The Bottom Surgeon (aka The Dick Doctor)

The doctor's surgery was about a block from Regent's Park. He's in private practice and the office was incredibly posh. The waiting room had what looked like 18th century prints, in four colours and several nice sofas. I felt under dressed compared to the furnishings.

The sign in form asked for my credit card details and insurance information. I told the receptionist I was on the NHS and she told me to fill out the other parts of it. I overheard the patients before and after me saying the same thing, so maybe Friday is NHS day.

I went up to the doctor's office, which was smaller and had two oil paintings hanging behind the desk of what looked like impressionistic Parisian street scenes. Rather clichéd art, alas, but hardly the focus of why I was there.

The doctor was a big man and spoke in a relaxed manner. He asked me my height and weight, my allergy information and what musical instruments I play. Have I had any previous surgeries? I told him about the benign tumour I had many years ago and he examined the scars on my wrist. "This is important for this kind of surgery" he explained and then asked if I was right or left handed. "So you want to get a phalloplasty." I said I wanted a meta and asked if I was in the right place. He explained that he calls them all phallos.

I didn't take notes and I wish I had, so some of this is not in the same order as it actually happened. My impression that a meta is only one operation was in error. It's actually three operations, depending on what happens. He said that 2/3rd of people who get it are unhappy later. Skinny people do have the best results, as it sticks out more. He told me about how they move everything they can away from it, to increase the sticking out. Natural dick growth happens over the first four years people are on T. I've only been on it for 3 years. The people who have the biggest dicks starting out will have the biggest dicks at the end.

In the first op, they do a hysto, if the patient is having one, add the waterpipe, move stuff around and build a scrotum. They start out giving the patient two catheters, one through his belly to his bladder and one in his new dick. They take out the one in the dick after a week, because it's irritating, and leave the other one for three weeks, to give the waterpipe a chance to heal before sending wee down it.

There's a 30% chance of developing a leak, either at the tip, which can split or at the base. If there's a leak, they give it a while for the patient to otherwise heal and then try to fix the leak. I've heard elsewhere that this is difficult and doesn't always work the first time.

Then finally, they add in silicon prosthetic bullocks. He opened his desk drawer and pulled out a bag of ovular, squishy balls. He showed me one about the same size as the end of my thumb, above the top knuckle. He said it would be that large and then pulled out another, clear ball and said it would be made of the material in the second ball. The first one seemed small, but it's not like I have a lot of experience with how big they normally are. He said they had to use small ones or it would dwarf the meta-dick.

I gave the material a squeeze. Again, not much basis for comparison, but it seemed kind of firm. If I sat down hard on something, I might bounce a bit. He emphasised how durable the material was, "You can pierce it with a needle or stab it with a knife, and it will be fine," listing several things I hope never happen to me. He took another, much squishier one from his drawer. "I used to use these. They're nice and squishy, but I kept having to replace them when they sprang leaks." I said I appreciated durability.

If I got a hysto at the same time, it would be two days in hospital, assuming that was done lacroscopically. However, the lacroscopic surgeon he works with isn't in London, but a hospital out in the country. I wondered if it was similarly posh to his offices, but didn't ask. That hospital is just off the main line from Paddington, which does not sound like it would be a fun commute while one has a catheter protruding from one's abdomen.

Then, back to work shortly afterwards. All the wounds are in the same area, so that apparently makes things simpler. He talked some about complications, but I've got them all jumbled in my head now. Apparently, smokers have the worst ones. So he's quit operating on smokers. Fortunately, I do not smoke.

He also said that skinny people have the best results, since it sticks out the most and many (but not all) skinny people can wee through their fly. The rest cannot. Which is probably related to the unhappiness factor. This truly makes a very small dick, which is not considered usable for 'normal' sex. However, it is my understanding that it's a dick that has normal spontaneous erections and, provided, one sleeps with yoga practitioners, it's possible to manage to stick it places.

He was generally fairly negative about the meta, so I asked about the normal phallo.

That used to be 4 operations, but they've got it don to 3, he said proudly, contracting his earlier statements about how given the complication rate, one shouldn't get to caught up on the number of operations.

They take skin from the patient's arm or belly and use it make a shape like a sausage roll, attach it to the existing blood supply and hook up nerves. He showed me some photos of post-surgical penises, that he had on his blackberry. They were on the large side, but they looked just like any other dick. (Again, not much experience, although one does see them a bit in pron.) The first was an arm one and the second was a belly one.

Of course, if you use the belly, you don't get any erotic sensation, he explained. "So the belly is out," I said. "Everyone says that!" he said.

He drew some pen marks on my arm, one of which intersected my tattoo. They would take one of two sets of veins and arteries leading to my hand and two sections of skin, leaving only a narrow strip. They would shape the donor skin "like a sausage roll" and sew it on, connecting up my existing blood supply and connecting nerves. They take some of the nerves from my existing dick and connect those up also, so most people get a mixture of erotic sensation and normal sensation. The existing dick can be stuck sort of under the new one, left out on it's own or taken off completely, but that's an extra thing and makes everything somewhat more complicated.

My tattoo would end up part of the waterpipe and not be visible. They replace the arm skin with skin from the patient's bum. "So it comes with a free bum tuck" he said. "I'm 9 stone, I don't need a bum tuck." He said if there was not enough skin on my bum, they could peel the surface off of my thigh and do a thinner layer of skin. Other surgeons do it that way routinely and it can also have a good result. He showed me a photo of a skin-grafted arm.

"Oh, I forgot about the head!" and explained how they built that, but I was thinking of half-peeled thighs and feeling alarmingly like crying, so I don't recall what he said.

He looked at my left arm and tested the blood flow to see if it would be good enough for me to sacrifice half of it. He said it would be fine. They had one patient, about ten years ago, who's hand died, but that guy was a heavy smoker and that probably wouldn't happen to me. Most blood flow problems happen to smokers. Some of them lose their entire penis. He's stopped operating on smokers because of the complications.

He took out a BMI chart and looked up my BMI and said it was a bit low. The layer of fat under the patient's arm skin was what provides girth for their penis. He told me I should try to put on a stone or two. "Not, muscle; fat." Once they made the penis, it would be "diet-proof" but eating more fat wouldn't make it get any bigger either.

He asked if I had a partner and when I said no, he asked if I was looking. They don't do the final stage until the patient has a partner or is looking. He took two devices out of his desk drawer. They were like those fat, ergonomic ball point pens, but half again as long as those normally are. One device just had one of those things and the other had two. He pointed at the single one and said they would use that for me, as I'm thin. Also attached to the devices were small squishy pumps and a bulb, maybe 10% bigger than a kiwi fruit.

The phallic portion would go in the phallus, the pump in a bullock and and the bulb somewhere in my abdomen where I wouldn't feel it. He squeezed the pump a few times. Water comes from the bulb and goes in to the phallic part to make it stiff. When one is tired of being stuff, they squeeze another part of their bullock to release the seal and squeeze the water back into the bulb.

A dick that reliably gets hard and stays hard as long as you want isn't all bad, really. He said the infection rate for adding these devices was 10%. I said this sounded high. He explained this was an achievement compared to the previous rate. The infection can take up to a month to become apparent. After that, one's body forms a protective shell around the devices and starves the bugs of food. they give antibiotics for a few days after the operation and then wait to see if an infection develops.

The devices are fairly complex and fail at 1-2% a year. This is why they don't do that part until the patient has a partner or is looking, he said.

I asked how long I'd be unable to work and he said it would be a month before I could use my left arm again. I don't know if that means actually a month or is like the "two weeks" my last surgeon told me.

He told me to go think about it. They don't want to force people to have operations. Patients need to be sure of what they want. I asked if I called back tomorrow and said I was certain, how long it would be until I would have the operation. "3 to 6 months" he said.

I could have a willy in 3-6 months.

I thanked him for his time and said I would call him after I'd thought about stuff and then went looking for fatty foods, feeling completely freaked out.

. . .

It took me many weeks after the last operation to regain my mental focus, so if I got an operation in the next 3 -6 months, the chances of me actually graduating are quite low. I've already made some sacrifices for this stupid PhD. In for a penny, in for a pound. It would be really stupid to bullocks it up (so to speak) in the home stretch.

If I do not graduate, my plans to stay on in the country are not going to work out very well (unless I could get married, but I suspect a bandaged wiener may impact my ability to find somebody to marry). So I would have to have the operation and then bugger off right afterwards. Given that I'm entitled to NHS coverage on the basis of being a student, taking this and then leaving without even graduating seems more than a little morally suspect. Assuming that I could get all the operations finished before my visa ran out, which seems unlikely.

