My First GRS Consultations

Earlier this week, two of my friends had gender reassignment surgery (GRS) on the exact same day.  What are the odds?  While I am happy for them both, I cannot help but be jealous—and that says something about what I need in the future.

My primary transition-related focus this year has been on my voice and my face.  Near the beginning of the year, I began working with vocal therapists specializing in feminization.  Luckily for me, there were qualities in my voice that meant I did not need to do a large amount of work to consistently attain a typical female voice.  I have since had my last vocal therapy session, and while I still need to work on consistency, my voice is in a good place.  In August, I had my first-ever surgery:  facial feminization surgery (FFS).  While an infection put me back in the hospital for a second surgery at the end of September, my face is noticeably improved.  I am less dysphoric on both fronts.  In those terms, I have been successful in my goals for the year.

Now that I am misgendered less and have been comfortably living as myself for nearly two years, I cannot avoid  thinking ahead to bottom surgery.  The visible features of my body read woman enough to “pass” a sufficient amount of the time.  I am frequently called “ma’am” or “miss.”  (Personally, I love when my daughter calls me “Princess Mom,” but that’s special to her, of course.)  However, the public does not see is what is under my skirt—something I see on a daily basis, and it is bothering me more and more.

I have not written much about gender reassignment surgery (GRS) because my focus has been elsewhere, but the time is now.  With my friends recovering from their surgeries, it is difficult to just ignore what has been in the back of my mind for some time now.  Now that FFS and vocal therapy are effectively completed, it is the next thing I can do something about.  That’s not to say I have not been thinking about GRS.

Six months ago, two things happened:  (1) I had a GRS consult with a doctor required by insurance, and (2) I set up a consultation with Dr. Marci Bowers.

Consult #1

Because Dr. Bowers is local to me, I asked my primary care doctor for a referral to see Marci.  Why not, right?  She is considered one of the best doctors in the world for this procedure.  It is her specialty.  However, back in June, I was still covered by Medi-Cal.  They originally denied my request to see Dr. Bowers because another doctor in the network who performed GRS.  So, I was referred to that doctor.  Being a good patient, I gave that doctor a chance.  I went for the consult.

Unfortunately, it was one of the worst doctor’s appointments I have ever had.  The doctor informed me that she had never performed GRS, but was about to begin offering the surgery.  To help her, she was bringing in another doctor to assist—but due to confidentiality, she could not reveal the name of the assisting doctor on his request.  She was very cold in her answers, and because of her lack of experience, she could not answer basic questions on complication rates, revision rates, etc.  Even the numbers she gave me were in conflict with the research I had done on my own.  Near the end of the session I asked her, “If you were a patient in my position, who was talking to a doctor who had never performed the surgery and was bringing in a doctor whose name cannot be revealed…” At this point, she began shaking her head anticipating the rest of my question.  I finished it anyway:  “…why would you choose that doctor as your surgeon for this life-changing and complex surgery?”  Her response?  “I do not feel I need to sell myself as a doctor.”  She went on to say that as a public practice doctor, she was doing these surgeries for the patients, not to make lots of money like the specialist private practice doctors.

After a quick physical examination, I left the office very unimpressed and a little upset.  Honestly, I do not care if you are private or public, whether you are performing something complex like GRS or something similar to a gall bladder removal, if you are going to cut me open, you better sell yourself to me!  My doctor needs to be my advocate and want to be my doctor.  I am not a guinea pig!

I used the fact that I had gone to the insurance’s recommended doctor and the fact that there was no other “in network” doctor available to appeal the initial denial to see Dr. Bowers.  I appealed on the grounds that I had unresolved questions and had the right to a second opinion under my plan.  With no other in-network doctor available, I asked once again to see Dr. Bowers.  I won the appeal.  I scheduled an appointment, but her first opening was in December.  Sigh.

