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Adhesion Complication and Frustrations


Guest vtphoenix

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Guest vtphoenix

Hi, everyone. My name is Ashley. I occasionally post here to give updates on how things have gone since my GRS with Dr. Brassard 4 years ago. I tried to post a really long message on Friday but then somehow lost it, so I'm going to try again now.

For the past few months, I have been having excess dampness in the genital region. I saw a gynecologist who said my vaginal PH was a little high (5.5 as opposed to 4ish) and prescribed me Estrace cream. She was not sure what was causing the dampness and asked me to follow up with her in a couple of months. Recently I did that and she prescribed Pyridium, a medication that turns your urine orange. This was so we could see if the excess dampness might be urine. Well, after a couple of days, it looked like it was. That weekend, when I wiped that area there was blood on the tissue. It was a weekend so I went to a local Urgent Care clinic and was seen. Well, the people there did not appear to be the most comfortable around me. I did a urine test to see if I had an infection (I did). But the dr. said she "could" do a physical exam (and looked really appalled at the thought) so I declined and just went home. This time I was prescribed an antibiotic. I was sent to a pharmacy I knew to be closed and when I said something, the dr. said that it was open. Thinking the dr. probably knew better than I did, I went to the pharmacy (fighting horrific traffic because the main streets of the city were closed for some event). Yep, the pharmacy was closed as I had thought.

Angry that the dr. hadn't listened to me, I called back and had the prescription sent to a different pharmacy and went there to pick it up. The following week I made an appt. with a urologist to get to the bottom of this urinary leakage issue. This can happen with cis-women so maybe it was just a growing-older thing (I'm 37). I saw the urologist on Friday and he had a pretty terrible bedside manner as he told me that I had some sort of adhesion. The way he talked about my vagina was like it was made in Frankenstein's lab or something and he callously made comments about how I might need reconstructive surgery. I tried to ask him questions about what exactly an adhesion was and what this might mean for me but he acted like he could not really answer my questions since he did not know anything about GRS and how Brassard had meant to construct my vagina.

Well, this was just great. I was getting increasingly anxious. I had thought things looked pretty much normal (and that's certainly what I paid for with Dr. Brassard) but this doc made me feel like I was just a mess down there and the thought of some kind of reconstructive surgery was just too much. It took every ounce of bravery I possessed to have my GRS and it was costly, painful, and mentally very taxing. I didn't think I could go through an ordeal like that twice. I left the dr.'s office in tears, more upset than I have ever been in my life (and that is quite saying something).

When I got home, I told my partner what was going on (she hadn't gone with me thinking this appt. was just going to be a pretty mundane thing). I tried calling Dr. Brassard. I was literally going to drive to Montreal that afternoon and have him take a look even though Montreal is hours away. However, Brassard is on a month long vacation! As an aside, following my GRS, I never received a follow-up appt. Most people I know agree that that is pretty messed up. Little did I know that the week I scheduled my GRS, many of the staff were going on vacation and that the following week, Brassard would be gone as well (on a 2 month long vacation!). I would not have scheduled my GRS for that time period if I would have known this was going to happen.

Anyway, I decided that I was going up to the ER and that I was literally going to camp out there until someone agreed to help me. It has been my experience that medical care for trans people is terrible here (even though I live in a supposedly trans friendly state). Even though I am supposed to have a relatively normal appearing, normally structured vagina, I have been referred back to my surgeon for extremely minor problems of the type that are common to cis-women (such as suspected UTIs). Never mind that trans people seeing their GRS surgeon for every little thing is not at all feasible, especially in situations where the surgeon is out of the country. My insurance would not pay for such visits, I would have to drive for hours and cross an international border. Come on. But it's all because so many providers don't want to touch a trans person with a ten-foot pole. I think it's because they imagine that trans vaginas are some very strange thing, they don't have education in trans issues, are afraid of malpractice lawsuits, etc. However, this is something that absolutely has to change. For the time being, I am mentioning this because I want people who are thinking about having GRS to know what they might be in for (I am sure that many of you have had much better experiences though, at least I hope so).

