depression

Going Through the Motions

Being in transition for me feels like everything in my life is temporary. For the past 2 years I’ve been taking all these steps to try to feel like a normal human. This week is my two year anniversary of being on hormones and I’ve also had my braces for over 2 years now as I get my bite corrected. I’ve been getting hair removal all over my body and preparing for bottom surgery. I’m been doing all the necessary things to treat my gender dysphoria and address other medical problems that I’ve been putting off for when I had good health insurance. But all these things just feel like going through the motions in hope that on the other end I can rejoin the real world and live the life I actually want.

Many days I feel like a ghost, like an interloper from another plane of existence trying to navigate a world that isn’t built for me. I feel like I can interact with the real world but I’m not a part of it yet. Like I need to somehow “earn” my way into that life by doing all the right things. And in the meantime my life feels ethereal and temporary, like it could all be washed away by a really bad day.

And now with all of the Seattle area on lockdown for this COVID-19 pandemic, life feels even more temporary. It’s hard to make plans not knowing how long this will last. And scary to know that my surgery date could be effected.

It’s not that I’m afraid of dying; in fact that’s partly the root of the problem. I don’t feel any attachment to living because most days I feel like I never actually have. I’ve never fully lived the life I want as the person I want to be yet so I have no stake in protecting that. The only thing that keeps me going is the hope that after all this transition work, I can actually have that life. I don’t know if it will be better or feel more real, but it’s the only anchor I have to reality right now.

And now that I’ve lost a lot of my routines and physical interactions, even more of my life feels unmoored. I feel like I’m adrift in a world that is panicking and chaotic while I sit here at home mostly feeling numb. I keep saying that I’m ok but if I’m honest I’m not really. I’m spending most of my time dissociating by playing video games to fully immerse myself in a different reality. A reality where I have achievable goals and can actually go out and kill the bad guys and save the day. Don’t get me wrong, the video games are essential to my survival right now. But they are also part of this temporary feeling where the real world isn’t real to me.

I’m not sure when these pandemic measures will all end but I keep holding on to the hope that I will still be able to have surgery in August. And that surgery gives me some grounding in my body and in the real world. Because I do want to live. I just don’t know how to yet.

Barely surviving

I’m going to say some things that might sound scary but let me be absolutely clear that I have no plans to commit suicide or anything drastic like that.

 

I’m sick and tired of barely holding on to life. I’m exhausted from just surviving and it’s hard to see a path to a place where I’m thriving.

Now I know part of that is my seasonal depression talking. I’m on three meds now to try and control it but the best I have at the moment is “not as bad as it was.” I’ve tried messing with them but it’s a dangerous proposition when I’m in the midst of it. The last dosage change I tried put me at too high a risk for suicide for me to continue.

And part of that is the mental and physical exhaustion of being disabled. My back and neck always hurt and that background pain is draining. And then there are periods like the weekend I just had where a seemingly simple task like assembling and hanging a medicine cabinet puts me in 24 hours of acute pain. And it’s demoralizing to know that you can’t even do basic things anymore.

Another part of it is trying to exist in a world that wasn’t built for me. Our westernized society still doesn’t know how to be inclusive of trans folks even on the most basic level. Even queer community makes it hard to be recognized if you are outside the binary gender construct we all take for granted. And when you can fight for decades for the most basic human rights and have those stripped away in just one politician’s term, it’s pretty demoralizing.

But the biggest part of it is the dysphoria I have around how my body is gendered. I have been on hormones for 2 years now and it has helped a lot, but I still can’t look in the mirror most days and see myself looking back. I see a face that looks hopelessly masculine to me, and I hear a testosterone shaped voice come out of my body that can be fun to perform with but still feels like a form of drag to me.

I want so badly to be ok with the body I was given, but that’s not how dysphoria works. I can do all the body positivity building I want and all that helps with is my weight. There is still a misalignment of who I know I am, and the body that others see. I walk around daily in a shell that causes people to make assumptions about who I am. And even when those assumptions are right, it usually means they are focusing on the wrong things.

At this point I feel like I am just barely clinging on to hope that bottom surgery will alleviate enough of this feeling that I can relax even the tiniest bit. I don’t know for sure if it will, but I also don’t know if I could keep going if I don’t try. So for now, I survive.

Inheriting a fixer-upper

I just scheduled my jaw surgery to do the first part of correcting my bite for mid-May. It’s something I’ve been dreading for the last 10 years since my dentist identified the root problem. And I’ve been surprised at how many emotions around surgery are coming up for me now that it is an undeniable reality, not just about this procedure but about my plans for bottom surgery.

My original plan was to get my jaw surgery out of the way this year and then go in for vaginoplasty next year. And in the interim I was going to meet with the surgeons I was interested in when they were in town for Gender Odyssey. But now I feel like that plan has come crashing down around my ears (like most plans have in my life).

