Tag Archives: Health

Let’s talk about the challenges of Phalloplasty

I remember when my partner had come out to me as trans, but before he (or I) had come out to anyone else, I began to share more educational information about trans people on my personal Facebook feed. I had already been running the Facebook page “Lesbians and Feminists Against Transphobia” (now, alas, deceased because I was unable to manage the traffic from the 10,000 people who liked the page). I started to migrate some of the content to my own timeline, in the hopes that people would be somewhat prepared for the forthcoming announcement.

At that point, we were at the “I’m transgender, now what?” stage. Because what we are is not what we do. Robin knew he was a trans man, but the thought of transition is daunting, and there are so many options. Name changes and pronoun changes were some of the possibilities. Medically, one option was just to have chest surgery, one was to take hormones and have chest surgery. We weren’t really going any lower than that just yet. For me, there didn’t seem to be any options for “non-binary transition” (little I knew) so coming out (or not) was really the only option I was considering.

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They say when you go through something big you find out who your friends are. This is true, but you also find out which of your friends are bigots.

This was the point at which we discovered that a (thankfully not close) friend of ours was on her way to becoming a prolific and formidable anti-trans campaigner.

I would post something positive about trans people, this friend would come back with a response about how transitioning makes people suicidal. I posted an article about trans men, she launched into a discussion of the dangers of phalloplasty. She was the ultimate concern troll.

So hung up on how what’s in everyone’s pants should determine the ultimate and unbreakable social order, our friend had assumed trans man = phalloplasty. Which is ludicrous. There are so many different surgical and non-surgical options for trans men because what’s in people’s pants should not socially define them. And nobody should have to go through major surgery in order to gain social acceptance and safety.

But her graphic, alarmist response, also made me terrified of phalloplasty in a way that really was unhelpful, because the reality is some people have lower dysphoria, a sense that there is something missing that they cannot reconcile. And dramatic as surgery is, it makes some people feel whole and okay with themselves in a way that benefits how they are able to be in the world. Which is obviously a win/win, because people who are happy with themselves and their bodies generally make for better citizens, friends, partners, workers, lovers.

Admittedly it’s hard for trans people to be happy with themselves, given what a shitty world this is to trans people (hence the suicide stats), but all the evidence suggests being trans in itself isn’t the problem – but rather barriers to acceptance, support, and being able to transition as we need to. Negativity and barriers just make a hard life harder.

Let’s not pretend we live in a perfect world, and that medicalising trans identities is ideal. It isn’t. The media still very much use language that speaks of a process of transforming a person from woman into man, or vice versa, and our community still talks about someone being “pre-op” or of surgery being something that assigns or affirms gender, as if we need the surgery to make us real.

This is awful, and it has to stop.

At the same time, in a world that places so much social emphasis on what is in a person’s pants, it is impossible to ask trans people to feel okay with what’s down there, even if their dysphoria is not fundamentally physical rather than social. I think this varies from person to person and some trans people admittedly feel a profound, instinctive sense of something missing from their bodies long before it can possibly be the result of socialisation.

Some  trans people will cope with their bodies configured as they are, and some will not. This does not make us more or less transgender, it just means we are not experiencing lower dysphoria to the extent that having surgery will be beneficial to us.

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I was going to talk about how hard phalloplasty in particular is to go through, having just nursed my partner through the first stage. It is exhausting, terrifying, psychologically demanding, and I promise you the gaslighting comments from the anti-trans brigade make things a thousand times worse.

But I don’t need to tell any trans person how big a deal this is. We all know. The idea that well-meaning (concern trolling) cis people need to explain to us the demands of this surgery is infantilising and outrageous. No trans person gets to the point where they are signed off for major abdominal surgery that will leave them with visible scarring without knowing what they are about to undertake. Many trans men go for the slightly more straightforward metoidioplasty, or have no surgery at all, content with the growth they gained from taking testosterone, or just content with how their body is configured.

Most trans guys will follow others in groups or on YouTube and typically for men, no gory detail goes undescribed, including the times things go wrong. And they do. Phalloplasty still has only a 97% success rate and that is a scary thought, that you might go through all of this surgery and end up with nothing but scars. All this is heavy enough to deal with without ignorant creeps making you doubt yourself that it can ever be worth it.

Maybe the societal issue of not talking about men’s health plays a part in how we react to phallo. We know about the gory details but we probably don’t speak enough about what trans men and their supporters go through with this surgery. The months off work, the worry about it failing, the overwhelming stress, the involved care required for a skin graft and several wound sites, the two or three equally complicated follow-up surgeries. Maybe it’s still seen as some sort of “optional extra” and so the pain and magnitude of it is somehow disregarded. But for those who undergo it, I don’t think it really is “optional” but rather integral to their wellbeing.

Maybe I didn’t fully understand that until I saw Robin going through it. How alongside the pain there was something else – a sense of confidence and completion. Of rightness.

And just to be clear, this has nothing to do with sex, or dominance, or any other notions we may have about dick-swinging men. It’s more about walking in the world, about being able to use male toilets more comfortably, about what may happen when he is old and needing personal care. And simply about his relationship with his own body.

