Surgery journey

PROBABLY like most guys in our position the day that I found out that I was approved to have my first surgery was one of the happiest days of my life. I had begun testosterone at the beginning of February 2007 and was keen as mustard to get the ball rolling as they say. Since I knew I had to wait 12 months before I could have chest surgery with Dr Megan Hassell I decided to approach Dr Anne Pike, one of Concord Hospital’s resident gynaecologists for my hysterectomy.

Dr Pike proved to be as caring and supportive a surgeon as I could hope for. She read the letter of recommendation from my GP which briefly outlined my FTM status and simply said “okay, you need a hysterectomy”. Even though I had to wait approximately three months for the actual surgery as I had elected to proceed as a public patient as opposed to using my private health insurance for the procedure when I look back now the time between that initial consultation and my date with the scalpel seemed to fly.

Hysterectomy

I was required to undergo a pre-surgery check-up approximately four weeks before my surgical date was confirmed. This was conducted at Concord Hospital and consisted of a visit to the nurse to check my blood pressure, height and weight, as well as a blood test. I next saw one of Dr Pike’s team for a general examination, and then a member of her anesthetic team to ensure that any issues in his regard were covered. Seeing as I don’t live in Sydney I had the option of having these tests done in my home town but I opted to have them done at the Hospital – if only for the fact that they would then be completely covered by Medicare. Depending on a patient’s physical health other tests may be required during this stage, including chest x-rays and the like.

My surgery was scheduled for 3 December 2007 and I couldn’t wait, even though the results wouldn’t be as physically obvious as some of the other surgeries we may undergo. After arrival at Concord Hospital on the morning of my scheduled surgery I checked in at the main desk and was issued with my wrist bands. I was then shown to the surgery waiting room and after a wait of about 30 minutes, I saw a nurse who took my blood pressure and rechecked my height and weight. Once this was complete I was directed to a changing room where I changed into my surgical gown and was then ushered to the pre-surgical ward. It was reassuring to know that a patient’s family were allowed to stay with them right up to this point should they desire. After a wait of about 15 minutes (and a few more checks by nursing staff) I was wheeled to the anesthesia bay located directly outside the operating theatre.

Here I was visited by yet more nurses, my anesthetist and Dr Pike herself. I remember being wheeled into the operating theatre and transferred to the operating table and then…it all goes blank only to wake up in recovery some hours later sans womb, cervix, and ovaries. I’ve not had a single regret concerning my decision to have a hysterectomy. I will admit, however, that the realisation that I was about to ‘remove’ the last possibility to produce biological children did occur to me as I was being wheeled to theatre. I’d toyed with the idea of having children since I was a teenager but something deep inside me had always stopped me from taking that step. I’ve never considered myself to be ‘good’ parent material as I don’t believe I have the necessary patience for such a life-long commitment. I have a niece and nephew whom I love dearly however it is always gratifying to know that I can hand them back to their parents whenever I want. Should this change and I do become a parent one day, the fact that I was adopted myself means that the lack of biological connection to any such future children will not be an issue at all for me.

Unfortunately I awoke in absolute agony. I used to think that I had a reasonably high pain tolerance but I’m man enough to say that it bloody hurt as I was coming to in the recovery ward. It took two nurses to hold me still as I thrashed in pain. All I can say is if you already know that you’re no super-hero when it comes to pain talk to your doctor before you have the operation and discuss pain management options before it matters. All in all however, the nursing staff were quite good, they listened when I persisted that I wouldn’t just “get used to” the pain and brought in what they call their Pain Team. I was hooked up to a special drip system which injected Pethadine every time I hit a magic button. This was changed to Morphine the following day when I advised that the Pethadine was really only taking the edge off the pain, not numbing it altogether. The only drawback with Morphine is the side effects, one of which is nausea which I suffered from and which also required complementary injections of Stemitol to overcome. Trust me, the last thing you want to be doing after this kind of surgery is dry-retching or vomiting. In addition to the above pain meds, I was also hooked up to a potassium drip for fluids and a Panadol drip to keep my temperature from spiking. I was released on Thursday the 6th with a dull ache in my abdomen, not a whole hell of a lot of energy, and a big smile!

As for tips I can offer anyone following in my footsteps, I recommend you go armed with at least strong cough drops or cough syrup because you also don’t want to have to cough after the surgery. I’d also recommend buying some Cartia tablets and take them as directed when you get home to avoid DVT’s. I was up and walking the day after surgery. Yes it hurt the first time I got up off the bed but the small amount of walking I was able to do eased the pain I was starting to feel in my back from having been bedridden. I had initially asked the nurses for a heating pad or hot water bottle but they said it couldn’t be done as it could cause excess bleeding so soon after surgery. I have used one on my back since getting home and it has done wonders to iron out the creases.

