On Dysphoria

I no longer find the concept of “dysphoria” to be useful in reference to myself, and no longer refer to myself as dysphoric. Dysphoria is a big, somewhat amorphous word that obfuscates nuance. I sometimes find that putting that label onto my feelings prevents me from exploring them further; it is a “just-because” answer.

I have been reading some detransition blogs, and this has been one of my key takeaways. One criticism detransitioners have of how transition currently functions is that the moment a person has “dysphoria”, transition is often the only solution offered by medical professionals, and the nature of the dysphoria is not discussed.

I am speaking personally, of course. Lots of people find dysphoria a useful framework within which to understand their experience of the world, which is fine. However, I also find that medically, the concept is mainly used to 1. Gatekeep transition related procedures, and 2. Medicalise transness by making it a diagnosable condition.

I have several issues with the medicalisation of transness. I am deeply uncomfortable with the idea of discussing my gender with doctors. Anxiety, cancer, the flu, are medical issues. My gender is not. My gender is a personal thing I have no desire to have examined or treated or even talked about under fluorescent clinical lights. Gross!! My gender does NOT need treatment. I resent having to broadcast my gender in order to access physical transition.

I disagree that “do you or do you not have dysphoria?” is the right question to ask before “allowing” somebody access to medically gatekept transition related procedures. A better question would be, “would you or would you not benefit from this procedure?”. The former values cis bodies above trans bodies. It implies that without diagnosable, “clinically significant” dysphoria, no assumed-cis person would transition or be trans.

I think that the psychological treatment of gender dysphoria should be separated from physical transition. For some people, physical transition is all that is needed to deal with dysphoria. That is fine. I am instead concerned with folks who may also benefit from therapy (i.e. most people, including cis people). Treating physical transition as the ONE answer to dysphoria does a disservice to people for whom physical transition may only be part of the answer, for any amount of reasons.

Clearly, if a person is in “clinically significant” gender-related distress, which is how dysphoria is defined, they should get professional help. But mental health professionals are simultaneously supposed to help people cope with gender dysphoria while gatekeeping access to transition. This is a conflict of interest, and for many trans people, therapy requirements become hoops to jump through rather than any opportunity for actual meaningful therapeutic relationship. I think that these functions need to be separated by demedicalising and providing free and easy access to physical transition.


The idea that cis bodies and lives are valued above trans ones is elaborated on here in Julia Serano’s piece on detransition and desistance. An example she provides is that if an assigned female at birth cisgender girl started producing testosterone (possibly due to an intersex variation), she would find it much easier to access hormonal treatment than a transgender girl, despite comparable safety of the treatment, and age/maturity of the girls. A transgender girl is much more likely to be told to live with her “natural” body until she is “old enough” to decide, while we are much more likely to accept that of course the cisgender girl is correct in her assessment that she does not want the excess testosterone. Thinking that everyone should obviously try as hard as they can to be as cisgender as possible is the same condescending position as “queer people deserve rights because queerness is not a choice… because who would choose THAT?”.

Transness as a choice, rather than an objective discoverable Truth, is elaborated on in Ozymandias’ blog here. They write that an identify-based framework in which you try to figure out if you are REALLY trans, and whether what you feel is REALLY dysphoria is often recursive and unhelpful. If transition would improve your life, you can just do that.

These are of course unorthodox views not in line with WPATH standards. The medical establishment, after all, is always between two and five steps behind trans people. This does throw quite a wrench into my hopes to qualify for transition…

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On Dysphoria

Boxers, Birthdays

It is an hour before my 21st birthday, and it is my second attempt at wearing boxers. It is weird. I feel very weirdly vulnerable. (And it’s not even mainly because I’m about to blog about my underfeelings.)

It’s just undies. Most of us have to wear some, at some point. Does it really matter what kind?

..

My undie situation has been kind of in the air for a while, and I’ve been suspecting that maybe I would benefit from trying different kinds. But I kept putting it off and telling myself that it doesn’t matter, probably as an excuse to maintain status quo.

