brains or bodies anyway.  Of the two, bodies are quite a bit easier to alter, so we try to do that (for those who desire it), but it would be a gross oversimplification to say that therapy, hormones, surgery or some combination of the three “cure” transgender identity.  Better to acknowledge that it cannot be cured, or even better yet, that there is nothing that needs to be cured.

Being transgender is just my particular burden to bear, neither rare as it turns out, nor hopeless.  I write about it because I can, and I think maybe it helps.  Lots of things help.  Psychotherapy helps.  Having supportive friend and family helps.  Chocolate helps.  Learning to take charge of one’s transition helps.  Sleeping helps.  Going south once or twice per winter helps–a lot.

Perhaps the purest and finest Counseling McNugget my psychiatrist has given me over the years is that the real, lasting changes are gradual ones.  I occasionally run into a transsexual biography or blog in which the author says that that she felt better instantly once she started taking estrogen.  That’s wonderful, I suppose, but of course it’s also the placebo effect.  It takes 3 or more years for hormones to make a boy or girl into a man or woman.  Why would it be any faster for a fully formed adult?10  Knowledge11 seems to progress in this way.  We gradually let go of rigid concepts of cause and effect, looking rather to a more complex picture of influences and variations, probabilities and possibilities, subtle effects and shades of gray.  It takes longer to explain, doesn’t boil down to a pithy phrase and probably won’t sell as many books, but there you have it.

Finis.  I don’t think I have laid a 1500 word epic on you for quite a while.  My compliments to you for having worked your way to the bottom.  With any luck, I’ll be back in a week with another spellbinding installment, almost certainly about hair.  First though, a quick personal note.  Given all the whining I have done over the past months about this or that trial, I would be remiss if I did not mention that I feel fine.

Live long, and prosper.