By Malcolm Venable
The Virginian-Pilot© July 27, 2008
One Saturday evening in spring, female impersonators strutted, sashayed and lip-synched to R&B and gospel songs at a Norfolk banquet hall while guests showered them with dollar bills. People feasted on a down-home spread of green beans, fried chicken and macaroni, on tables sprinkled with confetti.
Presiding over it all in a crimson evening gown was Vega Perry, who played the part of the regal, occasionally bawdy hostess. She threw the party to thank supporters of her business, Miss Models Inc., which puts on pageants for local members of the transgender community.
"Please be aware," she said with sugary aplomb, stepping gingerly over the microphone's cord, "that there is no alcohol to be consumed on the premises. Please do not embarrass me by violating this policy. I thank you so much. Up next we have... "
Vega, of Norfolk, is a pro at this. She's managed hundreds of pageants and balls for "gender illusionists" up and down the East Coast.
It wasn't long ago, though, that she was onstage herself, agonizing over the right wig and eyelashes to create a flawless routine. But to look like a beautiful woman instead of the man she was at birth, she played a decade-long, dangerous game of medical roulette.
Around 2002, she lost.
Vega paid a friend to shoot liquid silicone directly into her legs and hips to make them rounder, more feminine. The procedure is called pumping, and it's well-known among members of the local transgender community.
Pumping is illegal and risky, but it's a cheap alternative to the extensive cosmetic surgery required to turn a man into a woman. Often, people who pump experience no immediate adverse side effects. Yet things can go horribly awry. Vega barely escaped death and is reminded every day of that close call by discolorations along her legs that ended her competition days.
"The type of showgirl I am now," she said, "I don't wear anything too revealing because I couldn't compete in a portion where I would have to show hip. I would be so self-conscious."
To win pageants like the ones Vega hosts, a padded bra won't cut it. Contestants need to look as much like ladies as possible.
The rewards can be great. Many drag pageants are surprisingly professional, sometimes lavish affairs with all the stuff you'd see at Miss America: talent competitions, swimwear, midfinals and finals. Bigger pageants award prizes in the tens of thousands of dollars; one gives cash, a new car and a per diem for all-expenses-paid cross-country appearances.
And so, in order to seize that tiara and all its glory, Vega, 38, and many others like her on the pageant circuit have gladly taken a needle or two.
The legal method of getting silicone is through a physician, and in the form of implants, which keep the substance safely encased in pouches. But with pumping, a friend or "doctor" met through word of mouth injects the stuff directly under a customer's skin.
Like street drugs, silicone can be pure or cut with something else, such as baby oil. "Sil doctors," as they're called, can use medical-quality material or the sealant you buy at an auto parts or hardware store.
The liquid can migrate to other parts of the body. It can harden and form clumps. Tissue can become infected and fill with pus. Cases in which people died, sometimes within hours of an injection, have made the national news.
Many times, though, nothing bad happens. For a few hundred dollars, someone who has spent his entire life feeling as if he was born the wrong gender can do something about it.
Vega grew up in a stable, loving, two-parent home in Newport News, with a family who supported her when she was a feminine gay boy.
By 19, she was performing in pageants in Hampton Roads and along the East Coast. But after a while she was ready to change, ready to live as a woman all the time. So on a summer day in 1992, she went to a friend's house in the Lynnhaven section of Virginia Beach to get silicone in her face, to round out her cheekbones.
"I wasn't nervous," Vega said. "I just wanted it so bad. I wanted to look as convincing as possible and wanted to soften up my look. I reserved in the back of my mind that, 'If you really want the silicone, Vega, you have to lay there and accept the pain.' "
The house was clean and well-decorated, she remembered.
The "doctor" was a transsexual named Michelle, in town from Florida. In exchange for hosting Michelle and allowing her to inject other people, the Virginia Beach friend received a commission - free injections, cash or both.
Michelle had access to high-quality silicone, and she was known for good work. Over the course of a weekend, Vega said, as many as 50 transgender women would see Michelle. She wouldn't even come to Hampton Roads unless she knew there'd be at least $10,000 waiting for her.
When Vega arrived, five others were waiting; it was what's called a "pumping party." Those getting major work - adjustments of the hips, buttocks and thighs - went first because Michelle didn't want to run out of silicone for clients spending the most.
