Emily Macdonald
Episode 5

Defined By It's Outliers

Emily Macdonald

This episode includes topics about

In Episode Five of the Plastic Surgeon Podcast, Dr. Sajan sits down with his intersex breast augmentation patient, Emily MacDonald. She tells her captivating story from finding out she is intersex and her journey to seeking plastic surgery with Dr. Sajan.  

Emily discusses finding out she was intersex as a teenager. In college, health problems caused by her anatomy risked her life and forced her to undergo painful and invasive surgery. Enduring countless medical examinations and tests, Emily began to realize she was a woman.

She then sought out Dr. Sajan to perform a breast augmentation. Emily’s journey as an intersex woman is one not often told. Her story is truly amazing and one you will not want to miss.

Subscribe to the Plastic Surgeon Podcast for more plastic surgery stories from real patients and providers. Follow Dr. Sajan and the Plastic Surgeon Podcast on social media @realdrseattle.

To learn more about the Plastic Surgeon Podcast, visit https://www.plasticsurgeonpodcast.com

Learn more about Dr. Sajan’s plastic surgery at https://www.allureesthetic.com

Transcription pending. Check back soon!


Dr. Javad Sajan  00:00

Ever wondered what motivates people to get plastic surgery? Did they regret it? What can we learn from the stories of plastic surgery patients? We're here to explore these questions and get some of the answers today from my amazing guest Emily MacDonald on the Plastic Surgeon Podcast. Hello, my friends. Welcome back. And thanks to all of our listeners for the amazing feedback. We have had so much fun so far and look forward to more of your insights and suggestions. Please rate and review us on Apple Podcasts to help us get you more awesome content. On the Plastic Surgeon Podcast, we listen to the real plastic surgery stories of triumph and pain from real patients and providers to further understand the motivations of why they would risk their life under the knife. I'm Dr. Javad Sajan and my guest today is Emily McDonald. We're here to talk to you about your journey, how we came to know each other, the procedure you underwent, and how it helped or affected you, Emily. How's it going, Emily?

Emily MacDonald  01:12

Going well. Great to be here.

Dr. Javad Sajan  01:14

Thank you, Emily. I appreciate it so much. Emily has been my patient now since January. Emily, you have such an amazing and remarkable story that is going to shed so much insight for so many people and things people really have never thought about. I want to first tell people the surgery you had and then we'll describe your journey of getting there and what led you to come to me. So the surgery you had was a gummy bear breast augmentation. Is that correct, Emily?

Emily MacDonald  01:41

That is correct.

Dr. Javad Sajan  01:42

Emily, tell us why you sought that operation.

Emily MacDonald  01:45

There's many reasons why I sought out that one. Um, I guess, a multiple facets one is that you know, I want to be more like the firls in my family. And my my family has a lot of chestier ladies and that, I mean the body shape works and, and the size works and but you know, there's also the other element which is um. In 2020, right now, and how things go I'd like to be seen as normal woman

Dr. Javad Sajan  02:17

And, your gender identity is intersex, correct?

Emily MacDonald  02:20

No, my generation is female. I'm born intersex.

Dr. Javad Sajan  02:23

So, tell our, tell our listeners. What does intersex mean?

Emily MacDonald  02:27

Okay, so intersex means that you were born with either partially or incomplete dominance of one gender.

Dr. Javad Sajan  02:35

And, the old word for intersex used to be hermaphrodites that correct?

Emily MacDonald  02:40

It, it was known as a hermaphrodite for a while. And we're talking from like the seventh century through like, you know, the 1600s. It pops up again in the 19th century, which is you know, I could talk about that too much as for my degree is. But, yeah, basically what it is, is that they kind of kept on this kind of gross archaic term, which actually references homunculi.

Dr. Javad Sajan  03:10

What is homunculi?

Emily MacDonald  03:12

Homunculi is a non real person. It's a it's a fabricated person created, basically in a lab. Although, they wouldn't have had a lab or called it a lab in rosicrucian days, they would have, they would have called it something else. But it's, you know, the idea of this eldritch horror, which arrives at you know, multiple things, and unfortunately, that that term is actually still used for people.

Dr. Javad Sajan  03:35

It seems like a very derogatory term. Wouldn't you agree? 

Emily MacDonald  03:38

Oh, yeah. Extremely. 

Dr. Javad Sajan  03:39

So, when I was in medical school, when they taught us about people born with ambiguous or both genitalia, that's the word they taught us to use. 

Emily MacDonald  03:48


Dr. Javad Sajan  03:49

But, that's not correct. 

Emily MacDonald  03:50


Dr. Javad Sajan  03:52

I remember when I first met you that was the word I had learned and I used that. And you politely redirected me and shed insight on intersex. 

Emily MacDonald  04:00


Dr. Javad Sajan  04:01

So, how did intersex come about?

Emily MacDonald  04:03

I don't know. It was just that that was something that I had learned in a college course that I actually had the pleasure to be a TA on for three years. And during that time, it was actually just just kind of a thing where they're like, oh, and then they explain that term. And then I had a kind of medical thing happen during my time in college, and a blood test later, I found out what was wrong. And it's because I was intersex.

Dr. Javad Sajan  04:35

So, when people use that other word, it's or they they related to people being born with both sets or ambiguous genitalia. Was that your situation?

Emily MacDonald  04:45

Um, partially, yes.

Dr. Javad Sajan  04:47

And when you when you were born, how did your par--parents handle that from what you know?

Emily MacDonald  04:54

That's actually more of a tricky and interpersonal one. It's one that I'm probably not going to dive into-- 

Dr. Javad Sajan  04:59


Emily MacDonald  05:00

Fully, but I can tell you that I was given a male name initially. And I was raised being told I was male for quite a while.

Dr. Javad Sajan  05:14

And there's been a lot of, especially recently controversy about doctors doing surgeries on newborns, when they're born with different genitalia. You don't have to tell us anything about this if you don't want to, but can you share with us if you did have surgery shortly after birth, or in that newborn stage?

Emily MacDonald  05:31

I won't get the straight answer on that. 

Dr. Javad Sajan  05:33


Emily MacDonald  05:35

Like I've inquired, but the question was dodged by medical practitioners.

Dr. Javad Sajan  05:41

I understand. Then, you your identity was given to you as male was that was assigned to you, and then you were going or about your life. And what led you to feel this wasn't correct?

Emily MacDonald  05:55

Well, puberty has a fun way of letting you know for starters. But, you know, there's also lots of lots of little things that kind of are like out of place. But you know, when you're a child, especially when you're a teenager, I mean, I can't think about a time in life, I knew less than when I was a teenager. But you know how it goes is that you you kind of stumble around, you're trying to figure stuff out, you're like, "Wow, I suck at this." Like, there's, there's lots of your life, or, you know, you're watching boys do things, and I gotta, you know, I'm just not that tough. I can't, I mean, you guys can climb over that, but I don't know, I've just I've worked out just as much as you but I'm not getting a lot. But there's that that's just like, kind of surface level things. There's also lots of interpersonal elements. There's lots of how do you feel? How do you handle yourself? 

Dr. Javad Sajan  06:48

How are you feeling? How are you--how are you feeling that you thought was different than other people?

Emily MacDonald  06:56

Um, you know, that that's kind of an interesting kind of interest ingangle to look at it because if you look at it back from that angle, it's kind of like I always knew. Well, no, I didn't know I didn't always know and that was very I didn't know I actually, you know, a lot of people will read I was thinly read. I understood very little about what was going on in myself how, at the time you know, we're talking about like, I had I lived in like when I was in, you know, early puberty, I lived in Texas. They taught abstinence only. So there's no chance of me actually looking at a diagram of, you know, human anatomy and going "Hold up." You know, like, you know, or something like that. A lot of this was very disguised and hidden. Southlake, Texas is not the most understanding place.

