Do the least, not the most.

Hi guys, I’m going to try and make this a very quick video because by making this video I’m procrastinating on a lot of schoolwork that I need to get done. I’m a week and a half overdue on a paper, I’ve got two other papers due in a class, so really I should not be on youtube at all. And also my email inbox is just a mess, I owe everyone in the world an email, and ughhh my God, I don’t know, I just really take on too much guys. Ok, but I’m going to try to keep this at five minutes, right.

Ok, so I want to talk about the principle of doing the least that you need to do. This is actually my philosophy around approaching your gender dysphoria. I think for whatever reason that you have gender dysphoria, and you know people….the symptoms that we, the bodily experiences, the symptoms, the cognitions that we lump under gender dysphoria could come from all different kinds of places. And people really approach gender dysphoria with the idea that like if you figure out the cause then you’ll know the appropriate intervention to use to decrease the amount of distress you feel because of your gender dysphoria. And especially clients and patients tend to approach it that way, they tend to be like, “ok if I just know where it’s coming from, then I’ll know what to do to make myself feel better.”

The big question people email me with is like, “well how do I know if it’s my true identity that’s causing me gender dysphoria or trauma, or an anxiety disorder, or society being really fucked up.” Right? And if you know the cause, you’ll know, well, do you transition, or do you do this other stuff?

Ok, guys, this is going to piss so many people off, and I gotta do this in five minutes. These are big experiments that you’re undertaking. And there are people in the trans community who try to downplay how big of an experiment transition is in a person’s life. But you don’t know if a medical intervention is going to make you feel better until you do it. And then you don’t know if it’s going to continue to make you feel better into the future until you’re in the future and you’re there and you know how you feel. That’s just a reality of what happens, you don’t know if testosterone is going to make you feel better until you do testosterone, and people in the trans community will tell you that, people not in the trans community will tell you that, because it’s the way life works. It’s just important to keep in mind how big of an experiment these medical interventions are.

It’s a big experiment to get a mastectomy to see if it will make you feel better. Since it is a big experiment you just want to make sure that you do little experiments beforehand and really give them a shot to see if you can feel better without getting a mastectomy. I actually think that testosterone if a bigger experiment than a mastectomy is. When I was transitioning testosterone was kind of treated as like the thing that you did as sort of an experiment before a mastectomy and if you felt good on testosterone than that could give you some insight into whether you should go ahead and get a mastectomy. I think testosterone is the bigger intervention because we know, pretty much, what the effects of a mastectomy will be on your body 15 years out from getting it, 20 years out, 30 years out. We don’t know what the effects on your body will be after 15 years of testosterone, 20 years of testosterone, 30 years of testosterone.

People ask me what my ‘peak trans’ moment was a lot, you gotta understand that like I worked at an informed consent clinic for 6 months, I had about 4 peak trans moments a day, so I can’t….but one of them was we were sitting around the lunch table one day , we were talking about people who have been taking testosterone and need to stop to be able to get pregnant, and one person who worked at the clinic who was considering taking testosterone asked what the studies about people who are supposed to go through menopause and have been on a consistent course of testosterone instead, what those studies show about what happens to the female body, when you don’t go through menopause, you’re on a consistent course of testosterone. And one of the nurse practitioners said, “Oh for sure there is not that study.” Like, said it very assertively, very sure. And she was right to be sure about that and assertive, because yeah, there’s no longitudinal study of testosterone use, we don’t know what happens to your body when you’re supposed to be going through menopause and instead you’re injecting testosterone. And when that conversation happened I was really like, “Oh my God.” Like, the people prescribing testosterone know that we don’t know what happens ten years after use, 15 years, 20 years.

So, with that in mind, if you think about all these things as experiments in your life to make you feel better, you just wanna, kind of, try out different things based on how much risk there is to the things. So if you , so you know, if there’s any chance that like some stuff besides testosterone could make you feel more comfortable in your body, do that stuff first! Investigate it, give it like an honest shot.

If you’re the kind of person who like is up all night on the internet, and smoking weed every day, and not moving your body a lot, it’s not surprising that you don’t feel comfortable in your body. If you are that kind of person and you’re going to like middle school or high school every day, where like by the way, middle school and high school are some of the most sexist environments you’re ever going to exist in. They’re some of the most uncomfortable, hierarchical, sexist environments you are ever going to have to navigate in your life. So the idea that you would be like in that context and making decisions about medical interventions that are going to have unknown effects after 10 years, 15 years, 20 years, try some other shit out! Try like, man, try switching high schools, try home school, try just like doing the stuff that is better for your mental health like going to sleep when it’s dark, like not smoking weed, like not sitting on the internet five hours a day, you know like, just do the experiments first in your life that are not so hardcore on your body.

That’s what really trips me out about how I talked about testosterone before I took it, I had one conversation about detransition as a possibility before I took testosterone. It was not with my therapist, it was not with my endocrinologist, it was with the person I was dating who was VERY into the idea of me taking testosterone. The only thing that I knew about the possibility of detransition was that the person I was dating knew a person who no longer identified as an FTM, and had taken testosterone for some years, and now identified as a queer femme, and had to shave every day. Guys. Shaving every day is like, if that’s the only problem you get from testosterone use you’re lucky, ok? That’s, shaving – that conversation was not a real conversation about the long term downsides to testosterone use.

And I don’t want to scare anybody, there are people who take testosterone for years and their pelvic floors are doing a-ok, and they haven’t gotten cysts, and,… there are people who have taken testosterone for years and are doing ok. I don’t have numbers on how many people there are like that and how many people have what complications because no one has done that research. Seems like really important research to do, seems like really important research to fund, seems like you shouldn’t pass out a substance to a bunch of members of my generation without knowing how it’s going to affect them in twenty years. This is something I get really angry about.

Ok, and now we’re at 9 minutes, right. When you’re thinking about this stuff in your life, think about what is the least you can do. What is the least thing that you can do, what is the least intervention you can do that protects your body. You’re gonna want your body to be in good shape in 20 years, 30 years, and 40 years. I want your body to be in good shape 20 years, 30 years, 40 years, I want you to be around, I want us to be very old people together so we can talk about this together, so make decisions that prioritize that. You do have to approach it thinking about your daily comfort, but like, the least thing that you can do that makes you comfortable in this world is what you should do. Don’t do too much! Don’t do too much. Don’t do the most! Ok, take care, I gotta write three papers, bye.

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