Go for Broke

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23 August 2018

One of my biggest fears in coming out was rejection. Rejection from family, friends, my employers, my community…, but you know, I think we tend to only hear about the incidents of violence and tragedy against trans-women in the news and never about the good things. Like when I first started living full-time as a woman I was at a restaurant picking up a to-go order and couldn’t seem to locate where to get my food when one of the restaurant staff, seeing my dilemma and I think also recognized me as transgender, said “Oh, Honey! They moved the pick up spot. Come on, I’ll show you where it is.” and grabbing my arm like we were old friends led me to where I needed to go. It was a simple every day moment, but it was acceptance from a stranger. I wanted to hug her tightly but I just collected my food and was on my way.

I had some very real terror stepping out into the world at first knowing that I looked OK but I certainly didn’t look like a cisgender women. I thought that in time I would be pointed and laughed at, possibly menaced, maybe assaulted and worse. I didn’t think that people might be OK with me, that they would maybe even be helpful. I thought that their perception of me would be that of disdain and disgust, but in reality it was my perception that was wrong. I was making a blanket assumption about people. People  that may also have gone through the struggle of rejection, or have been through difficult medical situations, or lost loved ones. We all just want to be accepted.

The process of transitioning isn’t just physical and mental for the person transitioning. There is also a great deal in changing the supporting documents that identify us. Our drivers license, social security card, insurance, credit cards, bank accounts, library card, membership cards…… the process of changing each one of those things brings you in contact with yet another person that you feel can scrutinize you. The fear in ones mind is very successful at imagining every possible worst case scenario.

There is also the process that ones family and friends must go through when someone they know transitions to their true and authentic self. My oldest brother, who lives about 500 miles away and hasn’t gotten to witness my gradual change, said something interesting the most recent time we saw each other. He said that he heard a counselor that advises on transgender individuals say “you need to change your expectations of your sibling’s future.” That’s very interesting. I really don’t know the process that those around me are taking in accepting my transition, but I hadn’t thought about how my brothers and sisters have thought about my future in relation to my transition. I mean, sure, it’s up to each of us to live our lives, but I guess in a way I do have expectations for the futures of those that are closest to me as well. I think about where they will be in five or ten years and if I will still be in their lives. But things do change whether we want them to or not. In a way there is a mourning for all things we perceive as negative change, whether it be a death or any loss for that matter. Transitioning is a rebirth for those that have lived lives against their minds and hearts, but it’s also a loss for ones siblings and parents, and sometimes children.

In the blog post “My Transgender Life — Transitioning at Age 64“, Grace Anne Stevens writes “for many transgender people the act of “coming out” and transitioning means to realize the loss of everyone and everything achieved in life,” I think the older we are when we transition maybe we have more to lose but maybe also much more of a reward to gain.

I feel very lucky and blessed in my transition. I haven’t felt the loss that others have had in their journeys to becoming their true selves. I still have my job and my spouse. I still have generally the same group of friends and maybe I’ve even expanded that group and  strengthened some of those bonds. But it’s a gamble, transitioning. You have to bet it all, risk everything, go for broke. But when you win, it won’t be a flashing light and ringing bell telling you that you’ve won the jackpot. It might just be a complete stranger taking your arm and accepting you as an old friend.

– Tiff

My False Start

I don’t know how it is for other trans people when deciding what they consider to be the “official” start date of their transition. I’ve had many firsts that I guess could compete for this, my first therapy appointment, my first endocrinology appointment, telling my family that I am transgender…

I used to think that the beginning of my transition was when I started on estrogen. The

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July 30th, 2016. My first day of estrogen.

date was Saturday, July 30th, 2016, just a little over 2 years ago. But that wasn’t really the start of my transition, or rather that was start, but it was the false start. Two years ago today, at just about the same moment as I’m typing this, I suffered a transient ischemic attack or TIA, otherwise known as a mini-stroke. I was talking with some people in my office and I stood up from my chair and my left side, from my foot to my neck, went numb. At first I thought it may be low blood sugar, something very common for a diabetic. However, when I checked my glucose I was in range. Then I thought that maybe it was low blood pressure. I’ve had a few instances of feeling dizzy from this and would need to eat something salty to remedy it. I got myself a bag of chips and tried that, but I was still numb and a little “off”. I considered a stroke but I wasn’t having any slurred or confusing speech, and I had no trouble with muscle control. I decided to leave work early as it was already late in the day. I picked up my wife and we headed home. As we were exiting the freeway, the left side of my face became numb, so we headed straight for the hospital ER which is less than a mile from our house.

 

We got into the hospital and told the ER admitting nurse that I was concerned that I was having a stroke. I’ve never had such a rapid response for a medical situation as I did this day. I was immediately wheeled into an ER room. A team of about 6 medical professionals swarmed the room asking questions and hooking me up to monitoring equipment. I was given a shot of tPA (tissue plasminogen activator), a chemical administered immediately after a stroke that will dissolve a clot and improve blood flow to the part of the brain being affected. This has to be administered within three hours of a stroke for it to be effective in preventing damage to the brain. I was then given rapid tests including a CAT-scan and an MRI. While I was laying in the ER I could feel another wave of numbness hit my left side. They wheeled me into the CAT-scan room again right away to see of they could catch it happening, but nothing showed.

I spent the next two days in the hospital having tests run including an echo-cardiogram, which turned up a PFO (patent foramen ovale) in my heart. A PFO is a hole that exists between the top atria of the heart. It’s actually present in everyone while in utero. It allows blood to flow through the heart and bypass the lungs which are not functioning yet and won’t be until the baby takes its first breath. After birth, the foramen ovale closes within months and heals in all but about 25% of people. This is not a problem most of the time unless there is the presence of blood clot.  Luckily, after months of testing, it was determined that my PFO had in no way contributed to the TIA, however it was determined that my taking estrogen for my transition was the cause. Additionally, further MRI testing indicated that I suffered a non-event stroke at some point in the past (maybe 10-20 years). And while there should be no lasting physical effects from a TIA I had and still have numbness or paresthesia in localized areas on my left side.

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My wife helping me walk down the hall in the hospital.

After leaving the hospital I needed a cane to walk for a few days. The numbness in my left foot required me to get used to feeling the floor again. At first I was unsteady but was able to shed the cane eventually even though I still have that numbness in my foot.  It’s also still present in my left hand and torso.

 

The glorious start to my transition was turning into something like a scrubbed NASA launch due to a mechanical failure. I had to make the tough decision to not continue HRT (hormone replacement therapy) for my transition. That was an emotional time for me.  I had finally come to terms with the fact that I was and am transgender, I had come to terms with coming out to everyone as transgender, and I had overcome all the hurdles both medical and administratively to begin taking estrogen. And for 10 wonderful days I felt “normal.” I never realized how jittery I’ve felt my entire life until I had finally begun balancing my hormones with how my brain saw myself. Everything had finally started to feel right and then I had to decide to give it up. I appreciate my doctor for giving me the reigns in making that decision. He allowed me to decide, even though he knew that if I did continue taking estrogen I would be playing Russian Roulette with the chance of another TIA or stroke. It was hard. It still is.

Later that year, in November of 2016, I was able to begin testosterone blockers. They have some very beneficial side-effects such as lowering high blood pressure, slowing my leg and facial hair growth, clearing up my skin, and they have also given me some slight breast growth! My doctor has slowly increased the dosage of this medication to the typical level for a transgender female.

