Susan's Place Transgender Resources

Hi guys,

I'm starting this thread as a way to both keep myself organized and help other people who are starting to investigate and make plans for bottom surgery. This post will probably be a little lengthy, as I'm going to detail everything I've done up to this point. I'm planning to post updates every time there's something worth noting, or every time there's a bunch of things I need to keep track of. Feel free to ask questions, make comments, etc. Thus far I have done the following:

- Research (May 2015 - January 2016): I spent about eight months looking into all of the different bottom surgery procedures, common combinations of them, complications, pros/cons of each, and results from different surgeons. I eliminated several options from my list both in terms of procedures and surgeons. I am settled on full meta with a hysterectomy, vaginectomy, urethral lengthening, scrotoplasty, testicular implants, mons resection, and pubic lift. At least based on what I've researched, that is the likely combination of things that I'll need to achieve the results I want.

- Insurance Inquiry (September 2015): I wrote to my insurance company via email and asked about coverage for the above procedures, specifically asking if they were excluded and if they were not excluded, to tell me in depth about the coverage that I could expect. They responded back in October 2015 and said that all procedures would be covered under my surgical benefits at varying percentages based on whether the provider was in network or out of network.

- Requesting Referrals (September 2015): At my quarterly check-up with my PCP, I requested a referral to the mental health team at the clinic I go to for bottom surgery referrals. They could not start this process until I was officially on testosterone for a year, so this didn't happen until December 2015.

- All Referrals Received (January 2016): I met with a LPC for about half an hour in December 2015 and filled out a questionnaire that they use to fill in their referral letter for bottom surgery. She made an appointment for the end of January with a PhD level psychiatrist who will co-sign her letter in a similar visit. I also requested a letter from my PCP detailing the extent of my HRT treatment.

- Scheduling Consults (January 2016): I scheduled consults with Dr. Schechter and Dr. Bluebond-Langner. I feel confident that both could likely get me good results, but am leaning towards Dr. Schechter and am hoping to have surgery scheduled with him before my consult with Dr. Bluebond-Langner. I am going to keep my appointment with her (as of right now) to get more information for guys who are looking into her as an option.

I'm also running two separate to-do lists as I get closer to having surgery planned - one directly related to the surgery itself, and the other to all the little tasks that need to get done prior to surgery.

For surgery:
- Call Dr. Schechter's office and confirm whether or not he will perform a hysterectomy at the same time as stage 1 of meta.
- Follow up with PCP about scheduling a hysto locally if necessary.
- Get copies of all referral letters.
- Print out email from insurance to take to consult with Schechter.

Other tasks:
- Update name on Mastercard to pay surgery balance with.
- Update name on CareCredit just in case.
- Inquire about Schechter's recommended hotel, start making hotel or airbnb choices.
- Find a dog walker.
- Discuss options with potential caregivers.
- PUMPING.

Updates today:

I saw my PCP and got a referral for my hysterectomy, and the letter that Dr. Schechter requires regarding my HRT history and medical fitness for surgery.

I called the doctor's office I was referred to for the hysterectomy. What a debacle. It's an OB/GYN office, so I understand that the majority of folks who are calling are female. But I haven't been ma'amed in a while so that was a little irritating.

The first office person I spoke with took my insurance information and started entering me into their system as a new patient. He ma'amed me once and I corrected him immediately. He apologized and continued on filling in information. At the end of our call, he said that unfortunately my insurance information appeared to be inactive. We confirmed all of the information that he had input, and it all seemed to be correct. He advised me to call my insurance company and make sure there were no issues with my account and to make sure they hadn't issued me a new member number or anything.

So I called my insurance company. She told me that the issue was on their end, but that he had likely put some piece of information in incorrectly. I asked if gender marker could be one of those items, and she said that was 100% what she thought it was. I thanked her and gave the office a call back.

Luckily I got someone with a brain this time! I let her know about the previous call, what my insurer had said, and what I thought the issue was. She was extremely apologetic about the mix-up, and got it all sorted out. I now have an initial appointment with the doctor on Feb. 3rd to get checked out and hopefully I'll be able to schedule something within the next week of that appointment.

May I ask, does your health insurance cover the procedure? If so, what provider and what area are you in? I'm right outside of Philadelphia and PA has trans exclusions for non-private plans.

Quote from: CMD042414 on January 07, 2016, 01:53:39 PM
May I ask, does your health insurance cover the procedure? If so, what provider and what area are you in? I'm right outside of Philadelphia and PA has trans exclusions for non-private plans.

Hey CMD042414,

Yes, they will be covering the cost of the procedures (with the exception of my deductibles/co-pays/out of pocket maximum of course). I have CareFirst Blue Advantage through DC HealthLink (Affordable Care Plan Marketplace). I emailed them a few months ago and they told me that trans related or not, the procedures all fell under my surgical benefits as stated in the plan, and gave me an example of what that looked like.

I purposefully took a job in DC so that I could get DC health insurance. They aren't allowed to exclude on the basis of gender.

I have heard of guys taking part-time jobs with Starbucks or Apple to get health insurance. Both of those cover transition related procedures.

Quote from: FTMax on January 05, 2016, 03:45:19 PM
Updates today:

I called the doctor's office I was referred to for the hysterectomy. What a debacle. It's an OB/GYN office, so I understand that the majority of folks who are calling are female. But I haven't been ma'amed in a while so that was a little irritating.

I decided the phone call would be excruciating, so I went into the OB/GYN surgeon's office to introduce myself to schedule the hysto.  They didn't get it.  Even though I tried to explain it as clear as possible.  Was I there for my mother?  I kept trying to explain.  They just wouldn't get it.  All they saw was a man standing in front of them, so it was completely outside of their frame of reference.  I finally said, "Caitlyn Jenner, but the other direction!"  They were like, "oh!"

Quote from: FTMax on January 07, 2016, 04:38:15 PM
I purposefully took a job in DC so that I could get DC health insurance. They aren't allowed to exclude on the basis of gender.

I have heard of guys taking part-time jobs with Starbucks or Apple to get health insurance. Both of those cover transition related procedures.

How sad is this?  Guys taking jobs just to get the surgeries they need and so many guys moving to CA so they can get Medicaid to go to Crane.  Me, I spend every waking minute waiting to hear what price Crane accepts from the insurance company so that I can find out how much I have to pay.  I cracked 3 teeth about 3 months ago in my sleep. I know due to the stress of the complications that have occurred just to make this whole thing happen.  So, now I am in the process of getting oral implants.  $4,800.  Lovely.

Transition can be so stressful.  It is sad, but instead of being excited about my surgery, I just want it to get here, so I am done with all of it.  I thought this was supposed to be an "exciting time".  It very much hasn't been for me.

The lady I spoke to the second time I called was still a little confused. I had to clarify that I had a uterus that shouldn't be there, but she understood after that. I had originally tried to schedule the appointment online, because the hospital advertises that they do that. But the doctor I was told to request had no availability for the entire year on her online schedule.

Hadn't considered going in though! I'm not looking forward to the initial apopintment. My friend (who's having surgery with Crane around the same time you are, Bimmer Guy) went to the same place for his hysto and apparently they are pretty good once you're in. They let him hang out in an exam room instead of having to wait in the lobby for the doctors to be ready. So hopefully things go as well for me.

It is sad! I've read of guys who are unhappy working for the two companies I mentioned who are hanging on until all their medical stuff is complete because it's so hard to find coverage that doesn't automatically say no. I guess in that sense I'm in the same boat. I would be trying much harder to find a new job if I knew their insurance options would cover everything I need. But my goal is to not be working in DC after this year, so we'll see.

I'm not sure I've hit the excitement point yet. To be honest, I'm a little sad about having to do the hysto in advance. I understand that it's for the best, but it means I'm going to have to spread procedures out more than I wanted to in order to have enough vacation time. My insurance rolls over on July first, so I'm hoping that the hysto and stage 1 are complete by then to minimize the amount I have to spend. I don't think it'll be possible to get implants in before July unfortunately.

Touched base today with another guy who is going to see Dr. Schechter. He's going a few months later than I am, but he had the foresight to ask on the phone about how the schedule was looking.

Apparently they make every attempt to schedule surgery 6-8 weeks after the consult if you're ready to go. That'll still fall within my 3 month window post-hysto, so I'd be looking closer to 10-14 weeks out assuming that hysto falls within the 2 weeks prior to the consult or week after. That puts us at the end of May.

And that would be ideal! Fingers crossed that everything goes well with scheduling the hysto and insurance doesn't drag their feet with an approval that they've basically already given. Schechter currently doesn't have a wait list, and I'm hoping it'll stay that way for a bit. If I haven't already had it by then, I'll at least go into the consult with a date for my hysto and we can plan around that.

The amount of legwork we have to do is pretty astounding. I'm not looking forward to trying to set up my bottom surgery process.

This is a great thread. I hope you don't mind keeping it up.

Quote from: Arch on January 12, 2016, 03:49:46 AM
The amount of legwork we have to do is pretty astounding. I'm not looking forward to trying to set up my bottom surgery process.

This is a great thread. I hope you don't mind keeping it up.

Astounding is actually not an exaggeration.  I had no idea it was going to be like this.  I am 6 weeks away from meta and Crane still hasn't settled prices with the insurance.

Quote from: Bimmer Guy on January 13, 2016, 07:14:59 PM
Astounding is actually not an exaggeration.  I had no idea it was going to be like this.  I am 6 weeks away from meta and Crane still hasn't settled prices with the insurance.

I started speaking with someone the other day who was very involved in the scheduling process with Crane, and just told them to kick rocks. Scheduled a consult with Schechter instead. Apparently they had been giving him the run-around since Austin had to be rescheduled. I can't even imagine. It's terrible that you're being made to wait like this, especially with it being so soon. I was under the impression that everything was sent off to insurance 80-90 days in advance of surgery for Crane (since you generally aren't getting in sooner).

Quote from: Arch on January 12, 2016, 03:49:46 AM
The amount of legwork we have to do is pretty astounding. I'm not looking forward to trying to set up my bottom surgery process.

This is a great thread. I hope you don't mind keeping it up.

My goal is to lay it all out there and help guys come up with a checklist, so that when they get to that point, they can take a look and start planning. I was so completely confused prior to starting the process, and there really aren't a lot of solid resources out there about the initial pre-surgical process. I hope it continues to be helpful!

Quote from: Bimmer Guy on January 13, 2016, 07:14:59 PM
Astounding is actually not an exaggeration.  I had no idea it was going to be like this.  I am 6 weeks away from meta and Crane still hasn't settled prices with the insurance.

Well, at least you aren't three days away...but, seriously, there's no way I'm going to go through a repeat of my hysto insurance ordeal when I get to bottom surgery. If I don't have all my ducks in a row ninety days in advance, I'm going to start knocking some heads together. These procedures are too complex and too expensive and just too damned important for all of this last-minute crap.

Quote from: Arch on January 14, 2016, 12:52:38 AM
Well, at least you aren't three days away...but, seriously, there's no way I'm going to go through a repeat of my hysto insurance ordeal when I get to bottom surgery. If I don't have all my ducks in a row ninety days in advance, I'm going to start knocking some heads together. These procedures are too complex and too expensive and just too damned important for all of this last-minute crap.

True, not three days away, like you were with hysto.  Very true.  But, you truly do not know half the story when it comes to my experience with Crane and his office and the changing from Austin to San Fran.  The last 9 months has been daily, daily stress.  I will say it out loud.  I would not do this again.  I would not schedule with Crane again.  I have never had my mental health in this kind of distress before, and I have been through some ->-bleeped-<- in my life.

This has been a horrible experience.  They don't return phone calls.  They don't return emails.  I still do not know if 6 weeks from now I will be handed a bill when I get out of surgery.  Oh, and I don't know anything about the hospital either and how much I might owe them.  They don't call me back, either.  It's been grand.

And I have knocked some heads together.  More than once.  They say it will be different.  They say it will change (sounds like a freakin' relationship).  And here I am 3 weeks later with no information and no responses again.  They were sent the insurance offer 5 weeks ago.  And nothing.

If I had to do it again, I would go with Schecther.  Especially because I am getting meta.  I can't be confident and say what I would do with phallo, since I don't have any sense of Schechter's phallo work.

Am I even THINKING about my meta in 6 weeks?  Have I considered what I will buy/pack/etc?  No, I am just stressing out as to whether or not it is going to be paid for.

Your friend was smart, Max.  I was too deep into it to pull out.

I'm disturbed to hear about the unresponsiveness of Crane's office. I'm not sure that my insurance would cover Schecter or someone else. I know that my case manager immediately trotted out Crane, and I got the impression that he is THE man I'm expected to go to. But I also don't want to travel far. Northern California is bad enough; I don't want to go halfway across the country.

Did Crane's staff used to be better before Crane started trying to open the Austin office? Or have things always been iffy?

BG, I am SO sorry to hear about the stress you have been going through. I found my whole transition, with the resulting fallout, to be incredibly stressful, but I think the hardest parts (apart from dealing with my partner) have had to do with power held by others over my transition. Insurance coverage is great, but the process of jumping through insurance hoops can be excruciating. I'm glad I haven't had to do a whole lot of that yet.

I'm really hoping I can avoid most of the hoops. That was my intention in reaching out to them in advance, so we'll see.

Arch, you may have some struggles getting Schechter covered. I know Crane is the guy that most west coast insurers refer to. I think the only way you'd be able to have someone else covered (in-network) is if they were performing a procedure that Crane doesn't do. And I can't think of anything one does that the other doesn't. You could try for out of network coverage, but I don't think they'd reimburse for travel expenses because you have Crane in-network. I'd look at your policy though.

AFAIK, it has gotten progressively worse since Crane first conceived of Austin. It got really bad once Austin was delayed, and has not improved since.

I feel horrible saying it, but I was actually relieved to hear that Austin fell through. I figured that I'd be more likely to get Crane himself if he was still focused on California. But I don't know whether this "reprieve" will truly help; he might continue to work on the Austin problem, or he might start making plans for another city. My target date is so far out (probably summer 2017) that anything can happen.

My insurance charges more but will cover a surgeon in the "second tier"--not fully in network but not out of network, either. I didn't mind doing that for hysto because I already had a relationship with the surgeon, and I required only one procedure. I would hate to do it for two or three bottom surgery evolutions, especially on top of boarding out my cats for three weeks and losing thousands of dollars in summer income.

If at all possible, I'm staying fully in network. If that means Crane, then so it will be.

I didn't fall through all the way. Just very delayed. I think the last update I heard was this summer it would be ready. Basically the hospital he was working with decided at the last minute that they didn't want transgender surgeries being performed there, so he switched to another hospital that is still in the process of being built. I don't remember the name of it, or I'd check the status of it. I know the microsurgery team that will be working in Austin has been in SF the last few weeks training with the existing team.

