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Post-Opt Depression

depressionThis is a ‘second’ transition – a transition to living a normal life – and this is not talked about or at least not mentioned to the degree that it should be.  In some ways this was expected but perhaps none of us that have gone through SRS really understood the full ramifications of.  That is post-op depression. For some it’s huge.  For me it’s a slight sidelight hardly worth mentioning, but yet, very important to mention…

We have spent an inordinate amount of time and energy planning, researching, questioning ourselves and preparing for transition – taking almost every second of our day and occupying our dreams at night.  Suddenly all that planning etc. is over, done, accomplished – even the dreams stop.  And here we are – marvelously and finally our true selves, whole at last – but all that action is gone, finished, leaving us somewhat devoid and that sends some into a depression or just feeling down.

I use the word ‘we’ as I’m mostly talking about others in the sisterhood (I use ‘sisterhood’ to mean all those that I went through SRS with plus many others that are post-op).

I’m quite active in a number of areas, so for me I was able to simply ease into a relaxed life.  The greatest effect for me was being physically handicapped and unable to do a lot of the outdoor activities I enjoy (hiking, climbing, swimming, kayaking etc.).  But I’m also creative, love learning and do a lot with computers.  So I have many ways that I find rewarding and fulfilling.  I also had spent a lot of time pre-op getting my psychological self in order.

In addition to this sudden lack of intense activity, there is a low level pain that is pretty constant for 4 to 6 months as down there is swollen and still healing. I can see the progress, but it is very slow, measured by the week – not the day.  This has a couple of effects for me.  First it either prevents me from doing activities I love or at best it makes me think twice if I should do something or not.  But the thought is constantly present.

When I was researching SRS, as I was initially looking into the possibility that I wanted to go that far.  I read about the maintenance that is required and was taken back by how much there was.  Dilation for the rest of your life is a big one especially when you understand what and how and how often it must be done.  Add to that the normal but new (for us) activities a woman has to routinely do:  cleanliness, pads/liners, checking yourself/making sure all is ok and how to use the restroom – how to sit, clean, even how to urinate.

All these take additional time that before we never had to even think about.  And now, the time to do all these duties constrains our ability to get into the things that bring us joy and keep us (anyone actually) happy and away from depression.

At times we feel so good, but then something else happens and back we go.  The pain will sometimes abate, only later to come back in a different form.  Just when we think things are getting better something else starts in.  This is a long journey – it’s takes a year to recover from an operation this massively huge.  But relapsing after feeling so good can be very difficult to take mentally.

So we have this seven pronged threat:

  • Intensive mental activity leading up to surgery
  • Physical handicap keeping us pent up and unable to do activities we enjoy
  • Constant low grade pain
  • Things taking so much longer to heal than expected
  • The new duties
  • Maintenance required with our new parts and the lack of time to do enjoyable activities that keep us out of depression
  • Relapses after things were going so good

In a way, it’s equivalent to soldiers coming back from a war.  It’s suddenly over but perhaps too suddenly.  Everything keeps going around in our heads.  It’s hard to let all of that go and settle down.  It happens just too fast.  And the ‘way of life’ is completely different.  Whereas there was so much to do before, now there is a lot to do, but it is totally different.

For my sisters:  this is much larger than you think or possibly can imagine.  This is more than a change of your physical sex.  It’s more than just living as the opposite gender.  It’s also more than how society views you or more importantly, your own insecurities and fears. In addition to all of that, this is a profound life style change – right down to how you ‘wipe’ yourself in the restroom!

My advice for those that are contemplating SRS:  Do your due diligence in researching this.  Join online groups and social media that are targeted for pre-op’s.  Once you settle on a surgeon – ask that clinic what pre-op and post-op social media they have and get invited to those (these are almost always private).  Once connected – read back one year to get a good clear idea of what you are going to face.  You will read about complications, about troubles and issues, but also about marvelous achievements and proud moments.  A word of caution:  everyone is different both in what they experience and the timing for various healings to take place.  Take it all with a grain of salt as they say.  But at least you will have a better idea of the full spectrum of possibilities and outcomes.

A bit of a soapbox moment:  I saw so many sisters that carried high sexual expectations once they completed surgery.  It bears mentioning that around 50% of women (gender) born female (birth sex) ever have an orgasm.  A transsexual after completing SRS is no different and has the same statistics!  We are all sensate (feelings and able to have an orgasm) – but the big ‘O’ is more than just being sensate.  It requires a heavy mental aspect as well.  What it requires is an opening up, being in tune with your body and being calm mentally and letting go.  All of which are completely opposite of what is required of a man and is therefore even more difficult for a transsexual.  My soapbox is this – do NOT go into this for sexual reasons.  You really should only be doing this because you have a deep down need to have your life be congruent, to be whole, to embody the essence of who you are.  Let the rest come – it will.

