I want to go ahead and point out some changes that I have made around here. Notice to the left side bar it looks a bit different. I took a few things down and consolidated others.

• Topics are now in a drop down menu, makes it less cluttered.

• Links have been added: Take a second to browse there are some VERY useful links over there. If your one with  a personal blog you would like to share contact me as I will be adding a section for that shortly.

• New donation button: This is NOT a mandatory obligation, if you feel as though this resource is useful by all means donate. All money collected will be divided, a portion goes into my surgery fund and the other portion will be donated to a Trans organization. If there is a specific org. you want to donate towards please leave special instructions with your donation.

Now looking towards the top menu bar….

• There is a new page that has been added. This is the reveal of who I have chosen for phalloplasty and the technique as well. Trust me the debate was long and drawn out. I bounced between forearm and MLD for a while.

• I have also added a “Transmasculine Resource” Page. If you have anything you would like to add to the resources by all means let me know.

Moving along to the tutorial on how to use my blog efficiently…

Did you know that most of the top menus are actually drop down bars? Go head try it out; mouse over anything at the top.  Once you have done that you can click everything in red for a new page.

For instance lets say you mouse over “The man behind the blog”. You get a drop down to select from all 4 choices under the parent title are clickable BUT the actual parent title is clickable as well.

Within each sub menu, I’ve taken the time to link every page back to the parent page. So say you view the sample surgery letter, scroll all the way down and you will see “Click here to return to parent folder”. This will return you to “The man behind the blog”; so it’s like having a map, you can never go too far without a guide back to the start.

I’m taking the time to point these things out as I’ve seen some of you that are missing valuable information when its right at your grasps 24/7.

Features to be added:

• Video section: Yes I still will have my YouTube but for those  viewing that rather just watch in one place there will be certain videos only available within my blog. I have not made up my mind whether a pin would be required I will let everyone  know ahead of time

• Dedicated URL:The actual URL name of this site will be changing within the next few months. It will no longer contain the WordPress signature mark but simply just  www.toyneboi.com. I’ve found that shortening the URL makes it easier to remember. As well, if unaware WordPress has formatted every blog site to be compatible via any phone. iOS, Android, and Blackberry markets all feature a functional WordPress application that allows you to read, respond, and keep up to date. So never fear, if there is no computer you can still read in full feature! 

• Share buttons: At the bottom of all posts and all pages there are now 4 different share options: 

• Via Google Plus, for those like myself that DO NOT use Facebook and seek actual substance in posts try out G+. Lots of fuel for the intellectually inclined as well as for those techies. 
• Via twitter, I have an account I’ll post it somewhere around here for those wanting to follow. 
• Via Press This, for those with WordPress accounts this option is great to share right into your blog. 
• Via StumbleUpon, great site that will help you find alot of related material. 

I am not sure at this point if I am going to be adding a Facebook button, I have personal reservations with that whole site, but that’s another blog lol.

• More templates for Physicians: From informed consent to passport letters. I get asked all the time so I figure I’d step up and make it available.

• Possible addition: I am debating on a surgeon section complied of all surgeons CURRENTLY doing surgery, techniques, and prices. I’ll let everyone know more on this as this is going to take a lot of time to do, and to properly do at that.

Over all not too much change going on but many useful features that will appear over the next few months. If  ever any questions on navigation of this blog, where to find something, or suggestions on additions by all means hit contact me and let the fingers do the rest lol.

I’ll be updating shortly on surgery so definitely check back in!

Until next time…

Salaam

Here you can read a complete PDF of what the American Medical Association has said and believes is truth in the matter:

http://www.tgender.net/taw/ama_resolutions.pdf

Taking points from this PDF I will quotes the AMA exclusively:

“Whereas, GID, if left untreated, can result in clinically significant psychological distress, dysfunction, debilitating depression and, for some people without access to appropriate medical care and treatment, suicidality and death”

“Whereas, Health experts in GID, including WPATH, have rejected the myth that such treatments are “cosmetic” or “experimental” and have recognized that these treatments can provide safe and effective treatment for a serious health condition”

“Whereas, The AMA opposes limitations placed on patient care by third-party payers when such care is based upon sound scientific evidence and sound medical opinion”

