🛸 Icky Space 🛸

plea for gender affirming care

As some of you may know, I am a transexual individual seeking a truly unique form of top surgery. I have been fighting to recieve this gender affirming care for about 3 years now, with little success. What follows is a letter I have sent to TransCare BC at the request of my doctor, in pursuit of getting out of province care covered. I intend to document as much of my experience as possible, such that anyone else attempted to receive care like this doesn't have to start from square one like I did. My dream is a future of total bodily autonomy for everyone. May your body be your own. Thanks for reading 💚

This is about autonomy. I want a body that belongs to me.

For as long as I have had breasts, they have been a source of struggle. They have been an object for others to control. They have never felt like mine. They belonged to my mother, who forced me to wear bras I hated, because she didn't want me to have saggy breasts, and never asked what I wanted. They belonged to society, to the people gendering me, sexualizing me because of them. I have always felt disconnected from them. I have very little sensation in them to begin with, and absolutely none of it pleasurable.

The only joy I have ever gotten from them started as a joke. "I'd trade my right tit for that". Silly. A show of how little they meant to me. But only ever one.

The first time I spoke to someone at Trans Care BC about gender affirming care, they asked me if I had thought about top surgery. I had only just been able to start binding a few years earlier, at 18. Clawing back a tiny scrap of control for myself. I told them I wasn't ready just yet, but if I had to have anything, my real dream would be to just get one removed. I don't even know why I said it then, it sounded ridiculous coming out of my mouth. Like just saying that would discredit my dysphoria. Get me kicked out before even getting on testosterone. I will never forget what they told me. "Well, I've never heard of someone doing that, but I don't see why it wouldn't be possible… it's just less work for the surgeon isn't it?" I don't know if they ever wrote it down, I don't even know who I talked to, but that conversation was the spark. The idea that someone could take it seriously, that it could be more than a joke, more than an idea, it started a ball rolling in me that has just grown bigger and bigger over the years.

I got on testosterone. It was always my plan to stay on just long enough for the changes I wanted, and get off before the ones I didn't want became unbearable. Being nonbinary and desiring an androgynous body is always a balancing act. There is only so much we can do to tailor our transitions to how we see ourselves. On testosterone, my already small tits deflated. Easily hidden under a light sweater and the chronic transgender hunch. I started to love the way they looked. A cute little teardrop that didn't get in the way, didn't make itself obvious unless I wanted it to. I tried out trans tape, binding only one side to see how it would really feel. Through all the struggle of getting it on, practicing how to pull it just right without hurting myself, I could just start to see what it might look like. I started drawing myself with the chest of my dreams. Asymmetrical, off-kilter, just like me. I added a third nipple, something I have so enviously coveted on others lucky enough to have that natural mutation. Imagined myself with triangular areolas, furthering my beautiful oddity, a trinity of masculinity, femininity, and something else, something alien.

But all good things must come to an end. I got off testosterone. Something no one warns you about going on and off hormones: the third puberty can hit hard. Instead of growing back to their previous size, my breasts came back bigger, badder, and with a vengeance. Now an ache through my nipple stalk prevents me from hugging my loved ones as close as I'd like. I feel like there is a barrier between me and the world. The feeling of them bouncing when I walk is unbearable. The sensation of them rubbing against my shirt makes me want to tear my skin off. I bind every time I go out. I deal with chronic pain. My shoulders ache from the compression, but what else can I do? Living with them is misery. I stopped looking in the mirror. Can't make eye contact with myself. I keep my head down. I don't associate with the glimpses I see. Even at home, I dissociate. I don't see this body as my own.

So, I reach out. I tell my doctor I am ready. I am tired of living this way, lets get the ball rolling. The idea is a little different now. I know I couldn't live with even one breast at this size, but radical breast reduction exists. There are methods like buttonhole which are known to give non-flat results, and try to preserve nipple function, awesome! Sign me up! They are encouraging. They support me wholeheartedly. No one warns me how difficult this will be. I remember the words of the first person I spoke to. "I don't see why it wouldn't be possible." How hard could it be? Surgeons perform breast reductions all the time! They perform unilateral mastectomy for breast cancer, they even perform full nipple construction! All these things are possible, so what do I have to be afraid of? The world is open for me, I can do anything I want.

I see the first surgeon. The paperwork is wrong. My doctor forgot to put both mastectomy and reduction on the forms. The surgeon I see doesn't perform reduction. He has a very clear idea of what he thinks a transmasculine chest should look like. I tell him my dream. He looks at me like I'm crazy. Instead of just telling me he can't perform the surgery I'm looking for, he lectures me on the pursuit of symmetry. "Everyone wants to be symmetrical" he says "It would be like someone having an ear on the top of their head." I am a joke to him. It doesn't matter that asymmetry is the norm of natural chests. It doesn't matter that asymmetrical results are one of the most common complaints after top surgery. Someone must be crazy to choose that. He's a plastic surgeon after all. He makes people perfect.

