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.
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.
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 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?
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.