If I'm trying to get a job right after graduation, which seems wise, it might be problematic to take sick leave right away. My next likely break where I could lay about recuperating is the summer of 2012. Of course, by then, with the cuts, my NHS funding could evaporate. And the massive cuts in university-level arts education may mean that I can't find a job and I have to leave anyway. So a planned delay may well mean starting over in another country or it could very easily mean never. I strongly suspect it means never.

I am literally sacrificing my right nut for my PhD.

And my left one.

The next time I'm in a pub's bog, in a cubicle with no latch on the door, hoping nobody notices that I'm sitting down to wee, I'll be sure to think how fucking awesome my PhD is.

. . .

I feel completely freaked out. Indeed, even if my PhD weren't at stake, and I was certain exactly what I wanted to do, I'm not ready for another round of surgery. My chest still hurts and last week a blob of pus came from what I had thought were healed scars. I need 6-8 months for my chest to settle down before I can call it healed. I know some men do move this quickly, but arm, bum, chest and bits is a lot of things to be healing all at once and my uneducated guess is that this probably increases the chances of complications. An infected dick would be disconcerting, but a numb dick would be a personal tragedy.

Whatever I do, it's a few months of pain and then I'll have the results of it for the rest of my life. I think that provides a useful perspective. I should take time to think, but really, I know what I'm going to do and it's terrifying. However, step one is to wait.

This post talks about genitals

I got a letter in the mail telling me to turf out this morning for a "transvaginal ultrasound" at the Royal London Hospital. People who have been on testosterone for more than two years have a slightly increased risk of uterine cancer. The NHS has a strong emphasis on preventative medicine, because it saves money in the long run. So I get all kinds of tests that I wouldn't get in the States, where no bureaucracy has heard of anything but the next quarter.

I walked over. This is the same hospital I went to A&E at, not long ago. It's in old brick buildings and has a crumbling, Victorian look about it. It's definitely an urban hospital, swarmed with people form the tapestry of urban life. The woman at reception didn't seem to notice my accent, but she must hear as many foreign accents daily as native ones.

The clinic I was looking for turns out to be directly above the A&E, on the next floor. I went to the window at the nurses station and signed in. They directed me to a waiting room. Much to my immense relief, it was co-ed. There were as many unhappy looking men as unhappy looking women. I took a seat on a blue chair and pulled out the book that I had brought. Nobody else was reading. The white, windowless room had no magazines.

Rather quickly, my name was called. I was instructed to go pee and then meet the woman in a back room down a dark hallway. She lead me back to a darkish room. The lighting was indirect and the walls didn't go up all the way to the ceiling. She instructed me to remove my shorts and pants and then sit on a table. She did not leave the room for this, but just told me to put on a gown first. So I did as instructed.

She told me that my GP had referred me for this "because of the drugs [I'm] on." I started to say I wasn't taking post-surgical drugs anymore, but then I realised she meant testosterone. It's funny how I don't think of it as a drug, but rather something linked to a state of being. It's not that I'm on drugs, it's that I'm transitioning. I'm on T, which is, somehow, not a drug.

She asked questions about menstrual cycles, something that's long since been chained up and abandoned like an unwanted bike. Then she got a wand thing and said it wouldn't hurt, but it wouldn't be pleasant.

These bits, I don't speak of them. I avoid thinking of them. I'm unsure what to call it. But unlike Buck Angel, it's also non-functional. Testosterone has caused tissue to atrophy, so even it was not mentally troublesome - which it is, it's physically painful. The cure for this is topical oestrogen cream, which is alarming and for something I don't want anyway. The other option surgical removal.

So I told her it might hurt and she said that it would be fine. Very old ladies have some of the same physical issues and they're unhurt. She prodded with the wand and we chatted, as she looked at the screen. I should have taken paracetamol ahead of time. It's the kind of hurt of getting your teeth scraped by the dentist. Uncomfortable and annoying, but not overwhelming.

She was on the lookout for thickening of the uterine lining. She asked who was going to interpret the results, because it didn't look thickened, but it looked different than what she had seen before. I said my GP would probably forward it to somebody who was an expert. As it went on, I said something about a hysto and she wondered about osteoporosis risks associated with that. I said T would protect me. "We" women are at risk for that, "but I guess men aren't." she said.

She with her invasive, prodding wand, stuck into a site of all sorts of discomfort; a psychic wound; an unwanted opening. Chatting about "we" women. I did not say, "I'm a man," flying futilely in the face of what must seem like overwhelming evidence. I did not say anything about it at all. I talked about how sex hormones work in men. "Men like me," I did not say.

She finished and left me alone to get dressed. I thanked her on the way out. I did not do or say anything to challenge the notion that I'm an unusual woman; I just left. Thinking: I will be a subject of medical curiosity and tests and prodding for the rest of my life. It will never be all right. The surgeries I can get will never be perfect. I will never pass when my genitals are examined. When I most need sensitivity, it will never be forthcoming.

I walked out, past the entrance of the A&E, with the feeling of not passing. Outside, there was a man with a broken neck, smoking cigarette. I made eye contact with him and then thought it was rude to stare at the screws holding his head in place, so I looked down. "Nice DMs" he said. I was sure he could tell, sure he was feminising me, complimenting my body in some unwanted way. "What's a DM?" I asked. He smiled and pointed at my shoes, mistaking them for Doc Martens. "Oh!" I said as the lightbulb went off. It was all blokey and male bonding and fine. I smiled back, "thanks!" I said.

I cannot get a hysto soon enough.

Note

I don't want cis commenters on this. If you don't know what cis means, it probably means you.

Week 3

Life

Well, the nurse last week was very cautiously approving of my gig plans, but everybody I know who has actually had top surgery was against it. Meh, what do they know? I made plans to have a first practice with Jet on Saturday. To prepare, I was taking longer and longer walks, with my recently returned dog, to build up my strength, but not playing bass. I was tapering off painkillers. Life was good.

When I actually pulled out my bass, my dexterity was really low in my left hand and my playing kind of sucked. I got gradually better as the practice went on, but it was pretty short because I got tired really fast. Jet, who is lovely btw, went on to her next appointment. Then the pain started.

Oh my gods it hurt. The next day, I thought I might have torn something. I had no more of my more powerful painkiller left. I called NHS Direct to find out if it's ok to take parecetamol and ibuprofen at the same time. "I just had a mastectomy." I explained. "A vasectomy?" the woman asked. Um, not exactly. Anyway, mixing them is fine.

By Tuesday, the pain had receded enough that I thought I might manage being social in public, so despite not being able to use my left arm for things like wasing up, I got on a bus with Paula and headed to Vauxhall for Bar Wotever. I turned up earlyish, got a seat in the back and didn't budge for the evening. Dr. Jane came by. She noted that I'd written that she rushed up to me after my dressings appointment two weeks ago. "You were walking like this," she imitated an old man shuffle, eirily reminiscent of my grandfather and then described how pale I was. I guess it must have looked pretty alarming. Anyway, the night out was fun. I got pretty tired by the end, but it was ok and I was fine in the morning.

Which was good because I walked over to my GP's office to learn the results of having my hormone levels tested. Shockingly, they were fine! I'm very pleased as I've been feeling fine. In the past, feeling fine has correlated with my levels being too high, followed by my dosage being cut to a level where I don't feel fine. 2.5 years on Sustanon and I finally know how much to take how often.

Meanwhile, coincidentally, my godmother signed up for facebook. It alerted me, as they seem to have a copy of my addressbook. About a year ago, I had sent her a coming out letter and had heard nothing back. So, I sent her a friend requst and she accepted and then sent me an email. We had an exchange and she asked why my status messages were about being too tired to walk my dog properly. I explained I'd had an operation without further specification. She didn't ask what my op was, but instead what name I prefer to go by. My heart was greatly warmed.

Third Outpatient Appointment

Yesterday, I headed down to Tooting for my last appointment with the dressings clinic. I walked from my flat to Tower Hill at near normal speed! Just being able to walk quickly again is such a relief. I had the same nurse as last time. I described to her my bass playing woes and showed her my non-painful range of movement. She said there must be scar tissue and that I need to keep moving to keep from stiffening up entirely. She suggested shoulder roles and gently raising my arm as far as it wants to go. I need to work back to being able to reach things. I'm going to procede with caution.

I also asked about getting signed off for medical leave, as I haven't done any studies for about 3 weeks now. She said the hospital would automatically give me one week and if I want more, I need to talk to my GP. One week?! Good lord. The ideal Briton must heal very quickly indeed.

She looked at my wounds. My right nipple continues to heal as it should. The left nipple has become appropriately dry and therefore no longer needs bandages. The necrotic bits on it will turn to scabs and should come off on their own. She advised against picking at them, something I don't need to be told twice. Or even once, really. I'm to moisturise both nipples twice a day. This will help the puffy, ruffly bits to flatten out and thus hide my scars.

