Douglas K. Ousterhout, MD (retired)

It may seem odd to leave a review of a doctor that is retried, but my experience with him was a real high point in my life. Although he is no longer performing surgery himself he is working as a consultant with Dr. Jordan Deschamps-Braly. If you are at the stage where you are interviewing doctors I suggest you go for a consultation with these two doctors.

From as far back as I can remember my school years; my thought and behavior patterns did not fit those of the boys around me even though in genital terms, which were all that folks at the time considered, I was a boy. The girls and boys in my class soon picked up that something odd was going on with how I thought and behaved. As their vocabulary improved over the years, the most precise word that they used to describe me was “sissy.” The girls were mean by teasing me; the boys tended to beat me up physically.

Every day, going to school involved getting mentally ready for half a day's worth of combat. I hated the violence and being ostracized, and I hated the name too, but years later, I found out that it had been accurately chosen. As an adult, I can't begin to relate to the cultural things that men tend to like -- whereas the culturally typical female pastimes are enjoyable to me. In contrast with the men whom I know, I am vastly more sensitive and thoughtful with far more empathy. I finally concluded that the common theme in my thought patterns could be summarized nicely by classifying them as, generally, feminized.

I saw a gender counselor and she considered all this to be sound reasoning, and she encouraged me to explore looking (physically and aesthetically) as I felt mentally. The effect was like "coming home" emotionally. I liked looking feminized and it came naturally to me. Until then, my health had gradually been declining; I was putting on weight, my blood pressure was increasing, and I didn't really care. The idea of aging as a male seemed unpleasant and distasteful and the details didn’t really matter to me. The possibility of becoming physically feminized energized me.

I started working out and watching what I eat. I lost weight gradually, in all the right places. Recently I went to a health fair and my body fat & and blood pressure are now perfect. I have started privately modeling lingerie part-time and I make between $100 and $200 an hour by looking good enough to always get paid, even though the client always has the option of not paying afterwards, if it was not worth it. Life is exciting, challenging and I love it.

The key aspect for me is integration. I could, two years ago, have gone to Thailand and come back with a vagina instead of a penis and I would probably have felt no more feminized than before. Being feminized is a highly integrated process that involves surgical procedures and non-surgical procedures for the face, body and / or genitals -- and a lot of mental work in order to speak and move in a feminized way. I'm clear on the legal and stereotypical definitions as to what makes someone a male vs. not, and they have their reasons for being there. However, my approach to the issue of gender is primarily focused on my mind is wired, regardless of whether my genitals happen to be an "innie" or an "outie." If it comes to that, maybe I’ll have that operation too, but it’ll certainly not be the only aspect on which to focus. Recognizing my mental wiring as the essential aspect was for me a catalyst and an inspiration to wanting to look, speak and move in a way that's consistent with how I think. If the mind is the essence of a person, then essentially, I’m female regardless of what my driver’s license says.

My personal journey is multifaceted, as I suspect to be the case with most transgender / transsexual folks. In the hope that it will be of value, I plan to make updates on this site from time to time as I progress on this delightful journey. My first surgery will be to make the front of my neck smooth. I chose Dr. Ousterhout in San Francisco after meeting with him and his team in person. They made an exceptional impression.

My life experience has given me ample evidence that my approach to gender makes some people uncomfortable. If you disagree with me, I don’t really need to hear about it; I’m not here to debate the social aspects of transgender or transsexual life or to accept commentary on that subject. I do consider my approach to be well pondered and logical but that doesn’t make it open to general public dissection. I appreciate RealSelf’s initiative in making this forum available to people like me. I hope my particular story will provide others with guidance, comfort, strength and inspiration.

Updated on 23 Feb 2012:
Today, I made an improvement on looking better from the neck up.

This is a good time to be explicit as to a key point in my personal agenda. I'm clear that for many transgender / transsexual folks, the journey towards physical feminization is part of a generally unhappy life experience and it's all fairly morbid, and if they come out the other end of the process looking feminized, they will be at peace with themselves for the first time and not much else matters. I respect that and wish that sort of closure and peace for everyone who seeks it.

I, however, am too cheerful for that approach, so I'm almost giddy with delight during this whole process. I'm not planning to enter any beauty pageants, but even so, I am aiming at not just looking more and more feminized but also at looking feminized and . . . what's the word ... hot.

Some of the things I do accomplish little or nothing for making me look more feminized. Even so, as my agenda continues as such, it means that I can look in the mirror and be delighted at the visual image of the statuesque and pretty blonde smiling back at me.

Work on the “statuesque” aspect mostly involves, in my opinion, improvements from the neck on down. Progress continues to be made in that department.

As to being pretty, work as such mostly involves, in my opinion, improvements from the neck on up. Today was a red-letter day for that, thanks to Susan Danton, an aesthetics nurse who magnificently combines her enthusiasm for art, her degree in science and her experience in the medical field. The only disconcerting aspect was that she looks too young to have all the experience she shows on her resume, but given where she works it all actually makes sense. I’m not implying that she’s dishonest, just that she’s lovely.

Susan is part of the team of Dr. Tiffany McCormack in Reno, NV. Her field of specialization, as relevant to me today, is non-surgical procedures that focus on injections. In addition, she did a great job of making sure that I’m very clear on the issues and options, so it’s like we’re on a journey together.

Today, I had some Botox done on my forehead to produce a generally younger-looking effect and to essentially provide an informal brow lift, which helps with the whole feminization agenda. Thanks to belonging to Allergan's discount club (a process for which the lovely receptionist was happy to sign me up) I got $50 off and ended up paying $250. Was it worth it? We won't know for a few days since it takes time to take effect. If it works half as well as I expect it to, then ... yes.

As to Radiesse injections, Susan did the sort of musing and planning that I do before I create good software (which is what I do professionally, most of the time). She weighed the options, effects and costs, did some what-if exploring by trying different effects on my face by shaping it with her hands, etc. Finally, while involving me in the key decisions, she decided on an approach that made sense to her and that I liked too. So, an hour and $750 later, I look like a more relaxed, younger, prettier version of me.

Was it worth it? If this lasts 18 months, then that's 540 days (or so), which means I'm paying less than $1.40 a day to look quite a bit prettier. I have more of a apple-cheeked look and the folds between my nose and mouth (nasolabial folds) are less pronounced. I look better and I feel better. Definitely worth it to me, as to personal satisfaction.

