Transition Timeline Assistance

[Chanteur]

Oh my goodness, I love your organization! I hope your martial crisis is resolved with a happy resolution

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Thanks. I am a bit OCD about organization... Though you wouldnt know that from my computer desk...

And I do believe the marriage issues will be resolved soon. She is her own critic and feels bad for what she did. We have made some plans going forward.

I see a LCSW twice a week. Once by myself, for transgender and marital stuff. And then with wife to work together.

Going to add my kid to his own sessions to get rid of some inappropriate behaviors before school starts back up. And to make sure he is ok with my transition. He is 9, almost 10 so figured he is now old enough to make some decisions on his own. Not going to stop my transition for my son. But hopefully seeing the counselor might help with anything he may have underlying. Doubt much issues with him and my transition. But I want to cover all my bases and make sure he is ok.

[Donna]

It really great to have such a detailed time line. But I do hope you realize that once you start nothing will follow the time line. There are so many variables. If the doctors follow WPath  there are specific guideline. Your body will react at its own pace typically ffs and augmentation is not addressed for three years after HRT.
Wait lists can fluctuate for procedures. Once you start living full time what will happen at work.
The list goes on and on. I'm not trying to be negative but please don't lock yourself in solid or you could be in for a big impact when things start happening differently. Eg weight and body mass can impact surgery choices as some require a certain body fat mass minimum. Your physiological report and diagnosis.
You have to leave time for discovery and coping and all the other great things that are coming, wait for the hot flashes. I stopped T blockers in 1996 due to not being able to handle them, now they are not an issue.
Please stay open and flexible to changes and best of luck moving forward

[Chanteur]

Indeed I am open to changes...

And with me starting hormones this year (End of April was the start of that), my endocrinologist said to wait 2-3 years before surgical alterations. 2020 would be the soonest on that timeline. But I don't think I will need much work, if any. I am already at a 40C breast size (Though I suspect my band has since dropped to 38 size from weight loss).

I do know I want to possibly get rid of a small ridge on top my nose, my double chin, and lower my hairline. But will see how the fat gets redistributed and the underlying bone structure. I have a BMI hovering between 34-35 so pretty overweight right now.

I don't think my cheeks will need any alterations. Growing up I needed glasses but never got them so I was squinting a lot and it built up muscle/fat in the cheeks. But will see how things go.

I put vocal surgery sooner on the list than the 2-3 year wait since estrogen will not effect voice.

As I mentioned earlier, the official start of my full time is open for debate. I began using my female name, presenting myself as female all the time and using female pronouns and facilities in May of last year.

However, WPATH mentions (I believe) that official name change is what a lot of clinicians use as the official start. Which would mean I have been full time for about a month now.

I kept the future plans labeled tentative as things will be added and removed, or moved up or back on the list as things change and as I get new information. But if there is anything I missed with anything, please let me know. I am open to ideas and suggestions. I do understand a lot of it will be based on my body reactions to the hormones.

Wife so far only objects to the actual Gender Surgery. That is still a long ways away so we will cross that bridge as things get closer. I suspect she is a closest asexual. But I am willing to compromise and not do that surgery, even though I want to. We shall see how things are in 2-3 years.

She also has an issue with society thinking she is a lesbian. Nothing unfortunately I can do to prevent her from being seen as such. Society has not separated gender identity and sexual orientation yet. But I believe this is more of an internal issue as everyone is overly critical of themselves.

It does feel that a lot of things right now is just in wait and see mode. Nothing major coming up I think this year, and probably not really much next year. Other than keeping up with hormones and letting them do their work.

I do know I need to practice and learn makeup skills. I am pretty good now with eyeshadow, but have not even touched mascara, eyeliner, eyebrows, eyelashes... And not confident in my contouring skills yet. I was going to go to the Sephora transgender class, but they swapped the dates around at last minute at our local store and I missed the class. But I do go often to my local JCPenny location and get quick tips and things every now and then.

[Donna]

Keep Up the positive outlook. My wife hates the lesbian factor that creeps in so when anyone asks she just says we are cousins and anyone that knows us knows better. Name change date and living FT are so close together it's not an issue. Surgery is a 4 years wait here after getting in for your two sign offs after getting your initial diagnosis and after finding an HRT doctor which can be a 30 month wait. Lots of wait time to get things figured out

[Chanteur]

My wife is 4ft 11in... so she small...

I keep getting called her mother. Just a few days ago, we were at bank applying for a loan and they called her my daughter. lol.

She is 1 year older than me. But I think that works for her, to some extent. Though she calls me her spouse, not wife. I present myself as her wife.

And name change for me was 1 month ago (May 30th, 2018). Yet when I identify as being full time was May/June 2017. So a difference of a year. However, with how long it takes with hormones, I really don't think it will matter which start date we use...

