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merginglane · 7 years

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Top Surgery with Dr Esther Kim at UCSF's Center of Excellence for Transgender Health

I wanted to give a detailed account of my experience with Dr. Kim at UCSF because when I was considering her as my surgeon, I couldn’t find a lot of info outside of UCSF’s own literature.

UCSF In General

My experience with Primary Care at UCSF (Dr. Madeline Deutsch) hasn’t been great -

I’m nonbinary, and they aren’t great at allowing for that. They pretty much make you (at least on paper/in the system) identify yourself as FTM or MTF.

When I switched my insurance back to Medi-Cal and thus my Primary Care to Dr Deutsch at UCSF, they were never able to get my prescription for T worked out with the insurance and I wound up having to pay out of pocket one month (ultimately was able to crowdfund for almost the whole $500 cost thank you to my AMAZING support network), getting another month’s supply of T from a friend (LUCKY), and still having to go like 2 weeks without T, at which time I had given up on UCSF and switched my prescription back to Planned Parenthood who got me T in a VERY timely fashion (THEY ARE AMAZING).

It is EXTREMELY hard to get ahold of Dr. Deutsch.

So I was hesitant to seek top surgery through them. However, my insurance covered it and I figured at least it was the same internal system, so perhaps the paperwork would be minimal (which ultimately proved about half true).

Preparing for Surgery

I started the process of getting all the paperwork lined up for top surgery in January 2017. I almost had everything all set up in the beginning of March when I recieved an email from Dr. Deutsch telling me that she had seen that I was seeking top surgery and that I needed to make an appointment with her to discuss this (despite my efforts to try to contact Dr. Deutsch in January about this and being unable to). Her next available appointment was 1.5 months later, mid-April.

When I showed up at the appointment, Dr. Deutsch told me that it wasn’t even necessary for me to come in and made me feel like I had sought that appointment of my own volition.

Luckily, after that appointment everything moved fairly quickly. I made an appointment with Dr. Kim for a month later, mid-May. I had my appointment with Dr. Kim and was pleasantly surprised to get a surgery date for 2 weeks later - June 5th. The only commentary I have about Dr. Kim from that appointment was that she didn’t really tell me much, she expected me to have a lot of questions and when I didn’t have many, she just wound up leaving a lot unexplained. Sure I should have had more questions, but she also could have just given me an overview of what the surgery and recovery would be like, etc.

Everything leading up to the surgery date was fine until, 5 days before surgery, I received a call from Dr. Kim’s office asking for my “therapist letter” for the insurance. I informed them that I had never gotten a letter from a therapist (in SF it’s not required to access to hormones or on the doctor’s end for surgery, just for insurance purposes). I had never been told by Dr. Deutsch, Dr. Kim, or either of their teams, that I needed this letter. I’m ultimately not sure whose failure this was, but it was traumatic having to clean up the mess. I was told that if I didn’t get this letter in the next 2 or so days, my surgery wouldn’t be covered by my insurance. I just about completely fell apart. Luckily, my incredible partner was able to find a therapist who agreed to see me on an emergency basis that very night and write the letter. The appointment and letter were not cheap, and I’m incredibly blessed that my partner was willing and able to pay for it. I found out a day too late that the Director of Mental Health at Planned Parenthood would have happily also written and faxed a letter for me after only a brief phone call (seriously, can’t say enough wonderful things about Planned Parenthood (specifically my experience with the staff at the Walnut Creek PP and PP NorCal in general)). But maybe that info will be helpful for someone else.

2 days later (3 days before surgery) Dr. Kim’s office called me to let me know that the insurance had accepted the letter and would cover the procedure.

Aside from that, I will say that I didn’t feel like I got a whole lot of info from Dr. Kim about what to expect during/after surgery and how best to prepare. She did give me a list of herbs/supplements/substances to avoid in the few weeks/days before surgery (here’s my post about that), but that’s about it. I had a call with the anesthesiologist a few days before surgery and honestly that was where I got most of my info about what the day of surgery was going to be like.

Day of Surgery

I had to get to the hospital at 6am. After checking in I waited in the lobby for about 30 minutes and then was directed upstairs to a bed. I was really nervous but honestly everything moved so quickly that it was all kind of a blur which was nice.

