A good plan violently executed now is better than a perfect plan executed next week.
—George S. Patton
From the Accidentally Gay Blog: Change in Surgery Plans
Posted on January 31, 2017
In the following post I know I will use the term “we,” and it’s a bit like in a heterosexual relationship the guy says “we are pregnant.” However, it is hard not to think of it as “we” so I thought I would admit the hypocrisy up front.
Wolsey and I have been talking about pushing through his bottom surgery sooner than we originally were going to. He wasn’t sure if or when he wanted it at all and with having just finished his top surgery, we figured we had time to wait for him to decide if that was a path he was going to follow.
With the current political climate and the election of Trump, we have gotten more concerned about insurance coverage for him. Since we work for the Department of Defense and I had to push through an EEO up to the pentagon in 2015 for his insurance coverage, we know that his benefits are always up in the air.
Last week we decided to push forward with it by setting up the consult and getting on a wait list. With Trump elected we couldn’t be sure that the president wouldn’t repeal the LGBTQ protections that are currently in place. SCOTUS hasn’t made an official ruling and with the repeal of the ACA (Obamacare) in the air, we didn’t want to take a chance. Just to be clear, the DoD and DCAA have not indicated a problem, but they are a conservative military agency/department under Donald Trump, Fascist in charge.
We called his surgeon and the consult will be in Phoenix, meaning a three-hour flight to get to it (plus flying twice more for surgery). The surgeon said the earliest we can consult is in May. We were expecting that, but what we weren’t expecting is that surgery itself won’t happen until 12-18 months after the consult, closer to the 18 months specifically.
We were both shocked by the wait. We attempted to find a second surgeon. This one was in Portland and a lot closer. It was even worse; the consult wouldn’t be until September and at least a year after that before surgery.
This did cause both of us some anxiety. We weren’t sure if our [LGBTQ] protections would still be in place in that time so we talked to Wolsey’s insurance contact, Raelene, and she is going to see if she can get the surgeons to speed up a little.
I then asked Raelene if I went back to the state as an employee (they use the same insurance) if that would interfere with Wolsey’s surgery and she reassured it wouldn’t. This means we do have a backup plan if they strip his ability to use the insurance for transgender-related care. I will jump back to the state after August and keep our insurance going.
The reason August is a magic date is I will hit my three-year anniversary and I will be considered a federal employee permanently so in the future I will get preference if I ever apply for feds again.
The irony of this situation is five hours after we are pushing forward with this, an Executive Order repealing Obama’s protection for LGBTQ is circulating and that is hitting the news now. I really don’t even know what to say except “Fuck you, Trump!”
Lucky’s Perspective Now:
The election of Trump was terrifying by itself. The alt-right shouting and lauding their victory even more so. I had hoped that maybe Trump was so focused on being selfish and wanting to cash in on his presidency that maybe he wouldn’t delve far into the LGBTQ fight. I was wrong. Whether that was Pence’s influence, or some of his conservative dark money donors I can’t say, but in the end, it doesn’t really matter.
Even before Trump took office Wolsey and I began talking in earnest on his situation. Our plan had been to let him heal up from his top surgery, take a couple of years to catch his breath and then dive right back in. We figured slow and steady would be the best option.
That changed radically by the time Christmas rolled around in 2016 and then the start of 2017. A little birdie let me know at work we should be worried about insurance coverage. We got more and more anxious about medical coverage and the hubby’s rights. At the end of January, we decided it had to be done as soon as possible. We were already witnessing a change at our work, with our LGBTQ coworkers leaving, and more and more people being outspoken in their dislike of LGBTQ people in general. It felt like it was accelerating with Trump winning the election.
We talked with Wolsey’s insurance case manager, Raelene, who had led us to such great results for his top surgery. She had two doctors who would be covered and who had good reputations. One was in Phoenix, and had a great reputation, and one was in Portland with almost as good a history and reputation. We didn’t care who he saw, the problem for us was time. How much time did Wolsey have before they repealed his insurance coverage?
It was at this time that a lot of people told us we were worrying about a non-issue. I had to explain to multiple people that even under Obama in 2015 Wolsey wasn’t covered. There was a specific Department of Defense rider on our insurance forbidding the use of medical for any sort of transgender services. It was only after I had pushed it up with an EEO complaint to the pentagon that we were told at beginning of 2016 that there would be coverage. Wolsey and I had no illusion about how strong his protections were now under a Republican-controlled House, Senate and presidency.
We started calling around and got through to the Dr. Meltzer’s office in Phoenix first. They were incredibly kind but we would have to come down there for a consult and they couldn’t see us until May of that year. Then it would be a 12-18 month wait for his actual surgery after the fact. This panicked us greatly, but having no other options we signed up and got ready. It was better to be prepared for the long wait then to miss it all.
I didn’t give up on the Portland doctor though, it took a lot more phone calls and stress but finally got through to his staff and they said it would be at least until September before a consult, and closer to 18 months for surgery after that. Wolsey and I both felt crushed, but we decided to go with the quicker doc in May.
