The Prostap Nightmare
I spent the first 14 months of HRT living a nightmare. The T-blocker I was on (leuprorelin acetate sold as Prostap SR) crushed and suppressed my already failing mental health. I have read stories of people who take it for endometriosis and other ailments who have had their lives destroyed on it as I have. Some people react fine to it, all things considered as a t-blocker it has less side-effects than the others.
Now I am on Spironolactone, a 100mg tablet, twice a day. All of a sudden the dark clouds have been lifting around me and I begin to reassert a sense of personal identity. Some people conversely react as badly to Spiro as I did to leuprorelin, so I am saying to you now, if you have a blocker and your mental health is failing for no discernable reason, please look into it. Furthermore, I already pee quite a lot, and Spiro exacerbates this to the extent that I can barely make a 90 minute car journey without having to stop at least once to pee. In my case it seems I’m actually allergic to Spiro as evidenced by the rashes and hives I’ve been getting since starting. Anti-histamines help but I’m asking a lot from my body to process all these drugs.
Changing a male bodied physiology in terms of removing testosterone is asking a lot of the mind. On top of the depression, my libido was castrate – let me clarify, it wasn’t a low sex drive, it was a complete removal of a sex drive. If you know unfettered male bodies then you’ll know that quite regularly it will make sexual demands and get frequent erections in anticipation of the natural release. This is much less likely to happen on HRT, as such one’s neurology has to play catch up to the new information it is being fed against the template it was set at birth.
On Spironolactone, my sex drive is coming back, very slowly. It’s different now, visualization is an insufficient fantasy – there has to be a story, there has to be a connection. When it comes to sexual activity I can no longer just get ‘up’ and go. This works fine for me because as a demisexual I am only attracted to people I have a close connection with. This experience is not universal, some trans women experience a significant increase in sex drive as they are now free to experience sex more honestly. Pleasantly my infrequent erections have ceased to become as painful as they were a few months ago, though not necessarily from any change in my behaviour that way.
Surgery as a stick where the carrot should be
The grossest impediment to gaining a healthy sexual functioning (aside recovering from personal experiences of abuse and betrayal) is the configuration of my genitals. Not long ago I had my pre-op consultation with Mr. Thomas from Nuffield Hospital in Brighton. This process involves filling in a lot of forms, and speaking with a nurse who will be offering first hand care, who provided information sheets about the many things that must be done for GRS to be a success. She showed us the dilators which aren’t as big as I feared, although try telling me that after the operation.
Next, a meeting with the surgeon himself. He makes a brief explanation of what will happen in surgery and the likelihood of complications. He offered an 80% of things being fine, 15% acceptable, and 5% of something going wrong. For 100% of people, things can and will go wrong randomly, especially if you don’t follow procedure to the letter. He asked me to lie on a bed, take my trousers and pants down, put a sheet over my genitals and left the room to allow me to do that. He came back in, removed the sheet and handled my genitals so he could know what he was working with. We continued our conversation as he was touching me, so be prepared for that.
Then came the hammer blow. Because I am circumcised there is less material to work with in creating a vagina, therefore I need laser hair removal on my scrotum to give him more material. Those who are uncircumcised may not need any hair removal at all. As a consequence these women already have dates for surgery less than 6 months later and I am back in limbo after thinking I was so close to getting this whole process over and done with.
As much as anything it’s my own fault, I should have known, I should have been privately getting hair removal for the past two years and this wouldn’t have been an issue. See, the GIC won’t sign off on funding for hair removal until the surgeon makes his assessment, and when the surgeon makes his assessment he is ready to operate as soon as his conditions are met. Since, I have liaised with private laser therapists and electrolysists. The woman who lasered my face at a private clinic as I was waiting for NHS facial hair removal was happy enough to zap my scrotum, however she needed to know what the surgeon wanted. ‘Three fingers from the base of the scrotum’ Mr Thomas said, although he has pretty thick fingers so I’m saying four.
