My Transition - The Big Surgery, Part 5

I'm writing this after the surgery happened because I was far too loopy to write this during recovery. The following events happened on January 17th, 2020.

The day had come! I was not allowed to eat or drink anything, so no breakfast for me. I brushed my teeth, my parents had breakfast, and we went out the door.

When we got to the hospital we walked to the surgery center, and shortly after I was called into a back room. My partner, CJ, came with me. The nurse instructed CJ to wipe me down with antibacterial wipes - arms, chest, groin, butt, but not my legs, apparently, because I shaved them within the last two weeks. I used the bathroom real quick, realizing I better not have a full bladder when they administer the anesthetic. When I was done I wrapped up in the hospital gown that so gloriously shows off my butt.

I sat on the table and a nurse came in to put in the IV, and the anesthesiologist came in to say hi and get a couple of my signatures for consent. The nurse giving me the IV actually offered to numb my hand, which was very helpful! That made the whole process a lot more bearable! She did everything with far more expertise than anyone else I've had, and as a fun bonus, she also reminded me of a friend of mine.

After cracking plenty of jokes, because apparently my reaction in these situations is to become hilarious, it came time to wheel me off. I was given what the anesthesiologist called "happy time" medications through my IV. This is where things get fuzzy, and my jokes became very nonsensical... He claimed I wouldn't remember even being wheeled out of the room, and he was mostly correct, except that I do remember the act of being wheeled out, and I remember CJ recording a video.

(I had to upload this one to YouTube because the file size was too big)

As shown in the video, CJ wasn't allowed to follow me into the next room. In that room I think I got onto another table, and the anesthesiologist told me to bend over forward as I sat. I had a couple of pokes at the base of my spine, which caused me to yelp rather more loudly than I expected I would. It didn't hurt that badly, it just was a very strange and somewhat shocking sensation. I remember another nurse saying he's on a roll today, because I guess he administered my anesthetic impressively fast.

I remember nothing else after that except waking up in another bed with very heavy eyelids hearing nurses talking around the room. I tried to open both eyelids, but the double vision was very real, so I closed my left eye in order to at least see what was around me. Keeping even just my right eye open was quite a chore. If I remember correctly, this was the exchange I had with the nurse overseeing my recovery,

"CJ... Huh? Oh, hello."

"Hi, how you doing?"

"I'm coming about. Is CJ here?"

"Not yet, we'll bring you to your family soon."

"Oh good. I want to make sure he knows I'm okay."

As I was laying there, loopy as heck, I overheard some other nurses talking about some personal stuff. One was apparently having a very rough day, and had to deal with some very tough patients. So I spoke loudly enough for them to hear,

"Remember to breathe! You're doing admirable work! I appreciate you, even if your patient doesn't! I hope tomorrow is a better day!"

She replied, "I have tomorrow off, so it will definitely be better."

I said, "Well there you go, treat yourself to something nice!"

The other nurse she was talking to chuckled a bit, and so did my nurse. I recognized how funny this must've been for them, considering I'm crazy loopy and barely awake. My nurse asked why I only had one eye open. I replied,

"Because I can't see straight in 3D, so I have to limit myself to 2D, otherwise everything is double vision. I can open my other eye for you, though, to prove I can."

I opened my left eye and closed my right. She seemed to want both open at once, so I indulged her for a moment, then closed them again saying it was making me motion sick to have both open with double vision.

After a bit of waiting, the double vision gradually got better, and I was wheeled to the waiting area to be reunited with my family. I asked CJ to record a quick video for Facebook, to let everyone know I was okay.

We all went up the elevator to a floor I'd never been to and I was wheeled in to my hospital room. This room was actually quite nice! It had some decent furniture, cool remote controlled lights, and the bathroom was huge.

Asian Noodle Stir-fry

I had room service, and the food was surprisingly good. I wish I got pictures of the bathroom, but I did get pictures of the food.

Chicken Caesar Salad

Unexpectedly, after my delivery to this room, they had me stand up off my portable hospital bed and walk to my new bed. I was not expecting to stand up until at least two days from then, but I guess they wanted to make sure my legs worked, and they wanted to kickstart my body to remind it that I'm alive. They told me I had to walk again later that night after dinner, so I should rest up and prepare for that.

Later that night, with the help of holding onto my IV pole, I managed to walk around the loop of rooms on that floor. I wasn't expecting I could walk that far, but I guess I surprised myself, just as the nurse said I would.

