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FFS before hormones?

Started by Lunarite, April 23, 2019, 01:15:19 PM

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Lunarite

A month ago I had my first GIC appointment. Something I didn't realise before attending is that they (NHS) insist that you are living full time before you even get a whiff of hormone treatment. I am not. A bit of a shock to my system, so I've been pushing it all out of my head for a few weeks (which I know isn't the best idea). Now it's time to get on with stuff again.
Electrolysis is an ongoing process, and I hope to be on anti-androgens soon, after which I'll be looking into (fairly minor) hair transplants and growing it out a bit. Plus, yeah, voice training that I should really be doing.
Excluding those, the biggest thing I feel is a block to me having a hope of passing is my face. To the degree I seriously can't imagine even being able to try living full time the way I look now. In an ideal world*, I would get on hormones first, but that is now clearly not an option.

I really want to believe that it is viable to go for FFS first, but I've got to ask, is this reasonable? I've had quite a few hopes dashed so far in this process, and maybe this will be another one, but this seems like a path I can live with.
Yes, this means that my face will change again after HRT, but hormone effects are going to be comparatively minor, particularly on the most problematic parts - brow ridge and trachea.
I would hope that surgeons (Facial Team seems the likely option) would have the expertise to be able to advise on what is sensible, even without the knowledge of the full effect of hormones.
It would also mean that I get to do the horrible recovery bit (going to work with a swollen, bruised face and so on) whilst still presenting male, which seems preferable. I've been able to deal with looking rough (e.g. after electro) because it's only the male me. That people aren't seeing actual me. If I had to be the female me, which is going to attract significantly more observation and judgement anyway, that would be much more difficult.

Has anyone done this themselves, or considered it?
Will surgeons agree to it? I would hope there's no issue here, but, well, I don't know. As cosmetic procedures don't need a psych eval, I don't see that side of things being a barrier. Whether they think it's smart might be another matter, but I would assume that'd be part of the disclaimer they'd give. Besides, I bet there's a good few cis males out there who have sought out a more feminine face.


*OK, 'ideally' I'd elect for GRS first, but I know that's impossible! Actually, I suppose if we're talking 'ideal', it'd be nicer to have been born female! Sign me up for a unicorn too (no, don't).
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Sarah.VanDistel

Hello Lunarite,

There's no solid reason not to do FFS before starting your hormonal treatment; I know of at least one surgeon who clearly states that he'll operate people who are not (yet) under hormonal treatment. There are probably others.

There are multiple possible paths leading to our endpoint, which in itself can vary from one individual to another. I understand your frustration about that NHS policy and find it myself very damaging to us transwomen.

I seem to have understood that you intend to present as male for a while after FFS and that you are now busy with electrolysis and intend to do some hair autografts. Of course, it all depends on the extent of the FFS, but personally, after my FFS + electrolysis, I could no longer pass as a male... The timing of the metamorphosis is certainly not a trivial thing. So my timing was somewhat like this:

02/2017: decision to transition
03/2017: anti-androgen + HRT (grey market)
06/2017: first consult with my FFS surgeon
07/2017: first consult with my endocrinologist (optimized my medication regime), my voice therapist and my psychologist
07/2017: started hair removal (first laser then electrolysis)
07/2017: coming out at work - people started calling me Sarah, but my dressing style was essentially androgynous because I was aware that my facial features would not let me pass (so certainly still no skirts, dresses or high heels!)
08/2017: extensive hair transplant (Budapest, Hungary); from here, I used a scarf to hide it until the growth of the new hair.
09/2017: first consultation with my psychiatrist
02/2018: extensive FFS, tummy tuck, hip contouring with fat graft, both in Belgium; recovery time until work was 1 month. After this my degree of passability increased dramatically, to the point of being correctly gendered at the beach and in rather conservative parts of the world. I actually don't remember a single episode of misgendering since the SRS!
12/2018: official name and gender change on birth certificate
03/2019: GCS (incl. orchiectomie) + breast augmentation, both in Belgium.
Now I am still recovery from this last surgery. I don't intend to do anything else major. Just to live my life as Sarah.

