Chapter 26 ~Cocoon: Not Just a Cliché


13 May 2019

I got into art in my senior year of high school when a friend saw some of the work I was doing at home in my spare time. That lead me to going to a private art school for college where I majored in sculpture and graduated with a Bachelor of Fine Arts degree.

I don’t think I ever had a clear understanding of what my life was going to turn out like. But really, do any of us? While I was working on my degree I explored many facets of art but really found such beauty and creative spirit in every day objects. I was fascinated by Marcel Duchamp’s Dada anti-art and “Readymades.” I was also very intrigued by environmental pieces by artists like Edward and Nancy Kienholz, Duane Hanson, and George Segal. The fact that you could interact with someone or something in real scale blew my mind. The Kienholz’s even added smell to their environments.

I had an immediate draw towards the bright colors of the POP art of Andy Warhol, Robert Indiana, and Roy Lichtenstein. Magdalena Abakanowicz and her textile sculptural work also fascinating me.

I loved the cerebral work of Jenny Holzer, and the performance art of Laurie Anderson. And animation work by the Brothers Quay. I still do!

But those formative years of finding my “hand” or style was like measuring a quantum object. You couldn’t measure it. Or if you could it would immediately change. There were many things that I created that I have only now come to understand.

I was very lucky to attend a college that taught a lot about process and technique. It allowed me to learn various technical processes from stone carving and metal casting to drawing and printing.

A theme that I fell into around my junior year was rebirth and transformation, specifically through the symbolism of the cocoon. I was drawn to the relationship of transformation and its interpretation in different ways and different cultures. I likened the cocoon to the ancient Egyptian sarcophagus. I thought about how the body in ancient Egypt was prepared for travel through to the “other” world, and how the caterpillar will spin its own sarcophagus and dissolve itself into a gelatinous goo to be reborn into the beautiful moth or butterfly, whose colors and iridescence mimic that of the gilt artwork on the Egyptian coffin.

I began making sketch after sketch of cocoons. I also built them human sized with burlap, chicken wire and liquid latex. I was mad about them. My first presentation of these human-sized pods was in the classroom. I had built one that was the size of a small adult and presented it hanging from a 8 foot branch of iron wood which was then suspended in the studio space.

Cocoon Print 1
(lithograph on watercolor paper)

Another presentation had one about 7 foot tall and suspended in a tree among a forest in south central Wisconsin. In this “natural” setting it was almost completely camouflaged until you were right in front of it.

My most ambitious presentation was to build two of them in a stairwell at our school’s new location. In hindsight it wasn’t the best location for them as this was an emergency exit route. But what better place to put them than a little used urban environment. Life, death and change happens all around us, everywhere.

I had also been taking some print classes. These incorporated lithograph stone and plate print techniques. A few weeks ago I found some of these prints. They are almost two complete print editions of two separate images. I found them after going through an old musty portfolio that had been in my basement during a seasonal flood. Luckily none of the prints incurred any water damage.

Cocoon Print 2
(lithograph on watercolor paper)

At the time, all of this imagery and its relationship to myself remained hidden, but the meaning of these cocoons is very clear to me now. 30 years ago this was something that I thought was just a neat theme to explore. But now! Now “I” have transformed and transitioned, and am showing my glittering gilt and color.

I rarely look at anything that I’ve created in my early career as an artist and actually like it. But as I reflect back now as Tiffany and look at the signs that Tom was putting up, I can clearly see the subtle and quiet way he was shouting for help as if I were watching a B-movie with the sound off as the starlet desperately screams for help.

But thankfully I have merged from my pupa, and my film has a happily ever after. So I guess it is a cliche!


Chapter 25 ~Roll Credits


5 March 2019

I started therapy on the 18th of April 2016. Within 3 months I had been officially diagnosed with gender dysphoria and had started seeing an endocrinologist to investigate the medical side of transitioning. By then I had come out to my mom and then to my immediate family. It was just the beginning. There was so much ahead of me on this journey and at the time it felt as though it would never end. My friend Chloe, who had become a sort of guide for me on my journey, had said to me on a number of occasions, “One day you will no longer be in transition. You’ll just be you.” I wasn’t prepared for time to move so slowly in the moment, and yet seemingly so quickly now that I’m at the end.

Yesterday marked four weeks since I underwent bottom surgery. Yesterday also turned out to be my last therapy session. I hadn’t planned it to be when I scheduled my appointment, but at the end of last night’s session my therapist said that she thought I was done. I can’t even remember what she said exactly. I know we talked about how I have incredible support all around me. I was kind of overcome with emotion. It’s not like I can’t call her for, as she called it, “a tune-up.” I’ll definitely miss talking with her on a regular basis. I guess I’m just stunned by the fact that I’m done.

I’ve transitioned.

This is it.

I’ve gone through a failed attempt at hormone therapy. I’ve endured 11 months of laser hair removal on my face. I’ve had facial feminization surgery to “soften” my features. I’ve attended therapy sessions for 35 months. Lastly, I’ve had gender affirmation surgery. And while I’m still recovering from that last one, bottom surgery, I’ve finally come to the end of the “transition” part of this journey.

Many people have, with good intentions, said, “No, it’s not the end. It’s just the beginning.” But, no, this is the end of my transition. I NEED this to be the end. Pregnancy doesn’t begin when you deliver your baby. It has been three long years of medical complications that I thought would end my hopes of transitioning, of fighting with insurance policy and coverage, with hurdle after hurdle. It’s over and I can finally celebrate “just being me!”

Recently, a friend asked me if, now that I’ve had bottom surgery, I will still refer to myself as transgender. The answer is that it depends on the situation. For many transgender women they want to only be known as a woman once they’ve transitioned. The way I look at it is that in medical situations I will still refer to myself as transgender because while I now require some routine female health tests, I still also require a prostate exam. I can’t change my DNA or biology. But, to everyone I meet, everyone that perceives me as the female I am, I am Tiffany. A woman.

