When I originally planned my transition I decided I should start RLE before having FFS because I thought (still think) it's better to not have to rely FFS in that way. I would be on HRT for 4-6 months and the start RLE and have FFS perhaps 2-3 months later. Now that I am coming up to 5 months on HRT I'm starting to get really scared about starting RLE :-\ and I'm thinking of having FFS first. I always imagined this might happened so it's not necessarily a big deal to me.
What I'm wondering now is: is 5 months to early to start booking in for FFS? My doctor recommended waiting a year because that's approximately how long it takes for the majority of facial changes to complete (on HRT). Second, what do you think about have FFS before RLE? Has anyone else done this, thought about it, recommend or recommend against?
I just want to add that I actually have no idea how long it will take to go through the process of booking consultations, deciding on surgeon and then booking the surgery. I'm guessing it will be around 2 or 3 months, so by then it'll be 7-8 months HRT.
Thank yooouuu :)
The surgeons likely to have a wait list. Facial Team is 7 month I think.
I'm looking at going to London Bridge Plastic Surgery or somewhere else in London. Sorry forgot to mention that.
I can't speak to what you should, or should not do, but I will say that my face is still changing, even 5 years after starting HRT. Being XX intersex, I figured my face would change fast and be done in about a year, but the fact was that some of the biggest changes came after my vaginal surgery two years ago, though year two to three on HRT was also a time of very big changes.
For me, had I had FFS earlier, I would likely regret it now.
Missy
You can get FFS for free on the NHS?
Quote from: MissGendered on January 21, 2017, 11:19:20 AM
I can't speak to what you should, or should not do, but I will say that my face is still changing, even 5 years after starting HRT. Being XX intersex, I figured my face would change fast and be done in about a year, but the fact was that some of the biggest changes came after my vaginal surgery two years ago, though year two to three on HRT was also a time of very big changes.
For me, had I had FFS earlier, I would likely regret it now.
Missy
Can I ask why you think you would regret it? Because you are happy with the results of HRT?
Being off HRT for 10 years caused me to lose a huge amount of facial fat. Look at my avatar and envision me with cheek bones and sunken cheeks. I have been back on HRT for about a year at a half transition dosage and the changes that have taken place in that period of time are amazing. FFS is something I considered but I suspect a couple of more years on HRT will feminize my face sufficiently that FFS will no longer be needed. Will I be knock them dead attractive? No. Will I appear feminine? I think so and that's enough.
Quote from: AnonyMs on January 21, 2017, 11:24:54 AM
You can get FFS for free on the NHS?
I don't think so.
Quote from: Danielle P on January 21, 2017, 10:54:44 AM
When I originally planned my transition I decided I should start RLE before having FFS because I thought (still think) it's better to not have to rely FFS in that way. I would be on HRT for 4-6 months and the start RLE and have FFS perhaps 2-3 months later. Now that I am coming up to 5 months on HRT I'm starting to get really scared about starting RLE :-\ and I'm thinking of having FFS first. I always imagined this might happened so it's not necessarily a big deal to me.
What I'm wondering now is: is 5 months to early to start booking in for FFS? My doctor recommended waiting a year because that's approximately how long it takes for the majority of facial changes to complete (on HRT). Second, what do you think about have FFS before RLE? Has anyone else done this, thought about it, recommend or recommend against?
I just want to add that I actually have no idea how long it will take to go through the process of booking consultations, deciding on surgeon and then booking the surgery. I'm guessing it will be around 2 or 3 months, so by then it'll be 7-8 months HRT.
Thank yooouuu :)
Hi Danielle,
The rule of thumb is to wait at least a year after starting HRT to have FFS, because there are some soft tissue changes that will take place, and that can affect how a surgeon plans facial corrections. However, I personally know trans girls who did not wait that long, and they turned out fine. It really is an individual thing. I waited about a year after starting HRT to have FFS, and there were noticeable changes in skin softness, and subcutanenous fat, so I am comfortable with the timeline I chose.
