What are your preferred gender pronouns?
As a gender therapist, I am aware that use of gender pronouns (he, him, her, she, his, hers, etc.) are critically important all of us, not just gender variant folks. If you are reading this, and you identify as a male and look like a male, would you be uncomfortable if I referred to you as “ma’am,” or “miss?” Say for example, I’m working at the local Starbucks and you are next in line, but you are not paying attention, and I start saying “miss,” “excuse me ma’am,” louder and louder, asking the person next to you, “can you let her know she’s next?” – and then you are tapped on the shoulder by a stranger, who is looking you in the eye and says to you, “ma’am, she’s ready for your order,” – and everyone around is observing this. How would you feel?
Typically, it is an embarrassing thing to get gender pronouns wrong, for both the person being misgendered, as well as the person who is doing the misgendering. It is awkward and uncomfortable. The same is true for folks with gender dysphoria who are not yet at a point in their lives where their gender presentation matches their gender identity. Now, imagine a female-identified person who was born male, who is 6’5,” and is who is struggling to feminize her appearance in a way that the world can immediately associate as “female.” In her mind, no matter how she looks, she will feel no different than the man in line at the local coffee shop, if she is misgendered.
Our mind identifies our gender in such a way that it is an uncomfortable experience for many transgender persons to be referred to with incorrect gender pronouns (misgendered) even when they are not out to the world, and they are not asking for or expecting correct pronouns. Their discomfort is simply private; no one knows – except the female-identified person inside the male body who cringes with embarrassment with each misgendering. While she may not be ready to expose her true gender to the world yet (likely for fear of rejection and disconnection from loved ones and associations), she still suffers the pain of misgendering.
What can we do to help her, and other’s like her? We can work to make our world a more gender-friendly place.
Advocating with Gender Pronouns
It’s uncomfortable to not know what a person’s gender is. What do you do when you don’t know which gender pronouns to use? If in doubt, don’t use a gender. If in doubt, and you feel brave, or interested in participating in making the world a more gender-friendly place, the kindest thing, believe it or not, is to ask, “Which pronouns do you prefer?”
There is a common belief that it is rude to ask someone a question like this. However, if you are a person that embraces the diversity in the world, and you have a non-judgmental acceptance of the answer, it is actually quite kind to not assume that you know. For example, I would never be offended if someone asked me, “Do you prefer men or women (gay or heterosexual)?” The question itself suggests the the one asking realizes that not everyone is heterosexual! What a concept! To think it’s offensive to ask this question suggests that you consider it someone offense to be gay (or to be heterosexual, though I’m doubting that’s the case). If you are comfortable asking someone if they are married, what is the difference between a question like that, and a question like, “are you bisexual, gay or heterosexual?”
Ask: “Which gender pronouns do you prefer?”
Inquiring about a person’s gender is the same. If you are comfortable and confident in your gender, having someone ask you which pronouns you prefer is not likely to offend you; you’re more likely to be curious about the question. If you are uncomfortable with your gender, perhaps the question will bring you comfort – having the opportunity to clarify.
If you operate a business, or work with people on a regular basis – particularly those of us in “helping professions,” you can actually get into the habit of asking the question, “which pronouns do you prefer,” to everyone, so that it becomes common-place.
Gender pronouns on Email Signature Line
Another way to help make our world a more gender-friendly place is with your signature line on emails. On the signature line of my email, I not only include my name, address, website information and phone number, I also have a very simple line that says: “she/her pronouns.” I recommend you do the same, particularly if you are in the human service industry. Some people will ask you about this. You can educate. Others will be comforted, and they will know you are a gender-safe person for them to be honest with. This is a simple way to extend greater support, acceptance, and advocacy for non-binary, gender fluid, and transgender folks. I learned this from Dr. Gallagher’s Transgender Surgical Program Advocate, Nicole Jackson, who said she learned it from someone else… so see how this works… pass it along.
Gender Friendly Office Environments
A final strategy I’ll share about how to make your office a more gender friendly space comes from a fellow sexologist in one of my professional news lists. He shared that his office is posting this information for all to see:
Our office is attempting to be more gender inclusive.