I guess, if this is the time when I roll credits, I would like to thank some people.

First and foremost I need to thank my wife, Ann-Elizabeth. She’s known about my feminine side since we first became friends. It has never become an issue in our relationship. When people ask how she is doing with my transitioning we tell them first and foremost that we married another person and not another gender. We’ve been together for 20 years and we enjoy sharing every aspect of our lives with each other. We know that ours is a coveted union. In many cases, when one partner in a marriage comes out and transitions it causes a split. I think we both underwent such a transformation of self before we met, that when we befriended each other we had already shed the skin of our old selves and were available to being true to ourselves and each other. I love her with all of my heart and soul and can’t imagine ever being without her.

I need to thank Chloe and her husband Jon. Chloe has been in my life since 2005 and we’ve helped each other grow. At times we’ve traded roles of teacher and student. When Chloe met and eventually married Jon it was just like an extension of her. Jon is equally caring, compassionate, and nurturing. While I’ve always had the support of my wife, I think that if I had never met Chloe I wouldn’t have transitioned. I can’t quite think of the word that best describers Chloe’s role in my life. I think of her like a combination friend/shamaness/sherpa/guide. There is the mythical holy person that doesn’t preach but walks with you on your journey, sometimes engaging you in conversation, sometimes asking you questions to engage your own thoughts, like a therapist but able to reach in your chest and cradle your heart. That’s Chloe.

I want to thank my 86 year old mother, who was not prepared for her 46 year old son to eventually become her daughter. I’ve had a long time to discover and accept that I was born a transgender woman, but in three years she has grown to accept who I am. She now uses my legal name and mostly uses the correct pronouns. Sometimes she slips but she never does it out of malice. It’s always from habit. My Father and Mother-in-law have also been so wonderful and accepting, even from the start. On one Father’s Day after I had come out I thanked them for their support. My father-in-law said that he admired what I was doing. I had met and married his daughter as a man and yet he was accepting me now as a woman. I’ve been very blessed with my family. I come from a family of seven kids. All of my family has been gracious in accepting my transformation. I have two teenage nieces who have been exceptionally wonderful.

i want to thank my Aunt for her counsel in the very beginning. She and her wife have been a sounding board for a lot of doubts. Their love and reassurance were a beacon before I gained any sign of a path.

I am so very grateful to my mental and physical care team; my therapist Carolyn, my endocrinologist Dr. Javorsky who maintains my transitional changes as well as my diabetes, Dr. O’Quinn, my family doctor, Dr. Toby Mayer in Beverly Hills, CA, who tweaked my features and gave me my beautiful face, and lastly Dr. Gast, my plastic surgeon and Dr. Block my assisting surgeon who performed my bottom surgery. These people, some of whom I will continue to see and some that have come into my life only to aide in a specific part of my transition, have changed my life immeasurably. In 2015 I was headed for disaster by continuing to hide my true self and allowing  the stress in my life to increase to the point that it was manifesting physically. This group of people saved my life.

Thank you so very much to the close friends who have driven us to appointments and watched our home and precious kitties while we’ve been away for surgery.

Thank you to my employers, who hired me as Tom, and have kept a place for me as Tiffany.

I want to thank all of my friends from “The Boys,” my three steadfast mates of the past almost 30 years, to everyone who has supported my journey, those that contributed to my fundraising efforts for my facial feminization surgery, those that shared my social media posts, the folks that have messaged, called and emailed, the transgender people world-wide that I’ve met and whom I’ve shared advice, information and support with. and lastly to you, everyone who has read and continues to read my chicken scratch. I set out to share my journey. Thank you for coming with me. I wish for you a most authentic life.

I started this blog to journal my transition and to share my story. I wasn’t sure when or how it would end, but then again, I couldn’t fathom ever getting to the end. The last sentence of my very first post was ,“I can at least guarantee, someone WILL get the girl!”

And do you know what? Someone did get the girl.


I still have more to say though, so if you’ll listen I’ll still be talking (or typing). So, if this is the credits you’ll just have to stick around for the DVD Extras.

But for now, I guess this is the first day that I’m no longer in transition.

Finally, I’m just “me.”

I’m just Tiffany.

Chapter 24 ~Back in the Saddle Again


20 February 2019

Well, maybe not the saddle but definitely the stirrups!

10 days after surgery, Valentines Day to be exact, I had my surgery post-op examination. I was met once again by Dr. Gast, Dr. Block and Physician’s Assistant Clare, who has been involved in this surgery from my initial visit back in April of 2018 to the present.

I was and still am quite swollen, but I learned that that it completely normal at this stage. Some things I learned at this appointment are that the sutures should start to dissolve at 2-3 three weeks but can take up to a month. I was also cleared to start sitting up for short periods. I had driven myself to this appointment by sitting on a doughnut pillow, the type used for hemorrhoids or tailbone injuries. I had also split the hour and a half drive up into two segments.

Since starting my transition I’ve had many firsts or rites-of-passage, not just into womanhood but more so into femininity. It took a while for me to use a public women’s restroom, but that was a milestone.

Another very meaningful experience was being a bridesmaid in my BFF’s wedding, not just walking down the aisle holding a bouquet of flowers, but also being with her and the other bridesmaid’s as she had her makeup done and donned her gown.

This post-op visit also gave me another first of womanhood, stirrups! I know this may send shivers down the spines of many of my cis-gender female readers with the thought of cold medical implements and non-compassionate doctors. But this was very different in that these woman who were examining me, helped create the very essence of my new femininity. They were kind, compassionate, extremely intelligent, and most of all nurturing. I have had more than my fair share of good doctors in my life, but having these women who weeks prior used very intricate medical techniques surgically to transform part of my body that had caused emotional trauma into something that now brings me comfort and serenity, and then at this post-op visit to treat me with such warmth and care gave me such a lucid rebirth into my body. There’s no amount of gratitude I can ever show to equal what I feel for and about these people.

