Lost and Found

I bought mine in March of 2011. Since it shipped internationally, it took about 3 or 4 weeks to get to me, don’t remember exactly anymore. Either way, I’ve had it for well over a year. In terms of durability, I haven’t done anything special with it. I’ve worn it nearly every day since getting it and use it fairly regularly. It’s still in good condition. There’s a slight nick that recently showed up where the shaft and balls connect that I need to try to figure out what to do with, just so it doesn’t rip more. 

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I know I said I wasn’t going to think about this for at least another year, and it’s not like I’m putting too much thought into it now, just kind of documenting some thoughts. 

Anyway, I know that at some point during grad school I want to get a hysterectomy done. Partly because of health concerns - I want to get it done within a 5 year period of starting T. Plus I could lower my dose of T, which would be nice. It’s also partly because then I could finish changing all of my documentation and be done with the majority of my transition. 

Depending on my grad school, I may be able to get insurance that covers the procedure. If I can, then I may only need a few hundred dollars to finance the surgery, which I’m certain I could save easily. If it can’t be covered, then I would go through something like CreditCare, which is a credit card for medical procedures. This is what I tried to do for top surgery, but I didn’t get approved because I don’t have credit. 

My general thought that I was having as I was trying to organize stuff for school is that 1) I need to get a credit card. I don’t really care for them or the idea of them, but unfortunately it’s so important now to build a credit score that I need to suck it up and get one. I plan on getting one this summer and using it during the school year to buy the stuff I’d need to buy anyway, so I know I can pay everything off without a problem. This way, whenever I try to get the CreditCare card, I should be able to. 

2) After I get back on my feet from this surgery and organizing school, I’d like to start putting just a little bit away every month to start preparing for this next surgery. Before I even try to start seeing surgeons and dealing with insurance, I want $1,000-1,500 put away just for the surgery. That way, if insurance covers it, I’ll have some money set aside to pay for any little things that come up not covered. And, if insurance doesn’t cover it, then I have money already put away to start paying off the bills from the credit card. I’m estimating the cost of this surgery to be about $6,000. So that amount would keep me a little ahead of the game. 

My real hope would be to have this goal reached by / during next summer. At the end of the summer, I’d probably start doing my research on who to go to. Idealistically, I’d like to get the surgery done next winter break (the first winter break while I’m at grad school). But depending on my situation, money, etc, it’ll more than likely happen in two summers from now. 

Like I said, I don’t intend on putting too much thought into this for another year. I’m not going to start researching anything until next summer, when it becomes a real prospect. But I did think that it was good to consider money matters a little bit now. It would definitely be good of me to put just a little aside, so I’m not doing what I did this time, where I had to come up with everything in one short period of time. And, if it’s going to take longer to arrange than hoped, I could just keep saving slowly. 

For guys curious on the breakdown of how much it’s cost to transition, how much insurance has covered, etc, I thought I’d write this up based on my personal transition.

Firstly, my insurance states very specifically that it will not cover anything transsexual related, which includes therapy, hormones, endo visits, surgery, etc. However, as long as it’s not brought directly to their attention, they don’t seem to mind covering a bunch of things.

Therapy:

• 4 sessions for diagnosis
• 3 sessions for T letter, check-up
• 1 session concerning top surgery
• 2 sessions for family concerns
• A couple of misc sessions
• Total = about 15 sessions

Insurance covered all of these sessions. We have a $20 co-pay, but part of that is refundable through our insurance thing. So I personally paid about $60 out of pocket. My parents didn’t pay much more than that.

Name Change (NYS):

• Name change petition
• NYS license
• Cost to fax changes to college
• School ID

The petition was $210. The license was $42. My school ID was strangely free. The cost to send two faxes to change my records at school cost about $5. Total name change costs worked out to be about $257.

