12 years on Testosterone

I wanted to write about sort of the entirety of my transition on this anniversary. Content warning: surgery and recovery. 

Here is a list of all my important transition related dates: 

4/5/10 started testosterone (transdermal) 

9/21/10 started testosterie injections 

11/29/10 name change court date 

3/30/15 first chest surgery 

3/2/16 second chest surgery 

3/21/22 hysterectomy salpingo-oophorectomy 

In 2015, I got my main chest surgery. It really was crucial to my well-being. I had another surgery that was planned to revise the first one. I am still not entirely happy with my results and I may seek another revision to remove the rest of the breast and fat tissue and to make the nipples look more normal. 

This year I had a "full" hysterectomy. I have been pleasantly surprised with my recovery. I've had no fewer than 4 surgeries in the last two years, but the time in the recovery room for this last one was the worst. I generally don't have a lot of nausea, but I did this time. They also needed to keep me until I urinated, which took some time. Meanwhile, everytime I'd drift off to sleep the blood oxygen alarm would blare and wake me back up. But after peeing the blue dye out and heading home, the recovery has been great! Besides the significant cramping feeling in the recovery room, I've had no pain. In fact, getting an IUD (which I did in 2015) was much more painful for much longer. I've had no need of narcotics, just ibuprofen and acetamenafen alternating for a few days. I did have some pain in my shoulder for a day or two from the gasses they use for the surgery. A heating pad helped immensely.  My eyes were also a bit off for a couple of days. Hard to focus. Likely a side effect of anethesia, but not one I've encountered before. After a week, I have to consitently remind myself that I am still recovering and will be on restrictions for 6 weeks total. 

I admit I was more nervous about this surgery than the others due to the possible (however remote) ill effects it could have on my enjoyment of sexual activity. I will not know the extent of this until after the 6 weeks, but I am not terribly worried at this point.

It proved to be quite hard to find any sort adeqaute information for this surgery as it relates to transgender men (or non-cis AFAB folks). The majority of the information was for and about older women. I saw recovery times ranging from 6-12 weeks (including no sex of any kind!) I am cleared to retrun to work with some restrictions after 2 weeks. Restrictions should be lifted by 6 weeks. There was no ban on external stimulation, only penetration, and of course lifting and other pysical exertion. 

I think the biggest loss from this surgery was my shaved belly hair. Due to my age and duration on testosterone, my head hair has been thinning a whole lot these past few years and I take pride in the other hair I can still successfully grow. It will grow back of course, but it was sort of a surprise how much disphoria can be caused by a smooth abdomen. 

Though my surgeon works through the "Women's Clinic" I did not have any negative conversations about this surgery. Insurance required that I submit 2 (two!) letters from different therapists stating that I was in fact trans and could make this sort of medical decision. That was a bit ridiculous, but worked out in the end. My pre-op nurse did ask if my family knew I was there, getting surgery. I scoffed and said no, but pleny of supportive people knew. 

At this point I just don't want to rock the boat with my parents. I am confident in my identity and what needs to happen to my body. I don't want to risk getting into debates or anything with my parents about these things. It is possible that they'd want to know, just so they can pray for my recovery or whatever, but that's not necessary for me. 

As for effects of 12 years of testosterone: my hair is very thin these days and I have been taking finasteride to try to hang onto it. I'm hoping that on account of my most recent surgery, I'll be able to lower my T dose a bit. It's been on the high end to keep menses away. Perhaps with a lower dose, I'll be able to keep or regain some hair. It's also possible I just need to embrace the fact that I'm a guy of a certain age and give up the fight. 

It's been about two weeks since the second surgery, and all seems to be healing up fine. Doctor has cleared me for all activities. I will go back to see him in a few months to see how everything has healed. I may need another small procedure to make the nipples smaller or symmetrical.

I am happy with the results so far. Slightly disappointed in my nipple appearance, but I'm sure it will fade. I am super happy that I am flat. As flat as my strange chest bones allow.

I will post comparison photos in a month or so after more healing has happened.

Day of Surgery

This gets graphic. You've been warned.

So I went into surgery knowing pretty much exactly what would happen. And that I'd be awake for it. But knowledge is different from experience.