But, there’s more. I also privately model lingerie, and I get up to $200 an hour for that. Attractive models get more business. So, this makes a lot of sense, purely as a business decision. If I get 3 more gigs out of this sometime during the next year and a half -- and I might well -- then this procedure will have more than paid for itself, financially.

Long-term, I’m keen on something such as Artefill, i.e., something that I don’t have to repeat every 18 months. Then again, irreversible decisions should be made cautiously so I’m perfectly happy with the approach that Susan recommended and implemented today.



Updated on 11 Mar 2012:
There are some splendid people who will be healthy and manage what they eat, no matter what. Kudos to them, but I'm not part of that group.

About 15 years ago, I had a client who was about to retire. When I greeted him in the typical US way of "hello, how are you?" he'd reply with, "Not bad for an old, fat guy." Indeed, the adjectives did fit. That sounded like a horrible future, to me.

"Old" and "fat" are relative, but not too long ago, I started slipping down that same path. I took an attractive lady friend windsurfing two years ago, and I remember feeling horribly self-conscious when I took off my shirt in her presence to put on my wet-suit. I was grossed out by seeing my fat, white, hairy tummy -- and I was ashamed that she saw it.

The future, of becoming an old man, fat or otherwise, was a very sad prospect for me. I was not a happy person. I knew I needed to lose weight. My attractive, lovely, less-than-half-my-age girlfriend made as many comments as would be polite. My mom made more comments yet. My medical checkup indicated I was within a blip of needing blood pressure medication. My BMI index was in the "overweight" category and I was a blip shy of the "obese" category. My reaction was: "I know, I know." However, I just wasn't motivated. Being male was not great; being an aging male was worse yet. Becoming healthier seemed to me to be the equivalent of putting air in the tires of a car that's on fire anyway. It all just seemed rather pointless.

Finally, I figured out my mental wiring. I had a past riddled with puzzling reactions, thoughts and feelings that made no sense until I tried the hypothesis of "maybe I have the mental wiring of a female" and suddenly it all made sense. It was like trying to figure out cosmic events and then coming up with a heliocentric theory that makes everything fit clearly and logically.

So, now a cynical reader might interject: "what, you'd rather grow old as an old lady?" My reply -- heck yes, and such I am inspired to fight the aging process every step of the way. I used to be married, and the lady I used to be married to was (and is, of course) quite a bit older than me. Although she's in her late fifties now, she's not just lovely but also still a very fit, hot, slender, curvy, blue-eyed blonde. So, I've seen the possibilities from close up. I don't think of blue-tinted hair, a stove and a cat. I think of Michelle Pfeiffer, Christie Brinkley, Mariah Carey, J-Lo ... none of them technically young, but all so very pretty and sexy. And, then there is the wonderfully inspiring lady called Cher.

Meanwhile, modern science keeps coming up with ways to make things better yet. So, yes, I'll happily the check the "F" box in the "M or F" question. That is the camp to which I belong anyway, based on how my mind is wired, and I am sooo happy to here.

Just more than a year ago, when things were at their worst, and I decided to turn them around, I figured that for someone who is 6" tall and with an athletic build (e.g., muscular legs and butt) a goal weight of 185 pounds makes a lot of sense. At the time, it seemed ridiculously unattainable, but I chose it and went for it anyway. And, inspired by the concept of being an ever-hotter chick, I pursued this with the energy of a forest fire.

Yesterday, I got on the scale, and it read 185.0. Absolutely perfect. And, I have not in the process lost my butt, or my legs, or my healthy hair, or my glowingly healthy skin.

An acquaintance of mine had her stomach made smaller surgically and she reached her daily calorie quota without getting in enough protein. The results were disastrous. Her hair fell out dramatically and instead of looking pretty, she looked ill.

Me, I tracked the calories I ate -- carefully, keeping it in the 1530 to 1930 range most days; going over very rarely and if so, no much ... never going below 1500 because that's when my body switches to starvation, fat-hoarding mode.

I made sure I got at least 85 grams of protein a day, and I made sure that I wouldn't overload my kidneys with that, so I tracked my fluid intake and made sure I drank between 12 and 24 glasses of water or their equivalent, daily. I also made sure I was getting enough fiber, between 30 and 50 grams a day. The result is a svelte, happy me at my perfect goal weight.

Well -- sort of. I have now critically looked at the status quo, and my (bisexual, yay) girlfriend and I have identified one more fatty midriff area that might benefit from departing. So, I'm now planning to lose 5 more pounds as such, but bottom line, I'm very happy already.

I recall how Jay Leno was telling folks about how he got started with his amazing classic and exotic car collection. When he was a kid, a local neighbor had a collection of classic and exotic cars. Jay's friends would say, "Wouldn't it be awesome to be Mr. X's mechanic and get to work on all those amazing cars?" Jay's reaction was: "Why not aim high and actually be like Mr. X and get to own and drive all those amazing cars?" And, indeed, that's precisely what he did.

I recall watching a movie in which Susan Anton starred: "Goldengirl," back in 1979. The 6” tall, athletic, blonde, lovely lady intrigued me. My friends, 17 or 18 at the time like I was, had the general reaction of how great it'd be to seduce such a lovely lady. Now that I think back, I realize that my reaction was parallel to that of Jay Leno: "why not aim high and actually be like Susan Anton and get to be that gorgeous?" And, indeed, that's precisely what I ended up striving to become.

I'll never be a Susan Anton clone, and I have a long way to go on my own journey, but even so, I am making good progress and I already have my share of admirers. Three days ago, a nice gentleman wrote me, totally unprompted: "good luck with your transition, gorgeous, 6' athletic blond with great ass sounds like a really good start :)” I found that very ironic, given what I had thought all those years ago.

The picture below, of me in the 6" white-and-pink shoes and the lime-green bikini, is what I looked like just before I hit my goal weight of 185 pounds (and yes, the breasts are fake, as in: 450cc bikini-top inserts).

The point of this update is twofold:

1. Often, transgender folks have a really sad journey, and I wanted to offer my happy story as a sort of counterpoint, to show that it doesn't always have to be sad. Maybe reading my story gives someone inspiration or hope or perspective.

2. Coming to grips with being feminine might be vastly inspiring, with results that could be better than what you'd ever considered yourself capable of achieving.

