Wednesday, October 31, 2012

A General Treatise On Low-Cost and Helpful Options for Trans Folk

Disclaimer: The following post is intended only as general guidelines or advice only. I have built this over the past several years through research, personal anecdotal evidence, and the anecdotal evidence of other trans folk who I know have found ways to overcome some issues transition-wise. This advice is simply take it or leave it. Unfortunately the following mostly applies to Trans Women, since that is the area of knowledge I know the best, and while some of this could be applied to the Trans Man experience, I would recommend that any Trans Masculine/Men readers should consult another Trans Masculine person for advice, since they will be able to help you out more than I can. If any reader would like more specific information, please don't hesitate to contact me, and I will do my best to find you the options you need. Love you all!

The following is some general guidelines to help with the various stages of transition. I am writing this more-or-less in a stream of consciousness fashion, so I apologize if I miss something.

Coming Out: 
This is often one of the hardest steps to take in the transition, even if it is just the first step. Coming out takes a lot of courage, support, and can be definitely terrifying to those of us who get anxious easily. However, coming out is important, especially to Trans Women, as the sooner you come out and transition, the better your results will be due to less permanent Testosterone damage on the body and facial structures. Because of this, one of my personal biggest regrets is not coming out at 16 when I had the chance, and instead going back into the closet for 5 years. While I do have pretty good results for coming out and transitioning at 21, I do know that things would fare a lot better for me if I had come out earlier. So as the saying goes: hindsight is 20/20. If you are one of those who come out later in life, don't be discouraged as you can still get great results, and honestly living as your true life rocks compared to living in the closet and hating yourself for the rest of your life.

While with each passing year, it does get easier to come out and transition due to trans publicity and increasing trans support; an unfortunate reality is that a lot of us will have to come out in not so trans-friendly areas. However, you can still come out in a more or less safe manner. The key here is to build a support network that you can rely upon to protect you from the actions of others who would do some harm to you. Personal example: I came out to my two best cis-gender friends first, and I knew that they would be supportive of me, which was confirmed by their first words to me: "well you've always been more of a sister to us anyways!" One of the keys here is to determine the judgement of character and loyalty of your friends. Come out to those that you KNOW in your heart will support you. If some of those said friends reject you, promptly cut them out of your life or decrease exposure to them as it will save you some sanity and positivity in this critical point of transition. Another important thing is to create a support group of both trans and cis-gender folks. Your trans friends will be able to re-assure you that you are doing the right thing and guide you along the way, while your cis-gender friends can "make you feel normal" by commenting on your beauty, courage, and how much you do fit in with society, as much as those nay-sayers would like to say you don't.

This is very important in conservative areas. I went to Chapman University, a somewhat conservative college in Orange County, CA which is the second most conservative county in the state. I was the only publicly open trans person at my school (I knew of no other trans people at Chapman until right after I graduated). My cis-gender friends and the theater department I was a part of protected me from the rest of the school during my early days of transition, as I was receiving flak from the Psychology department (where I had the majority of my minor classes) and from the Business School (where most of my GE's were held) for being out and open. My friends have on numerous occasions protected my right to use a women's restroom, even when a lot of the women there were vehemently opposed to having any "male-looking person" invade their sacred space. My friends protected me from such hostile people and I am forever thankful to them.

But as time progressed and I was still the only Trans person at my college that I knew of, I knew I had to find a trans community to support myself. I found that both online through the Transgender Reddit community, and offline through the Trans community at nearby University of California, Irvine, where there was a substantial trans student population there. Here comes an important point: State colleges are more likely to have more liberal student populations, and to have some measure of resources for LGBT folk as a more of less general rule. This is because state colleges have less leeway over who they accept as opposed to private colleges who have freedom to determine their student demographics. The other thing about state colleges, particularly in or near large metropolitan centers is that they offer more low-cost resources to students and low-income populations such as disenfranchised racial minorities who are on the lower-end of the socio-economic ladder. This goes more so into the next stage of transition: Hormone Replacement Therapy.

