15 Days Post-Op - Home Sweet Home

"Home, where my thought’s escaping,
Home, where my music’s playing;
Home, where my love lies waiting,
Silently for me."

-- Simon and Garfunkel, Homeward Bound

Just after my last post, we went in to get the packing and catheter removed. Happy day!

The trip back in to the office was exhausting, and even the cushy couch in the waiting room was stupidly uncomfortable. We didn't actually see Dr. Bowers, but saw an assistant I'd worked with a little before, Melissa. After calling me back, she had me undress from the waist down and get in to a gynecology-type chair.

First, she drained the balloon holding the catheter in place, then counted to three and tugged it out. There was a terrible sensation for all of five seconds or so, but it quickly faded. Next, she reeled out the packing, which was apparently a very long single strip of gauze, wound back and forth. Fortunately, this made it pretty easy (if time consuming) to remove without any pain. Once both were out, I immediately felt a lot better.

Next, Melissa showed me how to dilate. I had forgotten my dilators at the room, so she showed us with one she had in the office. She applied lubricant and anti-bacterial gel, then slowly and carefully inserted it. It was strange and uncomfortable, but not exactly painful. Then she removed it and had me try. It was a little tough getting the angle right, but Melissa was patient, and after a slight struggle I managed. Normally, I'll have to keep the dilator in place for 15 minutes at a time, but this time she had me remove it right away, told me to swap lower nakedness for upper nakedness, and left the room to get Dr. Beck (my breast augmentation surgeon).

I forgot to mention in my last post, but we've actually been a little nervous and frustrated with regards to Dr. Beck, because he didn't visit at all while we were in the hospital. When he came in to the room, right away he started explaining that he'd had a personal emergency come up, something very major, and apologized profusely for not being able to see me sooner. Him bringing it up first made me feel loads better, and no harm, no foul, I suppose, since Dr. Bowers was keeping an eye on me.

Dr. Beck talked to me about maintenance and about having my stitches removed by a doc back home, then showed me some exercises to help keep the scar tissue around the implant from contracting. I'm really happy with the size, which is in the large B to small C range (just a little bigger than I was padding them to before), and they get softer and more shapely by the day. The stitches will hopefully be removed by the local doc that I'm seeing next week.

On Wednesday, the day after my follow-up, a friend who I game with online (but who I'd never met in person) offered to come visit! He and his fiancée offered to drive down from Berkeley, almost an hour away. I felt a little guilty, having them drive that far to hang out with people they'd never met, but he was very sweet and encouraging.

That morning, I managed to take a shower and wash my hair without feeling like I was going to pass out by the end, which was good progress. They arrived in the afternoon, and the four of us sat around in the hotel room chatting randomly for a couple of hours. It was surprisingly not awkward, thanks to both of them being very sociable and generally awesome people. As evening rolled around, we decided to go out to eat, and they suggested BJ's, a California-based chain with a location just 10 minutes away.

Erin has celiac disease, and can't eat wheat. Though we can usually find something for her to eat just about anywhere, we were pleasantly surprised to find out that BJ's has specific gluten-free options. The friends graciously drove, the restaurant service was good, and the food was delicious. Admittedly, I may have pushed myself a little too hard, which was compounded by our dessert taking far too long to arrive. Expending energy seems to turn my body in to a furnace right now, and by the end I was hot, sore, and exhausted. Still, it was worthwhile for me to get in some social interaction with such great people, and for Erin to relax with a couple of drinks and some yummy gluten-free pizza. It was also beneficial as a test-run for having to fly home just a few days later.

Around that time, I received a couple of Facebook messages from friends-of-friends saying that they'd read and appreciated this blog, which means a lot to me. Thanks to Google Analytics, I've always known that I have readers scattered around the world, but it was very heartening to hear such wonderful unsolicited encouragement. To anyone out there reading, please know that I keep this blog completely public on purpose, and that even if what I post seems somewhat personal, you are welcome to read and comment as long as it's not TMI for you. =)

On Saturday, we packed up and checked out of the hotel, then drove to the San Francisco airport. We'd called ahead and asked for wheelchair assistance, but I still had to walk and wheel a bag from the rental car drop-off to the luggage check. Thankfully, SFO has a cool tram system, and it wasn't that far, but I was still pretty tired by the time we got to the Delta desk.

I mentioned the wheelchair as soon as we got there, and I'm sure they could see that I was sweating and having a tough time, but for some reason they didn't offer any sort of extra assistance, or even seem empathetic at all, which made me kind of mad. They also didn't call for the wheelchair until we were done with everything, and then the lady who made the call disappeared, forcing the wheelchair assistant to search all over for her while we waited. >_<

After that, however, it was pretty smooth sailing. The wheelchair assistants and TSA people were very nice. The Delta agent at the gate let us board first, and even moved us to seats near the front of the plane, so we would be able to deplane much easier and faster. As we taxied out to the runway, I took two percocets and quickly zonked out. After sleeping most of the way to SLC, there was a wheelchair waiting for us on the jet bridge. Erin's oldest brother offered to pick us up, and even met us at the baggage claim, so I didn't have to drag the luggage any farther.

