Trans with the Quakers

Someone trans was near to tears, and I wondered, have they started on oestrogen?

Trans people are accepted by Quakers except when we’re not. We are not always understood. Waiting for the morning session, a woman asked me about her friend. “She- I can call her ‘she’ because she has gone back- was going to have surgery but found a partner, and decided not to,” she told me. She wanted to ask me, as a Friend, rather than ask the woman herself. She asked, “How does that work?”

Um. If we say “Trans men are men”, and I am glad people say that, what happens if they detransition? I said, I have heard of several people doing that. It’s because there are two questions: “Am I trans?” “Will I be happier if I transition?” The answers can be Yes; No. I did not say that when someone says I wanted it so much that I could do nothing else until I did it that they are not telling the truth. Someone told me that last night, and it’s how I felt.

I don’t really mind her asking, but some would. It should not be our job to explain, over and over, simple things about trans with all these books and websites published. I told her that everyone has fairly superficial relations with a lot of people, who might see them or might neither see nor accept them, and everyone needs a few close relationships with people who accept them unconditionally. If others accept me as I am, and I can be myself without masks, what does it matter what I am wearing?

She also told me her friend had been amazed at male privilege. When she started being seen as male, she was just treated with more respect, and as a teenager she could not understand it. Why boys but not girls?

I was delighted to meet Ruth. I loved her “Be more Becky” badge. I don’t think I have talked to her since I was raging at her nine years ago. “Will you be worried about it in ten years’ time?” is always a good question: after I heard she was supporting H, I had hoped to see her. “H wants a win,” she said, which some people might object to; but well, after all this time why begrudge H a win? It would be a win for everyone. H was so clever, she told me, she would see where we should be immediately (she mimes cogwheels spinning inside her head). Other people would get there very slowly (mimes cogs creaking round) and Ruth would want H to realise: give them time to get it. She was too impatient.

We have hugged. We have expressed our sorrow for the falling out, and our forgiveness for each other, and Ruth asks me if, on the hormones, it might be right to say that- trans women are like teenage girls?

Oh fuckyeah.

It can be awful. Women learn to live with their feelings, if unlucky suppress them but if lucky just feel them and not give an outward sign, because outward signs of emotionality in women are a weapon to be used against them. And I never have. It’s like being a teenage girl.

Quaker Gender and Sexuality Diversity Community had a meeting, and the gender-critical feminists turned up mob-handed. One read out an Area Meeting Minute pledging support for “single sex services as permitted by legislation”, and I saw that as unfriendly to trans people. They wanted to challenge our speaker from Stonewall. And yet still they came out with the trope about being frightened to speak, about how women and one or two men said how brave they were to speak out. It’s as if their allies on the hard Right don’t count. They know Lefties will mostly disagree with them. Most there support trans rights.

To me, the Left opposition to trans rights is a crying shame, because they give aid to the Patriarchy wanting to suppress trans, and prevent trans people moving on. I am sure surgery, and probably taking hormones, is bad for us. Without all this hostility, trans people could find new ways of being.

What about Quakers? Quakers are supportive, up to a point. We invited a non-binary person to speak, and we value trans women as a concept. And yet I know four of us who have got into trouble with our Meetings, or been tolerated, not for long periods been asked to do any of the work of the meeting, or walked away in dudgeon. The concept of a trans woman is perfectly acceptable. No-one is going to try to dead-name us, and they talk of how brave we are to transition. But when we behave like trans women- or like teenage girls- we get into trouble. Junior Yearly Meeting minuted, “Are we presenting ourselves openly?” It’s not good to lose my temper, but being emotional is being myself.

I feel that is a shame. My depth of feeling, whether it is induced by artificial hormones or not, is a gift, and my ongoing struggle to come to terms with it is a valuable spiritual journey. I am mortified and abashed that I lost my temper that time. Given the volcanic pressures inside, I feel I do quite well to express them as little as I do. If I could be accepted as me, rather than only if I appear as a cardboard Quaker, softly and evenly spoken, never rocking the boat, Quakers would be enriched. The fear-filled reaction of “Oh my God what is she doing now?” does no-one any good.

Gender dysphoria in intersex people

It takes courage to be between genders. Many people won’t accept that is possible, the law won’t protect you, and intersex people are assigned a sex at birth rather than let the child decide later. An intersex person told me that intersex people could experience gender dysphoria because of the hormone treatment they received. She/they did not refer me to any blog posts or accounts of it, but said the experience is shared on closed facebook groups. I did a bit of googling.

