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Thursday, April 18, 2019

My First Shirtless Event (in the General Public)

So I've been publicly shirtless before... at clothing-optional Pagan events it's normal for me, and I have been out in my yard and my household, but yesterday I had my first time shirtless in public.  I didn't get any smiling photos feeling titillated at the beach with all my friends... instead, I was told to start swimming to get exercise, and got a Y membership.

It was anxiety-inducing... I reverted to some of my older behavior, holding my arms in strange ways over my chest and draping a towel over my shoulders in the locker room.  Since this is such a highly populated establishment it wasn't like at Planet Fitness where I had very little issue changing in the group changing area even without surgery... if you know the Y, you know it's stereotypically populated by hundreds of naked old men all the time, and it turns out that stereotype is pretty accurate.

People stared at me, but I suspect it wasn't the scars, it was just that I am new there.  My scars are actually somewhat hidden as long as I keep my arms down... they tuck into my chest rolls.  I've found generally that because I have a large beard cis people tend not to read me as trans no matter how many clues I give them, so if they do notice the scars, they probably think it's something else.

Once I got out of the locker room?  Then I was fine.  Maybe a little awkward, but I was able to have a conversation with somebody telling me the lap swimming etiquette without feeling like I had eyes on me, and I was able to get my laps in.

Now that I broke that seal, it'll probably just get easier to go there, which is good because I really need that exercise... and I really like swimming.

Friday, March 22, 2019

Three Month Top Surgery Update

A while ago I had my follow up for three months post op (I kind of expected them to schedule a six month but apparently I don't need to go back until my one year).

Healing is going pretty well... well enough that I actually forget that I had surgery.  When I look in the mirror I don't really notice the scars, even though they're quite obvious, or really any of the flaws that I would have expected to bother me forever.

According to the doctor, there is still a lot of swelling, and I can see and feel it.  My activity level is starting to go back to normal and although I wouldn't say there is "pain" most of the time, moving certain ways (especially if I haphazardly lean on my armpit) reminds me that there's still pretty fresh surgical work down there.

Because my brain has turned it into "this is just how it is now" it's a little hard for me to remember to do scar care, so they're probably a bit bigger than they would be if I was diligent about it, but again, as far as my own feelings about it?  So far they aren't a big deal at all.

The surgeon does have some plans for flattening it out more if (the way he talks, "when") I lose weight (he didn't even once bring up my weight before surgery but keeps bringing it up after, as if he's bewildered that getting my breasts removed didn't naturally result in fat loss elsewhere).  I'm also pretty sure he forgets I'm not on hormones every single time we meet because he talks about it as if I'm still going to be experiencing regular changes to my body that reverted years ago.

Although I'm happy with how the surgery turned out, I'm wary of actually recommending this surgeon to anybody without a lot of heavy disclaimers, because so many people in the top surgery forums I've posted in were specifically looking for doctors who weren't going to fat shame them.

I haven't taken my shirt off in public public yet, although I have a YMCA membership now specifically so I can swim so we will see how that all turns out.

Anyway, not a huge update today, but wanted to get what did happen in there.
Happy trails,
-- Setkheni

Saturday, December 15, 2018

Two Week Top Surgery Update

It's about two and a half weeks since I got top surgery, which according to a chart I stole from another trans man off the internet means I'm in the "critical and nit-picky" stage.  I wouldn't actually call myself critical or nit-picky, but the original rush of "holy shit this is finished" is gone now, and with the end of the painkillers there's a lot of discomfort to attend to.

First, the good stuff:  Because I went for a year thinking I did not have top dysphoria, I had come up with a hypothesis as to why it seemed to go away and come back.  I discovered that my main source of top dysphoria was due to the way clothes fit... I wasn't distressed by seeing my breasts when they were bare, but seeing the way clothes warped over my chest did cause distress.  Anyway, looking at the mirror now when I am wearing clothes, seeing that everything fits better, noticing that the print on my shirts is actually visible, it makes me smile every time I see it.

