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.

Going Through the Motions

Being in transition for me feels like everything in my life is temporary. For the past 2 years I’ve been taking all these steps to try to feel like a normal human. This week is my two year anniversary of being on hormones and I’ve also had my braces for over 2 years now as I get my bite corrected. I’ve been getting hair removal all over my body and preparing for bottom surgery. I’m been doing all the necessary things to treat my gender dysphoria and address other medical problems that I’ve been putting off for when I had good health insurance. But all these things just feel like going through the motions in hope that on the other end I can rejoin the real world and live the life I actually want.

Many days I feel like a ghost, like an interloper from another plane of existence trying to navigate a world that isn’t built for me. I feel like I can interact with the real world but I’m not a part of it yet. Like I need to somehow “earn” my way into that life by doing all the right things. And in the meantime my life feels ethereal and temporary, like it could all be washed away by a really bad day.

And now with all of the Seattle area on lockdown for this COVID-19 pandemic, life feels even more temporary. It’s hard to make plans not knowing how long this will last. And scary to know that my surgery date could be effected.

It’s not that I’m afraid of dying; in fact that’s partly the root of the problem. I don’t feel any attachment to living because most days I feel like I never actually have. I’ve never fully lived the life I want as the person I want to be yet so I have no stake in protecting that. The only thing that keeps me going is the hope that after all this transition work, I can actually have that life. I don’t know if it will be better or feel more real, but it’s the only anchor I have to reality right now.

And now that I’ve lost a lot of my routines and physical interactions, even more of my life feels unmoored. I feel like I’m adrift in a world that is panicking and chaotic while I sit here at home mostly feeling numb. I keep saying that I’m ok but if I’m honest I’m not really. I’m spending most of my time dissociating by playing video games to fully immerse myself in a different reality. A reality where I have achievable goals and can actually go out and kill the bad guys and save the day. Don’t get me wrong, the video games are essential to my survival right now. But they are also part of this temporary feeling where the real world isn’t real to me.

I’m not sure when these pandemic measures will all end but I keep holding on to the hope that I will still be able to have surgery in August. And that surgery gives me some grounding in my body and in the real world. Because I do want to live. I just don’t know how to yet.

Barely surviving

I’m going to say some things that might sound scary but let me be absolutely clear that I have no plans to commit suicide or anything drastic like that.

 

I’m sick and tired of barely holding on to life. I’m exhausted from just surviving and it’s hard to see a path to a place where I’m thriving.

Now I know part of that is my seasonal depression talking. I’m on three meds now to try and control it but the best I have at the moment is “not as bad as it was.” I’ve tried messing with them but it’s a dangerous proposition when I’m in the midst of it. The last dosage change I tried put me at too high a risk for suicide for me to continue.

And part of that is the mental and physical exhaustion of being disabled. My back and neck always hurt and that background pain is draining. And then there are periods like the weekend I just had where a seemingly simple task like assembling and hanging a medicine cabinet puts me in 24 hours of acute pain. And it’s demoralizing to know that you can’t even do basic things anymore.

Another part of it is trying to exist in a world that wasn’t built for me. Our westernized society still doesn’t know how to be inclusive of trans folks even on the most basic level. Even queer community makes it hard to be recognized if you are outside the binary gender construct we all take for granted. And when you can fight for decades for the most basic human rights and have those stripped away in just one politician’s term, it’s pretty demoralizing.

But the biggest part of it is the dysphoria I have around how my body is gendered. I have been on hormones for 2 years now and it has helped a lot, but I still can’t look in the mirror most days and see myself looking back. I see a face that looks hopelessly masculine to me, and I hear a testosterone shaped voice come out of my body that can be fun to perform with but still feels like a form of drag to me.

I want so badly to be ok with the body I was given, but that’s not how dysphoria works. I can do all the body positivity building I want and all that helps with is my weight. There is still a misalignment of who I know I am, and the body that others see. I walk around daily in a shell that causes people to make assumptions about who I am. And even when those assumptions are right, it usually means they are focusing on the wrong things.

At this point I feel like I am just barely clinging on to hope that bottom surgery will alleviate enough of this feeling that I can relax even the tiniest bit. I don’t know for sure if it will, but I also don’t know if I could keep going if I don’t try. So for now, I survive.

Reflecting back on my beard

Last night I came across this photo in my Instagram history and I had one of those rare moments where I thought “Wow! That beard really was great sometimes.”

Caleb board portrait

To be honest, when I look at this photo I see an absolutely gorgeous queer person that I would date in an instant. But the problem is that it doesn’t look like me and never really did. What I see in the older photos of me isn’t the same person that I actually am inside. I may as well be looking at an old friend that I’ve grown apart from.

For a long time I despaired of ever getting my appearance and identity to match which is why I didn’t take any steps towards medical transition. I think now that I’ve done a lot of hair follicle removal and my facial features are changing, it’s getting closer. But I still have a hard time focusing on my face in the mirror.

My final jaw surgery, which includes some feminization of my chin, is in 3 weeks. Hopefully once I heal from that and get my braces off next year, I will be closer to who I am.

The queer dilemma

I feel like one of the constant queer dilemmas in figuring out your identity is whether you want to “do them or be them” (or the demisexual equivalent, date them or be them). When you get your first glimpse of queer representation or that gay awakening moment, it’s sometimes hard to tell if you are attracted to that asthetic or person because you want to become like them or whether you have pants feels for them. 

For me, that moment came in my teen years when I first heard in the sex ed books I covertly read in the public library about people with both/all kinds of genitals. Sadly at that time I wasn’t reading anything by actual intersex or trans people so the terms I learned initially were highly problematic but the idea still stuck with me. That it was possible to have both a vagina and a penis at the same time.

