6 years, 9 months (Day 2464)

15:24

After a few months of nervous procrastination, I have at last contacted Dr. Vlassis Travias, a specialist in laparoscopic hysterectomy outside of Concord, to begin the very first step of the process. It seems that he comes highly recommended as one of the best, no-education-required surgeons for trans men around, and after an initial phone consultation with him, I am definitely on board with him as my surgeon. Just like Dr. Brownstein years ago, Dr. Travias not only knows his trade like the back of his hand, but he did not have to stop and think while he was talking to me. He had no hesitation with language, pronouns or terminology, and as a bonus, he did not assume that I was squeamish about terminology, either. He explained the entire procedure very clearly over the phone, down to which size instruments he will use, how he will remove my organs and where they will go afterwards.

“Unlike a lot of doctors,” he said at one point, “who will tell you never to look up anything on the Internet and not to try to research on your own, I tell all my patients to Google everything.” He made sure that I knew the name of the procedure, names of alternative procedures to look up in case I wanted him to use a different method than his preferred total laparoscopic hysterectomy, and the pros and cons to each of the methods he is familiar with using.

After talking about my weight, height, medications, recreational activities and medical history, he was very happy to say that on paper I am a textbook patient, and he does not foresee having any difficulty or complications whatsoever.

In the coming days, someone from his office will contact me to schedule the actual dates that we will have to stay in Concord. The irony is not lost on me that out of all the surgeons in the country, I have somehow managed to pick the ones on exact opposite sides of the country — and as far away as possible from Colorado.

We are aiming for January 2015, which is quite some time away, but given that we took nearly a full year to plan top surgery, I know that it will begin to feel very real sooner than I expect.

For the moment, I am strangely excited.

6 years, 7 months (Day 2408) – a beginning

Well, quite a length of time has passed since I last posted anything, or had much to post. Incidentally, this will apparently be my 100th post, which seems fitting.

5 years after top surgery, my scars are nearly invisible, mostly aided by the fact that between 19 and 24 I have become an exceedingly hairy beast. My nipples, having been virtually numb to touch the last time I posted, have recovered completely. Although they had regained the ability to sense touch within a number of months, it has only been in the past few years that cold, heat, pain, pleasure or any other sensation aside from mere pressure has been able to register.

After 7 years on T, contrary to leveling out as I used to expect, both the effects and the effort of maintaining this kind of medicated existence have remained tumultuous. Several years ago, I discovered, unhappily, that Dr. P. had moved on, and the new doctor assigned to me in his stead was immediately resolved to lower my testosterone levels. Dr. P. had in the past expressed the same concern, but found it to be inexplicably impossible to control them, and had finally resigned to a “well, as long as you feel good” methodology.

Normally, a guy my age should, apparently, have a total testosterone level between 250-1100 ng/dL, and a free testosterone level between 35 and 155 pg/mL. My levels have always been drastically elevated, between 1200-1700 of total testosterone, and 325-475 of free testosterone, depending on where in my injection cycle I was. Obviously, my risk of suffering a horrible death from any and all common male health problems was exponentially higher than normal people.

So I certainly had no judgements when my new doctor, Dr. M., advised me to cut my dosage in half, although I was concerned for such a drastic change. However, at my next blood draw, Dr. M. reported — bemused — that my levels had not changed in the slightest, and instead suggested a quarter dose every week rather than a full dose every two weeks. Although this showed a large drop in my levels, within two months — despite 6 years of its cessation — I had begun menstrual cycles full-on, as if the entirety of my transition had never happened. Dr. M.’s assurance that my levels were satisfactory was no consolation, and I made the personal decision to revert to my bi-weekly 2cc injections. The cycling ceased, but I was back to where I started.

Months later, after making an appointment with a different doctor, at her request I began injecting every three weeks instead, a schedule I have continued with seemingly great success for the past 6 months or so. Several effects that I had simply become accustomed to and had forgotten were attributed to extremely high testosterone have disappeared, such as feeling volcanically hot at almost all times. In addition, the cramping that I used to have at the end of the second week — immediately preceding my shots — has also all but disappeared. I feel fantastic.

After the first few months, I was tested at the lowest end of the cycle, several days before I would inject, and for the first time since beginning transition, it was reported that my levels were utterly normal; 414 and 90 of total and free testosterone, respectively.

