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Sometimes its hard to justify why I prefer people to use male pronouns for me, because personally I dont really want to take T or have surgery. I am going to the Gender Odyssey conference this weekend and kind of scared or anxious. Because some friends of mine went last year and just attending helped them realize they wanted to make some of those physical changes, I wonder what will change about me or what will suddenly fall into place after experiencing three days of the conference and meeting and being around all those people.

Hey, my name is mana and I am genderqueer.  Ingersoll was gracious enough to give me this space to explain what that means to me, and to explore different ideas about gender and being trans, give support to people in the community, etc.

 I will soon be trained to facilitate the Genderqueer break out group during the All-trans support group, on the first and third wedndays of each the month. 

I like puppies and kitties, and zombies.

When my partner was at another company, we had the same insurance for 7+ years. I found it amusing in February when the insurance company changed my gender marker from F to M on their own. Problem is, I only found this out because they kicked back a claim for gynecological services because, well, guys don't need that. But some guys do and I will get to my master plan a little later. At the time, I didn't bother clearing the matter up. The bill was small and I paid it out of pocket and thought "kewl, I'm already a guy according to the evil insurance company."

Well, over the past 6 weeks or so, some more gynecological issues have come up (everything's fine so no worries). Because of my family history of ovarian cancer, my doctor is extremely cautious about any new symptoms that pop up. So when I started spotting after no periods for over 4 years (thanks to an endo ablation), off I went to get an ultrasound. On the 19th, I received my explanation of benefits forms from the insurance company and saw that a number of claims had been denied because, once again, guys have no need for gynecological services. Considering this time I'd be on the hook for over $1200 if I didn't clear this up, I called the insurance company.

The first line out of my mouth was "you have me listed in your system as male which it turns out is now  correct and I don't want you to change it but I have an explanation for why these claims need to be paid." I then went into an explanation that I am a transgender male but as of now, I do still have female anatomy and when I had some gynecological issues come up, my doctor did the prudent thing and sent me out for some tests. Considering that this situation has nothing to do with my transition, the claims should not be denied under the "transsexual exclusion" clause of the policy (more on what I think about THIS later).

Luckily, I had a very helpful agent and it was decided that all I needed to do was have my doctor send in some chart notes for a medical review. I did ask if this should be our default action whenever I have something come up that would generally fall under the female healthcare category and got an affirmative.

I also asked for (and received) an address to write to in order to educate the company on the need for a cogent internal policy to help transsexuals get the healthcare they need without having to jump through hoops like I had to do. So now the work REALLY begins.

The AMA is starting to get its ducks in a row with a resolution passed in June of this year that states that it is time to remove the financial barriers of care for transsexual patients. The World Professional Association for Transgender Health recently came out with a statement clarifying the medical necessity of treatment, sex reassignment, and insurance coverage in the US. I also found a study of the cost-benefit analysis of providing transgender healthcare benefits. This paper provides case studies of Lucent, Avaya and the city of San Francisco regarding the cost of trans-inclusive coverage.

Gender Identity Disorder is a very real medical condition that has been treated successfully for decades. The surgeries involved are far from cosmetic. Denying coverage for medically indicated treatment out of ignorance or bias is simply cruel and inhumane. It is time to allow doctors and patients make the decisions regarding their healthcare without impediments by health insurers.

Breanna and I decided to test out our new bikes by riding on down to Gasworks park. It was my first serious ride in some time and proved to me how much I need to work on cardio. But once again, determination won out and we made it there in pretty decent time. We spent about an hour at the park and then saddled up for the ride home. After a couple of miles, we decided discretion was the better part of valor because it was just too damn hot by that time and we took the bus to get to the other side of the  lake.

Today was my first appointment with Dr. G since beginning testosterone. I reported changes which basically boiled down to genital growth, extremely high sex drive, and the power fluctuations previously mentioned. I brought up the issue of spotting and she is sending me for a pelvic ultrasound. Normally, I wouldn't think anything of this but because of family history of ovarian cancer, Dr. G wants to play it safe. I am curious in finding out how I could be spotting after having an endometrial ablation in 2004.

My energy seems to be fluctuating alot today. When I run out, it is like running out of gas. I just can...not...go...on. I have noticed that I am sleeping MUCH better. Now, I just wake up for my 4am call of nature and then it is right back to sleep. This is a DRAMATIC improvement over my chronic insomnia.

I've got that wired feeling again. I like having all this energy. It is a nice change to wake up most mornings feeling refreshed from a solid night's sleep. I decided not to quit my job. While I don't even earn enough to pay any of our bills, I need to do what normal folks do and go be productive during the day.

