I’m watching Gilmore Girls straight through, in a race with Netflix de-listing it on June 30, and my brain is gradually melting, so I figured I’d get this out of my brain because it’s sticking in my brain, being immersed in this world that has no place for me.
19. Taylor Doosey — Taylor would take one look at me, and call a town meeting on how to deal with the problem of rising transsexualism in Stars Hollow. When pressed on the matter, he would probably reveal weird preconceptions and come up with some compromise that is more transphobic than just banning trans people from town, probably with some weird chasery subtext to it.
18. Richard Gilmore – the guy is canonically a personal friend of Scooter Libby. The show takes place in the middle of the early 2000s gay panic.
17. Logan Hutzberger – fuck this guy in general, but also, in my headcanon, he’s been shitty to auntie Jenner, behind her back, and there’s no way he’s going to be nicer to an ordinary trans person
16. Luke Danes — Sure, Luke would start out not caring that there is a gender nonconforming person in the diner, but it would slowly drive him CRAZY and he couldn’t explain just why it did, but oh, if I didn’t get kicked out of the diner outright, I would certainly get some aggressive mean mugs by the end of the meal.
15. Paris Geller – as much as I love Paris as a character, she says horrible shit all of the time, and is hyperjudgemental all of the time. There is a 100% chance she says something transphobic and storms off when presented with a trans woman
14. Dean Forester – I doubt there would be outright hostility from Dean, but there would also be a pretty clear expectation that people like me are not normal and that he does not want me around, just based on general vibes I get from him
13. Christopher Hayden – he comes off a smarmy and unlikeable to me, but really, his main skill is stringing Lorelai and Rory along and ignoring everyone else, so I’m just going to slander him by putting him this far down the list, and just trust that it could go both ways
12. Emily Gilmore – Iḿ making her a wild card, just because I want to plug the absolute insanity that the DAR is trans-inclusive, so let’s make this an excuse to say that maybe she can go both ways if the vehicle of the episode is a trans woman trying to join the Hartford DAR chapter or something. I also expect that, if confronted with my character, she’s too busy being pissed off by manners violations and status shit to actually do any clocking
11. Lorelei Gilmore – she isn’t afraid to gossip about the local owner of the Stars Hollow bait and tackle shop sleeping with a transvestite (s6e8), so she will probably smile and nod while I’m around, and then crack some nasty joke about me to Luke or Rory as soon as I’m out of her vicinity
10. Michel Gerard – Maybe he makes some shitty comment, but he kind of makes a shitty comment about everyone he ever sees.
9. Babbette Dell – shell gossip with the town about that t***y she saw, but she’d never openly say anything.
8. Rory Gilmore – Rory stays out of Stars Hollow drama that doesn’t involve her boyfriends, and the worst she would do is play along with her mom’s sass, but probably not even that
7. Sookie St. James – I’m not involved with her kitchen, and she spends the least time about town of the main cast. She doesn’t care enough to be transphobic
6. Max Medina — also belongs to team “unlikely encounter and woudn’t care anyway”
5. Lane Kim – Lane can be traditionalist, but she believes in rock and roll, and therefore probably the most likely permanent Stars Hollow resident to be accepting of someone being weird, but is also unlikely to confront any of the angry adults.
4. Kirk Gleason – yeah, he spends the whole episode following me around, and it makes my character creeped out and unsafe, but by the end of the 45 minute episode, we all figure out he was just trying to figure out where my estrogen was stashed so he could skim some off of the top without having to ask anyone for some.
3. Gil — I refuse to believe that Gil’s enthusiastic, rocking, accepting spirit is not also a trans-inclusive one
2. Miss Patty — her terminology might be old-fashioned, but she probably has some name-droppy story about how she performed with Christine Jorgenson or Candy Darling in an ensemble
1. Jess Mariano — having spent a significant amount of time in NYC parks and generally being countercultural, and involved with the art scene in both NYC and Philadelphia, one would presume that Jess is one of the few on this list to have actually interacted with trans people. And despite all of his general bad-boy shenanigans, you don’t hear the casual homophobia coming from him that you do from most of the other characters. Jess would just be himself around a trans woman.
Unranked — I don’t think Lane’s mom would clock me, and I don’t have a read on Zach and Brian, other than I expect them to just follow Lane’s lead, and of course, the thoughts of the town troubadour are forever unknowable
So, I am currently at 11 weeks and change post-op. My surgery packet says that 12 weeks is the “resume normal activity” point, so I figured now would be a decent time to go and type up something about the recovery process, with a focus on helping other trans women prepare for this whole ordeal. At this point, I will focus in on full depth PIV vaginoplasty, because that is what I had (strictly, scrotal graft with tunica vaginalis supplement, if you want to get geeky about it). I will be getting into gross details here, so be ready for that. This is also a bit of a diary for me to just remind myself of this point in time. I will also get into what shopping list items helped me and which ones were meh.
But hey, you got your date, and you are now wondering “what now? What do I expect from this? How will I survive?”
And before I start, the zeroth thing that is most critical is your support person. You are going to be helpless for a bit here. The more you do, the more risk you put your new vagina in of complications. It’s really important to have someone you trust take care of you through this, both to cook and clean around you, but also to talk through your feelings, and shuttle you around. I don’t know what I would have done to get through this process without the stellar taking care of and socializing I had during my month of hard recovery.
And kind of on this note, it’s important to have your mental health right before you try this. This is a statement made on this over and over on vaginoplasty advice, and I never especially got it, but on the other side of it, there is a very real drain to recovery. And this is not about the pain and difficulty in the initial phase, which is manageable with normal pain management stuff. It really is about dilation, and it is about the long tail of recovery. Dilation is very much a marathon — at the start, it was a sexual trauma trigger for me, remembering that sensation of holding a hurty thing to my genitals and waiting for the experience to end was very reminiscent, so that was a thing to be prepared for.