I don’t know if every transgender woman experiences what I have felt when and if they have bottom surgery. I feel like I’ve been born and also given birth. I feel renewed into my aging body. Every step I take to becoming the “real” me gives me more life. It makes me want to “be.”

Fast-Forward to today…

Today is Day 17. It has been two-weeks since the compression bandages came off. Swelling continues to very slowly go down. I’m still very tender in spots, but I am able to finally sit upright for longer periods. I am still not allowed lift more than 10 pounds so I’m relying on my spouse for quite a bit.

I think I’ve put on a few extra pounds as I am doing nothing but eating, laying around, and sleeping. I’m sure I’ll be able to walk this off and am returning to work in 5 days. I still, however, won’t be able to lift much for another month.

The idea of lying around for 3 weeks (6 if you’re having full bottom surgery) sounds good at the outset, but when you have restrictions it can be torturous. I’m actually looking forward to getting back to the office and into some routine. I am so grateful for all the support I have received from family, and friends old and new.

I will continue to update on my journey as things progress and heal. I had hopes of starting to video blog while I was recovering, but that will have to wait until I am able to get back into my regular routine.

So for now, stay tuned. Sit back. And um, ma’am, feet in the stirrups, please!

~ Tiff

A NOTE: This blog chronicles my experiences and my journey. I am not an expert or medical professional. I am learning as I grow and my experiences may differ from other transgender people. Everything is correct to my best understanding.

Chapter 24 ~Surgery: Complications?


11 February 2019

As I type this, it was one week ago that I was wheeled into surgery. There was a possibility of still being connected to my drain tube but I was sent home without that drain tube in place. While I was in the hospital I wasn’t draining much at all, and since I’ve been home it has steadily decreased and now resembles light spotting as if from my monthly cycle. My daily schedule is all over the place right now. When I’m awake I feel as coherent as I would on any average day, but when I get drowsy, regardless of the time, I fall into a deep sleep for hours. I’m attempting to keep meal times regular, but sometimes I can’t sleep until midnight. I’m just allowing my body to tell me what it wants.

All-in-all recovery has been steady and to be perfectly honest, boring. I’m not allowed to lift more than 10 lbs and I can’t sit upright. If any of you have had to reside in bed for more than a week you will understand. At least I can walk to the bathroom or kitchen to stretch my legs but my body longs for more exercise. I am, however, aware of the importance of allowing myself to heal. I’ve endured extended hospital stays for mini-strokes and heart scares. I’ve had to sit and rest after multiple eye surgeries, and reduce bending and activity following retinal hemorrhages. I would rather bore myself with lying around to recover than cause irreversible or unfix-able damage to the most important surgery of my life.

I was released from the hospital last Wednesday just hours after my bandage were removed. Just as Ann-Elizabeth and I were shuttled to Madison prior to surgery by a dear friend from Milwaukee, we were chauffeured home by another dear friend from Madison. We were unsure as to what day or time I would be released from the hospital so it made sense to make departure plans with someone local. After being discharged it took a while for me to make it from my 6th floor lodgings to the hospital entrance, as I only had the option of walking or laying on a gurney. I opted for the slow shuffling, think Tim Conway as Mr. Tudball in the Carol Burnett Show, rather than a corpse suddenly rising from a gurney like the Mummy’s Boris Karloff. I had spent the past 72 hours lying down and wanted to work my legs a bit.

We arrived home around 5:00 pm. All of the fluid that had been steadily infused into me over the past three days was encouraging me to visit the bathroom frequently. I was still getting used to the new method of urinating, something that was complicated by the fact that I had to use a squeeze bottle of warm water to rinse afterwards each visit i made. I was instructed that keeping the surgical site clean and dry was key to a quick, and more importantly, an uncomplicated recovery. Early in the evening I noticed certain areas of the surgical site appeared swollen and red. Over the next couple of hours it even started to “feel” swollen and uncomfortable.

Around midnight, after a few telephone calls to the plastic surgeon on call at University Hospital, the decision was finally reached that I needed to return to University Hospital at 8:00 am  My poor wife spent the entire night watching over me while I got a few hours of sleep. At 6:00 am a wonderful friend arrived to drive me back to Madison. It was a rainy and icy morning but we got to University Hospital just before 8:00 am. I waited only a few minutes before I was taken to an exam room where I was soon joined by my plastic surgeon, the assistant doctor on my surgery, and my physician’s assistant. After an examination it was determined that everything was fine. The concern had been that a hematoma had formed. In reality what had happened is that when the bandages came off the previous day, everything was abnormally “normal”, but when I got home I had been vertical for the first time and some swelling had started to form. Usually for this type of surgery the site is swollen when the bandages are removed. In my case everything looked prefect until I started spending a little time being vertical, during my travelling to and settling in back at home.

Another thing that had been decided that morning was for me to restart the testosterone blocker even though I could no longer produce testosterone. My blood pressures while i the hospital had been rather high as it still was that morning on my unplanned return. Prior to beginning my transition I had been on a couple of medications for treating high blood pressure, an unfortunate complication of diabetes. The testosterone blocker that I was then prescribed had originally been developed as a blood pressure medication, so as its dosage increased I was weened off of my other pills. Then, when I ceased taking the testosterone blocker several days prior to surgery I had no medication to combat my hyper tension. Incidentally, surgery itself can raise blood pressure. Weary from the past 12 hours, but with ease of mind, I returned home to settle in.

The past several days have been relaxing. I have settled into the routine of eating a high protein diet, sleeping as much as possible, and keeping off of my feet. My wonderful wife has been taking extremely good care of me and handling everything from cooking meals to shoveling the snow. In three days, on Thursday, February 14th (Valentines Day), I return to the hospital for a follow-up examination.

