Top Surgery when not on Testosterone

[Bimmer Guy]

Hi, Guys. 

I mentioned in several places that I had top surgery with Garramone on 10/10/13.  I am very pleased with the results.  I define as a transguy/transgender, not as transexual/FTM, and I am not on testosterone.  I just wanted to throw a thread on here for the TG guy/genderqueer who is not on testosterone and may be searching for a thread on the possible results of top surgery for themselves.

I can confidently tell you that it looks great and I have some muscle definition I did not expect.  I know it is early in the game, but Garramone was quick to point out that a portion of the pec definition is my own, and not swelling.  I don't know if it is his surgical hand or just my natural build (I would say that in general I have more natural muscle mass than the average bio female), but the definition is noticable. 

I am not a youtube person, but I was only able to find 3 videos of non-T people who got the surgery.  I know I would have appreciated more videos of this type, so I think I will post one.

So, to the people out there who are not on T, yet want surgery, be assured your chest can still look defined if you naturally have the muscle mass/build the muscle mass!

[aleon515]

I don't even know that he has a preference to do this pre-T or no T. Some doctors do. I don't know anybody personally who is not on T, but i do know people who got pretty awesome results who were not on T too long. I think the sklll of the surgeon plays very high here.

--Jay

[Alexthecat]

I will be having Top surgery in January and will not be on T.

[Bimmer Guy]

I will be having Top surgery in January and will not be on T.

  Are you planning on going on T in the future?

[lou7]

I thought you needed to start T first. Everything I've been reading or heard is start T before you do anything. Thanks for sharing this I was wondering.

[Alexthecat]

  Are you planning on going on T in the future?

I am still undecided. I was thinking about going to an endo to check my levels first. Then see about an estrogen blocker to block it from my brain to see if that makes me feel differently. Then maybe T on a trial basis if that is right. I'm not starting any of that until I'm healed from my surgery though. Plus then my insurance deductible will be maxed from the top surgery and the endo and any meds should be free then.

[aleon515]

I thought you needed to start T first. Everything I've been reading or heard is start T before you do anything. Thanks for sharing this I was wondering.

Just not true. Perhaps it was at one point, not so much for the results but because that was one way the surgeon would know you were "serious". There are people who never go on T for whatever reasons and have top surgery, and there are others who have such big chesticles they feel it would be silly to start growing facial hair and so on and have them, so they opt for the surgery first.

I've been on T for 8 months and really don't have that much in the way of pecs, even did push ups and planks, still not. i am gathering it is more my age. I think I have nice results so I don't even think pec development is an absolute necessity. Just nice to have! Your going to have a muscle there, which they can see as they are cutting into you. I know not a nice little detail to contemplate, but I saw a video where Dr. Medelie actually does a double incision. You can see the chest wall right there.

@Alexthecat--another option might be a low dose of T, might be a LOT cheaper than blockers which are in the thousands. You might check out neutrosis.me blog as he does this. Has good info.


--Jay

[Alexthecat]

I read his blog but I wasn't aware of exactly how it works. The low dose of T cancels out the naturally produced E?

[aleon515]

I read his blog but I wasn't aware of exactly how it works. The low dose of T cancels out the naturally produced E?

Might be. But it is a LOT cheaper than blockers and off the OP.
I'd be happy to answer what I know if you want to repost under the T section here. I researched it at one point.

--Jay

[mooncab]

Has anyone heard of folks not on T getting top surgery covered by insurance?

[Bimmer Guy]

Has anyone heard of folks not on T getting top surgery covered by insurance?

That's a great question.  I have no idea.  I do know that in order to get tax credits for your tax return you have to state that you have gotten the surgery in order to change your gender.  Since I am not seeking to change my gender (I do not take T), I can't claim the surgery costs.  I would have to wonder if there is an expectation that you sign something saying this is the purpose of your surgery for your insurance company.  Let us know what you find out!

[fightlikeoctopus]

I am very early on in my process of becoming who I am, but I hope to pursue top surgery in the near future, probably without T. Can someone tell me what general requirements need to be met before one can have top surgery? I'm going to a gender therapist for the first time next week and I've heard talk of people needing letters for surgery. Is it more difficult to obtain a letter if you aren't on T or aren't planning to fully transition?

[King Malachite]

I am very early on in my process of becoming who I am, but I hope to pursue top surgery in the near future, probably without T. Can someone tell me what general requirements need to be met before one can have top surgery? I'm going to a gender therapist for the first time next week and I've heard talk of people needing letters for surgery. Is it more difficult to obtain a letter if you aren't on T or aren't planning to fully transition?

I think it largely depends on the surgeon you go to and your gender therapist, but I wouldn't necessarily think that it would be harder as long as you make your intentions clears.  I told my therapist that I wanted to get top surgery done, yet still live as a female for a certain amount of time and she was fine with that, and based off of my preferred surgeon's website, he doesn't seem to mind either.  He just needs the letter of reccomendation, which my therapist will write as soon as I have the funds ready so it's definately possible.

