To The Letter

It turns out that Dr Harte is on leave overseas during January, so we scheduled an emergency appointment this morning to sort out the matter of a recommendation letter for surgery.

It reads like this:

Dear Dr Suporn

Re: Ms Amanda [Surname]

The above Ms Amanda [Surname] has been a patient under my care since May 2006. I have seen her on a total of 13 occasions. Ms [Surname] is a natal male who identifies as female. She has been assessed by the Melbourne gender dysphoria team and has been diagnosed with gender identity disorder with the specifier that she is attracted to males. She has been living full-time in the female role since January 2007. Ms [Surname] has undergone hormonal gender reassignment and hormones were commenced in September 2006. She has undergone a thyroid chondroplasty but has not had any other feminization surgery carried out. In my opinion she has satisfied both the eligibility and readiness criteria of the international standards of care for genital gender reassignment surgery. She shows no signs of comorbid psychopathology and I consider her a suitable candidate for gender reassignment surgery. There are no absolute contraindications in her presentation. Ms [Surname] is an intelligent transsexual woman who has made a realistic assessment of the possibilities, limitations and possible complications of gender reassignment surgery and is fully capable of giving informed consent to this procedure. I am happy to be contacted on the above telephone number to verify that I am the author of this letter of recommendation.

Yours sincerely
Dr Fintan B. Harte
Consultant Psychiatrist
Gender Dysphoria Clinic
Melbourne

This is the letter; I just need a good-health one from my GP now, and to sort out the final payment, and we're all sorted!

Flash Of Dysphoria

Friday was horrible. I woke in the morning feeling vaguely uneasy and in some kind of mood. Did my usual morning thing of breakfast and shower. Got dressed, got ready for work. Left my apartment, headed halfway down the street, then crumbled under a wave of paranoia and anxiety. I was convinced that people were giving me odd looks for some reason, and literally turned around and headed back home. I felt like I was utterly unpassable, that something undefined in my appearance or my manner or something just wasn't right.

It was as though I just couldn't be settled into being myself, as though for a moment I was back to being unrecognisable to the world, but so much worse than it's ever been because this time I was trying to be me. What does gender dysphoria feel like? It feels like everyone is staring when you're trying to avoid any attention, and like people talk past you to someone else when you are trying to get attention. I was taken aback by just how distressing it was, moreso because I haven't felt at all like that for months. And I've never had trouble passing before.

It took a moment for me to wonder if maybe it was just in my head. To be honest, I don't know at all. But I tidied myself up, got changed anyway, for good measure, and headed out again.

My mood was all over the place for the rest of the day. I spent my time in public with my gaze mostly fixed to the ground as I walked, both lost in thought and sort of trying to hide my face. As J said later from merely having passed me in the street, "You were in your own world." I felt listless and irritable, which wasn't helped at all by it being an especially stressful day at work. But rather than expressing any of that irritation outright, I guess I must have just swallowed it up in a cloud of sullen moodiness, because my friends at work most certainly picked up on it.

And terrifically, rallied. At various points during the day, individuals would ask if something was wrong or whether I was okay, to which I'd try to give an appreciative smile and explain that I was just stressed. One guy in particular charmingly tried to cheer me up in all sorts of ways. And when I went with friend A for a much-needed coffee, the person at the cafe (who knows about me from having known me before my transition) gave us a friendly "Thanks, girls!" That helped a lot.

After nearly a year full time and forgetting what life was like "before", and only two months from SRS, I'll admit it's a little worrying to have gone through Friday's events. Right now, I'm inclined to blame the change in hormone dosage for Friday. But I think I'm settling into the dosage again, having felt much better since.

Visas And Hormones

On Friday, mum and I paid a visit to the Thai High Consulate to get our visas done. Australian travellers don't need a visa if they're staying under 30 days, but since we'll be there for about 35 days, it's more convenient to just apply for the two-month single-entry tourist visa now rather than worrying about trying to get an extension later.

The parking meter out the front appeared to be made by someone who may have been color-blind:


Making the application itself was painless - just a matter of filling out a form, and handing it in with two passport photos and the passport itself along with a $45 fee per applicant. The clerk told us that they'd have it ready for picking up on Monday, which was surprising considering we were told to apply three months before travelling. Yay for efficiency. :)

And in the afternoon, I saw Dr Hunter for what would be my last pre-operative appointment. He gave me a list of instructions which basically goes like this:

1. Cut back immediately from two to one Microgynon 50 pill per day (half the dosage, 50 µg instead of 100).
2. Stop hormones altogether at four weeks pre-op (about mid-January).
   