I can’t quite express how affirming this surgery has been for me. I lived for almost 5 decades as a male, and I only knew one body. It’s not that I hated how I was born but I didn’t know any other way. In other words I didn’t know what I didn’t know. When Dr. Gast removed those bandages last Wednesday and I looked down, I had what my Aunt calls the “Ah ha!” moment. The week before the surgery I found myself questioning everything I have done these past three years since beginning my journey.

“What the hell was I doing? Am I really transgender? Do I really want to have this kind of permanent surgery?”

All of that doubt and questioning completely disappeared the moment I looked down. I had been given a gift. The gift of who I truly am. The affirmation that I am a transgender woman. And I am on the exact path I need to be on to become my authentic self.

~ Tiff


A NOTE: This blog chronicles my experiences and my journey. I am not an expert or medical professional. I am learning as I grow and my experiences may differ from other transgender people. Everything is correct to my best understanding.

Chapter 23 ~Surgery: Best Care Anywhere

best care

8 February 2019

“Best Care Anywhere”

This was the tag line for the fictional Army Medical Unit on the popular 70s-80s television show M*A*S*H. I know of a real-life contender for this moniker.

The nurse connected something to my IV tube and pushed the plunger on the syringe, the doors to the prep room were opened, and I was wheeled out and everything faded to nothing.

Not even to black.

I remembered nothing until the groggy haze of waking up in a hospital bed in a small private room. It felt like I was wearing a diaper and I lazily tried to survey my surroundings and get a grip. The past four hours felt like an instant. I glanced to my right and saw the smiling face of my wife. I couldn’t remember why I was there or what was happening. The anesthesia was doing a great job of sedating me.

11 months prior I experienced my first major surgery when I underwent facial feminization. I also experienced an awfully bad reaction to anesthesia. It had me vomiting for the first 24 hours after surgery. Not a good thing to be doing when you’ve just had your nose reconstructed and your brow bone shaved down. Going into this new surgery with that knowledge was extremely helpful. And worrisome!

All along the journey in getting to this point I made it a habit to let my new medical team know that I had had a bad experience with anesthesia, but it was my aunt that suggested requesting a scopolomine patch which is used for stopping nausea from motion sickness or anesthesia. It was a relief when I was in the prep room for surgery and one of the first things the nurse did was to place that tiny patch behind my left ear. The anesthesiologist also assured me that there were other things that they could do to reduce the chances of nausea after surgery. He was good to his word and I was very glad in my post-op state that I was just groggy and not sick to my stomach!

I think I slipped in and out of consciousness for a while. I remember my wife telling me that Dr. Gast came to her after surgery, telling her everything went perfectly. And that she was then told what my room number was and where she could wait for me.

At one point she asked if I was hungry to which I must’ve responded to the positive. We had brought tiny bags of Nilla Wafers, provided by friends Jon and Chloe (“They are the perfect snack and only 20 grams of carbs per bag! Easy to account for!”). My wife fed me while, not within my memory, I sang David Bowie tunes very quietly.

“Ch Ch Ch Ch Changes……”

I know that I slipped back into unconsciousness for a while and eventually woke to some sort of stable lucidity. I was laying in the hospital bed with an IV of fluids and antibiotics as well as insulin. I wear an insulin pumps 24/7 but it is only good if I am coherent and able to monitor it. As with my last surgery, I suspended the pump and relied on the anesthesiologist to control my blood sugar levels and make adjustments with glucose or insulin based on their incremental testing during surgery. Post surgery I was still unable to stay awake for long periods, so I was left on that insulin drip so that the nursing staff could monitor my blood glucose levels for me.

IMG_0559Panoramic view of the room from my hospital bed.

I was also catheterized, a new experience for me. But since the catheter was inserted during surgery, and afterwards I was wrapped pretty tightly, it just made it easier for everyone involved. It was odd though to not have to get out of bed to urinate even though I was hydrating regularly.

Eventually my wife left for the evening and retired to her hotel room. It was within walking distance but with the cold weather and the benefit of a complimentary shuttle service she rode back and forth to her accommodations. I quickly and easily fell asleep but was woken every hour for a blood sugar check and every six hours to take pain medication. It’s not as bad as it sounds, especially when you’re doing nothing but sleeping or lying about.

The next morning I received visits from the plastic surgery team that accompanied Dr. Gast. It is a college hospital so there were many of the staff from the OR to the nursing staff who were students. Mid-morning Dr. Gast came in and inspected the compression bandages. I was also visited by the assisting surgeon, Dr. Block, another wonderful doctor. I feel very fortunate to have had not only an extremely skilled and compassionate team but also predominantly female, something that I hadn’t realized made a difference to me until I was recovering.

Eventually Ann-Elizabeth arrived and I ordered some breakfast from the hospital food service. They have an ingenious method of using iPads given to each patient for choosing from the menu. The iPad is issued to each specific patient and contains several pieces of information such the food menu as well as ones care team.

I cannot say enough about the wonderful team that cared for me in recovery. There was Beth, Tara, Ashley, Rachel, Vivi, Pentrecia, Jasmine, Maddie, Devon and Bri, and I’m sure I’m leaving some out. I am so grateful to all the nursing staff on floor 6 as well as the room service staff that took such good care of me while I was recovering. Their dedication to care is inspiring and so very appreciated!

The day was not significant in any form except that by mid-afternoon I was cleared to connect back to my insulin pump. I do want to say that as far as pain, I did not feel anything other than mild discomfort. There really was only a dull pain in the general area of the groin. I was only on taking acetaminophen. The only other pain that I incurred was in my back from having to lay in pretty much one position. I was allowed to recline but no more than a 40 degree angle to avoid putting direct pressure on the wound. Even now as I write this on day 5 I am not allowed to sit upright.

