One Small Step, One Big Step

Got my official “referral for sexual reassignment surgery” letter from my physican today. It was a much more emotional moment than I would thought be.
Let me explain… This letter is simply to try to get insurance to cover the surgery.*
The letter that actually matters is the “gatekeeping” letter** I’ll be getting from my therapist shortly, saying that SRS is appropriate treatment for my gender dysphoria, that I’m not mentally ill or mentally impaired, and that I’m able to give informed consent. I can’t get surgery without it.
But still, even if it’s just “insurance paperwork,” this is a definite milestone. Shit’s getting real, real fast.
*Technically, California law requires insurers to cover SRS. But I’ll be having mine done in Thailand, which means paying upfront and then trying to get reimbursed your insurance company. Who usually do their best to avoid paying if you go overseas (which is ironic because the surgeons there are often better, and usually are less expensive).
I’m not that optimistic, but I’ve heard that the odds improve slightly if you get an referral from an in-network doctor, and seek pre-authorization. We’ll see…
**Surgeons typically require two therapists/psychologists to sign off your SRS, however, my surgeon has his own psychologist do the second evaluation, so I only need to get one letter myself.
I understand why surgeon’s want that sort of CYA, given that it’s an irreversible surgery. And certainly you’d be foolish to do without having done The Work about why you want it. (Which is true of any other plastic surgery). But yeah, it definitely poses issues around patients’ having autonomy over their bodies.

Boobs! Post-surgery, Day 6

First follow-up appointment, not to mention my first shower post-surgery (so good!).

As expected, my boobs don’t look quite right yet — too high, too far apart, not the right shape yet because of that. But over the coming weeks, the muscles will slowly relax and the implants will drop into their proper position.

Wearing the binder (full-time for the next week, and 12-hours a day for several weeks more) will help move the implants to where they belong. In the meantime, it’s still uncomfortable AF. <sigh> Massage exercises will help too — although it’s a bit of a misnomer. In reality it’s pushing the breasts, hard, down and then inward, to encourage them to move into the proper spot. Not fun….

Turns out the prohibition on underwire bras is less about having a compression bra, and more that the pressure from the underwire can close up the bottom of the “pocket” the surgeon creates for the implant. So all the current bras need to be moved into storage for the next six months, and in a month or so I can look for nicer no-wire bras.

But even with the girls not looking quite right yet, from day one it’s felt right finally having them.

Boobs! Post-surgery, Day 4

The pain from the breast augmentation surgery itself is gone, but now things are just tight, sore and uncomfortable.

Most of that is due to wearing a sports bra plus binder, so things are squished down. Did I mention squished? (They’re reducing swelling and keeping the implants in place until the (good) scar tissue forms around them.) Doesn’t help that I did also did some underarm liposuction, which left some bad bruising on one side — right where the bra strap and binder are, so they’re pinching that area. Ouch.

At least in another week-and-a-half I can take them off part of the day. Not sure how long I’ll need to wear the binder, although it sounds like it’ll be at least several more weeks, and I’ll be wearing sports bras (or at least no underwire bras) for six months.

But despite everything, I can’t stop smiling.

Boobs! Post-surgery, Day 1

Definite progress overnight. I’m nowhere near as sore as a I was yesterday — albeit I’m still on the prescription painkillers.

Feel good enough to walk about 10 minutes to the local shopping center to get lunch. It’ll be nice to get out of the house for a bit, and a bit of light movement will be good for me.

Also figured out a betterway to hold the ice packs where they’re most needed, so hopefully that’ll help reduce some of the swelling.

Boobs! Post-surgery, Day 0

Sorry, unlike my facial feminization surgery there won’t be photos this time around. Not that I can see my boobs anyway, between being held down tight with a sports bra and compression bandage.

I did mine under the muscle, and it’s a large implant (700cc), which for me is proportionate (D cup, about what I was pre-surgery). I’m told it hurts a lot the first few days because they cut through the pec itself, but more importantly the pec has sudden been stretched faaar further than it’s used to.

With the pain killers, it doesn’t hurt as much as it’s really sore. Probably a bit worse that typical because I also did some underarm liposuction, so there’s extra swelling (and the bandage they’d normally do for the lipo doesn’t work if you’ve also done breast implants).