Because neither side needs dressings anymore, I am not scheduled to return to the dressings clinic. I will see my surgeon again in about 3 weeks. It's possible to ask her to do the documentation for medical leave, but I'm going to try my GP first because that will take less time and because my surgeon, like all surgeons, thinks people recover from this after 2 weeks. If I can only get a note for 2 weeks, that's better than none, but since I've been useless for 3, that would be better.

I look forward to being able to bicycle again and play bass and take long walks with my dog, holding the leash normally instead of looping it through my belt. And also to write some new music. Being medicalised gets old fast. It's worth it, but I'd like to go back to normal.

Second Outpatient Appointment

My Week

After my overly-exhausting walk to my GP's office last week, I took a few days off from wandering around. Even going across the courtyard to my neighbour's house was leaving me pale for several minutes afterwards. But then, over the weekend, I was feeling better and asked my neighbour if she would go for a walk with me, along the bus route. I asked her to tell me if I started looking pale.

We walked about a kilometre, sat for a long time on a park bench and walked back. It was fine. I was feeling happy to be ok again. I went to the grocery store the next day, with Paula's help to carry stuff and then hung out the rest of the evening, felling completely normal. A lot of friends were coming around to see me. I wasn't going out at all, but had enough company to stave off loneliness. Things were pretty good.

On Tuesday, I picked up a novel before bed, intending to read a couple of pages. At 3:30, I realised I had read the whole thing and was up later than I meant to be. I've been going to bed around 1, so it wasn't that much later.

I woke up the next morning feeling like crap and in pain. I could barely stagger around my flat. I took a bunch of pain pills and when they didn't perk me up adequately, I called the Hospital to delay my appointment. I suddenly felt very fragile. They said I would be mostly recovered by 2 weeks and it was just shy of that and I couldn't even manage to stay up slightly late.

My friend Jet had asked if I could play some improv bass for her theatre piece on the 25th. Aside from not really being up on generic improv, I suddenly became worried that maybe I wouldn't physically be able to do it. I started asking around and most guys are saying it's not actually a good idea, but one shared a story about having a major recording session about 3 weeks after. Meh, I really want to do the gig!

Meanwhile, I was changing my dressings everyday and taking photos of my chest while the bandages were off. My right side is still looking perfect. It has hardly any bruising at all and the wound healed completely within a few days. The adhesive from the bandages began to irritate my skin, but, aside from that, there were no problems.

My left side is probably more typical. It's bruised and swollen. The haematoma has gradually decreased, but not vanished entirely. The dark band of necrosis on my nipple seemed to be decreasing in size, but the whole lower half of my nipple was oozy and gross and seemed to be slowly dissolving. It was sticking to my bandages. I tried not to pay too much attention to it.

Thursday

So when Thursday came around, I asked the TFL for a route with minimal walking. It sent me on a short walk to a long bus ride east to catch the DLR to Bank. Climbing the stairs to the DLR platform was surprisingly tiring. But the route was ok and had a lot of escalators. When I got to Tooting Broadway, I walked to the hospital rather than riding another bus.

Thursdays, the Dressings Clinic is not in some back corner of the hospital, but mysteriously moves to a ground floor clinic in the same wing as where I had my operation. I saw a different nurse than last time and asked a lot of questions.

People have been urging me to try Arnica, which is a flower that is rumoured to help with bruising. I had been concerned about drug interactions or possible allergies, but then I learned that Austrians make schnapps out of it. Anything that's made into schnapps has got to be relatively harmless. Still, I asked the nurse and she said that there were no studies that indicated that it had any effect at all. She did say it was harmless, so I bought some gel on the way home.

She said that the rash I was getting from the bandages is probably not an allergy, but from the irritation of pulling off an outer layer of skin every day. She suggested that from now on, I should peel off the bandages while in the shower, as the water would weaken the adhesive and thus spare my skin.

Because my right side has closed all the open wounds, I don't need to wear a bandage on it at all anymore, but should massage in moisturiser around the edges. She was demonstrating this and I felt a bit of pain where she was poking me, which is actually good, because it means my numb spots on that side are nearly all gone, except for my actual nipple, alas. My skin is really itchy, but this is apparently a sign of it re-awakening to sensation. Also, I've been feeling a lot of weird sort of stabbing sensations, like somebody is poking me with something kind of sharp. This feeling is nerves reconnecting and waking up. So despite it's being somewhat annoying, it's a good sign. And, I mean, some folks would pay good money to feel like they were being sharply poked repeatedly in the nipples.

My left side is still way more numb than my right side, but in the last couple of days, the sensate portions have dramatically increased. And it's got the stabby thing going on a lot more than the right, so it's continuing to heal. Ironically, that nipple is often itchy and has more feeling than the more perfect looking one.

The nurse said that the generally gooey yuck of the left did not mean that it was dying, just that it needed to dry out. She confirmed that the necrotic band had really reduced in size. In order to dry out my left side, she switched the sort of bandages to put on it. Now, I start with an iodine-soaked piece of gauze, which i press into the folds of my wound, as much as I can. Then, I put a regular sheet of gauze over that. And then a non-waterproof adhesive on top. Theoretically, the new bandaging is breathable and the iodine should encourage dryness. It was much less yucky when I changed it this morning, but alas, I pressed in the new sheet perhaps too gingerly.

She gave me all the stuff I'm going to need to bandage myself for the next week, including a disposable pair of scissors. The dressings clinics gets sterile pairs of steel and plastic scissors, uses them once, and then incinerates them. I was flabbergasted last week when I saw the nurse throwing them into a sharps bin. She said they used to autoclave them, but not anymore. I really find it hard to believe that many germs could survive a trip through an autoclave. If it's good enough for tattooing equipment, which actually touches blood, it's got to be good enough for scissors that only touch sterile dressings. If this is cheaper, it's certainly a false economy. Nothing that wasteful can seriously be a good idea.

I talked about how fragile I felt after staying up too late and asked about playing the gig in a little more than a week. She was cautiously encouraging but stopped well short of saying it would be fine. What she said was that the consequences of doing too much would make me feel over-tired and bad, but it does not actually impair the healing of my wounds. So the risk I would be taking by playing the gig was not any further harm than exhaustion. I'm not going to mess up my operation.

She said I should work up to it. I intend to do this by getting gradually more exercise leading up to the gig and also by practicing every day and making sure I have the stamina to play bass for the duration required of me. I'm not going to move any gear and I'm going to play while seated, so there's very little actual, physical stress. The only concern is exhaustion, which, while uncomfortable and definitely something I want to avoid, has no long-term consequences.

I feel cautiously optimistic. Anyway, taking walks and getting better at bass playing will both be good for me.

Outpatient Appointment

I woke up yesterday morning feeling relatively feisty, so I put all my clothes and stuff into bags, ready to go home to my own flat. Jara helped me carry the heavier bag. It was all good, but by the time I walked down the stairs, across the courtyard and up the stairs to my own flat, I was too tired to do anything. I didn't leave my flat in the cleanest possible state, and fixing this is very slow going.

In the mid-afternoon, Dr Jane came around in her awesome little sports car to collect me for my first outpatient appointment. I was very grateful for the lift and the company. Given that it was a trek for me to cross my estate, I wasn't quite ready for the tube and it's much more pleasant to go with a friend than alone in a cab.

There was a lot of traffic in central london and the outpatient plastic dressings clinic is in a strange back corner of the hospital. I arrived 20 minutes after my appointment time and then probably walked for at least another 10 minutes, around the perimeter of the hospital, until I finally found a dark hallway that seemed to be right. The plastics dressings clinic, where I was headed, was next to Bereavement Services. It's good that the hospital provides this service. It seemed to be a small, windowless room with 3 or 4 chairs around a low table. Kind of a depressing setup, but I guess that doesn't actually matter.

I apologised for being late, but they were running behind anyway and so I waited for a bit and then went in to a very warm, windowless room. There was a fan blowing, but the nurse turned it off when it kept blowing the paper off the examining table I was trying to recline on. The walls were lined with little plastic bins that contained different kinds of bandages and things like that.

I took off my shirt and chest binder and the nurse started to peel off my bandages. She did the right side first, first taking off the plaster covering were the drain had been. She said it was dry and didn't need to be rebandaged. Then she took off the plaster over my nipple. It had a bit of blood on it, but was fairly clean. I looked down at my chest.

I had been warned that it would look weird at first, but man, it is weird. The process the surgeon used was to cut out my nipple, but keep it attached to the blood supply and nerves, and then remove the moob around it. So this left a hole, so she stretched the skin from the outside of the moob towards the middle. To visualise this, think of cutting a circular hole in a sheet. Then you want to close the hole, so you bunch all the fabric from the perimeter of it together and then put a button or something in the middle of that. That's kind of what my chest looks like.

There's an expanse of pale skin, that gets kind of wrinkly and ruffly, which surrounds my pink nipple, poking out from the middle. All the stitching and scabs, etc are only surrounding the nipple. The nurse said it looked perfect. Ok!

