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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“F64.0” Or The end of one journey and the beginning of another.

“…He is clearly a transsexual male that could benefit greatly and gain quality of life by undergoing the gender re-assignment treatment he wishes and such will be duly recommended…”image

So read the teams judgement on me this morning (in my crappy translation) when I met the head of my team to get the result of my investigation summed up for me as well as the diagnosis that opens up possibilities for the treatment I want.

Off course, it is no surprise that this is their conclusion. Furthermore, nobody can tell me who or what I am. I’m certainly not my diagnosis, my gender or my body. But the help I do need to be me and to live my life the way I want to is only granted on the conditions that I’m now considered to fulfil.

It took almost a full year and I’m so happy this part of my journey is over!

This is the best Christmas gift ever! And it is not unlikely to expect a first visit to the endocrinologist or even my first testosterone-shot or voice cracks just in time to my birthday in the end of February next year…

/Emil

Ps. “F64.0” in this posts title is the ICD 10 diagnosis code for transsexualism. I don’t use it other than as a reminder for myself that there is a system based on the idea of sorting identities in more or less normal ones. It has been a strange goal to strive towards, to get a code put on you to enable proper medical care, but I had to do it.

Rorschachs hostage.

wpid-wp-1410862083754.jpegToday I was at the last meeting with the psychologist in the investigation team prior to diagnosis.

The last three or four meetings with him have been all about testing my mental resilience and general grade of functioning regarding IQ, memory, concentration, verbal abilities and problem solving. The team wants to know that my situation is stable, that I’m well enough to continue and that the gender dysforia I experience is not caused by a personality disorder or depression, for instance.

I’m usually totally exhausted after an hour and a half of intense testing.The first time I was asked intimate questions such as if I “like to behave like a woman, sexually”, what ever that means. That pissed me off so much I haven’t even been able to write about it properly. Then I had to solve logic problems, do advanced 3D jigsaw puzzles and answer questions regarding general education, like how hot water is at it’s boiling point or what the word “palliative” means.

Today, among other things, I had to do a Rorschach test, the old ink stain test that means to examine my personality characteristics and emotional functioning based on how I freely interpret nonsense paintings. 0 It is well known that Rorschach-tests are not reliable, so I didn’t think they were used any more. But I was wrong, they are widely used, especially in the juridical system in Sweden and it is a matter of some controversy.

It makes me feel awkward, frustrated and exposed to interpret pictures in front of a gatekeeper who decides if I will get the medical care I ask for, or not. The Rorschach test is a projective test, normally used to judge if a person has psychotic tendencies. I’m not convinced that it is a valid tool for evaluating my creativeness and personality, like the doctor said when I asked why I had to do it.

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Me at a larp, wearing a 1930’s doctors outfit matching the style and age of the Rorschach-test.

I feel like I’m someone’s hostage and cannot be free of this process until we are done with it. I have to cooperate and be a very, very good boy if I want to continue with the investigation. No matter how intimidating or insulting the questions are, how irrelevant they may seem or how badly the tests are managed.

The good news is that there will be no more psychological testing after today.

When I had finished the doctor summed up my profile as normal to above average, but uneven. No surprises here, I told him all about this the first time we met, about me being an academic nerd with ADHD. Perfectly in line with that he pointed out that I have dips in concentration that show extra well after a long time when solving logic or mathematical problems. Otherwise I’m generally very quick, performing well and I’m especially good at verbal tasks. Not psychotic at all, no signs of depression, no personality disorder and I have very low rates of anxiety.

That was it, all testing done and all relevant information gathered at this stage. I expect things to go more slowly from here. I’ll get a doctors appointment in a month or three. Hopefully I’ll get the diagnosis then. After that I’ll have to go through a thorough medical examination and get a recommendation to start the hormone treatment. I can’t wait. But we knew that, I have another diagnosis for it. 😉

/ E.

 

More about why Rorschach-tests are not reliable, in Swedish;

http://www.barnasrett.no/Artikler/rattssikkerheten_hotas.htm

http://ww2.lakartidningen.se/ltarkiv/2000/temp/pda20501.pdf