Posted on by Queer News

Female to Male Transgender: Mental Health

Mental health is tightly intertwined with general health. Most FTMs tend to isolate. Not only do they deny themselves contact with society at large, they tend to isolate from each other. Even though this has slowly been changing in urban areas within the past five years, it tends to be the rule of thumb. Many FTMs who meet at meetings are happy to share the physical changes they experience. They are very private about emotional and psychological changes. The struggle against gender stereotypes is more pronounced for FTMs; or the majority of FTMs are simply more aware of gender stereotypes. This often creates a barrier between FTMs and MTFs, creating an even greater sense of isolation&emdash;an isolation from those who might be best equipped to understand or help us.

It is quite often difficult for any transsexual to feel confident about themselves or even feel good about who they are when so many people in their lives (and society as a whole) have regarded them as deceivers, evil, worthless, liars, mentally ill, psychologically unfit, ad nauseum. We are required to seek psychological treatment just for verification of our circumstances. We are told how we are to act, whom we are allowed to love what our sexuality may or may not be, what clothes to wear. Many of us have been taught to lie about who we truly are by the very people who are supposed to be helping us learn to accept who we are. It has only been within the last ten years that some therapists and psychologists have become guides to our process and let us come up with the answers to who we are. Needless to say, the trust level transsexuals have for therapy and mental health professionals is very low. Most sympathetic counselors understand that they will have to do a great deal of coaxing and laying down of a foundation for trust with most transgender folk just to draw them out.

The constant threat of being “outed,” harassed, beaten/ and most profoundly, the threat of being killed is an everyday concern that wears on transgender people. People in the mainstream feel that Brandon Teena “got what he deserved, because he deceived” the people in the town where he was murdered. Sean O’Neil received the same general response from his neighbors: people felt he deserved to face the charges brought against him for deceiving those around him. Some of those charges were valid. However, the majority of them were not. (Ask us for more information about these people’s cases, if you are interested.)

If the person is “out” about their transition, or has even transitioned on the job or in a small town, the risks are even greater. The emotional and psychological toll of these threats is tremendous. There is the added threat in many areas of being locked up and committed to any number of treatments, including shock treatment. These kind of mental pressures make every transgender person susceptible to mental illness of one form or another at any given point in their lives. This does not mean that we are mentally ill or incapable all of our lives. Because this is usually the perception that we encounter, our frustration level is only compounded. The suicide rate for transgender folk is very high. Substance abuse, eating and sleeping disorders, abuse as children, and domestic violence have only recently been being viewed as symptoms of the social pressures that transgender people are under as opposed to being a part of our so-called illness. Not only do we need more help around these issues, we need more education and compassion.

As more and more transgendered people come together and share their experiences with each other as well as the rest of the world, the primary emotion that arises is anger. It is usually the first barrier that must be dealt with by mental health professionals. Because of that anger, transsexuals can be marked as socially unfit. Western medicine’s approach to classifying the symptom and not dealing with the root problem(s) is constantly used as a weapon against transgender folk. Until transgendered people are given space to feel safe, that will continue to be true. It is not just the transgendered folk who need help or have a problem; it is society as a whole.

Notes on Gender Transition

Revised September, 1997

FTM 101 — The Invisible Transsexuals

By: Shadow Morton, Yosenio Lewis, Aaron Hans–James Green, Editor

Posted on by Queer News

Female to Male Transgender: Hormones

Any person on hormones is a chemistry experiment. It is very important to listen to the FTM (or MTF) as they tell you what is occurring for them physically and emotionally. FTMs have learned to watch and monitor the changes they experience over time. On this note, it is very important that if you have a pre-op transsexual come to you for help, you educate that person to listen to their body and know how to monitor changes. It will be up to them to guide you through their changes so that you can help them navigate their future health as safely as possible. This is also true for the individuals who choose not to do hormones or surgery. Transsexuals are often dissociated from their bodies due to the schisms they experience between the way they feel and the way their bodies are (sometimes) perceived by others, or the way they know their bodies are. Many transsexuals have extremely high thresholds for pain, or cannot differentiate pain from other experiences.

It is important for every FTM to get a complete blood work-up before even beginning hormone therapy. Those who decide to go through the black market to obtain hormones are at risk for a variety of health problems. Even if someone comes to you who is not receiving injections through a program or doctor following the Harry Benjamin Standards of Care, it is important to listen closely to what they tell you. They will often times be able to tell you what it is that they need from you. (We do not wish to imply that we are telling you to throw out your knowledge or ideas. We simply ask that you not throw out the information and knowledge being given to you by the FTM in your office.)

