Later this month I'm scheduled to have a couple of procedures designed to alter my physical appearance as well as certain functions of my existing sexual characteristics. The goal of the surgeries is to make my body more in line with my desired gender.
A little personal (and general) background first:
If you're reading this, you already know I identify as transgender female - and if you've read my other posts discussing trans issues you might know I've been taking HRT (hormone replacement therapy) medication for a couple of years. The goal of HRT for transgender females is to suppress testosterone while adding estrogen (and sometimes other things like progesterone). My daily medications have prompted a number of desired changes, both emotionally (I now cry uncontrollably while watching the beginning of the movie 'Up') and physically (boobs). Ok, so those examples are a bit stereotypical - but it is difficult to convey the myriad of small and large changes that happen once your body's hormones are flipped around: body fat redistribution, hair growth changes, breast growth, increased empathy and emotional awareness, skin thinning and increased sensitivity, etc. Changes for transgender men are just as intense - although in a different direction. (Also testosterone, as part of trans male HRT generally has to be injected - and that sounds scary.) All that to say there are many, many changes that happen as a result of HRT.
But, ... (no, not butt - although that does get a bit bigger with trans female HRT [effects of fat redistribution])
However, ... (better word choice)
However, HRT can only take a trans person so far. HRT won't affect all a person's physical characteristics - with surgery being the only option for certain changes.
Statistically, few transgender people undergo some form of Gender Confirmation Surgery (GCS). These surgeries can also be called Sex Reassignment Surgery (SRS) or Gender Reassignment Surgery (GRS) or more (many terms exist). The exact statistics are a bit muddled - with various sources claiming between 25% and 33%. Part of the reason for this seems to be the difference between genital and non-genital surgeries. More trans people have 'top surgeries' such as breast enhancement (or reduction), and facial procedures (facial feminization surgery, chondrolaryngoplasty [tracheal shave]), while few trans people have 'bottom surgery' such as vaginoplasty or phalloplasty (creating a vagina or penis, respectively).
I should eventually sort through the sources and try to find more precise numbers. The truth is that not much of this kind of data has been collected. The 2020 US census won't even have questions about LGBT people (way to be progressive, America). Thus, we have one of my favorite (and perhaps only) quotations about statistics: "There are two kinds of statistics, the kind you look up, and the kind you make up." -Rex Stout
There are lots of reasons for the relatively low number of trans people who have surgeries - cost, risk, desire, practicality, etc. These are also valid reasons not to begin medically transitioning with HRT. This is a good place to remind everyone that choosing not to have surgery (or taking HRT) does in no way invalidate someone's identity as a transgender (or non-binary) person.
Ok, so finally we get to the details of my surgery!
(Hopefully I've thrown enough clinical terms and concepts out by this point so the reader is a bit dulled to the discussion of genitals and such. If not, prepare yourself.)
(Hopefully I've thrown enough clinical terms and concepts out by this point so the reader is a bit dulled to the discussion of genitals and such. If not, prepare yourself.)
I'm scheduled to have two procedures: the first is a component of 'bottom surgery' - a bilateral orchiectomy (with accompanying scrotectomy), and the second is a component of 'top surgery' - a chondrolaryngoplasty.
Let's break that down a bit - the medical terms are clinical to the point of being abstruse (much like that word - it means confusing). Ok, so the term orchiectomy means I'll be having my testicles removed (bilateral means both), and the scrotectomy means I'll be having much of the skin of the scrotum removed as well.
For you male readers, I hear you cringe. If it makes it any better, my wife and I use the term 'snip-snip' for convenience when discussing the procedure. (Yes, I know that makes it worse - heh.)
This procedure will essentially remove my body's ability to produce testosterone - making it possible for me to stop taking some of my HRT meds (spironolactone, an anti-androgen) while making the rest of my HRT meds (estrogen) more effective.
I haven't had a good night's sleep in two and a half years primarily due to the diuretic effects of the spironolactone. I can't tell you how much I'm looking forward to that. 'Oh, so now I can sleep through the night without having to get up and pee every three hours?? YES, OH MY GOD, YES PLEASE. THAT. YES.' (It really is that exciting.)
Obviously I won't be able to have children after this procedure. This is something that trans folks have to consider before surgery as well as before HRT (the meds can mess with a person's fertility). Many trans women choose to have some of their sperm frozen if they're not sure whether they'll want children in the future.
I will also finally be able to fit more comfortably into female clothing - as there is nothing worse than having your testicles squashed while trying to act elegant in a ball gown (no pun intended).
Since I'm discussing the 'bottom surgery' elements - I should mention that I have no immediate plans to have a vaginoplasty - I'll be keeping my penis (for now). The utility of being able to aim while I'm peeing is almost enough to overcome any dysphoria I might feel about the organ. (Public restrooms can be gross, right?) And I won't have to buy a 'Go Girl'.
