When Do You Stop Being Trans?

I've been asked this question quite a few times now by a surprising number of people and I feel like talking about it:

"So at what point during your transition do you stop being trans? Like, when do you go from transgender woman to just woman?"

This question irritates me, and I'm still trying to figure out exactly all the reasons why... I find it to be such a baffling question. What logical steps would lead a person to think about it in this way?

Perhaps it drives home the point that people really believe there is such a solid difference between transgender women and cisgender women? Like they're two entirely different genders, and thus should be treated differently?

Perhaps it also demonstrates such a great lack of understanding about how society sees trans people, and how we must live for the rest of our lives? 

I suppose it also reminds me that I will never not be trans, and thus I will have to continue receiving questions like these for as long as I continue to remain an open book.

In any case, I try to be patient. I tend to answer that question by saying something along the lines of, "Right now would be nice, if you'd like to start treating me as you would a cis woman. It's up to you."

Honestly, it's a label. A social construct. You are welcome to forget that I'm trans and just call me a woman. In fact, I would probably find that very refreshing. The "trans" adjective is merely used to describe how I was assumed to be a different gender at birth, just like how "cis" is an adjective used to describe a person whose gender was assumed correctly at birth.

Just don't forget that the noun used for both of those adjectives was "woman." You are using the word trans as a way of describing the woman, the same way you would say blonde woman, or brown-eyed woman, or cisgender woman. The noun is woman, and that means you're referring to a woman.

So no, chances are I will never stop being referred to as a transgender woman. Just like I will never stop being a white woman, or a brown-eyed woman. This is just the reality of my existence, and the only thing about this that can really change is the way I am treated by others. And the amount of patience I give to these types of questions, of course. ;)

My Transition - The Big Surgery, Part 1

Biological Content Material!

This is literally a post where I talk about what's going to happen to my genitals. If you don't want to hear about this stuff, you best not read ahead.

The process has begun! Here comes the big one!

So to put this into context, I should probably start from the beginning. I've been looking for a skilled surgeon that takes my insurance ever since I discovered the peritoneal vaginoplasty two years ago. Dr. Jess Ting is apparently the only surgeon in the United States who can perform this operation, and my insurance at the time was not accepted by The Mount Sinai Hospital, where he practices. I got a new position at my job, which came with new insurance, and my new insurance wasn't accepted either. So I started looking for other surgeons. It appeared that Dr. Marci Bowers was able to offer the peritoneal method, but it turns out not only is that an operation that is "outsourced" to Dr. Ting's office, but Dr. Bowers also does not take my insurance.

After fighting so hard for so long to get all of these things processed, questions answered, and trying to find other surgeons and other methods, my insurance case manager said that Dr. Geoffrey Stiller was moving his practice to Washington State - which is where I am. I had heard of this doctor amidst my research, and so I dove into some more googling to learn more about him, all the while waiting for my insurance to finish pending a contract with him.

Before Dr. Stiller moved his practice to WA, there was not a single surgeon in this state that offered this surgery in any form.

So FINALLY, after 8 months of waiting, the insurance finished negotiations! Ironically, this happened a week after I started contacting Dr. Stiller's office to try and ask if I could schedule a consultation before the insurance was done. So right after I sent some emails I was told in response that I needed a referral, but my referral arrived in the mail right after, and so their answer changed and I was suddenly scheduling my consultation!

I just had my consultation visit on November 4th, 2019. I was so nervous on the days leading up to the appointment, and worried that I was going to forget what to say. So I made a list! 

So here's how things went at my consultation appointment. I went up to the counter to check in and they asked me for my ID and insurance card so they could make copies, and they handed me a tablet with a series of questions and a couple of documents to sign, to allow them to retrieve my medical history and whatnot. I sat down to complete the questions and immediately I went back to the counter when I noticed the listed sex on the form was incorrect. They said it may have been pulled from my insurance, and sometimes they require it to be my birth sex. I told them that according to my official birth certificate I am female, and my social security, state ID, insurance, and passport all reflect that. They corrected the information manually for me. If anything or anyone ever asks for my birth sex again, I will refer them to my birth certificate.

