Is being on Testosterone required?

[Wolfy]

Is being on T required to start top surgery? and if not does it look any different or cause any differences when you start on t?

[Wolfy]

No, T is definitely not required. Plenty of people have top surgery and are NOT on T.

Will this cause any problems when starting T? or to your knowledge.

[Wolfy]

I'm not entirely sure how it'll turn out for me. Hopefully going for top surgery first and maybe t at the same time. I wish I could start T first but I highly doubt it.

Edited for personal information.

[Bimmer Guy]

Chest will still look good/like any other guy's, even if not on T.  Look at the Top Surgery Recovery thread (it is a sticky).  Both me (post#1) and Alexthecat (page 6, post # 114), were not on T at the time of the pictures.  I am not sure if there are others in the thread that were not on T, as not everyone indicated whether or not they were on T. 

[Mr.X]

It is required here, but it turns out the American systems works quite different from the European one.

Even so, it is still advised. You will get some pec development (that's why working out some beforehand is also a really good idea) which will help the surgeon sculpt your chest, using the developed muscles underneath. If you are not on T, the surgeon can still sculp it, but is left more in the dark about any pec development that will happen after. I'm not saying that people who have top surgery and no T have bad looking chests. Not at all. But if you have a choice, and want to help the surgeon as well as having the biggest chance of good results, start T first.

[aleon515]

Not everyone wants to be on T, so there is no reason to be required. I don't think Dr G cares one way or the other, so not sure all surgeons really care. I realize the NHS (and so on) are different.

--Jay

[Bimmer Guy]

It is required here, but it turns out the American systems works quite different from the European one.

Even so, it is still advised. You will get some pec development (that's why working out some beforehand is also a really good idea) which will help the surgeon sculpt your chest, using the developed muscles underneath. If you are not on T, the surgeon can still sculp it, but is left more in the dark about any pec development that will happen after. I'm not saying that people who have top surgery and no T have bad looking chests. Not at all. But if you have a choice, and want to help the surgeon as well as having the biggest chance of good results, start T first.

What I am reading is something that I have understood to be an old myth.

It isn't like the muscle is going to change shape after you get on T.  The boundaries of the pec will remain the same, regardless of size.  The surgeon can easily find the line of a pec muscle on anyone. 

Garramone said to me "there is no such thing as contouring the chest, you are just placing the incisions in the correct place [under the pecs]".  This is a loose quote.  His point was "contouring" doesn't really exist, it is just a term that is used...the best doc goes along the pec line...that is all there is to this "contouring". 

I am referring to the DI operation only when speaking about the above.  I know nothing about contouring and such for non-DI surgeries.

[wheat thins are delicious]

Not everyone wants to be on T, so there is no reason to be required. I don't think Dr G cares one way or the other, so not sure all surgeons really care. I realize the NHS (and so on) are different.

--Jay

Some surgeons definitely do require you to be on hormones, but not all do.

[aleon515]

What I am reading is something that I have understood to be an old myth.

It isn't like the muscle is going to change shape after you get on T.  The boundaries of the pec will remain the same, regardless of size.  The surgeon can easily find the line of a pec muscle on anyone. 

Garramone said to me "there is no such thing as contouring the chest, you are just placing the incisions in the correct place [under the pecs]".  This is a loose quote.  His point was "contouring" doesn't really exist, it is just a term that is used...the best doc goes along the pec line...that is all there is to this "contouring". 

I am referring to the DI operation only when speaking about the above.  I know nothing about contouring and such for non-DI surgeries.

Yes it was my understanding too. I think he has said something like he doesn't figure out where the line is, your body tells him (or maybe that was someone else). But regardless same idea.

@Wheat thins... Yeah but it is not so much a requirement for the actual surgery, as someone who is interpreting WPATH under the old standards or something. Because the current WPATH clearly has no statement re: having to be on T. I made a comment about NHS. I know things are different. But I think at least they have changed the old idea that you'd need bottom surgery first. I saw that on Transsexual summer and I was like WT (heck)!

--Jay

[Mr.X]

What I am reading is something that I have understood to be an old myth.

Really? If that is the case I stand corrected. For ages I was told that it would help the surgeon. I will definitely ask my surgeon when I see him in a few months.

