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Dr. Miroslav Djordjevic – FTM Metoidioplasty Surgeons, Part 4 – Dr. Miro, Serbia

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Dr. Miroslav Djordjevic

Dr. Miroslav Djordjevic

Dr. Miroslav Djordjevic is one of the best known surgeons performing metoidioplasty and has contributed significantly to the development of the procedure. As he is often referred to simply as Dr. Miro that’s what I will call him for the remainder of this post.

Dr. Miro is an Assistant Professor of Surgery at the Belgrade University Medical School and a  Urology Specialist. He previously worked as part of a team with Dr. Sava Perovic, another well known SRS surgeon. Together, they’ve authored many academic papers on SRS procedures, including this excellent journal article in 2003, Metoidioplasty: A Variant of Phalloplasty in female transsexuals. All trans men curious about metoidioplasty will want to read this.

Ethan posted a detailed backgrounder and account of his consultation with Dr. Miro on his website, so I’ll avoid duplication and simply suggest that you check it out.

Dr. Miro was very quick to reply to my emails and provided plenty of helpful detail with his answers.

Questions and Answers

What meta procedure do you offer for trans men?

Metoidioplasty with urethral extension and scrotoplasty.

Vaginectomy is usually done at the same time but is not required.

What is your current pricing (2008) for this procedure?

University Hospital: €9000 EUR plus the €780 EUR for the testicle prostheses
St. Medica: €10,000 EUR plus the €780 EUR for the testicle prostheses

At today’s currency exchange rates, this works out to:

Facility CAD
( 1 = 0.619613 EUR)
USD
(1 = 0.786475 EUR)
University Hospital $15,784.04 $12,435.23
St. Medica $17,397.95 $13,706.73

These prices include all anesthesiologist and facility fees (and do not include vaginectomy, per my request.)

Is an in-person consultation required prior to booking surgery?

A consultation is required, but it can be done via email.

What kind of waiting list do you have?

[No answer provided, will ask again and update this info.]

Do you perform this in one or two surgeries?

One surgery.

Where do you perform these procedures?

University Hospital or St. Medica in Belgrade, Serbia.

Do you require patients to stop taking testosterone prior to surgery?

Yes, patient must stop taking testosterone 2-3 weeks before surgery.

How long is the hospital stay?

2-4 days in hospital, then stay in the area for 10-14 days.

What tissue is used for the urethral extension?

We use a buccal mucosa graft for urethral reconstruction because it is very good material that is similar to urethral mucosa. We also use the part of anterior vaginal flap in reconstruction of the bulbar part of the urethra to prevent the possibility of having the fistula at that point.

How long is the suprapubic catheter left in?

The suprapubic catheter is left for 4-5 weeks after the surgery.

[This is a big difference from Dr. Bowers (within a week) and Dr. McGinn (10-14 days) and deserves further explanation. From Ethan's site:

They have had a much lower complication rate when leaving the suprapubic catheter in for at least 4 weeks, as compared to 2-3 weeks. With the suprapubic catheter, the only thing that prevents you from urinating out of the new urethra is voluntary holding of urine (ie. you could urinate out of your new urethra from the very beginning, but they recommend waiting at least 4 weeks to allow it to heal). At the end of 4 weeks, you can begin urinating out of the new urethra. The suprapubic catheter should remain in place for the first 2-3 days while you are using the new urethra. If everything goes well using the new urethra, you can simply pull the suprapubic catheter out yourself at home, and the hole in the bladder will contractually close immediately. They recommend you take antibiotics to prevent any bladder infections.]

What are the common complications with these procedures?

Urethral fistula occurs in about 25% in patients when vaginectomy is not performed. This is because of the strength of the urine stream at the point of anastomosis of native and neourethra.

How many times have you performed metoidioplasty with urethral extension?

[I didn't ask this question directly because it's well-known that Dr. Miro has performed more than 100 metoidioplasties with urethral extension and scrotoplasty.]

