Fundraising for surgeries

It makes me so sad that trans people have to beg for money from friends and strangers in order to have live saving treatments for gender dysphoria. And that we have to have our identities pathologized and our daily existence diagnosed in order to get access to insurance coverage. But this is the reality that we live in.

Transition is a very expensive process with exorbitant costs everywhere you turn. If you want to change your name, you have to pay $400 and spend most of a day in government offices getting a judge to approve it and other offices to accept it. If you want to treat dysphoria around body hair and have any hope of being seen as a trans woman, you need to spend thousands of dollars on hair removal that most people consider a luxury and insurance won’t pay for. And if you want surgery, you often have to travel out of state like I am doing to find someone trained in what you need which means the expenses snowball with housing, airfare, meals in a strange place, etc.

It is absolutely terrifying to be looking at my budget for surgery next summer and realize that I need to come up with $6,000-$9,000 for my out of pocket costs. And as much as I hate asking for money, that’s what I’m doing now. I’ve launched a GoFundMe campaign to start saving up.

So if you have ever benefited from my writing and how openly I share about my path to self actualization, please consider donating. Every little bit will make a difference in making this life saving surgery a reality. https://www.gofundme.com/f/haven-gender-confirmation-treatments

Surgical Consults

I have a date for gender confirmation surgery! August 3rd, 2020.

I’ve decided to go with Dr. Heidi Wittenberg for my vaginoplasty. She is who I have been researching for the past year and my consultation with her last week confirmed that she is everything I had been hoping for. Her staff were all wonderful and friendly. And she was very approachable with a great bedside manner and excellent at explaining the process and answering questions. She seems very factual and will be straightforward with the risks and complications. She also has the training in alternate techniques such as peritoneal pull through that would allow her to perform a revision surgery with the latest technology if that was needed. More importantly, she feels like someone I can trust completely and it makes sense to me to have a woman with a background in gynecology and urology doing my care.

I did do a second consultation while I was in San Francisco with Dr. Thomas Satterwhite who trained with Dr. Wittenberg at Brownstein and Crane. He comes highly recommended from friends but I didn’t have the greatest experience with him. In both his intro video and in person he was very fixated on BMI (Body Mass Index) and treated it 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. He brought it up multiple times in my 20 minute consult to warn me that if I gained 10 lbs before next summer, I would be ineligible for the surgery. And yes, I have what many people would consider excess fat around my belly, but I am not objectively that fat of a person. I am tall and large and I am built that way naturally. In fact, I am pretty average in build for a white American.

If I, who have quite a bit of relative privilege, am receiving this much fat phobia from him, how much more pronounced would that be for the many trans people who are larger than me? And if he puts stock in pseudoscience like the BMI, what other areas does he make inaccurate conclusions in? To me, this is the kind of thing I would expect from a plastic surgeon that makes money off of fatphobia. And maybe that’s his background, but I’m not giving him money to support that. Even if he was the best surgeon around. Luckily, I have choices.

Now I’m not saying other people haven’t had wonderful experiences with Satterwhite, but I loved Wittenberg and I’m excited to be having her do my surgery. Next up, I am submitting documentation to get laser hair removal done on my genitals to prepare the area for surgery. Then I need to get 3 letters from my physician, therapist, and a PhD level psychiatrist because my insurance still goes by the outdated WPATH standards of medical gatekeeping.

In the meantime, I’m starting my countdown now for surgery. 377 days!

If you would like to contribute to my transition fund, you can donate at: https://www.gofundme.com/f/haven-gender-confirmation-treatments

Dysphoric Bandaid Beard

There are times when I wish I still had my beard. In a lot of ways it was like a security blanket for me, allowing me to exist without having to constantly focus on my dysphoria around shaving and my chin shape. When I first grew it of course I had no idea what dysphoria was or why I hated my face so much, but I used it as a crutch for 12 years.

When I made the decision last fall to get rid of the beard, I knew that my dysphoria would get worse before it got better. And it most definitely has. It is starting to get better now that my growth rate and amount of active hair follicles have been reduced from laser therapy and electrolysis, but the first few months were hell.

Ultimately, the reason I chose to shave was because I chose to believe that it could be better eventually. That somewhere down the road I could be happier and less dysphoric than the low level that I was at with my beard. Sometimes it is hard to see through the high level of dysphoria I have now to that hope that I held for a better future. But I have to keep reminding myself that transition is just a stage in my life and the point of it is to pass through it to emerge from my cocoon as the beautiful butterfly I am.

I am lucky to be surrounded by wonderful people who constantly tell me how beautiful I am at every step along the way. But the thing is, attractiveness feels good but it doesn’t alleviate dysphoria. Dysphoria and dysmorphia aren’t the same thing. The only way to treat dysphoria is by addressing the medical and social needs around gender affirmation. Words alone can’t cut it. But luckily we live in an age where we have plastic surgeons who know what they are doing and are constantly refining the process to create and re-form the body parts that we need.

Thanks to a new trans friend for the title of this blog post and some of the thinking behind it. Maybe someday I’ll make the queer band to match.

