Thank you for this. I'm still a new chick, but I've already noticed subtle shifts in how I feel about my future, so I've adopted the attitude that things will change in ways I can't anticipate. It worries me a little because if I'm experiencing significant back and forth and up and down already, how much of a basket case will I be when I start HRT?
It helps to have the perspective that I'm uncovering layers that have been covered by my outer state of dysphoria, that I'm not playing whack-a-mole with insecurities that pop up randomly with no underlying pattern. Like my face dysphoria on the weekend, which I wrote about. It was suddenly stronger than it had been before, but it wasn't new.
Using a map analogy, I've picked out the cities I plan to visit on the way to my new home, but I expect detours along the way. And as I approach each waypoint, I might see another city I'd rather visit. At this point I think Facetown might be the first industrial city I visit after a long drive along the Hormone Coast, but who knows? Right now, I see an adventure laid out before me. I'm sure I don't appreciate how big some of the potholes will be.
I consider myself fortunate. Much of the dysphoria I suffer has to do with facial and body hair. I was able to start HRT in May, that helped. Waxing has helped, electrolysis has helped, we suffer for beauty, right? I expect there to be more. I work on what I can, remain patient, and see what comes next.
I've had some mild thoughts that MAY be bottom dysphoria. But for now, I'm like "let's put a pin on those thoughts for now and see what I think of them in a year or two." Since there isn't much I can do about them at the moment, but when I'm 1-2 years on HRT, there will be.
I'm a "Take it as it comes" kind of gal. Always have been. But to do that effectively, I have to listen to my body and see what it is trying to say.
6-18 months was... yep. That's when bottom dysphoria became painful. We already knew we wanted GRS, but the pain had been suppressed. Embodiment/mindfulness work was actually how we figured out we wanted bottom surgery. Body scan meditation -> whoops I envisioned the other parts and got feelings -> f*ck, I guess I want that now. I always told my therapist, dysphoria feels like my body isn't safe, and how do you embody in a body that doesn't feel safe?
I guess a lot of it is about accepting how different things can often be from what you expected and having that be all right. For me, it involved a lot of getting comfortable with uncertainty, but everybody's path is different.
I find that really interesting as I had my surgery about 17months after HRT and never really had much bottom dysphoria. Maybe if I'd left it another year or something it would of really started to hit me.
I've now read most of what you've published on your substack, and I just wanted to say thank you.
So much resonates. So much is familiar. Many of the personal experiences you share have echoes in my own life. It's a joy and relief to read of how you worked through challenges I yet face.
A partner once in frustration called me an onion, because of the difficulty in finding any true heart through the endless layers. This entry's title made me smile because of that. The irony is that those layers trouble me as well. But they evolved to protect me from the world and from myself starting from when I began school.
Understanding what you need requires connecting with yourself. After decades of disassociation, I'm still working on being able to feel emotions again. Very little of strength comes through. I *guess* at needs from the heartstopping, often physical reactions to certain expressions of feminity. Like large breasts, which have poked a spot in the back of my head since at least puberty that took me forever to recognize as "want". The emptiness of my arms at night still feels wrong, and has for so many years. If my mind could truly tear itself free of this body, it would.
But how to really determine what I want, who I am, when I'm still so shut down most of the time? I wish I could escape from the prison of coping mechanisms. Some of the entries you've written stirred me up inside and it took a day for me to realize that it was all the feels I had 8 years ago when I first cracked, starved of hope for so long, returned with a vengeance. And I recognized that I had begun to slip into a new state of coping. Having started hrt but making no other changes. Facing an unsupportive environment, pushing back at me, I was building myself a new prison, so little changed from the last one I could barely tell the difference.
How within the grasp of disassociation, the entrenched habit of self-denial of needs, unable to summon any emotional force, to believe in the muted impulses that are my only evidence of needs or indeed accumulate the strength to pursue them?
I have a psychologist. I will talk to her. But I've no idea how to regain contact with the strong emotions I remember in the few childhood memories that remain.
Much love for sharing you journey and your knowledge.
