So here we are. As many of you already know, I’m about to embark on a year-long phalloplasty/recovery journey which includes 3 surgeries and 3 round trips from Vancouver to Austin, Texas. This is without a doubt, going to be one of the most difficult things I will ever go through, not only physically and mentally but financially as well. I would be lying if I said I’m not overwhelmed and completely terrified… but I’m also excited and more than any of that, I am hopeful about a future where my body can feel like home to me. If you would like to support me in this journey, please donate if you can or share my fundraiser page. All my love. ❤
Here’s my (bad) diagram of what my body looks like.
I’m post-op from ALT phalloplasty with scrotoplasty and glansplasty without vaginectomy or urethral lengthening.
Things that the drawing doesn’t really show very well:
If you’re standing directly in front of me, you can’t see the scrotum behind my penis shaft unless I lift up my penis or move it to the side.
If you’re standing directly in front of me and I’m holding my penis up or to the side, you’d only see my scrotum, you can’t see my clitoris/vagina while looking at me from the front.
You can only see the original bits if you look up between my legs when I’m standing, or if I spread my legs while I’m laying down.
The labia majora are gone, they were turned into the scrotum.
The labia minora were used to cover the area where the majora used to be so it looks like they’re gone because they were flattened out and don’t stick out. It’s hard to explain this one.
I don’t know where my urethra is but it is in the same place as where it was when I was pre-op so I have to sit to pee, I’ve just never bothered looking for it. I might try using an STP at some point. So no, I can’t pee through the penis or ejaculate through it.
It took several months, but I have some level of sensation in about 90% of my penis now. It feels like a bigger less-sensitive clitoris to me.
After I get the pump erectile implant in June, I’ll be able to have an erection with my penis which will make it easier to top and penetrate my partner during sex, and my vagina still works like it used to, so I can also bottom and be vaginally penetrated if I want to.
I colored the donor site and the split thickness skin graft site in as one red square because I have hypertrophic scarring that makes it hard to find the line between the two since they were touching even before the scar growth so I just drew it as one block, but technically there are two different things happening on the same thigh.
I’ve gotten a few questions about how I can have a penis and a vagina, so hopefully this drawing helps answer that question by showing the gist of the set-up.
A journal of one of the first openly non-binary people to get phalloplasty without vaginectomy. OP also was not on T and had not gotten top surgery (search HRT to see this info). While OP will no longer be updating the blog, the information is invaluable!
Post op today to check the ED (pump) and start cycling between hard & soft. Can’t fcking wait to have the ability to be soft again wtf being mildly erect all the time is so uncomfortable………
Also gotta talk about the bulb placement in my scrotum cuz it’s feeling like an undescended testicle & If I want to get it repaired with the same surgeon I need a December surgery date……. Cuz I can’t afford the same insurance next year . The insurance I want to switch to doesn’t work with this surgeon & im concerned their bottom surgeon won’t work with me.
As I didn’t find any information about this topic, I figured you could find interest in this post !
As far as I’m aware, 5 out of the 7 surgeons performing phalloplasty inFranceoffer this technique. It’s broken down into 6 stages to reduce operating times and risks as much as possible. The final scar is similar to the one you get from a tummy tuck (look it up on google): discreet and easily hidable.
1st stage : Tissue expansion is accomplished by placing 2 balloons like expanders underneath the skin between your belly button and your pubic area. Over the next 3 months, the expander is filled with saline solution (saltwater) causing the skin around it to stretch and grow. Once the balloons have reached 800 mL (28-30 fl oz) each, the tissue expander is ready to be removed, which leads to the second surgery.
2nd stage : Tubing consists in the removal of the skin expanders and the creation of a penis thanks to the newly generated skin. The neo-penis is attached on both sides (your belly button and your pubic area), allowing a good vascularization and good healing (the complication rate drops)
3rd stage : Flap removal is undergone which allows your penis to hang and not be attached to your belly still.
4th stage : Urethroplasty (½) is performed in two stages to reduce the complications rate drastically. The neo-urethra is created with thin layers of skin removed from your thigh.
5th stage : Urethra connection (2/2) ; glansplasty, vaginal closing and clitoris burial can be performed if desired.
