The Promised Land: GRS for the poor?

I have turned a corner here in The San Francisco Bay Area.  I moved here all the way from South Carolina to start a new life and to hopefully get Gender Reassignment Surgery (my preferred term). I am also pretty poor. I know, so unusual for a transwoman, right? I spend my days toiling in a big box retail store for meager pay. Its a pretty cool big box store, but still, it pays a tiny bit over minimum wage. In California, minimum wage is $9.00 per hour. Nine dollars paid for one hour of your life. Think about that. I give up 8 hours of my life to be a slave to this place for a meager $72 minus taxes.

Being of low income is attributed to a lot of factors, which is for another article. I do alright. I live simply and I get the bills paid. I sometimes have some left over to enjoy life with. California makes it tough to be poor. The housing and cost of living here is higher. Working in the grocery section lets me know exactly how much things cost lately. Everything is sneaking upward. I try to stick to the $5 meal level. If you can make a meal for $5 or less, you are doing okay. I still need to apply for food assistance, which will help. Another help will be California minimum wage going up to $10 per hour on Jan 1, 2016. That will be a little relief.

When you are of lower income in California, you are saddled with something called MediCal. I made too little to be a part of the ACA. I used to have a silver plan that cost me $16 per month in South Carolina. MediCal is basically California’s version of Medicaid. I really never knew much about Medicaid before now. So far, its been okay. It cost me nothing and I get estrogen for free and Spiro for $11 for 360 pills. I have still yet to see a doctor. I keep trying to call for an appointment, but all of the appointments are taken before I can call. Apparantly you have to call on a certain date at exactly 7 a.m. or else you are sunk. I keep sleeping through that date and time since I work evenings. Its a little ridiculous. I am used to calling my doc, getting an appointment, and going to it when its scheduled. This MediCal is something like calling for concert tickets back in the day.

Dr. Bowers

So, I am stuck with MediCal. California just passed a law that insurance companies cannot discriminate against trans people and must provide equality in trans healthcare. Basically, they must pay for surgery if it is deemed medically necessary. We all know that it is. I have been trying to get myself to the point that I am ready for GRS. I believe that I am there now. I know it‘s hard and not so much fun at times. I know there is pain and possible complications. That’s why I want a proven doctor such as Marci Bowers, who is right here in this area. It’s The Promised Land, or its supposed to be. They are giving away free vaginas here! Come one, come all!

Not quite. Reality is hitting. There is no information on any of the doctor‘s sites here locally that state anything about MediCal. Marci Bowers’ site does state this about Medicare though:

“Despite our efforts to work with Medicare, we have been unable to contact any Medicare personnel who can guarantee approval and reimbursement nor has anyone offered contractual agreements with us to provide service. Our intention had always been to accept Medicare. In our test cases with Medicare coverage, there continue to be denials of our claims. Until we receive affirmations of coverage, the language suggests only a lifting of the ban. This should have the positive effect of no longer allowing private insurers to deny coverage with the argument ‘Medicare has an exclusion.’ In time, we do expect to offer Medicare coverage for transgender surgery but cannot do so at present with such uncertainty still in effect.”

I read this and thought, this may not be a good sign for MediCal. I know Medicare is a different animal, but still a government animal. I have heard info on MediCal as it pertains to GRS and trans healthcare. In early 2014 MediCal started allowing trans healthcare. BUT, that doesn’t necessarily mean the doctors have to take MediCal. It’s still kind of the wild west out there with insurance covering GRS. Insurance companies are like cranky old men who don’t want to change. They would rather us “nuisances” stay off of their damn lawn. But, we will not go away. We keep fighting for change. The only problem…I ain’t gettin’ any younger waitin’ for all this to happen.

I will never understand why it’s so difficult just to turn a small piece of flesh inside out. It has to be this HUGE production with insurance and $20,000 and deposits, and letters and pre-authorizations and 2 year waits, etc, etc, etc. So much consternation, it causes. Hell it’s easier to have heart issues, go in, get your angioplasty and bada-bing, on your way!  At least you don’t need a gatekeeper to tell you that you can have your surgery. Perhaps, I am just a little frustrated. I will keep fighting and making calls until I know what is available to me.

Some call this a “life saving surgery.” I can’t say that I am that bad off that I need the surgery or I will jump off The Golden Gate. Its not quite that severe. The hormones have satisfied a good portion of my needs. However, I am not able to look at myself naked for very long without covering up with at least panties. This digust that I feel tells me something.  It lets me know that I am proceeding along my intended path. I have been OK with things. But, now its time for the final phase. I am in the right place, the laws are favorable, the doctors are here. I just need to go the extra mile to get the ball rolling, to quote two cliches in one sentence. It’s there for the taking, for those who want it.

I know GRS is no picnic. I have seen it firsthand with my partner Jess. I have been told stories by the many friends that have undergone GRS. It’s a tough surgery to heal from. If you are lucky, you will have only minor issues and sail right through. On the other hand, there are some pretty tough potential complications that could happen. I just heard a story about a girl who had it done and it did not “take.” I would assume that the neovagina closed up or became unstable and the insides became damaged. I hear these stories and I do worry. Theoretically, you are intentionally mutilating perfectly good working tissue just to fix a problem with your mind. Or is it correcting a birth defect? It’s a bit of a grey area.

We see ourselves as the other gender. I see myself as a female with breasts and a vagina, as it should be. When I do not see that in the mirror, I get distressed and disgusted. Before Christine Jorgensen, there was no option for doing anything about it. [Ed. Note: Lili Elbe had the first publicized gender surgery in 1930.] Thousands of years passed with people who felt like us just living with their incongruent bodies. Now, medical knowledge has made it possible to come very close to letting us be in the body that we want. For some, it can be a lot closer than others. I have always imagined myself as a kind of bombshell and not a little pixie girl. My body type closely resembles a healthy bombshell female minus a few curves that I would love to have. Others, are 6 foot 2 and with a solid build but feel like a little dainty pixie girl. To this point, plastic surgery can only go so far.

I am blessed. I am one of the lucky ones. However, it doesn’t change the fact that my dysphoria is just as strong as a person who does not have a body type that would be considered in the common female range. I get down on myself, too. I grab, I pinch, I lift and stretch and sigh as I look in the mirror, not satisfied with my body. Its all relative. I have struggled with the decision to go forward with GRS. I see my friends one by one getting it done and ending up happy. Why have I resisted? I am scared. I am scared of the pain and of potential complications and of possible revisions. How will I save enough for lost work? How will my company handle my absence? How long will I have to be off? Will I have to work in pain at my physical job? How do I explain being off that long? These are my burning questions. HIPPA will help, my company’s tolerant policies will help, my friends and knowledge will help.

I am just in the beginning stages of this final phase. I am not rich. I cannot just plunk down $20K and be done with it. I wish it were that easy. I will navigate the waters of a low income transwoman living in The Bay Area. I will attempt to do all of this and still make the bills. I have a good support system and a loving Mother to help me. It may be a rougher road to take, the poor road, but I hope I can push through not only the pain of the MediCal red tape, but push through the pain and the mental endurance test that GRS involves.

Tags: featured, gender reassignment, GRS, Plastic Surgery, San Francisco, Transition

Category: Transgender Body & Soul