Remembering Gianna Israel

Did you know Gianna Israel? She was one of the most remarkable women I've ever met. I met Gianna before she met me, reading her columns in Transgender Tapestry. What she was writing about us and our lives was better than anything else I was reading about overcoming our struggles and how to overcome them, keep the people we love in our lives and to be happier in our affirmed gender.

I sent her an email and to my surprise and joy, she answered back. This was in 1996. I never think that people who have accomplished so much will have time to spend on me. I'm always wrong about that. Happens every time. Now, in some ways that is a pretty sad comment on how I feel about myself at times, but on the other hand, imagine how happy I am when someone of her stature writes back to me and even better, we become friends! That's the part I mainly end up thinking about.

Gianna and I wrote back and forth, then we started calling each other on the phone from time to time. I'll always remember her wonderfully hilarious sense of humor; once she had been complaining to me about her little dog, a Yorkie, for a while. Her dog was lavishing her affections on her roommate and ignoring Gianna, much to her disgust. She used to refer to that dog as "that farm animal" and was always talking about getting rid of it and getting another dog. I about rolled on the floor laughing the first time she called her a farm animal, and after that I always had to get updates on the farm animal!

 One day she sent me a picture of the dog over the internet labeled "farm animal. jpg. When I opened it, there was this little dog sitting on the roasting pan in the oven surrounded by potatoes, onions and carrots looking at the camera with her little bright eyes and a doggie smile on her face! I just about died laughing and still laugh when I think about it today.
Another time I had been complaining about how long it took to shave my legs and body. She said she had something that really helped her speed up the process and sent me this picture of a disposable razor with three heads! She was just about the funniest woman I ever met.

As our friendship grew, we would call each other once or twice a month between our emails and I would call upon her to consult with me on my transgender patients when I had just started working with others, or just for some nice girl talk.

As a professional courtesy, she did my evaluation for HRT, but I didn't use it until 2006 due to my own fear and indecisiveness about whether to transition or not. I kept the letter all these years and used it for the doctor I was going to see originally, who I have been referring to over the past 15 years. I have that letter in my scrap book I am making and I cherish it.

What was the most interesting thing about Gianna, was that even though she had been a throw away transsexual street kid and never even earned her G.E.D., she was highly self educated and was one of the best gender scholars I have ever known. She wrote and edited the book Transgender Care as the principle author with Donald Tarver M.D. The book discusses in depth how to provide quality comprehensive services for transsexuals and proposed revisions and additional recommendations that informed the American Psychiatric Association and the World Professional Association of Transgender Health of which she was a member, (At the time of the publication of her book, this organization was still known as The Harry Benjamin Gender Dysphoria Association) on revisions to enhance the quality of lives for people uncomfortable with their assigned birth gender.

But what I admired most about Gianna was that she had the most remarkably kind attitude and love for life despite having been thrown out on the streets as a very young teenager, having to cope with a seizure disorder and was suffering from AIDS. She eventually succumbed to neurological complications while writing and editing another book on treating transgendered people that I was supposed to write a chapter for on family preservation.

When we lost Gianna on February 22nd, 2004, we lost a bright shining light of love and hope in our community. In my own little way, to honor her presence in my life and that I may never forget how much she meant to me as a friend, I still keep her name and phone number on my cell phone as it gives me a reminder of who she was and of our friendship.

I'm Back From Southern Comfort Conference: Reflections and Observations

I'm home again from the Southern Comfort Conference. Well, actually I came home a week ago last week on Sunday. I was quite tired, had to work the next day and I've gone to bed fairly early each night until last night night when the Gods of Football television decreed that the University of Alabama begin their game at 9:15 P.M. local time, so I find myself tired again this morning and did not participate in my intentional community's service. Perhaps I will get back on track with that next week. I hope so, as I always feel better for having attended.

As always, I truly enjoyed my time at the conference. The Crowne Plaza Ravinia in the Perimeter area of Atlanta is simply a gorgeous venue and conveniently located across from a very nice mall and several very fine restaurants. Other shopping is convenient as well in the area and you won't get lost.