6th stage : Erectile device & testicular implants
Theoretically, 3 months are to be waited between stages 1 and 2, stages 2 and 3, and stages 3 and 4. The time between stages 4 and 5 varies a lot depending mainly on complications. Overall, the whole process is completed in 18-24 months (with urethroplasty)
I know it can be hard to picture the process, here is an illustration (TW: surgery illustration)
So you want to get phalloplasty huh? That’s great! Let’s start the process but first, you have to have insurance. This part is mandatory to get surgery in the US. If you were to completely self-pay, the cost of one stage of phalloplasty (out of often multiple stages) would run you between $75k - $150k*. “Paying out of pocket” for phallo involves paying for medical insurance that will cover the costs of getting phallo. Depending on your insurance premiums, paying “out of pocket” can range from ~$100 to ~$1,000 per month+. No insurance? Can’t pay for insurance? No phallo.
Cool, we have insurance, so far so good. But wait, does your insurance cover trans-related healthcare coverage? Do you live in a state that allows exclusion of life-saving surgical transgender care or do you live in a state with mandatory trans healthcare coverage? Does your specific insurance plan (often through an employer if not from the state a la Medicare/Medicaid) cover transgender care? No? No phallo
Alright, so you have insurance and your plan covers phallo. Exciting, ok now let’s find a phallo surgeon. This is a highly specialized procedure and needs to be performed by a specialized surgeon. Is there a surgeon in your city? In your state? In the surrounding states? Do you have a surgeon in mind? Do they take your insurance or can they pursue specific agreements with your insurance under specific circumstances? Does your insurance require you see a specific surgeon (or one of a specific list of surgeons)? Oh dear, looks like phallo surgeon you want to see or can see doesn’t live locally, alright gotta factor in travel & lodging costs. No surgeon? No phallo.
Ok, so your insurance will cover phallo with some surgeon(s), let’s start meeting with surgeons! Or maybe you decided to pay out of pocket for consults with different surgeons (~$250/consult’). Let’s get on the waitlist! Current consult waitlist times are ranging from several months to a couple years depending on the surgeon. Timeframe doesn’t work for you? No phallo
Insurance, check, surgeon, check, consult, scheduled. Awesome! In the meantime, let’s start gathering our required paperwork (often called “Pre-Authorization” forms). This includes two (2) separately letters from mental health professionals. One of them is usually required to have a Masters or above. Because everyone has 2 therapists right? And we all know that trans-competent therapists are always super easy to find, never book, and never require money! And these therapists could never have transphobic gatekeeping standards that require a certain amount of session or a certain attitude to even be willing to write said letter. By the way, gotta make sure you meet the criteria including at least one (1) continuous year on hormones (for most insurances/situations). Also, gotta have your mental health “reasonably under control”. No letters? No phallo
Alrighty, so we have our insurance check, letters check, consults scheduled/completed. Let’s prep for surgery. Gotta make sure we meet the surgeon’s BMI limit first. Different surgeons will have different limits btw so you may not know ahead of meeting them individually. Also, if you’re doing urethral lengthening for RFF or ALT with most surgeons, you’ll need to do permanent hair removal to prevent hair from growing in your new urethra. Yes it’s medically necessary, yes your insurance may even list it as a “covered” service in their documents. But wait! Most insurances require you get a referral to a Doctor or practitioner of some kind (like a dermatologist) and very very few derma clinics do electrolysis. You’ll probably end up paying for this out of pocket. Sessions are generally 1-2 hours, once maybe twice per week for roughly 9-12 months on average @ around ~$100-$300 per session. Hopefully you can get this reimbursed by the way but likely not. Not ready for surgery for any reason? No phallo.
Doing good, hair removal underway, meeting all other phallo requirements & surgery is coming up. Gotta do our surgery planning. You won’t be able to work for 8-12 weeks so hope you can take that time off and afford it. You could possibly get short term disability leave but that’s also around ~60% of your pay AND doesn’t start immediately. Gotta make sure you have some savings in place to float you through with rent, food, other expenses. Speaking of housing, are you traveling or staying at home? If you’re traveling, expect to be there for 5 weeks total - 1 in hospital, 4 nearby the hospital. Gotta find long term accommodations in the area, get an AirBnB usually for around $2k depending on the area. Plus flights! So let’s say another $300-$600 per person (you’ll likely NEED another person for the first few weeks out of the hospital). Also you gotta pay for food one way or another. And also a way to/from appointments. Let’s add another $500 on the very low end. Maybe your insurance will reimburse you for some of this, probably not tho. Also need recovery supplies! LOTS of recovery supplies, it’s a long recovery & often needs wound care multiple times a day. So let’s say another $500. You’ll also need someone to help you out the first several weeks so factor in the cost of food & transport for a second person idk let’s say $500 on the low end. No accommodations? No recovery supplies? No phallo.
