Monday, June 3, 2013

Ch 23: What to do for Transition before Hormones and Surgery

Hello Everyone,

Been sick with a cold, trying to get back in a routine.  Applying to jobs all over the US, looking to relocate, so if anyone has an 'in' with an accounting firm or for a private accounting position let me know.  Got 1 job I'm being considered for and was told I'm 1 of 6 candidates being considered, got a 2nd job that I got a callback from that I have to update my resume for the qualifications they are looking for and resubmit it.  I also found out that with my Graduate degree I may not need the 1000 hours of audit to qualify for my CPA.  So I'm hoping I just have to finish these last two weeks of graduate school and then start studying for the CPA exam.

Ok, now that I've caught you up on why I wasn't around for a week I'll launch into today's discussion:

What to do for Transition before Hormones and Surgery?

I recently was talking to an individual who hasn't begun the process, has only talked to people online and his mother.  He is MtF and has had a growing pain for some time about not being able to be true to himself, as we discovered in finding the 'Breaking-Point' it sounds very much like he is close to the point where he will need to do something.  Now in this situation there were concerns about age and availability of free treatment through LGBT centers as he is poor and expects that he may be kicked out of the place he is living in when he comes out to everyone.

For situations like this, while I'm not a licensed professional I say start therapy with a counselor or licensed professional right away.  While the underlying issue of Gender Dysphoria is a physical issue the psychological issues that come with it need to be talked about.  The previously know Gender Identity Disorder is not something that a person has to 'prove' to their therapists it is something innately inside that you know who you are.

Now before I go forward, in working with a counselor everyone finds their own truth, and we all have our own journeys and order of events.  However, I am presenting the way I believe presents the least resistance and allows for an individual to walk before they run approach.  In this case, the individual was under the impression it would be best because of the limited time they had to 'prove' to the therapist that they were indeed female in a males body that they should start dressing, talking, come out to family and do everything all at once.

While some people handle this pressure well and are able to take the 'quick removal of the band-aide' approach it is wrought with hazards.  Remember our discussions on discrimination, on workplace harassment, bullying and family issues.  By taking this approach we are effectively jumping in the deep end without a life preserver.  Some babies can adapt and learn to swim, but others will drown.  So why not build ourselves a raft before we go out on the water?

So here is my proposal, before going all out, go to the therapist.  In therapy the general principle they are looking for if they are a good therapist is that there isn't another underlying mental disorder that is causing you to believe you are female.  So they are looking over the generally accepted period of time 3-6 months for consistency and similar to tests for gastric bypass they want to make sure you understand the risks involved and know what your getting yourself into and making an informed decision.

No one ever has to 'prove' to their therapist that they are or aren't something.  We know it inside, while the therapists can act as a 'gatekeeper' to keep us from medication and other needed procedures, as individuals we can always go find another therapist.  Personally I have been with the same LCSW for 3 years now, before her I went through probably 10-20 counselors over a 10 year period of time.  Some were good, some were awful, but like anything else it's about finding one that fits your personal style and understands you well enough to get you to talk about the tough issues.  A lot of this involves trust, as I found a lot of counselors for whatever reason I wasn't comfortable with, so I stuck to the basics when I talked to them and didn't deal with the hard issues I needed to.

Finding a good therapist can be difficult, but generally in today's world there are reviews of therapists, they list their specialties and you can always get referrals from your PCP or other people you may know who use therapy.  Ok, so now your in therapy talking about the issues, my suggestion is to do this before you 'come out' and before you start dressing and doing other things as each of those steps creates difficulties.  So step 1: therapy - your therapist should be your biggest ally, a place and person you can confide in and not worry others are going to find out what you said.  They also should be a resource to give you information about the process, about the risks, and help you come up with strategies in how to 'come out' and what to say, or how to do it.  Granted most of this is determined by you as the patient because a good therapist doesn't actually give advice, but they listen and get you to make your own decisions about events.

So with step 1 completed you have someone at your back, even if it's just one person to lean on and begin having your support network.  Step 2 I think is coming out to people who you believe will be your best supporters, may be parents, brothers and sisters, cousins, close friends etc.  It may not be these people either, and you may feel more comfortable making new friends.  In either case you are continuing to build a network of people around you who you can call for support and who you know will be there when you need them.  Remember though friendship is a two way street and you should be willing to be there for your friends when they need you as well.

Then step 3 is generally starting to dress, learning the opposite genders mannerisms, practicing voice training etc.  But in each of these steps you will face difficulties.  Step 1 therapy you have to face your inner demons and learn to love yourself before you can let others love you.  Step 2 coming out to close friends, even people who you believe could be strong supporters may not be, so this can be difficult, nerve racking and it's possible you may lose friends or have friends who you thought were good friends who may 'out' you to the rest of the world.  Step 3 dressing, if your doing it in private at first, which I believe we all generally do it's not too big of a risk, but there still is the risk of someone 'catching' you in the act and can again have rammifications.

Step 4 If someone else hasn't outed you, you are ready to talk to the people who are in your life who you're worried will reject you.  With others at your side, a lot of times similar to an intervention if you're doing one of these 'family' meetings you can have your counselor come and act as a mediator and most of them will be happy to do it.  This gives you some protection and others are not as likely to act as rash or harshly in the presence of a professional who may also be able to explain things from an outside perspective or answer questions these people may have.

By taking this course of steps you are building relationships and support before each step and preparing yourself for the next one.  In doing this you are setting yourself up to succeed by taking steps to make sure if something does go wrong you have a strong foundation to fall back on.

Step 5 anyone who hasn't yet tried to go out and deal with the public will likely take this opportunity maybe in places they feel safe to express who they truly are through dress and mannerisms.  Safe environments can include, college campus or classrooms, support group meetings, dressing at the counselors office, at home with family, possibly a gay bar and other such areas that are likely to be progressive where you may be nervous presenting the true you but you know the people around you are likely to understand your situation.

Finally Step 6 is as we talked about in previous chapters likely at this point your ready to start hormones, and from there beginning your life as a female or male full time.  This may involve the year period of presenting before SRS and other surgeries, though I know some trans individuals decide to never have SRS because of medical complications.  Other steps in being female or male full time usually include legal name change, dressing full time in the gender we identify as, using the restroom appropriate to our gender identity, and other such things.

I give you this guide out of concern, please take care of yourselves and set yourself up to succeed, don't jump in the deep end without your life preserver, it can be dangerous out there.

Big hugs to all!

to be continued...
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