Selfies are hard

Dysphoria is hard ya’ll. I took a selfie yesterday after my haircut that everyone agrees is objectively hot and at the time felt like a really good photo of myself. But today when I look at it I have a hard time not focusing in on how much more prominent my chin looks now that my upper cheeks are widened by my first jaw surgery. It gives the illusion that I’ve lost weight because my face comes more to a point but to my dysphoric brain, it seems like it REALLY comes to a point.

Luckily, I’m going to have my chin reduced slightly during my second jaw surgery, probably in December. It is nice to know that there is potentially an end in sight to this source of dysphoria. And I am chugging away on laser hair reduction which is slowly making that source easier to handle. But it is still frustrating to have my day derailed by those obsessive thoughts.

Next up on my to-do list – call my top two surgeon choices in San Francisco to set up a consult for my bottom surgery (vaginoplasty).

61756817_10157152208944360_1997429246003249152_n

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…

Exploring surgery further

Content warning: I’m going to be talking about sex and genital surgery. Be forewarned.

Now that I have done some work in therapy to work through my fears about surgery, I am starting to explore my options in earnest.

For years I thought that I wouldn’t want to get surgery unless I found an option where they could add a vagina while keeping my penis intact. This was partly based on how I envisioned myself and those I was attracted to in my dreams as a teen. Before I knew that trans people existed, most of my imaginations centered around people who had both sets in tandem, sometimes with retractable phalluses and always with breasts. A year ago I tried to do some research to see if that was possible. At that time they had just successfully done the first neo-vagina made from peritoneum, the internal connective tissue in your abdomen. But everywhere I looked people either weren’t talking about that option or claimed that it was impossible to construct a vagina without damaging the penis.

So I had pretty much given up on that idea and gotten on board with a standard penile inversion vaginoplasty. But this time when I started doing research on surgeons I came across the website of Dr. Heidi Wittenberg who mentions that for gender nonconforming people she offers a penile preservation vaginoplasty. I can’t find many details online about the technique but apparently it involves using skin from another area such as doing a tummy tuck or a strip from the thigh. The scrotum is still used to build the labia and the phallus is left intact. And I hear from other trans people that she isn’t the only one. There are several surgeons who trained under Brownstein and Crane who can do this.

The odd thing is, now that I’ve finally found the thing that I always thought I wanted, I’m not sure that’s actually what I want. The more I think about it the happier I am with the idea of having a well constructed neo-vagina. I’ve seen the work that surgeons can do firsthand and it is incredible how hard it is to tell that it isn’t natal.

Luckily I don’t need to decide just yet. Next year is my jaw surgery (hopefully with some chin correction while I’m at it) and I know I can’t afford both in the same year so this will have to wait until at least late 2019 or probably 2020. My current plan is to go to both Gender Odyssey in Seattle and Philly Trans Wellness to learn more about the current techniques and hopefully catch Dr. Wittenberg’s presentation. I can get a consultation there and schedule something if I want. I do like the idea of having a surgery done with someone who recognizes transitions outside the binary and can talk me through the options. Not to mention that she specializes in Gynecologic urology exclusively for trans people and is considered an expert in neurology and minimally invasive surgery. Currently her waitlists appear to only be 3 months which is much better than most of the surgeons out there.

What I have noticed is that making up my mind that I do want surgery and giving myself permission to explore that in earnest has improved my sex life quite a bit. My libido has picked up and I find myself more ready to utilize my penis now that I know it is short term. It almost feels like I want to make good use of it while I have it as a way of wishing it goodbye. I have also noticed a difference in sensation as my brain rewires itself for estrogen. The head of the penis is more sensitive almost to the point that it already feels like I imagine a large clitoris must feel. And stimulation on the shaft somehow evokes the sensation of being penetrated. Not sure how to describe that and how much is me envisioning it in different ways but it does feel more and more like what I have right now is an inverted vagina, not the same penis I used to have.

That may be TMI but you can’t say I didn’t warn you.

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?

Increasing Dysphoria

Isn’t being on hormones supposed to help dysphoria? I mean it’s helping my confidence in my chest and overall shape but it’s definitely bringing up more feelings about my face in particular among other things. The biggest effect that estrogen has had so far other than breast growth is that it is making it harder to ignore things I’ve been burying and ignoring.

I often have days where I look in the mirror and literally see a blank where my face should be. My brain can’t handle the cognitive dissonance between my real appearance and my identity. And even more often I find myself avoiding mirrors or hyperfocusing on my hair to avoid looking at my facial features. And I can’t decide whether growing out my hair would help that or make it worse.

I’ve kept my beard thus far because it hides parts of my face that I can’t handle, especially my chin. But more and more I wonder if it is doing more harm than good. I get stares everywhere I go because people don’t know what to do with a bearded person in a dress. And it makes it so that I can be spotted blocks away as trans. I mean it’s not like I can hide easily with my height and tendency to wear bright colors, but maybe I don’t need to make myself that easy to spot. It also gives me a lot of “not queer enough” feels and makes me avoid spaces that are supposedly for femmes because I don’t think I would be accepted with my features.

