A Rule

From the news of the recent suicide of Leelah Alcorn in Ohio (long story, look it up), there has been a lot of opinion said and written about her and suicide, and many people resurrecting the advice to other how to know and then engage them if you think someone is contemplating and even planning suicide.

Well, here's a rule you should always remember! If you are not a professional therapist who has experience with suicide or a suicide counselor:

Do not think you know someone is suicidial and do not engage them in talking about suicide.

You don't know squat when it comes to suicide so don't make matters worse, and you can and often will, if you engage them to talk about suicide, and force them deeper into their own world. You can and likely will push them the wrong way.

The solution is to find someone who does know and talk to them, and then let them decide what to do, and if necessary, engage the person. And don't suddenly start acting and talking differently around them or to them. They're not stupid, and they're likley to react to you the wrong way.

And do not report them to anyone with legal authority. The last thing they want or need is legal intervention where they lose their rights and face legal hurdles. You could be wrong, and they last thing you want is to make a lifelong enemy.

In short, help them by not helping them, but just be a friend, no different than before, just be there whenever they want to be with you. No more. Just be there.

Not Getting It

A conversation between a woman and someone she just met.

Him: "So, are you pre-op or post-op?"

Her: "Does it really matter?"

Him: "I couldn't tell. I thought you are a woman."

Her: "I am a woman. That's the point."

Him: "You took it wrong."

Her: "No, you meant it wrong."

Him: "I was only asking."

Her: "Something that's none of your business."

Him: "It is if I like you."

Her: "Then, are you pre-op or post-op?"

Him: "What the hell does that mean, I'm a guy."

Her: "Yeah, that's the point."

Him: "But I haven't had surgery."

Her: "Really, could have fooled me. I thought you were a guy."

Him: "I am."

Her: "As I'm a woman."

Some Women

Some women transition not because they love clothes and want to always be "dressed", like to wear makeup and want to wear it everytime in public, want to be "feminine" and be seen as a "real" woman, want to go anywhere and everyone calls her "she" or "maam", no none of that.

Some women transition not to have a body that attracts men who want to have sex with her, want to have a face others, even women, call beautiful, want to be able to be wear the latest bathing suit, the less the better, to be seen as sexy, no none of that.

Some women transition just to be who they are whatever that is, to be themselves however they are seen, to be comfortable with their body, everything about it including and especially their vagina, theirs and not something they planned to have, wanted to have, but simply have.

Some women transition to be, nothing more and nothing less. They'll live with the rest, whatever it is and happens. Some women transition not for everyone else but just themself, all of that.

Some People

Some people don't fit into the binary sex or gender boxes most people like to put everyone into because it fits their idea of sex and gender norms. These people don't fit because while many don't have an internal conflict with their birth sex and their gender roles, they like to express themselves as the other sex or gender.

These people fit a variety of labels, some they identify with and some others put on them for their personal reason whether they fit or the person wants or likes it, and often it's a disparaging label, meant to either ridicule or demean them.

But there are some people who may appear to fit into that group of people who fit in between there is one big distinction which is often lost by others, and that's the fact that these people would rather be the other sex and gender and express the birth sex as a choice than as a life.

This means those born male would rather be women when and where they can present themselves as men or not, or just live in the clothes because it's convenient or the clothes are comfortable to wear on some occasions.

And that's what's lost in the difference because people assume they are just one of those who are men or women and like on occasion to be the other sex or gender because it fits their idea of them than trying to understand and accept some people don't fit their binary boxes.

Some people defy the norms of others, who in turn forget their norms aren't everyone's norm, and there are some people who would themselves not as the other sex but in the body of the other sex to feel whole as a person and themselves.

Some people, but then we're all just people, some in our own ways different than everyone else, lest we forget and be called out for the ways we don't fit into other people's binary boxes. Some people are really all people, all the same in the fact we're all different in some ways.

Transition and Fat

In looking at and reading some of the blogs of transwomen, meaning those in transition, and the descriptions they give about the hormone replacement therapy (HRT) drugs they take, often with dosages listed (not recommended), and the effects over time, I'm curious why they ignore two more important factors of their life and transition.

