Beam me up, Scotty.

I had an endo appointment today.  I finally spoke up about this cyclic mood swings nonsense.  I'm ashamed that I can't just rely on stoicism to get through it, and I wish there were another way to solve the problem because I otherwise like the pace of changes on my current dose.  My endo thinks switching to shots with an equivalent dose won't make a difference.  She said that with compounded cream, the minimum dose necessary to stop periods is twice what I'm currently getting from gel.  She wanted to just have me double my current dose of 12.5 mg, which is what she prescribed when we met for the first time, but I talked her into switching me to AndroGel 1.62%, whose smallest metered dose is 20.25 mg, a tad lower.  The fact that I can negotiate my prescriptions with my endo is really cool, BTW.  She questioned my info about the effective dose being different for the new concentration, so we simultaneously looked it up on our phones.  It was pretty funny.

In any case, I hope this is worth it.  My insurance covers any AndroGel, so at least it'll be worth it in terms of cost.  I don't feel like I really need any more changes, but I'm not willing to add female hormones to my body if they come with a risk of breast growth.  I can deal with more masculinization (wouldn't complain about it in most regards), just don't want to get changes fast enough that I feel dissociated from my body.  I wonder if I should have advocated more strongly for shots, because then I'd have more of an ability to fine tune my dose instead of taking whatever Abbvie offers me.  Gel is pretty fantastically easy though, and this is still lower than what my endo calls a "low dose" for trans guys, so maybe I'm making a big deal out of nothing.  I think I have enough AndroGel 1% to last until I move, so I'm going to wait a bit to start on the new stuff, at least until I figure out what I'm doing about top surgery.  I think my endo would be okay switching me to shots if I called and asked, but then I'd have to learn how to do it on my own when things are pretty crazy anyway.

This appointment had some other notable moments.  My blood pressure was totally normal.  It was a relief because at Dr. Johnson's office, my blood pressure was actually high.  The only other time I've ever had high blood pressure was when I was having an asthma attack in a hospital.  So now I know for sure that the culprit was indeed car sickness and I am not in earnest developing high blood pressure.

My endo was really concerned about my lungs though.  It was an early morning appointment, and I had a productive cough from when I woke up until a couple hours after the appointment.  It's been like that for over a week.  I told her I thought it was from binding too much at PTHC, since I've otherwise been cutting down substantially by working from home whenever possible and obviously not being very social outside the house otherwise.  She took a listen and kept coming back to the lower part of my right lung.  She asked if I was binding and tried putting the stethoscope under my binder in the back because it sounded "muffled."  I wasn't even binding very hard, just wearing a sportster.  Anyway, after asking me to breathe ten different ways, she concluded that my chest is not truly congested, but she can hear my asthma.  It wasn't really on my mind because I use my inhaler once or twice a year just for emergencies, usually triggered by cigarette smoke.  She expressed approval over the news that I'm in the process of making top surgery happen but didn't tell me I absolutely needed to do it, something that would have been preferable because it would take the decision out of my hands.

To lighten the mood, I'll end with the fact that my endo said my voice was definitely deeper than it was the last time we met (in February?).  alifjiim also said my voice was deeper than he expected when he visited last week.  (I have a couple half-written posts about PTHC and meeting super-cool internet people a couple weeks ago, swear I'll finish those up sometime soon.)  I also met a few people at PTHC who said my voice was deeper than they would have thought given my low dose.  I don't remember if theirearlystuff said anything about it though.  Did I ever mention that my father is a contra-alto?  My voice might be the deepest of all living males in my family, and it's a bit lower than my cis male partner's voice.  I'm pretty satisfied with that.  (-:

I think I just got hit on by a guy as a guy for the first time.  I don't really have any hard evidence, but I'm pretty sure that's what happened.  I didn't like it any more than being hit on as a girl to be honest, but maybe it was the context.

