see OP: https://beehaw.org/post/14997523
sorry for the delay on the writeup! life is pretty busy for me. that said, the bottom surgery consult went pretty well all around, i think
as a quick note, i've been presenting and on HRT for about 4.5 years, so i don't think about it much. but the requirements for getting metoidioplasty (or the consult, even) is to be on HRT for at least a (continuous) year and (maybe optionally?) presenting male for the same amount of time (i actually wasn't clear on this, they asked me, but i'm not sure if there was a strict minimum). they also required me to get two referral letters from qualified mental health professionals (thankfully, my therapist and psychiatrist were able to write these for me)
i got shown in and talked with the assistant, who basically broke down the surgery and went over the different customizable parts (e.g. you can get different kinds of meta, you can optionally get urethral lengthening, scrotoplasty, testicular implants, etc)
after that, dr. keith came in to chat with me. after that, i had to undress from the waist down. you'll have to be comfortable with a doc poking around your bits, but i would hope you are, if you're coming to let them slice them up and re-arrange them, too. during this, he pulled my mons pubis back to give an example of how things would look if he did a mons resection (said i might even need a revision, too 😭)
after that, i re-dressed and we went into his office, which had a big fancy leather couch, and talked about the anatomy of the AFAB clitoris and its blood supplies, as well as bemoaning the current state of both scientific studies on women and trans people. he showed me pictures of his work (very good) which spans both metoidioplasty to various degrees and phalloplasty
if i were to decide to get the metoidioplasty, they would schedule 3 months of topical testosterone to be applied to the gland of the clitoris every day, along with instructions to pump every day for those 3 months. it gives them more tissue to work with, according to the doctor. it's important to note that dr. keith is making you responsible for working with your current testosterone prescribing doctor to monitor your testosterone levels, because it will elevate them, and you will likely need to reduce your dosage to account for the topical testosterone
overall, it was a good and educational visit. i didn't learn TOO much, because i have done a lot of research ahead of time, but the things i did learn were very important:
- urethral lengthening without vaginoplasty: in general, apparently urethral lengthening is, by far, the riskiest part of meta/phallo. dr. keith compared doing UL without vaginoplasty as akin to building a house on an unsteady foundation. he also cited something like a 60% complication rate from the other doctors who do UL without vaginoplasty. as mentioned in my OP, i'm not too keen on UL myself, due to a large typical ejaculation volume, so i'm not that hung up on it. although thinking about it now, i think i would potentially feel weirder about it, post-surgery, than i do now. well, i'll sort it out later...
- phalloplasty following meta: dr. keith says this is totally fine. there'll be some extra scar tissue due to the meta, but it's not a problem. he also said that it's not his first choice to do meta and then phallo, like, if it's possible for you to settle on phallo first, it is a little better. but you can definitely do meta and then phallo
- reduction of labia majora: totally possible, mons resection, might require a revision if you have a lot
- HGH treatment: a complete no, it's not studied / proven in any way and it's not legal in the US. very understandable answer, but i did have to ask LOL
- (not in the original post) ordering of hysterectomy and metoidioplasty: the order doesn't really matter, but the hysto is a big surgery, so if i did it first, i'd need to give it at least 3 months before getting the metoidioplasty. i didn't ask about the reverse order, but i think it would probably be similar
- (not in the original post) insertion of a semi-rigid prosthesis in meta patients (https://www.tandfonline.com/doi/full/10.1080/26895269.2023.2279273): i found this after my original post, but apparently there are some docs that are doing meta with a semi-rigid prosthesis. if you don't know, the clitoral bodies are wrapped by the tunica albueinea, just like in the penis, but the clitoral tunica only has one layer (whereas the penial tunica has 2); so it's more difficult to get hard for trans men. so the insertion of a semi-rigid prosthesis is an appealing option to mitigate this. i asked dr. keith about this, and he mentioned that the device is being used and implanted successfully by doctors in europe. unfortuately, they're not seeking FDA approval in the US because it's expensive and the market share is too small, but i had the option to travel over there if it was something i wanted (and he would refer me, as well)
- dr. keith also mentioned that there are similar devices which are FDA approved for cisgender men, so somewhat jokingly, i said that, if i got big enough, he would be able to put one of those in me. he said he has both never seen someone get that big (at least 4 inches) and that he's never implanted one himself, but it was at least FDA approved
so overall, a very good visit. the only thing i would want them to improve is to give their own pronouns before asking for yours. i get they're trying to be polite, but it feels a bit like asking for someone's name before you give your own, you know? but otherwise, i felt like they were very kind, professional, and knowledgeable about the whole process
as for whether or not i'm going to get surgery at this point, i think i'm gonna figure out how to go to south korea. i realized it's probably... not cheap but much more affordable if i just fly there and get the HGH, instead of flying there and getting the HGH and meta. i'm gonna call (at some point) and talk to them about it, get information about flying to south korea, see if the 2 week covid quarantine is still in effect, etc etc. if i do that, i will be sure to post here about how it goes, as well :)
hope this was informative and educational for everyone here about what your goals might be for the future!
as i understand it, being told to behave more like a man is a common experience of being a boy, so seems like you're doing it right to me
slightly depressing jokes aside, your identity isn't determined by how you dress yourself, it's determined by what you say and believe you are
that said, not everyone is able to discern the distinction. that doesn't mean they'll never understand... but it might require your own rock solid belief in what you are, and explaining the difference, for some people to understand it
it's a harder path, especially if you want people to understand you and see you how you are... it's easier to be gender conforming for a reason, you know? but you can take that information into account and act according to your preferences, balancing between your expression and your desire to conform. there's no wrong answer
for what it's worth, it's a reasonably common sentiment that i've heard amongst transmascs, to enjoy feminine expression a lot more post transition. usually reluctantly expressed due to a desire to pass
for myself, i was content to dress quite femininely for a long time. recently, i've started working out and putting on muscle, which i've enjoyed a lot... but it does make dressing in a pretty way very challenging. i got too big for over half of my wardrobe... sigh. i'll get back to it, one day
as a last note, phallo doesn't require HRT as a prerequisite, the way meta does. unless, of course, your doctor specifically requires it, which is fairly commonplace but unfortunate. i imagine that's the case for you, but i figured i'd include this note on the slim chance it wasn't
hope this all helps you on your journey