Transitions – dauntless.love

Timing Surgeries

Since I’m older… it has been important to me to compress my surgical timeline as much as possible. I expected to need five surgeries to complete my medical transition and have completed two so far. I am about 4 months behind my ideal at this point because when I planned things, I didn’t have enough information.

I’d like to discuss what I didn’t know in the hope that it helps others when it comes time to plan their own surgical journey.

When I came up with the list of procedures I would require and started researching doctors, I was careful to consider several things: how impactful the procedure would be for me (how much dysphoria I thought it would alleviate); how much it would cost and how I would budget and pay for it; how available the various surgeons were and what their schedules looked like; and finally the expected recovery times for each surgery.

Here is the thing I didn’t understand or consider. A procedure can have two different “recovery times”. One is how long before you can return to your normal routine. For example, go back to work, resume your normal diet and exercise routines and engage in unusual but normal activities (such as travel).

There is a second stage to recovering from a surgery and that is… when you will be able to endure another surgery. While all of the surgeries I needed fell into the “3 months to recover” for the first category… one specifically had a different timeline for when I could have an additional surgery.

I’m going to use my specific experience as an example, but this could apply to any surgery depending on the surgery and the surgeon’s protocol for recovery. In fact, even the procedure I’m talking about has different “recovery windows” for different surgeons and variations of the procedure.

Definitely talk to your medical provider about both the “recovery time” and “when will I be able to have the next surgery”. This is going to be specific to your case and the surgeon’s practices and even to your (unknowable in advance) recovery and healing.

I’m thinking about my vaginoplasty. There are different variations, but I had a penile inversion vaginoplasty. One of the results of this surgery is that vaginal dilation is necessary after the surgery. This physical therapy follows a schedule that is dependent on your body’s healing process and the surgeon’s recommendations, but generally a surgeon can tell you what their “normal” schedule is, as well as the “worst case scenario” could be.

The reason I’m talking about this is the following: I was “recovered” after 8-10 weeks. I returned to work, resumed exercise and generally did not have any pain while going about my daily routine… however, I could NOT have a surgery at that time. This is because I was on a dilation schedule of three times a day for an hour at a time. It was critically important that I not miss or skip a dilation unless there were no other option because doing so would threaten my continued healing.

Obviously, there is no way you can be sedated for most of a day for a 6+ hour surgery and then recover for days in a hospital and convalesce for weeks if you need to perform an hour of PT approximately every 6-8 hours. This means that until my dilation schedule was reduced, I could not have another surgery that would demand that much “time off” from PT.

I hope this helps you when you consider the order of your surgeries if you require more than one and timing is important to you.

Insurance and Surgery Fees

I’m about 40% of the way through my planned surgical journey and feel like I’ve gotten enough experience that I can share some things and hopefully help others when they are thinking about and planning their own surgical transition.

One thing I have learned that I think it’s important to tell people is about insurance. Lots of people I know who have health insurance are worried about whether their insurance covers some specific procedure or another they want or need. This is always important to find out, but there’s an additional layer you should be aware of. Some doctors are “in-network” with a provider, but an awful lot (maybe most) are “out of network”. This means that while the insurance covers “the procedure”… it probably won’t cover much of the surgical fees.

To be more precise, surgery can be broken down into facility fees (hospital or surgical center costs) and surgical fees (what the surgeon and anesthesiologist cost). Usually a hospital will be “in-network”, but often the doctor will not be. When this happens and the insurance “overs” the procedure, the insurance company will have a schedule of fees it is willing to pay for various surgical services. They will pay a percentage of the fee they decide the procedure should cost, regardless of the surgeon’s fee. You get to make up the difference.

Here’s an example: Surgery is $20,000.00. Hospital cost: $10,000.00. Surgeon fee: $10,000.00. Insurance “covers” surgery. Hospital is “in-network” and insurance covers 80%… so you pay $2,000.00 to the hospital. Surgeon is “out of network” and insurance says the procedure “should” cost $2,000.00. They pay 80% of that, or $1,600.00… that means you pay the surgeon $8,400.00. Your total cost for the “covered” surgery is $10,400.00 out of the $20,000.00 total cost.

You see how this works. Be certain if your insurance “covers” a procedure that you know not only what is covered and at what percent, but what is “in-network” versus “out of network” and what the schedule of fees they “expect” a procedure (or breakdown of any services) to cost.

Finally, don’t forget to get as much as you can “pre-authorized”. If you do not, you end up fighting after the fact for reimbursement. I should add that pre-authorization will not guarantee you won’t be fighting for a reimbursement… but not having something pre-authorized guarantees you will have to fight for your money.