I slept very little that night due to an extreme ache all throughout my back. The next morning was Wednesday, Day 3. We had reserved the hotel only through noon of that day. We were waiting for Dr. Gast to arrive and find out if if the bandages would come off and we would be able to go home, or if we would have to remain another day thereby requiring us to hold the hotel room for another night for Ann-Elizabeth.

I ordered breakfast from the electronic menu. Food usually arrived within 30-40 minutes. The previous day I had learned the difficulties of eating while reclined and began to choose menu items based on their ability to be cut and consumed without too much mess. My omelet arrived and I began to eat. About halfway through breakfast Dr. Gast arrived to remove the bandages.

This was it! I would be more comfortable, I would be getting the catheter removed, and most importantly I would see my transformation!

I was packed and taped quite thoroughly. Over the bandages I wore some hospital supplied white mesh boy shorts. The shorts were pulled down and sniped off and then the impressively secure tape was peeled off, followed by the not too bloody gauze pads. I lay my head back as Dr. Gast and the nurse did their work. Next the drain tube and reservoir was removed. I was told that this drain tube may stay in place until my followup 8 days later, however not much fluid was draining so it was decide that the tube would be removed. Dr. Gast announced, “This is going to feel weird,” or something to that effect. She pulled the tube from the bottom of the sutures. It wasn’t that odd or painful. She then removed the catheter. Oh boy! I’m glad that it was quick because it was also intense! Not painful. Not too unpleasant. Just intense.

After a quick cleanup she called AE over to point out the different areas. Now, my wife is an amazing woman, but she is not prone to handling even mildly graphic medical situations too strongly. She admitted later on that she almost fainted, I knew the moment that Dr. Gast called her over it was not a great idea, but my trooper of a wife came over and saw my new transformation for herself.

I scrunched forward a bit and looked down. I almost burst into tears.

The previous Monday I had been at my day job questioning my entire journey. Was I transgender? Was bottom surgery the right thing for me or was I about to make a terrible mistake?

Looking down and seeing the smoothness of my new womanhood let me know that everything I had done was right. I could not believe the elation I felt. I was complete.

Erasmus or Rotterdam said, “The summit of happiness is reached when a person is ready to be what (s)he is,”

I hadn’t realized how ready I was to be me.

But I was ready, and I was extremely happy!

~ Tiff

A NOTE: This blog chronicles my experiences and my journey. I am not an expert or medical professional. I am learning as I grow and my experiences may differ from other transgender people. Everything is correct to my best understanding.

Chapter 22 ~Surgery: The Big Day

surgery big day

7 February 2019

Let me take you back to a more complex time.

A time of conflict.

A time of tucking.

Well, four days ago actually, to Monday, February 4th at 11:00 am.

I was wearing a purple disposable gown with a hose connected to it inflating it with temperature controlled air. The papery-plastic thing expanded like I had just consumed one of Willy Wonka’s experimental sweets, I had been anxiously watching the red digital clock on the opposite wall for the past two hours. It now glared 11:00 as the nurse slowly injected a sedative into my IV.  I think I remember them pushing the wheeled bed out of the room and down the hall.

Everything faded from color,

to grey,

and then nothing.


We had arrived the previous day, Super Bowl Sunday, at 3:00 pm  and checked into our room at the Best Western just down the street from University Hospital. I would only be staying the night but my wife would reside there for the next 2 or 3 days while I recovered. After settling into the room, we took a Lyft to the nearest Target store for some supplies, and then back to the hotel and dinner in the hotel restaurant. It would be my last meal until after surgery. We ate a healthy portion of a delicious pepperoni pizza and took the left-overs up to the room so that Ann-Elizabeth had something to eat the next day.

I had to take a preparatory shower that night as well as the next morning with a specific, hospital supplied anti-bacterial soap. After the morning shower I prepared myself with comfortable leggings and long sweater, and accompanied AE to her morning breakfast. I was only allowed the option of four liquids prior to 7 am that day: water, apple juice, tea, or black coffee. I had some water up until about ten to seven, but I really wasn’t hungry due to the anticipation of this major milestone in my transition.

Gender confirmation or gender affirmation surgery, often referred to as “bottom surgery,” previously referred to as sexual reassignment surgery, is THE surgery for so many male-to-female transgender persons. It is the surgery that removes the testosterone producers and allows, those that seek it, a more aligned physical representation of how they should have been born.

There are several options for how this surgery is performed, but in many cases the transgender woman will be able to have a fully functioning neo-vagina with sensate clitoris. There are variations to the surgery such as not having a full vaginal canal created but having everything but. This is the option that I opted for. I’ve written about this in previous entries so I won”t go into it here.

After breakfast I packed my bag and we rode the complimentary hotel shuttle to the hospital some 5 minutes away. I had been to the clinic entrance of this building twice prior for my initial meeting and pre-op appointments with the plastic surgeon who would be giving me my new future. However, this time we were entering the hospital entrance and making our way to the 3rd floor and “First Day Surgery.”

We were both in an extremely happy and giggly mood. Being a type 1 diabetic of almost 35 years, I have had my share of hospital visits, often out of necessity. This was the first time I was there to have a major operation that I wanted and had been waiting for for so long. I registered and shortly a wonderful nurse named Elizabeth ushered us to surgery prep room number 17. I donned my purple inflatable gown and proceeded with all of the necessary steps of answering questions, having an IV inserted, cataloging the things I was bringing with me for the duration of my stay. Opposite the wheeled bed I was lying in, above the sliding double glass doors that we entered through, was a large red digital clock. We were there the required two hours prior to surgery, and I kept looking at that clock as preparations were made and the flurry of medical staff came in a performed their parts. Dr Gast, my brilliant and skilled plastic surgeon stopped in as well as the assisting surgeon, anesthesiologist and other assorted surgical and prep people. I think at one point I was given two tablets of Valium and I remember someone saying  “We’re just waiting for the go-ahead that the operating room is ready.”

And then BOOM, it was go time.

The nurse connected something to my IV tube and pushed the plunger on the syringe, the doors to the prep room were opened, and I was wheeled out and everything faded to nothing.

Not even to black.

I remember nothing.

While I was in surgery, Ann-Elizabeth would be shown to a waiting area designated for the relatives of loved-ones being operated on. She was given a pager that indicated specific stages in the operation, and was eventually greeted by Dr. Gast at the end of my 4 hour surgery with news that everything went perfectly and that I was going to be taken up to my hospital room on the 6th floor where she could await my arrival.

– Tiff


A NOTE: These are my experiences with my journey., and this blog is a place for me to tell my story and journal my transition. I am not an expert or medical professional. I am learning as I grow and my experiences may differ from other transgender people. Everything is correct to my best understanding.


Chapter 21 ~Bottoming Out


21 January 2019

I have been working on this post for months. Something always gets in the way of posting it or finishing it for that matter. The short and the long of it is that I am two weeks away from bottom surgery which is scheduled for February 4th. To say I’m excited is an understatement! The journey from initial consultation to surgery date was very long and arduous requiring a lot of tenacity and patience. I admit that when I hit a slow-down it would throw me into a depressive state for a few days until I could gather my thoughts and reformulate my plan of attack.

My path to gender confirmation, or affirmation, surgery began last April. I had a consultation with a plastic surgeon in Madison, Wisconsin, not far from where I live. The surgeon, who is with our state university, specializes in gender confirmation surgeries. I posted about that consultation in the entry: My Surgery Consultation. Please feel free to read it but be forewarned that I illustrate some graphic details as it pertains to these surgeries.

In the months since that consultation I discovered the path and tasks required to qualify for the surgery and knocked off each one. The first step was to get my 2 letters of recommendation from mental health assessments, which are required for genital surgery. These were submitted to my insurance provider by the surgeon for determining coverage. Incidentally, I had made a call earlier in the year to my insurance to confirm that not only was gender confirmation surgery covered but also that my surgeon was in my network, and both were.

My insurance replied within a week and denied coverage for the surgeries claiming that my surgeon was in fact not in my plan, but I did find them in my network on my insurer’s website. I’ve worked with both the surgeon’s office and my insurer to correct tax ID and billing codes, but it required patience and persistence. Eventually they confirmed coverage of bottom surgery but not top surgery. My insurance plan does not cover top surgery or breast augmentation for mtf transgender clients. I will be working toward that in a few months, but for now I want to talk a little bit about the emotional side of this journey.

You know, I never started this journey because I chose to be transgender. Noone who is transgender chooses to be. This is a tough road even with support. I consider myself a mentally healthy adult who has had to live for just about 35 years with a insidious, slowly degrading health condition that has reduced my quality of life and continues to degrade. Choosing to undergo facial surgery and now genital surgery places me at greater risk for complications. Starting hormones was a risk that proved bad and left me with permanent damage, but I’m still persisting. And why? Because I have the chance to be happy within my mind and body. Who doesn’t want that? We all deserve it.

When I first came out as transgender I referred to the “Unhappy Person” that I was living as Tom. I received a few messages through social media chastising me for that. It’s pretty unfair calling me out for that. Just because someone doesn’t appear to be hurting on the outside doesn’t mean that they are OK on the inside. If we could identify anyone hurting inside we could possibly reduce or prevent depression and maybe suicides.

I may not have exhibited any outward characteristics of being sad but I also didn’t know I was transgender. For many people who discover that they are transgender, once in therapy the gender dysphoria and questioning only becomes more intense. So too does the doubt. Doubt that maybe we aren’t transgender.

I’ve made a lot of progress in becoming my authentic self. I have an amazing support team that includes a lot of you who are reading this. Thank you for that. For all of the forms it has manifested including becoming a more understanding person for others that you may encounter in a similar situation as mine. As I get older I care less about what people think of me, especially the haters. There are a great number of people that feel the need to weigh in on choices such as mine and attempt to cite a multitude of reasons why they feel it is wrong from religion to incorrect biology. But why does it matter so much to them to try and exert that power on someone else? My hope is that one day they will see that encouraging and supporting someone is far more rewarding than repressing and scaring them.

To quote a young transgender boy named Kaysen, “It shouldn’t be scary to be who you are”

Back to my path toward surgery….

On October 17th, I finally received confirmation from my insurance company that they would cover my bottom surgery, but it wasn’t until December 7th that I booked my actual surgery date. At times I thought it would never happen and was bracing myself for another round of submitting paperwork. So much stress was alleviated by finally having that date booked. I was now able to move forward on the many other tasks toward the surgery date like filing paperwork with my employer for an extended leave of absence. They have been so accommodating during this entire transition.

So now, two weeks from surgery, I have everything in place. I would to post daily updates if I can. I really don’t know what my mental or physical state will be but I want to share this experience for other trans-women, family members or transgender persons, and trans-allies. I will be taking video as well but it may be a while before I post any of that.

Thank you to all for your continued support on my journey. I so greatly appreciate it!

– Tiff


Chapter 20 ~The Mask He Wore


29 October 2018

Have you ever heard of The Moth?

They are a group, community, organization… that promotes live storytelling. Based in New York, they have events throughout the United States.

I wrote a piece for a Moth story telling event that occurred in Milwaukee on October 25th, but it conflicted with a trans support rally and I thought that my feet on the ground and my voice in the air was going to be more effective at the rally, so I’m presenting my prepared piece for you here.

The storytelling event was held at one of our local coffee houses and the topic was “Disguises.” The event description, taken from their posting, reads as follows:

DISGUISES: Prepare a five-minute story about your undercover self, about obscuring the real you- with a fake mustache, a nurse’s uniform, a cloak, a girdle or a giant hotdog costume. Mental disguises, like the Ph.D. you earned to appease your mother; or the “sensitive guy” persona you put on to get with the ladies. Undercover cops and chameleons. Pranks and mistaken identities. Wolves gussied up like lambs and lambs tarting-it-up to pass as mutton. The Trojan Horse, The Mighty Oz and now you!

I wrote the following:

The Mask He Wore

I used to know someone who was born in the last year of the sixties, the year we landed on the moon.

The second youngest of 7 kids he was raised in the south suburbs of Milwaukee. He was an inquisitive kid. He walked to school, played an instrument, loved Star Wars and wore a mask every single day of his life. He pretty much fooled everyone around him including himself.

You see, when you’re convinced that you are what you appear to be, you think that you only have one pallet to paint from, one store to buy from, one buffet to eat from…

A mask can hide your identity so well that you may not even know what you really look like, especially if you’ve never taken it off.

Sometimes though, there are hints. Sometimes you can feel the elastic holding the mask on your face like on one of those 70s vacu-formed masks.

Sometimes, in the mirror, you can see the thin rubber of the forehead move because there’s an empty cavity between it and your real head as if you are wearing the best Don Post rubber “life-like” mask, that claims to look “realistic” but somehow doesn’t look that real.

Sometimes you can see the shadow around the eyes, revealing that the mask is hovering above the face of the person within.

But the eyes are real.
The eyes are the tell.
The eyes are revealing.

They can’t hide the joy, or the fear, or the uncertainty.

They can’t hide it from you and they couldn’t hide it from me.

I lived with that mask until I was 46. Most rubber or plastic masks would have cracked by then, and I guess mine did.

You know how when you’re building a puzzle, and you’re looking for one particular piece, and you kind of think you know what the piece looks like? And when you finally see it you know that it’s right.

That’s what it’s like to remove a mask you didn’t know you were wearing. You don’t know that you are oblivious as to who you are until you are who you were meant to be.

You don’t know what you don’t know.

I finally removed the mask “he” wore and under that uncertain boy was a beautiful person, a woman,

who finally knew who she was,

knew what she liked,

and loves who she is.

I saw that there are infinitely more pallets to paint from,

more stores to buy from,

and more buffets to eat from.

There’s a part of me that wishes I would’ve been able to remove that mask sooner than I did, but the journey I took is what has allowed me to eventually take it off.

I hope everyone that wears a mask can know what it’s like to remove it; that “A-ha!” moment of finding the right piece of the puzzle,

and letting the sun shine on

and from their face.

– Tiff

Chapter 19 ~Are you, by chance, pregnant?

22 October 2018

I experienced my first mammogram three weeks ago. My wife and close female friends had been warning me about the negative aspect of this test, the only positives being that it was quick and was a necessary part of screening for breast cancer. I know that this latter point is debated among some people but I’m not going into that here.

I was a little concerned about this test only because it was my first time. I have had other procedures that in retrospect are far more painful, such as laser eye surgery for diabetic retinopathy. And while not something I look forward to, I am so familiar with them that I can calm myself before having them. But for this simple procedure I was a first-timer. I can hear the faint calls of “Virgin!” from the Rocky Horror crowd. I read up on the procedure so that I was somewhat informed not only of what would happen but also any possible preparatory instructions.

Since my facial feminization surgery last March I’ve wondered whether new people I encounter see me as a woman or a man. I know that when I look into the mirror I still see Tom, but what about others?

In the past 6 months, since the facial surgery, I have had a few medical appointments for this and that, and legally I am a woman and my medical charts indicate that fact. Usually with lab visits I am asked a series of questions and for this appointment it was the same but the difference is that during this appointment I was able to find out how I am perceived by people that I meet for the first time.

One of the first questions I am asked now is if I am pregnant. It’s usually twisted in it’s asking though.

“You wouldn’t by change be pregnant?”

I had thought that it was being asked in this way because they know I’m transgender and there is no way I could be pregnant, but it was from the second question that I now understood several things.

“Have you recently had a hysterectomy?”

Ummmm, what?!

A hysterectomy?!

They didn’t know! My medical chart says I am a woman, not a transgender woman. I suddenly realized that they ask if I am pregnant in that manner of supposing that I’m probably not pregnant because of my age, not because I’m outwardly identifiable as transgender. I will be 49 in two weeks, and generally woman do not have children at 49.

I responded this second question with a with a delayed, “I’mmmmm transgender.”

“Oh! Okay then!” The nurses demeanor changed to a wonderful conversation about if I’m getting top surgery and when. Am I on hormones, which lead to my unfortunate experience with estrogen and my mini-stroke. She was very helpful and explained everything to me like a new member of the club.

It was such a comforting and nurturing feminine experience, the kind that I had lacked so many times throughout my life when I was grouped with the boys, but would rather have been included in all things “girl.” I’ve missed out on all of those firsts that girls learn and master at each stage of life; having one’s ears pierced, learning about nail polish, how to appropriately sit while wearing a skirt, training bras, and of course the others that don’t and won’t apply to me because no matter what I do the biology is still different.

And while twisting myself into a slouching knot to have my chest pinched and x-rayed wasn’t the wonderful experience of getting one’s first prom dress, it was still pretty wonderful to find out that I am perceived as the woman I identify as, and then be welcomed and accepted as a woman instead of judged and mocked.

We all want to belong and be accepted, and we all want to be loved.

– Tiff




Chapter 18 ~Acceptance and Rejection


1 September 2018

I realized that I might be transgender back in the fall of 2015. It was a surprising revelation to me. I really began to examine my life as a whole – the daily stress that was affecting my health, my mental state, the expectations I felt were put upon me to act like a man. I knew I had to do something to change things for the better. Within 6-8 months I had moved from questioning to knowing. I had been in therapy a few months and in stages I began to reveal myself starting with those closest to me. First it was my mom, then my immediate family, close friends and employers, coworkers, and finally the world.