My sex drive is through the roof again. This must be tiresome to the Love of my Life. But me? I'm loving it. Oddly, I have a newfound attraction to women's breasts. I thought guys who would drool at the sight of them were sexist morons who needed to get a grip. But now? I'm not sure it is entirely our fault. I think we are wired this way, thanks to the testosterone. I mean, really, what else could it be? Everything else is pretty much the same.

I'm in a pretty bad mood. I thought it might be low blood sugar but I am still feeling cranky after lunch. It could be from the pain. Inflammation in my muscles from the big hike is subsiding but now my knee HURTS. I took a couple of ibuprofen which had a nice placebo effect, if nothing else. Or it could be because I wanted to give my notice but my boss disappeared for a meeting. Or, maybe it is the T though the last time my bad mood was near the end of my cycle, not the beginning. Or maybe it is just a regular old bad mood that has no rhyme or reason.

My second injection was today. I took the plunge, so to speak, and self-injected. My doctor's medical assistant walked me through everything. I had a hard time getting the plastic cover off of one of the needles and accidently poked myself. No biggie since it was my own blood and there was no medicine in the syringe. The MA then gave me a good tip about removing the cover safely. So here are the steps I take in order to self-inject:

1. Unwrap the syringe and place it to the side
2. Unwrap my needle that I use to draw with. I use two needles so that the needle that I inject with will stay sharp, making it easier to pass through the skin with little to no pain
3. Unscrew the needle from the syringe and set it aside (plastic cap should still be in place)
4. Take the drawing needle and screw it onto the syringe
5. Take an alcohol wipe and thoroughly clean the top of the vial
6. Take the syringe and draw about 1cc of air
7. Plunge syringe into center of vial and inject air into the existing air pocket. This creates positive pressure which helps the testosterone drip into the syringe
8. Pull back on the plunger to the correct dose
9. Flip vial upside down and watch that magic elixir fill the syringe
10. Pull out of vial once the syringe is filled with the correct amount
11. Slowly push the plunger until a tiny drop comes out of the needle. This makes sure you have no air in the dose
12. Clean the injection site with an alcohol wipe
13. Grab quad muscle HARD. This lessens the chance of that pain often associated with injections. This WORKS
14. Slide needle in at least 1"
15. It was suggested that I slightly draw back on the plunger to make sure I didn't hit a vein. No blood means I am good to go
16. Push that plunger in and feel the rush of another dose of testosterone!

Injecting myself had an almost zen-like quality to it. The message I am receiving is that I am in charge of my own body. It says that I am truly committed to the pasth I have chosen. I am surprised I did not feel more trepidation about it. I used to be the kid that would wait and have to be held down when it was time for a booster. But this time? It felt so natural. Of course, my motivation is much higher than it was as a child.

Oddly enough, my biggest concern wasn't about "sticking myself in the leg." It was making sure that I had the preparation down.

My dose is still 100mg/ml every 14 days

I hiked Mt. Si today! I made it to the top. I didn't scramble up the Haystack. I took one look at that and said OH HELL NO! Breanna did it and I admit the view is amazing. I might try for the Haystack the next time. But I figure for my first big test, 4000 feet over 4 miles is just fine.

Coming down the mountain was also brutal. But I did it! The last quarter-mile both going up and coming down was sheer force of will. But see, that's just it! Before, I would have given up long before the top. In fact, the last time I attempted this hike, I quit before I even reached the half-way point.

I think alot of it has to do with my attitude. I'm finding myself much more goal-oriented. And I am much more in tune with my body and am able to make it work for me. I am liking the challenge of testing my strength, of going beyond my limits.

On another note, I have been researching surgeons, even though I know I am ridiculously new in my process. So far, I think Dr. Brownstein is my choice for top surgery. I have seen his work and he really is an artist. As far as bottom surgery goes, if I choose to have it, I'd like to see either Dr. Raphael in Plano TX or Dr. Bowers in Colorado. Dr. Raphael has developed a technique that can provide added girth to the neophallus. And I've heard that Dr. Bowers is currently researching another method that I may be interested in.

The problem with "bottom" surgery is that the cost is outrageous and the results are less than ideal. With a metoidioplasty, the new phallus is much too small for intercourse but generally large enough to pee while standing. A phalloplasty has a much higher chance of complications and while the size can be that of the average bio-male's penis, sensation is quite limited. Another option is to just get a good prosthetic. I still wouldn't be able to pee while standing but it is much cheaper overall. his is one area that I will no doubt be exploring for quite some time.