Susan's Place Transgender Resources

I recently started full-time and want to start the process for SRS, since I know there's a long lead time.

When I checked with my insurance, it turns out the surgeon in NYC (Dr. Jess Ting, at Mt. Sinai) is not in network, but for some reason, Marci Bowers was listed as one of Mt. Sinai's SRS surgeons, and she is, so I looked her up.

I notice she writes that she won't consider surgery for anyone over 210 lbs.  I am around 260 or so.

Is this a universal requirement?  Or are there other surgeons who don't require this?

The surgeon I will be seeing for my modified top surgery wants me to get down to 235 pounds before she'll even talk to me So far I've lost 45 pounds, with 25 pounds to go. To get meta I have to lose a lot more than that.

For most doctors it depends on height/BMI - no one would expect a 6'5 person to be 210 pounds.

Asche this is a difficult reality for many of us.  GC surgical clinics in the US can and do write their own rules and that may seem arbitrary and capricious.  Statistically, obesity does correlate with greater risk and potentially more surgical and anesthesia challenges.  After a career in anesthesia i believe that an active person who does not smoke or abuse ETOH is a better candidate overall regardless of size.

BMI is a crude guide and may not really reflect good health, vigor or fitness.  As your post suggests you may have the option of shopping around.  Some surgeons may also be open to an appeal based on a more comprehensive evaluation of ones fitness to proceed.  There are more than a few of us watching the scales. ;)

Dr. McGinn has a limit of a 26 BMI . Although, I have heard from one person that was higher. Dr. McGinn said less anesthesia is administered. When I had GCS my BMI was 24 and I had a good amount of muscle. In my GCS area there is more fat than typical for an XY person. She said fat is not a good support for blood circulation and thus healing.

It very much depends on the surgeon; I ruled out McGinn in large part because I don't think BMI is a good indicator of health, so I don't trust any surgeon who has a hard BMI limit. I went with Brassard, who said he'd "prefer" for me to lose weight but didn't require it (I was 5'7" and 230 lbs). In the end, I focused on getting in the best shape I could - and my GP wrote a letter saying that I was in great health and an excellent candidate for surgery - and I also ended up losing about 20 lbs before GRS. I had no issues or complications related to weight whatsoever; the only problem I had was bladder spasms from the catheter. So I'm another who thinks fitness is a much better predictor than weight alone of whether someone will handle GRS well.

I'm 6ft 201lbs with a a bmi of 28 and had my surgery this morning with brassard. You should consider him if you can


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Quote from: Asche on February 08, 2017, 03:01:05 PM
....
When I checked with my insurance, it turns out the surgeon in NYC (Dr. Jess Ting, at Mt. Sinai) is not in network, but for some reason, Marci Bowers was listed as one of Mt. Sinai's SRS surgeons, and she is, so I looked her up.
...

Marci Bowers only performs surgery there on occasion mostly for teaching purposes and surgery there is billed through Mt Sinai not through Marci Bowers.

Have you checked to see if Dr Bluebond-Langner and NYU Hospital is on your network? (She is on BCBS Blue Network)

I'm having a consult with her in April and if I really like her, I'll use her instead of Dr. Heidi Wittenberg in San Francisco due to the proximity to where I live. It's only a 30 min Uber ride to the NYU Hospital from our house in NJ. (without Traffic)

She recently moved to the area from Baltimore. A friend of mine just had her surgery with her a few weeks ago and she is very happy with the results.

Quote from: Asche on February 08, 2017, 03:01:05 PM
....
I notice she writes that she won't consider surgery for anyone over 210 lbs.  I am around 260 or so.

Is this a universal requirement?  Or are there other surgeons who don't require this?

This varies surgeon to surgeon. I know McGinn is the strictest and prefers a 26 or lower BMO but will allow a 30 BMI for certain cases. She will not do it if you are over. I know someone that was 4 lbs over the BMI on operating day and would not do it. Dr Wittenberg will perform surgery up to 40 BMI (if your tall like me and I'm currently 30 BMI at 6'5"), but she prefers if your BMI is 30 or under.

