The Lowdown

So, you’re probably wondering about all the changes that I will go through, how they will work, what they cost, etc. Great! I am here to answer all of those questions.

Let’s start!

Physical Changes

  • Chest Surgery

How it works:

I had this surgery on October 26th, 2012. The surgery removed the fatty tissue in my breasts. The tissue that was left was sculpted into a more masculine chest, with pectoral definition. The nipples were removed during surgery, then actually grafted back onto my chest and regrew back on to my skin during the healing process. I have numerous posts about this process that you can read here.

The procedure:

My particular surgery was done in a local outpatient surgery facility. The surgery itself was about an hour and a half and I was under general anesthesia.

Post-op:

I had a very tight bandage and drains for a week and then they were removed. I also had sutures that dissolved in the week. I was not in much pain, the worst part of it was the tightness of bandage. I couldn’t lay down flat and had to sleep propped up for a week. I was prescribed Viccadin, which helped ease the discomfort. I wasn’t be allowed to lift my arms above my head for a couple weeks. I could’ve gone back to an office job after two weeks, but since my job was physical it was recommended that I stay away for 6-8 weeks. No exercise more vigorous than walking during that time too.

The surgeon:

The surgeon I selected was Dr. Kathy Rumer of Rumer Cosmetics. Dr. Rumer was voted Top Doc 2011 by Philadelphia Magazine for her plastic surgery work, and you can read more about her at DrKathyRumer.com. She was actually, coincidentally, my neighbor, so I know her on a personal level. She is a wonderful woman who is dedicated to her field and takes great care of her patients. She did an amazing job on my chest.

Cost and finances:

The surgery cost roughly $7,000. I raised $3,000 on my own and got my surgery cost down to $5,000 through a generous donation by Dr. Rumer. I took out the rest in a low-interest personal loan from the Federal Credit Union.

Dangers/issues:

As with an surgery, there are risks for infection. Also, going under anesthesia is unsafe. Most transmen who have had chest surgery also say their greatest fear is that their nipple will fall off during healing, since it is grafted on and relies on the pressure from the bandage for the full graft to take. There is also an emotional fear of depression post-surgery over the loss of my breasts. I am lucky that I had no adverse side effects to surgery, and it was the most amazing thing I’ve ever done for myself.

Red tape:

I had to receive a letter from a therapist who I’ve been seeing for three months that confirms I am making a sound, stable decision based off of my discomfort with my breast and desire to live as male.

The result:

I have a male-looking chest. There will be two 6-inch scars on my chest that will eventually fade over the course of some years. My nipples have some sensation, but I can’t feel light touch. My chest still feels kind of numb in some places, and I don’t really feel light touch at all in some places. But overall it actually feels pretty normal.

Photos:

Here are some photos of other chest surgeries:

(Note: These are just general examples. I took these photos from the web and cropped them to protect the identity of those who they belong to. None of these are the work of Dr. Kathy Rumer)

Photo 1

Photo 2

Photo 3

Photo 4

Physical Changes

  • Hormones

How it works:

I inject a dosage of testosterone (male hormone) subcutaneously into my stomach once a week. Testosterone can also be taken by intramuscular injection, patch, daily gel application or orally by pill (however pills are almost never prescribed because they have adverse affects on your liver). It’s really a matter of personal preference on how you administer the T. Some guys are afraid of needles, some are fine with the shots. I personally chose subcutaneous shots because they’re easy to self-administer and I only have to think about it once a week. I take .5ml once a week.

The procedure:

I was prescribed testosterone at my doctor’s office. I undergo bloodwork every 6 months to a year to test my metabolic profile, total CBC count, lipid panel and testosterone levels.

The doctor:

I will work with Dr. Nicholas from the Mercy and Wisdom clinic in Portland, Oregon. From their website: “The Mercy and Wisdom Community Health Clinic is a non-profit (501c 3) organization formed to provide health care to the Portland community, especially for those who cannot afford traditional health care. Mercy and Wisdom also serves as an educational institute to teach the public how to achieve and maintain health physically, mentally, emotionally and spiritually.”

