In less than one month, (unless COVID changes things) I will be going in for my next surgical procedure. This is how it’s described in my UNC patient portal. Yeah…a little overwhelming to read and digest — especially when you’re the patient.

“The worst loneliness is to not be comfortable with yourself.”
― Mark Twain

I’ve waited for what seems like forever, seen quite a few doctors, had some pretty gnarly (and very painful) procedures done (remember the needles — 10 of them — between my fingers and toes???), been through a lot of pain, discomfort, and yes…even shame to get here to this place at this time, and hopefully (with Dr. Yemi’s expertise and skills, some luck, a lot of positive thoughts and prayers, and support from family and friends) — I’ll come out of this with a chest I can finally be proud of (not ashamed and embarrassed about).

But I have to admit — and boy have I been trying not to — I’m terrified to once again go “under the knife”. Though this procedure (or it could be more than one) is less invasive, I’m absolutely scared to death. What if there isn’t enough blood flow (again)? What if Dr. Yemi gets in there and finds out he needs to do something different? What if the scar tissue is worse than we think? What if? What if? WHAT IF?!? Then what???

Lately I’ve been thinking about something. I’ve really started enjoying photography. I have this blog that I’m still adding to. I do the occasional video here and there. Thinking of starting to do more on TikTok and actually share my chest (on video) and tell my story. I know it would help others…but I’m so afraid to show my chest live on video. There are so many hateful, close-minded people in the world. And I don’t need the negativity right now. I’m also in the process of getting my website created for my business, GenderBend Consulting, LLC. I don’t want to “turn people away”. SO…WHAT DO MY READERS THINK??? I’d love to hear from you.

I am beginning, little by little, to measure myself in strength and perseverance…not scars.

“Adversity, and perseverance and all these things can shape you. They can give you a value and a self-esteem that is priceless.” — Scott Hamilton

Just over 20 days and counting………………………………………………..

Liam

“There is no perfection, only beautiful versions of brokenness.” — Shannon L. Alder was originally published in Becoming Liam on Medium, where people are continuing the conversation by highlighting and responding to this story.

So I thought I’d share them here. Maybe I’ll include them, along with some “Things Every Trans Man Should Know” in a book.

First…shoes…b/c I have a serious shoe fetish.

👞👟👞👟👞😁😁😁😁😁

No Bull — These are my favorite athletic shoes because (even the size 7 Women’s) look much bigger than they really are. So they make my very small feet appear much longer. Some might consider them expensive, but I think they’re worth every penny, considering the overall quality. And their customer service is top-notch.

• Adidas — Mainly because they offer a lot of their men’s shoes in smaller sizes, so I can wear them. And since they sell the Sambas (one of my favorite casual shoes), they remain one of my favorite brands.
• Bed|Stu — I can’t say enough about their shoes. I absolutely LOVE them. They are great quality…and though they don’t offer the mens’ shoes in smaller sizes (though I’m trying to push them to do that), a lot of their boots are very masculine-looking.

Now, let’s talk about vehicles. My absolute favorite vehicle (for many reasons) is the Jeep Wrangler. I have had numerous Jeep Wranglers in my lifetime. Whenever I buy a different make and/or model, I always end up coming back to the Wranglers. I currently have a 2021 Jeep Wrangler Unlimited Sport S. It’s Sting Gray and I love it.

One of the biggest reasons I love the Jeep Wrangler (other than the fact that it’s an awesome vehicle that holds its value) is it makes me feel much taller than I am. I know…I know…that may sound silly to some people, but I’m 5'4" tall — very short for a man, and that does cause some dysphoria at times. So sitting high up, driving a Wrangler — well, it makes me feel bigger, stronger…kind of like I’m on top of the world. 😀 💪🚙

As for clothing, you can’t go wrong with TomboyX. I mean if you just read about how the company was founded, that’s more than enough to entice you to check out their merchandise.

A TALE OF TWO TOMBOYS

TomboyX was founded the way many brands are, trying to fill a need that had gone unfilled for far too long. We asked ourselves, “How hard can it be to make good underwear?” And by that we meant underwear that fit regular bodies and fit how we saw ourselves. And underwear that any body could feel comfortable in, regardless of where they fell on the size or gender spectrum.

And then there is Kirrin Finch…

Clothing and accessories that let you be your authentic self.