In congenital adrenal hyperplasia, where the clitoris exhibits signs of penile development, but the child is 46,XX (46 chromosomes, two X sex chromosomes) there was a literature review in 2005. 250 of the children were raised female, and thirteen had serious problems with gender identity. Some of the most “severely masculinised” children were raised male, and four out of 33 had serious gender identity problems. The authors therefore recommended that the children be assigned female, even when they were most masculinised.

That is, the children were closeted from birth. You will be raised as a “girl”, or in some cases (I don’t know whether studies would be more likely on people with CAH raised male) raised as a “boy”, rather than as a “child”. There is a decision here. There may still be eugenic ideas in some people that CAH is in some way shameful. Parents should be open with a child, as far as that child may understand, and there is a decision to make about how far to be open with the wider public, in nurseries or schools. But definitely closeting, making a decision on which gender to raise a child and sticking to that, should not be the default position. Things may have changed since 2005.

Trans people would tend to think of hormone therapy as testosterone, oestrogen, and blockers. This protocol, also from 2005, says for CAH hormone replacement therapy is life-saving, because hormones necessary for survival, cortisol and aldosterone, are replaced. Androgens are secreted in excessive amounts due to an enzyme imbalance, so the therapy is to suppress them. That too involves a judgment, as to what is an “excessive amount” for an androgen. There are different normal amounts in boys and girls, men and women, and during adolescence.

That protocol admits that patient advocacy groups debate with the medical profession their decisions about hormones, and laments that some “harbour a sense of outrage about their life or treatment experiences”. Being visibly in between genders is not easy either, and I can imagine someone with CAH allowed to have a masculinising puberty might object to that later. The answer is public advocacy, so that greater variation is accepted.

We don’t know what effect hormones have on gender dysphoria. A consultant was shocked that my GP would take me off oestrogen, but the risk he named for that was osteoporosis, a physical disability not anything psychological. I know that hormone level changes can affect my mood and how emotional I get, but not what effect oestrogen and goserelin, the testosterone suppressant I used, had on my mood.

I was committed to transition. I knew I wanted to change my presentation from Stephen to Clare. Starting hormones, and suppressants, was a step on the path to it, and an affirmation from the medical profession that it was right for me. So the hormones could have affected my mood as a symbol that I was doing the right thing, and advancing towards my goal, rather than by some physical action. I heard it as, “Yes you are really female and because you are female we give you oestrogen”. I can’t see how a study might distinguish psychological or placebo effects from physical effects- and possibly the effects are so intertwined that these words, suggesting that they could be distinguished, mislead and reduce understanding.

In adolescence, it would be different. Testosterone has masculinising effects, on body hair and voice, at whatever age you take it (or if, in CAH people, it is not suppressed). But I was initially told that I could get hormones after I went full time, so I went to a private psychiatrist who would give me hormones before. That gatekeeping role increases the desire for hormones: they become affirmation.

What is preferable? CAH people who did not have their testosterone suppressed might be masculinised, and as many are raised as girls and appear happy enough with that, the masculinisation is not cost-free.

I want a society where gender and sex differences are seen as completely normal, rather than this one where we so rigorously differentiate between two sexes that those physically in between may be treated to make them more clearly one or the other, trans people are protected in law if we intend to transition from a clear classification as one to a clear classification as the other, and those who are non-binary, physically or psychologically, are seen as weird. Now, though, it is safer and pleasanter not to be seen as weird. This pressure to conform, so serious that people alter their bodies or have their bodies altered for them, harms us all, but for children with CAH, either medicalised conformity or allowing the child to masculinise could hurt a child, and be resented.

In complete androgen insensitivity syndrome, 46,XY children appear to be girls until they fail to have a normal female puberty. Of 156 brought up as female in another literature review, none changed sex in adulthood. Of 89 children with micropenis, 79 brought up as boys and ten as girls, none changed sex, and that might indicate how powerful an upbringing can be in creating a gender identity. Of 99 brought up as boys with partial androgen insensitivity syndrome, nine changed gender. I knew one, who identified as M-F trans, and later identified as non-binary.

Don’t have GRS

Personal stories of why people wanted genital surgery, and why they regret it.

