1. Cut open my penis.
2. Remove the spongey erectile tissue. Make sure to leave the nerves and blood supply intact! We’ll need those!
3. Invert all that stuff up into my pelvic cavity.
4. Use that tissue and blood supply to make me a brand new clit.
5. Shorten my urethra – won’t be standing up to pee anymore!
6. Take the extra scrotal tissue and shape me a good labia.

Perfect! Now that’s what I want to see when I look in the mirror.Vaginoplasty, the surgery described above and what most people mean when they say “gender reassignment surgery,” is terrifying. My cock is a sensitive thing, even more so since going on hormones and getting more in touch with my sexual self. Even if I’ll be under anesthesia, the idea of all that happening to me – the cutting and the slicing and the moving about – is scary. Terrifying, even. Violent. Bloody-sounding. The type of thing out of a horror movie, not a consensual and desired and medically-accepted surgery.

We pretend surgery isn’t violent. That knife-to-flesh is an act of healing, of care. We need to, to get through it. I need to, anyway. And I will admit that surgery is controlled. When it’s done right, it’s not messy. But cutting and blood and pain and recovery necessitates an act  of violence. To recover, to have recovery time, means that there is something to recover from. The scars on my stomach, from my gallbladder removal, are the result of an act of violence. Pain-relieving, potentially life-saving (had the infection spread), and absolutely necessary violence.

The Surgery requires about a week in the hospital – a week, in this day and age of outpatient surgery – and months of post-op recovery. It costs tens of thousands of dollars, plus travel and assorted fees and random expenses. There’s a possibility, albiet a very small one,  that Il’l never be able to orgasm again. I know the general consensus – from among surgeons, post-op trans women, and my therapist – is that the ability orgasm is extremely common with modern surgery, and even more likely if the woman is orgasmic and actively sexual pre-surgery (which I am).

But still, the possibility of never being able to cum ever again, and paying twenty thousand dollars for the privilege?

So why am I doing this? Why am I researching surgeons, with the hope and intent of having The Surgery in the next 12-18 months? What the hell am I thinking?

I hate the cliches surrounding The Surgery: That it makes trans women feel complete. Whole. Like themselves. At home in their body. All the things you hear on talk shows and newscasts and radio and best-selling tell-alls.

And yet, for all the pride I take in my ability to use words to communicate how I feel, I’m struggling to come up with a better justification or explanation for why I’m planning to have The Surgery. Gender reassignment surgery. A vaginoplasty. To have my cock turned inside out, and become a cunt. I’ll go into a magical sleep, the vagina fairy will fly through the window, and I’ll wake up with an innie instead of an outie.

In some ways, it’s a logical and natural continuation down the path I’ve been traveling: hair removal and hormones and growing my hair out and makeup and dresses and presenting (and usually being perceived as) a “real” girl. Perhaps the question I should be asking is “Why wouldn’t I want The Surgery?”

(I want to take a moment to clarify that I do not think all trans people “should” or need to have any sort of surgery or medical intervention to be trans or to be happy or to be “real” men, women, or anything else. I am speaking only of my own experience, and my own journey.)

What frustrates me is that there’s something of an inability to fully feel something if you can’t express the feeling. George Orwell knew this:

In the end we shall make thoughtcrime literally impossible, because there will be no words in which to express it.

Language matters.

Lets try this: I want surgery because….

• …when I imagine my idealized or ideal body, I imagine it with a vagina and not a penis.
• …I want to feel someone, something, myself, you, us inside my cunt.
• …I want to be able to wear tight clothing and bathing suits and dresses without resorting to tucking.
• …it would make me feel less different from other girls.

(Yes, I know that last sentence is problematic. Some of my favorite “other girls” in my life have cocks, too. But I’m trying to be honest with this list, even if my emotions or desires don’t always match my politics, and not self-censor.

Perhaps we use such cliches – at home in my own body, whole, complete – because language simply fails us. Difficult as it is to contemplate, maybe I don’t have the words to explain or justify why I want The Surgery.

But there is beauty in transformation. Flowers, butterflies, the changing of the seasons, growth and strength, the rush of blood and tightening of flesh. Of making myself who I am. Chipping away at rock until the final sculpture is made clear.  Hopefully I’m going in the right direction.

I think I am.

