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Preparing for the first consultation with your doctor about transitioning

By Andrew Adams

IMAGE CREDIT: Adobe Stock | lordn

Hello everyone and welcome back to Andrew’s phalloplasty journey! This is part 3 in an ongoing series chronicling my adventures in researching, preparing for, and eventually having gender affirming bottom surgery as a transgender man. Part one and two are on this website if you scroll back a little, which you will want to do if you want to read about the process of determining what bottom surgery is right for you and how to pick a surgeon, or at least how I did it. This installment will be about the consult, after you know what you want and who you likely want it from.

In order to schedule a consult, you will either need to fill out a form on the surgical center’s website or call. I had to call. Once it’s scheduled, however, there is some preparation that I recommend before the consult itself comes around. Mainly, you’ll need to prepare your questions, because the consult is the main opportunity to ask any questions you may have. Here is my list, pertaining to my needs for my procedure. Feel free to take from mine, leave what you don’t need, and add your own for your consult.

Q: How long will I be under anesthesia? How long does the surgery usually take?

A: Dr. Min said that I would be under for 10–12 hours, depending on how it goes.

Q: What is the waiting room situation like? What about the hospital guest policy for while I am in the hospital?

A: He did not know the specific guest policy of the hospital.

Q: Does BMI or body fat distribution impact my results?

A: No, me being a little thicker will not impact my results because I am using my arm instead of my leg. If I was using my leg as the donor site, yes it would be an issue.

Q: How many surgeries like this have you done on people like me? I meant this to mean a thicker guy, but I would ask for specifics if you are a person of color or disabled as well.

A: He said he has done many and assisted on even more, but didn’t have the number off the top of his head, I asked more to make sure he was comfortable with thicker people, not to hear a specific number.

Q: Does my disability impact my results? I have hypermobile ehlers danlos syndrome- will this be an issue?

A: He asked about my previous wound healing but said I should be totally fine because my wound healing has been really good in the past.

Q: How do you stage the surgery? Will it be multiple surgeries?

A: 3 stages- stage 1 is the creation of the phallus, vaginoplasty, and creation of the glans if there is good blood flow. If not, glansplasty is in stage 2, where they make the scrotum. Stage 3 is the erectile device.

Q: Can the surgery include all of the things that I want? For me this means scrotoplasty, testicular implants, an erectile implant, and vaginectomy.

A: Yes, that works for him.

Q: How long will I be in the hospital after surgery?

A: 5 days in the ICU with 24 hour supervision of the surgical site.

Q: How long before surgery do I need to be in the San Francisco area? When is the pre-op appointment and is there one on the day before or just the day of?

A: I actually forgot to ask about the pre-op but I will ask later.

Q: What kind of prep do I need? Do I need to do bowel prep or anti inflammatory diet?

A: Bowel prep will be involved, but no anti inflammatory diet needed.

Q: Are there any kinds of workouts I can do for the surgery or graft cite to improve my results?

A: I actually forgot to ask this, but I will be doing some forearm exercises to beef up the donor site.

Q: How long will I need to stay in the area? What kind of recovery center or hotel do I need?

A: After the 5 days in ICU, 4 weeks in the Bay Area at a recovery rehabilitation center.

Q: What kind of physical therapy will I need? This is in reference to the arm graft for phalloplasty and PT for my hand after.

A: Physical therapy for the hand on the donor site will be required due to the removal of several important nerves in the wrist and arm.

Q: What are the most common complications? What rates do they occur at? What kinds of remedies for complications are there?

A: 1% of patients have a big problem and lose the phallus. 10% of patients have a big problem that can be solved with another surgery. 40% of patients have a complication with the urethra of the new phallus. 100% of patients experience something — most often it’s extra bleeding that goes away on it’s own, but still something.

Q: Catheters? How many and for how long?

A: 3 catheters. The first comes out of your lower stomach area, the second is through the phallus, and the third is a drain to remove extra fluid from the area.

Q: What kind of scars will I be left with and how do they look over time?

A: 1 scar on the underside of the phallus, 1 big rectangle scar on the donor arm where the donor site was taken, and a little scar where the first catheter comes out.

Q: How does insurance work for this? Do I need to do anything right now for that?

A: They’ll reach out to insurance 3 months out from the surgery date.

Q: What letters do I need and from whom?

A: 3 letters. 1 from a mental health professional with a doctoral degree, one from a hormone provider, and one from another mental health provider with at least a master’s degree. These are required before scheduling the surgery.

Q: Do I need any sort of medical clearance from a doctor?

A: I forgot to ask this, too, but so far they have not needed anything.

Q: What is the timeframe for getting scheduled?

A: I asked about the timeframe I wanted and they said that would work.

My consult with Dr. Min, one of the surgeons at The Crane Center I chose, was in May of 2022, about a month after I initially called to schedule it. First, the doctor had some questions for me. Here are the questions he asked me.

Q: What procedure do you want? What specifics do you have in mind?

Q: Rank these 4 things — aesthetic (how the phallus looks), ability to have penetrative sex, ability to achieve sexual pleasure, and ability to pee standing up.

Q: What health concerns or family medical history do you have?

Q: Do you have someone who will be able to stay with you while you are in San Francisco?

Q: What is your insurance information? (I hadn’t yet given them my insurance)

The consult lasted about 30 minutes. Dr. Min answered all of my questions and I answered his. He concluded that I was a good candidate for this surgery and that he felt comfortable operating on me. After the consult was over, the letters department emailed me a list of the letters I needed and their requirements. So far, everything was going pretty smoothly.

Stay tuned next time for the next installment of Andrew’s Phalloplasty Adventure, where we will talk about the letters themselves and actually getting this thing scheduled!

About the Author

Andrew (he/him) is a transgender student at the University of Central Florida where he is studying psychology in the hopes of becoming a therapist. He is a peer mentor for at risk teenagers at Aspire Health Partners, and he enjoys gardening, taking care of several pet reptiles, playing the piano, and replaying Skyrim on X-Box. While he has focused on his own growth and wellbeing recently, he has previously worked or volunteered with The Trevor Project, Point of Pride, GLSEN, March For Our Lives, and for local political campaigns as an advocate for LGBTQ rights. Specifically, he also is the plaintiff in an ongoing legal battle against his high school who barred him from using the men’s bathroom due to him being transgender, and that legal battle is still ongoing (See Adams v. St John’s County School Board). Additionally, as an Autistic ADHDer with a connective tissue disorder, Andrew is an advocate for both neurodiversity and disability rig.

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