Reader

As I mentioned, I took a while to draft a letter supporting my position. I said:

Dr. Xx, thank you for the thoughtful reply. I do appreciate your caution in taking on such a permanent procedure.

I feel that I may not have presented myself in the best light at our recent appointment. As you know, I began this journey in April, 2021, over two years ago. At that time I began on the anti-androgen Spironolactone. I underwent the lengthy process of getting Cardiologist clearance and I was finally able to begin estrogen therapy in October, 2021. I have seen Dr. Yy on a regular basis since then

I have put together a great team of doctors to help me through this phase of my life, Dr. Yy, Endocrinology, Dr. Zz, Internal Medicine, Dr. Ww, Cardiology, you as Surgeon, Dr. Hh, Dermatology to help me recover my hair, Dr. Pp, Psychiatry, and Dr. Tt, Psychology. They have all been incredibly compassionate and supportive.

I have been consistent and devoted to my transition. At my last appointment with Dr. Yy in April, I brought up my interest in the next step of the medical transition, an orchiectomy. We discussed my motivations, including the medical benefits and the mental health benefits, especially the easing of dysphoria. She expressed her support, and I contacted your office for an appointment.

You have expressed your personal guidelines that patients should have 12 months of a “real life test”. I previously sent you some pages from the WPATH Standards of Care showing that they did not recommend a real life test for orchiectomies, just a year of hormone therapy. That was in fact from Version 7 of the SoC. Version 8 has reduced the recommendation to 6 months of hormones, and seems to have removed the real life test completely and several articles cited put doubt on the value of the real life test.

I note that SoC 5.6 recommends 6 months of hormone therapy before a gonadectomy.

In any event I would like to explain my transition and motivations. Your main concern seems to be the possibility of regret following a permanent procedure, and that a real life test will demonstrate the patient’s commitment and seriousness. I can understand the concern that younger patients may not be fully aware of the reality of their transition, and other patients may be struggling with a mental illness manifesting itself as gender dysphoria.

I am well aware of the permanence of the procedure. Concerns about fertility are not an issue. I’ve had my children and have no interest or need for more. Sexual desire as a male hasn’t been an issue for years. I acknowledge that there may be a need in the future for Testosterone supplementation and I expect to maintain my relationship with Dr. Yy. In fact I discussed this issue with Dr. Yy this week and she told me that very few of her Trans patients need Testosterone supplements.

I can begin by pointing out that I am 58 years old. I am not a 19 year old diving into this with abandon. I have known that I was a woman since the age of 9. That feeling has never wavered. I suppressed and denied it for decades, as many Trans people do, but there has never been a time I didn’t feel this way. SoC 5.3a recommends marked and sustained gender incongruence and I believe I fit this criterion with flying colors. I have also been in therapy for over a decade. My therapist is fully supportive of the diagnosis and supports the procedure.

SoC 5.4 also addresses the issue of surgery without social transition, noting that in some cases it may not be a feasible option and that this should not be a bar to treatment.

“Everyone’s transition is different” is a common statement in the community and I feel mine is unique. The first issue is that I am 6 foot 2 inches tall and in my life have weighed over 400 pounds. This presents a big impediment to a successful social transition, but I think I can overcome that eventually. The biggest impediment to my transition at the current time is familial and financial.

Unlike that 19 year old, I have a wife and 2 grown children. You’ve met my wife and she is supportive, but has strong feelings about the effect of my transition on the children. I don’t agree with her concerns, but I respect her wishes. In addition, I am essentially a small family business owner in a partnership with my father. My livelihood relies on personal relationships with my clients; I have no question that many clients would leave should I transition. Such a loss would affect not only myself and my family, but also the other people associated with the business including my father and our employees. I feel a heavy responsibility to my family and the possibility of harming them and their lives is a scary prospect. I am working on expanding and re-focusing the business to be more LGBT+ focused. Until then, I have some serious and practical impediments to full transition.

Two other examples of my moving my transition forward are that for the last two years, I have attended a bi-monthly support group, in my female presentation. They know me only as Jennifer. As part of that group I met with [Senior State Attorney General Officer], to discuss gender inclusivity in state legislation. The second example is that I was a panelist in an LGBT Patient Perspective Panel with Doctors from [Hospital], mostly attendings and residents from the Emergency Medicine Department. I helped provide a Trans patient’s perspective on a visit to the ER and how they could improve their interactions with Trans patients.

