Surgical liberation

CN: discusses top surgery and associated body parts in some detail (with post-surgery photo), also trigger warning for references of child sexual abuse, trigger warning for anyone with emetophobia

Today was the big reveal, my post-op appointment 10 days after chest reconstruction surgery with Mr Kneeshaw at Castle Hill Hospital, near Hull. This has been such an emotional ride, and I feel the need to share some of the highs and lows. When I made the choice to have surgery, it felt more like a necessary evil than something I longed for, so I was completely unprepared for the joy I would feel when it finally happened.

I was never one of those people that hated their breasts. I was happy with one aspect of them for many years – being an inconsequential AA cup size meant nobody had ever ogled them, catcalled me because of them or even really noticed them. Then I got fat, and they grew (a little), and for a while I enjoyed the fleeting sensation of being womanly.

I was always at odds with my gender, wanting to be a woman or at least feeling I ought to work at being a woman, and finding it impossible to achieve in a way that felt authentic. This despite enormous effort on my part to feminise my voice, my clothes, my behaviour, my walk. So for a while, having (still fairly inconsequential) boobs felt like an accomplishment, but soon enough, they began to feel like an anachronism, a lie.

But even after starting to take testosterone, it took me a long while to consider having my chest surgically reconstructed. At first, I bound them with commercial chest binders, but these caused me pain, (curse my fibromyalgia), and were difficult for me to get into and out of. I could at this point wax lyrical about how little we talk about the health risks of chest binding. Eventually I passed my binders on (please consider sending your cast-offs to Morf) and I made my own binder, a much looser garment created from an old bra, with a flat panel sewn in at the front in place of the cups.

After the surgery, I had a ritual burning ceremony for this by now exceedingly manky piece of kit. It made me wonder about the (somewhat apocryphal) bra burners of the 1960s, and whether any of them were actually suffering from dysphoria.

Would I have felt more comfortable with my breasts if they had not been constantly associated with social gender labels like “ladies”, “she” and “ma’am”? Would I have felt my gender dysphoria more keenly had I not suffered from such extreme dissociation for much of my life that it’s hard for me to connect to my body at all? It’s impossible to say, because what we go through makes us who we are. But I had a lot to untangle to get here.

How abuse stopped me hearing my dysphoria

I have spent a lot of time lately diligently reflecting on the journey my breasts and I have taken together.

At times, I was grateful to my breasts, because when they grew, the abuse I suffered throughout my childhood stopped. I don’t want to get into the head of my abuser, but he left my two sisters alone, and treated me in many ways like a boy, so I have little sense that the abuse I suffered was specific to my birth anatomy rather than my gender presentation.

It’s hard to mention abuse in conjunction with being trans, but here’s the reality – AFAB or AMAB regardless, around 50% of us are sexually abused as children, a figure that’s much higher than for cis women. A potential reason for this is because as non-conforming children we are less valued, looked after, believed, and socially supported. Easier to isolate and prey upon.

Because of the negative way society thinks about trans people, it’s easy to internalise “did abuse make me trans?” and ignore the reality, that abuse can interfere with the clarity with which we understand our trans selves.

If anything, abuse blocked the intensity of feeling I had towards my body, and pushed me towards thinking of myself as a woman, which was far from a natural inclination. I also thought of myself as a woman because society equates sexual abuse with femaleness and erases the high levels of abuse in minority populations such as trans, queer, racially oppressed and disabled.

When I went through recovery, there were no books for sexual abuse survivors who weren’t women. It was as if being a woman was the only kind of oppression in existence. This forced me to think about my gender in a particular way that was ultimately unhelpful. I was urged to learn to “love my body” by an old-fashioned and puritanical feminist rhetoric that disallowed the possibility of making your body more comfortable to live in. I worked through the abuse, but in the process got tangled into some very simplistic messages about gender, that delayed me fully acknowledging my transness.

I realise now, I freed my body from the abuse I experienced as a child, but handed it over to the control of a particularly toxic kind of feminism (other, wonderful, intersectional feminisms are available). Suddenly my body was owned by, and politicised by, a clumsy kind of second wave feminism. And amidst all the other liberations, surgery has also cut me free of that trap.

