Dr. Lubos Kliniken - Første konsultasjon om falloplastikk
Dette er en transkripsjon av min første konsultasjon om falloplastikk med Dr. Markovsky hos Dr. Lubos Kliniken Bogenhausen i Tyskland. For mer informasjon om klinikken, se Nedre kirurgi: Del 5 - De tyske klinikkene
Transkripsjonen er på engelsk. Under konsultasjonen ble det vist noen visuelle eksempler i form av bilder og/eller tegning på ark. Dette kommer dessverre ikke frem i transkripsjonen. Unødvendige ord og setninger har blitt fjernet i etterkant.
Her er lenker til alle konsultasjonene jeg har hatt i kronologisk rekkefølge:
- Første konsultasjon med UKMP
- Første konsultasjon med Dr. Lubos Kliniken
- Andre konsultasjon med Dr. Lubos Kliniken
- Andre konsultasjon med UKMP
Transkripsjon
Dersom du vil ha transkripsjonen i PDF-format kan den lastes ned her.
Sted: Dr. Lubos Kliniken Bogenhausen
Dato: 29.01.2024
00:00:00 Doctor Okay. 00:00:00 Doctor All right. 00:00:01 Doctor So what brings you here? 00:00:04 Doctor What can I do for you? 00:00:05 Levi I am seeking phalloplasty, as I am a transgender person. 00:00:12 Levi And I'm here. 00:00:17 Levi I'm here because they don't do it in Norway. 00:00:22 Levi So I have been talking... 00:00:26 Levi I went once to Planegg to listen to what they can do for me, and I also wanted to hear maybe what you do differently. 00:00:44 Doctor Where do Norwegians usually go? 00:00:47 Levi They just don't. 00:00:48 Levi They don't do phalloplasty. 00:00:51 Levi And it's also, we don't. 00:00:57 Levi Not many of us can afford to do it abroad, so I don't know anyone else who has gone abroad. 00:01:03 Doctor Your health insurance usually does not cover treatments out of Norway? 00:01:09 Levi No. 00:01:09 Doctor Okay. 00:01:10 Levi And it doesn't even. 00:01:13 Levi No health insurance covers transgender treatments either, so it's not great over there. 00:01:19 Doctor No matter. 00:01:19 Doctor In Norway or else. 00:01:21 Levi Yes. 00:01:22 Doctor All right. 00:01:22 Levi At all. 00:01:23 Doctor Okay, good. 00:01:25 Doctor Okay. 00:01:26 Doctor So then let's just, you know, I have some questions to know what the status is. 00:01:44 Doctor And then we'll see what we talk about or what I tell you and what I'll show you. 00:01:51 Doctor I would show you some pictures. 00:01:53 Levi I would like to take that. 00:01:54 Doctor Yeah. 00:01:54 Doctor But it's, you know, it's only examples, of course. 00:01:58 Doctor Okay. 00:02:00 Doctor So this is. 00:02:07 Doctor Okay. 00:02:09 Doctor So was there any kind of reassignment surgery performed? 00:02:14 Doctor So far? 00:02:15 Levi No, nothing at all. 00:02:16 Levi I have had hysterectomy and the breasts. 00:02:20 Levi And breasts, of course. 00:02:21 Doctor Okay. 00:02:21 Levi Yeah. 00:02:21 Levi I thought you meant genitals. 00:02:23 Doctor No, no. 00:02:23 Levi But yes, breasts and hysterectomy. 00:02:26 Doctor And where did you do this? 00:02:28 Levi In Norway. 00:02:28 Levi Both. 00:02:29 Doctor But you did pay it by yourself? 00:02:31 Doctor 00:02:32 Levi I paid for the top surgery myself. 00:02:34 Levi The hysterectomy is covered by public health care system in Norway. 00:02:39 Levi It's not really considered strictly transgender surgery. 00:02:45 Doctor So hysterectomy and ovarictomy? 00:02:48 Levi Yes, both. 00:02:49 Doctor Okay. 00:02:50 Doctor When was that? 00:02:51 Levi In November last year. 00:02:57 Doctor All right. 00:02:57 Doctor Okay. 00:02:58 Doctor So. 00:02:59 Doctor And then we just go through a list of things of surgeries that generally can be performed. 00:03:11 Doctor Let's see what kind of. 00:03:15 Doctor Or if you want all of these single items or something. 00:03:19 Doctor Maybe not. 00:03:20 Doctor So what about the vagina? 00:03:22 Levi I want to keep it if it's possible. 00:03:29 Doctor All right. 00:03:30 Doctor You said you want a phalloplasty. 00:03:33 Doctor Did you? 00:03:35 Doctor No matter if it's medically sensible or not. 00:03:39 Doctor What kind of tissue did you make up your mind? 00:03:43 Doctor Phalloplasty should be performed? 00:03:45 Levi I would prefer the arm because sensation is important to me. 00:03:50 Doctor Okay. 00:03:51 Doctor All right. 00:03:52 Doctor The phallus. 00:03:58 Doctor Do you want to have a glans plasty as well? 00:04:01 Doctor Okay. 00:04:01 Doctor Do you want to have prosthesis? 00:04:04 Levi Yes. 00:04:05 Doctor For. 00:04:05 Doctor Not only for testicles, but also for erections. 00:04:08 Levi Yes. 00:04:09 Doctor Okay. 00:04:09 Doctor So. 00:04:10 Doctor And one more important thing is, do you want a urethra within the phallus or not? 00:04:21 Levi I would like one. 00:04:22 Doctor Okay. 00:04:23 Doctor Which is what most of our patients want to have, but it's not mandatory. 00:04:29 Doctor It's if someone comes I don't want to have or I don't, it's not necessary. 00:04:39 Doctor Then it's also possible to do a phalloplasty without urethral lengthening, which is with less complications. 00:04:48 Doctor Of course. 00:04:49 Levi So I've heard and I've thought about it and I feel like urethra. 00:04:54 Levi I can't even say it. 00:04:56 Doctor Urethra. 00:04:56 Levi Yes. 00:04:58 Levi Important to me. 00:04:59 Doctor Okay. 00:04:59 Levi So I'm willing to do it despite the increased risk. 00:05:04 Levi I've also been told that if you choose not to close the vagina, it's also even more risky. 00:05:10 Doctor Yeah. 00:05:10 Doctor For fistulas. 00:05:12 Levi I don't even know what that is. 00:05:13 Levi I just heard. 00:05:14 Doctor Okay, so besides the top surgery and the hysterectomy and overreactomy, did you have any kind of surgery at all? 00:05:22 Levi No. 00:05:22 Doctor No. 00:05:24 Doctor Since when are you on hormones? 00:05:27 Levi October 2018. 00:05:30 Doctor Okay, and are they paid for by the health insurance, the hormones? 00:05:39 Doctor Yeah. 00:05:40 Levi That's actually paid for through the public healthcare system. 00:05:43 Levi In Norway. 00:05:44 Levi We have a lot of things that go through the public healthcare system. 00:05:47 Levi We don't really have a lot of private. 00:05:49 Doctor Okay. 00:05:50 Levi Healthcare. 00:05:50 Doctor Because, I mean, this obviously is also kind. 00:05:53 Doctor Not kind. 00:05:54 Doctor This is gender reassignment therapy. 00:05:56 Levi Yes. 00:05:57 Doctor So I. 00:05:58 Levi It's okay. 00:05:59 Levi It's a complicated system. 00:06:00 Doctor You don't have to understand it. 00:06:02 Doctor It's okay, I understand. 00:06:03 Doctor Is there still. 00:06:05 Doctor Do you still are on psychotherapy or is there done, or do you wait at all? 00:06:12 Levi I am completely done with my diagnosis and. 00:06:16 Doctor Okay. 00:06:16 Levi I wouldn't exactly call it therapy, but. 00:06:18 Doctor No, it's afterwards. 00:06:20 Doctor 00:06:22 Doctor Psychotherapy accompanying psychotherapy. 00:06:25 Doctor It's not therapy, it's just that. 00:06:28 Doctor Yeah, I think it's very important to check if it is real gender dysphoria or something else. 00:06:41 Levi Yes, I have gone through the diagnosis. 00:06:43 Levi I think this is system there. 00:06:45 Doctor Okay. 00:06:45 Levi There is a system for that in Norway. 00:06:47 Doctor Levi is obviously a male name. 00:06:51 Doctor Did you change your sex and all that? 00:06:53 Levi Yes. 00:06:53 Doctor Okay. 00:06:58 Doctor What do you need for, what do you need for the change in Norway? 00:07:05 Levi The legal gender change, you mean? 00:07:07 Levi Yeah, that's actually really easy. 00:07:09 Levi You just send in a form and it takes like, three weeks. 00:07:13 Doctor Okay. 00:07:13 Doctor So you don't need a statement by a psychiatrist. 