Tag: Top Surgery

Reflections on Top Surgery, Part 3 : Post Surgery

Gender affirming chest masculinization “top surgery” is one of the major defining moments for trans men. But getting from your existing chest to the one you want to have can be overwhelming from both the information overload and emotional point of view. Having had surgery 3 years ago, I wanted to share my thoughts on surgery in case it may help someone else in the same position. I’ve created a 3 part series on surgery : Pre-surgery, surgery itself, and post- surgery.

This will be mainly from my personal experience as a mostly binary trans man, but could easily be applied to non-binary/GNC people.

If you haven’t read Part 1: Pre-surgery and Part 2: Surgery, start there. To recap: I had a phone consultation with a privately funded top surgeon in Ontario, who gave me a surgery date 6 weeks later. I had my surgery, had my bandages removed, but still had to wear a compressive binder for a couple more weeks.

Initial recovery

Right after the disaster of visiting the clinic for the last time, we went to a nearby mall for some fast food self care. I went into the food court bathroom which was the first public washroom since surgery and I automatically felt 100 times safer. I felt like I belonged. I didn’t feel like an imposter that everyone would automatically clock and tell me that I was in the wrong bathroom. This bathroom euphoria wouldn’t last (more on this in a future post and other bathroom shenanigans here) but for now it was an amazing experience and I couldn’t wait to use another public bathroom!

Our flight home was uneventful. I was nervously waiting for a security officer to ask why I was walking so stiffly, or wonder why I was covered in bandages but nothing happened.

Once home I had another week off before returning to work, but my energy levels did not bounce back as quickly as I had hoped. I ended up taking an additional week off.

In those couple of weeks after surgery I was mostly numb across my whole chest and down my sides. Showering was weird since I could feel the water near my neck and on my belly, but not in between. I was also getting weird prickly sensations across my chest and I would itch but it didn’t help at all. Meaghan Ray said it was my nerves starting to boot back up, so I rubbed a rough cloth across my chest to help my skin remember what sensation was all about and stop freaking out which seemed to help. This technique is called desensitization. Leave a comment or send us an email for more info.

I wore the binder all day and night, and applied polysporin to my incisions and nipples. Slowly they closed up and started healing with more normal skin tones. There was a point in healing where the scabs on my nipples started coming off in small pieces, and since the healed skin underneath was so much lighter, it looked like my nipples had fallen off entirely! It was terrifying until more of the scabs came off and I could see that my nipple was still intact.

Getting back to normal life

When I returned to work after being gone for 3 weeks, people were happy to see me, but for them not much had changed. It was like I had gone for a vacation and come back. It was very frustrating because I had spent a bunch of money to have body parts removed in order to “pass” and meet society’s expectations of what I should look like, but people still couldn’t use the proper pronouns. It felt like I had a big incision and T-rex arms for nothing. My euphoria and confidence slowly drained.

Once I stopped wearing the binder and started feeling the shirt directly against my skin, my confidence began to return. I didn’t care as much about being misgendered because I could feel how flat I was and it was awesome.

I wanted to minimize scarring so I massaged my scars with oil at least once a day for several months. I also didn’t raise my arms above shoulder height for 6+ months which made getting back to working out consistently a struggle. Everyone heals differently so it’s hard to tell if it made any difference but protecting my scars was the thing I had control over and it feels like I did the right thing for me.

Post op Depression

One experience specific to top surgery is having to keep your elbows at your sides for months which limits your use of your arms and therefore your independence. I was a bit angsty with how weak and dependent I was and I am prone to depression so the first couple weeks were a bit rough for me. But having the support of Meaghan Ray and seeing how excited they were for me helped me find that excitement for myself.

Many people experience post-op depression after top surgery. If you google “post op depression” the autofill option for “after top surgery” is only 4 options below. It happens after many surgeries due to some metabolic and physiological reasons as well as having time to yourself while you recover to ponder your life choices. It can especially happen after top surgery or other gender confirmation surgeries because there is usually a long buildup from when you are starting to wonder if you are trans, to finally getting a result in the mirror you are looking for, usually years later. You are looking forward to having the surgery completed, but then there is physical recovery, there is pain, maybe there are complications which feels like it robs you of the excitement you were expecting. And now that the surgery is completed, there is a sense of not having something to look forward to anymore.

Another aspect is that while your brain is telling you what you want, the actual experience of being unconscious for 2 hours and having something removed that you were carrying for 15+ years, makes part of your brain go haywire. Something is suddenly no longer there. And while you were mentally picturing what it would look and feel like, you didn’t know exactly what that would be like. So there is an adjustment period while your brain catches up. And having to wait while your brain straightens itself out makes you doubt that you have made the right decision.

While I definitely experienced all these types of thoughts, they didn’t cause a spiral into depression which I am grateful for.

Where I’m at now, 3 years later

I am still a little self conscious when taking off my shirt around others. 31 years of social training will take a little while to fight against. I have gone swimming in pools and the ocean with no shirt which was empowering. Looking down while showering is great. Doing skin to skin contact on my chest with my newborn kid was thrilling.

Once I did get back to working out and doing other activity, not having the wobble of my chest was amazing. One of the first things I noticed after that wobble was gone was the jiggle from my belly! It was a weird sensation but I quickly adjusted.

Every once in a while after I wake up in the morning my brain will remind me to grab a bra from my dresser, but then I laugh to myself when I go to open the drawer. T-shirts and button up shirts fit so much better now.

There was a point where I was wondering if I wanted a revision for what we affectionately call “the crinkle” in the middle of my chest between my scars. It would be free and the clinic was more than willing to set it up, but when it came time to booking the appointment I never followed through. I had started accepting what my chest looked like, and then grew to love it. It will never be a cis male chest since I am not a cis male, and that is ok.

