Stress and Transition

[Simon]

Lately I've been encountering a lot of transition related stress and I just can't seem to shake it. It's not dysphoria and it's not anything to do with the aspects of socially transitioning because I've been living stealth for a good while now. It's more the responsibility and even the what if's that come along with being basically in the middle of medically transitioning.

A big thing lately that is causing me a lot of undue emotional stress is thinking about the implications of having had a complete hysto. I don't want to sound ungrateful for it because I completely feel blessed to have had it done. I was only approved to have it after I developed another benign tumor and endometriosis so it was completely a medical necessity.

Then what's the problem, right? Well, being dependent on hormones the rest of my life. Not that I would ever willingly stop taking T because I feel so much better physically and emotionally now. It's really worrying about availability and financial issues. My endo is really expensive and I pay her out of pocket. I worry about what might happen down the road if I can't afford to see her anymore. Then what...I'm kinda dependent on her for my hormones and in my State docs for us are few and far between.

The other thing I'm worrying my self to death over is top surgery. I'm planning to have it right around this time next year as soon as college ends for the Summer and my gf graduates. Then I have to get it done right then so I have 4 to 6 weeks to heal before I'm required to go in for my abdominal MRI and CT scans for my cancer. If the scans come back that I need another kidney surgery my urologists would basically forbid me to have top surgery before my kidney was worked on (yes, they can do that and if I don't follow their orders I would be kicked out of the Urology program).

It's just a lot of thinking and worrying lately. I'm certain that nobody here has the same issues but I'm also certain that you all have worries related to medical transition yourselves. What are your worries? How do you not let the stress just overwhelm you?

[Liminal Stranger]

How do you not let the stress just overwhelm you?

Because that's not an option. It comes with the territory of being trans, having to pick ourselves up and power through everything life throws in our faces. I've looked up to you as a tough guy with a lot of courage since I joined this forum, Simon, and you've dealt with things others can't even fathom.
Your concerns are justified- the cost of your endocrinologist does add up, though is there a way for you to have insurance cover the visits at least in part? Not completely sure on your situation on that, sorry if it's a dumb question. And I understand that you don't want to wait to get the all-clear from your urologists, but it might be better to do that. Yes, waiting sucks. However, your renal health is a priority and if there were an issue with that, my call would be to wait and make sure you are in the absolute best shape you can be with that before going through with top surgery. Not that I'm telling you what to do, but I would if I were in your situation.

The other day I had to present a research article on the anti-CD47 antibody-mediated immunological response to cancer cells in the body; in short, the cancer hides behind a naturally produced "don't eat me" signal but the two forms of antibodies to this molecule can alert macrophages (a type of white blood cell) to consume these cells anyway, and then later on a CD8+ T cell (another type of white blood cell) response is primed by further signals, presented by the macrophages.

The article and its implications are referenced here in this article: http://med.stanford.edu/ism/2013/may/cd47.html
In addition to a ruling that human genes cannot be patented, disallowing the pharmaceutical monopoly that up until recently existed in cancer treatment, this could mean that not too far down the line cancer will be highly treatable.

In such lies the answer: There is always some form of hope. Just by hanging in there, some things can change for the better. I wish I had some definite, fail-safe plan for the future that I could print out and read off to you, but that isn't possible. Your road has a lot more bumps in it than your average transperson, but freaking yourself out now when you've only just started your medical transition isn't going to do you any good. There is a healthy amount of worrying involved, which you can direct towards problem-solving now for your concerns in the future. That is why we always look ahead of us, Simon.

You're going to be alright, I have faith in you. Stay strong.

[Jared]

Because that's not an option. It comes with the territory of being trans, having to pick ourselves up and power through everything life throws in our faces.

I like your attitude about this Max.

For the original question, I had quite the same type of fear about starting T than you have with top surgery. I was scared that somehow I'm allergic to T or my body couldn't handle it in some other way. The thought made me sick that what if I can't transition medically, and will be misgendered in my whole life. I can change my name and gender of course but let's admit it, without T not much of us can pass in every aspect.
Can't you find a way to get T for insurance? After a hysto it seems legit to me to give it to you for insurance or cheaper.
I understand it's a lot of stress, I remember you maybe said something about working out lately right? I think it's a really good way to get rid from stress. And you're not alone, you have your girlfriend, I'm sure it counts a lot.
You're really strong, if I would be in your place I would've let myself die or whatever happens.
Hope for the best!