Hormone Replacement Therapy:
Getting on HRT is a big and somewhat scary step for trans folk, as it legitimizes and makes the transition all that more real to us. For some of us, we are lucky enough to have insurance that will cover HRT. For a lot of us though, we are not fortunate enough to have a backup such as insurance. Regardless of this, trans people should pursue HRT as soon as possible after coming out. This is because the longer you are in your old pre-determined gender identity, the more damage is dome to the body and the longer and harder it gets to have decent results. This is especially true for Trans Women as Testosterone is the stronger of the two hormones and causes more permanent damage to the body as compared to Estrogen. This is why it's very important to supplement whatever Estrogen you take with a high dose of Anti-Androgens aka T-Blockers. The Estrogen will not be able to take a large effect on your body as long as you have a lot of Testosterone in your system. As a general rule, the earlier you get on HRT the better results you get: again another reason why I regret not coming out at 16 when I had the chance.

Now if you choose to began do-it-yourself hormones while waiting for a doctor's prescription, this basic dosage will work for most Trans Women on average: Oral Estradiol- 4 mg a day, and Spironolactone- 200 mg a day. The vast majority of Trans Women I know have that exact dosage for the majority of their pre-op HRT (if surgery is a path you wish to take on of course). There are online pharmacies where you can order hormones to help you out while you wait for a doctor's script. A common one I recommend is here: Spiro is the Anti-Androgen most commonly used in the US and Estradiol is the most commonly used form on Oral Estrogen used in the US. For Trans Men: since getting Testosterone online is much harder due to Testosterone being a controlled substance, it is paramount to see a doctor right away to begin HRT.

If you need to see a doctor but don't have the cash, the best way to find such options is to find out the nearest low-cost/free/sliding scale clinic in your state. They are usually in or around large metropolitan areas and usually cater to those on the low socio-economic ladder. Sliding scale practices are great as a medical procedure that would cost $30 for example would only cost $5 for you. Great examples of these types of clinics in the Bay Area are Lyon-Martin in San Francisco, the Berkeley Free Clinic, and the Tri-City clinic in Fremont. For those in conservative states, look for large state college or city areas such as St. Louis, Miami, Baltimore, or Richmond are some areas that come to mind. A helpful tip: Any area that has a very large low-economic racial minority population will likely have a low-cost clinic that is dedicated to treating their needs, and this is a great place to start. (I only say the above based upon my experience growing up in Oakland, where clinics cater to the large African-American population, and going to college near Santa Ana, where clinics cater to the large Hispanic population. Please do not take this out of context and put it as a racial comment. I am merely making an observation based on inner-city racial minority populations in correlation to the location of low-cost/free clinics, that and I'm usually one of the first people to call out racist measure from Caucasians when I see it).

Since the World Practitioner Association for Transgender Health (aka WPATH, which legislates the legal rules for treating Transgender populations), make a ruling stating that HRT can be prescribed on the "informed consent model," one does not need a letter from a therapist recommending the start of HRT, although it does certainly help if you have one. Informed consent works on the basis of you doing your own research into HRT effects, and telling your doctor that you understand the benefits and risks of such medicine but are still willing to pursue HRT. Like when talking to a therapist, presenting your "case" for transition through anecdotal cross-gender experiences and thoughts will help convince your doctor that you are doing the right thing. If your doctor tries to convince you out of doing HRT, they are doing harm to you and you should dump them immediately. The same goes for any therapist. As a general rule: if they don't support you, then they don't deserve to be a part of your life.

Getting a therapist to help can be somewhat daunting, as we unfortunately still live in a society where getting a therapist makes you "not normal," where as the truth is the opposite: getting a good, supportive therapist is incredibly helpful when dealing with the stresses of transition, both from you personally and from society at large. The great thing about therapists is that you basically pay them for you to bitch at them, then they offer awesome help and advice/coping strategies. The other great thing about therapists is that they are legally obligated to protect therapist-patient confidentiality unless you threaten to kill others or kill yourself. While it is good to be honest to your therapist, it is important that any statement you make is backed up with clarity of your intentions: for example if you say that you are feeling so depressed that you are feeling suicidal, assure your therapist that you don't want to commit suicide, but that you are desperately looking for help and support. That way, they cannot legally report any suicidal tendencies and you can still be honest about how you feel (which is always important).

