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| Scientologists. |
So I had my last therapy session until September. I already planned on postponing to work on the other half of the state through the summer, I had to postpone early because a clinic I went to five years ago decided I needed a surprise bill! for about what one of my sessions cost, and I want to avoid borrowing money. I'm not in a bad mood about it, though, because I'm excited for the summer, my brother's wedding, and some other stuff and I know testosterone is going to happen anyway. I told my best friend about this and he said "You've been waiting a quarter of a century, what's another two weeks?"
So today's session was actually devoid of depressing stuff! But I've also for the past few weeks been thinking about the attitude I've been seeing among trans people with regard to therapy. I'd like to address that, and we'll see how long it takes for my little hit counter to spike from somebody being angry at me ^_^
I show up and I explain that due to an emergency medical expense I need to postpone early. I realize that my voice was shaky, which was an interesting voice artifact, my therapist reacted in a way which suggested I sounded like I had terrible, terrible news, but of course it wasn't. Just a coincidence. I was dressed nice which usually means I'm in a great mood, and I was.
Mostly it was just chatter, so if you want to read just the critique part, scroll down until the break. I will, just for you guys, go in order of what I think is actually relevant to other trans guys so if you hit something that looks totally irrelevant, well, there you go.
Most importantly I mentioned that I am trying to get a selective service status letter just in case financial aid discovers the no-match red flag resulting from having a male driver license and a female social security account. She seemed shocked, probably because people don't usually think I'm as old as I am. I am over 25 and so I can't register for selective service anymore. I am not legally required to, but financial aid might not know that and so I am being proactive about making sure I have that documentation because I'm going to be relying on that money next semester.
She asked if I was aware, although I'm not sure why I would be, of any qualified Wisconsin psychiatrists who are willing to write bottom surgery letters. There is only one right now, and since most people will need two, it's a big problem right now. Plus he's retiring, or something. I said I'd ask around, but I doubt anybody will know anyone because most of my trans friends are male, and most of us don't get surgery. My trans female friends do not live in the area.
We talked a bit about politics, largely how my politics tend to change as one cohesive unit for some reason. I was an anarchist for a while, God, how long? Five years? And with that came a lot of side-beliefs: radical religious styles, veganism, genderqueerness, and a well-meaning but short-sighted attempt to try changing every bad thing in the world at once. Then after graduation a lot of those things started to fall through, I had to admit to myself that I'm really not genderqueer, veganism and vegetarianism were not good for my health, I needed a more structured religion, and I became more focused. I still care about most of the same things, but my perspective has changed. The most visible thing was going from an annoyingly anti-militaristic stance to a patriotic-left-wing stance. But it all happened as one cohesive unit, politics seem to be a package deal for me. My therapist said she also tried vegetarianism and implied she had similar problems.
We talked about my weight concerns regarding testosterone. I guess I should have specified "fat concerns" because I hope testosterone makes me gain weight... in muscle! We talked about metabolism differences, I said that the problem I saw some trans guys have was that they had an insatiable appetite after T, so if I can avoid becoming a food trash compactor and stick to animal protein I'll be fine (my main problem on veganism was that without animal products I am always hungry and so my weight shot up... along with my blood pressure, cholesterol, etc. My animal protein-based diet does not do this to me.). I mentioned that I've been doing strength training, so far the main difference physically is that the veins on my hands are more visible and one muscle on my forearm protrudes more. We talked about Dance Dance Revolution for a little bit. I explained that I am pretty addicted to aspartame, but don't feel it would be appropriate to try kicking it right now because I'll go right back to gaining weight if I screw up.
I mentioned that my aunt was just diagnosed with pancreatic cancer and so we talked about that for a while, and how my uncle died on Thanksgiving two years ago, which also happened to be his birthday, while we were carving the turkey. We talked about the importance of the pancreas. I remembered that the reason I remember what a pancreas does is because of Weird Al's pancreas song, and also that's how I remember Newton's Law of Universal Gravitation.
Anyway, this is in regard to therapy. The genesis of the whole issue was when a bunch of trans guys who had gone the therapy route started explaining to new trans guys that they were going to have to go through so much therapy or they'd never be able to get testosterone. This isn't strictly speaking true... there are endocrinologists and surgeons who do not require therapists' letters, and so there are trans guys who never, ever see a psychiatrist. There are clinics as well that specialize in informed consent, you show up, they give you the low-down on hormones, you get a blood panel to assess your health level and see how much you need, and you get hormones. This method is becoming more common as people begin to demedicalize trans people.