Now I’m on the NHS pathway and counting down the weeks. 6 weeks until consultation, followed by 6 sessions of laser spaced around 6 weeks apart. 42 weeks. Then, most likely a further 12 weeks with an electrolycist to clear up the remaining hairs. 54 weeks. Another YEAR of waiting. If you want to be sure you are smooth down there, electrolysis alone will take two years. Some time can be saved however. Mr Thomas said to get in touch with his secretary for setting a date when hair removal was ‘nearing completion’ and I know some people try to set the date so that surgery comes just a couple of weeks after the last hair removal appointment and the area has had time to heal.
I really have always hated my balls, they’re disgusting things, and to feel held hostage by them, to feel my destiny is in limbo because of hair on them is extremely frustrating. More people have seen my genitals in the past few months than lovers do over years, although it’s only uncomfortable if you make it uncomfortable. Getting my balls lasered was nowhere near as painful as getting my face done, in a sick way it felt a bit nice, and for a change I could have a conversation with the consultant without screaming due to the big laser in my face.
This is the biggest miscalculation I have made in my transition so far, so if you are circumcised and want GRS then you may want to consider starting genital hair removal no sooner than 2 years before surgery is anticipated. Be wary though, some women have had GRS and been left with patchy hair patterns because they removed too much hair.
As a result of all this I’ve had to be a little more forward with the GIC, because it’s not just the waiting, t-blockers are poison. I let them know of my anger in putting trans folk though so much unnecessary medical treatment. The general health of a trans woman is considered to be better post GRS due to not having to take extra daily medication (I actually think that a large part of the elation after GRS is the rejuvenation of health from not having to take blockers).
I told my GIC therapist that ‘a friend’ who attended the clinic had been feeling depressed and was scared to bring it up in case they were denied service. She reassured me and I was able to then admit that it was me who had the problems. For any stories I’ve heard of her stopping medication she informed me that this mostly happens when a patient is clearly in a place of extreme distress. In explaining my situation calmly she had no reason to deny me. The next appointment I admitted to her that it’s possible I have Borderline Personality Disorder and she has offered to help me with it, because it is separate from my experience of being trans.
The medical stuff is hard. It’s important to put the fears of ‘transition takes years’ into perspective. Yes, this all takes a long time, slowly chipping away at the physical characteristics and growing into a new way of being. Throughout all that is a comfortable window in which to come to terms with your situation and take care of whatever legal issues you have as well as figuring out how you feel you want to socially transition and then doing it, in earnest.
Oh yeah, wasn’t I supposed to be transitioning?
So, what does that social change look like after over two years out and 15 months on HRT? It’s not what you likely expect, it’s much much less than that, depending on perspective.
You are already you. First you let go of what you’re not, then do you on a radical scale. That may or may not look like very much internally or externally, but for an adult trans person there is a body of work that will take years even if it just simmers. Understood and cherished concepts may go completely out the window as you come to learn about the experiences of life as another gender in a world where men and women are kept separate in the extreme. For non-binary and some intersex people comes yet another layer of awareness to the complexity of our gendered constraints.
Personally, I still don’t get the whole thing. I’ve been in too vulnerable a state the past year that I haven’t actively done anything to ‘transition.’ The good news is that regardless of HRT, transition happens automatically as you gain lived experience; every day brings a new experience, lesson or challenge of belief that locks you further into your identity, if you so choose.
When I buy clothes, I’m not transitioning anymore. When I put on make up I’m not transitioning anymore. Transition may last forever but there is nothing I’m actively doing aside allowing the concrete to set on my identity. Honestly, I just don’t care that much about presentation, I mostly wear jeans and a t-shirt – I can’t afford lots of female fit clothes and I still have plenty of good male clothes. Obviously I look more masculine wearing the male clothes but it doesn’t seem to be an issue because people are looking at my face and hearing my voice.
When I speak I am very much still transitioning. By all accounts my voice seems to be ‘good enough’ – I’m trying to be objective here…I can deduct that it’s not a male voice even though I kept my masculine parlance; it’s not really a gender neutral voice, because people’s brains assume gender automatically and the brain is seemingly only wired to say ‘male’ or ‘female.’ I work passively with my voice – through simple awareness of speaking – as an option because I spent 8 long months of intensive daily practice working on it and there is still a lot of fine tuning to do. The fun thing is, as soon as someone has that automatic assumption of your correct gender, it can take quite surprising amount of obvious male gestures to get them to question it.
