Dr. Kim gave me an order for a surgical binder, and I walked down to Supply at General, and picked it up, taking it with me to the hospital, the morning of my procedure. It was the softest, nicest binder I have ever worn; it was from a plastic surgery supply place, I don't remember the brand name.

Thinking about top surgery? Have you had top surgery?
 

If you are thinking about getting top surgery, or have gotten top surgery, please fill out this survey. It is data being collected by micah who has the neutrois.me It will be good to have this data.

https://docs.google.com/forms/d/1JS6...wdiI4/viewform

Top surgery eval. date 12/11
 

Need some advice about my upcoming appt. with a plastic/reconstruction surgeon within the next couple of weeks. Anyone have any advice of do/don'ts during the interview/examination?

As it gets closer, I get more frightened. Have this weird sense that my life depends on the appointment. It's silly, but that's how I'm feeling. I'm all shaky with my BP elevating.

Anyone know this feeling?

First question is to ask them how many top surgeries they have done. Make them separate out double incision versus peri/key hole method.

As them who trained them (hopefully a surgeon who's specialty is trans surgeries).

I am going to assume you are getting double incision.

I would ask them what size areolas they make. Old standard method is the size of an nickel...surgeons would literally draw around a nickel in the surgery. I personally have seen that when areolas are left too large (for my taste), it detracts from the look of the chest. I see "female", no matter what the chest looks like. It seems to me that the less experienced surgeons leave them too large (beyond the "nickel" size). I went to Garramone in Florida who makes them the size of a dime. They also stretch out. Ask to see photos and then tell them what you think of the size.

Ask if they do free revisions. This would mean not paying for the surgeons fee, but still would pay for the other costs of surgery. However, I am thinking you are using Medicare and/or Medicaid, so I don't know how it would fit into this. I paid out of pocket.

I think your emotional response is completely normal. For us with dysphoria, after the idea of having no breasts comes closer, we realize how important a male chest is to us. I hear this from a lot of trans people when they get closer to their surgeries. Often they (and I felt this way), have excessive worries something will go wrong and they won't be able to have the surgery that day.

Keep us updated!

Thanks Dapper,
Your note has helped me calm down a bit, but still bouncing off the walls. No one knows anything about this guy. He took the place of a surgeon who had quit. My TG/IM/Primary Care doc said he has heard good things about him. Plan to approach this the way I do most other things...as a skeptic and a cynic. Will let you about the appointment on Monday night. Thanks for the empathetic, calming words. They do help.
cathexis

Sorry, it took Saturday for me to get back. The doc is older with a very laid back, but knowledgeable demeanor. He seems like he has done a fair amount of plastic/reconstructive surgery with experience in trans. surgery ... top surgery at least. Sue and I perused his certificates on the wall, and were happy with his credentials.

Had pictures taken at various angles. He examined me, and questioned about how long I had been thinking about and why. I have a follow up in a month when he has all the WPATH documentation.

Will keep you posted, but I'm really excited about this surgery and the surgeon.

Good to hear! Thanks for posting and keeping us up to date.

I'm glad you felt good with him. You mentioned "a fair amount of plastic/reconstructive surgery with experience in trans. surgery" I am not sure what that means. Did you ask him directly how many top surgeries he has done? Did you ask to see pictures of his work?

Did ask to see photos. He wanted the medical records (even though I brought some of them with me) before going into specifics. He was especially interested in getting the WPATH documentation, probably because I don't look very masculine.

This is our first meeting. Perhaps, he thought it might be an impulsive decision. Not sure his rationale for waiting to discuss the specific surgery (like 2 incision vs keyhole, when I'm obviously not a candidate for the latter). Appreciate his need to be certain , but a bit worried about how far into the summer I'll be healing if he waits too long. Don't tolerate summer as it is.

So did he show you any photos (you only said you asked)?

Did you ask him how many top surgeries he has done?

Did you ask him where/who trained him in top surgery?

I know you said that he replaced someone. Is he there specifically to do trans surgeries, or he just inherited this role from this last surgeon?

Based on the fact that he doesn't know anything about WPATH and didn't immediately start talking about double incision (your chest is larger than a small B with no droop to your breasts, right?), concerns me.

I'm sure he is a good surgeon. He might be an excellent plastic surgeon. What matters is if he is an excellent (or good) top surgeon. The question is if he had any training in top surgery and how many times he has done it.

