Where have I been?

To say I have not posted much recently would probably be an severe understatement. I was going along so great with my blog. I was posting on a regular basis, keeping things going, really feeling into it. Then, I went full time, work went super busy, and life just plain got in the way. It was like I no longer had anything significant to say anymore. I was too bust living life to stop and write about it. I also think I began to feel that sitting here writing about what I was doing and what was going through my mind was almost like an exercise in narcissism. I began writing a few posts, and, after rereading, lost interest in them.

They were just too mundane and boring. Boring to me at least. It’s not that I lost interest in writing, it’s just that I lost interest in writing about every little thing that I did. It became clear to me that I no longer cared to write about the details of my transition, my feelings in certain situations, or what the next steps are for me. I just plain lost interest in that.

So, I sit here tonight trying to figure out where I am going with this. Is this a worthwhile endeavor for me? I feel that it is, but what is it I want to say here. I have always felt that my most satisfying posts were those that focused on issues. My all time favorite being the post I wrote about medical benefits for trans people. That was a post and a topic that are still near and dear to my heart.

This was brought home even more by the fact that I have three friends who just underwent GRS, and used three different methods to finance their surgeries. One cashed out retirement funds, another took equity out of her home, and a third will be covered by insurance. What these three stories show is that we are finding any way that we can to pay for transition related expenses. How many of us have maxed out our credit cards for hormones, hair removal, or surgeries. How many still are struggling to figure out how to pay for all of this. The person who is covered by insurance likely would not have been able to get GRS if it were not for coverage recently added by her employer. In fact, she was a scheduled for an orchi when the benefits were announced. She was pretty much resigned to the fact that surgery was just a pipe dream.

So many of us are in that boat. We reach a point in transition where we just cannot afford any more. Where does this leave us? What of the broken dreams of fully aligning our bodies with our minds? The fight needs to continue. We need to continue to expand health coverage for transition related medical expenses. Of course it is a hard sell right now. Not only are we hurting in this economy, but so are many of the employers we work for.

So many times, trans health benefits are carried only by companies that self insure. What exactly does that mean? Well, it means that if an employee takes advantage of let’s say GRS, the surgery is not paid by the insurance company. Rather the employer pays for it through the insurance company. In other words, the insurance company acts merely as a middle man in the transaction, accepting the claims, evaluating them, ensuring they meet the guidelines, and then making payments.

Unfortunately, so many times that benefits are also not paid until after the procedure. What does this mean for us? Well, if we don’t have $20K to pay for surgery, we likely do not have $20K to pay up front and wait for reimbursement from the insurance company. There needs to be better benefits coordination when those benefits do exist. The whole purpose of medical transition benefits is to remove financial barriers to transition. In many instances, these benefits do not remove the barrier, but rather jut changes the barrier.

I would also say that the surgeons need to become more flexible when it comes to insurance coverage. There operate on a cash up front basis, and often are not willing to wait for an insurance company to pay after the surgery has been performed. Essentially, we are forced to pay for the goods before we receive them. And, what choice do we have? There are so few doctors that perform the surgery, so they set the rules. No cash up front, no GRS. In many ways, they help maintain the financial barriers to surgery.

There is a long way to go to fully remove the economic barriers to transition. Medical benefits for transition should be universal, plus there needs to be ENDA in place to help ensure we can keep our jobs so that we can have benefits to help pay for transition related medical expenses. There is a lot of work to be done in both of those areas.

Now, as for my blog, where is it going. I’m not sure right now. It may become more issue focused, exploring the many issues that we all face, with brief glimpses of what is actually going on in my life. I really don’t think it will be the diary/journal it was before. I have move past that in many ways. But, I will forge on, trying to keep this going.

OK, a few quick updates. Work is still going fabulously well. The fact that I am trans is a non-issue, almost never comes up, and nobody treat me any differently. I’m working my butt of in my manager training program so I can get my own branch next month, which is very exciting, and a hell of a lot of work. I am actually managing two branches this month, and doing it well. Oh yeah, speaking of surgery, I am scheduled for my GRS next July in Trinidad. Hoping insurance coverage at my company will be worked out more by then, I cannot exactly put up the money up front and wait for reimbursement, but we shall see. Other than that, I am just enjoying life, though I am really trying to figure out a few things, ad figure out more about who I am. I neglected myself for so long, that I need to get out and finally enjoy being me. It’s time to relax, let down my hair(now that I have hair to let down), and have some fun!

