I started on testosterone and the weekly injections ran me about $100 for three to five months, depending on the size of the vial I could get. The exact same medication could be obtained by my husband for nearly free because he was a middle-aged ma and low testosterone was just starting to take off as a diagnosis.
To say that galled me, doesn’t even cover it. My doctor wanted me to have this medication, but the insurance company said no. Yet, my husband who has no issues at all, could get a superfluous testosterone prescription just because, and cheaply.
In addition, I had to go out of network to get a doctor that would even prescribe my medication. Capitol Hill Medical in Seattle was the only office at the time where I could get on hormones. Even if I could find a willing doctor through my actual insurance plan, I couldn’t find one without gatekeeping behavior that would have put me years and years out before I got my first testosterone shot.
Gatekeeping is like concern trolling. It’s basically a medical professional telling you that you can’t possibly be sure that you are transgender and forcing you to undergo years of dangerously trying to live as the gender you are without hormones with years of long, expensive therapy.
Let’s be perfectly honest, the old ways of having therapists and doctors forcing you to live as your real gender without transitioning isn’t safe for everyone. I got more aggression in that time that I was pre and on early hormones, than after the testosterone kicked in. Being forced to live for several years like that? It would have been a countdown to my getting my ass kicked.
Additionally, I was a 45-year-old man. I didn’t want to devote years to jumping through hoops, just to get on testosterone. I didn’t feel that at my age, I wanted to waste years on getting where I wanted to be, which was to transition medically, and be read as male by society at large. I know who and what I am, and no amount of forcing me to wade through someone else’s idea of therapy would change that.
These days, there is a growing body of evidence that transgender people are not confused and forcing us to undergo years of hoop jumping to get where we need to be is not just unnecessary, but actually detrimental.
There is a new model called “Informed Consent” that doesn’t force you to go through all that. I sought out my doctor at Capitol Hill Medical because she used that model. I spent an hour with her, discussing my situation and, just like that, I was off for lab draws and a prescription’s worth of testosterone was in the mail. Being a nurse, I didn’t even need to come back to learn how to inject it. For me, this worked.
That was all well and good, but since I had no insurance coverage, I decided to go to war with Group Health (which later became Kaiser), my insurer. Every doctor’s appointment, every lab draw, every prescription I got in relation to my being transgender, I sent in for coverage. Inevitably, it would be denied and I would then write appeal after appeal. At one point, I had six appeals going, with multiple new coverage requests. I had a whole file keeping system on it.
My theory was that if they were going cover testosterone for other men, which they were passing out like candy to every middle-aged guy that thought he might be extra tired lately, then they should damn well cover me. If they weren’t going to cover my hormones, then I was going to make them pay out more in wages to deny me, than if they just covered the damn thing.
Then I noticed the denials started having a change in wording. They no longer flat out denied me for transgender-related care, but started denying me for being out of network. There was a lot of chitchat out there at this time that insurance companies might start covering us, so I called to ask about it.
My first call didn’t go well. I was told by the uninformed gal on the other end that I could possibly get it covered the next year, but that I’d have to stop taking the testosterone I’d been on for nearly a year and go through therapy without it before being approved. I think I told her rudely how stupid that was to yank a transgender person off hormones for years after starting, in order to get coverage.
In hindsight, I think this was the beginning for Group Health, and not everyone was trained at that point. My next attempt at an appeal got me a call from a very nice woman that said confidentially that I could probably stop sending in my millions of appeals, because at the turn of the year they would be covering transgender people.
She was excited and told me they would cover me and that they were working on a new program. Top surgery was even going to be covered. After a full-on year of warring with Group Health, I was shocked and relieved. Washington State had decided transgender people counted for medical coverage.
It was around this time, that my husband started working for the Department of Defense. What we didn’t know was that the federal government had its own separate rider on their insurance barring any coverage for transgender medical care.
That was probably some of the single most frustrating set of issues I have dealt with. When everyone around me was suddenly getting access to insurance covered hormones and surgeries, the federal government had decided to continue to bar transgender medical coverage.
That was when Lucky decided to launch an official HR complaint. I was worried that by launching this complaint that my husband would be risking workplace harassment. He didn’t care. He was incensed that they would not cover me.
This was a slow, tortuous process because they took months to get back to him. Lucky gave them legal rulings, and state requirements, regarding medical coverage for transgender patients.
The people he dealt with were nice, but ultimately put him off. My case was being handed up the Department of Defense, “all the way to the top.” He was told I was the first civilian transgender person they had ever had to deal with.
The Department of Defense had just lost two very prominent court cases in regards to two active duty transgender women. I think those women were instrumental to my case being dealt with properly.
In the end, they told my husband to sit on it, because at the turn of the year, they would be dropping the anti-transgender rider on Department of Defense healthcare.
It was around this time I got hired at the same agency as my husband, so I was content to wait until 2016 to get my top surgery done.