Dr. Javad Sajan  07:51

And was your family more conservative from-- 

Emily MacDonald  07:53


Dr. Javad Sajan  07:54

--from a religious perspective?

Emily MacDonald  07:56

And more than ever, I wouldn't say in a religious--well, there is that element--but I would not say that was the defining element. I'd actually say they were more kind of, you know, conservative more on the lines of how conservatives used to be before it got a little crazy, but like, you know, fiscally, they had lots of like, you know, they would kind of look the other way on certain transgressions, but then they would really be into certain things and very much that financial kind of attitude. Now, I don't want to paint a picture of almost like strawman type of setup of--

Dr. Javad Sajan  08:32


Emily MacDonald  08:33

You know, it's Jesus or the highway you know, what, they were much more understanding and I think that's why ultimately ended up okay. At least I think I'm okay. But, uh, you know, I would like to imagine that I grew up alright, but um, but no, my parents were definitely have a more conservative background and things and as such, they weren't really equipped to handle that.

Dr. Javad Sajan  08:57

I understand. And when you were in puberty, like you said, you noticed that physically you were developing a little bit differently. Did you see differences--in what--in how you looked than other people? 

Emily MacDonald  09:09

Yes.  Well, there's lots of different things. First off, my skin was much more feminine than than boys. Which is funny because it actually got me some good jobs. But you know, believe it or not, I actually performed in a boy band and oh, wow, but I thought I was cute. But, you know, of course, I was. I'm a girl. But you know, that, you know, did all this kind of stuff. But uh, you know, there was things like for instance, when I was thin, which was most of my life. You know, I had to develop breasts. I had all this kind of stuff where I had to like wear baggy shirts. Fortunately, it was the late 90s and early 2000s. And that was very much in vogue the the kind of long shirt shorts look that make it look like you don't have pants. But uh, that was very cool for a very limited time but you know that you know, I had to kind of fly it up and try to play more of an androgynous angle to hide more of my features because as you grew up it got trickier and trickier to hide. And I just didn't want to hide anymore. 

Dr. Javad Sajan  09:10

What was that? Aside from your skin, what else was developing differently? 

Emily MacDonald  10:24

Lots of stuff. Um, I actually I don't think I--again, I feel like gender really gets to be proven to be a spectrum. Especially now that I've my wife who's non binary--has really kind of opened my eyes to how much of a spectrum gender is. So, please forgive me viewers at home for if I use archaic terminology, but I've always had more of a kind of a female way of looking at things.

Dr. Javad Sajan  10:51

Mm hmm.

Emily MacDonald  10:52

Way of processing things.But these these--I wanna say traditionally female just because, you know, again, there's women that don't, you know, that identify with them that have what would be more classically male way of handling things or doing things. So, I don't want to just say only women, you know, experienced something like this. But, um, but quite honestly, it comes down to things like you know, like, like, I kind of I was terrible at being one of the guys like, you know type of things like it was more like you're like, "Oh yeah, check her out." "Yeah, she has great hair.'

Dr. Javad Sajan  11:36

I see. Did you--were you getting feelings for people for women or girls while you were going through puberty like the other boys? It sounds like you said, you're saying you were getting them less?

Emily MacDonald  11:48

Ah, that's not that's not necessarily true. Well, first off, I'm gay. So that doesn't help. But, like, you know, like it you know, I'm into women, but uh, but you know, mostly women. I guess that's not gay that's bisexual. I don't care what the label is today. But you know what I mean? Like, I love my wife who identifies as neither male nor female. So I don't know what the heck I am. But, but, to be honest, it was just kind of all across the board. He was great. She was great. That was great. You know, you know, all over the place. It's just that then sometimes I wasn't really feeling anything at all. Now. Now, I know, in hindsight, but part of what of that was, is that, um, hormones were so everywhere. Cause what was happening is that in my medical case, this is not common in all intersex people, because that's pretty much a die roll with 2 D-100. But, you know, like, whatever you come up with, that's what random assortment you get. And so I had things like for instance, my I had one operable fallopian tube, and one that had partially developed and stuck. And, the fallopian tubes for those at home with your own home gender identification kits. In males, those are the testes. And women they developed to be the whole fallopian tube and things like that they're actually the same kit back and forth. They're just used and expressed differently. It's like nine alleles too. It's crazy. Genetics is absolutely bonkers. We actually share 90%, around there, DNA with a mushroom to give you an idea. But um, but basically just just one little switch, you know, made it kind of half open and not, not working. And so because of that what was happening is that I was getting a normal menstrual cycle, and then it would dump over 1500 mg of testosterone through my blood system twice a month. And now--

Dr. Javad Sajan  13:50


Emily MacDonald  13:50

Yeah, and it would trigger chemical depression. Because you know, it actually, you know, the farm but you probably know a lot more than I'm talking to a doctor.

Dr. Javad Sajan  13:59

No, it's all good.

Emily MacDonald  14:00

But, but, you know, with endocrine cycles and things like that, what that will do is create an artificial to serotonin, and then dopamine response. And a lot of that, a lot of these types of things get assigned to psychological disorders, manic depression, things like that, but they have a hard science mechanical piece to it. Of just "Oh, you're flushing your body with weird hormones."

Dr. Javad Sajan  14:28

So helping people understand your journey through puberty and how are you discovered intersex. You were feeling different. You, you were having different feelings, looking different. What was the next step in your in your journey?

Emily MacDonald  14:42

An accident. Um, in a in a show of you should be stronger than you are now and you should be more physically capable than you are now. I was asked by an individual to lift something very heavy. And I tried to, and it was way more than I was able to do. 

Dr. Javad Sajan  15:05

What was it? 

Emily MacDonald  15:06

A piano. 

Dr. Javad Sajan  15:07


Emily MacDonald  15:08

It was being asked to move it up, uh, it was for a church thing and asked to move up a incline. It wasn't like a hoist over your head, like a crazy person, right? 

Dr. Javad Sajan  15:17


Emily MacDonald  15:18

I don't want to paint the wrong picture. 

Dr. Javad Sajan  15:19

Yeah, of course.

Emily MacDonald  15:20

But it was just like, "A strapping young man come over here" and I'm none of those things. And you know, and I'm like, "Sure, I'll help you. What am I? What am I? That's a lot of piano." And, you know, lift that up and got an umbilical hernia.

Dr. Javad Sajan  15:34


Emily MacDonald  15:35

From the process, and you know, that's all well and good. So you get that taken care of. 

Dr. Javad Sajan  15:40

So, umbilical hernia just for for our listeners, right? It's a defect along the abdominal wall, where the intra abdominal contents herniates through the umbilicus, or around the umbilicus depending on the exact type you had. And that can happen sometimes due to extreme, what's medically called valsalva, or pressure or lifting. It can also happen because of pregnancy. So you lifted the piano then something was hurting in your abdomen and you went to a doctor? 

Emily MacDonald  16:08


Dr. Javad Sajan  16:09

And then what are the what happened then?

Emily MacDonald  16:11

So, the surgery happened. And, I woke up because you know, from a patient's point of view, there's a lot of "Adios!" and then you wake up. 

Dr. Javad Sajan  16:22


Emily MacDonald  16:22

Post up. But it was it was a significant amount of missing time. Very significant. I had apparently been out for almost three times longer than I was supposed to. 

Dr. Javad Sajan  16:33

Uh huh.

Emily MacDonald  16:34

And that was because they had hit a complication. 

Dr. Javad Sajan  16:38


Emily MacDonald  16:39

Well, in doing the surgery, the planned surgery was to put a gortex--

Dr. Javad Sajan  16:43

Yeah, very simple surgery. 

Emily MacDonald  16:44

Yeah, right. 

Dr. Javad Sajan  16:45

What you do is you go in there, you free up the intra abdominal contents, you put a mesh to separate the muscles from those contents and put a few stitches in that's pretty much it.