Being limited in my transition options I decided that I wanted to start living as Tiffany as soon as I thought I could pass in public on a daily basis. I finally decided on Monday, July 25th, 2017, almost a year from my “false start.” I now consider July 25th, 2017 as the true start date for my transition, but August 10th is forever present in my memory just as the numbness from the TIA is forever present in my body. But becoming my authentic self has been the greatest reward I could ever have achieved and I’m not going to let anything stop me now!

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– Tiff

Around My World in 365 Days

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July 27, 2018

This past Wednesday, July 25th, marked my one year anniversary living as my true and authentic self. It wasn’t just a lap-marker for my journey as a transgender woman; it also fulfilled one requirement, an important requirement, in the medical transition of a transgender person. W-PATH Standards of Care (V.7) state that:

“Genital surgery should not be carried out until…patients have lived continuously for at least 12 months in the gender role that is congruent with their gender identity.”

Similarly, my insurance company’s guidelines for gender confirmation surgery require that a potential candidate must:

“Complete at least 12 months of successful continuous full-time real-life experience in the desired gender.”

So this is monumental in my journey to become my authentic self and in feeling normal in my body. But it’s not just a light switch date. Like all good things it’s a process and a journey. Like any other journey, the journey of marriage or the journey of education, or the literal journey of a trip, it’s filled with activities and events that help get you to that point, and I’ve had my share of activity this past year.

One year ago I traveled to visit one of my “Besties” in California. It was a two-fold trip to see her and also to solve a major problem with being able to begin living full-time as a woman. About 10 years ago I started suffering from the common problem of hair loss. I have the all-to-familiar “widows peaks” and a thinning crown. With a buzz-cut I could play a monk very easily. Not a very feminine look, Sinéad O’Connor jokes aside, so I went to visit my friend and also find a hair solution. She asked a friend of hers who is a make-up artist in the entertainment industry to recommend wig salons. We hit a jackpot with the first one we visited, The Wig Shop on Wilshire Blvd. I walked in, explained my situation, and a wonderful woman named Amber helped me with the perfect crown topper that matched my hair color perfectly. She set me up with shampoo and conditioner and details on how to care for my new purchase. I was so elated that I wore it out of the store and I felt so much better about my appearance even though I was presenting make that day. The next day I went to my friend’s stylist Sara for a trim and style to blend my new hairpiece with my actual hair. It was perfect! It is what I wear today and is virtually undetectable. It was exactly what I needed to feel comfortable presenting female full-time. I flew home the next day ready to begin the first step of my new life.

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July 25, 2017 was my first day living and working as Tiffany. I hadn’t had my official name change yet but I was finally living full-time, 24/7, as a woman. At that point I had only been through half of my laser facial hair reduction sessions. I was going every 4 – 5 weeks to have the 15 minutes procedure performed. Because I still developed a “shadow” when it got close to my next appointment it meant I was wearing a pretty good coverage of foundation. I continued the laser sessions until February of 2018 at session 11. I had to cease the treatments prior to my facial surgery, but all-in-all I have achieved about 95-98% reduction in facial hair growth. I still shave every morning with an electric razor but only to catch the minimal growth which amounts to about a dozen or so hairs that pop-up. Now, unless I am going to a formal event, I don’t even wear the foundation makeup or even powder. I’m pretty confident in my appearance.

I remember feeling nervous and excited that first day at work. Everyone at my job had known for months that I was going to be transitioning so it was really that anxiety of doing something for the first time that was making me nervous. There were even a few work parties previously that I had attended as Tiffany. I survived that first day of work, and the next, and the next… It has taken some getting used to. My strength has steadily decreased as the Spironolactone has been working on suppressing my testosterone. That part has been an education for everyone. Using the women’s room was also an anxious event for me at first. The medication I take is a diuretic so I make trips to the loo quite a bit. But that too was no big deal. I had been accepted by my coworkers already and everyone was wonderfully supportive.

In October of last year I had my legal name change. It’s not an easy or quick process. There’s the usual paperwork to be submitted and a court date that is scheduled in the near future. The most ominous part is having to publish the court date in the newspaper for three consecutive weeks declaring that you are changing your name. It makes you feel like you’re the bride or groom at a wedding when the officiant says “if anyone has reason why this union should not happen…” and everyone holds there breath and looks around. Those three weeks I felt like someone was going to come out of thew woodwork and declare a reason why I couldn’t change my name to better align with my identified gender. It also makes you feel like you’re under the microscope because in the newspaper it clearly states that you (male name at birth) are changing your name to (female name that aligns with your preferred gender), and it makes you feel, well it made “me” feel, like I was going to be put on a list of “those” people, the “transgenders.” But I survived and had my court date. On Tuesday, October 17th I sat in a court room, just the judge, the court clerk, the court reporter and me (my wife was travelling out of the country and couldn’t attend). The session is very legal and formal in nature. Everything is recorded. Your voice is amplified by a microphone which you need to speak clearly into. It feels like a senate hearing and you’re the one on trial. After the legal part was over the judge said, off the record, “That’s such a formal process for such a momentous event. Congratulations” I cried. Later that day I was able to get my new Driver’s License with a corrected name and gender. It was a little more involved with Social Security. For that I had to obtain a letter from my Doctor stating that I had satisfied specific requirements for him to declare me legally female even without surgical procedures. According to my endocrinologist, more and more transgender people are forgoing gender confirmation surgical procedures. There is more acceptance in a person keeping themselves biologically intact while still identifying as the gender opposite to which they were assigned at birth. The amendment of other records have different requirements based on the state in which you live. For my birth certificate to be amended with the correct gender I have to wait until I have genital surgery. This is the State law in Wisconsin. I do have an amended birth certificate with my new legal name but the gender still states male. That’s OK. Baby Steps!

In March 7th of this year I underwent facial feminization surgery or FFS. The procedure[s] involved having the most prominent and telling male characteristics of my face softened so that I would not be misgendered. For this I traveled to Beverly Hills, California to the skilled hands of Dr. Toby Mayer of the Beverly Hills Institute. I had researched several plastic surgeons who specialize in FFS, but I really liked Dr. Mayer’s work. He seemed to be able to keep a person looking like themselves but softer. I think a lot of people thought that I would come out looking like a completely different person, but I still look like me. I certainly don’t look like the person I have lived as for most of my life but I still look like the person I was born as. I look like the female version of myself.  I had my brow ridge shaved down and eyebrows raised to place them into a more feminine place. My nose was re-contoured and straightened. And my upper lip was lifted and augmented with fat from my thigh. I am extremely pleased with the work that was done. I do have some other features that I would like softened but I need to wait a full year from the first surgery so that the changes that were made are fully healed. In the future I want to undergo a scalp-hair transplant to “fill-in” those thin and bald areas that are requiring me to wear a hair piece.

In mid-April I had a visit with a plastic surgeon in Madison, Wisconsin at the University Hospital. Not only is she a surgeon but also faculty at the University. She focuses on gender affirming surgeries from top and bottom surgery to facial feminization. I really like her and am proceeding with my plans for gender affirmation surgery before the end of this year, which brings me full-circle to the beginning, specifically to the point that I “have lived continuously for at least 12 months in the gender”  in which I identify.

And so I continue on my next 365 days and the continued alignment of my body, mind and heart. Thank you all for listening and encouraging me on my journey. I hope that my openness to present my transition helps demystify and humanize the transgender community. No matter if we are male, female, black, white, gay, straight…we all want to belong and be accepted.