The staff will be asking about your pronoun preferences (Male, Female, Gender Neutral).
You may also hear us call patients Mx. (pronounced Mix) rather than Mr., Mrs., Miss, or Ms.
Of course, we will refer to you however your prefer.
This is a work in progress, please excuse our errors.
If you intend to be inclusive, kind and compassionate to all, regardless of their gender presentation and gender identity, these are ways to bring your intentions to life.
What are some other ways to be more gender friendly – please share in the comments.
Q & A with Dr. Gallagher
Deciding on mtf bottom surgery is an overwhelming process for many transgender women. There are so many factors to consider when deciding which surgeon to choose for surgery: location, cost, comfortability, outcomes, aesthetics, experience, rate of complications, surgery style, willingness to work on higher BMI or other potential health complications, aftercare availability, and your overall comfort with his or her personality and bedside manner. Once you’ve decided on a surgeon, you must also consider your surgical options. Most people think of vaginoplasty when they think of MTF bottom surgery.
There are also three other options that are less commonly talked about when considering gender affirming surgery. Some women are not interested in penetration, or the dilating and maintenance that accompanies vaginoplasty. In particular, older ladies may be more interested in these less invasive options for surgical affirmation.
I asked Dr. Gallagher to share her thoughts on the following four questions related to choosing the right MTF Bottom Surgery.
What are the different options for MTF bottom surgery?
What factors are important to consider for each one?
An orchiectomy is the most affordable and least invasive procedure available for MTF bottom surgery. For some women, this is the only bottom surgery necessary. The orchiectomy allows women to eliminate testosterone blockers, and estrogen doses may also be reduced. For those hoping to have vaginoplasty later on, this will not prevent you from pursuing additional surgery when you are ready.
Scrotoplasty and orchiectomy
This procedure removes the testicles and the scrotal skin. This is only recommended for patients who will not be undergoing vaginoplasty in the future. Because the wound is slightly bigger, it is a little more invasive than an orchiectomy. Surgery is completed in one hour, and recovery time before returning to work is typically 1-2 weeks or less.
Zero depth procedure
Zero depth procedure is less invasive and much less likely to cause rectal injury or other complications. This surgery includes all of the steps involved in vaginoplasty (removal of testicles, scrotoplasty, labia pasty, clitoroplasty, shortening of the urethra), except for the creation of a new vagina between the bladder and rectum. This is ideal for women who are not interested in penetration, and wish to avoid the upkeep involved with a new vagina.
What is the most common mtf bottom procedure you do?
Orchiectomy is the most common procedure I do. This is often because many of our patients still sadly don’t have insurance coverage for their full bottom surgery. Orchiectomy is much more affordable for these folks and doesn’t take away any options.
What else is important to know about the various bottom procedures?
It is important to remember that with every surgery there are risks, downtime and in some cases a lot of care required. In order to have a happy vagina that will serve you well, it must be taken care of properly. You must be able to commit the time necessary to do the dilation, take the time off to recover, and have a good support system of friends and family to get you through this demanding surgery.
For folks who are not at a point in their lives where they can commit to this level of post-surgery-self-care, the other options described above may be more appropriate.
FREQUENTLY ASKED QUESTIONS about all things Transgender: Depression after Surgery
Answers to your questions about the medical and emotional aspects of transgender life by Sidhbh Gallagher, MD and Michele O’Mara, PhD
Why is it common to get the post surgery blues?
Depression after surgery is a common experience for patients of most major surgical procedures. However, when the surgery is designed to positively impacts your social presentation and gender identity, and you have spent most of your life waiting for this day to arrive, it can be very surprising to then experience post surgery depression.
According to Dr. Sidhbh Gallagher, many of her patients experience sadness and anxiety after any surgery. When asked why, she said, “There are many reasons for this, and it is completely normal.”