So, to continue my story, I was admitted at the ER and the intake person asked what my presenting problem was. I told her (mentioning that I was trans as that might be relevant according to the urologist) and her response was "Wow, I couldn't even tell! Good job!" I didn't want to get into a big thing about this but this is a pet peeve of mine. It is like the time my mom went to church with Jehovah's Witnesses and one of them made a comment to the effect of "Wow, you look nice today. You dressed just like us." Cue the cultic chanting of "one of us, one of us." I do not want society's treatment of trans people to hinge on how well they "pass" (I hate that term). I know she was just trying to be nice but I said to her "Well I think my appearance has more to do with luck than my somehow doing a good job at anything. In my ideal world, trans people are treated well even if people 'can tell'" Maybe others find this a compliment and I know she meant it that way so I didn't want to come across too harshly (especially since I was frightened by my encounter with the urologist). However, I personally don't like it. I am not seeking validation from others for being trans and particularly not in this instance where I just want to be admitted to find out what was wrong with me.

Well, I was admitted and did another urine test. I still had an infection. It had been a week at this point but my antibiotic was changed out during the week after the culture came back and determined it was a different kind of bacteria (Strep instead of E.coli). This doctor did do a physical exam. He was very nice but wow was he nervous. He also had multiple staff members come in with him (I'm sure he needed one female present anyway) and it was quite embarrassing. My trans vagina was on display like a freak show and the curiosity of the staff made me very uncomfortable. Then the dr. asked me how my partner and I have sex (my partner was right there fortunately), "do you use toys, mouths, fingers...?" And I was like "Excuse me, this is relevant how?"

Well, long story short, he said he could see the adhesion issue the urologist was talking about but he didn't explain what was going on with me very well. He drew a crude picture that didn't look right to me and he described my vagina as though it looked quite different than a cis-woman's vagina (he kept using the phrase "native woman"). Overall, the visit was not very helpful because he frankly didn't know what to suggest to me. I saw a provider later that day to try to learn more and thankfully she was female which did seem to make a big difference. She thought some of what I had been told that day was garbage (that Estrace cream wouldn't work because I have no estrogen receptors, for example, or that I needed a camera shoved up my urethra to figure out why I had a blood in my urine when I had an infection and the antibiotics hadn't even been given enough time to work). She explained that the adhesion was an area where skin had fused together.

The urologist had said that he couldn't even see my urethra and this had freaked me out but this other dr. said she could see it if she moved the skin a little (I guess something the other doc had been loathe to do). It seemed like this was probably the reason for any urinary leakage, my urethra was somewhat obstructed by this adhesion which causes a little bit of urine to get trapped to leak out later. My doc said I might not have to have surgery but that if I did it would likely be a pretty minor thing, NOT something as brutally invasive as the original GRS. She said adhesions are often done on an outpatient basis. She told me to continue to use Estrace cream on the affected site and that estrogen in that area could help the adhesion come apart on its own. It's been a few days and it seems like this might already be happening. I am hopeful at least. I plan to make more appts. today to get a better idea of what needs to happen next.

On Friday though I was more depressed than I've been in years and I found myself regretting my GRS entirely. I was reflecting on how much has not gone according to plan, how much has been different than what I was led to believe it would be like, and how little research has been done on trans issues.

I am studying social work and I've learned the importance of evidence-based treatment. Where is the evidence that a RLT is beneficial? Studies suggest that the biggest predictor of post-op satisfaction is the actual surgical outcome. In other words, you can't really know if you'll be happy unless you've already had surgery. There is no study that I know of that suggests RLT prevents regrets or makes anyone even a little happier. Instead, it seems to reflect a certain political mood, that genital surgery is so life altering (and this part is certainly no lie) that the medical establishment has to "make sure" that a person is ready. But how, how does RLT indicate this? Having GRS and the consequences of GRS have nothing to do with social transition. You could have GRS and not socially transition, for example, or you could socially transition and not have GRS. One's genitals don't have anything to do with their presentation, how they are accepted, how well they can function in society (with a few exceptions, such as sexually, of course).