This one might be a bit expensive, but Official Rebrand has got some pretty unique merchandise. And if you needed another reason to buy from them…

Official Rebrand revives discarded clothing, breathing new life into what was once unwanted. Through painting and other alterations, artist MI Leggett’s “rebranding” process proposes an anti-waste alternative to today’s industrial and social norms. OR?!’s transformative process celebrates the fluidity of identity, dissociating garments from gendered categories, reintroducing them without arbitrary social constraints.

Oh…and Wildfang. Definitely.

When two Nike executives realized they couldn’t find menswear-inspired pieces with silhouettes that flattered them, Wildfang was born. Named after the German word for “tomboy,” the label offers a range of workwear, suits, tees, and more, all of which offer the pared-down, structured look that’s often stocked in the men’s section.

We’re on a mission to rethink gender norms and how they show up in fashion. We embrace our masculine, our feminine, and our-everything-in-between.

FarFetch is awesome…and they even sell pre-owned clothing. Warning: they are quite expensive, even the pre-owned items.

Telfar Clemens was onto the need for genderless clothing well before the fashion establishment deemed it a trend. The self-taught designer presented his first collection in 2005, and has been producing coveted unisex garments ever since. Telfar has won a devoted following by living up to its motto, “not for you — for everyone”.

Hope and Harmony Etsy Shop — if you are looking for a great place to buy some cool t-shirts, look no further.

A Tribe Called Queer (also has a podcast)

A Tribe Called Queer is a multidisciplinary brand that features a gender neutral and size inclusive clothing line, podcast, zine, virtual events, and a blog.

Flavnt

FLAVNT Streetwear is an Austin-based independent clothing brand for everyone within and anyone who supports the LGBTQ+ community. Started with the goal of creating clothes that promote confidence and pride, FLAVNT is all about being comfortable with who you are and flaunting that to the world. We promote this message of self-love and confidence through our designs and actions by supporting the LGBTQ community as a whole, as well as impacting individual lives through our fundraising initiatives.

The Phluid Project — Definitely check this one out. They also have some “smell good” and I know how much everyone loves to smellllll good.

The Phluid Project, founded by Robert Garett Smith, launched in March, 2018 — in NYC and online — to make gender-free apparel and accessories available worldwide. We joined a movement committed to challenging the ethos of dated traditions that inhibit freedom and self-expression, embarking on a mission to improve humanity through not only fashion, but also community outreach, activism, and education.

We strive to amplify the rising voice of today’s youths, which rejects binary gender norms, and favors an inclusive world that allows individuals to wear what makes them feel good — that is, what best reflects who they really are inside.

We’re working to infuse the world with more empathy, equity, and compassion, to give all people a chance to explore and express their truest selves without fear, judgment, or the limits of traditional gender identification.

Annnnnd…they also partner exclusively with brands whose products celebrate the non-binary. As if you needed one more reason to shop here.

Okay…lunch hour is over, and thus so is this blog post.

Hope many of my followers find this post useful.

☮ and ❤,

Liam

Products and Brands I Appreciate as a Trans Man was originally published in Becoming Liam on Medium, where people are continuing the conversation by highlighting and responding to this story.

Apple Podcast: ‎SHARING LIFE LESSONS: Season 7; Episode: 62: A discussion with a transgender: Be unapologetically, authentically, and fearlessly yourself! on Apple Podcasts

Spotify: https://open.spotify.com/episode/4c33cIHIezgeNn59HpKNzH?si=O_x2HqTyTPa3X69v1Ylmow&dl_branch=1

Anchor.fm: https://anchor.fm/sharinglifelessons/episodes/Season-7-Episode-62-A-discussion-with-a-transgender-Be-unapologetically--authentically--and-fearlessly-yourself-e1429lq

Give it a listen. Hoping it will help to educate some, comfort many…and ultimately change hearts and minds.

Liam

Sharing Life Lessons Podcast was originally published in Becoming Liam on Medium, where people are continuing the conversation by highlighting and responding to this story.

