Facing Medical Care as a Trans Person

Image from Anton on UnSplash

Perhaps I should lead this post off with medical care as referring to myself as a "pre-opt" transgender woman. Since I have never had any of the gender affirming surgeries so appealing to more and more trans women, when I go to the hospital for any sort of a procedure I face the reality of being called a "biological male" as one gruff nurse called me years ago. At this point of my life, not undergoing any major surgeries at all is my final decision and I am sticking to it. For any number of reasons, having a vagina has never been that important to me to define my gender which resides firmly in my brain. 

Regardless I will face another gauntlet of doctors and nurses when Monday I go in for yet another colonoscopy. Which, if you have been through one, you know the prep work and fasting you have to go through is much worse than the actual procedure which is done under anesthesia. 

The last one I had was a year ago and the doctors found enough potential problems to schedule me another fun filled visit in a year. This time (again) I will have the work done at the Cincinnati Veteran's Hospital so I will be interested to see if there is any progress in how they handle transgender patients. The last time, I encountered one in-take nurse who couldn't or wouldn't attempt to use the correct pronouns with me. Even though I am listed as female on on my paperwork at the VA, she called me "Sir". I know in the last year, the VA has made a concerted effort to educate their staff in Cincinnati in the proper pronoun use, all the way to having a question specifically for transgender patients when you are visiting. I have seen improvement in past visits.  

Another problem I have is, because once I have arrived to when the procedure is about to happen, I am so hungry and sleep deprived from the prescribed prep (as well as being a little scared) I just want the whole deal to be over with. Call me anything you want, just get me out of there. By the way, my fear doesn't come from going through the operation itself which I barely feel, it comes from getting the results. Last year, the doctor cut out a polyp growing in my intestine which fortunately turned out to be non-cancerous.  Hopefully, I will receive a clean bill of health for at least another year. Even though I know the prep and procedure isn't the most pleasant thing in the world to go through, the fear of having any sort of colon cancer is much worse. 

Also if you are familiar with the colonoscopy prep, in addition to fasting, the remainder revolves a day and a half of a rapid "clean out" of my intestines'. In other words, the toilet will become my best friend on the next couple of days so I may not feel like posting. 

With any luck, I will be back soon with an update.   

  

The Million Dollar Girl

Image from UnSplash

Anyway you cut it, being transgender is an expensive situation. Most of us don't have a problem looking back, or currently are going through, changing gender wardrobes. I remember vividly trying to hide small amounts of money from my wife to add to my feminine wardrobe. Changing how you look externally can be expensive if you are a transgender woman or a transgender man. 

As it turns out, clothes are just the beginning as then the need for makeup came along. Again I remember sneaking out with my paper route money and buying lipstick and eye shadow. It was all so intimidating and managed to consume my meager funds, in a hurry. Even faster than I was trying to buy my treasures and get out of the store. Plus, don't get me started on the amount of money I spent on panty hose. Get them home and have them run on me almost immediately. 

Of course, the older I became, the need for and the resources for the best wigs I could find became a priority. The better clothes I could afford, the better I could look and blend in with my desired niche in society. For years I was mainly into business woman mode with heels and hose. I wouldn't leave home with out it. Finally I shifted gears and entered my boho fashion mode which was fun and natural as it brought back many of my fond memories of hippie girls during my days in the Army. 

As transgender became a term and surgeries became more mainstream, the cost of medical care was amazingly expensive. Years and battles would have to go by before various insurances began to help cover costs. Which to this day still is an issue. Surgeries became more frequent as well as complex, adding to the already expensive processes. All of a sudden, breast augmentation surgery became increasingly popular with cis and trans women alike. And, on the other side, transgender men were going through their own form of top surgery to remove unwanted breasts. 

After all of that, many decide to go through facial femininization surgery to permanently change the way they appear to the world. Naturally, it is very expensive and often painful too. When you add it all up, it is incredibly expensive to go through these major operations which are becoming more common with the people I know.

Myself, I decided long ago not to go with any surgery. The world would just have to adjust to who I was and I was secure in who I was. 

