October 16, 2011

In which I have some suggestions

Recently I've been getting a lot of unsolicited advice about my medical decisions, and it's reminding me of my experiences a couple years ago when I first considered becoming a little more butch, and my friends were deeply unhelpful. So I thought I'd put together a little guide to what I consider okay and not okay to say to a friend who is going through a life change.

It's okay to ask my how my transition is going! That's probably the way you should phrase it. This is a big part of my life, and one I don't have a lot of opportunities to talk about in detail - if you're genuinely curious, I'll probably appreciate the chance to talk about it.

It's not okay to give me advice on my transition, unless I've directly asked for it. Even if we're already talking about transitioning in general, it's just weird for you to start giving me medical advice. And if your advice is "wait until you're sure," it's not just weird, it's rude and hurtful. It's not like I'm going to drop by the mastectomy store and get my tits lopped off on a whim, like somebody getting a misspelled Chinese tattoo after a night out drinking. "Wait until you're sure" almost always means "wait until I am okay with it," which in turn pretty much means "wait forever." And that's not okay.

Along the same lines, don't suggest alternatives to transitioning. This one really baffles me - you're really not very likely to be suggesting something new. Or, if you do find something I haven't tried before, there's probably a reason I haven't considered it. For example, a well meaning friend suggested yoga to me, as an alternative to top surgery. It's true, I haven't tried yoga! And maybe I could learn to transcend my body. But, it's not like it will make my tits invisible - I'd have to keep binding, or people would still be calling me ma'am. "Try herbal tea before you try testosterone" is just another way to say "wait until I am okay with it," only it involves even less respect for my intelligence.

But, it's okay to ask me to answer your questions. Note the phrasing: please don't just start the conversation with "how do trans people have sex?" - start by asking me if I'll answer questions, and understand that I may not always be in the mood to do so. Also please make sure that your questions are actually questions - "Why not try hypnotism?" is just advice with a question mark on it. But in general, I want to help people understand. As long as you're making an effort, I'm not going to be offended that you don't know something, and I'd much rather have the chance to tell you than leave you in the dark.

It's not okay to mess up my pronouns. Yeah, when I correct you I'll probably tell you that it's okay, that I know it takes time to get used to it -- but what I really mean is that it's not okay, but I've forgiven you anyway. If you're having a really hard time, practice. I'm an understanding sort of person, but it hurts when you make a mistake, every single time. And I'm getting tired of pretending that it doesn't.

And finally, the most widely-applicable piece of advice: if I know I want to do something awesome, but I tell you I'm nervous about it, back me up. If I hadn't had so many people tell me not to cut my hair, I probably would've gotten a buzz cut at 15 and never looked back. Instead, I spent years going from waist-length, to shoulder-length, to chin-length, to a little bob, to a pixie cut - and at each stage, everybody I asked said I shouldn't do it. In retrospect, I'm a little disappointed in the sheer number of people who should have known better who reinforced mainstream expectations of femininity. People who never wore heels, or skirts, or jewelry, or makeup, or contacts, etc. nonetheless told me that I should keep wearing these things, even when I confessed that I hated them, because they made me so pretty. "Conforms to societal expectations" is not always the most important requirement for your friends' personal choices. Come on, be more awesome than that! Do things just because they're fantastic, and encourage your friends to do the same.

Anyway, because I'm in a little bit of a "trans 101" mood with this post, now is a great time to ask questions! You can argue with me, I guess, or ask anything that's been on your mind regarding trans issues. I'm pretty much never going to be offended by a question that's asked out of genuine curiosity, so don't be shy!


  1. Wow, I love this! And the general method of asking questions and general interest in one another's identities I think would be excellent advice across the board for asking about anyone's identity! Super awesome post!!


  2. This is fantastic. Thank you for always being so open and honest with us.

  3. I understand that mistakes with pronouns are hurtful to you, and I would hope that they become decreasingly frequent with time.
    It was unclear from your post, however, whether you are becoming impatient with mistakes from people who should know better or from new acquaintances. While I agree that your friends should be improving, it seems unreasonable to expect strangers to immediately share their experience.
    In an entirely unrelated note, would you be open to advice like "make sure you know all your options and their side-effects" (like surgery vs. hormones vs. a bit of both? It seems unlikely that you have not considered the potential permanence of many stages of your transition, but is it unreasonable for a concerned friend to worry that you have not considered undesired consequences of these therapies (such as systemic vascular pathology, for example).
    And while we're asking questions, have you consulted a doctor about your transition and, if so, what kind of treatment have you received? It is my understanding that the trans community faces more persecution than any other, and I wonder if it has affected the medical attention you have access to.
    I hope that my curiosity/opinions have not offended you, and I, for one, completely support your decision.

  4. Megan & anon1: thanks for the support :)

    Anon2: thanks for the support and the great questions! Brace yourself, here comes the deluge:

    On pronouns: honestly, by the second time I see someone after coming out to them, they should be getting my pronouns right. At the very least they should notice their own mistakes and not need me to point it out. It's just not that hard. I do it all the time, even with 'weird' genderqueer pronouns. But, in this case, my gripe was prompted by a series of mistakes by people who have known for a minimum of six months. I do understand that it's not as easy for everyone, and I try to be very forgiving - but just because I've forgiven someone, that doesn't mean they didn't do something hurtful. And I felt like several people I know could use that reminder.