A nurse came to talk with me and take my vital signs first and she was REALLY nice and comforting. Next the anesthesiologist came to introduce herself and explain what her role/process was going to be like. Then Dr. Kim arrived. I must say, after the first appointment I was giving her the benefit of the doubt, but her bedside manner is DEFINITELY lacking. She is not someone I would describe as “nice” or “warm,” she’s not mean, but she prioritizes efficiency at the cost of kindness, I think. She marked my chest up, which was a VERY difficult process for me, and one I had never been told about (I realize now that I should have seen it coming, but I guess I naively thought/hoped that they would just be able to do it once I was knocked out on the operating table).

The anesthesiologist came back and started my IV and honestly it’s pretty much all a blur from there. They wheeled me back shortly after (it bears noting that my partner was allowed to be with me all the way until they wheeled me back into the operating room), and asked me to help them move me from the gurney to the table, and the next thing I remember is waking up after. Honestly, looking back on it, this part was WAY less scary than I thought it was going to be.

It was HARD to wake up after, I was REALLY drowsy and fairly nauseated, but not in any pain. But I REALLY wanted to go home. So, I pushed myself to wake up and to eat/drink to feel better. My partner was able to come be with me probably 10-15 minutes after I woke up. My nurse after was VERY sweet and encouraged me to take it slow, maybe even take a nap etc. He showed my partner how to empty the drains and he told me what to avoid doing, etc. I ate some graham crackers, a popsicle, and some juice. I think I took a short nap, and then I left. They wheeled me out in a wheel chair and I remember it was REALLY hard to get from the chair to the car.

One final note on the day-of, I guess it’s Dr Kim’s general practice not to release the prescriptions for the antibiotics and pain killers until the day of surgery. Had everything gone smoothly, this would have only been minorly annoying. But of course, everything DID NOT go smoothly. When the nurse handed my partner the prescriptions, he said, “you will be able to get these filled at any pharmacy.” NOT SO. We had to try 4 different pharmacies before we found one that said they would fill it. THEN the pharmacists INSISTED on getting verbal confirmation from DR KIM HERSELF that these prescriptions should be filled. My partner called Dr Kim, and the hospital over and over. No response. Then, by some miracle, she found the number for an anesthesiologist at UCSF who just so happens to hate surgeons. This anesthesiologist first tried to lecture my partner about not having filled the prescription before the surgery date, but upon being told we had asked for the prescriptions early and had been told we could not have them until the day of surgery, she went to bat for us! She hounded several surgeons at UCSF until she was able to find one who would call the pharmacy for us. Then the pharmacist finally filled the prescription. This whole process took 4 hours. Luckily I was so groggy I just slept in the car the whole time. #AmazingPartnerForTheWin #AlsoPropsToThatAnesthesiologist

Then we went home and I slept.

Post-Surgery

So, Dr Kim does things SPECIFICALLY. First of all, I had to have the drains in for 8 days. According to my research, this is on the rather long end of the spectrum. Some people get their drains out after only 3 days, some people 5, some people 7, etc. After I got the drains out, I still had to wear 2 ace bandages for another 9 days (this seems to be right in the middle of the spectrum).

At my first follow up appointment, 8 days post-op, I did not even see Dr. Kim. I saw a Physician’s Assistant. She was very sweet although a little rough with my bandages/skin. She told me everything was healing great and I felt encouraged. Here’s the post I wrote immediately following that appointment.

At my second follow up appointment, 17 days post-op, I saw Dr. Kim plus a team of other people who Dr. Kim never even bothered to introduce (another minus for your bedside manner Dr. Kim). I will say, at this appointment, it was almost like Dr. Kim had been given the feedback that her bedside manner was lacking, and she was trying to be kind/gentle/explanatory. It still wasn’t great, but I would say it was an improvement. I was allowed to be ace bandage free but she told me I needed to keep bandaids and aquafor on my nipples until there were no more scabs on my nipples (this proved to be about 8-9 more days). She also told me not to put anything (like ointment, coconut oil, lotion, etc.) on the scars until I hit 6 weeks post-op, which really surprised me. My chest felt REALLY raw and sensitive under just a shirt. It was hard to do anything that day or the following day. Here’s the post I wrote following that appointment.

I have one more follow-up appointment, 6 weeks and 4 days post-op. I’m expecting she’s going to say everything looks good, because that’s how I feel, but I guess I’ll just have to wait and see.

