Shuffle Meme - Part 3

Unexpected HRT side-effect #15

My HRT regimen is an emulation, only simulating the real thing. Cis women experience a complex, month-long dance between estrogen and progesterone, swinging from one to the other and back again. I, on the other hand, experience an estrogen peak every two weeks, and a progesterone peak every quarter.

And that's okay! It's gotten the job done.

Sometimes however, my peaks and troughs happen to look just enough like an actual cis cycle to trigger some fascinating side effects.

This one occurred a few weeks ago. My day started as normal; but something seemed off. I got to work, and began to experience stomach cramps. My first thought was that I must have consumed some disagreeable foodstuff; but this was different - the sensations were prickly; and extended all the way into my pelvis.

It wasn't until lunch time, as I was driving my daughter home from summer school, that it came to me: these were menstrual cramps!

My hormone levels had aligned in such a way that my brain was now sending instructions down my existing nerve pathways to forcefully contract a non-existent uterus...

This state of affairs continued for two days; with what I can only describe as various muscle groups from the top of the abdomen all the way down to the thighs randomly and constantly pinging, eliciting a continuous stream of "Ow! Ow!" noises.

Now: is this exactly what cis women experience? I have no idea. Did the lack of uterus effectively cap the amount of discomfort I felt? Or did it cause the nerve signals to be redirected into other adjacent muscles, making their contractions worse? It's so hard to say.

What I do know is this: I already had a healthy respect for the unpleasantness of menstrual cramps as experienced by others; but this situation made for a very personal window into that world that really reinforced my prior understanding!

Addendum: there is a candy dish in my office that is periodically emptied, and refilled; fortuitously, its contents had been refreshed the day this all went down. My very audible "Oh, thank god!" drew laughter from one of the people that worked nearby and knew what I was going through!

Transition-focused

Sometimes I worry that I come across as overly focused on the subject of my transition.

“So what have you been up to?” “Oh, you know. [Transition stuff].”

In project management parlance, transitioning is a multi-year project with multiple tasks, all of which have their own sub-tasks, and so on. Resources must be acquired; unforeseeable issues spontaneously arise and must be resolved.

I would not necessarily call this timeconsuming or overwhelming (although transitioning can be these things at times); but it’s pervasive. It touches every part of my life and requires constant care and attention.

A simple example: I wanted to change my legal name. In America, this generally means going to the county probate court and getting an order to that effect.

Every county has its own process and paperwork (although the vast majority at least try to adhere to some kind of nationally-distributed model process). All together, there were five forms.

I also needed to provide notarized copies of various personal records, so I had to get those.

Once everything was submitted, I had to wait for an invoice from the local legal news publisher; and then pay them to release a statement recording the name change.

I had to talk to the court and the publisher multiple times for input on what to do; to check up on the status of my case (”Oh, sorry - the person that mails out the confirmation was on vacation for two weeks”); and so on.

Eventually the court order was created, and I could pick up my copy of this incredibly important legal document.

Having done all this...

...I now get to reach out to the dozens and dozens of organizations that keep track of my legal identity and inform them that it has, in fact, changed.

...And some of them have their own requirements for updating their records; which necessitates addressing certain organizations in a certain order (BMV; Social Security; employer)...

All of this, all of this merely to change my name. One of a multitude of tasks.

Overall, this has been one of the most rewarding processes of my life; I would repeat it in a heartbeat. If however I do come across as eternally preoccupied with my transition, it’s because - at least for now - it constantly effects me, every day and in all ways (physically, mentally, emotionally, socially, legally) and I have no choice but to dedicate the necessary brainpower to managing these things.

Sleeping arrangements: addendum 2

I have been reliably informed that my previous illustration of the idiosyncrasies of flashback-driven sleeping positions did not sufficiently emphasize my spouse's ample biceps; I have therefore attempted to rectify this issue as follows:

Interview

So; a funny thing happened at work today!

We're trying to hire in a junior developer. My boss is great at interviewing; but software development is outside of his area of expertise (he's more of a network / infrastructure guy), so he really wanted my input on this.

