Gender Affirming Care part 3 – Kaitlyn’s story

This is the third in a series about gender affirming healthcare for trans folks. Kaitlyn is a young trans woman who is a friend of mine. Her story, like the others, made me cry. We really have not got our heads on straight about what it means to be transgender, and how we handle it. You’re also going to want to read Huey’s and Wren’s stories, and please share the series far and wide. These stories are incredibly important, and I’m very privileged to have these folks sharing them with me, and allowing me to publish them!

Discovery of being Trans
Like Wren, I figured out I was a flavour of trans after I had my childhood puberty. Something had felt wrong for my whole life, and I was always told “Oh that’s just what being a teenager feels like” or “Oh it’ll go away after puberty and it’ll all fit back together”. So I waited, waited for the day I’d be able to stand looking at my face in the mirror and feel comfortable in my skin like everyone else did. Growing up in the spot that is, on a technicality, “Metropolitan Melbourne”, even though it took more than an hour to get to the CBD, meant that the society I grew up in didn’t have the best attitude to mental health, but god could we all stamp down on internal feelings, and hard. Go figure that a town with a lot of tradies could bury things well.

It was only when I got to university, and saw how other people expressed themselves that I even realised that being transgender was an option. Where I grew up, “Gay” was a grievous insult, and being remotely associated with being transgender (or more accurately all the slurs surrounding the concept) made people recoil with horror. Cue a good friend (who I have still managed to keep, even with all the mental distress they had to coach me through), explaining to me that being male wasn’t actually a requirement of me, and I could genuinely be who I wanted to be. We also missed all our classes that day and cleared out the university bar, but that was part of the experience.

So I entered the cycle that is probably familiar to people who have revelations about themselves. I picked up every piece of “me” and looked at it, now through a different lens and realised I could change it if I wanted, and this included physical parts of me, not just mental.

Skimming over half a year I had it figured out, or as much as that version of me could. She wanted to have boobs, she wanted smooth skin and no facial hair, she wanted to sound such that she wouldn’t get picked out of a crowd, and eventually she wanted something to be done to make wearing skirts and dresses a lot easier.

Interactions with the healthcare system
As a white, tall, AMAB (Assigned Male at Birth), het presenting adult, the Australian healthcare system has always been a breeze for me to access and to get the physical healthcare I need. Mental healthcare was easy too, once I had found a GP that recommended someone who dealt with a lot of the issues I was dealing with. My first visit to the clinic that I still use today was aided by someone who showed me a great kindness, I knew them from high school and knew they were trans, and they met up with me before my first appointment.

For context on how easy the healthcare system is when you are at an intersectionality of privilege, I saw a doctor and he asked me to get a psych evaluation before they would prescribe me hormones. All I had to do was ask him to refer me to a colleague that did informed consent, allowing me to dodge this requirement if the GP thought I was of sound mind and I got a second booking and walked away from that with a blood test, third visit I had started hormones.

(Informed consent within the topic of HRT/Trans Healthcare is a process where a GP will fully explain what the HRT is and will do, inclusive of all risks, benefits, etc, and with the patient’s consent HRT can begin without the need for psychological evaluation. This allows the patient autonomy and the dignity of not having to “prove” to a psychologist that they are “trans enough” to receive HRT.)

These hormones did, and still do cover a lot of the big things that I wanted out of the medical system. Softer skin, growing breasts (yes, actual breast tissue), and wow did it help my emotional state to actually have the correct hormones flowing through my system. As someone with a lot of anxiety, this at least allowed my body to look the part so as long as I didn’t have to speak, I could move through public spaces and no one would do a double take for me not fitting into my gender box.

The hormones aren’t perfect though, taking estrogen orally can lead to blood clots so there’s a maximum you can have. Also, as I went through my first puberty on testosterone, not estrogen there is a lot of support tissue for breasts that was not grown on me, and the second puberty can’t do a lot to place it in there. Some people worry about their broad shoulders and thicker waist from testosterone, and while looking in the mirror my outline isn’t perfect, I’m putting on enough muscle the way I want to move my body anyway.

Then we get to my voice. I come from a line of Australians who live on farms and work with their hands, and I went through puberty and then sounded the part. When a kid goes through a testosterone-based puberty their vocal chords will typically lengthen, and mine did with great enthusiasm. This is not reversible from taking HRT however, it’s like asking an arm bone you grew to get smaller. Due to this, there are 3 common options:

1. Not to care about your voice, it’s yours and you don’t need to change it.
2. Do vocal feminisation therapy, it’s basically training you to speak in a higher resonance and pitch, and eventually has you speaking the part.
3. Get surgery to reverse the lengthening.

Option 1 is for people who are not me. Much like there is no correct way to be a human, there is no correct way to be transfemme. A voice is a voice and it should be respected as it belongs to a person. However I really don’t like my voice (I hated every recording I was in since I was a child, I wonder why?) so I want something to change.