I am doing a lot better today, better mood, more hopeful, etc. but I am still kind of bitter that even our allies don't really understand us and that the medical establishment is not where it needs to be in regards to trans issues. I do not regret my GRS overall but I recognize that some things happened that should not have happened at Brassard's clinic (uninformative initial consult, attitudes of some staff members, treatment towards another patient, no follow-up). It feels icky to suggest anything negative about Dr. Brassard or his practice since he made my dream come true and I will be forever thankful for that. However, it felt somewhat like an assembly line there and I feel like we all deserve better than that. I would not dissuade anyone from going there, I don't want to come across like I am hugely dissatisfied, I only want to emphasize that better medical care for trans people can happen across the board even at clinics that cater specifically to trans people.

There also needs to be a demystification of the trans body as we are often treated like alien beings. Some people think trans people have de-sexed ourselves with hormones and surgeries, for example. And I think we need to work on being more honest with ourselves about our need to transition or have GRS. I believe I have a female identity but I also feel like my male identity was not completely inauthentic either. I realize now that to some extent, male sexual impulses exacerbated my drive to transition and have surgery, but who admits this? This goes back to the days of "primary" and "secondary transsexual" that eroticizing femininity somehow detracts from one's legitimacy (I don't think this is true, identity and sexuality are deeply connected). I don't like the term "autogynephile" but I can relate to this in some ways. But according to the literature (outdated, garbage literature admittedly) this means that I would not have "cross-dressed" (a pure social construct in the first place) before puberty, which I did. I also would not be able to experience arousal post hormones and GRS if some male urge was partly or entirely responsible for my transition (and I have no problems in this area). Further, hormones are supposed to reduce or eliminate secretions from my prostate during orgasm. Four years later, they have not. This is not a problem for me. I am not bothered by it. Only again stricken by how much I've had to learn post GRS.

When I had GRS I absolutely felt that I had to have it and if I could go back in time, I probably still would have it (this is the true test of one's decisions I think). However, I really do question whether I needed it to be happy. I don't think I am less happy having had GRS (although it is important to note that life IS worse in some ways, the adhesion complication for one, but I also think that sex with females is not as good). Nowadays, I find myself bothered by trans people who seem to put GRS on a pedestal. My experience has been that it has done very little for me. Like I said, I would probably still do it again, and that says something, but I think it's highly likely that people who are unhappy now will be unhappy after GRS. There is an initial euphoria for sure but there are very few ways that it has improved my life and I would strongly urge others to have modest expectations about what GRS can do for them. That being said, everyone's situation is different. I think if I had a male sexual partner, GRS would rate higher for me, for example.

I know this is very long. It's just that I have learned so much from my experiences and I feel like there were too many cheerleaders along the way. I'm not sure things could have turned out any differently. I would probably still have had stars in my eyes thinking of how great having a vagina would be and I wouldn't have listened to anyone anyway. I just wish there were more people encouraging modest expectations from transition and GRS. I have a friend who de-transitioned recently. I'm not going to encourage them to transition. I de-transitioned a long time ago and I understand how personal a choice that is and how hard it is to make. Being authentic is super important, I think, but it does come with a very high price that each individual has to decide for themselves if they can pay. I think if the time is right for my friend, they will transition. But if they are uncertain or if they are not brave enough or strong enough, then they probably shouldn't take this road anyway. It is the rockiest of roads, the maps are completely unreliable, and stopping to ask for directions is typically worse than useless.

I hope some of you find my experiences somewhat helpful. This is not meant to be a discouragement, I just think learning of potential hardships helps balance the narratives that are more skewed towards roses and sunshine. These are my thoughts and experiences only. I hope I do not sound as though I am trying to generalize them to what the experiences of all or even most people are going to be like. On the other hand, I think it is the rare transitioner who has no social or surgical complications so please don't dismiss caution out of hand because you think that none of this stuff could happen to you.

Thanks as usual for all of your support and understanding. I will answer any questions I can.

