Meeting with the surgeon

What is a surgical consult?

Your appointments with the surgeon to discuss surgery are called surgical consults. During the surgical consult, the surgeon will ask about your goals for surgery and provide you with information about your surgical options. It’s also an important opportunity for you to ask questions. 

What to expect during your surgical consult

Before your surgical consult, you’ll receive information about what to expect during this appointment. Sometimes you might have more than one appointment as part of this process. 

Intake appointment — First you’ll have an intake appointment over the phone with a nurse. The nurse might:

• Ask questions about your gender, general health and family history
• Talk about what to expect during the rest of the process.

Surgical consult — Your second appointment is with the surgeon and usually takes place in person or via Zoom (or a similar platform). The surgeon might:

• Ask about your hopes, surgical goals and health history (if needed)
• Conduct a physical exam, which can include checking the blood flow in your donor site The area of the body from which tissue is taken for use in a procedure (phalloplasty, for example). (if applicable) and conducting an internal genital exam using a speculum (to assess the genital depth and health of internal tissues) 
• Take photos of your genitals
• Assess the need for hair removal of your donor site (for phalloplasty A gender-affirming lower surgery to create a penis and scrotal sac (phase 1) followed by testicular implants and implants to obtain rigidity/erection (phases 2 and 3). with urethral lengthening A surgical procedure to extend the length of the urethra to allow for urination out of the tip of the penis. The procedure involves connecting a person's current urethra to the new urethra created in the shaft of the penis. only)
• Determine if additional assessments or diagnostic tests are needed.

As part of the process of informed consent, the surgical team (which consists of your surgeon, nurses and may include social workers and physiotherapists) will help you understand:

• The details of the procedure as well as the potential benefits, risks and outcomes
• Permanence of the surgery and how it affects fertility
• The possible need for additional surgery
• Recovery and aftercare in the months following  surgery (including when and how to return to physical activity)

You will also be shown pictures of the surgery and examples of results at different points of the healing process. 

Preparing for a surgical consult

Being as prepared as possible for your surgical consult will ensure you have the information you need to make the best decisions for yourself.  

Download the workbook

In addition to the information below, our Phalloplasty, Metoidioplasty and Erectile Tissue Release Workbook contains reflection activities to help you prepare your appointment(s).

A few things you can do to prepare include:

• Research the different surgical techniques and potential complications on our Understanding the Procedure page or use other resources we recommend including:
  • Rainbow Health Ontario’s Transition-Related Surgery Surgical Summary Sheets
  • Phallo.net
  • Metoidioplasty.net
• Search online for before-and-after photos of each surgery type, including photos of people who have a body similar to your own.
• Prepare a list of questions (see below) and bring along a pen and notebook to the appointment. You may also want to ask a support person to attend the appointment and take notes so you can focus fully on the conversation. 
• Prepare a complete list of any current medications and supplements (including traditional medicines, herbs, vitamins, minerals, etc.) including the dose and frequency.

Here is a list of questions you may want to ask your surgeon:

• How will this surgery affect your options for sex?
• Will you be able to pee while standing up?
• Do they have photos of surgical outcomes of other patients who had this surgery (both successful and unsuccessful outcomes)?  
• What medications, vitamins or supplements are safe to take before surgery? 
• How long will the swelling last? 
• What are the complications that could occur after the surgery? And what are the surgeon's complication rates for each procedure?
• What are the chances that you will need additional surgery with this type of surgery?
• What should you do if you experience a new symptom after you return home? 
• When can you return to work? 

Next steps after the first consult

If you choose to go ahead with surgery after your initial consult with the surgeon, you’ll follow these steps:

1. Hair removal 

Medically-necessary hair removal is usually required for people having phalloplasty with urethral lengthening. In these cases, hair is removed from the part of the donor tissue that will become the new urethra.

During your consult, the surgeon will assess your donor site to determine if you need to have hair removed. If you do, they will provide a referral and detailed instructions on how to access public-funding for hair removal.

• Many people wait to start hair removal until they’ve received a referral from their surgeon, which is required for hair removal to be publicly funded. Consulting with your surgeon prior to starting hair removal will also ensure that hair removal is done on the part of the body recommended for you. 
• In order for hair removal to be publicly funded, you need to work with a  pre-approved electrologist. If you start hair removal prior to your surgical consult this will be paid out-of-pocket and cannot be reimbursed.
• Electrolysis is the only process recommended for pre-surgical hair removal for those seeking phalloplasty with urethral lengthening. Electrolysis feels a bit like getting a tattoo. Speak with your hair removal provider if you are concerned about pain. Options for pain management can include distraction (through video, music, conversation or virtual reality), oral pain medication or topical anesthetic (such as EMLA, Zensa, BLT or Tetracaine). See the handouts below for more information. 

The hair removal process takes different amounts of time for each person, depending on the donor site The area of the body from which tissue is taken for use in a procedure (phalloplasty, for example). and the amount and type of hair you have (this can take up to 18 months). 

If you have been referred for hair removal, Trans Care BC will contact you and inform GSPBC once hair removal is near completion. You will then be scheduled for a second surgical consult.

2. Second surgical consult

This consult is a check-in on your surgical readiness and helps to determine if any additional steps are needed. If you are deemed surgically ready, you will be added to a waitlist for surgery. Please note: the second surgical consult is often completed in person and may require a physical examination of  your genitals to help plan for your surgery.

3. Surgery

GSPBC aims to provide patients 2–3 months’ notice prior to an available date. They may offer a date sooner than this if there are cancellations. Surgery typically requires a few days in the hospital. The length of stay depends on the type of surgery and follow-up requirements.