Rediscovering Pema

[Lori Dee]

But again... I'm a control freak, and one who really, really values clarity in communication.

Haha, I am the same way! Systems and flowcharts are my thing. I tell people I am a nerd, and I have the spreadsheets to prove it!

I do understand what you are saying. Maybe just ask what the plan is, or at least the goal?

In my gender therapy sessions, there really wasn't one. The psychologist told me that I was in the driver's seat, so it depended on what issues I was having trouble with at that time. Of course, that changed over time, too.

After a while, I had more issues with my PTSD than with gender issues. Part of that was because I became comfortable with who I am, so my other issues took center stage. Then the therapy focused on those issues with the goal of reducing the symptoms and my sensitivity to triggers.

Therapy is always about:
1. List the symptoms.
2. Identify the triggers causing the symptoms.
3. Remove or reduce the symptoms by desensitizing the triggers.

It doesn't matter what the modality is (hypnotherapy, CBT, EFT, Gestalt, or even Freudian), the process is still the same. As a hypnotherapist, my clients responded to hypnotherapy because I could change the modality to whatever they responded to. But as far as an outline for treatment, the above should suit you well. 

[Pema]

That's very interesting, Lori. Thank you.

Part of the challenge for me - and probably for my therapist - is that it's hard to pin down issues/symptoms. I'm happier and more at peace than I've ever been. A corollary of that is that I recognize that I've adopted behaviors that belong to a role that was imposed on me decades ago. I'd like to discard all of that conditioning, rediscover who I *actually* am, and build my life around that. For me, it feels like a huge opportunity and not a problem.

What I hope to get from therapy is twofold:
1) Guidance with separating the signal (internal truth) from the noise (external demands, including internalized adoption of cultural expectations).
2) Diagnosis and documentation to use as support for future GAHC.

I'm not a "screaming psyche" kind of person. I can adapt to just about anything, but that doesn't mean it's optimal. Sure, I can identify incongruities, and maybe we can call those "symptoms," but they're by no means debilitating for me the way they clearly are for some people. I think Life is amazing even when it's painful. It's just mind-blowing that we exist at all.

This may be my biggest struggle: Do I have the "right" to be transgender if I'm not suffering living as my assigned gender? Is it "enough" to recognize that I have a much greater opportunity for self-realization by discarding that assignment in pursuit of something more authentic? I think the answer is yes, but I'm not sure our culture agrees with me. (I'm accustomed to being in conflict with our culture.)

[Lori Dee]

This may be my biggest struggle: Do I have the "right" to be transgender if I'm not suffering living as my assigned gender?

Do blue-eyed people have a right to have blue eyes? Most people on this planet have brown eyes. Does that mean you do not belong? Of course not, and yes, you have every right.

The problem is that we are born the way we are. Because society has not figured this out and learned to accept it, we have to learn to adapt. Some people will wear sunglasses, others will get colored contacts, and a few may even opt for surgery.

The degree of your dysphoria is what helps you decide the next step. Many transgender people are not dysphoric and do not take any steps to transition. Some sense that incongruity, even though it isn't bothersome, and takes steps to transition anyway. Some have severe dysphoria and feel the need for drastic action immediately. Everyone is different.

So, as Ashley has told us many times, go at your own pace. Do what you want or need to do. When you feel comfortable, you have transitioned - even without doing anything. The goal is to be the person you know that you are, whatever that means. Nothing more is required. 

[Pema]

Thank you. That's a good summary of how I feel and how I'm approaching it. I see it very much as "Would I feel more at ease, more whole if I continue to do what I'm doing now or if I make this change?" That's really how I've approached most of my life, and I see no reason to change strategies with this new, big challenge.

It all takes place in the context of a society, though. There are not only countless often conflicting messages about whether we're <whatever> enough to deserve <whatever> - messages we can absorb or disregard as we choose, but there are people upon whom we depend for access to resources who may use those biases to evaluate us. I'm confident enough about my "deservingness" but I don't know whether my circumstances appear urgent enough that I'd meet the requirements to be granted access to GAHC.

I guess I'll find out. I've so far been very pleasantly surprised by the receptions I've received.

[Lori Dee]

I don't know whether my circumstances appear urgent enough that I'd meet the requirements to be granted access to GAHC.

Many providers, including Planned Parenthood, use the "informed consent" model. You are old enough to decide what you want to do, and they accept that. Their only requirement is to "inform" you of any potential risks, side effects, etc. The VA spent the first three months making certain that I understood that the changes from hormones would be permanent, and that is what I wanted. I kept saying, "Sign me up!" 

[tgirlamg]

For me, it feels like a huge opportunity and not a problem.

☝️😀 The recipe for success!

Onward Sister!

A💕

[Sephirah]

This may be my biggest struggle: Do I have the "right" to be transgender if I'm not suffering living as my assigned gender? Is it "enough" to recognize that I have a much greater opportunity for self-realization by discarding that assignment in pursuit of something more authentic? I think the answer is yes, but I'm not sure our culture agrees with me. (I'm accustomed to being in conflict with our culture.)

