I am thinking about surgery. I want to have my breasts removed and I want a hysterectomy, but chest surgery is more important because I have been binding my chest for like 9 years and it is way way too long. Surgery scares me, but my dysphoria is to the point that I think it’s worth it. The problem is I don’t know where to start. My therapist is aware of my gender identity and, while he has been helpful with my depression and anxiety troubles, he doesn’t know a lot about gender transition. He listens and is interested to learn from me, but I feel like I gave him all the information he has. I finally feel like he knows me enough at this point to work on some things I have a hard time talking about, so I don’t want to switch. And I don’t know that I am going to live here for more than about 6 months when I graduate from school. I recently switched my main doctor to a clinic that specializes in care for LGBT people, but I don’t think insurance will pay for a second therapist so I can have one that knows about transgender medicine. I guess my question is where do I go from here? I don’t know who to talk to about what so that I can do this for real. I’m ready now.
Do you plan on taking any hormones? Top surgery won't have any effect, but if you have a hysterectomy and they take out your ovaries too you'll need some kind of replacement hormone. It's not too good for the body to go without. It sounds like you want top surgery to be the next step. I would first find a surgeon whose results you like (transbucket is good), price range is good (if your insurance doesn't cover it), and location is good. See what the surgeon's requirements are, if you need one letter, or two, or none. I don't see any need for you to switch. If you have known him a long time then and he has a common certification, then he should be able to write you a letter. There will be sample letters out there on the internet if this is his first. Everyone has to start somewhere right? Even gender specific therapists had to have a starting point. Since he seems so interested in you then you might be his starting point.
Thanks for your reply. While I don't wand any sex hormones in my body, I don't want osteoporosis or any other long term effects of that so when I get to that point I'm sure a doctor and I can come up with the right solution. But like you said, for chest surgery that isn't important. I think my insurance covers transition related surgery, my understanding is that public sponsored health insurance in Massachusetts can't deny that anymore. I'll look at the site you listed, but last time I looked into surgeons in MA there were very few and I wasn't all that impressed. I doubt it would covered out of state and I can only do this if I have insurance to cover it.
Hi anann, I agree with going to your existing therapist. Especially if your doctor is going on, I would give them a link to the Standards of Care http://admin.associationsonline.com/uploaded_files/140/files/Standards%20of%20Care,%20V7%20Full%20Book.pdf and go from there. If you ever really need a gender therapist for anything, you can usually pay a discounted rate for a single half or whole session. The list I usually give people is here, Therapists Some links are out of date but most are still good. Just an aside, on my own to-do list (I own a not-for-profit) this year is to try to consolidate a lot of lists like that on the internet and come up with a way to see what's out of date and what isn't, so if you DO go to a therapist on that list, please let me know?
I'm actually going to go against this point. There are some top sergons that require you to have been on hormones for a certain period of time. There are a couple of reasons for this. The first is that they use hormones as a sort of gatekeeping device. If you have been on them, then you are for sure trans, and will not sue them later. The second reason is that T will redistribute the fat out of your breasts, and this makes the surgery easier and you often get better results. As for your therapist, I would talk to them about the issues that you are facing with insurance. Often times, they will be willing to find some way to help you out. It also may be worth looking into informed consent. In this process, you do not have to have a letter for hormones. There are some screenings that you have to go through before you start though. These differ depending on the clinic. It is a new process for getting hormones, so there are only a few clinics that do this. So, you may have to travel.
From a gatekeeping standpoint, hormones do make it easier to get surgery, meaning that's the typical path. (Most likely because T costs less so people tend to start it first.) However, there are loads of people that opt for just top surgery and don't ever start T. This may be because of they are a singer and don't want to chance changing their voice or don't identify as totally masculine and don't want all the effects of T. Some people go on T until they have had the effects they want and then they stop taking it (under doc supervision of course.) In short, it's definitely not necessary for surgery, you just need to have that conversation with your surgeon. If you plan on going on T and having surgery, it might be worth going on T for a bit first. If you don't plan on going on T at all, you'll still be able to get top surgery.
While it may not be completely necessary - I can't really say - having a surgeon is. Not every surgeon is going to be comfortable giving top surgery without T. Just like not every surgeon's going to be keen on a hysto or orchie without hormones. I really kind of like Brad's "no BS" way of putting it. Hormones really are a bit of a gatekeeping tool. I think I kind of self censor and put things in terms that are friendly to the docs and the way "the system" works, but the reality is it just doesn't always. For lots of people stuff like informed consent is the only help we have. I guess what I'm saying OP is I think the best approach here is going to be to work with the people that are working with you. Your therapist knows as much about this stuff as you or I do. Your doctors know a little more, but they have to blaze their own trail every time one of us comes to them. There just plain aren't a lot of us. That works against us more than anything. Everyone learns and everything is new to everyone. I threw that "standards" document out there but the truth is, there are no real standards. My hormones? Have "for Gender Identity Disorder" on them, and I was prescribed them in the beginning of 2014, after GID was taken out of the DSM. It kind of sucks feeling like a guinea pig, but you get the satisfaction of knowing that the next poor kid who ends up in your shoes will have an easier time because of you.
Here's a good resource someone has put up: The Art of Transliness Good luck in whatever you choose to do. We'll all be here for you
Thank you all for the responses. I am not interested in taking T. I do not identify with being male and, while the redistribution of fat and stopping my period would be welcome, I am absolutely not interested in my voice changing, hair growth, or most of the other changes that T can cause. Because of this I do not intend to take T (although I try to keep my mind open in case my feelings on the subject change). I consider myself to be agender, and to me that means not having the primary or secondary sexual characteristics of men or women. So if hormones are a prerequisite or gate keeper for surgery with some surgeons I won't be working with them. I have been able to bring gender up again with my therapist, but I'm still not sure what to say. Do I say that I want to make a plan to find a surgeon and proceed with that? I have anxiety troubles as well and contacting a surgeon or moving forward for me just doesn't connect right now. I just don't get how even though I understand how to search online listings and make phone calls. But this is something I'm sure I want to do at this point. I have been binding for so long, and even though it is physically uncomfortable, the discomfort of being without a binder is much much worse. I wish there was a set way to go about the process.
