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.
