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:


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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