Yes, out of country funding is available IF you have contraindications to Radial Forearm Phalloplasty (RFF.)

Yes, Dr. Monstrey is being funded.

No, Dr. Crane is not currently being funded because his fee is much higher than the Belgian team’s.

Yes, patients have been funded.

I would still prefer to have Dr. Crane do my surgery—there would be less travel involved, easier logistics with friends in Austin, I’d be closer to my surgeon in case of complication, and I wouldn’t require an in-person consultation to book a surgery date—but in the likely case that this request will be denied I won’t be disappointed to go with Dr. Monstrey, who has more experience and is getting very nice results with ALT Phalloplasty. Plus, I’ve never been to Europe and would enjoy seeing that part of the world.

The next step for me is to get a referral to a hand surgeon in Victoria, Dr. Djurickovic, who will support my case for ALT Phalloplasty as an alternative to RFF Phalloplasty.

I’ll also have to go to Ghent, Belgium for an in-person consultation before I can book a surgery date, and I hope to be able to do this in Spring/Summer 2016. (As a 4th generation brewer, I’m really looking forward to Belgian beer!)

Provided that I can save the large sum that I will need to cover expenses and time off work, I could potentially have surgery in Fall 2017 at the earliest. That’s a long way off, but at least I have some forward motion happening now.

A few days ago I went to take my morning supplements. One of which is CLA which reduces body fat. Over the years I have found it effective but it seems too effective for my penis.

Today I had my appointment with my local urologist and my implant is not broken. However, the fatty cushion I had between the tip of my penis and the implant is not really there anymore.

Though it isn’t broken and isn’t eroding we both agreed it is better to be proactive than reactive.

The current plan is to go in at my original implant incision and shorten the implant at the base then reenforce it at my pelvis with an extra screw. Luckily the coloplast geneisis is customizable so he doesn’t have to replace it entirely. By clipping it at the base this will create a greater distance between the implant and the tip he will also add fat back to my penis and if needed put a little mesh right under the tip skin to reenforce that. The incision for that will be right along the glansplasty.

Since fat grafting is involved he will also add fat to my scrotum as per my request. I do have time to decide if I want a small pair of implants added to my scrotum but as of right now I think the fat will be enough.

Though I am not looking forward to having another surgery I feel that this one isn’t so bad. I assume the healing will be pretty much the same as my first implant surgery which actually wasn’t too painful just a lot of swelling and tenderness. I will probably have the fat taken from my abdomen so that area may be sore but still I don’t see it being too bad. He did tell me that I can resume sex until the procedure which will likely be end of August. He did say for me to take it easy though.

Once I have that procedure I’ll post an update.

Outside of conferences and my own local stuff I feel my role in the “Community” shifting and it is needed to continue to pursue my other goals.

Shortage of critical TB, lung infection drug worries patient, doctor

Note that drug in question, ethambutol, is sold by Valeant Canada. Valeant is also the manufacturer of Delatestryl, one of only two brands of IM Testosterone available in Canada, and one that has been subject to several shortages, including two last year. The reason for shortage is “Delay caused by the manufacturing site transfer” — a change in location of where it is made in Canada. Efficient as always, Valeant!

Last week, DAILY VICE released an interesting (and alarming) video featuring Dr. Jacalyn Duffin, a doctor who has been raising red flags on prescription drug shortages in Canada since 2010. Dr. Duffin runs CanadaDrugShortage.com, a website dedicated to tracking the problem in Canada. From the website’s home page:

1. Why does Canada not start making the missing generic drugs for itself and others?
2. Why is the pharmaceutical industry divided into two warring factions–brand-name (called research) and generic?
3. Why doesn’t Canada show some international leadership in measuring the impact and extent of this problem and in finding solutions?
4. Why does Canada not have an Essential Medicines list as recommended by WHO and our own federal Standing Committee on Health?

In the video, Dr. Duffin notes that the growing problem of drug shortages was known to both patients and physicians as early as 2010 but that there has been very little governmental policy development since that time. She goes on to say that 75% of doctors hypothesized Big Pharma manipulation as the root of the problem by 2011.