First, the surgeon marked on my chest and told me that he'd be leaving some or most of the remaining breast/fatty tissue intact and just try to contour it so it helps smooth out my pectus excavatum. This worried me, as that's the reason I still had the tissue in the first place and it wasn't in the right area to do as he said it should. But of course I let him do as he thought best.

He numbed me up with lidocaine and got right to it. A couple of times I let him know that I felt a pinch and he'd pull out the syringe again. Mostly I just felt pressure though. It was the absolutely strangest thing ever. Not unlike the dentist in that you don't feel pain, only some pressure. But different in that I could tell he was cutting off soft tissue. And I could feel the stitches pulling tight.

The surgeon started on my right side, trimming the excess skin away. Then he "purse stitched" the remaining nipple area to the other area and drew the edges together. Again, strangest feeling ever. He then realized that my pectus would not allow his grand plan to work and decided he'd have to go back in to remove most of the remaining tissue. Then the gathering process all over again. *shudder*

The left side was much smoother, as he knew what he needed to do, and there was no back-tracking. Again there were a couple of occasions where I could feel a pinch of pain, but generally, just the pressure of cutting and sewing.

During the whole process- which took close two hours- the surgeon, his nurse and I talked about a number of things. We discussed politics predominantly. He talked about how he went to caucus last night and how inefficient the process seemed. I told him that I chickened out when I saw the crowds. We discussed how appalling and unbelievable the whole idea of Trump is. He made and interesting point about how perhaps this country/ the republican party needs to hit rock bottom (i.e. Trump) in order to rebuild into something more manageable. An interesting point, but I'd rather not get there.

We also discussed trail running, as my surgeon is super fit, and apparently runs Mount Sanitas on his lunch breaks. It's only about 3 miles, but it's steep and rated as strenuous. He also has a tendency to do Iron Man races. So yeah. We discussed how I'd like to do some official trail races and I know someone who is running the Leadville 100. He said something to the effect that 100 miles is just too long. I asked him if he'd done any ultramarathons and the answer was yes, a few 50 milers. So apparently, he has a limit. Cool.

We also briefly discussed his cat problem. He had two cats for a few years that were litter mates and recently one of them disappeared (likely eaten by a wild animal), so he got a kitten under the assumption that the older cat needed company. Apparently the older cat is quite unhappy about the new addition and seeks out ways to attack her. My doctor says the kitten sleeps on the bed with him and his wife and if they don't close the door, the other cat will sneak in and pounce on the kitten, waking everyone up with sudden yowls. An amusing image to be sure, but certainly a real problem too. I mentioned that I know female cats to be pretty territorial, but I don't know many tricks to make them play nice. The wife has already decided to call an animal behaviorist. Hopefully that helps.

So now I'm back home, wrapped up in an ace bandage, waiting for the lidocaine to wear off fully. I have a prescription for norco if needed, but I think I'll be okay with ibuprofen. I will probably have some swelling and bruising, hence the compression wrap. I am allowed to shower after 24 hours, and I have to keep wrapped until I can go in to see him in two weeks. I cannot wait to take the bandages off tomorrow to see how it looks.

All will be well and I'm excited to be near the end.

Chest Surgery Round Two

Tomorrow I go for my second chest surgery. I knew from the beginning that this would be a two-surgery process. The first surgery was nearly a year ago. I was anesthetized fully and most the breast tissue and most of the fatty tissue was removed from my chest via small incisions under my nipples. I had drain tubes. The purpose of that one was to decrease the size and allow my skin's elasticity to reduce any droopiness that often occurs when the whole process is done in one surgery.

This surgery will be quicker and I'll be awake for it. The surgeon will resize the areola and take in any excess skin. There will also be some slight liposuction to get rid of the remaining fatty tissue. I'll finally be flat! My nipples will be the appropriate size and in the appropriate place. I will not have to have any drains, and the recovery should be much easier. 

I've been working pretty hard on my pectoral muscles, hopefully my surgeon will have no problem contouring my chest. 

I could have had this second surgery as soon as three months after the first one, but it ended up being almost a whole year after, due to work schedule and money. It will be over soon though. And I can work on my torso tan this summer (so long as I first work on tightening up my middle).

