Further Along....... using the Myers- Briggs Inventory

Since my early thirties, I have been interested in the Myers-Briggs Type Indictor. This is a personality assessment tool that has been established to be an accurate representation of a personality in a way that is helpful and non pathologizing. It has a high level of validity and reliability (for all you psychometric aficionados). It's theoretical foundation is in Jungian psychology. The assessment tool measures personality across 4 dimensions: Introversion vs Extroversion; Intuitive vs Sensing; Thinking vs Feeling and Judging vs Feeling. This yields 16 personality types as described below:

ISTJ

Quiet, serious, earn success by thoroughness and dependability. Practical, matter-of-fact, realistic, and responsible. Decide logically what should be done and work toward it steadily, regardless of distractions. Take pleasure in making everything orderly and organized - their work, their home, their life. Value traditions and loyalty.

ISFJ

Quiet, friendly, responsible, and conscientious. Committed and steady in meeting their obligations. Thorough, painstaking, and accurate. Loyal, considerate, notice and remember specifics about people who are important to them, concerned with how others feel. Strive to create an orderly and harmonious environment at work and at home.

INFJ

Seek meaning and connection in ideas, relationships, and material possessions. Want to understand what motivates people and are insightful about others. Conscientious and committed to their firm values. Develop a clear vision about how best to serve the common good. Organized and decisive in implementing their vision.

INTJ

Have original minds and great drive for implementing their ideas and achieving their goals. Quickly see patterns in external events and develop long-range explanatory perspectives. When committed, organize a job and carry it through. Skeptical and independent, have high standards of competence and performance - for themselves and others.

ISTP

Tolerant and flexible, quiet observers until a problem appears, then act quickly to find workable solutions. Analyze what makes things work and readily get through large amounts of data to isolate the core of practical problems. Interested in cause and effect, organize facts using logical principles, value efficiency.

ISFP

Quiet, friendly, sensitive, and kind. Enjoy the present moment, what's going on around them. Like to have their own space and to work within their own time frame. Loyal and committed to their values and to people who are important to them. Dislike disagreements and conflicts, do not force their opinions or values on others.

INFP

Idealistic, loyal to their values and to people who are important to them. Want an external life that is congruent with their values. Curious, quick to see possibilities, can be catalysts for implementing ideas. Seek to understand people and to help them fulfill their potential. Adaptable, flexible, and accepting unless a value is threatened.

INTP

Seek to develop logical explanations for everything that interests them. Theoretical and abstract, interested more in ideas than in social interaction. Quiet, contained, flexible, and adaptable. Have unusual ability to focus in depth to solve problems in their area of interest. Skeptical, sometimes critical, always analytical.

ESTP

Flexible and tolerant, they take a pragmatic approach focused on immediate results. Theories and conceptual explanations bore them - they want to act energetically to solve the problem. Focus on the here-and-now, spontaneous, enjoy each moment that they can be active with others. Enjoy material comforts and style. Learn best through doing.

ESFP

Outgoing, friendly, and accepting. Exuberant lovers of life, people, and material comforts. Enjoy working with others to make things happen. Bring common sense and a realistic approach to their work, and make work fun. Flexible and spontaneous, adapt readily to new people and environments. Learn best by trying a new skill with other people.

ENFP

Warmly enthusiastic and imaginative. See life as full of possibilities. Make connections between events and information very quickly, and confidently proceed based on the patterns they see. Want a lot of affirmation from others, and readily give appreciation and support. Spontaneous and flexible, often rely on their ability to improvise and their verbal fluency.

ENTP

Quick, ingenious, stimulating, alert, and outspoken. Resourceful in solving new and challenging problems. Adept at generating conceptual possibilities and then analyzing them strategically. Good at reading other people. Bored by routine, will seldom do the same thing the same way, apt to turn to one new interest after another.

ESTJ

Practical, realistic, matter-of-fact. Decisive, quickly move to implement decisions. Organize projects and people to get things done, focus on getting results in the most efficient way possible. Take care of routine details. Have a clear set of logical standards, systematically follow them and want others to also. Forceful in implementing their plans.

