Insurance approval

I know to most cisgender people this doesn’t sound significant but I just got word from my surgeon’s office today that I got insurance approval for gender confirmation surgery!

This is one of those things that should be a normal occurrence. But for trans people, we have had to fight so hard for generations to get these surgeries covered by insurance that it is still a big deal for us to have these basic rights. I remember not that long ago when my friends were going to Thailand because that’s the only way most people could afford to get surgery out of pocket. And because of that legacy, there are still so few surgeons in the US that even those of us in major cities like Seattle have to travel out of state and incur huge expenses to get these surgeries.

It’s also significant because of the amount of medical gatekeeping we have to endure to get there. I can’t think of a single procedure where a cis person has to get more than one letter of support. But most trans people require 3 letters from MDs, therapists, and PhD level psychiatrists to get this insurance approval.

For me, I got these letter last fall because I was told the surgeon was going to ask for insurance approval in late winter. But they waited too long to submit paperwork so I had to go get the letter updated because they needed to be within 6 months. Which meant that the first time around I got an insurance denial which was scary even though I knew why.

The point of this story is, if you have the authority to be a medical gatekeeper for a trans person, PLEASE make it as smooth as possible for them. There are a variety of reasons that trans people don’t want surgeries and shouldn’t need them to transition. But for those of us who do, we are usually overwhelmingly sure that this is what we want. So don’t make it harder for us than it needs to be. Trust us to be the experts on our own experiences. And if you get asked for a perfunctory piece of paper, just sign it.

41 days until surgery!

I’m down to less than 6 weeks before gender confirmation surgery and I’m so nervous! I’m not anxious about the surgery itself other than a natural concern about the rare complications. I’m nervous that something will happen between now and then to prevent me from getting the surgery. Because the idea of delaying it sounds like torture. When I did my consult a year ago, I was ready. And now I am wishing I had started the process sooner.

I’ve done literally everything I can do. I’ve bought medical supplies, collected comfortable clothing for the recovery, changed our original flight plans to a roadtrip, booked an accessible AirBnb, and even scheduled my pre-op bloodwork. But my brain can’t stop focusing on all the things that could go wrong.

What if there’s a new wave of COVID-19 cases now that we are re-opening businesses prematurely? What if I get sick right before surgery? What if I get down there and find out that the hair removal wasn’t sufficient because I missed 2 months due to COVID shutdowns? What if the doctor says that my weight is too much of a problem since I’ve put on 20 pounds in the last year?

The last one is the one I hate the most. I’m a very fat positive person and generally I don’t care about my weight. But last year I had a bad experience with Dr. Satterwhite when I consulted with him and he was hyper-focused on my high BMI. He claimed that if I gained any more weight it would be “unsafe” to do the procedure. Thankfully Dr. Wittenberg, the surgeon I ended up choosing, told me that they are more like guidelines for optimal results which I absolutely agree with, but my brain is still anxious about it. Fatphobia is one of the few remaining socially acceptable forms of overt discrimination.

In the end, there’s not much I can do about it. I know all the data about how fad diets don’t work and can cause more medical issues than they solve. And luckily the nutritionist/therapist I’m working with agrees and is helping me balance my food in a way that feels appropriate to me. But the voice of that fatphobic doctor still haunts me. I also wonder how many fat trans people he’s turned away and made believe that they can’t get surgery.

On a more positive note though, my job is being super supportive. They have hired new permanent and temporary staff to take on my workload while I’m gone with enough time to train them before I go. So now I know I can leave even in the midst of a busy period of running COVID research studies and know my work is in good hands.

Currently I am hoping to be able to return to at least part-time work after 6 weeks which is the minimum time my surgeon recommends. Since we are completely online now it should be more accessible. But there is a potential that I may need the full 12 weeks before I’m lucid and off pain meds.

For housing I was lucky enough to find a basement apartment owned by a gay couple to rent that not only is ground floor but has a kitchen and even AC! It was very expensive at $3,400 but it’s centrally located in San Francisco so I can easily make it from the hospital and to my follow up appointments without sitting in traffic. I’ll be staying for a full month since I need to arrive 5 days prior to surgery for my pre-op and stay for 3 weeks after for post-op check ins before I’m cleared to travel. I’m really hoping that I can handle the 800 mile drive home without too much pain since I don’t feel very safe about airports right now.