Getting my body back

In the last year, as testosterone slowly made me happier with some parts of myself, I allowed myself to connect to my breasts and was shocked to discover the strength of feeling I had about them. I had thought the intense body dysphoria of other trans guys was altogether alien to me. Instead, I discovered it had been carefully and thoroughly suppressed. And as I let go, it was like discovering some hidden programme running in the background that’s hogging all your processing power – dysphoria is a truly disabling mental state, and when you unearth it, the relief and overwhelm is indescribable.

As surgery neared, I began to feel my fear of the anaesthetic’s impact on my fibromyalgia (and thanks to fibro pals especially womandrogyne, I took this warning card with me for the anaesthetist, which seems to have helped a whole lot). But there was another, growing feeling – excitement. Unambiguous, uncomplicated pleasure at the thought that I own my body and can shape it to be more comfortable for me to live in. My guilt, perpetuated by the mini-TERF that lives in my head, began to slip away. Perhaps, after all, a procedure that would allow me to connect to my body more and love and take care of myself and be happy is not so drastic. Not a mutilation, but an alteration, a sending to the menders of something that simply didn’t fit right no matter how hard I wriggled around in it.

The double incision procedure that I had is relatively simple. Two curved incisions, removal of tissue, nipple re-sizing and re-placing. You’re usually left with scars and loss of nipple sensation with this procedure. It’s an overnight stay. Under Dr Kneeshaw, you come home from the hospital with two drains concealed in fabric bags that the hospital lends you. I was given two very flowery bags, and a kind nurse offered to swap them for something more “manly”. Of course, I declined, but with gratitude for her sensitivity. For bigger folks the procedure’s technically trickier, sometimes revisions are needed.

I see a lot of overjoyed faces beaming through anaesthetic haze when my friends go through this. I wasn’t expecting to be one of them. But there I was, post-anaesthetic, lying in bed with a huge grin on my face. Even the projectile vomiting a couple of hours later didn’t completely wipe the smile away.

Pure joy. I thought it was perhaps some drug-induced high, but it hasn’t left me. A weight off my chest, indeed.

Transition hasn’t been easy for me. However much my story overlaps with that of trans men, it doesn’t quite compare and that has left me out on a non-binary limb. I don’t get the same civil rights as my partner. I’ve experienced job discrimination, and astonishingly bad behaviour from some members of the lesbian and gay communities. Testosterone has taken its sweet time to make changes and I’ve felt in limbo. I fell into a pretty bad pit of depression and got well and truly stuck there. And I was afraid that surgery and too much time to myself during recovery would only make things worse.

I simply had not anticipated the possibility of being happy about my new chest. But here it is, in all its rawness, freshly revealed; and it does make me feel incredibly happy – so happy that I’m sharing a picture of a bit of my body, not something I am used to doing.

It is curious the way I can connect to my body now in a way I never could, and this gives me hope for being able to care for myself better in the future, and potentially make health gains because of this. I feel not the slightest regret. Surgery was the necessary price of my wellbeing, and I’m confident that what I give back to the world can be greater now I no longer struggle under the burden of dysphoria.

I am unbelievably grateful to the NHS. It took time for me to realise I could not do without this op, that it was as necessary as any other procedure available in our increasingly beleaguered healthcare system. The nurses and doctors at Castle Hill are amazing. Mr Kneeshaw* is one of the kindest and most down to earth surgeons I’ve ever met; his results are good, and he’s not huffy about doing revisions if needed.

This procedure is life-changing and potentially life-saving, and I am simply overjoyed and full of gratitude.

PS – after the post-op, Robin and I treated ourselves to vegan rocky road brownies from Blondes in Cottingham – life really couldn’t get any better than this!*

*nobody is paying me for these endorsements

Testosterone Myths

I remember when I first realised my partner Robin might take T (testosterone) I was totally freaked out.

“You don’t need to act like any more of a man than you already do!” I whined, terrified that in changing his outsides to be more manly, I would lose from him some of the softer side of his already pretty blokey behaviours. “What if you get aggressive?” I pleaded. At one point I remember having a particular freak out and telling him I wouldn’t stick by him if he took that drug.

