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The process of transitioning


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Okay, so. I got approved for SSDI, and, after clearing my debts, I have a substantial chunk of back pay money left. There is sufficient to put a down payment on, if not completely pay for, top surgery and possibly hormone treatments, according to my web research. The sudden, very real possibility of being able to just...do this has dropped into my lap like a big soggy ball of magic star stuff, throwing sparks of "whoa, holy shit" everywhere.

 

So, how do I actually do this? I'm fumbling with it a bit. It's always seemed far off, so I have avoided doing too much research in order not to make myself feel worse. If it were for a "normal" medical procedure, I'd research surgeons and start making phone calls. Can I do that here? It seems too simple. I'm sure there are other considerations to be made. I've been in treatment and had a "formal" medical diagnosis of gender/body dysphoria for three years and some now. I think that's important, conceivably. I'm going to be doing more internet research, and talk to my pdoc too, but I wanted to ask here as well.

 

Has anyone else done this? Experiences, if you're willing, would be awesome. I have spent not a cent since I found out that this is actually within my grasp. I've completely slammed on the brakes. It's all a little surreal. I think I'm talking about it partly because I'm kind of trying to process it and I'm numb as hell.

 

 

Edited because I can't get my linguistic shit together.

Edited by Mim
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It's going to depend on where you live.

 

That's a lot of things to do all at once.  First step would be to speak to your prescriber about HRT.  They will fill you in on the necessities - in most cases, you need to have a formal letter from a mental health practitioner that diagnoses you with GD/GID before you can get any hormone treatment.  (I just went through this ~6 weeks ago).

 

Surgeries may have the same requirements.

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I'm going through some of the early stages of this by talking about my gender dysphoria with healthcare folks like my mental health team and my regular doctor (soon).  I've been using a more gender-neutral to male nick-name when I introduce myself and wearing a binder to hide my chest.  

 

Best of luck with it all, Mim :)

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It's going to depend on where you live.

 

That's a lot of things to do all at once.  First step would be to speak to your prescriber about HRT.  They will fill you in on the necessities - in most cases, you need to have a formal letter from a mental health practitioner that diagnoses you with GD/GID before you can get any hormone treatment.  (I just went through this ~6 weeks ago).

 

Surgeries may have the same requirements.

 

Thanks. :) (Welcome to the boards, too, by the way.)

 

The pdoc is going to be my first in-person stop, to find out what I need to take care of from that end, as far as requirements and such. I see her again at the end of February. The regular gdoc is the stop after that. I've done some reading up about it this evening after reading your post, and it looks like what you've described is pretty well what I can expect here. Complete physical sex reassignment is more involved and requires more, it looks like, but I'm not looking to fully transition. This would get me a good distance toward where I want to go. I hope the transitioning is going well for you. It is a lot to take on at once. I'm thinking it looks like hormones first, then top surgery second. But I'll sort it out more firmly after I've talked with the docs.

 

 

I'm going through some of the early stages of this by talking about my gender dysphoria with healthcare folks like my mental health team and my regular doctor (soon).  I've been using a more gender-neutral to male nick-name when I introduce myself and wearing a binder to hide my chest.  

 

Best of luck with it all, Mim :)

 

Thanks. You too! The binder feeling is still enormously liberating to me, even now that I've been binding for a good few years (though there's something funny in a way about binding being liberating, but you know). Having other people call me the "right" name might be just as good, though it's a close race, yeah? :)

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I want to echo Wonderful Cheese in saying how happy I am for you that the financial pieces are falling into place. I wish you the very best in your transition and beyond. Just want to add - I don't have any helpful first person experience to share and I don't know what your situation is regarding family or friends that you will/have come out to about your transition. But having a sister who is a transwoman who transitioned 15 years ago, I do have some thoughts about what was most (and least) helpful about how she disclosed her transition to us and helped us to understand it and support her better. I'm happy to share that perspective at any point if that's helpful. Mostly, though, I am glad that things are looking up for you.

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Thank you, Harp.

