Transramblings

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Top Surgery Navigation Part 1

After being pretty open and vocal about my surgery, I’ve had tons of friends, or friends of friends, or mother’s of trans children who are friends of friends of friends, or someone who saw me perform once, or someone who was passed my name, come to me to ask about where to begin. I have written this email a million times, so I figured I would post it on here for it to be more accessible for anyone to see.

This is where I started. Others have other experiences, steps, orders, etc.

This is also just the beginning. I’m happy to share more about next steps, or talk to through more.

This is logistical. I never shared all of the emotional processes I had around surgery, but I still wonder if I will share those writings one day…

Where to begin?

1. Location: Is it important to be local? Or is the surgeon more important? If you’re traveling, who can go with you and be a caretaker? Do you have a place to stay or the means to get a hotel/ Air Bnb? I went local because it was important for me to stay here where I had more caretakers and I wanted to recover from home. Plus, I’m kind of a home-body. I know a lot of people who travelled.

2. Type of Surgery: It depends on what you qualify for and what is most important for you. Double Incision is the most common, and usually the one that folks get if they have a larger chest size and it means more scars. There are other surgeries too that could work for larger chest sizes.

Then as you go down in chest size more things are available. They all have their pros and cons, the best resource I found on this is Scott Mosser’s website. He is a surgeon based out of San Fran, and whether or not one was to use him, his website is a topsurgery resource heaven! He created videos of animated surgerys so you can see what each technique is without the gore, and walks through ways that you can figure out from home what you may qualify for or not: https://www.genderconfirmation.com/surgery/

I got Periareolar, which means they cut around your nips, and resize your nips. The scaring also happens there, so I have very little scars. Often people cannot tell I even had surgery unless you know how to point out a trans body for all of it’s fun minute lovelies .

I highly encourage searching all the types of surgeries, and people’s results from those surgeries to get a sense of what they look like.

3. Insurance: If your insurance covers top surgery, and you want to go through them, find out their list of “in network” providers. This information isn’t readily available on most of the websites, but if you’re down to call and listen to elevator music for hours on end, you can get the information you need eventually. I ran into a problem with this because I had an out-of-network provider, but had to commit to a person ahead of time because of the pre-approval process. Even if you get an in-network-provider, the pre-approval process may take a month or so, so make sure you start that early enough too!

Navigating insurance coverage is different depending on the insurance provider – I know folks who have done it through a few different providers, so depending on who you have, let me know and I can see if I know someone who has done the process.

I saved up enough money to get surgery regardless of whether or not my insurance would go through, so I fought the good fight, but decided to make sure I had surgery that year regardless (I couldn’t wait any longer). I had a lot of privilege and more choice because of my steady income, so that definitely played a role in my process. I’ve seen most out-of-pocket surgeries cost ~ $7,000-12,000, but lots on the cheaper side of that range.

And I’ve seen lots of Go Fund Me’s.

4. Colorado surgeons:

I find that generally surgeon’s aren’t the most social bunch (which makes sense if your job is to cut people open!) but there is definitely a difference in how they relate to you! Find someone you feel comfortable with, and someone you’re willing to ask a million seemingly obvious questions to, over and over.

– Terrance Murphy: I used him, had a good experience overall. He was friendly, and answered all my questions. His staff was really friendly but sometimes disorganized. I would call and get one answer, and then I would go in and get another answer. He also puts the drains in pretty high up in your armpit, for some reason, maybe to reduce rubbing with the vest, but they hurt like hell in my armpits! The staff aren’t great at pronouns, but they aren’t terrible. I think I got “he, she, and they” all by the same people in the same visit! All of that being said, I’m really happy with my results, without the painful drain situation. He will take insurance if your insurance will cover him, but he’s not necessarily in a lot of networks. 

– Paul Steinwald: He is very popular here, and known for his Inverted T procedure. My friend went to him to inquire about a revision, and said he was straight and to the point. Very clear, not super social. I know someone else that went to him and liked him. He doesn’t take any insurance.