We talked some more and I decided to look into returning to the state as an employee. I had worked for the state before getting hired by the Department of Defense. While the state pays significantly less in wages, their medical benefits are generally better and cheaper. I would be willing to sacrifice tens of thousands a year pay just to get Wolsey covered. I was terrified Wolsey’s insurance coverage would end and we wouldn’t be able to afford the $60,000 or more it would cost out of pocket. Even with the increase in money at our federal jobs, the surgery cost was prohibitive. Switching jobs would have been a better option. Wolsey was worth whatever it took.
Because our state protects transgender care for insurance coverage, I prepared to quit in August since that was my three-year anniversary and would cement me as a permanent worker for the federal government if I ever wished to return. I felt this would give me a backup possibility if things fell through at the state.
What I didn’t expect was almost immediately after we put plans into motion, the Trump administration released an Executive Order repealing Obama’s protection for the LGBTQ crowd. Talk about timing... We got in just under the wire.
Wolsey’s Perspective Now:
It all started with a presidential election. When Trump was elected president, I was concerned for LGBTQ issues in the country. The Vice President’s track record with LGBTQ issues was a known disaster. It made me incredibly uneasy. I had already fought for my top surgery, and just getting basic testosterone covered by my insurance through the Department of Defense.
Then there was a phone conversation in January of 2017. Since Lucky had previously filed an EEO complaint, and talked to folks up the chain about transgender coverage for me, he heard from someone “off the record” that we might want to be concerned about getting our insurance coverage for me yanked for anything they could pin on a transgender issue.
This was before Trump’s attempt to ban transgender soldiers from serving, but it sure motivated me to start looking into my options regarding “bottom surgery.
”
I wasn’t sure I wanted to go out and buy myself a penis, but I had a slight complication to my life in the form of lichen sclerosus. It’s an autoimmune issue that showed up when my Graves’ Disease kicked into high gear back in 2007. The symptoms are losing patches of skin on your genitals. It’s your own immune system attacking itself. It was painful and a constant issue for me. Transitioning had lessened its severity, but the only real treatment was removing the surrounding tissue anyways.
That meant bottom surgery for me was a win-win. I would get to step across the last line towards masculinity, and my issues with lichen sclerosus would be gone because the areas effected where areas that would magically be removed.
Add to this little biological glitch the idea that I might not ever get something like this covered by insurance if Trump and Pence had their way, and I decided to see if I could get some kind of bottom surgery done quickly before I risked losing coverage.
My background in nursing meant I knew pretty well what all these different variations on penises would entail surgically. At my age, I wanted the easiest version I could get, with the least surgical intervention.
I thought I’d just call up and make some appointments. That’s when I learned Trump hadn’t just spooked me, but the entire transgender community. Wait times were shocking. I wasn’t sure if I’d have insurance coverage for 2018, so I remember just sitting down and making six hours of phone calls one day trying to find anyone that had a window. I called all over the West Coast and that’s when I discovered there are very few surgeons that even do this.
It was so demoralizing I started pricing out a trip to Phuket in Thailand, which if we paid out of pocket, would have been cheaper. Phuket was my Plan B, if I lost insurance coverage. Transgender surgeries were practically pioneered over there, and there were a lot of transgender people that wrote about their experiences going to get it done there. It’s literally cheaper to fly to Phuket, stay for three months, and get surgery, while having a vacation than to go anywhere in the US if you are paying out of pocket. Plus, the surgeons there have been doing this for a very long time.
That’s when I finally gave up and called Raelene. She had been my insurance case manager for my top surgery. She must have moved heaven and earth because she managed to get my May 2017 consult appointment rescheduled to March 2017. I’m not sure how she did it, but I’m deeply grateful.
The consult was with Dr. Meltzer and Dr. Ley. Dr. Meltzer is the go-to guy for transgender related surgeries. To my surprise he’d heard of lichen sclerosus, and had even managed to cover a young man’s surgery under that reason, and counted it as one of his only insurance-covered bottom surgeries before things started changing with ACA mandates to cover transgender people.
Dr. Ley was an accomplished surgeon in her own right, with the kind of surgical history people write into movies. She was learning from Dr. Meltzer and had been working with him for years. She hadn’t done a metoidioplasty, which is what I wanted done.
I explained my issue with the Department of Defense. Dr. Meltzer had an idea. He had a cancellation in May of 2017, and if I would let Dr. Ley do the metoidioplasty I wanted, he’d be right there with her to walk her through it.
I jumped on it. I felt that between Raelene and Dr. Meltzer and Dr. Ley, they moved heaven and earth to get me in during 2017 so I could get coverage. The feeling during this time was that transgender patients getting their insurance from the Department of Defense were going to be dumped at any time. Since I got my insurance through a sub-agency of the Department of Defense, my coverage followed regular Department of Defense rules. If they managed to flush transgender people out of the armed forces, and deny coverage, then my coverage would be denied as well as a civilian who got their paycheck from the Department of Defense.