Oh, the shame.

And frankly, the unnecessary stress I put myself through because of a whole chunk of lies society tells us about testosterone. Now, a little more learned on the subject, I sigh inwardly when I watch a film and see the male protagonists’ adolescent, competitive bragging put down to “testosterone”.

T gets a really bad rap, and it also excuses a whole lot of crappy behaviour it isn’t responsible for.

So first, let me tell you what it’s like living with a trans guy who has been on T for a couple of years.

Right from the start: So much calmer. Yes, you heard me right.

Robin has always, like me, been a little high strung and occasionally temperamental, but since taking T he has calmed right down. I’d like to say he’s happier, but that’s complicated. Life hasn’t been easy, with two of us transitioning. But he is less temperamental than he used to be, he really has chilled out.

The only exception was a few months in, he seemed edgy and grumpy and out of sorts and I thought to myself oh, aye, is this the T finally showing its true colours?

Turns out his T levels had dropped really, really low. A quick boost and he was right as rain again.

A year and a bit after Robin started on T, and a bit more than a year ago, I followed suit, and have experienced similar. I wouldn’t say I am calmer, exactly – I used to bite down my anger way too much, and these days I’m more likely to express it, to say “back  off” to someone who’s out of order rather than patiently explain myself ad nauseum. I don’t think it’s the T making me like that, it could be a growing sense of male entitlement or simply confidence as I feel more me. I’m less of a pushover, and I think that’s probably a good thing, although I have some way to go on that. One thing’s for sure, there have been no uncontrolled, T fuelled rages, no noticeable changes in my personality or who I fundamentally am. Maybe I am a bit more centred and growing into myself, but the changes are subtle.

And honestly, throughout life people change anyway, with or without hormones.

Of course, not all guys report this calmness, but most of the ones I know do. I worry about T’s bad rap, though, because just like it falsely legitimises crap behaviour in cis guys, so it can in trans guys who probably need to get counselling or anger management or do some anti-sexism work rather than blaming their shitty attitudes or bad behaviour on T. When Chaz Bono complained he was finding women’s voices more irritating, for instance, he blamed his “increasing maleness”, when a more likely culprit could be sensitivity to sound, a sensory problem common in trans people and exacerbated by stress. That or he’s just plain sexist.

And then there’s the sex drive thing. Yes, it does increase, and some guys don’t quite know what to do with that. Again, male mythology plays a part in this, as trans guys think they’ve developed a “male” sexuality with all the narrative baggage that comes with that. Having not (in some cases) enjoyed puberty first time round, they may have missed that burgeoning sexuality in their teen years, and think this is something exclusive to men (it isn’t).

Often, we’re just not quite ready to share this emerging sexuality with partners, we need to explore it on our own, along with a changing relationship with our bodies. It settles down, but my gosh we have such a dim view of men and their control over their own sex drive (poor helpless babies, my ass) that it can be almost frightening to feel like your body has been “taken over” by this drive. The mythology is at least as powerful as the increase in libido, and takes a bit of coming to terms with.

There is nothing exceptional about a male sex drive, and men’s sexual violence and objectifying behaviour has everything to do with rape culture, with notions of power and dominance, and nothing to do with testosterone or body parts. Studies show social and environmental, rather than biological, causes for human violence, including male violence. Meanwhile, guess what? Sex drives, violence, masculine traits and everything else are on a continuum, there are no binaries.

So, guys and enbys taking masculinising hormones: No excuses. it isn’t your hormones, it’s your socialisation, your trauma, your unchecked privilege, your sexism, your unsifted baggage. Roid rage happens to guys down the gym because they’re not being carefully, medically dosed and hormonal fluctuations indeed can cause problems, as can taking testosterone when you already have enough of it. Messing around with artificial hormones, taking them off prescription is not to be recommended, but if you’re transgender, and your brain maps onto a different hormone than the one running through your veins, T just might help (and it might not, and you can stop taking it if it doesn’t).