The chondrolaryngoplasty (tracheal shave) is considered an element of facial feminization surgery - or 'top surgery'. This procedure is easier to explain, and involves shaving away some of the cartilage of the trachea (thyroid cartilage) in order to make it less obvious. 'Adam's apple' is another term used to identify the prominent bump. I've always had a fairly obvious one - and this procedure should make it less so (fingers crossed).
Ok, so now you know what's in my future (yes, I'm scared - more about that later).
There is more, of course, to all of this then just discussing what procedures I'm having. Simply getting to the point of having surgery scheduled involves a long complex process.... I discussed the difficulties of starting medical transition via HRT in another post, but I thought I'd give a greatly simplified timeline here.
I should note that many trans people have different roads to medical transition (HRT or surgery) - and I can only comment on my own experiences. (For example, some choose to have surgery outside the US - where the rules and protocols can be different.)
My timeline over the course of about three years:
1 - Long period of questioning / exploration
2 - Discover I'm transgender female
3 - Go to lots of doctor / therapist appointments
4 - Do a lot of paperwork
5 - Go see a specialist (endocrinologist)
6 - Begin medically transitioning via HRT
7 - Celebrate!
8 - Lots of specialist appointments while adjusting medications
9 - My body goes through changes from HRT (2nd puberty)
10 - Time goes by (12 month minimum on HRT before surgery can be an option)
11 - Decide to pursue some trans surgeries - lots of research
12 - Obtain referral to plastic surgeon who specializes in trans surgeries
13 - Find out what insurance company requirements are (for much-needed financial assistance)
14 - Go back for more therapist appointments
15 - Meet with surgeon for evaluation
16 - Meet with and obtain a letter from therapist stating surgery is a good idea (I'm oversimplifying what the letter involves)
17 - Meet with a SECOND therapist to obtain a second letter (because trans people can't be trusted to decide these things for themselves? meh)
18 - Do lots of paperwork
19 - Get pre-approval from insurance company (yay!)
20 - See surgeon again - schedule surgery
21 - Prepare for surgery
2 - Discover I'm transgender female
3 - Go to lots of doctor / therapist appointments
4 - Do a lot of paperwork
5 - Go see a specialist (endocrinologist)
6 - Begin medically transitioning via HRT
7 - Celebrate!
8 - Lots of specialist appointments while adjusting medications
9 - My body goes through changes from HRT (2nd puberty)
10 - Time goes by (12 month minimum on HRT before surgery can be an option)
11 - Decide to pursue some trans surgeries - lots of research
12 - Obtain referral to plastic surgeon who specializes in trans surgeries
13 - Find out what insurance company requirements are (for much-needed financial assistance)
14 - Go back for more therapist appointments
15 - Meet with surgeon for evaluation
16 - Meet with and obtain a letter from therapist stating surgery is a good idea (I'm oversimplifying what the letter involves)
17 - Meet with a SECOND therapist to obtain a second letter (because trans people can't be trusted to decide these things for themselves? meh)
18 - Do lots of paperwork
19 - Get pre-approval from insurance company (yay!)
20 - See surgeon again - schedule surgery
21 - Prepare for surgery
I didn't mention money much - but there were expenses (even with help from insurance) related to most of these steps. Without insurance the costs would be much, much higher. Lack of funds is one big reason some trans people are not able to transition medically. And remember, not all trans or non-binary people need or want to medically transition (I want to be careful not to over-generalize).
Recovery after surgery will take some time - lots of ice, gauze, bandaging, and compression shorts. I'll also have to go in for a post-op appointment when a piece of rubber left in for 'drainage' will be removed. I won't tell you where... ugh.
OK, I mentioned above I'd talk about being scared.
While my procedures are outpatient (4 hour estimated surgery time) - my therapists and surgeon all made a point of mentioning how death or complication is a possibility with any surgery. The risks are substantially higher for smokers or those with compromised immune systems. Smokers, specifically, are at a much higher risk of blood clots (especially when combined with trans female HRT meds). I'm not a smoker, thankfully - and no one seems to care about my alcohol consumption (on a related note - my alcohol tolerance has dropped substantially. Probably related to HRT. Worth it, though.)
I'd characterize my scared feelings as anxiety mixed with nervousness. (Read my recent post to learn about the increased anxiety I've experienced as a trans person.)
The reason I wrote this post is to educate others (trans and cis) about my experiences as they relate to medical transgender issues. There was also a more personal motivation - to help me deal with my feelings by discussing the procedures in a frank, forthright manner.
I'm still nervous - but I'm looking forward to writing the sequel to this post: 'Gender Confirmation Surgery and Me - Part Two (after)' - where I'll discuss how the surgery and recovery went.
That's all for now - I'll see you after the anesthesia wears off!
UPDATE: Check out Part Two to see how the surgery & recovery went!
-Lia
Contact Me
My Writings (Transgender Woodworker content)
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LiaZero.com (all my online content)
My Writings (Transgender Woodworker content)
Artfully Functional (my studio)
LiaZero.com (all my online content)