I think you live in Michigan? I assume you have Medicare. You can go to the University of Michigan.

http://www.uofmhealth.org/conditions...ender-services

Since Medicare is a federal insurance, you can use it anywhere. Transgender health programs are popping up at all the University hospitals and they take Medicare.

It's true that every surgeon who does top surgery has to start somewhere. The question is if he had any training in it. I have seen too many guys in such distress over their results when using a non-seasoned top surgeon. I know travel is costly, but it might be worth it.

Yet, with all this said, there are many guys who don't care about how "good" it looks and just "want them off". There is nothing wrong with that, either.

Guess I was a bit worried in the office. He told me the WPATH documentation he needed before going any further. You wrote that it concerned you when he seemed unfamiliar with WPATH. Please explain.

Didn't ask the questions you recommended, He seemed reluctant to discuss it any more in depth before receiving the WPATH and other medical records? Will print out the list for Jan. visit. Do many plastic surgeons take telephone questions?

You mentioned that you were familiar with other medical centers. I live in NY way up near Montreal, Canada. The closest large US cities are Burlington Vermont (3 hrs.) and Albany New York (5-6 hrs) . Yes, I truly live in the boondocks of a small dairy town. Don't ask how or why this Chicagoan got stuck here. I'll tell you sometime, if you're curious.

Thanks for all the advice. I'd be lost without it.
Btw, do you know of any trans support groups in either city. We are saving up for Albany, though.

I'm sorry, I assumed you knew what WPATH was. WPATH informs the Standards of Care (medical care) for trans people. It is where all things spring when it comes to care for trans people. I looked back and I can't tell from your post if he had never heard of WPATH, or just wanted a letter from your therapist.

http://www.wpath.org/

Why are you saving for Albany?

I have to be honest with you. The number of people doing top surgeries have increased quite a bit in the last few years and I have not kept up with them. I could talk to you about bottom surgeons all day long, but not top surgeons.

I found this, however:

http://www.topsurgery.net/surgeons/medicare.htm

I would not assume all of these people still take Medicare and I would not assume that this list is up to date. There are probably more surgeons who take Medicare. I can tell you that Berverly Fischer no longer take Medicare.

Call your closest University hospital and see if they have a surgical trans health program. If they do, you can be pretty sure they will take your Medicare. It will be harder to find a private practitioner who takes Medicare since they pay so poorly.

Are you on FB? If so, the best thing you can do is join a top surgery FB group and the guys there will have everything you need to know. I can find out the name of the "main one", if you want. I bet that within one post of giving your location someone there can tell you the closest person to you who will take Medicare.

With all that said, it seems that you haven't asked the questions you need to ask your current provider in order to rule him out. But, his reluctance to discuss is a huge red flag. Why wouldn't a trans provider assume you would ask how many surgeries he has done and to ask to see pictures? YOU are the consumer. He is providing the service. I can't help but wonder if he has only done a couple and doesn't have any pictures. Anyway, I wouldn't move any further with this guy if he didn't answer these questions to my satisfaction. Don't let him intimidate you.

Remember, you want a surgeon who specializes, or at least has some decent experience in doing FTM top surgeries. Nothing else matters. Trans people often feel like they have to take crumbs. That we should be thankful that there is someone out there who will do our surgeries. Well, guess what? Shit has changed and there are now qualified people who will do them, who care about our community and want to do them. Unfortunately, some trans people still don't have a choice, based on their location, and that sucks (no money for travel). Insurance is often a sticking point, too. However, don't feel that you have to accept this provider without at least getting some of your questions answered to your satisfaction. With all of this said, I am not saying that one shouldn't accept a provider who is new to it and is eager to learn...sometimes that is the best you can get. Just DON'T forget to ask about free revisions. Do all your research about other providers before you next appt. with him so you know your options going in.

Good luck.

The doc is affiliated with U Vermont, Montpelier (capital city). They have an active youth trans program. At least they are familiar with the care. Went to the Jan. appt. It was just a check in to tell me that everyone (therapist, surgeon) appeared to be onboard.

It lasted about 20 mins. He knows that I live 3 hrs. away. Every appt costs 100 dollars in out of pocket expenses that I don't think can be re-cooped. Next (hopefully last pre-op) hoop is that Anesthesia wants cardiac and IM clearance based on my medical hx before surgery.

