WHAT WOULD IT BE LIKE TO WEAR A PRETTY DRESS?

What would it be like to sit while I pee?
To put ribbons in my hair, without mommy scolding me!
I'm going to have to hide , I guess.
What would it be like to wear a pretty dress?

What would it be like to have a doll of my own?
You know, someone to hug when you feel all alone!
Dad keep saying to me "Your different than the rest".
But he doesn't know how I look in a dress!

Why can't I play with the girls at school?
Hopscotch and jump rope seem really cool!
The boys are too rough, and everything is a test.
I wouldn't want them to see me in a dress!

What would it be like to kiss a boy?
To have him call me on the phone, after he walked me home.
Coach says I should play football a game I detest!
He's trying to stop me from wearing a dress.

What would it be like to make love to a man?
To feel the strength of his arms, and the softness in his hands!
But my marriage is really the best.
She doesn't even mind my wearing a dress!

I What would it be like to give birth to a child?
To feel her inside you, while you wait for her smile.
Since the kids have been born, our life has been full of duress.
She doesn't want them to see me in a dress!

Forty years have gone by and I'm still waiting to live.
My thoughts and feelings are mixed, something has to give!
There is no one left for me to impress.
I spend a lot of time in public wearing a dress

I'm desperate now, and my back's to the wall.
I feel like a woman, but I'm so damn tall!
The only way to get out of this mess,
Is to change my body to fit this pretty dress!

Charlegne Millet

MEDICAL INFORMATION

(The following is an excerpt from a letter responding to a questions asked by a XX Club member)

I will attempt to address for you some of the long term health concerns that our population faces. In the past year or so, it has come to my attention that a number of > five-year post operative transsexuals that I know have complained of various endocrinological / metabolic health problems. The chief problem has had to do with what appears to be an early onset osteoarthritis and associated bone loss. Also, Dr. Walter Futterweit of New York City reported to me that he had begun to see cases of pituitary, liver, renal, thyroid and cervical cancers in his long standing endocrinological practice.

Last year, as I graduated from the Medical College of Virginia, I took the opportunity to research the medical literature. This research has continued to date at the University of Connecticut Health Center. This resource is available to you - your local university / school of medicine library will have the Index Medicus. The index is a listing of all the studies / research journal articles that are published m the medical nursing and other disciplines. It's easiest to access by the library's in-house computerized catalog. However, the librarian can always provide you a hard-bound catalog of the listings. A number Of papers/studies confirmed findings that Dr. Futterwit described.

In the past year, I have done additional research, mostly keying in on topics such as Transsexuals and Estrogen. The findings were disappointing: the texts and journals have yielded next to nothing in the way of useful information. While there is a fair amount of research being reported m Psychology / Psychiatric / Surgical literature, there is next to nothing describing the long term physical health concerns. I've recently conducted a search on the Internet, which also was a disappointment.

However, in the past month I have changed my search focus, and it has yielded some interesting information. In the past, Eunuchs (and boys m the present who have Pubertal Delay) were/are reported to exhibit short stature (i.e. bone problems), and shortened life spans. This is not a common practice today, certainly it is not ethical - therefore, there is no current research on Eunuchs.

There is much written about Male Hypogonadism and Testosterone Deficiency Syndromes which are endocrine and metabolic disorders. The Merck Manual (Merck & Co., Rahway, NJ, 1992. p. 2226) states: " postpubertally, testicular function is maintained through a complex interplay between the hypothalamus, pituitary, and testes." Trust me when I tell you that this feedback loop is extremely difficult to explain. The manual goes on to say (p. 2227) that: "disorders of the hypothalamus or pituitary may be associated with low gonadotrophins (secretion of the hypothalamus), low testosterone...-. Some of the signs and symptoms of Postpubertal Testosterone Deficiency include (p.2227) "varied manifestations depending on the degree and length of deficiency. Decreased libido, potency, and overall strength are common. Testicular atrophy, fine wringing around the eyes and lips, and sparse body hair may be found with long standing hypogonadism. Osteopenia (bone that has been broken down and is in the bloodstream) may @ be present" (bold emphasis mine)- Kleinfelter's Syndrome, which is a sex chromosome aberration (XXY), is usually not present m the typical transsexual, Among other manifestations, these individuals (p.2229) 'have abnormal skeletal proportions...". Kallman's Syndrome, which is a deficiency of LH and FSH (hypothalmic-releasing hormones) manifests with (among other symptoms) (p. 2228) "midline skeletal defects". Additionally, other signs and symptoms mclude (spealang generally): bypothyroidism and hypoadrenalism in postpubertal panhypopituitarism.