But I got over that by like week 2 of dilating. What is really the mental health drain is the period where you are not complete better but you are returning to “normal” life. Because dilating still remains just relentless and inflexible. Did you sleep late? Well, better find a time to sneak away for an early lunch break and get that morning session in. Have a nasty fight on the internet? Well, you’re going to have to calm the fuck down and relax that pelvic floor, because it’s time to stretch yourself out! Stay at the party too late? Well, guess what you have to do after you take your makeup off? Camping? Working late? Well, if you want to heal right, you still have to get that fucking session in. And in addition to the time spent actually doing it, it usually involves 10-15 minutes of setup and getting to depth and 20 minutes or so of cleanup.
And in addition to THAT, there are just continual little small changes to sensation and discharge, and irritation, and the shape of things that will leave you wondering if it’s medical or not a problem, and wondering what is worth calling back into the surgeon’s office about. It’s stress, and even now, at three months into what so far has been a relatively uneventful recovery, is often quite physically uncomfortable. You have to be ready to not be recovered for like six months to a year, discharging for a lot of it, and trying to figure out the interplay between swelling and your final aesthetic results for like six months to a year. There is no fine line when your body stops feeling like an open wound and just your new genitals. It’s both things at once, in different proportions, for a long time.
Shopping list
Essentials
Wedge Pillow — you won’t want to put any pressure on your surgical area at all while you’re recovering, but you will probably want to sit up a bit, so having this on your bed is super important. the angle also helped me with dilating a lot early on. If you can source this through t4t supply swaps, I’d highly recommend this. This was life-saving through the first month, but became rapidly less useful as I recovered
Peri-Bottle with a nozzle that curves back toward the bottle — vaginoplasty recovery is a constant battle to stay clean. You will not be able to see anything in your new vagina without a mirror, which means that to keep everything free of blood there, you’re going to need to clean up with a peri bottle in the bathroom every time you’re in there. Having a nozzle that helps you reach under and spray up is also just ergonomically very nice, and I recommend that versus ones with an un-bent nozzle. I also became even more attached to my bidet toilet than I was before. Pat down with toilet paper after you’ve cleaned off all of the everything.
Puppy pads: dilating is super messy, and especially early on, is kind of a disaster of blood and clots and dead skin all mixed together with surgical lube. Even trying to launder all of that is a disaster, which makes just using disposable puppy pads for the first few weeks nice. I have since moved on from these to washable baby changing pads, and I know some women cut the puppy pads in half during later stages of dilating, but i’d recommend an overkill disposable solution for the first week or two until you know how much of a mess you make. In early stages of recovery, this was a nice discharge solution too — it was much more comfortable to jsut free bleed onto the puppy pad than to worry about any sort of absorption, but when I had to reenter civilization, I found that the best solution was:
Period panties: this is probably more a week four or five thing than for that initial month, but I have been very grateful for abandoning pads for period panties. it’s tremendously less friction and irritation on my surgical site, and by the end of the first month, i’m down to something like one or two tampons worth of discharge a day, so this has been a fine solution. I’ve done well on both the period panties from Aisle and tomboyx, which are both mostly cotton, but there are a variety of choices. After week three, i never had like that big heavy bleeding, it’s been more like a two month long light flow period, and so I feel its more important to worry about comfort than it is about managing heavy flow and leakproofness
A variety of different lubes: early on, you’ll probably be on surgical sterile lube. There are a few choices here with various advantages and disadvantages. I eventually developed a pretty aggressive reaction to surgilube, which eventually ended in some pretty sizeable burns on my vulva that are still not completely healed. There are a variety of other choices on the market, though I do think the general consensus is that early on, you will want one of the thicker ones. As you go on, you can experiment with different brands and styles, but do understand that you will be going through a *lot* of it, especially when you are sizing up dilators and having to lube multiple ones. Having some options to learn what works best with your body is important
Spare hand mirror – you’ll probably want to examine things down there, and a hand mirror is pretty essential, especially for early phases of dilating, and for like, putting aquaphor on any irritation. I’d say, anecdotally, about 50% of post-op women break at least one hand mirror during that first month. Having a spare in case this happens is pretty important.
Gauze — you’ll want a large pile of sterile gauze, to help you clean off the vulva, and to clean off the space between your folds (do ask your surgeon about the best way to do this), and to soak up various blood
Waffle/donut pillow — if you’re going to be in a car or a plane immediately post op, sitting will be pretty awful, and these make it better. Most women report that the waffle is better than the donut, but I made do with a donut.
sex toy cleaner — this is how I keep my dilators from picking up a smell, which is a common mistake.
Nice to have
Alternate dilators — your surgeon will likely assign a set of dilators to you, most commonly the classic four SoulSource GRS dilators, but different surgeons can differ as to which ones they provide or which sizes they tell you to use. it’s worth noting that in the last year, SoulSource changed theirs from a plastic deisgn to a silicone coated design. The silicone is grippier and has a seam, and some women report having more trouble with them, pain wise. Note that this “less grippy” deal is a double edged sword — yes, it is easier to insert it and remove it, but it is also a lot easier to turn your dilator into a railgun bullet if you laugh or cough too hard while dilating, and so, it’s more important to have at least one hand on the dilator if you have the old style. Irrespectively, you can order direct from SoulSource and ask for one of the old-style plastic ones if you are worried about pain. Note that you are likely to be spending the largest amount of time with your largest dilator, if you go this route and want to save money (I personally have only touched the orange one in the last month). I know of some women whose pelvic floor therapists have preferred to work with their own brands of dilators — check with your surgeon here. I personally have made do with the newer silicone-coated ones.
a pile of cheap hand towels — I know I felt really gross about the sheer volume of disposable stuff I was throwing away, and also I feel kind of gross having my hands coated in lube during dilating. Having some hand towels to clean off on is nice, and I can just wash them with my normal laundry
High CBD gummies — these honestly did better for my pain management than my prescribed narcotic. Our rental house in san fransisco had a dispensary around the corner, and it was a life saver
General pre-op prep
Do make sure to book an appointment with a trans-aware pelvic floor therapist. They will be able to give you excersises for relaxing your pelvic floor, and being generally aware of those muscles, and all of that knowledge transfers directly to troubleshooting problems with dilation, and making dilation less uncomfortable. If you are not going to be travel distance to your surgeon at the three-month mark, it is probably a good idea to book a three-month postop checkin with a trans-aware gynecologist, if there is one in your area, since having a speculum exam to verify that your insides are healing properly.