More range of motion than I expected — although just because I can move, doesn’t mean I want to move. But means I can get in and out of (baggy) clothes more easily than I thought. Important for me because I live alone.

Claiming What Was Denied Me

So tomorrow at 6 a.m. I go to surgery to claim the breasts that testosterone denied me.

No, anatomy isn’t destiny, and being able to do breast augmentation doesn’t make me more “real” than other trans women who can’t afford to, or chose not to do so.

But it is addressing something that’s been a major source of my gender-related body dysphoria.

It’s hard to love your curves when you don’t have any. (Well, except for the beer belly that makes me look male.) Much of the language body of language falls flat for me because I’m not the “right” kind of big-bodied. I don’t have hips, period, let alone ones that would balance with my wide child-bearing shoulders. Hormones added a bit of junk in trunk, but I still don’t all that much back there. I can’t change them; I can only learn to love them. (Right now we’re still in the detente phase.)

But breasts… breasts are something I can change. They’re something that unequivocally signals “woman,” even in the absence of other signals from the rest of my body.

It’s not that I hate my body, rather it’s that — as Sam Dylan Finch put it in his excellent essay, “I’m Transgender and I Need Body Positivity Too” — I hate “the way it tricks others into seeing me as something that I’m not. And no amount of self-love and validation can change the fact that, when I step out into the world, my body precedes me and erases a very important aspect of my identity.”

So I’m changing it. Because “sometimes modifying our bodies can be our greatest act of self-love.”

See you on the other side.

It’s Been A Year…

On the anniversary of transitioning to living as a woman full-time, rather than celebration, I’ve mostly been feeling the “is that all there is?” blues.

Don’t get me wrong, I don’t regret transitioning, not for a second. And I did it being well aware that transitioning (hopefully) resolves your gender issues, but you’re still you, and you’ll still be left with your other issues.

Partly it’s the season. I probably have a touch of Seasonal Affective Disorder, and the short days and long nights just make me want to hibernate.

Plus it’s the holiday season with all the pressure that puts on people to feel joyous, even when they’re feeling far from it. Especially for those of us for whom family reunions are more stressful than celebratory. To be honest, for various reasons each year, I haven’t had a joyous holiday season in at least a decade, and this one I’ve been both stressed out and sick once again.

Partly it’s looking back and realizing that 2017 has really sucked due to some pretty severe nerve pain problems. Both the problems in themselves, but also how they’ve kept me isolated.

But a big part of it is now that my #1 challenge has been resolved, it’s allowed other issues to surface.

In some ways I’m now less comfortable in my body than before. The contrast between who I am, and what my body is, have become sharper. As Sam Dylan Finch said in his excellent essay, “I’m Transgender And I Need Body Positivity Too,” it’s not that I hate my body per se. Much as it can be frustrating to live in at time thanks to some chronic health issues, it’s otherwise served me well. Rather, as Finch says, “It’s about hating what my body has come to symbolize… the way it tricks others into seeing me as something that I’m not.”

I’m exceedingly thankful for the my new face, courtesy of my my surgery in Argentina last January. I can look in the mirror now and see a woman’s face. It’s at the point where my face in pre-surgery photos is the one that looks a bit alien and “not me.”

But the rest of my body…. There’s some parts that I’ve mostly made peace with. Mostly. I will never have hips that balance out with my wide child-bearing shoulders. My hands and feet will always be big, making it difficult to find jewelry and shoes that fit. I continue to need to do facial electrolysis twice a week, with no end in sight.

And now that breast augmentation is at the “so close, but yet so far” stage — hopefully I’ll be having it done early next year — my body dysphoria about that has gone through the roof. I still feel more caterpillar than butterfly. I’ll get there, but there’s that surgery and another next July, the latter with a tough recovery that’s going to sideline me again for the latter half of 2018.

I’m also really starting to feel the financial pinch of doing the things I need to do to make my body congruent with who I am. When all is said and done, it’ll cost me more than $100,000, with a good chunk of that coming up next year. It will be money well spent, and trust me I know how privileged I am to have the financial resources to make it happen. But still…. It’s wiping out a lot of savings, when I’m at an age where one starts thinking about having enough money for retirement down the road.

