Good news and bad news.

The bad news

My doctor is gatekeeping me. When I last saw him in late November I told him that I’d like to take the next step and send in my applications for the juridical change of gender. I needed him to sign the papers and held a short but well prepared speech about why now is a good time. But he promptly disagreed for no good reason and wants me to wait another 3-6 months. I’ve learnt from experience that it is wise to always add at the least 2 months on every time frame given to me by him, just to keep expectations realistic. As everything in Swedish healthcare freezes over summer, he was actually saying something like “Maybe in September, when I’m back from my vacation”. Almost 10 months from the day I asked him.

He claimed that “It is protocol to wait for a full year after you started on hormones before signing any papers” That is not a valid argument. Firstly, I have been in the loop long enough according to the standards this hospital normally apply. Secondly, there are no specific requirements about a certain amount of time having to pass before an adult diagnosed with GID can apply for or be granted a change of juridical gender. No details regarding time is mentioned in the national recommendations for transgender healthcare or in Swedish law.

In the material about the application it says that you should have “lived as your self- identified gender for a considerable time”. The reason why it is so vague is because time shouldn’t matter. Every applicant is judged individually on the basis of their own story and the material they choose to enclose to their case. But my doctor was stubbornly unyielding, refusing even discuss the matter and nothing I said could make him change his mind.

I very much doubt that any more information supporting or threatening my case is likely to come of further waiting. I have cooperated and done everything they asked from me. There are no more tests, no parts of my body that hasn’t been subject for careful examination, no more specialists I need to see. The most likely outcome I could see following his “Just a little longer but I won’t say how long”– strategy was that my depression might get worse. I’ve been away from school and work due to depression for a full year now. The experience of not being in control over ones life is generally a serious trigger.

Sadly I was right in my suspicions and shortly after that meeting I got a lot worse. Friends and loved ones comment on how I’m so far from my normal self, they worry about me. This last month has been a struggle, I’m not well and I realise that I might not be recovering at the rate I was hoping for.

That was the bad news.

Now here is a challenge for you: Everything you just read is either objectively or subjectively true. I feel a lot worse. The healthcare system is unfair and not working as it is supposed to. Still there are plenty of good news in this post. They just doesn’t make the bad ones go away for me. Try keeping that in mind while you read –

The good news

Luckily I have more good than bad news, so here is a list:

  • Dessert more often I’ve met a dietitian. Surprisingly she approved fully to my approach on food and eating. Instead of scolding me for eating to much, to little or to unhealthy, she helped me with exactly the things I asked for. Then she sent me home with the advice to have dessert a bit more often! She also asked me if I’d like to come back for follow-ups and to learn how I could do even better, which I gladly agreed to.
  • Back at the gym My biceps tendon seem to have healed after an injury that kept me away from my normal routine for a long time. I have been seeing a physiotherapist and done some rehab exercises. Now I’m finally back on track and it feels great!
  • Mastectomy soon The rules state that I only should have to wait 3 months from when I was first put on the waiting list for surgery. That time is due by my birthday 28/2, but in reality surgery happening sometime before summer would be great. My surgeon was not nearly as socially awkward or insensitive as I had feared. Considering my already almost flat chest and the amount of muscle tissue he has to work with, he judged me an ideal candidate for the periareolar-surgery I wanted, just as I had expected. (Advice: Don’t google it if you think you might be more squeamish than curious.)
  • Massive voice improvement I’m much more comfortable with my new voice now. I use it with confidence most of the time, except this last week when I have been down with a cold and can’t speak at all. My voice therapist is impressed by the level of voice technique I can master so far. (One could almost think I had the same university degree as she has on voice and stuff, just waiting for me around the corner.)
  • Testosterone I’ve had my forth injection and been on the treatment for 8 months exactly today. The fresh results from testing my hormone levels reveal that I’m still a bit lower on testosterone than I should be. From now on I’ll be getting my injections with only 10 weeks in between, not 12. I really like what the hormones are doing already, so that is good news.
  • Flexibility Just before it was time for my injection I needed to leave town with short notice. I had to ask if I could get it a few days earlier and it was a relief to discover that it was no trouble at all re-scheduling it! Timing is very important when it comes to hormone treatment. If I miss one injection or if I get it to late, I might get my period back. Suddenly being fertile again when you thought you were not could mess things up a lot.
  • A major revelation Lastly but perhaps most importantly, I’ve recently had a major revelation about the nature of the gender dysforia I’ve been experiencing my entire life. I see so much clearly now how it has been affecting me. Given some time and work, I think this will be a breakthrough unlocking experiences and enabling positive emotions I’ve never had access to before. It could change everything. I know I’m cryptic, but be sure that I’ll get back to this later.