I came away from the first appointment (with Dr. Tobias) with mixed feelings. I can’t even describe what I felt — mostly let down…and even a bit confused and afraid of what I could potentially have to go through just to try and get a more normal looking chest…and there is no guarantee. Dr. Tobias’ suggestion is a combination of procedures and surgeries — both uncomfortable, scary and (of course) not guaranteed to give me what I want. He suggested tissue expanders — two below my scar and two above my scar (first procedure). Tissue expansion enables the body to “grow” extra skin for use in reconstructing part of the body. But it involves a surgery to put them in and expand them, and frequent visits to further expand (By the time the expanders were full, I would be walking around with what looks like four coconuts on my upper torso — as if I don’t already look like a bit of a freak), and, when the skin has stretched enough to cover the affected area, a second operation to remove the expander and reposition the new tissue to “fix” my chest. It would require me to stay in Boston for at least 6–8 months, if not longer. Now, being in Boston for that long certainly isn’t a bad thing — though I would definitely miss my wife.

So…I thought, “Okay…okay. That’s scary, but maybe it’s worth it. Of course my wife was concerned about more issues with blood flow during the surgeries.

But…at least I had an option.

I knew I had the consultation coming up with Dr. Yemi, and for some reason I just had a very positive feeling about it. Maybe because my friend told me how wonderful he is…and what a great surgeon he is…and well, it doesn’t hurt that he is UNC’s Director of Transgender Surgery AND he has handled/fixed complications for other patients.

Take a look at his video! He’s amazing! And even better in person.

And when I met him in person…I knew he was absolutely the right plastic surgeon for me. I felt completely comfortable with him and his recommendations. And I feel good about putting my health in his hands.

So, Dr. Yemi’s recommendation is to cut out the scar and do fat transfer to fix the overall shape of my chest and make my pecs/chest area look more normal. He plans to “clean up” the scar and make it “less messy” than it is now — with all the scar tissue. This will be an outpatient procedure that will take place in Chapel Hill in September (outpatient) if all goes well. Dr. Yemi said it may require two procedures — if I’m not completely happy with the first — just to do a bit more fat transfer. But…that’s still less invasive than Dr. Tobias’ recommendation.

We’re currently waiting on BCBS to approve the surgery, and Dr. Yemi’s office will contact me to give me a date.

So…though I like Dr. Tobias, and understand his recommendation, I think the best option is to put it all in the hands of Dr. Yemi. His procedure is less invasive with less downtime…and less opportunity for complications — though I know there could still be complications.

So, please keep your fingers (and toes crossed). If you pray, say a prayer. Send positive thoughts. Whatever you do to send as much positive energy my way…please do it. I need all the good energy I can get. And hopefully when the procedure(s) are done…I will no longer be embarrassed about my chest…and might even be able to go outside without a shirt on, without being afraid of people gawking at me or asking me what happened.

Much love to all of you. I’m going to try and record and post another video soon.

Liam

I’m Back…Now that I Can Breathe Again. was originally published in Becoming Liam on Medium, where people are continuing the conversation by highlighting and responding to this story.

I usually give people the benefit of the doubt. If they slip up and use my dead name, pronoun, etc., as long as they don’t do it again. BUT someone calling from my doctor’s office — that is just unacceptable…and has basically ruined my entire day.

Gender dysphoria is the feeling of discomfort or distress that might occur in people whose gender identity differs from their sex assigned at birth or sex-related physical characteristics.

Transgender and gender-nonconforming people might experience gender dysphoria at some point in their lives. But not everyone is affected. Some transgender and gender-nonconforming people feel at ease with their bodies, either with or without medical intervention.

I certainly went out to the MyChart portal and send my endo a message letting her know just how much this bothered me, and how disrespectful I thought it was.

I know…I haven’t posted anything recently. I promise I will be providing an update soon. There’s just a lot going on right now with my career, my wife and I trying to sell our house and buy a new home (to get out of this closed-minded city we currently live in), combined with my medical appointments, etc.

Take care of yourselves and each other.

Liam

Gender Dysphoria was originally published in Becoming Liam on Medium, where people are continuing the conversation by highlighting and responding to this story.

My hope was that they could tell me whether I did or didn’t have edema/lymphedema, and somehow “fix” me. Now I know that many of you have said to me, “You don’t need to be fixed”. While I appreciate that, I don’t know that I agree — because I have felt “broken” for quite a while now.

I did get to have some fun while I was there though. Just a few of the things I did:

• Attended a Red Sox game at Fenway — where I had a Fenway Frank, sang “Sweet Caroline” by Neil Diamond and “I’m Shipping Up to Boston” by Dropkick Murphys.