My north star has always been to chase that joy, those desires, that hope. It's become a real part of the theme of SGW in general--to chase your joy in transition, rather than fleeing from your dysphoria.
If you want big boobs, if your chest and arms feel empty without them--God, I know that experience well--then get them. You deserve them.
Thank you so much for this perspective! This is really helpful. It’s going to inform my own journey, not only with my transition, but also with the exploration of my own childhood trauma (with my therapist).
I was trying to find a more relevant article to post on, but I think this one is fair enough because I looked at this around the same time I restarted my own questioning about breast augmentation.
I am a younger trans femme who is looking at getting breast augmentation, but I don't know if the risks are worth it right now. I see that the rupture rate for some is about 5%( https://www.accessdata.fda.gov/cdrh_docs/pdf6/P060028b.pdf page 23)
for implants and that they weaken overtime. I want the surgery because I do think it would overall increase my own euphoria and help with my own brain affirming my body day to day.
However, I am concerned that I will need to get them replaced sometime in my life and might have loses to sensitivity or permanent damage done to my breasts that I am overall happy with except for shape and size.
How did/do you weigh the risks of breast augmentation for your own self?
That's a very fair worry! There are a few things that you want to remember with that 5%.
1. That's a lifetime risk for a lifetime medical device. Medical devices *of all kinds* fail from time to time. That's just how it goes--it's why, for instance, the average person will receive 2.3 total knee replacements over the course of a lifetime.
2. 5% is a 1 in 20 chance. Compare that, for instance, to a 1 in 103 *lifetime* risk to die in a car crash, and the rupture rate should make a lot more sense. Those ruptures largely come from major bodily traumas, like a car accident or something.
3. That 5% is from 2013, when modern breast implant shells were first introduced, but which also look back to older, significantly lower-quality implant shells, which were used before. The industry has continued to improve the strength of modern implant shells beyond the results of what was referenced in that report. Modern implant shells are *radically* stronger than older ones, and that's not fully reflected in that data.
4. I went with saline implants, which frankly have no real safety risks in case of a rupture. Even in the case of silicone implant rupture, modern conjugated gummy bear silicones don't leak into the rest of the body.
5. It is *technically* accurate that modern implant shells degrade over time, in the same way that a titanium knee replacement *technically* weakens over time. The degree of degradation is pretty minor, though, when you consider the strength of these implants--which are so overbuilt that a common party trick that surgeons will do to demonstrate their strength is to overfill them by a factor of *ten times* their rated fill size, and the things just sit there and wobble, completely unperturbed. So, yeah. Do they weaken over time? Sure. Does it *matter* with modern shells? I can't imagine.
6. Modern Mentor implants are warrantied for life. That ought to tell you what sort of confidence the manufacturer has in them.
7. I was worried about sensitivity loss from my implants, especially given how big I went. And yeah, I lost a little--but I was surprised to realize just how little it actually mattered to me when it happened. I have a numb spot on one boob, but I literally don't notice it unless I go looking, and I'm still healing. It's been getting better, and I expect that to continue.
8. If you want to be sure your breasts aren't damaged, go to a specialist. Any competent top surgeon shouldn't hurt you, but a specialist is doubly so.
9. Finally, and most importantly: there's a risk of complications in *any* gender-affirming surgery, just like any other surgery. Life is a full-contact sport. *And that's okay*.
I was much more worried about capsular contraction than any of these, because it's more common--but as with everything else, the bottom line comes down to: the more skilled the doctor, the lower the chance of complications, across the board. Talk to your surgeon and ask what *their specific* complication rates are. They'll be different than the FDA base rate.
So, there's been increasing research into CPTSD and dysphoria by the field in general (https://www.frontiersin.org/articles/10.3389/fpsyg.2018.00060/full, for instance), but one confounder is that CPTSD has only been generally recognized as an independent diagnosis from PTSD in fairly recent times(2018ish), so it lacks a lot of the depth of research that, for instance, PTSD does; the result is that formal research isn't there.
