Planning a hysterectomy

I had a doctor appointment the other day to meet the surgeon to as my ex put it "yank that ute". After looking at various techniques and the related recovery times, I've opted for DaVinci robotic assisted surgery and selected someone that has considerable experience with the procedure. I experienced for the first time being in women's space, without being a woman. I walked into the medical waiting room dressed in my black hoody and jeans, with my scruffy unshaved face , (because I had just gotten up), and was met with uncomfortable stares. This was a bit different than my experiences at the plastic surgeon's office where about half of the patients in the waiting room were transguys. So I take it not as many people get hysterectomies... Anyway, there was the typical "What's your name?" moment that I have learned to loath followed by the "My legal name is this..My REAL name is Hawthorne. Please call me Hawthorne". They seemed to roll with it without too much trouble. The doctor was lovely, great attitude, used the correct pronouns, bright, young, and attractive. The wait time for a surgery date will be a couple months if insurance doesn't give me any problems.

Transitioning and body hair

I am on a few different transmen lists on Facebook and I read quite a bit on the internet and I am amazed at the differences in the rates of change from person to person. Personally, I have lived a rather "hairless" 53 years. I have had very little arm, leg, or body hair. What I've seen in body hair growth, including facial hair seems miraculous to me, even when I see pictures of other transmen who have been taking testosterone for only a few months and already have a goatee. Our genetics are really what is determining what changes we see and how fast they happen and as disappointing as that may be for some transguys, this is how it works for cis-gendered men as well. we aren't special in this area. I remember watching that play out during high school when the boys who developed facial hair were the object of envy. Although I have as much butt hair as anyone could possibly want and some new hair on my legs, (along with 13 chest hairs), it's my turn to be envious of every transguy that has more facial hair than me. At 2 years on testosterone I have a little darkening and coarsening of the hair on my top lip, a few curling neck hairs, some wiry additions to my sideburns (grey unfortunately), and some patchy chin hair. There are other random beard hairs sprouting randomly on my face but they show little evidence of grouping together any time soon. Meanwhile, I shave them off because I prefer to look neat and tidy and my wife finds them poky (I have no idea how to spell poky..pokey..pokie?). So, as exciting as new facial hair is, my significant other doesn't really like it and I think that is also a something that cis-gendered guys also find out during puberty. I think I have a lot of shaving
ahead of me.

Differences between testosterone gel and injections on transition

I'm going to write a bit about my thoughts about the differences between Androgel, the topical testosterone gel, and testosterone intramuscular injections. I've used both so I have some experiences to share here. I did some research on both before using them and what I read said that there wasn't much a difference in transition speed. I was concerned about injections making my body have to deal with large amounts of "T" immediately after the shot and being on an emotional roller coaster ride while dealing with peaks and troughs of hormone levels. I was particularly wary of this because I am married to a wonderful woman who I didn't want to subject to a bunch of chaos. Anyway, I decided to go with the gel as it would provide my body with a steady, equal amount of hormone every day. I used the gel for about a year. However, physical changes were fairly slow and I was OK with that since I hadn't talked to my entire family about transitioning yet and I wanted to go about the process slowly for the reasons I already mentioned. My voice got a little deeper, (like I had a slight cold), I grew a lot of unwanted hair on my butt, and I checked my hairline for thinning (because I am vain about my hair). I grew a few hairs on my chest and chin.
After I talked to my family and got chest surgery, I got more impatient about looking more masculine. I switched to injections. At this point I have been using the intramuscular injections for 3 months. Within that period of time I've grown a lot more body hair. Before beginning transition I was virtually hairless besides some blonde arm/leg hair, and fine blonde facial hair that women normally have. I now have brown, coarser body hair in places that I never had like inner thighs, legs, and the backs of my shoulders. I also have more facial hair coming in brown on my sideburns, neck, jawline, and a "dirtstache". It's a lot of changes over a short period of time and I attribute that to the higher inputs of "T" even though it may be the same amounts averaged out over time, the shots give bursts that apparently have caused these changes to happen. Along with more body hair, my face has changed because fat goes to different places, it doesn't distribute evenly, it goes mainly to my stomach. Ugh.