You also seemed concerned that I would not be satisfied by the results cosmetically. That is not the primary objective, but it is a welcome effect. The removal of the testes will reduce the size of the area and will help the appearance, but the main objective is to get rid of them to ease my discomfort. They feel wrong, they do not belong there. Having them gone will improve my mental health.

I have been focused on moving my transition forward and am frustrated by the slowness of things. I believe an orchiectomy is a positive step I can take that would not be obvious to the outside world. It would allow me to move forward and take another step without harming my family.

So, I didn’t hear anything from him until the appointment. My anxiety was through the roof for days leading up to today. My wife couldn’t come to the appointment due to work commitments, so I went alone.

We started out with pleasantries and he said he hoped I understood that his message was supportive and I said I hoped I hadn’t sounded obnoxious in my letter.

He then opened by saying he was on board with the procedure and he thinks it will be a positive thing for me. My relief was palpable. We then talked for a good half an hour about the procedure, the scheduling and so on. He is currently scheduling surgery 4 weeks out, but I still need to get a short letter from my therapist, that she has already agreed to provide and a note from the cardiologist. He has to get approval from the insurance company, which he says is routine. I hope so.

I have now spoken to his office and we have a surgery date. I am incredibly excited.

I have mixed feelings about this experience. I understand his concern about doing permanent procedures that a patient might regret in the future. On the other hand, I object to his outdated standards that lag behind the current standards of care.

The Standards of Care are evolving positively. The old Harry Benjamin Standards of Care were first published in 1975 and amended several times, up until 2001. It had a very paternalistic attitude and was proscriptive. It had strict requirements to qualify as “transsexual” which was amended to “transgender” in later versions. These included crossdressing and real life experience. So, a patient had to really take potentially dangerous steps before getting treatment.

Those standards were supplanted by the WPATH Standards of Care and as I described above, they are much more patient focused. They now believe the patient and don’t make the patient jump through hoops to prove themselves.

My urologist still isn’t so enlightened. He says he is half way between the WPATH SoC 7 and 8. I think he is still being paternalistic, but he is improving. He doesn’t like the concept of “informed consent” where the patient asks for something, signs a waiver, and gets what they want.

I hope my experience has helped soften his position a little.

Having doctors in my family, I know very well how arrogant and paternalistic some doctors can be. They know best what is good for a patient. To some extent that is true, but they need to understand that the patient is the one in charge of their own lives. I don’t know my urologist’s age, but I am at least 15 years older than him. I know what I want and what I need in my transition. He doesn’t.

A doctor is trained to diagnose physical problems and provide treatment. Outside of psychiatrists, they are not trained in mental health. In my case a urologist is implementing a course of treatment requested by the patient. He hasn’t been involved in the diagnosis of the condition and doesn’t have a history with the patient. When a patient who has been working with a team of doctors and has been following a plan with those doctors, a new doctor should not step in with a new requirement and block the patient’s progress.

At the most, I would expect a doctor in this situation would want a letter from the Endocrinologist and Therapist. They should not be introducing new obstacles or setting up their own criteria for the procedure.

While his attitude is paternalistic, I can understand some of his caution. He is being asked to remove healthy tissue. There is no disease or injury to the testicles that would otherwise justify their removal. That idea goes against many doctors’ ethical mindset. He also has concerns about liability. There is not just the usual risk of malpractice, but also regret from that patient who then may try to turn around and blame the doctor. Again, letters from other doctors and waivers should cover that concern.

To conclude, I have my surgery date and I am looking forward to being free of the offending body parts. I hope it all goes well and I will report back after.

I finally broke through some gatekeeping.

As I approach my 2d anniversary of hrt, I felt that the next step I would like to take on my journey would be an orchiectomy. I’ve wanted them gone for as long as I can remember. They never felt right. I haven’t socially transitioned yet for a myriad of reasons, but this is something I can do to further my transition without coming out to the world.

I talked with my therapist and she supported the idea. At my next appointment with my endo, I talked to her and she also supported the idea. I spoke to my wife, I had mentioned the idea probably a year ago, and told her I was now ready. She has some reservations, mainly the usual risks of surgery. She is supportive, but still doesn’t fully understand the reality of being trans. She said she wants me to be happy and agreed to go with me to see the urologist.

