Coming out (to medical professionals)

[TheBear]

Hi guys

I finally plucked up the courage to come out to a doctor - I admitted to my pain specialist psychologist a few weeks ago that I identified as trans (I'm pre-everything still), and that my need for regular orthopaedic treatment / rehab was making my dysphoria a whole lot worse.

I'm stressing even more now about my upcoming ankle surgery this Thursday, as I hate that I automatically get transferred to a women's bay on the ward, so I receive very odd looks from the other patients, who are usually 60-70+ and therefore less open-minded about non-stereotypical looking women, hence they are naturally very wary of me. Beyond my large chest that is an absolute give-away (I'm very dysphoric about my FF chest), I'm otherwise very muscular with massive shoulders and strong arms, plus I have a large tattoo on my left upper arm of a stunning realistic looking owl portrait (I'm into birdwatching and wildlife - would love to be a pro wildlife photographer if I wasn't so mobility impaired). Therefore, I'm certainly not your average patient on a female ward in a frilly nightgown and wearing fluffy pink slippers!

Anyway, my psychologist, who isn't a gender identity specialist, suggested I should seriously think about coming out to my GP as she would be able to help refer me to a gender identity clinic. My psych is also going to talk with her boss next week, who has worked with trans people before, to see what the process is because I really need to talk about my dysphoria as it's getting worse and I don't have the mental strength to ignore it anymore.

I can't get an appointment with my GP till after Christmas as she's currently taking a holiday, so in the interim, I came out to my acupuncturist on Saturday who's treated me regularly for 14 years and been a good friend for most of this time. She knows I've been massively stressed, including about needing more ankle surgery, so I thought I should explain why going into hospital again in a few days' time is causing panic attacks (it's the indignity of bed pans as well as being on a female ward). I had an opportunity to bring up my dysphoria as she mentioned a friend who chest surgery because of cancer and they'd reduced her cup size at the same time because she was disproportionately large chested. I said I despised my large chest because of my gender dysphoria and her reaction was a look of shock and complete horror. She said 'what?', so I explained it more clearly and she was mortified. Her response was that I didn't know what I was saying and it's because I'm low, depressed and stressed that I've got it all out of proportion. I said I hadn't as I'd always struggled with being female and it didn't match my brain that sees myself as all male etc. And, no, I'm not happy passing as a butch lesbian anymore because I truly don't want to be female. So, basically me coming out didn't go very well at all and I'm now worried that I've jeopardised our friendship longer term.

This negative reaction has now made me doubt coming out to my GP, as much as I want and need to. She has also known me for over 10 years and has been very supportive with my need for regular ongoing treatment for all my other medical stuff. I'm worried that it will take her by surprise when I tell her about my gender dysphoria and again, because I am very reliant on my doctor's surgery (I'm very well known at the small rural practice), I don't want it to have a negative impact on all my other medical treatment from them. Yes, maybe I should have mentioned it before now (I'll turn 42 in a couple of weeks), but I can't keep it internalised anymore because it's too much on top of everything else I'm having to endure. My psych hypothesised that my barriers are down and I'm feeling more vulnerable because I've lost my resilience from having so many surgeries and being in a huge amount of physical pain long term.

I'm also in such a panic about my hospital stay on Thursday, I'm questioning whether I should mention it to my surgeon / or somebody else who will be looking after me whilst I'm in hospital, or is now not the right time? Again, I'm worried about prejudice but they won't understand my additional stress about the female ward environment unless I do say something. Plus I now have lots of leg hair as I've stopped caving and shaving, so that will be a noticeable difference... There are private rooms on the wards but I've never been offered one up till now and don't know whether I would even if I come out as trans...? If this surgery on Thursday doesn't help, then the next step is to lose my lower leg, so I may end up in my own room at that point because of the seriousness of the surgery and to not freak out the other patients.

Should I just shut up this time and get on with it (whilst freaking out on the inside and being super stressed), or should I come out to my medical team there and then to get it over and done with, even though I've not even started transitioning etc? My wife can't stay with me until I go to theatre this time as she can't get off work until after lunch, so she's dropping me off on her way to work. What makes things more complicated is she's not comfortable with my trans identity (she only found out this summer), so it's not something we can talk about together right now and I don't want to lose her. My wife doesn't understand why I can't be happy as a butch lesbian - big problem is they're happy being female and I'm not! My plan is to talk things through with a gender identity specialist myself first and then take things from there. 