And it needs to be said, because it's true. Therapy is not a requirement for everybody. The problem is that a lot of the people doing this educating have a poor concept of what therapy is for and are (whether intentionally or unintentionally) encouraging new trans people to try foregoing it based on that assumption. This is the attitude I am addressing here.
To start, I'll say the following: I am in support of therapy for trans people. I wasn't, always. I thought the same things about it that everyone else seemed to. "I shouldn't need to convince some stranger of who I am! I know who I am! This is an infringement on my right to be who I want to be!" The problem is that this is really an ancient concept of gender therapy. There are a lot of horror stories out there about trans women especially being made to do ridiculous things like prove they can walk in high heels before their therapists would write their letters. I assume that there are therapists who are still like this, but they are getting rarer as perceptions of gender identity change.
My own therapy sessions have so far gone like this:
- First session: I was asked what my goals were, and I said testosterone and top surgery. This was not questioned in any way, shape, or form.
- Second session: I am given a letter which I immediately use to get my driver license changed.
- Third and fourth sessions: Talk about life issues which are getting to me. Things most people talk to therapists about.
- Fifth session: Talk about endocrinologists, talk about various trans-related things going on. Talk about effects of testosterone. Talk about how we're going to try getting this covered by my insurance.
- Getting my name changed.
- Coming out at work, to friends, to my parents.
- Connecting with the local trans community.
- Finding a supportive spiritual community.
- Figuring out what on earth I am, if I didn't already know.
That doesn't mean that everybody needs therapy. I think therapy is incredibly useful, but I also think college is useful and not everyone needs that, either. If you've been at this for years, for example, you might very well not need it (although I will mention that I've been out since 2003 and I still find it useful). There are also funding issues that are highly relevant, not everyone can afford to go to a therapist, and regional issues, as not every state has a good network of therapists to pick from (To be fair, though, not everybody has access to an informed consent provider either. I don't, I've tried.). Not everyone wants or needs what therapists provide, either. So I'm not telling you that you need anything, I'm simply explaining that too many people are giving a rather incorrect description of what therapy entails in the interests of promoting something that is not appropriate for everyone.
"Not appropriate for everyone?" Alright, here's the part where I may get the storm. One thing I've noticed is that a lot of new trans guys are getting these skewed descriptions of therapy... people who have been living as 100% female until last week and who are getting into the online community, suddenly being told hey! You don't need therapy, you just need a doctor willing to write you a scrip! Therapists are just gatekeepers!
This is, I suspect, a great way to open a whole new market in the de-transition industry. I know two people personally who came out as trans, lived as male for a time, and then realized it wasn't for them. One identified as a trans man for about a month, the other for several months, before they realized "Well, no, I actually am a butch lesbian." Two people is a big deal, keep in mind, because I only know four trans guys in person who I see regularly. People change their minds about being trans pre-hormonally a hell of a lot, no problem, but what I worry about is how many of these discussions are centered around people who have been out for two, three weeks... people who haven't come out to their parents, people who haven't lived as male for any time at all, having this carrot waved in front of their noses by people who seem adamant on misrepresenting therapy as some medical buzzkill.
Sorry, that's just not appropriate. Those are the kind of people who need that guidance, they need the sessions separating out what they think they want from what they really want, they need the help getting legal stuff sorted out and coming out and all that jazz, and it's so nice to have that person be an expert in the subject. It's nice and romantic to think that they can just get all this information from other trans guys, and I'd be perfectly fine with helping anybody who asked me, but it's also not realistic. Having a formal process for getting these things done adds structure to what for many of these guys is going to be a rather turbulent time period.
Plus, and I know some people hate it when I point this out, what we're talking about is a major medical transition. The way some people talk about it it's like they're going out and getting a tattoo. A sex change is not a tattoo, guys. You are radically altering your body chemistry in ways that cannot be reversed. A few months of preparation for that, at least when you are new to the whole thing, isn't too much to ask.
I do support reform of the therapy process, don't get me wrong. We need to be helping each other find therapists who aren't dinosaurs who are going to reject trans guys who fuck guys or trans women who can't walk in high heels, and rewarding progressive, supportive therapists with service. And anybody who requires a yearlong real-life test, well, that's ridiculous and dangerous. But that's not the same as getting rid of therapy. Therapy is not the problem, it's antiquated notions which are starting to die anyway.