I am a patient with the Gender Clinic at a large University Hospital near me. They are great, but there is just one urologist in the clinic. I had seen him when I began my journey for the possibility of Lupron treatments. So I made an appointment with him. I had to wait 6 weeks.

My wife and I went to the appointment. The result of the appointment was that he wasn’t sure about doing the procedure. I hadn’t socially transitioned and he usually looked for a full year of living in your correct gender. He referenced the WPATH Standards of Care and their recommendations for this surgery.

Also, my wife was not enthusiastic. She was supportive, but she worries about the risks. So we ended the appointment, agreeing to meet again in a month. He was going to talk to my therapist and psychiatrist. I walked out to my car and broke down and had a good cry.

Over the next few days I thought about the appointment and realized I had been totally unprepared to argue my case. I had thought that it was just a matter of expressing an interest in the procedure and being an established gender clinic patient. I didn’t expect the gatekeeping.

I decided to send the doctor a note through the clinic’s patient portal. Immediately after the appointment, I sent the following:

Dr. Xxxxxx, thank you for meeting us today. I appreciate your time and your concern and cautious approach. I just wanted to add to our discussion concerning the WPATH Standards of Care. They do not call for a year of living fully transitioned for orchiectomies. They do recommend that for vaginoplasty, but not orchiectomy.

I’ve attached the relevant pages if you are interested.

I will see you in August.

He replied:

Thank you for continuing a thoughtful discussion with me. I appreciate your point, but will also point you to the following paragraphs (see copied below, my emphasis), which has led me think carefully about your situation. While “technically” not part of orchiectomy criteria, it has become part of my general criteria, which I think you would agree is reasonable given the permanency of the procedure. I try to appreciate the patient perspective always when making medical decisions and I understand this is something you have been working on for many years. I appreciate your courage with your transition as it is often more complicated than what you want alone. Let's continue the discussion. Best regards, Xxxxx

The criterion noted above for some types of genital surgeries—i.e., that patients engage in 12 continuous months of living in a gender role that is congruent with their gender identity—is based on expert clinical consensus that this experience provides ample opportunity for patients to experience and socially adjust in their desired gender role, before undergoing irreversible surgery. As noted in section VII, the social aspects of changing one’s gender role are usually challenging—often more so than the physical aspects.

Changing gender role can have profound personal and social consequences, and the decision to do so should include an awareness of what the familial, interpersonal, educational, vocational, economic, and legal challenges are likely to be, so that people can function successfully in their gender role. Support from a qualified mental health professional and from peers can be invaluable in ensuring a successful gender role adaptation

The duration of 12 months allows for a range of different life experiences and events that may occur throughout the year (e.g., family events, holidays, vacations, season-specific work or school experiences). During this time, patients should present consistently, on a day-to-day basis and across all settings of life, in their desired gender role. This includes coming out to partners, family, friends, and community members (e.g., at school, work, other settings).

Health professionals should clearly document a patient’s experience in the gender role in the medical chart, including the start date of living full time for those who are preparing for genital surgery. In some situations, if needed, health professionals may request verification that this criterion has been fulfilled: They may communicate with individuals who have related to the patient in an identity-congruent gender role, or request documentation of a legal name and/or gender marker change, if applicable.

I was unsure about how to interpret this reply, was this a positive position or not? I was not encouraged and wanted to say more, so I took a few days to draft a reply. It is too long to add here, so I will post it as another blog.

To be Continued…….

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An online friend on Mastodon posted the following:

Some cis people mourn who a person was when they transition.

What they don't seem to grasp is that we mourn too.

In much the same way you might mourn if you woke up to learn that you were in a coma for two or three decades.

You're awake and alive, and existing now, but what of the life that would have been?

@sasha_strange@tech.lgbt

This is so important to understand. This topic usually comes up in the context of a parent mourning the loss of a son or daughter who is transitioning. The parent may feel that their son has died and have trouble recognizing their new daughter. This is a completely natural and understandable reaction. How the parent deals with it is the big issue. Does the parent deny the daughter? Does the parent welcome the daughter with joy and open arms? Does the parent have compassion for their child and help them through the transition, love and support them and think of their child’s well-being before their own. Do they have the maturity and self-confidence to realize that their child is not doing this to hurt the parent or embarrass the parent. Does the parent have the ability to deal with their own feelings while also helping their child?