So, I'm completely confused as to what to do for the best and am experiencing stress overload and panic attacks. Arrrggghhh. I really don't know what to do or how to get through my next hospital stay and subsequent rehab...? I can't internalise my dysphoria any longer generally as it's suffocating me!

Any advice or suggestions would be much appreciated. I'm so glad I've found this forum. No one I know understands!!! Thanks guys x

[verkatzt]

I don't really have any advice, although I wish I did.  I wanted to post anyway to tell you I understand and wish you luck.

[Kreuzfidel]

Hi, PenRumbleBear.  Just wanted to start by saying it sounds like you're going through a lot at the moment, but just rest assured that "this, too, will pass" - nothing lasts forever and a lot of us, if not most of us, have been through a great deal of the same stresses about coming out/dysphoria that you are going through now.  I'm glad you posted about what's upsetting you.  Just a few of my thoughts on things:

I can't get an appointment with my GP till after Christmas as she's currently taking a holiday, so in the interim, I came out to my acupuncturist on Saturday who's treated me regularly for 14 years and been a good friend for most of this time. She knows I've been massively stressed, including about needing more ankle surgery, so I thought I should explain why going into hospital again in a few days' time is causing panic attacks (it's the indignity of bed pans as well as being on a female ward). I had an opportunity to bring up my dysphoria as she mentioned a friend who chest surgery because of cancer and they'd reduced her cup size at the same time because she was disproportionately large chested. I said I despised my large chest because of my gender dysphoria and her reaction was a look of shock and complete horror. She said 'what?', so I explained it more clearly and she was mortified. Her response was that I didn't know what I was saying and it's because I'm low, depressed and stressed that I've got it all out of proportion. I said I hadn't as I'd always struggled with being female and it didn't match my brain that sees myself as all male etc. And, no, I'm not happy passing as a butch lesbian anymore because I truly don't want to be female. So, basically me coming out didn't go very well at all and I'm now worried that I've jeopardised our friendship longer term.

I know that this may not be what you really want to hear right now, but in the long-run, if she's going to judge you and make comments that are pretty inappropriate (as far as I'm concerned), then you shouldn't be worrying about her "friendship" anyway.  Yes, perhaps she was taken aback because she wasn't expecting what you told her - she may just have been confronted with the issue and said what came to her mind, otherwise not knowing what to say. 

Nevertheless, I would give her time to digest the information and stand firm on the issue if she brings it up again.  Try to educate her if you can, but if she's habitually resistant and looking to "analyze" why you feel the way you do (re your dysphoria), then you may have to consider the fact that she may not be as much of a friend as you thought she was and is it actually healthy for you to continue exposing yourself to her comments.

This negative reaction has now made me doubt coming out to my GP, as much as I want and need to. She has also known me for over 10 years and has been very supportive with my need for regular ongoing treatment for all my other medical stuff. I'm worried that it will take her by surprise when I tell her about my gender dysphoria and again, because I am very reliant on my doctor's surgery (I'm very well known at the small rural practice), I don't want it to have a negative impact on all my other medical treatment from them. Yes, maybe I should have mentioned it before now (I'll turn 42 in a couple of weeks), but I can't keep it internalised anymore because it's too much on top of everything else I'm having to endure. My psych hypothesised that my barriers are down and I'm feeling more vulnerable because I've lost my resilience from having so many surgeries and being in a huge amount of physical pain long term.

Let me put it like this - is NOT telling her worse than what you are already feeling and experiencing?  It sounds to me as though you are already at breaking point - remember that your GP is a doctor, not an acupuncturist.  She will (hopefully) have the capacity to at least point you in the direction of some REAL help, if not help you herself.  If you don't tell her - well you know what will happen, don't you? 

If you DO tell her - well, you're catastrophizing the worst-case-scenario without thinking about the GOOD that could actually come of it.  You sometimes have to just take that leap of faith - for your own well-being.  You are 42 and you've lived a lie long enough.  The damage is only going to get worse for you.  I was 32 before I started transitioning and regret never coming out before.  It is TOXIC.

Should I just shut up this time and get on with it (whilst freaking out on the inside and being super stressed), or should I come out to my medical team there and then to get it over and done with, even though I've not even started transitioning etc?