Ashley

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Interesting story, Ashley. Sorry you had to go through some of those things. 
I've fantasized about having a vagina. It's nice (for lack of a better word) to know what negative things might happen if I were to get GRS one day. I don't want to have the highest of expectations and become too disappointed. Anyway, I'm curious what you meant when you said you de-transitioned a long time ago? "De-transition" must not mean what I thought it meant. I'm kind of new to all of this, so I was just wondering. I've also been worried that if I were to go through some of these things, that I would want to de-transition. I have doubts like that often.

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If you still are up in the air about what an adhesion is, after surgery, tissues that normally would not adhere to each other get bound together with scar tissue.  My sister had one after an ectopic pregnancy.  She had lost one ovary.  Years after the surgery she had some other problems and it turned out an adhesion formed from the abdominal wall to her intestine or something like that so when she moved, rather than her intestine being able to slide inside her abdomen the part that adhered got pulled around with her movement making things uncomfortable.

Can't of course comment on the specifics other than to say I expect doctors, who weren't SRS surgeons and weren't trained in treating neo vaginas (which is to say the vast majority), to refer back to the SRS surgeon.  Even if they had some experience they may do that as well since correcting the adhesion could impact the original surgery.

Urinary tract infections (which lead to bladder and even kidney infections) are far more common post-SRS just like they are more common with women.  Also since something like 80% of such infections and intercourse related, the detailed questions on the subject of sex would be understandable so as to provide some feedback as to what may reduce risk of repeats.

The act of dilating can move some bacteria to the urethra so common advice given to women is applicable to dilating,  That advice is don't urinate before intercourse and to urinate immediately after so as to flush any bacteria out that may have gotten in there.  So don't urinate for dilating, urinate immediately afterwards. 

I find it hard to believe some flap of skin was covering urethra.  I would expect such to make a bad spray when urinating, but perhaps its been like that.

As for any trapped urine, I note some urine is released when changing position so wiping after standing up is important if not already being done.

Incontinence is another risk item that is more common post SRS and especially as one gets older.  Age 37 isn't that old however.

 

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Guest vtphoenix

Mia, "detransition" probably means a lot of different things to a lot of different people. In my case, I had been living in role for about 6 months when I was overcome by doubts and fears. A large part of this had to do with falling for someone and having been lonely for a long time. It's been my experience that being trans can be very socially isolating. I don't think I was ready to commit to the process because I was afraid it might lead to my being alone forever. I had not done anything that could not be reversed except for facial hair removal. It was embarrassing to go back to living as a male for a while and I think it caused people to be more skeptical of if I was making the right decisions. But ultimately it's my life, it's okay to have some confusion about something so major, and I feel I needed that time to get some perspective and eventually come to the decision that transition really was right for me. That was about 15 years ago, so it's not like I have been wishy-washy about whether I should stay the course. I just needed the right support in my life so I could overcome my fears.

Cyndi, I wish you the best in your own recovery. I am glad that things are going well so far. As an update to my original post, I have been making phone calls and I can't find anyone who will see me. It sounds like you might have a better situation but healthcare can be precarious. If you need to move or if your doctor changes practices (as my primary care doctor just did). I certainly do not want anyone to have the issues that I have had but I think it's important to realize that healthcare can vary dramatically from state to state and even from city to city. My state is supposedly very trans friendly but I have not found that to be true. It feels to me that having good care in the decades of life following surgery can be very hit and miss and I don't think that it should be this way.

Drea, yes I know what adhesion is. I also know that when someone is having a hard time the best thing is to listen to them and be present for them, not to offer advice or to try to rationalize things you don't know anything about. During an emotional time, a person is not interested in how their perceptions might be wrong etc. You can rationalize why it might have made sense for doctors to act the way they did towards me but you weren't there. Referring me to my surgeon makes sense if seeing that surgeon is a possibility. However, Brassard is out of the country, my insurance won't pay for seeing him, AND he is on vacation for a MONTH anyway which renders the whole thing moot. Explaining this to a doctor is like talking to a wall. Regardless of whether seeing Brassard would be the best course (and I absolutely think it would if I could, which I can't), at some point I need to have recourse if this is not a possibility. Also, your info about urinary tract infections is well known and I'm not complaining about urinary tract infections. And a doctor asking about whether I use toys, mouth, etc. sexually with a partner, you can't defend it because you weren't there and things like context and tone of voice matter. I feel like you're playing devil's advocate (a huge pet peeve of mine btw, since it is at least possible that my perceptions ARE 100% correct, so please consider that that is the case here as there is really no reason for you to assume otherwise). Also, you seem to doubt the flap of skin covering the urethra, that I would notice because of spraying or whatever. Well there has been no spraying but as I said there has been some leakage so there you go. Lastly, your inclusion of a lot of extraneous information (such as how to wipe) feels like you're trying to take an expert role, which doesn't work for me since I too have been doing this for a long time. If you want to know how best to support someone, look at the other posters for an example, or better yet, just ask the person you're trying to support.