I’m in the final countdown period and I am so excited! Thank you to all my friends who donated over $2,500 to make this happen. And I couldn’t do this without the support of my wonderful spouse who will be my caretaker after surgery. I guess you could say it takes a village to make a vagina.

Giving up Control

Today I realized an important component in my coming out journey that I haven’t talked about a lot here – giving up control.

Growing up I was very much a control freak. I liked to be the most knowledgeable person in the room. I was obsessively clean about my own space to the point that my mom could come into my room and move one object and I would know the moment I walked in. I abused my authority as the oldest child to control my siblings unfortunately. I also had my entire life planned out, both long term and short term.

I know where that behavior came from. It was a way to reclaim a sense of my own control in a life that was controlled by others and was also pretty chaotic. My parents were very controlling of us in many ways with lots of rules and that was made worse by being in a fundamentalist cult that taught that as a moral imperative. They were also low-key hoarders and our house was always messy even if that was often hidden behind closed doors.

My first attempt to stop being controlling as an adult went horribly wrong. I tried to give up control by giving it to my ex-spouse who abused that authority and emotionally abused me. But in that relationship I learned pretty quickly that the only way to survive was to give up the idea that I could control anything in my life.

The only sure thing in life is that there will always be unexpected things that you can’t plan for. And oftentimes those can be good things if you are open to them. Like a casual dating partner turning into a wonderfully supportive spouse once you get the courage to leave your abuser.

But that mindset about giving up control was also key to being able to come out as trans. Especially as a trans woman, it can be a shock to go from a position where you are subtly and sometimes overtly given societal power to a situation where you are suddenly one of the most marginalized and powerless. And if I hadn’t primed myself to be powerless, it would have been pretty freaky.

I think a lot of us are finding ourselves feeling powerless right now during this pandemic. Everything is chaotic and out of control and very few people (in the US) have planned for something like this. And that vulnerability and constant vigilance can bring out a lot of trauma responses from people who have been abused.

Being treated as a man when you know deep down that you aren’t is absolutely a form of trauma. Especially in a culture where toxic masculinity runs rampant. And that abuse becomes more clear when you come out and aren’t supported, whether by the people close to you or by society at large.

So if you are finding yourself in some very dark emotional places right now, please have patience with yourself. We can’t control this but that’s ok. It is only in giving up control that we can find peace and acceptance of the world around us. That is a journey that I am still on but telling myself that on a regular basis definitely helps so I hope it helps you too.

Boob update

2 years and 1 month into hormones and my boobs are still growing! At this point I’m solidly a C-cup but they are pretty conical and haven’t rounded out so I don’t really have cleavage yet. Other than the shape and distance from each other, this is about what I was hoping for. It makes me so happy to see them in the mirror or my peripheral vision!

For my fellow trans health nerds who are wondering, I started by ramping up to 6 mg of oral estrogen sublingually spaced throughout the day and eventually backed down to 4 mg where I am now. I never added spironolactone (an androgen blocker) because my testosterone disappeared and never came back. In February this year, my estradiol level was 139 pg/mL (cis woman range is 12-498 depending on cycle) and serum testosterone was only 13 ng/dL (cis woman range is 8-48).

Do Trans Women get Periods?

Do Trans Women get periods? Absolutely.

As someone who is on my period now, I can tell you that it is very real and it sucks. I am ready to burst into tears at a moments notice and I could definitely bite someone’s head off right now. I’ve been tracking my mood cycle lately to confirm that it actually does follow a monthly pattern and my app was spot on this month. And it is synced up with my nesting partner so I knew it was that time without even asking her.

Do we bleed? No. But if you try to point out how “lucky” we are are some BS like that, I will slap you. Because that is a really sore point for someone like me who wants nothing more than to be pregnant. But I also know that it is unlikely to be possible while I am still young enough to do it because while uterine transplants are absolutely medically possible, they are only given to cisgender women.

The period is mostly caused by being on estrogen but I have always been sensitive to monthly cycles. Years ago before I had admitted to myself that I was trans, I noticed that my mood cycles were related to where my partner was on her period. But now that I am on estrogen it is a whole lot more emphasized.

