#also insurance doesn’t cover HRT in my state so

[kiran-monna]

If you don’t know someone’s pronouns, they/them is good when referring to that person in a conversation

[so-i-did-this-thing]

Hey! A trans minor here. I want to ask how should I proceed as a trans minor in Florida? I can’t move and my mother doesn’t take me being trans seriously. She says she supportive but I don’t think she is. I’m worried about all these bills coming into place and how they will affect me. I’m a FTgender fluid. Do you have any advice? Also, I play the flute :) it’s nice to see trans instrument players

Ayyy, trans orchestra forming!

So, I won't insult your intelligence by pretending things aren't about to get bad. But maybe I can help you understand the risks and how to keep yourself safe and sane.

An assumption: I don't know if you want to pursue physical transition and that is a convo 100% between you, your mom, and your healthcare providers, so I'm providing it as a neutral option for information purposes.

Also: The bills I mentioned have not passed yet, but they are sitting on the governor's desk. He will most likely sign them, meaning they'll take effect July 1, 2023.

Staying with your family

SB254 is the bill that affects you the most. It's the "kidnapping" bill. Yeah. :/

I don't know what your family situation is like, but if you have family members who oppose your mother's even lukewarm support, that could be enough for the state to remove you from her custody and turn you over to them. It would be up to you and your mom to figure out how to avoid/appease these family members so they don't think you are "at risk" of physical transition.

Gender-affirming care

SB254 also completely locks you out of puberty blockers, HRT, and surgery (the latter 2 in the past are sometimes pursued by older youth with parental consent) in this state. If you want to pursue any of this care, talk with your mother about getting it in another state. You will have to physically travel, because telemed for gender affirming care is also being banned due to new consent form requirements.

Once you are 18, you can pursue physical transition, if that's something you're interested in, but be aware that there are soon going to be so many obstacles to adult care, that it might as well be a transition ban for everyone. But if you're close to 18 and think HRT is for you, review the map for informed consent care. But be prepared for a long search and your insurance not covering things.

That said, if you need a therapist now, I think you may still be good here. Be very careful that you don't end up with someone who wants to use conversion therapy tactics -- these are typically going to be religious-based providers. Talking with other trans kids in your town might help you find a good provider.

Remember, if you don't like a therapist, you can stop going to them; shop around for one that makes you feel safe and makes you feel like they help you with the stress in your life.

Bathroom ban

HB 1521 does a few things:

Bans multi-stall gender neutral bathrooms (single stall is fine)

Requires schools to have bathroom policies

Empowers cis people to confront trans folks in a govt owned/leased bathroom/changing room and force them to leave, otherwise they are subject to a fine and/or jail

This is effectively a bounty bill. Examples of bathrooms where this bill will apply include schools, airports, stadiums, courthouses, etc. It isn't every public bathroom, but it is a lot.

People who are gender nonconforming or are being stalked/harassed by cis folks who know their trans status are most at risk here.

It is up to you how much you want to weigh your self-expression against your physical safety.

As a minor, you don't have a lot of rights, so I advise you choose your battles carefully and always have trusted adults to have your back. Being FTGenderfluid, a lot of how you dress might fly under the radar, but I'd avoid being too heavily masc for now.

Keeping safe & sane

Unfortunately, a lot of support you'd normally find at school is going to be unavailable from now on. But some ways to lessen your stress:

Get a job (if you are old enough). I know, I know, but money makes a lot of life easier, from buying little treats now to stockpiling for things you may want once you turn 18.

Be honest with the reality that you might have to be in the closet a lot, and brainstorm safe outlets for your gender expression. I know at your age, I dressed how I wanted at home and used roleplaying games to explore and express my gender.

Hang out with queer youth, especially in person. You might have a local organization that has events and support groups. It helps a lot to share your feelings with other kids going through the same.

Start following trans political commentators. Erin is a good follow on Substack - she makes it easy to understand all the legal stuff going on.

Consume happy queer stories, by queer authors. It will help counter all the doom scolling. I've been watching Dead End: Paranormal Park (it is a comic and a show), which features a trans masc protagonist.

Cultivate your relationship with your mom. Gently, but firmly set boundaries with her if she gives you guff for, I dunno, wearing boys jeans or whatever. But also be aware she probably has a lot of misinformation about trans people, so you will need to gently pick that apart and see how you can educate her. Trusted adults she also trusts can also help you here.

Build your network. The friends your age you make today could be roommates or coworkers tomorrow. Be social, it will also be good for your mental health.

Be kind to yourself. Things look bleak, but there are states in the US that are actually strengthening trans rights. There continue to be options, you just might need to spend time and resources achieving them.

I hope that helps, and a big hug from a trans adult who grew up in the closet. <3

[thebumblingbee]

It’s late and I’m sick and grumpy so I’m gonna rant a bit.

You know what narrative that’s being pushed that I’m getting very sick of?

‘You survived trump before. A second trump term won’t kill you.’

Because that is so. blatantly. false.

I mean, unless you’re cis, white, able bodied, upper middle class, and in a firmly blue state. Then you’re probably fine. But the rest of us aren’t going to be.

There are a thousand points that can be made here, but I’m just going to touch on what’s relevant to my personal life.

1. Trans rights. We all know that the second trump takes office, it’s one of his missions to absolutely obliterate trans folks in whatever way he can. That’s going to start with stripping healthcare away from them. No more HRT. Which will kill people.

1b. Another thing people don’t think about that scares me shitless: billing codes for doctor appointments. If you don’t know, every time you go to the doctor they submit the bill to health insurance using billing codes. Oftentimes, if you talk at all about chronic conditions or have a diagnosis for one, that billing code will be submitted. If you have ever discussed trans healthcare with your doctor, your bill is likely being submitted with associated billing codes. If all healthcare associated with being trans is outlawed, it’s likely that your doctor appointments won’t be covered by insurance because they have that billing code. So that completely wipes out all healthcare for trans folks, even that isn’t HRT related.

2. Gay marriage, and specifically walking back protections. If something were to happen and marriages would be dissolved (and don’t come into my notes telling me it’s impossible. After Roe v Wade, anything is on the table), people would start losing health insurance. Including me, a person that is so disabled that I cannot work and get my own insurance through an employer. Losing my access to health insurance would actually, literally kill me. I cannot afford my treatments out of pocket. I would just get sicker and then die.

3. Also related to LGBTQ rights, the whole thing about taking children away from families because their parents are queer. The intention is to put these children into an overburdened, abusive system simply for the crime of their parents not being cishet. This will result in the deaths of many children and adults for a number of reasons.

4. This is already happening, but will get worse: all of the women who have died due to their basic right to reproductive healthcare being criminalized.

5. The sheer increase in violence being perpetrated by trump supporters against anybody that doesn’t look like them or think like them. I’ve literally been threatened with murder by a trump supporter neighbor because I’m queer. And the city I live in is liberal as hell.

And I am well aware that many of these things are happening to people all over the country already. I am so, so sorry to all of those who suffer so greatly already. But we are going to see this on a much larger scale if trump gets a second term in office.

So you don’t get to sit here and tell me I’m not allowed to be scared. That I’m overreacting. That I’m a shitty person. That I survived last time and will survive again. Because I, and those I love, more than likely will not.

Until you’ve sat awake in the middle of the night planning how you’re going to leave your home and seek asylum elsewhere, you don’t get to tell me to get over it. Until you’ve had to preemptively rehome pets to prepare to be able to not be in your house quickly, you have no right to belittle me. Until you’ve had to think about your child, who has only ever known your home and your love, getting taken away and having to live in a fucked up system, you don’t get to tell me to calm down.

I am so incredibly envious of those that get to vote purely based on morality, who don’t have to worry about their literal survival. I’m so glad that you get to feed into your own superiority complex while many of us are panicking about the very real consequences on our own futures. Because we have to care more about ourselves and our families. Because we have to give in to the fact that we can’t help everybody in the world in one fell swoop. Putting our oxygen masks on ourselves before others, if you will.