The RLE question is very, very subjective. There are two issues here. One is how feminine you look now, without any medical intervention. The other is whether you even care if you pass. Again, I can only tell you about my experience. I was scared to death of RLE, and swore I would not even attempt it without FFS and a substantial time on hormones. For me, passing was an absolute requirement. Well, I ended up starting to present as female in public part-time several months before my FFS, even though I was only semi-passable, in my opinion. I went to stores, restaurants, and shopping malls, and I never once saw anybody staring at me, or make a rude comment. I made sure I was with someone supportive, and that where I was going was reasonably safe. It really boils down to how comfortable you are with yourself. If you have to "rely" on FFS, fine. Do that. If not, then you're ahead of the game if you have decided to pursue SRS. There is no "right way" to transition. Every one has a unique journey.
With kindness,
Terri
Quote from: Danielle P on January 21, 2017, 12:42:31 PM
Can I ask why you think you would regret it? Because you are happy with the results of HRT?
You certainly may ask whatever you wish, hun, no worries...
Overall, I am happy with what HRT did for my soft tissues, and fat re-distribution, and that wasn't the case early on, so I would likely have over-done things like a lip lift and cheek implants and maybe even had my face lifted too much.
The overgrowth of bones in my face are the real problem, and now that one can clearly see where the T and growth hormones masculinized my bones, it will be much easier to restore my face to the way it should have been all along.
My feeling is that a surgeon would have created a barbie face for me out what he first saw in year one, and that face would now look distorted...
Hope this helps...
Missy
I am one of those people who had FFS early. In fact, I had a feminizing rhinoplasty even before I started HRT. I was also already presenting as female part-time before my rhinoplasty.
About a month after my rhinoplasty, I started HRT. And then about 4 months after starting HRT, I went full-time. And then about 3 months after that, I did the rest of my FFS (which included brow bossing reduction, brow lift, trachea shave, and blepharoplasty). Note that I didn't do anything to my chin or jaw. For one thing, my jaw wasn't that pronounced to begin with. And secondly, I figured that with more time on HRT, the masseter muscle reduction would soften my jaw as well. I left open the possibility of going back for additional FFS to my chin or jaw if I later felt I needed it. So far, I don't think I do.
So it's really up to you how and when you want to do FFS. I do agree that it's generally better to wait a year or more after starting HRT. But as you can see in my case, I did things differently and in stages. The downside to doing FFS in multiple stages is that it ends up costing a lot more. And you have to take more time off work to recover from each surgery. But it worked out ok for me, and I'm glad I did it this way. I probably wouldn't recommend it for most people though. ;)
Mirya, did having feminizing rhinoplasty first cause any complications with your brow profile, or did they have to go back in to re-contour the top of nose when they did the brow? I've always heard it was better having those two particular surgeries together.
Quote from: Danielle P on January 21, 2017, 01:29:25 PM
Quote from: AnonyMs on January 21, 2017, 11:24:54 AM
You can get FFS for free on the NHS?
I don't think so.
If you're going to pay it might be an idea to look elsewhere. I don't think the UK has much of a reputation for FFS.
Quote from: staciM on January 21, 2017, 06:38:56 PM
Mirya, did having feminizing rhinoplasty first cause any complications with your brow profile, or did they have to go back in to re-contour the top of nose when they did the brow? I've always heard it was better having those two particular surgeries together.
Yes, I too always hear that it's generally better to do both the nose and brow at the same time. But for me, doing them separately turned out ok too. Actually, better than ok - I'm extremely happy with how things turned out.
There were no complications with my brow profile. And the surgeon didn't have to re-do my nose. In fact, right after the FFS, I remember the surgeon saying that the surgery went "perfectly". I did go to the same surgeon (Zukowski) for both surgeries though. So that probably helped keep things consistent with the brow and nose.
I also did
not do a full Type III forehead reconstruction. It was just a Type I, which is all I needed. I wonder if it's more important to do both the nose and brow at the same time for those getting a Type III.
If you want another example of a trans woman who successfully did her FFS in multiple stages, take a look at archlord. She did hers in 3 separate surgeries (as posted in her forum signature), and it looks like things went well for her too. She's certainly one of the most beautiful women on this forum!
HRT is not going to change the underlying bony structures of the face. Whatever changes HRT will confer -- skin, fat, etc -- will look just that much better with a feminine structure underneath.
I had facial surgery 10 months after starting HRT, and it did wonders for my dysphoria and, of course, was hugely important in eliciting the female gendering I so desperately needed.