We got back to my hospital bed and I figured out an effective way to sit back down without hurting myself by balancing my thigh against the arm of the bed as leverage. I was pretty tired after that walk. I asked CJ if they would be willing to sleep with me that night so I wasn't alone, and they said yes. As my parents were leaving for the night my dad came over and kissed me on the forehead, which is something I don't think he had done since I was somewhere around 3 or 4 years old. <3

I was awoken every few hours during the night for pain medication and antibiotics, and to drain my catheter bag. After breakfast and lunch, my parents showed up and I did another walk around the loop of rooms. Dr. Stiller came in that afternoon to ask if I felt good enough to head back to my Airbnb. I said yes, as long as it means I get to have my IV taken out. And so my IV was taken out! I went back to my Airbnb that evening with blood bags and a catheter hanging from the wrappings of my abdomen.

And thus begins my recovery! Every 3 hours I alternate in taking 600mg of ibuprofen and 975mg acetaminophen, every 6 hours I take 300mg of gapabentin, and every 12 hours I take 400-80mg of sulfamethoxazole-trimethoprim with a probiotic.

Further updates as events warrant. ;)

My Transition - The Big Surgery, Part 4

Sexual Content Material!

Just a mention of me having sex. That's it. If that bothers you, you can just skip paragraph 9.

We made it over the mountain pass, just barely! It closed right after we passed over the summit, and they allowed us to keep going. We eventually made it to the Airbnb and set up all my dietary needs and stuff. 

My pre-op appointment was the next day. As we were getting ready to go to that appointment, I got a call saying I was late for another pre-op appointment, to check me in with the hospital. I was never told about that appointment, so that was a lovely surprise. We went to the hospital and, with the help of Dr. Rick from Dr. Stiller's office, we found the right place for my check-in.

They had me confirm my identity repeatedly, spell out my full name repeatedly, and then they put an identification bracelet on my wrist. I had to wear that bracelet through until I was discharged from the hospital. Then I was taken to another room to answer a bunch of medical questions and have some blood tests. They needed to have a good sample handy in the of chance I needed a transfusion. I hate blood tests, and I've been really bad about feeling faint during them lately... Luckily I didn't pass out.

I was then taken to another room where we finalized a bunch of stuff, asked more medical questions, and then I was given instructions for how to prep for the surgery.

Immediately after they let me go, I went to the Stiller Aesthetics office for my pre-op appointment with them. During this appointment I was told how to prepare for my surgery with information that contradicted the hospital. Dr. Stiller appears to have a different way of doing things, and I was plenty okay with that, because his instructions were far easier to follow. We went over the risks involved with the surgery again and I got to have some more questions answered. 

Unfortunately I do not remember all of my questions, but I do remember getting to ask Dr. Stiller directly about whether I could, after both my surgeries are fully healed, take my progesterone vaginally, the same way I take it anally. He said that since we're using intestinal tissue it actually makes sense that that would work. Not only that, but because of the part of the intestine that's used in the surgery, it would most likely absorb more effectively than doing it anally. But, of course, he said I should consult with my primary care doctor before doing anything like that.

Dr. Stiller came out to meet my parents and answer any questions they had, and then we took off to buy some antibacterial soap for my pre-surgery shower and some Ensure to bulk up with protein that night, as he said it has immensely helped his patients recover faster.

The night before my surgery everyone was nervous. I was so anxious, and my partner, CJ, was shaking. We tried to watch funny videos to distract everyone, and that worked for a while. I was nervous to take my pre-surgery shower because it kind of symbolized that I was really going through with it. CJ and I shared many tearful moments this night as they told me so many reasons why they love me, and how I need to keep being stubborn and strong, and to not let this beat me. They added that if I die, they'll bring me back so they can kill me themself. We cried together as I said there's no way that will happen. I couldn't think about that possibility... The thought was too terrifying.

After my shower we cuddled together in my room and talked for a while. Talking lead to some... Other activities. CJ became the last person I will ever have penetrative sex with - at least with me being the penetrator. We did it one last time, for the sake of the physical closeness, and hugged each other close for a while as we both finished. I couldn't have asked for a better final experience than that, it felt like something out of a romance novel.

... That is until I realized I had just compromised my sterile shower, so I had to go back and shower with the antibacterial soap again. 😅

CJ and I cuddled for a while again before going to sleep in different beds. I slept alone because I had to wake up at various times of the night to drink Gatorade and Ensure, so I wasn't about to get any consistent sleep. I sometimes wonder if they do this on purpose to make me tired for the anesthetic. In any case, I did everything exactly as I was ordered to. I hadn't peed that much since I was on spironolactone...