He wants to see me again after getting that. Will call the office to see if we can Skype that visit. Really not thrilled about spending 6 hrs and the cost for a 20 min visit.

OK guys seriously now thinking about top surgery and do plan on talking with my endo on the next visit the binder is just a pain at times and even though being not um a lot I mean I can go with out but I just am getting to a stage where I am self conscious
I am also getting cysts from binding ugg most likely be able to do the keyhole just so much and well I am nervous so thought ??

Hi, Bard.

I am not sure what you are asking? I have never heard of someone getting cysts from a binder, so I would check that out.

You mentioned keyhole. The most internationally known/respected keyhole/peri areola surgeon is Beverly Fischer in Timonium, MD (close to Baltimore). Unfortunately, she no longer takes insurance. Her double incision is $9,500. I don't know what her keyhole/peri is, but it would be a bit more than the DI. She is also an amazing person. Has been doing top surgery since the 1990's.

Many guys think they can get keyhole who really can't. If there is any droop to your breast, you should plan on it not being a suggested procedure.

Also, I didn't know you were on testosterone. I didn't see it posted anywhere. Can I ask when you started? Congratulations.

I would suggest before you get super excited about a top surgeon that if you have trans health insurance that you call your insurance company first to see who is in-network. Hopefully, they won't have ANY providers and then you will have your pick of the litter (as long as your preferred surgeon is willing to work with your insurance).

Thanks Dapper been on for over a year now and taking my time with this as I do, yeah I had cyst before that was removed and when I had started feeling some pain and such had my doc check she feels small cyst but test came back clear soo just thinking this is the next or best step for me in the information gathering stage right now and will talk to my endo she had mentioned some surgeons in the area she works with for the trans community here for when and or if I wanted any being small if you will and no drop so I guess we will see I just want to make sure this is the best thing as it has been on my mind a lot thought I would reach out honestly I think it is all part of the processes that each goes through when becoming

Melissa Johnson is very good and carries a great reputation in the community. Check out transbucket.org for pictures of her work.

I assume you know you would only have to stay for 7 days in FL if you went to Garramone, right?

Bard,

I don't know if you have read my extensive ramblings to cathexis, but one thing I listed was this site: http://www.topsurgery.net/

It will give you a solid foundation when starting the process of looking into top surgery.

I forget to tell you that when you contact your insurance company for providers, you need to ask them to send you information on what is required for them to pay for your surgery. Look on your insurance website for trans health coverage which will also have the information.

Without a doubt both your insurance company and the surgeon will require at least one "letter" from a gender therapist saying that this surgery is medically necessary. Make sure that when you see said therapist that you give them a copy of what your insurance company wants in a letter and what the surgeon you have chosen wants in a letter. This way the therapist will make sure to have all of the information needed for both parties. Otherwise, you will find yourself returning for another letter.

If you don't have a gender therapist you can look for a gender therapist who will meet with you for an evaluation and write a letter for you. Usually this is out of pocket, rather than using insurance. Make sure you also find out the therapist credentials required for the insurance company and surgeon.

Let me know if I can help in any other way.

i think top surgery is amazing..i am just not sure about the hormone therapy..dated a few guys in transition and ftm..nice guys but seemed unhappy..had a lot of fun with mtf, we sync..a lit experience

Well, you are going to find unhappy people of every gender. I don't think that your sample of a "few guys" is statistically significant to determine the happiness of an entire population. :sunglass:

Typically, you see improvement in mood when someone begins hormone therapy. Their mood levels out since they are finally getting the hormone their body has been missing. That is why the 42% suicide attempt rate of trans people begins to decline when they begin medical transition. :)

My sample, is part of my life and very meaningful. You can disagree Dapper but my experience is my experience. I'm telling you from a girl point of view. Most couples i knew broke up, because transition put stresses on their relationships. Of course this is years ago and maybe it's better now. Unhappy was never meant to imply suicidal and since I was never deeply involved, my dates didn't share their issues. also..

btw the top surgery i saw about 20 years ago was top notch, beautiful work, very little scarring. This was in the PNW.

Years ago, wish that my doc had made such a recommendation when a solid cyst was found. Instead it was determined as benign based on an in surgery pathological eval. I had signed consents for mass removal, subtotal mastectomy, or radical mastectomy. Sure wish I'd had a pick one from column A, then one resolution from column B. Let's see...no cancer...subtotal mastectomy.