Where it gets *weird*, though, is that there's basically two groups of people exploring the idea of gender dysphoria possibly being a form of CPTSD, and they're diametrically opposed. First, you have trans people who are working from modern understandings of psychology and trans identity, and essentially saying "hey, if living as your gender is a need, we know that depriving someone of a need for a long time causes CPTSD. Wouldn't this perspective fit the data and explain why gender dysphoria shows up in some trans people, but not all, and in some cis people, especially those who've experienced some sort of bodily trauma that's degendered them in some way?"
Meanwhile, you've also got radical transphobes who are exploring the same idea, but from the presumption that conversion therapy--i.e., abusing someone until their gender or sexuality changes--works (it doesn't). By taking up that argument, they're trying to bolster the idea that being trans isn't even a thing, categorically, that we're all just mentally ill, and should basically be institutionalized (even though that isn't really a thing anymore).
So yeah. Basically, more formal, experimental psychology hasn't gotten to a place where it's seriously exploring these sorts of models yet, and the idea is a little bit out there as a result. I find it (well, trans peoples' version, anyway) to be persuasive and compelling in no small part because, absent that sort of thing, gender dysphoria has no real explanation, especially with the move to gender incongruence as the foundation of transness. Are the ideas currently being thrown around probably correct? Goodness, no--that's not how exploratory science works! But I think they're probably *more correct* than what we currently work with, so they're a step in the right direction.
I'm under the muscle. If you're going larger, as I was, it's really the only choice imo; the pectoral muscle does so much to support the implant. I have some sensation loss, but it's not that much, and nowhere really important. I thought I'd be a lot more upset about it than I am, but I mostly don't even notice the difference between areas with full sensation and those without.
In a perfect world, where your outcome would be flawless and ideal in every way, what would you want? That's a good place to start.
Thank you for this. I'm still a new chick, but I've already noticed subtle shifts in how I feel about my future, so I've adopted the attitude that things will change in ways I can't anticipate. It worries me a little because if I'm experiencing significant back and forth and up and down already, how much of a basket case will I be when I start HRT?
It helps to have the perspective that I'm uncovering layers that have been covered by my outer state of dysphoria, that I'm not playing whack-a-mole with insecurities that pop up randomly with no underlying pattern. Like my face dysphoria on the weekend, which I wrote about. It was suddenly stronger than it had been before, but it wasn't new.
Using a map analogy, I've picked out the cities I plan to visit on the way to my new home, but I expect detours along the way. And as I approach each waypoint, I might see another city I'd rather visit. At this point I think Facetown might be the first industrial city I visit after a long drive along the Hormone Coast, but who knows? Right now, I see an adventure laid out before me. I'm sure I don't appreciate how big some of the potholes will be.
That's a healthy way to look at it! It really is about the journey more than the destination.
That's a really good way to put it. The person I was early transition didn't even think being current me (12yrs later) was possible.
I consider myself fortunate. Much of the dysphoria I suffer has to do with facial and body hair. I was able to start HRT in May, that helped. Waxing has helped, electrolysis has helped, we suffer for beauty, right? I expect there to be more. I work on what I can, remain patient, and see what comes next.
I've had some mild thoughts that MAY be bottom dysphoria. But for now, I'm like "let's put a pin on those thoughts for now and see what I think of them in a year or two." Since there isn't much I can do about them at the moment, but when I'm 1-2 years on HRT, there will be.
I'm a "Take it as it comes" kind of gal. Always have been. But to do that effectively, I have to listen to my body and see what it is trying to say.
Listening and patience are *very* wise things to do in transition when you're not sure.
Just as wise to do when new experiences come about.
Almost 2 weeks on HRT. There will be many more weeks ahead and am going to savor every small change that comes about when they do.
6-18 months was... yep. That's when bottom dysphoria became painful. We already knew we wanted GRS, but the pain had been suppressed. Embodiment/mindfulness work was actually how we figured out we wanted bottom surgery. Body scan meditation -> whoops I envisioned the other parts and got feelings -> f*ck, I guess I want that now. I always told my therapist, dysphoria feels like my body isn't safe, and how do you embody in a body that doesn't feel safe?