I'm not 100% sure on what the logistics look like for everyone in the practice currently. The doctor Crane was teaching (Dr. Chen) has started performing his own surgeries, and they're looking excellent. I don't know if the plan is for them both to travel between both locations, or if Chen will primarily be in Austin, or vice versa. It doesn't mean there won't still be issues with the office staff, but depending on your timeline and who ends up where, Chen may be your surgeon. Something to look into.

Yeah, I have a lot to do. I've already written to the office, and I got what appeared to be a canned response with lots of information. I am pretty sure I know which procedure I want, and I know that Crane will be fully covered. That's it.

I'll start the ball rolling again in a few weeks or a month.

A real update for today!

I spent yesterday on pins and needles waiting to find out if the federal government in DC was going to close due to inclement weather. My doctor's office closes when they do, and it is abysmally difficult to schedule an appointment with the psychologist and psychiatrist they have on staff, because there are only 2 of them. I've had this appointment since the beginning of December and was dreading potentially having to reschedule.

So I woke up, went into work, and happily discovered that they would be open, and see patients up until 12pm. My appointment was at 11:30 :)

I met with a psychiatrist for about ten minutes who read over the letter the LPC wrote at my last visit. He asked me what my surgical plans were so far, if I had support, if I felt I would need any additional assistance from them in terms of meeting pre-op requirements or post-op care. He told me the surgeon who's performing my hysterectomy is a good one. Very, very short chat. He cosigned the first letter and I was on my way.

It's kind of surreal sitting with all three of these in hand after so long. It definitely feels good to cross it off the list of things to do before my consult.

I decided today that I'm going to cancel my consult with Dr. Rachel Bluebond-Langner. Though I'd like to hear what she has to say and see her work, I'd much rather schedule my hysto that week instead of spending time driving to and from Baltimore to talk to someone I know I'm not going to have surgery with.

Finally an update! Three updates, to be exact. Apologies in advance for length.

I had my hysterectomy consult today. I was kind of dreading this consult, as I wasn't sure what to expect - would they be confused when I checked in, would I have to undress, would I need any kind of lower exam, etc. It went very well. I will break it down here, in case anyone else is also wondering and worried:

I arrived, gave the receptionist my information, and let her make copies of all my referrals. She let me sit in a different waiting area so that I wouldn't have to feel awkward with all the pregnant ladies.

A nurse took my vitals and input my medical history. Then the surgeon's assistant (a junior doctor that she has trained) came in and described the procedure to me. He said there was nothing in my medical history that led him to believe I would not be a candidate for a two-incision laparoscopic assisted vaginal hysterectomy. They'll be taking everything out. As long as there are no complications and I'm able to urinate once I'm awake, I'll be allowed to go home that day.

We discussed my upcoming consult in Chicago and decided that it was best to wait until after that trip. We also decided that since my case is straightforward, we would do the pre-op consult today instead of having me come back. He gave me an information packet with the number of the scheduler who would be contacting me, a pre-op checklist to arrange my procedure at the hospital, prescriptions for pain medication, and an order for lab work.

The surgeon also popped in to go over things. I let her know that I get ultra nauseous from anesthesia, so she made a note in my file for the anesthesiologist. I also showed her my scars from top surgery, and she decided she would try to use Dermabond on my pelvic incision to reduce the likelihood of scarring.

So now I'm just waiting for a call back from the scheduler. I have a meeting at work tomorrow where we'll determine what the best course of action is. I'm hoping to have a day picked out before the scheduler calls, which should be in the next week. Even though I'm a little disappointed about having to wait, I feel a lot better not having to worry about that and my upcoming consult with Dr. Schechter. They did offer to do the hysto this Friday if I didn't want to wait, but it just wasn't enough notice.

I also got a follow-up email from Dr. Bluebond-Langner's office. They confirmed that she does NOT perform metoidioplasty. This is good news - it confirms that there are no surgeons in my network that perform meta, which means that I will most likely be able to convince my insurance to cover Dr. Schechter as in-network. I'm interested to see how much the hysto comes out to be. It's all in network, and my in network maximum is $4k. A friend of mine had his at the same facility/same provider a few months ago, and his bill was about $3400. He does have different insurance though, so we'll see. It would be hilarious to me to pay more for a hysto than for meta, but I'll take it. The second stage will fall after my insurance resets for the year, so I'm hoping to make the most of it.

And on a final note - I've decided that I will be reactivating my personal blog after my consult with Dr. Schechter later this month. Whatever updates I make there, I'll be cross-posting here. I'm still deciding if I will share pictures there or not. A few people here have already requested pics - whether or not I post them online, I am definitely willing to send them directly to folks.

Your experiences not only inform the rest of us but also remind us that big, daunting tasks need to be broken down into small, manageable pieces.

Of course, this particular puzzle seems to have about a thousand pieces...

And another update! I spoke with my boss today about upcoming surgery dates, and we met with my coworker whose wife is pregnant. Apparently she is not due on St. Paddy's Day like we thought she was, and is instead going to be induced at the end of February - on the exact date I had asked the surgeon for unfortunately.

So boss asked if I could push to have it done next week. That was what I had been leaning towards anyway, but thought he would have wanted more notice. Since it works out better for everyone that way, that's what I went with. I called the scheduler and let her know the situation, and she happily scheduled me for next Thursday. A friend will be chauffering me around for the day, and I'll be taking a week off from work to rest.

I confirmed the surgery with my boss, filled my prescriptions, and got my visitor parking pass back from a friend so that my family can come visit next weekend. I also spent the last hour making juice and some other liquid "food", as I tend to do better recovery-wise if I keep a liquid diet before surgery. I've got two pitchers of apple-carrot-ginger juice, a smaller pitcher of orange juice, and a week's worth of Soylent.

Tomorrow I need to call the hospital's registration team and stop in for blood work. I also need to send an email to my doctor and let her know that my hysto is scheduled so that we can make an appointment to adjust my T dosage in a few months.

I'm excited! I've felt like I've just been spinning my wheels the last few months, and this is the first real progress forward.

Quote from: FTMax on February 04, 2016, 08:07:05 PM
And another update! I spoke with my boss today about upcoming surgery dates, and we met with my coworker whose wife is pregnant. Apparently she is not due on St. Paddy's Day like we thought she was, and is instead going to be induced at the end of February - on the exact date I had asked the surgeon for unfortunately.

So boss asked if I could push to have it done next week. That was what I had been leaning towards anyway, but thought he would have wanted more notice. Since it works out better for everyone that way, that's what I went with. I called the scheduler and let her know the situation, and she happily scheduled me for next Thursday. A friend will be chauffering me around for the day, and I'll be taking a week off from work to rest.

I confirmed the surgery with my boss, filled my prescriptions, and got my visitor parking pass back from a friend so that my family can come visit next weekend. I also spent the last hour making juice and some other liquid "food", as I tend to do better recovery-wise if I keep a liquid diet before surgery. I've got two pitchers of apple-carrot-ginger juice, a smaller pitcher of orange juice, and a week's worth of Soylent.

Tomorrow I need to call the hospital's registration team and stop in for blood work. I also need to send an email to my doctor and let her know that my hysto is scheduled so that we can make an appointment to adjust my T dosage in a few months.

I'm excited! I've felt like I've just been spinning my wheels the last few months, and this is the first real progress forward.

Max, this is so great!  Things are moving along well.  Personally, I am glad I had/have 6 months out from hysto before vaginectomy.  I had some bleeding for quite a while after surgery, plus spotting for several weeks, so I am glad the "hole" was still there for it to drain out.  It made me think that it was good to have that extra time to heal, as well.

I hadn't considered that one would get some draining after hysto and still having a hole for it to come out would be best.  I want the hole gone for sure.

Fantastic news! When you said that next week was too soon, I was kind of sad that you were going to wait. Now you don't have to.

Will a week off be enough? I'm not sure what you do for a living.

Quote from: Arch on February 06, 2016, 01:05:27 AM
Fantastic news! When you said that next week was too soon, I was kind of sad that you were going to wait. Now you don't have to.

Will a week off be enough? I'm not sure what you do for a living.

I'm a hospitality consultant. Basically I go into bars and restaurants, audit their alcohol stock against their sales to see what's missing, and then write reports to managers and owners on how to improve. As soon as I go back, I'll have someone with me to do all the manual labor aspects of the job, so I'd basically just be driving to work, wandering around collecting paperwork, and then wandering around to find discrepancies. I usually do 2-3 venues per day so it's a bit of walking around but it's all self-paced.

I'm feeling okay with it. Glad to be getting it over with. My boss has said that if I need more time or if I have complications, we'll figure things out. So I'm sure if I needed longer off, it would be fine. I don't want to dip into too much vacation time though, since I want to have bottom surgery in June.

I took two weeks off from work and would have liked more, and I wound up leaving early on the first day. But because I'm alone, I had to do all of my own stuff and was more active than I probably should have been. And, frankly, I was a little too eager to portray a "business as usual" front to someone who doesn't know I'm trans.

If you take a week off, I hope you can take it completely off and not do anything at all. Below is a recreation of my timetable for the first couple of weeks, including surgery day.

Monday--surgery
Tuesday--went home in the afternoon; walked to the nearby grocery store to feed a food craving
Wednesday--home all day
Thursday--therapy, groceries, and a few errands (Christmas Eve, so I faced long lines and delays)
Friday--Christmas--left my friend's house after a few hours because I felt like crap
Saturday--drove about forty miles round trip to adopt a new cat I also had to set up his habitat and spend hours dealing with him and the other cat

Sunday--home all day
Monday--went to my friend's house again, and stayed much longer; didn't feel half bad
Tuesday--very tired after the dinner party; stayed home all day
Wednesday--home
Thursday--therapy and errands
Friday-Saturday--home all day, recovering from therapy and errands!

Sunday--worked at home all day to prepare my new class; moved around A LOT and slept only five hours that night
Monday--first day of work; had some period-like bleeding and left early
Tuesday--saw the doctor and ran an errand or two; he said I was fine
Wednesday--got through a whole day of work--three hours of driving, two office hours, three one-hour classes

Whenever I was home all day, I still had to feed myself (mostly microwave fare), feed the cats and pay attention to them, clean the litter box, run laundry, do other little household chores, that sort of thing.

I hope this gives people an idea of the activity level and healing process of one person. I was in my early fifties at the time of the surgery and had been mostly sedentary for a couple of years due to a chronic injury. Younger and fitter guys will probably have an easier time, and guys with someone to help out during that first week will be able to rest in ways that I just didn't (sometimes by choice).

Thanks Arch! I've been trying to figure out what everything will look like. I'm in my 20s and fairly fit, so I'm hoping that will mean good things. Both of the doctors at my consult said that while they'd prefer I take the full 2 weeks off to rest, they'd be very surprised if it took me that long to feel up to it.

I still have my consult on the 24th with Schechter in Chicago, so I'm hoping to ease back into more activity at the end of the first week. Today I made and froze 20 single servings of chicken noodle soup and a couple loaves of bread. Tomorrow is laundry, dishes, and general cleaning. I'd like to get everything taken care of by Tuesday so I can relax on Wednesday and mentally prepare. Even though it is something I want and something I'm ready for, it is sooner than I thought it would end up being. It feels like I have a lot less to do for it than I did for top surgery, so that's good at least.

Surgery is at 11:20 on Thursday. It's being done outpatient, so I'm expecting to be home in the evening, and I'm planning to *try* to eat a small dinner and go straight to bed. My only real activity planned for the weekend is taking care of my dog (walks around the block 3-4x per day). I'd like to get up and around a little more by Monday and start driving/leaving the house.

The good part about my job is that there's a lot of room for teleworking. Plus the hours that I am usually out and about don't fall into rush hour. I don't drive more than 10 miles each way, and I'm rarely in the car for more than 15 minutes at a time.

As a question for anyone reading this who has had a hysto - were there any supplies that you needed? They told me I didn't have to stop T, and advised that I wear loose, dark comfortable pants. My girlfriend bought me a box of pads so I don't have to worry about spotting, and I've got all the pain prescriptions. Is there anything else worth getting in advance?

Also - should I shave anything? They want to make an incision in my belly button and one over my pubic bone. Everything will come out of the opening downstairs. I know they'll shave stuff if they need to. I'm just wondering if it wouldn't be better to do any of it myself in advance.

Apart from food and meds and basic toiletries, I didn't need anything unusual except the pads. I had bought a box of panty liners much earlier but should have purchased full-size pads as well. Note to all: Get some maxipads. Even if you never use them, you're better off prepared.

I took stool softener tablets for a couple of days, but I don't know whether I needed to.

I bought pads eventually, but not in the best circumstances. I stopped at Target on my way home after the heavyish bleeding started. I needed to install my last liner, but the men's room was packed, and I had nowhere to toss my old liner. Then, I was standing for ages in the aisle as I tried to figure out which pad was which; I hadn't needed anything like that in ten years, so I was very much out of my element and felt spooked about the bleeding and conspicuous in the women's hygiene aisle. I eventually grabbed something and came home to discover that I had chosen THE biggest and most heroic pads on the market--not really what I wanted!

I feel that if I'd truly taken the first week off and done nothing at all, my healing process would have been hastened, and my first day at work might have gone better. On the other hand, my doctor said that as tissues shift and knit and as stitches stretch and dissolve, period-like bleeding can happen to anyone. He also said that bleeding can be precipitated by all sorts of seemingly innocuous events.

When I went back for my six-week check, he extended my restrictions for a further two weeks. I kind of wonder whether my early activities interfered with the healing process. I've never been a particularly fast healer, though.

Max, you really do seem prepared. Pay the bills, make your calls, run your errands, clean the house--and then come home and do nothing for a week.

Hysto Update!

I had my hysto today (2-port laparoscopic vaginal assisted total hysterectomy with bilateral salpingo-oophorectomy). Surgery was scheduled for 11:20, so we had to be there at 9:20. With DC traffic, we decided to err on the side of caution and left my house (ten minutes away under normal conditions) a little before 8. Picked up a bottle of ginger ale and some nutrigrain bars for the trip home.

We got to the hospital, parked, and were checked in at admissions by 8:30. They were super prompt in taking my friend and I back to get settled in. It's a teaching hospital, so there was a lot more foot traffic than you might experience elsewhere. Once I got assigned a bed, I changed into my robe and non-slip socks. The first person to come by was a medical student under the anesthesiologist. In addition to her pre-filling the paperwork, we had a really good (incredibly respectful) talk about the procedure and my transition in general. She said it would probably sound strange, but she wanted to thank me for choosing to come to a teaching hospital for the procedure since it would enable her and the other student assigned to me to learn more about trans folks. Very, very sweet.

After that, other folks stopped by and ran me through similar questions as they filled out their forms - attending and resident anesthesiologists, OR nurse, my doctor, another OBGYN, and several more nurses. Signed a bunch of consent forms. Everybody was very cool, and understood that I wasn't super comfortable with the idea that they were all going to be seeing me naked. The OR nurse put a large bandage pad on my butt, and told me that it would catch any drips since I'd be laying down for at least 3 more hours. My doctor came back by and drew on me a little bit. I asked her if she would take some pictures of the organs for me, just out of morbid curiousity. Around about 10:30, the attending anesthesiologist came back by and started my IV. Since I normally get incredibly nauseous when I wake up, she made a note to get me some anti-nausea meds in the IV prior to taking me back to recovery.