Having a flat chest has greatly increased my general gender euphoria, and decreased my chest dysphoria down to nearly zero. My social dysphoria was also decreasing as my voice deepened and I grew a scraggly mustache. About 3 months after top surgery when I was healed a decent amount and not struggling with day to day activities I did notice a shift in dysphoria. The very blatant dysphoria of “you have breasts, everyone thinks you’re a girl” was pretty much gone, but my discomfort with my lower area (which I didn’t have much of before surgery) started ramping up to noticeable levels. This is also very common in trans guys – once the seemingly obvious problem gets dealt with, the focus moves to a more personal but just as glaring difference between what you were born with and what you should have.

As trans or GNC people, our dysphoria will likely never go completely away. There will be sudden surprising moments of “I wish my hands were a better size, they completely give me away as trans” or having to explain a different name on a credit application. But hopefully as time goes on, our gender euphoria and comfort with our bodies (surgically altered or not) will increase and those moments of dysphoria will be so much less devastating than they were at the beginning of transition. Having top surgery was life changing for me and provides so much gender euphoria armour against dysphoria frustrations, and I am grateful that I had the opportunity to pursue it.

I hope you found this 3 part series on top surgery helpful! If you are contemplating top surgery and have questions leave them in the comments below, or send an email to letstalkgenderpodcast@gmail.com.

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Reflections on Top Surgery, Part 2: Surgery

Gender affirming chest masculinization “top surgery” is one of the major defining moments for trans men. But getting from your existing chest to the one you want to have can be overwhelming from both the information overload and emotional point of view. Having had surgery 3 years ago, I wanted to share my thoughts on surgery in case it may help someone else in the same position. I’ve created a 3 part series on surgery : Pre-surgery, surgery itself, and post- surgery.

This will be mainly from my personal experience as a mostly binary trans man, but could easily be applied to non-binary/GNC people.

If you haven’t read Part 1: Pre-surgery, start there. To recap: I had a phone consultation with a privately funded top surgeon in Ontario, who gave me a surgery date 6 weeks later. I booked my time off from work as well as flights for me and my spouse, Meaghan Ray.

Last Minute Researching

While I had been looking at post-op trans guys for a while, and reading their stories of heading into surgery, suddenly it was going to be me in that position! I refocused my searches on what other people had found useful after surgery.

While there weren’t a lot of medical sites with information regarding top surgery for trans people, there was loads of information for people recovering from breast cancer surgery. Some of it was not quite relevant (what to do while waiting for breast reconstruction), but a lot of the advice on recovering from a long incision across your chest was useful.

The things I found most useful were button down pyjamas and shirts, as well as a neck pillow. Other items that seemed like they would be helpful but then I didn’t use were dry shampoo, body/baby wipes, and stool softeners (though I REALLY wish I had).

Arriving In Toronto

Since we were staying with family, we arrived a few days before surgery for a visit. Similar to when I was travelling for archery competitions, arriving and settling into a new location a little early allowed me to start mentally progressing towards acceptance and excitement.

I did some journaling at the time to help get rid of all the bees buzzing around in my head. I knew that I was super excited for the surgery, but there was now also the return of the anxiety of wondering if I had made the right choice. Everything I did was the last time before having a flat chest, and it felt important to remember those things, mundane as a lot of them were. “This is the last time I’ll be flying with a round chest” “This is the last time going to a cafe with a round chest”. So journaling helped with clearing my head a bit and helping me feel less chaotic.

Pre-op Appointment

The day before surgery I attended the clinic to see where it was, meet the surgeon face to face, and ask any last questions. The staff were great with pronouns, and the clinic seemed modern and clean. However, my appointment time was more than 2 hours behind schedule, and no one bothered to let me know. The only good thing about that is my anxiety completely burned itself out, and was only left with mild annoyance.

Meeting the surgeon was good, he was very respectful but clearly he had his method of doing the surgery and didn’t seem to be interested in what my desires were (similar to the surgeon back home). Despite those nagging worries, I was happy with the pictures I had seen of his results, and I was far too excited for a flat chest to let that slow me down. We drove the 90 minutes back home and settled in for a long evening of no sleep.

Day Of Surgery

Due to my sleep apnea they moved by appointment up to first thing in the morning. Once we arrived I changed into a gown and had the two clinic surgeons as well as a visiting surgeon draw the anatomical lines that would make sure everything ended up straight and proportional. It was a little awkward but clinical (“this is the last time a stranger will see my female chest”).

Everything happened fast after that. They got an IV started and I was off to the surgery suite, and next thing I knew I was waking up crying inconsolably with a pressure on my chest. I don’t know why I was crying, just that I couldn’t stop.

The surgeon came by briefly, but otherwise I felt very alone and disoriented. I was discharged fairly soon afterwards, but with fumbles from the staff leaving me unattended to have a panic attack in the bathroom, and while discharging me out a back door with minimum instructions. This left the experience feeling less than excellent.

Eventually we got back into the car and Meaghan Ray drove us home. According to them, I was frighteningly pale and very nauseous the whole way home but I don’t remember much of that. I do remember the neck pillow came in handy to keep the seatbelt off my new incisions.

First Couple Post-op Days

I was firmly ensconced in the bedroom for several days. The pain was manageable with medications, though I was fairly drowsy so I slept lots and watched lots of movies in bed.

My main complaint was the post-op compression binder used to keep the bandages tight to the incisions. My surgery included liposuction along my armpits and sides to prevent the dog ears that the Edmonton surgeon had mentioned. While that would allow for a more masculine appearance, those areas were not as numb as the incisions and were very tender against the binder. Meaghan Ray helped to modify the binder so that it would be more comfortable. I was told I would need to wear it for 4 weeks! Guess I would need to continue to deal with a binder even though I no longer had breasts. Argh.

Post-op Reveal

The day before flying home, I had a post-op appointment at the clinic where they would remove all the bandages and tapes. There are many videos on YouTube of transmen seeing their new chest for the first time where they elatedly collapse in happy tears and emotion.