I probably could get my LCSW and my Psychiatrist to sign off on gender surgery now if I wanted to (and if I were to get the surgery done this year it would cost me $0 as I have hit my out of pocket max). Will surgeons take a letter from a LCSW or must it be from an MD? I intend to wait til the 2021 timeframe but knowing ahead is a good thing.

Besides, we have to give wife time to cope and decide if the GRS is a dealbreaker for her. Her concerns are more related to intimate activities (will leave it there to avoid getting into stuff not good for this forum section). But I do believe she is an asexual so I am trying to figure out exactly what it is about it. But I have told her I don't mind being non-op trans. But I do hope she comes around.

[Donna]

My wife was originally dead set against bottom surgery other than an orchi.
She now understands I have to go further but what further is is still an Unknow in my head.

[Chanteur]

Minor update.

Marriage issues are getting better. Hope to get back on track with transition. This lithium and spirolactolone combo is definitely drying my whole body out. I need to drink like 120 ounces of water to stay hydrated.

Speech has been finished as of next week. We would continue speech, but she doesn't want to push it with insurance. So glad it has covered things so far.

Fundamental frequency is at 270-ish with my top range just below 300.

Speech pathologist really likes the praat application but they use a different program. But given what we have seen with my practice and outputs of praat she likes it.

I took a photo of the book she uses for exercises and definitions.

Still need to work on my ease of onset and forward resonance. But I am able to pass 90% of the time now in phone. Believe my female name now is what made the key difference however.

Getting my "head voice" isn't hard. It's the ease of onset that's my biggest hurdle.

I am looking into praat scripts to give me more of a real-time analysis of my speech versus analyzing afterwards. But using the two books, and internet resources I can finish up the speech on my own easily enough.

[Chanteur]

I haven't posted na update in some time now. Have been busy with my marital issues... Still ongoing but somewhat getting to resolution.

Had a bump in the road as my LCSW I have been seeing was suddenly dropped from my insurance without notice. Have not found another one. However the recent release of the transgender southern guide shows there is one nearby (still a 45min drive though).

As always, new and updated information is in blue.

Current Transition Progress: (As of 1/24/2019)

• 2017
  
  • 1/2017: Accepted Transgender Status.
  • 4/2017: Began wearing female clothing.
  • 4/2017: Began counseling with LCSW who works with other Transgender patients.
  • 4/2017: Came out to wife and kid as questioning.
  • 5/2017: Diagnosed Bipolar I, ADHD, Gender Dysphoria in Adults.
  • 5/2017: Came out to family (wife/kid) as transgender.
  • 5/2017: Came out to rest of family.
  • 6/2017: Began identifying as female full-time.
  • 7/2017: Decided on female name (Ashley).
  • 8/2017: Wife veto's "Ashley" name.
  • 9/2017: Settled (and agreed on) "Sarah" name.
  • 9/2017: Scheduled 1st Endocrine appointment.
  • 10/2017: Agreement made with wife. We go to her Maiden name, and she picks my middle name "Elizabeth."
• 2018
  
  • 1/2018: Began referral process for treatment of Bipolar & ADHD.
  • 1/2018: Cleared by ENT for vocal therapy.
  • 2/2018: Began vocal therapy (So glad insurance covers this).
  • 3/2018: Began legal name change process.
  • 4/2018: 1st Endocrine Appointment.
  • 4/2018: Began Estradiol
  • 4/2018: Began Spironolactone
  • 5/2018: Began treatment for ADHD.
  • 5/2018: Bipolar I diagnosis ruled out.
  • 5/2018: Diagnosed Bipolar II.
  • 5/2018: Name legally changed.
  • 6/2018: Spironolactone dose doubled. .
  • 6/2018: Began Lithium for Depression/Bipolar.
  • 6/2018: Driver's License gender updated. (Got lucky).
  • 6/2018: Social Security gender changed (Lucky again).
  • 7/2018: Received out of network exemption approval for endocrinologist
  • 7/2018: Second Endocrinologist visit.
  • 7/2018: Spironolactone dose increased
  • 7/2018: Estradiol dose increased
  • 8/2018: Lithium discontinued
  • 9/2018: LCSW Dropped from insurance network (no prior notice)
  • 9/2018: Prescribed Guanfacine for Bipolar II
  • 9/2018: Discontinued speech therapy
  • 10/2018: Third Endocrinologist appointment
  • 10/2018: Spironolactone dose increased
  • 10/2018: Received information on potential Gender Surgeon (in Birmingham)
  • 10/2018: Prescribed Unison for sleep issues.
  • 10/2018: Filled for disability due to Bipolar, Social Anxiety and other ailments
  • 10/2018: Septic Tank overflows
  • 11/2018: Wife totals primary vehicle (no *major* injuries)
  • 11/2018: Plumbing issues resolved ($2000 bill, ouchies)
  • 11/2018: Floor breaks (Hole in floor)
  • 11/2018: Retain lawyer over car accident
  • 11/2018: Received (and lost) letter from Endocrinologist supporting medical need for hair removal
  • 11/2018: Received letter from Psychiatrist supporting medical need for hair removal (didn't lose it)
  • 12/2018: Wife graduates collage
  • 12/2018: Floor fixed (Bartered for fix)
  • 12/2018: Sent inquiries to surgeon over GRS
  • 12/2018: Began laser hair removal (They were having a BOGO so got face & Brazilian for $1200)
  • 12/2018: Decided on surgeon for GRS (In Birmingham)
• 2019
  
