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.

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.