All in all, the entire process is yet another proof being transgender is not a phase or a choice. It takes a lot to be the million dollar girl...or man.     

Gender Embarrassment

 
Yesterday was a big day for several reasons which involved my first visit to my Veteran's Administration primary provider. A primary provider role in the VA is similar to a family doctors in the civilian world. The significance to me was once again I would have to break in another medical provider into what makes me who I am.

Who I am of course can become quite complex to the average person if they allow it to be. Yesterday I was really surprised when one of the first questions I was asked by the nurse checking me in was how I identified. I knew the VA was attempting to learn more about transgender patients so I answered "transgender lesbian" and then added she and her as my pronouns.  From there we settled into the real reasons I was there.

Jessie Hart in Civil War 
Cemetary

As I have attempted to explain before, not only are my gender issues a point of separation between me and the "normal" other patients the staff may see but also trying to explain why my care is separated between two VA hospital centers. Add in the fact I am bi-polar and questions can become a little personal. Yesterday I needed two issues resolved above all others. One of which was getting my bloodwork done here in Cincinnati which saves me a trip to Dayton, Ohio to get it done. Fortunately after I learned each center has different systems, it would take some work and patience to accomplish the relatively simple task of blood letting. Then the major problem became was what was this estrogen and testosterone test for anyway. To make matters worse, to get it done, they had to ship it out to somewhere else. I lucked out and was assigned to a tech who stuck with the process, made a few calls and finally ended up drawing eight vials of blood. It seemed everyone wanted a sample of my blood.

Now, where the embarrassment came. Finally when I was able to see my provider for the first time, she and the nurse did a fairly decent  job of using my name in place of pronouns. Then in rapid order they screwed up twice and called me the hated "he" word. They apologized completely. So much so I was embarrassed for them. Plus I didn't want to be too much of a pain because I knew I still had two shots coming. One flu and one pneumonia plus I had another big favor to ask. I held my sharp tonged response back and mumbled something similar to it's all right. Which of course, it wasn't. 

The other favor I asked was admitting I was old and I needed a handicapped sticker to place in the windshield of our car when parking spaces are sparse and far away from where we are going. Of course all the worrying I did was for nothing as in five minutes later I had a legal document from the VA to take to the motor vehicle office to apply for a window placard. 

What seemed like hours in the clinic was finally over in probably a half hour and oh yay, I was tagged to for needing another colonoscopy. I was let free to stop at our favorite fast food chicken place NOT called "Fil A" and picked up lunch.

Now it is on to finishing up our wedding prep and picking up a new member of our feline family to replace the two who passed on last year. Hopefully, all the blood work will come back fine and my providers won't have to live through their self imposed gender embarrassment again.  

No I Don't Hate my Body

Overlooking the Ohio
Jessie Hart

 I recently happened on a post from a transgender woman about hating her body. Reason's of course bordered on the effects of testosterone poisoning. 

Similar to many others, I paid the price of T-poisoning. According to casual on lookers the only feminine attribute I had were my legs. I had the typical thick torso and broad shoulders of any other men. I had to try my best to camouflage my shortcomings. Because I was a cross dressing or transgender woman, I struggled with styles and sizes until I reached a level of getting it right. 

At this point too, I struggled with how I viewed my body. When I was cross dressing as a man often I was ego driven concerning my appearance. Over all I didn.t see what the fuss was all about and except the time I was at work and had to wear a freshly pressed shirt and tie, jeans and T-shirts were the way to go. It was the easy way out. 

The feminine side of my soul which was desperately trying to get out into the world was the opposite end  of the spectrum. The wonderful world of women's makeup and clothes presented a glittering opportunity to explore the world I always wanted to try. However, the fashion and makeup mishaps were numerous. It took me time to leave the fun behind and find the proper look to enable me to blend in and enjoy my time out of the closet. 

