post orchi not having testes was a huge benefit for that - but the empty scrotum would still slap the thighs and make me feel nauseated and upset whenever that happened.

I am on bed rest so I’m not allowed to walk or get out of bed until Friday, so I have no idea yet how walking feels - I am very much looking forward, though - that was one of the biggest sources of genital dysphoria and I can’t wait for it to be gone. I remember post-orchi saying “every step brings joy” because walking used to cause dysphoria and suddenly I could walk differently and feel so much better.

Not OP, but i can say 2 years post op it feels weird to think I used to have something there lol

thank youuuu 🥰

how long it has been since you made your mind for the op?

I was pretty sure I wouldn’t want a vaginoplasty when I socially transitioned in August 2023, but I knew I wanted an orchi.

It was probably around 6 months on estrogen when I realized I needed a vaginoplasty as well, so that was around a year before the surgery - maybe June 2024 (I started HRT in Dec. 2023).

does the public healthcare/private insurance cover the surgery and post op care?

I have insurance through my employer. The total cost of the surgery is $135,000 and insurance is paying for all but $1,400 of it which I have to pay.

how do you plan to celebrate this awesome life milestone with your friends?

I guess I haven’t thought of this at all, tbh - I’ll be moving in a few weeks to another state, so I won’t have time to celebrate (let alone recover!) so my life is just too busy for fun stuff 😅 Also, not sure most of my friends really grok the whole trans thing, so even if I had the time for it, I’m not sure what I would do to celebrate with them.

It’s a good idea, though - I’ll have to ponder this some more ❤️

Did you say anything silly when you were waking up from surgery?

Surgical tech of roughly a decade, here: This almost never happens. Of the thousands of patients I’ve seen wake from anesthesia, exactly 3 of them so far woke up saying funny/weird shit. Two of them were WAY over the top hilariously thankful; and one was completely convinced that we were bullshitting him when we told him his surgery was over and that he was just waking up. He had zero recollection of being unconscious at all: from his perspective, we rolled him into the OR, had him shuffle from his gurney to the OR bed, then immediately shoved him back onto the gurney while saying ‘it’s all done!’. He was a little more receptive to it once he saw the sutures, lol.

The vast majority of people either want to stay asleep, or they wake up kicking and punching.

aw, thank you! And not as far as I know or remember - I’m pretty sober and alert when I wake up from anaesthesia - I also usually have no headaches or confusion like can be common for others, and that was true this time too.

Well, the hospital I am going to has a whole trans healthcare wing essentially, though they don’t call it that. It’s a subsection of the plastic surgery group, but my surgeon in particular works with lots of trans patients.

What I’ve noticed is that they make a standard practice of asking for name and pronouns, and then sharing their own. I personally don’t like this, but I get how it would help with non-binary folks or people who use neopronouns - so I tolerate it 😅 Mostly it feels stigmatizing to me, and when I work with people who know I’m trans it’s a different experience than people who don’t know I’m trans and who just see a woman. Since I just wish I were a cis woman, I prefer working with the nurses that don’t know I’m trans and thus don’t try to treat me differently (even as accommodating or being nice) based on my transness. I don’t want to be trans or treated differently for being trans.

The healthcare team was pretty responsive to my questions through the online portal, and in general seem competent.

My surgeon has awful bed-side manner, despite his excellent skills in the operating room - each time I interact with him I come away thinking he could really work on his delivery, lol - for example, when he saw me right before wheeling into the OR for my orchiectomy, he looked at my thighs and said “you need to lose 20 lbs” - it’s true losing weight can improve recovery, esp. for a vaginoplasty, but the way he put it was so direct and rude. (And tbh a bit hurtful, I struggle enough with my body and weight, and it just felt like a confirmation of my negative self image.)

Right before my surgery yesterday, the surgeon said that if the orchiectomy left a scar that makes it too difficult to him to use the scrotum as a graft, he will just do a vulvoplasty / shallow-depth vaginoplasty and then I would have to come back in 6 months to get full-depth (presumably with peritoneal pull through). For context, we specifically asked about whether the orchi he did would interfere with the vaginoplasty, and he said no - so learning it could right before being wheeled into the OR was anxiety producing since I suddenly didn’t know if I would wake up with a full-depth vaginoplasty like we had agreed on.

Other staff had trouble communicating clearly - like they would mumble or speak too quickly for me to understand what they were saying, but these are more like personality issues.

If you want to know how to work with trans patients I would just think the most important thing is to think of them as their gender - if you have a trans woman patient, just think and treat her as a woman and all is well. Ditto for trans man, and for non-binary patients it’s not that different. Knowing and respecting pronouns, and doing what you can to put in your mind that they are the gender they say they are is probably the best advice I could give.