And then we were off! They wheeled me down the hall to the OR, moved me from my bed to the operating table and got me comfortable. The anesthesiologist reminded her resident and student that we were going to up my anti-nausea meds at the end of surgery. Then she hooked me in, and I was out.

I was taken back to recovery at 1:15 and woke up shortly after. No pain, no nausea, just exceptionally cold and shivering. It took me about ten minutes to warm up. My nurse walked me down the hall to use the restroom once I wasn't shivering anymore. After I got back in bed, she brought me a few packs of saltines and a ginger ale just in case. I finished everything, was sitting up, and very comfortable by the time my doctor came to visit. She was very happy that I was going well, cleared me to go home since I could walk, keep food down, and pee. Reminded me that if I was in pain, I could call her and come in before my post-op appointment. My friend came up to visit, went over post-op instructions with my nurse, and left to go grab the car. I downed two little bottles of water while she was gone.

When the nurse came to wheel me out to the car, I requested to walk just to be sure that I could do it. No issues, no pain. My last dose of pain medication was at 2pm. I'm supposed to take something at 6 if I'm starting to feel pain, but it's 5:55 and I'm not. The worst for me right now is my throat. It is a lot more sore this go around than it was during top surgery. My roommate is currently out buying me some lozenges, and I'm drinking water in the mean time. I have very little abdominal pain - it is akin to menstrual cramping, but is the most mild I've ever experienced. I wouldn't call it pain, but I am very aware that there was an incision in my bellybutton. There is also a bit of burning when I pee, which I would guess is catheter related. I've never had one before. Since coming home, I've removed all of the IV bandaging and electrodes. I'm leaving the butt bandage on for now since I've been laying down. My friend and I went for a regular paced walk around the block with my dog, I've changed my clothes, had a little bit to eat, and taken a short nap.

Overall I'm feeling very good! It went much better than I was anticipating, and I'm very happy with the care I received.

Damn, that's good news. I was in the hospital overnight. My throat was cranky for a full day, and peeing was a bit burny for a day or so. Sounds like my experience might have been fairly typical.

I hope you are as happy as I am about the results. For a few years, I was thinking, "Out of sight, out of mind," but it wasn't TRUE. At that point, I was thinking about those parts every damned day of my life. I am so glad to have all of that stuff out of me.

I could not sleep last night. There is a figure that Dr. Crane throws out there that has been bothering me for some time now, and I think it finally came to a head for me this week now that my consult with Dr. Schechter is less than a week away. Dr. Crane has said that of all of his metoidioplasty patients, 75% of them return for phalloplasty.

I don't know if these numbers are representative of the experiences of other surgeons, but it has had me second guessing myself this entire week. Thankfully, when I started researching bottom surgery options, MLD phalloplasty was at the top of my list. So I'm not having to do any additional research in that regard. I've been talking to several guys in a phalloplasty support group who have gone from meta to phallo and for all of them, it came down to size and meta just not being enough. What's upsetting is that for many of them, size did not matter to them until they were post-op. I am very worried that this would happen to me. I don't care about size now, but I also didn't care much about having a penis until a year ago. Who can say whether or not things will change?

I have also heard that the rate of complication is much higher to go from meta to phallo than to just get phallo from the start (but don't have an exact % to compare). So while I am young and healthy, if I did end up going from one to the other, my experience may be worse just due to the added risk. And then there's the issue of erectile devices. They are arguably the most complication-inducing part of phalloplasty, but unavoidable if you want to have penetrative sex. Dr. Monstrey released a study of erectile implants in 2009 that expressed ridiculously high complications - 59% had had their implant replaced, 41% had needed implant removal or revision. I know I would ultimately not be happy not being able to get an erection, but I do not like those odds.

Thankfully, Dr. Schechter performs both MLD and meta, so he can give me a good idea of his average complications, patient experiences, etc. I'm interested in what percentage of people he sees coming back for phallo post-meta. According to a friend's consult with him in 2014, instead of doing a 3 stage surgery by default like most phallo surgeons do, I could have everything but testicular implants and an erectile device placed in stage 1 and come back in 12 months to get both put in at the same time. If I still wasn't settled on an erectile device, I could come back in 3 months for testicular implants by themselves.

I am going to sit down tomorrow and start writing down all of my questions for the consult. At this point I am still leaning towards meta, but I will not be making up my mind until I talk to Dr. S and hear what he has to say on the matter. If anyone has any questions about bottom surgery that they would like answered by Dr. Schechter while I am in Chicago next week, feel free to message or write them below.

Quote from: FTMax on February 20, 2016, 09:32:35 AM
And then there's the issue of erectile devices. They are arguably the most complication-inducing part of phalloplasty, but unavoidable if you want to have penetrative sex.

The implantable erectile devices are not necessarily "unavoidable" to achieve penetrative sex with a phallo. Some guys have reported being able to get by without one. It has its own drawbacks, but there are sheath/sleeve-type products out there, including one specifically for guys who got phallo:
https://www.ftmprosthetics.com/sheath.htm
There was a thread here awhile back on the subject that may be of interest:
https://www.susans.org/forums/index.php?topic=160922.0

Since the implant has to be done at a later date anyway, not much to lose by trying the comparatively cheaper non-implant options out there first, for those who decide on phallo.

If you wouldn't mind, as for Dr. Schechter I'd be curious about:

1. How many times he's performed phallo
2. How many times a revision was necessary for urological reasons
3. Of those, how many times follow-up revision(s) were necessary before urological issues were fully resolved
4. Most number of revisions/longest time frame a patient has ever gone after phallo before all the plumbing down there worked without further issues, or if he's ever had a patient that has ongoing urological problems after multiple attempts at repair
5. Cost for the one-stage phallo with urethral lengthening including all the hospital fees, etc. if paid out of pocket
6. His policy on cost of revisions when they're medically necessary or for urological functioning reasons (as opposed to aesthetics)
7. If he's aware of any long-term effects on urinary tract infection predisposition after phallo, or meta, respectively, in either direction (either more or less common once everything is healed properly)
8. What in the world do they do if, despite all the electrolysis, a hair ends up growing in the urethra somewhere. This is something I think about too much.

Sorry I keep adding things.

Quote from: blink on February 21, 2016, 03:45:36 PM

Quote from: FTMax on February 20, 2016, 09:32:35 AM
And then there's the issue of erectile devices. They are arguably the most complication-inducing part of phalloplasty, but unavoidable if you want to have penetrative sex.

The implantable erectile devices are not necessarily "unavoidable" to achieve penetrative sex with a phallo. Some guys have reported being able to get by without one. It has its own drawbacks, but there are sheath/sleeve-type products out there, including one specifically for guys who got phallo:
https://www.ftmprosthetics.com/sheath.htm
There was a thread here awhile back on the subject that may be of interest:
https://www.susans.org/forums/index.php?topic=160922.0

Since the implant has to be done at a later date anyway, not much to lose by trying the comparatively cheaper non-implant options out there first, for those who decide on phallo.

If you wouldn't mind, as for Dr. Schechter I'd be curious about:

1. How many times he's performed phallo
2. How many times a revision was necessary for urological reasons
3. Of those, how many times follow-up revision(s) were necessary before urological issues were fully resolved
4. Most number of revisions/longest time frame a patient has ever gone after phallo before all the plumbing down there worked without further issues, or if he's ever had a patient that has ongoing urological problems after multiple attempts at repair
5. Cost for the one-stage phallo with urethral lengthening including all the hospital fees, etc. if paid out of pocket
6. His policy on cost of revisions when they're medically necessary or for urological functioning reasons (as opposed to aesthetics)
7. If he's aware of any long-term effects on urinary tract infection predisposition after phallo, or meta, respectively, in either direction (either more or less common once everything is healed properly)
8. What in the world do they do if, despite all the electrolysis, a hair ends up growing in the urethra somewhere. This is something I think about too much.

Sorry I keep adding things.

Thanks blink! I have been talking to some other guys about non-device ways to have penetrative sex, and there are definitely ways all with their own pros/cons. It's definitely something I'll be thinking about over the next few days.

I will definitely ask him your questions though! I'll try to stop back in this thread on the day of my consult just in case anyone has anything else.

PS blink - to clarify, when you say stage 1, what all are you hoping is included? I believe with Dr. S it is vaginectomy, phalloplasty, urethral lengthening, scrotoplasty, and glansplasty. Just wanted to make sure that is all you were meaning.

Quote from: FTMax on February 21, 2016, 05:05:26 PM
PS blink - to clarify, when you say stage 1, what all are you hoping is included? I believe with Dr. S it is vaginectomy, phalloplasty, urethral lengthening, scrotoplasty, and glansplasty. Just wanted to make sure that is all you were meaning.

That was actually more than I was hoping for in a stage one (didn't think glansplasty would be included in the first OP, but if he does that in stage 1 as well, that's awesome). Was hoping at least the vaginectomy, phalloplasty, urethral lengthening and scrotoplasty. Does he do the scrotoplasty like Dr. Crane, i.e., fused and hanging in the front?
Every time I think I've exhausted my pool of questions there are more.

Would be useful to know if he has someone operating with him to do a hysterectomy + oophorectomy at the same time or if that has to be done in advance.
And whether I'd be needing to bank my own blood - I'd rather not have a blood transfusion if avoidable. Some surgeons have more bleeding than others, especially with the vaginectomy, from what I've read.

And here'd be a pretty major question, should've thought of it sooner:
Have any of his patients ever experienced complete loss of the new phallus, and if so, what were the circumstances surrounding that (health issues etc.)?

I can answer some of these! :)

The glansplasty is done for sure for RFF in stage 1. I believe they wait until stage 2 for ALT. If I get phallo, it'll be MLD so I'll ask about that. I'll confirm the other two, because you're right that it's not the norm. Now that I'm thinking about it more, he may have done it earlier for guys who were traveling quite a ways and weren't coming back for a while.

He does do a fused scrotum and it looks very similar to Dr. Crane's.

I asked if it was possible to have my hysto done at the same time and they said no, regardless of which combination of procedures (meta vs. phallo). They could refer me to someone in Chicago if needed, but the hysto needs to be done 3 months prior to stage 1 of any procedure.

I'll check about the blood banking. When I got my hysto, they said they only recommend blood banking to people who have received multiple transfusions in the past due to developing antibodies and the increased risk of having a reaction from donor blood. But the vaginectomy does create a much greater bleeding risk, so it's a good question to ask.

I will ask about complete loss as well. After I finish working today I'll post my entire list of questions I'm planning to get answered (for myself and others).

Awesome. Will keep checking back to see how the Q&A turns out, thanks for sharing all this information.

Hey guys,

I tried to paste all of these here, but the formatting wasn't working out. This is the link to all of the questions I'm hoping to have answered tomorrow. If Dr. S is cool with it, I will be audio recording our consult and will either post that directly or a transcript of it.

https://docs.google.com/document/d/16QWdiVxGgiORFvNAAOnweWRY-83mGiyZoiTRhq22lCg/edit?usp=sharing (https://docs.google.com/document/d/16QWdiVxGgiORFvNAAOnweWRY-83mGiyZoiTRhq22lCg/edit?usp=sharing)

If you have anything you would like added, or if you think I'm missing something crucial based on my own needs, please message or comment! I will be checking this thread one last time around noon tomorrow Central time.

I'm going to continue hogging the questions and ask another thing if it's not too late. Sorry it's gross.

Is MLD contraindicated if the guy has bacne? I don't know if it's the skin itself, or because that's where a shirt goes and I'm physically active. I do not want to do the forearm, worried the only viable option is going to be ALT and that means a lot more extra time and $$$ for electrolysis (and goes back to my hair-in-urethra worry).

I'm planning to ask about skin quality of the donor site in general. I have some back acne, but thankfully it hasn't extended into the MLD zone. I have not heard that it is a consideration at all from other guys, but I also haven't asked. Will find out today!

I got to Chicago just fine, got my rental car, and I found a Panera a block away from Dr. S's office to hang out at until it's closer to consult time. Got a free upgrade to 4WD on the rental car since they're expecting snow here. Hoping I don't get stranded in Chicago! My flight home doesn't leave until 9:30.

Quote from: FTMax on February 24, 2016, 10:19:33 AM
I'm planning to ask about skin quality of the donor site in general. I have some back acne, but thankfully it hasn't extended into the MLD zone. I have not heard that it is a consideration at all from other guys, but I also haven't asked. Will find out today!

I got to Chicago just fine, got my rental car, and I found a Panera a block away from Dr. S's office to hang out at until it's closer to consult time. Got a free upgrade to 4WD on the rental car since they're expecting snow here. Hoping I don't get stranded in Chicago! My flight home doesn't leave until 9:30.

Yeah I've never heard any mention of skin quality, which strikes me as odd. I'd expect acne to be a concern in donor site suitability since it's essentially low-grade infection. I'm hoping that worst case scenario it's something that has to be treated and under control prior to surgery, but not a deal-breaker issue.

Good luck not getting stranded, that would suck.

I had a very eventful consult with Dr. Schechter in Chicago Wednesday. He answered the majority of my questions, spent a lot of time discussing what all options I had, and was incredibly helpful. While the day did not end with what I had been hoping for, I am very happy with how things went and I am excited to be his patient.

I first spoke with one of the nurse practitioners, and explained the difficulty I had been having in choosing a procedure and that while I was sure I wanted to go with Dr. Schechter as a surgeon, I wasn't sure what we'd end up doing. He also filled out all of my prior medical information and reviewed my referral letters to confirm that everything was in order for insurance. He left for a few minutes to share all of this information with Dr. Schechter.

After that, they both came in and we discussed my uncertainty about specific procedures. I explained what was most important to me (being able to pee standing up, and aesthetically looking decent), and explained that I was leaning towards metoidioplasty but wanted to be mostly sure (>75%) that I would have the length needed to pee standing without issue. I explained that while sexual function would be nice, it was not a major concern of mine. I also explained my dislike of the current erectile device options for phalloplasty, as well as my concern about the number of meta patients who return for phalloplasty, according to Dr. Crane.

Dr. Schechter corroborates Dr. Crane's figure of 75%. He said that while he felt it might be a little generous, it was believable in his experience and he would estimate his percentage as greater than 50% but less than Crane's 75%. He did dispute the idea that there was an increased risk of complications in going from meta to phalloplasty – he said it may be true, but with the current sample sizes being so small, he felt that there was not enough information to come to a data-driven conclusion.