Please note: This information is provided for information purposes only and in no way should it serve as a replacement for your own research and consultations. My intent is not to find a “winner”, but to figure out which surgeon I am best suited to. We each have unique requirements and criteria, so please don’t go on my word. At the same time, there are plenty of questions that surgeons have to answer over and over, so hopefully this series will cut down on some of that repetition.


Metoidioplasty  Surgeons

Also see: Metoidioplasty Surgery Guide

FTM Surgery Support Forums


Posted in Metoidioplasty and Scrotoplasty Tagged: grs, metoidioplasty, srs

DHT Is a Controlled Substance in Canada

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All About DHT for Transgender Men

As I recently indicated in a comment response, I still don’t have the DHT cream that I got a prescription for on December 2.

The pharmacy where I took the prescription tried obtaining DHT to make the cream from several distributors, but were unsuccessful. They referred me to Victoria Compounding. I reached their pharmacist on the phone and he informed me that DHT is a controlled substance in Canada—a narcotic, in fact. I found this surprising since I’ve never seen testosterone referred to as a narcotic. (It’s not listed on the International Narcotics Control Board’s  List of Narcotics Under International Control.) He repeatedly told me that trying to import DHT would be illegal. He wasn’t particularly friendly and made me feel like I was trying to buy smack or something.  Other than telling me about another testosterone cream he compounds with an aromatase blocker (which I doubt would be as strong or effective as DHT in the context of my intended use) his only recommendation was to obtain a government exemption.

I hung up the phone a little confused and disappointed. After all, if I’m going to drop $30,000-$40,000 on a dick, I want to do everything I can to get the best results. And, two out of the three surgeons I’m consulting with recommend DHT cream use pre-op.

Several patients of Dr. Miro have reported that they obtained DHT cream directly from him. When I asked him about DHT cream, he recommended I buy Andractim DHT Gel online. I’m not inclined to buy it online for a few reasons though:

  • The product is alcohol based and may cause a burning sensation when applied to genitals. Try that three times day.
  • It’s expensive and requires me to purchase a prostate  screening kit with my first order. (UPDATE: Simply check off “female” when ordering and you won’t have to buy the kit.)
  • How can I trust that what I receive really is DHT and the concentration specified? I’ve never bought anything from an online pharmacy located in Cyprus… have YOU?
  • And of course, I have to remember what the pharmacist said: it would be illegal for me to bring it into the country anyway.

I called my doctor’s office today and asked them if they had any experience with applying for a government exemption. The answer was no. However, the receptionist said that if I do the research to find the right forms from Health Canada, she’d ask my doctor to review the application and submit it if he supported the action.

I found a few things on the Health Canada website:

  • Office of Controlled Substances
    Manages an exemption process that allows individuals with legitimate scientific or medical reasons to possess a controlled substance.
  • Exemptions
    What’s missing here is the “Application Form For An Exemption To Use A Controlled Substance For Medical Reasons.” Hmm…

I also called the Office of Controlled Substances but it was too late in Ottawa, Ontario at the time of my call, so I left a detailed message. (That should raise an eyebrow come Monday morning…)

I suspect that my application will also need to be accompanied by some research, journal articles,  clinical info about DHT for FTM genital growthsomething more than “some guys say they got dick growth.” I recall Dr. McGinn telling me there was no clinical research available, so I’ll probably have to collate related studies and explain that those results, along with the recommendations from surgeons, suggest a valid reason for exemption. I’m not holding my breath, but I do plan to see it through as far as I can. Man, what a trans guy’s got to do to get a wee!

UPDATE, Jan 24: When I did my T shot earlier this week, I pulled out the leaflet that comes with the vial and noticed that it read: “testosterone is a controlled substance.” The difference with DHT is that it’s not marketed in Canada. In order to get an exemption, I’ll have to show that products that are currently marketed in Canada will not suffice, and that DHT cream is my best option.


