A New Reflection, or “Looking in the mirror and hating myself is so 5 years ago.”

I’ll be the first to admit that I don’t exactly have the most the health of body images. I struggle constantly with my self-esteem, and with feeling comfortable with how I look. But I think that’s part of life both as a trans person, and as woman in general for the most part. But despite all of that, I’m still astounded by how much transitioning has improved my self-image and my ability to love myself.

Gender dysphoria takes all kinds of forms, and we come to understand it in a myriad of ways. I don’t think I truly understood the true depths of my dysphoria until I actually started to transition. For much of my life, just looking in the mirror could bring on waves of anxiety, shame, and revulsion. I went out of my way to avoid looking in mirrors whenever possible, and to avoid being photographed or caught on video camera. Seeing any representation of my physical appearance instantly triggered a massive punch of self-hatred. In hindsight, I can’t believe I didn’t see how massively unhealthy this was. But, I was one of those kids who was relentlessly and brutally bullied from almost day one, and I lived through some pretty horrific abuse at home, so it’s not surprising that I had internalized a lot of what was said to me. I was picked on almost every day for being “fat”, and I had a parent who reinforced that bullying at home. The part that I still struggle to push past is that I really wasn’t overweight. I was a perfectly healthy and normal weight for my age and height until college. What I was really being bullied for was being different; the fact that was a little bigger than some kids just gave them as easy handle. I was very much the “weird” kid; the combination of being autistic and “intellectually gifted” left me with a profound difficulty relating to almost anyone. I was basically a sitting duck. But I was too young and socially-inept to understand any of this, so what I internalized is that I was fat, and that no one likes fat people, and that the reason I couldn’t be happy with how I looked was because I was heavy.

I continued to struggle with weight and body image through college, and my confusion about my gender identity began to come to head. Even the multiple occasions when I managed to get my weight down to the lowest it had ever been as an adult, I still recoiled every time I had to look at my reflection. In some respects, this colored my thoughts about my gender, and I had myself firmly convinced that because I was so fat and unattractive, I could never live as a girl and not basically look like a monster. So I buried all those feelings of confusion and unhappiness, and just tried to push on with my life. I had equated all those ugly feelings when looking in the mirror with my weight, and so I gave it absolutely no deeper thought. And to make matters worse, because I couldn’t gain any boost to my self-esteem when I was thinner, I felt almost no drive to do much work to stay at that size. After all, why do all the work of keeping your weight carefully controlled if it doesn’t make you feel any better about yourself? And so it remained for many years.

The early stages of figuring out my gender situation, and learning how to look and dress as a girl are pretty personal, and I’m not sure I’m quite ready to share those moments publicly yet. But eventually I realized that the situation wasn’t nearly as dire as I had thought, and eventually started down this path. And I will NEVER forget the first moment I looked in the mirror and didn’t want to throw up. It was a lightbulb moment like no other. By my current standards for myself, I was still a total mess…still new to makeup, hair still rather short and difficult, and so much else. But I remember staring at that mirror, and feeling comfortable with the image looking back for the first time in my entire life. And all I wanted to do was cry. It wasn’t that particular moment, but a similar one a few weeks later where things finally started to really click into place. I certainly wasn’t any thinner than I had been in a few years; the only thing that had changed was the gender presentation. And there it was…I had spent my entire life hating what I saw in the mirror every single day because it reminded me that my body was not one that matched my brain. And even those early attempts gave me a relief from that hate for the first time ever. And that was really the moment where there was no going back. Sure, a lot more examining and soul-searching and making sure I was really up to the trial that is transition occurred following those moments…but in my heart I think I knew what I needed to do. And as I moved through those early stages of transition, I started to realize that what I had spent so many years chalk up to “just” really awful self-esteem was actually deeply rooted in my dysphoria and my unhappiness with my birth assigned gender.

These days, I think I’m pretty much like almost any other woman…sometimes I’m frustrated by my hair, or my skin, or my eyebrows, or what-have-you. And some days, I just don’t feel all that pretty. But those are minor quibbles, not the previous heartwrenching disgust. More often than I could have ever imagined, I can look in the mirror and feel a surge of happiness, confidence, and comfort with myself that 10 years ago I would have said was absolutely impossible. Even on the days when I’m in what I like to call “comfortable and lazy mode”, with my hair in a ponytail and not much more than a smidge of eyeliner on, I can still walk by the mirror and feel happy with what I see looking back. I’m still don’t think I’m very photogenic, but I even manage to occasionally end up with a picture where I think I look pretty. But most of all, I just feel comfortable in my own skin, and it gives the confidence (usually…no one’s perfect!) to just be myself. Some of the most striking things I’ve heard from people who have known me through transition are the comments about how much happier and more confident I look. I’ve got a long way to go, but just the simple freedom to be able to glance my reflection and see myself smile back is huge step forward for me, and every one of those looks is like a tiny victory.

Doctor Appointments and HRT Progress, or “Medical students say the darndest things!”

For those of you keeping track (no one, I hope…that’d be creepy) today is day +99 since I was initiated on hormone therapy. So, what would be the best way to celebrate such an arbitrary occasion? How about taking a day off work and going to a bunch of doctors appointments. Clearly, I’m a girl who KNOWS how to have fun.

