Further Reflections on the Nature of Post Traumatic Stress Disorder in Transgender Individuals and Implications for Its Treatment

In October of this year, I completed 12 face to face educational hours and 16.5 hours online learning in depth about the nature and treatment of Post Traumatic Stress Disorder. I became a certified trauma counselor through the International Association of Trauma Professionals. I have had an intensive exposure to learning about the nature of Post Traumatic Stress Disorder as a dis-regulation of the Sympathetic Nervous System resulting in a person on a  frequent to continuous basis experiences being in the state of "flight or fight"response.

 The Sympathetic Nervous System is a subdivision of the Autonomic Nervous System. The other half of the Autonomic Nervous System is called the Parasympathetic Nervous System and it's job is to promote a physical sense of calm and well being, and allowing us to be present in the moment when there is no existing threat to us.

Normally, the Parasympathetic is the dominant or default condition of the autonomic nervous system, In those who experience dis-regulation of the Sympathetic Nervous System, it becomes the dominant system. The individual will experience symptoms of anxiety, excessive perspiration or dry mouth, muscular tension, sleep disturbances, feelings of panic and other symptoms of this nature when in reality, no threat exists for the individual.Experiencing these type of symptoms can range from frequently feeling dysphoria of a mild to a severely incapacitating degree.

It is not known at this time the number of transgender people who suffer from the symptoms of P.T.S.D, In my opinion, to the degree that a transsexual has developed a sense of self awareness, the discovery of one's physical body is not of the gender that matches one's gender identity, the greater the degree of traumatization the individual will experience. Similarly, the longer the individual lives with the inability to live authentically and denies one's true identity, the greater the risk for increasing levels of traumatization over the life span.

It is important to be able to identify the type of trauma experience of the transgender person as a complex trauma or as a developmental trauma, so that the type of treatment selection is important.
Developmental traumas do not respond well to psychotropic medications. That does not mean they have no role in the treatment of developmental or complex trauma, it does imply that medications will not be the solution alone in successfully treating this type of PTSD. Medications will be relatively less effective in this type of PTSD over the long term in resolving symptoms.

What is necessary is a retraining of the Autonomic Nervous System to give people more control in activating and learning to stay in states when the Parasympathetic  system is restored to being the dominant division over the Sympathetic system.

When a person is able to exercise more emotional regulation, it is then the therapy can move forward to process and resolve the significance of the past trauma. In part, this is accomplished by the individual recognizing that the past trauma is not occurring in the here and now. As one is able to leave the past behind, the trauma loses its powerful hold on the individual and she is able to continue through the healing process using the techniques learned to manage her levels of reactivity. She is able to be more present in day to day life as opposed to experiencing symptoms of rumination of negative thoughts of the past or future that remove one from what is going on in the here and now. She becomes free to build a brighter future.

An area that I think deserves further consideration and study is whether  the presence of lingering low self esteem or a sense of stigmatization in individuals who have successfully transitioned represents some type or residual state of PTSD that will be extremely treatment resistant.. Is it possible, as Bob Dylan wrote, "You can always come back, but you can't come back all the way..."?

If it can be addressed, it will likely come through cognitive restructuring requiring long term psychotherapy.  The longevity of the treatment will be as important as the frequency of appointments. In psychotherapy that lasts over several years, appointments are held once a week for a long period of time leading to appointments a few times a year over several years after the most intensive part of the therapy is completed. I believe this type of therapy offers the best chance of resolving residual issues of PTSD such as I described above.

I did a literature search on the National Medical Library of the National Institutes of Health and did several fetches using keywords such as PTSD, Transgender and Trauma and found no articles after an advanced search that directly address the concepts I am writing of here. The closest article was an article in a psychoanalytic journal. It is called Mourning the Body as Bedrock;  Developmental Considerations in Treating the Transsexual Patient Analytically. (www.NCBI.NLM.NIH.gov/pubmed/25277869). It suggests that psychoanalytic treatment can be helpful in resolving developmental or complex traumas experienced by transgender people. Research into the treatment of PTSD reveals that many different therapies can be effective in treating PTSD. What is most important is that the therapist be fluent in the modality of of treatment she employs over any particular school of therapy.

In any event, much more research is obviously indicated to help transgender people effectively resolve past trauma and build a future based on mastery over self and the social environment.

Hello Russia!

Russia is the nation with the second most views of my blog for all time after my own country, the USA. For the past month, I've had 600 views from Russia, not many less than my own country's views.

As an amateur student of Russian History and Russian Literature, I am curious about what it means to be a transsexual or transgender person in Russia or in Eastern Europe and in the former member states of the former Soviet Union.

My interest in Russia goes back to my adolescent years when I first saw the movie Nicholas and Alexandra. In my undergraduate studies.  I took a course in Russian History. I began to read literature by Dostoevsky, Chekov, and Solzhenitsyn. I found Ayn Rand on my own and have embraced many) of her philosophical ideas in my own personal philosophy (along with much of the philosophy of B.F. Skinner and Behaviorism). I was also fascinated by the influence of Grigory Rasputin (referred to as the "Mad Monk" over the Czarina Alexandra as well as his own story.

I grew up in the 1960's and 1970's in the era of what we call in America "The Cold War". One of my earliest memories was of the Cuban Missile Crisis. Here in the USA, my early childhood memory was of the adults fearing we were going to die at what seemed to be the beginning of World War III. Thankfully, that event would not become the catalyst of the destruction of two great countries and perhaps the entirety of Western Civilization.

I was a young adult when Ronald Reagan implored Gorbachev to tear down the wall separating East Berlin and West Berlin and saw that wall fall on television along with the disintegration of the United Soviet Socialist Republic, or as we called it, the Soviet Union.

 As an American transsexual who is a mental health professional, my practice is partly devoted to working with transgender people. I am quite interested in how people such as myself fare in other countries. My audience for this blog is truly international. I have readers in every continent, even from Middle Eastern countries and African countries where people such as myself suffer unspeakable persecution, to the point of torture and loss of life because of who they are. There are things worse than dying for who one is or one's religious belief, though, such as being tortured or living under extreme oppression.

I seldom get comments from people from foreign countries who read my blog. My guess is that in some of the countries my readers come from that they dare not leave a trace that they have read what I have written.

As I mentioned, I am quite interested in the lives of transgender people in other countries and other cultures. I would like to invite my Russian readers to participate in commenting on your lives, your struggles and your triumphs to live an authentic life.

Thank you my Russian friends!

An Essay on the Transgender Healthcare Experience

Today I would like to share an essay that I wrote for a contest for the University of Virginia health care system. Unfortunately, I missed the deadline to submit my essay, but I think that my readers would like to read about my experience interacting with health care in the United States during and after my transition. Here is what I wrote about my experiences:


 Identity seems like such a simple thing, but it can be anything but that. Identity can be as simple as seeing a beautiful bird and thinking, “Oh! There is an indigo bunting!” or seeing a piece of crystallized rock and saying to a friend, “That’s quartz.” Sometimes identity is not so simple; does this fish have 17 dorsal spines in its fin or are there only 16? It can make a difference in what species of fish you are identifying.

Identity in the health care system is something that we hold to be so important that a whole canon of law on how to go about correctly identifying a person, about protecting that person’s identity as well as her identifying health care information has emerged.

What happens when someone whose true identity has been hidden for many years, perhaps almost all of one’s life suddenly becomes known to the health care system? This is the situation a transsexual finds herself in when she makes the decision to live an outwardly authentic life that reflects her true identity. It is also the situation health care systems find themselves in when the patient who has always been identified as male becomes a woman outwardly and legally, matching her experience of her internal identity with her outward appearance and her day to day social life.

When a person such as myself transitions and begins to live authentically in public after many years of maintaining a false pretense, it is not necessarily easy, especially at first. However it becomes natural after a relatively short period of time. I have always known who I was, the difficulty was in shedding the layers of armor built to protect anyone else from knowing who I was. It didn't take very long at all though to feel as natural and comfortable as any other woman in my daily life.

Fortunately, I was able to recognize that while my very public transition was voluntary for me, it was not voluntary for my coworkers and patients as well as my loved ones. Those who have remained in my life, thankfully almost everyone who involuntarily transitioned with me did so with fairly little difficulty and successfully made the transition with me.

