Still a trans advocate (2)

I’ve just been published in a book.

Not my book, but as a guest in another book.

As Gina.

I’m writing about it as I continue to demonstrate that my resuming living as a male changed nothing in my quest to educate regarding gender dysphoria and advocate for transgender persons.

It was a year ago when I received an email from my former therapist informing me that the editors of this book on transgender health and aging were seeking short pieces from older trans persons. The book covers every topic imaginable regarding emotional and physical healthcare for trans persons, and the guest essays provide personal insights into the topic.

At this time last year, I was still living as a female, but I was not feeling female at all. No one, outside of immediate family and a few friends, was aware of what I was experiencing. I knew that if the sense of being male persisted I would be resuming living as a male, and then making it known. Indeed, by mid-April I was going back and forth how I presented depending where I was, then in late May I was back to Greg full time, and on July 9 I made it public.

By the time I decided to submit a piece for the book it was mid-April. I wrote an essay and sent it to the therapist who told me about this opportunity. She sent an encouraging reply, so I submitted my piece.

I submitted it as Gina. I felt a bit disingenuous, not acknowledging what was going on with me. I reasoned that I didn’t know what would transpire, and I was still living as Gina, and I was legally Gina.

In early May, they informed me that my essay would be one of ten included in the book. I was not back full time to Greg, so I left that be. They informed me they would send me a book upon its publication. I received it on March 16.

Regardless of my resuming living as a male, everything I wrote remains true. In the essay, I reflect on an event I had attended in April, mere days before writing the piece. My endocrinologist invited me to a presentation to over one hundred medical professionals of IU Health. A nurse, who has a trans son, gave an excellent presentation, educating about gender dysphoria and one’s being transgender. I then spoke to them for a few minutes regarding my experience transitioning in Indianapolis. Then, I sat with a group for ninety minutes, fielding their questions.

In my essay, I focused on the many doctors trans folks see while transitioning, and the variety of specialists I saw as a trans woman—from two eye specialists, to an oral surgeon, to a podiatrist, to a cardiologist. I stressed that even though my providers all are in the IU Health network, and IU Health admitted they were behind the curve with transgender healthcare, I was pleased to report to them that the care I received from this host of doctors, along with the many nurses, technicians, and office staff I saw, took great care of me.

Transgender persons need good healthcare. They need to know they will be treated seriously, and with respect. And, they need people such as myself, who have been there and done that, who are able to speak up, speak out, and speak loudly, to advocate on their behalf.

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The healthcare catch-up

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At the invitation of my endocrinologist, last week I attended an afternoon of transgender education at a local hospital, which is part of the IU Health system. The afternoon began with a one hour lecture to more than one hundred—Trans Ed 101, if you will—and concluded with a two hour Q & A with a number of representatives of various areas of healthcare.

IU (Indiana University) Health is in network for the insurance Julie has through her job. Because IU Health has doctors in town covering you-name-it, I became a patient with them for my transition, not to mention my new primary care physician, cardiologist, and more.

When, after Wednesday’s main presentation, I had opportunity to address the auditorium, I later learned that, besides being littered with nurses and technicians and doctors, this group ran the scale of the more experienced to those who have had little or no interaction with patients who are transgender. In the Q & A with the group of eight, only two said they had ever knowingly met a transgender person.

That meant that, for seventy-five percent of them, I was the first trans person they had knowingly met.

The purpose of the larger presentation was to provide the basics regarding gender dysphoria, the differences between sex and gender, the wide variety which comprises those on the transgender spectrum, and many helpful insights so that these folks might do well for their trans patients. The presenter did a marvelous job and, as the mother of a female-to-male trans son, spoke eloquently from her experience.

The purpose of the small group session was to dig deeper. My endocrinologist, Dr. Melissa Cavaghan, led the discussion. She provided both medical information and reflections from her having cared for many trans folks. It didn’t take much from Dr. Cavaghan to launch the group into enough questions that we never had a lull during the two hours.

During the main talk, the presenter showed the progression of names for the condition which is generally behind one’s being transgender. For years, it was “gender identity disorder.” Seeking to rid this of “disorder,” a few years ago the official name was changed to “gender dysphoria.” The presenter then suggested that, in time, it might be renamed “endocrine dysphoria,” to highlight what some, perhaps most, find is the origin of the condition/malady, that a person experiences ill feelings of self because the hormone system is out of order.

