Body Mods

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.

The Angry Half-Inch

The last half inch of buried suture from my facial surgery last January — which had become hugely encapsulated — finally worked its way to the surface. Nurse practitioner was able to snip the knot and pull it out. I’m finally free of something that had been annoying me to no end for months.

Riding The Roller Coaster

It’s been an emotional roller coaster the past two days.

Thursday brought some  good news for a change…

Got my latest blood tests back from yesterday’s blood test and while things are not fully back to normal yet, my kidneys are doing significantly better after stopping my testosterone blocker a week ago.

Meanwhile my hormone doctor started me on progesterone, which both blocks testosterone (although not as effectively as the first drug) and may cause some additional breast growth. Need to follow-up with my hormone doctor to see if that might avoid the need to do the orchiectomy — although progesterone has its own potential side-effects that might rule that out.

But just when I thought things were working out, I got some complicating news this morning.

The surgeon who will be doing my bottom surgery recommended against doing the orchiectomy because the scar needs to be fully healed and pliable, which takes 6-12 months, so there’s a good risk that I’d have to cancel the surgery if it’s not ready. And if I cancel the surgery, I probably wouldn’t be able to be rescheduled for another 12-18 months minimum, given how booked the surgeon is. Plus the new surgeon who’s taking over the practice would be operating solo, without his predecessor overseeing things.

They’re not worried about the effects of normal levels of testosterone for another eight months — but I’m definitely uncomfortable with my body remasculizing during that time, plus whether that may pose an issue for getting breast implants this spring.

Then I heard back from my hormone doctor that he thinks the amount of masculinization may be minor, which potentially means not needing to do the orchi (my interpretation). But need to meet with him in person to get a clearer picture.

Some hard, hard decisions ahead.


Speed Bumps Not Roadblocks

Doing a lot better this morning.

The kidney problems are a speed bump, not a roadblock. Sent messages off to my primary care doctor and hormone doctor to get things rolling towards a solution.

Not looking forward to an extra surgery, but so be it. Thankfully an orchiectomy is relatively minor as surgeries go.

Side Effects

Met with my regular doctor today and he confirmed the bad news I was expecting: spirolactone, the testosterone blocker I’m on is not only worsening my diabetes, but it’s now starting to cause serious kidney problems that could cause me to have to go on dialysis, or kill me if left unchecked.

So I need to go off it. But no testosterone blocker means my body will start re-masculizing. We’re doing a week-long test to see if maybe I can still take a smaller dose, but I’m not optimistic that’ll solve the kidney problems, nor prevent my body from changing in ways that are emotionally traumatic.

The ultimate solution is to have an orchiectomy to remove the testicles. Bye bye balls means no more testosterone. I wouldn’t mind seeing them gone, but doing that makes getting bottom surgery a bit more challenging next year. Without getting too TMI, one wants to avoid losing tissue and having scar tissue to work around. And Maude know if I can insurance to cover the orchi — my insurer will probably argue it’s “cosmetic” surgery and thus not covered (since they specifically prohibit coverage of almost all trans-related surgeries).

FML, just FML…