00:07:15 Doctor Okay. 00:07:16 Doctor Or diagnosis, something like, if you want to change it again? 00:07:22 Doctor I don't say that you want to change it again, but if I think. 00:07:25 Levi You can do it. 00:07:26 Levi But if you then later change it a third time, you might get rejected because there's someone looking at it. 00:07:32 Levi Is it a probable case? 00:07:35 Doctor Okay, so one important thing that we would need for the surgery is the indication. 00:07:43 Doctor Do you know what the indication is? 00:07:45 Levi Is that like a letter from my. 00:07:48 Doctor Letter of referral from the psychotherapist psychiatrist? 00:07:53 Doctor Someone who is familiar with the treatment of patients with gender dysphoria? 00:08:00 Levi Yes, I have that already. 00:08:03 Levi So I can send it to you by mail or email. 00:08:07 Doctor Okay. 00:08:08 Doctor So did you had a cryo conservation of. 00:08:16 Levi I have frozen egg cells, yes, but they didn't do that in Norway either, so I did that in Sweden, actually. 00:08:23 Doctor Okay. 00:08:23 Levi So I've been all over the place now. 00:08:25 Doctor Okay. 00:08:29 Doctor And is a Kurva Sesten Leibuterschaft. 00:08:34 Doctor If you need a woman with a womb to carry out a child with your egg cell, is that legal in Sweden? 00:08:44 Levi Yes. 00:08:44 Levi If that's woman is my partner, that's legal. 00:08:47 Doctor Okay. 00:08:47 Doctor And if it's not? 00:08:48 Doctor I don't know what the term in English is for. 00:08:50 Doctor Like, you know, surrogacy. 00:08:51 Levi Hey, that's a surrogate. 00:08:53 Levi I'm not sure if that's legal in Sweden. 00:08:55 Doctor Okay. 00:08:56 Levi I think when I have a child, it will probably be with a female partner. 00:09:00 Levi So I haven't really checked whether that's legal. 00:09:03 Doctor All right. 00:09:04 Doctor Okay. 00:09:05 Doctor Are you right or left handed? 00:09:07 Levi Right handed. 00:09:11 Doctor Your height and your weight, please. 00:09:14 Levi 170 and 63 kilos. 00:09:20 Doctor Any diseases? 00:09:22 Doctor Any illnesses? 00:09:25 Levi I have... or had, I don't know. 00:09:26 Levi PCOS. 00:09:27 Levi I don't know if that disappeared when they removed my ovaries, but that's about it. 00:09:38 Doctor But you probably should be gone. 00:09:42 Doctor Do you have any problems now? 00:09:46 Levi I never really had any problems either before. 00:09:50 Doctor Okay. 00:09:51 Levi So I just got the diagnosis. 00:09:53 Doctor Okay. 00:09:53 Doctor All right. 00:09:56 Doctor Infectious diseases? 00:09:58 Doctor HIV, hepatitis? 00:10:01 Doctor Do you have any problems with the clotting of blood? 00:10:06 Levi Never. 00:10:06 Doctor If you cut yourself, does it bleed longer? 00:10:09 Doctor Okay. 00:10:12 Doctor Allergies? 00:10:14 Levi No. 00:10:16 Doctor You have problems with the functions of your pelvic floor functions in terms of peeing, holding the urine, letting it go, passage of stool. 00:10:28 Doctor Okay. 00:10:29 Doctor What kind of medication do you have regularly? 00:10:32 Levi I take nebido. 00:10:34 Levi Testosterone? 00:10:35 Doctor Yeah. 00:10:35 Levi And melatonin. 00:10:38 Doctor For what? 00:10:39 Doctor For what? 00:10:39 Levi For sleep. 00:10:40 Doctor All right. 00:10:44 Doctor Smoking, alcohol, drugs? 00:10:47 Levi Not really. 00:10:47 Levi I drink maybe once or twice a month. 00:10:50 Doctor Okay. 00:10:56 Doctor What is your profession? 00:10:59 Levi It consultant. 00:11:04 Doctor Okay, so that's about it with my questions. 00:11:09 Doctor And then we would go through a presentation with pictures of the surgery. 00:11:20 Doctor Is it okay if there's blood on the pictures. 00:11:22 Levi Yeah, that's. 00:11:23 Doctor So it's pictures out of the OR. 00:11:25 Levi Yes, I've seen some pictures already, so I should be prepared for that. 00:11:29 Levi I'll just take my jacket off. 00:11:48 Doctor So, as I said, it's only examples. 00:11:51 Doctor It's not. 00:11:52 Doctor You cannot choose figure three and the next figure five. 00:11:57 Doctor A. 00:11:57 Doctor I want to have that combined. 00:11:58 Doctor It's just that. 00:11:59 Levi I understand. 00:12:00 Doctor All right. 00:12:00 Doctor Okay. 00:12:00 Doctor So generally we have two locations where we perform the surgeries. 00:12:07 Doctor It's the same clinic, it's the same doctors. 00:12:09 Doctor It's just two houses in Munich. 00:12:12 Doctor Okay. 00:12:12 Doctor This is here across the street, and this is in Pasig, which is another quarter of Munich. 00:12:21 Doctor This says, we are doing transgender surgery for quite a long time for a new field like this. 00:12:29 Doctor For more than 25 years in the beginning, not as often as now. 00:12:35 Doctor Now very often. 00:12:38 Doctor Of course, for that, we had a growth of the team that performs the surgeries. 00:12:43 Doctor We have plastic surgeons, which we need for the phalloplasty as well. 00:12:48 Doctor Urologist, gynecologist. 00:12:50 Doctor So it's the plastic surgeons and the urologist who would take. 00:12:53 Doctor Who would be important for you. 00:12:57 Doctor We are doing about 150 phalloplasties a year. 00:13:00 Levi Wow, that's a lot. 00:13:04 Doctor What we need is the indication so that the psychiatrist or psychotherapist says, yes, you are trans. 00:13:14 Doctor Yes, you have a dysphoria or you have problems with. 00:13:18 Doctor I mean, you could be trans and just live like this, but that the way of further gender reassignment surgery is something that you need not just because you want it, because it probably is good for you and for your dysphoria. 00:13:36 Levi So my letter says that. 00:13:38 Levi It doesn't explicitly say that I need it, but it says that there is nothing indicating that I don't need it. 00:13:44 Levi I don't know if that helps. 00:13:46 Doctor This is. 00:13:48 Levi It's kind of the wording. 00:13:50 Doctor It's halfway. 00:13:51 Doctor Let's say that it's like the street is wet when it rains or it rains, so the street gets wet. 00:13:57 Levi I also have another letter, which is their referral letter to surgery in Norway. 00:14:03 Doctor Just send them to me and I'll check them. 00:14:06 Doctor If there should be anything that is missing, then we would give you notice. 00:14:11 Levi That sounds okay. 00:14:12 Doctor Because, you know, just to say there's nothing that stands against it doesn't mean that there is something that stands for it. 00:14:21 Levi I understand. 00:14:22 Levi So I actually have this referral letter. 00:14:27 Levi It's for what they in Norway call phalloplasty, but what they do isn't really that great. 00:14:34 Levi But I have been to a consultation with a surgeon. 00:14:37 Levi There so I have letters for all that. 00:14:39 Levi But they're in Norwegian, so. 00:14:41 Doctor Yeah, that's a problem. 00:14:42 Levi Yeah. 00:14:43 Levi So I can try to have them translated. 00:14:46 Levi But can you look at the english letter first and then tell me if that's good or not? 00:14:50 Doctor Okay. 00:14:51 Doctor So as I said, we need a letter of referral that says it's necessary to do the surgery, because otherwise you go crazy. 00:15:04 Levi Yeah, I understand. 00:15:05 Doctor In easy words. 00:15:07 Levi Yeah, I understand. 00:15:10 Doctor Or that the Leidenstruck, that the pressure on you with the dysphoria is that high, that that is the only way that can... 00:15:20 Doctor Ease all that. 00:15:22 Doctor Okay. 00:15:23 Doctor Okay. 00:15:24 Levi I. 00:15:24 Levi If. 00:15:25 Levi I think that if my letter that I have isn't enough, I'm sure I can get the letter from. 00:15:31 Doctor That's fine. 00:15:32 Doctor That's fine. 00:15:32 Doctor Okay, good. 00:15:35 Doctor Then of course it can be paid by yourself. 