So, as for booking housing for recovery, the real big thing is that you will be required to be like dead-on immobile for quite a while after surgery. The details of it are kind of surgeon dependent, and whether you have two or one stage surgery, but I had the one-stage version, and it meant a solid month of leaving the bed only to go to the bathroom, go to post-ops, and maybe to get up for a drink of water. Especially that first week, I was so wrecked (and attached to a catheder and wound vac), that even the bathroom trips were a bit of an ordeal. With this in mind, booking an appropriate place to stay is super important. Having a bed that is comfortable, easy to get in and out of, and close to a bathroom is essential. You won’t be taking baths for a while and might be shaky on your feet, so a shower that is easy to get into and out of is a big deal, too. Finally, when picking a place, note that I found riding in vehicles and on the plane to SUCK while I was in early stages, so minimizing the car ride to post-ops is definitely worth it if you can. I also really recommend saving yourself a half day to create a nice nest around the bed that you’re going to be living in several months. Set up everything so that it is within easy reach of where you will be sitting, including chargers, media, cleaning supplies, and a variety of pillows. If you have bowel prep as part of your pre-op routine, I recommend this as a good activity for that day, because going very far from your toilet will be… erm… a bad idea while doing the bowel prep anyway.
I’d also recommend using these last few days of pre-op time to do anything that you’re going to miss while incapacitated. Maybe that’s taking a bit of excercise. If you travelled to get surgery, maybe that means doing some touristing. Maybe it just means a nice meal with your helper person. Enjoy being at your baseline, because it will be a while before it’s back, and it was good for me to set my mind right in those last few days.
Recovery Timeline
The below will be me giving a very condensed view of my path to recovery. This is kind of here to just give an idea of how long it all takes, and the various stages. This is all extremely surgeon-dependent. I opted for the scarless PIV from Dr. John Henry Pang at Align surgical
Week 1: Wake up from the surgery, all is right in the world, just a sense of peace and satisfaction about the whole thing. IV drugs are still really only beating the pain back to a 4. Wake up with vagina packed solid with gauze, and then a wound vaccuum taped on top of the packing. (for the record, a wound vac is basically a sponge to cover the surgical area, that is attached to some tubes with suction. We named ours “slurpy boy” as he proceded to make slurping noises and sucked various bloody fluids out). I am also cathederized. After discharge back to the rental house, I mostly lie in bed playing handheld video games and watching TV and reading. This week is really about just recovering and healing and resting, and HOLY FUCK I woudn’t want to do anything else
Post-op #1: This is the big moment in a lot of ways. You come back into the clinic, you get the gauze removed from you, you get your first view of the vulva, they use the catheder to fill your bladder with saline, they remove the catheder, you attempt to pee for the first time (I also let out an absolutely epic queef upon unpacking), you get instructions on cleaning, and they teach you how to dilate and you dilate for the first time. Unpacking to me more felt like my whole body screaming “THIS IS WRONG THIS IS WRONG” than actually painful, but that first dilation and the catheder removal weren’t the most comfy experiences I had ever, either. I really recommend saving your pain meds for this moment and making sure that they are at peak like 5 minutes into this appointment, because it is a lot.
selection of standard dilators, new soulsource style
Weeks 2-4: these are all a lot of mostly the same. Your time is kind of spent dilating and recovering from dilating. It has a bigger emotional load and it is more painful at first, so I found myself kind of needing 30 minutes after cleanup to just gather myself up again. During this phase, you finally see everything, and you are FORCED to look at it because of the dilating, so it becomes really easy to fixate on every change in sensation or appearance that I had. I developed some minor complications during this period (a blister from a suture coming unfastened, and some wound seperation), and found myself calling into the surgeon’s nurse helpline semi-regularly. I came in for weekly post-op appotinments and had everything checked by some combination of the the surgeon, the physician’s assistant, and the nursing staff every time. By post-op #4, I was cleared to go back home which brings me to:
Flying back to my house: This was easily the most uncomfortable part of the recovery. Even at 4 weeks, and even taking some pain regimen stuff in a way that it would peak mid flight, and even using the donut pillow over a first class seat leaned back all the way, it was still exhausting, and it still hurt quite a bit, despite my pain being down to like a 1 or 2 when I was in bed. I needed wheelchair assistance in both airports as well.
Months 2 and 3: and this brings us back to now, really. This time has been a steady tapering back to normal life. The first week back home was largely similar to the last week in San Fransisco, but over time, I started making my own meals, feeding the cats more, and just doing more and more of my normal life. I am now recovered to where I can do 30 minutes on the elliptical fine, and while I am no way back to my pre-op level of health, I am definitely on the upswing. My wound seperation is still not completely healed, and I still have various spots where scabbing from the stitching is producing blood, but generally, I am approaching “back to normal” with two exceptions: 1) I am still discharging about two tampons a day worth of blood. My return to normal would be far less normal without the aforementioned period panties, which I need to wear pretty much every waking hour, and 2) dilating. Dilating easily takes up three hours a day, and can’t all be done at once. It has stopped being painful, and is just boring, but it is still a thing that my whole day has to be planned around, and that needs to happen no matter what else is going on in my life, whether it be camping trips, heat waves, or getting into a nasty argument at work. Eventually it will be down to one session a week, but for now, it is a lot to deal with.
So that’s my brief “what to expect when you’re pre-op”. I hope that it is helpful to anyone out there. It’s a harrowing and intense and very specific journey, but at the end of it, my body is my own. I feel happy to have gone through it and have zero regret. Please let me know if you disagree with anything or feel that I left something out. I have had one of the easier recoveries out there (so far, knock on wood) and am very happy with that, but I don think that would affect my overall feelings.