So please. The people telling you that not voting is a smart thing to do are being malicious. Even if you don’t vote in the presidential elections, vote for your local stuff. Because that’s how actual change is going to begin happening.

[ciceroandthelistener]

Ive been to 3 different locations for my hrt and for me it really was leaving the places that fucked me over that made all the difference. and now i have a fantastic spot with no problems ever. Idk what state/country you live in but it is worth it to try another place imo

im unfortunately very USAmerican and im debating just giving the planned parenthood in town a call bc i’ve heard good things about them but my biggest concern is that my insurance from work won’t cover them at all. also it doesn’t help being from the midwest/too close to the bible belt for comfort. like i know i need to but also im trying to move to a state that’s not currently debating on whether or not ppl like me should have rights so its like. why bother

[ghostonly]

Planned Parenthood isn’t the only source of hormones

Hi there! If you’re trans and want to go on hormones, you’ve probably heard that you should go to Planned Parenthood. Yes, PP is a great source for informed consent hormone treatment, but it’s not the only one.

In many states, PPs are few and far between and many of them have stopped taking new patients since the start of the pandemic because they only take new patients in person and won’t do first-time appointments through video. 

I had been planning to start T in March of 2020. Right before I was about to make an appointment with PP, the pandemic blew up and I couldn’t. 

Because I had been convinced by the internet and trans friends that PP was the only way to get hormones that weren’t outrageously expensive, I figured there was no way for me to get hormones until PP opened up to new patients again.

Almost a year later, I heard from one of my doctors that there was a doctor in their circuit who knew a lot about trans care and who did most of the trans care in the area. I booked an appointment with him.

When I went in to my appointment, it wasn’t ten minutes after he’d gotten to know my situation that he asked if I was interested in HRT and/or surgery. I was shocked.

“Yes, but it’s not covered by insurance, is it? I can’t afford to pay out of pocket.”

He told me, “It is covered by insurance. State insurance in PA has to cover trans care since X law was passed.”

I was shocked.

He wrote me a prescription for T and, once my insurance approved it about a week or two later, I was starting injections.

All states are different, and all state laws may not be the same. However, if you’re not absolutely positive that your state or insurance doesn’t cover HRT, set up an appointment with a family medicine/PCP/general physician in your area who knows stuff about trans care (ask your PCP/GP if there are any doctors who do trans care or look up trans care doctors on Google or trans forums to find one)

A doctor who does a lot of trans care will know for sure if HRT is covered and can potentially get you started on hormones.

If I had known this when the pandemic hit, I could have started hormones a year earlier than I did, but the misinformation that PP is the only way to get hormones without paying hundreds out of pocket did me dirty.

Hormones aren’t the only thing that can be covered entirely by insurance. I also have a top surgery consult in January and my surgery will be completely covered.

If you’re picky about who does your top surgery, you may not be interested in local surgeons, or you may not have any local top surgeons (you might tho - do some searching into cosmetic surgeons), but if you’re not picky, you might be able to get top surgery completely covered by insurance

The trans care doctor who helped me get on hormones also set me up a video session with a doctor who could write me a letter of recommendation for top surgery. I spent like an hour talking to her about my social transition, medical transition goals, support network, and so on. She was very chill and, at the end, she said she would absolutely write me a letter. That letter of recommendation is now in the system of that medical group and I can ask my trans care doctor to send it to any surgeon I need him to.

so basically, don’t be afraid to inquire about transition care in your primary doctor’s office. Just because it’s a more generalized medical setting that’s not specifically focused on sexual/reproductive healthcare (like Planned Parenthood), doesn’t mean it’s not adequate at getting you the treatment you need.

[arentiinpain]

First post who dis

So this is where I’ll scream into the void about health issues. I have plenty.

Currently diagnosed with CPTSD, BPD, PCOS, endometriosis, hypothyroidism, NAFLD, gastritis, GERD, several vitamin deficiencies, and a temporary diagnosis of both orthostatic hypotension and some kind of autoimmune issue. The current theory is I have either dysautonomia and/or hypermobile ehlers danlos syndrome. I’ve been waiting to see a specialist for the eds idea for over a year now because there’s a single doctor in my region who specializes in it.

I’m also quite queer (genderfluid trans, they/he) and luckily on HRT (testosterone). I finally got a consultation with the single plastic surgeon in my region who does top surgery, but by they time our meeting comes around I’m not going to have health insurance that would cover it. So I’m trying to find a job with health insurance so that meeting that I’ve been waiting over a year for doesn’t end up being cancelled. Of course, I cannot personally fund this surgery because I’m unemployed in my mid-twenties in the US and am also chronically ill and disabled. I’m wanting to apply for disability in my state (at least to shove it to future employers) until I get further diagnoses to figure out why I’m fainting so often and I’m generally always in joint pain. So. That’s been fun.

So far I’ve had to leave 2 jobs (one of which was a dream job) because of my health, one of which (said dream job) I got fired for. Since I wasn’t legally disabled I couldn’t do anything about it. Yay USA.

So if listening to a man man’s ravings about being an afab disabled chronically ill queer in a red, mainly rural state in the US is your thing I’m sure I’ll be dropping occasional updates/vents/screamings. The main reason why I’m moving to tumblr to do this is because I no longer want to overshare and vent to my friends on our personal screaming chats. If you’re one of these friends, you’re free to follow me here btw.

Now I’m off to get my heating pad and an ice pack. Wahoo.

[tmitransitioning]

I hear so much about long wait times and multiple steps for HRT and surgery. But locally, people are getting straight into it. You ask for HRT or surgery direct with the doctor or surgeon with no need for diagnosis. HRT could be given and surgery could be done on the second visit!! All you need is to sign a consent form. This isn't suspicious is it?? Everything seems up and up. The only reason I'd ask is because all info online is completely different than locally.

lots of teh info online is based on what used to be accurate when it was written (or based on the info cis folks were told when they asked a trans person a couple years ago, or what was accurate when the trans person started several years ago). Things change FAST in trans healthcare. when i transitioned, it was very hard to find informed consent healthcare. while my primary care doc offered it (because i knew him for a long time)- my friend had to drive 3 states over to get his hormones, or else have a year relationship with a therapist. now, MOST states have someone who offers it (meaning a clinic or groups of clinics). The most common provider is planned parenthood (but because of state-by-state laws, it isn't allowed to offer it in all states, so check about yours). When i first came out, almost NO insurances covered any trans healthcare. now it's illegal for any plan that the insurer doesn't create itself (some employer-created plans) to refuse to pay for anything trans-related if it covers the same thing for a cis person. It's not sketch if you go to a real provider and sign a consent form that you understand the risks and get it- but BE SURE that you DO understand the risks. ask plenty of questions. many changes cant be undone and you don't want to find out that you misunderstood something 5 years from now when you were hoping that something different would occur. find out everything now, before! Also, this way (informed consent) doesn't require you to have therapy but i cannot stress how helpful it is to have someone to talk to about all these changes. they don't have to be a professional, but be sure you have enough emotional support. things get /Weird/ for a while and you'll need some support!