I guess a lot of it is about accepting how different things can often be from what you expected and having that be all right. For me, it involved a lot of getting comfortable with uncertainty, but everybody's path is different.
I find that really interesting as I had my surgery about 17months after HRT and never really had much bottom dysphoria. Maybe if I'd left it another year or something it would of really started to hit me.
Needed this one today. Thank you!
I've now read most of what you've published on your substack, and I just wanted to say thank you.
So much resonates. So much is familiar. Many of the personal experiences you share have echoes in my own life. It's a joy and relief to read of how you worked through challenges I yet face.
A partner once in frustration called me an onion, because of the difficulty in finding any true heart through the endless layers. This entry's title made me smile because of that. The irony is that those layers trouble me as well. But they evolved to protect me from the world and from myself starting from when I began school.
Understanding what you need requires connecting with yourself. After decades of disassociation, I'm still working on being able to feel emotions again. Very little of strength comes through. I *guess* at needs from the heartstopping, often physical reactions to certain expressions of feminity. Like large breasts, which have poked a spot in the back of my head since at least puberty that took me forever to recognize as "want". The emptiness of my arms at night still feels wrong, and has for so many years. If my mind could truly tear itself free of this body, it would.
But how to really determine what I want, who I am, when I'm still so shut down most of the time? I wish I could escape from the prison of coping mechanisms. Some of the entries you've written stirred me up inside and it took a day for me to realize that it was all the feels I had 8 years ago when I first cracked, starved of hope for so long, returned with a vengeance. And I recognized that I had begun to slip into a new state of coping. Having started hrt but making no other changes. Facing an unsupportive environment, pushing back at me, I was building myself a new prison, so little changed from the last one I could barely tell the difference.
How within the grasp of disassociation, the entrenched habit of self-denial of needs, unable to summon any emotional force, to believe in the muted impulses that are my only evidence of needs or indeed accumulate the strength to pursue them?
I have a psychologist. I will talk to her. But I've no idea how to regain contact with the strong emotions I remember in the few childhood memories that remain.
Much love for sharing you journey and your knowledge.
My north star has always been to chase that joy, those desires, that hope. It's become a real part of the theme of SGW in general--to chase your joy in transition, rather than fleeing from your dysphoria.
If you want big boobs, if your chest and arms feel empty without them--God, I know that experience well--then get them. You deserve them.
Thank you so much for this perspective! This is really helpful. It’s going to inform my own journey, not only with my transition, but also with the exploration of my own childhood trauma (with my therapist).
I was trying to find a more relevant article to post on, but I think this one is fair enough because I looked at this around the same time I restarted my own questioning about breast augmentation.
I am a younger trans femme who is looking at getting breast augmentation, but I don't know if the risks are worth it right now. I see that the rupture rate for some is about 5%( https://www.accessdata.fda.gov/cdrh_docs/pdf6/P060028b.pdf page 23)
for implants and that they weaken overtime. I want the surgery because I do think it would overall increase my own euphoria and help with my own brain affirming my body day to day.
However, I am concerned that I will need to get them replaced sometime in my life and might have loses to sensitivity or permanent damage done to my breasts that I am overall happy with except for shape and size.
How did/do you weigh the risks of breast augmentation for your own self?
That's a very fair worry! There are a few things that you want to remember with that 5%.
1. That's a lifetime risk for a lifetime medical device. Medical devices *of all kinds* fail from time to time. That's just how it goes--it's why, for instance, the average person will receive 2.3 total knee replacements over the course of a lifetime.
2. 5% is a 1 in 20 chance. Compare that, for instance, to a 1 in 103 *lifetime* risk to die in a car crash, and the rupture rate should make a lot more sense. Those ruptures largely come from major bodily traumas, like a car accident or something.
3. That 5% is from 2013, when modern breast implant shells were first introduced, but which also look back to older, significantly lower-quality implant shells, which were used before. The industry has continued to improve the strength of modern implant shells beyond the results of what was referenced in that report. Modern implant shells are *radically* stronger than older ones, and that's not fully reflected in that data.