[Simon]

Max, you're such a articulate young man and your parents should beam with pride. I hate to burst my own facade but I've never thought I was tough. I've always done what I've had to do to survive. There is a big difference between being strong out of choice and being strong out of necessity. My struggles have made me emotionless to a certain extent. In a way they've broken my spirit. I'm an old man before my time. That's about the sum of it.

Just to clarify, I do have clearance to have my top surgery. One of my surgeons knows that I intend on having it done shortly before my next scans and has given me a referral letter. I am currently on a two year break from scans and surgeries related to my illness. I don't name the genetic disease I have in here because it is rare and I don't want anyone to google it and find me in here. I'm involved with research organizations and the people there don't know of my trans status.

Thank you for the message of support.

Can't you find a way to get T for insurance?

You're really strong, if I would be in your place I would've let myself die or whatever happens.

Nope, I don't have insurance (big shocker, huh?). I can't afford it in the grand ol' US of A. The thing is insurance companies by law can not refuse me health insurance because my disease is genetic. On the other hand there is no cap on the rates they can charge me. Soooo, I can get it but I can't afford it. I'm talking hundreds and hundreds of dollars a month. My hospital is a government funded research facility. Basically I'm a lab rat. They offer me free surgeries and scans. I give them tissues, tumors, and when I die my body is donated to Science. The latter was my choice. I get some of the best healthcare on Earth and it's how I'll repay that.

When I was younger I thought the same thing. That there was no way I could fight cancer or deal with a chronic disease. Then in 2007 I was 25 years old and had a sore neck that would not get better no matter what I did. Finally went to the doctor, had a CT scan, and they found a tumor embedded in my spinal cord. Life has a way of changing your perspectives in a hurry. Any one of you guys could be dealt a hand like I have been and I promise that any of you would be just as "tough" given the same situation.

[insideontheoutside]

Maybe another change of perspective? We all are dependent on some things. Take air and water for instance. Without them, we die. We can go without food for a little bit, but we need that too. Hormones are powerful substances in the body and I'm not making light of them in any way, but you could still survive without them for a little bit if it came right down to it. My aunt had a full hysto when she was in her early 20s. She's never had HRT in her entire life and she's 75 now. Estrogen is something that can be obtained through plants like soy. There's a lot of natural HRT that's targeted to women of course, but that offers supplemental bits of that hormone to the body to help with keeping bones strong, that sort of thing. T is a little harder. Small amount of it is produced in the adrenal glads I believe, but I know you've got a unique situation going on too that throws a little spin on everything. But you've been dealing with that situation many years, right? And surviving. I can't begin to imagine what it's like to be you (just like you probably can't begin to image what it's like to be me) and we've all got out own personal battles. But after all the other stuff you've been through, I believe you can get through these major points of medical transition and come out the other side and let go of that stress.

[Soren]

You can go without hormones just fine. The adrenal gland may provide more estrogens, but the androgens are far more potent- you see this with post-menopausal women's fat patterns changing.
Your main concern health-wise with a lack of hormones would be osteoporosis, honestly. And that can be avoided by cutting dairy (something about the phosphorus or vitamin A getting in the way of the calcium- there have also been correlational studies between dairy consumption and osteoporosis, based on information from cross-countries saying that countries with less dairy consumption have less osteoporosis.) Things like cauliflower, spinach, broccoli and kale will help with this too, as well as being phytoandrogens.
If you do run into a time where you need hormones and can't afford them, try taking a vitamin/supplement that's supposed to assist with prostate problems, like nettle root. (You can get two months worth for under 20$) Since most, if not all, prostate problems have been linked to high estrogen levels, something designed to help the prostate should tide you over until you can get back on it.

[randomroads]

Simon, I really hope the advice you've gotten here and the reassurance helps you in at least a small way. I know how it feels to be under immense amounts of stress, although mine wasn't related to transition. I found the things that helped me feel alive and I enjoyed them as much as I could. That's how I coped with it and eventually got through it.

[Soren]

Oh, and according to a Harvard study, if you sprawl out on a couch for a few minutes, it will lower cortisol levels and increase testosterone production. You can google "Harvard body language study" to find the article, I don't remember the website.