Josie Noel
Episode 9

Transgender Marine

Josie Noel

This episode includes topics about

Episode Nine of the Plastic Surgeon Podcast tells the captivating story of a transgender marine, Josie Noel. Josie was assigned male at birth, but now identifies as a transgender woman. Having grown up in a religious and conservative family, Josie was unable to come out or come to terms with her identity until much later in life.

At 26, after moving to Seattle from Yakima, Josie decided to join the Marine Corps. Looking back, Josie refers to this time in her life as “passive suicide”. Feeling shame due to questions about gender, Josie felt the most shame about her body during her time in the Marines.

Josie served in Iraq. Once she returned to the States and after so many near death experiences, she started to come to terms with her body and transgender identity. Josie’s story is truly amazing and shows that transgender transitions are not linear. Eventually, Josie underwent male-to-female breast augmentation with Dr. Sajan. Tune in to hear Josie’s full story on the Plastic Surgeon Podcast.

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.

Learn more about Dr. Sajan’s plastic surgery at

Transcription pending. Check back soon!


Dr. Javad Sajan 00:00

Ever wonder 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 those questions and get some answers today with my guest Josie on the plastic surgeon podcast.

Dr. Javad Sajan 00:33

Hi, friends. Welcome back, and thanks to 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 podcast to help us get you more awesome content. On the plastic surgeon podcast, we will listen to real plastic surgery, stories of triumph and pain from real patients and providers before they're understand the motivations or why they would risk their life under the knife. I'm Dr. Javad Sajan and today my guest is the wonderful, amazing and fantastic Josie, Josie. How's it going?

Josie Noel 01:05

I'm doing great today. How are you?

Dr. Javad Sajan 01:06

Good. We're here to talk to you about your journey, how we came to know each other, the procedure you underwent and how it affected you.

Josie Noel 01:13

It sounds fantastic.

Dr. Javad Sajan 01:15

So, Josie, I know your gender identity is female, is that correct?

Josie Noel 01:18


Dr. Javad Sajan 01:19

And you were assigned male at birth?

Josie Noel 01:20

That's right. So tell us about your story. Where were you born?

Josie Noel 01:24

I was actually born in Corleen Idaho. That's the panhandle just next to Spokane, Washington, just right across the border. So like super North Idaho, really conservative family upbringing to a working class family.

Dr. Javad Sajan 01:40

When you say conservative, do you mean like religion or what do you mean by that?

Josie Noel 01:43

Religion? Like very traditional type family views and stuff. Like-

Dr. Javad Sajan 01:49

What religion was your family?

Josie Noel 01:53

Non-Practicing Christians and Catholics, right? Like God was this idea, right? Don't blast beam. We don't go to church, but we're going to say prayers before meals, but you know, there might not be a Bible in the house, but you still better believe in Jesus because that's what we do, you know, kind of like that.

Dr. Javad Sajan 02:11

And what kind of work did your parents do?

Josie Noel 02:13

Mom for the most part stayed at home. And she did some odd jobs through my childhood if I remember like hotel, maid and house cleaning. And I remember for a while she owned a business where she did cleaning for a realtor friend of hers and she'd go and clean houses that she was about to sell and dad worked blue collar jobs. He was a carpenter, he was a truck driver all sorts of different stuff like that.

Dr. Javad Sajan 02:50

And when did you start questioning your gender assigned at birth? And what do you mind telling us? How was gender assigned at birth different than gender identity for our listeners?

Josie Noel 02:59

So your gender assigned at birth, just a doctor is going to look at your genitalia and go, that's a boy or that's a girl and I think we're all starting to figure out in 2020, it gets a lot deeper than parts make the person.

Dr. Javad Sajan 03:15

Would you say the person makes the parts.

Josie Noel 03:18

The person can make the parts, right? Like if you're so unhappy with your body, I mean, that's why I'm here, right? Like I had some changes done to my body cause I wasn't happy with the parts and now I feel fantastic with my body.

Dr. Javad Sajan 03:31

And so gender assigned at birth is what someone assigned based purely on external anatomy and what's gender identity?

Josie Noel 03:38

Gender identity. That's like, that's who you are. That's and there's an argument about how people get socialized growing up as a boy or a girl or neither but things in your head just don't click when you're a kid, like, why do I have to do this? Just because I'm a boy, why can't I like these things? Why can't I do this? Why do I get picked on for liking that? Why does dad get mad when I do this?

Dr. Javad Sajan 04:11

Do you think we should socialize children?

Josie Noel 04:14

I think we should let kids be kids as a parent. I have a four year old right now. That's just starting to identify as both a boy and a girl. And that's when I started realizing as a kid that I started, I was questioning my gender was about four. I think that's when we all start coming into like who we are as people and start having like more complicated thoughts and-

Dr. Javad Sajan 04:39

How do you start questioning it?

Josie Noel 04:42

I didn't like the stuff that I was, I had to be forced to be a boy, my parents right? Like I didn't like the normal boy stuff.

Dr. Javad Sajan 04:55

Give me an example.

Josie Noel 04:57

I didn't like playing with trucks and cars and I didn't like really playing in the dirt unless I was like pushed to go do it. Right. I wanted to play with the dolls that were in the basement and I wanted to dress up.

Dr. Javad Sajan 05:08

Did you have sisters?

Josie Noel 05:09

I did.

Dr. Javad Sajan 05:10

Yeah, I knew about that. Were they older or younger?

Josie Noel 05:13

They are much older rather not get into the whole family story because it's really complicated.

Dr. Javad Sajan 05:20

No problem.

Josie Noel 05:21

I need to draw diagrams and stuff and it gets there. So but yeah, they were teenagers when I was a toddler and so there was stuff from when they were, you know, adolescents still floating around the house and I always like gravitated towards the Barbie's. Okay. Well, boys can't play with Barbies. So we're going to get you some He-Man toys

Dr. Javad Sajan 05:45

Who said that first year, do you remember?

Josie Noel 05:48

Had to have been, my mom, had to have been cause like dad didn't take like when I say traditional household, I mean like very like 1950 style, right? Like dad didn't have a very active role in parenting unless there was trouble. Right? So I'm sure it had to have been mom that was like, no boys don't play with that. And here's some He-Man toys.

Dr. Javad Sajan 06:08

Did your mom react a lot to you playing with the Barbies? Do you remember?

Josie Noel 06:13

I don't really remember like a big reaction. Just, "No, you don't do that". And anytime I'd want to wear like something that would even be like kind of more feminine, right? Like a shirt with kittens on it or something. No, no, no boys don't do that.

Dr. Javad Sajan 06:33

So you would go and find these from your other family members closets.

Josie Noel 06:36

Oh, just stuff that was like laying around in the basement or whatever. Right? Like the, my sisters were much too older to have clothes that would fit me. Right? But my mom did daycare too for a while. I remember when I was younger. So there was just like kid stuff floating around. Right? Be damned if I touched something that belonged to a girl and wanted to wear it and to the world and she wouldn't get, like, she wouldn't start screaming about it. She wouldn't raise her voice. Like just the, you know, that mom look up patchy, mom looks, what are you doing? What is wrong with you? Like, there had to be something just crazy wrong with me that I put on a pink shirt. Right?

Dr. Javad Sajan 07:17

How did that make you feel when that happened?

Josie Noel 07:20

I started figuring out real quick. The people that were different, got treated really badly and started trying to do the stuff that boys like to do. And I think-

Dr. Javad Sajan 07:30

Were you treated badly, aside from your mom pushing you away from the quote unquote girl activities?

