Mainly Phallo

Transguy in Maine documenting phallo journey

[mainlyphallo]

The people you meet on Scruff

I have a Scruff profile in which I out myself and say I’m post-op phalloplasty. I just had a multi-day conversation with a guy who said he was an MD/PhD student doing research on phalloplasty. He knew a bunch of stuff, like the name of a Doc in his town who does top surgery, and who Marci Bowers is, and about how long surgery takes.

There were a bunch of red flags though, and the final nail on the coffin is that particular med school doesn’t have an MD/PhD program, but honestly, I’m just so curious what his angle is. Like, why lie so extensively and to what end?

Honestly, I would’ve been happy to talk about my dick regardless...

[mainlyphallo]

I made a Facebook group for surgery. I’ll probably post mostly in that for a while because it’s easier and I won’t accidentally post on my main blog that way. I will keep this blog though and if I do long term updates they’ll be here not Facebook. Also, if I post dick pics they will be here, but don’t know if I will yet.

Anyway, send me a DM with your email or name or something so I can find you if you want to be in my group on Facebook.

[mainlyphallo]

Just got back from my pre-op appointment a little while ago. I’m not sure I totally believed that surgery was going to happen until we were sitting in the exam room with Dr. Watt. There’s apparently a 50/50 shot that I’ll get my glans tomorrow because my forearm doesn’t have that much fat. He also pointed out how much skin he’ll be able to take - I went and measured it and it’s only about 4.25-4.5” which is definitely less than I would like. Figuring out how to deal with and accept the limitations of my body and medical technology has been an ongoing struggle for me. There are a lot of things I can’t change - like my height and my hips. My body type isn’t well suited to aLT, even if I lost a few more pounds (5’6”, 135lbs, BMI about 22 I think), and I don’t think I personally would cope well with multiple stages of surgery to get a urethra or for girth reduction. And while I probably could have gotten a longer dick if I went with another surgical team (eg Gottlieb or Salgado), this is the team I’m most comfortable with and have the most confidence in. It’s also hard to know how I’ll really feel until tomorrow when I get to see it. Magnesium citrate is not as gross tasting as I expected. The last couple days of sightseeing flew by, it doesn’t really feel real that tomorrow at 7:30 I’ll be in the OR. Our Airbnb has some weird issues, but we are managing to get most of them resolved and it’s not bad otherwise. The beach is just two blocks away and everything is flat for a ways in every direction which I think will be a huge plus when I start walking.

[mainlyphallo]

I got my hospital pre-registration packet in the mail today and did the phone pre-admission phone call. My arm still has a bunch of red spots and a few scabs from electrolysis and the resulting ingrown hairs. It's been stressing me out so I texted Logan a picture today to make sure it wouldn't affect me having surgery. He said it will be fine, and suggested I switch to antibiotic ointment and try epsom salts. It's been two weeks since my last electro appointment and I have loads of hair growing in. The curse of being really hairy I suppose. It's definitely a lot less than the rest of my arm, but I still wish I had less. I suppose shaving my dick probably won't bother me too much in the end though.

[mainlyphallo]

10 days until we leave for San Francisco

[mainlyphallo]

27 days, but who’s counting?

I posted this on Facebook a few days ago, and I’m wanting to keep a sort of record of my emotional evolution through this process in addition to the physical and logistical challenges. Since writing this post I had an unexpectedly good therapy session (therapy often is not good) and am in a better head space.

So I'm one month away from surgery with Chen/Watt and I think I may be in the worst place I've ever been wrt dysphoria/self-hatred/dissociating or whatever. Sex is mostly unthinkable now, but it's also spreading into every aspect of my life. I suppose maybe I'm experiencing some form of pre-op depression (is that a thing?) - difficulty enjoying anything, pervasive sense of emptiness, reluctance/difficulty to make connection with people including my long-time partner. It's sort of like I'm not really here most of the time.

I guess I'm just looking for some kind of reassurance that this stuff could feel better after surgery. Because from here it seems like these problems have gotten too big to possibly be fixed by my anatomy changing, even though needing surgery is what got them started as problems in the first place.

[mainlyphallo]

Six weeks to go

Got my LOA final approval today! Everything is in order, feeling pretty good about that. I thanked Colleen for putting up with all my inquiries and meddling, and she said it was actually helpful because insurance moves faster for patients than for staff, so that made me feel good too.

[mainlyphallo]

CT scan

Every time I do anything new that’s phallo related I get happy/excited. I just had a ct scan with contrast dye of my arm to look at the circulation and see where the arteries branch. Dr. Watt said there is a low chance (like 5%) of them being in a different enough place to make a difference in my dick size, but this way I will know and get the biggest dick my anatomy will allow.

