I haven’t really changed my opinion about sharing personal details about decisions regarding lower surgery for myself, but I do want people to have access to as much information as they can about it. A lot of what I researched online is either out of date or not reflective of what Dr. Crane, at least, can perform.
I had a consult with Dr. Crane recently (January 2014), and I just wanted to share some general information I got out of it. I hope it’s helpful for other people who are trying to research lower surgery options.
If anyone has any questions, please feel free to ask or message me. I’m happy to answer general inquiries in a public forum and (potentially) more personal aspects of my experience via a private message.
It should go without saying but just in case it for some reason doesn’t, I am not a medical professional. This information was told to me by Dr. Crane and I’ve recorded it here to the best of my knowledge. It is provided as a means of offering information for those interested in both of these procedures as a starting point in their research on lower surgery. You should absolutely speak to a surgeon who performs these if you have questions regarding your specific situation and take their word over anything you see here if it differs from what I’ve written below.
Approximate cost: $26,000
- Cost includes the meta procedure, urethral lengthening, scrotoplasty, and vaginectomy; it will obviously be far less if you opt to skip any of these options (and Crane said it really was a “choose your own adventure” kind of ability with both this procedure and phallo…if it’s medically feasible, he will give you what you want, even if it’s not the “traditionally male” option)
- Unsure if this cost includes the hospital stay/operating room cost and anesthesiologist
- Hysto can be performed at the same time by an OB-GYN working in tandem with Crane, but costs more
- Unsure if a mons resection (monsplasty?) is included in that ballpark figure, but Crane did say the procedure could be performed at the same time as the meta if desired, just FYI.
Length of surgery:
- Anywhere from 2 to 6 hours (in specifics, if you just get a clitoral release, it’s a relatively short procedure. Adding urethral lengthening tacks on about 90 mins to the procedure; I didn’t ask about how long it took for other options)
- Outpatient, but Crane encourages 23 hour observation as an in-patient if you have the money/are able to get your insurance company to approve it
- Surprisingly (to me), Crane said the recovery time doesn’t differ very much between phallo and meta. He said he’d recommend 2 solid weeks off of work (probably because I was told the catheter in both phallo and meta for those who opt for urethral lengthening stays in for that long). He said no heavy lifting of 20lbs or more for at least 2 weeks, and you could return to exercising after about 4 weeks, if all goes well (6 weeks for phallo).
- Most of the information I got regarding complications related to the pros and cons of skipping the vaginectomy while having a urethral lengthening done (to allow for the ability to stand to pee). I was told there was a 10-20% chance of a stricture (scar tissue build-up in the urethra) either way. The increased risk came into place when opting to skip the vaginectomy and going forward with urethral lengthening in terms of fissures (holes developing in the urethral tube). With a vaginectomy, Crane said there was about a 20% chance of a fissure (meaning you’d be stuck sitting to pee or having to undergo another surgery in an attempt to close the fissure). If you opt out of the vaginectomy, he said the risk of a fissure increased to closer to 40%.
- If you choose to have a vaginectomy, you MUST have a hysterectomy, either as part of the meta procedure or prior to it (and with phallo you MUST have a hysto before it if you want a vaginectomy I was told, because the procedure is already 8-10 hours and who wants to be under general anesthesia for longer than 10 hours?). The reproductive organs drain through the vagina, I was told, so closing off that without removing them via hysto is impossible.
- Meta doesn’t increase your length; it simply releases the clitoral tissue from the pelvic wall. With urethral lengthening, you’re going to need to have a fairly sizeable growth as a result of testosterone, so Crane says he prefers patients who’ve been on testosterone for at least a year (even then, the point is to be able to clear your jeans when standing to pee, and some guys simply won’t have that growth, no matter how long they’ve been on T; in those instances, if you’re set on standing to pee, he recommends considering phallo; if you just want the clitoral release and other procedures that don’t involve urethral lengthening, that can be done, no problem, regardless of growth).
- If you choose not to have a urethral lengthening (I believe this is what he said but it might have been related to vaginectomy, not UL…sorry, my notes aren’t clear on this point) but do want scrotoplasty, Crane can do a graft to make the scrotum from the inside of your mouth/cheek as an alternate donor site.
- 100% of his patients reported experiencing sensation (tactile and erotic) after recovery.
- Patients are able to still wear a harness and strap-on for penetrative sex after meta (since generally meta doesn’t provide a long enough phallus to penetrate autonomously).
