Can’t You Wait Until I’m Dead? ~ Chapter 9: Is This What They Mean by Existential Crisis?
It didn’t seem like my minimal psychotherapy was a deal-breaker for Dr. Melnyk, but it would protect her if something went sideways and I scheduled a follow-up phone appointment with my psychologist. Guidelines urged counselling prior to starting hormones, but said it shouldn’t be a barrier if a patient couldn’t afford or access it. That didn’t describe me. Nevertheless, I didn’t have any issues, aside from wanting to start hormones, so all I could do was provide her with an update. Here’s how her notes went:
“Client stated he did talk with his partner and expressed feeling better for that. Client stated that his partner had been understanding; however, stating that he realizes that there will be a need for more talks throughout. Client stated that it was helpful to read a book by someone who had gone through similar experience. He expressed that he has known on some level for a long time, re: gender identity, and is feeling better for having come out and shared it. He stated he has read re: transgender, has talked at length to his doctor about the process and appears to have her support from what he stated. He appears to be taking steps carefully, understanding that the process of sex reassignment is a long process. Reviewed options to look into re: talking to someone who has actually gone through the process.”
After the call, I asked the agency if they could send the notes to my doctor. They replied, “We aren’t set up to do that. Your visits are private and for your own benefit, so we can’t pay our counsellors to write letters. Some psychologists offer services like that, but it would be outside of the arrangement we have with your employer.” I was stuck again. Would Dr. Melnyk delay prescribing hormones without proof of counselling?
I didn’t want to spend a few more months finding another psychologist and paying for sessions I didn’t need, so I called the agency and pressed again, explaining that I needed something to show my doctor. This time, the agent remembered they could send screenshots in a secure file, but I’d have to fill out a release form. The notes arrived a few days later, accompanied by a disclaimer stating that they “were not a formal, independent psychological assessment” and were collected as part of their employee and family assistance “Stay at Work” program. I printed the three pages of notes for Dr. Melnyk and left off the disclaimer.
I wasn’t going to leave anything to chance, and wrote a summary for her called “Q&A” in which I listed the WPATH criteria for initiating hormone treatment, described how I met the requirements, and added a few questions to describe how I planned to overcome any bumps along the way. If a specialist or provincial Medical Services Plan (MSP) auditor questioned why she prescribed hormones, she’d have this to give them:
Q1: Do you have persistent, well-documented gender dysphoria?
A: Am I transgender? Yes, I have a history of gender dysphoria since childhood (maybe once a month) and now more persistent discomfort (daily) for a year (Feb/March 2015).
Q1.1: What do you mean by gender dysphoria?
A: I just knew I was a girl, attracted to other girls. Not happy when facial hair and body hair started to come in on legs, arms, chest, now back and abdomen. Didn’t like it when Grandma titled letters to me with “Master.” Not happy when my muscles developed. Felt like “sheep in wolf’s clothing.” Felt like I was losing myself. Never liked being called “Mr.” or “Sir.” Always wanted to wear women’s clothes because I felt like a woman. Decided that I would ignore the feelings when I found a girlfriend who became my partner. Cry seeing transgender stories and stories of people finding their place in society. Stopped looking at my face with beard shadow in the mirror around March 2015, because it doesn’t match the image I have of my female self. Felt like myself after I shaved my abdomen and chest, but the feeling went away as it grew back. Little things like underwear, painting toenails, pierced ears, necklace, and women’s clothes only make me feel like myself for a little while, like an IOU that hasn’t been paid back.
Q2: Do you have the capacity to make a fully informed decision and to consent to treatment? A: I have a PhD in Neuroscience, chair the Research Ethics Board, and read just about everything available on medical treatment of gender dysphoria, including consent templates.
Q3: Are you the age of majority? Yes.
Q4: If significant medical or mental health concerns are present, are they reasonably well-controlled?
A: No known medical or mental health concerns other than gender dysphoria. Did the BounceBack program in July-Sept 2014, following a psychologically traumatic experience at work, and it has worked in dealing with those negative feelings.
Q5: Do you have adequate supports for transition?
A: My partner is supportive—we bought lipstick, underwear, and clothes together. I don’t expect difficulty with my employer; we have a supportive LGBT community on campus. I have been slowly introducing my family to the concept of feminine transition—painted nails, pierced earrings (my mother even gave me a pair)—and I haven’t encountered any pushback. Came out to partner on March 16, discussed with GP on March 29, and on May 2.
Q6: How do you see it playing out?
A: Starting electrolysis on my face on June 3. Will hopefully start hormones with GP and see how I feel. If it goes well, continue slowly replacing boy clothes with women’s clothes as appropriate for appearance. Hope that sex with partner will continue as normal, but will work it out if ED (erectile dysfunction) becomes a problem (e.g., toys, drugs, splint). Two to five years down the road, I will consider surgery, but don’t see an immediate need now (realize that genitals may become the next target of dysphoria after hair and body have changed).
When we met the following week, Dr. Melnyk was ready to order baseline labs, check my prostate, and clear me for hormone therapy. My kidneys, liver, thyroid, pituitary, heart, colon, and gonads all checked out fine. She looked more uncomfortable than I was, giving me my first rectal exam, and I had an odd sense of guilt putting her through it. A second, deeper guilt overshadowed that guilt, questioning why I was doing this to myself and everyone I loved. My way of processing it was just to let my fingers type what came to mind:
“Killing [Deadname]” Stream of Consciousness.[i]
I’m going through some guilt for killing [deadname]. Wondering who I really am. When I close my eyes, am I really a woman? I’ve found myself repulsed when I catch a glimpse of myself in a mirror, when I see my hairy arms, legs, chest, and stomach. Is this something I can psych my way out of, or am I really trans? I think the only way I will really know is to push [deadname] back the way he pushed me into the background and see how I feel. The only way I know how to do that is to start down the hormonal path of transition.