I'm personally of the opinion that it's better to get facial surgery (if that's in the cards to begin with) before going full time -- before coming out at work in particular. The whole point of the RLE ritual is to determine if getting your desired gendering is what you really really want before having irreversible sex-change surgeries. Well, you're not going to get a "real" experience of that gendering if you're constantly getting clocked. Plus, having a good presentation really greases the wheels when it comes to coming out at work, or moving on to another job if that's how everything shakes out.
Quote from: Sophia Sage on January 22, 2017, 12:24:29 PM
I'm personally of the opinion that it's better to get facial surgery (if that's in the cards to begin with) before going full time -- before coming out at work in particular. The whole point of the RLE ritual is to determine if getting your desired gendering is what you really really want before having irreversible sex-change surgeries. Well, you're not going to get a "real" experience of that gendering if you're constantly getting clocked. Plus, having a good presentation really greases the wheels when it comes to coming out at work, or moving on to another job if that's how everything shakes out.
Well - I would consider a FFS an irreversible "sex change" surgery. If it is done properly, it would be not really that easy to go back to square 1 after that. So if one is really unsure about transitioning. I am not sure FFS is a great way to start with getting sure. HRT is a good way or do RLT without it if you are even less sure. But surgical changes of any kind should be done at the point when one is quite convinced that this is really the way to go, I believe.
Quote from: anjaq on January 26, 2017, 07:45:52 AMWell - I would consider a FFS an irreversible "sex change" surgery. If it is done properly, it would be not really that easy to go back to square 1 after that. So if one is really unsure about transitioning. I am not sure FFS is a great way to start with getting sure. HRT is a good way or do RLT without it if you are even less sure. But surgical changes of any kind should be done at the point when one is quite convinced that this is really the way to go, I believe.
I agree that HRT and part-time RLE is absolutely wise before considering facial surgery. Depending on one's workplace, though, facial surgery (along with proper voice work and facial hair removal) may be the way to go to ensure a smoother transition at the place where one's living is made -- after all, these surgeries are very expensive and getting insurance to cover it all can be quite dicey, especially in the States.
But I quibble with facial surgery being "irreversible" -- anything that's shaved down can be built back up, more or less (though once you've done your nose you should pretty much leave it alone), through bone cement and/or implants.
More importantly, there are all kinds of steps that could be taken to regain male gendering. Facial hair can regrow given the right impetus of testosterone, though a full beard is probably impractical. Voice can be dropped back down into the male range. Breast growth can be removed. Bottom surgery (and top surgery for FTMs) is what can't be practically reversed.
If you base this on what Mirya did, I would think early is fine. If you walked by her on the street, the only thought you might have is how pretty she is. Hopefully, I'll be going in one year after starting HRT. That is early by the recommended timeline suggestions, but based on maybebabies and Mirya's results, I'm confident it will all be okay.
What I'm about to ask may not sit well...
Do you think you need FFS? I'm not saying you do or don't, that's entirely up to you.
IMO, beauty comes from within. Confidence in oneself is when you can look in the mirror and accept who you are. We are always, always our own worst critic. We see flaws others don't see.
My early months of RLE was tough, because I was paranoid people were scoping me out. I could never take a compliment. My therapist gave me great advice: always walk with your head up. If someone smiles at you, smile back. If someone stares at you, smile back. And if someone compliments you, don't negate the comment, say thank you and be quiet.
I had the money for FFS and vocal cord surgery, but the more RLE I had, the less and less paranoid I became. I'm glad I never spent the money - other than oodles on electroylsis and what I call minor surgery - trachea shave.
Confidence requires time. I don't know if FFS fixes that immediately. I don't know.
I wish you well which ever way you decide.
Unfortunately, you can have all the confidence in the world, if your face screams male, you're going to have a tough go of it. Think Renee Richards. No amount of make-up and dressing femininely will make you blend in. If you don't care of course, that's an entirely different circumstance. To many of us, the hope is to be able to walk out of our houses in minimal make-up and go about our business being recognized female. Some, like Nina get awesome results from HRT. They have a bone structure that responds well. Others? Not so much. FFS is one of the many wonders available to us as Trans Women that wasn't there previously. I'd never dissuade anyone that felt they needed it from doing it. To those that don't care and have no problem with being clocked periodically, more power to you. I prefer to take advantage of every possibility that is available to me to walk through my life minimizing my chances of being judged or experiencing awkward situations.
HRT had nothing to do with how I look.
All those hours getting electrolysis paid off.
