2 Weeks Post-Op Stage 2 (Semi-Rigid Rod & Testicular Implants)

My stage 2 surgery was on October 11th, 2016 with Dr Chen at the Greenbrae Surgery Center in San Francisco. The surgery itself went fine and there were no major issues.

TESTICULAR IMPLANTS: The right side of my scrotum ended up being a tad bit smaller than my left side and so Dr Chen had to shave down silicone-carvings-1 that testicular implant so that it would fit into the sack. Had he not done this it’s likely I would have had issues with erosion if he tried to force the full-sized medium implant in. The nice thing about the Silicone Carving implants that Crane/Chen use is that they allow the surgeon to modify and shave it down to the exact size of the tissue that they are working with. That way you aren’t limited to just small, medium, or large which is the case with any of the gel or saline filled implants – rather, you can get the perfect sized ones for your body with the carvings if the space you can accommodate falls somewhere between the factory issued sm/md/lg. The other thing worth mentioning that Dr Chen noticed while placing the right implant was that the skin was fairly “thin” meaning I could be at a higher risk for erosion on this side which was a contributing factor in his decision to shave the implant down a bit to take some of the tension off the already thin skin and smaller space. I appreciate his conservative approach and efforts to not make a risky decision even though I expressed how much I really wanted the largest implants possible and to have two symmetrical testicles. These factors weighed heavily into my decision making process when choosing an erectile implant type, but I far and away prefer having slightly uneven testicles than risking erosion and ending up with only one testicle, or even none! Ultimately though, my hope is that over time the tissue will stretch with the weight of the implant, gravity,  and by manually stretching it myself. Down the road, be that many months or years from now I think it’s reasonable to assume I’d be able to fit a full-sized medium implant in the right side as a small revision add-on while I’m having an erectile implant replacement/switch.

ERECTILE DEVICE – SEMI RIGID/MALLEABLE ROD: The model of erectile device that I had placed is called the AMS Spectra, one rod, not two. Prior to1-ams-spectra_300 surgery we had discussed doubling up on the Gortex sheath that he wraps the rod in, in order to further aid in bulking up the penis. Upon getting inside though it became clear that I didn’t have enough space to accommodate a second layer of the wrapping. So my surgery was similar to the technique he has always used when placing the rod. He also told me that he was really happy with the positioning that he was able to get and the angle at which the rod was mounted.
Everyone’s pelvic bones are angled just a bit differently, so they don’t know exactly how things will end up being mounted until they get inside and look. He said that in the OR he was able to fully bring my penis straight up against my stomach and that I had a great range of motion. However, since I woke up from surgery I have not been able to bring my penis up higher than a right angle from my body. I can make it stick straight out but I can’t

dacron
Image on right is similar to the Gortex (Dacron) used to wrap the rod

can’t bring it fully up against my belly. In the O.R. there is no swelling so it could just be that all the edema is what’s preventing me from getting the same full range of motion. However, I’m also noticing a strong tugging/tension on the underside scar (from stage one) that the runs the length from tip to base on the penis. The lower portion of the scar when I try to bring my penis upwards feels like the point of tension that is making me feel like I shouldn’t raise my penis any further. It’s also worth noting that this portion of the scar is hypertrophic (thick and raised, but clear/white in color) so it’s my intuition that this scar is what’s causing the issue and that the reason he was able to bring my penis all the way up in the OR, was because my pain from over-stretching that scar didn’t stop him while I was under anesthesia. However, Dr Chen said upon physically assessing things at my post-op appointment, that he believed it was the swelling at the pubic mound where the incision to insert the prosthesis was made (photos below) that is likely causing the current lack of mobility/tension. He told me to continue to gently but firmly test my limits for how high I am able to angle it and that he thought I should see improvement as the swelling subsides. I’m trying to stay positive while also being realistic. I truly believe it’s the underside scar that’s holding it down and I’m not sure if or how this problem can ultimately be remedied if that is the case. I don’t think it’s an issue that would inhibit sex, but it could potentially limit sexual positions and definitely already does limit positioning options in my underwear since wearing it down is the only angle it is comfortable in, pointing up is not an option. Time will tell if this ends up improving or presenting as a problem that needs correcting. One option I am beginning to mull over is potentially getting Kenalog injections along the scar which might help flatten it, but I’m not sure that it would impact it’s flexibility/stretchability at all, which I believe to be the true issue. Pre-implants I had been sleeping with my penis in an upright position to stretch/flatten this scar because I had noticed that it was thicker and almost seemed to bunch a bit from wearing my penis down all day since it’s right in the underside crease. I will continue to update about this issue as I gather more information about corrective options or as things hopefully positively progress on their own!

ERECTILE IMPLANT INCISION: I’ll be curious to see how the pubic scar on my mons from erectile-implant-incisionthe erectile implant heals as it’s about 1.5 inches below the SP scar, about 1.5 inches long and located less than one inch above the connection point/scar of where my penis is attached to my mons. I’ve had quite a bit of swelling at this site over the last two weeks. If I’m up and being more mobile (ie: cooking, driving, walking) I notice that the swelling here increases. I’ve been addressing this by icing 20 min on, 20 min off and that has helped to decrease the swelling.

SUPRA PUBIC CATHETER SCAR REVISION: This was a super minor revision and unrelated to the erectile or testicular implants. At stage one in February I chose to keep my SP catheter in for an additional 2 weeks because I had a bit of a urine leak coming from my scrotum. I chose to do this to allow further healing of the UL without the added pressure of urine constantly flowing through the healing fistula every time I peed. In doing so, I added to the amount of scar tissue that builds up around the SP tube from belly to bladder, since the longer you leave an SP in, the more scar tissue that grows around it. What formed was a thick stalk of scar tissue inside my body that ended up healing with some adhesion so that the skin at the point of the external scar does not float and move normally over the structures below it – it remains stuck . I’ve tried manually breaking up this scar tissue with massage,  but the stalk of scar tissue under the skin is far too thick. So I asked Dr Chen to break the adhesion since he was going to be “in the area”. sp-scar-revisionThe first 1 or 2 days post-op I noticed that the skin was free-floating and mobile. But after a few days had passed I tried to move the skin and it had adhered to the stalk of scar tissue below it again. I had a conversation with Dr Chen prior to surgery about the SP adhesion and I asked whether or not he would be removing the “stalk” of scar tissue as well, to which he said: no, he wasn’t going to chase the stalk because that increased the risk of damaging surrounding structures, and he wanted to be as minimally invasive as possible. We discussed this re-adhesion at my post-op appointment and he was disappointed to find out it had re-adhered. He said it was good information to know though, so that if he ever did this procedure for someone in the future he would advise them to constantly be massaging the scar early on post-op to discourage any re-adhesion of the tissues. I will probably have this adhesion broken again at some point in the future but I would only do so if combining it with other procedures. Again, it’s not a big enough issue that it causes pain or distress. I would just prefer the skin float rather than stick as it does make the scar a bit more noticeable. But still, really minor issue and not something that would equate to even being a minor complication, rather just a common factor in healing from any surgery that produces a scar -adhesion is always a possibility.

