Though I had been thinking of the 4th surgery long before even the 3rd surgery (BA), I did not make the decision to go ahead until after I had done all the paperwork for the surgery itself. Meaning that I did all the surgical readiness assessments and funding paperwork without knowing if I was going to do the surgery or not. I didn’t decide and then started the process; I started the process and once everything was ready I made my decision.


Deciding at The Very Last Minute

How did I decide on surgery if I didn’t speak with anyone? The fact is that a few years ago I had considered this surgery and back then discussed the idea with a few friends. During those discussions my conclusion was always that this surgery was not for me, or at least not to be considered at that stage.  Then in 2017 my thoughts started to shift and interest started to creep in; I started researching my surgical options.  Reading surgeons’ websites and reading from other people that had comparable procedures, I had found then the information to be inconsistent and all over the place making it difficult for me to decide.  So I did what has worked incredibly well for me before. I went to learn from the people that would put me though the process should I choose to go ahead.

I didn’t do my first surgical readiness assessment because I had already decided on having the surgery. I did that first assessment in late 2018 precisely with the objective of learning more and gathering further information to get me closer to a decision. After that first assessment I compiled lots of questions and information that helped me do lots of deeper soul searching. Still I felt I did not have solid knowledge to make a decision. Then I pushed for the second surgical readiness assessment with the same objective of collecting more details.

Because I had not made any decision further than gathering information “from the horse’s mouth” I didn’t feel any pressure to get things done as I normally do. Often, once I have made a decision I like to move steady forward at a fast pace. If I know I’m going to do something, I find it better for me to get it done sooner than later.

It was only after I met and spoke a couple of times with my second assessor and before my surgery referral was sent to the surgical centre that I finally decided. Meeting and talking with the 2 different assessors provided me with the information I needed to dig into my soul and make a decision.

Throughout all this process I did not want any external influence on MY decision beyond hard cold facts.

In Parallel

I don’t expect many people to do things the way I do. Quite the opposite.  I think very few people can relate to my decision making processes. Having said this, I believe that if I had done things in a different order, it would have caused me more or at least longer stress. I could not see myself spending all the months I spent researching, then making a decision in favour of having surgery and then starting the long assessment and funding process to eventually get a surgery date.

 

Surgery in sequence

In essence I ran 1) my research phase, 2) my decision making process and 3) the assessment and documentation process, all three in parallel. As I went through every pause and wait of each of these lanes I managed to advance on the other 2 at the same time.

 

Surgery in parallel

Keeping it All to Myself

Many times I felt like sharing what I was planning to do, specially on the days that I felt more excited about the prospect of the surgery. In all cases I decided to keep it to myself. Keeping the secret was a bit hard but manageable. After all for more than 4 decades I had kept my gender expression desires and interests secret from pretty much everyone. So choosing not to share my thoughts on this 4th surgery for a couple of years was comparably easier.

One of the hard aspects of keeping my surgery thoughts and then plans to myself was not giving away any auxiliary information that could lead someone to conclude what I was up to. For example, a few weeks prior to surgery I started taking an anti-androgen that I had not taken for about 3 years. A couple of times I almost slip and almost told my friends how much I hated taking that medication again after so long. Another that was hard to keep to myself were my traveling plans for surgery and being offline and out of commission for a few weeks during convalescence. Somehow I managed.

Conclusion

I amaze myself thinking back on how I decided on this surgery.  For me it was a very relaxed process though I sometimes feel it should have been harsher because of the importance of the surgery itself.  I’ve concluded that by learning at a slow pace about the surgery I also learnt so minimize the impact of the surgery. It’s as if it had gone from a very complex concept that for some it may define a person to a “simple” surgical procedure. I’m not disregarding the importance of any gender affirming surgery, but in my head the changes that this surgery provide me are not as important or as dramatic as the changes from other surgeries.

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