Tag: trans

  • The Cass Report / BMJ

    I had words for the BMJ. I don’t know if they’ll stay up on the BMJ’s site, but they’re here if they don’t.

     

    Dear Editor,

    The BMJ’s editorial supportive of the findings of the Cass review will stand as one of the poorest decisions in this journal’s storied history. On final publication it has become incredibly clear that the review was deeply politicised. Dr Cass and her team’s decision to exclude the 98% of studies on transgender healthcare – with positive findings – for failing to be double blind studies, but then to include multiple non-double-blinded studies, which were supportive of her own position, is damning by itself.

    It makes a mockery of the concept of a review. Had I handed this in as part of any of my degree studies I would have failed because it lacks even the most basic principles of scientific rigour.

    Furthermore, the position adopted by Dr Cass, that — because a large proportion of people who start puberty blockers go on to require further gender affirming care we should not prescribe blockers — shows a fundamental misunderstanding of the situation. That is broadly the equivalent of complaining that patients who present to an emergency department having an ST elevation MI go on to have reperfusion therapy. The guidelines have successfully identified those requiring treatment, we gave it, and it worked. Puberty blockers were always a compromise because people were concerned about children making their minds up too fast. It turns out that children know who they are.

    Indeed, that such a high percentage of people using puberty blockers go on to have further gender affirming care suggests they should be used more broadly, not less. And that the current guidelines are actually identifying people who should be placed on HRT so that they can go through an appropriate puberty with their peers. Instead she has used it to argue for an opposite, and completely unsupported by the evidence conclusion.

    The evidence is very clear that gender affirming care is safe, as has been found by less biased reviews in multiple other countries. It is vividly clear that this government study is purely a basis for further politicisation of transgender healthcare, and provides a figleaf for the NHS’s appallingly inadequate service provision. That a journal that I respect has decided to editorialise positively on such a travesty is deeply disappointing and engenders deep concerns regarding the decision making at the BMJ’s editorial heart.

  • FFS Day 7

    Okay, I know I said I was going to stop. But it’s me and I’ve never been one for reliably making a decision and sticking to it.

    One of the interesting things which I’ve noticed over the past couple of days as I have slowly been out in the world a little bit more (following the surgery and recovering enough that it’s an option), is that my face is different. And I know that seems obvious, I mean that’s the point. I just had FFS, ffs. But it’s different for me to experience in ways that I didn’t really realize it would be. Someone on one of the discord’s I’m on kinda mentioned it, but I didn’t realise it would affect me quite so much.

    So because my orbital rims have changed, I actually have a wider peripheral view than I did before. That’s just something I didn’t really expect. Like it didn’t occur to me that my peripheral vision would change, it’s actually better now than it was before. I mean I’m still blind as a proverbial bat, and so all I really see is blurry things, but it’s a noticeable change. Another thing is just the way that water runs off my face has changed. So when I shower, the shampoo and water go different places than I’m used to. Some of that is probably because my head is still largely numb in many places and my forehead has patches of sensitivity and patches of numbness which probably makes it harder for me to predict where the water is going and going to go when it’s run off those areas which I can’t feel. But I am having to shift the way I deal with soap and shampoo.

    Anyhow, it is fascinating to me that as the world’s perception of me has shifted because of FFS, so my perception of the world has also shifted.

    Since I’m here, I’m still pretty much the same – easily tired, verticality takes it out of me kinda quickly. But otherwise okay. My wonderful wife is such a sweetie and looking after me so well :) She’s just the best.

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  • FFS Day 7

    Handwritten checkbox list with every item checked off: ABX Ibu(profen) (2100) Para(cetamol, aka Acetaminophen) (1900) Peridex Nocté Goop

    So yesterday was the last day of oral antibiotics. Thank fuck for that because as is so often the case when I’m on penicillins, not that I’ve been on them a ton, but towards the end I start to get lousy acid indigestion. Although, to be fair, that could equally well be that I’m mainly living on a liquid diet. I have had some soft actual food – yesterday I shredded a tortilla and dropped it into my tomato soup, along with the egg and cheese, and y’know what? That was pretty good.

    And I also had an American style biscuit. That was also pretty good – it was a little salty, but it plus the peanut butter (smooth :-/ ) and jam made for a nice and unexpected treat. Kathryn also brought home icecream – which is not solid food but was very yummy.