In other news, I've been applying my T on an every other day basis since Thursday.  My voice was really ridiculously low on Thursday night, so I didn't apply it Friday.  I did apply it Saturday, and both Saturday and Sunday my voice felt really strangely deep.  Have I said "really" enough yet?  Anyway, it's not that I don't like where it is, but I'm kind of concerned about it changing so much at the inauspicious time of ten-ish months on T after previously seeming to settle down.  I know there's no "right time" to come out, but it will be a significantly better time once the semester ends.  I've already reached the point at which I can no longer pass for female at work, and my voice going into overdrive is not going to make the next month any easier.  I am not, however, considering taking a break again.  That was no fun at all.  So, ummm, awkwardness?

I've got far too many half-written posts to be starting another, but I guess this is kinda important.  I pulled an all-nighter on Wednesday-to-Thursday and forgot to apply my T the next day.  That was actually the first time I forgot to do it at all.  "No biggie," I told myself.  I got home late and decided to apply it at midnight and let that be the dose for Thursday and Friday.

Last night, I looked at my face in the mirror and saw dark hairs growing on my upper lip and got scared.  When I woke up this morning, the dark hairs were still evident in the mirror.  I didn't want to dose myself, so I didn't.  I haven't had T in my system for about 18 hours.  Since 7 May 2013, I haven't spent more than 12 hours without any added T in my body.

Apparently I really, really don't want to shave my upper lip.  I know there are women, plenty of them, with more substantial mustaches than what I've got, and some of them shave, too.  That's not what this is about though.  I don't care if other people see my facial hair and make assessments of my gender that are in any way influenced by that.  I love having sideburns, but I'm somehow deeply afraid of both shaving my upper lip and having a tween's 'stache.  This is one of those internal dysphoria things that's independent of what anyone else thinks, and I'm more comfortable heeding those feelings than those I know are responses to something external, like how people interact with me.

What does this mean?  I don't know if I'm taking a break or stopping or what, although I suspect I'll cave and apply a dose for Saturday and Sunday at midnight tonight.  I'm sorta glad my partner's out of town right now because I don't think talking to him would clarify anything for me.  While I think it's important to leave evidence of my doubts where I can't deny them, I don't think this is something for which I should make myself accountable to others, especially those who are invested in my choice.

How does it feel?  I haven't been really self-conscious about my voice or unable to interact with people socially.  I don't think I can go a week without T, not now anyway, because I'm starting to feel anxious about all the stuff I have to do this week.  I have some public speaking lined up, among other things, and just feel like I need T in order to face the world.  But I'm going to need to get over my fear of shaving my upper lip first.  I don't know who to ask for help.  I really wish I had a big brother right now, preferably a non-binary one.

It feels really good to be writing this now.  I've had a rough few days.  I've spent so much time on the phone sorting out things for my upcoming travel that I haven't gotten anything done for work.  My passport was finally mailed out today and should arrive tomorrow, and it will have a male sex marker.  And it will expire in two years, giving me that much time to get my name changed and update it without any additional fees, and I'll have at least some ID to use for everyday things in the meantime.  When the State Department called me to give me the update, they referred to me as "Mr. LastName," something that's never happened to me before and hadn't come up in previous conversations with them or anyone else in this process.  I was happy but unsure exactly what I was feeling at first.  Even though I write about it a fair bit, it still took some thought to determine it was recognition.

I've been considering whether this will be my last T-versary.  My plan was to stay on T through the summer and re-evaluate things before classes resume in the fall.  I'm not entirely sure what I was looking for, but I wanted to check in with my mental and physical health, my partner, and to what degree it was needed, because I delayed starting when it was only wanted.  It took a couple months before the novelty wore off enough that I could focus on other things again, my health has if anything improved aside from the acne, and my partner's had no trouble going with the flow.  The last thing I wanted to check is a bit more complicated.  I'm so pleased with the changes so far.  The biggest thing is obviously that I hear my own voice when I speak (though I still hope it keeps deepening, ha!), but there's more to it than that.  In my daily voice recordings, I've described it as stability and steadiness -- it just feels right.  For the most part, I don't think about changing my dose anymore, and at this point, I can't imagine discontinuing T in a month -- that would definitely be more of a disturbance than quitting when I'd vaguely planned to (derp, wrote the reverse of what I meant) continuing even when my ambient stress level increases.  I don't care whether that means it's needed or wanted because I've finally internalized that I am free from that condition.

