Tuesday, October 18, 2016

On Giving Up Testosterone And Forgoing Surgery (At Least For Now)

As a trans man I've been on hormones since December of 2011, or a little under five years.  Starting several months ago (and with little urges much longer before, some of which I noticed when re-reading blog posts recently) I started seriously considering stopping my testosterone injections, in favor of going back to being estrogen-dominant.  I've been going off of them for a couple of months now, starting gradually and now no longer taking any at all as of about a month ago.  So far the main effects of testosterone cessation have been:
  • I cry at weird times, but it's easy to control.
  • Hot flashes, which seem to have ceased.
  • Extreme changes in sex drive and sexual sensitivity (in a good way).
I talked a little about it on Facebook, which resulted in some of my long-time trans friends asking me why I decided to do this.  It's not an uncommon thing to do among trans men, but it's not something most of us talk about, and most of the people I've seen who go on T for a while and then stop have some sort of non-male nonbinary identity (later update: I've since started considering myself genderqueer, but still male; it's unclear to me how the hormone thing has contributed to that), stopped due to financial stress, or were forced off of it by incompetent doctors.  And although I'm happy to not have go give a few hundred bucks a year to drug companies, I could continue to afford it if I needed to, and my hormone doctor is in fact extremely competent in transgender hormone administration, being one of the most popular doctors administering it in the greater Milwaukee area.  I've had plenty of health problems aggravated by testosterone--something I'll talk about a little bit later--and not once has she suggested that I need to go off hormones because of them, dutifully treating each issue on its own terms as it comes along.

Before I talk about why I'm going off, I do want to mention a few things in support of hormones.  Testosterone therapy was one of the most profound and fantastic decisions I've made in my life.  When it comes to the changes that were important to me, I look exactly the way I hoped I would look.  This is mostly due to facial hair, of which I can grow an ample enough, and my voice.  Based on talking to other trans men who have gone off hormones for a variety of reasons, these are things that won't go away, although they might change somewhat.  But these things in the vast majority of trans folk assigned female are not possible without testosterone.  I've often gone on rants about so-called "natural transition," a program created by somebody who quite frankly just won the genetic lottery as far as pre-T trans men go and acted like it was a diet and exercise regimen that did it, because if you really want the effects of medical transition going on hormone replacement therapy is the only way to do it, as far as I know.  I'm a huge advocate of HRT for trans people.  It was fantastic.  I mention this because there's a tendency for people to think that going off of hormones is due to regret or something like that rather than the simple fact that I've gotten what I need from it and might not need it anymore.  I also will mention that this is all very experimental for me, and that there's of course a chance I will do as many other trans men and nonbinary trans folk have done and decide testosterone was for me and go back on it.

That run-on hell complete, what follows are the main reasons I decided to go off testosterone:  Needle Anxiety, Worsening Health Conditions, Pseudo-Spiritual Queer Philosophy, and Obnoxious Sexual Side Effects.

First, Needle and Injection Anxiety.

A warning that obviously this section has to do with needles, and it's extremely graphic.  If you have a problem reading about needle issues you can certainly skip to "Worsening Health Conditions."

I am actually one of the least anxious people when it comes to needles, among the pool of people who don't necessarily like needles.  I stopped being scared of them fairly early in life compared to some other kids, and my first self-administered testosterone shots went in really easy.  And going on hormones means a lot of shots, an intramuscular shot once a week for me as well as regular phlebotomies to manage secondary polycythaemia, which I'll talk about in the next section.  For the first few months, giving myself intramuscular shots was super easy, like I barely felt anything, the description "like a hot knife through butter" is actually a really good comparison.

After a year this was really changing a lot.  I started hitting hard spots in my right leg, and many of my injections faced me with the choice of pulling a needle out and starting over (my pharmacy only gave me a certain number of needles so I wound up ordering more because of these "misses") or biting my lip and just powering through the flesh when I'd hit a painful spot.  By the end of the experience I was picking the latter more and more, and with that most of my shots became "bad shots."  People who talk to me a lot probably are familiar with that... I'd have "good shots," which weren't very painful, didn't hit any calcifications, and didn't give me panic attacks.  And then I'd have "bad shots," which was everything else.

It was a combination of luck, toughening skin, muscle changes, and overuse of certain spots combined with an overactive imagination.  Again, the first shots were very easy.  I thought things like "Oh I could do this forever, no problem."  After a while I started needing to make changes... switching legs (not a bad idea anyway), pinching the skin, making sure I was sitting Just Right, playing foreign language music to psych my brain out, and having people watch me so my desire not to embarrass myself would take over.  But the bad shots still came, and were getting worse.  There were times it felt like I was cutting a steak with a dull needle, or I'd spurt blood and have a panic attack thinking I'd injected into an artery, or I'd get bruises that seemed to be permanent (I still have a mark from one of these instances that happened months ago).

