Thursday, January 30, 2014

Pain Response Changes Due to HRT


The purpose of this note is to provide anecdotal evidence in support of the statement that cognitive-evaluative pain in recollections of actual accidents jumps sharply due to exposure to sustained elevation of estrogen levels and/or testosterone poisoning in the brains of trans women (people would prefer omitting the and/or aspect in the assertion, but I am not certain).

When people recollect incidents involving physical pain from a present perspective, then they would tend to re-evaluate the pain or suppress or avoid it in various ways - not that this process alters the original memory of the incident. It is also well known that pain is multi-dimensional in nature with one of the dimensions corresponding to cognitive-evaluative pain.

While playing at home (I was about twelve years old then), I suffered a deep injury below my knee by accidentally smashing my knee into a glass window pane. Smashing into a glass pane was easy, but the pane was only partly broken and it was the retraction of my leg that caused the sharp edges to cut muscles further. I did not panic, scream or cry and was clearly aware of navigating the sharp edges (even though it was a matter of few seconds). The "full thickness" wound needed many stitches. A pain level estimate would be 6 in the scale of 11.

In recollections of the incident in pre-full-HRT stages, my reevaluations of pain and other emotions of the scene involved "nothing special". Obviously I am talking simulations here. But in last few months (as of this writing), reevaluations of pain of "sharp glass cutting muscles part" have become more severe and generate sharp emotions. I am reading this as a completion process of response that happens by aggregation.

Apart from the many conjectures and studies that this account suggests (given the limited  number of studies on the topic), I am also interested in formal models that capture aspects.


Sunday, January 19, 2014

Close To Death - Aspects of Living with Gender Dysporia

Abstract : This is not exactly a 'coming out' declaration, but a supportive document that seeks to provide an account of key parts of my life in relation to my handling of gender dysporia. It should be of interest to a wide variety of people including medical researchers, feminists, trans activists, social reformers and others. Admittedly I was not particularly interested in documenting my personal experience on-line as I prefer communications in the abstract-able - it was one of my ex-GFs who asked me to write it. 


Lived experience is naturally relevant in the discourse on trans-sexuality for resolving key questions in the development of trans-sexuality. A number of papers on foetal development of trans-sexuals and confirmation of parts of gender identity being in the brain have appeared recently. Gender identity, of course, is far more complex. Development of substantial parts of brain sex differentiation and gender identity happen during foetal development and independently of the development of sex organ differentiation. But much remains to be done for a fine grained account of the fact of 'gender continuum'. Is 'trans-sexuality' like an 'inter-sexuality of the brain'? There is much support for this view. If you want clarifications on terminology then do look at the links in my home page and this document.

It is often said that trans women live on the edge, but for some it is the closeness to death that captures the living.

Early Period

To start with, a few of my official documents do state that I am MAAB. Since the age of thirteen/fourteen, I had noticeable dysporia. This had expression in terms of hatred/strong dislike of secondary male characteristics and wanting to be a more beautiful girl (to start with). 

Some relevant background:

I remember very little about the period before I was 9 years old. Apparently I can recollect the existence of few neighbors, no relatives and some of my early field studies on the association between placement, form and type of physical objects in detail and emotions - interesting no doubt. I knew a few things about human sexuality then.

I have always been brilliant, studious and extremely imaginative and was so at school and had a huge collection of merit cards by the age of nine. The only nuisance subject was Tamil in which I never fared well. Physically was naturally androgynous, thin and strong during my school days. Friends circle at school was of pretty mixed type and restricted to my age group. In Indian schools we do not have sex education, but Life Science /Biology books of middle schools do have chapters on human reproduction. Diversity in sexuality was all taboo, never discussed or known and summarized in "bad words". I knew about some skewed sexual dynamics at the age of ten itself through such chapters and women's magazines. I was already into girls at about that age, but essentially from a lesbian perspective. It is also perfectly normal for me to dream in class about going down on my beautiful science teacher in particular in secondary school - some crushes can be strong. At times would reflect about GFs getting pregnant ... obviously the books were not well written.