This is the issue I struggle with, Pema.

For a lot of people, you only have the right to be happy if you've first experienced what it's like to be unhappy. An escape to the polar opposite of being from where you started. That never sat right with me. You can't be rich if you've never been poor. You can't be angry if you've never been sad. You can't love if you've never hated.

That's a bit hyperbolic but it's the essence of what you're dealing with. To know one you have to know the other. And I don't think that's necessarily true.

Being who you are isn't necessarily trying to escape who you are not, in my opinion. And is where a lot of people fall down trying to understand the whole thing. It isn't running to something as a way of running from something. Being who you are is a thing in itself. That some people started off from a different place and have further to go to get to that point is causation vs correlation. Both are valid, and neither should be taken as absolutes.

[Pema]

I had my third session with the gender therapist today. I think she's working out well. She said we're nearly through her standard questions, so I asked her what happens after that. She said that that is basically the next question: Where do you want to go from here?

So, I guess in the next session I'll need to ask: Is your diagnosis that I am gender dysphoric? I'd need that in order for my insurance to be of any help with any kind of treatment. I am very (very) seriously contemplating HRT, possibly this autumn or winter. But I also think that talking through these options with her may be of value.

[Lori Dee]

So, I guess in the next session I'll need to ask: Is your diagnosis that I am gender dysphoric? I'd need that in order for my insurance to be of any help with any kind of treatment. I am very (very) seriously contemplating HRT, possibly this autumn or winter. But I also think that talking through these options with her may be of value.

Sounds like you are on the right track. Even if you know, beyond all doubt, what you want to do, it never hurts to hear what your therapist thinks about your plan. They may raise an issue that you had not considered. They may explain something that you thought you understood well, but then you learn something new. The very process of talking it out with someone helps you to organize your thoughts and finalize your plans.

As Ashley would say, "Onward, brave sister!" 

[NoelleW]

I had my third session with the gender therapist today. I think she's working out well. She said we're nearly through her standard questions, so I asked her what happens after that. She said that that is basically the next question: Where do you want to go from here?

So, I guess in the next session I'll need to ask: Is your diagnosis that I am gender dysphoric? I'd need that in order for my insurance to be of any help with any kind of treatment. I am very (very) seriously contemplating HRT, possibly this autumn or winter. But I also think that talking through these options with her may be of value.

Hearing a professional opinion never hurts.  Now whether you listen to it or not is a whole other ballgame

[Pema]

Last week I had my fourth session with the gender therapist. I asked her where she thought we were on answering my two questions: Do I fit the diagnosis for Gender Dysphoria and how much of my shift in gender identity is coming from internal signals ("message") versus external ("noise")?

She said the second question is easy to answer: It's almost entirely internal.

On the first question, though, wasn't ready to commit. She focused most of the session on the ways that I experience discomfort with my gender incongruity. The truth is that I have virtually none. I'm not particularly upset about my situation, I have unconditional love and support from my wife and my mother, the two people who matter most in my life. I'm currently receiving laser treatment to remove my beard. I'm looking ahead to pursuing HRT this fall. I'm retired, so I don't have to deal with workplace conflicts. I'm pretty much a hermit, so I very rarely interact with people outside of my neighborhood. When I do, it's in a very LGBTQIA-friendly community in a very liberal state. In essence, I face no resistance to being myself. So, other than that I wasn't born with a female body, what do I have to be distressed about? I'm patient and committed to the process.

But that's criterion #2 for the GD diagnosis:
"The condition is associated with clinically significant distress or impairment in social, occupational, or other important areas of functioning."

Now, I can create hypothetical scenarios where - if one or more of my current circumstances didn't exist - I'd find myself a whole lot less pleased. But they're imaginary, and I'm still not sure I'd be distressed or impaired. I think I'd just deal with what I could and try to make the most of my situation.

I reflect on what the intended purpose of this diagnosis is. For me, it was primarily to see if I'd meet the requirements for some insurance coverage of GAHC. I'd very much like not to have to pay for everything out of pocket. But I imaging the broader intent is that people who are struggling to function effectively in society deserve to receive some form of support and relief from that society. I completely agree with that. And someone who's struggling in these ways would likely also benefit from a treatment plan, which follows the diagnostic criteria for GD in the DSM. So maybe I just don't fit in this bin (shock!).

At the end of the session, she said she was assigning me homework. First she said, "What are moments when you feel more feminine?" Then she went on to say other things that indicated to me that she's trying to get at something larger: How do I see myself as feminine? She has twice brought up Susan Brownmiller's book Femininity. It was written in 1984 and is very outdated. I've read a bit of it, and recent reviews of it are all over the place, many saying it borders at times on being transphobic. So I was initially disappointed, feeling like I needed to persuade her that I really am feminine and it isn't just something I've decided I'd like to try.

