Initial Surgery Consultation (March 5, 2019)

I met with my general physician and a surgical nurse to discuss the options and help narrow down a plan for what I'm wanting my surgery to look like. I had decided beforehand on phalloplasty as opposed to meta. The appointment ended up being 1.5 hours and they took the time to answer all of my questions without making me feel rushed, as well as extending their e-mails to me to field any future questions that I might have.

I want to start by addressing the initial questions I had going into the appointment:

• Length of waiting period - I will be having a hysterectomy (removal of uterus)/bilateral salpingo-oophorectomy (removal of fallopian tubes) sometime in the next 3-6 months and it is recommended that this surgery take place at least 6 months before a phalloplasty. My first surgical procedure for the phalloplasty is estimated to take place within the next 1.5-2 years.
• Personal Cost - The government covers all surgeries and revisions that need to be made, all time spent in the hospital, the cost of laser hair removal for the graft site (this may or may not be announced yet but the nurse assured me that it is happening), all prescription medications associated with the surgery, and if I am still living in Victoria they will cover the ferry cost to and from Vancouver. The largest expense that I will be responsible for is the lost wages from time off work (a largely unknown variable), all lodging outside of the hospital, comforts to accommodate the recovery period (the nurse mentioned things like cab rides because the pain medication can make driving unsafe, food/grocery delivery, a cane to help me get around post-skin graft, and doctors prefer the new phallus to be kept in an upright position post-surgery so some snug, supportive underwear is also recommended).
• Intake Questions - They obviously asked me what type of surgery I was wanting (phallo vs. meta), since I had made up my mind beforehand they didn't ask me anything relating to meta but said that it was something we can revisit if I do decide to go that route instead. The main thing they asked me was what the main reason driving my decision to seek bottom surgery was, and my answer was that my dysphoria regarding my genitalia has had a negative affect on my personal relationships, mainly sexually but in other ways as well. I don't struggle too much with public restrooms but the ability to use urinals is absolutely appealing, and I don't often feel the need to pack/haven't experimented much with packers or STP devices but that's mainly due to the absurd cost and maintenance involved with that sort of thing.

Phalloplasty information: The full process consists of multiple surgeries that span from 1-2 years or longer depending on healing times/revisions. These steps are:

1. The creation of a penis (neophallus) using grafting of tissue
2. Urethroplasty to create a urethra in the new phallus that is joined with existing urethra
3. Vaginectomy or the removal/closure of vagina
4. Glansplasty or the creation of a glans penis (essentially giving the neophallus a "head" to make it look less like a weird meat tube and more of  a penis).
5. Scrotoplasty or the creation of a scrotum and insertion of testicular implants
6. The optional insertion of an erectile device.
• A hysterectomy/BSO is often a requirement of the phalloplasty. I have not had periods since my first shot of testosterone in 2010 so I wasn't sure if I was going to opt for a hysterectomy because I simply viewed it as an extra surgery but there are additional benefits including reduced cancer risk and reduced levels of testosterone required due to no longer producing estrogen.

The ALT surgery that I desire requires an extra surgical procedure, as the skin from the thigh can result in an absurdly large phallus. The skin for the graft site is cut, shaved down, and then reattached to the original site for a few months of healing until it is ready to be removed and formed into a neophallus. I am still a bit unclear on whether this shock to the nerves/blood vessels would be better or worse for successful attachment of the neophallus.

The BC clinic is not yet open, so the nurse only referred to the Montreal and Texas locations where the surgery is offered. At this point the Montreal clinic only offers the forearm flap surgery, Vancouver has the possibility of ALT depending on the surgeon's ability but that has yet to be determined.

The Texas clinic currently has a 100% complication rate for the urethroplasty. The Canadian government is optimistic about improving this statistic by eliminating the amount of travel involved by opening the Vancouver clinic.

BC has been approved for use of the Zephyr penile implants, which are offered in both hydraulic (pump) and malleable (bendable rod) models. These have been installed successfully in the past and they have the added bonus of providing a more defined "head" shape for the neophallus, resulting in a more aesthetically-pleasing end result. For more information you can click here.

Goals for moving forward:

1. Quitting smoking. It is recommended that you quit smoking for 6 months prior to and 6 months after the surgeries. My nurse suggested that I quit before having my initial surgical consultation because some surgeons will reschedule consultations until smoking cessation has been completed, further prolonging the already lengthy process).
2. Weight - I'm currently 165lbs and my BMI is in the 31-32 range. It is ideal to have a BMI level of under 30 by the time of the surgery, and I have read online that the recommended level for the ALT surgery is 20 (although I have not confirmed this with a professional).

My next step: Hysterectomy/Bilateral Salphingo-Oophorectomy. There are multiple different methods this can be completed and I will post more at-length about what this process will look like for me as it approaches.

Below are the information handouts I was given at the appointment (my printer is currently having issues so these are just photos I took with my cell phone, I will upload higher quality scans when I get that sorted out). BUT for more or less the same information and lots of additional links to explore any particular areas that you're curious about you can click here.