00:15:39 Doctor Or is there, if there is no other possibility, you probably have to do it. 00:15:43 Doctor Otherwise, if your health insurance would cover the costs, we need a letter from the health insurance that they would cover the cost. 00:15:49 Levi Yeah, I don't have a health insurance that would cover this. 00:15:52 Levi What I have is. 00:15:54 Levi So there is this system in Norway where I can go to another Schlengen country like Germany, get the treatment paid for here similarly to what it would cost in Norway. 00:16:07 Levi But the phalloplasty that they do in Norway costs €9000. 00:16:11 Levi Okay, so it's not really. 00:16:13 Doctor No, that's a bit more than. 00:16:15 Doctor That's a bit more what we have here. 00:16:16 Levi Yeah, yeah. 00:16:17 Levi I've seen what the prices are. 00:16:19 Levi So I would get some coverage, but I would pay most of it myself. 00:16:24 Doctor All right. 00:16:26 Doctor Okay. 00:16:27 Doctor So usually we start with something that is not that what you want to have in the end with a metoidioplasty. 00:16:37 Levi I'm sorry, can you repeat that? 00:16:39 Doctor Usually we start the. 00:16:40 Doctor It's not only one surgery, I guess you know that. 00:16:43 Levi Yeah. 00:16:43 Levi It's stages, right? 00:16:44 Doctor Yeah. 00:16:44 Doctor The first stage is, even if you don't want to have that, finally, it's the metoidioplasty that we do first. 00:16:54 Doctor One very important reason is that we mobilize the clitoris. 00:17:00 Doctor We do not lengthen it, we just break it. 00:17:03 Levi Just release it from the. 00:17:04 Doctor We release it. 00:17:05 Doctor We make it more stretchable so that later on, when we combine the both urethras, it's more towards the phallus. 00:17:17 Doctor I'll show you in pictures you don't want to have. 00:17:20 Doctor So what we would do in your case is you had. 00:17:24 Doctor That says you had the hysterectomy and the ovarictomy. 00:17:27 Doctor So we'll do a klitpen metaedioplasty without closing the vagina. 00:17:34 Levi Right. 00:17:34 Doctor Okay. 00:17:38 Doctor It's about two weeks hospital stay. 00:17:40 Levi Okay. 00:17:41 Levi That's not too bad. 00:17:43 Doctor It can be 13 days. 00:17:45 Doctor It can be 17 days, but it's not. 00:17:47 Doctor We cannot calculate it exactly in the beginning. 00:17:50 Doctor Okay. 00:17:51 Doctor And you should calculate at least two weeks at home that you are not fully capable of going to work or. 00:17:57 Levi What, for the metoidioplasty? 00:17:59 Doctor So it's all in all, at least four. 00:18:02 Doctor I would suggest you to calculate four to six weeks. 00:18:07 Doctor You already had this. 00:18:08 Doctor This is the hysterectomy. 00:18:10 Doctor And now I'll show you pictures of the metoidioplasty. 00:18:13 Doctor So this is the clitoris pulled upwards with a suture. 00:18:19 Doctor And we do not only pull the clitoris upwards, we pull also the urethra and the entrance to the vagina. 00:18:25 Doctor If we do an incision like this and mobilize the tissue here that goes back into the relaxed position, this still with the sutures, is stretched forward, and then we have a gap of tissue. 00:18:41 Doctor This is the length that it is stretch or stretchable. 00:18:49 Doctor Afterwards, if we now release it, it goes back here as well, but we can put it forward again. 00:18:54 Doctor Okay. 00:18:55 Doctor So this gap is filled with tissue from the inner side of the small labia. 00:19:01 Doctor In your case, we would not close the vagina. 00:19:06 Doctor So then we took the outer layers of the inner of the small labia and create the urethra from the opening, from the original opening to the tip of the clitoris. 00:19:20 Doctor Okay. 00:19:21 Doctor [Phone rings] 00:20:23 Doctor 00:20:29 Doctor At the end, it would look something like this. 00:20:32 Doctor So this is the lengthened urethra. 00:20:35 Doctor This is the more stretchable clitoris. 00:20:40 Doctor This is the closure of the entrance of the vagina would not be in your case, but what would happen? 00:20:47 Doctor Or two things that you need to know. 00:20:48 Doctor I mean, there are some risks totally with that, but the risk of fistulas. 00:20:53 Doctor A fistula is a hole between two compartments that should not be there. 00:20:59 Doctor One compartment would be the urethra, the other compartment would be the vagina. 00:21:03 Doctor Because if we close that, we have a lot of tissue layers that we can put over the new urethra. 00:21:11 Doctor If we don't close the entrance or the vagina itself, we don't have these layers that we can suture over the urethra. 00:21:21 Doctor It's just two layers. 00:21:22 Doctor And the risk that it does not heal properly in this area, especially down here, where the old urethra and the new one is connected, is higher than if we do it like this. 00:21:38 Doctor That is one of the risks. 00:21:40 Doctor Special ones that you need to know. 00:21:41 Doctor About this. 00:21:42 Doctor And what also happens is that the entrance of the vagina gets smaller or tighter. 00:21:50 Doctor Because, you know, we take this tissue here, we need it for the urethra because this comes up here. 00:22:00 Doctor So we take some tissue out of the entrance of the vagina here and here. 00:22:05 Doctor And then we close it again. 00:22:06 Doctor So if I cut away this and I cut away this and close it again, it gets tighter. 00:22:12 Levi Right. 00:22:13 Doctor Okay. 00:22:14 Doctor So penetrative sexual intercourse, if this is something that you want to do with your vagina, still could be. 00:22:22 Doctor Not really impossible, but more difficult. 00:22:28 Doctor If that is a problem, then the entrance can be widened afterwards again. 00:22:34 Levi Right. 00:22:34 Levi So would I in that case need to dilate? 00:22:39 Doctor You could try. 00:22:41 Levi Okay. 00:22:42 Levi Understand. 00:22:43 Doctor Okay. 00:22:44 Doctor So first step, next step would be the phalloplasty. 00:22:50 Doctor Let me please have a look at your arm. 00:22:52 Levi Of course. 00:22:57 Doctor Okay. 00:22:59 Doctor This is. 00:23:04 Doctor It's tight, but it's alright. 00:23:06 Doctor I would say. 00:23:07 Doctor Let me measure it. 00:23:11 Doctor Okay. 00:23:12 Doctor All right. 00:23:13 Doctor So it should not be smaller, it should not be thinner. 00:23:18 Doctor It's alright. 00:23:19 Doctor One thing that you need to know, the thickness of the phallus. 00:23:23 Doctor Results of the thickness of the fat tissue here. 00:23:26 Levi Oh yeah. 00:23:27 Doctor Okay. 00:23:27 Levi I don't really have a lot of. 00:23:29 Doctor You don't have a lot, but there is some, you know, there are people that only have skin like that. 00:23:35 Doctor But there is some tissue under here, under the skin. 00:23:39 Doctor If there is more fat, it gets thicker. 00:23:43 Doctor I would say it can, we can perform a phalloplasty of the forearm at any time. 00:23:49 Doctor But if it's, you know, if it would only be like that, if it would be smaller and if the fat would be less, then I would not suggest you to do it. 00:24:01 Doctor It should be alright. 00:24:03 Doctor I cannot simulate what the size of the phallus will be, but I would say it is alright to do it from the forearm. 00:24:16 Levi Okay. 00:24:16 Doctor Okay. 00:24:17 Levi So you're unable to give an approximate about the size. 00:24:21 Doctor Approximate, yeah. 00:24:23 Doctor But you know, not guaranteed. 00:24:26 Levi Of course. 00:24:26 Levi Yeah, I understand. 