What do most transsexual get first, top surgery or HRT? and why?
I've seen/read about different people getting different ones first. I'm wondering if it makes a difference which is started first? Or which is better to start first?
And for anyone who hasn't had either top surgery or HRT (like me), which would you rather do first?
This is one of those "it depends" questions. I have an FTM friend who had it done prior to starting T while others go the other route. I think most people do the HRT first largely due to costs. Additionally, often there is a requirement by some surgeons that you meet some kind of standard to ensure that your chance of recidivism is truly low and that this isn't a mistake for you.
For me, I wanted the HRT first to ensure that I wasn't mistaken in what I felt. After nearly 3 years on T, I'm now looking into surgery and should meet the standards for what's required as far as GID standards are.
When I started to think of myself and my transition I thought I would have top surgery and not go on testosterone. I thought that top surgery was what I needed to make myself happy. Then I went through a long period of researching testosterone and getting to know myself better and decided that I did indeed need testosterone. Since starting testosterone the dysphoria around my chest (which is fairly large) has decreased. I'm considering top surgery but since my chest is a secondary sex characteristic which is getting a bit smaller, and isn't something easily visible the need isn't there.
It's a matter of figuring out what bothers you the most. What makes you most uncomfortable.
In my province - you do HRT first. There is only one person in the provincve that can sign off on top surgery.. and he can take a year to get in to see in the first place, and he does HRT first (most docs won't prescribe HRT - so you're waiting for his go ahead).. Top surgery he'll start thinking about 6ish months it seems from what I've heard after you've started seeing him. After you got your referal it's likely another 8 months before you can get in to the top surgeon.. so top surgery first is not really an option here, unless you're willing to wait a couple of years potentially before you start T.
He says my second appointment with him he'll write the referal. Second appointment is in July (first was in Decemeber).. then after that I might be waiting as long as 8 months for surgery.. so it was a no duh moment to go for T first.
I likely would have preffered top first because I was a little iffy about T, and already passed well.
Everyone I've met has done HRT first because you can get it at a younger age where I live. I've heard top surgery looks a lot nicer on guys who have been on T for a couple of years and and have male fat distribution and such.
Like what R.E.M said, its better to get top surgery after because the surgeon can have a better idea of whats going to happen with fat redistribution and stuff. But, i have seen a few guys that have gotten top surgery first, and it ended up just fine.
For me personally i also am going on hormones first because as much dysphoria as my chest gives me, i can bind. I cant deepen my voice or grow facial hair or any of that stuff without T and for me that is what i personally need. Plus i need to save up for surgery.
If I could have done top first I would have, but since I couldn't I did hormones first.
I started T first because I can't afford surgery yet. Below is another part of my reason for doing T first.
Quote from: Michael James on March 22, 2011, 12:34:18 AM
I cant deepen my voice or grow facial hair or any of that stuff without T and for me that is what i personally need.
Quote from: Andrew Alexander on March 22, 2011, 01:10:22 AM
I started T first because I can't afford surgery yet. Below is another part of my reason for doing T first.
The need for secondary sex characteristics is my second reason like you. I'm not sure how the situation would be different if I could have afforded top surgery first. Probably no different because at the point I was so dysphoric by being seen as a female all the time. No matter how hard I tried to look male I didn't have the characteristics needed to help me pass.
In my personal experience with being on T (and not having top surgery yet) is that it can worsen your dysphoria. It just felt like testosterone is out of the way, now I want my top surgery but can't quite afford it yet. My body was changing, but my chest was staying the same, which really hurts. However I agree with what others say about the changes of testosterone that are needed to pass, unless you are one to not care so much about passing...surprisingly trans guys like that exist, I don't know how they do it! Another problem with starting T first is if you're having trouble binding. Like me personally, I may be small but they never bind to how I want them, so I got all these changes and chest that's not really matching. So I have to shave my face and wear pants so I don't have to shave my legs and look like some sort of naturalist woman. Honestly in my opinion, both ways got ups and downs. I don't personally know if there are benefits of doing T first for the surgery, except it does help you build muscle easier, and it's always better to have a more muscular chest for surgery, also I've seen pictures and it makes the chest look better than with no muscle gain.
I am not on either and I would prefer top surgery first. I have felt this way for about 3+ years. However, I am one of those extremely lucky people who is able to have a portion of their surgery covered under insurance (if I can find a surgeon, that is). The catch is that I need to be on T for 12 months previously. Therefore, it just is not reasonable for me to pay out of pocket for top surgery before T when I could have a lot of my costs taken care of through the insurance I pay for every paycheck. For me, I'd prefer top first, but that's not going to happen.
Quote from: PandaValentine on March 22, 2011, 08:00:35 AM
In my personal experience with being on T (and not having top surgery yet) is that it can worsen your dysphoria. It just felt like testosterone is out of the way, now I want my top surgery but can't quite afford it yet. My body was changing, but my chest was staying the same, which really hurts.
agree, my chest dysphoria has gotten worse, because I can see how much T has changed my arms and shoulders and I want to show it off, but I still have these gross things flopping around.
I think most people start HRT first because it is cheaper and its good to let yourself grow a bit before surgery, pec muscles etc
I'm very big chested (G cup) so I would like to get surgery first, I'm not binding because it causes me too much discomfort, I just wear baggy clothes and pretend I have a flat chest ::)
Something that may be worth knowing is that pre-T, your skin will heal better due to the estrogen. However, post-T you're able to build muscle far easier, meaning you can give the surgeon something to work with and get a better scar placement.
