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.