I straight-up told him: "You need another me; a generalist that can do everything from front-end to back-end, and more importantly, can figure out how to do things they have no prior experience with".

Fast-forward: we have a candidate coming in for an in-person interview. Two items peak my interest:

She's female. (This absolutely shouldn't be remarkable; but unfortunately, there is still a very, very heavy gender imbalance in the software world.)

Her name was simultaneously contemporary and fashionable, yet rare.

This really made me wonder... And my suspicions were confirmed when I entered our conference room and saw that she had bright blue hair.

I can only wonder what her thought process was - how intimidating it must be to walk into a prospective job interview as a trans woman, only for one of the interviewers to be introduced.... as a trans woman.

It was a good interview. Afterwards I told my boss: "When I say you need another me, I didn't mean literally"!

The final decision isn't mine to make; but part of me really hopes that she gets the job. I see a lot of my younger self in her (outside of the obvious parallels); and I would love to be able to mentor a neophyte developer, in much the same way that I was tutored by my friend and colleague.

“The Importance Of Having Focus”

A Familiar Comedy for Inattentive People.

Act I.

LAUREN.

[Stiffly.] Good heavens, my back! This suffering is most insufferable; one would pen a remonstrative missive to the Times, were such an endeavor permissible in the purview of one’s own pernicious musculature!

LAUREN.

[Crossing room.] Oh, ibuprofen; faithful, dependable ibuprofen! Come to me now; I require release from the animosities of this fractious anatomy. [Opens bottle and swallows pill.]

Act II.

LAUREN.

Wait.

LAUREN.

…That was the cat’s thyroid medication.

LAUREN.

[Exclaimingly.] Fuck.

I know they selected “Death Riders” as their new group moniker; but “BCC: PAC and White” was right there!

I love that the uniform is white shirts and then there’s PAC.

I went the injectable route at the advice of a friend; and I always wanted to share my knowledge on this subject with others. Talk about perfect timing, too - it’s injection day!

Disclaimer: there’s a lot of room for variation in terms of what’s injected, how it’s injected, etc.; be sure to ask for and follow the instructions of your provider.

Medications

I inject 1ml of 5mg/ml Estradiol Cypionate (brand name: “Depo-Estradiol”), every two weeks; and 1ml of 150mg/ml Medroxy-Progesterone Acetate (brand name: “Depo-Provera”) every ninety days.

Keep a diary of your injections; and in particular the manufacturer, lot, expiration, and serial number of every medication (all of which will be clearly printed on the packaging). This information can be helpful when identifying issues.

Vials

Both medications come in little glass vials. There’s a sterile plastic cap on top (which you break off); and underneath, a rubber seal designed to prevent air from entering the vial.

The Progesterone comes in a single-use vial, containing just one dose; you dispose of the vial afterwards. The Estradiol comes in a multi-use vial, containing five doses; you keep the vial for next time.

Note: there is a risk that multi-use vials can become contaminated with bacteria. Be sure to follow the injection process carefully; maintain sterility; and store your medication in an appropriate location and at the correct temperature, per the instructions.

In medical settings, multi-use vials are good for 30 days after opening; at which point they are disposed of. In my case, I’m keeping the vial for 52 days. I wouldn’t recommend pushing too far past that, as the longer the vial is in use, the higher the risk of contamination.

Injectable supplies

Each injection requires the following:

A syringe,

A large needle (mine are 18g, 1.5′ long, and pink),

A small needle (likewise, 25g, 1′ long, and light blue),

Two alcohol pads,

A Band-Aid (mine has llamas on it)!

Normally you’ll be proscribed a syringe with one of the needles already attached; and the other needle by itself. Alcohol pads and Band-Aids can be purchased from your local pharmacy.

Needles

During the injection process, you will need to switch the needle attached to the syringe. The syringes I use feature a “Luer-Lock” connection, which means they screw on and off.