Emily MacDonald  16:54

Right.  Yeah.  Should be open and shut.

Dr. Javad Sajan  16:56

Yeah. 30 minutes, Max, maybe 20. 

Emily MacDonald  16:58


Dr. Javad Sajan  16:58


Emily MacDonald  16:59

Well, six hours later. 

Dr. Javad Sajan  17:01

Six hours?

Emily MacDonald  17:02

Yeah. I had a visit with with a doctor but it was just me because I was staying alone at the hospital.

Dr. Javad Sajan  17:10


Emily MacDonald  17:11

It wasn't that far from my home. My my dad is corporate higher up that's always away and he was in town when he could.

Dr. Javad Sajan  17:21

Was this in Texas or Seattle? 

Emily MacDonald  17:23

This is Texas. 

Dr. Javad Sajan  17:23


Emily MacDonald  17:26

Texas, and it's quite a while ago too. So this is you know, I don't think they even use the gortex that they used at the time as well. 

Dr. Javad Sajan  17:34


Emily MacDonald  17:35

Because, you know, stuff changes over over years and everything but um, but basically, we had gone through all of the all of that stuff and you get the doctor going like um, so I don't know how to tell you this. But we're going to keep you for several days because you're going to need to be on an IV because your digestive system has shut down. There was an accidental amount of damage, everything's fine and healed, but we accidentally nicked her uterus.

Dr. Javad Sajan  18:04

Through an umbilical hernia the uterus is way below.

Emily MacDonald  18:09

Yeah, like this, but it apparently had a herniated prior.

Dr. Javad Sajan  18:13


Emily MacDonald  18:14

As part of how it was not, not--was not built well. Something had gone wrong. I have had a nominal pain for years. 

Dr. Javad Sajan  18:23

You were presenting as a male. 

Emily MacDonald  18:26


Dr. Javad Sajan  18:26

 And they said they nicked your uterus.

Emily MacDonald  18:29

Yep. Because they had found that during during their because they found that "Oh, it herniated but it wasn't the top layer." The intestine had a herniated below another level below another level below another level and apparently was a nesting series of issues where there was a cyst or something that had to be removed. That had built up. I have no idea what it was. And this was I was 13 years old. 

Dr. Javad Sajan  18:53

You were 13? 

Emily MacDonald  18:53

And, I was being given some of this information very, very quickly and only once. So forgive me if--

Dr. Javad Sajan  18:58


Emily MacDonald  18:58

In the time I I get my--

Dr. Javad Sajan  19:00

So, how did the doctor explain you had a uterus and you're a man, a boy?

Emily MacDonald  19:05

He just went, I don't know, I don't know how to, I don't know, to tell you this. I don't know what you want to do with it. Like, first off, you're giving it to a 13 year old,

Dr. Javad Sajan  19:13

Were your parents--? And your parents weren't in the room at this time?

Emily MacDonald  19:15

No, it was just me and I was scared as hell. And so I said nothing. I did nothing.

Dr. Javad Sajan  19:19

So, did he tell you that you have feminine parts. Did you even know what a uterus is?

Emily MacDonald  19:23

Right. Yeah, I knew what a uterus was. Uh, my mom's a nurse. So I had that working for me.

Dr. Javad Sajan  19:28

So, the doctor said, you have a uterus and we nicked it. But you're going to be fine. 

Emily MacDonald  19:31

Yep, basically. 

Dr. Javad Sajan  19:32

Did you ask why do I have a uterus? You were 13. I don't know if you knew--

Emily MacDonald  19:35

I just went okay. Okay, I was also partially drugged. So, um--

Dr. Javad Sajan  19:40

Yeah, yeah. 

Emily MacDonald  19:41

There was lots of, you know, everything. But, you know, as it was all said and done, I was like, "Huh, that's interesting." And, you know, there's also other stuff like for instance, growing up, most of my friends were female, you know, things like that. I've always had like, especially as it got into like middle school and higher. It was like, there'll be me and a bunch of girls. And it's funny because like, the anticipation was like, like some like, you know, like some player that had all these, you know, women around. But, mm-mm, no. But, but there was all this kind of stuff and as I got older and as you know, everything went through I got up to college and had another--

Dr. Javad Sajan  20:24

So what happened? Just a follow up. So after you found that news you went back to life as normal?

Emily MacDonald  20:28

Yeah, I had pretty much had it. That's it. I kind of kept it to myself like it was some dark secret that  I did something wrong.

Dr. Javad Sajan  20:35

Did your parents find out?

Emily MacDonald  20:36

No, it wasn't until after my surgery.

Dr. Javad Sajan  20:38

They found out after the umbilical hernia?

Emily MacDonald  20:40

Oh, I mean, like, like,

Dr. Javad Sajan  20:42

 Oh, so life went back to normal?

Emily MacDonald  20:43

 There's--there's another I had to do full lower reconstructive surgery. 

Dr. Javad Sajan  20:49


Emily MacDonald  20:50

There was a part where it became life threatening.

Dr. Javad Sajan  20:52

Mm, so falling back up to 13 you went home Everything was normal, quote unquote, right after you were in the hospital for a few days. 

Emily MacDonald  21:00


Dr. Javad Sajan  21:01

And then what happened?

Emily MacDonald  21:04

Life continued on as normal.

Dr. Javad Sajan  21:07

And you were presenting as male at this time.  Yeah. But, you knew inside something was different.

Emily MacDonald  21:12

Only in hindsight.

Dr. Javad Sajan  21:13

Only in hindsight.

Emily MacDonald  21:14

Only in hindsight, like retro actively I could I could easily say, "Oh yeah, no, it's so obvious." To give you an example when when I finally explained this to some friends and you know, barely remembers. The surprise was nonw, like, there is this like, "Oh, okay."

Dr. Javad Sajan  21:34

Did your parents know when you left the hospital that you had a uterus?

Emily MacDonald  21:37


Dr. Javad Sajan  21:38

Only you knew? 

Emily MacDonald  21:38

Only I know. 

Dr. Javad Sajan  21:39

Okay, and then you're a 13 year old child. Life is continuing on. You're feeling different. You have this itch in the back of your mind or this thought. And what was the next aha moment?

Emily MacDonald  21:51

Actually, I wouldn't even say it was more like a like a. I know that sounds really dumb. But but basically I had just gone, "Ignore that" and moved on with my life. Like, just kind of let that move on because it doesn't make, it didn't make sense to me. There was nothing in place. There was nothing that said, "Hey, you know, you might actually be a woman." Or, there was nothing that said, "Hey, you know, there might be something serious that have to do with the fact that you have both sets of partially both sets of genitalia." There's nothing that said, you know, this might be a problem later on. And then become a problem right later on which, you know, I got into college

Dr. Javad Sajan  22:36

So, did there--I'm just curious, was there any CT scan or anything done? Do you know? You remember when you were 13? Or some kind of imaging?  There was some kind of imaging, yes.  That's where they probably saw the uterus and everything.

Emily MacDonald  22:46

Yeah, I wouldn't know. 

Dr. Javad Sajan  22:47

You wouldn't know.

Emily MacDonald  22:48


Dr. Javad Sajan  22:49

Okay. So then life is back to normal. And then what happens after that?

Emily MacDonald  22:54

So, life gets back to normal. But you know, as I grow up, there's a lot more elements--that again, I could only speak to the lens of after after thought that kind of the anti promethian. There's another guy that means afterthought. He's the guy that ruined all the animals. But um, you know, in Greek mythology or. But, um, that kind of, you could only look at it in that lens, but I can just tell you that what had happened was that I was a teenager that didn't fit in anywhere. 

Dr. Javad Sajan  23:29

Mm hmm.

Emily MacDonald  23:30

I mean, I did really well. I was quite popular. I got I got all sorts of, you know, things go on for me and I, you know, did all kinds of stuff. Did voice acting, did all sorts of, you know, fun things. But, you know, as I got into the college era, I was in my second long term unhappy relationship.

