CONTENT WARNING: surgery, mention of pregnancy and childbirth
Among many other exciting happenings this year - getting a dog, having my first and probably best full-time job, buying my first home - possibly the most exciting thing for me is that tomorrow, I'm getting a gender-affirming hysterectomy. For those who didn't realize that was a thing, it's exactly the same as a normal hysterectomy, except that instead of being for cancer or family planning, it's to affirm my gender and prevent experiences that cause dysphoria. (And, since it's an entirely joy-oriented experience, I also get to call it things like "yeeterus" and "utern't". Fun!)
I don't plan on having any of the traditional gender-affirming processes - top surgery, bottom surgery, testosterone, etc. I've considered them all and decided that I'm happy with a binder and the features and hormones I started with. There are only a few things that have caused major and consistent dysphoria: being misgendered, having to pretend to be cis, having a period, and the idea of pregnancy and childbirth. There is no surgery or hormone that can prevent me from being misgendered as a nonbinary person, and regrettably, we live in a world where sometimes I have to pretend to be cis. But there is a way to prevent periods and childbirth, and by god, I am getting it. (And in a uniquely delightful twist of fate, I'm getting it the day before my birthday.)
There are, of course, several ways to prevent those things. I could, for much less money and a much shorter recovery time, get an IUD or other birth control device. But those are ongoing costs, repeated discomforts, and the risk that I will still have periods and get pregnant. There is no birth control method with a 100% success rate besides abstinence and simply not having the necessary plumbing.
While many people I know have had hysterectomies, very few of them have been gender-affirming. So I've decided to document my experience, from start to finish, both for posterity and to provide a window into the process for anyone else seeking a gender-affirming hysterectomy.
I'm lucky enough to live in Massachusetts, a state that is, in the grand scheme of things, extremely safe for trans people. I still worry about what might happen, but I have never been the victim of a hate crime, I have never been the subject of medical discrimination or abuse, and I have access not only to gender-affirming surgeries, but also coverage for those surgeries. My insurance, in fact, covers all traditional gender-affirming procedures and gender-affirming hysterectomies and family-planning hysterectomies - a rarity even in this very blue state. Even better, because Massachusetts is progressive in its legislation, I didn't need to go through the rigorous approval process that I might have gone through in another state. In other states, I would have needed two letters of support from therapists (at least one of whom had a long-term relationship with me), a year on testosterone, and a longstanding formal diagnosis of gender dysphoria - and that's assuming I could even get a gender-affirming surgery of any kind. Here, I needed one letter from a therapist I met one time, a note from my PCP saying I had dysphoria, and nothing else.
THE PAPERWORK
The letters were pretty easy to get; one was from a trans therapist with whom I bonded during our session because we had been in the same Jewish youth programs, and the other was from my PCP, a remarkably chill guy whose response to most of my concerns is "that sounds like something you're experiencing, let's find out why", instead of "have you considered that you're imagining it". (Example: I said I was pretty sure I had long COVID, despite never having tested positive, and he just believed me and put it in my chart.) I am very lucky to have the care I have, and I have definitely had worse doctors throughout my life, from the therapist who didn't believe me when I said my meds were exacerbating my depression to the PCP who wouldn't address my concerns about being underweight because "you look great!" Regardless, circumstances and research conspired to make the letter acquisition process easy enough.
Getting in touch with my insurance was harder. Blue Cross is one of the best insurance companies in Massachusetts, and my coverage itself is very good; however, what they provide in care, they lack in customer support. My questions for them were fairly straightforward:
Is a gender-affirming hysterectomy covered by my plan?
If so, what requirements do I need to meet?
If not, is a family-planning hysterectomy covered?
Two of these three are yes-or-no questions.
It took six weeks to get them answered.
Six.
Weeks.
I started with the "contact" feature in the online portal, because I'm HoH and also hate talking to people. I asked the first two questions in one message, figuring that it would be easier for them to answer both at once. Apparently, however, the BCBS online support team are the fairies from J.M. Barrie's works who "only have room for one feeling at a time". I received an answer within a week: yes, a gender-affirming hysterectomy was covered. Cool! I wrote back immediately, asking what the requirements were. No response.
A week later, I sent a separate message through the online portal, along the lines of "I know gender-affirming hysterectomies are covered; what are the requirements?" About a week after that, I received a document detailing the requirements for top and bottom surgeries for both AMAB and AFAB people - fascinating, but not what I was looking for. I wrote back, emphasizing that my question was about hysterectomies. No response. I realized that the "reply" feature was useless.
My following inquiries grew more and more aggressively specific as I tried desperately to encompass all of the information they seemed to be missing so that I could get the answer I wanted. My last missive was something like this:
"Hi! I'm looking for specifics on the requirements to get a gender-affirming hysterectomy covered. I am not seeking a mastectomy, phalloplasty, orchiectomy, or vaginoplasty, nor am I seeking hormones. I am specifically looking for information on getting a gender-affirming hysterectomy covered as a nonbinary person who is not on hormones and does not have or want any other gender-affirming services planned."
I received a packet on coverage for gender-affirming electrolysis.
Fed up, I did the unthinkable and called them. Under ten minutes later, Tracy from BCBS had heard my question, sent me the correct packet, and called me back to walk me through it and answer any remaining questions. Moral of the story: sometimes you have to make the phone call.
