Super Sounds of Transition

TFW when the woman at the next table, who you’ve been chatting with, compliments you on your voice and asks if you do radio work.

She was right in a way… as a man I had a deep and resonate voice — think of the DJ from “K-Billy’s Super Sounds of the Seventies” in “Reservoir Dogs.” Consequently, I’ve spent the last two years working with a speech therapist to change it.

My voice is still one the things I’m most self-conscious about, and it’s still one of the things that causes me to be misgendered — it’s a given that I’ll get referred to as “sir” when I’m on the phone with someone who doesn’t know me.

Unfortunately, with everything else that’s been going on this year, I just haven’t had enough time to practice to really get my voice where I want it to be. I’ve more or less gotten the change from chest resonance to head resonance; on a good day my pitch is an octave higher where I want it; and I’m able to do the 180-degree change in inflection between men’s speech and women’s speech. But it still takes conscious effort and all too often, the latter two slip a bit.

So it’s nice, really nice, to know that sometimes it all comes together.

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.

Transgender Day Of Remembrance

Today is Transgender Day of Remembrance — an occasion that honestly I have very mixed feelings about.

Not that we shouldn’t remember our dead. On the contrary. At least 23 transgender/non-binary people have been killed so far this year in the U.S. As usual, almost all of them were trans women, the vast majority were WOC (mostly black trans women ), a number of them were street sex workers. I point out the latter not to denigrate sex work, rather that they were so marginalized by society that the only way for them to survive was to engage in a highly risky profession.

A partial list of our dead from around the world is a  the TDOR website. Many of them were killed with extreme brutality — what criminologists refer to as “overkill,” which is an indicator of extreme rage and hatred toward the victim.

There were undoubtedly more. Usually they were people who couldn’t afford to change their name and gender on their legal ID — or lived in states where social conservatives intentionally pass ed laws to make it difficult/impossible to do — and consequently when their bodies are found, they usually suffer the final indignity of being misnamed and misgendered by the police and the media. It’s only through people who knew them that we learn who they really were.

They deserve one final recognition as their proper selves.

Mesha Caldwell, 41
Sean Hake, 23
Jamie Lee Wounded Arrow, 28
JoJo Striker, 23
Tiara Richmond, also known as Keke Collier, 24
Chyna Gibson, 31
Ciara McElveen, 26
Jaquarrius Holland, 18
Alphonza Watson, 38
Chay Reed, 28
Kenneth Bostick, 59
Sherrell Faulkner, 46
Kenne McFadden, 27
Kendra Marie Adams, 28
Ava Le’Ray Barrin, 17
Ebony Morgan, 28
TeeTee Dangerfield, 32
Gwynevere River Song, 26
Kiwi Herring, 30
Kashmire Nazier Redd, 28
Derricka Banner, 26
Scout Schultz, 21
Ally Steinfeld, 17
Stephanie Montez, 47
Candace Towns, 30

OTOH, for years TDOR was the only time trans people were publicly recognized. If you were gay or lesbian, you had Gay Pride — an event, even if less and less political over the years, still has an attitude of celebration and defiance. As gay writer Joe Jervis summed it up: “They wish we were invisible. We’re not. Let’s dance.” (From his must-read essay about the value of Pride).

For us, not so much. Pre-Laverne Cox, pre-Janet Mock, pre-Caitlyn Jenner, the only public occasion for trans people was one marking our persecution and deaths. Fortunately, that’s changing, Transgender Day of Visibility, on March 31, intended to celebrate living members of the transgender community, has been gaining traction.

As Daye Pope eloquently said:

“Transgender people are real, and vibrant, and powerful, and beautiful, and resilient, and enough. Despite every obstacle stacked against us we rewrite the rules, beat the odds, defy expectations. I believe with all my heart that we have a bright future, because we will build it together.”

So today mourn our dead, tomorrow fight like hell for the living. In March, celebrate our fabulous selves.

They wish we were invisible. We’re not. Let’s dance.

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.


Some Days

Some days are you’re strong in the face of various health challenges, and embrace the suck. And some days you just want to curl up in a ball and cry.

I’ll be better tomorrow, but today I’m having all the feels.

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.

Reflections On Gratitude

This time last year, I was a bit of an emotional wreck as I felt my masculine self slipping away. Obviously, it’s something that I desired, but at the same time there was a tangible and acute sense of loss and grieving that’s incredibly hard to describe. I could not be who I am today without his decades of self-sacrifice, and willingness to step aside for me. So I offer my gratitude once again:

Thank you for the gift of my life. I love you so very much. I will always cherish and protect your memory, and this soul you’ve given me. As I delight in this increasingly feminine body, I think warmly of you. You may not have ever fathered a child, but you were a loving brother and father-figure to your sister who is now taking her place in the world.

You have done so, so much for me. You will always be a part of me, and I will always honor your life and respect your journey. Now your journey’s end is in sight. As the days count down, I sense you fading into me, subsuming yourself, growing fainter. Sweet surrender… well, more like bittersweet surrender. But more sweet than bitter.

Enjoy your soon-to-come retirement. You did an exceedingly hard job, you did it well, you did it until you couldn’t any more. You deserve peace, rest and comfort.

I’d like to think he’s off enjoying his retirement, drink in his hand, toes in the sand, on some beach somewhere. Gone, but definitely not forgotten.

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.