Dr. Javad Sajan  23:55

Were all your relationships with the opposite gender at this time?

Emily MacDonald  23:59

No, I tried going all over the place with seeing if I was just gay. No mixing of you know, or all this kind of stuff. It just didn't work, you know. And then we get into to college, which is the only, you know, this is where I actually go, "Oh." Which is you know, I went to college at University of Hawaii, University of Hawaii is--

Dr. Javad Sajan  24:27

What made you want to go to Hawaii from Texas?

Emily MacDonald  24:29

Oh, I actually at that point was living in Oregon. I was living in Portland, Oregon. 

Dr. Javad Sajan  24:34

Mm hmm.

Emily MacDonald  24:35

And, I'd wanted to go to Hawaii because I had aspirations to be an ichthyologist. 

Dr. Javad Sajan  24:41

What's that?

Emily MacDonald  24:41

An ichthyologist studies fish. I really like sharks. And so I wanted to work with sharks and and so I wanted to be a marine biologist and ichthyologist to study them. Much in the same way that I had seen on all the new Jean Jacque Christo and all that kind of stuff.

Dr. Javad Sajan  24:57

Like Shark Week?

Emily MacDonald  24:58

Sort of. Sharksplotation films definitely had their way of, you know, getting in with that. I would not call uh shark week a very good representative of, of anything. But yeah, that's kind of just, you know, kind of a shock jock, you know, deal doesn't represent the animals at all. But, but no like, I actually want to work with real animals and get to get to know them. I have an affinity for them. I still do. I've been diving with them several times. And you know, they're wonderful. But, but yeah, you, I just wanted to kind of be a part of that. And I wanted to study, you know, medical things. There was a myth at the time that sharks don't get cancer. That's not true. They get cancer. But, you know, there's, there's all this kind of stuff and that the, you know, the cure for autism--actually, it's funny that the baloney that was made as the kind of grain of truth of the movie Deep Blue Sea. You know, all of them was based around, you know, like curing mental disease through shark brain. I don't know. But anyway, you know, craziness aside, what it had built up into is that I thought I could help my my autistic cousin, Steven. I wanted to help him and I wanted to try to study sharks to find this cure. But I was reading and medical journals and things like that that was complete baloney made up by one guy that wanted to get his name in the paper so. But you know, but while I was there and doing that kind of stuff, um, I liked doing fun stuff with my friends. And so cliff jumping became a popular thing. And a lot of baby cliffs, if you will. Be that they're only 12 feet up or I think--

Dr. Javad Sajan  26:56

Is this in Hawaii? 

Emily MacDonald  26:56

Yes, Hawaii. 

Dr. Javad Sajan  26:58

Then, you went there for the shark studies?

Emily MacDonald  27:00

Yep, for the sharks. I think that's what you know can't--. You come for the shark studies, you stay for history, science, and technology, and you know all that stuff. But you know you you go there and and you know like I was doing stuff in freshwater and freshwater has all sorts of elements. 

Dr. Javad Sajan  27:18

Mm hmm.

Emily MacDonald  27:19

And I picked up something very bad. And it actually got to the point where I was in serious medical trouble and I don't know what happened but I was able to get through that one. I knew I was in trouble when my mom flew to Hawaii from the west coast to come see me. That normally doesn't, you know, she doesn't normally do it, but she overnighted to Hawaii. But I've gotten better through through that illness. Right after that, I started getting knock on effects knock on--

Dr. Javad Sajan  27:47

You were in the hospital? Getting IV antibiotics? Or, what was?

Emily MacDonald  27:50

No, I wish. Uh, no, I was in I was in my my room at the time. A lot of this was handled very lackadaisically. And it wasn't until I needed serious antibiotics was I checked into a hospital for this. 

Dr. Javad Sajan  28:05

Uh huh.

Emily MacDonald  28:07

But, it was basically, "Oh, you're sick? Well, not really sick." And then I couldn't get up. I couldn't get up, I physically couldn't get up. And that's where and then I started getting sick. And I was in and out of classes. And, you know, I got my professors going, "Where are you?" You know, and all that and trying to figure out where I am. And, you know, and then realizing I'm in trouble. And that's when we got into figuring out what was up is that I was bleeding. Well, I was bleeding because apparently that giant cocktail of whatever that was taken to to cure me of the previous illness had kicked on a menstrual cycle. 

Dr. Javad Sajan  28:49

Oh, I see. 

Emily MacDonald  28:50

So I was bleeding internally from--

Dr. Javad Sajan  28:52

And, where was the blood go going? Because there wasn't, you know, you had male external genetalia at the time.

Emily MacDonald  28:58

Well, now well. Well, I had male mostly male genitalia at the time. But um, but yeah no, I was I was bleeding, bleeding when a urinated, bleeding during defecation, all sorts of stuff, throwing up blood. 

Dr. Javad Sajan  29:15


Emily MacDonald  29:15

It was figuring out a place to go basically. 

Dr. Javad Sajan  29:17


Emily MacDonald  29:18

And there was, there was fear of sepsis and various other types of things going on from you know, like I had like a distended thing. I actually still have stretch marks from that look almost like post pregnancy stretch marks from this period and things like that.

Dr. Javad Sajan  29:35

Were you in the hospital when this was going on? Or were you in and out of the medical facility?

Emily MacDonald  29:39

In and out of the college campus. That was again, ill equipped to handle intersex people. 

Dr. Javad Sajan  29:44

Through a college campus clinic? 

Emily MacDonald  29:46

Yep. Because that's what I could afford. 

Dr. Javad Sajan  29:48


Emily MacDonald  29:48

I was living in Hawaii for 500 bucks a month. 

Dr. Javad Sajan  29:51


Emily MacDonald  29:52

Yeah, um, actually had this peer fish to supplement food because I couldn't afford food. So he's to actually go out and I learned how to do really good sushi. Sashimi, but you know you don't you don't need anything other than a fish and a knife to do sashimi, so. Yeah, I made it work but um, but yeah I had I had whatever medical assistance I could get.

Dr. Javad Sajan  30:16

Mm hmm.

Emily MacDonald  30:16

Got through all of that. And getting into work life, I was done. Well, I had basically we realized, you know more and more that I was a woman and everything had lined up that I was i was a woman, and--

Dr. Javad Sajan  30:34

How did you realize that?

Emily MacDonald  30:37

It's complex, and I've thought about it in preparation for this interview. 

Dr. Javad Sajan  30:42

Mm hmm.

Emily MacDonald  30:43

But, I don't know if I can directly give you a straight answer. And it's an it's probably a myriad of things over a long period of time. And I wouldn't want to guess a curveball that but it was more than just the physical stuff. It was more than just "Well, that makes sense for everything in life." It was just, it felt right. And kind of in a everything clicked kind of away. But at the time, I had fallen in love with my wife who had come out as transgender. And her concerns were ahead of mine. And, we live in a world that doesn't understand any of this and doesn't respect any of this. And so I had to take a gamble and basically play as being male for a couple more years to make the money needed to be able to take care of the young life that you know, I promised I would take care of as she escaped Tennessee to come out there and be with me and I had nothing left. I had spent all my money in previous things coming out of college. I managed to graduate at the worst time. I graduated in 2008. And that was the recession. And so I come out with no job prospects and you know, everything had an honors degree, and nobody wanted to take me.

Dr. Javad Sajan  32:19

So, where in this time period did intersex come up? Or, where did you start? 

Emily MacDonald  32:23

I had already known by that point, I learned about that during college.

Dr. Javad Sajan  32:28

Okay. Was there a test that you got or something that you got?

Emily MacDonald  32:31


Dr. Javad Sajan  32:31

Tell us about that, please, if you can.