In terms of finding a therapist, a great low-cost option is to investigate and find college that have large psychology departments (both undergrad and grad but preferably grad). Such colleges and institutions usually have supervised low-cost or free counseling, as this provides their students a chance to practice what they learned, give you low-or free cost option for therapy, and such sessions are usually supervised (not in person but after the session) by PhD's, MFT's, and LCSW's. When you need a letter, tell your student psychologist to ask their supervisor for a letter, and usually you can get one from the supervisor because the student presents a good case for you. In terms of letters: for HRT it can be a PhD, Marriage-Family Therapist, or Licensed Clinical Social Worker that can write it. For surgery letters, you need at least one from a PhD, and one from a MD (Doctor). For those of us that have insurance but need multiple letters (I had to give my insurance three letters, super ridiculous) after your PhD and MD letter, you can usually get a third letter from an MFT or LCSW, which gives you more options.

When talking to a therapist, the same rules apply when talking to a doctor: you have to present your case for transition to them, through telling of cross-gender experiences and thoughts, when those experiences happened, etc. While you shouldn't exaggerate anything as a general rule, it is good to post transition things as a life-or-death choice, since when it comes down to it, the difference is living freely as who you truly are, or living dead inside the closet for the rest of your life. Hopefully that makes sense, and will allow your therapist to truly take you seriously. If a therapists doubts you, give them more evidence. If they still doubt you, dump them as they are doing you harm. So in general: if a state or private college as a large psychology department, contact the psychology department and see if they offer low-cost counseling sessions. Don't tell them that you're trans if you feel they might deny you. Simple say that you need a low-cost therapy option and that you were wondering if the department offered anything like that. If they ask for a reason why, say it's related to severe depression and anxiety, and that usually does the trick to get you in the door.

Hair Removal:
In terms of choosing which hair removal method to do one has to consider three things: skin color, hair color, and how much hair needs to be removed. The two main forms of hair removal are laser and electrolysis. Laser works great for people who are light-skinned, have dark hair, and have a lot of hair to remove. This is because laser causes skin discoloration for dark-skinned people and helps to lighten hair, so those who have light colored hair would not benefit as much from laser as compared to electrolysis. With laser you can blast an area at an time, whereas with electrolysis you zap one follicle at the time. Because of this, when everything  adds up, electrolysis is usually more expensive then laser in the long run. While laser is more expensive per session (usually 300-400 for a group of a 4 sessions as compared to $70 an hour for electrolysis), laser does clear more hair per session then electrolysis does. Unfortunately if you have light hair, or are dark-skinned, then you will most likely have to do electrolysis instead of laser. For most of us, we usually do enough laser to clear most of the hair, and then use electrolysis to clear the stragglers.

In terms of finding cheap laser or electrolysis, there are several options. A wonderful low cost option for electrolysis is to go to an electrology school  like the American Institute of Electrology, as they offer supervised sessions for as cheap as $20 an hour. Thankfully the students are supervised so you will get some results. In terms of finding cheap laser, it's a bit harder. Do your own research in your area, but usually there is a place (especially near big metropolitan areas) that offers cheaper laser if you get the right referral. For example, in San Francisco, there is a place called Aesthetic Laser Concepts near Union Square that offers $75-100 per facial session if you say that you were referred by Hagar Orren Electrolysis, which is nearby where I  live.

