Body Mods

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…

Stubborn Viking Hair

As I now close in on 190 hours of facial electrolysis, I look back on my naive optimism from two years ago.

Still a long ways to go,* although these days I rarely shave as long as I’m getting two hours of work done each week.

But the remaining hair is pretty translucent, making it hard for my electrologist to find, so I have to let it grow longer . Thankfully, it’s not terribly visible, but the feel of it — and the gender dysphoria it triggers — isn’t much fun.

* Hoping that I’ll be finished up in another six months or so. It’s a triumph of hope over experience, since my “stubborn Viking hair” as she calls it, is not giving up without a considerable fight.

Bottom Surgery 101

I know people probably have questions about bottom surgery, after yesterday’s post, so I wanted to shed light on something that’s probably pretty mysterious for most cisgender people. I will talk about some specifics of the procedure and its recovery, but hopefully not in a way that will squick people out. Nonetheless, if you’re squeamish, you might want to sit this one out.

OK, so what is bottom surgery? For trans woman, it’s creating a vagina and vulva out of male genital tissue. It’s not cut off, it’s reused. (I’ll talk about trans men later.) It’s commonly been referred to as sexual reassignment surgery, or more recently, gender confirmation surgery a term I’m personally not fond of because I know my gender identity regardless of what pink bits I have. The antiquated term, “sex change,” is one to avoid using.

Why go to Thailand? Short answer: If you were re-arranging the furniture, wouldn’t you want to go to the best surgeon you can find? While there are some excellent surgeons in the U.S. (and more surgeons are learning the procedure), surgeons in Thailand are usually using a technique that’s more advanced (the Thais have been pioneers in this field). Generally the results have better aesthetics, are better at retaining sensation, and involve a single surgery, rather than two months of surgery several months apart. The trade-off is that it’s a tougher recovery because more work is being done at once.

Does it look “natural” and perform “naturally”? Yes, definitely. (Trust me I’ve looked a more than my fair share of post-surgery pics when doing research.) Obviously there are some scars, most notably along the creases of the leg, but after healing, they’re surprisingly invisible. As far as the second question, usually you end up with the same depth as a factory-installed version, however it is a bit less stretchy, and some more adventurous forms of penetration are probably off the table. However, it doesn’t really self-lubricant to same degree, so lube is a must. Also, state the obvious, no, it doesn’t menstruate — one aspect of womanhood, I’m happy to miss out on — although it can it vulnerable to yeast infections, etc.

How do they do it? Contrary to popular lore, they don’t cut it off, rather the tissue is reused. The “penile inversion” technique that’s widely used in the U.S. is exactly what it sounds like: They essentially turn the penis inside out, strip away unneeded tissue — e.g. the erectile tissue — and reform that into a vagina and clitoris, as well as reroute the urethra into the proper location. Dr. Suporn invented the “Chouburi Flap” technique, now used by other Thai surgeons, which does things somewhat differently and places a premium on “mapping” tissue to it’s equivalent place, e.g. the foreskin and glans are similar tissue to that of the inner labia, so it’s used to create them. The technique also emphasizes making sure the appropriate levels of sensation are in the right place, e.g. the vulva is more sensitive than the vagina, and that the vagina uses more sensitive tissue near the opening and less further back (just like the factory-installed version). If there’s not enough genital donor tissue, then they may use skin grafts from other parts of the body. I’m not sure if it’s part of the Chonburi Flap technique per se, but Thai surgeons are adapt at stripping away the layer of skin (dermis) of scrotal tissue where the hair follicles are, eliminating the for genital electrolysis <shudders> pre-surgery. Either is necessary to prevent hair from growing inside the neo-vagina.

How long does it take to recover? With Dr. Suporn, you’re there for a month post-surgery, before you fly home. You need the time to physically recover, and he can fix any problems that might develop. (Usually they’re minor, but there can be some nasty complications if the some area don’t get enough blood supply and develop tissue necrosis.) After that, one really should take at least another 2-4 weeks before returning to work. As you might imagine, sitting can be uncomfortable for quite a while. Surgeons will give you a special pillow. But the worst part of it is dilation — insert a medical dildo to neo-vagina from closing during the first two weeks, and later on to prevent scar tissue from contracting, and yes, it hurts as much as it sounds like. Imagine trying to insert an oversized dildo (even though the dilators aren’t that large) and then pushing it hard against the back of your vagina at least 15 minutes, 3x/day for the first 2-3 months post-surgery, 2x/day for another 3 months, 1x/day for another 6 months. After a year all the healing is finished, although one still needs to do it 2-3 times a week (for the rest of your life), although… other things, ahem… can be substituted for the dilators. If there are problems after 12 months, Dr. Suporn offers one round of revision surgery for free — although you have to pay your way back to Thailand for it.

Do many trans people regret it? No, it’s only around 1-2% — much lower than almost any other kind of plastic surgery. In part that’s because — for better or worse — there is a lot of gatekeeping involved. Typically you need two psychologists/psychiatrists to sign off before surgeons will operate. Some of that is CYA on the surgeon’s part, they don’t want someone to sue because they ended up unhappy after an irreversible operation. Partly it’s just a smart thing to make sure your head is straight first. Honestly, I think the vast majority of people, trans or cisgender, would be wise to do some therapy before getting any form of major plastic surgery for their own benefit, since there’s number of people who get it done for reasons they later regret. (Reputable surgeons will screen for this, even for something as routine as a nose job.) But yes, it also raises huge issues about body autonomy, particularly in the bad old days, when fuckability was quite literally a criteria some surgeons used to determine who they’d operate on.