Okay, that really good feeling is coming back.  I just saw the new Star Trek and am feeling euphoric again.  Yes, it exceeded my expectations and was actually really good (and sufficiently nerdy), but what was really good was hanging out with someone from work that I have not been getting along with lately because I think we moved past our problems and can almost maybe be friends.  And that was enabled by me functioning socially at a level I rarely achieve.

I'm no quicker to find words, and I'm not much better at knowing when to break into conversation.  I don't exactly feel more confident, but something is different.  The word that comes to mind is "grounded," and I've never felt it this strongly before.  The last time I felt anything like this was when I stopped shaving my legs and underarms in 2008; suddenly I was connected to the immediate surroundings of my brain, namely my body.  My limbs became an extension of my head, and then I felt like I could do things with them, and that's when I started doing yoga, because I had posession of a body capable of it for the first time.

Now, it's more than just an immediate connection to my body, and in fact that's not really consciously part of it at all.  I think it might be a connection to my voice, and since hearing is an entirely different sense and making sound is its own sensation, I guess that's why I'm experiencing groundedness in a new way that's manifesting socially.  I'm not really feeling much social anxiety anymore, even though I'm still perceived as female among most people.  I honestly don't know if it's because I no longer care how I'm treated. . . I'll have to think about this more.

My roommate made a reference to me being on T to a housemate and her girlfriend, in my presence, and I didn't mind at all.  I don't know when people from work will notice my voice, since it's changing remarkably fast, but I'm not feeling anxious about it.  I mean, I should have a plan for what to tell them, but I'm not sure I want to do some kind of formal coming out.  I already go by a gender-neutral name, and I've all but disappeared.  I don't think I'll necessarily mind feminine pronouns if, if, if I'm not sure what, but I think I'm approaching it on this path, although I don't know at what distance.  I just feel right in a way I can't recall feeling before, and I'm okay with other people knowing.  How to get that knowledge to them in a way I'm comfortable with is something I really should think about, because I'm pretty sure it's not going to be easy.  But that's a problem for another night. 

I just wrapped up a session with my health coach, and since we talked about gender things a lot, I wanted to write something here before I forgot everything (though I did take notes, as always).  Obviously things are a lot more complicated than what I said in our brief phone conversation, but it was more than I'd gotten to say with my therapist over the last month, and I feel like it was a good start in the sense that I can now tell my therapist, "Hey, I got help from a health coach in these ways, and here's how it was useful, can we talk like that, too?"

Therapy has been going really slowly, and I find that immensely frustrating.  I initially said that what I wanted to get out of gender therapy was a decision about what aspects of transition were right for me, but upon taking that apart a bit, I think what I really want is more certainty about what parts I've pretty much already decided to pursue in the nebulous, distant future.  I think I already know what I want, but I want to be confident that I'm doing what I need to, not just indulging something optional or something that I could regret.  And I feel like I really need to decide soon, so that it's easier to just be Ilan, not Ilan who used to be [birth name] when ey registered here, when I head off to grad school in June.

We talked about what changes I want from T.  I really, really want my voice to be lower and for my face to look more masculine.  I'd also like the changes to face, body, and head hair (though I worry I might regret those later on).  Ease of gaining muscle and body fat redistribution would be fantastic, but I'm not sure if I'm even thinking about being on T long enough for that.  And we talked about changes I'm less enthusiastic about, too.  I don't know if I want downstairs growth.  What if I can't ignore things as well then and spend more time being dysphoric about my crotch?  I'm also concerned about my hormonal acne worsening. 

