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More Information About Me
INTRODUCTION
My name is Nick...welcome to my world. I’m a female to male transsexual or FTM (also known as transman, F2M).Transsexuals are individuals who identify as a gender that differs from their physical sex but can align that ambiguity through hormones, Gender Reassignment Surgery (GRS), and Sex Reassignment Surgery (SRS). Through masculinizing hormones and trans-related surgical proceedures like "top" & "bottom" surgery I’ve made my body congruent with my mental gender identitification as male.
On October 26, 1972 when I came into this world -- a little scrap of humanity about the size of a professional football and quite goopy -- an obstetrician in scrubs and a mask eyeballed me and erroneously proclaimed me female. I squalled. For almost thirty years I didn't possess the terms to tell anyone that this misconception -- not I -- was incorrect.
Since that time I've been a daughter, son and a member of a gender spectrum largely ignored by a normatively-gendered majority in the United States that favors a polarized gender binary consisting of only male & female. I now speak publicly as a responsibility to the community of courageous gender conflicted people in order to educate and advocate.
Until beginning masculinizing hormones at 30 years of age, my body never really fit my gender identity, which is male. I hated my body (and through it, myself) and longed for a scruffy beard and the raspy voice of actor Clint Eastwood.
As a child I was too masculine, even for most tomboys my age. Peers and adults mercilessly bullied me for not conforming to the gender role assigned to me at birth. Grown-ups always whispered I would grow out of it. I never did.
As an adult I was a victim of a hate crime, weighed well over 500 lbs., dropped out of junior college and continued various self-injurious behaviors that began as coping mechanisims when I was a six-year-old. Suicidal and despondent, I literally hated myself.
I never questioned my masculinity; it was my sanity I questioned. There was treatment available for insanity but I had no way to articulate to anyone the extreme pain I lived with every day of my life because of my male identification.
After viewing the movie "Boy's Don't Cry" in 1999 I found out about transsexualism. Shortly thereafter, I began to actively transition.
For me, transitioning was a choice between life or death; I chose to live. It has not been easy.
Transsexuals undergo treatments that compromise their economic and personal resources. They risk increased exposure to transphobia in society, the workplace, medical insurance and in their personal lives.
FAMILY
Once educated about transsexualism, my family was suportive, sensitive and respectful of my wishes. In fact, my elder brother is really the one who humanized the concept by taking me to see the movie "Boys Don't Cry."
Though some relatives were initially uncomfortable with the idea of "changing sex", nobody was really surprised. I'd always been obviously "different." Neither I nor they knew there was a label I fit under.
My whole family honored decisions I made regarding my transition even if they had trouble with the fluidity of gender. When I chose Nick for my name, they immediately addressed me as such and used the appropriate male pronouns per my request (he, his, him, and so on).
My suggestion to families, friends, and partners of transpeople is if uncertain about something, never assume. Ask. Personally, someone's sincere effort to understand, learn, and use correct pronouns made the difference.
GENDER IDENTITY DISORDER (GID)
Gender identity disorder or gender dysphoria is a general diagnosis used in the Diagnostic Statistical Manual, Fourth Edition (DSM IV).
I’ve heard the DSM IV referred to as the “Psychiatrist’s Bible.” This manual contains codes, diagnostic guidelines, and treatment protocols for mental health professionals.
The diagnosis of GID includes (but is not limited to) transsexuals and transgenderism in children, adolescents, and adults.
The inclusion of GID in the DSM IV is a double-edged sword for transsexuals. While helpful in obtaining aid from insurance companies for hormones and surgeries, viewing transsexualism as a mental illness is incorrect. If there is any emotional difficulty for gender dysphoric individuals it is usually in response to outside not internal pressure.
Transsexuals are often erroneously labeled with Bipolar Disorder (a.k.a. Manic Depression) by mental health practitioners. Hallmark symptoms of Bipolar Disorder are mania or severe depression. These can manifest themselves in spending sprees, suicide attempts, and/or self-mutilation in addition to other behaviors. In my case, these symptoms led to the misdiagnosis of Bipolar Disorder which has recently been removed.
My personal suggestion is that GID is to be not a mental illness diagnosis but a medical diagnosis. This would remove the stigma of gender dysphoric people as “crazy” or “mental” and make surgeries related to transsexualism not elective or cosmetic but medical.