You haven’t even had surgery at this point btw. This all just needs to be done prior to surgery. Then comes the post-surgery costs. How much will you be paying for surgery? That depends HEAVILY on your insurance plan and can range from $0 to $12,000 with insurance. That’s just for surgery costs, anesthesiologists, hospital stay. A lot of this is calculated in advance btw & a lot of it has to be paid up front. Can’t afford that? No phallo.
This is for the phalloplasty (phallus creation) stage btw. You may need multiple stages (common) or surgical repairs (common) depending on your personal goals & recovery. Recovery time can range from 2 - 12 weeks depending on the surgery in question. These are spread throughout the period of a couple years if multiple surgeries are necessary.
Phalloplasty is a huge investment financially, physically and emotionally. It also requires TIME. Money & time are the biggest (but not only) barriers to phalloplasty access. Our medical system is horrendously lacking & transphobic because it actively bars trans people from necessary, life saving, competent transition care. Everything from basic coverage to consultation costs to pre-op prep/supplies to recovery needs should be freely available to all trans & non-binary people interested in phalloplasty.
I don’t think it does. There’s multiple components to UL which is 1) rerouting the natal urethra to the neo urethra & in the case of phallo 2) creating a urethra through the length of the penis.
The electrolysis and hair removal in general is for the second part - to ensure hair growth in the urethra along the shaft doesn’t obstruct urine flow. Then again, I don’t know much about meta
So you want to get phalloplasty huh? That’s great! Let’s start the process but first, you have to have insurance. This part is mandatory to get surgery in the US. If you were to completely self-pay, the cost of one stage of phalloplasty (out of often multiple stages) would run you between $75k - $150k*. “Paying out of pocket” for phallo involves paying for medical insurance that will cover the costs of getting phallo. Depending on your insurance premiums, paying “out of pocket” can range from ~$100 to ~$1,000 per month+. No insurance? Can’t pay for insurance? No phallo.
Cool, we have insurance, so far so good. But wait, does your insurance cover trans-related healthcare coverage? Do you live in a state that allows exclusion of life-saving surgical transgender care or do you live in a state with mandatory trans healthcare coverage? Does your specific insurance plan (often through an employer if not from the state a la Medicare/Medicaid) cover transgender care? No? No phallo
Alright, so you have insurance and your plan covers phallo. Exciting, ok now let’s find a phallo surgeon. This is a highly specialized procedure and needs to be performed by a specialized surgeon. Is there a surgeon in your city? In your state? In the surrounding states? Do you have a surgeon in mind? Do they take your insurance or can they pursue specific agreements with your insurance under specific circumstances? Does your insurance require you see a specific surgeon (or one of a specific list of surgeons)? Oh dear, looks like phallo surgeon you want to see or can see doesn’t live locally, alright gotta factor in travel & lodging costs. No surgeon? No phallo.
Ok, so your insurance will cover phallo with some surgeon(s), let’s start meeting with surgeons! Or maybe you decided to pay out of pocket for consults with different surgeons (~$250/consult’). Let’s get on the waitlist! Current consult waitlist times are ranging from several months to a couple years depending on the surgeon. Timeframe doesn’t work for you? No phallo
Insurance, check, surgeon, check, consult, scheduled. Awesome! In the meantime, let’s start gathering our required paperwork (often called “Pre-Authorization” forms). This includes two (2) separately letters from mental health professionals. One of them is usually required to have a Masters or above. Because everyone has 2 therapists right? And we all know that trans-competent therapists are always super easy to find, never book, and never require money! And these therapists could never have transphobic gatekeeping standards that require a certain amount of session or a certain attitude to even be willing to write said letter. By the way, gotta make sure you meet the criteria including at least one (1) continuous year on hormones (for most insurances/situations). Also, gotta have your mental health “reasonably under control”. No letters? No phallo
Alrighty, so we have our insurance check, letters check, consults scheduled/completed. Let’s prep for surgery. Gotta make sure we meet the surgeon’s BMI limit first. Different surgeons will have different limits btw so you may not know ahead of meeting them individually. Also, if you’re doing urethral lengthening for RFF or ALT with most surgeons, you’ll need to do permanent hair removal to prevent hair from growing in your new urethra. Yes it’s medically necessary, yes your insurance may even list it as a “covered” service in their documents. But wait! Most insurances require you get a referral to a Doctor or practitioner of some kind (like a dermatologist) and very very few derma clinics do electrolysis. You’ll probably end up paying for this out of pocket. Sessions are generally 1-2 hours, once maybe twice per week for roughly 9-12 months on average @ around ~$100-$300 per session. Hopefully you can get this reimbursed by the way but likely not. Not ready for surgery for any reason? No phallo.
