September 14, 2014

Family! Genetics! Reproduction! Surgery! (Or Doubting Tomás And Decision-Making)

There is definitely the perception among most people, including most trans people that you need to do something now and do it all. All of it.

Let me just say that one of the first things that I felt like, coming out again, was this horrible sense of urgency that was not just external. It was a feeling of what have I been doing all these years? I am 30 already!”. My life does feel like part of it has been on hold, waiting for me to get a clue, while I dilly-dallied in a fog of denial, working too hard and crap pseudo-relationships.

For trans women it seems like surgery is the point everyone fixates on (cock or no cock) and for trans men it is hormones (hair and muscles!). Because a transition in the popular view is not necessarily about the person involved, it is about future stealth, dropping out of the category of trans” and conforming to your new” gender category.

A good transition is one that is as easy as possible for others to understand! How inspiring!

To be honest I would take hormones in a heartbeat if it was simple. It is not simple.

This is the biggest rub. I cannot tell my extended family in Sri Lanka.

What a cop-out! I am sure they would get over it and learn new things about gays and trans people!”

That is what people usually say, and it means that they do not really understand. Just to clarify, mainstream modern Sri Lankan culture has no conception of what homosexual or transsexual/transgender people are, other than something awful that foreigners do” (bisexuality or genderqueer would blow their minds). Marriage and reproduction are something that people just do” and their primary purpose is to continue the social order. Yes, love marriages exist but they conform to this social order. You could almost argue that heterosexuality does not exist because the primary purpose of marriage is not necessarily romantic and sexual gratification or self-actualisation.

The extended family is very close in Sri Lanka. There are good and bad things about this. The good thing is that while there is a big chunk that my extended family do not know about me, emotionally we are close and I visit fairly frequently (every two or three years) even on my own. I love them a lot! I do not want to cut them out of my life. The bad thing is that people get over-involved in each others’ lives, fall out and judge each other, often with very limited information.

I do not really care as much if they think I am an awful weird deviant. What I care about is that they would blame my parents for exposing me to evil Western ideas and turning me into a deviant. A selfish deviant no less, since I am not just conforming to the social order anyway. Completely unfair and completely based on a lack of real knowledge and information but also not something that they would necessarily bother to learn about.

It is a completely different mindset. The individual and self-actualisation is not valued as highly as community and family and social order. In some ways people are happier because they have more social support and in some ways they are less happy because they cannot be who they are. I could not have ever lived there, myself.

So here is the question:

Can I take testosterone and still dress in drag for 2-3 weeks every 2-3 years and get away with, if anything, claiming I have a medical condition?

I do not know the answer to that. The men in my family are pretty hairy. If I got body hair (I would, pretty rapidly since PCOS gave me some before I went on the pill) I would get (most of) it removed. Some of the men in my family went bald in their 50s and 60s (eek!). I suspect I would get pretty androgenised pretty quickly. But then again there are plenty of drag queens out there? Would makeup help?

I do not even know anyone who has the answer to those questions.

Another question is about health. I have just finally stopped having abdominal obesity (yay!). I have a pre-diabetic condition (PCOS), I am subcontinental and I have a reasonably strong family history of cardiovascular disease- granted, in a family of smokers with poorly controlled diabetes, dyslipidaemia and hypertension who ate things deep-fried in coconut oil all the time- and supplemental testosterone has recently been implicated in increased cardiovascular risk in population studies. This finding of increased cardiovascular risk is preliminary and further studies will be needed to confirm or deny this, but it is an important thing to consider for me.

There is something kind of compelling about the idea of getting rid of my cancer organs. I guess I should not refer to my breasts, uterus and ovaries as such, but that is what they are! I am not going to bear a child myself. I have had horrible cramps and heavy periods for many years. My ovaries intermittently cause me pain. One part of my extended family probably has the BRCA2 or a similar mutation as almost everyone has had ovarian or breast cancer, though this is very unlikely to involve my part of the family. Some sources imply a higher rate of breast and ovarian cancer in those taking testosterone but there is not enough evidence one way or another. I kind of like my breasts sometimes when I am not looking at myself in a mirror thinking about how girly I look though. Because they have a strange texture like a Japanese pillow, and I could probably balance things on them.

However consider that a bilateral salpingo-oopherectomy and hysterectomy (removal of both ovaries and uterus) is major abdominal surgery, and bilateral mastectomy while a much smaller operation certainly has risks of wound infection, scarring and seroma formation. These are not decisions to be taken lightly. If I were to have my ovaries removed I would have to be on sex hormone supplementation because of the high risk of osteoporosis, something that I am also at risk of as I have both male and female relatives with it.

I guess the final question is about how much testosterone changes a person. You certainly hear some pretty full-on descriptions of what the high testosterone doses do to trans men- mainly related to a very large increase in sexual desire.

Androgenisation, though gradual, seems so irreversible in some ways. It causes hair growth, changes in muscle and bone structure, a deep voice and more. It is the reason that GnRH analogues (pituitary hormones that suppress sex hormone release) are beginning to be more widely prescribed to female-identifying biologically-male adolescents so that they can at least delay their decision-making till adulthood if not commencing oestrogen/progesterone. For trans women it can be pretty challenging because they may want or need to remove as much of the physical signs of androgenisation as possible. It is something I would want to make absolutely sure of if I go down that path in the short term or long term future.

There is a lot of pressure to be gung-ho and to be really sure” about things. How can anyone be 100% sure of these things? I think it is lying to oneself to say that you are sure”. Sometimes you have to take a leap of faith, of course, but I think that should be done knowing that nothing is certain. Nothing.

Maybe as a doctor, a Sri Lankan and the relative of old people with sicknesses I have more doubts than the average person.

Oh well. I am going to take my time. It is not as if 30 years have not passed already.


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Dysphoria I used to tell myself a bunch of excuses for why I would not even consider being actually deep down a guy. I mean look, I would think about it. I