I’ll try and check back in more regularly, but no promises here!

New Year Reflection

Yes, It’s that time of year. Time to reflect on last year, where I started it, where I went, and where I ended it. It was an amazing year. I started out 2008 entrenched in what seemed like a never ending cycle of wishing I could transition, not knowing if I would ever be able to transition, feeling like wishing to transition was hopeless, and just not really being fully engaged in life. 

Even in that, I think I fooled a lot of people. I pretended like everything was ok. I fooled myself into thinking I could keep fighting. What I didn’t know was that it was really beginning to be a losing battle for me. Sleep was never really something I looked forward to, mostly because I couldn’t. I lay in bed tossing and turning, knowing who I was on the inside, and not knowing how, or if, or when I would ever be able to express that. At the same time, I was trying to keep a marriage from sinking, but I was hitting icebergs. The more I struggled on the inside, the more I withdrew from my spouse, and the more our day to day relationship suffered. 

By the end of February, things were not looking good. One night, she came to me. She told me that she knew I was hiding something, she told me that she didn’t want to lose me as a friend and a parent to our children, she reached out to me and threw out a lifeline. That night, for the first time, I spoke the words the described how I felt on the inside. I described by gender dysphoria, my feeling of not being a “man,” my need to live as a woman, my need to be true to myself. To my amazement, she expressed support, she displayed understanding, and she accepted me for who I was.

That was the first step. We talked and realized that we did not know where this would take our relationship, but we knew, no matter what, we would always have our friendship and we would always be committed to working together to raise our daughters. Over the next few nights, I tried to figure out what the next steps were. Despite years of knowing I was trans, I had never searched out information to determine what I had to do to transition. I was afraid to look before, I was afraid the knowledge of what it would take would draw me in, that knowing what to do would make it easier for me to take that next step and actually transition. But now, I had finally found that I could reveal who I was and that the people I loved the most might not turn their backs on me, that I might not become an outcast. So, I reached out and sought out. 

I found that there were local groups and organizations. I e-mail one such group, the Central Texas Transgender Society. I soon was put in touch with my two dear friends, Karen and Tiana. We arranged to meet for lunch. So, on March 19th, 2008, I met with Karen and Tiana at Dave and Busters, here in Austin. For the first time in my life, I sat down and talked to two people who had been where I was at, two people who understood what I was going through, two wonderful women who would become my friends. They told me more about the monthly CTTGS luncheons, a great opportunity to get out and meet other people in the community. I would have gone that month, but, as luck would have it, the day we had lunch I was a little sick, but, by the time Saturday rolled around, I was on my way to the doctor to treat the cold that had progressed into bronchitis. I was sick and miserable for days.

I continued to search for information, looking to understand better what I was going through, what the future held for me, and what I needed to do to get to where I needed to be. I found my therapist, and started therapy in April. To sit down in front of a total stranger and relate my story again was an amazing relief. That month I also attended my first CTTGS luncheon. I went in drab, but still enjoyed getting to meet some other people in the local community. Over the next month, I learned how to do my makeup, bought my first female clothing, got a laser and electrolysis consultation, and purchased a wig to tied me over until my hair got longer. In May I took the big step of going out presenting female for the first time. It was for the monthly CTTGS luncheon. The luncheon had been rescheduled for the following weekend, but I didn’t realize it. I wasn’t on the mailing list yet, still not actually(hmm I’ll have to look into that one again.) Fortunately one other person did not get the e-mail either, so she and I ate lunch together, and then we went out to a shoe store. First time out, I had lunch and went shopping for shoes. Not bad.

At the end of May, I talked to my therapist about hormones. She agreed that I was ready, and said she would provide a letter. I made an appointment with my doctor for the end of June, after getting a full physical first. At the end of June, I walked into the doctors office with my letter in my hand. I actually didn’t need it in my hand, as it had already been faxed over. That day, I was prescribed hormones. That afternoon, I picked up my spiro, and called in to order my estradiol! I was on cloud 9!