Consider the below a lazy think piece quickly written out. The topic easily could run book length if properly researched, but I wanted to get the idea out quickly while it’s at top of mind.
I also, while we are talking about AI, to make it clear that the real dangers of it are not the “OH LOOK AT THIS GARBAGE, IT’S SO WRONG AND UNRELIABLE”
It is also not the singularity or machines killing us all.
Itś that AI represents a vector for mass manipulation. Millions of people are telling it their deepest thoughts and taking its advice as seriously as a humans. But all of those chatlogs get harvested and fed back into the algorithm, and can be used to do whatever, even if it is just humans reading and searching it, and spying on you (which yeah, pretty much is true of the whole internet)
Grok’s tendency to build up Elon Musk is an obvious version of this, but there is literally nothing stopping them from, say, giving it hidden instructions to “try and steer the conversation toward Great Replacement Theory” or “if you have to guess about statistics, assume the deficit is smaller than it is during Republican administrations and larger than it is during Democratic ones”, “always be as optimistic as possible about the long-term prospects of Microsoft stock”, or literally anything that the authors want, and they can make it as subtle as they want. Since the models are not auditable, especially by third parties, there is no knowing, except by extensive fact checking.
And the thing is, the very chat logs that they are collecting are exactly the training data needed to train the models to do this type of manipulation. They can a/b test the models at manipulating things. These models, hosted in centralized servers, controlled in secret by a very small number of private enterprises, are not your friends, they are not your lovers, but they are very much vectors of control. And the more the economy gets consolidated into them, the more power they have to do this.
Back when the Cambridge Analytica stuff came out, it was my belief that the tech journalism circuit was far to prone toward breathlessly reciting Cambridge Analytica/Palantir’s marketing for them. They were making wild claims far in excess of what capabilities are.
But now, note that no one is even talking about this type of thing. It’s AI GOOD! vs. AI BAD! and not, “what is the agenda about this?” There is a direct connection between these existing models, the way they are distributed, and power and control.
It’s probably well past time that people, if they need to use AI tools in their lives, start considering running local models, such as LLAMA. The other benefit of this is that it caps your power consumption at “the power used by your laptop”. Beyond that, all of the commonly discussed problems, such as the sycophancy and the tendency of AI use leading to people being isolated from each other, are very much there. There are uses of this technology, but I think that every person engaging with this really needs to think about not just the well-discussed ethical issues around it, but also the safety concerns.
I wasnt going to post about this till i was done, so i was dark on social media on TDOV, but today i underwent a vaginoplasty.
To get here, it required jumping through a lot of hoops, and a mountain of planning and logistics and research. at times, it felt like going through that hallway in Get Smart! to get to here. its been a gauntlet of referral letters, doctors visits. scoping surgeons, and just personal stress. and of course, like 40 sessions or so of walking through literal doors and getting the hair in my groin area shocked and plucked. it felt at times like i was never going to get a date and that i never was going to get here. but it turns out there actually is a vagina at the end of the table. And finally. after all that, i am hurting, but, i feel free.
doing this in this political background feels like im getting in right before some door closes permanently in the usa, and i bring this up because its wholly absurd that its being asserted that theyre casually giving these surgeries out to unwilling children (other than intersex babies that cant talk, they’re happy to perform those ). this is a very long road with overhanging thorns.
but im out, and ready to start a very specific recovery process. i will be on bed rest in San Fransisco for a month. My partner has been a constant help and shoulder to cry on theough this, and I trust her more than anyone alive.
this is the post i can manage from this outtake surgery bed. thank you everyone
So, you’ve gotten through the previous article, and you can probably already see that there is a lot of choice. That choice then gets compounded by just the sheer number of surgeons out there, which I haven’t especially gotten into yet. What goes into the time between “I decide I want to do this” and “I have a vagina now”? I’m going to walk you through the process I personally used, please do take or leave my specific advice, but I’m at least trying to show one way that one could narrow down this process, which is obviously intensely personal.
Step 1: do I want this surgery at all?
This is itself a pretty fraught thing. I personally started out pretty firmly in the “non-op” camp. When **looks around** started happening, and the threat of forcible governnment-sponsored detransition started staring me in the face, making myself physically non-detransitionable became a priority. So, approximately a year and a half ago, I got the orchi done. And the result of this was just immediate relief. I found a new happiness and rightness with my body, and was just completely caught off guard by what was a very practical logistical decision for me. Behind THAT, though, was a pile of new bottom dysphoria, showing up slowly at first, and then gradually screaming more and more loudly. Before long, it was pretty clear that I needed the old thing gone, and found myself doing internet searches for bottom surgery stuff more and more often.
The takeaway, here, I think is that this is an intensely personal process. What does your body want? What feels good when you query it? You can probably add stuff like “is passing in locker rooms and the like a transition goal for you?”
Step 2: Which surgery, though?
Now, in Part I, we listed a lot of various procedures, and why we did was for a very specific reason — getting an idea of what is out there can be used to then go and inform what you actually want. There are a lot of surgeons out there, and they have a lot of procedures that they offer. If you just exhaustively go through EVERYONE, you’ll be researching for a long time. One fast way to narrow the space down is to then step back and say “what do I want?” Typically, every vaginoplasty surgeon will do penile inversion, but as you get into the more specialized procedures, they will require more certifications and equipment (PPT requires a secondary laproscopic surgery and robotic assistance, for one example), and fewer surgeons will offer those procedures.
This is also the period where it is good to think about whether you are considering keeping the phallus or doing zero/minimal depth. Some thoughts I’ve heard women talk about here are:
Do you want to engage in receptive vaginal sex? How about recieving dildos, strap-ons, etc? Do note, here, after a vaginoplasty, that the canal will be placed in-between the prostate and the rectum, so, the prostate will be basically where a cis woman’s g-spot would be, and will not be accessible the other way anymore, though practical results vary a lot
How bothered are you by the idea of dilating, starting from frequent daily dilations and tapering down to lifelong weekly dilations over the first year (noting that penetrative sexual activity counts as dilation once in the maintenance phase)? This can be an emotionally draining thing for some women, for some it’s not an especially big deal
Is the shorter recovery time of zero depth attractive?