My workshop was well received and I'm always both flattered and humbled that people enjoy my presentation and I always give an historical context for the present state of the WPATH standards of care, as well as what the standards actually do state. There is a lot of myth about the standards of care that continues to abound. It confuses both people who are wanting to approach a transition and be healthy, and puts so many people off who resort to illegal sources to obtain hormones for a number of reasons. I'll be writing more on this topic next time.

Chloe Prince had a reception for Pink Essence members which was well attended and very lovely. She announced that she is launching a new web enterprise called TrueEssence.org. It's purpose is to be a one stop website to help people find the various resources we all need on our gender journey. This is a much needed service to our community and I wish her all the success in the world with this venture!

I didn't attend many workshops myself this time. Many of the topics I've heard on a number of occasions. This is not to say I am above it all or that there isn't more to learn, because there is always more to learn and I need to stay current so that I can help others better and for my own needs at this late time in my transition. I attended a workshop on transitioning in the workplace that was excellent and got a few ideas about better ways to go about taking this up with the workplace administration. The other workshops I attended were on sexuality for the male to female transsexual taking hormones and one on coping with and resolving internalized transphobia. That is a very important topic as even those of us have dealt mostly with coming to terms about who we are and coming to terms with the people in our lives, can sometimes feel a degree of doubt or guilt and shame creep into the back of our minds. Resolving internalized transphobia isn't like completing a contest, or arriving at a destination, just like the process of transitioning, it is a journey.

My purpose this time, besides the main purpose of presenting my workshop, was to get some time to destress from my practice of psychotherapy which has been very busy and undergoing a lot of changes with the changes coming with the new health care systems. I wanted to get a massage for a back problem and for the holistic health benefits from a therapeutic massage. So the good news is that I got my back straightened out after almost a month and I was able to return to playing golf this week. I played twice in fact! On Thursday I played 9 holes with a friend after work and then yesterday I played 18 holes by myself. I played well for my level of skill on both occasions. I'm playing on a course I've never played before this Wednesday afternoon that is rated #36  in difficulty in the United States. I'm pretty sure I will stink it up, but I never take the game seriously, don't get angry when I don't play well and generally have a fun time and get rid of my stress.

Another purpose was to network with other psychotherapists, gender surgeons, and other allied health care professionals who I know. I took the opportunity to meet some other professionals I hadn't met before.

Then of course one of the biggest reasons is to see old friends I don't to see more than a few times a year and some I only see once a year. Wonderful people and I wish I could see them more often. I have friends like them all over now because of the opportunity to give the workshops in various places.

One of the things I enjoy a great deal is the opportunity to make new friends and each time I go to give a workshop, I meet new friends and look forward to seeing them the next time I'm in their city. That's always a lot of fun for me!

One of the things I reflected on is the debate on gender identities and I recently wrote on that topic here. The article is called The Dialectic of the Gender Continuum. One of the things I wrote mentioned that various gender identities are all valid, though not necessarily having anything in common with each other. Before I went to the conference, I wrote another article about the important role conventions such as Southern Comfort play for our communities. Some people I know expressed that they no longer go to these conferences because they feel they have nothing in common with others who have different gender identities. They feel clearly different from people with other gender identities and don't wish to socialize with them. I find that attitude disappointing. While I personally don't feel as if my identity has common elements as a woman of transsexual experience, I don't like the idea that I shouldn't socialize with others because they are different. I think if those who segregate themselves from others with different gender identities were to reflect on this attitude, they might be shocked to realize that that notion is no different from segregation due to racism and that they would not find those attitudes to be attractive within themselves. I'm not going to like every person who identifies as a cross dresser, fetishistic transvestite, transgender, or whichever identity someone may claim, but I am going to like some of them and I would not wish to not have the opportunity to make a new friendship. I've found that I never have enough friends and that all my friends, close or not, have something to offer me or teach me. I'm pretty shy, people wouldn't guess that, but I do like people.