Consult #2

In the intervening wait, I have since transitioned from Medi-Cal to a Covered California exchange plan.  I was forced into this change due to income requirements, and I have done my best to make due—and pay premiums, co-pays, and the like.  What it also meant:  My appeal to Medi-Cal and my previous insurer was moot and in order to keep the consult with Dr. Bowers, I would need to pay her consultation fee up front and be reimbursed by insurance later.  I was on the verge of losing this long awaited appointment because of my financial situation when an angel stepped in and help me with the fee.  I am so thankful to her!

Finally, after six months (and a one week rescheduling delay), I finally met Dr. Marci Bowers this past week.  Even though a consultation is not required to get on her surgery calendar, I treated this experience like any other trip to the doctor.  Famous or not, I wanted to meet her and have me tell me what she could do for me that another doctor could not.  Sell me like Doctor #1 did not do.  And sell me she did.  She talked about her low complication rates, her successes with a one-stage surgery (instead of two), her amazing ability to provide patients with a 90% chance to achieve orgasm after surgery, and her ability to satisfactorily answer all of my questions.  While she is matter-of-fact, I can project that her bedside manner is sound, and she cares about her patients.

When I walked out of her office, I was content.  She clarified a few things for me.  I know that I want her as my GRS surgeon.  Not because she is famous.  I want her because she is experienced and offers everything I need.  Plus:  She is local.  I can go home after a few days and recover instead of being holed up at a hospital for an extended stay.

When asked by my wife how the consult went, I gave her kind of a puppy dog smile.  She told me I was giving her the same look she gave me when we went to see the kittens at PetSmart, and we walked out with an adopted kitten after dating for only six months.

The Logistics

The downside to choosing Marci Bowers is the queue.  Her wait list is now approaching four years, and now that Jazz Jennings has publicly selected Marci to be her GRS surgeon, the wait will likely skyrocket to closer to six years soon.  (Because I am local, I could be on her cancellation list, which could potentially cut my wait in half, but that’s still two years at the very best.)  If I were on Medi-Cal, I could jump through hoops and get on her calendar without paying a dime.  Now that I am on an exchange plan, I will need to fork up a $1,000 non-refundable deposit with my surgery application.  I certainly do not have that kind if money right now.  As it is, the basics of rent and credit cards are a balancing act.  How do I come up with that kind of money?

My wife believes I need to find a way to get back on to Medi-Cal.  The only way to do that is to reduce my income.  Clearly, that would be a problem, as our family needs every dime.  But what if we were not a family anymore?  That’s her take.  I feel like she is using the opportunity to suggest a separation or a divorce.  However, even bringing that topic up makes me cry, and that is just what I did when she made that proposal.  I am not ready to deal with everything a separation or a divorce entails, and it is not as simple as merely dividing our incomes.  To go down that road, we would need to talk custody of the kids, and I am in no mental position to have that conversation rushed in order to reduce my income to get onto a Medi-Cal plan.

A friend of mine has an alternate plan:  crowdfunding.  She has offered to set up a GoFundMe page to raise money for my deposit.  While I am at it, I could ask for money to pay for necessary electrolysis and my previous hospital stay.  This idea does intrigue me, but I also hesitate because I hate asking for money and assistance.  Feelings of bruised pride and guilt come to mind.  Also, to be effective, I would need to advertise my page, and the public nature of it all makes me a little wary.  What kind of position does it put my family in if I am actively begging for money in a public forum?

Now What?

GRS is the next step.  That is becoming clearer to me.  My friends recent surgeries will help me learn more about the recovery process firsthand, but in the end, this decision is a personal one, and my body is telling me that it is time.  I want this surgery sooner rather than later.  I could go with a lesser doctor and have surgery in a year or less, but if I want Marci, the reality is that I must wait four years (maybe two)—and that feels like an eternity!  Furthermore, the clock does not start until I either magically find $1,000 or find a way back to Medi-Cal.

I find myself facing another monumental decision that I must effectively make alone.  These kinds of major decisions have been weighing me down immensely.  I am so tired of having to do things on my own without much support.  My wife is excited that I got the consult with Marci, but she is also terrified of having to go through another surgery with me.  She wants to be apart from me but still be happy for me.  Who knows what the reality of the next two, three, fours years is?  How does one plan for the longer term when the short-term is such a question mark?  Do I crowdfund?  Do I wait for another insurance change?  Do I actively start considering a separation or divorce to see what the financial implications would be?  What about the children?

