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MtF transition - Looking for surgery advice
Squidget0
Registered User regular
Registered User regular
So I started transition a few months ago, MtF, still part-time but I'm already fairly sure that it's what I want to do. I'm also pretty sure that, eventually, I'm going to want to get (bottom) surgery, as living transitioned with male genitala doesn't hold much appeal to me. Recently I've been wondering how I will actually do that, and I'd like to start making a real plan instead of just dreaming. I need to figure out what things I need to do in my life to make it happen. I am hoping there is someone on PA who has either gone through the process, or knows something about it.
1. How does one go about finding a surgeon? I don't think any insurance around here covers SRS (my current and previous ones didn't), so it seems like I'm pretty much on my own in terms of locating someone to do the procedure. There's also huge potential for harm from a failed surgery, so finding a surgeon who knows exactly what they're doing is paramount. From what I've read about this so far, it's substantially cheaper to get this surgery overseas than domestically, and the quality of care can be just as good. In particular I've heard a lot about surgeons in Thailand being both skilled and (hopefully) reasonably priced. I've set aside a good amount of savings for this, but obviously I'd much rather spend $10K than $30K, if it's giving me the same quality of care. Are there groups or websites that can help me locate a good reputable surgeon, especially overseas? Some kind of searchable online database?
2. How long do people usually wait between making the decision and getting the surgery? My current timeline is to get it 8-12 months from now, but I don't know what waiting periods are like, or exactly what I'll need to go through. I'm a few months into HRT and not currently full-time, as I'm still working on voice and other things. Is 8-12 months a realistic goal under those circumstances?
3. What kind of hoops/gatekeeping should I expect to have to go through to actually get this done? A lot of the places I've looked at seem to require 1-2 therapist letters, x years of RLE, or other arbitrary things. Am I going to have difficulty finding a surgeon without a lot of restrictions? I went through a psyche evaluation for HRT, and while the therapist was good, it's not something I'm interested in spending a whole lot of additional money/time on. My current insurance doesn't cover mental health, so therapy time would add substantially to the projected cost. What ways are there to fulfill the common requirements without investing a huge amount of time/money?
4. From reading around, it sounds like there are several different procedures one can actually have done, all of which aim for similar results. Is there a place where I can read an overview and get a better idea of the pros and cons of each technique?
Any other general SRS-related advice is also welcome, as it's still a new (and scary!) idea for me.
Obviously this is a sensitive topic for some, so feel free to PM me if you prefer privacy.
Thanks for any help!
1. How does one go about finding a surgeon? I don't think any insurance around here covers SRS (my current and previous ones didn't), so it seems like I'm pretty much on my own in terms of locating someone to do the procedure. There's also huge potential for harm from a failed surgery, so finding a surgeon who knows exactly what they're doing is paramount. From what I've read about this so far, it's substantially cheaper to get this surgery overseas than domestically, and the quality of care can be just as good. In particular I've heard a lot about surgeons in Thailand being both skilled and (hopefully) reasonably priced. I've set aside a good amount of savings for this, but obviously I'd much rather spend $10K than $30K, if it's giving me the same quality of care. Are there groups or websites that can help me locate a good reputable surgeon, especially overseas? Some kind of searchable online database?
2. How long do people usually wait between making the decision and getting the surgery? My current timeline is to get it 8-12 months from now, but I don't know what waiting periods are like, or exactly what I'll need to go through. I'm a few months into HRT and not currently full-time, as I'm still working on voice and other things. Is 8-12 months a realistic goal under those circumstances?
3. What kind of hoops/gatekeeping should I expect to have to go through to actually get this done? A lot of the places I've looked at seem to require 1-2 therapist letters, x years of RLE, or other arbitrary things. Am I going to have difficulty finding a surgeon without a lot of restrictions? I went through a psyche evaluation for HRT, and while the therapist was good, it's not something I'm interested in spending a whole lot of additional money/time on. My current insurance doesn't cover mental health, so therapy time would add substantially to the projected cost. What ways are there to fulfill the common requirements without investing a huge amount of time/money?
4. From reading around, it sounds like there are several different procedures one can actually have done, all of which aim for similar results. Is there a place where I can read an overview and get a better idea of the pros and cons of each technique?