Yes, mistakes were made along the way. What I found to be most helpful in facilitating my transition for these people was to grant them grace and not get upset when mistakes were made by using my old name or using the wrong pronoun in referring to me. Being mindful of the involuntary nature of their position was a way for me to extend good will and gratitude for finding acceptance and understanding with my transition.  They were getting a more open and authentic person to work with. Who wants to work with someone who has to live a lie? I wouldn't and I would feel sad for that person and would want them to be who they are and be all they can be. It’s why I do what I do for a living.

Working in health care as well as being a recipient of health care has been an interesting experience in becoming public with my identity. For most of my life a change of public gender identity, was just not done. Health Care, just as the rest of society, is slow to react to the truth that not as rarely as we once thought, poorly understood biopsychosocial factors create a split between gender identity and a  body habitus that does not match one's gender identity. My experiences have ranged from inconvenient to mildly embarrassing to being subjected to flat out discrimination by Health Care. Mostly my experiences were those of being inconvenienced and on one occasion it was rather embarrassing. On that occasion I was pretty sick with the flu which only added to my misery at the the moment.

Because I work in healthcare, I also transitioned on the business side of the organization and I can only say wonderful things about my supervisor and Human Resources. The transition happened with very little fanfare which is how I hoped it would be. I am very thankful to my employer.

Getting the health care system to identify me correctly was not as easy as managing the rest of my legal identity. It was a pretty simple process to get the world to legally say that Lauren Tancyus is a female. Legal name change: file the court form that I filled out myself and pay a fee. Driver’s license: one form to be signed by a health care professional to change my gender to female on my license and one form to get my legal name on my license along with a small fee. The court notified vital statistics in the state I was born and my new birth certificate (unfortunately with the WRONG gender due to that state’s laws) was sent to me with my new legal name. I went to Social Security and filled out the form to have my name changed. I notified the Board of Social Work and they changed my name and gender on my Social Work license for free. All in all it was fairly simple with no frustrations along the way to become legally identified as who I am.

Now getting the health care system to recognize me as female and my legal name change was not as smooth and seamless as getting my legal identity changed. I knew that my medical information needed to reflect who I am. I coordinated with my wonderful office manager Carmen to change my identity in the system with permission from our Health Information Management department. I provided the needed legal documentation which was entered into the system. All seemed right with the world!

About 5 months later, I went to one of my health care system’s prompt care outpatient offices on a weekend. Imagine my surprise when I registered with my legal female identification and my health insurance card reflecting my correct identity, only to be called back by my male name by the health care professional who would treat me. It was extremely embarrassing to me. Much worse was when I got to the pharmacy and found the prescriptions in my male name even after I explained to the treating physician that my legal identity was now female. I did not have any old identification with me and felt too sick to go home and come back. My only option was to out myself to the pharmacy staff, personal and private information they did not need to know to perform filling these prescriptions, if only Health Information Management had performed this task correctly when I gave them my new legal identity information.

  Fortunately, they were wonderfully kind and under the circumstances quite merciful to me in not insisting I go home to get the old identification in order to fill my prescriptions. They also made no issue of my gender transition. That at least, was a very positive experience during that unhappy episode of my health care.

I contacted Health Information Management about this experience and told them how embarrassed I was on top of being pretty sick at the time. They investigated the complaint and found that while some things had been changed to reflect my gender and name change, others had not which resulted in my unpleasant experience. I was assured that policy and procedure would be updated so that this did not happen again to someone else. I was also given a very sincere apology from the director of medical records. As far as I’m concerned, in correcting this problem, health care worked well and I consider my grievance with the health care system resolved. I think that this reflects my attitude in that for Health Care, my transition was involuntary for them while it was voluntary for me. Health Care can be behind the curve in this area, but I do see an effort being made to change these problems and get up to speed.I'm glad that my experience will pave the way to make life easier for someone else in the future.

In all of Health Care, there is only one area that the transsexual interacts with that fails most of us catastrophically. It is within the domain of Health Care Insurance, or for me at least with my health insurance to be subject to bigotry and discrimination and that is the failure to cover my health care expenses related to the treatment of my gender dysphoria. Not a dime of my treatment was or is eligible to be covered by the insurance coverage I have through my employment in Health Care. Even though my condition is medically recognized and the treatments I have had are considered medically necessary, I am left with no avenue to become whole. I am blessed however that I was able to personally pay for most of the medical care that I need. There are so many more like me without the resources even to do that. Imagine how they must suffer! I can certainly say that my quality of life would be so much better even as improved as it has become. To deny my healthcare insurance coverage for transgender health care is unconscionable. It puts medical care out of reach for some of my most important health care needs.

The message received is that as far as my healthcare insurance company is concerned, my identity is not a valid identity. It is a very stigmatizing message from my insurance company, in my opinion.

In terms of providing quality health care for transgender people, I would give my health care organization pretty high marks. I have one of the largest mental health practices in Virginia serving transgender patients and generally see 5 or 6 individuals a week. I have been able to successfully coordinate other health care services for transgender people to be provided by our organization. We offer speech therapy, endocrinology, aesthetic dermatology, psychiatry and gynecologic services all leading to referral for gender reassignment surgery and we provide the necessary services for after care post gender reassignment surgery. We offer every needed service except for gender reassignment surgery itself all in one system. I see this as tremendous progress for people whose identity changes in the health care system and I am very proud of that accomplishment for Health Care.

Further Along: How I Spent My Summer Vacation

Well, Its been quite a long time since I updated the blog about what has been going on in my life. When last I wrote about the bigoted, transphobic and inexcusable hatred directed by my daughter in law and stepson towards me and towards poor Patty who did not deserve the treatment she received from them, I knew that if I did not take positive action to help us both, we would both fall into despair. The real victim in all of that episode was Patty. For her to essentially lose the relationship she had with her son for things that have nothing to do with her directly was a terrible and unjust loss. We really didn't expect anything else from our daughter in law. She never liked me from the day we met over 20 years ago and it was clear to Patty as well that she didn't like Patty either. Nasty remarks she had made about Patty to another of our children's spouse came back to us,so being cast out of her life was no real loss to either Patty or me.

While I thought that my stepson and I were very close at one time. He had told me that I was like a father to him as his father had left the family when he was very young. Two years ago when my own father died, he never even lifted the phone to offer any kind of support or comfort to me during one of the most difficult times in my life. After the initial shock of my step daughter's bad behavior, his refusal to talk to me about my being transsexual was no surprise to me. It was a reflection of the weakness of his character. My daughter in law had verbally attacked Patty about me, she was too much of a coward and a bully to speak to me about this. she saw Patty as an easy target. So this loss of family, while painful, was not nearly as hard for me as it was for Patty and my main concerns have been for her. Not visiting on Christmas or other occasions was actually a relief for me as I am glad I don't have to see them anymore. when I have known for years I really wasn't welcome at their home by my daughter in law.

To watch Patty suffer through this was heartbreaking for me though and I knew I had to do something to be here with her more and spend more time with her that our daily lives generally do not allow us to be together as much as we both long for. I also knew that with my own history of depression that I could not allow myself to fall back into depression. Truthfully, I can say I have not had a depressed day since I transitioned, but I have a real fear of ever becoming depressed as I was the prior 6 years before I did transition.

So I made a decision to take an extra day off from work each week. I am fortunate to work a four day work week with every Wednesday off. That has allowed me to play golf and attend to business matters that can't be taken care of on the weekends as well as having more time during the week with Patty. I was fortunate to be able to take Tuesdays off for the summer months giving me two days off in a row during the week and of course my two day weekends.

We decided to start doing home renovations that were long over due and to take more time for each other. I was also able to play golf more often as my back allowed, which I find is good for my spiritual condition. Our house is over 130 years old and my father had bought it in 1969. He remodeled it then and it was time to renovate again, but I never seemed to have the time to make any big improvements. We had also inherited two estates over the past 20 years and much of that stuff had been cluttering the house for years.

So what we did was rented a construction site sized dumpster and began decluttering, and getting rid of the debris from the renovations that we did! By the summer's end we had filled the dumpster completely which was my goal!

As far as the house was concerned we came up with a two year plan to upgrade and repair the house. I also had a lot of help from a good friend all summer long. I couldn't have gotten done all that we accomplished without his help. Patty and I enjoyed his company and he would bring his dog over to play with Jack which was good for Jack as well. After a hard day's work, Patty or I would cook him a wonderful meal and enjoy his company and friendship. It was truly a reflection of the depth of his friendship to be so generous with his time and energy to help us get so much.

First we emptied out the utility room and scrubbed down the floors, walls and ceilings. This probably had not been done in 20 years as because of Patty's and my physical disabilities we were unable to do much in the way of heavy work, but I have been blessed to have had a wonderful recovery from my cervical spine surgery and can do a lot of things I thought I would never be able to do again (like play golf!). We got rid of the accumulated clutter in there as well and got the room organized.