Option 2 is great and I have been exploring that for the better part of 2 years. While voice therapists are rather fully booked (much like most specialists), I eventually found a wonderful person who is doing their very best to help me. However after doing therapy for 2 years, I don’t sound much different, so this leads to…

Option 3, surgery. Fuck surgery is scary, and for some people it’s necessary. After not having much results from therapy I went to get my throat checked and it turns out that some people just have their vocal cords lengthen too much, or they have naturally too much stress from speaking and they may never achieve their goals without surgery. Guess what camp I recently found out I was in.

Next up, is facial hair. “Just get laser”, yeah I know I’ll book it at some point when I can look at my calendar and see free time. Shaving every day is a pain and is a big insecurity, but I do have to say that I look at my face in a mirror with bright lights at a distance of about 10cm. If anyone else is that close, it’s my fiancé so I really don’t have to worry.

Finally, bottom surgery. This is a part of the system I have not yet brushed up against. From talking to doctors, there are maybe a handful of surgeons per state that do bottom feminisation surgery, a handful of surgeons in the country that do bottom masculinisation surgery, and a number approaching none that do nullification surgery. Doctors that I have seen when I bring up the topic do generally say “While I can’t recommend you just go to Thailand to get it done, I don’t really see many other options.”.

Review of the healthcare system

So everything I have said so far sounds pretty good, right? Well…

Look, whenever there is a societal health issue, disease, contraceptive, medical condition, cancer, there are a few steps that are taken to ensure that the maximum amount of people possible can not only access the healthcare, but not get the condition the care solves in the first place. First, a healthcare system will ensure it has a cure for a condition. Whether that cure is a drug, antibacterial, surgery, or medication to remove the worst of the effects there will be an effort to ensure that anyone who has the condition will live their best life.

Second, a healthcare system will work on prevention. Sunscreen, pre-screening recommendations, testing the sewerage supply for viral markers. All of these things help prevent outbreaks in a community or an individual from acquiring the condition in an immediate sense.

Third, a healthcare system will work on awareness. Messaging about the dangers of sun damage, posters about how to wash your hands to ensure they are perfectly clean, booklets about dangerous diseases that could crop up and their symptoms, pamphlets of signs that someone is under acute stress or could be suffering a mental illness. All of these things allow a community to check in and make sure everyone is safe and has the information on how to report if they are displaying symptoms.

The failure of the system for me was not the hormones, or the therapies, or my need for surgery. Healthcare has failed me as at no point in my childhood was it pointed out that I didn’t need to be a boy, no one told me that I didn’t have to go through a testosterone-based puberty, that I could have switched puberties or taken some puberty blockers while I considered how it would impact my life. And now I get to pay for it in the scars on my body that a testosterone based puberty wreaked on me. Scars that I did not want and was not told that I could have avoided.

When I see a voice therapist, my voice therapy sessions aren’t booked to Medicare under “affirmative gender care” or anything to say that someone like me should have to see a voice therapist, my sessions are booked under “Chronic Disease Management”, and like a lot of Chronic diseases, I wouldn’t have to be there if I got the information and treatment when I needed it, when it would have been the most effective.

Gender Affirming Care part 2 – Huey’s story

This is the second episode of our series on trans healthcare, platforming trans voices. Today Huey shares his experience of being a young trans man, having to fight every step of the way to receive the care he needs for his mental and physical health. If you haven’t yet read Part 1: Wren’s story, I recommend reading that too.

Huey’s story.

When I was 10, I found out what nonbinary meant, and came out to my family almost immediately after. A year later, in the middle of year 7, I came out to my classmates. I started going to the gender clinic section of the Royal Children’s Hospital, which, until COVID made telehealth an option, was an hour drive from school and sometimes meant I missed most of the day.

I started binding in order to flatten my chest, both to be seen as masculine and also because I have hated my chest since I started puberty. Binders, as opposed to clothes that would disguise my chest without compressing it, also prevented my chest from moving, and therefore stopped me feeling it move, when I walked, ran, went over a speed bump, etc (handy, because my bedroom is up a flight of stairs), and also made it easier to wear seatbelts without having lumps on either side.

As I got older, binders stopped fitting me, because they are designed for a certain ratio of shoulder width to breast size typical of AFAB (Assigned Female At Birth) people, (ie bigger bust). This does not fit my proportions – when I put my school shirt on when we got out of lockdown in year 10, I popped the seams of the shoulders. Not to mention that my older sibling, who is the same height as me, gets the shirts that don’t fit me anymore, and finds them loose.

On the bright side, this made it easy to bind for a full day of school without incurring the issues that come with overdoing it (difficulty breathing, rib damage, etc). Unfortunately it also impaired my ability to be seen as masculine and be gendered correctly by strangers.

In the months leading up to my 16th birthday, I realized I was a trans man, rather than nonbinary, and I wanted to go on testosterone. Even though I was legally allowed to start it, as I was over 15, and both my parents consented, I needed to go through a year long process of reciting a list of side effects and risks for every session until the cisgender psychiatrist and endocrinologists decided I knew what I was doing.

In contrast, my mother started menopause towards the end of the process, and acquired estrogen gel (from the exact same brand as my testosterone gel) within a week. I also had to take a lower dose for longer than usual while I completed my exams, and then I could up the dosage. Then, as my 17th birthday approached, we started looking into top surgery. The surgeon we were recommended in Melbourne had glowing reviews from several people we know, but wouldn’t perform surgeries on people under 18, and some required you to be above 21.