Being home has been nice, if nothing else because it's comforting and familiar. I was most excited about being able to play games on my nice computer, instead of the crappy lappy we brought. Sadly, sitting up at the keys for very long seems to put odd pressure on certain sutures, and has even caused a little extra bleeding, so I've been keeping the computer sessions short until I'm a little more secure in my healing progress.

The bruising is almost completely gone, and the swelling has gone down considerably. The sutures are healing nicely, but I'm still careful to baby them and apply Neosporin religiously. Most of the pain is going down slowly but steadily, and I'm taking about half the pain pills that I was when I first left the hospital. My breasts, on the other hand, seem to be getting a little more sore as time goes on and they realize what's been done to them. =P

For the past few days I've also been trying to get up and move around the house a little more, and my energy levels are much better than they were last week. Tomorrow, we're going to hang out with some friends and play DnD, which I'm excited about both because I've missed them, and because it's a comfortable atmosphere where I know I can relax.

Dilating is still strange, but getting less uncomfortable. Being unused to it at first made it tough to relax, and my muscles tensing up was causing a lot of the discomfort. It's also a little difficult getting the dilator under the pubic bone, since I wasn't blessed with the higher pelvis pubic arch that comes with teenage female puberty, but that's also getting easier as the tissues learn to accommodate.

For now, I have to dilate three times a day for 15 minutes at a time. After three months, I can go down to twice a day. After six months, once daily, and so on. I can picture myself getting really lazy about it in the future, but so far, I've managed to stay pretty regimented. Within the next few days I'm supposed to move up to the medium-sized dilator though, which is somewhat intimidating.

Dilators in three sizes: small, medium, and scary. Melissa actually had yet one larger size in the office, which thankfully wasn't provided to me.

Next week, I have a post-op checkup. As I mentioned a while back, my primary doctor wasn't sure if she would be comfortable checking out the healing, but I did manage to make an appointment with Dr. Luikenaar for Friday the 16th, and I'm sure she'll do just fine.

I've still had very few doubts or major concerns, which is especially unusual for me and my overly analytical mind. Really, I'm just happy to feel like my body looks normal. I wouldn't mind losing a few pounds, but I think once things heal, I may even be semi-comfortable in a swimsuit for the first time in my life, which is incredibly exciting. Most of all, I'm grateful to finally look in the mirror and be able to say with confidence that I see me looking back. =)

6 Days Post-Op - Back at the Hotel

"I'm taking her home with me,
All dressed in white;
She's got everything I need,
Some pills in a little cup."

 -- A Perfect Circle, The Nurse Who Loved Me

I've been out of the hospital for three days now (since Saturday)! =D

On Friday, I was able to get up and walk around a bit. I managed to make it to the door to my hospital room and back (with help of course). Moving around stretched sutures and hurt a bit, but mostly it was just exhausting. Those few steps made me feel as though I'd run a mile. Later I tried again and made it out the door and down the hall a bit before returning. Baby steps!

Erin loaned me a small mirror, and I got a better look at the new parts. The brusing is surprisingly minor. I've seen pictures of people covered in bruises from thigh to thigh, but in my case I've just got some light patchy bruises on each thigh, and some bruising and swelling on my left outer labia.

Of course, the sutures look a bit ugly at the moment, but even the nurses were complimenting them, saying that they would heal very nicely and with very little scarring. Dr. Bowers was even asking me to send her pictures once everything's healed, so she can use my results as an example on her website. =D

After a couple of days, the drain slowed down considerably, but also started to sting pretty badly. Thankfully, on Saturday morning Dr. Bowers came in to remove it. She snipped the stitch holding it in place and slid it out. I was surprised at how long it was; apparently it had been curved up and around through both outer labia.

There were one or two nurses that we really disliked, but most of them were great. Our definite favorite was a woman named Pat. She was sweet, thorough, and genuinely invested in my well-being, but never sugar-coated things, and also took the time to make sure Erin was fed and comfortable, which helped Erin to help take care of me. We made sure to give her a hug before we left. =) 

I had thought that they would take the catheter and/or packing out before I left the hospital, but it turns out that both have to stay in until my followup appointment on Tuesday. >_<

We checked out of the hospital and headed back to the hotel Saturday afternoon. Erin helped me get dressed and gathered, then went to get the car while and one of the nurses loaded me in to a wheelchair.

The nurse wheeled me down to the front door, then helped me carefully transfer to the car, and on to the donut-shaped pillow we brought. The car ride was painful, but short, and Erin was careful to avoid jerks and bumps wherever she could. Our hotel has a parking lot in the basement, with spaces very close the elevator. The room is also pretty close to the elevator, only a few doors away, so the walk to the room was manageable.

Since we got back I've basically just been lying in bed, working through the Netflix instant queue with Erin (Memento, The Producers, Howl's Moving Castle), and playing PS3, DS, and Android games (PixelJunk Shooter, God of War II, Dungeon Siege III, New Super Mario Bros., Advance Wars: Days of Ruin, Words With Friends, Hanging With Friends, yesI'magameaddictshhhh!), while Erin reads manga online. Honestly it's been a lot like being at home, except that my lappy sucks too much to play DotA 2 or SW:ToR. Thank goodness for a room with free and decent internet access. =D

Overall it's pretty easy to stay happy and entertained, though we do both get a little stir-crazy. Erin makes almost-daily trips to Safeway or CVS pharmacy to pick up food and sundry useful supplies. I honestly don't know how I'd manage without her. She's been so amazing, doling out my meds, helping me get up and down, getting/making food, keeping me company. She's been like a super-nurse, except her shift never ends, which I feel bad about. She's too sweet for her own good; sometimes I can tell she's getting a little frazzled, and I have to remind her to slow down and take care of herself for a little while.