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Thanks! – Tiff

The Boys Club

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July 14, 2018

The other day I was reflecting on the fact that for 46 years while I was presenting “male” I held a certain amount of privilege. Not white privilege, which I whole-heartedly acknowledge exists, and which I’ve witnessed first-hand. I’m talking about the privilege that exists between male versus female.

When I was younger I used to watch a black and white television show called Our Gang, later known as The Little Rascals. It aired from the 1920s thru the 1940s and featured a young group of kids and their adventures. In one episode the boys establish the He-Man Women-Haters Club. It was a cute plot device and I would jokingly flash their club sign, a hand brought up to the chin with fingers extended and wiggling, almost like a comedy beard fiercely waving in the wind, to some of my friends over the years. It was one of those things you do or did, like a catch phrase or goofy hand shake. But the fact is that I’m no longer entitled to that club, to be in the “boys club.” I mean, I’m really fine with that, but I never realized the unspoken privilege of being a male.

In a week and a half I will have completed my first year living as a women. In that year I’ve experienced some of the less savory aspects of attitudes, spoken and unspoken, toward the female gender. I’ve been whistled at from a passing car. I’ve been followed closely from behind at the grocery store, a little too closely. I’ve received a d*ck pic through social media. I’ve been looked up and down by men like I’m being graded by the USDA. There was one occasion when I accompanied my wife to a conference where she was the keynote speaker. I was wearing a very pretty black and white polka-dotted dress that admittedly showed a little leg. While walking through the large conference center hallway toward her presentation room I observed several men eyeing my legs and not one of them ever looked up at my face. Sure it was a little flattering and a bit affirming that I was perceived as a female, but also very revealing to me as to one of the things that women routinely experience.

You know, while living as Tom I guess I just never had to feel like I was in danger too often. Or have to assess any situation I was entering whether it be a conversation, meeting a new person, or where to walk, or park my car. I’m acutely aware now of the change in some people’s body language and demeanor toward me, at least now that I am an “out” and transitioning transgender woman and no longer a “man.”. In some circumstances I’m no longer engaged in conversation the way I used to be. And in some I’m not even “allowed” into the conversation. Is it because I’m now seen as a woman or a transgender person? Often I find that I am left standing to wait until I am addressed or until I perceive that it is appropriate for me to speak. That’s fu**ed up! My thoughts and ideas are just as brilliant and valuable as they were before I was Tiff, possibly even more so now that I have had the chance to exist in both gender roles.

Honestly and sincerely I’d like to say to all of the cis-gender women that I’m sorry if I have ever “mansplained”, or talked over you, or didn’t acknowledge you. When the #metoo movement began and many women started speaking out about there experiences I had pause for reflection as to whether or not I had ever been inappropriate as a male. I asked my wife and several of my very close female friends if they had ever recalled instances of my doing so. They’ve all assured me that to their knowledge I never had. I wonder if it’s because I never really felt like a male so I never acted that way. I also think that my Dad was a good role model and teacher for how to act toward another person, not just the opposite gender.

It’s been an eye-opener during this Freshman year as a woman. I do feel fortunate to be transitioning during this empowering time for gender expression and gender-fluidity. There’s a great bond not only within the groups of L, G, B, T, etc… but also between them. Knowing that someone has your back even if you don’t know them is a pretty awesome thing. It’s like being a card carrying member of an exclusive group with millions of friends that you’ve yet to meet.

It’s not like I always feel like this powerful female or empowered trans-woman though. I certainly don’t feel like a male, but there are days when I don’t feel like I belong anywhere. Like I don’t exist as a man or woman, or even gender non-binary. But, that’s a rabbit hole that I don’t let myself fall down. It’s too dark and full of snares. But I do struggle daily with my identity. I’ve been assured that I outwardly appear female, something that is very important to me. Not all transgender people want to “pass” but I do! It’s important to me. There are days when I look in the mirror or see my reflection while passing a window and think, “I look good! I look feminine.” But most days have me wondering if everyone I meet views me as a male. It’s all a journey.

Perhaps that journey of transitioning physically and legally from male to female is just one aspect of the journey and not the entirety of it. I have been under the impression that once I’m done, I’m “done.” That after gender affirmation surgery I’ll be a woman. But I think the journey that I’m on, that we’re all on, to find ourselves, transcends self-discovery at the gender level. For those of us open to it, I guess we’re all still figuring out who we are as a people. The greatest hope is that one day everyone can be enlightened to themselves and to those around us regardless of gender. And that maybe then none of us will be made to stand waiting to be accepted into the conversation.

– Tiff

I Had Help

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July 7, 2018

I get comments all the time like, “I wish I could do makeup as good as you do.” or “Where did you learn how to do your makeup?”, or “Can you help me with my wardrobe?”

Frankly, I’m doing the basics for makeup! I couldn’t do a glam eye if my life depended on it. And for clothes, I am buying what I like and what I know fits my body. I’m working against the lack of some things that cisgender woman have like natural hips and bust, but I’ve learned what to do to make myself look and more importantly feel like the person I want to be.

But here’s the thing, I didn’t arrive at the point where I am by myself. I had help! I may not have learned that I was transgender until I was 46, but I have been mimicking and learning things about being a woman for at least 30 years. I had been crossdressing, if you can even call it that, a very long time. I mean, clothes are clothes. In the early days it was a bit of a thrill to get dressed up and maybe go for a drive just to feel what it was like for other girls. And on my first outing to an lgbt+ club I was very nervous. I had tried the trick of gluing my eyebrows down with an Elmer’s glue stick, applying thick foundation on top and then drawing thinner ones back on. Within an hour they were popping up looking like plants sprouting in a garden! I also wore some Aldo almond toe black patent wedges. I teetered from the car several blocks away down to the club and flashed my “male” I.D. It wasn’t for a few years that I learned about heel placement on a shoe and which tall pumps are easier to walk in, something I see young girls downtown haven’t learned yet. That one is a small personal triumph in my effort to catch up!

Even in those early years I had help. When I met my wife we were just friends. We had both come out of difficult relationships and neither of us was looking for a partner. I had found out through my past failures that honesty was best, so even as friends I told her that I had a feminine side. She admitted to me that she had had previous relationships with both males and females. So we knew that we were cool with each other and each others pasts and presents. She helped me out and supported me when I would want to try a piece of clothing or buy a pair of shoes that I would only wear around the apartment. She is so important to me and my development as a woman. We really do have a “partnership” and I think that neither of us could be as successful in any of our endeavors without the other one.

My wife, self-admittedly, is not the girlish of girls, and our styles a very different. She likes baggy clothes, long tees, Doc Marten boots, most of it all in black. She’s very much into the Lagenlook, and her style fits her perfectly! I am much more “girly” in my style. I love heels and short skirts and dresses. I have an entire drawer dedicated to tights and leg coverings. I enjoy form-fitting attire, and I LOVE the color pink! But I certainly didn’t come by this style on my own. I had help.

When I was 35 I had already been working at a summer festival for quite a few years. and I had met this young 18 year old girl who had just graduated high school and had come to perform for the summer as a fantasy character. My job was to apply her makeup using an airbrush to paint her face. We spent hours every morning talking and getting to know each other. She had a maturity unlike anyone I had met at her age. She had a compassion and understanding. And she had a brightness to her. Not just her face and demeanor but her soul. through our morning chats we learned about each others histories, our hopes and dreams, and our plans for the future. It was easy to confide in her and we just “clicked.” She was the one to tell me that I was OK, that there was nothing wrong with the person that I was. This person 17 years younger than me normalized and validated me for “me.”