I am constantly carrying out overt and covert social experiments to understand the boundaries of layman gender understanding. Maybe it’s a dangerous game but I seem to get away with it. I am often quite cocky in public (I’m a total poser), even alone, I walk often with a masculine gait, and I think that confidence deters people who are determined to involve themselves in my day. That and wearing pretty scruffy clothes that leave little room for extreme gendering.
I can do this because I know how lucky I am. HRT has done wonders to feminize my face, and since it is many people’s first identifier I have an advantage for an easier life until society catches up with the notion that a woman, or a trans woman, shouldn’t be judged for her looks (see Mia Violet’s article Transgender Liberation Means an End to “Passing”). Also 15 sessions of laser hair removal over the last 2+ years has made a massive difference. If so inclined I could count problem hairs on my face and they would number less than 100, which is more than enough to make my face smooth. When I finish laser some hair may eventually start to grow back, then it’s either top-up laser or electrolysis. I can go a couple of weeks without shaving, even then it’s only because of those few little hairs annoying me.
To illustrate these changes I took a photo of my face every day for my first year of HRT. For your awareness I already had 7 laser treatments when the first photo was taken. Here are the results:
Attractiveness isn’t exciting
Around 14 months HRT I had to make the conclusion that in general I look like a woman, and it’s a pretty good feeling, though it is relative. It doesn’t do anything to improve my life however, in fact I find it quite annoying at times. My looks have become a focal point of praise for who I am, and I just don’t think my looks are an interesting topic except as a study into human behaviour.
I ‘pass’ most of the time now, in fact I haven’t been misgendered in quite a while, somehow. The infrequent odd looks I would get from people don’t happen at all really, although people stare at me for acting weird the same way they did whilst living as male. What I have noticed though, is that the rare times I do go out wearing a dress or a little bit of make up it’s almost exclusively men, not looking, but staring at me…if I was more confident I’d say they were checking me out. On the one hand I can strongly assume I’m passing at that time but on the other I have all these guy boring their eyes into me. I can totally see why some women get annoyed at the sense that these men are not just objectifying, but almost trying to impose ownership on women’s bodies.
Aside from a blatant sexual assault over the summer (a story for another time) I have guys coming up to me in bars and other public spaces. I forget that I’m not being seen as a guy; they aren’t coming up for a chat or a fight, they’re coming for a woman, and if they can get away with it, to impose on my personal space. It’s jarring to have to live this experience I’ve seen from the outside with apoplectic anger since I was a teenager. Women aren’t oppressed? Try being one. I’m still waiting for the first decent man to come and talk to me, aside friends of friends. I was imposed certain principles of what a man is growing up – it was somewhat misogynistic but with honourable intent, as in respect for all people, especially women, to protect women, and to not touch them without consent. Even in general, you don’t get into someone’s personal space ever without their permission. Just another perspective on the puzzle that is people.
Body changes happen also in the mind
On a more pleasant note, I have been noticing the changes on my body more and more. Now it’s my body I look at in the mornings rather than my face. My breasts, though still not ‘dropped’ are much bigger than I ever expected they would be and I actually feel a weight behind them. They look very small but they feel much bigger, and personally I’m satisfied, all I have to do is wear a bra and there’s no dispute that’s they’re probably breasts. I’m almost pushing a C cup, surprising since both sides of my family have pretty small boobs.
They don’t look great but they work for me, the same as when I do look at the changes in my body I do it with the affirming knowledge that I have a woman’s body, on a male frame. That’s what being trans IS. You must, at some point, come to a place of acceptance of your born state. Even though I envision myself as looking indistinguishable from a (certain kind of, cis-) woman naked, I still allow myself the peace of what I am, what I have strived for, rather than what I can’t change. My hands will always be suspiciously large, my shoulders will always seem a little broader, my feet may seem larger than is expected of a woman in the cis world. Again, we’re talking centimetres here, that is the difference between male and female bodies, not whole worlds. In reality this isn’t something I think about often, I’m just trying to explain what can happen; I’ll give my breasts a little squeeze at the end of the day and glow in the light of my determination. Regardless of how much you may know you need to go through all this, it takes a special human grit, and we all have it in us regardless of circumstance, remember that!