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15 things I do that prove I’m doing better than I think

3 months ago I was diagnosed with clinical depression. One of the most damaging effects of the disease is that my filter for understanding reality is severely biased. I “connect” better to negative feelings than positive ones, so a negative interpretation of anything feels much more plausible than a positive one. Such reasoning soon spirals into very destructive patterns. I often end up with conclusions so awful that it is unbearable to exemplify them here. Because of this I no longer trust my own assessments of how bad things might be. Instead I made this post to remind me of 15 important things I’m actually doing right, things that prove I’m doing better than I tend to think.

15 things I do that prove I’m doing better than I think

1) I keep trying. This luckily apply for other things as well, but for example – writing and reading coherent blocks of text is very hard for me to do right now. This post took me the better part of three days to produce, but it felt important and I eventually managed to get it together because I kept trying. When it comes to depression, to keep trying is the number one survival skill, only challenged by…

2) Ask for help. I know I can do it. When in doubt – a god time to ask for help is when “Keep trying” is not working, preferably before you stop trying.

3) I have a supportive network. Due to the depression I tend to think that people don’t like me or have forgotten about me. But I am very capable of maintaining relationships even now and my loved ones haven’t given up on me. They stay in touch even when I’m no good at answering and help to push me out of my comfort zone so that I don’t isolate myself. The bravest ones ask how I feel.

4) I eat. I’m almost never hungry. But with a little effort I plan, cook and eat anyway. Proper food, several times a day.

5) I sleep. When you are depressed, sleep is often disturbed in some way. I have struggled with difficulties to sleep my entire life. Surprisingly, I’m doing much better now than I have for a long time.

6) I get out. I have a dog. That means I have to take him out on his walks, even if I’m having a bad day. I get up in the morning, I get some daylight and basic exercise. Daytime walks and exposure to sunlight is clinically proven to ease (if not cure) mild to moderate depression.

7) I challenge myself at the gym. It is not uncomplicated to go there, but I try to disregard the difficulties and have a proper workout 3 – 4 times a week. I get stronger by the day and my routine also helps to keep dysphoria at bay. The plan is to stay active and create some structure in my life built up around training.

8) I get the medical care I need. I’m an active patient, I see my doctors and therapist every week. I follow their advice in the smallest detail and take notes on how my meds are working to get the best possible follow-up. Except for the inadequacies of Swedish transgender care, I feel that I get everything I need.

9) I cry. Much more than I’d like to, admittedly. But to allow oneself to cry is to be honest with oneself. It is okay to feel things. Life is tough and sometimes the most reasonable thing to do is to give in and cry until you feel better.

10) I protect myself. The other week something very tragic happened that caused lots of people I know to grieve and very understandable they wrote about it on Facebook. Suddenly my wall and inbox was full of my friends reflections on death and suicide. I triggered hard on it and I panicked. I escaped Internet for several days to avoid further exposure to things I felt that I couldn’t handle to read about. A friend had to log in on my account and clean up triggers before I could come back. There is only one good thing about this, but it is not to be underestimated: My first reaction was to take my feelings seriously and protect myself.

11) I commit to the future. I cant stand thinking ahead more than a few hours. I dissociate a bit in order to be able to put something in my calendar, but every time I do it is as if I anchor myself a little bit in my own future. I usually manage to have something set up for every day, something to do that makes that day feel meaningful.

12) Secure income. Dealing with the authorities in the well fare system is neither easy nor kind on personal integrity. But after a long bureaucratic procedure I made it. I now have the right to a minimum income. I don’t have to work or study and I can pay for (most of) the basic necessities in life. Hopefully this will allow me to focus on my recovery.

13) I’m creative. Not nearly every day and I keep it very simple. But there is something deeply therapeutic in being creative or fixing broken things so I have made it a priority. Working with my hands is one of the few things that still feels good. It puts my mind at rest.

14) I don’t hide feelings. When I feel terrible, I tell someone. I try to trust a few of my best friends to bare with me even in my darkest moments. Some degree of transparency on my emotional state keeps my friends and my security network updated. That is why you can read about this and together we can help break the stigma of mental illness.

15) I have an escape plan. If life becomes unbearable, I have a plan ready. It is about breaking isolation and seeking support to get professional help quickly, if need be. Or just hot food and company, if that is enough. I have asked a few friends if I can come and stay with them in case of emergency, so there are safe spaces to go to.

/ E.

