Bottom Surgery without Transition

[suzifrommd]

You DO NOT have gender dysphoria if you do not want to alter your gender expression.  A more accurate way to describe your situation would be maybe genital dysphoria.

Um ... Isn't this a form of gender dysphoria?

[jeni]

Maybe, but it comes to depend on choice of terminology. As I have frequently seen it defined, it'd be sex dysphoria (or genital, as calicarly suggested, which strikes me as interchangeable).

That's from the school of terminology where there's sexuality (who you're attracted to), gender identity (how you identify internally), gender expression (how you present yourself socially), and biological sex (which parts you have).

I'm not sure how this would fit in terms of clinical / DSM terminology, but I think it's exactly the case where distinguishing gender identity from biological sex is important. That's probably also the rationale that would be used to deny surgery in such a case. I am not saying I agree with it, but I think the argument would be that GRS is intended to bring biological sex in line with gender identity, the latter of which is a well established condition. I suspect there's little documentation of sex/genital dysphoria as "real," which may be why doctors would be hesitant to treat it. (Scare quotes, of course, because I am not decidedly not questioning the reality of the condition, but a doc might.)

[LizMarie]

I am aware of others who have had SRS but not socially transitioned. Each that I know has, however, moved towards a more androgynous mode of presentation, almost "genderless", if you will.

But each person has to find what makes him or her comfortable.

Getting your letters to this may take a bit more time, as you work through issues with your therapist.

Question, do you plan to do HRT? Facial hair removal? The more mixed or ambiguous our outward gender presentation, the more I've found that therapists want to explore those issues and that takes time. One person who did this took about 6 years to convince their therapist of the need for SRS without full social transition.

[Muffinheart]

I sort of skimmed over the responses, but what I haven't read is that don't most surgeons require you have been living full time for at least a year? I know with Dr. Brassard, a requirement is proof of full time and HRT

[WendyAnn.1969]

I will speak from personal experience that you absolutely do NOT have to socially transition to be on HRT and after a year, qualify and be accepted for SRS with multiple US-based highly regarded surgeons.

It's certainly atypical for sure...remember, the WPATH guidelines are NOT standards or requirements - they are guidelines.

I had no problem calling as high as I needed: my V.P. of HR, finding a great therapist, gynecologist, and Ph. D. They all understand the big picture with me.  Heck, I have even visited face to face with the president of WPATH about my case to be absolutely 100% certain I didn't encounter things that would prevent me from getting the job done. 


Oh, I even got it covered with insurance. I did all this while living as authenticity as I need to - which by some peoples idea, isn't very female.

[AnonyMs]

Hi WendyAnn,

I'm just curious, but at the end of it all was all that effort really required? My understanding is that in the USA you just need the psych letter.

[AnonyMs]

I sort of skimmed over the responses, but what I haven't read is that don't most surgeons require you have been living full time for at least a year? I know with Dr. Brassard, a requirement is proof of full time and HRT

I can't comment on Brassard in particular, but I believe there's scope for special cases. There's must be as there's a non-zero number of people actually doing it. Since I like Suporn and he is very clear about his requirements, I'll point out what he says - its 12 months, except when its 6 months, except ...

http://www.supornclinic.com/Restricted/Scheduling/protocol.aspx

[Karen5519]

I think that what you are looking for might be difficult to obtain.  Although I do not practice in this area of the law, to me the medical professionals that would approve this might be setting themselves up for a malpractice suit.  People are so litigious nowadays I could not imagine a therapist or physician sticking their neck out that far and not strictly going by the WPATH criteria.  They could also be putting their licenses in jeopardy as well.....which is their means to make a living.  If you did find a therapist or surgeon to allow you to move forward I am certain they would go well beyond the normal to show the needed level of proof that you would mentally competent to make such a decision that would alter your body in this manner.  That may in itself take awhile.  I know that they have changed the WPATH criteria in the past five years....but that does not mean that therapists and surgeons will say yes.  I think you are more likely being told that there are other ways, outside of SRS, to address your gender dysphoria.  Professionals also know that their malpractice insurance can be voided if they were deemed to be wantonly careless in their actions.  They do not want to go there.  That is just my opinion for what it is worth.   In any event, best of luck in achieving your desires!

[WendyAnn.1969]

Hi WendyAnn,

I'm just curious, but at the end of it all was all that effort really required? My understanding is that in the USA you just need the psych letter.

All the effort I listed was required - if I didn't want to pay cash, so yes.
It's like wining a $30,000 lottery - post tax.

[WendyAnn.1969]

I think that what you are looking for might be difficult to obtain. 

I could not imagine a therapist or physician sticking their neck out that far and not strictly going by the WPATH criteria. 

I know that they have changed the WPATH criteria in the past five years....but that does not mean that therapists and surgeons will say yes. 

Yes, difficult for sure, but it is definitely possible, my story is proof.

As I mentioned, the WPATH standards of care - are guidelines, and one of the items that is very clear is that it's up to the individual therapist/Ph. D. to determine what needs done or can be avoided - specific to each case with regard to supporting initiating HRT or GRS.

In my case, I have a therapist, a Ph. D., a gynecologist, a surgeon, my HR department, my insurance carrier (who had a Trans surgical exclusion in place), and my management - all on the same page.. Now that, took some doing.  Yes, I have met several surgeons in person and they were all supportive when they learned of my story.

That said, I live as openly as I am able to - based on the local rural bigoted and close-minded environment where I live. I don't dress in your face over the top female, and also haven't changed my name, but then again, that isn't always a necessity.

All of these items were documented and addressed in my collection of 7 letters.

What a trip and I haven't even gone for the surgery yet.

Wendy

[BeverlyAnn]

I met someone quite a few years ago who presented as male but was post-op.  I was going to be in another city and had contacted a local support group who would be meeting while I was there.  Since I was still on the staff of Southern Comfort Conference at the time, I was asked to give a presentation at the meeting about SCC and what all was offered at the conference.  I met the person at that support group and understood quite a bit of money and lawyers were involved in getting the surgery, IIRC, in Thailand.  This particular person was then going to transition slowly due to their business. 

[AnonyMs]

All the effort I listed was required - if I didn't want to pay cash, so yes.
It's like wining a $30,000 lottery - post tax.

Any idea what you'd have needed if you'd paid cash?

If you don't mind me asking, why are you talking about it? Because there's more than just you and its almost like no one is willing to speak up.

[WendyAnn.1969]

Any idea what you'd have needed if you'd paid cash?

If you don't mind me asking, why are you talking about it? Because there's more than just you and its almost like no one is willing to speak up.

Of course. $29,999.00 short of anesthesiologist and labs.. Plus food and a place to stay post discharge for 10-17 days in SFO area. Oh, then the cash for all the bribes.....just kidding, there were none. I'm as authentic as they come and there was no need for that type of nonsense.

I posted and tell a bit of my story because the discussion was focused on the (apparent) extremely low quantity of people that may seek GRS without full social transition. If no one speaks up - then the story won't ever be told and wild speculation will run wild.  I have never understood why the two events have ever been tied together. How you live and what is or isn't in your pants are completely different items.

While atypical I'm not unique. I'm just an older lower intensity MtF Trans female who also happens to be .... also a lesbian.  I knew I wasn't gay - as I wasn't attracted to men.  I have a natal male body and was attracted to females but things were never right.  Ultimately, it was quite a mental jump to figure out through deduction that I am not only a Trans female but also a lesbian. That was at the very end of a very long list.

[AnonyMs]

Thanks for speaking up. I have to admit I wouldn't in your situation.

Of course. $29,999.00 short of anesthesiologist and labs.. Plus food and a place to stay post discharge for 10-17 days in SFO area. Oh, then the cash for all the bribes.....just kidding, there were none. I'm as authentic as they come and there was no need for that type of nonsense.

What about the amount of paperwork, if you pay cash? 7 Letters seems excessive, and given its Thailand I'd expect you to really only need 1 letter (psych), possibly 2. They are a very accepting society and I don't think they have the cultural hangup's we experience in the west.

[WendyAnn.1969]

Thanks for speaking up. I have to admit I wouldn't in your situation.

What about the amount of paperwork, if you pay cash? 7 Letters seems excessive, and given its Thailand I'd expect you to really only need 1 letter (psych), possibly 2. They are a very accepting society and I don't think they have the cultural hangup's we experience in the west.

First, I am unsure you are addressing me, but I will assume you are since you quoted part of my reply.

Why would I not speak up? There is absolutely nothing wrong with how I live or what I am doing and no wrong way to be Trans.  I don't understand why others wouldn't be more open in this thread to share their story.

My procedure is covered by insurance tied to my HR department overriding the surgical exclusion primarily because I provided enough evidence to open their eyes to not only the Trans situation but also my specific medical needs.  It do believe this took 7 letters to be successful on the first try.  So, no, I'm NOT paying cash.

Umm, I'm also not going to Thailand.. I am confused.

Wendy

[michelle]

We do what we do when we do it.  There is no one way to transition.

[AnonyMs]

First, I am unsure you are addressing me, but I will assume you are since you quoted part of my reply.

Why would I not speak up? There is absolutely nothing wrong with how I live or what I am doing and no wrong way to be Trans.  I don't understand why others wouldn't be more open in this thread to share their story.

My procedure is covered by insurance tied to my HR department overriding the surgical exclusion primarily because I provided enough evidence to open their eyes to not only the Trans situation but also my specific medical needs.  It do believe this took 7 letters to be successful on the first try.  So, no, I'm NOT paying cash.

Umm, I'm also not going to Thailand.. I am confused.

Wendy

Sorry I wasn't overly clear. I was addressing you, and I was confused about the Thailand bit. The question about the 7 letters and cash was really to ask "if you paid cash how many letters do you need?".

I agree with you entirely about what you're doing, and I would do it myself. I'm not sure how to explain why I'd not talk about it without getting moderated, so I won't.

Thanks

[JS UK]

Thanks for your posts Wendy Ann.

I'm in a similar position in the UK. I cannot socially transition due to work and family and was hopeful that I could at least have an orchie. If I could have full GRS then I'd be much happier.

I'm on the waiting list for an appointment at my local gender clinic and hopefully only have a few months to wait. When I have my appointment I'll post back.

Julie xx

[Sebby Michelango]

If you're going to take bottom surgery without HRT, you may get very dangerous and risky consequences. You can get osteoporosis, a skeleton disease and you can die.
Your body would not produce any testosterone post-op and without taking HRT the body wouldn't work. The body needs hormones to live. But it's up to you how you want to transistion and what you want to do to your own body.

[JS UK]

If you're going to take bottom surgery without HRT, you may get very dangerous and risky consequences. You can get osteoporosis, a skeleton disease and you can die.
Your body would not produce any testosterone post-op and without taking HRT the body wouldn't work. The body needs hormones to live. But it's up to you how you want to transistion and what you want to do to your own body.

I was thinking low dose HRT would take care of that issue.

J xx