I put a call on my Facebook for input from my local trans friends for information on how they acquired top surgery and I think I have a pretty good idea of what is going to happen (although I'm not sure of a timeline yet) and I've actually already contacted both a therapy center and a surgeon's office.
Here's the thing: I've been transitioning for a really long time compared to almost all of my friends. So my perception of how to get top surgery is incredibly skewed, and I had been assuming based on the barriers that used to be in front of me that I would never have insurance that covered this and would have to go to a prohibitive amount of therapy yet again. I had really bad experiences with my HRT therapy, so was planning on going to a particular doctor who does not require letters.
My friends all indicated they'd had to go to basically no therapy to get letters (one got his on his second session, another went to three sessions but ultimately didn't actually need a letter to begin with). So I immediately reached out to a transgender-centered therapist to ask if they did surgery letters (she replied that they do).
One of my friends, though, it turns out he went somewhere super local. Like, in my city. He's a surgeon I've never heard of before, he takes my insurance, and I might not need a letter to go to him. There are some complications there... since I'm not on hormones anymore I don't have a dedicated doctor for trans concerns anymore, my primary care physician has mostly worked with my blood pressure and a few acute maladies, and the folks I used to work with (my HRT provider and my HRT therapist) are basically MIA. I had tried to contact my HRT provider when I was going off hormones and failed, and my therapist is sort of a gatekeeper who wouldn't write a surgery letter without a fuckton more therapy anyway.
The discussion we had about this (reassuring me I don't need to be on hormones anymore to be eligible, etc.) implied that letter requirements are going to be looser than I expected. So what's going to happen now is I'll go to the office, get a consultation, he'll give recommendations on what kind of surgery would go best with my body type, he'll work with my insurance to try to get it covered, he'll get back to me on cost, and we'll go from there regarding whether I need a letter or not.
Again, no clear timeline here, although I definitely would wait until at least after PSG (I assume I wouldn't be able to get it that early anyway!).
I have a couple of concerns regarding nipples, as my friend got his surgery without nipples and I don't know how comfortable I am with that. This is actually really complicated for me in particular because of the following issues:
- I am extremely worried about healing, and getting no grafts will mean no risk that my nipples will fall off in the shower or some other things I see happen to other trans men.
- I am worried that if I don't get nipples I'll feel incomplete.
- If I don't get nipples I have a whole world of tattoo options I can consider (I'm leaning toward getting flowers tattooed there instead, possibly tribulus terrestris).
- My girlfriend likes my nipples.
- ...but I'm actually not a fan of nipple play, as I don't feel erotic sensation in my nipples (the non-nipple parts of my chest have more erotic sensation than my nipples!).
- If I get grafts I will likely at least for a period of time feel nothing in my nipples at all, which could trigger my dermatillomania.
So I'll just bring my concerns up with the surgeon, see if I get any gross vibes from the practice, and go from there.