Josie Noel 07:37

No, not really. I mean, it was just anything I would, anytime I'd express interest in anything that was even slightly feminine. Like if it wasn't just like blue collar, hardworking stereotype, masculine man, you can't like it and I mean, that was always the family, right. That was like everyone in the family, it was like that. Right? Like we were just a solid blue collar family that came from, what did great, great grandpa do for traders from Canada or something, you know? Like it was, it's always been like that.

Dr. Javad Sajan 08:14

So you had these thoughts when you were four and then how did you push it away or for a few years or what happened?

Josie Noel 08:20

And I kind of like, I mean, just out of a sense, so safety, I kind of like, okay, I better start doing a little more what's expected of me because like, this is not going to keep being comfortable. Cause I see how people, you know, it was North Idaho in the eighties. Right. So this would have been 84 and like there were still like clan rallies on the regular, right?

Dr. Javad Sajan 08:45

In the 80's?

Josie Noel 08:45

Yeah. Oh yeah. Like there was a big Neo Nazi presence up until the nineties in North Idaho. Like they had a compound, they ran training exercises. Like it was scary there.

Dr. Javad Sajan 08:56

And you saw that as a kid.

Josie Noel 08:57

Oh yeah.

Dr. Javad Sajan 08:58

In the streets or how would you see these people?

Josie Noel 09:00

Yeah, I mean, it was super common to see Nazi flags flying on trucks and like next to houses with Confederate flags. And like, there was not people of color in North Idaho in the eighties. Like it was very uncommon.

Dr. Javad Sajan 09:18

Wow. But you put those feelings aside for how many years?

Josie Noel 09:22

I mean, I started like, you can have a really put them aside, right? Like it's always in the back of your head and it's always beating you up and stuff.

Dr. Javad Sajan 09:31

Of course.

Josie Noel 09:31

Right? well when you're a kid, you just kind of go along with what you're being told. Right? And okay. This is how I have to be cool. And it's not until the hormones hit in puberty that you're like, what is wrong with my body? This is no, this what's happening. This is, I knew this was supposed to happen, but I didn't know. I was supposed to feel like I need to kill myself because my body is wrong. No one mentioned that part ever.

Dr. Javad Sajan 09:59

This was in your teens now.

Josie Noel 10:00

Yeah probably like, you know, 13, 14, like when puberty really kicks.

Dr. Javad Sajan 10:05

Sure. Now, you know, last week I had somebody who was under 17, you started a minor and that person where they started having this feelings and started doing research on the internet, but at your childhood, that, that wasn't possible.

Josie Noel 10:18

Oh, there was no such thing as the internet.

Dr. Javad Sajan 10:21

How did you start learning about it or what did you do?

Josie Noel 10:23

Oh God, I'm kind of a strain, but as a child of the eighties. And I think a lot of people that grew up then like as latchkey kids will remember Horaldo.

Dr. Javad Sajan 10:34

Yes. I remember that.

Josie Noel 10:35

It was like spot the trans woman episodes. And I'm like, what do you mean there's women? That were born as met, what? I can do this. And then like, I don't remember who it was, but he had like an honest to God, like heartfelt interview with a trans woman from Brazil that was non-op and very open about it. And I was like, Oh my God, I could do that.

Dr. Javad Sajan 11:00

So TV's where you learn?

Josie Noel 11:01

Yeah, yeah. TV at first. And then when did I get AOL? Like 93,

Dr. Javad Sajan 11:09

I own the nineties too.

Josie Noel 11:10

Right? Like, so like early nineties, the internet starts becoming a thing. Okay. Right. So more people. Okay. I'm not necessarily by myself, but by that time there was like so much feeling of guilt and shame built up around it.

Dr. Javad Sajan 11:25

So how old were you in the 90?

Josie Noel 11:28

19. Yeah, late teens early twenties

Dr. Javad Sajan 11:35

Until then had you come out or said that you were not-

Josie Noel 11:39

No. In high school? I came out as BI and I identified as BI and that got a lot of static.

Dr. Javad Sajan 11:47

Who did you tell that first?

Josie Noel 11:49

Just like my close friends group that I didn't think would be. Cause I hung out the weirdos. I was like a goth kid. Cause that was like my excuse to wear makeup.

Dr. Javad Sajan 11:58

How did your parents respond to that?

Josie Noel 12:00

Oh, They hated it. They hated it. I remember coming home one day and like, my closet was empty. Like all my black shirts were gone and stuff and like all my like satanic band shirts were gone and I was like, what happened? "I Didn't like all those devils symbols in my house. So I threw them out". Cool. Mom, that was your money. You gave me that money to buy clothes. You just threw out your money. Okay. Cool.

Dr. Javad Sajan 12:27

Were you ever hit or anything?

Josie Noel 12:30

I mean, when I was little, right. Not as I got older, I mean, I got in fights in school and stuff but not for like how I dressed.

Dr. Javad Sajan 12:40

You were a Gothic. So you could identify more with what you were feeling.

Josie Noel 12:44

Yeah. I mean, I could wear makeup. I could like people didn't really like, Oh, they're wearing a skirt today. That's okay. Right? Shock rock was a thing. And Manson and Rob zombie, were like, everyone were like, Oh my God, what are these people doing? Like as long as that was in the forefront of the media, I felt like it was kind of safe to be on that edge.

Dr. Javad Sajan 13:07

How many people were in your friends group?

Josie Noel 13:10

I mean, we were pretty small. We're just probably like seven or eight of us.

Dr. Javad Sajan 13:13

You all get picked on.

Josie Noel 13:17

Yeah, but like also, like, it was such a small school that like, we'd all known each other for a really long. Everyone had known each other for a long time. So there was a lot of like, if you just leave me be, I'm going to leave you be. Cause yeah. Tiny school outside of a tiny town. I had a graduating class of like less than 250.

Dr. Javad Sajan 13:42


Josie Noel 13:42

Right? Like tiny. So like most I got there in the sixth grade. Most of the kids have been together since kindergarten. So like by the time we got to high school, there was definitely a, okay, you guys do that and we leave you alone, you go over there and do your thing and don't bother us. And like, but if you come bother us, Oh, it's going to be a fight, kind of a thing. It was weird.

Dr. Javad Sajan 14:09

Yes. I can understand.

Josie Noel 14:11

Fun towns are weird.

Dr. Javad Sajan 14:13

When you say you identified as BI, you mean bisexual, is that correct?

Josie Noel 14:17

Yes. Yes.

Dr. Javad Sajan 14:18

Would you mind sharing with us how that first happened?

Josie Noel 14:21

Even at that point, like I'd never, I hadn't experimented with anyone sexually at that point, I was just realizing that I had not the standard attractions to just women and I didn't know if I was necessarily attracted to men, but I knew I wasn't only attracted to women.

Dr. Javad Sajan 14:41

Did you have any female relationships up to that point?

Josie Noel 14:44

I mean I had some like kissy face hold hand middle-school girlfriends, right. But like, no, I didn't really date all up until after high school.

Dr. Javad Sajan 14:55

Got it. But you identified as BI through high school.

Josie Noel 14:58


Dr. Javad Sajan 14:58

And what was the next phase in your, and your parents were unhappy? They weren't with the whole goth look. And were you sort of pulling away from them or what was happening?

Josie Noel 15:08

Well, I've never been really close with them ever there when I refer to my parents, they're actually my adoptive parents and I've just never been super close with them for whatever reason we still don't really talk very much. That's somewhere, I don't, I think it was junior or senior year. Someone took me to like one of those really culty churches. And I like when you're a teenager, it is so easy to start drinking someone else's Kool-Aid and I just kind of fell into that. And then there was definitely a lot of shame because it was like an evangelical, like creationist type church, you know? So like you're a made in God's image. This is what the Bible says, men do. You're in. That is, I think that's where I really got messed up. Like really started feeling like serious sense of shame.