Then we started pulling up old tile and carpet downstairs and upstairs, The tile wasn't too bad for the most part, but I never realized that when you take up old carpet, then you have to pull up the various tack boards and staples out of the floor that holds the carpet in place. That was tedious work!

We bought ourselves a new refrigerator and had new energy efficient windows installed downstairs. I felt ambivalent about replacing those old windows because of the antique wavy glass which added a nice touch to our old house, but the need to be energy efficient made the decision necessary.

Then we began the project that took up over half of the summer and into late fall. We painted the lower portion and the larger part of the metal roof. We decided to not paint the high part of the roof because it needs to be replaced and that is part of next year's project. We just got done with that by the time it got too cold to paint outside as it took much longer than we thought it would. The last time the roof was painted, the people I hired did a very poor job and it began peeling in months after it was painted. First we had to scrape down the roof removing the old paint. I think that the people I hired didn't do that and that is why it peeled. Then we primed the roof and after that painted it. This year, I will have the upper roof replaced and touch up the roof that we painted from whatever damage the winter has done.

I have been a coin collector since I was 7 or 8, but never organized my collection in any meaningful way. So I really didn't know what I have in my collection. I spent many enjoyable hours organizing and cataloging my collection on a spread sheet so I know what I have. I enjoy identifying and organizing my foreign coins as much as my American coins, Its also fun to find out the history of what was going on when the coins were first struck and circulated as some coins were struck due to historical circumstances and there are some very interesting stories behind the images on some coins.

One story I will share is about the "flying eagle" once cent coin which was only struck and circulated for two years in 1857 and 1858. It was used before the Indian head penny. The eagle lived at the Philadelphia mint. It was a wild eagle and not captive, so it would come and go as it pleased. The men who worked at the mint considered it as sort of their pet and named him "Pete" So it is Pete the eagle who was the model for that coin! Sadly, Pete met an untimely and tragic end. Somehow, Pete got his wing caught in one of the coin stamping presses and despite doing everything they could to try to save Pete, he did not survive the injury and died from his injuries.Another reason I didn't write here for so long is that I have spent a lot of time on creative writing this summer and fall. Patty is a quite talented poet and is a published author. I have also written poetry over the years and featured my favorite poem that I wrote from the 1980's called the Tao of Fishing earlier on this blog.

We have been fascinated with the Japanese form of poetry called Haiku. True Haiku is written only about nature and follows the form of three lines with five syllables in the first line, seven in the second and five in the third line. I have written in the past that I can see that even though born male and raised male that I had a girlhood growing up, albeit a very unusual one, mainly in my inner life. I decided to write a long form poem using Haiku poetry structure as the format for each stanza. When it is ready for publication, I will post it here.

We are getting ready to have a new back door installed which will be stronger and better insulated as well. I have also been preparing to paint the upstairs hallway and bathroom, which we will do in two weeks.

This summer I'm planning to take an extra day off each week again. We have the upstairs windows to replace and more decluttering to be done so that we can have those windows replaced, as well as removing the old tile in the bedrooms and bathrooms. We need to have the down stairs bathroom redone and then we can finish painting the upstairs. After that we will repaint the downstairs as well.
We have some minor painting to do outside on some outbuildings too.

So the lesson I would leave you with from my experiences this summer is that in the face of such adversity, it is important to focus on the blessings in your life. Find positive things to do that will enrich the quality of your life and do not dwell on what cannot be helped.

In the end, who really lost from my stepson's and daughter in law's malicious attitude? Patty certainly did and to a much lesser degree I did as well, but what did they lose? They lost our love and generosity. They tried to turn my stepson's brother and sister against us and that failed, largely due to my daughter in law's nasty treatment towards them which they are aware of and now my stepson feels totally alienated from his whole family. He has no one left there for him in his family due to his wife's actions.

In the future when it is time for me and Patty to leave this earth, they will not benefit from what we could have left them, nor will their children be helped to go to college or get their own start in life as we are not allowed to have anything to do with our grandchildren. In the end, they will have been hurt more by their own bigotry and hatred than they ever hurt us when the inevitable hard times we all experience in life come along. This has to do with the time I have spent in prayer asking for my anger to be taken away and to forgive them, not for their sake, but so that I will have peace in my life. To be frank, it is a way to become indifferent to what they have done to us. I have found that engaging in that spiritual discipline always works, but it doesn't work immediately. But it has always worked for me.

Spirituality: Creating a Religion of One’s Own

I was privileged, as I had mentioned earlier, to have attended a workshop in Birmingham, Alabama recently on the topic of spirituality and psychotherapy. I believe that the path of being transsexual is a profoundly spiritual journey. To the degree that one develops their spiritual life on this journey reflects the enhancement and sense of wellbeing we experience throughout the decision to transition, the transition itself and the quality of life we lead after we transition. Many people assume that once the transition is complete, you have arrived at your journey, but I, like many others recognize the journey continues and we are faced with many challenges. Many of these challenges are the same one faces whether they have been through the transsexual experience or not, but there are still unique situations that will come along. Having a well-developed sense of spirituality will help you to not only weather the storms of life, but will also enhance the pleasure one finds in everyday life as well.

In this article, I would like to begin to share the concepts that Dr. Moore believes will help someone to develop a deeper spiritual life. This is the first installment in a series.

1.     Deepen your formal religion

Many of us have a background of having been raised in a church, synagogue, or Islamic place of worship. It is something that is ingrained in our being and affects us in many profound ways, both positive and in negative ways, depending on the orientation of our faith and in the way a particular denomination of our faith teaches us about God and how we need to behave within our faith. I was fortunate enough to have attended a Southern Baptist church during my adolescence that taught love and tolerance for each other. Other people have experienced and learned that their denomination or church were very legalistic and were condemning, particularly if they were gay or transsexual. 

In my adult life, I experienced this with a United Methodist pastor. Her condemnation led me to leave that church and find a home in the Episcopal Church where I am welcome and made to feel part of the church family. Having found a place where I can formally worship is very important to my spiritual life, though over the years, I have been an episodic attendee. I may attend for a year or so at a time and then find myself not being very active in formal worship. Most recently, I stopped attending due to the death of my father a year and a half ago. I simply did not have the energy to go during that time, which coincided with my work transition. Yet I find that I do better all the way around when I attend on a regular basis. Formal worship keeps you from neglecting your spiritual life. 

The most profound spiritual experience I ever had was when I visited a church my friend Marsha attends in New Jersey. It was the first opportunity I had ever had to stand before my God and worship as I am with others who accepted me as I am. It was also the first time I had ever taken communion as I am and I remember tears running down my cheeks during the whole service. It was something that had been missing and  much needed in my life to move forward on my journey as Lauren. 

2.     Get to know one or more other faith traditions. 

The idea of becoming more familiar with other faith traditions is one that is not often encouraged. Some of us who are more spiritually advanced than I are familiar not only with their own faith, but have deeply explored other faiths as well. 

I have explored Taoism to a certain degree and have read several translations of the Tao Te Ching (Book of Changes), written by Lao Tzu. From that I have learned to be still and allow events to unfold, not wishing them to be anything other than what it is. It teaches acceptance and to live harmoniously with nature and in your culture. These lessons I do not practice faithfully, but having explored this avenue of spirituality has made a positive impact on me at various times of my life.

I have been interested in learning more about Islam. I think because of the acts of terrorists who falsely claim their actions are due to teachings of Islam, as well as the poor treatment of women by Middle Eastern cultures who practice Islam, many westerners have a decidedly negative view of that faith. My opinion is that each of the monotheistic religions has leaders and followers who claim to follow their faith. They pervert the message to use it to spread hatred and condemnation of those who do not adhere to their version of their faith. Knowing that my faith tradition has such people and knowing the truth of my faith, I have felt some sense of the need to learn more about Islam rather than to reject it out of hand without real examination. So perhaps this is another faith that I will learn more about to harvest what it holds that can aid me in my spiritual journey.

3.     Explore secular sources of spiritual insight

When Dr. Moore began to talk about this, it puzzled me about how to go about doing that. One of many ways to do this is through service work. Become involved in activities that serve others who are less fortunate. By doing so, it takes you out of your usual life of thinking of yourself and your needs and puts you in the position of giving to others and being with people who are in service to others. This is particularly true when engaging in a service activity that allows one to interact with the people who are benefitting from your service work directly. The examples that first come to mind are participating in programs like Meals on Wheels, Special Olympics or volunteering at a nursing home or to read to children at the library. Participating in Big Brothers or Big Sisters is another example of secular activities that will deepen your spiritual life and there are countless others.