HORMONES
Testosterone is a masculinizing hormone. Both biological males and biological females produce testosterone, but at different levels. Bio men produce this hormone in the testes.
Biological females must obtain testosterone from an outside source in order to acquire secondary sex characteristics such as increased body and facial hair, roughening of the skin, deepening of the voice, and increased libido. To my knowledge it comes in three forms: gel, pill, and injectible solution. These are the same hormones that are prescribed to biological men who for various reasons have below normal levels of testosterone.
Following the Harry Benjamin International Gender Association's Standards of Care (SOC), I first visited a gender specialist. He wrote a letter and helped me find an endocrinologist to prescribe the topical gel form of testosterone (a.k.a. T) under the brand name Androgel.
I began applying Androgel once a day on July 8, 2002. This cost almost $200 for a one-month supply that I obtained at the local Costco’s pharmacy. I was 30 years old. I was on it for a total of nine months.
I applied one packet (about the size of a mustard packet) on my right or left bicep being careful not to inadvertently share some with my cats or Mom through contact with my upper arms.
Androgel was great in that application was easy and my T levels were kept fairly level through daily applications; however, it became apparent that there were no significant physical changes occurring. I had relatively no body or facial hair to speak of. My voice was still was the very high tenor of a pre-adolescent boy. I still had no libido. If I passed at all, I was seen as a prepubescent boy.
At over $200 a month and with no noticeable changes, Androgel wasn’t worth the financial hardship. I contacted my endocrinologist.
In March 2003 I began receiving 200MG (10ML) of testosterone cypionate intramuscular injections in the right or left butt cheek once every two weeks.
Almost immediately I noticed a change in my libido. Also the "grandma hairs" on my face thickened and darkened, becoming visible first on the shelf of my jaw. Body hair began to thicken and darken in clumps and then spread. I also began growing hair on my back, behind, toes and fingers. Emotionally, how I experienced and dealt with anger also changed.
This amount of T was reduced 5 months later to 160MG when my endocrinologist determined that a lower dose would produce similar results and be better for my red blood cell count.
In the year since beginning T injections, my singing voice has dropped from high tenor to bass. I’ve also noticed fatty deposits have migrated from my behind and hips to my gut. I have more muscle mass in my sholder and chest and a libido for the first time in my life. My manhood is never questioned; I am more likely to have to "prove" that I was ever seen as female.
Negative side effects of T are: increased risk of problems with the liver, bad cholesterol, male pattern baldness, high blood pressure, stroke, and heart attack.
While retaining many of the problems female bodied people have, once beginning T transmen can also expect to inherit the health risks of biological men. Knowing this I did research before starting T and took measures to combat these potential health risks. I began to take supplements like milk thistle (for liver) and fish oil while continuing to lose weight and exercising.
Though my blood pressure is now lower than when I started on T, this could be attributable to several factors. I’ve lost 200 lbs. (and continue to loose weight), began the aforementioned supplements, and deal with stress/anger differently because of a combination of T and being in a good space mentally.
A common rumor amongst guys who are just beginning to have facial hair is that shaving often will increase growth rate and quality of beard growth. Men's Health Magazine says no and I tend to agree, but if it works for you, go for it. At least it is good practice. I suggest getting shaving tips from episodes of Queer Eye for the Straight Guy and (if feasible) getting a shave from a barber. Generally, transmen don't have the benefit of getting tips as children while watching their fathers shave .
In my case, Androgel increased the presence of pimples (zits). Injectible T made them problematic. The type of suspension the injectible T is in (mine is in a cottonseed oil suspension). I’ve had zits places I cannot reach. Pores get irritated by changes in pH of sweat, increased oil production, and by changes in texture and quality of body and facial hair (just as adolescent boys do).
I recently consulted my general practitioner and was prescribed Tetracycline. This has reduced both the amount and quality of my zits. It is a pain to take four times a day, but worth the trouble! There are over-the-counter astringents and remedies as well as stronger persctiption drugs available. The best rule of thumb is to use the least invasive method that does the job.
Testosterone effects everyone differently. The manifestation of secondary sex characteristics and health risks depend upon one’s family tree, age, and form of T used. Though I admit satisfying the requirements of the SOC in order to be prescribed hormones was problematic and frustrating, I don’t regret the help of my endocrinologist.
