Weird yet wonderful doctor’s visit

[Trigger warnings: explicit language about genitalia, sexual intercourse, and gynecological visit/examination.]

I’m a boy. A boy with female genitals but a boy nonetheless. 

Today I had a weird but probably the best ever gynecological medical experience. It was my first gynecological visit in a couple years and the first one since starting my “trans-journey” explicitly. 

Fortunately, gynecological visits have never been too triggering or upsetting for me. I’ve always taken them in a very practical, matter-of-fact way, as any other type of medical examination. After having my first sexual intercourse involving penetration at 18, I went to have my first gynecological visit simply because I knew it would be wise for me to do so, to get “things checked”. When it became clear that my first relationship with a boyfriend was “serious” (exclusive, committed, monogamous), I went to my doctor (who also happened to be my gynecologist at the time) and got on “the pill”. I’ve always taken this kind of thing in a very practical way, also partly because I enjoy sex very much but am extremely careful about doing things safely. 

Today’s visit was with a new doctor, through my new health insurance, and the first gynecological visit since getting on testosterone, since deciding to get a masculinizing mastectomy, since changing my legal name and pronouns to align with my non-binary/trans-masculine gender identity… And one of the things I intended to discuss with this new doctor today was the option — pros and cons — of doing a gender-affirming hysterectomy. 

I didn’t really know what to expect and since I had to go to the “OB/GYN clinic” which includes lots of different “women’s health services” I was expecting to be addressed as “M’am” more than once. But actually, not only was I never addressed as “M’am” there, I also had one of the best, most gender-affirming, satisfactory, and gentle medical experiences in a long while. Everyone interacting with me addressed me by my chosen first name and referred to me either with the “they” pronouns of my choice or neutrally as “the patient”. When the new gynecologist walked into the examination room, she introduced herself and then asked me immediately, “What are your preferred name and pronouns?”. I was so (pleasantly) surprised that before replying I exclaimed, “WOW, thanks for asking!”. The doctor then proceeded to ask me how I’ve been feeling on HRT and whether the bleeding that I’m still getting with my monthly period is gender-dysphoric for me; moreover, before starting the actual physical examination, she asked me if any anatomical terms are triggering for me or whether I’d want her to avoid using any particular term. No doctor, and in particular no gynecologist, has ever asked me such a question — but now I truly believe every doctor, particularly doctors examining genitalia and other possibly gender-dysphoric body parts, should ask every patient. During the physical examination itself, the doctor was gentle and warned me in advance of each step. Then, we talked at length about the practical aspects of a gender-affirming hysterectomy. Finally, as the visit was coming to an end, I sighed and said, “This feels so weird. This has been one of the best visits I’ve ever had with a doctor but it also feels weird to have my female body-parts checked and discussed when I feel like a boy…”. The doctor responded in a kind, understanding way and added, “Next time we see each other, we can have the visit in the endocrinology clinic so you don’t have to come to the women’s clinic, if that feels more comfortable for you” — WOW! Of course, I promptly accepted her offer — and I might actually be seeing her again next summer to set a date for the gender-affirming hysterectomy (if everything goes well before then)… 

For the first time in a long while, today I felt truly seen and heard by a medical professional, and receiving all that gender-affirmation both on the emotional and on the practical/medical level felt really good!

Identities lost and found

Last night I had a very vivid dream: a stranger (getting on a bus or into an elevator with me) asked me kindly, “Are you male or female? I cannot tell from your voice…”. Their question elated me: it felt like the best thing possible I could get from a stranger, i.e. their not knowing whether I’m male or female — or other…! I also realize the importance of the detail of the stranger in the dream not being able to gender me specifically because of my voice: in fact, I am struggling a bit lately with the disappointment or impatience of my voice not dropping lower (or faster). 

