Additions to VA Care

[Janeshannon]

I was at my local VA hospital this morning, and I met my VA LGBTQ VCC. She let me know the VA is now offering orchietomies. They need a letter from the mental health provider, legal name change, and one year on HRT. To get this procedure approved they basically said that MTF HRT can create a high risk of blood clots, and that since an Orchiectomy will reduce required dosages they should be performing them as part of MTF transition. Interestingly, she said the Seattle VA has been doing this for about 15 years, but they kept it quiet. 

She also said the VA is offering electrolysis and laser hair removal, but to prep for GCS. 

 

[KymmieL]

My GYN said the same thing. It is line with the MtF transition.

 

Kymmie

[ShawnaLeigh]

7 hours ago, Janeshannon said:

She also said the VA is offering electrolysis and laser hair removal, but to prep for GCS. 

OMG I was getting so excited when I started to read this last sentence.  But then saw it was for GCS surgery prep.  Darn it, I was hoping the VA would cover facial electrolysis.

Its the one thing that is my MOST dysphoric issue is my facial hair and its the one things I need done that is not covered under insurance for me.  (sigh)

[MiraM]

The hair removal from the VA is not only for GCS prep, at least not at the VA hospital I go to.  I am having laser hair removal done on my face by the dermatology department at the VA hospital.  As far as orchiectomy goes, the way I read the Trans care guidelines say that it can be done if traditional HRT methods are ineffective, or in the case where it would cause serious complications with another medical condition.

 

c. In cases when anti-androgens and/or doses of estrogens cannot be tolerated by the patient, are ineffective, or if the Veteran would be at increased risk for adverse effects, such as cardiovascular or other thrombotic events, and when an appropriate medical provider has determined that there are no other standard medical options for hormone management, surgical orchiectomy is an acceptable treatment recommendation. In these select Veterans, orchiectomy can be considered medically necessary as part of their hormone management, and not gender confirming/affirming surgery. Decisions about the appropriate use of orchiectomy should be made on a case-by-case basis as determined by the treatment team, and should include a medical provider who has expertise in the management of hormone therapy. NOTE: Transgender E-consultations and/or ethics consultations are available for case-specific consultation.

 

 

[TommieAnne]

Orchidectomy as a VA option  would be great. I will check on that with my therapist, as we move along to HRT.

[Bree76]

Just had my 1st appointment at the Los Angeles Trans clinic (run through Women's Health by docs who are doing it voluntarily on their own time turns out) and yeah laser treatment has always been turned down here and the head gal is still trying to find loopholes to get it covered but not yet successful.

[Janeshannon]

Does anyone know how much it would cost to have a VA orchi?

[TommieAnne]

8 hours ago, Janeshannon said:

Does anyone know how much it would cost to have a VA orchi?

It would all depend upon your VA classification. Those categories determine not only costs to you but also treatment priority (barring bleeding out in the ER of course).

TA

[ShawnaLeigh]

On 2/11/2020 at 8:26 AM, MiraM said:

The hair removal from the VA is not only for GCS prep, at least not at the VA hospital I go to.  I am having laser hair removal done on my face by the dermatology department at the VA hospital. 

I am not a great candidate for laser treatments as my facial hair is mostly grey at this point   Laser only really works on dark hairs follicle.  Si I have been told.  I need electrolysis to do any good and I would rather go that route as electrolysis is a permanent treatment were as laser can grow back in over time.  

If I'm going to let someone torture my face with pain it better be permanent.  LOL

[Wichita]

On 2/12/2020 at 9:28 AM, ShawnaLeigh said:

I am not a great candidate for laser treatments as my facial hair is mostly grey at this point   Laser only really works on dark hairs follicle.  Si I have been told.  I need electrolysis to do any good and I would rather go that route as electrolysis is a permanent treatment were as laser can grow back in over time.  

If I'm going to let someone torture my face with pain it better be permanent.  LOL

 

Ditto! I had two rounds of laser 15 years ago before I chickened out of my process. After even those two rounds, though, not only did the dormant folicles activate, but shaving those was even harder. I just couldn't seem to get everything short of taking off a layer of skin.

[Kjiersten]

Jane, Yes the VA Does perform early pre-GCS orchiectomies but, from my reading of the manual, this would be available in the case of two or three HRT chemical fails. Contact your Endocrinologist or PCP for more detailed intel. I will try to find the manual for citation. Hope all goes well for you.   Kjiersten,   <Kj>

[Vini]

Thank you MiraM, Janeshannon and everyone for the great information.  I am waiting for my first appointment with Seattle VA Endo so its good to know there is hope for me at my age and history.  I already had a vasectomy so I would'nt miss the little guys since they would shrink anyhow, from what I have heard : ) I wish the best for all of you, Vini

[Kjiersten]

G'Day all! A bit of "Catchup," if you will.