Each needle comes with a protective plastic cap; you always want the cap on the needle when attaching or removing it from the syringe. (Safety aside, the needles are intentionally designed to make them difficult to add or remove without the cap attached.)

There’s a reason there are two needles: when you need to suck fluid into the syringe, it’s very difficult if the needle is too small. (This is why blood draw needles tend to be on the bigger side.) When you need to squirt fluid out of the needle, however, the size doesn’t matter as much. (Plus: smaller needles cause less discomfort when poking people!)

So the big needle is going to be what you use to draw your medication; and the small needle is what you use to inject it. (When I started my regimen, I asked my provider if a nurse could show me what to do. I wasn’t aware at the time that there were different needles involved; so when I saw the big needle, I was terrified!)

Drawing the medication

First things first: wash your hands! (At every step, you want to prevent the possibility of germs getting into your supplies or worse, into you!)

Take your vial, remove and discard the plastic cap, and clean the surface of the rubber seal with an alcohol pad. (This prevents contaminants from being carried into the vial.)

Next, you attach the large needle to the syringe, and withdraw the plunger so that it contains the same amount of air as the medication you wish to withdraw. (In my case, 1ml.) The plunger will have a rubber seal that meets the inside of the syringe surface; the top of the seal is what you will be measuring against.

Hold the vial level, and with the syringe pointing down, insert the needle through the rubber seal of the vial. Now, carefully turn everything upside down: you should have the syringe pointing up, and the vial pointing down (with the medication pooling around the seal).

Inject the air in the syringe into the empty space in the top of the vial; this will help keep the pressure in the vial constant. Submerge the needle tip in the medication, and gently draw it into the syringe.

It’s normal to have some air left in the syringe; or to accidentally draw some in from the vial. You can squirt some medication back into the syringe to remove the air bubbles; or tap the syringe to shake them free. Tiny air bubbles are normal and harmless; but you don’t want a large bubble in there!

When finished, withdraw the needle from the vial smoothly and quickly. (This is a non-issue with thicker medications, such as Estradiol; but with a thinner medication - such as Progesterone - withdrawing the needle slowly can cause a small amount of medication to squirt out of the vial.)

Preparing the injection

Remove the large needle from the syringe and replace it with the small one. Push the plunger ever so slightly; if you see a tiny drop of medication at the end of the small syringe; this confirms that there’s no air remaining.

You should now have a filled syringe, ready to go!

These injections are intramuscular; that is to say, the goal is to create a 'depot’ (i.e. little bubble) of the medication in a muscle. This is exactly the same as most vaccinations; except they are normally delivered in the deltoid muscle of the arm, whereas these injections will be delivered to the vastus lateralis muscle in the upper thigh.

(Location is determined by a number of factors; primarily, the size of the depot being created. Vaccinations tend to involve very small amounts of fluid; and so it is more convenient to inject them into the likewise smaller deltoid.)

Imagine the top of your thigh is divided horizontally into three sections, and you can see the dividing lines. The line nearest your body is the target. It is recommended that you rotate your injection site with every shot. My rotation schedule looks like this:

Outside of the left thigh,

Outside of the right thigh,

Middle of the left thigh,

Middle of the right thigh,

Inside of the left thigh,

Inside of the right thigh.

Keep in mind that some spots are more awkward to access than others. (Today’s injection was in the outside right thigh; as I’m left-handed, having to reach across my body is a nuisance.)

Once you know where the injection will be going, clean the area with your other alcohol pad. Give it some time for the alcohol on your skin to evaporate. (You can fan air over the skin to speed up this process.)

If there is still alcohol on your skin when you perform the injection, it will be carried into your tissue and create a burning sensation. This is not dangerous; but it is unpleasant and something you will want to avoid.

Inserting the needle

Everything is ready! (Also, there are no images for this part; I needed both hands here for what I was doing.)

Sit on a chair or similar object, so you can your thighs are horizontal and your lower legs vertical. Find a position where your muscles are relaxed. (Tense muscle tissue is harder to penetrate; it won’t stop you from completing the injection, but it can cause more discomfort.)

