My Journey Pursuing Gender-Affirming Care (so far)

CW: transphobia, fatphobia, disordered eating, bullying, self harm, substance addiction.

Anyone who’s been following me on social media knows about my many years-long struggle to get my top surgery/chest masculinization operation done. Four consultations across multiple states (Indiana, Florida, Oregon), multiple different surgeons… and now, December 20th, I have my official new surgery date! It’s been a heck of a journey, so let’s start from the beginning:

I’ve known that I’m not a girl ever since high school back around 2012. It was when I met an out trans woman for the first time and learned the term ‘genderqueer’. I was attending youth groups in Indiana for fellow LGBTQ+ teens to meet members of my local community (huge thanks to IYG). I started to play with they/them pronouns and other GNC (gender non-conforming) culture. This brought immediate comfort that I never thought I could feel, and I wanted to keep exploring it. My fellow queer peers immediately accepted me, and the adults at IYG were also supportive of me exploring these parts of my identity… But outside of IYG was a very different story.

I was frequently bullied and harassed growing up. This started back in the 3rd grade and continued up until I graduated high school. Whether it was my alternative/punk fashion, my interest in anime and cosplay, practicing Paganism, my weight, my large breasts… and, the worst target of all: my queerness, both orientation and gender. The bullying was horrendous, whether it was physical or psychological. I had a tight-knit group of friends, but since I was chronically ill and at home a lot due to undiagnosed disabilities, I often felt disconnected from these friends. I struggled to do or be anything for MYSELF as I was desperate to keep hold of whatever connections I managed to make…

When I finally decided to come out as trans, I decided to tell my dad first. I was living with him at the time and figured that he was a trusted adult. While he demanded that I stayed in the closet around my family, he had expressed support when I previously came out as bisexual. I’d hoped he would also be supportive of this as well; and while he didn’t disown me (yet) or become aggressive on the matter, that prior support was lacking. I asked him to sit down on his bed as I paced around his room and struggled to find the words.

“Dad… I don’t think I’m a girl. I don’t think this is the body I want to have, I want to be more like a boy…”

He sat in silence before giving a sigh that I couldn’t read.

“Are you sure that maybe losing a bit of weight would help you feel better?”

My weight was always a topic for bullying and harassment. My parents and I are all stockier folks, like the build you see at the Scottish highland games. Tall, fat, and broad. I had been raised to love these things about myself, to appreciate my squish and blubber- especially in the rural midwestern winters. But in that moment, I felt all of my dad’s prior praise of my build just melted away… suddenly, my weight was a problem, not a celebrated feature. And as always, my dad thought he knew more about myself than I did. He refused to take me to therapy, claiming I didn’t actually need it. He blamed President Obama and ObamaCare for making health insurance impossible to get,meaning that our medical needs were always ignored. No doctors appointments, no ER trips… and it was clear that he wouldn’t make exceptions to get me gender affirming care. Not that I was asking for medical support, I was too old for puberty blockers and also too young to start HRT, I just wanted my dad’s support.

But, as usual, that support for my authentic self was lacking. So, I ignored the feelings and urges for years. I developed eating disorders and explored self harm as a way to have control over my body. I continued to use substances to try and numb the mental and physical pain I experienced every day.

Later in high school I did eventually come out to my mother, who I was living with at the time. When I’d come out as queer, she had come out to me in return- we were both queer. That was mind-blowing for me, but also strengthened the bond that we had. She had always been nothing but supportive towards me in regards to sexuality, aspirations, spirituality, interests, etc. And, unlike my dad, she never forced or even suggested that I should remain in any closets if I felt inclined to come out. She was truly supportive, and that continued into my gender identity journey.

“Mom? … I think I’m transgender. Like, a trans man.”

She sat in shock for a moment, but I could read her look. The gears were turning, she was in thought.

“Okay. So like… Laverne Cox, but in the other direction?”

The relief that washed over me. Even with her limited exposure to the topic of being transgender, she at least had a positive reference.

“Yes. Exactly!”

“Alright. What can I do to help you?”

I almost cried when my mama asked me that. She and I have always had a complicated relationship, but the love was never lacking. She couldn’t afford to get me a binder, but she could take me to get a cheap haircut and to get men’s clothes from the thrift store. I remember her walking around the men’s section with me, offering up patterns that she thought I’d like. She asked a lot of questions and she listened to what I said in return. Even if she didn’t know how to help or didn’t have the money to do what I needed, she always did what she could. Once I was old enough, my mom even helped me find an office near us with a doctor who would actually help me transition (even though it didn’t end up working out). She took me to appointments, helped me get the paperwork, and supported me when I left Indiana to live in Florida for a few years. (At the time, Florida was the upgrade. Wow how times have changed).

