Doctor, Doctor, I feel like a woman

‘The best time to transition was in the past, the second best time is now’.

Today, we meet Kezia, a surgeon from Edinburgh, who’s recently navigated transitioning after 40, whilst working as a bone and muscle wizard. I’ll let her explain the technicalities of her job, she’s the professional.

Kezia and I met because the wisdom of the almighty algorithm made it so. We crossed paths on Instagram, probably because we’re both trans, and have been in parasocial orbit ever since.

I reached out to Kezia because she went to the same FFS clinic as me, Facialteam. I related to her FFS journey, and I was super curious about what it’s like transitioning when you work in medicine.

For the record, FFS stands for Facial Feminisation Surgery, but there are definitely moments of For F*ck’s Sake in the recovery period.

Trans healthcare isn’t always gender affirming though. Having been plunged into hospital lately after breaking my leg, I’ve experienced first hand what it’s like to navigate care in a world not built for trans folks.

However, behind the scenes and often out of sight, trans people and our allies are working from within medicine to make it a better place for all. Sometimes we even get lucky enough to spot a trans healthcare worker in the wild…

So Kezia, can you tell us what exactly it is you do?

My job is kind of split into 2 different parts, one clinical and one academic, which makes for quite a nice balance of challenges in my work life. I’m a consultant orthopaedic surgeon, specialising in lower limb arthroplasty (hip/knee replacements) and paediatric trauma (kids with broken bones), and a senior clinical lecturer in digital education and orthopaedics, which involves teaching 2-3 days a week in our medical school.

What’s trans representation like in medicine, and the culture in general?

When I went to medical school in 2000 at the age of 17 (I definitely did not spend any time drinking alcohol in the university union), there was absolutely no visible representation of trans/NB/GNC doctors and zero teaching on trans health included in the medical course itself.

After med school and my first couple of years as a doctor, I started training to be an orthopaedic surgeon. Anyone medical who’s reading this will know that ‘orthopods’ have a bit of a reputation, which I think is now becoming outdated (and definitely is where I work), but may have been more accurate in the past. The terms ‘bro culture’, ‘old boys network’ and ‘knuckle-dragging neanderthal rugby lads’ have all been applied to orthopods over the years.

I didn’t really fit into any of these stereotypes, but being 6ft 3, heftily built and able to drink most people under the table at social events, meant I played up to them in some way, perhaps in the ‘performative masculinity’ that many closeted transfemmes adopt. I think this probably pushed me further into denial and added ‘if it’s difficult to be a doctor and trans, it’s impossible to be an orthopod and trans’ to my internal narrative.

Tell us how you’re changing the face of trans representation in healthcare, through teaching

So, in addition to my orthopaedic career, I’ve always had an interest in teaching, and the fact that I’m a total geek meant I gravitated towards digital education.

My university work is mostly developing online teaching in the medical school, but I also do a lot of in-person lectures, and found myself teaching on the new trans-health module that was introduced to our course around 4 years ago.

I recently took over as lead of this module and am really excited about it, as I think it’s the first time that an ‘out’ trans clinician has led the trans health teaching on an undergraduate medical course.

What’s been your experience of attitudes towards transgender people in medicine?

This is a really difficult question to answer, because as an employer, the NHS have been fantastic, but as an institution? Oof. I don’t think I need to go into how badly the NHS is failing trans patients but suffice to say I am devastated by how steep the decline in provision of gender-affirming care has been, particularly over the last year. So, that massive caveat aside, I have had a fantastic experience as an employee in the NHS, both in an official and unofficial capacity.

I’m really lucky, in that a fellow surgeon in my hospital transitioned around 5 years ago, and she trail-blazed the process with HR. That meant when I did get involved with NHS HR, they gleefully got to use their already prepared ‘Gender-Transitioning Consultant’ folder.

Throughout the process, they were respectful, caring and never questioned the validity of my transition. When it came to taking medical leave for my FFS, they agreed to 6 weeks full leave, followed by a month of phased return.

