anxiety

41 days until surgery!

I’m down to less than 6 weeks before gender confirmation surgery and I’m so nervous! I’m not anxious about the surgery itself other than a natural concern about the rare complications. I’m nervous that something will happen between now and then to prevent me from getting the surgery. Because the idea of delaying it sounds like torture. When I did my consult a year ago, I was ready. And now I am wishing I had started the process sooner.

I’ve done literally everything I can do. I’ve bought medical supplies, collected comfortable clothing for the recovery, changed our original flight plans to a roadtrip, booked an accessible AirBnb, and even scheduled my pre-op bloodwork. But my brain can’t stop focusing on all the things that could go wrong.

What if there’s a new wave of COVID-19 cases now that we are re-opening businesses prematurely? What if I get sick right before surgery? What if I get down there and find out that the hair removal wasn’t sufficient because I missed 2 months due to COVID shutdowns? What if the doctor says that my weight is too much of a problem since I’ve put on 20 pounds in the last year?

The last one is the one I hate the most. I’m a very fat positive person and generally I don’t care about my weight. But last year I had a bad experience with Dr. Satterwhite when I consulted with him and he was hyper-focused on my high BMI. He claimed that if I gained any more weight it would be “unsafe” to do the procedure. Thankfully Dr. Wittenberg, the surgeon I ended up choosing, told me that they are more like guidelines for optimal results which I absolutely agree with, but my brain is still anxious about it. Fatphobia is one of the few remaining socially acceptable forms of overt discrimination.

In the end, there’s not much I can do about it. I know all the data about how fad diets don’t work and can cause more medical issues than they solve. And luckily the nutritionist/therapist I’m working with agrees and is helping me balance my food in a way that feels appropriate to me. But the voice of that fatphobic doctor still haunts me. I also wonder how many fat trans people he’s turned away and made believe that they can’t get surgery.

On a more positive note though, my job is being super supportive. They have hired new permanent and temporary staff to take on my workload while I’m gone with enough time to train them before I go. So now I know I can leave even in the midst of a busy period of running COVID research studies and know my work is in good hands.

Currently I am hoping to be able to return to at least part-time work after 6 weeks which is the minimum time my surgeon recommends. Since we are completely online now it should be more accessible. But there is a potential that I may need the full 12 weeks before I’m lucid and off pain meds.

For housing I was lucky enough to find a basement apartment owned by a gay couple to rent that not only is ground floor but has a kitchen and even AC! It was very expensive at $3,400 but it’s centrally located in San Francisco so I can easily make it from the hospital and to my follow up appointments without sitting in traffic. I’ll be staying for a full month since I need to arrive 5 days prior to surgery for my pre-op and stay for 3 weeks after for post-op check ins before I’m cleared to travel. I’m really hoping that I can handle the 800 mile drive home without too much pain since I don’t feel very safe about airports right now.

I’m in the final countdown period and I am so excited! Thank you to all my friends who donated over $2,500 to make this happen. And I couldn’t do this without the support of my wonderful spouse who will be my caretaker after surgery. I guess you could say it takes a village to make a vagina.

Increasing Dysphoria

Isn’t being on hormones supposed to help dysphoria? I mean it’s helping my confidence in my chest and overall shape but it’s definitely bringing up more feelings about my face in particular among other things. The biggest effect that estrogen has had so far other than breast growth is that it is making it harder to ignore things I’ve been burying and ignoring.

I often have days where I look in the mirror and literally see a blank where my face should be. My brain can’t handle the cognitive dissonance between my real appearance and my identity. And even more often I find myself avoiding mirrors or hyperfocusing on my hair to avoid looking at my facial features. And I can’t decide whether growing out my hair would help that or make it worse.

I’ve kept my beard thus far because it hides parts of my face that I can’t handle, especially my chin. But more and more I wonder if it is doing more harm than good. I get stares everywhere I go because people don’t know what to do with a bearded person in a dress. And it makes it so that I can be spotted blocks away as trans. I mean it’s not like I can hide easily with my height and tendency to wear bright colors, but maybe I don’t need to make myself that easy to spot. It also gives me a lot of “not queer enough” feels and makes me avoid spaces that are supposedly for femmes because I don’t think I would be accepted with my features.

But the thought of removing my beard and having to come to terms with the face underneath terrifies me even more. I am dreading what is going to happen when I’m forced to shave next winter for a long planned jaw surgery to correct my bite. But I also find myself wondering if there’s a way to capitalize on that to change my face. From what I remember of the consult, they are already going to need to make adjustments to my chin to make my face symmetrical and I wonder if I can talk the oral surgeon into taking some of it off permanently. Or if I could work with him to do a combo jaw surgery and facial feminization technique. The thought of cutting open my face twice doesn’t sound pleasant.