We immediately ruled out ALT as an option. He thinks my body fat percentage is too high for it, I know it's too high for it, and I'm not willing to lose the amount of weight that would be required. Unfortunately for me, he also felt that MLD was not the most ideal option for me, and that was what I had been considering the most. During the physical exam, he pointed out that I'm thickest through the torso, and while there would be no issue with the graft, he worried that it would result in the same considerations as ALT due to my body fat concentration in that area. He agreed that he would do it if I wanted to, but wanted me to expect multiple revisions and likely liposuction of the phallus. He would also want me to lose about 30-50lbs, which is not something I want to do. For the record, I'm 5'5" and 170lbs @ 20% body fat – and I apparently carry all my fat in places that you can make penises out of.

Unfortunately again, he felt that I was right in a gray area based on my goals for metoidioplasty. In his opinion, even with a lift and a mons resection, he was not positive that I'd be able to pee without issue. This was a pretty big letdown for me, as I am in the same area of size as other guys who have had the procedure, but it's more so my body and the places I carry weight that would cause issue. Again, he said he would do it if it was what I wanted, and that he didn't anticipate it being a complicated procedure, but his feeling was that it would require additional cosmetic work and weight loss to make it everything I wanted it to be.

So that left RFF. The one option I most did not want. He explained that he's started taking some extra steps to improve the donor site scarring so that it's not such an eyesore. I'd also be getting a lot more done during stage one than I would with the other options (vaginectomy, phalloplasty with urethral lengthening and nerve hookup, scrotoplasty, and glansplasty). The only things I'd be needing to come back for at a later stage would be testicular implants and an erectile implant. He said he could do both at once 12-months post-op, or I could come in for one of them at 3-months post-op as long as there were no prolonged complications at that point.

I am not thrilled about it. This is the first consult I've had where a doctor has said I can't have what I want – but at least his reasoning was explained and I know that it's coming from a place of concern for my wants/needs. Based on the discussion and the amount of time spent looking me over and explaining why certain procedures weren't a good fit, while I don't like the ultimate choice, I do agree that it is the best option.

I left his office with homework – start electrolysis immediately, and try to lose another 10lbs while reducing my body fat. For now I'm just changing my diet – I'm still not cleared to go back to the gym post-hysterectomy. I'm hoping she will clear me at my appointment this week. I've also booked two consultations with local electrologists, and I'm seeing the first one on Monday. I've also sent off a letter to insurance to see if the cost of the sessions will be reimbursed due to the medical necessity of the hair removal. So wish me luck! This was not money I wanted to be spending, but I'm trying to accept that it will mean better results in the long run.

I'm worried about weight, too. I'm about 5' 7", and my best post-transition weight was around 160 for a brief time. I don't see how I could have lost much more; I looked really good and had almost no extra weight. I had to watch every mouthful and work damned hard to get down that low, and now my injuries prevent me from exercising. I am stuck at over 180.

I don't know why I'm so heavy for my size even when I'm down to the quick. I seem to be very dense. I had a borderline BMI in the 160 days despite the absence of lots of extra body fat. I don't know what to do now. I want ALT and most definitely do NOT want RFF.

Maybe my bones are laced with plutonium.

Dang, Max. I'm sorry you're not gonna be able to go with one of your preferred surgical options, that is a big letdown.
Thanks for keeping us updated.

Arch, for what it's worth, people throw the terms around interchangeably a lot but I'm sure in this case it's 100% a question of body fat, not weight. BMI was not intended to be used the way it's employed today and is almost useless for this purpose, who knows why it's so persistent.  Maybe because it's so easy to use, but it only factoring in height and weight is what makes it so useless. Many bodybuilders - in their lean phase - would be considered overweight or obese going by BMI, but that's obviously crap. In any case, don't panic based on someone else's consult, this stuff is too individual.

Yeah, I was very surprised. And he did caveat and say he by no means thinks I'm overweight, it's just an unfortunate fact that I carry what fat I do have in all of the best areas to use as donor sites. He also said that the weight coming off before surgery wasn't a must - he just thought it would make things easier. But that was after I explained that 170 is the lowest weight I recall as an adult and that I had lost at least 30lbs since October. I told him I would push for 150, but that he would most likely have to settle for something in the 160s. He was fine with it.

It's definitely upsetting. I've been putting a brave face on since Wednesday and really just going through the motions. I have my first hair removal appointment tomorrow morning. At my consult the girl said that my hair is dark enough that we could clear the majority of it with laser to start and then come back for anything that continues to grow with a few electro sessions before my surgery date.

I'll go back through and update that question document with all the answers I got when I get a chance over the next few days.

Quote from: blink on February 27, 2016, 08:05:43 AM
Arch, for what it's worth, people throw the terms around interchangeably a lot but I'm sure in this case it's 100% a question of body fat, not weight. BMI was not intended to be used the way it's employed today and is almost useless for this purpose, who knows why it's so persistent.  Maybe because it's so easy to use, but it only factoring in height and weight is what makes it so useless. Many bodybuilders - in their lean phase - would be considered overweight or obese going by BMI, but that's obviously crap. In any case, don't panic based on someone else's consult, this stuff is too individual.

I know this, but Crane's people say that he goes by BMI. His cut-off for ALT is 35 (I'm okay there), but the cut-off for avoiding an extra surgery is 25. Even if I do manage to get back down to 160--highly doubtful now--I will still be on the borderline and might still need the extra procedure. And, of course, I'm sure that the requirements vary somewhat by person.

I have to admit that some of my anxiety stems from other things. I'm self-conscious about my appearance since my injury forced me to stop exercising. I'd love to get back down to 160, but if I could get down even to a stable 170, I would look halfway decent for my height and build. I would be too heavy by Crane's standards, though.

I had my first hair removal session today. It was worse than I thought it would be, but not unbearable. The electrologist decided that we would do laser treatments every 8 weeks and electrolysis in between them to maximize the short time we have before my intended surgery date. She has apparently worked with several other transguys in the past, but this is her first time doing a forearm. She said she was fairly confident that we'd be able to clear the majority of my arm by July, but at a bare minimum she'll make sure the urethra gets completely done.

She also said it is not a big deal if I need to come back for a touch up post-op, though for comfort-sake, it would be best to do it as soon as I come back from Chicago before the nerves get too much of a chance to reattach.

Quote from: FTMax on February 27, 2016, 09:25:13 AM
I'll go back through and update that question document with all the answers I got when I get a chance over the next few days.

Thanks for planning on doing that even though this didn't go the way you were hoping, I'm sure the Q&A will be helpful to a lot of us here.

Quote from: Arch on February 27, 2016, 06:20:41 PM
I know this, but Crane's people say that he goes by BMI. His cut-off for ALT is 35 (I'm okay there), but the cut-off for avoiding an extra surgery is 25. Even if I do manage to get back down to 160--highly doubtful now--I will still be on the borderline and might still need the extra procedure. And, of course, I'm sure that the requirements vary somewhat by person.

If he strictly goes by BMI and doesn't take body composition into account then I am also in trouble. I'd barely make that 25 cutoff now. I'd do forearm if that's really the only option, but not knowing a good cover story for the scar and being concerned with long-term hand/arm function effects makes it not my favorite option. Topping that off, I have a specific size range in mind I'd ask for, that my arm probably wouldn't accomodate thanks to wizard wrists.

Max, the idea of a post-op electrolysis "touch-up"... yowch.

Quote from: blink on March 01, 2016, 10:18:07 AM

Quote from: Arch on February 27, 2016, 06:20:41 PM
I know this, but Crane's people say that he goes by BMI. His cut-off for ALT is 35 (I'm okay there), but the cut-off for avoiding an extra surgery is 25. Even if I do manage to get back down to 160--highly doubtful now--I will still be on the borderline and might still need the extra procedure. And, of course, I'm sure that the requirements vary somewhat by person.

If he strictly goes by BMI and doesn't take body composition into account then I am also in trouble. I'd barely make that 25 cutoff now. I'd do forearm if that's really the only option, but not knowing a good cover story for the scar and being concerned with long-term hand/arm function effects makes it not my favorite option. Topping that off, I have a specific size range in mind I'd ask for, that my arm probably wouldn't accomodate thanks to wizard wrists.

Max, the idea of a post-op electrolysis "touch-up"... yowch.

I'd be shocked if he is strictly looking at BMI. I know they're two different surgeons, but the packet I got from Dr. Schechter basically says that his firm cut-off for surgery is a BMI over 35. Between 30-35, you may lose some donor sites as options, or you may be told to lose weight just because of where you're carrying it, but you can still have *something* done.

I need to measure around my wrist, just out of curiosity. I don't have the girthiest arms to begin with, but my wrist is super bony. I'm also wondering just how much of the arm they can take. I know they leave a few inches where they grab the vein. I'd like to get 5" in length, but I've got tiny T-Rex arms, so I might have to settle for 4.5" if they need to leave some room near the elbow.

Quote from: FTMax on March 01, 2016, 10:46:26 AM
I'd be shocked if he is strictly looking at BMI. I know they're two different surgeons, but the packet I got from Dr. Schechter basically says that his firm cut-off for surgery is a BMI over 35. Between 30-35, you may lose some donor sites as options, or you may be told to lose weight just because of where you're carrying it, but you can still have *something* done.

I need to measure around my wrist, just out of curiosity. I don't have the girthiest arms to begin with, but my wrist is super bony. I'm also wondering just how much of the arm they can take. I know they leave a few inches where they grab the vein. I'd like to get 5" in length, but I've got tiny T-Rex arms, so I might have to settle for 4.5" if they need to leave some room near the elbow.

I'd find it remarkable if it is strictly a question of BMI, too. I can understand the 35 thing, as it's highly unlikely to have a BMI of 35+ and be all muscle. Unless you're the Hulk.

I'm trying not to speculate too much. I won't really know my options until I can speak with a surgeon, and I won't be speaking with a surgeon until I'm in a position to pay for surgery. Still, I like getting an idea of what my options might be.

Quote from: blink on March 01, 2016, 11:38:30 AM
I'd find it remarkable if it is strictly a question of BMI, too.

25 is the number his people quoted at me, so I'm treating it as gospel. I'm still a ways off from even getting a consultation, so I'm going to keep trying to lose weight by controlling diet alone. I finally saw some progress in the last few days; one problem I have is winter carb cravings. I have a harder time controlling food cravings at this time of year.

Spring is right around the corner.

I am NOT looking forward to electrolysis--neither the discomfort nor the expense. I don't think insurance covers electro even if it's a prereq for surgery that is covered. Max, did you get an estimate for the whole forearm hair removal process?

Quote from: Arch on March 02, 2016, 01:05:01 AM

I am NOT looking forward to electrolysis--neither the discomfort nor the expense. I don't think insurance covers electro even if it's a prereq for surgery that is covered. Max, did you get an estimate for the whole forearm hair removal process?

Arch, I didn't get a quote for the full arm. She wasn't sure we would be able to get it all done in time for surgery (depending on when the date is). But if everything goes according to plan scheduling wise, I should have time for (3) laser sessions at $150/session and another (3) electrolysis sessions in between them. The price of these is dependent on how long I can sit at once. I was planning to ask for 30 minutes for the first one to see how it is and then hopefully bump up to an hour if it isn't too bad. It is $79 for 30 minutes or $128 for an hour. She also said she wouldn't change the rate if we had to do my penis after the fact. Some places will charge more for genitals.

Prices will probably vary though. I know guys who are closer to Baltimore where it is cheaper paying $80 for an hour of electrolysis. If my plans stay the same and I don't need to come back after the fact, I'd be paying $785. I have asked insurance if they will reimburse and got a call yesterday saying someone was looking into it for me.

I wish my case manager were more reliable about answering e-mails. To get a reply, I really have to call, and I hate telephones. Setting up bottom surgery is going to be an uphill battle...

Slightly annoyed, but glad I got everything figured out now instead of a few weeks from now. When I left my consult, the NP told me that they had everything they needed to submit to insurance and would do so by Friday of that week. He said I could expect to hear something back within 45 days, and that we'd be able to schedule a date then.

I started to get a little antsy last week and reached out to a guy in one of the support groups I'm in. He has the same insurance and is going to Dr. Schechter as well. Apparently it only took him 14 days to get an approval and a surgery date. My 14 days would've been last Friday at the latest. So I called my insurance today, and they said they hadn't authorized anything yet and that they didn't see anything being reviewed. I called Dr. Schechter's office and the receptionist said they typically wait to submit to insurance until guys just have a few electrolysis sessions left so that they don't have to resubmit at a later date. I told her that I ideally wanted a date at the end of June, and that I was certain that at least the urethra area would be clear by then. She was cool with that, and we picked June 28th as my tentative surgery date so that she could put the request in to my insurance.

I'm a little upset that the process didn't go like I was originally told it would, but I'm glad I called today. There were only two more openings left for June, so at least I was able to snag one. I'm not sure I would've been so lucky if I had waited the full 45 days before calling anyone.

For the most part, it looks like my arm has responded really well to the laser hair removal session I had. I'm still shedding dead hairs and there are a few lighter areas that will require electrolysis, but the bulk of the hair that was there is gone. It's making me really dysphoric, but it is what it is. Hopefully I don't get a lot of regrowth in the next few weeks. I'm having my first electrolysis session tonight for just 15 minutes. I'm not sure how much length they need to be able to do it. If I have enough hair for 30 minutes, I'll extend the appointment. Not very excited about it, but will let you guys know how it goes.

Now I'm sort of glad that my legs didn't get as hairy as I wanted. Less dysphoria when the hair goes away.

But you got a June date--that's huge. Congrats on getting everything set up.

Electrolysis isn't bad! The only unpleasant thing about it was the position I had to sit in while she worked - seated on a chair, hunched forward, with my arm extended. Much, much less painful than laser. I wish we had time to do the whole arm that way.

She said overall it's looking great, and she was excited that I didn't have a lot re-growing yet. She gave me some tips to help along the shedding process and told me to wait until the week before my laser appointment next time so we could have a longer appointment. I was there for about twenty minutes and that was all it took to get the few hairs that didn't get affected by the laser.

Fingers crossed that my June date gets to stay! My insurance rolls over on July 1st and I'm planning on coming back for testicular implants at least in the fall, so I'm hoping to minimize the amount I'm paying by getting the bulk of the procedures taken care of prior to the roll over date.

Quote from: FTMax on March 17, 2016, 10:10:11 AMFingers crossed that my June date gets to stay! My insurance rolls over on July 1st and I'm planning on coming back for testicular implants at least in the fall, so I'm hoping to minimize the amount I'm paying by getting the bulk of the procedures taken care of prior to the roll over date.

I forgot about annual maximums. Urkh. Another thing I'll have to look into. I think that mine was $25,000 the last time I looked, but I'm not sure. And my insurance goes by calendar year.

Thanks for reminding me.

Insurance approved! Dr. S's office is working on a single case agreement with them now, so hopefully they'll consider him in network for the procedure. The hospital and one of the other doctors he works with are in network, so I'm hoping it all works out. Either way - progress! The difference between my in network and out of network maximums is $2k, which I'm happy to pay if it comes down to it.

I also got the final bill for my hysto - insurance paid out $35k, I contribute $1500.

