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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