I can't remember if I had said any of this about my Abreaction to Spiro, but I was in VAMCWX (VA West Roxbury, MA) for 3 days w/ VIOLENT Gastric Issues, w/ my K through the roof and Mag more than a little depressed (Hadda have IV Tx for that.) Anyway ... later on, I went on Leuprolide where my Glucose shot up to over 650!!!! My next A1C was 9. something! I terminated the med STRAIGHTAWAY after the third shot.  <<Told the shot nurse I valued my DMT2 control over my Transition, so ... (OBTW, My last, best A1c is 7.9. Right 'in book' for me, but still working on it <Kj>)

 

NOW this update from my most recent post, wherein I had talked to my Endo, He DID, as I had said, advise me that the Orchidectomy was/is available on 3 medical fails, IAW VADIR 1341(2) and invited me to consider it. I did so and asked him to cut me a consult to Urol shop. The Consult came back in Three DAYS (Now, in VAese, 3-5 generally means weeks) but I got mine back in 3 days. I made the appt. for a week post and talked to the screening MD for almost an hour. She said I looked good and guessed I'd do well when she presented my case to the board of Urol. Attendings.  She called me back later and told me I had passed.

 

FastFwd. I just finished with my PATC (PreAdmissionTestingClinic) yesterday and the date set for my orchidectomy is 04 March!  Great Date, as it were, right!?! {S Forward MARCH! March FORTH! {S May the Fourth be with you!!

 

When everything "comes out OK"  😉 on 4th, I'll be doing a Captain Queeg, playing with his two steel ball bearings ...

 

STAY WELL Girls! SAtay Sweet and don't let daBugzGITCHA!!!   Kjiersten   <Kj>

 

[Kjiersten]

On 2/10/2020 at 10:43 PM, Janeshannon said:

I was at my local VA hospital this morning, and I met my VA LGBTQ VCC. She let me know the VA is now offering orchietomies. They need a letter from the mental health provider, legal name change, and one year on HRT. To get this procedure approved they basically said that MTF HRT can create a high risk of blood clots, and that since an Orchiectomy will reduce required dosages they should be performing them as part of MTF transition. Interestingly, she said the Seattle VA has been doing this for about 15 years, but they kept it quiet. 

She also said the VA is offering electrolysis and laser hair removal, but to prep for GCS. 

 

Jane, I not long ago got an orchiectomy within the VA. "Here's the KICKER! Under VA regulations, (VETERANS HARK UP!!!) (VADir1341(2), amended 06/26/2020; Appx:A, para. 11, p.A-3; quoted here.)"However, transgender Veterans cannot be denied access to surgical interventions that are medically indicated for other medical conditions simply because the procedure is also consistent with transition goals." This was interpreted by my Medical Provider to include the "Three Medical/Chemical Failures" described in the document. " (Bartlett, K, 2022/04/11) Me endo MD informed me, as a result of the "three medication failures rule" I DID qualify for the orchiectomy IAW, that reg.

I was referred to the Urology Dept. for evaluation. Once again "Mackerels Appear in the Strangest of Places." The consult WITH appointment came back in _5_ days!

NOW, cut to the chase. I was interviewed, presented and cleared for my Orchiectomy. My operation was the scrotal approach, as opposed to the inguinal/laporoscopic procedure, under general anesthesia.

PATC (PreAdmissionTestingClinic) workup uneventful; PreOp workup uneventful and Operation was completed in under an hour. My Post-Op course included Rx:Oxycodone, sig #5, @5mg. p.o., t.i.d. p.r.n. and then ibuprofen: sig: 600mg, p.o., q.i.d.. p.r.n for pain, NTX 2400mg/D. I was Not "drained" as one would have probably been in an inguinal/laparoscopic procedures, but instead, was managed by placement of #s of 4X4" pads, layered of the site to absorb any latent fluid discharge. I maintained those pads for about two days until there was no discharge. I DID have some edema in the genital zone and there was (as expected) some relatively large hematoma in the overall genital area. I did have sort of a pulling pain (L) superior to the mons pubis; but that resolved w/in about two/three days w/o need for medical intervention. The hematoma cleared within the week. I WAS VERY careful not to lift Anything; ergo, I bought my milk in HALF-gallons to keep it light, as it were. I had never encountered any of the "phantom pin" you describe; I didn't even have that "kick-in-the-balls" feeling so widely described by others. -crap-! I was glad to HAVE 'EM OFF!!!.

NOW, in aid of those who want/need to, I applied an antibiotic ointment to the incision area doing the following "DiamondK SLIKTRIK" to whit, I bought *ahead of time) some SMALL (your sized needs may vary) "POISE pads. When it came time, I'd open up a pad and {FOLD it BACK on ITSELF as 2/3s folded to the body and 1/3 away.) I'd then apply the ointment to the exposed pert of the pad; lifting the penis up so as to place the pad on the SCROTAL Sac over the incision. I did this t.i.d. after washing area clean w/ a wet-pad cleaner supplied by the hospital. Doing this, DO NOT BE ALARMED if you see a stitch come aloose. They are SELF-DISSolving and are desIGNED for that. If the pad falls out when you sit on the toilet, just chuck it out and re-pad up. My OP was of a Friday and I Stayed @ my Ex's for the weekend, and was up and out by Monday afternoon, when I came home. The rest of my post-op course was totally uneventful. You mentioned post-op depression over the loss of an organ, I did not have ANY of that depression WHATSOEVER!!!! As a matter of fact, regarding MY response, I had more of an ELATION of having the bloody things GONE! GONE! GONE!!

This was my experience. I hope you have as good an outcome as did I. If you have any Qx or comments, email me @ [email protected]. I'll be happy to help.

Be well. Stay sweet and "DonLetDaBugzGITCHA"   "KjierstenSedIt!"    <Kj>