And in case you think I’m making it up, you should read what other trans girls say.

Barely surviving

I’m going to say some things that might sound scary but let me be absolutely clear that I have no plans to commit suicide or anything drastic like that.

 

I’m sick and tired of barely holding on to life. I’m exhausted from just surviving and it’s hard to see a path to a place where I’m thriving.

Now I know part of that is my seasonal depression talking. I’m on three meds now to try and control it but the best I have at the moment is “not as bad as it was.” I’ve tried messing with them but it’s a dangerous proposition when I’m in the midst of it. The last dosage change I tried put me at too high a risk for suicide for me to continue.

And part of that is the mental and physical exhaustion of being disabled. My back and neck always hurt and that background pain is draining. And then there are periods like the weekend I just had where a seemingly simple task like assembling and hanging a medicine cabinet puts me in 24 hours of acute pain. And it’s demoralizing to know that you can’t even do basic things anymore.

Another part of it is trying to exist in a world that wasn’t built for me. Our westernized society still doesn’t know how to be inclusive of trans folks even on the most basic level. Even queer community makes it hard to be recognized if you are outside the binary gender construct we all take for granted. And when you can fight for decades for the most basic human rights and have those stripped away in just one politician’s term, it’s pretty demoralizing.

But the biggest part of it is the dysphoria I have around how my body is gendered. I have been on hormones for 2 years now and it has helped a lot, but I still can’t look in the mirror most days and see myself looking back. I see a face that looks hopelessly masculine to me, and I hear a testosterone shaped voice come out of my body that can be fun to perform with but still feels like a form of drag to me.

I want so badly to be ok with the body I was given, but that’s not how dysphoria works. I can do all the body positivity building I want and all that helps with is my weight. There is still a misalignment of who I know I am, and the body that others see. I walk around daily in a shell that causes people to make assumptions about who I am. And even when those assumptions are right, it usually means they are focusing on the wrong things.

At this point I feel like I am just barely clinging on to hope that bottom surgery will alleviate enough of this feeling that I can relax even the tiniest bit. I don’t know for sure if it will, but I also don’t know if I could keep going if I don’t try. So for now, I survive.

First surgery prep laser

I had my first laser hair removal session on my genitals today to begin prepping for bottom surgery. I’ve been dreading it all week because it is so extremely painful when I do it on my face that I assumed it would be even worse on such a sensitive area. But I was pleasantly surprised. I don’t know if it’s because the numbing cream works better on the thinner skin (it did last longer), or because it is a wider dispersal laser head but it was a breeze and over really quickly. It honestly hurt a lot less than waxing or sugaring.

Turns out the worst part of laser down there is the shaving. It is a pain in the ass (literally) to try to get it all and the aesthetician stillĀ  had to clean it up. I recommend having a friend or partner help you shave. The other part that sucks is the insurance approval process which took me three months of pestering.

But session 1 is finally over. I have 6 more months of doing this every 6 weeks and hopefully it is enough for surgery. I’m also going to finish laser treatments on my face since I had to stop because it is expensive to pay out of pocket ($300 every 6 weeks). But the stubborn hair patches that have come back are giving me too much dysphoria to keep waiting.

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My skeptical face as I wait for the numbing cream to work

Captain Marvel Cosplay

Today I did something scary for me – cosplay at Geek Girl Con for the second time.

Last year I did Stevonnie from Steven Universe and I put a lot of work into my costume but ended up not feeling great about the photos because I really felt dysphoric about my ridiculous grin with braces. This year I wasn’t going to do one due to money and because I’m not feeling great about my body during transition most of the time. It’s also hard to do cosplay when you are larger and fat. Most out of the box things don’t fit well.

But 2 weeks ago I found the Captain Marvel jacket I’ve wanted since the movie came out on sale and decided to go all in. I found red boots, red gloves, patterned leggings, and even a matching shirt for when I needed to cool off. It took a lot of returns and online orders to find things that fit me but I managed to get it all together in time.

And I have to say, even though I’m not a big fan of all the photos, I felt much more confident in my outfit today. Captain Marvel / Carol Danvers is my personal hero. She is strong, fiercely feminist, and doesn’t give a fuck. And the best part is that she doesn’t smile a lot. So I don’t have to worry about braces in my photos.