But probably one of the biggest issues is dealing with the loneliness in my life. Much of it my own doing — for decades I distanced myself from others because if I didn’t let anyone in, they couldn’t hurt me. I’m working on letting the armor down, but it’s harder to make friends in your 50s, especially out in the suburbs. Harder still when the people I am friends with are 30+ miles away up in SF and Oakland. Also, despite all the talk of sisterhood, burly friendships can be a mile wide, and an inch deep. (I’m grateful to the folks who did reach out when I was sidelined.) And yes, I know I need to force myself to get out more. That’s in the plans, and hopefully health problems won’t sabotage that again.

There’s also recent work with my therapist, that’s made me realize there’s things about my own ways of interacting with other people that need to change. Tired of being the long-suffering friend, the long-suffering co-worker, of always ending up having to be the responsible adult. The person who’s always there for others, but not necessarily there for herself. Growth is good, but sometimes it’s also a bit painful.

All that said, while I may be having All The Feels at the moment, things will get better. Changing some of the problematic parts of my life may be challenging, but at least I know that they need changing. I’ve been through worst. I’m high functioning and I’ll power through things. I’ll just keep dancing. If that’s all there is.

But yeah, I’ll be happy to see 2017 go, and not a moment too soon.

Chop Wood, Carry Water

One year ago today, I picked up the court order changing my legal name and gender — the penultimate step before living as me full-time.

Looking at my post about this from last year, I can’t believe how ecstatic I looked. It truly was a milestone. I thought about sharing that post, but honestly, it has a photo with a face that doesn’t feel like me anymore, between hormones and facial surgery. (A subject that’s probably worth a post in itself for another day.)

I still have some parts of my life (various bills, legal documents, etc.) with my old name on them — with the health problems this year, I just wasn’t up to dealing with bureaucracies — so cleaning the loose ends is going to be a priority in the next month or two.

Days of Miracles and Wonder

One year ago today I came out to my co-workers and was amazed by the support they (and my employer) showed me.

It was the penultimate step in my transition, which ended up happening far faster than I expected, because they actually asked me to come to work as me sooner rather than later.

I am truly privileged and lucky to have had my transition go about as smoothly as it could. Every day, I’m reminded that too many of my trans sisters, brothers and siblings aren’t as fortunate.

And thus begins the Week of Feels…

Achin’ To Be

So I’ve started interviewing surgeons to do breast augmentation. It’s honestly the part of my body I feel most dysphoric about, more than my face was, more than my nether regions.*

Not having them** bothers more than I’d even realized. One of the surgeons had an opening in late December, and I wanted sign up for it right then and there. Hell, I was ready to go under the knife the following day.*** Aching was the best way to described.

I realize there’s other women who are unhappy with their breasts, but in my case Teh Tranz adds an extra level of discomfort.

As Sam Dylan Finch said in his excellent essay, “I’m Transgender and I Need Body Positivity Too,” it’s not that I hate my body, rather:

“It’s about how invisible my body makes me feel — the way it tricks others into seeing me as something that I’m not.

And no amount of self-love and validation can change the fact that, when I step out into the world, my body precedes me and erases a very important aspect of my identity.”

This is where the language of body positivity — e.g. “you’re perfect just the way you are,” “you should ignore society’s messages,” etc. — falls flat with me, and with other trans people.

Because, as Finch says, sometimes modifying our bodies can be our greatest act of self-love.

I’m not looking forward to the next two rounds of surgery in the coming year — nor the months of after-care after the second one — but I am looking forward to the changes they’ll bring, to them helping what’s on the outside feel congruent with what’s on the inside.

There are prices to be paid physically, emotionally, and especially financially — since probably none of the renovations will be covered by insurance. But peace of mind is priceless.****


*Standard caveat about how if you’ve met once trans person… you’ve met one trans person, and every trans person feels differently about their body

**Thanks to hormones, I’ve actually developed what’s probably are probably A+/B- sized breasts. But given my frame, they look tiny by comparison.

***I didn’t, much as I wanted to, because he’s a celebrity surgeon and his price was far steeper than I’d expected.

****I’m fully aware that I’ll still probably face the same sort of body image issues that most women in our society face — in fact I’m already dealing with them. But it won’t be with the extra dose of gender dysphoria.