Problems of Transition Later in Life

[Beth-Lock]

There are advantages to transitioning late in life, getting past one's working life, completing it with male levels of pay and without disruption, of problems finding a job due to being trans, and also having the savings to pay for surgery and counselling, saved up. Still, the most often cited regret in transitioning, is not being disappointed with one's new life as a woman, but regretting one did not do it earlier.

An informational radio program, however pointed out one more reason that postponing surgery might be bad. It was saying that the weakening of a persons's immune system's ability to cope with cancer, and after surgery the cancer really take off, and is unstoppable. Few will be recovering from cancer before SRS, but it may effect other problems of old age. And the double whammy of SRS and FFS/BA, might be too much to recover from, without health problems late in life, especially when the psychological/depressive problems of commencing HRT are added in. Another problem with surgery of any kind late in life, is that one needs to be fit physically and not too fat. When all these three physical changes of transition are added together, you might not meet the qualifications for the second or third of the physical changes in the series.

I know myself, I am now too obese for any further elective surgery, though I certainly could use the advantages of BA. .There were good arguments for not having it at the time of SRS, while still on the operating table, but in retrospect, I should have opted for that, and it was offered at Montreal. So, losing weight, not an easy thing, while eating healthy is my challenge now. So, already, I have many reasons to regret having transitioned too late, even though the delay due to counselling problems likely added at least five years to my age when I was able to get approval for the first of the physical changes. So many things you think you have control of, can get out of control for reasons one does not anticipate and cannot do anything more than I did, to avoid. Managing the Doctors, is not so much under ones control as one might think. This means that you may be deprived, in complicated circumstances that ensue, of all the choices you thought and planned to utilize. What actually happens may not be what you foresaw, as options can be taken off the table by circumstances beyond your control. That kept happening to me.

[Eryn]

You make some good points. However some of us north of 50 are not contemplating bottom surgery, simply because we don't plan to use the equipment. For some, SRS is absolutely needed to be "whole", but for me at my stage of life the benefits don't warrant the discomfort, risk, and recovery issues.

HRT, on the other hand, has some positive benefits in terms of blood pressure, prostate health, and urinary tract issues. I'm actually healthier now that I am on HRT!

[karenpayneoregon]

I would like to add this thought for those contemplating gender reassignment surgery, at least for me whom seriously started my transition, living fulltime six years ago without hormones which began two years ago was because there was “that” driving force within the brain saying “you” can’t continue on this path living as a male when there is a female that refuses to stay contained within.

Up to this point the female inside was subdued, not content at all yet did not rebel to the point I was unbearable to let her out. It was never about trading male parts for female parts and have the capability to use female parts at all and if never used I knew (or should I say, she knew) it had to be done. Physical fitness has never been a problem because I have always kept in good shape from teaching physical activities to exercising several times per week where the exercising has now gone to six days a week. Couple this with good genes, females in my family history tend to live past 95 (my mother is 94 currently).

I believe if transitioning later in live there are going to be regrets but for some without transitioning life will become intolerable which could very well lead to suicidal tendencies or worst. I never got to that point but know the signals were there pointing to unhappiness if transition was not done. Breast augmentation was never a factor in that it would satisfy me and didn’t have BA until four months post-op, this was simply to complete the image and to forego the need for breast forms which I endured for many years.

Thinking back to being rolled into the operating room I remember the assistance saying I was one of the most relaxed going into surgery. I simply smiled and said "I feel not different than going to the grocery stored to buy a loaf of bread".

[Linda Z]

total agree with Eryn

I have had 4 years on HRT, and have had many positive benefits in terms of blood pressure, prostate health, physical activity and other body issues.
yes! "I'm actually healthier now that I am on HRT!"

[LeaP]

The OP is right in the general caution against age as a factor in taking options off the table. As in, you're not getting it no matter what you want. You may not. End of story.

To the extent I disagree, it is (as I see it) in partially presenting this as a matter of options and relative weight in decision-making. There is a subtlety here. All of us weigh our options to SOME degree. But risk and competing considerations are often overwhelmed by raw need.