~Tanya

Updated on 11 Mar 2012:
A bit more than a week ago, I was making a sexy video of myself. The last frame was of me smiling happily. I recall looking at that and thinking, "that IS a nice smile."

But two weeks before, i.e. pre-Radiesse, my reaction to that sort of scenario was more likely to be: "Gee, I really am not eighteen any more."

This is probably as subjective a reaction as I can imagine, but ultimately, that's really what I want to accomplish -- I'd like to look good enough to where, of all the people in the world, I am the one whose reaction to my looks is: "That really does look nice."

If those around me happen to agree, that's a nice bonus, and I suspect that my aesthetic standards are not so far off that, when I think I'm lovely, the rest of the planet thinks I'm hideous. Still, it's ultimately my journey and I'm the person whom I'm most interested in pleasing aesthetically.

With that agenda, the Radiesse and Botox have done a splendid job. So, if a little is good, more might be better. On March 9th, two weeks or so after the initial Radiesse treatment, I went back to Susan at Dr. McCormack's Office. She and I discussed my transgender journey and the likely benefits of some more high-cheekbone looks resulting from a bit more Radiesse. Aware that I'm not 100% "out" (i.e., I'm managing my gender transition precisely and slowly) she asked probingly and gently how feminized a look I was going for, as to the Radiesse. On that front, I'm open to veering as far towards feminization as possible, and I told her so. She proceeded accordingly, and I'm very happy with the results. They're subtle yet noticeable.

It is interesting to watch Susan work. I consider her a walking encyclopedia of relevant information and whenever I'm with her, I tend to ask questions non-stop. It was cool how at some point she indicated, most professionally and politely, that she was checking out of the Q&A session because she needed to, and preferred to, concentrate on what she was doing.

I liked how every now and then she'd say "look at me" and she'd evaluate her work from a 100% frontal-look perspective to make sure it was all in balance, though she also looked at me from many other angles too. Working with Susan was like watching an expert mechanic work on my semi-exotic German car.

I enjoyed the experience and I love the results.

Interested in what the rest of the world thinks too, I have just asked my girlfriend as to how different I look now compared to a few days ago. She looked at me for a long time, thought, and then said: "You look kind of more bright" and "more smooth." I liked hearing that.

So, kudos to Dr. Tiffany McCormack and her team -- especially, for this post, Susan.

Updated on 11 Mar 2012:
The following is an experience-based short story on integrity and why I value it, with practical application to my own cosmetic-surgery plans. Some might find it inspiring. Even so, if you’d like to skip the story, please fast-forward down to the paragraph that begins with “I value integrity …”

* * *

About fifteen years ago, I was very, very broke. I could no longer afford my apartment rent. I lived in my office, and I slept on an old couch in its corner. It was a small and humble office; the rent was $100 per month.

The neighbors’ office used to be a house, so it still had a bathroom, but they’d had the hot water turned off long ago. Still, they were kind enough to allow me to use their shower.

The car I drove at the time was a 1976 Volvo station wagon that someone had rear-ended. The back was bent in, and the transmission was unable to go into reverse or beyond 2nd gear. The car had cost me $265, and I was happy to have been able to afford it when I bought it from a local junkyard.

On the premise that “broke is a cash-flow condition, and poor is a state of mind” I was broke, but not poor. Still, I desperately needed billable software development work.

My best-paying client had also become a friend, and right about then, he decided to launch an enterprise database system that I was to create. My financial troubles would finally be over. He invited his entire staff, and me, to the first requirements-development session. Early on in the meeting, the client started conveying what the design should be. As a professional software requirements engineer, I know that this is how bad software is made. A client might sometimes attempt to convey requirements by describing a design or a solution -- but as a basic premise, the client is supposed to convey the requirements, and the designer-and-developer is supposed to design and develop the software. An analogy might be someone who owns a private jet and tells his pilot, “never mind waiting for clearance from the tower, just go duck behind that 747 and then take off.”

Not just was my friend-and-client crossing the line, but his proposed design also happened to have a fundamental flaw in it. I gently made him aware of both aspects. Nevertheless, he insisted that his point of view should prevail. I was aware that I was about to lose my client, the project and my financially rosy future. But, I’d by then read “The Fountainhead,” by Ayn Rand, enough times to appreciate the value of integrity. So, I continued to reason with my client while refusing to simply give in.

As I’d expected, my friend-and-client ended the meeting, the project and the business relationship. That evening, still friends, while were at a grocery store together, buying ingredients for dinner. He again brought up the issue of the design, and I used a set of chewing-gum packs to build him a data model diagram to explain the flaw in his design. He finally understood and for the remainder of that evening and night he frequently chastised himself conversationally for having been both mistaken and stubborn. Even so, he didn’t say anything about resurrecting the project, or the stand I’d made on principle, with integrity being exercised to his intended benefit.

Now, fifteen years later, my financial picture is different. I now own and manage eight different companies across two continents. My office is large and pretty, with modern equipment, beautiful ceramic tile detail, and huge posters of Hawaii -- a place to which I’ve been probably fifteen times in the last x years, so often that I now own a turbo 7-series BMW on Oahu so that I don’t have to deal with rental car issues any more.

I don’t sleep in my office any more. I live in an elegant two-story townhouse in a nice neighborhood in Reno. In the parking spaces are an almost-new convertible Mercedes and one of the dozen BMWs that I own as part of my classic car collection.

Recently, my phone rang. It was my friend and client from fifteen years ago. He needed someone with integrity to advise him in a difficult software project, and he was choosing me. He ended up spending several thousand dollars in a short time-span and he was happy with the results.

* * *

I value integrity and it’s worked well for me. So, when I see it in the person and staff of Dr. Tiffany McCormack, it really makes me happy about having chosen her.

I have a lovely friend who’s also a professional make-up artist, and according to her I have perfect lips. I agree that they’re pretty, but what I would like even more is the sort of triangular-shaped short-upper lip look that some models have, so that even in a relaxed-seeming lip position, their incisors are showing.

So, I contacted Dr. Tiffany McCormack and asked for that to be added to the list of things planned for my surgery visit. She warned me about scarring and conveyed her interest to discuss this with me in person. Last Friday, she and I met. Dr. McCormack took a close look at me and announced that the results I wanted would be very unlikely to be achieved by surgery. So, rather than cashing in on making an extra $1.5K or so and saying “well, let’s take a whack at it” she turned down the possible revenue in the interest of professional integrity and her client’s best interests. And this, I could appreciate.