For most males (birth sex) under the ‘influence’ of testosterone, they have an almost daily urge.  For me this was confusing and at odds to the woman (gender) that I am.  Those urges caused a conflict in me as the male influence of testosterone had it’s way.  This is part of what I called the testosterone poisoning.  Getting on HRT and now completing SRS solved this and got that poison out of my system along with all of it’s effects.  Mind you, if you are a cis male (meaning your birth sex and gender match), testosterone is perfect and wonderful and I appreciate that in others.  However, for me, a transsexual, that was an awful burden that caused great disphoria and conflict.  Of course for some this is a concern – will they still have sexual urges after HRT and SRS?  And for a lot of sisters going through SRS this translated to worries about size/depth (again think testosterone – how many males do you know that are concerned with ‘size’ …) and orgasmic potential (especially after being able to, on demand).  Granted, for those that are young and have or will have a male partner, these things are important – I’m not saying otherwise.  I’m saying these should not be the top priority nor the reason for coming this far.

You are changing into a female (you are already a woman). Your body is now going to act and respond as one.  This includes the much more subtle urges, the relaxed sexual tension (compared to before) and a completely different way that we orgasm.  Many worry (I did) about how will we be satisfied if perhaps we can not orgasm or as often and ‘easily’ as we could before.  When you come out of the ‘testosterone fog’ and into femaleness, the urges change too.  In other words, you are now a female and your urges and abilities will match a female’s as well – do not fret over this, let it happen.  Let me put this yet another way:  your new body and self will match … perfectly!

And for those that have had surgery:  This is HUGE!  You had a major surgery – it does things to your body that take a long long time to heal.  You might feel ok at the moment – but is it not finished.  We need to take this one day and one thing at a time.  Conquer it and it alone, then focus on the next.  Don’t get overwhelmed – it’s so easy to do.  This is going to take up to a year – all the adjustments, all the issues that come up – both physical and mental.  So many times, the clinic has told us – recovery is 90% mental and it’s very true.  I remember the first time I saw blood on my dilator – omg I went crazy worried.  I reread the ‘manual’ the clinic sent me a dozen times.  Did what they said – and no problem.  But the mental anguish was difficult.  Of course now I just put pressure on the spot (always a granulation) and it’s gone and done – not a biggie.  And that is how most of recovery has to be dealt with.  One day at a time, one thing at a time and put-in the time!

For some, this is a difficult period and an unexpected complication.  I have a feeling that this may have been the reason two people I know of that committed suicide. So this is serious.  If this is you – please, there is so much help out here – reach out – please ….  There are a lot of us that have been through this – we made it, it’s more than possible – it’s just more hard work.

With so much Aloha

Sifan

 

3 Months Post Opt

20141127_173748Oh this has been a long 3 months….  part of it was the most painful of my life.  I’m still quite sore down there but remembering what I went through – this is nothing. See my previous posts for details of the SRS operation, my recovery and painful complications I went through.  For the most part the pain had to do with the complications – the UTI, not being able to urinate and extending my bladder.  Without that complication this operation and recovery, especially in the first month would hardly rate as discomfort or low level pain.  For that I am glad – glad that I didn’t have to deal with anything else over and above the complication.

Normally (with out complications) the first month is pretty easy.  It’s the second and third months that are hardest.  This is due to a number of factors.  First Dr. Suporn’s technique is very ‘accurate’ and true to the female anatomy – his technique is the different from all the rest and results are as they say, the Cadillac of the business. This means there is a lot more surgery and construction underneath/inside and this takes longer to heal.  It’s like scare tissue which becomes swollen and hard and progresses from one area to another as it heals.  This is one reason we have to dilate, to keep the neo vagina open, soft, and to depth.  One of the ‘sisters’ called it “beating the dragon” (I prefer to call it ‘training’ the dragon …).  By the way, I call the other women that were there in Chonburi having SRS along with me – ‘sisters’ as we formed an international closeness and constantly keep in touch.

This becomes difficult during the 2nd and 3rd months where most of the healing takes place.  It gradually gets easier and for some even pleasurable.  For others this period is very hard – even extremely hard.  I’ve heard of some that took hours to get to depth – which you have to do before you can start timing your dilation.  I was lucky this way – the worst I had was maybe 1 min before I reached depth.  It is recommended that we do 3 dilations a day – so you can imagine the pain and agony some have had.  I had cut down to 2 a day because I was able to maintain my depth.  I feel lucky that way.  It was hard for a while and I had a hard time preparing mentally for them.  But they gradual became easier, less painful and became routine.  I will have to dilate the rest of my life – but the frequency tapers off to once a week after 1 year (3 times a day until month 4, 1 once a day after month 6, then once a week or so after a year – mostly to check depth).

Those are the major milestones as well.  After the 3rd month things get easier and we can start doing just about everything (swimming, hiking, long trips, working, baths, some exercise, etc.).  Then month 6 is another milestone and 1 year basically marks completion.  Ya, one year ….  Of course every ‘body’ is different and these are only approximate timings for the majority of people that go through this.

In this next section I’m going to tell it like it is – this could be TMI (too much information) for some, so be warned.  However, for those who are going to have surgery, I think this is important to know – I wish I had known this beforehand – not that it would have changed anything – just so I could have been more prepared and aware.  Of course this is ‘my’ experience and reading the private accounts of others tells me that I’m in the middle as far as my experience and pain/discomfort is concerned.

By the way:  most surgeons or clinics have a private FaceBook page that is only for ‘post’ opts.  These are very helpful for us to a) keep in touch b) ask questions c) see how others are doing d) peer into the future to see what to expect.  Unfortunately they really do need to be kept only for those that are post-opt or immediately pre-opt.  But this information is invaluable if you are going to have surgery.  They recommend that once you are invited into their group, that you read back 1 year to get a full understanding of what to expect.