I got to talk a little about why I've waited so long to get started on medical transition.  I felt so comfortable at school where everyone important knew I was genderqueer that the issue wasn't really forced.  Dysphoria regarding my crotch was mostly isolated to one week a month, and as long as I didn't have to wear a bra, my chest didn't bother me because I rarely left campus.  I talked about wanting facial hair and a deeper voice, but I didn't feel like I couldn't live without it. . . now that I'm not surrounded by supportive people who will take my word for it regarding my gender, I feel like I can't be perceived the way I should be without changes from T.  The health coach asked if I wanted to pass, and I said I wasn't sure, because it just seems so impossible and far away.  If I really wanted to pass, I should have already done a bunch of things like cutting my hair, right?  It was another one of those things that just wasn't an issue when I was in college and has been painful on a daily basis since I graduated and moved away, but I haven't done anything to fix it yet.

I also opened up about questioning my motives for transition -- am I just a misogynist? am I doing this for me or for other people? -- and its effect on my health given my other problems.  I'm concerned about being on T for the rest of my life.  I don't like being on medications, and I'm on several that will probably be life-long commitments due to chronic illnesses.  It seems counterproductive to sign up for more of that if less is an option.  But I can't see myself continuing to let my body be dominated by regularly fluctuating female hormones for much longer, and there doesn't seem to be an option to not have sex hormones.  I really don't know if starting T soon will help me resolve this.

I got some useful medical-type information, too.  Though genes control a lot of the hair distribution type stuff (face, head, and body), apparently voice isn't quite like that, because I won't be getting voice changes like a cisguy would during puberty, which makse sense because I know my voice has "matured" in some ways since I hit puberty the first time around.  This means that while I can probably count on not being able to grow a beard, my voice is not doomed to be the same as my father's bizzarely high voice.  It's also possible that my hormonal acne could improve on T, that I might have problems because my hormone levels are currently between the femle and male ranges, and my skin might stop rebelling if given the correct dose for either sex.  Obviously some testing is in order, but it's an option I wasn't really aware of before.

However, there was a lot that I didn't talk about that I would want to discuss further with a counselor.  One of the changes I'd really like from T is an end to the monthly reminder that I have female reproductive organs.  I feel bad about this because there are other ways to stop it that are perceived as "less drastic,"  and I've never pursued any of those for what seem like weak reasons, plus I might want to be on a low dose that only makes things wonkier.  I'd also be overjoyed to see my chest shrink further, so maybe I could get surgery by a method that's less likely to result in loss of sensation.  (EDIT: I just spent the afternoon looking at Transbucket, and I think I've got a real shot at peri if I ended up going for surgery at all, moreso if I get just a bit more shrinkage.)  One of my unsaid fears about starting T is that the changes will make my long-term partner stop being attracted to me.  He's not making any promises, but knowing that he's trying not to have to break a promise that our feelings will never change doesn't make me feel any more confident in possibly putting our relationship at risk. 

I also didn't go into my non-binary identity at all, which is a bigger deal than I generally let on.  I want people close to me to see me as Ilan, who isn't a woman or a man, but I want those not close to me to just see another guy, because if I have to choose, and I very much feel that I do, I need to be perceived as not-female, which means transitioning to male, at least on the surface.  I guess I didn't mention it explicitly to the health coach because I see him as being part of the not-close category, and I guess that makes sense since we've only met once and talked on the phone three times, but I feel like this is something I should be able to talk about more in counseling.  And because we didn't go into my non-binary identity, we didn't talk about my alternatives to T, namely more exercise, voice coaching, and other things I can do to be read as male and feel more comfortable with my body.

Anyway, we talked a bit about what I can do about getting T if therapy moves too slowly and I end up having to move before starting T.  I think that was really important to consider and not something that would have come up with my therapist.  I'm going to be making an appointment for shortly before I move with one of the sliding-scale informed consent clinics here in the Bay Area. If I get a "T letter" (probably just a referral to an endocrinologist?) before the appointment, I'll cancel and someone with an emergency will get my slot.  But if therapy never gets off the ground and I feel like I need to get going before introducing myself to my new department, I can still make it happen. (EDIT: I called the Lyon-Martin Clinic but got lost in a maze of automated voicemail subroutines.  I'll try again tomorrow with a script for what my message will say and a stimulant to back me up when it comes to following the instructions.)