Re HRT. My general health is also better. But I also accepted the risks hormones carry, up to and including shortening my life (i.e., killing me). You all know the whys of that ... no need to detail them

[pamela7]

http://www.endocrineweb.com/professional/gender-identity/transgender-hormone-therapy-safe-when-monitored-certain-risks

this article provides backup review of the hrt dangers, recommending them to be small in most cases.

[LeaP]

The full text is here: http://www.jctejournal.com/#/article/S2214-6237(15)00049-6/fulltext

Let me say that the conclusions are as thin as the data. Some are simply VERY old news (ethinyl estradiol impacts). Some border on absurd ... The cite of transgender men not showing liver impact after 3 months(!) of hormones is an example. Some miss the point - citing no VTE impact associated with oral estradiol when the concern is actually liver impact - and then confirming elevated inflammation rates! Figures can look more reassuring than they MIGHT be. Breast cancer risk in the MTF not elevated? Maybe, maybe not ... But the studies cited depended on the *identification* of trans-women. I.e., had you come down with breast cancer and never identified yourself as trans, you never made the study. And no-one collects such statistics outside of studies with identified cohorts anyway. Surveys and studies that sample outside of these are very problematic.

There are severe limitations to how far you can project conclusions even in a single trans study, as you likely know. The problems in getting to precision are legion and well-known, making any of them something of a blind exercise in feeling elephants. Surveying the surveys is akin to interviewing all the blind people who weren't exactly sure what they grabbed. Volume sometimes makes up for data deficiencies in interesting ways. Lynn Conway's incidence analysis is a good example. This study? Not so much.

I think your characterization is a little off, Pam. What it really says is: "Compiled evidence from this literature review suggests that HT for transgender individuals is safe without a large risk of adverse events when followed carefully for a few well-documented medical concerns ..." Shall I say the converse is true? What do you think?

[pamela7]

i think it's complex beyond the likely understanding of any medic so far, because research has been thin on the ground. I've personally seen no stories here that show HRT to cause problems; anecdotal, small sample, yes.

My Dr was aware enough to get a comprehensive blood test and to review it with me, to say i seem safe for HRT.

But yes I think we'e woefully ignorant presently. Biochemistry is still a science in infancy. I'm also not convinced about the effects of not taking HRT after an orchidectomy. For example, for thousands of years eunuch's flourished with no signs of osteoporisis, and one of our members here was castigated for having srs but no hrt. I don't see this as cut and dried at all.

[LeaP]

I'd say we're in violent agreement, then.

Not so on eunuchs! Skeletal studies on Ottoman, Chinese, and Russian (Skoptze) eunuchs all showed osteoporosis, often quite advanced.

Your last line ... Cheeky!

[pamela7]

didn't know that part, tho the question stands as to whether they lived a more sedentary lifestyle leading to osteoporosis?
i did see a programme about a japanese chef serving up her testicles at a special meal post-op ;-)

[Starling]

This is super-anecdotal, but I believe from my own experience that the stress-reducing effects of orchiectomy plus HRT would provide great long-term benefits to my overall health.

:) Lallie

[Rachel Smith]

You make some good points. However some of us north of 50 are not contemplating bottom surgery, simply because we don't plan to use the equipment. For some, SRS is absolutely needed to be "whole", but for me at my stage of life the benefits don't warrant the discomfort, risk, and recovery issues.

HRT, on the other hand, has some positive benefits in terms of blood pressure, prostate health, and urinary tract issues. I'm actually healthier now that I am on HRT!

100% agree.

[flatlander_48]

B-L:

Everything that we do as humans carries some degree of risk. Sometimes that risk is insignificant; other times if far outweighs the benefits. To properly evaluate risk, you have to think about it in current times and with whatever available information that you have. Clearly what information you have from the past may be quite important,

BUT YOU CANNOT CHANGE THE PAST WITH A CURRENT DECISION.

I won't say ignore the concept of regret, but it is a place where we cannot dwell. We can't change it or fix whatever happened or didn't happen. If we dwell there, it has the effect of poisoning the future and that is something to be avoided.

DeeAnn

[MsVal]

Risk, compared to WHAT?

There is risk in transitioning.
There is risk in NOT transitioning.
There is risk in every decision we make.

Some members of the community determined that FOR THEM the risks of not transitioning outweigh the risk of transitioning. Others either came to another conclusion, or no conclusion at all. It's a personal case-by-case decision.