Shortly after filling out all the information about my medical history and signing a couple of documents, I had a Q&A with one of Dr. Stiller's nurses, who stated that she is also transgender, and so she could answer my questions not only from the statistics, but also from first-hand experience. After a Q&A with her, Dr. Stiller came in to meet me. He shook CJ's hand and then mine, sat down, and asked me to tell my story - what brought me here. I told him he can read all about it on this blog! We talked for a bit as he asked about my life, interested to hear about my experiences, how long I've been on HRT, my relationship with my parents, and all those little details. In the midst of everything I got to ask the remaining questions that the nurse couldn't answer.

Here is the list of questions I had for Dr. Stiller and his nurses, and paraphrases of the answers I received:

• Do you know about the peritoneal vaginoplasty?
• Yes, I am fully capable of doing that procedure, but until there is further documentation about the long term effects of that method, I am not comfortable performing it. It is very recent and needs another 3 to 5 years before I am willing to consider practicing it.
• I have concerns about depth due to my orchiectomy causing tissue shrinkage.
• It's unlikely that there will be issues with that from an orchiectomy. But in addition to the standard penile inversion method, we also offer a grafting technique, similar to the peritoneal method, but instead using colon tissue. That would eliminate the need to use scrotal or penile tissue to form the vaginal lining.
• Would Irritable Bowel Syndrome be a complication if we were to use colon tissue?
• Depending on the severity of your IBS, maybe. Since yours is caused by anxiety, and you will be drugged up on painkillers with anti-anxiety traits, you will very likely be fine. Since your main symptom of IBS is diarrhea, the biggest thing to expect is that you might have to use the bathroom one more time than usual, because you have a little less colon tissue to hold it in. And this applies to every day as well, not just from IBS.
• What happens to the nerves of a particularly sensitive area under my glans?
• Put simply, those nerves will be severed, and that area will not likely exist anymore. The clitoris is formed using only the glans, and the part of the clitoris that shows is formed from the tip and top parts of the glans.
• How long until the numbness goes away?
• This highly depends on the person. Some people say they experience numbness as long as a couple of months afterward, and some say they have full feeling within a week. Others don't experience any numbness at all.
• How long until I am able to have sex again?
• The doctor will suggest you practice using your clitoris after about 2 weeks. But you will have to wait upward of 2 months before doing anything rough with penetration.
• After the surgeon orders the electrolysis, will there be any clinics you could refer me to that will bill my insurance directly, instead of the painstaking reimbursement process?
• Since you have opted to choose the method that uses colon tissue, you do not need electrolysis for the operation. But the Queen Anne Medical Center has an electrology clinic that should be able to bill directly to your insurance.
• What is the timeline for recovery? How long will I stay in the hospital, how long do I need to stay in the vicinity, and how long until I can return to work?
• You will need to stay in the hospital for two days, and after discharge you will need to stay in the vicinity for two weeks. Most patients return to work after 4-6 weeks, but for strenuous work and exercise you will likely have to wait 6-8 weeks.
• What does the aftercare look like? What am I putting my family through?
• You will be able to walk when you're discharged from the hospital, so you should be able to mostly take care of yourself. Though you will be very tired and in a drugged up daze from pain medication, so your boyfriend should make sure you're taking your medications and eating/drinking regularly.
• How long will I likely have to wait for the surgery date itself?
• Once insurance is processed, we could get you in for surgery within 3 weeks.
• What is the timeline for dilation? When can I switch from three times a day to two times a day?
• For the colon vaginoplasty you will likely be able to switch to twice a day after 3 weeks.
• The muscles in the crease of my legs on either side are quite tight. Will that be problematic?
• The muscles in question should not be a problem, but it would be a good idea to look up some pelvic floor physical therapy exercises before the surgery regardless.
• The spots where my epididymis was severed during my orchiectomy are still sore to touch. Will those be cut further back?
• Most surgeons who perform orchiectomies are unfamiliar with the needs of transgender patients, so they make these cuts way further down than they should. We will absolutely cut that further back, all the way up to its source.
• Could I have a tracheal shaving done at the same time so I don't have to go under more than once?
• If your insurance will cover it, absolutely. Since you already have a referral for it we will see about making that happen.
• Will I need to undergo physical therapy as part of my recovery?
• No, you will be able to walk just fine.
• Why do I have to stop taking estradiol in preparation for the surgery? I ask because I become suicidal when my estrogen levels are low.
• Estradiol Cypionate comes with a risk of clotting, and we take that very seriously. So we put a hold on any medications that can increase any risk of surgical complications. In your particular case, because it is detrimental for you to stop your estradiol, we could bridge the surgery with bioidentical estradiol pellets, which do not have the same risk of clotting.
• Do you perform a single-stage procedure or do you do a second visit for labial construction?
• For this particular operation it is two-stage. The first stage will be the construction of the labia and clitoris, and the second stage will be the formation of the vaginal canal using colon tissue. It will be about 6 months between the first and second stages.
• What pain medications are used, IV and oral, for pain management and anesthesia? Are Gabapentin or Toradol part of that regimen?
• We do general anesthesia for the surgery itself, and we use Gabapentin and Toradol for the pain during recovery. We have a non-narcotic policy for recovery pain relief.
• Who else is on the OR and anesthesia team? Is it typically the same group of people? Have they worked together often?
• The same group of people have worked in our team for a majority of the surgeries we have performed. They are certainly experienced as a team, and they have gotten into a good groove together.
• Do you know your complication statistics, and can you stratify me into that risk profile?
• This is a high risk surgery as a whole, with the overall statistics of the surgery having a 60% complication ratio, the highest risk factor being necrosis. However, out of the 200+ intestinal vaginoplasties Dr. Stiller has performed, only 3% had complications. And you, personally, being under age 45, are in a low risk factor bracket. Patients over age 45 must have their colonoscopies before having this surgery, but for you that would be unnecessary. In the event of any complications, we would, of course, work to rectify the issue to the best of our ability without additional charge. However, a majority of our vaginoplasty patients merely return to have a "touch-up," for aesthetic reasons, and we offer revisits for this purpose free of charge as well.
• Do you do ultrasounds or something similar to check the colon before using the tissue?
• No, we don't.
• Do you have any resources for my post-op care that I can give to those who will be taking care of me?
• We will give generalized after-visit instructions, but they are intentionally very broad, because we want to encourage you to call us directly with questions.