I don’t know why I am having feelings about this. Maybe it feels like a more significant step: I see women in menswear and short hair all the time, but not in men’s undies, though I am told lots of women do wear boxers. I guess I liked having plausible deniability, and being able to “go back” at any time.

Women’s undies, and presenting femininity, are familiar. I know how to do those things, with 21 years of practice, and they are fine. Every few months I decide that being a woman isn’t that bad and that actually I could do that for the rest of my life, because it is familiar and easy and it feels safe. This, this is new and suddenly my gender *stuff* feels real and no longer deniable and I am uncertain.

I feel like maybe there is a truth here that I am trying to deny, and maybe just sitting here in boxers when several parts of me are screaming go back go back GO BACK is me sitting in that truth.

I have not felt this vulnerable in months. I had been growing confident in my identity, and maybe it is time for that complacency to crack again, and to resume the work of figuring myself out.

..

21. Now I can have hormones if I want them. Top surgery. Both questions I had put on hold, to think about slowly, if at all. I don’t feel ready, and don’t know if I ever will be.

I never thought there was anything particularly brave about being trans. I’ve been lucky, and everything has been easy so far. I never faced much external opposition, actually, and never thought myself to be the kind of person particularly bothered by what other people think. But here I am, sitting here, and today that is taking courage, and I am a little bit proud.

 

Boxers, Birthdays

Transition: where I’m at

I’ve been tracking my menstrual cycle for a few of the seven years I’ve had one, but rather ineffectively with a messy excel spreadsheet. A few months ago I finally got the app Clue, which I mainly use to track sleep and mood, but also occasionally other related stuff like pain and caffeine intake. It’s a pretty good, reasonably customisable, gender neutral app.

Recently I noticed that I tend to get tired and sad right around the end my period and just after the middle of my cycle, with varying degrees of incapacitation. These periods correspond to the increases in estrogen, as seen in the chart below. Some months are a lot worse than others, but it does seem to happen predictably. I don’t know if it happened before I started to notice it or if it is a new thing. I have also known for a while that I tend to be anxious and unable to sleep just before my period, though that has gotten better this year. That is pretty common, and probably due to the decreasing progesterone. I usually feel great during the first three days of my period, when everything is low. I used to get bursts of anger but not recently.
HormoneCycle

Fig 1.1: random unsourced chart from The Internet. Day 0 is the first day of menstruation.

Definitely hormones aren’t the entire story and my mental health is a complex culmination of things, and obviously hormones themselves are much more complex than the chart implies. This is also based on observation and fitting of my menstrual cycle and not blood tests, so I don’t actually know my levels for sure. But increasing estrogen does seem to be an unpleasant thing for me, which is unusual but not unheard of in cis women. Everyone reacts to hormones differently, but in general the decreasing levels right before menstruation is the unpleasant part, which is why premenstrual syndrome is a thing.

There isn’t necessarily a solution to this, nor is it an extremely debilitating problem, though being able to identify what is happening does help when I occasionally suddenly can’t function for no apparent reason. People put up with a shocking amount of terrible shit in relation with their menstrual cycles and that is considered “normal”. Or, if they do try to do something about it, they are usually told, maybe after a bunch of scans etc that don’t find anything, that there is nothing medical science can do for them and they just have to put up with it. Which, first of all, is not true. There are hormonal methods of regulating or stopping periods that are generally considered safe, and should be tried or at least considered if your menstrual cycle is causing debilitating pain or otherwise significantly impacting your quality of life. Some doctors just aren’t up to speed on that front and you should maybe try another one. (I asked the uni health service doctor about this once and he hadn’t heard of it and laughed at me.) But that also isn’t a perfect solution because messing with your hormone levels is always iffy and lots of people have weird side effects on birth control pills.

Which brings me to testosterone. If I want to even out my estrogen levels I could take birth control pills, which are rather expensive, and might fuck me up even more, or I could take T. And that’s a whole other thing.