Quote from: FTMax on March 29, 2016, 05:16:11 PMI also got the final bill for my hysto - insurance paid out $35k, I contribute $1500.

I still haven't gotten my hysto bill yet--it must be coming soon--but I was told that the price without insurance would be in the twenty thousands. I think the initial quote was $26,000. I'll be antsy until I get a bill and know that I'm covered for real. I should wind up paying out around $1800, I think.

Funny, I've never WANTED a big bill to come my way.

Sorry for the lack of updates everyone. It has kind of been a whirlwind last few weeks getting everyone on the same page.

Insurance approved the procedure, but Dr. S's office wanted to know exactly how much they intended to pay towards the procedure because apparently Blue Cross has a history of approving and then denying certain pieces of the bill. So Dr. S wanted what is called a single case agreement - basically a legal document saying "In the case of this specific surgery, we agree to pay $X toward the procedure". It would be nice for me to know as well. But I couldn't get anyone on the phone to talk about it.

I called twice and sent an email. Both directed me to the same department, which is apparently a healthcare provider only number. But whatever - I called it. Sat on hold for nearly an hour before someone answered. I described what I was looking for - all Dr. S wanted was the contact information for someone who would be able to work on it. And this was when the runaround started. "Well, I'm not sure I understand. We approved the procedure, so obviously we'll be paying our portion. Why do they need an agreement?"

I repeated the call on two more days, and got the same response from two different folks. Needless to say, I was annoyed. I sent a follow up email and let Customer Service know about the issue. Dr. S's office told me that if it was an issue I could pre-pay and that would 100% secure my date. My total pre-payment amount is $7500, which is $1500 more than my annual out of pocket maximum. Some of it may be refunded based on what Blue Cross pays. Dr. S told me they would make sure it was applied towards any of my out of pocket expenses and deductibles through their office, though I will still be responsible for the hospital co-pay.

I still need to put together a gap exception, which would be directed to insurance to have Dr. S covered as an in-network provider. There is another guy I've been working with who is encountering the same issue - there is a surgeon in our network (Dr. Bluebond-Langner) who also does phallo, and Blue Cross won't pay for Schechter in network because she is. He had a consult with her and says that her technique and experience level are vastly different, so I think we have a good shot of drafting something that works. Fingers crossed! His surgery is next month, so I'll have a better idea if Blue Cross will go for it after that.

So despite the roundabout crap with insurance, and despite paying more than what I expected to pay at this point - it's happening. Surgery is in 87 days. I have another laser session this Sunday. I broke my intended schedule and had 2 extra electrolysis sessions, because my arm hair looked really ugly where it was growing back in. I'm a little concerned about the underside of my forearm, which they make the urethra out of. Apparently all the hair there is very light and fine, and doesn't even show up under the magnifying light that they use. My electrologist told me she would do her best, but she wasn't sure she'd get all of it. I talked to a few other guys who are similar and they said that thus far they've had no issues with their urethras. So hopefully I'm worrying for nothing.

I gained a little bit of weight back, probably due to the stress of all the insurance stuff. So total since October, I'm down 25lbs. Dr. S would like me to lose 10-15 more before the procedure. I'm pushing for double that to drop my BMI below 25. It hasn't been too bad so far, and I think it's completely doable at the rate I'm going. Because of the timeline I have in mind and how much I'd like to lose, I'm doing 30-60 minutes worth of cardio, drinking around 100oz of water, and eating below my BMR. If there was not a date set and a light at the end of the tunnel, this would absolutely not be sustainable. I want tacos. But I can have tacos after I have a penis.

So my surgery date has changed 3 times so far, and now it's just a vague question mark. All I have now is "in or after late August". Dr. S is taking paternity leave sometime around mid-July, so I likely won't have a date until the baby shows up. Hopefully I'll get at least a month's notice.

In some ways I suppose it's good. It'll give me time to fit in 2 more laser appointments, and as much electrolysis as I can afford. I can bug insurance some more about a single case agreement and a gap exception to lower my costs. I have more time to figure out arrangements for my dog. I'll definitely be able to lose the weight that Schechter wants me to lose. It actually works out better for my job if I wait until the end of August instead of earlier in the summer.

But I won't have anyone to take care of me. I've been planning on having my dad be my caregiver post-op. He's a high school counselor, and he was completely available from mid-June through mid-August. If I'm lucky, it'll line up so that he can fly out with me and stay through surgery day, whenever that ends up being. But I'm not counting on it lining up.

My girlfriend may be able to come out for about a week, but probably not for more than that. I have a friend whose surgery will be in June, and he's said if he's still out on medical leave by the time I go, that he'll come with and take care of me. There's also another guy I know who's waiting to be scheduled. I know he's hoping for something in June or July, I'm not sure if he can take a later date than that due to work but if his ends up around the same time, we might be able to arrange some kind of joint accommodations and save money that way.

Ugh. This has been the most exhausting thing I've ever done, and I haven't even done it yet.

Hi guys,

It's been a minute since I updated. I am still waiting on a concrete surgery date. I've exchanged emails directly with Dr. Schechter and he's promised me that we are looking at late August or early September. His scheduler confirmed this in a more recent follow-up email, and told me she would be getting in touch in early July to schedule. So fingers crossed for that.

In the mean time, the issue of having someone to come with me and where I'll stay during surgery has been solved. I've made quite a few good friends during this whole process, one of whom just recently had surgery with Dr. Schechter. After his experience, he has decided to permanently move to Chicago and open a recovery space in his apartment for trans people undergoing gender confirming surgery with the surgeons in the city. He is working incredibly hard (despite still recovering himself!) to make this a reality before my surgery date. And, he's made arrangements with friends of his in Chicago who have agreed to let me stay with them in the event that he isn't able to move by then. So I feel infinitely better now that at least that portion of the planning is taken care of. That still leaves plane tickets, time off work, a dog walker, etc. to figure out, but that is all easily managed once I have a date to work with.

If anyone is interested in more information about the recovery space, feel free to message me. He will be charging for folks who want to stay, but it is substantially lower than the cost of a hotel and includes transportation to/from the airport, the hospital, office visits, etc., as well as food and medical supplies. He is also running it on a sliding scale, and will not be turning away anyone that can't pay. I'm really excited to see how it works out, and promise to be candid about my experience.

Wow, he's really performing a service for trans people. I could never do what he's doing.

He's doing a great deed there. That's awesome, thanks for telling us about it and keeping us posted.

Do you know how long recovery will take you and when you'll be able to do things like drive and return to work?

Quote from: alienbodybuilder on July 04, 2016, 06:24:36 PM
Do you know how long recovery will take you and when you'll be able to do things like drive and return to work?

From guys I have spoken to, anywhere from 4 weeks to 12 weeks is normal with zero to minimal complications. I am planning to take a month off from work and physically be in Chicago that whole time. I'm planning to work remotely whenever possible during that period (probably for the last two weeks for a few hours each day). After I come back home, I am planning to take another 2 weeks to work remotely or go in for partial days. Depending on how things are going at that point, I may go back to work full time or I may continue to work remotely.

I should be able to drive as soon as I'm off narcotic pain meds, but I will probably take it easy for a while. The past few surgeries I've had, I've stopped taking meds very early on and went back to normal activities way earlier than most people do. I am planning to rest the entire 4 weeks I'll be in Chicago, and hopefully that will help me get back to regular stuff more easily once I'm home.

I posted about this on another group, but figured it was a relevant addition to my thread here. While I hope this doesn't happen to future Schechter patients, I think it's worth putting it out there so that folks know it has happened at least once.

Tl;dr - I keep getting disappointed by Dr. Schechter's office, who has yet to schedule me for surgery after months of being ready and waiting. Still no surgery date. I scheduled a consult with another surgeon and am considering going to someone else.

To recap, I consulted with Dr. Schechter at the end of February. I asked during my consult if summer would be doable for surgery, and was told yes. It took about 3 weeks after that for my insurance to approve the procedure. Shortly after that, I got my first surgery date. And it was subsequently cancelled. This process repeated 2 more times. I've had a total of 3 dates, all of which were cancelled shortly after being scheduled.

Around mid-May, I reached out to Dr. Schechter directly to confirm what exactly we were looking at in terms of dates, and was told late August or September. Not what I wanted to hear, but fine. I got an e-mail from his office coordinator about a month ago, saying that she would be in touch in July to get me scheduled. She did get in touch last week, and asked if I was ready to pay the balance of my portion for the procedure. I assumed this meant that they had a date lined up, so I asked when I'd be having surgery.

Apparently she didn't remember cancelling my last surgery date and that's what she had wanted me to pay for. I told her I wasn't keen on paying any more toward my balance until I had a date, and was 2 weeks out from that date because of all these cancellations. She asked me to reconfirm what date range I was looking at, and I reiterated what Dr. Schechter and I had previously discussed about late August or September if there wasn't an earlier option. I could hear her scrolling over the phone and after a few seconds she finally goes, "Hmm well we're booked up for both of those months. It looks like the earliest we might have is October."

It took me a few hours to get over how ridiculously angry I was. After I did, I emailed Dr. Schechter and, as politely as possible, went through the timeline as I did above, reminded him all the dates we had discussed at various points in this process, and questioned why guys who had consulted after me, whose insurance had approved after mine, and who were at the same stage of readiness as me, had had surgery already this year, during the periods that I had wanted to have surgery.

Unfortunately I didn't get any kind of answer. He said they are still looking at dates and coordinating with the urologist that he works with. He didn't give me any kind of timeline or date range this time, just that they would "be in touch ASAP" with a date. This was exactly the kind of headache that I wanted to avoid by not going to Dr. Crane. It has taken every ounce of willpower in me not to call and ask to have my pre-payment refunded.

I'm still pretty upset about it. I've done everything possible to breeze through this process. I decided the day after that I wasn't going to wait for them to get in touch again, only to find out that there are no dates available until winter or later. So I got in touch with Dr. Bluebond-Langner's office in Maryland and scheduled a consult. She can't get me in until the beginning of October, but it doesn't seem like I'll be getting in with Dr. Schechter before then, so there's no harm in it.

There are a lot of pros to potentially going to her for surgery. She's about an hour away from my house, so travel costs would be minimal and lodging expenses would be non-existent. I have lots of local resources in place, all of whom highly recommend her. And my out of pocket expenses with insurance would be at least $3k less. The only con that I can see is that she is significantly less experienced. I've asked my doctor for copies of my referrals. Once I get those, I'll be asking if Dr. BL's office can add me to the cancellation list so I can potentially get in earlier.

I'm not excited about potentially having to restart this whole surgical process, but I'm really disappointed in the experience I've had thus far with Dr. Schechter's office. At first I thought it was just an issue of scaling up his capacity to meet the increased demands now that his name is more out there, but the fact that I've been passed over at least 3 times that I know of really makes me question what the hell is going on.

Feel free to leave feedback and thoughts. Every time I write this out, I get more angry about it and think about cancelling with him altogether. I want to give them the opportunity to do the right thing, but it seems pretty bleak at this point.

Is Crane's office typically as bad as Schechter's has been for you, or were you just tangled up in the whole Texas situation? Seems to me that after all of this, you might have been better off with Crane after all--but not if you had to go to California unwillingly.

I'm just blown away by your situation. I, too, would be absolutely furious. We have to put our lives on hold, arrange leave from work, sometimes get a significant other to get time off from work, get people to care for our homes/pets/kids, that sort of thing--and certain times of the year are significantly worse than others. We need some kind of assurance that, barring truly unavoidable circumstances, we will have some control over the surgery date and some expectation that the date will stand. After three cancellations under the circumstances you've detailed, I would certainly want to look elsewhere, too.

Frankly, I'd hesitate to have such a delicate surgery performed by someone without tons of experience, but I can see the attractions of staying close to home. What other reasonable options have you?

There were a lot of really awful stories about dealing with Dr. Crane's office around the time I started surgeon shopping. They were hard to get in contact with, hard to hear back from, people were waiting for months on end without any kind of confirmation about what stage of the process they were in, etc. I have heard it has gotten better over the last few months. I also would not want to travel to SF. I've heard a lot of bad experiences with the hospital they operate out of. I'd be open to going to Austin, but I don't think I'd want to be one of the first patients to be hosted there. I'd want them to have some time to work the kinks out, and that would probably push me out into next year.

I am still pretty angry about the whole situation, and I think deep down I would like to cancel with Schechter. I have a friend who had surgery with him about a month ago who is still there, and mentioned that he would talk to him today and see if he could get a sense as to what happened. I've been racking my brain the last few days trying to think if there was any possibility that it was something on my end that might have led them to cancel, but I feel like they would've said something after the first one if that was the case. Either way, I'm interested in hearing what he says. My general feeling right now is I will wait until the end of the month for them to give me a date, and if I haven't heard from them then, I will cancel.

I definitely like her results from what I've seen. My doctor showed me a fairly lengthy presentation that Dr. BL did, and aesthetically it's very impressive. I would love to find one of these guys and talk to them to see if functionally everything is as good as it looks. I have a friend who will be having surgery with her sometime this fall, so I may be able to talk to him afterwards if mine hasn't been done by then.

She has done far fewer than Schechter has, but she's well into the double digits at this point. I do think as a community we should be more open to lesser known surgeons. I like the approach Crane took with Chen, and I think ideally that is how everyone should do it. I can't remember who Dr. BL trained with. I want to say the London team, but not 100% sure. She's a big fan of MLD, which makes me think she also spent some time with one of the Serbia teams. If I end up going to her, I may have her look at my MLD donor site. Schechter said it was not ideal, but I've lost over 40lbs since then so maybe it is now. I've already done a lot of hair removal on the arm though, so that would be a waste.

I could consider other surgeons, but there's really no one else I'm interested in going to. Out of everyone I'd consider going to, they all have cons that outweigh the lack of experience that Dr. BL has, at least for me at this point.

Man, sorry you are getting the run around with this. Sounds like there's big room for improvement with their scheduling system. Or something else is not right.
Thanks for keeping us updated, it is important and helpful to hear the good as well as the not so good experiences.
I hope you get a solid date set soon, whichever surgeon you ultimately end up with for that.

Does this Dr. Bluebond-Langner have results photos available at all, perhaps if one contacts the office by email? I'm finding nothing online. Surgery's still a ways off for me so I'm still keeping my eyes open for options.

I don't know what is up with Crane's office. My case manager told me I'd be using Crane--as if I had no other options--because he is in my primary network. Yet Crane's office says that he doesn't deal with my insurance provider at all.

I do have a PPO, but it covers only half for a surgeon outside of the system, so I don't know whether Meltzer or someone else on this side of the country is a possibility.

Now I'm starting to worry that I'll get into the same kind of merry-go-round that you are on, FTMax. When I finally schedule procedures, it's because I'm reaching the end of my rope and cannot gracefully handle delays.

How the heck do you cope?

Good news is that my friend who recently had surgery with Schechter spoke to him about all this, and Schechter said he is working to get me in this August. So, fingers crossed that (1) that happens, and (2) they tell me about it with enough notice that I can actually take the date.

