Claire

@leeen@toot.community says "remember to burn down the patriarchy/capitalism and go have sex in the woods"

Gender clinic has decided to accept me as a patient! This means I can get the operation this year, instead of waiting until next summer with Radboud ​​ Next step: wait for gender clinic to contact me

I have an intake for gender clinic scheduled for Monday! Assuming I don't find any major red flags, I'll contact Radboud after that to tell them to take me off their waitlist.

I got confirmation that I'll be waiting 20 months for Radboud, not 44. 20 months isn't great but 44 felt impossible, so yay for a small bit of good news.

The intake at gender clinic went well, although apparently I missed that I was supposed to watch some online videos before today. Also my weight is slightly outside of the acceptable range, as my BMI is just over 30. I need to lose weight before my next appointment in a month. At least I'm not too far over the line, and I'm optimistic that changing some habits could be enough (like not drinking beer anymore) Next up: talking to a psychologist at gender clinic at the start of June

MediDerm finished figuring out what's happening. They are refunding me for the first session (Radboud will be paying) and instructed me to make an appointment so I can be checked for the viability of laser hair removal. Laser hair removal will not work on me, as my hair is too blond. MediDerm should also know this, as they got a good look at this hair during the one session I had. Regardless, I'll go to the appointment for this tomorrow to confirm this in person. As I'm tired of waiting for this mess, I've also made myself an electrolysis appointment at 2pass in Antwerp at the end of the month.

I had an electrolysis appointment this past week for hair removal on my face. While there, I complained about the whole MediDerm situation (I've been going to this place for my face for well over a year now) The electrolysis tech's response was "hair removal before surgery in the Netherlands isn't really a thing anymore, can you find a second opinion?" So I'm now really curious if gender clinic will require hair removal in advance or not. I guess I'll find out if/when I finally have an intake there.

I got a letter in the mail today informing me that I officially have an intake appointment at Radboud in late November! I was expecting the letter a bit earlier than this, but I'm happy to have made another tiny step here forward.

I had another appointment at burojij today. My indicatiestellingformulier was sent to gender clinic, and I'm scheduled to be brought up at the next meeting of "the multidisciplinary team" on March 30th. After that I'll know if I can get the operation at gender clinic. One bit of hopeful news is that the wait at gender clinic is currently "2-6 months", so if they agree to take me on as a patient then I can definitely get this operation this year! I'm still going to continue with hair removal in the meantime. I get the impression that gender clinic doesn't require it, but I've been advised by multiple people to do it anyway and the concept of ingrown hairs 10 cm inside of me is not pleasant to imagine. Although it's unclear if I'll finish hair removal by the end of the year, so that's something to discuss with gender clinic at the intake.

I just had that "is laser a good idea" appointment at MediDerm, and the answer is "maybe". After talking things over with them we've decided that I'll go to 2pass in Antwerp for needle epilation, and ask 2pass if they recommend laser in tandem with electrolysis. If they say yes, then I'll round robin between MediDerm for laser and 2pass for needle. This is more hassle and expense than I wanted going into this, but honestly I'm happy that I seem to have a viable path forward.

I had another appointment at Radboud today, this time with a pelvic floor therapist. We went through a bunch of questions to confirm my pelvic floor is operating normally, and then there was a check that I'm able to consciously contract and relax my pelvic floor (I can). We talked a bit more about dilation too. Interestingly the person I spoke with said that gender clinic offering bottom surgery is taking some pressure off of Radboud, and the (post-psychologist) wait should be around 12 months for me, which would bring my operation date 2 months earlier.

Today I met with the actual psychiatrist at burojij, who has agreed to refer me for bottom surgery. It was a rather short meeting (just 20 minutes), but a rather important step. I'm happy to now have the official referral, but he told me that he expects it to still take a few years before I can get the operation. I'm currently working with the assumption that he's most familiar with the hospital in Amsterdam where that's true, because the Radboud website says something completely different (~14 months). At least I'll have a clear picture on this soon, when I can ask Radboud to give me a timeline at my intake with them in a month.

I had my first session for hair removal today on my perineum and scrotum (specifically the area that we'll use for a skin graft to get more depth), and I found the pain very easy to manage. Today's session was 45 minutes and we covered maybe 25% of the area, so next I'll schedule a much longer session I guess.