For me, right now, I’m going through multiple phases where ‘things get tight’ down there.  First a very hard ball (size of a marble) formed just above everything (up by the pubic bone).  I had to stay in bed for a couple of days with nothing on down there (as everything, even the weight of the bad sheet, hurt).  This gradually ‘morphed’ down along both sides of the frenulum, basically tightening that entire area up (it was all swollen, so this is actually ok, just a bit painful).  Now the same sort of thing is happening starting at the tops of the outer labia and working down.  Which is also good because my outer labia is huge (swollen) making it difficult at times to close my legs, especially when I want to sleep on my side at night – I have to place a hard thick pillow between my legs.

I still can not sit without using the infamous seat cushion although it is getting better.  I forgot it once and was able to carefully sit on a hard chair for about 10 mins.  However, if I do too much, like a long car ride or sitting too long at work, or like one day I had to go up to the summit to work – the next day I wind up in bed, legs spread apart and nothing on to let it heal.  Sometime I have to take pain meds – sometimes I’ll take a pain pill before I need to do something (like a long ride) where I know it’s going to be hard.  At times, it feels like a bowling ball down there between my legs – and I walk like I’ve been riding a horse for hours.  My panties feel like they are crushing me during those times and I can’t wait to get home and lay down in bed and allow my bottom to ease up.  These times seem to coincide with the ‘tightening’ phases I mentioned above.  So I’ll be ok, even ‘great’ for a few days and then another one of these ‘phases’ kicks in and I have to take it easy, stay home and sometime stay in bed.  But these ‘seem’ to be getting less as time goes on – progress is being made (although soooo slowly it seems).

I saw my GP doctor today – another checkup.  My UA came back ambiguous – but at least it didn’t have the bacteria  (e-coli) that caused all the pain and agony before.  I sent a question off to the clinic regarding this and they said (and my doctor agrees) that if none of the symptoms are present than all is ok.  There are high levels of something I don’t remember what, but those can also be do to the SRS surgery.  So we are leaving things alone unless symptoms come back.  That is good news!

I’ve been having bleeding  (very minor) about once a week, all coming from the same spot (at the bottom inside where the major and minor labia come together on the left side).  The doctor examined that in more detail and found it was the equivalent of a ‘skin tag’ – an 8th in long growth protruding out.  This can happen as internal ‘sacs’ sometimes comes out through the skin (the labia are created with many layers of internal stitching and sometimes as these heal one of these small sacs can pop out).  So the middle of January I go back and will have it removed (plenty of local anesthesia ….!).  I’m relieved to know that is all it is.

Other than that, everything looks and operates correctly now.  There is sensation is all the correct places.  Still sore so I’m very careful with my new parts.  A number of the ‘sisters’ that had SRS the same time as me are now reporting they had their first umm, “The Big O’ ….  For me, the surrounding areas down there are still too sore for me to even contemplate that ….  Put it this way, I still cringe when I see another woman riding a bike or motorcycle.  Maybe someday I’ll be able to do that but right now I have that automatic ‘pain’ – same as when someone talks about getting a flu shot – you automatically feel pain in your arm … or when someone talks about going to the dentist … ya … that kind of thing:  my bottom immediately goes into panic mode!

So today is the 11th, my 3 month celebration as finally being the true authentic me.  I can not tell you how absolutely wonderful it is.  First you have to understand the shear disphoria that was before – I’m not sure I have words to describe that horror – the pain of my complications can not come close to the lifelong battle I have gone through attempting to live in the opposite gender.  Now I am free to ‘be’, to express myself and to live as who I always was.  It is a fantastic and welcome change.

It just struck me – theoretically I am finished with transition!  I say theoretically because I could argue both sides of that.  Some transsexuals go stealth now that they are fully a woman, truly marking this as the end of transition and simply blend into society as women.  Even though this is a completion – on so many levels – I feel that it is important, especially today, to be visible to some degree.  The more society sees that transsexuals are ‘normal’ people, involved in normal or credible vocations or even honored/esteemed positions, the better it is going to be for those that follow.  The more professionals like myself that come out, the more that society will start seeing us as part and parcel of the human condition.  Just like red hair or blue eyes, transsexuals are but one more variation of the human condition.  There is a balance of course – this can be and has been deadly (we just honored those murdered on Nov 20th – TDOR – Transgender Day of Remembrance).  I am cautious:  I do not proclaim who/what I am to just anyone – but I am an advocate and will do what I can to help achieve parity for everyone.

With much Aloha,

Sifan

PS: I’m hoping to swim in the ocean this weekend – I have missed that soooo much ….

Surgery in Thailand – Part 3, Dilation

20140929_155212Caution this post contains TMI (for some this could be “too much information”).  Continue only if you wish – you have been warned.  I will be discussing the routine ‘maintenance’ that I now must do a number of times each day.  I’m writing this for those that are contemplating SRS so they can get an idea of what to expect.