00:24:27 Doctor So the length that we usually just draw it. 00:24:31 Levi Yeah, of course. 00:24:32 Doctor The length that we usually take is around 15 cm. 00:24:37 Doctor Okay. 00:24:37 Doctor Okay. 00:24:38 Doctor Does not mean that those 15 cm still stay if they are down there because it shrinks a bit. 00:24:43 Doctor Right. [Draws on Levis arm] 00:24:43 Doctor Okay, so this is u and u means urethra. 00:25:02 Doctor From that part we create the urethra. 00:25:07 Doctor And what is important that these hair here will be removed as permanently as possible. 00:25:14 Doctor Laser or needle like electrolysis. 00:25:18 Doctor Yeah. 00:25:20 Doctor There are some hair here as well. 00:25:22 Doctor They would be on the outside of the phallus. 00:25:25 Doctor So you can remove them yourself later on like shaving or waxing or whatever. 00:25:31 Doctor Okay. 00:25:32 Levi But would you suggest I start getting electrolysis? 00:25:35 Doctor Yeah. 00:25:36 Doctor For that part here, in any case, because you will not have access to those hair in that part because it's inside the urethra. 00:25:46 Doctor Okay. 00:25:46 Doctor You'll have access to this hair because it's on the surface of the. 00:25:49 Doctor Of the phallus. 00:25:50 Doctor Okay. 00:25:51 Doctor So hospital stay for the phalloplasty, at least three weeks. 00:25:56 Levi That makes sense. 00:25:59 Doctor Six to eight weeks. 00:26:00 Doctor I would calculate in total. 00:26:03 Levi Six to eight weeks in total at the hospital? 00:26:05 Doctor No, three weeks in hospital and the rest of the time at home. 00:26:09 Doctor Okay. 00:26:09 Doctor Okay. 00:26:10 Levi Would you recommend that I. 00:26:12 Levi That I book a hotel close to the clinic? 00:26:16 Doctor I mean, I would recommend if you have a good doctor, a good surgeon that would take care afterwards in Norway. 00:26:26 Levi I wouldn't say that. 00:26:27 Levi So, I mean, I have. 00:26:29 Levi If something happens in Norway, I will get help, but they don't have a lot of knowledge about. 00:26:35 Doctor So then maybe it's not bad if you stay a week or ten days longer here, if they should be just for security. 00:26:43 Levi Yeah. 00:26:45 Levi Then probably just stay a couple of weeks extra. 00:26:49 Doctor We need skin to cover the gap that results here. 00:26:55 Doctor Usually it's taken from the belly very low. 00:27:01 Doctor So that is if you wear, I don't know how often you wear bathing suits or swimming shorts in Norway. 00:27:08 Levi I would prefer if I can take the skin from somewhere else, because I really don't want any scars on my upper body. 00:27:15 Doctor Okay. 00:27:16 Doctor Yeah. 00:27:17 Doctor Usually it's. 00:27:18 Doctor We try to choose it. 00:27:20 Doctor I mean, what are the scars from the. 00:27:22 Doctor From the breast? 00:27:23 Levi Oh, it's basically nothing. 00:27:25 Doctor Okay. 00:27:25 Levi I have the keyhole. 00:27:27 Doctor Okay. 00:27:28 Doctor But keyhole for the breast as well. 00:27:31 Doctor For the breast? 00:27:32 Levi Yes, I can. 00:27:33 Levi You want me to show you? 00:27:34 Doctor Yeah. 00:27:37 Doctor Okay. 00:27:37 Doctor All right, good. 00:27:39 Doctor Okay. 00:27:41 Doctor Yeah. 00:27:42 Doctor It is also possible to take it from somewhere else, but the other part would be the inner side of the thighs. 00:27:48 Doctor But we have to check if there is enough skin. 00:27:51 Doctor If there is too little skin and we suture the skin together, it might tear apart the labia too much. 00:28:05 Doctor And you check this. 00:28:06 Doctor Okay. 00:28:07 Doctor So either the belly or the inside of the thighs. 00:28:12 Doctor We need to go to the belly in any way. 00:28:16 Doctor So if we do not take the skin from here, we make a single incision here, because we need to have access to vessels on the surface and in the depth and nerves as well, because we need them for the connection with the phallus. 00:28:34 Doctor So there will be a scar, a cut in the belly anyhow. 00:28:40 Levi Okay. 00:28:40 Levi But will it be much bigger if I take the skin graft from there? 00:28:44 Doctor Yeah, it would be at least three times the size. 00:28:47 Doctor But, you know, as I said, we try to have it below the belt line, below the line that you usually wear swimming shorts, so that it's not that obvious from the side. 00:29:01 Doctor Okay, so this is what I draw on your arm. 00:29:06 Doctor We take the skin and the fat and the fascia, the muscle. 00:29:10 Doctor Skin. 00:29:11 Doctor No muscles, no bones, no tendons, whatever. 00:29:16 Doctor This is the skin prepared. 00:29:19 Doctor What you see is we put it a bit towards the elbow, but also there is some kind of. 00:29:28 Doctor Not really shrinkage. 00:29:29 Doctor But it pulls itself a bit together, because here it is in the combination with the tissue outside. 00:29:41 Doctor And if it is loose completely, then there is some tension in the tissue that takes it together from the inside. 00:29:49 Doctor We perform the urethra. 00:29:51 Doctor That's that. 00:29:52 Doctor That's the first tube. 00:29:53 Doctor And then we take the rest to do another tube. 00:29:56 Doctor So that's the tube within a tube technique. 00:29:59 Doctor Usually we leave this area as wide as possible. 00:30:09 Doctor So sometimes there is some tissue for attention, less closure of the phallus missing, and we replace that with it. 00:30:19 Doctor Skin graft, skin transplant from the place where we already took skin, which is on the. 00:30:30 Doctor On the lower side of the phallus. 00:30:32 Doctor This is the phallus completely sutured, still on the arm. 00:30:38 Doctor And then it's taken away. 00:30:39 Doctor It's taken off the arm with the blood vessels and the nerves. 00:30:44 Doctor This is the area where we will transfer, where we will fix the phallus. 00:30:48 Doctor And we put the clitoris penoid through that incision. 00:30:53 Doctor And now you see why it is important that we have a lengthening of the urethra and a stretching of the clitoris before, because we needed to get it up here. 00:31:02 Doctor This is the urethral opening of the clitoris. 00:31:04 Doctor And the urethral opening of the phallus is here. 00:31:06 Doctor And we need to put them together here with the microscope. 00:31:13 Doctor We do the connection of the blood vessels from the phallus with those from the abdomen. 00:31:19 Doctor The sutures are very thin, thinner than hair. 00:31:22 Doctor So this is the reason why we do it with the microscope. 00:31:25 Doctor Not only the blood vessels, but also nerves. 00:31:27 Doctor And not only this, but also the urethras. 00:31:31 Doctor So this is the klitpen urethra. 00:31:36 Doctor And this is the phallus urethra. 00:31:38 Doctor We need to put it together. 00:31:39 Doctor This is the lower surface of the clitoris, which looks inside the urethra. 00:31:49 Doctor The rest of the clitoris glands is behind the urethra in that area. 00:31:57 Doctor This is the skin graft that I told you before. 00:32:02 Doctor This is the arm. 00:32:03 Doctor We have nerves and tendons here. 00:32:05 Doctor We need to cover that because they are very... empfindlich? 00:32:12 Levi Vulnerable? 00:32:13 Doctor Let's say vulnerable. That's good. 00:32:14 Doctor Tissue. 00:32:15 Doctor So we take that muscle and put it over here and we take the muscles between those two tendons and put it over the tendons. 00:32:24 Doctor So we have filled up the step a bit because we take out fatty tissue, but we only put skin on sides. 00:32:33 Levi So you get kind of a. 00:32:35 Levi It's lowered. 00:32:36 Doctor Yeah. 00:32:37 Doctor And we fill that up a bit with that technique. 