The reason I chose Florida was because my then long-distance partner, now wife, was living there at the time with her family. My wife has always been one of my biggest cheerleaders, no matter what I’ve chosen for myself. We’ve had our ups and downs, but supporting one another has been a constant through our highs and lows. Her family, on the other hand, was another story. While most of her family accepted me as a trans man, some members of her family were vehemently against it… With that, and with how family outside of my mother handled my transition, I felt it safer to claw my way back into the closet.

I began using she/they pronouns again, I pushed myself to by hyper-feminine to not raise any suspicion of not Being A Woman. That act alone brought so much peace amongst my family and my wife’s family, but it ate me alive inside for years. I forced vanity onto myself because it was the only way I could handle being in the body that I was in… A fake it til you make it sorta thing.

Sometimes I sit and wonder how far along in my transition I would be if I hadn’t gone back into the closet / socially detransitioned as I had. I’ll use the word ‘detransition’ with myself and feel fear that I was, in some way, proving the points made by transphobic groups… but I think, if anything, I proved just how important that support was. When I wasn’t supported, I couldn’t safely be my true self.

Years later, when my wife and I first agreed that we wished to pursue marriage, I knew I couldn’t keep swallowing my teeth about this. I couldn’t continue to live as an empty shell, a feminine husk that felt more like a prison than a body. My wife, of course, was supportive of this and whatever it would mean for me- for us. To this day I’m endlessly appreciative of her unending support and care.

My mother had passed away by this time, but I know she would have also been supportive of the choice.

My father was supportive this time around. He was adamant that he had always been supportive and accepting, claiming to have no memory of the talk I previously mentioned in this post… I let him have his skewed view on the past, I was just relieved to have him in my corner about all of this.

I came out to a fair few of my wife’s family, most of them were accepting this time around. But the family member that had previously pitched a fit over it was upset once again, but my wife was already working on distancing herself from them for other reasons. This time, we weren’t letting anything stop us from this.

2019 was the year that I was finally able to get into a medical clinic that was serious about helping me transition. A medical clinic in Ybor had doctors from the LGBQ+ community that specialized with helping queer folks. After MANY conversations with my then therapist and psychiatrist, we finally got all of the needed forms and letters to get me on T (testosterone) injections. It was so exciting and thrilling, I could finally start HRT after years of waiting!

I was on T injections for a couple of years, and I was working with a local hospital to try and get myself set up for top surgery. I connected with trans men in the area who had gotten their surgeries and asked for connections.

The first surgeon I saw was a genuinely sweet woman, but she didn’t seem to fully understand what made FTM top surgery different from your run-of-the-mill double mastectomy. Also, I didn’t have medical insurance, so I’d be having to pay out of pocket for everything. During my pre-op (pre-operation) appointments and blood labs, she found that some of my blood levels were concerningly high… but she didn’t know why. No one did, not for years. So my surgery was canceled due to her not being sure how safe it would be.

Then it came to 2020–21. COVID was, and still is, a high concern. As a disabled asthmatic myself, I’ve needed to be extra careful. But I still was determined to get my top surgery. I found a doctor down in Miami who was relatively popular on social media for giving FTM folks their needed gender affirming operations… It was a long-shot, but I signed up to potentially be seen by her. After a tele-health video call consultation, she said that she would definitely be willing to see me and give me my top surgery. I was over the moon! I started to crowdfund to be able to afford the operation, my support circles helped raise so much money, and my wife offered to help pay for the other chunk… we were figuring it out, the surgery was going to happen.

Until Florida became too dangerous for us to stay in.

Florida had been getting progressively worse over the years for us, a polycule of queer and mostly trans folks. The cost of living, the weather, the politics, the work environments- we all needed a change, we all needed to get out of Florida. So my wife, the highest earner in the house, began the journey of applying for jobs in states that would be safer for us than FL. After months of searching and applying, we were approved to move to Oregon! Ever since my former Twi-hard days back in junior high, I’ve always wanted to visit the Pacific Northwest, so I was particularly excited. But there was a catch…

The cost to fly from Oregon to Miami, FL and back for the surgery would be far more expensive than we could manage. I couldn’t fly there and back alone, and I’d either need a hotel room or to stay with my dad in his new house… which, for a list of reasons, I didn’t want to do. And then I also started to learn about people who had gotten operations through this particular doctor and had horror stories about this surgeon. Apparently she wasn’t good at post-op communication and upkeep, leading to transmasc (trans masculine) folks to need additional surgeries and emergency medical care to not die by infections, poor draining, and other concerns. With all of these things together, we decided that it was safer to cancel the surgery and find someone in Oregon. Especially since my wife and I could share her new insurance!