During my school days I had about three circles of friends. The local neighborhood circle was essentially organized around shared interests in sports and games, though the primary interest of most of them was about career, studies, getting into various technical fields or science or commerce (typical of the middle class)... most of them were older than me by over a couple of years and I was a junior member of the group. Cricket was privilege. I bowled with a run up of 20 or 15 steps, but never developed genuine pace ... was a good aggressive, and elegant left hand batswoman with good technique. Even went on to open the innings for my school team and few other clubs. This group had boring addas (discussion sessions) and naive views on sexuality ... nothing special.

The students at school were divided partly on the lines of gender and further in a nested way on 'relative goodness'- those who were good at studies and are not into pursuits like smoking, scholarship in verbal abuses and sexist western/bollywood movies were all 'good' and the rest were deemed to be 'bad' in the gendered narrative. I was of course in the 'good' category. The school catered to middle and lower middle class students and substantial sections suffered from malnutrition. As far as I can remember, nobody bullied anybody else at school or in any other circles. People lacked energy in general.

 

Onward With Gender Dysporia

I had clear gender dysporia since I was 13--14 years old. It was accompanied by gradually increasing levels of depression and the 'poisoned by testosterone' feeling. Academic performance was affected somewhat in my school final exams, the difference being between "very good" and "excellent" (We were never trained for writing examinations). In the following two years, I became severely deviant from prescribed "course work" - diversifying into higher mathematics, physics, psychology and politics that did not quite belong to the higher secondary (HS) syllabus. I could not cope with dysporia and my performances in the exams were erratic - obtained a rank in medical entrance examinations and bad result in the HS examination. I was interested in pursuing physics and mathematics at UG level and so did not join medicine. That I did and soon the focus shifted to Mathematics. Dysporia was however not an important reason for my severely nonstandard style of approach to the subject.


My ability to handle partial information and information gaps played an important role in my knowledge acquisition, assimilation and research at all times -- apparently I developed the some of the killer skills in my studies on psychology. Methods of reasoning and knowledge processing are not slaves of a subject.

I had access to vast collections of books in STEM, literature and arts at all times. Plus I built my own personal collection in STEM fields and had access to over three libraries since late school. I read a lot about Pavlovian behaviorism and work of Soviet psychologists early on when I was in class-IX or so. The interest in psychology was also due to depression accompanying dysporia. I usually prefer cognitive approaches for almost anything. Behavioristic approaches can be useful in mass psychology and similar contexts. During my undergraduate years, I had access to the British Journal of Psychiatry reports on application contexts - including ones on trans-sexuality cases. The poorly written reports were about trans woman in UK and their treatment. It was difficult to find many reports on lesbian trans woman then as people were closeted or bigoted and doctors reluctant. Accounts of the interaction of lesbians in the media then were wild and often filled with myths and erasure. Media reports about trans woman in the early nineties were naturally lacking in information and stuck to ridiculous paradigms like "sex change is all about SRS". The best treatment regimen then would involve more than 100x the modern dosage of ethinyl estradiol (not recommended) along with its difficult multi-pass side effects. Spironolactone was also not the anti-androgen of choice. In those days, a plethora of irrelevant psychiatric clearances were required for hormone replacement therapy (HRT). I did contact a psychologist for related clearances then, but was not allowed to proceed due to opposition at home.

My parents have always been of a conservative, highly superstitious, religious, casteist, bigoted, narcissist and brainwashed type serving the interests of the patriarchy and corporatocracy. Of course, my father was worser of the two. Their expenditure on religious nonsense would exceed many fortunes and their concept of 'gender = sex' has always been contaminated with religion, caste and related nonsense. They have been a hindrance all through and that is that. For reference, typical conservative Tamil brahmins of their age group would be better in comparison. We do not really communicate much as a consequence.

I have always been a rather reclusive genius with a sharp orientation and commitment for research work in academics (mainly mathematics) and hacking. My intense style of working was further determined by problems of the heart, trans-sexuality and high art. Dysporia did dictate socialization.