Emily MacDonald  32:33

Yeah, no hormone test. A simple hormone test that was actually being done. In an almost experimental capacity as a University of Hawaii had started to care for people that were trans.

Dr. Javad Sajan  32:44

University of Hawaii was testing?

Emily MacDonald  32:46

Yeah, they were they were trying to, like we would have this more commonplace today. A lot changes in 10 years. But lots of campuses do have some sort of support in the Pacific Northwest, especially Washington and Oregon. Both have decent plans for health care that they're working on building. It's not quite as good as an office like social medicine or something like that. But it's, it's a start towards getting some sort of care for people who aren't rich, you know, going where they can kind of get you hormone replacement and things like that. And so they were they were learning more about these sorts of things and doing more blood tests and things as a facet of, "Well, maybe, maybe this is a psychological thing, maybe you're, maybe you're you're, you know." Like they're kind of going at it from a really a kind of an archaic way of approaching transgender type of things like, "Maybe this is it. Maybe this is a psychological issue." And, you know, I didn't think I didn't think a lot of blood was a psychological issue, but, you know, that's just me. But, you know, as we were going through these tests and things are like, "Wow, we almost want to say you're having a menstrual cycle issue just based off of all of these these sort of things now." I'm like, "Yeah, I think it's because you know, I have these things." And they're like, "Well, let's get you doing some more tests. Let's get this set." Like they kind of approached it from like a, the only way I could kind of describe this is almost like an exorcism where the Catholic Church whether they want to they want to be like, "It is anything but this. We do not require an exorcism." 

Dr. Javad Sajan  34:30


Emily MacDonald  34:30

And, they did this, this round of testing of it's like "We are not wrong. You know, we we've read your driver's license, we can read, you know, the letters and numbers and that says, it says, 'M'. And we will test this. And our blood tests say 'F'." And you know, and they go through this, you know, they had gone through all these sorts of things and-- Did they check your chromosomes?  Yeah, they did. 

Dr. Javad Sajan  34:55

What did that? What did that show?

Emily MacDonald  34:56


Dr. Javad Sajan  34:58


Emily MacDonald  34:58

Like blue thing, result inclusive.

Dr. Javad Sajan  35:01

So it was an xy, xx xxy?

Emily MacDonald  35:03

So, they did a test and they're like 'xy'. Did another text, 'xx'. Hold on. Do a test 'xy'. Well, one of the things that probably not visible from this camera, but you might be able to see is that I have two different colored eyes. One blue eye, one green eye, and that is a form of chimerism and incomplete chromosome dominance, known as heterochromia. Yeah, the doctor is nodding. I'm using the right terminology?

Dr. Javad Sajan  35:12


Emily MacDonald  35:14

But yeah, you know, as we're going through this, and and so basically what it is, is that very commonly, there are intersex people like me, and it was way more common than I thought at the time. I thought I was like one in a million. I'm one in seven. But so you know, but basically, it's you could have been fraternal twins. But you weren't. You were one person.

Dr. Javad Sajan  36:00

So, chromosomal testing was inconclusive?

Emily MacDonald  36:02


Dr. Javad Sajan  36:03

You had high levels of estrogen or?

Emily MacDonald  36:05


Dr. Javad Sajan  36:07

All over the place.

Emily MacDonald  36:08

Depends on what time of the month you took the blood test.  Yeah. And so the I wish I could have said that, you know, the American medical system handled this great. They didn't. People got mad at me like I did something wrong.

Dr. Javad Sajan  36:11

Yeah. I've heard that before. I've seen it so many times. Did they do any invasive tests, Emily?

Emily MacDonald  36:29

Oh yeah.

Dr. Javad Sajan  36:30

 What do they do that was invasive? If you can tell us.

Emily MacDonald  36:36

Very low tech tests, lifting up of genitalia, checking for things like honestly it was the only thing I have to describe that's very similar to these types of events are when we had to figure out what gender my pet leopard gecko was. They kind of picked him up and held him up to a light. 

Dr. Javad Sajan  36:58


Emily MacDonald  36:58

And they were like, "Ah, it's a boy gecko."

Dr. Javad Sajan  37:01

Uh huh.

Emily MacDonald  37:01

Well, that's, you know, of the level of technology that we're talking about. Very, it went straight you know caveman like very fogged, checked out person. You know like like type of like oh everything went out common decency went out. And it was just this poking and prodding in a kind of disrespectful kind of a way and going, "I don't know what the hell you are" was basically what it came back as. I'm likes "Thanks." "Well, I just want to say male but everything here looks very female."

Dr. Javad Sajan  37:33


Emily MacDonald  37:34

You're probably eating something wrong.

Dr. Javad Sajan  37:38

That's unbelieveable.

Emily MacDonald  37:39

Like that causes bleeding in the menstrual cycle.

Dr. Javad Sajan  37:41

Now, now, please share with us as much as you're comfortable. 

Emily MacDonald  37:44


Dr. Javad Sajan  37:44

But, during this time were you able to engage in sexual activity? 

Emily MacDonald  37:47


Dr. Javad Sajan  37:48

With the genitalia you had?

Emily MacDonald  37:49

Not well, but sure. 

Dr. Javad Sajan  37:51

Okay. Okay. And the doctors did they make you feel--the doctors or providers who were seeing you--when they did their examination what would they tell you?

Emily MacDonald  38:04

Um, nothing quite so uniform. It was usually somewhere between crass jokes or just general not nice types of things. It was always done in this tongue in cheek like "Oh people's with--." And you know, as we got towards, you know, the kind of the rise of like neoconservatism and things like that it became you know, like you know jokes about "Gender's a spectrum!" You know type of things like "Haha there it is, on the spectrum." Yeah type of things and all that kind of stuff of like, "Oh, isn't that funny?"

Dr. Javad Sajan  38:43

And during all this time now you're comfortable. Your understanding intersects more, it seems, you know, during this time, in your, in your--

Emily MacDonald  38:52


Dr. Javad Sajan  38:52

--in your journey. When did you identify more as a female?

Emily MacDonald  38:57

Well, what it was--

Dr. Javad Sajan  38:59

Or, come out as a female? I should say.

Emily MacDonald  39:00

Yeah, no, no. Yeah, what it came back to, because again, this is, as you can tell, even as we're talking, this is so different from somebody that was transgender, you know, things like that. And, and that's not to belittle anybody that's been through any, any transgender journey.

Dr. Javad Sajan  39:12

It's a different journey. 

Emily MacDonald  39:17

It is but it is so different.

Dr. Javad Sajan  39:19

It is.

Emily MacDonald  39:20

That I like while we while intersex people get lumped in with transgender, which is kind of a double edged sword for me.

Dr. Javad Sajan  39:30

Mm hmm.

Emily MacDonald  39:32

On one hand, I think that transgender people are some of the bravest people I've ever met my entire life. 

Dr. Javad Sajan  39:37

Mm hmm.

Emily MacDonald  39:37

So it's kind of like an honor and a privilege to be lumped in sometimes. And other times, it's things like where you get like legislatures making decisions where they're like, "Ah, we don't need to support this." Well for some people, if you're if your umbrellaing that together, you're also taking to what might be deemed as it's not, but might be deemed as a choice to some person. And you're applying it to a medical necessity to somebody else. So that's pretty dangerous. But basically we were we had a kind of period where I got to work with seeing my my now wife.

Dr. Javad Sajan  40:28

How did you meet her?

Emily MacDonald  40:29

Internet. Long story. That's probably equally as long as everything that we're talking through. But um, but um, getting to meet my wife and see her go through hormone replacement therapy and things like that. Just talking with people and stuff during the time where it built into a let's see where it is, you know, like, let's try let's try female hormone replacement for you and see where it is. 

Dr. Javad Sajan  40:58

Who recommended this?

