Please indicate any major medical problems and any previous surgery as well as any current medications. If you have any heart problems, you must provide a letter of surgical clearance from a cardiologist. You may also be required to provide additional labwork or testing prior to surgery. If you are diabetic, you must provide additional labwork within 30 days of surgery. Please contact the office if you have heart problems, diabetes, or any other significant medical conditions, within 6 months of surgery to obtain instructions for possible additional medical requirements.
Per the WPATH Standards of Care, two (2) Letters of Recommendation must be provided for FTM genital surgery, usually by a psychologist or psychiatrist working in the field of transgender healthcare. For hysterectomy, a letter is welcome but is not obligatory, just as it is not for natal women. We’re gradually building a list of mental health professionals who work with the transgender population. If you are having trouble finding someone in your area, or if you are a therapist and would like to be added to our in-office list, please email or call Robin.
Dr. Bowers requires one letter from any PhD or MD therapist/psychiatrist, and a second letter from any licensed therapist. Both letters must follow the format outlined in the WPATH Standards of Care, and one letter must be dated within one year of surgery. Specifically, both letters must include the following information:
The patient’s general identifying characteristics:
- The initial and evolving gender, sexual, and other psychiatric diagnoses;
- The duration of their professional relationship including the type of pyschotherapy or evaluation that the patient underwent;
- The eligibility criteria that have been met and the mental health professional’s rationale for hormone therapy or surgery;
- The degree to which the patient has followed the Standards of Care to date and the likelihood of future compliance;
- Whether the author of the report is part of a gender team;
- That the sender welcomes a phone call to verify the fact that the mental health professional actually wrote the letter as described in this document.
The readiness and eligibility criteria are outlined below:
The minimum eligibility criteria for various genital surgeries equally apply to biologic males and females seeking genital surgery. They are:
- Legal age of majority in the patient’s nation (normally age 18 but increasingly under question). Dr. Bowers is reticent to perform hysterectomy or genital surgery for clients under the age of 18 and does not routinely do so.
- Usually 12 months of continuous hormonal therapy for those without a medical contraindication.
- 12 months of successful continuous full time real-life experience. WPATH standards are less adamant in this criteria although we consider it a gold standard for resolve to fulfill an unambiguous transition.
- If required by the mental health professional, regular responsible participation in psychotherapy throughout the real-life experience at a frequency determined jointly by the patient and the mental health professional. Psychotherapy per se is not an absolute eligibility criterion for surgery;
- Demonstrable knowledge of the cost, required lengths of hospitalizations, likely complications, and post surgical rehabilitation requirements of various surgical approaches;
- Awareness of different competent surgeons.
The readiness criteria include:
- Demonstrable progress in consolidating one’s gender identity;
- Demonstrable progress in dealing with work, family, and interpersonal issues resulting in a significantly better state of mental health; this implies satisfactory control of problems such as sociopathy, substance abuse, psychosis, suicidality, for instance.
In general, despite her misgivings about the Standards of Care, Dr. Bowers is required by the hospital and insurers to require two letters of approval (except patients who can document a real life experience of 5 years or more, in which case just one letter is required). Our rigid adherence to a standard of care allows Dr. Bowers to retain insurance for this important, but still rare, practice of medicine. Please be sure your letters of recommendation are received by Dr. Bowers no less than 30 days prior to your surgery date.
Suitability for Surgery
Please note that the final determination indicating acceptance for surgery is made by Dr.Bowers, usually no later than the day prior to surgery. Consultation prior to setting a surgery date is offered if you are in the area at a cost of $225. Skype and phone consults are $175.
Acceptance criteria include:
- Weight less than 210 pounds (unless height/weight proportional) (If you are over 210 pounds (regardless of proportion or level of fitness) you must let Dr. Bowers know in advance; she will contact you to determine if surgery should be postponed. Surgery simply takes longer in heavier patients and puts you at greater risk for complications, If you arrive greater than this weight, you risk postponement, or you will be charged a $750 surcharge to cover the longer length of surgery.) In addition, both simple meta and ring meta are only appropriate for slender guys with minimal lower abdominal bulk.
- Non-smoker (unless specifically exempted by Dr. Bowers). For smokers, tissue healing is truly poorer and the risk of surgical complications greater.