The she took off the bandages on the left. These were much more dirty and I averted my eyes for the rest of the process because I didn't want to feel faint. She also, very happily, removed an electrode that was still stuck to my back, that I couldn't reach. "You haven't taken a bath for a week?" she asked. Um, no. I started thinking about who it would be least awkward to ask to come over to rub my back with washcloth.

She was concerned about the swelling, so she asked another nurse to come have a look. The other nurse was busy, so we had a longish wait where we made awkward small talk. She put a paper towel sort of thing over my chest, probably because I was obviously freaked out by the scabbiness. I took it off after a bit to get a better look. Meanwhile, I had kept my binder on nearly continuously since my op and the sensation of having it off was also kind of strange. It's purpose is to reduce swelling, and while it was off, I could feel swelling tugging at my stitches. The nurse told me not to worry about it.

The other nurse finally came in and looked at a lump I have on my left side between my armpit and nipple. It's somewhat larger than a golfball. She said it was a hematoma, which means a bunch of blood and other goo trapped under my skin. "We could aspirate it with a needle," she said and then laughed at the look on my face, "but that would increase the risk of infection, so we'll just see if it goes away on it's own." I m deeply in favour of that plan over the popping-like-a-water-balloon plan. She said the (now extensive) bruising was also normal and not to be worried about it.

Then she got out a mirror and showed me my left nipple. "Do see you the shadowed part underneath?" On the bottom of my nipple, below the pokey bit, about 10-20% of my nipple has darkened. She explained that this indicates a blood shortage. The shadowed bit will probably die. It will dry out and then she and the nurses have a way of getting it off. And then, I guess, somebody will tattoo the pale skin around it and the world will be none the wiser.

They told me I could take showers again! Huzzah. I should moisturise the ruffly bits of my chest afterwards and when I change the bandages, which I should do everyday. They gave me some moisturiser to use and meant to give me a week's worth of bandages, but accidentally only gave me enough for one side. I'm allowed to keep taking the same pain meds, despite the prescription ending. She told me to look out for signs of infection, which I have not absolutely committed to memory, because of my propensity to worry. If it doesn't seem wrong, it's not wrong. If does seem wrong, I should just call them. I'm to come back in a week.

I walked around to meet Dr. Jane by the café in front of the hospital. Jane came rushing over to meet me. Later she explained that I was shuffling like an old man and looking very pale. She suggested we sit for a bit and have a bite. "How are you doing?" she asked. "Part of my left nipple is dying, but it's not a part I was really using." I said.

We sat nicely for a bit and then went back to mine and hung out for a bit more. I took my last antibiotic, thank gods.

This morning, I had to go get my T levels tested at my GP office, which is a bit further than a kilometre away. I asked the guy drawing my blood if having an operation and the massive stew of drugs I've been on since my last T injection would skew the results. He didn't think so, but wasn't sure. I guess if it says the levels are too high, I can push for a re-test, since this new 0.8ml / 18 days is the best I've ever felt on T and I am not entirely keen to decrease.

On the walk back, I had to stop and sit about after every third of the trip. I was back to my old man shuffle, but trying to stand up as straight as possible. I'm so used to slouching that it's very awkward looking when I try to stand up straight. But since I'm wrapped in a piece of elastic and recovering from surgery, I'm all awkward anyway, so might as well get used to it now.

When I got back, I was shattered and slept for a couple of hours. I probably should have taken a cab home or waited longer in the waiting room before walking back. Still, stronger ever day.

Home From Hospital

The doctors had said I was going to be out "mid-morning," so when it got to be afternoon, I asked the nurse what was going on. She explained that there's only one pharmacist working in the hospital on Sundays. The ward didn't have my antibiotic on hand. They only kept supplies of one I'm allergic to.

She came around again later to remove my de-pressurised drain. The right one had been gently coaxed from my side by a different nurse. But this one she took out all in one quick motion. It was quite a bit more uncomfortable than the right side, but everything on the left has been more uncomfortable. I remarked on the speed at which she removed it and she claimed there was less pain overall if it was done quickly. She also, finally, removed the IV line, which had been painfully poking me for the last few days. I couldn't move my arm much without the needle n it restabbing me. It was such a relief to come out.

She came back again with a bag full of pill boxes and a letter. The pill boxes were all my prescriptions for pain killers and everything I had been taking while in hospital. They even included boxes of paracetamol (aka: Tylenol or acetaminophen).

The letter explained what procedures had been done and who had done them. There were also appointment letters for two outpatient followup appointments.

I asked the nurse if I should watch out for anything. She said I was going to be back so soon for a followup, that I really didn't need to worry about anything. But if there was discolouration, then that would be something to lookout for.

I had texted Paula that I was being freed and I knew she was on her way, so I got dressed and walked over towards the nurse's station to stand around. I was thinking of going outside and sitting there, but wanted to tell them where I would be, so they could direct Paula. However, by the time I got to the nurse's station, I was feeling more tired, so they pulled me up a chair and then suggested I could go to the day room. So I went down the hall there, where two other patients were half passed out, watching Wimbledon. I have to confess that I don't understand the popularity of tennis. Or golf. After sitting there for several minutes, I realised that what I really wanted was a nap, but I thought they might have made up or given away my bed, so I stayed where I was while Paula and Jara navigated the weekend engineering work on the tube system.

We went downstairs to the cafe and I had a bite and then got a cab from Tooting back to Wapping. The bouncing of the cab was extremely uncomfortable, but as there was nothing to be done for it, I didn't complain. We got back and I very slowly climbed the two flights of stairs to Paula's flat. It was a relief to be out of hospital and finally able to walk around a do things. However, things like pitchers of water turned out to be unexpectedly heavy. As I was getting ready for bed, I put a glass down on an unstable surface and made a grab for it with my left arm to catch it before it fell. Something in armpit pulled uncomfortably. I went to bed.

In the morning I woke up and stumbled towards the bathroom. I looked down at my left hip and saw some bruising. Funny I didn't notice that when I was still in hospital. I splashed some water on my face and then realised it hadn't been there when I was in hospital. I took off my binder to look at it, and it was a line of purple bruising from up in my armpit where the drain had been, all the way down to my hip.

I got the letter the hospital had given me and called the number on it and got the main hospital switchboard. I asked to speak to my surgeon and they put me through to her fax machine. Paula suggested that I call NHS direct, which is an advice nurse service run for the whole of the UK. The friendly nurse on that line suggested that I draw a line around the bruise and if it got worse, I should see a practice nurse or ring the hospital. Paula obligingly drew a line around it.

After a few hours, I asked if it was worse and she wasn't sure. Some parts might have been darker, but there didn't seem to be anything new. I took a nap. At dinner, I asked again if it was worse. Paula gasped, so I rung the hospital and asked to be connected with the ward in which I had spent the most time. The person who answered the phone told me I should go to a walk-in clinic, or if that was closed, I should go to an A&E (Accident and Emergency, aka the ER).

I hadn't eaten in several hours, so I picked at my dinner for several minutes, trying not to panic and then we called a cab to go up to the Royal London Hospital, which is very close by. The receptionist there said the wait might be four hours long. The waiting room was packed and there was a chair shortage. I sat on the floor for a bit. They called me after only an hour wait.

The triage nurse phoned their plastic surgery department and asked what to do. The doctor advised that they give me a blood test to make sure I wasn't haemorrhaging. When I had been in hospital, they had been giving me shots of blood thinner every night and I mentioned this to the nurse. He nodded and led me to a cubicle. Another nurse came to take my blood. He had to get something and while he was up, I saw a drunk man start hurling abuse at the triage nurse until security threw him out. Then another man started screaming at the guy who was to draw my blood, telling him to open a locked door. The nurse asked what was going on. The screaming man's nephew had just died and he was distraught. Somebody else came along to talk to him, but the nurse was shaken to have been screamed at and needed a few moments to calm down. I suddenly realised why so many TV shows are set in hospitals.

He finally came to draw my blood and then went away for a while. He came back several minutes later and said the blood test had gone wrong because my blood had been mishandled and he needed more. I decided not to complain because there was already enough drama going on without my contributing. Fortunately, the second time was adequate.

After several more minutes a doctor came around and asked me a few more questions and said my haemoglobin numbers were good. He told me to call the plastic surgery department in Tooting in the morning and said the amount of bruising I had was not exceptional for an operation.

I started putting on my shirt and he threw open the curtain before I had gotten the first button fastened. I was momentarily exposed and ashamed and then I remembered that it doesn't matter anymore. My bare chest is not a site of privacy.