There are too many questions and not enough answers.  In that situation, it can be difficult to make any kind of decision and wallow in a depressive state.  I suffer from enough depressive thoughts; I do not need more.  But I need GRS, so I must find a way.

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The Paradoxical Roller Coaster of Wait

Over the last two months, I have felt like life has been moving quickly and slowly simultaneously.  I feel like I am racing towards a goal, and yet the wait is eternal.  I am both in control and not—at least emotionally.  A perfect storm of emotions is weighing heavily on my soul, but I cannot always identify what is causing the waves.  It’s like riding an out of control roller coaster.

After many two consults and some insurance wrangling, I was approved for facial feminization surgery (FFS) and now have an August date with a plastic surgeon.  I am nervously excited about this development.  Looking at my face each day is like flipping a coin.  Some days, I feel cute.  I see the authentic me with beautiful eyes, cheeks, and wavy hair that falls in front of my face.  Other days, I cannot help but focus on the squarish jaw line, the facial hair I still must shave and color-correct out with make-up everyday, and the nose.  OMG, the big nose.  I can appreciate the positive qualities of my face, but I focus so much on the remaining masculine features, it frustrates me and affects my mood.  I am not looking for a whole new face, but I am anxious to put it in the hands of a skilled plastic surgeon.  However, I have never had major surgery before.  I have never had to lie in a hospital bed attached to IVs while in pain, hoping for company, and eating bad Jell-O.  The idea of recovery is a scary one, but any fears I have regarding the logistics of surgery and recovery are easily eclipsed by my need for FFS, and thus I am excited.  Still, August seems so far away…

I have also begun the process of seeking consults for gender reassignment surgery (GRS).  Now 2 1/2 years into transition and over one year full-time, I am beginning to struggle with the anatomy between my legs.  For awhile, the idea of GRS has been a fleeting faraway thought—something I may or may not do in the future—but the need to make that change is becoming more relevant in my mind.  I am tired of tucking on a daily basis.  I am nervous on the rare occasions my young children share a public bathroom stall with me, as I fear I may need to answer uncomfortable questions.  And while I continue to be attracted to women, I cannot help imagine what penile penetration would feel like from the receiving end.  These thoughts are in my head more often than not these days.  With the added political pressure that my insurance could be jeopardized by a potential repeal of the Affordable Care Act, the time is ripe for me to begin seeking GRS.

My anatomy is not the sole focus plaguing my transition.  My voice has long been a sore point for me, no matter how much friends and family say I talk closer to an average woman these days.  For the last few months, I have been working with a vocal therapist who specifically works with me to train my voice to stay in the average feminine range.  She has confirmed that I do not actually have far to go; I just need to practice more to keep consistent.  Each of these appointments is affirming that I can one day full present as a woman without the need for extensive additional surgeries.  Woo hoo!

As I wait for FFS, move the needle on GRS, retrain my voice, and re-evaluate my hormone regimen (I keep my care team busy!), other things keep me both excited and on edge.  This year has been a roller coaster year, and I am only about a third of the way through it!

Work has been troublesome lately.  In the last few months, a new supervisor was hired into my equivalent position.  While we need the help, rumor had it that his starting pay was significantly higher than others at the same level.  This caused me great concern, as I already feel undervalued in my role.  After bringing my concerns up to management, an adjustment was made for me, but for the first time since I began working there, I feel like I am being low-balled and lied to.  The actions they took were not sufficient, and I now have to look at other options.  With all of my medical needs, I am fearful of changing jobs, but I also know that I cannot remain in an environment that is becoming more toxic.

