scrubjayspeaks (![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png)
scrubjayspeaks) wrote2024-02-01 03:49 pm
scrubjayspeaks) wrote2024-02-01 03:49 pm
On Getting a Letter of Support
[CW for discussions of surgery (general, no details), medical gatekeeping, imposter syndrome, and dysphoria.]
Sometimes, if you’re a very strange person, you schedule meetings with a licensed social worker to get a letter of support for gender confirmation surgery on your birthday. Look, I knew I would be off work, which is 9/10ths of the battle most of the time. It did mean, however, that I spent a few hours vibrating out of my skin as part of the general birthday festivities.
But now I’ve got a letter that seems to tick all the boxes that the insurance (and by extension, the surgeon) will expect to see. I technically had a letter before, but it was much less formal and did not come from someone with the sorts of letters after their name that the insurance will expect. So this is round two on that front. (Please, please, please, let this be the last round.)
On a purely emotional note, reading this letter is, uh, kind of intense.
The doctor refers to me as Mr. [Legal Last Name]. The meme of “please, call me X, ‘Mr. Y’ was my father” really hits different for guys, huh? That’s an actual experience, not just a funny joke. Also I’ve never been called mister anything before. It’s...very formal. Very grown-up. It’s a lot to carry around when you just think of yourself as a little gremlin.
(This is a fascinating contrast to being referred to as “Ms. [Legal Last Name], though that has never happened much either. Being called miss feels so condescending! I don’t know how much of that is because of the misgendering aspect and how much of it is something women also feel.)
There’s also the fact that it has he/him pronouns throughout. That had been my preference on the patient intake forms. In part, I really am enjoying using those more, and it reflects the strongly positive feelings I’ve had around the idea of being a transsexual male since starting medical transition.
Partly, it’s that I don’t have a lot of faith in the insurance to accept my need for this if I focus more on the nonbinary aspects of my identity or use they/them. Keep things simple for the miserly little bastards.
Both things together--that’s not something I get to hear a lot. Even among people who know I’m trans, we’re talking to each other; I’m not listening to them talk to someone else about me at length. So this is two pages of concentrated affirmation of my gender. Which is wonderful! But it’s the kind of wonderful that becomes overwhelming almost immediately.
But what of the content of the letter?
There’s some stuff that is probably stretching the truth, but I’m not sure which one of us is doing it. There’s an implication in the letter than I’m living full-time as a man. Then in other sections, it’s clear that this absolutely isn’t true, in large part because my chest makes it impossible to pass casually. This I can chalk up to the general stupidity of needing to write these letters at all. The insurance companies need to be convinced I’m a Real Boy, which leads to some weird, convoluted logic.
The thing that is tripping me up are the descriptions of my dysphoria and its negative impacts on my life. This is weird for two related reasons. It’s all literally things I told the doctor for this exact purpose. Like how I used to be an avid swimmer and can’t now because the mere thought of a wet t-shirt clinging to my chest where other people can see makes me physically nauseous. Or how I don’t like to hang out with people who don’t know I’m trans because it will mean being misgendered the whole time, and no one will ever, ever default to thinking of me as a guy when my body looks like this.
I told him all those things. And I knew they would be used as evidence in favor of my need for surgery. But there’s still something very strange about seeing it written out in formal language. It’s strange to see my experiences given a stamp of institutional approval. Yes, this guy is legit. Yes, this guy has correctly identified the source of his distress.
When has a doctor ever talked about me like that? Even the ones that ended up treating me have done it with a pervasive air of humoring the deluded. Trans healthcare has been the first and only space in which the baseline assumption is that I can accurately report my experiences.
Maybe that’s the reason for the second thing that’s tripping me up: it all sounds really bad when you put it like THAT.
I can’t do things I used to love because of how my body looks and how people will react to it. I avoid socializing. I’m self-conscious, and even basic interactions feel invasive because anyone looking at me can know I was born female. The sense that my anatomy is incorrect shapes how I dress, what I do, and who I interact with.
When someone else describes my experiences, they sound debilitating. Humiliating. Dysphoric.
That should be obvious, right? That’s the whole point, isn’t it?
And yet...
Reading the letter in my inbox, about to forward it on to my surgeon’s office, I’m hit by intense imposter syndrome. Just an absolute folding metal chair to the head of it. I must have lied to the doctor. Or maybe he misunderstood. Or maybe I’m just delusional and have actually convinced myself I have anything worth being upset about. I should be ashamed for dragging him into my charade.