After the Q&A stuff was all over, Dr. Stiller took some pictures of my neck for the tracheal shaving and had me change for a physical examination. Since I was wearing a dress, he said I may as well just leave my dress on and only take off my leggings and underwear.

The way he checked me for a hernia was kind of familiar, and yet at the same time very foreign to me. It was the "turn your head and cough" routine, except that I don't have testicles. So instead he stuck his finger into my inguinal canal on either side and felt my epididymis. Then he checked my lungs and we were done.

Dr. Stiller asked if I had any additional questions periodically throughout everything, making sure I had opportunities to talk. At the end of everything he held my hand in his hands, looked me in the eye, and said that he will make sure I am well taken care of, everything will be okay, and he is here to help. And once all the insurance stuff is taken care of over this next week or so, we can move forward and schedule my big day.

He then said I can go ahead and put my leggings back on, we said our goodbyes and thank yous, and CJ and I were by ourselves in the examination room as I got dressed. After I got my leggings back on I started getting emotional. CJ took a video that pretty much sums up how I felt, and I think that's probably a good way to end this post. <3

"That's Just The Way It Is."

I hear this all the time as an excuse for the way things are, or as a reason for why someone does something: "That's just the way it is." I don't believe I've ever truly considered this a valid reason for anything. It doesn't explain anything. It's an excuse to not know and to not think. It resigns control of your life to the ether, for people who do think to decide what's right and wrong.