Take the syringe in your dominant hand, and hold it like a throwing dart. With your other hand, pull the skin of your thigh taut, towards your knee. (This is the “Z-Track” method - it helps to prevent your medication from leaking back out of the injection site.) Take care not to place your fingers on the area you just cleaned.

Now, the part that gets people: you have to stick the needle in your thigh. Understandably, there is fear that this will hurt. It’s okay if you need a minute to work up the courage! Try to keep in mind that if you do everything right, discomfort should be minimal.

When you are ready: stick the needle in, quickly and smoothly, at a 90º angle.

Do not hesitate. (I totally get it - but if the needle doesn’t fully insert, you’re either going to have to push it the rest of the way, or remove it and try again. The faster and more confidently you insert the needle, the less you will feel it!)

Don’t worry about it going too far in. There’s a plastic nub at the end of the needle, designed specifically to prevent this from happening.

If everything has gone to plan, then the needle should be fully inserted in the thigh, and no longer visible. You can now remove the hand holding your skin taut. (This can feel a little weird at first, as the underlying tissue is trying to move back into position against the needle.)

Delivering the medication

With one hand, hold the tip of the syringe steady against your skin (so that you don’t accidentally withdraw the needle). With the other, slowly depress the plunger, injecting the medication into your muscle.

How slow? Slow. Nursing guidelines recommend ten seconds per 1ml of fluid injected. I normally double that. (Also: as aforementioned, Estradiol is frequently delivered in an oil-based medium, which makes it thicker. Thicker fluids take longer - and more effort - to push through a small needle. When in doubt, go slower.)

Cleanup

Once the medication is fully delivered, carefully remove the needle, and place the cap back on. You might see a drop of either medication or blood at the injection site; this is normal. Cover with a Band-Aid. You’re done!

Place both of your capped needles in a solid container. (I use an old prescription bottle.) This way, when you dispose of them, there’s no danger of someone getting poked by a used needle.

All other supplies should be disposed of (barring the aforementioned multi-use vials). Tempting though it might be to save time and money, do not reuse syringes or needles. (This is just asking for an infection!)

Aftercare

It’s normal for the injection site to be sore the next day (as if you had an invisible bruise). This is because the act of creating the bubble of medication in the muscle does a small amount of damage.

It’s not normal for the site to swell; turn red; itch; or become hot to the touch. These are signs of an infection. Such infections are easy to treat (usually with a course of antibiotics); but it’s important to seek medical attention quickly, as they can cause serious complications if left unattended. (This is especially true of the red patch grows rapidly!)

What can go wrong?

I’m not going to lie: lots of things.

A couple of times, inserting the needle has triggered a leg spasm. This doesn’t hurt; it just feels really, really weird.

Occasionally I will accidentally hit a blood vessel with the needle. (This is unavoidable; you can’t see them from the surface.) This doesn’t pose an issue other than being mildly painful.

I once hit a nerve the same way. The pain from doing so left me in tears. (I want to stress however, that this happened once in fifty-seven shots.)

There was a syringe with a defective plunger that wouldn’t depress the whole way. That was frustrating; but simply meant I had to start over and go again.

Likewise, I had a friend whose needle detached from the syringe while it was still in her thigh. Obviously, an upsetting scenario; but one that can be avoided by ensuring that the needles are firmly locked into place prior to use.

If you have questions or issues, and need help - be sure to ask to talk to a nurse at your provider’s office! They spend a lot of time poking people in various ways, and have a wealth of expertise to offer.

Another really resource is trans men! The amount of information they’ve gathered on the analogous act of injecting Testosterone is staggering! When I run into a problem I’ve never seen before, they are my first port of call.

What can go right?

If you perfect your technique and can overcome the mental hurdle of sticking a needle in yourself, the process can be quick and discomfort-free!

On the science side: different methods of administering Estradiol have corresponding levels of bioavailability (i.e. how much of the Estradiol actually ends up in your system and doing what it’s supposed to instead of, say, accidentally being digested). Of these, intramuscular injection has the highest degree of bioavailability .

