Experiences of trans and gender diverse young people

I asked questions in my consultations, I asked people in Facebook groups that I knew had had surgeries from also the same clinic or at least in the UK. I researched things on pages like Reddit and stuff like again mostly blogs, YouTube channels by UK residents talking about top surgery and different options for top surgeries. And again, very little of that information was kind of like official health sector NHS kind of information. I think I was given one kind of like pamphlet kind of thing that was going through the different surgery options like a little brochure that also covered like hormone replacement therapy and trans feminising surgeries. It was just a little section and that talked about I think two or three different kind of top surgeries for trans men. That were like two or three pages and that was like the most official document that I think I referred to. But mostly I was looking at people’s experiences, personal experiences.

I’ve been very sure about this for a very long time, as it being something I want. But that again that doesn’t mean that those doubts aren’t there occasionally. Not particularly often, I don’t find in this, certainly a lot less than in sort of my back and forths with testosterone and the impacts of that. But again I think I’ve got to a point now where I’m like well, it’s, it’s okay to be nervous about it. It’s okay to be worried about it, it’s a big change to make to your body. It, you know it’s, it just is. It’s a big thing as you know as certain you are that that’s the way you want to look, or you don’t. It, you, it’s a big thing to do and therefore it’s okay to be nervous. And it’s okay to have doubts around that.

So it’s Metoidioplasty and they, so there are two main options for lower surgery which is Meta or Phalo and Meta they, it’s essentially they use what’s already there and they sort of untether the clitoris and make it longer but they don’t really add anything so with phalo they take a skin graft and sort of construct a penis, with this they sort of alter what’s already there, they can use a small graft from inside your mouth to re-route your ultretha so that you can pee standing up they then do a hysterectomy and a ovariectomy so they can remove your ovaries and like everything. And they can do sort of they can implant like silicon or so it appears sort of more cis passing but I think yeah there’s some really good videos out there that sort of detail what the procedure is without being super graphic.

So I had my two assessments at the GIC at the end of the second one, I guess I was, it was clear that top surgery was going to be a part of my treatment plan going forward. And I, yeah, I was given a list of surgeons, to go away and think about and do some research on. And then to email back in when I’d made a decision. Again, it, I mentioned it earlier, but I think that’s where I’ve really noticed the, the lack of available information and I don’t feel like I’ve made a particularly informed decision. I’ve, the information I was given at the time was these are the surgeons, these are where they are, these are the sort of waiting lists for each of them. So then it was about me going off and sort of looking up what different methods they used, what their results were like, what people, other people’s experiences were with them. And that information I actually found quite hard to find. I thought I’d kind of be swamped with a lot of people talking about it, in different forums and on social media platforms and stuff like that. But actually, I couldn’t find, I couldn’t find that much information. I didn’t think in the end I made a decision partly through because I, and I think I ended up, you know once, once I had realised that I, that I was, that I didn’t have access to enough information to make a properly informed decision on it, I just kind of went with it.

I was like, okay well, this person is based geographically closest to where I am. That’s going to have a huge impact on my aftercare and recovery and stuff like that, in terms of you know getting days off work to go to appointments, and all these different, you know who’s going to be around to look after me when I, you know when I’m going to need some help straight afterwards. Cos I guess I’m split, like you know I’m based and work in [town], but my family are in [city], so for me it was like well do I want to be up there, or do I want to be down here? Who do I think is going to be around to help me? And also just the fact that this person did or does a range of different methods of top surgery, so I felt like okay, well I can, you know that feels like somewhere where I can talk through what the options are. Because I don’t really feel like I have a huge amount of information on that either at the moment. So okay well I’ve heard that there are different ways of doing it, and I don’t know, but I don’t know the ins and outs, what the, you know what the risks are to different ones. What the potential complications are, what might be best for me? That information feels quite lacking, so I, you know I feel like it would be different if I was going into that decision going okay, well I’ve already had a discussion around you know that method’s probably not going to be appropriate for me, but this one is. So, I’m going to look for people who have good results with that method. That to me is a different decision to going, “Okay well I don’t know what method I want, so, I need to talk to somebody who does a range of them for them to figure out what they think will be best for me. And to come to a decision on that.” So that played a large part of my decisions, was like okay this, this person does is happy to do a range of different methods, he’s had decent results with those, and therefore I can talk through those options with them. So Yeah, I, I don’t feel like it’s been a particularly informed decision and I guess, yeah, I’m just, my I gave them a name, they’ve passed that onto the surgeon and I’m waiting to, to hear.