I was at a mall last week and I heard someone say this, word for word: "Thinking is hard." We live in a society where is has become difficult for people to think for themselves. They're not used to it! They're used to people just telling them what to do. This happens at home by authoritarian parents, it happens by teachers at school who do the work for the kids instead of having them come to their own conclusions, and it happens through peer pressure in their circle of friends. We wonder why people can't think for themselves, but then we turn around and reinforce it by telling people what's right and wrong.

Well you know what? I could easily be wrong. Everything on this blog is derived from my own personal experiences, opinions, delusions, and feelings. You don't have to agree with anything I say, and you probably shouldn't take any of it away as absolute fact. It could be used as a guide, sure, but what I say is certainly not "just the way it is," rather, it is "just the way it was for me." Everything people say is filtered through a lens of personal bias, opinion, and experiences.

When I was trying to start hormone treatment, my first doctor told me that I had to present socially as a girl for a year before I could be prescribed the medication I needed, and I needed a note from a therapist. If I had resigned and simply said "well, that's just the way it is," then I wouldn't be where I am today.

Everybody says you need a degree and a teaching certificate to become a teacher, and you need to finish college before you can land yourself in a career. I became a teacher before having a degree of any kind, thus proving that that was most certainly not just the way it is, cut and dry, end of story. We like to label things so we can definitively say exactly what something is, but it's not as simple as that. Life is a series of gray areas, not just yin and yang. I found a teaching position that didn't require any of that, proving that my degree didn't matter.

There was an episode of That '70s Show in which Eric Forman says to his girlfriend, "I have to do better than you because I'm the man, and the man's the man, and that's just the way it is." Well you know what, Eric? No, that's not "just the way it is."

I've seen people work themselves into a crippling amount of debt by buying a house and two cars they couldn't afford. They blamed life and said, "Well, most Americans are in debt, so I guess that's just the way it is." No, it's not. You could have avoided it by pacing yourself and not buying crap you can't afford. Yeah, you may have still wound up in debt, but it would at least be more manageable.

That last example does not describe everyone, obviously, because one example does not, in itself, describe an entire class of people. One example does not establish that "that's the way it is."

Christiaan Huygens determined that light is a wave, as demonstrated with the "double slit" experiment. It was well confirmed and acknowledged that "that's the way it was." But Albert Einstein discovered proof that light also behaves like particles. It wasn't as cut and dry as people believed, and this is why science isn't about trying to prove something, it's largely about trying to disprove something.

I hope that this has given someone something to think about. The next time you find yourself saying anything along the lines of "that's just the way it is," try to recognize that by saying that, you've given up on thinking. You've stopped exercising creativity, and you've just accepted something without even having an actual explanation. Just be aware that by choosing the action of willful ignorance, you have given up another piece of your own free will.

My Transition - The Orchiectomy Story

Archived from December 22nd, 2018:

It is done! I have officially had an orchiectomy! I will do my best to describe as much of the process as possible.

Once I was at the outpatient surgery center, we had a volunteer approach me to verify who I was and check off on a list that I was there. We arrived an hour early, but they still checked us in and everything. I approached the main check-in counter and signed the paperwork that says I allow them to operate on me. My co-pay was $15, which I was completely okay with paying up front. They stuck a little identity bracelet on my left wrist after I verified that all my information was correct.

I go to sit back down, but I only manage to get my coat off before someone approaches us and says they're ready to take me to my hospital bed. We walk with her to an area with a bunch of curtain-closed rooms. I take all my clothes off and put on the hospital gown. These things always leave your butt hanging open, but hey, I'm proud of my butt. It's only natural people would want to see it.

There was this fancy space-age blanket on the bed. I get on the bed and lay down with the blanket over me. A nurse came in and verified all my information. We had a little chat and she stuck a vacuum tube thing into my blanket and it puffed up with warm air. Can I have one of these for my couch at home?! She gave me some painkiller medication and a glass of water before she left.