Too bad life doesn't work like that.

Wish I could choose binder vs surgery; instead,

I've basically got renal failure vs relief from gender dysphoria
OR
Heart problems vs feeling better about my body

If you're younger, I'd look really close at surgery as an option.

Turning back the clock is not an option later.

Instead, many must put Justice's blindfold on and weigh the best you can

I've seen Johnson's work up close and personal with two friends who went to her. I saw them imediately after surgery and through the healing process and I would highly recommend her. She was great, the results were great, and both friends were thrilled with their results.

If time away from the store is a concern, I would say go to Johnson. As an outsider. Hope it's ok I posted in this thread.

I hear you. As CCB said, Johnson does good work. You will be in good hands. I would definitely set up a consult and you can see how she "feels" to you. She will also have pictures of her work. Of course, surgeons always have their best pictures, but that is why transbucket is such a good resource.

I have always thought that Johnson had done quality work, but years ago she used different incision lines, instead of cutting under the pec muscles, which is the standard with the double incision method. Since we just simply cannot get away from scaring, the scars were more noticeable for those who have the ability/choose to, build up their pecs that can hide the scars somewhat.

I know you have been thinking about this for a long time/planning this. Good luck to you.

Just had a bunch of surgeries
 

Hey all,
Back in January I had to get a mammogram prior to top surgery simple right.
My schedule was like this start T appx Jan 15

Get top surgery April
Get lower removal surgery April

Well I went and got a mammogram , two days later they call I need a more detailed one....ok cool prolly a cyst.
Well long story short it wasn’t a cyst
So schedule had to be adjusted:
Lumpectomy, so I did that and in one day I had appt to return visit surgeon and endocrinologist.....
Endocrin refuses to start the T said see your surgeon... long story short cancer....
sooo now it’s other breast testing, radiation, genetic testing,
Well of which needed to be done b4 top surgery and a vacation to Italy in March.
So had all the basics and then was faced with a decision full bilateral mastectomy..... or take tamoxifen for 3 years and no T

Genetic testing came back verified what I already knew

Two weeks ago I had a bilateral mastectomy and a complete hysterectomy and three lymph nodes removed in arm pit area at same time. All pathology reports are in and all is clear no cancer no possibility of “female cancer since everything is gone”. Every 6 months I will get a ct scan.
Tomorrow I start T

Now this is not what I planned.... but it is all working out.... in about 6 months the plastic surgeon will do top surgery and contour and I will get tattooed on nipples for the look.

Right now hi am getting accustomed from going from a DDD to nothing but a swollen strip with stitches from armpit to armpit...
So I pass sort of.... next week I start speech therapy to teach me how to maintain my voice in the lower octave range as well as fine tune male word inflection. So as the T takes hold and the facial hair and voice goes even lower than it is already... I’m prepared sort of
I’m 65 and doing this and tomorrow my adult kids and the grands are throwing me a Happy T Day. Party

Why am I scared and doubting myself after all this ?

Wow, you have been through a lot!

Sorry about the cancer. :( It was hard for me to understand what you were saying, but I think you are done with radiation?

Good luck with your top surgery. I know a guy that had to get mastectomy due to genetic testing. The surgeon was supposed to make his chest more male looking, but he did not. It was a horrible situation, and clear transphobia. He is going to go to a top surgeon now that he has trans health care.

Is your insurance paying for voice therapy? That is very unusual.

Make sure you use a medical tattoo artist for your areola/nipples

It isn't unusual for someone to doubt themselves before going on T. However, you have been through a hell of a lot. I know that you decided to go on T prior to all this stuff hapenning. However, it certainly wouldn't be a bad thing to give yourself a breather before you get started on T.

Just a thought.

I am pretty lucky where I live, I have penn medicine which is a great nonphobic place. Even non gender bathrooms.

The speech therapy is paid for by insurance since it is part of my treatment for my diagnosed condition of gender dysphoria.
I met one plastic surgeon and I thought he was just an asshole so I.met with another and he is great so we are just counting days and pounds if I can drop about 40 or so pounds then with the contouring I will also get some stomach work done.. since the internal material needed for top is coming from the gut..
I also moved back to pa from nj because of the better medical care and thanks to Obamacare care the insurance is affordable.
Also I am a vet, and if the va can not provide a needed service then they send to civilian... and of course I say send me to penn medicine and get the needed treatment.

