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.

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?

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?

Not so coverage of the same story in Australia’s Herald Sun:

Lyralisa Stevens, who was born male but lives as a female, said in a suit filed in San Francisco’s 1st District Court that the removal of her male genitalia and subsequent transfer to a female prison were necessary to save him from the threat of harm, the Los Angeles Times reports. (Emphasis added)

Well, no, actually the LA Times said the suit claimed the surgery was necessary to save her from the threat of harm. But the token “her male genitalia” is the only nod the article makes to the prisoner’s gender – the rest of the article uses male pronouns, and even goes so far as to say “In supporting documents, psychotherapist Lin Fraser – referring to Stevens as “her” – said she held “grave concerns” for Stevens’ safety because the inmate “had been put alone in cells all night long with men who threatened and abused her,” the Los Angeles Times reported.” (Again, emphasis added.)

Fuck you, Herald Sun! Fraser is referring to Stevens as female because – imagine that – it’s the respectful thing to do!

But both papers avoid the larger question: should the court require state-provided SRS?

US courts have ruled that, if you enter the penal system on hormones, you should be able to continue those hormones. I think that’s pretty clear cut, and wholeheartedly agree with the decision. Likewise, if any prisoner is suffering from harassment, sexual assault, or rape, something needs to be done.

But why the hell is Stevens in the mens’ prison to begin with?

From the LA Times article:

Stevens, 42, and her expert witnesses say that surgery is medically necessary, and that removal of her penis and testicles and transfer to a women’s prison are the best way to protect her from rape and abuse by male inmates.

It would seem to me that the best way to protect her from rape and abuse by male inmates is to remove her from proximity with male inmates! (Duh!)

But wait:

California law requires prison administrators to assign the state’s nearly 162,000 inmates to men’s or women’s institutions based on “gender,” which officials determine solely by a prisoner’s genitals. Richard Masbruch, who tried multiple times to castrate himself while in a Texas prison and eventually succeeded, is in the California Institution for Women in Chino. Masbruch, who goes by the name Sherri, was transferred from Texas to serve 40 years for a 1991 rape in Fresno.

Well that’s fucking stupid. Why not find a better way to determine gender than looking between someone’s legs? (Which, if you’re reading this blog, you probably know leads to HUGE problems!)

It’s not clear, though, if the officials determine gender by genitals because they have to, or because they chose to. Either way, changing that policy seems cheaper and easier than providing SRS to prisoners.

Because, I gotta be honest, I feel for trans folks in the criminal justice system. They’re treated like shit and all too often physically and sexually assaulted. But I’m really conflicted as to whether or not protecting trans inmates should extend to surgery.

My immediate reaction is that no, it shouldn’t. Whether prisons are supposed to be places for punishing criminals or reforming them, I’m not sure surgery for trans folks is necessary for either of those outcomes. At the same time, I’m not a mental health professional. I don’t know how Stevens is doing in her body right now, how her mental health is.

But it seems like fighting for relocation to a women’s prison, without fighting for surgery, would be better in lots of ways.

So what have I found? Here’s the list of doctors I’m most actively investigating:

Dr McGinn – Pennsylvania

Dr Bowers – Colorado (but moving to California some time within the next year)

Dr Brassard – Montreal

All three have mostly positive comments from patients, and seem like they have their shit together. (I haven’t been able to find any docs with exclusively positive comments, but I don’t imagine that I will.) I like that Bowers and McGinn are both trans, which gives something more of an emotional connection. I’m also going to own up to my inner sexism, and say I like that McGinn and Bowers are trans women.

Going doctor by doctor…

I like McGinn’s website. In my own (artistic) career, I’m realizing how important that first impression is, and I think she succeeds. I also like how straightforward her info on vaginoplasty is, including an FAQ about orgasms post-surgery, electrolysis, and more. McGinn also prominently lists her prices, something that may seem kind of crass to some but feels very open and honest to me. That’s one of the factors I’m considering, and I appreciate her being blunt about it.

Bowers also has a very functional website, with good information and FAQs. I like that she recommends laser hair removal, which fits with my own experiences of laser. So far as I can tell, she doesn’t list prices (please correct me if I’m wrong!) which I find a little frustrating.

I like Brassard’s website the least. It’s all Flash-based, which I find incredibly obnoxious. I also think the text is unreasonably small, and the design difficult to navigate. He does present good information, though (if you can find it…) including a nice diagram of how GRS works. No pricing information, so far as I can see, and no before-and-after photographs, something Bowers and McGinn both have.

All three are about the same distance from me, 800-1000 miles from Chicago. From the little I’ve looked into it, Bowers is the least accessible by plane, being in a small Colorado town (at least until she moves). McGinn is near Philadelphia, and Brassard is in Montreal, both of which wold be easier to get to/from.

I found some reviews/feedback for McGinn, Bowers, and Brassard at a trans resource site, and they all have similar ratings. Brassard has the most ratings, McGinn the least, which (from what I could gather) reflects how long they’ve all been practicing.