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I have a complication myself (hypergranularizaiton tissue) and I relate to what you say. I already had a couple of doctors refusing treatment with the same look you talk about. My doctor is fortunately is familiar with trans* and she knows what she talking about. I found out in my own case that it was good to wait since the first doctors were talking about treating the tissue with azote and it's really silver nitrate. Can you imagine own badly it would have hurt with azote? ouch

 

The thing I did before GRS was to talk to trans* who already had it. I knew how imperfect it can be. One of my friend lost sensation to a part of her leg because the blood damaged a nerve that is near the skin....

 

I hope it gets better for you. I'm sending positive energy :)

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1 hour ago, vtphoenix said:

Mia, "detransition" probably means a lot of different things to a lot of different people. In my case, I had been living in role for about 6 months when I was overcome by doubts and fears. A large part of this had to do with falling for someone and having been lonely for a long time. It's been my experience that being trans can be very socially isolating. I don't think I was ready to commit to the process because I was afraid it might lead to my being alone forever. I had not done anything that could not be reversed except for facial hair removal. It was embarrassing to go back to living as a male for a while and I think it caused people to be more skeptical of if I was making the right decisions. But ultimately it's my life, it's okay to have some confusion about something so major, and I feel I needed that time to get some perspective and eventually come to the decision that transition really was right for me. That was about 15 years ago, so it's not like I have been wishy-washy about whether I should stay the course. I just needed the right support in my life so I could overcome my fears.

Ah, I see. That in a way makes me feel better, because I've been having a lot of doubts about this, as I said. I just gotta take my time to figure myself out, just as you did. Anyway, I'm sorry you felt that way, but I'm glad you figured it out.

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Thank you phoenix, my apologies

I did not understand it was a rant, hard to tell if something was intended soliciting input or simply soliciting agreement/sympathy.

Personally I always consider I may be wrong.  Interpretation of things so often colors ones viewpoint so I am always open to input and always feel I can disregard anything not relevant.  My views are not that of others.

The extraneous information was for general information as many who may benefit find out reading topics such as this, again nothing intended to reflect against you.

 

 

 

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Guest vtphoenix

Update: I finally got in to see a dr. that seemed to know what they were talking about. There was no sign of an infection so either I never had one to begin with or the antibiotics did their work. This dr. was a urogynecologist who often sees trans patients. She said the blood in my urine was actually most likely from an irritation around the adhesion and not an infection. She could clearly see my urethra and was pretty sure that the first dr. I went to had just been confused about where my urethra was (despite his being a urologist...). She said that I did have an adhesion but that it wasn't obstructing my urethra. The adhesion was on the labia minora and she said I could have it repaired but that it wasn't causing me any problems and that if the skin was separated the adhesion could still occur again later. That being said, she said that if the appearance bothered me, she would do the procedure for me. I am undecided on this but leaning towards leaving it alone.

Long story short: the drs. I had seen had most likely gotten me worked up over nothing. Still, I am disappointed that my vagina really doesn't look like a genetic woman's vagina. I feel like I was given too high of expectations in this regard. It looks healthy, it is functional in every way, I have good depth. But there are obvious scars and the structures are in slightly different places (the vagina angled a little differently, the urethra a little higher, etc.) so I find it very hard to believe that a lover could not tell from appearance if not feeling. This is not a huge issue for me as I am in a long-term relationship (married for 10 years) but I just thought anyone considering this surgery should keep in mind that at least in my case the "indistinguishable from any other vagina" hype may be just that.