Being sickly for so long is very hard for me not only because it’s concerning and boring, but also because it undermines the most important parts of my identity. Being ill & sickly for so long and thus unable to do almost any of my usual activities is alienating for me. It robs me of my “scientist” identity because I’m too fatigued (& getting splitting headaches) to do any work that requires concentration. It robs me of my “mentor/advisor” identity because I’m too ill or tired to supervise my mentee regularly or to go on campus and interact with the students. It robs me of my “athlete” identity because, of course, I cannot exercise — I can hardly go for walks still… In particularly, it robs me of my “climber” identity because I cannot climb, or even hang out with my climbing buddies — and I really miss them. And these losses now are also combined with the loss of my “non-binary/trans-masculine/boy” identity because not being able to see my male climbing buddies and the students on campus effectively robs me of pleasant, affirming male company. For over three weeks now I’ve been interacting (in person) almost exclusively with strangers and my housemate, all of whom see me as a woman, so I’m being constantly misgendered and it feels awful: it’s painful, frustrating, alienating. Moreover, there are the practical aspects that enhance the feeling of being robbed of my “non-binary/trans-masculine/boy” identity because of my illness: I cannot exercise, so I cannot enhance the physical, visual aspect of my masculinity through muscles and physical strength; I cannot go get a haircut, to look more masculine in that sense either; I cannot go get the boyish/manly clothes that I need (I need a new wardrobe for the winter!!!). So I effectively look less masculine even to myself in the mirror and this hurts immensely. 

I need to get back that boy, that athlete, that scientist in me ASAP. I need it for my emotional and mental health (on top of physical health).

On the other hand, though, there is a little silver lining to all this forced idleness: I have rediscovered the little artist in me. My “artist” identity has had the opportunity to come up to the surface to breathe and express itself again. And this feels good. 

I have started sketching again, including drawing my own second tattoo and the fourth tattoo for my oldest friend (a surprising request that warmed my heart like few other things ever). And yesterday, thanks to another dear friend (who is a real artist!), for the first time ever I submitted three poems of mine to a poetry contest! I didn’t do it for the competition or prize, nor even with the hope of any of my poems being published. And yet it was one of the most relieving and empowering, liberating and exhilarating feelings of my life. A huge affirmation: I am an artist (albeit one with hardly any talent and very moody creativity)!!! But it’s not just that. It goes further, deeper. It’s connected to the act of publicly sharing those poems, those very intimate poems of mine, with other people: with total strangers but also people who have something in common with me since they also, supposedly, write poems themselves and might use this means to express their own feelings, emotions, troubles, fears, joys. Moreover, these three poems of mine are related to, and were inspired by, a very complicated (and in many ways painful) relationship, a situation that I’m still struggling to let go or make sense of. And recently I have had the feeling that if I had the chance of sharing some written form of art more broadly, to tell my story about all that, it would bring me more — and maybe ultimate — healing and peace.

So submitting these poems feels like the closest I can get, at least for now, to that “public yet anonymous act of healing disclosure”. I am not saying “This is how I felt” just to myself or my therapist or my closest friends — which is good in itself but somehow doesn’t feel enough to me. I have gone one step further, taking my courage and vulnerability to stand up and say “This is how I felt” to a whole community of strangers who will read those poems.

Double bliss — and food for thought

Yesterday evening I had the double bliss of my housemate (who makes me feel so uncomfortable) being out, away for an overnight trip, and one of my best friends here in Colorado coming to visit me. 

For several years I had the fortune to live with good friends, i.e. to have some of my closest and dearest friends as housemates, and I miss that. A good alternative or substitute for actually living with good friends has often been visiting with friends for shared meals or even for longer stays. The fact that I cannot have that while my housemate is around is yet another source of distress for me here — and thus, on the other hand, a great source of joy when I can have a friend visit when my housemate is away. 

Yesterday evening was particularly nice: first of all because this friend and I hadn’t been able to see each other in person for over a month; and additionally also because there wasn’t a “time-limit” or a “curfew” based on the return of my housemate since she’s away overnight. So my friend came over in the early evening and we cooked together and sat comfortably on the couches to have a relaxed dinner, talking and talking and talking; then we had dessert, and talked some more; then we cleaned up in the kitchen, talking some more, until past ten thirty. We were able to spend five hours together and to actually do it in “my house”, which is something I really enjoy doing. 