So for GRS, so I’m planning on getting there’s three options on the NHS at the moment, so there’s either penile inversion, or something like I can’t remember what’s, it’s like a superficial vagina, vaginoplasty where it’s there’s no actual depth, it’s just, it looks like a vagina and it doesn’t really work like one, but it looks like it, for all intents, or, and or orchidectomy which is just the removal of the testicles, and I’ll be going for that one, purely because I don’t if I was to get something like a vagina I don’t want penile inversion. So that’s the only thing they offer. So, I thought go with this at least, and that means I could stay off blockers, I don’t need to take blockers anymore. I don’t think I have to take oestrogen just make life a little bit easier in general.

They’re just like, so they give you this like, you can this talk, okay so they, they, it’s like this group, group talk about like what to expect and what to go, and like, and they give you these guidelines about, mostly about dilating and but they kind of treat you like you won’t know how to wipe your own arse after having surgery. And yeah which is, is really, I guess is quite patronising. And yeah it just, it just seems quite, it seems quite ridiculous and they give you like an, a hygiene regime which is like, like really intense and it involves using quite harsh chemicals, I had a really bad reaction to those chemicals. And they couldn’t, they like didn’t really clock that that was what was happening. they, yeah, and just like saturated with whiteness, like I got, they show you like this like, this is not, obviously not exactly what they’re called, it’s like a big book of vaginas, or whatever, of like a big book of vulvas, in terms of like cosmetic appearances after surgery. And I think it was like they’re all, like people, like white people’s like post op vulvas, and I was like, “Oh, this is, is this, does this say something about like trans people of colour not getting the healthcare that we need? Or is this just like the classic like whiteness is a, you know, the blinkers of whiteness, not paying attention to lack of diversity.” Yeah, I could, I could go on, and like but I could go deeper into like what kind of, yeah, it was just like very, very weird like, it felt like very not like, it’s almost like pre-third way feminist ideas of like what, what gender is, is around this surgery. Yeah, it was not so, not, not prepared for like how, to encounter that degree of like gender conservatism again, after so long, you know having not, not really engaged with the GIC as a site of gender conservatism for a while.

So with regards to the nipple grafts there’s things about like where you want them placed and, you know, how big and all that sort of stuff. And so being fully equipped with all the options that are available to you before you go in is really helpful and also knowing a variety of surgeons and their techniques and their general outcomes. So a lot of surgeons do have photos of their results on their websites be that private or NHS surgeons, because a lot of the NHS surgeons also work privately, so you can see them that way. And so trying to see the surgeons that have done work on people with a similar body type and body shape to you can be really helpful in measuring your expectations of how you think it’s gonna look afterwards and also things like being fully aware of the recovery process and what that might look like for you. And other things that you’re gonna need to get you through that. Things that you might not even think of like are you gonna need a really long phone cable because you can’t twist to pick up your phone from your bedside table, all that sort of thing. So, yeah, just being as informed as possible about all the techniques the surgeon that you want and their kind of a lot of them have different demands and requirements for their patients as well. So some doctors place a, a certain BMI limit despite the fact that I’m not gonna rant about BMI. I have many rants about BMI. But yeah, so things like that. So that you can make the best choices for what works for you. And things like drains as well, so post surgical drains are still really really common. I can think of two surgeons, off the top of my head that well one, doesn’t use drains at all and one is using drains in fewer cases. And so, kind of, looking into whether you want that sort of thing. ‘Cos it speeds up healing for some and slows it down for others and trying to figure what might be most helpful for you.

And at the moment there's been a crisis in times of surgeons to do bottom surgery. At the moment, because there was a mess up with the NHS contracts with the surgeons to perform this type of operation. There are currently no surgeons in the UK at the moment that can do that surgery. So in terms of the waiting list, all the referrals are going to a NHS central hub so when they find a new vendor to perform these surgeries all the referrals will be sent to there. So at the moment no idea when that's going to be, they said that they would hopefully have it sorted by July this year and they obviously haven't got that sorted yet. So it just really is, it's a bit of a, it's a bit of a joke at the moment with what’s going on with the gender sector. Obviously with, in terms of the support from the gender clinic, don't really have much of that. I haven't really heard from them since my last appointment in June apart from when I, I messaged them to find out what’s going on with my referral but they, I don't think they're very supportive. And any complaints that I’ve made have not ever really been, you know, I don't feel my opinion has been taken seriously. All they've done at the end of it is maybe given me an appointment which would have been long overdue anyway. So yeah I just feel like they need to invest more and the people that they bring on into this sector they need to get people who actually genuinely care or put some sort of standards, you know, have some sort standards that are clear to everyone who works in this field because. I mean this is just my experience, of course there's probably people who have had a really good experience with their gender clinic. But this is just you know soley my experience, it hasn't been a great one. It's taken far too long to get round where I need to be. So from when I was first seen in 2019, I then had my surgery mid 2020 and obviously I'm still waiting to sort of have you know one consultation with the bottom surgery providers, which there are none of at the moment. So yeah it’s just a constant battle. I feel like it really is like a, they do play God with it a lot.  Because a lot of the times you hear them saying “ah everyone has to wait” “you're lucky to be seen” things like that. And I just think why should I feel lucky to be seen when you know I'm a, I'm a hard-working citizen, I pay my taxes, I pay my national insurance. You know this to me it's life-saving treatment and you know someone who has life-saving treatment, you know maybe transplant or whatnot or anything to relieve pain or you know. I can never see any of them doctors turn around and go, “you're lucky to be seen”, “you're lucky to be here” like “stop moaning” sort of thing. But yeah I just hope that in time things can get better because obviously I'm not just thinking about myself I'm thinking about people who come after me like obviously all of this put together has been really, has really affected my life and how I am having as an adult and you know my mental health as well. And there's been times when I’ve just said to them, “I don't know how much longer I can cope with it” because how long they take and a lack of empathy that they show. But yeah that's my experience with gender clinic.