When the surgery funds were refunded, we ended up using the money for fleeing Florida and other living costs- including my HRT and other psychiatric medication. Also, due to feeling guilty for the money not going towards a surgery, I ended up going around and donating money to other trans-led crowdfunding to help others get the care that they need as well. It was a rough time, but we were gonna make it.

Two states, multiple clinics- nothing had worked out yet. But surely Oregon would work out better than Indiana or Florida. And since my wife’s work gave her insurance, that meant that I had health insurance for the first time in years.

But before we could even look into top surgery, I had to figure out getting someone to prescribe me T in Oregon. My Florida connections wouldn’t be able to approve me for meds out of state, so I needed to hurry and find a new medical provider who could approve hormones. I also needed to find a therapist who worked with the LGBTQ+ community so I could have someone to approve the mental health side of things. I was very blessed to be able to find myself a nonbinary therapist who I’ve now been working with for years, but finding a therapist is often a bit of an exhausting endeavor.

The hardest part was finding a doctor for HRT. The process took so long and we were so unprepared for it, that I ended up having to stop my T injections for a while- long enough that my period returned back with a vengeance. All of this tied together with active family tensions, I ended up going a bit more hyper-feminine again in my presentation as a safety net. I didn’t go back into the closet to the same extent, but having HRT taken away from me by the medical bureaucracy of it all definitely caused a regression in my mental health.

But, a good thing that came from it all: my blood levels went back to normal. After I finally found a doctor who would help me with HRT, we found out that I had previously been on a ridiculously high dose of T during my first few years of injections. So, while mentally it was rough, it ended up being beneficial for my blood levels and getting things back to order.

Side-note: please don’t ask what was high, there were so many forms and so many acronyms that I had never heard of before. I could ask my doctor, but I don’t feel it important right now since I’m back in healthier ranges… as long as I stay hydrated, heh. Keep yourselves hydrated! Dehydration is rough on the body in many ways, as I’ve learned.

I worked with my doctor to get me back onto HRT, focusing on testosterone gel that I rub on my arm every day. While my period hasn’t fully gone away again, I’m still noticing transitional changes that help me feel like I’m physically getting closer to where I want to be.

So, we had HRT figured out again, I got my therapist, I had a physician, I was living with a group of people who genuinely support my transition. It was time to, once again, start the journey towards getting top surgery.

My doctor recommended a surgeon in town, he had even done a friend of mine’s top surgery as well. He seemed knowledgeable on the operation and understanding of general trans experiences in regards to these surgeries. I had to wait a few months to get a consultation appointment with him, and those months were grueling. I kept counting down to the consultation, telling myself that it was almost time. I’d get an exact date, the uncertainty could be quelled.

The consultation with him went very well. It was my 3rd consultation, so I had a general idea of what to expect. And we got a date scheduled: November 17th. It would be another few months of waiting, but we had an exact date!

A lot happened during those months. I was crowned Mr. Queervallis Pride 2023, I won my first drag pageant, I began releasing podcast episodes again, I started joining other people’s projects to keep myself busy (and to try and make a lil’ extra money)… I was doing a lot.

I also got a full-time job as a social worker for my local community, but then ended up being let go from that job after a couple of months. This happened when I called out transphobia and other harmful behavior in the workplace. Apparently, according to their employee handbook, using words like ‘transphobic’ and ‘bigoted’ were harassment and slander. They also did not appreciate us communicating with other co-workers about workplace complaints and began to implement some union-busting type behavior. It was a gut-punch, but I learned a lot about myself during my time at that job… but I think all of that is best to have its own blog post- someday, for sure.

About that time, fear and dread really began to settle in. I had a date, but my surgeries had been canceled on such short notice before… I feared that it would happen again. I had many talks with loved ones (and therapist) that I had this gut feeling that it wouldn’t happen. A voice of anxiety in my head told me to prepare for this not working out… but as the date got closer, as pre-op appointments went smoothly, as pre-op phone calls were happening regularly to tell me how to prepare, and as the clock & calendar told me that my top surgery was less than 24 hours away, I finally allowed myself to be excited and hopeful. It was finally going to happen.