When asked about the drug shortage I was facing in 2011-2012, my doctor told me that drug shortages were “orchestrated to drive up pricing.” Case in point: Due to a Pfizer shortage at the end of 2008, I switched from Pfizer Depo to Delatestryl. In 2010, the price of Delatestryl doubled in Canada, from $60 CAD to just over $120 for a 10ml vial of 200mg/ml. (Compare to two vials of 10ml Pfizer Testosterone Cypionate 100mg/ml, currently available for just over $70.) During the 2011-2012 shortage, the cost of Pfizer increased to between $80-90 for the same amount of the drug. Pricing went down again after the shortage. (See: Transition Expenses)

Watch the video now: VICE Meets Dr. Jackie Duffin

(I submitted my story to Dr. Duffin’s website in 2012, which is addressed at 9:15 when hormone replacement drug shortages facing trans people are discussed. There’s another story from 2014 of a Delatestryl shortage on Dr. Duffin’s website here.)

“The causes are behind a curtain that no one wants to lift… In a country like ours, with all our resources, and all our creativity, and that we have this problem and that we’re putting up with it, I want to find out why.” — Dr. Duffin

If you have followed my blog for a while, you’ll remember that I’ve written about testosterone shortages in the past:

Canada’s Testosterone Shortages
Jan 15, 2012
When I was considering testosterone therapy and weighing my options, one thing I felt sure of was that because testosterone is a common medication for men — not a “transsexual drug” — I wouldn’t be subjected to shortages. This was naive. In the 3 years and 9 months of being on testosterone, I’ve experienced not one testosterone shortage, but four. Testosterone shortages seem to be quite common here in Canada.

Testosterone Shortage Update: Sandoz Suspending Production
Feb 20, 2012
We can now safely assume that Sandoz testosterone will remain unavailable for some time: Sandoz Canada announced Sunday it was temporarily suspending production at its Boucherville, Que., facility.

Testosterone Shortage Update: ETAs, Alternatives and Causes
Feb 28, 2012
An update on the current intramuscular (IM) testosterone shortage affecting both Valeant and Pfizer brands.

Since that time, I’ve continued to track news stories about how the Canadian government is addressing—or not addressing!—the problem of drug shortages:

Aglukkaq calls out Sandoz on drug shortage
Mar 13, 2012
A stern letter written by Health Minister Leona Aglukkaq to Sandoz Canada about its “lack of transparency” isn’t good enough, according to the NDP, which will propose a motion in Parliament Wednesday that aims to prevent another worrying drug shortage.

NDP drug shortage motion gets government’s support
Mar 14, 2012
The House of Commons unanimously supported a motion from the NDP on Wednesday that would require drug companies to report any planned production disruptions to Health Canada. Conservative MPs, including Prime Minister Stephen Harper, sided with the NDP and the Liberals when the non-binding motion was put to a vote Wednesday.

Plan needed to fight drug shortages, journals argue
Aug 20, 2012
Ottawa needs to take the lead in formulating a national plan to manage Canada’s prescription drug supply and deal with ongoing unpredictable medication shortages, argues an editorial jointly published Monday in two medical journals. As with most countries worldwide, Canada has been experiencing shortages of many critical medications, among them chemotherapy drugs, antibiotics, anesthetics and pain killers.

Voluntary drug-shortage reporting adopted despite concerns
Health Canada bureaucrats worried of ‘bad company behaviour’ by drug makers
Dec 27, 2012
The federal health minister opted to let drug makers voluntarily alert doctors and pharmacists of medication shortages despite concerns from her own department that the approach could put Canada’s drug supply at risk, documents show.

Drug shortages worsening as Health Canada starts study to address it
Health Canada starting 6-week consultation on how to avoid pharmaceutical shortages
May 26, 2014
The president of the Canadian Medical Association says the problem of drug shortages is becoming more and more common. Dr. Louis Hugo Francescutti says doctors are raising the problem with him every time he travels across the country as president of the CMA. And they all want to know why the problem is getting worse.

Drug makers to be required to post info on shortages
Doctors have criticized voluntary system of posting information
Feb 10, 2015
The Canadian government has announced it will make it mandatory for pharmaceutical companies to post public notices when drugs are not available. Currently, posting notices to a website about drug shortages is voluntary. For months, doctors and patients have complained the approach is not working, and people are not able to get the medication they need.

