The picture accompanying this post is important to me. I took it yesterday, 16 November 2020, unsure what I'd find. It's been nearly eleven months since I came off oestrogen for reasons I'll get into in a moment. Undoubtedly this has had an effect on me, bodily and therefore psychologically, but the accompanying selfie gives me a reassurance that I look like a forty-something trans woman / transwoman. In what has become a fragile state of mind, these little things – a photo or even a comment – can feel like a delicious cup of tea. This photo is my cup of tea.
Trans Healthcare – my recent experiences
*Note: this post is not critical of the medical practitioners who have overseen my transitioning. They have always been both professional and approachable and I consider myself lucky to have worked with them.
Just over one year ago, and with me poised to have sex-reassignment surgery, an intense talk with one of my two medical case workers led to the postponement of surgery in order for me to store gametes in case I wanted to have a family. I came off hormones and did not renew my testosterone blockers in December 2019. The medical practitioners dealing with my case were hopeful I could 'regain' fertility within four months, but as I've said, the reality is that my body required over double that time.
With it now being mid-November, I have witnessed my body remasculinizing most noticeably in terms of body hair and fat distribution with a more masculine face. I've also effectively stopped crying, on oestrogen, tears came very easily to me. These are the main physical effects, it's been difficult identifying the psychological impact in a weird year of lockdowns, unemployment, zombifying nightshift work, and a turbulent end to PhD research.
Last week I booked an appointment at the Royal Infirmary fertility clinic. That first attempt failed to produce usable sperm. A second visit yesterday produced the same results. If I wanted to continue down this road, I would need to wait for three months before trying again. I told them I don't. Today I booked an appointment with my local clinic to re-start testosterone blockers (Goserelin) and to gently restart taking oestrogen. My attempt at becoming temporarily fertile has failed.
I think there are major development points for trans healthcare here. My contribution comes partly from this experience but also a separate set of recent experiences while researching gender-critical feminism and considering my own identity.
(1) Fertility: it isn't good enough to ask a trans person at the outset of transition if they want to have children, and if they say 'no,' to accept this statement at face value and move on to the next question. I gave my answer because I was ashamed, through internalized transphobia, to say that it's okay for trans people to have families. To wait until I'd been on hormones for three years and with my surgery due the following month, before really exploring this issue, is really problematic. Am I infertile because I always was, or because I'd been on oestrogen for three years? I guess I'll never know. What I do know is that I've had the distressing experience of being off hormones for nearly a year, while watching my body re-masculinizing after three years of bodily feminization. The opportunity to have surgery, which I wanted, has passed by, and I don't know when the next opportunity will present itself.
(2) The woman issue: at the beginning of the process of transitioning, it is less useful to tell a patient they are a woman, than to discuss the ways assimilation are likely to occur. I'm thinking a lot about GC feminism and its clash with trans activism. Point 3 should clarify this.
(3) We've never really talked about women, which I realize is unusual for a patient transitioning to become one, or alternatively assimilating into society as an approximation of one. Yet while 'gender reassignment' is one of nine protected characteristics, so is 'sex' and the understanding that women form an oppressed group with global, historical patterns of suffering male violence and oppression. Connected to this are the legal ramifications of the Gender Recognition Act 2004 (Trans women are women) and the Equality Act 2010 (but not completely). The issue of access to women-only spaces and the philosophical underpinnings of this gap between trans woman and woman need careful nuanced discussion and reflection. In my transitioning, we never discussed the global and lifelong condition of being a (natal) woman. This includes the horrifying statistics connected to male violence against women, and the related position of women-only spaces as safe spaces for women. I wish we'd had this talk at the outset and in recurrence to contextualize what we're assimilating into - an already oppressed and disempowered group with lifelong experience of the threat of male violence - as well as the counter positions we're likely to have to engage with. For the longest time, I used words like 'TERF' and bore a sense of entitlement (though also a deep-seated unease I couldn't at the time explain) concerning female identity, and saw myself as part of a culture war with a privileged enemy (white, middle-class, natal women). I wish I had been more sensitive to alternative perspectives such as gender-critical feminism - not the hateful stuff, but the kind that wants to highlight women's concerns and accordingly debate any issue that affects women. Our presence is not necessarily part of a Manichean fight to the death, and refusing to listen and consult with sufficient rigour has not helped anyone's cause, or been good for society in general. In short, transitioning to becoming a woman should mean addressing what this means. What are women? What defines them and their experience? How does the experience of trans women differ? If trans women are women, then how does our experience make it so?
(4) Connected to this, I wish we'd talked about the different ways of being a trans woman (or just being trans). There are plenty of thoughtfully-constructed ideas within Trans Studies and informally online via social media and blogging/vlogging about what it is to be trans. We never looked at Trans Studies, which is admittedly a massive field. Because of this absence, there's an implicit understanding that the switch is very much binary, from male to female. But of course it doesn't need to be this: trans identity is diverse. We have non-binary to talk about too. Some trans women do assimilate into female identity but others do not, and of course, there is also detransitioning. More time spent on different options I think would be a good idea to help raise awareness. Not everyone is suited to a total binary switch.
(5) In the entire four years of transitioning (summer 2016 – winter 2020), I never had psychotherapy. No shrinks, no talks except with medical nurses. I had my friends and my blogging with which to think out loud, but I think there should be periodic opportunities to sit down and talk with therapists. There was a point in early 2017 (some three quarters of a year into my tradition) when I was in a bad place mentally. And recently too, I've gone through a major upheaval in self-awareness. I've even considered undertaking a form of detransition, quite a traumatic place to be. It's interesting that I've been offered counseling following the negative results of my fertility tests, I'm grateful for the offer, but I think this kind of service should come with transitioning too. Perhaps my service providers thought I was okay, but I guess appearances can be deceptive.
(6) I want to end this list by emphasising that the healthcare specialists handling my case were very nice. I think additional trans-related specialists would have been good, that's all.
So these are some reflections on some of the social and physical experiences that transitioning has recently given me. In spite of everything, though, as well as the tortuously repetitive, Sisyphean night-shift work I now do at an Amazon warehouse, I've made it to the end of 2020 as the trans woman/transwoman in the photo. This Thursday I return to having testosterone blockers and taking oestrogen, and with money beginning to trickle back into my bank account, there is the sense of a new chapter beginning.