Anyway, yeah... the discomfort.

I wound up modifying a post-op binder so that it fits better... I'd measured my chest before buying it, but these things aren't made for fat people, so I wound up having to cut it off below the chest and then modify it so I could choose between four tightness levels.  Now I can wear that throughout the day, but it's still too tight to wear at night without waking up in a panic, so I wear a right sports bra instead.  All of week two this went fine, but starting at the beginning of week three, sleeping is extremely uncomfortable; I have been sleeping on my side since getting the drains removed with the help of a big pile of blankets to hold onto, but throughout the night I'll feel random pains that cause me to want to switch position.

I'm very tired all the time.  I had this lofty goal to blog a lot at a different blog, and have not even gotten one post done because there's just too much thinking involved in that particular subject!  The transition-related stuff isn't difficult to write about because it's all stuff I'm feeling right now, but anything needing more brain-power and I just stare at the screen and want to go to bed.  I did have an "incident" yesterday where my roommate's dog decided to run away; without thinking I sprinted for a short distance to get him, and subsequently felt like I was going to die.  So he's going to be on a leash now, and I've been just chilling.

I also have been having a lot of nipple pains and grossness.  They scabbed around the edges, and those scabs are now gradually falling off (I'm relieved that my dermatillomania has been easy to control through this experience and I haven't been clawing those scabs).  The right nipple is still bunched up, although the left is now unfolded and looks relatively normal.  Both of them are the same color they were before surgery, outside of some lighter areas where scabs used to be.

There are still waterproof dressings over the incision lines; once that gets taken off I'm sure I'll get a better idea of how my chest is going to sit.  As it is now, it feels like they're kind of providing support and pushing things up.  Some areas are pulling up and I can see kind of where there are some "puckers" where the skin came together; they are small and probably will go away as I heal over the next year; if they don't, it'd be a very easy revision, if I even feel like I need it.

At the outer edges there is some solid... stuff.  I'm not sure what it is, whether it's some kind of swelling or buildup or what.  They are not painful and are shrinking, so we'll see at my next appointment in a week and a half what the doctor thinks.

So that's it for now.  Happy trails,
-- Jackson

Wednesday, December 5, 2018

One Week Post-Op Results

What could be beneath these bandages?
It is after the jump!
So I was going to write about things as they happened, but then I went and lost my computer cable so you get an after-the-fact update instead of a during-the-fact update.  Anyway, I had my top surgery on November 26th.  This is that story.

I had a pre-op appointment two weeks before the 26th in which I locked in a nipple-sparing surgery (also known as pedicle-sparing, pedicle graft, etc.).  I was warned there would be more tissue left over because of the breast tissue on the pedicle, to which I responded that I'm fat and so some extra tissue will just look proportional.  I was also warned there would be a vertical scar; basically, I was supposed to get what trans men usually call a "T-anchor" or "inverted T" procedure.  When I was still trying to go to a top ten doctor, this is the procedure I wanted, so I said "let's rock and roll" and we locked it in.

The week of Thanksgiving my roommate got sick and I had a little freak-out because I had been told I would need to postpone surgery if I got sick.  So I wound up cutting off my deer hunting early (I went three days instead of the six I expected) and basically hid in my room the whole week, desperately trying to avoid every sneeze I could.  This mostly worked and that Monday I was at St. Liz's getting prepped for surgery, with my girlfriend (who would be caring for me that week) and later my roommates (well, they showed up while I was under).

Everybody at the hospital was super nice, and the nurses were enthusiastic about having a trans patient because to paraphrase one of them they are so used to having to work with people who are there for some horrible reason and it's nice to work with somebody who wants to be there.

There's a jump here because there is a picture of my before breasts; click on it to read the rest of the story.

Saturday, November 3, 2018

November 26th... That's The Date!