[actualsunflower]

I have a huge life update to share rn--- My top surgery consultation is scheduled for July 5th!!!! I’M SO EXCITEDDDDDDDDDDD!!!!!!! I’ve also been vaccinated!! :D ANNNDDD MY LEGAL NAME AND SEX HAVE BEEN CHANGEDD!!!!! :DDDD kind of a lot has happened since I’ve been actually active around here But now I guess is the much harder part, my official surgery date will be set at the consultation, but there’s a required $1,000 fee to set the official date for my surgery. The $1,000 covers a portion of the surgery as well, and the base price for the surgery is $8,500. I’ll get the exact price on July 5th, but that’s their base rate. I need to earn or raise at least $1,000 of the total cost before July 5th to secure my surgery date!! I’m going to take commissions when I can, I have 1 almost entirely complete right now and then I can take on more! I’m gonna have a more detailed explanation of everything under the cut so this isnt super super long so pls read under there if you want all the deets Pls consider commissioning me or donating so I can get top surgery!! read more for more info and me being sappy abt my emotions--

I’ve waited so long for this and I’m fricken excited, it’s the last step in transitioning for me! It really means everything for me, I feel like I’ve been waiting forever and I can’t believe it’s finally happening !?!!! I am forever in everyones debt here and everywhere because I never wouldve even been able to start hrt if it wasn’t for the help here. I’m just so. Overwhelmed with emotion and gratitude I cant even tell how many times Ive cried and just felt like... actual gender euphoria since starting t..

So abt the appointment, I’m getting surgery with Dr. Javad Sajan, and I’m getting button hole double incision. Im serious his before and after pictures make me so emotional I am so happy and emotional for those people and I cannot wait to feel that kind of happiness and relief. But a big problem about this for me, is that he is in Seattle, and I live in southern Oregon. I can’t drive, so I have to rely on someone else, or take the train from a nearby city (Eugene). My consultation is over skype (which is amazing and a huge relief), but my pre-op appointment is in person, and of course so is the actual surgery. We’re planning on taking the train from Eugene because it seems to be the most reliable way to get there and back each time. Aside from my surgery, I’ve got to cover the price of the trip there and back (twice, once there and back for pre-op, once there and back post op,) and the price of a place to stay during the pre-op appointment. Right now my goal cost wise, is just the booking and base appointment price ($8,500, that’s including the $1,000 appointment setting deposit, which is just a part of the surgery cost and the base covers everything, surgery, the stay at the hospital, nips, anesthesia, everything). The full price is due at the pre-op appointment, and that’s the final bill. My insurance doesn’t cover anything because it’s out of state and county, and because its informed consent model. (which Im choosing because Id have to battle insurance for 2 years minimum if I was getting the surgery in Oregon, but I am very set on my surgeon after considering everything and calling many offices and looking through many subreddits and talking to ppl who’ve gotten it here and there) A lot of this information is on their site as well. As soon as I have my consultation, I will be right here to update everything and set the exact price, which I’ll also be including the price of transportation and staying there. As for paying, I’ve been applying to so many jobs, and even when I get interviews I never hear back from them. People keep telling me to stop admitting I’m disabled but I just can’t do that. Lying about being disabled doesnt make me abled and they don’t get that. I’m still trying though, and I am not going to stop trying until I get a job. But until then commissions and donations are my only source of income. I’ve been struggling getting help psychologically, because I have schizophrenia, and because I was diagnosed with adhd as a child, but I think I’m actually autistic rather than having adhd, and it’s been really hard trying to get diagnosed because I keep getting pushed off or told I cant have autism because I have paranoid schizophrenia or because its “just adhd”, but the medications are just making everything worse, and Ive tried more than one already. My medications for schizophrenia have started not working right, and when my schizophrenia meds get under control, it makes my adhd (?) significantly worse. Genuinely, I really dont know what’s happening. I really dont know whats going on with me right now and it’s hard and confusing and I keep swinging back and forth and it’s making everything deteriorate so fast I cant keep up with it. It seriously effects my ability to do anything at all, even art, and its been like this for the last 6 months. I am trying though, still trying to work, still trying to get a job, still trying to get a real diagnosis and help and Im not going to stop any of that. But I think getting top surgery as soon as possible is going to help me too, because dysphoria has just gotten so much worse focusing on my chest since t has started helping me pass and look so much more masculine. It’s like all my attention went from everything DIRECTLY to my chest and its almost unbearable. Even now since my sex has been legally changed I keep having the horrible thoughts of ‘why, why I am a man Im not supposed to be this way’ and shit idk. I’m getting too serious right now I have an appointment with the dmv to get a new updated driver’s permit with my name and fixed legal sex, and when I do that I can set up a bank account (I cant yet bcs I dont have a valid id/ id at all because I actually lost the other one and have been carrying around that paper one you’re supposed to destroy that is literally from 2016) and when I do, I’m going to set up a proper gofundme for my surgery and the travel expenses, but for now all I have is my paypal and online banking savings account. I’ll get that up asap once I have my id, though (Ive already been to the bank with my notarized judge passed papers and they wont take those yeah I know it’s stupid its like the same thing) But uhhh yeah! Thank you for reading this far if you did lol and considering helping me bcs my god, it literally means everything to me. pls share hehe

[feargender]

Help me be financially independent

Hello, my name is Kieran (they/them or fae/faer), I’m 19, and I’m in a difficult financial situation. I live at home with my parents, who are emotionally manipulative and abusive, and I depend on them financially, having next to no money of my own. I have only recently been able to open a bank account, but cannot get a job because my mother has been extremely sick and I have to be at home to help her care for my 3 year old sister.

I want to be able to move out with a few friends out of state next summer, which requires funds I don’t have and also don’t really have a way to obtain. I also want to be able to enroll in online classes in the spring semester, starting January, and will have to cover anything financial aid doesn’t. Additionally, there are life expenses I need to contend with, like paying for my depression medication and HRT once my insurance runs out now that I’ve turned 19, and covering driving classes so I can get a permit and eventually a car.

I don’t have much to offer in terms of repayment, but if you want me to write you a fic for one of the fandoms we share I will, or I can give you my nsft blog where we can work out ✨something else✨

Donation links:

CashApp- $ikam65

Venmo- ikam65

TL;DR: I’m trying to become financially independent from my abusive family and save up for moving out and going to school, but can’t get a job, and so need help until I find a way to gain an income.

[spidergwenistrans]

I'm sure lots of people have talked about this already, but I think it's really shady the way only parts of transition healthcare are ever covered by so many insurance providers. I'm talking both public and private here.

I want to be very clear about the fact that I'm arguing we add any additional roadblocks or gatekeeping to transition care. All I want to argue for here is that more options be available.

In Ontario, I was able to access HRT through an informed consent process, which means I proved to my doctor that I understood the limitations, side effects, and risks associated with estrodial and cyproterone, the meds I take.

I was lucky, this wasn't my GP's first time with this, so he knew what to do, I didn't have to educate him on the basics of it. He has his limitations, and eventually I want to see an endocrinologist about progesterone, and long term management of my hormones, especially post bottom surgery.

In lots of places, it's way harder to access even HRT. In the UK for example, my understanding is that you need to see a specialist, and GPs are generally unwilling to prescribe HRT even in the interim before seeing a specialist.

As far as I know, the UK is the only publicly funded health care system that covers gamete preservation for trans people, though it's not a part of the system I hear much about. Obviously the UK system has lots of issues, but on paper it sounds like it should be the best one to be trans in.

OHIP (Ontario's system) won't cover HRT for lots (most?) people, because OHIP doesn't really cover medication for anyone from 26-64(?). It does allow your doctor to prescribe you hormones, which was a big win. It also allows bottom and top surgery to be covered, but each has to be approved individually, according to the page listing the requirements.

The fact that top surgery to remove breast tissue has to be approved, but breast reduction is covered automatically, and all you have to say is that it prevents you from living the life you want (essentially, there's a specific wording, but any good surgeon will coach you during a consult, as my friend learned).

I don't want this to read as me thinking we should add gatekeeping to breast reduction, I just want to call out the double standard here.

Meanwhile, all of the trans affirming surgeries require 2 seperate assessments, by 2 health care providers, stating you have a diagnosis of persistent gender dysphoria. They also have that classic requirement: "have completed 12 continuous months of hormone therapy (unless hormones are not recommended) you have lived 12 continuous months in the gender role you identify with (for genital surgery only)."

