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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

Friday, June 1, 2018

Expression and Sex Drive Changes

I mentioned (perhaps multiple times) that I've been feeling a lot more masculine lately and preferring that kind of expression more than I did when I first went off testosterone.  I'm kind of piecing together that part of the journey a bit, because I went from actively trying to express myself in a fem manner only to gradually have that desire fade away... there are certain outlets I utilize for it, but even those I am in some respect losing interest in.

My running theory is that a part of it was the high of going off testosterone... I was nervous about going off T, as I wasn't sure if it was going to make me dysphoric again or not, and when it didn't, I got a rush from that and was reclaiming a lot of things that cis people had shamed out of me through pervasive "let's help him pass better" negging in my early twenties.

"God, going off of testosterone was great! What else could I reclaim? My Girl Scout camp clothing? Nail polish?  Earrings? Eyeliner?!"  I did learn a lot about myself during this, and it felt great to say "fuck that" to the way I was treated in my twenties, so no regrets, but most of the high is gone there and trying to reclaim them further (outside of masc versions of them) just doesn't bring me that high anymore.

One thing I've noted is that in many respects I feel and express myself the way I did pre-T but without the constant undermining of my identity by cis people.

I'm still very much genderqueer (I might talk about this in a different essay I've wanted to write for a long time and haven't gotten around to), but I definitely feel more "man first" than I did a year ago.  I crave being masculine and I crave men's spaces and other stuff like that.

Some other things that could be going on... it could be that my hormones are changing (either due to the ovarian problems I was having before or due to just natural changes) in such a way that it's affecting my expression, or I could just be fluid and on the masc side right now.  Only time will tell, I guess.

Something that dramatically changed in the last month or so?  My sex drive has increased quite a lot.  If you followed that part of this journey at all, you know that going off T my sex drive almost immediately tanked.  On testosterone I was extremely orgasm-centered but had a really hard time with it, I'd go numb extremely quickly and would bleed during sex, and to make matters worse I had to deal with needing increasingly weirder mental imagery to do it.  All that went away off T, so although my sex drive was almost nonexistent, sex was better due to some reversion in the way my body behaved.

Anyway, it's way higher now.  Not the level it was when I was on T by any means (and honestly, thank Gods for that) but I'm reverting to probably about where I was before T, so I have a lot of fantasies, my tastes expanded more, I overall get aroused more.

I really like where it is now, and I hope it stays this way.  Since it was consistently where I was pre-T, I'm optimistic about it.  I definitely don't want to go back to the oversexed bullshit I felt on T, but having a sex drive as low as it was before was also not ideal.

Anyway, that's your sex update for the moment.

Happy trails!
-- Jackson

Wednesday, May 30, 2018

The Basic Four Ritual Tools

Recently I wrapped up my run-down of the four basic ritual tools from a more queer perspective. These are all in their own playlist on my YouTube channel, but if you want to view them all without leaving... here they are!

No, Seriously, You Really Don't Need Dysphoria To Be Trans


Last night, in the heat of greasy-haired passion, I filmed and posted a video about dysphoria... specifically, a little bit of a historical takedown of why you don't need dysphoria to be a member of the transgender community.  I also expanded that a bit to explain why dysphoria purists (trans people who believe you must have dysphoria to consider yourself transgender) are actually borderline appropriative: That word wasn't coined for them and was actively rejected by them for years.

You can of course watch the video, but if you'd prefer to read it, I've provided the script I used below.  It's not verbatim but all the main ideas are there.

--

Here's the deal: lately I've been really concerned with... community drama I guess?  It's not something that I've really dealt with for a while, I've been kind of out of the community loop, so when I started getting back into the community to learn more about top surgery I learned things that I guess I was kind of sheltered from, having been living my life mostly either stealth or around other trans and queer people who are as out of the loop as I am... there are a couple of things people have been saying that have been particularly bothersome to me because they are very ahistoric, and the way they are ahistoric is really personally offensive to me for reasons that will be explained in the rest of this.  I knew these perspectives existed, but I didn't know they had become as widespread as they are, especially among teenage trans people who I honestly never expected this shit from.

There are two main topics I'll be talking about here.  The first is the idea that dysphoria is necessarily a prerequisite to being transgender.  The second is that "transgender" is not an umbrella.  A quick note that although I did some quick Googling to confirm what I already knew... a lot of this is from memory as somebody who started transitioning long enough ago that I actually was there for some of the major events that make these wrong.

Recently I saw a young trans person--a seventeen year old trans guy--who tweeted a statement that was basically "well no shit Sherlock, of course you need to have dysphoria to be trans, it's right in the diagnosis: 'Gender Dysphoria.'"  And I seriously flipped my shit over this, because it's such an ignorant n00b thing to say, because "Gender Dysphoria" as a diagnosis didn't become a thing until like 2012.  Since I went on hormones before that, I actually wasn't diagnosed with gender dysphoria at all... I was diagnosed with gender identity disorder.

And the thing that makes my jaw just drop over this is that part of the reason they switched this diagnosis from gender identity disorder to gender dysphoria was explicitly to acknowledge that simply being transgender is not a disorder and that not all transgender people have dysphoria.  They weren't saying that people must be dysphoric to be trans, they were literally saying the opposite: That the only trans people who need to be medicalized are the ones who have dysphoria, and that the dysphoria itself is the disorder, not the gender.