ESFJ

Warmhearted, conscientious, and cooperative. Want harmony in their environment, work with determination to establish it. Like to work with others to complete tasks accurately and on time. Loyal, follow through even in small matters. Notice what others need in their day-by-day lives and try to provide it. Want to be appreciated for who they are and for what they contribute.

ENFJ

Warm, empathetic, responsive, and responsible. Highly attuned to the emotions, needs, and motivations of others. Find potential in everyone, want to help others fulfill their potential. May act as catalysts for individual and group growth. Loyal, responsive to praise and criticism. Sociable, facilitate others in a group, and provide inspiring leadership.

ENTJ

Frank, decisive, assume leadership readily. Quickly see illogical and inefficient procedures and policies, develop and implement comprehensive systems to solve organizational problems. Enjoy long-term planning and goal setting. Usually well informed, well read, enjoy expanding their knowledge and passing it on to others. Forceful in presenting their ideas.

Excerpted from Introduction to Type® by Isabel Briggs Myers published by CPP.

Over the years, I have taken the test over and over and was impressed with the stability of the results. My profile was almost always ISTP. Once in a great while I would test out as as INTP because the sensing vs. intuitive aspects of my personality are fairly well balanced, but overall most often I would have a profile of ISTP.

Imagine how surprised I was to take this test again for the gazillionth time only to find a major shift in my personality type! I tested out as an INFJ. What could account for such a significant (in my opinion anyway) shift? I'm wondering if it may be due to being on a feminizing hormone regimen and after so many years that it contributed to a shift in my personality. The other thing I might attribute it to is being more comfortable in all aspects of my life since my transition to living as a woman in my true identity which gave my true personality the chance to shine through. I don't know but I would love to hear the thoughts of my readers about this.

Do It Yourself Hormones: Is this a good idea?

I had a nice discussion with a lovely woman from Florida who came to my workshop at Southern Comfort two weeks ago. She had been on do it yourself hormones for awhile, stopped taking them and went back on them, but after she heard my comments, she changed her mind and was going to look into getting prescriptions and medical monitoring of her hormones.

I am someone who is not an advocate of doing it yourself, also sometimes known as D-I-Y. But I am also someone who has tried do it yourself, albeit a long time ago and it was only for about 3 or 4 months. I hope that this article will help people to reconsider the D-I-Y route and seek medical supervision.

My personal adventure with D-I-Y does not contain a horror story and I am not going to paint dire pictures of certain doom, illness or death, but there are potentially serious health complication that the D-I-Y person should be aware of and at least take some reasonable steps to minimize the potential for harm that exists with D-I-Y.

I have said before and I will say again, hormones are not playthings. Misuse of hormones can lead to heart, kidney and liver damage. They have the potential to raise blood pressure and cause heart attacks and strokes or fatal embolisms. Some people are not candidates for HRT because of other pre existing serious heart problems.

One of the most serious problems is that the pharmacies that one can obtain these hormones from do not require prescriptions. There is no guarantee that the drug you have purchased was manufactured with adequate standards to insure that the two milligram estradiol tablet actually contains 2 mg of estrogen. It may contain 2.5 mg or it might not even contain 1 full mg if estradiol. You just don't know what you are really getting. When you get a perscription filled, you are buying hormones that have been manufactured under rigorous standards and can feel safe that you are actually getting what you expect to be getting.

Many people who do it themselves ignore the need for regular blood testing every 6 months. This is important for many reasons. One reason is this is how physicians determine that your organs are not being negatively impacted by what you are taking. It confirms that you are getting proper amounts of hormones so that you can get the most benefit from taking them. You just might not be getting the serum levels of hormones up to where they should be in order to be most effective! It allows you to be aware of your cholesterol levels which can affect your heart and arteries and your liver. Adjustments can be made with other drugs, you don't necessarily have to cut back or eliminate HRT with this information if things aren't in balance.

One of the many reasons people don't go to their personal physician is because they continue to experience guilt and shame over experiencing gender dysphoria. That is something that occurs frequently and needs to be addressed, I've been there. I had literally had an old country doctor who was getting near retirement. My own guilt and shame at the time prevented me from going to him and telling him about myself. My solution was to ask my gynecologist to refer me to a female doctor as I'm not keen on having men seeing my body. So now I have a female primary care doctor who I can go to and talk to without feeling ashamed of myself. Whatever you have to do to get rid of the guilt and shame to have a health care provider you trust, please do it. You deserve nothing less than quality health care!