Seeing a professional makeup artist who defined my look helped.
Having a hairstylist create a look for me that framed my face worked.
I'm not against FFS, but more of RLE first and see how it goes.
HRT had no effect on my face. I got FFS as soon as I could and well before going full time; I would recommend this approach to anyone who has the resources and their bone structure requires it. Electrolysis and growing out hair are also easier to do in boy mode before going full time. I have no trouble passing as a boy when I want to. Feminine faces look good on men anyway. There are a few soft tissue procedures I might add on to push things more feminine when I'm ready for it, but trying to do RLE with my original bone structure would have been impossibly demoralizing.
And for what it's worth, as long as Electrolysis has been brought up, I urge anyone on the path to do as much of that as possible prior to HRT. I did 30 hours prior to starting HRT and it was a blip on my pain radar. A minor aggravation at best. Once I got on AA and E, it went from a walk in the park to nearly intolerable. YMMV, but I've heard other Women complain of the exact same problem. :(
Another electrolysis pro tip: ask your doctor for prescription painkillers, they work
Glad they work for you.....I haven't responded at all to hydrocodone and it was making me nauseous in the end. I use the cream but it has minimal effect on me. I just kind of gut it out and deal with it...no fun though. Wish I'd have gotten it done ages ago....certainly before HRT
Quote from: Sophia Sage on January 26, 2017, 10:58:10 AM
But I quibble with facial surgery being "irreversible" -- anything that's shaved down can be built back up, more or less (though once you've done your nose you should pretty much leave it alone), through bone cement and/or implants.
More importantly, there are all kinds of steps that could be taken to regain male gendering. Facial hair can regrow given the right impetus of testosterone, though a full beard is probably impractical. Voice can be dropped back down into the male range. Breast growth can be removed. Bottom surgery (and top surgery for FTMs) is what can't be practically reversed.
Hi Sophia,
I have to agree with anjaq on this one.
In my opinion, reversing any of those procedures is hardly "practical". First of all, who could afford it? Secondly, bone cement and implants are not a reversal of the procedure. They are a surgical revision on top of a surgical revision, and you are going to be left with even more damaged nerves and muscles and skin that are never going to work or look the same again. I am still trying to recover from FFS. I can't feel parts of my forehead, neck and scalp, and I will have scars, however minor, that will be with me the rest of my life. I can't even imagine assaulting my face again, trying to make it look like it used to.
Hair follicles can't grow hair once they are destroyed so, yes, "impractical" is a nice way of saying that whatever facial hair you get back is probably going to look like crap.
Mastectomies leave scars and can result in permanent numbness of the remaining tissue.
I haven't had VFS, but that is a surgical alteration to your vocal cords, yes? So if you cut your vocal cords again, to "reverse" the procedure you are left with additional scarring, which probably does not result in the voice you started with.
SRS, yeah, I agree, that's pretty irreversible in terms of form and function. But if you have any surgical alterations done, there is a financial and physiological commitment inherent to all these procedures.
With kindness,
Terri
Quote from: cej on January 26, 2017, 03:54:52 PM
Another electrolysis pro tip: ask your doctor for prescription painkillers, they work
If I did enough pain meds to make a difference, I would have trouble walking, let alone drive home.
Quote from: jentay1367 on January 26, 2017, 03:59:34 PM
Glad they work for you.....I haven't responded at all to hydrocodone and it was making me nauseous in the end. I use the cream but it has minimal effect on me. I just kind of gut it out and deal with it...no fun though. Wish I'd have gotten it done ages ago....certainly before HRT
It took me almost two years of painful electrolysis to figure out how to get topical anesthetics to work for me. I had to slather them on at least 90 minutes before show time, and by "slather", I mean applying multiple coatings so thick it almost looked like shaving cream. Then I could get about an hour of relief, whereby white-knuckled, table-gripping pain was reduced to noticeable discomfort.
With kindness,
Terri
Quote from: Maybebaby56 on January 26, 2017, 05:56:44 PM
If I did enough pain meds to make a difference, I would have trouble walking, let alone drive home.
With kindness,
Terri
Been there, done that and got the t-shirt, Terri! I drove home one day after my appt. and some fellow pulled me over, walked up to my window and told me to park the car before I killed myself or someone else. I was soooo embarrassed! :embarrassed: Never again.