Half an hour later, I was in a session with Susan, the injectables specialist at Dr. Tiffany McCormack’s office, and in conversation with Susan, I explored the possibilities of my lips perhaps getting to where I wanted them to be, courtesy of some or other amazing substance that she’d inject just so. Susan seriously pondered the question and the options, and she decided and announced that the result was more in danger of looking odd than achieving what I was looking for. So, Susan also turned down potential revenue in the interest of professional integrity and her client’s best interests. Twice in one hour, I was most impressed by Dr. Tiffany McCormack and her staff.

If you react with “well, they’re board-certified, etc. -- of course they’d respond like that” then I disagree with you. As a proponent of the free market and a very critical observer of government involvement in the economy, I have concluded that being able to meet official requirements is no guarantee of having personal or professional integrity.

The remainder of this post serves as a study in contrast. If you’ve seen the movie “Total Recall,” then imagine a cosmetic surgeon’s office having the style and tackiness of the “Recall” memory-implant business. Well, I’ve seen it, first-hand. Before choosing Dr. Tiffany McCormack, I have also been to another cosmetic surgeon for an in-person consultation and a prescription -- no, not Dr. Ousterhout, who is wonderful and whom I also plan to involve – let’s just say, someone else yet in California. Even before I walked into his office, his staff had already started exuding a lack of professionalism, and it got worse and worse. At some point I was almost shaking my head in amazement as incident after incident made me conclude that it would be a cold day in a hot place before I ever entrusted my tender self to this doctor’s knife. The parallels to the aforementioned movie were so stark as to be almost a caricature.

So, I hasten to say that, even with (or more precisely, perhaps due to) all the government involvement in this field of endeavor, it’s certainly possible to find a highly unprofessional cosmetic surgeon, as I have personally proven. In that context, and in sharp contrast, finding someone with the integrity of Dr. Tiffany McCormack was a very happy event for me.

Updated on 17 Mar 2012:
[Posted March 17th, written March 16th, 2012.]

Today, was a "very validating" day for me on my path towards increased physical feminization.

Officially, I grew up as a male. As to the visually discernible shape of my body, it was male (though with a leaning towards a few feminized features that I tried hard to dismiss at the time).

Mentally, however, I've always felt like I had feminized thinking patterns. My youngest memory of this goes back to when I was about five or so. I also dimly recall coming to the conscious realization, not too long after that, that this didn't fit the social pattern and might be problematic. And I also dimly recall realizing, not too long after that, that adults were making quite a mess of things and that they'd probably mess this up too, and I'd be wise to keep this issue very much to myself.

Unfortunately, even while being continually aware of this, I was less than intellectually honest in how I deal with it. Until 2011, i.e., for decades, much of my intellectual energy as to this subject was spent on trying to deny this -- joking about it, overcompensating for it and so on.

And, managing to confuse sexual attraction with gender identity, I rationalized that I couldn't really have feminized thinking patterns, could I, because I find the female of the species to be so sexually attractive. It didn't occur to me that I could simultaneously have feminized thinking patterns, and have a female-to-female attraction too, i.e., be gay albeit with an interesting twist to the phenomenon.

Denial (trying to convince myself I was imagining things, in spite of a steadily growing accumulating amount of factual evidence to the contrary) worked about as well for me as it seems to work for most people ... i.e., not that well.

Relatively recently, as I pondered my deepest personal reactions, emotions, thoughts and preferences over the course of my life, much of it made little sense unless I considered the possibility that I have a lot of feminized mental wiring in my head, as in: to a significant extent, I think in a female way.

I'm not implying that I was as intellectually honest about this as I should have been ... but with that clearly in mind: an analogy might be an astronomer who is puzzled by how the celestial objects are moving, until Galileo suggests considering a heliocentric theory -- and suddenly everything clicks into place.

Certainly, me thinking in a female way would explain much of what's been puzzling me as to how and why I don't fit the male stereotype, even remotely.

Using the rather morbid approach of physical post-mortem dissection, scientists have proven that the female mind is physically, structurally different than a male's. I'm not implying that a female should want to start thinking like a male -- but even if she wanted to, she couldn't just flip a switch and do so. This premise seems to have become a fairly well-accepted premise in general culture. Hoping a lady will fundamentally think like a man makes about as much sense as hoping that a cat will think like a dog. Physical brain structures are no small factor.

Having a female brain while also having a body (including a crotch) that is female ... that's totally non-controversial. Having a body (including a crotch) that is male while having a female brain ... that has tended to be very controversial. Yet, that describes the transgender male-to-female person.

Some post-mortem work, done relatively recently by some Dutch scientists, has analyzed the brains of a large-enough sample of transgender male-to-female people to support the conclusion that, regardless of what's in a person's pants or on the person's driver's license, many transgender male-to-female people have brains whose structure (the post-mortem showed) was definitely and fundamentally female. In other words, the transgender folks weren't simply being silly and making it up. Expecting a transgender male-to-female person to think like a man would make as little sense as telling a genetic girl to do so.

If how a person thinks defines them, then how my mind fundamentally works is more important than what happens to currently be in my pants or written on my driver's license. If I have a feminized brain, and if I personally feel the strong need to have a vagina, DD breasts and to wear 6" stilettos, then it's not the result of me being silly (which is a self-reproach I've often felt on bad days) but rather the result of me being true to my deepest nature -- how my brain fundamentally works -- assuming that my brain actually has strongly female wiring. That's always been the pivotal question for me... is that really the case? Or, am I just imagining things?

The "you have female brain wiring" premise explains so many historical riddles in my personal past that for me, this aspect alone has been a good-enough cause for adopting this hypothesis.

To elaborate on my reasoning as to why: the philosophical guideline called "Occam's Razor" suggests that when there are multiple possible explanations for a situation, the simplest one tends to be the correct one. It is sometimes summarized as: "If you hear hoof-beats, think horses, not zebras."

Still, for me, it would be nice to be even more sure. And yet, the concept of a personal post-mortem isn't an appealing option to me. I don't want someone else to be sure, after I'm dead, how my brain was wired structurally. I'd prefer to know this right now, while I'm very much alive, with a significant degree of certainty. And, finally, I do.

