Hello everyone! I haven't been around for awhile but I have a couple questions.

In my current situation, I don't think that I can afford the recurring cost of testosterone injections, but I'm thinking that if I save up for awhile I could probably get enough to pay for top surgery. I really just want to get rid of these things as soon as possible, since it will probably be awhile before I'll be secure enough financially to start on T. So my question is, is it possible to get top surgery before starting on T? What kind of steps would it take?

If it helps, I live in California, in the bay area.

Thanks in advance!

It's do-able, for sure - but I would imagine that you would still need to provide some form of letter to the surgeon from a psychiatrist/psychologist/doctor stating that you are either aware of the implications of the surgery, that you are not suffering from some form of delusional or psychotic disorder or that you have been diagnosed with Gender Dysphoria.

I don't live in the US, so I don't know about surgeons in Cali, but I know there are some Cali guys here who may be able to help you more specifically.  Every surgeon is different, so YMMV. 

It is very possible.  That's the route I'm taking since I am in no position at this time to constantly take T.  The step you take will depend on the surgeon you want.  I'd think that many surgeons would still require a letter from a therapist.  You should decide on the surgeon you want to go to and find out about his/her steps and requirements.

There are many really good surgeons out there who do not require T at all. I think most surgeons don't think it matters.

--Jay

I've heard several guys say they will just save for surgery because T is too expensive.

Honestly, the logic behind this has always mystified me. I have budgeted out $8k for Garramone top surgery and travel to Florida. 8k would fund T for years and years. Saving the money is saving the money, and T is much cheaper, so you could get it and always have a reserve to get the next supply of it.

Am I missing something ?

If it is just that they want top surgery first, well then that makes sense, and I understand it completely.

No offense at all you to OP - I thought I wanted top surgery first too, but then I realized top surgery was too expensive and would take awhile to save for, so I decided to start T. Garramone will do it without hormones but still wants a letter from a MD or psychologist. The guy who succeeded Brownstein in CA (Crane) will also do it without hormones I believe.

I am paying around a thousand dollars a year for T. That includes my Endo visits, blood work, and prescriptions without insurance. That breaks down to 20 bucks a week. Just not going out to eat would easily pay for it if someone was on a budget. If someone can afford to save for top surgery then they can afford to start T. 

Like Spacerace said, if you just want to get surgery first then that's a different matter. Yes, there are some who go that route. I think there are a few on this site that did it that way. Every surgeon I've looked into has required a letter to get it done though. I got mine from a doctor that has been over most of my care for over 5 years now. It doesn't have to be a new therapist you pay to just get a letter if you already have a medical professional who knows you well enough to vouch that you need this done for your well being.

Since there was a change in WPATH,it seems that a letter isnt needed for top surgery (if i read it right that is) as long as you are 18 and consenting,then you can pretty much have it done.Has that been taken into effect by ALL surgeons? no one knows but i agree you should call around and ask.

Quote from: spacerace on August 12, 2013, 02:17:27 PM
I've heard several guys say they will just save for surgery because T is too expensive.

Honestly, the logic behind this has always mystified me. I have budgeted out $8k for Garramone top surgery and travel to Florida. 8k would fund T for years and years. Saving the money is saving the money, and T is much cheaper, so you could get it and always have a reserve to get the next supply of it.

Am I missing something ?

If it is just that they want top surgery first, well then that makes sense, and I understand it completely.

No offense at all you to OP - I thought I wanted top surgery first too, but then I realized top surgery was too expensive and would take awhile to save for, so I decided to start T. Garramone will do it without hormones but still wants a letter from a MD or psychologist. The guy who succeeded Brownstein in CA (Crane) will also do it without hormones I believe.

I can only speak for myself for my particular situation.  If I could, I would start T before I have top surgery, but that is not viable in my situation.  For me, it is more feasible and much cheaper to do top surgery first.  T is more of an on-going process than top surgery where it is more of a one (maybe two) time thing along with the appropriate maintenence.  With T, you have to (or you should) go to the doctor at least every three months so they can check to see if everything is alright.  Yeah people should be going to the doctor to get their check-ups, whether cis or trans, but lets face it, as of right now in the U.S. many people (including myself) cannot afford to get their routine check-ups, even with insurance (heavens forbid if they don't have insurance) so add that along with T costs.  Don't forget actually getting there to the doctor's office.  In my area, I would probably have to travel far to get to the approriate doctor.  Public transportation is horrible here so I would have to drive.  I am an inexperienced driver so there's a great chance I would cause a wreck and have my insurance go up or get a police ticket....hidden potential costs for getting on T once I get my license and start to drive, and then there's the gas cost.  Perhaps I could take a taxi there and back (which I probably would) but they aren't cheap either, especially for the routine check-up.  With top surgery, I could take a taxi to get to a doctor that would give me medical clearance, and take it back home.  I would take a taxi to get to the airport and then take a taxi to get back home and (hopefully) that would be the end of it.

Then there's the social cost.  I am not fully transitioning all at once.  When I get top surgery, I still have plans on living as a female for a significant amount of time.  Don't get me wrong, I would LOVE to fully transition, but I don't feel comfortable doing that in such a small southern town that I grew up in.  I want to move up north before I go full-blown on T because the social costs of transitioning down here is just too high for me.  As a 21 year old that has never had a job before, I don't want to do something so extreme (like take T) that would hinder my chances of getting a job....especially going for a job where I had an internship at and was seen as female.

Until I have the means to move up north I can just live my life as a "female with a mastectomy".  At most, some people may just feel sorry for me and think I had it because of breast cancer (no offense to anyone), but going in with a deep voice, hairy body, masculine face when people have known me as female?  Yeah, not an ideal situation in this Bible Belt town.  A female with a mastectomy though?  So what?

Now lets say I do want to go on T while I'm living down here as I am still thinking about doing that.  I hate needles and there's no way I would self-inject or take a taxi bi-weekly to have my doctor inject for me, so I'm going with androgel or androderm. That stuff is not cheap, and I'm a larger guy so there's a chance it may take longer for results to happen which I'm fine with since I would only be taking it to get subtle changes to make me personaly feel better, yet still navigate society as a female, abit more masculine female.  However, that would be done after top surgery because for me, there's no rush.  If I'm pumping money into androgel the same time I'm pumping money into top surgery, then that means my savings for top surgery will be slower.

I live with my mother, so this is the perfect time to earn enough savings to get top surgery without having to pay for rent, food, etc.  It would be very frustrating when I do move, to have to worry about how I have to pay for T, rent, food, bills, etc and top surgery at the same time.  Why not knock one out.  By that time I should have been healed decently so that's one less thing to worry about.

In short, top surgery is A LOT cheaper for me.  I plan on going to Dr. Garramone to get his top surgery AND mansculptue procedure if I qualify which may run me up to 12 grand minimum if his price doesn't increase.  That's not including transportation, food, medical clearance, surgical binders, room and board (which I plan on staying at new Beginnings for at least two weeks instead of one), scar creams, flight, etc.  Even with all of that (at around 15 grand if I'm lucky), it's STILL cheaper for me than going on T

Sorry this was so long and I don't mean to derail the thread, but I hope I have sort of "demystified" the logic of getting top surgery before T, at least from my perspective.  I know my approach may seem a bit unorthodox compared to others but there are a few guys out there like me...that like get "all their ducks in a row" before they start T.

Thank you to everyone for the replies! I think I'll do some research on the local surgeons and work from there.

To spacerace & Si - Malachite basically summed it up. I'm a college student, and my only income is an internship, which will of course expire at some point when I am no longer needed. Any job I get after this will probably not pay too well, so realistically, if I started T right now, I would eventually have to stop taking it because I would not have enough income to keep paying for it. Unless of course I get lucky and land a high paying, part time job.

So yes, although T is technically cheaper, it's an ongoing expense, and I'd rather not stop taking it once I've started. Thus, it makes more sense for me personally to save up and do top surgery first, especially considering I will also probably have to continue living as female for awhile.

Being on T first can make a difference, so it's worth noting for guys new to or planning to start T.

T helps you get more masculine muscles so you can build up your pec area a little. They often advise guys try to do this a little pre surgery, especially if they're going for that look. The point being that then they can sculpt more than guess. If you don't have much muscle there, there's more guess work. The other potential problem would be fat distribution (still goes to that area pre T) so unless you're in good shape, watch out for that. Also, when you go on T, if you do work out and get pec muscles, there is the possibility that things can become a little off. Nipple placement might be affected, or stretching can happen and knock off the symmetry. You may end up with divets where too much tissue was removed, or lumps where not enough was removed. While it may have looked fine before, problems can appear once more muscle forms.

It's not for definite of course. The better surgeon, the less chance of these issues.  Some guys will be fine, others might get issues. It's just worth noting that it can make a difference. Perhaps not so bad if there's no time limit on revisions too.  For me, I want to wait a year just to be sure I get a year's worth of T and working out. But maybe these potential issues won't mean much to you anyway. Depends on the person.

Good luck!

I want to get a top surgery asap because my chest dysphoria is so strong, it's awful. I am thinking about my chest all the time, going to the beach is awful. I am on holidays at the moment and i just can't stand looking at shirtless guys, it makes me SOOOOO depressed!!!  I want to get rid of that crap on my chest asap!

I have one question for you guys - if i get the top surgery before starting T, will i get something like small breasts again or not??? I mean it might be a while before i can start T so can estrogen make my breasts grow again??? Or is it impossible? (i hope it is!!!).

Quote from: JaredLeBlanc on August 13, 2013, 06:50:26 AM
I have one question for you guys - if i get the top surgery before starting T, will i get something like small breasts again or not??? I mean it might be a while before i can start T so can estrogen make my breasts grow again??? Or is it impossible? (i hope it is!!!).

You might get some, just as a man with gynecomastica gets small breasts from having estrogen levels which are too high, but it shouldn't be considerable seeing as cancer patients who have mastectomies don't grow their breasts back.  To be more certain I would talk to your surgeon about that.