Then there’s the matter of my genitals. I’m feeling more disconnected from them recently which goes along with my feelings of asexuality. Most days I’d rather forget they are there and sometimes my brain does that for me. The other day I was on a date and I was trying to get myself in the mindset but everytime I thought about what was between my legs all I could picture was a black hole. I ended up not being able to do anything with my own body because I couldn’t reintegrate. Luckily queer sex doesn’t revolve around a penis or any specific kind of sex. But when I think about bottom surgery I’m still not sure whether having different genitals would help at all.

I’ve also realized that I only feel confident at all when my chest, stomach, and legs are shaved. Which even with the estrogen means trimming twice a week. I need to go back for more hair removal but I can’t decide between laser which requires $1,400 up front for 3 sessions (probably twice) or electrolysis which has more guarantee of permanency and I can break into smaller chunks but means more sessions.

Basically I’m feeling dysphoric most of the time now but I don’t know what to do about it and what interventions would help and how I would pay for those. So my brain gets overloaded with that background anxiety and I end up being less productive or mildly dissociating. I know I should try to do things that connect me with my body more instead of just escaping into video games. But I have a hard time figuring out how to do that in ways that a) don’t involve gendered locker rooms, b) don’t trigger my asthma (running is out of the question), and c) don’t make my back and neck pain worse.

There’s a little peek into what’s in the back of my brain most of the time these days. So when you ask how I’m doing and I say I’m fine, please know that there is a giant asterisk there.

Religious but not Spiritual

As open as I am about most things, one of the most challenging things for me to admit both to myself and to those close to me is that I am really struggling with how I engage with religion and spirituality lately. This isn’t necessarily a post about gender but I think it is important to show how everything in your life can be interrelated and this is (or was?) a significant part of my life so I want to take a moment to talk about it honestly here.

In the past I was skeptical of people who said they were spiritual but not religious because that seemed like an artificial divide to me. But more and more I am coming to see how that distinction is meaningful and how I have been essentially practicing the reverse for the past decade. I’ve been religious but not spiritual.

I honestly don’t know what I believe. I guess that makes me an agnostic. I don’t think you can ever rule out or disprove a god or deity or metaphysical property because by their very nature they are outside of science and tangibly observable facts. But the way I’ve been justifying my continued involvement in Christianity and the Episcopal Church is because humanity has been searching for the divine and building religious structures as ways of doing that communally since before the dawn of agriculture and civilization as we know it. And I figured that if so much of human history has been devoted to that, it is pretty foolish of me to think I am outside of that pursuit. I use Christianity as my lens mainly because that is my culture and the context in which I grew up and I don’t want to appropriate someone else’s religion and culture, especially when I am not ready to lean into it as a whole but approach any religion as a skeptic.

As I’ve mentioned before, I grew up in a Fundamentalist Evangelical Christian community. And built into that culture is a lot of spiritual abuse, patriarchy, and denial of the real world in many forms such as rejection of scientific discoveries, gender variance, and sexualities. I am sad to say that their techniques worked on me and for a long time I was a good Fundamentalist bible-thumper who had successfully pushed my questions and doubts to my subconscious and at least ostensibly bought into the propaganda hook, line, and sinker. So part of the reason I stayed in the church is because I thought it was important to heal from that past by reclaiming “good” Christianity or at least fully understanding how it didn’t need to be practiced that way. If I had just run away I don’t think I would be the same person I am today.

But my doubts have never gone away and the harder I try to lean into the discomfort, the more resistant I grow. It’s been a long time since I’ve believed in miracles, divine intervention, the heaven/hell divide, or “the power of prayer” to do anything other than change (or more often confirm) how the person praying thinks. Does the afterlife exist? Maybe. But I don’t know how it has any relevance to my life if I don’t believe in a god who would send people to hell and wouldn’t want to spend eternity with one who does.

And my doubt isn’t exclusive to Christianity either. In queer community there is an abundant amount of “woo” in the form of astrology, tarot cards, reiki, meditation, pagan rituals, witchcraft, etc. And while I’m slowly learning to just accept that other people find meaning in it I don’t think I could ever dive into that with an open mind myself.

For years I’ve been going through the motions of going to church partly for the reasons above about reclaiming and retraining myself, partly because I want to change the church and make it a more welcoming place for people who want it, and partly because I think intergenerational community focused on doing social justice work together is valuable. But recently I’ve realized that the only thing that keeps me coming back is the people. I am lucky enough to have spent the last few years in a very affirming and supportive small community where I have made many friends. And because of that I’m tied into various commitments like childcare, hospitality, and policy changes.

