2 Days Post-Op - The Waiting Game

"My vagina has two sets of lips,
But I don't get monthly blood drips;
My vagina, hardly even used."
-- NOFX, My Vagina

We got to the hospital at 10:00am on Wednesday morning and checked in with the surgery center's admissions desk. After a few minutes, they called us to a little desk to have me sign a bunch of consent and release forms.

Another few minutes went by, and a nurse called us back in to the back rooms. She had me strip down and helped me change in to a hospital gown and silly paper booties. All my clothes went in to a plastic bag, and everything else, my wedding ring, tongue ring, cellphone, and wallet, I gave to Erin.

The nurse directed us to a small room with a recliner for me, where she put an inflatable warming blanket over me and attached a couple of wristbands for identification. She worked away at the computer, and gave me a few more forms to initial and sign saying that I knew who my doctors were and what I was getting. She also wrapped compression sleeves around my lower legs, which rhythmically contract to keep the blood flowing.

She then left, and we continued waiting. One-by-one over the next half hour or so, various people from the surgical team dropped by.

The anesthesiologist was the first to introduce himself. He was a nice, slightly quirky, wiry-looking guy who spoke quickly and wore a black bandana on his head. After he left, Dr. Bowers dropped by to say "hi", and to assure us that everything was going to go great. At this point we were both pretty excited, but Erin was also obviously nervous. She teared up a couple of times, but tried to hold back and smile to keep me from worrying too much. =3

Lastly, a sweet and reassuring younger woman who said she'd be helping with the surgery came in and asked me to come with her to the operating room. Erin and I gave each other a hug and a kiss, then parted ways. I was then led down a hallway in to the OR, where I lay on a flat table under some giant movable light structures, and people bustled around me. There was a slight depression in the table's surface, and they had me adjust until my butt was right at the edge of it.

They removed my gowns, so that I had just one loosely draped over me, and put oxygen tubes in my nose. My arms were propped straight out to the sides, and the anesthesiologist started telling dorky jokes while he inserted the IV in to my left forearm. The last thing I remember was chatting with the anesthesiologist and assistant woman about it being a little awkward that everyone in the room was there for me, and then I was out.

I woke up in the recovery room around 4:30, and a nurse immediately noticed me and offered me some bits of ice, which I happily chewed. Within half an hour or so, I was fairly lucid, and they wheeled me to my room. Erin was there waiting for me, grinning from ear to ear, and she gave me a kiss.

Erin was planning to go back to the hotel to sleep, but I have the hospital room to myself, so they offered to wheel another bed in for her and she has stayed with me both nights so far. It's been so comforting to know that she's only a few feet away if I need her. On Thursday morning she went back to the hotel to shower and grab a few things, but otherwise she's been hanging out here, playing video games, and even eating hospital food with me.

The nurses are, for the most part, awesome, though there was one incident where a CNA was trying to adjust my tray and accidentally slammed it downward on to my crotch. I saw stars for a second and nearly swore, but it was an honest accident, and I did my best to keep calm while she apologized repeatedly.

My crotch has been completely bandaged over, with packing inside as well. I have a JP Drain coming out my left side which they have to empty red goo out of a few times a day, and a catheter tube going to my right. The catheter feels horrible, like I always have to pee, but I'm sort of getting used to it by now.

My breasts feel tight and tender, but don't hurt much. I really like the size, and I think I'll be really happy with them once the skin stretches and they settle. For now, they're just sort of stuck in place.

The pain in my groin area was fairly bad on the first night. The nurses gave me morphine through the IV, which helped a lot, and percocets by mouth, which didn't seem to help at all. For a while, there were rhythmic zaps of pain centralized in one spot, but I couldn't figure out what part it was originating from, because as far as my brain is concerned, the old nerve map of my genitalia is still valid, and nothing has changed. After a while it dawned on me that the zaps were almost definitely coming from my clitoris, which was exciting! Eventually I was able to get some sleep, and the pain was much better in the morning.