These are a big improvement, for Ontario at least, over what they used to be. We used to be required to see a psychologist, which meant a 6+ month wait list just to get an initial assessment, followed by probably several appointments, hen being sent back to your GP before finally getting a referral to a (the, at the time) surgeon.

Under current requirements, I could probably see my doctor, and then a nurse practitioner with his office and get my surgery approval submitted in less than a month. Of course, that doesn't mean I'd be seeing a surgeon all that quickly, especially right now.

I'm supposed to talk to my doctor on Tuesday about getting this process started, so that's exciting, if a little terrifying, it feels like the biggest step in my transition so far.

I'm kind of rambling here, the thing I really wanted to talk about was what isn't covered.

There's no support for gamete saving, which kind of amounts to a form of mass coerced sterilisation, since many of us can't afford to save our gametes on our own, especially before we even start transition, and we know the hormones will probably make us infertile as long as we're on them. I know for me, I don't think I could tolerate the 3+ months off hormones required to produce viable gametes again.

I probably could have waited a couple more to start if I'd been trying to save gametes then, but there was no way I could afford it on my own, and I'd be wanting to start them for months at that point, and only waited until I came out to my family. I'm personally not that upset about never having children from my own gametes, it doesn't bother me that much, it's not being able to carry them that hurts more. But my personal feelings about this don't mean that I shouldn't have had the option??

The other thing that isn't covered, which really bothers me, is facial surgery. I know that masculising face surgery is in a very different place than feminising face surgery, but I'm going to speak from the perspective of a trans gal that wants FFS, I can't speak to wanting FMS, trans masc folks who know more than me feel free to comment, or link to other people talking about it. I don't think it's exactly my place to talk about it, and I really just don't know very much anyways.

Bottom surgery being covered is so incredibly important to so many of us, but the idea that bottom surgery should be covered, but face surgery shouldn't is wild to me? Ultimately, they're both somewhat cosmetic, but you know what else is? Brushing your teeth. Bad tooth health will eventually ruin your life, and so will dysphoria, so why can't we cover a surgery that would deal with a major source of dysphoria?

FFS procedures are not especially new or experimental, lots of cis women have some of these procedures as well. From a safety-via-passing perspective, FFS is probably more important than bottom surgery for at least some trans women.

I don't mean to say that we should all have it, or that anyone's priorities are wrong, personally even if both were free, I would still get bottom surgery first. I also don't want to imply that passing should be a goal, requirement, or something everyone, or even anyone should strive for. But, it's sometimes useful to frame things for the cis people that still get to make these decisions about our bodies, to be able to understand why it matters to us when it does.

In an ideal world, trans kids won't be forced to go through the wrong puberty, and hopefully some of these surgeries will be less and less necessary, but I don't think we'll be there for a while, and even if we get there, there will probably always be adults who realise their transness long after puberty.

[karanan]

Hello I’m now officially and legally considered a man in the eyes of the state

Oh boy I’ve been waiting patiently for my legal stuff to go through and I did finally get my papers this Monday. However, I’m almost 2 weeks past my shot window. I’ve never gone this long without a dose of T before which is a little scary but I should be fine according to my research. The reason I’m waiting is because if my legal stuff is processed and the hormone clinic informs the social insurance institution of my new ID number, the cost for my HRT will be covered 100%. Which in less words means I’m pretty poor so I’ve opted to wait a few weeks for the insurance stuff to be processed rather than pay 80-120€ out of my own pocket for my medicine.

Now what I found out the hard way is that when you change your social security number, some things become a bit messy. Like how I can’t log into any government accounts because the ID system I use uses my bank account to identify me and my bank doesn’t have my new info... So I can’t apply for my monthly income on the social insurance institution’s website which means I can’t pay rent and other general life things you need money for.

Also now that my legal gender marker has changed, I physically cannot go buy my meds even if I wanted to opt for spending the money because my social insurance card no longer matches the information in the citizens’ registry. I have no valid identification to show the pharmacists rn haha. I’ve called the hormone clinic so they’ll deal with the insurance stuff but until then, I can only wait. The nurse I talked to knows it’s urgent so hopefully I’ll at least receive the new insurance card asap so I can go get my T from the pharmacy. And hopefully by then my bank has fixed the login issues as well since I also messaged them about this stuff.

I’m hoping everything will be sorted in time for me to get my dose next week pretty please

[renaissancebadboytransitiondiary]

Choosing a Surgeon

Guess I should talk about the things leading up to having a confirmed surgery date.

My top surgery will be with Dr. Hope Sherie of the Cosmetic Concierge in Charlotte, NC. I wanted surgery in my home state just to minimize travel and, honestly, narrowing a search to one state helped me not be overwhelmed by a whole country of surgeons.

I found her on topsurgery.net first and already had been leaning toward her since she was the only surgeon in NC that I found who operated under the informed consent model. Which meant I do not need letter(s) saying that I’ve met some “trans criteria” so top surgery’s totally fine.  I hate that very hoop on principle.

(As a note, and your mileage may vary, I get HRT through the Planned Parenthood in Raleigh and when I mentioned looking to get surgery they were on board with writing letters if I needed them.  Your nearby PP may be the same? And if you are looking in NC and there are some facets that are prohibitive with Dr. Sherie, that may be an option.)

I also asked my doctor at one of my HRT follow-ups if they had any surgeon recommendations and, while I think they can’t really “recommend” a surgeon in that way, they did give me a packet of NC/Southern trans resources that had her as a top surgeon and said other patients had good experiences there.

Dr. Sherie may be prohibitive as her office doesn’t take insurance and no longer offers help with asking your insurance to reimburse you directly post-surgery.  They will work with financing companies and you can pay directly in installments up to 21 days pre-surgery date.  There are no additional fees: the consult cost and surgery reservation cost are credited toward total surgery cost.

I requested to schedule a consult on their website and was emailed a few days later to start that process.  If you hover around their website as long as I did because I am both socially anxious and desire all the information, meaning I will hunt down every piece of info I can get without talking to another human being, the intro email may feel a bit redundant or like ‘yeah I saw that one the website!’ but, at the very least, the consistency is reassuring.

I was asked if I had thought about what surgery would work best for my goals and body, which I had (and will post about later), but I don’t think not being sure would stall anything (after all, what else is a consult for?) and also what time of day would be best for the appointment and if I wanted in-person or over-the-phone.  I went over the phone just to make things a little easier.

If you do over the phone, you have to send them pictures but their email has very good instructions.  They also send you a link to register and fill out medical info in a patient portal.�� Some of the tasks can wait, but the patient portal and payment had to be done in 24 hours.  Originally, my consult was for late July, but since I sent them everything the same day, they offered to put me on a waitlist for an earlier time if anyone cancelled. So I ended up getting an earlier date.

The consult was pretty easy and short, though that may be because I was already very sure in what I wanted and so didn’t have questions or need advice to weigh pros and cons.  Plus, I got sent a very thorough information packet about the surgery in its entirety to look over well before the consult, so that helped answer things too.

You don’t have to schedule immediately, you can get a quote and think on it and get back to them later, but I don’t do things by halves so I jumped into scheduling.  I got a whole rundown of the entire timeline and deadlines over the phone, but was also immediately sent an email reiterating the information and was told it will be repeated plenty, so I didn’t worry too much about notes or memorizing stuff.

It is $1000 to reserve a date which... was a lot to drop at once but the information packet had said as much and I was prepared.  Being prepared and well able to cover it did not make my eye twitch any less though sdhjfghjdssdjhfg

They do require that you have someone care for you at least for the first 24hrs and I’m lucky in that my dad is willing and able to be my caregiver, but if you don’t have anyone, their info packet does have a recommendation for a home care company.  You’ll have to make the arrangements yourself, though.  I will say, at no point in working with the team at the Cosmetic Concierge was I ever at a loss of what came next with them, so I hope if you have more stuff going on, you won’t be either.

