Today begins the journaling of my SRS experience with Dr. Gary Alter in Los Angeles. My journaling of this event is in part to provide the community with more information than is currently available about Dr. Alter and his work. Dr. Alter is a relative newcomer on the SRS scene, and consequently there are not many examples of his work to be seen, and no published testimonials, at least that Iíve been able to find.
Dr. Alter is a plastic surgeon who works in Beverly Hills, California, and who, in addition to general plastic surgery, specializes in genital reconstructive surgery -- not just in transsexual women but in natal women as well. His work in this area has been documented in two womenís magazines, Cosmopolitan and Marie Clare. Taken from his own website is the following statement: "Gary Alter, M.D. is one of the rare doctors (only two in the United States), who is certified by both the American Board of Plastic Surgery and the American Board of Urology. He specializes in genital reconstruction and facial and body surgery for transgender patients."
I had occasion to first meet Dr. Alter at a seminar hosted by the Los Angeles Gender Center in December of 1998. I had only just come out and wasnít yet presenting enfemme and was very shy about asking questions. However, there were about 35-40 people at the seminar so virtually every question I had, as well as some I hadnít thought of, were well covered that day. His answers were always clear and concise and given in terms anyone could understand.
One of the things that impressed me so much that day, and still does, is Dr. Alterís devotion to attention to detail. He explained, as he does at his site, that his "goals in SRS surgery are to create as normal a vagina and introitus as possible, provide maximal clitoral and vaginal sensation, furnish a deep vagina allowing satisfactory sexual intercourse, and minimize disfiguring scars." Indeed, he explained that his SRS surgery is an all day affair, requiring 8 to 9 hours to complete. He explained that his intent is to sever as few nerve connections as possible. In addition, one of his patients, obviously very excited about her results, got up to speak her praise of the doctors work. Her story was most compelling. In fact, I have corresponded with her I recent months, to ask if she still feels the same way -- she does.
Dr. Alter is not inexpensive; in fact, I believe he is probably the most expensive SRS surgeon out there, but in my opinion he is worth the money. The surgeonís fees are a little over $10,000, and the hospital and anesthesiologistís fees add another $12,500. I believe this is the single most important surgery Iíll ever have (Dr. O is a close second), and I want it done well. The issue of price, although obviously important, is secondary to me.
For myself, the important deciding factors in choosing Dr. Alter are:
a. Vast experience in genital surgery, including vaginal surgery in natal womenDr. Alter performs his procedures at Century City Hospital in Century City, a short distance from his office in Beverly Hills. So far, my experience there has only been a single visit to self donate a unit of blood, which I will repeat again this coming Monday. That experience was very frustrating in the beginning, dealing with the administrative people, but once up on the nursing floor, I was very pleasantly surprised by the courteous, professional and compassionate manner with which I was treated. This coming Monday, I have my pre-op appointment with Dr. Alter, which I am anxiously awaiting.
b. Experience in urology as well as plastic surgery
c. Extreme attention to detail
d. Proximity to my home (about 20 miles)
e. Proximity to Rodeo Drive (about 2 blocks)
f. All around nice guy
My appointment time last week turned out to be incorrect, so I saw Dr. Alter for my pre-op appointment today instead. I was quite nervous and had a lot of questions, which seemed more difficult for me to ask in person. I was very happy to have my friend Magi there to help see me through.
Dr. Alter answered all of my questions at great length and with due respect to my state of mind, and to my satisfaction. His assistant, Xena, gave me a sheet of pre-operative instructions to follow. I left his office this day with little fear of June 13th, other than the normal pre-op jitters anyone might feel before going under general anesthesia. But I also left his office with a new and wonderful excitement about my entire future.
The last few days were quite hectic for me, the way it would be for anyone
about to take a seven day
vacation. I had my two children with me up until the second night before
surgery, and we were all
excited that day by a large brushfire that came to within a half mile of our
home. So there were enough
distractions to do an adequate job of keeping my mind off the impending surgery.
Today I am very much at ease. In stark contrast to my extreme fear prior to
my visit to Dr. Osterhout last
March, I am wonderfully calm today. Tonight, the producers and the film crew
that will document the
surgery tomorrow are coming to my home to interview me. Iím not sure how I feel
about all of this, but
they seem like decent people, and The Learning Channel seems like a good place
for this story.
Although we talked about the surgery for most of the 3 hours of on-camera
interview, it strangely
distracted me from being nervous about it.
My friend Magi and I arrived at Century City Hospital at about 5:15 am, and
my spirits were definitely
way up. I was asked to step into the admitting office to make the hospital
payment, where I was met by
yet another unpleasant administrative person. We had a disagreement and I
reminded her that I was a
customer of the hospital, paying for elective surgery out of my own pocket and
could make the choice to
leave then and there which she would then have the duty of explaining to her
superiors. She quickly saw
the situation differently and all was finished there. I was taken up to the 4th
floor, where I was prepped
for surgery and had final discussions with Dr. Alter and the anesthesiologist.
There were a few questions
from the film crew and the next thing I knew, Dr. Alter was telling me that it
was all done! He told me
that the 7-1/2 hour procedure went perfectly and that everything looked fine. He
said I was doing great
and that heíd be back to see me the next day. I am sure that I had a myriad of
questions for him but I was
too out of it to ask him anything. I remember little from that night, actually,
other than that there were
some calls (not sure who). Magi was with me until quite late, and I didnít seem
to be in much pain. I did
feel a need to use the PCA morphine pump a few times that night.
I awoke early on Wednesday, feeling quite wonderful. Rested and cheery, full
of life and energy.