Additionally, the hormone levels of cis women are not static; there’s a complex interplay at work where they rise and fall. Injecting Estradiol every two weeks more closely resembles this cycle than taking the same amount of medication every day.

A final plus: you only have to remember to take your medication fortnightly!

In conclusion

I hope this is helpful to every trans woman thinking about going down the injectable rabbit hole. It can be rather daunting; but if you’re willing to invest the time and effort, it can be incredible rewarding!

why the fuck did I willingly switch to injectable estrogen im fucking terrified of needles

Bruises

Last night I got hit with the flashback stick, and spent most of what should have ostensibly been time in bed as time sleeping on the floor instead.

As a double whammy, I feel like both of my thighs are now bruised on the outside. This does not please me; not least of which because retreating to the floor has been a more common occurrence of late and that's bad enough without adding extra layers of physical discomfort on top of it...

Scars

I should probably preface this with a content warning for discussion of self-harm.

I’m left-handed; when I’m receiving a vaccination or having blood drawn, I will normally offer up my right arm - as was recently the case when I received my first COVID vaccine dose.

While staring at my arm in the mirror, I realized that I had self-harm scars that are still very visible; and based on their appearance, very obviously self-inflicted. (This is not the case elsewhere - they have either faded, or are normally hidden.)

I’m mortified, as it means the provider that administered my dose absolutely saw them (and will again, as I tend to get pretty mean injection site pain and I really don’t want to experience that in my dominant arm).

More generally though, it got me thinking. The reason I struggle with others seeing what I did to myself is not because I’m ashamed, but because on some level I feel that my suffering was not legitimate - that I hurt myself not because I was truly in pain, but for attention. An imitation of the struggles of others.

There isn’t really a good answer here; just another piece of the puzzle to make sense of.

The great chain

(Not to be confused with The Great Chain Of Being or The Great Chain as envisaged by Bioshock antagonist Andrew Ryan; or even Fleetwood Mac’s The Chain (although that is pretty great)!)

The start of my transition was... furtive. I imagine this is a fairly common phenomenon - trans individuals trying to build up a head of steam, as it were, before actually coming out.

In my case, I let my hair down; replaced my wardrobe with somewhat androgynous items from the women‘s section; began the process of facial laser hair removal; and painted my nails.

And it worked! These were all major milestones for me; but ones that went relatively unnoticed. (The one exception were my nails, which ended up breaking the ice with three particularly attentive colleagues.)

The first person to put all the pieces together was a barista at Starbucks. It was fascinating to experience: he had just taken our order, and was most of the way through the sentence “Have a good day-” before his eyes locked on to the crystal bracelet I was wearing and smoothly segued into “-ladies!” without missing a beat.

Later on I discovered that one of his fellow baristas was trans. At the time I really struggling with summoning the confidence to be out; and it was this particular barista that, by example, lead me to the solution: stop caring what other people think.

(Placing too much emphasis on the expectations of others is how I got into this mess in the first place!)

I make a point of thanking the people that help and inspire me (whether they are aware of it or not); and was both surprised and delighted to discover that I was now the fourth trans individual that this girl had aided.

Now that I am quite out to the world, I’m trying to pay this kindness forwards. There are trans girls I’ve run into in the wild, and I always compliment them; trans guys that have picked just the most awesome names and deserve to hear it!

There’s a young trans girl that I’ve taken under my wing, and I try to pass to her and her friends the knowledge that I’ve accumulated so far in my own journey.

I spoke with my friend Abigail about this (another individual that has done so much to help me personally); and she made the observation that one of the beautiful things about the trans community is its close-knit nature; how those that have already walked the path offer guidance to those behind them, and so on, and so on.

This is the great chain I speak of: stretching from past to future; each link a trans individual, clasped hand in hand with those before and those after them. I am so appreciative of those that paved the way ahead of me; and could not be more pleased to do my part and shepherd those that follow.