We got back at maybe 12:30 AM. I took painkillers and went to bed. When I woke up this morning, the purple bruises were the same as last night, but I now have yellow bruises spread over a lot of the left side of my chest and into my upper arm. I called St George's in Tooting and explained to the plastic surgery department what had happened. The man on the phone sent me to somebody's voicemail. I left a message but haven't had a call back. My outpatient appointment is tomorrow, so if it can wait, I would much rather let it wait. The cab ride is long and expensive.

As it has from the start, my left side hurts more than my right and the drain site hurts the same as when it had a drain in it. It I extend my arm too straight, I feel a pulling around where the drain was inside. I wish I had made more expansive gestures with my left while I still had the drain embedded, but the IV line poking me discouraged this quite a lot. Alas, for my having been a wimp.

In all the story so far, nobody ever asked me for ID, nor for money. The receptionist at the A&E just wanted my name and address, but didn't ask for any verification. The registration took less than 5 minutes. When they told me I could go, both times, I just walked out the door. This sort of non-capitalist efficiency used to be shocking to me, but I managed to get used to it very quickly. If your country doesn't have a system like this, it could.

Top Surgery Part 3

When I got out to the ward, I felt good enough to start blogging and high enough from opiates to think it was a good idea - and to make loud declarations about my genitals when offered a bottle to pee into. This is probably part of why they wanted me to stay in bed rather than try to walk.

My surgeon came by, and was concerned about my left drain. She thought it might need to be flushed out in the morning, which would be a second operation under full anesthetic. She asked that I get no food after midnight.

Paula stayed with me a while and then visitng hours were over. It was a dramatic night. One old man kept wanting to know where his wife was. A young guy woke up screaming and ripped out his IV line. Then morning came. My left side still seemed swollen to me, but when the surgeon came by, she said it was ok. I felt very relieved.

she told me to try walking around some and to move more like i would at home. She also told me that they'd been forced to take out my ear piercing and it had been lost. It was a ring through my upper cartilage, which was alright, but it did get in the way a bit when i wanted to wear headphones for more than an hour. Apparently, it's a very big deal when a piece of jewlry gets lost. I'm not overly bothered by this, but the principle is important, she said.

I would need to spend another day in hospital to have my drains observed.

The drugs given to me by the anesthesiologist were all wearing off and i began to feel ill. Paula came to visit and coaxed me into eating a bit. In a sharp contrast to my other nurses, the one i had then was not sympathetic. Paula eventually interceeded and i got a shot of something that was supposed to make me feel better. It took the edge off, but didn't really help. Around midnight, i rung my buzzer to tell the night nurse that I thought I was going to be sick, but I ended up demonstrating the verb rather than saying it. I didn't keep anything i had swallowed that day.

A doctor came around to talk to me. I told him I had tossed my cookies. He looked bemused. I said, "is that something you can say in Britain?" He said he got my meaning and then he poked at my stomach and prescribed some drugs for constipation, as apparently the food I ate just had nowhere to go. The nurse came around later with two gigantic syringes. I was alarmed, but she noted the IV thing is still in my arm. So the contents of the two huge syrninges went into there. Then she gave me pills and a sweet liquid. She told me to drink a lot of water with the liquid. I actually felt thirsty, which was a change.

In the morning, I felt dizzy and weak and could barely sit up. But as my stomach settled and I ate things, I gradually felt more alive.

A doctor came by to examine my wounds and said that my right drain should be removed. A nurse came around later and depressurised the drain container, which apparently has some suction on it. Then she used a bunch of pointy tools to pull the hose out of my chest. It was kind of uncomfortable, but didn't hurt overly and afterwards, it was a nice relief.

Because the left drain was still in, they would keep me for another night. But the ward was getting ready to close for the weekend, so they got a push chair to move me upstairs. I was greatful not to have to walk as I still felt kind of dizzy.

The ward that they moved me to seemed to be full of people suffering from weekend-related accidents. Directly opposite me was a very unhappy man with his arm in a sling, being gaurded by two bobbies. The cops were on the phone, trying to figure out who had arrested him. Other people had broken arms, dog bites, etc. When Paula came to visit, she said it seemed more peaceful than the previous ward, but she missed the arrested guy angrily explaining about how he was the victim and was intending to sue the police.

"Are you alright?" Paula wanted to know, "Jara says you haven't been on facebook for hours!"

As of this very morning, they say they're going to let me out. A doctor has come to tell me my prescriptions and my remaining drain has been depressurised. I feel good enough that I think I could go straight home, but am relieved that I don't have to.

I've gotten top quality care here and at no charge. The NHS is fabulous. Socialised healthcare is awesome.

Top Surgery Part 2

Somebody was moving my shoulders. "I'm sorry, I think I fell asleep." I said and opened my eyes. I was in the recovery room and still quite groggy. I was shivering or started to shiver and then got a warm air blower and put the pipe of it under my blanket. It seemed to work instantly.

it seemed like a flurry of activity around me, but it's also possible that i slept between spread out things. Also i had a blood pressure cuff that did measurements every 5 minutes. I can't remember many details, but the nurses were very good.

The room haf 9 gurney bays and there was one nurse for every 3 gurneys plus 1 or 2 extras to spell them on breaks or help for 2 person jobs. My nurse was named Helen. When she got her tea break a nurse named Joan filled in. They were both brilliant. Capable and caring. They were lovely.

Not long after I became alert, my left drain started filling quickly, such that it was nearly half a litre of blood. They asked what to do and were told to sit me more upright. That worked.

they gave me morphine in a drip, but not enough to make me loopy. Then they gave me some water. Then tea! Such lovely tea. It soothed my sore throat, and was one of the most satisfying cups of tea ever. Then a sandwich. Then a pain pill.

I looked down at my bandaged chest and was filled with a profound sense of relief. I was fine. I made it. It worked! It was amazing. Somethingthat for years I was afraid to even want and it was done and I was ok.

However, because of the drain issue, They thought they might need to send me back to the theatre, so I was in the recovery room for a long time, so I chatted w Helen and had more tea. Eventually, a surgeon that I didn't recognise said it would be fine and i got sent to a ward.

A gurney pusher and two nurses, one of them a student at Kings College, came to move me. They asked an elevator full of people to clear out for me. "Sorry," i said to a woman who got off. "You must be very important," she joked. "Everywhere I go, the paparazi!" I said. The gurney didn't take up the whole elevator, so the nurses were telling people to squeeze in. "Come on, get in there. Ok, now climb on top!" "He's a bit too young for me" the woman said.

We got to the ward and Paula was there.

Top surgery part 1

I woke up before 5 this morning, took what i knew would be my last shower for a while, gave myself a T shot, packed my bags and got on the tube. My appointment letter was for 7 but I arrived almost 20 minutes early and waited for the surgical admissions lounge to open. That was the same place I had gone for my previous appointment, at which they had collected vital signs and data. A sign by the door said they open at 7, but it closer to 10 minutes after that.

The head nurse gave a speech about the admissions process. He then called us by name one at a time and asked us if we wanted to give them a phone number for a visitor. I gave them Paula's number and later they called her and told her what ward i was in.

at the same time, other nurses were calling people one at a time and taking temperature, blood pressure, weight and allergy information. Shortly after I talked to the nurse, I got called by the anesthesiologist who explained a bit about the drugs she would give me to kill pain, knock me out, keep me from feeling ill, etc. She (or the nurse before, i can't remember now) game me two red id badges- one for each arm. They're red to indicate that i have allergies. Which are to two different antiobiotics. She told me they do my op around 10.

i went to wait again and then the surgeon called me in. She drew on my chest in permanent marker. "You're quite wonky, aren't you?" She said. Apparently my spine is curved which she said was the reason my moobs were very assymetric. I felt guilty about my bad posture and tried to blame playing sousaphone in school, but she said it was likely genetic. I told her that a piercer had said i had weird nipples and she sympathised with the piercer! The lack of social skills made me more confident in her surgical skills.

She explained how the op would work: they cut away tissue around my nipples, while keeping the nerves and blood vessels attached to them. Then the would sew that to what was left. She explained that an insufficient blood suplly could cause a nipple to fall off, but told me should build a very comvincing new one and tattoo on an areola and it would like fine, so i shouldn't worry. Sensataion in my nipples will be decreased. Then, she went through a consent form and asked me to sign it.

i went back out to the lounge and checked my email and then started to read a book. They called me up again and said it was time to get changed. I was extremely nervous. I took off all of my clothes and put on a hospital gown, a bathrobe, anti-bloodclot socks and foam slippers. The the nurse took me downstairs to another nurse who double checked everything. Yet another nurse took me to the anesthesiologist's room. In it was a gurney, which i lied down on. They put electrodes on me and a needle into my hand. There was a large numbers of ampoukes laid out.

The doctor chatted about her honeymoon in california as the she gave me a shot of pain killer and the nurse gave me an oxygen mask. Then the doctore hooked up a huge vial of milky white stuff she said would know me out. She warned me it would sting.

