Question about the order of surgeries

[Anne_lifetrip]

Dear all,

I have been asking myself why is the genital surgery the last one. Please bear with me my thoughts, as this is a brainstorm...

From my point of view, no one else sees my genitals other than me, or whoever I let. For me, they are my main dysphoria element.
But to be able to reach this surgery, I have to go through other surgeries or more evident changes. But why?.

The reasons I get to identify are:
1. Once the genitals are removed, I will need HRT (for whatever gender I would go for, in my case, Femenine) for the rest of my life, so, no real reason why I can't start there.

2. I believe this might be the key reason...legally?. If unconscious, my ID gender is determined by my ID documents...but, once again, I can change my legal gender, but still have my genitals in place.

3. By medical transition protocol I understand that you need at least one year living with your selected gender, and have a medical professional certify it before having access to the Gender Reaffirming Surgery. I understand it as a failsafe so as to avoid regret after surgery and to make sure you are sure about what you want...but, once again, the justification is bleak.

So...Is there something else I am not reaching to understand?

Please, once again, this is just a thought that I have been having for some time now and I can't get it off my mind.
As you may understand...I am really looking forward to that surgery, but the time will come. In the meantime, I enjoy the process.

Thank you all.
Love

[Tills]

Hi Anne,

Great post and questions!

There's a balance in this process between affirming one's own journey and not being encouraged into something self-harming. At times gender services have veered too far down the latter and have ended up as gatekeepers over something which it is not their right to control. On the other hand, and this is important, nor does any medic wish to encourage behaviour that is dangerous to a patient. This website would concur with that, strongly.

Now I'm not a medic and it's important from the above that you do have a properly qualified physician whom you can also trust to have your best interests at heart, which includes your gender transition.

With all of those caveats in place I don't see any reason why genital surgery should not come early on in the process, once you're sure this is the right step. What you would want to avoid in my opinion is a sudden crash out from testosterone, which you will lose with the operation, and into estrogen. That part of the change really does take a little while as these hormones are powerful things. Your body does also take time to feminise from estrogen but I too cannot see in principle why the genital surgery couldn't be earlier in the process.

Others may disagree and it's good to listen to their experiences on here.

Good luck with your journey!

xx

[Devlyn]

Some of your statements run against the current protocols. Have a good read of the Standards of Care. 

Hugs, Devlyn

[Anne_lifetrip]

Some of your statements run against the current protocols. Have a good read of the Standards of Care. 

I am aware, which is why I have shared this post with all the respect and just as a brainstorm, not making any suggestion that it would be this way.
As I said in my introduction, I am a medical staff and am aware of the Standards of care...but as a medical staff I am also aware that coffee for all is not always THE solution, but the best solution to create protocols and standardization of procedures, which make treatments replicable and able to be followed.

Now I'm not a medic and it's important from the above that you do have a properly qualified physician whom you can also trust to have your best interests at heart, which includes your gender transition.

I believe this is the key to my answer.
 
Thank you very much!
Xxx

[Devlyn]

Ok, just making sure. The "one year in gender" thing stood out to me. Definitely no longer a requirement. 

Hugs, Devlyn

[Allie Jayne]

Anne, surgeries are a deeply personal consideration, and the order of surgeries is entirely up to your needs in terms of dysphoria disruption and other life considerations. The current WPATH Standards do not prescribe a year of real life experience, but there are still doctors and surgeons who haven't caught up. There is still a requirement for a show of commitment, and I believe this includes 6 months of hormones.

Honestly, I believe I could have avoided social transition and all the problems that caused if I could have had genital surgery to alleviate my key dysphoria trigger, but my surgeon followed the old requirements. Needing hormone medication for the rest of my life was a significant concern for me, and remains so given the global shortages we have seen.

You need to assess what is important for you, and how it may affect your life, and proceed guided by those considerations. Surgeries are a serious undertaking, and are not without risk, and I know a few transpeople who have had complications which have left them with lifelong disabilities, so surgeries should be something you need, not something you want.

Hugs,

Allie

[KathyLauren]

In my case, genital surgery was the last one because it was my first and only one.  I needed it.  I didn't need or want the other possible surgeries.

[Anne_lifetrip]

Honestly, I believe I could have avoided social transition and all the problems that caused if I could have had genital surgery to alleviate my key dysphoria trigger, but my surgeon followed the old requirements. Needing hormone medication for the rest of my life was a significant concern for me, and remains so given the global shortages we have seen.

I believe I might be going through something similar in the social transitioning and it would be way easier if that surgery was solved. I have no problem with the 6 month HRT, but the requirements I have been told seem to be following the old protocol.

I an following @Tills recommendation and am currently looking for a practitioner that adapts to me. (I started after reading her post...I hadn't even thought about that option).

Thank you! 
Love

[Anne_lifetrip]

Sooo, update. 
Found another doctor and confirmed that it is not necessary and that those are the old recommendations, such as you told me, and that we can meet to review my situation and needs.
The only issue is that he is fully booked and we might be able to meet by September or so...but it is a complete change of relationship with the practitioner that is managing my case.
I am both excited, thrilled and scared...

Once again, thank you all so much! 

[KathyLauren]

Found another doctor and confirmed that it is not necessary and that those are the old recommendations, such as you told me, and that we can meet to review my situation and needs.

I am delighted that you were able to find a better doctor!  I hope it all works out for you.

[CosmicJoke]

I guess it's last for me because I found the social transition to be more important. I'm going to be brutally honest and even say that I don't know how I would feel about being a woman with a vagina that can't pass as a woman.

I think it's a personal thing for everyone but that's just my take on it.

[Lori Dee]

I don't know how I would feel about being a woman with a vagina that can't pass as a woman.

I think that if you are doing it for others, you are doing it for the wrong reason. In my case, I doubt anyone is going to see it but me (and my doctors), so whether I pass or not isn't relevant to that. I would like clothing to be more comfortable, and from a safety issue, I would prefer my anatomy to match my identification documents.

But from a general "passing" perspective, I refuse to alter my body just to please the public and ease their discomfort with me. If they have a problem with my looks, that is their problem. Something as serious as surgery must be done to please yourself. Everything else is secondary.

[Tills]

I think that if you are doing it for others, you are doing it for the wrong reason. In my case, I doubt anyone is going to see it but me (and my doctors), so whether I pass or not isn't relevant to that. I would like clothing to be more comfortable, and from a safety issue, I would prefer my anatomy to match my identification documents.

But from a general "passing" perspective, I refuse to alter my body just to please the public and ease their discomfort with me. If they have a problem with my looks, that is their problem. Something as serious as surgery must be done to please yourself. Everything else is secondary.

There's such wisdom in your response Lori-Dee. I hope many people will find encouragement now and in the future from such an important post.

[CosmicJoke]

I think there's still a Standards of Care we have to follow to some extent. It's not as strict as the old one, but I think that exists more for the doctors providing hormone therapies and surgeries rather than the patients themselves.

[Michelle_K]

It was my understanding that the certificates are more for the insurance companies. Some even requiring two for each procedure.
That said, the surgeon doing breast augmentation may require a certificate that you have been on estrogen long enough to have full breast growth.
In my case, medicare considers the surgeries to be cosmetic, and will not cover any.

In a magazine long ago, a woman stated that her boyfriend doesn't mind her small breasts. She stuffs her bra to make herself feel better and her clothes fit better.
Michelle