The summer was a whirlwind of activity. I began to get involved with Transgender Advocates of Central Texas, which promptly changed their name to Transgender Education Network of Texas when I attended my first meeting. In July I received my first hormone injection. I was nervous, I was excited, I couldn’t believe it! Two weeks late I was a total b***h for a few days as I adjusted to the shifting hormones. But, overall, I felt so much better. I felt more grounded, more centered, less pissed off at everything. Over the summer I began to let my hair grow and I started my faical hair removal. I found that laser really hurts. Ouch! During the session, I realized that if I was not serious about what I was doing, I probably would run out of that room. But my desire to be rid of that facial hair was far stronger than the pain of the laser.

In September, I officially began the coming out process. I started with my former police partner and close friend. I had not spoken with her in nearly six months. I wasn’t ready to tell her before that, and I couldn’t talk to her without telling her. So, one evening, I sent the letter. The next morning, I awoke to find her response. I cried when I read the words,”I’m sorry that you felt that you could not tell me earlier but I am honored and gateful that you have shared this with me now.  You are my friend and I miss you dearly and think about you often……..I don’t want you to be or feel alone.  I guess what I’m saying is what can I do to support you decision?” I felt relief in knowing that I had the support of one of my closest and dearest friends. 

The following month, my Mom came out for a visit, and I told her while she was here. I waited until the end of the first week of her visit. By then the emotions of holding it in overtook me. I broke down, and my wife went to get my mom. On the way upstairs, she told my mom,”Be Strong.” She didn’t mean to be overly dramatic, but it did put a lot of thoughts running through my mom’s head. Especially when my mom saw me crying on the bed. After I assured her that I was not dying, I told her what was going on. I was met with complete love and acceptance, the kind of support that only a mother can give. It was an amazing relief to me. In November, I told my Dad and my brother. They also expressed acceptance and support, but I think they struggled with it a little more at first. They are good now.

The rest of the year has been a little more low key. I put anymore coming out on hold until the end of the year, and I took the time to enjoy the Holidays. I also looked forward to the fact that the coming year hold the promise of many more steps forward, many more changes. I ended the year coming out to another friend, who also expressed support and his friendship not matter what. That was last year in a nut shell. There was so much more, so many details, many of which I left out, but I wanted to touch on the most important. 

This year taught me that I could be myself, that I could finally stand up for something, that I could be an advocate for something I believe in, and that I don’t need to live my life wishing I could be who I am, I just have to take control and be me. Am I going to make a new years resolution? I’m not sure if I would call them resolutions. Each year I typically resolve not to make any resolutions. Instead I will make plans. If I have a plan, I can implement it and carry through on it. So, I plan to go full time(probably April, before my birthday), I plan to take my children to Disney World, I plan to be more involved in Trans education and advocacy, and I plan to just be me, finally.

Thank you to everyone have have met over the last and thank you to the friends and family who stayed and supported me. I wish you all find what you are looking for out of 2009, and if by chance you don’t find it, keep pushing forward and never lose hope.

Follow-up thoughts on trans healthcare and coverage

Lately I have been doing more thinking about the issue of health care coverage for trans people. My original post on this topic can be found here. This topic seems to be one that comes up repeatedly, and I think that it is one that deserves more attention and more analysis. Over the next few weeks or so, I am going to do more research into the issue, looking at coverages, barriers to health care access, costs of health care for transitioners, and the medical needs of the transgender community.

A few months ago, we had the Town Hall call on this topic, but I have seen little follow-up in this issue. In fact, we have seen things get worse in some respects. Recently we saw the policy changes allowing doctors to refuse treatments if it goes against their religious beliefs, and this was followed closely by the Pope’s condemnation of homosexuality and transsexual persons. Was this a coincidence? Maybe, but the timing is suspect. I wonder if this will be followed up with statements and opinions about what “good” Catholic doctors should and should not do. I grew up Catholic, and I have always held out hope that the Church will move into the 20th Century, but it seems to continue to root itself in the dark ages. 

