Zack Hogle woke up feeling groggy, sore and — at last — whole. He had just undergone more than 14 hours of surgery, but he was elated. “When I looked down at my body, I couldn’t stop crying,” he says. “I finally felt like myself.”
The surgery was the last step in what had been a lifelong journey. Growing up in a small town in Western Massachusetts, Zack, now 24, says he always knew he felt different. “I hated my body,” he remembers. “I thought, ‘I’m not the same as other kids and this isn’t okay.’” It wasn’t until he was in high school that he learned the word transgender and what that meant. The realization was a turning point.
The next several years held a series of milestones as he began his gender transition. A lengthy and extensive process, it included everything from online research to coming out as trans to his family and friends, most of whom have been overwhelmingly supportive. Through meetings with clinicians, Zack now knows that the extreme discomfort he experienced was a symptom of gender dysphoria, the distress that results from a conflict between the sex a person was assigned at birth and the gender with which they identify.
Transitioning can mean different things to different people: Some may choose to change no more than their name, clothing or preferred pronouns, while others opt for hormones, surgery or both. Zack chose to pursue the latter. After taking supplemental testosterone for a year, he underwent chest reconstruction surgery, as well as a hysterectomy, at a local hospital.
When it came time for “bottom surgery” — surgery on the genitals — Zack decided to travel to Boston Children’s Hospital, which had just launched its new Center for Gender Surgery. He knew that he wanted to undergo phalloplasty, or the surgical creation of penis, to feel complete in his transition. In this intricate procedure, surgeons harvest one or more “flaps” of skin and other tissues from a donor site on the body (commonly the forearm or thigh) and use it to form a penis and urethra. It’s typically the last major step in surgical transition and is only performed after the patient has undergone months of electrolysis to remove hair from the donor site.
After meeting with social worker Elizabeth Boskey and the Center’s three co-directors, Dr. David Diamond, Dr. Oren Ganor and Dr. Amir Taghinia, Zack felt comfortable with his choice — even after realizing that his was the first ever phalloplasty that the surgical team would perform. “These three men did something amazing,” he says. “And they trusted me as their first patient.” On January 29, 2018, he underwent the procedure.
‘This too shall pass’
The recovery from phalloplasty has been intense, he admits. He experienced a fistula, a relatively common complication of the procedure that can cause urine leakage and required a return to Boston Children’s and extended use of a catheter. The obstacle was mentally draining, says Zack. “I was so close to being where I wanted, and this delayed things,” he explains. “But my girlfriend, Brittany, would talk to me and help me relax. She kept reminding me that this too would pass and that it would be worth it in the end.”
He also found support in his care team, from his surgeons to administrative staff. “My doctors never acted scared or worried — whatever happened, they tried to figure it out and keep me calm in the process,” he says. “Some of the staff had never treated a trans person before, but they were so respectful and wanted to learn as much as they could. Everyone was so supportive, and that really helped my recovery.”
Always a good morning
One month after his catheter was removed for good, Zack stood in the bathroom, phone in hand. “I called Brittany and we both started bawling,” he remembers. For the first time ever, he was able to urinate standing up — one of his biggest goals after surgery. “I felt like a little kid on Christmas morning who had waited all year just for this one gift. Of course, now she’s like, ‘Please stop FaceTiming me every time you go to the bathroom,’” he laughs.
It’s a simple act, and yet a joyful testament to Zack’s new normal. He’s back at work, enjoying life and connecting with other guys who are considering undergoing phalloplasty. “I want to be there for them and show them what’s possible,” he explains. And even on mornings when he’s still a little sleepy, it isn’t hard to get out of bed. “Every morning, it’s like January 29 all over again,” he says. “I never get tired of waking up now because my body is aligned with my gender. I’m finally who I should be.”