Surgery questions in general

[LoriLorenz]

Hey gang,

I've been out of communication for a bit, but there's a very good reason behind it. I have a few questions that I'd like to have some ideas on, as I'm trying to plan out some things.

When the psych writes a letter for surgery, what is entailed in that?
How long does that letter last?
Does it count for both upper and lower or are they separate letters for each procedure?
What, generally, is the timeline from letter to surgery date (best guess or average is fine)?
How soon after starting T is it okay to have surgeries?

Thanks for your help.
Lorenz

[Ian68]

You do not have to ever take testosterone to have top surgery.  If you plan to have an oopherectomy, you will have to be on some form of HRT for life, basically.

If you're already on T, the doctors will most likely want to have monitored your blood levels for about 3 months before surgery - this is medically smarter but that doesn't mean they'd require it.

You need one letter from (preferably) a counselor but it may come from your endocrinologist for top surgery.  I wouldn't plan to use that letter after more than a year has elapsed because re-evaluation is medically in your best interest in that situation.

Bottom surgery (metoidioplasty, phalloplasty) require two letter, and one must be from a counselor - this is a separate letter than the one written for top surgery.  You should not expect a letter for bottom surgery sooner than about three years after starting to see at least one of the referring doctors; it may be that they'll write the letter a year in or it could be five years, it is completely individual.  Also, the more you've already done to physically transition, the faster you're likely to get a letter for bottom surgery.

Hope that helps.  For more info, check the WPATH Standards of Care.

[FTMax]

When the psych writes a letter for surgery, what is entailed in that?
How long does that letter last?
Does it count for both upper and lower or are they separate letters for each procedure?
What, generally, is the timeline from letter to surgery date (best guess or average is fine)?
How soon after starting T is it okay to have surgeries?

Hey Lorenz,

My letter was 5 pages long and detailed from childhood to present, and discussed how my understanding of my gender had evolved. It also explicitly stated that top surgery was the next move for me. There is a date on the top of it that it was written, but I don't think it expires at all.

You'll need 2 more letters for bottom surgery. My top surgery letter could not be used for bottom surgery, but the therapist could write me an additional letter for bottom surgery. For most surgeons, they require (1) letter for top surgery and (2) letters for bottom surgery. My therapist had an arrangement with a second therapist who was willing to write a secondary letter.

I started therapy in October 2014. Switched to a new therapist on Thanksgiving 2014. Spoke with him for 3 sessions (basically through the end of December 2014). Had my top surgery consult February 2nd, and had top surgery April 21st. You don't need a letter to get a consultation, so you can start meeting with surgeons whenever you'd like. My surgeon wanted the letter at her office 3 weeks prior to surgery.

You don't need to be on T to have surgery, so that number will be different for everyone. I've been on it for basically five months at this point.

[Adam (birkin)]

Hey gang,

I've been out of communication for a bit, but there's a very good reason behind it. I have a few questions that I'd like to have some ideas on, as I'm trying to plan out some things.

When the psych writes a letter for surgery, what is entailed in that?
How long does that letter last?
Does it count for both upper and lower or are they separate letters for each procedure?
What, generally, is the timeline from letter to surgery date (best guess or average is fine)?
How soon after starting T is it okay to have surgeries?

Thanks for your help.
Lorenz

Let's see, in my experience this is how it went.

I cut ties with the official gender psych because they teed me off, lol. The psychologist I see for other stuff doesn't have experience in diagnosing GD, but the letter was accepted nevertheless. She basically outlined how long she has known me, that I was living as male in that time and seemed comfortable and certain in doing so, and what she knew of my history (that I had seen some formal GD psychs in the past). If I remember correctly she said that she felt the surgery would be a good thing for me as well from what she knew of me.

Because of confidentiality, she only had the letter last until about a week after the surgery was due to take place. After that, the letter and the revealing information would no longer be valid and I would have to request another one in order for my information to be released.

Mine was only for the one surgery. I suppose, in theory, you could try to use one letter for both - but given that they will be happening probably years apart, I imagine a doctor for the later surgery may want something more recent. I guess it depends.

I got my letter probably two or three weeks before surgery. I had the operation booked and they said to have a letter ready before the day of operation. So I went to my psych right away and she gave it and then the day of the surgery I presented them the letter.