Anyway, I would like to ask for your help with this little project of mine. If anyone has any stories about health care issues such as being rejected by doctors, insurance plan issues, or any other problems related to being trans and seeking health care, please e-mail them to me. E-mail me at transgenderhealthcare@gmail.com. I would even like to hear the good stories, the improvements in coverage, etc. When sharing your stories, I will always keep your personal information confidential, but please let me know if you would prefer me not to republish your story as part of this. If you don’t I will just use the information as a reference points as I look for trends, opportunities, or discriminatory practices. Thank you to anyone willing to share their experiences. Also, if you have any good links to information you may feel is relevant, please send me that as well. I think the more information I can pull together, the better I can put together a picture of where we stand today, where we need to be, and some ideas of how we can get there.

Relief- Coming out

I had been planning to come out to my mother today for some time now. As I mentioned before, I was quite nervous about this process, as I think many of us are. We fear losing those who we love, losing the connections we have built up over a life time, losing support during a time when we need it the most, in short, we fear rejection. This fear is renewed with each time we come out to someone else.

For me, coming out to my mother caused me so much fear. In the back of my mind I knew that I would never lose her love and acceptance, but, still, I feared for the worse. As this week went by, with her here visiting, I found it hard to hide the fact that I had something substantial on my mind. I could see it in her eyes that she knew I had something I needed to talk about. It began to eat me up. 

Last night, as I went to bed, my spouse asked me how I planned to go about coming out to my mom on Sunday. I was not sure if Sunday would be the right day. I told my spouse that I would do it on Monday.  Today came. We had fun with the girls in the morning, including a water balloon fight in which my mom and I both got soaked by little ones. After that I had some homework to do for school. I was also not feeling well. The stress of not talking to my mom was beginning to eat at me, and make me physically ill.  I managed to work my way through my reading, and then I curled up and I cried. With my face in my pillow I cried in my room until my spouse came in. I told her that I could not wait any longer and asked her to go get my mom.

She did, asking my mom to come upstairs for a minute. Then she gave the reassuring words of,”Be strong.” I don’t think she picked quite the right words before bringing my mom into our room. I was still in tears. After an long embrace, and reassuring my mom first that I was not dying, I explained to her what I have felt and known my whole life and that I was trans. She responded with love and support, concern and reassurance that her love for me would never change. We talked, we laughed, we cried a lot. We talked about hormones, transition, and what the future holds. Later we pulled my step father aside and I came out to him. Again I received words of love, understanding, and support.

A massive weight was lifted from my shoulder today. I received such unconditional love and support from some of the people from whom I value that kind of love and support from. I realized that I have to trust my gut instinct, that I know the people around me so very well. I have formed deep, loving, and trusting relationships with my close family and friends. These are relationship that transcend gender. We accept each other no matter what.

I sit her tonight so grateful for those I have around me, my spouse, my family, my friends. I have many more people to come out to in the future, but the future is a little brighter, a little easier to negotiate with each positive and supportive reaction. This is a difficult journey that we all make, it is one that is filled with so many unknowns. We never really know what lies ahead, how people will react, or what each day will hold. We push ahead anyway, we risk losing it all to become who we truly are inside, to bring our presentation into alignment with the person we are on the inside. We would not take these risks is this were not so vitally important to our living a meaningful and happy life. These are necessary steps. 

I took a risk today, even though it was one I was sure was not a huge risk, and I stepped away from it with the ability to be more honest and true with my mother than I have even been able to be. Her love is so important to me, and I love her so much. Thank you mom for being you and being my mom! And finally and thank you to my friends out there who voiced their support or silently kept me in their thoughts, you are all amazing and I love you all.

Pondering each step

I’m coming up on a milestone of sorts, tomorrow will be four weeks since I started on full HRT. It’s been an interesting four weeks, filled with excitement, emotional ups and downs, and the beginnings of changes. I have to admit, I went into HRT hoping for the best, but not really having any set expectations. Getting accurate data on the effects of HRT is pretty much impossible. There are many sites that will talk about the common regimens, the possible effects, the possible side effects, and the fact that results will vary. No two sites or papers seem to give the same perspective on HRT, and, I guess, I can’t blame them for this ambiguity.