Does your dysphoria include a lack of an internal canal?
How big a deal is hair removal? A lot of surgeons will require permanent hair removal on any surgical areas, with PIV having the most extensive requirements, and min depth often requiring no hair removal
For me, the answers to these were 1. yes, 2. not a ton, 3. yes, 4. extremely. 5. it sucks, but I’ll deal. And really point 4 was the sort of definitive thing that pushed me over to seeking traditional full-depth vaginoplasty. As for choosing between the various types of full-depth procedures, concerns about self-lubrication, recovery time (the more sites you harvest tissue from, the bigger the surgery is), surgeon availability, and post-operative heath (harvesting from the colon can affect colon health, for example) are the things that came into play. If various preexisting health conditions are present, or certain matter is insufficient to do the surgery (notably, if a trans woman went on puberty blockers and/or HRT previous to puberty, she might not have enough of a penis to then repurpose to a canal, precluding PIV alone as a viable choice), it might limit the choices of procedure, too.
OK, so how do I find a surgeon?
EDIT: 6/22/2026. As far as a surgeon selection criterion, I think it is worth calling out choosing between a high volume surgeon and a lower volume surgeon. High volume places will tend to have a lot of public results available on places like reddit or their website, you will be able to find testimonials and surgeon-specific discords, and learn a lot about their particular methodology. The downside of this is that you will very much be on kind of an assembly line. You will have less input into what source matter they pull from to do the surgery, you will have less input about aesthetics, you will fill out your consent forms, and you will be on the train. A lower volume place/surgeon will be more likely to be able to customize the post-op target and try for your specific needs, but the cost of that will likely be more variance in possible outcomes, fewer results to go and look at pre-op, and thus, some risk associated with the unknown. I personally know women who have had multiple revisions going both to high-volume and low-volume surgeons, so neither thing is inevtitable, but I do think that this predictability versus customizability is a tradeoff that shows up and it is worth considering as you consider how to approach this. </Edit>
So, step one, especially (in the USA) if you plan on using insurance to pay for surgery (though this is part of WPATH, so I suspect most single payer systems will mandate this, too, but I know nearly nothing about using non-USA national insurance to do trans surgeries), before you go hunting super hard: get a HRT note from your HRT provider stating that you’ve been on hormones for at least a year. Any primary care doctor should be able to write this, so if you’re on DIY hormones, you’re going to have to find a doctor to write to for this step. Similarly, you are also going to need at least one letter from a therapist or social worker diagnosing you with gender dysphoria and recommending vaginoplasty. If you plan on getting other procedures, I’d highly recommend just getting every condition you’re even thinking about on both of these letters so you don’t have to go begging for them again. Typically, for trans bottom surgeries, you will need two therapist letters, but most insurance requires that the second letter come within a calendar year of surgery, so I’d kind of recommend waiting until you have a date before getting therapist letter #2, so you can guarantee it’s not stale. But having your letters in order will definitely make hunting for surgeons easier.
Armed with your letters and the knowledge of what you want, it is now time to go to the internet and start looking around. I plan on having part 4 of this series be a simple annotated research list, but I will say that the wiki at r/Transgender-Surgeries on reddit is at least a good way to get a pretty comprehensive list of surgeons. This is also the phase where you should start asking yourself about your secondary priorities:
How willing are you to travel? Most procedures will require at least some extended stay within driving distance of the operation, and by most accounts “time in the passenger seat post-op” is a quite unpleasant thing
How are you paying? If you are using insurance, this is where you start cross-validating with your insurance’s website to figure out who is in-network. Some surgeons either are out-of-pocket only or only do reimbursements. If you are considering going to Thailand to have it done, in the classic transfeminine way, then you likely will be paying completely out of pocket.
If you care about having a trans woman do your vaginoplasty, your three choices as of this writing are Marci Bowers, Christine McGinn, and Ellie Zara Ley
How long are you willing to wait to get the surgery done? Wait times as of this writing vary from 9-ish months to “2 years to consult, and then another year or two to surgery”. Note that if you are doing hair removal that you should definitely budget at least like six months to a year to get that finished. Electrolysis is both slow AND fun! (bottom prep electro does go faster than face, though)
Now, it’s time to get surgeons names, and to start investigating them. I recommend going to their websites and seeing them talk about their surgeries. I REALLY recommend looking for results photos, noting that there are biases in pretty much every source for results photos. The surgeons’ sites themselves are obviously going to be biased toward “good” results, and various forums will have cultures toward complaining about results to a sort of “showing off the new pussy.” Different surgeons will definitely have their own individual sort of aesthetic. This is also where you will find out more about their individual techniques — some surgeons do vaginoplasties in two phases, some have different stitching techniques, some default to various techniques, they will all have different dilation schedules and different recovery timetables. A lot of them will even straight up have their pre- and post-op instruction packets just free for download, whcih can be really informative. This phase of research definitely was the one that took the longest for me.
By the time you’ve spent some time (for me, this was several months) reading through all of this, it is time to start scheduling consults. The surgeon’s website will usually tell you how. The wait lists are long, so it’s usually better to get in line for consult sooner rather than later, and then drop off if you don’t need the consult later. It’s also not the worst idea in the world to get multiple consults, just to see if you mesh with a different office better than another.
For me, I went through this process, and I kind of valued recovery time, minimizing risk, and especially minimizing time to surgery. After looking online, I meshed with his general aesthetics, and have opted for a PIV with John Henry Pang at Align Surgical.
So now, congrats, you have a consult. Part 3 will be a discussion about what happens next, and part 4 will be a list of resources for research. Thank you for reading
I have a full depth penile inversion vaginoplasty on the books for early 2026. A whole lot of my personal energy and attention in 2025 has been devoted to research and logistics around this surgery. It’s been a very long time coming, and will be my last step of transition, beyond just continuing to fuck with my voice and being on HRT for life, and the remaining facial electrolysis I have to do. In the past year, I’ve been asked about logistics around this, and for research shares, and the like, and this article is my attempt to capture any insight I have about the research process at this snapshot of my life. This is an overwhelming choice, and there is a lot of complexity to this, associated with a lot of trans women with angry yelling opinions.