I am pretty sure that I would still have had GRS but there have been a lot of let downs on this journey nevertheless. I would say that the best parts have been finding those authentic ways of expressing myself that I never dared before and really coming to know myself. I think that if those things are one's primary focus they're likely to be happier than if "passing", looking "beautiful", or living "stealth" are highly valued. Those things are not realistic goals for many, many people. Self-acceptance is the hardest part for me still, although I am doing much better in this regard. I think a lot about something I learned recently and that's to focus on behavior goals vs. outcome goals. We can control what we do, we can't necessarily control outcomes.

- Ashley

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  • 3 weeks later...
On ‎8‎/‎8‎/‎2016 at 6:32 AM, vtphoenix said:

I just wish there were more people encouraging modest expectations from transition and GRS....And I think we need to work on being more honest with ourselves about our need to transition or have GRS.

I sure do agree with you on this 1000%.  Even though there are many who say that SRS/GRS/GCS is not necessary "to be  woman", logic and reality seem to dictate otherwise.  I think you are very right in recognizing that this surgery has been reified to the point of almost magical qualities.  I can assure that is not the case.

I always tell anyone that asks and is willing to listen to an answer from a now aging woman who  has decades of lived experience post-op and lives generally with little regard for what is considered the "conventional wisdom", that no one should have the surgery or even 'transition' to full time unless there is absolutely no other way that they can live without doing so.

On ‎8‎/‎8‎/‎2016 at 6:32 AM, vtphoenix said:

Where is the evidence that a RLT is beneficial?

This is an excellent question, especially since this RLT is seen as just another meaningless impediment and failure is not an option.  Just consider the amount of social and psychic energy invested in this simple yet for many, seemingly impossible task.  How can anyone even consider that maybe the truth is that living as the opposite sex really is more trouble than it is worth. Why is transition, with all its many pitfalls and drawbacks any better than just simple, pleasurable cross-dressing in such a way as to not be as totally disruptive, (and potentially destructive) as a full transition, much less a full transition.

I am glad that you are coming to accept yourself better and that your medical issues seem to have been resolved.  Best of luck to you and remember to just be patient with yourself as well as with others.

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I'm glad to hear your that problems were dealt with by someone who was competent and understood what they were doing. Some people say that trans folk shouldn't have to tell medical professionals that they're trans, but as far as I can see it's issues like this (as well as prescribing medications that alter hormone balance, for example) that make it pretty much a necessity, at least in some situations. Until medical schools catch up in the training they provide (if any) about trans people and their bodies, it also demonstrates the importance of having access to an information network that knows which doctors are respectful of and have experience with trans people.

Re. Alejandra's comment, if you aren't (too) dysphoric about your genitalia and can get by without GCS, I don't see that there's any 'requirement' to have it done (transmedicalists and politicians be damned). Unfortunately, the procedures are not yet perfected. While CDing may work for some people, others may require various surgical or endocrine interventions to bring their bodies in line with their identity. What matters is if it matters to you.

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6 hours ago, Mayo said:

Re. Alejandra's comment, if you aren't (too) dysphoric about your genitalia and can get by without GCS, I don't see that there's any 'requirement' to have it done (transmedicalists and politicians be damned). Unfortunately, the procedures are not yet perfected. While CDing may work for some people, others may require various surgical or endocrine interventions to bring their bodies in line with their identity. What matters is if it matters to you.

I am wondering what you mean by a 'requirement'.  Requirement for what, a gender marker change on gov't. ID?  That is of course a question for individual governments and IO a subject for a separate discussion.

When you refer to others that might "require" other various intervention, I think you are referring to the wide variation in personal preferences. As for whatever surgical procedures you might be referring to being not yet perfected, I guess that it might be considered that nothing is perfect and that in many cases, every little bit helps. As in half a loaf...

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Yes, I was talking about legal requirements in some states (politicians) as well as the fact that some people (transmedicalists) seem to think that GCS is 'necessary' for someone to be 'really' trans. As you may be able to tell, I don't think much of either, and am a firm believer that expressing one's true gender identity is not a 'one size fits all' deal (due to the 'wide variation in personal preferences'). As I understand both your post and those of the OP, everybody's needs (and solutions) are different, and that's something with which I fully agree.