3. Two to three weeks post-op (when I'm active and mobile), start on Progynova (1 mg estradiol varelate pill).
   

I'm apprehensive about the lowered dosage, and have been carefully monitoring myself for any changes in the last two days. Nothing drastic yet, however. Dr Hunter does this as a safety precaution, because 50 µg of ethinyl estradiol is considered the minimum effective dosage to maintain the suppression of testosterone after several months of HRT and to continue feminisation (less than 50 µg has been observed in studies to be ineffective, and more than 50 µg hasn't shown much more effectiveness while significantly increasing the risk of liver problems in the long term). In his words, "feminization requires this much estrogen," (holding his thumb and forefinger slightly apart), "but you've been getting this much" (holding his hands about a foot apart).

Dr Hunter said he usually prescribes Premarin as the post-op maintenance HRT, but had no problems recommending Progynova instead on the grounds of my ethical objection to how the horses are treated.

The switch to Progynova is because Microgynon is a combined estrogen/progesterone treatment, where the progesterone is primarily for protecting the uterine lining (which I don't have). In my case, the progesterone has been to suppress the pituitary gland so that less estrogen is required to block the level of testosterone. Post-operatively, there'd be no gonads to produce testosterone, so the progesterone won't be required (all going by the minimalist theory of HRT). On the other hand, Progynova is a straight estradiol varelate, which is about similar in effectiveness to ethinyl estradiol where feminisation is concerned (the difference in order of magnitude of the dosages is due to estradiol varelate being destroyed much more readily in the digestive tract). The dosage and treatment scheme using Progynova is what is commonly prescribed to post-menopausal women who have had a hysterectomy, which is basically equivalent to what my situation will be.

The post-op dosage of 1 mg seems a little low to me - I know other specialists do prescribe 2 mg as a maintenance dose, and 4 mg or even 6 mg for the short term post-op to continue mimicking the female puberty. However, Dr Hunter did say that 1 mg can be conservative, and that if I experience any menopausal symptoms (eg. hot flushes), we'd move up to 2 mg.

*twiddles thumbs* Slightly apprehensive. Probably mostly all in the head though. Mind you, Step 2 is so not going to be fun.

Stance On Sitting

Why is the toilet-seat-being-left-up thing annoying? It's easy: when you're used to having to sit, you sometimes forget that with menfolk about, you need to look before sitting or risk an awkward (and probably hilarious on far hindsight) tumble into a dunny. I suppose there's also that issue of sitting being a voluntary choice for men and, well, not a choice for women, but I won't get into that.

Why do I insist on sitting even though, when it comes down to it, I don't strictly need to? Because at some point later, I am going to strictly need to. And there is that urban legend in trans circles about the trans-girl who never sat, until one day newly post-op, she forgot she needed to.

It's all about dignity, see.

Cruisin'

Um, okay. So I haven't written much of late. And I'm writing this pretty much because it'd be nice to look on the links over to the right there and see that - uh huh - there's posts (well, a post...) for each of the months gone by. ^.^

No, that's not exactly true. I do want to say a few things about how everything is unfolding, because there's a pace gathering to my life which is probably going to hurtle towards that certain event in February in the blink of an eye. Like many others, I suppose I do a fair bit of reading about the stories of people in similar situations, and gosh darnit I can't shake that combined happiness and guilt that I've "gotten away with it" all too easily. My transition came at just the right moment, under precisely the right circumstances, to allow me to feel like myself without drowning me in anxiety. I had some emotional baggage, I suppose, but nothing I haven't grown beyond, like a divorce and kids or anything of that magnitude. I had male features (facial hair) which were handily taken care of in a timely fashion. I had a bustly familial household without privacy (but ultimately, with deepest love and caring) that I moved out of. I have friends old and new who really just take my situation for granted almost as much as I do. I pass; heck, I'm accepted, not confronted or accosted or treated as a freak as many others are.

There are a number of people who have entered my life for whom I cannot guess in the slightest if my situation is known. And while I'm curious, I don't care if it is or isn't known (nor would my friends care to inform them if not, I suspect).

And all this trans stuff? Well, the therapy sessions are far enough apart for me not to pay much attention to their dates on the calendar anymore, and even when they occur they're so matter-of-fact that they seem more like a formality. Hormones are just a thing I do in the mornings and evenings, no biggie. I still peruse the forums and discussion groups, and keep an eye on the politics and issues, but the things that are really on my mind at the moment? Surgery, obviously, but beyond that, career movements, my various hobbies, dear family, and a relationship.

Do I wish I wasn't trans? Of course. Do I love my life? Abso-bloomin'-lutely.