Through it all, it would have been easy to hate my male body but I didn't. Primarily because this was the body who helped me to play athletics . Playing sports was the way I kept the bullies away. I wasn't particularly good but the plan worked anyway, Also, perhaps the biggest deal with my body was how healthy it was. In fact the only operation in my life outside of dental surgery was when I had my tonsils taken out when I was a kid.  The older I became, the more I learned how wonderful good health was,

Now of course I have all the aches and pains of a soon to be seventy three year old body but I still have to remember how good my body has been to me. Primarily now since it tolerates my hormone replacement therapy and equally as important the medications I take to control my Bi-polar condition. I am indeed fortunate. 

Not long ago I wrote how some transgender elitists may pull a transer than thou with me because I had not pursued or under gone any gender realignment surgeries. In my mind why should I when I have been able to live a fairly successful life as a full time transgender woman without subjecting my body to extremely invasive operations.   

So no I don't hate my body for happening to be male. It's taken me a long, often interesting journey. 

The Results are In.

 

Photo Courtesy Connie Malone

After a reasonably short wait, my mammogram doctor contacted me and said everything turned out fine and they would see me next year. I take nothing for granted, especially with my health so I was naturally pleased. 

Others are not so fortunate I realize but I didn't remember Connie's wife had the different response from her doctor that no one wants to hear. Here  is Connie's comment:

" It's good to hear that your mammogram went OK.

I will always remember the day, many years ago, when my wife's doctor called the afternoon after her mammogram of earlier that morning. I was at home, all dressed up in my closeted feminine glory, to answer the phone, as my wife was at work. The doctor told me nothing, except that she needed to talk to my wife ASAP, so I was almost certain that she had cancer. I called her work to leave the message that she needed to call the doctor, and then proceeded to withdraw to my locked room and further depression. When she got home early, I was still hiding myself, and I could hear her crying in another room.

This may sound selfish of me, but I had never felt the urge to fully come out to her more than I did at that moment. She knew that I was "cross dressing" and hiding myself, but I had reached the point where my gender identity had far surpassed the activity of cross dressing. Of course, I wanted to be there for her, but, because of my ever-increasing withdrawal, I had become unable to be fully there for her as the husband she so much wanted me to be. That doesn't mean I didn't do my best to try, however, so I quickly de-feminized myself and went out to be with her. That dichotomy of love and guilt/shame has never been so intense for me.

Throughout my wife's radiation treatments, surgery, and chemo, I suppressed my femininity as much as I could. I tried the beard growing technique and began lifting weights. My wife was suffering from her perceived loss of femininity after her surgery (I never thought that she was any less feminine, myself), while I was trying to overwhelm my femininity by letting my testosterone aid in my physical masculinization.

My wife has been cancer-free for many years now and, thanks to reconstructive surgery, still has amazingly perky breasts for a woman in her 70's. I'm so jealous of them, of course, but I'm also happy to have shed the beard and musclebound body that I'd developed. Her attitude toward life changed after realizing that it could be cut short at any time, and I'm sure that is the biggest reason for her acceptance of me being the woman I am today. I don't recommend this method for coming out and transitioning, at all, but I think this proves that happy endings can come from tragedy."

Happy to hear your wife has been cancer free for all those years and thanks for the deeply personal comment. In many ways I consider my transgender transition came from a tragedy also. I'm sure most of you know my story. My un-approving wife passed away quite unexpectedly from a massive heart attack. All of a sudden I was free to pursue being my authentic feminine self. Not the ideal way I wanted to change my life. 

Now, down with the negative, the results are in...on with the positive!

Lets Get Comfortable?

 

Photo credit Jessie Hart

Yesterday was mammogram day. The price I pay for being on hormone replacement therapy. The actual treatment is very minimally painful. Getting there was the problem. I don't walk long distances well and had to park quite away from the hospital where my appointment was scheduled. Since I had been there before I knew exactly what to expect and knew there was a big ledge I could sit down on and rest before I actually went into the hospital to register. Once I made it there I figured I had it made. 

Registration was a little more complex than I bargained for as the hospital had to figure out how my Veterans Administration coverage worked into my procedure. Once that was figured out it was clear sailing to the location of the actual mammogram.

