For those of you unfamiliar, Dr. Chen is a urologist and Dr. Watt is a microsurgeon.

My partner and I traveled down to San Francisco to stay for two nights. We flew in on Thursday evening and flew out on Saturday evening, not wanting to be gone for too long and rack up even more expense on the hotel bill. If I had planned ahead several months ago, I would have tried to stay at the Quest House during this time but I didn’t realize a short stay was potentially possible. 

We are fortunate to be able to use the public transit system offered in SF, which is pretty good in my opinion. They have buses, trolleys (cable cars?), and an underground/train system. We utilized this to make our way over to Castro street, where the medical office building and also the hospital are located. 

Without any plans for the day we went ahead and headed over about 3 hours early because I had seen that there was a dog park right nearby. We sat and watched local dogs come and play and have a break in the middle of the day and we ended up meeting an older gentleman whose dog wouldn’t leave us alone asking for pets. It was pretty great, and nicely calming as I was pretty nervous before the consultation. We then got some food at the local cafe on the corner. It was actually pretty good. 

We realized we still had time to kill so we decided to hike up the hill to the Buena Vista park where we looked out over the city and rested for a bit. There’s a path that has some disturbingly friendly squirrels on it.

About 30 minutes before my appointment headed over. Inside the medical office building, Dr. Chen’s suite is right across the hall from the Buncke clinic. I wasn’t sure where to go to check in, so we walked all the way down to the entrance of GU Recon and saw the door was open. Inside the waiting room was fairly spacious with comfy seating and plenty of random coffee table books to peruse. There was nobody else there at the time. At the receptionist window was a sign indicating to check in over at the Buncke clinic, so we quickly hopped across the hall. 

The Buncke clinic waiting room was much smaller and was actually quite crowded for a Friday afternoon. I checked in and they asked for my ID and insurance card (even though I had sent in pictures), and they didn’t ask for any kind of copay or payment. I suspect I will receive a bill at some point for the specialist copay from my insurance which is $30. Hopefully.

They instructed us to head back over to Dr. Chen’s office to wait, so we went back over and started looking through a photography book. At this point I was still about 25 minutes early to the appointment so I was ready to wait however long it would take. 

About 5 minutes later, Dr. Chen himself appeared behind the reception area with pizza and Starbucks in hand, apparently not expecting anyone to be in the waiting room. He noticed us right away and began apologizing for the wait. He explained the schedule didn’t indicate whether or not we were having a phone consultation, so he just assumed it was going to be over the phone based on my address. 

This whole interaction solidified every good thing I had heard about Dr. Chen, and I immediately felt so… normal. That’s the best way I can describe what I felt. I felt like I had known Dr. Chen for years and that he was.. reachable. Human. 

He told us it would be a few minutes, and sure enough a few minutes later Dr. Chen and Dr. Watt appeared at the door and we made introductions. My partner came with me because I wanted her to hear what the doctors had to say and I wanted another pair of ears listening, and also because I wanted the doctors to see that I had support. 

We went down a narrow hallway and went into Dr. Chen’s office, which hosted another comfy couch which he had us sit on while he and Dr. Watt sat across on office chairs. They each had some papers (my medical information). The room was somewhat dimly lit, but calming and comfortable. 

The consult started with Dr. Chen confirming my reason for the visit (seeking phalloplasty), and he asked me how important it was to me to stand to pee. I explained that my personal goals were 1 - Sensation, 2 - Stand to pee, 3 - Aesthetics, and 4 - Sexual function. Which, again, are personal goals and it is completely valid to have other priorities with lower surgery. This is my own journey. 

We then went over my medical history, which is fairly short, but Dr. Chen was thorough and asked me about my minor eczema, asthma, and migraines. Dr. Watt was quietly taking notes and listening during this time. Next, they asked about any trauma to either arm and I basically explained how my right arm is essentially immediately disqualified from being a donor arm. In my specific case, I broke my right arm when I was 18 months old and had to have a surgical repair. This repair didn’t heal correctly and now my arm when extended is quite crooked. 

This has put some strain on my ulnar nerve and gives me hypersensitivity in my palm.  Further, I had a different surgery on my forearm which involved an incision and left me with a scar right in the middle of the graft area. This could compromise the blood supply, so we pretty much immediately dismissed my right arm as an option. To top it off, it is my dominant arm for most activities. I kind of would have preferred to keep my left arm nice and clear of any scars, but I think having 1.75 properly functioning arms is preferable to only 1 functioning arm in case my right side nerves ever gave out. 