Emily MacDonald  40:59

This was kind of an ongoing dialogue between several people that I've talked to and, and some medical practitioners. And, a couple people that were like, well, I'd say friends, but they're, they're professionals in their field that understand endocrinology. One of them is a doctor, another one's a surgeon, you know, but they're friends of mine that that understand, you know, their field very well that have more knowledge over these sort of things than me. And then, you know, as we're going through this and talking about things going, "Well, you know, that ultimately genders a choice, but, but, you know, in your case, so much of you is female. So, so I'm, I know you were raised in a certain way, but, but let's, let's see, you know, let's try hormone replacement therapy and see how it works." I really wanted to do that.

Dr. Javad Sajan  42:04

Before this, did you ever try testosterone?

Emily MacDonald  42:08

Yes, we did. We did a little bit of that and that was really bad. It actually it triggered all sorts of additional troubles and, and like serious depression and suicidal thoughts and things like that. Like it was it was very bad, very quickly. And, so it was like this short and "Oh stop."

Dr. Javad Sajan  42:28

Okay, and your primary--you had a primary care doctor who was helping manage all this? Or how were you getting hormones?

Emily MacDonald  42:33

But, by this point, no. Most primary care doctors had come across as so ignorant or so abrasive that I just stopped going. 

Dr. Javad Sajan  42:42

How are you getting your medication? 

Emily MacDonald  42:45

Oh, so for that. I had found Cedar River clinics.

Dr. Javad Sajan  42:51

So you moved to Seattle? Why?

Emily MacDonald  42:53

Yes, sorry. I when I picked up my my um my wife from the airport in things that we had, we basically redirected our whole lives. I had moved back to Portland when the economy collapsed twice. And then, you know, I had I had gotten a job in Tacoma. 

Dr. Javad Sajan  43:14

Mm hmm. 

Emily MacDonald  43:14

And so I had driven up there. She moved in with me. And, you know?

Dr. Javad Sajan  43:19

She was coming from Tennessee, right? 

Emily MacDonald  43:21

Yep. That's right.

Dr. Javad Sajan  43:22

What was your job?

Emily MacDonald  43:24

I was a software developer. I had originally done a six month contract.

Dr. Javad Sajan  43:29

You had no formal training in software, right? Your your, your education was--?

Emily MacDonald  43:33

Oh yeah, I had I had education in several other things. Sure. But I got a job at a software developer because I have also been a writer and developer for games and things. No joke, I've been writing since I was six years old. And I've been contributing and working with with projects and games and stuff like that. For, for--at this point--it'll be over a decade by the time I had gotten this job. And so since I couldn't work with anything with my degree, my fallback was actually to continue working with with software. But, but, longer story than that, I had also started my own company in 2011. But it has taken actually until now to get up to full speed. So that couldn't have been the day job because it had to finish its projects. So we had all been moving to the Pacific Northwest to build our team and development cycle. But I needed a job that made money fast to take care of my--at the time girlfriend--would be wife.

Dr. Javad Sajan  44:46

Yeah, then you all moved to Tacoma.

Emily MacDonald  44:48

We all know the Tacoma. Thank you. 

Dr. Javad Sajan  44:50

How was that job? 

Emily MacDonald  44:52

It paid the bills. 

Dr. Javad Sajan  44:53


Emily MacDonald  44:54


Dr. Javad Sajan  44:55

And then you started your your, your company?

Emily MacDonald  44:57

Yeah. So, we had we had our already started the company, but it was just that when you for that, again, for our viewers at home, when you start a game company and you start working with start building like a full, it's a full science fiction universe with books and things like that. That doesn't get built overnight. 

Dr. Javad Sajan  45:15

Mm hmm.

Emily MacDonald  45:16

Even when I worked with a pre existing universe, even popular ones, like we worked with some of our previous prime some of my previous work was with Star Wars, the Battletech series, and these are established stories. They're, they're great. They're they they have their own stuff, but even then we're talking project times of like, five, six years to get products out. And so we realized that as we were doing this ourselves during a recession it would probably take a little bit longer. So we had to do a day job if you will while doing our other job. And I've only been able to switch to the this being the CEO of Viral Entertainment as as my day job if you will for the last year. 

Dr. Javad Sajan  46:01

Mm hmm. 

Emily MacDonald  46:02

And now it's slow because of Coronavirus. But, you know--

Dr. Javad Sajan  46:04


Emily MacDonald  46:05

Case in point, well we're getting through this, but you know, but we had to do this other job, but I only could do it as long as I could. Because again, it was becoming medically important to kind of switch over the gender.  Mm hmm. As soon as I got to have estrogen. First off, I've been saddled with depression most of my life.

Dr. Javad Sajan  46:24

Mm hmm. You were getting through Cedar River clinics, right?

Emily MacDonald  46:27

Yeah, yeah. So they helped me out. I got I got estrogen for the first time. And it--sorry, it's a corny, corny way to put it--but it was like a cloud had lifted. And everything started being normal. When I got a period, became normal. when everything started going through, all of it started to be normal. 

Dr. Javad Sajan  46:52

How were you getting a period? Where was that because you didn't know you didn't have the form?

Emily MacDonald  46:56

Sorry, I skipped a part. I actually had to do full bottom surgery. Because that's how it resolved the whole bleeding thing. 

Dr. Javad Sajan  47:03

Yeah. So when did that come about? Now, can you tell our listeners what bottom surgery is?

Emily MacDonald  47:10

So, bottom surgery, which I think would be different for, for transgender people. 

Dr. Javad Sajan  47:17

Mm hmm.

Emily MacDonald  47:17

So, I think it's physically a different surgery. But, um, basically I they had to take what was there for, for the vagina for the lower area and make it the whole area rather than it being kind of half and a half or pardon. It was like, you know, like 85 you know, I do myself in the remaining you know, like part of it, you know, like getting it getting through the, you know, the split there.

Dr. Javad Sajan  47:48

Was this in Seattle or was this back in Portland?

Emily MacDonald  47:51

I had the drive down to a rather fly by night facility in Lake Oswego, Oregon to take care of the surgery out of pocket.

Dr. Javad Sajan  48:04


Emily MacDonald  48:05

Yeah. One of the most expensive things I've ever had to pay for but when we got through it. 

Dr. Javad Sajan  48:14

How did that surgery go? 

Emily MacDonald  48:17

Not good. Um, it was a lot of pain probably the worst pain I've experienced in my entire life.

Dr. Javad Sajan  48:23

Mm hmm.

Emily MacDonald  48:24

For about 15 weeks. But, it's done. So that's good.

Dr. Javad Sajan  48:34

You were able to connect to the existing--? 

Emily MacDonald  48:36


Dr. Javad Sajan  48:37

--uterus and-- Yeah. 

Emily MacDonald  48:39

So much of it was there it was able to work out which is from what I have learned since then, is not normal. Normally, it's way more incomplete. 

Dr. Javad Sajan  48:39


Emily MacDonald  48:49

Mm hmm. Yeah. I'm a very extraordinary case. This is apparently a rare one. Again, for our listeners at home, so you listening at home, you may have something similar to me but that doesn't mean that there's like a secret. You're just waiting for you at home. That that could be all sorts of things you don't know.

Dr. Javad Sajan  49:07

Did you try to have insurance cover this? 

Emily MacDonald  49:09


Dr. Javad Sajan  49:10

And they said no?

Emily MacDonald  49:11

So to get insurance to cover this, we had to do a long winded set of psychological evaluation to make sure I wasn't crazy. Which first office insulting beyond measure. It also resulted in very awkward two way conversations with very intelligent people that were, you know, these psychologists and things like that, where they're like, "Well, what tipped you off to you feel like, like you're a woman?" "Well, breasts and a uterus, and menstrual cycles. Definitely tipped me off a little bit." But, um, you know, I also really like my hair, but you know. But yeah, which was sad, because if I made jokes like that, they'd be like, "Let's work with that part. Let's, let's talk about your feelings. And I'm like, "I don't want to talk about my feelings." But yeah, you get you get to that, that that kind of we play that like, you know, "Tell me about your mother." "She's also a woman." But you know.