I will be taking some before photos, and once I'm healed up I'll be sure to post some comparisons from before the first surgery to now to after the whole process is complete. I'm hopeful about the results. 

Check out my tumblr for routine updates.

Surgery Round 2

I scheduled my second surgery a few weeks ago. The office visit version for less than half the price. It's March 2. I was going to have my roommate/coworker drive me to Boulder and back that day, but as chance would have it, work has a mandatory all-staff meeting that day. I am excused, as I scheduled before this was announced, but roommate is not, so I think I convinced a friend to take that afternoon off to act as chauffeur.

I should be feeling more about this. The money is minimal, comparatively, so that's not even a blip this time. I won't be under general anesthesia, so I won't have much to recover from on the day of. I will be out of work for about a week and a half, and the minimal activity will likely upset me. But supposedly it will heal a bit faster this time around. And it will be me. My final form if you will. Ignoring my pectus excavatum, I'll finally have a truly flat chest. I'll feel comfortable in tighter shirts or even without one (if I can get my waistline to cooperate).

Since I made the appointment, I've been making it a point to work out my chest so there is decent definition. Also for the month of February, I've quit sugar and alcohol cold turkey. Not specifically for surgery, but it won't hurt. And not drinking is super easy, even when people around me drink. The sugar thing is super hard though. I allow myself lots of fruit and some honey in things to keep me stable.

Anyhow, I guess things on this blog will be heating up again in less than a month's time.

This insurance thing is taking some time. The first inquiry was denied because my doctor's office hadn't sent the referral correctly. Now that I've officially been referred to the surgeon, they had to appeal the decision. I should probably have had my doctor write another letter of medical necessity, I have a feeling they're going to deny it again due to it being "cosmetic". Worse come to worse, I'll pay for it. It isn't much comparatively.

I asked my boss when a good time to take a week and a half off would be and she said not til early January because we're still slammed and short staffed. Hopefully by then there will be a lower animal population and we'll have new people all (or mostly) trained up.

Setting things in motion for my second surgery. There a a couple of really exciting things about it. One is that I can probably get it covered by insurance so long as my doctor writes a letter stating that it's not a cosmetic surgery. The other good thing is that it can be done as an outpatient surgery, so even if I do have to pay out of pocket it will be well under a thousand dollars.

The recovery time will supposedly be a bit shorter than the first one. I am trying to store up enough PTO for about a week and a half, which, with weekends added will be adequate. Work is really rough right now as we're very short staffed and the population is very high, so I don't know if they will even approve a long absence as I'm one of very few staff who have been around long enough to train new people properly. So with that and insurance, I may have to wait until January. I was hoping for early December.

I want to get it done in the winter so everything will be healed up for next summer. Hiking, swimming, running. I am excited to work out and be comfortable without a shirt.

I need to start paying more attention to my diet and exercise again. The change of seasons really messed it up for me.

four weeks

Yesterday marked four weeks post op. The swelling has largely gone down. Generally, my chest looks mostly flat in the morning, but swells a bit about half way through the day. I still tend to wear the binder during the work day because it's tender. I think because the skin is not used to being exposed in that way. Also, my nipple placement is not yet ideal, and is uneven. So we'll see how these intervening months will go with regards to binding. Luckily, I have no need to bind tightly, as I did before. I wear my oldest, loosest binder just to keep a little bit of compression and to negate any uncomfortableness. That binder is not tight under the arms or around my ribs, so it's really not comparable to binding prior to surgery.

My flex spending account funds finally came through. I was denied at first because they called it a cosmetic procedure. So I had to call my doctor and have her write me a letter of medical necessity. They immediately paid. I've been in the process of paying everyone back for contributing to my fund. Actually, many people are refusing to be repaid. This blows me away. I appreciate my friends so much. I now have about 2/3 of the funds for the next surgery, so it may not be as long a wait as I dreaded.

Three weeks post op

I finally feel fairly confident in the way my chest looks, but only after comparing the photos that I've been taking every few days. I will share a photo I took today. Later on, I'll post more for healing comparison.