I leave his office in tears. It took months to even get this appointment. I go back on the waitlists. My dysphoria worsens. I can't remember the last time I felt like this body belonged to me. Has it ever? How could it, if other people can decide what I do with it?

I seek out body modification, anything to feel like I have control over my form. Cost is prohibitive, but I save up. I find someone who will alter me in the way I choose. I trust them. I get scammed. I discover that they have done this to others. It feels like the universe is showing me the obvious truth. My body is not mine to change. I contemplate self harm, and all I can think of is how much it will upset my loved ones. My body is not my own, there is nothing I can do to it without someone else's approval.

A year passes. I get another consultation. It's not without struggle, as Trans Care lost my referral for months, and it was only the kindness of the surgeon's clinic that kept me from yet another year of wait when that was discovered. This one has the grace to act nice about it. She hides her disgust as I describe what I want. I ask her, are you capable of performing mastectomies? "Yes." Are you capable of performing radical breast reductions? "Yes." Can you put them together, for me, if I ask you so nicely? "Absolutely not. It's just not done. I don't feel comfortable with that." But why? "Because I'm not comfortable with it" Well, what about lesser weirdness, what about a regular mastectomy but you give me a third nipple? "Absolutely not" But you can do it right, you have done that, before, for others? "Of course." So why- "Because I'm just not comfortable." It is useless to suggest alternatives. She closed her mind the moment she heard my ridiculous request. There is no room for freaks in plastic surgery.

I am howling down the street to our car. My partner holds me as I exclaim how utterly devoid of autonomy I am. I feel reckless and desperate. Desperate for any ounce of control, I have to fight myself to keep from jumping into traffic. At least that would be my choice. At least no one could stop me. We get ice cream. I return to dissociation. None of this matters anyway. I'm not a person. I don't have wants. How could I? I'm just here for other people. What do you need? How can I serve you? I'm just a doll. Good dolls don't change.

My doctor is sympathetic. They know of a group, every provider of gender affirming care in Canada. All of them. They post my desperate plea, along with a list of possible concessions. I am tired of hoping, but they try for me. In the entire country, there is one bite. One singular surgeon who says "Well yeah, it's weird, but why couldn't we do it?" An echo of my first spark, a hope too good to be true. Yet even the follow up doesn't scare him away. He sees my vision. He is on the other side of the country. They tell me it won't be easy. We have to convince the province that there is no other option. They tell me that we will have to make sure none of the surgeons in BC will do it. 10 surgeons who perform mastectomies. Two crossed off. Wait lists that span months to years. I picture the next decade, parading myself in front of laughing surgeons just to hear the answer I already know. "Go home freak. We don't serve your kind here."

Trans Care takes pity on me. They contact the surgeons for us, give them the gist so they can handle the reactions. I try not to imagine what the surgeons say without a patient listening. But hey, we get one hesitant bite! A surgeon who says she'll consider it. Amazing! Get me on that waitlist! I'll be a good little transsexual and wait like the rest of them. I'm hoping again, despite my better judgement.

It doesn't last long. In two weeks I check on the status of my referral. She changed her mind. "There's just no precedent for this. There's no research." I bite my tongue, don't ask how there will ever be research if everyone refuses to try. It barely phases me anyway. What does any of this matter? The universe has shown me over and over: I don't make the choices here. This body does not belong to me. Other people's standards, other people's expectations, that's what matters.

I lose myself for months at a time. Giving myself to any cause that will have me. How can I help you? What do you need? Oh, me? I don't need anything. What can I do for you? Who am I? Who do you want me to be? Why don't you pose me? Dress me up, tie strings to my arms, make me dance if that's all I'm good for. I can be good. I can be empty. Anything to avoid being present in a body that isn't mine.

So this is my plea. I have a handful of people holding on to the vision when it is too hard for me to bear. I am fighting to remain present in a body that does not feel like my own, in a world that is determined to take control away from me. I'm not asking for much. I know that what I want is strange. I know it hasn't been done before. I am hoping that you can see in this message just how much this means to me, and how much I am harmed by the delay. I am asking you to see that this is life-saving care, that there is no life without this for me. There is only so much therapy can do when my autonomy is being denied. How can I believe in my own power to change if no one will let me? How can I believe that my consent matters at all if someone else can override it? I just want my body to feel like mine, I want the chance to experience my own decisions made flesh. If you think this is a mistake, then let it be my mistake to make. Allow me the dignity of risk, to live with the consequences of my own choices, instead of someone else's.