As a parent my instinct is to protect my child against every danger in the world. My kids are grown and have moved out on their own, yet this instinct remains and I have to restrain myself from trying to fix everything and let them do it and learn how to be confident and self-reliant adults in the world. But I am always there for them.

A parent who thinks that their own feelings about their child are more important than the child’s own feelings about itself are narcissists. I can hear the phrases, “Why are you doing this to me?”, “What will the neighbors think?”, “What do I tell Aunt Karen?”, “Why are you being so selfish?”, ”You killed my son.”, “My son is dead”. None of these things do anything other than hurt the child.

I feel a better way to frame it is to realize my child has been suffering for so long. If they had any other long term medical issue, I would not be angry at them. I would not try to talk or threaten them out of being sick. I would seek professional help and do everything I could to help my child.

Much of this attitude comes from ignorance. Ignorance just means not knowing something and is understandable, as long as they seek to learn the truth. A parent that refuses to learn, or refuses to accept the truth of gender dysphoria is directly harming their child.

But, few people understand that the trans person also mourns. They mourn the loss of what could have been. If you are lucky enough to have realized your reality at an early age and were encouraged and supported in your gender exploration and presentation, you don’t have as much to miss.

Those of us who were unable to face their gender issues until adulthood, in my case, my 50s, have missed plenty. I grew up a boy. I did boy things, I wore boy clothes, played with boy toys, played boy sports, and was a Boy Scout. At the time I didn’t know any different. I didn’t mind these things, and some of them I enjoyed, but I was never happy, never satisfied, never content. I was not able to form deep meaningful relationships with friends. I knew there was something wrong with me and I was afraid of opening myself up to anyone. At the time I told myself I was boring and overweight, and no one would be interested in spending time with me.

I realize now that I didn’t know who I was. I wasn’t me, the all American boy. I was a confused kid. I spent my life feeling that; Insecure, unsure of myself and my place in the world. When finally, in my 50s, the truth broke through. I finally realized who and what I was. I was a woman, I should have grown up as a girl, and suddenly it all made sense. All those puzzle pieces fell into place. I now knew why I was so out of it as a kid and through the rest of my life.

Here’s where we get to the mourning. I began to realize all the experiences I missed growing up. I didn’t get to do the girl stuff. I didn’t make friends with other girls, have the sleep overs, learn the behaviors and mannerisms of being a girl. I didn’t get to learn all that fun girl stuff, like fashion and makeup along with the not so fun stuff, like heartbreak and periods and so on. Of course, I am not reducing girlhood to these few things, I am trying to give some examples.

I realized that I will never get those experiences. I will never know what it is like to be a young girl, a teenage girl, a young adult woman and an adult woman. I now hopefully get the chance to experience being a mature woman. I particularly think about my high school and college years. That is the time for lots of confusion and problems, but also joy and freedom. I had a ’79 Jeep CJ-7 that I loved and always had the image of driving with the top down and my long hair blowing in the wind, looking good, feeling good. Doing that as a boy was great, but not the same in any way.

One TV show that appealed to me back then was the Mary Tyler Moore Show. That is who I wanted to be. That was the life I wanted; a young, single, confident, capable, and intelligent woman. Needless to say, I missed out on that fantasy. My daughter is living that now and I am envious of her and I support her as much as possible.

The feeling of missing out on a childhood, lost experiences never to be found, is real and painful. It really is mourning a lost life. Parents, friends and others should be aware of this and be supportive.

The joy a trans person experiences when they accept themselves is profound. They may appear almost giddy and full of life. But underneath, next to the fear of coming out and the reactions of the outside world, is also the disappointment of realizing all they missed out on in their life. While they are celebrating the birth of their new self, they are mourning the lost childhood they never got to know.

Every human who has ever lived, that had a secret, had to decide whether to share that secret with the outside. This conundrum is not exclusive to LGBT+ people, but that is what I want to discuss. My personal experience is with the T part of that initialism. Coming out is a deeply personal decision and one that everyone must make for themselves. Add in the issue of transitioning and it becomes even more difficult. First a disclaimer, I would never make light of the struggle of the L, G, and B. Perhaps I am being naïve in this blog post. I have not had any of the experiences of a gay person coming out and living their authentic life. I do not know their struggle and I cannot know their actual journey and compare it to mine. There are many similarities, but I want to draw attention to one big difference. They can choose who they come out to, and they can generally walk in the world without drawing attention. They come out once to each person they choose to tell.