My appointment was not like that. I mostly felt relieved to be free of the bandages, continued tiredness from recovery and pain medication, and a touch of feeling surreal. Luckily Meaghan Ray was there to capture the moment and feel excited for me, even if I couldn’t stir up those feelings very well.

Again we fell through the cracks while waiting to be fully discharged. We waited a respectable amount of time, and another 15 minutes on top of that. We finally had to sneak out into the hall where someone finally went “oh, I didn’t know you guys were still here!”

Everyone else who had surgery with this surgeon had nothing but good things to say about their experiences with this clinic, so it appears my experience was an anomaly. I believe most of their private pay clients stay at the hotel adjacent to the clinic so perhaps they were thrown off by me staying 90 minutes away?

I was (and still am) very happy with my results, though the experience itself was far from ideal.

Up Next

Now I got to take my new flat chest back home! I couldn’t wait to finally experience that gender euphoria around my friends, family and colleagues, when they would stop misgendering me since I now had a flat chest! Right?

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Reflections on Top Surgery, Part 1 : Pre-surgery

Gender affirming chest masculinization “top surgery” is one of the major defining moments for trans men. But getting from your existing chest to the one you want to have can be overwhelming from both the information overload and emotional point of view. Having had surgery 3 years ago, I wanted to share my thoughts on surgery in case it may help someone else in the same position. I’ve created a 3 part series on surgery : Pre-surgery, surgery itself, and post- surgery.

This will be mainly from my personal experience as a mostly binary trans man, but could easily be applied to non-binary/GNC people.

Deciding to pursue surgery

Wanting to pursue top surgery can come before wanting/deciding to transition and be a driving force towards wanting to transition. AKA your chest dysphoria is so strong that any other steps towards transition (hormones, coming out) are secondary.

Or like in my case, my social dysphoria was my driving force to transition, and once I had started the process for getting hormones and coming out, top surgery was my next urgent priority.

Applying for funding

In Canada there are two main paths to take in order to get top surgery – public and private.

The public funding model in Alberta involves being diagnosed with gender dysphoria by any psychiatrist who then submits for surgery funding on your behalf. When I was going through this process in 2017, there was one approved psychiatrist that had a long waiting list of his own. I was referred to the psychiatrist in September 2016, saw him in July of 2017, and I had a consultation with the surgeon in November 2017. At that time the waiting list for surgery was 1.5 – 2 years since dysphoria-eliminating surgery is not high on the list of priorities when those same surgeons are assisting cancer survivors.

In other provinces there are variations on how to go about getting funding, and the wait times vary.

Having to wait for surgery after coming out as male, attempting to “pass” as male with friends, family, colleagues, and strangers while still having a rounded chest was frustrating, tiring, and a safety risk. I decided to look into privately funded surgery.

In searching “top surgery in Canada” there was really only one option which was in Ontario, which was ok since my in-laws lived there. I submitted the documents the week after my consultation with the Alberta surgeon, and was set up for a phone consultation for March 2018.

Research while waiting

Part of my frustration with the Alberta surgeon besides the long wait time was that he didn’t seem interested in my goals for my chest. He asked me to take my shirt off, looked at me and told me what he would be doing. He told me that I would likely have a common complication called “dog-ears” where pockets of skin and fat remain along the sides, but also that Alberta wouldn’t cover the surgery to remove them, or the technique necessary to avoid creating them. So while I would have a drastically flatter chest, it would still be not quite ideal (in my eyes).

I started researching the different methods of masculinizing surgery and saw that the Ontario surgeon offered more than the one kind the Alberta surgeon offered me.

I spent lots of time on surgeon’s websites as well as different Facebook groups where I could see pre and post op chests and compare to what I thought I might want, and what my results were likely to be. In attending a PFLAG group in Edmonton I discovered that a couple other people had gone to the same Ontario surgeon and were happy with their decision. One person actually offered to show me their chest in person after the group which was great. I began to earnestly look forward to my consultation in March.

Private surgeon consultation

The consultation was similar to any other health professional, but since this surgeon was using the informed consent model as opposed to having mental health professionals vouch for me, I had to start at the beginning yet again and prove to another person that I was trans enough to get the surgery. Since this was a common occurrence at the beginning of my transition I had all the answers at the tip of my tongue, but it was still mentally exhausting. Its like the stress of a job interview every time, but instead of trying to land a job, you are trying to justify your ideas on why you are who you are. There are no certificates or diplomas, just defending the difference between your appearance and your thoughts.

While I had moderate chest dysphoria, I still felt like I had to exaggerate my feelings a bit in order to get the approval from the surgeon. What if he felt that I was a minor case and could wait? Maybe there were people out there who were suffering more than me.

I successfully “passed” that consultation and was given a surgery date for 6 weeks later! Suddenly I had to change from endlessly waiting to preparing for surgery.

Preparing for surgery

The physical components were easy to do and were a distraction from having to emotionally prepare for the surgery. I completed all the forms and bloodwork, submitted for time off from work and booked flights.

But when that was all completed, I had a relatively short amount of time to emotionally prepare. I had started questioning my identity in 2016 and had spent many hours in my own head up to that point, but admittedly I was fine with being stuck in the trans angst of “I have to wait so long, this sucks!”

Chest surgery was the next logical step for my happiness and safety, but I had a lot of conflicted feelings. My dysphoria was not overly bad. I enjoyed having nipple sensation. I was worried about surgery. I didn’t need to wear a binder very often. I was worried about what I was permanently doing to my body. In my anxiety I even started wondering if transitioning was the right thing to do. My therapist is highly regarded by many trans people in the city (read: long wait time) and I was not going to be able to see her before surgery.

To get through this mental hurdle I had to trick myself a little bit. I thought to myself “what would I say to someone in my exact circumstances?” “would I be jealous of someone else getting my 6 week date?” and “what would happen if I waited?”

