Buckle-up – this is a long one:

I’ve been insistent for months that I can’t have a conversation about bottom surgeryGender Reassignment Surgery (GRS) vaginoplasty until Katie had done the research. We kept going around and around in the beginning of the transition. Katie knew early on she wanted Thailand. The surgeon, the reputation, the procedure, the cost – there are a million good reasons to have the surgery there and I ultimately want what Katie wants. It’s her body and this is an important step for Katie in her transition.

That said, for me, the complications of surgery are so much more than the heaviest, most obvious question of what our sex life will be like after. How do we pay for it? How do we cover our mutual loss of income? How do we pay our bills after? When? If it’s in another country, insurance, even if we are lucky enough to have insurance that helps cover any portion of the procedure at all, won’t be applicable. GRS surgeryVaginoplasty is still considered cosmetic by a lot of the medical community and is therefore not required as part of the insurance packages that employers offer employees.

Yes, Thailand is cheaper – lots cheaper. Vaginoplasty in the United States can cost 10s of thousands of dollars for the procedure itself. This does not account for the surgeon’s time, the cost to stay in a hospital, the follow up visits, cost of travel to get to and from the location of the surgery, the hotel needed for me nearby. There are no surgeons in Seattle that offer this surgery making travel required. Travel is not cheap in the US. In Thailand, the procedure total is around $15,000 from what we can tell, and this includes the cost to travel, stay, eat, everything. It’s an unbelievable price when compared to the US.

In addition to the cost of actually doing the procedure, there is the time off work and how we cover the loss of income. If the surgery is in Thailand, time off required for Katie is one month. They want to keep you in the facility to monitor your recovery longer and ensure there are no complications. So, while the procedure is the best in the world offered by the best surgeon in the world at the best facility, we have to plan for how we compensate for a month of lost wages for both of us. Do I coordinate shifts and ask friends and family to help me with Katie while we go through this so I can come back to work?

Amongst the many layers of the finances, there is additionally my concern about the support system. Ultimately, it will be easier for my family, friends, and Katie’s family and friends to travel to us if we have this procedure in the US. Anywhere in the US is closer, more familiar. It’s not thousands of miles, one lay-over in Hong Kong, and 16 hours of flying away to be in another, unfamiliar, land. It is selfish of me, but I need the support system. What if something goes wrong? It’s a lot faster for my family to be on a flight to help me if we are in the US. Not to mention the emotional complexity of watching my wife anatomically become my wife and all that means for me and to me.

All of this to say, it’s a complicated issue for me and for Katie. There is a lot to consider. Throughout Katie’s transition, I have felt ambushed by the different steps. There has never been a step I didn’t want her to take, because I want her to be happy and to be her best self. But there have been plenty of times where I wanted more time and couldn’t have it. This is ultimately the result of how whichever step Katie was on was then communicated to me and my feeling like I wasn’t given the option or a say in the timeline. This is my life too, and it’s always felt like I should have a say, however small, in how my wife transitions. I say this knowing my opinion ultimately doesn’t matter. Katie has to do what she needs to do. I console myself by believing that the Dysphoria and its horrible control make Katie incapable of considering my feelings in all of this. To transition is to be selfish, isn’t it? Part of me feels disgusting for even talking about it. Who am I to complain when I’m not experiencing the extreme discomfort of gender dysphoria’s intoxicating reach? How can I want all these things for this person I love, but feel so completely hurt and lost in it?

Knowing my own vulnerabilities and limits, knowing that the decisions made about vaginoplasty will be important ones in which all my own shit would need to be put aside so I can be there as much as possible for my wife, I asked her to warn me when she was ready to talk about it. What I wanted was a heads-up that a conversation about her research, about how she made the decision was coming so I could prepare myself and be ready. At lunch on Saturday, we were discussing our finances, how we needed to make a budget for when I start grad school in April, when, somehow, Katie brought up that she had decided on Thailand. Our conversation almost completely halted as I sat wondering how I got to this point. How was I sitting in public with my spouse about to discuss vaginoplasty? Didn’t I ask her to warn me? Didn’t I make it clear that I wanted to be mentally prepared? I felt hurt at the lack of consideration for my request, a request that had been reiterated and very clear for several months.