[Felix]

This really has more to do with the hangups of your surgeon and your insurance than anything else. I had a lot of chest dysphoria and spent years thinking I'd get top surgery and not even go on testosterone, but I changed my mind about hormones and they turned out to be much easier to get than surgery so I got T first. Part of the problem that I had was that healthcare providers understood that transpeople want hormones, and I was able to explain that to them, but I had a very hard time explaining the need for top surgery. Once I had been on hormones for awhile and had changed my name, it was easier for them to understand why I did not want to have female breasts anymore. That kind of obstacle may not be such a big deal in your healthcare setting, idk.

[Bimmer Guy]

Part of the problem that I had was that healthcare providers understood that transpeople want hormones, and I was able to explain that to them, but I had a very hard time explaining the need for top surgery. Once I had been on hormones for awhile and had changed my name, it was easier for them to understand why I did not want to have female breasts anymore. That kind of obstacle may not be such a big deal in your healthcare setting, idk.

Wow.  You know what?  I have never thought about it this way before.  Meaning, it makes sense to me that the questions from others as to why a "woman" would want to remove her breasts goes away after one starts testosterone.  It is like people need to SEE you are a man before they believe you.  Makes sense.  No doubt this is elementary to others, but somehow reading it the way you posed it, put it into a different light for me...I just hadn't framed it this way in my head prior to your post.  Good stuff!

Mr. X, it will be interesting to see what he says.  Perhaps he is one that prefers you be on T.  My main issue was the idea that T is needed to see the muscle, but even more so the idea of being in the dark about muscle development without T. 

As an aside, your pic looks fantastic in the Before/After thread.  Great changes, and handsome guy!  Go you!

[aleon515]

This really has more to do with the hangups of your surgeon and your insurance than anything else. I had a lot of chest dysphoria and spent years thinking I'd get top surgery and not even go on testosterone, but I changed my mind about hormones and they turned out to be much easier to get than surgery so I got T first. Part of the problem that I had was that healthcare providers understood that transpeople want hormones, and I was able to explain that to them, but I had a very hard time explaining the need for top surgery. Once I had been on hormones for awhile and had changed my name, it was easier for them to understand why I did not want to have female breasts anymore. That kind of obstacle may not be such a big deal in your healthcare setting, idk.

Actually I have heard this idea before. It is the T shows that you are serious but also has you read as male. Also the concept of being female you have to love them and want a lot of them (which I think is a stereotype). Funny thing though. BEFORE surgery, pre-op, Dr G was required to have a nurse in the room while he examined me.( I was actually a bit more uncomfortable with her but she did her best to play invisible.) OTOH, AFTER surgery, while I was getting unwrapped, he was by himself. Without the chesticles I am now seen as male enough that I don't need a nurse in there. Weird actually if you think about it. (Wonder re someone with chest dysphoria. They will perform it on a female identified person. I wonder re the nurse in the room then? Or would top surgery render someone like that almost male status?)



--Jay

[Bimmer Guy]

Actually I have heard this idea before. It is the T shows that you are serious but also has you read as male. Also the concept of being female you have to love them and want a lot of them (which I think is a stereotype). Funny thing though. BEFORE surgery, pre-op, Dr G was required to have a nurse in the room while he examined me.( I was actually a bit more uncomfortable with her but she did her best to play invisible.) OTOH, AFTER surgery, while I was getting unwrapped, he was by himself. Without the chesticles I am now seen as male enough that I don't need a nurse in there. Weird actually if you think about it. (Wonder re someone with chest dysphoria. They will perform it on a female identified person. I wonder re the nurse in the room then? Or would top surgery render someone like that almost male status?)



--Jay

Interesting, Jay.  Did he tell you this is why she was in there?  I had my girlfriend with me, but when it was time for him to look at my chest, I asked her to step out of the office.  He didn't call a nurse in.  Maybe because it was unexpected that my GF would leave?  Was the nurse in there the whole time, or just when you had to take off your shirt?

Inquiring minds and all...

[aleon515]

Interesting, Jay.  Did he tell you this is why she was in there?  I had my girlfriend with me, but when it was time for him to look at my chest, I asked her to step out of the office.  He didn't call a nurse in.  Maybe because it was unexpected that my GF would leave?  Was the nurse in there the whole time, or just when you had to take off your shirt?

Inquiring minds and all...

I'm guessing that's why he didn't, he probably expected the gf to stay there. I don't think it is a legal requirement but it is to protect the doctor's arse, but he didn't say anything whatsoever about it. (I think it is typical for any kind of nudity for a male doctor examining a female bodied person.) Yes, the nurse came in only when I took off my shirt, she didn't look at me. I think for such a small room she played very invisible!

