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.

Inheriting a fixer-upper

I just scheduled my jaw surgery to do the first part of correcting my bite for mid-May. It’s something I’ve been dreading for the last 10 years since my dentist identified the root problem. And I’ve been surprised at how many emotions around surgery are coming up for me now that it is an undeniable reality, not just about this procedure but about my plans for bottom surgery.

My original plan was to get my jaw surgery out of the way this year and then go in for vaginoplasty next year. And in the interim I was going to meet with the surgeons I was interested in when they were in town for Gender Odyssey. But now I feel like that plan has come crashing down around my ears (like most plans have in my life).

I found out a few weeks ago that my jaw surgery is so intensive that they need to split it into two separate procedures with a year of expanding my top palate in between. So now I have another surgery on my face to dread but at least I have jaw feminization included to look forward to. Unfortunately that means I have to rethink my whole plan around bottom surgery.

To complicate things further, I found out that Gender Odyssey isn’t in Seattle this year and they aren’t doing a conference for trans adults this year anyway. So now there’s no opportunity to meet with them that doesn’t involve investing in travel. I feel like I need to decide whether to try to attend Philly Trans Wellness where I might meet some potential providers (although not my top choice – Heidi Wittenberg), or whether to travel to San Francisco to meet with them directly.

And trying to figure this all out while I’m also undergoing intensive laser hair reduction on my face (I put electrolysis on hold for now because it was too slow) just feels like so much. I feel totally overwhelmed by how far I still have to go before I’m done with all these medical procedures and honestly I’m feeling pretty despondent and hopeless about it all.

I just want to fast forward to a point in time where I feel like my body is my own. But instead I feel like I inherited a fixer-upper house that needs major repairs to be livable and every time I fix one thing, another breaks. I know that all these surgeries and procedures aren’t going to fix everything but I still have to rest my hopes on life getting easier once I’m past it all. Because without that hope I don’t know how to keep going.

This is one of those points where I really wish I had been born with a brain and body that matched and I didn’t have to go through all this work just to be myself. And sometimes it feels like I should just throw in the towel on life and give up. Don’t worry, I don’t actually have plans to do so but I can’t say I haven’t thought about it.

Anyway, I don’t know where all this is going right now other than hopefully forward even if it takes a painstakingly long time to get there. I know I wouldn’t be able to keep wading into the fray if it wasn’t for my partners and friends so I am very thankful to all of them for keeping me going. I know things have to get worse before they get better but I really hope I turn that corner soon.

Jaw feminization

I just talked to my oral surgeon about what can be done to feminize my chin, the biggest source of dysphoria for me at this point, when I go in to align my teeth this Winter. This is a major oral surgery I’ve been dreading for almost 10 years now as I waited for the right insurance and financial stability to make it possible. But now that there is the possibility it could make my face more tolerable, I’m actually excited.

I started the process 2 years ago when I first met with the surgeon before I was out and thinking about what the impact of my prominent, square, cleft chin was. I’ve been using my beard to cover it up for so long that I sometimes forget that this really ugly-feeling part of me is underneath. I found out just how much it would cost and realized I needed a new job to make this work. The next step was the braces I got installed in January which re-align my teeth back to where they will need to be after the surgery. Unfortunately, in the short term, the braces have made my dysphoria and confidence worse. The first day I had them I dissociated so badly that I felt like I was walking around viewing the world through a long, dark tunnel. It has gotten better since but I still can’t wait to get them off.

But the end of stage one is finally in sight so I got up the courage to reach out to the surgeons office to find out if there were parts of facial feminization that could be accomplished as part of this procedure. I was both excited and terrified as the appointment got close this month fearing that he would just dismiss my concerns and focus on function. But it went surprisingly well. For an old white cis dude he seemed to really get it. He talked about the various things that he can do to tilt the lower jaw back, shave off the harsher edges, and bring it more in line with the rest of my face. He even was aware enough of the gendered aspects that he is suggesting increasing how much of my upper teeth are visible when my lips part because apparently that is a feminine trait.

He was cautious about over-promising and he is limited with how much he can do because of the potential impacts on my breathing and sleep apnea and the amount of muscle I have on my chin. But I am hopeful that it can be enough better that I can actually face myself in the mirror without my beard. He promised to do some advanced prediction models and show me several options we can discuss at our pre-surgery appointment so I can have some say in how my new face will look.

I’m especially excited for this since my insurance doesn’t cover facial feminization. And overall that’s not really a primary concern of mine on the rest of my face since I have great cheekbones (even according to the surgeon) and a good nose that balances my face. So if I can get this all done in one surgery that I’ve been planning for so long, I will be very happy.

Now to see if I can actually live without the beard for the next few months before surgery. I haven’t gotten up the courage to go into the barber yet…

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?