She became a frequent friend year round for my wife and I. While in college she spent a lot of time talking with my wife and I about life and the future. We would never “tell” her what to do. When she would ask our advice we would always respond by telling her what we did at that age and in that situation. It was important to us to let her be her own person. Over the past 13 years she has grown into a very important friend for us and now so too is her husband and her family as well. They’ve become the larger family that we’ve found in addition to the families that we were born into.

She is the one who has helped me immeasurably. She has been the one to teach me makeup tips. She was the one to accompany me the first time I went out in public as Tiff. And she was the first one to refer to me as transgender. She told me that she had been talking to someone and referred to me as her transgender friend. After telling me about this conversation she asked, “What do you think?”

Wow!

Transgender.

Was I?

It was after that that I began looking into therapy and learning what it meant to be transgender.

But here’s the thing, if I hadn’t met her I don’t think I would’ve ever started on this journey and would have just lived out my life with all of the stress of not living authentically. Early in my relationship with my wife she would ask if I ever thought about “transitioning” but I never equated it with being transgender. In those days my understanding was that a male went through sexual reassignment surgery and then lived as a female. I didn’t understand that I may have been assigned male at birth but my brain and my identity had been female my whole life. This young woman who was almost two decades my junior in many ways was my savior. Without her help my quality of life would have continued to be stressful and in a quiet sort of way, sad. I’m very fortunate to have both her and my wife as my confidants. They both have helped me. I certainly could not be who I am today with out their help and support.

I also don’t want to forget my medical team who has been so wonderful and work together for my whole health. They have helped me very importantly. After I had started on estrogen and had a TIA within a couple weeks, my endocrinologist, who monitors both my transition and my diabetes, asked me about the idea of continuing hormone therapy. He didn’t “tell” me to stop, even though he knew that continuing on estrogen would probably lead to more and possibly worse strokes, he “asked” me. And I knew the answer. I knew that restarting the estrogen would be a huge gamble with odds that weren’t in my favor, so I stopped. That was a very difficult decision. It took me over four decades to figure myself out and I had to abandon the course of treatment that would finally allow me to be who I was supposed to be. I still have permanent damage from that mini-stoke. It would have been easier for him to make the decision so I could complain that it wasn’t my choice, but it was my choice. And he allowed me to make it. To be clear though, I’m a good patient and I’m not just tooting my own horn. I have a journal that I keep for my medical visits. I know when each appointment is or was, with whom, where, and an after visit update. I also have most of my test results for lab work either graphed or I have access to them. That’s my responsibility. But again, I couldn’t be where I am or who I am without their help, from my family doctor to my therapist.

So I had help.

Not being able to progress along the traditional route of Hormone Replacement Therapy (HRT) narrowed my choices for transitioning. Estrogen not only begins the process of breast growth among other things, but also softens the skin and redistributes body fat in the mid-torso and more noticeably in the face. It helps sculpt the face into a more feminine form. Having this option closed for me guided me toward Facial Feminization Surgery (FFS). When I started looking into this procedure, or procedures, I quickly realized that they were beyond my reach. Insurance does not cover facial feminization claiming that it is “cosmetic.” A dear friend suggested that I start a crowd funding campaign to help me get to my goal. I was reluctant at first but she convinced me that people would want to help. And they did! I was able to raise 50% of my surgery cost. Loans helped me cover the rest. But again, I had help, from those that donated to my campaign to the bank loan manager who was extremely helpful in finding creative ways for me to achieve my goal.

I continue to have help. When I look in the mirror and the voices in my head say that I look that same and that no one is fooled my wife is there to help. When I have to confide in someone about my fears my therapist is there to help. When my medication levels need adjusting to keep my diabetes in check and keep my transition progressing my endocrinologist is there to help. And when I need to ask advice on experience with this whole process of becoming the “real” me I have support groups to help me.

So don’t be fooled by what you see. I didn’t get here alone. I had help!

– Tiff

It just takes time

ItJustTakesTime

25 June 2018

I first came out to a family member who happens to also be a retired therapist. I remember them saying in regards to transitioning that, “It takes time!”

And it does!

Whether or not you are ready for hormone therapy, or gender affirmation surgery, or living full-time in the gender in which you identify, it all takes time. I started this journey in late 2015. It took months just to locate a therapist who specialized in gender dysphoria and then I had to wait for an available appointment. And really, It’s not the actions that take time but the space in-between.

I’m currently in one of those spaces in-between. I’m in the process of planning my top and bottom surgery and I’m hoping to have them done at the same time. I had an initial meeting with the plastic surgeon whom I absolutely loved and definitely want performing these procedures. At the moment I’m in the process of getting my letters of approval from two therapists. I will be eligible for gender affirmation surgeries in July 2018 (next week!) when I will have completed a full-year living 24/7 as Tiffany and as a woman. W-PATH standards of care dictate that this must be accomplished before a person is eligible for genital surgery.

I’ve been trying to get a jump on things because I first need to know what, if anything, my insurance company will cover. After that I’ll have a better idea of how to schedule it with as little impact to the rest of my life as possible. I know that this will all happen very soon and that next year at this time I could have all of my transition surgeries completed. I’ll no longer be “in transition.” I’ll just “be!”

I love that the terms for these surgeries has changed from SRS or “Sexual Reassignment Surgery” to GCS/GAS “Gender Confirmation Surgery” or “Gender Affirmation Surgery”. It’s about “affirming” what the person is feeling inside. It feels more nurturing.

It’s been 15 weeks already since I had my Facial Feminization Surgery. It seems like it was only yesterday that I was just beginning my investigation into prospective surgeons for facial surgery. I couldn’t be happier with what the doctor was able to do for me. Sure I’m still unhappy with certain aspects of my appearance but that’s gender dysphoria. The benefit of having had facial feminization surgery is that I’m no longer misgendered. My wife and I have resigned ourselves to the question of “separate checks?” when we’re out to eat. Let’s face it, Milwaukee, Wisconsin is not the hub of alternative lifestyles. I haven’t been publicly shamed or threatened from being identified as trans but it is nice to be referred to as “Ladies” when we’re out.

But let’s get back to time, or really, let’s get back to patience. For those of us in transition or those of you just beginning your transition, it is all going to take time but it WILL happen. I’m already two years into my journey, two and a half if you count that first time I revealed my true self to someone in my family, and I can’t believe how quickly this is all moving.

To help me with my patience while waiting for the next operation or appointment I’ve found ways to occupy my time . I’ve been doing my own research into what’s available for transitioning, especially being a non-HRT transwomen who can’t benefit from the softening effects of estrogen. It may not be important to others in completely “passing” as a cisgender woman, but for me I want to appear as naturally feminine as I can.

Some trans-people want to sound more in-line with their chosen gender. For trans-males, I believe testosterone will assist in the deepening of the voice. For trans-women who have already gone through puberty there are the options of vocal training and voice feminization surgery.  Voice feminization is not a new or experimental procedure. The surgeon who performed my facial surgery has been performing voice feminization for 15+ years. The Yeson (Yay-Zahn) Voice Center in Korea (yesonvc.net) appears to represent the Rolls Royce of voice feminization options. A YouTube search on “Yeson Vocal Feminization” will return an impressive list of pre and post examples.