Along this same theme, I heard the attitude shared that many younger people at the conference philosophically don't like the idea of having a gender identity at all. They identify as gender queer or other similar labels and they would deny everyone their own right to a gender identity as male or female in a society of their own design. I find it interesting that they would segregate themselves and impose a societal code that denies others of their own gender identity. You see this theme in much of feminist academic writing and in the presentations these individuals give at workshops. They want to impose the use of new language in the use of pronouns that deny the existence of gender identity. Ironically, these folks seem to be a small proportion of those in the gender community. I can never see myself identifying as anything than "female" or "woman" and would feel oppressed by a society that denies me my own identity, much as these individuals feel oppressed by a society that expects them to have a gender identity of either male or female. I find that rather ironic that they would choose to subject others to the same oppression they seek to be freed from.

I hope that the gender communities will come to accept others with different identities than their own and not feel threatened by those identities that are different than their own, just as we expect the dominant culture to accept us and respect our place in an open and free society. Sometimes I think the dominant culture is way beyond us in acceptance of us when we can't be tolerant of others with different identities in our own community. What do you think?

In Praise of Pink Essence and Social Networking

To rip off old Willie Shakespeare and misquote him, I would like to say that I come here to praise Pink Essence, not to bury it (and other similar transgender social networking websites).

If you are not familiar with Pink Essence or other social networking websites such as URNotAlone, perhaps you might visit one of them and see if you enjoy being a part of an online community specifically for those who are transgendered and those who support them.

I speak specifically of Pink Essence in this article because that is the social networking website that I have been most familiar and I have participated to varying degrees of activity for almost 4 years. UrNotAlone is notable in that it was the first of it's kind and was begun in 1995. There are some others too that I have heard of in passing but I am not really knowledgeable about them.

There are a lot of people who love Pink Essence and those who don't care for it at all. There are members who have been active on the site and remain very involved to this day, those who briefly become members, find it is not their cup of tea and close their membership without ever having much involvement in the activities available and those who were once very active on the site who remain members, though participate almost in a nominal manner. This latter type of member would probably describe me best. Then there are the members who remain very active since they joined to this day.

There are people who vehemently loathe Pink Essence and denegrate it and its creator for various reasons. There are ardent members of the site who seem to devote much or all of their online life to it like some people on Face Book do.

The detractors complain about all sorts of things they don't like and some of them demonize the creator and owner of Pink Essence. Personally, I admire her. She has created something that has been a source of support during a terrifying time for a transgendered person when she comes to terms with who she is after years of either being in denial of herself, or being aware of who she is but living in terror others learn about her. Typically, she has never known anyone like herself or has no where to turn to gain access to support groups or knowlegable allied health care professionals who could be of help to her. Sometimes even when these resources are locally available she may almost be petrified with fear and a site like Pink Essence is her first foray into coping with herself in a healthier manner. This is one of the most important reasons that these sites exist.

In addition to that, Pink Essence also offers ways to express one's opinion on things Trans, non trans, and trans related including chat rooms and blogging. There is a forum on book reviews, on spirituality, on people who have the same career, information on how to contact professionals who help transgender people. There are political discussions and information on real world support groups, social gatherings and transgender conferences where one may meet others on a similiar journey and have the opportunity to speak with many professionals face to face. Most important of all is the opportunity to forge life long friendships like I have with some of the members of Pink Essence. They don't live very close, but they have become some of my dearest friends and I never would have gotten to know them without the presence of Pink Essence on the internet.

Is Pink Essence perfect? Of course not, silly! It has its strengths and its challenges. Some people call them faults, but I think a challenge is something that can be overcome. A fault is something there is no hope to ever change.

Pink Essence is really a big extended family. As in all families, there are squabbles; people get mad at each other and cut each other off emotionally. Sometimes they "kiss and make up" and sometimes they never have anything to do with each other ever again. They become estranged. They adore their "mother" (the website owner and creator) and sometimes they get angry at "mother" because something occurs they don't like.

Personally, while I have had some disagreements with the creator of Pink Essence, just as anyone does in any type of relationship. Most importantly though, I really admire and respect the creator of Pink Essence for what she has created. She has something she created that hasn't just helped people in the U.S., but it has helped people all over the world. I think that is pretty special, don't you?