After spending Wednesday evening laying down, I decided to sit up and play around on the lappy on Thursday. That afternoon, Dr. Bowers stopped by. She told me that I looked like I was recovering well, and that she was really proud and happy with the way my surgery turned out. She also said that she's sure I'll like it. I hope she's right! =D

As the evening wore on, the pain from the sutures nearly went away, but it was replaced by a new aching throughout my entire lower abdomen. At first, I thought it was just from sitting in the same position for so long, so I carefully tossed and turned, trying to find a comfortable spot. After a couple of hours of this, the pain just continued to get worse, so I told my nurse, who pointed out that it was probably gas build-up. She gave me some gas-ex, but said it would take hours to take effect. Since I was nearly in tears, and it was getting late anyway, she gave me some more morphine and an ambien to knock me out. This morning, I still feel a little bloated and sore, but much much better.

At 7am today, a new nurse came in to remove my dressings! She had me lay flat, and she slowly peeled the bandages off of my vagina (that still feels weird to say). I only got a short glimpse before she replaced the bandages with a maxi-pad, but so far it looks great! My labia are very swollen but good, and the clitoral hooding is perfect. Even though I knew logically that everything was there, it's nice and extremely exciting to be able to finally see it and know that it's real.

I should be able to get up and walk around a little today, which I can't wait for. I'm sick of being stuck to this bed. If all continues to go well, I should be checking out of the hospital tomorrow morning! W00t! =)

T Minus 1 Day - Surgery Eve!

"Tomorrow! Tomorrow!
I love ya, tomorrow!
You're always a day away."
-- Annie (Annie), Tomorrow

Hooh! It's been a full week, as expected, which has kept my mind from wandering too much. Every once in a while a wave of realization will hit me, and I'll reel for a couple of seconds. It's finally here!

The flight from SLC to LAX was fine. After going through the body scanner, a TSA agent did give me a "thorough patdown", but she was very amiable and professional. The flight was short, but I'm already considering looking in to an upgrade for the trip back, just for slightly more comfortable seats.

Disneyland was a lot of fun, though the lines were longer than expected, and rides kept going down right when we wanted to go on them. Erin and I take a trip down there every couple of years, because it's an easy/fun road trip and we get to stop in Vegas, but I've never seen the rides go down that much.

We'd only planned to hang out with Erin's brother Chris while there, but we found out a couple of weeks ago that Erin's oldest brother, Dave, who lives in SLC, was coincidentally also going to the LA area at the same time as we were. He and his girlfriend ended up joining us at Disney, which was brilliant. Funnily, both of Erin's brothers are averse to roller coasters, so us three girls ended up going on Space Mountain without them.

The visit with the grandfolk on Sunday was good. Since we were exhausted from Disney, it was nice to just sit around chatting over dinner, and they're such good people.

I knew we'd forget to bring something from home. The something ended up being hairspray, a mouse for the laptop, and a car charger for our phones. The charger was the most problematic, since we use our phones for GPS directions. Thankfully we found a Best Buy (and grabbed a couple more video games to boot) before driving up to San Mateo.

We met with Dr. Bowers yesterday, and she talked us through the expected outcome and possible (but unlikely) complications. I thought I'd have a million questions, but I just kept looking at Erin, and neither of us could think of anything. I spent so much time over the last couple of years researching the surgery in general and Dr. Bowers in specific, I think all I really needed was to hear her reassurances. And she was amazingly reassuring.

She's obviously been at this a long time, and being trans herself, she has a unique and very comforting perspective. She said everything looked fine and that there shouldn't be any problems.

After that, we went and picked up my prescriptions (laxative, bowel prep, pain relievers, antibiotics, and antibacterial cream) and some supplies, i.e. neosporin, baby wipes, and clear liquids for me to subsist on today. We'd thought about doing something touristy for the remainder of yesterday. Instead, we relaxed in the hotel for a while, then went out to a steak joint for my last meal. It was a nice recharge that I think we both needed.

We saw Dr. Beck this morning, and he was a little less personable than Marci, but still very nice. After he took some pictures and measurements of my chest, he had us work with his assistant Jasmine on sizing and such, and she was wonderful. She knew just what to say to boost my confidence and make me feel good about what I'm doing.

Next, we had to drop by the hospital for some quick blood work. Then back to the hotel to start in on the bowel prep to clean me out. The solution came in a jug, which I filled with water to mix it. I was then supposed to drink a glass every ten minutes until gone.

The first five or six glasses went down fine, but after that, the stuff started to make me nauseous. I know it was partly psychosomatic, so I did my best to power through it, but I couldn't seem to down a full glass without feeling like I was going to throw up. It didn't help that the jug was four freaking liters, meaning about 16 small glasses over the course of several hours to get through it. Ugh.