    Healing continues to trundle along. I keep feeling like I’m mostly better, then try and do something and discover that I’m really not. For values of “do something” where “sitting in my office chair and editing the next chapter of my audiobook version of Glow, worm” is the level of activity. But I have managed to go outside and do outside things. Well, walking. Kathryn and I like to wander – and once the sun’s down (since I’m now even more vampiric than before, I’m meant to avoid the sun basically all year), we headed out for a little wander which I managed without, I think, any of my little unsteady wobbles that I’ve had the past few days.

    Honestly, I think I’m quite likely to stop doing the daily updates unless something crops up. Photos, yes, for my own interest. But realistically I’m now at just posting that I’m tired and waiting for that to wear off and start actually doing things again. Like exercise. Which apparently is a thing I like. Let’s not talk about the fact that’s happened.

  • FFS Day 6

    Well, that’s it. Done and dusted assuming nothing crops up in the next chunk-o-healing. After last night’s debacle with not sleeping I could not have been more grateful that Kathryn so kindly took today off to go up with me. Traffic was pretty chill, which so far has been the case, and we got up there about 45 minutes early.

    The main event was the removal of the staples (sides of my head, within my hairline) and the removal of sutures (on my forehead at the hairline) – which was all done by the nurse before being seen by Dr Liu. All that healing seems to be going fine – I just have to keep putting the antibiotic ointment on for 2 more days and then I’ll be switching to a silicone scar reduction gel. Dr Liu whipped off the dressing on my throat, so today’s the first time I’ve seen that without an Eve’s apple for – well – probably nearly 30 years. That I put scar reduction gel on today.

    All in all there wasn’t a lot to it. He checked motor function (I can move my eyebrows, smile, etc all just fine). Told me I don’t have to sleep as sat up as I have been (thank fuck, because I can’t sleep – I did get some kudos for having put up with the lack of sleep to stick to the instructions), sadly he’d like me to continue to wear the jaw strap for at least another week to help keep control of the swelling (boo), but at least I can tolerate it now it’s not a fight between my glasses, the staples and the jaw strap.

    I need to go back in about a year for a follow up appointment, but otherwise that’s it.

    Unsurprisingly I’m now completely f’kin knackered; I apparently slept a little in the car (I definitely dozed and probably did actually fall asleep for a bit). We grabbed some not-very-good smoothies and snacks for the trip back (seriously, quite disappointing), and we snuggled on the sofa for a bit to watch Ghosts (startling me by causing me to cry at the 2019 Xmas special when Pat watches some family videos – it’s always interesting when you find these unprotected and bare bits of pain from trauma). And then I spent a long time listening to Halcyon and on and on, Miami Nice, Kruppa, Sunsick Day and some other track that I intended to save into a loopable chill playlist but failed to do so.

  • Pregaming FFS Day 6.

    So today I should get the sutures out – which is great. And the staples. But after 6 and a half hours of staring at the inside of my eyelids I got sick of it and got up. I don’t really know what to do with myself – I think I’m going to have to ask for some kind of sleeping pill because I now feel well enough that sleeping sat up is just impossible for me a lot of the time. Last night I took oxy in the hopes it would make me drowsy as well as deal with the pain, and it totally failed on the drowsy front. Did help with the pain though. Now the pain’s wandering back (mainly I think the pain from the staples being squashed by the jaw wrap right now, everything else seems to have settled down fairly much), but I’m completely fucking exhausted.

    I’ve sat up for an hour dinking, poking at the new story I’m writing, but not very successfully. I did, however, at 1:30 am submit my story to my beta reader who had e-mailed me back. Hopefully my comments in the submission box made sense.

    Right.

    Let’s try sleeping again, shall we?

  • FFS Day 3

    Mostly just a lack of sleep which is wearing me down. Lots of swelling although that’s definitely improving. And the day has mostly been spent chilling and watching films (Bring It On, and Pump Up The Volume).

    Not really much else to report. The pain remains manageable with Paracetamol / Ibuprofen. Mostly I’m just tired. I kinda want there to be more to add. I’m going to add in doing some drainage stuff to help with the swelling. I’d really like some food that isn’t a shade of brown and liquid. I had some scrambled eggs last night which was nice, but then a bit got stuck on a stitch in my mouth and bleh.

    Otherwise it’s been pretty intriguing – because I have face blindness I now have absolutely no recollection of what my face was like before. Logically, I know it was different and because I’m not 100% face blind, I can tell that there’s something different. And because I know what work I had done I know where things are different. But I can’t point to them and go “oh, that’s changed”. I just look at my face and am vaguely aware that it’s not the same as it was.