When does it become irreversible? Are hormones diagnostic or a self-fulfilling prophecy of a trap? I feel I should learn to love myself the way I am, like the recent body positivity movement for weight. But if being overweight made me unhappy, shouldn’t I try to lose weight and see how I feel?
If gender dysphoria is making me unhappy, shouldn’t I let myself be feminine and see how I feel? The happiest few days recently have been letting myself be me, shaving my chest and stomach and seeing the difference. Sometimes I catch a glimpse of my lengthening hair, imagine my face rounder, imagine my arms with a softer edge, picture larger breasts and feel happy, if only for a moment.
Gender for me isn’t something I feel with my eyes closed—it's only there with eyes open, and my eyes aren’t seeing what they expect to see. I’ve crossed that threshold where I can’t twist what I see enough to make it fit. I’m older and hairier than my coping mechanism can deal with anymore. Stuffing my feminine side down isn’t an option anymore—it hasn’t been healthy. Sure, I can feel okay if I distract myself with work and projects, but is that really how I want to live? A workaholic only because I’m trying to hide something from myself.
“Don’t Do It” Stream of Consciousness
You have a handsome male face and body. Male privilege and respect. The pinnacle of human power and strength. Why give it up to become a trans woman? Not even a real woman—not a born woman. People will give you a look. You’re too thin-skinned to take it. Start playing guitar and writing—it’s an unhealthy obsession you can treat with a bit more counselling.
Do more art—improve your self-esteem, and it will all be better. You’re just doing this to be provocative—make a show of it. Maybe you want to confront people. A psychologist said some people are reactive. Maybe I’m reactive to trauma or reactive to bigots? Maybe it’s family bipolar disorder coming out. A little lithium will cure it. You just want to be different because you feel so common. Get used to it. Suck it up, buttercup! Be a man.
“Acceptance” Stream of Consciousness
Listen to yourself—that last bit was from outside yourself. What do I say to myself? I’m more than half feminine—wait, what is feminine? I don’t want to be the breadwinner. I want to be a homemaker. I want to be the nurturer. I want to look at my nails from the back of my hand. Look at the sole of my foot over my shoulder.[ii]
If I have to wear clothes, I want them to be pretty. I've always had these needs that I’ve set aside to be the man everyone else wants to see. Maybe I did it because I thought it was the only way to be accepted, but I care less about being accepted than accepting myself now. To play with my hair and jewellery without being self-conscious. I’m not flirting, I’m tactile. If that makes me “feminine,” then so be it. I need to be authentic to myself, and if medicine has a treatment for it, I should try it. If I had a severe infection, would I let myself die to prove a principle? This may be my last chance to be myself.
My psychologist said that talking to other women who transitioned might help, and it moved to the front of my mind when my transition edged closer. I needed to connect with someone who had been down this road and find out if it was the right step for me. I called QMUNITY first to see if they had a peer support program. They offered a drop-in on Saturdays, and a seminar and discussion series twice a month on Friday afternoons, but the thought of a group session on a Friday or Saturday made my skin crawl. Try a personal ad?, I thought.
A 2015 New York Times article about the project, To Survive on This Shore, by Jess Dugan and Vanessa Fabbre,[iii] showed me older trans women, men, and gender-nonconforming people who looked like me. Jess and Vanessa travelled across the US, interviewing and photographing trans people, and planned to develop the project into a book and several exhibitions.
I wrote to Jess, “I’m writing not because I’d be a great model or that I have a story to tell, but I’m embarking on an MTF transition at the age of 50 and wonder what I’m in for. I’m a scientist, professor, and ethicist (under my birth name). I was wondering if any of the trans women you’ve met would be willing to talk to me by email, text, chat, or phone. I’m really at the beginning of it all and have had a hard time finding peer support. Most are so much younger.” She wrote back that she couldn’t give out contact information (I hoped she would forward mine!) and that Vanessa would follow up with some good places to start. Vanessa, an Assistant Professor of social work, replied that many others transition later in life, that I was far from alone, and that peer support and one or two good professional supports were important.
If I couldn’t break the inertia of my settled routine and venture into Vancouver for even one group session, how would I make it any further in my transition? I was trapped again by the anxiety and introversion I thought I’d overcome. It would take finding a new me in a new city to break the impasse.
[i] I’ve replaced references to my birth name in my own writing with “[deadname].” See Merriam-Webster, “deadname,” https://www.merriam-webster.com/dictionary/deadname.
[ii] In Grade 7, a group of boys tried a “gender test” on me to see if I was a boy or a girl. Maybe it was a trick, but they said I failed when I looked at my fingernails with my fingers extended, rather than curled, and the sole of my shoe by bending my knee and looking behind me, rather than folding my leg in front.
[iii] Jacob Bernstein, “For Some in Transgender Community, It’s Never Too Late to Make a Change,” New York Times, March 6, 2015, https://www.nytimes.com/2015/03/08/fashion/for-some-in-transgender-community-its-never-too-late-to-make-a-change.html.