And here’s an interesting article about one of the causes of drug shortages in the U.S.:

‘Fake pharmacies’ tied to drug shortages in United States
Mar 21, 2012
U.S. lawmakers are investigating three pharmacies in Maryland and North Carolina accused of passing critical drugs in short supply directly to wholesalers, who are likely to profit from the scarcity of life-saving medicines, rather than to the patients that need them. The probe in October sought to discover why certain companies were peddling cancer drugs at more than a hundred times their normal cost [emphasis added], while hospitals and patients were scrambling to receive any. The findings illuminate gaps in the patchwork of state legislation that governs this sometimes shady network of pharmaceutical distribution known as the “grey market.”

Because money is surely at the root of drug shortages, I’ve also tracked articles that discuss the booming Testosterone industry. This one in particular caught my attention, from the New York Times:

A Push to Sell Testosterone Gels Troubles Doctors
Oct 15, 2013

Aging, insecurity and the $2 billion testosterone industry

Sales of prescription testosterone gels that are absorbed through the skin generated over $2 billion in American sales last year, a number that is expected to more than double by 2017. Abbott Laboratories — which owned AbbVie until Jan. 1 — spent $80 million advertising its version, AndroGel, last year.

“The market for testosterone gels evolved because there is an appetite among men and because there is advertising,” said Dr. Joel Finkelstein, an associate professor at Harvard Medical School who is studying male hormone changes with aging. “The problem is that no one has proved that it works and we don’t know the risks.”

Nevertheless, many insurers cover the cost of the high-priced hormone treatments, requiring only a small co-payment from patients. AndroGel and another popular testosterone gel, Axiron, by Eli Lilly & Company, sell for more than $500 a month retail, and about $400 with pharmacy coupons.

Such advertising also leads patients to seek out more expensive treatments, rather than cheaper ones that are often equally effective. [emphasis added] Drugs that are advertised are almost always the ones that are costly.

The puzzling FDA approval of Aveed last June also got me thinking: at almost $900/injection, Aveed certainly represents a more profitable form of IM Testosterone compared to the standard T. cypionate and T. enanthate formulations, which ring in at about $8-14/injection. Does the introduction of Aveed put us on a path to limited access to Testosterone for those without insurance or the means to pay? Even worse, is it the first step of the phasing out of affordable Testosterone in the U.S.? (Aveed is the U.S. brand name for the long-acting testosterone formulation known in other parts of the world as Nebido. Nowhere else does it cost as much as it does in the U.S.)

Now, concurrent to this boom in Testosterone profits, I’m also seeing troubling signs of limited access to the cheaper IM Testosterone in the form of anecdotal reports from trans men, including:

• Intermittent shortages around the U.S., including the popular Strohecker’s Pharmacy which in the past has been a rock star of reliability in providing T.
• Some pharmacies and(/or?) insurance companies in the U.S. have been putting 28 or 30 day blocks on re-orders of IM Testosterone.
• Inability to locate vials of T larger than 1ml in the U.S. Some brands of 10ml vials have been on backorder in the States for over 6 months.
• Some insurance companies in the U.S. no longer covering 10ml vials, only 1ml vials.
• Bayer Spain has suspended production of Nebido: “The Ministry of Health has forced it to lower its price by 35%… and now considers that it is no longer ‘profitable’.” A petition on this issue started by a trans man in Spain has acquired almost 65,000 signatures. A German company warned that price revisions made by the Spanish Ministry of Health “could jeopardize the situation of Nebido in Europe because the price of medicines in some markets becomes a reference price for other countries.” (Note: While Aveed and Nebido are the same drug, licensed by the same company, Nebido has been drastically less expensive in the EU compared to the cost of Aveed in the U.S.: less than $200 USD vs. almost $900 USD for a single Aveed injection.)
• While not verified, I’ve heard from trans men in Texas who were recently told that injections must now be performed at a doctor’s office or approved clinic.

