I'm not trying to pat myself on the back, but I do want to point out what "support" means, since soc.support.transgendered is a support newsgroup. I've had the pleasure today of helping two people with tough problems. It's what makes my time here worthwhile. There are also several other people here who have been and continue to be excellent at giving support; I make no claims at star status or that I'm carrying the load all by myself--that would be utter bullshit, and I would lose some good friends in the process.

But support is what we're here for. Yes, there are community issues to talk about, and those are important as well, but these are secondary when someone comes in with a specific problem.

I'll copy the two support pieces I did, since I think (I hope) that I've been able to give some useful support to each of these people. The reason I'm copying them here is to point out the nature of support:

1. I listen to them.
2. I understand that it is their problem that needs solving, not mine.
3. I understand that my personal solutions may or may not work for them.
4. I give understanding and empathy where I can.
5. I give pointers to resources where they can find more information on their own. It is NOT the goal of support to make people dependent on us, or to make them follow us.
6. If possible, I describe the experience of peole in similar situations, which may be me, and may be anyone I've ever met.
7. I offer possible solutions. I do not tell them what to do. It is their issue, after all, and my suggestions could be completely wrong for them.
8. I do not pass judgment on either the people, or their issues, or their goals, or the efforts they've made to deal with their issues.
9. If I do not have an answer for a particular question, I will say that outright. It is more important to be accurate than it is to look like you have all the answers. No one has all the answers.
10. I make sure that they know they are welcome to come back and ask for additional information.
11. Conversely, if I subsequently discover important information, I will attempt to follow through for that person, and make sure that they get the additional information. The third example below is an example of that follow-through.
12. In short, I am empowering these people. They are in control, and they can make the decision that is best for them. THAT is support.

There are a few points worth emphasizing:

• I do not force my personal agenda on these people. Both of these individuals are seriously seeking SRS. That's fine with me, even though I'm not interested in SRS for myself. Instead of trying to argue them out of SRS, I gave specific suggestions on how they can get there, or at least how they can determine for themselves if it really is the direction they want to go.
• For those who think that I couldn't possibly help a transsexual, since I chose not to have surgery, take a hard look at the second example. I talked about gatekeeping, and what to do about it. I offered alternative solutions for hormones in a difficult medical situation. I know about Dr. Schrang's pet pshrink, and offered specific suggestions on how to deal with a situation in which a second psych recommendation won't be a rubber stamp. I know about going off hormones before surgery. (I know why it's important, too.) Anyone still want to say that a transgenderist doesn't understand transsexual issues?

It takes some work to understand how to do this, but it really isn't hard. It's more a frame of mind, along with a few skills that most people can learn, and having enough resources and experience to be able to point to additional support avenues. One of the reasons that I have my own web site is that it's one place that I know what's available, and how to find it. I keep support issues in mind every time I update my site. But I don't hesitate to point people towards the resources that will do the most good for them, wherever they may be.

You can say that you've learned to give support when you've talked someone back from suicide. I've done that twice, within the gender community, and joined with others in providing support in the depression community.

You can say that you are a seasoned veteran of giving support when you've tried to talk someone back from suicide, and they kill themselves while you're on the phone with them. I haven't had that happen yet, but I assume it will happen one of these days. I know that there are others in this group who have had this experience. None of us want to have that happen again.

People, support is a serious and important issue. And I'll tell you this, flat-out: Debating labels and partitioning people into boxes isn't going to help you give support when it counts.

But if you really want to learn how to do support, volunteer for a local helpline. The good ones will have excellent training programs, and you'll get some live experience talking to people on the phone. And trust me on this, they always need new volunteers.

First support example

NetNut writes:

> A married couple with children, friends of mine, need advice badly.

> The husband confessed to his wife, in Novermber 1995, after 10 years of marriage, that he was a transvestite. Just this week, he confessed that he thought he was a transsexual and that he wished to "become a woman" within the next two years.

This is a very individual issue. There are several marriages that have survived intact, even with a full transition, hormones, and SRS. There are others who find some other balance, which might perhaps include hormones and transition, but not SRS, or partial transition, no hormones, and no SRS. The best thing that your friend can do is to get active in the gender community, not to seek out immediate transition, but simply to listen to other people's stories. Your friend also needs to keep an open mind on her issues, because many of us find that our perception of ourselves and of our needs evolves as we learn and change.

