transition

(Re)starting Vocal Feminization

Yesterday I made the plunge and signed up for a vocal feminization course through Undead Voice Lab. I met the voice coach at Trans Pride Seattle and decided that now was as good a time as any to restart that work. It’s expensive but I was able to get a partial scholarship to make the monthly payments more affordable.

I tried working with a trans voice coach once before a few years ago but I ended up stopping because I was experiencing so much dysphoria from hyperfixating on how masculine my voice sounded. It is easy to ignore most of the time but if I think about my voice too much, it becomes overwhelming quickly. At that point I was in the middle of my physical transition and it was just a lot to handle at once. So I put that work on hold.

My roommate asked me yesterday why I was doing this work and I realized as I answered that it isn’t as much about my own dysphoria around my voice but rather about other’s perception of me. I get misgendered on the phone so often or don’t have people take me seriously in person, ostensibly because of my voice, and that misperception is what causes the dysphoria. If we lived in a perfect world where people didn’t make assumptions about you because of your vocal pitch, I probably wouldn’t put in the effort.

This time around I think I’m in a better place to do the work. I’ve finished my physical transition and have fewer areas that cause dysphoria on a daily basis. I’ve also done a lot of work in therapy to be able to approach this more non-judgmentally and just accept the pace at which I’m able to work. I know this is more of a marathon than a sprint.

If I really focus on it, I have the skills to feminize my voice but I’m not sure if I’m doing it sustainably. I also don’t want to have to always focus that hard on it so the real work is creating something that is effortless and natural and doesn’t take conscious effort every time. Fingers crossed that that is something I can achieve this time around.

Trans Day of Visibility 2022

Today is Trans Day of Visibility and while not all trans people want to be visible, I am very happy that I am. A lot of people are sharing before and after photos but for me, there never was a true before and after. I have always been trans, there were just phases of my life where I didn’t have the language to access that part of my authenticity. From a young age I was very gender non-conforming and I adopted that label quietly in college at age 20. It wasn’t until 2014 though that I finally began to see myself as Genderqueer and falling under the Trans umbrella thanks to help and advice from other genderqueer folks. At that time I was still trapped in an abusive marriage so I couldn’t come out publicly. But in 2015 I finally escaped and with that freedom, claimed the first parts of my true identity openly.

My path to coming out was slower than many people because I was so scared of not being accepted for who I really was. When I first learned about trans women in college, I didn’t think I belonged in that category because I could never “pass” and I thought that to be a woman meant you had to be primarily attracted to men. I didn’t have access to the kind of tomboyish, lesbian-leaning gender and sexuality that I needed. Even when I came out in 2014/15, I was afraid of even attempting to be treated as a woman because of all the negative self-talk about my body and ability to change those features. So for many years, I kept my beard as a way to hide the parts of my face that were most dysphoria inducing.

Slowly by 2018 though, I accepted that I am a woman, even if I am a gender-nonconforming, nonbinary tomboy, and I started to take the medical transition steps that I needed. I started hormones 4 years ago this month which is one of the best decisions of my life. My body quickly began to change shape into the beautiful curvy shape I am now. And in October 2018, I finally took the scary step of shaving off my beard and facing the long uphill battle of hair removal.

Now I am nearly complete with my physical transition. I am still trying to get insurance coverage for the last remaining hair removal I need to be able to stop shaving occasionally but my surgeries are finished and my body finally reflects what I want to see. I am so happy that my face has softened and rounded out and that my breasts have filled in and give shape to my clothing. Getting here was a long hard path but now I get to reap the reward and enjoy myself more. I still have mental health challenges, but I no longer feel ugly all the time and avoid looking at myself in the mirror. I appreciate the body that I have, even if it took modification to get here.

Thank you to all the people that have supported me on this journey, both emotionally and financially. Being trans is hard and expensive at times but the pot of gold at the end of that rainbow is definitely worth it.

Me today in March 2022
Me in 2016 before my physical transition

Why is gender affirming care so expensive?

I’ve written quite a bit about the costs that I have incurred along my journey of trying to inhabit a trans body. But even as I look forward to the upcoming revision surgery on my vulva, it is a harsh awakening to realize that I am going to have to spend yet another $6,000+ for housing simply because Seattle has no transgender vaginoplasty surgeons and most insurance refuses to pay for out of state surgery costs.

So how much have I paid out of pocket so far for gender affirming care?

  • $5,000+ for electrolysis and laser hair removal on my face and body (not considered “essential” by insurance)
  • $9,500 in travel costs for consults, surgical recovery housing, and post-op appointments
  • $6,000+ for housing for revision surgery recovery

All told, I can account for over $20,000 in costs that insurance refused to cover.

I am one of the lucky ones. I am privileged enough to have a good job with decent health insurance so my co-pays are minor and I can afford to save up for these procedures. And I have a large network of friends who have generously donated over $5,000 towards those costs.