Another thing to consider is that you may be paying way over what you should for those black market hormones. Did you know that a prescription for 90 days of the maximum therapeutic dose of estradiol is $36.00 (U.S.) at Walmart, Kmart, Kroger or Martins for example of stores in my area? That's $12 dollars a month! That's dirt cheap. Most insurance companies' co pays would be higher than that. So isn't it worth dealing with your fears to find a competent practitioner you can trust? Then you know you are getting what you are supposed to be getting. How much is Spironolactone? $18.00 for 90 days at the recommended highest dose. Some of us take progesterone and there is some debate whether it is at all helpful or not in breast development. Generic progesterone is also inexpensive. My gynecologist prefers Prometrium because it is bioidentical to women's natural progesterone. It is expensive though. The maximum dose runs me a bit over $100.00 a month. In 6 more months I'll make a decision whether this is benefitting me or not in terms of breast development. If after 18 months on it and the results aren't that much, I'll likely discontinue it.

"Sherri, you don't get it, do you? I live in BFE (that is a remote place in Egypt). There is no doctor where I live who I can trust to go to or is willing  to prescribe HRT. I know this for a fact because I have called around."

Ok fair enough, not all health care professionals are as enlightened as I am or as enlightened as the ones who take care of me. I'll grant you that.

At least, go get your blood work done every six months, Please, please, PLEASE! get your liver and kidney functions tested and cholesterol too, even if you choose not to tell the doctor you are doing it on your own. We have a term for that. It's called HARM REDUCTION.

Speaking of harm reduction, being a member of WPATH, we strongly advocate harm reduction. What does that mean? It means that anyone who comes to see me on DIY hormones goes to the head of the class. I issue a letter of referral and give my patient the names of two, soon to be three doctors in my area who are willing to prescribe HRT for trans people. I give this letter on the second visit.  Harm reduction is the overriding principle and it is a principle supported by the WPATH standards of care. I want my patients to be safe!

Please consider these thoughts when you decide whether you decide to go see a doctor or do it yourself. You only get one shot at HRT and it has to be done right so that all we have to endure pays off on our journey to be who we truly are! What good is it, if one ruins her health on the journey?

Trans Conventions: Why Should You Go to One?

Each year, there are opportunities to attend one or more trans conferences around the country. As time has gone by, there are more and more conferences available to attend regionally, providing opportunities to learn more about ourselves, meet people like ourselves, have fun and find out about options for medical and aesthetic care. At some conventions there are also continuing education tracks available to educate professionals such as myself. We are taking the responsibility for finding professionals who can educate other professionals who are interested in helping us and providing these important opportunities. I have both given workshops to other professionals and received a substantial amount of continuing education over the past two years. That has allowed me to solely focus on studying sanctioned curricula by my profession and teach to other professionals. Because of these opportunities, I have completed 73 hours of continuing education in the last two years on top of the self directed studies that I have been engaging in over the past 16 years. That is equivalent to 4.5 semester hours in a graduate program.



Since 2009, I have been attending conferences to offer workshops on the history of mental health treatment of transsexualism and what is the present state of the art in transgender care. I do my best to provide education to other professionals and seek out the best education opportunities that I can find, as well as unravel the misconceptions about the WPATH Standard of Care, and myths that abound in the gender community to the members of our community.

I have not been to all the conferences available to go to, but have been going to Southern Comfort Conference each year. Southern Comfort is the largest conference I have attended and is one of the longest running and largest conferences in the U.S. This year will be my fourth time presenting a workshop there. This conference is the most dear to me because Southern Comfort gave me my first opportunity to present a workshop on my area of specialization.



 I have given a workshop at the Trans Philadelphia Health Conference, which is the largest health conference in the world on the topic of transgender care and last year chaired the mental health workshop selection committee for this conference. I have also attended the Keystone Conference in Harrisburg, Pa., TransOhio Conference in Columbus, and Chicago Be- All and I have to say, I have enjoyed them all. Besides the opportunity to give or get these educational opportunities, I have treasured the friendships I have made at the conferences and the opportunity to spend time with many wonderful friends that I have across the nation thanks to the Internet and through the past four years that I have been a member of Pink Essence. I attended five conferences last year.