This has been my thought, so I liked her idea. When in the small group, Dr. Cavaghan, who is an expert of the endocrine system, said that she does not think this is only a disordering of the hormones, and might not be at all, and that we really have no idea why some people experience gender/brain and sex/biology which do not match.

Putting into my own words what she said in conclusion, she hopes we get to the day where we simply accept it, that it is a fact of life for some people, and that we provide good care to those experiencing gender dysphoria and give these folks a fighting chance at a good life.

I certainly want the latter two of her thoughts to occur, but I am not with her on the first one. No matter how a person considers gender dysphoria—the range is from those who find transgender a completely normal way to be, to the likes of me who find it a physical malady and a terrible situation—the fact is that, in most cases, it has to be treated medically, at the very least with cross-sex hormone therapy, and with re-socializing as the other sex, and with great disruption in the lives of those transitioning, perhaps with surgeries, and at great cost.

Since when do we accept any situation in life that has so much struggle and effort and cost attached to it? We do not. We seek to find causes. Create solutions. Keep it from occurring it if it might be preventable.

At the close of my short talk to the group in the auditorium, I quickly sketched the wide range of doctors I have seen since moving to Indy in 2014—the three surgeons for my transition surgeries, a cardiologist, a podiatrist, eye surgeons in two offices, an endodontist, and a primary care physician—and remarked on the wonderful treatment I have been given in every place. I thanked everyone in the room and encouraged them to keep on doing well.

Politically, Indiana is quite conservative and very traditional. (We sacrificed our governor, Mike Pence, for the sake of the nation. You’re welcome!) Yet, let no one accuse Indiana of being in the dark, of living in the past, of being backward. Having now been here nearly four years, my experience, living outwardly as a transgender person, has far exceeded all notions and concerns I had, of everything Julie and I discussed before deciding this is the place to which we would move.

IU Health admits that it is a bit behind with transgender healthcare, hence the title I chose for this piece. Fair enough. The good news is that they recognize it, they are striving to catch up, and they have a collective heart to do so, to provide good care and a hopeful future to its transgender patients.

Sex reassignment date set

In forty-three days, I will have sex reassignment surgery (SRS).

Last Friday, I met with my SRS surgeon, Dr. Sidhbh (rhymes with “five”) Gallagher, hoping to determine that I am ready for surgery. Four days before that, last Monday, I met with a doctor to determine whether I am a candidate for surgery on my vocal cords, to raise the pitch of my voice.

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Dr. Sidhbh Gallagher

When we moved to Indianapolis, and if I were to make the decision to transition, I never dreamed that I would be able to do everything right here. After Julie got her job and I knew what insurance would cover, I was positive that I would have to go to Ann Arbor, to the University of Michigan hospital, for SRS, the closest in our insurance network. A year after we moved to Indy, to my wonderful surprise IU Health announced that they were bringing on a surgeon for SRS. Dr. Gallagher began working over a year ago.

And when I learned that vocal cord surgery is now a viable option for raising the pitch of the voice, I thought the odds of finding a surgeon in town were slimmer than our getting an SRS surgeon. Well, shut my mouth, but The Voice Clinic of Indiana, on Indy’s north side, in Carmel, has a surgeon experienced in this procedure.

Assuming I get insurance approval on everything I desire—I am awaiting word for my facial surgery—I will not have to leave Indy to transition. Color me dazzlingly delighted!

Sex reassignment surgery

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This section contains sensitive information.  If you don’t want details about SRS, please skip to the next section where I talk about the vocal cord surgery.

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Julie and I had my initial consultation with Dr. Gallagher last March. Dr. G thoroughly went over the surgery. Since my penis and scrotum will be used to construct the female genitals, my “homework” was to get the hair removed from my genitals, as that skin will go from being on the outside to the inside.

My weekly visits to Barb the Impaler now ignored working on removing my facial hair, to focusing on my genitals. Since last spring, she has worked 27 pain-inducing hours in the area. Dr. G had given me a diagram, showing what to remove and, by mid-November, Barb felt she had accomplished that, so I went to my appointment on Friday hoping for good news from the doctor.

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Last March, Barb “The Impaler” Clayton and I celebrate my article arriving in Indianapolis Monthly.