A Trans person has the same issues with regard to who to tell, but deciding to transition will mean coming out every time they step out the door. A gay person can come out to their family and still go into work the next day without worrying that everyone else will know. A trans person will come in to work looking very different from the day before, and they will be noticed. You can’t choose to tell just your family and close friends if you plan to transition.

So, that is what I am struggling with now. I’m sliding out of my mid-50s. I’ve spent my entire life playing the part of a man in society. It is all I know. I’ve been pretty convincing. I’ve nurtured relationships, and built a business in that guise. Coming out to family is doable, but transitioning and living as my authentic self has some serious potential pitfalls. I have no experience being a woman. I’ve known that I wasn’t right my whole life, but I didn’t get the opportunity to socialize and interact with the world as a girl. How am I supposed to do this?

The first is the fear of looking absurd. Some AMABs can appear very convincing when presenting as a woman. Not so much for me. First, I am 6’ 2”. While not impossible, that is way out of the norm. Second, I weigh too much, way too much. Even if I lost the weight, I am not a slight person. I will stand out. To put the cherry on top, I wear a size 15 men’s shoe. That is a hard enough size to find for men, women’s shoes in that size are rarer than hen’s teeth. Surprisingly women’s stores seem to do well for “extended sizes” and I can find stuff to wear.

So, assuming I got the clothes right. The hair, makeup, whatever. I’m still a giant presence and will never be able to blend into the background the way I have wanted my whole life.

The next fear is rejection. My wife knows and is broadly supportive. She does not want me to tell our kids because she is afraid it will emotionally harm them. We have a 28 year old daughter living on her own in NYC and a 23 year old son pursuing a PhD in Albany. They are both well educated and very liberal. My son has a couple of friends who are non-binary, so he is well familiar with the concept. My daughter gets along well with his friends as well as having her own LGB friends. My wife is particularly worried about our son feeling betrayed and abandoned by his male role model. That he will feel he has been lied to his whole life. At first I didn’t think that would happen, but now doubts are creeping in and my wife’s worry is eating into my psyche.

Then there is my father. He is 93 years old now, still going strong, but won’t be around forever. He and I have built a business together over the past 28 years, so we see each other every weekday and get along well. One positive is that one of our clients confided in him that they have a grandchild who is trans. Then his, I guess you would say, girlfriend has disclosed that she too has a grandchild who is trans. So, he knows it is a thing and it does not repulse him. He is definitely confused by the phenomenon.

When he told me about these two kids, my reply was that they just needed love and support and they would do fine. I didn’t make a big deal about it, but inside I was screaming, We have a part time secretary/assistant who has worked with my dad for 40 years. I overheard the two of them talking over lunch and her saying that she was so glad they were past the stage where they have to worry about these things. I gave a little internal chuckle at that.

I have lots of thoughts about telling him and how it would play out. You see, when I was about 12 or 13, he walked in on me dressed in women’s clothes. I had snuck some of my mom’s stuff. He demanded to know what I was doing, and as a terrified kid, I said, I don’t know. He told me to take it off and then he came to my room and again asked and I again said I didn’t know. He said don’t do it again and don’t tell your mother. And that was it. Needless to say, it didn’t stop the feelings and the desire to dress. It continued on and I was just more careful.

But from that day on, I lived in fear of that coming back to bite me. Fear of him saying something. I knew it was wrong, weird, and perverted. I was terrified of messing up, making a mistake and him bringing the incident. I have likened it to the sword of Damocles, hanging over my head. It wasn’t until recently that I was able to work through the trauma associated with it. I can say that EMDR worked amazingly well for me.

So, what do I imagine would happen if I told him. I think he would believe me. I think I would break down. I worry that he would feel guilty about the incident, if he even remembers it. Since he is aware of the “condition”, I don’t think he would be hostile. I would like the chance to discuss it with him and explain what I was dealing with growing up, but I don’t want to blame him or make him feel guilty. I know he already regrets traveling for work so much and not being home all the time. I hold no ill will, my parents did the best they could and it was pretty good.

He is 93, still very healthy, but age is most certainly catching up. He is not the most steady on his feet and uses a walker sometimes. He has developed prostate cancer, but if you last until your 90s, a man will get prostate cancer. It won’t kill him. He’s also developed a basal cell carcinoma behind his ear. Also treatable. Pretty amazing since he spent a lot of time outside and never used sunscreen or wore a hat. So, a part of me wants to just wait it out and I won’t have to tell him. But, his mother lived to 103, and I am getting older every day.

