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Jan. 4th, 2012 | 11:05 pm
location: outta my head
disposition: draineddrained

So... yeah, now I need breast surgery.

Click the link to read about my doctor's visit.

My (ex-)partner wouldn't go with me and just said, "Sorry." The friend who was supposed to go got pneumonia. So, I went alone. I wore my standard androgynous uniform.... men's shoes, women's jeans, and a men's button up flannel shirt... no accessories, jewelry, makeup, or perfumes. This differs from my "presenting as male" work attire only in that I wasn't wear an under armor sports bra and didn't have my pulled back into a pony tail. And people think Clark Kent's glasses are a thin disguise?

When I arrived, I discovered that a major mix-up happened that basically made me not have a scheduled appointment for either of the two things I was coming in for. The attendant made repeated calls, asked my doctor to fax paperwork, had them correct things, etc. They were full for the day but she managed to get me in to be seen on both floors. Aside from the unexpected exceptional kindness, nothing was out of the ordinary.  Everyone was being nice and addressed me as mam and miss.

When I went through registration, I handed over my driver's license and said, "Please try to be discrete if possible." The registrar nodded, looked at my license, asked me if my address was correct and read it to me, and sticker-ed several hospital forms. When she was done, I was ready to go back to waiting but to confirm said, "So... there's no problem with the discrepancy?" and directed my eyes toward my driver's license. She looked again and said, "Oh!" and began peeling off stickers and re-doing things. I offered, "Could we just pretend that I didn't point it out?" She said no, that it had to match for the insurance and billing which is what I supposed. So then it was there on my forms and on my paper wrist bracelet and I felt as if I had been given the Star of David.

First, I had to do gastro. That meant that I had to drink Nuka-Cola (barium), a radioactive isotope that allowed the doctor to say, "See?" and show me what a minor hiatal hernia and medium acid reflux looks like. No action was recommended. The advice was what you would expect: Try not to eat within three hours of laying down to sleep, try to elevate my upper torso slightly, avoid acidic foods, continue using an acid reducer. Then it was on to the women's clinic on the next floor.00

At the front desk, I said my name and asked if they needed anything else. She motioned toward my chest and said, "Nope, just the girls." I noticed that there was one door that said "women only" and also noticed that when I was called to come to the back that I had to take the long way around rather than go through THAT door. Rules are rules, I guess. As I was passed from person to person in the medical assembly line, each person either didn't notice or didn't say anything until I did.

We arrived in a closed room that was the fabled station of mammograms. Not knowing how much the first medical tech had looked at my paperwork, I volunteered that this was my first time. A large stand that resembled scales stood near the wall. It had a rotating platform at chest height. I was expecting this to hurt and was almost disappointed to find that it was really only a little uncomfortable and only for a moment--they were vice grips... they just weren't tightened all the way. It was not remotely bdsm. "Hold your arm along the edge here and then hold the other breast back." Sandwich, x-ray, rotate, sandwich, x-ray. Now, the other one. "Try to place the BB where the lump is." Confirmed, it is a lump--money well spent. So, they would have to do ultrasound, which we already knew but you know, people have to work, I guess.

Ultrasound was especially cool for me since I've never been pregnant. I was told again to stand next to this big platform and face my feet forward... then the entire thing rotated into a bed. This seemed awfully high tech compared to just laying down on something. It was totally a Han Solo moment.

"This is going to be a bit warm," the tech warned. I braced anticipating but alas, no wax play was to be had and it was instead only lukewarm. Then she rolled a wand around and showed me the image. In the typical medical visit, this would be the part where I try to trick the tech into telling me what she thinks even though she's not supposed to. According to the experiences of female friends, I wouldn't be finding anything out today and would instead have to go home and wait for a call or a letter telling me how many breasts they had to remove or how many weeks I had left to live.

But this time, there was no barrier and the information came readily. "It's a tissue mass," she said. "Which means what?" I asked. I imagine in her daily job, she just waits for the patient to say "cancer," before saying, "Probably not, but we would want to check." A few moments later, a pair of male doctors came into the room. One shook my hand in that enchanted princess way and the other just gave the more gentle female version of the normal handshake. It's sad that even in times like this, I pay so much attention to things like that but it's called dysphoria for a reason.

One of the doctors confirmed,"You're on hormone replacement therapy, right?" I confirmed, "Yeah, estradiol." He said, "Ok, so we could biopsy it but if you're going to keep taking estrogen, you may as well just have it removed." I attempted to translate, "So in other words, I could have it removed now or I could leave it alone and just biopsy a sample... but if the sample is ok and I want to have it removed later anyway, insurance won't want to cover it?" "Right," the doctor said, "It's probably fine but it would be a good idea to check either way."

After the two doctors left, I remained alone in the room with the ultrasound tech. She asked, "Did you have any questions?" I probably looked a little perplexed and asked, "What would you suggest?" She said, "Personally, I would go ahead and have it removed." I asked about the incision and she said, "You'll want to go to a breast surgeon. He'll cut around the aureola so the scarring will be less visible. Don't go to a regular surgeon, though." I translated again, "Because they'll be butchers?" She answered, "Correct." I asked if she knew whether the surgeon would be good with someone like me. She acted as if she didn't know what I meant. I said, "I'm sure you saw the paper work but..." and turned my paper bracelet to the part that said, "Male." She said, "Oh, I see, right... Well, let me check on that... I know some people I can ask."

I asked, "So what is this exactly?" She said it was gynecomastia, which I had always thought was a more general term for "male breast growth." She explained that it was basically a condensed lump of normal breast tissue that has broken loose and that if I have it removed, I will notice the indentation at first but that it would go back to normal and be closer to the same size as the other breast. She said, "It's caused by hormone fluctuations like guys using steroids or marijuana use. It was probably from when you first started taking hormones." I said that I had a slow and unusual puberty and she said, "So it was probably there from puberty but began to grow when you started the estrogen. Since you're probably always going to be on estrogen, you probably want to have it removed because it will just keep getting bigger."

I said, "I would assume you've probably gotten people like me before?" Seeming proud of herself, she said, "You're lucky you got me. One of my husband's friends from college is transgendered and she went all the way with the full surgery and birth certificate change and everything. More often, we get the guys in here and it's worse for them..." I nodded and said, "Imagine that some of them have full beards and everything and still have to get a pap." She said, "All the guys ask for me here... they won't let anyone else see them because I'm sensitive about it. So... let me find out about surgeons. Call back up here and ask for me." I asked her to write her contact info and she wrote her name and a phone number on the back of one of my form copies.

On the way out, I passed the charge nurse who had been so friendly when I first arrived. I searched her face for disapproval wondering if her friendliness would be withdrawn with her new-found knowledge about me. She smiled and asked, "You're still here?" sympathetically.

It was almost 4pm as I left the clinic yesterday. By 11am, I had a message on my phone from the ultrasound tech. She said, "I was just calling you to let you know that I have spoken with some of the staff over at one of the breast surgeon's office and they will be glad to see you. I explained a little bit of the situation and the office manager was glad to go ahead and try to set up an appointment." She gave the surgeon's name and the office phone number, then said, "His office is on the same floor as ours... just across the hall. I spoke with the office manager yesterday about your concerns for privacy and everything and she understands that. If you have any other questions just call me back and let me know."

So... I need breast surgery.

And, I guess I need to plan to have my driver's license updated soon since I'm apparently passing as female.
Or, failing as male... whichever.

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