It can be worth it. It’s not an easy decision, but the reality is, like any self-awareness, dysphoria once acknowledged can’t just be wished away. Demi-boys like me spend a lot of time hoping that the little niggles of lower dysphoria we swat away will never manifest into something big enough to make surgery feel necessary. Nobody wants to need major surgery. But living with a trans man, I see it very clearly – how dysphoria has been taking up too much of his mind, his life. his energy. How this surgery has set him free from that and will allow him to live.

 

 

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Testosterone Myths

I remember when I first realised my partner Robin might take T (testosterone) I was totally freaked out.

“You don’t need to act like any more of a man than you already do!” I whined, terrified that in changing his outsides to be more manly, I would lose from him some of the softer side of his already pretty blokey behaviours. “What if you get aggressive?” I pleaded. At one point I remember having a particular freak out and telling him I wouldn’t stick by him if he took that drug.

Oh, the shame.

And frankly, the unnecessary stress I put myself through because of a whole chunk of lies society tells us about testosterone. Now, a little more learned on the subject, I sigh inwardly when I watch a film and see the male protagonists’ adolescent, competitive bragging put down to “testosterone”.

T gets a really bad rap, and it also excuses a whole lot of crappy behaviour it isn’t responsible for.

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So first, let me tell you what it’s like living with a trans guy who has been on T for a couple of years.

Right from the start: So much calmer. Yes, you heard me right.

Robin has always, like me, been a little high strung and occasionally temperamental, but since taking T he has calmed right down. I’d like to say he’s happier, but that’s complicated. Life hasn’t been easy, with two of us transitioning. But he is less temperamental than he used to be, he really has chilled out.

The only exception was a few months in, he seemed edgy and grumpy and out of sorts and I thought to myself oh, aye, is this the T finally showing its true colours?

Turns out his T levels had dropped really, really low. A quick boost and he was right as rain again.

A year and a bit after Robin started on T, and a bit more than a year ago, I followed suit, and have experienced similar. I wouldn’t say I am calmer, exactly – I used to bite down my anger way too much, and these days I’m more likely to express it, to say “back  off” to someone who’s out of order rather than patiently explain myself ad nauseum. I don’t think it’s the T making me like that, it could be a growing sense of male entitlement or simply confidence as I feel more me. I’m less of a pushover, and I think that’s probably a good thing, although I have some way to go on that. One thing’s for sure, there have been no uncontrolled, T fuelled rages, no noticeable changes in my personality or who I fundamentally am. Maybe I am a bit more centred and growing into myself, but the changes are subtle.

And honestly, throughout life people change anyway, with or without hormones.

Of course, not all guys report this calmness, but most of the ones I know do. I worry about T’s bad rap, though, because just like it falsely legitimises crap behaviour in cis guys, so it can in trans guys who probably need to get counselling or anger management or do some anti-sexism work rather than blaming their shitty attitudes or bad behaviour on T. When Chaz Bono complained he was finding women’s voices more irritating, for instance, he blamed his “increasing maleness”, when a more likely culprit could be sensitivity to sound, a sensory problem common in trans people and exacerbated by stress. That or he’s just plain sexist.

And then there’s the sex drive thing. Yes, it does increase, and some guys don’t quite know what to do with that. Again, male mythology plays a part in this, as trans guys think they’ve developed a “male” sexuality with all the narrative baggage that comes with that. Having not (in some cases) enjoyed puberty first time round, they may have missed that burgeoning sexuality in their teen years, and think this is something exclusive to men (it isn’t).

Often, we’re just not quite ready to share this emerging sexuality with partners, we need to explore it on our own, along with a changing relationship with our bodies. It settles down, but my gosh we have such a dim view of men and their control over their own sex drive (poor helpless babies, my ass) that it can be almost frightening to feel like your body has been “taken over” by this drive. The mythology is at least as powerful as the increase in libido, and takes a bit of coming to terms with.

There is nothing exceptional about a male sex drive, and men’s sexual violence and objectifying behaviour has everything to do with rape culture, with notions of power and dominance, and nothing to do with testosterone or body parts. Studies show social and environmental, rather than biological, causes for human violence, including male violence. Meanwhile, guess what? Sex drives, violence, masculine traits and everything else are on a continuum, there are no binaries.

So, guys and enbys taking masculinising hormones: No excuses. it isn’t your hormones, it’s your socialisation, your trauma, your unchecked privilege, your sexism, your unsifted baggage. Roid rage happens to guys down the gym because they’re not being carefully, medically dosed and hormonal fluctuations indeed can cause problems, as can taking testosterone when you already have enough of it. Messing around with artificial hormones, taking them off prescription is not to be recommended, but if you’re transgender, and your brain maps onto a different hormone than the one running through your veins, T just might help (and it might not, and you can stop taking it if it doesn’t).

Hidden disability and its losses

When I look at the way disabled people are being persecuted to their deaths in my own exceptionally wealthy country, I wonder if disability is getting left out of our discussions on social justice. When we reel off our well rehearsed lists of intersecting oppressions, disability is often missing. This has led me to reflect on the impact of my own disability, and how much I discount it (and hide it).