DOCUMENTS
Steps involved in the two methods for changing legal documentation such as driver's liscence (DL), social security card, birth certificate, passport, birth certificate and school documents varies by state. I suggest searching the state website from which these documents were issued in order to find out if this is a possiblity and how it is done. The process is much easier if you are only changing your first and middle names (as I did).
"Common Usage Method"
I changed my driver's license, social secutiry card, medical records, and school records through a method called "common usage." The basis of this method was in establishing my new name on paper documents such as bank accounts, bills, voter registration...anything official that clearly stated my new name. I created a file for these.
I changed my driver's license first. Once I obtained a file folder of documents that clearly stated my new name and some that stated my old name, I needed a form titled a "Medical Information Authorization (Name and Gender Change) DL 328". this must be filled out by a doctor (more impressive with an MD behind their name). Once this was completed, I went to the DMV, appeared confident, knowlegable and helpful. The attendants had no clue as to what to do, listened to me, and actually changed not only my name but also my gender marker.
Once that was complete, I immediately went to the Social Security office that afternoon with paperwork from the DMV addeed to my file. The DMV does a check that takes roughly two weeks for them to complete. It is to verify that the new name on your DL matches the one on your Social Security Card.
Once again I appeared confident, helpful, and knowlegable. Once again, the clerk had no idea how to complete the process, so took my advice. I walked out of the Social Security office with paperwork to tide me over until my new SS card arrived.
"Legal, Court-Ordered Name Change"
Legal, court-ordered name changes on birth ceritificates (BC) can be done without having had Sex Reassignment Surgery. An applicant would simply go on the Superior Court website for their County of residence, follow the directions, pay the fee, and attend court to change their name; however, changing one's name and gender on their birth certificate is more complex...I am awaiting my court date at this time.
Due to cost and lack of consistent good results of SRS for FTMs, the Harry Benjamin Gender Identity Dysphoria Association's Standards of Care do not require that FTMs have had SRS in order to change the gender marker on their BC.
I visited the Superior Court Website for my county of residence, completed and printed out two copies of each form. In addition, I requested a letter from medical professional stating that according the the Harry benjamin Standards of Care, I had had "all necessary surgeries" (the letter does not have to be specific). I also completed and printed out two copies of forms requesting a fee waver (because of my income, or lack thereof). I then went to the Superior Court Clerk in the Monterey County Courthouse, filed, and obtained a date for the hearing.
While at the Superior Court Clerk's office, I had to choose and list the newspaper in which my legal ad announcing my court date for name and gender chnage would appear for four weeks. My ad cost me a total of $270.30 At the end of my ad's four week run, I recieved a form from the newspaper stating that the ad had run for the required amount of time.
On June 24, 2005 I handed over my letter from my medical professional in addition to the form from the newspaper verifying the publication of the announcement of mane and gender change in the Salinas Californian for threee weeks. I was awarded the name and gender change on my birth certificate. Since I am a California resident, an amendment will be stapled to the origional birth certificate.
The choice of what documents to change and when is a personal one. Purposes of financial aid, personal preference, or profession are most likely to motivate such a change.
For FTMs an additional difficulty concerns the Selective Service. When applying for school or financial aid, these institutions require that males over the age of 18 (even those who are 30 or 60 or 90) have either registered with the Selctive Service or prove why they did not do so.
I obtained a form on their website for a Status Information Letter. The URL is: http://www.sss.gov/instructions.html There is a box to check which indicates "transsexual." In addition to this form, you must also submit medical documentation (letters from medical practitioners) to support this.
In several weeks I recieved a letter on official stationary which simply stated that I was exempt from having ro register with Selective Service. It does not state why, nor is it anyone's right to ask why when you proviede this letter.
I strongly suggest keeping copies of all letters from medical practitioners, documents pre and post change, as well as the Status Information Letter (if applicable). These are importaint documents and saving the origionals and copies can save time and make the whole process of changing documents easier.
TOP SURGERY
Top surgery is the removal of breast tissue and reconstruction of a masculine appearing chest. The surgeries involved can be keyhole (subcutaneous mastectomy) or mastectomy and nipple areolar reconstruction with grafting or pectoral implants. The method used depends upon the size of the breast tissue.