I did PG courses in statistics, programming during and after my UG but tried to get into particular research institutions through non standard routes. I could directly jump into research in mathematics after UG in-spite of an apparently unbalanced background then in the subject. Even got an opportunity in CMI/SPIC school, but my interest was fixed point theory, summability and algebra then. In retrospect, I did the right thing as that would probably have stopped me from getting into formal logic and related fields. For quite a few years had lot of problems with communicating research, the situation improved subsequently - but even now I commit only a fraction of my research to digital form and publication in International peer reviewed journals. I had plenty of published research papers before getting relevant higher degrees (relative the "standard-product" discourse) in Mathematics. One axiom, at that level of discourse, that affected the approach to research problems till 2013 was the realization that "I have less than x years left ... and 0 < x < 10 ".

 

A Suicide Attempt [Trigger Warning!]

Internal consumption of phenol can cause the kidney to collapse and precipitate a not too painful death - the book on toxicology said that and lot more across many pages. Luckily (in retrospect), I did not know that the white transparent product is present in low amounts in black phenol. My second suicide note was inside my book shelf -- interestingly I had also written a brief guide of my work on languages (mentalese) and Mathematics. The reason for suicide was of course dysporia and a relationship problem with a spouse. The hospital staff did not doubt my "story of accidental consumption of black phenol" and I was in hospital under observation for 24 hours. Nobody knew that I had attempted suicide as I could act well. Some lessons learned from the incident were:
  • Be careful about interpreting the written word in practice.
  • Specifications for suicide attempts should be written from a safety-critical point of view.

 

Dysporia Control Paradigm?

I never used this paradigm. My strategy was to proceed with HRT and other procedures to the extent possible. Previously more severe legal hurdles were in place and society was too backward and intolerant - these were limiting factors. Even now it is not supposed to be really safe ... that is going by the reports in the newspapers and media.

I did not "cross dress" in any sense due to dysporia ( but evolved a unisex body concealing style over time). Other things that I did include
  • Mild not-so-periodic hormone supplementation with Estriol and Ethinyl Estradiol (sub-lingual + subcutaneous),
  • Eyebrow shaping,
  • Regular use of epilators for hair removal. Laser machines were unfortunately not available for a long time,
  • Breast Stimulation,
  • lots more.
Not surprisingly, my body chemistry and sex was very different. Some people definitely got confused in gendering/mis-gendering me. People always get confused about my age...probably because I don't smoke, drink or do drugs and follow a strict lifestyle.

I had decided to commit suicide after my degeneration becoming substantial ... estimates were corresponded with age. The underlying argument included the badly justified presumption that ''transitioning at older ages would be suboptimal'' and of course the lack of sanity of most of the population and infrastructure. Was looking for a trigger...in the year 2010, I seemed to develop some pain in the fingers (that was actually due to excessive typing on a worsening keyboard). As I was finalizing the safety critical process in 2012, noticed that anyway quite a lot of my writings on trans-sexuality and my own trans-sexuality would be public and even before that happening my GF would not remain silent. So whatever all this would end up as negative signals to sane and progressive forces working for a better world. The initial decision was to monitor the quality of progress under full HRT for a period of three months or so and act as per progress - I was not really sure.

In urban parts of India, if you are at least apparently petit bourgeois and have gender diverse expression that does not fall within the boundaries of either of the binaries as per the general population, then you are likely to face quite a lot of micro-aggression and hate (less likely/depends on location). Of course this is apart from the default discrimination that you would face if you are a women.

I came out from stealth mode at least 3 months earlier than planned mainly because the first psychiatrist whom I had contacted for the clearance certificates was uncooperative and anti-trans. Moreover the psychiatrist was a behaviorist and not a cognitive behaviorist as I had presumed earlier. As per current DSM-V understanding, trans people who understand their problem require about 30 minutes of session for their approval certificate for transitioning. One of the advantages of using free software is in its security model revolving around openness. It applies to real-life situations as well - I was pretty much officially trans for many people and groups at ~ 3 months of full HRT itself because of the situation. It is supposed to be difficult to trust one's shadow in places like these according to the official discourse.

 

Job Question

I never saw anything in full-time jobs in teaching or other sectors. Working for the corporate sector is death, the idea of working full time for corporates is based on decadent capitalist values, teaching jobs are ill conceived, jobs outside academics are less sensible and most importantly "you do not need the property papers of a building to jump off it". And there has always been the need to evolve alternative leftist strategies in the decadent Indian economy. Somehow the dynamic part-time opportunities in the teaching, short-term project, freelance academic and statistical/soft computing consultancy sectors fell in place to some extent. The main advantage was that I could devote more time to research than from a regular teaching job. Yes, I have always looked down on the slave mentality of the middle and upper middle classes on the job question.