PERINEAL DIVOT REVISION: My body took a long time to heal from the revision I had back in June to remove some granulation tissue that had formed at the point of vaginectomy closure at stage one. I had a fistula (not urinary related, just a hole or opening) that had a lot of difficulty healing. When I had the revision in June it opened back up and again had trouble healing. When I finally used an antiseptic powder on this site, it miraculously closed. However, it was open for so long that it did leave me with a small divot once it finally healed. This time around this area has healed well and when he did the revision there was no granulation tissue at the site which is great! I haven’t gotten too up close and personal in that area because I’m still pretty limited in how mobile/flexible I can be. Squatting is quite painful and I try no to do anything that increases pain, as those were a big part of my post-op instructions. If it hurts, STOP – or DON’T DO IT! I have used the Columbia Antiseptic Powder a few times just to make sure that area is healing over well, but I haven’t felt or noticed any issues with it. However, it does feel like there is minor tactile difference/dip between the perineal raphe and where it connects to this revised area which is about an inch from the anus. It’s subtle but it’s there. So I’m not quite sure yet if the revision actually improved the divot or not. I thought I would include a diagram of the male perineal area which labels all the different structures as a reference point. I thought folks might find comfort in knowing that many natal males have a visible raphe/ridge that runs from the underside tip of their penis to the anus. Their bodies closed this gap in utero, whereas transmen who have phallo and opt-in for a vaginectomy and achieve this closure via an incision line really aren’t all that different from the natal male anatomy in this sense.

raphe_on_male_geniitalia_with_labels
This is not a picture of my anatomy, this is an example of a natal male.

 

PEEING W/ THE ROD: Initially it was a bit harder to urinate the a couple of days following surgeryholding-a as I’m sure I had a good deal more swelling than I do now. I was also in SOOO much pain when I stood up that once I got to the bathroom I needed to sit down to relieve pain before I was able to relax enough to pee. Sitting to pee is more difficult for me and I think it’s something about the changed angle of the neourethra with the natal urethra ever since stage one that has made it a bit harder to pee in that position. I’ve noticed it takes longer to empty my bladder and my stream is weaker when my body is bent at that angle. The differences I’ve noticed with urinating since the rod has gone in is that I prefer to hold my penis differently now. I instead of holding it in the “A” position (pre-implants) I now hold it in the “B” position. The reason for this, is the rod is now filling up my penis as much as is safely possible without minimizing the needed space for the urethra to expand and fill with urine. If I hold it like photo “A” gravity is angling the rod down and adding pressure holding-bagainst the urethra where my hand wraps around the underside and creates further pressure. I can still pee that way if I really wanted to but I can feel the urethra being somewhat compressed and it’s just more comfortable to give it the full amount of space by holding the sides or top half of my penis so that the underside, where the urethra runs is unobstructed. I meant to mention this earlier, but if the last sentence didn’t explain it and you’re still wondering, the rod is placed on the topside of the urethra… This dick-handling adjustment hasn’t been all that big of a deal. Grip “B” is not quite as instinctual or natural as “A”, but it’s a small price to pay for being the proud owner of a hard dick. Also, if I really wanted, I can easily pee without holding my penis at all since the rod really keeps it at whatever angle I put it in. But it just feels more natural to hold him while I’m peeing. And since I’m not really holding him UP exactly when I’m peeing, I’m really kind of just mostly using my thumb to guide him in the direction I’m aiming, if that makes sense.

BENDING THE ROD/STIFFNESS: The rod is actually a fair amount stiffer than I had anticipated. I messed around with the model that was in the office, but I’m sure that one has seen plenty of handling and was likely much looser for that reason. I do think that even in the 2 weeks since I’ve had it, it’s already started to loosen a bit and I’m quite happy about that. There was a palpable clicking sensation when pointing my penis in different angles. I could also hear a very soft clicking noise as the “joints” flexed into different positions, and I can’t say I found that aspect all that sexy. It made me wonder what that sensation might feel for my partner when I was inside them. I’ll have to get back to you on that one as it continues to loosen up. The good news is that I’ve talked with some guys that have had the rod in for months or even years longer than me and they reported that is did indeed go away! Otherwise the rod is easily bent and positioned with one hand. I can move it up to a right angle and even a bit higher. If I am laying down and I point it to a right angle my penis will stay pretty much at whatever angle I put it in. If I am standing it will want to lower a bit, but generally will stay close to the angle that I put it in when I take my hand away.

(GIRTH) SIZE INCREASE: At this point and there is likely still a bit of swelling along the shaft but not much, but I’ve gained close to 3/4 of an inch in girth. This might not seem like a whole lot, but slight increases in girth are much more drastic than slight increases in length, in my opinion anyway. I feel much more comfortable with my girth now. Ideally I would have landed squarely on the 5 inch mark for a nice beefy thickness, but the 4.5ish range feels like a reasonable size to me as well. I can comfortably live with that and feel satisfied.

GUESSTIMATIONS ON EASE OF PENETRATION: I honestly can’t speak from experience about this for obvious reasons. Being only 2 weeks out I’m nowhere near being able to use my guy for play yet. However, I will say that going into this, I anticipated having far less rigidity than I do. Obviously I was getting an erectile implant for the purposes of topping. But a VERY close second on that list was choosing an option that enhanced my current package and really beefed things up. From obsessively reading phallo listservs over the past decade, participating in groups, and talking with numerous guys who have had different models of the rod, I’ve heard more than a couple guys say they wished their erections were firmer and heard some guys have issues with buckling, or the tip of the head drooping over the end of the rod which was possibly placed very conservatively far back behind the glans, etc. But I must say, I’m impressed. My rod goes all the way to within one cm from the tip of my penis, so I don’t anticipate any issues with the head not being firm enough and causing issues with initial penetration. There is zero droop at the tip of my penis. The rod itself bends easily, yet gentle exploration thus far seems to look like it will be plenty firm enough for sex, both vaginal and anal. Again, I’ll have to give factual, experienced-based updates on this at a later time… for the good of science of course!