It still feels like I'm wearing a binder: Physical therapy and stretching helps

It's been 7 months since my top surgery. I already talked about "cording", learned about what might cause it, and then had a couple visits with a physical therapist to deal with it. Apparently you can break the tissue under the skin, but it will often grow back. The way to make it less noticeable is to do stretching until it is loose enough under the surface to not be taut and appear raised from the underlying tissue. So, the point is, it's eventually not a big deal if you do the stretching and can no longer feel any constriction when moving your chest or arms. The stretches consist of sticking your chest out as far as you can and bringing your arms and shoulders back for 10 reps, multiple times a day. Lifting your arms up in a sweeping motion as far as you can reach, again, multiple times a day. I had complained to the physical therapist about how it still felt like I was wearing a binder (24 hours a day!), and that the top surgery was supposed to give me a break from that. I asked her how long it would be before that feeling of tightness would last and she said that the stretching should alleviate that feeling in 3-4 months. So if you do not have access to PT (physical therapy), find chest stretching exercises and DO them. That binder feeling will go away eventually. I am including a gratuitous chest pic below. It is very obvious that some of my skin was NOT tan. I'm looking forward to being able to even up my skin coloring after I am finally able to go in the sun!

Even more about scar care

It's been a little over 3 months since my top surgery. I continue to have sensation from my "phantom nipples". It's not that big of a deal though. The major thing right now is the scar tissue changes. It seems to be thickening in some places and I have some stabbing pain occasionally for what seems to be no reason whatsoever. My doctor recommended using scar strips, but also using thick lotion and massaging the scars. Those 2 suggestions seem counter productive. The lotion makes the scar strips not stick and the "massage" could be done in a lot of different ways, but I don't have very specific instructions :( Anyway, I try to switch back and forth between the 2 instructions while looking longingly at the sun that I must stay out of for another 9-10 months. Other than that, I'm still very happy with the surgery and am typing RIGHT NOW with no shirt on!

Note: 11/8/17

I talked to a physical therapist who works with people who have had mastectomies about the stabbing pain in my chest that happens sometimes. She said that it is part of the nerve damage that can happen as a result of the surgery and that the nerves have to be "retrained" how to feel. She suggested firm tapping in the area where the pain is happening to remind the nerves of REAL sensation. I've been following this advice and have had less frequent problems with pain for no reason.

Almost 2 months since top surgery, but mostly about "Cording"

I am healing well and am able to lift normal amounts of weight so doing some carpentry wasn't an issue. The skin on my chest feels a little tight, but not nearly as much as it did a month ago. I recommend doing the exercises that the doctor tells you to do and as frequently as you are supposed to do them if you don't want to be all bent inward!
However, the thing I wanted to discuss in this post is a condition called "cording". Cording is the short and easy name for Axillary Web Syndrome. The weird thing is that no one really knows how or why it happens, but it happens to about 20% of people who have mastectomies, including transgender patients and women being treated for breast cancer.  What happens is connective tissue grows in "cords" from the incision sites in the armpit or on the trunk and forms long strands of stretchy, (but not stretchy enough) "cords" that appear under the skin. They can run all the way from the armpit to the wrist or from the chest incision site to..who knows where. As soon as I heard it doesn't happen to most people I knew that it would happen to me because I'm special. Great...and it DID happen to me. I have cording in my left armpit down to my forearm and from a part of the incision on my chest. The left arm one happened first and I could feel a weird pulling sensation before I could see it under my skin. The cording on my chest happened a few weeks later and was raised under the skin and visible when I raised my arms up over my head. somewhat like in the image below. I pushed on it while it was taut under my skin and I actually felt it tear away from whatever it was adhering to. Ouch, but not incredibly painful. My wife was far more affected than I was. Anyway, I brought it to my surgeon's attention and she referred me to a physical therapist, who I start seeing next week. Since I tore mine I have no images to share but from the web there are some available:



http://www.mylymphedemalife.com/axillary-web-syndrome-aws-also-known-as-cording/


Axillary Web Syndrome
**Photo taken by Elisabeth Josenhans, Hamburg, Germany
elisabeth-josenhans@hamburg.de

