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I was in a similar position to you. Painful dilation, lost depth and single. And then covid hit. And I just stopped dilating.

It's years later now, and sometimes, I feel a bit of regret. Yet when I think about going for another round of surgery to get my depth back, the idea of having to start dilating again feels really forbidding.

Ultimately, I haven't been able to have the sex life that I was hoping for. But that was true before I had bottom surgery as well. And when I look at it that way, despite that issue, the other results of bottom surgery are still there. I feel better in my skin. My dysphoria is gone. Even if the outcome wasn't perfect, and wasn't quite what I hoped for, it's still better than where I started.

All of which to say is, even if you do stop dilating, at least in my experience, it's not all doom and gloom.

I don't have any advice for you, other than to say you're not alone. Like you, I transitioned nearly 10 years ago, got the surgeries I needed out of the way. I've been a runner the whole length of my journey, and I don't really "fem up" much at all. Also, like you, I did all the things. I volunteered, I went to trans events and pride etc, I took up roller derby, and made lots of friends. And then covid came along, and then facebook banned my account, and suddenly, I was without the social connections I was used to having, and most of those friendships faded away.

These days, other than online spaces, my only regular queer and trans connections are my partner and the odd catchup with people that I used to see regularly, before covid changed everything.

But, it's ok. I still volunteer (though less than I used to). I'm the event director for my local parkrun, which is a pretty amazing community. I've been parkrunning for nearly 10 years, and even though I'm not close friends with any of the folk I've met there, it still makes me happy to see the same faces every Saturday, and to share our habit and our passion for getting out of a Saturday morning!

My life is less social than it used to be (and I'm an extrovert), and I've got less queer folk in my life on the regular than I would like, but I'm happy and I'm doing ok.

I won't pretend to have any answers for you, or tell you how to magically solve loneliness, but hopefully, there's something in knowing that you're not alone

It's a factor, but not the whole story. Social norms also influence things a whole lot.

I came out at 41, and that was close to 10 years ago!

Age won't stop you :)

Asexuality, and romantic attraction are also part of many relationships. Romantic and intimate, but not necesarily sexual.

what is relationship anarchy and it's relationship to ENM and polyamory?

ENM is an umbrella term. Similar to how "gender diverse" includes not just trans folk, but anyone whose experience of gender is outside of cis norms.

In this case, ENM is an umbrella term for ethical relationships outside of the monogamistic norms of society.

Relationship anarchy is a way of viewing relationships that doesn't focus on trying to name or define the specific type of relationship. People within it connect with each other in consensual ways, on their own terms, often in defiance of cultural norms and assumptions.

Polyamory is a more tradition "partner with partner" approach to relationshps, but with one or more partners in the relationship being open to having more than one partner themselves.

What they all have in common is a strong focus on consent, communication and respect for boundaries. (That's the ethical part). Other than that, they can be platonic, sexual, romantic or any combination of the above. Relationships even outside of those are part of the framework as well. Your partners partner may not be your own partner, and may not even be your friend, but your shared experience with the same partner means that your relationships impact each other, even though you don't share a direct relationship.

You are absolutely welcome to start those conversations. But the only arbiter of you is you. We get involved when other people try and over talk your experiences and tell you that they know you better than you know you.

Listening the the experience of others and finding your own truth in their words is powerful. People telling you that their experience let's them define your truth is where we step in :)

Yeah. The best way to lower risk of prostate cancer is to lower testosterone levels. And the best way to stop it growing if you do develop it, is to lower testosterone levels, and add estrogen. And they rarely, if ever choose surgical intervention when it comes to prostate cancer. So, despite being at the age where a cis man would have to start thinking about this, it's not something I plan on investigating, given that I've got a reduced risk profile, and I'm already on the same medication they use as treatment...

A good chunk of lab values have different ranges for male vs female.

You've actually hit on a major reason why disclosing isn't as simple as you think it is.

Sure, a good chunk of values have different ranges for male vs female, but the normal ranges for cis folk and trans folk are not the same.

Hormones are the obvious example, but there are large parts of the body that respond to the endocrine profile that we have after hormone replacement. Heart attack symptoms, body fat percentages, resting heart rate, blood oxygen levels, iron levels etc, are all shaped by our hormone profile, not the hormone profiles of cis folk.

That said, I have no idea if those are intrinsic to the sex, or to the hormone levels, so HRT might completely negate or flip those differences.

It entirely depends on the specific medical issue, but in general, it's the latter more often than the former.

I'd run this by your HRT doc.

It's not always that simple. On top of the fact that it's not realistic to see the HRT doc every time you have an unrelated medical issue, the other aspect is, as you're probably aware, sometimes, the patient knows more about their health care needs than the treating doctor, because we need to become experts in a way that a GP does not. If your doctor isn't a specialist in trans care, they're just as likely to give you conservative, incorrect information that was drafted in a time when trans health care even less understood than it is now.

As you're a nursing student, I want to give you some advice. When you are dealing with a patient that isn't "new" to their situation, whether it's trans health care, or long term illness etc, you need to allow for the fact that the patient likely has a lot of lived expertise in dealing with their situation, and broad, general advice is rarely going to be useful to them.

I may be wading into a minefield here

You are. And not only that, you're in a community aimed at trans folk, offering advice to trans folk who are aware of the reality of the situation in a way you very likely are not. That's not a good position to start from when it comes to offering advice. Doubly so, when your advice appears to be coming from a position of "in a perfect world" rather than from the practical realities that trans folk have to deal with in the world as it is.

I've learned it's actually pretty important for doctors to know someone's status as trans

As with all things, this depends on the context. Sometimes, it's relevant. Mostly, it's irrelevant. And sometimes, knowing causes doctors to make mistakes about our healthcare needs when they incorrectly assume our medical symptoms align with those of cis folk of our assigned genders (this is particularly likely if the doctor is not familiar with trans health care).

On top of that, there is a thing called "trans broken arm syndrome", in which doctors tend to immediately aim for HRT or transition surgeries as the cause of whatever ailment the trans person has. Again, this is particularly true with doctors that don't often treat trans patients, or worse, that hold anti trans opinions (even if they keep those opinions private).

Yet, even when it is relevant, telling the doctor can lead to all sorts of othering and exclusion. Sometimes, it's outright transphobia and misgendering. Sometimes, it's being isolated from other patients, because the medical staff don't know how to deal with you. Sometimes, it's just medical curiosity, where the doctor just wants to ask all sorts of irrelevant questions out of medical/personal curiosity, because they don't often deal with trans patients.

I live in a very trans inclusive country, with protective laws. I'm openly trans, and wear a trans flag dog tag, and a trans flag arm band. Yet one of the few situations where I won't openly out myself unless I have no other choice, is when dealing with medical staff who don't recognise those flags. And I do that, because the folk who don't recognise the flags are the folk more likely to other me, more likely to be confused by me, and more likely to ensure that my interaction with them is as uncomfortable as possible. And that's in a safe, accepting country. Imagine what it's like for folk who live in places where transphobia is not only common, but sometimes legally mandated...

Which is to say, each and every trans person navigating healthcare has to decide for themselves how to walk this tightrope. And general advice of "you should tell them" suggests you're not familiar with the lived realities of trans folk, despite working in a hospital

My surgeon did follicle removal during the surgery from the underside of the skin. The goal of hair removal wasn't perfection, but just to reduce the amount of time he had to spend on hair removal during surgery.

That being said, I understand not all surgeons do the same...

Getting away from a community that exists only for trans people to self flagellate is probably a good idea...

Communities like that exist only to hurt trans folk, and they're used by trans folk who think they deserve to be hurt.