- This is a one-visit procedure. For patients who opt for scrotoplasty, I believe he said you’d have to stop by his office as an outpatient about 4-6 months (he might’ve said 6-8, not sure) after surgery to have the testicular implants put in.
- Meta allows for the ability to get erect when aroused without the need for a penile implant.
Approximate cost: $68,000-78,000
- Cost includes phallo, vaginectomy, urethral lengthening, glansplasty and scrotoplasty; it will obviously drop your cost to opt out of any of these
- Unsure if this cost includes the 5 days required as an inpatient at the hospital, the operating room fee, or anesthesia
- Cost does not include hysterectomy, which MUST be performed prior to getting phallo (if you want a vaginectomy as part of the procedure)
Length of surgery: 8-10 hours
- In-patient – 5 days; recovery is similar to meta, with 2 weeks recommended off of work, no heavy lifting of higher than 20lbs for 2 weeks, but no exercise for 6 weeks.
- I’m sure there are more that I don’t know about, but see what I wrote above for meta. The only thing I was told that’s different is that instead of a 40% chance of a fissure related to urethral lengthening if you keep your vagina, it’s more like a 30% chance of fissure.
- Again, you can pick and choose the procedures you want. Crane said he’s performed phallo before where the patient didn’t care about standing to pee, so he didn’t do a urethral lengthening. He’s left vaginas intact during phallo, and has had patients who decided not to get a scrotoplasty. The only requirement based on these choices is you must have a hysterectomy performed prior to phallo if you want a vaginectomy.
- While recovery time is similar between procedures, phallo is generally considered a more major surgery because it creates a penis out of skin from a donor site elsewhere on your body. Crane recommends the lateral forearm because he says there are some great nerves and veins (I believe he said veins) to reattach to the penis. There’s also the ALT donor site, which is on the thigh. He said since there’s more fat on the thigh, results often end up getting you something that looks more equal parts wide as it is long (like a soup can, he described it as). The ALT donor site still allows for good sensation, although he can’t sculpt the glans at the same time as the rest of the phallus so that’d be a procedure you’d need to come back for. He also does the dorsal flap (under your arm down to your hip, I believe), although that one is less certain about retaining sensation. He said the forearm was best. Also note that in any of these cases, if you want a smooth penis, you’re going to need to have body hair removed prior as well.
- In terms of retaining sensation, Crane said 100% of his patients (excuse me, but WOW) retained tactile sensation at the very least. He reported 85% of his patients experienced erotic sensation.
- You can’t get erect without a penile implant, which he can install (along with adding the testicular implant) on an outpatient basis about 9 months after surgery takes place. I believe Crane prefers the non-pump option for penile implants (I’m going to suck trying to describe this, but it’s basically just a bendy piece of material, so you’ll always be semi-erect if you have it, but you’ll be able to bend/straighten it as desired for penetrative sex without the need of a saline pump, which has a higher likelihood of complications or breaking)
General info about obtaining a consult with Dr. Crane for lower surgery:
- Cost: $150
- Cost to reserve a surgical date: $1000 (note: I heard this through another Tumblr user and didn’t actually ask while there myself because they’re currently not scheduling any more lower surgeries until about June 2014…and the dates of the actual surgeries take place in 2015 and beyond, FYI; **update: I’ve also heard the cost is $2000 more recently, although check with Crane’s office since I haven’t been able to verify this on my own); this fee can be applied to the overall cost of the surgery you get, btw.
- Insurance: I’m sure he takes other insurance carriers, but I only asked about my own, Anthem Blue Cross. I received confirmation that he is now an in-network provider for Anthem. Huzzah.
- Crane will do consults via webcam, although I personally went into his office since I’m local so can’t speak on that particular experience.
- You’ll need a letter from a therapist (unsure if licensed social workers are OK) and an MD who prescribed you testosterone or is in charge of your transition care prior to surgery (and probably some other requirements I forgot at the moment…if anyone wants it, I have an attached doc with more requirements and general information about both procedures)
- His office is moving from San Francisco to Greenbrae (North Bay area, north of San Francisco) on February 1.
Any other questions? Feel free to ask. Sorry if I was unsure of some of the information. I tried to make note of the information I wasn’t 100% certain I’d heard correctly as clearly as possible though.
I also highly recommend the Hung Jury anthology. It provides testimonies from transmen who’ve undergone some form of lower surgery (from the mid-90s to present), as well as some selections from their cisgender partners (all women, unfortunately, for those of us who identify as gay), and even selections on the historical background relating to phalloplasty and FtM pioneers during the 70s and 80s.