Pink Essence: Why I Chose to Discontinue My Membership

I was a member of Pink Essence for a number of years and I recently decided to discontinue my membership as did Patty.

There were many benefits that I got from being a member and my decision to end my membership in this community ultimately has to do with a decision that Chloe Prince made to open up Pink Essence access to the World Wide Web.

I have known about this decision for quite a long time and at times worried about what the personal implications for my private life might be. Then again, I have this blog which would throw into question why I might be so concerned about my privacy. After all, I have given a great number of workshops around the eastern U.S. over the past 5 years and I have documented my transition here as well as on Pink Essence.

However, when I decided to write my own blog, I made the decision to be more public. When Ms. Prince made the decision to open Pink Essence up to the internet at large she made a decision that has the potential to harm many people who are not prepared to be potentially discovered by family or employers or by friends. It is a difficult path that we walk and for those who are not ready to deal with being outed at a time when they are just coming to terms with themselves, this is potentially disastrous. When  one considers that we have a rate of over 40% of us who attempt suicide at some point in our lives due to the heavy price we pay for attempting to come to a place of peace with ourselves and the associated losses of families, friends and careers, among other things, perhaps Pink Essence is no longer a safe haven for those who are just coming to terms with themselves.

In my situation, family did discover my presence on Pink Essence and it did recently cost me and Patty some relationships that we held dear. I don't fault Pink Essence for my own losses, but I think someone not as far down the path as I am and who has not worked as hard at self acceptance as I have may not be as emotionally prepared to pay the price that Patty and I just paid by not ending my membership when I first became aware of the new policy opening up Pink Essence to the World Wide Web.

The value of Pink Essence is mostly for new people who are coming to terms with their gender identity. They are also the most vulnerable people on Pink Essence. Having made the decision to open up Pink Essence to the World Wide Web puts the most vulnerable of us at risk.

Unfortunately, I have seen a huge turnover in membership. This is most likely because many of us who have transitioned and accomplished what we set out to accomplish (a successful transition), have no need for what Pink Essence offers. Other people who have successfully transitioned stick around to offer advice on what worked and what didn't on our journey to becoming whole.

I believe that opening up Pink Essence is a huge disadvantage to those who have transitioned and want to live a private life, even if they wish to contribute in a positive way to the lives of others who feel lost and are trying to figure out how to be happy and live a fulfilled life.

It is also a huge disadvantage for those who need a safe and private place to discuss the often painful issues that we face on our way to finding peace and happiness.

I only wish Chloe Prince well, as well as future success. I hope that those who join Pink Essence find what they need on their journey, but I also hope people will be aware of the risks associated with membership on Pink Essence and make a wise decision if the benefits of membership will outweigh the risks involved.

To read an article I wrote about the benefits of belonging to social websites such as Pink Essence that I wrote earlier, please follow this link:

http://twoworldstranstherapist.blogspot.com/2012/08/in-praise-of-pink-essence-and-social.html

Disowned, the Story Continues, Oddly Enough

Surprisingly, I find that my Daughter in Law is apparently aspiring to become my cyber stalker. For someone who made it clear to Patty a little over 24 hours ago that she wants nothing more to do with us, she was on the phone again bright and early at 8 am this morning to continue to harass Patty over what I had published here less than 8 hours before that about her uninvited verbal attack on us.

She told Patty that what I had written was a "pack of lies", but Patty who then read my blog after the phone call found nothing I had written to be untrue.

If I were dead to her and did not exist as she informed Patty yesterday, one would think she would have better things to do with her time than obsess over anything I might write about.

Perhaps it has something to do with her failed attempt to turn Patty's daughter against us. She seemed to have a need to call her to tell her all about this but my stepdaughter's response was that if her mother and I were happy together then it was no concern of hers.
Considering how she attacked my stepdaughter's husband two years ago, calling her was a rather pathetic move on her part. Her behavior is becoming rather laughable! Quite a change for Patty and me in less than 24 hours.

I thank God my prayers to Him asking him to bind her from harming Patty and me have been answered! Once again, it has been proven in a powerful way that God always answers prayer.

Patty and I were discussing these developments this evening after I came home. We began thinking about what she would do if one of her children came to her and told her that they were transsexual. Given that no one asks to be transsexual because of the hatred and disgust people like my daughter in law harbor towards us, we wondered if she would tell them they too were vile, disgusting and perverted as she thinks about me and about Patty whose only transgression is to love me? For my grandchildren's sake, I pray this does not come to pass. It is sad to know that so many transsexual young people are thrown away by their families like garbage. She seems to be someone who is capable of being that way in my opinion.

It also gives me pause to worry that as a health care provider, would her bigoted and hateful attitudes translate into abusive or neglectful care of a transsexual patient if someone like me would be unfortunate enough to be placed under her care. It is highly likely she will encounter a number of patients like me before her career is over and she retires. I know I would be fearful to have someone with her attitudes responsible for my care.

It is both my and Patty's wishes that she do what she said she would do last night; leave us alone and stop bothering us. Enough said.

Disowned

In the span of a little over an hour, my life took another radical change again. At first, I thought it had taken a serious turn for the worse. It felt catastrophic and I wanted to vomit. Then I felt empty and could not put any words together. I wanted to die, but I had no urge to kill myself. I was not suicidal. I just wondered why my life goes on and why can’t it just be over. I had no answers for those questions, but that all turned around in a rather short period of time as you will see.

What happened was that shortly after I got home from work, my daughter in law called to tell Patty that they (she and my stepson) knew the truth about me and what a pervert I was. She went on to tell her that she was vile and disgusting and that as far as she was concerned that we were dead to them and she would tell our grandchildren that we do not exist. She also said that she would also call Patty’s other two children to inform them so that they would be sure to disown us as well. Poor Patty endured this venomous spew from this unlovely person and never returned an angry word.

Patty, of course, is devastated. We had agreed that I would not present myself to them as I truly am out of consideration for Patty’s feelings. It was a small sacrifice to me for someone I love, as we were pretty sure of this type of reaction as my daughter in law has been a very destructive force in the family dynamics on so many levels over the years. She has ensured that her husband is alienated from his brother and has created major problems in the family relationships with her husband’s sister’s husband, his brother in law, our son in law. Now, when we try to arrange a family get together, our son in law will not attend. Once in awhile, my step daughter attends and I have tried to avoid these occasions because I know my daughter in law doesn't want me around. Patty has sensed the same thing over the years. We are never asked to spend any time with our grandchildren except when my daughter in law is present. We have never been asked to babysit and have never spent any time with them unless she ensures she is present. This is true even if I weren't involved. My daughter in law has always excluded my wife from spending time alone with the grandchildren, unlike the access she has allowed her family.

It seems though in the aftermath of this, it has become a very freeing experience for me. It was a painful sort of rebirth of which I have experienced many such along my journey.

I am free of having to pretend that I feel accepted and a part of Patty’s family. I have almost always felt like an unwelcome outsider, particularly by my daughter in law over the years. That was going on way before my daughter in law’s discovery about me today. Now I will never see them or interact with them again. My daughter in law, once again has shown us her black heart.

However, the pain that my truth causes Patty once again, just by my truth of being me becoming known to others, is heartbreaking for me. I don’t know how I can ever make up to her that her choice to remain in a relationship with me cost her relationship with at least one and maybe all of her children. It may not be possible to do that at all.

In two days we leave to go on a vacation we have both been looking forward to a long time to a place we both enjoy when we visit. I’m not sure either one of us cares at this minute about that vacation any longer. Hopefully though, this will be an opportunity to become even closer through experiencing the unreasoning and ignorant hatred of my daughter in law. I hope we will just forget about this over the next week and focus on us having fun and relaxing together.

What is positive from this horrible experience is that I feel no need to retaliate in kind, though I have first hand knowledge of things my daughter in law has done that would jeopardize her professional career and reputation, due to the same destructive need to maliciously gossip about people.

Her treatment towards my wife shows her to be a low and common person, someone who enjoys inflicting pain on others and she lacks the courage of her convictions to say them to my face over the phone.

However, they failed to recreate the feelings of guilt and shame that are common to people who grow up knowing they are transsexual. This is a reflection of the hard work and growth that I have accomplished in self-acceptance.