I gave Radboud some documents from burojij, one of which included the detail that I'm being referred to gender clinic as well. My contact at Radboud responded by saying they don't support double referrals like that. God damn it, I was just doing what burojij told me to do. Now I feel like I need to commit to either Radboud or gender clinic immediately when I know almost nothing about gender clinic other than they'll hopefully be faster, because this system makes it impossible to talk to anyone without going through so much red tape. My frustration levels with the Dutch healthcare system have been growing a lot.

Also I'm starting to think that even if gender clinic can see me faster than Radboud, I'm tempted to go with Radboud anyway. Everyone I've talked with at Radboud has been very pleasant, and I'm pretty convinced I really want to do hair removal on the area we'll use for a skin graft, which will be slow regardless. Also I really should make an appointment at 2pass for that, I've been waiting over a month now for the MediDerm mess to untangle.

So if my weight is what my scale told me this morning (unclothed, before breakfast or drinking anything) then my BMI is exactly 30. Assuming gender clinic's scale is consistently 1.5 kg higher than my scale, I suppose I should lose 1.5 kg in the next month (and slightly more to account for my clothes), and go to my appointment hungry and dehydrated. 1.5 kg isn't a healthy amount of weight to lose in 28 days, but if that's what I need to access this care then that's what I'm going to do. Notably they told me that my journey at gender clinic will be paused unless I meet the BMI requirement at my next appointment, unfortunately I can't just promise to lose that amount of weight before the operation (which I'm hoping will be in October).

@Fiona@blahaj.zone Radboud told me at my intake with them very directly to not expect any lubrication. My understanding is that no existing bottom surgery technique does self lubrication based on our current medical knowledge. That said, I've read a handful of personal stories of trans woman who do claim to be able to self lubricate after healing, but I've not seen a consistent explanation on how that works nor seen this possibility written down anywhere authoritative. I'd be thrilled to learn otherwise though if this is something that's offered somewhere! My current line of thinking is that I'll probably get small amounts of self-lubrication after things have healed, and will need additional lubrication for any serious penetration, and I'm personally fine with that.

Today I had my intake appointment at Radboud for a vaginoplasty operation, with the assistant of the surgeon that does the operation. I feel it went well. She wanted to make sure I understand what I'm asking for and why, believed my answers, walked me through the details of the operation and aftercare, and we went over what to expect, possible complications, and stuff like that. She also did a quick physical evaluation and determined that with a scrotal skin graft I could get 10-11 cm of depth, which is slightly less than I was hoping for but also upon reflection seems like plenty lol The bad news is that first I need to meet with their psychologist. We'll be able to rely on the report from burojij to speed along the conversation with the psychologist, but there's a 6 month wait-list to talk to them, and only after that's done can I start the 14 month wait-list for the operation, so I can expect another 20 months of waiting with Radboud. There's a small footnote here that they're planning on moving some more stuff to an outpatient facility which will open up capacity to start making the 14 month wait shorter, which I might benefit from. So with Radboud I'm looking at July 2027, which is far longer into the future than I'd like but at least this is the first time in this journey I've had a semi real date. Now to see if gender clinic can give me a shorter timeline. And perhaps renew my efforts to talk to surgeons in Spain, as a backup plan.

There's been a couple developments since my last update. I was honest with Radboud and told them that I'm not currently on gender clinic's waitlist but am interested in learning more about it and potentially getting on it, and promised to tell Radboud immediately if this happens. This seems to have been sufficient, they haven't brought it up since. In other news I had my second appointment for hair removal scheduled on December 30th. On the day of the appointment the hair removal practice called me, telling me that they're cancelling my appointment because they don't feel that they can give me fast and good results due to their inexperience working on this part of the body and they recommended I look for care elsewhere. I told this to my contact at Radboud, who was surprised by this as Radboud has a contract with MediDerm for this care. Apparently MediDerm also should have never billed me for the first treatment, and sent the invoice to Radboud. Oh, and ASR (my health insurer) told me they won't be covering this, but afaict that's fine because Radboud will be paying, not ASR. I've emailed my contact at MediDerm these details and am waiting for a response. This whole thing is quite the mess. MediDerm did suggest to me that I look at 2pass clinic in Antwerp for hair removal for this, and they can definitely do it, but I'd be paying myself. I'm tempted to make an appointment there anyway just so I can get started until the MediDerm mess gets sorted.