Dr. Javad Sajan  50:11

So the hormones, were you on them before or after your bottom surgery? If you--

Emily MacDonald  50:15


Dr. Javad Sajan  50:17

And, then what pulled the trigger for you to get bottom surgery?

Emily MacDonald  50:21

Blood. But no, but uh, you know more than that. It was it was more along the lines of that the partially--what I had down there that was that was male genitalia--was still producing testosterone. And so not only did I have to be on testosterone blockers to keep myself regular, but it was doing that thing where every now and then it would just dump testosterone into the bloodstream. 

Dr. Javad Sajan  50:48

Mm hmm.

Emily MacDonald  50:49

Which, you know, it's like, it's like someone flushing a toilet with the plumbing not hooked up. 

Dr. Javad Sajan  50:54

Mm hmm.

Emily MacDonald  50:55

Like if, like, you know, like that's bad. Like it was it was at the point where it was, it could hurt you. Not only like not only do you feel like, like junk because you have the wrong hormones, because when when hormones are in mount that, it's pretty bad. Like, you know, I, the best way I could put it as like, like, you know, at the time, you know, as gentle more exercise and stuff like that. Unfortunately, during that period of long depression while I had the work or the other job, I gained almost 100 pounds. I used to be about 100 you know, somewhere between 130 to 160 pounds at different points and then pain went way high because of the chemical depression does that to you. 

Dr. Javad Sajan  51:34

Mm hmm. 

Emily MacDonald  51:35

Um, but you know, I'm still working that off, obviously. But you know, as you're going through all that kind of stuff, it's like, you you feel like you're you're a triple weight, like you're not you're not getting anywhere. It's very intense. It builds up, and it's a nagging feeling of something being wrong, but you can't really shake. Chemical depression strikes me--I mean, I've been regular depressed before. Heck, regular depressed right now. I actually have a family member, just had our funeral before I came over here, but you know, but but that's a different feeling. That is a rational feeling. You can you can feel that you can work with that you have you can you can go, "What's making me sad?" "This is." "How do I fix it?" You know you can work you work, you work it out. It's a psychological feeling.

Dr. Javad Sajan  52:26

Mm hmm. Mm hmm.

Emily MacDonald  52:28

But um, with chemical depression, it's "Why can't you get out of bed?" I have no idea.

Dr. Javad Sajan  52:35

Its the hormones.

Emily MacDonald  52:36

Yeah, like you're like, I have no idea. It could even be things like, "It's a really good day. I had a great week. Why are you stuck in bed?" I have no idea.

Dr. Javad Sajan  52:46

So getting the male genitalia out was help would help get rid of the chemical cycles you were having? 

Emily MacDonald  52:52

That's correct. 

Dr. Javad Sajan  52:53

And, that was one of the reasons you decided for bottom surgery?

Emily MacDonald  52:56

That is definitely one of the reasons. The other one is that at this point I have been a little bit fed up with playing back and forth with things. I definitely do not identify as non-binary. I just at this point got reached the point where I just want to be a normal flipping woman. I just don't wanted to just, just regular. Like, like just just not having to deal with any of this and let it be normal.

Dr. Javad Sajan  53:25

Mm hmm.

Emily MacDonald  53:26

For at least a portion of my life, that'd be wonderful. And so I had taken care of that surgery. And it was normal.The only problem with that is that, you know, it's, it's 2020 and how are you know, how do we how do we identify if you're a woman? Well, a woman has an hourglass shape, long hair, and she has great skin. I had one of those things, but you know, but uh, you know you. Yep, I had to finish looking the part, if you will.

Dr. Javad Sajan  54:06

Then, you started thinking about breast augmentation, which is where I came into picture, correct? 

Emily MacDonald  54:10

That's correct. 

Dr. Javad Sajan  54:11

How did you hear about me?

Emily MacDonald  54:13

Google search. I want to say it's a it's a much better way. I just went "Breast Augmentation Seattle."

Dr. Javad Sajan  54:22

I know you're a smart person. You're well researched. You're in the techie space, if you will. 

Emily MacDonald  54:27


Dr. Javad Sajan  54:27

What made you want to come to me out of everybody else?

Emily MacDonald  54:30

I have the good answer and the not good answer. The good answer is that because I had seen different types of write ups and things like that from other people from third party sources that talked about how respectful you were as a person and how and how basically decent that the office was and and everything like that. The not good answer is that you look like you know what you're doing.

Dr. Javad Sajan  54:58

Mm hmm. Why is that not good?

Emily MacDonald  55:02

Because it's rather superficial. But, I have found that sometimes you can judge a book by its cover. 

Dr. Javad Sajan  55:10

Mm hmm.

Emily MacDonald  55:10

But you know, like the I've dealt with a lot of doctors and some of them are smart. It is in the minority. But it is, you know, the, you know, something I when I went to high school, if I can give a quick example.

Dr. Javad Sajan  55:28

Oh, please, yeah. 

Emily MacDonald  55:30

We went to a place called the Center for Advanced Learning. And this is a tech school, where you actually you, you don't go to normal classes, you actually run a business. So I was a lead of a web development team. So this is in high school, already as like a student leader of software development. So, but you have three different cohorts, there was the tech side, which is software development, which was deemed as foolish and who would do that? There was engineering and that was considered the really strong way to go, which they did. They did cool stuff. Robots, their senior projects were battlebots. I am jealous. That's really cool. But, and then the medical area we had called The Smurfs. And that's because most of the students were probably the dumbest people I've ever met. And they often had one trait. And that was that we were all joined for the sciences. So when we did chemistry and biology, everybody was there. And you would have people talking about things like for instance, a breakdown of, you know, mitochondria, there's the Golgi bodies, and so if we're doing that cross section everybody has to do in high school. You know?

Dr. Javad Sajan  56:47

I haven't had I haven't heard Golgi bodies since medical school. 

Emily MacDonald  56:51

Yeah, well hold on to your ribosomes. We got an hour. We're doing this. All the way down the endoplasmic reticulum. 

Dr. Javad Sajan  56:59

Oh, yeah.

Emily MacDonald  57:00

Yeah, but, uh, you know, as you're going through all this kind of stuff, which of course you know, me as a software developer are definitely would be out of my knowledge. Yeah. But um, you know, we'd have halfway through a lecture have one of the medical people raise their hand and call on them. They're like, "Is this for a plant?" There'd be like strange silence, you know, in the room that teacher just "No, this is an animal cell. Is that what you're asking?" "Oh, it kind of look like a plant in my room. Oh." Well, that guy's a doctor. He's still on my Facebook friends. So I know he's a doctor. But you know. But anyway, so yeah, being able to tell that you look like actually, a real doctor, if you will? 

Dr. Javad Sajan  57:57

Sure. I can understand that. 

Emily MacDonald  57:59


Dr. Javad Sajan  58:00

You wanted a more feminine physique, that's why you seek breast augmentation. 

Emily MacDonald  58:04

Right. Correct. 

Dr. Javad Sajan  58:04

Was that the primary reason?

Emily MacDonald  58:06

Mm, kinda. But, but, only because, you know, I'd actually also it's really a big one. It's like now now like looking at myself and things like that, especially when I'm with my like, like if I get to see my extended family like my I look like my Aunt Bet. I look like my Aunt Dot, and, and so now I look like I actually match with the rest of my family.

Dr. Javad Sajan  58:30

We hear that from so many women. And they often say that "I seek this operation because I didn't feel like who I was. And what I identify with. I had it and now I look more like XYZ person in my family."

Emily MacDonald  58:45

Right. I look like one of the McDonald girls. And that's, that's great. Because you know, I am! So you know, like it makes a big difference. 