I will however point out that many had a "transition or die" choice.

Best wishes
MsVal

[Beth-Lock]

B-L:

Everything that we do as humans carries some degree of risk. Sometimes that risk is insignificant; other times if far outweighs the benefits. To properly evaluate risk, you have to think about it in current times and with whatever available information that you have. Clearly what information you have from the past may be quite important,...

I thought it through carefully while on the waiting list for SRS. Problem is, if things go really badly wrong, you completely ruin the life you have, and so on. You can only hope the consequences of losing the gamble are not devastating. Then too, those seeking SRS are likely to be fragile, so the impact of problems are magnified.





BUT YOU CANNOT CHANGE THE PAST WITH A CURRENT DECISION.




But, when you face trying to fix the problem afterwards, you hopefully learn not to make the same mistakes. I am now rather risk averse Just one minor example, is that now, I will tell nobody the real story (in full), and even then only tell part of the story to someone face-to-face that I trust. So arguing these things over the Internet is silly and non-productive.



I won't say ignore the concept of regret, but it is a place where we cannot dwell. We can't change it or fix whatever happened or didn't happen. If we dwell there, it has the effect of poisoning the future and that is something to be avoided.



In the words of an old joke, I could only say, "Fantastic!" to that. And as I have said many times before, I am NOT a regreter.

[LeaP]

I won't say ignore the concept of regret, but it is a place where we cannot dwell. We can't change it or fix whatever happened or didn't happen. If we dwell there, it has the effect of poisoning the future and that is something to be avoided.


As a truism, I agree. I'm not sure it applies well to a transsexual. After all, the same could be said - and often is, by non-TS - of living with what you were born with. It's the substantive difference between choice as preference vs a fundamental violation.

[flatlander_48]

But, when you face trying to fix the problem afterwards, you hopefully learn not to make the same mistakes. I am now rather risk averse Just one minor example, is that now, I will tell nobody the real story (in full), and even then only tell part of the story to someone face-to-face that I trust. So arguing these things over the Internet is silly and non-productive.

There is nothing to argue about. What I said is a fundamental fact of human existence. As I said earlier, information from the past may be quite important, but the original event happened and it will forever be so. As has been said here many times, you can't unring a bell. That original mistake, regardless of what you do subsequently, will continue to exist. About the only way to change that would be time travel.


In the words of an old joke, I could only say, "Fantastic!" to that. And as I have said many times before, I am NOT a regreter.

Sorry, but that's the impression I got from the middle of your last paragraph.


As a truism, I agree. I'm not sure it applies well to a transsexual. After all, the same could be said - and often is, by non-TS - of living with what you were born with. It's the substantive difference between choice as preference vs a fundamental violation.

If someone is stuck in a state of regret, that takes time and energy away from moving forward. And, it's easy to become a social pariah if every time you open your mouth you say something about what you regret. On one wants to be around that kind of negative energy. Saying that this doesn't apply to transsexuals is sort of like saying that the Laws of Physics wouldn't apply to them either.

DeeAnn

[LeaP]

DeeAnn, all I think you've done is emphasize the truism again. I referred to the same concept being applied to a transsexual learning to live with their birth condition, i.e., their physical sex and assigned gender. As a practical matter, that simply doesn't work for lots of transsexuals. There are things which cannot be tolerated or which one cannot move beyond. I really don't know what to say if you don't accept that as the starting premise for my next statement. Which is, that if it is not possible to move beyond one's condition pre-transition, then its failure is equally intolerable, i.e., also not amenable to moving on.

If you think through a few scenarios, a few paradoxes will be evident. Should one need to transition else forfeit their life, for example, and then regret, it appears to call in question the original need. The invalidation of the original need might suggest that the post transition regret is something not so fundamental after all. Meaning that one possibly could move on! Conversely, were someone to transition without the threat to their life, it's implies they should have been able to move on with their lives as they were!

The missing elements are, of course, personal characteristics and considerations. But just as the scenarios can't be reduced to logical constructs, the personal aspects cannot be reduced to the psychology of options and coping.

People can cope with a lot. They can endure loss and hardship. Broken relationships. War, injury, disablement. Severe psychological issues. And, of course, people can and do endure affronts to their dignity and identity.