Here’s my list, which feels pretty scary to put out there – ME/CFS, depression, autism, ADD, attachment disorder, PTSD, dissociation. Some of these have been medically diagnosed, and some realised through non-diagnostic psychological therapy. I may disagree with the construction of some of these labels, I certainly oppose any label with “disorder” in it, but I still feel their weight.

Photo0475I often spend time reflecting how lucky I am. I think it’s important, reflecting on privilege, being aware of your advantages. I grew up middle class, well educated. I was white. But home was not remotely safe, and school was where I was bullied for being different – traumatised, aspie/ADD, trans, and poorer, more neglected and scruffier than the other kids in my posh school.

Life continued with its benefits and losses. Family trauma led to me leaving home at 17 and becoming homeless, living on the breadline well into my 20s and becoming dependent on substances to cope. My good education meant that I was eventually able to get myself to university as a mature student, where I learned a lot and had access to free therapy. My poor health meant I was unable to complete the degree, and to this day (nearly 2 decades later) have never earned enough to start paying back my student loans. But having been to university still broadened my horizons.

I have ended up with a complicated relationship with privilege, where I have often discounted my own struggles because there are always people much worse off. I’m sort-of posh and sort-of university educated, but my mental and physical health has weighed pretty heavily in counterbalance to those privileges. It has created a wealth gap that we all just take for granted. We expect disabled people to have to struggle financially.

Hidden disability is ignored and dismissed and often I’ve struggled to get people to believe it’s there. Because it is inextricably bound up with trauma, it’s also too easy for people to say it’s “all in the mind”. Well, some of it really is neurological, but saying “all in the mind” makes it sound like a choice, and then people don’t have to take it into account. People are often quick to assume you’re shirking or lazy or melodramatic or manipulative, because they simply cannot see the pain or difficulty you’re having, and they require a proof that does not exist.

It doesn’t help that like most army brats, I was raised to be a brave little soldier, and showing my vulnerability is no easy task.

I have rarely been able to work full time, or managed to continue in employment without chunks of time off to recuperate. I’m in one of those off-times just now. Being on the cusp of disability, I’ve been able to claim sickness benefits for short periods, but always under duress to get back on my feet. The walking wounded, I always feel thankful for how relatively unscathed I am, but at the same time sometimes I just want someone to let me ride on the stretcher for a bit.

The underlying problem, I am beginning to realise, is that our current culture trains us to see ourselves, and our problems, in competition with each other. Some folks take the “my problem is bigger” approach: “Why should I care about your broken ankle when I have a broken leg?” “I bet it’s not broken really, it’s just twisted” . . . “and anyway, mine was a really, really bad break”. But as a counsellor, I actually see far more of the flipside of this – people discounting even the most horrendous of their own problems because there is always, inevitably, somebody worse off. This is what I tend to be guilty of. In doing this, people are often avoiding the discomfort of being vulnerable. It’s called not dealing with your own shit, and it isn’t as virtuous as it appears. But it’s entirely understandable – we believe somehow we can make a bargain with our minds to minimise our pain through a process of denial, as if “positivity” is all about pretending.

[Image: quotation reading "That quote, 'the only disability in life is a bad attitude', the reason that's bullshit is ... No amount of smiling at a flight of stairs has ever made it turn into a ramp. No amount of standing in the middle of a bookshelf and radiating a positive attitude is going to turn all those books into braille. Stella Young on how 'inspiration porn' gets it wrong"

So, here’s the thing. I am a very lucky person, and I know that. I grew up with enough to eat, with the enormous benefit of being white. With praise for my “masculine” qualities, with intelligence, and the ability to articulate myself, and the benefit of a good education. I am disabled but I am also brimming with able privilege compared to many.

But I increasingly suspect that in order to live in a compassionate world, we need to learn to give due consideration to every stubbed toe – we should learn to stop measuring other’s distress against our own and be able to wholeheartedly empathise with how it feels to suffer migraines and bad backs and brain fog and depression and eczema and IBS and asthma and ingrown toenails and griefs and traumas both large and small. I will support you to grieve for your broken iPhone and not compare that to my lost family, because no two problems are ever comparable, and all feelings matter. Being able to tune in to each others differing experiences is never wasted.

I am slowly learning not to dismiss my own pain and trauma in the face of the overwhelming suffering and oppression I see around me. It makes me a more compassionate person when I learn to offer myself that same compassion. Lately, my physical health and depression have been so bad there have been lots of days when I have wondered if I can carry on working or even functioning. There are days when I have cried out for a carer, knowing full well there really is nobody out there better off who can swoop down and lift my burden off me. I tell myself I have to be strong, but the reality is being strong is exactly what gets us into this pickle.

We are none of us strong, we are all of us vulnerable, and often there are difficulties we don’t see in the faces of those who we set up as “the lucky ones”. I will continue to own my privilege, as we all must, but I also need to learn to own my vulnerabilities, and I am increasingly realising the importance of that. Compassion is not a commodity, it isn’t in short supply, or more valuable if we ration it. Capitalist, austerity-based models of caring do not fit our hearts. We can afford to be as generous as we possibly can be towards our own, and each other’s, suffering.