Each ring represents a day until
top surgery; I tear one off each morning.
This is a top surgery update, but I wanted to address something that I noted in my last post.  I said I had a weird skin issue I assumed was due to hormones, but didn't give any detail.  It was actually a patch of darker skin (it looked like dirt but wouldn't wash off), which happened right after a weird hot flash, and... it did go away.  I put coconut oil on it.  I still don't know quite what it was.  It hasn't come back since, and I forgot until I re-read my last post that it even happened!

But here's a good update:  My top surgery is scheduled!  It was a real fucking mess dealing with my insurance, which didn't actually notice there was new documentation in the appeal the surgeon's office put in, then they decided the new request was a "duplicate" and closed it, and it was just an immense clusterfuck.  After pestering them and having the surgeon's office pester them I got a letter saying that they were authorizing the surgery, but then neglected to actually tell the surgeon's office despite my letter saying it was CCed to them.  I let the surgery center know, they called me back, and I got my date:  November 26th.

This was, by the way, my absolute perfect date.  When I was thinking about what date I'd aim for, I was trying to consider whether I wanted to sacrifice deer hunting (which comes but once a year and is an important event for me) or working Christmas (which would land me a huge paycheck).  There was only one date where I felt I could do both... and that was November 26th.  So I'll be going under the knife the day after a day in the woods, it appears, and when I get back to work it'll be on Christmas day.

Maybe.

See, after getting the insurance authorization and the date there was one more hurdle:  Short term disability.  I looked at the policy which said cosmetic surgeries did not qualify for short term disability "except for certain medically necessary ones," which I assumed was a euphemism although I found no trans-specific verbiage.  I put in the request anyway and had to muddle through everything because there wasn't an explicit option for "surgery" (It was either "injury" or "illness."  I regrettably picked "illness" because the questions in "injury" didn't fit.).

Then I flat out said in my form that it was for a gender transition surgery and sent faxes to the doctor to get that documentation in.  They accepted it right away, although they're only giving me two weeks.

I have a very sedentary job, but according to most of the folks I've talked to I'll probably still be super tired at three weeks.  My boss had already planned for four weeks, so when I told him this he said he's still going to plan for four weeks and then if I come back at two, great, or if I need reduced hours, I'll be accommodated.  He was concerned at the idea of me being gone longer than two weeks and not getting paid, but I think if I do need more time I'll just need to send documentation to disability insurance to extend the leave.  My roommate will also help me if need be.

(I probably mentioned this before at some point, but it's fairly easy when doing a background check on me to figure out that I am trans, and my boss's reaction when I said I was having surgery but didn't immediately say what it was for suggested that he probably knows what it's for already.).

All this complete I started acquiring the last of the things I'll need for recovery.  I have a husband pillow, a neck pillow, slippers that look good enough to wear outside if I need to go out, silicone bendy straws, dry shampoo, a bromelain supplement to help with swelling, CBD oil for pain and general well-being, a soil probiotic to recover after the antibiotics, and medical silicone tape to reduce scarring.  I already had appropriate clothes (I wear button-down woven shirts at work and they're too big for me to make up for not binding and I have a lot of pajama pants).  I'll get laxatives later on (anesthesia makes your gut sluggish so there are problems with constipation).  I might need a post-surgical binder... I can't really find any I like that aren't really expensive, so I think I'll wait until the surgery, see what I get from the surgeon, and then get one of the expensive ones if I think I need it.

I started a mealplan with meals my girlfriend can cook when she's up here to care for me, as well as a list of movies to subject her to.

A lot of my anxiety is gone now that I have a concrete date, but there's also a lot of shitty stuff going on in the world that makes it feel like it's further away than it is (it's less than a month, it's really soon!) so I stole an idea from Transgeneration and made a paper chain calendar to give me a more visual understanding of how close it is.  Each day I tear off a link and put it on my shrine; when it's all gone maybe I'll burn it or something, but the chain shrinks so rapidly and the pile of links grows so quickly that it's helping keep my mind off how stagnant and anxiety-riddled the rest of my life is.

Anyway, that's my update now.

