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

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

The Biggest Decision I've Ever Made

"This is life,
What a f***ed up thing we do,

What a nightmare come true,

Or a playground if we choose,

And I choose."

 -- Offspring, I Choose

Transition has been one set of objectives after another... hair removal, various stages of coming out, therapy, hormones, bathroom issues, work. My life has turned in to a strange series of stepping stones, which I think the rest of the world calls "goals". I have no clue how "normal people" go about their lives like this; I have no idea how I've done it for the past year, but it has definitely improved things for me.

With the bulk of work transition successfully behind me, the next life steps I'm looking toward are marriage, and a legal name change, but I keep asking myself, "What's after that?"

I guess I don't know why there has to be a next step, but it feels like there should be, and I never really planned this far out. Suddenly the road forks in big ways, and I don't know which forks to take.

I hate decisions, especially big permanent decisions. When I was a kid, I came up with all sorts of rationalizations for why my decisions were not important, just to make it through the day without anxiety attacks. Some day I'll write several posts just about all the life "rules" that I came up with during my teenage years, and still use, but for now I'll spare you by sticking to the ones about decisions:

• If I can't decide between two or more options with a reasonable amount of information and time, then all options must be nearly equal, and I may as well just pick one.
• If time and space are infinite, then my decisions are infinitely unimportant.
• If a decision can be undone, and doesn't cause permanent harm, it's ok to try it just to try it.

Unfortunately, the decisions I need to make now are bigger than anything I've dealt with before. Especially with regards to "the" surgery. Rule C above doesn't apply, since it can't be undone. B isn't much comfort now that I'm emotionally invested in my own future (I know, what a weird concept, but it is surprisingly new to me). And A, well, it somehow doesn't seem appropriate to flip a coin or Rock-Paper-Scissors for this one.

Don't get me wrong; if Sexual Reassignment Surgery (SRS) were cheap, with safe and predictable results, I would do it in a heartbeat. Unfortunately, surgery is expensive (around $15,000-$20,000), and comes with many risks and possible complications. For a young and relatively healthy person such as myself, the risks are lessened, but extremely scary nonetheless. This is a major surgery, after all.

There's also the timing issue. Due to the Standards of Care, I can't have SRS until I've been living "in role" for at least a year. Shouldn't this make the decision less urgent? It would, except that $20,000 is not pocket change, and I've failed to save more than a few thousand in the last year. If I want to do this, I'm going to need to start saving aggressively, and even selling a lot of the nostalgic junk I've held on to over the years.

It would be nice if insurance covered any of the cost. The American Medical Association's House of Delegates passed several resolutions in 2008 asserting, among other things, that Gender Identity Disorder is a serious medical condition, that treatment is not "cosmetic" or "experimental" but is medically necessary, and that denying coverage is discriminatory. Most insurers however, go right on with their blanket policy exclusions, or statements that GID is a "pre-existing condition". Of course, I know that's not why most insurance companies don't cover GID. They don't cover it because they don't have to, even though its low prevalence means that paying these costs would likely be much less impacting to their bottom line than most seem to think.

Most reassignment surgeons are also booked anywhere from six months to a year out at any given time, which means I need to know whether or not I'll have all the money quite a while in advance of when I actually have the surgery.

I want the surgery. I know that it would make me feel a lot better about myself, despite the fact that it may only ever matter to me and one other person. In the end, I have to acknowledge that my fears are the biggest thing stopping me, and flying in the face of those fears has gotten me too far to stop now.

I decided a couple of weeks ago that I will definitely be getting the surgery, it's just a matter of when and how. As much as I hate to, I will probably eventually have to ask for some help. For now though, I'm going to see how far I can get on my own.

Telling Erin's Family

"Breathe, keep breathing,
Don't lose, your nerve.

Breathe, keep breathing,

I can't do this, alone."

 -- Radiohead, Exit Music (For a Film)

*sigh*

I've been meaning to write for quite a while, as usual. For the same reasons that I really want to write, it's also been hard to find the time.

Between coming out to Erin's dad two weeks ago, planning our wedding, voice classes, planning work transition, and hanging out with old and new friends and family more in the past three months than in the whole previous year, sometimes I'm surprised I find time to breathe. It's good, but it's scary; I'm not used to my life being like this, and I always feel like I'm forgetting something really obvious.

I like to be aware of things. As long as I'm aware of everything, especially my own faults, then I can correct them or decide not to feel stupid about them ahead of time. The current pressure makes me worry that I'm losing awareness of details, like I could have something horrible on my face all day, and not notice. *sigh* C'est la vie.