I had another appointment at burojij last Wednesday. Honestly we didn't really accomplish much. At my next appointment in early February we'll fill out the paperwork needed to be referred to gender clinic for bottom surgery.

During my intake at Radboud we discussed what kind of depth is realistic based on my anatomy. The number is a bit smaller than I had hoped for, but something I'm confident I'll be happy with. That said, to get that number we're going to do a skin graft with leftover skin from the scrotum. The scrotum has hair on it ofc, and these days they can remove that hair as a step during the operation. According to the person I spoke with, removing that hair is stressful for the skin, so the chances of good outcomes with the skin graft can be increased by doing hair removal in advance on the perineum/scrotum where they'll take the skin from. They told me to talk to MediDerm about hair removal, and sent me a letter to give to them. That letter stated that I can only be entered on the wait list for an operation once hair removal is complete. MediDerm during my intake today confirmed that, and said that hair removal can take up to 2 years. They also said they're quite surprised to see me have to do this, I'm the first person to walk in their door in 5 years asking for hair removal for a vaginoplasty operation because these days the surgeon can do it. So now I'm wondering if my waiting time will actually be 44 months instead of 20 (24 hair removal + 6 waiting for psychologist + 14 waiting for operation), and why I'm being instructed to do something that they stopped doing a half decade ago. I've asked Radboud for clarification.

Today I had another appointment at burojij, during which we finished and reviewed the indicatiestelling formulier, which is the form summarizing my entire gender journey and my request for bottom surgery. It'll now be checked and then sent to gender clinic, who will review my case with a multidisciplinary team, and then decide if they'll let me on the wait list for an intake. I've been led to believe I'll hear back from gender clinic within a couple months. I'm hoping that at that point I can learn how long the wait will be there.

Oh and this means the time from my initial appointment at burojij to the point where they're handing me off to gender clinic was almost exactly 1 year.

Something I'm wondering now is if I could have done the full novel on my gender dysphoria with the psychologist at Radboud, and thus avoided working with burojij at all. Burojij took about 2 years, so cutting that out would've really shortened this timeline. It's not a useful thought to me at this point, but I'm writing it down in case it's a useful thought to someone reading this.

Also I got asked, yet again, if I'm sure I don't want a vulvaplasty instead. At the very least this question came from someone who isn't from the same organization as last time? I'm tired of being asked this question.

I had my electrolysis appointment in Antwerp today, with local anesthetic. The anesthetic injections aren't pleasant, but I tolerate them well and they made the rest of the process very easy. The tech also strongly recommended finishing with electrolysis before the operation, which really contradicts what the tech in the Netherlands said. Finishing hair removal first makes more sense to me, and the idea of hair growing internally invokes feelings of body horror, so I'm going to be continuing these treatments in Antwerp. I wonder if burojij has sent the psychiatrist referral I got last October to gender clinic yet. My next appointment with them is in 3 weeks, so I guess I'll ask then.

@Fiona@blahaj.zone are there any surgeons that will claim they can, at least with the penile inversion technique?

Also the scale at gender clinic reports my weight as 1.5 kg more than my scale at home does (I checked when I got home) which is not great :/

I'm on the train back home and ruminating on how July 2027 is almost 4 year after I arrived in the Netherlands. Almost 4 years of trying to get this operation. Almost 4 years of trying to take active steps to fix my bottom dysphoria, only to have to keep waiting. If gender clinic isn't able to offer me something sooner then Spain is going to start looking reeeal tempting.

I recently came across a dashboard at work to see how many AI tokens you use, and compare your usage against your team/product area/the company. I've remained firm in my stance that I refuse to touch AI code generation tools, and I've been nervous that it's only a matter of days until I need to justify this to my VP. Interestingly, this internal dashboard shows I have a significant AI usage, my current usage is trending up, last week I used 2.58 million tokens, and I consume AI tokens on almost every Saturday and every Sunday. I'm allegedly in the top 10% of AI users in my product area, and top 13% of AI users at the company. I guess if these are the tools that we're using to track who's pro-AI I can confidently continue to fly under the radar 😅