There is some evidence that trans people with physical dysphoria may simply have brains that aren’t suited for the bodies they are born with. Trans people who start Hormone Replacement Therapy often talk about how more than the physical changes, the most positive change is that their emotions start to make more sense to them. It’s like they’ve been living on the wrong hormone all their life, and their brain and body weren’t supposed to be bathed in the amounts of hormones they naturally produce. This is the part of transition that is impossible to predict or know until you try. It is impossible to know if you will be more functional on different levels of hormones than the only levels you have known. (We also cannot know if there are cis people who might be happier on different hormones, but most of them aren’t asking themselves that, which in my opinion is their loss.)

I don’t know how I would emotionally respond to testosterone until I try it. That’s not helpful for decision making. So I think about how I feel about the other changes. I don’t want to be read as a man all the time. I like many of the things about me that are soft. I like having soft skin. I don’t want to look like a man. But I want to move a little in that direction. I don’t know, ideally I would have a mix of gender signifiers. I want a more masculine face and body shape but not a lower voice. But I also wouldn’t mind having a slightly lower voice as long as I didn’t read as completely male. You know?? But the voice drop on T is weird and you have to stretch and do vocal exercises for optimal results, and I am lazy af. I could also voice train without T but I am super awkward about that. I am neutral about having more body and facial hair, but I’m chinese so I wouldn’t get a lot of that even on a full dose of T. I think that I don’t have specific dysphoria about particular traits, I just want a more even mix than I currently have. I think that I would like to look “soft boy”, and not just soft. (I love the term soft boy and hate that it now means something bad.)

What is dysphoria and what is just, vanity? Do I even have dysphoria or is it just an aesthetic that I want? I want more muscle tone, and I know not all of that comes naturally with T. I will have to work out, but I am lazy and most likely will not. I would LIKE to have a flat chest, but I don’t have debilitating dysphoria about it. Is that enough to justify surgery? Surgery is a big deal. Would I rather have my current chest or a flat but uneven/scarred chest if surgery goes badly? Whenever I see someone with beautiful pecs, my wish for top surgery increases. Wanting that is different from just wanting a flat chest. Do I have unrealistic expectations? Do I just want to transition because I keep looking at beautiful men thinking that’s how I want to look? Would I still want to transition if I end up average, which is realistically what will happen? I feel like I should only get surgery if I think it will make me happier no matter how it turns out.

When I imagine myself years later post-physical transition, I think of myself, but cooler.. more powerful. Do I just want to transition for aesthetics? Do I just like the idea of change and transformation? Do I think that looking different will change the things I don’t like about myself?

Currently I’m just sitting on these things. It doesn’t really bother me that I don’t have answers right now. I have loose plans to start low dose T and get top surgery in the next few years if I decide I do want them. Maybe at some point I will just have to take the leap, but I also have the rest of my life to decide. I am fortunate that none of my dysphoria is crippling, so none of this is urgent. But I also think that I deserve to take the steps that will make me happy, without having to be suffering where I am now.

I do know that I definitely don’t want a hysterectomy though. Apparently removing your uterus might suppress ovarian hormonal production, while oopherectomy would stop that completely. That commits you to permanently supplementing either estrogen and progesterone or testosterone, because not having one of these in healthy amounts is pretty bad and causes osteoporosis. I don’t want to do this. I am extremely okay with having a uterus. I don’t mind it much, and it’s good to have a backup source of hormones that I don’t have to buy. In Singapore you have to do this in order to change your gender marker, but fortunately I don’t want to do that either. Mainly for safety reasons I would rather have an F than M, even if it disqualifies me from subsidized public housing. No, I would not remove my uterus or give up my F for subsidized housing, though I joke about it frequently.

Transition: where I’m at

Underworks Binders Masterlist

The underworks website is a huge confusing mess. Here’s a summary with reference numbers that you can type into the search bar at www.underworks.com.