To my surprise, there was no fallout for my husband making a complaint about my coverage. After the law firm I worked at, I could only feel relieved that you could work somewhere, be openly transgender and it was met with reasonable adult reactions.
Group Health did a lot right, as in helping my primary care physician to feel comfortable prescribing testosterone for me and having a case management system specifically for transgender people to help us get through the system.
However, not everything was the way I’d hoped. Group Health still required me to see a therapist to get an official letter stating I had gender dysphoria and needed top surgery.
My case manager, Raelene, was excellent. I explained my dislike of gatekeeping behavior and that I wanted a one-appointment therapist. I was in my 40s and had been on testosterone for years. By this point, I had been hired by the Department of Defense and my job had me flying across country leading to repeated hold-ups in airports because men should not have giant double D breasts in the scanners.
My case manager steered me to a wonderful therapist that would rubber stamp me through the system after I explained I was not willing to spend any amount of time in therapy to get surgery. I felt safe in this ultimatum because I had a credit card with $10,000 in credit available just for this. I was going to get my surgery, even if I had to pay it out of pocket.
I had the choice of two therapists in the area: one was a wonderful woman that believed I was a transgender man and one was a terrible guy who demanded a minimum of three appointments to make sure it wasn’t some sort of sexual fetish.
I chose the better option and got my letter in one fell swoop. I also had a backup therapist that was out of network, but was anti-gatekeeping as well.
I wasn’t sure about all the time and hoops, but I did get through it
. I got my letter of approval from Group Health and just like that, I had won the war I started with them.
Chapter Eleven:
Top Surgery
I’ve had so much plastic surgery, when I die they will donate my body to Tupperware.
—Joan Rivers
From the Accidentally Gay Blog: Some Top Surgery Thoughts
Posted on April 3, 2016
Things are going great with Wolsey’s surgery. He is looking fantastic. It has been a little over eight weeks since he had it and his chest is healed up well. The liposuction on the hips and belly are a bit rougher healing-wise for him, but look great. I will post pics in the future of him, but I felt it was better he got to post his results first.
However, the flat chest is something I am still getting used to. Not in a bad way, because he looks really good. I am still really attracted to him, but it is still taking a bit to get used to the changes.
Holding Him: For 22 years, I had a hard time holding him around the chest from behind. I would often come up behind him, wrap my arms around him, and hug him. My arms would barely wrap around. Now, my arms wrap around completely and I can actually hold my opposite elbows. It isn’t bad, but every once in a while, it just catches me off guard, and I usually have to do a double take.
Open Windows: This became apparent yesterday. We had just gotten out of the shower and he was sitting at his computer without a shirt on. I was on autopilot as I shut all the drapes. I had been so used to doing this for him for 20 plus years, so he could walk around topless without people freaking. I find myself doing it on autopilot when he doesn’t need it.
Body Reassurances: Sometimes, when I was feeling lovey or stressed and we were in private, I would lean over and cup a breast (sorry if its TMI, but then again you have read my other posts right?). When this is done, it is usually a subconscious thing, I don’t actively think, “Hey, I want to hold his breasts,” it was just something that developed between us. It became a weird automatic thing, which now I find uncomfortable that I had ever done it at all.
I have done it a couple times since then, followed by the resulting awkwardness as I look up realizing I had tried to touch, but just ended up poking his flat chest. We both laugh when it happens. It is just weird how an unconscious habit like that keeps going.
New Clothing: He is tossing out half a dozen shirts. He likes clothes that are nice, and now most of his shirts are billowy on him and don’t fit. When we went out and bought a new shirt, I was caught off guard, because even with a binder he had a thicker chest, but now he wears shirts that hug his body and it gives me a double take. He worries about the money to replace his wardrobe but I am more than happy to get him whatever he wants.
As a side note, I still like laying my head on his chest. The missing breast tissue doesn’t seem to really make a difference for me. It is still a very comfortable place to be and I get to hear his heartbeat better.
In short, I love the way he looks. I think the old habits are extinguishing quickly and I am sure inappropriate new habits will develop.
I am really proud of the struggle he went through and I couldn’t imagine being with anyone else.
Lucky’s Perspective Now:
I never would have imagined that Wolsey’s top surgery would prove to be the toughest situation I have ever dealt with in my life. It was tougher than living with my entire family in a car for almost two years as a homeless kid, while having a contract on our head. It surpassed any childhood experience of cops breaking down doors, of biker parties, or of family going to and getting out of jail.
Top surgery was an exciting prospect for Wolsey. He had been wearing binders that reduced his rather large double D breasts to almost flat for close to two years. I would see how uncomfortable he was wearing them, and even more so when he wasn’t wearing the binders and had to go in public and risk being outed.
I suspected it was a little easier when he got hired at my office at the Department of Defense. The entire office has never been anything but accommodating and supportive of Wolsey. Even before he started working there, they always asked about him, and wanted to help in any way they could. I can’t thank them enough for that.