I also wasn't allowed to eat anything today, just liquids. Remarkably, I haven't been that hungry. A light snack probably would've helped settle my stomach when drinking the bowel prep, but I made do with ginger ale or apple juice chasers.

At this point, I'm just waiting for bed time so we can wake up and head in to the hospital. We're supposed to be there at 10:00am, but the actual surgery doesn't start until around 11:30. It should last around 4-5 hours, with both docs working at the same time. I'll be in the hospital for about three days, then back to the hotel for another week before heading home.

I half-expected to have a lot of doubts and moods swings to work through over the last week, which would've been normal, but I've had surprisingly little apprehension. I'm anxious and antsy, but I think I made up my mind and overcame my qualms a long time ago.

By now I'm just excited that the wait is finally over. Of course, this is also just another beginning, but in my head, it's the beginning of the rest of my life, and I know that I'm ready for it.

T Minus 5 Days - Heading Out Californee Way

"Airplane, airplane,
Don't you go down today;
Take me away, off to a better place,
You know just where I'd like to go;
Please get me there on time,
Don't delay me from losing my mind."

 -- Plain White T's, Airplane

I mentioned in my last post that I've had way too much to do. Well, other than at work, most of that ran out a couple of weeks ago. Since then time has been dragging, and I've had way too much time to sit around and think, and make myself anxious. I couldn't wait for today to come, just so that it could be over with.

I've had various pre-admission phone appointments over the last week with Dr. Bowers' staff, Dr. Beck's staff, and the hospital staff. We've booked flights, hotels, a rental car, etc. I think we're ready, but I know I'll forget something. Hopefully it's something stupid and small, like toothpaste. ;)

I stopped most of my hormones a little over a week ago. I'm still on a little bit of estrogen, but temporarily off progesterone, and thankfully I'll never have to take spiro (testosterone-blockers) again. Yay!

After a few days off hormones, I started having mild headaches that won't go away. Normally, the only time I get headaches is when I'm about to get sick, so it's been really scaring me. Getting sick right before surgery would not be good. So far, the headaches are the extent of the physical discomfort, though.

A few days ago the mood swings hit. It really seems unfair that I had to stop hormones during one of the most emotional times of my life. In addition to minor bouts of depression and anxiety, I've been feeling really self-centered. I'm making an effort to reach out to friends to help them, but at some point I also have to accept that it's ok to be a little self-involved right now, even though that's tough for me to do.

The great support I've gotten from friends and family has helped a lot. (THANK YOU!!!) I'm never down for too long before a new heartfelt text or Facebook message rolls in to remind us how loved we are. I also got an insanely sweet 'Good Luck' card from a bunch of friends that made me tear up a couple of times while playing Dungeons and Dragons. I am so freaking lucky.

My last day in the office was on Wednesday. It's strange thinking that I won't work again for around six weeks. My boss was super cool about it, though, and helped me wrap everything up and train people to cover for me. We had a last meeting to make sure everything was settled, and she kept telling me to forget about work for a while. =)

The only real uncertainty remaining is my time off work being qualified as medical leave. I'm still pretty sure it will go through, but they don't give the official word until I'm actually hospitalized, which seems idiotic.

Tonight, we're stopping by my sister's to receive a mystery present, then to Erin's mom's, and finally to the airport to fly to LA. Honestly, I'm a little bit terrified of the TSA right now. I've heard way too many horror stories of people who got pulled aside, outed, or berated because their bodies didn't look like "normal" male or female bodies under the scanners. I can deal with answering questions and outing myself. But I can be really defensive and ornery if I feel I'm being pushed farther than I should be, and the TSA are the last people I want to be ornery with. >_<

Tomorrow, we'll be in Disneyland with Erin's awesome brother who lives in that area. In two days, we'll be hanging out with Erin's grandparents and other family from around there before driving up to the San Francisco area. The last time I saw her grandparents, I'd just started transitioning, but didn't tell them. Later I found out that Erin's mom told them, and that they were amazing about it, so I'm excited to let them see the real me.

In three days, we'll be meeting with Dr. Bowers, then hanging out in San Francisco. In four, we'll meet with Dr. Beck, and I'll spend the day stuck in the hotel drinking a bowel prep, and not eating anything. And in five days, I'll be on the operating table!