@blink : I don't believe she has any results online. That is an issue I've run into with all of the surgeons who are affiliated with University hospitals - no online results to speak of, unless the patient has posted them. If I find some, I will definitely point you in that direction. And if I end up going to her, I will be posting online and would be happy to share.

@Arch : If your case manager is saying one thing and Crane's office is saying the other, I would see if you can do a conference call with them to hammer out where the disconnect is. A lot of guys recommend asking for Ursula at Crane's office. She will make sure stuff gets done. I'd also look into Dr. Dugi and Dr. Berli at Oregon Health & Science University. They have trained with Dr. Miro and are starting to offer phalloplasty this fall, so by the time you are ready to go, should have a decent practice started up. I know someone who has gone to Crane who is having them do his implants, and he was very happy with his consult and excited to work with them.

As far as coping, I'm really not. I'm super stressed, anxiety is awful, and I don't think I've ever wanted to not exist more than I have during this whole period of time.

August! Fingers crossed for you.

And thanks for being willing to direct me to results. Frustratingly, websites with readily available results photos such as Dr. Crane's seem to be the exception rather than the rule. I understand only so many people are comfortable sharing their results, but to me it seems many surgeons just have not hired someone to create such a website, for whatever reason. I don't understand it. Seems like it'd be a huge factor in how many patients one would get. Maybe these surgeons feel they already have enough patients through word of mouth. Or maybe I am underestimating how many hundreds of patients a surgeon has to have to find a handful of dudes comfortable with sharing their results.

Dr. Dugi, Dr. Berli. I keep seeing more names in this thread I don't recognize and really wonder how many good options I'm unaware of. After all, I ended up going with Dr. Gary Lawton for top surgery and I had to dig around awhile before his name came up. He's not one of the more talked-about surgeons (or wasn't when I went to him, maybe that's changed) but I'm satisfied with my results. Max, I agree with your view that it's a good idea to consider lesser-known surgeons. Dr. Crane was also once such a surgeon.

Not ever? Is it worse for you now than before starting transition? That sounds horrific, I'm sorry. Wish I had something more helpful to say but, hang in there. It'll happen at some point, and then it will have been worth it.

Quote from: blink on July 15, 2016, 12:20:15 PM
August! Fingers crossed for you.

And thanks for being willing to direct me to results. Frustratingly, websites with readily available results photos such as Dr. Crane's seem to be the exception rather than the rule. I understand only so many people are comfortable sharing their results, but to me it seems many surgeons just have not hired someone to create such a website, for whatever reason. I don't understand it. Seems like it'd be a huge factor in how many patients one would get. Maybe these surgeons feel they already have enough patients through word of mouth. Or maybe I am underestimating how many hundreds of patients a surgeon has to have to find a handful of dudes comfortable with sharing their results.

Dr. Dugi, Dr. Berli. I keep seeing more names in this thread I don't recognize and really wonder how many good options I'm unaware of. After all, I ended up going with Dr. Gary Lawton for top surgery and I had to dig around awhile before his name came up. He's not one of the more talked-about surgeons (or wasn't when I went to him, maybe that's changed) but I'm satisfied with my results. Max, I agree with your view that it's a good idea to consider lesser-known surgeons. Dr. Crane was also once such a surgeon.

Not ever? Is it worse for you now than before starting transition? That sounds horrific, I'm sorry. Wish I had something more helpful to say but, hang in there. It'll happen at some point, and then it will have been worth it.

It seems the way some of them luck out at least early on is by accepting a lot of common, local insurance plans and relying on that instead of word of mouth. At least speaking in terms of Dr. BL, I know she is covered by the majority of plans in the greater DC region now so I have heard of quite a few folks going to her (mostly MTF, but I've met 2 other guys who are planning to go to her for surgery and 1 who is using her for post-op care though Schechter did his phallo). I would never have heard of her if I hadn't asked my doctor who locally was doing bottom surgery.

Also, if you're on Facebook I can direct you to some secret groups with tons of results. Feel free to message me if that interests you. You'd have to add me as a friend in order for me to add you to them. They grow by direct word of mouth only, which is cool.

I think the trend will continue and we'll likely see a lot of new names over the next few years. Dr. Miro from Serbia has been traveling pretty extensively throughout the US teaching teams at different hospitals how to do both phallo and meta. I'm not sure if he is planning to continue doing that, or if it has all been by request, but I think it bodes well either way that there was enough of a need for him to come here and do that.

And yeah. I think pre-transition I was able to distract myself with enough other stuff that it wasn't as overwhelming. But up until now I've been able to do everything transition-wise on my terms so being stuck and not knowing why or when it'll be fixed is just awful.

Quote from: FTMax on July 15, 2016, 09:19:19 AM
As far as coping, I'm really not. I'm super stressed, anxiety is awful, and I don't think I've ever wanted to not exist more than I have during this whole period of time.

Oh, god, I know that feeling. It's unspeakable, especially when it goes on and on.

I am sorry. Online, you come across as very controlled, even when you are angry. That'll teach me to make assumptions.

On the Friday before my hysto, I found out that my insurance actually hadn't approved the procedure. I was told to reschedule. I kept the date, knowing full well that I would owe hoards of money if the insurance didn't come together in a matter of hours.

I didn't want to miss work, but I knew perfectly well that the department would get someone to cover my classes for a couple of weeks. The issue was mainly that I'd started the process six months earlier when I was just about at the end of my rope, and I didn't think I could hold on anymore. I had calibrated my whole life to that December date and felt that even a huge amount of debt was better than a one-month delay. I had gotten to that point.

I guess when I'm setting up bottom surgery, I'll have to keep telling myself, "This is not a sure thing yet. This is not written in stone. Don't count on it." But I don't know how much that will help. I suspect that the anxiety will continue until I'm actually flying up there and checking in for my surgery.

Come to think of it, I don't think my hysto was pre-approved either. I had it less than a week after the consult. They didn't seem to care though. My insurance has been pretty cool about all the stuff I throw at it.

Quote from: Arch on July 15, 2016, 03:17:05 PM
I guess when I'm setting up bottom surgery, I'll have to keep telling myself, "This is not a sure thing yet. This is not written in stone. Don't count on it." But I don't know how much that will help. I suspect that the anxiety will continue until I'm actually flying up there and checking in for my surgery.

Yep! I've decided I'm going to call them the day before I'm scheduled to fly out just to confirm that we are indeed going to do it this time around. At this point, experience tells me that when they call with a date, it's not real. It's pretty sad that it's gotten to that point. One time, I could forgive. But 3? Absolutely absurd.

Talking about it helps though, so thanks for listening and engaging :)

Three times is ridiculous, yes. Makes me wonder what leads to that kind of scheduling issue.

Ah, man, I don't have a facebook. I've refused to register one this whole time. This would be a good reason to get one, though. I'll have to mull it over. In the meantime, thanks.

I came across this thread whilst Googling to try find Dr. Bluebond-Langner's email. I am FTMax's friend who is planning to move to Chicago to open a recovery apartment, and who recently had surgery with Schechter on May 31.

I am incredibly disappointed with my experience, and the lack of care, concern, communication, and follow up that has taken place following my RFF Phalloplasty with Schechter on May 31, and thus am looking to try to schedule stage 2 potentially with Dr. B-L.

Does anyone have her email address? I'd like to try to email her to ask a couple of questions.

cheers-
rhys

Quote from: rhysharper on August 12, 2016, 04:53:15 AM
I came across this thread whilst Googling to try find Dr. Bluebond-Langner's email. I am FTMax's friend who is planning to move to Chicago to open a recovery apartment, and who recently had surgery with Schechter on May 31.

I am incredibly disappointed with my experience, and the lack of care, concern, communication, and follow up that has taken place following my RFF Phalloplasty with Schechter on May 31, and thus am looking to try to schedule stage 2 potentially with Dr. B-L.

Does anyone have her email address? I'd like to try to email her to ask a couple of questions.

cheers-
rhys

I can get you her scheduler's email address if you can't find a direct one to her!

Also - I don't think I updated here but did elsewhere online. I did end up cancelling with Dr. Schechter's office at the beginning of this month. They immediately tried to offer me dates, but I turned them down.

I have a consult scheduled with Dr. Bluebond-Langner for Oct. 4th, and am on her cancellation list if something earlier opens up. While I'm not happy about things getting pushed so far off schedule-wise, it feels like this was the right choice to make given the circumstances. Her scheduler told me it is usually a 6-8 week turnaround on consult to surgery if you're ready by then so *hopefully* I can have surgery before 2017. Insurance is the biggest part of that turnaround period, so I'm optimistic knowing that they approved in just 2 weeks last time. And Dr. BL is in network, so that may speed the process along a little bit.

Fingers crossed! I will keep updating with how it goes. I am expecting a refund check next week from Dr. Schechter's office for the money I prepaid. They were nice enough to send me back my referral letters so that I could reuse them with Dr. BL.

I have my fingers crossed, Max.

A mini update about a persistent thought I've been having since cancelling with Dr. Schechter.

When I first started exploring bottom surgery I was torn between metoidioplasty and MLD phalloplasty. At my consult with Dr. Schechter, I found out I was not a good candidate for meta, and that because of my body fat distribution, MLD was not a good option either. His advice, if I wanted to pursue MLD, was to lose about 50lbs. At the time, it did not feel doable so I settled for RFF.

But I ended up losing 40lbs, and I'm on track to lose another 20-30lbs. When I look back and think about that conversation, I get the impression that Dr. Schechter actively did not want to do MLD and felt that it was inferior to RFF, and that was why he gave me the worst case scenario that he did along with such a large amount of weight loss. I've also heard that Dr. Bluebond-Langner's opinion of MLD is much more favorable based on what I have heard from my doctor and others that have consulted with her.

So it feels like MLD could be back on the table.

As a result of that, I'm planning to stop hair removal on my arm until my consult. I have had some re-growth, so my arm isn't completely bare. The difference between my arms in terms of hair is causing me a lot of dysphoria. I think the current level of re-growth could eventually get to a point that I'd be comfortable with, but given how much success I've had with hair removal, I don't want to get any more done until we've firmly ruled out the possibility of MLD.

If Dr. BL feels that MLD still isn't an option for whatever reason, I just need a few more hours of hair removal and that can easily be done in the period between the consult and scheduling surgery. If we move forward with MLD, I'll at least have some arm hair on the left arm, and I could maybe do a few sessions of laser on the right to even them out if it really bothers me.

Thoughts? My girlfriend and parents feel like it's a good move but this whole situation has thrown me for a loop and I'm second guessing everything.

What is the point of the hair removal. Is it necessary for the surgery or is it because you want it?

Quote from: alienbodybuilder on August 22, 2016, 11:01:41 AM
What is the point of the hair removal. Is it necessary for the surgery or is it because you want it?

If you're having RFF or ALT phalloplasty, they are using the top few layers of tissue on either the arm or the thigh. In my case it would be the arm. A small portion of that will be used to extend the urethra, so at a minimum this section should be hairless before surgery to reduce the risk of complications.

The remainder of the donor site is used to create the phallus itself. You can have surgery without doing hair removal on this section, BUT you'll end up with a hairy penis. That doesn't bother some guys, but I would say the vast majority of guys do get it done. Most people work on it for about a year in advance of surgery.

Aesthetically, I think it looks a lot better hairless.

A quick update - my consult with Dr. Bluebond-Langner is two weeks away as of tomorrow. I am just about finished with my list of questions I'm planning to take to her, and will post a link when they're complete. Some of them are carried over from my consult with Dr. Schechter, some of them are related to her techniques and experience specifically because there is much less information out there about her.

I cross-posted my Q&A from my Schechter consult with some other bottom surgery groups and a lot of guys were really thankful for it. In talking about it with one of those groups recently, I asked if it would be helpful for folks if I put together a sort of Bottom Surgery Consults 101 document that would include what to expect, what to take, what questions you should always ask, how to formulate questions that are relevant to you, how to make the most of your time, etc. The answer was a resounding yes, so I figured I would also ask here - would something like that be of use to anyone here? I am in the process of putting it together now and would be happy to either message the link to interested parties or to post it here if it's a lot of you.

Quote from: FTMax on September 19, 2016, 10:04:20 PM
A quick update - my consult with Dr. Bluebond-Langner is two weeks away as of tomorrow. I am just about finished with my list of questions I'm planning to take to her, and will post a link when they're complete. Some of them are carried over from my consult with Dr. Schechter, some of them are related to her techniques and experience specifically because there is much less information out there about her.

I cross-posted my Q&A from my Schechter consult with some other bottom surgery groups and a lot of guys were really thankful for it. In talking about it with one of those groups recently, I asked if it would be helpful for folks if I put together a sort of Bottom Surgery Consults 101 document that would include what to expect, what to take, what questions you should always ask, how to formulate questions that are relevant to you, how to make the most of your time, etc. The answer was a resounding yes, so I figured I would also ask here - would something like that be of use to anyone here? I am in the process of putting it together now and would be happy to either message the link to interested parties or to post it here if it's a lot of you.

HI, Max!  I just logged in to see if you had posted any updates.  i knew that that you were scheduled in October.

How is the electrolysis going?  Are you near your weight goal/are you where you hoped to be at this timeframe?  Do you know how far out Dr. Bluebond-Langer is scheduling from consult?

I think it is great that you are willing to write a bottom surgery consults document.  Do you plan to include meta?  I know that at first you were going in that direction, so you would have this information, as well.  So...you know...wanna add some more work to that?  Taking the time to do this is a great service to the community.  Thank you!

Quote from: Bimmer Guy on September 19, 2016, 10:30:09 PM
HI, Max!  I just logged in to see if you had posted any updates.  i knew that that you were scheduled in October.

How is the electrolysis going?  Are you near your weight goal/are you where you hoped to be at this timeframe?  Do you know how far out Dr. Bluebond-Langer is scheduling from consult?

I think it is great that you are willing to write a bottom surgery consults document.  Do you plan to include meta?  I know that at first you were going in that direction, so you would have this information, as well.  So...you know...wanna add some more work to that?  Taking the time to do this is a great service to the community.  Thank you!

I've paused the electrolysis for right now, for reasons which are weight related :) I've actually met the weight goal Dr. Schechter put out there for me in terms of an ideal weight if I wanted MLD. I'm going to ask Dr. BL what she thinks about it. I don't want to zap anymore arm hair if I don't have to - being hairless there is giving me a lot of dysphoria, and it's a stupidly painful process.

Since I've lost the weight and dropped my body fat percentage down, I think I'm a better candidate for MLD and I would strongly prefer it to RFF. It would probably be 2-3 stages as opposed to the 1 I'd need for RFF, but that's not a huge concern now since my travel expenses will be so minimal just having to drive to Baltimore. So fingers crossed that she thinks I'd be good for it. If she doesn't, I will probably do another 2-3 hours of electrolysis followed by a laser session and that is easily done in a month.