The clinic did give me the option to postpone if I wanted, but after thinking about those questions, and endless talking about it with my spouse, I decided to go ahead with the surgery in 6 weeks.

Things I wish I had done differently to prepare

While I am happy with how things turned out, with the benefit of hindsight, I wish I had done a couple things differently.

I wish I had researched more surgeons – since I was paying out of pocket anyway, I could have chosen to go to a variety of surgeons.

I wish I had gone to see my therapist before going for surgery to try knock down some anxiety. Though I knew she had a long wait time, she always has space for emergencies. I didn’t even make a phone call to inquire, which I wish I had just mustered up some courage to ask for an appointment.

Up next

I’m getting on a plane heading to Ontario for surgery! The next post in this series is all about the few days prior, the surgery itself and the few days after.

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Let’s Talk Gender S1E8: Legal Transition

OVERVIEW

We start by talking about Meaghan Ray’s thoughts on top surgery because we didn’t have time in the previous episode. Then we talk about Jake’s process of changing his legal name and gender marker, Meaghan Ray’s role as his partner through that process, and Meaghan Ray’s thoughts on potentially changing their name and gender marker in the future.

This is the last episode in this series which has focused on the various stages of transition as we have experienced them so far. We will be taking a break and will return with a new series in the future.

SHOW NOTES

Meaghan Ray’s Thoughts on Top Surgery

  • Some NB people will get top surgery without testosterone, take testosterone but not have top surgery, or do both.
    • I have a harder time relating to the NBs that do both because I am genderfluid and have a significant female component to my gender
  • I don’t feel the need to wear a binder all the time
    • When I have top dysphoria it isn’t debilitating, just irritating
  • Having top surgery to have a flat chest doesn’t feel right for me at the moment but I would consider having a breast reduction
    • Enough that I wouldn’t need to wear a bra if I didn’t want to and could get the appearance of a flat chest fairly easily but could also wear a bra to have the appearance of breasts
  • Got lots of good info from a talk at the Trans Philly Wellness Conference on top surgery
    • To get a more NB look you can look at various factors separately to mix and match more female-typical and male-typical markers
      • Contour
      • Overhang
      • Nipple placement
      • Nipple size
      • Shape of scars
      • Placement of scars
    • If you know what look you want with relation to all these things you just have to find a surgeon who knows how to do it!

Jake’s Legal Transition

  • Jake started to live ‘full time’ in May 2017 which is when he also started HRT
  • Saw gender psychiatrist in July
    • Received generic form to certify that he is transitioning and said it would make sense to amend his sex on any ID
    • Also can be used to explain why he might look male when his ID still says female
    • This document counts as the ‘medical letter’ that was required to change provincial ID
      • No longer required!
  • Went into registries in August
    • Found out he had to get fingerprinting done to get his legal name change and needed to apply for a legal name change before
  • Got fingerprints done
  • Applied for legal name change in August
    • If he was born in Alberta, could have gotten birth certificate and marriage certificate done all at once but he wasn’t so the process was even more convoluted
    • Received certificate in the mail in October
    • Got a new driver’s license!
  • Had to apply for marriage certificate from Nova Scotia
    • Took two tries for them to get it right
  • Tried to submit for a new SIN card which eventually was returned saying that he needed to change his birth certificate first
  • Hardest part was birth certificate
    • New Brunswick hadn’t changed their laws yet – still required proof of ‘sex reassignment surgery’
    • Need an updated birth certificate to get updated passport
  • Was stuck in limbo with a drivers license that didn’t match his passport and a passport that didn’t match how he presented
    • Made it too unsafe for us to travel to the states and had to cancel a trip we had planned
  • Getting banking info was also convoluted and for some reason he still can’t order cheques without the wrong name coming up
  • His workplace wouldn’t update his name in their system until his SIN card had been changed (which required the birth certificate again)
  • Wrote a letter to an MLA in New Brunswick about how frustrated he was and how many problems this archaic law was causing (December 2017)
    • Heard back at the beginning of February that it was already in the works
    • They ended up emailing and calling him to tell him that the forms were up and how to apply
    • Was very lucky in his timing because if he had started any earlier he still would have waited for this law to change and would have spent even more time stuck with mismatched documents and old work ID
    • Finally got it back in March 2018
    • Allowed him to update his passport and SIN card which he received in May 2018 – one year after coming out
  • In the meantime, he had found a way around the issues at work
    • Concerns with payroll’s info not matching his banking info and a T4 being issued in the wrong name
    • Got in contact with an HR Diversity and Equity person who had all his work stuff changed over in two months (done in December 2017)
      • As random things kept coming up he would contact her again and she would fix it super quick
      • Had been out since May and had lots of co-workers wondering why they couldn’t find him in the system to send him an email and he kept having to tell them to look under the old name
        • Very long 8 months
  • Found several resources for recently married people with lists of documents you need to get changed once you change your name
    • Land title, mortgage documents, credit score, etc
    • Super helpful but often ran into problems where the forms or procedure for changing the document did not include either change of first name or change of gender marker
    • Felt like he had to tell his life story and out himself as trans in order to get the document changed (over and over)
  • Situations keep coming up
    • Recent election – two voter cards showed up, one under each name, tried to get it changed, just caused confusion
    • Now that he passes as male people are even more confused because they can’t compute that he ‘used to be a woman’
    • Still can’t order cheques at the bank – has given up on that one after going in person and calling on the phone many times
    • Had to contact the city because he was getting his old name coming up during a job application and in emails despite applying under his current name
      • Had a fast, positive response and got it fixed quickly
  • In general was he was burnt out and apprehensive from having to go back to the same places over and over, never knowing what response he would get, if he would get different info from the previous time
    • He was super strategic about which locations he went to and at what time of day because he knew it would take a while and didn’t want there to be a long line of other people behind him listening to him explain his life story
  • No overt transphobic experiences (hurray for Canada!)

