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.

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