This is a quote from Jack Drescher, who literally was member of the committee responsible for making this change:
“All psychiatric diagnoses occur within a cultural context. We know there is a whole community of people out there who are not seeking medical attention and live between the two binary categories. We wanted to send the message that the therapist’s job isn’t to pathologize.”  End quote.

That's literal proof that using the diagnosis title of "gender dysphoria" as a weapon against non-dysphoric trans people is historically inaccurate.  I was there and Drescher's analysis here?  It's exactly what I remember.  There was no point during that change in which any of us thought it was to solidify dysphoria as a requirement for being transgender.

Another quote, this one from Dana Beyer who was working with the Washington Psychiatric Society:  “A right-winger can’t go out and say all trans people are mentally ill because if you are not dysphoric, that can’t be diagnosed from afar.  It no longer matters what your body looks like, what you want to do to it, all of that is irrelevant as far as the APA goes.”  End quote.

Basically, transgender people lobbied like hell to get the diagnosis changed because when folks my age were diagnosed, we were given a label that implied that our genders themselves were mental disorders.  The switch not only moved the focus on things that actually mattered, but it reinforced that non-dysphoric trans people--including certain nonbinary folks, binary trans folks who don't have dysphoria, and trans folks who have already sufficiently transitioned already--exist and are not disordered at all.

But here's where it gets doubly insulting:  The fact that truscum slash transmedicalists are even trying to claim the term "transgender" at all is borderline appropriation.

The word "transgender" was independently invented a couple of times... there was a time long ago when it primarily meant somebody who lived as the "opposite" gender full-time but who did not desire sex reassignment surgery, often people who still identified as their assigned sex but who were full-time crossdressers, think Angel Dumott Shunard from Rent and you get a good idea.  During this time period, trans medicalists would not have touched this word with a fucking ten foot pole, and yet they want to monopolize it now.

As an umbrella the word transgender became popular in the 1980s and 90s, popularized by folks like Leslie Feinberg.  It was an expansive umbrella... it included binary trans men and women but also pretty much anybody else who significantly strayed from their assigned sex.  When I came out and started navigating the trans community back in the early 2000s, the word "transgender" was an expansive umbrella.  When I used to educate local queer groups about the transgender umbrella I would flat out list as members not only trans men and trans women but genderqueer people, genderfuck people, bigender people, and even drag performers and crossdressers.  And the folks who we would now call truscum or transmedicalists?  They didn't want any part of it.  It wasn't that they thought they should be the one true transgender people... they didn't want to be called "trans" at all.  They were calling themselves absurd things like "sufferers of Harry Benjamin Syndrome," if they wanted to be called any variation of "trans," they were transsexuals and did not want to be called transgender.  Fun fact... the word "transsexual" wasn't only limited to binary dysphoric trans men and women at first, either.  But I digress, this is about the word "transgender."

This is why there's a level of appropriation here... this is an ideology that has been around for a while, but has spent *decades* trying to stay as far away from the word "transgender" as possible, only to suddenly try monopolizing it as soon as it's beneficial for them to do so?  And I get that a lot of these people are quite young and weren't around when these shifts were happening, but it doesn't take much to actually talk to trans people who are more experienced than you, and if you're going to make blanket statements like this that have the potential to incite harassment and possibly even ruin people's lives, I expect you to at least learn the history of the words you're trying to lay claim to.  And in this case, it just doesn't follow.  It makes no sense.  It's entirely ahistorical for truscum to call "transgender" theirs and theirs alone.

Finally, I want to talk about all of this as it is "in practice."  One of the problems with trans-medicalist ideology is that it's like a lot of bullshit ideologies... there are some ideas there that look good on the surface.  For instance, claiming that dysphoria is necessary to be transgender doesn't seem so ridiculous when you factor in that a lot of us think that we aren't dysphoric when we really are... if you want surgery or hormones, for instance, you're almost definitely experiencing dysphoria on some level otherwise you wouldn't do that.  But because of the way this argument is set up, truscum try to be the gatekeepers of what constitutes "dysphoria," too, and they tend to change that bar depending on whatever would exclude the person they're trying to invalidate at that time.

For instance, I was goaded into an argument with a couple truscum where I was basically begging them to acknowledge that I was a valid trans person because I had been dysphoric in the past--even though I wasn't dysphoric anymore at the time--and that if I hadn't gotten hormones I definitley would still be dysphoric.  But they didn't like my transition methods and so they changed their already-bullshit standards specifically to exclude me.  Plenty of people experience dysphoria that is relieved by a change in expression, name, and pronouns rather than hormones or surgery... this should count as transgender just fine, it's still dysphoria, and yet truscum often exclude these people.  There have even been some super insulting cases where people have insisted somebody wasn't truly trans for not going on hormones or getting surgery when the only reason they weren't doing those things was because of access issues and not desire.  This is infuriating as fuck.


I know that the likelihood of me converting any dipshit truscum over to my side is slim, but at the very least, if you're in the position where you don't feel dysphoria or--more likely--you don't feel dysphoria in the way some truscum believes you should, I hope you find this video so that you can rest assured that, yes, you are a valid trans person.  And coming from me that's a big thing... I am notoriously critical of the Tumblr culture that tries making every identity endlessly valid.  In this case, though, they are definitely the ahistorical ones.

Happy trails,
Jackson