It’s The Little Things…

Among the challenges of genital reassignment surgery is re-learning how to go to the toilet. At home I installed a Western-style bidet* (based on advice I’d gotten), but here at the hotel, there’s a simple spray nozzle. The trick is to wash away the fecal matter without spraying everywhere else. 😬

Then there’s the issue of wiping oneself. After a lifetime of wiping back to front, I need to re-learn to wipe front to back — so that I don’t get… ahem… foreign matter…. into the new parts. Definitely a bit harder in that direction.

*Definitely worth it, and I’m told it works even better without the dangly bits getting in the way.

Post-surgery Tools

Some of folks were curious about the dilators used post-surgery.
The hotel key gives you a sense of scale. Generally, you only use the clear ones with the markings on them (so you know whether you’ve reached the proper depth.
However, the clear ones can chip if they’re dropped (easy to do with lots of lube), so the clinic also gives you the white one, which is unbreakable.
Initially you start with the smallest dilator for the first 15 minutes, and then switch to the medium-sized one for another 15-minutes. Over time, you switch to the medium and large.
However, the whole process takes considerably longer, usually an hour minimum, since you need to do prep work to make sure everything’s sterile, and then clean-up work afterwards (dilating is pretty messy).
More to the point, it can take some time for your body to relax enough to get the dilator to “full depth,” which is when the clock officially starts. I’ve heard of people for whom this can take an hour or more.
During the official dilation session, you press hard inwards for 10-15 seconds to stretch the scar tissue at the end of the neo-vagina, release for a couple seconds, then “stir” the dilator for another 10-15 seconds to stretch the scar tissue at the entrance of the neo-vagina, then release for a couple seconds. And then repeat, and repeat, and repeat, and repeat.
(FWIW, this method of “active” dilation seems to be unique to my particular surgeon, although preventing scar contracture definitely makes sense, since I had to do scar stretching exercises after knee surgery, and yeah, that hurt like hell.)
As mentioned previously, I’ll need to do this three times a day for the first three months, twice a day for the next three months, and once a day for yet another six months (and then 1-2 week for the rest of my life).

In-take Day

Short but intense day as J. and I did our in-take with the clinic.

Trip to the hospital for x-rays, EKG, and blood tests. Annoyingly the nurse failed to draw enough blood (she was having trouble finding a vein), so I had to go back for a second blood draw.

Then lots of paperwork at Dr. Suporn’s office.

Thanks to the ever-increasing hostile environment in the States towards LGBT people, and trans people in particular, I opted to spend extra getting a notarized statement that I’ve had sexual reassignment surgery.

Hopefully, I’ll never need it, but until only a few years ago, the only way you could get your proper sex listed on your passport was if you had proof of SRS. And given the current administration, I fully expect them to revert back to that requirement — and it wouldn’t surprise me if they attempt to further roll things back to force your passport to show the sex listed on your birth certificated. Which needless to say makes it dangerous for trans people to travel to a number of countries — which is one reason for doing it. Fortunately, California allowed me to update my birth certificate (and the original is sealed), but I wouldn’t put it past the Talibaptists to try to circumvent that as well.

Then it was an exam with Dr. Suporn and Dr. Bank (who will be doing my surgeon under Dr. Suporn’s supervision) to make sure my nether regions had sufficient donor material to be reconstructed into lady parts.

Finally got a look at the dilators 😲😲😲 — they’re far more intimidator to see in person.

TMI details…
Post-surgery you have to dilate to prevent the neo-vagina from closing up, since to your body it’s essentially a ginormous puncture wound. Most surgeons just have you insert the dilator and leave it there for a half-hour to an hour, but Dr. Suporn has you take a more aggressive approach, which requires you to push against the scar tissue to prevent contracture. Good for maintaining depth, but it hurts. It definitely hurts. Just gotta embrace the suck.

Three times a day for the first three months, twice a day for the next three months, and once a day for another six months until you’re fully healed. (That’s assuming healing goes according to plan. If not, then the frequency can be more for longer.) After that it’s maintenance mode, of at least once a week for the rest of my life.

On The Edge of Seventeen

They tell you that going on hormones is like a second puberty, and it is. But lately I’ve also been feeling like I’m going that teenage gawkiness where my mind hasn’t yet caught up to changes in my body.

Admittedly, my body *has* been through a lot of changes during the last 16 months, with some another major change coming in two months.

There’s definitely a bit of cognitive dissonance every time FB surfaces old photos of me. A big part of it is seeing my face pre-facial feminization surgery. I mean, I know it’s my face, but at the same time, I don’t quite recognize the person in the photo. Especially as some of the facial changes have been accentuated by losing a lot of weight (which I’ll get to in a second).