– Michael Baetman: I heard this guy is an asshole and transphobic and in it for the money. Word of mouth says don’t go to him!

– Lisa Hunsicker: I don’t know anything about her personality, but I have a friend that got surgery from her and their results were great and they had a good experience.

– There is one person in Boulder, but most are in Denver. I just had a friend go to the person in Boulder but I don’t know how he is feeling about it yet, but I may ask out of curiosity! 

– I’ve heard good things about both Denver Health and Anshutz … 

Here is a list of other surgeons in the area: https://www.topsurgery.net/states/colorado.htm

And across the US: https://www.topsurgery.net/surgeons/

5. Choosing a surgeon: Again, this is going to depend on what is most important to you: type of surgery, price, location, insurance, recovery time, interaction, trans-friendly staff, etc. You can set up free consultations with pretty much all of them, which I highly recommend doing a few of.

At your consultation: Ask as many questions as you want! Also, if they do it in person, they will have to see what type of surgery you qualify for, so they will look at your chest. It’s uncomfortable as hell, so heads up. 

Things to ask at the consult:

– Type of surgery, how it works, what is involved in each one (feel free to ask about scars, pros & cons of different types)

– Recovery time and what it looks like for that surgery

– Price – make sure it includes everything, after-care visits, etc.

– Ask if they have photos they can show you of their past surgeries and results

– Do they do drains for this surgery? How long typically?

Things to consider… 

– How trans-friendly are their staff? Good with pronouns?

– How do you feel when you’re interacting with them? Do you feel comfortable with them generally? Are they thorough in their responses to your questions? Do you feel comfortable asking them questions?  

6. You’re not alone. There are tons of FB groups out there. This one is the most active and logistical: https://www.facebook.com/groups/topsurgerysupport/

This one is nonbinary topsurgery: 

https://www.facebook.com/groups/202648340208220/

There are some for certain surgeons as well. At least, Dr. Wolf in Michigan (I think) has a fan club group on FB.

 There are also a ton of blogs. I love this one and it is loaded with good information for the whole process: 

https://genderqueer.me/2011/02/11/top-surgery/

7. Preparing for surgery: Since I’m already on #7 and this is a ton of information, hit me up when you want some blogs and resources for preparing for surgery. I have shopping lists, things to know about recovery and preparation for it, info about pain, what you can do and not do, etc. 

8. Overwhelm: I can personally get overwhelmed by really big processes like this, so something that helped me was to make a list, and just do one thing at a time. For example, start with insurance, figure out if it’s covered and who is in network. Then, it narrows your list so it’s easier to go from there… 

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Clothing

June, 2018

I wish I had a pull-over hoodie so I could look like them. Because they seem to be “further along” in their transition process. “Further along” doesn’t make much sense in the context of wandering lost, but their eyes keep telling me they know something that I don’t. Their gentle smile that runs along their closed mouth suggests their internal world is long and dark and vivid and they found something there.

If I could find one at a thrift store then it may only cost an hours worth of work. But it will probably be several hours worth of searching the extra small mens, womens, and large children’s sections to find one thing that both, (1) I like and (2) fits me. But that is still better than the day’s worth of work to exchange for one therapy session, or the week’s worth of work for my name change, or the 4.5 months of work that I’ll exchange for surgery, not counting my other living expenses, of course.

If I could find the right one, it would both hug my body like the soft blanket I long for in the morning chill, but hide my chest from myself to ease me into the day. It wouldn’t break like all my zip-up hoodies have. I wouldn’t have to hide the part of the zipper that falls off every time I unzip my jacket, shoving it deep into my pocket, until I’m ready to zip it up again, risking being witnessed by that confused gauze I see in the eyes of anyone who grew up replacing broken things, or even fixing them. Maybe then I wouldn’t feel so broken when seen. 