Partner Experience During Legal Transition

  • Provided support and encouragement
  • Gave permission for him to take some time away from working through the long list
  • Would have gone with him as a buddy to all the various offices if our schedules allowed
    • Moral support
    • Safety
  • For parents: call ahead to medical offices to ensure they have the proper name and pronouns in their system before your kid arrives
    • Old information can keep popping up depending on when the last time was that you interacted with that particular medical office/hospital
  • Had to change Jake’s information on my benefits plan
    • The form had a list of reasons that did not include transition so I had to write it in
    • Did not have a space to indicate a change of gender marker
    • Had to call them multiple times to correct it as they returned various iterations

Meaghan Ray’s Plans for Legal Transition

  • Could change provincial documents to ‘Meaghan Ray’ and X
    • May do this some day but it’s a lot of work and not necessary for now
  • Could change national documents to ‘Meaghan Ray’ and X
    • Would be more dangerous to travel internationally to places that don’t recognize that as a gender marker
  • Potential incentive was to get it changed before having a kid because we can’t change parent’s names on your kid’s birth certificate
    • However, it’s only first and last names that appear on the birth certificate, no gender marker, and we can choose the parental labels that we use (mother, father, or parent for either or both of us)
  • So for now, the emotional cost of changing anything out-ways the benefit for me

This brings our series on transition to a close. We will be back sometime in the future with a new series and hopefully some guests! Stay tuned!

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Let’s Talk Gender S1E7: Medical Transition: Top Surgery

OVERVIEW

In this episode we talk about Jake’s path to top surgery and his experiences of the procedure and the recovery process. We also discuss the role of the partner and Meaghan Ray’s experience during each stage of this process.

SHOW NOTES

Jake’s Top Surgery Experience

  • Referral to gender psychiatrist September 2016
  • Saw gender psychiatrist July 2017
    • Referral to top surgery – likely a two month wait
    • No word, called back, finally heard from the surgeon two months later
  • Two surgeons in our area that rotate so one is taking consults then start working on the surgeries while the other one takes consults
    • Trans people are at the bottom of the list in terms of priority
    • A friend got in for a breast reduction after a year, Jake has been waiting two years and still hasn’t heard back from them
  • Initial consult was a fast twenty minute run through with minimal information
    • Didn’t know what questions to ask yet
    • Learned that he would likely end up with dog ears
    • Revision to get rid of dog ears is not covered by provincial health care
    • Liposuction to prevent dog ears was not covered or even discussed as an adjunct out of pocket
    • Offered double-incision method only
    • Left Jake feeling uncomfortable and frustrated
  • Started googling where else he could get surgery
    • Found McClean Clinic in Toronto where they do ‘Mascuplasty’ to create appearance of a male chest instead of just double mastectomy
      • Includes liposuction and revision
    • Called the clinic, filled out the application, and was put on the list for a phone consultation which happened 4 months later (8 months after original referral)
    • Likely wait was listed as 3-6 months after consultation
  • Phone consult in March 2018
    • Surgery is done under informed consent – don’t need a referral from psychologists or psychiatrists but instead have to pay out of pocket
    • Similar vetting process to the gender psychiatrist – what are your expectations for surgery, why do you feel you need this surgery, describe your dysphoria…
    • Feel like you have to explain how you feel in stereotypical ways in order to ‘qualify’ and get access to the medical treatment you need
  • Offered a date 6 weeks later!
    • Took a day to consider if this was what he wanted
    • Much less time to logistically and emotionally prepare
      • Good support from community, even people who had personal experience with the McClean Clinic who all had great experiences
      • One friend showed his results and provided a list that he had made of tips and tricks after his surgery
      • Did lots of research on facebook groups for trans guys and breast cancer survivors
  • Trip to Toronto for surgery!
    • Willing to pay for better results and less wait time
    • Able to stay with family
    • Second guessing at the last minute
      • Not a ton of physical dysphoria but lots of social dysphoria that was severely anxiety inducing especially in public washrooms
  • In-person consult the day before
    • Surgeon was 2 hrs late
    • Jake burned through all his anxiety during the long wait
    • Brief but thorough description of the surgery plan, results, and follow up
  • Day of surgery
    • Measurements and markings based on ratios
    • Awkward but done in a medical way
    • IV started
    • Went into surgery and came out crying for no reason
    • Very sore across the chest
      • Wearing a compression band over the bandages
    • Got up to the bathroom and was dropped off with no supervision, felt very panicky, light-headed and gross
    • Was rescued by a nurse who then asked about any history of anxiety
      • Maybe they should ask about this before surgery?
    • Eventually met up with MR and was escorted out to the back door in a wheelchair
      • Lots of difficulty finding the car, figuring out where they wanted him to be picked up, etc

Partner Experience of Top Surgery

  • Included in all the pre-op appointments
    • Helping remember information and nice to know what was going on
  • Day of surgery
    • Stayed for pre-op measurements etc
    • Kicked out when he went in for surgery
      • Told it would take about 2 hrs and they would phone when he was done
    • No word after 2 hrs so I checked in with the desk and was shooed away with no actual updated estimate
    • Waited another 45-60 mins with no word so I checked back in
      • They went to check with the nurses and this time gave me a spot to sit around the corner
        • Had all our winter gear and personal belongings and my entertainment to keep me occupied during the surgery piled around me
      • Eventually came back and told me he was just crying a bit and I could go back in a few minutes when he was feeling better
      • Would NOT let me go back to help him calm down/recover
        • Tried really hard not to get in the way but also mentioned that I am familiar with medical things and could probably help him
    • Eventually got to see him once he was back in the pre-op room (after the whole anxious bathroom experience)
      • Very pale, shaky, sweaty, nauseous and in pain
      • Got a wet cloth for his neck
      • Helped him eat crackers
  • Generally poor communication with me
  • Fiasco with getting him to the car was very frustrating
  • Drove home very carefully
    • He was already in lots of pain and getting very nauseous
    • Had to pull over a couple times to make sure he was doing ok
  • Got home, got him settled and took it easy for a few days