Where was I? Oh yeah-- Erin's dad and stepmom took the news really well! Erin really loves her dad, so I think keeping this secret has been hard on her. That she loves him is also exactly why we were afraid to tell him. I was so scared that he was going to take it badly, and that I would blame myself.

We went to visit them with the intent to get it over with. When we got there, we skirted around it for a while, trying to find the right situation, which never comes. Suddenly, they started searching around the internets, and saying they wanted to see our FaceySpace profiles.

Me: *sinking feeling, tugging on Erin's arm* "Say something!"
Erin: "So... we came here to tell you something... [my old name] is transgender."
Dad-in-Law: "Ok, so? Why does that matter?"
Me: "It doesn't really matter, but it was still important that we tell you."
Dad-in-Law: "That makes sense... Listen, I may not agree with it, but as long as Erin's ok with it, it's fine."

The "I may not agree with it" caveat is always weird, but that's for another time. With the way they were going after our FB profiles, I'm pretty sure they knew ahead of time. I find that parents are often more clever than their children give them credit for.

They asked a few questions about it, which is always a good sign of acceptance. With the air cleared, we decided to stay and play a few rounds of Rummikub. Erin slipped back into calling me "she," and by mid-game, her dad picked up on it and started using female pronouns as well. At one point, Erin left the table to use the restroom, and he told me "You know, you can call me Dad." =3

I'm surprised I didn't write about it before, but the rest of Erin's family has been similarly accepting. Her brother was one of the first people we told, and he was actually excited for me. We told her sister last summer, and her mom, stepdad, and other brother in December. The last three even took us out to dinner to celebrate our engagement.

I thought people were supposed to hate their in-laws? If this is a dream, please, don't pinch me.

Engaged!

"But there never seems to be enough time,
To do the things you want to do,
Once you find them.
I've looked around enough to know,
That you're the one I want to go
Through time with."
-- Jim Croce, Time in a Bottle

Today, Erin and I are officially engaged.

I haven't talked much about Erin here in the past, mostly because I didn't feel comfortable putting her on the spot. That sort of thinking is honestly silly, since she agreed without hesitation to stay with me through transition, and has never been ashamed of me. I just tend to feel like she doesn't know what she's gotten herself into, like I have to protect her from the prejudices of the real world, and sometimes I forget that all too often she's the one protecting me.

Four years ago, I saw Erin's profile on MySpace, and was attracted by three things: her gorgeous picture, her nerdiness, and the word "androgyny." I told our mutual friend that I thought Erin was cute, we began talking, and the rest is history.

I won't lie and say that we haven't fought from time to time, or that our relationship has never been rocky, but I believe one major thing has held it together: trust. I have never in my life felt as though I could trust another human as much as I trust her. She has integrity, of a type that I never thought I would find.

Erin was the first person I came out to, about 14 months ago, and though it was hard for her to accept at first, she has always supported me. We've talked about marriage many times over the last few years, but I have a major fear of permanence, and knew that we didn't communicate as well as we should. Over the last year, we've been forced to work together and support eachother in entirely new ways; out of necessity, our communication skills have grown, and we have become closer than ever.

With our relationship becoming stronger every day, I realized that the only excuse I had left was my fear. If there is one thing that my transition has taught me, it's that the things I'm most afraid of can also be the most worthwhile, as long as I'm willing to give them all the effort and energy they deserve.

This realization, along with the fact that we won't be able to legally marry after I change my legal gender, placed an urgency on the subject. A few weeks ago, we again started talking about marriage, about who would propose to who, about how we should go about it. Last week, we made plans to go to the jewelry store together. Later, I found out that Erin had been preparing a romantic proposal with a Ring Pop, to be replaced at a later date, and I almost wish she would have gone through with it; I would've bawled. ;)

Last Saturday, we picked out matching solitaire diamond rings, then held our breath for the next five days, as we waited for them to be assembled. Today, the rings were finally finished, and we "made it official."

As an aside, the person that helped us at Shane Co. was great. Being a transgender woman, in a "lesbian" relationship, with a low budget, and living in Salt Lake City can be a scary combination sometimes, but he was completely professional. He listened to what we wanted, he gave us options without trying to upsell us, and he never once acted like anything was abnormal or out of place.

The rings are beautiful, simple, and effective. The glint catches my eye from time to time, and makes me smile uncontrollably. We haven't set a date for the wedding yet, but we're discussing it, and it probably won't be that far off. Thanks to everyone who has congratulated us so far, it means a lot to have the support of so many friends and family!

Most of all, thanks Erin, for loving me unconditionally, and wanting to grow old with me as badly as I want to grow old with you.