Doc Impossible@Impossible_PhD@hachyderm.io
One thing I feel that's less common in the trans community is that there does need to be some sort of "seriously, listen" before most bottom surgeries. The letter system is bullshit, for clarity--I feel this for the same reason that there are those kinds of meetings before other massive surgeries, like open heart, major organ transplants, or total knee replacements.
People who haven't had major surgery before do not understand how hard these are on a body. For a successful recovery, you need major support, lots of rest, and to follow your recovery orders to the letter.
People who're getting bottom surgery deserve to know in detail what that looks like well in advance--and for a vaginoplasty, that often looks like months out of work--so they can be financially, logistically, and socially ready for what that recovery means.
People have waited that long to get the genitals that are right for them. They deserve the very best shot possible at having an ideal recovery, and I've heard an uncomfortable number of stories of people like, turning up in Thailand for bottom surgery without having started short-term disability, because they didn't understand that three-day dilation for three months sometimes means a 4-5-hour-a-day commitment (for gals who have snugger canals and more inflammation, and therefore take longer to get to depth).
Its for that same reason that I believe our current financing/insurance and disability systems are fucking evil, because it's way too easy for the financial part of that recovery (ignoring the up-front cost of bottom surgery) to cost people their jobs and have major financial knock-on effects.
Getting bottom surgery should never risk financial ruin. Period.
Doc Impossible@Impossible_PhD@hachyderm.io
Hmm, what else...
I wish there was better access to surgeons, in terms of wait times and availability of surgeons. There just plain aren't enough surgeons who do this work, especially for phallo- and metoidioplasty. Wait times for medically necessary surgery that range into years is always wrong.
At the same time, I also understand why there aren't more. My mom teaches in a nursing program, believe it or not, and she's the only instructor who even addresses gender-affirming care. There's zero gender-affirming care on any med exams.
That's typical, and it's a big part of why trans broken arm syndrome is so common.
For someone to get into bottom surgery, they basically have to apprentice with an existing surgeon, and that training takes time, which decreases the number of surgeries the surgeon can complete.
It's a catch-22. Either we maximize surgeries now, and accept that as the trans population rises proportionally fewer of us will be able to get surgery at all, maximize training, in which case few people now will get surgery, or the system as more or less it is.
Until gender-affirming care is a significant item on the NCLEX and the USMLE (and equivalent licensing exams internationally), med schools won't teach gender-affirming care, and the problem will stay the same. Med schools crunch out everything that's not a major concern on those exams.