They do offer post-op recovery packages which I sprung for because this is already a very expensive birthday present might as well commit and, also, I already have other arrangements to make and things to buy on my own, let’s take some of the hassle out.  However, they do list the items in the care package and even say what they’re for in their initial info packet, so you totally can get them yourself and omit what you don’t think you’ll need, etc.  I don’t know how the pricing shakes our between the package and buying individually and I’m not into figuring it out I’m ngl.

If you’re not from the area, their packet also has hotels that are close by so you’re not completely on your own there either.  So far, everyone on their team has been incredibly kind and professional and have made things as smooth and clear as possible.  Even so, I know I am lucky to be in the position I’m in with being able to afford it out-of-pocket.

[trans-advice]

Hey I’m a trans guy who came out to unsupportive parents a year ago. I am held back by my therapist and family b/c “it’s a big decision I can’t make because I’m a virgin” (I’m ace) and they act like me sleeping with someone will make me cis? It’s dumb. I’m 18 now and I want to find a new therapist to help me transition but I don’t have a driver’s license or anything and my parents would flip if they found out, but I have so much dysphoria I don’t think i can wait till college (in August). Help?

well, when you're having a mental health crisis, college is too high stakes. but you should find a volunteer or online course to take up that like 20-48 hour gap of your time. apply to the dean's office for some sort of leave of absence to pause your education there. choose a semester basis in order to have a slower pace that's thereby more forgiving if your dysphoria messes you up for a week or half a week or something.also you should look into getting a State ID card. this way you don't have to drive, but you'll still have ID on you. it's just very helpful in general. I think your parents would be supportive of that overall. you can just search like " state ID card" avoid ones that says something like " IS A *PRIVATELY OWNED* WEBSITE" &or "IS *NOT* OWNED OR OPERATED BY ANY STATE AGENCY". you can also call one of your state's DMV offices for more information. you can also search for that information online.you can probably change your ID documents later, depending on where you live & who's issuing the ID. https://transequality.org/documents (for changing documents)then yeah, like i never understand why people/gatekeepers be saying like being single disqualifies us from transitioning. I think it has to do with reproduction. the answer to That is sperm/egg storage. and then using Artificial Insemination with whoever your partner would be. or for a surrogate. But that's expensive as heck. and there are sterile cis people &or cis women who would be harmed carrying & delivering a baby. (i know of a cis woman who was in a car accident when she was 16. her cervix got tilted. this meant that while she could get pregnant, she wouldn't be able to deliver it without a C-section because the baby wouldn't be able to get out like normal. so overall she couldn't have a baby.)now requiring your parents insurance to cover your HRT, informed consent clinics do exist. i would look for sliding scale ones, or ones you can generally affors.http://www.trans-health.com/clinics/http://mytranshealth.comalso "Planned Parenthood" doesn't have a sliding scale. But if you search for "planned Parenthood " then you find locations & some of them do offer HRT for trans people. They're somewhat pricey, you can either use insurance or self-pay. the good is they're relatively widespread, and they use informed consent. this means in some places they are the only provider, but they don't have a bunch of gatekeeping, and cis people & straight people also have incentive to keep them open too.so yeah, the money can be a problem. but you do have options for finding other treatment. you also have the ability to not mess up your college experience because of your current mental health crisis.Peace & Love, Good Luck,Eve

[umyikesiguess]

“You don’t need dysphoria to be transgender.”

“You don’t need dysphoria to be trans.” 

This is a sentence that can make people feel strongly. This is a sentence that has sparked up countless debates. People push and pull on either side of the argument until the sentences exchanged dissolve into petty insults; into worthless exchanges. No one seems to get anywhere.

I think the biggest problem here is that lots of people see this as an open debate, when in reality there truly is only one correct side. This correct side has scientific analysis and data to back up their reasoning, while the other side simply makes claims based off of their own opinions of what exactly gender is. Definitions are not taken into account. Data is not taken account. The only thing taken into account is one’s own warped definitions, opinions, and sick ideas of “inclusivity.”  

Another problem that usually arises is truscum leave areas of the conversation open, instead of closing and filling in all of the gaps. This leads tucutes to jab at areas where the argument has not yet been developed, only briefed upon for fleeting moments. They take words and twist them, purposefully misunderstanding them to make up for their lack of any real argument.

So here, in this post, I will leave nothing up to debate (well, you can still express your opinion and explain why or why not you agree or disagree with me, but factually, I will be correct), I will tie all loose ends. I will cite my sources and be thorough. I will fill in the gaps.

Truscum, terf, tucute, feminist, transphobe, lgbt, cishet, and so on, I welcome you all to read this post and give me your input.

Now, onto the main post: You need dysphoria to be transgender.

Firstly, let’s get some definitions out of the way.

Google defines the word “Transgender” as, ‘denoting or relating to a person whose sense of personal identity and gender does not correspond with their birth sex.’

Merriam-Webster Dictionary defines the word as, ‘of, relating to, or being a person whose gender identity differs from the sex the person had or was identified as having at birth; especially : of, relating to, or being a person whose gender identity is opposite the sex the person had or was identified as having at birth.’ (https://www.merriam-webster.com/dictionary/transgender)

“Gender” is defined by Google as, ‘the state of being male or female (typically used with reference to social and cultural differences rather than biological ones).’

Merriam-Webster Dictionary defines “Gender” as, ‘the behavioral, cultural, or psychological traits typically associated with one sex.’

The term “Gender Dysphoria” is defined by Google as, ‘the condition of feeling one's emotional and psychological identity as male or female to be opposite to one's biological sex.’

And by Merriam-Webster Dictionary as, ‘a distressed state arising from conflict between a person's gender identity and the sex the person has or was identified as having at birth; also : a condition marked by such distress.’

Keep in mind (tucutes especially), I am not choosing to define these words the way that they have been defined. These definitions have been worded carefully and are based upon factual evidence. How you or I may define these terms is irrelevant, because these are the correct definitions, and they have already been decided upon. Unless new data comes up stating otherwise, which I doubt will happen, these definitions are static.

Now that we have defined these key terms, we should move on to the argument, and it’s simple, this sentence will sum it up: You need dysphoria to be transgender.

Why, though? Isn’t being transgender just an identity? And can’t anyone identify as whatever they please? And after all, gender is on a spectrum, and non-dysphoric transgenders aren’t hurting anyone. Maybe truscum should stop being gatekeepers---the LGBT community doesn’t need that kind of negativity.

These are common arguments I see tucutes making. First, I’m going to address the “why?”

Now, my favourite place to gather information from is the DSM. If you’re not already aware, the DSM stands for Diagnostic and Statistical Manual of Mental Disorders (https://en.wikipedia.org/wiki/DSM) (and before we go any further, I do want to say that the DSM I’m using for reference is two editions out of date. The current version of the DSM does not include transgenderism in it, as the DSM stopped considering it a mental illness in 2013 [https://www.scientificamerican.com/article/where-transgender-is-no-longer-a-diagnosis/]. Furthermore, recently the WHO (World Health Organization) changed the classification of transgenderism, following in the DSM’s footsteps, just five years after the fact. However, despite the fact that my references are slightly out of date, I assure you they are reliable sources, and that the diagnosis that I present is still valid.) The DSM is basically just a big book of diagnoses for any and all mental illnesses. It is a book used religiously by psychiatrists, and me too.

The DSM I’ll be using for reference is the DSM-III (https://link.springer.com/article/10.1007/s10508-009-9562-y) (which by the way, links countless references that you can check out.) In this book, we see the diagnostic criteria for transsexualism (transgenderism, GID, GD, or GI, whichever term you choose to use is fine. Though some of these terms may be classified as out of date, they all mean the same thing) as (a) sense of discomfort and inappropriateness about one’s anatomic sex, wish to be rid of one’s own genitals and to live as a member of the other sex, the disturbance has been continuous (not limited to periods of stress) for at least 2 years, absence of physical intersex or genetic abnormality, not due to another mental disorder, such as Schizophrenia.

