A reader writes: “I’m 17 years old and have been thinking about and researching FTM transitions since I was 13. I did the ‘wait a year to think about it,’ like you would for a permanent tattoo, for the past four years.
“I decided August of last year that I honestly want to go through with the process. I have friends and a girlfriend who will be there for me, even though I know my family might not be.
“I’m asking you about recommendations and for any advice you could spare. I have a few ideas on how to go about it, but I’m not sure what’s proper, or if there is even a proper way. Like, what kind of therapist(s) should I contact to get the ‘green light’ to start the process, and what kind of doctor should I talk to for treatments and surgery and such?
“That, and I’m not sure which surgery I would go with first, top or bottom. I was thinking bottom, because I heard they can do womb transplants, and I want to give a woman in need something that could make her world – I’m just not sure if I should get that surgery before even doing T so that it would be safer for transplantation. But I really do want to know your opinion on that, on everything!”
I’m going to assume that you’re in the United States, but I don’t know this for sure. I’m not that familiar with health care systems in other countries, so if you are not in the U.S., you would need to check with your (probably far superior) health care system to find out what you need to do. Some countries’ health care plans have very specific steps that must be taken in order to receive transition services that are covered by the health plan.
At 17, you might have a difficult time getting a doctor’s approval for hormones without parental consent. But you will soon be 18, so if this is a barrier, it will go away in twelve months or less.
The first thing that I would recommend is that you find a therapist. Depending on where you live, you might have gender specialists already there who are advertising as such. If not, I would look for a therapist who has something in his or her advertisement about self-discovery, moving past obstacles, living an authentic life, or other phrases that might ring true to you.
Do some research online to see who feels “right” to you, and then start there. You can always change therapists if you’re not happy. And if you have insurance, there might be certain therapists who will take your insurance, which will make therapy a lot cheaper (but will probably also necessitate you coming out to your family). There also might be therapists who operate on a sliding fee scale, so look for those as well if money is an issue.
Although there are informed consent clinics where you can get hormones after seeing an in-house therapist or counselor, and I think this is probably a lot less expensive, I don’t know if there are any near you. I found one list on tumblr. If you do a search for Informed Consent Clinics in your area, you might find one.
As far as getting a prescription for hormones once you have a letter from your therapist, you could really go to any doctor – it does not have to be an endocrinologist or other type of specialist. My hormone doc is a family practitioner. Your own doctor might do it once you have that therapist’s letter.
Again, the only problem you might have here is your age, because a lot of doctors will say, “Come back when you’re 18,” unless you have a parent or guardian’s consent. You will also need money for pre-hormone blood tests and, of course, for the hormones themselves.
For most guys, but not for all, the first step is hormones. And for most guys, but not for all, chest surgery is the first surgery they look at, because breasts are such a strong signifier of “female” in our culture.
Chest surgery will run you about $6,500 to $7,500 for a double mastectomy and reconstruction. Most insurance companies will not pay for this. If you have small breasts, you can often get by with a less complex procedure, such as liposuction. This will be less expensive as well, but again, you’re on your own with regard to costs.
Bottom surgery is even more expensive. Metoidioplasty can run anywhere from $8,000 for the simplest procedure to $42,000 for a complete procedure, including hysterectomy and the works, according to this chart at metoidioplasty.net. Phalloplasty, depending on the technique, can run $65,000 and up.
The type of bottom surgery you get, if any, will depend on what you want and what you can afford. Some guys never get any kind of surgery. Other guys work five jobs and take out second and third mortgages on their house to pay for phalloplasty.
A complete hysterectomy, by itself, can run you around $10,000 to $12,000. Insurance will sometimes pay for this if you have a medical condition that warrants it. Otherwise, that has to come out of your pocket as well. You can see how the costs are starting to add up. I’ve been on T for sixteen years and have not had a hysterectomy.
Now, as far as womb transplants – I honestly don’t know much about this. I think that this procedure is in the experimental stages, and my understanding is that they are transplanting from blood relatives, which is probably necessary at this time to prevent rejection of the organ. I would not base my decisions on some future possibility of this becoming a general practice.
I don’t know your financial situation. I don’t know your insurance situation. And I don’t know how soon you are turning 18. But I honestly think that you might be getting slightly ahead of yourself with your surgery aspirations, and I don’t mean to discourage you. I just think that you need to take things one step at a time.
There’s nothing wrong with having a long-range plan. In fact, I think that’s probably a good idea – “First, I want to do this, then I want to do this, then I want to do this.” That will help you keep your eye on the “prize” and save money accordingly – which is why I would recommend starting with a therapist.
Sit down. Take a breath. Do some research on therapists in your area, and find one that you like and that you can afford. Start there. You and your therapist can come up with your plan for transition. And be patient. Transition is a process, not a product. It can take years, depending on what you need to feel “done.”
Readers, what advice do you have?