Bottom Surgery: Hurdles, Prep and Joy

I’ve known bottom surgery was the answer to a major source of my dysphoria for a long time. Once I was ready to come out in 2021, searching for a surgeon and understanding how to correctly get permission for surgery became my number one priority.

If you’re unaware, a trans person cannot have a vaginoplasty from any reputable surgeon in the US without first meeting certain criteria:

  • A letter from an Endocrinologist stating the person has been on HRT (Hormone Replacement Therapy) for at least one year continuously and a good candidate for bottom surgery.
  • A letter from a Dr level mental health provider.
  • A second letter from a mental health provider.
  • Electrolysis for hair removal on the surgery site.
  • Surgeons will also have their own requirements such as being within a certain BMI range.

By the time I had started HRT I knew what kind of surgery I wanted, a Peritoneal Pull Through Vaginoplasty, which limited my search to what surgeon would do it. I’m lucky enough to live in NorCal and can commute to the bay so I was able to get on the waitlist for my surgeon of choice. His wait list was very long so I knew it’d give me time to get everything done and save up some money.

After securing my endocrinologist for HRT, and I booked a consultation date with the surgeon, I started therapy.I wanted it to work through life in general but also to get one of my letters.

I sought out an electrolysis tech and found a local girl who has been incredible in prepping me for my bottom surgery journey. It took us about a year of electrolysis to get the surgery site completely ready. I went about every Saturday and she always made it feel like visiting a friend.

There’s a gender health center local to me and they helped me obtain my second mental health provider letter. They also helped me with my name change paperwork. They’ve been a great resource to me in my transition.

After a year of hormones, I submitted my letters to my surgeon and I received my surgery date. While waiting for my date my surgeon left the center I was having my surgery through. I found out about my surgeon leaving the center through Reddit…eventually he opened his own practice months later and I followed him there. I resubmitted my letters and had another consult to get my new date.

After a little over a year of working through all these hoops and getting my surgery date back I had a couple work promotions to help me save more money. This was especially helpful because my insurance has refused to pay for electrolysis and I’ve spent about fifteen thousand dollars on it so far.

Some other large life events happened during this time that changed what my care team would look like and how I could best help them.

I started by making a google calendar I could share. I broke down all the individual tasks I do in a given day/week/month and added them to the calendar. I marked individual dog sitting days and the days I’d be in SF (San Francisco) for my pre-op, surgery and post-op in the calendar. I also added labels to all the cabinets in the house to make things easier to find for those helping. Setting up a multi-tiered rack in my room for all the dilation, cleaning and medical supplies was also helpful.

Let me include what I was told to order from the surgeon, what I was told by other people who’ve had the surgery and what I actually used/am using:

What I was told to order from the surgeon

  • White vinegar
  • Vaginal douche
  • Peri bottle
  • Mild soap
  • Wet wipes
  • 4 x 4 in. cotton gauze (pack of 200)
  • Disposable chucks pads
  • Unscented sanitary pads
  • Disposable gloves
  • Water soluble lubrication
  • Donut pillow for sitting

Told by others to purchase

  • bidet
  • leak-proof blanket
  • depends
  • ice packs
  • leg massager
  • vagisil
  • aquaphor
  • antibiotic ointment
  • wedge pillow

What I’ve actually used and replenishing

  • White vinegar
  • Vaginal douche
  • Peri bottle
  • Mild soap
  • (Replenishing) Wet wipes
  • (Replenishing) 4 x 4 in. cotton gauze (pack of 200)
  • (Replenishing) Disposable chucks pads
  • (Replenishing) Unscented sanitary pads
  • (Replenishing) Disposable gloves
  • Water soluble lubrication
  • Donut pillow for sitting
  • bidet
  • leak-proof blanket
  • wedge pillow

Eventually, surgery week had arrived. My friend Ray took me to the train station where I rode an Amtrak to San Jose, then Uber-ed to Redwood City where my hotel was. During my stay at the hotel I began my liquid diet and had my pre-op appointment. During my pre-op appointment it was mostly just reconfirming why I’m there, what the recovery process looks like, and what to expect when I wake up. After the appointment I went to my hotel and lived on soda and juice all day until Katy and Omi arrived.