Next, Dr. Chen went on to explain his portion of the surgery - he starts with the vaginectomy and then relocates the end of the urethra to the natal phallus using labia minora tissue. He then mobilizes this and relocates it to the other side of the pubic bone to come out to the site of where the neophallus will be placed. At some point during this discussion, Dr. Chen explained the complication rate and he was both realistic and optimistic about it. He said the vast majority of complications that happen are fixable. Further, the most common complications often heal on their own. I can’t remember the exact numbers, but he said of the patients that do have fistulas, only around 20% of them end up needing a surgical fix. Strictures don’t show up right away, and usually occur within the first year. 

While Dr. Chen does the work down below, Dr. Watt explained his team mobilizes the RFF and prepares it for the new location, using the tube-in-tube method to create the urethra and phallus. Dr. Chen places a foley catheter through the neophallus and into the relocated urethra to line everything up, and he sutures everything together once the microsurgeons connect the blood supply and nerves. Dr. Chen then places the suprapubic catheter and the RFF site is covered with the split-thickness graft from the leg.  If requested, Dr. Watt would place integra on the RFF donor site before the split thickness graft (not staged like other teams).

They then explained what recovery typically looks like - 5 nights in the hospital, including 4 days of strict bed rest and then up and walking on day 5.  If you’re able to walk well enough, you get to leave to recover elsewhere. They then check up every week for four weeks before sending you home. During your 1 week post-op visit, Dr. Chen removes the foley catheter from the neourethra complex. You start your peeing trials just before the 3 week checkup, and if you’re able to empty enough of your bladder the SP catheter can be removed. If you have significant fistula(s), an additional week for healing may be allotted and the SP catheter retained for that time. 

Dr. Watt then did an exam of my arm, performing the Allen’s test to see if my hand receives enough blood if the artery they harvest for the RFF is removed. The test seemed really quick, but I guess with how fast my hand refilled with blood he was very confident I was a candidate for RFF. He indicated that no further testing of my forearm blood supply was needed. 

He examined the hair on my forearm, which turned out to be really funny because while he was looking at it he guessed that I had undergone electrolysis up to about 6 inches down my forearm. I laughed a little and explained nope, I just haven’t grown hair there in my ~5 years on testosterone. He gently pinched/grabbed the skin to see the thickness and said they’ll likely delay my glansplasty, and when he looked at the underside of my arm where the urethra graft would be taken he said I was basically hairless there and that any electrolysis at this point would just to be to remove hair from what will be the outside of my phallus, which is optional and he said I can always shave or use something like Nair. 

I then had a chance to quickly look over my questions to try to find any that hadn’t been answered. They were pretty thorough so the most I asked about was about Integra because I was most curious about it. Dr. Chen then explained that he needed to do a quick visual exam of the genital/mons region and we walked across the hall to an exam room.

He apologized for the discomfort and had me just quickly drop my shorts while standing. All in all I think it took about 5 seconds of exposure. When we got back into the other room he reported to Dr. Watt something along the lines of “minor prominence” of the mons. I checked my questions one more time and asked if they had any testicular implants that I could feel, but Dr. Chen explained that he had a patient waiting that was somewhat urgent and he promised that he would show me next time. He was very polite about it and I understood, and all in all I think the consultation took about 30 minutes. 

We said our nice to meet yous and goodbyes and Dr. Chen showed us out the shortcut out of the clinic and boom it was over. Despite the quick ending, I still didn’t feel rushed out of there and felt like they really took the time to make sure I understood the surgery and that my possible concerns were heard. 

All in all I left feeling really good, which for me was everything. I was actually excited about the future. Also, they said they would be forwarding my information to the phalloplasty team about our consultation, and that they should be reaching out to schedule with me. What ended up happening was I emailed Logan with a follow-up question and after we emailed back a forth a couple times, Logan asked me if I wanted to set my date. So now I am officially on the books for Left RFF Phalloplasty and words cannot describe how much joy/relief/excitement I feel about it. 

Like, I still can’t believe I get to do this and I don’t know when reality will set in. But for the first time in months, I am hopeful and optimistic about the future.