  • 1/2019: Submitted name change paperwork to State for Birth Certificate update
  • 1/2019: Continuing laser hair removal. Noticeable results already after 2 visits
  • 1/2019: Prescribed Lamotrigine for Bipolar II

Hormone Replacement Therapy (Began: 4/2018)

• 2 Weeks (4/2018): Skin softer.
• 4 Weeks (5/2018): Occasional sensitivity in breasts (not much).
• 1 Month (5/2018): Body fat percentage increased +1.3% (per scale).
• 2 Months (6/2018): Breasts beginning to be tender (rarely though).
• 3 Months (7/2018): Breasts begin to show a bud forming (super small)
• 5 Months (9/2018): Skin incredibly soft. Thinned out and bruise easier
• 7 Months (11/2018): Breasts incredibly tender... Even sleeping causing pain sometimes
• 7 Months (11/2018): Cheeks much fuller in appearance
• 8 Months (12/2018): Lips appear much fuller/plump.
• 8 Months (12/2018): Breasts are now 38C (natural, down from 42D however due to weight loss)
• 9 Months (1/2019): Breasts more pointed shape
• 9 Months (1/2019): Can definitely tell fat redistributed to waist & hips
• 9 Months (1/2019): Breasts budding bigger, can be felt when touched.

Current Weight Loss Progress:

• 7/2017: Began weight loss (Started @ 284lbs).
• 8/2017: Broke 275lb mark.
• 1/2018: Broke 250lb mark.
• 3/2018: Broke 245lb mark.
• 5/2018: Broke 235lb mark.
• 6/2018: Broke 230lbs mark.
• 7/2018: Broke 225lb mark
• 9/2018: Broke 215lb mark
• 10/2018: Broke 210lb mark
• 1/2019: Broke 200lb mark (Hope it holds, just hit it)

Tentative Treatment Timeline:

• Summer 2018: Begin hair removal.
• Summer 2018: Second endocrinologist appointment.
• Fall 2018: Finish Vocal feminization therapy.
• Spring 2019: Undergo Vocal Feminization Surgery (Speech Therapy produced desired results).
• Spring 2019: Change gender on Passport.
• Spring 2019: Resolve marital crisis.
• Spring 2019: Establish new counselor.
• Summer 2019: Change gender on birth certificate.
• Summer 2019: Finish laser hair removal
• Summer 2019: Per surgeons discussions, begin process of GRS (getting paperwork and establishing myself a patient)
• Summer 2019: Submit to insurance for reimbursement for Laser Hair Removal
• Spring 2020: Surgically remove excess skin caused from weight loss
• Spring 2020: Undergo SRS.
• Summer 2020: Undergo Breast augmentation (if needed).
• Fall 2020: Undergo Facial Feminization Surgery (if needed).

Tentative Weight Loss Goals:

• Spring 2019: No longer be classified Obese (~195lbs)
• Summer 2019: Hit 175 lb mark.
• Winter 2019: Hit target weight (~150lbs).

Questions:

• How early should I begin looking for surgeons?
• How long are waiting lists for surgeons?
• Is there any weight guidelines/restrictions for Surgical operations?
• Are there any questions I am forgetting to ask?
• Any recommended steps to be added above I may be forgetting?
• Any idea on how to keep these estradiol patches on, I have tried waterproof bandages & tegaderm patches?
• Any known providers in the following areas (Or anywhere between) capable of billing insurance for electrolysis (To finish off when done with laser):
  
  • Birmingham, AL
  • Atlanta, GA
  • Jackson, MS

As you can see, lots of progress...

I have more definitive plans in the future as far as transition. I just hope to find another counselor asap.

Any advice would be greatly appreciated.[/list][/list][/list][/list][/list][/list][/list][/list]

[Michelle_P]

Chanteur, I don't have any advice for you, but I did want to say that your progress is just awesome!  You have accomplished a tremendous amount in the past year.