We were also recommended two surgeons in Sydney, both of whom were willing to perform surgery on a 17 year old, but the consultation had to be in person, meaning that I have to fly to Sydney either during my first year of uni or 4 days before it started, have the surgery during the winter break, and pray to some ancient deity that my recovery has absolutely no issues and I’m healthy enough to resume normal uni at the end of the four week holiday.

If I had decided to wait until my 18th birthday in order to get it done in Melbourne, I would need to recover from surgery and wear a compression binder in an Australian summer (which is better in Victoria than it is in other states but still completely incompatible with my sensory issues as it is, for a multitude of reasons: sweating under a binder makes it cling to your skin and itch, and I can’t stand being too hot, so multiple layers aren’t ideal), survive an extra year of excruciating dysphoria, and still have only four weeks to recover until the start of uni.

Cis people benefit from gender affirming care all the time. In addition to the menopause example above, cis people frequently get hair transplants, breast implants and reductions, butt lifts, facial surgery, laser hair removal, etc. The difference is, when a trans person wants any of these, they need to wait a year to prove they actually need it and get a diagnosis of gender dysphoria signed by a psychiatrist, or sometimes several.

Often, when it comes to more minor treatments like hair transplant or removal, one can just walk into a clinic and get it done, but a trans person may be heavily ridiculed or even turned away, while a cis person will be treated with respect, both by the practitioners themselves and by society in general.

Trans healthcare would be very different if it started from a position of respect.

Gender Affirming Care, Part 1 – Wren’s story

Our family has been navigating the world of gender affirming care for some years now, and I am increasingly frustrated with how many of the health care decisions made for (not by!) trans folks are made for political reasons, rather than medical or health focused reasons. I’m going to write about that, but I’m just the parent of trans folks. I’m not trans. So first I want to platform some trans voices. I think we can build a vastly more inclusive world when more of us understand what it’s like to be trans.

Today I’m starting with a post from a former student of mine. I asked Wren if they’d be interested to help me write this piece, and the next thing I knew, they had a whole blog post that deserves to be shouted from the rooftops. So here is Wren’s story, in their own magnificently powerful words.

Wren’s story

I realised I was trans as an adult, meaning I didn’t necessarily experience the horror and trauma of going through the wrong puberty in real-time (though it was weird, for reasons I definitely couldn’t explain at the time, and find myself not really being able to do so now either). However, either way, pretty soon after coming out, I realised how badly I wanted gender-affirming surgery – in my case, top surgery, AKA breast removal, AKA chest masculinisation, AKA bilateral mastectomy. Being extremely broke and scared at the time, I then spent several years making excuses as to why I definitely couldn’t get surgery and that was fine – I had never had surgery before, it was too expensive, I had no idea how the process even worked, I liked my chest sometimes, I won’t be as attractive, my parents wouldn’t support it, etc. Despite all of this, obviously, I deep down wanted absolutely nothing more. I used to joke that I didn’t want top surgery, I just wanted a flat chest – it was accessing surgery itself, the expenses, the hoops I would have to jump that made me feel unsure – not my actual desires at all. Those were extremely, viscerally real.

I don’t want to play into a narrative that all trans people are miserable and feel uncomfortable in their skin, or that you need to experience those things (or indeed suffer the broader concept of ‘gender dysphoria’) to be trans – I myself had times were I experienced very little dysphoria around my body at all, even pre-surgery. But I think a lot of people outside of the community don’t understand at all what it’s like to experience dysphoria, to need gender affirming surgery. When you’re in it, it gnaws at you every single day – every moment of every day. Every mirror or slightly-reflective shop window you pass, every time you look down at yourself, every time you feel someone’s eyes on you. It’s such a visceral feeling of wrongness, and despair, and lack of control, and frustration, and sometimes disgust. It makes you buy all your shirts 3 sizes too big – you look ridiculous, but anything tighter than that around your chest and you can’t leave the house. You can’t. It makes you wear a binder every day without taking breaks and eventually your lung capacity is shot – you used to be a long distance runner, too. And it’s not like they’re comfortable to wear – think an extremely tight compression shirt that (sort of) makes your chest flat, at the cost of not really being able to expand your ribcage fully when you breathe – there’s a reason you’re not supposed to work out in it, or wear it for more than a few hours, not to mention the sensory discomfort from the weird fabric. Kind of awful, but a lot of the time it’s better than the alternative. You don’t exercise for years on end because feeling the movement in your chest makes you want to die. The lack of exercise and increased isolation, of course, makes your mental health worse, which makes it even more difficult to manage your dysphoria.

All of a sudden one day, I returned to the realisation that I needed top surgery. I was sick of feeling gross in my body, of having to plan every outfit and outing around my chest, around how long I could handle a binder that day, or how many layers I could get away with wearing. I was, in the scheme of things, extremely lucky in accessing surgery – I was an adult, which in the current system makes things infinitely easier. I had trans friends who pointed me towards a supportive GP who could make the referral to the surgeon for me. I could (just) afford to pay out of pocket (around 14,000 Australian dollars), because if you don’t already have private health cover, and get it just for the surgery, you have to wait 12 months for it to kick in.

