Tag: Waiting

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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Getting Pregnant is Hard To Do Without Sperm

When Jake and I first met we were unsure if we wanted kids. Once our lives stabilized it seemed a lot more feasible. Around the same time we spent some time with a couple small babies and had our parental instincts kick into high gear. Since both of us had a uterus and ovaries we had a choice of who would carry. Jake was more worried about being able to bond with the kid and I was more worried about the physical process of pregnancy so initially he was going to carry (this was pre-transition for him). This decision came with the caveats that if for some reason he couldn’t conceive or if gender ever became a question and he was no longer comfortable with it, I would carry.

Since neither of us produce sperm, our options were sperm banks, fertility clinics, or known donor. We were both less comfortable with the known donor path and there was a two year wait for our local fertility clinic. So the best option for us was to start with a home insemination program run by a sperm bank. We started saving money as each attempt through this program would cost between $1,500 and $2,000. When Jake’s gender questioning led him down the path of transitioning and he started to come out, we figured that was enough emotional stress on its own so we put the baby making on hold.

A year and a bit later, things had calmed down and we were ready to start trying. We started with home insemination from the sperm bank in Toronto. We signed up for the program, had a consult, and got blood tests done. We went through the online catalog and each month on day 1 of my cycle we would send in our top three choices to the sperm bank. On day 11 a 2.5 foot tall box would arrive which contained a large cryo container and a tiny vile of frozen sperm. It also contained specific instructions on how to thaw it and inject it. I tested for ovulation (LH surge) each morning and when it was positive we carried out the instructions. Then the dreaded two week wait (that anyone who has struggled to get pregnant will understand) began.

After four cycles and no success we decided to save the rest of the money we had put aside for future options. We quietly asked a few friends and family members if they would be interested in being a donor for us and ended up trying twice with two different donors (four more cycles). This involved a lot more social engagement and logistical planning but ultimately followed the same pattern of make plans, test for ovulation, do the thing, wait two weeks. Again, no success. We decided it was medical intervention time.

We went to our family doc to request a referral to the fertility clinic. Since we had only technically completed 8 tries (equivalent to 8 months of TTC – trying to conceive), he was reluctant since the typically referral criteria require 12 months of TTC. So instead, I got a referral to a women’s clinic where they ordered more specific blood work and other tests to make sre there was nothing structurally wrong. When this all came back normal, that doctor finally referred us to the fertility clinic.

The two fertility clinics in our city (one public and one private) had recently amalgamated which cut the wait time from 2 years to 6 months. When we finally got our appointment there was more blood work and tests. They started me on a low dose of Synthroid to get my thyroid levels from low normal to high normal. On the scan of my uterus they found a fairly large polyp that they decided should be removed prior to any insemination attempts so I was on a waitlist for that for another four months (which turned out to be 7 months). I had very little warning when my surgery date came up so, suddenly, I was having surgery (which went totally smoothly) and then we were told we could try on the next cycle.

Except with all the waiting I had slacked off and hadn’t gotten the mandatory counselling session booked, a requirement before ordering sperm. Within a week we had that done (a stupid, expensive hurdle that I could rant for a paragraph about but I will spare you), we ordered sperm (a fairly straightforward process since we had done it before), Jake got his final blood work done, I had my surgery follow up, and we were ready to try!

We decided that we would start with IUI (intra-uterine insemination) with a natural cycle (ovulation is not enhanced or induced with drugs) since I don’t have PCOS or endometriosis or other conditions that interfere with the menstruation and ovulation cycle. Again, I peed on sticks to detect ovulation, we phoned the clinic early in the morning when I got a positive result, and went in a few hours later. We received a mini report of the quality of the sperm and how well it had woken up from cryo. The insemination was completed by a nurse and off we went.

The two week wait was even worse than last time. Unfortunately our first attempt didn’t work. The month after we were out of town during my ovulation dates so we gave ourselves the month off to regain our emotional stability and tried again the month after. Somehow, this time felt different. A week after insemination my breasts became very sore and I had a few sharp pains in my uterus area. Since we were doing a blood test for pregnancy (HCG) two weeks after insemination we didn’t bother peeing on a stick. This time, the result came back positive. We were pregnant!!!

Read the next part of our journey in Pregnancy, Miscarriage, and Gender (coming soon).

If you relate to any part of the story above or have any questions, leave a comment below and I will respond!