It's so surreal to think that in less than a week, my body will be significantly changed forever. It's nerve-wracking, but it's exciting! At the same time, I know that the surgery itself is just the beginning, since I'll spend the next few weeks/months healing. Still, I'm huge on life experiences, I wouldn't trade this ride for anything.

T Minus 29 Days - Insurance and the Many Machinations

"We didn't choose to be bureaucrats,
No that's what our mighty Ja made us;
We'd treat people like swine and make them stand in line,
Even if nobody paid us!"

-- Hermes Conrad (Futurama), The Bureaucrat Song

Only 29 days remaining! I've had way too much to do to prepare, but I suppose I should be grateful, because it's made the time go by quickly. On the electrolysis timeline, I only have one session left. Things in general are also coming together really well!

The craziness kicked off in earnest when Robin with Dr. Bowers' office sent me a surgery info packet a few weeks ago, which included a checklist of various forms and such to send to them, recommendations for hotels, a list of important dates, etc.

Among the things to send, they requested HIV test results. Normally these tests can cost around $150, but the Utah Pride Center does free testing on certain days, so Erin came with me and we both got tested. Of course, both our results were negative, but it's always nice to know, and it's very cool that we have such great local programs.

I also had to send off my letters of recommendation, an information release form, medical history, an anesthesia evaluation form, my name change court order, a picture of myself, and a one-page self bio. No, I'm not making that last bit up. =P

At the start of the year, I switched to a new insurance plan with Anthem Blue Cross that covers trans surgery. I was still nervous about my chances for approval, and trying really hard not to get my hopes up, just in case. As soon as Robin had all my info, she contacted the insurance to get the pre-authorization started. It was only a few days later (last Friday) that I heard back from both the insurance rep and Robin, telling me that I'd been approved! SO EXCITING!

This is such a huge weight off my shoulders. I've said many times how terrible I felt having this huge cost looming over Erin and me (even knowing it'd be worth it). My out-of-network deductible was $3,000, which is a substantial discount from the $22,500 I'd planned on paying. After surgery, we're hoping to take a vacation or two, then start looking for houses. =D

I'm a little sad that we won't be able to thank Robin in person, since she works in Trinidad, CO. I know it's her job, but Robin has been amazing to work with, and I can't imagine coordinating all of this paperwork without her help. I can definitely see why Dr. Bowers kept her on in Colorado, even after moving her practice to San Mateo.

In addition, I've been researching plastic surgeons for the possible breast augmentation I mentioned in my last post. Oddly enough, Salt Lake City has a thriving plastic surgery industry, with a lot of good surgeons with good rates. With the power of the internet, I found a nearby surgeon who gets great reviews, and decided to schedule a consultation. Of course, one of the first things I asked the girl on the phone was if the doc had any experience with trans clients. I was surprised to hear that he very much prefers to not work with trans people, and also that the rep had no idea why. "It's just his policy." Although I wouldn't want to work with someone that doesn't want to work with "my people", it was still incredibly disappointing. =/

After that, I decided to call one Dr. Beck in California. Not only does he have a lot of experience with trans clients and enjoy working with us, he often works with Dr. Bowers, to perform aesthetic surgeries during the same session as the SRS. I had a phone consultation with him a couple of weeks ago, and I really liked his demeanor and his recommendations. At first I was wary of the prospect of healing from both SRS and a BA at the same time, but the idea of having it all done with and not having to be put under twice is quite appealing. After insurance came through, I went ahead and scheduled the BA with him.

On another front, Erin and I have both put in for medical leave from our respective work places. Mine is still in the works, though I'm pretty sure it will be approved. Erin's, well... a couple of days after she turned in all the paperwork, they said that her request was denied because "they don't recognize domestic partnerships."

When Erin explained that we're actually married, they told her that even if we're married in another state, it wouldn't count since same-sex marriages aren't recognized in Utah. *facepalm* She then, of course, had to divulge my history and explain it in detail before they decided to look at it again. Thankfully, in the end, they did approve it. It's just frustrating that we'll always be forced to come out in order to validate our marriage, and that they wanted to discriminate in the first place.

Originally, we'd planned to drive to Cali in order to save money, but between Erin not liking to drive, the possibility of hitting snowstorms on the way back, and me being unsure how I'll feel sitting in a car for that long, we decided it's smarter to take a plane. We booked our flights a couple of days ago, and we'll be leaving February 17th and coming back March 3rd!