I’ve had people say “Well, you’re not going to do that are you? Your voice sounds fine!”

Yeah, sure, my voice sounds fine. These are also some of the people that said, “You don’t need facial surgery! You look fine!” This is for my benefit beyond it being for anyone else. I think that’s something that needs to be expressed more, that any and all of these surgeries or even hormone therapy is about allowing the trans-individual to feel more “normal” or more “in-line” with the gender in which they identify. It’s for them. It’s for me.

So I think patience presents itself to us in multiple ways. It take patience during this period of transitioning when we are chomping at the bit to get everything done so we can feel “normal.” We need patience for wading through the insurance red tape. We need patience to find the right doctors and determine the right procedures. But there is another kind of patience. It’s the patience we need to summon for those around us. We may have known inside ourselves that we didn’t feel complete for a very long time, and now we’re ready to hear the starter pistol so that we can run as fast as we can to our finish line. In my case it took me 40+ years to figure it out what was “wrong” with me, what didn’t connect in my mind and heart. But even though we may just have found our solution, our “ah-ha!” moment, and now we’re ecstatic about it, it may take a while yet for our friends and families to come to terms with what we are revealing. They may only hear the part about our changing from someone they’ve always known, or the person they think they’ve always known, to what they think will be a completely different person that they won’t recognize physically and socially. They may not see that this new person is the true person, the “complete” person. You’ll need patience to give them time and possibly gentle reiteration about our lifetime of uncertainty and unhappiness, and of this new hope. It will take patience for allowing them to get used to the new name and pronoun. For some of them it may never happen. They may not like to “real” you. That will require you to have patience with yourself. But it’s OK. You can’t force anyone to like you anymore than you could have forced yourself to like and tolerate being the incomplete person you have had to be for however long. In the end your patience will teach you that life is short, that there are many people there to help you along your journey, and that finding yourself and making yourself “whole” is worth all of that patience, and yes time. And when you are whole and complete, friends, family and even strangers will see a truly happy person. And those that have known you for any length of time won’t be able to ignore the fact that you are a happier, more complete, and authentic person. The won’t be able to ignore that any more than a moth can ignore a flame and neither will you!

~Tiff

 

Who am I?

whoami

April 28, 2018

Prior to my facial surgery a friend asked me, “When you look in the mirror do you know who you are?”

I was puzzled. I wasn’t sure I understood the question and I certainly didn’t know the answer. I guess prior to discovering that I am transgender I wasn’t really sure who I was. I have my likes and dislikes. I enjoy windup phonographs, repairing them and playing them. I love metal detecting. I love history, all kinds. I love music, singing it and playing it. I love all kinds of art from the great impressionists through pop art and modern art, even some performance art, and especially little kid’s art.

But those are things that I enjoy. Is any of that who I am?!

Even now, after living for 9 months as Tiffany I’m not sure who I am. Of course I’m still in flux with more surgery possibly before the end of the year. But surgery doesn’t define one. It’s interesting that I never think of my diabetes, which I’ve had for 34 years, as part of who I am, or what defines me.

So, who am I?

If I search myself now for an answer I guess I’d say that I am someone who is concerned with other people’s feelings. I try to think of another person’s perspective. I try to do good. If I have extra I will gladly give to someone in need. If I won the lottery I think I would donate a lot to well-run charitable organizations and medical research. I would love to start a company to produce a generic insulin for diabetics in need.

Who am I?

Hmmmm, well, I’m very concerned with my quality of life especially as I age. My family genetics is not great. It’s not as bad as others, but it definitely worries me and how it will affect those that I love and am around.

I’m not all that religious. I was baptized and confirmed Catholic. While in my early 20’s I jump started the folk choir at my church. But I have questions with my relation to the church as a whole. I do believe in something, but I guess I categorize myself as agnostic. I definitely don’t agree with the some people’s use of religion and not just here in the USA. Any group that uses their religion or religious stance as a reason to hate anyone else is contrary to the love that most religion’s preach. But I don’t want to get into religion or politics. I am not intelligent enough on either subject.

Recently I was talking with a friend that I met in college years ago. They were talking about my writing style and how easy it seems to flow. I admit that this is the easiest I’ve ever been able to write. I used to carry a journal with me all the time. It started around the sometime in the early 90’s. I wrote all kinds of things from journal entry’s to words or phrases that people would say. The thing is that I always wrote in the style of the author of a book that was then reading. It wasn’t “my” style. Now I am finally writing in my own style, in my own hand.

Another thing is that I never, ever wrote about my feminine thoughts. I never put down to paper the fact that I wore female clothing in secret, or that I had an internal dilemma with posing as a put-together male on the outside but having a feminine mind and thoughts inside. How could I? It would be the end of existence if anyone accidentally read that! They could read anything else; who I had a crush on, what I had for lunch, what train I rode, but not who I truly was. So I wrote about fluff, about facts, but not about my feelings. Not about me. I think that says a lot about who I am, or who I was.

As the saying goes “Write what you know.”

With my revelation first to myself and then to the world, my world, that I am transgender, I can finally be more “me.” I’m finally writing “what I know.” I don’t think there’s any way that I could be more vulnerable. Even before I took the steps to reveal myself I had always admired anyone, gay or lesbian, for “coming out.” They put themselves out for ridicule, harassment, abandonment, bodily harm, to be who they really are. They are true heroes to me. They are the people in my mind know who know who they truly are.

So now my writing flows because I am living true as myself and I’m writing what I know and what I’m no longer afraid for anyone else to read. I’m on my true path to find out who I am.

Are you?

– Tiff

My Surgery Consultation (caution: graphic surgical terminology ahead!)

barbie.png

April 21, 2018

When I first thought about how much I wanted to tell people about my transition process I was hesitant to reveal the details of both my top (breasts) and bottom (genital) surgeries. Like, do I really want to tell that much about myself? But, isn’t that the whole point of this blog? I mean, I wanted a place to log my transition, but I also wanted this to be a resource for other trans-individuals, friends, and families of trans-folk and everyone on this planet. When it comes to talking, or more to the point, asking someone about their top and/or bottom surgery, generally it’s not something one should do. It’s a social faux pas, a no-no. It would be like asking a married couple how they have sex. It’s personal.  But, I really want this blog to be open and honest.

With with all of the blogs and forums out on the internet, it has been difficult even for me to find out what I want and need to know about these surgeries. Interestingly enough, the people that I have surrounded myself with to aid in my transition don’t have all of the answers either. They do know their part of things. And I liken it to the crew on a submarine. No one person operates a submarine. There is a main officer, a helmsman, crew in the engine room, a navigator, and so on.

For my transition I have a therapist to help me with my emotional and mental state, and to make a formal diagnosis which is required for making the legal change as well as beginning the medical portion of the transition. I have an endocrinologist who assists in the prescribing hormones and in my case testosterone blockers for transition. An endocrinologist is also the type of medical specialist that a diabetic would see to help control insulin levels so I benefit two-fold from seeing an endocrinologist. I had/have a plastic surgeon who performed my facial feminization surgery. And now I am employing another plastic surgeon who is trained in the medical practice of changing the primary and secondary sexual characteristics for a transgender individual to the characteristics of the gender to which they identify.

