tithonis [she/her]

Pharmacy Benefit Managers (separate from, but mostly vertically integrated with, insurance companies in the US) absolutely have been doing this for years now. It lets them say they’re providing a service and reducing prices when they’re doing the opposite.

Without getting into the details, the cash price of drug x gets set obscenely high, pharmacies bill this price to the appropriate Pharmacy Benefit Manager who then tells the pharmacy “we’re paying you whatever we pay you”. By and large you’re lucky to break even. For some medications and some contracts it can cost a pharmacy hundreds of dollars to fill a prescription. You’re not allowed not to fill it. You’re not allowed to charge the patient less than the cash price you charge everyone, which is the inflated number the PBMs conspired to come up with. If you do, you risk losing even more money getting audited by Optum or Express Scripts and good luck with that lol lmao

That’s the short/comprehensible version. A 30 count bottle of ondansetron (generic Zofran, nausea med) costs $0.39 or so but the U&C most pharmacies use for billing purposes is >$1,000/30 tabs. Actual reimbursement for #30 ondansetron looks more like $0.39 + maybe a dispensing fee that doesn’t cover the cost of keeping the lights on. That U&C also becomes the cash price without goodRx or one of the other middlemen who aggregate PBM data and pick a price more or less at random from what reimbursements actually look like. GoodRx also bills pharmacies $8 for the privilege of checking a price with them, every time you submit them a claim.

It’s fucked. There’s compounding pharmacies that’ll make injectables for you cheaper than you can find at a standard retail pharmacy, if you can find one.

I don’t try to go stealth but apparently I pass reasonably well because I have told cis people that I’m trans, or at least alluded to having transitioned in a way that I’d think the people I was talking to understood and they just continue to believe that I am somehow just a very tall cis lesbian with a deep voice. I have told medical professionals who can see the gender dysphoria diagnosis on my chart that I do not have a uterus, I have never had a period in my life, I was born without a uterus or ovaries and they just shrug and go “huh alright”. I’ve had coworkers who didn’t realize I was trans for a year. I told them I was. They forgot? I’ve fostered kids who didn’t realize I was trans (the kids who did realize were uniformly cool about it, this could mean nothing).

I live as out as I can but sometimes there is that math you have to do in your head about whether it’s worth disclosing to someone or not. Most of the time I just let people figure it out themselves eventually. If it comes up, it comes up, it’s part of who I am but it is not the most interesting part of who I am and I’m not leading with it.

Never underestimate the obliviousness of cis people. It’s really something.

Some of the fiercest cis allies I’ve had have been random people in (fuckass nowhere reactionary shithole) who happened to know trans people. When you’re confronted with the reality that we’re not some weird Other that exists in porn or as a punchline or just that weird lady (?) who makes me kind of uncomfortable and scurries around like a scared animal whenever I see her, it makes it hard to maintain those prejudices. This goes for any people who are marginalized/othered. It goes for us too.

It’s unfortunately not uncommon for people to find your transitioning cute or endearing or positive in the abstract but once they have to acknowledge that you are in fact who you are and you expect them to respect that, fall off like that. You’re cute to them as a pet, as a toy, but not as a fully realized human being.

Transitioning really put into contrast who my friends were and who tolerated me so long as I was useful to them somehow. I keep my friends close, anyone who tries to put a disclaimer on their support of trans people - of transfems in particular - can fuck right off. I don’t have time for that shit.

I’ve always been a hot mess but the maternal instinct is too strong. Sometimes we find the strength to help ourselves through helping others. Sometimes they help us back. What’s fraudulent about your help as it exists?

Matrix update for those who use matrix.org:

https://bsky.app/profile/matrix.org/post/3lxwhw33wms23

The Matrix.org Foundation‬ ‪@matrix.org‬ · 6m Status update: we’ve restored the 55TB snapshot and subsequent incremental backups, and are about to replay the remaining traffic since the backup. There are still several unknowns, but if things go well the matrix.org instance should be back in 3-4 hours.

