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Top Surgery

- Criteria for breast/chest surgery (one referral letter)

MtF patients:
Criteria for breast augmentation (implants/lipofilling)
1. Persistent, well-documented gender dysphoria;
2. Capacity to make a fully informed decision and to consent for treatment;
3. Age of majority in a given country (if younger, follow the SOC for children and adolescents);
4. If significant medical or mental health concerns are present, they must be reasonably well controlled.
Although not an explicit criterion, it is recommended that MtF patients undergo feminizing hormone therapy (minimum 12 months) prior to breast augmentation surgery. The purpose is to maximize breast growth in order to obtain better surgical (aesthetic) results.-World Professional Association for Transgender Health-
The Standards of Care 7th Version

FtM patients:
Criteria for mastectomy and creation of a male chest
1. Persistent, well-documented gender dysphoria;
2. Capacity to make a fully informed decision and to consent for treatment;
3. Age of majority in a given country (if younger, follow the SOC for children and adolescents);
4. If significant medical or mental health concerns are present, they must be reasonably well controlled.
Hormone therapy is not a pre-requisite.-World Professional Association for Transgender Health-
The Standards of Care 7th Version

Bottom Surgery

- Criteria for genital surgery (two referral letters)

1. Persistent, well documented gender dysphoria;
2. Capacity to make a fully informed decision and to consent for treatment;
3. Age of majority in a given country;
4. If significant medical or mental health concerns are present, they must be well controlled.
5. 12 continuous months of hormone therapy as appropriate to the patient’s gender goals (un- less the patient has a medical contraindication or is otherwise unable or unwilling to take hormones).
The aim of hormone therapy prior to gonadectomy is primarily to introduce a period of reversible estrogen or testosterone suppression, before the patient undergoes irreversible surgical intervention.
These criteria do not apply to patients who are having these procedures for medical indications other than gender dysphoria.
Criteria for metoidioplasty or phalloplasty in FtM patients and for vaginoplasty in MtF patients:
1. Persistent, well documented gender dysphoria;
2. Capacity to make a fully informed decision and to consent for treatment;
3. Age of majority in a given country;
4. If significant medical or mental health concerns are present, they must be well controlled;
5. 12 continuous months of hormone therapy as appropriate to the patient’s gender goals (un- less the patient has a medical contraindication or is otherwise unable or unwilling to take hormones).
6. 12 continuous months of living in a gender role that is congruent with their gender identity;-World Professional Association for Transgender Health-
The Standards of Care 7th Version
Although not an explicit criterion, it is recommended that these patients also have regular visits with a mental health or other medical professional.

Almost a year into Covid-19, Surgeries had been completely closed off for months. We were not able to get on the schedule let alone get a theoretical date for the operation.
Then Finally it all fell into place and we were ready for our first surgery ever!Checking in to the hospital was a little nerve racking, but by the time I got undressed and into the hospital bed they had some anti-anxiety meds for me, and that helped immensely.I don't remember much after the bed started rolling, we got into the OR and the Anesthesia provider put a mask on us before time jumped to several hours later, and waking up on the other side of the hospital.After the initial fog wore off, we could feel how tight our chest was, the new bulk stretching my button up shirt to its max. Riding home however was a lot more interesting, with every bump on the road sending shocks of pain thorough my body. crawling back into bed was wonderful, and I was able to pass out quickly.Waking up at night for the first week was fairly rough, having cut through the pectoral muscles we we're unable to use our arms or core to get up and out of bed. Waking up my partner to help support us was the only solution.Getting off of OXY was extremely helpful for bodily functions, and when the pain spiked we were able to use ice packs to reduce the swelling and irritation.Half way through the 2nd week healing was going well and we did not have any further issues, aside from the inability to lift.You will be very surprised at how immobile this will make you.

I had been dreaming of this surgery for years, multiple insurance denials, several COVID cancelations, and months of struggling with Electrolysis, we were finally heading down to Oregon for my second surgery.Since this was an out of state surgery we traveled a few hundred miles to our hotel for the night before surgery. Once we checked in to the OR, there would be no leaving the hospital for about a week...Anxieties were high again the morning of, a mix of excitement, and fear that the OP would be canceled yet again. Checking in went smoothly, and we were able to get settled into the bed in pre-op.Shortly after we got our IV and metrics, there was an entire parade of Medical Assistants, Doctors, Nurses, Anesthesiologists, and Surgeons in training stopping by to check on me and confirm all of the details. The primary surgeon doing our experimental procedure stopped by as well to make absolutely sure we had all of the details finalized as there would be no turning back.As my bed rolled down the hall, my excitement grew, knowing the next thing I would wake up to would be the treasure I had sought for years.
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When I came to, I was still in a recovery area, details are foggy but at one point I was picked up by staff and slid onto another bed, One I would be tied to for the next several days...Waking up again hours later, I found my partner sitting next to me. We had been moved to our own hospital room for recovery and observation. I remember trying to figure out where I was physically, not knowing this hospital or city well at all. There was a window in our room, but all I could see was other buildings, and I was in no shape to get up or move.When I looked down I could see layers of bandages and medical tapes completely encasing my groin. I had no way to confirm how the surgery went or if I even still had my dick(lol).Damage Report:
-Left arm, multiple punctures and bruising, as well as an active IV-Right arm, more punctures and a port for another IV-Neck, Blistered, with damaged skin and extremely tender from another IV site-Stomach, very bloated, and tender, with a bandaged incision sites on my left hip and navel-Groin, Catheter and multiple layers of bandages and who knows how many stitches-Legs, Compression cuffs around both ankles to promote blood flow. Right lower leg Completely numb with the little needle feeling.
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I was not allowed to get up and move around for about 3 days. My appetite was gone, and my guts were extremely bloated with no way to get relief.Staff kept me on a steady stream of meds, that really helped with the pain, even waking me up every 4 hours to take my blood pressure and make sure I was doing well. great for health bad for sleep.Speaking of sleep, having this intense surgery meant I could not lay on my sides or roll over at all. spoilers, hospital beds are not comfy, especially when you are practically tied down to it haha. several days of cramping, bloated intestines, and sleepless nights later, we were finally allowed to get up and even sit in a chair.

OMFG this was probably the most difficult recovery for us, I thought that this would be much easier.Checking in for surgery early in the morning, and getting ready for the operation went smoothly. I let my partner know that I would likely be in recovery by about 2pm. No problems rolling back, and I don't remember making it to the operating room.When I came to, it was almost 11PM!
I was able to take a selfie and check in with my partners, but I was not allowed to leave the hospital due to my lack of blood pressure. Once I made it into a recovery room, several nurses helped me to get comfortable, and I was able to sleep for a few hours.After a few nurse checkups and several hours of not being allowed to leave my bed, I was discharged, went home, and slept for several more hours.The first 2 weeks of recovery were very difficult, my stamina was completely shot. Leaving me hardly able to walk from room to room without being winded. One of my eyes was fairly swollen causing double vision and headaches. Reading, games, and screens of any kind would lead to heavy eye strain.After the first few weeks I was able to get stitches and stables removed, as well as the stents in my nose.I feel that I am still recovering over 6 months later