For a later article I wrote on the potential downside of membership in Pink Essence and other social media websites please follow this link:
http://twoworldstranstherapist.blogspot.com/2014/05/pink-essence-why-i-chose-to-discontinue.html

I would like to again restate, I believe that Chloe Prince created something very positive for transgendered people, but nothing is seldom all good or all bad; it is up to the user of social media to be responsible in educating themselves about the benefits and risks of belonging so social support websites.

Do the Gender Police Confront You?

Sheri Berenbaum led a thought-provoking discussion about the often-debated topic of gender differences. An inquisitive crowd kept Berenbaum on her toes as she answered questions concerning whether gender differences are innate or learned. Drawing on over 15 years of research on congenital gender disorders—and using props such as Legos and make-up kits to illustrate her points—Berenbaum challenged the audience to "think outside the box" about the mix of social and biological factors that make us male or female. Sheri can be found on the web and also at her University, Penn State.

The Gender Police have drawn hard lines on people of my experience. We have the extreme Right who would say our very existence is an abomination and we have the extreme left who insist that we must identify as some blend of gender that is neither wholly male or wholly female. I find one as constraining as the other.

I wonder where it came from that if we were free and perfectly healthy individuals that if we identify as women, we are not respected as women or if we identify as men, we are not respected as men. This is the problem of the extreme Right. We simply want to live our lives and be left alone to the right of privacy as any other American Citizen.

The other side of the equation exists from the extreme fringes of Feminism and is solely an extension of Womens' Studies professor Janice Raymond's ideology. Even today as she rewrote a foreward to her book The Transsexual Empire: The Making of the SheMale.  Even with her new forward, which is a rather shallow apology to transsexual women, she still sees us as victims of a patriarchy. She was unable to and continues to fail to recognize that we are woman who for many different reasons ended up at odds with our assigned gender. The majority of these do not involve obvious anatomical variations. For this reason being politically coerced into a continuum known as "Gender Spectrum" includes vastly different presentations because of vastly different etiologies, makes us pawns in a political struggle between Left and Right.

Interestingly, the most negative people about the realities of our lives both as individuals and in varying collectives include the extreme Right and the Extreme Left.

For one group, our very existence on the earth is anathamema. For the other group, our very right to a unified gender identity is sacriledge. I find both extremes both nullifying simultaneously.

At this time in our culture, very few who wish to fall under the umbrella  of transgender identify as gender queer. They have every right to that identity. It's not my identity. I do not consider them to have the same orientation of gender or have much in common with me other than a political desire to be left alone and become the best me I can be.

Similiarly people who feel a mix of their genders but have no burning urge to match their physical being to their identity, may be known as transgenders, crossdressers or by other labels that they define themselves by, have every right to be left alone and become the best people they can be.

Simply put, I am a woman. This is not a sociological statement, nor is it a political statement. It is who I am. There are more women who were correctly assigned at birth and individuals such as myself who were not, but sought to correct that error. I do not identify as a third gender or a fourth or a fifth. I'm just a woman.

This is a dual journey that I travel. I am the gender therapist and the gender patient, I bring my experience, professional and personal to the therapeutic alliance. All therapists do that. It is somewhat more unique for my patients as I am also someone who has been going through a legitimate process per the standards of care established by the World Professional Association of Transgender Health, a body of which I am proud to me a member.

As many of you know, I have been developing a comprehensive health care system for transgender people in the Shenandoah Valley of Virginia. I have been instrumental in initiating the Speech and Language Department of my health care system to offer voice and communication therapy for transsexuals in order to be able to communicate in a gendered manner that is congruent with our identity.

In announcement to a health care online network, this program was rebuked with a harsh and in my opinion, unwarrented attack. The author of this attack who is a faculty member of a large institution of higher learning, stated that she found it highly offensive that such a program would state that the therapy offered would improve the ability to communicate in a more masculine or feminine style, depending on the preference of the patient. She stated that because of this, she would not wish to refer anyone there for voice therapy.