I've come out to my sisters, but not the rest of the family yet. I've been thinking over how to get it out there without just dropping it like a hot rock into a conversation. :P It was easy with my sisters, with whom I live. When I talked to them about my MI issues, it was easy to include that GD is part of what makes the MI worse. It'll be harder with the bros, though. Neither of them will be willing to talk about it, and it's apt to be awkward. I'm confident they'll be supportive, and older bro may already know; he's scary perceptive. But it's probably going to be strange, maybe more for them than me, haha.

Anyway, perspective would be great, if you're willing to share.

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  • 2 weeks later...

I have a bunch of friends that are trans (MTF, FTM, and non-binary).  A close friend had top surgery by some rockstar of a surgeon out in Frisco a decade or so back.  I googled, and I believe that he is named is Michael L. Brownstein.  I recall my friend saying that he was related to one of the ladies in Sleater-Kinney, and indeed one of the ladies has a last name of Brownstein.  You can find him if you google him.  Again, I'm no expert, but I believe the surgery required the aforementioned proof-of-GD-yadda-yadda stuff.  I seem to recall that the price tag was somewhere around $10K or $12K, but that was a decade back so it may have gone up.

 

My friend had a good result.  The nipple reconstruction largely is okay, although he doesn't have strong feeling in them.  As for the scars, they are less pronounced than they once were, but are still a little difficult to miss on bare skin.  He does have chest hair growing now thanks to the T, so that hides some of them.  He had drains in his tissue for a week or so after surgery and that seemed to have gone okay (no infections, etc).

 

I can't really recommend this Brownstein dude other than my friend's experience was okay.  As I recall, my friend said that the surgeon is sort of a rockstar, who focuses on this kind of surgery.  That's good, because he is specialized, but bad because he is a bit arrogant.  Also, not knowing where you are located, clearly going out to the Bay for the surgery may be complicated.  My friend is in the midwest, and he said that it was a bit of a clusterfuck to coordinate his various doctors and this guy, but such is the world.  I believe that the surgery was fairly quick.  I don't think he even had to spend a night in the clinic / hospital.  He did stay in the Bay for a week or two to recuperate and be near the doctor in case anything came up.

 

Good luck with surgery!  If you have any other questions, I might be able to get you some more information. 

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  • 3 weeks later...

Fairchild, I'm so sorry I never replied to this. I've been in a sand pit for awhile, and it slipped my mind.

 

I appreciate the input; reading online, I've seen several other people recommend Dr. Brownstein. I haven't ruled it out yet, though SF is quite a distance from where I live. I did also find a certified, very well reviewed plastic surgeon close to where I live, whose rate is excellent and who will finance if by chance I can't cover the cost up front. It looks like top surgery is an outpatient procedure for all the surgeons I've scoped out.

 

At this point, I've pretty well decided to do the HRT first, in order to begin to get a feel for what living in transition will be. I'll be making a gdoc appointment to ask about that, so I can find out what sorts of hoops I have to hop through regarding therapy and such.

 

Anyway, I appreciate the support and info, thanks! :)

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Congratulations. I'm happy for you!

The hardest part is the first steps. Then it gets easier. I hope everything goes smoothly for you. I'm in the point where I want to do HRT, but not really transition except for top surgery and get rid of my uterus. (The uterus causes other problems: endo)

 

I hope all goes well. I really do. It takes a lot of strength to do what you're doing. 

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Finding out the local resources and "rules" is a huge first step.  If you are not in a place major/big enough to have a GLBT sort of centre, try finding a GLBT sort of place in a nearby city or town - they may have more specific information for you.

 

Look for therapists and/or pdocs who have some experience with trans people.  A tdoc who is specifically a gender therapist can be good for working out specific remaining issues like internalized dysphoria, remaining "who am I?" questions, etc.  BUT BUT BUT they are also specifically knowledgeable about the actual process of medical and social transition for your area and can help provide you with information and guide you through that process.