Fortunately, for people like me, there exists something called "the Bem test," named after Sandra Bem, who created it. The test has been around since the 1970s. Early on, it focused on some studies involving Stanford University. It is very methodical and is one of the more-respected scientific tests on this particular subject. It analyzes (amongst other things) how much of a fundamentally feminized premise a person has in his or her thinking patterns.

According to my test results today, which were also reviewed by a professional sexologist, my thinking is just slightly more feminized than 85% of genetic girls. To me, that's very significant. To put it crudely, it means that if you pick a random sample of 99 genetic girls, and put me amongst them, and arrange us from least to most mentally feminized, with "1" being the least and "99" being the most, then I would be number "85." More precisely, my score is 1.0337 standard deviations from the mean, and if it had been 1.033 then I'd be more feminized than 0.849% of genetic girls. So, add a blip (0.0007) and it pushes the percentage to just about 85%. I feel like having a T-shirt custom-made with an "85" on it.

For me, personally, this additional certainty makes today a red-letter day for me.

I ended up being so intrigued by the test that I also bought the $40 professional counselor's guide about this test, and I worked through it until my eyes just about glazed over. The guide delves into vast intellectual complexities, and it impressed me how well this test was devised. As I understand it, it is structured in such a way that even if people were to try to cheat on it, the thought patterns in their own mental premises would make cheating difficult.

As I continue making my body physically more feminized, I feel like I'm exceptionally vindicated and validated. For example, next week I'm having surgery to have my Adam's apple removed, and it's nice to be even more sure that I'm on the right track.

In the interest of a balanced perspective, I should mention that the test also showed my masculine thinking patterns to have a high score too. In all fairness to the test and the situation, I'm not sure what to make of that. I honestly don't know how much weight to assign to that factor. I am trying to not be like a bad scientist who throws away any data that doesn't substantiate his or her favorite hypothesis. I'm trying to not oversimplify, one way or the other.

Regardless, the high feminized score means a lot to me, and so even on bad days when I doubt myself, I can feel less ridiculous as I ponder everything I've already done and am still planning to do in my journey to becoming physically ever more feminized.

Yay!

Updated on 18 Mar 2012:
To me, yet another measure of integrity is when there is a more-affordable comparative product and whoever is offering their more-expensive product tells me so. Susan at Dr. McCormack's office is an example of doing this the right way.

My software business is doing great and I have more work than I can handle, and it makes financial sense for me to spend my time generating revenue as opposed to spending hours on trying to save a dollar here and a dollar there. So, when it came time to buy sunscreen, I was sorely tempted to buy the high-quality stuff that is available from Susan at Dr. McCormack's office. If I had done so, I'd probably be money ahead now.

Instead, my bargain-hunter mindset prevailed and I chose to go to the local Walgreens and I spent much time staring at the rack of sunscreen products and reading many small-print labels.

It was nice how Susan had educated me as to what she thinks makes a sunscreen good, and why. Sufficiently empowered, I spent a lot of time trying to find something that has both Zinc Oxide and Titanium Dioxide, and I like how Susan had explained to me how the modern products have integrated these ingredients so well that such sunscreens no longer makes one's nose shine a bright white after applying it, as zinc oxide sunscreens used to do some years ago. I should probably have bought Susan's sunscreen instead, just out of sheer gratitude for all the information she provided.

My quest finally led me to the one sunscreen product that had what I wanted, on the massive shelf filled with alternatives: "Natural Reflect" "Baby" from Banana Boat: 50 SPF, with Zinc Oxide and Titanium Dioxide. Yay!

By the time my shopping was all done, I had saved $28. And, in the time it had all taken, I could have made $60. At least, I had fun.

I belong to many transgender websites, and I have a girl crush on one of the members on another site. She recently blogged that she's happy that spring is here and she's planning to go work on her tan. I sure hope she uses sunscreen.

If looking better is what this site is all about, then sunscreen on your face, ears, hands, neck and chest is a must if you're going outside (and here's the key point) -- even if you're just going to be driving in your car.

Susan mentioned a case study where the left side of a lady's face was probably 20 years more aged than her right side, just due to the effects of a lot of driving in a sunny climate, without sunscreen.

My dermatologist's office has a picture of a 90-year old Buddhist monk who never or almost never went outside. I'm not sure how well he did on his Vitamin D intake, but his skin looks great.

I'm now a believer in sunscreen, and I appreciate how Susan at Dr. McCormack's guided me. And, I enjoy putting on my Banana Boat sunscreen product before I go outside. I hope you do too.

Updated on 1 Apr 2012:
List Pros & Cons, Advice you can offer others

Updated on 1 Apr 2012:
The day before the surgery, the doctor and has staff were warm and informative and calming. The doctor's assistant, Mira, offered to personally drive me back to my hotel after the surgery even though it was not very close. I appreciated it a lot. The post-care instructions included not straining myself for 10 days after the surgery and I asked if this included sex and/or orgasming ... yes it did. :-(

I felt like I was being treated like visiting royalty even though there was no strain or effort in the actions of the doctor or his staff; everyone seemed to just naturally be nice, well-informed and professional. The doctor mentioned how he'd done more than a thousand of these operations, and he mentioned a few isolated (anonymous) examples of complications. I knew nothing is totally safe but I was willing to take my chances. My mom worries about everything so I didn't even tell her about the surgery until it was all over. :-)

That night I went to Walgreens and they filled the prescription the doctor had given me: a strong antibiotic, plus Valium (or the generic equivalent) plus Vicodin (or the generic equivalent). The latter were, I knew from hearsay, pretty intense, so I suspected I might be in for a rough time.

I showed up at the indicated time. From the gentleman who signed me in, to the nurses, everyone at the hospital was nice and positive in their odd Californian way; laid-back yet highly professional. I was so impressed by the hospital staff.

There was one last pre-op discussion, and the opportunity to feel my Adam's Apple the last time. Goodbye! (Good riddance). I recalled an incident a few weeks ago, when I looked in the mirror and I so liked the look of my hair, face, make-up and so on .. and the shape of my neck in front greatly detracted from the look. Soon ... no more.

Pretty soon the sedation kicked in and I was sort-of-out ... I sometimes dozed and sometimes heard the conversations but couldn't move. It was intense.