July 2014 update: I received a call from Dr. Crane’s office around the first week of June saying they were now scheduling lower surgeries for late 2015. Since I’ve decided to wait until 2016, I didn’t schedule anything myself but I thought this timeline might help people understand where they’re at, in terms of scheduling upcoming surgery dates. I don’t think this timeline applies to top surgery, which can be scheduled much earlier on, I believe.
A cup, possibly smaller. I didn’t really graduate very far from training bras.
It’s not just about how much breast tissue you have, but also about the tightness of your skin/sagginess of your chest. Check Bartlett’s results page and compare your chest to the keyhole images. Additionally, try the “pencil test” on your own - if your chest is heavy/sags enough that it can hold up a pencil in the crease, you are likely not eligible for keyhole. Peri-areolar (incision all around the areola), particularly pursestring (a “donut” of skin is taken out around the areola) may still be an option in your case. There are C cups with sufficient skin tightness to have gotten periareolar; I think there’s one on transbucket, which was actually how I found Bartlett in the first place.
I haven’t been keeping very close tabs on my changes, but there have definitely been some. here’s some of what I’ve noticed:
- I started losing weight after top surgery, which had been just before my 1 year on T mark. by 1.5 years, I was much leaner, particularly around my hips and love handles.
- Especially noticeable at this point (probably because I hadn’t been paying much attention) are my legs and butt - they’re much more masculine looking than before, though still very hairless, and the bone structure isn’t going to change (inward angled thigh bones, wide pelvis, etc.) But I’m still really, really happy with how I look naked now.
- I’m currently anywhere between 106 and 111 pounds depending?? I guess the bit of time that I was 117 pounds was just bloat earlier in T
- muscle gain continued very slowly, but muscle retention improved a lot, and I stopped being so freaked out about what I ate/when I worked out/etc. I’m still a little weird about it though I guess.
- I think there is something to be said about an effect I’ve heard described often - that at the 2 year mark a lot of trans people on T report a sudden “spike” in stuff like muscle mass, fat redistribution, facial hair, or things they’d previously been finding were stubborn to change. dunno what it is, but I definitely got it good esp. with fat redistribution
- zits never really improved - in fact they got really bad, particularly by a year and 8 months (so around the beginning of 2014) - I finally got off my ass and got some acne meds prescribed about a month ago and they’ve been really helping
- my appetite is a normal appetite, unlike the sucking black maw it was between months seven and eleven of T
- more chin hairs, thicker mustache hairs, all of which grow back faster when shaved (chin hairs faster than mustache interestingly enough) also sideburn hairs, which I only noticed in the last couple of months
- Face changes. Maybe it’s to do with deciding not to go with a shaved head anymore (seriously why did I think that was a good idea) or slightly different glasses, or something, but my face is…..really masculine now, and also really attractive?? Like, since about the end of last year (a year and 9 months on T) I’ve been feeling really like I’ve finally come into my own as a hottie with a body and it’s really nice for my ego. My cheeks are definitely slimmer and my mouth and chin area looks different too.
- The irritability I noticed around half a year on T has definitely either subsided or become more adapted to my personality. I feel pretty calm, happy, and optimistic the vast majority of the time.
- My voice may have gotten a little deeper but I seriously haven’t noticed or cared or made a recording in such a long time
- I can sing a little better!! so maybe my voice has settled a little. I’ll give it another year or two though.
- dick growth like hella. Can’t really report when, though I think there was a bit of change around September (so a year and a half) as well as early this year, but probably due to getting sexually active in the last four months (finally!!) I’ve been paying more attention to my junk.
- In that vein I’ve stopped feeling quite as much bottom dysphoria. I like my dick. A penis would be nice but honestly I feel like at this point most of what I’ve been calling “dysphoria” now feels a lot more like average male insecurity, at least if i’m not reminded abruptly that the majority of the world would not consider me a man if they saw what i refer to as my dick. Basically day to day I’m not so worked up about my junk anymore, and being in a relationship has really helped that. it’s not even anything that my partner’s specifically said or done besides just plain ol’ wanting to have sex with me. I packed daily for a really long time but in about March I just kind of stopped, it didn’t feel worth it. I’m still a bit interested in metiodioplasty though, but not enough to consider it beyond “that would be cool yeah”
- tl;dr. Leaner body, more manly legs, slight increase in body/facial hair growth and speed of growth after shaving, shittier acne, calmer, bigger dick, became super attractive. Basically a very good addition to the major changes which had already happened in the first year. Woohoo
numbness of the skin around my nipples made it easier for them to get irritated and itchy; the nipples themselves weren’t itchy per se but the nipples were the ones that ended up getting infected and now i gotta take cephalexin (an antibiotic) and slather on bacitracin, woop woop.