However, another test a week after taking a shot — halfway through the cycle — was not so optimistic. My total testosterone had jumped to 1400 again, and the free testosterone to 400.

On Tuesday I return for a third blood panel, skipping the shot I would normally do on Sunday, in order to confirm that my spectrum of testosterone levels is indeed that wide. I will then await the next instructions from a team of befuddled doctors, all of whom have never seen a case like me in their careers, and have admitted plainly that no one knows how to treat me.

---

The difficulty of these past three years has convinced me, finally, to begin the next and final step of my transition. Although I have had thoughts of a hysterectomy many times, I have realized that the time has come to make it happen. My body, battling a hormonal war within itself since the very beginning of first puberty, is ready to be rid of the organs that fight to regain control even after 6 years of lying dormant.

I am ready.

2 months, 4 days post-op

21:10

At eight weeks, the incision scars have flattened out to the extent that they can hardly be felt when running fingertips across my chest. The colour, after a month of Kelo-Cote usage, has also faded considerably, although more in tone than contrast; while obviously still evident, the colour more resembles a light sunburn pink rather than a deep scarred purple. The areolae, as well, have taken on a natural pinkish-beige in contrast to the radiant pink displayed of late. They have regained a very slight amount of sensation; while unable to recognize pain, both the nipples and the areolae are capable of feeling the pressure associated with touch. This is a tremendous development, as complete numbness had persisted up until merely a few weeks past.

The small translucent sutures have fallen out; or rather, were not actually attached at all, a fact I discovered in a moment of annoyance as I happened to pull on them, and, to my great astonishment, they came out quite effortlessly. Some fatty tissue has migrated back into the breasts, providing both padding and a pleasing pectoral contour, more natural than the flattened, sunken chest wall that had remained after surgery. I have also rather rapidly gained back a large amount of body fat and muscle, although my overall weight remains at a concerning 15 less than ideal.

In the midst of the summer, I realize how astonishing the change of body temperature is. Without the heavy, dual-layered, spandex binder hugging my torso from neckline to hip, I realize that the intense and unbearable heat experienced last summer, through which I felt I barely survived, was not caused by the testosterone as much as I had believed. Though certainly exacerbated by such, without the extra layer I experience none of the heatstroke, dehydration, chronic fatigue or constant sweating suffered throughout the previous year.

After a month without the surgical binder, as well, I have begun to become accustomed to the idea as well as the profound sensation of wearing only one shirt — no matter what shirt. I had, I realize while wearing each one for the first time since surgery, subconsciously memorized its look and feel; as I prepare to step outside for disposal of trash or recycling or to check the mail, the initial thought springs to what I am wearing; a selection of shirts, namely those with large logos covering the chest portion, were able to hide me without a binder with the help of some slouching; and these I often would wear around the house or to short trips outside to avoid the constant discomfort of binding. Others, such as muscle shirts or sleeveless basketball jerseys, were not only revealing but also, simply not designed to fit over such extremities. In this, I have also noticed that a large collection of my shirts are rather uncomfortable. As most of my shirts were tested, bought and worn with the binder, I seldom felt many of them against my skin; particularly, I am acutely aware of and exceedingly bothered by tags, loose threads and bunching of seams where a loose thread may have once been pulled.

In the middle of August, I am able to not only wear a t-shirt, but also to tuck it in; where previously, tucking any shirt in would manifest a personal volcanic sauna between shirt and binder.

My range of motion has recovered almost completely, with minor pain only during high reaches or concentrated use of chest muscles, such as lifting a heavy object from a height. Though I lack the energy for much exercise, I am able to produce push-ups, pull-ups, sit-ups and crunches with no difficulty. Although I still exert caution with things heavier than 50 or 60 pounds, my lifting capability is no longer limited by pain tolerance.

I find, surprisingly, that I am comfortable shirtless in the presence of others, although the only people to witness it as a daily occurrence have been my mother and a childhood friend, having recently spent several nights in each other’s immediate vicinity. Even to those who are entirely unaware of my transition, I no longer experience the paranoia of someone seeing my chest upon waking up, walking to the bathroom, showering or dressing.

---

Today, nearly 9 weeks.

The left nipple.

The right nipple.

