Therapy Reqs for Bottom Surgery

[Eccentric Moe]

Greetings,

I've been living as male and on T for a little over a year and I am looking into bottom surgery.  More specifically a hysto & meta with U/L & implants.  I've been researching a lot of different doctors in the states and each of them mention letters from two different doctors, however there is not any more detail than that.  Does it matter if they are psychiatrist or psychologists?  How long do I have to see these doctors in order for a surgeon to accept them? 

I just want to make sure I have all the requirements down... I saw a therapist for a several weeks before going on T & getting top surgery so I would have the letters, but that is it. 

[Flan]

The classic letter requirements as in the qualifications of the person writing them are a masters (degree) and either a separate PhD signed (psychiatrist or psychologist, doesn't matter) letter or signed off by a PhD supervisor if part of an institutional mental health system. There isn't any hard and fast rules around how long you've seen the letter writer as long as they have assessed you for surgery eligibility (and recommend the proposed surgery to remediate symptoms of gender dysphoria).

edit: the surgery letter has to be from a year ago or less otherwise most surgeons will reject it because the referral is akin to a prescription that can expire.

[Bimmer Guy]

If the surgeon follows the SOC (wpath.org)

1) two letters (psychologost + a masters level therapists, two psychologosts, or psychologost + psychiatrist)
2) one year living as gender full time
3) one year on T

Now that i am thinking about it not sure about the T. Check t h e Standards of Care.

I dont know that there are any surgeons out there that don't follow the SOC when it comes to bottom surgery.

[aleon515]

Not following standards of care, well probably they are, but a few doctors don't require anything if you can show evidence of a long term transitioner. This is probably someone who has been on T many years, has had ID changed for years, and so on.

--Jay

[GnomeKid]

hmm I suppose this means that if I'm planning on getting surgery within the next couple years I should probably try to get back into therapy as soon as possible eh?

[mangoslayer]

My letters were from a counseling student who had the letter signed off on by a psychologist (with a PH.D.) and one from a therapist I had seen only once for an assessment. My insurances requirements were a regular therapist and an assessment from a gender therapy specialist.

[mangoslayer]

Also, I know the general reccomendation is to wait at least 2 years after starting T to get meta, to maximize growth. Just throwing that out there.

[Eccentric Moe]

Thanks for the info everyone, that helps a lot.

Also, I know the general reccomendation is to wait at least 2 years after starting T to get meta, to maximize growth. Just throwing that out there.

Does a meta prevent further growth from T ?  I haven't heard that before.

[aleon515]

Thanks for the info everyone, that helps a lot.

Does a meta prevent further growth from T ?  I haven't heard that before.

I don't think he said that actually, but it doesn't. You do keep growing and you can still possibly enhance it.

--Jay

[devention]

I think he may have meant pre-surgery growth? I imagine it's easier for the surgeon if there's more to work with.

[aleon515]

I think he may have meant pre-surgery growth? I imagine it's easier for the surgeon if there's more to work with.

Off topic:
I believe that some surgeons care about how much is there and some do not at all. How much you have determines how much of a phallus you get though. Otherwise you will look very Greek god sculpture-ish.
(take a look-- large testicles, small phallus). There is a limit in terms of urethra lengthening (ring meta). You would need to clear the zipper. Perhaps they can do it otherwise, but it might not actually be too practical.

For a phallo it doesn't matter.

--Jay

[sneakersjay]

Your junk does need to be at least a certain size (to be determined by the surgeon) before they will perform surgery, to maximize size but also so you will be satisfied.  They need a certain amount of tissue to work with.  I don't measure, and I could be wrong, but I do think my junk is a little bit bigger than it was at the time of surgery.  Or maybe it's just wishful thinking, LOL


Jay (the other Jay!)

[aleon515]

Your junk does need to be at least a certain size (to be determined by the surgeon) before they will perform surgery, to maximize size but also so you will be satisfied.  They need a certain amount of tissue to work with.  I don't measure, and I could be wrong, but I do think my junk is a little bit bigger than it was at the time of surgery.  Or maybe it's just wishful thinking, LOL


Jay (the other Jay!)

Hello Jay (such a nice name) and anybody reading

You're right. The surgeon determines. Some surgeons don't care and some definitely do. What the big size problem is is with UL. UL depends on a certain length or you can't clear your zipper. Also just generally size mean you won't be happy with it. I've heard that Dr Crane will work with anybody, but Dr McGinn will tell you if you aren't big enough. (Ouch!) But she has said that some people say do it anyway.

--Jay

[sneakersjay]

I went to Dr. Miro in Serbia but had a consult here in the US first.  I was just shy of 2 yrs on T when I had surgery.  His feeling was that if you're not at least a certain size, you're probably not going to be happy with the result. I used to be on a surgery forum and there were some guys who were still not happy because their junk wasn't like the pictures. Everyone's junk is different.  And it doesn't need to be huge; I'm really not that big (approx. 1" soft) but I can pee at a urinal.  It took nearly 3 years of practice, though.  I finally got it mastered last summer (wearing overalls will encourage you to figure it out!) but even now still learning new techniques.  But it can be done if you are determined!

Some time ago I posted a link to an xtube video of me peeing through my fly with my 1 incher.  I no longer have the link but I'm sure it's in the archives somewhere.


Jay

[aleon515]

I went to Dr. Miro in Serbia but had a consult here in the US first.  I was just shy of 2 yrs on T when I had surgery.  His feeling was that if you're not at least a certain size, you're probably not going to be happy with the result. I used to be on a surgery forum and there were some guys who were still not happy because their junk wasn't like the pictures. Everyone's junk is different.  And it doesn't need to be huge; I'm really not that big (approx. 1" soft) but I can pee at a urinal.  It took nearly 3 years of practice, though.  I finally got it mastered last summer (wearing overalls will encourage you to figure it out!) but even now still learning new techniques.  But it can be done if you are determined!

Some time ago I posted a link to an xtube video of me peeing through my fly with my 1 incher.  I no longer have the link but I'm sure it's in the archives somewhere.


Jay

Yes, that's true. I know people who should have planned for a mons resection. It's where they take the fat off the pubic bone (I think that's the explanation). Not all surgeons are completely upfront about this one. But from what I have heard you don't need to be overweight to need this. But it could be important because you could look down and not be able to see it. I don't know how much extra it would be, but something to consider.

Wow Jay you are a talented individual.

--Jay