I can't make that decision for you, but my instinct would be to tell you 'yes', you need to come out.  You seem to me to be in a great deal of physical and emotional pain.  Help yourself.

My wife can't stay with me until I go to theatre this time as she can't get off work until after lunch, so she's dropping me off on her way to work. What makes things more complicated is she's not comfortable with my trans identity (she only found out this summer), so it's not something we can talk about together right now and I don't want to lose her. My wife doesn't understand why I can't be happy as a butch lesbian - big problem is they're happy being female and I'm not! My plan is to talk things through with a gender identity specialist myself first and then take things from there. 

That is something that you need to process in due time.  While you can't expect people, especially a partner who believed they knew all they could possibly know about you before now, to just up and accept your coming out - there is still a need for you to be accepted and loved for who you are.  If your partner is not willing to do that because she wants to cling to an identity more than a person - then do you really think that's true, committed love?  Just something to think about.  You've already hit the nail on the head - I think that, without a doubt, therapy with a gender specialist or at least someone familiar with trans* issues is the way to go.  Perhaps for both of you.

So, I'm completely confused as to what to do for the best and am experiencing stress overload and panic attacks. Arrrggghhh. I really don't know what to do or how to get through my next hospital stay and subsequent rehab...? I can't internalise my dysphoria any longer generally as it's suffocating me!

I think you've already pretty much internally decided what you need to do in order to be happy and to heal - you just need someone to say 'it's okay'.  Well, it's okay.  Yes, you may confuse people with the news - however, their awkwardness and their hang-ups are not about you but are about them.  You can't control how others react and you never will - so worrying and holding yourself back because of 'what ifs' is going to do absolutely nothing for you other than poison you. 

[sneakersjay]

I came out to my doctor because I needed a referral letter to an endocrinologist.  I ended up seeing the nurse practitioner, who was very professional, non-judgmental, etc, and wrote the letter. The endocrinologist (well, her office) turned out to be a nightmare so I ended up using another endo.

I then had multiple appointments with my actual doctor prior to bottom surgery (physicals, bloodwork, EKG, etc) and she was very professional and interested, since I think I was her first trans patient and we'd had a good rapport before.  Then I actually had to go post-op lower surgery for a minor complication and for the first time wasn't weirded out by a doctor looking at my junk.

Anyway, if you feel you need to come out to get the help you need, then do it.  Currently I don't feel the need to out myself to people who aren't involved in that aspect of my care ie eye doc, dentist, etc.  So if you fear bad reactions (like the acupuncturist) then choose who you come out to carefully.  Coming out is very hard.  Congratulations for speaking your truth.  I hope it goes well for you!

[TheBear]

Hey again

I wanted to say a HUGE thank you for your advice and support. It's helping tremendously and is giving me the courage to start making life easier on myself.

Some good news - yesterday, after reading your replies, I made a double appointment to see my GP on her first day back after Christmas on 7th Jan so I can finally come out to her and ask for her help.

Even better, whilst at the hospital today for another hydro session (I'm becoming a little bit more comfortable in my new swim shorts and vest, even though I'm certainly the odd one out in this attire but I don't care as much right now what other people think!), I tracked down my OT who has known me for a few years and came out to her. It went really well. She was nothing but fully supportive and is now trying to arrange for me to have a side room when I've had my ankle operation this Thursday, rather than be automatically put in a women's bay. She understood why I was freaking out about having to undergo more surgery and endure yet another hospital stay and immediately started formulating an action plan. She said she would be nothing but discreet when talking to the relevant bed allocation managers etc whom she reassured me were lovely but I said it was ok to mention the reason for the request if need be. I have confidence that she won't publicly out me, nor make announcements in front of my partner as to why I'm in my own room this time. I can joke that I've earned my loyalty points! Hopefully, from now on, I can sleep and recover in private rather than face the awkwardness from female patients and me send my blood pressure through the roof from all the extra worry...!
My OT said she would come and see me again before I head up to theatre and then afterwards when I'm settled, as she really wants to support me. That was such a better experience than coming out to my acupuncturist!