 

Aspects of Sexual Orientation

I have always been sexually attracted to a large spectrum of femme women. Pre-HRT, I was also attracted to so-called "boys" -- femme types bordering on butch. So I used to think that I am predominantly a lesbian, but actually bisexual. However I always hold that "any sufficient aggregation of masculine features in a person" is a sign of decadence. So much about boys and men. I have always been mature enough not to translate this into general misandry. Under HRT, my orientation shifted to "exclusively lesbian".

Body chemistry does matter, women can be spontaneous and I do not have the permission to write more.

 

My HRT Time-line:

The actual transition was more of a cakewalk for me as I needed none of FFS, breast augmentation, hair transplants etc. HRT proved to be more than sufficient on these counts. Laser treatment for a little facial hair removal was needed. I am not posting photos because I am not photogenic even though am beautiful .
  • Decision to start full HRT in Sept-Oct was taken in July/August'2012.
  • Started full HRT in October'2012.
  • Had a 3 month DIY with 2mg/d sub-lingual 17-beta estradiol (E) + Some Subcutaneous E + 100mg/d Spironolactone.
  • Got prescriptions after that. But I took all decisions on hormones myself and did not need progesterones or other anti-androgens.
  • Effects commenced with much immediacy. I managed almost all aspects of my HRT including dosages, delivery and test directions - though I had formal prescriptions, related clearances and schedules in place. I will do a separate post on the methodologies that I have been following and related complexities.
  • Increased E to 4mg/d in beginning of January - one temporary effect was dry hair. Basically it takes a few days to adjust all metabolic processes when one increases the E dosage. But there is a limit to admissible dosages for a person.
  • Increased E to 5mg/d after July and that is the maximum oral part I have used over long periods of time. 6mg/d seemed to have severe side effects like dry skin and hair.
  • Since October'2013 or before, my T levels have been below female levels - but have had no side effects and E at high female levels
  • I am not changing my name like other trans woman do : "Mani" is a girl's name.

 

Some HRT Effects:

  • Severe improvement of emotional health.
  • Suicidal thoughts just vanished in about four weeks.
  • Skin became softer, smoother and thinner.
  • Severe increase in cranial hair density and increase in hair growth rate (the minor pattern recession in hair line that I had got rectified in about 3 months).
  • Facial and body feminization.
  • Body hair reduction (I hardly need to use epilators).
  • Increase in bone strength. I have never felt stronger before.
  • Continuous Breast Development (I always had fully functional A+ breasts since my teenage years. Under HRT, it has been continuous development accompanied by tenderness since first week).
  • Body fat redistribution has been reasonable, muscle loss took almost 6 months to even commence and body mass loss has been ~ 10+ kg in 14 months.

 

Adaptive Aspects

These are trivially important, but I did not have to do much though. All of my pre-HRT wear including inner wear gradually became impossible. I changed the sex of my collection of designer shirts, but shifted to tops, ladies shirts and camisoles exclusively. Skin-fit ladies jeans/jeggings/low waist jeans proved to be perfect, standard ladies shoe sizes posed no problem and I am better than many other women at finding a bra that fits. See this subreddit /r/abrathatfits for the problem complexity. Ethnic wear do look nice, but I am yet to adapt to them. I will do separate posts on related details and other adaptation aspects as they would be of interest to many women.

 

Hacking

Even before I got into free software, I was into hacking hardware and chemistry. That was probably all up to me as most people in the milieu stopped at 'repair and use' principles and practice. My skill level in custom-cosmetic manufacture is very high/excellent and has been very useful at all times. I will do a separate post on this aspect later.