After we arrived at the hotel from being discharged from the hospital, one of the clinic staff came up to our room and helped setup the room for my new daily routine.  Oh boy, life is now a bit more complicated then it ever used to be.  Things like showering and even how to wipe oneself after using the toilet are now vastly different and hygiene takes on a whole new level of importance.  More about this later.

For the rest of my life, I, like anyone who has SRS, must dilate.  Basically the body views the neo-vagina as a wound and will attempt to close it up.  Dr. Suporn’s technique uses a mesh, which new skin grows on, to form the vagina.  It also forms new tissue deeper inside surrounding the vagina as well.  One way to think of this is scare tissue – in some ways it is similar – but not really.  This new tissue will form hard and expand closing the vagina if not countered.  And that is what dilation is all about.

20141014_131948We were given four dilation stents, one small one, two medium ones and one large.  We start off with the medium stent, inserting it all the way back and then applying pressure to the back to keep our depth.  When Dr. Suporn took out all that packing, he inserted this same stent showing me how to do it and measured my depth (I was 6″ in the hospital).  Each stent has markings in both inches and cm.  As you can see in the picture, these are HUGE (both is length and width) and FRIGHTENING at first.  The first couple of dilations I did, I was amazed I could take all that!  At first, we have to dilate twice a day, 30 minutes each – basically I have to go to full depth and then push hard.  That was difficult.  It is somewhere between uncomfortable and mildly painful.  Some people take pain meds before they dilate.  I did at first but quickly found I didn’t need to.  One has to sit up straight (usually on the bed, pillows behind, plastic sheet on the bed and an absorbent bed sheet on top of that), legs must be straight out, no bending and somewhat close together.  Any other position will engage muscles that will make dilation harder.  We are taught that no matter what complications or difficulties we face – we always MUST dilate.  As you will see later – I had complications where the last thing I wanted to do was dilate – but I still did.

We start with the medium stent and later (6 weeks) we graduate to the larger one.  The small stent is used if it becomes difficult to insert the medium one.  We then have to dilate with the small one for 5 mins or so and then move up to the medium and complete the dilation.  The white stent is an extra medium size and is a bit softer.  I think everyone loses a little depth from what was measured in the hospital.  I’m at 5.5 inches and have stayed at that ever since – it could be the way they measured it there vs how I measure.  The important part is to maintain depth.  As I was told, depth will change with the time of day, if we just ate, if we didn’t go to the bathroom first, etc.  So it fluctuates, but again, what is important is that it stays somewhat consistent.

20140918_193204There is an entire procedure surrounding this.  The person from the clinic setup the bed table and bathroom so that everything I needed is close at hand.  As you can see – there is a lot.  The procedure gets better and less intense with time.  But at first, we shower to clean off, using a special surgical soap on our new bottom – and rinse it off immediately as it can actually burn the skin if left on or used to much.  I then lay down as stated above, put on surgical gloves, place a condom over the stent and apply a lot of lube – that last bit is important!

Until things heal enough (Dr. Suporn tells us when) we do ‘static’ dilation which I described above – straight back and apply pressure.  When told to, we start dynamic dilation (about 2 weeks after surgery for me – but that is different for each person).  Dynamic dilation is a bit easier I think.  I start by fully inserting the stent, applying pressure for 10 seconds, then rest, then ‘stir’ it around to enlarge the sides for 10 times.  Then we repeat this for 15 mins and have to do this 3 times a day.  Months 2 and 3 is where the most healing occurs and where this is most important.  The internal tissue is building and this needs to be countered and ‘softened’.  Unfortunately, the nerves are becoming active during this same time …..  I’m 1/2 way through month 2 at the moment – so far ok.

Then we have to clean up after.  This includes douching with warm water three times then a fourth time with a mild solution of betadine.  Then a half shower washing our new parts with that surgical soap.  For the first month we also have to apply betadine to the stitch lines down there and apply a silver cream to the inside of the inner labia.  And then – collapse on the bed and rest!

At home we no longer have to coat the stitches (most of which have already dissolved), but we do need to get a douche kit that fully reaches inside.  As they said – lube plus byproducts of healing inside create an idea culture for bacteria – all lube has to be rinsed out.  Also at home we can use regular soap.

One issue is the trip home vs dilation.  Having to dilate 3 times a day and having a flight home that for most of us is 20 some hours long makes for an interesting dilemma – no we do not dilate on the plane or in the airport!  So we dilate extra long just before we leave for the airport (the van came to pick us up at 4 am … that meant I was up and dilating around 2:30 am….).  Then we need to dilate when we get home.  The trouble is, it’s been a long time, things down there have already started to tighten up and the flight home has made us very tense – what a mess.  So, we are to wait an hour or so after we get home – do something relaxing – have a glass of wine – whatever to relax us.  Then we dilate – this is where some people have to resort to the small stent to get started.  I was ok – my depth went down to 5.1″ but withing the next 2 days I was back to my 5.5″.

Sifan at Thailand airportAs you can see from this picture – there is a lot of stuff we bring back with us (the huge pink bag).  This includes supplies to last us for a month or so after we get home.  It includes betadine solution, bed pads, tons of lube and condoms, a mirror, clock, my stents of course and pantie liners and pads.  They gave us a large bottle of betadine but I also had a smaller bottle.  The airport security ‘found’ the big bottle and confiscated it, but left the small bottle alone … go figure.  Other transwomen were allowed to take theirs – as far as I’ve heard – I’m the only one that this happened to – ratso!

