I have been working towards bottom surgery for years. Having done much research and extensive soul searching, I have decided I want phalloplasty (phallo for short) with urethral extension (aka u hook-up) and scrottoplasty. In other words: I want the ability to pee my name in snow. It’s the little things in life, right?

My top priorities are size and ability to pee out of my dick. A close third is least visible scars as possible. Other priorities that can be more important for other guys include erotic sensation, number of procedures (their toll on body and mind), existing tattoos and scars placements (when deciding donor site, though this is not a concern to all) as well as cost. There are also with all donor sites potential complications (in terms of swelling, grafts not taking, and so on) and it is wise to factor in where one is more wiling or able to handle that. (e.g. I need maximum dexterity in my wrist but I’m not as concerned with my thigh given my lifestyle and hobbies) Also, each procedure (the forming of the phallus, glandplasty, u hook-up, testicular implants and stiffener) comes with potential complications, and not everyone has the same comfort level with those individual risks. In short, not everyone getting bottom surgery gets “the works” even if they can afford it and on some level want it.

There is no “best” procedure for all transmen. There is the better alternative according to your preferences, circumstances and resources. Very closely tied to this is: these are our dicks. They are parts of our bodies, for some the most important one. There are many good reasons not to undergo surgeries (besides it being financially free) just as there are for getting procedure X or Y. People need to be supported for their choices and when applicable, supported to have the ability to make a choice.

I began to see psychs in order to meet certain surgeons requirements and to get letters of support in 2006. I had to be evaluated by CAMH to qualify for OHIP coverage. I have seen all the shrinks I need and letters are signed. *phew* I have sorted out financing the portion I must pay. I will not be discussing those details here but I mention it as financing is a huge barrier for most people wanting bottom surgery even with the coverage possible under OHIP.

I had my first consultation with one of the surgeons I considered in 2008. Two years later, through changes outside my life (i.e. insurance coverage changing, surgeon retirement, malpractice suit), my discussions with the surgeons and changes in my life, it’s come down to two potentials. One is in the US the other in Europe. I am on the lengthy waiting list for the European team for one technique and I meet with the US surgeon offering a different technique next month to (hopefully) make my final decision (and get on his much shorter waiting list).

Why must I travel outside Canada? There are no surgeons who do phallos in this province. There’s a surgical team in Quebec but it only offers the radial forearm phallo and metoidoiplasty (aka meta). Meta offers marginal additional size and the radial forearm technique comes with the more visible scar. There’s a surgeon in Vancouver but he has difficulty getting OR time.  OHIP’s coverage is not the same for all surgeons so besides having to fork over many thousand dollars for surgery, I will have to cover full travel and accommodation costs.

The first difference between the two surgeons/techniques I am considering is the donor site. Once I have decided definitely which surgeon/technique I want, I can start getting electrolysis on the appropriate donor site. I love my fur but I do not want any on my dick or growing inside my extended urethra. Given my hairiness, I will have to start this as soon as I have made a final decision.

With the different waiting lists at play, if I go to the US, I could have the first surgery as early as November and if I go with the European team that could be as early as December. Either way I will not be done the surgical process this year but I will end 2010 in a body noticeably different than present. Woohoo!