Relatedly, there are lots of intersex people who are trans, so also not making too many assumptions could be good - sometimes anatomy will be different than you thought for a trans person, i.e. a trans woman might be intersex and not even realize they have an intersex condition which might mean they have anatomy they don’t realize they have, etc.

And when you’re working with trans patients I would say it’s important to just treat them like any other patient - when I looked very trans and wasn’t passing, I often would get this overly nice treatment that felt more like pity than respect or support.

Let me know if you have specific questions I didn’t cover!

Thank you for even thinking about these questions! Remember that trans patients are patients, and while some things can be due to medical transition, not everything is. Unless it’s specifically transition-related care, most of us are just there for a stomach bug, or a headache, or the same procedures everyone else is getting. Ask our pronouns, ask our preferred names, make us feel like all of your other patients. This goes such a long way to making it a good experience. When it does come down to gender expression or transition-related things, ask about preferences and goals. Not everyone is binary. Even the binary among us have different options and plans. And sometimes, we can change our minds about things! Don’t stop being an inquisitive person. Learning gives you options and understanding and empathy, and those are the best tools you can have as a caregiver. Thank you for doing what you do!

Not OP but I went through this in 2017

The good: staff was overall very helpful, seeing my friends was great

The bad: explaining to the chaplain every time he came in that I don’t necessarily care for religion (at least not xtianity)

How long was the waitlist, or the time between your consultation and the scheduled surgery date?

That’s a good question - I started HRT in December 2023, and I couldn’t have any surgeries until 1 year later (Dec. 2024). I knew I wanted an orchi, so during my first year of HRT I got a letter from a therapist for surgery, and then called up the hospital and scheduled a consultation, which happened probably sometime in the summer or fall of 2024 (sorry, details are a little fuzzy here).

Then I had the orchi scheduled with them for December and I started laser hair removal on the genital region a couple months before the orchi as I started to think a vaginoplasty would be a good idea.

Electrolysis for hair removal started ASAP after the orchi, so that was early February.

So overall the wait was like 6ish months since if I hadn’t been so dismissive of my bottom dysphoria and taken vaginoplasty more seriously, I might have done hair removal my whole first year of HRT and then had the vaginoplasty ASAP in December 2024 rather than waiting for June 2025.

Either way, I consider this a pretty short timeline, though I really wish I could have had my orchi when I started HRT in 2023, that insurance requirement to wait a year is blatant transphobia.

Which PIV method did you get? I was looking at a specific method in the northeast and am trying to get an orchi ASAP with a request to preserve some tissue for a specific method, and am wondering if this is the same method. This seems like a VERY short time in the OR.

Honestly I have no idea - I tend to think about getting the best surgeon and then getting whatever method they are best at. Since this surgeon is best at PIV that’s what I went with. I wish I had more details about it, because I’ve never heard of a full-depth vaginoplasty being done in 2 - 3 hours, that’s just insane.

Did you discuss personal priorities with your doctor? I have in mind the juxtaposition of sensation vs function vs aesthetics.

In visits before the operation I did ask the PA and nurses about what to expect in terms of sensation, function, etc. I didn’t give a lot of input on aesthetics, but that’s partially because I’ve seen his work before and it matches what I would like.

Last one: how big was your grin when you woke up and realized everything was the way it should be?

Leading up to the surgery was so nervous I was making a mistake and scared that it would look awful and I would immediately feel regret. Once I was in my own room and could look at it more closely, despite being the first day I felt this immense relief - like I had just shed a mountain of burden. I was shocked to find that I was so extremely happy with the results, and that led to some happy sobbing.

I’ve had intrusive thoughts about cutting off my penis since I was a teenager, and my scrotum has always seemed extremely gross to me - I just coped by not taking those feelings seriously, and so in a real way I didn’t understand my own bottom dysphoria or how severe it was. Right now at least I just feel so much relief and happiness - and I can’t explain why, it just is that way despite not expecting it to be like this at all.

Sometimes people will use vulvoplasty to mean a shallow-depth vaginoplasty, I was just specifying I had full-depth (which has a longer recovery time and more risks of complications. Basically with a vulvoplasty / shallow-depth you have labia, a clit, etc. but no vaginal canal. With a full-depth vaginoplasty you have all the things a vulvoplasty provides (labia, clit, etc.) as well as the vaginal canal (as Ada points out).

thank you!! 💕

thank you 😊

thank you 🥰