1. Cording is rarely discussed as a complication by the surgeon; My surgeon didn't mention it.
2. Some forms of cording may be difficult to see and feel; If you do feel it, you probably won't know what you are experiencing.
3. Some women do not want to complain to their surgeon; (many people feel that doctors are gods)
4. There is no recognized comprehensive physical assessment of Cording; Yep
5. Cording assessment may not be a standard practice in the breast cancer clinic; and
6. There is very limited research into treatment protocols. I find much disagreement about what it is and why it happens. Treatment?  Not much.

Note: More research and conversations with specialists lead me to believe that cording originates where there are damaged lymph nodes.

Scar strips get itchy

I have been somewhat regularly using the silicone scar-strips on the front part of my chest (the part that is the most visible) and so far I think it has evened out some of the higher parts of the scar tissue. However, wear time is supposed to be pretty much, as long as you can stand it. My skin likes to breathe and after about 12-16 hours it itches and makes me want to rip and tear at it. So I take it off. Then it isn't supposed to be put on until your skin is dry and clean so if you are into bathing a lot, this product is for you! I like to give my skin a break from soap occasionally as well so right now I've gone almost a day without the scar strips. Ugh. That defeats the purpose. Oh well, I will pout them back on in an hour or 2. In other news, most of the skin glue has finally fallen off. what I see is just me.

All about scar tissue and how to deal with it

It's a month and 2 days since my top surgery. I am healing really well, but I have some concerns about the condition and extent of the scarring on my chest. There are some obvious things to avoid, like the SUN. I am aware of many Youtube videos where the transguy is relatively healed up and can't wait to take that shirt off and sunbathe. Do not do this unless you think scars are sexy. If you want your scars to be minimally visible, shun the sun! My doctor recommends an entire year out of the sun. I'm afraid of skin cancer so that probably won't be an issue for me. I am excited about wearing my suits and looking good in them :) Another thing I wanted to mention is scar treatment. I am using adhesive silicone strips to cover the scar tissue. What this does is flatten out the scar and relieve pressure from bending and stretching the scar tissue. Check out the pic from today below. As you can see, I have applied the scar strips to the front scars because I am most concerned with how they look. I haven't applied the strips anywhere else as I am almost certain to have revisions under my arms due to loose skin from weight loss.

4.5 weeks since my top surgery

OK, this post is mostly to upload a picture since I got my stitches out and apparently nothing is going to fall off. The surgeon gave my right nipple 2 thumbs up as far as being ahead of the curve on healing, and a C grade for my left nipple. Since my top surgery I no longer see myself as awesome so every time I look at a picture I think "OMG you are sooo fat", but I know I am in a lot better shape than I was a couple months ago!


Picture from 5/10/17

Warning, if closeups of stitches being removed makes you queasy, do not watch. Stitch removal on my nipple grafts including close-ups of the nipple grafts are available in a video here:

https://youtu.be/_TQVoiv-6WY

4 weeks since top surgery

There are a lot of things that I read about, but couldn't know about since it has to be experienced. One of those things is "dog-ears". In my case, I was quite a bit over weight and lost 20 lbs right before surgery and I continue to lose weight. The incisions under my arms, (in my lower arm pits), are now the only part of my body that actually jiggles if I jump up and down. I don't like this, it is not a good thing. There is a bunch of loose flesh there and immediately after surgery it was mostly numb. After a couple weeks the nerves woke up and it was just painful..all of the time. It hurt when I raised my arms, it hurt when I lowered my arms. It hurt when I was laying down, it hurt when I was standing up. It was maddening because there was no position that I could be in that would make that low level pain go away. As a sleep aid I took CBD/THC pills rather than than the opioids that I was prescribed. An addiction to pain meds is not something that I wanted to deal with on top of having to wear a really uncomfortable compression vest and nagging pain and itching, healing flesh.