Doing good, hair removal underway, meeting all other phallo requirements & surgery is coming up. Gotta do our surgery planning. You won’t be able to work for 8-12 weeks so hope you can take that time off and afford it. You could possibly get short term disability leave but that’s also around ~60% of your pay AND doesn’t start immediately. Gotta make sure you have some savings in place to float you through with rent, food, other expenses. Speaking of housing, are you traveling or staying at home? If you’re traveling, expect to be there for 5 weeks total - 1 in hospital, 4 nearby the hospital. Gotta find long term accommodations in the area, get an AirBnB usually for around $2k depending on the area. Plus flights! So let’s say another $300-$600 per person (you’ll likely NEED another person for the first few weeks out of the hospital). Also you gotta pay for food one way or another. And also a way to/from appointments. Let’s add another $500 on the very low end. Maybe your insurance will reimburse you for some of this, probably not tho. Also need recovery supplies! LOTS of recovery supplies, it’s a long recovery & often needs wound care multiple times a day. So let’s say another $500. You’ll also need someone to help you out the first several weeks so factor in the cost of food & transport for a second person idk let’s say $500 on the low end. No accommodations? No recovery supplies? No phallo.
You haven’t even had surgery at this point btw. This all just needs to be done prior to surgery. Then comes the post-surgery costs. How much will you be paying for surgery? That depends HEAVILY on your insurance plan and can range from $0 to $12,000 with insurance. That’s just for surgery costs, anesthesiologists, hospital stay. A lot of this is calculated in advance btw & a lot of it has to be paid up front. Can’t afford that? No phallo.
This is for the phalloplasty (phallus creation) stage btw. You may need multiple stages (common) or surgical repairs (common) depending on your personal goals & recovery. Recovery time can range from 2 - 12 weeks depending on the surgery in question. These are spread throughout the period of a couple years if multiple surgeries are necessary.
Phalloplasty is a huge investment financially, physically and emotionally. It also requires TIME. Money & time are the biggest (but not only) barriers to phalloplasty access. Our medical system is horrendously lacking & transphobic because it actively bars trans people from necessary, life saving, competent transition care. Everything from basic coverage to consultation costs to pre-op prep/supplies to recovery needs should be freely available to all trans & non-binary people interested in phalloplasty.
anyone know if like any surgeons anywhere have looked into phallo/meta techniques for fat people that don’t just involve yelling at them to lose weight and withholding surgery otherwise? not a thing i am going to look up on my own because i don’t want to get stuck in fatphobia hell
There’s a Facebook group call “fat trans/non-binary bottom surgery” or something like that you could check out OP.
I don’t have personal experience with this but I did ask the team at Scott Mosser’s Gender Confirmation Center in San Francisco about the BMI limit for their new bottom surgeon Dr. Ellie Ley & the team said around 40 & above that on a case by case basis.
I was asking on behalf of a friend for vaginoplasty. The reason this clinic specifically is because Scott Mosser openly does not have a BMI limit for top surgery. I was hoping that the same policy would apply for bottom surgery but the BMI limit for Dr Ley is higher than I have seen elsewhere
Hey fam currently on the road to getting hysterectomy! I’m finally fully vaccinated so hoping to move along with my medical transition donations are so appreciated during this because I wont be able to work first consultation is scheduled for 10/28/21 . Been dealing with amenorrhea and atrophy of these organs for over 2 years now so hoping to get some relief and also finally be able to move on in my bottom surgery journey.
not read the article but the whole thing about trans bucket being name dropped is so bad :( we need safe spaces, there are down sides to visibility!
i’ve heard that they’ve since got NYT to remove the namedrop and will be checking their security before putting the website back up again, so fingers crossed all is well
On January 30th 2019 I underwent my first stage of RFF Phalloplasty. It seemed appropriate that I return to this blog to at least give a bit of an update.