Jake’s Top Surgery Recovery

  • Returned to the clinic the next day to ensure everything was going ok
    • 15 minute appointment with lots of driving to get there and back
  • First few days were mostly sleeping, resting, watching movies, sleeping propped up
  • Became very itchy from the pain meds
  • Pain from the compression vest under his armpits where they had done liposuction
    • Sensation in areas of liposuction came back very quickly with lots of bruising
    • Tucked some towels over the edge to make it feel less sharp
    • Moved the vest down a bit and loosened it a bit
  • Went back for a follow up after 7 days where they took off all the bandages
    • Could already tell his chest was flatter but with no bandages or vest it felt very flat
    • Subdued reaction due to pain meds and that it matched his expectation so it didn’t feel surprising
    • Partner reaction was much stronger
      • Had spent so many months picturing him with a flat chest because that’s how he pictured himself that his chest area had blurred out and had become uncomfortable to really pay attention to
      • With the bandages off it was the first time that I could comfortably look at that part of him and have it look right
      • Also knew how awesome he would feel about it once his head was clear of the meds and he was feeling better
      • Took some pictures and video including the side view which was the greatest
  • Flew back to Alberta
  • Took an extra week off work in order to recover enough stamina
  • Was supposed to keep the compression vest on for 4 weeks but ended up taking it off after 3 because it was so uncomfortable to wear under work shirts
  • Kept nipple covers on to keep nipples moist
    • Nipples scabbed as they healed (normal)
      • Looked like two black nipples and felt like something was wrong (also very common)
    • Scabs started coming off and the nipple was so light that it looked like it wasn’t there but everything was fine
  • Sensation returned slowly
    • Lots of areas across the top of his chest that started to itch as sensation came back
    • Then down into armpit and across towards the nipples
    • Played games where we would test where his sensation had gotten to
    • Nipple sensation has returned part way, somewhat hypersensitive
    • One spot in the left incision where a nerve ending was exposed and caused serious stabbing pain each time it was touched
  • Traumatized by liposuction video
    • Makes sense why those areas were so numb
  • Scar care
    • Bio-oil
    • Scar massage
    • Really careful to not raise his arms
      • Found other ways to exercise by modifying activities to deal with the feeling of being cooped up
  • Mostly frustrated with the irritating symptoms as the sensation returned and changed constantly
    • Had to use numbing gel at times

Partner Experience During Recovery

  • Listen to what they are experiencing
  • Look up extra info such as scar care and desensitization strategies if needed
    • Your person is so irritated by those sensations and burntout from the whole experience
  • Had fun figuring out where the sensation had returned to
  • Helping out others in the community since

Looking Back On It

  • If you’re considering private options, take the time to look around, including international options
    • Worth pricing them out regardless of distance
    • Consider amount of post-op support from family/friends
    • Consider whether you will get the results you want and what medical follow up is offered
  • Most people have had positive experiences with McClean Clinic
    • Jake found a big difference between the high quality customer service at a distance vs less awesome experience in person

Next time: Legal Transition

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Interpersonal Dysphoria

After my husband decided to transition I slowly started picturing him the way he pictured himself: with a flat chest and facial hair. Seeing him with a female chest became uncomfortable. But I couldn’t really picture exactly what he would look like with a flat chest. So instead, this area of my mental image of him kind of blurred out.

In prep for his top surgery consult we had to take topless pictures for the surgeon and take measurements which was a very uncomfortable experience for both of us as neither of us pictured him with a female shaped chest at this point.

After surgery we went back to the clinic about a week later for removal of the bandages. It was a very interesting experience to see his chest flat for the first time. I was finally able to look at that part of his body and not have what I was seeing conflict with what he looked like in my head. Over time the blurry part where his chest was in my mental image cleared to match what his chest looks like now.

I have started describing this type of experience as Interpersonal Dysphoria. This is when your mental image of your friend/partner/family member has changed to match their newly affirmed gender but their physical body hasn’t changed yet.

Experiencing interpersonal dysphoria is a good sign!! It means you are ahead of the game and have adjusted your mental image to match your partner’s identity. But it still sucks because it makes you somewhat uncomfortable with how they look. If you never experience dysphoria for your own body this is as close as you are likely to come to knowing what it feels like.

The areas of their body that now seem ‘wrong’ to you are likely the areas that they experience dysphoria with. But making this assumption can cause problems. Are you comparing their body with a cis body of their ‘preferred’ gender? Or are you comparing their body to how they personally wish their body looked? These are two different scenarios. Comparing to a cis body can be dangerous because they may not have any problem with certain areas of their body. If you are comparing to a cis body you are assigning a gender to their body parts the same way society does which can lead to shame, disgust, and dysphoria or avoiding interacting with parts of their body that they are actually comfortable with.

To avoid this scenario you need to have open conversations with your person to learn how they feel about different parts of their body and why (or as open a conversation as is appropriate given your relationship to that person – coworker vs sibling vs partner). Give your partner room to think about these questions and change their mind at different times. Recognize that these conversations will cause a temporary increase in dysphoria just by having your partner focus on those body parts. You may want to break the conversation into small pieces and revisit it with recovery time in between. Build in self-care recovery time after each of these conversations for both of you.

If your person can articulate how they feel about their body and how they picture their ideal body that would match their identity, you should cultivate a mental image that matches. This will help you adjust to using a different name and different pronouns and help you unconsciously interact with them in more gender affirming ways.

If this person is your partner, this type of interpersonal dysphoria will also lead to changes in how you will be intimate with each other. If you haven’t already had conversations about what ways your partner is comfortable having you interact with their body and what they are comfortable doing with you, now is as good a time as any. Keep in mind this is a two-way street – the conversation should also include what you are comfortable doing with them and having them do to you.