BMI is not a great indicator for those over 6'. If you look at the BMI for tall basketball players who are perfectly healthy, many of them are considered overweight ( https://bmicalculator.mes.fm/sports/top-10-nba-player-bmi/10 ) with a BMI over 25.

Quote from: Sydney_NYC on February 08, 2017, 10:43:31 PM
BMI is not a great indicator for those over 6'. If you look at the BMI for tall basketball players who are perfectly healthy, many of them are considered overweight ( https://bmicalculator.mes.fm/sports/top-10-nba-player-bmi/10 ) with a BMI over 25.

But those are men!  They are professional male athletes with ridiculous amounts of muscle (and muscle weighs more than fat).  We have the hormonal balance and muscle mass of women.  You need to be comparing us to female WNBA players, not male NBA players.

If you look at the current roster of WNBA players (https://en.wikipedia.org/wiki/List_of_current_WNBA_team_rosters), you will see that the vast majority of those who are over 6' tall have a normal BMI of less than 25.

Quote from: Mirya on February 09, 2017, 02:03:30 AM
But those are men!  They are professional male athletes with ridiculous amounts of muscle (and muscle weighs more than fat).  We have the hormonal balance and muscle mass of women.  You need to be comparing us to female WNBA players, not male NBA players.

If you look at the current roster of WNBA players (https://en.wikipedia.org/wiki/List_of_current_WNBA_team_rosters), you will see that the vast majority of those who are over 6' tall have a normal BMI of less than 25.

Most of those women are under 6'1" and under. Take a look at Zahui B., Amanda from that list. She is 6'5", 250lbs with a BMI of 29.6 (30 and higher is considered Obese), She does NOT look like she is overweight and nearly obese.

(https://www.susans.org/proxy.php?request=http%3A%2F%2Fjge9m26i0ig15ie3p1c2j3lq.wpengine.netdna-cdn.com%2Fwp-content%2Fuploads%2F2016%2F05%2FRS363226_PE2_7443-mar.jpg&hash=9a448dec3df445733aef6a1106c0168e516a73fb)

It's more about skeleton size than muscle. Basketball players are not know for a lot of muscle since playing basketball is more aerobic and endurance than about strength. Athletes with a lot of muscle mass do not do well with endurance compared to an athlete with a normal amount of muscle mass.

BMI is a farcical measurement by height and weight alone.  Either a caliper measurement or waist measurement should be included in those metrics.  I am 5'6" and weigh 163lbs.  My BMI using height and weight?  26.3 and overweight.  Oh, really?
Besides my Lady Gaga pooch, where am I supposed to lose the weight to meet the 'standard' that the NIH uses?
https://drive.google.com/file/d/0B_i9m0dDjayOTHdMU3N3SXh3Mkk/view?usp=sharing

Calling BMI a "farcical measurement" is a little extreme, isn't it?  Granted it's not perfect, but it's accepted by the worldwide medical community as a reasonable measure of obesity.

Anyway, I'm not the one that needs convincing here.  The fact is almost all the top SRS surgeons have a BMI requirement, so the bottom line is regardless of what you believe, you need to meet those requirements for surgery.

Dr Chettawut's BMI limit is 35.  For colon vaginoplasty, it's 28.

Quote from: Mirya on February 09, 2017, 09:30:07 AM
Calling BMI a "farcical measurement" is a little extreme, isn't it?  ...

BMI is a farcical measurement by height and weight alone.  That is not extreme, that is using a standard that is not applicable to all body types, but applying it to all body types - worldwide...
Even my fitbit scale only measures my body fat % if I weigh barefoot because it takes into account your skeletal structure:
"Each quadrant of the scale's glass top contains electrodes. When you stand on it, it sends a small electrical current through your feet and into your body to measure how much fat you're carrying."

Quote from: Cailan Jade on February 08, 2017, 03:05:36 PM
To get meta I have to lose a lot more than that.

  Okay Cailan et al,

    I do not want to derail the thread, but....

  I've see this "meta" a few times now and know not of what your speak.  It is probably due to my extreme age (64) but inquiring minds need to know.

