It doesn’t matter if you are female to male or male to female, everyone who has ever transitioned has their list of doctors they would recommend, doctors you should stay away from, and hours upon hours of well-meant advice about being transgender and/or becoming your authentic self. I didn’t know this until after I’d begun my journey. Hell, the words “top surgery” weren’t even in my vocabulary before I’d made up my mind to start the transition process. It seems that the more I learned the less I knew what to expect. No supper-time table talk when I was a kid could have prepared me for any of the decisions I would need to make as I moved step-by-step along my self-determined path.
You see…growing up on a farm near towns where the number of cattle and pigs far outweighed the human population gave one little exposure to much more than discussion about weather, crop yields, and baseball. Culture was relatively non-existent. There were no people of color and no known homosexuals. If anyone had even heard of the LGBTQ community or activism, they certainly weren’t forthcoming with their knowledge. From where I sat, it was clear that in high school girls took home economics class and the boys took shop class. Narrow-mindedness was the norm. It was okay – funny even to some – to call someone a faggot or a queer if you were just ribbing them in fun. It was a community where no one ever talked about being gay. Cross-dressers were only on television for entertainment, the AIDS crisis had not yet hit the news; and any expertise on the subject of transsexuals was riddled with ignorance, repulsion, and the general understanding that they were clearly freaks. I don’t remember ever hearing the word transgender. I don’t think the word existed yet.
I knew I wasn’t like anyone else that I knew. But, I got by. Ever vigilant that I could find some sameness, for years I covered my eyes and ears and made my way. We moved to the house where I would live my middle school and high school years early in the summer before I was to start the fifth grade. It was a two-story farm house set in the middle of a large yard. Windows in every room could be opened to catch the strong cross breeze that substituted for mechanical air conditioning. There was a table in the kitchen large enough for the entire family to eat supper together, although dad and mom usually ate in the living room while they watched the news. Garages and machine sheds, a corn crib, and the hay barn were opportunities for play and exploration. There was a large, deep puddle after heavy rains that created a frog farm near the gate to the field; and watching the tiny frogs jump in and out of the water was one of my favorite rainy-day activities.
On dry days when the wind was blowing just right, a cloud of dust preceded every truck and tractor that passed the farm and left a hazy veiled grey reminder of where we were. It was impossible to travel in secret on a gravel road. It wasn’t unusual to sit in wait for expected travelers – dad coming home from work, the school bus, or the mailman. When the sun beat down during the hottest hours of the day, the best shade could be found under an umbrella-shaped tree by the driveway. The grass there was perfectly soft enough to lie on. It was there where I would often read or draw, and from there it was impossible to miss the mailman’s afternoon delivery. Though we never spoke, through him I was able to stay connected to everything I’d been forced to give up when we’d moved from the city. I knew how long it took for the mail to travel from the city to my hand and would wait for the familiar sound of the blue-gray station wagon to emerge from its dusty cloak to bring a letter my way.
I could count on one hand the number of people with whom I corresponded, and for years they were my connection to the outside world. I’d known all of them before we’d left our home on the edge of Cedar Rapids for life that some days seemed to be only ever so slightly more civilized than the Ingalls family on Little House on the Prairie. Sometimes our letters would be short and to the point. Often we wrote so much that we had to force the folded note paper into the envelope and tape it shut for fear that no amount of licking would hold the flap closed. For a bunch of pre-teens we certainly had much to say!
Despite writing late into the night so I could be sure to leave a letter in the mailbox before jumping on the school bus, not much of what I wrote really mattered. I gave them what I thought they wanted to hear. We wrote about their boyfriends, about what I imagined most teens would have written – school, music, and what it would be like to hang out again when summer came. We all signed our letters with “best friends forever” but we never really knew each other at all. They never knew me. It was all good, though. There were things better left unsaid at the time – easier left unsaid.
Looking back, I can’t even imagine how the conversation would have gone if I’d told anyone what I believed to be true – that something was not right. To speak with them about the fact that they were wrong about who they thought I was; and that so little about me genuinely fit, was an exchange that I held was better left off the table. I told myself then that someday all would be different. I repeated this pledge to myself many times over many years. I repeated this promise to myself until hearing it wasn’t enough anymore and I needed to do something.
When I decided it was finally time for me to transition, I sat down to my laptop and typed in google.com. It was time to find out what I had to do to get a mastectomy. I was 53 years old and had never wanted female breasts and it was time for them to go. I knew without a doubt that if I had a chest that looked more male, I would be able to spend the rest of my life feeling more masculine. A mastectomy was exactly what I needed. That was my plan and I was ready to put it into action.
Since I lived in St. Louis I figured it made the most sense to start there. With all of the award-winning medical facilities in the area, I was certain I’d find a plastic surgeon that could perform the surgery and I could finally move forward. I quickly lost count of the hours spent on the internet. Any time I had a few spare minutes, I was searching. But, between my computer, iPad, and iPhone I wasn’t making a whole lot of progress. I had only managed to learn who I didn’t want to call. And, I discovered that my answer was not to be found locally. After countless attempts to convince myself that one of the surgeons would be “just fine” I knew I had to expand my search.
A statewide search proved better results. It didn’t take long for a particular surgeon in Kansas City to catch my eye. Stellar patient reviews and the expressed support of the doctor and her staff made the choice easy. In between work stops, I pulled my Jeep to the side of the road and made the call. Protocol was to first speak with the nurse to explain your case and set a plan in motion.
I had never seriously discussed the plan to transition with anyone before. I didn’t know what to expect once I got someone on the line. After a few quick questions, the nurse informed me that for my insurance to cover any part of the surgery, I would have to get them a letter from a doctor or therapist. She was surprised to learn that not only did I not have the required letter, I hadn’t yet spoken to any medical/health professionals regarding the surgery. I figured if you want a surgery you call the surgeon. It seemed pretty simple to me. As it turned out, there would be so much more to it.