I want explain the conversation we had as we requested the bill and paid, but I don’t really remember. I do remember saying that I wasn’t ready for the conversation right then and there. I remember Katie asking me when I’d be ready. In the flood of thoughts at the time, I remember not even knowing how to pick a time. I ran the calendar through my own internal dialogue: “Tomorrow I have Sunday-Funday with Abby, that won’t work. Monday through Friday work. This doesn’t seem like an after-school conversation. Next weekend? Is that too far?” Katie’s ask did not feel like one to me, it felt like a demand, like there would be repercussions for not providing a specific date and time to have this conversation. As we walked home, I would start to word vomit my money/date/time/how/when questions. Then, before Katie could answer, I’d realize the magnitude of the conversation and immediately follow up with a “I’m not ready”. It wasn’t productive. It wasn’t great.

As we walked into our apartment, I told Katie I needed a moment to gather myself. I felt like my back was against a wall, that this conversation needed to happen now or else we would have a really giant space between us with our avoidance of the topic until we did. Additionally, we were supposed to be figuring out the budget, which we needed to do in order to plan the next few months. I told her I wanted to see all the research, see what surgeons are in the US. I wanted to understand why Thailand was the right choice for her. I told her I would be ready later that evening, but I needed a break first. I needed a nap, to sit and relax, to gather myself so I could synthesize what Katie was going to tell me without losing my emotional rationale.

We had the conversation. Again, I don’t remember the exact verbiage, but I remember the energy of it. We felt disconnected from one another and almost opposite. It felt awful. I couldn’t understand why Katie didn’t see my side of the conversation, why she didn’t understand why my questions were not coming from an unsupportive space. I was hurt that she didn’t apologize for not honoring my request for the heads-up. As the conversation wound down, I sat on the floor of our living room staring at the sheets of paper with Katie’s scribbled handwriting on them, willing myself not to cry. Thailand it is.

We talked about the entire event in therapy on Monday. Katie cried as she described what it felt like to hear me suggest that the surgery timeline might have to wait as we save the money needed, about how the idea of even having to wait a year for this surgery felt like too long. Seeing her cry connected the dots for me, helping me understand how important this really is for her. I still don’t feel resolved. I feel like she can’t understand where I’m coming from as much as I can’t understand what it’s like to live with dysphoria. I feel lost in transition, like my feelings about any of it are secondary. I feel like an asshole for even being worried about any of the details at all. Again, how does my struggle even compare? My wife is in pain – isn’t that the only part of any of this that matters?

Re: Surgery – I want to end this by saying I’m well-aware of the myriad of the things I don’t know right now and how many facts I probably butchered throughout this post. I have intentionally not done all the reading about the procedure, the facility in Thailand, the money, the politics, and everything else in-between because I’m not ready to. Please don’t email me all the links and information and opinions on what worked for you on the topic. While I appreciate the perspectives and wisdom from others who have lived this experience, I’m not ready and I won’t read them regarding this specific topic right now. I’ll let you know when I am.

That said, for those with wisdom on how fucking hard this is as the spouse – please feel free to pass that along. I’m still waiting for the “How to be Married to Your Transgender Spouse” guide. Is there a chapter in it about crying in the car? If not, do you need help writing it?

P.S. I struggle with the word ‘vaginoplasty’. I made myself use it because it’s the correct term. ‘Bottom surgery’ seems to crass and not politically correct. GRS encompases all the surgeries typically associated with transition (face, chest, body, genitals) in whatever combination the transgender human feels is right for them. This term didn’t seem right to me either. Vaginoplasty – guess she’ll do.