9 Month Post-Op

This week marks 9 months from my bottom surgery and I just had a post-op check in with the surgeons office. Overall healing has gone well other than the very notable exception of my clit falling off. Dilation is easy now and I can go down to every other day if I want. I’ve gone though all the sizes they gave me and even ordered one bigger. I managed to get all the granulation tissue (bleeding spots) to heal up and there hasn’t been any discharge for several months.

I do still have some urinary leakage after peeing which is annoying so I’ve started going to a pelvic floor physical therapist and I’m doing kegel exercises at home. Having a physician put their finger in your vagina every week certainly takes some getting used to! I’m hoping it also helps with sex because I can get up to the edge of orgasm but I still can’t crest that peak which is eternally frustrating. The doctor says that’s still within the realm of normal but I’m at the average time that it usually takes so I’m getting more anxious about ever being able to fully enjoy sex.

Now that me and my partners are fully vaccinated I get to start dating again. I’ve been seeing someone new I met online during the pandemic and after 8 long months we finally get to touch each other this weekend. I’m definitely nervous about having sex with someone new when I haven’t even figured out my own new body parts yet but they’re trans too so I’m sure they’ll understand. I’m just glad that the waiting is over.

The Braces are off!

Last Monday, after almost 3 and a half years, I finally got my braces off! And while it has been exciting to finally be able to eat without spending the next hour getting pieces out of my teeth, the most surprising thing for me has been how significantly my facial dysphoria has been relieved.

When I first got the braces, I went through a week of intensive dysphoria so bad that I was dissociating completely out of my body and it felt like I was seeing my life from the bottom of a deep well. It was the worst. And while I managed to pull myself out of that well, the dysphoria for the last 3 years has been bad, enough so that I was afraid to smile completely, especially in photos. I’ve also been seriously contemplating whether I needed facial feminization surgery (FFS) because I hated my face so much.

But the last week has been so much better! I keep glimpsing myself in the mirror or my zoom screen and smiling instead of cringing. Even with my retainer on, I look so so much more beautiful! My face has changed so much, even in the last year, and it is nice to finally be able to see that.

BMI Cutoffs are unscientific and harmful

As I’ve written about before, BMI (Body Mass Index) is an unscientific concept that is often used to deny trans people life-saving surgeries. It is treated by far too many surgeons as medical fact, despite the vast body of evidence that it is wildly inaccurate, scientifically useless, and never intended by the creator to be used on an individual basis.

Recently, the only surgeon in Washington State, Geoffrey Stiller, formerly one of the few surgeons who would accept fat patients, updated his policies quietly to exclude people over the arbitrary and oft-used cutoff of 35 BMI. That means that at least two people close to me are now being denied gender affirming surgery without so much as a notification about the change. So I wanted to take the opportunity to share some scientific research recently published on the topic.

  1. Recent research shows that there is no correlation between BMI and surgical complication rates in trans people in either vaginoplasty (bottom surgery) or mastectomy (top surgery)
  2. “Obesity” (aka normal body variation) is very common in trans people seeking surgery (26% at Mount Sinai) and did not change despite efforts to lose weight prior to surgery
  3. BMI is not an empirically based method of denying gender-affirming surgery

Trans people should not have to bear the burden of educating providers about our care but all too often we are put in that position anyway. So next time a surgeon tells you they won’t perform surgery because of “policies”, please feel free to use this research to push back on them. Even if you don’t win a single conversation, hopefully you will plant a seed and prompt them to actually read the scientific literature on the topic. I found these articles with only a cursory review of the topic and I’m not even a doctor.

Citations

  1. Ives GC, Fein LA, Finch L, Sluiter EC, Lane M, Kuzon WM, Salgado CJ. Evaluation of BMI as a Risk Factor for Complications following Gender-affirming Penile Inversion Vaginoplasty. Plast Reconstr Surg Glob Open. 2019 Mar 13;7(3):e2097. doi: 10.1097/GOX.0000000000002097. PMID: 31044103; PMCID: PMC6467628.
  2. Rothenberg KA, Gologorsky RC, Hojilla JC, Yokoo KM. Obesity is Not Associated with Complications or Revisions after Gender-Affirming Mastectomy in Transgender Patients. Plastic and Maxillofacial Surgery. 2019 Oct 1;229(4):sup1. doi: https://doi.org/10.1016/j.jamcollsurg.2019.08.494
  3. Martinson TG, Ramachandran S, Lindner R, Reisman T, Safer JD. HIGH BODY MASS INDEX IS A SIGNIFICANT BARRIER TO GENDER-CONFIRMATION SURGERY FOR TRANSGENDER AND GENDER-NONBINARY INDIVIDUALS. Endocr Pract. 2020 Jan;26(1):6-15. doi: 10.4158/EP-2019-0345. Epub 2019 Aug 28. PMID: 31461357.
  4. Lisa M. Brownstone, Jaclyn DeRieux, Devin A. Kelly, Lanie J. Sumlin, and Jennifer L. Gaudiani. Transgender Health. ahead of printhttp://doi.org/10.1089/trgh.2020.0068

Reflections on Trans Day of Visibility

Today is the annual Transgender Day of Visibility. A day dedicated to celebrating trans people while we are alive and appreciating trans excellence.