The other big body mod obviously is my breast augmentation back in January. Even though it’s only been a few months, it’s getting hard to imagine a time when I didn’t have them. That image of my body has gone down the memory. (And we’ve always been at war with Eurasia.)

OTOH, I’m now about a cup size smaller than when I wore breast forms — and while my breasts look really natural, I also think they’re a little small for my frame. No one’s fault, all the surgeons I consulted agreed on the recommended size of the implants, and my surgeon even went a size larger while I was on the table because he could tell my chest muscles were acting like a giant sports bra to schmush things down. But disappointing. Obviously, I’m not the first woman to be dissatisfied with the size of her breasts, but it’s especially disappointing given I paid a lot of money for them (not covered by insurances), and there’s no easy fix,* and because I was used to being a size larger when I was wearing breast forms.

But probably most of the feeling of being out of sorts with my body has been due to the weight loss — 35 pounds so far, and I need to lose another 15 in the next two months for bottom surgery.

It’s meant that I’ve dropped from a size 20/22 down to a size 14/16. Which has meant constantly not having clothes that fit right — either too baggy, or a bit tight, since I’m trying to avoid buying too many “interim clothes.” It’s suddenly having rings become too loose, and knowing that I’ll need to get the heirloom rings resized, but not until I know what my new weight will stabilize at. On the plus side, now that I can fit into misses-sizes clothes, and that opens up a far wider range of clothes than when I was plus-sized. But it’s still a bit odd to realize that stores I hadn’t even bothered to look at previously now have clothes that might actually fit me. (And yes, I’m well aware of the thin privilege that I’ve now gained.)

But the biggest challenge is coming to terms with being “big bodied” but not necessarily fat. I’m not squishy like most women my size. Admittedly, I’ve always been built that way, and it was hard to love my curves when I didn’t have any. Well except the one curve from my belly that makes me look male, and is fraught with gender-related body dysphoria issues.

Which is where a lot of the language of the body positivity movement has fallen flat for me. Don’t get me wrong, I *do* believe one should be able to embrace one’s curves. That you should love your body, no matter the shape or size. But you *don’t* necessarily need to love it “exactly the way it is.” As Sam Dylan Finch points out, that sort of language is definitely off-putting for trans people. Because, as Finch says, “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.”

More to the point, it’s damn hard to find — even within the body positivity movement — positive images of women with bodies like me. I’m glamazon-sized. With wide child-bearing shoulders, no hips and not much of ass (which makes it really tough to find jeans that fit). Big hands, big arms, big feet.

Laverne Cox may have reached a point where: “I am not beautiful despite my big hands, my big feet, my wide shoulders, my height, my deep voice and all the things that make me beautifully and noticeably trans. I am beautiful because of those things” but reaching that level of self-love is a helluva lot easier when you look like, well, Laverne Cox.** Personally, I’m still struggling.

Especially because as I’m settling into my identity as a woman living as a woman, the stakes are changing. For years, my sense of being attractive came with an asterisk — pretty good for a crossdresser, pretty good for a drag queen, pretty good for someone who was gender queer. The asterisk was always there because I just assumed I was “visibly trans.” I’m realizing that that’s not necessarily always the case. So the goal posts have moved significantly…. Now it’s, how attractive am I as a *woman*? Especially one of a certain age, an age when many women become invisible.

And yes, I realize I’m falling into the “beauty myth” trap, and so I’ve got that layer of self-criticism going on too (i.e. why can’t I shrug it off). But it’s hard to avoid, as a women living in our culture, and especially as a woman in burlesque, where I’m putting my body on display. And where, although there’s lot of talk about body positivity and beauty at all sizes, there’s also still a strong undercurrent of preference for a certain body type, and certain plus-size body type (hour-glass), that I don’t have, that I’ll never have. Testosterone wreaked changes on my body that can’t be undone.

As I said, it’s complicated. I’m still doing a lot of processing.

In the meantime, I’m trying to remind myself there are women built like me. Going to Kansas City last year, I saw a number of large, stocky women, ones who shared a heritage of being the daughters of German peasants, with bodies suited to working the farm. I’ve looked for role models. Olympic hammer thrower Amanda Bingson, who was featured in the famous 2015 Sports Illustrated “Body” issue, with its photos of naked athletes of various shapes and sizes. I’ve seen myself in crew members of collegiate rowing teams. I’ve seen myself in Xena (even if I’d much rather have the body of Gabrielle).