SENSATION/ORGASM: This is a big one and I almost left it out. Since the rod was placed I completely lost all sensation in my penis. ALL of it. I had the most sensation at the tip which was incredibly sensitive and a few large spots around the shaft where sensation was coming in. Dr Chen assured me that it really should come back and that it’s fairly common but that it could take a few months up to a year to come back and that it’s likely that the nerves are just in shock. I’ll be totally honest and admit that I’m pretty scared. This fear provoked me into making sure I still retained the ability to orgasm even in spite of not having any shaft sensation. I’m happy to report that all is ok. Although I don’t recommend it, since you’re risking detaching the erectile device, we do what we have to do to manage and get through these really difficult surgeries where there are of course no guarantees and a level of uncertainty even though most guys will make out ok in the big picture. I personally don’t know any men that are not able to orgasm. I know guys that don’t have much or any shaft sensation but orgasm is still possible. I won’t get too much into the mechanics of all that and exactly how it’s possible, but I’ll say that the base where my penis was fixed to my pubic mound, is HIGHLY sensate and erogenous. Actually quite a bit more so now with the introduction of the testicular implants and i believe also the placement of the rod had something to do with it. I can actually “reach” (stimulate) my original smaller buried penis easier than I could pre-implants. Hopefully the nerves are just stunned though and they’ll wake up soon. I’ve spoken with some other rod-guys and they had a similar experience. So chances are everything is fine. I also noticed post fat grafting that my sensation decreased a fair amount for a while. It makes sense if you think about it because they are jamming things down into the penis where the nerves are growing for both the fat grafting and for any erectile device, rod or inflatable.

THE BATTLE OF THE BULGE!: Ok, so I’m pretty IMPRESSED! Again, there is certainly some getting used to this aspect of having a firm penis 100% of the time and never being flaccid. BUT, I must say, I really am enjoying it so far! I feel like it’s definitely had the impact on my self confidence that I had anticipated would result immediately following stage one. Had my forearm contained a more dense layer of subcutaneous fat, I think it’s likely that would have been my experience immediately following stage one. But this stage feels really fulfilling for me because it’s finally “scratched that itch” that I’ve been desperately waiting for since stage one and just never felt like I landed on. I experienced some pretty heavy depression in February after my first surgery, I believe in large part because this basic need I had just didn’t feel met. But now I really enjoy how effortlessly I fill out my underwear and I love reaching down and feeling my full package. I can’t speak from the experience of having had the pump (since I haven’t) and being able to compare this to that. But I do believe this experience is a better fit for me, at least at this point in my life given the current erectile device options that are on the market as well as current options for insanely expensive, “permanent” (lasting up to 2 yrs) fillers to add fullness and bulk to the penis. The pump is absolutely amazing in that it allows for the more natural experience of a flaccid AND and erect penis and all the stages in between of becoming erect and filling up. I do hope I get to be able to experience that some day as well. Clearly that’s the more “natural” option for many, if not most guys that are seeking an erectile device. But with my circumstances, I really do like that even though I’ve ended up with a more modest sized penis both in length and in girth, that I appear to be a show-er now, even if there’s no growing that will be happening later on, no passersby actually know that. That’s been really exciting for me – a definite confidence booster. Here are some quick photos I snapped just to show what my guy looks like in undies. The bulge is definitely MORE noticeable with just underwear – and much LESS dramatic/obvious with shorts or sweats on over the top. Also, keep in mind that I do have some swelling still going on (mostly scrotal)… Once I get back home and have more clothing options to play with I’ll probably snap some better photos in a few different kinds of underwear and types of pants, shorts, sweats etc. and model those for you.

 

SLEEPING: It’s still very EARLY DAYS and so I’m sleeping on my back to not cause any pressure on the pubic connection point. This is pretty miserable because I’m predominantly a belly sleeper, and an occasional but much less frequent side-sleeper. I’ve done a bit of side-napping using two very fluffy pillows propping my legs apart and then propping my penis up a bit so it’s not dangling at a drastic sideways angle. But I’m really paranoid that I’m going to fall asleep and then try to roll the rest of the way over onto my belly. It’s hard to know for sure yet, but I think I should be able to comfortably and safely belly sleep in another 4-6 weeks. I am doubtful that I’ll be able to do as many belly facing yoga poses as I was able to in the past though. I can indeed see this device potentially limiting me in that sense when it comes to lying on hard or even firm flat surfaces. Being a really lean guy means that I don’t have that extra belly or thigh fat to buffer the rod that’s sticking out when lying on my stomach. Hopefully I’m wrong about this though. If it ends up restricting my mobility enough it could be the deciding factor in eventually switching to an inflatable.

THE SHWING!!!: Alright, so I am noticing a bit more movement and jiggling while I walk as the days progress. I’m sure the decreased swelling and the loosening of the joints in the rod are probably equally responsible for that. Things of course don’t flop around nearly as much as they did pre-stage two, and it’s undoubtedly a big adjustment. I enjoyed my floppy dick, but not all the time, and not all that much. I didn’t like how it fell between my legs when I was sitting or driving – I felt like it got lost down there. Of course, the lack of testicles I’m sure played a large part in that too. But overall, I wasn’t all that happy with the size of my package. I had always imagined myself having a lot more going on, even though I’m really not a size queen. Anyway, things seem like they’re loosening up a bit. I notice that it is more likely to swing left to right a bit than it is to go in any other direction when I’m walking. There isn’t much downward motion/bounce since the shaft sits firmly against my scrotum and I kind of curve him around my nuts. I wouldn’t mind a bit more of a SHWING when I walk, but I may get that over time as swelling continues to go down, and the device continues to loosen up a bit with some *ahem*, “use”.

WRAP IT UP: I think that mostly covers things for now. My next post: which is already in draft, will be an explanation of Pump vs. Rod – How I Decided. I’ve been getting that question at least daily and I figured it’d be easier to have a post to direct people too with the long-winded reasons rather than typing the cliff-notes version over and over… As always, if you have any questions please feel free to ask or make requests for specific topics to be covered. I will update on all of these topics again at the 1 month mark. I can’t promise that it will be posted exactly one month post-op to the day, but I am still aiming to get all the correct content in for the listed timelines even if they are days or weeks late to go live. Thanks for reading!

Stage 2 Pre-Op w/ Dr Chen

On October 6th, I had my pre-op appointment with Dr Chen. I thought I would do a rundown on some of the questions that we discussed at my appointment. It’s been a little over two weeks since I met with him about these topics and I didn’t write down too much in the way of notes afterwards, so I’m just doing my best to recall what I can and going off of the list of questions that I had prepared before meeting with him. Here they are:

Me: “Is the semi-rigid rod MRI safe?”

