4 days to surgery!

After a 2 day drive down the coast, I’m now settled in my Airbnb and just finished my pre-op appointment.

My anxiety is mostly gone now that there are fewer things to go wrong and I couldn’t be more excited to finally be here! The doctor and all the staff at the clinic are wonderful and friendly. Though they did give me the predictable fatphobic lecture about my BMI being slightly over the “recommended weight.”

I have my COVID test tomorrow and then it’s smooth sailing until my bowel prep starts the night before surgery. Monday morning I’ll show up bright and early and go under for the 4-5 hour procedure.

We chose to drive down since airports felt too risky. The drive down the 101 coastal highway was beautiful but long. And we couldn’t stop much because everywhere we went there were hundreds of white tourists without masks.

I’m glad to see that the most Asian neighborhood we are staying in is much more compliant with mask laws. It makes me feel safer walking around though I suspect the tourist areas here are going to be bad too.

We’re trying to find things we can do while we’re here since everything is understandably closed. I guess we’ll go wander around some parks and eat lots of amazing takeout.

Thank you again to everyone who donated to make this happen! I’ve gotten some unexpectedly large gifts this week which make me feel so loved and supported.

As I’ve said before, it takes a village to make a vagina!

Hot flashes

I’ve been off my estrogen pills for over a week now per doctors instructions for surgery. The hot flashes started a few days ago and yesterday they were happening almost all day. That coincided with a heat wave in Seattle and a lot of physical labor loading the car for the drive down which made for a very sweaty, unpleasant day.

Hormone withdrawal is no joke!

1 week to surgery!

My long-awaited surgery is next Monday and I couldn’t be more excited! I’ve spent so much time and energy preparing and yet it still doesn’t feel real and probably won’t until my pre-op appointment.

I got a call from a San Francisco area code today and definitely freaked out when I saw the caller ID. I am so scared that something will happen, especially during a pandemic, to push it off. But luckily it was just the confirmation call for my appointment.

The car is all packed and tomorrow we leave bright and early to do a fun roadtrip down the 101 coastal highway with my spouse and her other partner who lives with us. He’s never been to the Redwoods so I’m excited for him to experience that for the first time.

I’ll keep posting here at on Twitter with updates about surgery.

How I knew I needed Surgery

Content Warning: I’m going to talk explicitly about sex in this post.

How did I know I needed surgery? It is a question I get a lot in different forms and it’s a good question, particularly for other trans people to ask each other.

My earliest inklings were from when I first learned what vulvas were. I was immensely curious as a child so I secretively turned to my local library and sex education websites to find out what women had that made them so amazing and supposedly so different. That’s when I found out the beauty that was the human vulva, vagina, and especially, the magical clitoris.

What was initially curiosity quickly turned into an obsession. And I doubt it was the same kind of obsession that my cisgender peers were starting to have as their libidos awakened. It crept into my psyche and my dreams. It wasn’t long before I was having both sleeping dreams and daydreams that involved strong, powerful women with both penises and vaginas. Because to me, the peak of human achievement would be having the best of both worlds. This was before I even knew that trans or intersex people existed.

It took me years of suppressed queerness before I finally admitted those dreams in group therapy as an early adult. And in the meantime I went through phases of hyper-masculinity as I tried to reconcile these desires to experience a vagina that kept pestering my brain. When I first had oral sex with a woman, the obsession only grew.

Eventually I finally got enough exposure to trans people that I realized I was one too. Not out of peer pressure like the media tries to paint it, but from seeing examples of people like me. I started out slowly and it took me awhile of my social transition before I decided to take any medical steps. You can see a lot of that progression if you read the early posts on my blog.

I had a lot of hesitation about starting estrogen because I was worried it would change how my already anxious/depressed brain worked. But once I started, I knew I could never go back. After the initial adjustment period, my brain had never felt more “right” and like I finally had the right operating system installed. But it did fundamentally change how I experienced sex.

I have always been hesitant and anxious about using my penis. But after starting hormones, there was some significant rewiring of my nervous system that took place and changed how I felt sensations. Suddenly an appendage that felt like a blunt tool now felt like a fine tip brush. It honestly felt like I imagine an inverted vagina would feel with a clitoris on the tip. My sensitivity increased immensely and I also lost all desire to use it for penetrative sex.