00:32:40 Doctor And there's all muscles. 00:32:42 Doctor So it's a good ground for the skin transplant to heal on. 00:32:51 Doctor This is the skin transplant, which is a full thickness skin transplant. 00:32:59 Doctor The holes are by purpose, so it's like a drainage. 00:33:05 Doctor They heal with the time at the end of the surgery. 00:33:09 Doctor This is the suture from where we took the skin and where we had the access to the vessels. 00:33:16 Doctor Other possibility would be, as I said here, but we need to look if there's little tissue and we make the suture like this, and like this. 00:33:24 Doctor Sometimes it takes this very much apart. 00:33:26 Levi So you recommend doing? 00:33:30 Doctor Not necessarily, but depending on the anatomy. 00:33:35 Levi Yeah. 00:33:35 Doctor Okay. 00:33:35 Levi I'm not sure if I have that much extra skin. 00:33:39 Doctor We'll have a lot. 00:33:40 Doctor So this is the extra skin on the... Unterseite? 00:33:44 Levi Underside. 00:33:45 Doctor Is it underside? 00:33:46 Levi Yeah, I think so. 00:33:46 Doctor Okay, it's underside. 00:33:48 Doctor All right. 00:33:49 Doctor On the other side of the phallus, the connection of the both urethras is about here. 00:33:55 Doctor But the catheter comes out here. 00:33:57 Doctor Why? 00:33:57 Doctor Because we leave emergency exit in the urethra for the next half year. 00:34:06 Levi Oh, really? 00:34:07 Doctor Okay. 00:34:08 Doctor That means when the catheter is removed about five days after the surgery, you will pee in a sitting position. 00:34:17 Doctor From here, the urethra needs time to heal. 00:34:20 Doctor The anastomosis needs time to heal. 00:34:23 Doctor If there are problems, it can shrink, there can be a stricture, they can be very much fistulous. 00:34:31 Doctor The urethra can maybe not heal properly and open again. 00:34:36 Doctor That's all not nice, but it does not affect the micturition in that time until it can be fixed again. 00:34:45 Doctor This is the reason why we leave it open. 00:34:46 Levi Okay, so you wait to connect the urethra? 00:34:51 Doctor No, the connection is already done, but the tube is opened in one position so that the urine goes out here and it goes up. 00:35:00 Levi Okay. 00:35:01 Levi So that will be closed at the later stage, then when things are healed. 00:35:04 Doctor Exactly. 00:35:05 Doctor Okay. 00:35:06 Doctor This is the ALT which we would not perform in your case. 00:35:13 Doctor So third step would be the closure of this opening of the urethra. 00:35:20 Doctor But the urethra must be alright for this. 00:35:23 Doctor So there must be no stricture or whatever kind of problems. 00:35:26 Doctor Okay, so we would check that in that surgery. 00:35:28 Doctor Then what also would be. 00:35:30 Doctor The plan is we would do the scrotoplasty and the glansoplasty. 00:35:35 Doctor We do it minimum six weeks, six months after the first, after the phalloplasty. 00:35:43 Doctor Okay. 00:35:43 Doctor If there should be scars, smaller problems, like smaller fistulas or whatever, it can be done in the same session. 00:35:50 Doctor But if there are bad problems with the urethra, maybe it's necessary that we first take care about the urethra and see what we have to do there. 00:36:00 Doctor Maybe a reconstruction which takes two surgeries. 00:36:05 Doctor Also some months time in between. 00:36:08 Doctor It's not always possible to do that in one stage. 00:36:13 Doctor A glansplasty could look like this without a skin transplant. 00:36:17 Doctor And this is a glansplasty with skin transplant. 00:36:20 Doctor What would be better sometimes also depends on the tissue, if, how soft it is, how stretchable it is. 00:36:26 Doctor We would discuss that before this surgery. 00:36:30 Doctor So the urethra now is closed down here. 00:36:33 Doctor The catheter goes through the urethra of the phallus. 00:36:37 Doctor And this is the scrotoplasty means we shift some of the tissue of the outer labia more upwards to the belly. 00:36:49 Levi Okay. 00:36:50 Doctor This looks much more like a scrotum than it looks like labia. 00:36:54 Doctor But still there is something in a lying position that looks like a hanging scrotum. 00:36:58 Doctor But if you stand up, it doesn't bounce forward because it's always closer to the body than the real one. 00:37:04 Doctor Okay, so, and the last step would be the implementation of prosthesis, which is done minimum six months after the scrotoplasty and minimum twelve months after the phalloplasty. 00:37:18 Levi Okay? 00:37:19 Doctor Okay. 00:37:20 Doctor You said you want a prosthesis for erection, so I would suggest a hydraulic version. 00:37:28 Doctor The pump of the hydraulic version is the one testicle, and the other testicle is a testicular implant. 00:37:35 Doctor Okay. 00:37:37 Doctor Testicular implants are made of silicon. 00:37:41 Doctor The size will choose whatever size fits in the scrotum. 00:37:48 Doctor Inflatable penile prosthesis looks like this. 00:37:51 Doctor There is a reservoir which is put in the lower abdomen. 00:37:55 Doctor There is a pump which is put in one side of the neosrotum. 00:38:01 Doctor That's a typical cis man scrotum. 00:38:03 Doctor Yours would be much more like this. 00:38:06 Doctor Okay. 00:38:08 Doctor You press the pump to get fluid from the reservoir in the cylinders they erect. 00:38:15 Doctor You push the button, and the fluid goes back again through those tubings, which are underneath the skin. 00:38:23 Doctor Okay. 00:38:24 Levi Can I ask, how long does a prosthetist last? 00:38:28 Doctor Approximately five days to 17 years. 00:38:34 Levi That's a big range. 00:38:35 Doctor Yeah, five days. 00:38:37 Doctor That's the cases we had. 00:38:40 Doctor We had to put one out after five days because of an infected hematoma. 00:38:44 Levi Yeah, that makes sense. 00:38:46 Doctor 17 years was the longest one that we had. 00:38:51 Doctor But to be honest, the guy told us that in the last years, he did not really use it. 00:38:56 Levi Okay. 00:38:56 Doctor So it depends on how often in how hard you use it because it's a mechanical product. 00:39:04 Doctor There are valves in that pump here that just can break. 00:39:13 Doctor Five to seven years is a good average. 00:39:16 Levi Okay. 00:39:17 Levi So after five to seven years, if I would have to, or if. 00:39:24 Levi And when it breaks, would I replace it or would I just remove it? 00:39:28 Levi Is it replaceable? 00:39:29 Doctor Depends on what you want. 00:39:31 Levi Okay, so it's replaceable. 00:39:33 Doctor It's replaceable. 00:39:34 Levi Okay. 00:39:35 Doctor If you want a functioning one, you need to replace it. 00:39:39 Doctor If you don't care about the function and it does not make any problems like pain or whatever, you can leave it inside. 00:39:47 Levi Okay. 00:39:47 Doctor Okay. 00:39:49 Doctor So that's an empty phallus with an empty scrotum. 00:39:53 Doctor That's the testicular implant. 00:39:56 Doctor That's the pump here. 00:39:57 Doctor The cylinders are inside the phallus. 00:40:01 Doctor And this is with erection pumped up at the end of the surgery to see if it's stable, to see if it's in the right position and working. 00:40:11 Doctor It's pictures. 00:40:12 Doctor Two months after the implementation of the prosthesis, what do you see? 00:40:18 Doctor You see that there are hair on the skin? 00:40:21 Levi Yeah, that's those. 00:40:23 Doctor But you do not have very much. 00:40:26 Doctor That's the skin transplant on the underside. 00:40:30 Doctor This is the scrotum with testicular implants. 00:40:35 Doctor Another example. 