Thoughts on surgery

My brain has been rather obsessed lately with thinking about if and what next steps I should take in my transition. So I’ve been trying to figure out what my options are around gender affirming treatments and beginning the very overwhelming task of delving into the surprisingly difficult question of what do I actually want.

Unfortunately I’ve found, with the help of therapy, that that question is very deeply tied to the related question of what do I actually believe I deserve. I didn’t realize I had so much around self worth entangled with my transition. While I 100% support my friends who pursue gender affirming surgeries, I have a hard time convincing myself that I am worth spending that much money on. I had the same issue with my upcoming jaw surgery to correct a crooked internal angle that prevents me from biting on one side. A lot of emotions came up as I went through the steps to book it and talked with my spouse about the money involved. I don’t know the full costs yet but so far we have shelled out $5,500 out of pocket for the braces and I have some significant guilt around needing her help to do that and taking away from money we could use on other things, especially in this political climate.

I firmly believe that while surgeries and treatments are definitely not required to be a valid trans person, they are medically necessary in various forms for many of us as important treatments for gender dysphoria. And I certainly have been having a lot of increased dysphoria lately. But when it comes to the next logical step of then believing that I deserve these treatments, I fall into the trap of hearing all the naysayers whispering in my ear about how trans people are too expensive and a burden and, and, and…

So I’m trying to work past that part of it. But there are also other fears to conquer. I realized I have a very deep fear that I will go through all these steps to try to get closer to the person I know I should be seeing in the mirror and still not feel like I can achieve it. I worry that being so close will just make the last little bits that I can’t change, things like not being able to be pregnant or have the kinds of sex I want, even more frustrating. That’s certainly the biggest thing holding me back from thinking about vaginoplasty.

I realized recently that vaginoplasty is covered by my insurance. Of course there are no surgeons in Western Washington and wait lists are a mile long but theoretically, this is one of the easier things to accomplish financially on my list of options. But that is also the one I was most unsure about. Mostly because I was afraid that I would have complications or worse, that I wouldn’t be able to orgasm afterwards. I don’t particularly like the equipment I have now but at least I know how it works and have figured out how to get it to do what I want, at least some of the time (though that is getting harder while my brain is undergoing estrogen rewiring projects). And is it worth the risk for the potential reward? And am I just caving to transmedicalists (aka truscum, people who think you need surgery to be trans) and societal pressure if I take a more linear transition path?

Arguably, the things that would make a much bigger impact on my dysphoria and certainly on my ability to function in the world are facial feminization surgery (FFS) and hair removal. Unfortunately those are the things that my insurance has classified as “cosmetic” and doesn’t cover. Hair removal is top of my priority list and as I discovered last time, is very expensive. So I am trying to call around and see if I can find a clinic that would work with me to fight insurance and advocate with my doctor for its medical necessity.

Facial feminization is a greater challenge. I’ve realized only recently that the main reason I keep my beard is because it hides my chin, which I can’t stand looking at in the mirror. I’ve obviously grown to love it as evidenced by the name of my blog and how much it has shaped my identity. But it’s also just a tool to reduce dysphoria which has the unfortunate side effect of making me hypervisible. And even in a city like Seattle, it’s no fun being able to be spotted as trans from 3 blocks away. Increasingly I’ve been realizing how much my beard shapes how exhausting daily life in public is for me. But I don’t think I can shave it off unless I at least have a plan for what to do about my chin.

My chin is rather prominent and cleft. In my head and when I look at photos of the few times I’ve shaved (only twice in 12 years), it looks like Gaston from the animated Beauty and the Beast – comically large and masculine. There is a possibility that with estrogen softening my facial features, I will end up liking my face without surgery. Or that after my jaw surgery I will like my look better. But I am honestly scared of having to shave next winter to do that.

Facial feminization is a very expensive proposition. I’ve heard estimates anywhere from $7k for just the chin to $30k. And the odds of me getting insurance to cover it seem pretty slim. I did take the step of emailing my jaw surgeon to see if there is any chance he can leave off the portion of my chin he was planning on rearranging in the surgery or if he would be willing to partner with a specialist to do the work while I am already in surgery. No word back yet though.

I have talked a lot with several trans women in my life over the past couple weeks as these thoughts have been distracting me which was very helpful. And the more I talk about it, the more I realize just how much I’ve been trying to ignore my dysphoria out of fear and shame. I desperately want to be the self confident, visible, bearded trans icon that people seem to think I am. But the reality is that I am having an increasingly hard time looking at and thinking about my face and genitals. When I shave my chest, stomach and legs, I can almost start to see something that looks attractive. And sometimes a good photo can make me feel ok about my face. But my crotch often feels like a black hole on my body, something that doesn’t exist. Or sometimes my genitals feels like a fake nose someone glued on my body when I look in the mirror. And it makes relationships a lot harder when you are moving farther along the asexuality spectrum.

I need more time to think about it but I wanted to get some of these thoughts down while they were still fresh. I don’t know what the answers are yet but I’m increasingly starting to think that the fact that I can’t stop thinking about these questions means that these are inevitable steps I have to figure out how to take.

On a lighter note, if I eventually get rid of my beard, what should I call my blog? The Artist Formerly Known as Genderbeard?

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