Mia’s Medical Upgrade

Grandma, I was wrong

Early August, 2015 — I come out to my extended family at a reunion in Michigan. The same reunion I’ll be at next week. It’s the first time I call myself trans in front of other people.

I still don’t know what that means.

Grandma asks how often I wear dresses. It depends on the weather. She seems happy with that.

—What pronouns should we use?
—She… or they.
—I don’t like they. Are you going to have surgery?
—I don’t… think so?
—Will you still date women?
—Will they still date me?

In October of that year, I change my name publicly. In January, I swallow my first hormone replacement pills — a mix of Spironolactone (an androgen-blocker) and Estradiol (an estrogen).

On September 10, 2018, I will stop taking the androgen-blockers, after completing the first surgery of my life: a procedure officially called vaginoplasty, but more colloquially referred to as bottom surgery.

Grandma, I was wrong.

"The Surgery" Disclaimer

When we come out as trans, the most common reaction (after losing friends and family) is to ask about the surgery.

When we ask to change the gender-markers on government-issued documents, many states require proof of the surgery.

Historical terms like Sex Reassignment Surgery (SRS) or Gender Reassignment Surgery (GRS) also imply a centrality and finality to this one procedure — as though we aren’t real men or women before we’ve undergone genital reconstruction.

But there are many aspects to transition — social, legal, and medical — with every person choosing their own path. There is no right way to be trans, just as there is no right way to be a woman.

Bottom surgery is only one in a long list of medical interventions that can help reduce gender dysphoria, and improve our quality of life. It is absolutely necessary for some of us, but it does not validate our genders or transitions. It is not the primary intervention, nor the most common, nor the final — but in a society that places the full weight of gender on our genitals, this one procedure tends to grab the most communal (often salacious) attention.

There is no "the surgery" for all trans people, and there are no correct genitals for womanhood. I’m already a complete and real woman — I only hope to relate to my body in new ways: to trade in some of my body dysphoria for a chance at bodily joy.

Change of Plans

Trans people are often asked to explain ourselves, and defend our medical interventions to a cis public that finds us fascinating or disgusting. We are expected to beg for validity at every step — a mindset that leads directly to the current moral panic around trans children.

(I don’t love linking The Atlantic here, since they stoke the flames from all sides — but it’s a good article on the topic.)

I don’t want to play that game, but I am happy to share some of my experience in case it can help other trans people in similar situations.

I spent years dissociating from my body — entirely unaware of the pain or identity driving that distance. Looking back, it’s easy to read all the signs, but at the time no one in my life (especially me) knew what to look for. One of my favorite comedians expresses this best, with her roommate metaphor near the end of this wonderful set. Laugh break!

Over the course of my transition, I’ve begun to heal that relationship with my body — but the progress is not linear or clean. Every step forward reveals a new layer of repressed trauma in my body, along with a euphoria of new discovery.

In the spring of 2017 I begin to consider bottom surgery more seriously. I do my research on how it works (warning: this animated video is still graphic, and uses outdated "MtF" language), and learn about the development of genital tissue. I begin to see my body in new ways, and find that it’s much easier to own and understand my physical form. I talk to friends, and learn what to expect from surgery. I research available surgeons, and eventually send an application to Dr. Marci Bowers — a ground-breaking expert in the field.

One week later, I get a phone call from her office:

—Are you available on June 9, 2020?
—Uh… Sure?

I call mom:

—Some people will struggle with this.
—What are they resisting?
—It’s like they feel about tattoos, permanent changes to your body.
—Like having your ovary removed?
—Maybe it’s harder when it’s on the outside.
—Great! Tell them I’m moving it to the inside!

The Wait

With limited surgeons and increased interest, waitlists have been growing quickly. We’ve come to expect a 2-5 year wait, and out-of-network (out-of-pocket) treatment, far from home. Many people wait on multiple lists, and hope to get moved up after a cancelation. But recently, there’s been a push for more doctors to become certified.

This is a wonderful development, but what we gain in access and affordability, we lose in detailed knowledge about our surgeons and their credentials. This used to be a specialty procedure, performed by the well-known expert of your choice (if you can afford it). As it becomes more common and covered by insurance, most of us simply have to go where we’re told. Meanwhile, there are no national standards for certification, and each hospital is making it up as they go.

While I’m looking into insurance options, I discover that Denver Health is working with Dr Bowers to train two local surgeons, and a Denver Health insurance plan would be guaranteed to cover this new Denver Health surgery. I switch my insurance at the end of the year, apply for the new DH waiting list, and immediately begin preparation. With an unknown timeline, I want to be ready.

In the meantime I do some research on my new surgeon, Dr Chris Carey. Previous patients of Dr Carey recommend him, and he seems to have experience and training to back up his new credentials. I sure hope that’s enough.

In early July, I get the call:

— Can you be ready in August?
— No, I’ll be traveling.
— Have you completed hair removal?
— Mostly.
— Get it done.

They call again this week:

— You’re traveling, right? When will you get home?
— September 9.
— Can we schedule you on September 10?

😳😳😳😏😂

"How Can I Help?"

As I’ve started to share the news, several people have asked how they can help.

I’ll be in the hospital for 3-4 days. After that, recovery is slow and difficult — with 4-6 weeks of limited movement before I’m back to my routine, and back to work. My bills and my boredom are likely to pile up, so you can help with either or both: