May 2007

Mary and I were talking yesterday, and it was my first visit to Chuck after a layoff due to my academic duties. I was telling him (and Mary Jo) that while I feel good, I also feel quite conflicted, almost to the point of despair. While I may not have a secret, I still have a horrible dilemma.

Mary was saying that I’ve been terribly grumpy this past 6 weeks, and hypothesizes that it is the hormones. I don’t really feel much different; in fact, I feel better. But upon discussion, I think it’s the case that I feel horribly trapped and torn between two desires, one selfish and personal, and the other duty-bound and social. I honestly don’t know what I can do about it.

One of the easiest shorthand phrases is to say “I’m having a sex change.” Or, more precisely, I guess that’s understood as “I’m having a sex change operation,” which means for most people that you go get your penis cut off and a surgeon fashions a vagina for you. And that makes you female, and thus you’ve enlisted the help of surgeons to facilitate a change of sex.

But if I ask myself honestly if I’m having a sex change operation, I answer honestly that no, I don’t think so. I don’t see any reason to get a vagina since I’m not ever going to go stealth.

So what am I doing? First, giving power to someone else by saying “I’m having a sex change” is deceptive. I’m not having anything. I’m seeking something, and I’m doing something. Is it fair to say, “I’m changing my sex?”

Yes, I think that’s entirely fair and accurate because that’s what I’m doing. I’m taking drugs to change the biochemistry of my body from male to female. I’m actively taking steps to remove male secondary sex characteristics (beard, balding) and to introduce female secondary sex characteristics (breasts, less body hair). I also want, and am seeking, a slow adoption of feminine gender characteristics, which, while not sex proper, are associated with female-ness. Earrings, a certain walk, being more demonstrative, experimenting with my voice, imagining the dress and garb of a professional woman — these are feminine activities.

It’s also that I’m actively planning (perhaps some plans in more concrete form and others more like possibilities) changes in my presentation to the world — thinking of what a suitably feminine name might be, how I’m going to tell people I’m changing, what I’m going to do professionally if I change, etc. I think this mental activity of “changing sex” is huge, and has a lot more to do with a sex-change than genital surgery.

I realize that if I think about this structurally, I have three goals that have emerged in this crisis.

First involves feeling, an internal sense of relations with myself. I want to feel less masculine and more feminine. This change involves biochemistry, therapy, self-acceptance. It is an awakening of other possibilities, akin to gradually opening your eyes in the morning to let little fragments of light into your consciousness. It’s a sobering and challenging set of moments because these feelings may stand in direct conflict with my current existence. You can’t really get outside validation about feeling because it’s nothing more than cognition and self-honesty.

Second involves being less masculine and more feminine, meaning a physical and mental adjustment, and this involves biochemistry, letting go, imagining alternative realities and alternative relations with my being. To me, “being” is allowing the “feeling” to pervade because one can feel joy fleetingly, but not be joyous. One can feel feminine through a variety of techniques, mental and physical, without being (most of the time) feminine. Being involves a gradual shedding of former being and a gradual assimilation of the future being and, while it can’t be forced or faked, does involve visualization, hope, trust, and optimism.

Third is to receive affirmation from outside of myself that I’m female/feminine — the mirror or the digital camera can stand in as a brief proxy for others, just as we can be our own audience for our writing in a pinch by imagining how others might hear our speech. But overall, relations with the world must be social, and this third step involves simple things like presenting myself as female, getting called “ma’am,” being able to go places without being terribly self conscious about formerly being a male. If you’re stealth, I suppose this means simply transitioning physically and starting a new life — however, in my case, it is going to involve telling others and winning them over with my sincerity, along with simply going about my business and hopefully feeling less and less like a transitioner and more and more like a person.