I had a radical, bilateral mastectomy and male reconstruction done by Dr. Edward Falces on January 21, 2003 at Saint Frances Hospital in San Franciso. After almost a year's worth of legal battles, my medical insurance – MediCal – covered the cost of the procedure.
The only hesitation in my mind was the thought of surgery. It lasted maybe a second in duration. While I hated the tissue, the idea of being anesthetized, bare from the waist up, and helpless while somebody operated on me wasn't a comforting thought. I weighed the benefits and risks, then dealt with my fear.
Due to the large amount of offending tissue, I underwent a bilateral mastectomy and spent 3 days in the hospital. I arrived on a Tuesday and went home on Thursday. The surgery itself only took a couple of hours.
I'll be honest about one thing: about ten days after my surgery when the gauze came off and the drains slithered from beneath my skin like a greased snake, the nipple grafts were the most disturbing things I’d ever seen.
Since I hadn't previously thought of what their appearance might be, I wasn’t mentally prepared. In the shower the first time, I nearly puked. They looked like black, rotted plums and felt like a leathery bat wing. I got used to them. As they heal, the black wore off and they looked human. Initially, it was just a nasty shock. Everyone I talked to before the surgery had forgotten to mention this minor detail. For those about to go under the knife, consider yourself forewarned!
I healed fast and took no pain medicine. My body apparently absorbed my nipples, as I now have none to speak of. As of this day in November of 2004, the scars that extend from either armpit and extend almost to my sternum are flattening out but still apparent even under all of my chest hair.
One thing that I think helped my body heal so well was Arnica Montana 30X. They’re homeopathic pills I placed under my tongue to dissolve two or three times a day for about a week prior to the surgery and for a while afterwards. My surgeon recommended it.
FTM bottom surgery consists of creating external male genitalia (phallus) through three methods: clitoral release, metoideoplasty, or phalloplasty.
Unlike bottom surgery for male to females (MTFs or transwomen), current surgical results for transmen are largely substandard and extremely expensive. The best results for FTMs are generally found beyond United States borders.
The SOC requirements for bottom surgery for both FTMs and MTFs are more stringent than those for hormones. Instead of one letter from a therapist (for hormones), two letters are required for bottom surgery regardless of the method or type of SRS desired. Those few insurances which do cover transsexual-related surgeries (example: AETNA) have a cap on the costs. This primarily effect transmen seeking bottom surgery.
Which surgical method chosen is a matter of choice by the transman.
While the metoideoplasty is more expensive and differs in size and appearance from that of a biological male, it is sensate, but not usually sufficient in length for penetrative sexual intercourse.
The phalloplasty is more asthetically appealing and results in more length allowing for intercourse. Its results are more likely to pass in a locker room situation.
In addition to the creation of a phallus, there are also surgeries such as testicular implants or the clitoral release in order to "free" already existing tissue enhanced by use of testosterone.
BOTTOM SURGERY
On November 11, 2005 I underwent the first stage of pedicle flap (suitcase handle) phalloplasty and urethral extension at Centtennial Medical Center in Nashville, Tennessee by Dr. Michael Stephanides. In addition, Dr. Zimmerman performed a vaginectomy, hystorectomy, and colpectomy. First stage was completed in 4 hours at a cost of a little over $15,000. I can already honestly say that was the best investment I ever made.
When complete, I will posess the closest thing to male genitalia that modern medicine is able to provide at this time. It will be completed in several stages over the next year. Surgical costs alone are estimated at between $60,000 - 80,000 for phalloplasty with "the works".
From personal experience, I know this and other trans-related surgeries are not "cosmetic" or "elective." My gender dysphoria was so great
without these treatments I know I would not be alive. Prior to transition, I was a social liability, dependent upon society to care for me. Now -- post operative both top & bottom surgery -- I'm working towards a professional degree, am self-suficient, independent, and able to contribute to society.
AFTERMATH
“Be the change you wish to see in the world.” –M. Gandhi
It’s been a long time since my first application of Androgel. It’s been a slightly shorter time since I entered Saint Frances hospital for top surgery and left over six pounds lighter. It has been a few days since first stage SRS was completed. Over the ensuing years I've transitioned mentally and physically. For me, the mental transition has been more difficult than the physical one. Learning things at the age of 33 that most people learned as teenagers is both frustrating and wonderful.