What a non-trivial percentage of transsexuals cannot endure is the denial of their essence. The proof of the pudding is in the suicide statistics. And, if you'll accept it, as well in the rates and depths of psychological issues the population suffers as a whole. The denial may come or hit home pre-transition or post-transition. It may also come post-transition in ways not anticipated.

[flatlander_48]

There are things which cannot be tolerated or which one cannot move beyond.

No, I don't think that is true. It sounds like an excuse to be stuck.

There are people who have forgiven murderers of their loved ones, detainees who have forgiven their concentration camp guards and victims of the worst kinds of discrimination who have forgiven the perpetrators of that discrimination. Our usual way of going about things would make it very hard to deal with these kinds of things, yet some people can. It is possible. Not saying it is easy, and it may require external help, but it is possible.

To me, what you're saying is that the internal turmoil that transsexuals can have, and considerable though it is, is somehow worse. I don't think that I can agree with that. This is not an attempt to lessen the degree of internal strife that transsexuals can have, but I think trying to quantify and compare degrees of difficulty is not useful. If the chosen method of dealing with a problem is suicide, does it really make a difference that the fundamental issue was being transsexual, gay, divorced, etc.?

From my understanding, people commit suicide because they believe their situation is hopeless and there is no way it can ever change. They do not see a path forward. However, what I believe is that if you find the right situation with the right people and support, progress can be made. Sadly many people do not find a situation that would change things for them.

DeeAnn

[LeaP]

DeeAnn, the logical endpoint of your argument is that because the transsexual condition is no different than any other life problem, transition isn't strictly necessary under any condition and is a choice under all conditions.

My position IS that there's a fundamental difference. That though choice plays in a number of ways, the condition is also something that is not reconcilable without transition. I.e., the one (and only one) solution. This is hardly a novel idea, as it is firmly embedded in both theory and practice. Please note that I am not interested in arguing semantics here. You can adapt your definition of transsexual or, alternatively, adopt a broader view of what constitutes transition. Same rationale.

One of the reasons the OP is worthwhile is in its warning that one's transition may be short-circuited by something as simple as time. The best case result for a transsexual in that scenario is still dismal. Even if they don't dwell on it and even if they optimize what ever it is they have left or available.

[flatlander_48]

I don't like the suggestion that one person's agony and misery is necessarily worse than someone else's. I don't believe you can quantify this because it is all internal. It is how it feels to that person. In real terms, if I have a stomach ache or a migraine, can I explain to you EXACTLY how it feels? No. Further, even if I could explain it, would it be understood EXACTLY how it was intended? No.

DeeAnn

[LeaP]

There's nothing here that requires comparisons of pain and suffering. Nor is this the only condition that kills people. It does have a unique solution.

[flatlander_48]

It relates to what I quoted in post #19. People get beyond horrendous things every day. Not saying that it is easy or the work of a moment, but it is possible. When you say "There are things which cannot be tolerated or which one cannot move beyond." it leaves the impression that the related experience is somehow worse than what others may experience and is therefore intractable.

That's a slippery slope because it can lead to making all sorts of odd judgements: Is divorce worse that the death of your favorite uncle? Is losing a leg worse than losing an eye? Is not being able to transition worse than losing your home and all of your belongings in a flood? Is being mis-gendered worse than being the object of a sexist or racist comment?

When value judgements continue to be made, it's a short step to some people being better than, or worse that, others. That's not a place where we should be going.


DeeAnn, the logical endpoint of your argument is that because the transsexual condition is no different than any other life problem, transition isn't strictly necessary under any condition and is a choice under all conditions.

Clearly not true. The condition is certainly not the same, but I believe the potential for causing pain, despair and depression isn't any different. One can adopt addictive behaviors, be severely depressed and even suicidal for a number of reasons; not being able to transition is one of many.

DeeAnn

[Barbara Ella]

Lots of nice comments here. It is true to some extent that age is a factor, but it is a highly individual one. No one should come away thinking that just because I reached a certain age, I cannot pursue the surgeries I deem necessary for my life. A very good friend just completed her FFS, and SRS all in the same year at age 69, and is doing wonderfully. Have never seen her more happy and healthy. We make our decisions, and we work to achieve what we need.

Barbara