 

You might hear talk about needing to do a year's "real life test" sort of thing before medical transition even just HRT can be achieved.  This is not always the case even in areas that are more conservative/old-school with transitioning.  It REALLY depends on who you talk to, in the end.  It can be easier in more liberal areas, sure, but yeah.

 

Where I am the endocrinologists (who you'd see for HRT) won't give out hormones for transitioning until you have a letter of referral from the only psychiatrist in the whole province who the government recognizes as a GID specialist -- it makes sense for surgery approval since public health care will pay for that, but for HRT it makes NO sense since the government DOESN'T pay for that.  But anyway, it's still the process and I guess they want it streamlined or someshit.  Dude has a super effing long waitlist.  Once I got in to see him in January though, there were no demands made of me to "live a year as your (preferred) gender," but then again I could easily demonstrate to him many factors: I changed how I dress/present at least two or more years ago, I've been binding my chest for at least that long, I've gradually come out to EVERYONE in my life including family, friends, people of my spiritual community, etc. (and I don't have a workplace to come out to anymore,) doctors, etc.  So I've effectively done that "real life test" thing on my own already.

 

Some doctors want you to do the "live a year as" thing while under a tdoc's specific supervision almost as a sort of 'verification' that you're doing so -- which is kinda really effin' ridonkulous 'cause the tdoc doesn't exactly follow you around 24 fucking 7.

 

If you can tell I'm not a huge fan of the "live a year as" "test" thing.  It's not always feasible or safe or possible for someone to do this without at LEAST the help of HRT.  I do NOT pass as male once I open my mouth and at least half the time I don't pass as male even keeping my mouth shut, pre-HRT, and it was very very very possible I would have lost my job had I come out as trans 'cause they only hire women in the storefront and there was actually no laws in place yet at the time preventing someone from being fired for their gender identity or expression.  While I was still working the plan was basically to only come out to them once I got onto HRT and could flat-out no longer keep it from them -- though I dressed how I wanted.

 

But there are endocrinologists and transition-specific surgeons who will work with you without needing that kind of requirement.  A lot of them will still need letters of referral from a "qualified professional," and just who is considered a "qualified professional" will depend on laws where you are, the doctors in question, etc.  And then those "qualified professionals" will differ in their own standards of what they expect from you before they'll write you a referral.

 

Generally it is a lot lot LOT easier to get something like HRT compared to surgeries, and not just because of the cost/time required for surgery and healing/etc. either.

 

You may find that a lot of dgocs, tdocs, pdocs, etc. while supportive, helpful, even with past experience with trans patients, they might not know the specific channels you have to move through to properly access medical transition.  It's worth asking, but seriously try contacting a gender clinic or a GLBT centre or something - you might not even have to travel to one of those places they might have all the info required on a website.  The Internet can be pretty valuable here too, finding gender-specific tdocs for example, or info that trans people have supplied about how they managed to go about medical transition while being a resident of your state, etc.  You can find tdoc and surgeon reviews for people who are local or at least nearby to you all over the Internet.

 

Getting those "qualified professionals" though can be really really invaluable even if initially difficult to track down - again even just going by their knowledge of local resources.  I thought the only way to get surgery in my country would be travelling to the clinic in Montreal that does SRS - but I learned from the pdoc I saw in January (remember: the only one my province recognizes as a GID specialist) that there are surgeons who do "top surgery" for trans people right here in my province.  In my city, even!  That's not "bottom surgery" to be sure but I thought I'd have to go to Montreal for top surgery so... it was a really awesome revelation.  He's the one who can write me the referrals, and the one who knows who to write the referrals to, so yeah.  Also I did see a gender therapist for a short while -- she realized I didn't need to KEEP seeing her at the time as I had to basically go on the waitlist for the GID pdoc and had already done all my unpacking/questioning/etc. and most of my coming out on my own.  But she helped me see that, and she was able to provide me with concrete information on yes, I had to see the GID specialist pdoc to even see an endocrinologist, blah blah blah.

 

I wish you the best.

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