I got the referral, called the surgeon’s office and it was a 9 month wait for a first consultation. For the consultation. I booked the appointment, and almost as an after-thought, they mentioned that with covid they get a lot of cancellations, and they could put me on a cancellation list to bring my appointment forward if I filled in all the patient intake paperwork straight away. Still crushed from the idea of waiting another 9 months just for an appointment where I’d probably be told I had to wait a year for surgery, I said sure, but I didn’t really expect anything. Lo and behold, another massive, massive stroke of luck. Three days later, they called me and asked if I could come for my consultation just a few days after that – I called in sick to work to do so.

The way it ended up working out, my actual surgery date was a month earlier than that first consultation would have been. And it was still agony the entire time I had to wait for it. My dysphoria became much, much worse now that there was an end date in sight. I was constantly, constantly anxious that something would go wrong and I could not get surgery. It genuinely ate at me for those entire 8 months or so. Not to mention the other hoops I had to jump through – the money, the paperwork, the four psychologist appointments (again, paid out of pocket) to be told what I already knew (you’re transgender and it sounds like surgery will improve your life). Most people are nowhere near as lucky as me.

On the note of improving my life, I can’t overstate how much it has. My mental health, while not perfect, has skyrocketed. I literally go for a walk for fun nearly every day, where previously leaving the house was almost insurmountable most of the time unless I really needed to. I go to the gym regularly. I love looking at myself in the mirror. I love hanging out shirtless when the Australia summer is inhumanely warm. I love my scars. I love waking up every day and not having to wear anything under a t-shirt – it sounds so stupid but nothing has ever made me happier. I am so grateful every single day, and every other trans person I know feels the same way.

This is only my experience – it doesn’t speak much to transfeminine transition, which is obviously quite different, but I know those feelings of dysphoria hit the same way, and I know that access to corrective hormones, surgery, and other procedures such as laser hair removal save lives. An ill-informed argument I’ve been given against trans people getting surgery is that it’s cosmetic, and that you can’t cure insecurities by changing them because you’ll always find something else to be insecure about. One counterpoint to this is the medical model – gender dysphoria is a medical condition, not an insecurity, and transition is the treatment. There’s evidence to support this and I wouldn’t say it’s wrong, per se – I was, as part of those psychology sessions, diagnosed with gender dysphoria, and while I haven’t been assessed post-op, I dare say I no longer meet the criteria. But on the other hand, even if it was ‘cosmetic’ – so fucking what? Trans people have the right to autonomy and self-determination. Trans people have the right to do what makes them happy. Trans people have the right to feel at home in their bodies. Trans people have the right to feel fucking hot, and know it.

Disabled activists have a rallying cry of ‘nothing about us without us’. I hope that they don’t mind me paying respect to their cause by saying this applies to trans people too. The guidelines, processes, and frankly gatekeeping around gender affirming surgery are not constructed by trans people, despite supposedly existing for us. Overhaul of these things, by trans people, in cooperation with service providers, is needed. At the very least – can they start with listening to us?

Impact Analysis

Way back in 2020, when I was talking to my big brother about the pandemic, he compared my tightly locked down Melbourne existence to his (relatively, at that time) care free Perth life and said “there will be so many PhDs analysing the impact of all of this in ten years’ time.”

I think about that comment a lot. What exactly has happened to us? And what is it that’s continuing to happen? Here we are, in 2024, and the geographic playing field is pretty level. Covid is rampant all over the world, and no government anywhere, as far as I can tell, is making any of the simple, sensible moves we could make to minimise its impact. We’re not fixing indoor air quality in public buildings, mandating proper, N95 masking in healthcare settings and other public spaces, or maintaining testing to track the prevalence and severity of the disease.

Most populations seem divided on their attitude to risk. We have the “back to normal” crowd who believe (or pretend) that there’s no risk. Then there’s the “normal with precautions” folks who are trying to get out and do things in the safest ways possible – dining out, but only outdoors or in well ventilated spaces, masking indoors as much as possible, using CO2 levels as a proxy for risk, carrying portable air filters. And finally we have those at high risk who feel trapped and abandoned because covid is rampaging through communities and the consequences of catching it are likely to be death or disablement at best. They do all their shopping online, and most of their socialising too. Their isolation is extreme.

The impact of this pandemic (which is far from over, whatever the government and media would like us to believe) is wildly different for each group, just as it was different, in the beginning, for folks living in Perth and folks living in Melbourne, but I’m starting to see patterns emerging.

First of all, I don’t think I’m just projecting when I say there seems to be a lot more exhaustion in the world. Everyone is so much more tired. So much closer to the edge. Desperately in need of an afternoon nap. How often do you hear sentences like these?

“I just can’t do as much as I used to.”

“I can’t get through the day without a nap anymore.”

“I used to be so fit, I don’t know what happened.”

“I go to bed so early but I never feel like I’ve had enough sleep.”