The priorities of a transition should be, in this order, your life, your health, your fitness and your transition. Without the first three, the transition is just that where you go through it risking if not wrecking your health and fitness in the process.

And never forget you have a life above all else, because without it you get through your transition to discover you don't know what you want to do with the rest of your life. Never lose focus on where you're going as a person and fit the transition into that.

The transition will make its own schedule with your finances and life, but your life won't if you sacrifice it for your transition. My concern here is reading, and sometimes seeing in the photos, which is a puzzle to my why they post selfies but then I'm not one who likes my own body so I never take them about the changes.

It's common knowledge HRT will reduce muscle mass, often helpful, and it will add or change the fat distribution on the body, and expected with estradoil, especially with the hips and breasts. And therapists and physicians who have overseen transition will tell you adding weight, aka fat, is the result of HRT.

And often they'll tell you it's "normal" and don't worry. But it's not and doesn't have to be as you'll find if you want to lose that fat, you don't have the same metabolism  with exercise to reduce the unneeded fat and you have to work harder and longer than you did before, and the biggest risk to one's health is fat.

And it's the fat you often don't think about because it's slowly added or out of sight, such as intramuscular fat (muscle mass changes), internal fat (inside the abdomen on/around organs), arms, legs, etc., and over the course of your transition it's easy to find your self tens of pounds heavier.

I won't argue some people lose weight, but if you read the details, it's often they're physically active or continued to exercise through their transition so the HRT works on the areas it will naturally but won't add fat where it's burned in the exercise program.

And that's my point, don't sacrifice your health and fitness for something you think is good. Fat is still fat and not good for you. Some fat is helpful to help feel like and see yourself as a woman but much of it isn't, it's just fat, and over your new life will be there unless you change.

Funds

Why do women in transition seem to ask for donations to fund their transition? Yeah, obvious question since the cost of a transition depends on a number of factors but has several automatic costs, such as hair removal, therapy, doctors, drugs, clothes, etc. and the always surgeries.

The type and number of surgeries varys with the individual. Some, especially younger women, don't need cosmetic facial surgery, but most do to some extent. Some, but not most, elect to have breast augmentation surgery. And almost all, especially where it's necessary for documents but mostly personal choice, have gender affirmation surgery.

The last is often called sex or gender reassignment or confirmation surgery, but I like the feeling of gender affirmation surgery because it does what every transitioning woman wants to have for the rest of their life, the feeling and experience of their own vagina.

Anyway, back to the point. In even the most straight forward transition where the woman easily physically transition to integrate into the world as a woman, often calling passing, the cost can easily be in the $25-30,000 range, most of which will be the vaginoplasty.

If they're not so lucky and need or want additional surgeries, the cost quickly rises to $40-50,000 or more depending on the extent of the surgeries. It's only less if they have health insurance which covers part of the cost of their transtion.

But even then, breast augmentation and facial surgery is not covered by insurance and all the rest have co-pays, especially the surgery which doesn't include travel, accommodations, followup visits, etc. In short, it's not cheap.

And that often leads to some setting of accounts to donate to the transition costs. How many women who are transitioning can afford to help without taking money from their own transition? Outside of friends family, co-workers, etal, who's going to donate for a total stranger?

I'm sure many people donate to some of the women and it clearly always helps, which is why transitions should be covered by insurance. It's a known medical condition with an established treatment plan and protocol for a complete success.

I just wonder about why women out themselves to ask for donations and what they expect in terms of the amount. It's a choice if you don't have a ready source for the costs of your transition, like family which some do with supportive parents or access to a retirement, home equity or similar funds if you're older.

In any case, money seems to be the biggest impediment to transitions, and mostly for the last surgery. We need to find a better solution in the US, which are available in other countries where the costs are  covered including some surgeries, eg. Canada, Great Britain, etc.

Finally

Finally the Office of Personnel Management (OPM) is considering requiring, or at least prohibiting explicit exclusion (the current practice with all policies under the Federal Employees Health Benefit Plan (FEHB), coverage for transition care including Sex Reassignment Surgery (SRS).

This, noted here, follows the Department of Health and Human Services (HHS) decision recently to include transition care in Medicare plans. Currently it's neither excluded or included, unlike the FEHB where it's excluded.