The result of these limitations to access is inconvenience. But I don’t mean that lightly: the inability to acquire medications like Testosterone for all men, trans and cis gender, has serious health repercussions. And while I’ve focused my blogging on the drug shortage that has affected me, Testosterone, please note that people from around the world have died as a result of shortages of drugs ranging from cancer to HIV medications. Drug shortages have reached global epidemic proportions.

What’s a Trans Guy to Do?

Have no fear, Big Pharma’s got your back, brother! With persistent IM T. shortages, the convenient option, according to drug manufacturers, is to switch to one of the more expensive preparations, like AndroGel, Nasonex or Aveed. They’ve planned well for this, haven’t they? I hope you have insurance!

Meanwhile, there’s no end in sight for the intermittent Testosterone shortages in North America. Valeant had two shortages of Delatestryl in Canada last year, and several U.S. brands continue to be unavailable. (Mexico has also faced testosterone shortages, including a 6 month back order on Sustanon in 2011.)

Resources:

• Canadian Drug Shortage Database
• ASHP’s Drug Shortage Bulletins for the U.S.

Have you been affected by a Testosterone shortage? Please share your story in the comments below!

This year was different. After attending the Post op lower surgery closed discussion workshop I had the extra push I needed to not bother. That workshop helped me realize though I want to give back and I do give back I also shouldn’t feel guilty for wanting more time for myself or to not feel like my sole purpose is to be at the beck and call of pre op guys.

For the first time I went to NO surgeon presentations on surgery. Some of the guys from my group attended and I did ask them to share notes but for the first time I didn’t feel like if I didn’t go I was some how failing or not helping my “community” It felt good to sit down and talk with folks as well as just enjoy the experience. It was weird, new and good all at the same time.

It was awesome to start to move towards just living life.

I am so happy to be free. Though I was down to every few months it is good to know that I am doing that well that seeing me more often isn’t necessary. That made my day.

I did ask about testosterone pellets since I am getting kind of sick of the shots. Dr. Z referred me to his colleague that does that in his office so I made an appointment with him. I am going to check the copay and stuff related to that whole thing. If it is worth it then I will keep the appointment. If not then I will just keep doing my shots. It feels so good to be free though!!!!

Sensation is great, I am peeing without issue, natural hang and now with the implant sex is AWESOME

I had a minor issue with my healing from my erectile implant. Long story short I slipped in the snow but didn’t fall. How I slipped in the snow loosened something. The implant is anchored to my pelvis but there is some other locked part which clicks. I was worried but when I saw my urologist he manually held and moved things and he said that the most important part which is the anchor is in tact and the part that moves will only be an issue if it pokes or presses me in a way that is painful. He advised me to have sex and see him in a few weeks. If sex is technically hard due to this issue or I have pain then it is an easy fix. The only thing about the easy fix is that if ANY bacteria gets in the wound and I get an infection the whole implant will have to be removed and replaced.

Fast forward now a few weeks. I tried having sex several times since I got the green light. The first few times I felt tenderness and discomfort but this past week it seems all the soreness from the muscle in my groin where they anchored stuff is gone. I was able to have a lot of great sex and no pain. I was also able to try different positions and now with this malleable rod I have some new favorites. Masturbation is a little different now and still learning the most effective way to get off that way but I am always able to. Also blow jobs are weird but fun since sensation isn’t even throughout my penis.I have full sexual sensation but some spots are more sensitive than others.

I will try to do a longer post but wanted to do at least a mini update.

Surgery day was just amazing. They actually called me on the way there to tell me that the OR my surgery was going to be in was available earlier so instead of getting there and waiting a long time to get into the OR I was able to check in and get things going. They confirmed that I was getting the coloplasty Genesis Malleable rod implant.

I remember walking into the OR (I had a choice to walk or be wheeled in) and instead of feeling nervous I had this feeling of joy. The OR also had a “Sterile: implant procedure in progress” This was to keep the room from getting contaminated once they started because of the high risk of infection with implants. They had a ton of tools on the table and what looked like a drill and metal things of different sizes. Usually seeing something like that might make me nervous but it actually made me excited. I remember looking up breathing in the gas and all of a sudden I am waking up in the recovery room. When I woke up I Wasn’t in any pain I Was just really thirsty and hungry.