As they explore their gender and gender expression and find ways to deal with dysphoria during intimacy and sex the boundaries of what each of you are comfortable with may overlap or not in various ways and may change over time. These are conversations that you should get used to having on a regular basis. I don’t want to go into full sex talk mode here so I’ll leave the rest up to your imagination. If these conversations are too difficult for you to have with your partner or your partner isn’t able or willing to engage with you in this discussion I recommend finding a couple’s therapist that is familiar with trans issues to help you out.

 

Have you experienced interpersonal dysphoria with your partner, friend, or family member? How did you navigate the conversations that needed to happen for you to know how they pictured their body? Leave a comment below with your experiences or questions!

My Husband’s Transition – A Partner’s Perspective (Part 3: Medical and Legal Transition)

The story began in Part 1: Exploration.

The story continued in Part 2: Social Transition.

And now, the conclusion.

Where do we start?

As soon as Jake knew he needed to transition we searched for any information about the medical process where we live. There was nothing online. The most reliable source of information came from Jake’s psychologist who is very involved with the trans community, including moderating a PFLAG group that we had been attending for several months. At this community support group we heard from others that were further along in their transition process how they had accessed medical care and got their legal documents changed.

Jake started by going to our family doctor who was allowed to prescribe hormones following a very clear algorithm in the WPATH guidelines but, having been to a seminar about the transition process ten years ago, our doctor felt like he knew the appropriate process (all referrals had to go through the psychiatrist) and refused to overstep his bounds. As you may have guessed, the medical management process has changed somewhat in those 10 years but very few family doctors are aware or feel competent enough to provide the treatment that trans people require. And although he was ‘aware of the correct procedure’ he didn’t know that the wait to see the psychiatrist was over a year long or believe us when we informed him of this repeatedly after talking to other trans people who had just gotten their first appointment and phoning the psychiatrist’s clinic.

Luckily, through the community, we learned of a family doctor who had prescribed Testosterone for another member of our group. Jake booked an appointment with him asap and was able to start T a week later. At the time I’m writing this Jake has been on T for 14 months.

Testosterone

The first change was his voice. He was starting a second puberty at the age of 30, complete with the cracking voice which led to much hilarity and some mild embarrassment. Until his voice had dropped enough to be more consistently recognized as male, I was the designated representative when interacting with strangers – ordering food, making phone calls, giving my name for contact info.

As his voice dropped mine started sounding higher by comparison to the point of sounding nasal and squeaky at times. I naturally found myself lowering my voice which in the end made me more comfortable due to my own gender identity (more on this in the posts from the ‘Personal’ category).

Jake then started growing facial hair, a sleazy mustache at first, then very slowly sideburns and a goatee. He got stronger, especially in the arms and shoulders. The slow nature of these changes gave me plenty of time to get used to them as they happened. I never had a moment of hesitation or question about whether I still found him attractive. The more his body changed the more confident and comfortable he became. Confidence is very attractive. My mental image of him had included a lower voice and facial hair for quite some time so as his physical body changed it simply fit my mental image more closely rather than being more and more at odds.

As he was read more as male this in turn made us read as a straight couple and put me squarely in the female category. All of this took away our visibility as a queer couple, something which we both continue to struggle with. It was also a trigger for my personal gender exploration – more on this here.

The struggle of Changing his ID

When it came to getting his documents changed Jake encountered too many barriers to list here. Forms that did not include options for his situation, systems that couldn’t accommodate a change in this information, customer service people who were not familiar with the process, conflicting answers that often required backup from unrelated documents that he was also struggling to get changed, all of which required a fee to be processed.

My personal experience with this was when I had to change his information on my health insurance through work. You can’t do this over the phone, you have to email them, they will send you the form, you fill out the form and fax it in, they will email you when it’s completed. The form has a section for changing your  dependent’s information and reasons why you need it to be changed including information is incorrect, marriage, divorce/separation, etc. There was no ‘transitioning’ category (which I wasn’t expecting) but there also wasn’t an ‘other – fill in the blank’ category. So I ticked off the ‘information incorrect’ and wrote beside it ‘transitioning from female to male’. When I got the email saying it had been processed I checked my account and found his name had been changed but he was still listed as female and ‘Mrs.’ So I emailed them back. A while later it got updated to Mrs. Jake, male. Another email, another wait, and eventually they got it right.

This whole time we weren’t sure what would happen if Jake tried to claim health expenses using his updated Alberta ID if his info in my account didn’t match. So he had been holding off on a couple of things until this went through. This was a needlessly frustrating process but still was much safer than many of the interactions he would go through to get ID changed – for example justifying himself in front of a line of waiting people to a clerk who then had to go get their manager to whom he had to explain himself again.

Getting his national documents changed was the biggest ordeal because he was born in New Brunswick, the one province or territory that had not yet passed legislature for people to change their gender marker on their birth certificates. And until your birth certificate is changed you can’t change your passport. And until your passport is changed it’s not safe to travel to a variety of places including the United States. So we had to cancel our planned vacation to go to Arizona in February at a time when we really could have used it.

Frustration levels rising

All I could do was try to support him, provide a sounding board for his frustration and provide positive outlets and distractions. Very few people could understand what this process was like. When voicing our frustration to others we would usually get the response of ‘oh yah, when I got married it was such a pain to change all my documents, it takes forever, but it’ll be done eventually’. Oh yah? Did the forms you had to fill out not have the option you needed to check off? Did the clerk never know how to process your request or require medical documents as proof? Did it take a huge amount of emotional resilience to walk into each office and out yourself every time? Just like coming out as gay and coming out as trans are not the same thing, changing your last name on all your documents after getting married or divorced and changing your first name and gender marker because you are transitioning is not the same thing. I know people were just trying to be supportive but the amount of educating we had to do to get people to understand the differences was exhausting.