I'm still working on hotels. We're trying to save money wherever possible, but I also think it would be a good idea to stay somewhere with a kitchen, since we'll be there for a while. Decisions, decisions.

And last but not least, I still need to find a local doc who can give me a post-op checkup a few weeks after the surgery, to monitor on healing and such. My primary care physician said she didn't feel like she'd be good for it, and I feel stupid even broaching the subject with other offices without being referred. However, there is a nearby Dr. Luikenaar who recently announced that she's looking to help trans clients, and whose specialty is gynecology. Perhaps it's meant to be? I'll give her a call soon. =)

Overdue Update, on Electrolysis, Surgery, Insurance, and Boobs

"The boob fairy never came for me
No the boob fairy never came for me
Look, I wasn't wanting melons, just a cute curvaceous "B"
But the boob fairy never came for me."

-- Deirdre Flint, The Boob Fairy

I know this is where I'm supposed to make some excuse about why I haven't been updating for the last three months, but I've got nothing. Well, I've got a few things, but they're empty excuses that don't really matter in the long run. It's probably best if we all just move on and pretend that nothing happened. =P

Electrolysis continues. I've now logged just over 8 hours on my face, and 15 down below (and spent about $1,200 on it). I saw my physician for a checkup back in August and finally asked for lidocane/prilocane numbing cream, which she was happy to prescribe. In general, the numbing helps a ton, especially on my upper lip, but there are certain areas I'm not so sure about.

The cream only numbs the top layers of skin, and in a few spots this has the strange effect of removing most of the pain, but not the itching. With the top layers numb, scratching does absolutely nothing, and I end up wanting to crawl out of my skin by the time she's done. At least without the cream, the pain from each successive zap helps relieve some of the itching from the previous stabs.

It helps my mental well-being to think about the time until surgery in terms of how many electrolysis sessions I'll have in the interim. Assuming that I continue with my current schedule of two weeks between sessions, and that I stop around four weeks in advance to allow the skin to fully heal, I only have six more sessions before surgery! Contrasted with the 17 sessions I've already endured, I think I just might make it with my sanity intact.

Yep. Surgery is less than four months away (if I haven't established, I'm definitely waiting for the official date of February 22nd), and once again it's all I can think about. Honestly, damn this wait!

For the longest time I racked my brains over whether or not I even wanted surgery, then whether or not I was ready, whether we could save the money, what surgeon to go to. It seems unfair that the seemingly interminable year-long wait could only happen after these decisions were made. At this point, I check the countdown calendar on the right side of my blog constantly. I'm ready to move on now... please? =P

Still, the year since scheduling is more than two-thirds over. I just hope the days fly by faster as the date approaches, and not slower.

Saving is going well, and I'm pretty sure we have the funds secured, but I've been stressing over money a lot lately. All I can think about is what else we could be spending $20k on, like truly starting our married life together. I've recently been having dreams that insurance pays for it, and suddenly we have enough to put a down payment on a house, buy furniture, take a vacation.

Erin is amazing for taking this all in stride. I also appreciate all my friends for putting up with me repeatedly doling out the same tired excuse: "I want to, but I can't. I'm saving for surgery." If you're sick of hearing it, believe me when I say that I'm sick of saying it, too. I think the fact that I've never had to pretend to be broke for this long is affecting me, though. I'm definitely a child of the consumer age, and I miss spending money on stuff.

On that note, I'm trying really hard not to count any chickens just yet, but it's looking like I probably will be able to get insurance through work that will cover my reassignment surgery. It's insanely exciting, and hopefully I'll have more details soon. Fingers and toes crossed!

Speaking of doctors and insurance, I also saw my endocrinologist not very long ago for a yearly renewal, and to discuss my pre- and post-surgery hormone regimens. Female hormone replacement pills are known for increasing the risk of thromboembolism (traveling blood clots), so most surgeons, including mine, require patients to reduce or stop taking hormones a few weeks before surgery. My endo suggested that I wean myself off slowly, to reduce the inevitable hot flashes and moodiness. Though I'll resume estrogen and progesterone after surgery (and for the rest of my life), I'm definitely looking forward to never needing to take testosterone-blockers again. =D

She also gave me the regular blood work, to check my hormone levels, but apparently she forgot my insurance situation and coded it under "psycho-sexual disorders". My insurance will have none of that, and denied the claim, so I recently got a bill for $400 worth of blood tests. =(

I've talked to the hospital and asked them to change the coding and try again, but I'm nervous that the damage has already been done. A friend of mine recently tried to claim her SRS through the same insurance (SelectHealth), and after denying her, they also decided to start denying anything and everything else that they could claim was related, whether it actually was or not. Hopefully the re-code on my blood work will pass through, and that's the last I'll hear of it, especially since I'm planning to switch insurance ASAP.