    The fact of the matter is, HRT is one of the biggest unknowns in the transition process. He know that the hormones will do something to our body, but we don’t know what or to what extent. In my case, I was expecting emotional changes for a few months and then to start noticing physical changes in 3 months or so. My nipples started swelling and hurting after two weeks, and palpable breast buds were present after three weeks. This was a bit surprising to me for a couple of reasons. The first reason being that my doctor starts patients off at a lower dose of estrogen, and the send being that almost everything I read says that these changes start between 3-6 months. 

   Now, I must be honest, I am not at all disappointed in these rapid changes, I am rather trilled by the fact that my body is responding so quickly to the HRT. I am pleased that my body hair does not grow back to quickly when I shave it. I did no have a lot of chest hair, but what I had seemed to be visible again in less than 24 hours. It was dark in spots, and it grew quickly. I also never felt that I could get a close shave when I removed it. There were always bumps and stubble. Now I shave it, and my chest actually feels smooth, and it was four days or so before I could really notice the re-growth. 

   These little advances, these victories, really help to bolster my confidence and make me feel like I am making progress. It helps me see that full time is something achievable, and possibly something that will happen sooner than I initially planned. Not that I set hard a fast dates. You could say that my transition schedule is flexible. I thought I would be starting HRT at the end of July, but that happened about three or four weeks sooner. Right now, my plan is to go full time in July of next year, but I think it will happen sooner. My therapist even dropped the suggestion that I probably will not wait that long. I think that she sees my confidence and the fact that I am kind of charging comfortably forward into each step of transition.

   The way I like to frame my transition is in terms of how what I am doing feels to me. For so long, things I did in life either did not feel right or I was just completely apathetic about what I was doing. Now each thing I do to move myself towards transition feels right. There are days I look at the transition schedules of others and wonder,”Am I going too fast?” I stop and I think that I am going at the pace that is right for me. We each have out own time line, we cannot judge ourselves or others based on our unique timelines. We have to be comfortable with what we are doing, and sometimes , depending on our family situation, others have to be comfortable and ready for the next step.

  I am fortunate to have a spouse who realizes that I need to transition in order to be comfortable and at peace with myself. She realizes that this is something that is part of my core being, and something that I have carried with my for as long as I can remember. For her, it is easier because of our personal situation. We were headed towards divorce. My repression of my gender identity got in the way of our love, and drove us apart. In the end, my coming out saved our friendship and our joint commitment to our children, but the love that was there was lost in many ways. The love that comes with a deep bond of friendship is still there, and it is that friendship that gives her the strength to support and encourage me. 

  Each step in this journey takes me closer towards living my life in a way that is more genuine, and in a manner that will not only bring happiness to my life, but allow me to give to those who are important to me, bringing more joy into their lives.

Access to Health Insurance

I want to start off by just apologizing for being a little haphazard in my posting here. I am hoping to get on a more regular posting schedule. I have had I lot of different things going on, and I have had a lot that I have wanted to write about but little time to do it. I do appreciate those who have stopped by to see what is going on here, and I look forward to writing more and engaging in some discussions of the topics and issues.

I just got off the Town-Hall conference call with Donna Rose, Jamison Green, and Becky Allison. I thought it was a good start, and I hope there can be more opportunities for our community to come together like this. I think one of the major benefits of calls like this is the breaking down of economic barriers. Todays topic was essentially health care, and underlying the need for coverage is the need to break down economic barriers. Far too many in our community are unemployed or underemployed. For many, making the journey to a conference may not be possible for economic reasons. Calls such as this will help those members of the community to be able to reach out and interact with the Transgender community at large. I think this will also be of value to those who may live where there is no trans community to speak of. 

Now on the topic. I think most of us have heard about the AMA resolution in June and the WPATH statement in July. These were both significant statements. I would like to start with the AMA statement, which was actually three statements related to removing barriers to care, removing insurance barriers, and removing financial barriers. The one thing that struck me was the repeated use of GID throughout the statements. They did, however, reference GID as a medical condition, and referenced not only the DSM but also the ICD. Now, I was not familiar with the ICD until this evening. I would appreciate information about it if anyone knows a little more about it, and how GID is treated in the ICD. I think that it is positive that the AMA referred to GID as a medical condition as opposed to a mental disorder. I am curious about how this statement in conjunction with the WPATH statement and other papers could serve to help legitimize our need for treatment if GID were removed from the DSM.