Dr Chen: “Yes, it won’t cause any problems.”

Me: “Will I set off metal detectors?”

Dr Chen: “No”

Me: “Are you familiar with the “no-touch technique”?

(SIDE NOTE: If you’re curious about what this technique is you can check out this link “No-Touch Technique“, in short it’s a draping method used to prevent direct contact with skin (which harbors bacteria) thus reducing the risk of infection during implant surgery).”

Dr Chen: “Yes. What we do is similar and in some ways and actually takes more extensive steps for cleansing the body. The body is cleansed multiple times, even inside the urethra since it’s skin, the body is draped multiple times, we changes gloves and gowns at different points during the surgery. Once we make the incision and create the area for the erectile device a solution is poured into the space and allowed to sit in order to cleanse the area while we change gloves and gowns and prepare the erectile device to be inserted.

(SIDE  NOTE: I wish I had taken notes on exactly what he said in regards to this explanation because it was the most detailed explanation of anything that he’s given me to date. He literally told me step-by-step exactly what they do from the time I was put to sleep up until the last suture is placed and they are finished with surgery. It was at least a 4-minute detailed explanation and really made me feel confident that extensive efforts are taken to prevent the risk of infection – which is a much higher risk with this surgery than any of the others).”

Me: “Do you prescribe antibiotics prophylactically for implant surgeries?”

Dr Chen: “Yes, we prescribe Bactrim which is started 3 days before surgery (technically 2 days, but you take your 3rd day’s dose the morning of surgery). It’s a 10-day course taken twice daily.”

Me: “Do you have any photos or a piece of the Gortex sheath laying around in the office that you use to wrap the semi-rigid in?”

Dr Chen: “Yes, I have some in the other room, one second:”

SIDE NOTE: Unfortunately, I accidentally deleted this photo from my phone, sorry guys. So I’ll have to describe it to you. As soon as I saw this material it reminded me of a Chinese finger trap for some reason, probably because of its tubular nature with an opening at both ends. It was dry and a bit stiff. But inside the body it would be moist and more flexible. It had the texture of a thick woven mesh and was an off-white color as I remember. The semi rigid rod is placed inside the sheath then the ends of the  Gortex material are folded tightly over both ends of the rod and then sutured down securely. It’s my understanding that the sheath is what makes it possible to suture this whole device to the pubic bone, otherwise they would need to puncture the actual device and thread the metal sutures through it which I imagine would eventually cause weakness and breakdown within the device. You have to remember that these rods were designed to be inserted and encapsulated with the corporal cavernosa structures which natal penises have two of. Since neo phalluses don’t have those erectile bodies, suturing this device to the pubic bone is the current work-around for this incompatibility.”

Me: “I’ve heard many guys report that in order to reduce the risk of erosion that very conservative measures are taken, whereas the tip of the erectile device is placed about an inch back from the tip of the penis. I understand that this drastically reduces the risk of erosion but that in addition it causes the head of the penis to kind of droop over the end of the erectile device. This drooping reduces the amount of usable length for penetration (even if only by a little) as well as making it a bit more difficult during insertion since the head of the penis is so squishy. How far back will you be placing the rod?”

Dr Chen: “We should be able to get it quite close to the very tip of the phallus, usually within about 1 cm. Safety is always the top priority though. ”

 *          *          *          *          *

Those were the main questions that seemed relevant to share with you guys. Next post will be an update from the actual surgery itself.

Phone Consult w/ Dr Chen Q&A (Stage 2)

The following is my best recollection from my notes following my phone consultation on August 25th, 2016 with Dr Chen regarding my quickly approaching “Stage Two” Semi Rigid Erectile Rod and Testicular implant surgery on October 11th, 2016. This is by no means a word-for-word account. Rather this is the closest I can share with you of the full extent of our conversation that makes sense to present via this type of platform. This also covers some questions that I have that are unrelated to the specifics of implants but I thought some of you might still be curious about regardless.

Dr Chen is a great guy and an extremely talented and innovative surgeon. I always appreciate speaking with him because he shares information with me that I haven’t had the opportunity to hear or learn about elsewhere. I value how receptive he is to the person he’s speaking with and how willing he is to go into greater detail when he senses someone’s desire to know more than just the glossy basics. I hope you come away with that feeling as well after reading this and learn something new today.

Me: I’ve been experiencing a disturbing dripping sensation internally at the place where I imagine the vaginectomy/colpocleisis was performed. I’m worried that this is a sign that a piece of mucosa that was missed during the initial procedure and that fluid is now building up in this space.

Dr Chen: We actually hear about a lot of weird sensations being reported within the first 6-12 months in that area. And that’s because we cut a lot of nerves in order to close up that area. You’re the first person that I’ve heard describe the sensation of wetness, whereas most others are describing the sensation of tingling or discomfort off and on. If you’d like I’m happy to write an order for a CT scan to take a closer look at that area, I’m not sure if insurance would approve it, but I’m happy to write an order for one and see if they’ll approve it because I’d be curious to see what it would show. But in general, odd sensations in this area are quite common up to around the 12 month mark since the nerves are the things that take the longest to heal.

Also, there is a technique that we used to use when creating the urethra that put the patient at a higher risk for having a urethral diverticulum. We used to use this technique because it minimized how many incision lines there are in the urethra. However, it created “outpouchings” (or side pockets) where urine could collect. It also made it necessary for a camera to be used to help guide a catheter because the the tip could caught in one of the outpouchings instead of continuing along the urethra. What we found is that very rarely, urine would pool and collect in this pocket and cause an infection. If this was the case it would require surgical correction. But we’ve only had one case where surgery was needed. However, I spent a lot of time thinking about how we could do this differently but in a safe way. Beginning August 1st, I started using a new technique. Since using this new technique which no longer creates pockets along the urethra – a catheter can now be inserted no problem without a camera! I mention this because I don’t know if these more recent patients might report a different kind of internal sensation in the first 12 months with this technique since it’s still so new.

Me: This is more of an aside question but just so I’m clear, does this mean that anyone that had surgery with the Brownstein Crane team (you or Dr Crane) before August 1st, would need a camera assisted catheterization?

Dr Chen: Yes, it wouldn’t have to be myself or Dr Crane that did the catheterization, but just as long as they used a camera to avoid those little pouches and be guided into the bladder it wouldn’t be an issue.

Me: I’m guess I’m most concerned about a situation where I might have some kind of emergency need for a catheterization but not be awake to let someone know that it must be camera assisted. If someone didn’t use a camera could they potentially damage my urethra if they tried to insert the catheter?