Posted in Metoidioplasty and Scrotoplasty Tagged: ftm, hormones, metoidioplasty, Testosterone, transgender, transition, transman, transmen, transsexual

The ongoing saga of obtaining DHT in Canada

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After numerous phone calls to Health Canada and getting shuttled around department to department within the Office of Controlled Substances, it’s now clear that the Canadian government doesn’t really know anything concrete about the status of DHT in this country!

I won’t bother going into the detail of the circuitous, runaround conversation I had today with the Special Access Program rep, but I will reveal the outcome of our dialogue: Health Canada has referred me to a drug distributor in Ohio, USA to find out if and how my pharmacist can import DHT from them. That’s right: Health Canada doesn’t know how Canadian pharmacies get DHT, and want an American company to tell us how it’s done. I really am laughing. I’d be more frustrated if this wasn’t so hilarious.

I tried ringing the person at the US company but got her machine, so I passed on the contact info to my pharmacist since I think they’d have a more constructive conversation anyway.

I hope to update this story soon with some forward motion!


Posted in Metoidioplasty and Scrotoplasty Tagged: ftm, hormones, metoidioplasty, Testosterone, transgender, transition, transman, transmen, transsexual

DHT and determination

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All About DHT for Transgender Men

DHT is currently being shipped to my compounding pharmacy!

After passing on the information (or lack thereof) that I sourced from Health Canada last week, my pharmacist took the reins and sourced my DHT through PCCA. He had to write a letter requesting access to the drug, but we’re now just waiting for it to come in. It should arrive later this week. At that time, the pharmacist will be able to compound the cream for me.

It would seem that in the case of DHT, determination pays off.

If you are wanting a prescription for DHT, speak with your doctor or endocrinologist. Be prepared to present some detailed information about DHT, especially if you’re approaching a GP, who’s unlikely to be aware of it. Please keep in mind that they may deny you the prescription. If successful, take your prescription to a compounding pharmacy. If they don’t know where to get DHT, tell them to contact PCCA. If they tell you they can’t get it, persevere. Anyone in North America should have access to DHT with a valid prescription.

I just called the pharmacy in Victoria, BC where I previously spoke to a pharmacist who rather gruffly told me I couldn’t get DHT, and I informed them that their information was incorrect and out of date. Hopefully that will help out the next guy who tries to get DHT from them. I’ll call Health Canada tomorrow and let them know as well. Sheesh.


Posted in Metoidioplasty and Scrotoplasty Tagged: ftm, Testosterone, transgender, transition, transman, transmen, transsexual

Using DHT for FTM genital growth

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dht-me

All About DHT for Transgender Men

Lost in all the hubbub about my hysterectomy and resulting VVF complication, is the fact that I finally obtained DHT cream and started using it on April 29th.

I have a three-month supply of 10% DHT compounded into a non-alcoholic cream.

The total cost for this was $630… but, British Columbia PharmaCare ended up covering $468.18 of this, leaving me with an expense of $178.80.

My dosage is 20mg topically applied three times a day. My pharmacist wisely packaged the cream in syringes which makes dosing really easy: at 20mg / 0.2ml, one line = 0.2ml = 20mg.

My blood work requisition that was originally ordered by my endocrinologist over a year ago recently expired. Since I have just had a hysterectomy and expect my hormones to jump around a bit, I asked my GP to write up another requisition for a year’s worth of monthly blood work. My free testosterone on April 22 was high, at 117.6 pmol/L (25-89 is normal range.) Considering this, and the fact that that I am now adding DHT to the mix (which can raise testosterone levels slightly) I have dropped my dosage of injectable T to 150mg / 2 weeks (down from 200mg) as of my last shot on April 29.

dht

I’ve written about DHT here before, including information about what DHT is, how to legally get DHT, and about DHT being a controlled substance. I also recently put together a video for my YouTube channel all about DHT:

