Vaginoplasty after a short "real-life experience"

I feel vaginoplasty is one of the last things to worry about, and shouldn't really even be dealt with until you are full-time. This is a controversial opinion, but I believe vaginoplasty has nothing to do with your ability to function in society. The only place it will be important is in a handful of intimate situations. So, in other words, it's important, but it has nothing to do with your ability to keep a job or walk down the street without being harassed because of your presentation.

Vaginoplasty four months after full-time

People keep asking me how I scheduled vaginoplasty so soon after going full-time. Easy. I had everything done before I even THOUGHT about scheduling surgery. Below I outline my philosophy and theory about the whole thing.

Scheduling surgery: the harsh reality

I suspect surgeons are very interested in treating patients who are likely to have positive results. It makes the surgeon look better. That's probably why some surgeons have been accused of favoring women who are accepted as female.

Yes, I realize that's terribly unjust, etc. In a perfect world, we'd all be able to get vaginoplasty on demand no matter what we looked like. But I don't live in that world, and either do you. You can try fighting injustice in hopes of changing the world, or just play along and get your surgery done quickly. I limit my activism to consumer issues for women in our community and transition advice. I'll let others fight the surgery on demand battle.

So, putting aside larger political issues, here's how to negotiate the politics of a quick real-life test.

Surgeons adhere to the Standards of Care insofar as they usually require two letters from therapists with specific advanced degrees. The therapists are responsible for that decision to recommend. While I suppose surgeons might screen you for other reasons, such as being obese or psychotic, they do not seem especially stringent if you do not pass or seem unable to function in society as female (unemployed, etc.).

The myth of waiting lists

I believe waiting lists are not applicable if you have money and letters. I am most familiar with Toby Meltzer's situation, so I'll use it as an example.

What's happened is word has gotten out that Meltzer has a long waiting list, so people make surgery dates far in advance of the time they are ready mentally, socially, or financially, then find they can't make that pie-in-the-sky date.

Since Meltzer only does about 150 vaginoplasties a year, his waiting list gets longer and longer as word of the wait spreads. It's a self-feeding cycle. A significant portion of these scheduled dates cannot be met by patients, though. At least 10% of his 1998 dates were available as I rescheduled; I was offered over a dozen different dates in 1998 alone on the days we talked.

These same people who reschedule rarely cancel altogether, but "postpone" instead, with no guarantee they'll make their new date. And so the list keeps getting longer.

Important note: Meltzer does not give preferential treatment to those who pay up front, nor do other surgeons. You don't get moved up the list because of bribery. You get moved up because you are prepared. If they know you have the money and letters in hand and are ready at a moment's notice, they will very likely be able to move you up into a spot held by some postponer. There are no guarantees, though. Being prepared only increases the likelihood you'll be moved up.

Don't go in and tell a surgeon you have only been full-time a few months. Turn in the psychiatrist letters when you schedule a surgery. Don't go in and demand you be moved up because you heard you can get moved up. That's just not a good diplomatic move. Go in, say you're available to move up (but only if you really are), and then hope for the best.


Is a pie-in-the-sky surgery date right for you?

Some people seem to find that having a hypothetical date set up is reassuring or validating. Some women even send you "welcome to the club" notes once you announce a set date. These sorts of rewards for setting a date make it tempting for some to set a date just to look like they really are serious about this. For some, it can also be incentive to get money or letters together by that date. After all, it's hard to hit a target that doesn't exist.

However, you risk major disappointment and embarrassment if you are unable to make the date. This puts a lot of unnecessary stress on some people and may not be the best way for you. Some people are devastated when they have to postpone, and fall into a deep depression. Do you want to risk that?

I recommend having everything together before scheduling. At the very least, you should have a realistic budget in place if you're saving for a specific date. If you're too ambitious or not brutally honest about how much you can save, you may find yourself forced to reschedule.

I was originally scheduled for late March 1999 before I visited Meltzer's office in April of this year, but once I whipped out my letters and money and assurances I could come as soon as June, I had a choice of June dates. I believe I could have gone in late April if I'd been able to get off work. If you're really ready, you can probably go within 8 weeks pretty easily. I expect Schrang and others are the same.

For those interested, I have included my presurgical timeline with my surgery journal.

Getting therapist letters--

To get letters, you'll need to find therapists who are willing to write letters for people who seem to have their acts together. Ask around before starting with a therapist to see if they've ever written letters early. Some therapists follow the Standards of Care religiously. If you do not want to wait for a year, ask women in your area who had a quick "real life experience" who wrote their letters. I've had a three-year relationship with my primary therapist, and a one-session relationship with my second one, who basically seconded what my first therapist recommended.

However, just because a therapist recommends one person quickly doesn't mean he or she will recommend you as quickly. A good therapist will approach this on an individual basis. My primary therapist has refused to write letters for people who claim they have been full-time longer than I. The key to getting a therapist to write a letter early is to be well-adjusted, both generally and in your chosen gender.

Here's a simple one: if your therapist is holding back a letter, start looking elsewhere. Don't walk out in a huff, but explore other avenues. Too many women just accept "no" as an answer. There's always a way if you are determined. An example: my first hormone physician refused my request to add progesterone to my HRT. So I found another doctor who would prescribe it and switched. Simple, huh?

Therapists are providing a service for which you are paying. If you are not pleased with the service, go elsewhere. Women in our community tend to be pretty non-confrontational, the type who wouldn't return food in a restaurant, etc. Don't get mad when someone says you can't do this or that. I had several people say that to me. Move on until you find someone who will honor your wishes.

Things you'll need to get therapist letters early:

Being able to present as a functioning member of society

Being mentally well-adjusted and self-accepting

Being employed

Being organized

Being out to all friends, family, and coworkers

Showing that you've thought everything through carefully

Not being belligerent, suicidal, etc. if they say "Not yet"

Being able to negotiate and convince them that you are really ready

Things that can't hurt:

Being accepted as female at work and outside of work

Being done with other transition needs (electrolysis, etc.)

Being in good physical condition

Being pleasant to your therapist

Getting money

Things you'll need to get money:

A pre-transition job (no excuses!)

A post-transition job (no excuses!)

A very precise spending plan

As austere a lifestyle as you're willing to live

A realistic savings plan

A realistic timeframe

See my section on financing transition. Basically, there's always a way if you're willing to make certain sacrifices. If that sounds like self-help bullshit to you, and you think, "Well, my situation is hopeless," then I didn't write any of this for you. I write this to enable those who would rather achieve their goals than come up with excuses for failure. I know people from ages 22 to 64 who were able to get the money, with all sorts of different financial impediments. This isn't some rich white conservative pull-yourself-up-by-the bootstraps speech. I'm not saying it's easy to get the money. I'm just saying it's definitely possible if you really, really want it.

Final checklist for moving your surgery date up

Things you'll definitely need:

Two therapist letters

ALL the money

Ability to present as a functioning member of society

Flexible schedule

Things that can't hurt:

Being accepted as female socially

Being employed

Being in good physical condition

Meeting the surgeon in person at his or her office

Asking thoughtful questions

Having genital electrolysis scheduled or even started

Mentioning friends who've been to the surgeon

Being nice to schedulers and the surgeon