What good is any of this if I killed me or someone else :embarrassed: :embarrassed:
Quote from: Maybebaby56 on January 26, 2017, 05:47:57 PM
Hi Sophia,
I have to agree with anjaq on this one.
In my opinion, reversing any of those procedures is hardly "practical". First of all, who could afford it?
My perspective is that if you enjoy the process of improving your body and have money/insurance to afford whatever, it can be psychologically easier to deal with making changes that are challenging to reverse instead of undergoing RLE while non-passing. RLE while non-passing won't teach you anything about what passing privilege is like, it's just needless hazing.
My insurance fully covered FFS. But I would have paid cash if I had to. If you can already afford $N for FFS, you can probably also afford ~$N to do FMS if you want detransition and can't handle having a feminine face as a guy.
Quote
Secondly, bone cement and implants are not a reversal of the procedure. They are a surgical revision on top of a surgical revision, and you are going to be left with even more damaged nerves and muscles and skin that are never going to work or look the same again. I am still trying to recover from FFS. I can't feel parts of my forehead, neck and scalp, and I will have scars, however minor, that will be with me the rest of my life. I can't even imagine assaulting my face again, trying to make it look like it used to.
This is a risk that all FFS patients have to deal with, it's not great but we make make an informed choice that the benefits outweigh the risks. Personally, I had no problems with the scars and numbness, they are fading and totally worth it. You can't ignore the real financial, health, and safety costs of trying to navigate with world as female with a non passing face if that isn't something you're comfortable with.
Quote
Hair follicles can't grow hair once they are destroyed so, yes, "impractical" is a nice way of saying that whatever facial hair you get back is probably going to look like crap.
True, but most cis men shave their facial hair. I've have a cis male friend who lasered his face and wished that it had worked better.
Quote
Mastectomies leave scars and can result in permanent numbness of the remaining tissue.
A lot of people who transition are going to want BA so they're signing up for that anyway.
Knowing that detransition was possible and practical for me made me more comfortable doing FFS early in my transition when I was still figuring things out. I realize that it would be harder / not worth it for you and many other people, but I wanted to share my perspective in case it gives comfort to someone who wants to transition but can't be sure they won't want to detransition someday.
I'd love to be able to get FFS, or even a damn trach shave. Nope. My HMO apparently has some secret timing requirements. At least they won't share with me...
So far I've found that I had to be on HRT at least 6 months before they'd authorize a dermatologist to evaluate me for electrolysis or laser. Yeah, like HRT is going to make a 63 year old's beard go away.
I've gotten hints of a one year or 18 month requirement before they'll consider evaluating me for any surgeries. By the time the evaluation happens I will have been full time for over a year. Add in the wait time for the actual surgery, and I'll have been full time for two years or more.
I HAD to go full time. Waiting for FFS to get done first would have killed me. I was given a hard deadline to leave the house, and I wasn't about to move out, on my own, and still try to get by cross-dressing as male.
Meanwhile, I'm looking at another summer in turtlenecks because 'no trach shave for you.' Gah.
Sent from my iPad using Tapatalk
Quote from: Maybebaby56 on January 26, 2017, 05:47:57 PMIn my opinion, reversing any of those procedures is hardly "practical". First of all, who could afford it? Secondly, bone cement and implants are not a reversal of the procedure. They are a surgical revision on top of a surgical revision, and you are going to be left with even more damaged nerves and muscles and skin that are never going to work or look the same again. I am still trying to recover from FFS. I can't feel parts of my forehead, neck and scalp, and I will have scars, however minor, that will be with me the rest of my life. I can't even imagine assaulting my face again, trying to make it look like it used to.
Well, when we put it like that, transition itself isn't very "practical" when you think about it!
Okay, a better word choice might be that facial surgery is
technically reversible, however impractical, in a way that SRS really isn't. By "technically" I mean it's possible from a technical perspective to more or less regain one's previous facial features, in more or less working order, such that male gendering is automatically and subconsciously conferred by the general public once again -- even without the beard shadow. But sex organs, once we have SRS, can't ever fully regain certain functionalities, particularly that of procreation.
To bring this back into the actual subject of where this fits in the context of RLE... Anjaq is right, it's certainly better to fully sure of what one wants before having surgery. I do think it's possible to know that without RLE in the first place. I certainly knew I wanted it and needed it before I even started HRT; facial surgery was always on my radar when it came to planning my transition. The "technical" aspects of potentially reversing facial surgery were never a consideration for me.