My God requires that I forgive her and I have made a lot of progress this evening towards that goal.  In this sense, it is a purely selfish act. It is only for me and not meant to benefit her in any real way. It allows me to feel the full grace of peace and love that God has for me. I bind her from doing emotional harm, something she seems to crave the need to do to others, as evidenced by the many examples over the time I have known her. My most sincere wish is that she is also bound from harming Patty in the same way. I simply won’t think of her in the future.

Thanksgiving 2013

Although I have had many extremely unhappy Thanksgivings in my life, this day has always been my favorite holiday because of the traditional meaning of the day. It is a reflection of my profound faith as a Christian and it is the time of year, along with Christmas where I am focused on the many things I have to be thankful for and not thinking of the difficult things I have come to terms with that have happened in recent years.

When I write my articles, I try to write them for you: the people who read them. I only write about personal things when I think there is benefit by sharing my privacy with you. Then again, what I write I want to be interesting to you as well. As I share the things that I am grateful for, I am aware that this might not be so interesting to you, but I hope the thought that even under difficult circumstances that you might be experiencing, no matter how sad or painful, we do have things to be thankful for and when we remember those things, it makes the difficult things easier to bear.

Most of all, I am thankful for my wife Patty. I am very blessed that she has chosen to remain with me through my transition. Many, if not most marriages do not survive transition. I know that my decision to transition was and continues at times to be painful for her. Through it all she has chosen to stay with me and I am so thankful for that.

I’m also thankful that I found Dana to be my therapist. She is very gifted and guided me through my transitioned. She asked the hard questions and threw up every possible or potential roadblock or challenge I had to overcome and it resulted in my decision to transition with no regret. She helped me to finally put to rest past traumas and they don’t bother me anymore for the first time I can recall in many years. She “held my hand” when I was afraid and helped me find my courage to do what I needed to do to be happy. Thank you so much for all you did to help me, Dana.

I’m thankful for my dog Jack the bipolar beagle and my cats Taffy, Callie Sue and Jill. I’m especially thankful to still have Taffy who was diagnosed with cancer a year and a half ago. He is still happy and active and is not in any pain. He is very special to me as he “picked” me as a kitten. He was a stray I found down at the country store. He was one of a litter of kittens down there. He wouldn’t have anything to do with anybody and no one could catch him, I was told. For some reason he came running up to me and he has always loved me best. Yellow cats are special, indeed!

I’m thankful for having a home and plenty of food to eat. There was a time when I didn’t have enough, though I can’t say I was starving, but I definitely was hungry a lot of the time and there was even a short period of time when I was homeless in a new city through my own stupid decision making. Sometimes it takes not having enough to eat and not having a place to live to make you remember to always be thankful for and never take for granted something as simple as having enough food and a home.

Even though at work we no longer get raises based on performance and no longer get cost of living increases in our wages, I am very grateful to have a job in my chosen career. This may not be true in the future with the coming of Obamacare when specialized care will become less available and strictly rationed as in other countries with socialized medicine that I read about, but that is not happening to me at the moment. Rather than worry about that day coming, I choose to be thankful for what I have today.

I’m thankful for my health and the health care providers I work with who take care of me and keep me well. I know they respect me and I am treated with the dignity I deserve.

I’m thankful that I had the opportunity and access to higher education. For any of us who are transsexual, education, whether academic or vocational in nature is the key to preventing many of the horrible things that happens to some of us.

While this may be difficult for some of you to understand, I am thankful for my father’s passing away peacefully last year three days after Christmas. He had suffered a great deal over the past two years of his life and spent most of it, especially in the last year, either in the hospital or in rehabilitation facilities when he would have preferred to be home. I miss him so much, but I also grieved for him a lot over the last two years and in his death I found relief from my own grief. He is at peace and home with God. He was a man of strong faith and it is the most important gift he gave to me as a child.

I’m thankful to have a very rich spiritual life; my faith in God has carried me through all of this, in good times and in difficult times.

Even though I hate winter and cold weather, along with the long dark nights, I am thankful for winter because without it I would not appreciate the beauty of spring, the warm long summer days and the beauty of autumn.

I know that some of you who read this are going through some difficult or even terrible times. I hope that this might be a small gift in some way and that it will encourage you to remember things that you have in your life that you can be grateful and thankful for, even if it is some of the little things you might not think about on a day to day basis and that will make today a little bit better for you.

Judge Not, Lest Ye Be Judged: Is it Possible You Might be Cisphobic?

I had an experience this past week that I would like to share with you. It does not reflect the best of me, though it turned out well. I think the lesson I took from this is one I would like to share because we can all benefit from it. It is a lesson that has been profoundly repeated at least weekly, if not almost daily since I made the decision to complete my transition over the past 6 years or so. It occurs so frequently now that in many ways I have begun to take it for granted. It is the more poignant examples that I now find to be emotionally moving.

There is another type of bias and prejudice that I have described in vague ways. It is something that we must search within ourselves and sit in judgment of ourselves. It is a form of oppression of the worst kind. It is oppression of the self and it is called CISPHOBIA. It occurs when we expect cisgendered people to discriminate against us, hate us, or perpetrate violence against us with no basis for that expectation. It is rarely discussed and even more rarely described.

Do cisgendered people at times discriminate and publically express hatred towards us, even to the point of having perpetrated violence against us solely for the reason we are transgendered? That is an unequivocal YES. It is the legacy that I grew up with, the same type of virulent hatred also characterized by racism and homophobia, however we must also recognize the tremendous advances our society has made in accepting us and recognizing our right to participate openly in a free and just society with respect to our Constitutional rights. There is, however much that remains to be done to further the progress we all have made. That progress benefits cisgendered people as well as transgendered people.

Incumbent upon us is that we also reflect and identify those areas of potential and/ or unrecognized cisphobia that impair our ability to experience a fully free and self actualized life. It is also incumbent to make necessary changes in our own personal attitudes when necessary to eliminate cisphobia in our lives.

The example I would like to share with you involves a former patient of mine who I had not worked with for about two years. Quite frankly, the experience of informing all of my current patients that I was transitioning, while very successful (I retained over 97% of my patients), was also very stressful, at times exhausting, and it was an experience that I am glad is over. On occasion, I still have to disclose to a former patient who is insistent about wanting to work with me. I don't look forward to the times I have to do this. I just want to live my life without having to review the past, but in my choice of work, that is not always possible. Here is where the problem arises and it is where I have personally struggled with an area of cisphobia.

This patient came to the office two weeks ago, unaware that I had transitioned. He had asked to see me for a few minutes, but because of the unanticipated nature of the visit and that I had already seen 9 patients with a serious crisis patient in the afternoon I was not prepared to deal with the situation.

My thoughts were that due factors of his cultural background, his religious background and his personality that there was no way that he would be accepting. In other words, I made a cisphobic judgement about him. It turns out that I was grossly unfair to this gentleman.

The front office staff did an admirable job handling the situation. They began to try to explain without discussing my transition that I (my former male self) was no longer there. Out of genuine concern and care, he pressed them to tell himwhat happened to me as he was clearly worried that something tragic had befallen me. So they explained in simple terms that I had undergone a gender transition. His response to them was that it did not matter a bit to him and that he felt that because of the work I had done with him that I had saved his life. (No I didn't save his life, I was simply the tool he chose to use to save his own life).

The front desk staff relayed this information back to me and I asked that he come by on another occasion. It had indeed been a very long day and I was tired.

Yesterday my patient had an appointment with me and saw me for the first time. The first order of business was to apologize to him for my misjudgment. He graciously told me that no apology was necessary, but I insisted that I had been wrong, apologized to him again and thanked him for his acceptance of me.

In the past, I have seen opinions expressed that people who are oppressed cannot be oppressors themselves because of their oppressed status. I have always sharply disagreed with that opinion. By the act of being bigoted, prejudiced or biased against people, whether they are members of an oppressed class of people, or by the act of being bigoted, prejudiced or biased against people who are members of a class of people who have been oppressive towards another class, we perpetrate the impedance of societal progress. We injure those we have unfairly judged. We injure ourselves by depriving ourselves of the opportunity to take advantage of the progress we have made as a society. We slow the process and the progress of our own full integration into society.

Now I am someone who believes I am fully assimilated in daily life; I do not fear going to the ladies room, using the ladies dressing room in stores, nor do I fear an encounter with the police, going through TSA when I travel or interact in any way with the predominant culture. I generally don't see myself as a person who is cisphobic, but there are these areas of cisphobia that apparently do exist in my life.