Everyone I know started HRT first but I think it was mostly due to the fact that starting T is a much easier and cheaper process. If I had been able to afford surgery from the beginning I think I would have done that first.
My thing is though, I'm larger chested. I don't get completely flat with a binder. I think I'd look a little weird with a deep voice and facial hair and a large chest. I'd rather get the surgery first.
Quote from: Fumbling Towards Ecstasy on March 22, 2011, 03:05:38 PM
My thing is though, I'm larger chested. I don't get completely flat with a binder. I think I'd look a little weird with a deep voice and facial hair and a large chest. I'd rather get the surgery first.
I thought the same but it worked for me until I had surgery. A bio guy I work with has a big chest (i'd guess at least a D) and nobody thinks twice about it. His one feminine trait isn't enough to negate his masculine ones. Although like I said, If I could of I probably would have chosen surgery first too.
Because of the cost, I'm going to take T before I get top surgery. I would rather get surgery first, if I could, because my chest bothers me a lot. I have PCOS, so I already have a somewhat high level of T (I even have a bit of facial hair, it's not that noticeable because it's blond-ish and practically invisible because I also have a light skin tone, but it's enough that I have considered shaving so I'll look more female until I actually start transitioning. It's so weird to me that for the next few months I have to pass as female, but then I'll be taking T and I'll have to try to pass as male...) so I could probably pass if I had surgery first. My voice isn't very deep, but I can make it sound low enough that I could pass if my chest was flat.
Quote from: Ryan on March 22, 2011, 01:36:48 PM
Something that may be worth knowing is that pre-T, your skin will heal better due to the estrogen. However, post-T you're able to build muscle far easier, meaning you can give the surgeon something to work with and get a better scar placement.
That's very comforting for me to know, I'm one of those oddballs that doesn't plan on going on T for various reasons. I just hope I'm able to find a way to get top surgery
without being on it, but unfortunately that's going to be a long ways off anyway. I still don't have the money for a therapist, letalone the money for a car to
get to a therapist.
My chest is (thankfully) relatively small and though it occasionally bothers me, I think other issues are more pressing. That and the fact that I don't have anywhere near enough money for top surgery. ::)
If I had my way I'd get top surgery first. But alas, I'm lazy with no money.
But I'm excited to get on T too, since my voice causes just as much dysphoria as my chest.
@N.Chaos:
Quote from: N.Chaos on March 23, 2011, 01:33:26 PM
That's very comforting for me to know, I'm one of those oddballs that doesn't plan on going on T for various reasons. I just hope I'm able to find a way to get top surgery without being on it, but unfortunately that's going to be a long ways off anyway. I still don't have the money for a therapist, letalone the money for a car to get to a therapist.
Dr. Garramone doesn't require that you take T before getting top surgery (www.drgarramone.com/procedures-transgender2.html (http://www.drgarramone.com/procedures-transgender2.html)), and there's probably several other surgeons who would also be options for you. Also, there's some therapists who will do sessions via Skype or some type of instant messaging thing, you can find them on www.therapists.psychologytoday.com (http://www.therapists.psychologytoday.com).
Awesome. Thanks so much quinn, I'll definitely be looking into those therapists.
I'm a really small person with a really big chest (E cup) and getting rid of that is what's most important for me. My chest impacts hugely on my life. I have really low blood pressure, so getting too hot (I live in Australia, so that's always a problem) can make me pass out, it can happen up to 10 or more times a day, and having to wear a binder makes that problem so much worse. Not to mention I have problems with the cartilage around my ribs, which makes breathing hard enough as it is. And from a passing point of view, no binder gets me flat. Because I have such a small frame and large chest, it's always visible no matter what I do.
The first psychiatrist I went to was a total cow, but even she could tell it was a big issue for me. She wrote in her letter to my endo that while she thought HRT was a bad idea, because it was irreversible and I was still young, that chest surgery should be considered for me. I don't see how chest surgery is any less permanent than HRT, but that's beside the point. You could probably get a therapist to write a letter for surgery without having to be on HRT, so long as you explain yourself properly.
That being said, practicality dictates I go on hormones first, since I won't be able to afford surgery for a very long time. >:(
I got letters for both at same time. Top surgery first. My surgeon says to leave off T before surgery. Went to first endo appointment 3 weeks after surgery and got first shot that day.
Have read somewhere that peri results can be slightly better with surgery before T.
After thinking about this for a while I will try to get top surgery before starting T. I have a very large chest and I'm terrified to bind it for any longer than I need to. The money I would be using to buy my T would just go towards top surgery first and besides, many surgeons require you to be off T for about 2 weeks prior to surgery.
Quote from: Malachite on February 22, 2012, 09:26:55 PM
After thinking about this for a while I will try to get top surgery before starting T. I have a very large chest and I'm terrified to bind it for any longer than I need to. The money I would be using to buy my T would just go towards top surgery first and besides, many surgeons require you to be off T for about 2 weeks prior to surgery.
In my research, I've found that very few actually require you to be off T before surgery.
HRT first because (1) I could not get surgery first. (2) I could NOT go on dealing with periods.
And is it possible for breast tissue to grow back after surgery if you are still going through female puberty? If so then that's my third reason for T first.