The only reason I brought that up was because of the question of whether it made sense to have it before or after starting RLE. Now, RLE is
ostensibly required to make sure we are willing and able to receive our desired gendering before SRS -- which is not only irreversible, but was extremely taboo (and really still is taboo, if not to the same extent), not to mention coming right up to that line of medical ethics. It was a ritual requirement, and if you couldn't hack it (bad pun) you wouldn't get your SRS.
But facial surgery isn't treated the same way by the medical establishment, despite its being just as profound (if not more so) than bottom surgery itself. We can get facial surgery
before going full time, and for very good reasons it's often wise to do so, though by no means is it always necessary -- many don't need it to get properly gendered, and really it's voice work and electrolysis that are just as if not more important in the short run (which isn't short at all, it's all a marathon in the end).
So what, really, is the point of RLE in this day and age? Besides a ritual requirement, I mean. Well, it can be treated as a ritual requirement, just passing the time after performing certain changes in documentation... or it can be treated as an opportunity to immerse one's self in a female life, which necessarily requires (I think) actually getting properly gendered consistently throughout that period.
Back in the day, the transitions I recall getting derailed (in the sense that the goals of consistently receiving female gendering and/or getting to SRS were thwarted) were typically transitions where someone jumped into RLE far too soon -- before getting enough electrolysis, voice work, and facial surgery -- and then failing to adapt to the mixed gendering received, leading to heightened dysphoria... and with that psychological distress the loss of one's job. Without that job, there's no money to finish electrolysis let alone get facial surgery, and being visibly in-between (not to mention continually dysphoric) makes it extremely difficult to find new work. This can turn into a vicious circle... and one that's "practically" irreversible.
And sure, it's a lot better today than it was a couple decades ago, but I think the point still stands -- in many cases, if not most, assuming facial surgery is in one's future, I think it's better to get it (and the electrolysis) before going full-time at work. If the workplace doesn't pan out, for one reason or another, at least one can present reasonably well enough to get a new job and hence secure the funding for bottom surgery, but at least now one is in the same boat as any other woman who's lost her job.
Surely this is a more "practical" approach? :)
There's no one right way to transition... but I do think there are plenty of "wrong" ways to go about it, too...
Quote from: Michelle_P on January 27, 2017, 01:04:23 AMI HAD to go full time. Waiting for FFS to get done first would have killed me. I was given a hard deadline to leave the house, and I wasn't about to move out, on my own, and still try to get by cross-dressing as male.
Meanwhile, I'm looking at another summer in turtlenecks because 'no trach shave for you.' Gah.
Okay, maybe "wrong" isn't the right word, either. Rather, some transitions are more "impractical" ;) than others, at least in terms of getting what we ultimately want.
And sometimes circumstances beyond our control force us onto the impractical path, and we just have to make do with what we got. At least you've been able to keep your head afloat, Michelle!
Well - GRS is technically also a thing that can be done again - just like with FtM. Doing this on the face would be similar. I guess though most who would decide against a transition even after having FFS would just leave it that way and go with a feminine face, which is after all something more acceptible for a man than a masculine face for a woman.
I think deciding on FFS has not much to do with doing RLE before. It has to do with being sure about the whole transition thing - if that needs RLE to get to that decision, ok. Otherwise it is just like all the other parts of transitioning - each decision is to a degree irreversible - although some have more impact and others are possibly correctible. I understand that especially in some places in the USA and other more dangerous countries it makes sense to only transition fully and openly once all the things like HRT, electrolysis, FFS, voice have been done, to minimize risk of being attacked.
I like what Warlockmaker did, and I'll do something similar if/when I fully transition.
Wonderful transition without any RLE
https://www.susans.org/forums/index.php?topic=209027.0
I'm having a hard time understanding why people do what they do. Coming out worries me as its irreversible and could have a serious impact on my life. FFS would worry me a bit as it makes the coming out even harder to reverse, except by then I'd have had electrolysis and that's going to out me anyway. GRS worries me not at all because I don't have to tell anyone, and it would have no practical impact of my life.
I intend to do everything in reverse order to everyone else. If I have social problems at the end of it that's too bad, because being trans is the problem, not the ordering of things.