Deciding Top Surgery Was My Top Priority
Top surgery actually wasn’t one of my immediate goals — maybe something I would do within the next few years. But then something exciting pushed it to the forefront of my reality: I learned that my university explicitly covers “GRS” (gender reassignment surgeries) under its’ students health plan. I’ve been on-leave from school for the past 3 years, and apparently it’s only within the past 3 years that they’ve been covering…what a thing for me to almost miss!
Once I learned that I could get top surgery covered, I figured I might as well go for it if it was something I wanted to do anyway; I could save the thousands I would use on surgery and build something else exciting for my future. And maybe I could help some other guys along the way by documenting the process. (Unfortunately, I think universities covering top surgery are an exception rather than a rule at this point, but I’d recommend everyone read their health insurance plans front-to-back. I will cover more insurance details in a future post).
Top surgery is covered by my health insurance! Time to pop the champagne?
Insurance companies covering trans*-related surgeries isn’t yet common for most employers and universities. Mine happens to cover, presenting me with what at first appears to be a “jackpot!”, followed by the realization that there’s a long rainbow to walk over to get to the gold.
Even a glance tells me that the requirements insurance companies place on us are much stricter than if you were paying out-of-pocket. As this account points out, many top surgeons require a letter from a therapist or doctor stating that surgery is the next step in your transition. Some surgeons do not even require a letter from a doctor, and instead ask for your informed consent. Insurance companies will likely require lengthier letters from all your clinicians, a letter from your prospective surgeon, and a requirement for a length of time you have expressed gender dysphoria to your clinicians (whether or not you acted upon it).
Continued from TfTM Blog: Legally Transitioning, Part 1 — My Name Change
With 4 months of gender therapy behind me and with my hormone letter (in which my therapist states I have no underlying mental illness and am ready for a doctor to prescribe me testosterone) in sight, I began the process of legally transitioning my gender marker from “F” to “M” on my identity documents. In some states this requires you to have proof of having gone through “sex reassignment surgery” — whatever that means. Usually just top surgery suffices … but I’ll save my rant on why this is an unfair way for the state and federal government to determine a gender transition “complete” (is it ever really over, in some senses?) for another post.
Anyways, in the state of Massachusetts you do not have to show proof-of-surgery in order to change your drivers license/state ID — all you need is for your gender therapist to fill out and sign a gender reassignment document to submit. For efficiency, I decided to change my legal name on my ID at the same time, which actually required me to change my legal name on my social security card first …cue frustration crescendo as the RMV rejects my initial attempt to get a new ID!
I decided to legally change my name shortly after I began gender therapy, with the prospect of being prescribed testosterone at least another half year away. In transition, there’s no hard-and-fast rule about when to change your name (if you decide to change it at all), as opposed to a legal gender change, which does require a certain chronology (at least in Massachusetts). To change my name, all I had to do was pick one, file the appropriate paperwork at probate court, pay the exorbitant fee (~$200), and wait the 5 weeks to receive my official name change document in the mail. Unlike others I know, I did not have to announce the change in the newspaper or even appear before a judge; all I had to write was that the change was “personal”/”name I use daily” and I received the stamp of approval. I got the impression that as long as the change wasn’t in service of evading a past crime, the state didn’t really care why I wanted it.
The minute I received my official name change document in the mail is where the fun began . With this piece of paper in hand, I suddenly felt the power, duty, and burden of having to inform everyone from my school to my bank to my job to my utility companies. As soon as the name change order was stamped into being, my former name ceased to be “real” and the new one was “who” I was … yet the old name persisted on everything I had touched up until now.This left me feeling in a sort of limbo where everything felt false, down to even the perfunctory level of giving my name to the barista for my daily coffee. Unless I went to everyone individually and changed it. (I acknowledge that this sense of
“falseness” was a personal — and actually somewhat unexpected — reaction, and not everyone who doesn’t immediately switch over to using their new name after a legal change is somehow deceptive. Moreover it was a personal feeling of not being true to myself, rather than feeling I owed it to everyone else to not “trick” them — none of their business, in my opinion!)
However, to go to everyone and announce my name change was, in a sense, to announce my transition.
So, you’ve defined your goals (though they may change) and are ready to start transitioning. If only it were now as easy as flipping a switch to get what you wanted! Unfortunately we live in a world of limitations and opportunities, privileges and obstacles. While you may be in an emotional and mental place where you feel ready to start achieving your goals as quickly as possible, you have to recognize that we all have to work within a structure. The ways in which you achieve your goals may fight to break this structure or you might find comfort in following in the footsteps of those who have gone before you.
Particularly if you have chosen a legal and/or medical transition, you are a guy who has to deal with systems that are often not defined by transmen themselves. This can be really frustrating at times; you might feel that it’s not working fast enough or you’re being left out of the decision-making process. I have two related pieces of advice for you in approaching this: set yourself up for success and be realistic about how and how quickly you can achieve your goals.