What can you expect at these conferences? Be prepared to meet all sorts of people from every walk of life and from all over the U.S. It is not unusual to meet people from all over the U.S.



You will have an opportunity to attend workshops on various topics that include counseling, etiquette, how to move in a feminine manner, fashion styling, medical health issues such as hormone regimens, aesthetic and gender reassignment surgeries, voice therapy, how to transition at work, improving family and spousal relationships, sexuality, spirituality, substance abuse, laser and electrolysis hair removal, legal issues in identity management, advocacy and participating in the legislative process. There are many more topics too. If you are a female to male transperson, there are plenty of topics for you too!

Just as importantly there is time for FUN!! Usually there will be organized activities and excursions to see local points of interest, to shop, and get pampered in salons.



The conferences provide special attention to first time attendees, so they will not feel frightened. For some, this will be the first time she will have had to be in public and this can be very overwhelming. Some conferences will offer a "big sister or big brother" to help first time attendees. There are sad stories about people coming for their first time who were too afraid to even come out of their room and hid the whole time they were there. Often there are 12 step meetings available for our recovering brothers and sisters.

An illustration of the important role conferences play in some of our lives can be seen frequently on the last night. You will see many people who stay up all night that last night with friends who they wont get to see for another year. Most poignant is watching those who are sad that they will not have an opportunity to express who they truly are for another full year. They look so forlorn, it is heartbreaking. That is exactly how important these conferences are.

If for no other reason, this is an opportunity to learn more about yourself and sometimes you will learn a little bit about other people, different from yourself, but in some ways the same.

I hope to see those of you who I have met and meet many of you I have only met through the Internet this year!

The Long and Winding Road: After the Bell Goes Off

Many of us go through life sitting on the fence about transitioning for years        before we do it. We know who we are, we just aren't sure what we want and/ or need to do about it.

