Aging

The following are some of the subjects that were addressed at the meeting:

1. Binding (larger chests)
2. Funding for Chest Surgery
3. Hormones
4. Passing (at work - transitioning on the job)
5. Passing in public
6. Aging

Binding is a frequently discussed issue at FTM+/SOFFA meetings. Those who are larger chested often have significant concerns about if they will bind "successfully" enough that they can pass as a flat-chested person and be perceived male.

There are several options for binding (or choosing NOT to bind!). Larger chested people often fret over their binding, fearing they will not achieve the effects they desire. Some binding techniques -- such as the use of athletic ("jog") bras, tight t-shirts, ace bandages, spandex bike shorts (inverted shorts with the crotch cut out) lycra "body trimmers", thin latex undershirts, etc. - that are effective for smaller chested people, tend not to work as well for larger chested individuals.

Tips:

• Use a binding method that is most comfortable for you.
• Use an approach that balances the ease of use and the appearance you most prefer.
• Factor in health conditions and body variables. If you have back or lung problems, you may want to consider not binding at all, or using a method that places equal pressure throughout the chest/back area. If you have skin problems, tight (or even loose) binding may cause additional irritation.
• If you sweat a lot and use binders that are a “wrap around” (like an abdominal support device), you may end up with unusual looking sweat marks on your clothes, which may “give you away”.
• To minimize chafing or skin irritation, try wearing an A-shirt or T-shirt under the binder and/or use talc or other powder to help keep the skin drier under the binder.
• For large chests, pressing the breast tissue down and out towards the armpits often helps “tuck away” and keep a flatter appearance.
• Clothing styles can greatly create a masculine appearance. Many people wear men’s work or flannel shirts, left unbuttoned, over a dark t-shirt. Wearing sportcoats is another effective masculine gender cue, especially if worn with a crisp button down shirt and tie.
• More tips can be found online at many sites, but one of the most complete and up to date is “FTM PASSING TIPS”, found at http://www.geocities.com/ftmpass/passing.html

“Myths” about binding:

• You HAVE to bind in order to pass as male or to create the appearance of a masculine chest.
• The tighter you bind, the flatter/more masculine your chest will look.
• You have to buy expensive binders made just for FTMs in order to bind well.

Some cautions about binding:

• It’s easy to over compress, which can inhibit the amount of air you can take into your lungs, which obviously results in “breathing issues” - difficulty catching your breath, or just plain difficulties getting enough air.
• Due to the strong pressure from the binder around the chest/back, which changes the normal spine alignment, back pain or other difficulties can occur.
• Out of “fear” that a binding method isn’t as effective as they hope it would be, many people “slump” or curve their shoulders, in an effort to conceal the shape of their chest. These postural changes can have significant impact on the ability to breathe easily and fully, as well as issues with back pain, headaches, and other body discomforts.
• Acne or other rashes can develop due to lack of adequate ventilation over the bound area.
• Compressing the breast tissue may result in semi- or permanent damage. (While some of the changes in breast tissue may actually make binding easier more elongation and malleability - these changes may be permanent. It is unknown what the long-term effects of damaging the breast tissue may be, or what effect it may have on surgery, if that is desirable.)
• Use common sense: binding when you need to, but also allowing time for your body to heal and have some room to breathe (literally!).

Types of Binders:

Find a binding technique that works for you. Body size, skin irritation, health conditions, desired appearance, type of clothing to be worn, cost and many other factors play a role in determining what binding method to select. Many people need to try several options before settling on the one(s) that work best for them. The following are SOME of the many options:

• Futuro (or other brand) abdominal binder ($20-30 - available at pharmacies, grocery stories, internet, and discount department stores)
• Neoprene back braces ($10 - 30 - available at pharmacies, grocery stories, internet, and discount department stores)
• Girdles ($10-60 - available at department stores, internet, and women’s specialty stores)
• Spandex bike shorts [cut a hole in the crotch, which will end up being the hole for your head. The legs of the shorts will be for your arms. The spandex offers a nice snug fit, and the anchoring of the “arms” helps keep it in place.] ($10 - 50 - available at discount department stores, sporting goods stores, internet)
• Latex undershirts ($20 - 80 - available from “fetish” stores, and online)
• Gynecomastia vests ($30 - 100 - available from online vendors and some specialty pharmacies)

Where to buy:

Morris Designs
(offers several options of gynecomastia vests)
http://www.morrisdesigns.com/gv.htm
800-766-5578 (toll free)

Mr. S. Leathers
(offers custom made latex undershirts)
http://www.mr-s-leather-fetters.com/

Underworks
(offers a large selection of options for binding)
http://www.underworks.com/

T-Kingdom
(offers 8 different designs: t-shirt, mid-length, and sports-bra styles)
http://www.t-kingdom.com/products.htm
Telephone: +886-955-580-595
Address: No.6 Alley 1 Lane 52 CHUNG-HSING Street,YUNG-HO CITY,TAIPEI COUNTY
234, TAIWAN

Funding chest surgery can be a very stressful journey. While many people work several jobs in order to try to save enough money for surgery, others may not be physically or emotionally able to work at all (or work extra hours due to disability issues).