Any other general SRS-related advice is also welcome, as it's still a new (and scary!) idea for me.
Obviously this is a sensitive topic for some, so feel free to PM me if you prefer privacy.
Thanks for any help!
Squidget0 on
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thailand has a pretty good reputation for medical tourism generally but i don't know anything of use here.
#2 and #3 are going to be determined in part by what is best practice but also what your specific surgeon wants.
I went through my srs early un 2012.
1. This seems like a reasonably well out together website with required info: http://www.tssurgeryguide.com/Welcome.html
Finding a surgeon is going to require a lot of research and talking to various surgeons. I researched a bit the other surgeons and found that all the 'big name' surgeons do good work, and with Quebec medicare covering him, and him only being an hour away from me sealed going to Dr. Brassard in Montreal as a foregone conclusion
I've also heard very good things about Dr. Marcy Bowers in the states, and some good things about Dr. Suporn in Thailand. There are some websites out there which will show you some post-op photos that each surgeon has been completed, though they may be out of date, and I'm pretty sure linking them would be strictly no-no on these forums.
And yes, there are serious risks to the surgery, from the standard "you may not wake up" risks associated with all surgery, to "you may not be happy with the aesthetic results" to "you may never be able to orgasm again".
Honestly, those risks are going to be there with every surgeon, though with the bigger names it'll be diminished as much as reasonably possible.
Like, one phase of showing your therapist that you're ready for the surgery will likely be that you've accepted the possibility that you'd never be able to orgasm again, and still want to go through with the surgery.
Look around at the surgeons and their results, and decide which one looks best for you. Always keep in mind however that natal vaginas are drastically varied in their looks, and generally all the surgeons produce work which visually 'passes' as one form on vagina or another. Its basically looking at a bunch of vaginas and determining which one looks right for you.
2+3. Most of the surgeons you'd want to go to will require (based on WPATH standards, the last time I checked hte standards was a year or two ago):
1 - Referral for SRS from primary care therapist. In general the standards require that the therapist wait until at least one year has passed while on hormones.
2 - Referral for SRS from secondary care therapist. This is a lot less exhaustive than primary care. /I only had to go see a second therapist twice to get that referral.
3 - Note from your doctor on how long you've been taking hormones ( at least a year required by standards)
4 - Note from a doctor saying that you are physically healthy enough to survive a surgery.
In general, the kinds of surgeons who don't require that information, aren't exactly the kinds of surgeons you want working on you?
So the timeline you're generally looking at based on the WPATH guidelines is something like:
0 months - start seeing therapist
3 months later - get hormone referral
12 months after hormone referral - get SRS referral.
My waiting time between when I sent all my documents to the surgeon and when I got my surgery date was about 10 months, but that was because mine was being paid by medicare. I talked to the office staff and was told that if I were paying cash, the wait time would be
1-2 months.
Some other surgeons may be more or less busy, the impression I get is that Dr. Bowers is extremely busy so her wait time may be longer.
Those are the absolute minimums in terms of time, and while it may suck, it may be better for you to take longer time though. That's something you will have to go through with your therapist.
Most important part: keep in mind that transitioning isn't just a race to SRS. There's a lot of growth and self-development to go through to get there.
Is there a way to fulfill the requirements without a huge amount of time and money?
Not really, sorry
I'm not sure about #4, you could try reading that website above, but to be honest I never went too far into it when I was researching.
Other advice:
Be prepared for a long recovery period.
Like, one year kind of recovery period.
Dilating takes a long time as well. For the first month after my surgery I had to dilate 4x per day, and each time wound up taking about 1.5 hours. This decreases as the months go by, until after a year you should be at 1x per week for about 30 minutes. (this is lifelong as well).
You will almost certainly be told to stop taking hormones 3 weeks before the surgery and for 1 month after the surgery because of blood clotting risks.
Some surgeons may require laser hair removal/electrolysis on the genital area before operating, some may not. That's something which you'll have to bring up when you research/talk to various surgical offices.
Also check how long they keep you after the surgery. Personally I'd make sure they have the ability to keep you for a week post surgery before sending you home.