The way transgender is understood in Anglo-American culture, in the theory and practice of law and medicine and in the way trans people understand ourselves (until it’s too late) puts overwhelming pressure on trans women to have genital surgery which is not in our interests. When we regret hormone treatment and surgery, there is pressure on us not to say that in public. I regret surgery, so I have an interest in this- to save others from my mistake, as I cannot rectify it- but I am not alone, evidence of regret is suppressed and evidence of satisfaction exaggerated.

The circumstances of MtF and FtM around motives for surgery are completely different.

The diagnostic criteria for gender dysphoria in the DSM and gender incongruence in the proposed ICD-11 both require a strong desire to be rid of primary and secondary sex characteristics and to have the characteristics of the opposite sex. The Equality Act protects people who want their sex reassigned, or have had their sex reassigned, though the heading is “gender reassignment”.

At the time I changed my name and went full time, I was ambivalent about surgery, but a year later I passionately wanted it. Why would you want surgery? I believe I wanted it at the time because I wanted social acceptance, or possibly to accept myself. Where a person male by genes gonads and genitals wants to dress as a woman, there were two categories they could fit- transvestite and transsexual. The transvestite is considered to be a sexual fetishist, which I found unattractive, but the transsexual had a medical condition, which I found more congenial. I felt my personality was feminine, a concept which now I consider meaningless.

If there were more acceptable categories, protected against discrimination by law, not involving surgery, perhaps I would not have wanted surgery. Medicine tends to categorise health problems which require the intervention of doctors to cure, but possibly we could reconceptualise gender dysphoria. Gender incongruence type 1 is a desire to live in the role of the opposite sex. The treatment is to live in the role of the opposite sex, using an appropriate name and clothes. Gender incongruence type 2, a distinct condition which may or may not co-exist with type 1, is a desire for hormones. Type 3 is a desire for surgery. Type 4 is a desire to subvert gender, by not fitting any particular gender role, and the treatment is to be allowed to present as you want, male, female, androgynous.

There should be the freedom to present as you want anyway, without the need for medical affirmation, but I did not feel free and medical affirmation, or a category defined by doctors, might have helped me accept myself. The health problem would be shame and distress rather than cross-gender behaviour, and the treatment to alleviate the shame and distress rather than to change the behaviour. As the medical model is about desiring cross-sex characteristics, the GICs can’t cope with non-binary people. They still demand change of name, as Charing Cross did when I first went there in 2001.

I would have said, I want surgery because I am transsexual. I am a woman and my penis distresses me (it did). In the bath I want bubble-bath to hide it (I did). I now feel I wanted surgery to be classed as transsexual and so to be socially acceptable, as demonstrated by the available legal and medical categories. If there had been different types of gender incongruence recognised by medicine and protected by law, I might not have wanted surgery or hormones.

Transsexual support groups enforced the desire for surgery because it differentiated us, the real TSs with a medical condition, from all the weirdos and perverts, just as law, medicine and the wider culture did.

Hormones can reduce fertility, possibly permanently. I wanted to reduce my sex drive because my attractions shamed me. Self-acceptance would have been a better way.

Surgery is irreversible. I mourn being mutilated, and the pain is keener because it was my choice. That choice was socially constrained, and I am moving from self-blame to rage against those constraints.

A great deal of research reports high degrees of satisfaction with treatment, and low rates of regret of surgery. I am unsure why. Possibly it involves people surveyed shortly after surgery, when I and others experienced euphoria; possibly people feel shame about our regrets. I certainly do. People are unwilling to score below Neutral in a satisfaction survey, marginal people are less likely to complain of bad treatment, and while we might open up to a qualitative researcher we might not on a survey. In my case, I have been loath to speak out because I don’t fit the accepted understanding of trans women, and might spoil it for those wanting surgery now; and I want to maintain links to trans groups. Though Johns Hopkins stopped doing GRS as they decided it did no good.

 ♥♥♥

Sylvia Morgan undertook qualitative research, trying to find difficult to reach trans people rather than using the customary routes of gender clinics and trans support groups. Post-op, most people lose touch with those sources and that might be a reason why some research reports such high satisfaction rates. Four out of thirteen post-op trans people expressed regret. That is a huge figure.