i’m very happy with how my chest looks (i have had doctors and various people who know i’m trans ask me whether i actually had surgery, since there is so little scarring) but not really with how it feels. i was okay with the potential for numbness, but it’s like, itchy and gross, also my nipples/areolas are kind of hard and swollen a lot, especially on my right. so that makes it awkward cuddling with my partner, or having anyone give me bear hugs or lift me off the ground or anything to do with pressing my chest/rubbing it hard against anything, since my nipples stick out and aren’t soft
sorry for the lack of updates, especially with 1 year post op and 2 years on t having passed. i just haven’t really cared quite as much about trans stuff in the last few months
I just had my (probably) final follow-up appointment with Dr. Bartlett.
In the last few months it’s been hard to tell what’s been the effects of healing and what’s been the effects of a different/better workout schedule, with regards to how my chest (and the rest of my torso) looks. My pecs are getting a little bigger and more toned in different places; I’m still trying to even them out since my left pec is noticeably bigger, or at least to me it is.
My nipples are still healing, and the checkup with Dr. Bartlett confirmed that. Healing is a process that keeps on going for up to two years post-op. Not only that but the wound itself isn’t just the incision under the nipples - it’s the whole area where tissue was removed and where nerves still have to regrow and stuff still has to patch itself back together. My nipples have a little bit more sensation than they did last time I updated. However it’s kind of weird - when I touch them they get hard, and I can feel something that’s kind of close to erotic sensation, but after a few moments of this they go numb and get super hard and also a little itchy sometimes. Sometimes the incision area swells up a little too, and feels hard and numb. Particularly on the right side, the lower half of the nipple is still kind of hard and lumpy, and protrudes in a kind of weird way. However, I don’t think it’s incredibly noticeable, although you’d probably be able to tell on fairly close examination in real life. Dr. Bartlett said that he’d be willing to revise at no cost (i.e. redo the incision and try something that will make the nipple lie flatter) if I wanted but also said just sitting and waiting would be a good idea. My nips also get kind of dry and itchy, I think because of the weather. I’ve been putting lotion on but asked him if it was okay and he said it was. My chest is still kind of tender in some spots, in the sense that when I got bearhugged from behind by a friend and lifted off the ground it hurt where his arms were crossing my chest and kind of pulling on the skin, but it was okay afterwards anyway.
Bartlett also said my areolas decreased in size. apparently they went from like 30 millimeters all around to 28 by 22 millimeters which is supposedly the ~ideal male size~ hahahha which is funny because I think my nipples look a little bigger than those of other dudes my age and build and ethnicity - so maybe it’s to do with body size overall providing a different scale, since even among skinny Asian teenage dudes I’m still on the way small end of the scale. Who knows lol
regarding T: my hips are definitely still slimming down, my acne may have gotten worse, chin hairs slightly increasing, for some weird reason the hair on my left thigh got a little longer in the last month. It’s also very interesting to just think of where I was at a year ago, since the things that had been kind of bothering me then - the ridiculous black hole of hunger that was my stomach, some of the irritability I was feeling - are either gone or much much easier to deal with. Actually, it’s more like both are pretty much gone. And like, my body just makes me feel loads happier.
Oh, and soon my pre-op photos are gonna be on Bartlett’s website, since I just took my post-op photos today. Maybe in like a week to two weeks? It might be obvious which are mine but idk how comfortable I am with pointing out which boobs were mine
9300 bucks. I don’t actually know what the insurance situation is like right now, mine (Blue Cross Blue Shield Empire) said they’d cover like at least 4000-5000 bucks? We had to make them change their policy a bit because I was 17 at the time of surgery. But my parents have been trying to sort things out and I don’t know whether we’ve actually gotten any money back.
Check the posts I’ve tagged insurance for more stuff, I guess?
Feel free to ask more.
1.5 years on T, 6.5 months post keyhole with Dr. Richard Bartlett, 18 years old
In celebration of my recently turning 18 I am posting some booty pics. I am packing in the photos. (I doubt you would assume that I wasn’t but ???)