It is my hope, through my own personal growth in this area and by bringing this potential problem to the attention of other transgendered people that we can do our part to make our society a more free and open society.

Ain't That America?

Today was a day that made me proud to be an American! We hear so many stories about how awful our country is and how we as people of trans experience are hated and driven to despair. That isn't always the case and we need to focus on positive things. We can overcome adversity and we can have happy, fulfilling lives!

Today, I had a very positive experience interviewing with the Veteran's Administration for a job that has a lot of opportunity for advancement. The five people who interviewed me were all very positive and seemed interested in my experience and skills as a Social Worker. They informed me that I was a finalist for the position and they indicated that they would be in touch no later than the first of next week about the position.

Then I went to vote. It was the first time I ever voted as Lauren, here where I have lived a male life out in rural Virginia since 1992. I grew up here before leaving for college and grad school.

It was a very comfortable experience. There were no challenges to my right to vote and the election officials were very polite and professional.

The world is a much better place for us, even as recently as twenty years ago. I live in one of the most conservative (both politically and religiously) areas in the U.S. here in the Shenandoah Valley.

If I can do it, so can you! Yes, there have been obstacles along the way. My biggest obstacle was my own fear.

I hope that you will follow your dreams and become the best you that you can be!

"The Other Side of the Mountain" OR "Today is the First Day of the Rest of Your Life"

Two weeks ago I went to work for the first time as myself for the first time. While I thought that I would be nervous as I got ready, I felt just like I did on any other day. I felt quite content and happy with my decision to transition and was glad that (FINALLY!!) my day had arrived. I would never have to tell another patient that I was intending to transition. I was looking at starting out with a full caseload for the week.

By the end of my period of preparing to transition at work, I had informed over 70 patients of my intention. I am very pleased to report that a little over 96% of the patients that I told either chose to continue to work with me or to begin to work with me. These are important figures because it represents enough data points to be categorized as a large N sample as opposed to a small N sample which makes the 96% more powerful statistically speaking. Using a one tailed T test to analyze the data demonstrates that people from a rural environment in Virginia conclusively are willing to work with a health care professional who is transsexual and transitions on the job. In other words, the results of this data are valid for this geographic area.

Unfortunately, there is no way to test the reliability of this data. In order to do so, I would have to gather another sample of more than 64 patients in order to attempt to replicate the results. I would have to inform them of my transition and I am not willing to do this. My intention from the beginning has been to live my life as a woman, not as a publically trans- identified person. Informing so many people about my transitioning at work has been a quite stressful, but quite manageable experience. I just don't wish to repeat it.  

I think it is notable to report that of the 4% of people who did not wish to work with me, 75% of them were new patients for who I completed an assessment and disclosed my transition at the time of the assessment. There were no differences in the numbers of each gender: two males and two females declined to work with me. Two were fundamentalist Christians, the other two had no particular expressed religious beliefs other than being Christian. The age distribution was not significant. But enough of those dry statistics. Suffice it to say, it is often a better world than we are led to believe.

Despite having a full schedule for the week, on my first day only three patients kept their appointments. As the day wore on and more patients did not show up, I began to think "Oh my God, what the hell have I done?" I was having periods of anxiety and was thinking that the decision to transition at work was the biggest mistake of my life. But then I would think, you've been waiting all your life to do this and my sense of peace and contentment would return. I called the patients who didn't keep their appointments and they rescheduled.

Most of the week this pattern of patients not keeping their appointments continued until Thursday. It was then that I discovered my patients were not getting their reminder calls. While I was off to take care of the necessary legalities involved in my transition, the office staff removed me from the automated system. They had not put the new reminder message into the system by accident. Discovering this oversight was a tremendous relief for me and our staff called my patients individually to remind them of our appointments for Friday and my schedule was full for that day.

Having taken 8 business days off and then not having my patients notified took a toll on my schedule this week as well. It usually drops after returning from a vacation and my patients not being notified for 4 days did not help the situation. But last week my schedule rebounded and I saw almost enough to meet my productivity goal for the week. Next week my schedule is soft and I may be forced to take some time off, but I am confident that it will soon be back to full strength. I feel just as confident and at ease working with my patients as I did before my transition and my patients have all responded positively to my actual transition on the job. The new patients I have seen in the past two weeks seem quite comfortable working with me as well. I am glad for that and grateful to God for being by my side through this part of life's journey.

Before I returned to work, I thought to myself that while my work transition was a monumental personal accomplishment, it is not the destination, nor is my transition complete.

Life itself is a transition. Now I must continue to live and work in a life that feels as congruent outwardly as I experience it inwardly. I can now live my best life with all the joys and sorrows that necessarily come along with the human condition. I have no idea whether life will be easier or harder. It does not matter. My life could become difficult and painful for so many reasons having nothing to do with who I am. Conversely, it can become filled with joy for nothing to do with who I am. That's just the way life is. I am certain that I will experience both the joy and pain of the human condition in the future. I will no longer carry the oppressive burden of not being outwardly who I am inwardly. That brings me a simple sense of comfort and contentment.

While I was off from work, I spent some time in reflection. I spent a lot of time thinking about and writing about the little girl that I was, the little girl that no one knew and I didn't want to be. I had spent so much of my life not wanting to be who I am and not wanting to think about her. I was able to remember a lot of things I had forgotten about her and what she was like. I was able to remember what she was like and the things that she liked and dreamed about and hoped for. That helped me to heal some of the wounds from my past and made me feel much better about who I was when I was little. I can't think of many things sadder than a child who hates herself or an adult who hates the child she was simply for being. I no longer hate that little girl for the simple fact of her being alive. I can see her for who she was with clarity and I can embrace her now as a good and healthy part of who I am. She was who made me someone who is kind and has a lot of compassion for others. She is with me always looking out and seeing the world through my eyes, even when I pretended that she was never there.

There is another thing I knew at some level, but perhaps wasn't always consciously aware of a lot of the time that also became clear just prior to returning to work. It is something I hope that will help you on your own life's journey, no matter where it leads and the experiences you encounter day to day.

Many people don't realize that fear is not the opposite of being brave or having courage. If they experience fear, they often think it means they are cowards, especially if they don't act because of their fear. In reality being brave or having courage has nothing to do with fear. My fear may have gotten in the way of allowing me to become who I am, but it ultimately was an act of courage to be outwardly who I am. While fear may have slowed the process of becoming way down, fear could not defeat the courage to do what I needed to do. Being brave allowed me to act in my own best interest to become outwardly who I am. Ultimately, no amount of fear could have prevented me from what I needed to do for myself.

On your own journey, I hope that you also will find the courage to be true to yourself, despite the sometimes overwhelming fear that comes along with life's journey at its worst moments. Sometimes it takes time to find that courage, but it is there inside you to find.

I have not spent time condemning myself for not having transitioned when I was 18 or 22 or 25 or when I was 36, all ages and at turning points in my life when I seriously considered it. The past is gone. I shall not regret it. It would be a detriment to myself to dwell on it. I prefer to remember all the good things that did happen and while the life I led did not allow me to live outwardly as I am, good things did happen to me and I did good things as well. That allows me to have a sense of peace and acceptance about my past life.

Tomorrow is not promised to me or anyone. I have to live in the present and make the most of today. It is my most sincere wish and hope that you are able to do so as well, no matter what your day to day circumstances may be and never give up your hope. We must be mindful that there is no such thing as perfection. I think that sometimes we have to recognize the incremental progress we make, even if at times we seem to be standing still.  If we sustain our hope, things will improve over time and that belief will carry us from day to day.

When I Was In Second Grade

When I was in second grade, I found a book called the Box Car Children. It was the story of three children, an older brother and sister, and a younger brother. They had a nice dog too! They had been orphaned and were to go to live with their grandfather. They were afraid of him and didn't want to live with him and ran away. On the edge of a town on an abandoned railroad spur was an old box car. They made the box car their nice little home and made their surroundings nicer and more fun! They went to school and were clean and not starving. No one knew they lived all by themselves because they were doing so well!

Then I had this wonderful idea! I could run away, with a whole new wardrobe of clothes appropriate for an 8 year girl and live in a cave just outside a town where no one would know me! I could go to school and no one would know. I could be just like the Box Car Children!! I look back in real amusement at how sweet but impossible that idea was. I even put some planning towards it! I looked through the Sears and JC Penny catalogues so I would know what clothes I liked and to buy so I could do this. I even looked at a Virginia map! I saw some cities near by, but I didn't see any caves on the maps, so maybe that's why I never did that.