I do accept that, given I’m a consultant, I might have been given the ‘VIP treatment’ and people in different roles in the hospital might not have had so much leeway. The HR people that looked after all my admin seemed to be genuinely kind and interested in my well-being, though.

Like many trans people, you had to navigate transition in a professional setting. What’s that been like?

Back in late 2022, when I first accepted that I needed to transition, I was absolutely terrified at the prospect of coming out at work. I worried about how my colleagues would react and, as the public sentiment towards the trans community worsened, I worried about how patients would react too.

So, at the start of transition, I made a ‘game plan’ which boiled down to ‘hide everything until I get FFS then return to work with a ‘OH HEY I’M A GIRL NOW LOL’. After a bit of thinking, I realised that wasn’t a great option so began to tell some trusted friends at work, who I knew would be supportive. That was the single best thing I could have done as the support they gave me, particularly some of my cis female friends, was incredibly helpful.

By about 6 months into HRT, my news had leaked to a few more people but by then I had realised how accepting the majority of people in my life were. I had come out to all my close family and friends with universal acceptance, so I was confident that, even if some people proved difficult at work, I’d be ok.

In October ’23, I talked to my department’s clinical director, to tell him I was trans and discuss the timeline for FFS and transitioning at work. He’s a fellow orthopod who I’ve known for 15 years and his immediate response was ‘my job is to make sure you have as easy a transition at work as possible. If anyone has a problem with you, they’ll have an even bigger problem with me.’

“If anyone has a problem with you, they’ll have an even bigger problem with me.”

He also told me that, over the last couple of months, a few of my colleagues had approached him to say they were worried there was ‘something going on’ with me and were wondering how the department could best support me. I was honestly so bowled over by it all, that I got a bit emotional as I left to go home and had to sit in the car for a bit to calm down before driving!

I came out publicly in October ’23, by making a post on my Facebook account, which seems like a bit of a cop-out, but I knew most of my colleagues would see it, and I trusted that the hospital grapevine would take care of the rest. Literally 5 minutes after making the post, I got a deluge of lovely messages from people with support and congratulations. None of the bad stuff I worried about materialised. More than a few people told me they thought I was going to come out as gay, so I took great pleasure in telling them ‘you’re right, but a different kind of gay!’ (I’m still happily married to my wife).

In December, I went to the work Christmas night out in ‘girl-mode’, and although I was incredibly nervous (managed badly with too many glasses of wine) everyone seemed utterly thrilled at seeing me look so happy. I was adopted by the female scrub nurses for the night and they even chummed me to the loo en-masse when I said I was worried about using the ladies!

How did you decide on timing your official ‘coming out’ at work?

Even though everyone knew I was trans and had met me outside of work while presenting female, I opted not to socially transition at work until after Facial Feminisation Surgery (FFS). I think that was partly as I just didn’t have the confidence to see patients yet, but partly due to all the admin around name change and professional registrations.

So, I did all of that during my medical leave and it’s worked out really well. I think it made for quite a tangible watershed for everyone, in that I left work in late-March, had about 2 months away, then returned as my new happier, true self.

Kezia's recovery from Facial Feminisation Surgery

The only issue with the above was when I was started to male-fail and get quizzical looks from patients. I got blanked in the corridors a few times by staff who I’ve worked with for years but who just didn’t recognise me. That felt good!

My most recent challenges are around just the sheer amount of admin there is to change my details on NHS systems and professional registrations. Not that I’ve had barriers to doing so, it’s just a pain in the arse. On the university side of things, the fact that I’ve been recording online lectures for more than 5 years means there are a LOT of videos of male-presenting me that I now need to re-record to replace.

There’s also the inevitable challenge of changing rooms in the surgical areas. I’m getting changed into scrubs in my office at the moment, but at some point in future I’ll hopefully feel comfortable to use the right changing rooms.