 As Bob Dylan wrote, "Some of us turn off the lights and we live in the moonlight shooting by. Some of us scare ourselves to death in the dark to be where the angels fly..." There are those of us who desperately know what they want, but are so filled with fear over what the implications of recognizing their transsexuality means and what is necessary to resolve the situation that they are paralyzed and live in a state of denial for many years, only to realize much later in life what they must do. Many among us call that "The bell rang or the bell went off". There are those of us for who the bell rang immediately when they realized their female identity and plunge ahead. For some of those people, they intuitively made the right choice. Then there are those who jump in only to find somewhere down the road that they made all the wrong decisions. So they took steps that are irreversible and live with painful regrets. This isn't to say they don't have a feminine identity, but for various reasons they conclude they made a terrible mistake and might not be transsexual.
Various studies indicate that the vast majority of us will never have GRS. The reasons are myriad. Some will never be able to come up with the money and will live in that in between state for the rest of their lives. Others simply have commitments that mean more to them than having GRS, though they dearly desire to be complete. Then there are those whose health is too poor to undergo these procedures, and there are as many reasons true transsexuals cannot fully transition as there are those who choose not to or are unable, too numerous to name here.
Years ago, in my internet searches about information that I could use to help myself, I came across an article written by an anonymous woman who has gone through transition and GRS. I'm not sure I agree with every single thing she said, but from my own personal experience and of the transgender people I've treated or met, I think that there is much wisdom in her article. It is quite lengthy. She makes the point that you either are a woman or you are not. That isn't the question though. The question is: Did your bell go off? I think that is an important insight. If your bell hasn't rung, she believes you should not transition and if it has gone off you will have no choice.
I remember vividly the day my bell rang. It wasn't, as the anonymous author notes, a joyous occasion. My life had been dedicated to not having to do this and I gave it one hell of a shot. I can look back at my football career. When I was 13 I went to preseason practices with the varsity and practiced with them until the J.V.'s started after school began. I got the living hell beat out of me until my freshman year when I lettered on the varsity team the first time, the only one in my class who played on the varsity team. From my sophmore year on, I started both ways on offense and defense. It was great cover for me, or so I pretended.
 Later, I would go on to rock climbing, caving, and I even rode a bull several times. That was nothing but sheer stupidity trying to deny who I am and live that man's life. I lived wrecklessly and honestly should have been killed on at least 5 occasions. I lost my first marriage over this when it didn't go away as I had hoped. I, like so many others thought getting married would make it all go away.
On the day my bell rang, I had been treating transsexuals for 13 years. My thinking was, if I can't do this myself, at least I can help others so they wouldn't suffer any longer as we so often do and live their lives authentically, if that was their right path. Seven years earlier, my dear friend Gianna Israel who is no longer with us wrote me a referral letter for HRT but I didn't use it at the time. I wanted to get on hormones, but the bell hadn't rung yet. I knew it would come, though.  I had returned to therapy and my transsexualism was the reason for my return. I needed to figure out where I was going with all this. Six months into therapy, my bell rang and it rang loudly. I gathered my courage and called the gynecologist I have been referring to since my first male to female patient. I had been referring to her for all of those thirteen years and she was one of the biggest supporters of the work I was doing. I took three days after deciding I wanted to go on HRT to screw up my courage and then I called her. I vividly remember blurting out to her "Melinda, I just can't do this any more, I need your help." She had no idea that I was a transsexual myself, but she is very compassionate and told me, of course she would help. Then I had to go home and tell the person I love more than anyone or anything, more than life itself, what I had decided to do and what I had done about it. Our lives together have never been the same. That is the point of the writer's book.  There will be losses and some will be very painful losses. Be darn sure you are a transsexual before you make the decision to transition . You may possibly lose everything you hold dear. If you are a transsexual, it will be extremely difficult to transition and extremely difficult emotionally not to transition. There seem to be no winners here, at least in the short term to mid term. Recently, I made the comment to Dana, my own therapist, that I was every wife's nightmare. She's heard me make this statement several times and this time she said, "No you aren't. {your wife} loves you and is staying with you. Don't you know any other couples that stay together?" Yes, I do. Besides myself, I know my friend Christina and her wife are successfully working this through, not that it is very easy. I also thought of Christen and Nikki off the top of my head during that session. So, we are not every wife's nightmare.
 I do see a lot of happier women who undertake this rite of passage and successfully transition, but it seems to take a long time to get there from what I can see. Those who do survive the losses and the transition generally tell me they have some improved sense of peace and sense of self as complete and a better quality of life but they always seem to have a bittersweet quality to their lives as well. Others I have known have not fared so well at all.
Here's the link; it's worth the time it take to read it. As I said, I don't agree with all of it, but I think most of it rings true. It's something everyone who is seriously contemplating should read and reflect upon.

http://www.tgchatroom.com/wiki/index.php/So_You_Want_To_Be_a_T-Girl

To Your Health!

One of the more important things that I am both personally and professionally concerned with is the status of our overall well being. It worries me that we don't pay enough attention to our general health and worry most about getting HRT and the surgeries that we want to feel complete. Many of us ignore our health towards this goal by obtaining black market hormones off the street or from pharmacies that sell on line that don't even require a prescription. We don't really know what we are getting from these sources, but the imperative to move our bodies towards a better fit with our minds allows us to take risks risks with our health we would never consider doing otherwise regarding the rest of our health care. It is not entirely our fault, but we share some of the responsibility for this conundrum.

It has been notoriously difficult to find therapists, physicians and other health care providers to provide the care we need, yet more and more health care professionals are willing to treat us and more and more insurance companies are willing to pay for some, if not all of our health care needs on a parity to that comparable with other diagnoses. Many health care systems offer financial assistance based on income. There are also free clinics in many communities that offer health care to those who work, have no insurance and are of limited income. 

When I began working with transsexuals, way before I ever considered that it would be possible for me to transition, I was the only therapist who provided transgender care for the greater part of Virginia. I had one resource for a physician who provided HRT for my male to female patients. I had no resources for my female to male patients, but I had never encountered one until the last 4 years and I was able to find a doctor willing to provide his care.