From talking with my therapist, her recommendation was, basically, do a consult with a few different doctors (if financially possible) and choose whoever you click with the most. She was saying that, at the level I’m looking at (i.e. not back-alley doctors) there isn’t going to be an “obvious” choice, so I should go with whoever makes me feel the most comfortable. That advice makes a lot of sense, even though it counters my (unrealistic) desire to always have an “obvious” winner when comparison shopping.

So I’m hoping to start looking into travel possibilities, once my show is done, and try to get some consults within the next few months. Eeek! (I have another post in the pipeline about how all this research is making me feel…)

Yeah, it's a little cheesey. What do you want from me?

Transitioning, for me, has primarily been an experience of moving away from things. At every stage, I’ve thought about how unhappy I was, not about how things would be better if I did XYZ.

I went into therapy because I was miserable, not because I was particularly sure I could be happy. I went on hormones because presenting and living as male fit me horribly, like an itchy and too-tight outfit, full of pins and needles. Not because I thought I’d succeed as living as a woman. I underwent hair removal because being hairy felt all wrong, not because I thought being smooth would be pleasant.

Fortunately, I was wrong about those things: When I reached whatever minor goal I’d set for myself it was better, not simply “less bad.” But my thought process was still about moving away from things – a false presentation, hiding something, masculinity – not moving toward anything.

I’ve been continuing to think about The Surgery. And I’ve realized that, for the first time in my transition, I’m interesting in moving toward something rather than away.

Scalpels and scissors and SCARY!

I’ve talked about The Surgery before (most recently here) and I know that I’m much more interested in SRS than I was two years ago, let alone ten. But this is the first time I’ve considered it in terms of ‘moving away’ versus ‘moving toward’ something. To be honest, it’s kind of a scary proposition. I’m so used to thinking about what’s wrong in my life, what makes me unhappy, that thinking about what could make me happy seems really foreign and overwhelming.

It’s much easier to say “What’s going on right now is making me unhappy. I guess I’ll have to do something about it”" than it is to say “What’s going on right now isn’t so bad, but it’s not what I want. Lets change it!” The former seems obvious. The latter seems selfish and indulgent.

Obviously, that’s a false picture, because it’s not selfish and indulgent. But I’m really bad at recognizing what I want (in any situation) as legitimate and worthy of consideration. I’m so used to settling, to assuming that things aren’t great but could always be worse.

I think I’m also carrying around a lot of cultural baggage. Sex reassignment surgery is not something that’s viewed respectfully in 99% of the media out there, and that’s taken its toll on how I think about it for myself. There’s something that feels dirty about the idea of wanting a vagina. Of rejecting my penis.

But I want to like my body, enthusiastically and all over, not just feel like I’m settling.

This is my gallbladder, Tim.

First, apparently it’s “gallbladder” or “gall bladder,” not “gal bladder.” Good to know.

Second, a little more info on what has been going on.

The gallbladder is used as sort of a digestive backup: it stores bile produced elsewhere and, when hard-to-digest food is introduced to the digestive tract – the gallbladder will send in the reinforcements. That means it’s useful, but not critical.

Gallstones are formed out of normal bile components that somehow solidify and get stuck in obnoxious (and potentially dangerous) places.

So today, Tuesday, they’ll be doing an endoscopy (through my mouth – ICK!) to find and remove gallstones. They’ll also use the procedure as an opportunity to check out my gallbladder and see if it’s inflamed. If it’s not inflamed, they’ll (either later today, or sometime on Wednesday or Thursday) perform an arthroscopic procedure to  remove my gallbladder. If the gallbladder is inflamed, they’ll schedule an appointment with me for 4 to 6 weeks from now, when it’ll hopefully not be inflamed anymore.

(I’ve been told that an arthroscopic removal of the gallbladder is very difficult if it’s inflamed, which is why they want to make sure the gallbladder is as happy as possible before it’s yanked forcibly from the body. Tricky doctors.)

The nice ‘bringing it all together’ part of this is that my painful stomach problems have been happening around rich food: deep-dish pizza, really fatty and delicious soup, too many cupcakes, and so on. Those are exactly the types of situations where the gallbladder would kick in, but if there have been gallstones it would be incredibly painful. Which is what I’ve been experiencing.

So hopefully this will not only resolve the pain I’ve had this weekend, but will help stop it from occurring again in the future.

(I’m going to devote a future post to talking about my gender- and trans-related interactions and experiences during this hospital stay, but did want to reassure y’all that it has been nothing but smooth sailing so far. Knock on wood and all that.)

If they decide not to remove the gal bladder this week (to let swelling go down) I’ll be back in 4 to 6 weeks for that.

More later (posting from my phone) but wanted to shoot out an update.

I figured I’d start by asking y’all if you had any links or resources you’d recommend for someone beginning to think about The Surgery. Or, if you’d had The Surgery and are willing to share, what doctor did you use? How was the experience?

I have some links I’ve been finding, and will hopefully post those later this week, but I’d love any recommendations for where to start looking. Thanks!