Thoughts on M-to-F Gender Confirmation Surgery

Laura Ann Charlot has authored another guest post for T-Central.  Laura-Ann is a member of my local transgender group, the River City Gems; a group with membership numbering into the hundreds.  This girl writes so well.  I've suggested to her more than once that she establish her own blog.  I'm still waiting!

In this post, Laura Ann shares her thoughts with a friend (and us) on male-to-female gender confirmation surgery. 

Over the last couple of days, I have been in an email conversation with a trans friend of mine, who is currently living part-time, but who has given some thought to Transition. We were discussing gender re-assignment surgery, and she wrote the following to me: "...some days I think that having breasts and a vagina might help things make more sense, but often those are just fleeting thoughts in terms of basic plumbing and how I feel about myself."

Her words forced me to take a closer look at myself, and I responded to her with the following thoughts (I have changed her name to protect her privacy).

"Marcie, if you ever do decide to Transition, or you even start seriously thinking that you might be headed that way, I would like you to consider this, my own thoughts on gender re-assignment surgery:

Basic Fact #1 - a person's gender identity lives between their ears, and not between their legs. If this wasn't in fact true, gender dysphoria wouldn't exist, and we would all be perfectly happy to live in our assigned-at-birth gender. Getting a vaginoplasty, FFS, and a breast augmentation won't "make you a woman". You already are a (trans)woman, or you wouldn't even be thinking about these surgeries.

When I look at myself in a mirror, I see the same face that has been staring back at me for 61 years, but there's a difference: For almost all of that time, I hated, absolutely HATED, to look in mirrors. I was never very happy with the boy name that my parents had given me (I had known from age 4 that I thought of myself as Laura). I had self-esteem that was so low, it would have been negative if there could be such a thing. Now, two years after my Transition, nothing has changed in that image in the mirror, except that my hair is a little longer, I wear earrings, and my face is even fatter than it already was thanks to the HRT (I've GOT to lose some weight!). I haven't had any surgeries. But, when I look in the mirror, I see Laura-Ann! She smiles back at me, and she's a very happy girl. I am Laura-Ann because I just know that I am. I will probably get a vaginoplasty, if I can ever shed enough tonnage to get under the upper weight/BMI limit that my health care provider requires, or I might just get an orchiectomy: less invasive and less painful than a vaginoplasty, and it gets rid of the testes and the testosterone just as completely and effectively.

As for breast augmentation: I quit wearing breast forms about a month ago. The forms were starting to bother me on an emotional level, and I think they were actually causing more gender dysphoria than they were curing. I have very small breasts, they're not even an "A" cup size, but I do have them. They are real, and the forms are not. Breast forms are primarily a prosthesis, designed to help breast cancer victims who have had a mastectomy recover emotionally from that devastating disease. Breast forms are also used by both cis and trans women to enhance their femininity and appearance. But thinking about that, I have to face the plain fact that I am 61 years old, 6'-2" tall, 300 pounds, with a baritone voice that isn't going to "get feminine" no matter how much estrogen I take. Even with GCS and a breast augmentation, I will never really look like a born female. I'll never be "passable". I'm way too old to get any substantial benefit from FFS, so I am not even remotely considering that surgery. I'll always look much more like a retired NFL linebacker gone to seed than I'll ever look like a born-woman. Breast forms, or a breast augmentation, aren't going to change that. Either way, silicone enhancement is fake, and at my age, I think I need to "get real" if I am ever going to find my place as Laura-Ann in this world. So, as it stands now, I am more leaning away from a breast augmentation than I'm leaning toward it.

But those are just my own feelings, my own perceptions of myself. Your perception of yourself is bound to be different. Maybe you will be absolutely certain that these surgeries will help you feel better about yourself, if the time ever comes that you officially transition. Your therapist will help you figure all of that out. But don't rush into anything. Transition is a process; and it might be a decision you arrive at after long, slow deliberations, or it might follow a gender-identity crisis that hits you in a single instant of time, as it did to me, but the actualization of that transition will take several months to gather momentum, and several years to complete. Gender re-assignment surgery (vaginoplasty), Face Feminization surgery, and breast augmentation are all major surgeries, and the first two are irreversible. There are very solid reasons behind the insistence in the WPATH Standards of Care that a patient must have completed at least a full year of HRT before even getting put on a schedule for vaginoplasty, FFS, or BA. The process will seem agonizingly slow as you crawl along from one waypoint on the journey of your transition to the next - the pace of the removal of your facial hair by electrolysis will make you wonder if there is enough time left before the Sun burns out and hell freezes over to complete it - but you will eventually get there. You will have at least a couple of years from the day you take your first dose of HRT to to think over what your expectations, needs, and desires are regarding transition surgeries.

To summarize: you are Marcie as you stand right now, no matter what clothes you are wearing, in makeup and a wig or not, and despite the guy name and "M" on your driver's licence and Birth Certificate. If getting dressed and made up to go out to a social event en femme brings you happiness and a sense of peace and self-acceptance that is greater than what it was before you put on the dress, the makeup, and the wig, then what more do I have to say? You already know that you are Marcie even without having had gender re-assignment surgery, FFS, or a breast augmentation. I have a hunch that if I ever do get a vaginoplasty myself, it is going to turn out to be anti-climactic. It probably won't make me feel one bit more like Laura-Ann than I do right now. It might make me feel more comfortable in form-fitting clothes like bathing suits, and it will force me to pee sitting down, and it'll be easier to get through the body scanners at TSA airport checkpoints. But it won't make me any more "Laura-Ann" in my own mind, where the essence of who I am resides, than I already am."