For those on disability who desire chest reconstruction, the prospects of slow, incremental saving for chest surgery is often daunting (and may take a dozen or more years). So too is the realization that one may never be able to afford surgery and may need to bind or “conceal” his chest or live with the body he has.

FORGE has heard of individuals who have been able to have chest reconstruction or breast reduction paid for by Medicaid. We are still looking into finding out more details and will post an additional follow-up when we have more information.

Some options for funding surgery can include applying for a loan. Many people seeking chest reconstruction have used the following loan agencies:

ASPS (American Society of Plastic Surgeons) Patient Financing Program
800-834-9262

Cosmetic Fee Plan
888-440-2375
http://www.amerifee.com/cosmetic-surgery-financing/

Patient Financing System
888-737-3679

Unicorn Financial
3520 Thomasville Road
Tallahassee, FL 32308
888-519-6111
http://www.unicornfinancial.com
inforequest@unicornfinancial.com

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A request was teasingly made at the meeting to see the results of some chest surgeries. Transter.com houses dozens of surgery pictures and is a great resource for checking out the results of various surgeons, body types, and outcomes.

A few post surgery results pictures of one FORGE member can be viewed at:
www.forge-forward.org/socialsupport/surgerypix.html

Last month's follow up resource focuses on hormones. Please refer to http://www.forge-forward.org/socialsupport/hormones2003.html for more information on

1. Methods of testosterone delivery
2. Effects of testosterone
3. Health maintenance
4. Where does testosterone (injectable) come from? Is it kosher?
5. Injection how to (& needle phobia)
6. Factors that may influence dosage or ability to take hormones
7. Testosterone availability

Several specific questions arose around hormones at the November meeting that were not addressed in October or in the follow up.

a. Androstenedione

Androstenedione is an over the counter product that contains synergistic ingredients that work together to increase natural steroid testosterone levels for accelerated muscle and strength gains. This line of products are often used by non-trans men body builders in hopes of achieving greater muscle mass. Its safety or efficacy is unknown and unstudied.

The effects of androstenedione in naturally estrogenated bodies (i.e. pre-T FTMs) is unknown and may prove to be harmful, or null in its overall effect. Please use caution when using non-prescription supplements.

b. Typical dosage of testosterone

There is a WIDE range of dosage variability, based on desired outcome, health status, medical conditions, other medications, etc. Many healthcare providers prescribe a dose of 200mg/ml of injectable testosterone every 2 weeks. Body size has no effect in determining dosage. Blood levels are one of the few ways of accurately gauging how much testosterone is being absorbed and metabolized, and if these levels are achieving desired results.

Taking additional testosterone in hopes of creating more masculine effects sooner can backfire, since testosterone does convert to estrogen, when the body cannot absorb and metabolize the amount of testosterone in the body. Working with your healthcare provider is the best way to assure the safest and most desired results from the use of testosterone.

c. Do you have to be on testosterone for life?

The majority of FTMs+ who start on testosterone, continue on with hormones for the rest of their lives. Sometimes medical conditions require them to stop, or they may change dosage based on age, desired effect, hysterectomy, or other factors.

Some people choose to use hormones to achieve specific masculinizing effects. For example, some people wish to have a deeper voice. Since vocal cord thickening is a permanent result of testosterone use, after the desired vocal range is reached, testosterone therapy can be discontinued.

There are many variables in determining how long, and how much (if any) testosterone is used. Decisions are typically made by both the individual using testosterone and his/hir health care provider.

d. What effects are permanent vs. what goes away when t is stopped?

Some effects from testosterone are permanent, including deeper voice, enlarged
clit/neo-phallus/..., hair loss, and/or body hair growth.