This starting T stuff is a bit unnerving for me, it’s weird I am looking forward to greater hair growth on face, I already have a deep voice, but for 40 years have thrown the voice higher to more easily be acknowledged as female... I really got tired of being met by police outside the ladies room doors.

Well in 2 hours I get T, for so many years I have waited for this...wanted it, now I am in the Countdown and honestly have no idea if I am going to go thru with it and get the first shot and the rx. Guess I will know when I know... dean

Hi, Dean.
I hope you are comfortable with whatever decision you made today.
I don’t live in PA but I live near the area. I am curious to know who your top surgeon is. Since you mentioned a male being an “asshole”, I am going to assume you saw Dr Leis. He is a misogynistic jerk, yet does fine work. The thing about him though, is that he has no idea. And supposedly all of the women who go to him find him to be very kind and caring.
I work in the trans health care field and have worked with all the major insurance companies. I am also very involved with the trans community nationally. This the first time I have heard of an insurance company paying for voice therapy for a FTM billed under a “Gender Dysphoria” diagnosis. I know of one person who had it approved under “hoarseness”, because he is a teacher. I have only known of one company who has paid for voice therapy for a female under Gender DyphoriA
Are you sure they are using the ICD-10 code for Gender Dysphoria (F64.1) for your voice therapy? You mentioned Obamacare, so I assume this is your insurance. Who is the
carrier? Or is the voice therapy under TriCare?

Would you mind asking your voice therapist what code they are using to bill? I interface with a lot of trans people and it would be helpful. Insurance companies are still not following WPATH standards and voice therapy is so very important for many MTF individuals.
Thank you for your help.

I did it
 

I love my kids, my 30 yr old daughter picked me up we went to the endocrin, by the time we got there her and I were laughing and joking so much I was calm and ready. So I got my first T shot.... a tiny amount... but a shot. I handed them the papers that instructed male pronouns and name to call me tho they can change my name on records they will Call me the name
After that daughter took me for a haircut and then returned in time for the T DAY PARTY. 😀😀😀

Hey Dapper,
The first plastic surgeon I saw was Joshua do’s not, penn med, very excellent surgeon but a bit of an asshole egotist. And just a real condescending jerk; so after I left the appt I talked to a few docs and got a referral to Dr Au another fine plastic reconstruction surgeon at penn med who has a good amount of sensitivity, trans experience, and I trust him. The speech therapist office I am going to is penn medicine on at the good shepherd location, it took my choice person 2 weeks to find a qualified person. Actually I asked my VA PRIMARY DOC and Va psych person who did my trans psych profile for a speech referral and I cited about 20 different reasons as to why it was necessary. So the VA said yes but since they don’t have a qualified spec they gave me vet choice I said penn med... so then the va makes aptmt with the civilian doc and they pay the costs. Penn med is great for vets and all docs under penn med accept the vet choice payment schedule
I have my speech aptmt may 4 so can give u more info after that. That worth standards book has great info and I quote from it frequently... if u private msg me I will try to find a copy of my notes and justifications I used to get the referral. And what to emphasize. Passing with appropriate voice is major important due to rest rooms and the danger associated ...
ok so dapper I just looked in mirror and my chin hair growth hasn’t increased..... 🙃🙃🙃 damn wanted to start waxing my beard ( joke, I know it will take a bit, my kids have a pool going as to when the beard and mustache is visible from 10 feet away)

I can feel the joy in your heart when you write Dean. Congratulations!!

(hope this was ok to put here)

Dean, I am glad things went well with your shot and that you have a supportive family. What dose did they put you on?

You might want to consider going with a trans surgeon for your surgery. I would strongly suggest this. There are two surgeries in your area that have surely done well over 100 surgeries. I can't suggest this strongly enough.

Your two options of trans surgeons in the Philadelphia area that take insurance are Dr. Kathryn Rumer and Dr. Leis. Most prefer Dr. Rumer. She also does well with larger guys. You can see pictures of both of their work at transbucket.org. You might want to visit topsurgery.net. You can also visit their websites. I have seen two many guys go to surgeons who have some experience and have poor surgeries, only to seek out actual trans surgeons to revise their surgeries.