Not sure on the scheduling. Her office says they try to get people in as soon as insurance approves and their OR is available. Insurance approved in 2 weeks last time, so hypothetically I could be offered the end of October if it was the same this time and they have availability. No idea what her holiday schedule looks like though, and the end of October starts cutting close to that. I wouldn't want to be released from the hospital and have something go wrong only to find out that my surgeon is away.

And yes! The document I'm working on is going to be inclusive of both procedures. I will actually probably send you a link on FB before I post so you can review/see if there's anything to add :)

I just got off the phone with my Dr. Bluebond-Langner's office. She has decided to move. She's going to be leaving the Baltimore area at the end of the year and will be joining the team doing bottom surgeries at NYU. They gave me a few options - I could keep or cancel my current consultation if I just wanted to meet her, BUT her OR time is booked through the end of the year currently so there is no way I'd be able to have surgery in Baltimore. If I still want to go to her, I have to have a consultation at NYU and then schedule surgery there.

I've decided to keep my current consult with her. I figure there's no point waiting to meet her at NYU only to find out that there's something I don't like and get set back even further. I do plan to ask her if Dr. Miro is planning to return to NYU to do any phalloplasties next year. He was originally who I wanted to go to before I got insurance, so if he's planning to come back at all (which I've heard he is but haven't heard a date range), I'm going to try to schedule while he is around.

With how long Dr. Schechter's office dicked me around, and now this - I will have lost an entire year of time. I'm so tired of surgeon shopping. If I'm not enthusiastic after my consult with Dr. BL, and Dr. Miro won't be at NYU at all next year, I'm torn about my backup plan. Crane is the next closest distance that I'd consider going to, but his scheduling will probably be even further out than I want. I have also thought about the new team at OHSU, but would worry about the huge travel costs incurred.

It also possibly throws a wrench into my insurance. She is currently considered in network, as is the hospital she works out of. I've already sent them an email asking if NYU and any of the physicians there are considered in network. I couldn't find my plan listed on the NYU website. Ugh, so much work.

Quote from: FTMax on September 21, 2016, 09:57:36 AM
I just got off the phone with my Dr. Bluebond-Langner's office. She has decided to move. She's going to be leaving the Baltimore area at the end of the year and will be joining the team doing bottom surgeries at NYU. They gave me a few options - I could keep or cancel my current consultation if I just wanted to meet her, BUT her OR time is booked through the end of the year currently so there is no way I'd be able to have surgery in Baltimore. If I still want to go to her, I have to have a consultation at NYU and then schedule surgery there.

I've decided to keep my current consult with her. I figure there's no point waiting to meet her at NYU only to find out that there's something I don't like and get set back even further. I do plan to ask her if Dr. Miro is planning to return to NYU to do any phalloplasties next year. He was originally who I wanted to go to before I got insurance, so if he's planning to come back at all (which I've heard he is but haven't heard a date range), I'm going to try to schedule while he is around.

With how long Dr. Schechter's office dicked me around, and now this - I will have lost an entire year of time. I'm so tired of surgeon shopping. If I'm not enthusiastic after my consult with Dr. BL, and Dr. Miro won't be at NYU at all next year, I'm torn about my backup plan. Crane is the next closest distance that I'd consider going to, but his scheduling will probably be even further out than I want. I have also thought about the new team at OHSU, but would worry about the huge travel costs incurred.

It also possibly throws a wrench into my insurance. She is currently considered in network, as is the hospital she works out of. I've already sent them an email asking if NYU and any of the physicians there are considered in network. I couldn't find my plan listed on the NYU website. Ugh, so much work.

Schecter is who I want to go with due to insurance and location. Would you not recommend him? And that guide to Phallo you spoke of would be awesome.

Quote from: CMD042414 on September 21, 2016, 09:24:41 PM
Schecter is who I want to go with due to insurance and location. Would you not recommend him? And that guide to Phallo you spoke of would be awesome.

I won't totally knock Schechter as a surgeon. I wanted to go to him because of the good results I had seen and the good reviews I'd heard from other people. But he and his office were just not on their A game this summer. I had 3 friends go to him for phalloplasty towards the end of May/beginning of June. Two of them had complications that necessitated staying in Chicago through the middle of August. Schechter never explained to them why their care was being drawn out so long, nor did he give them a timeline as to when they would be able to leave. One of them ultimately needed to have corrective surgery with another surgeon because the urologist Dr. S works with was unwilling to listen to patient concerns and provide aftercare in a timely manner. Neither of them are 100% happy with their results. Compared to them, my experience (detailed in past posts) was more benign but still frustrating.

To make up for my bad experience, they did ultimately end up offering to do my surgery on any date that would work for me. I said no, because of how disrespected I felt throughout the scheduling process and because of the terrible experiences my friends had. Going to him no longer felt like a smart decision for me, but if he meets a lot of your criteria maybe at least go for a consult with the understanding that consults are essentially sales meetings for surgeons.

Knowing everything I currently know, if I had to divide the US into 3 regions - I'd go to the team at OHSU if I lived out west (not knocking Dr. Chen - SF is just too expensive for me to think about traveling to), I'd go to Dr. Crane if I lived in the midwest, and living where I do on the east coast, I'm going to Dr. Bluebond-Langner. If I was willing to entertain the idea of Miami, I would also consider Dr. Salgado. But I hate Florida, so that's a hard pass.

Quote from: FTMax on September 22, 2016, 08:36:50 AMKnowing everything I currently know, if I had to divide the US into 3 regions - I'd go to the team at OHSU if I lived out west (not knocking Dr. Chen - SF is just too expensive for me to think about traveling to), I'd go to Dr. Crane if I lived in the midwest, and living where I do on the east coast, I'm going to Dr. Bluebond-Langner. If I was willing to entertain the idea of Miami, I would also consider Dr. Salgado. But I hate Florida, so that's a hard pass.

This is so helpful. Thank you. I'd never heard of Dr. B-L but I'm going to look into it. The money I'd save in travel alone is worth it. I spoke with Schecter on the phone once awhile ago and he was helpful. I am concerned about the complications you mentioned. I want phallo with microsurgery and I was always under the impression that it's only Crane or Schecter in the U.S.

Max, I'm so sorry about this latest setback. Not just because you're a good guy who doesn't deserve all of these obstacles but because I'm becoming more and more apprehensive about my own path!

I hope you have a good way to deal with your frustration.

Quote from: CMD042414 on September 24, 2016, 04:52:50 PM
This is so helpful. Thank you. I'd never heard of Dr. B-L but I'm going to look into it. The money I'd save in travel alone is worth it. I spoke with Schecter on the phone once awhile ago and he was helpful. I am concerned about the complications you mentioned. I want phallo with microsurgery and I was always under the impression that it's only Crane or Schecter in the U.S.

The market is definitely getting a bit more saturated, which I'm glad for. In terms of completed phallos, Dr. Crane and Dr. Schechter are definitely the top two in the country currently. I don't know how many Dr. Chen has done on his own, and I don't have numbers for Dr. Salgado either. I would imagine they have probably done the same amount. Chen probably comes out ahead when you add in everything he assisted with before Dr. Crane moved to Austin full time. When I first checked in on Dr. Bluebond-Langner (in January of this year), she had done just over a dozen and was averaging at least one per month. The OHSU team hasn't started doing phallos yet, but they've trained very intensively with doctors that I have great respect for.

I know there's a doctor in Michigan doing them, but haven't heard anything about him. The microsurgery clinic that Dr. Crane used to work with in SF has also separated from him and is planning to offer their own. Last I heard, Dr. Rumer is also in the early stages of (forgive the pun) boning up her phallo offerings with UL and microsurgery.

Based on what you want, the only surgeons doing this that you could immediately cross off your list would be Dr. Leis and Dr. McGinn and that's based solely on the microsurgery. Microsurgery is really becoming the standard for phallo. Leis is older, and I don't see him adding it to his offerings but McGinn is totally capable. I'd actually be surprised if she DIDN'T jump on the bandwagon in a few years.

I will say, I can't 100% remember but I feel like you mentioned to me in another thread that you wanted ALT? If that's true, I would actually not recommend going with Schechter. I was speaking earlier with some other guys who've been to him or consulted with him and he apparently tries to talk everyone out of anything that isn't RFF. He's done ALT on less than 5% of his patients. I honestly thought I had a great consult with him and got good feedback regarding donor sites, but talking to other guys about it, I'm really second guessing it.

Quote from: Arch on September 24, 2016, 06:05:07 PM
Max, I'm so sorry about this latest setback. Not just because you're a good guy who doesn't deserve all of these obstacles but because I'm becoming more and more apprehensive about my own path!

I hope you have a good way to deal with your frustration.

FWIW - I haven't heard any horror stories come out of any of Crane or Chen's patients lately :) It seems now that Austin is up and running and they've taken a more proactive approach in their dealings with CPMC, everybody's been pretty good.

I have a long way to go before my surgery. I have to find out what my options are at work (our leave options are incredibly convoluted), decide for sure on a procedure (I still think I want ALT), sort out insurance issues and choose a doctor, go through the hair removal process, deal with scheduling and logistics . . . not to mention the emotional side of things.

If Crane isn't doing any procedures in CA anymore, or if he does very few, I'll probably wind up with Chen. I don't know whether Meltzer is a possibility; Arizona is about as far away as Northern California, but if Blue Shield says to stay in California, I don't have much choice.

But, hey, two years will give Chen time to practice more.

Quote from: Arch on September 24, 2016, 10:29:05 PM
I have a long way to go before my surgery. I have to find out what my options are at work (our leave options are incredibly convoluted), decide for sure on a procedure (I still think I want ALT), sort out insurance issues and choose a doctor, go through the hair removal process, deal with scheduling and logistics . . . not to mention the emotional side of things.

If Crane isn't doing any procedures in CA anymore, or if he does very few, I'll probably wind up with Chen. I don't know whether Meltzer is a possibility; Arizona is about as far away as Northern California, but if Blue Shield says to stay in California, I don't have much choice.

But, hey, two years will give Chen time to practice more.

I looked at Meltzer. He's only doing the pedicle flap right now unfortunately. SF may be a little more expensive, but I think Chen is really the way to go if you're already in that general region. I haven't seen anything but good work come from him, and everybody absolutely raves about his bedside manner. I think you'd be in good hands. You could also make a call to Dr. Safa at the Buncke Clinic and see if they're planning to work with your insurance. They previously did the microsurgery for Dr. Crane and are planning to start offering their own. They're in SF too, but it would at least give you another option if you want to cover Plan A and Plan B :)

I figure that I'm most likely to wind up with Chen, but I didn't know about Safa. This thread is immensely useful. We really ought to sticky it!!

Gents,

Here is the Google Drive link to the Bottom Surgery Consultation Guide I put together. If anyone has any points to add or things I should clarify, feel free to send me a message. I hope it helps folks get ready for their consults.

https://docs.google.com/document/d/1Wp8TYoHZPSKz5xNAenV0x1qUr2nHnp3ojGWmQwr2cTQ/edit
(https://docs.google.com/document/d/1Wp8TYoHZPSKz5xNAenV0x1qUr2nHnp3ojGWmQwr2cTQ/edit)
And here is my list of questions for my consult with Dr. Bluebond-Langner. For that consult, I will be recording audio and then transcribing the answers after the fact, so it should come along much faster than the one with Dr. Schechter did since I won't be having to translate my hieroglyphic speed handwriting. I think this includes everything that I personally care about, but if there is anything anyone would like me to ask on their behalf that isn't included here, feel free to comment or PM me anytime before Tuesday morning and I will be sure to add it on.

https://docs.google.com/document/d/11tq5MSbMhJo9qy1qQkpepPQMFUN011dUVHkCqGSg-sI/edit (https://docs.google.com/document/d/11tq5MSbMhJo9qy1qQkpepPQMFUN011dUVHkCqGSg-sI/edit)

You win!  You win the "Most distressing pre-bottom surgery experience".  I knew that Dr. B-L was going to NYU, but for some reason I thought it was down the road.  Geesh, you can't win.  I read through the info. on why you are looking at MLD.  I know I asked you about it on FB.  I haven't come back to the thread since the last time I was here.

Good luck tomorrow!  I hope it is all good news!

As an aside, to everyone here, I would consider going to Dr. Safa.  I didn't realize that not only do they do all the nerve hookups, but they also are the ones that create the phallus itself.  I am less clear on what Crane/Chen do besides the UL and vaginectomy.  I bet people can get in pretty quickly too, since they are just starting out with their own program.  Looks like they don't do MLD.  Marci Bowers is doing their hystos.

http://sftrans.org/

I had a really good consultation with Dr. Rachel Bluebond-Langner in Baltimore today. She answered all of my questions and showed me some cool pictures. While we can't move forward with scheduling anything further until she's officially up at NYU in January, I'm fully intending to move forward with her as soon as she's able to get me in. Some highlights and points of interest:

- She was willing to use any of the major donor sites based on my current weight and body composition. We've decided to stick with RFF. Her concern about MLD wasn't actually anything related to body fat or potential girth of the phallus, but in changing the aesthetics of my chest. Apparently when they pull the MLD site closed, the nipple on that side has a tendency to shift over. Since I like the composition of my chest currently, I don't think that's a good option for me.

- Her stage one is actually a full metoidioplasty – they release the clitoris, reroute the urethra through the clitoris, do a vaginectomy, and create the scrotum. Stage two is the phalloplasty itself and hooking up everything downstairs. As someone who was strongly considering meta initially, I'm actually really excited about it despite it being a bit different from the usual sequence of events. What I'm curious about, and planning to ask next time we're in touch is if I'm able to stand and pee post stage one, if there'd be any issue in just stopping there since that's what's most important to me. Based on her responses to everything I threw out there today, I don't think she'd have an issue with it.

- Her required hospital stays are short – no more than three days for stage one and roughly a week for stage two. Her local stay requirement is just two weeks for each stage, which is a huge plus since New York is much more expensive than what I had planned for. The gap between stage one and stage two is three months at a minimum, so if I'm able to get in early enough next year, I could manage to get everything done before my premium rolls over in July.

- I don't need to do any additional hair removal or lose any more weight unless I want to. The hair removal I've already done on the arm has been super effective on the urethral area, which is all that needed to be clear before surgery. The rest would just be for aesthetics. She said if I wanted to lose more weight I could, but it wouldn't be required to move forward with surgery scheduling.

- She wasn't sure yet on whether or not I'd have to come meet with her again at NYU pre-surgery. Apparently it varies by insurance company. Some of them want to see a consultation from the same license number prior to authorizing surgery, while others will give it the go ahead since it's the same doctor. Mine has been really great so far in terms of making this process as manageable as possible, so fingers crossed that they will just go ahead and approve without needing another consult. I could afford to travel up to New York for a day, but I'd much rather save a vacation day and put that money toward supplies.

Overall – She was incredibly informative, thoroughly focused on making sure that my needs and wants were completely understood before making any recommendations, and had a great attitude throughout all my questions and hypotheticals. It was very different from my consultation with Dr. Schechter, and it's left me excited and hopeful about surgery next year.