“Whereas, Many health insurance plans categorically exclude coverage of mental health, medical, and surgical treatments for GID, even though many of these same treatments, such as psychotherapy, hormone therapy, breast augmentation and removal, hysterectomy, oophorectomy, orchiectomy, and salpingectomy, are often covered for other medical conditions”

“Whereas, The denial of these otherwise covered benefits for patients suffering from GID represents discrimination based solely on a patient’s gender identity”

These above points gain traction but this point lastly is the biggest one of them all and should be read VERY clearly;

“Whereas, Delaying treatment for GID can cause and/or aggravate additional serious and expensive health problems, such as stress-related physical illnesses, depression, and substance abuse problems, which further endanger patients’ health and strain the health care system;”

The conclusion within the AMA:

“RESOLVED, That the AMA support public and private health insurance coverage for treatment of gender identity disorder (Directive to Take Action); and be it further

RESOLVED, That the AMA oppose categorical exclusions of coverage for treatment of gender identity disorder when prescribed by a physician (Directive to Take Action)”

With these points in mind we find time an time again policies such as this of BCBS, I will only list 2 major exclusions you can read in full here:

http://www.bcbsvt.com/member/MemberBenefits/benefit_Exclusions.html

“In addition to the specific exclusions listed elsewhere in your Contract, the following General Exclusions apply:

7. Services or supplies we determine are not Medically Necessary.

58. Treatment leading to, or in connection with, transsexual Surgery.”

In question to exclusion 7, who is making these determinations when sound evidence has been shown that transgender treatment is as medically needed as getting me my inhaler? Are these people within the corporate areas even qualified to make sound medical determinations based on notions of many prehistoric unethical medical practices? Are they even medical professionals that truly know and understand the workings of GID and everything the condition truly entails? Or are these pencil pushes half-way reading there own rules and saying no on a bias?

As well in question to exclusion 58, let me tell you from personal experience once the company sees any claim for any thing GID related you account is flagged and everything will be scrutinized and ultimately denied. It could be a regular counseling session because a person is just so depressed and has nothing to do with the condition, DENIED! It could be a normal preventative screening, DENIED! Thanks to exclusions 7 and 58 this company is still going around what has CLEARLY been stated by the AMA as unethical in any medical approach.

I am so sick of losing good friends and people I consider as close as family to depression, risky behaviors due to lack of money to cover care, and in many case them taking their life because they never see themselves being able to get the needed care that has been PROVEN to alleviate the symptoms of said condition.

So I ask you all to come to my aid and take a step that will change the face of healthcare for transgender men and women everywhere. Just as we are working men and women and further more american tax paying citizens why is it possible that some of the leading corporations are not shunned for openly discriminating against us?

Many people think this is a choice but lets ask our self, did you choose to have the medical conditions you have? Or did you choose to make sure they were corrected so you could live a life that was of good quality?

This is the reality of the situation and its time we take action. Anyone with more solid facts you would like to add or any of you that were denied by insurance please feel free to post segments of your denials and/or facts in your additional comments when signing this petition.

One voice stirs the secretaries nerves, 10,000 with wake the CEO up in the middle of the night. If this is as important to you as it it for me and so many others please take the time to sign and pass this along.

thank you all.

https://www.change.org/petitions/all-major-health-insurance-carriers-in-the-united-states-stop-transgender-health-care-discrimination

Salaam

I have the privileged to speak with Dr. Miro today for a phalloplasty consultation. Many of you are probably like “When the hell did you go to Belgrade?!” lol. Well for those of you out there that have been wanting to speak with Miro but have no means to fly to Serbia or any other state for that matter I can happily say I have gotten him to use video chat! In the next month or so probably less he will be opening a newer site and this consultation via Skype will be made available to all patients seeking his procedures. I’m going to continue to speak with him about some other aids that will help guys feel more at ease when it comes to such a large step in life and transition. As well if complication arise he can now physically see what is wrong and physically show patients how to go about intervention of if physician assistance is needed. I will also be seeing him in person in about a month or so, come to find out he’s in TX quite often due to some urological workings/teachings he has been doing in Houston (lucky me that I live down the street from where he does this!). I swear this mans drive to prefect things is awesome in more ways than one for all of us.