This stage included the creation of the phallus, urethral lengthening, vaginectomy, scrotoplasty, and glansplasty. Overall I’m healing well. I still haven’t decided if/how much I’ll update this blog but I have been updating my transition related Instagram: willssurgeryjourney
It’s been quite a while since I’ve been on this blog and I’m moving towards documenting my transition and more specifically my lower surgeon on Instagram for a variety of reasons.
If you would like to follow or shoot me a message on there, please do. My instagram is willssurgeryjourney.
Choosing a surgeon was a new experience for me because for my top surgery and hysto, I only had one choice. I had three choices for phalloplasty, so I thought I would talk a little bit about how I made my decision.
The three options were: The Team at GRS Montreal led by Dr Belanger, Dr. Schecter and his team, and Dr. Crane and his team.
Before I go any further, I want to say that I respect everyone’s decision to go or not to go with any surgeon but these were the factors that led my personal decision.
The Montreal Team:
I always assumed I would have my surgery in Montreal because it’s the only place in Canada currently performing phalloplasty and when funding first became available in B.C. it was only for that clinic.
For a few reasons, I was a bit hesitant. First, they don’t do UL in stage one. It’s really important to me that I get that in the first stage, as I think would have a really hard time, mentally, dealing with that. I have heard of a few cases lately where they have but that’s done when the patient is under and not something decided on beforehand.
Another, smaller thing, is that you have to have an in person consultation and I live on the other side of the country, getting there wasn’t really a viable option. While they are in Canada, which seems like a bit of an advantage, they are actually quite far away from where I live.
Another problem is that they won’t report on complication rates. I know that almost all complication rates that have been reported on are self-reported and inherently flawed to a degree, however, not reporting at all made me uneasy.
As well, I’ve been informed that they require electrolysis not only before stage one but between stage one and two, below the belt. If this could be avoided, I would like it to be. Overall, I wasn’t super comfortable with the idea of having surgery with them.
I was given two options for surgery in the states; Dr. Schecter and Dr. Crane.
Dr. Schecter
A big pro with Dr. Schecter is that he does do UL in the first stage. He does have a pretty short wait list which I know is a pro for a lot of people but personally, not for me, as I needed time to do hair removal and also get other parts of my life sorted. He also requires an in person consult which would be difficult for me. From reading reviews I wasn’t completely comfortable with his approach to surgery at all times. It appears that he might be coming from more an old school approach, including requiring patients going off testosterone for surgery. It also doesn’t seem like this is really his niche or that he performs it as often as other surgeons.
Dr. Crane
Dr. Crane appealed to me for a couple of reasons. One, is that he is a trained urologist and plastic surgeon, has a lot of training, and has done a high volume of these surgeries. He does the UL and the glansplasty in the first stage which is also a huge benefit for me. He also doesn’t require an in person consult which was helpful for my particular situation. I’ve also seen the most results from him and I’m impressed.
His wait list is pretty long but that’s also okay for me because like I said, I need some time for hair removal and other stuff.
Of course, he is a bit of a controversial topic in the community right now and I don’t dismiss that but based on my research and also consulting with him, I am feeling comfortable with my decision to go forward with surgery. Given my three options, he is the surgeon I feel best about going forward with.
I received a call from Trans Care BC today and I have a tentative date with Dr. Crane - January 30th 2019! It’s tentative because they have to confirm with the aftercare facility that I can be there at that time, so fingers crossed. I also said that I would be open to taking a cancellation spot, if one comes up that works for me.
It’s sort of a perfect time. It’s long enough away that I have time to complete hair removal, save up some money, and make sure my health (in terms of my lupus) is in check. At the same time, it’s pretty close which makes me feel really excited. I was actually expecting a date in mid to late 2019, so this is a nice surprise. It’s very strange to think that I’ll only have to deal with being pre surgery for just over a year. Unbelievable and exciting.
I forgot to post but last Friday I received my approval for provincial funding for out of country surgery. I’ve been approved to have phalloplasty with Dr. Crane in Austin, Texas. The surgery is still a while off but having this next step done is a big relief. The funding is only good for 12 months so I’ll need to apply for an extension but hopefully that shouldn’t be a problem. I had to apply for an extension for my top surgery too. Now, I’m just waiting to hear about a date and need to book in to start my hair removal asap. This is an exciting time.