- CHANGE IN ROUTINE. One of the most basic reasons for post-surgery depression and anxiety is the basic change in your normal routine. When you are admitted to the hospital, you become temporarily displaced and while you may have the support of friends and family, it is unlikely that you have the same kind or quality of contact with them during this time. Routines provide comfort, structure, and predictability to our day. Whether you turn to a morning cup of joe, a hearty workout or yoga class, or a Mc-breakfast to start your day, your body will notice this change in routine.
- PERMANENCE ANXIETY. In the weeks following surgery, it is very typical for a transgender patient to think, “What have I done to myself?!” Not only is it common to feel depression after surgery, feeling anxiety is also common. Even when you know that you have taken the right step in aligning your body with your true gender, it is common to question yourself. When you progress through a gender transition, it is common to forget the pain that drove you to make the choices to start HRT, to pursue surgeries, and to transition in the first place. Each step you take toward a gender transition brings relief. From this place of feeling better, it is easy to question if you really needed to make these changes at all. Think about the messages you have received throughout your life about who and how you “should” be. It is a monumental task to counter everything you were told and taught that you are supposed to be, that you were born a boy/girl, and that your body is that of a boy/girl, and you are expected to behave, dress, think, and socialize as a boy/girl.
- HORMONAL CHANGES: Adding insult to this already complicated surgical scenario, is the fact that many transgender patients will need to stop taking their hormones for a period of time before and through the surgery process, to reduce medical risks for blood clotting and other concerns. This, alone, contributes to a low mood and lack of energy.
- GRIEF. It’s a bit counter-intuitive to think we would grieve something that we’ve desired for so long. However, from an emotional perspective, surgery is often the last item on your list of “todo’s” as you journey toward your truest self and authentic gender expression. Consider the time, energy and resources that you invest throughout your gender transition. It is all-consuming. For many, transitioning is the most dominate focus in life. When you complete this list of todo’s there is a feeling of “now what?” To feel depression after surgery is natural. The process of transitioning involves a roller-coaster of emotions. From the lows of fearing the loss of (and sometimes not just fearing, but actually losing) relationships, supports, jobs, and more – to the highs of feeling aligned with your true self, is an exhilarating ride. After surgery, the roller coaster begins to slow and you are faced with having to adjust to a new normal.
- WHAT IF’S? Gender-related surgeries invite a lot of “firsts.” While for many this is a wonderful adventure, it can also be very anxiety provoking. Whenever we do not know what to expect, it is natural to feel anxious. When you go through a gender surgery, there are a lot of “what if” questions. What if I don’t like how my _____looks? What if I never orgasm again? What if my swelling never goes down? What if I still don’t feel happy even after having surgery? What if this does not take away my dysphoria? And, on and on….
Some Helpful Tips To Deal with Depression after Surgery:
- Focus on the here and now. If you are seeking information about how to deal with your post surgery blues, know that in this moment, as you are reading these words, all is well. Focus on right now; not what used to be, not what you are afraid will be, but what is. When you stay grounded in this moment, you can also stay connected to the reality that you are okay, that all is well.
- Remember the pain will go, the wounds will heal, and the numbness or itching all gets better! Your body knows what its doing just give it time. Put down the mirror! Many patients will not see their final results for up to a year.
- Surround yourself with supportive folks as much as possible and talk it through.
- Be aware that bad habits like smoking can be very hard to avoid after going through the stress of surgery. Have a plan for when temptation sneaks up on you.
- Remember to ask for help if you need it. Some patients experience real episodes of anxiety and depression after their surgery. Your mental health professional is available to you and can be incredibly helpful during these times reach out if you need help.
MTF Vaginoplasty (GRS) Before and After Photos of SRS with Dr. Gallagher (10 weeks post op)
In a series of articles I wrote about Dr. Gallagher, I provided one post on vaginoplasty and at the time I was unable to include before and after pictures of the GRS.
Recently Dr. Gallagher sent me the following before and after photos of a recent MTF vaginoplasty (SRS) she performed. With the consent of her patient, I am providing these here so that you can view the early results of her surgery.
The before photo:
The following after photos are taken at 10 weeks. These do not reflect the final results, as this patient is still healing from surgery.