While DHT is responsible for beard growth, paradoxically, one of its potential side effects is hair loss. DHT leaves a waxy substance at the root of hair follicles on the scalp that can inhibit hair growth. Saw palmetto berry extract is a natural product that’s found in many DHT blocking preparations. While taking a DHT blocker internally would counteract the effects that I’m aiming for, could saw palmetto be topically applied directly to the scalp to help block DHT at that specific level?

dht-sawpalmettoHairGenesis has a line of hair products with saw palmetto as a primary ingredient. They claim clinical studies have shown effectiveness at combating hair loss. I spoke with my pharmacist about saw palmetto berry extract and blocking DHT topically, and he thought it was worth trying. Initially, I’d purchased saw palmetto berries to make a strong tea from that I could add to one of my thick conditioners. However my pharmacist thought I’d get more benefit from a tincture. Today I started using saw palmetto berry extract tincture: 9 drops diluted in 1/2 cup of water, massaged into my scalp. I’ll use this daily throughout my 3-month trial of DHT. (UPDATE: 9 drops was not enough. I wound up using 30-60 drops daily.)

I don’t plan on using DHT longer than 3-months. I’ve taken photos and measurements of myself pre-DHT and will repeat this monthly. Whether positive or negative, I’ll report my findings here. Every body responds differently to hormones, but with more anecdotal information, we’ll start to get a better idea about if DHT cream is something that’s worthwhile for trans men to use to encourage genital growth.

Have you used DHT cream? Please leave a comment and let me know how it worked for you!

FTM Surgery Support Forums


Posted in Metoidioplasty and Scrotoplasty Tagged: dht, metoidioplasty

DHT discontinued, no longer available through PCCA

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All About DHT for Transgender Men

Alex tipped me off about a possible supply problem with DHT in North America. I had my pharmacy contact the PCCA yesterday and it was confirmed: the PCCA is out of stock and their supplier has discontinued the manufacture of DHT. While there may be other suppliers in the US that I am unaware of, my pharmacy was only able to obtain DHT through the PCCA. Unless another manufacturer steps in, the supply of DHT for trans men in Canada just dried up like the rivers of Mars.

Thankfully, I got my 3-month supply, and my trial with DHT has been positive: I’ve achieved about 1 cm of growth in 2.5 months. I don’t plan on using DHT again until/if I book a metoidioplasty surgery. If I do have a meta, I will want to use DHT for 3 months pre-op, then again for 3 months after a few months of being post-op. Hopefully by that time, DHT will be available again in North America (without having to buy the 2.5% Andractim Gel online.) I mean really: it’s a proven enlargement product! There should be a huge market for it.


Posted in Metoidioplasty and Scrotoplasty Tagged: dht, ftm, metoidioplasty, Testosterone, transgender, transition, transman, transmen, transsexual

Dr. Toby Meltzer – FTM Metoidioplasty Surgeons, Part 5

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Dr. Toby Meltzer

Dr. Toby Meltzer

Originally, Dr. Toby Meltzer was not on my radar as a potential surgeon for metoidioplasty, mostly due to cost. However, Dr. Meltzer’s reported 2% complication rate stuck in my head. Inspired by my hysterectomy experience, reducing the risks of complication is my top priority.

I had the chance to see Dr. Meltzer’s presentation, FTM: GRS, at the Gender Odyssey conference last week in Seattle. These are the points that stuck out for me in his talk:

  • The complication rate with urethral lengthening without vaginectomy (colpocleisis) can be 15%-20% higher. (Dr. Webb states this is actually 40%-45% higher.) Vaginal secretions into the surgical site just don’t contribute to good healing.
  • In his practice, vaginectomy takes just over an hour, has limited blood loss, and has a less than 1% complication rate. (He recalls one bladder injury.)
  • Metoidioplasty with urethral lengthening takes 2 – 2.5 hrs.
  • Pumping works. It enlarges corporal bodies and skin. Recommended both pre- and post-op.
  • Growth can continue post-operatively.
  • Atypical bacteria is found in androgenized vagina (re: weakened vaginal tissues from testosterone use.)
  • Hardest part of urethral extension is getting the curve right. There are no “L” or “J” urethroplasty procedures or methods. The goal is an “L” shaped hook-up; poorly executed the result is a “J.”
  • There are no long term complication risks to his knowledge. Once you’re past 6-12 months post-op, there’s no complication that could occur that couldn’t be handled by any urologist.
  • Dr. Meltzer displayed photos of excellent looking metoidioplasty results from his patients.
  • See further notes below about complication rate and tissues used for urethral extension.

That evening, I also had the opportunity to have an in-person consultation with Dr. Meltzer. I found him and his two staffers to be friendly, easy to talk to, and very knowledgeable. I told him how impressed I was with his complication rate (which is even lower than 2%!) We briefly discussed why he doesn’t use vaginal tissue for urethroplasty and how that relates to my theory that trans men are at higher risk for post-hysterectomy VVF than women are.

We also talked about scrotoplasty. When Dr. Meltzer talks about “scrotoplasty” he’s referring to the surgical procedure of moving and rotating the labia majora, then fusing them into a scrotal sac–without implants. If the patient desires implants, expanders and implants can be done at a later date. Dr. Meltzer sees no issues with waiting years for implants, or not having them at all, and he will do scrotoplasty–without expanders or implants–in combination with vaginectomy, and metoidioplasty with urethral lengthening.

Dr. Meltzer offered to do a simple visual exam to ascertain my suitability for urethral lengthening based on my dick size. I mentioned to him that I’d used DHT for three months. He said, “Well, keep doing whatever you’re doing because you’ve got great growth!” I asked him what kind of post-op length I could expect and Dr. Meltzer gently grabbed my dick between his gloved fingers and pulled it straight out. “There’s your length!”

I’m extremely impressed with Dr. Meltzer, his low complication rate, the very swanky surgical venue and the North American location. His pricing is higher than my other options, but after my hysterectomy experience, I would pay twice as much to avoid a complication (and this is coming from someone who has saved $0 for bottom surgery.) If I were booking surgery tomorrow, it would be with Dr. Toby Meltzer.

Questions and Answers

What meta procedure do you offer for trans men?

  • Metoidioplasty, with or without urethral extension, and scrotoplasty.

  • “Scrotoplasty” refers to the surgical procedure of moving, rotating and fusing the labia majora. Scrotoplasty may or may not include expanders and/or implants.

What is your 2008 pricing for this procedure?

  • Vaginectomy: $8,073
  • Metoidioplasty with scrotoplasty – no prosthesis: $9,750
  • Primary urethral lengthening: $12,950
  • Total: $30,773 USD.

Is an in-person consultation required prior to booking surgery?
Yes. The cost for this is $100 USD.

What kind of waiting list do you have?
It’s recommended to book your consultation 2-3 months in advance. The waiting list for a surgery date is about 6 months, but those with more flexible schedules may be able to take advantage of a short notice cancellation.

Do you perform this in one or two surgeries?
Vaginectomy, metoidioplasty, scrotoplasty (no prosthesis) and primary urethral lengthening can be done in one stage. If scrotal prosthesis is desired, expanders can be put in 6 months post operatively (Stage 2), and replaced at a later date with a permanent prosthesis (Stage 3.)

Where do you perform these procedures?
Greenbaum Surgery Center, Scottsdale, Arizona, USA.

Do you require patients to stop taking testosterone prior to surgery?
Yes, patient must stop taking testosterone 2-4 weeks before surgery and can resume normal administration post-operatively.

How long is the hospital stay?
2-4 days in hospital, then stay in the area for 14 days.

