Here in California, the DMHC said insurance companies must provide transition related care. This is an important step. And with it, it brings challenges. Increasing numbers of people will surgically transition and with those increasing numbers will come increasing numbers of people who detransition. The fact that access to surgical procedures has increased doesn’t mean that surgery is right for everyone. Anesthesia is an insult, an injury to the brain. I don’t know where I read or heard this but it takes a month to heal for each hour a person is under. Surgery is permanent, too. People cannot predict the aesthetic outcome. It could be good and it might be different than you were expecting.
Some general advice. Be sure to base your expectations on real bodies. Real bodies are imperfect. More importantly, it is important not to rush and yet that is exactly what happens for many people. Our system rushes people as well. Doctors spend 5 or 10 or 20 minutes with a patient-not much time at all. You deserve to take the time at each point and experience the changes that are happening and experience who you are at that moment. Hormones change your brain at the same time they are changing your body. Your social world changes, too. Your support system, friends and family are trying to catch up with you. Partners may think they can handle the transition only to discover they are not who they thought they were so they can not be who you need them to be. One of the biggest issues that people talk about with regret is loss. Loss of community, family, partners, religious communities. It may feel intellectually possible to tolerate a loss but for some people, until they live with that loss, they cannot know.
Sometimes expanding one’s social role, increasing comfort with gender expression, expanding the box of male or female and addressing misogyny or investigating the genderqueer, two-spirit, agender, bigender, is what helps. Some peoples gender dysphoria decreases enough with just the use of hormones. Some people’s gender dysphoria decreases after an orchiectomy so much so that further surgical intervention is unnecessary. One step at a time. People will have an idea about having everything at once-chest surgery and genital surgery. That can backfire.
Some people have what feels to them to be a birth defect that can only be improved through hormones and surgery. Some people just don’t feel stereotypically male or stereotypically female and we don’t have much tolerance for them in a polarized society. There is a range of people who experience gender dysphoria. There is no one size fits all. I know I say that a lot. But we like boxes and we like people to neatly fit under their lids. It’s disconcerting to our society when people are popping out of the boxes.
Make sure that your provider spends a lot of time and answer all of your questions. What the risks and benefits and what are the alternatives. You want the MD to know things you don’t know. That’s why they are the doctor and you’re the patient. But we know that many transgender, transsexual and gender non-conforming people have to educate their medical providers so you often cannot count on genuine information to provide the “informed” part of the consent. Find legitimate information.
Changing one’s gendered body is not like getting a tattoo. It’s not like getting pierced. It is a life long treatment with many psychological and physical implications. Even when a person wants hormonal, social and or surgical transitions, there is so much to know. And there is so little we know.
We have no tests, not really. What we have are clients who come in self-diagnosed and who say they know. And the truth is, people generally do know themselves so much better than anyone else. What is also true, is that there are things a person cannot see in themselves, that others can see. There are things they believe are connected to one thing and it turns out they are probably connected to something else in entirely, or that it’s overdetermined. Sometimes, we don’t really know how to put the puzzle pieces together until time passes.
Make sure you give yourself time. There is no rush, at least not in adults.