One day, I hope to be able love all the things that make me “big bodied” (and probably “visibly trans” as well). To internalize it. To truly believe it. But for now, it’s one day at a time.

*The FDA currently only has approved silicone breast implants up to 800cc in size, which is a size larger than what I have now, and at most would maybe add a half-cup in size. To go larger, I’d have to switch to saline implants, which I’d prefer not to do. But it’s all moot at this point anyway, since any potential redo will need to wait until 2019.

**No disrespect to Ms. Cox, who I adore, and who’s made it clear it took her years to reach that level of self-acceptance. But fact of the matter is that she’s also beautiful in ways that fit the cis-het norms.

T Minus 60

So in 60 days, I’ll be waking up in Thailand after having my parts rearranged — and yeah, I’ve been having a moment about that.
To say the least, my feelings right now are… complicated.
Part of me is definitely looking forward to shedding the last of my pupal form.
Which is a little surprising because I’ve never been one of those trans people who’ve felt that my genitals were something alien — something that made it a harder decision to get genital reassignment surgery. In fact, when I socially transitioned, I didn’t think I’d get it done, because I didn’t feel the need.
But gender dysphoria, can be like an onion — as I resolved the visible issues, it unexpectedly surfaced deeper ones.
And the reality is this, I don’t hate my genitals as they are now, but I hate, as Sam Dylan Finch aptly said:
“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.”
Consequently, sometimes changing one’s body can be be the greatest act of self-love.
And yet…
Some of it are the “normal” jitters — it is major surgery after all, and if I weren’t having some anxiety, I be worried. Although it’s less about the surgery itself, and more about the recovery, and lengthy, and involves some rather painful aftercare. (Or why you probably won’t see too much of me during the last half of 2018.)
There’s also anxiety about needing to lose another 15 pounds in order to meet the surgeon’s weight limit. Worse case scenario if I don’t make the goal is that they refuse to operate — and there’s currently a two-year waiting list if I needed to reschedule. (Plus I’d probably forfeit some/all of the surgical fee.) It’s a stretch but it’s doable — but I’m also running out of time. And being stressed makes me want to eat…
Another part of me just wants to get it over with. I’m tired of feeling in limbo, like I’m just in a holding pattern until July, or more realistically 2019, when I’ll be healed enough to really get out and about again, to be intimate again.
And for yet another part of me, what’s currently in my panties is feeding into some major body image issues going on — between the weight loss (35 pounds so far) and the breast augmentation, I feel like a gawky teenager, who’s not quite grown into her current body. But that’s topic for another post altogether.
Meanwhile, the waiting is the hardest part…

Hair Transplants, Post-surgery, Day 6

Six days post-surgery for the hair transplants, which means now that the follicles have been absorbed into their new locations, I no longer have to use the ultra-gooey antibiotic gel on my scalp, and I can wash away any of the remaining scabbing.

I can’t tell you how happy both of these make me.

All Systems Are Go

Got my official “referral for genital reassignment surgery*” letter from my therapist this evening!
Unlike the prior letters from my medical doctors — which were strictly to try to get insurance to cover the surgery — this one is the critical one, since it means I’ve cleared the gatekeeping to get the surgery.
Because for better or worse, before you get GRS done, surgeons require you to get two letters** from your therapist/psychologist stating that you’re a “suitable” candidate for the surgery.
Since it’s a permanent, non-reversible surgery, I understand why surgeons want to make someone won’t have regrets (and potentially sue) later. OTOH, needless to say, the requirement also is at odds with the notion of patients having autonomy over their own bodies.
So yeah, getting the letter is a BFD.
*Also known as “sexual reassignment surgery.”
(Please don’t refer to it as “sex change,” since that’s a outmoded term that most trans people find offensive as a verb, and definitely offensive when used as a noun, i.e. referring to trans people as “sex changes.”
**Dr. Suporn has his own psychologist do an evaluation when you arrive in Thailand, that psychologist writes the second letter. It’s usually a pro forma thing,*** but they could refuse to give you the green light if they have concerns.

***Dr. Suporn has a waiting list of well over year, and by that point you’ve paid a hefty non-refundable surgical fee, so you have to be pretty committed to doing the surgery by the time you arrive in Thailand for the evaluation.

Hair Transplants, Post-surgery, Day 0

A quick post before I catch the flight back from LA…

Hair transplants went well. Now I’m sporting a stylish surgical cap for the next week until the scalp heals.

It’ll take up to three months before the newly relocated follicles get over “transplant shock” and start growing hair again.

Been a long day. Glad to be heading home.