Patient's Voices

How FFS Benefits my Privileges

I’m one of the relatively few trans people who have access to the privilege of FFS benefits. As a fortunate one, the “burden” of this privilege to me is the sentiment of guilt and shame that I feel when others are not able to have FFS or are not satisfied with their results. Another kind of difficulty is navigating who to tell or not that I had FFS and other gender affirming surgeries..

Once, in a trans feminine support meeting, someone was complaining vigorously that FFS was not covered by health insurance where we live. She was comparing it to genital reconstruction, a trans surgery which is covered by the health system. “What people see is my face, not my genitals!” she argued. 

And there I was, sinking in my chair because not long before I had paid for my facial gender affirming surgery out-of-pocket. That despairing feeling I had for her compared to me is an example of what I mean by the burden of FFS.

In an ideal world where quality of life is prioritized, everyone that requires gender affirming surgeries should be able to access them. Unfortunately that is not possible without health insurance coverage depending on where the person lives and/or their surgical plan(s). 

Some people don’t even have healthcare access, never mind a health plan that covers what is incorrectly referred to as “sex reassignment surgery.” Due to this large inequity between those who can and those who cannot pay for private gender confirmation surgeries, I feel extremely privileged to have had FFS with Facialteam in Marbella.

FFS Benefits by Becoming Cis-assumed

Having certain privileges, such as a white privilege, cis privilege, and socioeconomic status (wealthy privilege) opens the doors to advantages. The intersections of a lack of privilege, for example, for indigenous people, people with disabilities or a dark skin color, multiply the disadvantages of many transgender patients.

On the other hand, I think a benefit of FFS is that it helps me access more passing privilege, from two slightly different angles. The first is feeling assured that I’m not being read as trans or masculine. The second approach is the fact that people that don’t know my background cannot tell that I am trans. 

There’s a slight but fundamental difference. One is the security I feel, which affects how I portray myself. The other is how others treat me based on what they see. Think of it as a nice self-feeding loop with no beginning or end.

An example is walking into my ballet class. When I come in I feel confident I’m not being read so I don’t retract myself and can have a worry free conversation with others. On the other hand, when the other people in the room cannot tell I’m trans from my physical appearance, they treat me without prejudice, contributing to that worry free conversation.

The Triggers

Not having access to FFS is the most common trigger. These could be

  • Cost, making it inaccessible or limiting to just the procedures that fit within a tight budget
  • Previous medical conditions, that would make FFS unsafe
  • Fear of surgery, complications, or prejudice, where the person creates mental blocks that prevent them from seriously considering surgery

I know these are some of the triggers mainly because I dealt with them in one way or another. Cost of FFS is probably the main limiting factor for a number of people. It certainly was for me and often comes up in online discussion groups.

I Don’t Want to be a Trigger (Changing in Behaviour)

Envy, jealousy, bitterness, spite. All of these are terrible feelings to have for someone. Human nature often triggers these sentiments when we compare ourselves to others. 

In the case of a trans woman having a desire for FFS but not being able to access it for one reason or another, can initiate these thoughts of envy. I don’t want to induce these attitudes so I’ve been changing my behavior in regards to talking about FFS benefits.

Self-Censorship – To Tell or Not

This is the “burden” of having the privilege of access to FFS benefits; this is the gist of it. The real question is, should I out myself or not? 

Navigating if I should share my excitement of my FFS and how it has changed me, or keep it to myself. Here’s another way of seeing the conundrum. Sharing my experience, knowledge, and views for the benefit of all, or keeping quiet to prevent triggering another person that may not have access to surgery.

I find the so-called gender affirming surgeries and procedures fascinating for so many reasons. 

One of those reasons is that I love the technical aspects of a surgery and how they are controlled traumas. I think human anatomy is incredibly interesting and how advancements in multiple health sciences take advantage of that. Also I like to observe and analyze both the physical and mental impacts these procedures have on patients, especially myself. 

An extension of that is noticing the nuances of how each patient has a very different decision process when it comes to these operations. I’ve also gathered all sorts of notes at every step of my surgery since I find it so interesting. They include my observations from my own decision process, surgery, and all the way to recovery, and lately the philosophical shift in my relationship with myself. 

This information can be useful and/or triggering to other trans women.

To Tell Cisgender People?

By default I do not share with cisgender people that don’t know me well that I had FFS. 

To get to the stage where I’m questioning if I should tell someone or not, they already know that I’m trans.  Thanks, greatly in part to the privilege of FFS, I am cis-assumed, so in most cases I don’t even open up or come out as trans anymore. When I develop a friendship or some other relationship with someone, that’s when I first question if I should come out of the closet or not. 

Then, in the cases where I do open up, for example to a friend, then telling them about FFS takes an even deeper connection.