People report long waiting times to see gender clinics, and long waiting times for surgery referral once there- perhaps seven years. A friend waited longer. Another friend said the psychiatrist kept challenging her desire, saying that it won’t grow back once it’s cut off, as if she did not realise that. Of Dr Morgan’s research subjects, Lady G who wanted penetrative sex had to wait many years because she had to work in male role, as a lorry driver, and the protocols demanded the “real life test”. She also refused to fit the stereotype of a “woman trapped in a man’s body”- “I don’t know how women feel. I just know how I feel. I’m definitely not trapped. All I want is the wee operation down there.” She passes as a woman, unlike most of the MtF research subjects, and has a strong sense of being one.

Kylie, though, felt hurried. She was not sure how she felt and questioned the conclusion of her first half-hour consultation that she had “insight” and an “excellent understanding” of the transition process.

People used The Script, saying they felt trapped in the wrong body, felt they were not of their assigned gender from very young. “People play the game to get what they want.” Dr Morgan reports that discussions in support groups are dominated by medical procedures and visits to the GIC, and I observe that on facebook, with regular delight at getting surgery or despair at the delay. It is a way of getting status in the groups, that you are seeking surgery. Four said they had never considered medical procedures before joining support groups.

Phoenix felt pushed through a process. She had said she did not particularly want surgery, but had it three years after her first referral to the GIC. She drifted through the process and does not know how she got where she is, post-op.

Vida first went to the GIC in March 2010, and had surgery in October 2012, having pushed for it. She was processed quickly because she demanded progress. There appears to be little consistency in procedures and protocols. Waiting times appeared arbitrary. One psychiatrist was described by many participants as condescending, patronising, clock-watching. Trans women felt disrespected, as I did.

We want medical recognition in order to get legal recognition, so we have surgery as that is what the medical model requires. The participants wanted a vagina in order to “feel fully female”, rather than for what one would do with it: gynephile trans women still go to surgeons who can give depth. The psychiatrists generally did not attempt to dissuade them. (We would hate it if they did, denouncing them as cruel gatekeepers.) Yet the surgery is a symbol of being a woman or truly transsexual, rather than a choice because of what the penis and testicles can do, or the neo-vagina can do.

Dr James Bellringer, who does NHS vaginoplasties, said the backlogs were “spiraling out of control”. In 2013/14 they received over three hundred referrals yet did 180 operations. “The nature of gender surgery is that the vast majority of these referred patients will go on to GRS,” he said.

Iain, a gender queer trans man, thought better of it. The effects are irreversible… there’s so much that can go wrong… it sounds like a world of pain and struggle and scarring and infection.

Oestrogen is a symbol too. Subjects perceived it as enhancing emotions and gentleness, but one reported that her powers of concentration were a lot worse, another that she was considerably weaker, making her job more difficult.

As hormones and surgery are primarily symbolic, that one is really trans, entitled to legal recognition, others as well as I feel euphoria after finally having surgery. But then Carina reported that reality hit her like a big sack of potatoes. Surgery does not mean social acceptance, necessarily, and the body has to heal its effects. The neovagina is in effect a wound, so you have to fight the healing process with dilation.

Vida felt recovery took two years, and had further depression ten years after surgery, “because there is no aftercare or support”. Dolores said she had not understood how difficult and time-consuming dilation would be: “A lot of girls just don’t bother with the dildo, they just let the vagina close up”. Lily agreed. “Nothing really prepares you for what happens afterwards.” I think when some people go for the gender reassignment there is a hope for changing your life, starting a new life, but then it’s still just you with your same problems, and after the surgery you have more to worry about… Some of them just give up, they stop dressing in female clothes and everything.

Sally hoped surgery would give her psychological relief and social acceptance, but it brought neither. She had had profound ongoing depression since transition. Trans support group organisers told me not to talk about my personal problems, not to talk about being depressed since my surgery.

People determined to get the surgery are kept in the dark and fed on bullshit. Nine out of 28 participants had attempted suicide, some more than once.

While people are taking hormones and having surgery for validation as a true trans person rather than for the actual results treatment will provide, there will be inappropriate treatment, and social pressure to have treatment. I know what the desire for the operation feels like. I felt it. Now, I feel betrayed.

 ♥♥♥

When T-Central linked to this post, Calie wrote, The last two T-Central featured posts were based on very successful transitions. One from Halle, who has transitioned, and the other from The Transgentle Wife, the spouse of one who has transitioned.

This post is from Clare Flourish who has regrets. It is important to read both sides.

I will add that I know many who have transitioned and are happy and I know some who are not. In all cases, it seems that the lack of love in the life of those with regrets, or the lack of a job, is often the case.