Here what we see is what I’ll call The Pattern of Distress.

Now, if the criteria provided by the DSM doesn’t cut it for you, then let’s take a look at some other symptoms of transgenderism.

Psychology Today has this to say about transgenderism.

‘Gender dysphoria (formerly gender identity disorder) is defined by strong, persistent feelings of identification with the opposite gender and discomfort with one's own assigned sex that results in significant distress or impairment. People with gender dysphoria desire to live as members of the opposite sex and often dress and use mannerisms associated with the other gender. For instance, a person identified as a boy may feel and act like a girl. This incongruence causes significant distress, and this distress is not limited to a desire to simply be of the other gender, but may include a desire to be of an alternative gender.’

(https://www.psychologytoday.com/us/conditions/gender-dysphoria)

Now, what I want to address first is what I called the Pattern of Distress.

From each symptom of transsexualism, we see one consistent thing: Distress is caused by one’s biological sex. This is the key symptom of transsexualism, and this distress is otherwise known as Gender Dysphoria.

“A sense of discomfort and inappropriateness:” Distress. “Wish to be rid of one’s own genitals:” Distress. “The disturbance is continuous:” Distress.

All of these symptoms include distress. This distress is Gender Dysphoria, which is needed to transgender. You know why? Because distress is a key symptom of being transgender, and distress is equivalent to Gender Dysphoria.

Transgenderism and Gender Dysphoria are synonymous. Which is another thing I want to briefly touch on. In the medical world, these two words are, more or less, the same, and warrant the same diagnosis.

So, I think I’ve proved my point significantly. There’s no way around it: Gender Dysphoria is needed to be transgender.

Now, let’s move on to arguments I see tucutes commonly using. The most used argument that I’ve seen is anyone can identify themself however they please. The only way to be transgender is to identify as it. However, this argument lacks any evidence to support it.

Firstly, this implies that being transgender is simply a choice. If all you have to do is identify as transgender to be transgender then hypothetically, anyone could be transgender. And then, if being transgender is a choice, that would mean that it’s not a serious condition, and therefore things like top surgery, bottom surgery, and HRT would no longer be covered by insurance, and would be classified as cosmetic procedures. There would also no longer be a medical diagnosis for transgenderism, and it would not be a valid disorder, because, after all, you can just identify yourself as transgender and then you are. By that logic, being transgender is clearly just a choice and a choice does not warrant the need for a diagnosis.

Furthermore, what would be the incentive for people to not discriminate against people who identify themselves as transgender? After all, who would make a conscious decision to become the other gender. Who would pay thousands of dollars to mutilate themself in an irreversible way. Who would want those pink, puffy scars on their chest, or the pain of taking hormones? Surely only a freak would. So again I ask: What would the incentive be? (Also any discrimination would not even be classified as such because being transgender would a choice.)

See, this wishy washy idea that anyone can be transgender as long as they identify that way is extremely dangerous. It’s important to consider the consequences before we decide that being blindly all-inclusive is a good idea. We must consider the risks that these ideas pose. All of them.

But, now, let’s go into why someone can’t just identify as transgender and...be it.

First we must ask the question: Why is someone transgender? What makes this disorder valid?

The simple answer here is that there is an observable neurological difference between the transgender brain, and the cisgender brain.

‘In particular, researchers are identifying similarities and differences between aspects of the structure and function of the brains of trans- and cisgender individuals that could help explain the conviction that one’s gender and natal sex don’t match.

The results may not have much effect on how gender dysphoria is diagnosed and treated, notes Baudewijntje Kreukels, who studies gender incongruence at VU University Medical Center in Amsterdam. “It’s really important that it will not be seen as, ‘When you see [gender dysphoria] in the brain, then it’s true.’” But the insights from such research could go a long way toward satisfying the desire of some transgender people to understand the roots of their condition, she adds. “In that way, it is good to find out if these differences between them and their sex assigned at birth are reflected by measures in the brain.”’ (https://www.the-scientist.com/features/are-the-brains-of-transgender-people-different-from-those-of-cisgender-people-30027)

‘Several studies have looked for signs that transgender people have brains more similar to their experienced gender. Spanish investigators—led by psychobiologist Antonio Guillamon of the National Distance Education University in Madrid and neuropsychologist Carme Junqu Plaja of the University of Barcelona—used MRI to examine the brains of 24 female-to-males and 18 male-to-females—both before and after treatment with cross-sex hormones. Their results, published in 2013, showed that even before treatment the brain structures of the trans people were more similar in some respects to the brains of their experienced gender than those of their natal gender. For example, the female-to-male subjects had relatively thin subcortical areas (these areas tend to be thinner in men than in women). Male-to-female subjects tended to have thinner cortical regions in the right hemisphere, which is characteristic of a female brain. (Such differences became more pronounced after treatment.)’ (https://www.scientificamerican.com/article/is-there-something-unique-about-the-transgender-brain/)

The cause of these neurological differences is not yet known, and it is extremely difficult to pinpoint where they stem from, however, it is speculated that it starts from the development of the baby in the mother’s womb.

‘One prominent hypothesis on the basis of gender dysphoria is that sexual differentiation of the genitals occurs separately from sexual differentiation of the brain in utero, making it possible that the body can veer in one direction and the mind in another. At the root of this idea is the notion that gender itself—the sense of which category one belongs in, as opposed to biological sex—is determined in the womb for humans. This hasn’t always been the scientific consensus. As recently as the 1980s, many researchers argued that social norms in how we raised our children solely dictated the behavioral differences that developed between girls and boys.’ (https://www.the-scientist.com/features/are-the-brains-of-transgender-people-different-from-those-of-cisgender-people-30027)

So, if there is a clear difference between the brain of a cisgender person and of a transgender, and this clear difference is the cause of Gender Dysphoria, then that means that you cannot just identify as trans and just be it. You must have the transgender brain (which causes Gender Dysphoria) to be trans.

Now, onto the whole, “gender is on a spectrum” myth.

There’s this idea that’s been going around that is less than factually correct, yet it spread like wildfire simply because it allowed Tumblr’s narrative on gender to flourish.

Is gender on a spectrum? No. Biologically, there are only two genders, and there always will be. Now, I know some people will be happy to argue that gender is different from sex (I used to be one of those people), and while there are only two sexes, there can be millions of genders. And gender isn’t biological; it can shift and change...but this simply isn’t right. (Take a look at the definition of “Gender” again.)

You see, there is a clear difference between the male and female brain (this is part of the reason why transgenderism is valid.) An example of this is brainmass; a male brain is slightly larger than a female’s (for more information on the neurological differences between the sexes, you can read this wiki article, though it is a little dry https://en.wikipedia.org/wiki/Neuroscience_of_sex_differences.) And (with the exception of intersex people) you will either have a female brain or male brain. Your brain will usually correspond with your sex, the only exception to this is transgender people, who have a brain that acts more like that of the opposite sex.

Therefore, gender is not on a spectrum. Nor is is a feeling. Nor is it something that can shift or change. Gender is innate; biological; ingrained in you from birth. And though it’s fun to think that you can shift throughout the “gender spectrum,” and be a boy one day and a girl the next, it is impossible.

(I think people are mistaking gender with gender expression. These are two separate things.)

“But non-dysphoric transgenders aren’t hurting anyone. Let people live!”

See: Firstly, this implies that being transgender is simply a choice…

The last argument I’ve come across is that truscum are gatekeeping, and I’m gonna give it to you straight: We are. And we have to. You know why? Because we cannot blindly accept everyone into the trans community. The more we accept non-valid trans people into the community, the more we water down what it means to be transgender. The more we water down the severity of the condition. The more our community becomes a joke to society. And the more we are at risk to the demedicalization of transgenderism, to the shift of surgeries and HRT from medical procedures to cosmetic. The more we are risk to discrimination not even being classified as such.