I found out a few weeks ago that my jaw surgery is so intensive that they need to split it into two separate procedures with a year of expanding my top palate in between. So now I have another surgery on my face to dread but at least I have jaw feminization included to look forward to. Unfortunately that means I have to rethink my whole plan around bottom surgery.

To complicate things further, I found out that Gender Odyssey isn’t in Seattle this year and they aren’t doing a conference for trans adults this year anyway. So now there’s no opportunity to meet with them that doesn’t involve investing in travel. I feel like I need to decide whether to try to attend Philly Trans Wellness where I might meet some potential providers (although not my top choice – Heidi Wittenberg), or whether to travel to San Francisco to meet with them directly.

And trying to figure this all out while I’m also undergoing intensive laser hair reduction on my face (I put electrolysis on hold for now because it was too slow) just feels like so much. I feel totally overwhelmed by how far I still have to go before I’m done with all these medical procedures and honestly I’m feeling pretty despondent and hopeless about it all.

I just want to fast forward to a point in time where I feel like my body is my own. But instead I feel like I inherited a fixer-upper house that needs major repairs to be livable and every time I fix one thing, another breaks. I know that all these surgeries and procedures aren’t going to fix everything but I still have to rest my hopes on life getting easier once I’m past it all. Because without that hope I don’t know how to keep going.

This is one of those points where I really wish I had been born with a brain and body that matched and I didn’t have to go through all this work just to be myself. And sometimes it feels like I should just throw in the towel on life and give up. Don’t worry, I don’t actually have plans to do so but I can’t say I haven’t thought about it.

Anyway, I don’t know where all this is going right now other than hopefully forward even if it takes a painstakingly long time to get there. I know I wouldn’t be able to keep wading into the fray if it wasn’t for my partners and friends so I am very thankful to all of them for keeping me going. I know things have to get worse before they get better but I really hope I turn that corner soon.

HRT Week 8 update

I just got the results back from my first checkup post-hormones. My estrogen is twice the maximum for recommended male range and on the low end for women (90.5 pg/mL). My testosterone is almost nonexistent (21 ng/dL). I’ve been swinging pretty radically between extremely depressed to extremely euphoric throughout the course of the week and my breasts continue to grow. I talked to my doc about the mood and she said that there is a 50/50 chance that more estrogen will make that either better or worse. So tomorrow I start with 4 mg in the morning and 2 mg at night (currently 2 twice a day). We’ll see what happens!

PS – I’m not taking spiro to suppress my testosterone because my T levels were already below the male range before I started and clearly I don’t need them now.

Libido changes – HRT week 6

Content Warning: Discussion of sex ahead

I’m now past the 6 week mark of starting estrogen and the changes are coming quite quickly now. My breasts are continuing to grow noticeably every week and my nipples are at least 50% larger and much more prominent. Whereas before my nipples used to lay flat about half the time, now they are pretty much always erect which means I have to cover them when I go out. Yesterday I almost had a very embarrassing moment where I arrived a professional conference I was helping host only to realize I had forgotten my nipple covers. Luckily I always keep band aids in my bag so I had to go and strap them down.

Some of the other changes have been less pleasant. Last week I was extremely moody, irritable, and depressed. There were times I wanted to strangle people who annoyed me and moments where I wished I could not exist (not the same as suicidal but close). Luckily I have an amazing chosen family who talked me down during my emotional breakdown where I felt like life wasn’t worth living if I couldn’t make a difference in the fight against greed and evil. Right now I’m taking a break from the news and some of my social justice communities until I can better handle the demoralizing parts.

This week has been more stable in terms of mood but I am really becoming aware of just how much my libido has changed. I was never a “think about sex all the time” kind of person. But I did have an active sex drive and sex life. Now I’ve realized that I haven’t masturbated in weeks and don’t even really miss it. And I haven’t been able to have sex without viagra in a very long time either.

What I’m not sure of is if this is truly a drop in libido or just me not being used to how that looks different. I am still very interested in other people’s bodies but I have almost no interest or even enjoyment in using my own. And whereas before I use to have more bisexual interests, I am definitely becoming more and more focused on just queer women and nonbinary femmes. Some of this started before estrogen but has continued to be more pronounced.

So the short version is that I’m not sure what sex looks like right now or how to relate to it. I am extremely lucky to have people in my life who don’t have expectations of exactly what that looks like either and the benefit of being polyamorous is that nobody is relying solely on me to have their sexual needs met. Having that pressure taken off is a huge relief while I am in this phase where I am essentially becoming a demisexual or gray ace.

Right now it is mostly confusing for me as I try to navigate this new feeling (or rather lack of feeling) and it is a lot less frustrating than I expected. But I know I will be sad if my libido doesn’t come back so I’m hoping this isn’t permanent or that my relationship to sex improves as I adjust.

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!