It would be easy to ascribe this all to post covid effects. Whether you call it long covid or just a long tail of symptoms, covid is definitely leaving many of us less well than we were pre-infection, but I wonder if it’s more than that. It feels to me as though life has changed in a whole lot of ways that are simply more tiring. More people are off sick more often, so work is just a bit (or sometimes a lot) harder than it used to be, simply because we’re carrying a bigger share of the load. I don’t know of any strong data about the number of people in the workforce compared to 2019 – a lot of the employment data is more political than scientific, so it can be pretty difficult to tease out what’s really going on, but staff shortages seem to be the norm.

Many people who’ve had covid aren’t quite as sharp as they were pre-infection, either. They’re not solving problems quite so well, they’re making more mistakes, just not firing on all cylinders. That ramps up the load for all of us, as we’re not just getting stuff done, we’re trying to put out more fires, too. Again, this is perception rather than hard data, but things certainly seem tough in indefinable ways. As a data nerd and a scientist, it grieves me intensely that we are not even trying to collect data on any of this.

There are also emotional impacts from the long years of fear and lockdown that we really haven’t processed. We’ve had to relearn a lot of our strategies for going out into the world, and of course for many people the nature of work has irrevocably changed. We’re working from home more, or we’re working different hours, picking up more dropped shifts, and getting less flexibility in the way we work. Handling more complaints, wrangling grumpier customers, and finding it harder to connect with colleagues we rarely see face to face. We’re still doing risk analysis – is that a sore throat, or is it just allergies? Should I go to that event? Will I spread covid? Will I get covid??

And then, of course, there’s the cost of living, cranking the vice of daily life a bit tighter every day. Some of us are lucky and can manage by trimming the edges. Some of us are trimming out whole chunks of our lives. Most of us are feeling it, one way or another (excluding, of course, the rich and extremely rich, who are making pots money out of the “cost of living crisis,” but that’s another post entirely).

It feels as though all of these effects are not merely elephants in the room, they’re actively forbidden. Covid and its effects are “political” so we can’t talk about them in polite society (and isn’t it convenient, that we’ve made politics unmentionable? Because that, of course, means we can’t talk about fixing it. And Hooo Boy does it need fixing!), just like climate change, homelessness, and rising inequality are off the conversational table.

It seems crucial, to me, that we look covid full in the face. We need to acknowledge the growing body of evidence that shows that every covid infection does damage. We need to recognise that our society is suffering from the continued onslaught of wave after wave of new variants. We need to take steps to mitigate future damage (ventilation especially), and we need to start actively tackling the existing damage, for people, for workplaces, and for society as a whole. It’s time to stop pretending.

Unless someone like you cares a whole awful lot, nothing is going to get better. It’s not. The Lorax. Dr Seuss.

Transcendent and Creepy, all at once

Start with an exquisitely beautiful number from an immensely talented and skilled string quartet. Add in a gentle, reverent voice, floating words out upon the light. Each syllable a caress. And then make it creepy as all hell.

Give each common, everyday instrument – violas, a violin, a cello – the power to produce extraordinary music, but also a weird bird, a didgeridoo, a cry in the night.

Give the voice the timbre of the kindest, most comforting bedtime story, and have it speak, and even sing, of unspeakable horror – but not always.

Amidst the vampires, psychopathic killers, and bones, throw in an achingly beautiful, heartbreakingly intense song about… umbrellas? (Please, oh please, record this piece so that I can obsess over it some more.)

Because things aren’t quite bizarre enough, mix in a chanteuse singing about Googling you, and, of course, a song which simply recites a whole section of a dictionary, which happens to be devoted to slang for sex. Then add some megafauna for good measure. We mustn’t forget the megafauna.

If you’re feeling a little disconcerted and off balance, welcome to Fourplay and Neil Gaiman performing their Signs of Life album, and a whole lot more.

From our place in the centre of the very second row – the kind of seats we always thought were for special folks, not the likes of us – we were enthralled, every moment. Occasionally, I admit, horrified. Also a touch grossed out, and often so emotional the tears flowed freely, but, above all, enthralled.

Being at the front felt intimate, and intense, and yet such was the atmosphere Gaiman and Fourplay created between them, that I suspect the whole audience felt as though they were at the front. The personalities, the stories, the music – oh! the music! – combined to create a secret love affair that invited each of us in. A personal connection between the performers and the audience. A joke, a romance, a soaring melody, a moment of horror, created for us, and us alone.

I’ve never been to an event like this before, I suspect because there has never been an event like this before. A flight of fancy that took hold of my heart, elevated it, wrung it out, and placed it every so gently back in my body, larger than it was before. What a privilege.

You should watch this…

My mum has dementia. It has irrevocably consumed her brain to the extent that there is almost nothing of her personality left. She is gone, by any reasonable definition. Now that I’m a parent myself, I look at my own upbringing with horror, so losing mum to dementia has been less the loss of a precious relationship, and more the end of any chance to repair a broken one. At some point you have to acknowledge that you’re never going to receive the unconditional love a parent is supposed to provide.

Recently I’ve been hanging out with friends who are spectacularly awesome parents. They are emotionally aware, kind, compassionate, loving, and fun. Design the ideal parents and you’d come up with people very like Nicky and Sam. Their kids are loved, empowered, and supported to be awesome. And, surprise, they are, indeed, spectacularly awesome.