During the workshop, however, something came up that I had not previously considered. Specifically, someone asked about how trans youth are (medically) treated. I said that it varies, but that there’s an increasing use of hormone blockers to delay puberty. This allows a twelve or thirteen year old to age a few years and – hopefully – be able to make a more informed decision about transitioning. In my I-am-not-a-doctor opinion, it’s a good compromise: simply doing nothing can result in spending thousands of dollars to undo puberty, but launching fully into hormone replacement therapy opens the door to a twelve year old realizing they weren’t really trans at thirteen or fourteen.

Ultimately, I said to the questioner, there isn’t a perfect solution. Once a child realizes they’re trans, it’s a matter of picking the best choice from some bad options. Which, to be very clear, doesn’t mean that being trans condemns an individual to a life of misery. But it does, as far as I can see, necessitate some tough decisions and a difficult journey.

The questioner then posed something that has been bouncing around my brain this past week: Could allowing fifteen and sixteen year olds to be making informed consent decisions about their healthcare lead to the criminal justice system saying they were able to make informed decisions about crimes, and should thus be tried as adults?

I don’t think she was talking specifically about trans youth committing crimes, but looking at things from a more general question angle. That is, how do we as a society determine in which areas teens are able to make life decisions, and in which they’re not?

For the record, I am very against youth being tried as adults or sentenced to death.[1] At the same time, I do think teens should have some say over their healthcare. In particular, I know what my decision would have been had someone asked, “Do you want to go through puberty as a boy, or wait a bit and go through it as a girl?” There wouldn’t have been any question in my mind. But how do we – or can we – distinguish those areas of judgement?

The first thing that leaps to mind is the difference between “this decision impacts myself” and “this decision impacts others.” Transitioning, at its core, is about changing the self. Crime, at its core, is about impacting others. Which is really why crimes are, well, crimes.[2] So there’s a difference between a teen saying “I know enough about myself and my actions to change my body” and society saying “a teen knows enough about how their actions will impact others externally, so their crime should result in prosecution as an adult.”

But I know it’s not that simple. I can – looking back – say with 100% certainty, “I wish I had transitioned earlier, and I really wish I hadn’t gone through  puberty in the first place.” I know lots of trans people who would say the same thing. At the same time, as an educator who works with teens, it’s scary to think of a student of mine (let alone a child of mine) making such big decisions. Kids’ identities change so much from day to day, that – as an adult – believing something can be that constant feels like a leap of faith.

I suspect that one’s sense of gender, however, is fundamental enough and develops early enough for most people that – by fourteen or fifteen – they do know who they are. Or, at least, they can. Even if they don’t know how they’re going to express themselves, who they’re going to sleep with, what they want to do when they grow up. They can know who they are.

We can know who we are.

[1] – I’m also against the death penalty, period, but that’s only tangentially related to this topic.
[2] – This is why, in my opinion, drugs and prostitution should be legal, regulated, and safe.

I really transitioned to get into bars for free, without having to pay cover.

I really transitioned because I heard there weren’t enough women in science, and I wanted to do my part.

I really transitioned so I could drink sweet pink drinks at bars without being judged.

I really transitioned because when I paint my toes pink, I want to be a boy with pink toenails!

I really transitioned so I could wear tight pants all the time without looking like a member of an 80′s rock band.

I really transitioned because I wanted to save on car insurance.

I really transitioned because the clothes are *way* better (so i still wear BDUs and t-shirts most of the time)

I really transitioned because I was born on Stonewall Day.

Exclusions. Covered expenses of the Plan shall not include … procedures, treatments, equipment, transplants, or implants, any of which are … for, or resulting from, a gender transformation operation. – 215 Illinois Compiled Statutes 105 – Comprehensive Health Insurance Plan Act

It’s unclear whether the State of Illinois has defined – through statute or the courts – what specifically “gender transformation operation” means. But it seems pretty safe to assume that the surgery I’m currently considering would fall under its purview. Surgery in which the “spongiform erectile tissue of the penis is removed, and the skin, with its nerves and vascular system (blood supply) still attached, is used to create a vestibule area and labia minora, which then are inverted into the neovaginal cavity created in the pelvic tissue.” That seems pretty gender transformative to me.

What’s interesting about the Illinois Comprehensive Health Insurance Plan Act (or the ICHIP Act) is what other injuries, procedures, and categories of coverage are excluded.  Gender transformation operations (item 14.iv on the list of exclusions) is lumped in with cosmetic surgery (item 1), anything which exceeds “reasonable or customary” cost (item 4), injury due to war (item 9) , services that are “not provided in accord with generally accepted standards of current medical practice” (item 14), contraceptives (item 19), weight loss programs (item 21), acupuncture (22). Interestingly enough, the act itself does not, as best as I could find, mention abortion or early termination of a pregnancy, but the ICHIP website stil says such services are excluded.