A further goal, perhaps an extension of #3, would be to seek a variety of legal transformations so that one’s official persona also reflects a change — this is a legal, contractual, formal step that involves name changes, getting your sex changed on birth certificates and driver’s licenses, changing wills, personnel forms, and so on. It involves getting Human Resources involved in the bathroom issues and talking to credit bureaus and professional organizations about your change. The more mature you are and the more responsibilities you’ve got, the more extensive this process is. Given the number of sex changes in the past 20 years, however, it seems to me that while burdensome, this process is no longer shocking to most bureaucratic entities. This step is nothing but a vague possible future for me and really is not a plan at all at this stage.

So, am I scheduling a sex change operation? Am I going to go somewhere and be magically transformed from a normal man into a normal woman? Ha! Hardly. I was never a normal man and if I take this route, I’ll never be a normal woman. More importantly, no surgeon is going to move me through these three (or even four) steps I’ve identified above. It’s not something someone does to you.

Am I having a sex change (no “operation”)? Or am I changing my sex? Yes, at least rolling the momentum that direction, yes, probably continuing mental, hormonal, and physical improvements to affect these plans. Maybe leading to announcing some sort of shift to others, but maybe not.

First laser treatment was on 5/3, all along my neck up to my jawline. I filled out paperwork and disclosed estradiol and spironolactone, but no one asked. I did all my stuff in the waiting room, which was a little weird because there was no privacy. I kind of froze up and just let the technician go with what she assumed to be the case, namely that I wanted my neck and jawline to be cleaned up — I suppose that must be what she sees from men, so I figured it would make my life easier. I was doing a test on the place, on my skin, and the people, anyway, so it didn’t really matter if I had a full-beard test or just a neck test.

We put numbing gel on my neck and I played solitaire in the waiting room for 15 minutes, then reapplied gel for 15 more minutes. We then went into a room, talked about outcomes, expectations, cost, etc. I got a pamphlet and a cost sheet and then we went into the room, put on anti-laser glasses, and got to work.

It was fast, with a little blast of cryo-fluid just before the zap. It hurt a bit, but really not too much — the huge difference from electrolysis is that it was really fast, working from ear to ear all the way down to the bottom of my beard in 12 minutes She asked mid way, “so, why do you want to get rid of my beard?” but I figured I’d just waffle until I determine if she’s trustworthy and I answered something about having done electro before.

My neck was red, but not too bad. Mary was in town (I had thought she’d be at a horse show), and at dinner was concerned about my neck. I haven’t talked to her about this because so much has been happening, but I will — she likes my beard and is probably going to be disappointed in this. The redness went down quickly, but I noticed as I shaved in the following days that it looked as if I had missed spots. I think what’s going on is that these hairs are no longer anchored in their follicles, and thus, don’t stand up in order to be cut off during shaving.

Here, about a week later, on May 11th, I noticed that there were hairs kind of sitting up, but that they just rubbed out or pulled out if I tugged on them. So I guess this is the process I’ve read about online whereby the hairs (follicle-less), gradually work their way up and out over a period of time. In my case, this period appears to be 7 days on the low side, and we’ll see what the high side looks like (let’s estimate 14 days). At that point, I can examine my neck and see what sort of results I’ve got.

At this point, I am pretty impressed with it — fast, cheap, initially good looking results. What I anticipate doing is going in for my whole face after my May obligations, or the week of May 29th or so. I’d like to discuss with her working on my chest hair, but I am not sure whether the hormones will lessen it or not. Everything I’ve read online suggests the hair may vanish entirely or my lessen, but the variance is so large that it’s really hard to make any generalizations. What I could do is shave a small test area, let’s day around my nipple or at the top of the hairline, and laser it to see what it looks like, sort of a top of the shirt line like I did with electrolysis. It wouldn’t hurt anything and wouldn’t interfere with natural thinning, if I get it.

From Alexandra’s Virtual Facial Feminisation Surgery service

Hi Joyce.

Please remember that these virtuals are not and could not be 100% accurate but I hope they will give you a good idea of the possibilities and take you a long way towards planning how best to proceed.