• Had some good food (lobster roll and clam chowder), beer and conversation at Ye Olde Union Oyster House — the oldest restaurant in Boston and the oldest restaurant in continuous service in the U.S. — the doors have always been open to diners since 1826.
• My daughter came and spent some time with me. Took her to Cheers, since she had never been. I mean, it’s an iconic Boston landmark. I had been before but she hadn’t. So of course we had to go.
• Went to Faneuil Hall Marketplace and Quincy Market on the day I arrived. It was super cold and raining. But glad I went, because there was a special event going on — the Boston Red Sox City Connect Jersey event. Wally was there, of course. I got to take pictures with the World Series trophies.
• Did a lot of walking and sightseeing. Wanted to go on the Whale Watching Tour but couldn’t find any availability on this trip. Maybe next time.

But…the fun stopped (for the most part) on Tuesday morning when I had to be at the hospital for my first appointment (lymphoscintigraphy imaging)- which included injections containing lidocaine and dye, inserted between the “webbing”of my fingers and toes — 10 total. I was the first person to ever get all 10 in a day. That was absolute torture! Think of the movie, “Saw”. OMG! So painful!

Below is the list of appointments that were scheduled for the week.

Wednesday consisted of meeting with the cardiologist, Dr. Brett J. Carroll, and physical therapist. No pain involved. Just lots of tests and conversation. No issues with heart and lungs. Whew!

Thursday was MRI day — first one I’ve ever had. So it was a little scary, and it didn’t help that yet another injection was involved — though this one was a piece of cake. So, after almost an hour of staying really still and hearing, “Breathe in, breathe out. Hold your breath. Relax”, I decided to go grab a beer at a local bar. I think I chose a good one. 🏳‍🌈

Friday was the big day. It was the day all the doctors and nurses were supposed to get together to discuss my case. I had an appointment at 11:00 for an IcG Lymphangiogram, but early that morning I got a call from the PA that it was no longer needed, and that they would see me at 12:30 for the discussion with Dr. Dhruv Singhal.

I was already super nervous — on pins and needles — scared to death — because I already thought I was going to be officially diagnosed with edema/lymphedema. Getting that call made me even more concerned, because I just knew that meant they had already diagnosed me with it, and that more tests weren’t necessary.

Well…I arrived about 45 minutes early and (finally) met Sarah Thomson in person. She has been such a big part of all of this — ever since I first contacted Beth Israel. Such a wonderful, compassionate, caring nurse. I could never thank her enough.

As afraid as I was, you have no idea how good it felt to see this inclusive intake form. All medical professionals and facilities should take note. This is a great example of healthcare that is safe and inclusive.

Finally Dr. Singhal arrived. As soon as he arrived in the room, I knew right away that I liked him. He gave me an elbow bump instead of a handshake (COVID…you know). We talked a bit. He examined my upper torso. Then he proceeded to share with me what had been decided in the early morning meeting with his colleagues.

I’ll make it short and sweet — Dr. Singhal and his team are 99.99999999% sure I do NOT have edema/lymphedema!!! Thank goodness! Dr. Singhal said he’s only had one patient in his career with lymphedema of the chest wall or abdomen…and it’s one of the worst things you can have. I had to ask him if he was sure at least three times. This man is an expert in the lymphatic system. He’s the Director of Lymphatic Surgery at BIDMC. And all of his colleagues completely agreed.

New Treatments for Lymphedema Available at Beth Israel Deaconess Medical Center - Boston Magazine

When I got ready to walk out of their office, I had to take a long pause — after thanking everyone immensely, of course (including two more elbow bumps from Dr. Singhal). I couldn’t hold back the tears — the happy, thankful tears — any longer. I had been holding this in for 7 long months…wondering if I really had edema/lymphedema.

Rather than edema/lymphedema, everyone agreed that I’m dealing with three things:

1. I still have some swelling from the surgery + complications + the second surgery + complications.
2. I have a very oddly shaped ribs. I’m a bit barrel-chested.
3. So…because I now have no female breasts, PLUS my chest has concave places where there should be pecs, the swollen section (just below my chest) looks much more swollen than it really is. Apparently this is something that a lot of cancer patients experience after a mastectomy.

Now I am awaiting a call from Dr. Adam M. Tobias, an amazing plastic surgeon from BIDMC. Dr. Singhal took a ton of pics before I left and sent those, along with all of my reports, over to Dr. Tobias. I’m hoping and praying he can help me — that he can reconstruct my chest…and give me a chest that I can be proud of.