And then there’s my favorite exclusion. Item thirteen. “Blank.” The item isn’t actually blank, but the text reads open-parentheses-b-l-a-n-k-close-parentheses. Blank. I’m assuming there was an item thirteen, but it was removed by some later amendment I’ve been unable to find. Either that or the Illinois State Legislature was worried about the superstitious ramifications of having an exclusion number thirteen. But that seems unlikely, because there is a benefit item number thirteen (diagnostic x?rays and laboratory tests). The ways of government legislatures are opaque and confusing.

As far as I can tell, gender reassignment surgery (or gender transformation operation, or sex change, or whatever you want to call it) is the only accepted standard of medical practice (to use the ICHIP ACT language) explicitly excluded. Nowhere else did the Illinois Legislature say, “Doctors recommend this treatment. There are safe and reasonable guidelines for its use. It has been shown to be beneficial to patients. But there’s no way in hell we’re going to pay for it.”

Because the Illinois State Legislature is obviously the best-equipped body to decide medical coverage and treatment.

I talked to my lawyer, who said this isn’t great news – that would be if Neal decided to cooperate with the EEOC from the beginning. But it does mean that the EEOC hasn’t forgotten about my complaint, and hasn’t (yet) said it’s not under their jurrisdiction.

In other news, my dad sent me a Chicago Tribune article about Dr Schechter, a plastic surgeon in the Chicago suburbs who does gender reassignment surgery. This is very interesting to me, since the only folks I’d found doing surgery were decidedly not in the Chicago area. At the same time, the fact that I haven’t heard of this guy makes me hesitant – all the doctors I’ve been researching are well-established, with reviews online over at this site. The article also says Schecther works with the Drs Etner, who I’m not fans of.

Has anyone heard anything about him? Positive or negative?

Hopefully won't end up in police custody like she did, tho.

I talked with my therapist recently about ‘the rest’ of transitioning. I don’t mean The Surgery, although that’s something which is still on my mind, I mean moving from actively transitioning – changing my name, going on hormones, fretting about levels, watching my boobs grow, constant hair removal – to simply living as a woman. (As if living were ever simple, for anyone.)

More specifically, I said I’d been having trouble getting motivated lately. Sure, I could spend extra time doing my makeup, extra energy wearing a skirt, extra effort walking in heels. But I’m never going to look like Mexico’s beauty queen over on the right (using her as an example simply because she came up when I did a Google Image Search for ‘beauty’) so why not just throw on jeans and a t-shirt?

Laura, my therapist, smiled and said that’s part of what being a woman is all about.

Except I’ve become very used to the idea of transition as moving toward something: getting hair removed, growing breasts, buying a new wardrobe. The idea that I’ve arrived (or am close to arriving) at status quo, at whatever ‘normal’ is going to be for me for the foreseeable future, is battling it out with internalized transphobia and, more simply, internalized desire for the unobtainable female ideal.

On good days, I’m able to remind myself that I’m not only attractive “for a trans woman” (whatever that loaded statement means) but simply attractive as a woman. Touring this summer demonstrated that; it may not be that all the girls wanted me, but enough did to be a boost to my confidence.

On bad days, however, I feel stuck. As if I’ve reached my asymptotic height. And while convincing myself that transitioning was possible has helped keep me sane for so many years, I now need to put the breaks on that line of thinking: there is a limit to how I’ll look, determined by genetics and biology. I’m never going to be 5’6″ and 120 lbs, or have a 36-26-36 figure.

But that’s OK. I’m working on it being OK.

A generic surgery

Yesterday I schlepped out to Be All Chicago for a brief consult with Dr Meltzer, a surgeon from Arizona. (Side note: I didn’t actually register for or attend Be All for a few reasons. First, while it claims to be a “Chicago” conference, it’s actually in Downers Grove. Second, it caters to a significantly older audience, which isn’t a bad thing by any means, but doesn’t make me feel a huge desire to attend.)

Back on track, Dr Meltzer is on my Short List of doctors I’ve researched and would now like to actually meet, or at the very least speak with. Others on the list include Dr Bowers, Dr Reed, Dr Alter, and Dr McGinn. If you’ve heard anything about any of these doctors – positive or negative – please let me know.