And it’s been making me cry.

Mum is at the stage of dementia where there is really no one home. She mostly sleeps in an arm chair, occasionally mumbling incoherently. There’s not the closure of death, but there’s a finality nonetheless. Although her behaviour is up and down, it’s clear that she will never again know who I am (arguably she never really did). There’s no chance of repairing our fractured relationship.

It seems impossibly difficult to accept that finality. To build my own kind of closure, and recognise that the absence of a mother who knew me and loved me for who I am is not a reflection on me. Rather it’s a sign of her own issues. Like everyone (yes, you too), I deserve unconditional parental love. We all do. We just don’t necessarily get it.

It’s long been a joke in our house that I need to have my viewing carefully vetted by my family. My kids will watch things before me and tell me whether they think they are safe for me. I can’t watch anything too dark, too scary, or too sad. It affects me too deeply. I like my fiction to be light, loving, funny, and escapist.

So when people tell me I really should watch things about dementia, I have an absolutely visceral reaction. I recoil in horror. The very idea is appalling to me. I don’t want to immerse myself in that world. I have watched it consume my mother, and it’s an awful, traumatising, and painfully slow death. It has taken away who she is, and left a physical husk. I find it difficult, in truth, to accept that happening to her. I am terrified of it happening to me.

Perhaps a better person would watch and read all the stories about dementia patients, and be more compassionate about the process. But to me it just seems cruel. Like a kind of emotional acid, it eats away at the victim’s life, relationships, and their very soul.

I’ve always been profoundly disturbed by illnesses that change the way the brain works. Head injuries that leave personalities changed are terrifying to me. When I had a post viral syndrome in my 20s, the worst part was that it made me somewhat aphasic – I couldn’t always find the words I wanted to say – which, to me, was a devastating loss of something intrinsic to my sense of self. Fortunately I recovered, though long covid has brought the aphasia back to some degree. This time I have more faith that it will be temporary.

So immersing myself in stories about people losing themselves to this horrific disease is unthinkable to me. It’s like asking me to have nightmares voluntarily. I don’t want to look dementia in the eye, to understand it, to think about what it’s like for sufferers and their loved ones. I’m living it. I want to push it away from me with every fibre of my being, not invite it in.

I know there are some who are comforted by those stories, and I am glad for them. I take my comfort elsewhere.

No issue off limits

I am a member of The Greens, because they seem to be the only party that has evidence based, practical policies to address climate change, income inequality, and many other things. But I am appalled by the small group of Victorian members who vehemently pursue anti trans agendas, under the toxic umbrella of free speech. Freedom of speech has become the rallying cry of people who want freedom to oppress and harass other people.

Recently this group produced a document they call the “Docklands Declaration”, in which they propose a very reasonable sounding set of principles which actually seem to be designed to ensure they can pursue their transphobic bullshit without facing consequences. I have had it up to here with deceitful, reasonable sounding arguments that aim to harm, bully, and harass minority groups.

Among other things, the declaration states that there must be no issue considered off-limits. See how carefully it’s worded, in that “If you’re not with us, you’re against us” way, so that anyone who feels some issues should be off limits obviously supports totalitarian censorship. Obviously we all want free speech. Obviously we all support a free and frank exchange of views. Obviously we don’t support censorship.

Yet in a decent society some issues are always off limits. Anyone saying that women are not fit to hold office, for example, or that any member of a particular ethnic group is a terrorist, or less fit for office than any other, is beyond the pale. These things we must and do declare off limits. Freedom of speech means you can say what you like without being jailed. It does not mean you can say what you like and still be a member of any group, or, indeed, be considered fit to hold office.

If you insist that no issue is off limits, you open the door to anti science lies like climate change denialism and anti vax movements, yet that’s not even the worst of it.

Anyone who argues that some group of people is less human, or who tries to constrain anyone else’s human rights, is clearly unfit to hold office, or even be a member of The Greens.

The right of trans folks to use the toilets and changing rooms they identify with, and feel safest in. The right of trans folks to play sport. The right of trans folks to self identify as the gender they know themselves to be. The right to gender affirming care – which, by the way, is not medically controversial at all, it is literally lifesaving. These are human rights. If you are going to challenge these rights, however subtly and manipulatively you do so, you are, in my view, unfit to remain a member of The Greens, and certainly unfit to hold office.

I’m not trans, so I can’t speak for trans folks. But I am a vehement trans ally, and we can’t afford to sit by and say it’s fine for people to debate the human rights, or indeed the very humanity, of trans folks or anyone else. Fuck that noise. Time to shut it down.

“I support trans folks but…”

I read an article in the Guardian yesterday that I won’t dignify with a link. It was along these disturbingly common lines: “I support trans folks to be themselves, as long as they are clearly identified as trans people and not mistaken for REAL men and women, because sometimes it’s important to know someone’s biological sex”. Too many people support trans folks conditionally, and want to make it clear that they are allies, but only if trans folks are over there somewhere. Clearly labelled. Visibly, obviously, and outwardly trans. So that we don’t have to get too close. So that we know exactly what we’re dealing with. Not who. What.