I would get dark blue, but probably just to match them. Maybe black, because then I could match it with everything else I wear, which is almost always white or brown or grey or black because nobody ever showed me how to match. Because the dresses mother made me wear matched only the empty sound of my limited vocabulary and defeated temper tantrums. Because looking good was much further down my priority list, given that surviving took up so much space. Because hand-me-down umbro soccer shorts and t-shirts that fell to my knees and my hair pulled back in a low ponytail was the closest I could get to looking like my brother, who I really wanted to be, and that was the closest thing I could imagine to freedom at that time. 

Until he died. Then I imagined that freedom could stretch beyond our flesh and maybe even our clothes.

But I still want a pull-over hoodie so I could look like them. I still search for freedom in the corners of a world that consistently reminds us all that it will bless us with anything but that. That it will taunt us with smells of freedom but has no intention of giving grace. But I don’t know myself as anybody but a fighter. Or a searcher. And a child trying to find myself again, longing for a cotton dream that I pray will set me free.

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Backpacking

©Megan Newton Photography
June, 2018

It wasn’t until I realized that I was conflating fear with uncertainty, that this process could begin to unfold. When my brother, Caleb, and I ventured off into the Flattop Wilderness in Colorado, we came across a giant lake imbedded in a valley, surrounded by cliffs, and he came to a complete stop. Our normal adventures are made up of long days until dark with a few dumpster veggies and an early crash to wake up and do it all over again. But that day something was different. We still had several hours of light left and yet I watched as he threw his backpack down and asked if we could stop. Out of his backpack came an extra set of boxers, that he said he packed for me in case we wanted to go swimming. 

I threw my backpack down and immediately changed. Our normal is to race in. But the water was cold and rocky and he took a head start, inching in towards the middle, water almost up to his calves. I looked over at him and paused. “I only have 1 binder. I don’t want to get it wet.” He looked over at me and immediately told me he didn’t care what I was wearing or not. 

I stripped down to boxers only and came sprinting in the alpine lake. I closed my eyes and didn’t look down at my chest. Rule #1 of not wearing a binder is to not look down. But when I dove into the water, winning the race of course, I forgot what existed. With him, and only him, could I pretend that I was a young boy in the body I always wanted, and finally free. 

It was in that moment that I became certain that I would get surgery. It was the first imaginary taste of what it could be like to not be so afraid of my own body. I had no idea it would take me another year to do it and what freedom could actually taste like, but I knew it was the first step in a long journey of making decisions that would ultimately save my life. I went home and made a to-do list and wrote at the top, “the map to freedom in my skin, or one step closer to letting my bones off the hook, or something that sounds dreamy but certainly doesn’t feel that way all of the time.”

Hayden June 25-27 Edits-0013
©Megan Newton Photography

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Introduction

©Megan Newton Photography
June, 2018

When I told my brother Caleb that I decided to have top surgery, I paired it with a 30 minute download on my emotional process of arriving at the decision, on the C train, from Brooklyn to Manhattan. I wanted to keep telling him more but we had reached W 4th St and I needed to get off while he continued up into the Bronx. I wandered around Washington Square Park waiting to find my partner, while I continued to tell myself aloud, how I had arrived. From that point on, I decided I would capture this process in a more tangible and lasting way. 

I considered what had helped me navigate this journey, including countless blogs and facebook posts, FAQ’s for surgeons, and insurance navigation advice. I feel infinitely grateful for these resources and this is not that. Instead, I sought to name my experience in the spaces between the to-do lists and physical labor, between the dysphoria and freedom. I wanted to capture and pause and hold what happens in the liminal space of transition.

TransRamblings is a collection of journal entries, poetry, and random stories, and photos taken by Megan Newton, who became my friend throughout this process. It is not a full story, but instead excerpts that can be read linearly, or not. It tells of an emotional journey capturing the intersections of my trans identity with my very personal experience of growing up in a dysfunctional household, losing my mother and brother at age 9, and being a social justice activist, organizer, performance artist, poet and nature-lover. The overlap exists in order to not separate my trans identity from the rest of my life.