Today I have developed resources for my patients that include the psychotherapy I provide, substance abuse treatment, treatment for co occurring mental health problems and second letter evaluations (psychiatry), primary care, endocrinology, aesthetic dermatology and voice therapy. Generally, we think of male to female people benefiting from voice therapy, but female to male people can benefit from this service as well. That is because communication within our gender identity does not only include the pitch, tone and inflection, of our voices, but it also includes non verbal communication such as gestures and body movement.

For whatever reason, even if you decide to go the DIYS (do it yourself) HRT route, there are some things that are absolutely necessary and should not be neglected.Please do these to maintain your good health!

1. Blood work: We need to have some blood work done twice a year when first beginning hormone reassignment therapy and after full induction, at least once a year. These tests include a metabolic panel to check the functioning of your organs. The liver and kidneys are particularly stressed by hormone therapy. Having a lipid panel is important as well because hormones can elevate cholesterol and raise the risk of coronary artery disease.

2. Depression, anxiety and substance abuse: These problems are epidemic in our community and we have an overall suicide rate of 41% of those who have attempted suicide at least once. People of color have a much higher rate of attempted suicide than that reported overall.

3. Substance abuse is a particularly severe problem for us and exacerbates depression and anxiety and is often a huge factor in attempted suicides. It has been difficult for us to find substance abuse treatment that is sensitive to us as individuals, but this has been an emphasised area for improvement among substance abuse treatment professionals. This problem is taking too many good brothers and sisters away from us. It is so unnecessary too. There are 12 step programs available. They work for more people than anything else. Check out Alcoholics Anonymous   or Narcotics Anonymous

   . Click on these links to find a meeting near you! http://aa.org/ or http://na.org/ . Some of the groups in some localities are for GLBT people specifically, if you don't feel comfortable with another type of meeting, but if there aren't any of those type meetings available in your area, please don't make that the excuse to not get the help you need. It is truly a matter of life and death.

4. Don't forget your annual mammography! While we generally have a lower rate of breast cancer than genetic women, we are at higher risk with family histories of our moms, sisters and aunts having had breast cancer, especially if they had one of the mutations that cause the more aggressive breast cancers. It is really a painless procedure and will be a life saver. Then there are a couple of tests that we hate as a reminder of having a body we felt was wrong for us. We still have to have the digital examination of our prostate glands. While the risk is reduced, we still are at risk for prostate cancer as we age, even though estrogen and progesterone are treatments used to slow the growth of prostate cancer. We also need to have the PSA blood test done on a yearly basis.

For the guys, it is important to continue to get that pelvic regularly along with a pap smear, and even if you have had a hysterectomy and oopherectomy, you will still need that done periodically, perhaps not as often.

5. See your dermatologist once a year, especially if you have had heavy sun exposure or have a history of skin cancer in your family. It is imperative that you do this yearly if you have has any relatives who had malignant melanoma. This is an extremely dangerous skin cancer and it is too often the case that when it is finally found, it is often too advanced to be successfully treated.

6. See your dentist twice a year! People who are able to keep their own teeth are healthier and live longer. Poor dental health can often lead to heart disease.

7. Don't smoke! It is the most difficult of all addictions to overcome, but it can be done! Smoking is a deceptive addiction, because it doesn't kill you as quickly as some other addictions, but the long term health consequences are devastating and are well known.

8. If you use alcohol, please use it in moderation. Alcohol in any quantity has negative effects on every tissue and organ in the body and is one of the more deadly addictions. Alcohol causes many ruined relationships and injuries due to accidents as well as fatalities. Know when you have had too much and don't be too proud to ask for someone else to drive or take you home. There is no shame in that and it may save some one's life if not your very own life.

9. Get some exercise daily! Even if you can just take 30 minutes and go for a brisk walk, it will improve your overall health as well as cardiac health. It will help you with weight control as well.

10. Be sure to laugh every day! Enjoying humor has been known to benefit general health and one's outlook. Cultivate a positive attitude. It is part of being healthy and attracting positive people. It will be part of being successful and happy in your own life. Smile! positive people are attracted to people who smile and are interested in their well being too.

11. Do something for someone else. It is good for one's outlook and overall attitude to do something nice for someone else. It doesn't have to be anything big, just look for that little opportunity to do something special to help someone else. The return will be ten times what it took to do that little helpful or kind thing!

I hope that you all have a happy and healthy 2012!