First up was my very first appointment with a brand new primary care doctor. I haven’t had a primary care doc in nearly five years, because I have tendency to fire them for any number of things. The most common reason has been an obnoxious obsession with my weight, but others have been fired for giving me transphobic nonsense, or not being willing to work around some of the anxiety triggers I have. But my therapist has been pushing me to be a little better about taking care of general health type things, and did the leg work of tracking me down a trans-friendly family medicine specialist. So, I figured the least I could do was give her a chance. Since I use an academic hospital for most of my medical care, I pretty much always have to endure the physical and verbal prodding of a medical student and/or a resident. I endure with a smile because I recognize that I represent a good learning opportunity for these soon-to-be doctors. Today was no different, and I had my initial exam and history done by a very friendly young female student. While I can often tell when I’m someone’s first transgender patient, this young woman went about our time together as if it were absolutely nothing she hadn’t done a hundred times. I’m very grateful for it, as I was already fairly nervous about the whole encounter. She was honest about the skills she was still practicing, apologized for her cold hands, and engaged me in actual human conversation. All in all, I was fairly impressed and encouraged. After this, I got finally meet my new doctor, and I was also pleasantly surprised. She was supportive and encouraging, and had none of the fat-hating overtones that I had grown accustomed to with other doctors. She even took the time to ask me about my triggers AND note them in my chart. It feels so good to have a doctor who is on my side, and is actively interested in working with me, instead of just treating me like another patient to hurry out the door. Anyway, I got a clean bill of a health (other than the couple of known little problems), and a big pile of blood tests run to make sure there’s nothing weird hiding and to check my hormone levels, plus my responsible adult STI screening. It will be really nice to have a general doctor I can rely on when general health issues come up, and not have to risk an urgent care or something similar unless it’s serious.

Next up on my agenda was a trip to my endocrinologist for my first HRT check-up. Once again, I had the pleasure of chatting with a young medical student. This one was a little more nervous talking to me, and she rambled during the history to cover her nerves. I felt a little bad for her. She lost her head for a second when her notes got the reproductive systems review portion, and she asked when my last period was, then panicked and blurted out “Oh wait, you don’t have a uterus, right?” Still not the most awkward encounter I’ve had with a med student, but still kind of silly. In the end, hopefully she learned something, and will be better able to handle her next transgender patient. Anyway, after my chat with nervous med student, my doc came in to do our quick check of progress and side effects from my current HRT regimen. I really enjoy talking to my endocrinologist. He’s been working with transgender patients for twenty years, and he seems so genuinely excited and happy to be a part of our transition. Anyway, I had my moved up my Estrace to 4 mg for 2 months, and then to 6 mg after that. But I don’t have to come back for 4 months, which is wonderful to hear given how busy my life is going to get here shortly. My estrogen levels are at 93, which is fairly good for a 2 mg dose. Testosterone is now well below normal male range, but still higher than is preferred at 1.1. But the increased Estrace dose should help push the T down even more, and the hope is that I’ll be essentially hormonally indistinguishable from a genetic female.

All in all, not a terrible day for having to spend a lot of it at medical appointments. It would have been nice to have gotten my eye appointment done today too, but alas, I couldn’t get in, so that’ll have to wait a week. I’m pretty excited about that one…I haven’t had an eye exam in about 5 years, so i’m sure my script has changed, and my new vision coverage has a pretty nice frames allowance. Hopefully I’ll be able to get some cute new glasses!

+60 Days from HRT Initiation, or “Hey ma, no testosterone!”

It’s now been 2 months since I started on hormones. I’m still on the “intro” regimen of 2mg Estradiol and 200mg of Spironolactone. I’ve generally been very good at not missing doses…just the occasional forgotten morning dose of spiro when I’m running late. Overall, side effects have been minimal…some cramping and some acne and a little more swing in my moods.

Noticeable effects so far are mostly mental. While I’m a little more emotional, I’m also a lot more…peaceful? Less inner conflict, more fuzzy hearts. My libido is absolutely in the toilet. It’s just not even something I think about pretty much at all (a far cry from life a guy). But there’s been a definite uptick in my cravings for physical affection…cuddles, hugs, etc. I’ve also noticed that my “drive” to want an emotional partner is stronger. Less aloof, more vulnerable. My body hair growth has slowed a bit. And I’m definitely starting to feel the tell tale signs of “development”, mostly sensitivity and a lot of soreness. Not much in the way of growth yet, though. Appetite is DEFINITELY way down, which I assume is due to my lowered metabolism. There have also been some odd changes to taste…less tolerance for the taste of greasy foods.

I should have had another endo appointment, but work got in the way and I had reschedule, pushing it back out to the 30th of May. I also have an appt with my new (trans-friendly) PCP that day. i’m very much hoping she’ll be able to take over my hormone maintainence eventually, since a visit with her is much less likely to trigger a cranky rejection from my insurance company than my endocrinologist, since he’s technically an OBGYN. I’m just hoping she’s fat-friendly/fat-accepting too. I’m getting really tired of every doctor on earth telling me that everything in world is caused by being overweight.

In other words, so far so good!