Dr. Javad Sajan 16:05

Where you and your goth phase during this?

Josie Noel 16:07

Yeah, but it, like sloughed off. It was definitely just a phase for me. I know I've got a lot of goth friends now that still do that and I'm happy for them. And I love that they have their fashion, that it was really just a phase for me yeah, that kind of sloughed off after awhile and yeah.

Dr. Javad Sajan 16:28

Then you were back to normal binary, male?

Josie Noel 16:32

Normal binary, male. And I still the internet, right. The internet was still there. So I knew, I still knew that there was trans women and that like-

Dr. Javad Sajan 16:44

Were you chatting with any of them?

Josie Noel 16:46

I wasn't because at the time, like I didn't, I was just the stupid boy. I didn't know how to start talking to a trans woman. Right? Like, and so I feel for these guys to try to talk to me now, right? Cause I'm like, Oh, you don't even know how to approach me. You're just talking to me like, I'm another dude, this is okay. You got to stop. That's not, you not walk up to someone and ask them that question. I don't care how thirsty you are at the bar. You would not have said that. Come on.

Josie Noel 17:17

But right? The Internet's out there and I'm seeing events that are happening and I'm seeing more and more people and I'm like, okay, this is people do this. And I'm like, how can I start dabbling foot? Right. So like I started wearing women's clothes around the house and I started-

Dr. Javad Sajan 17:36

Were you in high school at this point?

Josie Noel 17:37

No, I was, this was after high school. I'd actually got married almost out of high school and then divorced really quick after.

Dr. Javad Sajan 17:44


Josie Noel 17:44

So there's like a flash in the pan marriage right there. And then after that I was like-

Dr. Javad Sajan 17:50

And were you married to someone who was SIS?

Josie Noel 17:52


Dr. Javad Sajan 17:53

Okay. Female person.

Josie Noel 17:55

Yes. SIS woman we knew each other from church that did not go well, comes to find out when I start, you know, as we start getting to know each other and I, you know, the walls start dropping down and he stopped wearing the masks around each other and like, Oh, you're BI, well, that's a sin. Oh, you do what? That will. That's not. Okay. You know, like that kind of stuff started happening.

Dr. Javad Sajan 18:19

Is that what led to the divorce?

Josie Noel 18:20

By and large. Yeah.

Dr. Javad Sajan 18:24

Were you working?

Josie Noel 18:25

Oh yeah.

Dr. Javad Sajan 18:27

What was you doing?

Josie Noel 18:27

I was a line cook at the time.

Dr. Javad Sajan 18:29

Okay. In Idaho?

Josie Noel 18:31

No. Oh, I'm sorry. We moved to, when I was 12 years old, we moved to Yakima, Washington.

Dr. Javad Sajan 18:37

What led to that move?

Josie Noel 18:38

Yeah. That's where dad's family was. So we just up and moved to spend time with dad's family, I guess. I don't know. I never saw my uncles ever. So I don't know why we moved to hang out with them.

Dr. Javad Sajan 18:50

Was he Yakima different than Idaho?

Josie Noel 18:53

Oh yeah. I mean, cause Yakima is Yakima is a farm town in the middle of Eastern Washington. Right? And at the time I moved there, it wasn't as Hispanic populated as it is now. But like now it's like 60, some percent Hispanic. And I definitely spent some time, like in my twenties when I was single, like bouncing around from little towns around there, just finding cheaper places to live. And there was definitely times where I was like the only white person in town, like the only white person in the club that's definitely not the time for anyone to think. You're not like a hard dude. So there was a lot of fronting for that.

Dr. Javad Sajan 19:39

So after your divorce, what did you do?

Josie Noel 19:41

I was working, I went to work at Walmart. Just like dead end job. There it is. There's not much to do in Yakima. Believe, you know, like a lot of small towns. There's just not a lot of employment opportunities by most people leave. So why I left. Right? That's why I moved up to Seattle was, you know, just to find work.

Dr. Javad Sajan 20:03

When did he move? How old were you?

Josie Noel 20:05

I was a year and I move up here 2016. So I would have been 26, 25, 26 when I moved up here.

Dr. Javad Sajan 20:13

And were are you identifying as male at that time?

Josie Noel 20:15

Still, still very much. Cause that same year, 2016, my dumb joined the Marine Corps.

Dr. Javad Sajan 20:22


Josie Noel 20:22

Yes. This is a phase that me and my therapist referred to as passive suicide.

Dr. Javad Sajan 20:30

Tell me what does that mean?

Josie Noel 20:31

I wanted to die. I was so ashamed of who I was and what, like, you know, like the super religion had like the love for myself could not be there. Right? Because I was not living the way, this book that I was supposed to be living. Right? And the way the cult that it's complicated to explain, unless you've been like in a really like evangelical hard right wing cult. And I have no other words for it. It's a cult.

Dr. Javad Sajan 21:06

Sure. So you said shame a few times today. When you say shame, were you feeling embarrassed because you weren't fitting a norm that the culture wanting you to, is that what you mean?

Josie Noel 21:21

You mean some of that? Right. And at the same time, you know, like you look around and you see just in society, how trans women are treated. Right? And there's in the nineties, we wanted to think. We were like so progressive in the nineties and they were just absolute trash there's shows. I still can't. It's like some of my favorite shows. I can't go back and watch anymore because the trans the like transphobic jokes that are all through.

Dr. Javad Sajan 21:45

So how do the Marine Corps go.

Josie Noel 21:49

Oh, that was a shit show.

Dr. Javad Sajan 21:51

Tell me about it. Do you're 26, right?

Josie Noel 21:54

Yeah. I joined super late average age of a Marine is 19. I had to get two doctors to sign off on this two different times because I turned 27 in bootcamp and a second doctor had to sign off and say they wouldn't kill me during training.

Dr. Javad Sajan 22:09

And did you tell your family, you were joining the Marine Corps?

Josie Noel 22:12

Yeah, like right before I went.

Dr. Javad Sajan 22:13

What did they say?

Josie Noel 22:14

Mom lost her mind?

Dr. Javad Sajan 22:17

She wasn't happy for you?

Josie Noel 22:17

Oh no. She just, Oh God. I mean, I racks in full swing right now, so she's just like, "Oh my baby boy, you're going to go die in the war". And I was just like, "Yeah, well, I aren’t doing anything here. So I might as well go and do something over there".

Dr. Javad Sajan 22:32

What did your dad say about it? Not much?

Josie Noel 22:35

Not much. Good for you, go run. And then like, as soon as I got out of bootcamp, like next thing I know dad's got that. My son is a Marine sticker on every God dam thing. And he's wearing a Marine Corps, hats and Marine Corps shirts. And I'm like, dad, you were a garbage man. You didn't do. I was the Marine. Why are you the one? Like you got a flag on the house now, dad, what are you doing?

Dr. Javad Sajan 23:00

How was the Marine Corps?

Josie Noel 23:02

It was a trip. I mean, it really was. I was.

Dr. Javad Sajan 23:05

Was it hard?

Josie Noel 23:05

Oh yeah. Super hard. I wouldn't do it again.

Dr. Javad Sajan 23:08

What did he have to do? What's bootcamp?

Josie Noel 23:11

Bootcamp is 16 weeks of being physically abused while physically and mentally and psychologically abused. While you figure out how to kill people.

Dr. Javad Sajan 23:20

Were you good at it?