So you have, as I did, define your priorities. Mine were passability, going to the beach without fear, become officially me... GCS was actually secundary, so I left it for last.

Hope my history helps and happy to have you on the forum!

Warm hugs,

Sarah



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Casady

I thought the NHS didn't insist on being full-time now before prescribing hormones, although they will expect commitment to transitioning. I would have thought steps like electrolysis would have helped here.
I've heard people say that it's best to be on hormones for a while before FFS, but as you say many of the features addressed by FFS aren't improved by hormones. If these features are minimal then worth giving hormones a chance to work first in case FFS can be avoided. However, if these features are marked then being on hormones won't make a difference. You'll still benefit from any general softening and redistribution of fat if it happens once you start hormones.
In my case, I had FFS to address brow, jaw/chin, Adam's apple, etc and my surgeon said no need to be on hormones (for any length of time) first. I had however obtained a private prescription through GenderGP in the UK and had been taking them for about 9 months when I had my FFS.
I'd recommend arranging some FFS consultations and seeing what they advise for you.
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Casady

I must have been typing my reply the same time Sarah was posting her reply. I think with FFS, like anything in transition it's a case of your mileage may vary. I had FFS with the same surgeon that did Sarah's and I still present as male currently while finishing off electrolysis. So far, I've just had one confused "can I help you, sir, madam, um sir?" That's not to say that my FFS was a disappointment and it has done much to help with my dysphoria, but I think much more is involved in passing than FFS alone. In my case, male clothes and a face of either hairs or electrolysis rash go some way to still being interpreted as male. (I am back next week for a facelift and some other bits, which will hopefully further improve my FFS results though, so with a bit of luck this will change.)
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Lunarite

Thank you for describing your experiences! I feel so relieved! My goal is to be socially transitioned by my next appointment in ~11-12 months. I am very aware that's (very) ambitious (my pessimistic side says barely realistic, but I need to exercise my optimism!), but I think I need a bit of pressure to progress. I'm not going to rush things unnecessarily, but I shouldn't be too slow either, and I have waited long enough that I do want to get going with it. If I'm not ready in time, it's not like I need to wait another year, as there are private routes I can avail myself of. Indeed, I might even do so ahead of time, but I don't like the idea of my body having very visible changes before my face fits. I wasn't totally sure GenderCare/GenderGP didn't follow the same pathway, but from what you say, @Casady, it sounds like they do not, which is more good news.

The full-time requirement seemed weird. I made sure I wasn't misunderstanding, and had her clarify it. There was no specific duration given, though (I'm guessing "I socially transitioned on the train here this morning" probably wouldn't cut it!). It was also recommended, though not mandated, that electro not be started until after hormones take effect (and therefore well after transition) and voice training be started after transition. Seems a little muddled-up to me.

Time to start reading and planning, it seems. I understand I can expect quite a long wait (like, a substantial fraction of that 11-12 months!), so getting it queued up should be done soonish. A budget jaunt to Marbella might be in my future - guess I'd better get a new passport!
I am rather scared of the surgery itself, but the end goal is a significant incentive. Also, the idea of travelling internationally afterwards seems a daunting prospect - how do you get through customs when your face is bandaged up or swollen up and looking unlike your passport photo?

As to presenting as male afterwards, well. It seems a more reasonable prospect to actually make the leap when my face is settled. If I'm not fully male-looking in that time, that's not really a negative. Plus, if there's still a decent amount of electro left to do, I'd wait, though fingers crossed that seems unlikely to me. If I look the part immediately (hah), then hey, I'd probably go for it.

Having a period where I look like an unusually feminine man is not without its appeal, though. My identity definitely lies on the female side, not neutral/enby/fluid, and yet I sort of like the idea of 'cross-dressing' as male.
In my lengthy period of self-examination/realisation, there were thought experiments. Like, what if I start and change my mind, decide I want to be male after all? Pretty much every step seemed acceptable, if not desirable. I think the only MtF change that I thought would be bad for me in the event of a detransition would be having breasts.
With all those thoughts in mind, I kind of want to see what it's like to temporarily be a 'better' sort of male, even if that's definitely not what I want to be in the end.