Who the hell do I think I am, pretending that I need surgery? Who do I think I am, even suggesting that I’m out of the closet? As though all my friends, my D&D group, one out of two family members I still have contact with, and all the internet count! If random strangers don’t gender me correctly and I’m not getting in fist fights with them over it, can I really claim to care about my gender?
Again, when you put it like THAT, it sounds ridiculous. Of course that’s not how things work. Of course that doesn’t “prove” I’m not really trans enough.
And yet...
It feels like there’s a terrible Catch-22 in all this. I’m expected to be able to say, hey, I’m living as a guy, so I should get to have surgery to make me look like one. But the fact that I need surgery to look like a guy is the whole reason I can’t live as a guy.
Do they* think we all live in some liberal bastion where we can have H cups and a full beard and still find employment, housing, and basic safety? How out am I supposed to be when there’s a very, very limited number of people who will accept it if I say, yes, I know what I look like, but I am still a man? Am I supposed to have an elaborate conversation with the gas station attendant about why he ought to address me as sir, my tits be damned?
And I really wish they would stop asking me to explain why I don’t bind. You know how I referenced H cups up in that last paragraph? Yeah, that’s not accurate. If I put my measurements into a bra size calculator, it tells me I’m an I cup. Which doesn’t even sound like a real thing in the world. I’ve only recently found a company that will make custom-sized binders in my size; most of the big names top out ten inches smaller than my bust size. And I’m hesitant to buy a custom one because I probably can’t safely wear it while I’m working, which is 99% of the time I would want to wear one.
If I was small enough to be able to bind, I might** not even care about surgery. But surgery is the only thing that will get me even in the ballpark of a body shape that feels natural to me. There are zero effective alternatives for me. Being asked if I bind and why not feels, even unintentionally, like shaming me for not being serious enough.
It’s a weird see-saw. Validation one moment, gatekeeping the next. And I know that this is a formality. This doctor specifically provides this service, free of charge, because he believes, as many do, that such requirements are an unnecessary hurdle designed to keep people from accessing care. Short of any major red flags, the appointment’s purpose was to craft a letter that will help me over this hurdle. It doesn’t have to be the true definition of my experience.
But it’s weird. It’s weird that this is, as much as the cisheteronormative world around me, a space in which I need to perform gender in a certain way. The truth, however different, remains something only for me.
*generalized institutional they
**This is an impossible-to-answer hypothetical. If I were the last man on Earth, would I care about having a flat chest? I don’t know. I think so. I think it would still feel right. But I, regrettably, live in a society and cannot know myself except in that context.
Sometimes, if you’re a very strange person, you schedule meetings with a licensed social worker to get a letter of support for gender confirmation surgery on your birthday. Look, I knew I would be off work, which is 9/10ths of the battle most of the time. It did mean, however, that I spent a few hours vibrating out of my skin as part of the general birthday festivities.
But now I’ve got a letter that seems to tick all the boxes that the insurance (and by extension, the surgeon) will expect to see. I technically had a letter before, but it was much less formal and did not come from someone with the sorts of letters after their name that the insurance will expect. So this is round two on that front. (Please, please, please, let this be the last round.)
On a purely emotional note, reading this letter is, uh, kind of intense.
The doctor refers to me as Mr. [Legal Last Name]. The meme of “please, call me X, ‘Mr. Y’ was my father” really hits different for guys, huh? That’s an actual experience, not just a funny joke. Also I’ve never been called mister anything before. It’s...very formal. Very grown-up. It’s a lot to carry around when you just think of yourself as a little gremlin.
(This is a fascinating contrast to being referred to as “Ms. [Legal Last Name], though that has never happened much either. Being called miss feels so condescending! I don’t know how much of that is because of the misgendering aspect and how much of it is something women also feel.)
There’s also the fact that it has he/him pronouns throughout. That had been my preference on the patient intake forms. In part, I really am enjoying using those more, and it reflects the strongly positive feelings I’ve had around the idea of being a transsexual male since starting medical transition.
Partly, it’s that I don’t have a lot of faith in the insurance to accept my need for this if I focus more on the nonbinary aspects of my identity or use they/them. Keep things simple for the miserly little bastards.
Both things together--that’s not something I get to hear a lot. Even among people who know I’m trans, we’re talking to each other; I’m not listening to them talk to someone else about me at length. So this is two pages of concentrated affirmation of my gender. Which is wonderful! But it’s the kind of wonderful that becomes overwhelming almost immediately.
But what of the content of the letter?