Clare mentioned in a comment to her post that there is pressure to physically transition. I have seen this and know several who gave in to that pressure. Some are happy. Some are not. Clare is one of my favorite bloggers. She is just lovely in her pictures and I do hope things will turn around for her.

I am grateful for the link and kind words, but I am glad I transitioned. It was how I found myself. I feel transition could mean something different, that it does not need the monolithic full-time + hormones + surgery. I feel people should be encouraged to find those parts of transition which work for them, without imagining they must come as a package.

Some of the comments below go into these issues in depth.

Norethisterone V

It seems my choices are to take Oestradiol only, and completely lack energy so that if I do my washing in the morning I just want to slump in the afternoon, or to take synthetic progesterone, and have febrile energy manifesting in highs I don’t fully trust- I seem rational, but its my Norethisterone brain doing the judging- and crushing lows.

I phoned the Samaritans, wanting to explore this low, quite how bad everything is. I would go into the darkness, and start by saying “I am not suicidal” to reassure Helen (or me). Thinking of how to express that I realised, “I want to die”. I don’t trust myself to look after myself.

The low is deep but I know it will end. That is an improvement. The high on Tuesday was really good. Even low, I feel more energy and purpose. Georgia O’Keeffe wrote, I’ve been absolutely terrified every moment of my life – and I’ve never let it keep me from doing a single thing I wanted to do. Well, I have mostly suppressed my terror below consciousness, and it has stopped me doing things, or even knowing what I want to do. Her way is better. I don’t trust my rationality, but having more energy may be worth that cost. Feelings pass.

As a benefits adviser I dealt with a man who cared for his mentally ill sister. She would do things like wander off at 2am without shoes on, and he would try to keep her safe, that is, well-managed. She was getting DLA high care low mobility, the most she could get, but he wrote to the benefits office asking if she could get more. Rather than telling him “No” they sent him a review form, and decided she should get less. He was distressed by this. She was calm, well enough fed, irked by his control as walking off in the night is fairly harmless, really. He was constantly stressed.

We did the tribunal, he was stressed, picking up various bags and papers, shaking, and she whispered to me, “Help him, Mr Languish”. So I helped him with his bags, and she was quietly caring for him.

It feels I have a carer, looking after the Inner Child, because I do not trust that spontaneous being. I trust the carer to understand the world, but the carer understands no better, is as insane as it imagines the Child is, and does no better than the Child would. The Carer’s first ambition is to avoid the Child having painful feelings, rather than to keep me safe, and it does not manage that, just anticipating painful feelings and worrying about them, and avoiding action. It falsely imagines that is “keeping me safe”. The Catholic Meditations are on getting rid of the Carer, an emptying of all the contents of the ego-consciousness to become a void in which the light of God or the glory of God, the full radiation of the infinite reality of His Being and Love [or, perhaps, the Child] are manifested. It quotes Matthew 10.39, He who loses his life shall find it.

Before today’s low, I discussed all this with Tina. I could lose my income, yet then was sanguine. All I could do was monitor the situation: no point in worrying. Life is bearable, with the occasional pleasing sensation. It is only not bearable if I imagine that I cannot stand this, there is too much unpleasant emotion. I might think that my current existence, at home most of the time, is not enough. I can get more pleasing sensation by noticing more: if I go into that state of awareness of my surroundings, particularly outside, there is a great deal of beauty and the state itself feels lively and energised.

I don’t know if I want more experience. I judge that I ought to. I find what I want when I see what I do. I do what I do. I feel dissatisfaction. I do not want to put plans into practice, as the Carer anticipates defeat.

I see a need for Advance into Greater Spiritual Maturity, and I am working on that. I am coming to appreciate my own good qualities.

I don’t trust the benefits system. It claims to pay a very low income to people unfit for work, but does not keep that promise. If some people in a wheelchair might not qualify for ESA, its criteria are far too strict. And I think I have identified the Gotcha moment, the moment where I could not have known but she seems, now, to have decided I did not score particular points. I am frightened.

Tina asks, are there any human systems which don’t make promises and fail to live up to them? Well, in 1948 the benefits system was more honest. Now there are deliberate cuts, and intended holes in the safety net. And we never manage perfection, just imagine it- each person differently. What we achieve is good enough.

-What do you hope for?
No idea.
-You might get it then.
That is a good question, and I shall go away and consider it.

I have now been blogging for six years.