Happy trails,
-- Setkheni

Tuesday, August 21, 2018

Anxiety and Top Surgery Update

I haven't updated in a while, not because nothing has happened, but because I have had some anxiety issues over the past couple months.  I'm kind of missing that honeymoon period after giving up testosterone where everything felt fantastic (although I assume I'd probably feel worse if I was still on it, as every anxiety was higher on testosterone for me).

I've gotten a couple comments from folks who found me on Twitter (I had to edit this because I forgot I even put my Twitter account in my bio, ha!).  Soooo you finally get an update.

I haven't scheduled top surgery yet, because I got my letter much later than I expected and my insurance appeal hasn't come back yet.  I've been antsy waiting for it, but it's not that late and from talking to my friend who went to the same surgeon, he was able to schedule something very soon after getting the prior authorization.

I have definitely decided on getting the nipple sparing surgery after thinking a lot about it.  I vlogged about it on my YouTube channel (if I remember right), but as soon as I thought I'd committed to getting no nipples I had what I call NIPPLE PANIC!  Basically my nipples started feeling... not pain, but I was hyper aware of their existence, like they were rebelling and telling me "don't you dare murder us."  It kept me up at night for a few days and I realized that the threat of possibly getting a chest that is less flat than I want (which can be fixed through revision or, if I'm really unhappy, another surgery) is much less dire than the threat of losing something I absolutely won't be able to get back.

I also have yet to see a radical reduction/nipple sparing surgery that I would consider "botched" if it were on me.  I looked at a lot of these, and in addition to the fact that I don't actually think they look bad at all on the bodies they're on (it's obviously up to them to decide if they like the results or not; I happen to think they look great) I'm much larger than they are.  I already pass topless because I'm fat and my boobs just look like man boobs.  So I'm committed to the sparing surgery.

I have been having a weird skin issue that I strongly suspect is due to hormone issues common to an estrogen-dominant body.  I don't want to talk about it yet because I don't know enough about it (This Is Not Medical Advice and the like), but it appears to be largely a cosmetic issue that's going away.

Anyway, my anxiety ramping up of course made me think "is this going off hormones?!"  My impression is that it isn't, it's external-factor stuff.  I'm anxious because I really want to  schedule top surgery... once that happens I think a huge chunk of the anxiety will fade away.

The rest of the anxiety is all financially related; my workplace just had a major shift and my paychecks are fucked up for a while (I make the same amount of money but I get paid at different times, so the dutiful job I've done the past two years making sure my major bills fall right after I get paid is basically for nothing and I'm having to scramble to make ends meet (I'll be fine, but if you're not struggling and get something from this blog or my vlog I would appreciate tips in the tip jar).


Friday, June 29, 2018

Therapy and PSG

Last week (the week of the solstice) I went to Pagan Spirit Gathering, probably my favorite week of the year, and it dawned on me why I was confused into thinking I might not need top surgery:  That environment really tricks me in a way.  This isn't uncommon.  PSG and other Pagan festivals tend to change people's emotions in such a way that it's not rare for people to do things like stop medications during it (for better or for worse) thinking they've been "cured."  It is, after all, one of the instigators of my going off testosterone.

As far as my chest goes, PSG is a flurry of external and internal pressures... there is the pressure of wanting to live a natural lifestyle, only getting those surgeries I really need, with the perplexing external pressure of being somewhere clothing optional where by some miracle I actually still pass.  For all the jawing from truscum about how going off testosterone has changed me to the point where "everyone can tell," very few people actually can tell.  Even when I'm not wearing a shirt.  They just think I'm a cis man who is particularly fat and it doesn't occur to them they're not just average man boobs.

Case in point:  My girlfriend was literally asked by a guy why, when I kept going to the port-a-potty while drinking a little too much alcohol, I didn't just whip my dick out and piss in the woods.  That happened.

