I started this blog to document the process of getting phalloplasty with as much detail as possible, and make the process easier on others who prefer to have a clear idea of what to expect.
(Obviously there will be differences in experiences and surgeries and doctors.)
I'm in my 30's.
I came out in 2010.
I started T in 2019. (gel for about a year, switched to injections and saw results I was much happier with)
Top surgery in 2023.
#starting - Starting the process
#stage_0 - everything to do with hysterectomy <- I am here
Upcoming dates:
Waiting for stage 0 scheduling phone call
July 27- Phalloplasty consult
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I had my hysterectomy in person exam yesterday (7-16-2026)
I live about 6 hours away, so that car trip back and forth + the appointment in one day was EXHAUSTING, for the next trip (7-27-2026) I'll leave the night before. My whole body hurts like hell and my energy is shot.
First a nurse came in and took my blood pressure; I think there normally would have been more intake questions but I answered them online a week ago so this part moved pretty fast.
The doctor first came in and talked/asked questions about the surgery (they can't do this and vaginectomy at the same time at this hospital, which was my main question at this point) and what the recovery time looked like (about 4 weeks). Two years ago I'd had a pap smear (after being on testosterone for about 5 years at that point) and they wanted me to get another because the results of the first one came back odd (and it had been two years). People that have been on testosterone a while frequently get weird pap smear results and they wanted to see if it was normal weird or scary weird. Regardless of those results, she said the surgery would probably be around December 2026 and I'm waiting on a call for that date now. She said she would leave the room and asked me to undress below the waist and sit on the table with the paper blanket over my lap.
I had two lower exams, a pap smear and a pelvic exam; the doctor said I could opt out of one or both at any time but I did both in the interest of getting everything done as well/thoroughly as possible for the best outcome (and so I never have to do this shit again)
She did the pap smear first; she narrated what she was doing and when she was about to touch me anywhere, I appreciated that a lot. She inserted a speculum and used a swab inside, then took both out.
The pelvic exam consisted in her inserting a finger and using her other hand on the outside of my stomach to feel something. The physical feeling of the speculum was uncomfortable, but personally I found the dysphoria to be the worst part of it. No part of this was overtly painful, just weird sensations and uncomfortable. When she did the pelvic exam I had a very brief pang of light headedness/nausea, because some people can have a vasovagal response to that.
She mentioned the results of the two tests would be back in about 3 days for one and a week for the other (to the best of my memory). She sent in a prescription for an estrogen cream (to be inserted inside) to be used in the month before surgery to help with healing.
There were no needles/bloodwork that needed to be done at this exam or in preparation for it. (In my experience)
I got my estimates for the consults later this month (phalloplasty and urology) and they're both about 600$ (each); asking around in the phalloplasty discord, this seems pretty out of the ordinary, so I'm going to try and apply for financial aid.
Just got a text early in the morning (about 8am when the hospital opened) saying they had an earlier availability, so my in person pre surgery exam has moved up from August 7th to July 17th.
Phalloplasty consult that I waited 8 months for got cancelled the week of; they said they'd reschedule it for as soon as possible, but I haven't got the new date yet.
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Phalloplasty consult that I waited 8 months for got cancelled the week of; they said they'd reschedule it for as soon as possible, but I haven't got the new date yet.
Something to look out for if you decide to get bottom surgery is that your mental health/dysphoria might get worse; you're thinking a LOT more about something you probably compartmentalize and bury.
My pre-surgery in person exam is August 7th!
Instead of calling the line I had been calling, I intentionally dialed the wrong extension and was directed by a real person to a relevant phone number with a real person.
Still waiting on the return call for my pre-surgical exam being scheduled, and I got a message for a bill for the (30 minute, telehealth) consult that was $600, so I'm trying very hard not to have a panic attack about that and am hoping it's just an insurance thing I don't understand that can be fixed to not be $600 (magic).
Still waiting on a return call, I called Wednesday (4/29) and left a message.
Surgeries are covered, but the bill on that one was so big because it was a 'meeting with a specialist', which isn't covered by my insurance. I'm paying it increments, but there shouldn't be many of these so I'm keeping on.
Still waiting on the return call for my pre-surgical exam being scheduled, and I got a message for a bill for the (30 minute, telehealth) consult that was $600, so I'm trying very hard not to have a panic attack about that and am hoping it's just an insurance thing I don't understand that can be fixed to not be $600 (magic).
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Still waiting on the return call for my pre-surgical exam being scheduled, and I got a message for a bill for the (30 minute, telehealth) consult that was $600, so I'm trying very hard not to have a panic attack about that and am hoping it's just an insurance thing I don't understand that can be fixed to not be $600 (magic).
I had my regular appointment with Planned Parenthood recently and asked them for the letter I need from my hormone provider for surgeries, so I have all of my letters now.
The hospital sent me a message to call a specific number to set up the in-person exam (that is in 3 months) but it went to voicemail, I left a message and have been climbing the walls all day waiting for a call back and to find out when the exam is.
I honestly didn't think phalloplasty would be remotely possible for me and assumed it would be out-of-reach expensive, but I wanted to look and see what the reality of the situation was and what the actual number looked like and was shocked that insurance is saying they'll cover it. This to say, "if you already think it's impossible to attain, it's not a loss or a let down to check it out and confirm it, but you might get a surprise about the situation being better than you thought". Just look into it, you don't have anything to lose if this is your starting point.