Personal disclaimer: I was involved in the initiative to develop these services, provided a number of training resources and linked them with other Speech and Language therapy professionals who are members of the World Professional Association of Transgender Health in their field who could be of further help in developing the program that we offer. In my opinion, they have developed a quality program that I myself have participated in and am so more than just comfortable in referring my patients who are interested in these types of services.

What I find to be most outrageous of this experience is the lack of forethought in the reckless condemnation of a service that person has no personal knowlege of, just a blind conviction of an ideology leading to  the same type of rigid results that the extreme right can be accused of (and rightfully so at times).

This is why I always say that I have found as much as bigotry, prejudice and hatred on the far right and the far left.

The issue at hand that I object to is that this person made a judgement that this person knows better for you than you do, therefore would not even grant you the opportunity to decide if this service would be helpful to you or not. Considering the philosophical orientation of this person, I find as much patriarchy in the Third Wave Feminist theory as they railed against in the Second Wave of Feminism. Each wants to control you, just to a different end, but neither will be the one of your own determination.

A pity, isn't it? I've seen absolutely no growth since Janice Raymond. 

Reflections On who Comes to My Blog

I'd like to take a moment to create a sense of community with the people who view this blog. I am always honored that people will take a little time to consider some idea I had and maybe post a comment. Some of the people who view my blog are dear friends and some are visitors I don't know from around the world.

I'm quite interested in the people who read this blog from cultures other than Western cultures. I have had visits from  Central and South America, Middle East, Africa, Asia and the Balkans, along with Eastern Europe and Russia. I often wonder about a very different culture that finds something that is of interest in what I write and how I can communicate better with them, both in asking them to comment and writing in a manner that is more clear. Sometimes I imagine when some of our North American and European visitors might be wondering what I'm talking about too! So, please tell me!

I also wonder about the experiences of our Middle East, Asian and African visitors who are transsexual or have a relationship of any kind with someone who is transsexual. I would love to learn about all of your experiences as well as other cultures represented by my visitors.

Free Falling

It's been a good run. Over 45 years. It all came to an end quite accidentally, when my mother found one of my business cards for my consulting company, Excellence in Transgender Care (E.I.T.C.) that also has my picture and my last name. There was no mistaking that this was me.  She found this on Monday, and called Patty Tuesday to ask about it. She hadn't been able to sleep that night and was crying while she spoke to my wife on Tuesday. Patty reassured her that she and I are fine, that she is OK with me and she knew about me and that I had a lot of support from my own therapist Dana. 

Patty called me at work and told me to sit down, she had bad news for me and told me what had happened. I was not really prepared to hear this, but was able to continue to be professional and see my last three patients, without any clue that I was upset about this development. It was not the way I would have chosen for my parents to find this out about me and, in fact, have been working in my own therapy on how to go about informing them specifically.

This was also Valentines Day. I had brought cards for Patty from me and the dogs and cats (they each sent a card to her), and I had a card from both of us to Mama. Patty suggested I call her and see if she wanted to talk, but I felt that it would be best to do this on the weekend when I could talk to her alone and without my father who suffers from moderate dementia.

I did want to take her the card from us I had gotten and asked Patty to go with me. I waited a bit to settle down and then called and asked if I could bring her card up to her. She began to cry and told me no. So there was an awkward  silence as I was actually quite stunned that she would not just want me to bring her card to her. So I just said goodbye and told her I loved her. She just said "Ok" and I hung up.

My heart was broken of course over this turn of events. In my two worlds, having worked with families of transgender patients for years, I know how often this scenario ends badly, but often it can work out very well too. The key to a positive outcome seems to lie in allowing parents to work out the emotional trauma that comes along with an unexpected discovery. It's so hard for a parent to realize that they thought they knew this child of theirs who they raised and launched and seen their successes and failures in life, only to discover they really didn't know such an important part of who their child is. They wonder if they ever really knew this child at all. Make no mistake, this is a tremendous loss for most parents and they deserve compassion in order to make sense of this and regain the wholeness of their relationship with their child, if at all possible.