Then there is the mater of dating.  I mentioned in my last post that I had begun thinking about dating and what relationships might be like since my wife has shown no indication she is reconsidering staying with me.  Recent experiences have opened my eyes to the difficulty I will face pursuing any relationship.  I feel an internal pressure to have more experiences and to test my limits.  I feel external pressure to push those limits a little faster and farther than I might be ready for.  And then there is the uncertainty of how actively dating others would affect that fragile balance my wife and I have formed.  My body and mind are being pulled in multiple directions, and I am alone to sort it all out for myself.  I have very few people to offer guidance in this department.  Is this what a 14-year-old girl would be going through if she had no one to talk to about her sexual feelings?  How would I know?

I feel focused and lost at the same time.  On the medical side, I have plans and a timeline.  The logistics of physical transition are taking shape.  On the emotional side, I am without direction and a destination.  The uncertainty, combined with the sheer quantity of things I juggle in the air on a daily basis, is overwhelming and stressful, and I cannot always identify which thing is causing that discomfort on any given day.

The twist and turns of this emotional roller coaster are unpredictable.  The track directly in front of me is visible, but I have no idea what is around the next curve.  Is it a corkscrew to upset my equilibrium?  A dark tunnel to cry in?  Am I about to drop uncontrollably 250 feet screaming the whole way?  I don’t know.  It’s all so complex.  The months feel like they are going quickly, but I do not feel like I am resolving enough to be happy and get all of the things off my plate that I need to deal with.  August really is not that far away, but it still feels like an eternity.  I love roller coasters, but this one is rough.  Everything and nothing is in my control.  Lots of highs.  Lots of lows.  Lots of twists and turns.  All just to hurry up and wait.  Such a paradox!  Such is life—an authentic life.

The Danish Girl

Anyone following me will know I am in a terrible state right now.  I am tired, stressed, and emotional.  Last night, I came home from a trying day (really, weekend) at work to my wife rushing out the door to party at the neighbor’s.  I collapsed on the bed and cried in my isolation.  I wrote last night’s post, then mindlessly watched some TV.  When my wife came home, she almost instantly went to bed without conversation.  There as no real opportunity to decompress with her, and it compounded my feelings of isolation I described yesterday.  Then, I decided to watch a movie, and what did I find?  The Danish Girl.

For those not in the know, The Danish Girl was released last year.  It is based on the true story of Lili Elbe, who was one of the first people to receive gender reassignment surgery (GRS) back in the 1930s.  The story details her transition and its affect on the relationship with her wife.  I had not seen the movie before.  I had always meant to get around to it.  I am not sure why I chose last night to watch it, but that is what happened.

The movie is not perfect and has its flaws, but it gets a lot of things right.  There were several moments that I could feel both Lili’s pain and that of her wife, Gerda.  Aside from the sexual aspect of Lili’s transition (which is practically non-existent in my life), there were so many things with which I could identify, especially when it came to Lili’s feelings and the obvious strain on their marriage.  Being married myself, I have experienced firsthand the devastation a transition causes.  The fights, the tension, the negotiating.  It’s all real and palpable, and watching the movie reminded me how real that struggle has been.  Like any transition story, mileage varies, and Lili’s transition does differ from mine in many ways.  However, the need to be one’s authentic self in spite of the severe and everlasting consequences cannot be understated.  Watching this movie was like being slapped in he face, a stark reminder of the reality of my situation.

I cried and cringed several times, and I bawled during the closing credits.  Waves of emotion crashed against me.  I could not help be reminded of the struggles of the last two years.  Further, the fears I have of the future were renewed.  Who will love me?  Who will accept me? What have I done to my kids, my wife, my family?  Will anyone remember me when I die?  If so, how will they remember me?  As a woman or something else?  My recent bouts of isolation and depression fed into these fears, and I lost it.  I must have cried for about 20 minutes, but really I have no idea.  It wasn’t like I was watching the clock at 2:30 in the morning.  A friend of mine happened to be awake, so I vented on her a bit, and then I fell asleep on the couch.  I woke up after sunrise and an hour before I was to take my son to school, so I stayed up and took a shower.  I took so long in the shower, that my wife ended up taking him to school, and I went to bed for a few hours.  When my daughter woke me up, I was still very sleepy and exhausted.  I continue to be.

