The intricacies of transitioning: How to safely make the change

Purple Romero

Posted at Jul 15 2017 07:09 PM

Transman Jhen Latorre of Pioneer Filipino Transmen Movement with his partner Kris Menao. Purple Romero

When Charice Pempengco– the girl whose singing prowess brought her to popular American programs such as “Ellen” and “Oprah”–decided to transition to embrace his identity as transman Jake Zyrus, one of the biggest questions from the public who grew up watching him was, “What will happen to his voice?”

It was a concern that also boggled transman Jhen Latorre six years ago, as he pondered whether to go ahead with transitioning or not.

“I used to sing before. It was one of the things I really thought about when I started taking steroids,” he said in Filipino. “I was known then as the lesbian who can hit high notes.”

Latorre, now 33, said that prior to transitioning, he could belt out songs with high notes such as “Listen” from the Dreamgirls soundtrack, and Chaka Khan’s “Through the Fire.”

“I told myself, if I transition, my voice will become deep, I will never be able to sing those songs again. That was one of my realizations. [I asked myself,] am I ready for that?”

Latorre’s worry is but one of the usual dilemmas faced by transgender people who want to undergo female-to-male transition and vice-versa. Now a transman, Latorre said what can be considered as the “littlest things” posed the biggest points of doubt and anxiety for transgender people.

Changes in the tone of the voice, however, is just one of the considerations and consequences of transitioning that transgender people need to learn about and have guidance for.

In a conservative country like the Philippines though, it’s not a subject that can be tackled easily or even openly.

FOR TRANSMEN AND KATHOEY

One might be surprised to learn that even the Philippines’ neighbor– the often-cited lesbian, gay, bisexual, and transgender (LGBT) haven of Thailand–has also just recently started to acknowledge the intricacies of transitioning.

Tikky, a 29-year-old kathoey or ladyboy as they are called in Thailand, said that when she transitioned 10 years ago, she had not the slightest idea what brand of pill or medicine was safe to take.

“I didn’t know anything,” she said.

In the absence of a doctor or expert she could talk to, she only confided in a friend.

“I just chose the brand by myself,” she said, laughing as she explained that she chose a particular pill because she liked the name. After a year, however, she noticed that her appetite significantly increased, and that she had gained weight.

Tikky later learned that her increase in appetite was an effect of the pill she was taking, prodding her to switch to another brand.

When they realized the importance of medical, psychological, emotional, and social support for transitioning, Latorre and Tikky took part in initiatives to help other transgender people.

Latorre is one of the founders of the Pioneer Filipino Transmen Movement (PFTM), a group which provides counselling and advice to transmen. Tikky, on the other hand, works as a counselor at the Sisters Foundation, the nongovernment organization behind a transgender-run clinic for transgender people in Pattaya.

Three months ago, Sisters Foundation introduced in Pattaya the guidelines or trans health blueprint in action which was developed by the Asia and Pacific Transgender Network.

Established in 2013, the group used social media networking sites such as Facebook and online forums to provide much-needed answers to the questions of those who wanted to transition.

Latorre said they have a list of steroids, intramuscular injections that medical practitioners proved safe. They also have nurses among their group, whose knowledge about health come in handy. They also have contacts with transmen from the US who can give advice.

‘TALK BEFORE TESTOSTERONE, EXPLANATION BEFORE ESTROGEN’

Sisters Foundation meanwhile has an office designed to walk transgender people through the process of transitioning.

“We designed the counselling room [in our office in Pattaya] as if it’s a coffee shop so the people will be more relaxed and will feel more open in talking about their concerns,” said Sisters Foundation executive director Thitiyanon “Doi” Nakpor.

Counselors like Tikky talk to transgender people about the levels of their estrogen and testosterone, and the safe dosage of hormone-boosting medicine that they can safely take for the transition process, including after sex reassignment surgeries.

Doi said counseling is vital because it dispels common, erroneous beliefs among the transwomen or kathoey.

“Most of [the] transgender in Thailand I think in my experience, didn’t know a lot about this information. Most of them think that when you take a lot [of hormone-boosting medicine], you will be more beautiful, but it’s not true. It’s about what you take, how to take it,” she said.

Guidance is important because testosterone and estrogen supplements can be easily bought in Thailand.
 
“Here, you can buy the hormone [boosters] anywhere. You don’t need a prescription. It’s over the counter. You can go to the pharmacy and say I want one of the birth control pills. You can pay and you got it,” Dr. Jiraporn Arunakul said.