Laser Hair Removal for the Body

In May of 2019 I needed to do something about my body hair. I’m hairy… as in hairy Italian kind of hairy… and I finally HAD to have it as gone as possible. I’d read a lot about hair removal and over the years I’ve literally tried every crazy thing you’ve heard of and some you haven’t. Let me tell you NONE of it worked. Including at least a thousand dollars worth of home laser/IPL devices.

I decided I needed a professional so I started googling around for options. I knew electrolysis was probably going to give me the best result, but I couldn’t afford the expense (or the time) for that. The next best solution for me was laser. I contacted three places, one a national chain, one a local “jack of all trades” doctor and one a clinic specailizing in laser procedures.

I’ll write something about the specific provider I chose for the curious, but I’d like to keep this generic in the hopes that my experience can help the next person get a better result than I’ve had.

Now if you don’t know much about hair removal, have a look at the resources page (or Wikipedia), but the short answer is: “Rome wasn’t built in a day”… and hair doesn’t get killed off in one shot. Because hair grows in 3 stages and it can only be impacted in one of them, and you can’t know what stage any given hair is in… it’s a bit like wack-a-mole where you swat it and it comes back and you swat it again and again until it stops coming back. Additional complications being you can have multiple hairs in different stages growing out of the same opening in the skin and so forth!

Suffice it to say, hair removal professionals know this and will sell you a “series of treatments” intended to eventually get the hair in the right stage by simply repeating the treatment on a time schedule. The schedule is approximate and imprecise and the timing of every human’s hair growth cycles/stages are going to be different. Even to the point that the location on the body and hormone levels impact this. There’s a LOT of luck involved since every single hair can be on a slightly different schedule, and there’s nothing you can do about that aspect except hope the professional’s experience is enough to guide them to making the best schedule choice for you. You can help them out if you know your hair is fast/slow growing… but chances are you don’t because you never actually tracked the growth of specific hair follicles… no one does.

Anyway, the thing you do have control over is the intensity of the treatment. The laser is just a tool that delivers energy into the skin at the site of the hair growth. The idea being that enough energy will overload/kill the cell. Particular lasers are used with particular wavelengths of light to “target” the hair as opposed to the surrounding skin. If the laser delivers the energy to your skin… you end up in the ER with a burn, so you do NOT want that.

The problem is that the laser light is not smart or anything… the way this system “targets” the hair is by targeting cells by color and depth. The laser won’t penetrate inches for example (and doesn’t need to since the hair is within 3/8 of an inch of the skin surface). But the laser effectively targets a color… the pigment of the hair cells will absorb the light, generating heat (energy) and hopefully causes the hair follicle to die. The issue is light hairs are impacted less, and dark skin is impacted more… the ideal candidate for laser treatments is an albino skinned person with jet black hair. Chances are good that’s not you. (It wasn’t me either). But at least I’m relatively fair skinned and most of my hair is between light and dark brown. Anyway, the point here is this… if you have darker skin and/or lighter hair… the treatments will be less effective (or perhaps completely ineffective). Again… there’s nothing you can do about this… you have what you have. The only advice I can give here is: age will lighten your hairs (reduce the pigment amount/darkness), so tackle this before you get too gray.

So… back to the point… the level of laser application is all that’s really completely under your (and your providers’) control. But it’s important to know that there’s no way for them to assess how much energy is too much! Because of that, they’re going to err on the side of caution and start you off low. They have to walk a fine line between enough to get the job done and so much you end up in the ER!

Your job is to let them know if you can take more… This isn’t a day at the spa… it’s not going to be fun, relaxing or even pleasant… if the laser is doing it’s job, it’s going to hurt… the difference is it shouldn’t HURT!!! I can’t really explain it except that it’s like working out… if you’re not sore after the workout… you didn’t do it right, if you know what I mean.

I ended up with the laser at its highest setting and it was still barely noticeable. The problem for me was we didn’t dial it up to 10 until the 4th treatment (out of 6) which means 50% of my treatments were at sub-optimal levels… and therefore substantially less effective.

I wish I understood this from day one when I walked in or I would have told them not just that I didn’t feel anything, but that we should do a test where they treat a small area with several levels and see if there’s any damage/effect. Had we established that I could go to 10 without any burns BEFORE I started treatment I’m sure I would have had a much more successful outcome.

So, let me boil this down to two pieces of advice:

Tackle this before your window of opportunity closes due to age/graying of the hair.
Demand that the provider determine the maximum level of energy for each area of your body BEFORE you actually start the treatments you’re paying for so you get the maximum return on your investment.

I hope this helps… those are the two key things I wish I had known twenty years ago. I doubt it would have changed my timing… career and financial restrictions certainly circumscribed my opportunities (as they probably do for most of us), but the second thing would have made a huge impact for me… probably to the tune of many thousands of dollars.

Good luck!