00:40:37 Doctor And what you also see here, there is like a. 00:40:39 Doctor I don't know what a knick is. 00:40:41 Levi It's the same word in Norwegian, knick. 00:40:43 Levi Knack. 00:40:43 Doctor Okay. 00:40:43 Doctor Okay. 00:40:44 Doctor So there's a knick, and there's even more knick here. 00:40:48 Doctor Why? 00:40:49 Doctor Because if you take a straw, a drinking straw, and you kneck it on the point where it's knicked, it gets wider. 00:41:00 Doctor And this is what you see here because the cylinders knick here. 00:41:05 Levi So that's from the. 00:41:06 Doctor From the prosthesis. 00:41:07 Levi Okay. 00:41:08 Doctor So you will feel the knick, and you will feel the material of the prosthesis through the skin because there's some. 00:41:17 Doctor It's softer, more, or tender, whatever, without the prosthesis. 00:41:28 Doctor And then afterwards, you feel there's something different than it was before because you can feel the material. 00:41:33 Doctor The thinner the fat layer is, the more the sensation or the more you see or feel the material from the prosthesis because it's not covered within damage. 00:41:50 Doctor There are also hair here. 00:41:51 Doctor That's a glansplasty without skin transplant. 00:41:59 Doctor That's the scrotum with the testicular implant. 00:42:01 Doctor On the other side, we'll have the pump of the prosthesis. 00:42:05 Doctor Another example, flaccid and stiff scrotum. 00:42:14 Doctor Scrotum skin transplant. 00:42:18 Doctor And this is one picture with the scar that we have from the belly. 00:42:24 Doctor As I said, we try to get it as low as possible. 00:42:27 Levi Yeah, I mean, that doesn't look as bad as I thought it would. 00:42:32 Doctor Sometimes they are one. 00:42:33 Doctor I mean, it's a bit here on the side. 00:42:36 Doctor Sometimes it's worse, means wider. 00:42:40 Doctor And sometimes there are scars that you actually do not see at all. 00:42:47 Doctor Or if you only take a very close look. 00:42:49 Levi Yeah. 00:42:49 Levi Because that sort of looks like, you know, when you wear very tight pants. 00:42:53 Doctor Yeah. 00:42:55 Doctor Pictures of the arm. 00:42:56 Doctor About two years after the surgery even. 00:43:00 Doctor You do not care if someone sees the scar. 00:43:04 Doctor And I mean, that's your decision, of course. 00:43:06 Doctor But if someone sees that scar, someone can see the scar here as well, from my point of view. 00:43:15 Doctor Or you only wear long arms or you have it tattooed. 00:43:22 Levi Right. 00:43:22 Doctor You can also do this, but only one and a half years to two years later. 00:43:27 Doctor So there will be some time where you have to hide the scar if you do not want anyone to see it. 00:43:31 Levi I don't think a lot of Norwegians know what that type of scar means. 00:43:35 Doctor Probably not. 00:43:36 Levi I mean, I don't know anyone who's had phalloplasty in Norway, so it shouldn't be a problem. 00:43:43 Doctor Okay, we have now we talk about some more risks or special risks, not general risks. 00:43:48 Doctor You have heard of those. 00:43:51 Doctor They are valid for all those surgeries. 00:43:54 Doctor We would talk about them when we would see each other again for the surgery. 00:43:57 Doctor But now we have to go to special risks. 00:44:02 Doctor The first we can cancel, because this is if you close the vagina, there can be some cysts with slime or fluid. 00:44:09 Doctor Still, you do not have that. 00:44:11 Doctor Second is what happens. 00:44:13 Doctor What is the main problem? 00:44:15 Doctor That's the urethra. 00:44:16 Doctor You can have fistulas, as I told you, and the risk would be higher for the fistulas between the urethra and the vagina. 00:44:25 Doctor They can be strictures. 00:44:27 Doctor They can be diverticulous. 00:44:29 Doctor This is if the. 00:44:32 Doctor If Donald Duck stands on the hose, he makes a stricture here, and the hose grows bigger before the stricture. 00:44:41 Doctor That's a widening of the urethra, which we call diverticle. 00:44:44 Levi Okay. 00:44:44 Doctor Okay. 00:44:45 Levi That's a good way to explain it. 00:44:48 Doctor There might be hair growth in the urethra that can cause problems like they can. 00:44:53 Doctor There can be the formation of urine stones around those hair. 00:44:57 Doctor You can have recurrent infections in the urine. 00:45:04 Doctor Some problems need to be resolved by surgery. 00:45:07 Doctor Prosthesis can be infected, can be defect, or can not stay in place. 00:45:16 Doctor Surgery, surgery, surgery. 00:45:20 Doctor The erogenous feeling, the physical erogenous feeling will probably change. 00:45:27 Doctor Most say that it changes. 00:45:28 Doctor For some, it's better because this fits better. 00:45:32 Doctor Some just say it's a bit more dull because if you can imagine if the clitoris is inside the phallus, you cannot stimulate it as directly as you do it. 00:45:43 Doctor Now, very, very small group says that it's worse, and a very, very, very small group said that there are problems with orgasms. 00:45:57 Levi So those are minority. 00:45:59 Doctor Yeah, absolutely. 00:46:01 Doctor I cannot guarantee you that the possibility to have an orgasm will stay. 00:46:09 Doctor If we talk about that, it stays, it needs to be here in the first place. 00:46:15 Doctor That's one thing. 00:46:15 Doctor Some trans people do not have any kind of sexual experiences, so maybe it's hard to know what to talk about. 00:46:28 Doctor But most of the people are able to have an orgasm. 00:46:34 Doctor Some say it's better because as I said, it just fits better. 00:46:37 Doctor It's very unlikely that you have bad problems or the loss of the possibility to have an orgasm. 00:46:46 Doctor Problems with blood flow, with thrombosis, embolism or infections can cause the loss of tissue, muscles, skin, and the phallus completely. 00:46:58 Doctor We did have this and we will have it again because there always is this risk with that kind of surgery. 00:47:06 Doctor But the risk is very low, under 0.5%. 00:47:12 Levi Yeah, I mean, that's much better than in Norway where they have. 00:47:19 Levi It's much higher. 00:47:20 Doctor There can be problems with mobility, movability of the hand, with power, with the force that you can use with the muscles, and with sensations. 00:47:38 Doctor You will not feel this as you do it now, you will feel this. 00:47:44 Doctor Hot and cold is not as good as it is now. 00:47:47 Levi Okay. 00:47:49 Levi But mobility and strength, will that affect. 00:47:55 Levi I like to, I like to work in the gym. 00:48:00 Levi Will that be a problem? 00:48:02 Doctor Not really. 00:48:03 Doctor I mean, you should not do it in the first weeks. 00:48:05 Doctor Okay. 00:48:07 Doctor I mean, you know what some people say, they don't, they do not feel a difference at all, which is always hard to imagine for me, because I know what we do with the muscles here. 00:48:21 Doctor The biggest group says, yeah, we feel that it is not as it is before, but it's not a problem that we have with something. 00:48:31 Doctor Maybe I cannot lift a box of beer with one arm. 00:48:36 Doctor But then the thing is that I take it with both arms. 00:48:38 Doctor So that means maybe you cannot lift as much weight as you do now with that arm, but that's not a bad thing. 00:48:47 Doctor This is a change, but not a severe change to your life. 00:48:51 Doctor And it's a very small group who have to change their. 00:49:00 Doctor They have to change what they do in everyday life or maybe even have problems with the job. 00:49:06 Doctor It's a very small group. 