A great example is with the friendships I’ve developed taking ballet classes. At first I didn’t tell anyone about my background. Then, with certain people that I became closer to, I came out of the closet to them. 

As we developed a more intimate affinity I felt more comfortable sharing about my trans experiences and points of view. Then, in some cases, I’ve shared about my surgical history, sometimes talking about FFS. By this point the trust level is pretty high between us.

To Tell TransPeople?

To tell transgender people, specifically women, is a similar process. Probably the largest difference is that by sharing a lot of the trans experience, my relationship with them does not have to be as deep as with cisgender people. As trans individuals we are already on a very similar wavelength. 

Having said this, I’ve learnt to initially steer away from surgical topics, regardless of the kind of surgery.

In the majority of cases I shy away from initiating a discussion about FFS with other trans women that I don’t know well. I avoid the topic of FFS initially because I don’t know their situation and possible triggering threshold. 

If the topic of FFS is brought up by them or someone else then I start sharing about my experience, but still avoiding some details at first, like cost. All these because I feel like walking on eggshells.

How Much to Share With Cisgender Individuals

Sharing details about FFS with cis and transgender people is fairly different to me. As I’ve mentioned above, with trans women my main concern is avoiding triggering or getting some sort of envy. 

Cisgender people don’t get triggered as much because they’re not interested in FFS. Though the concept sometimes causes some sort of negative reaction because it’s so alien to them.

On the origins of facial feminization

I find it quite engaging talking with cisgender people about female and male facial differences. In the great majority of cases they don’t have a clue about the divergences which have even been the focus of scientific study. 

Anthropological findings on the difference between male and female skulls have been published on the topic since the last century (i.e. Borovanský, 1936; Keen, 1950; Ousterhout, 1994). For example, masculine foreheads typically have more bony prominence and hairlines often are more M-shaped than their rounded feminine counterparts. Masculine noses and chins are wider. 

Women don’t usually have protruding Adam’s apples, one of the reasons the tracheal shave and other feminizing surgical procedures are popular among trans women.

On my motives for wanting FFS

Yet, when it comes to details like telling them that I have 3 incisions inside my mouth that were needed to reshape my lower mandible, then they get grossed out. In some cases I get questioned why go through such a risk. 

Often the perception from cis people is that I put myself in undue harm to achieve something I don’t need. It’s not hard to find someone that argues that it’s vanity and therefore has a further negative context to them. What they don’t realize is that gender dyshporia and body dysmorphia are massively debilitating for many trans people.  

The reality is that the chronic dissonance between gender identity and physical characteristics drive people who suffer it’s effects to intense depression, anxiety and unfortunately, high rates of suicide.

How Much to Share With Trans Women

When the discussion of FFS comes up with other trans women I find myself constantly evaluating the level of detail I can comfortably give out. Again, the idea of walking on eggshells with the risk of triggering negative emotions causes my self-censorship.

I’ve also noted that I retract more and share less in proportion to the size of the group in a discussion. I find it easier to get a sense of what topics may be uncomfortable to someone in a one-on-one conversation. Being in a larger group of trans women probably there are very few, if any, that have had FFS. There’s a fair chance that surgery is not accessible to them.

Having said the above, I don’t shy away from a conversation about the details of the privilege of FFS if the party of trans women are interested in FFS, and even better if they are actively looking at their options. In those cases their interest in gathering information takes precedence over their quibbles.

I feel more comfortable talking about matters that would help someone to choose a surgeon or prepare for surgery and recovery. In contrast I shy away from personal details like cost or suggesting a surgeon or a procedure. 

I’m an advocate of first learning as much and then making an informed decision. When it comes to cost, which is one of the most touchy subjects, I always suggest approaching more than one surgeon/surgical center and get their current quotes for their individual cases. After all, cost is based on so many factors, all emanating from a personalized treatment plan.

It Doesn’t Have to be This Way

Another possible title for this post could be “Self-Censorship to Avoid Triggers From FFS“. I describe why my burden of FFS is navigating self-censorship. I am careful about what I share with different people to prevent them from triggering or feeling resentment.

The main issue that causes those negative feelings is the lack of access to gender affirming surgeries, FFS specifically in this case. A lot of these issues could be alleviated if the barriers to access quality surgeries were lowered. This way more people could receive treatment therefore reducing the reasons for triggering. 

Thankfully more surgeons are performing gender affirming surgeries like FFS which increases competition and in some cases lowers the cost. Having said that, cost remains the largest bottleneck even as additional people are covered by more inclusive insurance policies.

Yet, everything stems from society’s prevalent rejection of transgender people, and furthermore towards those that are visibly trans. At the end, the more exposure we get as trans individuals, the higher the inclusiveness and acceptance.