Suzanne Clayton
Suzanne Clayton

Planes, change, and automobiles: Suzanne Clayton is going the distance.

Suzanne Clayton, like many transgender women, finds the “journey” metaphor helpful in talking about her gender transition. Clayton lived 37 years as a man before coming out as female two years ago. Since then, Clayton’s gender transition has required a good deal of internal navigation, but it has also resulted in more classic expenses: about $5,000 for travel and lodging.

Last week, she returned from her sixth excursion to Carrollton, Texas, where she receives electrolysis treatments on her face and body. She’s traveled to Philadelphia four times in relation to her sex reassignment surgery. After nearly four decades of self-suppression, Clayton has amassed enough savings to make the procedures, and their travel budgets, possible.

With dozens of top-notch cosmetic surgeons in the D.C. area, Clayton’s surgical needs should be as close as a cab ride away. But while Clayton’s procedures are more urgent than your average lipo—she’s got plenty of documentation to prove them medically necessary—D.C. doctors are more equipped to administer the elective nips and tucks. It’s not known how many sex reassignment surgeries are performed yearly in the United States, but millions of biological women seek out physical treatments each year to help feel comfortable in their own bodies. Last year, 355,671 Americans underwent breast augmentation surgery; 341,144 received liposuction; more than two million were injected with Botox.

Jessica McKinnon, a local transgender advocate, says that plastic surgery specific to the transgender community has become a highly specialized field. “The surgeons who do the much more specialized work—like the genital surgery and the facial feminization—often decide to really focus on that line of work,” says McKinnon. “There’s such a great demand…those surgeons tend to be flooded and ultimately end up treating mainly transgender patients.”

Online trans resource TS Roadmap lists only 19 surgeons known to perform vaginoplasty in the United States. Those trans women who choose to undergo physical surgeries are often forced to take their journeys cross-country.

Electrolysis: 2,600 miles

The removal of facial and body hair through electrolysis is one of the most common nonsurgical cosmetic procedures performed in the United States. That hasn’t made the procedure more accessible for transgender women. “I used to have a fairly thick beard, and it’s been difficult to permanently get rid of,” says Clayton. For months, she slowly thinned her facial hair in one-hour electrolysis treatments at Alexandria’s Alternative Health Associates. But the painful sessions were too short to adequately clear Clayton’s face—and more extensive zapping sessions require some special accessories. The key to heavy-duty electrolysis is access to lidocaine—if you’re going to endure the currents for over an hour, you need the drug to numb the pain.

Clayton’s local electrolysis source wouldn’t administer lidocaine in the office but suggested that she might hop over to a dentist down the street to numb up between sessions. Since Clayton’s extended electrolysis sessions would require several doses of the stuff, she decided to really hit the road.

For the past year, Clayton has traveled to the Carrollton, Texas, Electrology 3000 center every two months in an attempt to permanently eliminate her facial hair. E3000 is “very well-known in the transgender community,” says Clayton—but E3000’s community points result from its extensive services, not its inclusiveness. “They’re just geared toward handling the very difficult electrolysis,” she says.

Clayton’s first visit was a marathon 20 hours of face-clearing. Now, Clayton’s E3000 treatments in Texas leave her face bruised and burned for several days after the procedure. Clayton, at least, was happy to ditch one complication: the constant shuttle between electrolysis and dentist chairs.

Breast Augmentation: 40 miles

Clayton didn’t opt to have breast-augmentation surgery, another very common procedure that nevertheless raises specific concerns for transgender patients. “Many trans women look to have breast-augmentation surgery, and that’s something that is extremely common among natal women as well,” McKinnon says. “But a lot of the surgeons that practice these procedures are only doing them on natal women, so they don’t necessarily have the same experience working on a slightly different frame.”

Tailoring the most common cosmetic procedure in the United States to trans patients requires some small but significant changes in procedure—including working with a wider rib cage, a larger gap between the breasts, and differences in tissue growth. “Even within the surgeons that do operate on a lot of male-to-female trans women, it’s hard to find surgeons that actually take those sorts of things into account,” says McKinnon. “That’s really why a lot of people do a lot of shopping around.”

This time, D.C.-area trans women are in luck: The Austin-Weston Center for Cosmetic Surgery in Reston, Va. provides a popular trans-friendly option.

Sex-Reassignment Surgery: 300 miles

Sex-reassignment surgery is referred to alternately as vaginoplasty, SRS, or simply “the operation.” But it’s unlikely that any of these descriptors will appear on the menu of your local surgeon, cosmetic or otherwise. Beyond the relatively low demand for sex-reassignment surgery, the procedure nearly always causes a health care headache: It’s rarely covered under standard health insurance plans. For the uninsured, the lack of coverage for the procedure may have one advantage: You can get it done way, way out of network. Clayton considered three surgeons in the United States, one in Canada, and another in Thailand. She settled on the most local expert: Dr. Christine McGinn in Philadelphia. “I didn’t care how far I had to travel for the surgery,” she says. “I just wanted the best result possible. I ended up going to the closest doctor, but proximity wasn’t the biggest factor for me—I just wanted it to go smoothly. You only get one shot.”

Facial Feminization Surgery: 4,800 miles

Most cosmetic surgeons modify the features of both male and female faces—a rhinoplasty here, an eye lift there. Feminizing a male face, however, comes with its peculiar challenges. A full facial feminization package includes: hairline correction, forehead recontouring, lip lift, brow lift, cheek implant, jaw recontouring, and tracheal shave. While a local doc may excel in one or two of the procedures, the whole shebang is mostly left up to specialists like Dr. Douglas Ousterhout, whose San Francisco clinic is still considered one of the best.

Though Clayton considered many of these procedures at the outset of her transition, she later found that hormones alone helped to feminize her features in lieu of surgery. With her electrolysis program nearly finished, Clayton is weighing one final procedure—rhinoplasty. This time, the line between “medically necessary” and “elective” is becoming more blurred for Clayton. “I don’t want it to be the case where I’m always looking for the next procedure to feel more complete—to be the person I should be. I want to get to the point where I’m happy with myself,” she says. “This is not a phenomenon that’s just isolated to transgender women—it’s all women.”

If Clayton does decide on the nose job, the procedure, at least, would come a little bit closer to home. “If I could find somebody local for that one, I wouldn’t mind that,” she says. “I would not mind that at all.”

Photo by Darrow Montgomery.