Do you need a letter for surgery if you pay put out of pocket with absolutely no insurance used? I don't see why I need a letter of recommendation for plastic surgery. Top surgery is basically plastic surgery right? So why do I need to go through hoops for it?

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It depends on the surgeon. Any surgeon will want to make sure your reasons for having the surgery are ones you will embrace in the future. With my nose job and adams apple shave, there wasn't much of a possibility I would regret the changes. Top or bottom surgery there is more room for doubt.

On the other hand, if you have doubt about your ability to get a letter, it's possible all of your issues haven't been worked out yet. When I was ready for my letter, it was clear in my mind that it wouldn't be refused because I knew I had no other option than to go forward. The thought didn't cross my mind that my letter would be refused.

Quote from: haeden on March 02, 2016, 06:05:32 PM
Do you need a letter for surgery if you pay put out of pocket with absolutely no insurance used? I don't see why I need a letter of recommendation for plastic surgery. Top surgery is basically plastic surgery right? So why do I need to go through hoops for it?

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i'll have to agree with dena on this—you really do need to consider the ramifications that surgery has. they want you to go to therapy and consult a professional to make sure that you're capable of making this decision for yourself... top surgery is a pretty big deal. although it's not the same, imagine having another ligament removed. there will be post surgical depression, there will be a time of healing, and there will also be mental adjustments.

i'm not trying to come off as rude, but when i went into surgery, i had tunnel vision. i didn't know what the pain would be like and i didn't realize that my recovery would take so long. the smallest things can really set you back, which i unfortunately had happen. it might've been because my chest was large beforehand, but my recovery was bumpy at times, still it was overall a smooth process. i opened a car door (DO NOT DO THIS) and ripped the stitches for my drains. every day until i got them removed, my mom had to shove them back in. having the clots threaded out sucked, and i was pretty miserable.

surgery is emotionally draining... yes, it's a fantastic thing, but you need to make sure you are 100% about this. your mind must be clear and you must be certain that this is it for you. it is irreversible. well.... not completely, but without costing you additional money, that is.

Quote from: Dena on March 02, 2016, 06:41:53 PM
It depends on the surgeon. Any surgeon will want to make sure your reasons for having the surgery are ones you will embrace in the future. With my nose job and adams apple shave, there wasn't much of a possibility I would regret the changes. Top or bottom surgery there is more room for doubt.

On the other hand, if you have doubt about your ability to get a letter, it's possible all of your issues haven't been worked out yet. When I was ready for my letter, it was clear in my mind that it wouldn't be refused because I knew I had no other option than to go forward. The thought didn't cross my mind that my letter would be refused.

It's not that I doubt my chances of getting one because it's like the one thing I am 100% on and really the only thing I want. I just don't want to waste any extra money or time on a therapist. I'd rather just save up or get a loan for the surgery now than have to wait any longer. I'm super busy right now and pretty much have the next 3 semesters of college filled and then I have my graduation trip right after my last class ends. After that I start my new manager job hopefully in another state. So I really don't have any extra time to look for a therapist and also go. I know I want this and as just a ca I have more leyway on time off so I'd like to do this before I become a manager.
So I figured the letter was because insurance companies don't want to pay for things if they don't have to. So if I just pay out of pocket for it I wouldn't need the letter and would be able to hurry this up and not have to worry about taking extra time off as a manager. I'd already be starting 10 days late most likely and if I go to a property that needs extra help then I'll definitely be doing a lot of work that I won't be able to do until 6 weeks after the surgery

Quote from: palexander on March 02, 2016, 10:24:06 PM
i'll have to agree with dena on this—you really do need to consider the ramifications that surgery has. they want you to go to therapy and consult a professional to make sure that you're capable of making this decision for yourself... top surgery is a pretty big deal. although it's not the same, imagine having another ligament removed. there will be post surgical depression, there will be a time of healing, and there will also be mental adjustments.

i'm not trying to come off as rude, but when i went into surgery, i had tunnel vision. i didn't know what the pain would be like and i didn't realize that my recovery would take so long. the smallest things can really set you back, which i unfortunately had happen. it might've been because my chest was large beforehand, but my recovery was bumpy at times, still it was overall a smooth process. i opened a car door (DO NOT DO THIS) and ripped the stitches for my drains. every day until i got them removed, my mom had to shove them back in. having the clots threaded out sucked, and i was pretty miserable.

surgery is emotionally draining... yes, it's a fantastic thing, but you need to make sure you are 100% about this. your mind must be clear and you must be certain that this is it for you. it is irreversible. well.... not completely, but without costing you additional money, that is.

I understand that it's a big decision to make but people get their entire face changed without needing a letter. My friend got bigger boobs at like 16 for pageants and I'm sure she didn't need a letter. So I don't see why getting them removed and transformed needs a letter.

