I arrived an hour ahead of schedule for my appointment, budgeting for a variety of obstacles. I’d only been to this medical center once before, and only to the ER section to visit a friend who’d been in an accident. I remembered the labyrinth of cold linoleum, the many identical passages branching from each sterile hall. Even after rereading the emailed directions a dozen times, I feared I’d wind up in the wrong building, resulting in me missing my appointment (and perhaps being trapped forever within an infinite sick-white sprawl of hospital walls).
I couldn’t afford to miss this consultation. I’d scheduled it almost a year prior after leaping through a series of hoops just to earn the right to be seen. I’d changed primary doctors in order to have a better shot at being referred and I had to see that doctor regularly over the course of several months before he felt equipped to write a strong enough letter of support for me. I collected letters from him and from my therapist, knowing that I’d have to collect new versions of those letters eventually anyway. I called my insurance and spent almost two hours on the phone confirming and documenting coverage with a young woman who, though kind and patient, was not at all familiar with what I was asking after. I’d even contacted a local health support group to get back-ups of the required letters and documentation in case my doctor or therapist accidentally misphrased anything in a way that my insurance would automatically reject.
If I missed my consultation, I wasn’t sure that my heart would be able to take it. That’s why I plopped myself in that waiting room an hour before I was scheduled to be seen, clutching a folder stuffed full of my medical history and extra copies of every document that had ever been requested of me.
“Last name Douglas?”
A tiny moment of relief as the nurse called me by my surname and led me past the reception desk. I’d heard great things about the surgeon I was seeing, but didn’t know how tactful his staff would be.
While I waited in the exam room, I mentally rehearsed my arguments.
Hello, Doctor. My name is Gordon and my pronouns are he/they. I am transmasculine and have socially transitioned. I am out at home, at work, and in public, and feel safe and supported enough to continue with my medical transition. By July, I’ll have been on testosterone for a year, and it has been the best year of my life. I have worn a binder off and on for ten years and have worn one almost every day for the past year. It is very important to me that my body more accurately matches my gender identity and expression, which is why, after years of consideration and discussions with doctors and therapists, I’ve decided to seek a double mastectomy.
As it turned out, I didn’t need to be prepared for an interrogation. The top surgeon walked in, greeted me warmly, and we got down to business. After a few minutes of conversation, questions, and physical inspections, he announced that I was an excellent candidate. He also noted that, thanks to the pandemic, surgery couldn’t be scheduled yet, even though operating rooms were opening back up. He told me to expect a call late in the summer for a surgery that could happen in late fall or at the start of the next year, at the latest. Disappointing, sure, but I’d waited 30 years to get this done. What was one more year?
At the end of the visit, after the surgeon assured me that he was experienced at working with picky insurance companies, he looked me square in the eyes. “We will get this done,” he said, and I almost cried.
That was in January of 2022. I’m writing this in December of 2022, and as of yet, no surgery date in sight. The updates I used to receive every two months have stopped arriving in my inbox. When I finally contacted the surgeon’s office to make sure I was still on the waitlist, I was assured that I was, but instead of the just-under-a-year wait they’d originally predicted, they were now estimating one and a half to two years between the consultation and the surgery.
I was gutted. I was supposed to swim topless next summer. I’ve been loading up my closet with cheap button-downs to wear during recovery. My mom was awaiting a date from me so that she could take time off work to care for me after the procedure. I had tried to keep myself somewhat pessimistic about the surgery time frame in the first place. “Definitely in 2023,” I’d repeated to myself. Now even that isn’t a guarantee.
2022 has been a rocky year, to put it mildly. I experienced new and interesting ways in which to get my heart broken. I finally caught Covid for the first time, and boy howdy, did that suck. I flew from Indiana to Oregon twice, and the second time, I returned via U-Haul with my girlfriend, two cats, and a sense that all of our lives were about to change dramatically.