Cost and finances:

The doctor visits and bloodwork are sliding scale since I am uninsured. Testosterone and needles, the last time I bought them, were $40 for a five month supply.

Red tape:

None! Yay! Hormone replacement therapy usually operates on “informed consent,” which means you are totally making a decision to take them on your own, and you do not need a therapists’ approval.

Dangers/Issues:

Fertility: Although I pursued fertility preservation prior to hormone replacement therapy (HRT), a lot of transmen don’t. Within a few months of HRT, your menstrual cycle ceases. You can stop HRT and eventually become pregnant, as some transmen who want to carry children do (Thomas Beattie is a famous example here). A lot of transmen seek hysterectomies after testosterone use, because there is risk of your female reproductive organs atrophying. This also means an increased risk for cancer of the reproductive organs. Other risks are high blood pressure and heart disease. Lastly there is the risk of mood swings and depression.

The result:

I will essentially go into puberty again (whoopee!!) and produce male secondary sex characteristics. My voice will deepen, I may grow facial and body hair, my sex drive will increase, I may break out in acne (oh joy), and my muscle mass and fat distribution will shift to a male form. I may experience male hair loss. I will not grow a penis and my breasts (if I still have them) will not shrink and go away. How much I change really relies on genetics. Some transmen develop no facial hair, some have full beards. Some transmen go bald, some don’t. Some get heavier, some get thinner. A lot of transmen look younger than their actual age because of using hormones and growing peach fuzz and being short.

Legal/Documentation Changes

I have the ability to change some of my documentation: my legal name, driver’s license, social security card, transcripts, etc. I know a lot of transmen who don’t change any of these things and in my urban, LGBT-friendly city, get by usually just fine by explaining that they are trans. It might be a good idea to keep a letter or card signed by my doctor on my person that I am transgender, to avoid harry situations where what I look like doesn’t match my name and gender identification on my government-issued ID’s.

  • Driver’s license

The process:

The law in PA just changed recently, and you are not required to have had full sex-reassignment surgery (SRS – so glossary!) to change genders on your driver’s license. You need to simply have a letter from your therapist stating that you are living full time as the opposite gender. There is a form at the DMV you can fill out and I believe the cost of changing your gender on your ID is $12. Most people don’t do this, however, unless they legally change their name as well, because what is the sense of being named Sarah, for example, and being marked M on your driver’s license? Changing your name at the DMV is as easy as showing your name change documentation, filing out a form, and paying the fee.

Pros:

Your driver’s license is the one piece of ID that is seen by a lot of people. It may save a lot explaining if your name and gender marker are changed. It also may get you out of dangerous situations, like being pulled over in a rural area or being handled by an EMT if you are alone and unable to speak. Also, changing these two things on your state-issued ID is the easiest and cheapest, and gives you a base to start changing other documentation.

Cons:

For people who are in the middle of gender, or unsure about transitioning, it might be hard to have to be solidified into one gender for the rest of their life. Also, changing your name and gender on your state-issued ID may lead you to change your name and gender on your insurance, in which it can be difficult to receive health care coverage for services that you may still need, even as a transman (like a pap smear).

  • Legal name change

I’m leaning toward changing my name. I’m undecided right now – some options are Raye, Rayen, Rayand or Rayend. As for my middle name, Eli, Elek (which means defender of mankind). I’m unsure. Suggestions? Ha ha.

The process:

The Mazzoni Center works with transgender individuals to help them change their name. I believe the Center can work with you to change it for free. Otherwise, it is a lengthy, expensive process (a few hundred dollars). Ultimately you have to stand in front of a judge and explain why you wish to change your name and you have to publish your name change in two newspapers. The last requirement is viewed as discriminatory toward transgender individuals, because especially in more rural areas it could lead to harrassment and discrimination. Some transgender folks wish to be private about their transition.