As for the after surgery process that's why I want to do it now. I'll be able to stay home for 2 weeks to recover enough to go back to work if I can do it now

A letter may only take a few therapy visits if your life is in order. I received one letter from my regular therapist and the second letter only took one visit. Depending on how well your transition has been documented it may only take you a few hours of time to get the letters you need.

What is the second letter for? I'm concerned I won't have time to see a therapist though. I go straight from work to school and don't get done with my day until well after normal business hours. I haven't really seen anyone online that had reviews that weren't a mix of "don't trust them!" and "they gave me my letter" so that's out too. Plus I currently don't have insurance so if I'm going to pay out of pocket then I mine as well just pay for what I want anyway. I have a non gender therapist and she's great (and free since she's paid with my tuition) I don't want to start up new with someone else and waste so much money I don't have

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Some doctors require two letters. Your current therapist might be able to write the first letter and the second most likely would come from a psychiatrist and could be obtained in a small number of visits. I also viewed your file and noticed you still haven't start T yet so you may have plenty of time to gather both letters.

When I was going the other way, I needed a year of RLE, a year of HRT and half my beard removed before I would be considered for surgery. The facial hair was the biggest killer because we didn't have laser so it was one hair at a time.

Don't listen to the girls on this they are making it way more complicated than it needs to be. Go here http://gendertherapist.com/ and you pay I think its $320 now. I got my letter here in a month and all I did was tell Dr. Graham my life story and how top surgery was just fine for me at the time. You just talk to him in a text chat. Medalie is guaranteed to accept Dr. Grahams letters and you are guaranteed to get a letter. That was my biggest hang up about top surgery. I knew I wanted top surgery but local therapists either didn't guarantee me a letter (which meant money wasted for nothing) or wanted me to have 6 months of therapy and I don't got time for their bullcrap. I regret nothing.

On the other hand there are a few surgeons that you do not need a letter. Just depends where you are and who you want it done with.

I paid out of pocket for my surgery and no letter was required.  I was unsure if I wanted to transition but KNEW that the chest had to be fixed, so I got it fixed.  Best decision I ever made for myself.  It will depend on the surgeon you select if they require a letter or not.  Go make some consultation appointments and find out what you need.

I thought I'd have a look at the WPATH Standards of Care on this, since its supposed to be best practice (even if it is quite widely ignored)

On page page 59 of version 7, it says FtM top surgery requires one referral.

The curious thing (being MtF myself) is that also applies to a MtF getting a BA, and I've never heard of that before. So a cis-women can have a BA without a referral, but a transwomen needs to see a psych first?

It really does depend on the surgeon, so you have two choices if you don't want to do therapy: call surgeons Til you find one that doesn't require a letter (I personally agree that, as an adult you ought to be able to do whatever the heck that you want with your body and if you can tattoo your entire face or have the fat sucked out of your gut or have your nose broken and reset without anyone's permission then you should be able to do what you want with your chest--it isn't like an arm or a leg that you actually use for something) or you can call therapists until you find one who will do a letter writing session.  These are therapists who don't believe in gatekeeping for adults and will write a letter in one session.  Though I do attend therapy at times, this was how I got my letter for T, in and out.  I will say that if you don't have time for one therapy session then you probably don't have time for top surgery--you will have to take a lot more time off work for that than the couple of sick hours you need to see a therapist.  Good luck on getting your surgery!

Here are some surgeons who do informed consent surgery. http://www.topsurgery.net/surgeons/informed-consent.htm

That site has a more extensive list of surgeons as well who aren't on the informed consent list. You should be able to find someone. I agree you shouldn't have to spend time and money on therapy if you know what you want. 

Hugs, Devlyn

Most surgeons will require a letter from a therapist, but some don't. Some will also accept a letter from your hormone provider discussing your transition. It varies by surgeon, so you would need to have one in mind to get a concrete answer. I have never heard of top surgery requiring two letters - that is only for bottom surgery.

The need for the letter is so that you don't make a decision that you will regret. It is a big surgery, and one that has big ramifications on the rest of your life. I knew I wanted top surgery from the age of 17 to the day that I had it, but I still needed a professional to sign off on that desire and make sure that I was completely informed about all aspects of the procedure and what it would/would not do for me.

It is easy to get a letter. I second Alex's recommendation of Dr. Graham. He is cool, and he won't give you the run around. Pay the $320, have a few sessions online, get your letter. Or you could ask your current therapist if she would be comfortable writing one. There are examples online that you could show her if she needs a reference.

Quote from: Dena on March 02, 2016, 11:06:01 PM
Some doctors require two letters. Your current therapist might be able to write the first letter and the second most likely would come from a psychiatrist and could be obtained in a small number of visits. I also viewed your file and noticed you still haven't start T yet so you may have plenty of time to gather both letters.