If you have never been, they ask you to strip to the waist and give you one of those stylish hospital gowns to put on. Open in front of course. From there they take you to the room where the big mammogram machine is located. I always find it humorous they are in such a hurry. Once I got undressed I was hurried  into a hallway which luckily was deserted. 

The procedure itself as I wrote is basically just a pinching of the breasts so somehow they can get a good X-ray. The unpleasantness to me came when I had to stand that long and contort my body to get a good "picture" Finally two nurses had to come in and assist in the procedure. To add insult to injury, I had to totally take off my hospital gown. Naturally I was more embarrassed than anyone else because I am sure they had seen it all before. 

Finally the procedure was over. They had gotten two X-rays on each breast and I was set free to put my clothes back on and leave. This was actually was my fifth mammogram, so I know what to expect. I am directed to have one every year because my maternal grandmother passed away from breast cancer way back in the 1950's. So I am always extremely concerned about the results of the mammogram tests. 

So far, I haven't yet received any news about the latest tests. As directed I do self examinations and have felt no lumps so I hope everything is all right. 

Now my week continues tomorrow with my latest virtual appointment with my therapist. Among other things I can explain how stressful a week it has been since also, my credit card was hacked and blocked before any significant damage was done. I had to go to my bank branch yesterday to get it settled and had to sit through a sales pitch for another credit card which I was ultimately turned down for because of my credit. Which I knew was going to happen since I am on Social Security and don't make much money. 

On the positive side, I needed the extra exercise and feel much better today because of it. I even went out early this morning to the huge grocery store we have nearby and found a few necessities we needed for the refrigerator. Plus, the rumor has it I stopped at Connie's favorite coffee chain for a couple of nitro/coffees for Liz and I.   It felt good to do it!     

Hello Ms. Hart

 Imagine my surprise when the phone rang and a pleasant voice from the Veterans Administration said "Good Morning is this Ms. Hart? " It was a surprise to me she referred to me with the proper pronoun because normally I need to correct them every call when they ask for Mr. Hart. Even though I didn't have any earth shattering (fortunately) health issues to discuss, it was nice to talk to a friendly voice who didn't start out miss-pronouning me.

I have told myself over the years, the VA receptionists just don't see many women at all, so they automatically revert to the default male pronoun. The whole process reminds me to to be on point with my feminine presentation and more importantly my voice. I have never been particularly successful at all on the phone. In fact, I go into every phone conversation prepared to defend my gender.  

We discussed getting signed up for the next round of Covid booster shots Which I did and how I could get referred for another Mammogram. I need to be scheduled for one every year since my maternal grandmother passed away in the 1950's from breast cancer. So over the recent years I have been through over four Mammograms. The first one I considered to be a sort of rite of passage for a transgender woman with her own breasts. Since then I know what is going to happen so the entire process is rather mundane. Only one time over the years have I had any remotely negative experiences. One time a nurse just had to ask questions about any operations "down below" which of course was none of her business. Following her question nothing more was said. 

After the conversation I had with my VA contact, I did realize I just experienced a gender euphoric highlight. Being referred to as "Ms. Hart" then discussing setting up a Mammogram. It doesn't get much more feminine than that. 

In the midst of my euphoria though, I forgot to set up an optometrist appointment or renew my gout medication. It will be interesting to see if I receive the same gender reception I received on my last visit. Since I will be going there in person for my booster in the not so distant future maybe I will run into the last person (woman) I encountered who refused to accept my correct pronouns. I believe they have personalized business cards to identify themselves. If she does, I will know specifically who to complain about. She needs to be told what a big deal pronouns are to transgender people. 

I need to point out also, over the years I have had very few problems with anyone at the VA. It is just at the closest satellite center I go to, they don't seem to care and represent the right wing population around the clinic. Maybe I can help to change it. 

Menopause?

 

Pre Menopause? Photo Source Cyrsti Hart

As I have been whining about here in Cyrsti's Condo, today (Friday) was my second big medical appointment for the week.