I am behind Kelley Winters’ efforts, my only concern being that we have another avenue by which can can continue to gain the medical treatments necessary to transition. I know some have argued that they do not want to be medicalized. To those I would argue, how can one justify medical treatment in the absence of a medical condition. I want to be medicalized, I just don’t want to be pathologized. I believe that part of our process towards equal health coverage is strengthening the medical need and the recognition of GID in the medical community as a medical condition.

I rather liked the fact the the WPATH statement included things such as chest reconstruction and FFS. A Jamison mentioned, many chest reconstruction is the only surgery that many FTM’s want at this time, and for many of them, this surgery is very validating for their gender presentation. The WPATH statement acknowledges that the path to transition is about more than GRS. There are other surgeries and procedures, which some consider cosmetic, that go a long way towards helping to affirm ones gender identity and help make a transition more successful and less emotionally painful (I think anyone who has been through laser or electrolysis knows these don’t reduce physical pain!). 

I think one of the most powerful things in this statements was the AMA’s statement of dispelling the myth that treatments, procedures, and surgeries for trans people are cosmetic or experimental. For us, these procedures are necessary for us to be able to live a life that is more genuine and more true to who we really are. These procedures reduce the emotional stress that can cause so many other health problems. When it comes to insurance companies arguing about cost, I have a few examples of my own situation. Prior to coming out and beginning transition, I smoked almost a pack of cigarettes a day and I was borderline high cholesterol. Within days of coming out, I quit smoking. I stopped cold turkey, now that I was on the road to being me, I didn’t need that crutch. I also changed my eating habit and reduced my stress levels significantly. I was no longer eating the bad foods we eat when we stress eat, fast food, high fat foods, high cholesterol food, you know that stuff that tastes so good but is horrible for you. Since then, by cholesterol is half of what it was before. Not smoking and reduced stress are also significant. Essentially, I likely saved my insurance company easily hundreds of thousands of dollars by transitioning. I greatly reduced my risk of heart attack and stroke, reduced my need for cholesterol and blood pressure reducing medications, slashed my cancer risk each year that goes by, and greatly reduced the potential costs if depression were to lead to suicide of suicide attempts and the related hospitalizations. You tell me, which is better. I think I would take the road of paying for therapy for a few years, GRS and a few other procedures, and HRT. Over my lifetime I bet that it will cost them a lot less then the bypasses and other procedures I was headed towards! 

Another thing I did take away from this was the need to education, Educating our employers, the insurance companies, and the insurance brokers that our companies deal with. There were several stories of brokers discouraging Trans benefits, or pricing them too high to be affordable. I worked in the insurance industry for a brief period of time, and when you are a smaller company, you have little or now ground to negotiate when it comes to benefits. It all comes down to what can I and my employees afford, and what do we have to give up this year. The education has to start with the insurance companies and the larger companies that have the negotiating power. If every company listed in the Fortune 500 index said we want full coverage for out trans employees, I am sure that the insurance companies would take notice.

I find it interesting that many insurance companies offer full benefits to their trans employees, and yet make it difficult and expensive for other companies to provide the same benefits. I wonder about the concept of creating and index that would measure and rate insurance companies not only on the benefits they provide their own employees, but also on how they make the same benefits available to subscribers. Imagine being self employed and having to shop for health insurance with trans benefits, I am sure that is impossible, and if possible prohibitively expensive. 

We need insurance companies to recognize trans benefits as a fundamental part of any group or individual plan. Spread over a sizable group, the costs are negligible. I believe one study showed that it was pennies per premium. I will find that presentation and post it later, I think it was from and Out & Equal conference. If this is part of every policy, cost would not be an issue, and we would finally have equal access to health insurance and the procedures that we need. 

I look forward to future calls, and the discussions and actions that they will generate. There are a few things out there that are dividing some of us, we need to concentrate on many of the things that bring us together. We will always have differing opinions on how to tackle a particular issue, but I think we need to respect the diversity of opinions in this community. We are an educated community, and we need to realize that there is more than one way to approach an issue. Good night to everyone, and hope to talk about some of this more.