I started responding to this intense fear by giving myself shots incredibly late, and then excusing myself thinking "if I do it now I won't be able to get to bed right away" and doing it the next day.  I'd find all sorts of excuses not to do it the day I was supposed to, up to and including ordering my meds the last possible minute so that I would have some time to wait until the meds got to my house.  My pharmacy and clinic didn't always like talking to each other, so sometimes this could buy me a week of lateness, not good for my body but still a relief for me psychologically.

I considered changing to subcutaneous injecting (as many trans men do now) or topical application, but the fact of the matter was that injection anxiety wasn't even the worst of my problems.

Worsening Health Conditions

I'm not super unhealthy, but there are some health conditions that I've struggled with since I was a teenager, mostly acne and high blood pressure.  Testosterone aggravated these to the point that I'm on blood pressure medication (although, to be fair, I probably should have been on it at like 19 years old) and sometimes the acne is physically painful.  The acne is more an annoyance than anything, but the blood pressure is barely controlled and just keeps getting higher.  I don't expect to get off meds any time soon, if ever, but I'm hoping going off of testosterone will help them be more effective and prevent me from having to take more of them.

But the thing I'm really worried about?  The secondary polycythaemia.  This is a common thing to happen to trans men, a condition in which our bodies start making more red blood cells and shedding fewer, which can eventually lead to a heart attack or a stroke.  This is just a pain in the ass for me to manage.  The treatment is simple and free for most people... just donate blood.  This is a serious problem for a queer man, who may wind up with a choice between:
  • Lying about his sexual history and donating blood.
  • Telling the truth and then costing the blood center money to do it for free after which the blood will be thrown away.
  • Getting a prescription and then billing insurance for it, if he has it.
  • Not getting blood taken away and hoping for the best.
  • Doing something weird as an alternative.
This decision was stressing me out so much that I shit you not I briefly considered finding a fetishistic vampire to relieve me of my extra blood cells, but most of them ironically do not take enough blood for me to stay alive, and besides, what vampire wants blood with the consistency of ketchup?

Again, are these problems particularly scary?  They're all pretty manageable, and I don't want to scare people out of taking T who need it.  But their management plus the needle anxiety just makes the continuing effects of T not worth the effort.  Basically "I have a deep voice, a beard, and a handlebar moustache, so why am I still doing this to myself?"

A connected issue is I'm starting to value my overall health in a way that reduced the importance of transition-related things.

A notice that this section talks about self harm; I start talking about the subject a little after my story of giving up binding, about when I start talking about surgery.

And that includes surgery, which I fairly recently decided I probably don't want.  And it's hard to explain from the position of somebody who is not "detransitioning."  Trans people are "supposed" to need transition-related healthcare (hormones and surgery) so much that we would sacrifice other aspects of our health, unless of course the alternative is literal death (and hell, maybe even if it is).  This was true for me early in physical transition, but due to issues I'll talk about in my last section that calculation has changed, and has been for a while.

The biggest first step that I took?  I stopped binding.  I haven't bound my chest in months, probably almost a year.  This was a rash but excellent decision.  I have an alternative work day with twelve hour shifts, and so there would be days I'd be binding over 13 hours straight, giving myself short breaks if I had a breathing-related issue.  I didn't bind tight, but I bound long, and it led to problems ranging from annoying to very detrimental to my health:
  • It was itchy.
  • It hugged my shoulders in such a way that it was aggravating shoulder problems.
  • It smelled gross, something I didn't even notice until somebody else pointed it out and I became eternally self-conscious.
  • It triggered anxiety-related breathing issues.
  • I was constantly afraid I'd get pneumonia or some other horrible illness.
One day when I was about to put it on before work, I said "fuck this," and just didn't put it on.  I put on my biggest work-appropriate shirt and just left.  After that work shift I went to replace my work clothes with similar but baggier clothes.  I changed the types of clothes I wore, and just decided outright to not give a fuck that it was possible to detect that I had breasts.  My breathing has never been better.  I can concentrate at work better.  I haven't looked back.

This inevitably leads to questions of surgery.  I noticed that, although occasionally I'll worry a bit, for the most part people either don't notice my chest or don't say anything, something easily credited to the rest of my appearance.  And the longer I go without binding, combined with generally not getting shit about it, the less I care about my chest in general.  It turns out--and again, I'll talk about this later--my dysphoria may have been more about how people perceived me than about how I perceived my own body.

I also finally started thinking about a particular surgery-related dilemma:  I am a dermatillomaniac.  I'm actually covered with fresh wounds because it's very difficult for me to not gouge and pick at any imperfection in my skin, whether a patch of dry skin, a wound, a blemish, or whatnot.  I have a beautiful tattoo that has some holes in it because of this (and allowing it to heal was an ordeal in and of itself).  Considering the fact that I am generally comfortable with my body now, is it worth the risk to get a surgery that may leave me with a giant wound to gouge out?  Will the resulting scars trigger me more than my breasts do?  Every once in a while people will ask me how on earth after so many years of transition I ever made any progress on surgery, even when I thought I really wanted it.  The reality is that this has always been a concern for me, and my current moratorium on trying to reach that goal is an extreme relief.