'Coming home' for transgender man through surgery, support

I want to personally thank everyone at Beth Israel Deaconess Medical Center for their care, compassion, treatment and communication last week. Not only did they make me feel confident in “my team” of medical experts, but they also made it clear how important it was for them to know, see and understand the real me…all of me. And they gave this #Trans man the best medical care and #Healthcare experience I’ve ever had. I want to especially thank Dr. Dhruv Singal, Dr. Brett Carroll, Sarah Thomson, and the doctor who referred me, Dr. Sumner Slavin. Special thanks to #Cisco for getting this all started for me.

Fingers crossed I don’t have Cushings. Yes, my endocrinologist wants to check. So this week I’ll be getting that test done. And fingers and toes crossed that one of the best plastic surgeons for #GenderAffirming top surgery, Dr. Adam Tobias will be willing and able to provide me with additional surgery to “repair” my chest from the initial complications I had.

If you need excellent medical care with heart, look no further than Beth Israel Deaconess Medical Center in Boston.

While I’m updating everyone, I thought I’d share a recent pic. This is me — after a year on testosterone. I guess I’m making a little progress. 😁 I’ve actually got quite a bit of facial hair — but it’s super blonde (almost white). So it’s hard to see. Just my luck! I’ve always wanted a nice beard and moustache.

#TransHealthcare #LGBTQ #MedicalCare #TransMan #Belonging #InclusiveHealthcare #Equality

Thank you to everyone following my journey. If my journey can help even one person — then it’s all been worth it. Send positive thoughts, prayers, whatever you feel comfortable with that Dr. Tobias is willing and able to fix my chest.

Peace and Love,

Liam

Back from Boston (No, they Didn’t Keep Me) was originally published in Becoming Liam on Medium, where people are continuing the conversation by highlighting and responding to this story.

I really don’t understand why so many people in the world fear me…and people like me. What is a transgender person going to do to you? How many times has a transgender person shown up in the news, harming anyone — other than themselves (sadly)?

If you’re one of those people who fear me and others like me, this is for you. Keep reading. Maybe, just maybe you might change your mind. Or maybe it will at least open a little.

How can I possibly convince you that you shouldn’t fear me?

How can I convince you that I deserve to exist just as much as you or anyone else does?

How can I get you to see that I only want the same things you do? Love, happiness, a roof over my head, a family, good health, a good job, time spent with friends, good music, good food, travel, peace, a safe, accepting world to live in…you know — all those things that most people want?

Imagine for just one moment how it would feel to know that your rights, or your child’s rights, or your parents’ rights were in the hands of politicians — politicians like Lindsay Graham, people who viewed you or the ones you love as a threat to them. Just stop for a moment and really imagine how that would feel.

Why do politicians like Lindsay Graham get to decide how my life will be shaped through policy and whether I have the same rights as other human beings in this country? Will he or others like him take responsibility for the my life and the lives of those they refuse to protect??? Of course not, but they’re pro-life…or they are until it comes to members of the LGBTQIA community.

Some transgender people are able to live with a small degree of safety — a very small degree, but only in some parts of the country. Let’s not even begin to discuss how it feels for those who live in places like Alabama, Mississippi, the Bible Belt.

Even places like Atlanta where there are protections for LGBTQ people, the Georgia legislature is trying to restrict transgender youth from participating in sports, based on their sex assigned at birth, and prevent them from any gender-affirming healthcare.

It’s almost like we have some protection for a little while, and the next day or week or month or year…or whenever we get a super conservative president (I won’t name names here), our rights can be reversed — without any concern at all for us, our families, friends and allies.

Imagine planning a trip and wondering about access to a caring, considerate doctor who understands transgender healthcare in that state, or wondering if you might get attacked if you use a public restroom. Imagine being afraid to go through airport security, for fear that you might be called out, patted down and questioned about “what’s in your pants”.

Many of our Republican lawmakers look at the Equality Act as something that attacks religious freedom. They say they look at it as an attack on women’s rights. We all know they could care less about the rights of women in this country.

Did you know that 44 transgender people were killed in the United States in 2020 — making it the worst year on record for transphobic violence??? And that number — those are just the ones that were reported.