Dr Chen: It’s possible. I’ll say though that most health care providers are very gun-shy when it comes to new things and a neo phallus is a new thing. It’s much more likely that they would probably just automatically call a urologist.

Me: The other sensation I notice sometimes too is an odd buildup of pressure along the perineum. I’ve sort of asked around and I know that there have been some other reports of wetness sensation from other guys that have had the colpocleisis type of vaginectomy which only partially removes the lower part of the canal and then fulgurates (or burns) the remaining mucosa layer that cannot be safely removed with scissors, which would increase the risk for things like bladder, ureter, urethra, or rectal injuries. But I don’t know that I’ve heard of these same odd sensations being reported by those having a full vaginectomy, which is I guess is a more typical procedure in cases of vaginal cancer where it’s much more crucial that the entire structure be removed and thus the higher risks associated with that procedure are more warranted.

Dr Chen: The way we do it now, I’m VERY confident that I get all the mucosa. I check 2 or 3 times before I close up the vaginectomy site. The one CT scan we got for someone post-op where we used this technique I think is the only CT scan we have on record, which I believe was for a differently related reason. But I looked at the vaginectomy site to see if there was anything going on one month post-op in that area and I didn’t see anything, it was completely closed, totally obliterated. But of course, that’s only a sample size of one.

Me: I guess then I will wait out the odd sensations for now and see if that improves on it’s own. So I do have a very small divet where the hole along my perineum took so long to close/heal. Ideally I would like a flat surface rather than a dip at my perineum. I’m wondering how easily this might be revised during my implant surgery?

Dr Chen: We could. The only downside with that is that it lengthens the time of the surgery and it gets into the area behind the scrotum that’s closer to the anus which could put you at higher risk of infection of some sort. I try to do avoid that area is possible when I do these implants because that’s where a lot of bacteria lay. Now I’m not going to do anything silly like have the implant exposed while I’m doing the perineal revision. I do whatever I can to minimize the risk of infection, so the risk I think, overall is low, but it’s slightly higher when we do revisions in that area.

Me: I see what you mean, so there’s a higher risk of infection with regards to the IMPLANTATION area getting infected, not the perineal area?!

Dr Chen: Yeah, exactly.

Me: Ok, I think I’ll give that some thought then and make a final decision when I come out there to see you for pre-op and you have the opportunity to take a look at that area in person. Maybe in the meantime we can still add those tentative insurance codes to the pre-authorization just in case I decide to move forward with that procedure?

Dr Chen: Yeah, sure.

Me: So in terms of implants, I know I want the largest testicular implants that you can fit. And it seemed like you thought that I could probably accommodate the largest one. In terms of the erectile device I’m probably leaning more towards semi rigid rod than the inflatable, I’m not going to have insurance past around the December mark so I’m trying to think about what is going to give me the best shot at not having complications and also having something that’s going to last for a while. I’m not quite sure when I’ll have insurance again that would cover this. Girth is really the biggest thing for me and obviously I want an erectile implant because I want to be able to have penetrative sex but girth and fullness is really a big concern for me. All the fat grafting melted away and at about 4 or 5 weeks out it was totally gone. I was well informed that there was a high likelihood of that happening, but it was something I was willing to try. So really at this point I’m just focussed on coming up with a solution for what the best option is for giving me the most all around girth and fullness. Not even being super thick, but an all around very full appearing penis and I feel like it has kind of more of a deflated look than I want and so I’m wondering is the rod the best option in terms of fullness? I know you mentioned that the rod is about 30cc in size, what would you say the pump is when it’s fully inflated?

Dr Chen: The measurements for the fully inflated pump, the circumference is slightly larger than the semi rigid. That being said, the inflatable, we can’t wrap it in a sheath all the way to the tip, whereas with the semi rigid we are. So when we add the sheath over the semi rigid, they’re about the same size in terms of girth even though on paper it’s higher for the inflatable. I think girth-wise they’re gonna be the same but it’s basically which one are you more excited about. Is it the inflatable one that’s more natural with more moving parts and a high potential for revisions and surgery sometime in the near future? Or would you want something that’s always semi hard but has a lower chance of mechanical breakdown?

Me: I am leaning MUCH more towards the malleable rod, mostly because it’d be 100% the same girth all the time and then also I would be able to have two symmetrical testicles which feels pretty important to me… Is it possible, you said you wrap it in a gortex sheath, is it possible to layer up on that, to add more Gortex to give even a fuller look?

Dr Chen: We potentially could. I haven’t done that before but, we could. I don’t know what the performance characteristics would look like because we’ve never done that. But if it’s safe to do so we can try that.

Me: The other question I had in terms of girth and being creative and trying to find a solution for that problem because I know you have to be careful about how close to the tip you get with the rod with both the pump and the malleable, but have you thought about or has anyone asked you about using some kind of permanent filler like Juvederm as an extra or addition to the IPP to kind of fill out areas that the rod or inflatable might not reach, like the head?

Dr Chen: No we haven’t tried that. I think that’s a reasonable thought. I would think though that adding any foreign body into that area would require sticking a needle to get the Juvederm there and that then introduces a passageway for bacteria to get to that area. So, I’m not super excited about that, but that’s the main reason why. That’s the only hesitation I have for that. Bacteria.

Me: Ok, well then it probably makes the most sense to do just do the rod, layer up on the Gortex sheath if it’s safe and possible to do so, get the testicular implants, heal up, and then see where that leaves me a few months down the road once any remaining edema has subsided… In terms of how the rod is mounted, a couple of questions, 1.) Will the rod change the angle/direction of the base of my shaft, kind of making the penis come out in front of my body a little bit more?

Dr Chen: It could, for some patients it does, for others it stays the same so I can’t tell you for sure but that’s definitely a possibility.

Me: I enjoy doing a lot of yoga and I’m wondering if anyone reports issues with laying on their stomach? In terms of where the rod is mounted I’m worried that I might displace the mounting point even after it’s fully healed months and months down the road, even after I’m cleared for sex. What am I looking at in terms of mobility?

Dr Chen: Yeah, it can limit how active you can be because it’s always there. Certain positions are not good for it. Belly down might not be comfortable. If it’s not comfortable you shouldn’t do it. The biggest complication we’ve had lately is the attachment rips off the pubic bone. And that’s in guys who are unlucky that get kicked in the groin or pulled to hard, something along those lines. We’ve changed our technique a little bit as we’ve seen that. We’re now using stronger metal wire as opposed to the thick silk suture which is what we used before and usually that worked just fine. But we’re starting to use metal wire now to make sure that that risk goes down.