IMAG5352Note to self – Here is a little practice in positive thinking. Remember that a secret admirer sent you flowers last week? Also, you excel at the gym right now. Lunch date scheduled with long-time-no-see BFF tomorrow. And there is chocolate cake in the fridge, eat as much as you like. You managed to spring clean the balcony and fix the pride flag – very well done! See? Everything is going to be all right and things will likely start to get a lot better soon.

More:

5 Things to Do (And Not Do) to Support Someone with Depression

The Gatekeeper

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This morning before my meeting, waiting nervously outside the hospital.

I was nervous about today’s meeting, but not in the way people seem to think. I’m not afraid to tell my story or to meet new people. I’m not worried about being denied the medical care I ask for. I’m not afraid to be questioned, I’m well prepared for that and just waiting for an opportunity, for someone to ask and listen. I wont be speechless, quite the opposite.

I’ve been more nervous about getting very conservative questions about my relationships and the gender of my friends and lovers. I dread to be asked to elaborate my own sexual identity or my presumably unhappy childhood. I’m afraid to be judged after the questioners maybe limited understanding of my answers. I don’t want to be misunderstood by the gatekeepers that I have to pass on my journey, but that is a very real risk.

I was disappointed today, at the meeting. I was at the right place in the right time, but when the person in front of me presented himself, I realised that he was not the one I’d expected. He was just another gatekeeper, one of at the least three I’ve met so far. He’s a psychiatrist but does NOT work together with the transgender team responsible for investigation and diagnosis, only in the same house and department so I see now why I was mistaken and got my hopes up.

The procedure is that you must see a psychiatrist before you meet the team and enter the system for real. So it is a step in the right direction, but I thought I’ve already met someone like him and were done with it. I must have mixed things up during the eons of time I’ve been waiting and the long row of people I’ve met in order to get my investigation process started. As things now were, I had to answer all the basic questions about my situation, health, family and such, like I’ve done before with other gatekeepers.

Why do you want to do this investigation? was the first tricky question. It is wide open and I could elaborate on that topic for hours. But for today I was prepared with a short answer, explaining that I feel like a guy and have changed my name and pronoun accordingly. My life would be easier if my registered gender could be changed to match and if I could receive the medical care an investigation such as this could unlock.

So, it is important for you to be addressed as a man? And your name is Emil now? He scribbled something on a piece of paper, thoroughly noting this fact. I was impressed by this, he really got the point without me pushing it down his throat (I’m always ready to do that). This early in our conversation, we had already achieved my set goals for the meeting, him understanding what name and pronoun to use and that I’ve already gone a far way transitioning before we met.

How long have you felt like this, felt like a guy rather than a girl? he asked. This is important since the diagnose criteria states that you have to have felt like this for “a substantial time”. I answered truthfully that I’d never identified myself as a woman, but only lately found out that there are words to describe this, others who feel the same and on top of that – something you can do about it.

He asked about my earlier marriage – Was I married to a man or a woman? Did that person ever question their gender identity? Did I myself, during the marriage? For how long were you married? Where do you live now? In a large apartment with your best friend. What gender does your friend have? Do you live together as friends or as a couple? 

I got a bit annoyed with this, his assuming that friends don’t have sex but couples do. If he thinks it of importance whom I sleep with or not, I’d prefer if he asked directly. As it now were, I pretended not to understand what he was after. Who I have sex with and what my preferences on gender are when it comes to attraction is really not important at this early stage, if ever.

If I have a partner or not (or more than one) is of huge importance tough, I’ll need a good network and solid support to go trough an investigation process as this. But he did not ask about that, so I said nothing. Later, when we talked about my family’s history when it comes to health an heredity, I explained that my friends, partners and family are 100% behind me on this and that I feel that I’ve gotten so much closer to them trough this process, coming out as the person I really am. My intentions where to give him the information he missed to ask me about and I hope he got it.

Then he asked if I was in a hurry with this investigation thing and how important it is to me? I told him that I expect the process to take somewhere between 2 – 4 years and that it means the world to me. He marvelled at this, obviously having no idea himself that it could take so long time. But he seemed to understand that this was important to me and that I had a good idea about the time-frame.

He was confused when I used expressions such as “transition” instead of his “gender swap” or “gender dysforia” to describe the particular sensation of gender related anxiety I sometimes feel. I sighed under the weight of this never ending educational task you seem to have as a transgender person, you have to enlighten and educate everyone you meet, even within the medical care system.

PicsArt_1399056408082[1]All in all, it was a good and efficient first meeting. Now, my plan is to repeatedly and regularly call the transgender team and politely tell them that I’ve seen the psychiatrist down the hall and that I’m ready and eager to meet them as well.

I think I can be rather persuasive.