Some last points regarding dilation:

Contrary to what you would think – if you are having troubles dilating, then you need to ‘increase’ the number of times.  They can be shorter in time, but you need to do more of them during the day.

As time goes on, we get to reduce the number of dilations each day.  Until the end of the critical period (month 3) we need to do three a day.  After that we can reduce to 2 a day.  After 6 months about once a day and finally after a full year we can reduce to a couple per week – basically to check depth and then if needed do more dilations.

Also, once past month 3 – dilations become easier and other umm activity can substitute for a dilation, making it pleasurable indeed …

I should also mention some of the problems that could be encountered dilating.  Make sure you use plenty of lube, you could chaff and that’s no fun.  Also a veteran post-opt warned us about the ‘sword in stone’ problem that could happen when you are too tight and when withdrawing the dilator it gets ‘stuck’ (probably because of a vacuum being created above it inside).  Just take it slow and use dynamic dilation to ease it out.  Something else we all find out right away is sneezing, coughing, laughing too hard and a close lightening strike (I found out about this last one the hard way) can all make for an uncomfortable experience.  I wonder if anyone broke things in their room due to flying dilators (to my knowledge only one person said their dilator actually came out – but just barely, mostly it just hurt a bit)!

Another issue is bleeding.  As you dilate, you are basically stretching scare tissue (first 3 months) and it will sometimes bleed.  Also as things heal, little ‘bumps’ (granulation) can poke up and dilating will cause those to bleed.  Counter to what one would think – the solution is to reinsert the dilator and hold it there to stop the bleeding.  I had this happened to me twice.  Others have said they bled the entire 2 months!  Most said they never bled.  Everyone is different and this goes away with time and healing.

I had some severe complications which I will talk about in the next post.  But even during that period of time – I still had to dilate.  It was difficult, but had to be done.  Nothing like complicating a complication ….

With Aloha,

Sifan

POISONED !

woman in fog 2Some of the following I have written about in previous posts.  Something wonderful and difficult has happened that brings a slight twist (and then maybe not) to my perspective on being a trans-woman.  Perhaps it’s a nuance, most of what I’m about to write seems like what I have always been feeling and saying.  However, there seems to be a deepening and a visceral understanding of my life as a result of this.

If you have been following my posts, you already know that I had my SRS surgery last month.  In fact I just celebrated my 1st months anniversary.  This is actually a bit scary, as months 2 and 3 are the hardest.  This is when the ‘insides’ finish healing and the nerves start reconnecting and become active.  The body views this as a wound and attempts to close it.  I have to counter that with daily maintenance (three times a day) to soften and keep it’s form.  The combination of these makes these next two months difficult and painful.

Needless to say, this means that I’m quite familiar with my ‘new’ anatomy.  I put quotes around new because it is new only that it’s one month old.  But here’s the kicker:  it’s not new, it’s been there all along ….  Now that might seem a bit strange, so let me explain.  This realization came to me when I was in the hospital, minutes after I woke up from surgery.  My immediate thoughts and feelings were “Finally, I’m back to the way I was” – even though I was never like this.  But that was the internal visceral response I had.

I have talked about the ‘body map’ a few times before.  As a refresher:  medical science has found that we carry a body map located in a part of the hypothalamus.  This map basically says what we have and where it is at any moment in time.  It also tells us what things are supposed to feel like and the feeling those parts are normally supposed to produce.  The oft used example is the person that has their arm amputated yet still feels their fingers and can tell you where their arm is located – even though it’s not there.

My experience post surgery was a huge confirmation of this body map.  That is what I meant “I’m finally back to the way I was” and that this was not something new, but was always there – it was always there in my body map!  My ‘new’ bottom did not feel different – did not seem new – was not strange – I was not missing something.  Instead I felt normal, I felt the ‘nothing’ that everyone else feels about their parts – it’s just simply is who I am.  Ask yourself, what does it feel like to have your ‘parts’?  Does it feel like anything at all or is it just the way it is – that is, just you – nothing – nothing special – just is.

That is how it is now for me.  That was NOT how it was pre-surgery for me:

That … is the big difference.

That … is the hardship a transsexual faces daily until they transition.

My previous ‘down there’ was not in my body map.  Things did not match up to what was supposed to be according to my body map.  And, it is not just the physical aspects but also the mental, emotional and hormonal aspects of the body map that were not in agreement.

Let me re-tell a couple of incidents from my youth plus another one from my previous marriage to illustrate:

As a very small boy, I knew that I was supposed to be smooth down there, I was not supposed to have ‘that’ hanging out.  Ever being the budding scientist, I have a distinct memory of trying to figure out how was I supposed to urinate if it was smooth there!  This is when I was around 5 years old.  I had no concept of sex or what a woman/girl looked like – I just knew this was not me – I was supposed to be ‘smooth’ down there.  When I was 7 years old, my sister was born.  The first time I saw her ‘down there’ – well, everything came together.  For the first time in my young life I knew what I was supposed to look like, what my young body map identified with.