There’s some stuff that is probably stretching the truth, but I’m not sure which one of us is doing it. There’s an implication in the letter than I’m living full-time as a man. Then in other sections, it’s clear that this absolutely isn’t true, in large part because my chest makes it impossible to pass casually. This I can chalk up to the general stupidity of needing to write these letters at all. The insurance companies need to be convinced I’m a Real Boy, which leads to some weird, convoluted logic.
The thing that is tripping me up are the descriptions of my dysphoria and its negative impacts on my life. This is weird for two related reasons. It’s all literally things I told the doctor for this exact purpose. Like how I used to be an avid swimmer and can’t now because the mere thought of a wet t-shirt clinging to my chest where other people can see makes me physically nauseous. Or how I don’t like to hang out with people who don’t know I’m trans because it will mean being misgendered the whole time, and no one will ever, ever default to thinking of me as a guy when my body looks like this.
I told him all those things. And I knew they would be used as evidence in favor of my need for surgery. But there’s still something very strange about seeing it written out in formal language. It’s strange to see my experiences given a stamp of institutional approval. Yes, this guy is legit. Yes, this guy has correctly identified the source of his distress.
When has a doctor ever talked about me like that? Even the ones that ended up treating me have done it with a pervasive air of humoring the deluded. Trans healthcare has been the first and only space in which the baseline assumption is that I can accurately report my experiences.
Maybe that’s the reason for the second thing that’s tripping me up: it all sounds really bad when you put it like THAT.
I can’t do things I used to love because of how my body looks and how people will react to it. I avoid socializing. I’m self-conscious, and even basic interactions feel invasive because anyone looking at me can know I was born female. The sense that my anatomy is incorrect shapes how I dress, what I do, and who I interact with.
When someone else describes my experiences, they sound debilitating. Humiliating. Dysphoric.
That should be obvious, right? That’s the whole point, isn’t it?
And yet...
Reading the letter in my inbox, about to forward it on to my surgeon’s office, I’m hit by intense imposter syndrome. Just an absolute folding metal chair to the head of it. I must have lied to the doctor. Or maybe he misunderstood. Or maybe I’m just delusional and have actually convinced myself I have anything worth being upset about. I should be ashamed for dragging him into my charade.
Who the hell do I think I am, pretending that I need surgery? Who do I think I am, even suggesting that I’m out of the closet? As though all my friends, my D&D group, one out of two family members I still have contact with, and all the internet count! If random strangers don’t gender me correctly and I’m not getting in fist fights with them over it, can I really claim to care about my gender?
Again, when you put it like THAT, it sounds ridiculous. Of course that’s not how things work. Of course that doesn’t “prove” I’m not really trans enough.
And yet...
It feels like there’s a terrible Catch-22 in all this. I’m expected to be able to say, hey, I’m living as a guy, so I should get to have surgery to make me look like one. But the fact that I need surgery to look like a guy is the whole reason I can’t live as a guy.
Do they* think we all live in some liberal bastion where we can have H cups and a full beard and still find employment, housing, and basic safety? How out am I supposed to be when there’s a very, very limited number of people who will accept it if I say, yes, I know what I look like, but I am still a man? Am I supposed to have an elaborate conversation with the gas station attendant about why he ought to address me as sir, my tits be damned?
And I really wish they would stop asking me to explain why I don’t bind. You know how I referenced H cups up in that last paragraph? Yeah, that’s not accurate. If I put my measurements into a bra size calculator, it tells me I’m an I cup. Which doesn’t even sound like a real thing in the world. I’ve only recently found a company that will make custom-sized binders in my size; most of the big names top out ten inches smaller than my bust size. And I’m hesitant to buy a custom one because I probably can’t safely wear it while I’m working, which is 99% of the time I would want to wear one.
If I was small enough to be able to bind, I might** not even care about surgery. But surgery is the only thing that will get me even in the ballpark of a body shape that feels natural to me. There are zero effective alternatives for me. Being asked if I bind and why not feels, even unintentionally, like shaming me for not being serious enough.
It’s a weird see-saw. Validation one moment, gatekeeping the next. And I know that this is a formality. This doctor specifically provides this service, free of charge, because he believes, as many do, that such requirements are an unnecessary hurdle designed to keep people from accessing care. Short of any major red flags, the appointment’s purpose was to craft a letter that will help me over this hurdle. It doesn’t have to be the true definition of my experience.
But it’s weird. It’s weird that this is, as much as the cisheteronormative world around me, a space in which I need to perform gender in a certain way. The truth, however different, remains something only for me.
*generalized institutional they
**This is an impossible-to-answer hypothetical. If I were the last man on Earth, would I care about having a flat chest? I don’t know. I think so. I think it would still feel right. But I, regrettably, live in a society and cannot know myself except in that context.