fracture

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!

hey y'all, i have my bottom surgery consult on tuesday, for metoidioplasty, specifically. at the moment, i'm not interested in pursuing phalloplasty, although i'm not taking it off the table entirely, it's for a later time

the doctor i will be consulting with is dr jonathan keith in new jersey

i wanted to give y'all the opportunity to post any questions you might have about it. i might be able to answer myself, but if not, i will try to ask the doctor as well

for full context, i don't expect to schedule the surgery coming out of this appointment.

• i am going to ask about the potential of HGH treatment to improve bottom growth, as one clinic in south korea is pursuing (https://www.urodoc.co/ftm-metoidioplasty.htm)
• i also plan to ask about options for reduction of the labia majora, because that's a big concern i have with my body, specifically
• additionally, i will ask about how a theoretical phalloplasty following metoidioplasty would work
• finally, i will also ask about urethral lengthening without vaginoplasty (my preferred option), although i expect the doc will confirm what the research says about the heightened risk of urethral fistula post surgery. i'm also not sure that it's something i'd want, as i think my typical ejaculation volume would be... inconvenient for sex, to say the least

also on my list, but not strictly about the surgery, is asking about the anatomy of the arterial structures that feed the clitoral cavernosum bodies (i know their penial analogues and can find decent diagrams, but finding the equivalent clitoral diagrams is challenging)

i will write a follow up post with this information, as well as my general experience at the appointment, after it happens on tuesday (probably wed or thurs)

i got top surgery (double mastectomy) like 3.5 years ago now. i stuck to massaging my scars because i didn't actually want to reduce the appearance of my scars (idk why i was worried about this, they're fucking massive LOL). i was more concerned with blood flow / nerve functionality than appearance

however, that was 3.5 years ago and, due to some unrelated scarring (i scar like a mfer (i keloid a lot)), i got recommended to get some silicone tape, so i was like, what the hell, i'll put it on my top scars too

i also got nipple grafts, so i've been putting it on the edges of my nipples as well (i've noticed they're scarred quite badly on the outside)

note that my skin seems to be allergic to the glue in standard adhesives, so i've actually been using silicone gel, just applied topically twice a day, instead of silicone tape / strips (i'm also using a lot, so it would be a lot of tape to put on / take off / clean every day... the gel you just wash off)

it's a really good excuse to be shirtless more often during the day, and the results have been pretty promising thus far, 2 weeks in. my scars already feel a lot softer. i think the gel has also been helping things get cleaned out... my scars have been a little prickly and itchy, which is generally a good sign for that happening. so you might consider it for helping restore your blood flow / nerve functionality as well

also cool that it's still working after this many years... i guess 3.5 years is a lot to some people, but not a lot in the absolute scale of things

just something for y'all to think about. i've heard it does help reduce the appearance of scars, if that's something you want (i think they look badass, so i'm tryina show em off)

for the science of how this works, from what i've found, we can consistently reproduce the effects of softening / reducing scars, but we have no actual idea how it works LOL. so that's kind of interesting

have you gotten top surgery? what kind, and did / do you use silicone for treating the scars? if you haven't gotten top surgery, is this something you'd want to do?

(additional note: i'm not sure how long you need to wait after getting top surgery to apply the silicone tape/gel, but i would check w/ your doc and wait till they're fully healed at the very least)

when it gets difficult to get gel out of the pump, i was tossing the bottle. but because of laziness, i left an old bottle for a day, and i noticed that it actually can generate enough pressure to pump more testosterone since i had left it alone for that long

so if you keep your low bottles of testosterone gel, you can get one pump out of them per day for longer than you might think they're empty, and extend the lifespan of your testosterone gel for a little while

*dependent on if your testosterone gel bottles work the same as mine

obligatory reminder that gel is just as good as injected :)