Norethisterone IV

My dear friend Richard explained to me that I transitioned because I misunderstand what femininity is. Well, of course I do, but I feel he simplifies it worse. My father, a pansy, found a virago, and they were married for 33 years. Then 18 months after she died he found another, who is now his widow. He was happy.

We had some difficulty on finding the right word. I want to be- dominated? No, no, yuck, the connotations of leather, pvc, whips and chains revolt me. Subordinated, perhaps. Ruled, even. Those words will do. He says this is inauthentic, a cop-out from the existential duty Sartre called all human beings to. Yeah, right- so tell me again why Sartre had a fifty year relationship with a woman who was cleverer than he was.

I said that if I were a woman seeking a man, wanting to be dominated would be unremarkable, and at that he said no, only equality is acceptable within a relationship. Why should my father not be happy? Or I? He insisted, and then said I misunderstood femininity. He accepted it was cultural. Women are strong. I agree equality is a good model for a relationship, yet feel “Wives be subject to your husbands as you are to the Lord” is OK if that fits the people involved- and the other way round, too, for some couples.

What would a gay man know about it anyway, I wondered. Possibly he was projecting, but as we were getting a little heated we agreed to change the subject, and went onto politics.

I have enough norethisterone to have ten nine-day sessions of it, at the dose I had been on. I find that it makes my emotions more intense, so came off it, and the endocrinologist said I should not take it, but I wanted to experiment. At times, more intense emotions could be fun or a learning experience. This is day three.

I arrived a little early, and phoned his house in case he had not left yet. When we had poured the tea, I noticed a tedious chord progression in the background music- I V VI IV repeated, eight semiquavers to each- so unimaginative- and complained about it. “That sounds like Batman”, he said, Nananana nananana… I put my hand up to stop him, embarrassed and peremptory. Ah. Possibly that’s the norethisterone. Its purpose with HRT is to prevent endometriosis, and as I have no uterus, it has no value. My needs and desires have greater immediacy, and then I find myself apologising and explaining.

Sartrean authenticity may be impossible.

Testosterone overdose

Men in the US increasingly take testosterone supplements. This can lead to impulsive decision making. Hypo-gonadism, causing low T levels, can make a man fatigued, and uninterested in sex, which can be cured with T; but men with ordinary T levels are taking T. What is the effect?

Men and women were given the Cognitive Reflection test, which is a series of maths or logic puzzles with an intuitive, wrong answer and a need to think carefully to get the right answer. Eg, a bat and ball cost $1.10, the bat costs $1 more than the ball. How much does the ball cost? Not 10c.

Men and women given a testosterone boost are less likely to analyse carefully. They care less about what other people would think. They are more likely to think they outperform others. In simulated asset trading, they were more likely to overprice assets, and slower to recognise that prices were falling.

I got all that from the NYT, and recall a factlet from something I read some time- after watching a football match, fans of the winning team had increased T levels, and fans of the losing team had decreased T levels.

More impulsive decision making could be worthwhile in a leader. Where are the mammoths we need to hunt? If our best way of working it out is magic with mammoth bones, it’s better to just guess. We need a decision and it almost does not matter what that decision is. Other people will be grateful for leadership.

In the more complex modern world, good decision making takes account of a wide variety of expertise, and a testosterone-inspired random plumping may be sub-optimal. The problem is, only the women notice.

If high-T males rampage through life damaging things, and women trail in their wake, fixing the mess, the man might never realise he had made any false steps. However the research does not prove that high-T is a bad thing, just that a sudden change in hormone levels can discombobulate a person. I knew that already.

The effects of hormones

Taking oestrogen reduces your blood pressure. Or not.

There was a study published in 2015 of 23 trans women and 34 trans men commencing hormone treatment, measuring blood pressure, BMI, lipids and sex hormone levels at the start of treatment and six months after. Trans men continued menstruating throughout the time. The trans women’s blood pressure reduced from 130 to 120.

When a doctor takes my blood pressure I become tense, and they tell me this may give a falsely high result. Trans women beginning treatment are likely to relax. They are on their way, so their stress will reduce. So blood pressure reduces. These people are undergoing such an extreme life change that it is impossible to isolate one possible cause of change of blood pressure. “The study had insufficient power to detect other associations,” the summary says, and I wonder, decades after doctors started giving us hormones, that so little has been done to find what they do to us.

I wanted to read the article Priorities for Transgender Medical and Health Care Research, but it will be published on 1 April.