All of these are things clear issues that come along with supporting a factually incorrect narrative. I understand that wanting to include everyone stems from a place of kindness; of not wanting to hurt anyone, but sometimes people need to be told “no.” They need to know where they belong and where they don’t, and they need to understand that being transgender is not quirky, cute, or fun. It’s a serious, painful disorder that is not to be taken lightly.

[tmitransitioning]

Im the anon who asked the process of getting T prescibed, i live in the US, specifically west coast

Thank you for that—I’m going to write out a list here, but there are a few options you might have, so bear with me if it gets a bit convoluted!

I also strongly encourage followers to chime in in the notes on this post if I messed anything up; my experience with healthcare is all Canadian, and while I’m fact checking as I write it’s also possible I might miss things.

Also after I wrote this I realized it was incredibly wordy so I’m going to put it under a cut. There will be a TL;DR at the end.

First, if you have a GP or primary doctor, check their clinic website to see if they do HRT care. If they do, that’s great, and all you may have to do is talk to your doctor about how to access that; they will walk you through the particulars.

If you don’t, or if your doctor’s clinic doesn’t do HRT, you have a couple different options:

You can ask your doctor if they know where to refer you to; they may know trans care clinics or endocrinologists that take trans patients.

You can see if there’s a Planned Parenthood in your area that offers HRT on an informed-consent model; many places on the west coast do this. They usually require you to be over 18 in order to consent without a guardian present.

You can check local universities or health centres yourself to see if you can find a clinic that does trans healthcare. Googling “[local major university] trans clinic” often is a good way to discover this, and they may have resource guides with provider names.

For the latter two options, start with their website to gather information and then call their front desk and lay out specifically what you’re looking for—the message I left was, paraphrased:

“Hi, my name is [legal name] and I read on your website that you do hormone replacement therapy for trans people. It also said to set up an appointment for more information, so, can I set one of those up over the phone or should I come in person? I live in [city], and my PHN [Canadian personal health number, may be different for you] is [redacted], my name again is [full legal name], last name is spelled [data expunged], and my phone number is [double redacted]. Alternately, my email is [triple redacted]. Thank you, and have a good day!”

It’s okay to say your preferred first name too, but I personally used my legal name so that they could look me up in the provincial medical system.

The individual clinic might vary, but in my experience most places ask you to cold call them, which is very intimidating. Having a script helps. You want to make it clear what you’re looking for, ask how to set up an appointment, and give clear contact info. If they don’t get back to you in like... two weeks or so, then call again and try to get a live person rather than an answering machine.

Some places (Planned Parenthood especially) might offer online appointment booking, which is also cool!

When you’ve made the appointment, show up with these questions in mind:

Does the provider require a therapist letter?

Informed-consent models usually don’t, many doctors still do.

This is a letter from a psych professional (usually a psychologist or psychiatrist, not a counsellor) that says you have gender dysphoria for which the indicated ‘treatment’ is HRT, and that any of your mental health conditions are well-controlled and don’t make you legally unable to consent to treatment.

This is partially a gatekeeping holdover, and partially because, in the States, “gender dysphoria” is a medically formal diagnosis that allows you to have controlled substances prescribed.

Does the provider take your insurance?

Bring your insurance info to the appointment if you have it.

Do you have to do anything in particular to get T covered (like a special authority letter, I’m not sure what the US equivalent is), and what are the expected costs of various forms?

What kind of lab work do you have to have done?

The vast majority of the time, you will have blood drawn, where they will check things like: cholesterol, red blood cell count, your “baseline” testosterone levels, ALT (liver function marker), blood sugar, and infection/inflammation markers.

You will probably be asked to fast for 8-12 hours before the blood draw if your blood sugar is being tested.

Some clinics can do same-day labwork; this might be a good thing to ask on the phone if you get a call back to set up an appointment.

What forms of T are easiest and cheapest to access where you are?

Your doctor prescribes this a lot if they do trans care, so they’re likely to know this.

The answer will probably be injections, but if you have a strong preference for something like gel instead (needle phobia, maybe?) then you can ask about how much that usually costs.

Costco and Walmart pharmacies are often the cheapest.

Where you go from that first appointment depends a lot on what kind of clinic you access.

Many informed consent clinics can do all the labwork etc on the same day that you walk in. This isn’t universal, but allows many people to access HRT quickly, assuming they don’t have health conditions that would need additional monitoring, analysis, or treatment.

If you need a therapist letter, and you don’t already have a therapist, the doctor you see will probably be able to refer you to one who’s trans-competent.

If you do have a therapist, they might be able to write the letter, and if they can’t then they probably can refer you to someone who can.

Some doctors or clinics have specific procedures they follow.

For example, the clinic I went to was all-in-one and worked on an interesting combination of informed consent and diagnosis.

I had three appointments—the first one talked about my dysphoria history and psych diagnoses, the second was a physical and analyzing the results of my bloodwork, and the third was signing consent forms and walking out with a prescription.

This is becoming an increasingly common model, with GPs performing the “gender dysphoria” diagnosis themselves rather than requiring a therapist’s letter. It isn’t universal, but you may encounter it.

If you have a health condition like liver damage or polycythemia that would be affected by HRT, your doctor will give you specific information on how to treat that, and may require it to be controlled or ameliorated before you start.

A nurse at the care clinic may be able to show you how to administer a shot if you go with injection methods. If not, there are lots of youtube tutorials, or you can write to us.

The common outline of events looks like this:

Set up appointment

First/intake appointment

Bloodwork

Followup appointments; “gender dysphoria” diagnosis

Consent forms

Prescription

Or, if you need a psych:

Set up appointment

First/intake appointment

Therapist’s letter for “gender dysphoria” diagnosis

Bloodwork

Followup appointments

Consent forms

Prescription

Or, if you go to an informed consent clinic that does everything the same day:

Set up appointment

Meet with doctor who will:

Draw your blood and run bloodwork in the clinic’s lab

Ask you questions about your psychiatric and medical history

“Gender dysphoria” diagnosis

Prescription

The psychiatric questions you’ll probably be asked are, among others:

What labels and pronouns do you use?

When did you start identifying as trans?

What was your experience of gender like as a child? How did it change and develop as you grew?

Did you play with children of the “opposite” gender?

How did you dress? Did you pick your own clothes?

Did you insist on being not your birth assignment to adults?

Were you a “tomboy”/”sissy”/some other gendered or pejorative term atypical for your assigned gender? Were you singled out or harassed based on your gender nonconformance or behaviours?

When you went through first puberty, how did you feel about your body changing?

Were you most upset about primary or secondary characteristics? Which ones?

How did you feel about your voice/chest/genitals/body shape?

What have you done to hide or change them (affected voice, binding, tucking, etc.)? How long have you been doing that?

What changes do you want from HRT? How will those changes make you feel better in your body and/or affirm your experienced gender?

How has your dysphoria impacted you socially? How would HRT change that impact?

What psych diagnoses do you have?

How long have you had them?

What are you doing to treat or control them (medication, therapy, mindfulness, etc.)?

You may also be asked to rate things like anxiety or depression on paper inventories/scales.

Whether or not a psychiatric examination will focus on you as an adult or as a child is entirely a tossup on the provider’s part. Many doctors now acknowledge that not every trans person experiences identifiable dysphoria in childhood (ex. I didn’t know what nonbinary was until I was like 15, and it wasn’t an issue).

Don’t downplay your experiences. There’s an urge for a lot of people to do that, to act like oh it wasn’t That Bad, out of a reflex where we’ve been told to conceal pain or distress. It’s important that you give space and acknowledgement to how important your experiences are; you are there specifically to get help for something that majorly impacts you, so tell them about it. They’re not going to think you’re weak for it, they’re going to see it as a reason to prescribe you hormones.