The article was aimed at some new guidelines from the National Health Service (NHS) in the UK, saying that patients can’t ask not to be treated by trans folks. It clearly states that trans staff should not be required to out themselves. The Guardian article rejects this stance, and insists that patients have the right to ask to be treated (or not treated) by people of particular sex (as distinct from gender), whether it’s for religious, cultural, or personal reasons. The article said trans rights should be defended, but as a protected characteristic – ie a trans person’s rights hinge on the fact that they are trans, not on their actual gender.

I don’t want to speak for trans folks – goodness knows there are far too many cisgendered people trying to explain how trans folks should and should not be. We do not need more of that. But I’d like to tackle this article from the perspective of cis people, because what these “I support trans rights but please can the trans folks gather over there and be clearly labeled” folks don’t understand, is that gender essentialist attitudes impact all of us. And not in a good way.

I’ve seen this argument before – that trans rights are separate from “sex based” rights, and that it is possible to support trans rights and say that trans women are women, while at the same time saying “But they’re a different class of woman to REAL women. Sex based women.” It’s a bit animal farm, really. “All animals are equal – but some animals are more equal than others.” Trans men are men, sure, but they’re not REAL men. Trans women are women, as long as we remember (and can tell) that they are actually men underneath.

There are so many problems with this argument, but one of the problems that doesn’t seem to get much airtime is the idea that you can tell who is trans and who is not, just by looking. Here’s the thing. You can’t.

Oh, people think you can. A woman who is too tall, too broad shouldered, whose voice is too deep – a woman like me, in fact – is obviously trans (despite the fact that I am not). A woman who prefers pants to skirts, and shirts to frilly blouses. A man who wears make up, and has a high pitched voice. A woman who works in tech. A man who works in child care. A woman with facial hair. A man who can’t grow a beard. Are we all performing our gender well enough to be gendered correctly?

Because that’s the inevitable result of this obsession with knowing someone’s chromosomes or genitalia (which are themselves neither clear cut nor definitive, btw). That’s where it leads. We must all perform our genders clearly enough – conservatively enough – to satisfy the gender police that we are using the correct bathrooms.

You only have to look at some of the laws being enacted in the USA at present to realise that trying to define gender clearly and unequivocally has some pretty bizarre consequences. One law, in Kansas, defines women as people producing eggs. Now, I don’t know where that leaves women who have had their ovaries removed in a total hysterectomy, or women whose ovaries never actually produced eggs, or post menopausal women, or women who are using contraception to avoid producing eggs at all. Or, indeed, girls who are pre-pubescent. And it again begs the question of “how could you tell?” The truth is that you can’t tell. Even if you try to look under a trans woman’s skirt – assuming you somehow believe this is a morally acceptable thing to do – you won’t necessarily be able to tell.

It turns out that trying to define men and women biologically is actually rather complicated and fraught. But all the complexity goes away if your definition is, instead: you are whatever gender you know yourself to be. With some wiggle room for those who are still figuring it out. (Of course, if you stop segregating folks by gender the complexity magically goes away, too. Have unisex bathrooms, change rooms with individual stalls, and categorise sports by height and weight rather than gender. Boom. Done.)

The idea that you can tell gender by looking has caused a lot of harm, over the years. We harass girls with short hair and boys with long hair, and we make assumptions about skills and capabilities based on gender presentation. Perhaps it’s time we got over this fixation with two rigidly defined and observable genders, and moved on to letting people be themselves just as hard as they can.

Those good intentions

What’s with the stick?

Oh no, what’s happened to you?

What’s wrong with you?

I can see where these questions come from. I’ve asked them myself (except for the last one, which seems really off, to me). They’re well meant. They’re compassionate. Sympathetic. They recognise that I am injured, and they want to know why. They want to know if I’ll be ok. They want to know what’s going on with me. And from close friends, those questions are obviously fine. But from acquaintances, or even strangers, I’ve been getting increasingly uncomfortable with them.

The story around my hip and back issues is long, complicated, and not particularly interesting. I have a lot of pain, which is exhausting, and I don’t particularly want to have to explain the details several times a day. In fact, I don’t really want to explain the details at all. So I tend to brush it off with “it’s complicated, but I’m getting better.” Often this results in tales of hip replacements (which I don’t need) and offers of referrals to specialists – which, again, are well intentioned, but misplaced. I have a team. My well being is a work in progress. I don’t need your advice, your medical history, or the horror story of your friend and her hip replacement.

But it wasn’t until my daughter shared this article from The Conversation in her Instagram Story, and it included the comment “It is inappropriate to ask people about their diagnosis or impairment if not related to the topic at hand” that it dawned on me that, actually, even though people ask with good intentions, it’s ok to defend my privacy, to deflect, and to say “I really don’t want to go into detail.” And it’s NOT ok to ask people why and how they are impaired.

Like I said, I’m sure I have asked those questions. And it applies to trans people, too (not that being trans is an impairment!). Cisgendered people (ie not trans) want to show their support, and sometimes they do it by asking a lot of questions. Questions like: Are you on hormones? Have you had surgery? When did you know you were trans?