Me: I’m planning to take a full 6-8 weeks off of work and being incredibly sedentary and immobile during that time to ensure I don’t cause any added strain on the connection points, is it true that even going for a long walk is not advised?

Dr Chen: Yes, anything that causes discomfort. If it’s uncomfortable or painful, stop.

Me: I think those are most of my questions. I did want to also ask though about my SP scar. When I touch it and try to move the skin it feels like it’s completely adhered to my bladder? Would that be correct or maybe it’s muscle?

Dr Chen: Muscle.

Me: Is that something that can be released fairly easily? I know you had mentioned that it’s wise to let the scar mature for a year but I’m trying to finish everything up in this October surgery.

Dr Chen: It’s actually really close to the incision that I make to put the implant in, so there is a good chance that it would just be gone as a part of our procedure. But if it’s too high from where I make the incision I can easily just dissect that way and break the adhesion.

Me: In terms of making sure that I get the largest testicular implants that can safely fit, is that something that needs to be ordered ahead of time? I know a decision about erectile device needs to be made a couple weeks in advance so that it can be ordered.

Dr Chen: Nope, we have all the sizes here and I’ll put the biggest and safest ones in as possible. Safety will always take precedent, though.

          *           *           *           *           *

Well, that was pretty much the bulk of our conversation. There were a couple other minor things that I left out and will spare you, but nothing major. I will however be in the office next week for pre-op, so if there are any lingering or unique questions that anyone has that they haven’t been able to find answers for elsewhere I’m always especially eager to toss those out.

 

7 Weeks Post-op, & Stage 2 Update

Heys folks. Not really a ton to update about this week, in terms of things looking differently, so no pictures. I do have the last remaining stitches from my glansplasty finally flaking off, which is nice. My arm pretty much looks the same as last week as do the rest of my scars. I’m still having a bit of trouble with the hole along my v-nectomy and decided to have a “local” (90 min away) specialist look at it, just to make sure there is no infection and to have someone actually following me, since I’m really not seeing anyone right now. So this afternoon I’m driving to Boston to meet with a urogynecologist… ugh… It’s for the best though. After the appointment I plan to send an email to Crane and follow up with him as well to cross check any instructions I’m giving to make sure it’s safe and he concurs. The main thing I want to confirm is that there is no infection, which it doesn’t look like there is. Last weekend I was running a fever though and feeling really ill, so, another reason to be checking in with someone about it all. The other thing I’m not sure if I should be doing is packing the hole. I know a lot of guys have been instructed to pack their wounds and Crane never told me to do that when I had my last post-op appointment with him. Since I left CA, the hole did open a bit further into an area just below, where the incision line looked weak, so I was expecting that to happen. It’s still relatively small. I don’t think I could fit the tip of my pinky in their. So hopefully after meeting with him and emailing Crane I’ll have some further direction on how to move forward. I think it’s just going to take time, as my understanding with wounds that are holes is that they need to heal/fill in from the inside.

I’m generally feeling really well! I had initially taken 3 months off work and I’m now considering going back a month early! I feel strong. To be honest I probably could have gone back at 6 weeks, it would have been tough, and I’m glad I’ve had the extra time to take it easy and continue to heal, but I just don’t know that I need an entire extra month. Depending on how today goes, I might contact my employer and let them know. The hole along the v-nectomy is sore and annoying, but it’s really not bad enough to keep me from working. My arm is still stiff and not 100% but I think working will just be further exercise and rehab for it getting back to normal faster.

Lastly, I’ve scheduled my date for stage 2!!! I currently have a date to get the inflatable pump and one testicular implant on October 11th, 2016 with Chen! At some point I’m going to have a phone “consult” with him about some remaining questions that I have surrounding the surgery as well as the best practices they use. So I won’t get into all of that right now, but I will eventually do a detailed posting with the info I find out. I’ll check in again at 8 weeks.

6 Weeks Post-Op

Well, another milestone. Today makes 6 weeks since I had RFF with Dr Curtis Crane in San Francisco, CA. Things are coming along well. I did make a brief post when I had noticed that my small urine leak which was coming from my scrotum, closed up. Since my last big post at 4 weeks, the biggest changes have been that my scrotum stopped leaking (both urine and other fluids that were draining), and my SP (supra pubic) cather was removed. Those two things were HUGE for me. Honestly, since the time I started plugging my SP (at 13 days post-op) and was able to ditch the catheter bag, having a SP catheter got A LOT easier. It wasn’t a big deal – it wasn’t exactly ideal either, but it was manageable. It was mostly just annoying, and thankfully not painful. But still I did have a constant worry of something accidentally getting snagged on my tubing (even though it was under my clothes), or accidentally tugging on it with my hand when I would reach into my underwear to adjust my guy (that WAS painful). There was also general tenderness around the opening where the tube entered the body and the need to clean the opening a couple times per day so the scab didn’t take over. So while it wasn’t a huge deal to have the SP, and I mostly tried not to think about it, it was an utter relief to have it removed.

Before SP Removal.jpg

I felt human again afterward. From the time you arrive at the hospital the morning of your surgery and get that first medical device hookup up to you (usually an IV) you’re connected to a ridiculous amount of stuff – both devices and bandages, for many weeks. So as you shed them, one-by-one it’s like coming to life again. It seriously felt like being reborn, especially with the introduction of your radically altered anatomy!

After SP Removal.JPG

Everything felt new and fresh and I was soooo grateful for the freedom and mobility that has come with each new step towards full health. haha. It’s like that scene in Forest Gump when the bullies were chasing him down the dirt road and Jenny yells: “Run, Forest, RUN!!” And as he does he starts to bust out of the leg braces that he’s been wearing forever to help straighten his back. Annnd, life is just never quite the same again.

FOREARM: My arm is doing well, and looking super healthy:

Top Side @ 6 Weeks.JPG

At this point the graft is 99% healed and has been for a while. I’m well past any fears with it “not taking” which can be worries early on with patches looking odd and all sorts of colors going on.

Underside @ 6 Weeks.JPG

There are too teeny tiny scabs still present, both existing along incision lines. One where the two grafts are sewn together:

Graft Merge @ 6 Weeks.JPG

And the other along the edge of one of the incisions that meets the “bridge”. If I am too rough with massaging it with lotion they will open a bit and bleed the slightest bit. You might not even be able to see them in the photos because they are so tiny…

Bridge @ 6 Weeks.JPG

I continue to have some mild to moderate swelling in my hand. The amount of swelling really fluctuates depending on how much I’m using my hand and what I’m doing with it. The more physically demanding, the more edema.