The second incident occurred a few years after this.  My mother was a seamstress – not professionally, but she created clothes for our family, relatives, neighbors and friends.  Being intrigued both by the creativity but also by the mechanics and design aspects of sewing, I would watch and learn.  Finally I felt that I could create and sew something myself – from scratch – no patterns, I would make my own.  So I did.  I made a beautiful skirt that fit me perfectly.  It had a hem (I remember using this stick with a bulb on top and a movable nozzle that would squirt chalk at where you wanted the hem to be – in order to get it perfectly level all the way around), I also had belt loops, elastic around the waist plus a zipper on the side.  I was very proud of my creation.  I did all this without my mother’s knowledge as I wanted to surprise her.  When it was finished, I waited for her to come home and proudly showed off my new creation.  My mother is 100% German and very strict and conservative and was very brutal.  My pride turned to shame is less than a second.  The scolding and punishment and continued reminders of what I did drove any thoughts of me being a girl to be deeply buried.  This was the start of the ‘layers of the onion’ and more and more layers were added to deeply bury any sense of me being a woman.

In one way I consider myself fortunate.  I attended a very conservative Catholic grade school back in the 1950’s, in a very redneck conservative northern city.  I was ‘fortunate’ to witness some of my classmates as they tried to assert who they were (being different than anyone else) and witnessing the severe reaction of both the other kids but also from the teachers, nuns and priests.  I was an observant little girl inside a boy’s body who learned very quickly from others to keep my identity secret.  This sort of sealed the onion layers for good.

Later in my teen years all that was left was a rationalization that I was a boy but with all these extra capabilities – emotions, what I liked, mannerisms, ability to understand and listen to people … the list goes on.  I could not stand the playground games of the boys and would prefer the girls but I had to be careful to mix it up …  I had buried my truth so deep that I no longer knew myself and accepted my role as a boy and rationalized the rest.  It took another 40 to 50 years to unravel and peel back that onion.

Now, here’s the new part.  This revelation suddenly came to me during a talk with my ex-wife.  I don’t think I would have seen this before surgery – somehow it took being whole again to be able to see this next piece.  This is a bit hard to discuss and embarrassing for me – please bear with me as I try to find the words for this ….

During puberty my body changed drastically.  Testosterone was now cursing through me and creating a lot of changes that were upsetting.  However, I could not figure out why – again I had a deep rationalization that I was a boy.  It wasn’t the physical aspect of puberty but the mental and hormonal parts that really disturbed me.  Here it gets hard for me to put this to words – hang on:  one example, it’s a pretty well known fact that most men masturbate many times a week, some daily.  This urge was intense and of course I hated that – that part was not me – why was this happening.  I had so much shame around that but I could never understand.  Of course the Catholic church drills into us that is a sin.  And of course the other boys bragged about it.  Why was this so awful for me?  That wasn’t all – there are other incidents that I was very ashamed of as well, both growing up and throughout married life.  I carried these all my life, not understanding what drove me and carrying the guilt and shame all these years.

In my talk with my ex-wife a couple of days ago it suddenly became crystal clear and I broke down crying.  Hindsight is like that I suppose, but this required me to already have had my surgery in order to be able to put this together.

I was POISONED!!!!

Others have called this the “testosterone fog”.   If you are a male (birth sex) and a man (gender) then testosterone is the correct hormone.  But I am not.  I don’t expect men to get what I’m about to say, but I think any women would and any transsexual definitely will.  As a woman, having a high testosterone level, I would experience these hormone driven urges and their results and was mortified by them.  Disgusted and shamed as I would witness myself in those moments and then the regrets afterwards.  Again, for a male/man these are natural and congruent – no problem.  But for me – this was horrible and these feelings have haunted me my entire life.  But, I didn’t know why – the layers of that onion were so thick by now – I had long ago buried and lost my gender identity.  Only these hints were left.

It’s only now, that I’m physically, mentally, socially, hormonally and internal-chemistry-wise finally a woman that I could solve my last great quandary that has plagued and weighed on me all my life.

As a woman – I was POISONED by testosterone!

I had to go off of spiro (a testosterone blocker) a couple of weeks before the operation – this gave me a really good ‘scientific’ test of what for me was the intensity of this poison. It confirmed and validated my views and led to the realizations that I am writing about here.

Again, testosterone is absolutely appropriate for a male/man, but I am not – I’m a woman and this has tormented me so much.  At last I have come to peace with those disturbing aspects of my life that only now do I realize are part and parcel of being a transsexual woman.

I want to apologize profusely to those that I have hurt  unintentionally and hope for your forgiveness.

I now understand.

I am now free.

With much aloha,

Sifan

Pono

Another incredible experience: Today is my last day here in Chonburi (unless a certain typhoon that is scheduled to land at Tokyo the same time our plane does – actually does …. grrrr).

So today I had the last visit by the staff. Again, I do not want to mention her name because all of them are so very special, so this post is dedicated to staff of Dr. Suporn’s clinic.

She made a comment about my optimism and enthusiasm – about how that has helped the staff to remember just how much of an impact they make. It is so difficult and hard to work with people from all over the world, all of different cultures and personalities. Some not prepared psychologically – not about transition – but about being in a situation far away from home, having such a radical surgery performed, being in a foreign culture (maybe for their first time) – all these things add up and a person can become quite negative and demanding.