What tissue is used for the urethral extension?
Labial tissue and the urethral plate. Sometimes buccal mucosa is used (inner cheek) but it’s not preferred. Vaginal tissue (anterior vaginal wall, mucosa) is not used. Androgenized vaginal tissue is weakened and more prone to fistula. Future plans include experimentation using small intestine for urethroplasty.

How long is the suprapubic catheter left in?
This depends on the patient’s healing progress, but typically it is removed 21-28 days post-op.

What are the common complications with these procedures?
Since 2003, Dr. Meltzer has had just two patients with a [notable] complication: one with a fistula (which healed spontaneously) and one with a stricture (which was healed with a simple outpatient cystoscopy.) Note: I’ve inserted “notable” into the claim above because I’ve learned that surgeons and patients don’t necessarily have the same definition of “complication.”

How many times have you performed metoidioplasty with urethral extension?
Dr. Meltzer has performed more than 800 FTM lower surgeries. He has done metoidioplasty with urethroplasty many, many times, but I don’t know the exact number. My guess is that he has the most experience with these procedures in North America.

Learn more about Dr. Meltzer:

* UPDATES to Ethan’s consult:

  • The vaginectomy now removes all vaginal mucosa.
  • Dr. Meltzer no longer uses vaginal mucosa for urethroplasty.
  • Dr. Meltzer’s OB/GYN Dr. Webb reports minimal blood loss with vaginectomy: 125 – 300cc. Only once did he have a patient require as much as 800cc. Many surgeons talk about 1 L of blood loss and multiple blood transfusions. Dr. Meltzer’s team has not experienced this.
  • Dr. Meltzer will perform scrotoplasty at Stage 1—but without expanders or implants.

Please note: This information is provided for information purposes only and in no way should it serve as a replacement for your own research and consultations. My intent is not to find a “winner”, but to figure out which surgeon I am best suited to. We each have unique requirements and criteria, so please don’t go on my word. At the same time, there are plenty of questions that surgeons have to answer over and over, so hopefully this series will cut down on some of that repetition.


Metoidioplasty Surgeons

Also see: Metoidioplasty Surgery Guide

FTM Surgery Support Forums


Posted in Metoidioplasty and Scrotoplasty Tagged: dht, metoidioplasty, scrotoplasty, vaginectomy

Second Round of DHT Cream

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I recently obtained some 10% DHT cream and today started a second round with topical dihydrotestosterone.

I originally used DHT for dick growth back in 2009 and was pleased enough with the results to give it one more go. Honestly, I have low expectations this time around — it’s likely that I’ve already maxed out my DHT receptors — but I’m hopeful enough to try again. I’ll take what I can get!

It’s long and uninteresting so I won’t bother with the details around why it took me so long to pick it up, but this DHT is from the original supply that my pharmacist obtained for me three years ago. I asked my doctor to provide me with a new prescription and got the last of what was available, about 25ml. I estimate this to be about a 4 week supply. Unfortunately, PharmaCare didn’t cover any of the expense this time so I paid $270.49 CAD.

Once again, I’ll use the same dosage: 20mg 3x daily. I will not be adjusting my testosterone dosage in any way.

Saw Palmetto Extract & He Shou WuI did experience hair loss when I used DHT the first time, though I also had some success at slowing that down with topical saw palmetto extract. This time I’m using the SP extract again (to help prevent DHT build up in hair follicles), along with a tea of He Shou Wu (aka Fo-ti), as a topical rinse after showering in the morning. He Shou Wu is a popular TCM herb for promoting hair growth, and it also has DHT-blocking properties.

Even though I only have a month’s supply and I’m not certain that this is necessary, I plan to cycle the DHT cream in an attempt to further mitigate hair loss: something like 2 weeks on, 2 weeks off.

DHT has been extremely difficult to source in North America for the past few years, and I don’t expect to be able to get more. One last kick at the can!

For more about using DHT cream, see my 2009 blog post, Using DHT for FTM Genital Growth, as well as my article at TransGuys.com, DHT for Transgender Men.