I want to mention the compression vest. It was cleverly designed to be able to hook the drain reservoirs to, but it was so tight that it bruised me in areas that I didn't already have bruising from the surgery. Yes, bruising is a result of the surgery. I imagine that when the skin is pulled together it has already been roughed up when it is moved from its original position to a new one. The reasoning for the compression is to keep the skin and nipples in close contact with the blood vessels so they will grow into the grafts, and the skin that was moved is almost like a graft. The nipples take about 3 weeks to be out of danger of being easily "sheared" off by normal activities like putting on a shirt or washing. I am past that milestone and I am very happy to report that my nipples stayed where they were sewn. My wife was their guardian, making sure that I didn't brush them off, scratch them, or do any damage to them accidentally.

My pain levels are at about 0-1 unless I stretch something that hasn't healed up quite yet. The places where the drain tubes went into my chest seem to be pretty deep and are healing inside slower than the outside. My biggest irritation is the tightness I feel in the areas of the incisions. My upper chest is very tight and if I try to stretch it feels like something might split. I don't know if that is actually true but I don't want to find out. I stretch until it feels uncomfortable, then I stop. I had thought originally that there would be a little slack because I was losing weight but the surgeon cut all of the excess skin off. It's strange, (more like ridiculous), because my chest is muscular from the 5 weeks of upper body building I did before surgery, but I have a big belly below it. Sigh..eventually I can lift weight again. In the meantime I go for walks, but I get tired easily. Healing takes a lot of energy.

Day 11 after top surgery

It's been 11 days since my top surgery and I finally have no drains or tubes hanging out! The drain on my right side was removed yesterday as the PA made me "cross my heart and swear that there had been less than 30 CCs of fluid daily for the last 3 days. The last time they talked to me about it the requirement was <25 cc per day for 2 days, anyway, I didn't know how to do the cross my heart thing and he removed the drain. Sweet! Showering is much easier and the only concern I have is keeping water from the shower head from spraying directly onto my nipples. Apparently new blood vessels grow into the grafts in 3-4 days, but the cells that attach them to the existing skin takes a few weeks to get strong. Shearing force (side to side movement) can rip a nipple graft right off so I am very careful when changing shirts.
I am super happy with the incisions on my chest and unhappy with what is going on in my arm pits. Most of that skin is either numb, or screaming about being touched. "Dog ears" is what the surgical result is called, but I had no idea how uncomfortable it would be to feel the bundle of misshapen flesh, with damaged nerves under my arms. There is no escape from it. I am told there are often revisions required, which makes me think about more drain tubes and cutting! Ugh. It would be nice to just be in the healing part of this adventure.
My wife is concerned about intimacy and heart rates. The surgeon told her that my heart rate is not supposed to go over 100 beats per minute (BPM). I am not sure why, but it could be to keep down swelling. Yes, swelling is uncomfortable, but I have no idea when this limitation is supposed to be lifted!
< 5/14 Note, I asked my doctor about the heart rate thing and it is about blood clots. Increased blood pressure could send a clot from the surgery to your heart or somewhere else terrible>

Oh, an interesting thing to mention about me. Before the top surgery I was unable to see myself as I was in a mirror. A lot of people have this issue to varying degrees. Many people see themselves as fatter, or their nose looks too big. In my case, what I saw in the mirror was always good. Now when I look in the mirror it's like some spell has been broken. I can see my wrinkles, my fat stomach, and my stretch marks. I think I see everything now. I attribute this to coping with gender dysphoria. It must have been how I was able to cope, to not see the things that were distressing. So now I know just how fat I am. This is good, and it sucks at the same time.