I gather human bodies vary greatly in some major respects. Sadly, the area being operated on had such a variation -- a major one. In a place where hardly anyone has an artery or a vein, I had a huge artery or vein (I don't remember which) right where the work was being done. It was very thick, too. So, major complication. The surgery took way longer than planned but the doctor didn't charge any extra and he remained calm and professional. He was really cool. I recall how at some point in the process he told everyone "don't move" in such a tone of unstressed authority that even I, who couldn't move anyway, made a point of not moving. I felt quite silly about it afterwards. There was some sort of unpleasant surprise as to tools not being where expected and I could tell the doctor wasn't happy and he was candid about it yet totally professional. I've never felt so dependent on another human being and yet in such good hands. It was a wonderful feeling, not least coming from someone who's a control freak when it comes to control over myself.

Pretty soon it was all over, and the doctor allowed me to touch my "new neck." I loved it!!! And, he explained ... get this ... that this was the MOST complex such a procedure that he's ever done with ANYONE due to the complication ... and it happened with me. He explained the complication. I appreciated his calm demeanor more yet, and I looked at the clock and saw how much longer the operation had taken than planned. Later, his assistant revised the estimate as to when next I can have strenuous (read: sexually themed) activity and the date got moved into the future to three weeks (as the most conservative value that was mentioned on the outside).

Mira, his assistant, took me back to the hotel. Another assistant also came along, for good measure. They were relaxed but very concerned for my well-being. It was wonderful.

I ate a lunch at the hotel and I started taking my antibiotics. I didn't feel any pain nor did I feel stressed out so I didn't feel the need to take the Vicodin or Valium (or generic equivalents).

I was not allowed to lie flat. This turned out to be the hardest part. I dozed a bit but it was hard to sleep, sitting up. I didn't get much sleep. The next day I was supposed to get lots of rest (doctor's orders) and my website business had a major crisis -- the most important hard disk on my most important server crashed. All sorts or systems and websites were down. Normally, I'm at the office and I just deal with it. Now I was in a bed 300 miles away. My staff really struggled with the issue. Finally, a long-time vendor-and-friend helped and got the situation sort of under control, but it was the most professionally difficult day I have had all year. I almost took the Valium on general principles thinking that if anyone deserved a chill pill, it was me, that day. But, I hate feeling out of it and somehow, I didn't actually feel stressed out. So, no Valium. That was the first day I was allowed to shower, but I was nervous about the wound. My neck looked like I was a turkey -- I'm slender but it looked like I had a double chin and it was kind of reddish too. I got a friendly phone call from the doctor's assistant, checking on me. That night, very little sleep, again.

The next day I managed to implement a work-around to the worst website crises, working from my laptop in the hotel room. I dozed some more and started to feel better. I took off the bandage under my chin. It looked like a relatively healthy scar. Those were my two surprises; somehow I'd assumed the scar would be where my Adam's Apple was. I'd already planned a set of outfits based around high-collar turtleneck shirts and sweaters. Yet, the scar was below my chin. From there, the surgeon had been able to access my Adam's Apple and do all this complex work ... but the tissues along the way from my chin to my Adam's Apple area were understandably bruised and swollen. I now wish I'd taken pictures but it looked so bad I was embarrassed. Imagine me with a huge red double-chin and you get the idea.

Every day got better after that including my ability to sleep while sitting up. Except, the swelling didn't go down much.

Five days after the surgery, I went to the Doctor's offices and his assistant removed my stitches and examined the healing process and said some encouraging things. I checked out of the hotel and drove home, 300 miles, much of it along the lovely Sierra Nevadas. I was so happy that I stopped along the way and took some from-the-neck down pictures of myself, by the side of historic highway 40. I was a happy person even before the surgery, and now with one major conflicting aspect removed, things were looking better yet.

It's now 11 days after the surgery. Even though I have been waxing my body hair and facial hair into gradual oblivion, I still have some stubborn follicles who refuse to die, especially on my face, so I have to shave to have smooth facial skin. And, I'm clear that it's bad to shave on the scar, but ... I have a hard time even telling where it is any more. I am so happy about that. The swelling ... is still very much there, though better. I'm not delighted but I understand that it's my body's way of healing itself. I just need time.

Socially, I've been wincing before every meeting, having to explain the whole transgender thing to those who haven't as yet heard it or drawn their own conclusions. Yet, nobody, even in the relatively rednecky small town where my office is and where I've spent the last four days, asked me what had happened to my Adam's Apple. I think I have been far too concerned with what others might think, or even notice. Meanwhile, life goes on, and it's better yet than it's ever been.

I'm sort of coming to grips with how non-hysterical the people in my life are about me being transgender. They respect my for my values, and these haven't changed. If anything, facing the fact that I'm transgender, and doing something to make my looks match my mind, shows realism and integrity.

I tried to buy Dr. Ousterhout's wonderful book on Facial Feminization, but the doctor insisted on donating it to me instead, with a personal inscription on the flyleaf. I have been reading up on what a logical next step might be. And, not so surprisingly, this journey has me inspired to work harder and earn more money so as to be able to afford whatever's next on my agenda. I cheerfully work seven days a week, from about 9 a.m. to midnight, and that excludes time I take off for personal reasons such as to write on this wonderful website.

And, I have yet to feel pain or stress about the process, so I have yet to open the containers of Valium and Vicodin (or their generic equivalent). They're sitting in the medicine cabinet. That by itself is yet another symptom that things went well.

Updated on 8 Sep 2012:
It's been months since I last posted an update. Wow. My life has SO changed for the better. Nowadays, when I look in the mirror, I like what I see, and that's a very, very nice feeling. I had my eyes and nose and some other non-surgical work done at Dr. Tiffany McCormack's in Reno and I recommend her, and her wonderful staff, especially Susan, most warmly -- not just due to their technical skills but also being genuinely good and nice people, and transgender-friendly too, yay.

It's wonderful to wake up and feel pretty. I've always had female mental wiring but I really disliked my male looks. Nowadays, it's like the caterpillar has become a butterfly. I enjoy having my picture taken, getting dressed, going out, etc. and I'm inspired to be extra healthy. I eat better, exercise more, drink more water and take very good care of myself including every sort of cancer test that seemed reasonable to do. So, I don't have skin cancer, lung cancer, colon cancer and that covers my main risk factors, yay!