Filed under: Metoidioplasty and Scrotoplasty Tagged: dht

Dr. Christine McGinn – FTM Metoidioplasty Surgeons, Part 3 – Ring Metoidioplasty

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Dr. Christine McGinn

Dr. Christine McGinn

Dr. Christine McGinn performs the Ring Metoidioplasty technique, and has worked with Dr. Ako, Dr. Bowers, and Dr. Sherman Leis.

I sent an email to her office via her website and was responded to quickly by her office assistant who notified me that Dr. McGinn would be in touch with me directly about my questions. I then heard from Dr. McGinn who requested my phone number. She called me five minutes after I emailed it to her. I very much appreciated the chance to speak with Dr. McGinn personally. She called herself a “straight shooter with no bull” and said she has a “conservative approach to get the best possible results.” I instantly liked her. She answered all of my questions in depth and exhibited a willingness to share and inform.

Questions and Answers

What meta procedure do you offer for trans men?

  • Ring metoidioplasty (Stage 1) and scrotoplasty (Stage 2).
  • Ring metoidioplasty includes urethral extension.
  • Scrotoplasty may include fusing of the labia to create a single scrotal sac. This depends on the amount of labial tissue present and would require an in-person consultation to assess.

What is your 2008 pricing for this procedure?

  • Stage 1: $15,500 USD (metoidioplasty with urethral extension)
  • Stage 2: $3,800 USD (scrotoplasty)

This includes all anesthesiologist and facility fees.

Is an in-person consultation required prior to booking surgery?
A consultation is required, but it can be done on the phone. The cost for this is $150 USD.

What kind of waiting list do you have?
3-4 months advance booking.

Do you perform this in one or two surgeries?
Two. Stage 2 is performed a minimum of 6 months after Stage 1 is completed.

Where do you perform these procedures?
There is a choice of two hospitals: DSI of Bucks County in Bensalem, and Doylestown Hospital, both located just north of Philadelphia, Pennsylvania, USA.

Do you require patients to stop taking testosterone prior to surgery?
Yes, patient must stop taking testosterone for 1 month before surgery.

How long is the hospital stay?
2-4 days in hospital, then stay in the area for 10-14 days.

What tissue is used for the urethral extension?
Vaginal tissue.

How long is the suprapubic catheter left in?
This depends on the patient’s healing progress, but typically it is removed 10-14 days post-op.

What are the common complications with these procedures?

  • Stage 1: Fistula, strictures.
  • Stage 2: Extrusion is “common.”

How many times have you performed metoidioplasty with urethral extension?
Participated in 10 simple metas, 5 metas (with urethral extension); independently performed 1 ring meta (with urethral extension).

Learn more about Dr. McGinn:

Please note: This information is provided for information purposes only and in no way should it serve as a replacement for your own research and consultations. My intent is not to find a “winner”, but to figure out which surgeon I am best suited to. We each have unique requirements and criteria, so please don’t go on my word. At the same time, there are plenty of questions that surgeons have to answer over and over, so hopefully this series will cut down on some of that repetition.


Metoidioplasty Surgeons

Also see: Metoidioplasty Surgery Guide

FTM Surgery Support Forums


Posted in Metoidioplasty and Scrotoplasty Tagged: grs, metoidioplasty, srs

DHT Cream and Pumping for FTM Genital Growth

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All About DHT for Transgender Men | Buy DHT Cream

The administration of testosterone causes the FTM body to try it’s very best to grow a penis. More specifically, a trans man’s clitoris* typically grows to about the length of a thumb (though size varies with each person.) Genital growth is highly desired by trans men seeking a metoidioplasty. Are there ways to optimize that growth?

Yes!