The eye takes a little while to tune-in to facial changes so you may be disappointed at first glance. It is best to spend a few days getting used to the pictures before you make any decisions and it is important to imagine the face in a more feminine context with a little make-up and female hairstyle.

You have suffered a lot of hair loss and unfortunately it is probably too late to regain a useful head of hair. Having said that, it is worth talking to a good hair transplant surgeon about the possibilities - he/she can look at the density of the remaining hair and advise you if transplants would be helpful. I have not been able to do anything with your hair - there is not enough there for me to work on.

You have mild bossing over the frontal sinus but none over the orbital rims. I have set back the frontal bossing to bring your forehead into normal female ranges. You also have a strong vertical frown line between your eyebrows. I have reduced this for you and this should be achievable with an injectable filler. Getting rid of this line will soften and feminise your expression.

Your eyebrows already sit in a high feminine position so you do not need a brow lift, however they are thick so I have thinned them by plucking along the underside to give them a thinner and more feminine arched shape.

The soft tissues above your eyes are a quite heavy and are hiding your upper eyelids. I have given you an upper blepharoplasty to correct this and reveal your upper eyelids. You also have bags under your eyes so I have given you a lower blepharoplasty to reduce them. This is not strictly speaking feminisation because these kind of eye features are common to both sexes but blepharoplasties can soften the face and a softer is generally more feminine.

Your nose is fairly symmetrical and in good proportion to your face. From the side it has a slightly humped bridge. From the front there are no notable problems. I have lowered the bridge to remove the hump and I've given it a fairly straight profile. I have also given the tip a gentle turn-up by angling the base upwards a touch more.

Your cheekbones are perhaps a little flat and I think you might benefit from cheek implants to build them up a bit. However, hormones will make your cheeks fuller and rounder and I have simulated this for you. It is impossible to predict exactly how the hormones will affect you (everyone's different) but I've given you an idea of the kind of change you can expect. I would wait until you have been on a full dose of hormones for a good year or so to see how your cheeks develop before you decide on cheek implants.

The overall shape and fullness of your lips is OK but the distance between your top lip and the base of your nose is too long. I have given you a lip lift to correct this. I have also rolled the top lip out a little to give it a fuller and more feminine shape. You could consider plumping up the lips a little depending on your personal taste but I have not simulated that.

The height of your chin is OK but the shape is very wide and square with a flat base and 2 corners and it protrudes forwards too far. I have shaved off the corners to make your chin a lot narrower and to give it a more rounded and feminine shape and I have set it back a little. The cleft is more problematic - different surgeons take different approaches to the problem. I think it should be possible to reduce it but I do not think it will be possible to remove it completely and I have reflected this in the pictures. Chin clefts are only mildly masculinising so it is not a huge problem.

Your jaw is good overall but it is a little wide at the corners. I have narrowed this area for you but this might not require any surgery because hormones can sometimes help with the jaw width - they don't alter the bones but they do reduce muscle mass and if this affects the chewing muscles it can effectively narrow the jaw a little at the back. It will be worth waiting until you've been on a full dose of hormones for a good year before you make any final decisions about jaw surgery.

Adam's apple:
I don't see an adam's apple problem in these pictures.

Other points:
You still have quite a strong beard shadow and I have reduced this for you. I can't get rid of it completely without making your skin look plastic but I have made a big improvement. I have also removed some of the hair from the back and sides of your neck. Laser would be a good option here.

One thing you can't see in these pictures is the full potential effect of hormones. These can have a strongly feminising effect on the face and on top of narrowing the jaw and filling the cheeks, they add layer of fat that rounds off your features and makes the skin texture itself feminine - these two together are really quite powerful, especially when added to beard removal. The baldness will strongly bias you eye to see male in these pictures so you need to be aware of that and concentrate of the facial features.

Try to see the pictures as plans rather than predictions. They are just a starting point and neither you nor your surgeon has to agree with my suggestions.

See also
Dr. North’s surgical assessment
Dr. East’s surgical assessment

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