My surgeon tried to talk to me earlier but I was out of it.The resident came back about a half hour or maybe more later and told me that they only placed one rod instead of two but due to the size of my penis that should be sufficient. Since this conversation about one verses two was had at the office and in the pre op suite before surgery I didn’t feel sad or anything I was just happy to have the procedure done.

I was given ice chips to start then a little while later I Was taken up to my room. I was shocked that I Wasn’t really in much pain. When I got to my room I had to pee so they gave me the urinal but peeing with essentially a hard on was kind of awkward so I asked if I was allowed to get out of bed. The nurse helped me out of bed and that is when I felt the pain. My groin was sore like I over did it on leg day at the gym.  My penis felt heavy and swollen but not pain in my penis. I wasn’t allowed to eat because the first few hours you are at the highest risk of hematomas in the groin and if I did develop a hematoma they wanted my stomach to  be empty. I was only able to drink apple juice, water and eat jello. I wanted food but after eating the jello I didn’t really feel too hungry. The nurse gave me pain meds and I called and sent text messages to folks who I wanted to know I Was fine then I went to sleep. In the morning the residents from the plastic surgery team came to check on me and they said that urology would be by shortly to give the official word on whether or not I could go home. They moved my penis around a little to check the incision and it was tender when they moved it.

Shortly after they left the urology team and my surgeon Dr. Zhao came by to see how I was doing. They unwrapped my penis and said all looked good. They told me I could shower in the evening and to wear boxer briefs that were close fitting or briefs to support my penis. After they left I got up to pee again and to take a look at my unwrapped penis. When I held my penis to pee. I noticed that the underside of my penis where the incision from my initial phalloplasty surgery felt even more sensate than pre surgery. I even touched the implant and it didn’t feel or look abnormal. It looked and felt natural in a way but when I squeezed it that is when it from like a foreign object in my penis. While Peeing I noticed my stream was stronger and a little straighter but being high on pain meds I felt more comfortable using the urinal instead of using the toilet and peeing on the floor.

I was discharged from the hospital right around breakfast time and decided to take a taxi home. Getting in and out of the taxi was a little painful so was hitting the potholes. I opted to make a nice spot on the sofa in my living room since it seemed like it would be easier for me to get up from there than my bed. I was due for pain meds so I took them and went to sleep. The rest of the day was just me resting. I was told I could bend my penis  to fit more comfortably in my underwear but I was nervous about bending it too soon so I walked around with it pressed against my left thigh and it looked a little obscene.

When my wife got home I showed her my penis and due to swelling it looked massive. She even cracked a joke about “who do you plan to fuck with that”. She did compliment the fact that with the implant my glans seemed more prominent and natural. I missed a dose of my pain meds and that is when I really felt it so after that I made sure to be on top of it the rest of the day.

On day 2 post op I was able to skip two dosages of my pain meds and be fine as long as I Wasn’t moving too much. I would only get up to pee and I would time my water intake so that I wouldn’t run too often while I was sore. My hand where they had put the IV was really swollen and hurt a little.

The IV had slipped out the vein or blew out the vein but fluid was still going into my had. I only noticed something was wrong when the nurse tech came to take my vitals. Though my nurse came and took out my IV right away my hand was huge and painful it was more swollen and more painful than when I had the tissue harvested for my penis. It’s swollen and if it doesn’t go down or improve in any way by tomorrow I plan to follow up with my Doctor about it because it hurts and looks really big. IF I press my hand you seen an indentation of my finger.

Outside of the hand issue everything has gone without a hitch. I am looking forward to this swelling going down because my penis is hard to keep comfortable in my undies while swollen.

I have to wait 4-6 weeks til I can have sex. I definitely will be posting about that when the time comes.

My life has been in transition to focus more on my larger, non medical journey related goals. This involved me leaving a job that I only took to have the insurance for my phalloplasty. I promised I would only stay a year but stayed longer which made sense. As a result of snow storms are other timing issues there was a delay in part of my insurance getting pre-authorization. Long story short in order to keep my surgery date I had to pay part of the fees up front. Luckily it is tax season AND I always try to live below my means and have emergency savings in case of situations such as this. I know once the issue is resolved I will get my money back. I am just happy to be having this surgery. I am ready to be done. I was giving the choice of waiting til the issue resolved or pushing back my surgery for at least 6 weeks because of the schedule being full and “holidays” that I decided to just pay the money.