I had already started to think about surgery but my initial explorations had all been about whether or not it was possible to have a vagina and a penis simultaneously. I thought for sure that’s what I wanted because that’s what all my dreams still involved. I scoured the internet and couldn’t find anyone except naysayers who claimed it was anatomically impossible.

Finally, the first surgeons started to do what they called “penile preservation vaginoplasty” and my dreams were vindicated! Except ironically, by the time I discovered that, I was beginning to realize that it wasn’t what I wanted. I came to understand after almost 2 decades of dreaming that that form was more about what I was attracted to, not about what I wanted for myself.

Once I finally accepted that I wanted a vaginoplasty, the rest was just about getting through the medical gatekeeping. Last year when I went for my consult, I was sure that it was what I wanted. Now I am 120% sure and for months now I have been counting down the days (12) until I could finally achieve what I’ve secretly desired for so long.

I’ve been trying to decide for a couple years now if I am asexual or if I just have a low libido and as I think about life post surgery and all the sex I can have uninhibited, I think I finally have my answer. I just needed the right parts!

I’m in the home stretch now and I’ve started taking the pre-surgical meds. The Gabapentin is making my brain a bit hazy and I’m rather scatterbrained so hopefully this blog post makes sense. But in 6 days I pack up the car with my partner who will be my caregiver and her partner who lives with us and we drive down the coast to San Francisco.

12 more days!

Insurance approval

I know to most cisgender people this doesn’t sound significant but I just got word from my surgeon’s office today that I got insurance approval for gender confirmation surgery!

This is one of those things that should be a normal occurrence. But for trans people, we have had to fight so hard for generations to get these surgeries covered by insurance that it is still a big deal for us to have these basic rights. I remember not that long ago when my friends were going to Thailand because that’s the only way most people could afford to get surgery out of pocket. And because of that legacy, there are still so few surgeons in the US that even those of us in major cities like Seattle have to travel out of state and incur huge expenses to get these surgeries.

It’s also significant because of the amount of medical gatekeeping we have to endure to get there. I can’t think of a single procedure where a cis person has to get more than one letter of support. But most trans people require 3 letters from MDs, therapists, and PhD level psychiatrists to get this insurance approval.

For me, I got these letter last fall because I was told the surgeon was going to ask for insurance approval in late winter. But they waited too long to submit paperwork so I had to go get the letter updated because they needed to be within 6 months. Which meant that the first time around I got an insurance denial which was scary even though I knew why.

The point of this story is, if you have the authority to be a medical gatekeeper for a trans person, PLEASE make it as smooth as possible for them. There are a variety of reasons that trans people don’t want surgeries and shouldn’t need them to transition. But for those of us who do, we are usually overwhelmingly sure that this is what we want. So don’t make it harder for us than it needs to be. Trust us to be the experts on our own experiences. And if you get asked for a perfunctory piece of paper, just sign it.

41 days until surgery!

I’m down to less than 6 weeks before gender confirmation surgery and I’m so nervous! I’m not anxious about the surgery itself other than a natural concern about the rare complications. I’m nervous that something will happen between now and then to prevent me from getting the surgery. Because the idea of delaying it sounds like torture. When I did my consult a year ago, I was ready. And now I am wishing I had started the process sooner.

I’ve done literally everything I can do. I’ve bought medical supplies, collected comfortable clothing for the recovery, changed our original flight plans to a roadtrip, booked an accessible AirBnb, and even scheduled my pre-op bloodwork. But my brain can’t stop focusing on all the things that could go wrong.

What if there’s a new wave of COVID-19 cases now that we are re-opening businesses prematurely? What if I get sick right before surgery? What if I get down there and find out that the hair removal wasn’t sufficient because I missed 2 months due to COVID shutdowns? What if the doctor says that my weight is too much of a problem since I’ve put on 20 pounds in the last year?

The last one is the one I hate the most. I’m a very fat positive person and generally I don’t care about my weight. But last year I had a bad experience with Dr. Satterwhite when I consulted with him and he was hyper-focused on my high BMI. He claimed that if I gained any more weight it would be “unsafe” to do the procedure. Thankfully Dr. Wittenberg, the surgeon I ended up choosing, told me that they are more like guidelines for optimal results which I absolutely agree with, but my brain is still anxious about it. Fatphobia is one of the few remaining socially acceptable forms of overt discrimination.