But can we talk about why these costs exist in the first place? Why is it considered ok for transfeminine people to have to pay for face and body hair removal to deal with dysphoria? In a world that demands that we “pass” as women to use public facilities such as restrooms, that is incredibly classist and discriminatory. And why does insurance not have to pay for the costs of getting an out of town surgery when there are no local surgeons available? My insurance now pays for cancer patients to get out of town specialty care but despite my advocacy for the past several years, continues to deny trans people that same right.

Luckily, starting in 2022, insurers in Washington State are now going to be required to pay for all doctor-prescribed gender affirming treatments and will no longer be allowed to label them as “cosmetic”. This is thanks to the tireless work of many many advocates and organizations who fought for years against insurance denials. And I hear through the trans rumor grapevine that Seattle may FINALLY be getting a surgeon soon who can perform vaginoplasties locally. But while that helps people here in Seattle, that doesn’t change the fact that far too many trans people around the US aren’t given equal healthcare access. We need laws in place federally to mandate coverage of gender-affirming care.

So next time you think of asking someone if they have had “the surgery” or make any kinds of assumptions about what trans people should look like, think about how expensive it is to look like I do. How inaccessible it is to the vast majority of trans people in this country to achieve what Laverne Cox, Caitlyn Jenner, and Elliot Page have done. And if you have resources, I encourage you to donate generously to your local trans fundraisers and places like the Jim Collins Foundation to help more trans people get the care we so desperately need.

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.

Boob update

2 years and 1 month into hormones and my boobs are still growing! At this point I’m solidly a C-cup but they are pretty conical and haven’t rounded out so I don’t really have cleavage yet. Other than the shape and distance from each other, this is about what I was hoping for. It makes me so happy to see them in the mirror or my peripheral vision!

For my fellow trans health nerds who are wondering, I started by ramping up to 6 mg of oral estrogen sublingually spaced throughout the day and eventually backed down to 4 mg where I am now. I never added spironolactone (an androgen blocker) because my testosterone disappeared and never came back. In February this year, my estradiol level was 139 pg/mL (cis woman range is 12-498 depending on cycle) and serum testosterone was only 13 ng/dL (cis woman range is 8-48).

Do Trans Women get Periods?

Do Trans Women get periods? Absolutely.

As someone who is on my period now, I can tell you that it is very real and it sucks. I am ready to burst into tears at a moments notice and I could definitely bite someone’s head off right now. I’ve been tracking my mood cycle lately to confirm that it actually does follow a monthly pattern and my app was spot on this month. And it is synced up with my nesting partner so I knew it was that time without even asking her.

Do we bleed? No. But if you try to point out how “lucky” we are are some BS like that, I will slap you. Because that is a really sore point for someone like me who wants nothing more than to be pregnant. But I also know that it is unlikely to be possible while I am still young enough to do it because while uterine transplants are absolutely medically possible, they are only given to cisgender women.

The period is mostly caused by being on estrogen but I have always been sensitive to monthly cycles. Years ago before I had admitted to myself that I was trans, I noticed that my mood cycles were related to where my partner was on her period. But now that I am on estrogen it is a whole lot more emphasized.

And in case you think I’m making it up, you should read what other trans girls say.

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.

My decade in review

I started this decade still thinking I was mostly a man and mostly straight. I had just gotten married in what I could already tell was a terrible relationship and I stuck with it for 6 years because I thought that I would never be loved for who I actually was. And because of that, I put all my gender and sexuality questions on the back burner for over 5 years.
 
I’m beginning this decade with a new name and a much clearer picture of who I am. I’ve finally recognized why I was always different and claimed the complicated womanhood that I always had. I have built a stronger queer community and found more love than I could have possibly imagined.
 
Transition and self exploration are hard work. But with my gender confirmation surgery coming up in 7 months, I feel like the hardest parts are almost over. If I can make it through this year, I will hopefully have some relief from the intensity of dysphoria that has been in the background since puberty.
 
There is light at the end of the tunnel and I know that I’ve made it this far because of the many people who have supported me and made this corner of the world a safer place to be myself.

1 year without a beard

Today is the 1 year anniversary of me shaving off my beard. It was a big scary leap for me to give up something that had been such an important part of my identity for 12 years and accept that I would have to deal with more dysphoria for awhile as I dealt with the facial hair. But I’m so glad I did.

I’ve now had 5 sessions of laser hair removal on my face and spent over $2,000 in the process but all the pain, time, and money paid off because now I’ve gone a week without shaving and my face is still smooth! I have no more stubble or that dark shadow on my face and the amount of hair I have left to pluck isn’t any more than many cisgender women have to deal with.

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In other news, I’ve conquered two of my biggest fears around bathrooms so far. I’ve used a women’s room at a mall (with my spouse), and I’ve had a conversation with a coworker in the women’s room at work. Both things that I never would have felt safe doing with a beard.

This transition has been expensive and I’ve managed to make it this far with the help of my spouse but I still need to raise another $5,000 for my bottom surgery next year. If you are able to contribute I would really appreciate it. https://www.gofundme.com/f/haven-gender-confirmation-treatments