00:49:08 Doctor Chronic pain can be a problem. 00:49:10 Doctor The general area or where the flap is harvested, you may not like the cosmetic outcome. 00:49:20 Doctor Too short, too small, too big, too knickerich to whatever. 00:49:26 Levi Yeah. 00:49:26 Levi I've kind of just understood that that would be a problem most people with penises would have. 00:49:33 Levi I mean, nobody chooses what it looks like. 00:49:40 Doctor If something occurs, we do have to do more surgery than is planned. 00:49:48 Doctor Smoking and overweight is not a problem that you have. 00:49:52 Doctor So ahead of the surgery, you should have electrolysis here. 00:50:01 Levi I think I'll probably do the whole area. 00:50:04 Doctor Why not? 00:50:05 Levi Because I don't think it costs more to do around the hole. 00:50:10 Doctor I would say so because it just takes more time. 00:50:13 Doctor You need more sessions to do it, but you just have to check. 00:50:19 Doctor Nebido should. 00:50:21 Doctor I mean, one to two. 00:50:23 Doctor You should not have it one to two weeks before the surgery. 00:50:28 Doctor You come when it's actually time to have the nebido. 00:50:32 Doctor You bring it with you, and we'll give it to you when you go. 00:50:36 Levi The nebido. 00:50:37 Doctor Yeah. 00:50:38 Levi Right. 00:50:38 Doctor Okay. 00:50:40 Levi So I'm sorry. 00:50:41 Levi Just so I understand. 00:50:43 Levi So I shouldn't take it two weeks. 00:50:44 Doctor Before the surgery because then the hemoglobin and the thickness of the blood could be a problem. 00:50:51 Levi That makes sense. 00:50:55 Doctor You could bring a special pillow, like a doughnut with a hole in the middle. 00:51:04 Doctor I've seen those doughnut cushion, whatever it's called. 00:51:08 Doctor And you should check with your doctors at home, surgeon, urologist, general practitioner, who take care of you afterwards, who check the wound, who check urine, who check if the ultrasound, if the bladder is empty and all that. 00:51:19 Levi Yeah. 00:51:20 Levi So I have confirmed that the hospital in Norway, they will follow me up. 00:51:26 Doctor Okay. 00:51:26 Doctor All right. 00:51:27 Levi For this, if I do it abroad. 00:51:29 Doctor Sometimes it's necessary to have psychotherapeutic treatment afterwards or still, whatever. 00:51:36 Doctor I don't know. 00:51:38 Doctor I don't say that it is necessary, but you should have the possibility. 00:51:43 Levi Yeah, that makes sense. 00:51:44 Levi I've heard it can be a traumatic surgery overall. 00:51:48 Doctor Yeah. 00:51:49 Doctor And maybe your expectations are higher or maybe I thought I would feel much more different after. 00:51:56 Doctor It does not take away all the things that you experienced in your life so far. 00:52:01 Doctor Okay. 00:52:02 Levi Yeah, I understand. 00:52:04 Doctor This is length in centimeters. 00:52:07 Doctor This is percentage or percentage groups. 00:52:12 Doctor The red dots are stretched, measured phalluses. 00:52:19 Doctor The blue spots are stretched, measured penises. 00:52:24 Doctor From a big study. 00:52:27 Doctor The red ones are 104 cases that we examined after the surgery. 00:52:35 Doctor The shortest one was 11.5. 00:52:39 Doctor Longest one was 16 cm average. 00:52:44 Doctor All those kind of statistic average values. 00:52:50 Doctor And there are a lot of. 00:52:51 Doctor I do not know them all in that case are the same because of the number of participants. 00:52:57 Doctor So the average is 13.2, 13.1. 00:53:00 Doctor I don't know, something like this. 00:53:02 Doctor And it's exactly the same, like the blue dot. 00:53:06 Doctor So the length of a stretched phallus in that population is exactly the length of a stretched penis. 00:53:16 Doctor So we are not very far from mother nature in that kind. 00:53:19 Doctor And also both lines are very close to each other. 00:53:23 Doctor That means the distribution in the other lengths is also quite similar. 00:53:30 Doctor So you can expect something between eleven and a half and 16 cm. 00:53:34 Levi Yeah, that sounds good. 00:53:36 Doctor Okay, so more questions. 00:53:44 Levi From me. 00:53:45 Levi Yes, I have a little list here ready. 00:53:50 Levi So. 00:53:52 Levi Well, my first question is, from what you've explained to me, probably you already answered it, but it's that whether the metoidioplasty and the clitoris burial is an absolute requirement. 00:54:10 Doctor I would not say it's absolute, absolute. 00:54:13 Doctor But as I told you, it's the reason what we can reach with this surgery is an important condition for what we need to do later on in the phalloplasty. 00:54:30 Doctor And this is the way we are used to do it. 00:54:34 Doctor So this is the typical. 00:54:35 Doctor I mean, you know, you can do something else, but if it works properly, or if you do something for the first time, or if you do not do it very often, then there is something new which you don't know how the outcome will be. 00:54:49 Doctor So I would say yes. 00:54:52 Levi The reason I ask is because I am scared of losing sensation. 00:54:57 Levi So I want to do clitoris burial, but at the same time I'm scared of losing erotic sensation, which is why I'm asking. 00:55:06 Levi I haven't made the final decision yet on what to do that there. 00:55:12 Levi So you sort of explained the sensation to me. 00:55:17 Levi But I guess what I'm asking is, should I be very worried of losing most of the sensation? 00:55:27 Doctor You know, you should not be very much worried about losing the possibility of having an orgasm. 00:55:36 Doctor About the qualities of sensation, I cannot tell you very much because this is absolutely subjective. 00:55:44 Levi Yeah, of course, it makes sense. 00:55:48 Levi My other question is, so the extra stage with the metoidioplasty, do you know approximately how much that costs? 00:55:59 Doctor Not really, because I do not make the price. 00:56:06 Doctor So I will have. 00:56:09 Doctor I don't know if I say a number now, maybe it's not right. 00:56:12 Doctor So. 00:56:12 Levi Yeah, but I should be able to get, like, a cost estimate. 00:56:15 Doctor Yes. 00:56:16 Doctor Yeah. 00:56:21 Doctor And it's not only that, you know, it's not only the stretchability of the clitoris that is important, it's also the lengthening of the urethra that is performed in that surgery. 00:56:36 Doctor So there already is a stable part of the neo urethra which already is there, and we put the new one on top of it, and we do not do that new urethra with the other urethra in one stage. 00:56:53 Levi So you take kind of the biggest. 00:56:55 Doctor Risk, take risks apart. 00:56:59 Levi Yeah, yeah. 00:57:04 Levi How much time is usually between the stages? 00:57:08 Levi So I suppose there are... 00:57:10 Doctor Half a year, something like this. 00:57:12 Doctor So we're talking about, in total, about two, two and a half years, something like this. 00:57:17 Levi And I don't remember exactly everything you said in your presentation, but how long recovery should I expect with each stage? 00:57:28 Doctor Two to four weeks. 00:57:30 Levi Yeah. 00:57:30 Levi That's the common for each one. 00:57:32 Levi Okay. 00:57:34 Doctor Does not mean that afterwards you are fully on top again. 00:57:37 Doctor That might take some time longer, but you should. 00:57:40 Doctor Two to four weeks, just the recoverance. 00:57:44 Levi Yeah, I'm thinking. 00:57:46 Levi So after two to four weeks, I should be able to work. 00:57:49 Doctor Yeah. 00:57:49 Levi Again. 00:57:49 Levi Yeah. 00:57:52 Levi I have one more question, because, like I said, I talked to a surgeon in Norway. 