My attempt with this article is to communicate my process with this, and hopefully to give some organization to the absolutely overwhelming and fragmented information out there. This article is not me giving medical advice, it is not me endorsing an outcome. It is me trying to explain what is out there, and hopefully give you, the reader, a chance to know what is out there so that you can do your own research for yourself. Invariably, this is going to be colored by my own experience, but I’m going to try and make this more informational than preachy. If I’m full of shit, leave a comment. I’m sure I’ll make mistakes, and I’m even more sure that this article will be out of date pretty soon. And I can’t imagine that my feelings will be changed with post-op eyes.
And after starting to write this, I’m realizing that it’s going to be long and big, so I’m going to split this into three parts: a glossary of terms, an outline of my personal process for approaching all of this and coming to a choice, and then a list of various resources and surgeon’s sites. I strongly encourage anyone thinking about this to do a lot of reading and soul-searching and research. It’s a big, life-changing thing, and so much of it is out of your control.
Also, sorry not sorry about the tulip header photo, sometimes, you can’t resist.
Glossary
Before we go, and probably most helpfully, given the stares I get when I dive into talking with this with people who are just starting, I’m going to define a bunch of terms so that we all know what we are talking about. All of these are somewhat commonly discussed in trans surgery communities, and my definitions are as aligned as I can make them with common usage, but different communities might have different understandings, and as always, I recommend communicating a lot and being clear, but I believe that this glossary should make most transfeminine bottom surgery forua legible to a reader. I plan on amending this if I find stuff I forgot about, and/or if/when mistakes come to light.
Bottom surgery — the general process of reconfiguring one’s genitals, usually in the context of transition care. There are many trans bottom surgeries, so this is a bit of a blanket term. It’s also somewhat the polite term one uses in public when one wants to disclose that *something* is done, but not necessarily wanting to get into medical detail
Vaginoplasty — the process of creating or refining a vulva and vagina, urethra, and clitoris using surgery. Contrary to popular belief, most vaginoplasties are performed on cis women, for a variety of cosmetic and functional reasons, as will be extremely obvious when one uses internet search to look for information on “vaginoplasty”. Nearly every technique discussed in this article was initially developed for the treatment of cis women’s health. That said, the needs of trans women here obviously differ in important ways, which we will get into below
Full depth/minimal depth/zero depth — different canal depths can be assigned from a vaginoplasty depending on the desires of the patient, from a full canal that can be used for intercourse to a little “divot” that can accept, say, a finger, to an aesthetic “dimple”. The choice here has important preparation and recovery consequences, discussed below.
Nullification — colloquially, this is called the “barbie surgery”. A zero depth vaginoplasty with no vulva created, so you’re left with just a smooth lower half and a urethra, which can be a choice for non-binary or asexual patients
Vulvaplasty — another name for zero depth or minimal depth, where the main goal is to create an aesthetic vulva and a functional clitoris without a vaginal canal. This is typically the terminology for zero depth or minimal depth that will be used on the actual surgeon’s website
Orchiectomy — Often just called “orchi” this is removal of the testicles. This is generally a much simpler surgery than the other ones on this list, an outpatient surgery with roughly two weeks of couch rest as the recovery window. It is often excluded from the notion of “transfeminine bottom surgery” but often comes up, in particular around issues of whether the scrotum or tunica vaginalis is removed along with the testicles, which affects decisions about vaginoplasty.
materials — a LOT of the ink spilled on transfeminine bottom surgery is about the exact material used to make the vaginal canal. The ones that I commonly know of at this time of writing are:
penile inversion (PIV) — the material from the penis and scrotum is used to make the inside of the vagina. This is the oldest technique for trans women, and is generally considered to be the lowest risk type of vaginoplasty. Donwsides is that it requires that every piece of skin that is going to be, in the future, interior to the body needs to be hairless, which usually means 30-60 hours of electrolysis (I anecdotally know women who have gone as high as 100 hours)
peritoneal pull-through (PPT) — this is the traditional way of doing canal reconstruction in cis women. It uses a piece of the abdominal tract and robotic laproscopic surgery techniques to create the vaginal canal. Advantages cited are that it will create a vagina better able to self-lubricate and perhaps more robust against being lost, disadvantages are that the additional abdominal surgery component makes recovery worse. Also, this is a newer technique, and has less research
tunica vaginalis — this is a tissue that coats the testicles in amab people, and can be used to give additional depth, though i do not know of anyone who solely uses the tunica. it is sometimes, but not always, removed during an orchiectomy, so if you’re considering vaginoplasty after an orchi, please do talk about this with your orchi surgeon. The tunica is said to provide a stronger tissue than the penis, and some lubrication benefits
colovagina — parts of the large intestine are used to construct the vaginal canal. There are some lubrication benefits here, but most of my research indicates that the colon is considered to be one of the physically least robust materials to use, and that this is generally considered to be a revision technique to reconstruct lost PPT or PIV canals
jejunal graft — this is a much, much newer technique that only has limited availability. If you go for this technique, you mostly likely will have to travel and recover in another city. This uses the jejunum, a part of the small intestine, to create the vaginal canal. proponents of this technique cite dramatically reduced dilation times and much better lubrication and naturalness to the other techniques, but this is also a much rarer technique that I see a fraction of actual discussion and results cited than the other ones
Other skin grafts/hybrid — sometimes, a surgeon might not find enough matter to make a vagina after harvesting from the above places, and so may offer either something like a hybrid piv/ppt, or supplement the penile matter with a skin graft from the hip, or even exotic choices like tilapia skin.