@Sarah - that seems like a remarkably fast transition! Sounds like it was entirely private, but I didn't expect even that to be able to be done so fast. Depending on how much of my savings are left after FFS (and/or how I feel about a loan), I will definitely consider going private for SRS. I'd rather not spend quite so much, but if it gets me to a better place in life a year or more ahead of the NHS schedule, it could well be worth it. Serious props to you for making the leap at work a mere 5 months after the first decision.

@Casady - from everything I've been told, getting past the initial hurdle and switching presenting female is the big deal. FFS might not be enough alone to be convincing to other people, but it's me I've got to convince first, and the rest will follow. Best of luck with next week!
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Casady

#5
Hi Lunarite,

It's definitely good to have a goal. I'd hoped to be socially transitioning around now but have slipped slightly. I'm fine with that though if I feel I'm progressing towards it, which I am. There doesn't seem to be a correct order to do things that fits everyone unfortunately. In hindsight, I'd say concentrate on getting rid of facial hair and (if required) have a hair transplant immediately you decide to transition. I did the former (but it still takes an age) and didn't think I'd need the latter, although I'm having second thoughts now. HRT won't help with facial hair (so why wait until on it) and, even though Finasteride and Minoxidil may help with a slightly thinning crown and FFS may improve a hairline a little, should you not be satisfied with those results and decide on a transplant at a later date, you face having a shaved head at exactly the time you don't really want one (where I am now)! Also, even for anyone changing their mind about transitioning socially or deciding to delay it, it's no real problem having already taken these initial steps and nobody will suspect you're transgender for taking them. I perhaps agree on leaving voice training (if seeking this professionally) until a bit later. In my case I think I need the motivation of socially transitioning to provide me with the urgency and the push to practice.

GenderGP are definitely a good choice for HRT if you don't want to or can't wait for a GIC appointment. You do need to have two or three phone/Skype sessions with their counsellors before they prescribe HRT of course, but they certainly don't insist on you having already transitioned socially. Also, they'll liaise with your GP (if you want them to) for blood tests, which need to be carried out every few months.

Regarding FFS consultations, both Facial Team and <other clinic removed> come to London every so often so check their websites for dates. I was planning on using Facial Team but felt I should have at least one other consultation before putting down a deposit. When I met <removed> (at the time, more to rule him out than anything) I felt he was addressing my personal requirements far more and I immediately made my mind up to go with him. He was also cheaper and had a shorter waiting list, both of which enabled me to bring my target date forward a few months so as to be able to recover over Christmas. I'd highly recommend him and the wonderful stay at the <removed> guesthouse! Also, and ideal for anyone on a tighter budget, Priyamed (Jane and Clare Watson) in India seem to be producing some excellent FFS results. I hadn't paid much attention to them when I was seeking an FFS surgeon, but I'm in contact with them now about other stuff and Clare is extremely helpful.

Immigration wasn't too bad when returning from having FFS. I just had tape on my nose, plus of course a lot of swelling and bruising. I was asked what had happened to my face and I just said I'd had some surgery. I showed him a letter I had from <removed>, but that caused more confusion as it referred to me as "she". I explained I was transgender, but I could probably have got away with not showing him the letter and just saying I'd had some cosmetic work done.

Quote from: Lunarite on April 24, 2019, 04:28:12 PM
@Casady - from everything I've been told, getting past the initial hurdle and switching presenting female is the big deal. FFS might not be enough alone to be convincing to other people, but it's me I've got to convince first, and the rest will follow. Best of luck with next week!

Yes, you're correct there. Best of luck moving forwards. And thanks, I'm actually looking forward to it!

Casady


< References to one particular clinic removed by moderator due to their TOS violations and spam in 2018. >
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Drexy/Drex

That is what I did ...there was no way my prior face was going to feminise just with hormones alone ....so 6mths into hrt I got ffs done in Mexico by Dr. Lazaro Cardenas
I  and other people think it made quite a difference ..though I feel I need an enhancement to feminise my face more ...however considering what the Dr had to work with in the beginning I consider myself lucky

https://i.vgy.me/jLioUt.jpg

https://i.vgy.me/i9P9op.jpg

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