We had just gotten Wolsey’s approval letter and the top surgery process started on target with our plan. Our goal was to have Dr. Mangubat perform the mastectomy and possibly some masculinizing liposuction. Wolsey was a very attractive and femininely shaped woman, so he understandably wanted to get rid of the curves along with the breasts.
We met with Dr. Mangubat and went over the process for top surgery. The doctor gave some suggestions on the mastectomy, and even more on the masculinization liposuction. In the beginning, we weren’t sure how much of the latter Wolsey would want, but we knew that Dr. Mangubat is a great doctor and that we could trust his word.
We had saved a little bit of money and were eligible for medical credit. We had anticipated we would need that for the mastectomy itself, but surprisingly the mastectomy was covered except for $1,000. This unexpected lack of debt, meant we could switch it over to help pay the lipo that would masculinize body areas that he was unhappy with.
We went home and prepared for the early February surgery. Wolsey arranged to spend all of his accumulated leave, but was still going to be short. I volunteered to donate mine, but the paperwork just wouldn’t go through. We prepared our budget for his paycheck to be short about a week’s worth of pay. It was definitely worth it.
During this time, I think the binders were bothering Wolsey more. He was a bit grumpier about them, they hurt more, and he was just more uncomfortable. Don’t get me wrong. The binders are horrible to wear, but the closeness of the surgery made him think about it more.
In addition, Wolsey was now working for an agency that required him to fly across the country for training. Every time Wolsey flew for the job, he would go through the scanners and the TSA agents would pull him aside and body search him. He appeared male, but the X-rays showed boobs. This was pretty frustrating for him and it annoyed me when I heard about it.
He was also uncomfortable without the binders on. When he was home and took the binders off, he covered his chest more when it was just the two of us. I was incredibly grateful we could fix this in the next few weeks.
During this waiting period, we talked about the liposuction. I am for whatever Wolsey wants to make him feel better. The way that Dr. Mangubat explained it, it actually sounded great. The one fear that both Wolsey and I had was the recovery for liposuction. We had heard from the media and others online that liposuction recovery could be “problematic.” This means it could be pretty damn hard on the patient.
We went to one last pre-surgery appointment and Wolsey asked the medical assistant what the recovery was like for liposuction. The causal response of six months came up. I think both Wolsey and I were pole-axed by that comment. At no point in time did we even comprehend that the liposuction would take six months to recover from. We realized there was a lot of areas, but six months was gobsmacking.
The medical assistant noticed our reaction and immediately went on “don’t be over reactive” mode. She tried consistently to quiet Wolsey’s worries about being out a long time. I think she realized we were considering backing out on the liposuction while still keeping the mastectomy.
The assistance’s answers started ping ponging back and forth and Wolsey eventually pushed the assistant to get the doctor. Doctor Mangubat came in and it was apparent that the assistant had reported us as being difficult. The doctor’s arrival was to reassure us. He told us that he had similar liposuction and had returned in three days. He also was pretty good at using a weird form of peer pressure that Wolsey wasn’t a wuss and could handle it. Reluctantly, Wolsey agreed to keep the liposuction because he really wanted those results.
Later that week we got a call from my mom. My father had gone into the ER with pneumonia. We went up to check on him, driving the hundred plus miles each way, and while it is always a bit disconcerting that my dad goes in
to the ER so regularly, it was standard operating procedure at this point.
My father would go into the ER a couple times a year with pneumonia, get antibiotics and oxygen and go home. He had emphysema and COPD, both of which are lung diseases. He had been like that for years and we all had a rhythm on how to handle these interactions.
We got there and he had already gotten out of his bed, went out and had a cigarette, then checked himself out. The doctors weren’t sure about this, but my dad always did things his way. They gave him a final checkup, gave him his meds and he went home. Within a day or two, he was feeling better and the crisis had been averted.
The day of Wolsey’s surgery arrived and things were in high gear. I took Wolsey down to the surgeon, and sat with him while they started the prepping process. Then the longest three hours of my life occurred, as he disappeared into the back of the office. The surgery was in the office and not in a hospital setting. That was something I hadn’t expected when we started this.
I went out and ate at a fast food place, then picked Wolsey up a giant three-foot-tall teddy bear and placed it in the passenger side of the car. I then called my parents and talked to them. They are always the go-to for me when I am stressed. Turns out they were worried about Wolsey too and were also excited. It was great that they were as excited as we were.
Wolsey came out of surgery late that afternoon. I was so happy to see him when they took me back. The problem was he wasn’t making any sense. He obviously was very slow to come out of the anesthesia. I was a little worried and asked the nursing staff if he was ready. They assured me he was, but I still suspect since it was after 4:00 p.m. on a Friday that they wanted to go home.
Like I said, he was out of it. He was bandaged up super tight around his chest and was wearing his hoodie. He looks like he was in so much pain that I was starting to get alarmed. Once again they just reassured me, put him in a wheelchair, handed me two chucks (basically incontinence pads) to put on the car seat and escorted me out the back door.
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