Last, but not least, I've been doing a lot of ruminating about possibly getting a breast augmentation. It's something that's been in my head for a long time, but something that, for a few reasons, I haven't really talked about. It's odd to me that I find it fairly easy to disclose all sorts of information about my transition and body, but not so easy to talk about this one thing.

To be honest, I have some self-esteem issues around my body. I still pad my bra, and though I know that's not that strange, I guess I just want to feel like I can have more confidence in my image, without having to think about it daily.

Even though putting it that way makes perfect sense to me, I still feel guilt around the subject. I suppose I view SRS as simply necessary, but implants have been socially drilled in to my brain as being purely superficial. Well, sure, they are superficial, but we live in a superficial world, and if that's what it takes to make me feel comfortable in my own skin, then I should probably stop feeling guilty and do it.

Letters to a Surgeon

Won't you please,
Please tell me what we've learned?
I know it sounds absurd;
But please tell me who I am.

-- Supertramp, The Logical Song

I can has two letters of recommendation for surgery! =D

As I wrote before, I was having a tough time finding someone for my second letter, as required by the WPATH Standards of Care (and more importantly, as required by my surgeon). I'd collected a couple of suggestions from trans friends and called a few psychologists, with no luck. Among those I'd called was one prospect, a Dr Beckstead, who was out of town. I waited until he got back in near the end of June to leave a message, which he promptly returned a few hours later. He said that he had experience working with trans clients and writing these letters, and that he'd be glad to meet with me. W00t!

I had an appointment with him on July 7th, and he was awesome! He was very courteous, kind, patient, and a great listener. For some reason, I'd expected a battery of dry evaluation tests, with ridiculous questions questions like, "How often are you angry?"

Instead, we sat and chatted casually for an hour about my transition, the ups and downs I've experienced, my emotional state during various stages in my life, etc. The hour flew by, and by the end of it, I'd rambled off my entire life as it relates to my gender. He told me he'd be happy to write a letter for me, and agreed to have it ready the following week. I picked it up on the 14th, and... wow.

I expected half page or so. This sucker is four pages long, and recounts nearly every detail I shared with him, but in a more cohesive, less rambly way. It's really interesting to see a summation of so much information about myself. Even though much of it is a direct interpretation of what I'd told him, being reworded and peppered with his observations makes it feel slightly surreal, like hearing a recording of your voice for the first time and wondering, "Is that really what I sound like to other people?" Even though none of the information is a secret, the letter feels very intimate, and makes me realize just how much I expose my naked thoughts and feelings to the world. I'll cherish it always. =)

My regular therapist told me long ago that she'd be happy to write a letter if/when I decide to have surgery, so I also set up a recent appointment with her to go over the details. I hadn't seen her for the better part of a year, but most everything I had to share was good news, so the session had the odd feeling of catching up with an old friend, then paying her for it. =P

She offered to mail her letter, and it arrived on Saturday. Her letter is much more what I expected, basically just an overview of our therapy and her recommendation:

Dear Dr. Bowers,

This letter is in regard to [Vivienne]. Vivienne is a male to female transsexual woman who I have been treating for Gender Identity Disorder (GID) since March of 2009. [Vivienne] has been on hormone replacement therapy since July of 2009; she has undergone a legal change of name and gender marker and has been living full time as female since April 2010.

I have spent many clinical hours with [Vivienne] addressing issues pertinent to her gender identity and transition. I am confident that she is psychologically and socially prepared to complete a surgical transition to female. [Vivienne] has considered all aspects of gender reassignment surgery and will continue to live a productive and emotionally healthy life as a woman. Therefore, it is my recommendation that she be considered for further medical or surgical procedures as she wishes.