 My heart goes out to the little girl back then. Who was going to feed this poor little waif? How was she going to keep her clothes clean and who was going to hold her and tell her everything was fine and she was safe when she was scared? Who was going to take care of her if her tummy hurt?

Then I think about her vision for becoming herself and I'm so proud of her! For even then, at that young age, she was trying to figure how to get where I am today. And she only thought about how much better it would be than to be where she was, even back then. As she grew up, she never really gave up, and here she is today! And now I'm feeling kind of proud of that little girl too!

I Told My Best Friend on Thursday

As my actual work transition date comes closer, I was becoming considerably more anxious because I had a major task to complete before I felt that I could do this. I had to tell my best friend "Janet" who I mentioned last summer in an article as the friend I like to play golf with. I have a few "best friends" Of course, my very, very best friend is my wife Patty, but she enjoys the elevated category within "best friends" as my wife and soul mate.

Janet is my very best female friend for several reasons. I have known her since I was 18. I have one other best friend who has known me that long and like Janet, I went to college with him. Janet and I also had the same major so we spent a great deal of time together in college. She is someone I can honestly say has never hurt me or betrayed a trust, no matter how small and seemingly insignificant. I think that is pretty rare.

After college, Janet and I went our separate ways and I didn't see her again for 31 years. When I would think back to college, I would remember our friendship fondly. I had gone to some college reunions in the past, but the ones I had attended, she didn't, which was disappointing because I had wanted to see her more than anyone else in my class.
A year from this past October was the reunion for the class after mine, so I had no plans to go. Out of the blue, I got a call from Janet asking me if I would like to come up and have lunch with her and her friend "Martha". I talked with Patty and she said she would be ok with me having lunch with them, so I went up to Bridgewater and met up with them to eat at our old favorite pizza place. It was good to see them both and they both looked wonderful! Just as I had imagined them! Janet and I picked up our relationship as if we had not missed a day even though it had been 31 years since I last saw her. That is the mark of a true friendship.

After that, she and I have gotten together every other month or so and played golf or gone to lunch and I have looked forward to each time so much. I wish we lived closer so we could see each other more often.

Because of the closeness of our friendship, I found that telling her was one of the hardest things I had to do in order to move forward with my life and the anticipation of doing this was horrible. I was so afraid that she would not be able to accept this and that I would lose my friend. I was so anxious that I spent a great deal of time talking this over with my therapist Dana.

Even though I knew Janet loves me as a dear friend and I knew she would accept me, I was still afraid. She and I are both devout Christians. God and my angel have been with me through this whole process, which has resulted in a sense of peace when the time comes for me to accomplish something important in my transition.

Before I could tell Janet, however, I had accidentally outed myself to Janet's daughter "Christi"! In November, when my father was in the hospital and Patty was also in the hospital with a kidney problem, I got a message from what I thought was another friend who knows about me. The message asked me what I was doing that day. I was off of work to take care of both Patty and my father and that was the day I was also changing my gender marker on my driver's license. So I replied that I was going to do that on that day. I got a message back, "Why would you want to do that?". I thought that was odd, but as it was early morning and I was half asleep, I wrote back "Because I want to be a woman." "You do?" was the next message.

By then I was wide awake and wondering what had I done. "Who is this?" I messaged. "Christi...."

 OMG!!!!!! THE WORLD TURNED UPSIDE DOWN for a brief moment and then Christi messaged "Call me..."

That was when the calm returned. God had been with me the whole way and I thought to myself, this is a good thing and it will be ok. I called Christi and we had a long talk about my gender identity. She wanted to know if I had told her mother and I said I hadn't. She wanted to call her and tell her, but I told Christi that Janet and I were such close friends that nothing less than telling her face to face would do. I asked Christi to keep the confidence and not say anything to her mother until I could tell her face to face.

With my father's terminal illness, his death and informing my supervisor, hospital administration and coworkers, there wasn't any time to talk to Janet until mid January. Christi and I chatted off and on and she was as anxious for me to tell Janet as I was.

We set several dates to get together, but things would come up at the last minute that necessitated Janet's cancelling out. This was making me even more anxious as I wanted this part of my transition to be over. I felt I couldn't move forward and transition at work unless I told Janet first face to face.

This must have been so hard for Christi as she must have been bursting at the seams to tell her mama. But Christi is her mother's daughter through and through and kept my confidence for four months. What a tribute to Christi's character!

Thank you for helping me do this the right way for me Christi, I'm proud of you and I know your mama is so proud of you too! I know it must have been hard not to tell her.

Finally the day came two weeks ago when I was able to sit down with Janet and tell her. I was so nervous that I could hardly eat my lunch. The restaurant was too crowded to discuss something this personal, so we talked in her car. We ended up talking for three and a half hours and though I was so anxious, Janet reassured me that we will always be friends and that she was proud of me for coming to terms with this and being who I am instead of living with such a painful secret.

The lesson I learned once again is that people are kind and caring. I believe my relationship with Janet is deeper and we are more connected than ever. Through this experience, I also gained a new friend too,Janet's daughter Christi! How truly blessed I am!

In this journey, the biggest discovery for me has been the spiritual growth that it has provided. When I made the decision to transition, I never thought that the biggest and best part of my journey would be the spiritual aspect of it. And it has!

What are the fruits of the spiritual growth that I have harvested from transitioning? Most importantly, I have grown closer to my personal Lord and Savior and I am comforted by my walk with the Lord. The friends that I have talked to about my authentic self have all embraced me. The support from my employer, my supervisor, my coworkers and my patients has been overwhelming in the caring and support they have demonstrated towards me. This has also drawn Patty and I closer as well. Our marriage, I think, has grown stronger with each passing day. I am truly blessed and truly thankful for all that has happened and all I have been given. I never would have dreamed it possible.

Do Transsexuals Discriminate Against Each Other?

I was exchanging emails with my friend Amanda who is a relatively new friend I met on Pink Essence. Amanda is a very sweet lady who is coming to terms with her gender identity later in life. This is not unusual for people in their 40's, 50's, 60's and even 70's or older. There just weren't any resources readily available to people of our age.

The few sources of medical research and psychological research suggested in the 1960's and 1970's that people such as me were extremely rare, so rare that the estimate of our population was around one in 33,000 (1:33000). In 1970, when I was 12 and went to the public library in Charlottesville, Virginia to read about people like me in books by Harry Benjamin, Robert Stoller and Richard Green, the principle authors of the time, Charlottesville, in 1970,  had a population of about 30,000. I knew this because on the Interstate signs for the exits for Charlottesville, they posted the population at that time.

 Can you imagine how alone I felt as a 12 year old? It was a terrible feeling and I continued to feel that sense of terminal uniqueness until about 1990 when I got a subscription to Compuserve and found live time chat called "CB channels". Compuserve was very expensive at the time. It cost over $6.00 USD an hour over the basic plan. It didn't take too long for someone who was dire in need to talk to people who were like me to run up a huge bill and this limited how often I could talk to another transsexual after weeding out the fetishists and people with various interests other than realizing their internal gender identity.

Just before that, I had taken a "mental health" day off from work and watched Geraldo Rivera's daytime talk show that afternoon. Marsha Botzner was on his show. She was (and is) the director of the Ingersoll Center and the next day, I called her in Seattle where she is located. She was the very first person like myself I had ever spoken to and that gave me a tiny glimmer of hope. She was extremely encouraging with me, but it wasn't until 1997 that I made the decision to begin taking baby steps to actively seek my own transition and stop living with the misery of living with my secret.

My dearest friend Christina and my wonderful beautiful wife Patty were my rock in beginning the painful process of coming to terms with myself and the world I live in. Although I had been helping other transgendered people, it wasn't until 5 years ago that I found the strength to seek therapy for my own gender dysphoria. I deeply appreciate what my therapist Dana has done to help me find my way on a difficult life journey. She had no experience with people such as me. I'm the only therapist around for about a 3 and a half hour drive who works with adult transgender people. She is a highly skilled therapist and had the courage and compassion to stretch herself in her own growth as a professional to help me. I could have easily skirted the standards of care in obtaining my hormones, but I followed the process that I ask others to follow. I believe in the WPATH Standards of Care and cannot exclude myself from following them.

Along the way, from time to time, I would run into someone who would tell me that because I hadn't already transitioned, gone on hormones and had my genital reassignment surgery, that I wasn't a transsexual and that I was something else, less than the person who made these observations and not worthy of being friends with this person. I was "otherized". I found this reaction to be very painful and it would often increase my sense of emotional isolation and being unacceptable. I know my sister Christina experienced a lot of the same treatment by some of the other transsexuals with who were we were acquainted online.