This means before (Medicare) or after (FEHB) January 1, 2015 patients undergoing transition with either Medicare or FEHB can have as much as 60-80% of their costs covered, especially the major costs of SRS, which can run $12-15,000 overseas or $20-25,000 in the US.

It's likely any coverage will be for US surgeons but there isn't a lack of them, only the waiting time varys from a few months to 6-9 months depending on the surgeon. But as with some health coverage, patients may still have to pay (always full payment up front with SRS) and get reimbursed.

Some surgeons are in some state or local government health plans because their clinic is in the state which makes coverage through the insurance company. Companies which cover it usually do so through riders with their employees health plans and pays direct for the employee minus other costs such as travel, lodging, etc.

This is good news for active or retired federal government employees and those on Medicare. Currently some coverage is defaulted in the health plans, such as drugs, therapy and etc because they're not sex/gender specific than specific to transitioning people.

But it took four years after President Obama endorsed a letter to OPM on LGBT issues which instructed OPM to act on the health insurance coverage. And a good number of patients under FEHB have either paid out of pocket or delayed finishing their transition because of the time for this decision.

At least OPM got there, and so in the 2015 policies people under the FEHB will not see the words, "Sex transformation services and surgery excluded" in the plan coverage brochure and an explanation of the coverage based on the status of the provider (preferred, general or other).

Not Always

When people who have transitioned talk to those who are considering or in therapy to start their transition or who are in their transition, these people always tell you to go ahead, don't hesitate, come out, go public, be fulltime, and take charge of who you are and your life.

It's often the advice Nike gives, "Just do it", something you expect from the one minute manager expert. These people are usually the ones who often passed as women before or during their transition, who didn't need cosmetic facial surgery, who didn't need very much facial or body hair removal and for whom hormones had an extraordinary change to their face and body.

In short they easily and readily passed. Or if not, they found or had the money to get cosmetic facial surgery and/or breast augmentation surgery. In other words, once they decided they went full speed through their transition through their Sex Reassignment Surgery and got on with their life.

And so they can hand out that advice like candy, they did it so everyone else should do the same, or as some often say, "You're not a true transwoman.", meaning they're the ones who subvertly decide who's true and right or not.

They will always tell their story of hardships and challenges, and how they overcame them or got through them to transition. They'll will always talk about well they were seen and accepted as women, forgetting how easily they passed.

This is often true of those who become public figures or celebrities as transgender women, accepting that word as who they are, but then always arguing they're also just women, like other women, except their experience is different.

They argue they're trying to change the public perception and image of "transgender" women, meaning calling anyone who is transitioning or has transitioned is transgender by definition, theirs and the public's, even if the woman doesn't want the label.

They either forget or disregard those who don't follow their path and advice. And unfortunate for those who can't and have to live with the stereotype these women set and the stigma of how they fail. These women argue against stereotypes while being one themselves.

Not all women transition like they do, and in fact, most don't, taking longer because of work, family, money, health, fitness, time and other reasons or factors. Some take a long time to or don't even transition because they're more afraid they'll be worse off and not accepted if they do transition, and to them, life of quiet desparation is better than a life of public isolation.

We forget that at the heart of this is someone's own gender identity inside the physical body genetics, time, experience and circumstance gave them, and that along with the realities of the transition, especially the cost, overshadows everything anyone else can say about them.

To all those public transgender women, I say to your words and advice, not always. And don't speak for anyone else and especially all transwomen, just speak for yourself.

Goal

A goal of many people, especially those who transition, is to lie in bed naked and feel a body which is complete and whole, and is everything you are and want to be and nothing else from who you were. To lie quietly in bed and feel your own existence as you know and feel.

Who can argue against something even genetic (cis)gender people know about themselves? So, what's all the fuss, and even the anger, about transpeople wanting to know the same about themselves? Don't we all want that goal?

Photo credit

HRT

While Hormone Replacement Therapy (HRT) is one, and often considered the most, part of a transition, many transitioning people not only tolerate HRT, their body change significantly to even dramatically over months to years on it.

But some have issues if not problems with it as their body requires a very narrow range of hormone levels to work, meaning their estrogen levels can't go higher than their normal and their testosterone levels can't go much lower than their normal level.