Josie Noel 23:21

Yeah. That's the scary part because I was so used to being psychologically abused already.

Dr. Javad Sajan 23:27

What kind of, give me some examples?

Josie Noel 23:29

Oh gosh. Someone's lock was not on their locker or no, I'm sorry. It wasn't set to zero. The lock was there. It wasn't set to zero drill instructor came by he'll stomped, lock off, look like, Oh yeah, your lock's broken. Made everyone then empty out their stuff, dump it in the middle of the room. They kicked it all around. And then we just had to, like, they gave us a minute to find stuff. And that's what we had for like two weeks, whatever stuff I had, like an extra small Paris give you shorts and like a shirt that barely fit for like the next four days.

Dr. Javad Sajan 24:09

What were some of the hard physical activities you have to do?

Josie Noel 24:12

You know, we ran everywhere three mile run has to be done at bootcamp they wanted us doing it in. It's 17 minutes was top points, three miles and 17 minutes.

Dr. Javad Sajan 24:27

How are you doing with these activities where you doing pretty well?

Josie Noel 24:30

I was doing okay. Like I was in pretty decent physical shape. I was doing okay. Not great. But the Marine Corps is like really where I started to hate my body. And at that point I didn't really think I had an option to be more femme. Right. Cause-

Dr. Javad Sajan 24:50

You're going to an extreme in the Marines, right?

Josie Noel 24:51

Oh, super extreme. Right. Like, and this is where, like my extreme behavior kind of like really began. Right? Cause it's like, okay, well I just put on this costume and I am apparently going to have to wear this costume for a long time. And that's when I, you know, in the Marines you work out a lot. So I was working out a lot. I got really big, on deployment you lift a lot of weights in your downtime cause there's not much to do for stress relief cause you can't drink and you can't smoke weed and there's no one to date.

Dr. Javad Sajan 25:24

Well, so you pass bootcamp.

Josie Noel 25:26

Oh, pass bootcamp. Great. Yeah pass bootcamp. That's they? I mean, they do give you an option to fail. Like, but you have to like quit.

Dr. Javad Sajan 25:36

Did anybody, quit in your class.

Josie Noel 25:37

Oh God. We started with a hundred and it was 124 and I think we graduated 63.

Dr. Javad Sajan 25:46


Josie Noel 25:47

So yeah, people, people drop out if they can't, they're not passing physical tests. If they can't shoot, if they can't swim, if they can't, you know, there's just like points along the way. If you're not meeting the check marks, you can either get stuck there. Or if the next group coming along doesn't have enough and they don't have like space for you. They'll just kick you out.

Dr. Javad Sajan 26:09


Josie Noel 26:10

I don't think the other branches are quite so hard, but I know, you know, the Marines, like if you don't pass like a thing, they'll just keep recycling you until they give up.

Dr. Javad Sajan 26:21

And you got deployed as your first mission to Iraq.

Josie Noel 26:24

Yeah. One deployment to Iraq.

Dr. Javad Sajan 26:26

What did you have to do there?

Josie Noel 26:27

I was a mounted machine gunner for the most part. So like I was sat up on top of a truck and I had a machine gun.

Dr. Javad Sajan 26:34

Yeah. I don't know if you can tell us, but did you have to kill people?

Josie Noel 26:38

I never thank God. I don't think I only ever had to open fire one time. It was pretty quiet where we were, there was lots of door kicking ins and like security, sweeps and things like that. But like not a lot of active combat.

Dr. Javad Sajan 26:55

Where in Iraq? What city?

Josie Noel 26:57

We were on a forward operating base, like Syria, Saudi Arabia ( what's the other ). We were super- My geography is a little off, but yeah, we were equal distance from Syria and Saudi Arabia. Like we were in the middle of the absolute desert.

Dr. Javad Sajan 27:17

And did you have any physical altercations during your deployment?

Josie Noel 27:21

Oh yeah, we got, I got in fights with other Marines. We got in fights with locals sometimes when they weren't being cooperative about what they were being told, we'd rather get in fist fights than shoot someone most of the time, honestly. So

Dr. Javad Sajan 27:35

How did that deployment overall. How long did it last?

Josie Noel 27:40

Let's see, I was on the fob for like four months and then they shipped me back with, I got separated from my main company and I got put with another company and they were on this really nice air force base that had bus lines and like a movie theater and like one of those USO stages that like rockstars come and play at. I'm at this little place you can only get to by helicopter. And we've got like one shop selling bootleg DVD. I'm like, you can't even all the time, get them in English. I watched transformers too with Cyrillic subtitles and it was dubbed in Spanish.

Dr. Javad Sajan 28:17

Oh my God.

Josie Noel 28:18

I don't read Russian and I can't speak Spanish, but it was transformed. So did you really need the dialogue? Right? It was just like robots go boom.

Dr. Javad Sajan 28:28


Josie Noel 28:29

Right? So like that was moving I one night, we're just like, are you, we just spent $20 on this. Are you serious? Oh my God. Yeah, so I was there for about four months and then they sent me to the rest of my unit and this really nice place. Then we were there for, I think another three before we came home.

Dr. Javad Sajan 28:47

You did one deployment or how many do you end up doing?

Josie Noel 28:50

A one. Yeah. I was actually supposed to be a reservist and I checked into a reserve unit. There was immediately deploying to Iraq. So I came straight out of bootcamp, checked into the unit three months later, I'm in Iraq. There was a tank school in there too. So it's like bootcamp. And then you go to your job school, and I was a tanker, so they sent me to Fort Knox, Kentucky. I was there for three months then to the unit. As I check in, they're just like, "Oh, you're a bad luck. We just got our deployment orders. Like last week, your bad luck". I'm like, "Are you serious? Okay, cool". I can't wait to tell mom.

Dr. Javad Sajan 29:29

What happened after that then?

Josie Noel 29:32

Came back when I got back stateside, I definitely was embracing more that I was not SIS straight man.

Dr. Javad Sajan 29:45

Did you have any relationships with other men?

Josie Noel 29:49


Dr. Javad Sajan 29:49


Josie Noel 29:50

I'm still not to that point. So yeah, now at this point I'm like, I'm starting to like, okay, I know who I am. I've done some like some shit. I've been through some stuff I'm starting to, like, I'm starting to figure out who I am as a person. And like being in the military, you have to make some decisions, like some split second decisions sometimes like that's a character check. That's a super like who you are check and then I definitely had some moments where I was like, Oh, shit that could have been it. Like that could have been it and I kind of realized I was living on extra. Right? Like I said, at the beginning of the Marine story, like we thought it was past it like me and my therapist referred to as passive suicide. Cause like I wanted to die. I just didn't want to kill myself. And then I started, you know, I started realizing that like the costume I was wearing for the rest of the world was just a costume. They weren't really seeing me.

Dr. Javad Sajan 31:05

Were you in therapy at this point?

Josie Noel 31:07

Oh no, Marine's in therapy. That doesn't happen tanks your career. It used to, it doesn't anymore. I want to see if there's veterans out here listening, go to therapy, please. God, get your meds, smoke some weed, go to therapy, please get your stuff treated. Cause it wasn't until I started dealing with my PTSD that I could like transition, like love myself enough to transition. So please, if there's veterans out here listening, you don't have to keep wearing a costume if you don't want to.

Dr. Javad Sajan 31:40

Then what happened after that? After you got back to state side.

Josie Noel 31:43

Met my second wife or we got, yeah, we got married. I was doing a lot of stuff in like the Seattle kink community with the CSPC and stuff like that.

Dr. Javad Sajan 31:59

What's CSPC?

Josie Noel 31:59

The center for sex positive culture. It's not around anymore, they lost their building. Gosh, I don't know how many years ago.