My insurance approved it no problems so that’s why I went ahead and got it. It was pretty unpleasant really - I had to lie on my stomach with my arms outstretched over my head for like 15 minutes which made my shoulders hurt a ton. And then the first time didn’t go well so we had to do it again. The dye gives this crazy hot flash that travels down the body until it felt like I’d peed myself. Thankfully the tech warned me about that in advance so I didn’t freak out.

Should be able to pass the images along to Dr. Watt within a week or two, but I don’t know how long until I’ll hear what the results were.

As an aside, I have Reynauds which is a circulation problem where my extremities don’t always get enough blood flow, so I don’t know if this scan will show how much my fingers will be affected by surgery, but maybe I’ll find out. The doctors weren’t too worried about it though so that’s nice.

[mainlyphallo]

56 days to go

My LOA got signed by Dr. Watt today, all that’s left is for insurance to sign it which should happen tomorrow I think. I almost started crying on my way home from work.

I was checking out the VRBO place where we’re staying online recently and I’m getting excited for it. It’s near the ocean, a big park, and two different streets with shops and stuff. It’s also near the train line to downtown and the hospital.

Electrolysis is coming along. I definitely won’t be hairless before surgery, especially since I’m planning to stop almost a month in advance to let my arm heal. I’m down to super blond hairs in my urethra area, we’re going to try dying them and this follicle enhancer stuff so hopefully my electrolygist can see them.

I’ve also been working out a bunch and trying to eat healthier so I’ll be in better health for surgery and hopefully minimize my complications.

[mainlyphallo]

It’s looking like my surgery has been approved! There’s some weird stuff about whether they’ve signed a contract already and whether it will be at in-network rates. But my case manager said once they sent me the approval letter they can’t retract it! My insurance will pre-authorize procedures up to 1 year in advance. Because my case manager didn’t think my insurance would approve the Buncke clinic, I asked them to submit the paperwork further in advance than the usual 90 days (which is because that’s how far in advance most companies will approve things), and they were willing to do it. Less than 4 months till surgery.

[mainlyphallo]

This week my electrolygist gave me the dubious honor of being the hairiest person she knows. My hair isn’t that dark so it doesn’t all show up in the pictures- also that’s why I couldn’t do laser. I have a ton of regrowth after round one of electro, so last week we switched to the blend method which uses both electricity and a chemical reaction (I think). Each zap takes like 8 seconds and it hurts more than the other kind but remains bearable, even for two hours. She said it usually takes fewer treatments per follicle to kill it with the blend, and since I’m in a time crunch that is important. 5 months and 11 days away from surgery. In other news, my consult with Dr BL got denied even though I had a pre-authorization from insurance. I called insurance and they said I was only approved for gender identity disorder and NYU coded me under transsexualism. I called NYU and they sent the bill back to be re-coded. Hopefully they’ll fix it, because the charge was about $550 for that one visit.

[mainlyphallo]

Electro and Lodging

A few good things have happened lately.

My insurance (Harvard pilgrim) didn’t cover electrolysis although they did cover phallo. I started the appeal process to get it covered in early February. I got a denial and started the second level of appeal. Then, last week I talked to my case manager at HP and she said that HP was rewriting their policy, effective April 1st. It will now cover electrolysis if needed for GRS. Today I got an email from my appeal coordinator confirming that, due to the change in policy, they had reversed my denial and were going to pay for the electrolysis. The specifics (reimbursement vs making someone be in network) aren’t worked out yet, but I feel confident I’ll eventually get all my money back.

I’ve done 11 hours so far, and at the moment I’m aiming to do 2 2-hour sessions per week for a total of 4 hours. We’ve just barely gotten around my arm, although she’s done multiple times on the inside since that’s where the urethra will be.

Turns out my skin is really sensitive. I get really red, scab some, and still get lots of ingrown hairs. I’m using an oatmeal bath immediately after treatment, then some combination of a sugar scrub, calendula cream, and shea butter. I don’t really care about intermediate problems as long as the hair all goes away.

Oh, I’m also finding it not too painful - much less so than the big tattoo I have on my back - so I don’t need any lidocaine or anything.

Last thing is we booked lodging in SF yesterday! It was a huge hassle. Airbnb has a no refund policy if you book longer than 28 days, so we were stuck with VRBO (in case insurance approval doesnt come through or I have to reschedule for some reason) which has fewer properties. Then, SF doesn’t allow rentals for less than a month so a lot of owners seem gun shy about renting for such a long time so far in advance. We thought about Berkeley but ultimately decided we’d rather have a 1 bedroom in SF than 2 bedrooms somewhere else, just for convenience. We’re paying $5100 for 47 nights.

