#meta process

[buytheticket]

i moved AND had my meta consult 

i had my consult on 6/22 and have been wanting to write about it but i haven’t had a chance to sit and really collect my thoughts since i had to hustle on my move (moved in with my bf, it’s been really wonderful but that’s for another post)

read more for my detailed experience with the consult

my surgeon (dr Purohit) practices out of mount sinai so i had to go down to the city. it was an all day event- the train time i was able to get and the time of the appointment meant that i needed to take off work. my boyfriend and i took the train down to nyc. i had a bit of a sour start because my time anxiety kicked in and i was afraid we’d miss the train but we had plenty of time and my bf was really reassuring and i felt immediatly better as soon as we pulled into the station’s parking lot

 it was a really nice ride i really enjoy taking the train. the route goes right along the hudson river. saw so many bald eagles, herons, and cranes that i lost count! also got super stoned and relaxed on the ride down

i also took the time (the trip was just under 3 hours) to review the questions i had for the surgeon (i need to transcribe them, i wrote down a lot) to make sure i covered everything i could possibly think of

we got into the city around 11 and went straight to a diner since we didnt get a chance to eat before we left. it was pretty good! we had some time to kill before the appointment so we took the subway to greenwich village because i thought it’d be interesting to check out where stonewall is since neither of us had been. i’d never been to that area of manhatten so walking around the area was cool (ended up seeing a lot since we kept getting turned around the whole trip lol) stonewall inn was very unassuming as i had heard but it was also cool just to see it in person once. i was kinda hoping for a more indepth idk monument? i think i should just find a queer history museum. there’s gotta be one lol

we didn’t stay long since i had to take a piss and it was impossible to find a bathroom so we decided to head up to the dr’s office (ended up finding one in a subway station and a guard had to buzz me in and the stall was like something out of a movie lol)

as we got closer to the office and appointment time i started getting more and more anxious and irritable. i also skipped my adderall and my patience level plummets and i’m more susceptible to moodiness if something is stressful or challenging to me so it was kinda a double whammy.

my bf was such a angel though- i was getting stressed out trying to navigate so he took over and guided us and we had a good talk before my appointment about why i was feeling so moody and that helped too.

on the walk over to the office i got incredibly anxious. like the worst i’d been in a long, long time. meeting a new medical professional always gives me anxiety especially when it’s for transition related care. plus like hearing about some negative experiences with some staff and just like the general state of the world i was pretty much a walking wreck

we got lost going into the office and wound up in an apartment building. very funny in retrospect but i was like pissed off and having a melt down! my bf was very kind and helpful and we made it to the office (it was one door over but the office and apartment shared a street number. confusing!) 

i checked in and we sat down and my bf held my hand and helped keep me calm. i had been so worried that they would turn me away and cancel my appointment! a few days before i got a call from the office saying that my insurance was out of network. i had brought this up when i scheduled and sent over what my insurance needed for prior authorization so someone fucked up and for once it wasn’t me lol

they called me back and i hopped up on the table. dr purohit’s fellow came in with a nurse who was taking notes i think. i think he was from eastern europe based on his name and accent and he was learning how to do metas! he asked me some questions and i threw a ton of mine at him lol but he answered them all!

or tried to lol when i said i want to keep at least an ovary he was confused why and my bf helped explain that us trans folk might not always have access to t because of the way of things rn and that was a pretty interesting experience! i hope it was a teaching moment. i think dr’s should really be in step with current events and be advocates, know what their patients have to deal with day to day and truly strive to be an ally  

dr purohit came in after a bit (he was wrapping up another appoint which i didnt mind at all! i feel it means he makes sure everything is covered) and wow! i really like him and he made me feel so at ease and it was incredibly reassuring. i knew right away that he was gonna do everything to get as close to my needs as possible

i gave him a run down of what i wanted (simple release, mons resection, no ul/v-ectomy/scrotoplasty) and we had like a real convo!

then i had to drop my drawers so he could see what he was working with. this was my first time having to show my cock n balls to a medical professional. really wasnt bad at all! very professional touch. but like the fellow was observing and the dr was going over my configuration with him. i have “substantial growth” of my clit

like i have a medically certified hog, 100% usda grade a beef, baby! pretty sure i gave my bf some kind of shit eating expression when i heard the dr say that. like...it was very affirming tbh!

it was very quick and after i pulled my pants up we jumped into an overview of the meta process. he broke down all my possible options and went over everything in detail and explained possible pros and cons and reasonings for each option/his technique. my bf took notes and i will try and transcribe them. i think it’s very useful info for anyone seeking a meta- there are so many different options! you really can pick and choose what you want (so long as your ok with risks. like a ul with no v-ectomy has like a 50% to 70% rate of fistula development. the body is weird!)

