Top Surgery Options Without the Gatekeepers

[debias]

Does anyone know of any resources to get top surgery without going through the gatekeeper BS. I understand councelling and care for trans people to get surgery, but in our province of Alberta, Canada, the wait to see our doc (Warneke) for the letter is rediculious.

First though, a little history. I am 43 and have been trans identified for 20 years. I have a letter to start T from a trans specialist phycologist Dr. Alderson, but not the phyciatrist, ( which sucks because my phycologist did his residency under he phyciatrist ).

Anyway, because of my age and being Type II Diabetic, I ave already been told by my trans friendly doc, that T may not even be an option for me and she wont start refer me until I ave the "official" letter. T, however is the first step, so Ihave been told, so my surgery will be even longer. It worries me that because of my age/ health that the surgery option might be dwindling aswell. These large bags on my chest are the biggest part of my disphoria.

I have been waiting for years to just keep waiting. If T is not an option, I can deal with that, but having to wait longer for top surgery is very frustrating. Which I am sure most transguys can understand.

Suggestions?

[aleon515]

There are several doctors who perform top surgery without the gatekeepers. I know that Dr. Garromone is one. There are others as well. I can't find my list but I can look for it.

OTOH, if you have medical issues that would make top surgery esp. risky then it is going to be harder. For instance if you are injecting insulin or taking oral tablets. You might work on controlling your diabetes thru diet and exercise. People have completely controlled this this way-- look into low glycemic diets. I have heard of many people who eliminated their need for them that way.

You can also take T thru informed consent. But same problem with your health.

OTOH I know of someone in his 50s just starting T. Age itself is not a bar to this, though I think less is known about it.


--Jay Jay

[Kreuzfidel]

Dr. Garramone doesn't require a letter to do top surgery?  Does anyone have links to info about what he charges?  It may be worth flying to the US for if he doesn't need a letter.

[debias]

Sweet, thanks. As for health, I am on pills and a low glycemic index diet. Maybe I should consult another doc then. She maybe using my type II as an excuse.

Thanks for the info guys, Ill check doctor G out.

[MrTesto]

There are many FTMs who are diabetic...perhaps partly because T can increase the risk of developing Type II diabetes. If you already have it, you would benefit from oversight from a doctor who can help manage both conditions.

But I'm confused. If your psychologist is willing to write a letter for T, why do you need one from your psychiatrist? (If that's personal, no need to answer.) You don't need two letters to start hormones, or get top surgery. (You do still need two letters for lower surgery.)

About Garramone: His site says he requires a letter, although you don't need to be on T. And you do need medical clearance from your PCP, and guys over 35 need a mammogram.
http://drgarramone.com/transgenderflorida/html/requirements.html

[aleon515]

There are many FTMs who are diabetic...perhaps partly because T can increase the risk of developing Type II diabetes. If you already have it, you would benefit from oversight from a doctor who can help manage both conditions.

But I'm confused. If your psychologist is willing to write a letter for T, why do you need one from your psychiatrist? (If that's personal, no need to answer.) You don't need two letters to start hormones, or get top surgery. (You do still need two letters for lower surgery.)

About Garramone: His site says he requires a letter, although you don't need to be on T. And you do need medical clearance from your PCP, and guys over 35 need a mammogram.
http://drgarramone.com/transgenderflorida/html/requirements.html

That seems like new info. There are several women (did not id is male or ftm) with severe chest dysphoria who are not typically trans (I don't know some of them may be genderqueer, but that isn't mentioned-- a longer version of the Standards of Care includes gender noncomforming people) who have had surgery with Dr. Garramone.

I think in Australia they require both a psychiatrist and psychologist. Dr. G. is a long way to go for that.

I'll check the reference. As there were other doctors mentioned.

--Jay Jay

[Adam (birkin)]

I went through the same thing he did, and the reason we need to see a psychiatrist after the psychologist is because in order for the government to fund top surgery, they need permission from a doctor they recognize as an "expert" with GID. Just so happens that Dr. Warneke is the only one, but to my understanding he is preparing others to take over for his retirement.

I got the impression that the psychologist does the actual "therapy" portion whereas Dr. W gives final approval and permission for the surgical steps of transition. It makes sense because the waiting list would be longer for Warneke if everyone who needed gender related therapy (but perhaps would not move on with certain aspects of transition) were to see him.

Just for the curious minds lol.

[MrTesto]

It's worth calling Dr G in case his public site guidelines differ from his case-by-case arrangements. (Although if you can link to that list, that would be cool.)

... the reason we need to see a psychiatrist after the psychologist is because in order for the government to fund top surgery, they need permission from a doctor they recognize as an "expert" with GID. ...

Ah, say no more. Here in the US, insurance company coverage for surgery also often requires stricter documentation than the Standards of Care. 

[Robert Scott]

Dr. Tholen in Minneapolis, MN. does not require a letter.

I am type II diabetic and I started T.  I even started with my diabeties wasn't under control.   My primary physican approved it -- since it is considered a medical necessaity in the community of doctors I am in. So, I started T when my a1c was 10.5 - yikes I know.

I have approval for top surgery once my a1c gets under 8 - currently it's 8.5. 

My hormone doctor is a gyno so once my diabeties is more under control I will get the full hysto --- she said because of my advanced age 41 - she saw no point in waiting to do it since it was clear I was not going to have children.

[aleon515]

I think I mentioned Dr. Garramone as he does do surgeries for non-binary people. You still need a letter. There is another list here which is for genderqueer FAAB. Some require letters and some don't.

http://genderqueer.tumblr.com/post/15348879855/resources-for-faab-non-male-identified-people-who-want

Otoh, you need to make sure your medical situation is well controlled. This is not as routine a surgery as some people seem to suggest. It's major surgery where you need to be in good health.. I don't mean you couldn't have medical conditions, but they should be in good control and under treatment.

I think that most doctors in the US require only one letter, but you have to foot the bill here. The government doesn't cover this. The Affordable Care act is basically health insurance reform not "socialized health care".


--Jay Jay

[Felix]

Garramone is on the high end pricewise, but if you call around plastic surgeons and breast cancer specialists you can find people who do top surgery but don't publicize it. The trick is to find someone with experience who can show you good prior work.

[Felix]

I don't know how to address gatekeeping. I'm focused on the money myself and i figure when I get enough money I can make a letter or two happen.

[TwoSpirit]

I don't think Dr Cameron Bowman in Vancouver needs a letter. He's apparently the go-to guy in the western part of Canada. His website is www.fairviewplasticsurgery.com.

Also Dr Hugh McLean in Mississauga (just west of Toronto) doesn't require a letter. His website is http://www.mcleanclinic.com/

Nor do Drs. Marc Dupere or Peter McDougall in Toronto.

And you don't have to be on T to have top surgery, as others have already said.  And just so ya know, I have been binding for over 10 years, now. If money were not an issue, I would have gone to see Dr Dupere, or Dr Beverly Fischer in Baltimore, because they do peri and purse strings with great results on bigger guys. But instead, because I am poor, I had to jump through the CAMH hoops and the only doctor they would cover are the ones in Montreal, who are more skilled with M to Fs than they are with F to Ms, but beggars can't be choosers as they say, and since I have no family nor any other source to ask for help with financing, I must go to Montreal. In less than a week! Yikes! I am nervous.

Oh, and I am also 48, so there are plenty of guys around our age and even older, getting top surgery. I would just focus on getting your body in the best health and shape it can be for surgery, because anesthesia is a lot harder to recover from for us senior citizens.