But the most important thing is for each of them to understand that they really do have the freedom to make their own choices and compromises. Their marriage doesn't have to end. There are many possibilities, but only they can decide what is best for them. The gender community is here to help them find those decisions, not to tell them what those decisions should be.

My own history is this: I began coming to terms with being transsexual over the summer and fall of 1993. I was leaving a relationship at that time, and expected not to be involved within anyone else until after surgery. As I finally came to the inescapable conclusions in late 1993, I found that there was a woman who was very interested in me. It was not fair to deceive her in any way, so I told her everything about my gender issues. She stayed with me, and we are still together today. I've been on hormones for over two years, and I've been full-time as a woman for one year. Part of my decision not to have surgery involved considering the consequences to our relationship; Carol did not say that it would end the relationship, but only that she couldn't predict what her reaction would be. In the end, I had no real reason to take that chance, and I decided that I had the things that were really important to me simply by living as Diane.

My personal history and thoughts, including relationship issues, are recorded in depth on my web pages. Please pass my web address to your friend. <http://www.firelily.com/diane/>

> this couple, who love each other very much, need advice badly from

The sentence above is extremely important. As long as they love each other and continue to work together, they have a very good chance to come through this together.

> reliable medical sources (psychological and physiological) on all issues related to transsexualism. Can someone please point me to a FAQ or some other list of places where they can go or write to for help? They want medical advice and counseling. Does John Hopkins still have a place where she can obtain information? The couple lives in northern California.

They will benefit from talking to a therapist with experience in gender issues. There is a hormone FAQ online; I don't remember the address, but I do have a link to it on my web pages (gender resources; you can get there directly through <http://www.firelily.com/gender/resources.html>

I think it's the second link on the page, right below the Standards of Care, another important document.

I believe that the John Hopkins gender clinic shut down some years ago, but there will be far more extensive resources in the San Francisco area. IFGE provides lists of support groups and gender therapists, both in their magazine "Tapestry" (possibly "Transgender" now), and also online. The online link is also available on the same resource page I listed above.

Please pass my best wishes to your friend and her wife. If either of them wants to email me, I'll be happy to talk to them further.

BTW, NetNut, bless YOU for asking on their behalf. If your friend is not online, I hope that you'll be willing to continue to help them in this way; the net is full of gender resources, once you begin to know where to look.

Second support example

Rapunzel60 writes:

> I have started living as my self in March and life is getting better all the time. My friends, family and co-workers are adjusting just about as fast as I am. On the whole I am starting to feel like I am of the human race again or maybe for the first time. There are just a few little problems that I could see turning into some major barriers in the near future.

Overall, it really does sound like things are going well. Congratulations on a smooth transition!

> My doctors have indicated that I may be Bi-polar (manic-depressive) and to be safe we decided to medicate me as such. OK, everything seamed to be going well then some side effects started to surface. I am taking carbamazipine (tegretol) because I had intolerable reactions to the other drugs of choice. One of the problems with tegretol is that it causes the liver to start to metabolize everything at an ever increasing rate so I have to increase all my meds and hormones to match. Thus I am always a step behind on the blood levels, my liver could become over worked and the expense will go beyond my budget.

I don't have a lot of direct experience with bi-polar, but I'm not unfamiliar with it, either. I do understand that the meds are a bitch.

My first suggestion, for you and your doctors, is to try to figure out a compromise that doesn't eat your liver alive--hormones aside, killing your liver is a bad idea.

I will also suggest that you find some support groups where you can get some peer input on various meds. One place to start is alt.support.depression, where there are several bi-polar people who are regulars. There is also a bi-polar specific support group online, but I don't remember the name. Here's how you can find it, though. There is a home page for the alt.support.depression newsgroup; the URL is <http://www.firelily.com/support/depression/>

If you scroll down, you'll see a list of links for resource pages. One is Dr. John Grohol's Mental Health Page (or something like that). Go there. He has a list of all the mental health newsgroups, and you'll find what you need there.

