Yesterday, I had to go to a walk-in clinic to address the unfortunate situation of a swollen epididymis (I dare you to look that up). The examination led to some rather interesting talks with the clinic physician about how gender dysphoria manifests from person to person. Though in discussing that, I also want to turn a bit of attention to body dyphoric disorders on the whole, because GD is far from the only one. Let’s start with how the facility handled it.
The clinic is part of a larger medical facility where my primary care physician already works. All of my information was already in the Electronic Health Record, and when I was checked in, it dinged my PCP who immediately made a call to the clinic desk. The clinic physician was also briefed on the fact I am a transwoman, so she already had an idea of what needed to be discussed and how to tactfully approach the examination. If I had to fault anything, it would be that their medical assistants are too rushed to make that distinction themselves. In the EHR, it shows legal name and preferred name because that is required by law. The physicians have always used my preferred name; the MA’s almost never do. That will need to change as it does reflect exceedingly poorly on the medical field.
When the clinic physician came in, she made sure to first ask where in the transition process I was, if I was comfortable with having the examination performed, and what effects any medications thus far have had on my physical anatomy. In my opinion, these are all very good things to ask because they allow the patient to dictate the flow of the conversation. Once that was out of the way, the examination was performed, and she moved on to discussing the general health of that body system, which is where things got rather interesting.
This physician has conducted examinations on other transwomen with the same level of tact, yet she noticed a very different range of expressions when compared to my own. When I told her that I was more dysphoric about my face and less about my genitalia, she responded that the inverse was much more common. I explained to her why that was, and that is why I want to explain it to you all as well.
When you are dysphoric about a part of the body, you wake up every morning and see that body part when you stand in the mirror. You ask yourself why it is there, why it is shaped the way it is, and if other people will notice it and be as repulsed by it as you are. The clinic physician believed that my face was actually quite feminine, especially considering I have only ever been on herbal estrogens (still waiting for the paperwork to get on the stronger stuff, sadly). She wasn’t able to see it from my perspective, thus she was unable to recognize its symptoms.
This is what makes treating dysphoric disorders incredibly complicated. The medical community realized back in the days of DSM-IV that when you put a trans patient on hormone therapy, their dysporia can skyrocket for the first six to twelve months while the physical changes are manifesting. If a patient is not emotionally ready for that step, it will end their transition and could potentially end their life. Physicians became terrified of prescribing the treatment because their role is the saving of lives, not ending them. As a result, it became harder to clear a person for hormone therapy.
The largest misconception among the transgender community today is the idea that hormone replacement therapy is an immediate cure-all. The community willfully ignores that many of these medications (Ex: spironolactone, the most commonly prescribed anti-androgen) were originally meant to treat other conditions and have potentially life-threatening side effects. Additionally, because we are administering these medications to children as young as fourteen, we will now need to place a Black Box warning on them due to the aforementioned increase in suicidal behavior. This is a big deal.
I started living as a woman literally two months after I turned eighteen. That was four years after coming out. I am now twenty-three, and I am still waiting for what many look to as being miracle drugs. However, I am far less dysphoric now than I ever was growing up, and there is a reason for that as well.
If you have been reading “Pseudonym,” then you will know that much of my femininity is derived from my body’s flexibility. It is a very abstract feeling, but it is one which keeps those insecurities from controlling my life. In transition, you need to have something you can gravitate toward whenever it feels like you’re stagnating in yourself. That is the only way to truly combat dysphoria and to ensure that hormone therapy will work as intended.
I have had talks with people who desire femininity and people who fear it. My response is always the same: “Ask yourself what femininity means to you.” Knowing and understanding will give you the confidence to immerse yourself within it. The very same applies to the concept of masculinity. Know yourself intimately. Do not let your body be in control of your mind.
So just another blog update: the final chapter of “Pseudonym” should be up by Saturday night if all goes well. There will be a few more recordings, maybe a few short stories, and then I have plans to begin a new project. I will be running a poll on my Twitter account (@SnarkyHime) this week that pertains to what the project should be. If you would like to give your input, please vote in the poll there.