Name and Gender Changes:
The one thing about name and gender changes is that they do take some time for the process to complete. I had my name change done in Oakland, CA. I filed for the name change in mid-June of 2011, got a court date that day to appear in mid-September, and went to the Oakland Tribune to give them the Notice of Name Change form for them to publish. So all in all I had to wait three months for my name change to complete. Wait times can often be as long as six months, so it's very important to file a name change date as soon as possible! Thankfully I got my name changed right before my 1 year HRT mark which made things so much easier for me. The day I got my name change I was able to get my Social Security card updated, and got my license updated a week later, along with all my insurance info as well. Having your name and correct gender on your license was such a relief to me and I am so thankful for the peace of mind it brought me.

The good news is that name change forms are usually very simple to fill out and are straightforward. Another piece of good news is that while you can't usually wave the fee of submitting your notice of name change to a newspaper to publish, you can get your court filings fee waived by filling out some extra forms. If you have little or no-income, you can usually get a free name change basically by filling out the fee waiver forms!

One of the banes of transition is that too many of us don't have the insurance coverage we need to transition effortlessly, despite that many of us do have insurance but not insurance that covers trans issues. If you go to a state college though, there is usually some sort of insurance program they offer to students to help with medical costs. If you don't go to a state college, then there are other means to get insurance. Doing research in this area helps a lot, since any policy you want you would like to see if they cover trans medicine period. If you have insurance through work and they do not have a trans policy: contact your HR manager and Insurance Rep and explain to them why you need coverage (of course this only works if you are out publicly at work). Some cities offer their own insurance programs, such as NYC and San Francisco. Another option is to find someone that you personally that is a friend and works in an insurance company, and see if they can't do a favor for you. For example, a friend of mine babysits for a mother who works at an insurance company. My friend is openly trans to the mother, and explains that to the mother that she needs better insurance, as her insurance is screwing her out of HRT. The mother then proceeds to offer my friend a job at her insurance company, and is willing to train my friend for her insurance license. Now my friend is working as a trans liaison for the insurance company. So like in many other job areas: it's often about who you know, rather then what you know, that builds options for you. So if you know an insurance agent that needs a babysitter and is friendly, go for it! You never know what reward you might get. Also, if your insurance is being a nuisance to you, a good idea is to contact the Transgender Law Center in SF at (415.865.0176) and they are usually willing to fight your insurance for you. Same goes for work troubles. They always offer great advice and I swear by their actions for the trans community. 

Not all of us want to go down the surgery route for transition, and I totally respect and support the non-op populations for that. But for a lot of us, we do want surgery in some way, shape or form. Surgery is a very personal choice, and each surgeon gives slightly different results. While I am very proud and happy that I chose Marci Bowers to do my surgery, I know that her techniques won't work for everybody, and that's why I recommend doing your own research on this. Other good options for surgery for Trans Women include Dr. Christine McGinn in Pennsylvania, Dr. Broussard (sp?) in Montreal, and Dr. Suporn in Thailand. All of my friends who can gone to these doctors and Marci have all more or less loved their results and recommended them. Each surgeon's technique is slightly different, so doing your own research is key here.

In terms of cost, if you are uninsured, Thailand offers cheaper options for surgery where you can get good results for half the price (for example, Dr. Suporn as far as I know charges $10,000 for Vaginoplasty as compared to Dr. Bowers who charges $23,000 for Vaginoplasty). Other factors in determining surgery are geographic location (The nearer you are to your home usually the better, as recovering in your house is very nice compared to recovering in a hotel), and whether you have any financial backing for surgery. For those that are insured, there are grant programs such as the Jim Collins foundation can offer partial grants to help cover surgeries. Some doctors are even offering grant programs of their own (I heard of one in Florida recently that offered one). Although option is to use a fundraising site like IndieGoGo. You may be surprised by the kindness of strangers who offer support. If you use crowd-source funding, do not use Kickstarter, because if you do not raise your amount of money they will take it all for themselves. IndieGoGo gives you whatever you raise, which is why I love them as compared to Kickstarter.

If you do have insurance, fight for as much coverage as you can, even if it is partial. If you live in a state that supports partial coverage such as California you are in luck. If you live elsewhere, talking to an HR or Insurance rep might help. If there is any doubt, contact the Transgender Law Center and see what they can do for you.