Administrative Side of Things

I’ve already given most of my commentary about the admin side of both UCSF and Dr Kim’s office, specifically. I guess the one thing that I haven’t mentioned is time. Every single appointment I’ve had at UCSF, and with Dr Kim specifically, I have checked in at least 15 minutes early, sometimes even 30 minutes early, and I’ve always had to wait anywhere from 45-75 minutes before even being called back to have my vital signs taken. One appointment took 3 hours from check-in to when I left (and the actual happenings of my appointment probably took about 30 minutes). Everyone I encountered in Dr. Kim’s office (aside from Dr. Kim who’s demeanor I’ve already commented on) has been VERY sweet and makes a very concerted effort to ask what I would like to be called and what my pronouns are. If they do not know the name I go by, they simply call me my last name. Which is AMAZING.

Quality of Surgery Itself

Here’s the kicker, while the bedside manner, and administrative dealings certainly leave something to be desired, the outcome of the surgery is INCREDIBLE. I had double incision with nipple grafts and I am ELATED with how everything looks. The nipples are slightly different shapes and the scars come to slightly different places in my armpits, but you know what, bodies are asymmetrical, and if those are my biggest complaints, I wouldn’t trade this outcome for the world. In fact, for this outcome, I would have put up with 2 additional large hurdles, at least. Dr. Kim may not be the nicest surgeon out there, but SHE DELIVERS. Which ultimately, feels the most important, because I had to live with her for 4 appointments but I will have this chest (presumably?) for the rest of my life!

Here’s a pic of me 17 days post-op, 23 days post-op, 27 days post-op, 31 days post-op, and 36 days post-op

If you have any questions I didn’t answer here

Go ahead and message me! I’m so happy to discuss my experience and/or point you toward any resources I may know about.

#Dr. Esther Kim #Dr. Kim #UCSF #UCSF Center of Excellence for Transgender Health #Top Surgery #Double Incision #Surgery #Surgeon #Experience #Transgender #Nonbinary

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tmitransitioning · 6 years

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Does T affect your bone structure? I thought bones were set past a certain point but I've heard conflicting information

Most people’s growth plates, aka the things that enable your bones to get longer and your height to change, fuse by age 18. The structure of your facial bones can still change into your twenties, according to the Director of Clinical Services at the UCSF Center of Excellence for Transgender Health. Additionally, the shifting of fat deposits changes the way your bone structure looks, and certain conditions can sometimes cause your growth plates to remain un-fused for longer, such as EDS.

- Mod Rabbit

#mod rabbit #hrt #testosterone #Anonymous

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mykidsgay · 7 years

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"When is a good time to start a medical transition? My 12-year-old had two suicide attempts in November and in January. He came out as trans and is now living as a boy, and his happiness has drastically gone up. I don't know if it's worth the risk of not being able to backpedal or the risk of nearly losing my baby again. He mentions wanting to start hormones and I just don't know what to do. As recent as a year ago I had a pastel wearing girly girl, but I've always allowed my kids to be who they are and express themselves."

Question Submitted Anonymously Answered by Irwin Krieger, LCSW

—

Irwin Says:

I am sorry to hear about your child’s despair and so glad to know he is feeling better now. We often see a dramatic improvement in well-being once a young person affirms their transgender identity and is supported by family. I strongly recommend meeting with a psychotherapist who specializes in gender identity if you have not already done so. You can look at the “Find a Provider” tab on wpath.org (which stands for World Professional Association for Transgender Health) to find someone near you. A gender identity specialist working with your child will provide you with an additional measure of safety, and help you and your child arrive at a full understanding of his gender identity and helpful transition steps. As he has already made a social transition (living as a boy) and is happy in his affirmed gender, I understand why you are considering medical interventions.

In regards to starting hormones for a medical transition, there are a couple different paths to consider and understand, including puberty-blockers and cross-sex hormones. Puberty blockers provide relief for trans youth who are in distress about pubertal changes that don’t fit with who they know themselves to be. For example, youth who begin blockers prior to breast development are relieved of the need for top surgery (breast removal with male chest reconstruction) in the future if they continue on the path of gender transition. Even an interruption of breast development that has already begun can be helpful, since less intrusive surgical techniques are possible for those with smaller breasts. Blockers will also stop menstruation, which for some trans masculine youth is a painful monthly reminder of the discordance between body and gender identity. If the young person later decides that their innate biological puberty is the right one for them, blockers are stopped and their puberty proceeds as it would have, just delayed. The impact of these medications is considered fully reversible.