Pros:

It would be nice to have legal and business interactions take place with my name that I use all the time, anyway. Especially when I go on hormones, if I have a beard, it might be uncomfortable to, for example, be doing my banking with my name being Raeann. This also lessens tension and stress when it comes to employment. Also, since I am not a homeowner or a parent yet, it might be easier to change my name now instead of going through the headaches of changing it on lots of important documentation.

Cons:

It is emotionally difficult to lose one’s birth name, even if they don’t identify with it anymore. It is also a lengthy process that requires a lot of time and energy, and following up with my credit card providers, library card, bills, etc.

  • Birth Certificate

The process:

Depending on the state you live, your birth certificate may be reissued with your appropriate sex marker on it, or amended, where they literally cross out the sex and place a new one next to it. The state of PA amends birth certificates for transgender individuals. There is a $40 fee and you have to have a letter from your surgeon stating that received sex-reassignment surgery, and your name-change court order document. The birth certificate amendment form also has notarized. You have to have full sex-reassignment surgery to have this done, however (aka below the belt). Unless the law changes like it did for the driver’s license, I will not ever be eligible to amend my birth certificate, since I do not plan to have full sex-reassignment surgery.

  • Social Security Card

The process:

This is the process that I am most unsure about. There is no indication on the form to change your SS card for a gender change. You must go in person to the office, taking probably a letter from your therapist, your name change court order and your new (and old, just to be on the safe side) driver’s licenses with you. You should be able to have the government worker make the change for you, and hopefully the clerk working with you is knowledgeable, sympathetic, and efficient instead of confused, transphobic, and unkind.

Pros:

When I get a job, I will submit your driver’s license and social security card to my new employer and I won’t have to worry about explaining to them right off the bat that I am trans.

Cons:

It is again a big decision that may be difficult for transgender folks living in the inbetween to legally prescribe to a gender for the rest of their working life.

  • Transcripts

The process:

I’m also a little unsure of this, but my guess is to go to my University (if I am still living in the same city, otherwise call) with my new ID, name change court order, and letter from my doctor or therapist and convince them that I need my transcript changed.

Pros:

I can enter into a new schooling situation without having to worry about my old name and gender being all over all of my paperwork. Especially if my name is legally changed, it could get really confusing for the college administrators.

Cons:

If I don’t get as good of grades as I did when I was still identifying as female, maybe I should keep my old name on there! Ha! Just kidding. I actually can’t think of any reason not to do this if I have already changed my ID’s. I have heard of some colleges refusing to do this, however.

Emotional/Personality Changes

This is the change that I think people fear the most. I will undoubtly change. But guess what? I’d change even if I weren’t transgender. You will change. We all grow.

The core of who I am will not change. My sense of humor will still be the same, my creative personality, my level of kindness and compassion will all stay the same. My likes and dislikes won’t change. What I do suspect will change is that I will become a better person. I am already less depressed and more motivated than I ever have been. I feel lighter, happier, and more free.

When I go on testosterone, I may be moody, irritable and emotional at first. Remember, it is essentially puberty. So please, remember what puberty felt like and try not to be mad at me if I seem like a jerk. You might even remember what I was like when I went through puberty the first time! Things will eventually settle down, as they did for everyone who is an adult.

What will change is my experience of the world. I experienced the world as a queer woman for a long time. I will now experience the world as a queer transman. This point of view has the possibility to change my opinions, the direction of my art, and my level of activism and what I deem of utmost importance. I consider myself lucky – how many people do you know who have lived as a man and a woman in one lifetime? I feel I have a pretty unique perspective.

The past is also very important to me, and I deeply treasure my time spent as a woman/girl. I wouldn’t trade my journey for the world. I honor the person I have been and am in awe of the person I am becoming. One thing I want people to remember is to not be afraid to approach memories and the past. I was Raeann. I was a girl. I’m not anymore, but that doesn’t change the good times I had as that person, and one of my favorite things to do is reminisce. But we all have to keep walking our own paths, and I hope you will respect the changes that come with the new direction I am taking.

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