[mainlyphallo]

Last week I had consults with three different electrolysists. The first one seemed competent, I just didn’t really like her as a person. The second one went on and on about how much more training she had than everyone else and how she was so much better. I did a 30 minute session with her 5 full days ago, and my arm is still bumpy and scabbed up and itchy (that’s what the picture shows). I guess I have sensitive skin but she just like burned the shit out of all the follicles and there’s still hair coming out of some of them already. The last woman is much newer to doing electrolysis, but she took a long time with me, talking over different types of current and working on figuring out what’s best for my arm without burning it. She’s the only one who keeps track of her machine settings so she can track what’s working for my arm. Also, she’s willing to do two hour sessions with me. On Tuesday I start weekly two hour sessions. She thinks at the least we will be able to clear the inside of my arm for the UL, but hopefully also get a substantial way on the outside too.

I also started the process of appealing my insurance to cover the electrolysis. They cover GRS but explicitly do not cover electro. I’m expecting to have to appeal twice through the insurance and possibly another through the state. I’m not sure that I will be successful but it is worth trying.

[mainlyphallo]

Consult w Dr. Bluebond-Langner

I want to preface this by saying that this is my experience and my opinions. I had an overall negative perception/experience, but other people have had good experiences, and wherever possible you should do your own research and have your own consults.

Also, although I tried to be open-minded and friendly in the appointment, I did walk in fairly certain that my preference is for chen/watt.

I originally scheduled my consult with her and Dr. Zhao for early January. They called me two weeks in advance and rescheduled me because Dr bl was out of the office. They picked the new date for my consult which was today. Then on Wednesday the office called and said that Dr zhao wouldn’t be there and asked if I could reschedule. I said no because I already had plane tickets and a hotel, so I just saw Dr bl today.

This office has been incredibly irritating to deal with. First all the rescheduling, plus I can almost never get the right person on the phone. Also, they had me put all my medical info into their online system, then had me fill out paperwork of the same info when I got there, then asked me all the same info in the consult room.

Also, right after I checked in I’m pretty sure I heard someone else check in for an appointment 15 minutes after mine, despite the staff telling me last week that I had 30-45 minutes for my consult and that she wouldn’t rush me.

The room was really small. I brought both my parents because they’re really worried about me having surgery and I wanted them to be able to meet a surgeon to hopefully reassure them. We were one chair short and the medical assistant didn’t offer to get my mom a chair (although Dr bl did). Obviously none of this stuff is directly related to surgery, but it does concern me to an extent and generally reflects poorly on the practice.

The consult itself

I really liked Dr bl when I saw her at philly trans health. Today she seemed really rushed and almost upset. Also somewhat defensive of her own techniques and a bit dismissive of other surgeons. All of this could easily be because of poor scheduling/bad staff/her being sick or having a bad day etc, but it made me feel less confident in her as a surgeon anyway.

The main things that I remember as significant:

-my arm is small (15cm around) so there would be no bridge which could increase swelling in my hand

-they use a different artery than the femoral, which they flip up toward the graft, which I think gets closer meaning the leash can be shorter meaning the flap can be a little longer

-they do a complete vaginectomy not just burning the lining - I didn’t ask for clarification since zhao wasn’t there. Then they stick gracilis muscle from the thigh into the vaginal canal to support the urethra where it turns plus push it upwards so it doesn’t dip down so much.

-for RFF Stage one would be flap creation and stage two would be scrotoplasty, vaginectomy, and UL hookup. I forgot to ask when she would bury the natal phallus. She does them at least 3 months apart but said that it can be longer because of needing the robot for the vaginectomy.

-she thinks they are booking out to the end of the year right now but said someone would call me at the end of the week

-they strongly believe that a staged procedure has fewer complications. She said I could look into articles about urethroplasty, esp. multistage ones, like for cismen who have problems related to their prostates (I forget what exactly). She also mentioned a recent meta analysis paper about staging for GRS that her team strongly disagrees with. I haven’t looked it up yet but I think it may be authored by a guy named Shane.

-I asked how they felt about doing complication repairs if I went to another team and she said they would do it but strongly preferred people go back to their original surgeon. It seemed like there was some kind of serious emotion/a history of problems in the past because she was pretty vehement.

-integra - she seemed pretty plus minus on it and wasn’t familiar with the type that Dr watt told me about. She mentioned a couple other things, including alloderm and some Skin thing, but didn’t think they would be good for the arm graft.

-they have done about 5 phallos to completion and have about 30 in various stages. They are currently scheduling one per week on fridays.

