Can’t You Wait Until I’m Dead? ~ Chapter 7: Getting Help
With our relationship forming a solid base, I returned my focus to being comfortable in my skin again. I began reading the medical literature and treatment guidelines published by trans healthcare organizations, like one based at the University of California in San Francisco (UCSF), and discovered that many in my situation took the generic testosterone blocker, spironolactone, and oral or transdermal estradiol. One case study reported that spironolactone alone could cause unintended growth of breasts in men (gynecomastia) when prescribed for heart failure or high blood pressure.[i]
Most doctors wouldn’t prescribe spironolactone or estradiol without a letter from a psychologist documenting gender dysphoria, and would make me sign a lengthy informed consent form outlining all the potential “side effects” of the treatment. The consent forms I found online also included an acknowledgement that the effects were often permanent. The side effects included shrinking testes, sterility, weaker erections, dry skin, decreased muscle mass, reduced facial and body hair, high potassium (a risk for cardiac arrhythmia), high cholesterol, high blood pressure, blood clots, pituitary tumours, and breast cancer. Cautions included that a low-pitch voice would not raise, hair already lost on the head would not regrow, fertility might not return, and mood might change. Balancing the dire warnings were reports from other trans women that their anxiety and gender dysphoria disappeared within days of taking their first doses.
My resolution, made nearly a year earlier, to stop buying men’s clothes led to the next challenge: finding women’s clothes at the local mall. I suppressed the fact that I still looked like a balding, lanky, middle-aged man and walked into the women’s section of Walmart. The bravest I managed in the crowded store, afraid that all the women were watching me, was to buy fluorescent multicoloured socks, extra-large capri pants, and a pale green tank top in extra-large. I wasn’t ready to face the stares of a change room attendant asking to see what I was taking in, so I bought them without trying them on.
I found the next women’s store in the mall occupied by only one customer and a busy shop owner, who was distracted by stocking the store, so I wandered the racks looking for something in my size, unsure of what size I might be. I first discovered that I loved the colour aubergine (dark purple). A simple hooded aubergine raincoat fit me perfectly and made me feel sheltered, unlike any other coat I’d ever worn. It was hard to understand the emotion, but I became myself when I put it on.
My second discovery was an affinity for tights. A pair in black caught my eye, and with no hint that she’d been paying attention, I heard her say, “A pair of good black tights always come in handy.” I finished the odd ensemble with a sheer neon pink long-sleeved blouse. March was a little early to wear something that thin in Vancouver, but it brought me back to taking ballet and modern dance at university thirty-two years ago, and I had to have something to go with the tights.
Sarah wasn’t back from work yet, so I ran upstairs to our bedroom, drew the curtain, stripped off my clothes and pulled on a pair of fluorescent pink socks, the black tights, and the green tank top. When I turned myself just right in the mirror to take a selfie, from the neck down, I was…feminine. It was my first experience of gender euphoria. Proud that I’d overcome my fears, I snapped photos of the receipts, tossed them into recycling, and stashed everything away in the back of my closet and drawers. Sarah’s return sparked fear that she’d sense a difference in me or find a new purchase—I still wasn’t ready to talk to her about transitioning socially.
I spent the few evenings before my March 29 appointment with Dr. Melnyk cramming in as much reading about transfeminine treatments as I could, finding the 2011 World Professional Association for Transgender Health (WPATH) Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People, a UCSF medication protocol, a 2015 hormone guide from Vancouver Coastal Health, and two sample consent forms from San Jose Central Health Center.[ii]
On the day, I came prepared for the appointment with printouts of everything in a folder, including a list labelled “What were earlier feminine/trans feelings?” Still, I was unprepared for the emotional energy it would take to come out to her. After we sat down in her office and chatted a bit about the weather, she asked me, “So what’s the reason for your visit today?” Tears started welling up instantly, and I choked out, “I think I might be transgender.”
It took me a few minutes to compose myself, and she asked me to explain why. I recounted the office origin story of my crisis, and the personal and social signs that fit with female gender identity and expression. “When I’ve had patients like you, I’ve referred them to Three Bridges and hardly ever see them again.” I wondered how many other patients had been where I was now, but didn’t think it was the right time to get into it. After I thanked her for her help, she said I would probably hear directly from the Three Bridges transgender health clinic when they had an appointment for me.
The wait for the appointment weighed on me as I carried on teaching and chairing the research ethics board. In April, as Sarah and I prepared for a trip to attend a wedding in South Dakota, I realized my dysphoria would be worse in a suit and tie and hit upon shaving my chest. There was no risk of swimming or being seen with a bare chest, and although shorts were possible in the spring, I could leave my legs unshaven and avoid notice. I experienced my next rush of gender euphoria when I looked down and was free from the wiry salt-and-pepper hair that plagued me. I snapped a selfie, copied it to a hidden folder on my desktop, and deleted it from our digital camera.