Transitioning was a question of survival, not choice. My decision to transition – essentially, to survive – was the best choice I ever made. One day spent as my true self is worth so much more than nearly thirty years of hating myself. I'm now 180 lbs, have begun dating for the first time, and am pursing honors in my Undergraduate major of Community Studies (empahsis trangender studies) at the University of California, Santa Cruz. I speak publicly in an educational capacity on my personal experiences as a transman on my own and with a non-profit organization in Santa Cruz, California called Triangle Speakers. My plan is to continue my education at San Francisco State University's Humnan Sexuality Masters Program in the Fall of 2006 so I can further serve the trans community as a gender specialist and board certified sex therapist. I’ve contributed to numerous books, journals, projects, and documentaries on transsexualism and advocate for gender variant people in every way I can. As Audre Lorde eloquently points out, silence is not an option...at least, not for me.
I’m still changing physically, growing mentally and emotionally. Puberty is fun this time around! I relish the privilege of learning about intersecting identities within myself and value difference within others, no matter what form diversity takes. I faced many challenges prior to transitioning; I battle them still. These challenges have served to make me a stronger man. I’ll never be "that guy" who drives big old trucks, are social dynamos or chick magnets. I try not to let the stereotypical "man's man" define me. I redefine it. I enjoy football and video games as well as the company of my three cats and always entertain the hope of meeting Ms. Right.
I’ve had the priceless experience of toeing the line between genders. It’s kinda cool to stand out or blend in at will. Most of all, it’s cool to be proud of being alive as I get to know myself.
Experiences vary widely among transmen and transwomen based upon their class, ethnicity, sexual orientation, family and living situation, education, background, and birth gender. Mine is but one experience among many. I’m not so arrogant to assume I speak for all transsexuals, only myself. The only way transsexuals can be adequately represented is to hear from many, not just a few.
I honestly don't think anyone would voluntarily choose the discrimination and ever-present threat of violence that we who identify differently experience on a daily basis. I’ve often dreamed wistfully of being "normal" more than once in my life, especially as a teenager and young adult. Fact is that nothing in life is a polarized choice of either one thing or another. Its more a complement or blend. Sadly, there are always people who will hate me for who I am. I now know that is their problem, not mine.
I appreciate who I am and how much I have evolved. As a man--body and soul—I’ve felt true happiness for the first time. Being unfamiliar with this emotion, it both thrilled and terrified me. It is still a trip to be able to look at myself in a mirror without shame or disgust.
I've found solace within the words of such people as Kate Bornstein, Mildred (Millie) Brown, Mark Rees, and Dean Kotula, myself; writers who were either MTF, FTM, or in Mrs. Brown's case, a leading therapist in the gender field (who recently retired). I also found a heck of a therapist in Stephen Braveman who challenged and encouraged me when I needed it as well as giving me the Holy Grail--a letter for hormones--when I earned it.
It all comes down to the fact that we each put our pants on one leg at a time (or our bra on one strap at a time if that fits you better). No one wants the nightmare of wearing a horrid mask that cannot be removed and having to lie to sustain it. My biological sex was such a mask.
Through surgery, therapy, and masculinizing or feminizing hormones, there is hope that true selves of transsexuals (both MTF and FTM) can be liberated from lying and self torment. We can be made visible by speaking, performing, drawing or writing, collective action, and within our own personal lives if afforded the opportunity to safely express ourselves. Transitioning requires inner resolve and strength but is often more an action of survival than mere courage alone.
Anything worth having is worth fighting for. I was fighting for my life, dignity, identity, and self-respect. I won. I now work to aid those fighting to just be themselves by educating through my words and by example.
The grass is greener on the other side. I'm glad to report that is where I now stand.
A guestbook is available below for any commentary. Be well.
Transgender Law Center
FTM International
Harry Benjamin International Gender Dysphoria Association
The Transitional Male
American Boyz (FTM Site)
Guest Book
Trans Advocate Jamison Greene
Stephen Braveman, M.A., L.M.F.T., D.S.T (awesome Gender Therapist)