"so this is the last ting i'm going to remember." I said and then verified that it does sting. I thought about how it was very odd to have an experience knowing it was going to be erased. I could already be past the point of where i would forget, but right now it was all real and i felt very present. I don't know what I felt after that.

Pre-operative Consult

Three weeks ago, I had an appointment to meet my surgeon. It was at St. George's Hospital in Tooting. The hospital seems to be a new construction or has recently been renovated. The landscaping had not yet been planted, and I passed some heavy equipment outside. Inside was nice, but had confusing hallways, like all hospitals must. I found my clinic quickly. There was a guy I knew in the waiting room, waiting to see the same surgeon. He had gone online and found some pictures of the surgeon's work and talked to a happy recipient of the same surgery, so he was very positive about her. After a longish wait and a nice chat with my friend, I was ushered into her office. She examined me, told me what sort of operation I'm to have and talked about recovery times.

She asked me to take off my shirt and produced a small tape measure, which she used to measure the distance between my neck and my nipples. One of my moobs has always been more droopy than he other, something exacerbated as testosterone has slightly (not entirely, alas) deflated them. "You're quite asymmetric" she said, which suddenly called to mind the time I got my left nipple pierced. The piercer had gotten it crooked and had blamed it on my having "weird nipples." It's a good thing I already wanted to get rid of the moobs!

Anyway, what will happen is that the surgeon will cut off my nips, remove extra moob from around where the nips were, then re-attach the nips and sew it all back up. This method leaves minimal scars. I forgot to ask if I would have any feeling in any temporarily amputated parts, but it seems unlikely. Alas for that, but it seems like a worthwhile trade off and it's possible that feeling may slowly return over time. When I had a tumor cut out of my finger, years ago, the top of my finger was numb for a couple of years, but is now normal. 


The surgeon explained that given my existing asymmetry, I should expect to have some later and cautioned me that if I got out a tape measure, I might be disturbed. (Buck Angel, who has a perfect chest had greater asymmetry than I, but he went to a Hollywood doctor and paid a small fortune. As I'm getting this for free and don't plan a career in porn, I'm pretty ok with this.) So I will be keeping my odd nipples and my lopsided chest. Whatever. At least I'll be able to cavort around topless and even do wild and crazy things like wear T-shirts. 


Any surgery carries an infection risk, which she didn't seem overly concerned about. And there's some chance my nipples would fall off, which, thankfully, is very rare. She blocked out 2 hours of operating room time, but it should be quicker than that. I'll have to stay overnight in hospital. So the risks are acceptably low and I'm happy this is coming, but it is more serious and invasive than I had realised. 


I can expect to feel really shit for a week. Because Xena pulls on her lead, I probably can't walk her during this time. Then, I can't lift anything or do any exercise for 6 weeks. So no gigs for me, unless I get a roadie. I'll also need to wear a post-surgical binder. She explained that the NHS did not currently fund the one she thought was best, although she's been pushing for it, so I should try to buy my own. She cautioned me that it will be kind of pricey. How much? I asked. Around £50. She explained that if I couldn't afford it, they could provide something else and I shouldn't worry about it. So I'll be that much out of pocket, plus the £7 copay on whatever pain killers. My first new T-shirt is going to say "God Bless the NHS."


The surgeon asked me if I had anymore questions and I asked why she goes by Ms. rather than Dr. She told me that she, like all surgeons, was qualified as a doctor. But then she had done several extra years of training to qualify as a surgeon. It's customary for surgeons to go by Mr or Ms to signify their greater level of training. She also said it had historical roots from the old days when surgeons/barbers had entirely different training than doctors, who just did bloodletting and prescribed drugs. It's kind of weird that her profession is descended from shaving beards. I did not bring up Sweeney Todd, but I thought of him. 


After answering all of my questions and whatnot, I was sent off to have "before" pictures taken. The NHS documents everything, she explained. I got somewhat lost on the way, but a helpful woman noticed me looking lost and offered directions. On the way to the multimedia department, I passed several classrooms and a student examination in progress. St. George's is also a medical school.

The multimedia department had a proper photo studio with lighting and backdrops. I had to sign a consent form which asked if my pictures could also be used for teaching. I said they could. The photographer explained my face would not be in the pictures. I told him that I had recognised somebody's before pictures from his tattoos. The photographer looked surprised by that idea and I suspect may bring it up at a future meeting. For the pictures, I had to face different directions. It felt like I would imagine how getting a mugshot feels. 


And that was it. I went home. About 2 weeks later, I got voicemail scheduling my pre-op appointment, which will be 15 June. The operation will probably be two weeks after that, I think. I don't know. It's hard to plan things when I don't know dates, but I'm pretty happy.

The NHS said yes

On monday, I had my second appointment with the gender clinic at Charing Cross (which moved to Hammersmith in 1973). The doctor tried a bit too hard to be charming as he asked me all the same questions as I've been asked innumerable times.

He wanted to know my family tree. Do I have any LGBT family members? What's my first memory of gender issues? At what age did I leave school? Do I have any friends? (Would they lend me £20 if I asked?) Do I take drugs? Etc etc etc

He also asked me the last time I wore a dress. "That includes weddings and funerals." I can't remember. I know I put one on occasionally as a joke at Mills. Nicole said it made me look like a footballer in drag for a comedy skit. As it happens, I'm not really into cross-dressing, and I'm not really genderqueer these days. But the question is troubling for transmen who do like to drag it up a bit. It's even more alarming for those dealing with intense family pressures. Do we want to force people into being ostracized so they can get the treatment they need? I don't know what would have happened if I'd said less than 2 years rather than guessing 15.

But, as it worked out, he said I will be having top surgery "rather quickly."!!!!! As soon as my PCT approves the funding. I asked if being here on a student visa was going to be an issue and he pointed out that they were already paying for me to talk to him. He said that the primary concern of doctors is what's best for their patients and described the NHS as a vast left-wing conspiracy.

This was one of those moments when I really love Britain. God bless the NHS! The good doctor also suggested that I become British. I'd love to.

Advice for Migrant Trans People in the UK

The doctor also gave me a very useful bit of advice, that I need to double-check with my university, but which sounds very good. He said that I could change my name in the UK and put off changing my name at home until it's feasible. He says there is no problem having one legal name and gender in one country and a different name and gender in another. I need to verify that I can still get my uni to give me the right forms to extend my student visa, but I think their non-discrimination statement for trans people means they will be willing to deal with the two names problem.

Of course, it's not ideal to carry around a US passport with name change documents. What I need is government-issued ID, ideally with the right name and gender. He told me that I can apply for a provisional drivers liscence. I do not need to learn to drive, it's basically a permit to learn which doubles as a photo ID. He said he knew of a blind person who had one. It stays valid for years and counts as proof of legal residency and can be used as a travel document (instead of a passport) within the EU. He is going to post me a letter which I can use to get the correct gender markers.

I don't know if I'm happiest for finding out I'm getting top surgery or for finding there's an easy solution to my paperwork disaster. I'm also wondering if I can use British documents to bluster my way through getting stuff changed in the US. To change my name in Alameda County, California, I need to publish a notice in the newspaper and then get on a 4+ month waiting list to appear in person, in court. It would be a hassle if I wasn't abroad. Changing my gender on my US passport is even more of a hassle, to the point whre I think becoming a British citizen might even be easier.

I promised more blogging

I haven't written about gender stuff for a while. I finally had my appointment with the Charing Cross Gender Clinic, after months of waiting. Fortunately, the shrink had actually read the amusingly stupid report from the previous shrink, so I was not forced to recount my childhood yet again, just a few details of it. I don't know why they care about it. Some trans people aren't dysphoric at all before puberty. Heck, some aren't really dysphoric until well after puberty. And I hate that my unwillingness to skip rope is considered a sign of being trans. It was mostly a sign of being a huge nerd, something that was not tied to gender at all. I was awkward and unathletic. I also was unable to protect my face during dodgeball and hated it too. Does that mean I'm really a girl after all?

They need two appointments before they will give me a referral and they're understaffed, so appointment number 2 is in february. I might be able to call occasionally and see if something sooner has become available, but I don't want to feel guilty about queue jumping, so I might not. The UK economy is kind of fucked, so maybe I should just pay privately, especially if I can get a part-time job.

All the gender stuff is still really vital to me, but I just don't want to talk about it. Somebody on a website had a go at me a few weeks ago about my gender issues and history and it really sucked. So I quit posting anything of import there and I've quit posting here and I quit seeing my shrink when T died, but the not-talking-about-it school of dealing with life seems to work as well as the talking-endlessly-about-it approach. After a while, it all gets boring. My cousin had a book called "After Enlightenment, the Laundry." Like, no matter how fascinating your current thing is, after a while, the mundanity of real life reclaims the center stage.

