My "Transition"

Covering the story in chronological order, which means that current/recent events don't come in until 2/3rds of the way through the blog post... skip ahead if that's the only part you care about.


See this previous blog (written mid-2012) for my childhood and early adult experiences with hormones and gender roles.

Estrogen-based hormone treatment (birth control) was the only option the doctors gave me back when I first realized that PMS was the cause of my apparently random mood swings. I accepted that treatment plan without realizing that this would come with an appearance-feminizing side effect... by the time I found out that detail, it was too late to do much of anything about it; the primary complaint (mental health issues driven by menstrual cycle) was under control and bigger boobs is something every woman wants, right? [yeah, right. I'm up in the range where even cis-women have reductions. Doctors somehow don't acknowledge that detail though.] I'd queried the possibility of a testosterone-based treatment plan a few times in the subsequent years, but never got taken seriously with my requests.

Right around my 30th birthday, chemical sensitivity kicked in. There'd been a few random things (like plug-in-to-the-wall air fresheners) that I'd had atypical reactions to earlier in my life, but now the number of things to be avoided at all costs more than doubled in a period of only 6 months. Reading everything I could find on this poorly documented condition, the main takeaways were that
1) it primarily shows up in aged 30-something females, and usually gets better after menopause [i.e. probably hormone related]
2) aside from small improvements that can be achieved in limited circumstances, it's generally a degenerative disease... repetitive exposures are not just miserable, they do permanent and irreversible damage to the immune system
So I got good at avoiding the growing list of chemicals that I have extreme adverse reactions to, managing to live a not-terribly-inconvenient life with that limitation.

In December 2013, I moved to the Portland area to start a new job, which of course meant switching to a different employer-provided health insurance plan. The new insurance put me on a different brand of birth control pills, which might technically not have had anything to do with the following adventures but the timing is certainly suspicious. Disabling endometriosis flareups started happening again, as did psychiatric episodes similar to the ones I'd previously had before starting hormone treatment. Again I asked for a testosterone based option, was only offered varying dosages of the estrogen version... experimentation with these in Fall of 2014 verified what had previously been concluded... hormone regulation is necessary to keep the psychiatric symptoms under control, while the estrogen treatment contributes significantly to chemical sensitivity. I was about ready to self-impose weekend isolation on myself (doing ANYTHING outside of my normal routine resulted in 24+ hour migraines) when one of my husband's friends suggested paying attention to what I eat... that experiment added artificial colors and flavors to my avoid-at-all costs list (rainbow jello + single dose of high-strength birth control = 3 day migraine!). Eventually I settled on a balance of low-dose birth control and being super careful of what I eat (in addition to avoiding artificial ingredients, even a minor digestive upset from eating slightly old leftovers would interfere with medication absorption enough to cause several days of misery)... but also started to seriously wish for a non-estrogen treatment option.

Mid-2014, I heard through the grapevine that Kaiser Permanente has a "Gender Pathways" clinic for connecting transgender patients with doctors who have the training/background for providing the associated health care as well that the current WPATH standard of care allows for less-restrictive access to treatment than previous versions had allowed. I saw one of the doctors in that facility in August, which was a disaster. She flat refused to treat me, after her line of questioning found me to not meet the definition of transsexual, and put an assessment of "not transgender" in my medical file. Now it's normal for the general public to get those two terms mixed... but you'd think that a health care provider who is supposedly following a standard of care with the title of "Health of Transsexual, Transgender, and Gender Nonconforming People" and an included glossary that distinguishes between those categories would know the difference!

For the record, WPATH7 allows for prescription of identity-conforming hormones and access to surgery for all three of the identities listed in the document's title, not just the first category. Also, unofficial surveys of other trans-identified people who have had experience with this particular doctor indicates that she treats conventionally MtF or FtM people great, while giving all non-binary identified people the same refusal-to-treat. I reported her to Kaiser's administration over this... twice. No action taken, as far as I know.

That left me grudgingly stuck with the estrogen-based treatment plan for another two years, until I got the names of two other doctors in Kaiser's system that also treat trans patients. Not wanting to go through a repeat of the round 1 drama, I pre-screened both for willingness to treat non-binary patients. The nurse assistant for one indicated that she was non-binary friendly, then the nurse assistant for the doc that refused to treat me somehow got ahold of my file/case and said I wasn't allowed to schedule appointments without her authorization. The other doctor, I was able to schedule an appointment with. He bounced me over to an outside counselor for formal assessment/diagnosis of gender dysphoria, but happily proceeded with pre-treatment health screening for possible complications and prescription of testosterone once that paperwork was filed.

I got my first testosterone injection in October 2016, and am very much enjoying the improved treatment outcome. I still have chemical sensitivity, but not anywhere as near as severe as when I was on estrogen. I can sleep in on weekends instead of needing to get up at the same time to take my medications. I can eat small amounts of artificial colors and flavors, and the unavoidable environmental contaminations (brief exposures to cigarette smoke or vaping, contractor using spray paint on a construction site, etc) no longer give me instant migraines. When my hormone dose gets delayed by a day or two (or even a week), I don't suffer any significant mental or physical ill effects. Massive improvement over constantly having to choose between mental or physical health!

I sent out an announcement email to my coworkers when my voice started changing (late December) letting them know what's going on there (I'm fine with using the cleaner restroom, going to continue wearing a mix of men's and women's clothes indefinitely, am not going to police pronouns, etc). All of the responses I got were incredibly supportive. I rarely talk to my family, so haven't told most of them yet.

At my annual employee review in January, I was asked what my transition goals are, which was a nice opportunity to formally state the priorities I've been operating under all along:
#1: my head needs to function (minimize psychiatric symptoms and migraines)
#2: physical health (ability to move freely, avoid unnecessary onset of osteoperosis)
#3: appearance compatible with my non-binary identity
The estrogen treatment plan was only marginally successful (if that) at the first two priorities, and was directly counter to the third. Testosterone is giving me superior results on all three. Even if you hold beliefs that deny validity of that third item, the first two are health standards that any sane person should be fully supportive of... and this is the best option available for my situation.

That being said, I'm also excited to see the decade of unwanted feminization being reversed, and masculine aspects starting to show in my appearance. My gender identity is neuter... while I doubt that I'll ever really be able to present in a way that would consistently get interpreted as such, the possibility of being able to present myself as not-female is a welcome relief. My bone structure is stuck in the "female" pattern, it'd be nice to have some male features to balance that out. There's a photo of my dad from back when he was about the age I am now that is reasonably close to how I'd like to eventually appear (blonde hair the same length as mine is now, plus full beard)... I need to track down a copy of that to post for illustration.

I don't currently have the option of pursuing any surgeries through the Gender Pathways route because Ms. nonbinary-isn't-trans is the head of that department and so gets to act as gatekeeper to surgery access. I'm pretty sure I don't want bottom surgery (what I have is nicely functional; don't see any benefit to tampering with it), undecided on whether or not I want to pursue top surgery... that's probably going to depend on how androgynous-balanced I look after the testosterone-driven appearance changes have stabilized. Even if I did opt for top surgery, it'd probably be more of a reduction (which cis-women are allowed to have, so don't you dare be applying a different standard to me) than a "sex change" operation... not that my surgery plans are any of your business, of course.