Econo high power compression chest binder: top 943, tank 947(long)
Cotton lined power chest binder: top 975, tank 977(long)
Cotton concealer chest binder: 988(long,half binding)
Tri-top chest binder: 983
Microfibre concealer v-tank: 996(long)
Ultimate chest binder tank: 997(long)
Microfibre conceal crew: 998(long)
Extreme Magicotton Sports and Binding Bra: 3108

Most of the binders, except the sports bra, are under men>compression shirts. The one most people talk about when they talk about underworks binders is the tri-top (983), but there are actually Options.

For the short binders, econo/943, cotton-lined/975 and tri-top/983 look pretty much the same. The econo/943 is cheaper, with only one slightly translucent layer of material (the tri-top/983 is 3 layers) and hence suitable for people with smaller chests who would not benefit much from additional binding power. The cotton/975 is also one binding layer, but lined with cotton on the inside and MUCH more comfortable than the other two, which are scratchy nylon/lycra/spandex material on both sides. The cotton/975 is lower cut than the other two, which might result in some spillover at the armpits. The tri-top/983 is A LOT stronger than the other two, and much more difficult to get on.

Comparison with gc2b: gc2b (another popular line of binders) is made of swimsuit material except the binding panel, while underworks is all-round compression. gc2b feels MUCH nicer and less rough overall with better and sturdier design, but causes back pain for me due to proportion of shoulders or something, which is why I’m trying different brands. Unlike underworks, gc2b is specifically designed for trans people, shapes better, and is more bindy than the econo/943, less bindy than tri-top/983. Price is about the same, underworks shipping (to singapore; idk about other places) costs more and is much faster.

For the full length binders, stomach compression tends to “smooth things out”, and is good for bigger chests to prevent slipping out, but can be uncomfortably constricting and tends to ride up. Consider heat! The 988 is long but only bindy in the top half and has the benefit of looking like a tank top without stomach compression. The 996, 997 and 998 are fully compressing and only differ in neckline and sleeve shape. 988 vs 997.  996/7 vs tri-top/983.

The binding sports bra/3108 is more comfortable and less bindy than the other binders, and hence may be useful for people with larger chests who don’t want that much compression, or in combination with the full length binders (3108+998, video). Sports bras don’t do anything for people with chests smaller than the built-in cups though, obviously. (As such a person, I usually wear training bras without the cups. Occasionally I use athletic tape. I don’t bind very often.)

Underworks Binders Masterlist

Detach/Reattach

My brother, on occasion, slips and calls me his “sister.” Like a good trans person, I correct him. But some part of me cannot admit that when he says it, I am sometimes comforted—not because I am a woman or was ever a girl, but because I remember the warmth and protection his voice carried when he said it to me, when I was small and still new to this world.

When he says “sister,” it evokes a memory—a very particular one—of blood. When I cut my head open when I was 13, and despite his undeniable phobia of blood, he held his breath and a towel firmly against the wound while I cried. He was brave and he was sensitive and he spoke so softly to me. Then, and many times over, I was so proud to be his “sister.”

I admit that I am still learning to be proud of being his “brother,” too.

Like many trans people, I am learning to reattach to new words and new parts.

How I Both Need and Grieve My Gender Transition, LQTU

Transition takes so damn much effort; both external, eg coming out to people, and internal RECONFIGURATION. Detachment from the familiar. Reattachment to the foreign.

You know how chemical reactions require activation energy to break apart existing bonds so that new, potentially more stable ones can form? Look I found a graph. There’s even a “transition state” labelled, lol.

Image result for activation energy graph

I want to be on the right side of that graph, nicely settled into my gender and body, empirically more comfortable and requiring less energy than my birth assigned gender. But here I am still having to climb that cliff, moving away from the familiar discomfort into even greater unfamiliar discomfort, aka a rock and a hard place, aka the frying pan fire thing, but that’s enough metaphors in one sentence.