Fingers crossed it’s back up soon. Tracha Aux is still running. If anyone needs a link my matrix info is in my bio.

Edit: it works now

Everyone lagughed at tithonides for having so many alts… whose laugehging now !!!

• https://status.matrix.org/
• https://bsky.app/profile/matrix.org/post/3lxuslbzjuc2t

still ongoing they really shit the bed with this. matrix.org is affected, anyone/anything on self-hosted servers is fine. i hope it’s back soon.

I know someone who got bottom surgery without doing any hair removal? She seemed surprised that it was a requirement and as far as I know she hasn’t had any hairs appear somewhere they shouldn’t. The surgeon scraped the follicles off while they were in there and that was sufficient, evidently. I’ve never heard of anyone else doing this, though. Vale la pena!

I also grew about 2 cm taller after a year or two on E, and I have no better explanation for my own growth.

Nothing quite like freshly grilled Hatch chiles from some dude on the side of the road. I don’t live in chile country anymore so I order bags of frozen roasted hatches to keep in the freezer for when I get a craving for green chile. It’s a but pricey but worth it, nothing else is quite the same.

Seconding (thirding?) what the other two replies have said. You did nothing wrong by confiding in a friend. Boundaries don’t work like that, hurt feelings are inevitable, and you’re never responsible for regulating or predicting someone else’s emotions.

It does get better. Life goes on, it always does, it will look different than you thought it would, but it goes on. There’s always the possibility of bigger and better things ahead.

If this is a consequence of being raised AMAB I wish all the creepy cishet men on earth who I’ve had the displeasure of interacting with would have internalized it. If anything, the performance of hegemonic masculinity expects that you be brazen, threatening, indifferent towards the consequences of expressing your desire. And to show any hesitation is blood in the water.

It’s a queer experience (ask cis queer people about it!) and it’s a neurodivergent experience. It’s an EMPOC experience too! It’s nothing to do with what a doctor decided when you were born however long ago, though. It’s a consequence of existing outside of hegemonic conceptualizations of masculinity.

What do you use the algorithm for, even? I don’t stray outside the little bubble I have curated for myself on my timeline because there are horrors beyond my understanding out there. And a lot of transmisogyny. I just want to look at lovely landscape photography and talk to other weird communist trans women tyvm

I sent my girlfriend my cutest flannel in the mail and it finally showed up a few days ago. There’s a package somewhere in transit to me right now from her and I could not be more excited for it to arrive.

It took me 20+ years to finally work up to doing something about my gender but everything that has transpired since I transitioned (it’s been a while!) has made me more convinced every day that I did the right thing. I had no idea life could be this good.

I used to live in a very red part of a very red state, early into my transition and I’ve never been misgendered less than when I lived there. Cis people tend not to be thinking about trans people 24/7, and if you present remotely feminine, people just assume you’re a woman. Sometimes the reactionary brainworms work in your favor. I’d have people tell me their abhorrent opinions about trans people to my face without any hint of consideration that I might be trans. Or running an Antifa training camp in the woods outside of town. They were afraid of that, too.

When I lived in the gay part of a big city before that I got misgendered all the time. But why accuse someone you’re not certain is trans of being trans when that’s something that only people in the city do? I never got hassled for using the bathroom, either. No one cares, by and large. No one cares as much as we convince ourselves they do. Some people are genuinely dangerous, but there is an entire media ecosystem dedicated to scaring trans people into the closet by hyping up how bad it will be to be trans in public.

No one cares. No one is really paying that much attention.

The more women you meet, trans or cis, as a woman, the more you realize that we’ve got everything in common. Sexgender is built and maintained through coercion and violence.

Awesome news! I’m applying for mine shortly too, while I can. I’ve got places to go.

Find someone as unfunny and weird as you are and you’ll wonder why you wasted your time with anyone funny or normal. It’s worth being unapologetically yourself until you find someone who matches your freak.