These deaths are just a part of a continued epidemic of homicides against trans and nonconforming communities around the world. 98% of victims included in the Transrespect Versus Transphobia Worldwide (TvT) report were trans women and 62% were sex workers. An estimated 79% of those killed in the U.S. were trans people of color.

Transgender people are denied employment, housing, and healthcare on a regular basis — in some areas more than others.

Again, I ask, “Why am I a threat to you??? Why are others like me a threat to you???” I cannot wrap my head around that. I just don’t understand.

Do you think that if you respect my rights, that you will lose some of your rights? That’s not how this works. I promise you.

Transgender people are everywhere — they’re members of your family (unless you’ve now decided to ostracize them for being who they truly are), they’re your colleagues, your neighbors, your doctors and nurses, your professors. We are here and we want to live in harmony with everyone else in the world. Believe me…equality never hurt anyone.

I think I’ll need to finish this post later. Starting to get upset and I don’t need that right now.

More to come.

Liam

WHY are You Afraid of Me??? was originally published in Becoming Liam on Medium, where people are continuing the conversation by highlighting and responding to this story.

I had everything scheduled for my trip to Boston in April to be seen by doctors at Beth Israel. First, Jet Blue (a little over a week ago) sends me an email that they’ve changed my flight times. And of course they didn’t have anything that would work for my return flight home. So I had to cancel the flights with JetBlue and book with Delta instead.

Fast forward to yesterday. Phone rang. I recognized the number — Beth Israel. I figured they were simply calling to verify some information or ask more questions. No, it was someone calling to cancel one of my appointments with Dr. Carroll (the main doctor I needed to see), because the “machines are being replaced during the months of April and May”. At that point I felt like a balloon that someone stepped on, popped and then proceeded to stomp on. I mean…seriously…what else is going to happen???

I reached out to my point of contact via email shortly after, and today she informed me that, while she is double-checking, she’s fairly certain that the Nuclear Medicine (Lymphoscintigraphy) devices are being replaced. AND…the best part — there is no place in NC that I can have that done, and send the results to Boston. Even if there was, they prefer for patients not to have it done elsewhere.

So now I’m waiting…waiting…waiting for them to get back to me. Will I keep all the other appointments and go back for the Lymphoscintigraphy after May? Will all the appointments be rescheduled?

Also, in my last Physical Therapy appointment, my PT said that I may actually have a seroma. So I could have a seroma with slight lymphedema, lymphedema with a small seroma, or total lymphedema. But I won’t know until I have an MRI or ultrasound. Damn it! Can I just get some good news for a change? Can I just have someone tell me (and know) that it’s going to be alright…that I’m not going to look like an absolute freak all my life???!!!

To top if all off, I actually found out from someone in a Transgender group on Facebook that there is another plastic surgeon in Raleigh (at DUKE) who does top surgeries for transgender men — Dr. Kristen M. Rezak. Don’t get me wrong — I love my plastic surgeon, Dr. MacPhee. But it would have been nice to have options that were actually easy to find. In addition, Duke is in-network for my insurance. So, while Dr. MacPhee’s office did file my insurance, and the insurance paid for 80% of the procedure, etc., I had to wait to be reimbursed for some of that.

So…even though I’m still having appointments with Dr. MacPhee, should I also schedule an appointment with Dr. Rezak — just for another opinion? My endocrinologist thinks it might be a good idea.

And I think so, since one of the reviews a patient left for her states,

“I have no complaints. Dr. Rezak did a complex procedure due to complications from surgery by a prior physician. Her approach with me was cautiously optimistic which was good and I am now able to proceed with the next level of surgery which is good too procedures have not been unnecessarily rushed.”

All of this waiting…and roadblocks…and hurdles…and hard-to-find information and doctors and procedures — I’m absolutely over it!

On another note, I am so beyond thankful for my doctors at Duke: DR. CARLY ELIZABETH KELLEY (Endocrinologist) and LAUREN BAUER (Physical Therapist). They are amazing. I wish I had started out with them when I began my transition in March of last year. They are absolutely phenomenal. And they’re very focused on transgender healthcare. I know they will continue to do great things for the transgender community.

UPDATE: March 16 at 2:15 PM from Beth Israel:

Liam,

Plan on coming and do not worry about anything. :-)

Let’s stick with these appointments and if for some reason we can get a Nuclear Medicine scheduled, we will. Otherwise, all other imaging should be good!