I feel so good about my looks and have found that my look appeals to a few gentlemen so I've been doing some in-hotel-room lingerie modeling. Were my face not pretty enough, it would not have mattered how hot my legs look. As you can imagine, it can get very racy so I screen people VERY well so that it's comparatively safe. I charge $140 per one-hour session and folks tend to be so delighted than they often tip / overpay. On Monday I made $170 this way, and last night $200. Yay!

Last night I was at a wild club named the Power Exchange in San Francisco. This was my first visit there. I ended up having a celibate visit, which (due to its theme) isn't the only way that visits to this club can be, but I had a really good time. The club has a large central hall and the centerpiece of that is a stripper stage so I gradually got into the mood and ended up giving a 20+ minute show, stripping from jeans and a conservative top to fishnet stockings and some very sexy black underwear. As you can imagine, in order to be OK with doing this in front of a room of strangers with high aesthetic standards ... the confidence that one needs in one's own looks is significant which is why I bring this up, to show how far I've come. (Being able to move well in a pair of 6" stilettos helps too).

My love life is happy too. What used to be a hurdle in me coming to grips with being a transgender chick (my sexual attraction to girls) has worked out perfectly during me changing my looks to match my brain. Fortunately the wonderful people in my life as such are bisexual and that's turned out to be a very good thing. They liked me for my mind when the relationship began (someone who seemed male and thought like a female). Nowadays I also look female but I think as I always have, plus I'm way happier yet. So, I'm a far better "me" yet.

I've been surprised at how much time and money it costs as to ongoing maintenance of feminized good looks: shape, hair, nails, skin care, putting on make-up, taking it off, cleanliness etc. I understand and appreciate better than ever the effort that goes into looking good. Surgery and other procedures will get you started but a lot of it is up to you as to how you tailor your daily routine, and as to its requirements regarding time and money, I have had to budget generously. So, nowadays when I see another pretty-looking female I make a point of complimenting her and the results have been most positive.

It has been interesting for me to understand transgender culture more, from inside and as to how others react to it. What I learned so far has been disconcerting, disturbing and inspiring, all combined.

My family, friends and IT business clients have been delightfully rational and accepting, with the exception of, ironically, my mom and a nice man who has sort of been a surrogate dad for me (no, not my stepfather; someone else yet). They each have recently conveyed to me that over the years they've gotten used to the idea of thinking of me as male and they'd appreciate it if I were to continue acting accordingly in their presence. This isn't an option that I'm willing to extend any more than I'm willing to help someone continue in their preferred illusion that the earth is flat. They're each treating me being transgender a bit as if I'm dealing with a bad cold. I find this to be both sad and amusing. Especially when it comes to my mom, I'm at the point where I've given her more than enough information with which to make good decisions. If she chooses not to, then so be it. I tend to prefer the company of people who are nice to me and transgender-friendly and if my mom had been in that group, that would have been my preference, but that's simply not the case and life has to go on.

Fortunately, there's no lack of wonderful other people who haven't just accepted the better-looking, better-integrated me but they have embraced me as such, with relationships becoming more warm and good yet. One female client, with whom I've worked to make complex business database software ... when I explained to her that I'm transgender, she was fine with it and her main comment was that she finally understood why she and I thought so much alike. Almost universally, people (even those about whose reaction I wasn't very hopeful) have been wonderful. And when I do run into someone negative, they tend to be an isolated example and in the grand scheme of things, they just don't matter.

If you've been following my journey and wishing me well, I thank you -- and do feel free to email me for additional pictures or any questions you might have.

If you're transgender and feeling stuck, also please email me -- if I can provide helpful input, I'd be happy to. As a general comment, I'd say that an important thing to understand that is, like the earth not being flat, someone being transgender might be a fact that's mighty unpopular with some people. Their opinions (which matter to them greatly and which they present in the strongest possible terms and treat as if these were the messages of divine and universal truth) actually deserve to mean less than "very little" in the grand scheme of things. Someone saying, “that's disgusting" doesn't have a monopoly on what's universally disgusting. It simply means that this individual personally considers something to be disgusting. Such an individual is welcome to his or her opinion, but it's just one person's opinion. When it comes to transgender issues, the most anti-transgender folks are often those whose opinions are uninformed, flawed, and illogical. Yet what they lack in the merit of their opinions, they compensate for in rudeness and emphasis, probably because the opinions cannot stand on merit. If you're transgender, it can be hard to realize how truly meaningless such opinions are, but it's been really helpful to me to reach the point where others' negative world views don't affect me negatively, including about transgender issues and about me.

On a related note: in the last few months, Mark Schoen of SexSmartFilms released a wonderful movie about transgender folks. It's called TRANS and I recommend it most warmly.

On the premise of "your right to swing your fist ends where my nose begins" I got some refresher (and official) handgun instruction for legally approved concealed carry of my very elegant black Beretta .32 pistol whose black leather holster goes very well with my favorite black bra and thong. Anyone choosing to initiative ant-transgender violence against me is likely to find out, briefly, how effective high-powered ammunition can be even with such a relatively small caliber. I live in cowboy country -- and I agree with the local premise that it's better to be judged by twelve than carried by six. Fortunately, Nevada law is refreshingly rational when it comes to recognizing the right to a vigorous self-defense. So, whether they're mean verbally or violently, people who have an issue with me being transgender are not scary, and I like it like that.

Updated on 8 Oct 2012:
Things are going really well. Until recently, I've been "hedging it", wearing androgynous clothing, not hiding that I'm flat-chested and avoiding make-up in public.

These last two weekends, I was in the SF Bay area and I felt more confident. I wore a bra that gives the sort of shape that I'd like to have; not flat-chested but not huge either. I wore make-up -- the whole "nine yards" except for lipstick since my lips are naturally the color that others use lipstick for. And, I wore skirts for the first time. As girls go, I no doubt looked unusual and I probably always will. I like high-heeled shoes and when you add 6" to someone who's 6" tall, that's a tall person. And, I still have a masculine-shaped chin and jaw. And, large hands. And, my voice isn't feminized nearly enough yet.

Still, visually, I think I look more feminized than not. But, what's a good reality check? There's no hard-and-fast certainty, but here some things happened that bode well.