On to some more in-depth details, and please excuse me if they are a bit jumbled together as I took from notes from our conversation. So if anything needs to be clarified please let me know.

Miro was telling me of all his upgrades and having that visual was AWESOME!

As it stands, he has been talking to the Gent team, and we all know their rep for sensation ratios. Further anastomoses can in fact be done and he has been tinkering with a few upgraded ideas. One of which im very found of introducing the urethralplasty within the first stage. His goal is to be able to lengthen to the tip of the phallus during stage one, not something he is doing in full right now but he is one that continues to work on things until they are to his liking. So quite possibly by my first stage I will be his first full test drive, I’ll let you all know as I told him im more than happy to let him try as I know how I personally heal and also as we both agreed my urethra workings are very suited for this attempt. In figures of sensation he gave me the numbers I was looking for 50% tactile sensation will be there possibly more. Meaning normative sexual intercourse would be fine as well as masturbation. This 50% ratio for some is horrible but if you think about it logically 50% is ALOT of sensation I know cis-males with less than 50% sensation along the shaft. Also with proper inguinal anastomoses 25-50% erogenous sensation is possible, he is fine tuning some more things now to bring these numbers up. With much mention as well that erotic sensation also has to deal with prior clitoral sensation, as we know post T some have more sensation then others which in turn plays a role in you phallus sensation which completely makes sense. He mentioned this tactile sensation would be equal to say if you touch your nose. Even without anastomoses because of some tweaks he’s done over the last year you will be able to feel, masturbate, have sex, etc with very nice feeling. He also elaborated that much sexual sensation is in fact mentally based, which I would have to agree thinking back on how I had sex pre everything with a strap on I didn’t put thought into things like I do now and that mental stimulation added to me watching my partner get off which in turned did the same for me. Embedding of the neo-phallus is also something he spoke about, due to his tweaking he has found a way to incorporate this even more for sensation not just from embedding which I think is quite promising.

I will be putting down my deposit possibly in June but probably before then I just want to give myself ample time as anything could happen. But 1500, shall be an easy target goal. I have set things up to where there are 2 dates pending school and funds. One date is for next year the same month that I had metoidioplasty since I will be easier to take a break from classes well the actual classroom I can still do homework while in Belgrade. The other date is 14 months later 2 weeks before my birthday in Feb.

Ok I believe I have everything, I know I prob forgot something but if so I’ll just add more later lol…

As I learn more I will keep everyone update, oh and for those curious YES I still have 2 other back up plans you can never be too prepared. It s always common practice to have many back up plans for things like this which mean RESEARCH IS KEY. You must know what is offered, who does it, costs, and accommodations that fit you needs in order to be able to  have multiple choices aligned that suit your needs.

Until I hear more…

Salaam

So as you all can see from the previous context of my blog, I have been a seriously busy and all over the place young man over the past year. It has been one of great learning experience and I’ve taken a lot of lessons from it. As contemplated in the last blog from Oct, I will be attending school for my BS in Psychology (no i’m not bsing in psych lmao, bach of science guys). I actually start class tomorrow, it’s one of those bitter-sweet feelings lol. I’m ready but really not ready for the homework, research, nor group projects; but this is what I must do in order to get where I want to be in the long run. I am happy to also announce that I will only be needing 1 year of general chemistry, organic chemistry, biology all with labs, and English to be accepted into med school at my 90 credit mark for my BS! It’s one of those unbelievable feelings, like anxious but nervous all at the same time lol. So looks like 3 more years are standing between myself and me officially using Dr before everything I say lol. Yes I will use it as soon as I’m a freshman! People ask me why I do that when it comes to things I have not yet finished, positive affirmation my friends. If you believe you will achieve, myself using the future notion of something in present speech or thinking usually brings it to pass over time. So I claim it now as mine and it shall be later with ease.