I am in the market for a slimmer waist, a fairly unreasonable goal. As much as it hasn’t gotten slimmer at all, my hips continue to grow, further creating the illusion of a narrower waist. That said, some mornings when I look at my body before eating I become shocked by the extent of apparent changes. With the presence of my breasts it creates a figure that I would find attractive in a woman, so I concluded as humbly as possible that therefore I can be attractive. Sometimes I still don’t like my body, especially with, you know, a penis in the mix, but that’s totally normal. It means I’m at the point where my sense of body image is dependent on my self-confidence, not the sense of my own inevitable masculinity. I could compress my waist with a year or more of corseting, but corsets are deeply uncomfortable and remind me too jaggedly of the aspects of transition I don’t really need to achieve that badly through struggle.
With so long to wait still until surgery I’m trying to put it out of my mind for now. Soon will come a time where I must get stronger, healthier, fitter and happier to maximize my chances during recovery; quit smoking, come to terms, prepare etc, but that isn’t now. All I can really do now is keep working on my voice and keep learning, every day.
Misery doesn’t have to stop transition
Finally, I know I don’t post much, I have a lot of topics aside these general updates that I really want to write about, but to be honest, I’ve been in a very bad emotional state for a long time. A large part of it was down to the t-blocker I was on. I thought it was just how HRT worked, that I could tough it out, and I have no idea how I coped with it for so long. However the root cause is personal experience, a really horrible dragged out ending to a relationship with my first love over two years ago, and foreknowledge about losing the best job I ever had, coalescing to become the catalyst for me to realise I am a transsexual all happening within a few weeks.
Transition ironically became moot to me, it was something I had to do that I have invested the minimum amount that dysphoria directs me to do – by that I mean I have been assertive in organising transition related appointments for as soon as possible and going to every single appointment no matter how inconvenient, whilst letting every other aspect of my life fall apart – but I’ve been dying inside throughout the whole process with a broken heart and broken dreams. My mental health is improving, but I still don’t have any reason in my life, and while that is the case transition just hasn’t been a priority. I’ve still done all I could to speed up the process because I just want to clear the path to deal with these more pertinent issues. Being isn’t everything, it’s one thing.
Transition has never been the top priority in my life, and I’ve done it with a constant intense feeling of hopelessness for the fate of my life that severely depressed people go through. I’m trying to be kinder to myself, and I have a better chance on the new t-blockers, but the life I want to rebuild isn’t as a woman, it’s as a successful person. What I’m saying is, you can still feel awful through transition, you can be totally broken, and you can still do it as well as you want to. I haven’t had the motivation or the reason to do anything for over two years now, there’s no joy in it for me, but somehow I just kept allowing my dysphoria to push my journey and it has worked out.
I was lucky enough to have a relationship with a woman this year – it didn’t last because frankly I’m just too messed up (we’re still on good terms), but she showed me that I really can meet someone who treats me right, who respects me, who listens to me. For all the shock of transitioning, it’s such sweet solace every time something or someone grounds you back to reality in a way you thought was lost, to the point now where I consider myself as secure and unconcerned with my identity as a woman as I was with being a man before I had my realisation.
On top of everything, I have a fantastic network of incredibly supportive cis and trans friends, and my immediate family are amazing. I’ve spent my life investing in my personal relationships so much as I am able, and the payoff is loving friends who stick by you, regardless of the adversity you face together as transgender person, and public ally.
I’m a very lucky woman. And if you’re preparing for this journey, or on your way, you can feel this way too. Just keep going and it will come, in your own way, for you, to share with the people you love, and who love you.
P.S. If you would like to see some of the physical body results, or are just a pervert, feel free to visit @wrathoftran on Twitter. Here I post about body and sex issues, so it has a few nude photos of me that I have posted for education and my own satisfaction. Be warned this feed has a lot of swearing and potentially undesirable content on it. Or visit my main Twitter @unexpectedamy for trans information, experiences and affirmations almost daily.