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Moving Forward Despite the Next Battle

I was born in November and many of my life’s hallmark events happened during the October-November time frame.  It was in November 2012 that I put away my male clothing and started to present myself to the world as Lois 24-7-365.  So the delays in scheduling notwithstanding, there was something fitting to have my consult with Dr. Sherman Leis on November 30, 2016.

Map of Dr. Leis’s location

My mother told me that when she went to the hospital in labor with me, it was pouring rain.  And it was doing the same thing when I drove to and from Bala Cynwyd for my consult with Dr. Leis.  Making the trip that much more unpleasant, there were many trucks in the lanes of the New Jersey Turnpike that are reserved for cars.  The Simon & Garfunkel song talks about counting cars.  I had no desire to count trucks, especially all the ones splashing water on my windshield.

There are two ways to go from Rockland County to Bala Cynwyd: a lot of secondary roads but low tolls, or divided highways all the way with high tolls.  And no matter which way you choose, you will eventually deal with the Schuylkill Expressway (either with or without center city Philadelphia).  I love maps, but after exploring many possibilities, I reluctantly ended up with the high toll route.  Any other route would usually take much longer.  So off I went to the Garden State Parkway, New Jersey Turnpike and Pennsylvania Turnpike, before leaving the toll roads for I-476 (aka “The Blue Route”) to the Schuylkill (an aged highway disguised as Interstate 76).

Now I had planned on visiting some friends in eastern Pennsylvania on the way home.  I would spend some time with each one, including a night.  And then I got the notice: they would be repairing the elevator at this time.  I had no desire to lug a suitcase up three flights of stairs.  So I came straight home.

Carole Sherman

But the most important thing was the consult.  I had already met one of Dr. Leis’s staff members, Carole, via e-mail and phone.  So I already knew how helpful she was.  I would get to know Jenna over the coming months.  Competent people are usually confident and pleasant to deal with.  And Dr. Leis’s office staff runs a most efficient and effective office, not always easy when dealing with someone like me who will send wordy e-mails or be a chatterbox on the phone or in person.  Through it all, Carole and Jenna are confident and pleasant to deal with.

Furthermore, I believe a competent and pleasant staff reflects well on the person who hires them.  So between the recommendation of Dr. Leis I received from Dr. Carolyn Wolf-Gould and the favorable impression made by his staff, I already felt comfortable with the choice of surgeon before meeting Dr. Leis.

Dr. Sherman Leis

Meeting Dr. Leis face to face confirmed this favorable image.  I found him easy to talk with as he exuded a quiet, pleasant confidence in his abilities.  He answered my questions straight on with good eye contact.  I found out that his reputation for being a caring physician and man was what led to him entering the field of gender reassignment surgery: a trans man sought him out and persuaded him to consider this field at a time when it wasn’t easy to find surgeons willing and able to do this type of surgery.

Dr. Leis also explained that part of his philosophy was to avoid post-operative pain. This intrigued me because most of the trans women whose experiences I had read or heard about described significant post-operative pain, especially when they started to walk, sometime around day three.

What was very encouraging was that Dr. Leis described me as having an ideal profile for avoiding post-operative pain and complications from surgery.  I never smoked, I gave up drinking alcohol over thirty years earlier and was never more than an occasional social drinker, was not diabetic, had good blood pressure and a low BMI.

In other words as far as the last item, I was at a good weight and height ratio.  No one would ever describe me as being overweight.  I am making a special point of mentioning this because of the online reviews of Dr. Leis.  While most of them are positive, one or two cited him for telling them that they were overweight and needed to lose weight and they claimed they were not.  (One even claimed that he told a spouse, not a patient, that they needed to lose weight.)  These negative reviews were totally inconsistent with my experience with Dr. Leis and the type of person he is.

Related to post-operative pain was healing time.  He said that someone my age and in relatively good health would heal well from the surgery.  The healing may take a little longer than a younger person, but no reason why I wouldn’t heal.

An apartment like the one where I recuperated from surgery after release from the hospital

We discussed his options for recovery after the release from the hospital.  Normally, the GRS patient is able to go home two weeks after surgery.  Dr. Leis has a few rooms at his facility, some private and some semi-private.  He will also see patients after surgery at two nearby hotels.   Neither hotel was part of my rewards plan, so I indicated my preference to stay at his facility.  I later found out that this is his preference as well, as it makes it easier to check on his patients’ progress during recovery.