FFS isn’t something a lot of people know about, what was the reaction like at work?

I did quite a lot of prep with colleagues in the lead-up to my FFS, so they’d know what to expect. I’m pretty open about my FFS journey and am always keen to educate people who are interested, but it was particularly fun to discuss it with fellow surgeons. Most of them were fascinated by the techniques used and delighted by the intra-operative photos that give most people the dry boak. [Lucie: boak is a Scots word for being sick]

It also helped to have the virtual FFS pictures that simulated how I might look post-op, as I could show people what facial gender markers actually were, and how subtle changes in a few features can add up to a huge change in gender perception. It helped to make it clear that I would still look like me, just a version of me that might have gone through an oestrogen-driven puberty.

I honestly don’t think I had many worries about the surgery itself, other than uncertainty about whether I’d be perceived as female by the time I returned to work.

I’ve had a few hugs from patients, a few ‘you look so happy!’s and a couple of people who seemed to be in disbelief that I’m the same person they saw 6 months or a year ago.

When I did return to work at 6 weeks post-op, I was met with 2 types of response: Some people just adjusted to calling me ‘Kezia’ and carried on as normal, which was great. Others, which probably made up the majority, were celebratory and filled with joy at seeing me so obviously happy. I think quite a few of them were absolutely mind-blown by how different I looked, particularly as I had very strong masculine features pre-FFS, even though they had softened a bit with HRT.

My main worry was still about how patients would react to me, particularly ones who I’d been seeing for a few years. So far, I’ve only had responses similar to my colleagues: neutral or positive. I’ve had a few hugs from patients, a few ‘you look so happy!’s and a couple of people who seemed to be in disbelief that I’m the same person they saw 6 months or a year ago.

One older lady in particular, to whom I had clearly explained my transition from ‘Mr B’ to ‘Ms B’ at the start of our appointment, ended by telling me ‘Well, it was lovely to meet you, dear. Please pass on my regards to Mr B’.

I’m sure I’ll meet some people who have an issue with seeing a transgender clinician at some point, but it really does seem like the vast majority of people who I see in clinic just want to talk about their own problems. As long as I listen to them and offer treatment in a timely manner, they just don’t seem to care.

The reception in my university role has been quite similar, with the added joy that most of the medical students, particularly the ones I’ve had more contact with, seem genuinely thrilled for me.

Probably my biggest worry from the academic side of things is how I am almost guaranteed to be a target for the anti-trans movement at some point in the near future.

A transgender clinician teaching about trans health in a post-Cass Britain is bound to prompt cries of ‘Gender Ideology!’. I’m really not looking forward to that, but I think trans representation in the medical world is incredibly important, and I’m lucky enough to have a great support network, both in my career and personal life.

What piece of trans joy would you like to share with my readers?

I started my transition relatively late in life (HRT 2 months after I turned 40) but it has been an incredibly journey and I don’t regret it for a moment. The saying is true: ‘The best time to transition was in the past, the second best time is now’.

I’d also like to extend an open invite to any doctors/healthcare practitioners who are struggling with gender incongruence or the thought of coming out at work: Please feel free to get in touch for a chat. We have some unique challenges in the medical world and it’s always lovely to help someone live as their authentic self or increase trans representation.

Is there anyone you want to uplift, celebrate or promote?

There are loads of great charities that are fighting for trans rights and helping those in need. Not-A-Phase (I’ve recently joined their trans-advisory panel), Mermaids, TransActual, The Good Law Project. If you can, get involved with them, vote in elections and join some protests (but protect your own physical and mental health as an absolute priority)!

Thanks also to YOU, Lucie, for sharing your story, your activism and being bloody hilarious.

[Lucie: well that last sentence lovely and unexpected, and I definitely chose to keep it in.]

Where to find Kezia

Go follow Kezia on Instagram to see more of her surgery results, and her incredible work to further trans representation in medicine.