For the sake of completeness, I've also included some of Dr. Beckstead's letter below. I've pared it down to around 1/2 the original length, but it's still pretty long, I wouldn't blame anyone for thinking it's TL;DR and skipping it. ;)

Dear Dr. Bowers,

This letter is to document my assessment of Vivienne and my recommendation that she is eligible and ready for male-to-female sex reassignment surgery (SRS). My evaluation is based on 1 individual evaluation on July 7, 2011. After this meeting, I was confident in making this recommendation. Vivienne has also met with another local therapist, who is highly competent in gender-identity issues, starting in March 2009 to the present. Regarding Vivienne, she is 29 years old, employed, and married, with no children. My overall impression of Vivienne is that she is intelligent, thoughtful, warm, sensitive, easy-to-get-along with, independent, practical, and confident about her choice of SRS.

History of Gender Dysphoria & Sexuality
[Vivienne] describes herself as an awkward, emotional child that never felt right being who she was... She was never into sports but also never interested in “girlie toys” but building toys. She would always play female characters in video games, not only preferring the identity but also being attracted to the character’s characteristics. She sees herself as always having feminine mannerisms and that people considered her to be homosexual or the “gayest straight boy,” which caused her to question and explore if she were gay. She relates that this focus on sexuality clouded her exploration and acceptance of being transgender.

She describes always feeling out of place in men’s locker rooms and bathrooms and never using the urinal. She hated gym class because she would be forced to change in front of people and would often leave her shirt on while swimming, always feeling awkward in her body but never understanding why.

She recalls that a pivotal time for self-acceptance and identity was when she worked in the Philippines for six weeks in 2008. Transgender issues were more prevalent, obvious, and accepted. This compelled her to do research for a couple of months on transgender issues, which helped her “put the pieces together” and realize that transitioning was worth the risks of social rejection. This process led to her talking with her then girlfriend, which Vivienne describes as emotional because her girlfriend was afraid of losing her. However, once her girlfriend realized the possibilities of staying together (her girlfriend is bisexual) and that Vivienne would be happier, both were okay with the decision and she has been supportive ever since. They married in September 2010.

Vivienne describes having slight “bi-tendencies,” open to the idea that she could be with a man if she met one with whom she fell in love; erotically and emotionally, however, she states that she has always preferred women and does consider herself a lesbian. She relates never being sexually aroused or interested in female clothing or going through a cross-dressing phase of buying and purging clothing. She describes herself as “not that girlie of a girl,” and typically wears jeans and a t-shirt. She has never been interested in wearing feminine-typical clothing because she believes women can wear what they want and still be a woman. She does relate how thinking of her body as female, especially being able to have sex and interact the way she wants as female, is arousing. In her words, “It’s never about the clothing but about the expression of myself through my body that is important.”

Overall, she describes feeling uncomfortable about her body, although less now because she appears female, but she feels “squeamish, weird, awkward” when she does think about her current genitalia and knows that she would be happier and excited with “the correct body” and wants “everything to match.” She is considering breast augmentation but wants to give hormones more time to have an effect. She is also determined to eat better and exercise more.

She states that making the decision for SRS has been difficult, mainly because of finances and her concerns about its effect on her wife and their relationship. She reports exploring and evaluating the risks of surgery, especially with concerns about having a good sex life and sexual sensation, but she states that she sees herself having more fun and pleasure with the correct body.

Social Support, and Current Life Stresses
She describes her relationship with her wife as equal, where both can discuss and resolve issues, and her transition has strengthened their relationship. They can lean on each other for support. Vivienne also states that she has not lost a single friend or family member’s support.

Current stresses for Vivienne include saving money for surgery and a house and managing any guilt about putting her wife under this pressure. Vivienne states that she also worries about body issues and what people think of her (e.g., has she offended someone).

Mental Health History and Status
Vivienne reports that she has suffered with anxiety and depression since childhood. Vivienne sees herself as independent and able to “deal with it” on her own. Vivienne describes having strong emotions but also strong logic that help her maintain balance.

She describes her anxiety as worrying too much about what people think and feel, trying to please them, and then blowing things out of proportion. Her depression was strongest when she first came out and feared its impact on others, which involved breakdowns of wondering if she was doing the right thing. Vivienne states that since her transition, her depression has gradually disappeared as she expresses who she is more: “Not needing to pretend has helped a lot.”

Overall, she states that her sense of independence and responsibility can become to extreme and turn in to anxiety. Vivienne considers that she will always be anxious but has learned to manage it better. Ways that help her to cope currently include expressing more with people who care, processing issues with her wife, and using reality as a check-and-balance.

