September 2007

I’ve always thought about my life and its complexities, but quite a bit more so while working with my therapist this past six months in relation to my gender identity issues. I believe that my identity in general has often come from others — from others’ expectations. This isn’t necessarily a bad thing; we don’t live in a vacuum, after all. We understand cultural expectations and values — when I was little, it was clear that being a doctor or lawyer was what good, bright people were expected to do. You heard these things and you internalized them. But when I say my identity comes from others, it’s more than this cultural definition of happiness, success, or ambition.

For me, it’s very hard to separate or distinguish or understand when an action of mine taken in the past, however small or big, was undertaken for me in some kind of intrinsic action or rather to gain someone else’s approval. I believe it’s the latter. And when I think on it, it’s a very weird or sad dichotomy, but I think it turns out that if I have no inner core, if I have always taken actions to secure the blessings and approval of others, then I have no free will. I’m a puppet, perhaps a very gifted one who’s able to satisfy many people and lots of different expectations, which I think is certainly my case, but a puppet nevertheless.

If that’s the case, then I have a strange, pathetic existence, and right or wrong, I feel that that describes me, the motivation through fear of rejection and the seeking of approval.

And it comes up at this time through therapy, insight and just generally thinking about myself, through this question of what’s essential and “what must I do?” to keep my sanity or to keep my existence.

And I look back on things I’ve wanted — what I’ve had a burning desire for, what I’ve really wanted — and it’s hard, and maybe I’m just picky with words, but when I think of dreams (as in when people ask you “what have you always dreamed of doing? What do you desperately want to do? What’s your highest priority?), I think of these things as belonging way out on a scale of desire, maybe with 1 being abhorrent, 5 being indifferent, and 10 being highest desire. I myself have certainly enjoyed doing lots of things: hang gliding, owning a business, going to graduate school, but I’m not sure I ever had a desperate dream (a 9 or a 10 on my scale) to do those things at all. I never had a desperate dream to be a professor. I look at the activities I engage in now and I am not sure if any of them came about because I desperately dreamed about them, like being a parent or being married.

But having entered into these things, I really enjoy them and go at them and try to be my best, to learn and try to improve on being a husband, a professor, a business owner, and whatever else I’ve ended up doing. I think I’m blessed (I guess it’s a blessing — maybe a curse) with the ability to acquire passion for my activities, whether I sought them or they just fell into my lap.

But when I think on what I ever desperately wanted or dreamed about, what would constitute a 9 or a 10 on my scale of desire, there are only two things that come to mind that I ever, ever dreamed about ever since I was young. One was being female and the other was playing music. Those two things were always, always part of my inner being, I think always meant something to me different than other things, other “normal” things.

And I think it’s interesting looking at my life and analyzing my activities, how I seem to have deferred or avoided taking steps in those directions. Maybe “deferred enjoyment” might be the kind of psychological term we’d use to describe it, or “delayed gratification.”

Instead of majoring in music or pursuing my gender identity disorder when I got off to school on the west coast, where there would have been ample occasion to do so, I simply dabbled, put my foot in the water, then backed away. So I suppose there’s always been an understanding, but pulling the trigger, taking action, those are things I’ve never been able to do.

The thing is I know about myself, I have a persona or a veneer of not caring what people think about it. In some regards, of course, I don’t; however, I also really, really fear rejection, particularly from people I admire. That is horribly, horribly frightening to me.

So I’m not sure, when I speak with my therapist and I think about my life and I think about my possible future, I don’t’ know if I’m able, logically at least, to separate fear of being myself or confronting my gender identity disorder–fear of taking a step, committing to something I’ve always known and cared about–from my fear of rejection. I don’t know if I’m able to separate those two things.

I think they’re so intertwined in my mind, I don’t know how to separate them. And I wonder, I’m thinking about this, regarding gender, it’s very frightening because gender is such an essential part of one’s self image of one’s identity, and even though it can be awfully fluid, it’s frightening to find yourself messing with it.