In the end, there’s not much I can do about it. I know all the data about how fad diets don’t work and can cause more medical issues than they solve. And luckily the nutritionist/therapist I’m working with agrees and is helping me balance my food in a way that feels appropriate to me. But the voice of that fatphobic doctor still haunts me. I also wonder how many fat trans people he’s turned away and made believe that they can’t get surgery.

On a more positive note though, my job is being super supportive. They have hired new permanent and temporary staff to take on my workload while I’m gone with enough time to train them before I go. So now I know I can leave even in the midst of a busy period of running COVID research studies and know my work is in good hands.

Currently I am hoping to be able to return to at least part-time work after 6 weeks which is the minimum time my surgeon recommends. Since we are completely online now it should be more accessible. But there is a potential that I may need the full 12 weeks before I’m lucid and off pain meds.

For housing I was lucky enough to find a basement apartment owned by a gay couple to rent that not only is ground floor but has a kitchen and even AC! It was very expensive at $3,400 but it’s centrally located in San Francisco so I can easily make it from the hospital and to my follow up appointments without sitting in traffic. I’ll be staying for a full month since I need to arrive 5 days prior to surgery for my pre-op and stay for 3 weeks after for post-op check ins before I’m cleared to travel. I’m really hoping that I can handle the 800 mile drive home without too much pain since I don’t feel very safe about airports right now.

I’m in the final countdown period and I am so excited! Thank you to all my friends who donated over $2,500 to make this happen. And I couldn’t do this without the support of my wonderful spouse who will be my caretaker after surgery. I guess you could say it takes a village to make a vagina.

Bottom Surgery is still a Go!

I’ve been on edge ever since this pandemic started because I have been so worried that my bottom surgery this summer would be postponed. But today I got confirmation that I can re-start laser hair removal to prep the area this weekend. And based on what the surgeon’s office has said, I think I should still be able to get enough of it in by July 29th to head down to San Francisco for my August 3rd gender confirmation surgery.

I’ve changed my plans and instead of staying with a friend-of-a-friend, I will be staying in an Airbnb so that we can maintain social isolation. My spouse and I will also be driving down instead of flying because as asthmatics, airports are a pretty big risk. And I don’t know what the visitors policies will be like at the hospital during my 3 days there after surgery. But damn am I glad that it is still happening.

Lately all the little things have been bothering me because my body just can’t wait to get this finally resolved. I am grumpy about having to use my hands to pee. And I hate everything about my balls. But it is only 68 days away now! I am almost there.

First surgery prep laser

I had my first laser hair removal session on my genitals today to begin prepping for bottom surgery. I’ve been dreading it all week because it is so extremely painful when I do it on my face that I assumed it would be even worse on such a sensitive area. But I was pleasantly surprised. I don’t know if it’s because the numbing cream works better on the thinner skin (it did last longer), or because it is a wider dispersal laser head but it was a breeze and over really quickly. It honestly hurt a lot less than waxing or sugaring.

Turns out the worst part of laser down there is the shaving. It is a pain in the ass (literally) to try to get it all and the aesthetician still  had to clean it up. I recommend having a friend or partner help you shave. The other part that sucks is the insurance approval process which took me three months of pestering.

But session 1 is finally over. I have 6 more months of doing this every 6 weeks and hopefully it is enough for surgery. I’m also going to finish laser treatments on my face since I had to stop because it is expensive to pay out of pocket ($300 every 6 weeks). But the stubborn hair patches that have come back are giving me too much dysphoria to keep waiting.

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My skeptical face as I wait for the numbing cream to work

Insurance delays

Medical and insurance gatekeeping of essential gender affirming treatments is exhausting!

It has taken me 3 months to get all the approvals from my insurance lined up so that I can get genital hair removal, an essential step before bottom surgery. This is despite them claiming in their own documentation that these procedures are covered for trans people. And before I could even begin that approval process, I had to get 2 letters from psychiatrists, one of whom had to be PhD level.

Because of this nonsense, I’m not going to be in ideal shape for surgery by August. Hopefully my surgeon can successfully remove the rest with follicle scraping while I’m under.

Oh, and the only way I even got insurance to finally respond was by having my HR person at work badger the insurance company on my behalf.