I liked Dr Meltzer from our first introduction. A big part of why I want to meet with doctors, perhaps the biggest part, is to see if we ‘click.’ All the doctors I’m looking at have a large enough history and enough reviews that I know they’re not simply back-alley charlatans. But a lesson from having my gallbladder our – where I had no choice of doctors, cuz it was emergency surgery – is that clicking with a doctor can make you feel safer and more comfortable.

We met in Meltzer’s hotel room with his assistants, and talked about the experience at his clinic, how the process would work, and son on. On a first visit with Meltzer, he performs a vaginoplasty to construct the vagina itself. This costs about $24,000(!!) but includes a nine day stay in the clinic, all on-site treatment and meds, custom-made dilators, and so on. Basically, everything but transportation and any post-visit prescriptions. He recommends staying in an area hotel for an additional day or two, to make sure you can get around on your own when not surrounded by hospital staff. He says 85% of his patients report being able to achieve orgasm post-surgery, a number which is good but still kinda scary. I like orgasming!

Dr Meltzer then provides, at a patient’s option, a labioplasty (a pretty-ifying surgery) at least three months after the vaginoplasty, for an additional ~$5500, which includes a single night in the hospital. Meltzer doesn’t specifically require or recommend a labioplasty, but does say lots of patients prefer it to create a more  visually appearing vag.

Meltzer is currently booking 4-6 months out, with longer waits for holidays or high-demand dates. He also showed me a book of photo results which, I gotta say, mostly looked like vaginas. (Definitely a good thing!) It was also interesting to see how the before/after shots of the labioplasty made a big difference on appearance.

As for ‘what’s next,’ right now I’m just filing all this information away. I like Meltzer a lot (he had a son at NU while I was there, though we never met) and he was super personable.  At the same time, I’m a compulsive comparative shopper, and want to meet with at least a few other surgeons before making any decisions. Likewise, Meltzer said his office would send some contact info with patients who are willing to speak about their experience, so hopefully that’ll give more info, too.

And, of course, I now need to start thinking about how to raise ~$30,000…. Any suggestions? A “Farewell to the Phallus” party?

Serum estrogen levels measures all estrogens in your blood whether given as an Rx, or produced naturally. Estradiol measure a single type of estrogen that is made naturally in a genetic female. So, for our purposes estrogen is what we measure.

In the meantime, I’m down to 3 pills (6 mg) a day, from the original 10. Hopefully I won’t start sprouting gorilla hair.

First, and something I’ve thought a lot about in the past, is the question of how to handle trans minors. As an educator and a trans person, I have a very conflicted view of this. On the one hand, as a trans person, I absolutely believe it’s possible to ‘know’ that one is trans before hitting 18. Access to medical care and hormones prior to 18 can make a huge difference in the ease and emotional success of transitioning. At the same time, as an educator, the idea of allowing teenagers to make such fundamental choices about their bodies worries me. I feel super hypocritical expressing that worry, since I would have been offended had someone questioned my trans identity (and, indeed, was offended when I had mediocre therapy support from folks who did question my identity). But what should the guidelines be for handling people who are not necessarily in a legal position to make their own decisions?

More broadly, the discussion got me thinking about whether or not healthcare is a fundamental right.

I want to be clear: I believe modern governments have a responsibility to provide healthcare to their citizens. I think the Obama health care plan didn’t go far enough, and support a single-payer socialized health care system. But I’m not convinced I have a right to such a system, even while I’m convinced it’s in the best interests of society to provide such care. Using the language of “rights” seems to dilute the idea of rights as something inherent to being human.

For example, I believe individuals have a right to free speech. But I don’t think governments are required to provide a venue for speech, they simply need to prevent censorship. (“Simply!” Ha!)

Likewise, I do think individuals have a right to a healthy environment – free from pollutants, poisons, and so on – since your right to act as you will doesn’t (in my opinion) extend to a right to negatively impact me.

But I’m hesitant to go a step further and say “I have a right which only makes sense if there’s someone else to provide a service.

At the same time, I’m in a super privileged place to be able to say that. A right to free travel (for instance) becomes somewhat moot if traveling is made prohibitively expensive. Likewise for healthcare. And I’m not sure how much the language matters since, as I said, I do believe governments should provide socialized healthcare.

But language is important, especially about such fundamental things as ‘rights.’