Once hormone therapy has begun, it is a good idea to do blood work-ups every three months for the first year. If there are no indicators of complications, this can be changed to every six months in the second year. After the third year, unless complications arise, once a year is not unusual practice for blood work-ups. The blood work-ups should not only monitor bilirubin levels for the liver, but should also monitor the cholesterol level. An occasional check of the serum testosterone level is a good idea, to be certain that the level is within the normal range for a male of the patient’s age.

In the United States, the most common approach to hormone therapy for the FTM is intramuscular injection. This is usually prescribed at 200 ml/cc, lcc every two weeks. This can vary between individuals, and it will take time to determine the proper dosage and frequency of injections. Testosterone Cypionate, a cottonseed oil suspension, and Testosterone Enanthate, a sesame seed oil suspension, are the two most common forms prescribed. There are doctors who insist on administering the shots. However, most doctors will do so only for the first few injections, and will then teach the FTM how to inject himself so the FTM can take care of this at home. Most doctors who insist on injecting the hormones themselves are also charging higher rates for the injections as well as the office visits. This usually occurs in rural areas or isolated areas where the FTM has little choice but to comply. Oral Testosterone is still sometimes prescribed, but is strongly discouraged. The high doses of testosterone administered through this method are harmful to the liver. This method has also caused high blood pressure in many FTMs.

A growing number of FTMs who have been on hormones for 4 to 5 years who have not had hysterectomies, have developed intrauterine complications. These range from endometriosis to fibroid cysts, to fibrous scar tissue forming around the reproductive organs, to absorption of the organs into the abdominal muscles or even, in a couple of cases, into the intestines. The rising number of FTMs who have been experiencing these complications has pushed many of us to ask for an hysterectomy earlier in our transition. Many FTMs, however, do not experience these problems, and for them hysterectomy may be an unnecessary surgery. Some FTMs require hysterectomy/oophorectomy for psychological reasons.

Some FTMs may experience migraines in the first few months of hormone therapy. This can sometimes be alleviated by adjusting the dosage or the frequency of injections. Whether the dosage should be raised or lowered varies from person to person. This is a totally experimental stage, and also a very important time for the doctor to be listening to the instincts of the patient. Many FTMs choose to weather the headaches. They usually dissipate after 3 – 6 months. Others may experience cold-like symptoms in the first few months; others may be at a higher risk for yeast infections for the first few months.

Diet is very important. Lowering fat intake will reduce the risks of high blood pressure and heart disease. Taking supplements of milk thistle can assist the liver in processing any toxicity. Smoking and drinking should be discouraged. If the FTM intends to pursue any kind of surgery, he should be educated on the damage smoking does to the vascular system. Most surgeons performing any of the alterations sought by transsexuals insist that the patient quit smoking 6 to 9 months before surgery.

Hormone therapy begins at different times in life for different people. Those who start at a very early age will probably notice a variety of changes at several stages of their lives. Even people who do not walk this path experience hormonal fluctuations throughout their lives. Those who begin hormone therapy later on in life will probably have fewer fluctuations, but will need to pay closer attention to the changes that do occur. Anybody is at risk of arthritis and heart disease, but with the added factor of hormone therapy, the usual course of events may not apply. It is also important to note that all of this information will vary from person-to-person depending on age, ethnicity, diet, and current health.

Listed below are some of the differences between the cypionate and enanthate suspensions.

Testosterone cypionate&emdash;This form brings on the secondary male characteristics sooner than enanthate. However, since this is a cottonseed oil suspension, more guys have a variety of allergy reactions to it. These reactions can manifest in the form of mild rashes or itching at the site of injection. Acne is usually more prevalent and harder to control. Muscle and bone density increase is fairly rapid. However, ligaments and tendons are at risk of damage or injury because they take longer to “beef up” in correspondence with the muscle/bone increase. Any sport activity for the first two years of hormone therapy should be approached with this in mind. The voice usually begins to change at two months and settles at about nine months. Body hair appears within the first two months and can continue to grow in new places up to seven years. Balding is a very real possibility. It can begin as soon as three months into hormone therapy. Fat distribution shifts: thighs and hips may flatten out. However, fat frequently does not disappear, it merely shifts to the sides and the gut. Depending on the FTM’s body type and diet, the person will gain or lose weight.