we also went over what the procedure would be like and what i should do to prep. he gave me a “poor man’s pump” ( i said it was DIY! very punk rock) - a 50ml syringe that he said to saw the tip off and use the plunger to create the seal (i’ll take a pic [just the pump], easier to show than tell). never thought i’d be pumping my dick but it’s dr’s orders!

he even called the gyno (dr tran) who wll be doing my hysto to ask about her opinion  on me keeping an ovary and she said it def was a good option so i will keep one (the one opposite of the one my bf kept lol) i was also worried about vagina prolapse if i get my cervix removed but she said the risk was very very low (i’ve also been doing pelvic floor exercises to ease my mind lol). she was nice to talk with too and i’m looking forward to meeting her in person

but yea it was really great to meet dr purohit and it was really reassuring to do my consult and i felt so much better after

we wrapped up with him and the patient liaison came in and she gave us a run down of the next steps. i had a letter from my pcp and my therapist recommending me for the procedure. i still need to do thru their psych and social worker and md...she took my letters though and acknowledge that the process was silly and frustrating  (my therapist says the hospital prob does this to get more money from insurance companies lmao the gall of these fuckers)

i’m in touch with their trans clinic and playing phone tag to get the appointments set up. i can do the social worker appoint over the internet but i need to see the md and the psych in person plus a pre-op appointment with the dr. hopefully i can get the psych and md appointments in one day. i’ll also need to stay in the city for at least a week post-op. i have my fingers crossed my insurance coverage will go smooth (my copay would be $75....) so i can budget for a nice room with a kitchenette.

we got outta the office and took a sec to like gather our thoughts! i wasn’t expecting it to be so emotional but i was getting choked up throughout the rest of the evening and ended up taking the following day off work; i was exhausted

(i got my other appointments set up but i had this sitting in my drafts so i’ll end this one here and do another post for all that) 

[buytheticket]

things have been progressing pretty fast, all things considered

finally got in touch with the trans clinc after playing phone tag for a few days. she gave me a quick overview of the next steps and set up an appointment for me to speak with a social worker over zoom. after that, we could get my psych and MD visit scheduled

the social worker ended up calling me a couple hours after i set up the appointment since she had a conflict and we just did the appointment over the phone it it literally took 5 minutes. she just needed to confirm that i was in a stable situation for post-op care and made sure i understood i need to be in the city for a bit after the surgery (doc told me one week, someone else said 2 and she said 3 so i’m just going with what the doc says lol)

then a nurse reached out to me via the hospital’s painet portal. i need to get blood work before they could get the MD appointment and was going to get it done thru my pcp. nbd

i called my pcp and they said they couldn’t do blood work for another provider (no clue why) so i figured i could get it done through a lab. i told the nurse and asked if she could send the order to a lab but their doc’s can’t do that for people who aren’t yet patients (?) and she said she’d check with her higher ups

i ended up getting a call a few days after this from the hospital to set up my psych and md appointments (first week of September) so i guess i’m all good

it was just a very bizarre hoop i wasn’t expecting to jump through. i was worried that the fuckin blood work would hold up my appointment but it was resolved without too much hassle. it was just frustrating since it was more of that bureaucratic nightmare shit

i’ve also been thinking about getting a scrotoplasty. after the consult i started thinking about it and did a bit of research and i think i’m gonna go for it (still not gonna do the UL and v-ectomy tho)

i have some more things i wanna type up but it’s been a while since i made updates and wanted to get the big stuff down

[buytheticket]

from time to time i’ll see a posts asking about how to explain top surgery scars and most of the answers will be like off the wall or super convoluted.

there’s nothing wrong with saying “this is a personal thing i don’t discuss” though having been post top for awhile and going out in public without a shirt or in a shirt that shows my scars i’ve never been asked about them. like it’s rude to ask about people’s scars or other visible conditions so only like the stupidest fuckers would ask a stranger about that and a firm “no” is a proper response

with friends i think a variation of the same response is fine and acceptable if you’re stealth or simply don’t want to share that info with someone. especially if you mention boundaries, friends should respect that and not pry

i’m in a bit of a similar spot with how i want to discuss my surgery at work. since i plan on taking extended leave there’s a form i’ll need my doctor to complete and i’m not sure how descriptive it needs to be or how descriptive i want to be!

my bf had a really nice convo with his coworkers about his hysto and they were all  sharing their experiences and giving advice and it sounded very matter of fact and normal. ideally, i would like to be able to just say “i’m getting a hysto and a gender affirming procedure” (ok half truth, i would really want to say “hysto and a sex change”) and that’s that. and like...my boss and my coworker had like an in depth convo about chron’s in front of me so i def know it’s not so much the tmi medical talk than it is it being a trans thing

i know with my top surgery i started a new job like 2 days before my op date and during the interview i said “im getting a surgery, i need time off” and it was all cool, no questions asked at all. this time i’ve been doing a lot more self reflection and thinking on what being trans means to me and how i think about it and how i want to share it with others

i’d like to branch this off into a couple of separate posts later and try and tie it into some other thoughts i had on transphobia and how the terf mindset is similar to the q anon mindset (from first hand experience living with someone who is/was into that!)