Example: I gag a bit whenever I try to think of myself as “she”. But at the same time it is so familiar, like very old shoes. It took almost a year and a lot of angst (SO MUCH angst) not only to get at least some people to use “they” at least some of the time, but also for me to hear it enough that it no longer feels unnatural and foreign.

In some areas I have “transitioned” and gotten over the hill and at least partially reattached. But then there are so many more people to come out to and have to constantly correct, new contexts to come out in, gendered situations to renegotiate… and I need to get used to all those things; recently it often feels like too much trouble to climb those hills.

My family calls me meimei (little sister). Sometimes when female friends call me girl I don’t correct them either. At work, where I am not out, people call me xiaojie when they are pretending to be formal, and when I do something dumb. When I buy things hawkers call me xiaomei and are nice to me because I am young. These words are affectionate. I don’t like being misgendered, but what gender neutral equivalents are there that hold the same emotional meaning? Even if there are words that I could start practicing using, they don’t currently have the weight of personal and cultural history, and there has to be all that effort.

I feel like the “good trans person” response is to correct all these people every time, because how else are we going to get to the other side of the hill? But I always let it slide, in order to accept and enjoy the connection that the person is trying to make with me. I don’t want to detach, and I don’t even know what there is to reattach to. That’s what you get for trying to transition to an avant-garde gender. There are ALL THESE THINGS to uproot and replant, and there is nowhere to plant most of them.

This is also how I currently feel about physical transition. What does that even look like if I don’t in any way want to look like or be read as a man, and what do i do with my attachment to my current body? BLEAH it’s all so much EFFORT and I don’t! WANNA! OKAY??

But of course, dysphoria fucking sucks and transition helps, and I am always trying to avoid difficult things I know are prolly good for me. So I know that what I need to do is to give myself time and space, but also suck it up and be brave sometimes. It will get better. I will grow into my gender, even if right now I cannot imagine what that might look like. Bring a brick, not a cathedral. Okay? Okay.

Detach/Reattach

What I Want

No, I don’t want strangers to read me as a man. I’m not a man, why would I want strangers to think I’m a man? Would you (hypothetical non-male participant in this conversation) want people to read you as a man?

“oh, but I thought…”

I want people to read me as genderqueer. I want them to look at me and decide, hm, genderqueer. Isn’t that also what YOU (hypothetical binarily gendered participant in this conversation) want, or even expect? You expect people to read you as your actual gender, not something “close enough” that isn’t actually even close, don’t you?

“but realistically… people are only going to pick from male/female. Don’t you prefer one over the other?”

Say you have green hair. Would you prefer people think you have blue or red hair? Would you, (hypothetically) a binary cis woman, prefer people think you are genderfluid or genderqueer?

Why do I have to choose? I want people to read me as my gender, is that too much to ask? Apparently it is if I’m not a binary gender. But you asked what I want. I want to live in a world where my gender is an option on lists, and I want people to select that option for me. I want my gender to be affirmed every day in the thousand little ways that binary genders are affirmed, in bathrooms and honorifics and pronouns and “welcome, how may I help you, SIR”. I want to experience the relief and joy and affirmation my binary trans friends experience when they begin to transition and the world starts to read them correctly at last. Confusion is not good enough. Avoiding referring to me is not good enough. Being read half the time one way and half the time the other, and wrong all the time, is not good enough.

So, no. I don’t want to be called sir by random people. It’s not “close enough”. It’s NOWHERE near close to what I want, and you asked what I want.

What I Want

Doctors: Allies/Gatekeepers

So it turns out that parts of the trans healthcare landscape in Singapore, and in particular my therapist, are much more excellent than I had thought.

I am hypothetically maybe possibly perhaps thinking about going on T, but not soon: a post for another time. Meanwhile though, I have been researching my options and thinking about things. One thing I have been wondering about is: do I, a nonbinary person, have to lie about being a binary trans man in order to get prescribed T? Continue reading “Doctors: Allies/Gatekeepers”

Doctors: Allies/Gatekeepers