This is the first post in a 2-part series about how I’ve arrived at a decision about having further SRS, specifically ALT phalloplasty. The time line graphic highlights key events that helped shape my final decision, and illustrates the steady increase of body dysphoria. Full text is below the graphic, and further details will be published in the next article in this series.

Also see:

For those of you considering metoidioplasty or phalloplasty, do you see any similarities between my process and your own?

The Road to Phalloplasty
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<a href=""><img src="" alt="The Road to Phalloplasty" title="The Road to Phalloplasty" width="600" height="1200" /></a><br/><a href="">Gender Outlaw Blog</a>

I begin my transition. I feel certain that genital reconstructive surgery is not in my future.

I start researching surgeons who perform metoidioplasty with urethral extension and scrotoplasty. I’m disappointed that top surgery alone didn’t “do it” for me.

I publish a series of posts on metoidioplasty surgeons. I’m particularly impressed with the ring metoidioplasty procedure performed by Dr. Bowers and Dr. McGinn, and with Dr. Miro‘s meta procedure.

I undergo hysterectomy (LAVH-BSO) and suffer from an iatrogenic VVF complication. I swear to myself that after healing from this I won’t have any more surgeries. I’m too scared of another complication.

I heal from the VVF complication without surgical intervention. (The urologist calls it “a miracle.”) I’m so thankful that I resolve to envision my life without having further SRS. This turns out to be unrealistic and in a few short months I’m back to researching my surgery options.

My doctor requests funding from MSP of BC for metoidioplasty on my behalf. There is no funding available and we know this; the letter is strategic, part advocacy effort and part of getting me “in line” for future SRS funding.

At the Gender Odyssey conference in Seattle, I attend a presentation by Dr. Meltzer and Dr. Webb on FTM bottom surgery, and have an in-person consultation with Dr. Meltzer regarding metoidioplasty with vaginectomy, urethroplasty, and scrotoplasty. I’m very impressed, and for the next two years my focus remained fixed on having a metoidioplasty performed by Dr. Meltzer.

I attend the 10th annual Gender Odyssey conference and once again take in Dr. Meltzer’s presentation on FTM bottom surgeries, adding to the knowledge I’ve acquired on the topic over the last couple of years. While at the conference, I learn that the push for funding in BC for FTM bottom surgeries has progressed, and it’s expected that funding for both metoidioplasty and phalloplasty will be available within two years.

This news has a motivating effect on me. I re-assess my surgery goals and determine that metoidioplasty will no longer satisfy my needs. While the radial forearm and MLD phalloplasty procedures remain outside my interest, I’m intrigued by Dr. Meltzer’s pedicled phalloplasty using a groin flap.

At my request, my doctor once again requests MSP funding on my behalf, this time for phalloplasty. There’s still no funding available and we know this; the letter is strategic. (Also see 08/01/09.)

I get official confirmation that, “[MSP is] seeking Ministry approval to add phalloplasty to the list of insured services under MSP.”

I receive an email from my contact at MSP confirming that funding for phalloplasty and metoidioplasty will now be offered for up to five men per year. Patients must see Dr. Brassard in Montreal for these surgeries. MSP will cover the costs of the surgery itself but patients will need to cover travel expenses for their initial consultation in Montreal, getting to/from Montreal for surgery, and the stay at the recovery facility.

This news is officially announced at the CPATH conference in Winnipeg, Sept. 21-23, 2012, and subsequently breaks the story on Oct. 3, 2012.

I speak on the phone with Dr. Curtis Crane, a reconstructive urologist and plastic surgeon in San Francisco who performs the full range of both MTF and FTM surgeries, including three variations of free flap phalloplasty. We discuss the procedures around reinnervating a Meltzer pedicled phalloplasty, as well as the ALT phalloplasty procedure.

I have a second phone conversation with Dr. Crane and ask more detailed questions about nerve anastomosis in a pedicled phalloplasty. While the possibilities are interesting, it’s starting to look like a roundabout way to get the results I seek. My research over the last few months has me leaning heavily toward ALT phalloplasty and the answers I get today from Dr. Crane further cement my resolve. ALT phalloplasty it is!