Since you go through the VA I assume the insurance you are using is Tricare. Is this correct? Is Tricare your primary insurance and Obamacare (the health care marketplace), is your secondary that picks up the copay?

If so, Tricare would have been the insurance to authorize voice therapy, and again, that would be useful to know. Trans people have attempted to justify voice therapy for years and it has never come to fruition. I am wondering if the key is your insurance. I don't know anyone who tried to get voice therapy paid for under Tricare. Thanks and congrats.

Oh, and 10 feet away may take a bit of time! lol

Life is short
 

Dapper,
First off Thank you those words are simple but really meant, your advise and assistance is helping me a lot. And I am most appreciative also jealous of your car,,, I miss my spyder more than I can say; and have been looking but trying to hold off till I get the legal name change and gender change on my legal docs and college transcripts. By August that shud be done.
With regard to T My beginning dose is very tiny, it will be increased every two weeks as long as the blood pressure stays under control. So I am at 25 and am doing weekly shots; I wanted the lowest possible to start... they were going to start at 50 per week which I knew was small. But I had wanted even smaller. The endocrin and I have been talking for months about this and at this stage being overly cautious is my rule of thumb. What’s a few months at real low doses and staging if it helps prevent heart attack etc. currently living in 4 diff heart meds and still watching the Bp hit high levels I really want to prevent any heart complications.
Dr Rumer , I met with her some time ago, she does her work at Hahnemann hospital... she just became the head of the trans program their. Truth is I was uncomfortable with her; and I am not fond of hanneman hospital, it’s a personal prejudice and bluntly its dirty And the staff is cranky.
I’ve seen au’s work he’s great, he was also in the or when I had the mastectomy to draw lines for my oncology surgeon so the cuts where done where needed for top work.
Dapper I am a disabled veteran and have use of va hospitals/ medical care. Any veteran that applies to the med center can get treatment there with or without service connection illness. I strongly recommend it. With a few newly implemented programs over the past couple years the VA has become more inclined to send folks out of the VA medical center for care to local specialists.
So when I approached the VA regarding my gender dysphoric issues and needs I made sure I had done the homework and research and had laid the groundwork.
I have found insurance companies and the VA are very responsive when the issue of passing and dangerous restroom situations are brought up and really pushed. Also the fact that for over 50 years I have been escorted or dragged out of a ladies room, more times than I can count on my digits. Also the vocal adjustment one does so one is not mistaken.... I raise the pitch of my voice for so long to try and reduce the yes sir,,, thing,, that lowering it just back to the normal speech octave is so difficult I need speech path assistance. Basically dap because the voice can in fact cause one not to pass and put a trans in physical danger the VA took quite seriously. Bluntly I point to places like North Carolina, and I show the “bathroom app” and say if I am in this location the info on this app says the safest unisex washroom is 6 miles away.... now at my age the washroom and time to get there does not include a 40 minute drive in the city. Etc etc etc
And I was approved, the VA doesn’t have a qualified speech therapist for my needs so they had to send me outside of the veterans administration health system.
I also knew penn med aka univ penn hospital had what I needed so I was helpful to them and told them where I could go.
��

I started on a very low dose of T too, so I hear you on that. I agree that UPenn is a good hospital. There is no question about that. In fact, I recently had some surgery there. Good luck with your top surgery. You shouldn't go with a surgeon you are uncomfortable with.
Trans people have been living dangerously for years when it comes to their voice, most pointedly trans women. Doctors saying it is a "medically necessary" or "making a case" does not work with insurance companies. If it is on their exclusion list, it is on their exclusion list. That is why I am so curious about you getting it covered. I am going to be with a group of trans health providers and surgeons over the next few days. I am going to find out if anyone else has heard of someone getting Tricare to cover voice therapy.

I hopefully will be having top surgery at the end of May. I just got my insurance approval and am waiting for the surgery scheduler to get back to me so we can get the ball rolling. I'm so excited and cannot wait!

Awesome and congrats! Who is your surgeon and how long is the usual wait time for them?

Thanks!! I'm seeing Scott Harris in Plano, TX. When I had the consult at the end of March, they said they were booking into April so hopefully I can still get end of May at this point.

Not tricare
 

Dapper it’s not TriCare it is the veterans administration health system. Ck out va.gov and click on veteran health.
Also thru that site u can get the va book on trans care.
Any trans women vets tell em talk to me I will help them.