My Transition - The Big Surgery Part 3

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.

My surgery is in two days. As I get closer and closer to the day of the surgery, I find myself contemplating many things, and I am becoming very nervous.

I'm nervous that we might not make it over the mountain pass on our way to Spokane. I'm nervous that I'm going to do something wrong in the days leading up to my surgery, and that they're going to have to cancel or delay it. I'm nervous that I'm going to run into logistics issues, and that they're not going to include the tracheal shave at the same time. I'm nervous that insurance is going to let me down and stick me with a hopeless amount of debt. I'm nervous about the IV, because I hate IVs. I'm nervous about the anesthesia, because being put out is a scary concept.

But I'm finding that not only am I nervous about these things, I'm also nervous about the surgery itself. There's a voice in the back of my head asking, "What are you getting yourself into?" I find myself contemplating what could go wrong, and if going through with this is worth it. I find myself thinking, what if something horrible went wrong and I didn't wake up? I finally love myself, I'm finally happy with my life, for the most part. I don't want to lose that. Is this surgery worth risking my life over?

Why am I going over this again? I already came to the conclusion that it is worth the risk. I fought for over two years to make this happen. I clearly want it, I know I want it. I'm so certain that when this is all over I'm going to be ecstatic.

This feeling I have is so similar to the way I felt when I was starting hormone replacement therapy, except that this surgery is going to involve a lot of pain and recovery, and hormone therapy didn't really require any of that. Well, except for the breast pain, I suppose. But I doubt that will compare.

If it does compare, you know I'll be describing that in my post-op blog post...

This almost feels like having to come out to myself again. It's like having to build up my resolve, to remind myself that it's okay to have doubts. People who are happy with having a penis typically don't complain about their bulge constantly. They typically don't tuck it every day. Not having to tuck my genitals and not having to worry about how flat the area is will be incredible... Not having that on my mind ever again... Because it always is. It's always there in the back of my head, that worry that someone is going to see bulge and use that as an excuse to treat me like garbage.

It's not just about other people though. For the most part people will still treat me that way. They'll probably see bulge simply because they're looking for it, whether it's there or not. Those people will always treat me like garbage, and I can't expect that to change from this surgery.

No, this is for me. This is about me. This is something I want. I don't want the option of peeing standing up. I want to have to wipe my front every time I pee. I don't want to ever feel an erection again unless it's someone else's. I want to be able to feel comfortable in yoga pants. I want to have a clitoris. I want a vulva. I want everything that comes with having those body parts, for myself, not for the satisfaction of other people.

Although it would be pretty self-satisfying to use my vulva as ammunition against people who claim I'm not a woman, that is not the reason I am willing to take this risk. I am taking this risk because I want this. Having this will make me happy, even when I am by myself and other people aren't a factor whatsoever. This would make me happy even if I weren't in a relationship. This would make me happy even if I had no friends, and even if everyone in the world had no idea I was trans. This is going to feel right, and I will probably look back at how nervous I am right now and laugh at how cute it was that I ever doubted myself.

Doubts are okay. Doubts are a normal reaction to anything scary. This is scary, and that's okay. I knew it was going to be. Being scared doesn't mean this is the wrong decision. I'm scared because I love myself, and I know what I'm about to put myself through. But I'm also entering into this decision because I love myself.

Well anyway, I think that about sums up my pre-surgery thoughts. I will try to document as much of the actual experience as I can. Next up will be the pre-op appointment and surgery aftermath.

My Transition - The Big Surgery, Part 2

My insurance took longer than expected to process, so my surgery had to be scheduled further out. January 17th, 2020, was the earliest date I could get while still giving my workplace enough reasonable notice for medical leave.