As far as hormones go, the liver gets two passes at oral hormones, both during digestion then taking them out of the blood. Talk to your endocrinologist about alternate ways to deliver the hormones, such as injections and skin patches. Both should be feasible, especially since you've already been on hormones for a while, and there certainly won't be any immediate problems (my endoc's objection to injection, when I started). That cuts the liver problem down, without changing anything else.

> Now here is the other kicker. My doctors got together for a little pow-wow and then told me of a matter that I should " think about". If I am Bi-polar then that may prevent me from being approved for the SRS which was starting to progress as a reality.

This is a tough one. As long as you get the bi-polar aspect under control with meds which co-exist with your hormone therapy--something your doctors should be helping you with--I can't see why being bi-polar should disqualify you for SRS. You may have to work longer with your therapist, both to talk through any direct issues, and to learn more about coping with bi-polar, but I can't see it as a real show-stopper. From the medical side, there would be no direct reason for not having surgery, as there would be for diabetes or AIDS, but there might be an interaction between meds and anesthesia. It's something to check out. Of course you can always go off meds before surgery; you'll have to do that anyway with hormones. (It's only for a few weeks! Don't panic! It's only like PMS.)

> So the questions are: is this a problem; can it be explained to the "gatekeepers"; is there a better way to deliver the hormones to the body; and if there are no answers then how do I live with "it"?

Gatekeeping is a problem, not just for you, but for our whole community. Right now there isn't much you can do to get past those idiots except to go around them. There are other pshrinks, though not many other surgeons. I know Dr. Schrang keeps a pshrink on contract to do the second recommendations, but in your case I would suggest that you make your own arrangements to get a second recommendation letter, so that you know it gets done.

In the worst case, meaning that you can't get SRS, it is not the end of the world. You won't be the first--I know others who can't even go on hormones, for medical restrictions, and without them can't transition--and you won't be the last. But it's how we survived before there was SRS, and it's still how some of us do it, either by choice, or because SRS isn't available for whatever reason, including financial.

But if it's not your choice, yes, it's going to be a disappointment. Let's hope it doesn't come to that, but if it does, we're here for you, both on the net and as a community across the country. Life DOES go on.

Third Example: Follow-Through

>Dear Ms. Wilson,
> Thank you for your suggestions that you have shared with me and the "web". What you have offered is very sensible and helpful and I would ask for your permission to convey your correspondence to my battery of healthcare professionals. As I am paying then to learn about my issues, they will happily accept this information for the right fee.

You've already paid my fee. Use it however it will help.

However, since I responded to you, I've learned something else. If by any chance you are taking spironolactone as a testosterone suppresser, you should be aware that it has side effects on the central nervous system, including the ability to mimic bi-polar disorder. If your bi-polar symptoms started after you started hormones, you need to consider this possibility. Also, you need to be monitoring potassium levels; spironolactone is nasty about causing a build-up of potassium, which can have lethal consequences. Check out a copy of the Physician's Desk Reference for more details.

This is not to say that you can't use a testosterone suppresser. I've been taking depo-provera for that, and it is both more effective and much safer. If your doctor wants more info on that, he can contact my endocrinologist, Dr. Donald Pittaway, at Baptist Hospital in Winston-Salem, North Carolina. (Depo-provera is a progesterone injection; it's good for three months, and avoids a lot of the problems of taking progesterone orally. I understand that progesterone does have its own effects on breast development--"finishing" according to Dr. Shiela Kirk, whatever she means by that, but I think it would be about nipple development.)

> You will probably notice that I have reposted my plea because I noted that the first one kind of vaporized. Since I am new to electronic media, I didn't know if this was proper or even prudent.

Most newsreaders keep track of what you've read, and don't show it to you again. In any case, news is only stored for short periods; as I remember, AOL is 14 days, which is actually pretty long by internet standards. Both my newsfeeds delete after seven days.

> Actually, I have been really enjoying the banter that I have seen on the Newsgroups, although if it were my feet in the fire I would probably be singing a different tune... Maybe not. I'll let you know if that happens.

As long as it stays at the banter level, it's fine.

> Well, go enjoy a bath. Bye, bye

Long, hot shower tonight, followed by lots of cuddles. Cures what ails ye.

Take care,
Diane