For most people, if testosterone is stopped, the change in fat distribution will return to a more "female"/hourglass form, menstruation will likely resume, libido may decrease.

e. Title 19/Medicaid paying for hormones

Many people have their hormones paid for through Medicaid. Coverage tends to happen with fewer holdups or challenges when the gender designator on the insurance card/plan "matches" the hormones received. i.e. if you are wanting testosterone paid for, the billing process has fewer problems when your gender designator is male.

f. Compounded testosterone cream

Our Minnesota neighbor FTM group, The TMen (www.tmen.net), wrote FORGE
a great note after reviewing the last FORGE follow up resource on hormones.
Tyler wanted to share his/their experiences with our FORGE readership:

“I always appreciate your great meeting writeups! I was surprised to see that compounded testosterone cream was not included in your list. Just about everyone here is on it or considering trying it. It's a much better alternative to shots than the gel, around 1/5th as expensive, as well as easier to use (a great option for those with no insurance coverage). We are finding out the hard way (and medical research confirms) that the gel (AndroGel) 'lives' for 10-20 hours outside of the body, including on doorknobs and sheets. Partners of transmen on testosterone are reporting unwanted side effects from exposure to this leftover AndroGel. It can be especially damaging to partners who are taking medication for depression, as hormone level changes can throw a good depression management situation completely out of whack.

“Any compounding pharmacist should be able to make testosterone cream. The dosage varies; usually 1/4 teaspoon a day is prescribed, with the percentage of testosterone in the cream varying from 5 - 20%. It requires a high degree of personalization / hormone level testing, as absorption rates differ from person to person. The cream does have a potential for passing testosterone on to others as well, but the time period is much shorter and it is more easily washed off.”

Coming out and/or transitioning on the job can be nearly (if not equal to or greater than) as stressful as coming out to family. In working with people, relationships are formed and roles are often defined, which are sometimes difficult to shift after they are initially forged.

Some suggestions that were addressed at the meeting about how to make transitioning at work easier included:

a. Pick a transition date

Some people find that choosing a specific date and announcing it, makes the transition go more smoothly at work. Some find it easier to pick a date that accompanies returning from chest surgery or having their name legally changed, while others pick an arbitrary date.

b. Use “fun”/playful language in “coming out”

Some people like to announce their gender transition at work in a serious way, while others use more casual language, concepts or means of coming out. One suggestion, for work settings that would accept it, is to use a “birth announcement”. A card that states: “It’s a boy: male pronouns gladly accepted” is often a great kind of “icebreaker” that also gives people some concrete clues about how to interact with the transitioning person.

c. Androgynous vs. masculine names

Some people are very attached to their given name, or a name they chose at some point in their lives - often an androgynous name. In some work environments, depending on the relationship of individuals, how long a person has worked there, the company politics, etc., keeping an androgynous name can make co-worker acceptance and behavior change more difficult. It’s often easier for OTHERS, when the name, gender and everything changes, marking a distinctive difference and new set of expectations. Of course, picking a name or keeping a name is very personal and likely shouldn’t be dictated by co-workers’ abilities to make changes!

Passing in general can come easily or can be quite difficult. It’s not always clear why some people pass successfully most of the time and why others have routine challenges.

At the meeting we discussed many traditional concepts surrounding passing, including secondary sex characteristics cuing, facial hair, vocal patterns and pitch, wearing ties or other overtly masculine cues.

Some interesting concepts that arose at the meeting included how the lack of confidence can often lead an outsider to have a female perception. Likewise, how, in American society, smiling is sometimes associated with females and femininity, and when men smile, this may tip the scales a bit to the outside observer. We also discussed the “energetics” of being male or female, as well as the internal confidence of our gender. The more confident we are, the more comfortable and certain we are about our gender, the more we energetically “give off” that we are that gender. One way to reach a higher level of confidence can be through “simple” affirmations.

Many people also like to be prepared for when they experience people’s ambiguous or “wrong” perceptions of our gender. When the store clerk says, “thank you sir, oh, I’m sorry, I mean ma’am”, what can be done to affirm that she was initially correct? Having ready-made, quippy comebacks can be quite helpful to bolster confidence and affirm your gender in situations like these.

Because of the format of our meeting, we didn’t have much time to discuss the pre-determined topic of aging!

For more information on how aging and transgender intersect, please refer to the Transgender Aging Network’s section of the FORGE website, located at www.forge-forward.org/TAN/

If you are over 50 and would like to join a very active, friendly email support list, contact LoreeCD@aol.com and say why you are interested, to be added to ElderTG.

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For more information about FORGE (meetings, past meetings, basic information, resources), please contact FORGE, PO Box 1272, Milwaukee, WI 53201. Phone: 414-278-6031. Email: info@forge-forward.org.