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At first i wasn't going to write about this, or not here anyway. Then i started to write about it somewhere else and the keyboard flew away from me and i ended up writing about something completely different. Now my mind is still circling so i'll try here anyway and the hell with it. My journal, my introspection, feel free to page down if you're not interested.

My latest project is one that's popped up several times for me since 2001 - doing research into post-transition regret in bipolar transsexuals. Yesterday i finally read the few academic papers i could find on the topic. Freakin scam, by the way, how much they charge for a few pages. The problem in researching this is that the transsexual community doesn't have a particularly strong interest in publicizing stories of failure because it could negatively affect the medical guidelines that currently restrict access to surgery. Most of the public failures are people who got a sexual buzz out of crossdressing (actually having to live for real as the other gender kills the buzz) or people who found religion and decided to go back to their God-given gender. The rest tend to be schizophrenics.

When i think back to how it went for me, i know i started experiencing regret before i even had surgery, but i pushed it to the back of my head because i had just gotten myself so convinced it was the way forward. I'd told my family, the few friends i still had, i'd told my medical professionals and set a deadline (before my 21st birthday). My mom and grandma were ready to pay for it, i had fine enough features to pass pretty well as a woman, so why not? About a month after surgery the regret in the back of my head exploded through my whole being. I'd go through a week here or there where i was happy with it, where i even found it kind of cool or unique and sexy to be physically female, then several weeks of hating my body as much as i did before the surgery. It kicked off one of the worst depressions of my life and a really tumultuous few months where i got diagnosed with manic depression and struggled through those first awful steps of trying to deal with it.

The thing is aside from two cases, i can't find any medical reference that seriously addresses comorbidity of these diagnoses. In those two cases they speak about bipolar patients wanting to change their sex due to acute psychotic mania - essentially putting us in the same bucket as schizophrenics. It's fucking scary to think that perhaps i fell into that category because i really, honestly believed at the time it all made sense.

As i think back, it was 1998 and i was going to a lot of parties, doing a lot of drugs, and watching my friends disappear off into weird delusions of their own. It was the ex-punk-turned-hippie crowd, and they had their own stack of wacked out conspiracy theories that made my life and belief system seem altogether normal. But gradually i became paranoid too, convinced that my roommate (a gay man who was desperately and futilely in love with me) was spying on me. It occurred to me recently that the only evidence i really had of this was another friend's testimony years after the fact, one who was experiencing speed psychosis at the time and later got so paranoid he thought the government was spying on him through the cable box.

I remember when a transsexual friend came out to me it was the first time i'd ever really considered being the other gender (warning sign number 1 - you're "supposed" to already know when you're a kid). By that time i thought my ICQ conversations were being logged by my roommate, and was extremely distressed that even my explicitly heterosexual conversations hadn't thrown off his affections. I actually remember hatching a plot to scare this guy off by talking about being transsexual online. It seemed like the only way to stop him from obsessing over me, though it's altogether possible perhaps that the obsession was only in my head. Either way, i also put together a huge list of things i didn't like about myself, things i felt insecure about, things that changing my sex would certainly fix. It did all make sense. It did, damnit!

And when the ball started rolling that was my whole life. I quit drugs and disappeared off the scene, stopped talking to all my online friends and got a job. I learned everything there was to know about transition, everything the shrinks needed to hear, everything you should do to make sure it's successful. The biggest project of my life, and i screamed through it like i'd die if i stopped. I honestly felt like i would. And that just made it all the more obvious to me and everyone around me it must be the right thing - the whole point of transsexualism is hating the sex of the body you're in and wanting to correct it as soon as possible. Depression and wanting to self-mutilate, anxiety, it's all explained away by gender dysphoria... Or it is until you "finish" transition and then realize every single feeling is still there, down to the last weird insecurity. So what do you do then?

Well, you make lemonade. Everyone makes dumb decisions in their lives, i guess some are dumber than others. You live with it. What still interests me, though, what puzzles me is how i got there in the first place. It is very hard for me to believe i could've spent over a year high functioning yet completely delusional. And if the idea of changing my sex was only triggered by a shorter episode then why didn't i stop the first time i got depressed? One of the articles i read yesterday implies that depression can feed the feelings of gender dysphoria as much as mania can, which kinda makes sense i guess, but ... ugh. I guess i've always felt happier with the idea of being transsexual than the idea of being so crazy i convinced myself i was transsexual. Still, the regret over changing my sex persists, as does my craziness. Guess that's the answer right there... But i do so prefer Diet Coke.