Each of these individuals is an expert in their own right but not necessarily the bearer of the keys to all of the knowledge on every aspect of transitioning. I have had to scour the internet and talk to my medical team to piece information together. I admit I haven’t reached out to my local LGBT center but I guess in a way I don’t feel like I belong there. Not because they have given off that vibe but because I feel like I’m in a kind of floating limbo. Half in and half out of cis and trans. This is my own hang-up really and I suppose one that I should bring up in therapy next time.

Yesterday I had a consultation with a female surgeon in Madison, Wisconsin. I live in Milwaukee, about 75 miles east of Madison. I’m so fortunate to have a gender affirmation surgeon this close to me. Not only is she a practicing surgeon but also a teacher at the University Hospital. In fact, most of my medical team is associated with medical colleges, another aspect of my health care that I am fortunate to have, and one which I feel is very important in my overall health care.

The first thing that I’d like to say is that the nurse that I met with prior to seeing the doctor introduced herself and said, “My preferred pronouns are “she” and “her”, what is your name and preferred pronouns?” This is such a wonderful way to instill a sense of confidence in my choice to see this doctor at this facility. I think so many people feel that they don’t have a choice in their medical care.

Over the years, through a very long medical history of doctors, I have developed the view that I am more the customer than the patient. I am the one paying for the service of medical care. I also am very well informed about my body and my medical needs. I have “fired” doctors from general care physicians to specialists when I am certain that I know more about my specific needs and when I feel that they are contradicting me. I don’t want to give anyone the idea that I am a know-it-all but when I am prescribed a medication that I know would interacts poorly with either a medicine that I am currently taking or one that would negatively impact a surgery or health care path that I am currently working toward. Example; within the past few years I was prescribed a maintenance medication by a specialists that I had seen a total of three times and about 5 minutes each time. After that visit of being prescribed the drug in question I went home and researched the medication only to find out that once on it I would experience increased risk should I ever cease taking it. Additionally, it would complicate any future surgeries. I messaged the surgeon with my concerns only to have his assistant tell me to “just start taking the medication immediately.” I sought a second opinion at a completely different hospital where I was given a diagnosis contrary to the initial one and more in-line with what I felt was improper.  To be clear, I wasn’t just looking for a doctor to tell me what I wanted to hear. I was also doing my research on my own and taking a risk that what I was doing was the correct path. But remember that you are responsible for your health with everything from what you eat and drink to whom you seek for your health care. I see any one of my doctors about every 3-4 months. Granted, I have a chronic health condition, but I believe most insurance plans allow you to see your doctor annually.

OK. Here endeth the lesson. I don’t want to get too preachy!

I guess what I am trying to say is that the staff at the hospital was interested in making the patients feel welcome and cared for from the very greeting, and it didn’t go unnoticed.

I’m going to get technical and personal here.
If you’re squeamish or in any way prudish please stop reading now.

In my previous post “Time Flies…“, I talk about the options for “Top” and “Bottom” surgery.

For top surgery or breast augmentation I personally am going to have a round silicone insert placed under the breast muscles. Modern silicone breast implants are not your mother’s implants. The problems associate with the leaking silicone breast implants of the 1980s have long-since been fixed, and the inferred risks and negative side effects been refuted. Modern silicone implants are a cohesive gel which, even when ruptured will not “leak” into the surrounding tissue. They would also retain pretty much the same shape much like a run-flat tire, and just need to be removed and replaced with a new implant, Saline implants, if ruptured, would deflate and the saline would absorb into the body leaving a flat breast. Also, the exterior structure of both the silicon and saline implants are made of silicone, so either way there is a silicone portion to the implant.

There are two shapes to the implants, that I am aware of, round and tear-drop. My surgeon only uses the round implant. One potentially negative complication of the tear-drop is the possibility of it turning inside the body and creating an unflattering shape which would then need surgery to correct. The placement of the implant can be either on top of the muscle or underneath. I do not know if one is a more involved surgery than the other, but the doctor did say that placing the implant under the muscle produces a more natural and flattering look when finished. The incision would be under the breast as opposed to around the nipple, two options.

Onward and downward!

The four options for bottom surgery are Penile Inversion, Sigmoid Colon, Peritoneal, and Limited-Depth. I’m choosing the fourth, limited depth. Basically it is all of the surgeries involved in bottom surgery without the creation of the neo-vagina. The reason for this is for the simple fact that I am 48, I am married to a woman, and I have no intent to engage in an intimate relationship with a man. Also, by omitting the procedure of creating a neo-vagina, the surgery is less involved, less expensive, recovery time is greatly reduced and after-care is less intense. “Traditional” bottom surgery involves the following procedures:

  • Orchiectomy (removal of testicles)
  • Penectomy (removal of penis)
  • Clitoroplasty (creation of clitoris)
  • Labiaplasty (creation of labia)
  • Urethroplasty (reconstruction of female urethra)
    and finally
  • Vaginoplasty (creation of vagina)

I will have all of the above except for the final one, Vaginoplasty. The after care for vaginoplasty requires the use of dilators to prevent the neo-vagina for closing up like an ear piercing when the earring is left out for too long. The schedule for using these dilators is multiple times per day for the first few months and taper off to once a week for the rest of the person’s life. For clarification, intercourse is not accepted as dilation. Many trans-women have published articles describing the after-care of bottom surgery. This is just not for me. There are some trans-women, trans-women of all ages, that want a fully functioning vagina. Every person’s journey is different.

All through my research for bottom surgery I had been saying, “I want everything but the vaginoplasty. I just want a to look like a Barbie Doll!” , and that is exactly what the doctor said to me!

There are some pre-surgery things that I will need to have done, chiefly making certain that my insurance covers both top and bottom surgery, and obtaining proper mental health paperwork. These are actually the first steps and I’m already in the throes of doing so. I had said that wanted to have all of my transition surgeries completed by the time I turn 50 in late 2019. It looks like I may attain that goal much sooner! I think I may have to change the name of our bungalow to The Barbie Dream House!

– Tiff

All information above is gathered by myself and any errors are entirely by accident.

 

Time Flies…

timeflies

April 18, 2018

It feels like it wasn’t that long ago that I started looking into Facial Feminization Surgery (FFS). In the grand scheme of things it actually wasn’t that long ago. But, it’s already been six weeks since I had the surgery.

I also remember back when I started taking estrogen by patch. I thought to myself, “This is it! This is the beginning! It’s going to take a long time before my body will change.” But I was already making plans for how I’d change and how happy I would be. My skin would soften. Fat would redistribute in my face and body. My facial hair would slow and become finer.

10 days later I had the mini-stroke and I felt the crushing blow of uncertainty. It felt like I was cut off from what had taken so long to find and accept. I suddenly had tests and procedures, and appointment after appointment with this doctor or that. I was eventually able to see some forward movement by that November, just 4 months later and not very long after all, but when you’re waiting for a bus in the rain it feels like it will never come.

It’s been almost two years since my false start with hormones and accompanying medical mishap. I’ve come a long way, I’m on my testosterone blocker and am at the full dosage that is recommended for mtf trans-women. It took a while to increase the dosage to the full level because of the potentially harmful side-affects with the rest of my health concerns.

I have to remember that I’ve made a lot of progress. I’ve been living full-time as Tiffany for almost 8 months now, my name and gender have been legally changed, and I’ve had facial feminization surgery.

Tomorrow, April 19th, will begin the next phase of my transition. I have an appointment to consult with a plastic surgeon on top and bottom surgery.