This easy access carries risks. Jiraporn said there are those who take pills without knowing their side effects, one of which is the increase in cholesterol and liver enzymes. “You need to monitor that regularly.”

Dr. Jiraporn Aranakul of the Gen-V clinic in Bangkok, Thailand. Purple Romero

Jiraporn, who opened the first transgender clinic for young people, the Gender Variation or Gen-V clinic, the first of its kind in Southeast Asia, said this health threat can also be present among young transgender people, as even those who are young as 13 years old can just buy hormone supplements anywhere.

“In a survey I conducted, I found out that Thai transgender teenagers take the hormones by themselves, because here, they can buy anywhere. They can just buy here or buy it via the Internet.”

In worst cases, taking the wrong dosage of testosterone boosters for those who want to undergo female-to-male transition can cause high hematocrit, or increased production of red blood cells, cysts in the ovary and infertility, according to Dr. Tim Lopez, owner of Maximum Performance Wellness Center, a transitions hormone clinic in Pattaya.

Those who take the wrong dosage of estrogen can experience breast pain and ovarian tumor, he said.

“It’s more dangerous for those doing the female-to-male transition. For a [biological] man taking estrogen, not so much,” he said.

Hence, it is paramount that transgender people, young and old, consult experts first before they do anything or take anything that can affect their body.

Latorre said the PFTM does not just give the list of hormones or doctors who perform sex reassignment surgeries to those who ask for it—they first ask for proof that the transman has first consulted an endocrinologist.

“A member should have first gotten the right dosage for his hormones from an endocrinologist, must have taken lab tests. Some say we’re not that generous with our information, but we’d rather stay strict and be called ‘selfish’ than sacrifice the safety of transmen,” he said.

POINT OF NO RETURN

There are some transmen and transwomen who do not see the need to have sexual reassignment surgery. However, there are ways to ensure that those who wish to undergo surgery are sure of their choice.

Jiraporn said that, in her clinic, those who want to have the surgery must first talk to two psychiatrists to make sure they have gender dysphoria, or the difference between a person’s assigned gender and the gender they identify with. Second, they must have a “real-life” experience.

“This means they should have lived by the [biological] sex they want to be for at least one year before they have sex reassignment,” she said.

If they want to transition to being a man, they should dress and talk like a man. The same goes for those who want to transition to being women. “This is because it’s the point of no return,” she said.

The transgender clinic of the Sisters Foundation also has similar guidelines.

“The counselor and lab technician, before you have an operation, will ask you how many years have you taken your hormones,” Doi said. She said it is crucial that the transman or transwoman should have taken their hormone supplements for at least a year, as this will indicate that they are sure about their decision.

Thitiyanun Nakpur, executive director of the Sisters Foundation in Pattaya. Purple Romero

Sex reassignment surgeries can also only be performed on those who are at least 18 years old and those who have parental consent. When one reaches 20 years old, however, the surgery can be done even without parental permission.

Hormone boosters can be taken by those who are at least 15 years old. Prior to that, Jiraporn said young trangender people can take hormone suppressors or inhibitors to prevent them from undergoing the changes brought on by puberty.

MORE THAN TWO BOXES

Aside from guidance for physical changes, however, transgender people also need emotional and social support.

Jiraporn said that, in a study she conducted recently on gender variation among Thai teenagers, 11 percent of the 3,000 respondents in Bangkok experience gender variation or are LGBT. Fifty-three percent are not accepted by their families.

“Those who are not accepted by the family face risks of being suicidal, [experiencing] depression, not being successful in education,” she said.

This is why in her transgender clinic, she welcomes both those who decide to come only by themselves and those who send only their parents. She talks to the parents and explains to them what gender variation is all about. She tells them that gender is a variation, and that it is not right or wrong

“[It is not] only two boxes,” she said.

She remembered that in one instance, there was a teenage transwoman who came with her father. The two had not been in good terms ever since she came out as a transgender. After undergoing counseling in Jiraporn’s clinic, the father made a turnabout.

This poster in the Gen-V clinic in Bangkok says, "I hope you see me the way I see myself." Purple Romero

“He was pretty aggressive, initially, but later on, after counseling, the father decides that he would like his daughter, I mean like male-to-female daughter, to get hormones. The father said, whatever makes their daughter happy, it’s going to be fine for them too.”

If one’s family does not support or accept their loved one for being a transgender, groups like Sisters Foundation and PFTM are there to fill the gap. Experts like Jiraporn are there to listen too. With just one Facebook message or one call, they can stand by transmen and transwomen in their journey to being their true selves.

* This article was done under the International Reporting fellowship