Luckily for me, despite the grief and chaos, I’m a professional silver linings finder. I spent what could have been a very lonely summer pushing myself out of my comfort zone and making new friends. I finally proceeded with my legal name and gender marker change, since it no longer seemed like I’d have to time that around my surgery (else risk further insurance hurdles). Despite feeling pretty gross and miserable during my Covid experience, it also gave me the chance to slow down and rest a little without feeling as guilty about not being productive. I attended two weddings, got two(!) tattoos, started running a D&D campaign with my buddies, and even performed a very silly cowboy-themed burlesque act, complete with a fake mustache, tear-away pants, and a lasso trick that I practiced for hours using my stationary bike as a bull.
You know what they say: Save a horse…
When it comes to putting a positive spin on my indefinitely delayed surgery, however, I tend to struggle. Still, I’m looking for the bright side! To start with, between rising inflation, car trouble, and several cross-country journeys, finances are a bit tighter than usual. Even with insurance, my top surgery will be a larger expense than I’m accustomed to swallowing. I need time to fill my savings back in, and while I’m emotionally devastated by the distance between me and a flat chest, I’m financially relieved.
Another unexpected benefit of waiting is that I am immediately readable as trans to fellow trans folks. Would I like to pass as a man better than I currently do? Certainly I would, but from the jump, I figured a short, flamboyant, baby-faced fairy like me would always have some sort of tell. That aside, passing isn’t the be-all end-all of transition for some people. I like being perceived as queer, and if my bound chest tips other queer people off, then that’s great! I’m fortunate to be surrounded by friends who use my correct name and pronouns, and when trans and/or non-binary strangers see me being loud and happy and respected as transmasc regardless of the shape of my body, it conveys that this is a safe place to be oneself, even if your looks don’t line up with your identity.
On that note, I’d like to remind folks that presentation and appearance are not the same as identity. We live in a culture that has trained us to make quick and “accurate” gender assessments with everyone we encounter. That culture is shifting, albeit slowly. For most folks, their gender and their presentation are likely in sync. But for plenty of other folks, whether or not they’re transgender, that’s not the case. There are straight, cisgendered men who have lived their whole lives as men with he/him pronouns but who happen to wear more traditionally feminine clothes. The “gender reverse” of that is true as well (though perhaps less visible, considering how masculine clothes have become the “neutral” standard). I try to use neutral language until I know someone’s pronouns, and when I introduce myself, I try to include my pronouns as well.
These are behaviors and attitudes I had to learn and which I’m still learning. Despite everything I just said about avoiding assumptions, I still hope people look at me and see a man. A quirky little muppet of a man, sure, but still a man. That’s difficult when one of the major ways people make gender assessments is through body shape. I’ve managed to grow a goofy little goatee that helps guide people toward masculine assumptions, but what good is that under a mask? Even when I’m not masked, there are times when I get the quick, awkward up-down glance from strangers who are usually trying to be polite and don’t want to “sir” me in case I’m just a butchy, hirsute lady.
The best I can do for now is to continue being my boldest and kindest self. I’ve had to fight quite a lot just to get where I am now (I’ll have to write about the ridiculous experience I had just trying to get my pharmacy to fill my first testosterone prescription sometime soon, because wow, I really wish I’d been braver back then). The surgeon who spoke with me is skilled and sympathetic and surely overworked, as so many in the medical field are, especially in midst of ongoing pandemics. Currently, he’s the only top surgeon in my state who takes my insurance, and while I’m tempted to find a way to pay out of pocket for another plastic surgeon, that feels like such a financial waste.
So I’ll wait. I’ve made it this long; I can certainly make it a bit longer. My body isn’t who I am. I know this, but the more I pass, the lighter my heart feels. It’s hard knowing that there’s nothing more I can do but be patient and keep enjoying the things I do have control over.
Maybe it won’t be next summer, but some sunny July, I’ll run down a dock and dive into a lake looking more myself than ever, and I know it will feel just like flying.