I’m feeling quite nervous but I feel excited because I know it’s gonna help me a lot especially now that I’m doing a lot of sport because it’s not that, because the binders that I have are like five years old so they’re like very stretchy and roomy so I can kind of play sport in them and they do their job well enough. But what will help me is the fact that I can like change, because when you play rugby you change positions so you change top. At the moment if I have nothing on under my top I can’t change my top in the middle of the field, so it would help with stuff like that so I could just whip it off and like put another one on. I can go swimming without fear because I was like gonna go swimming but I asked the pool if I could wear a t-shirt and they said, “No.” So my mum got angry at them and they still said no, so I haven’t been able to go swimming so that would be nice. It would be nice to be able to go to a really hot country and not sweat to death under a binder. It just, I’m really looking forward to not having to wear a binder; that’s my main motivation for it.

I still desperately want that facial femininization surgery. I am saving up for that. And yeah, I mean, I kind of, it annoys, yeah, I want the boobs. I want the bum, you know? I want, it depends I will get my facial surgery and then see how I feel because I just, because what gives me dysphoria sometimes is when I see the shape of cis women and just how, you know, just the different bits are accentuated. And I just kind of yeah, I just kind of want that, like so I’ll think about it for a few more years before I go and get breast implants, bum implants, whatever. But like I feel like I suppose that’s just, I just like the idea of having, you know, those things there. And then orchidectomy, maybe in a year or something when I’ve only just started—when I get started on a more effective blocker. I’ve been on a blocker for a while. I’d like to get orchidectomy and then, and then think. Maybe think indefinitely whether I want lower surgery because you know, maybe I, maybe I do want vaginoplasty, but I don’t want it for another ten or twenty years, you know? So, I think transition is like something that’s gonna keep going for the rest of my life. I don’t want to get to a point, I don’t see myself getting to a point where I think, I’m done now, you know? So, I suppose yeah. I don’t know if just getting to a place where I’m more comfortable with my voice as well, I suppose is something that would help. Electrolysis on my face. Just sort of, yeah, little things, little things like that.

I definitely want facial surgery. I, that to me is the most important one. That to me when I think about the surgery is that’s my surgery, you know. Because I feel like it might just give me the option of going outside without make-up and being less likely to get misgendered, you know? Or just it would bring me closer to this idea of being able to tell people I’m trans or not, if I choose not to, maybe. And yes, it’s being able to face myself in the mirror. So, that, that’s surgery I want, but it’s ridiculously expensive and it’s affecting the whole way I live my life, because my life is geared towards saving money for it. So, there’s that. And, yeah, I think I have all these ideas in my head about getting breast enlargement, bum implants and orchidectomy and maybe vaginoplasty, but it’s all, haven’t thought in detail about those ones, but the face ones are the main one.

I don’t want anything else after hormones. Maybe one day, I want FFS (facial feminising surgeries) maybe like theoretically plausibly. It depends on how much my face changes because of hormones and whether I feel like I’m still dysphoric. The truth is, I just want...

I’m just tired of having this combative relationship with my body and hormones and I feel like that’s becoming the very obvious solution for that. I don’t have, I don’t have bottom dysphoria. I like my penis. It’s done me right. So, I think I wanna keep that. I also wanna keep like—I want to change as little about myself as possible whilst still alleviating my dysphoria. I just feel like that’s a really strange thing. It’s a really odd trans narrative, it’s not a very common one. You get a lot of people saying like, wanna go from here to here or if they’re non-binary, they’ll just like roll the dice and then they’ll just end up somewhere in the middle of the spectrum and that’s fine. That will make me happier. I just wanna get rid of dysphoria, like get off my plate, I have like a life to live. I have like family members to hang out with. I have, you know, jobs that I know even know about that I wanna apply for now. I just wanna, I just wanna be myself and dysphoria is getting in the way. So, get this thing out the way and I’ll be fine, basically.