Lately I’ve noticed an increase in my anxiety every time I try to engage in anything related to church. It started out slowly with more and more resistance to attending on days I didn’t have commitments, but lately I have started having near anxiety attacks just sitting through services and last week when I tried to go, I couldn’t even get up the courage to walk through the doors. Part of it is that I feel like an impostor but there is definitely something deeper going on. And I suspect the reason it is really surfacing now is because the estrogen is really shaking out any emotions I haven’t dealt with yet.

I spoke to my very wise, queer femme priest who said this about what might be going on: “I think Christianity (all Christianity, not just bad Christianity) is wired into you entangled with the kinds of ways you were taught to shove yourself down and hate yourself. I think this is true biologically, even, that the neural pathways that are marked “Jesus” are also marked with the awful things you were told about how to be and how to behave, and that any encounter with Christianity, whether in line with your values and politics or not, sends an alert down that pathway. That’s a lot. It may or may not be reclaimable. But to repeat a pattern of forcing (the way you forced yourself to conform, and forced yourself within your marriage) with Christianity will likely only do you harm.”

I think she’s really onto something there. Christianity may not be something I can reclaim, at least not right now, and I need to listen to the wisdom of my body instead of fighting it. Christianity was integrally tied to painful and abusive parts of my past both through my upbringing and with my ex wife who wanted to be a priest and felt threatened anytime I had doubts. So as much as it hurts me to say, I need to step back from church for the time being. I need to find the things in life that give me hope and meaning and right now that isn’t religion or spirituality. But hopefully I can learn to open myself up to what is next.

The game of anxiety life

Life with anxiety is like a game of whack-a-mole. If you deal with one thing, another will just pop up. And adding more estrogen to my system shakes it up and switches the game to advanced mode. I am (re)discovering so many things that I thought I had dealt with hiding beneath the surface.

Resourcing myself

This winter was really rough for me. I wrote about my depression a little bit but mostly I didn’t have the mental energy to write a lot here since November. The short version is that the combination of the bleak political situation with the record rain and dark, long days we’ve had in Seattle forced me to confront the fact that my depression isn’t just situational. There are definitely things that make it worse but it’s clear that it is a bigger problem than just something wrong in my relationships or at work. My personal life is objectively better than it ever has been and yet I barely had the energy to get through the day most of the time.

But I did what I’m best at – I used my resources and courage to look for solutions. And luckily, I didn’t just look for a simple quick fix. It took a combination of a lot of factors to bring me out of it. I’m recording them here partly for my own sake so if/when this happens again I can recall what worked, but also to hopefully inspire others to take some steps towards radical self care.

First off, I have been seeing a great therapist since the beginning of last year who has helped me find ways to break patterns of anxiety and recognize my triggers early enough to help get out of the cycles. But even the best self soothing and awareness only seems to work for me when I’m dealing with the “normal” amount of mental health challenges for me. When I add the layer of depression on top of my anxiety, ADD, and PTSD, I get stuck.

So I found myself a psychiatrist (well technically an ARNP) and started working on finding the right antidepressant for brain. The first try with Lexapro was disastrous – I had a bunch of side effects including worsening anxiety. And even with the second try, Zoloft, it took a long time to find the right dose. But now things seem to have leveled out and I can tell there is a huge difference in my ability to self manage my mental health.

Another important factor was (re)engaging heavily in my core relationship building. Being depressed can take a heavy toll on the people around you and I know I was much more irritable for a long time and my libido was way out of wack. Things aren’t perfect but now I can confidently say I’m feeling a sense of secure attachment and I can see the growth and evolution of my relationships instead of stagnation. I have two romantic relationships that have passed the two year mark and I’ve built a chosen family around myself that can weather a lot of change.

One aspect I didn’t anticipate being such an important key was my physical health. I tend to be pretty good about going to the doctor but I had stopped going to the chiropractor last year due to money and schedules. My back and neck clearly weren’t ready for that though because as I was trying to track my mood for medications, I noticed an unusual pattern. My anxiety was peaking shortly after I arrived at work and again at the end of the day. It turns out that was when my neck pain was worst and it was so bad that it was breaking down my ability to manage my mental health. So I found a new chiropractor who I’ve been seeing weekly and it is making a world of difference.

Finally, at my therapist’s encouragement, I took steps to bring things back into my life that ignite my creativity and passion. I am starting a trans acapella group and even though we haven’t met yet, I can tell the excitement of that is giving my mental health a big boost.

The weather and longer days are of course helping too but between all these factors, I am radically better than I have been in months. My energy has returned, I don’t need to constantly take time every day for pain management, and I can be myself finally. This in turn gives me motivation to do more things that I love like open myself back up to new dating opportunities and see friends more. The positive feedback loop of well managed mental heath sure takes a long time to get going but I’m glad it has finally kicked in.