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Guest vtphoenix

I think I pretty much agree with both of you. The only part I can really add to is the part about not transitioning/having surgery unless there is no other way. I think that's a whole complicated thing because what does it mean for there to be no other way? Many people in the trans community will say things like "It was either do this or commit suicide" which I think is extremely disingenuous. There is almost no situation I can think of where our choices are so extreme. I think this a false dichotomy. We could do other things, we just really, really are unhappy with the alternatives. I think the pursuit of happiness is legitimate in and of itself, without invoking some "do or die" justification.

I am not trying to invalidate the people who feel this way, only trying to call attention to the fact that it is just a feeling, not based in objective reality. I was not suicidal before I had surgery nor do I think one has to be for surgery to be on the table as an option. I WAS however suicidal before I started transitioning but even though transitioning helped me to overcome those feelings, I think that had to do with facing a truth about myself, not necessarily taking this step or that step. In other words, I believe that there are probably a lot of ways we can be happy and "transition" can look like a lot of things. I think we tend to resort to strong language ("I did it because I had to", "I had no other choice"; "I would have died") because social pressure is so strong against our transitioning that we feel we need an equally strong justification. In my ideal world, it would be enough to say "I did this because I WANTED to".

Another way the "no other way" idea is problematic is that it depends so much on context. If that idea is rooted in our present set of circumstances, I'd say I would agree with that advice. It is just so hard to transition that I don't think anyone should do it unless they're really, really sure and have exhausted other options. However, if things were different socially then we might not have to approach the issue with so much fear. The costs are high right now but they might not always be so high. This is something I'd like to address in my social work practice, helping to shift society's thinking about trans issues so that a person can live as the other gender (whatever that means) without necessarily needing to already know what their endgame is.

So much emphasis is placed on certainty but I'll tell you true, I was full of fear and doubt as I laid down on that operating table. Now that I've had GRS, it feels even stranger for me to consider if there might have been another way. I did it, after all and that in itself seems to be evidence that I HAD to do it. I know logically that there were other choices but I don't think I could've pushed through all that doubt and fear (and spent so much money) if I hadn't thought it was of the utmost importance to me at the time.

I wonder about a lot of things related to transition and GRS but in a sense it's all moot because I did what I did and now I have to live with it regardless of how I feel about it. I usually feel pretty good but even when I'm feeling dissatisfied in some way, I truly value how much this experience taught me about myself and I am glad to not have to worry about the issue of "should I, shouldn't I?" for the rest of my life.

I think that self-acceptance is a necessary component of transition and at some point we all have to be satisfied with having less than what we'd like to have. I wish I was prettier. I wish I wasn't so tall or that my voice was more feminine. But I have come to accept myself where I'm at. If GRS did not exist as an option, is it possible that I could've come to accept that my penis was a permanent part of myself? This is more a philosophical question than anything right now since GRS does, in fact, exist, but there is an interesting Ted Talk about how we synthesize happiness that I find really relevant.

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45 minutes ago, vtphoenix said:

Many people in the trans community will say things like "It was either do this or commit suicide" which I think is extremely disingenuous. There is almost no situation I can think of where our choices are so extreme.... I was not suicidal....

I notice that you are obviously speaking for yourself and clearly understand that what may be the case for you, will not necessarily be the case for others. What I meant was very similar to your own thinking, (unless I misunderstand)...that because transition, (with or without GRS), is such a life altering experience it just seems prudent to fully and exhaustively explore other less potentially catastrophic alternatives.

In my case, I did in fact explore and fully investigate all other possible alternatives.  I really did not want to undergo a sex change and it had absolutely nothing to do with any social pressure. Unfortunately in my case, nothing else I had tried worked to relieve the extreme discomfort I had within my own skin.  For me, transition and surgical re-assignment was absolutely a last resort.  The good news is that for me, after a few bumps along the way, it worked out much better than I could have ever hoped for. I did not want to transition.  I had to.

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