Musings of a Singaporean Transgender

One of my primary struggles with gender dysphoria have been about desperately wanting to see a woman reflected in the mirror. With makeup and the right outfit, I could see that. But my bare-faced self looked androgynous to me on good days and male on bad ones. Being regularly gendered male by random strangers further confirmed that perspective to me, causing a lot of internal turmoil, with swirling emotions of anger, disappointment, envy, resentment and resignation. I felt that FFS was necessary for me, chiseling bone to carve out a feminine appearance. But I also struggled with the shame of so intensely desiring FFS, instead of working to accept myself as I am. Friends and my wife have said that I conflated passing with beauty. But the line between wanting surgery to look less masculine versus becoming conventionally beautiful was blurry; the latter to me was an added bonus, as long as I didn't keep pursuing surgery after the initial FFS.

A year ago, I decided to book a consult with a surgeon in the US. Popular doctors in the US have long wait times stretching years, so I knew I needed to get my foot in the door, even though I was still early in my transition. This involved waking up at 5am to call the clinic due to timezone differences and jumping through a few hoops because the clinic thought my call was spam and blocked my number initially. But I eventually secured an appointment for a consult about 1 year ahead (it has gotten worse for this doctor. Currently waitlists are almost 2.5 years).

"Why US?", many have asked. Taiwan, Thailand and Korea were nearer, cheaper, and had surgeons familiar with Asian faces. The waitlists were also much shorter, with prelim consults done using photos sent over to the clinic. While that was true, being unable to properly research a surgeon's credentials based on reviews, having a language barrier and a tendency for surgeons to be aggressive in the amount they corrected that resulted in unnatural results was something that bothered me. I wanted my post-surgery look to be natural. Korea had an added problem of "ghost doctors", where the person doing the surgery isn't the person that you signed up with. Patients usually have no idea of the bait-and-switch until something goes terribly wrong. It was my face and I couldn't bear the thought of living with a less desirable or failed result, after significant financial expense and enduring the long recovery process. Knowing myself, I would regret, hate and shame myself forever. I needed to go for something with assurance of success.

Finally after what felt like an eternity of waiting, it was time to fly to the US. It was 16 hours of flight time, with a 2 hour layover in Japan. By the time I rented a car and drove to my accomodation, I had travelled for a full day. As I lay down on the bed exhausted, I wondered what the f*** I was doing travelling this far. Maybe Asia was a better choice. I missed my family, I had to tell my kid and my parents I was on a "work trip", and felt like I didn't have anyone to lean on in this trip. I didn't do much research so I booked an accomodation near the hiking spots and premium outlet mall. Which turned out to be so far from the city, there was no way I could partake in the queer nightlife. So my exploration as Isabelle was mainly shopping 😅

The consult took place on Day 4 of my trip. I parked in the medical building at 8.30am, to go for a CT Scan of my facial bone structure before my doctor's consult at 10am. The purpose of such a scan is for the doctor to have a clear understanding of the facial bones, where and the extent to which they can shave down the bone to obtain a more desirable structure. After paying for the scan, a technician led me to lie down on a flat bed, which moved me back and forth into a donut shaped scanner. This process was fast, taking only about 5 minutes.

I returned to the clinic to wait for my doctor's appointment. I had been feeling anxious before the trip even started, so this morning was no different; this was the consult I had been looking forward for so long, an expensive but necessary step forward in my transition. I sipped on my coffee and ran through my notes on the questions and issues to bring up to the doctor. Soon enough, a nurse called my name and gave me an elastic cloth to hold back my hair for the consult. 

The doctor was a young, confident man who spoke with a reassuring voice (important for doctors). After exchanging pleasantries, he asked me about my personal history, past surgeries, my medical and social transition journey. He was quite amazed that I took a 16 hour flight to the US just for this consult and also asked me why I didn't go to Asia. As his specialty was in brow and nose work, and because I was paying out of pocket, he suggested that for any chin and jaw work, it would be much cheaper for me to do it in Korea, adding that he would provide me with recommendation of a clinic in Korea.

 

He started the consult by asking me the parts of my face that bothered me and wanted to change. In descending order of dysphoria causing parts, I told him that I wanted to advance my hairline, smooth out my browbones, reduce the size and bulbosity of my nose and sharpen my jaw and chin a bit to give it a slightly sharper V-angle. I told him that I liked my cheekbones, even though they protruded outwards a bit and another Taiwanese clinic had recommended for zygoma reduction. He listened to me before giving his opinion on what he felt should be done, limits and risks. He touched the skin of my forehead and said that it was quite tight, so he would only be able to advance my hairline to 70% of where he would have liked it, with the difference easily made up with a future hair transplant. He felt the texture of my nose to determine if it was skin or cartilage, to get a sense of how challenging the rhinoplasty would be. Based on the number of surgeries recommended, he estimated that it would take 6 hours, which was just at the self-imposed limit that he doesn't exceed. For those who are curious, the doctor's notes are shown below:

It would have been a happy day, if not for a curveball during the consultation. In the medical history form, I had indicated that I have a heart issue, where some general anesthetic drugs are not recommended, due to the potential to increase the risk of ventricular arrhythmias, which could lead to cardiac arrest. Unfortunately for me, the drug not recommended for use was exactly the one used in the clinic. And no surgeon wants to have a risk of their patient going into cardiac arrest midway through what some might consider elective surgery. He told me that there was a low chance that he would be my doctor, but he would like to get my medical records and run them through his anesthesiologists to see if alternatives were possible.

I felt time stop and my heart drop so hard I nearly broke down in the clinic. It was a terrible feeling, to feel like there was another road block to my transition. I had been looking forward to this surgery consult for more than a year and this was a huge wrench in my plans. One step forward, two steps back. If this doctor didn't go through with my surgery, I needed to go back to sourcing for another doctor that I could trust, wait even longer for a surgery date and delay my transition further. I could feel the anguish building in my chest, which I shoved back down with my well-practiced skill of suppression. On hindsight, perhaps I should have just let myself cry in the clinic.

The doctor could see the disappointment on my face and tried to reassure me that there could still be a chance for the surgery to proceed. We moved on to taking photographs as part of records for consultation, before moving on for the final chat with his assistant, who explained logistical details about the cost, post-care needed, payments, how to go about booking the next surgery date (April 2026 was the earliest) and other details. With that, it was the end of the consultation. The main objective of my trip to the US was done, albeit with a new, unexpected detour.

There is a tinge of envy when I look at younger transwomen who grew up with the large amount of information on the internet that sped up their discovery of themselves. Perhaps my egg would have cracked way earlier and I would have transitioned before puberty, without testosterone shaping my body into what it is now. But such thoughts are unhelpful and poisons the mind. Wishing for the impossible is an exercise in futility. There are many things in my life to be grateful for, even in my seemingly tumultuous journey. Like my kid, one of the greatest joys in my life, who would not be around had I transitioned earlier.