I do not know why I decided to watch The Danish Girl on this particular night, but I did.  I am happy I got around to it, but no matter what I do and how much things improve over time, I cannot help but watch a movie like this and be reminded of all the uncertainty I still have yet to face.  I have overcome many hurdles, but there are several more landmines ahead, and just the the thought of them challenges my resolve and heightens my fears.  I feel like I am on the verge of mental breakdown, but no one asks how I am doing.  At least Lili found internal happiness even if cost her everything else.  My search continues, and who knows how much more pain myself and the people around me must suffer for me to find that peace.  Such a cruel trade-off.

Next Steps: Vocal Therapy(!) and Facial Surgery(?)

In my last post, I talked about some of the celebrations that should have happened, but did not:  my court date, my birthday, telling my story publicly for the first time.  It has been a busy summer, even though it does not really feel like it.  The sadness I have felt over the lack of celebration has been looming over me, especially as my wife helps plan two weddings and, a few weeks ago, a neighbor’s birthday.  Combined with the continuing dysphoria surrounding my face & voice and my family’s financial struggles, I have not been in the best of moods lately.  I am tired, lonely, and isolated.  But, as I said in my last post, I do trod on.

I finally received some good news this week.  My insurance has approved me (without a fight!) to begin specialized vocal therapy, so that I can begin to properly address my voice and work to make it sound more feminine.  That should be a great relief to me, but the excitement was muted by the fact that my first appointment will not be until December due to scheduling availability!  I will have to wait for this about as long as I had to wait for my court date to come, and that was tiring.  Hopefully, a cancellation will move me up the wait list.

On the face front, I am flummoxed.  I am beginning to struggle mightily when it comes to how my face looks.  I really long to restart electrolysis that I suspended in June due to financial stresses.  That means I have to shave every day and then work hard to conceal that shadow that remains.  It is exhausting.  I love make-up, but I would like to be able to walk out the door without it every once in awhile if I am in a hurry.  Doing so now would just make me look awkward.  Also, for the first time, I have really started to take some time to look at the potential for surgery.

Since the beginning of my transition over two years ago, I have put off the notion of surgeries.  I had soooooooo much other stuff to work through that the idea of any surgery was put out of my mind, as I deal with the here-and-now.  But as time passes and I settle into my life as woman, I begin to think about the future.  My facial dysphoria has put the idea of facial feminization surgery (FFS) as an attainable way to correct the masculine features of my face.  To that end, for the first time, I have begun to ask questions of friends, analyzed my face to project the kinds of work I need (and luckily don’t need), and even gone so far as to begin researching potential surgeons.  The latter may be a bit premature, but at the same time, I know consults and surgeries have long wait lists, and it could be to my advantage to start the ball rolling now.  However, I really want to resume and finish electrolysis.  FFS does not seem smart unless I have finished what I can do without it.  So many questions, and no money to do it.  The thoughts weigh me down and compound my frustration with myself.

And of course, opening the door to surgery discussions, cracks open the idea of potential gender reconstruction surgery (GRS) down the road.  I am not quite ready to start that process, but I definitely lean in that direction.  But as I have done all along, I try not to jump ahead too much.  One step at a time.  I don’t really consider GRS right now because there are more pressing needs.  I don’t really consider breast augmentation because my breasts are still growing, even if at a slower rate than I would like.  But FFS seems attainable with the right surgeon and the right timeline.  It is something I need to bring up to my family, too, and I really have no idea how to begin to introduce that topic.  Surgery is a big deal and a big step.  It requires doctor’s visits, consults, the procedure, and the post-op aftercare.  How much support can my family provide if I take this step?

I am markedly happier as a woman.  Now 7 1/2 months full-time, I am still secure this is how I was meant to live my life.  But until a few things change, I continue to be insecure of how I present to the world.  That change will not happen on its own, and I continue to look for ways to make those changes happen.  I just wish I had more of a support system behind me to encourage me on my journey. Maybe then, someone would celebrate me and my accomplishments.