Antidepressants

Yesterday I did the big scary thing and met with a psychiatric nurse practitioner to explore antidepressants.

I’ve known I had an anxiety disorder since at least puberty before I knew about psychology diagnoses and medication. In my early 20’s it was clear that depression was part of that mix. I show signs of adult ADD and OCD as well but to what degree those are independent of the rest, I don’t know. For a sense of what that is like for me, see my previous post.

Despite knowing all that, I have avoided even thinking about medication for years. My mom has always tended towards naturopathy and pharmacophobia even though she shares the same mental health issues I do. I think because of that I have been scared to approach a medication that would put me in any kind of dependency even after I’ve seen how much it has benefited her to be on SSRIs. I guess it felt like admitting defeat to use a “crutch” like meds. I’d rather keep battling through on my own and try to find coping mechanisms.

But it has become clear recently that I’m not doing myself or the people around me any favors by holding out. It takes so much energy just to get through the day trying to be myself that I often don’t have the stamina to do the relationship building and activism that I want. And I have been around enough people who are on medications without shame now that I have broken down some of the phobias and misconceptions.

So today I took my first, very low-dose of Lexapro. It helped a lot to sit down and have a specialist really explain it all to me in a thoughtful way. The way he tells it, frequent depressive episodes train the brain pathways to be better at repeating that way of being and feeling, right down to modifying the epigenetic code. The reason antidepressants work is because they help you retrain those neurotransmitters into healthier patterns. It takes time but knowing that it doesn’t need to be permanent and there is actual hope for stopping someday really helps.

I was surprised that by the end of the conversation and even today as I took the first pill, I didn’t have fear around doing so. I’m actually rather excited about the possibility of feeling some relief and knowing for the first time that I can remember what it is like not to constantly fight my anxiety. We’ll see what happens now.

 

A mental health break

I know it’s been awhile since I last posted. And I was going to try to come up with some deep gender insight this week based on all the thoughts swirling in my head. But instead I decided to be honest about why I haven’t written.

It’s been a tough couple of weeks for my mental health. I have the interesting challenge of living with a combination of anxiety, depression, ADD, and OCD. I’m what you might call “high functioning” which can be useful but also means I often forget to engage in the type of self care that would keep me that way. But I have been trying to do more of that. To give myself a break from the chaos of unpacking my new home, to get off social media for a bit, and to do things like playing video games and watching TV with a new cat in my lap.

But it is hard to overcome the various external and internal messages that can trigger debilitating anxiety and depression. Last week I had a few days where I was really struggling with the “not enough” messages. I felt like I wasn’t good at my job and it was only a matter of time before they figured it out and fired me. I felt like I wasn’t a good partner and soon my partners would realize I’m actually really boring. And one day didn’t feel like I was trans enough to wear a dress so I wore a more masculine outfit which then caused me to later feel like I wasn’t trans enough because I wasn’t wearing a dress. It was an overwhelming day!

During that time I KNEW logically that those messages weren’t true. I get validation at work all the time that I’m on the right track and I’m good at what I do. And I know my partners love me and are choosing daily to be with me. And I’m writing a whole frickin’ blog about how “not trans enough” is total bullshit! But yet…

Luckily my therapist reminded me that those feelings are OK to have, even if they aren’t true. And that those kinds of doubts are even part of the official physiological diagnosis of “gender dysphoria” that I am submitting to insurance. Periods of transition and intense gender exploration can bring those more to the forefront and make them louder. But that doesn’t make them any less false.

I’m also in this place where the horribleness of the world (and particularly the U.S.) is really getting to me. I know some of it is that I’m just more aware now of the reality that most people have been facing their whole lives. But I still have a hard time figuring out if I feel depressed and despairing because the world is so terrible or if the terribleness of the world is just emphasized and oversimplified because I’m depressed.

So I’m here sharing this with you to remind you to take those vital mental health breaks. To engage in self care in a radical way that allows you to go back out into that terrible world with enough energy to face it. It’s not selfish to take care of yourself because without that you wouldn’t have anything to give back. It’s like putting on your own air mask before helping the person next to you.

One way I’ve been doing self care is by beginning to read Jeffrey Marsh‘s new book, How to Be You. It’s very affirming to read and I’m getting lots of ideas for new posts which I’m sure you’ll see soon. I’m also very encouraged by how much positive feedback I’ve gotten on this blog. After only a month and 8 posts, I’ve had 950 views from 370 readers. Thank you all for being there for me and listening to my ramblings. Until next time!