But once I got started making my list of feminine traits, I realized that this was a really good exercise - not only for my therapy, but for myself. As I kept finding more and more things to add, I could see even more clearly the totality of the "evidence" that (as I've said from Day One), I'm sure not a man, AND look at all of these traits that the vast majority of people in this culture today would say are feminine. So even as my therapist is signaling that she's not convinced, her assignment is reinforcing my clarity. I choose to believe that this was her hope all along.

I'll be interested in seeing how she receives it. Even if she's unconvinced, I already know who I am and what my next steps are, so her buy-in isn't critical for me.

[Lori Dee]

If I may play Devil's Advocate here for a moment:

I'm not particularly upset about my situation, because I have unconditional love and support from my wife and my mother, the two people who matter most in my life. (This is an important support system, but it does not relieve dysphoria in itself.)

I'm currently receiving laser treatment to remove my beard. Why? Is it a trigger of dysphoria? Why not just shave like men do? There must be a reason you want it gone permanently.

I'm looking ahead to pursuing HRT this fall. Why? What benefit will you receive from HRT? Will it make you feel better, as in relieve some level of dysphoria, even if it is minor? Doctors do not just give out medicine. It must be a treatment for something. What will HRT be treating you for?

I'm retired, so I don't have to deal with workplace conflicts. But if you were still working, you would have to deal with workplace issues, right? How would that affect you?


I'm pretty much a hermit, so I very rarely interact with people outside of my neighborhood. Is that a choice? What if you needed to for some reason?

When I do, it's in a very LGBTQIA-friendly community in a very liberal state. That helps with the support system that you mentioned in the first statement. You have given them a reason not to diagnose you. What are the things that affect you that would give them a reason? Having a good support system is very helpful, but it does not "cure" dysphoria. It just makes it easier to be yourself.

In essence, I face no resistance to being myself... from others. The incongruence they are looking for is internal, not external.

So, other than that I wasn't born with a female body, what do I have to be distressed about? I'm patient and committed to the process. This is very good, but from their point of view, why then do you need the process at all? If you are happy with who you are, why change anything?

But that's criterion #2 for the GD diagnosis:
"The condition is associated with clinically significant distress or impairment in social, occupational, or other important areas of functioning."

I love your positive attitude, and it is a very healthy one to have. They are looking for distress or impairment. If there is none, they do not need to intervene. They do not need to treat you for a condition that does not exist.

By all means, do the homework. But also look at the questions I have asked and look deep inside. Advice that was given to veterans at the beginning of the transition journey (until the White House cancelled it) was to be totally honest with your providers. Do not tell them everything is fine if it really isn't.

That does not mean to lie or exaggerate. They need a true evaluation of what you are experiencing, so they can evaluate the proper course of treatment. If you have a headache when you go to the doctor and tell them you have no pain, you will walk out of the doctor's office with a headache. And the doctor has no clue that you were suffering even a little.

There is nothing wrong with feeling that your life is generally good. It just might be. But that doesn't mean that nothing is hiding in the deep shadows. That stuff you pushed down there so that life would be good.

I think you get my point. I wish you all the best, even if you flunk your homework.   
 

[tgirlamg]

Pema!

One size seldom fits all... Pursue the things you need to make your life the experience you want it to be! All shall be well!!!🤗

Onward Brave Sister!

Ashley 💕

[Pema]

Thank you,Lori and Ashley. I always welcome your perspectives.

Lori, your long, thoughtful reply deserves another from me, but I don't have time right now, so here's a short one:

Since the initial shock of realizing I'm transgender, I have been happier and more peaceful - frequently euphoric. My wife compares it to the shift when I retired a couple of years ago. The freedom to be myself is genuinely hard for me to believe at times. The clarity of the awareness of "THAT's why so many things felt so difficult!" So, if anything, I feel considerably more euphoria about this situation than dysphoria.

But...

I hear what you're saying. There are reasons for my wanting to transition. I really do think it can be as straightforward as "I'd live a more fulfilling life," but I recognize that there could be more to it. I tend not to wait to make changes until I absolutely have to (unless it's impossible). As time passes, if I'm delayed in my progress, I can imagine becoming displeased about it.

As my wife says, "If you want to play the game, then you have to play their game." I will find ways to reframe my experience as hindering my soul's mission of personal growth and self-expression.

[Lori Dee]

As my wife says, "If you want to play the game, then you have to play their game."

Bingo!

If we could write our own prescriptions, it would be no big deal. But we can't. They need a diagnosis for them to begin treatment. They need to know why they are giving you medication, and they need to document that reason for legal and regulatory purposes.

If you have a mild headache, they give you aspirin. If you have a broken bone, they give you Percocet.

My questions were rhetorical to prompt you to consider what is happening deep inside you and how you can reframe it so that the "powers that be" can give you what you want.