[buytheticket]

here are the steps i’ve taken so far to get a metoidioplatsy:

1. make the decision that i want bottom surgery i’ve thought about bottom surgery for awhile but never seriously considered it until last year. i never had very strong bottom dysphoria or discomfort with my current genitalia, especially after starting t. i also didn’t realize that i can really specify what i want: i think i had the assumption that you needed the full monty, sack to head.

i also had to like get over my own prejudices with bottom surgery and change the way i think about it. for me, it was helpful to think of my genitaila as it’s own thing- it’ll never be cis by it’s very nature which makes me feel good. it’s an example of the physical diversity of humans and it’s pretty cool to be someone with a variation like this.

i think being relatively comfortable with my present genitalia really helped me come to this conclusion as well as exploring my sexuality more thoughtfully and think about what feels good and what i want to do in bed. which gets us to step 2.

2. consider my options: so you basically got the meta and the phallo and those branch off with their own set of options. i looked at a lot of other people’s pics which was very helpful. i think both offer really great results and it’s really just a matter of personal needs from the procedure. Meta makes the most sense for me since i really like my bottom growth and feel like meta will free it up more.

I’m also going to get a mons removal to help further. I’m also going for a simple release with no pee tube lengthening, no vag removal and no scrote (too lazy to look up how to spell the medical term). I have no desire to stand to piss , i like using my vagina for sex, and i also don’t want balls since i like how things are currently set up down there. i could also do all of this with phallo which is cool, even keep my clit or get one post-meta, but i don’t feel a need for a meatier member and the trade off of a longer process, more surgeries and the possibility of scaring are also some of the reasons i don’t want a phallo.

 i guess the main takeaway here is that you can really keep what you want with either surgery, it’s more deciding how you want the penis part to look. (i have read that doing a meta with UL and no vag removal can lead to more severe complications during healing and that many surgeons will not do bottom surgery if you want the UL without removing the hole so if UL and keeping your hole are very important i would look into other’s experience getting this done and things to ask when doing surgical consultations).

3. i started looking at my options for surgeons. i live close enough to NYC and can access the hospitals that offer bottom surgery (there’s several options in the city) so that’s where i looked. right now i’m working with Dr. Purohit at mount sinai. their website has a lot of useful info and details the steps you need to take to get started. i reached out to Dr. Purohit’s directly via email and asked him if he’d be able to do a simple meta with hysto at the same time ( he can) and if someone can help with insurance. he got me in touch with one of his staff members, Sam, to work on that. So far, my emails have been responded to in a reasonable timeframe. I set up my consultation with Sam and she forwarded my info to the insurance team. I saw a recent post on a trans subreddit from someone who went with Dr Purohit and he mentioned that scheduling can be a hassle and that Sam was all over the place. I spoke with her once so far but she was easy to talk to and nice. From what i gathered, it just sounds like she is very busy and hospital systems are another bureaucratic nightmare so i think it’s less the people and more the system. i’ll make updates once i get further along in the process

I also looked at my insurance policy. since i live in new york state, all insurance companies based in the state must provide gender affirming care. i checked to see if any surgeon who offered bottom surgery was in my network and there was not. i reached out to my insurance company for what they’d need from me and the dr’s office to get it covered and they need a prior authorization request from Dr Purohit’s office submitted. the insurance will review and approve it. if the dr was in network, i wouldn’t need to do this step (i went with the damn hmo plan at work, this is what you get for being cheap!)

The hospital requires that you don’t smoke like 6 months prior to the surgery and they will test for nicotine. they said the nicotine can hinder recovery. they also require you to have a bmi that’s 30 or under and, at this time, they’re following covid precautions and are requiring testing a few days before your surgery date and i believe they want to to be vaccinated if you’re able to be