Surgery day, Katy and I drive into SF and get to the hospital as directed at 5AM. We wait for about half an hour. We’re brought into another room where I reconfirm why I’m there at the hospital and pay the remainder of my out-of-pocket deductible ($1900). We’re then directed to go down the hall, up an elevator, to another room down a hall and call the number on the wall with the phone provided. It was weird, not gonna lie. I follow the directions so Katy and I have a seat and wait in the room with the phone. We both notice a mouse trap under the seats across from us and just look at each other then laugh. A girl comes out to grab me and bring me to the back to prep me for surgery. Katy stays and I go.

I’m given supplies to wipe myself down and hospital gowns to wear while I get warm on the hospital bed. IV is hooked up, stats taken, allergies confirmed and we wait for my surgeon who was stuck in traffic. Katy is allowed with me while I wait. We just hang out being goofs until they take me back. I’m asked to breath into the mask and the next thing I know I’m waking up in a hospital room.

Not long after I wake up Katy and Omi arrive and keep me company as I slowly return back to the waking world. Staying nights in the hospital was exhausting. Constant stat checks and medications I was having to take at odd hours. I would just play games on my switch and take walks around the floor I was on in the hospital. The Blue Angels happened to be doing a show that weekend so I got to see them practice all week from my window over the Golen Gate Bridge. Katy and Omi would keep me company through the day. They also got me a really cute orchid lego set to build that I finished the night before discharge. Eventually I go back home and spend a couple days there before going back to SF for my first post-op.

At my first post-op the surgeon removed my catheter and packing. It was pretty easy and I didn’t feel much. When removing the packing my surgeon said, “this is a game of tug-of-war I will win. Just relax while I remove this packing.” It cracked me up. After some extra inspection the surgeon taught me how to dilate, gave me my own dilator set and concluded our appointment. Ray brought me back home and I got to prepping for my new dilation-schedule-controlled life. Later that evening my girlfriend Kat arrived. ❤

After getting Kat settled in she quickly learned my dilation schedule and the prep involved. She would help setup my prep and check in when my next dilation was. She helped take care of my babies and make home cooked meals during her time here. We went to the park and some restaurants as well to get out of the house. Kat got us the Milky Way Galaxy Lego set which we put together during her stay. She was just simply amazing (as always).

During Kat’s stay she took me to post-op two and three. Post-op two wasn’t much but just a check in to see how I’ve been with dilating and to answer any new questions. Post-op three we did an inspection of my vaginal canal and answered more questions. My next post-op is at the 6 week mark which is when I’ll update this post.

I’ll be adding in my rough total of costs so others can prep better for their journey ahead. Some caveats, I have decent insurance which covered my surgery. My max Out-Of-Pocket (OOP) Deductible is four thousand dollars so I had a ceiling on medical costs. I also live “locally” (2 hours) from the bay and was able to recover mostly at home. As a buffer, I took a roughly ten thousand dollar loan out to help cover surprise expenses and give room to pay for normal living expenses:

  • Hospital Fee: $1900 (with insurance)
  • Surgeon Fee: $1100 (with insurance)
  • Anesthesiologist: $500 (with insurance)
  • Hoteling: $2000
  • Medications: $80
  • 1 year of HRT: $300
  • Misc. Medical Costs: $600
  • Recommended surgeon supplies: $400
  • Electrolysis: $15000
  • Helper food + gas/charge: $1000
  • Standard living costs: $6000
  • Bidet: $150
  • Blanket and wedge: $50
  • Food: $300 + my gf paid for a bunch ❤

Total: $13280 + Electrolysis = ~$29280

As you can see there was a lot of time, money and work put into reaching this point. I’m thankful to everyone who helped and especially to my girlfriend who traveled multiple states to be here with me. Couldn’t have done it without my amazing care team. ❤