You’ll wake up with a catheter and a wound drain in which takes quite a bit of getting used to if you’ve never experienced either. The catheter made me feel like I had to poop…badly…until I got used to the sensation. When it came out (which didn’t actually hurt) it took me almost five hours to be able to pee properly. If you’re anything like me, it’s worth the effort to make it to the toilet for your first attempt, as a bed pan only made the pain in my abdomen worse. Pooping, on the other hand, was a different matter. The day after surgery I started to take two Senokot tablets morning and night just to soften things up as I did not want to be on the toilet and having to strain! Unless you either have nerves of steel or already have relatively loose bowel motions I cannot recommend this strategy enough. Being able to just sit on the toilet and ‘go’ without effort was heaven. Having the wound drain removed did cause some minor pain, however the burning sensation receded soon enough.

The only down-side to the whole experience was the fact that they kept me on a ‘free fluids’ diet the whole time I was there. This basically meant pureed soups, milk, tea, water, apple juice, jelly cups and ice cream cups. Since I can only stomach the jelly and ice cream options I lived on two jelly and ice cream cups a day for three days. Consequently I’ve also lost three kilos. Dr Pike advised that I would probably need 5-6 weeks off work (and I only do a desk job) and she was not far off. It was not until the end of week four that I could move without feeling pain in my abdomen. You will need help with most day-to-day activities, especially those involving lifting of any kind.

Chest Surgery

Three months and 2 days after having my hysterectomy I returned to hospital for my chest surgery. Since my surgeon of choice – Dr Megan Hassall – only does this sort of surgery for guys in the private hospital system I found myself this time at North Shore Private Hospital. The differences between the public system at Concord Hospital and North Shore Private are huge, to say the least. I was greeted with a private, motel-style room and ensuite all to myself. The quality of the meals was exceptional with menus offering wide variety including beer and wine for dinner should you so desire. The service and attention from all staff was equally exceptional. Dr Hassall had “pre-warned” me that she did not usually do her gender-related surgeries at this hospital (she usually completes these surgeries at Hunters Hill Private Hospital) and despite a few incorrect pronouns and names when I first arrived (I had to supply my female name as my Medicare card has not yet been changed) a few quick words from Dr Hassall and all the staff without exception made the change-over right away. I cannot compliment the staff at North Shore Private Hospital enough. Every single one of them were caring, respectful and professional and I would not hesitate to recommend this hospital to others should Dr Hassall give them the choice.

The surgery itself was far less traumatic than the hysterectomy, no doubt due to the fact that chest reconstruction surgery does not require the cutting of any major muscle groups. Due to my breast size (approximately 14B) and degree of extant sag I had, Dr Hassall felt it best to remove all flesh, including nipples, via two elliptical incisions. I was the first patient on the operating table on Tuesday morning and was up on my feet again that night. The surgical binder that Dr Hassell uses post surgery is probably no tighter than the average breast binder however the added fact of wounds and drains underneath make it a little more uncomfortable than usual, especially since the whole kit and kaboodle effectively prevents you from sleeping anywhere other than on your back. My drip was removed the day after surgery allowing me a little easier movement and the drains were removed the day I was released from the hospital, three days after my surgery. The waterproof dressings covering the wounds were somewhat painful when removed, however the removal of the drains themselves caused only a brief burning sensation which dissipated quickly.

I am now one week post-surgery and have had the opportunity to see the results of Dr Hassall’s handiwork. I have had my follow-up appointment with her which involved a change of dressings (this occurred earlier than expected as the waterproof dressings she initially put on sprang a leak resulting in an influx of water over the wound site). There were no sutures to be removed, and I now have a more user-friendly, porous dressing over the two incisions. Dr Hassall advised that these will peel off over the next two weeks and when they do I will have to cover the incisions with a special tape (3M micropore tape).

I am due to see Dr Hassall again in four weeks time, when she reassess my need to continue wearing the binder and advise me when I can recommence weight training. All I can say is that the reports of her skill and surgical brilliance are not exaggerated. She has given me a beautifully contoured chest with no dog-ears – all of which is perfectly suited to my existing body type. In 3-6 months time I will return to her to have my new nipples constructed and will then be able to have matching areolas tattooed on.

I have no idea if I will go on to have any genital surgery or not. Interestingly, since I’ve completed these first two surgeries I have felt a huge weight lift from my shoulders – a weight I didn’t even know I was carrying. I feel more comfortable and confident and any last lingering doubts or anxieties concerning my decision to transition have disappeared altogether. I know that I’m the same person on the inside, but it truly is amazing at just how much of a difference the new packaging makes to my outlook on life!

Jakob, NSW

page updated 10 January 2010