Hormones:

• 1 endo consultation
• 1 “learn to inject yourself” lesson
• 2 endo check-ups
• 3 blood work appts
• 4 bottles of T
• 4 bags of needles

Only the consultation and check-up had a co-pay, which were both reimbursed. The lesson and blood work were completely covered. The needles cost about $2 for each bag of about 15 needles (so more than enough per bottle of T). The T itself cost $80. My insurance would not cover the T, so the first bottle was $80, the second I got reimbursed through my family’s plan, the 3rd and 4th I had to pay the $82 for. Thus far, I’ve paid $244. I’m considering figure out how to pay through the online store my endo has suggested so that it only costs about $60.

Top Surgery:

• 3 consultation appointments
• 1 blood work
• $5,324 Surgery (break down was explained in an earlier post)
• 3 Post-op check-ins (so far)
• Gauze
• Surgical pads
• Vest
• Palmer’s lotion

The consultations and post surgery check ups were free, as the price is already worked into the cost for surgery. The deposit is 10% of the surgeon’s fee and thus worked out to $350. The blood work was covered by insurance. My father had a lot of gauze, so that was free, but I did have to buy some surgical pads, which cost about $7. The vest was included in the surgical charge. I really haven’t gone out of my way to buy anything for scar treatment or anything like that. I did buy a lotion to rub onto the area to help with the skin elasticity. The total works out to $5,338. 

Total Transition To Date:

$60 + $257 + $244 + $5,338 = $5,899.

Future Expenses:

• Hormones for the next five years
• Nipple correction
• Hysterectomy in the next 4 years
• Change birth certificate

In the next 5 months, I’ll probably need another 12 vials of hormones, as each vial lasts me 20 weeks and I just got a new vial. If I go through the online store, that will cost about $720, over 5 years. (If I paid through the pharmacy, it’d come to $960.)

The nipple correction, if I feel it’s necessary, I believe will be free, as it will be done in his office under local anesthesia. Correction charges should be included in the surgical fee.

The hysterectomy I’d estimate, out of pocket, is about $6,000. At least those are the estimate I’ve heard from other people. I expect that any blood work needed for the surgery will be covered by insurance. I’m hoping to try to get the surgery covered by insurance, but I’m certainly not holding my breath.

In NYS, to change my gender on my birth certificate I need to have had top surgery and a hysterectomy as well as be on hormones. After I have the next surgery, I’ll changed my birth certificate. I believe it costs $40 or $50 to change.

This is the last step in my transition that I plan on taking for a while. 

I tried to change my gender when I changed my name but was told that I needed a letter from a surgeon who had performed the sex change operation. The statement of what was required was rather vague and I’ve heard that some guys have gotten their gender changed with a letter from their top surgeon, though I believe the intention is that you’re supposed to have proof of a hysto. 

I asked my surgeon and he said he’d write the letter and give me a copy of the operative report. So even if they reject my request to change it, I’ll have the documentation I’ll need later from him to change my birth certificate (in NYS, I need top surgery and hysto documentation). 

I plan on going to the Social Security office nearby as soon as I get the letter from him, probably next Tuesday when I go in for a visit. 

For anyone wondering, the documentation you need for this is:

• Proof of citizenship (birth certificate)
• Photo identification (license)
• Social Security Card
• Change of information form (found on their website)
• Letter from surgeon
• (Name change forms, since my birth certificate doesn’t match my current name)

For people wondering about the logistics / costs of top surgery, I just wanted to share how much it cost for me at the end of everything:

• 3 pre-surgical visits - $0, no co-pay without insurance. Cost covered in surgeon’s fee. 
• Blood test - $0, covered by my insurance. (Just don’t tell them that…)
• Pain medication and nausea pills - $6, covered by insurance
• Surgeon’s Fee - $3500. 10% paid as deposit, the rest in full 2 weeks in advance. This covered all visits plus the vest. 
• Hospital Fee - $1070. Paid 2 weeks in advance. 
• Anesthesia - $889. Paid 10 days in advance. This price was for 2.5 hours, an estimate of how much would be needed. 
• ~4 Post-Surgical visits - $0, no co-pay. Cost covered in surgeon’s fee. 
• Refund check - $204. The estimation was high by about 40 minutes of anesthesia. 
• Unknown bill - $68. I have no idea what this is for. I was billed for it the day of surgery and received the bill a few days ago. I wasn’t warned that any other bills might be necessary. It seems like I was charged for some kind of test they ran, but they didn’t inform me that that would happen, they didn’t take any blood or a urine sample. So I don’t really know. 