1 month, 2 days post-op

20:15

The healing process has taken a tremendous leap in the past week, physically as well as in regards to capability. Although I have yet to gain back any of the weight lost prior and during surgery, my strength and muscle mass has been slowly returning.

After believing to be witness to minor changes after four days of use of the small Kelo-Cote sample provided by Dr. Brownstein, I was encouraged to purchase a larger quantity as the recommended usage is three months. As a majority of sizes are intended for smaller scars of 4-6 inches, my 12 inches of scarring required purchasing the largest tube available, which although retailing at a costly $130, so far seems to be well worth the expenditure. Although much effect cannot be observed, there has been a definite immediate decrease in the striking colour.

The ends of several small, translucent sutures can still be felt on the right side, at the very end of the incision where I assume the knot must be. Although both sides have flattened considerably, there is a concerning grey color to the inch-long vertical section of scar under my arm. It is slightly painful, but I surmise the reason may simply be the sutures taking their time dissolving; and not, I hope, a developing infection.

I have also, somewhat on accident after intending its purpose to be for the scars, begun applying a thin solution of vitamin E oil to my stretch marks; which, after a little under a week, have to my utter astonishment disappeared nearly entirely. While I cannot be truly certain whether this is my body itself healing or cause of the vitamin E, nonetheless I find a new faith and no desire to discontinue the treatment.

The grafts are healing well; the left one still remaining a bit raised, in addition to the strangest occurrence of dryness; almost as though the thing is suffering the peeling aftermath of a sunburn. While it is neither painful nor harmful to its appearance, as well as that there can not be any evidence of such a thing found anywhere else on my body, its presence perplexes me.

Reaching, lifting and general movement reaches a new milestone day by day. Directly following the removal of the binder, the area of my breast between the incisions measured roughly 3/4 of an inch and was extremely tight, so much so that I could feel its tautness under my fingertips. In the month to follow the skin has relaxed considerably, to the point that it now measures nearly 1.25 inches. Other areas having relaxed as well, I find that moving my arms no longer tugs on the incisions as it once did; the tissue is beginning to move as it should normally. I find that I am also capable of lifting most objects under 40lbs without pain, whereas even this past week my range was limited to 30lbs; and immediately after my return to work, was barely 20lbs. I am able to raise my arms entirely vertical above my head, although the last inch or so to straighten out pulls slightly.

My bodily hair, strangely, seems to be growing at an exceedingly fast rate of late. Not only has my beard appeared to grow twice as fast and thick since our return from San Francisco, I find that the dark hair on my stomach and chest has been multiplying daily. I had noticed an increase in hair growth during the week in California, but had expected it to cease immediately upon return to my own hot, dry, high-altitude climate; which leads me to ponder whether the removal of breast tissue might have anything to do with my testosterone level. Though it is obvious that a small line of hair was shaved near the incision site, it has already grown back in full form and there remains only a small area between belly and breast that is hairless. This belief is further accentuated in my mind as an acne outbreak on my chest is to be observed; which, oddly, was a very distinct and recurring bother at the onset of female puberty, seeming to worsen near the beginning of my cycles.

Incidentally, a visit from a 30-year friend of my mother’s took place several days past, which although he was aware of the change, had not seen me for three years at least. His first comment after introduction: “Nice beard.”

“Thank you,” I said. “I grew it myself!”

---

The site today, one month.

Sort of sickly lighting; also, it looks like I have one arm.

A pose. The scarring on my arm is a remnant of adolescence, and, obviously (one might hope?), not an effect of the surgery.

Slightly different angle, more from the front.

3 weeks, 2 days post-op

20:00

Today, I experience my first continuous 48 hours in six years without a binder. I have worn it intermittently during the night for the past week, but as it is now possible to sleep on my stomach without discomfort, the support is no longer needed.

The nipples have healed almost completely, though still without any sign of sensation returning. The areolae are very raised, but appear to be acquiring a pleasingly elliptical shape instead of the initial oblong oval.

While still sore, I find that I am capable, albeit slow, of a great deal of previous activities, the scope of which continues to expand day by day. Raising my arm to the height required of hanging it out the car window is not longer painful, although any object above my head is still difficult to reach. I am becoming accustomed to the appearance of the scars; yet, the more they heal, the more prominent I find my natural bodily oddities to be.