I found out that Dr. Leis accepted laser as a method of removing the hair in the surgical area, which was a relief as that is the method I had been using.  And I got information on the area which needed to be cleared of hair.

Finally, he answered a question that concerned me and Dr. Carolyn.  He told me that he didn’t see any significant problems because of my psoriasis.  That was also reassuring because I didn’t want to go on medications to treat psoriasis, all of which basically compromise the immune system, leading into major surgery.

With the consultation concluded, I went out to talk logistics with Carole.  The earliest I could have the surgery, based on Dr. Leis’s schedule and where I planned on staying, would be June.  But it was too early to schedule anything hard and fast yet.  I had other ducks to line up.  And I needed to know how long it would take to give me good clearance of the hair in the genital area.

All in all, I headed home through the pouring rain and late autumn early darkness feeling very relieved.  What I spent most of my life thinking would never happen was now one major step closer to reality.  But it would turn out that a lot of other major steps would be needed.  I was not finished with Wonderland by any stretch of the imagination.

The first step was to arrange and begin genital hair removal.  I had to approach that two ways.  One was to find out how to get approval for this step.  That took a few weeks to find out.  One of the advantages of my insurance carrier over the others I could have chosen was the assignment of an individual caseworker to me.  With the others, you dial in to customer service and take your chances.

Even so, my caseworker is generally swamped with work servicing her client load.  In addition, around this time she had some medical issues to deal with.  During that winter, she would be out for at least a month because of medical problems, leaving her case load (and my situation) to another caseworker who was doing her best to fill in.

The other step I had to take was to approach my laser tech for hair removal.  I needed a little time to think of how I was going to approach her.  Joy Vanderberg is excellent at her craft.  She is a trained electrologist, but switched to exclusive use of laser once high end lasers were developed which had both a greater degree of effectiveness and could also distinguish between the melanin in the skin and the melanin in the hair.  (It is melanin that the laser seeks to target its pulse.)  She acquired such a laser and donated her electrology equipment to a school.

http://www.derma-lase.com/

Joy Vanderberg and part of her equipment

Joy can tell you the characteristics of the different types of lasers.  She can also tell you just about everything you’d want to know about hair (e.g. the difference between facial hair and eyebrow hair).  She also had performed genital hair removal on other trans women.  So I felt very confident continuing to place myself in her hands.

But I also had a concern.  In the past she categorically stated that she did not take insurance to cover her fees.  So I felt the need to appeal to her sympathetic side somehow to make an exception in my case.

I need not have worried.  When she was telling me that she didn’t take insurance, it was because she hadn’t looked into it.  One reason was that until recently, insurance didn’t even cover it.  But when I approached her on the topic, she immediately got on board.  She did not want me going to a stranger, perhaps someone not familiar with a transgender client, especially for such an intimate area of the body.  We would go on a journey together so she could find out how she could be eligible for reimbursement.  Starting on the day after Christmas 2016, Joy and I took this section of the journey through Wonderland together.  There were times when it worked well and times when she swore she would never deal with insurance again.  (In fact at this point, she is unlikely to take insurance again: a pity and the blame to be laid totally at the feet of the insurance system.)  But she stuck by me to the very last session before my surgery and did her usual excellent job.

Genital hair removal is an important step in the process.  One does not want hair growing inside of the vagina.  And from a procedural point of view, I needed to begin this step ASAP because I needed her to give me a ballpark estimate of how long it would take to clear me of my genital hair.  There was no sense in scheduling a surgery date until she could give me a reasonable time estimate.  She couldn’t do that until I was in front of her and she could examine the area.  And she wouldn’t do that until the insurance was arranged and a fee was agreed upon.  And this proved easier said than done.

Joy jumped through all the hoops and then some to be an eligible provider who could be reimbursed for her services by insurance.  And then we ran into a troll at my insurance carrier.  That’s the most accurate and kindest term I can use to describe him.  I didn’t deal with him directly, but Joy did and she forwarded me their e-mail correspondence.  She also clued me in on their phone conversations.