Talking of whom, prior to me dropping the bombshell on her at the weekend, she said she would visit me in hospital, so I imagine I will find out then whether our friendship is no more. Until then, I will give her the benefit of the doubt as it was probably a bit of a shock although it shouldn't have been. I'm no different now than I have been in the past beyond losing my resilience, thus feeling completely suffocated and no longer able to live in the wrong body. I half considered contacting her to apologise for saying what I did with no warning but then I thought, why should I? I'll give her time to process the news and see what happens later this week.

You're right, Kreuzfidel, I do feel like I've reached breaking point and I don't think I can take much more, so standing up and being courageous can only bring a better outcome than keeping my dysphoria internalised to the point that I can't breathe anymore. Rather than fearing the worst, I will continue. I feel kind of euphoric now from my OT's reaction although mentally drained. Fingers crossed my GP is nothing but helpful too. I imagine she won't be massively experienced in gender dysphoria but I've given her other unique challenges with my weird orthopaedic stuff and she's happily admitted previously that she'll learn along the way whilst helping me. Hopefully that will remain true!

I guess, further down the line, how many medical professionals I come out to depends on when I can start T etc. I've lived in the same area most of my life and wouldn't particularly want to have to move away. Once I've been on T for a few months, hopefully the physical changes will be obvious...? That's a way off though. One day at a time first. At least I've made a start!

Thanks again everyone. Your reassurances and support are transforming me :-)

[Lake James]

Hey Bear  I did write out a reply and post it but it seems to have not go on.....my annoying man pants must have made me hit the wrong button lol  I will redo it tomorrow when the coast is clear again !  p.s still not caved and shaved either...man my ankles are furry

[TheBear]

Hey Lake. Ha! Your post made me chuckle! The joys of man pants. At least they have pockets! My wife has complained for years that women's trousers don't tend to have them, or only have decorative non-functional ones instead! She finally bought a pair of men's short jeans but still had to cut about 3" off the bottom. Glad I've got long legs! :-)

Furry ankles. Amusing. I'm convinced my leg hair has grown in the past week from one hydro to the next! It looked like jellyfish fronds floating around in the water horizontally out from my legs. I was slightly less conscious about it today. Will stress though come Thursday when my surgeon has to draw a big black arrow on my right leg! Just doin' what he said - he told me not to shave now as it might cause a rash!

Look forward to hearing from you tomorrow. Must go. Wife just got home...

[Lake James]

Hello again   

Right I'm going to try again....annoying, riding up man pants have been ripped off and lobbed across the room, so hopefully can concentrate better now   Oh and I hear you on the trouser pockets thing !! Do clothing manufacturers not think that women have stuff to put in pockets, although I suppose we are all meant to have a handbag *shudders* lol   As for coats, never an inside pocket either....luckily my gf does have a hand bag so she gets to carry round all my bits and pieces. 

So, a reply to your post.  I am only going to say about the GP bit as that's all I have experience of.  However I will just say that the reaction of your acupuncturist sucked big time....must have felt like a right kick in the balls (possibly not the best choice of words there, but you know what I mean)

As for your GP.  I can so empathise with your worry as I know that as transgendered all we really want is acceptance and that any sort of rejection hurts massively.  I never planned to say anything to my doctor, it really just did slip out, so I didn't have time to worry about her reaction.  However due to the fact that she had been helping me talk about past abuse I did already feel that I really could tell her anything.  I was always checking with her that she was ok to hear it all, that I could tell her anything and she wouldn't freak out.  Her response was always that I could never shock her and whatever I shared, she would always support me.  This kind of gave me the green light to talk about literally anything.  When I did utter the words "I feel like I don't fit my gender" she obviously didn't see it coming and there was a second or so where she did look a bit shocked, but then after that fleeting moment she was fantastic.  I guess what I am trying to say, is that if you do decide to tell your GP, give her a bit of slack regarding her first reaction.  If she looks shocked or surprised, its probably only because she wasn't expecting you to say it.  When patients sit opposite them and start to look all uncomfortable they probably straight away expect it to be piles or some kind of embarrassing sexual problem and not that you feel misgendered (is that a word??) As someone said earlier, you may be her first !  I think I am with mine, she seems quite interested lol
If I were you I would start with an appointment where you go in and say that you have something troubling you but you are very scared to share it, are worried about her reaction and whether it will affect your relationship.  Then you can judge her response to that and she will be aware that something big could come up soon.  I also find that writing stuff down is better for me.  I tend to clam up during my appointments, so now when I sit down, she simply gives me a piece of paper and pen and then if I want, we will have an entire conversation on paper.  The good thing about this is that I take that paper home and get to reread the conversation when I have calmed down and am less nervous.