00:57:56 Doctor Yeah. 00:57:59 Levi She told me something that the reason why they don't do the urethra, they just kind of take a skin flap from the thigh and roll it up, and that's about it. 00:58:11 Levi And I told her that I am probably going to go abroad, see another surgeon willing to do this. 00:58:19 Levi And she warned me that with the urethral lengthening, that the tissue, the arm isn't made to withstand the acidity of urine. 00:58:33 Levi Is that something you've heard before, or is she just making it up? 00:58:36 Doctor No, there are problems with this skin inside the urethra. 00:58:45 Doctor Of course, it's not that kind of skin that usually is there. 00:58:49 Doctor But you know, what urologists also do is if a cis man has strictures in the urethra, we take skin transplant from somewhere and put it next to the urethra, let it heal, and then close it again. 00:59:03 Doctor So it's the same kind of skin. 00:59:05 Doctor I wouldn't say that it is a problem with the skin. 00:59:08 Levi Okay. 00:59:08 Levi That's. 00:59:10 Levi I had a suspect that. 00:59:11 Levi I mean, I've never heard that anywhere else, but I just wanted to ask you directly. 00:59:17 Levi You seem to do this a lot and you seem to know what you're doing. 00:59:22 Levi I don't really think I have any other questions that I can think of. 00:59:28 Doctor So I would like to have to make a physical examination from the genital area. 00:59:35 Doctor If it would just lay down there. 00:59:37 Doctor You don't have to take off the pants completely. 00:59:40 Doctor Just put it a bit down. 00:59:41 Doctor You can leave the shoes on. 00:59:46 Levi So just pull down my pants? 00:59:47 Doctor Yes, exactly. 00:59:59 Levi Okay. 01:00:00 Doctor Just relax. 01:00:01 Levi Yeah. 01:00:05 Doctor This is from the. 01:00:06 Doctor From the. [Points at hysterectomy scars] 01:00:07 Levi Yeah, that's from the hysterectomy. 01:00:12 Doctor Okay, I have a look at the clitoris. 01:00:14 Levi Okay, go ahead. 01:00:17 Doctor Yeah, that's fine. 01:00:18 Doctor There is enough tissue for the lengthening of the urethra. 01:00:21 Doctor That's not a problem. 01:00:22 Doctor There would be, because you have very soft skin. 01:00:25 Doctor There would be enough tissue to take skin from here. 01:00:33 Doctor Also would be possible to take skin from here. 01:00:37 Doctor Well, but take a look at the labia if I do this, and I want to have all that tissue to create the scrotum later on. 01:00:51 Doctor And as I said, we try to. 01:00:54 Doctor Maybe it's a bit. 01:00:56 Doctor Maybe it's somewhere around here where you have that imprinting. 01:01:03 Doctor I don't know, whatever. 01:01:06 Doctor From your trousers now. 01:01:07 Doctor Yeah, but that's not something that we need to make clear now. 01:01:12 Doctor It's just that you. 01:01:13 Doctor Okay. 01:01:14 Doctor You can get dressed again. 01:01:19 Levi But from what I saw, I thought that the scars were going to be a lot bigger. 01:01:25 Levi So I'm not entirely opposed to using the skin, if that's what you think is best. 01:01:37 Doctor Okay, so. 01:02:43 Doctor All right, so if you said that you have been in Planegg before, did you already have a price list from them? 01:03:00 Levi Yeah. 01:03:00 Doctor Did you give that to your insurance or not? 01:03:05 Levi I don't have an insurance. 01:03:07 Doctor You do not have one at all? 01:03:08 Levi No. 01:03:08 Doctor All right. 01:03:09 Doctor Okay. 01:03:10 Doctor So I don't know their prices, and it's not important for me to know, but I would guess that it's not. 01:03:16 Levi That big difference, because I read somewhere on the Internet that this clinic is about twice as much as Planegg. 01:03:25 Levi But. 01:03:27 Levi But I haven't really seen any actual prices in estimates. 01:03:31 Doctor Well, to be honest, I don't know. 01:03:34 Doctor As I said, I do not do the prices. 01:03:37 Doctor It's something that the administration does. 01:03:44 Doctor What is the price that you get from Planegg? 01:03:47 Levi I think it was €36,000 in total. 01:03:51 Doctor In total. 01:03:52 Doctor With prosthesis, everything, all the steps. 01:03:55 Doctor Okay. 01:03:57 Doctor So I don't know what the price list would be in our case, but I would just send them to you. 01:04:04 Levi Yeah. 01:04:04 Doctor Okay, good, good. 01:04:07 Doctor Do we have your email address? 01:04:09 Levi I wrote it down on a form to the front desk. 01:04:13 Doctor All right. 01:04:13 Doctor Okay. 01:04:14 Doctor Then let me just check. 01:04:23 Doctor [Reads email address] 01:04:29 Levi Yes. 01:04:29 Doctor All right. 01:04:30 Doctor Okay. 01:04:31 Doctor So then I can send you that by email. 01:04:34 Doctor I can also send you a letter of our talk today. 01:04:40 Levi Yes, I very much like that because I'm going to apply for some funding and they would need the price estimate and an explanation of what. 01:04:48 Doctor And I mean, you know, what you need to know is that if there are complications and that kind of surgeries is not unlikely, that there are problems. 01:05:02 Doctor All those. 01:05:03 Doctor If you paid by yourself, all those complications are extra costs. 01:05:10 Levi Yeah, they can add up. 01:05:12 Levi I understand that. 01:05:13 Doctor I know that there's. 01:05:14 Doctor That there are some insurances in Germany for people who pay for surgeries themselves, especially for cosmetic surgeries, but they cover the risks. 01:05:25 Doctor Maybe there is something like that in Norway as well. 01:05:29 Levi I should probably look into that. 01:05:30 Doctor Yeah. 01:05:31 Doctor Like risk insurance for surgical procedures. 01:05:37 Doctor Something. 01:05:38 Doctor You should have a look at this. 01:05:40 Levi I will definitely do that. 01:05:41 Doctor Because it can be, you know, if something and something and something. 01:05:45 Doctor And then we are not talking about, I don't know, 36 or 40, but we're talking about 70 or 80 or 90 or whatever. 01:05:52 Levi Yeah, that adds up fast. 01:05:54 Levi Probably. 01:05:54 Levi Yeah, I will definitely look into that. 01:05:56 Doctor Okay. 01:05:58 Doctor All right. 01:05:59 Doctor So then I think we're done today. 01:06:02 Doctor I'll send the letter to you by email with the cost estimate. 01:06:07 Levi That sounds good. 01:06:09 Levi Is it possible to get the letter in English or would that be very difficult? 01:06:14 Doctor That would be quite difficult because I do not have it in English. 01:06:25 Doctor And the thing is, I mean, generally... 01:06:28 Doctor Yeah. 01:06:30 Doctor We could need an international version, but if I translate the letter by myself, it's just not my mother tongue. 01:06:40 Doctor And as you probably realize now, some words, we have to find a way. 01:06:48 Doctor And if I give you an official form or an official letter, I need to be sure that all the terms are correct. 01:06:57 Levi Of course. 01:06:57 Levi Okay, I understand. 01:06:59 Levi I can have it translated. 01:07:02 Levi Just wanted to ask if. 01:07:03 Doctor Yeah, yeah, I understand. 01:07:06 Doctor Rief und kosten of stellung. 01:07:10 Doctor All right. 01:07:11 Doctor Okay. 01:07:12 Doctor If it might take two to three weeks. 01:07:17 Doctor If you do not get it, please take a card from me. 01:07:22 Doctor You'll find an email address. 01:07:23 Doctor Just write. 01:07:24 Doctor I'm still waiting. 01:07:25 Levi Okay. 01:07:25 Doctor Okay, great. 01:07:26 Doctor All right. 01:07:27 Levi Thank you so much for the thorough explanation of everything. 01:07:52 Doctor Bye bye. 01:07:52 Levi Bye bye.
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