There is still swelling, but not nearly so much so I am confident that it is indeed subsiding. The second surgery with tighten up any skin that doesn't do so on its own in the months between surgeries. The areola will also be resized, leaving me only with small scars around the nipples that will be neatly hidden by the skin tone changes.

Now if I could just get back to running and eating healthfully, I'd feel so much better about my body. However, I tried to run yesterday and it hurt my chest because of the bouncing, so a bit longer on that.

Well, it's been over two weeks since surgery. I've just gone back to work without restrictions which is fantastic, because I wasn't so keen on spending the whole week in the call center. I feel mostly healed up. A bit sore and tight, but basically back to normal. I might try running soon, just to see. The doctor seemed a bit perplexed about the remaining swelling, but said that since it wasn't fluid, I wouldn't need drains anymore. He assured me that it was flat when he was finished with the procedure, and that it would be again. I've been gently massaging everything and I think it might be helping. I also have still been in a compression vest. Actually, a binder, as it's more comfortable that the zip up surgical compression vest they supplied. It sucks to still have to wear that regularly though. Last night I put a washcloth in the abyss in my chest and I think it may have helped with the swelling a bit. I think the fact that the compression doesn't actually compress down between is part of the problem. So I'll just keep doing that and hope it helps.

I keep taking photos every now and then to compare. Someday, when it's all done and I feel confident, I'll likely post some of them for comparison to catalog the process. 

Honestly, I'm a bit discouraged with the visual results so far. I can wear a t-shirt and it looks mostly normal, but I still feel odd about it when I move certain ways. And without a shirt is definitely not an option. I know it's a process and I knew going in, that it would be incomplete until the second surgery. But that doesn't stop me from being impatient and slightly disappointed. 

A week and change.

I got those horrible drains removed. I feel like a real person now. The flat-chested sort! There is still a lot of swelling, but it's gone down quite a bit. It may swell a bit more as my body switches from draining the fluid to absorbing it. The process for removing the drain tubes hurt rather a lot on the right side, but after it was all done, it felt amazing. No more itchiness and discomfort. I only have to deal with the compression vest/wraps for a few more days and then I'm basically back to normal. I cannot wait until I can start being active again. I feel so fat and lazy. I know I'm supposed to be lazy for a time, but it sure feels horrible, and notice my gut seems to be expanding. I need to rein in my eating. But since Easter's just past, I cannot pass up half price candies. Ugh.

Anyhow, I feel much better and it's amazing to sit around in a t-shirt. What a feeling to not have to deal with layers. This summer is going to be great.

5 years

Today is the fifth anniversary of starting hormone replacement therapy. I took the last photo a few days before surgery because I knew there was no way I was getting into that shirt only a week after surgery. I messed up because I took it landscape instead of vertical. Oh well.

These five years have been some of the best I've ever had. It's really great to comfortable in my presentation. I am super excited to no longer have to bind. Next year the comparisons will be fantastic.

Have I mentioned that I hate the drains? I am so ready for them to be gone. I'm also going crazy with inactivity. I want to hike. I want to run. I want to do push ups. Ah well. Soon, I'm sure.

Post Op day 6

Not a whole lot new to report today. Drains are really bothering me. Itchy and painful. But I can last another two and a half days until Tuesday afternoon. I think the swelling has gone down a bit. I took off the bandage for awhile around the house. It's so odd to only wear one layer. And it's awesome to be visibly flat.

Post Op Day 5

The bandages are off and I got to shower. However, they decided to leave the drains in until next week. Apparently they’ve been having to put them back in for others because of fluid build up. So that sucks, but at least I won’t have to deal with ballooning back up. Showering was amazing. No more funky antiseptic smell and much less itching.

I’m pretty swollen, especially toward the abyss in the center of my chest, so the reveal wasn’t as amazing as I’d hoped, but in time the swelling will leave and then I can enjoy a comparatively flat chest.

Everything is pretty numb, with some slight tingling sensations when touched. It's a very odd feeling. No pain to speak up, but definite discomfort where the drains are inserted. 

The reality hasn’t really hit me yet. Probably because the swelling makes it so that there isn’t a huge difference in size (yet). Also, I have to keep a tight wrap around my chest for a couple more weeks, so it still just seems like I’m binding.