I say, both to myself and to others, that I’m an entrepreneur, a risk-taker, but in all honesty I’m not. If I were really a risk taker I would have majored in music; I would have had a sex change by now. I would have said, I suppose, to those I’ve always been afraid of their rejection, like my parents, or my wife or other people, I would have said, “this is something I’ve gotta do. If you’re with me, wonderful; if not, well, I’m sorry. This is something I have to do.”

But I never did say that. I have yet to say that. I don’t know that I’ve said something like that, ever, about anything. “Something I have to do.” The so-called risks I’ve taken in my life have been pretty safe, I’d say.

Obligation. What would it be like to be obligated to do something for myself? Oh, I can do obligation — I know it and respond to it. I’ve been obligated by virtue of jobs– I have a very strong sense of duty, there’s no doubt about that, but this is a duty to others. But what about duty to myself? I don’t know about that.

There have been moments, of course. I’m not just entirely self-sociopathic (or would self-psycho-pathic be the term?). There have been moments, and this year is an example, where my duty to myself — it became so obvious to myself that I was not attending myself that I absolutely had to do something. So there have been times where I have HAD to take action, but it would be really hilarious and wrong to call it Pro-Action because it’s anything but a proactive approach to thing. It’s more like a Re-Active mentality because it involves self-denial, wishful thinking, delay, all with the intent of putting action off until some other day. It is something that builds from something small, then it builds, then it builds some more, and I go through some period — days, months, years — of self-angst and thinking and analysis and the pressure builds and the necessity builds and then, and only then, although it’s been known to me, either in fleeting senses or growing senses of priority, climbing higher in my chain of priorities, I have known that I have needed to take a step, until it gets to desperation or urgency. Then, and only begrudgingly and with great trepidation, and concern, have I taken steps, have I done something.

It’s a pitiful way to live one’s life.

Which is not to say that my deeds, professions, and relationships have been pitiful. I think that I have had an absolutely glorious and very fortunate life, filled with excitement, loving friends and family, and meaningful jobs. I’ve traveled, worked in varied settings, studied lots of different things — all with what I think is an honest zeal for living. I’ve got an unfathomable love for my kids and wife, and while we get frustrated with things, as any family will, I think we genuinely enjoy each other’s company and have fun being a family. I’d do anything to protect them.

Would I bury myself to protect them? I’m sure my father would have written that he’d never do anything to hurt us, and yet he did. Maybe it’s a foolish vow to make — to promise to protect family from the pain of life and change.

Chuck was asking me the other day about whether I’d change anything in my life, and it’s easy to say without hesitation that I wouldn’t really change anything about my life except my self. I wish I had learned early on to understand and respect my inner voice and be more assertive about what I needed. I wish I had learned to respect not only what you do, but who you are.

I was writing the other day about whether it was selfish to be thinking of myself in this therapy, this daily anxiety about my identity. I wrote that I feel a fall depression coming on, a wearing down, a feeling of being burdened and somewhat angry I can’t seem to escape from my prison. It’s not just gender — it’s taxes, the job, the program. Where’s the happy, playful child? She’s buried under a pile of obligations and guilt.

I wrote that it felt like a congealment, and I asked myself, “how do you thaw?” What does it feel like to be thawed? Why do I have to consume mental space on this gender issue? Why do I worry about the future when I have so much? Why is even the happiest moment with my family tinged with melancholy as I anticipate loss? Am I living a narrative of loss? Lost parents? Lost youth? Lost time? Lost opportunities? Lost future?

Can you be a good person if all you feel is loss, real or anticipated?

The realm of the biological is a lot more powerful than you think.

I’ve come to understand, or believe, that my GID is probably something that was built into my being. Where, I don’t know — maybe the brain? But this clock is set ticking at birth, or at least at the age you become aware of yourself as a self, or the Ego stage of Freud’s theory.

And I don’t think its influences are confined to the realm of gender. I think it manifests itself in entirely non-gender ways, too.