Thank you for your time.

the jukebox problem

i don't think i can fix my music problem. i think there is a solution, somewhere, but i think my trying to fix it is a losing game. finding new music was always easy for me before, it would juce come to me in the exact moments i needed it. i thought the problem was that i didnt know where to look any more, but theres music all around me, people are always sharing songs they like. i just dont connect with it the same way. i so rarely have opportunities to just Listen to music, and focus on that. sure music can be playing and i'll hear it, but i rarely pay attention to it in a meaningful way. i won't remember it later or have any desire to seek it out.

the times when i do still listen to music are when i need it to complete a task. i have to have music on when im doing dishes or otherwise cleaning, and i've learned to like having it on when i shower. but in those situations it has to be very specific music. it needs to be music that i am already intimately familiar with, and music that i can sing without getting dysphoric.

i really didnt expect the voice drop from t to affect me as much as it did, like, emotionally. it was the thing i wanted most before i started, but it's probably the one thats given me the most trouble since. i had no idea my singing voice was so important to me. i never thought i was good at singing before, i didn't want to even consider it a possibility. i spent years hating drawing because my desire to be good at it stripped any joy i could take from the act. ive always Loved singing along to music, ive done it as long as i can remember, and i decided early on i would not let perfectionism take that from me.

i guess somewhere along the way though, perfectionism seeped in. i may not have a theoretical understanding of music, but i can tell when i'm not hitting the notes i used to. but unfortunately without a theoretical understanding of music, i dont have a clue how to harmonize, or switch to a lower octave. i learned to sing by basic mimicry. if it doesnt sound exactly the same to me, i dont recognize it. songs that used to be comfortable to me are now just pockmarked by my failure to adapt.

V has tried to help me expand my range a few times. it usually results in me crying. the way my voice just putters out when it gets too high, i cant even make a bad sounds most of the time, its just air passing through, not catching whatever vocal folds allow a sound to be produced.

it hasnt been all bad. i'm feeling meloncholy about all this, but my new lower range has been a joy to explore. i have found songs that fit in it that make me feel happy and fulfilled to sing, and plenty of my favourite songs are still in my range. its fine. im not ruined. its just frustrating, trying to relearn a skill i swore id never learn. the language is confusing to me. i prickle at any implication that music can be objectively "good". some of the music that has meant the most to me in my life has been music that sounds scratchy or poorly recorded, on voices that others would describe as unpleasant.

i've always been more of a lyrics cat. if your words resonate with me i dont really care how they sound, as long as it feels honest. the power of music for me is having someone hold a mirror up to your soul. being able to see your experience reflected in another. to be given language for something that you could not name yourself. music like that always found me when i needed it before. but now i just, i don't know. its not there. and i cant tell if its my unwillingness to sit down with it and let it affect me, or if the music just cant find me where i am now. do they make songs for people like me anymore? or have i become unrecognizable?

i tried to talk about some of this recently with a musician. someone who prides themself on liking "good music". not pop music that 'knows what chords sound good but doesnt do anything interesting with it'. these conversations were incomprehensible to me. i cant recognize chords by name, i'm not inclined to doubt the authenticity of someones work. trying to share music with this person is a minefield. i felt like i was being graded on it. will you think less of me if i like a song you deem bad? "please don't be offended" how could i be? if you know good music and i dont, clearly i am wrong, clearly what i got out of this song doesnt matter.

i am inclined to these patterns of thought whenever anyone presents themself as an authority. i had hoped i had more emotional resilliancy to it now, thought my previous bad relationship had given me the experience to say, "I am myself whether you like it or not." but really that statement back then was just coping. if i could annoy them enough at least i knew where i stood. i could paint myself as a little freak who liked "bad" art before they could do it for me. i really should have seen the pattern coming. i know i can't handle playful meanness anymore.

this is messy. theres so many layers of pain tied up in my experience of music. bands that could get me through anything revealed to be taking advantage of fans. a lack of free time to devote to just listening. pressure to be good, to be right, to be seen as worthy. pressure on myself to just find it again, that spark, that missing piece that will let me enjoy it again, let me see myself again. i think the pressure is making it harder. i thought if i made it a challenge, just make a monthly playlist, just investigate one artist a month, this used to be nothing to you, you could do this in your sleep, i thought i could bring it back. but all it did was make it a chore. made me afraid to listen to familiar music because i was wasting time i should be spending finding new stuff. made me scared to listen to anything for fear of doing it wrong. now, two months behind on my musical commitment, i think its time that i accept it as a failure. i dont want to keep putting myself through the stress of trying. it wasnt helping anyway.

i hope the music finds me again when its ready. but for right now, i have to stop chasing it.