Final Thoughts:
Despite that things are getting easier for us in terms of being publicly trans and having support, the truth is that the world is still a somewhat harsh place for trans people. Because of this, my biggest piece of advice to you all is to developed a no-holds barred, hell-bent mentality on getting what you want. You have to say that "nobody and nothing will hold me back from being who I am and accomplishing what I need to do." That kind of strength and conviction, more than anything else, is what will carry you through the hardest of times during your transition. Nobody can take you away from who you are, and you have every right to be the person you know to be. As long as you keep on putting one foot in front of the other, you will eventually get out of the dark tunnel, cross the bridge, and go into the bright light of happiness and wonder. And that my friends, that light and happiness, is worth every bit of pain and hardship on the road of transitioning. 

That more or less covers what I wanted to say. If I missed an area, do tell me and I'll update this post! If you want more specific information then contact me at and I will see what I can do.

Love you all and best of luck! Remember: you are not alone, you are loved, and you are beautiful. I will be thinking about you all in my heart always!

With Love,

The ODST Girl

Tuesday, October 23, 2012

My GCS Experience: How I Learned To Love My Vagina

Hello Dear Readers!

Please do forgive me for not posting for a while, things have been rather hectic for me back home in the Bay. That said, I can now say with pride and dignity that I am a post-op transgender woman, and I am so proud to be able to say that! It's been about a week since my surgery with Dr. Marci Bowers (who is awesome and gives great hugs btw, along with great vaginas)! Even though surgery results look their worst about a week out of surgery, I am very pleased with my results, and I love my vagina so much it's crazy. I wanted to share my experience with you dear readers, so that you may gain some answers if you are trying to have Gender Confirmation Surgery yourself, or are interesting in learning more about GCS as well. So without further ado, let's go on a journey, shall we?

I applied for my surgery at the beginning of July, finally having the time to think about it because I had recently resigned from my job at Old Navy over legal issues that I found the company to be violating. But that's a story for another day. It was in mid-august that I got my call from Robin at Dr. Bowers' office, and in that call I got my requested surgery date of mid-October. I only had two months to prepare for surgery, which was nuts. What was even more nuts was that my insurance, Anthem Blue Cross of California PPO was going to cover over 90% of the $23K cost of the surgery. How was I able to accomplish this? By bending two laws to my advantage: Because I was under 26, I could still be a dependent on my mother's insurance under Obamacare, and she has excellent insurance through her work, so I lucked out there. The only law that I was able to bend was a new law just passed in California earlier this year requiring insurance companies to cover Transgender bottom surgeries, which is super kickass! So I used those two laws to my advantage.

At least through Dr. Bowers' practice, there are three primary payments that one must pay, in addition to the $500 deposit you pay when you apply for surgery in order to reserve a surgery date: One to Dr. Bowers' personally, one to the Anesthesia Group, and one to Mills Health Center, which was where the surgery was going to take place. Insurance covered the Mills Health Center and Anesthesia Group payments, leaving me only having to pay what amounted to $2000 all in all for my surgery: the $500 surgery deposit, the $900 payment to Dr. Bowers, and several tests and fees that aren't covered by insurance. For example, there is a pathology test for tissue excised during the surgery (to test for diseases, tumors, etc), which costs $150. So all in all I paid $2000 out of $23,000 for my GCS. Super kickass right?