Anyway, it dawned on me that a huge part of my insecurity isn't really my breasts so much as the results of having them.  This includes things like clothing fit; I feel in some respects more dysphoric when wearing clothes because I notice the disparity in shape more.  In addition, I definitely am not comfortable going shirtless anywhere but PSG even though I probably could get away with it... even in my own household, when I'm around somebody who would be totally cool with it and who has definitely seen my breasts in-person before, I just can't do it, and the further away from PSG I get each year the more likely I am to do unhealthy things like hunch over and try terrible products designed to hide my chest.

So that's where I'm at now... it wasn't that I wasn't dysphoric, it was that the dysphoria was not the same as I expected it to be and that caused me not to recognize it as such.

Luckily, that will hopefully change soon.  I have updates.  Life comes at you fast.

So I mentioned I had a consult with a surgeon who indicated I would need a letter, and in fact my insurance is demanding a letter.  How do I know they are demanding a letter?  Well, the plastic surgery office jumped the gun and already submitted a prior authorization for surgery and then called me to state that I needed two letters from trans specialists to qualify.  I got the call literally ten minutes before I left for my first therapy appointment.

The two letters thing I'm fairly certain was a mistake, and I have a lengthy message on my phone from somebody at United Healthcare who didn't directly answer my question ("do I need one letter or two") and merely went through all the requirements, in which she definitely stated I needed only one letter, and that follows all the rest of their documentation as far as  I can see.  I called the plastic surgery office to inform them of it and we'll see how it goes.

How easy will it be to get a letter?  It turns out, extremely.  The therapist is writing one for me after one session and I don't need to go back unless I want to.  I explained that I did not get much out of pre-HRT therapy when I went on testosterone, but that I did get some value from post-HRT therapy and would be willing to call back if I need it post surgery.  She will be writing that in the next week or so and mailing a copy to me and one to the surgery office.  I had mentally budgeted for like three sessions which appears to be what most of my friends needed, so I'm relieved because costs are starting to... uh... mount up.  I'm surprised to get it after only one session, but also not terribly surprised because it's pretty easy to document how long I've been transitioning.

I've been slightly wavering regarding whether I want double-incision (which would not have nipple grafts) or inverted-T.  There's a particular type of inverted-T that is used for trans men and it's unclear to me if they know how to do that; I have seen their double-incision surgeries but also recently saw a really bad result of inverted-T on a trans guy that basically just looks like a reduction (not from my surgeon, but it convinced me that this is a surgery that really needs a trans specialist).  I think it would look fine on me now, but I still have a pipe dream of one day losing weight, and it won't look as good then.  It's also important to note that I have no erotic sensation in my nipples, so losing them and getting them reconstructed or tattooed later shouldn't be a big deal.  I've also seen his double-incision work on somebody with a body not unreasonably close to mine, and while I was scared of the appearance for a while, recent updates show it's looking better and better as it heals and I just need to remind myself that all surgeries look jacked up at first.

Finally, a co-worker accidentally opened up the conversation about leave with my boss for me.  He's going in for heart surgery soon and will be out for six weeks.  Somebody joked "remember team, only one surgery at a time!" to which I looked at my boss and said "Yeah, about that, I have something to tell you."  I went to his office and said I was going to have surgery requiring four weeks off but that I'd try scheduling it for about when the other co-worker came back.  It's a nice happenstance because he comes back at exactly the time I was planning on scheduling my own surgery (late enough to deal with insurance but early enough to have a stone's chance of going deer hunting in November).  Since I work somewhere we need to worry about coverage I was really worried about bringing it up, but it's all fine and my boss just told me to contact our disability insurance provider because they're the ones who set up leave ("Call right now! As soon as you leave the office!" he said, but we determined I should not call yet as I don't have a surgery date).

I also got the impression he might know what the surgery is for because he framed it as "I hope you are happier" rather than "I hope you get better," but I may just be reading too much into it; as somebody involved in hiring me I always assumed he had access to my background check and just didn't say anything.  But I guess that's irrelevant because I do a good job and people like me.

Anyway, that's my update for today.

Happy trails,
-- Jackson