In the hospital, the nurses were keeping me clean-ish with washcloths, but after a couple of days at the hotel I was feeling pretty disgusting and decided to try a shower. Erin managed to wash my hair, while I spent most of my energy trying to balance and just generally rinse off. Unfortunately I pushed myself a little too hard, and ended up feeling a pretty faint and dizzy by the end. Still, after sitting down and recovering for a few minutes, it felt amazing to finally be clean again.

I'm still taking percocets for pain, which seem to be helping more and more as the pain from the stitches decreases. I still get random stinging from sutures, and strange zaps as nerves slowly re-establish themselves, but I swear that most of the pain at this point is from the catheter and packing. The packing causes lots of pressure, which is constant, but gets much worse if I try to sit up for any period of time.

The catheter doesn't help in the pressure department, and though I've gotten a little more used to the always-have-to-pee feeling, I don't think my body has. If I'm off the percocets for too long, everything gets generally tense and very uncomfortable in that area. The tubing has also gotten kinked once or twice,  before I figured out how best to situate it, and each time it has taken a bit to even figure out what was causing the extra pain.

My breasts have gotten slightly softer as the skin stretches, but they still have a long way to go. The stitches (in the creases underneath) get itchy from time to time, which is a good sign, and other than some minor aching here and there, they've been relatively pain-free.

Later today, we'll be going back to Dr. Bowers' office for the follow-up, and removal of the packing and catheter. I seriously can't wait, as I think these will ease my discomfort by a lot, but I'm also pretty nervous, because it means the start of dilating.

For a while, my body will see the new configuration as semi-foreign (like a piercing), and try to close things up. Among my bag of clothes from the hospital, we discovered my very own set of dilators (smooth medical-grade dildos is honestly the best descriptor =P), which I'll have to use routinely for a few months to keep things from collapsing. I suppose it can't be much worse than this damn packing, though. >_<

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.

Updates on Electrolysis, Surgery Prep, and the HRC CEI

"Easy now, hush, love, hush;
Don't distress yourself, what's your rush?
Keep your thoughts nice and lush;
Wait.
Hush, love, hush, think it through;
Once it bubbles, then, what's to do?
Watch it close, let it brew;
Wait."

-- Wait, Helena Bonham Carter as Mrs. Lovett (Stephen Sondheim's Sweeney Todd)

The updates are slow(er than usual), because life is simple and relatively routine. That's probably a good thing.

Another two hours of electrolysis down. I've started doing sessions every two weeks, instead of one, to allow some time for the dormant hair to cycle back in. We're still doing about 30m at the beginning of each session to re-clear my face, and the rest of the time on the lower area. So far I've logged just under 5 hours on my face, and about 6 hours down below. My electrologist still leaves the room while I change in to the towel skirt thingy, but it seems like a silly ritual at this point. All other pretense is gone, and she doesn't even pretend to keep me covered any more. =P

My insurance won't cover a physician checkup until August, so I'm still managing the pain with just an Ibuprofen or two, but I'm considering calling to ask if my doc will prescribe some EMLA (numbing cream) over the phone. Some electrolysis sessions, I feel like I can take about anything, and I almost fall asleep while she's working. Other days, the pain consumes me, and I start getting visions of that one Fight Club scene ("I tried not to think of the words 'searing', and 'flesh'." "Stop it! This is your pain."). =P

Speaking of surgery prep, I've still got a lot to do in the next few months. Besides electrolysis, I need a psychological evaluation and two letters of recommendation from therapists (one being a PhD/MD), I need to get HIV testing, and I need to work with my endocrinologist regarding my pre- and post-op changes to my hormone regimen.

The most pressing of these is probably the letters. My primary therapist has agreed to write the first, but I'm having a hard time finding someone with a degree and familiarity with GID to write the second letter. I've been calling various people suggested by trans friends, with no luck so far. I'm sure I'll find someone to write it; it's just another thing I want to get out of the way. =)

As I mentioned before, my set SRS date is in February 2012, but I'm on a cancellation list for November. When I scheduled, there were a lot of personal advantages to having my surgery done in November, but those pros are slowly being overwhelmed by the possible advantages of waiting until the scheduled date in February.

The Human Rights Campaign (HRC), a major organization focused on the advocacy of BLTG rights (you've probably seen their bumper sticker logo: a blue square with a yellow "=" sign), releases a Corporate Equality Index each year. Basically, companies volunteer to send in a survey and information about their TGBL-related policies, and HRC scores each company on a 100-point scale. My employer has consistently gotten 100 points each year that they've participated (2009, 2010, and 2011).