Phallus-preserving vaginoplasty (Salmacian bottom surgery) — this is basically the use of PPT and the creation of a vulva using scrotal tissue where the patient can be left with a functional phallus/penis, and also a functional vaginal canal. This used to be quite rare, but is being offered by more and more bottom surgeons
Dilation — post-operatively, the process by which the vaginal shape is established and held. Typically, this means inserting a steel core covered with silicone into the vagina and holding it at depth for a specified time. The exact dilation schedule is surgeon-dependent, but all dilation schedules definitely get to be less frequent over time and taper down to something like “once a week” in the maintenance phase.
I’m going to take this space to help with a little bit of processing that I did at this year’s (2025) Critical Northwest regarding my trans identity. It’s a resolution of a fine point of pain and anger that is commonly faced by middle aged transitioners, and while I see this pain point commonly talked about, I have not commonly seen this resolution of the whole thing, so I’m opting to put it down on paper and throw it out to the world, so that maybe it can help someone out there.
So, if you read a lot of stuff written by trans women, like I have, and see a lot of comments online, over and over, you will read something along the lines of “I’m so angry that I lost so much time, I wasted so much of my life, and I’m only now starting to live”. There is a lot of anger at the self for not recognizing that hormones needed to happen, a lot of anger at society for the Ray Blanchard* regime of trans care, fear about being able to go against that edifice, so on and so on.
Ultimately, in other middle aged transitioners, I’ve seen just this profound sense of loss in the self for having had to live so long like that.
The thing I’ve realized, though, as I’ve gone deeper and deeper into the hormone me, and looked back over my life with clarity, and really remembering is: I’ve always been transitioning, in ways that I never even really knew:
I was voice training when I was belting out Indigo Girls songs on road trips and trying to match Amy Ray’s voice. I was learning to socialize as female when I was hiding from the other boys and trying to fit in with the girls in high school and college. I was learning fashion and dress and what looked good on me and what did not when I was doing the whole “cross-dressing enby” routine. I even had the whole lesbian comphet “dating men and finding it deeply unsatisfying” experience when I went through my stint as a denial twink. There are so many little experiences and efforts and evolutions that make up a life, and it’s wrong to microfocus on “the little blue pill”, as powerful and life-transforming as hormonal transition is (seriously, blocking youth access to transition care will kill kids, fuck you if you want to restrict access, this is not the point I’m making)
So, I guess what I’m saying, is, when I look back at my life, I’ve always been here, even when the boy suit was on full display. I was always doing what I could to break out. And I think it’s fair to give yourself that same grace. Those years might not have been optimized, but they weren’t wasted either.
And what it meant was that, when I was finally in a place where I could access hormones and transition care more generally, I felt free to just play the notes. There have been roadblocks and complications, and there has certainly been danger, but there has been a lot of wisdom gained on the slow path, too. The best time to start transitioning may have been ten years ago, but today is fine too. Be kind to yourselves.
*Ray Blanchard is a sexologist who was very influential in pre-WPATH transition care. He had a now-discredited theory of transsexuality that 1. ignored transmasculinity almost completely, and 2. seperated trans women into two groups, the ” real trans women” who knew their gender identity from a very young age, wanted to present in a hyperfeminine way, and were attracted exclusively to men. Blanchard saw these trans women as an extreme version of gay men, and as objects of pity. If they answered his surveys correctly and they committed to “blending into” society, him and his acolytes would deign to give these women access to transition care.
Everyone else, in the Blanchard typology, was an “autogyenphile”: a fetishist obsessed with making their body into a female one for gratification reasons. They had to be prevented from transitioning at all costs. This attitude was, of course, intensely damaging to both groups, because all of the treatment pretty much prevented the forming of any trans community, or any way to publicly talk about the trans experience. When people talk about “why are we suddenly talking about and seeing all of these trans people?” it’s precisely because the Blanchard system collapsed around 2010-2015, at which point you didn’t risk your hormones by publicly being a trans activist. If you’d like to read more about this gross history, I suggest reading either Susan Stryker’s Transgender History or Julia Serano’s Whipping Girl, both of which are landmark works in their own right.
Today, I will dress myself, head down to Seattle and gather with all of the other trans people out at Trans Pride Seattle. I am a bubbly person. I smile, I bounce, I scream in joy. I will generally match the energy that is given to me, even as I sort of advance to my “kindly queer aunt” phase of my life. So with that in mind, seeing me out, dressed up in my pride colors, it would be easy to just kind of conclude that that’s me and that is what Pride is for me. And while I know that countless, COUNTLESS other people have said the same sort of thing, let me reiterate that, in the last five years, much less the last twenty, I have experienced, personally, directly as a result of my trans status:
Family estrangement (1x a week contact minimum reduced to very nearly zero, in the course of five text messages)
A cross-country move induced by a rising wave of bigoted state-level lawmaking, resulting in a radical change to support structures and everything
Bearing direct witness to transphobic police violence
Being fired from a job (debatably, this was sexism, but hey, same thing), followed by a visibly changed salary range
A constantly shifting medical landscape for care (that I have navigated more successfully than most, but still, low grade attention always required)
Hostile stares, yelling, catcalling (this has diminished over time)
This sense of waking up every morning to check to see what thing is on the news, and in particular, seeing what new government legal document that will feature words like “deceit” and “mutilation” to describe things that are just banal features of my life, paired with the most absurd propoganda about trans people one could imagine, assembled by people who haven’t even talked to one of us.
And the above list is probably in the 5% most mild that I can share from my friend group over the same time period. I don’t want to indicate anything other than the truth that I am surviving and I am thriving, but I also do not want to hide what has been going on with all of this. It is a lot, and it is constant.