I received a pre-surgery phone call on December 19th, 2019, and asked the following additional questions:

• When will I be able to go swimming?
• About 3 months post, which would be 2 days before my birthday.
• Can I use reusable pads during recovery?
• No, mostly for sanitation reasons, as there will be a lot of discharge.
• Will I be able to take progesterone vaginally?
• No idea, need to ask Dr. Stiller.
• How do I clean the inside of the vagina post-recovery from stage 2?
• Douche. They give me a high quality reusable one for this purpose.
• I have had intestinal cramps as a period symptom. After full recovery, since the inside is formed using intestinal tissue, will I have vaginal cramps?
• Probably not? I've never thought of that. Maybe, but probably not.
• Can I get a temporary handicapped parking permit to use during recovery?
• I haven't had this question before either. I don't know. Probably. I'll look into that, but you probably send a letter or something to the Department of Licensing for that.
• 1st vs 2nd stages:
• As expected, there will be a small opening about half an inch, and that is what the colon graft will extend from. They use tissue that is naturally hairless (from my shaft?) to form that area.

We set a pre-op appointment for January 16th, 2020, and she told me to call once I'm in town.

Unexpectedly, during that phone call I learned that my surgeon's office didn't know of anyone other than them in Washington State who would be a bioidentical estrogen implant to bridge my hormones through the surgery. So I had to schedule an appointment for January 2nd to have that done. 10 hours of driving, round trip...

The process of putting in the implant was actually quite simple. We talked for a bit beforehand to make sure everything was in order. The doctor injected me in the butt with some lidocaine, and after that point I really didn't hardly feel anything. I couldn't even tell when he started making the incision to put the estrogen pellet in.

The recovery was pretty easy. I had to keep the bandage on for three days, which was the second hardest part, next to driving 5 hours sitting on it. It felt like a bruise for the first two days, and then devolved into feeling rather itchy by day 3. After the bandage came off I started forgetting about it.

My Transition - The Big Surgery: Limbo Thoughts

In this limbo state after the consultation, while insurance is processing, and before the surgery date has been set, I find myself doing a lot of thinking.

I'm thinking about the recovery, the struggles I'll experience, the waiting to heal, the relearning to pee, the pain of sitting down wrong, the dietary changes, the permanent intestinal changes, the dilations... Yeah, it's scary. But overall, I'd say I'm far more excited than scared.

It's funny. You'd think that that's what I'd be thinking about the most. Being nervous about the operation and recovery and sex life stuff, etc. But it's like I've already processed most of that. I've had over 2 years to think about that. Instead I find myself dwelling on something entirely different...

My voice...

My voice still very much outs me. It is not very subtle, especially when you can't see me in person. My appearance helps, but over the phone? Nope, I get misgendered 100% of the time, unless they are told that I am a woman, or otherwise corrected. Not a single time has a stranger assumed I was female on the phone. Not once. And that isn't likely to change anytime soon. The US seems to have little interest in medical science for this department. We seem to be far more focused on - obsessed with - genitalia when it comes to gender. Voice plays such a large part in transgender women's lives... It is honestly one of the hardest things I have to cope with in my daily life. I'm convinced that my voice is one of the most consistent reasons I get misgendered.

I know my friends are going to disagree with me and say that my voice sounds fine. And maybe it does to them. Maybe they're used to it now. They got to see me through my entire transition as everything slowly changed, and so I guess it seems to them that my voice just matches what I am. But again, they practically never talk to me on the phone, because I avoid the phone for this reason. I text everybody instead. Otherwise they just see me in person, and my appearance just gives creates an illusion that makes my voice seem more feminine, even though it's really not. But I know that they would never tell me this because they know how sensitive a subject it is for me.

And there's not much I can really do about it. Voice therapy has only gotten me so far. I'll continue trying, but I think it's kind of a lost cause at this point. After a certain amount of voice therapy with limited results I get to start considering a surgery for my vocal chords, which is extremely risky, and could result in my losing my voice altogether. So someday I'm going to be faced with the decision of whether I would like to have no voice at all more than sticking with the voice I have now.

So I guess ultimately what I am pondering is how I will soon have the correct body. I will be unmistakably assumed female, even when I'm completely nude at a spa. But despite all of the struggle to get here, my voice is still a problem. And I guess what scares me is that I am honestly questioning whether I even want a voice at all if it's going to sound like this for the rest of my life.

I want my old voice back. The one I had before  my first puberty ruined it. The one that made people call me a girl, even before I had boobs.

Maybe in the time it takes for me to recover from my bottom surgery there will be some advancements in medical science. Maybe transgender people being in the news spotlight will actually help some development in this field within the United States, so I won't have to go to South Korea to get the voice I should naturally have.

I guess we'll see what happens. All I can do right now is try not to let these thoughts dampen my spirits. I'll just try to focus on the fact that I will never have to tuck again, and that soon, walking past the underwear sections in grocery stores is no longer going to upset me.

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