Today was my bone density scan, typically given to elderly women and men. My provider (doc) told me I needed one because I was a woman which was nice I guess. 

Fortunately, my partner Liz could get the day off and go with me. I wasn't dreading the visit as much as I was trying to find a parking spot and not have to walk a long way in the hot morning sun. The Cincinnati Veterans Hospital is in a very congested area and parking is always at a premium. Since Liz went, she could drop me off at the door and come back when I was finished. 

I did fairly well finding the room I needed to check in at and actually didn't haven't to wait very long before my name was called. A young male tech came out and off we went. Along the way he asked me what I did in the service and he was fascinated when I told him the "American Forces Radio and Television Service." I told him I actually was a disk jockey over in Southeast Asia, serving in Thailand just after Adrian Cronauer of "Good Morning Vietnam" Robin Williams movie fame. Since I was laying on the x ray table by then, I couldn't tell by the look on his face if he believed me or not. 

By then it didn't matter because the machine was doing it's work and he asked if I had been through menopause yet. Of course I was flattered and then finally outed myself by telling him I was transgender. I had gone through many other things but menopause wasn't one of them. 

The good news is/was my bones are good and strong. 

I'm sure I was one of his (the tech's) more interesting patients of the day!

Lull Before the Storm

 I have mentioned before here in Cyrsti's Condo, I have two very feminine related medical appointments coming up next week. Now, as it turns out, I have other appointments scheduled also. 

The two feminine appointments are a mammogram and a bone density scan. The mammogram will be interesting if I am examined by the same person who did it the past two years. Two years ago during the first appointment with her, she asked me the requited questions like had I felt any lumps or had any implants. But she didn't stop there and asked a highly personal question concerning any other major surgeries below the waist. I ignored her and never really directly answered the question. Obviously, it was none of her business to ask. 

At that point my self awareness kicked in an I realized she was in a position to put me in a potentially uncomfortable spot. If you have ever gone through a mammogram, the procedure is not painful but can be uncomfortable as your breasts are squeezed for X rays by a big humming machine. So I guess I thought about not poking the bear when she asked the question. Ironically her curiosity must have been satisfied because the next year she asked only the required  questions. 

I also have a bone density scan next week two days after the mammogram. I have been through one before but it was so long ago I don't remember much about it. The good thing is Liz took the day off to go with me. It is at the Cincinnati Veterans Hospital which is in a highly congested area and she will be able to drop me off at the door as she finds a parking place. 

Wedged in between  the two appointments is a virtual therapy appointment. I am sure we will commensurate about how fun a mammogram can be. Hopefully too, I hope nothing crazy shows up in the breast scans. I try to save my crazy for my therapist. 

Just for good measure next week I have two dental appointments. One is a fitting check up for my dentures which I can and will cancel if I am not having any problems and the other is a cleaning of my complete set of original lower teeth. Since I have been to the office so many times, my gender dysphoria doesn't have a chance to set in.

Why?

 It occurred to me recently, after my posts on going to the dentist, just what did all of that really have to do with a blog supposedly dedicated to a transgender lifestyle. 

Then I thought perhaps I was approaching it all wrong. Here is one example.  As bad as the anticipated discomfort and suffering associated with a long put off dental appointment was, the bigger fear came when I thought of the amount of gender confusion I had absorbed in the past. Would I have have to put up with being mis-gendered?

Because, as many transgender women and men know, a visit to a medical facility can bring on embarrassing mis-gendering situations. Even to the point of your "dead name" being screamed out in a crowded waiting room. 

Many times too,  transgender people are forced to educate their medical care givers who have never encountered another trans person.  All the way to being refused treatment altogether. 

Depending upon where you live, the situation is getting somewhat better, even in Ohio a few major hospitals and other organizations are stepping up their game as they offer and interact with transgender individuals. 

Plus, even webinars are popping up here and there focusing on LGBT elderly adults. In fact, I am attending one in May. 

Now if I could go back and erase all my unpleasant medical experiences from my past, I would experience less anticipatory problems.