Testosterone enanthate&emdash;Since this is a sesame seed oil suspension, it is usually easier for the body to absorb. The secondary male sex characteristics usually take longer to manifest than with the cypionate – usually the process is 3 – 6 months behind, though this can vary, too. This slower body adjustment can make it easier on the tendons and ligaments, however, the risk for injury still exists. Acne is less of a problem, and for some has been non-existent.

Notes on Gender Transition

Revised September, 1997

FTM 101 — The Invisible Transsexuals

By: Shadow Morton, Yosenio Lewis, Aaron Hans–James Green, Editor

Posted on by Queer News

Sexuality

By and large, the transsexual condition is referred to, and often dealt with, as a sexual problem. Gender identity and sexuality are two separate aspects of our lives. Yet, it is amazing how many people have trouble conceptualizing the difference. Since transsexuals began approaching the medical community after W.W.II, the general view of those practitioners was one of taking a social deviant (socially embarrassing, “effeminate” men) and through chemical and surgical adjustments create a socially acceptable woman. Once it was discovered that a portion of these “new” women took female partners and identified as lesbians, the medical screening process was tightened up. Those who identified as anything other than heterosexual were forced to lie. If they mentioned any behavior that smacked of bisexuality or homosexuality, they were rejected from most gender programs. Those who felt they could not fight the system learned to lie. The medical community taught many transsexuals that their gender and sexual identity were inseparable.

One of the first people to challenge the gender programs and the medical professionals on this attitude was Louis Sullivan. He was the founder of the largest and longest-running FTM organization (to date) in the world, now known as FTM International, Inc. Lou identified not only as an FTM, but also as a gay man. He spent ten years of his life writing letters, personally visiting doctors, educating them, and persevering against the system. For ten years, he was denied hormone therapy or surgery. Finally, his persistence paid off and he was granted the right to pursue the treatment he felt he needed. He was the first FTM who openly led the way for others who identified as gay or bisexual.

Within the FTM experience, the entire gamut of the sexual spectrum is covered. A large portion of FTMs identify as heterosexual men who date and even marry women. There are those who identify as non-sexual and others who see themselves as asexual, choosing only self-stimulation. A large number of people identify as gay or queer, others identify as bisexual. There are those who identify as pansexual or simply sexual.

Of course with the exploration of sexuality comes the discovery and exploration of sex. And with sex, the specter of HIV/AIDS and STDs arises. Most of the FTMs on the street hustling for survival and money are fully aware of the risks they run. They face some of the tough problems that other male hustlers face on the streets. Most johns will pay higher dollar if they don’t have to use a condom. In San Francisco, $10 to $30 dollars will get you a blowjob. These are usually performed with condoms. To kick without a condom, the asking price is $75 to $150. Several of the young men have commanded prices of $500 or more for the john’s privilege to not use a rubber. It seems an awfully low price for their life. The chance of drug use, mostly intravenous, is high for these young men. To our knowledge, at this point in time, the number of young FTM men who work the streets is low.

The FTMs who are probably at the highest risk of transmitting or contracting STDs are those who identify as heterosexual. Many hetero FTMs feel they are immune to HIV/AIDS because it is still considered a gay disease, and not all FTMs emerge from the dyke community. Their biggest risk is their ignorance and lack of education. This is probably less so in urban areas, but the attitude is still alarmingly proliferant. Not surprisingly, those FTMs who identify as gay or bisexual are usually the most educated in regard to any STD as well as safer sex practices. This has not, however, kept FTMs from contracting HIV or other STDs. In both urban and rural areas, the number of FTMs who have sero-converted has risen in the past three years. Herpes is wide-spread if not epidemic. A large number of FTMs have spoken up about cases of gonorrhea as well. When asked why they choose not use condoms or other forms of protection, many state that they have felt pressured into not using them. Several have spoken of being told they won’t be seen as “real” men if they insist on protection. This kind of pressure has come from straight women, bisexual men and women, and gay men. Peer pressure seems to run the gamut in the sexual spectrum as well. More education is needed about safe sex that recognizes the unique conditions of FTM bodies and psyches.

Notes on Gender Transition

Revised September, 1997

FTM 101 — The Invisible Transsexuals

By: Shadow Morton, Yosenio Lewis, Aaron Hans–James Green, Editor