Full Q&A transcribed from audio here (https://docs.google.com/document/d/11tq5MSbMhJo9qy1qQkpepPQMFUN011dUVHkCqGSg-sI/edit).

That's great that the consultation went so well. You deserved to have something go well after the horrible experiences you've had so far.

Thanks for sharing the information you've gotten along the way. Bottom surgery is years down the road for me, but it's still helpful information.

Keep us updated on how everything goes!

I am having the worst luck with surgeons.

A friend I've made through the various bottom surgery groups on Facebook had a consultation with the other surgeons at NYU today. Dr. Bluebond-Langner had encouraged him to meet with them because he had some additional health concerns. He got a chance to meet with the scheduler after his consult...and they are already booked out to 2018. Apparently they utilize a robot during the vaginectomy and there are very few of them available at NYU. So if you need a vaginectomy, you're not getting in until Q1 2018 at the earliest. That would be another year's wait for me. Another year in a job I hate just for the sake of having insurance to get this surgery.

He is already one step ahead of me and has sent Dr. BL an email telling her the results of his consult and asking if he could have a vaginectomy done locally in advance to get in earlier for phallo. If he gets the green light for that, I am intending to follow up with her and ask to do the same.

But for some reason I don't feel very confident about it. I've already waited much longer than I initially wanted to for surgery. And while I like her and feel confident that I'd be happy with my results from her, I don't know that it is worth waiting another year without investigating other options. Some things I'm considering:

- Scheduling a consultation with Dr. McGinn for ring meta. She doesn't do a complete vaginectomy, so I would need to ask her at the consult if (a) I could have it done in advance, or (b) I could have someone do it after. I believe she uses vaginal mucosa in her UL so I imagine it would have to be done afterward. The downsides to this would be realizing down the road that I need phallo and having to come up with a way to pay for it, and the fact that I'd have to pay out of pocket up front and be reimbursed by my insurance after the fact.

- Reconsidering pedicled phallo options. Sensation isn't important to me. I could add about 5 more surgeons to my potential list if abdominal or groin phallo were options for me. The downside here is that a lot of surgeons who offer pedicled options don't do UL, so I'd need to find someone to do my UL after the fact if I ended up choosing one of them. It can apparently be done, but that would be another surgery.

I'm going to marinade on all this for the next week or so. I'm hoping my friend gets some good news from Dr. BL and is told he can get a vaginectomy done in advance and still get in before next summer, but I put all my eggs in one basket with Dr. Schechter and that got me into this position so I'm not going to make that mistake again.

What would make you lose sensation, Max?

Quote from: alienbodybuilder on November 30, 2016, 02:45:56 PM
What would make you lose sensation, Max?

With phallo, everyone retains sensation in their buried clitoris. But different choices of donor sites mean different levels of sensation in the attached phallus. The arm and the thigh are highly regarded in terms of their post-operative sensation due to the specific types of nerves that are harvested from those sites and reconnected via microsurgery at the groin.

That isn't possible with all donor sites. With ab or groin flap (pedicled options), those types of nerves are lacking. So the only sensation you would have if you chose those options is in the base of the penis where your clitoris is buried. You'd also have the option of having a nerve harvested from elsewhere to do the microsurgery, but that would require an additional surgery most likely performed by a different surgeon.

So it's not so much that you would lose sensation. Nobody loses sensation. It's that with some phalloplasty options, no new sensation would be gained. I'm 100% fine with that, but the majority of guys that want phallo are not.

Thanks for explaining. I hope you have better luck with getting your surgery. Maybe someone else scheduled to have surgery will chicken out and you'll get in sooner than you think. Even 2018 would be better than never. I wish mine was that soon if I had a way to pay for it.

Thanks. :) And FWIW, I think despite the political changes we'll continue to see insurances starting to cover these procedures so that more people can access them. So don't think it'll never be an option for you!

I've got all my fingers crossed that this will work out exactly like I was told it would. I'm really hoping that either there was a miscommunication somewhere along the line or that Dr. BL will say to go ahead with the vaginectomy here locally. I just don't want to get stuck again waiting around for another surgeon's office. I've lost a full year already due to my experience with Dr. Schechter.

I think knowing that my first stage with Dr. BL will be a meta has gotten me back to thinking more about that as the better option for what I want. The more I think about the logistics of standing to pee as well - everything I want to do with it doesn't really require length. I don't care about using a urinal. It's mostly for convenience on road trips or while camping. And of course if I were ever hospitalized and they needed to give me a catheter.

I've spent the day thinking about what would need to change in my life for me to want something more sizeable, and being mildly asexual I can't think of anything. When you cut sexual function out of the equation, it really just comes down to the functionality I care about (peeing) and aesthetics. So with that in mind, I've identified 5 different options, some of which I've already started to pursue:

- Dr. McGinn: I sent off her intake forms and a request for a ring meta consultation today. I know she's already booked up through July, but that's still sooner than 2018. The downsides would be that I'd need to get a vaginectomy done elsewhere after the fact, and that I'd have to pay out of pocket and be reimbursed by my insurance.

- Dr. Meltzer: I also sent a request to Meltzer's office for a meta consultation. No idea what his schedule looks like, but it doesn't hurt to ask. He could do everything I want, potentially in a single session but most likely two. I have a cousin out there I could stay with, so even though it'd be outside of my usual willing-to-travel-to radius, it wouldn't necessarily be a more expensive option. He also accepts single case agreements from some insurers, so I may not have to pay out of pocket and be reimbursed.

- Dr. Leis: Leis doesn't do UL with his ab phallos but will do everything else. I could have UL done by another surgeon after the fact. I've heard awful things about his personality, but his work is aesthetically attractive and he schedules people quickly. He would also take a single case agreement from my insurance. I haven't taken any steps to move forward with this idea yet. It is probably my least favorite out of all of the ones listed here just because I'm not a huge fan of the things I've heard about Leis's personality.

- Dr. Berli or Dr. Dugi: They're the new team at OHSU in Portland and could do a meta or ab phallo, both with everything I want. They both trained with surgeons I respect and I've heard great things from folks that have already been to them. I'm sure I could get my insurance to play ball. Downside would be that it's on the exact other side of the country and would likely require 3+ trips back and forth, which is not cheap. Apparently they are willing to do Skype consults though, so depending on the outcome of this situation with Dr. BL, it would be pretty quick to at least set that up.

- Dr. Miro: I initially had planned to go to Dr. Miro before getting insurance. With my out of pocket maximum increasing this year, getting what I want here might be around the same price as getting a meta done in Belgrade. I am planning to send him an email asking about his meta prices currently. His phallo prices were super affordable, so I don't think I'll be in for any sticker shock. I'd just have to do a comparison between what I'd pay here versus what I'd pay there plus flights.

Ultimately, I'm still holding out for good news from Dr. BL's office. My friend got a call from her scheduler asking if she could "put him on the books for January", but didn't specify a year and he hasn't had a chance to call her back yet. I am planning to send her an email if I haven't heard from her by next Friday. I do think I want to have a follow up consult with her at NYU before scheduling just to lock down everything and confirm that I'd be getting exactly what I want. I'm still not feeling great about any of this, but spending the day laying out all my different options has made me feel a bit better.

First off, thanks FTMax for being gracious enough to reply to my endless messages! Does anyone around here who's made contact with Bluebond-Langner's office recall how long it took to receive the email with all of the paperwork for the consultation?

CMD - I think I answered your question in a message but if I didn't, it took me a day or less to get an email with paperwork to fill out from NYU after talking to the scheduler there on the phone.

Now, an update and a question!

After the last update, I did some more digging and looking at time frames and numbers. My out of pocket maximum went up fairly significantly this year (it was $6500 last year, now it is $10k). With Dr. BL being in NYC, and needing to travel to her at least twice, I'd anticipate spending a total of $15k to have surgery here in the US as long as I didn't have to stay longer than planned and had no complications that required me to travel back to her. The worry would be that everything I'd need to get done would stretch out over more than one premium period. Given how much luck I've had with scheduling things so far, it makes me super uneasy. That would be another period that I'd have to pay up to my out of pocket maximum again - raising the price to $25k potentially.

Fortunately I did get in touch with Dr. Miro. His price for meta with everything is $10,000 Euros plus $960 Euros (currently converts to $11600 in USD) for testicular implants. Roundtrip flights are under $1000 with insurance. The apartment Dr. Miro has for patients is around $75/night so planning on 14 days is $1,050. All that brings me to $13,650 - and that's assuming exchange rates don't change and I have to pay the full $1000 for a flight (there are cheaper ones but I don't want to change planes in Istanbul or Moscow).  So even if I have to splurge on something, I still have $1350 available to spend before I'd hit the full amount I'd be spending here.

I've talked to friends and family about it, thought about it, prayed on it, and made my decision: I'm going to Serbia! I have a friend going around the same time, and Dr. Miro said he can get us both done within a few days of each other, if not on the same day. Surgery will be around March 21st. I'm meeting Dr. Miro next Sunday in New York to pick up some DHT and have a quick consult. If anybody has any questions they'd like me to ask him, feel free to post below and I'll be sure to add them to my list.

Now for my question - When I originally put this thread together, I had assumed it would be a few pages of build up, logistics, and then surgery and my post-op experiences. Obviously it didn't quite go that way. Now that I know where I'm going and when, would it be helpful to continue this thread and keep all my info in one place, or start a new one related to my "official" bottom surgery experience and leave this one as is?

Quote from: FTMax on December 10, 2016, 06:10:52 PM
CMD - I think I answered your question in a message but if I didn't, it took me a day or less to get an email with paperwork to fill out from NYU after talking to the scheduler there on the phone.

Now, an update and a question!

After the last update, I did some more digging and looking at time frames and numbers. My out of pocket maximum went up fairly significantly this year (it was $6500 last year, now it is $10k). With Dr. BL being in NYC, and needing to travel to her at least twice, I'd anticipate spending a total of $15k to have surgery here in the US as long as I didn't have to stay longer than planned and had no complications that required me to travel back to her. The worry would be that everything I'd need to get done would stretch out over more than one premium period. Given how much luck I've had with scheduling things so far, it makes me super uneasy. That would be another period that I'd have to pay up to my out of pocket maximum again - raising the price to $25k potentially.

Fortunately I did get in touch with Dr. Miro. His price for meta with everything is $10,000 Euros plus $960 Euros (currently converts to $11600 in USD) for testicular implants. Roundtrip flights are under $1000 with insurance. The apartment Dr. Miro has for patients is around $75/night so planning on 14 days is $1,050. All that brings me to $13,650 - and that's assuming exchange rates don't change and I have to pay the full $1000 for a flight (there are cheaper ones but I don't want to change planes in Istanbul or Moscow).  So even if I have to splurge on something, I still have $1350 available to spend before I'd hit the full amount I'd be spending here.

I've talked to friends and family about it, thought about it, prayed on it, and made my decision: I'm going to Serbia! I have a friend going around the same time, and Dr. Miro said he can get us both done within a few days of each other, if not on the same day. Surgery will be around March 21st. I'm meeting Dr. Miro next Sunday in New York to pick up some DHT and have a quick consult. If anybody has any questions they'd like me to ask him, feel free to post below and I'll be sure to add them to my list.

Now for my question - When I originally put this thread together, I had assumed it would be a few pages of build up, logistics, and then surgery and my post-op experiences. Obviously it didn't quite go that way. Now that I know where I'm going and when, would it be helpful to continue this thread and keep all my info in one place, or start a new one related to my "official" bottom surgery experience and leave this one as is?

A separate thread would be awesome, actually. And yes you answered my question. Thanks. Just wanted to see if any other guys had a different experience because I've yet to receive the email and it's been like 2 weeks. I called again last week and still no email. It's not sitting well with me.

So your insurance plan does not 100% cover surgery? You have to come out of pocket?

Quote from: CMD042414 on December 10, 2016, 08:10:50 PM
A separate thread would be awesome, actually. And yes you answered my question. Thanks. Just wanted to see if any other guys had a different experience because I've yet to receive the email and it's been like 2 weeks. I called again last week and still no email. It's not sitting well with me.

So your insurance plan does not 100% cover surgery? You have to come out of pocket?

Yes, unfortunately. And I'd encourage folks to look into their specific policies as well. One of my friends has had to meet his out of pocket maximum for the last three years (which is what I'm trying to avoid). Some people get away with just their deductible. I know when Schechter ran my insurance and got approval, they wanted my full out of pocket max plus an additional deposit on top of that (that would presumably have been reimbursed).

And then there's travel expenses. I was thinking about it and I just didn't feel comfortable staying with any of my friends for this particular surgery. My insurance apparently only covers travel in very limited circumstances, which this would not be.

As soon as I have a firm surgery date I'll start a new thread and start updating with logistics stuff there :)

Hi folks,

Now that I have a firm idea of when, where, and with whom my bottom surgery will be I am going to be adding all future updates to a new thread. This thread will continue to exist and I will respond to any feedback/questions on it, but my specific metoidioplasty experience with Dr. Miro will be located here (https://www.susans.org/forums/index.php/topic,217494.new.html#new).

I've updated with everything that has occurred thus far. I am meeting up with Dr. Miro in New York this Sunday and I'll be posting another update after that. Thanks for hanging out :) I appreciate all of the thoughts, feedback, and well wishes that have been given throughout this thread. I hope it has helped you all and maybe inspired some of you to blog about your surgical experiences for all the guys who will come after us.

Wow. This is quite a dramatic turn of events.

You are really doing the rest of us a service by detailing all of your experiences.

I've run into a number of guys, both online and in person (and by secondhand reports), who have had delays and reschedulings. What is it about bottom surgery that seems to cause such problems? Or does it just seem that way?

I have to abide by an academic schedule, so I'm super worried about the possibility that I'll be delayed for years once I'm even ready to do the dirty deed.

I think it's just a lot of moving parts to coordinate to make everything align.

We've got our schedules, which have limitations and considerations. Like you needing to rely on breaks from school, some folks I've heard were trying to have it done and be healed before their partner had a baby, some people like me needed to have it line up properly with an insurance premium period start to minimize the expense.

Then you've got the actual doctors performing the surgery. That's at least 3 people in almost every case. And usually these aren't the only procedures they do, so they've got to find a time when all three of them are available at once for 2-12 hours.

And then you've got the facility's availability. They need to have OR time available, they need to have a room to put you in for 2-7 days, and they need to have full access to the equipment needed to do the surgery. The reason the wait list at NYU is getting so big is because there is apparently only one robot available to do the vaginectomies and it's the same robot that's used for other surgeries.

It's basically the perfect storm of circumstances for things to go wrong and need to be moved around. I was initially planning to have surgery when my dad was available. He's a teacher so similar availability to you. My plan was a winter consult followed by a surgery as early in the summer as possible. Depending on who you can go to, your consult might need to be 1+ year in advance of surgery though.