Then there is my sister. She’s 2 ½ years younger than me. We had a younger sister who died at age 30 from epilepsy. Anyway, my sister had difficulties growing up. She’s been exposed to every lifestyle out there and would probably deal fine with it.

I don’t have much more in the family department. I have one sister in law, who I think would be fine. I have some cousins I haven’t seen in over 5 years. My mother in law and her sisters might be a problem.

The next huge issue would be work related. I am essentially a small business owner and my business requires a personal connection. There is no doubt some of the people we work with would not be receptive to a trans person. We would certainly lose business. I can’t inflict that on my father and I can’t afford that. So, that is another big hurdle. If I worked for some major company, they would likely have policies in place to protect employees and I could probably transition with minimal disruption. Not so when your business relies on personal connections. So, before I do anything I will have to cultivate some more business with LGBT+ friendly people.

I am fortunate enough to be physically large and strong enough and mature enough to not worry too much about bullying. I know that is a major obstacle to younger people coming out. I had a bit of verbal bullying about my weight as a kid, but I never really faced any physical bullying. Actually the only time a kid did try to bully me was in junior high school, I picked him up and held him against the school lockers and suggested he stop the behavior.

So, these are some of the obstacles to transitioning that trans people face. Were I just gay, I could still tell a small group of people and continue on my way. I wouldn’t have to tell the world. It wouldn’t be obvious just looking at me that I was gay. But, if I want to live as my real self, there is no hiding. Oh, there I go, the grass is always greener, right? I apologize if I am making light of anyone’s experience. However, that is the place my brain is right now.

One of the effects of growing up as a repressed and suppressed trans kid is a lack of confidence and identity. You never feel like you belong anywhere or to anything. You don’t know who you are. You never feel like you are entitled to anything. You’ve never earned an award. You give, but you feel you shouldn’t get. All these other kids seem to know who they are and what they want to do. They go through life with confidence, with a direction, with a plan, with a future. They knew how to relate to other kids. They weren’t afraid to be silly, stand out, show off, and have fun. They wanted attention, they wanted to be noticed, That idea was anathema to me.

I was a shy kid, I could not, for the life of me, take the initiative in any social encounter. I still can’t. I wasn’t weird or off putting, just withdrawn and scared. In school when we had to pick a partner for a project, or pair off for something, I “knew” that no one would want to pair up with me, so I held back and ended up with the odd person out.

I learned early on to never stand out. You did not want attention. For some it resulted in bullying, for some it resulted in praise and reward, for some it would result in punishments, but I knew, for me, it would result in inquiry leading to exposure. I was hiding something. I didn’t know what it was, but I knew it wasn’t acceptable. There were butch girls and femme boys in school, and they stood out as different, especially the femme boys. I didn’t dislike them, but I sensed something about them, perhaps a kinship, but I didn’t want the attention. So I avoided them.

Here’s one example of my social anxiety. In 2nd or 3rd grade everyone had to learn to play the recorder. I was not good at it. I got “hot cross buns” down pretty well, but after that, I was lost. After a certain amount of time, we were put into some sort of recorder club that was going to play for the school and parents. I absolutely refused to participate. I remember the music teacher talking to me in private, and I remember her being very kind, but did not want to do it. I knew in my heart that if I went up there I didn’t know the songs and it would be a disaster. I would draw attention to myself. So I never joined this recorder club, but I do remember that we all had a recital for the parents and I stood on the risers and moved my fingers and never blew any air into the recorder.

In 4th grade it was real instruments, and I got the trumpet. The same thing happened. I managed the basic stuff, but never progressed. Again, after getting past a certain page in the music book, you joined the school band. I refused again. That was the end of my music career. I do remember one incident; I was walking home from school with my trumpet. To get home we passed the high school and as I did, I was looking down at the ground and swinging the trumpet case. I didn’t see the parked car, and my trumpet case bumped the bumper of a car. This was the mid ‘70s, cars were built like tanks and I certainly didn’t bruise the car, but the adult driver hopped out and was really upset. Giving me what’s for, and I distinctly remember him telling me to “go home and tell your elders what you did”. My elders? Weird.