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::hugs tight tight::

I have to admit, almost ten years after the fact, I regret introducing the idea of transsexuality to you. I felt like I had someone to talk to, finally, going through what I was going through.

I felt like i pushed it on you, and the chances you had to turn away, I put you back in the wrong track.

We've talked about this all before, and I know you don't blame me. I blame me, though, and still feel for you.


You shouldn't blame yourself. If it hadn't been you talking about that it might've been someone else talking about something else that sent me off. The end result would've been superficially different but probably just as devastating. At least i'm alive! In the end it's all worked out okay because i've had some wonderful experiences over the last 10 years - experiences i might never have had as a guy - and i'm sure there are many more to come.

I have a severely bipolar friend who might know something about this co-morbidity you're researching. She seems to be ridiculously well-versed in all things bipolar, but that could just be her delusions of grandeur.

I have often wondered about transitions gone wrong, not in a Hedwig kind of way, but psychologically wrong. I know in fits of craziness I've convinced myself of some pretty batshit things, so I'd expect that it your situation wouldn't be exceptionally unique.

This letter was the most promising start point for me, although they seem to be more interested in the genetics: http://ajp.psychiatryonline.org/cgi/content/full/164/7/1122 It references an article about a case where the patient lived as a woman during manic episodes, but when depressed reverted to present as male claiming indifference or exhaustion. That case actually sounds like genuine comorbidity to me. I've tried to dig deeper but it's very slim pickings, even if you expand it to include schizophrenia. I need to check the university libraries here to see if they have the older journals i can't get to online.

Post-transitional regret is fascinating because it's such a furtive thing. It's pretty embarrassing to admit to, so i can understand why there's not more information out there. I know i never reported any of this to my primary care physician or psychiatrist who treated me during transition - i went to a new set of professionals who didn't specialize in gender dysphoria.

I guess what i'm most puzzled about is how i managed to stick with it for over a year. Mania shouldn't last that long. I got a job, started hormones and electrolysis, came out, got a nose job, did vocal coaching, changed my name and got through several months of "real life test" before the doubts started bouncing around. And even then i didn't heed those?! It's not like i was just changing my freakin hairstyle yanno. I might be a little crazy but come on, over a year? Hmph.

I need to see a psychiatrist again, a good one who is interested in this stuff.

(Deleted comment)
The kind of "regret" you talk about does sound normal - people will always wonder "what if" over decisions they made in the past. The kind of regret i have is not like that at all. You know all those "years" you spend hating your body and the way people address you and the clothes you wear and your place in society? For me i only felt that for one year prior to transition, but i've been feeling it every day for the eight years since.

Edited at 2009-09-26 08:15 pm (UTC)

"Mania shouldn't last that long." can't mania last that long in bi-polar 1? I know I have had greatly extended periods of hypo-mania with just tiny maybe one day depressions with bi-polar 2. hrm I don't know

When i first looked at this stuff years ago i remember reading the same thing (that sometimes mania can last for a year or two with just the odd spiral here and there). Back then there was less information on how mania affected gender identity, though, so i kinda abandoned the whole thing. Now there's more information on gender identity but it's like everyone started rapid cycling overnight so it's harder to find information on long episodes.

By the way, i thought if you experienced mixed episodes that ruled out bipolar 2? I don't know either heh. I guess if i'd actually seen a psychiatrist since 2002...

I wonder how HRT affects your symptoms too. If you are aggressive, irritable etc (manic symptoms) then anti-androgens and estrogen will lessen that. I could see testosterone having an opposite affect on lethargy and lack of confidence (depressive symptoms). Plus there is the obvious impact on libido. Getting on hormones for me was a big relief, at first anyway. It's almost like a wacky approach to self-medication (i remember doubling or tripling my anti-androgen dose on days i felt more agitated).

Edited at 2009-09-26 08:32 pm (UTC)

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