Being transgender is very different today than it was 30, 20, even 10 years ago. I only know this from reading about other folks and their experience transitioning. I feel that the public is more accepting of transgender, gender-fluid and non-binary people today. It feels to my like anyone under the age of 30 has grown up with trans and gender fluid people in their midst and so the taboo doesn’t exist as it had decades ago.

The options for surgeries and surgeons has grown too. However, not every trans-person chooses to undergo top and/or bottom surgery. There has been greater acceptance for those choosing to not undergo these very expensive and time intensive procedures. It is also extremely inappropriate to ask a transgender woman or man if they’ve had either top or bottom surgery. It is a very personal part of one’s transition and unless the information is offered up it shouldn’t be asked about, and if learned it should never be given out freely to any one else.

Reputable doctors (most doctors) follow the WPATH “Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People.” These standards of care were first drafted in 1979 and are periodically revised. The latest standards were revised in 2011. (You can read the actual standards here: www.wpath.org/publications/soc) These standards require specific goals or steps in transitioning. For instance a letter from a mental health professional documenting ongoing therapy and gender dysphoria is required prior to medical intervention for hormone replacement therapy. Another requires a letter from a mental health professional for breast augmentation or chest reconstruction. Two letters are required for genital surgery. These are the safety checks and balances that have been adhered to by health professionals to aid in the physical and mental well being and transitioning of trans and gender nonconforming people. Prior to these guidelines there were no global standards for following a path to assist in the development or transition. All of the doctors on my team follow these guidelines.

So let’s talk breasts and vaginas…

Breast augmentation for a transgender woman is not “required” or even sought by all whom are transitioning. First of all a transgender woman must complete a period of hormone replacement therapy (HRT) for a period of time if possible. This is where I have a conflict. I am not a viable candidate for HRT because of my risk of strokes from taking estrogen. Secondly. if you are a transgender woman looking to get breast augmentation you will want to seek out a plastic surgeon that is familiar with transgender woman and the difference in anatomy between a trans-woman and a cis-gender woman. Also, there are options for your breast augmentation or “top” surgery. Your surgeon will go over options such as saline or silicone, tear-drop or round, and most importantly size! You will want a size that fits your frame. Some insurance companies cover this procedure and some don’t. I am still investigating whether or not mine does. I think they do. I hope they do!

Now for the biggie, bottom surgery, or as some call it “The Surgery!” I am by far not an expert on any of this. I am just in the process of investigating it for myself and trying to determine if any of it is right for me, or if the risks out weigh the benefits. When it came to my facial feminization surgery the benefits did outweigh the risks, and I’m happy to say they paid off! But back to bottom surgery.

As I understand it there are several methods for creating a “neo-vagina.” The most popular is penile inversion where the skin of the penis is used to create the vagina, kind of like turning a sock inside out. If this hasn’t made you squirm, you can see a computer generated example on Vimeo of how this surgery is performed by clicking this link.

The second method is by using a portion of the sigmoid colon called Rectosigmoid Vaginoplasty, or Sigmoid Colon Vaginoplasty. This is, as I understand it, a longer and more expensive surgery as the procedure to remove a section of sigmoid colon is also required. And, there a more draw-backs to this procedure.

The latest in the arena of vaginoplasty surgery is in using a portion of the peritoneum, a membrane that covers the abdominal organs. This is known as pull-through peritoneal vaginoplasty. My understanding is that the greatest benefit of this method is that the peritoneum is self-lubricating unlike the other methods.

There is a fourth type of bottom surgery. I’ve read it referred to as “limited-depth” vaginoplasty. It involves the reconstruction of the urethra into a female form and creates the appearance of a full vagina but without the full depth and need to dilate, which is a process of using dilators to exercise the aperture and prevent it from closing. Think removing your earrings and the holes closing up!

All of this is so new to me. I’ve been reading some great articles of trans-women who have gone through bottom surgery. They give invaluable first-hand knowledge of the physical and emotion sides of what one goes through. Recovery for these surgeries is somewhere along the lines of 6-8 weeks, that’s for bottom surgery and not breast augmentation.

I’m excited and apprehensive about my appointment. I just keep it in my head that this is just a consultation. I’m not being pressured into anything and in the end the choice is mine.

I’ll post an update when I know more!

– Tiff

My Authentic Self

madeinchina

I grew up in the 1970s and ’80s in a family with 6 siblings.

I am the second youngest child, with my two sisters being eldest, and the remainder being boys.

When I was growing up, my parents were much older than all of my friends’ parents. My dad was born in 1924 and served in the US Navy in WWII. He was already 45 when I was born (47 when my younger brother was born!). My dad had his share of health issues: a triple coronary bypass in the 1970s, type 1 adult onset diabetes.

In March of 1984, when I was 14, I caught a pretty bad cold. I recovered from my cold, but my pancreas didn’t.

The first troubling sign was that I started wetting my bed. This eventually got to the point where it was happening twice or more a night. I was also eating ravenously. I recall that for lunch, one Saturday, I consumed a sandwich, an entire pot of macaroni and cheese, and an entire pitcher of Kool-Aid, probably grape. Mind you, I was a pretty skinny kid, but despite my continual appetite, I was dropping weight rapidly. My vision started getting blurry, and my energy level was so bad that I couldn’t climb two flights of stairs at one time.

In school I  had joined track and was running as a sprinter. At our first outdoor meet, I remember having to go to the bathroom so badly, but the coach wouldn’t allow anyone inside the building. I didn’t tell anyone what I had been going through, so I can’t fault him for sticking to the rules. It was a frightfully cold evening. I had to run 330-yard low-hurdles and my energy plummeted. I made it around about two-thirds of the track before failing to get over two hurdles and smacking them. I ended up walking around the last several and just made it across the finish line.

My mother knew something was up with me and told me that she thought that maybe I had become diabetic. I was used to seeing my dad inject his insulin every morning and the smell of alcohol was a familiar accompaniment at breakfast, so diabetes itself wasn’t weird for me, but the idea that it could happen to me was shocking.

Mom made an appointment for me to see our family doctor. Dr. Malone had not only delivered me as a baby, but he’d also delivered every one of my siblings. He had become my Dad’s doctor when his original doctor retired at a ripe old age. Eventually, when my parents married, he became the family doctor, not just for us, but for my mom’s parents too. He remained the family doctor for years, through my grandparents death as well as my father’s strokes, dementia and death. My mother had still been seeing him when he was in his late 80s.

Mom made an appointment for Friday, April 27th. The previous Sunday, the 22nd, was Easter. I remember that I was very fatigued, always hungry, and going to the bathroom about every 50-70 minutes. My grandmother had an appointment with our doctor the following day, Monday the 23rd. She told my mom that she and I should switch appointments.

It was a good thing that we did because when Dr. Malone checked my blood sugar, it was almost 900. That kind of blood sugar level would send the average person into a coma. I think my youth helped me in this case.

I didn’t go home for a week. The doctor marched me and my mom out of his office, which was located in the physician’s building next to the Hospital, and through the connected doorway to the emergency room. I was admitted immediately and placed on an insulin drip to bring me into a safe range.

I stayed in the hospital the entire week of spring break 1984, learning how to draw and inject insulin, measure food, all of the intricacies of managing my new condition. I had lost so much weight over the previous weeks that I was down to 93 pounds. The only place I could inject was into my stomach.