“Third time’s the charm!” I often joked.

The day before my operation, I was waiting for my final pre-op phone call from the clinic. They would give me the exact timeline of the operation, would let me know when and where to show up, and would make 1000% sure that insurance was all squared away… but when I finally got that phone call, it was not what I was expecting.

“Hello, is this Casper?”

“This is him, yes!”

“This is the manager of the clinic, I’m calling to let you know that unfortunately, your surgeon will be out of the office tomorrow due to unforeseen circumstances and will not be able to perform your operation.”

I went into full shock. My blood ran cold. I literally couldn’t say anything other than one single word.

“Okay.”

“We’re so sorry. We’ll get back to you in the next few days about rescheduling it.”

“Okay.”

“Again, I am so sorry… have a good rest of your day, Casper.”

“Okay…”

I then began to sob as soon as I hung up. I screamed and threw my phone at a pile of towels. I knew it, I knew it. It was all going too well, too smoothly. Something was bound to fall through.

Those next few days were genuinely a blurr. I was in shock, I was depressed, and I felt so utterly powerless. My partners and I all tried over and over to get in touch with the clinic, to get any shred of information about the situation…

All that we were told was that the surgeons (the one I was supposed to see as well as the other surgeon who offered top surgery at the clinic) were both no longer working with the clinic. Because of that, my surgery went from ‘rescheduled’ to ‘canceled’. It took online sleuthing and members of the community passing along information for us to learn that the clinic had, as a financial choice, let go of both surgeons to replace them with newer (and less expensive) surgeons. This choice, likely from the owners of the clinic, left every single patient suddenly without their care.

My wife was a damn saint and took up the work of finding another surgeon covered by our insurance who could see us before the end of the year. She had used her PTO to take off 3 weeks from work for my recovery time, we had planned everything around my operation being in mid November. She spent many days placing phone calls around, passing along information for me to follow up on, and offered many different options to help keep us moving forward.

I struggled to pull myself out of the rut, I had all but given up on ever getting my surgery. I stumbled back into some old vices for a bit, I became so bitter and angry at the world and all of the systems in place that hold people back, cis or trans, from getting the medical care that they need. I was so infuriated that we had done everything right, only to have it ripped away from us due to the owner of the clinic wanting to pay their staff less.

“I’m never betting on 3rd time’s the charm ever again.”

After a while of us making call after call to get something in place, we found another surgeon. It would be a bit of a drive to the clinic, but it was someone who was willing to get us in for a consultation within the next week.

We drove to the clinic and met the surgeon, she definitely had the best energy of all of the surgeons I’ve met on this journey. Truly passionate about gender affirming care, empathetic towards our hardships up to this point, and very accepting of us as queer people. She could even get a surgery on the books before the end of the year! We were so elated!

Then another gut punch: this clinic didn’t accept insurance. Heck, that happens a lot in the world of cosmetic medical care… but we were confused as to why this clinic was listed by our insurance in the first place.

Whatever the reasoning was, we had two options:

We pay $11k+ dollars out of pocket, or we find another surgeon and wait for another consultation. Most offices we had called beforehand had given us estimated dates out in February or later.

As a polycule, we decided to ask about scheduling a surgery date and to pay out-of-pocket if it was before the end of the year.

December 20th. Little over a week before my birthday!

As of learning this yesterday, we’ve been hard at work to make this possible. Crowdfunding has started again, I’ve been applying for medical credit help and any gender-affirming care grant that I can find. So far, I haven’t been approved for any help from those, but I was able to get a credit card from my bank so I can use that to help pay for the operation. My polycule and I all sat down for a house meeting to make plans on handling finances and for my post-op recovery time.

And now, here we are. I have another pre-op appointment on the books, I’ll go in for my fourth round of blood lab work, and then I’ll finally get this surgery. I’m finally taking control of my body in the way that I want it.

There has been a lot of processing rage. Trans rage, feminine rage, disabled rage, poor rage… so many Very Big Feelings to work through.

No one else can say “maybe it’s for the best that things have worked out like this”, but I can make the most of the situation at hand… or I can give up. Thankfully, ‘giving up’ ain’t in my list of options.

I’ll give more transition updates here, likely after my top surgery. But I felt compelled to share my story of how I got here and how many years I’ve been fighting for this.

If you read this far: thank you so, so much. I appreciate you taking the time to hear my story and to listen to my perspective.

Have a wonderful day, hydrate or die-drate, happy holidays, and all that jazz.