Hey, 

Thanks for reaching out! Congrats on starting T- what an exciting time!!!!!

With regard to top surgery, my advice would be to set up as many free consultations as possible (even if you aren’t especially interested in the surgeon) to get a feel for the procedure and how various offices operate. Many surgeons offer free consultations in-person, over-the-telephone or online. See my incomplete list below: 

Dr. Miguel Delgado in San Franciso, Califronia Dr. Gehaan D’Souza in Carlsbad, California Dr. Scott Mosser in San Francisco, California Dr. Rex Moulton-Barrett in Brentwood, California Dr. Alexander Sinclair in Beverly Hills, CaliforniaDr. Jamie Schwartz in Beverly Hills, California Dr. Winfield Hartley in Boulder, Colorado Dr. Paul Steinwald in Denver, Colorado Dr. Timothy Alexander in Miami, FloridaDr. Charles Garramone in Davie, Florida Dr. Harun Zekirovski in Orlando, FloridaDr. Brian Aslanian in Atlanta, GeorgiaDr. Troy Austin in Evans, Georgia Dr. Navin Singh in Chevy Chase, Maryland Dr. Paul Costas in Concord, Massachusetts Dr. Kenneth Wolf in West Bloomfield, Michigan Dr. Carol Ann Aylward in Kansas City, Missouri Dr. Perry Johnson in Omaha, Nebraska Dr. Orna Fisher in Las Vegas, Nevada Dr. Keith Blechman in New York, New YorkDr. Emese Kalnoki in Rochester, New YorkDr. Elliot Jacobs in New York, New YorkDr. Jeffrey Rockmore in Albany, New YorkDr. Douglas Senderoff in New York, New YorkDr. Hope Sherie in Charlotte, North Carolina Dr. Steven Robinson in Cincinnati, Ohio Dr. Hugh Mclean in Mississauga, Ontario Dr. Dustin Reid in Austin, TexasDr. Matthew Stanwix in Richmond, Virginia Dr. Manish Champaneria in Vancouver, WashingtonDr. Megan Dreveskracht in Tukwila, Washington Dr. Antonio Mangubat in Tukwila, WashingtonDr. Javad Sajan in Seattle, Washington 

Consultations are a great way to get yourself educated… and they are a wonderful opportunity to speak one-on-one with a surgeon who will answer all of your questions. Prepare a handy-dandy list of questions, or use my list below:

has anyone died?

likelihood of developing a hematoma/ seroma?

skin necrosis- how to recognize dying skin?

other surgical complications?

how long should swelling occur before consulting a medical professional?

can i contact office about complications?

how far in advance should one quit smoking?

fasting before surgery?

how many additional pre-op appointments before procedure?

is blood work/physical needed for surgery?

how does the procedure work?

scar locations/ scarring/ scar treatments?

revisions?

how long under general anesthesia?

how long is the surgery itself?

recovery timeline?

post-op recovery questions: medications, showering, driving, post-op visits, drains, dog walking, class, sex.

is total cost including anesthesiologist, facility fee, surgeons fee, consultation/post-op follow-up fees and future revisions?

how many patients require revisions?

are there ways to lower the cost of the surgery?

how much of cost is required upon booking/before surgery?

how far in advance is payment due?

Take notes. Jot down what you like and dislike about the surgeons you consult with an go from there. Be a wise consumer. Don’t go to a surgeon that doesn’t vibe with you and makes you feel uncomfortable. 

Be sure to seek clarification about what’s included in the fees. Seek a surgeon who offers free revisions and follow-up appointments (EVEN if you aren’t seeking revisions or follow-up appointments). Steer clear of surgeon’s who tack on additional un-covered “cosmetic” or “contouring” fees in addition to billing your insurance company. 

My last bit of advice would be to expect the worse, hope for the best, and prep for all the rest. Anticipate all the bad and gnarly outcomes imaginable, prepare for complications, and expect suboptimal results so anything less than suboptimal feels mind-blowing (because all too often people really go into surgery with unrealistic expectation and that jazz kills). Mentally prep and brace yourself so you’re in a solid head-space and have a decent mindset before the procedure!!!