    I think I’m happy with it though. Definitely happy with the forehead/eye work, assuming that when the swelling goes down and the skin reattaches things are kinda where they are now. The jaw is more intense than I was expecting, but I think it looks cute, so, that’s going to take a little more getting used to. Also, because of the giant elastic jaw strap that’s something I’ve seen much less off.

    Of all the things, the giant elastic jaw strap is the most irritating because it makes wearing my glasses incredibly difficult. Which means I end up with kinda a headache just constantly nudging them into a semi functional position.

  • FFS Day 2

    So, another fairly sleepless night. Sleeping sat up is just something I find incredibly hard to do, which is weird and almost certainly just psychological, because I can do it fine during the day. I probably could sleep if I took the oxycodone, because the drowsyness would probably take over, but I really don’t want the constipation that goes along with that. Especially since (TMI) I’ve not been since the day before surgery. I’ve taken some laxatives but I think I’m just not moving enough for my body’s slack guts to get food processing through. That and all I’ve had are meal replacement drinks.

    As a side note I’m so very grateful to my wonderful wife and her mum, it’s been startlingly debilitating – just almost total exhaustion, the last couple of days and keeping track of which meds when? It would have been very difficult. They’ve both been so lovely, especially given Kathryns had very little sleep too, what with me floofing about on my side of the bed. I don’t know why but I didn’t expect to be quite so absolutely floored by it.

    Today, in about 30 minutes, the bandages come off. Theoretically I could shower but I’m going to be sensible and wait for Kathryn to get home. Despite the fact a shower sounds like a delicious thing. One of the deeply exciting things about having the bandages off, other than that my head will no longer be wrapped in miles of gauze bandage, is that I can wear my glasses again.

    Which means I can watch trashy films.

    I mean what good is recovering from surgery if you can’t watch trashy films?

     

  • FFS days 0 and 1

    Day 0.

    This one going to be kinda hazy because, well, anesthesia. So yesterday morning I rocked up at the surgery center at 7:15 and was ushered into a back room where I promptly realized I’d given my (borrowed from my wife) glasses case back to my wife when they told me to leave my valuables with her.

    Weight, a quick run through of health questions, and then getting changed into a gown and a wrap. And of course shitty hospital socks. My confusion as to why people love hospital socks has now grown because they are no where near as nice as the socks I took off. But, y’know, y’all do you. A check of my blood pressure (high, for me), and then it was time to chat with my anesthesist. He seemed nice, but since I am fairly frequently involved in anesthetizing people I didn’t really have much to ask. I debated asking which drugs they’d be using, but decided I wasn’t that bothered. I know they use propfol a lot from a discussion I overheard…

    Anyhow, then Dr Liu came in and had a quick chat and finally, Jess, my OR nurse came in and walked me into the room. Unlike my last surgeries I have a really clear recollection of the room because they gave me the premed in the room. Having popped an IV in my head they gave me a med that felt super cold. And him asking if I could feel it and me saying it felt cold was the last thing I remember.

    My surgery took about 3 and a half hours and they booted me from the hospital around noon.

    Now apparently there were whole discussions and I was wearing my clothes again when I started being able to store memories again. Which, it turns into our, was several minutes into the car ride home. I don’t really remember much about it, apparently there was a huge hail storm that I slept through, and apparently I behaved enough that when my wife told me to stay in the car while she unlocked the house I did. Good, because I was about as stable as a 5 minute old lamb.

    Most of the rest of yesterday passed in a haze of sleeping and occasional drugs. I took a couple of oxycodone through the day, the pain was pretty rough. It’s only about a 6ish out of 10 but it’s constant, like a toothache in my head. The absolute worst thing was the nausea. I’ve not had really severe nausea after meds before but last night was rough. In the middle of the night I got up to use the loo and good fucking god did I want to hurl. I was way too early for another ondansetron, so I threw a cold pack on my chest and did some steady deep breathing.

    Last night’s sleep was expectedly pretty broken, I slept in our rocking chair because that stopped me from slipping down in the bed… I’m not sure how tonight’s will be.

    Day +1

    Today has mostly been sleeping. I’ve not needed any oxycodone, just acetaminophen/paracetamol although I can’t wait to add in an NSAID. Because the head pain is bad, just not oxy bad. I’ve drunk huel and the nausea has been, mostly, better. I’ve also been able to get up and walk about and write this which I think is mostly coherent.