The treatment of Prostate Cancer presents us with a model that is interesting. Like transsexual male to female individuals, male prostate cancer patients are given a course of treatment which includes female hormone therapy and bilateral Orchiectomy. They also often receive radiation therapy. These patients acquire a state of hypogonadism (hormonally and/or surgically) as an unfortunate side-effect m the treatment of their cancer. I recently read an abstract at the-school of medicine library at the State University of New York at Stoney Brook which described the onset of Osteoporosis in some men who had underwent orchiectomy for their prostrate cancer. Regrettably, this journal article was not available: that particular issue was out to the bindery. I believe that this area of research can be very useful in identifying similar bone related problems that the community may face.

In the normal course m treating transsexuals, a regimen of estrogen is initiated. There is a wealth of information available m the use of estrogen by both males and females. You can read these yourself by referring to the "package insert' which is normally included with your Rx from your pharmacist. I won't bore you with a verbatim description about estrogen from the Physician's Desk Reference (PDR) which is essentially the same as the package insert. But I will mention the highlights from the 1990 version, pp. 2388-89: Warnings associated with Estrogen: Induction of malignant neoplasms (increased risk of endometrial carcinoma), ... gallbladder disease increased risk of thrombosis in men (in use for prostate cancer) pulmonary embo@ stroke, and myocardial infarction hepatic (liver) adenoma elevated blood pressure a worsening glucose tolerance Hypercalcemia (increased calcium in the blood stream secondary to bone breakdown/loss) Fluid retention increased incidence of mental depression. increased circulating total thyroid hormone. Because estrogen influences the metabolism of calcium and phosphorus, it should be used with caution in patients with metabolic bone diseases that are associated with Hypercalcemia or in patients with renal (kidney) insufficiency. As a rule, estrogen should not be prescribed for longer than one year without another physical examination being performed-

Hypercalcemia is defined in Pathophysiology: Clinical Concepts of Disease Processes, Fourth Edition, Mosby Year Book, St. Louis, 1992, (p. 860) as a total serum calcium level above 10.5 mg/100 ml. Many conditions may lead to hypthe most common cause. There are many other conditions in which hypercalcemia develops independently of PTH. In fact, PTH is suppressed by a high calcium level. ... Symptoms of hypercalmia include (but not limited to) formation of bony cysts." Which is interesting because Osteoarthritis (Degenerative Joint Disease, OA) is the (P. 968) "the formation of new bone (bony cysts / bone spurs) at the articular surface (end of a bone at a joint)." It is "chronic, slowly progressive, non-inflammatory and is characterized by the deterioration and abrasion of articular cartilage."

Personally, I have been told by a neurosurgeon that "it's like getting grey hair, - gets OA-" Tlus is p-ally true. According to the Merck Manual (p. 1339) it (OA) "becomes universal by age 70." However, the aforementioned Pathophysiology text claims that (p. 968) "the disorder is more common in women than in men (Merck claims men and women are equally affected, but onset is earlier in men) and is found primarily in people over the age of 45."

What is interesting is the relationship between estrogen and the onset of OA. The Patho text (p. 968) states that "sex hormn. and other hormonal factors seem to be related to the development of osteoarthritis. The relationship between estrogen and bone formation and the prevalence of Osteoarthritis in women both strongly suggest that hormones (italics mine) play an active part in the disease's development and progression." this appears to be "the smoking gun". Essentially what happens is that a normal XY "transsexual gender dysphoric" male individual is placed on a course of estrogen hormone therapy (which itself I an approved therapeutic intervention in post-menopausal women to help Prevent osteoporosis) and then that the same individual undergoes a bilateral orchiectomy which removes the gonads which are the primary producers of testosterone. Some testosterone remains present, as it is produced in both men and women in small amounts by the adrenal glands. But the delicate, fragile and very complex hypothalamic-pituitary-gonadal negative feedback loop has been broken with the removal of testosterone in a phenotypical male - a body that was not designed to be bathed in female hormones. There is research available that suggests that similar men (prostate cancer patients) who are treated with estrogen can develop osteoporosis.

Recently, an endocrinologist mentioned to me that the normal, typical Post-Operative transsexual has "more bone average woman" which is fine, I guess, if that normal, typical post-operative-transsexual is actually an XX individual. However, most TS's are not XX - most are invariably XY and were constructed to carry a much larger frame - which, it appears, after some number of years, begins to show the signs and symptoms of an accelerated bone loss / abnormal new bone formation. Personally, from my readings, and from personal stories from long term Post-opts, I believe there is a very strong association/relationship between bone disorders and Transsexualism in male to females.

I believe that this area alone has much to provide in the way of additional research. The other reports of cancers in various organ structures also needs to be examined in more detail. The problem that will face any examiner is the fact that transsexuals have a tendency to "move on" and "disappear into the woodwork' in an attempt to integrate into mainstream society. Follow-up studies will be extremely difficult because the older, long-term post-opts often cut their ties to the gender communities. Onset of the disorders outlined here are slow and insidious - a ten year post-op may dismiss a thyroid or pituitary cancer as a random, genetic, environmental or familial occurrence. A five year post-op may be told by her MD that an early (<45 years old) onset of osteoarthritis is just a normal consequence of the aging process. Certainly the medical community needs to be alerted to the possibilities of the long term health effects - not to mention the researchers also. The nursing implications are many - and from my experience, the transsexual community is not being adequately addressed. There is much to learn. The knowledge base is far from complete.

