Metoidioplasty Blues Part 2

The Results (AKA, The Cons)
Once the swelling and bruising went down, I was initially fairly pleased with the results, or at least at first glance. My little guy was free, I had decent length, and the positioning definitely made it feel more like a dick. What I didn't anticipate is over the next few months my balls got into a war over who got to be front and center. At about 2-3 months post-op, it was clear who won. My right testicle found its way up and stationed itself right next to my dick, pushing it off to the side. My left testicle dropped, landing almost directly behind my right testicle. This is not at all how I intended or wanted my genitalia to look. Beyond that, my left testicle settled into a position that makes me perpetually feel like my scrotum is being pulled on or pinched. It's incredibly uncomfortable. To make a long story short, I went back for a revision 9 months later at a greater cost to me, enduring more pain, and nothing changed. The kicker is that I also discovered that I have scar tissue in my front hole from the surgery and any penetration is painful.

How I Feel
I am deeply and profoundly disappointed. My dysphoria is through the roof and has never ever been this bad at any other point in my transition. I don't look at my genitals, my libido is almost non-existent, and I am in constant physical discomfort. There were points in the last year or so where I felt absolutely hopeless. And, all of those self-shaming thoughts of internalized transphobia would roar in my mind. I deserved this. I did this to myself. This was all my choice/fault. I should've just been happy with my body as it was. My body will never look anything other than disfigured. I am a freak. Luckily, self-love won out and I started opening up to the "what if's" of having a phalloplasty. I still feel like I've lost years of my life from this and it'll be hard to let those resentments go.

The Pros (cause nothing's that simple)
Although I am overwhelmingly disappointed and unhappy with my surgery, there are some positives that came from this experience that I will acknowledge. Foremost, I felt a complete shift in how my mind made sense of my genitals. My opening no longer felt like a vagina - it felt like a hole at the base of my pelvis. Likewise, my phallus no longer felt like my clit. It did not feel like a penis, but it definitely did not feel like a clitoris. This departure from how my brain made sense of my previous genital configuration, I think, blew the door open for me to recognize and acknowledge that what I really wanted was a phalloplasty. It was too hard for me to envision my body with a penis when it still felt like I had a vagina and clitoris. That jump was too big for me to make. Sadly, it took a spike in my dysphoria to understand what I really wanted.

Another other pro is that I decided to have inner/outer thigh lipo as a part of my surgery. I am genetically prone to carrying fat in this area and hormones did not redistribute it to other areas. It made it difficult to find pants that fit and, in my mind, was another manifestation of my gender dysphoria. My silhouette has changed subtly from that procedure and just enough for me to not notice those areas anymore.

The Cost/Insurance
I could write a whole series of blog posts on the horror that was my pursuit of insurance coverage for this surgery, but I'm not going to. I'm still too exhausted by it. Those ghost stories would include threatening legal action and threatening to expose the dirty laundry, so to speak, to the community they were raising money from. In a nutshell, it ended up getting covered with the exception of the lipo and pubic lift. Medalie would not submit the pubic lift through insurance as medically necessary although he does not perform the procedures without it.

Metoidioplasty Blues Part 1

This series of posts include less detail than I would like. I believe that as a result of the traumatic nature of my metoidioplasty, I have fewer memories than I normally would.

In the fall of 2013, I began exploring options for a metoidioplasty and advocating for a change to my employer's health insurance policy, which explicitly excluded SRS. So, why then? The simple explanation is that I had a significant amount of swelling in my genital area after my hysterectomy and that was the first time that my genitals felt phallus-like in nature.

Why Medalie?
The largest factor in my decision-making is that I wanted to retain my front genital opening. It was something that brought me pleasure and I didn't want to compromise that. I joined a few yahoo groups and did some google-powered research to find that this preference would likely not go hand-in-hand with a urethral lengthening. It can be done, but that increases the complication rates and, for many, shrinks the size of that opening. I was also confident that I wanted testicular implants.

Taking urethral lengthening off of the table allowed me to include a greater diversity of surgeons on my list. After looking at various results on Transbucket and the yahoo groups, I was most attracted to the results of Dr. Curtis Crane (in SF then), Dr. Daniel Medalie (Cleveland, OH), and Dr. Christine McGinn (Philadelphia, PA). I arranged for an in-person consultation with Medalie (in October 2013) and McGinn (scheduled for Feb 2013).  I was leaning towards McGinn and Medalie since they were both within driving distance, which made me feel more comfortable.

I drove 9 1/2-10 hours to/from my consultation and had what felt like an informative conversation with Medalie. He answered all of my questions, provided me with contact info to talk to other post-op guys (which I did) and would be able to schedule my surgery for the following May. I think my favorite part about Medalie's process (which I now regret) is that his technique was very simple and less invasive than others. He released the clitoris, wraps it in the tissue from the inner labia, and uses a pubic lift method to pull the genitals forward. Instead of surgically constructing a scrotum, he plops the testicles right into the outer labia. To me, this seemed like a modest next step. I didn't want to jump in the deep end of the pool, so this was me taking the stairs into the shallow end.

Before deciding to go with Medalie, I got a phone call from McGinn's office saying they had to reschedule my consult and that McGinn wasn't scheduling any metoidioplasties until 2015 at the earliest. It was only December 2013. I did not want to wait that long. By then I was emailing with a guy who was post-op and really pleased with his results and I had talked with another on the phone. I thought, why not? These other guys seemed super happy. I canceled my pending phone consultation with Crane and scheduled surgery with Medalie.

The Surgery
In May 2014 I underwent a metoidioplasty, scrotoplasty with testicular implants, pubic lift, and inner/outer thigh lipo with Dr. Daniel Medalie in Cleveland, OH. I spent about a week at a local La Quinta Inn and my partner drove us home after the post-op appointment. I was still draining fluids, so I had to take out my own drain a few days later (that was cool!), and I had to wear a compression garment (with the crotch cut out to free my new willie) for a handful of weeks. See photos below.

4 days post-op with compression shorts (for lipo)

The surgical drain. The flat white part was inside my body!

Initial bruising from lipo (photo: right inner thigh).

See Metoidioplasty Blues Part 2 for more.