Dr. Javad Sajan  58:54

How was your family responding to these changes?

Emily MacDonald  59:00

Um, mild neglect. Kind of like a, like a dog you wish you would leave. But, you know, like, but it's basically a kind of like, "We love you." And you know, people showed up for my wedding, for instance, which was good. But there's just this kind of like a distancing thing. My mom actually drove up for three hours from Portland to come to try to talk me out of doing my bottom surgery. Not understanding any part of the situation or things like that. And we ended up having a polite conversation and I bought her lunch and then at the end of that, she was just like, "Okay, you'd really think this out, you know? You know what you're doing?" Like, "Yeah, I know what I'm doing mom."

Dr. Javad Sajan  59:50

How was your dad?

Emily MacDonald  59:53

My dad's still weird about it.

Dr. Javad Sajan  59:55

But, how is he weird? What do you mean by that?

Emily MacDonald  59:57

Um, just distant. Like, it's been a lot better in the last couple years, like, especially as he's seen, for instance, that I look a lot better now. Actually, I look like a woman now rather than, you know, kind of a halfsie type of thing. 

Dr. Javad Sajan  1:00:13


Emily MacDonald  1:00:14

Um, you know, a lot of that kind of stuff. He's kind of just having to get used to it. But my, my dad takes a while to get used to anything. So this is not surprising for me. So, you know, I'm working with it where I can. I love my family very much and there's no there's no like, you know, I'm not mad at anyone or anything like that. And I don't think they're mad at me. But uh, you know, you might be forgiven if you think otherwise, you know, every now and then. But, um, and then I've got, you know, family members back East that I'll probably never get to see again. That are just very conservative and they think that you know genders an on and off switch, you know or something like that. And they don't understand and they don't they don't get it. I think I'm doing something weird or in some weird phase like, like a teen goth or something like that.

Dr. Javad Sajan  1:01:14

We then met for our consultation. 

Emily MacDonald  1:01:16


Dr. Javad Sajan  1:01:17

Was that the only consult that you had?

Emily MacDonald  1:01:19

For that one? Yeah.

Dr. Javad Sajan  1:01:20

We did measurements. We looked at different implants. How was that process?

Emily MacDonald  1:01:25

I suppose well enough to be expected.

Dr. Javad Sajan  1:01:29

We decided to go with gummy bear implants to give you the most feminine physique. There's three kinds of implants, as you know: saline, traditional silicone, and gummy bear. The reason I opted for gummy bear for your surgery is because you had breast tissue development if you don't mind me saying that had developed. However, it was a little bit incomplete in that you had tissue around the nipple, and above more what's called a tubular breast. A tubular breast can develop because, while oftentimes, in utero, the fold of the breast gets stuck a little bit high and the tissue prolapses above the inframammary fold or the fold of the breast and you get a puffy areola and tissue above. And, because of that, you didn't have tissue on the lower half. So, the gummy bear would help us even out that proportion. It would give you more shape and in your situation, I felt it was the lowest risk option to give us a more curvy aesthetic. We went through the fold under the muscle. How was the pain after that surgery?

Emily MacDonald  1:02:38

Um, the pain after that was rather mild. Um, I feel like I'm a bit of a skewing that to the mild side though just because of how intense the previous surgery was.

Dr. Javad Sajan  1:02:53

How was it? How did you feel after surgery?

Emily MacDonald  1:02:57


Dr. Javad Sajan  1:02:58

Did you feel any more womanly or more with your identity or not? Or was that the same?

Emily MacDonald  1:03:07

That was about the same.

Dr. Javad Sajan  1:03:09

Do people know? Have people since then noticed a difference in you and how you act?

Emily MacDonald  1:03:16

Oh, no, not really. 

Dr. Javad Sajan  1:03:17

How have you felt since having the implants placed? 

Emily MacDonald  1:03:20

Oh, I love them. I think that's great, but it just feels right. Like to have the fact that they they are not a big deal is more of a big deal to me if that makes sense to you.

Dr. Javad Sajan  1:03:32

Tell me more about that.

Emily MacDonald  1:03:34

Well, it's just just being able to look at myself and going "Yeah, okay." "Well, now you just need to lose weight." But you know, like, that's, you know, just that, that we all have that, you know, right? But that that's what I'm kind of that was the goal. The goal was to get to the point where I just, now, I'm just a fat girl. So you know, like, look it up. Hey! You know, you know, but that would mean that that's the whole deal because, for my case, I'm not going to speak on behalf of all intersex people. Oh gosh, I can't handle that responsibility. But you know, on behalf of Emily McDonald, the goal is to just be a normal frickin woman. So you can, you know, get on with your life. And now I can do you know, you know, now I just now I get to be, you know, a female business owner that gets marginalized for that instead of, you know, other things. And that's refreshing. But um, you know, I'm ready for the next chapter. And I am you know, breast augmentation helped me get there.

Dr. Javad Sajan  1:04:44

Are there any other surgeries you're considering?

Emily MacDonald  1:04:46

Oh, a whole lot, yeah.

Dr. Javad Sajan  1:04:48

Could you give us a little preview?

Emily MacDonald  1:04:51

Well, the one, the one stubborn thing that is still there. The one male thing that is still really holding on is the chin area. And so that area by whatever dice roll I got when I was born, that that decided that I'm going to have a little, you know, hanging out there. It's barely visible but it I know it every day and it bothers me.

Dr. Javad Sajan  1:05:20

Mm hmm.

Emily MacDonald  1:05:20

So, I would really like to be able to do that but you know 2020 has been a rough year for money. So--

Dr. Javad Sajan  1:05:28

For many of us. 

Emily MacDonald  1:05:30

Oh yeah, I everybody across the board. And, starting you know, getting into a production cycle for your business so you're producing goods and doing things like that. That is the--for those that do not have their own business--that is the biggest downturn of any part of this process because now you're spending money while you haven't been making money. And that is how that goes. So I'm gonna have to wait. But you know, as I get through that, awesome.

Dr. Javad Sajan  1:06:00

If you could share one thing with somebody else who is having a similar journey, certainly not exact, but someone who's young or not young, but has just learned about intersex. What would be one thing you would tell them that in hindsight you feel would have made your journey more comfortable?

Emily MacDonald  1:06:21

Sure, that's a great question. I guess what I would have to say to you, this hypothetical person who lives on the other side of this camera is that there is no normal. That whatever you're looking through, and whatever you're going through, understand that normal is only defined by its outliers. And, as such as a silly concept, you will not find a frequently asked questions you will not find a guide to help you through whatever it is that you are going through whatever it is that you're discovering. And as such, what you should do is do what works for you. Do what's best for you. Do what what is something that you can do? That will figure you out? Because there is no one else that's you.

Dr. Javad Sajan  1:07:10

That's so insightful. Very deep, very thoughtful. Thank you, Emily. Thank you so much for being our guest today, Emily. Your story shed so much thought, insight, and is gonna help so many people understand more how gender isn't a light switch like you described. Now, I believe this that gender is fluid. It's a continuum. It's a spectrum. For many people, it's a journey, and that's okay. You really shared with us how trying to put people in a box isn't the right thing to do. People have to find their own way and they're in their own path.

Emily MacDonald  1:07:49

That's right. Thank you for having me.

Dr. Javad Sajan  1:07:51

Our pleasure. I have learned a lot. I know your ordeal will teach our listeners how and what to expect as they start their own plastic surgery journey. I appreciate your time and I am honored to have you as my good patient, and more and more of a friend. Thanks for listening to the Plastic Surgeon Podcast and please rate and review us on Apple Podcasts to hear more great content. For all my weekly surgeries and adventures throughout the week, catch us on social media @realdrseattle. You can watch me do live surgeries on Snapchat @realdrseattle. See you next time. Bam what!

Episode 4

Episode 6