But the thought of removing my beard and having to come to terms with the face underneath terrifies me even more. I am dreading what is going to happen when I’m forced to shave next winter for a long planned jaw surgery to correct my bite. But I also find myself wondering if there’s a way to capitalize on that to change my face. From what I remember of the consult, they are already going to need to make adjustments to my chin to make my face symmetrical and I wonder if I can talk the oral surgeon into taking some of it off permanently. Or if I could work with him to do a combo jaw surgery and facial feminization technique. The thought of cutting open my face twice doesn’t sound pleasant.

Then there’s the matter of my genitals. I’m feeling more disconnected from them recently which goes along with my feelings of asexuality. Most days I’d rather forget they are there and sometimes my brain does that for me. The other day I was on a date and I was trying to get myself in the mindset but everytime I thought about what was between my legs all I could picture was a black hole. I ended up not being able to do anything with my own body because I couldn’t reintegrate. Luckily queer sex doesn’t revolve around a penis or any specific kind of sex. But when I think about bottom surgery I’m still not sure whether having different genitals would help at all.

I’ve also realized that I only feel confident at all when my chest, stomach, and legs are shaved. Which even with the estrogen means trimming twice a week. I need to go back for more hair removal but I can’t decide between laser which requires $1,400 up front for 3 sessions (probably twice) or electrolysis which has more guarantee of permanency and I can break into smaller chunks but means more sessions.

Basically I’m feeling dysphoric most of the time now but I don’t know what to do about it and what interventions would help and how I would pay for those. So my brain gets overloaded with that background anxiety and I end up being less productive or mildly dissociating. I know I should try to do things that connect me with my body more instead of just escaping into video games. But I have a hard time figuring out how to do that in ways that a) don’t involve gendered locker rooms, b) don’t trigger my asthma (running is out of the question), and c) don’t make my back and neck pain worse.

There’s a little peek into what’s in the back of my brain most of the time these days. So when you ask how I’m doing and I say I’m fine, please know that there is a giant asterisk there.

Debunking “Biological Sex”

So this is probably an unpopular opinion but I think the term “biological sex” is meaningless, as is the distinction between sex and gender. While I continue to hear trans people use it and share it in various forms such as the problematic genderbread person, it is primarily used by cisgender people as a way of convincing themselves that the binary does exist in some form even if they support diverse gender identities. But as a biologist (by training) and a real life trans person™, I am here to tell you that it is just as much of a shared illusion as binary gender.

Hopefully by now you are aware of the existence of intersex people. According to the Intersex Society of North America, “intersex is a general term used for a variety of conditions in which a person is born with a reproductive or sexual anatomy that doesn’t seem to fit the typical definitions of female or male.” Without going into excruciating detail because you should hear it from intersex people themselves , both chromosomal sex and reproductive organ configuration exist in more than two options. There are 6 different ways that chromosomes can combine (X, XX, XXY, XY, XYY, and XXXY) that create various different kinds of humans and most people never have their chromosomes tested so using this as the basis for your gender is ridiculous. And various other changes in development mean that regardless of genetics, genital variation is nearly infinite.

But even putting intersex people aside for a moment, let’s talk about how useless the term biological sex is when you are dealing with reality. Many trans people such as myself have known from an early age that our brains are different. Long before I ever knew the term transgender or nonbinary, I thought that I didn’t fit in because I didn’t have a boys brain. And more and more evidence suggests that the brain can develop in utero in ways that more closely match the gender identity that child eventually expresses than the gender they are assumed to be based on external signs (although even that research is hopelessly binary). Though huge disclaimer here because there is no one way to be trans. Not everyone knew they were different from birth and not all trans people experience things like dysphoria.

Ok, so say you put aside natural variation in genitals AND you ignore differences in brains. Well I hate to break it to you folks, but the differences continue to be useless. Trans people do not all experience socialization the same way or come out at the same age so there is no point at which you can make a valid argument that we are somehow “essentially male” or some such bullshit. And there are MANY different kinds of gender confirmation surgeries that make trans bodies infinitely variable and often indistinguishable from their gender.

So what’s the point of this? It means that you should stop using terms like “female bodied” or lumping people together based on binary genital arrangements. And you should stop saying things like “all women are” and reducing your research to binary sex results. Yes, statistically there are vast swatches of people who never have cause to question their gender or assumed sex. And you could do your research based on those people and ignore the tails of those statistical curves. But you are missing out on some of the most amazing parts of human experience when you do so. I am here to tell you that the conversations that happen among trans and nonbinary people behind closed doors that cis people rarely get to experience would blow your mind! And because of constructs like “biological sex”, many of these people intentionally avoid revealing that complexity to cis people and often rule out dating or interacting with you altogether.

So if you want to benefit from what we could bring to the conversation, think deeply about how you can be more inclusive and the assumptions you make on a daily basis. We are here and we are so much more queer than you could possibly imagine.