As of 2012 however, HRC is changing the criteria by assigning 10 points for having trans-inclusive benefits-- health insurance that covers GID therapy, hormones, surgery, etc. Since my company seems pretty proud of their CEI rating, I've informed the powers-that-be that we are in danger of losing our 100, unless they add an inclusive insurance option by the end of this year. They definitely listened, but I probably won't find out what they've decided until around November. It's an off-chance, which is why we've been saving and planning for paying for it ourselves. But as the date approaches, waiting three more months for even a small possibility of saving twenty-thousand dollars is sounding more and more worthwhile.

We've also found out that Erin isn't eligible for family medical leave through her work until she's been there for a year, which will occur in January. She gets 40 hours of PTO a year, and at the moment, she has to save every minute of it to be able to go to Cali with me in November, which really isn't fair to her. Finally, waiting until February means the date is no longer uncertain, and gives us that much more time to settle the funds.

I was really looking forward to November, but logic dictates otherwise, and I think (hope) I can deal with waiting just a little longer.

By the way, if you want to see the CEI ratings, here are the 2011 results (ratings start on page 38):
http://www.hrc.org/documents/HRC-CEI-2011-Final.pdf

And a few previous years:
http://www.hrc.org/documents/HRC_Corporate_Equality_Index_2010.pdf
http://www.hrc.org/documents/HRC_Corporate_Equality_Index_2009.pdf
http://www.hrc.org/documents/HRC_Corporate_Equality_Index_2008.pdf

Does your company participate? What's their rating?

On Electrolysis and Saving Money

"Money, get away;
Get a good job with more pay and you're okay;
Money, it's a gas;
Grab that cash with both hands and make a stash."
-- Pink Floyd, Money

I had my third hour-long electrolysis session yesterday, and started genital electrolysis in prep for surgery.

The bits of remaining facial hair are being cleared faster and faster. The first session took about an hour, the second took 40 minutes, and this latest only took half an hour. Each time, everything that's visible is cleared, but since hair grows in stages, the dormant hairs have to be cleared in successive sessions. Still, it should take less and less time from here. After zapping my face, we used the remaining half-hour to do a test patch down below.

I was terrified. The pain worried me a little, but mostly I was nervous about the idea of it. I don't hate my body, but I'm not exactly comfortable with it, either. Fortunately, my electrologist has experience with doing genital electrolysis for trans women, which does help ease my mind a bit.

She gave me a fluffy skirt wrap with snaps on it, asked me to wrap it around my waist, then left the room. I followed her instructions, and she came back a few minutes later. She worked like a masseuse, using a towel and the skirt to cover everything except the spot she was working on. For some reason it seems easier to handle a little square patch being exposed. My anxiety went away pretty quickly, but starting the surgery-prep electrolysis also caused the reality of surgery to settle in a bit. After all, this is the first concrete step I've taken in getting ready for SRS.

For the pain, I've been taking ibuprofen before each session. It only dampens the stinging of each zap a little, but I think it keeps the pain from building up as my skin gets more and more tender, and that helps a lot. I'll probably look in to getting some EMLA, which is a topical numbing cream, though I'd need a prescription from my physician to get it.

The pain from the genital electrolysis was... different, and difficult to explain, but the patch she did was not nearly as painful or annoying as when she does my upper lip. Being able to talk and distract myself while she works makes it much easier on me as well; I have a hard time sitting still and quiet for very long. Unfortunately, pain-wise, the worst is probably yet to come.

Hopefully, it will only take around 10-20 hours to clear what I need for surgery. Most surgeons (including mine) do a follicle scraping of the skin graft between removing it and replacing it, but they can't get everything, so most also recommend clearing certain areas of hair before surgery. Personally, I'd rather be safe than sorry, since it can't really be cleared after surgery.

I've also been thinking more and more about cost recently. My electrologist charges $50 per hour, which is pretty average. I looked up how long it takes most trans women to completely clear their face of hair with electrolysis alone, and most sources say it takes about 200-300 hours (though some people manage it in 100, and some have taken 700+ hours). If we go with the low average and say 200 hours, that's around $10,000 on electrolysis.

I spent about $1,300 on laser. Even if clearing the remaining facial hairs with electrolysis takes 10 hours, I will have saved $8,000. Not to mention the 180 hours I got to spend doing anything other than enduring the pain of electrolysis. Even if it had only cleared 1/6th of my facial hair, I would've come out ahead.

There is a lot of heated (no pun intended) debate over the effectiveness of laser, and I know that it's not for everyone, and that it doesn't work well on every skin/hair-type. But for those who are good candidates, and who can find a good price, I think it's worth trying. Of course, take my advice with a grain of salt, as I think you should with any advice about hair removal. =)

Speaking of saving money, my surgery fund is coming along!

I crashed my car a couple of months ago, and the insurance company called it totaled and gave me a check. Since then, I've been carpooling with Erin, and I've been considering saving that money for surgery, but I don't think that's really feasible. I've made Erin late for work a few times, and her work is not very lenient with tardiness, not to mention the fact that her schedule may change at any time. The tension over sharing a ride is only mild right now, but another year of this would probably be a different story.

We've been expecting a tax return of a couple-thousand dollars for a few months now. I filed (our first joint return! =D ) back in February, but after a few weeks of not hearing anything, I got worried and called the IRS. The rep I spoke to said that due to my name change, there was a delay, and that we'd get a notice by mail if we needed to provide more information. Since then, I've been nervous about being audited, or that they'd reject it because we're both legally female, but I just checked my bank account and there was a deposit from the US Treasury. W00t!