Hand @ 6 Weeks.JPG

Funnily enough these two hand pictures were taken just moments from one another. Just an example of how deceiving photos can be. You don’t really see how swollen my hand is without the comparison to my non-donor hand, and the different angle helps too:

Hand Comparison @ 6 Weeks.JPG

I also continue to have some moderate swelling along the tattoo/incision line towards my elbow. But otherwise, the “leash” incision line has flattened out really well. Initially there were some weird puckers going on and they’ve completely smoothed out without a whole ton of effort on my part, just minor occasional massage.

Leash @ 6 weeks.JPG

Finger strength is pretty good. It was measured at my OT appointment 1 week ago (3/10/16) and it’s almost 2/3 of my non-donor arm. I think my grip strength with my left hand was 70lbs and my right was 45lbs. So still strong, but indeed has a long way to go. Wrist flexion continues to be my biggest noticeable issue/hinderance with my donor arm. I’m hoping in another 6 weeks that I’ll have about 80% (or more) of my range of motion back. I’m currently going to OT 2x per week. I planned my surgery to happen at the beginning of the year so that once I hit my max out-of-pocket the rest of my care for the year would be free. So my OT appointments are totally free now. No co-pay and no co-insurance. I think I have 35 visits per year, so I’m utilizing all the “free” care that I can get. I could certainly rehab my arm myself, but since I have the time and the free care, there’s no reason not to take advantage of it, it’s part of why I planned things the way I did… I’m using Eucerin on my forearm 1 or 2 times a day (I applied it more frequently initially). I have my silicone sheet that I just got recently –> Cica Care Silicone Sheet and I’m planning on wearing that for at least 6+ hours at a time to really help continue to flatten the scars out and blend them in with the surrounding tissue. This silicone sheet is VERY comfortable!

Cica Care.JPG

There is also a much cheaper option of a silicone sleeve that you can find on Amazon for a fraction of the price. It was recommended by Olga, one of the hand therapists at CPMC and she said has been used by a lot of guys. Depending on your graft size, you might even be able to cut it in half and get TWO sleeves out of it. You can find it here –> Silipos Gel Tubing. I was also given a cheap compression “sleeve” at OT (the one that’s cut off a long wheel and then they cut a hole for your thumb):

Compression Sleeve.JPG

It’s ok. I’ve worn it a couple times. It’s long enough that it covers the area I’m experiencing edema along my tattoo at the beginning of the “leash” incision point. They do wear out after a week or so of use and you eventually need to replace it. The other issue is that it doesn’t provide full compression coverage in my hand where the majority of my edema is. So I’m overall not into it, since it doesn’t address my main need from a compression garment at this time.

My hand therapist also fitted me with a relatively cheap compression glove at my OT appointment and charged me $12 for it. You can buy them here.  –>  Isotoner Glove. I ended up being an extra small. You might want to just have your hand therapist measure you for one so you don’t order the wrong size. It seems as though I’m a medium in most other gauntlets that I had been looking at online, so I was surprised when I was an extra small for this one.

Isotoner Glove.JPG

Today she started me using thera-putty and charged me $7 for one container of the orange strength.

Putty.JPG  Putty.2.JPG

FYI, you can buy a set of 4 containers/”strengths” on Amazon for $9 with free shipping –> Therapy Putty. I’ve always been given putty for free at every other OT location, so I was surprised they charged me for the putty and the glove. I have even been given a silicone sheet for free which are much more pricey than putty and an isotoner glove.

I’ve been given lots of hand exercises to do, with and without putty. I’ll include photos of the exercise sheets. From my first appointment at 10 days post-op, till present:

IMG_2402.JPG

IMG_2404.JPG

OT @ 6 weeks.jpg

THIGH: My thigh continues to itch like CRAZY! I’m often tapping or slapping at it though my sweatpants to make it stop… it doesn’t. So lotioning is really the only thing that helps. I’m applying lotion and massaging it probably 5-8 times per day. The lotion feels good but the massage really helps to stop the itching for longer than just a quick “rub & run” application (*wink). When I’m massaging it I can really see how the tissue is healing. I’m better able to see which areas are going to fade sooner than others and the general look of the scar is less severe after spending just 3 or 4 minutes doing this. I’m still experiencing drastic changes in the scar color depending on what I’m doing and what my body temperature is. If I’m colder or well vascularized it’s still turning a dark purple color:

Purple Thigh.JPG

If I sit down and rub my thigh for a minute it turns this pink color again and the purple fades away. This is just my personal experience with new scars – it will eventually stop.

Pink Thigh.JPG

PHALLUS/PEEING: Man, I feel like I am like an 8 year old boy. I am sooooooo grateful to have a penis and be able to pee from it. That function alone has totally transformed how I feel IN and ABOUT my body. When I stand in front of the mirror and look at my shape I am still just utterly amazed. Standing sideways looking at my profile and seeing my penis jutting down and slightly out is just so amazing. Even the color changes when I stand up – it flushes and turns a shade of pink, especially in the glans!!! I wasn’t expecting that and I view it as a total bonus for the time being, even though I’m planning on having veins tattooed and adding a more natural or flushed genital skin tone at some point. I honestly still can’t believe it, there are so many feelings I am still processing about all of this – mostly gratitude and joy. At times it’s just so overwhelming and I can’t fathom the reality that I am finally a man with a penis that I can relate to, and that I feel whole. I feel more whole than I ever dreamed was possible with this process. I’m not sure if this statement will convey what I mean for it to, and I hope that it doesn’t come across as offensive, because I certainly don’t mean it to. But I don’t feel like I have a phalloplasty – I just have a penis. And I’d imagine that’s probably a really common experience among the men that have this surgery. From the moment I woke up from surgery, I immediately felt it was mine, but when I had my glans done 15 days later, I deeply related to my phallus as the intrinsic piece of my body that I had been mourning for 31 years. The flesh, the warmth, the hang, the jiggle, the sensation of it in my hand as it fills up like a hose and thickens when I pee, and having something to shake off after I’m done. I’m sure these things sound ridiculous and silly to to people that haven’t lived with a missing body part that’s integral to so many different daily bodily functions, as well as being so intimately woven into their gender identity. But these seemingly “small” things have radically transformed my life in ways I don’t know that I’ll ever “get used to” or have the capacity to take for granted. When you’re life’s biggest need and deepest wish convene and MANIFEST, new ground is broken and what lies beyond is completely unknown territory. I feel like a massive mental landscape has been swept clear for me to focus on other crucial areas of development, growth, and pursuits that I was incapable of fully accessing till now. I still have lots of healing and stage 2 (erectile and testicular implants) to take care of, but the majority of the emotional shift for me with this surgery has already occurred and truly exceeded my expectations.