Wow I feel like I have rambled on and I have to go pick up the gf from work, so I will say cheerio for now .  Speak soon xx

[AdamMLP]

I never had a particularly close relationship with my first GP, I rarely go there, but I did get on with him the best out of the people I was seeing for mental health problems back when I was younger.  I think I came out when I was 15, and my parents brought it up to him over the phone, so I didn't get to see his initial reaction, but I never had any problems with him that I can remember.  He was professional about it, said that it wasn't his first time dealing with something like this, which I was very surprised about coming from a rural part of Suffolk where the only people you ever see in the surgery are either pensioners or toddlers.  I came out to my current GP the first time I met him two months ago, the first thing I said to him was "I'm transgender, and I was wondering what you could do for me," so I didn't have any sort of rapport with him at all, but again it was professional and I wasn't his first either.  I don't know what the demographic is here (Hampshire now) so I didn't have any sort of expectations.

I suppose all I can really say is that your GP may have dealt with this more times than you'd think, although they still might not know the current procedures.  Writing stuff down on paper is a good way to go as well, although personally I think it would be harder for me to give them the paper than to say it out right, which is why I made sure I said it as soon as I met him, just so it was out in the open and we didn't have to dance around the topic with me trying to get it out and wasting the meagre 7 minutes or so you get to see them.

And I understand your frustration with women's trousers, although I only ever wore them for work it was so frustrating trying to cycle to work with either having to wear a coat in the middle of summer so that you can carry your phone, keys and baccy, carry them in your hand, or try to cram them into the worlds tiniest pockets!  That said, even cis females get irritated by those.  Just try getting used to having the buttons the other way around, all of my work trousers had the buttons ripped off because I'd finish a busy shift desperate for the toilet because I hadn't had time to go, and in my desperation forget they weren't the normal way around for me and break the damned things.  Every single pair was lacking a button.  Thankfully they're all gone now, and I get my cargo trousers with massive pockets.

[David27]

You will have to come out to all of your doctors that know you as female. However, you don't have to right away. The most important would be a therapist and GP because they can help you. From what I gather you have a history health issues, which means your GP should know a lot about possible risks. I'm going through my GP right now because they know my medical history.

The room situation seems odd to me. In the US I haven't been put in any wards for inpatient stay (everyone gets a room). For outpatient I have been in a general ward even though I'm slow to discharge from the hospital. If your out of it enough during your stay it may help your disphoria. Also focusing on sleep (what I do), getting recovered enough to leave, requirements to leave, or other random things will make the stay more bearable. 

On the pants thing I use my back pockets regardless of womens/mens pants. Womens dress pants are the worst no pockets and they will say female.

[TheBear]

You will have to come out to all of your doctors that know you as female. However, you don't have to right away. The most important would be a therapist and GP because they can help you. From what I gather you have a history health issues, which means your GP should know a lot about possible risks. I'm going through my GP right now because they know my medical history.

The room situation seems odd to me. In the US I haven't been put in any wards for inpatient stay (everyone gets a room). For outpatient I have been in a general ward even though I'm slow to discharge from the hospital. If your out of it enough during your stay it may help your disphoria. Also focusing on sleep (what I do), getting recovered enough to leave, requirements to leave, or other random things will make the stay more bearable. 

On the pants thing I use my back pockets regardless of womens/mens pants. Womens dress pants are the worst no pockets and they will say female.

Hi Trenton

Thanks for your advice on coming out. I'll slowly go through them one by one with the GP being a priority. Although I may well have to come out to my surgeon today if the room thing doesn't materialize...

Sounds like the US medical setup is way more dignified than here in the UK! It is the norm here to go onto mixed wards, usually with single sex bays of 4 patients in each. Hence why I've always been shoved onto a women's bay in the past and had to share with 3 females who look at me like I'm an alien from another planet as I stand out a mile for not being your average female by a long way. The only dignity you get is a flimsy curtain that can be pulled round, which I request at night. It's not fun. I seriously hope I don't have to go onto a female bay again later today!

Sigh. Off to the hospital in 30 minutes for a 7am arrival...

Will be back on the forum soon.

Thanks again