If they change those levels outside the range, their body revolts from physical problems to mental problems, including excerbating some inherent problems, especially those prone to depression. This is true for estradoil in any form.

It's why some transitiong people have to find alternative routes, from surgeries to just living with what their body allows. So, don't judge someone who doesn't look like their transitioning and isn't on HRT, and don't tell them they're not real or serious about it because they're not on HRT.

They can't and you shouldn't.

The Difference

When someone decides to transition, the hardest part is recognizing the difference between chasing a dream of themselves and the reality of their being. The former will almost assuredly lead to problems between what they want to become versus what they are becoming.

The latter, however, won't necessarily lead to complete happiness with themself, but it will lead to being comfortable with what the could have and did achieve with their transition, someone they can live with and be the rest of their life with no regrets.

All I want

All I want is to be comfortable in and with my own body. You would think the medical community would jump at the chance to say ok, and do what's expected and necessary for that treatment which leads to a cure.

You would think. Some of them do. In fact most of them do. So why doesn't my insurance company? What don't they understand about a cure for a problem easily doable with a known treatment plan? And why hasn't the medical community demanded fair treatment by the health insurance?

They've "recommended" it. To date, however, the health insurance has never explained why they explicitly exclude the very treatment which is a cure, and they keep ignoring the medical community's advice. All for a condition easily and affordably treated.

Surprising

It's surprising that some small change in a person's physical anatomy, the change, addition or removal of something, can make the greatest change in the mental health of a person, so they can say they are complete and whole.

You would think the medically community would quickly jump at this small treatment which cures so many problems of a person that all the therapy, medical intervention, or anything other treatment can't do. One simple thing.

So why do they put so many roadblocks to this one thing? It's not rocket science. It's not really medically confusing. A simple decision to say ok, and all the other issues and problems fade into their past and give them a future.

You would think. Surprising it's not.

Sometimes

Sometimes people transition not to become someone but to unbecome someone else. Sometimes people transition to female not necessarily because they want to embrace everything women have, do and are, but to get away from being everything men have, do and are, to become who they want to be, even if it's a boyish or androgynous woman.

It's about becoming someone they are comfortable being and being in their own skin and body. Sometimes it's not what's expected of them to be, which often creates it's own internal and external conflicts with the transcommunity and transpeople, especially transwomen who demand all are overtly women, but who and what they want to be.

That's where they live and are, something not often understood, let alone respected, by the transcommunity and other transwomen. Sometimes it's just about being human and nothing more or nothing else, wherever it lies on the gender continuum.

At Some Point

The almost always certain rule about transitions:

At some point in a transition the woman stops thinking of herself as transitioning and describing herself as trans-something and simply thinks and feels of herself as a woman. And at that point, she starts her life over and everything before is forgotten.

At that point she erases everything she did to identify as trans-something and just lives her life as a real honest person and woman. It almost always happens, and it's why they disappear in the society as any other ordinary woman.

Only those who are openly out or public about their trans-something history can't erase it and they're stuck with the stupid little adjective the rest of their life, that "transgender" woman. All the rest just get on with the life without it.

And so it should be, but don't leave those who were your friends during your transition behind to wonder why you left them without a word. They were there for you then and they can still be there for you now.

Give Thanks

For all those women transitioning and happy when they get to start Hormone Replacement Therapy (HRT) and get the effects and results of HRT, give thanks you can take the drugs, for there are some who want to transition as much, if not more, than you and can't tolerate HRT without serious adverse side effects.

Give thanks you get the changes which are often miraculous over months and especially years, for those who can't take HRT can't get the changes to make their transition better and easier. Give thanks you can and be accepting of those who can't.

Give thanks you can smile as your body changes from male to female as best that HRT can accomplish, for there are those who can't smile because they can't get and won't get the changes to make their transition better and easier.

Give thanks. You can change. Some can't give thanks. Some can't change.

The Sad Reality

The sad reality for some women who transition is that even with facial surgery, and maybe, but not necessary, breast augmentation or liposuction surgeries, they will never really pass beyond getting through life with some occasional stares or soem questions or comments.