I was prepared for the worst, which would have been, “You’re making progress, but this area and right here need more work,” but almost immediately into the exam Dr. G said, “You’re looking really good, Gina.” That prompted me to ask, “Good enough?” When she replied in the affirmative, I asked about hairs that might still grow; indeed, some have popped up in the three weeks since I last had Barb work down there.

Dr. G said she scrapes whatever remaining follicles she finds and, with that, answered a big question Barb and I had. (Another question was whether the live follicles are easy to spot from the back of the skin. Dr. G said they are, and that the ones that have been removed leave no mark—no hole or scarring—and that only smooth skin appears underneath, just as on the outside. Oh, the things I am learning!)

Barb had told me that a client of hers said that Dr. G scrapes the back of the skin, to remove hair, the impression being that a person need not have any at all cleared before surgery. Of course, in my consultation last March, Dr. G had told me exactly the opposite. So, I had been very curious to find out the truth.

Dr. G’s answer was that, no, she will not accept a person’s not having had the majority of the hair removed, as it is way too much work for her to remove that many follicles. The opposite would be if she did no scraping at all—which was my concern—meaning that a person had to be sure all of the hairs have been completely removed or risk having post-surgical ingrown hairs. I was so hoping her answer would be exactly as it was that I exclaimed, “I wish I would have bet a large sum of money on this!”

With that, my next question was natural: “May we set a surgery date?” “Yeah. Sure,” she almost-too-casually replied, in that lovely, Irish accent of hers.

Her earliest available date was January 24. I snatched it up. I am now counting down the days.

Vocal cord surgery

At the voice clinic, Julie and I met with Dr. Noah Parker. After a bit of getting-to-know-you, in which we immediately found Dr. Parker to have a good bedside manner, he did some tests. First up, placing a stethoscope-type thing on my neck he measured my pitch.

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Dr. Noah Parker, next to the machinery he used to test me.

My voice vibrated 115 times per second, which is right on the average for males. Since Julie was in attendance, the doctor checked hers. She clocked in at 246, near the top of the typical 200-250 for females. Neither pitch was a surprise.

Next came a scope down my throat, to look at my vocal cords. He numbed my throat with a spray, then proceeded to run a laryngoscope down my throat. He hit the top of my throat, causing me to gag, and removed the scope. Two more tries, and each time hitting the top of my throat I gagged. He said this was not uncommon, so he ditched that method and went for the nose scope.

Now, there’s a unique/creepy sensation that I’d never before experienced, feeling that scope go through my nose and into my throat. (A year ago, when a laser was used to repair my torn retina, I experience another weird feeling, one of intense pressure on the eye, which I had to strain to keep open during the procedure.) Thankfully, the scope went down and back up pretty quickly. Even more thankfully, when he showed us my vocal cords, he pronounced them perfectly healthy.

I am a candidate for surgery.

Dr. Parker makes no guarantees how high my pitch will be after surgery. I spoke for him in the higher-pitched voice I can do on my own (but have not been able to do it for long, so I gave up trying). He measured my pitch. 180. He said that if surgery can get me to 180–200, and with some voice therapy, I should have a voice which fits my presentation as a female. I am very eager and excited at the prospect.

Reflections

A question I will not presume to answer now, but know it will arise, is whether I will have a really hard time in the days leading up to each surgery, as I did before getting my name changed. While I am very pleased to have my new legal name and female sex marker, as I have been thankful for each accomplishment I have had over the course of transitioning, no big change has come without deep introspection and prayer, and great emotional suffering.

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My driver’s license after getting my name change.  The “F” is hiding above my thumb, lower right

Just because transitioning is working for me does not mean that it doesn’t come without a cost. The costs have been many and varied and steep. I can still say that my preference would be to remain male, to be Greg, to end all of this. If I had a reasonable expectation of being able to do that, I would cease my transition.

Since I have no reasonable hope of living as a male without the extreme suffering I had, which only worsened each time I stopped transitioning and resumed trying to be a male, I move forward. And, forward it is. I feel good about myself. Healed. Whole.

Healing and wholeness allow me to be happy, and while happiness is neither my ultimate goal nor promised to anyone, I’ll take it, and I’ll be thankful for it, and I will continue to live in a manner which benefits my family and community, and glorifies my Lord Jesus Christ.