From 2007, there is an NHS leaflet, addressed to both trans men and women. The aim of hormone therapy is to make you feel more at ease with yourself, both physically and psychologically. That is, the fact of taking hormones, whatever effect they have physically, affirms your transition so makes you feel better. Some people find that they get sufficient relief from taking hormones so that they do not need to change their gender role or have surgery. I had decided to transition: I am transsexual, therefore I will transition to expressing female. A more fluid way of proceeding, trying things out, would have been better. I railroaded myself.

Hormones will affect your appearance, but you need to be realistic (the leaflet says). Fat may be redistributed, hair loss may reduce though probably not significantly reverse, facial hair may be easier to electrolyse, you may grow breasts though that might take years- ten years, in my case. You may have blood clots in brain, heart or veins: a woman I met in Thailand had a stroke a few months later. You should stop smoking, which increases risk: I was told you could not have hormones until you stopped.

If you start to feel better this is a good sign that you are having the right treatment. However, I railroaded myself. I committed to the whole thing. Moving forward on that track made me feel better, because I thought I had the solution, waiting at the end of the track.

You may find erection and orgasm harder to achieve. You may become infertile: it is not known when. You may become less interested in sex. This was a good thing for me, as I was so thoroughly ashamed of it, but I might have found better ways of living with it.

It is unethical and impossible to conduct a study comparing transition with other modes of treatment. People wait for years to see an NHS psychiatrist, and have definite ideas of what treatment we want. From Lili Elbe onwards, doctors have seemed delighted to have a subject they could try things out on, rather than merely wanting to find the best way to help, which might be to do nothing.

“You will need to take hormones for the rest of your life.” I was told I had to, to avoid the risk of osteoporosis.

Study: Effects of Cross-Sex Hormone Treatment on Transgender Women and Men.

Patient leaflet– A guide to hormone therapy for trans people, pdf.

norah-neilson-gray-self-portrait-1918

Gender psychiatrist

I am one person. This is not immediately obvious.

Penny Lenihan, at Charing Cross, is my eighth psychiatrist. I liked her practical manner, and she shook me up, so that I don’t want to go where I am going this weekend. Cos it ain’t competent me that is going, but shit me, shit me who does fuck all and whom I despise. She observed me communicating calmly and well, and me weeping in anger frustration and sadness, and said “You compartmentalize”.

And I think that’s a bad thing, and I should stop, and I don’t even know what she means by it, particularly. One of my thoughts was that this is a good experience, because however unsettled I feel now I might get to better ways of coping. And now I think that I might bring things to consciousness: see what I am doing, see I have choices.

I got a different view of Serra Pitts. Dr Lenihan has some familiarity with my case, because she has been supervising Serra, who was a trainee and is no longer working with the clinic. I was unaware Serra was a trainee. It is “contrary to protocols” that trainees work with patients privately after sessions at the clinic end. Dr Lenihan will see that the new trainees are aware of the protocols, she says drily. And now I see, yes, that is appropriate; and Serra just not turning up for work does not mean Serra having great difficulty but Serra doing something any employer would object to.

We started by discussing what hormones I was on. She saw no reason for me to be on norethisterone, and did not think my emotional issues were anything to do with hormone doses, though she did want me to see the endocrinologist.. This morning I have been entirely miserable about that: so much of what I have done over the last four years to get my head together has been at best useless. So we were off to a bad start: I thought I would be discharged. She asked if I had been offered group therapy. Well, no; I would be willing to attend but needed it sold to me: what might I gain? So the offer of groups appeared rescinded, because I was insufficiently enthusiastic, and I was confused.

Like many group patients, I like to imagine I am better than the people I would meet in the group; and perhaps fear opening up to them.

Serra told me that the clinic is under great pressure to put patients through, and achieve desired outcomes. I should come knowing what I wanted to get out of it.

So because my emotional issues are not particularly related to transsexuality, she will refer me to my local CMHT. Yes, I do know that means Community Mental Health Trust. I know what they will say: “Sorry, we have no funding”. Well, I am not a risk of killing someone, and if I were they could always leave me to the prison system.

So I gave myself permission not to go to the AM clerks’ conference, and considered the possibility that I would be still tearful, there, and actually disrupt it, rather than merely gain nothing and give nothing to it; and decided that the risk was worth it, and that I could get there without undue difficulty, and would just go.