Speaking of which

In my real life, shortly after I gave my concert in May, my dad came to the UK for a month. He stayed down the street from my flat for a bit and traveled for a bit and then we went to Ireland together and then he went home. In July was gay pride and a bunch of other stuff that seemed to suck up all my energy and now I can't even remember what it was. Helen and I cycled in a big loop around the Isle of Wight, which was nifty and very hilly. I love biking. August is going to slip quickly past.

I joined a bad called Helen's Evil Twin. I'm the bassist, so I'm in the non-acoustic line up. My first gig with them is on August 13th. As it happens, this is a high profile gig and a large percentage of people I know in London will be there.

In other news, I'm trying to get caught up with where I should be in my PhD, but this is making the writers block thing worse instead of better. It seems like everything I write takes a long time and then comes out boring. I should write a whole huge amount of stupid crappy pieces, just to get going and then pick the good parts from all of them and combine them into one good piece. Or something. I'm worrying too much and I think I need to do a masterpiece or something. I keep reading about symphony composers from a hundred years ago, and they're all geniuses who write masterpieces and spend years on them and say something really meaningful. Intellectually, I'm against that, but intellectually, I'm against a lot of things that I can't actually seem to shake free.

And now, here's a boring blog post to go with my boring attempts at music lately. I had a conversation with a guy a couple of years ago about how he would rather be crazy and write good music than happy and boring. I'm happier than I was when I had that conversation, but I think I would have ended up musically boring either way.

Further Adventures with the NHS

I went today for a psychiatric assessment. I spend a lot of time being evaluated, alas. This one was at a Tower Hamlets Primary Care Trust medical center. It seemed like most of the other people there were for more body-focused medical stuff. It didn't have the kind of security that Dutch mental health centers have. Indeed, the doors opened automatically as I approached.

My appointment letter was for "Ms Celeste," which is better than Miss, at least. The receptionist looked at the letter and looked at me and asked who the appointment was for. I said my name. She looked at me a long second and then said ok and told me to sit.

The shrink was youngish. He had a student sitting in, a man about my age. I said I was ok with that. "Just ignore him" said the shrink. Right.

He had me go on and on about my childhood. Which, frankly, is not that interesting. Any fascinating memoir of my life would start later. I mean, the first time a gender shrink asks you about your childhood, you get to construct a narrative of yourself in regards to gender. Did you always know something was different? Were you blissfully unaware? Did others point out locations of difference that you didn't see for yourself? All of this tempered by the understanding that the receiver of said narrative is a hurdle between you and hormones/surgery/whatever you've come for.

So I banged out a narrative for an hour about how I'm a totally reasonable sane person. He wasn't a gender specialist, so when I said FTM, he asked what that stood for. So gender issues weren't even that present in the conversation. He did use the phrase "Gender Identity Disorder" though, and it got my hackles up a bit.

I don't like being called disordered. At all. The catholic church calls homosexuality "intrinsically disordered," which is a value judgment that I'm not keen on either. Why must every location of difference be called a disorder? Could it be a condition instead? Some other medical phrase? I'm proud of who I am. Indeed, to be different means that you have to be proud or be crushed. My identity is not a disorder, it's just atypical.

Then funding came up. He asked me when my student visa expires and started talking about "planned elective surgery." Which, I mean, Tower Hamlets is not awash in cash. It's one of the poorest boroughs in London. Why should they allocate their tax money to a foreign student? I don't know how NHS funding works, but it seems to be geographically divided. Are the residents of Tower Hamlets the main funding source for their primary care trust? Or does it come out of a large pot and then is distributed by population?

In order to change my documents in California, I need to get top surgery. Also, to be able to go swimming or wear a T shirt ever again in my life. So if the NHS won't fund it, I can . . . wait or self-fund. I don't think it's reasonable to try to get it too far from where I'm actually living, so surgery in California is not a good plan unless I move back there. It's possible for people in the UK to "go private" which means pay themselves for stuff rather than wait for the NHS to decide to pay for it. I have no idea how much this would cost here, nor if it would effect them covering my T prescriptions or anything else. Aside from whether or not I could afford it, there's issues about recovery time. It's long. I won't be able to lift things for weeks. This sort of situation requires close friends and I've only lived here since August. So even if I got NHS funding, it still might not be a reasonable plan. So maybe I'm destined to wait years no matter what.

When I do get it, if I still have savings, the first thing I'm going to do is buy the bike jersey I've been wanting, which I so can't wear right now.

NHS Mental Health Trust Shrink

In order to ration care treat trans patients, the NHS wants shrinks to be involved. Specifically, you can't get a referral to an endocrinologist without a psychiatrist. Also, importantly, nobody wants to pay for anything unless you jump through all the proper hoops like a trained circus dog. So this morning I arose bright and early to go see a shrink.

The letter informing me of my appointment told me to go to the Queen Elizabeth Psychiatric Hospital (QEPH), which is right by school. It always struck me as highly convient, having the mental hospital right next to the Uni. I also often wonder how the queen feels about having a mental hospital named after her? There must be a great number of strange things named after her. The Queen Elizabeth Car Park. The Queen Elizabeth Strip Mall. The Queen Elizabeth Home for Rabid Puppies. Does she get any say in it? "Oh, thank you for the kind offer, but I was really holding out for a suspension bridge?" (Or can there be multiple Queen Elizabeth Bridges? Would that be too confusing? Could there be both the Queen Elizabeth Bridge and the Queen Elizabeth Suspension Bridge?) I mean, personally, I wouldn't be picky, but I have many fewer people asking to use my name for their construction projects. Nevertheless, I think I would balk at a mental hospital. What are you trying to say?

Most Brits probably have odd ideas about America. I think they imagine the shootout at the OK Corral as being highly symbolic of the country as a whole, which is not an entirely unfair assessment. Similarly, I have various stereotypes floating around in my head about the UK, many of which come from Victorian novels. High school English classes typically spend one year on American Literature and then one year on British literature. The Victorian era seems to have been a golden age of writing in England. Or, at the very least, it's the one most enshrined in American highschools. Costume dramas made by the BBC are also a major cultural import into the states. We all imagine a dark, smoky gray London with a polluted fog overhead, women in petticoats, Dickensonian beggars, murderers left and right (with Sherlock Holmes or Miss Marple on their tail) and hulking brick asylums, filled with suffering upperclass women who can't accept their station in life. Women who want to read too much. Women who want to be men.

Fortunately, I have managed to avoid being committed. I woke at an extremely early hour and managed to spill every drop of my morning coffee on the floor before I left for my appointment, alas and woe. The QEPH is in a typical largish medical building. They have automatic doors, which, unlike mental health centers in the Netherlands, are actually automatic. The reception was separated only by a normal counter, again, unlike the Netherlands which was behind glass. Maybe they think I'm crazy, but at least they don't think I'm dangerous. That was nice.

The doctor asked me when I first knew I might be trans. I should have a set answer for this by now. I should write out my official narrative and post it to my blog. Then, when somebody decides that I need to see a shrink, I can just give them the link. I don't fucking know when I first had gender issues, ok? sheesh. I really don't want to draw any kind of line anywhere. I don't want to validate all the homophobic bullshit I used to be subjected to. I don't don't want invalidate decisions of other butch women not to transition. When did I cease just being a butch woman? When I started taking hormones and told people to call me he. Not before. It happened then.

Lack of coffee, up early in the morning, strident (formerly) lesbian feminist, so very very american. I must have seemed a bit like Hillary Clinton. But, you know, if she were a bloke. I was confused by the questions and gave confusing answers. I'm pretty sure I annoyed the doctor. Nevertheless, I have successfully jumped through this hoop.

He explained that there were evaluations and waiting lists and whatnot. We don't just give out hormones on demand to people who ask for them, he explained. Why the hell not? What terrible harm would befall the commonwealth is trans people had easy access to transition? None!

Alas, this is just one hoop. This doctor is not a gender specialist. I'm to keep seeing him while I wait to see the one specialist for the region. Who is not in Birmingham. The second largest city in the UK has no gender clinic. The waiting list is apparently months long. In the mean time, I can keep taking T - and I can keep paying for it.

I am so very, very, very glad I started on hormones while I was back in the states. Sure, we're all cowboys and it's the wild west and all, but that's not all bad. The social worker in San Francisco explained that the city had no vested interest in saying no to trans people. What purpose would it serve? The city pays for it's residents to get this service if they want and need it, like the NHS pays for Brits (and foreign students). And San Francisco found it was coming out ahead when it got rid of all its hoops. People who come in for hormones also get the other health services that they need. Happier people tend to take better care of themselves and are healthier. Does it save tax money to say no to trans people? No, quite the opposite.

I left my heart in San Francisco. Sometimes, I think it's the only place in the world where anything makes any sense.