“I have never heard of such a thing happening before.” My mother traces her finger along the angled scars near the base of each incision in relative awe; like claw marks, they stand out brilliantly against the taught skin. “I never had stretch marks on my breasts when I went through puberty.”

“Well,” I say, with the intention of continuing a half-hearted explanation; there is nothing to say. I had been aware of the stretched skin along the inner side of my breasts since their inception into my life, but perhaps somehow had hoped that they would be removed along with the better portion of the tissue. They have not.

“They’re really the worst part,” she says, attempting to ease my opinion of the scarring.

Ironically, it is this that causes the revulsion now; that spurs a new obsession with hiding my chest. While I had been nervous yet eager to show family and friends initially, I no longer harbour any desire to display the results of the surgery, even to those who ask in curiosity.

The battle is never-ending.

---

At three weeks.

With the flash on, slightly from the side.

The left nipple.

The right nipple.

Day 16 post-op

20:00

After 48 hours of air and activity — as well as my slow acclimation to them — the incisions have, at a great relief to my peace of mind, improved slightly and even begun to flatten. Some of the swelling, I believe, is actually due to the dissolving sutures, which can be observed to lessen day by day. The end of the incision on the right remains raised and slightly pinched, and a small protrusion of clear thread can be seen from the tip; while the left, devoid of noticeable stitches, has relaxed and flattened. While still striking, the appearance is not as ghastly as it seemed upon first revelation.

The areolae, as well, have healed with increasingly considerable speed in these past days. Nearly all of the scabbing has fallen off; and though the nipples themselves remain numb to the touch, the tissue underneath appears to be regaining feeling. I have noticed a distinctly odd sensation of late, being that when I happen to drink cold liquids, in addition to the coolness felt as it travels down my throat, I am also acutely aware of the chill in my nipples. My only explanation would be that of the damaged nerves attempting to both recuperate and distinguish where on my body they actually are, given the large number of them now missing or rearranged. While not, perhaps, as strange the amputee who subsequently experienced his orgasm in his missing foot, it is nonetheless a fairly unexpected sensation.

There was a singular black stitch remaining at the top of the left areola this morning, with which I was not quite sure what to do; I resolved to leave it alone, and I find after the course of the day that it appears to have fallen out on its own.

The most obvious obstacle has been a constant fatigue. My range of motion is still rather limited; while only a dull soreness is felt throughout the day, I have discovered several activities that produce a sharp pain: including uncapping or capping pens, hanging my arm out the car window, hiccuping and the precise reaching angle of using the drive-up ATM. Arching my back, however, an impossible feat for the past two weeks, has been accomplished only in the past day with no pain at all.

A great deal, I realize now, of my initial reaction to the scars was the surrounding tissue — spotted with marks every few centimeters to estimate the location of a stitch and outlined with a muddled dirty substance, dark pink further accentuated by a contrast of colour. Following my shower tonight, during which I made attempt to scrub the area surrounding the incisions as much as sensitivity would allow, I find that it appears much cleaner and certainly less horrific.

My body itself, as well, is recovering. Partly, I am sure, due to the lack of food and extremely limited movement throughout the first days of the surgery, I found that I have lost a measure of muscle mass, and felt that I appeared rather sickly. This has not dissipated entirely, as I still feel slightly weak and nauseous as though I am coming out of a long-lasting flu.

The site this afternoon, prior to showering. Still a bit dirty, but the nipples are looking better.

After the shower. There seems to be a slight dye still on my skin from the protective yellowish film applied during surgery.

The left nipple.

The right nipple.

2 weeks post-op

23:40

Inspired by the midday heat, today I removed the binder halfway through my workday. I was surprised to find such a difference in tolerance within a day; aside from slight uneasiness due to an unshakable concern that someone might notice my breasts, it was an immediate relief in regards to temperature and brought only vague discomfort. After nearly 12 hours of activity without it, however, I find that I am extremely sore; particularly near my underarms at the edge of the incision, almost too sensitive to touch. Although today marks the end of my medically assigned binding period, I worry for both the pain and the exposure and may wear the binder during the night for some days more at least.