If I think of anything more I'll let you know
Good luck!
http://www.thedailybeast.com/articles/2014/08/25/obamacare-now-pays-for-gender-reassignment.html
Even if the insurance says they won't cover it, you could try bringing that up and telling them they need to cover it?
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Thailand's reputation is mostly undeserved as far as I hear. There's definitely good doctors over, but there's also a shitload of people who need corrective surgery afterwords. I wish I could cite who told me this, but they asked to remain anonymous - so take that how you will.
Also, I know what you meant, Squidget, but let's not refer to a penis as "male" genitalia since there are plenty of women who have one.
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Obviously a lot of research ahead. I really appreciate all of the advice.
Well crud. Just do everything dubh and psykoma say
Also trans girl picture party!
This is extremely true. It's definitely worth just typing like, "vulva" into Google image search just to see the crazy diversity, if you're getting hung up on tiny things.
The highest and lowest rated (from personal experience) surgeons I got recommendations about were both from there.
I think most of the essentials have already been covered, since we have a boatload of awesome people here.
This however
Isn't correct. WPATH is a guideline, not a hard and fast rule. Both the surgeons I considered (Bowers and Suporn) had the same requirement: one year RLE. The letter requirment was different- Bowers wanted two, Suporn one, and my regular therapist was fine (they require two, but apparently do the second as part of the pre-op workup)
I was out for less than a month before starting HRT; by the time I have SRS it'll be about 18 months, total. That chart would have added several months to HRT and nearly half a year to SRS for me. The important thing is to go at the pace that works for you.
Time wise, if you're certain SRS is for you, start looking into things shortly after you're out 100% of the time. Bowers currently has over a year wait time, Suporn is about 8 months, I'm sure many others are similar. It meshes up fairly well with the time delay WPATH wants.
Technique is kind of hard to judge, unfortunately. Surgeons being surgeons, they all think they've got the best results. Your best bet is probably to figure out what's important to you, results wise, narrow down your choices, and email your top several options with questions about timing, methods, results, etc.
Cost- for me, the difference between US and Thailand was about 9000 + hair removal costs. Keep in mind though that you'll be in for a very long and either very expensive or very uncomfortable plane ride if you go that route.
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One thing that worries me time-wise is I recall reading that extended time on hormones tends to shrink the genitals, and that makes the surgery more difficult and dangerous to perform. Is there truth to that? Some surgeons on the TSSurgeryGuide site mention that they can take skin grafts from elsewhere, but I'd imagine that adds to the risk of the process?
Thinking about it more, I think I could probably get a therapist letter from my old therapist without too much hassle, in six months time or so once I'm out more often. He was very accommodating with my hormone letter (that only took 3 sessions), and we had even discussed the possibility of a future surgery at that time.
Reading around the tssurgeryguide site, it seems like surgeons overseas charge about 1/3rd of what local surgeons do. Because of that, I suspect I'll look at those first, and see if I can find someone with an excellent record of performing the surgery. I'm lucky to be able to afford this at all, and there is no question in my mind that a rougher recovery and a long painful plane ride is worth $20K. That's more a question for later though, once I start researching and speaking to specific surgeons.
I'm still pretty terrified of the idea, mostly fear of death or disfigurement. But if someone came up to me tomorrow and offered me the surgery I would take it in a heartbeat, so there's that.
As far as understanding the effects hormones will have on your genitals, look for surgeons that will grant you a consultation and are ready to answer all your questions. Some endocrinologists might have an idea, as well. I am pretty sure it takes a while before the shrinkage can get that extreme - but don't cite me on it.
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I've been on hormones for three years and there's been some considerable shrinkage. But, see, the thing is, the skin hasn't shrunk, just the testicles. My sack is just as big as ever.
Just with two little peanuts in there.
I've been on hormones for two years, five months and mine have shrunk by at least half but probably more like two thirds
As for the penis itself, mine was never anything to brag about, but it's probably 10-15% smaller than it was before. I'm not worried about it much though because, like my sis, I have an abundance of sack flesh
e:
Don't.
You can find him at http://www.drspiegel.com/
Good luck on your journey.
Hospital stay was three days, followed by three days more at a hotel, and then I was able to fly home. Already feeling significantly better.
Its been a crazy journey, thank you everyone for all the help and well-wishes.