I only cried twice during that period.

The first time was weeks earlier, at breakfast, when my mom told me that she thought something was wrong with me and that she thought that I was exhibiting symptoms of diabetes.

The second time was the day I had to give myself my first injection.

I had been learning for a couple days prior on how to do this. I would draw an amount of saline into a syringe and inject it into a rubber ball. The day that I had to “graduate,” I drew the syringe, thinking that I would be practicing again with the ball, but the nurse educator said that I would injecting into myself that day.

I was scared.

It was a lot less like standing at the end of diving board and being afraid to jump, because you can’t turn around and climb down the ladder. You just have to do it.

It’s not fun, and it was the beginning of something that will never end, but I did it. I pinched as much skin as I could, lined up the needle, pushed it in, pressed the plunger, and drew the needle out. I cried that time, but not because it hurt; I barely felt anything. I think I cried because this was my life now, and I didn’t want it. It wasn’t my choice.

But with time and reflection, I realize that none of us has a choice with absolutely everything in our lives.  And some of the choices thrust on us aren’t fun or fair. I’m very lucky though. There are many other chronic or fatal health conditions that I could be forced to deal with.

Back in 1984, when I was diagnosed, there weren’t personal glucometers for checking your glucose levels at home or on the go. I spent months going to the hospital multiple times a week with my dad to give blood to check my glucose levels. Now, 34 years later, we have so many advancements in the personal care and management of diabetes, and in the understanding of how food, activity, and stress affect the short and long-term health of a diabetic.

After 20+ years taking multiple injections daily, I was able to graduate to an insulin pump. I am now on my fourth pump, and it has changed my life for the better.

There are still complications to my body because of this insidious disease.

I have stage two kidney disease. I’ve received multiple rounds of laser eye surgery for retinopathy, which has now progressed to foveal cysts forming in the macula of my left eye. And I’ve suffered a stroke and a TIA (a transient ischemic attack).

I’ve had people say to me, with good intentions, that they may find a cure yet!

That may be true, but they won’t be able to repair the damaged nerves, my lost vision, my damaged kidneys. Those are permanent hurts.

The worst is when someone insists that if I just change my diet, I can kick my diabetes. Or worse yet that I can “pray” it away. I know people mean well, but the road to hell is paved with good intentions, as they say.

I think that one major factor in not realizing until my mid-40s that I was born transgender is having been diagnosed with type 1 diabetes at age 14, an age when puberty had just started and my body was already flooded with hormones and emotions.

It was also the early 80s, and suburban Milwaukee wasn’t a place where transgenderism was on my radar. I knew that I was heterosexual as a male – that much I could identify. I had certainly questioned myself on that point (as did several other people). I knew I liked girls. But I also I knew that the softer feminine things resonated with me. Sure, I still liked climbing trees and having an adventure – but those aren’t strictly male things.

There are things that I’ve done through the years that, afterwards, I had attributed to the emotional baggage of being saddled with diabetes. At age 14, I had to become responsible for my health in a way that none of my friends did. I had to take on some adult responsibilities when I mentally wasn’t ready for it. There were times that I pushed the envelope, especially in the early years. I ate foods that I shouldn’t have eaten, sometimes in quantity. I casually picked up cigarettes during college. All these things were poor choices, but I never intentionally missed an injection, and I never consciously did something to “get back at” my diabetes.

Since entering therapy for gender dysphoria, I’ve been able to look back on some of my choices, chiefly in relationships, and identify that the failures and mistakes were, more often than not, due to the fact that I wasn’t who I really needed to be, and I didn’t know why. It was like I was running away from admitting I was gay, but I knew I wasn’t a homosexual male. To be clear, I’m not talking about sex; I’m talking about relationships, and gender, and identity. There were many girls that I dated with whom I think I must have sabotaged any future or longevity, because it was getting to the point where I felt I couldn’t be honest about who I was and what I was feeling, even though I really didn’t know either of those things.

By the time I was in my mid-30s, I had been through some bad break-ups, and I had an opportunity to move to North-Central California to get away from it all and try to make a fresh start. I moved to Marin County, just north of San Francisco across the Golden Gate Bridge. I lived there for a year, and I really had a chance to understand some things about myself, and about who I needed to be for myself, before I could be in a relationship. I still didn’t know I was transgender. I was still secretly wearing feminine underthings and still living in fear that I would be noticed or “caught.”

I came back to Milwaukee after a failed career attempt. That’s when I met the woman who I would eventually marry and who accepted me as the person I was – a person who, much like myself, underwent a personal time of relationship turmoil followed by a period of reflection and rebuilding.

When we first met, we were just friends. We were honest with each other. The stress in our previous relationships in trying to become who we thought the other person wanted us to be was detrimental to our spirits and growth personally as well as for the relationships. We wanted to enjoy each others’ friendship. I told her of my secret dressing. She told me of her relationships with both men and women. We shared a common upbringing culturally with older parents, and found comfort in talking to each other.

We were friends first and foremost before we were a couple. We still are.

We eventually became very close and started dating. Within a couple of years we were living together and eventually married. She would occasionally ask if I ever thought of transitioning. At the time, I didn’t think I would or could transition.

I pictured my life falling apart if anyone knew at the very least that I was spending a lot of my evenings and weekends wearing feminine attire around the house. What would my friends and family think? Would I lose my job? I worked with retired military servicemen, hardly the people I thought would be OK with my choice to be whom I really was.

But you know what? I’m still friends with many of those people even after switching jobs. They have been some of my most ardent supporters in my journey to become my true self.

I think the turning point for me in deciding to come out was due to multiple factors.

Caitlyn Jenner had brought transgenderism to public attention with her own revelation and transition. That helped open the door.

I had also been dealing with so much stress in my life that it was manifesting physically. Having a disease that is made worse by stress, having a father with similar health concerns and having died at 69 because of stress related issues, and feeling like I had no future goals led me to the point where I had to do something.

I entered therapy in April 2016 after a friend had described me as transgender to an acquaintance.

“What do you think about it?” she’d asked me.

Was I transgender? Was I? I knew I was attracted to women. I also knew that I was far more comfortable in feminine attire – and not just in private or at gay clubs that tolerated my then-poor attempts at makeup. Did I want to live as a woman? Was I a woman? Was I transgender?

I feel that everyone should go to therapy at at least one point in their lives.  If your car is acting up you, don’t just hope it gets better, do you? If you have the flu, you don’t just hope you’ll get better. If your heart and your head are aching, it won’t just go away. When the stress manifests itself to the point of physical pain, the best thing to do is get the help that’s needed.

A therapist was the exact mechanic I needed to help figure it all out. I can’t imagine how miserable I would be if I hadn’t sought help. Maybe I would be dead, or worse, maybe I’d have had a debilitating stroke and be in nursing care, still living as a closeted, mixed-up person with little chance of figuring out my life.

But I did take that first step.

April 18th will mark two years since I began therapy and my journey to my authentic self.

And April 23rd will mark 34 years since becoming diabetic, my “diabetiversary”  – so it’s a significant month for me.

You know, it took me until my mid-40s to figure out who I was. I’m still working at it.

Some are lucky to be born aligned in gender. Some are lucky to have parents that understand these things at an earlier point in their child’s life. I’m just lucky to have friends, family, coworkers, and most importantly a spouse who all accept me for who I am and who I’m trying to be: my authentic self.

–  Tiff