Cross-sex hormones, such as estrogen and testosterone, provide feminization or masculinization of the body in accordance with a teen’s affirmed gender identity, and prevent further changes in the direction that does not fit for the youth. These include irreversible changes, which some parents worry about, understandably, for someone so young. For that reason, your child’s therapist will refer you to a knowledgeable medical provider. You, your child, the therapist, and the medical provider will together come up with the treatment plan that is best for your child. Depending on your child’s level of pubertal development, hormone treatment may involve cross-sex hormones. But for many 12-year-olds who are ready to begin medical intervention for gender transition, their hormone treatment at first will be only puberty-blocking hormones, or puberty blockers in combination with low-dose cross-sex hormones. When low-dose cross-sex hormones are used, changes occur at a slow pace, allowing everyone time to assess whether going ahead with these changes is in the best interests of the child. Historically guidelines recommended waiting until the age of 16 to start cross-sex hormones. Sixteen is the age of consent in Holland, where puberty blockers were first used. Experienced practitioners are now moving toward individual assessment and timing for hormones.

You can find medical providers specializing in hormone treatment for gender transition at the ‘Find a Provider’ tab on wpath.org. You may want to schedule an appointment to get information about hormone treatment even before your child’s therapist is ready to make a referral. I discuss hormone treatments in more detail in my new book, Counseling Transgender and Non-Binary Youth.

With a history of two suicide attempts, it is especially important to be aware of any harassment or rejection that could lead to a resurgence of despair. Be alert to any negative responses your child is receiving from his friends and neighbors, from peers and adults at school, on social media, or from family members and family friends. Share any concerns you have with your child’s therapist. Be prepared to advocate for your child at school and with any disapproving family members. Act quickly to address any setbacks that occur. If you remain open-minded and supportive of your child’s gender exploration he is more likely to let you know about any difficulties he encounters.

People often wonder how someone can be sure he is a boy when a year ago he seemed to be living comfortably as a girl. Keep in mind that many transgender people try hard to fit in with their birth-assigned sex, since that seems to be what society expects of them. It is not uncommon to see a young person go from embracing being the girl or boy others expect them to be, to feeling despair because inside they know that’s not who they are, followed by expressing their authentic gender identity and feeling much better as a result. For parents this can seem to come “out of the blue,” making it difficult for many parents to fully accept their child’s affirmed gender. Take time to ask a lot of questions in a spirit of curiosity, without judgment. Ask him how his awareness and feelings have developed over the past few years, what his feelings about gender were when he was much younger, what his distress has been over this period of time, what he needs from you now, and what his hopes are for the future.

I would also like to recommend that you seek out support groups, both for you and your child. If there are no transgender youth and family support groups in your area, some online supports are available, as well as wonderful conferences for transgender youth and their families if you are able to travel. For information about these and many other supports see my webpage: www.HelpingYourTransgenderTeen.com.

Thanks to Jennifer Hastings, MD of the Center of Excellence for Transgender Health at UCSF for your help with the information on hormone treatments for transgender youth.

***

Click here to read about our brilliant contributors!

#my kid is gay #my kid is transgender #my kid is trans #lgbt #lgbtq #lgbtqia #transitioning #trans #hrt #hormone replacement therapy

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md-admissions · 7 years

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Hi! I just got some immature hate from someone about a post from 3 years ago regarding puberty blockers for trans kids and I was wondering if you, being an actual doctor, could let me know if they're actually indicated or not? Just out of curiosity lol. Thank you! Also I hope you're doing well!!

Hey there, friend!

I don’t get a lot of direct training or practice on this in my residency, so your question was a great opportunity to educate myself on the literature as well on my sick day (flu got my body down but not my curiosity!).