Dr. Javad Sajan 32:08

And how did you meet your wife? Was she a CIS woman?

Josie Noel 32:12

CIS woman, Yeah, CIS woman Cause I'm still hard on that man costume still really hard. And that like very alpha man costume. We met online and rushed into.

Dr. Javad Sajan 32:29

Did you know that you had other tendencies or thoughts?

Josie Noel 32:33

She did like real quick and just, that was not a concern in our relationship and it was kind of with her that I was able to start embracing the like, okay, I can wear panties at home. That's not a big deal. Okay. No one else needs to know about that. I can still be hard when I'm out in the streets and okay, this is right. And it was kind of with her that she got me like comfortable to the place that I could start doing that.

Dr. Javad Sajan 33:03

She was comfortable with, should have any issues with that?

Josie Noel 33:06

No, she didn't have any issues with that. We had plenty of other issues, but that was not one of them that was like, that was a Hollywood marriage. Like I think we were only actually married for like three or four months before I pieced out.

Dr. Javad Sajan 33:23

What made you peace out?

Josie Noel 33:25

Found out she was lying to me during my deployment.

Dr. Javad Sajan 33:29

Oh, she cheating?

Josie Noel 33:30


Dr. Javad Sajan 33:31

How did you find out?

Josie Noel 33:34

Found the other dudes underwear under our bed.

Dr. Javad Sajan 33:37

Oh my God.

Josie Noel 33:38

I want a deeply in the apartment. I was like, what's up with these? I'm like, they're not mine, can you explain, no, crickets when I called my bestie and I was like, "Hey, do you know about my wife living with someone? Oh yeah. We thought they were being poly. We figured you knew all about it. We're all polyamorous". Right? And I'm like, yeah, but I didn't think we were so cool.

Dr. Javad Sajan 34:08

What's polyamorous?

Josie Noel 34:09

When you ethically and I want to stress the ethically part there ethically have more than one partner, like more than one romantic relationship.

Dr. Javad Sajan 34:18

Did you ask her? Did she say anything?

Josie Noel 34:22

She? Yeah. I really, God, it was such a ridiculous. I'd rather not get into it, honestly.

Dr. Javad Sajan 34:28

No problem.

Josie Noel 34:29

It's just, just ridiculousness. That's what, it was.

Dr. Javad Sajan 34:33

Know it's been very painful for you?

Josie Noel 34:34

It was, it really was. But my next partner who was and this might get a little factually detailed, I guess adult content, warning kids. She was a dominatrix and I had not been seeing her as a client. We met socially and clicked and started dating and she very much guided me into being comfortable doing things that were not necessary masculine.

Josie Noel 35:17

Did you were submissive.

Dr. Javad Sajan 35:18

I mean I was submissive to her. Right. But that still wasn't, that wasn't the front that everyone else saw.

Dr. Javad Sajan 35:25

Would you mind just briefly telling people what a submissive and a dominatrix is?

Josie Noel 35:29

Well, so in our situation sexually and in life, actually, it was kind of our dynamic kind of spilled out. Right? She was in charge of the relationship.

Dr. Javad Sajan 35:48

She older?

Josie Noel 35:49

She was but not by much, we were very close in age. Okay. She was in charge of the relationship. She was in charge of herself for one, like I had shut your mouth, you're not talking to me. Right? Like I like shut your mouth. You're not talking to me, but like shut your mouth. You don't have an opinion in this. This is my decision you know, like she made the decisions. She was in charge in the bedroom, things were the way she wanted it. Right? and then there's the, you know, the kink aspect that goes along with that. And I don't know if I really want to get into that it's on the podcast. Strangers.

Dr. Javad Sajan 36:28

No worries.

Josie Noel 36:29

But with that, I started getting more comfortable being, not like hard, alpha masculine all the time. There was more not that I never did housework cause that's man's work or anything. Cause that was stupid mother would have slapped the out of me if I ever said anything like that. Right? But like. This is kind of really hard for me to explain. Definitely that relationship made me more comfortable.

Dr. Javad Sajan 37:06

Would you say made you more comfortable in a classic quote unquote female role?

Josie Noel 37:09

Yeah. Yeah. I think that would be the way to but not even necessarily just feminine, like a more feminine role, right. Like, or more, I hate the term, but a more beta role, right? Like not, I wasn't in charge of the relationship. Right. Like it was very different for me.

Dr. Javad Sajan 37:30

And what happened with that relationship?

Josie Noel 37:32

My drink, I mean a lot of people have drinking problems out of the military and my drinking got in the way.

Dr. Javad Sajan 37:39

You left the military during that?

Josie Noel 37:41

I think I would, no, I was still on the reserves.

Dr. Javad Sajan 37:45

What were you doing for work at this time?

Josie Noel 37:48

Oh, what was that? I was the security guard I had. I was managing, I don't know how many buildings in downtown security like corporate type, nothing like fancy, but once you put out your Marine onto a resume and then, you know, you get kind of pigeonholed into doing things.

Dr. Javad Sajan 38:06

And what happened next in your life? How did that relationship end?

Josie Noel 38:11

Like I said, the drinking had kind of gotten in the way and by this point and I want to say this was probably five or six years, eight years ago now, about eight years ago, probably five or six years. And I had been pretty much in most of my free time, just cross-dressing like fully. It was kind of a rare occasion. If someone was going to stop over there, they would see me dressed as a man still.

Dr. Javad Sajan 38:50

And did you, were you in therapy at this point or not yet?

Josie Noel 38:53

No. I was really stubborn about that. All my friends telling me I'm depressed and I needed to deal with my PTSD and I just won't listen.

Dr. Javad Sajan 39:01

Do you mind giving me an example of what you were having PTSD?

Josie Noel 39:05

There, we had we had an accident one day where we were burning trash out in the desert and I kinda got lit on fire. And then a bunch of Iraqi kids came over and started kicking me in the head and I couldn't get to my sidearm before their dad shoved them all off of them and try to help put me out. And the other Marine that was on the ground with me just stood and looked like he was watching. He was just in shock. So the moment came all that training for anything to happen. And he just stood there like a statue.

Dr. Javad Sajan 39:48

Wow. Sorry.

Josie Noel 39:51

Yeah. So that was pretty scary.

Dr. Javad Sajan 39:54

I can't imagine. Did you have burns?

Josie Noel 39:56

Yeah. They've mostly healed up. I still have a couple of scars, but yeah, that stuck with me. Not, I don't get too close to the campfire anymore. You know.

Dr. Javad Sajan 40:09

Worse. And then you were cross-dressing at home. Did you, were you thinking female was the gender identity or what were you thinking?

Josie Noel 40:19

I still wasn't sure. Right? Like I knew, I knew the amount of privilege I had in the world as a man. And especially as a veteran, right? Like it was as a combat veteran from the Marines. Like you walk around with like a lot of privilege in the world. Right? And especially, well, not the world in America, no one gives a shit. And the rest of the world. In America, you walk around with a lot of privilege especially with the type of people you need privilege with like the cops, right? Like white guy that's Oh yeah. Marine Corps plates, then a combat tag and get away with anything I know have seen me do it.

Dr. Javad Sajan 41:05

Like, what, give me one example. If you can.

Josie Noel 41:09

I made an illegal you turn on a Jeep Wrangler where I went over a median, like bump, bump, bump, bump over a median in front of us no homage County sheriff. I got a lecture. Yeah. He also had been a Marine. So all I got was the lecture and I was like, "Oh my God, how are you not dragging me out of the car right now for breathalyzer? That was the stupidest I've ever done".