Thanks Alex! I did a little research on this subject and from what i have read i think it's impossible to get new breasts after the surgery, unless you are very fat. Fat men have small "breasts", so it wouldn't be surprising for someone who is fat to develop something like gynecomastyca. Otherwise, it seems pretty unlikely.

Quote from: Malachite on August 12, 2013, 04:26:50 PM

Sorry this was so long and I don't mean to derail the thread, but I hope I have sort of "demystified" the logic of getting top surgery before T, at least from my perspective.  I know my approach may seem a bit unorthodox compared to others but there are a few guys out there like me...that like get "all their ducks in a row" before they start T.

Hey Malachite - I completely understand your situation. I also had to "get my ducks in a row" as it were before starting T, and delayed it for over a year. You are saving for top surgery because you can't start T for many reasons, not just financial. I think it is great you are doing what you can save to your money. good luck!

Quote from: JaredLeBlanc on August 13, 2013, 09:30:18 AM
Thanks Alex! I did a little research on this subject and from what i have read i think it's impossible to get new breasts after the surgery, unless you are very fat. Fat men have small "breasts", so it wouldn't be surprising for someone who is fat to develop something like gynecomastyca. Otherwise, it seems pretty unlikely.

I wonder if there is a way for a trans guy who wanted to de-transition to get his chest back - I mean, trans women grow them when they take hormones. Is there something that is removed that prevents it from happening? Probably varies - maybe a difference between DI and keyhole? Keyhole leaves more than DI I think.

Quote from: spacerace on August 13, 2013, 11:47:42 AM
Hey Malachite - I completely understand your situation. I also had to "get my ducks in a row" as it were before starting T, and delayed it for over a year. You are saving for top surgery because you can't start T for many reasons, not just financial. I think it is great you are doing what you can save to your money. good luck!

Thanks!

I know guys whose chests are so large they don't feel they can bind at all. So surgery is a big priority over T. There are some guys that don't chose to take T at all. It's everybody's choice.

I son't think you'd grow breasts back. I am pretty sure they take out too much breast tissue. Otherwise ciswoman would grow back breasts after masectomies. I have never heard of this. Don't know about with peri, but you have to have a super small chest anyway. And cisguys are seldom completely flat. A I don't think you'd get gynecomastia as you have had the breast tissue remove-- same question as growing them back actually. I think it's generally caused by hormonal imbalance (just like FAAB people can high T.) I think these may be myths perpetrated by a certain blogger. DON'T READ HER! I am sure she maintains this is a rather common thing and so on.

There are definitely surgeons who do top surgery without the letter. And even those requiring the letter do not require T necessarily.

--Jay

I've been thinking about this myself, my chest bothers me so much it basically drives any thought of T from my mind (which isn't to say I don't want it.) What do you guys think about getting a date scheduled and then hardcore cleaning up your diet and working out like a maniac? I've worked out properly before and enjoyed it but I don't really have a motivation because it doesn't really do anything I want. Top surgery would definitely be a motivation.

Quote from: Frank on August 14, 2013, 03:43:47 PM
What do you guys think about getting a date scheduled and then hardcore cleaning up your diet and working out like a maniac? I've worked out properly before and enjoyed it but I don't really have a motivation because it doesn't really do anything I want. Top surgery would definitely be a motivation.

I think if you're going to get in shape it needs to be a lifelong commitment and not just something you do to have top surgery. If you get in shape for surgery and then just let yourself go afterwards I would think the results would be worse than just getting the surgery done as you are now and slowly working on your fitness afterwards if you want to.

To be honest, I rarely work out because it requires having to bind. Then I get overheated, the binder retains the sweat, and I don't think I'm able to breathe as well as I should be. Even if I workout in my own home I have to bind because I can't take the "jiggling". Makes me horribly dysphoric. I think I'll be more apt to workout afterwards. If that happens and I need a revision eventually then so be it. I still think the results would be better to do it that way then to be in shape before and gain the weight back afterwards.

Quote from: Si on August 14, 2013, 04:10:07 PM
I think if you're going to get in shape it needs to be a lifelong commitment and not just something you do to have top surgery. If you get in shape for surgery and then just let yourself go afterwards I would think the results would be worse than just getting the surgery done as you are now and slowly working on your fitness afterwards if you want to.

To be honest, I rarely work out because it requires having to bind. Then I get overheated, the binder retains the sweat, and I don't think I'm able to breathe as well as I should be. Even if I workout in my own home I have to bind because I can't take the "jiggling". Makes me horribly dysphoric. I think I'll be more apt to workout afterwards. If that happens and I need a revision eventually then so be it. I still think the results would be better to do it that way then to be in shape before and gain the weight back afterwards.

I'm actually good at getting in shape and staying that way, I just don't and stay a little overweight because my gut helps hide the chest. It sucks, because seeing in shape guys can just completely throw my day off.  !@#$ing chesticles.

its 100% possible but breast tissue can grow back due to estrogen still being the dominant hormone in your body. Plus testosterone injections are very affordable.