The wedding in South Dakota and a brief visit with my family in Minnesota carried the uncomfortable undercurrent of what was now a secret between us and our families. Sarah’s family hadn’t seen me in a while, and I had visibly aged, but I had pierced ears in a conservative, farming community, where men didn’t do such things. When we were catching up, my mother pulled out a small jewellery box and opened it to reveal a pair of small diamond earrings my father had given her. She asked, “Now that you have pierced ears, would you like these? I haven’t worn them since the divorce, and I thought I’d give them to Violet one day, but she doesn’t seem that interested in earrings.”
Violet was my nonbinary nibling,[iii] who preferred baggy clothes and avoided any pressure to wear makeup, so piercing her ears wasn’t likely. Does she sense that there’s something more to my wearing earrings? I thought. She deflated that hope when she pulled out a dull green men’s polo shirt and beige shorts she’d bought for me at Kohl’s department store. Realizing that she’d spent precious time and money on a gift I’d never wear, my chest tightened. We hugged, and I packed the gifts away in my luggage. They were already in a donation bin in my head.
The wedding in South Dakota was beautiful as weddings go, but as we sat down at a picnic table afterwards with Sarah’s eighty-seven-year-old father, he looked at me, my sparkly diamond earrings, and rolled his eyes. He was always a joker, and Sarah brushed it off as his sense of humour, but it couldn’t help but sting in my sensitive state. When we returned to Vancouver, my bottled-up dysphoria and uncertain path to transition spurred me to write another blog post. This one, the twelfth, was about why it took so long for me to consider my gender identity. I opened the list of earlier feminine experiences I’d written for my doctor, added and subtracted a few, inserted the selfie, and hit publish on WordPress.
On Discovering My Gender Identity
21 April 2016 — When I look back on my past, and list everything I can think of that might have tipped me off that I am trans, none of it in isolation seems that significant. It looks like normal youthful exploration if I try to be objective. What boy likes shopping for clothes and hasn’t tried on mom’s shoes? Finding a girlfriend was tough, but is it easy for any guy?
Before I kick myself too hard, I don’t remember seeing any trans celebrities, or even any (out) gay celebrities, growing up in the 70s, so I didn’t have a frame of reference or role model in my isolated, suburban world. I never really thought about gender, and it wasn’t anything that came up in health class. So why now? At fifty, my testosterone is probably starting to wane, and whatever it was in my brain that kept me from thinking about gender is beginning to turn off.
Hair is also getting thicker all over my body except my head, where it’s thinning, so it’s getting harder and harder to fool myself into thinking I’m a woman when I squint into the mirror. In graduate school, we learned that testosterone is converted to estrogen before it acts on the brain, so my brain is probably estrogen-deficient. Not surprisingly, some “men” like me go on estrogen and are fine continuing to present as male. I haven’t started estrogen, so I don’t know what the future holds. Pre-hormones, I can’t continue as I have and need to change.
As I start this journey, here are the questions I’m hoping to answer:
• Am I just a feminine, gender-sensitive man who wants to fight for trans and women’s rights? An ally?
• Was I depressed years ago because I was repressing my trans self (gender dysphoria), or do I just think I’m trans because I was depressed and identified with trans MTF in the media?
• Do I need to transition, or is dressing and acknowledging it enough, like it seems [Susy] Eddie Izzard does?
Here’s my gender history with all of its retrospective, possibly revisionist, bias. I hope this list will help someone questioning their gender. Maybe even someone younger, when transition might be a bit easier.
1970s
• Tried on mom’s shoes in Grade 3.
• Became a wedding bride in a playmate’s basement and liked it.
• Cried in elementary school for no apparent reason—something wasn’t right in gym class—I think it was a boys vs. girls game.
• Best time playing with the girl across the street was with her paper dolls.
• Always “thin-skinned.”
• Tried mom’s dresses in junior high.
• Loved repairing mom’s earrings as a teen.
• Hated shopping for clothes.
• Hated team sports with boys.
• Parents signed me up for judo and baseball, but I didn’t fit in with the boys.
• Liked knitting and sewing.
• Loved playing domestic bliss with Big Jim and GI Joe (camped, cooked and sat around the fire), knitted a scarf and blanket for them.
• Felt like mom’s peer.
• Teased for being too feminine in Grade 7 or 8: two boys pulled on the back of my favourite form-fitting shirt like there was a bra strap underneath and said, “He should get the picture now.”
• Liked working as a babysitter and spent a magical day soothing crying babies and watching them sleep on my lap at a car show. I was the only one who could get them to sleep.
1980-90s
• Not happy in high school when Mom complimented me on growing muscles.
• Always hated facial hair, shaving, and wanted a smooth face.
• Loved wearing a puka bead necklace at sixteen.
• Loved my long hair in university and grad school, especially when mistaken for a woman.
• Haircuts never looked right.
• Loved Speedo underwear and short shorts.
• Got a job on a female residential ward because the manager thought I was gay like him. I wore rolled-up khakis to mid-calf, loafers without socks, and crossed my legs.
• Regularly bought W fashion spread (coloured newsprint) and covered my dorm room and hallway door with the dress-filled pages. When friends asked why, I said I was into fashion.
• Missed favourite puffy shirt when it disappeared.
• Wore a bra and earrings for my girlfriend when we first moved in together, and decided to repress those feelings to have a relationship.