When it was her turn, Vega went into her friend's bedroom and saw a hospital bed, which Michelle had rented. That made Vega feel safe.
Tools were laid out on white towels on a dresser. Michelle was adamant about not using a needle twice; she liked for you to see a fresh needle coming out of a pack, Vega said, and after she was done she would drop it into a biomedical waste container. She even changed the sheets after each customer.
"She wanted you to feel like you were coming into a doctor's office," Vega said.
Michelle numbed Vega with Novocain and, for $150, shot silicone into her face, starting at her temples and working down the side, with special emphasis on the fleshy area of the cheeks nicknamed the "apple."
"The girls would be waiting for you to come out," Vega said, "and they'd say, 'Ooh, girl, that is flawless' or, 'I love it,' "
State law makes it illegal to perform such procedures without a license. But it's a healthy little industry in Hampton Roads, according to local transgender people, medical workers and a statewide transgender health survey.
The survey, conducted two years ago by researchers at Virginia Commonwealth University for the Virginia Department of Health, found that the eastern region of Virginia, including Hampton Roads, had the highest number of respondents in the state who admitted to getting silicone injections.
Three transgender people interviewed for this story - Vega and two others who did not want to be named because they still get pumped - said there are two to four practitioners in Hampton Roads, each with a thriving customer base.
Last August, a transgender woman named Frances White was arrested in Suffolk for injecting people with silicone in the lips, cheeks and breasts. She pleaded guilty in December and was sentenced to five years of supervised probation.
"If there is any humor in it," said De Sube, a Norfolk transgender woman and activist for the Hampton Roads gay, lesbian, bisexual and trans community, "it's that she was charged with 'practicing medicine without a license.' What she was doing isn't medicine."
Peggy Meder, a registered nurse who runs Skin, a Norfolk medical spa specializing in cosmetic injections, has been so concerned about pumping locally that she's extended discounts to transgender people, so they'd have an alternative.
"Are these people medically trained?" she asks. "Do they clean needles? If a person gets an infection, where do they go? There are all kinds of things that can go wrong, from infection to lumps and bumps on their faces to tissue necrosis - which means the face goes dead. And that's permanent. I have seen skin infections lead to death."
White's arrest was unusual locally, because people within the pumping culture don't snitch. There was speculation that a nemesis or disgruntled customer ratted her out.
"I'm probably the only person in Portsmouth law enforcement that knows what it means to be pumped," said Roberta Monell, a sheriff's deputy who transitioned from male to female years ago. She has never been pumped but said she knows many people who have. "The only way it gets found out is if someone is not happy with the result or there's some dispute over money."
Ordinarily, a transgender person like Vega would begin his transformation by meeting regularly with a psychotherapist. Then he would receive female hormones from a physician, in the form of shots, pills, patches or a combination of them.
Then, after maybe a year, the next step would be small procedures, including electrolysis to remove body hair. Only after all this treatment, at a cost of thousands of dollars, would the patient begin full feminization through plastic surgery. That's $20,000 to $150,000 more, typically not covered by insurance.
"Now imagine yourself coming from the projects facing all this," said De Sube.
At one time, transgender people could have turned to a physician for the liquid silicone, but the potential dangers prompted the U.S. Food and Drug Administration in 1992 - the same year Vega got her first illegal shots - to order doctors to stop offering it.
The FDA approved silicone for fixing detached retinas in 1997, so some doctors have begun using it again, off label, for cosmetics. But it's not recommended.
Many clinics offer other products that are believed to be safer for sculpting the face, but those injections are more expensive than silicone shots offered by unlicensed practitioners, and they're temporary. Silicone is permanent.
In some circles, peer pressure encourages pumping. Especially vulnerable are teens who've been kicked out of their homes after revealing that they want to become women.
These young men are often adopted by a "mother" - another feminine man or transgender woman who heads a tribe. Driven by trauma, low self-esteem and a search for belonging, they turn to pumping as an easy, quick fix. Same for sex workers, for whom appearance is vital. Pumping is a rite of passage. Beauty is just a syringe away.
"They're scared," De Sube said. "They aren't stupid. They understand the negative outcome. But they don't have the medical ability to get it the right way. From their perspective, this is life-giving."
Vega hosts a support group for trans women called TS Ladies Talk. They meet twice a month, talking over issues relevant to their community. Pumping comes up every so often, and although Vega does discourage the practice among her peers, she doesn't sermonize.