Kathy E Reilly BSN RN

HAIR TODAY, SKIN TOMORROW

DATELINE: New Hartford, CT January 7, 1997

I have just surviveded what was a very painful but tolerable, experience having all the hair ripped off my face m order to better reveal the woman I am Let me explain. Today I underwent a new type of electrolysis, using a laser rather than electric needle, in the hope that in a year or year and a half and for some $2250 to $4000, 1 will never have to shave my face again. The procedure, known as Softlight, has arrived here from California and is currently being offered at the office of a plastic surgeon, Dr. Patrick Felice, in Bloomfied (CT). It is actually being performed by a wonderful, compassionate and caring nurse, Billie Beatty. The procedure involves first removing all facial hair using a "waxing" method as is used for legs and eyebrows, followed by passing a low-energy laser beam over the skin. Prior to the laser, a black solution is spread over the skin. This contains carbon which is supposed to penetrate into the empty hair follicles (left empty by the hair's removal during waxing). When the laser is passed over the skin, the carbon is heated and hopefully kills the cells of the hair follicle without harming the skin. No promises are currently being made for permanency of the hair loss because there is not enough long-term experience as of yet.

My experience actually began three weeks ago when I went to Dr. Felice's office for a free evaluation. the staff was wonderful. They were friendly, warm, and ever respectful of my situation. I was given a complete introduction to the procedure and was also evaluated by Dr. Felice. So far, there appears to be very little experience with doing male facial hair. He does feel it is absolutely necessary to be on estrogen for some period of time to soften the hair. I had been on hormones for four months prior to the actual treatment. It was necessary for me to allow my facial hair to grow to a length of one-quarter inch in order for the wax to have enough hair to gnp, thus the three week delay between the evaluation and the treatment.

The actual experience was, as I said at the beginning, quite painful. Imagine having about a thousand band aids attached to the hairs on your arm and pulled off one at a time with the hairs stubbornly refusing to let themselves be sacrificed for the greater good. it took about four hours just to complete the waxing and removal phase. Billie was wonderfully patient and was always ready to stop and wait for me to collect myself before continuing. The most painful area was my chin where most of the hairs hung in them for dear- life-. Fortunately, for one half of the clearing of my lip and chin, Dr. Felice was available and able to anesthetize the skin which made a HUGE difference. to do this for the entire face and neck is probably unrealistic given the extent of terrain to be covered, but I would definitely recommend it for the area around the mouth and chin. The laser part was much easier to tolerate but was still painful, probably due to the fact that my skin was now so sensitized. The actual sensation of being lasered has been described as similar to having rubber bands snapped against the skin for 5-10 minutes. I personally felt it was more like having Jiminy Cricket tap dance on my skin while wearing hot-soled shoes. (There is a tapping feeling during the laser probably due to its being a pulsed laser)

About six hours after I started, I walked out of the office under my - power actually feeling pretty good- My skin felt sensitive and warm and there was some swelling but overall, I was in good shape. Although a single treatment is never enough, it is hoped that over the course of one to one and a half years, five to eight treatments will give pretty complete and permanent hair removal, but there is absolutely no guarantee. Future visits should be less painful as there should be less hair to remove in a given area each time. Cost is computed by the number of 'areas" treated. Upper lip, chin, cheeks, and neck constitute four areas and a cost of $675 for a single visit. Five treatments within the 12-18 month span are about $2250.

So-o-o-o-o-o, the big question is, would I do it again? Ask me that again after I complete my next treatment.

Your currently hairless reporter, Jessica Winograd

Reflections the next mormng:

I awoke with the same mild burning in my face. In the mirror, I saw that the swelling and redness had almost disappeared There were a few small discolored areas which may be slight burns but they were not particularly sensitive. The overwhelming emotion was joy. Joy at my hairless face WITHOUT SHAVING and gratitude for being supported through the pain with God's help. It made it all seem worthwhile. As I had said to Billie during the procedure, the experience was probably akin to that of childbirth where the pain may be terrible during the act of birthing , but it is soon forgotten in the joy of what has been brought forth. And it is similar in that I feel that this procedure as wen as all other aspects of my transition are birthing a new me. So, as of now, I will definitely be back for more.

And one week later:

The joy continues. It is such a great feeling to look at myself in the mirror each morning and see an essentially hairless puss that I almost wish I could go tomorrow for another treatment just to move the process along. Alas, there is a minimum waiting period of 6-8 weeks between treatment, and maybe more, depending on how much and how fast the hair returns. Bottom line, the pain was definitely worth it. Follow-up reports will be found in future XX Club newsletters and at my web site, <http://www.jessicawinograd.com>.

Jessica Winograd