Another nurse came in, verified my information, and told me a bunch of information about the anesthesiologists, which doctors/nurses were in charge of my area, who was going to be checking on me, etc. And then she stuck the IV in my left wrist... I hate IV's, and I made sure she knew that. She stuck some numbing stuff on my wrist to try and make it less awful, but just the fact something is sticking into my vein freaks me out. Honestly, the IV was the worst part of this whole thing. I just tried to pretend I had a cybernetic arm and that made it somehow more okay.

My surgeon arrived and spoke to us briefly. He told us a bunch of stuff I already knew from the consultation visit, and explained to me that they'll be sticking a breathing tube down my throat once I'm out to make sure I stay out. I guess there's a tiny chance of tooth chipping from the removal of this tube, for people with highly sensitive teeth. I wasn't really worried about that, it seemed like something they just had to say to cover their butts.

My mom and I waited for about an hour cracking jokes, and I about fell asleep before the anesthesiologist arrived. She told me what drugs they'll be pumping into me to make me sleep through the surgery, and then they started to wheel me out. Amidst this whole series of conversations, I was misgendered a few times, but each time the people either corrected themselves or each other. I made sure to let them know that I appreciated their correcting themselves so I didn't have to, and I appreciated how often they got it right without any corrections needed at all. We spoke briefly about what my job was, and I mentioned I'm an IT tech for a school district.

When I got to the operating room, I scooted over onto the operating table and they stuck a bunch of blood pressure monitors on my right arm and legs. It was all pretty cold, and I couldn't help giggling as it all touched my skin. It kind of tickled. One of the people in there said if I kept laughing it would become contagious and they'd all start in. I said,

"Well, why not! Let's all have some fun here, the world needs more laughter."

I got a couple of giggles, and the anesthesiologist said she likes my attitude. One of the nurses stuck a mask over my face and told me to breathe in deep. I coughed a couple of times as I was breathing in for some reason, I'm not sure what it was that was irritating my lungs. But as I was breathing in, I was looking all around the room, and I had a thought that I just had to vocalize...

"Hey, you know? I think I could tell you how this entire room was wired. And probably even the names of all these cables, and the ports they plug into."

The anesthesiologist said, 

"Heh, really? That's interesting. Alright, we're gonna get you to sleep now."

I said, 

"Cool, I'm pretty tired already anyway. That'll just make your job easier."

Very quickly, even as I was saying that, my hearing started turning muddy, I began to feel very dizzy, and I gradually got some tunnel vision and closed my eyes. I remember hearing the anesthesiologist saying something about a number that was 4 digits long, but I have no memory of what it was about. 

I woke up in another room 2 hours later. 

I remember some of the first things I said as I woke up,

"Damn, I feel rested. I haven't slept like that in a long time. I should test my brain to see how things are working... To hack a windows 7 user account and remove its password, just go to the system32 folder in the windows folder and replace the utilman.exe with a copy of cmd.exe. Then reboot the computer and click the little button in the bottom left. In the command window that pops up type net user, the username you want to hack, and just put two blank quotation marks. That will erase the user's password. Yeah, I seem to be fine. What? Your medical equipment is plugged in with 9 pin serial cables? That's hilarious!"

I remember the nurse saying something along the lines of, 

"Now, Josie, you're not at work. You should be relaxing!"

"Relaxing? What's that like? Hah! Nah, this is me relaxing... This is fun to me."

As I struggled to open my eyes and gain a better idea of my surroundings, I started to noticed there was some kind of lip balm on my lips. And after realizing that, I started to gain more understanding of the rest of my body. I realized that it felt like there was something missing between my legs, and it felt amazing.