2 Steps Forward, 3 Steps Back was originally published in Becoming Liam on Medium, where people are continuing the conversation by highlighting and responding to this story.

So I have a bit of good news to share this week. I met with my new endocrinologist, whom I really like. She viewed all of my lab results (one before starting testosterone and two after). I’m happy to share these two very positives:

1. The testosterone doesn’t appear to be having any negative effects on me. So I don’t need to reduce or stop taking it. Will get more labs done in May.
2. I no longer have to take intramuscular testosterone injections in my thighs every week. I’ve been switched to subcutaneous!!! What a relief! It’s a relief for me because I hate those needles my wife has to use for my IM shots. Sometimes it really hurts, and I’ve only been able to give myself a shot once. Plus if my wife is ever away on a Thursday evening, I’ll be in trouble if there is no one else who can give me the shot. It’s a relief for my wife because she no longer has to worry about giving them to me.

In addition, Dr. Kelley, my new endocrinologist has taken me on as a patient of hers. She will now be in charge of my testosterone, lab requests, etc. She also shared my story with her Physical Therapy colleagues, who specialize in treating patients with edema, and they asked her to see if I would give them a shot at working with me. What have I got to lose, I thought. So they scheduled an appointment for me to see the Duke PT on March 18th. Yesterday I got a call from one of the therapists asking if I wanted to be moved up to March 1st. Of course, I did. So, I’m hoping that there might be some more good news to share after that appointment. Maybe they can do something that the therapists at Pivot couldn’t. It’s worth a shot at this point.

On another note, I’m thinking of writing a children’s book — or maybe I should call it a parent’s book — about a child who is transgender and the positive response they receive from their parents. I’ve also considered turning this blog into a book — to help other transgender people. Thoughts??? I’m not looking to have a bestseller or make millions. I just want to help educate others.

More to come after my March 1st appointment.

Much love. 💓💓💓

Liam

A Silver Lining was originally published in Becoming Liam on Medium, where people are continuing the conversation by highlighting and responding to this story.

This is going to be a lengthy one. So sit down, strap in, and read carefully.

It took me having to experience it myself (during my transition from female to male) to recognize that there is a major problem with our healthcare system with regards to the treatment and care of members of the LGBTQ community — particularly transgender and gender non-conforming individuals.

From the patient intake forms to the office staff to nurses and doctors, a safe and inclusive healthcare environment should be top of mind for everyone — and it hasn’t been for the LGBTQ community for a very long time. To put it bluntly, they are mostly ignored by modern medicine. That desperately needs to change. Members of the LGBTQ community face many barriers in the healthcare system — from intake forms with non-inclusive language to challenges finding knowledgeable providers who genuinely care about their healthcare needs.

The act of simply going to the doctor can be nerve-wracking for anyone. It can be a very stressful experience for most people — but LGBTQ patients often experience additional stress and fear. According to a recent article from Health Nexus, a survey of more than 27,000 transgender people showed that 33% reported having at least one negative experience with a healthcare provider related to their gender identity, which included having to actually educate the provider about being transgender. Most nurses and doctors do not have the proper training to fully understand what it means to be transgender or non-binary.

This recent BBC Article provides a detailed experience of Cameron Whitley, his need for a kidney transplant, and the terrible experience he had — which could have been prevented. Though this took place in the UK, similar experiences happen around the world all the time.

Though I won’t address all of the challenges here, I do want to cover some of the more significant ones. Let’s start with patient intake forms.

Here is an example of a good New Patient Intake Form. Notice the section under “Sexuality/Gender Identity”. Some healthcare facilities are getting it right — or at least trying.

I absolutely love this Intake From Best Practices for LGBTQ Patients from the University of Colorado Anschutz Medical Campus.

Unfortunately, the vast majority of patient intake forms look something like this:

The way gender, sexuality, and relationships are treated on the forms patients are asked to complete is critical to a patient getting the very best care. The easier it is for LGBTQ patients to complete the forms with answers that truly reflect who they are, the better they will feel and the more likely they will be to provide complete and accurate information.

With regards to gender, many forms offer only two options: male and female. There are many people for whom neither of these options is accurate. Individuals who identify as transgender, genderqueer, etc. may find that neither of these options really applies. Some transgender individuals may choose the gender with which they currently identify, without indicating that this does not correspond to the sex they were assigned at birth.

Every patient intake form should include detailed sections for:

• Gender Identity
• Sex
• Pronouns
• Sexual Orientation
• Sexual Behavior/Activity
• Relationship Status

Let’s talk about bias and discrimination and how members of the LGBTQ community are often treated when trying to get necessary medical care. No matter how much education and training is provided, nothing is going to change if medical providers continue to employ and ignore the behavior of those who treat members of the LGBTQ community as less than or second-class citizens. How people are treated when seeking medical advice and treatment is of the utmost importance.

Every employee should be aware of the inclusive policy. You know…the one that goes a little something like “Equal care will be provided to all patients, regardless of age, race, ethnicity, physical ability or attributes, religion, sexual orientation, gender identity or gender expression.” Every medical facility should have one, but more importantly, every member of their staff should be in 100% agreement with it and treat LGBTQ patients with genuine care and compassion. Unfortunately, that is often not the case.

Making a point of sharing this policy with staff and patients is critical. This makes it clear that a medical provider wants LGBTQ patients (and all patients) to feel comfortable and expects them to be treated with respect and courtesy. Including a non-discrimination policy in promotional literature and advertising also helps prospective patients feel comfortable and welcome.

Want to know more about this topic? Take a moment to read How Bias May Affect Providers’ Knowledge of Transgender Health.

I also want to touch on the importance of “what people see”. There is a major lack of inclusivity in medical offices. No one should feel uncomfortable or unsafe going into a restroom to do what comes naturally to every human being. Something as simple as single-stall bathrooms marked as gender-neutral help to make transgender and non-binary patients feel more comfortable and safe.

If a medical practice is truly welcoming and inclusive, it should “advertise” it on their website, in their offices, in pamphlets, etc. I can’t tell you how difficult it was for me to find a trans-friendly primary healthcare provider, a female-to-male top surgeon, and a trans-friendly physical therapist. It was literally equal to searching for a needle in a haystack. Wanna know how many plastic surgeons specializing in transgender surgeries are located within 4 hours of my home? Two! And neither of them accept insurance. Oh…and I could go on and on about health insurance providers and the changes that need to be made. Wow! That would have to be a separate article.

Because many LGBTQ people have experienced rejection and stigmatization, they are often sensitive to subtle signs in the environment that can be interpreted as indications of whether they will are welcomed or not. Making a few simple adjustments can communicate to LGBTQ patients that they are welcome and safe.

Last but not least, medical providers need much more education and training — and more research needs to be done. For example, most doctors have no idea how hormone therapy affects the risk of disease in transgender patients. For example, long-term exposure to hormone therapy can increase the risk of cancer. Currently, there are no standardized cancer screening guidelines for transgender patients. Proper guidelines need to be established. And then this information needs to be shared with medical providers and patients to make sure there is clear messaging.

Disparities affecting the LBGTQ community are complex. They intersect with race, ethnicity, age, and gender. A staggering 70% of trans and gender non-conforming people reporting experiences with discrimination in care, such as being refused necessary care. And despite being at higher risk for HIV, 56% of gay and bisexual men say that a doctor has never recommended they get tested for HIV.

It is 2021. This is just a small number of the issues that the LGBTQ community still face when it comes to healthcare. Healthcare isn’t the only challenge that we face on a regular basis. BUT it is one of the major ones…considering it can be the difference between treatment or constant illness and/or pain…and sometimes the difference between life and death.

As a trans man who has:

• Been on testosterone since March of 2020
• Had female-to-male top surgery in September
• Recently changed primary healthcare providers

I am happy to speak with any medical provider who wants to have a serious discussion about this. I’m happy to share my experience and recommendations. Feel free to also read my blog, where I have tracked my journey since I started my transition last year. Disclaimer: there are pictures on my blog that some may find difficult to look at. I questioned whether to even share my blog, as it is very personal. But it has helped quite a few people in their own journeys. And if it helps others, that’s all that matters.

“Openness may not completely disarm prejudice, but it’s a good place to start.”

#Transgender #LGBTQ #Doctors #Nurses #Medical #Healthcare #Diversity #Inclusion #Belonging #Bias #Discrimination #Equality

The Need for More Inclusive Healthcare was originally published in Becoming Liam on Medium, where people are continuing the conversation by highlighting and responding to this story.