Some changes I’ve noted recently/sometime in the past month or three
A billion planks basically. Some stuff like leg lifts on the power tower? But a lot of planks. Currently I can do a two-minute plank relatively easily.
Also I guess I try to eat pretty healthy - I actually really like salad, so that helps.
It’s kind of funny because I really don’t consider myself super cut or whatever I’d honestly offer that maybe 60% of the answer to your question is also “good lighting and a bit of ab-tensing”
edit: if you scroll down my page a little/check in the exercise tag, there’s my workout regimen that I had been following for about a month or two pre-surgery, and I’d been kind of faffing around with weights and exercise and whatever for a good couple of years before that - but since surgery, I really haven’t been in the gym as obsessively as I had been. And honestly I think that’s been nice. Testosterone is still changing my body, making it easier to retain muscle and strength. I’m no longer as paranoid that my shoulders will shrink into oblivion after a while of not working out. Most of what I do now is bodyweight stuff. Pushups, pushups with feet elevated (works shoulders more), planks, pullups/chinups. (I should probably do squats but I’m terrible and neglect my lower body like hell.) Being less stressed, not so crazed about trying to fill myself up with the right amount of proteins or carbs or whatever, or follow the right regimen, may honestly have contributed to my getting a bit leaner recently (thus making some muscles stand out more.)
lol edit was longer than original ask response
17 months on T, 5.5 months post keyhole with Dr. Bartlett
Sorry for being away so long. I’ve been really caught up in a bunch of things offline and also kinda busy moving into college and stuff (that’s my dorm room you see there, if you recognize somehow please don’t out me or whatever) Additionally trans related stuff has been making me +50000 anxious lately for a whole bunch of very ?????? reasons so. Pfffff anyway
Also I no longer have binders available, I donated them all to the In a Bind program, sorry.
I’ll try and get higher-quality pictures up at some point.
Testosterone-wise: my love handles/hips have gone way down. I’ve really stopped being so obsessive about working out - I think the forced break from working out because of recovery (and then because of being busy over the summer) and only really working out maybe a couple times a week, and not going nuts over a plan or whatever, has been really helpful. I don’t know if I’d say I’m more secure since I still do feel pretty anxious about some parts of my body but it’s very manageable and I’m definitely happy seeing progress continue.
There haven’t been a whole bunch of changes recently - honestly it’s more like I don’t give a shit anymore. Like who the fuck cares. I have gotten a little hairier on my belly and some other places I guess. Whatever.
Top surgery wise I’ve also stopped giving much of a shit? Honestly I forget I had it a lot of the time. My pecs are still a little lopsided but that’s because of the muscle being more developed on my left (???? i’m right handed wtf) I’m still numb and a tiny bit tender on my chest, mostly in like an inch or so radius of my nipples. I have a tiny bit of sensation back in my nipples. My left I can kind of feel if I touch the actual sticking-out nipple bit itself, but not really the areola - the right it’s a sort of weird situation, since I can feel sensation in the nipple, but only if I touch along the incision line under the areola and/or directly to the right of my areola (???????) And it’s not exactly the same as the sensation I had before. It’s not particularly pleasurable but mentally it’s pretty nice being able to go like, awww yiss I can feel my nips sort of. Also, my right nipple sticks out a bit more and sometimes when I touch it, it gets hard kind of around the incision. I have no idea what the fuck is even going on there but it really doesn’t bug me and I guess I might ask when I go in for my next Bartlett follow-up.
Being shirtless fucking rocks, also. Basically none of my anxieties re: top surgery came to pass. I forget I ever had it. It’s cool.
Oh yeah, and my drain scars are a bit itchy sometimes. And they kind of got hypertrophic but they just look like pretty bad bug bites or something. I don’t really care much. Besides they’ll fade with more time it’s only been five months.
Again, sorry for the absence.
Okay, so this is extra motivation for me to actually make a proper binder giveaway post, so probably in the next few days.
I don’t want to give any one person priority or whatever - really sorry - I decided it’s going to be raffle style so sometime soon I’ll post a list of the binders I have, along with pictures, so you can decide which binder might be best for you. Then I’m going to make a separate post for each binder and catalog all the likes and then at the end of the time period (probably a week) randomly select one person. You can totally enter more than once btw. There’s six binders total so your chances aren’t horrible. (Also binders101 is doing raffles too for the next few weeks and the binders are all small or xs sizes too so go check those out as well.)
Good luck and stuff!