I truly believe Dr. Meltzer and Dr. Ley went out of their way to get me scheduled. I can’t believe how amazing they were to do that. I regularly recommend Dr. Meltzer and Dr. Ley to other transgender people because they are community first and really understand the issues that we deal with.
In the current climate there are a lot of surgeons entering the transgender surgery market because a lot of us are willing to pay cash, if we can’t get our insurance companies to cooperate. Only a select number of procedures are covered, so even if the surgeon goes through the patient’s insurance for one procedure, the odds are likely they will also be doing a non-covered cash pay procedure in addition. Not all of these new surgeons are trained or skilled in the specifics of transgender-related procedures. Not all surgery stories with these surgeons have a happy ending, judging by the community chatter online.
It was with this in mind that I was more than happy to let Dr. Ley do the surgery. She had been a very accomplished surgeon before she came to work with Dr. Meltzer, and had been working with him for years. She obviously really cared about the transgender community and was willing to spend a long time with Dr. Meltzer’s transgender practice.
I had two surgery dates set up during this consult. One for the bulk of the procedures in May and one for a Mons Resection to pull it all up into place in December.
This would mean all my surgeries would be done in 2017. I knew for certain my surgeries were covered through then, but I had no way of knowing if that coverage would be yanked out from under me in 2018.
Chapter Thirteen:
“The Surgery”
“It’s a penis,” Margo said, “in the same sense that Rhode Island is a state: it may have an illustrious history, but it sure ain’t big.”
—John Green
From the Accidentally Gay Blog: “The Surgery”
Posted on February 19, 2017
I had asked Wolsey to write a guest column on my blog explaining his choices for bottom surgery. I felt he could write a bit on transgender-related bottom surgery, and what that means for a transgender man. As someone that is not a transgender man, I just didn’t think I could do as good a job.
—Lucky
I thought I’d discuss “The Surgery.”
Every time the subject of my being transgender comes up, inevitably there is somebody out there that immediately asks if I have had “The Surgery.” There is this idea that there is one big all-in-one genital surgery for trans folks. I’m not sure where the scare quotes around “The Surgery” come from, but that’s how everyone has asked.
What they really want to know is if you have a penis. I’m pretty sure for transgender women, when they get asked about “The Surgery,” it’s because people want to know if the woman has a penis. There seems to be a huge obsession, culturally, about whether or not transgender people have penises.
This voracious appetite for what we do with our genitals is one of the reasons I decided to write about my surgery. I’m not going to get into the nitty gritty details here. I have a not-so-secret Tumblr for that. If you are trans, and want more bottom surgery info, shoot me a line, and I’ll tell you my Tumblr for that.
In the interest of education, here is how buying a penis works for transgender men.
The first myth we need to dispel is that there isn’t a single surgery for this. There is a smorgasbord of options. Every transgender person picks and chooses what works for them, depending on what works for their anatomy, economic reality and desires.
When it comes to shopping for a penis, you have two main kinds of penises to choose from.
There is phalloplasty. It’s where they actually build you a penis from scratch, pretty much. You have donor sites for skin and you can pick your size, have nerve endings moved, and all sorts of things. It’s a bigger surgery, that realistically is multiple surgeries over a period of time. This is the Cadillac of bigger better penises. It’s a lot of work to get there, though.
Then there is metoidioplasty. This is taking your own anatomy, the clitoris that has been enlarged by testosterone, and helping it reach a longer length. At the very minimum, this can be called a basic release, because it’s about disconnecting a ligament and some labia, and let
ting your little friend gain at most a couple inches in length, if you are genetically able to. This will not create a typical cisgendered penis, but it is a penis with retained sensation. There are cisgendered men with penises this size, so it’s well within the bell curve of normal masculine expression. It’s just small.
I chose the metoidioplasty, because the increased chance to retain sensation, and the less invasive nature of the procedures, and reduced number of surgeries. There are great results with either—it’s all about what you want.
With a metoidioplasty, trans men can always upgrade to a phalloplasty later. We can also decide if we want to keep the vagina, and if we want to lengthen our urethras to go through the new metoidioplasty, or not. We can also have testicles. This is a pick and choose situation, where each transgender man will decide what procedures he wants, or not.
For the best results of a metoidioplasty, you might need to have a mons resection if you have body fat. This is basically removing the fat from the mons area under your pubic hair, and then pulling everything upwards to a more masculine sitting position. It’s like a facelift for your penis. I’ve talked to some guys that have not done this, and the metoidioplasty was not very visible at all, and they were unhappy. Insurance does not cover this, because apparently, we are half-assing this whole trans-coverage thing. If I’m buying a new penis, I want it to be visible.
However, we aren’t talking just one procedure for me. I will require a list of optional surgeries rolled into this one procedure:
• Hysterectomy - The uterus is voted off the island.
• Oophorectomy - The ovaries can go too.
• Vaginectomy - Don’t go away mad, just go away.
• Mons Resection - This is necessary, if I want there to be any visible change.
• Metoidioplasty - The whole point is a penis.
Acidentally Gay Page 14