But this staff tries hard, not just surgery related, but as a helping hand, someone to listen to, someone to give advice and help, especially in this culture.

I can commiserate with them: for 13 years I was a director of international training. I was overseas 1 out of every 5 weeks! One heck of a lot of travel. Many time, the overseas offices in the entire region would send their students to where ever I was teaching. For example, if I was teaching in Singapore, the Thailand office, the Taipei, Hong Kong, Seoul, and Tokoyo offices would send their students to Singapore or where ever I was.

As a result, I was the ‘only’ common person they had with the country and culture of that venue. I had to not only teach, but take care of these people – much like the staff here does for us. Same as the staff here, personalities range from demanding to enthusiastic. I have first hand experience of what they do and I commend them highly! It can be so difficult.

Ok, small story: was teaching in London and had a handful of French students in the class. They ‘hated’ English food – so who did they ask for suggestions and help – me. That was scary: an American giving culinary advice to the French – the top of the list experts on food !! They liked it, only one hitch: the English always have a condiments tray that has about 5 different mustards, etc., one of these was called ‘French’ mustard. Oh boy – the comments: “Dis is NOT ze French Muesterd ….” etc.

Can’t help it – another small story:  I was teaching in Seoul, Korea in the winter.  We had people from all over the region including Singapore up there.  For many of the Singaporeans, this was their first taste of very cold weather.  Well on the 2nd day of training, they are all looking to the front of class but I’m looking out at them and the windows beyond, and noticed it started to snow.  I stopped the class and brought the people from Singapore outside to experience the very first snow fall in their lives!  What an experience to watch the joy and happiness in their faces!

One only has to look at the experiences and blogs of others that have had surgery else where, especially in the US with it’s tight Insurance grip resulting in minimization of expenses, to see how wonderful we have it here in Chonburi. Back there, they do not have a clinic staff to hold our hands, sit with us all night after the surgery, pick us up, arrange medicine and care in the middle of the night …. etc.

So once again, I am thrilled that someone noticed kindness and joy and as she said – brings back the feelings of why they choose to be and do what they do – to balance out their hardships with others and to again demonstrate how much of a difference they make in the lives of others.

And for me – what an affirmation of my spirit – that for me, is the best and most important experience I take away. I, in some small way have helped.

In Hawaii we have a saying about pono (do what is right and show respect) and do everything with and always show aloha (love):

“When a person is Pono they have the feeling of contentment that all is good and all is right in their life, a life of full integrity: Ma‘alahi is a Hawaiian word we’ll often use to describe this feeling, for it’s “a pervasive persuasion toward calm, peace, and serenity.”

With much aloha,
Sifan Kahale
Hoku Wahine (Hawaiian: literally “star woman, eg. woman astronomer)

Transition: Mental and Physical

I just had an incredible experience: Dr. Suporn’s clinic staff make daily rounds between 10am and noon. I’m not going to mention her name because what I’m going to say applies to all of them.

This was her last time she was going to see me (as they take rotations and I’m leaving on Monday). So she took extra time to sit and talk.

This was unexpected – she thanked me for my positive attitude and optimism. I can only imagine the range of people and personal issues they have to deal with and this is what I want to share with everyone: this staff goes so far beyond just simple care, they truly are amazing. To me, this was a high complement – it’s also means that I really did touch others here – I hope I was able to make my trans-sisters more comfortable but also the staff and everyone else.

Yes, everyone has different experiences – but think about what the staff has to do (and what they have to put up with). And they do it with love and a smile!

You know – it’s sort of like my last post about being able to tolerate pain having a down side. Dr. Suporn’s surgery is (for a lot of us) almost pain free – it’s like little has happened. We get back to the hotel feeling so good and ready to party on the town, not fully taking into account the 7 hour surgery, 7 days in a hospital, etc. And then those that do, get in trouble.

I remember Dr. Suporn’s words about mentally relaxing and not worrying etc. that a lot of this has to do with the inside aspects of ourselves. And that brings up another huge issue: this is both MENTAL and PHYSICAL. You have to ‘solve’ both of these for yourself. His surgery solves the physical – if you are not mentally ready – after surgery you are now going to have to deal with the other half.

I was fortunate. I had a great therapist and worked on the mental aspects of this for more than 10 years. This surgery was the icing on the cake as they say. The night before surgery is when the final pieces of the physical aspects came into sharp focus. See “Why have Surgery” for more on that.

That was the big message the person from the clinic and I came to this morning – being prepared both mentally and physically for this.

And I really do hope that I shed cheer and happiness to those around me – to me, that is an important aspect of my life.