Anyway, back to the thesis. This deep feeling of not knowing who you are leads to that lack of confidence and your feeling of not being worthy of things you are entitled to. You are afraid to stick up for yourself. I absolutely never sought out help in school when I was struggling. I was terrified that if I admitted to a teacher that I didn’t know something, the teacher would be very disappointed in me, and would wonder how I could be so ignorant, and then things would begin to unravel because I had opened myself up to inspection and my failures would become an open book. From grade school to law school, I did what I could by myself. As a result I didn’t do as well as I could have.

I didn’t participate in much either. I played little league baseball. I was not good, but for some reason I felt comfortable and played through 5th grade. After that they got serious and I dropped out. I wouldn’t play any other sports, because I didn’t know how and if I showed up, not as advanced as the other kids, I would be ridiculed. In junior high, my father encouraged me to try ice hockey. I wouldn’t do it. By the end of high I had actually started playing and I love the game.

This feeling persists to this day. When I finally accepted that I was trans, a huge weight was lifted from my soul. I wanted to go to a mountain top and shout it to the world. But, obviously I didn’t. I knew that was a bad idea. When my therapist encouraged me to say out loud, “I am a woman”, during a session, I had a very difficult time.

I know in my heart that I am a woman. But, 50+ years of hiding and being conditioned to be a man makes it very hard to assert myself as a woman. I don't feel like I have the right to claim girl status. In our support group we begin each meeting with an introduction where we say our names and pronouns. I have always said that I didn't care what pronouns people used for me. I don't feel that I have earned the right to be referred to as she/her. I have finally been able to say I like they/them.

Sadly, I personalize a lot of the nonsense that is peddled by the anti-LGBT brigade and the TERFs. Despite knowing that most people support trans people and feeling this same way about others, that a Tans girl is a real girl, I can’t own it for myself. I am terrified of being confronted and told I am not a girl, that I am an abomination, a disgusting pervert, a pathetic little man, a Shrek like ogre trying to fit into a dress and heels. I look absurd and should be embarrassed. This is internalized transphobia and it is insidious.

My therapist had to write a letter for me recommending voice therapy. In it she referred to me as she and her. It was very surreal reading the letter and knowing it was about me and that I was a girl. I really liked it and it felt good.

As I write this, I have been on estrogen for about 15 months. I haven't made any outward attempts to appear female. Everything I have done can be explained. I'm letting my hair grow out. I have always wanted long hair and plenty of men wear their hair long. Alas, I am thinning on top. I saw a dermatologist today who is getting me on a treatment plan and hopefully that will improve the hair situation.

I have made some progress, I have come out to my therapist, my wife and a multitude of doctors, not to mention my support group family. Two years ago that would have been unthinkable. No one has pointed at me and screamed. But the doctors are professionals who understand the situation and are compassionate, and the support group are all in the same boat. The next people to tell would be the rest of my family. Two adult children, my 93 year old father and my sister. I don't think any of them would shun me, but I am sure it would get weird. More on that topic in a future post.

The fear of drawing attention is still very strong. It is holding me back in my development. There are other factors holding me back, but this is a big one. I have a strong block on doing anything to draw attention to myself. Transitioning would certainly do that.

Tŵt staff routinely boost toots to help your content gain visibility using boosts, featuring your content on #DyddDilyn or #MidweekMindful, and approving your content for the Explore pages and the Trending list.

Please note, to be included your content must meet our Code of Conduct and follow our guidelines: – no swears without a CW – media files must have alternative text descriptions – no links to Twitter or Meta-owned properties

If you'd like to nominate someone for Dydd Dilyn/Follow Friday please DM @teamtoot

February is Low Vision Awareness Month

Vision impairment, including low vision, affects hundreds of thousands of people on the Fediverse, including me. Vision impairment can make it hard to enjoy the visual media that gets posted to Mastodon and the wider Fediverse, especially if it's a screenshot of text.

Adding a simple description takes a few extra seconds, and can make everyone's experience so much more enjoyable.

We know that not all apps are helpful in showing you how to add alternative text descriptions, and we know that not all apps do a great job of showing it if it's there, but to raise awareness we are going to blur or highlight your media on Fridays in February.

To simulate what some see all day every day, on Fridays we are going to make any media with no description just a little bit blurry or add a highlight border for a few hours.

Don't be offended, we aren't editing your pictures, they will show up 100% normal on Saturday and every day after that, but on Fridays, if your photo looks a little off, please consider adding a caption next time. It won't affect everybody nor every app, but hopefully just enough that we can stimulate some discussion.