I learnt programming in early nineties and also independently studied some computer science and general structure of classes of languages then. However regarded these as hobbies. Have been involved with free software and related training and activism since ~2k. Free software activism definitely helped me with my communication skills and without activism skills one cannot think of openly transitioning in sub-educated terrain. Free software philosophy including my variants also helped in key decision making on strategies. Middle and upper middle class people usually are extremely subservient to the patriarchy and class methods on questions of transitioning would invariably correspond to "security by obscurity". The number of economically well-off transsexuals seeking more than HRT in Kolkata is over 500 -- the overwhelming majority simply change and vanish.

 


Levels of Micro-Aggression and Transition

I experienced quite some micro-aggression in different sectors. Usually this consisted in deliberate mis-gendering to cause hurt. Apart from that there was nothing really - the main reason was that in the past I always looked like a woman dressing in 'not-so-womanly way' relative most people. In July'2013, I was yet to really change my body-concealing dressing style, but I traveled as a woman with no issues and the photograph (admittedly, not so clear) in my identity proof document (non-gendered) was over five years old - I am saying something. I am not a proper role model for other trans women seeking to assess potential discrimination across the city or this country. My experiences are too limited.

In the academic sphere within the country, many people gendered me correctly, some would avoid gendering in a rather odd way, while some (obviously belonging to backward irrational cultures) deliberately mis-gendered me. Naturally had to try and educate people on some of the key issues including feminist ones. Here the problem is that substantial parts of the older generation and part of later generations are brainwashed by traditional conservative nonsense, the patriarchy and sometimes religion and superstitions. Of course, the people from the western academic environments are far more progressive in comparison.

The on-line behavior of some Secretary of Calcutta Mathematical Society (I don't know this mal-a-propos entity) was ridiculous in particular. I asked the person to change the salutation 'sir' in group mails to all members, along with detailed guidelines. Initially there was a change to "Sir/Madam" and then it was back to the old discriminatory style. Mail filters are good at filtering Spam.

It was also possible to educate some of the Indian FLOSS groups. Most of them are tech savvy, would try and look at on-line resources - irrespective of their level of awareness of human perspectives. I am also active in improving participation of women in FOSS and feminism and importantly use an impersonal approach to most questions (My involvement with feminism goes back to the nineties). Did have to deal with a few mal-educated misogynist on-line trolls ... which woman does not?

The quality of medical support available in the city has a long way to go. Some doctors may be anti-trans. So one needs to be careful.
I do plenty of on- and off- line shopping at malls, specialized shops, hardware and wholesale shops. In all these places, I am not an unfamiliar face. Only a small percentage indulged in mis-gendering in any form. Usually I am addressed as 'madam' (I am yet to explore ethnic wear) in these locations.
Job/work-place discrimination: Some contracts from within the country may be colored with discrimination. 

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Supplementary Notes on Political Scenario in Relation to Sexual and Gender Rights


In the whole country, the mainstream left is the most progressive - but they practice a weird pragmatism to the point that till recently it was like "although we are progressive and have ideas about women and gender rights, social conditions are not conducive for taking a revolutionary stand on the core issues". The view of other parties range from those corresponding to the dark ages to "maintain status quo" and many feed the patriarchy. Majority of the so-called "men" are slaves of the decadent patriarchy, the extreme capitalism, religion and deluded about their own privilege. Despite this most of the feminist and LGBTQ movements are yet to really take off and the former suffer from severe conservatism. 


Exclusion happens if the social environment is backward, intolerant and bigoted. All the talk of the social milieu being advanced enough in their views is not factual. The fact is they are entrenched in a decadent patriarchy that few try to deride or question. There is little or nothing for gender diverse people in such a society. More so for trans-women who implicitly seek to destroy the patriarchy/decadent intersectionality.


In India, as in many other parts of the world, the super-rich and global forces manufacture consent and play on the anti-progressive aspects of the middle and lower classes. But revolutions on sexual and gender rights among the educated middle and upper middle classes would not be stoppable by any of the other classes for a variety of reasons. This would affect other classes as tools of consent manufacture can never likely be independent of gender expression and society. 

Rape, rape culture, sexism, gender discrimination and misogyny are all essentially products of the patriarchy systematically suppressing the freedom of potential LGBT people and imposing decadent family values. The patriarchy (decadent intersectionality, if you please) should be destroyed for any real human progress.

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Copyright, A. Mani 2014. 
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