    On medical advice: No matter how genuine your concern is, I just don't need unsolicited medical advice from my friends. That's kind of what "unsolicited" means. I prefer to decide for myself who to talk to about my medical decisions, because, well, it's kind of personal! There are friends that I discuss it with fairly frequently, mostly trans men who have already started testosterone and have a lot of direct expertise, but also non-trans friends with whom I am comfortable discussing private matters. When a friend brings the topic up themselves, instead of waiting to see if I want to talk about it, and especially if they only want to talk about the negative aspects of transition, it makes me feel like they think I'm an idiot, or making a rash decision, or completely uninformed. I'm… not. I read and reread the Harry Benjamin Standards of Care like it's my new favorite book.

    Moreover, (related to your third question), I will get this medical information from my doctors. One of the actual requirements for a testosterone prescription (as set out in the Standards) is an understanding by the patient of all possible effects, and which ones are irreversible. It's hard to access hormones, let alone surgery, and the system is kind of paternalistic about everything. It's impossible to go through the process without being well-informed.

    And-- everybody has a different cost-benefit analysis running in the back of their mind, and my tolerance for undesirable side-effects is pretty damn high when weighed against the benefits. My vascular system is unusually healthy and probably going to be fine, but even if it wasn't, I'd still make the same choice. Maybe you wouldn't, or other trans men wouldn't, but people have different priorities and that's okay. It's just really unpleasant to feel like other people are trying to impose their own value systems onto my choices; it always feels like they're trying to talk me out of transitioning, when I've never been so sure about anything in my life. It's very difficult for it to come across as supportively as it's intended, and it's not necessary.

    Talking about going to the doctor more generally, though, it gets maybe more complicated. When I'm going to the doctor for things like pneumonia, I receive totally normal medical care, because I just let them assume I'm a girl. It's awful. They always ask when my last menstrual cycle and pap smear were, even if I was just there last week, and they can clearly see that last week the answers were "2007" and "never," respectively. When I was hospitalized a few years back, people would ask "last menstrual cycle?" before even saying hello, and nobody wanted to take my word for it that I wasn't pregnant. I hate my uterus a lot, and I hate the fact that I can't get treatment for anything without having to talk about it.

    (to be continued...)

  5. (continued from last comment...)

    When I'm trying to seek medical care specifically as a trans person... I can't even cope with the question of therapy right now, because I spent nearly six months actively searching and subjected myself for ten or twelve grossly unqualified therapists before giving up, so I'm going to answer just regarding medical care for the body. And… well, it took me three days of phone calls to make an appointment with the endocrinologist I'm going to see. Everybody was convinced that I wasn't their job, and they didn't know whose job I was. Luckily I got in touch with someone who was very invested in helping me figure out who to call, and he got me the name of the endocrinologist I'm seeing, and the phone number for the secretary who would make me an appointment (since the main secretary refused). Another trans friend of mine sees the same endocrinologist and says they're amazing, so I am probably going to get really good care when I show up for my appointment in only seven days (eee!!!) -- but on the other hand, they're the only endocrinologist at the Duke hospital who works with trans students. When it looked like the wait was going to be six months to see this person, I asked if there was anyone else I could see, and the answer was pretty much nope, not because no one was qualified, but because no one was willing. Through another trans friend I knew of a place in Cary that might work, but it seriously made me consider starting myself on black market hormones. (Those who know me in person are probably laughing right now, trying to picture me purchasing black market drugs. I don't think anyone would sell to me.) -- To make all that clearer, right now I haven't discussed my transition with a doctor, but I have an appointment to do so with an endocrinologist.

    So even despite the fact that I've been lucky, I have to say that I have a contentious relationship with the medical system. I'd like to get a pap smear (maybe I'll have cancer and can get a hysterectomy!) but I really don't trust a gynecologist to be respectful, and I don't think I could suck it up and pretend to be a girl for the duration of the encounter. I'm also kind of worried about what will happen when the testosterone takes effect. Most places I will probably either pass for female or pass for cigendered male, but in a medical environment I'd almost certainly get outed as a trans man. (Either I bind, and pass for cis male, and then they find the surprise boobs when they listen to me breathe, or I don't bind, and I want in with a beard and tits - there's no good option.) There have been a lot of cases of trans people being denied non-trans-related medical care (and sometimes dying because of it), and even if it's not that bad, doctors' visits get very personal in a way that would be deeply uncomfortable if the doctor knew of my trans status and wasn't okay with it. But the one time I did disclose, it went well, so I'm trying to remain optimistic.

    Haha, so much for my writer's block! If only I had this much to say about Ben Johnson. Thank you for asking really interesting questions, and feel free to ask anything else you might be curious about. I think I got a little prickly at some points trying to formulate answers for you, but your questions aren't the problem, it's the frustrating people they made me think of (like my parents, augh!). Thanks again for your support, and thanks for reading!

    Lawrence <3

  6. Hey Lawrence! We've never met, but I just wanted to thank you for writing such candid, honest (and snarky) posts every time. I always enjoy reading them and learning from them! You're awesome, keep it up.

  7. Hi Lawrence, thanks for writing about this and being willing to share with people! I'm sorry to hear you are having so much trouble accessing proper medical care.

    I choose to go to a primary care physician who also works with pretty much every trans person I know in Orange County, because even though I don't have the same set of concerns as someone who's trans, I want my gender and sexuality respected and to be comfortable talking about the medically relevant bits with my doctor.

    I don't think she's ever asked about my menstrual cycle since the intake visit when I let her know that pregnancy was not a relevant issue for me. She remembers my orientation and tailors care appropriately (asks about the right STD risks without linking to birth control, etc). I think I could trust her to do a pap smear and understand that my uterus is an organ that may need medical care but does not create my gender.

    Just wanted to let you know that there ARE supportive and professional docs out there. Let me know if you would like a recommendation - even if Chapel Hill is too far away, she might be able to recommend a practice with allies closer to you.