Dr. Javad Sajan 41:38

Were you drunk?

Josie Noel 41:39

No, I was just trying to get to a job site. Yeah. I was installing like ADT security systems at the time or something and I was just like, Oh, all the science keeps saying, no, you turns. And there's all these mediums. And I got to go that way. Okay.

Dr. Javad Sajan 41:55

Any drugs?

Josie Noel 41:57

Nope. No, stone sober at like three cups of coffee that morning.

Dr. Javad Sajan42:02

What happened next as you, what did you do next? When you started presenting more as female after only dressing at home?

Josie Noel 42:11

Well there started being like it got out in the friends group, right? Like I told people, I started showing up to Halloween parties and found and right? Cause no one can say anything. Cause it's Halloween. There's like so many trans people come out and Halloween.

Dr. Javad Sajan 42:27


Josie Noel 42:28

Oh God. Yeah. It's like the one time you can be safe, right? No, one's going to say anything. If you dress up as the slutty kitten and you're a guy, Oh, that's cute. You put, Oh good for you. Good for you, honey. You put on this slutty kitten outfit today. You're good for you and embracing your femininity, you slutty kitten. Good.

Dr. Javad Sajan 42:45

You know I see that so many times. And I sort of wonder behind in the back of my mind, these people seem to be embracing this different identity on this day. So many parties, you know, when I was in college and all that graduate school, wow.

Josie Noel 42:59

Yeah after I started cross-dressing I don't think I went, there was one year I went as, like with a male body type character.

Dr. Javad Sajan 43:11

When did you start cross-dressing in public? What was the next phase?

Josie Noel 43:15

I mean, that had always kind of benefiting like, you know, once it became a thing, it was just kind of a thing. It was like, I was Josie going to show up as a boy or a girl tonight. Like most of my friends were like really cool with it. Like if I showed up as a girl, they called me she. Right. Like very few of them needed to be reminded. And, but at the same time I couldn't be too mad. Cause the next day they could, they'd seen me. Right? As a boy, like, Oh yeah, let me come over and help you move furniture and load stuff in the back of my truck. I mean, you saw my truck this morning pulling in, right. You're not expecting the lady to climb out of that truck.

Dr. Javad Sajan 43:54

I don't make judgements, but I knew that was you. Cause I knew your history.

Josie Noel 43:57

Right. Most people don't expect me to get out of that truck. Right? You know, so yeah, yeah. Right? So I wasn't, I wouldn't be upset if like during that period that if someone mis-gendered me, cause the next day they could see me as the boy. Right?

Dr. Javad Sajan 44:17

When did you start knowing your gender identity was not male?

Josie Noel 44:22

I had to deal with my depression first. So I was so sad like my depression was like so severe and I really had to deal with that first and after about three or four months on Prozac, I think which my therapist recommended. So I started therapy and antidepressants at the same time.

Dr. Javad Sajan 44:48

How did you get into that?

Josie Noel 44:50

Me and my current partner got in a really big fight and I walked away from it and I didn't trust them. Like in my heart, I like in my head is telling me like, this is the stupidest thing you can feel right now. You know, you can trust her. She's like the most trustworthy person, you know. And I was like, "this is depression. This has to break. And that's when I finally start looking at them" like, okay, this is, I wonder how many relationships have this is destroyed for me. I wonder how much of my life has just been to depression.

Dr. Javad Sajan 45:29

How did therapy go?

Josie Noel 45:31

It's still going great. I think everyone should be in therapy I think everyone needs someone professional to talk to about their feelings. Just talking to your friends, isn't enough, your friends got their own problems.

Dr. Javad Sajan 45:44

Exactly. I agree.

Josie Noel 45:46

Right. Especially now everyone's got their own shit going on and I can't lay off my stuff on someone else. So really glad for my therapist really glad for Prozac.

Dr. Javad Sajan 45:57

Did your therapy helped you learn that your gender identity is female?

Josie Noel 46:00

It did. It helped me, well, I showed up to my therapist to get my letter to start HRT. So what I had done.

Dr. Javad Sajan 46:15

What's HRT?

Josie Noel 46:15

Hormone replacement therapy.

Dr. Javad Sajan 46:17


Josie Noel 46:18

So what I had done is after about three months on the antidepressants and like really, there's like a lot of really sorting out who I was during that time, started realizing that I was female, right. Like the shame and the depression. And like, all this stuff starts coming up. Like once I could see clearly, cause I'm not depressed anymore. Right? And like happy brain chemicals, serotonin are back and stuff. Oh God, this is what I've been missing my whole life. Why have I been doing the miserable thing most of it. And the happy thing for part of it. Right? And I did this kind of, I was like, "Okay, I did an experiment in February where I just, I called it fem February". It was the month before I started hormone replacement. I dressed as a woman every time I went out I asked my friends to refer to me as they them. And the first thing I noticed was how much privilege I immediately lost.

Dr. Javad Sajan 47:28

Give me an example.

Josie Noel 47:29

People don't move out of the way for people they see it as women, men will just like walk straight through you cause they expect you to move. I'd never been catcalled before.

Dr. Javad Sajan 47:50

What's that?

Josie Noel 47:51

You know, when some random guy yelled something at you across the street, like, Hey honey, nice Ass or something like, you know, actually got honey nice Ass walking through downtown Seattle. And I was like, it's dark. And I'm wearing all black. Oh you mean like streetlight? There's not even a streetlight. Oh. yeah. So like that was the, like the realization and it was like that held me up for a really long time.

Dr. Javad Sajan 48:22

And how did starting hormones make you feel?

Josie Noel 48:25

Oh, at first it was craziness.

Dr. Javad Sajan 48:27

Like what, how was it crazy?

Josie Noel 48:30

So at the like extra dials going up, right. So like your estrogen is going up and at the same time your testosterone starts going. Cause I didn't take test blocker didn't take any testosterone blockers. So my tests started going up when my estrogen started going up because my body was like, okay, more estrogen, more testosterone. That's what we do and it took quite a long time for my body to stop producing more testosterone than it needed for like the first three months I was on HRT was just, I was angry and aggressive and crying constantly. And like up until that point, I don't think I cried for like eight years.

Dr. Javad Sajan 49:13


Josie Noel 49:13

You know, like, and now it's like constant, not constant, but like it's pretty rare. I go a week without crying now. Yeah. So I think I saw you I'd been in HRT for less than a year when I saw you.

Dr. Javad Sajan 49:32

When did HRT start making you feel better or did it?

Josie Noel 49:37

Honestly not until after surgery.

Dr. Javad Sajan 49:39


Josie Noel 49:40


Dr. Javad Sajan 49:41

How did you start thinking about surgery?

Josie Noel 49:43

Well, I looked at it from two aspects, right? Like I looked at it like, I was not happy with my body. I knew HRT was going to take a very long time to see any changes and then I looked at it pragmatically from like a medical standpoint. I'm older, right? More time for testosterone to do its thing, more muscle development. So I'm going to lose less muscle mouth potentiality for me to gain breast development is lower and I wasn't expecting great growth from, from HRG at this point light. So it's just like, if I want breasts, they're gonna fit my frame and that was my big thing. Right? Like I just wanted to fit my frame.

Dr. Javad Sajan 50:33

And why did you decide on now for gender affirming surgery to for genders, for surgeries that increased feminamity? There's many options face, neck, bottom. Why did you pick breast first?