Including the tax return, but not the insurance money, we have about $18,000 saved, with between six and nine months (six is if there's a cancellation in November) to bring that up to $22,000. Thinking of other things that money could go to is a little depressing, but it will be worth it, and I'm excited to think that we may actually be able to save up the money in time. =D

My First Electrolysis Session

"After all this has passed,
I still will remain;
After I've cried my last,
There'll be beauty from pain."
-- Superchick, Beauty From Pain

On Saturday I had my first electrolysis session.

Not. fun.

I haven't done much in the way of hair removal thus far, mostly because I've never been very hairy, even before hormones. The hair on my arms is pretty light, I've never had any back or chest hair to speak of, and I can deal with shaving my legs on the rare occasion that I actually wear a skirt.

I have, however, been getting laser hair removal on my face for almost two-and-a-half years now. It was actually the very first step I took towards physical transition, and I started just a couple of weeks after coming out to Erin. I wasn't sure at the time if I'd end up transitioning or not, but I knew that I hated my facial hair enough to get rid of it regardless.

I spent more on it than I probably should have, but on the plus side, they gave me a two year guarantee, so I've been going back once a month since then without paying anything more. Laser has eliminated 95% of the hair on my face, but there are a few hairs it just hasn't cleared. Still, I don't regret starting with laser versus electrolysis, because it has saved me a lot of time and pain, while costing about the same in the long run. Laser was also enough to get rid of the beard shadow on my face, which helped me dramatically in passing as female.

I've now started electrolysis for two main reasons, to clear up what's left on my face, and to start genital electrolysis in preparation for surgery. To put it simply, in sex reassignment surgery, some of the outside skin gets moved to become inside skin, and I need to get any hair removed from those areas before then.

Back when I started laser, I did a lot of research on the differences between laser and electrolysis. The only thing I learned with any certainty should probably be obvious: never trust an electrologist or laser tech to tell you which method works better. Both fields are chock-full of the kind of propaganda and superstition that's spread around so often, even the pros believe it. The truth, as far as I can tell, is that both methods work, and both have many pros and cons.

As far as effectiveness, laser is more like lobbing grenades, where electrolysis is more like sending in a sniper. The grenades are quicker and easier, but you have to be more careful not to damage the scenery, and there's a lot more luck involved. (Yes, I'm a dork, but it's a good metaphor. =P) Electrolysis also seems to be more dependent on the skill of the technician, for better or worse, while laser is more dependent on the area being treated, the skin type, and how dark the hair is.

Technically speaking, most laser hair removal devices don't actually involve any lasers, but use xenon flashbulbs, which flash high-intensity light at the skin. The skin itself lets most of the light pass through, but the hair's melanin (pigment) absorbs the light. The hair briefly heats up, effectively frying and killing the follicle around it. The hair is then left to eventually fall out on its own.

An average session of laser hair removal for me involves lying down, and being given goggles to protect my eyes from any errant flashes. They then spread clear goo on my face to keep the skin cool. Next, the tech dials in the intensity for my skin type and progress, and presses the small flasher part against my cheek. The machine beeps, I feel a sting, the tech moves the flasher gun about a centimeter, and then repeats.

The pain is semi-intense, but manageable, though I usually forget to breathe until they stop, and it always makes my eyes water when they go over my upper lip. Each monthly session only takes about 15 minutes. When they're finished, they clean the goo off my face, apply lotion, and give me an ice-pack to go. After each of the first few sessions, the room smelled like burning hair, and my face was red and tender for a couple of hours.

Electrolysis, on the other hand, uses a tiny needle-like electrode. The tech inserts the electrode in to each follicle, next to the hair, and zaps it at the root with an electrical current. They then grab the hair with tweezers and pluck it out.

At my first session on Saturday, my electrolysis tech began by joking about how every trans person she's talked to says that electrolysis is the worst part of transition, which got me nice and psyched. =P

She wore medical gloves, and glasses with little telescope-y magnifiers attached. She also dialed in the intensity, starting low to see what I could handle, then raising it a few times as she worked. Though I couldn't see exactly what she was doing, it seems like inserting the electrode stings, but is bearable, since it's being inserted where there's already an opening in the skin. The zapping and plucking hurts much worse. The pain was pretty manageable at first, but as she slowly moved across my face, my skin became more sore, and the stinging became more intense. The only things I can compare it to are laser hair removal, and getting a tattoo on my back, but it easily beats both.

My upper lip has the most hair left, mostly because the laser techs were afraid to zap too close to my lips. While the electrologist progressed across my upper lip, my eyes were watering like crazy; If you've ever plucked your nose hair, it's like that, but more hurty. Thankfully, Erin came with, and at this point I asked to hold her hand. I also had to ask the tech to stop a couple of times, so that I could sneeze and blow my nose.

The session lasted a little over an hour, and she cleared most of the remaining facial hair. Hair grows in cycles, with one set of follicles being dormant while another set grows, so I'll have to have my face done at least a couple more times to clear everything.