Not that being trans is a disability. But trans folks and disabled folks are faced with similar lines of intrusive questioning. “What’s wrong with you? What medical treatments have you had? What treatments are you going to have?” Along with a whole heap of unwanted advice. We should not be asking people about their medical treatment, or diagnoses, or why they are using mobility aids. It’s not our business. Just stop. Please.

In Sydney last week I was getting into an uber when a random stranger nearby decided I needed help. She was tiny, and kind of frail, and in the same breath as asking if I needed help, she picked up my heavy bag (which I was very capable of lifting myself) and slung it into the uber, tried to help me as I got into the car, and then helped make sure my skirt wasn’t going to get shut in the car door. All the while ignoring my response that I was ok, thanks, and did not need help. She was extremely well intentioned. As I thanked her she said “My husband is in a wheelchair, I know.” She was trying to help. I didn’t actually need help, I just needed time and space to get myself into the very low slung car (a problem for tall folks with mobility issues), and I was ungainly. I did appreciate her help. I was happy to have met such a kind person. But at the same time I could see how someone else might have felt disempowered by her leaping in and giving help where it wasn’t wanted or needed.

I have a close friend who I call my adoptive big brother. He is an impressive human being in many ways, but one of the things that always strikes me when I spend time with him is how alert he is to the people around him. He doesn’t leap in where he’s not needed, but he is aware of anyone struggling around him, and he will just pause to make sure they’re ok before he moves on. That is incredible compassion and understanding. Many of us, with compassion but less understanding, will leap in and try to help where it’s not wanted. My big brother just checks that they’re ok, and doesn’t intervene until it’s really necessary. And even then, he will ask, and honour the response.

It’s that sensitivity to people’s autonomy that is difficult for most of us, but something we should all be striving for.

It’s ok to want confirmation that someone is ok. It’s ok to want to know what’s going on with them. But maybe we need to stop, more often, and ask ourselves “is this something I need to know?” “Is this really my business?” “Am I asking very personal questions?” and just stop before we get started. It’s also ok to ask if there’s anything we can do, but be prepared to be told “no”, and honour it.

Start from the assumption that people are private, and autonomous, and you won’t go far wrong.

Sticks and Stones

Like many people, life has been throwing a lot at us over the past year or so. Much of it, it may surprise you to learn, I haven’t written about. Turns out I do have boundaries. Or limits. Or something.

One of the particularly challenging things has been my hip troubles, which, despite support from a fabulous physiotherapist and wonderful myotherapist, have been quite recalcitrant. I work hard, make progress, then get hit by something else that sets me back yet again. For example, I was very nearly back to normal mobility when I got covid in April of 2022, and the combination of being bedridden and largely immobile for too long, and the inflammation that goes with covid set me back so far I began to believe progress was impossible. My attempts to prevent pain and protect my poor abused muscles lead to a kind of cascading failure state where everything I did to try to fix one thing made something else sore. I felt quite beleaguered.

It reached the point where I was lurching like some kind of twisted, drunken, troll, and couldn’t even begin to figure out how to walk normally anymore. At some point along the way I purchased a walking stick, having carefully measured according to all the guidelines I could find, though I resisted using it for anything except extreme pain during travel. Unfortunately that careful measurement failed me, because none of the guides to measuring reminded me to wear shoes. The only stick I could find that was tall enough was only tall enough (and it was marginal) when I was in bare feet. Like most people, I wear shoes when I’m out, and a walking stick that’s too short tends to make the twisted, drunken, troll thing even worse.

When my physio suggested using a stick to train me to walk more upright, I embarked on a search for a walking stick tall enough for all 185cm of me. Sadly, the walking stick industry appears to cater exclusively to short people, and I was stumped. I managed to find a nice tall set of crutches, which my kiddo made much more palatable to me by decorating them with rebellious slogans like “Fuck da patriarchy (& the fossil fuel industry)”, “Trans Rights”, “Crazy Cat Lady”, and my personal favourite: “Warning, will attack the education system if left unsupervised. (Supervision may not be sufficient).” I felt so seen.

Elbow crutches, though, are tedious, especially in the heat, and tend to rub on the forearms if used for any length of time, so I was keen to graduate to a walking stick. On social media I lamented the lack of options for someone my height. Enter my amazing friend, Christian Klopfer.

Christian is the founder and proprietor of Oztables, where he makes the most extraordinarily beautiful, functional, and strong furniture you’ve ever seen. In 2020 he designed and made these glorious shelves for our living room – note how the wood grain on the front of the cupboards goes all the way across, those doors were made out of a single piece of reclaimed timber – and we have long admired his work.

Christian offered to make me a walking stick out of reclaimed timber that would be exactly the right height for me, long legs and all.

Being a meticulous sort, he carefully researched the ideal shape of both stick and head, and set to work. He chose an absolutely beautiful piece of timber (though I suspect that all timber becomes beautiful in Christian’s hands), invited me over to test drive the handle and check the height, and then finished it with careful polishing and a natural hard wax finish. I was so inspired by the final result that I used it as the centrepiece of a talk at the ATSE Activate conference.

My walking stick is a truly glorious thing that brings me great joy, and every time I use it I am reminded of the power of friendship, kindness, generosity, and sheer artistic talent. I am extraordinarily lucky in my friends. See for yourself.