So many thoughts on so many topics:
On surgically altering bodies: it’s a big deal for some people and cultures and not for others. You treat it as a big deal because it is a big deal for you. I think this is a wise thing.
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I also think that if you figure out how to make your outsides please you more, it is okay to not have completely figures out all the inside pieces. Sometimes our heart sings and we know we have made the right life altering decision before we can articulate why it is right[/details]
On money and surgeons and aftercare.
Let the money rain down. If you are doing an elective medical procedure, find the right people to do it. There is a huge difference in surgical outcomes, techniques and approaches to surgery.
ongoing rambles
Medical tourism in elective surgery is something that I highly recommend. But not if the goal is to save money. Only if the goal is to go to the best equipped and most successful team. You need a doctor who will understand what you’re discussing especially in terms of masculine vs feminine shapes. They should have pictures to make sure that you agree with each other. There should be ugly and pretty scar pictures and scar placement discussions.
Aftercare should cost a fucking bomb. If I was getting my abdominal fat transferred to my bum, it would happen in Miami, and they would have me twice daily at a clinic for a week after getting manual lymph drainage before I went home with custom compression garments, a list of therapists to get treated by at home, and laser procedures to get after. In Miami, the Bay area, LA, Latin America* and eastern Europe elective procedures come with a serious and effective post treatment plan that probably costs another few thousand but makes the results work. I try to pimp out these post treatment plans to people getting non elective surgery. Usually there isn’t a single studied best practice, but instead a range of practices that doctors are reccomending based on their clinical experience. And many of the awesome doctors are probably within reach of the options available under health insurance, but if possible I wouldn’t want to be limited to doctors under health insurance.
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On Money and Insurance and stuff
35 year old me working in healthcare has more sympathy for the difficulty of insurers deciding what to cover, than 18 year old me does. I unequivocally think that life saving surgeries should always be covered by national health insurance schemes. I think that current legislation in most places makes this incredibly difficult for people
still rambling
who require alterations to internal and external primary and secondary sex characteristics when the person is not following a MTF or FTM path. I expect to see a gender queer person challenge these restrictions, and hope that they already have and have won.
Specific diagnostic requirements or pretreatment requirements narrow the definition of what type of procedure is being covered. Taking female hormones will change the body composition and may start to lay down breast or fatty tissue in the breasts. Taking male hormones may effect body composition and start to change how muscle growth patterns happen. If the intention is to continue these hormones, then you’d want to be on them 12-18 months pre surgery so that your doctor has an idea about how your body works before reshaping.
Counseling before major procedures mb isn’t wide spread enough, but the ways and places it’s enforced in my insurance system are gendered and patriarchical. To my knowledge it is mandatory only before IVF or gender reassignment surgeries. That’s fucking bullshit. But if you work with a good counselor, I’ve heard great things about the experience. Preparing yourself for outcomes, for recovery, for emerging as a new version of yourself. I’ve seen a lot of people who’ve had elective (and usually self funded) surgeries where counseling wasn’t mandated or done beforehand, who would have done well with counseling. Like knee replacements. Let’s get them all in therapy first.
Who should pay? I live in a country with national/provincial health care. I’m writing from that perspective. I find it hard to know which surgeries should and shouldn’t be covered, when we don’t all have dental, vision, and pharmacare. I see people with knee surgeries paid for by the government, where the money would have been better put towards an insulin pump. But we’ve decided that knee surgery is covered at the surgeon’s discretion. So maybe top surgeries should be at the surgeon’s discretion too. But what if your family doctor refers you to a plastic surgeon who doesn’t believe it’s medically necessary for you, but there’s a surgeon in another province who thinks that it’s medically necessary for everyone to choose their own body and is spending provincial money on purely cosmetic enhancements. It’s not wrong of either set of patients to want their surgeries. But neither physician is equipped to decide what’s covered and what isn’t. I could guarantee that if the province let providers choose who needs top surgeries, rich white kids would get a blank slate on reshaping and contouring, while native and recent immigrants were denied life saving surgeries.
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So I can see that somewhere we need to have a line drawn for top and bottom surgery between paid for and self pay. I can partially understand the current laws even though they are bullshit. I know it needs to be challenged and reworked, and that even then there will be cases where people don’t fit in their current body and don’t get funded for surgery and that decision is wrong.
*I’m an asshole, listing US cities and then chunks of continents. But like, I don’t suggest anyone go to Venezuela for surgery today, but I do reccomend going there 28 years ago for some feminizing procedures plus aftercare. And my eastern European patients will literally just say that they had the surgery “in Europe”. Because I guess they are sick of people not knowing anything about Croatia? Or because they left their country while it was still part of the Soviet Union?
Where to get it done, type of surgery, type of surgeon, and-- everyone’s favorite-- the American Healthcare System.
(2020)
It’s, I think, to weed out the “real trans” ??? Because all trans people want to be MEN or WOMEN with the full compliment of hormones, of course. 
Not only do you not want to hinder blood flow and, like, breathing (lol) but if you intend to have surgery later, you don’t want them too tight as that can reduce skin elasticity, something that makes surgeries a little less effective.
I hadn’t read that article before. It’s really sweet. But WOW the emotional energy they put into doing outreach (inreach??? when people come to you? ihni lol) is incredible.
). That’s the good news.