Once she was done, she had me hold a metal rod with a cord sticking out, and I started wondering why she wanted to electrocute me. She applied what smelled like VapoRub to my face, then pressed a metal roller to my skin, and I could feel a very mild current as she rolled it around. Apparently this is called cataphoresis or electrophoresis, which reduces redness by causing pores and blood vessels to constrict, and helps transfer medicinal substances into the tissue. Who knew?

She asked me not to touch my face or wear any makeup for a couple of days, to avoid infection. Most of the redness went away after a couple of hours, but my face was sore for the rest of the day, and there are still some tiny red spots and slightly tender areas four days later.

I definitely plan on taking some pain meds before my next appointment on the 18th. Since I normally avoid meds, they're pretty effective when I do take them. That should be enough to get me through the rest of my face work, but I don't know what to do for the genital electrolysis. Some people go as far as using numbing cream, or even local anesthesia. I'm really not looking forward to it. =/

After just one face-clearing session, I wouldn't say that electrolysis is the worst part of my transition, but we'll see if I feel differently about it after the surgery prep work. *knock on wood*

Video: Documenting my Voice(s)

"And if you're still within the sound of my voice, watching this video,
I just want you to know that it always made me rejoice,
Just to have you so near, there's a place for you here,
If you're still within the sound of my voice."
-- Linda Ronstadt, Still Within the Sound of my Voice

Video documentation, ZOMG!

I wanted to show the progress that I've made on my voice over the last year, and the only way to really do that is to record it, so voilà! Just a heads up, I switch in to my old voice-- or at least, as close as I can get to my old voice-- which may look/sound a little weird. ;)

Something else that really helped in figuring out my new voice is the fact that I've always done a lot of impressions. It took me about three months of reading and watching videos about the human voice to get the basics of it down, but about seven or eight months before I stopped having to think about my voice every time I spoke. I also took a vocal feminization class, which ended up not helping me in the slightest. These days, the new voice is habit; it's the way I talk when I wake up, and it's the voice my internal monologue uses. =)

Surgical Decisions and Scheduling

"I'm so much closer than,
I have ever known.
Wake up!
Better thank your lu-cky stars."
 -- Green Day, Waiting

I've decided on a surgeon, and scheduled my SRS! =D

After my last post debating the pros and cons of various surgeons, I couldn't get surgery off my brain. The more I mulled it over, the more I liked the idea of Dr. Bowers' "one stage" procedure, but I still had concerns.  I realized that the main reason I like Dr Meltzer is not just because he's good at what he does, but because I know he's good.

I've read tons of accounts from satisfied trans women who've had their surgeries performed by Meltzer; I've seen quite a few images of the great results he can provide; I've even read a step-by-step walk through of his procedure, complete with graphic images detailing every part of the surgery. So, I resolved to find just as much information on Bowers.

This last weekend, I read countless threads on around eight or nine different trans forums, I found newer pictures of surgeries Dr. Bowers had performed, and I even managed to find a video of her performing a MtF reassignment surgery. While everything I learned swayed me more and more towards Dr. Bowers, it was the video that did me in; the woman is a freaking artist. If you'd like to see it, I'll warn you that it's very graphic (NSFW), and not for the faint of heart, but you can find it here.

Yes, the video is scary, but I also find it fascinating; I love information. What amazes me the most from watching the video is how simple she makes the procedure look. Though I'm no expert, coming from what I do know, her procedure seems very straightforward and smooth. It also filled in some gaps in my knowledge of how she operates, and reassured me that her "one stage" technique is only subtly different from the standard. It's enough to make an aesthetic difference, without adding any extra healing burden.

On Monday morning, I called her office, and her staff informed me that I needed to fill out an application found on the website. I emailed the app back to them this morning, with a note asking to call me to arrange payment by phone for the $500 deposit. I was anxious, but I tried to continue my day, figuring it would take at least a day or two for them to call me back. Nope! Within an hour of sending the email, my phone rang, and a helpful woman named Robin worked out the deposit and scheduling with me.

My reserved surgery date is February 12th, 2012, but I'm on a cancellation list for November/December of 2011. She told me that they often have cancellations, and that they should be able to get me in this year. While November would be ideal, I can live with February if I have to, so either way, I'm set.

On a related note, thank you tons and tons to those who have donated to my surgery fund! Even a couple of dollars here and there adds up, and helps a lot! <3

I still have a bunch to do, including getting two letters of recommendation for surgery, having some electrolysis done, and working out the time off I'll need from work. I don't know if I can contain my anxiousness for nine months to a year, but I'm sure it will fly by faster than I can imagine. =)

Holidays, and Planning for Surgery

"Did you ever have to make up your mind,
Pick up on one and leave the other behind?
It's not often easy and not often kind;
Did you ever have to make up your mind?"
-- Lovin' Spoonful, Did You Ever Have to Make up Your Mind

Whooh! It's been a while. Shall we catch up? =D

The holidays came and went, and Erin and I kept Christmas small in order to save money for other things. I saw family, many of whom I only see at Christmas, and some of whom hadn't seen the new me yet. Quite a few people gave me that soul penetrating curious stare, as if reconciling it all in their heads just requires looking at and through me for a while. I can't say it really bugs me; it never feels malicious, just weird. =)

Quite a few other family members complemented me on my looks, including my mom, stepdad, aunts, and a few cousins. As someone with chronic self-esteem issues, I treasure every piece of unsolicited praise I get. More importantly, I think most of them have had time to adjust, and those that have just act normally now, which is nice.