Basically, he tried to low ball the amount of reimbursement he was offering her.  Now I believe in saving the taxpayers money when possible.  That fits in with my general philosophy of government.  So I asked Joy if this man was a misguided bean counter, trying to save money or something far worse.  Joy told me that based on phone conversations she had with him, he thought that people like me (i.e. transgender people) are disgusting.  And in the end, Joy did accept a rate of reimbursement lower than her usual fees, but not when dealing with the troll.

What he tried to do was justify a ridiculously low rate and claim it was based on what he could pay through use of Groupon (which would never cover all of the sessions needed to clear my genital hair).  When he was called on that, he claimed he surveyed list of hair removal providers in my area.

By now it was tax season and the conversations between Joy and the troll occurred on a day when I was out on a group of tax appointments.  When I got home, my phone and e-mail was lit up with frantic messages from Joy.  Her concern was for me.  She wouldn’t work for the rate he was offering, so she knew that either I would have to pay the difference or go to whatever stranger this guy found.

I got off the phone with Joy and I was downcast.  After how long I had waited to get this close to surgery and hair removal was going to blow it out of the water?  It took me twenty minutes to snap out of the funk.

Years earlier when I worked for a local housing authority, I did rent surveys and fuel cost surveys over the phone as part of my job.  By now, I was an experienced Internet researcher.  Verifying his claims that he had found providers who would go that low would be easy.  He had sent Joy his list of providers that he supposedly researched.  He had gotten it from Google Maps.  And every provider’s listing included their website.

Two hours later, I had the real information: a comprehensive list of what each provider offered and how much they charged (if they put their prices online; some did not).  No one stated that they provided services for transgender clients and none advertised genital hair removal for someone with male genitalia.  Based on the information that Joy gave me, I had to use either bikini or Brazilian prices for comparison purposes.  The lowest price I found was five times what the troll was offering Joy, and that price was a sale price that would expire before my sessions would be completed.  A more typical price was ten to fifteen times what he was offering.  And at least one provider charged fifty percent more per session for male clients compared to female clients for the same service (e.g. removing hair on one’s forearm).  Just because years of estrogen had softened my hair, don’t think that someone unfamiliar with me wouldn’t have charged me the male price level.

And then there were the places I immediately disqualified because they were using inferior lasers.  Often they were spas, not primarily hair removal providers.  Their hair removal might be limited to upper lip peach fuzz during a “day of beauty” spa treatment or temporary removal for beach season.

The troll had given Joy an ultimatum with his last communication: accept his offer or he would assign me to someone else.  He gave her one day.  So I put all this information together into report form and e-mailed my insurance caseworker with an urgent subject line, explaining to her what had happened and that we had little time to work with.  And then I waited.  Health Insurance Wonderland tends to be filled with waiting periods punctuated by messages of bad news.

After a couple of weeks of waiting and checking with Joy, I suddenly remembered: the troll had threatened to assign me to someone else in 24 hours.  That time period had come and gone two weeks ago.  So I contacted my caseworker, explaining where we were at this point in the process, asking what happened and also asking how I could file a complaint against the troll.

The caseworker apologized that no one had gotten back to Joy to negotiate a price.  But she told me that every supervisor in that area of the insurance carrier was familiar with my case by now.  Apparently I had made some waves and did an excellent job presenting my case.  As for the complaint, she told me I could go ahead with it if I wanted to and that she could not tell me the circumstances about how this happened, but that the troll was no longer working for their organization.  So I don’t know if he quit when he saw he couldn’t cause problems for trans people or was fired.  But there was little reason for the complaint.

Within 24 hours, someone new contacted Joy, apologizing profusely.  In the end, Joy did accept a rate of reimbursement lower than her usual fees, but one she could live with.  It was a win all around.  The government saved money, Joy had additional income and I had a hair removal provider I knew and trusted.  And she did a good job: the day before my surgery, my surgeon confirmed it.

Little did I know, I would have more battles ahead.  And their timing couldn’t have been much worse.

Watch ye therefore, and pray always, that ye may be accounted worthy to escape all these things that shall come to pass, and to stand before the Son of man. – Luke 21:36

God bless,

Lois

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