I had begun to accept that I was drawn to feminine things many years earlier, but it wasn’t until I met my wife and she accepted me, and helped me accept this “thing” that weighed heavily on me daily, did I feel like it was OK. Like I was OK. This was years before the thought of being transgender ever came into my head. My life and emotions were still a jumble, like the early stages of a galaxy with its amorphous turbulent whirlpool. Once I developed the vocabulary for my situation, that whirlpool started to take shape and make sense, and in spring of 2016 it allowed me to begin to try explaining it to everyone else.

I’ve had a long time to accept that I was born a transgender female. Anyone else who has known me for any length of time, whether its 48 months or 48 years, has had to try to come to some sort of understanding in a relatively short amount of time. That’s natural. People grow at different rates, and so too do people’s ability to accept.

It’s very important for everyone to know that being born transgender is no more a choice than being born with green eyes. We’re not choosing a “life style” by being trans, and it’s a costly endeavor to correct this biological wrong, both monetarily and emotionally. We fight an uphill battle with insurance companies to cover these life saving procedures – and yes, the are lifesaving. I’ve stated before that the suicide rate among the transgender community is somewhere around 40%. Insurance companies are willing to cover psychological therapy and hormone therapy, but when it comes to corrective surgical procedures, they are still reluctant to approve them. I’m currently in a battle to straighten out the red tape to have my gender confirmation surgeries covered. My first request was denied. It’s emotionally draining to a person who has already had to overcome the battle within one’s own psyche, and then perhaps has had to fight with their family, friends, employers, or community for acceptance, to then be rejected by the very institution that exists to assist in caring for this biological anomaly.

In addition to the fight to become whole, transgender people are routinely discriminated against because of their gender identity within the workplace. As of the time I’m writing this, only 20 states have protections for gender, and mine (Wisconsin) isn’t one of them. I could be fired from my job for trying to live as I should have been born. This is yet another emotional toll that pushes so many transgender people to take their own lives. If I would just conform and live as I was assigned at birth, I would be accepted, but because I want to be healthy and whole, I and others are stigmatized. Again, being transgender is not a choice. Who would choose this?

The Name Game

Let’s talk about names and how I feel that they relate to acceptance and rejection with regards to a transgender person like me. Do you like the name that you were given at birth? Do you think it describes you? If you don’t or didn’t like your name have you wanted to or in fact changed it? Have you changed it because of marriage, taken your spouse’s last name?

Most of us have heard the song or at least heard the title of the song A Boy Named Sue, sung by Johnny Cash. The whole premise of it is that boys aren’t generally named Sue. But what about naming a girl Thomas? Now throw in the complexity of gender identity. Natal females can be transgender males, and thus, as in my case, natal males can be transgender females. To live more “in-line” with one’s gender identity, we change our names to better suit our identity. Poor old Sue didn’t seem to have that option. Instead he went and found his Dad and confronted him with the intent of killing him. His father explained:

“Son, this world is rough
And if a man’s gonna make it, he’s gotta be tough
And I know I wouldn’t be there to help ya along
So I give ya that name and I said goodbye
I knew you’d have to get tough or die
And it’s the name that helped to make you strong”

The topic of toxic gender stereotypes aside, that’s pretty heavy to lay on someone. But Sue responds in the last two lines of the song:

“And if I ever have a son, I think I’m gonna name him
Bill or George! Anything but Sue! I still hate that name!”

It’s kind of like that for transgender folks. To be called a name that doesn’t align with one’s gender can be an emotionally arresting thing, especially if it is being done against the wishes of the transgender person. Particularly after one has gone through the costly, laborious and emotional process of changing it.

Dale Carnegie, the American writer and self improvement lecturer said,

“Remember that a person’s name is to that person the sweetest and most important sound in any language”

“Using a person’s name is crucial, especially when meeting those we don’t see very often. Respect and acceptance stem from simple acts such as remembering a person’s name and using it whenever appropriate.”

There’s that word again, acceptance. To say to a transgender individual, “I can’t or won’t call you by your new name” is a way to say “I reject you.”

In a study by researchers Naomi Eisenberger, PhD, at the University of California in Los Angeles, California, and Kipling Williams, PhD, at Purdue University in Indiana, it was discovered that rejection activates many of the same brain regions involved in physical pain. My wife uses this information in her training and public speaking engagements that involve human interaction. As she puts it “When you reject someone, the brain reacts physically the same as if you had punched them.” This is explained in greater depth in the article The Pain of Social Rejection  (

It took a long time for my mother to finally call me Tiffany, but now she does. She falters once in a while and then corrects herself, but it’s a process. I know it’s difficult for some people, especially a parent. She has known me my whole life and after 46 years I am asking her to call me something new. A name that is replacing the one she gave me. I’ve accepted the fact that for some people this process of calling me by my new, chosen name may take a while. It is a pleasant surprise when someone who has known me for a while automatically accepts this and is able to switch to calling me Tiffany instantaneously. In the early days of my transition the sweetest sound to my ears was when I would doze off at the end of the day while sitting on the sofa, and my wife would wake me by saying in a soft voice, “Tiffany, time to go up to bed.” To be called Tiffany was heavenly, especially by the person I hold dearest in my life.

Most of us have gown up with some form of name calling. I feel that by calling a transgender person by their birth name is kind of like that juvenile name calling. But it feels doubly vindictive when an adult decides that they won’t call a person by their chosen name. Because they should know better. Kids actually have an easier time understanding this. Maybe as adults they don’t understand that choosing a new name is part of the life-saving process we transgender individuals are going through to make some sense and meaning of our lives. And by resorting to referring to someone by their birth name it’s like taking a life-preserver away from someone drowning. There may or may not be malicious intent, but the mere act can have devastating consequences. We have all seen what bullying can do at the high school level.

For International Transgender Day of Visibility I wrote about the African greeting that literally means “I see you.” I think that by looking at someone and saying their name, especially their chosen name, you are letting them know that they are seen. And hopefully accepted. Because we all just want to belong. I know I do.

– Tiff