[KC]

I am NOT on T and I got my surgery with Garramone in Sept 2013.  I am also a lazy SOB when it comes to exercise so I didn't even work out even though I know it could have garnered better results.  Regardless the end result was absolutely AWESOME.  As appealing as bulking up on T and having face hair seem.... I am a singer in a touring band and can't have my voice switch up on me.  I have no illusions of "passing" as a man... but to be honest, I don't really care.  I feel very masculine and I am comfortable being sort of in between the lines.  I absolutely HATED my chest before surgery. but now that its gone... Im very happy with where I am at. 
My very cool ONLINE therapist was Marybeth Markham ( http://www.marybethmarkham.com/ ).  Three very comfortable 1hr skype sessions at $100 got me my letter.  She is also a friend and crusader for the queer community.  She fills out the necessary paper work for your surgeon and will even help walk you through gender change forms for whichever state you are from. 

[Bimmer Guy]

I am very early on in my process of becoming who I am, but I hope to pursue top surgery in the near future, probably without T. Can someone tell me what general requirements need to be met before one can have top surgery? I'm going to a gender therapist for the first time next week and I've heard talk of people needing letters for surgery. Is it more difficult to obtain a letter if you aren't on T or aren't planning to fully transition?

WPATH Approved Letters of Recommendation for SRS Includes:

1. The patient's general identifying characteristics.

2. The initial and evolving gender, sexual and other psychiatric diagnoses.

3. The duration of their professional relationship, including the type of psychotherapy or evaluation that the patient underwent.

4. The eligibility criteria that have been met and the mental health professional's rationale for hormone therapy or surgery.

5. The degree to which the patient has followed the Standards of Care to date and the likelihood of future compliance.

6. Whether the author of the report is part of a gender team.

7. That the sender welcomes a phone call to verify the fact that the mental health professional actually wrote the letter as described.

-----------------------
The SOC say that testosterone is not a prerequisite for surgery.  More surgeons are open to working on people who do not define as male.  Dr. Garramone even mentions on his site that he treats "genderqueers".  He no longer requires an extensive letter from a therapist (like the above), but instead the therapist only has to check two boxes.  One states that the person is 18 or older and can give consent.  The second says that the surgery, "is the next step in the transition process".  What "transition" is, is not clarified.  Subsequently, people like me, who are not taking testosterone nor legally changing his sex, qualified for surgery.  If your therapist is supportive of you getting the surgery, I am sure they will write whatever they need to for the surgeon of your choice.

I personally would ask your therapist in the first session if they supply people with letters who are not on testosterone.  No reason to go to them if they don't.

Good luck on your gender journey!

[aleon515]

Dr G's requirements seem to be of the CYA variety. I got a letter, but I do think that checking the boxes works. I am guessing it is all due to perceived WPATH requirements. So many, but not all, surgeons require a letter of some kind. There are some that do not. And some will treat genderqueer folks and those with severe breast dysphoria (I am guessing a lot of these folks are under the trans umbrella even if they don't want to identify that way). AFAIk, that's the only requirement. Obviously you need to be physical fit for surgery (get clearance for surgery), have fairly good lab results, and if you are over 35 some doctors require mammograms. Kind of awful but I survived.

--Jay

[Bimmer Guy]

Dr G's requirements seem to be of the CYA variety. I got a letter, but I do think that checking the boxes works. I am guessing it is all due to perceived WPATH requirements. So many, but not all, surgeons require a letter of some kind. There are some that do not. And some will treat genderqueer folks and those with severe breast dysphoria (I am guessing a lot of these folks are under the trans umbrella even if they don't want to identify that way). AFAIk, that's the only requirement. Obviously you need to be physical fit for surgery (get clearance for surgery), have fairly good lab results, and if you are over 35 some doctors require mammograms. Kind of awful but I survived.

--Jay

Yes, I had my first (and LAST!) mammogram as he requires it for us guys over 35 years old.

[aleon515]

Yes, I had my first (and LAST!) mammogram as he requires it for us guys over 35 years old.

Well maybe not my first but first in decades I think.

Someone asked re: surgery thru insurance without T. I think there are a few possibilities why you would not be on T so this is a very hard question. If you are genderqueer I think it would be very very difficult, I'd say impossible, but maybe it isn't. I don't think insurance is too gungho on doing it if you are actually transitioning and some people do have to fight for it. But there are people, who for whatever reason want to do surgery first. So let's say you have really large chesticles and want to do surgery first. I think that insurance could cover that. However right now most insurance doesn't cover any surgery.

--Jay

[aleon515]

Yeah, that was me who asked about insurance coverage, I've since posted about this in more detail over here: https://www.susans.org/forums/index.php/topic,155298

This is a very good post. I was answering a general question. There MIGHT be insurances out there which do not require T, but I am thinking most would. It would be more of a sign that you are serious and CYA kind of thing. Doctors and hospitals really do a lot of CYA so it's not surprising.

--Jay