Next, Pseudo-Spiritual Queer Philosophy.

This part deals with two main issues.  The first is my continued diversion from what I guess is the party line of transgender discourse.  I do not, for the record, believe that anybody's narrative is incorrect for them, but the universalizing of The Transgender Narrative is frustrating and in many ways not accurate to my own experiences.  Right now the narrative du jour is that you're born the gender you identify as now and you go on hormones as fast as you can, because hormones are magical anti-depression juice and men are inherently uncomfortable and stressed out when estrogen-dominant and women are inherently uncomfortable and stressed out when testosterone-dominant, so you'll totally know right away if you aren't trans because hormones will make you depressed if you take the wrong ones.  And it's hard for me to express how absurd I think this is without insinuating I somehow think hormone therapy is optional for everyone.  It's not.  But there's more to it than just hormones affecting you psychologically, it's an individualized need based on a lot of different factors.

The more I think about it, the further I find myself from that narrative.  I was thinking, for instance, how different my life might be if I lived in a culture that had a deeply established and respected third gender category available to me.  Would I have been comfortable with that?  I can't imagine not being a man anymore, but I'm also fairly certain that in such a case I probably would have occupied that role and been quite content with it.  Or if I lived in a culture where I could be seen as a man without the hormones and the surgery?  I think maybe I could have done that, too.

I've become more comfortable with the fact that--even though I acknowledge that my appearance is fucking awesome, a miracle of modern science really--a huge percentage of my dysphoria actually sprang from cissexism rather than any intuitive sense of my body being "wrong."  When I see old pre-T pictures of myself, when I hear my old voice, I still hear a man, and was perfectly comfortable when in contexts where people acknowledged that.  Even the increased chest dysphoria I got shortly after starting hormones may not have been ingrained, but due to the fact that my changing appearance made things like that really stick out and look awkward to other people.

Again, this is an uncomfortable admission.  I'm supposed to have been inherently uncomfortable with my body and I'm supposed to feel inherently uncomfortable with my body being awash with estrogen, remember?  But I have to admit my own truth, and my own truth is that my need for hormones was probably mostly cultural.

To reiterate from before, I'm not advocating the replacement of one enforced narrative with another.  I'm saying that there are multiple ways to be a trans person, and mine is valid.

The spiritual aspects are hard for me to talk about because they're quite personal and perhaps triggering to other trans people, and they'll certainly come off as a lot of woo woo to a lot of you.

This involves the fact that I miss a lot of the spiritual aspects of having been estrogen-dominant, both as a woman and later as a pre-T man.  I miss things like mapping my cycles (it's probably odd to a lot of other trans men to picture missing menstruation, and I'm sure it'll be a pain when it comes back, but I miss it in my own way).  I miss some of the spiritual and psychological mysteries I lost when on hormones, like deja vu and lucid dreaming and an almost clairsentient level of empathy.  These were things that were for better or worse deep religious experiences for me that to some level went away after hormones.

This reminds me, there were some really weird sexual side effects, which luckily were some of the first things to come back after going off of them.  As a "no shit Sherlock" warning I'll mention that this section has to do with sex.  Weird sex.

One of the things a trans man warned me about when I first went on hormones was this:  "Your sex drive will make you feel like a bad person.  You are not."  I had a strong libido as a woman and so I assumed naively that it couldn't possibly get more extreme.  And, yeah, I was able to handle it, but... it was scary.  I went from having a lot of really weird but generally pretty standard fetishes (BDSM, soft vore, etc.) to stuff that physically and emotionally repulsed me, much of which I've only talked about to very close friends who were trying to help me through the goddamn thing.  I learned that this is common among testosterone-dominant individuals.  It's manageable.  But it blindsided me in a way that I never entirely got over.  Symbolic of this was the fact that suddenly I couldn't get off on normal written erotica anymore... and the visual stuff I was into started getting worse and worse.

But that's nothing compared to the physical stuff.  On testosterone I have a really hard time with physical intimacy with other people, even as the emotional aspects were fine.  It's hard to explain how you can want to orgasm all the time but somehow want actual sex with other people less, while also wanting other forms of connection with other people more.  Part of it was the frustration of having a hard time getting off on normal sex acts just on a mental level, this being combined with an intense lack of sexual sensitivity compared to before.  Alone it was frustrating to try having an orgasm--it took a long time and I would often go completely numb beforehand--but I also felt like I needed it to go to sleep.  With a partner it was doubly hard, often becoming painful before the end.  And vaginal penetration was something you could basically just forget.  It was painful and I'd often bleed from it.  There never seemed to be enough lube to get that job done.

This is the section currently giving me the most relief.  There was a point where my body very abruptly and without warning reverted to the way it used to feel.  I still have fucked up tastes but they're not as bad, can be assuaged with normal erotica, and it's no longer physically painful (unless I want it to be).

Anyway, lengthy though that was, it's the short story regarding why I went off hormones and what's changed about it so far.  Since it's not something I see people write about a lot, I'll try to update with how things are going, but for now this is all very new territory for me.