So I realize that the current living situation I have with this housemate, although seemingly very good “on paper”, is not the best type of living situation for me — it’s actually quite stressful and detrimental for me and will require change.

How can one love so much?

How is it that one can love so much? 

How is it that while still being ill three weeks after first testing positive for COVID, while putting up with a contradictory housemate, while struggling in an uncomfortable living situation, while reading a book on trauma (& thus addressing my own traumas), while facing frustration and fear and even anger — how is it that I can feel so much love today? 

Love for the warm sunshine beaming through the kitchen windows. Love for the cats and snake (the household pets). Love for specific people (quite a few of them, actually). Love for this lazy afternoon. Love for my drawings and for the food I made myself. And love for this love that I feel. 

Where does all this love come from? 

Humans, the “social animals”

 […] In a statement released in June 2011, the British Psychological Society complained to the American Psychological Association that the sources of psychological suffering in the DSM-V were identified “as located within individuals” and overlooked the “undeniable social causation of many such problems”. […] ‘ 

‘ Mental illness is not at all like cancer: Humans are social animals, and mental problems involve not being able to get along with other people, not fitting in, not belonging, and in general not being able to get on the same wavelength. Everything about us — our brains, our minds, and our bodies — is geared toward collaboration in social systems. This is our most powerful survival strategy, the key to our success as a species, and it is precisely this that breaks down in most forms of mental suffering. […] the neural connections in the brain and body are vitally important for understanding human suffering, but it is important not to ignore the foundations of our humanity: relationships and interactions that shape our minds and brains when we are young and that give substance and meaning to our entire lives. ‘

{From Chapter 10 of the book “The body keeps the score” by Bessel A. van der Kolk, M.D.}

Tugs-of-war

Two more quotes from the book “The body keeps the score” by Bessel a. van der Kolk, M.D.: these two snippets in particular, although from different chapters, for me go together somehow and are particularly important as they relate, among other things, to some recent experiences, conflicts, and needs that I have felt and that receive important validation from these (professional) words.

‘ In order to know who we are — to have an identity — we must know (or at least feel that we know) what is and what was “real”. We must observe what we see around us and label it correctly; we must also be able to trust our memories and be able to tell them apart from our imagination. Losing the ability to make these distinctions is one sign of what psychoanalyst William Niederland called “soul murder”. Erasing awareness and cultivating denial are often essential to survival, but the price is that you lose track of who you are, of what you are feeling, and of what and whom you can trust. ‘

‘ […] neuroscience research shows that very few psychological problems are the result of defects in understanding; most originate in pressures from deeper regions in the brain that drive our perception and attention. When the alarm bell of the emotional brain keeps signaling that you are in danger, no amount of insight will silence it. [… ] When our emotional and rational brains are in conflict (as when we’re enraged with someone we love, frightened by someone we depend on, or lust after someone who is off limits), a tug-of-war ensues. This war is largely played out in the theatre of visceral experience — your gut, your heart, your lungs — and will lead to both physical discomfort and psychological misery. ‘  

Demons?

[Trigger warning: trauma somatization]

‘ […] 

Don’t you ever tame your demons

But always keep ’em on a leash ‘

{from the song “Arsonist Lullabye” by Hozier}

Lately, my demons have been getting totally unleashed at night. To the point of waking me up in the wee hours every morning, usually around four, and keeping me awake for one or two hours until I then finally, exhausted, fall back asleep and can’t wake up until 8 or 9am. Last night was even worse: I woke up just past 2am and couldn’t get back to sleep until almost 5am and then finally tore myself out of bed this morning past 9 o’clock. 

Are they just demons, anyway, or are they actually a more clear and trustworthy sign of what is going on for me now? 

My asthma symptoms, which were something I had never had until my first COVID-infection in 2020, were triggered again five or six weeks ago, as soon as I moved into this new place. Triggered so badly that I had to get back on both inhalers, including the inhaling steroids, which I hadn’t needed in nearly two full years. There definitely were, and probably still are, legitimate allergens in my new living space and/or on the boxes of my belongings which are still scattered around: dust, maybe even mold, long cat hairs which usually don’t really bother me but that together with the carpet and all the rest might be compounding things. 