**Of course, note to all: I am an internal medicine resident who does not specialize in this field, I just happen to like reading, I’m just doing my due diligence to inform myself as a physician, and there are definitely people out there like transgender health specialists and endocrinologists who specialize in this area who could get into the nitty gritty of this all. I’m just here to answer a question with what knowledge and information I have.**

So UCSF, which is a center of excellence for transgender health (that means they have to fulfill multiple criteria to earn that title, so that means roughly they know what they’re talking about), has a nice summary here about the healthcare considerations physicians should keep in mind when caring for gender non-conforming children and adolescents. I think what they say makes a lot of sense; this is a burgeoning field so it’s understandable that there are numerous, robust studies with walloping statistics proving that puberty blockers or gender-affirming hormones are the best, definitive treatment but that they do appear to make a difference in alleviating behavioral and psychosocial problems that arise with the trauma of gender dysphoria and development of secondary sexual features. Now considering that reducing these issues is nothing to dismiss, I would say that’s important to a child and their loved ones.

There is also a joint recommendation guideline published by consensus of 4 different endocrinology societies in the US and Europe and the World Professional Association for Transgender Health that anyone can find here. In regards to puberty blockers: “We recommend that suppression of pubertal hormones start when girls and boys first exhibit physical changes of puberty (confirmed by pubertal levels of estradiol and testosterone, respectively), but no earlier than Tanner stages 2–3.”

So this is a clear statement on the utility and the time of initiation.

Of course, puberty blockers are not forever, let’s dispel that myth right now. It’s meant to prevent distress and trauma to the child pending the time at which they are able to transition in a safe way without compromising their health and well-being.

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epochryphal · 7 years

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mmm hey mind if I ask about, like, subjective experience-type motivations for going on blockers? and/or psychological effects of them? because like, I kept telling myself for years that dissociation as a method of dealing with dysphoria was a better/cheaper option than dealing with Fucking Doctors, but... here I am not at work now for the past week because I can't lift more than 10 lbs currently, So.

i mean…. hm.

so i did get to have my blockers covered by insurance for $0, nice (after paying out of pocket $200 for one month’s dose uncovered, not nice)

also got a bunch of “oh noes but this is for CANCER PATIENTS and I, As A Cancer Patient, Hated It, It’s Bad” from family members which wh… and “no no this is Temporary because Your Bones and Unstudied” from doctors, who wanted to do a lot of Observing levels of things to let me stay on it

which is…why.. i… decided hey, how about i Naturally reduce my hormone level, but Not to the zero oh-no-bones-what-is-science level, by just having one outta two ovaries out. yeah? yeah

this is apparently about the same as going on blockers but a littler Safer, Maybe, We Still Just Don’t Know

but yes. so, the whole specter of POSSIBLY MENOPAUSE! which is there with t also but Somehow Different, Handwaving. and that was an actual concern because heyyy that can be a time for bipolar ii to kick up symptoms and have a first manic/mixed episode, which is common in my family actually. so there was watching for THAT.

otherwise it… i mean…. i did feel better while on them. i don’t know if that was a placebo effect of Finally, Progress? and it was only for a year while i was waiting for surgery to go through (which they, wouldn’t do until i, tried blockers?? ???)

however nothing really…stands out. as a major sign they were doing anything. (although i mean… what IS gender. what IIIS dysphoria. fuck.) there miiight be some records of it on my transition blog, @blockers-and-ectomies, but i’m not sure i haven’t, poked that much lately because it’s kind of depressing and full of medical trauma that was more to do with surgery and subtle doctor badness blahblah autism blah.

they’re supposedly pretty low risk for short-term use, in the low dose i was given anyway? which was nowhere near high enough to affect menstrual nonsense btw other than maybe make it a little wonky. it’s the whole “long-term no hormones weak bones” thing which, makes no sense to me given eunuchs have always existed

but yeah. that was through the center for excellence in transgender health’s doctor, maddie deutsch, buuut i could only see her through ucsf’s women’s center… which despite having gq and man gender options, multiply misgendered me including on envelopes of paperwork to my house thanks, and one time the receptionist took Initiative and Asked me if i was Sure the Gender was Right on my Forms. i hate.

…this is. maybe partially about what you asked about. sorry! i hate doctors. take an advocate with you, god i wish i had more often.