Total Cost: $5261 + $68. 

The original estimate I was given was for a total of $5560, which is what I’d been aiming for. I only ended up paying $5460 and then received the refund of $200. So it actually ended up being cheaper than expected. 

Since I did it locally, gas costs was nominal and I had no other travel expenses because I simply went home. 

I actually owe my mom $314, since that’s how much she loaned me to help me pay for it. I’ll be giving her $100 from the refund check and using the rest for some other things I have to do, but it’ll make me feel better to start paying her back. 

I have to call on Monday to ask about this other bill because it’d be really lovely if it was a mistake or something. I really don’t know what it’s for… 

I also wanted to say at the end of all of this that the entire experience, in many ways, was a really positive one. For one, it’s helped me feel more in control of my life. This was something that I really wanted and needed to do for myself. I put a lot of effort and work into it and I made it happen. In the end, I feel really proud of what I accomplished. Secondly, I’ve never really held a real job, I’ve never tried to save this much money, and I’ve never dealt with bills before. This was a positive reality check for me. Just learning to how to save properly while still enjoying myself, plus how to balance work and school and a life. I also had no idea what I was doing before with the bills, but I managed to figure it out. I tried getting credit and failed, then figured out how to pay out of pocket. I learned how to pay bills, get checks from the bank, that I have a limit on how much I can spend daily… Lots of fun things. 

What I think I liked most about this experience is that I did on my own. I went out and found a job. I worked hard and had a positive work experience. I found the surgeon on my own, figured out how to do all of that, and arranged the surgery by myself. I figured out how to pay the bills on my own and did it all on time. But I also found that I did have my parents support. My mom helped me with the small difference in what I had earned and what it cost. My dad was there for me the entire way through the surgery and the week following. 

And now that it’s all over, my plan is to take this next year easy and not worry about transitioning for a while (one exception, sometime soon I’m going to try to fix my gender with social security). I definitely want to get a hysterectomy and I want to do that in the next 2-3 years, for personal and health reasons. But for this next year I want to focus on healing from surgery and the other changes T will still cause. I also want to focus on school, being in a relationship, getting into grad school, and my writing. I’m pretty sick of saving money, so I don’t even want to think about that for a while. I think next summer I might look into whether or not my insurance will help me with the hysto but I’m neither very hopeful on that nor too focused on the possibilities just yet. 

Things are looking much better. 

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In order to prepare for surgery, I ate a solid, filling meal the night before. I was supposed to stop eating by 12am, but I was in bed before that. I also had everything organized. I have snacks up in my room, so I don’t have to walk downstairs as much. I got the clothes out that I was going to wear - my PJ pants and a comfortable button-down shirt. I also needed my ID, so I had that ready. 

I was up a little before 5.30, which is when my dad and I headed out. I showered the night before and couldn’t eat, so I pretty much rolled out of bed and left. I was really surprised by the fact that I was completely calm all morning. 

We arrived at the Surgery Centre a little before 6.15 (my arrival time). I checked in with the nurse. Pretty much I had to sign a few papers, show my ID, and wait. 

A nurse called me back. She had me strip to my boxers and put on stockings (for blood clots), a gown, and the scrub booties. All my stuff was put into a little bag. Then I got settled into a bed. The woman was really nice and she made me feel very relaxed as she worked. 

My dad got to come back then. 

The junior anesthesiologist (I guess you call her) came back and asked a bunch of questions and explained what would happen. A little after that, the nurse anesthesiologist came back and checked everything. Finally, a little after that, the anesthesiologist himself came back and double checked everything, spoke to me, and then left. Just like the first nurse, they were all really wonderful and comfortable. The anesthesiology nurse was wonderful too as she asked me questions like how excited I was and really understood what a big step for me this is. She was also really happy to see how supportive my father is and told me she was very happy for me. 