"The reality is that it's one of those things that girls are just going to do," she said.
One way of minimizing the practice, the study from VCU and the Virginia Department of Health concluded, is to offer transgender people safer, more affordable medical care.
Park Place Medical Center in Norfolk started a program in April called Transition Your Life Clinic, in part as a response to the study.
The idea is to encourage transgender people to get routine health screenings and to discourage behaviors that could result in HIV infections. The program is modeled after Richmond's Fan Free Clinic, which draws people from all over the state and is known for its transgender outreach program.
For half a day on Fridays, staff members at the cozy Park Place clinic see up to six trans people. Some can get prescriptions for hormones instead of buying them on the black market. The program is being paid for by the Health Department and a donation from the MAC cosmetic company's AIDS fund.
"The basic concept is that if you make people feel good about themselves, the more likely they are to protect themselves and take care of their bodies," said Dr. Subir Vij, a doctor at the clinic. "The reality is that many transgender people do not have doctors. They don't feel comfortable going to other routine providers. We want to create that safe feeling for them and eventually have them adopt Park Place Medical Center as their home."
Specialized medical care has been hard to find locally for transgender people - even those who don't pump. When Tona Brown, a classical violinist living in Norfolk, was transitioning from man to woman in 2003, she had to go to Baltimore to find an endocrinologist.
She knows that there are people who will deem her transgender peers unworthy of sympathy, because, well, shouldn't common sense stop them from getting shots with a used syringe full of silicone from a hardware store?
"People know they're not supposed to have unprotected sex or use drugs, but they still do it," Brown said. "You have to put yourself in their shoes. Be empathetic. What if you had breasts and you didn't want them, and someone said they could remove them for $300?"
That's the thing with pumping: It is so fast and so cheap that it's very tempting. But then, the dream of a better life can quickly become a nightmare. One woman who has been pumped, but asked not to be named, said silicone "doctors" will sometimes half-joke, "Girl, if anything happens, I'm dropping you off in a Dum pster."
Vega knows well what happens when pumping goes wrong, after that night six years ago.
A friend had offered to do the work as a way of advertising her expertise. She gave Vega a discount.
Vega had reservations but went ahead anyway. What could go wrong?
After three injections, she started getting worried.
"I'm more a lady," she said. "I didn't want a gigantic butt and wide hips, but she started pumping me really wider and wider. I said, 'You have to stop.' "
On the fourth shot, she began to bleed uncontrollably. Bleeding is common in pumping, and sometimes to contain it, the "doctor" will dab a bit of household glue on the site. But Vega didn't want glue on an open wound, and anyway, no glue would hold this in - blood was gushing everywhere.
"I was scared," Vega said.
A few hours later, she was wheezing, totally out of breath.
"It was like my lungs were giving out."
She called her friend, who had pumped herself in the breast that same night; she was also feeling bad. At around 5:30 a.m., they went to the emergency room.
"On the way, she was afraid of me pointing at her as the one who did it," Vega said. "I told her I would never tell them who did it, but I did tell her that I would have to let them know I had injections."
She'd gotten a bad grade of silicone, an ER doctor said. The substance had already caused an infection that had begun migrating to her lungs. Doctors gave her antibiotics, and she remained hospitalized for two days. Her friend didn't have insurance and had to be released sooner, but she didn't suffer any lasting harm.
In the following weeks, bruises appeared on Vega's legs. Eventually she had plastic surgeries to correct the work; one doctor cut into her face to scrape out silicone that had solidified. In another, silicone was sucked out of her hips with a medical vacuum. She wore tubes in her hips for four months.
She regrets her bad luck, but not necessarily the pumping.
"There are so many success stories that would outweigh the bad ones," she said. "There are lovely, lovely girls out here that have had silicone done the illegal way and have not had any problems for years.
"It's that instant gratification of seeing the result right there, versus going to the plastic surgeon if you don't have the money. So, honestly, I think I would possibly consider doing it again."
Malcolm Venable, (757) 446-2662, malcolm.venable@pilotonline.com
I think it's a travesty and a shame that one of the wealthiest countries on the planet has such piss poor health care for its citizens, and it is an embarrassment to me as an American we don't have Universal Single Payer health care like other comparable industrialized nations. 
