transgender surgery consults are still too hard to get

I’m trying to get an orchiectomy, or rather to decide if I want one. It’s a procedure where a surgeon removes your testicles, and I don’t know much else about it because I think surgery is gross and unpleasant.

I’ve been trying to get a consultation with one of the surgeons that does them and other transgender bottom surgeries, so I can ask some questions about orchiectomies and how they might interact with future surgeries. And this has been really hard! I’m used to a hostile medical system but the level of bureaucracy here has been really astonishing.

I actually did schedule a consultation with one provider very easily, and then found out that they have had a number of malpractice suits and a history of litigating against former patients with bad experiences, as well as a few other stories I won’t repeat here.

Everyone else has been virtually impossible to get ahold of. Yesterday I got an 850-word reply back from MoZaic Care, the practice of Dr. Heidi Wittenberg, in response to a request for a consultation.

Here’s what I need to talk with a doctor about a transgender surgery, even to ask basic questions:

  1. Insurance card
  2. Photo ID (front and back!)
  3. Vaccination card “if vaccinated” (why ask for it then?)
  4. $250 for a consult for “self-pay” patients (everyone who doesn’t have a few Californian insurances, and of course “please be advised that Dr. Wittenberg and Dr. Bonnington has opted out of Medicare”)
  5. Prior authorization from referring physicial or PCP “for your intial consultation” for patients with “HMO/EPO/Managed Medi-cal/Narrow Network Plans”
  6. Three letters (from your hormone therapy prescriber, psychiatrist or psychologist (PhD), and your current therapist): required to “secure a surgical date” and “recommended” for the consultation. “If you submit your letters prior to your consultation, please be advised that they must be dated within 12-months of your surgery date and may need to be revised.”
  7. Ten different intake forms:
    1. Optimizing surgical outcome agreement
    2. Medical intake form
    3. Financial policies
    4. Notice of HIPAA privacy practices
    5. Patient record sharing & medical history authorization
    6. Rules of conduct agreement (“Waiting patiently for the physician’s and staffs’ availability is expected.”)
    7. Postoperative safety agreement
    8. Patient registration form
    9. Authorization for verbal discussion of protected health information
    10. An arbitration agreement, which waives your right to a jury trial. “Please note, the arbitration agreement must be sent back in color (please sign with black or blue ink).”

And this is all just to get in the door! Seems like the surgeons all know we don’t have any other choice. Part of me wonders if this process was intentionally designed to exclude all but the most obedient and well-resourced trans people, and the other part of me knows that the purpose of a system is what it does.

I always wonder how cis people seem to come under the impression that transgender surgeries are easy to come by and accessible to anyone but the wealthiest trans people. I hope and dream that we can build a world where transgender people are allowed authority over their own bodies.

An anecdote from a friend, for contrast:

My mom is getting a face lift in the next year, apparently it was absolutely painless to schedule as long as they know you can pay. It’s wild how cis people can get gender assuring surgeries no questions asked.