But for many of us, this year feels particularly hard. While we have recently enjoyed many of the benefits of being more visible in media and politics and the allyship we have gained from intersecting communities, that visibility has also come at a high cost. Violence against trans women of color is at an all time high. And the political right has chosen to make our identities a wedge issue, pushing forward hateful and harmful legislation across multiple states and at the federal level. The horrendous laws in Arkansas, Mississippi, South Dakota, and Tennessee have targeted trans teens in particular, excluding them from sports and gender-affirming care.

If you are cisgender, I encourage you to take some time this week to read about the issues facing our community right now such as the scientific evidence supporting trans youth in sports and find ways to act to support your trans colleagues, friends, and trans youth across the nation. As a starting point, I recommend reading this brief article from The Nation about how Visibility Alone Will Not Keep Transgender Youth Safe. I also encourage you to find transgender-led advocacy groups to donate to such as Seattle’s Gender Justice League and the grassroots Trans Women of Color Solidarity Network Fund.

Fuck TERFS

I am so sad that one of my favorite fandoms has been ruined for me by a transphobic author. I am so angry that I can no longer see the anti-bigotry story lines in Harry Potter the same way now that JK Rowling has turned into a Trans Exclusionary “Radical Feminist” and become a bigot towards my community. I am so scared when I see that same dangerous rhetoric being thrown around by lesbians in my own small communities. It is like a virus that destroys feminism from the inside out. I just want to be able to enjoy Harry Potter like I used to without having to worry that every friend posting about it is secretly a transphobe. Why do TERFs ruin everything?

My greatest fear

I know this sounds dramatic but all this waiting in dread and frustration to find out if my greatest fear is being realized is terrifying. Before making the decision to have bottom surgery, I had to overcome a pretty significant fear that I could be in the rare group of people that can’t orgasm (anorgasmia) after surgery. I decided to go ahead anyway because my dysphoria was getting worse but that fear has still been in the back of my head the whole time. And now, here I am, 7 months after surgery and still unable to orgasm. I know it’s early and that the average healing time is 1 year but it is still absolutely scaring the shit out of me.

It honestly wouldn’t be so bad if I still had the libido that I did before surgery due to dysphoria. But now that I have the right body parts and my sex drive has returned, this waiting is absolute agony. And I don’t have the other outlets through kink that I would normally have since I’m limited to contact with one partner. I’ve tried pretty much everything I can think of including ordering way too many different vibrators but still no luck.

Honestly, right now, I kinda regret having surgery. I don’t say that so that cis people can justify denying trans people life saving treatments but rather to normalize being honest about that when you’ve had a disappointing experience. I hope that this feeling will pass but right now I would take the dysphoria over the frustration personally. And I honestly don’t know how I’m going to get through life if this keeps up.

Sorry to be depressing today. Thanks for listening to me vent.

Quirky Vagina

Good news! I went to see the urologist today about what I was worried could be a urethralvaginal fistula and she was able to determine that there’s nothing wrong, I just have a harmless little cul-de-sac that splits horizontally from my vagina towards my clitoral area. Turns out my vagina is quirky in more than one way. I’m so relieved!

The only thing she recommended was that I go see pelvic floor physical therapist to help improve some of the minor incontinence issues I’ve been having. That should certainly be interesting!

Rarely Shaving

I shaved this weekend for the first time in 3 months and all I got was some fuzz! I mean I occasionally have to pluck but so do most women. It’s really incredible to go from a thick, full beard to basically nothing in just over two years. It was expensive and painful but so worth it. Not shaving is such a relief and not having the dark stubble in photos means I’m a million times more likely to feel beautiful.

My past is like another life

Sometimes I look at photos of me from my past and think, “damn, that person was sexy.” Not as in a “I wish I was still that person way” but more of a “if that was a stranger, I would date them.” It is such a mind trip to have most of my previous photos feel like they are a completely different person. I’m glad I’ve evolved into more of the person I want to be, and yet it is still so weird to think how recent that shift into feeling like myself has been.

Yet another post-surgical complication

Content warning: medical shit below

I’m so tired of having to worry about my new vagina and whether something is wrong. I really wish I had just been born with the right hardware in the first place so I didn’t have to think about it all the time and I had something I could rely on to work properly.

Yesterday I went to the doctor because I was worried that I had a vaginal tear. And while it turns out it probably isn’t a tear per se, it could potentially be a fistula to my bladder. I have to go to a urogynecology specialist to confirm. It’s also possible that it is just a harmless little pocket in my vagina that just healed weird but either way, it is likely something that will need yet another surgery to fix.

I also keep having bleeding from this granulation tissue right next to my vaginal opening that I am going to have to treat with silver nitrate for a few weeks until it clears up. But unfortunately, the treatment makes it bleed more, a lot more, in the short term while it heals. It is really scary to go to the bathroom and see blood literally dripping from your vulva after you pee. Luckily I have a whole set of homemade flannel pads that my partner made for me so I don’t have to use up a million disposables during this process.

I still haven’t been able to orgasm yet, though worrying about hurting your parts and whether you’re going to start bleeding isn’t exactly conducive to relaxing into it either. And the combined effect of all of this is incredibly frustrating. I just want things to work right! Is that too much to ask for?

Anyway, thanks for listening to me vent.