On another note, it has been officially a year since metoidioplasty. Well as of today over a year almost a year and a month actually but nonetheless I made it! It has been quite interesting to relearn my anatomy in ways I felt like would’ve happened in toddler years but as they say better late than never. I am very happy to say that I have yet to experience any issues post operative. I am very happy with this stage of surgery, yes stage as my original plan was always phalloplasty but I did metoidioplasty first for various reasons that are more so personally based then FTM generalizations. I find that my dysphoria level has dropped off significantly the only time I seem to catch myself being uneasy now is just around certain women. Nonetheless everything that I wanted to achieve with metoidioplasty I have and I am more than happy that I followed through with my own plan and did not let the opinions of others fluctuate my final decisions. It’s hard at times to become sound on things when you have and/or see a lot of opinions of what you should and should not do when it comes to your own personal benefit. I knew for myself I was not mentally, emotionally, or physically ready for the multiple stages of any kind of phalloplasty surgery. I knew I was not ready to deal with such a large scar, as this is one main reason I was not keen on double incision so it did take some time to prepare myself internally not just externally. I think a lot more guys should take time to do things so that they are not just physically ready but mentally and emotionally as well. Surgery is not just hopping on the OR table waking up and being done, there are processes of recovery and some are nothing nice to deal with. Having that in mind one with no will power will find themselves set in a mini episode of deep depression, so as you see you need to REALLY be ready for any sort of surgery and especially genital surgery. This is one of the reasons I do agree with people seeking counseling prior to lower, not  for the gate-keeper aspect of the process but more so for the idea of having a personal vent session to dispel certain tensions and/or fears one would have prior to surgery. For my next surgery I do plan on still speaking with a therapist just to have that vent session. It’s one thing talking to your friends but having someone outside of that totally not judging you gives you better room for expression, in my opinion. I can always say though if I pass on tomorrow I will be with no regrets on my surgical decisions.

Well the big deal of the year…

I am officially planning phalloplasty, no big surprise to those of you that have been consistently following. It’s not in the near near future, near near would be 1-2 years, I’m thinking of 3-4 years but things happen and time flies. I didn’t plan to be having metoidioplasty until I was 5 years on T but circumstances allowed me to move forward well before then so anything is possible. My goal though is to start first stage (which is technically second stage for me) between dec 2014 – feb 2015. I’ve mulled over multiple surgeons and multiple procedures giving me head aches like no other but making sound decisions in this process is one that MUST be taken into consideration. My decision has changed fluently about 5 times, but now I see it more as having plan A-E set in stone. I have a top pick and a bottom and ones in between that can replace top picks if circumstances of insurance or inheritance come into play. This is why I tend not to discuss phalloplasty plans so much as I would like to be 100% in who I am going to before I share with the masses. So far my plan A is about 90% soundly made but that slight 10% can be shifted if lower payment options fall through as I’m currently thinking that they will.

I am in between two different procedures as well. Forearm phalloplasty has hands down been the most recorded consistently having erotic and tactile sensation which is a major things for me. At the same time with this the idea of having such visible scaring is less than appealing. Even though more and more seem to be getting with the full thickness graft to relieve donor site morbidity, many are still using split thickness grafting which is known for healing, at times, indented. Being a physician I wonder how this would affect me? As well as this worries me about the dexterity of my donor arm, nerve endings, and range of motion with my fingers as these are all important factors when doing surgical procedures. So as you see these are VERY serious things to think about when considering forearm phalloplasty. I am honestly less worried about the scaring and more about function as I have been privileged to see phalloplasty and donor sites from several men of color. I am so happy that more men of color are sharing these things so that pre-op men can have a template to assess. It is really hard to see what you are getting into when you have no point of reference. Yes, there are many examples as a whole of phallic representation in FTM‘s but only about a handful that show how men of color heal after such procedures as people of darker complexion do heal differently. Then with the option of various scar creams, silicone sleeves, and vacu-therapy options i have no doubt that my arm would look just fine over an 18 month period post op.