I had always assumed internal conflict was part of the human condition, and it probably is, but there is a particular kind of conflict in a growing boy who has GID, and I felt all of these things:

  • Distance from people
  • Distance from myself, almost as I could be two people, or compartmentalize, you might say
  • Real difficulty or maybe it was just real caution, at making deep friendships.
  • Deep introspection — not surprising if you’re the only one you can trust.
  • Sadness — you hear TS’s on discussion boards talk about their old photos, and the mood always seems sad.
  • Confusion
  • Fear — of discovery, of rejection, of embarrassment

I learned that Dr. Clinton was giving up the practice because his costs were too high and he could still practice medicine as a traveling emergency room doctor. Since he’s a pilot, he’d be able to fly his plane to all these small towns — it actually sounded fun to me, and I would have been super enthusiastic if it weren’t for the fact that this was the one person in whom I had confided beyond the small circle of my wife and therapist. It was really, really hard to get up the nerve to go do see him, and I felt we were on a roll with the hormones and the medical side of my treatment.

So now I was faced with finding a new doctor. Dr. Clinton reassured me in a number of ways, some of which were reassuring. First, my files would be moved to the Kelly Clinic for 50 years, so they were safe and secure. Second, while he didn’t have any idea as to who might be a good PCP with sympathy for gender issues, he suggested the Kelly Clinic because a) they’re good people, b) they have my files, c) they’re new and need new patients, and d) they have some young residents who have probably been exposed to GID more than old farts. Third, we discussed my prescription and he said he was happy with my levels and that he’d write me a 12-month scrip at 60 pills per month, which would allow me to continue at my current levels for 24 months or I could double my dose and make them last a year. Since I was already thinking of doubling, this sounded good to me. This year, he explained, ought to be plenty of time for me to find a new doctor. Fourth, he’d still be my aviation medical examiner (AME), probably at a friend’s clinic and probably once or twice a month, so that aspect of my GID ought not to involve any doctor transition as he was already familiar with all my issues.

I said farewell, paid my bill, and left, feeling quite alone in the world. Where do you find a new doctor in this neck of the woods who knows about sex changes? I figured it would be a long and straining process. Still, one must try, so I filled my prescriptions, doubled my dose, and began my search.

I searched the web for “Bedford Falls & gender & doctor” and came up empty handed. I asked Chuck and he didn’t know, although he said I might like Art Simon because of his open mindedness and demeanor, but that he wasn’t on my insurance. I next broadened my search by studying the Kelly Clinic’s website and their doctors and their specialties. Most seemed to be good old boys from around here with a few exceptions. So, using my Yahoo account as Joyce, I wrote them and explained my situation and asked if anyone on the staff was familiar or could take me on. I got a reply back a few days later saying no, no one knew anything and good luck. Fairly straightforward rejection, but I figured maybe I had asked too specific of a question — maybe asking if anyone knows anything about GID is perhaps too narrow.

I did the same thing at the University Medical Center, looking through their typically bureaucratic website for some kind of contact info. I could only find a vague email about family practice, so I sent the same email to them, getting no reply. Well, I thought, I’m probably screwed.

I looked on the web for Art Simon, since Chuck had mentioned his name, and discovered that he’s not only a family doctor (independent), but he’s also a specialist in sex hormones and thyroid issues, and has a glowing reputation on the web with lots of endorsements. This was promising, I told myself.

I figured, well, I have time, with 12 months of hormones, and all, so I let things rest. But as October came around, my sense of despair grew and I felt almost pushed into doing something, anything, to sooth my tormented mind (too dramatic? Well, it felt like it at the time, ok.)

Serendipity arrived in the form of a flyer in my faculty mailbox for the family practice at the UMC and it had an email link called something like, which was not the email I had used before. Ok, I thought. Maybe they didn’t answer me because of the labyrinthine and outdated nature of their website. So I mailed my query to them again.

This time, I got a very nice note back from one of the staff who said that they had discussed this with family practice, and yes, from a general practitioner perspective, they were familiar and could help. She listed several doctors who were taking new patients. I was quite thrilled and studied their website looking at their pictures and specialties. One of the doctors the clerk listed was a nurse practitioner (Meredith) who everyone I know raves about, so I wrote another letter asking about which doctor should I choose, could I switch around between them if I needed something different, and could I also see Meredith instead of the docs. I got another fabulous note from a different woman this time who said yes, I could move around, even though I had picked a named PCP, and yes, I could see Meredith.