Summary
Vivienne demonstrates the capacity to understand anticipated physical, emotional, and social changes and drawbacks associated with SRS. She is realistic about the changes that can and cannot occur through SRS. I consider her eligible and ready for SRS because she has consolidated her gender identity in the last 2.5 years during her use of hormonal therapy and full-time, real-life experience. She is highly supported by her spouse, family, friends, and job. Her mental health is stable and she does not suffer from any self-abuse, psychotic thought patterns, severe psychological or personality symptoms, or impaired decision-making skills.

These are letters #4 and #5 that I've had to acquire throughout my transition, the first to start hormones, and the second and third for changing my legal name and gender, which shows the kind of crazy hoops we trans folk have to jump through. =/

Anywho, everything's coming together nicely. Now I just wish I didn't have six more months to wait! ><

Freedom and Acceptance, a Rant

"We are a family that should stand together as one,
Helping each other instead of just wasting time;
Now is the moment to reach out to someone, it's all up to you,
When everyone's sharing their hope, then love will win through;
Everybody's free to feel good,
Everybody's free to feel good." 

-- Rozalla, Everybody's Free

Forgive my need to rant. I just found out that a trans acquaintance committed suicide over the weekend. =(

Sadly, this kind of thing is not uncommon. I hear about murders and suicides of trans people all the time, and it horrifies me. Though I didn't know them well, the fact that I knew them at all makes it hit home that much harder. I hope they're at peace.

I won't pretend to speak for this person, and there may have been any number of difficult things going on in their life which caused this. But I do know that all-too-often the fear and pain of rejection is what drives many of our community members to take their own lives. Nobody deserves to feel so out of place in this world that they're forced to leave it.

As a very open trans person, I often come out to new people during the first few times I meet them (so long as I feel relatively safe). I do this mainly because I'm a control freak. If I tell everyone, I'm not left to wonder "who knows?", and it's that much more difficult to use the information against me.

In these situations, I nearly always hear "Oh wow, I would have never guessed!" or "When I met you, I couldn't tell at all." These sayings are a well-known cliche among the trans community, and they're sometimes even considered rude or insulting. After all, what makes anyone feel that they should be able to tell? And is being able to tell somehow bad?

Personally, I usually take it as a compliment and try to smile, mainly because the people saying these things probably have good intentions, and probably aren't thinking about the deeper implications. But I also smile because these phrases are a guilty pleasure for me. Passing does provide privilege, and I am constantly aware of it. When I walk down the street, or in to a public establishment, or meet new people without strange looks or harassment. Much as I hate it, the words "I never knew" say to me, "Nobody knows. You are safe."

But passing as one gender or the other should not be an indicator of acceptance. Further, passing should not be a measure of personal safety and freedom.

Many people put off expressing their true selves for years, decades, or even their entire life, because they are afraid. Afraid of the reaction, of how they'll be treated. Before I even came out to Erin, I weighed the very heavy possibilities. Is it worth the risk of rejection to be myself? Is it worth losing any number of my friends and family, my job, or even Erin? Is it worth becoming one of the worst treated minorities in the country? We hope for the best, but we must plan for the worst. With being true to myself on one side of the scale, and possible social rejection in every form on the other, it was the most difficult decision I've ever made.

Acceptance changes lives, and I feel so extremely fortunate, grateful (and sometimes guilty), that I am as loved and accepted as I am by so many people. Scary as it has been, being appreciated as myself has kept me from thinking about suicide for a very long time. Whenever I feel strong enough, I try to use this acceptance as a platform to show others that we exist, and that we only want what everyone else wants.

Still, I am usually more open about being a lesbian than I am about being trans. Though both identities leave Erin and me prone to all sorts of discrimination, the public's treatment and understanding of trans people is still leagues behind. =/

I'm ever so thankful to live in a country that lets me choose what to do with my own body, and in a time when the world is slowly coming around. But freedom isn't just about the law, who gets to serve in the military, who gets to marry, and who is theoretically protected from discrimination (though these are very important steps along the path). It's also about the personal freedom to be ourselves; to express our thoughts, feelings, and personalities the way we'd like without fear of retribution; to love and be loved; to not be shunned or hated for simply living the only way we know how.

We've come a long way, and it's an exciting time to be alive, but we still have a long way to go. And none of us will ever be truly free until we all are.