Tl;DR:

Call the most accessible trans care provider for you and ask how to access their HRT services. When you’ve made the appointment, come prepared with a few questions, and find out if you need any extra documentation like a therapist’s letter. You will be given both a medical and psychiatric examination or interview, and they’ll take your blood for testing. Your provider will have you sign consent forms showing that you’re aware of the effects and risks of HRT, and will probably be able to give you insurance information on how to get hormones covered.

- Mod Wolf

[bitter-bitchbites]

Genuine question, if being trans isn't seen as a medical condition isn't that a bad thing? Insurance wouldn't cover life saving surgeries/hormones, so isn't that detrimental and against the trans communities interests?

“fair” point in theory, but you’re not seeing the matter from the right angle, because you got a transantagonistic and cissexist bias.

being trans isn’t a medical condition and it does not inherently implies medical care. 

transitioning does. like, yeah, hrt, surgeries, stuff that some trans people need so their dysphoria stop beating them in a metaphorical bloody pulp, because they need their body changed so they stop feeling so suicidal. insurance should cover that, because yeah, their mental health and life depend on it.

and no, the “trans” isn’t short for “transitionning”. it’s short for “transgender”, that was thought to contrast with “cisgender”, and “trans” has the sense of “crossing to the other/another side here, while “cis” means staying on the same side one starts on, more or less. that’s ancient greek, i think. so being trans isn’t defined by transitionning. transitionning is a choice, and sometimes it’s not, because sometimes it’s the only solution to not break because of dysphoria.

because of course, dysphoria is also its own medical thing, it’s a mental disorder, that can cause depression, self harm, self hatred, and suicidal urges.

but not every trans person has deadass terrible dysphoria that we can’t deal with without changing our bodies at a high price. some have mild dysphoria, that they can deal with haircuts, different clothes, and shaping their bodies in one they like themselves as and all. sometimes it’s bargaining because they can’t afford surgery, but sometimes, they just don’t feel like they need surgery. and yeah im mainly talking about nb trans ppl, altho there gotta be binary trans ppl who are like that too. i just know that it’s smtg we nb ppl often feel like. 

nonbinary ppl show that (hence why transmedicalists aka truscums hate us, tho idk why they care so much about pathologizing us and themselves). we don’t always hate our body. there are trans ppl, nb or not, that don’t suffer dysphoria, because dysphoria isn’t smtg you’re born with, it’s a disorder that’s caused by a bad environment that triggers it. 

extreme example, imagine a trans boy who’s forced at age 0 into pink dresses, pink shoes, pink hats, drinks from pink cups, in a pink chair, sleeps in a pink bed, in a pink room. and he’s said “you’re a girl girly girl” all the time, goes to dancing class because “that’s what girls do”, is put on make up cuz “that’s what girls like” and can’t put on pants cuz “that’s not a girl thing”. forced in a cissexist bs mold. a nightmare. it’s not that that makes him a boy, he was a boy at age 0, regardless or circumstances; but he grew in an environment he could not be comfortable exploring his identity and questioning his assigned gender. and that’s going to worsen his already possible dysphoria. 

but being trans isn’t what’s going to make him break down and slap his abusive mother with that fucking pink violin, and run away to live with his bf in the next state raising cats, no, that’s his anger caused by the hurt of his many mental illnesses, dysphoria being one of them.

being trans doesn’t cause pain. it’s dysphoria’s fault. and not every trans person has dysphoria, and sometimes nb ppl have dysphoria, and sometimes not and they’re still trans, and some trans ppl’s dysphoria goes away at some point. but being trans doesn’t.

and take me for example. i have dysphoria. had it since i was 10. im a demigirl. that’s a nb(trans) woman identity. but i don’t wanna change my body with surgery. i don’t want to take away parts of myself, because i got enough of that, and i want to love my body. so instead i wanna add stuff, like letting my body hair do its thing, and not wearing bras and getting muscles, and asking ppl to use they/them for me, and not try and push me into being whatever tf they think a cis girl does. and that, plus mental work on my image, helped me tone down my dysphoria. maybe i’ll see if i can get hormones, if it doesn’t turn out i already have pocs. i was sick because of my dysphoria. not because im trans.

there’s a lot of cases like this that are weird and hard to understand, maybe, but they all point to one thing: the problem is dysphoria and other mental illnesses caused by being misgendered and abused.

i wanna be trans. i like that. it’s good, it’s me, it helps me, the community is mostly nice, im at peace with that label, and i don’t want to have it taken off. because that’s what it’d mean, to see transidentity as a medical condition. it’s be an illness. something to correct, to fight, to destroy. i don’t want to fight myself. neither does the majority of trans ppl.

so no, not pathologizing transidentity isn’t anywhere near detrimental to the trans community. because we still have valid problems that deserve specific attention, we still have dysphoria, we still want to transition, and we deserve the health care that we need to cope with cissexist abuse. the problem isn’t being trans. it’s the environment, the ppl, the society we live in. and doctors already know that. they don’t allow you to get hrt on insurance because you’re trans. they do because they dx you have dysphoria. that’s literally how they decide if we deserve to get the treatment we know we need. sometimes they won’t even dx ppl with dysphoria that they have dysphoria, because they’re “too mentally ill for that”, or “too sane to be trans”. and hormones don’t even cost as much as we gotta pay them. the prices are artificially inflated, like most medicines, because a compagny own them.

trans ppl don’t need to be pathologized to get the issues linked to our marginalized identity acknowledged. insurance would/should cover surgery and hrt regardless of what ppl think being trans is. because when we say we got a fucking problem or need things, we should be listened.

we would be, if our society cared. we wouldn’t be pathologized if our governments weren’t cissexist trans-hating little shits.

another example, a comparison this time. being afab isn’t an illness. but we still need medical attention, like detecting breast and uterus cancers, or other gyneacological treatment that can be a matter of life and death. and to that, you add the mental baggage caused by being in a mysoginistic cissexist patriarchy. sounds like worth being covered by insurance, uh? well not to many pseudo-civilized countries, but to the happiest on earth, it does, and it works. and yet being afab, especially a cis woman, isn’t an illness, or a curse.

because yeah, we also used to think that women were inherently sick and taht they needed men’s guidance and validation to be allowed to live, it’s just the same fucking mentality, but applied to trans ppl, with cis ppl. 

we’re not the correct gender, we don’t even perform it correctly, so we’re not worth being cared and listened to.

that’s victim blaming. that’s putting ppl under oppression, making them grow in a toxic environment they can’t escape from because it’s their very identity that’s thought to be inherently hostile, and we tell them it’s their fault. that they’re sick and that’s it.

considering being trans a medical condition is fucking murder. you’re placing the power in cis ppl’s hands doing that, because that means we’re to be corrected, and only them can do that. it also gatekeeps from getting treatment. it also misplaces the blame on our identity when it should be on our oppression.

being transmedicalist is allyship to the cistem. that’s believing the lie they made up to say we only deserve care if we accept that we’re sick, and to be ashamed.

im repeating myself, but insurance should cover our treatments for our dysphoria, and let us do what we wish of our bodies and identity as we endanger no one. nobody is allowed to call us ill for what we are while ignoring what we suffer of. we should get at least partially insurance covered surgery and hrt and completely insurance covered when we have dysphoria. it’s possible. spain does it, in good enough conditions. yeah, spain, the catholic country that was still a royalist dictatorship fourty years ago. and france too, can do the insurance coverage, even if it’s harder because you need psychiatric approval first, which is bs and intrusive. 

we aren’t sick for being trans, we deserve to be listened on our terms, that’s not a fleeting dream, and that’s not up to debate. 

and we’re going to change shit so we can get that.