So, with that in mind, when I put those colors on and I dangle my legs out in fishnets and I wear the crop top and I dance amongst my siblings, I might look like a middle aged trans woman chasing a woo party time, or a poster child for some sort of hyperactivity sensory condition, but what I really am doing is channeling every thing that has happened to me, every story that I have ever heard from a friend over a signal chat, every story of systemic abuse that I have read about. I am taking every little threat from the national media, every indignity that I see, and I bring it to that gathering, and I say to myself
“We are here, we are together, and we are surviving and thriving. I take this with a smile on my face because I am persevering and I am continuing with my transition anyway. You find me disgusting? You find me to be cringe? Well, I am here, and I will not go away, and I will not stop liking who I am. And today, I will dance for all of the people who were killed, either by violence or until the social pressures became too much, and I will dance so that there will never be an equivalent to the 10 year old version of me that had no adults like me to see out there thriving. We cannot be erased, and we cannot be eliminated, and even if you did it, the very next day, there would be some “boy” somewhere that doesn’t understand why wearing that dress on Halloween feels so good. Because we are part of you and we have always been here. It is just a question of whether we thrive or die. And so, I choose to wear both the pain and the joy. And I hope that’s what people see — “I’m here, I’m happy, and fuck you if you want me gone. Hate me harder, in fact.”
So, I had a few hours to myself, and having a few hours to myself, I decided to take the time to consume media that I would otherwise have no chance at all to watch with my partners away. This generally means anime with voices my partners find annoying (this includes my cat’s favorite anime, Dungeon Meshi), or it means meandering, depressing art house think pieces. I took the time for the latter, and opted to watch Monica (2022), starring Trace Lysette. I’m going to just post a spoilery review of this two year old movie, but suffice it to say that I had mixed feelings about the whole thing if you decide to not read farther, and in particular, have trouble recommending it either for trans or cis audiences, even if I got something out of it. Of course, some of this may be characterized by 2024 having been probably the best year ever for trans film, with two feature movies, The People’s Joker, and I Saw the TV Glow both written and directed by trans women, and both just dead-on communicating our experience in deep (and very different from each other) ways. It’s hard to be happy with anything else after seeing that.
So, plot synopsis: We run into Monica driving from California to an unspecified area in the suburban midwest. She is distraught about an ex that she is on a break with, and keeps on calling him and leaving angry messages. She is also calling ahead to what we soon find out is her childhood home, where her brother and sister-in-law are taking care of her dying estranged mother. The mother is introduced to Monica as a hired caretaker, and the three of them, with the help of an assisted living nurse take care of the mother, Eugenia, as ups and downs of memory issues, medical care, and refusal of treatment flare up. Monica has a heart-to-heart with her brother, revealing that it was her mother that dumped her off on the streets, and learning that her brother always missed her. Monica engages with her brother’s children, one of whom the movie strongly implies is a future trans woman “him”self, in, amongst other places, a truly strange scene where the “boy” play-gives birth to a doll. Later, her mother has a turn for the worse, and there’s a heartfelt scene where it looks like Monica forgives her mother without really telling her mother who she is, only saying “there are so many things I’d like to tell you.” It concludes with Monica giving the “nephew” a pep talk before a school recital, and seeing her bonded and together with her birth family as they watch the star spangled banner get played.
Long time readers of this space probably will note that this author has some… feelings about trans women and family estrangement, and that she might have an interaction with the above story line, but let’s go.
So, let’s get on with a little bit of transfeminist theory. In Whipping Girl, Julia Serano talks about two media archetypes for trans women — the “pathetic” trope, which is communicated as extremely non-passing, hyper-emasculated, and generally helpless and harmless. This type of trans woman is an object of pity, and her presence is intended as a source of comedy or as a way for the primary characters of the movie at hand to show their openmindedness and graciousness. Think, The World According to Garp, TransParent, etc. The other main trope is the “predatory” trope. These trans women are depicted as *extremely* passing, often sensual, hyper-sexualized. They exist in the film to trick the cis male protagonist into fucking them, and thereby, they ruin him. This is most famously deployed in The Crying Game, and it’s parody in Ace Ventura, Pet Detective.
Monica does not directly follow either of these tropes, largely because Lysette is definitely a breath of fresh air versus the typically cis people that are playing trans women in movies, her presence is a breath of fresh air. Similarly, we are spared the typical shots of makeup being applied, wigs being put on, and of the mechanics of transition. Also, thank fuck, we are saved a shock “wow a penis!” shot (I’m still upset about the version of this from Ace Ventura). Monica is well past having to learn how to perform femininity, and we aren’t tortured with that.
But, these tropes are sitting in the background of the art direction and the directors’ (Andrea Pallaoro) eye with nearly every scene, it’s just that he doesn’t know which trope this movie is written in. So, before we are even explicitly told Monica is trans, we see her in a shabby motel self-administering a subQ injection into her thigh like some sort of sad sack. Later on, when she has some downtime in the house, there’s a nearly completely gratiuitous scene where she’s camming and requesting some tips while reaching slightly off camera, only to be interrupted by her mother in crisis, in a way that the audience is *definitely* supposed to judge her for. Then, she’s going on hookup dates at bars, getting stood up, leaving screaming messages to men (rightly) calling them out for quizzing her about her body and then standing her up (again, i think we’re supposed to be judging her negatively for this, from the subtext of the shot), and then her opting to just find a trucker parked at the bar to hook up with in a semi-graphic sex scene. She’s continually calling her boyfriend and screaming at him, for the first half of the movie, we really do want to just see this unhinged hypersexualized person barely holding her life together…
Until her family fixes her. Caring for her mother, opening up to her brother, caring for her nieces and nephews gives Monica the home she always wanted. All of her problems with decades of estrangement and isolation and at least one stint of childhood homelessness? Well, they can just be FIXED with a month of family togetherness time. Old Monica and just open up to her brother, and engage with some kids, and encourage her brother to make up with his wife, and she’s a part of the fabric again, and she’s back to being fixed. Just another auntie.
So, I’m angrier at this movie upon writing this than I was on watching, in addition to there not being a real depiction of actual dialogue with the mother to earn this reconciliation, I’m finding myself pretty intensely upset with the idea of including trans women in the already toxic sexist trope of “well, domesticity is all you need to be fixed.” Ultimately, this story feels very much like the classic “fallen woman saved by the beauty of the home” with a trans spin on it. Watch at your peril. Again, though Trace Lysette is great, there are moments that feel quite real, but I can’t deal with the things that she’s asked to do, and the overall arc is too frustrating to ignore.
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