Now onto surgery prep: I knew that because of my short time limit before surgery, I would only be able to get a few laser sessions in on the surgery site. I was able to get two sessions for pretty cheap (100 per session) through a local laser clinic deal at Aesthetic Laser Concepts in San Francisco. In order to make it before surgery, I had two laser sessions spaced three weeks apart, since Dr. Bowers doesn't want any laser done on the surgery site two weeks before surgery. So time is of the essence. In terms of laser, what is zapped is the shaft of the trans clit (aka penis in old male terms) out to the beginning of the thighs next to shaft, then down to the entirety (more or less) of the ovarian sac (read: scrotal sac). Then going down in a V formation, ending at a point just one inch or so above the anus. You can look here for an idea of what I'm talking about a bit:

When it comes to buying supplies for recovery, what is most important is Surgilube for dilation, bed pads, and Overnight-strength pads, since your vagina will be bleeding for a while after surgery. Also, for bathroom times, get non-alcoholic baby wipes. It may burn when you wipe for a while, but at least you stand a less-likely chance of getting an infection when using baby wipes as opposed to toilet paper. Also, be really serious about wiping front to back. It actually can take time to retrain yourself to wipe as a post-op woman. It'll make more sense once you have the surgery. Also, Neosporin, as you have to apply an anti-biotic ointment several times a day post surgery for a while as you heal and recover. Now ladies, when it comes to the lube for dilation, make sure at the very least it is water-based, as silicon based lubes can weaken the vaginal lining. I believe this is also true of cis-gender woman as well.

Pre-surgery prep is gonna be one of the banes of your existence. As the bowel prep you have to drink the day before surgery to clean and dis-infect your colon will make you sit on a toilet for hours. Now it is important to note that whether you get a penile inversion technique vagina or a colon transplant technique vagina, you will still need to drink the bowel prep. I could only drink 2/3rds of the four-liter jug they gave me at CVS. Yea it's that much you have to drink and it tastes like ass and will trigger your gag reflex. So drink lots of water in between chugging those 8 ounce glasses of BP every ten minutes (*shudders*). Also, if you're a fan of Ginger Ale like I am, buy a lot since it makes the BP easier, along with dealing with some pressures and issues in the first week of post surgery since Ginger Ale helps calm down the stomach.

Now onto surgery itself: I arrived at Mills Health Center at 6 AM this past Wednesday for a 7:30 surgery appointment. It's a 3.5 hour surgery so you will be knocked out. I remember cracking jokes with my anesthesiologist and several of the nurses in the surgery room, while the anesthesiologist injected something into my arm. The next thing I remember, I wake up in recovery at 11:15, fifteen minutes after surgery. Now you may experience a slight psychotic break for a few seconds, since your consciousness literally transfers you from the surgery room to recovery in less then a second. One could say it's kinda like being roofied, except you wake up with a brand new vagina, a lot of catheter pain, and a slight hangover. The most painful thing off the bat will be the catheter and the pressure it builds in your bladder. Now if you haven't had a catheter before, basically all you feel is being constantly full and like your bladder is about to burst. But there isn't much urine in there since it is being drained by the catheter to your urine bag. You have that in you for 6 days, which seem to last an eternity but actually goes very quickly.

Be prepared to be stuck in your bed for the first 48 hours of your hospital stay, so bring magazines, stuff to listen to, etc. On your third day you get to walk around, which feels amazing after being stuck in bed for so long. On the morning of the fourth day, you leave the hospital, albeit tugging around a pee bag for the next couple of days. Be careful when showering and be careful not to touch the surgery area.

Moving on to day six of post-op recovery, where I finally get that painful ass catheter removed and the vaginal packing too. You will immediately feel a helluva lot better after getting those removed. First dilation experience is amazing, it's like everything you ever hoped for, tingling, a bit of stretching and pain, but you feel the stent go deep inside you. It's such a trip and I love that feeling so much! Is it weird to say that I like to dilate? Now dilation is messy so put a towel on top of a bed pad before you dilate as lube will inevitably drip down from the vagina towards your butt, which is messy and not that fun, but its a small price to pay for dilation.

All in all: I love my vagina! It makes me so happy just to see it, despite all the pain, and all the swelling, and how crazy things look after one week post surgery (where they will look their worst, but at least it that's the worst it looks!) I am so happy and I feel free and more complete and whole now then at any time previous in my life.

With that, I hope you have learned a thing or two about GCS. If there are any questions I would be more than happy to answer them.

Till then, take care and stay fierce and fabulous readers!

With Love,

The ODST Girl