Could someone kindly enlighten this out of touch old fart?

  Jeanette

Metoidioplasty or metaoidioplasty (informally called a meto or meta) is a female-to-male sex reassignment surgery.

Mirya: Or you find a top-notch surgeon who doesn't have that rule. ;) As I said, I did not "need to meet those requirements." (Brassard indicated that the only hard cutoff was the weight limit of the surgical table, which I presume would apply even if someone were ten feet tall with a BMI of 20.)

Not in the USA of course, but Chettawut is BMI 35 and Suporn 30.5.

Quote from: Jenna Marie on February 09, 2017, 11:58:28 AM
Mirya: Or you find a top-notch surgeon who doesn't have that rule. ;) As I said, I did not "need to meet those requirements." (Brassard indicated that the only hard cutoff was the weight limit of the surgical table, which I presume would apply even if someone were ten feet tall with a BMI of 20.)

Same.  Brassard never asked me my BMI, nor told me a BMI requirement.  And he is Top Notch.  So, is Maud Belanger.  When I woke up during my surgery she was the one working on me.  I did the spinal with propofol combo and woke up several times.  I went back last year for another issue and Belanger did the work then, too.  Love her!

Ainsley: Yes, Belanger is also fantastic! She was so nice, too.

Quote from: JeanetteLW on February 09, 2017, 10:17:12 AM
  Okay Cailan et al,

    I do not want to derail the thread, but....

  I've see this "meta" a few times now and know not of what your speak.  It is probably due to my extreme age (64) but inquiring minds need to know.

Could someone kindly enlighten this out of touch old fart?

  Jeanette

"Simple release metoidoiplasty," aka "meta" is the least extreme form of female to male sex reassignment surgery. After one to two years on testosterone, the clitoris grows considerably larger.

The clitoris is made of the same material as a penis, and the glans is nearly identical, if smaller. In a woman, it's bent in half and held down by connective tissue. In metoidioplasty that connective tissue is cut, then the entire thing is straightened and repositioned to form a small penis, which can be 2cm to 6 cm long, but usually around 3-4 cm, about the size of a prepubescent boy's penis, and usually looks like it has been circumcised (which it is not). It is fully erectile and functional as a male sex organ, though not usually large enough for penetration. Simple release meta also leaves the vagina fully intact and fully functional, so there are amazing sexual options available.

There are additional procedures that can be done at the same time for a more complete physical transition.

The urethra can be lengthened and rerouted through the new penis structure for urination through the new penis, and the labia can be re-purposed to become a scrotum, including testicle implants. However, the urethra requires a vaginectomy, because it uses part of the vaginal wall to create the urethra extension. The scrotum addition can leave the vagina intact but not sexually functional because the surgery closes off part of the entrance.

Many transmen choose to also have a vaginectomy, hysterectomy and oophorectomy (removal of ovaries) at the same time, usually leaving a natural-looking male perineum.

Meta is often preferred to phalloplasty because the new meta penis is still as sensitive as before, if not more, has natural erections, and still capable of producing multiple orgasms. It also requires less surgical time and recovery.

Thank you Cailan Jade for the education.

   Jeanette

Quote from: ainsley on February 09, 2017, 12:28:24 PM
Same.  Brassard never asked me my BMI, nor told me a BMI requirement.  And he is Top Notch.  So, is Maud Belanger.  When I woke up during my surgery she was the one working on me.  I did the spinal with propofol combo and woke up several times.  I went back last year for another issue and Belanger did the work then, too.  Love her!

When you do your intake day of they do record your bmi using a scale of height and weight. But just before I went in I asked dr brassard if I was too fat with a bmi of 28 he's like we r cord it for the extreme cases but he could tell I am healthy and take care of myself. Which is much more important

I suggest coming to Montreal but I'm a little biased seeing is im posting this from my hospital bed in Montreal


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I actually wasn't even weighed or measured, nor was a close friend of mine who went about five months ago. I wonder if that's a new thing or if they were just busy when we were there. :)

They did that to me on Wednesday so it's anyone's guess


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