My understanding is that there really isn't any timeline for surgeries in relation to HRT. That being said though, I had my surgery right in the middle of the two weeks of my shot and they said that was fine. However, if my injection had been on a different day, I couldn't have taken my injection too soon before or after (like a few days I think they said) because the testosterone could impact blood clotting in these vital stages of healing. It just worked out for me that I didn't have to change my shot day.

[MacG]

I'm having top surgery 2.5 months after starting T. I was originally going to wait to start T until after surgery, but my surgery was delayed.
This aspect depends on your surgeon. I suspect I wouldn't want to have surgery any sooner after starting t than I am, since I want to have an idea how my body is responding to the hormonal changes before putting my body through the hardship of surgery.

[aleon515]

My  own letter was 1 page long. It was not in the slightest detailed.
Contained this info: how long I was seeing the therapist. He evaluated me as having gender dysphoria. How long and to what extent I have lived as male (that in itself is not actually required to get top surgery-- since some surgeons do surgery on women with chest dysphoria). What I was doing in my transition (again T isn't required). That I had realistic expectations re: top surgery. That I was capable of making informed consent re: surgery. You can contact him for more info, and contacts as well as certification number. (This is what they REALLY want. It's in the CYA category.)

There was a checklist Dr G had and I believe he was happy if that's all he got.
(persistent well documented gender dysphoria; can make informed consent; mental health issues are treated and accounted for; has been evaluated; duration of therapist relationship; therapist available to consult.)


I honestly do NOT think a surgeon reads 5 pages. Well most do not. But if that's what the therapist does that's what you get.

--Jay

[Bimmer Guy]

My  own letter was 1 page long. It was not in the slightest detailed.
Contained this info: how long I was seeing the therapist. He evaluated me as having gender dysphoria. How long and to what extent I have lived as male (that in itself is not actually required to get top surgery-- since some surgeons do surgery on women with chest dysphoria). What I was doing in my transition (again T isn't required). That I had realistic expectations re: top surgery. That I was capable of making informed consent re: surgery. You can contact him for more info, and contacts as well as certification number. (This is what they REALLY want. It's in the CYA category.)

There was a checklist Dr G had and I believe he was happy if that's all he got.
(persistent well documented gender dysphoria; can make informed consent; mental health issues are treated and accounted for; has been evaluated; duration of therapist relationship; therapist available to consult.)


I honestly do NOT think a surgeon reads 5 pages. Well most do not. But if that's what the therapist does that's what you get.

--Jay

Yep, all I did was check off the two boxes for Garramone (actually, now his form has them checked off for you).  All I did was hand it to the therapist and have her sign it.  One stroke of a pen.

[LoriLorenz]

Thanks guys,

I'm in the decision making point of transitioning, got my assessment and it's been sent off to the endo and things seem to be falling into place pretty well. the psych I saw mentioned that I need to take care of getting out of my current morass of pain before we should consider any surgery, and I agree, but I'm eager beaver here and want to know deets!!!

[AeroZeppelin92]

thought maybe this would be helpful, I had a digital copy of my letter on hand to present as an example. as you can see my letter is very short and sweet but got the job done, I'm scheduled for top surgery this July.

[aleon515]

Actually not too different from mine. Simple and sweet. Mine was maybe a paragraph longer.

--Jay

thought maybe this would be helpful, I had a digital copy of my letter on hand to present as an example. as you can see my letter is very short and sweet but got the job done, I'm scheduled for top surgery this July.

[Jameson]

Congrats on getting things lined up for beginning. I have been investigating and trying to get things in order for myself as well. My life circumstances have lined up in such a way that I am ready to do the top surgery asap. Unfortunately, like you, I have pain issues taking precedence. It looks like spinal surgery will have to come first.

One thing I wanted to mention is about HRT, I recently consulted about  having my hysto and was told that research and current thinking have changed and HRT after hysto is no longer default or even necessarily desired. I was afraid of having HRT required because of a bone density issue and was looking at T as an alternate route. It turns out that if desired, no HRT of any sort is required and bone density is now being treated as a stand alone issue.

I would still want to go the T route for a while at least for the voice change, it's nice to know there are new studies providing more options.

I just wish I could get my top surgery first.