It saddened me greatly to learn that Amanda had formed a close friendship on a transgender social website with another person who identified herself as a transsexual. After being friends and with someone who Amanda considered a close friend for a while, the friend learned that Amanda has chosen to honor her spouse's wishes that she not begin hormonal reassignment therapy and to not appear publically in her authentic gender identity. Her friend was not supportive of her, instead she was quite incensed that Amanda has chosen to make a compromise to preserve the relationship of many, many years with her spouse. In fact, she was so upset with Amanda's decision that she decided to "unfriend" Amanda. Amanda, understandably, was quite hurt by her friend's shallow an insensitive attitude towards her.

Now I do not know who Amanda was referring to and I do not care to know her identity. I think that this person must be very insecure with her own identity to insist that every transsexual follow in lockstep and begin HRT and eventually (the sooner, the better?) have genital reassignment surgery. it really matters not a whit, in my opinion whether someone begins HRT or has the surgery to confirm they are, indeed, a transsexual. There are many among us, particularly those who are older and in committed relationships who choose to not make our gender identity not "all about me". We love our spouses and want to remain with them for the rest of our lives. So, we make compromises that we are able to live with.  We try to find a middle road that our spouses can support as well as what brings us a level of congruency that allows us to live as comfortably as we can. It isn't the best of all possible worlds, but it is what works for us as individuals.  Gladys Knight and the Pips got it right in their song, Leaving on That Midnight Train To Georgia- " I'd rather live with him in his world than without him in mine".

Relationship is about compromise. To be in an intimate relationships, we have to find a middle ground with our partner. It doesn't matter what that compromise is, as long as we can live with it. Having a transsexual identity has nothing to do with what we do about it. It's simply about the identity.

We transsexuals frequently resent being lumped into the "transgender" umbrella. To me this is understandable because we don't care for the thought that we are identified by the public as being many things we are not. However, that has never influenced my choice of my friends. They are my friends because of their character and not because of their identity. It is particularly distressing to me that some of us who identify as transsexual will choose to denigrate others who identify as transsexual because of the compromises they choose to make to preserve the most important relationships in our lives.

I'm so glad you are my friend Amanda!

The Face of Trans Today

Over the past few months, I've begun to think about the question, "In the predominant culture (the United States, my culture) today, what is the image of being transgendered today?" I'm not sure that this is as easy a question to answer as it would appear on the surface.

This is something I've been thinking about since my adoptive niece Erica, made a comment about the featured speakers and content of the conference workshops at Trans Philadelphia Health Conference. Over the past few years, the content of workshops and speakers reflect a trend towards those who identify as "gender queers", particularly in the Northeast and West Coast.

According to the National Transgender Discrimination survey approximately 13% of people who were included in the survey identified as gender queer. Those who identify as gender queer are much younger than the general population obtained in the survey. 67% identified within the gender binary of male or female. Another 20% identified themselves as sometimes living as male and sometimes female, but still clearly identified with the gender binary concept to a large degree. 71% were under the age of 44 years, so the study does not accurately reflect the age distribution of transgendered people. 20% were in school at the time of this survey. It was also limited to those with internet access, so there are some confounding variables to this survey. In other words, the results cannot be considered statistically valid or reliable.

However, it remains the most important study on discrimination transgendered people face in the United States conducted to date. In my opinion, despite the limitations of the survey, it is the most accurate reflection of the life experiences of transgendered people in the US today.

 Individuals who identify as gender queer appear to be heavily influenced by an extreme left feminist ideology that is fashionable in academia at colleges and universities. It is known as third wave feminism. They advocate the ideological belief that individuals who identify with the gender binary schema are hurt by it as their lives are limited and scripted by having to conform to either a male or female identity. Instead, they argue, we must create a genderless society.

In October 2012, a Gallup Poll reported that a survey conducted from June 1, 2012 through September 30, 2012 found that approximately 3.4% of Americans identified as being transgendered. These are very similar results as reported in several other surveys since 2006 and can be considered a good estimate of the general population of the U.S. These surveys have a much higher degree of internal validity and reliability of the findings.

It is a more difficult task to ascertain how the culture perceives transgendered people. There are several ways of coming up with a general idea. One can look at how transgendered people are portrayed in the media such as in movies and television. Another way is to look at how transgendered people are portrayed in news sources. A third is to look at the programming presented at transgender conferences.

Curious to me, is the image that Jerry Springer provides on his television show. I'm also surprised that someone as strongly identified with liberal politics gets away with the way transgendered people are portrayed on his show and that he is so revered by the left. He regularly brings on the worst examples of transgendered people in our society. If one watches his show, one would draw the conclusion that transgendered people are promiscuous, adulterous, drug addicted and essentially shiftless people who engage in outrageous low life behavior. I do not dismiss the thought that at least some of what he portrays is staged, but I also think that some of the people he has on the show are real people. How Springer gets a pass on this from the transgender community is beyond me, but I see more far more attacks on conservatives who make negative comments about transgendered people and I can't ever recall anyone complaining about Springer. Yet he damages the image of transgendered people tremendously. Why is that? I wonder...

Another problem I see is very complicated and is a conundrum with no easy solution. We have a very high rate of suicide attempts, unemployment, addiction and alcoholism. Those of us who have been disenfranchised by lacking an education because of dropping out of school are also often marginalized and often end up working in the sex trades. I was very fortunate that despite being physically and emotionally abused in school for a significant portion of my high school years that I was able to endure that and later a brief period of homelessness (directly related to being who I am) and manage to overcome those experiences. I was fortunate to have overcome these experiences and I know that it was only by the grace of God that this happened. The majority of transgendered people are also people of color and in addition to the burden of institutionalized racism, bear the stigma of being transgendered.

Having said this, I clearly want to say this is not an attempt to "blame the victim". People do what they do to cope with being stigmatized. Transgendered people don’t have the same access to the opportunities that people who are not transgendered have and they experience a much higher rate of being victimized physically, emotionally and sexually.

 Remember, when you were in grade school on "career day" and the teacher asked the classroom "What do you want to be when you grow up? No one is raising their hands and waving them wildly exclaiming" I want to be an alcoholic and addict when I grow up!!" or "I want to prostitute myself when I grow up!!!!!"

But we do have a responsibility to overcome the illness of addiction with treatment and 12 step programs, seek help for mental health disorders such as anxiety, depression and post-traumatic stress disorder. We do not have the luxury of just rolling over and giving up, as tempting as that may seem at times.

I looked at the content of workshops offered in recent years at transgender conferences as a way to understand how we are portraying ourselves to the public. I'm not sure that this is a way of discovering what the public's perceptions are, but based on the percentage of workshop programming devoted to gender queers. I do know that they are a very vocal and public image of the "transgender community", much as drag queens and kings" draw a lot of attention and possibly could be a strong influence on the perceived image we have by the predominant culture.

 Another element that influences the public image of transgendered people is something that I have seen decried frequently in our community. That is the tendency for transsexuals who have successfully transitioned to end their involvement in the transgendered community. Their attachment to the broader transgender community is often more tenuous than other transgendered people. They are often criticized harshly for not "giving back" to other transgendered people who are coming along and finding their own way on the long and winding road of successfully transitioning. Because they "disappear" into the predominant culture, the public has little context for these individuals in our society and this further skews the public perception of transsexuals (as opposed to transgendered individuals not including transsexuals). While this is ultimately the goal of most transsexuals, it is not necessarily what is desired by other transgendered people who have a strong attachment to the transgender culture.

My interpretation of what this represents is that the majority of transsexuals do not identify with other people considered to be transgendered and they do not share the same sense of community with drag kings and queens, cross dressers, gender queers, and other diverse identities that consider themselves members of the transgendered community.

In my opinion, a transsexual who has managed to transition and does not wish to continue being involved in the community has every right to do so. She does not owe the community or others coming behind her anything. Her sole responsibility is to herself. In the words of Oprah Winfrey “… to live your best life...”

Because of my profession and my experiences as a transsexual, I will remain active in the transgendered community to a large degree to help individuals with their transition and in overcoming addictions and mental health issues that we all too frequently have. This is a choice I make voluntarily as a professional, not a personal responsibility. This necessarily means that I will have less privacy about my identity than I desire, but because of my special set of skills I will continue to make my skills available to the transgender community.

These are just my observations. What do you think is the image of the transgendered community and what are the reasons for this? I'm very interested in your opinions and I hope you will share them!