The Surgeon (Cusenz) came in. He had me stand up and drew on my chest. I found, in the office, Dr. Cusenz was very professional and business like, but also quite personable. In the surgery centre, however, he really made me feel relaxed and confident. 

After that, I signed a consent waiver and then the anethesiologist gave me something that was to start relaxing me before surgery. Technically I was still conscious for a little bit after that but honestly I don’t remember a thing until I woke up in the recovery room. 

My dad told me that the surgery took a little under two hours. The doctor went out to talk to him and let him know that everything went well. My dad was waiting for me when I woke up. Surgery started at 7.30 and I was feeling well enough by about 11.00. 

When I woke up, I wasn’t nauseous and wasn’t really hurting. I had some apple juice and graham crackers and a pain pill. The nurse emptied the drains and showed me how to do it and record it. I felt fine on the ride, even hungry. Once I got home, I was told to take a naseua pill, but after walking upstairs, I felt kind of shaky. I had a glass of orange juice, a banana, and then went to sleep for a while. I had to empty the drains twice so fair. The right side filled up a lot after the first one, though it didn’t have much in it when the nurse emptied it. The draining has slowed a lot now. 

After I woke up from my nap, I was hungry, which was a good sign. I can move around, but I feel kind of tired and a little shaky staying standing for too long. 

Mostly I’m just sitting and reading. Watching a movie now. It’s not too bad. 

Over all, I’m feeling great. Definitely relieved that it’s all (basically) over. I’m excited about getting the drains removed in a week and seeing what I look like. It’s really strange though thinking that there’s about 30 minutes I can’t remember at all and strange to think how quickly it feels like I went from being pre-op to post-op! It’s crazy. 

Everything went great!! Right now I’ve been home for over 5 hours. I’m feeling fine. I felt a little nauseous and dizzy once I got home but I think it was a mixture of the pain killers kicking in, walking up the stairs, and being hungry. I had some orange juice, a banana, and slept it off. 

I’m a little sore, but over all feeling fine. I took a second pain killer even though I didn’t think I really needed it, but better save than waiting until I hurt to take one. 

I’m going to write another post in a moment to detail the experience, but for now I just wanted to say that I had a great experience overall. I’m doing well - better than expected. Also, that I’m really grateful for my dad’s support and help with everything, between driving me there and keeping an eye on me after. 

So, with less than a week until my surgery, my dad suddenly throws out the question of whether or not I checked to see if our insurance will cover the costs if something goes wrong with surgery. 1) I have no idea why he waited until now to voice this concern. 2) I realized that this is something I’ve NEVER heard anyone talk about. The only thing I’ve ever heard about is the very low risk of nipple death - and from the one guy I read about who had this happen to him, the costs of correcting this were covered by his surgeon. 

From what I’ve heard in the FTM community and the small amount of research I’ve done about risks with breast reduction, I feel like the likelihood of anything happening are quite slim. I wasn’t really worried about it at all until my dad mentioned it. I’m trying to keep relaxed about it now and this article helped. It’s what I just googled:

http://www.realself.com/question/pays-for-the-cost-emergency-room-after-surgery-happens

All these plastic surgeons say the risk of complications after this kind of surgery are very limited. Now, DI is a bit different, but it’s a similar level of surgery (breast reduction, out-patient kind of thing) and I feel like the risk of complications is truly quite small, as long as the surgeon is good. I’ve heard a lot of great things about the surgeon I’m going to and I feel very comfortable with him. 

I also feel like, if anything does go wrong, I would feel very comfortable going to him and having the problem taken care of quickly and probably without a fee. 

To be safe, as much as I hate calling and don’t want to, I will call our insurance tomorrow like my dad said to do to ask if they’d cover an ER visit or hospital bills at all for something like this. I feel like the answer will probably be no; but I’ll call to show that I tried and in case it’s yes so I can feel better.