Antoine Caron, The Triumph of Winter

Norethisterone III

How does synthetic progesterone, Norethisterone, affect my mood? I can only find out by varying what I take.

My retired doctor friend said an option would be to take norethisterone all the time. When my levels change, then my moods will. I could cut it out, continue on the current regime of twelve days in every four weeks, or take it all the time. The GP was happy to prescribe norethisterone: it is oestradiol which causes the elevation in risk of deep vein thrombosis and so heart attack, stroke, pulmonary embolism etc. I can do what I like with norethisterone.

The norethisterone I take is licensed as a contraceptive. I did not think my risk of pregnancy was that high, but there you go. It is a dose a third of what I was taking, so I have to take three pills: I heard that contraceptives had far higher doses of hormones than HRT, which is not true of these pills: you have to go into these things in great depth or just do what feels right, and trust. I don’t know that an in depth understanding of current endocrine theory would help me make better decisions. I also see that norethisterone is used to delay bleeds or mitigate heavy periods, which might seem to contradict what I had heard, that it is used in HRT to precipitate a bleed; but different doses may have different effects in different situations.

The first thing I decided to do was take it all the time. I wanted greater control; and I wanted to see what effects altering what I take might have; but I am not sure I want to reduce my emotional lability. When it’s good, it’s really good. My friend said that menopause was a relief, as she got her analytic mind back. During her period, it left.

I want the intensity of feeling, because it feels good, and may help me understand my desires. I find myself swayed by attraction and aversion rather than calm analytic thought, and that feels like me making the decisions.

And on Sunday night I sent off an email. I reacted rather than responding. I did not improve the situation, and may have made it worse. I made a politic decision: rather than saying “I am angry” I wrote “I am distressed”, because that gets more sympathy, even though as I read on facebook “Angry is Sad’s bodyguard” and my choice of word was calculated- analytic enough. The communication I had received was badly expressed, but it was a lot less offensive when it was explained to me than it had seemed. That is, there are risks; however my feeling angry sad or fearful is usually a good thing, and not to be feared.

Rousseau, Jungle at the Equator

Letting off steam

Trouble with hormones. Man cycling on the pavement of Midland Road, which has little vehicular or pedestrian traffic, a wide pavement and low kerb so you can fairly easily move on and off the pavement on a bicycle. Being in an arsey sort of mood, I think to myself “It’s a road vehicle,” and walk so as to force him to the edge of the pavement. He wobbles on the edge, passes me, and shouts abuse: “Slut!” he shouts. “Slut! Slut!” Quotidian human interaction…

Here am I on the green pills, which may or may not cause emotional lability, and my emotional reaction shows in my face and actions. Sometimes I am upset, and I start to cry (Oh God, I think, why can I not get this sentence out? Such frustration!) and sometimes I get angry. There is a rational basis, an explicable factual stimulation behind both responses, the world is not as I want it to be, do you want it to change too, can we make it better? The crying produces “there there” noises and offers of help and sympathy- still frustrated, I think No! Under this I am sensible- and the anger produces an equal and opposite reaction, or sometimes expressions of hurt from others which get sympathy and I am the Bad Person.

It is so frustrating! If only I could choose: calm, rational explanation; turn on the waterworks to elicit, “Oh! How can we help? What can we do?” Anger just at the right moment…

Arse excelled himself. (Quakers do not know whom I mean.) Now, when exactly the same circumstances are about to arise, I think, surely he will not do it again? Fearing that he will, I find anger and irritation rising, and wonder if I will be able to resist the sarky remarks which he just might take as a challenge. I know a soft answer turneth away wrath, and it is oestrogen I am on, and still.

Or, total bore whose topics of conversation with me, when I fail to avoid her, are what a wonderful Ally she is and what right-on opinions she has about LGBT (which I feel is my topic, and I don’t want to talk about it except when I do) and ghastly sympathy about how awful it must be to wear a wig, be unemployed etc. Actually, wearing a wig is like having your own hair: sometimes I love it, sometimes I think Oh God I look like a man! It looks like a wig! I look terrible! To which the appropriate answer- most women understand this- is “You look beautiful. Of course I mean that. I would not say it if I didn’t mean it…”

So I shouted at her, making my aim about which I was really stressed less likely to be achieved, making me less able to contribute to achieving it, and making me the bad person. Yes, I know I upset people. Sometimes I regret that, and sometimes I just regret the results.

Feuerbach, Medea