    Tomorrow I get to take the gauze wrap off and shower which is exciting. And will mean I can wear my glasses again.

    Yeah, so that’s that.

     

  • Noted genius

    Today’s mostly been spent getting organised. Meal replacement drinks into the fridge. Smoothie goop out and ready. Checking through tablets n times +1. Laundering the sheets so that the bed has clean sheets and the sofa is also culovered (they’re very explicit that they want you to return to clean sheets). Also washed the towels, too. They were due it, but I’m not going to get to enjoy the fruits of that labour until I think 48 hours. I had to do a run to target to get the pillows and shite since the ones I ordered didn’t come. And I also grabeysome stuff to help me sleep.

    So, both surprisingly – given that I went through and made sure I’d packed everything on the list, and unsurprisingly, given that I’m a chaos angel (or gremlin, or avatar), I forgot to bring my HRT with me. Which would be not a problem if I was on injectables, because I’d already have it in me. But I’m not. So I’m going cold turkey on my estrogen for the next two doses, so whoop to that.

    I think I was thinking that I’m not meant to take it in the morning anyway, so I didn’t need to pack it. Which obviously makes zero sense because I’m 60 miles (almost to the mile) from it and while I have long gangly arms, they ain’t that long.

    Anyhow.

    Otherwise I’ve eaten an overpriced but adequate hotel chicken burger, been served in the restaurant by a very gay and very sweet bartender, discovered that TV really is that shit, and drunk a large complimentary glass of wine. Go go gadget hotel stay, I suppose.

    I’ve also taken my first hibiclens shower and I’m super glad that they said I could moisturise after the first one (I can’t after tomorrow’s) – because I vaguely recalled how harsh this stuff is but feeling my skin trying to flat itself from my body (okay, overstatement, it’s more like I’m being dehydrated through every single pore) is not as much fun as you might think. My skin’s pretty sensitive so YMMV with that information.

    Anyhow, now it’s just one sleep to new face time. Which is…a thing. Exciting and terrifying all rolled together. It kinda feels like I did when I got SRS/GCS. Like I know I want this, and I’m 99.9% certain it will be better, but also it’s freaking scary. It’s my face.

    Still.

    I dunno whether I’ll have time or what to post tomorrow since I’m first in surgery, so… Well, we’ll see.

  • Bye face.

    Today’s the last day that I’ll have this face. Which is an interesting situation.

    It’s hopefully the last day that the damage that testosterone did – most noticeably in those four years between 16 and 20, when I finally started HRT, when I finally got my shit together at least somewhat, and that I see in the pictures of me, will be there. I know that it’s going to take a long time for that damage to disappear because it takes a long time for the swelling to go down and your tissues to adjust. And I know that I’ll look in the mirror at least for a good long while and wonder whether it was worth the pain, and whether I look different at all. This I know, because I’ve been chatting with people who’ve had FFS.

    And I also know – because in the last 2 years I’ve put in a ton of effort to lose a ton of weight (stabilized at ~66-67 kg for a good long while) that my face has been changing, constantly. The change over these two years has felt pretty dramatic as I’ve shed the extra weight, but it’s also brought more clearly into focus the things that I dislike. Despite that, I know, and can see that over the years the woman looking back at me has aged and changed, I’ve had my hair long, and short, and whatever the fuck it is now (it’s PURPLE! And I have a number 1 on some of it and the rest of it is longer than its been in years. But all the same, how do people not notice that it’s PURPLE?! I’ve had 3 people notice at work – and only one of them is someone I work with regularly. I mean it’s handy because i can just point at my hair if anyone asks if I look different. But still).

    I’ve worn make up and not.

    I’ve worn glasses and not.

    But also – also – underlying the nervousness, the anxiety about surgery, about healing, about sleeping sat up which is something that I have never, historically, been able to do (incidentally, ebay sellers: check the address before you send stuff? My sitty-up-pillow-thing did not arrive and y’know why? Because the dozy pillock appears to have sent it to a random not-my-address)  – underlying all that is this bubbling excitement.

    The idea that I might be able to look at myself in the mirror and not just see the damage.

    That I might be able to look in the mirror and not shy away, or find myself focusing on the things I hate.

    Because I don’t see him, I don’t see the person I pretended to be to survive.

    I haven’t for a long, long time.

    But I also don’t see me. And the idea that I might get more than a passing glimpse of me is terribly, terribly exciting.