Now they begin the grieving process and go through the stages of grief that Elizabeth Kubler- Ross defined in the late 1970's. In her seminal work, she out lines this process as:         

1. Shock and Denial: Sometimes this manifests as a feeling of surrealism or a factual belief that what is happening isn't or that it can't be true.

2. Anger: This can be directed towards the person or situation that created the perception of  loss, whether it is a death, the loss of an ideal, or can just be a feeling about the situation that really isn't attached to any specific aspect that the person can identify.

3. Bargaining: This can be seen in situations where the person attempts to strike a deal in an attempt to make the painful situation go away and is closely related to the denial process.

4. Depression: During this stage, the process involves losing the cherished ideal of someone or of a situation and despair sets in. In this situation, my parents will never see me again as they once had and are experiencing the loss in an exquisitely painful way. Sometimes people are never able to move past this process in their grief.

5. Acceptance: This comes about when the person is able to reconcile themself to this new concept of how things will be from here on out. It is the healing that comes about from moving through this process and being willing to create a new relationship with the person in the situation. Again, some people are never able to achieve this resolution of what has occurred.

We have to be mindful that people will often move back and forth between these stages as a part of their grieving and that is quite normal. Sometimes people skip some stages and others may never even resolve the first state of this process.

We also must be mindful that people resolve their grief not on our time frame, but their own and we need to be sensitive to that.

When one comes out to someone with such a close relationship, especially not at the time and field of our choosing, we also go through this process. It would be nice to be able to say, "Well OK, it's done and over", but that isn't reality for most of us in these situations. We need to find as much support as we can find for ourselves during this time and we need to really do a super job of taking care of ourselves. That means we need to pay careful attention to our nutrition, don't skip meals even if you don't want to eat. If you can't eat very much, please be sure to supplement with vitamins, especially B vitamins, as they are rapidly depleted when one is going through a crisis. Getting the proper rest is crucial and if one isn't able to sleep, I would advise you to seek medical help because if you can't get your sleep hygiene right, nothing else is going to get better very quickly.

One of the things that is helping me is the tremendous outpouring of love and support I am getting from you, my readers and from members of the transgender community across the country. Please know that I am greatly comforted by this and I'm so grateful and also humbled that there are so many people who care about me. I'm also fortunate to have Patty to lean on and my professional friends and colleagues here who know about me at my hospital. I also am getting tremendous Pastoral care from the clergy of my church who are in daily contact, and of course, Dana too.

I am realistic about this situation. It will be resolved one way or another. While my experience is that many times there are sad and even tragic outcomes with family members, there are many many very happy outcomes as well, even though the process to get there seems bleak at times before it works out successfully and I've learned from my practice that this may take a long time to occur.

Although I am in tremendous emotional pain at the moment, I do know that I will be OK and that what ever way this works out, it will be for the best and my life will be better.  That's the thing about my walk through these two worlds; while I am a well seasoned therapist and have worked with people on these situations, having lived it myself makes me an infinitely better psychotherapist, and all my patients will benefit from this experience, not just my transgender patients. It's one of the gifts I'm being given.

Becoming One: Within and Without

This past summer after an extremely moving experience I shared with one of my sisters in small town New Jersey, one Sunday, I discovered a community of intention and have been meeting with them on an ongoing basis. I have made some new friendships that are nurturing and sustaining.

      

                                                                                                                                                                   

Today we met and sought insights as to how we can, as an intentional community, reach out to more people in many more ways. We looked at our strengths and we discussed our challenges to create and realize such a vision.

Over the past several weeks, I have been coming to terms with something from long ago that was never resolved that frustrates me and leaves me confused wondering why it can occupy space in my mental and emotional life sometimes. Not every day and not necessarily all day either, but enough that it bears examination.

One of the things my community does is takes me out of that space and restores my sense of well being, physically, emotionally and spiritually. It does this by allowing me to feel connected to other people who as I get to know, I grow to care about.

These people accept me and want me to be with them, listen to what I say, allow me to listen to them and show that I care too. It has created a space where I don't need to think about gender. I can just be.