I also need a letter from a therapist or social worker who’s worked with me and a letter from a mental health practitioner i’ve never worked with that say i’m a True Transsexual (ha). I’ve been seeing my therapist for about a year and she said she can do my letter np and refer me to another practitioner for the other letter so i’m covered. I did something similar for top surgery to get that covered so i know what to expect. If you know you want surgery at some point, its a good idea to start working with a therapist as soon as you can so you can if your insurance has a similar requirement

i’m really happy and fortunate that my insurance company will cover the procedure but the requirements are the most frustrating part to me. it’s important for insurance to cover trans health care but these diagnostic and approval criteria need to go and trans health needs should be cared for like any other health care need. like my insurance didn’t need a freakin letter from my psych to prove i really needed my wisdom teeth removed and my dr didn’t need to see anything from my therapist to prescribe me zoloft. it just makes it that much harder for trans people to get what they need. having a trans inclusive single-payer health care system would save so many people a lot of pain, time and money. i really hope we can get there

4. and the first waiting game begins. my consult isn’t til june 22 and the surgery date would be 6-8 months from now. i think the insurance stuff will be taken care of pretty quick and without too much hassle and i think it’s good to get it taken care of asap. the hospital also needs me to meet with a social worker who will help prep me for what i need leading up to and after the surgery and i’ll need a psychical and a gyno exam.

other than that i’ve started a light exercise regimen to gain some strength in preparation for the surgery. i’ve also made some minor alterations to my diet, mainly just watching stuff with added sugar. i’d like to be a bit more fit before the procedure and since i’ve got a while to go i figure this is a good way to feel like something is happening while i’m waiting. i wish i had done more exercise before top surgery to help with recovery

i’m also saving for transportation, food, hotels and any items i might need for recovery. having insurance cover the surgery cost helps a ton and means i don’t have to save as much to cover these extra costs. i’ll share what i spent to give a better idea of the overall cost

[buytheticket]

this past march (2022) was the 10 year mark of me starting hrt. it’s really wild to think about being on testosterone for 10 (ten) entire years and just about thinking how it is to be living as a trans person in this present time.

i’ve also been on tumblr for like...12? years? though i haven’t been active for awhile. i basically started my transition on tumblr- i had a blog where i’d make really pathetic text posts under read more tags and post like “2 months on t” pics and get way too into personal details about my life. i got rid of the blogs that stuff was on but i kinda wish i kept some of it as like a journal. which is why i’m makin a brand new tumblr! i’m in the very first steps of getting a metoidioplasty!

I really wanna document the process, my experience and just keep a journal of what this is gonna be like. i think it’s important to keep a record of something like this, i think it’s something of value anyone can do. i really liked those fuckin like historical girl diary books? like the “’my sorrow knows no bounds’: a depression era diary” books. anyway, i think you learn a lot about the past thru a first hand account like a journal, like how shit really felt from day-to-day life.

i felt tumblr is the best place to do writings like these too, and a lot easier for me to keep up with than like a paper journal. i also like the cycle of it all, talking about such a late stage transition thing on a webiste where i talked about my very early stage transition but like this time i feel in such a much better place and be much more cognizant of what i’m sharing about myself and why cause like i want this to be a jounral but also a detailed account of how to go about getting bottom surgery. it’s oversharing with boundaries!

main caveat here: this process will be really influenced by a whole bunch of factors so the info i want to share might apply to a small number of folks. i do want to note down some basic facts about myself and my situation so it’s clear where i’m coming from and how that lead me to where i am and what i’m able to access

I’m 28, started to transition around 17. had, for the most part, supportive parents that helped me get what i needed (was able to get on t as soon as i turned 18, my pops paid for my name change, had health insurance, new name and pronouns went reasonably well with them) was born in california and always lived in states and cities where i had access to gender affirming care. i’m white and present pretty masculine/binary and, for a lack of a better term, am “cis passing”. i’ve had my share of negative/bad/uncomfortable experience with trans stuff but i feel fortunate that i’ve had a by all accounts easy time transitioning. i have a good therapist and am doing well in therapy and making really good progress. i am also on low dosages of zoloft and adderall to help with clinical depression and anxiety, and moderate adhd. i’m able to easily access the adderall and didn’t have much trouble getting my prescription like some folks do. i have a BA degree which made me eligible for my current job. I have a decent salary, good benefits and ample sick and vacation time. i also live in new york state where gender affirming care is required to be covered by insurance companies based in the state and gender identity is covered under the state’s human rights law

i want to say all those things cause they’re privileges and circumstances that mean i can get a meta- like i can get the time off paid, i have the means to travel into nyc for consults and the surgery, pay for lodging and food and really most important of it all a really supportive partner to help me with all of this. my living situation vastly improved a couple of years ago and i’m better equipped mentally to dedicate time to prepping and healing from the surgery

i’m really excited to do this! and document it, i hope it can help a couple of people out. i’ll make a few more posts about how i came to the decision and what i’m looking to get done along with the steps i took to get insurance approval and scheduling, the paperwork of it all lol

(also if any one knows an andrew who lived in the philadelphia area around 2012-2015 dm me, he is an online friend i’ve lost contact with)