The removal of the surgical tape was also to take place today. I had peeled away a small portion from each incision at the front some days past, it having become saturated and, as well, for my own curiosity as to the appearance of the developing scar. Some slight scabbing was peeled away with the tape, leaving an evidently pink line from sternum to side. Having not been washed nor even touched since the surgery, the skin surrounding the incision was dirty and sticky. Although it is not recommended to wash the area, the crumpled skin was unsightly but did seem to improve after several minutes of patting with a warm washcloth. The edges both at the middle and at the underarms are distinctly raised and somewhat pinched, leaving me with concern of their healing ability; having a disposition of developing slightly keloidal scarring.

“It looks so…. real.”

My brother observes my chest with a touch of mirth for the first time this past Monday, eager to see how nearly $12,000 has transformed my body. “Is it worth it?”

“I can’t tell yet,” I say. My nipples dark and scabbed, my incisions obscured with tape, I have not yet seen the final result. Only after I emerge from the shower, expecting somewhere in my mind the femininity which has been ever reflected back to me, am I presented with the image that will redefine how I perceive my body.

I am horrified.

The lines cut in vivid angles beneath my breast, bunching in small areas where the muscle within tender tissue has been severed; not in a smooth semicircle as I had, for whatever reason, anticipated or hoped for. The incision surrounding my nipples seems to jump out in striking colour the more that I stare. As I acknowledge the fact that I have given everything I have to afford completely and utterly irrevocable plastic surgery, I cannot help the revulsion that I feel as I realize that the image in the mirror is not someone else’s body.

Perhaps it is the obvious masculinity that conjures this thought. While my body has changed dramatically in the past two years, the ever-present appendages, despite how I chose to perceive them, projected an undeniable female shape into my subconscious; and, perhaps, continued to fuel the childhood allusions that my body did not in fact belong to me. Without them, and with the crafted appearance of male, there is nothing to disprove possession of my body. I realize that I am seeing myself for the first time, and in realizing, I am unable to process what I have created. I can only stare as media coverage of Michael Jackson’s death cascades uncontrollably through my mind, projecting images of disfiguring plastic surgery to the result of an unrecognizable body. I don’t want to think about it. I don’t want to look. I put my shirt on.

Hours later, as I observe photos, I am struck with the impressive result. It does not feel as though the body in pictures is the one that I will see when I look into the mirror — they are, merely, as the countless other post-op photos I obsessed over for years in anticipation, never expecting to arrive at the other end.

I feel ruined.

Is it worth it? The question reverberates in my head as I attempt to disassociate my revulsion, forcing myself to look past the scars. Then it is worth it. The flatness when wearing nothing but a shirt is a sight so surreal I can hardly comprehend, and I cannot believe what luck I have had. But the horror that I cannot help but see when it is removed, when I tend to the areolae each morning, when I take a shower, when I undress is far too reminiscent of the childhood feelings of utter wrongness that took so much effort to overcome. I feel as though I am beginning my transition from scratch all over again.

I do not know how to cope. The overwhelming agony of being unhappy with the body that I so recently learned to accept, and indeed to enjoy looking at, is almost too much to comprehend. While the shock of the initial view has worn off, still I can hardly stand to look. I should have left the tape on.

The thought tortures me.

---

Today, 14 days post-op.

Also today, slightly different lighting.

From the side.

Day 12 post-op

19:00

I have felt very fatigued since arriving home; most of the previous days have been spent much as they were in the hotel: sitting or sleeping, and making the effort to move for only bathroom breaks and food. Before, with room service to clean and provide for me and thus most activity taking place at waist level with minimum effort, my incapabillity did not seem so obvious; I now find that returning to my lifestyle has presented several unanticipated difficulties.

My reach is limited to a 45º angle at best; the majority of dishes and pantry shelves require a tall stool to access. My mother has arranged a selection of cups and bowls on a countertop, which I anticipate on rotating through for another week at least. My bedroom being on the second floor, I have also found descending the staircase rather painful.

The tissue above and beside the areolae feels very bruised and slightly swollen, although the areolae themselves appear to be healing well. The left one is of some concern to me as nothing of the scabbing has shown the slightest sign of falling off, leading to an increasingly blackened and hardened appearance. However, the edges of the incision are pink and holding securely, so tissue death does not appear to be an issue. There has been a little bleeding around the nipple itself and the bottom edge of the incision on the right for the past few days, although it ceases quickly.