4. I went with saline implants, which frankly have no real safety risks in case of a rupture. Even in the case of silicone implant rupture, modern conjugated gummy bear silicones don't leak into the rest of the body.
5. It is *technically* accurate that modern implant shells degrade over time, in the same way that a titanium knee replacement *technically* weakens over time. The degree of degradation is pretty minor, though, when you consider the strength of these implants--which are so overbuilt that a common party trick that surgeons will do to demonstrate their strength is to overfill them by a factor of *ten times* their rated fill size, and the things just sit there and wobble, completely unperturbed. So, yeah. Do they weaken over time? Sure. Does it *matter* with modern shells? I can't imagine.
6. Modern Mentor implants are warrantied for life. That ought to tell you what sort of confidence the manufacturer has in them.
7. I was worried about sensitivity loss from my implants, especially given how big I went. And yeah, I lost a little--but I was surprised to realize just how little it actually mattered to me when it happened. I have a numb spot on one boob, but I literally don't notice it unless I go looking, and I'm still healing. It's been getting better, and I expect that to continue.
8. If you want to be sure your breasts aren't damaged, go to a specialist. Any competent top surgeon shouldn't hurt you, but a specialist is doubly so.
9. Finally, and most importantly: there's a risk of complications in *any* gender-affirming surgery, just like any other surgery. Life is a full-contact sport. *And that's okay*.
I was much more worried about capsular contraction than any of these, because it's more common--but as with everything else, the bottom line comes down to: the more skilled the doctor, the lower the chance of complications, across the board. Talk to your surgeon and ask what *their specific* complication rates are. They'll be different than the FDA base rate.
Hi, thank you for the article, as someone about to (hopefully) start transitioning soon, your perspective rly helps :)
Could you please share the sources on dysphoria being considered a specific form of CPTSD? I'm really interested in learning more. Thanks!
So, there's been increasing research into CPTSD and dysphoria by the field in general (https://www.frontiersin.org/articles/10.3389/fpsyg.2018.00060/full, for instance), but one confounder is that CPTSD has only been generally recognized as an independent diagnosis from PTSD in fairly recent times(2018ish), so it lacks a lot of the depth of research that, for instance, PTSD does; the result is that formal research isn't there.
Where it gets *weird*, though, is that there's basically two groups of people exploring the idea of gender dysphoria possibly being a form of CPTSD, and they're diametrically opposed. First, you have trans people who are working from modern understandings of psychology and trans identity, and essentially saying "hey, if living as your gender is a need, we know that depriving someone of a need for a long time causes CPTSD. Wouldn't this perspective fit the data and explain why gender dysphoria shows up in some trans people, but not all, and in some cis people, especially those who've experienced some sort of bodily trauma that's degendered them in some way?"
Meanwhile, you've also got radical transphobes who are exploring the same idea, but from the presumption that conversion therapy--i.e., abusing someone until their gender or sexuality changes--works (it doesn't). By taking up that argument, they're trying to bolster the idea that being trans isn't even a thing, categorically, that we're all just mentally ill, and should basically be institutionalized (even though that isn't really a thing anymore).
So yeah. Basically, more formal, experimental psychology hasn't gotten to a place where it's seriously exploring these sorts of models yet, and the idea is a little bit out there as a result. I find it (well, trans peoples' version, anyway) to be persuasive and compelling in no small part because, absent that sort of thing, gender dysphoria has no real explanation, especially with the move to gender incongruence as the foundation of transness. Are the ideas currently being thrown around probably correct? Goodness, no--that's not how exploratory science works! But I think they're probably *more correct* than what we currently work with, so they're a step in the right direction.
You're welcome. And for what it's worth? God, fake boobs are awesome.
I'm under the muscle. If you're going larger, as I was, it's really the only choice imo; the pectoral muscle does so much to support the implant. I have some sensation loss, but it's not that much, and nowhere really important. I thought I'd be a lot more upset about it than I am, but I mostly don't even notice the difference between areas with full sensation and those without.
In a perfect world, where your outcome would be flawless and ideal in every way, what would you want? That's a good place to start.