My other option is MLD Phalloplasty. I was going to originally go back to my original surgeon but as things progress I believe I may go to another team for phalloplasty. Not due to any lack of anything with Dr. Miro as he and the team are beyond excellent but more so due to style variation and aesthetic value. I like Dr. Rados out come and his glansplasty is also to my liking. Now there is some stipulation regarding sensation within MLD phalloplasty. Those that go to Miro have reported little to no sensation throughout the phallus itself more so the sensation is found at the base of the penile shaft and whether or not by the patients discretion the orignal neophallus is embedded or left minimally exposed so this also determines a degree of sensation. The same minimal exposure can be done with Rados’ MLD technique but the thing that makes a difference in the matter is the connection of the femoral artery and the inguinal nerve. There is however still controversial statements when it comes to this as I have talked to both Miro and Rados and get two different accounts on whether connection of this nerve gives sensation. Miro is very much set that this anastomosis is not medically possible. He states:

“Due to the fact that the nerve used is a motoric nerve, meaning that it gives the contraction to latissimus dorsi muscle. Something that is motoric can not be anastomosed with a sensitive and to give a result.“

Where as, Rados is quite set on his way of doing the connection of such nerve to nerve anastomosis and has had result. Speaking to the patients I know that have gone to Rados there is a report that such connection has allowed more than sensation at the base of the phallus but up the shaft and to the head. There was also clear feeling stated of the erotic nature which also has led me to ponder what is really going on with this. Honestly speaking, it may just be variance in what one was taught before and what one was taught after. There are many surgeons and doctors that believe til this day urethral lengthening is a waste of time and nothing but complications when there are multiple studies that disprove this logic. So as time goes on I will see whats what, as I have more access to patients of both surgeons over the next few years and it will be about a 7000 euro difference in teams. I also like the fact that Dr. Rados will be and has been actively working with a surgeon from the Chicago area and will be learning some of his mircosurgical techniques to apply them to MLD as well as teaching the surgeon how to properly perform MLD so that possibly it can be offered here in the US as an alternative. Even though that would drive the cost of MLD sky-high,it would give chance for insurance coverage as well as alternative options to procedures and great for Serbian patients needing a good follow-up surgeon stateside. I think by Rados learning and fine tuning microsugical aspects, by the time I’ ready for stage one MLD‘s sensation ratio maybe rivaling forearm in great leaps and bounds. This is why I’m really not rushing a thing as time and patience will bring me exactly what I want and need. I would be staying in another apartment while in Belgrade, this time I found a few on my own that I favor, one less than 10 minutes from the hospital that Rados uses. Not badly priced but very nice and modern, 50 euros a night, I’ll be there 7 days each time after leaving the hospital. I plan to have my scrotum pulled forward more  to allow a bit more natural hang and also am upsizing my testicular implant size to accommodate the new phallus size. The one thing I do like the most about being post op meta then going to phallo is that when I come home from that stage I will have a package viewing to the untrained eye as natal which is very important to me. Not that I’m going to run around flashing folks but I do plan on being one with the gym and showering is a part of the atmosphere especially if I’m doing so between classes or have a presentation shortly after a workout.

I will have settled soundly by summer on who I will finalize with and from there continue saving. I’ve already started and have figured down to the cent how much each stage is going to cost plus any expenses outside of that. I could be looking at 15K total or 42K total, it is solely dependent on what team is chosen and why. Ideally I would like to be done with either surgery prior to admission into medical school as I know it will be a full course load it’s already going to be one hell of a task to balance working and school I would seriously rather not balance stages of surgery, recovery, travel, and time off on top of that. If anything in that stage of my life I want to be settling into my first house, even though I plan on being in real estate well before then lol. I’m already sick of rental properties and their craptastic regulations so I’ve began looking for the purchase. So technically you can also say I’m double saving but I know there’s first time buyer programs I more than qualify for. Just so much to think about when it comes to the next few years of my life.

On another notice…

I am nicely settled in at my new apartment. I love it here actually and you can see what it looks like on my YouTube channel. I did a nice little walk through  of my bare naked place lol. Just glad to be back in Houston, sucks that I’ve been away for so long but such is life when you have things to do. I do think this is where I will be for some years as I don’t see too much of anything sparking my interests enough to make me move. Plus my med schools of choice are all within 10 minutes of me so that’s also a BIG factor in the midst of things lol.

Over all I’m doing A-OK, and I will be letting you all know more of whats going on as the year progresses. Especially next month as it will be a great month of celebration seeing as though it’s my birthday. Can’t believe I’m soon to be 24, feels like I was just 20 taking my first T shot but hell I’m also going on 4 years of T which definitely feels odd lol. Time surely flies when your really not focused on how long but where in fact your going.

Well ladies and gents I have work to do, so until next time…

Salaam