I had my hysterectomy consult today, the entire thing went about 30 minutes. (This doesn't include the 15 minutes they tell you to show up early for, in case you had unfinished paperwork.)
Rest of the post continued under the cut, for length (I took lots of notes throughout and tried to keep track of every part of it) and anatomical language.
The consult started with the doctor asking if I had been wanting a hysterectomy for a while or if it was mostly part of the phalloplasty process, then asked how long I had been on testosterone, if I still got periods, asked if they were normal (didn't bleed a huge amount, didn't have abnormal amount of pain, etc) when I had them. If I currently experienced any kind of pelvic pain, if I had bowel issues (frequent constipation or diarrhea), if I had issues with urinating (leaking, trouble peeing, etc).
She asked if I was sexually active, and then went on to specify that this includes things that aren't PIV, and asked if I had pain during sex. When I said that I didn't do PIV and nothing goes there, she asked if it was because of physical pain, dysphoria, or just didn't like it. She asked if I felt pain during any penetration/sex using a condom.
After this, she asked when parts of my transition had taken place (when I started T, when I socially transitioned, when I had top surgery), and asked if I had any interest in having kids, either through birth or donating genetic material.
She then explained what kind of hysterectomy they do there (laparoscopic), explained how it would be done (through 4 small incisions with long instruments), and that the uterus, cervix, and fallopian tubes are removed, and optionally one or both ovaries.
She mentioned the benefits of having both ovaries removed: removing the risk of it forming cysts or developing cancer.
And the risks of having both ovaries removed: If you lose access to testosterone, you can experience surgical menopause and be at risk for fractures, heart problems, dementia, and memory problems. She mentioned most guys getting hysterectomies nowadays are opting to leave one in.
She mentioned the risks of the surgery, most common to surgery in general: bleeding, infection, damage to other organs, anesthesia risks, heart issues, but specific to hysterectomy, there is a low chance of issues with the stitches in the cervix, because it's harder for them to heal when the parts are unused/don't have estrogen in them. I apologize, this information went by very quickly and I don't think I got enough notes down to explain it very well.
She mentioned I should be out of the hospital the same day of the surgery and should be clear to leave, but some people that live far away feel better renting a hotel for the night just to not have to make a long trip immediately after surgery. I'll be sore the first few days and should be back to normal after a few (2ish) weeks. In the first month, no heavy lifting and no submerging in water.
Before the surgery, I'll need:
-2 letters of support, one from a mental health provider and one from my hormone provider (I already had my MH letter for phallo and because the letter says "hysterectomy and phalloplasty", it can be used for both. I'll get my second letter for both surgeries on the 15th and will remember to specify that to them also.)
-One more followup, where I'll drive out to the hospital (6 hours away) and get an exam in person. That'll be in three months, I'm currently waiting on the call back on that
The hysterectomy is supposed to be (no date yet) in August or September.
The questions I brought to this consult:
What happens if I go off testosterone (not on purpose)?
(answered above)
Will this affect my hormones in a way that I need to account for with a dosage change?
Answer: No, but give your provider a heads up before surgery. Some people need a dosage change, but that's usually for people that have had both removed.
Will this affect my hormones in a way that things affected by hormones might change, like hair loss?
Answer: No, you're good.
Is it possible for the surgery to be done closer to where I live? (6 hours away and in the rural South US)
Answer: [Basically she said I could get it done in a blue city closer to me, but that the phalloplasty surgeon's patients typically get their hysterectomies done at the same hospital] and I'm going with that so everyone is medically on the same page and miscommunications are less likely.
So currently: I'll have both my letters around the 15th and should be able to get my follow up/pre surgery exam soon.
My hysterectomy consult is this Tuesday and I'm really excited, it's been 6 months since I started making phone calls and pursuing phallo. The previous Tuesday (a week before the appointment) is when the intake questionnaire went up on MyChart and I filled it out as soon as it was available at midnight.
The consult will be a video call, because I live about 6 hours from the hospital. The past 6 months, I've been keeping Word documents filled with questions to ask at the hysto/phallo consults, I plan to print those out the night before the consults. (I'll share the questions I asked/the answers after each consult)
Edit: I received a phone call from the hospital this morning that was the intake, I think. A real person (as opposed to AI) asked me questions about the medications I was taking, family history, surgical history, stuff like that. She also texted me the link for the video call appointment Tuesday.
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I started the process by asking about phalloplasty at a Planned Parenthood appointment in October 2025, they advised me to look at phalloplasty doctors covered by my insurance (if your insurance is Aetna, this (link to pdf) is what I used to find that) and call the hospital directly and ask for a consultation. I did that the next day and talked on the phone to the people at UNC Plastic and Reconstructive surgery and they set up my consult (June 2026) and directed me to another part of the hospital to set up an appointment for a hysterectomy consult (April 2026), because that's the first step for this doctor's (Ogunley/Figler) phalloplasty surgery.
For my insurance to cover the surgery, I need two letters of support: one from a mental health provider and one for my hormone provider.
For the mental health one, I didn't want to come out to my regular therapist, so I found a therapist to meet with that writes letters. (Here is a directory of providers that will write letters, it's sort-able by insurance/state/etc) I don't have my second letter yet, I plan to ask at my next Planned Parenthood appointment. Here is a pdf for guidelines on what's required in a letter of support.