I think it's interesting how my "status" appeared to change after top surgery.

--Jay

[Bimmer Guy]

I'm guessing that's why he didn't, he probably expected the gf to stay there. I don't think it is a legal requirement but it is to protect the doctor's arse, but he didn't say anything whatsoever about it. (I think it is typical for any kind of nudity for a male doctor examining a female bodied person.) Yes, the nurse came in only when I took off my shirt, she didn't look at me. I think for such a small room she played very invisible!

I think it's interesting how my "status" appeared to change after top surgery.

--Jay

I know male doctor/female pt. means a female person comes into the room.  Well, along with our boobs being lopped off Garramone gives us a letter saying we are male, so I guess we were female before that surgery, even if we (you) were on T.  It goes back to the laws, I suppose.  I would be curious to know which specific states allow gender change after top surgery.  I don't know of any that will allow gender changed based on just T, and I know there are some who won't no matter what one does (Texas, I think?).  Anyone have a link?  I will have to check out the Transgender Law Center.

[aleon515]

I know male doctor/female pt. means a female person comes into the room.  Well, along with our boobs being lopped off Garramone gives us a letter saying we are male, so I guess we were female before that surgery, even if we (you) were on T.  It goes back to the laws, I suppose.  I would be curious to know which specific states allow gender change after top surgery.  I don't know of any that will allow gender changed based on just T, and I know there are some who won't no matter what one does (Texas, I think?).  Anyone have a link?  I will have to check out the Transgender Law Center.

I don't think it is so simple as a letter like that. But it may be in Dr G's mind. Simple. He does the sex reassignment surgery and you are now male, switcho-chango. LOL. I know some people were very impressed with his letter, and whoever writes them did a great job, but I was like "okay". I don't feel like it changed anything whatsoever in my mind (the surgery did, but that's different).

Male according to the law, varies by state, document, and what it is you are "legally" male for. I think i went over this elsewhere but there aren't too many documents that are "gendered": driver's license; SS card; passport; and birth certificate. Everyone puts a lot of stock in the BC but not a lot of identification is based on it. Very much is based on SS card and driver's license. But I don't actually think that say walking down the street one is legally anything, unless you have one of those absurd "walking while trans" incidents or something. I doubt any trans guys have these, but it is possible I suppose.


--Jay

[Bimmer Guy]

I don't think it is so simple as a letter like that. But it may be in Dr G's mind. Simple. He does the sex reassignment surgery and you are now male, switcho-chango. LOL. I know some people were very impressed with his letter, and whoever writes them did a great job, but I was like "okay". I don't feel like it changed anything whatsoever in my mind (the surgery did, but that's different).

Male according to the law, varies by state, document, and what it is you are "legally" male for. I think i went over this elsewhere but there aren't too many documents that are "gendered": driver's license; SS card; passport; and birth certificate. Everyone puts a lot of stock in the BC but not a lot of identification is based on it. Very much is based on SS card and driver's license. But I don't actually think that say walking down the street one is legally anything, unless you have one of those absurd "walking while trans" incidents or something. I doubt any trans guys have these, but it is possible I suppose.


--Jay

Ok, here it is:  http://www.lambdalegal.org/publications/sources-of-authority-to-amend#D

Here is a list of each of the states and what needs to be done in order to change your birth certificate.  For my state (and New Mexico, as an aside), I would need to present Garramone's letter and then I could get a NEW birth certifcate stating that I was male (a "new" birth certificate means that it would not be amended with my old sex still on it.  Some states just amend the old one).  That is what would make me "legally male".  Now that I am "male" I can marry as a male to a female, I can get health and life insurance as a male, etc.

My driver's license and passport marker can be changed with just a therapist's or HRT provider's note.  This is a gender marker, not indication of my sex (but yes, it does say male or female, but it is how one sees themselves, not how one's State sees them).

This is the information on social security cards:  http://www.lambdalegal.org/blog/lambda-legal-applauds-ssa-update-to-gender-marker-policy

Historically, the SSA required people to send in proof of STS (for FTM this was top surgery).  "Now transgender people can change their gender marker with the SSA by submitting either certain government-issued documentation reflecting a change, or certification from a physician confirming that they have received appropriate clinical treatment for gender transition. " 

http://transequality.org/Resources/passports_2012.pdf

Passport gender marker change is through ANY physician (including your PCP) saying you have received treatment for your preferred gender.