There is not a lot of representation in media that I feel like I can cosplay. Until recently, I never saw people like me on film. Heroes with big thighs, jiggly bellies, and are tall and curvy. And even now there aren’t many queer, trans, or nonbinary characters available in geekdom. But that number is growing every year and I strongly believe in making a character your own. I don’t wear a wig because I want to be MY version, not an exact imitation of the actor.

I’m excited to go back tomorrow and continue to own Captain Marvel and walk around feeling confident in my leather jacket and stompy boots.

1 year without a beard

Today is the 1 year anniversary of me shaving off my beard. It was a big scary leap for me to give up something that had been such an important part of my identity for 12 years and accept that I would have to deal with more dysphoria for awhile as I dealt with the facial hair. But I’m so glad I did.

I’ve now had 5 sessions of laser hair removal on my face and spent over $2,000 in the process but all the pain, time, and money paid off because now I’ve gone a week without shaving and my face is still smooth! I have no more stubble or that dark shadow on my face and the amount of hair I have left to pluck isn’t any more than many cisgender women have to deal with.

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In other news, I’ve conquered two of my biggest fears around bathrooms so far. I’ve used a women’s room at a mall (with my spouse), and I’ve had a conversation with a coworker in the women’s room at work. Both things that I never would have felt safe doing with a beard.

This transition has been expensive and I’ve managed to make it this far with the help of my spouse but I still need to raise another $5,000 for my bottom surgery next year. If you are able to contribute I would really appreciate it. https://www.gofundme.com/f/haven-gender-confirmation-treatmentsĀ 

Feminizing my voice

Sometimes I feel like I’m taking two steps forward and one step back.

A few weeks ago I started taking lessons on how to feminize my voice from another trans woman. Because unlike with taking testosterone which lowers your voice, taking estrogen doesn’t bring it back up. Once your voice has dropped, it takes a lot of conscious effort to retrain your muscles not to use that lower range and resonance. Eventually it becomes a subconscious thing but it takes months of hard work.

I’ve been avoiding doing this for a long time, partly because I’m not interested in passing, but mostly because I knew that focusing on my voice would trigger a lot of dysphoria. The reason I finally started is because I’ve realized that a big part of my fear of using the women’s restroom is the fact that I don’t feel like I can safely talk without creating a ruckus. Having a more feminine voice would open up more doors and make it easier to move through the world.

Trans femmes in particular also face a lot of subtle transmisogynistic messages, even in trans community, about how “scary” or “aggressive” we are, often based on our size or voice. And we can often be targeted and excluded because of it.

I definitely right about it being triggering. Paying attention to my voice and having to listen to recordings of it is really hard for me. When I’m in choir, somehow it feels okay to hit the very bottom notes. It’s really fun actually to be all rumbly and resonant. But that’s partly because I’m blending with other voices and it feels like I’m intentionally putting on a vocal costume and performing my voice in a particular way.

But when I try to consciously listen to my voice outside of that context, it is just a painful reminder of that choice that most trans people face. Do I put a lot of work into trying to pass, knowing it will only ever be semi-successful, in order to be safer or more accepted? Or do I “just be myself” knowing that I will forever be experiencing transphobia everywhere I go?

For my voice lessons, I was asked to pay attention to the voices around me and how they use their resonance in their body and sinuses. And then I was supposed to imitate various extreme examples of those such as cartoon voices to learn how to move and use those vocal centers. Which is great in theory but it also means a lot of practice time where I have to sit with a lot of discomfort.

Today I made the hard decision to put those lessons on hold. I’ve realized that I don’t have the emotional capacity right now to push through that intense dysphoria to do the practice necessary to make it worth my teacher’s time. My work has been stressful and demanding now that I am doing 2 and a half people’s jobs during a hiring freeze. And I already have to fight so much dysphoria with my preparations for jaw surgery and bottom surgery. I feel like I just have so much work to put in to transition at the moment (and so many appointment) and something had to give. So for now the voice lessons go on hold.

Luckily my voice has subconsciously raised a little bit from where it used to be. I still use a more masculine resonance but I speak more in a tenor range with an effeminate touch than my singing voice as a second bass would suggest. I guess I’ll take the little wins for now and try to go back to ignoring my voice until I am past some of this other transition work.