From Hormones to Coming Out—The First Steps of Medical and Social Transition
Binary to Binary: A Gender Transition Roadmap
by Susanna Blake, Part 4
Click here to read Part 3.
Physical and Social Transition Begins
One of the most difficult and frustrating tasks in 2017–18 was finding an endocrinologist who was willing to help Caroline with her 15-month pre-surgical hormone treatment following her decision not to save sperm. I searched her insurance network and called group practices of endocrinologists, one after another, and was told that not only did they not have anyone trained in transgender care, they had no one interested in coming up to speed to do so. Planned Parenthood was not yet offering such care, and the two major hospital systems in our area had no advice about where to go.
Finally, through calling around, someone pointed out that an endocrinologist had recently relocated from Chicago who might be trained to help. It turned out that she was an expert, even though her affiliated hospital system did not have transgender care listed as one of her specialties.
Caroline could not take a full day off from work (not to mention staying awake all day since she worked night shift) and take multiple forms of public transportation once or twice per month to be treated at the Mazzoni Center. She needed blood work every month to track everything, but especially her estrogen and testosterone levels. This proved critical since one of the several methods available for administering hormones—the one Caroline initially chose—was sending her hormone levels sky-high from time to time. Also, gradually reducing her testosterone levels prior to surgery was important so her body would not go into shock after surgery.
I might mention here that Caroline went into this whole process with needle phobia so severe that in the beginning she needed to be knocked out with anti-anxiety drugs and led around like a sleepwalker for the first few appointments. She was able to overcome this two-decade-long phobia early on sufficiently enough to forego medication.
Choosing Surgeons and Beginning Social Transition
The most critical task was researching and selecting a highly qualified top/bottom surgeon for her chosen procedures: vaginoplasty or vulvoplasty, labiaplasty, tracheal shave, breast augmentation, forehead surgery from hairline to eyebrow, and rhinoplasty. This process was made fairly easy since some of the best surgeons attended the PTWC and gave graphic, no-holds-barred seminars on the various procedures being provided by fewer than a dozen surgeons in the United States at that time.
I narrowed down my list to a few. For example, I eliminated two who seemed to think more highly of their skills than patients did, including poor ratings for after-care. I eliminated another who would not take insurance and did not offer the full spectrum of procedures that Caroline wanted. I eliminated a few who had lengthy waiting lists. At the time, the best New York surgeons had a four-year wait list.
Caroline left her employer and started an 18-month COBRA (insurance extension) while she completed her second degree. I asked her if she was ready to go full speed ahead and she said yes. We wanted her to complete all surgeries during the 18 months with a couple of months to spare at the end while she had her current insurance policy (which included coverage of three of her chosen surgeries). A top-notch surgeon in Arizona could fit Caroline into her timeline. This surgeon was trained by a surgeon with a national, if not worldwide, excellent reputation, and is transgender herself.
We convinced her office that we could skip the first brief appointment and were thus able to make three round trips to Arizona instead of four. During our first visit with the surgeon we explained why a vulvoplasty would be more appropriate for Caroline than a vaginoplasty. We also insisted that she weigh in on which of about six possible facial feminization surgeries that I learned about during PTWC seminars made the most sense to feminize Caroline’s face. We agreed that reducing the size of her nose a bit would help, and re-contouring her forehead would make a subtle but surprisingly significant difference.
Part 5: Navigating the Legal System—Name and Gender Marker Changes Without a Lawyer
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