To get help using captions try the #AltText hashtag or the #Alt4Me hashtag. And we know not everyone can add descriptions, this is not a rule, just a temporary way to raise some awareness of a larger issue, hopefully to see an overall increase in the number of people taking the extra couple seconds to add a caption.

If you operate a Mastodon server and would like to join in, simply choose an option (blur with unblur on hover, red dotted border, caution tape) from this CSS snippet to add to the custom CSS in your server settings and let your membership know using some of the educational links below.

It will take a minute or two to show up, and you can quickly remove it later in the day.

Learn More

• https://mstdn.social/@feditips/107757781709598274 – thread on adding Alt Text
• https://mastodon.art/@Curator/109279035107793247 – another thread worth reading
• https://mastodon.ie/@mastodonie/109398218679478019 – one more great thread
• https://botsin.space/@PleaseCaption – friendly bot reminds you to add descriptive text
• https://webaim.org/techniques/alttext/ – a five minute read on how to add good captions
• https://tips.vivaldi.net/tip-174/ – how-to for Vivaldi Social and Blogs

Examples

This is what images will look like with the blur added:

Here's the red dot border option:

Here's an image that's not loaded, so the alternative text shows up:

Here's some #Defaidodon with a description

Participating Servers:

• https://artisan.chat/
• https://fandom.garden/
• https://flipping.rocks/
• https://mastodon.art/
• https://mastodon.thomaspreece.net/
• https://oliphant.social/
• https://queer.garden/
• https://revachol.city/
• https://toot.wales/
• https://vivaldi.net/

Participating? Let me know –> @jaz@toot.wales

Starting in November 2022 we have seen an influx of members seeking to migrate from Twitter to Tŵt Cymru. We are very happy to accomodate the move and are glad to welcome everyone, however we are now seeing a large number of accounts exhibiting various habits that are disruptive to the community. Of particular note is the unmonitored use of a Twitter crossposter, a means to automatically post Twitter content to Tŵt.

We understand many people are testing the Mastodon waters and are worried about losing their Twitter community. However, our public timelines are not intended for absentee tweeters pushing content into the public feeds that includes non-functional Twitter usernames, bot spam, and high volume retweet content that is only available on Twitter.com, a site many of our membership prefers to avoid.

Personal accounts registered on Tŵt are generally intended for engagement, not broadcast. Our members expect to be able to engage with you and your posts. If you wish to use both platforms and plan on using a bot of some kind to mirror content from Twitter, the following rules will apply beginning Monday January 16th, 2023:

1. Do not crosspost retweets or quote tweets to Mastodon. Only crosspost your original content, your personal tweets. These settings should be available in your crossposter settings.

2. If you are a high volume tweeter you must post Unlisted or Followers-only. This setting should be available in your crossposter settings.

3. If you are not monitoring replies to your crosspost-connected Tŵt account you must mark your account as a bot. You can accomplish this by visiting https://toot.wales/settings/profile and check the box that says “This is a bot account” – this is a way to tell followers that the account mainly performs automated actions and might not be monitored.

Starting on January 16th, Tîm Tŵt will reach out to any account that appears to be an unmonitored account. If we get no response after a week, we will try one more time to contact you. If we still cannot reach you, we will limit the account such that your toots will be restricted to those accounts that follow you; they will not appear in our public timeline. You will be searchable and messageable. In very rare instances where the volume of unmonitored content is considerable, we may suspend the account.

Additionally, any message that we see from Twitter containing irrelevant spam or tweets that are solely images of text with no alternative text option will be reported and deleted. For example, if you use fllwrs.com to tweet about your follower count and it is crossposted to Tŵt, we will report and delete the toot. Accounts posting excessive spam may be limited or suspended.

If you have questions or feedback about our approach to this issue please comment here: https://toot.wales/@jaz/109625492544360829

Going forward we will be posting our donations and expenses to this URL: https://github.com/tootwales/documentation/tree/main/finances

We operate three managed services: Mastodon, Pixelfed, and WriteAs, for which we pay managed hosting fees.

In addition we have four domain names with annual fees, and some administrative fees to operate the non-profit.

Cyber liability insurance is the only other major expense, and will be reflected in the New Year.

As of November 2022 we have seven volunteer staff who take no money from the charity, but if donations increase we will consider a stipend or a wage as the service becomes self-sustaining.