The overall the frustration level rose considerably while he was on waitlists for surgery and endocrine, waiting for paperwork, and even waiting for laws to change so he could change his birth certificate. Frustration is a stagnant emotion that I learned leads to considerable burnout. Eventually I had to start paying more attention to my own mental health and I started a bullet journal including habit tracking, weekly debriefs which eventually lessened to monthly, daily journalling which tapered off quickly, and making sure I had emotional outlets that provided some sense of progress and connection with the queer community – for me this is creative writing and music. It took me five months of consistent personal work but I improved significantly and was pretty much back to normal.

Top Surgery

Jake had waited 4 months for his consult for top surgery with a local surgeon which would be covered by health care. The consult was not particularly encouraging, suggesting that he would likely need a revision a couple years later which would not be covered. It would also be 1.5-2+ years wait before he would be having surgery (because of the waitlist). So he had booked a consult with a private clinic in Toronto which he waited another 4 months for.

In prep for this consult we had to take topless pictures for the surgeon and take measurements which was a very uncomfortable experience for both of us as neither of us pictured him with a female shaped chest at this point. Any time he saw himself in a mirror it would cause dysphoria. My image of him had a blurred out section at his chest. Since he overheats easily and has asthma he couldn’t really wear a binder comfortably so instead he had been wearing baggier clothes and adopted a slightly hunched and rounded posture which was causing upper back and neck pain.

This consult went very well and, as it turned out, they had a cancellation and could do the surgery a month later. We had a brief scramble to make sure we could both get time off from work, see how much flights would cost, make sure my parents didn’t have other visitors staying at that time, and then confirm everything.

Just before leaving for top surgery he received his final national documents in the mail – a huge milestone and a huge relief for both of us.

Getting him through surgery

The days leading up to surgery were filled with excitement and nervousness. After the pre-op appointment the day before surgery this went to a whole other level and all I could do was help him manage anxiety about surgery and self-doubt about whether this was right for him or not.

While he was in surgery I waited and waited and waited. I checked in with the clinic at the time when they said he’d likely be done, was sent away, returned an hour later to be told he was in recovery but that they wouldn’t let me in. I came back 45 minutes later to be told he was a little teary but was doing ok (What does a bit teary even mean? Why was he teary? Wouldn’t I be the best person to support him if he was upset?). Not having access to him in recovery to help with the immediate symptoms was even more frustrating because I work in a hospital and I’m very familiar with how to deal with people who are coming out of anesthetic and dealing with post-op pain.

Half an hour later I finally got to see him. He was super pale, sweaty, and shaky. But even with the post-op binder on his chest was flat! I asked him about the tears. Turns out it was just an endorphin response when coming out of the anesthetic, not an emotional response to the surgery or his chest like they had made it seem. I helped him change out of the gown into his clothes, grateful that we had been told by friends to wear a button up shirt. Eventually he was feeling good enough to go home but they insisted on escorting him to the car in a wheelchair. As far as I’m concerned they’re either ready to release him or not but whatever. This caused more hassle than necessary because I had to go get the car and figure out how to get back to where they were waiting. I tried to stay calm because Jake didn’t need any more stress than necessary but was ready to scream or burst into tears by the time we were finally in the car and driving away.

We spent the next few days resting in bed. I visited with my family while Jake was taking naps. I helped him manage the binder, adjust it as needed, and folded face cloths to wrap over the edges of it where it was digging in under his arms. I helped him stay cool or warm, got food and water, made sure he had entertainment when he was up for it so he didn’t get antsy, got him different meds when he got itchy or nauseous from the narcotics, and put arnica on the bruises (very gently). His energy slowly came back and the pain decreased enough to wean from narcotics but the binder was still digging in under his arms in the most painful bruised areas where they had done liposuction so he couldn’t use his arms much as a result. T-rex Jake.

Post-op reveal and return to normal life

We went back to the clinic about a week after surgery for removal of the bandages and to see how the nipple grafts were doing. I’ve seen incisions before so it didn’t make me queasy or concerned. His nipples looked really dark but this apparently is normal and the surgeon was pleased which was a good sign. It was a very interesting experience to see his chest flat for the first time. I was finally able to look at that part of his body and not have what I was seeing conflict with what he looked like in my head. Over time the blurry part where his chest was in my mental image cleared to match what his chest looks like now.

Once we were home he struggled with the binder for another few weeks but eventually gave up and stopped wearing it. He was instantly more comfortable using men’s washrooms which in turn decreased my own anxiety about him being at risk in public washrooms. He slowly started wearing the clothes that he hadn’t been able to for a while because they had been too fitted across the chest. Now they fit perfectly. I don’t think he had realized how much stress he had been dealing with whenever he was putting clothes on to go out until he was able to put on whatever he wanted and not worry about it getting him misgendered. It’s an amazing experience to see your person finally be at ease with themselves and gain the confidence they had been searching for for so long.

The end?

So in the span of about a month we went from huge amounts of frustration and burnout to all legal documents changed and top surgery complete. It took a while for the stress to dissipate and the relief to settle in but man, did it feel good. Not everyone has the opportunity to pay for private surgery and get it in a timely fashion. Not everyone has support from family when they’re going through these medical procedures or transition in general. We are extremely fortunate in both these areas. And yet, even with all that support and stability it was still a very difficult, stressful, emotional process that was very hard to explain to the people around us. Spending time with each other and other trans people and finding online resources that related to our experiences were the things that kept us going. It is not a surprise to me at all that approximately 50% of trans people attempt suicide at least once in their lifetime (reference).

There is no specific end point to transitioning. Jake may have other surgeries in the future and will continue to have slow changes from Testosterone. But in our experience, after being on T for year, having completed top surgery, and having all his documents changed he has been able to pass consistently as male and has considerably less daily struggle with being trans. When we go through future transition related experiences I will make separate posts about those so stay tuned.

I hope you found this account interesting and helpful. Leave a comment if you have had similar or different experiences or if you’d like to hear more about any particular aspect.