If you know, you know.

Note: This post contains a brief overview of the four surgeries available to trans women.

Our experience with well-meaning advice and other comments led to a big discussion around medical transition, specifically surgeries. Where Veronica had been quite open about the early parts of her transition, she decided not to disclose any of her surgical plans to anyone outside of a very close inner circle, and even then, she would make it very clear that these plans weren’t open for input.

There are four surgeries that trans women consider, all of which are only available to people over the age of 18 or 21, depending on the country:

• Top surgery, which generally involves waiting for around 2 years to see what natural growth the additional oestrogen might give, then augmenting that with breast implants under the pectoral muscle or under the skin
• Bottom surgery, which can be done at any point in transition and usually involves creating a vulva and neovagina out of the scrotum and penis or out of the scrotum, penis and a section of the colon
• Facial feminisation, which is generally done a couple of years after starting oestrogen and involves any number of surgeries to reverse the impact of testosterone on the bones of the face and Adam’s apple
• Vocal feminisation, which involves adjusting the proportions of the vocal cords to change the pitch of the voice, although for success, it requires considerable vocal training before and after the surgery

Not every trans woman opts for surgery and not every trans woman opts for all four of the surgeries. These are individual decisions that people come to in their own way and according to their own physical, emotional and financial resources. And, to be absolutely clear, a trans woman is still valid if she doesn’t have any surgeries at all. Transmedicalism — the belief that every trans person must have surgical interventions to be valid — is a form of gatekeeping that ignores that not everyone can or wants to have surgery.

Veronica took her time to think things over, but eight months in, she had a fairly clear idea of what she wanted. She informed me and I did what a good partner should do: I took on the information and offered my full support. Her body, her choice. Her initial focus was top surgery, and despite having a year and four months to wait for the right timing, she was starting to look into options. You see, by this time, we’d both learned how slow the Irish medical world moves, even private clinics, so we knew that getting things lined up now would mean she’d have some chance of being ready to go at the two-year mark.

In the meantime, she chose to wear fairly realistic breast forms — realistic in both shape, weight and texture — that adhered to the chest and stayed put for most of the day. Using them gave her a sense of what size she hoped for, what shape she liked, what kind of bras would work for her, and so on. She liked them but hated taking them off in the evening, sometimes to the point of tears. Bedtime became a very quiet and serious time for me to be as supportive as I could. She really suffered with the dysphoria of these nightly changes back to what she saw as “her boy chest” (the A-cup she had naturally developed didn’t feel sufficient, as it felt out of proportion to her shoulders). But they had to come off, be cleaned and dried ready for the morning, so we went through it each night.

Since we’d chosen to keep this information close to our chests (ha), I started getting some messages from people who weren’t in the know, all with some variation of “when did Veronica get surgery?!?” It’s understandable: the breast forms were very realistic. My responses were increasingly silly as I had her permission to screw with people. “When you weren’t looking.” “It’s just the oestrogen.” “On the 33rd of Disober.” “We did it ourselves with helium balloons and bathroom silicone.” “She went to the clinic that did Michelle Visage’s last month.” and “…what do you mean?” If someone added unsolicited feedback on the size, I got sillier.

We have to keep ourselves amused somehow.

In the background, Veronica had found a clinic in Ireland that had agreed to do the actual top surgery when the time came. However, nothing in transitioning in Ireland is ever easy…

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