When I was going the other way, I needed a year of RLE, a year of HRT and half my beard removed before I would be considered for surgery. The facial hair was the biggest killer because we didn't have laser so it was one hair at a time.

Will they require T? I don't think I want that.  I really just want top surgery. I want to go to a therapist for anything else because I don't really want anything else so I want to talk to someone to figure out if that really means I'm trans. But I know whole heartily that I want top surgery and even plan to talk to my mom and friends about it soon because I want so badly. So I don't think I need a therapist for just the surgery but I know that that type of surgery has different guidelines than other plastic surgery. I really don't want to start t just to get it though

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Quote from: HeyTrace19 on March 03, 2016, 10:28:41 AM
I paid out of pocket for my surgery and no letter was required.  I was unsure if I wanted to transition but KNEW that the chest had to be fixed, so I got it fixed.  Best decision I ever made for myself.  It will depend on the surgeon you select if they require a letter or not.  Go make some consultation appointments and find out what you need.

Thanks! This sounds exactly like what I'm going through right now. I don't really think I want anymore than just the top surgery BUT I'm not against anything else in the future if I can properly talk it out with someone. I don't need to talk anything out about top surgery because I know for sure I want that. I've never wanted my boob's and when they came in at 7 I was horrified! So this has been a long battle that I'd love to end soon

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Quote from: Alexthecat on March 03, 2016, 12:45:08 AM
Don't listen to the girls on this they are making it way more complicated than it needs to be. Go here http://gendertherapist.com/ and you pay I think its $320 now. I got my letter here in a month and all I did was tell Dr. Graham my life story and how top surgery was just fine for me at the time. You just talk to him in a text chat. Medalie is guaranteed to accept Dr. Grahams letters and you are guaranteed to get a letter. That was my biggest hang up about top surgery. I knew I wanted top surgery but local therapists either didn't guarantee me a letter (which meant money wasted for nothing) or wanted me to have 6 months of therapy and I don't got time for their bullcrap. I regret nothing.

On the other hand there are a few surgeons that you do not need a letter. Just depends where you are and who you want it done with.

They gave some good info tho so their words aren't unwanted. I heard about Graham and it's a real hit or miss so I'm worried about him.
I'll keep him in mind though if I absolutely do need a letter. I'm trying to avoid any unnecessary payments if I can

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Quote from: AnonyMs on March 03, 2016, 10:42:57 AM
I thought I'd have a look at the WPATH Standards of Care on this, since its supposed to be best practice (even if it is quite widely ignored)

On page page 59 of version 7, it says FtM top surgery requires one referral.

The curious thing (being MtF myself) is that also applies to a MtF getting a BA, and I've never heard of that before. So a cis-women can have a BA without a referral, but a transwomen needs to see a psych first?

See and that's my point! Why do I need any referral for any type of plastic surgery?! But honestly I think a cis woman will need a doctors note for a BA they have to show like physical problems caused by their breast to get a reduction I believe. Just another way to own a woman's body [emoji19]

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Quote from: FtMitch on March 03, 2016, 10:44:53 AM
It really does depend on the surgeon, so you have two choices if you don't want to do therapy: call surgeons Til you find one that doesn't require a letter (I personally agree that, as an adult you ought to be able to do whatever the heck that you want with your body and if you can tattoo your entire face or have the fat sucked out of your gut or have your nose broken and reset without anyone's permission then you should be able to do what you want with your chest--it isn't like an arm or a leg that you actually use for something) or you can call therapists until you find one who will do a letter writing session.  These are therapists who don't believe in gatekeeping for adults and will write a letter in one session.  Though I do attend therapy at times, this was how I got my letter for T, in and out.  I will say that if you don't have time for one therapy session then you probably don't have time for top surgery--you will have to take a lot more time off work for that than the couple of sick hours you need to see a therapist.  Good luck on getting your surgery!

It's not that I don't have time for one it's that I don't have time for many. I'd have a hard time fitting more than one session into my weeks for an undetermined amount of time than I would just saying I need two weeks off for surgery. My biggest issue is having rent covered so if I miss random days rent will be short but if I ask off for 2 weeks then I'll know I already have rent covered

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Quote from: Devlyn Marie on March 03, 2016, 11:25:42 AM
Here are some surgeons who do informed consent surgery. http://www.topsurgery.net/surgeons/informed-consent.htm

That site has a more extensive list of surgeons as well who aren't on the informed consent list. You should be able to find someone. I agree you shouldn't have to spend time and money on therapy if you know what you want. 

Hugs, Devlyn

Thanks so much for the link! I'm glad a few of you agree with me about this. It just doesn't make sense that some surgery (and by some I mean any that deals with gender and making boobs smaller)  you need a referral for but they can have an entire show on the messed up surgeries people got done to their face without referrals! Like a criminal can seriously get a whole new face just like that but I can't get something that will make me feel more comfortable with myself?

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