Many people speak of feeling less than, or "otherized" as I like to call it; not having a sense of belonging, or of less than equal worth. There is none of that in my community. It is a place I can be me. Simply just be me.

Some of us find ourselves along the way and experience that serenity, some of us don't. I'd argue that this is really what it is about, not a gender identity, male or female or whatever number of genders you may opine to exist. That is not what matters, really. What matters is that one can be who one is, be accepted as one is, without thought or pretense about where you fall on a binary or continuum.

Within ourselves we have to cultivate the level of self acceptance that when someone meets us or when we are a member of a community, we don't worry ourselves to death about the level of acceptance we are experiencing and how we are identified by others or how we identify ourselves.

Instead, in my community, we are focusing on how to strengthen each other as we reach out to be of service and comfort to those who find themselves disenfranchised and seek a hand up. We want that open hand to be there for each other and for those who have need.

These are the more and more frequent things I am experiencing in my life. They are nurturing me and giving me more opportunities to live in service to others, as I have always striven to do my whole life.

My wish for those of you who share a similar life journey, whether it be my walk in two worlds, or one, or even multiples of worlds, is that you too will find more and more experiences in life that allow you to just be in the moment, without thought about who you are or how you think others think about who you are.

                                    

2012 Don't Look Back (They Might Be Gaining on Ya')

Happy New Year everyone!                        

 I hope that no matter how difficult or how wonderful 2011 was, I hope that 2012 brings you all good things this year and to your loved one's as well.

I'm hoping for a much better year and am looking forward to a lot of changes for the good. Many of us make resolutions and plans for positive changes. Generally in years past I have not done much of that. It is the perfect time to make some changes and try to plan and anticipate what might happen in the next twelve months.

To that end, I am thinking of what the year will bring and what I would like to accomplish. I want to work on some health issues and have some medical appointments coming up. Most are not too serious, but it appears that I will need another cervical spine surgery in the near future to remove the plate that was used for my fusion in December of 2010. The first surgery was much more extensive than originally anticipated and was quite successful in relieving my pain. I have had serious difficulty in swallowing since and have had a lot of difficulty with weight loss. I've lost 25 lbs since the surgery. Up until the surgery, I, like most girls, was working on losing weight. Now it is quite a different story as I need to graze to keep my weight stable. This problem is caused either by the presence of the plate or nerve damage to the 10th cranial nerve. I'm hoping the removal of the plate will take care of the problem, but I'm not overly optimistic about it. I dread going through this again so soon (Here is the surgery you get, it's not the surgery you want) more because of it messing up my conference workshop schedule for the year than the surgery itself. I'm going to have to drop two conferences this year which I really hate to do. It will be a hit on my leave time as well. So aside from resolving my swallowing issue, I'm going to ask him to clean up whatever new damage he finds while he is in there. I have developed a problem on the right side of my shoulder, arm and hand.

I'm going to use the time off recouperating to work on the book I am writing on transgender care with the same theme of this blog; a therapist teaching other therapists and relating the transsexual phenomenon from this rare point of view. So that will be a good thing! The other downside to having to have this surgery will probably mean that I will have to delay my GRS and FFS that I wanted to have this coming December.

Other plans in the offing include the possibility of changing employment. I'm contemplating going to work for the Veterans Administration. The VA offers many attractive options for me. They pay significantly more than other mental health employers in the area, a better retirement benefit and an EEO policy that is trans inclusive that was newly implemented by the Obama administration this past year. There is a downside to leaving my present situation. I have been there 10 years and have a well established caseload with many long term patients that I have built a relationship with. Working for  the VA would preclude my continued work with them. Even more difficult for me is to end my work with the most comprehensive transgender health care program offered in Virginia that I created. I would not have the opportunity to help as many transgendered people directly as I do now if I am offered a position with the VA, although they are making great advances in providing treatment for transgendered veterans.