Does insurance cover it? Complicated question. Technically, yes. California is one of the states that requires insurance companies covers bottom surgery. (Usually insurers specifically prohibit coverage for any other trans-related surgery, and yeah it sucks, and many trans people can’t afford to do it out of pocket. Doesn’t make them any less trans for not doing so.) In practice though, it can be hard to get insurers to cover it if you go outside the U.S. You have to pay upfront and hope that they’ll reimburse you, which often times they never get around to doing. Which is particularly annoying because the Thai surgeons are less expensive, and usually have shorter waitlists.

What about trans guys? I admittedly only have a high-level knowledge about their procedures (trans guys feel free to chime in!), but here goes. There’s a greater a variety of techniques from ones that simply free the clitoris from it’s surrounding tissue, since if a trans man has been on testosterone, that often causes the clitoris to grow into a small penis (they’re both actually made of the same tissue), so freeing it makes it look more penis-like. The most ambitious technique is a phalloplasty, which reconstructs tissue to form a penis. That said, bottom surgery options for trans men are usually far more expensive than trans women, and the results less satisfactory. Partly, because as one surgeon put it, it’s easily to make a hole than a pole. Partly because there’s simply been less research into better techniques. So many trans men opt to skip bottom surgery,and just do “top surgery” to remove their breasts. Doesn’t make them any less trans for not doing so.

Adventures In Body Modifications

Finally got on the calendar for having bottom surgery about a year from now, with the one of best surgeons in the world for that operation, who’s retiring in mid-2019.

Lots of feels — it’s a mixture of excitement and “holy fuck, what I am doing?!” (it’s a demanding surgery physically, I’ll be in Thailand for a month for the immediate post-surgical recovery, the after-care takes over your life for the better part of year, and yeah, I’d be radically changing my body).

Lots of self-examination coming up to make sure I truly want to do it. Fortunately, I’m not one of those trans people who feels like their genitals are some sort of alien appendage. OTOH, I’d feel much more congruent with an innie rather than an outie.*

But given circumstances, it makes sense to at least get a date reserved, since he’s fully booked for the next 1-1/2 years until his retirement date.

* TMI warning: Contrary to popular lore, no they don’t cut it off, rather they quite literally turn things inside out, and then reshape the analogous tissue to match its counterpart in female genitalia. (We’re all born with the same materials in our genitals, it just gets shaped differently depending on which sex-related hormones we’re exposed to in the womb.) And yes, the result looks and performs like a factory-installed model — this surgeon in particular is known for the quality of his results in that regard.

Well, I Do Declare!

During today’s session, my speech therapist had me experiment with using a character voice as a way of getting out of my usual speech patterns.

I broke out the “Southern belle” voice that I’d developed for m y stage persona — and I do declare that my voice improved dramatically!

The slower pace of a Southern accent helped me avoid pitch drops that occur when I’m speaking faster. It improved the legato between syllables and words (which women typically use more of). Most surprisingly, I was able to raise my pitch almost an octave without straining — taking my voice from the top end of the typical male pitch range, solidly into the typical female pitch range.

(I’ve been frustrated in recent months because my pitch had dropped back down as I was focusing on the other vocal characteristics that typically differentiate women’s voices from men’s. Pitch and resonance are the big ones, and the only ones that are physiological, but there’s half a dozen others, most notably, huge differences in inflection.)

My homework is to practice switching into my Southern belle voice and dialing it back into my normal California-accent voice, while retaining the vocal improvements.

So if y’all hear me slipping into a drawl, now you’ll know why.

Hair, Not-So-Long Beautiful Hair

I’m grateful that the second round of hair transplants started growing in far sooner than expected. The transplanted hair goes into “transplant shock” and falls out because the follicles go into their dormant cycles, and typically it doesn’t regrow until about three months afterwards, i.e. for me, the end of June. But a few never fell out, and the there was some regrowth starting as soon as a month after the transplants. The bulk it did start regrowing in the past t month. But it’s growing extraordinarily fast — my acupuncturist, who hadn’t seen me in two weeks, remarked on what a different there was.

There’s still a long ways to go, but:

  • It’s covered the lengthy scar running across my forehead from the facial surgeries in January.
  • I now have enough of a “typical female” underside down U-shaped hairline (i.e. no more male baldness recession on the temples) that I’ve been able to start wearing my hair pulled back when I want to.

Still short, and still thin. But time will take care of that. So glad I did it.

The Nose Knows

Going on estrogen re-wires your entire body, and one of the changes is that your sense of smell becomes more sensitive (on the whole female humans have a better sense of smell than males).

That was really brought home to me earlier this afternoon during my stop in Carson City. There have been thundershowers today and the petrichor (the smell after it rains) was so strong that it was pungent at times. Never had that happen before.

Come, You Chicken Fat, Come!

t’s interesting to see how, after almost a year, estrogen is reshaping my body.

Besides some (not nearly enough) boob growth, I seem to have a bigger booty, my shoulders have gotten smaller as I’ve lost muscle mass* (yay!), and I’ve now got underarm chicken wings** — I’m probably one of the rare women who’s glad to see the latter.

* The Olympics will let trans woman compete in the women’s divisions after two years on hormones, because their muscle mass is equivalent to that of cisgender women.

** The underarms are the third area women tend to accumulate fat, along with the hips and thighs.