2000s
• Over the years, I asked if I could wear my partner’s lipstick when I didn’t have Chapstick.
• “Joked” about wearing skirts and dresses with co-workers and partner, especially in the summer.
• Complimented a student sitting next to me in a seminar on her dress, and she thought I was making a pass at her rather than loving her dress.
• Saw [Suzy] Eddie Izzard in concert wearing a bra and wondered if it was something I could do.
• Didn’t understand why I cried watching Avicii/Aloe Blacc’s “Wake Me Up” video, where a young woman leaves her small town and finds her chosen family.
• Thought/talked about getting pierced ears.
• Thought/talked about shaving body hair.
• Attended QMUNITY Queer Competency Training at work and when asked about my pronouns I didn’t want to say “she,” so I said, “I don’t like pronouns.”
Since July 2014
• Got pierced ears.
• Argued with co-worker about transgender rights—light bulb went off.
• Mentioned to our department head afterwards that I was probably so emotional because I might have transitioned if I were younger.
• Read Whipping Girl, She’s Not There, Mean Girls, researched hormones, surgery, and read many trans stories on the web about gender dysphoria.
• Wear a necklace from my partner.
• Wear a bracelet.
• Paint toenails and would do fingernails, but I’m afraid of the upkeep.
• Hair is not right, thinning—got it buzzed by a barber in frustration.
• Dislike my body/facial hair.
• Want to wear dresses in summer.
• Bought tights.
• Bought a women’s rain jacket.
• Wear swimming tights.
• Bought women’s clothes.
• Tried on lipstick.
• Partner knitted pink socks for me.
• Love wearing my partner’s hand-me-down gloves and sweats.
• Study other women’s clothes and ask myself, “Could I wear that?”
• Starting to dislike all my old clothes and hats.
• Don’t want to buy any more “boy clothes.”
• Bristle when called sir, he, him, Mr., etc.
• Take women’s/trans issues personally.
• Considering a name change.
• Shaved chest and stomach and felt great for a few days, until it grew back.
***
What did I share with my doctor but leave out of this public, anonymous post? One of my earliest gendered memories was playing in the bathtub around four or five years old and treating my penis like just another bath toy. I could push my penis back into my body at that age, and it was fun to make it disappear. I remember wondering if there was a way to make it stay, but the game disappointed me and grew old when it popped back out again. I don’t remember ever seeing my mother’s or any other girl’s genitals, but mine felt wrong.
The other gendered memory I left off the blog post was that in my teens I revisited the penis hiding game, this time by pulling it behind my crossed legs and pubic hair. I could get used to this, I thought.
My language was also more gender neutral than others. Friends and family had “a kid,” or “child,” rather than a boy or a girl, and I used they/them/theirs pronouns more often than he/him/his, or she/her/hers. When I addressed a group, I said, “Hello everyone,” instead of “Ladies and gentlemen” or “Hey guys.” My subconscious was setting me up for a nonbinary gender identity.
The rest of my collected notes for my first doctor’s appointment included the bullet points:
• Don’t want to be ‘guy in dress’ (but realize that even ‘guy in dress’ is better than not liking what I’m in now).
• Thinking gender neutral clothes for work (like Ellen [DeGeneres]).
• “Thinking about name change (Bertie, Allison).
The notes also included three sections: “How to Know,” “Things I’m Scared About,” and “Things I’m Excited About.” I don’t remember whether we discussed all my experiments and thoughts at the appointment, but the discarded experiments included trying an antidepressant, getting tested for low testosterone, and dressing in women’s clothes, noting that Jennifer Finney Boylan started dressing in private and successfully transitioned afterwards.
I was scared about hurting Sarah, losing my home, my status at work, that I would look ugly in women’s clothes, and after it all, end up in the same place. On top of that, I was too sensitive to handle the discrimination and abuse I thought would come. The hopes outweighing the fears included finally being honest with everyone, a sense of calmness and inner peace, a congruent inner and outer image, not seeing a stranger in the mirror, and finally having some new clothes that made me happy.
All these hopes and fears stirred in my head as my teaching year came to a close and summer approached. Work was my primary distraction; without it, I’d have to face it all in the coming three months.
[i] Bridgett A. Haynes, and Farouk Mookadam, “Male Gynecomastia,” Mayo Clinic Proceedings 84, no. 8 (2009): 672, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2719518/.
[ii] World Professional Association for Transgender Health, “Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People,” [7th Version] (2011), https://www.wpath.org/publications/soc.
“Primary Care Protocol for Transgender Patient Care: Hormone Administration,” University of California, San Francisco, March 27, 2016, http://transhealth.ucsf.edu/trans?page=protocol-hormones.
Marshall Dahl, Jamie L. Feldman, Joshua Goldberg, Afshin Jaberi, and Vancouver Coastal Health, “Endocrine Therapy for Transgender Adults in British Columbia: Suggested Guidelines,” (Vancouver, BC: Vancouver Coastal Health).
“Client Information for Informed Consent: Feminizing Medications for Transgender Clients,” March 27, 2016, (San Jose, CA: 1691 The Alameda).
[iii] “Nibling” is a gender-neutral alternative to "niece" and "nephew.”