My bed was moved from the first recovery room to the second one soon after I woke up, since I guess I was doing pretty well. They moved me to a chair and kept asking if I felt nauseous, and I didn't. I guess they expected that I would for some reason. I pulled up my hospital underwear, since apparently it wasn't up all the way. My mom came over to the new room and sat down while I recovered. I took off my hospital gown and put my pajamas on. They gave me some apple sauce, which I gladly ate because I hadn't eaten anything since 11pm the night before, as ordered. I also drank a cup of water. They wanted to wait until I could use the bathroom, to verify that I was able to pee okay.

Eventually I felt ready to get up and pee, though I was quite dizzy. I walked to the bathroom holding a nurse's hand, and it was after getting up and walking that I truly felt how there was nothing between my legs. That felt so weird, and I loved every moment of it. As I sat down on the toilet I saw the area, and I started feeling excited for it to heal so I could poke it and laugh maniacally.

I peed just fine, no issues there. In fact, peeing somehow felt easier than usual.

When I walked back to my chair I reminded one of the nurses that I was promised the IV would come off as soon as I'd peed. The IV came off, and I immediately felt much better. God I hate IV's...

It was around this time that I learned my phone was left in the car, so I couldn't write about exactly what I was feeling in this moment... I'm writing about all this the day after. But anyway, after everyone confirmed that I was okay, it was time to go. I heard some nurses talking in the background about me:

"How is she doing?"

"She's doing amazing!"

I guess I was recovering pretty fast.

The nurse stuck me into a wheelchair after we got all my stuff packed up and wheeled me outside to my mom's car. In the car ride I posted a Facebook status to try and make sure I didn't forget some stuff, but I started to realize the phone screen was making me feel nauseous, so I put it down. I was getting really tired, so I tried to sleep in the car as best I could, despite the traffic and scary mom-driving.

That's pretty much everything! When I got home I plopped down on the couch with an ice pack on my crotch and fell asleep. I woke up and ate a buttload of chicken soup and vegetables with toast and baked apples. I was starving...

The Power of Language

Language has a great deal of power. Language can raise a person's heart rate, it can change someone's blood pressure, it can cause fluid overflow in someone's sinuses, and it can incite actions that would otherwise not occur. It can motivate and it can depress.

The line between purposefully painful words and physical action is surprisingly thin. The act of causing mental distress is so often ignored in favor of physical distress, despite the two being directly linked. If our physiological state can be altered purely through communication with language, then that would hint that the mental and physical are one in the same. Harmful communication can cause physical harm, and physical harm can cause emotional harm.

So why is it that emotional harm through language is not treated as seriously as direct physical harm?

Those who doubt the power of language should consider how dictatorships have formed. Did the tyrants themselves directly do all the work, or did they use the nuance of language to get others to do it for them? Would those others have helped if it were not for the power of that one person's language?

How about mental health counselors? They use nothing but language in their practice. It's all just words, and yet those words are healing to their clients. Those words change people's lives.

Lawyers develop arguments that determine the entire lives of their clients, and those arguments are comprised of nothing but words. The fate of these people lie in the way their representative words their arguments in court.

The entirety of our laws were written using nothing but words. The specific wording of those laws are referenced every day during legal battles to determine whose language was more powerful than the other's. Who used their words more effectively?

Language has power. Words have power. And therefore, doesn't it make sense that choice of wording also has power? Wrong choice of wording can make or break a leader, a lawyer, a therapist, a mediator, a teacher...

Since words and language can have such influence as this, why would we use such power as carelessly as we do? And why would we deny the power it holds, despite using it every day and creating evidence to the contrary?

Those who just want to say whatever they want without repercussion clearly do not understand the power their words have over others, or, whether it be through ignorance or denial, even the power words can have on themselves.

It seems very irresponsible and extremely inconsiderate for someone to willfully ignore the impact their words have on others, and for them to deliberately choose to continue using harmful words, despite it being explained to them how those words are harmful.

I dunno, just food for thought. I don't really have a point of conclusion, I'm just thinking aloud. But if by reading this my words have changed your emotional or physical state, then I guess that's a point I mean to prove.