As I said I’m feeling fairly certain about my decision but I’m going to sit down soon and make a list of pros and cons and generally organize my thoughts. One thing I want to try and be aware of is paying more attention to answers when they agree with my preconceived notions and dismissive otherwise, because I think it can skew my perceptions.

[mainlyphallo]

I had a consult for laser yesterday. Logan at the Buncke clinic said I might be able to do a combo of laser and electrolysis because laser is faster. The laser guy was super up front with me and said he didn’t think laser would do anything because my hair is too light and fine. He did a test patch and said if it stays relatively clear in 3 weeks then it worked and laser will help get rid of some of my hair.

Either way, it’s pretty clear that I’ll need electro, so after that I put my first call in for an electrolysis consult as well. Hopefully I can get the ball rolling on that soon, since I have hair to spare right now.

[mainlyphallo]

Consults

Back in September I went to Philly trans health and went to pretty much every lower surgery session. From that I was able to eliminate a few surgeons from my list because they seemed less skilled or just rubbed me the wrong way. My favorite presentation was the one by Dr. Zhao and Dr. Bluebond-Langner from NYU. I have a consult scheduled with them in a couple of weeks.

In November I had a Skype Consult with Dr. Watt from the Buncke Clinic in San Francisco. He is a microsurgeon who works in a team with Dr. Safa. They worked with Dr. crane for about 4 years and are now working with Dr. Chen. Watt told me that he and Safa have done 200-300 phallos, which I think is the most of any micro surgeons in the US.

I was able to schedule the Skype consult only about 6 weeks in advance, and I didn’t even have to pay anything for it. They were also fine with me scheduling a surgery date after that one consult, even though I told them I wasn’t 100% decided on going to them, and that my insurance wasn’t totally sorted yet. I scheduled a date for mid September 2018 with Logan, who is their main contact guy.

I had also scheduled a consult with Dr. Chen for early January, and Logan was able to get me an in-person consult with Watt for the same day, since I was flying across the country. I had those two consults last week. Dr. Chen’s fee was $250 since my insurance doesn’t currently cover him, and Dr. Watts was no charge again.

I liked both of them a lot, and am comforted by the fact that they seem to be among the most experienced surgeons in the US at the moment. Both of them also expressed that there isn’t any data showing that single vs multi-stage phallos have fewer complications. Dr Watt said that their preliminary data from doing Kaiser patients in multi-stage and all other patients single-stage shows no difference in overall complication rates. This is only from ~100 people and is obviously not yet published data, but it is nice to hear that they are in the process of collecting it. They also said that their personal preference is to do a single-stage operation. Since that is also my personal preference (due to my bad reaction to anesthesia during my hysto and having generally less life disruption from doing it all at once), this adds to my desire to go to them.

Dr watt also confirmed that I’m not a good candidate for ALT tube-in-tube, and I’m not real interested in the multi-step process to do UL for someone of my body type. He also said that ALT can have higher complications, and the nerve density and size is lower which reduces the possibility of good tactile sensation. These things confirmed my own research, so I’m pretty settled on RFF. He did say I’ll only be able to get about 5” long due to my forearm length, which I’m disappointed about. He seemed generally unwilling to do vein grafting which allows a longer penis because he says it increases complication risk. I think this is something I can acclimate myself to. My needs are sensation, stand to pee, ability to penetrate, and size, in that order. I’m not willing to risk the former just to achieve a larger size, and I know I would be unhappy if I took a risk and ended up with major complications or a loss of one of the more important things for me.

There’s already a high risk of complications, so for me, I need to do everything I can to minimize my risk, so that if/when something goes wrong I don’t waste time and energy wishing I had chosen differently in the first place.

I probably won’t write up a full summary of what we talked about in my consults, but if anyone has questions I’m happy to answer them or elaborate more on anything.

[mainlyphallo]

My hysto scars are healing nicely so far, almost 3 weeks post op. Recovery has actually been way tougher than I expected. 3 days post-op I got a headache that basically didn’t go away for two weeks. I had a lot of migraine like symptoms, especially light sensitivity and some nausea. I basically spent the first week lying on the couch unable to do anything but listen to audio books; I couldn’t even watch TV. The only thing that really seemed to help was CBD-heavy pot edibles. It’s been slowly getting better lately, but I’m really glad I didn’t have any work or school during this time. I do have a history of headaches and migraines, so I’m predisposed to have problems. The doctors I’ve talked with said these new headaches could be the result of anesthesia or hormone changes because they took my ovaries, but it was hard to know for sure. My PCP is going to check my T levels in the next couple of weeks and we’ll see if I need to adjust my dose.