I went clothes shopping in a clothing store, and I'm well-accustomed to how girls treat someone who looks like a guy; I've had many years of experience. And, this was different, like night and day. I finally saw what it's like to be one of the girls, being included, such as a pretty girl coming up to me and asking my advice on something she's considering (and no, that doesn't mean she wants my advice; she will follow her own but my input is requested if only as a sounding-board). I went to a very upscale hotel because, well, I love their ambiance. I used the restroom -- the male one, which I'm legally obligated to do until my driver's license says otherwise. A gentleman came in, saw me, looked unhappy and walked out. A few seconds later, a maintenance gentleman came in, frowning. He approached me, stopped and looked at me for a long time. I calmly smiled and looked back at him. Finally something seemed to dawn on him and he sort of had an "oh! okay, I get it now" reaction. On another occasion, I was at another elegant hotel, and everyone was super-nice to me until, again, it was time to use the restroom. As I walked out of the men's restroom, there was yet another maintenance man, and he looked at me with puzzlement, the gist of which was "hey lady, what are YOU doing in a men's restroom?" I didn't go there to cause confusion or issues, but the reactions ended up very validating. And, all in all, all weekend long, people were just nice to me with a new ambiance that I've never felt when I looked like a guy.

Now that I'm back home, I continue. I wore a pretty skirt to the movies the other night, and everyone was super-nice to me. I actively avoid talking until I have my voice trained well, which is super-difficult and I'm working on it. I recently watched a video of a lovely transgender lady in which she doesn't say anything, just looks demure and sexy. She looked SO pretty. Then, I saw another video of her, in which she spoke, and it really detracted from the original impression. Voice training is SO important.

Meanwhile, I continue my face-and-neck lasering at Dr. Tiffany McCormack, a wonderful lady with a wonderful team. Also, I've started a blog for girls like me.

Updated on 11 Feb 2013:
Life keeps getting better. My driver's license now officially reads "Female" and that's a nice change. I no longer have urinals in my future, yay! It's SO nice to be treated like the lady I am. When I'm out alone I tend to still get mixed reactions but oddly when I'm out with another lady then we get called "ladies" without hesitation. And, it's so intriguing to me how different the female-to-female dynamic is ... warm, collaborative, positive. I love it. As to the male world, some of it seems to love my look. Demand for modeling keeps going up ... one week in January I made $1240 by modeling. It feels odd to manage a software company and be a software developer for part of the week and the other part of it, I'm a strip-show model. I'm noticing how many male modeling clients seem to be responding with a submissive mode so I reinvested the modeling money I made and got formal professional [RS bleep] training in San Francisco. My approach to that is very mellow, mentoring, encouraging ... and specializing in transgender people who need a little push ... like I did. My face still doesn't look feminized enough for me but some Sculptra sessions bode well. It's a very long-range solution, which is what I tend to prefer anyway. It's interesting to me how my facial features looking better also inspires me to be in better shape. I exercise a lot nowadays and it seems to be paying off.

Updated on 25 Mar 2013:
A key issue that seems to be common amongst many transgender girls is feeling materially deficient, aesthetically.

Puberty tends to be the worst time for us. At a time when the genetic girls around us were being beautifully transformed into curvy, pretty ladies, our own bodies became misshapen relative to how our brains are wired: female. No wonder that even in the latest version of the Diagnostic and Statistical Manual of the American Psychiatric Association, the concept of "Gender Dysphoria" is alive and well as the opposite of, well, euphoria.

My own unhappy reaction at the picture in the mirror became a downward spiral a few years ago. It was hard to be motivated to remain healthy. After I formally realized I'm transgender and I committed to live accordingly, I am a year or so later in good shape as to my body fat percentage, my blood pressure is perfect, I am in great health and so on.

I'm still flat-chested and I don't like that. But, I do what I can with what I have. I've read about ab exercises that make my shape more hourglassy due to a thin middle instead of wider hips. My butt is curvy due to lots of exercising. My legs and tummy are toned and muscular. My long blonde hair has grown out nicely and my Invisalign is helping my teeth be more straight.

I have gradually evolved to look good enough to where I'm in quite high demand as a part-time stripper and model, even though I am flat-chested. I made $400 this weekend in two and a half hours, modeling in (initially, anyway) a sexy dress, black thong, black bra and 6" black stilettos.

I didn't have to undergo massive facial surgery or get butt implants or breast implants in order to look good enough to do this. I still look forward to all three of these pocedures so that I can feel better yet about my looks, but it feels good to know that I do not have to look like Marilyn or Barbie so as to be able to earn money with my looks.

Money tends to be an objective measure of value, so this definitely helps with my self-confidence, too.

In case someone wants to point out, politely or otherwise, that sometimes a paradox is interesting in its own right (e.g., someone who looks to some extent like a girl but has a male crotch) -- I agree. But, that wasn't the theme of these last two sessions nor do I plan to entertain clients whose main agenda is morbid curiosity nor have I ever been approached as such. :-)

Updated on 18 Apr 2013:
When I'm not doing part-time modeling I also manage a software business, and a used BMW and Mercedes-Benz parts business that I founded. This last week the latter required me to go to a scrap metal dealer in, pretty much, the middle of the Nevada desert, near a small town in a rural area. It's a pretty intimidating prospect. But, I put on my make-up and off I went to the business meeting. As it turned out, the people there were super-nice. One day, after work this week I took some pictures. Not a lot of make-up and just my blue sweatshirt, but I figure if I just show pictures of me when I'm about to go out that's not very realistic. Also, my mom told me this week she thinks she has a beautiful daughter, which is maybe the biggest relationship milestone yet. I never thought that would happen.

Updated on 21 Dec 2013:
My life has settled down to where I'm now just one more girl. Almost across the board, guys still focus on my masculine forehead and jawline, and the call me "Sir" whereas girls pick up on the cultural cues. and they "get it." A knowing, friendly smile and collaborative attitude tells me they're clear, even if they don't say a word.

I have a not-that-great relationship with my mom. She said some deeply hurtful things that really had no logical basis, and if someone hurts me and I keep coming back for more, that's what I'm going to get, so I've been distant. Still, I met her yesterday for a Christmas lunch, and I didn't have time for a lot of careful makeup application since I was running late. So, I just put on eyebrow pencil and mascara, and off I went. And, felt fine, and looked well enough to be treated like just one more girl and to get a compliment besides.

My software engineering and automotive engineering businesses are struggling but surviving. The latter is an inte