5 days since top surgery

It's been 5 days since my top surgery. I went to a doctor appointment to be looked over and have some tubes removed. I had a pain deliver system that involved a pressure pump and tubes that delivered a pain medication under my skin. It felt weird to have the tubes (about 4" each) under my skin removed. I am left with one drain under my right arm pit. It is painful (slightly), irritating, it itches, and I would very much like it gone. I also got the bandages off of my new (slightly used tissue) nipples. The doctor says they look great. They look like scabby prune skin and they hurt when I get out of bed or do anything to pull the skin across my chest, but pain is how you know you are alive, or that your nipples are alive.

3 days since top surgery

It's been 3 days since my top surgery. Among the jokes from my family about how it looks like I have tomatillos attached to my new nipples, there's more about nipples.
Because my breasts were large, I had double incision chest surgery. Because of some "extra" tissue (quoting the surgeon here) between my pectoral muscles, those incisions actual join together where some special extra cutting happened to prevent me from having a fleshy "nose" in the middle of my chest. Anyway, along with those incisions, I also had my nipples removed, grafts made out of them, and then they were moved to a more natural masculine positioning. There is much explaining about how there will be loss of sensation in them, (think about if that is important to you), etc. However, what no one explained about is how there could possibly be phantom nipple sensation. I repeat, phantom nipples. Apparently I am one of the lucky folks who can still feel the old nipples in the vicinity of where they were previously located. It's not pain though. It's like it's cold outside and they are contracting. It's a particular sensation that pretty much anyone with nipples has experienced. From what I read, it could go away, it may not. It's weird.
Other than phantom nipples, which is just strange, I feel pretty good. My right drain is putting out way to much fluid for me to be super hopeful about it being removed on Monday, but it could still slow down enough. Maybe.

Middle-aged Top Surgery

I just had top surgery a couple days ago. I wondered if I would mourn my smooth unbroken flesh, but I don't. My new chest is strange to me, but it is intriguing. I learned to live with my old chest, but I had to work up to that from terror, disgust, horror, to resolve. As an adolescent I wished and prayed that I wold wake up and some kind of magic would happen while I slept and the mistake of my body would be corrected. That doesn't happen.

At 53 years old I re-shaped myself. I looked at myself and I see a stranger, but an interesting stranger with potential. I have no regrets about it at all. Anything was better than what I had, even uneven raised scars and a missing nipple would be better. Anything.

When I started this process, seeing doctors and therapists, jumping through hoops for insurance, I didn't want to get my hopes up and have it taken away from me. It didn't happen for me truly, until it was done. It's not like I didn't make preparations though, I did. I was very over weight and my surgeon talked of all kinds of complications like they were a given. I lost 20 lbs and that talk stopped. I did upper body weight training in the hopes that the surgeon would have an easier time following the contours of my muscles while making the incisions. My results look good, but I'm not sure that is the reason. I wanted to do all the right things to prepare, but there is no way to know for sure what your personal experience will be. I found out that I should have done sit ups because I must use those muscles to get out of bed. I was very cavalier about it the first day, now I am agonized every time I must do it AGAIN. I am not taking pain meds because I am taking 4 classes and I was concerned about slowing down my digestion. It still sloooowed. I'm not sure when that will be resolved. Maybe I need to drink more water.

The big things I'd share if anyone cared to ask about are:

You can't do this on your own. It requires friends or family to help you. I have 24/7 care that my poor harried spouse is providing. The things she is helping me with are bathing, emptying fluids draining from the incisions, feeding me, helping me dress and walk. She is also taking care of everything else in our house. She is doing a lot. This surgery makes you helpless.

Using the toilet is difficult. I installed a bidet (it sprays water on your butt) right before having surgery. Wiping is mostly just drying off. The bidet has made that issue a lot easier. It cost under $40.

Top surgery is a huge decision. It is a permanent decision. After the surgery, you are still the same person with the same problems. It may help a little on the outside, but not so much on the inside.

Afterwards, you need time to adjust. You need time to heal.