It wasn’t long before that idea had seeped into my imaginations and people with hybrid genitals dominated my teenage fantasies, both waking and dreaming. For a long time, even after I started transitioning, I thought that was my goal. Two years ago, I tried researching whether it was possible and at that time there wasn’t anything published about it yet so it was only theoretical. Last year, I discovered two surgeons who had started offering a penile preservation vaginoplasty which gave me the chance to think about it seriously.

Now I am planning for my “classic” vaginoplasty and I couldn’t be happier about it (other than that it’s not soon enough!). I don’t feel any confusion or serious doubts anymore. But as I have thought about it more and why I thought I wanted more nonbinary genital options for so long, I’ve realized that it’s because I’m very attracted to that kind of body. The people I find hottest in the world are the folks who have a penis and boobs on the same body. And I’m so glad that the many people I’ve met who want that body now have more options to achieve that.

Statues

Reinterpretation of the Tres In Una statue by Paul Richer

I need new genitals like, now

Content warning: I’m going to be talking explicitly about sex here so proceed at your own risk.

I can’t wait for bottom surgery. As in the idea of waiting another 11 months seems like torture. I need it so badly and while it feels good to finally have it planned and even some of the money raised, it still feels like forever away.

I tried for so long to feel comfortable with the body that I had, but I only had mild success. There were times where I was comfortable with partners who I felt truly saw me that I was able to have enjoyable sex, but for the most part it always felt awkward and performative. I wanted the connection and release so badly but the means I had of accessing that weren’t great.

The best sex I’ve ever had has always been with queer sex. The kind of sex where someone’s fingers or toy is inside of me and they are using their mouth in the ways that it seems only a queer person can. And the most comfortable I’ve been penetrating others is when I’ve worn a strap on. Otherwise being in that role feels weird for the most part.

This week I decided to try having sex “the old fashioned way” one more time to see if there was anything I’d miss about it. I took some generic Viagra because I can’t have those kinds of erections otherwise anymore and had some anniversary sex with my spouse. And while I love having sex with her, it just felt awkward and I was distracted the whole time by how uncomfortable I was. It felt like I was using body parts that didn’t belong to me but that somehow still transmitted sensation to my body. And not in the good way like I’ve managed to access a couple times. We eventually stopped and switched over to the ways we know we both like.

I feel like that was the moment that any last shreds of doubt I had were banished. I’ve proved to myself that my dysphoria really is “bad enough” to warrant the amount of money I’m spending and the amount of pain it will take to get my new vagina. Which is a terrible way to feel. Like you have to justify not wanting to be dysphoric all the time by degrees of severity.

So this week when I met with the PhD level psychiatrist to get my letter for the red tape of insurance approval, I was able to say with confidence that I know I’m making the right choice. And luckily I can also say that I have the right support in my life now to make that plunge. My work and my spouses work are both being very supportive in giving us the time off to go down to San Francisco for a month. And my community has been so generous in helping me raise $880 in less than a month already (plus a promise of airline miles) to put me well on my way.

If you are able to donate to support me as well, I would be very grateful. I can’t wait to finally get this surgery. https://www.gofundme.com/f/haven-gender-confirmation-treatments 

A new life

It’s been a little over 10 months since I shaved my beard and almost a year since I started using my new name everywhere and already it feels like another lifetime and another person. I’m still getting photos from a year ago popping up in my Facebook memories and it is hard to even recognize them as myself. I can see that the person in (some) of the photos is beautiful but it isn’t me anymore. I have moved so far beyond who I was in that moment.

The first few months after shaving were definitely rough with having to face my dysphoria around my chin and stubble. But now there is so little hair left that I don’t have to think about it 90% of the time and I often forget to shave the few stubborn hairs around my lips. I feel so much more feminine now without the shadow on my face.

It also helps that I can really visibly see the changes that estrogen has made in my body. My facial structure has been changed by both rounding of the edges from hormones and from a pretty distinct cheek structure change created by the first jaw surgery. Many acquaintances I see think I have already had the feminization portion of the surgery which feels great. At this point I’m feeling more excitement than dread about the second surgery and the final results I’ll have. Especially since I can finally get this annoying metal out of my mouth and feel confident smiling again.

There are still a lot of hurdles to cross. I’m trying to get the letters from the psychiatrists that I need for surgery and the hair removal on my genitals to prep for that. I have appointments today and next week that should hopefully cover those barriers.

I also started vocal feminization lessons last week. While my voice has subconsciously raised a few degrees already, estrogen doesn’t automatically bring your voice back to where it was before testosterone (yet another reason to support hormone blockers for trans teens). I have to do a lot of conscious work to expand my upper range and retrain my muscles not to create the masculinized resonance my vocal cords are used to. Someday it will hopefully be second nature but for now it is exhausting work.

However, I do seem to have crossed some magical threshold now where many people in public recognize me pretty quickly as a trans woman. Whereas before with my beard I would get stares of befuddlement everywhere I went, now I mostly get recognition, at least in liberal Seattle.  Which has meant that I get a lot more “ma’am”s and “she” either automatically or from self correction.

I tried using she/her pronouns before just around my chosen family but it still felt grating at the time. Like I was too far away from that reality and the pronouns just reminded me that no one would automatically assume that. But now I have decided to use them again as another option in addition to they/them and it feels wonderful. Especially when it is coming from strangers who I am first meeting.

In the moment, progress can feel so slow but it is nice to have these moments where my head comes out of the water and I feel like I can breathe again.