THE CONSULT
Finding a clinic was more of a challenge than it needed to be for one reason and one reason only: most trans clinics in the Boston area had not (and likely still have not) updated their websites to reflect current requirements. My insurance didn't require me to be on hormones, but according to their websites, most trans clinics did - an access barrier I found utterly baffling now that I had made it through the grueling process of insurance.
As it turned out, most of these clinics do not require hormones, or a second letter from a therapist, or anything else besides the one letter and a reasonably consistent desire to get something done. They're just understaffed and/or technologically lacking. I finally got in touch with the Massachusetts General Hospital Trans Health Program, and my consult was scheduled for a month later.
The consult was by far my favorite part of the process. Two weeks ago (can it really be so recent?), I met with my urogynecologist, who I can say with complete certainty is the most enthusiastic doctor I have ever met. This isn't a woman who merely takes pride in her work; this is a woman who takes joy from her work. She was friendly and warm, answered my questions clearly and accessibly, and was obviously in her element. I made a joke about spring-cleaning my organs and she cracked up. Most delightfully of all, I asked about the possibility of vaginal prolapse, and to my astonishment, she lit up and exclaimed that that was her area of interest, then proceeded to screenshare diagrams while she explained the mechanics of the pelvic floor. She did the same a few minutes later when I inquired about the benefits of leaving versus removing my cervix.
Never, in 26 years of care, have I received a multimedia infodump from a doctor. I have never had surgery before, and of course I'm experiencing some amount of trepidation, but it's hard to be particularly nervous after your surgeon spends almost ten minutes excitedly explaining how prolapse works. (Plus, the prolapse thing was by far my biggest worry, so it's pretty cool to know that if I do experience it, my surgeon knows a lot about it.)
As we were wrapping up, she mentioned that I would likely need to acquire some letters and things for my insurance. I let her know that I had already taken care of it, and she exclaimed, with genuine pleasure: "JO! I wish I could hug you right now!" No doubt about it: I'm in good and friendly hands.
When I asked about timelines, she said, "I'm not technically supposed to tell you a specific date, but we just had a cancellation earlier today for April 20th, so I'm gonna confirm that cancellation, and if it's confirmed, you can get in then. If not, it'll be this summer." I couldn't believe things might happen that quickly, but later that day, I logged into Patient Gateway to find that I had an appointment freshly scheduled for April 20th. I was suddenly getting a hysterectomy.
THE PREPARATIONS
The hardest part of such a surgery is recovery. I'm getting a laparoscopic hysterectomy, meaning they'll make several small incisions and snip my uterus (and fallopian tubes and cervix) from of their moorings for removal. It's not unlike carving a jack-o-lantern by scooping the insides out through the eye holes. (I know, gross.) This is the least invasive method and requires the least recovery time, averaging four to six weeks; but I've been told that I likely won't be back to full strength for a couple of months. In the meanwhile, I'm likely to have abdominal pain and swelling, constipation, nausea, and other fun things. Plus, I'll have three incisions in my abdomen, which is where my muscles are.
So there were things to get done. First, I had to tell my workplace that - surprise! - I would be going on medical leave in two and a half weeks, both of which were partial work weeks due to Passover. Instead of the expected fourteen work days over those two and a half weeks, I had eight.
My boss is, at this moment, astonishingly overburdened, being both the CEO and interim development director. Furthermore, when I broke the news, she was about to travel for ten days, return for two, and then travel again for another week. My leaving right now is not precisely convenient for her. But to her credit, she took the news with equanimity: we made a list of my tasks and discussed how they would be covered and what I had to do before I left. We managed things pretty well, but there was still a lot to finish.
I had to apply for medical leave, and my nesting partner, Jack, had to apply for family leave. I had to buy clothes in larger sizes than my usual to be prepared for the swelling - a task that was uniquely unenjoyable because I discovered that I had, at some point in the last six months, gone up two sizes. (It's wonderful to not be underweight anymore, but I would really like to stop having to replace my pants.) And I had to gather all kinds of accoutrements for surgery prep and recovery: an abdominal binder, medications, a special antiseptic soap, my cane, and enough sedentary activities to keep me amused until I can move comfortably again - fiber crafts, games, and a two-foot pile of books.
My friends, family, and partners, being who they are, went completely overboard. One friend sent me a link to a shirt bearing a picture of a uterus and ovaries and the caption "here to cancel my monthly subscription" (which I am in fact wearing to surgery). Another friend bought me a hysterectomy pillow for support and padding, which has a belt and a pouch for ice packs. A third friend sent me an ominous message about how she had a birthday gift for me that I was "going to want" after surgery; she showed up at my apartment with a pro controller for my Switch. And my mother, ever the comedian, got me two different items featuring awful uterine poetry. One is a notebook whose cover proclaims:
"ROSES ARE RED
GIRL PARTS ARE HUMOURLESS
YOU'LL BE MUCH BETTER OFF
WITHOUT THAT DAMNED UTERUS
❤️"
It was accompanied by a card, which says on the front that "Along with that heavy flow, your uterus has to go!", and then adds inside: "Hooray for hysterectomies and super quick recoveries!"
My father, not to be outdone, contributed a birthday card featuring a glued-in "yeeterus" graphic, as well as a larger printout of the same graphic. Look at this:
No one else I know has as strange and wonderful a family as I do.
At this time tomorrow, I'll be through my first (and, God willing, only) major surgery. I should probably be a little more nervous, but I've already achieved so much and received so much support that it's hard to feel like this is anything more than the next step in the journey.
See y'all on the other side!
Comentarios