To me it is worth it. To have my penis so far I only paid a $40 consult fee and a $500 deductible. Originally years ago when I decided to have phalloplasty I prepared myself mentally to pay cash so having saved so much money to date and being so close to the end the decision was clear. The cheap side of me died a little as I signed the authorizations for payment but at the same time wholeness is priceless.

Next update will be how things are going.

Dr. Zhao examined me and he said he wouldnt recommend the pump for me but if I wanted it he would do it. He said the rods would be a good fit for the way my penis and urethra are set up. I asked him whether he used the AMS spectra or the coloplast genesis. He said he actual can use either byt he recommended that because of the size of my penis AMS spectra was on the amaller side. They do have those caps to make it longer but thoughs caps can get flyid or bacteria stuck and if he could place an implant without the lengthening cap that would be best. We also discussed 1 rod or 2. My penis is thick and how things are set up urethra wise he will go in with the intention of putting two rods but if my urethra, sensation or circulation might be risked then he will put just one. Either way I will be in a better position in regards to rigidity so though 2 will be great 1 is fine.

Based on all of that the coloplast was recommended. I say recommended because if I wanted AMS he would and could do that but I trust his judgement and insurance is paying for it. He gave the green light for me to be scheduled. We were shooting for an end of January date but by circumstance it didnt work out that way so I will be getting my implant right before Valentine’s day. As of right now I still plan to skip the testicular implants. My sac is full and fine without them. I may get more fat put it down the road though. In all honesty my penis is like the lead singer stealing the ahow because of how big it is and my balls are the back up singers no one pays any mind to. To the touch they feel great and natural. I like them so that’s all that matters.

I think it is kind of poetic because my whole medical journey had been abaout me loving myself. To end this journey with my last surgery right arou d Valentine’s day seems fitting.

I’m ready for this end of a 10+ journey.

Life has been great having my penis.  Everything about it just fits me  down to the size it is. Sometimes I feel small when my bulge isn’t obscene and i make it look more modest then When naked I am reminded how hung I am and just smile. My glans is great too still Dr. Salgado did me well in that area too. With or without a condom I seem to have good definition in the head.
Masturbation is very fun and sensation is great. It’s weird because I can feel along my shaft very well but there seem to be small areas where sensation is waking up even more which is fine by me. Sec had been good but after February it will be great!!! I don’t know how I’m going to handle the 6 weeks of no sex but I will have to figure out a way.

This has been such a long road. I feel like a huge weight has been lifted from my shoulders and I feel more and more peace within myself.

Since surgery I have focused more on achieving goals I have put off.

There were things I didn’t get to do for 2014 but I decided that it was okay. I know sometimes I am way harder on myself than anyone could ever be.

2015 will be about:

– Closing my medical journey chapter

– Pursing more educational goals (Yes ANOTHER DEGREE!!!!!)

– Building my businesses both my Not-for-profit business and my for profit businesses

– Building the physique I want

– Building healthier interpersonal relationships

– Having more fun

– Going on vacation

– After my implant lots of SEX

This list seems so trivial but when you spend the good part of a decade focusing on medical transition and surgeries the small things get lost.

I know I haven’t been posting as much as I have said I would or as much as I wanted to but I consider that a good thing. It means nothing eventful surgery wise has happened. It also means that I am off busy with life.

I will try to do “check in posts” but posting “everything is still the same” seems a little weird.

I am still peeing well. I am disappointed that it has not snowed so I can write my name in the snow. It snowed once so far but it was just slush so no name writing could occur. I look forward to writing my name in the snow. I even have a pyridium saved so that my urine will be a bright orange so that it is plain. I may even take a picture and post it.

That’s all for now. Off the work on some goals!!!!!!!!!!

Here’s an excerpt:

Madison Square Garden can seat 20,000 people for a concert. This blog was viewed about 66,000 times in 2014. If it were a concert at Madison Square Garden, it would take about 3 sold-out performances for that many people to see it.

Click here to see the complete report.