So far this year has been pretty uneventful, except that I've been thinking about surgery lately. A lot. It feels like the concept is always looming over me, waiting to consume my thoughts whenever I have a free moment. As I wrote here, I plan to have the surgery eventually, it's just a matter of when. I know that I wouldn't have been ready six months ago, but each day that the thought has been left to marinate, I've become a little less afraid, and a little more anxious to just get it over with.

Marriage put even more urgency on it; I feel guilty for holding back our lives with this huge financial burden. Erin has said many times that she doesn't mind helping with this, but I know that the sooner it's done, the sooner we can start working towards other goals.

It's the money that complicates the timing the most at this point. I'm thinking (hoping?) that around November 2011 would be a good time in many ways. It's far enough out that I can hopefully book it, and can hopefully have the funds ready, but close enough to satisfy my wanting to have it done with already. Thanks to a court ruling almost exactly a year ago, SRS is considered a tax deductible medical expense, making the end-of-year timing even more beneficial. Of course, if I want to schedule it for then, I need to figure out if we'll have the money and who will be performing my surgery soon.

One good thing about insurance not covering surgery is that I'm free to choose any surgeon I can pay for, but deciding on a surgeon for something so life-altering is extremely difficult. Researching surgeons is frustrating at best. The internets have provided a lot more information than might have been had 20 years ago, but not nearly as much as you might think.

The major surgeons have websites with pages of text on things like aftercare, but never much detail on their technique. They'll post pictures of their best patient results, but these aren't always informative as a sampling, especially when they haven't posted new results since 2004. Talking to other trans women helps, but each person obviously only gets one reassignment surgery from one surgeon, so it's nearly impossible to compare things like sensation. It's also (understandably) a very private thing for many people, so it's tough to find a large enough sampling to feel like I really know a surgeon's work and range of outcomes.

My main concerns are good sensation, good aesthetics, and no complications. Since I'm big on informed decisions, I've only been considering the surgeons I can find the most information on. This also has a side effect of leaving me with the popular surgeons, who also have the most experience. So far, I've been focusing a handful of them: Toby Meltzer, Pierre Brassard, Suporn Watanyusakul, and Marci Bowers. These are all excellent surgeons, and I've seen pictures of good results from all of them. With the exception of Dr Suporn, they also use the same basic penile inversion technique, though everyone has their own subtle variations.

Dr Suporn works out of Thailand (Chon Buri), where more reassignment surgeries are performed each year than in any other country. As far as I can tell, his fee is around 500,000 Baht, which is about $16,000 US, but I would also have to pay for travel. His technique is well known for providing greater vaginal depth, which is something many trans women are concerned about. This seems to be a holdover from a time when the standard techniques didn't provide enough depth to have intercourse. Being a lesbian, depth is not really a priority for me. ;)

Traveling also comes with its own set of complications. If I went out of country, I'd likely stay there for about a month to recover. I would want Erin to come with, but bringing her would increase travel costs, and there's no way we can both take a month off of work. She could come home early, but she's scared of traveling alone (and I don't blame her). I've also spent a month in another country without her before, twice, and we both hated being apart for that long.

Dr Brassard works out of Montreal, Quebec, which would come with some of the same travel issues. From what I can find, his cost is around $18,000. I haven't done much in-depth research on him, mainly due to being put off by the travel concerns. Based on what I've seen, he uses more of the urethral mucosa than most, and I don't think I like what this does to the look of the final result.

Dr Bowers used to be in Trinidad, CO, but recently moved, and now works out of San Mateo, CA, about an 11 hour drive from SLC. I called her office for her cost, and it's about $22,500. Marci is a trans woman herself, and learned her technique from Dr Stanley Biber, though she has made many of her own modifications and improvements since taking over his practice when Biber retired in 2003.

While many surgeons recommend a "second stage" outpatient procedure called a labiaplasty at least three months after the initial surgery, mainly for cosmetic improvements, Marci is often touted as performing a "one stage" procedure. Labiaplasties cost around $4,000-$5,000 dollars, plus another trip to the surgeon, and more healing, so that's quite a savings, but some people still opt for a labiaplasty after SRS with Marci, and some people opt not to get one after SRS with "two stage" surgeons, so I don't know how much weight to put in this.

Dr Meltzer works out of Scottsdale, part of Phoenix, AZ, which is also about 11 hours from SLC. I emailed his office, and they quoted his current cost at about $25,000. Of all the result pics I've seen, his outcomes seem the most consistent and "clean", but I especially like the aesthetics of his results after the "second stage" labiaplasty. Though the labiaplasty could be performed any time down the road, this would obviously put my total cost much higher.

Overall I'm thinking it's between Meltzer or Bowers. Yes, they're the most expensive, but for good reason, and they're both close. Here's where I need your help.

If you're trans, do you have an opinion on any of these surgeons? If so, please tell me why you feel the way you do, good or bad. Also, does anyone have any other surgeons I should be considering? I've also briefly looked in to McGinn, Alter, and Reed.