My other plans are more modest and are the kinds of things that most of us do; resolve to get more exercise, do more for others in terms of service work . That's one of the things that bugs me about not going to a couple conferences on my schedule; all the workshops I do are done as service work. I don't seek compensation for giving of my time and knowlege. The friends I have made through these opportunities has been greatly rewarding of itself. I've also resolved not to be such a harsh critic of myself. While there is always room for improvement, I don't really need to as hard on myself as I am at times. Partly, this is the result of being a victim of abuse over a fairly long period of time. One thing I have been working on in the last few years is forgiving the ones who abused me. This is not easily done, but I concluded several years ago that I needed to forgive them, not for them, for myself. For too many years I have carried too much anger with no where to direct it. I've made a lot of progress, there is still work to be done.

The last thing I have resolved is to make this a more fun year! I think that will be the best resolution of all! So what are your plans for 2012?

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!

Little Things Make a Difference in My Life

In daily life, I, like most women like me, sometimes wonder in the back of my head if I'm really being accepted in public as any other woman, or are people reading me as a transwoman and being polite. At this point, I'm very comfortable with daily activities. I go shopping for clothes, go to the grocery store, now have a church I feel comfortable attending and am welcome to be there by congregation. That was a huge milestone for me in my comfort in public as well as in feeling accepted by others.

Over the last three weeks, I have had a couple of experiences that tell me that I am making progress in being seen as just another woman, which is what I see as my goal in the transition process. What has happened is that twice now I have been asked by another woman for assistance. The first time I was on my way into the grocery store and a woman stopped me and asked me if I could look at her receipt from the grocery store. She was concerned that she had paid too much for an item that was on a buy one get one free special. I explained that usually you only get charged half price for one item, but she had been charged a little over half, maybe three quarters. She was asking if I thought she should ask the managers about it, as if she was going to have to pay that much, she would go back and get the second item in that case.

Now being a Social Worker by profession, I just have that natural urge to help people. I guess it's like a pointer who hunts birds (No smart remarks PLEASE!!!! LOL!) So, naturally it gives me a good feeling to be able to do something, even if it is a little thing like that for someone else. But being able to do that little helpful thing gave me so much more. I felt accepted as just another woman!

The day before yesterday, I went to see my doctor for a horrible case of bronchitis I'm dealing with and then had to drop off a prescription. Now Walmart is always a mixed bag for me. On the one hand, I get all my HRT prescriptions there and they cost me a lot less because my insurance doesn't cover it. Two out of three of my prescriptions are on the $4.00 list. Ironically, because my insurance won't cover me for those, I save a dollar on two of them because it's a dollar less than my normal copay! What a little twist that turned out to be, in my favor for once!!

Otherwise, Walmart pharmacy has been a pain to deal with for some other reasons. I really don't like the long lines and the waiting. I also had one of the very few unpleasant experiences there during my transition interacting with their staff at the beginning of my relationship with that pharmacy. But, we got that straightened out and things have been ok with them since then. I can forgive and move on. Still, it's not the most convenient place to get my presciptions.

Dr. Laura Jean had called in my antibiotic to Walmart since it was closest. I was feeling very poorly and knew it would be a little while, so I went grocery shopping. That took about 45 minutes and then I went to Walmart (Here in the sunny south we call it "Walmarts" or if we go to Kmart it's pronounced "Kmarts". I don't know why, it just is!). After the perfunctory long wait, I learned it would be another 45 minutes, so I left and went to Books a Million to hang out.

When I got back, on my way in I noticed a woman in a handicapped parking spot and she was on oxygen. She called out to me and I went over. She was struggling to change out an oxygen bottle. She was literally crammed in her car with all her groceries and I wondered how she would ever get all those groceries into her home without a lot of physically agony from oxygen starvation. She asked me to change out her bottle for her. I told her that I worked in the medical field and knew how to do this. It's pretty easy actually and I've done hundreds of them over the years. So I was able to help her out and she was very grateful for my help.

But it was really me who got the help! I got another affirmation that people look at me as just another woman out there taking care of her daily business. To me, these two women gave me something more than I gave them. They gave me confidence that I can lead a regular life and be seen as who I see myself; another woman leading her life in an ordinary everyday way.