While there aren’t any clinical studies proving these techniques are effective in trans men, two of the three surgeon’s I have been consulting with have recommend DHT cream and pumping to maximize growth and improve final surgery outcomes. Dr. Bowers doesn’t discourage these methods, but she doesn’t specifically recommend them. Dr. McGinn concedes that there aren’t studies to prove results, but does recommend DHT cream and pumping. Dr. Miro (aka Dr. Djordjevic) not only recommends DHT cream and pumping, he also thinks these techniques work.

DHT Cream for FTM genital growth

A 10% concentration of dihydrotestosterone cream is what’s recommended. This is not the same thing as testosterone cream or testogel/androgel. These can be applied topically for genital growth but have a lesser effect.

Dihydrotestosterone or DHT is a metabolite of testosterone and is 3-30 times more potent than testosterone. The body converts some testosterone into DHT with contact to the 5a reductase enzyme. It plays a very important role in facial and body hair growth, voice changes, sex drive, and growth of muscle and genital tissue. Unlike other androgens such as testosterone, DHT cannot be converted to estradiol. It is not anabolic, so it doesn’t build up in tissue, muscles and bones.

DHT can be topically applied to the clitoris in a transdermal cream formulation. It should be noted that estrogen is responsible for the growth of labial tissue, so DHT should not be applied to the labia if a scrotoplasty is in your future. One could try a topical estrogen cream for this, but that’s outside the scope of this post. (UPDATE: I’ve since read that labial and scrotal tissue are completely analogous. It’s unclear if it’s testosterone or estrogen that has a greater effect on growth of these tissues.)

Topical DHT shouldn’t drastically affect your testosterone levels, but it is wise to observe your moods and keep an eye your blood work and adjust as required. (Remember, bio-men with T naturally in their systems use DHT cream.) Because it isn’t converted to estriadol though, it shouldn’t cause the feminizing side effects that too much testosterone can. You may want to get your T and DHT levels checked periodically throughout your use of DHT cream.

You can buy DHT cream online without a prescription. You can also ask your doctor for a prescription and take that to a compounding pharmacy. (This is what I’m doing in an hour.) You’ll want to be very clear however that they don’t make it with an alcohol-based gel, which can cause a temporary burning sensation for some people. (UPDATE, July 2009: DHT is no longer being manufactured in North America. You may have a hard time getting a prescription filled at this time.)

Dr. Miro recommends a minimum of three months of usage prior to surgery, and suggested that the longer you’re using DHT cream pre-op, the better. (UPDATE: This may not be true. In a clinical study, the mean increase rate (153%) in the first 4 weeks of treatment was higher than that (118%) of the second 4 weeks.)

Apply the DHT cream in small amounts (20mg) a few times a day.

Pumping for FTM Genital Growth

Pumping is another technique that’s recommended to stimulate genital growth. Basically, we’re talking about application of low pressure vacuum or suction to the clitoris. The immediate effects of pumping are temporary but pumping over time stretches genital tissues and can lead to permanent enlargement in some people. It’s recommended for pre-op trans men as well as 6-12 months of post-op to ward off retraction (shrinkage.)

Pumping is safe when done properly. If overdone however, you can cause nerve damage. The rules of thumb are: never pump dry (always use a lubricant), when starting out don’t pump for more than 15 minutes, use mild pressure, and stop pumping immediately if you experience pain or any bleeding. We’re talking about genitals here—be conservative!

Here are some resources for learning more about pumping:

Videos about FTM pumping:

Cheap ‘n’ Easy Trans Man Penis Pump

Pumping and Testosterone Cream for Dick Growth

Conclusion

When performed in conjunction over a period of time, DHT cream and pumping can provide extra genital growth that can put metoidioplasty results over the top. While they’re not guaranteed to work for everyone, these techniques seem a small and worthwhile time/money investment that can potentially improve surgery results.

*Note: I realize that some trans men find the term “clitoris” offensive, but I’m using it here for clarity.

FTM Surgery Support Forums


Posted in Metoidioplasty and Scrotoplasty Tagged: ftm, grs, metoidioplasty, srs, transgender, transition, transman, transmen, transsexual




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