# FFS

Image credit David Tenant, Hamlet, 2009

The arc of a ball through the air can be described mathematically.  For each fraction of a second, the ball approaches you at a certain rate, drops slightly due to gravity and perhaps curves in one direction or another due to spin.  In a second, the ball moves so far.  In a half second, less.  It is possible to consider smaller and smaller increments of time.  In fact, if you consider an instant, an infinitesimally small increment of time, you may still describe the position and motion in that moment.  To do so requires a branch of mathematics known as calculus.  Odds are, you don’t understand calculus.  Nevertheless, through practice and experience you catch the ball.  Your brain gets calculus even when you don’t.

Something parallel happens regarding gender.  The senses give input to the brain which turns this information subconsciously into complex ratios and estimates of probability.  Men tend to be taller than women, but height alone does not distinguish between them.  Similarly, women tend to speak in a higher pitch, but there is sufficient overlap that pitch alone does not reliably allow for gender recognition.  At any given moment, nearly instantaneously, we measure thousands of parameters in order to classify our human companions with regards to gender.  Most of the time, we are unaware that we are doing it.  In fact, if we try to consciously measure and process data in order to make a gender determination, we suddenly get very, very bad at it.  Our brains are really good at making gender determinations that cannot easily be made if we set our attention to it.

Consider the face.  You recognize the difference between male and female faces, but if asked why you think a face is male or female, you either draw a blank or tend to mention things (shape, for example) that are not particularly potent predictors of gender.  At any given moment your eyes are picking up subtle details and your brain uses this information to calculate ratios which you have probably never considered.  There are nearly 4 billion male and 4 billion female faces on the planet.  They are so unique that even genetically identical twins can be recognized by close contacts.  Somehow, your brain recognizes them as male or female, familiar or unfamiliar and may instantly assign a biographical file to a face before you have a moment to think of it.  And, to today’s topic, you assign gender to a face almost instantaneously, despite the fact that there are four billion men’s faces that don’t look all that alike and four billion women’s faces with the same degree of variance.

Certain patterns tend to hold.  Women on average have smaller heads with smaller features.  The male hairline is a relatively higher “M” to the female’s upside down “U”.  The male forehead slants backward subtly compared to the relatively vertical female counterpart.  The female mandible is narrower, culminating in a somewhat more v-shaped chin.  The male nose to lip distance tends to be longer.  Without even considering the relatively obvious marker of facial hair, there are patterns and ratios which, taken together, help to form a gender impression.

I write today five days post facial feminization surgery,1 still a bit bruised and sore from 6 hours under anesthesia during which dozens of millimeter scale adjustments were made to my features.  When next we meet, you will still recognize me, but your brain will tend to classify me differently.  Some of the changes (higher brow, smaller nose) will already be present, whereas some (lower hairline, narrower chin) may take six months or more to settle.  Although most people have never heard of it, FFS is often the surgery most coveted by male to female (MTF) transsexuals.  It is expensive, painful, and unlike GCS, aka “The Operation,” impactful in day to day social interactions.

Unfortunately, it is also widely considered to be purely cosmetic and elective.  Insurance rarely picks up the tab, and it can run anywhere from \$15,000-\$50,000 depending on what is done, by whom and in what facility.  Personally, I opted for a fairly limited course, concentrating on the upper part of the face, particularly the forehead, which seems to play a crucial role in how the brain processes gender.  Most transwomen never get the opportunity.  I write this fully cognizant that I am a woman of great privilege.

I also had the procedure done in a local office, which given the length and intensity of the surgery was not the sort of caution I would have preferred, but I am not immune to the economic argument.  And, I seemed to have escaped death, for at least the period of time that I would likely have been hospitalized elsewhere.  It is not my intention to review here the care of my surgeon, but Kathy and I were drawn to him for his reassuring demeanor, his thoughtful listening, his artistic eye and ultimately, his training in complex craniofacial procedures.  I appear to have won the bet, and saved thousands over what the same care would have cost in my hospital system, which as I mentioned, wouldn’t financially support it anyway.

The bruises and swelling are still too extensive to permit much of a look, but I like what I can see.  Mostly, I see my eyes, but the way I think they were meant to look.  The pain is intense, but I was never particularly afraid of that–a few butterflies the day before at most.  My biggest fear was that I would wake up with regret, thinking that I had made some sort of a mistake.  I don’t.  Not one bit.

I hope that my surgery will help you to see me differently, but ultimately it was more about greeting the person I see in the mirror each morning.  I want, in the words once given to me by my friend Anne, to feel at home inside my skin.  Time will tell, but the deed is now done, I am convalescing, and I am feeling very grateful.  I do hope that you will not think me vain.  I am of course, but it’s still uncharitable to think that.  This fixes for me something that was existentially broken for 50 years.

Perhaps my new lines will persuade your brain to accept my femininity.  Nevertheless, I remain ever hopeful that you will accept it for the best reason of all…because I asked.

1. Hereafter, FFS

## 5 thoughts on “FFS”

1. Julie Harmon

Awe…makes me cry…beautifully, artistically written. I can vividly see your heart on the page…. you’ve always been beautiful Renae I saw that in you before…I can only hope that, when healed, you will see what those that have known you and loved you have always seen. ,, a strong, intelligent, witty, talented and gifted woman with a heart of gold. (((((Hugs)))))

1. Jenny

You are amazing and your way of describing things truly an art. I am so happy for you and am anxiously awaiting your return to work?

2. David Studer

The physics analogy marks your intelligence for us, if we hadn’t perceived it already, and gives an acutely manageable metaphor to aid the expansion of our understanding of where we and you are. Cool
More pertinent to me is the display of courage. Not so much the physical challenges and the pain; those are ephemeral and shall quickly pass, one expects. It is the psychic bravery that gives me pause and creates my awe as you journey through this. Really, this is simply the logical extension of that road less traveled you have been wending down these many years. It is the length of that road, the complexity of the terrain, the relentlessness of its challenges, the very mystery of the next turning that leave me in humble awe of what you have been able to achieve.
Thank god for the strength that has been shared with you by your many friends but especially by Kathy. How fortunate to have such strength at your side. Such does not come to those who have not earned it. So my congratulations to you for having earned it through the very strength of your character and person. All my best.

3. gisselle

hi there! I found this very informative website from susan’s place, about the dr you went too. I was going to go to him as well and just had a couple questions, do you mind if I email you? I would really appreciate it

thank you so much!
xoxo