Josie Noel 50:49

I'm really comfortable with my face. And there is actually research that says you shouldn't have FFS until after two of progesterone and I know where you're near at that point. I had just started progesterone. We talked about briefly before we actually started recording that I've always had a lot of dysmorphia around my Adam's Apple. And I remember definitely as a teenager getting picked on a lot for it because I was tall and ganglion stuff like there's scars and contouring and things. Right? But like ended the day taking off patting the like you've presented to the world as your body. And then you come home, you take off this pad and it's really sad because your body doesn't like, you put out this image, this is what I look like. And now you've got, now you're looking at yourself in the mirror after you just took off your breasts and your hips and your house. And you're like, okay.

Dr. Javad Sajan 51:52

I've never heard it that way. It makes so much sense.

Josie Noel 51:54

Yeah. The day I decided I had to transition permanently. I had done a drag show, did a real MacIntyre set, did fancy, came home. And when I took my padding off, I just started crying because my body was wrong.

Dr. Javad Sajan 52:17

How did you hear about me?

Josie Noel 52:19

I don't remember what the Google search was, but it would have been like top plastic surgeons, Seattle, top plastic surgeons, West coast, something like that.

Dr. Javad Sajan 52:27

That's how you found my name first.

Josie Noel 52:29


Dr. Javad Sajan 52:30

Do you remember, when you Google those things and see a few different people, do you remember? What about me made you want to come see me?

Josie Noel 52:38

Well, there was your locality for one, right? Like close hometown to like your assess ability to your website, the way it laid everything out, your priceless and stuff. And then three, I could watch all your stuff on social media. So I knew exactly what it was going to be. I knew the procedure knew how it was going to happen. I knew what the implants looked like. I knew everything like, just from your website and like initial appointment and stuff that I needed to know to be comfortable with, like the implants we chose, the size we chose you doing the procedure, right? Like it, you were my no, I'm sorry. I had two consultations. One was the video. And I don't want to give that surgeon's name. They were not their bedside manner wasn't great.

Dr. Javad Sajan 53:32

Were they someone that does gender affirming surgery?

Josie Noel 53:34

Yes. Yeah. But I think it's more because insurance and things like that. Right? I don't know.

Dr. Javad Sajan 53:44

How do you feel? Can you give people an idea, what wasn't great so they can understand?

Josie Noel 53:50

I definitely got a lot of a condescending tone, like and a lot of you don't want to do this so early. Like I had a lot of, I had some of my trans friends telling me that I didn't want to get augmentation so early because I'd have more growth later. And I'm like, "No, I won't. That's cool. You've been on hormones for six years. You have a cup honey. Don't tell them I'm going to get more growth". If any of my other friends could have said that they couldn't because they've had augmentation you know, I'd have been like, okay, cool. I have a potential, like maybe, but I just really didn't feel like natural growth was in the cards for me on hormones

Dr. Javad Sajan 54:34

And at the consult. What made you decide that this was for you?

Josie Noel 54:40

The first time? I mean, honestly the first time I tried on the sizers and like, we found the size that like matched what I'd been padded. And I was like, Oh, I was like, I just held them up in the bra. And I was like, Oh no, that's mine. Please let's have these.

Dr. Javad Sajan 54:58

I remember that constantly very clearly. And you said my bedside manner was a little bit different. How was it different?

Josie Noel 55:04

Oh, you're so sweet and caring. Like, you've your whole staff too. Like everyone here is always great.

Dr. Javad Sajan 55:10

Thank you. We love our patients.

Josie Noel 55:11

I remember coming in, like I was early, right? Like I was like 15 minutes early for an appointment one time. And like they stressed, I was in the waiting room for like five minutes. I was like, I've got a book here, I was just going to chill, eat a cookie and have some coffee.

Dr. Javad Sajan 55:27

Yeah. I know.

Josie Noel 55:30

Those are like, "Oh God, we know we gets you in for your massage right now"? I'm like, "thank you. Cool". And that was the other thing, right? Like the ultrasound massage and everything being able to have access to after like surgery, aftercare from your office as well was a big deciding factor for me.

Dr. Javad Sajan 55:50

It's really important. You know, healing is 50% of this. You can do the best surgery in the world, but if you can't support your patients not going to have good results.

Josie Noel 55:56

Right. And the ultrasound massage was like, I saw super improvements and like bruising and just, you know just comfort levels, like right after too.

Dr. Javad Sajan 56:08

Tell me how the day of surgery was? What did you feel the night before?

Josie Noel 56:13

Oh, I was super nervous.

Dr. Javad Sajan 56:15

What were you nervous about?

Josie Noel 56:16

I've done this every time. I've gotten a tattoo as well. Like you make, you've made this decision that you're going to permanently change your body and there's that chance you could look down and your brain could just start screaming at you. What the fuck did you do? I had that with the tattoo. That's bad enough. Right. Like, I didn't want to do that with like my entire chest. So yeah, there was some nerves around it. Right. And then also, like, you know, it's surgery, I'd never had surgery before do go wrong. I, to be candid, I smoke a lot of marijuana. And I remember the anesthesiologist was not very happy about that. Cause I know that can cause side effects. So it's kind of nervous about that. You know?

Dr. Javad Sajan 57:15

I asked that question, because every night I fall asleep, I always think, what are my patients thinking? You know?

Josie Noel 57:21

No worries. I had no worry about your skills all about me. Right? Like what if I have a seizure? Cause I smoked too much weed well, the innovation tubes in or whatever, you know, or like what you know, what if afterwards I wake up and I'm just like, "Oh God, I don't want to do this". I mean, I guess there was this small worry of rejection.

Dr. Javad Sajan 57:41

Of course. Yeah. Things can happen. I do so many. I see it all, you know, I believe in informed consent. I believe if somebody wants a surgery, if it's a SIS person or a not SIS person, they have the right to choose as long as it's safe and we're taking good care of them. I've gotten some heat from some other doctors about that and they tell me, you should make gender afirm people go and get multiple letters. And I was having a discussion with one doctor and I told him, when you have somebody who comes for a breast reduction, their SIS, you make that person get two letters. When you ever 23 year old woman who wants breast augmentation, you make that person get two letters. Tell me the difference. What do you think about that?

Josie Noel 58:24

That was actually another reason I had chosen to go with you. Cause I didn't want to pay, I could not afford to pay as on I'm on Medicaid insurance. So the surgery was out of pocket for me. I could not afford to pay to go and see another doctor to say, "Yes, you're trans, here's your letter saying, you're trans". Like I think my birth certificate had been changed by the time I'd seen you like social security card, which I think I changed everything except my passport at the time right? So like, and at no point at any I'll take that back. My driver's license I needed one letter from my doctor. Yes. Josie's trans here's your please change it. I don't even think I needed that for my birth certificate in Idaho. And I've recently learned, cause I know someone from the internet in Idaho going through this right now that there was like a two year span where you could change your birth certificate and now like the form to do it on the website, not even available.

Josie Noel 59:30

So like it's not even an option if you're trans to change your birth certificate in that state now. But yeah, I mean I had everything changed to female by the time I'd seen you just about like, so the idea to go see another doctor to just to like, you know, how many hundreds of dollars would that be out of pocket, right? Or like a fight with an insurance company or just, you know, it just adds more stress to someone's life. That's already been super stressful, right? Because transitions, not just a medical thing, it's a social thing. And it's a legal thing too. And the legal thing, the legal aspect of it is super stressful. And there's not a lot of people that like really advocate for you during the process. I mean, you've got to do it all yourself.

Dr. Javad Sajan 1:00:22

How did surgery day go?

Josie Noel 1:00:24

Oh, it was fantastic for me, you know, I showed up, it was super early. You guys got me prepped and to the, to the operating room and everything was great. And I was feeling fine that morning, but my wife told me that the procedure took longer than she thought she was starting to get like, like worried in the waiting room because there wasn't a bed long enough for me or something. And you guys had to like move around tables.