So, in sum:

1) Passport and social security cards - letter from physicians
2) Driver's License - depends on your state (some will take a letter from your therapist)
http://transequality.org/Resources/DL/DL_policies.html
3) Birth certificate - depends on your state, but I believe that any state willing to change it requires top surgery at this time.

Birth certificate = what I have always heard people describe as them being "legally male" because they can getting married, get life insurance, etc., as male.  Additionally, if you change your BC, you can get all the others changed, no physician note needed.

I hope this is useful to people.  I found this to be the most updated information out there, but if it is wrong, please let me know/post in the thread because I certainly don't want incorrect information left standing as accurate.

[aleon515]

Ok, here it is:  http://www.lambdalegal.org/publications/sources-of-authority-to-amend#D

Here is a list of each of the states and what needs to be done in order to change your birth certificate.  For my state (and New Mexico, as an aside), I would need to present Garramone's letter and then I could get a NEW birth certifcate stating that I was male (a "new" birth certificate means that it would not be amended with my old sex still on it.  Some states just amend the old one).  That is what would make me "legally male".  Now that I am "male" I can marry as a male to a female, I can get health and life insurance as a male, etc.

I don't know re: birth certificate being the be all and end all. Maybe it has in some people's experience. I have maybe been asked for it about 3 times in my life. One having to do with my teacher license  (well actually twice since I got two different ones). A lot fo states do NOT require it for a marriage license. I am pretty sure that AARP and my retirement board are more than happy to sell me life insurance for a price (I have some kind of bare bones one anyway). Maybe other people's experience is fairly different. Actually the last time I was asked for it was one of the 3 and that was for surgery. They told me almost nobody had a changed gender marker on the BC, which is logical I suppose given it often requires surgery!

It's very simple to change the SS (it doesn't actually change the card, there is gender marker on the card). It requires an affidavit that you are receiving medical care from your PHP (I would get a PA or NP to get the MD to co-sign this). The same with a passport. (If you already have a passport. If you don't you do need a BC. I pretty much imagine you can take any BC, your name change document, and affidavit, and  you'd be fine. There are some states which do NOT allow gender marker change on the BC.

I was born in Wisconsin. The statement I guess is sex reassignment surgery. It depends on how they want to define that. NM is very easy, and I have heard of people going in with a letter saying they have had medical treatment... The driver's license is super easy. Motor vehicle actually went to the trans resource center and said, how should we do this. Amazing.


--Jay

[Bimmer Guy]

I don't know re: birth certificate being the be all and end all. Maybe it has in some people's experience. I have maybe been asked for it about 3 times in my life. One having to do with my teacher license  (well actually twice since I got two different ones). A lot fo states do NOT require it for a marriage license. I am pretty sure that AARP and my retirement board are more than happy to sell me life insurance for a price (I have some kind of bare bones one anyway). Maybe other people's experience is fairly different. Actually the last time I was asked for it was one of the 3 and that was for surgery. They told me almost nobody had a changed gender marker on the BC, which is logical I suppose given it often requires surgery!

It's very simple to change the SS (it doesn't actually change the card, there is gender marker on the card). It requires an affidavit that you are receiving medical care from your PHP (I would get a PA or NP to get the MD to co-sign this). The same with a passport. (If you already have a passport. If you don't you do need a BC. I pretty much imagine you can take any BC, your name change document, and affidavit, and  you'd be fine. There are some states which do NOT allow gender marker change on the BC.

I was born in Wisconsin. The statement I guess is sex reassignment surgery. It depends on how they want to define that. NM is very easy, and I have heard of people going in with a letter saying they have had medical treatment... The driver's license is super easy. Motor vehicle actually went to the trans resource center and said, how should we do this. Amazing.


--Jay

"Sex reassignment" for FTMs is top surgery, while for MTFs, it is bottom surgery.

I think you are missing my point here.  I am not debating the fact that we can show our driver's license and get what we want, I am suggesting that it is dangerous to do so if we have not had a "legal" sex change, which I believe equals a change in birth certificate.  I am talking about the legal repercusions from signing a document claiming that you are one sex, when your birth certificate says that you are something else (as in a marriage license).  To me, that is like any other lie on any other application.  Criminal intent.

The original question came from someone's whose birth certificate says female.  His driver's license says he is a male.  Your belief is that since his license says male that it will not be an issue that he marries as a male?  I just don't think this is accurate.  This is what I am wondering about. I don't want it to bite him back in the ass.

I would love to hear from others, their understanding of what is "legally male and what is legally female".  Is it what the birth cert says?

Thanks.