#i'll have you know i grew up in hospitals having surgeries because disability and i LOVED hospitals and doctors.#even through the end of college.#but then... THEN: non-normative transition that i personally had to advocate for outside of a university setting with paid reps #hell.#nonbinary bloggin #estrogen blockers #dysphoria bloggin #menstruation ment #medical trauma shit

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nmcpag · 7 years

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National Transgender HIV Testing Day: Review of 2016

Globally, transgender women are nearly 50 times more likely to be HIV positive than the general population, with transgender women of color being at highest risk for acquisition.1 One study reported a 56% HIV prevalence among black transgender women in the United States compared to a 17% prevalence among white transgender women.2 There are also discrepancies in reported and confirmed HIV status, which suggest that many transgender women are unaware that they are living with HIV.3 Although HIV prevalence among transgender men (0%-3%) is fairly low,4,5 some transgender men who have sex with cisgender men do engage in behaviors that place them at risk for HIV acquisition.6

In response to the disparate burden of HIV experienced by transgender women, the launch of the inaugural National Transgender HIV Testing Day (NTHTD) on April 18, 2016 marked the first HIV testing initiative focused exclusively on the HIV testing needs of transgender people.

Spearheaded by the Center of Excellence for Transgender Health (CoE) at the University of California, San Francisco (UCSF), in collaboration with community partners and several federal agencies, the first NTHTD proved to be a huge success.

The inaugural NTHTD involved a year of planning and the rollout of the very first transgender HIV testing toolkit. The information contained in the toolkit mirrors the most current HIV prevention research and best practices for serving transgender and gender non-binary communities. Leading up to NTHTD 2016, the CoE hosted two well-attended webinars in collaboration with the Capacity Building Assistance Provider Network (CPN) to familiarize community-based organizations (CBOs), health departments, and other service providers across the country with NTHTD and the toolkit, and to encourage organizations to host NTHTD events in their respective communities.

Highlights from NTHTD 2016

Rollout of the Transgender HIV Testing Toolkit

Organizations in 13 different states hosted NTHTD events

City of Newark, New Jersey, issued a resolution commending the African American Office of Gay Concerns for hosting an NTHTD event

Twitter chat featuring transgender celebrities Chandi Moore and Candis Cayne, provided a rare platform for transgender women to speak candidly about their needs

In April, the CoE Twitter account yielded 14,500 tweet impressions, 1,166 profile visits, and approximately 1,000 individuals used the hashtag #TransHIV on Facebook

Multiple media outlets wrote articles to increase awareness about the prevalence of HIV in transgender communities and to raise awareness about the new transgender HIV

“Dear Colleague” letter was provided by Dr. Jonathan Mermin, Centers for Disease Control and Prevention (CDC)

NTHTD April 18, 2017

For National Transgender HIV Testing Day (NTHTD) 2017, the Center of Excellence for Transgender Health (CoE) capacity-building assistance team, led by Jenna Rapues, Interim Director, along with NTHTD collaborating partners, seeks to build on the successes of last year. Specifically, the CoE has tailored the planning and promotion for NTHTD 2017 to:

· Increase participation from CBOs across the country

· Increase capacity of participating organizations to provide routine HIV testing services to transgender clients

· Increase utilization of the Transgender HIV Testing Toolkit

· Increase utilization of CoE capacity-building assistance (CBA) resources and services

Similar to last year, NTHTD 2017 will include several webinars that help familiarize participants with the Eight Best Practices for HIV Prevention Among Transgender People and the Transgender HIV Testing Toolkit developed by the CoE. The inaugural NTHTD had great success in engaging the transgender community via social media. This year, we will partner with AltaMed in California and CDC’s Division of HIV/AIDS Prevention to roll out new HIV prevention materials for transgender people and HIV pre-exposure prophylaxis.

The NTHTD kick-off webinar on February 8, 2017 provided an opportunity for the CoE to engage CBOs in an effort to begin planning for NTHTD events. It provided an opportunity to highlight the importance of competent HIV testing services for transgender individuals and the HIV testing toolkit. For instance, webinar participants learned about the importance of recruiting transgender individuals and the need for professional development for transgender-identified staff. Additional kick-off webinars in March 2017 gave CBOs the chance to directly engage the CoE with questions that will support them with organizing successful NTHTD events!

The CoE encourages CBA and community providers to visit our website. The following resources are available to expand providers’ knowledge of transgender health: HIV treatment guidelines, fact sheets, best practices, and the Acknowledging Gender and Sex online training course.

Remember to use the hashtag #TransHIV during NTHTD on April 18, 2017!

#hiv testing #transgender #HIV #transHIV

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