The tape covering the breast incision is becoming slightly saturated, and although its removal is recommended around two weeks, I am hesitant to do so as the incision itself is rather sensitive and I worry about the possibility of it opening during a high reach or quick arm movement, in particular given that tomorrow I return to work for the first time in a field that is quite physically demanding. While for the past few days I have hardly been able to stand to not wear the binder for the feeling of tension, exposure and tenderness, just today I find that it is becoming more tolerable to go without it.

Nonetheless, the overall healing process seems to be progressing with little obstacle. A natural stomach-sleeper, I have as of yet been unable to accommodate such a position as I am very aware of my skin stretching and of the weight on both the grafts and the bruised tissue, which causes a lot of discomfort. Sleeping on my side is both comfortable and painless, however; so it has become my position of choice.

The site this morning. Very little aesthetic change so far. The smudges here and there are tape residue from the nipple gauze, and there is some faint indentation from the binder.

From a different angle; not the best photo as my hands occupy half of it, but there can be observed some swelling above the areola in the upper left. The drain holes are beginning to close.

Day 9 post-op

8:00pm

At last, we arrive home from California.

The removal of the sutures was less painful than I had expected ; while I was aware of a slight sensation of pulling, the fact that the areolae are completely numb continues to surpass my conscious thought.

There has been a level of pain following their removal, mostly localized around the edge of the chest incision, which seems to be a target for irritation from clothing, the binder and general arm movements. While not unbearable, on occasion it has become a cripplingly sharp, yet quickly subsiding, stab at the attempt of rapid movement or the act of pulling; difficult this past night as maneuvering into a bunk on the train involved a small level of bodily lifting. There is also a bruise-like sensation throughout the general chest area, in particular directly between the incisions in the middle of the sternum where the skin is rather taught.

Today was my first shower in 9 days, which was a great relief. Showers are to be taken facing away from the water for the next few weeks, while as the incisions can become wet they cannot be hit with a direct stream. I encountered slight panic as I happened a glance downwards sometime during its duration and found the grafts covered with shampoo suds despite my efforts to shield them from any foreign substances; — this being their first contact with air for more than a 30-second period — but they appear to be fine and, in retrospect, soap was likely the best of a number of possible things with which they may have had contact. As I removed the gauze for the first time prior to showering, a moment of Dr. Brownstein’s session wherein he recounted the occurrence of someone pulling off their newly grafted nipple haunted the recesses of my consciousness, but they are secure and a slight wetting of the gauze allowed its removal with ease.

It was also to be observed that the somewhat revolting, bumpy and blackened skin is not severely bruised areolae, as I had originally assumed, but in fact merely a gigantic scab covering the entirety of the area. A small flap seems to have peeled away during the shower, revealing a very pink and healthy nipple beneath.

These pictures are graphic.

My chest prior to surgery.

The site prior to the removal of the sutures, one week post-op. The lighting is rather sickly as the hotel bathroom fixtures left something to be desired. The tape will remain on the incisions for another week. The small red dots are where the drains were sewn in, although the faint scar lines directly below them are from an infantile surgical procedure.

One week post-op, from the side. Definitely obvious that I spent the past week in bed in comparison with the pre-op photo.

Prior to showering today, after removing the nipple gauze. Most of the purple marker had worn off over the past few nights.

The left nipple today, a little squashed.

The right nipple today. This is rather nasty; but I was loath to peel away any of the scabbing for fear of bleeding or infection.

Day 7 post-op

09:20

Today Dr. Brownstein removes my sutures. It will be a great relief to be rid of the gauze and surgical binder, as its tendency to slip down has become an increasing annoyance in these past days.

I am now nearly fully mobile and able to raise my arms above my head; a small yet significant feat, considering some days past the farthest they could reach was horizontal with my shoulders. There is still a measure of pain down the side of my chest, from the underarm to the bottom of my ribs; particularly when the binder has slipped, as both the incision and the graft become partially exposed and are almost too sensitive to touch. A good deal of feeling has returned to the exterior of the areolar graft site, although directly along its incision is still devoid of sensation.

With the minimal bandaging I have, somewhat guiltily, found it quite easy to pull at the front to allow peeking. The nipples are hidden behind gauze and tape covers the incision lines, but I can clearly see the obvious flatness. Despite this and the fleeting glance on Friday, I am slightly nervous to see the end result this afternoon.