Trans Talk: My Meta Experience

SFGN File Photo

In May 2018, I had a hysterectomy and a metoidioplasty. It was one 6.5 hour surgery with three different surgeons. Dr. Kristene Whitmore came in and took out the cervix and uterus, then another doctor came in and removed both fallopian tubes, and finally Dr. Kathy Rumer performed my metoidioplasty, commonly referred to as meta. 

For those who don’t know, meta is a lower surgery option for people assigned female at birth. Meta is the process of releasing the clitoris from surrounding tissue which increases the length and exposure of the clitoris, which has grown through the use of testosterone. If I had chosen to do just that, it would be known as a simple meta.  

However, I also chose to have my urethra rerouted through my clitoris. My surgeon took tissue from inside my cheek to help elongate my urethra and then rerouted it through my clitoris. This has allowed me to stand to urinate. If I wanted, I could have also had a vaginectomy which removes all or part of the vagina. I also could have chosen to have scrotal implants to create testicles. 

The process to get the surgery approved was not easy. At the LGBT Community Center where I work, we have health insurance that is supposed to cover gender affirmation surgeries. I called my health insurance and asked what they required for this surgery. They told me I needed a letter from two different therapists, one of which has to have a Ph.D. and the other from the therapist who originally diagnosed me with having gender dysphoria and suggested hormone replacement therapy (HRT). 

I also needed a letter from the doctor who is prescribing me my HRT, in addition to the information from the surgeons who would be performing the surgeries. I luckily kept records of all my letters and had the original letter from the therapist who prescribed me HRT, but I didn’t have a letter from a Ph.D.-level therapist. I knew a therapist with a Ph.D. because of my connections through work so she was willing to just meet with me one time to write the letter and only billed me my copay. I’m privileged in this way because many trans people don’t know trans-competent therapists, and if they can find them, they often want multiple sessions before they’ll write the letter. If they find one, their insurance may not cover it and they can’t afford to pay them out of pocket or they may have to travel long distances to see them. 

I sent in all the paperwork and a few weeks later, I get a denial letter from my insurance company in the mail stating that they won’t cover the surgery because the therapist who originally wrote me my letter didn’t have a master’s degree at the time she wrote the letter. This was not true. I was also privileged in that I still was in contact with this therapist, so I called her, and got her to send me her resume as well as the resume of her qualifying supervisor. I wrote a letter appealing their denial and sent it in with the resumes. A few weeks later, I was approved for surgery.  

Following the surgery, I received the Explanation of Benefits in the mail from my insurance company. Besides copays, I didn’t have to pay anything out of pocket. There’s no other way I could have afforded it because it cost $241,000. 

Dealing with therapists, surgeons, and insurance companies isn’t easy. There’s a lot of bureaucracy to deal with. Nevertheless, even with a post-surgical complication I’m finally at the tail-end of dealing with, I would still do it all over again. Hopefully, these surgeries become better and more affordable for all the trans guys out there still waiting and hoping for their day. 


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