Is it really only the allergens, though? 

Or is it also, and maybe even mostly, the feeling of being unwelcome in the shared spaces? Feeling limited, constricted, restrained, confined to my little rooms downstairs? The sensation of walking on eggshells every time I’m upstairs in the shared spaces, not only when my housemate (& owner) is at home but also when she’s out as I feel I shouldn’t leave traces of my having been there, of having used stuff? 

I know it’s not all in my head, not all “just my imagination”: she stated it clearly from the beginning that she would need “visual privacy” in the living-room upstairs and probably would often not be up for conversation when she got home from work on weekdays because of her job forcing her to be social for so many hours, five days a week. I totally get that and had no problem with it. As long as I can get my dinner ready and eat it upstairs, I don’t need to have conversation — I can actually catch up on my own stuff while having dinner. But this “each to their own”, “share the kitchen in silence” thing on weekday evenings has evolved into a dynamics that makes me feel in the way and as if I should get out of the way ASAP any time I’m upstairs in the kitchen — and is making the living-room upstairs feel completely off-limits to me anytime she’s home. She often leaves when I’m pottering around in the kitchen. That’s okay: I respect it and don’t mind it (I really wouldn’t mind it either way). But it’s her comments, her body language: she doesn’t just leave the kitchen; she leaves saying, “I’ll get out of your way now”. Or instances like yesterday, a Saturday, when she had been out several hours for a hike with a friend in the gorgeous weather, and the moment she got home her whole body was screaming for wanting me out of the space upstairs; and then, in fact, she brought up again her need for “visual privacy”, for having “her house to herself”. 

Let me make it clear: I have access to three small rooms downstairs, in a relatively bright basement apartment (with a separate bathroom but no kitchen). One room I’m using as my bedroom (it’s really small); one as my home-office; and the third will be my little “living-room” as soon as I’m able to clear up/out the boxes of belongings from my move and get myself some living-room furniture like an armchair. Until now, though, and especially in the past two weeks while ill & recovering from COVID (& subsequent complications), I have only had my tiny bedroom with my bed to relax in the evenings. Which is probably one of the “practical” reasons why I’m not sleeping that well. When I wake up in the middle of the night and have trouble falling back asleep, there’s nowhere I can go to try and coax myself back into slumber — I cannot put into practice one of the main pieces of advice against insomnia, i.e. “get out of your bed and go do something else”. I have nowhere to go. One Friday night, over a month ago, when I had the first big onset of insomnia and asthma symptoms, I went upstairs to the living-room because I felt I would literally suffocate in my bedroom downstairs. When she heard me upstairs, she came out of her bedroom and rather than asking me what might be leading me to lay on the couch instead of my own bed in the middle of the night, she said, “With all the square feet you have downstairs, do you have to be up here now?”. She did get kinder once I explained I was having an unexpected asthma attack and she even helped me with my boxes the next day. But her initial, instinctive reaction remained with me — and still remains with me now. I understand, rationally, that it’s due to her own needs, maybe even to her own traumas or, at least, “quirks”, and that it’s not “personal against me”. But we know that the rational level of understanding is not the only one. Emotionally, psychologically, and even physically, I cannot see it as “just her thing”: at these deeper levels it feels like an attack on me, and a constant attack at this point. 

I am quite aware of my own history of trauma connected and due to living spaces where I felt uncomfortable, even unsafe. I grew up in one such living space. So that trauma is real and deep for me, and then it got compounded with one of my partners with whom I lived for several years back in Europe. Now I’m also more aware of the fact that traumatized bodies are “hypervigilant”, often can never relax back to their “baseline”, and often (hyper)react to situations which are not real threats. Traumatized bodies do so because their brains have been “rewired” so they get (re)triggered even when unnecessary. 

Is that what is going on with me? I am getting (re)triggered without a “real threat”? Is it “just” my old, deep traumas talking and trying to alert me, through asthma attacks, chest tightness, and insomnia, of a threat that isn’t really there? Or is this living space actually hostile and/or unsafe for me?