The sad reality is that they know who they are as a woman, but the mirror tells them something else, the body they were born with and have just doesn't get them very far as a woman. What's worse is they read the blogs and columns of women who do pass who tell them, "Hang in there.", among the rest of the hype to make them feel better.

But really all that does is make them feel worse, as there is nothing worse than someone who has succeeded in passing telling someone who doesn't it's ok. It only makes the other woman feel superior and better. No one needs it or wants it.

And it's the sad reality all the way around, to transition and never really arrive at your goal, to just be invisible as an ordinary woman when you see other women not only finish but succeed and even be beautiful.

Transition Suggestions

Here are my suggestions if you are starting your transition or even some ways into it but still have some changes to go. These assume you have access to good professional transgender resources found in most cities, but if not then find the nearest city with them.

First, forget the transgender/transsexual community. Don't attend in group meetings and only have a few trans friends you've knownand trust for years. All the rest will either lie to you or hate you for being either passable or successful with your transition.

Second, find a good trans experienced physician and a good trans experienced therapist who have overseen a lot of transitions and focus on the issues of your transition. Walk away from gatekeepers and any professional who judges you before they say they'll help you.

Their goal is to help you get through your transition and on with your life, nothing more. Everything else is just talk you don't need. Both should be knowledgeable with other professionals who are trans friendly to help with what they can't.

Remember with your transition your priorities should be, first, your life; second, your health; third your fitness; and last your transition. It doesn't pay to transition if you wreck the first three. Remember you need a job, some money and necessary resources for and after your transition.

Without them your transition will leave you what you want but not what you need. Fit your transition into the first three and you'll be surprised how easy it can go, or not and you can adjust or adapt your transition, maybe longer but still succeed with your life, health and fitness.

Third, never tell you health insurance company you're transgender or have GID. Have the physician and therapist avoid any trans diagnosis or treatment with any claim. Just treat you like a normal person and you'll be surprised the insurance company won't question the expenses.

Read your health insurance coverage benefits and exclusions. You'll be surprised that they'll cover therapy of a general nature, maybe at higher co-pay but still covered, for non-specific conditions without requiring a diagnosis.

That said, only use GID if you know you have the coverage for transgender care, often called "sex transformation", for therapy, drugs, care, surgeries, etc., but first be very sure. Don't risk letting them know unless they have it written in the policy.

Fourth, find a trans experienced electrologist or laser specialist, preferably the former if you want permanent facial (and other) hair removal but some have success with the latter. They tend to be more understanding.

Fifth, find a trans friendly clothing expert or wardrobe advisor. Don't use any transwomen as examples or go to "transgender" friendly clothing stores, they're too expensive. You'll find many clothing stores, even the upscale and larger ones, understand transwomen.

Sixth, follow women's fashion for your age and style. Don't use transwomen and especially crossdressers as examples for anything fashion. Don't let anyone tell you to buy a lot of clothes to try different things if you don't have the money or the interest, unless you plan to give a lot of clothes away later.

Remember a few good styles and clothes go a long way. Find a style you're comfortable with being you and then explore styles and clothes when you want if you have the extra money. Clothes collecting dust or sitting in the closet only hurts your pocket book.

Seventh, your therapist should know the process for name change, sex/gender marker changes, etc. and legal experts to help you through the process. Don't let them require you pass some sort of test or play dressup for their approval and letters.

Remember you're a woman, not a stereotype, be yourself with your own style. Any good therapist and physician understands diversity to write the letter you need for legalities or surgeries. It's not about how you present yourself, it's about who you are.

Lastly, stay away from the transcommunity at all cost. You'll be living in the world of women, not transwomen. Be a woman like all the rest of them. Just my thoughts and experience. Good luck.

Is Nothing Worse

Is there anything more depressing to be in the middle stages of your transition where you don't often pass to meet a woman who finished her transition just a few years ago to discover she doesn't want anything to do with you let alone talk to you because she's only wants real girlfriends?

Something to Hide

The difference between a post-transition woman and an in-transition is that one has something to hide and the other has something to hide. One is what is expected and one isn't what is expected, but both don't want to share it except with their closest friends. It's a small difference and a big difference, but it's what makes the difference.