GLANSPLASTY: I am now 4 weeks out from this procedure and my glans is healing SUPERBLY! I haven’t had any issues with it since the bleeding drama I had while in SF. Once that was stopped using a 10 min pressure hold by Chen at CPMC, there have been zero issues. I was applying a layer of bacitracin to it 2-3 times per day for like 2+ weeks and then stopped about 10 days ago. There are still visible sutures present at the glans. I don’t pick at or try to remove them. I just let them do their thing. If they clearly appear to be unattached and dangling, then I will give a gentle tug or trim it. But only if it’s long or likely to snag on something.

GLANSPLASTY INCISION: This incision is of course also 4 weeks old, as it was the location where the graft was harvested to use on my phallus for the glansplasty procedure. The incision line looks beautiful. It’s thin, and very flat. I can still feel a few sutures present. Again, not messing with them. I’m happy to let them hang out till they’re ready to let go.

Glansplasty @ 4 Weeks.JPG

You can also sort of see the SP scar hidden in a nest of pubic hair. The scar has an interesting shape to it. It’s fully closed, and has been since within 24-hours of the catheter being removed (10 days ago). However, I feel like the pubic skin while I had the catheter, was being pulled down by the weight of my phallus more so than it was when they initially placed the catheter. At the time of placement, my phallus hadn’t yet been created and so I don’t think there was any tug happening to pull the skin down, I was also in a supine position. But after 4.5 weeks of having it in and the skin being pulled down a bit by the weight of my penis while I sit or walk, I think it contributed to a bit of a dimple. Here’s a closer look at it:

SP Scar @ 6 weeks.JPG

When you have an SP in the body starts to create a tunnel of skin that heals around the tubing. Once the tube is removed and the hole closes up, but the outer tunnel/scar tissue still remain. So when I press/rub on the scar I can feel where the tunnel used to be. I haven’t done any massaging of this scar yet, but I think with a little regular effort working at the adhesion, I can likely resolve the minor dimple.

NERVE HOOKUP INCISION: I’m fairly confident that all the sutures have finally dissolved/fallen out along this incision. I have done ZERO massage or moisturizing of this area – I probably should as it would likely help to lighten the scar. The nice thing about it though is that it largely blends in with my natural hip/groin crease.

Hookup @ 6 weeks.jpg

SENSATION: I still only have partial sensation in my scrotum. The far right side (opposite of the nerve hook up) is highly sensate (both tactile and erotic) but the rest is still numb. From what I understand this is not unusual and sensation could take many weeks or months to return. In terms of the phallus, I have both tactile and erotic sensation in some spots on my mons pubis around the connection point of the phallus. I was not expecting this, this is new. It’s a radiating sensation that feels like it’s coming from my pre-surgery penis – it’s interesting. Also, when I tug on my phallus or when I walk around with no underwear on, press my hips up against a counter that I’m leaning against, or grind into my bed while I’m laying on my stomach, I feel erotic sensations coming from the base where the little guy is buried. I started having orgams at day 34, just shy of 5 weeks. Having the ability to both pee from my penis, and orgasm is a total relief. Knowing that I can already orgasm while having zero sensation in my shaft, and that things are only going to get exponentially BETTER… well, it’s a beautiful life. I’m really looking forward to the nerve hookup growing in, but I am surprisingly not desperate for it. It just feels like an exciting bonus that I’m going to slowly start to experience – an unfolding of sorts. The painfully long wait just for my penis to be here and to gain the ability to stand to pee made me all the more grateful for it. I anticipate a similar experience in that over the next 2.5 years while full sensation grows in, in equal parts will grow my gratitude for that gift of that sensation, having had to wait for it as well.

VAGINECTOMY: I am continuing to deal with a pretty minor hole that opened up along my vaginectomy incision line. This experience is all too common and usually rectifies itself – so I’m not too worried. In the meantime it’s mildly annoying because it is leaking a very tiny amount of fluid (far less than it was initially) but it’s also tender and sore if I sit completely upright and put pressure on it. I keep it clean and dry and do a visual check of it almost everyday with a mirror. There looks to be no sign of infection, no puss, no red irritated skin around the small opening. However, to be on the safe side I did reach out to my local provider who performed my hysto exactly 4 years ago. She doesn’t personally do vaginectomies so she referred me to a provider that does. So I’m going to call on Monday and see if I can get in to have him take a peek at the wound and possibly swab it just to make doubly sure that there is no infection going on. It’s always good to play it safe. While I do feel somewhat self conscious of that area seeing as there is currently a form of small hole going on, I feel safe knowing that the provider who did my hysto and performs them on tons of transmen, gave me the referral. I also received a call from Crane’s office today and one of the nurses was checking in on me. I updated her about this issue and she reassured me that this is super common and eventually it WILL close up, but that it wouldn’t hurt to get it looked at by a professional. Hopefully by the next time I make another update it will have closed up/filled in. But I know it’s not uncommon for it to take many months at times. I can’t complain, this is a very minor thing and everything else has gone so well.

STAGE TWO (IMPLANTS): I’m currently aiming for stage 2 with Chen in San Francisco. Crane said I could have that done as early as October, which is when I’m hoping to be scheduled. I’m waiting on a call back from their scheduler to set an exact date. The plan right now is to get the inflatable, and one testicular implant, since the implant will utilize one nut for the placement of the bulb to pump up the inflatable. I hope eventually they design the bulb on the pump to emulate the size and shape of the testicular implants that are available. It’d be really nice to have two testicular implants that are more closely symmetrical. I don’t think visually it will really be noticeable, but it would be nice to feel the symmetry as well. Until just recently with the “Zephyr Implant Line” up and coming there were no erectile prosthetic implants that had been designed specifically for the neo phallus, and the FTM one at that! The current pumps with their odd shaped bulb is designed to be implanted in the cis male scrotum, and the patient retains both of their testes (assuming they have two). So it was never meant to replace a missing one, as it should in our case… I’d be tempted to ask for two testicular implants as well as the pump and just have the bulb be a third entity, as it is in natal males that have an IPP (intrapenile prosthesis) or ED (erectile device). However, it’s my understanding that the European teams site that the most common reason for failure of the pump is typically related to tightness and lack of space in the scrotum. For that reason alone it wouldn’t be worth it to me to risk it. I think I will be getting the Coloplast inflatable and either a medium or large testicular implant (whichever fits).

Alright. That’s all I got for now. I’ll catch ya again probably around 8 weeks if I feel like there have been some changes that seem worthy of posting about in the next couple of weeks. Take care guys. Thanks for reading and of course, feel free to ask any questions or make requests.