I took some photos, but I am unwilling to share them just yet, I feel really self-conscious. Mostly because I know it’s all still swollen and funky, but also because it’s such a new idea to me to share photos of my chest. Once the healing is much further along, I’ll definitely share.

It looks much different than any other ftm chest surgery results I’ve seen personally. Because it was the peri-areolar technique, the incisions are only a couple inches long under the nipples. I have been used to seeing two long incisions that span nearly the whole chest. I think this method will be very good in the long run because of the slight scarring, but for now, it seems as though hardly anything was actually accomplished.

Post Op day 4

Tomorrow is the big reveal. I am so excited to get this tight and itchy bandage off, as well as the very uncomfortable drains. I am excited to see my chest. It will obviously need to heal more. And in a few months, I will be getting a revision to remove any skin that doesn't shrink up and to resize the nipples. But for the first time since I was 12, I'll see myself with a flat chest. Well, as flat as possible with my pectus excavatum. I hold 12 as my magical age. It was that age before menstruation. The age before breasts. It was the last age I was happy with my body. Testosterone has done wonders for my self confidence. I love the added body hair and the muscles. But I have never liked my chest. I have never felt my naked body was really mine. I have never had the debilitating revulsion that some trans people feel for their bodies, and for that I am grateful, but I have always disliked it. This is a huge step into really owning my body. I cannot wait to see the results.

Post Op Day 3

I'm restless. I hate being cooped up lying on my back all day. Got a nice sponge bath, and felt human again for a bit. I cannot wait to get these itchy drains out on Friday and have a proper shower. I've pretty much phased out the norco. I took only half of one today and I haven't been in any pain. I will likely only be taking it at night now.

I had a memory of waking up from anesthesia. My entire body was shaking like it does when I used to drink too much. I remember trying to explain to them that it's not an unusual thing to happen to me.

People are being really awesome. I've had some friends come visit and hang out. Everyone has been texting me and sending nice messages on facebook and tumblr. It's nice to have support and love and well-wishes.

I have a nagging fear of my mother. I really just think that things will be best if she never knows of this. I have no intention of telling her, and I certainly hope no one else does, as it is my business and mine alone.

Post Op day 2

Drains are pretty blech. Still no real pain, but I can feel where they go into the sides and it’s just odd and uncomfortable. I got my hopes up a tad at my pre op appointment when I was told that for this procedure, drains weren’t always necessary. Welp, they were for me. 

So far so good. Bit more tender today than yesterday but not as bad as I’d feared.

Post op day 1

I'm now a day post op. So far so good. Yesterday I felt really good, just a bit tired. It felt like I just did heaps of push ups to make my chest tight and sore. Today its a little more sore in the pain way, but still not bad. I'm using lots of ice packs to numb it and take the swelling down. I've been taking arnica and prescription strength ibuprofen for the inflammation and bruising.  I have also been taking norco (the not quite vicoden narcotic). I have had no ill effects that I was worried about.

I am definitely limited on movement, but I don't feel trapped in bed which is good. I've just been relishing the ability to relax with no nagging feelings that I need to be elsewhere doing anything specific.

We'll see how long it takes me to get truly restless.

Pre Op Appointment

The pre op appointment went well enough. I asked a couple more questions of my surgeon. All of my fears are quite allayed.

Side note: He's possibly the most dapper person I've ever met. Today, being St. Patrick's Day, he was wearing grass green slacks with a matching pocket square in his black jacket. Possibly the only person I know who can pull of green pants in a professional setting.

Anyhow, the nurse gave me all of my herbal supplements for proper healing. It was also mentioned that due to the nature of the periareolar procedure, I may not have to have drains. This is a surprise, but definitely a good one. Everyone I know who has had chest surgery has said the drains were by far the worst part.

Two more weeks of waiting.

Then more waiting after that for everything to heal up.

So close!

Tomorrow, I go in for another consult with the surgeon to ask a few more questions about why he does periareolar in two separate surgeries and exactly what each surgery entails. I also have my pre-op appointment with his nurse where she will give me all the supplements that will help me get through everything.

Soon.