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

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

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.

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.