I felt good about myself when I left QEPH. I got through this round. I was treated more or less like a normal person. When I got back outside to the bike parking, somebody had left a nice, new, red mountain bike leaning on my bike. With no lock on it at all. You'd have to be crazy to leave that bike out unlocked like that! . . . oh right . . . I wish my issues weren't treated as mental health issues.

Sharp

If you're wondering about that photo shoot magazine business, well, they haven't paid me yet, so I'm going to wait to mock them. But I got my T shot finally on Monday (and I feel so much better).

On Monday, I showed up to my doctor's surgery and after asking the receptionist if I could speak with a nurse, I asked her if, as a favor, she could please change me from "Miss Celeste" in the NHS system to "Mr." They have to use my legal name, fine. But titles aren't legal. And every time I got something addressed to "Miss Celeste" I felt like they had tied a pink bow around my neck. "Mr" would help. A lot.

The receptionist looked at her computer. "Is your real name 'Celeste'?"

"uh. yeah."

"Are you from the states? Are you American?"

"yes . . ."

"Oh! Well, over here 'Celeste' is usually a girls name! That's probably what's caused the confusion."

I did not start laughing. I said, "My mom was a big Johnny Cash fan." Which is true, but I wasn't exactly a boy named Sue. I went to sit down and out of the corner of my eye, I saw the receptionist get more and more confused looking until she went into the back. And then my name came up.

The surgery has a sort of an announcement system. "Would so-and-so please go to room 15?" I couldn't tell if they said "Miss Hutchins" or "Les Hutchins" or what. They pronounce "Les" like "Lez", not like "less." And "Liz" is also a name, which sounds very very much like Les. It's confusing. But my last name was clear, so I went to the room.

The nurse showed me how to open the ampoules. They're made entirely of glass. You have to snap them open and be careful not to cut yourself. But they snap cleanly. She told me not to worry about bits of glass getting into the T. I asked her if she could just do the shot for me, since she'd opened the container.

She agreed and I asked for it in my bum. It's a good idea to rotate injection sites, because of scar tissue and whatnot. Since I use my legs, I thought I'd ask her to do someplace that I can't reach. She was anxious that I not lower my trousers in front of the window, but then she just pushed the needle in. No gloves. No hand washing for her. No antiseptics for me. Not even a quick jab with the needle. It just went right through my unsterilized skin. I'm surprised the British aren't ultra-cautious about this, like they are about everything else Is it just her? I guess I don't need to be too paranoid about that part then.

I asked if I could just have a few needles instead of buying a hundred, so she gave me some (yay) and then asked me how I dispose of them after using them. I explained that I put the cover back over them and put them back in the little plastic pouch they came in, so nobody would get stabbed, and threw them away. "Oh no, you'll go to hell for that!" she said.

My friend has a joke he loves: There are Jews in hell for eating bacon. There are Catholics in hell for eating steak on Good Friday. And there are Anglicans in hell for eating the meat course with the salad fork.

I won't go to hell for being all kinds of queer, I'll go to hell for not following proper safety protocol with used sharps. She told me I need a sharps container and wrote me a prescription to get one from the pharmacy. When I saw the name on the scrip, I knew my conversation with the receptionist had not been in vain. It's written for "Miss Les."

Feeling Sleepy

When last I posed about my adventures with the NHS, I had just gotten a prescription from a completely uncertain doctor. She had no idea if she'd written me the right amount of the right type of T nor whether or not I should have to pay for it. She didn't even know what kind of needles I would need. She went to ask a nurse but couldn't find one. She promised me a referral to an endocrinologist, so that somebody with experience could be checking on things. I agreed this was for the best.

If I had stayed in the states, I would have 10 weeks of testosterone left on my initial prescription, so as long as I'm getting an equivalent amount to what I was first prescribed, it's ok that nobody has checked up on me yet. And I went asking around on the internet and the doctor had, indeed, given me an equivalent amount. So I took my prescription note to the chemist (British word for "pharmacy") to get it filled, the day before I was due for my shot. They had to order it.

I find injecting to be stressful as hell, so I didn't actually hurry to pick it up the next day. I arrived on Friday, a day late, to get my T. The pharmacist gave me 3 ampoules and 30 needles! But they were insulin needles. They only held 1 CC and the needle part was about half the length needed for intramuscular injections. And, I mean, I like to have spare needles, so I can practice on oranges a few times before I stab myself, but ten per shot is a little excessive. Ten per shot of totally the wrong needle is beyond useless. The pharmacist (chemist?) said he could order 2 CC needles for me . . . in a case of 100 for £20. That's a fairly major investment on my part, not just economically. If I stay on the same kind of T, instead of switching to the once every three week formulation most frequently used by European ftms, that's enough needles to last me 4 years. If I practice with an orange every time, that's 2 years worth of needles. I was kind of hoping to switch from injecting to some other form, like a patch or implant or whatever. That's a hell of a lot of needles. He promised to order them. They would arrive on Saturday. Two days late for my shot.

I got home and found I had one needle left from before. yay. Obviously, I'd prefer to have an extra (one time I took the cover off of a needle and promptly gouged into my thumb. So much for that needle.), but if I only have one, then I only have one. I watched a youtube video about how to DIY it, just to double check that I'm doing it right (more or less, I'm fine) and I put on some Steve Reich phasing music to feel happy and relaxed. I did the prep. Wash my hands. Figure out where I'm going to stab myself (left leg). Clean it. Clean the top of the ampoule before . . wha? What's this? It's made entirely of hard plastic. Where do I stab it? How do I get the T out of this thing?

I looked at the clock. 17:15. I looked at the web page for my Doctor's Surgery (British word for "office"). Oh christ, they're closed until Monday morning.

I was already a day late.

I don't know how to describe what this feels like. People who have taken the pill or whatever can probably relate, on some level, since they're messing around with their hormones also. The goal of the T dose taken by an FTM is to cause masculinization, but also to overwhelm his ovaries so they just give up. It's early menopause. Which is fine, because he's got new artificial hormones to keep him going. It's better living through chemistry! Except that's only as good as the pipeline coming to you.

When I started T, I still had a fair amount of anxiety, so I'd never typed the name of my drug into google. I thought reading the information might freak me out, since, you know, I got freaked out kind of easily. Oh my god, this is the most sought after steroid for weightlifters. There are body builders who take more every day than I take in two weeks. Well, I guess I don't need to worry about dying of an overdose or something. They all report the same effect I did. More energy. More stamina. Easier to make muscles. All this physical energy and strength.

Missing a dose for several days, though, isn't just going back to baselines levels. My baselines hormone levels have been shut down. It's going to zero. Not only am I below the normal male range, I'm below the normal female range. I'm at nothing. I feel like. I don't know. I want to take a nap. A really really long nap.

I feel like I'm underwater, somehow. You know how it sounds when you've got your head underwater and somebody's shouting at you? You can hear it, but it sounds strange and distorted and barely understandable. I feel like that sounds.

I can get through a few days of this with tea (caffeine is a little like T. (if only there was T tea)) and chocolate. In Harry Potter, you recover from dementors by eating chocolate. It sort of revives you from having stared into the abyss. That's the most true part of those books. But, now, I dunno. I got nothing. I don't want to eat. I don't want to walk around. I don't want to make music. I don't want to make tea. I don't want to eat the chocolate sitting by my bed. I just want to sleep. And not, like, with a longing, just like a default. It's like staring in the abyss, but the nothing staring back at you isn't infinitely horrifying in it's emptiness. It's not horrifying at all. It's like the abyss is made up of shuffle board courts and corporate team meetings and sandwiches made of wonder bread and waiting rooms and BBC Gardening shows. It's not dread, it's complete numbness. The mummy's curse causes dread. But being a mummy is all white bandages and laying in a box and nothing ever happening, just a really long nap.

A half hour goes by and I haven't even noticed. I could stare at the wall for days.

Of course, some part of my body has noticed this state of affairs and is rousing itself to action. It's kicking at my ovaries telling them to wake the hell up and do something about this. I really don't want them to wake up. stay asleep. Stay asleep. It's only another day. I'd rather be a eunuch.

Is it bad for me to oscillate like this? How the hell should I know? Probably it's not good. It doesn't seem like it could be. When I made a list of pros and cons, this possibility was at the top of the con column. I'm tethered to doctors and prescriptions and chemists and needles and and and. Not that being anxious all the time constituted total freedom.

I don't want to sound like I'm complaining. I'll get through this. I don't regret my decision. Not that I have the energy for regret.

I want to go abroad this summer for a few weeks. I don't see how I can work that out and my prescription at the same time. Especially since the referral that came was for a shrink. I have to jump through some hoops in May and probably June. There must be a way, obviously. I'm sure I'll work it out. And it's not like I don't have a fuckload of options. When I go to play a gig in the states in July, there's 10 weeks of T I've still got prescribed to me. I'd rather not have to fork over the $$ for it, but I know it's there if I get stuck.