Dr. Javad Sajan 1:00:55

For people who have more height, we extend our bed. It takes a little bit longer to start the case when we do that. But yeah, that's it.

Josie Noel1:01:03

She was thinking it was going to be over much faster than it was. And like starting to do the little worried. Me on the other hand I was unconscious, yeah. Now day of surgery was great. We got home, no problems. We also live super close. So thankfully one of the best surgeons I know in the state, at least that does all this and doesn't require trans people to jump through a ton of hoops is in Seattle.

Dr. Javad Sajan 1:01:30

Thank you. And how did you feel the day after your post-op when you saw your new chest?

Josie Noel 1:01:38

Oh, I don't think I really like the day after. I don't think I was even conscious like probably about two days later, like when the Oxy wore out, I was just like, Oh my God.

Dr. Javad Sajan 1:01:51

How did it feel?

Josie Noel 1:01:52

It's my body. Oh, everything hurts so bad. Oh, it felt like I got hit in the chest with a two by four over an over but I was the only on the Oxy for like a day and a half and I was able to switch to Tylenol and I was up and walking around after two days.

Dr. Javad Sajan 1:02:13

How do you feel about your body now? Since you've had surgery?

Josie Noel 1:02:17

I love my chest. I just, I absolutely love the work you did, the scarring there's like hardly any scarring and where they are, you can't see it. Like if they're underneath the fold and just really invisible, like you know, they fit they were the anatomical gummy, and so they look extremely natural, yeah, I'm super happy with them.

Dr. Javad Sajan 1:02:42

No, you told me earlier that your feelings of dysphoria didn't, with the estrogen didn't really start better too after your surgery, is that correct?

Josie Noel 1:02:53

And I think part of that was I didn't, I wasn't on estrogen for a really long time before surgery and then I had to go off of it prior to surgery cause the blood clotting risk.

Dr. Javad Sajan 1:03:09


Josie Noel 1:03:09

So then T spike back up during those like six or eight weeks I was off estrogen. And then right now estrogen surgery recovered. Right? Then you got everything with surgery, recovery that your body's going through. And yeah, I just really feel now that I'm in a place where like my hormones have been able to stabilize and do what they're supposed to do.

Dr. Javad Sajan 1:03:36

And how is life now? What are you doing for work? Tell us about your family.

Josie Noel 1:03:40

Well, I'm in between jobs right now because the pandemic's fantastic and it's hard. It's sometimes it's hard to work with the public when you're trans, I'm living in Snohomish County in Washington, which is generally a little more conservative and you know, so sometimes coworkers and people I'd encounter were a little hostile and decided I needed to take a break from that and focus on my own mental health, which has never been better right now.

Dr. Javad Sajan 1:04:12

And you told us you have a son?

Josie Noel 1:04:14

NB daughter, she's a female assigned at birth, but is identifying boy and girl right now and is very, very clearly looks up. No, I'm both.

Dr. Javad Sajan 1:04:28

How did they start that?

Josie Noel 1:04:31

Gosh, I can't even remember. It's been, they have been this way for several months now. I'd say at about three and a half, they'd sometimes refer to themselves as a boy and we wouldn't correct them. You know, we just talked to them about gender and more from the assigned at birth aspect and then, so there are four and I've been transitioned for two years. So clearly they remember me as a male. So they know that there's like, gender is in your head and in your heart and it doesn't have to do with your part.

Dr. Javad Sajan 1:05:18

Do you think them seeing your transition influenced them in any way?

Josie Noel 1:05:25

I mean, I think I let them know that it was possible just to be themselves.

Dr. Javad Sajan 1:05:29

Did you talk about or explain your transition to your child?

Josie Noel 1:05:33

Oh, definitely. Right? Cause I mean, and I have trans friends that are present as women now and their kids still call them dad and they love it and they don't have any problems with it, but for me it was really hard to keep being called dads. So like we talked about it at length and then we've had several like.

Dr. Javad Sajan 1:05:54

So three and four years of age, they were able to have a level of understanding.

Josie Noel 1:05:58

Yeah. And you know, just recently we had a conversation about pronouns and gender identities and was like, well, she, hers normally for girls. And he, him is normally for boys. And I'm not saying you have to pick, but there's a choice you can go with they, them, which a lot of people that aren't boys or girls like to do. And they were like, yeah, I like that. I want to do that.

Dr. Javad Sajan 1:06:23

And your child were they with one of your previous partners or your most current partner?

Josie Noel 1:06:29

My current partner. Yeah. We've been together for five years now. So SIS woman also.

Dr. Javad Sajan 1:06:35

Okay. And are you planning on having any other surgery?

Josie Noel 1:06:40

I don't know. Money is definitely a hurdle, right? Insurance is a hurdle. I'd like to get some more stuff done. I'd like to have a tracheal shave. Will see how the progesterone and my gym workout does from but maybe a BBL is always, has always been on my list. I've seen you for a consult for that before. Yeah, I'll probably, I mean, definitely a trick shave. I think I definitely do want to get a trick shave at some point but at the same time, I'm like, I'm really confident, like in who I am and like my appearance and especially with my body now after augmentation, like I feel really confident, like other than being six foot tall, I feel like I kind of physically presents this most of the time now.

Dr. Javad Sajan 1:07:32

I agree.

Josie Noel 1:07:33

But I feels really good. I feel like my hips are still kind of skinny, but whatever, not everyone gets perfect hourglasses unless they come see you.

Dr. Javad Sajan 1:07:45

Thank you. Thank you tell me Josie. You've had such a tremendous life gone through so many things. If you could share one piece of insight with someone who's living, sort of a parallel life as you, that you think would have made your life less painful or less difficult, what would that be?

Josie Noel 1:08:07

If you're happier when you're in girl mode, if you spend your day thinking about when you can get back to girl mode, stop going into blame. There's no reason you hate yourself. Stop it. Don't throw out your clothes. Don't throw out your wigs, stop throwing out your makeup. If girl mode makes you happy, go into girl mode and stay there.

Dr. Javad Sajan 1:08:32

Are you happy Josie?

Josie Noel 1:08:33

I am so happy. I've never been happier. Like honestly, like I was so miserable right before transition yeah, I was so miserable before transition and now life is great. I mean, it's great as it can be for 2020 ship apocalypse, right?

Dr. Javad Sajan 1:08:53

I know, the ending is going to be, I think it's going to finish with a bang.

Josie Noel 1:08:57

It's definitely going to finish with a bang.

Dr. Javad Sajan 1:09:00

Thank you so much for being our guests today, Josie, I learned so much from your insight. Everyone's story is so unique and yours is one that so was so tumultuous. So up and down, but you've arrived at a spot that's healthy and good for you. I feel really privileged that I was able to play a part in your journey. Thank you.

Josie Noel 1:09:21

Thank you. Thanks for having me here today. It's actually a really big honor to talk about my story and like hopefully inspire some other trans women to transition.

Dr. Javad Sajan 1:09:32

I know your deal. We'll teach our listeners how and what to expect as they start their own journey. I appreciate your time and I'm honored to have you as my good patient. And I would say my friend, I hope you feel that way too.

Josie Noel 1:09:44

I do. Thank you doctor.

Dr. Javad Sajan 1:09:45

Thanks for listening to the plastic surgeon podcast and please rate and review us on Apple podcast to hear more great content tune in next week for an amazing clinic talk episode from my live surgeries on Snapchat and my adventures throughout the week, catch us on all social media @realdoctorseattle. See you next time.

Episode 8

Episode 10