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