• Elijah Castle

preparing for a gender affirming surgery consultation

Updated: Jan 17

Gender-affirming surgery is an exciting venture to go through. It is also a process that requires planning, logistics, and patience. This document will help prepare us for the process of going through a consultation.

Before The Consultation

The first step is to find out which health insurance we have, and then find out what surgeons are covered under our insurance. Depending on the type of surgery, out-of-pocket costs can range from a couple thousand dollars to hundreds of thousands of dollars. It is always optimal to have our health insurance cover as much as possible.

Once we find a surgeon, we can call them to schedule a consultation. Depending on the type of surgery and the surgeon, our consultation may be in only a couple of weeks, or it may be in a year. This may feel discouraging, but it is always a good idea to schedule consultations with multiple surgeons, so if we are waiting for one consult, we can always have others in the meantime. It is important to find a skilled and experienced surgeon, but it is equally as important to find a surgeon whose personality we match well with, which is why it is a good idea to talk with at least a couple of surgeons before making a decision.

We will need letters of support for our surgery in order for our health insurance to cover it. Generally, we will bring these letters to our surgeon’s office or fax them, and our surgeon’s office will fax them along with the other necessary paperwork for insurance coverage. We should try to have these letters ready for our consultation, because we will not be able to schedule a date for surgery without them. If we don’t have them ready by our consultation date, we can always send them to our surgeon’s office later on – unless the surgeon requires them beforehand.

The necessary letters vary depending on the surgery, and are guided by the WPATH medical necessity requirements. We may only need a letter from our hormone-providing doctor indicating a diagnosis of gender dysphoria, but for most surgeries, we will need 1-2 letters of support from a mental health provider (a therapist, social worker, psychotherapist, psychologist, psychiatrist, etc.), and one must be from a provider that is solely in an evaluative role, meaning that we do not see them regularly for therapy.

It can be helpful to prepare a written list of questions to bring with us to the consultation. We may tend to get nervous or overwhelmed during a consult, and forget our questions. A written list of questions on a physical piece of paper (not on a phone or tablet) is helpful not only as a reminder, but also to indicate to the surgeon that we are taking notes and have points we want to go over.

During The Consultation

Our surgeon will likely talk to us about our expectations and desired outcome from surgery. They can talk to us about how the procedure is performed and what parts of our body will be affected. They may also do a physical examination.

We should be aware that a consultation can be triggering, as body parts we may currently be uncomfortable with will be talked about.

We will likely also be asked about our care plan for post-surgery. We will need someone to accompany us home from the hospital, and likely help take care of us for at least the first few days post-op, if not longer. We should make sure we have plans in place for having someone to help with things like grocery shopping, doing laundry, household chores, etc.

After The Consultation

We will be able to schedule our date for surgery as soon as the surgeon’s office has all of the documentation they need from us, including our letters of support for surgery. We should make sure we keep in touch with our surgeon’s office to ensure they don’t need anything else from us, and follow up if it takes a long time for them to get back to us regarding a date for surgery, a follow-up appointment, etc. Surgeons who perform gender-affirming surgery are often in high-demand, and so, the offices are often very busy. We may need to advocate for ourselves and keep tabs on them to make sure we maintain communication with the office.

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