With much aloha,

Sifan
“Hoku Wahine” (literally: star woman, eg female astronomer)

14 Month Summary

Everything is now focused on next month:  SRS.  Because I’m ‘older’ they wanted a cardiac stress test.  Now, I’m in pretty good shape and that, for a stress test, is bad news.  It means they keep you on the treadmill longer, faster and at a higher incline (and keep increasing until you start pumping harder).  The good doctor brought me up to heart rate required for the stress test, looked at me and said, “want to see what you can do?”.  You know, I must be slow in the uptake or maybe I was just not completely taking in what he just said.  Well, from my perspective, all hell broke loose – not supposed to run just walk fast, the darn thing was now a ramp to the ceiling – but, like a fool, I did it.  Then he asked me again – I think my muffled huffing response sounded like a yes.  Right after they had me lay down and they took sonograms of my heart – asking me to ‘hold my breath’ – I was like “WHAT” – that’s not fair and it’s impossible!!  They actually can measure the thicknesses of the different walls, measure blood velocities, etc.  Very impressive.  Well, I passed – however – about three days later my entire upper chest was sore and I had what seems to be a muscle strained under my arm.  It took me a few more days to finally connect this to the stress test.  I was using my upper body – hands on the front bar of the treadmill – to do a lot of work.  When I hike in the mountains I use hiking sticks that basically do the same.  My legs are in the best shape because of the walking/hiking I do, but my upper body was not used to that.  It’s now almost a week later and at last I’m slowly recovering.  Wow – mental note – don’t accept a ‘dare’ from a doctor doing a stress test on you!  Unfortunately, I had to work up at the summit the rest of that week – this really zapped me.

I was sent an invitation to a private FaceBook group for those that have surgery with Dr. S. in Thailand – and for those that have been accepted for surgery.  It’s turning out to be a great resource.  Everyone is helping everyone, lots of good advice, worries, complications, things around town and the clinic and doctors weigh in as well.  So good sound advice.  One person said they just arrived – about 20 others replied with where they are meeting for breakfast, who to see and what to do before hand.  I joined the fray and said I would be arriving next month and already I have 4 other gals (two from here in Hawaii) that will be there the same time – we’ll be getting together!  By far the best is to go back about 1 year and read all the questions and answers, issues real and those easily fixed, what to expect and how everyone else has fared.  I have lots of good advice and perhaps an even better idea for what to expect almost each and every day I am there (one month).


 

One of the purposes of my blog site here is to help others, especially those that are older, to get the information they need to understand and know what this is all about.  To that end, I plan on making as many posts from Thailand as I am able to.  Some might be a bit detailed but I’ll warn you right up front – continue to read at your own …. whatever ….  I’ll probably write the first one tomorrow – about planning and pre-travel.


 

On a different note:

I had a conversation with Lisa a while back.  I was telling her about catching myself in unconscious automatic behaviors, feminine behaviors, behaviors that were not learned or made automatic by rote – how could they be.

We went out to eat at a restaurant in an outdoor mall (most of our malls in Hawaii have open air promenades).  We had a wonderful meal and had strolled down the open air mall talking and admiring clothes and nick knacks in the store windows.  On the way back to the car I mentioned that I had just noticed how I instinctively held my skirt down before a gust of wind suddenly blew and then smoothed it out.  Then it struck me that there are many other instinctive automatic things I do as well – feminine actions that I did not learn and was unconscious of doing.

What is intriguing is the recognition that these behaviors or actions were unconscious and very normal – what I would describe as just being me.  This is in contrast to before when I was presenting as a male – most of that had to be leaned and was deployed  ‘consciously’.   Having had to do this for the majority of my life, it sometimes baffles me to realize that most people have never had to consciously ‘be’ what society says is their gender.  That for most people, suddenly realizing that they are acting authentically, is simply never seen or experienced.

I learned quickly at a very young age.  I saw what happened to others, the harassment and bullying they endured and I was blessed with a quick intellect that allowed me to quickly assimilate their examples into a workable model for my own existence.  I learned to keep my truth inside – not hiding from myself – but to present what was expected.  It’s sort of like the cliches “pick your battles” or “work from within the system” or “know your truth and pick the right timing”.

The other fascinating aspect of this, was that I had a detached presence as I watched these behaviors unfold.  That was what prompted the conversation with Lisa.


 

And, I thought I would include a response I wrote to an article questioning why a ‘man’ would ever ‘want’ to change into a woman, considering all the disadvantage:

I’m a transwoman, let me see if I can make some sense here – I can only speak for myself. I was born this way, this is not a choice or something I ‘want’. It’s who I am. The issue becomes how do I deal with this – not about which gender has it easiest. There are a lot of false stereotypes and beliefs surrounding this – that compounded the issue for me as well. As a result it took me until I was older to sort out what and who I am. Just like everyone else, I had to sort out what was real – then I had to accept who I am and then despite all of that plus, as you stated “the disadvantages of being a woman in today’s society” – to proceed and become true to who I am. The fact that there is so much against this should speak for itself.  It has nothing to do with advantages/disadvantages, etc.  For many trans* it is life or death (or even a living death) – makes the disadvantages seem moot huh. To have your core being at odds is very disconcerting. Ask yourself if you really know what it feels like to be a woman (or man) – I mean, do you really know? On a personal level the only way to know is to actually know the opposite. For a trans* person this is a daily and deep question: who am I – not what do I want to be or the relative merits of one gender vs the other. This was one of the reasons it took me so long to come to terms with and accept who I am. The mind does a wonderful job of trying to protect and therefore deny or explain away things it thinks will be harmful – especially in this case. I am glad that trans* issues are becoming better known and slowly things are getting better – especially for the younger trans*. I hope they don’t have to go through what I and many others have.  My hope is that society will understand this better and drop all these pre-conceptions, stereotypes and false beliefs.

With aloha,

Sifan