This is AMAZING. The teacher’s rebuttal:

I just commented this on a transphobic post that was all like, “In a sexual species, females have two X chromosomes and males have an X and a Y, I’m not a bigot it’s just science.” I’m a science teacher so I responded with this.

QT Says: Considering HRT? What’s right for you?There’s a lot to consider when you’re thinking about starting hormone replacement therapy (HRT), especially if you’re nonbinary, questioning or just generally not 100%, “give me hormones now” about the whole process.

Here are some questions you may have and our best answers to them. If you think of more, let us know in our ask box! (We won’t be able to answer specific medical questions about your personal care but we can share thoughts, resources, and questions!)

1. What does testosterone/estrogen do to my body, anyway?  

Good question. Take a look for yourself!

2. Okay, that’s fine, but what if I don’t want all of that right away?

You get to decide what’s right for you! For some people, it can be a bit overwhelming to think about ALL of the changes – some of them may seem exciting, others not so much. One of the things you get to do (need to do!) as a person considering hormones is weigh the pros and cons of all of the changes and decide what feels like the right path for you. You can do that on your own, with a mental health counselor, with your care provider. Thinking it through and making an informed decision for you is incredibly important.

(Some of our patients benefit greatly from therapy and report positive experiences and that’s important. However, at PPSFL we do not require our patients go to therapy to prove their true gender, or to get permission to change their bodies. One of the ways we approach our transgender services program at our health center is called an Informed Consent Model. That means you get to decide what is right for you and we support what you choose for you.)

Some of our patients are very happy on a smaller dose of hormones; others feel better on a higher maintenance dose. We have rules (called medical protocols) that give us guidelines but we work with our individual patients to make sure they are comfortable with their care and hormone plan.

We find that most of our patients are really good at figuring out how they ~feel~ on hormones, emotionally and psychologically, before some of the bigger changes occur. The key is to keep checking in with yourself. How do you feel? What’s going on for you? Does this feel exciting and like a “click” of cool, yes, THIS! Or are you feeling ambivalent like, huh, sure, I guess, maybe? If you’re feeling less enthused we recommend chatting with your care provider and deciding what’s right for you. You get to choose when to start, if you wish to continue, and help make decisions about your dosage. You get to choose. It’s your body! The time it takes for some changes to occur can be good news and/or bad news for some folk. The good news is you have some time to see how you feel. The bad news can be the waiting.

3. Okay, my dude, but what if I want to stop taking hormones. Can I do that? Will I explode?

Yes, you can stop taking HRT, and no, you will not explode. That said, like with most medication, just stopping taking it, cold turkey-style, is not a thing we recommend. 

Talk to your care provider about how you want to stop and you can come up with a plan together on how to lower your dose or take you off HRT. We look at your care as a partnership. We are experts in a lot of things when it comes to health but you are the expert on you and how you feel. 

4. Can I just take, like, a smaller dose of HRT, but permanently?

Yes. Most providers start their patients on a lower dose and then make adjustments based on the patient’s experience and medical protocols. Key thing here: what’s right for you? People take different doses of HRT for a multitude of reasons, and “I just want to see how I feel” is a totally valid reason to stay on a lower dose for a few weeks, a few months, and also forever. Neutrois has written extensively on this topic, from their POV.

5. If I stop taking HRT, which changes are permanent?

For trans men/ transmasculine folks, the irreversible (won’t change back to how they were before taking HRT) changes may include:

Deepening of the voice

Growth of facial and body hair

Changes in hair (possible hair loss, thinning, or male pattern baldness)

Growth/changes in genital erectile tissue (clitoris)

Breast tissue atrophy – possible shrinking and/or softening of tissue

For trans women/ transfeminine folks, the irreversible (won’t change back to how they were before taking HRT) changes may include:

If sperm production has ceased it may not return if hormone treatments are stopped; it may be irreversible (this can depend on length of time and dosage on HRT).

breast development/growth