And finally, I've got around $12,000 saved, and we should be able to save most of the rest by the end of the year, but every bit added will help us feel safer, less anxious, and more confident. I've set up a donation button on the right side of my profile, where people can send money to my cause. I personally hate asking for money, so please know that it is with a very humble heart that I ask for donations. This is a daunting cost for a newlywed couple; while I secretly hope donations can help us fill in the unknown gap, we will figure this out one way or another. If you donate anything at all, feel free to brag about it... or leave it anonymous if that's more your style.

Thank you, and I love you. <3

New Doc, New Meds, New Prescription Madness

"You kn-kn-know what I want!
Gimme more. Gimme more.
Pretty please, a prescription!"
-- Mindless Self Indulgence, Prescription

I usually avoid talking very specifically about my body, but this is pretty limiting in a transition blog. Physical changes are a huge part of my transition, and if any place should be safe to talk about them, it should be here... I just worry that I'll make other people uncomfortable. Since I've really got to stop worrying so much about other people, I'm just gonna give you a heads up: I will talk about my boobs. There, I've said it. Whether you know me or not, if you think you might be uncomfortable with me talking about anatomy, nobody will blame you for ducking out. =P

As usual, I've waited far too long to talk about what's going on in my life, and I've got quite a backlog, so let's catch up on hormones. =)

My first endocrinologist sucked, so about four months ago, a month before my hormone prescription ran out, I decided to look for a new doc. I had three goals in mind: find someone who cares, is in my insurance, and prescribes *progesterone. I got a big list of endos and ratings of said endos from various trans friends, then narrowed it down by insurance, and started making calls. The only one within my plan that was taking new patients however, was only accepting referrals from a primary care physician. The good news was that there was a PCP in the same office that works closely with the endo. The bad news? The physician was booked about a month out, and the endo three months. =/

*(Progesterone is a primarily female hormone often prescribed as part of both post-menopausal and transsexual hormone replacement, but many docs are afraid of it, because some synthetics have been known for nasty side-effects, and its full effects on development aren't well known. Progesterone is key in breast development, among other things, but there is still a lot of disagreement as to how much is gained, and which meds, if any, benefit trans-women the most. Part of the problem is that most of the data comes from post-menopausal women, and broad testing with trans-women is virtually non-existent.)

Since I wouldn't see the new endo for a while, I called my old doc to ask for an extension on my prescription, and she told me that she would grant it, but never followed up. Fortunately, my appointment with the new PCP was just a few days after my prescription expired.

The new physician was awesome! She listened, she answered, she genuinely cared. I know, weird, right? She even chatted with me excitedly about my (then) upcoming wedding, and gave me a three month extension to last until I could see the endo. About a month later, when I went through my legal name/gender change, she was also nice enough to write up a letter of recommendation for me to present to the judge.

When I finally saw my new endocrinologist, she was just as cool. She was extremely enthusiastic in getting to know me and explaining things to me in detail. Before I could even bring up the progesterone, she asked, "How's your breast growth?" I explained that I'd had some growth spurts in the beginning, but nothing much since then, and she immediately followed up with "We should get you on progesterone!" =D

Of course, there's always a hitch. To save myself from having to go in at different times for different prescriptions, I waited for my other two to run out before filling the progesterone. When I did, the pharmacy informed me that I could now get three months of the spironolactone and estradiol, but that my insurance would only let me get one month to start on the progesterone. That seemed reasonable, but when I got home, I realized that they only gave me half my normal dose of spiro. It turned out that the new endo had accidentally prescribed it wrong. =/

Unlike with my old endo though, I was actually able to get a hold of one of the new doctor's staff, and they immediately sent a correction. The pharmacy then told me that I should just take the spiro at the correct dosage, and that they'd get it corrected at the 45-day marker when my supply is gone.

Last night, I called in a refill on the progesterone, but when I picked it up, they said they only had enough for 5 days, and that they'll call me in the next few days when the rest is available. I also asked them about the spiro, and they told me that they'll probably just refill for three more months when I run out.

So now, even though I'm getting meds for three months at a time, I had to go in yesterday for the progesterone, I'll have to go back in a few days for more progesterone, then back in two weeks for the spiro, again 45 days later for the estradiol, and repeat. Despite my efforts, my three prescriptions will never be on the same schedule again. *sigh*

Anywho, I've now been on progesterone for one month, and I've definitely noticed a few effects. Like with my first hormone post, I'll just present the evidence, and let you decide what's unrelated/psychosomatic and what's not. =P

• My breasts have been tender and itchy almost constantly for the last month, which indicates growth to me. This is basically what it felt like off-and-on when I first started hormones. Their shape has also rounded out a bit, and they look more natural.
• I've noticed some skin changes, and the weirdest thing, the tattoo on my back sometimes "raises", and I can feel bumps where the lines are; when this happens, it's also itchy.
• My skin is a little more oily, and I've gotten a few more zits than usual.
• My anxiety is back, which is odd, because progesterone is supposed to be calming. Of course, this could easily be due to a lot of other things going on, too. =P

I really haven't experienced any extreme side effects so far; the acne is a little annoying, but hopefully that will fade after a few months, as it did when I first started on hormones. Otherwise, med-related things are going pretty hunky-dory, and still far better than when I had to deal with my old endo. =)