Incredibly happy in fact! There was minimal pain, and I chose not to self-
administer any morphine
during day. Of course, there was still a minimal amount of morphine being
administered throughout the
day by the machine. Still I was amazed at the low level of discomfort. Breakfast
was at about 8:00 am,
which was actually quite good for hospital food, and then a nice little sponge
bath refreshed me. Dr.
Alter came by to see me just after 10 am to check out his handiwork. It seemed
the first matter of order
for him was to check the sensitivity of my new clitoris. Yikes! It was indeed
sensitive. He talked to me a
bit about the procedure and asked if I had any questions but I was still way too
excited about it all to
think of anything at that time, so he said that although heíd be in to see me
every day, it was now just a
matter of lying in this bed for 6 days and healing. I do want to mention that
the staff at this hospital are
incredible. They are professional, attentive and very concerned for their
More of the same today; the care and attention by Dr. Alter and the staff
here are wonderful, but one can
only count the windows in the building across the street just so many times
before going batty! The
point is, nothing new happens: you just continue lying here, healing, and
watching Donny and Marie.
Since I live in the area, at least I have plenty of visitors, which is a great
distraction from boredom.
Going home today! Canít wait!
My sisters, Gale and Debbie, arrived from Seattle today to help care for me.
Walking is tough, but there
is still very little pain. Gale took a peek at my new vagina today, and despite
its swollen condition, she
says it looks very real.
Tonight I was given the most wonderful party by my sister Gale and my best
friend Jackie. There were
35 people there to wish me a sort of "Bon Voyage" as the next part of my journey
is beginning. There
was dinner, a full bar and a wonderful DJ. The most amazing part is that I am up
and dancing until 1 am,
less than two weeks post surgery. Maybe I did take on too much, but it is still
a testament to my
Oh my God! Just 5 weeks after surgery I have just, unmistakably, experienced
orgasm! And it was good,
very, very GOOD! If only I had someone to share it with. I was so certain that
this would never happen
again. I am thanking Dr. Alter for his great surgical care and attention again
Back now from a 3-1/2 week, 4300 mile road trip up the US West Coast, where I
spent a great deal of
time with my family in Seattle, I have more questions than ever. In spite of all
of the angst that I am
dealing with right now, at least I have the comfort of knowing that my
transition was indeed the right
path for me. I am quite happy with the results of my surgery, it looks right and
works right and I am very
happy with the work that Dr. Alter performed on me. I continue to experiment
with my newfound
orgasmic response. I noticed also that there is a clear sticky fluid being
excreted from my urethra during
these delightful experiments.
Today was disaster day. The dull throbbing pain that Iíve felt in my lower left leg the last few days greatly intensified this morning. I am usually very active physically, although I havenít been to the gym for a workout since my surgery, under the good doctorís orders of course. We had planned to take the kids out boating tomorrow, so I went to the storage place to get the boat. In the past the task was never a difficult one but today was much different. The pain in my leg was much stronger when I finished that when I had started.
We stopped on the way home for a smoothie and I found I could hardly walk. I looked down at my leg to see that my left calf was swollen to twice its normal size. I was quite frightened, and called my doctor from my mobile phone on the way home. But today being Saturday, no one was in the office. However, his associate, Dr. Barnett, was on call. It is interesting to note that I thought to call my regular doctor, rather than Dr. Alter, even though at the time I thought this must be due to my surgery on June 13th. I am sure now that I was in a panic mode at the time.
Dr. Barnett called me soon after I got home and I described to her what was happening. She didnít hesitate at all in advising me to get into the emergency room at Cedars-Sinai straight away. Her thought was that I had developed a blood clot in my leg.
My friend Magi drove me down to Cedars and I saw a triage nurse in the emergency room within 10 minutes. A couple of hours later, I was on a gurney somewhere upstairs having a Doppler ultrasound being done on both legs. A short while later I was admitted as a patient at about 8:30 diagnosed with DVT (deep venous thrombosis) -- blood clotting. On the Doppler monitor, the tech had shown me the extent of the clotting: one started from just above my knee and extended to my ankle and several smaller ones were found just at the top of my leg, in my groin area.
Of the three residents that I saw, none of them failed to explain the extreme danger of my condition. There was the possibility that a piece of any of those clots could break off and find its way to my lungs, where, depending on its size, it might do serious damage, possibly even death. Needless to say, my emotional state at this point was very severe. Fear and panic set in, and I start to ask the inevitable question, "Why? "
Before I decided to follow this path, I was healthy, hardly ever being in a hospital at all. "How did I get here? " I asked. Nearly 2 years on hormones, two major elective operations in the last 6 months, a year and a half of visits to Dallas having large amounts of lidocaine and epinephrine shot into me until my heart beat so fast it scared me. Am I here now as a result of all of that? Magi tried her best to calm me, but I wasnít going to put my extreme emotions to rest.
The doctors began an IV with a drug called heparin, which is a blood thinner.
This would insure that the
clot would not advance and might perhaps even dissipate somewhat.
Dr. Barnett came by today to verify what I already knew, and to explain what
might be done over the
next few days. She said that the heparin therapy would be used for 7-10 days in
the hospital, and would
result in a passageway being made through the clot to allow for nearly normal
blood flow. That would
be followed by a procedure in which a filter, a small umbrella shaped basket,
would be inserted in my
main vein to catch any particles of the remaining clot that might happen to
dislodge in the future. Then I
would be put on an oral drug, Coumadin, that would be required for up to 24
months. This news was
good, in that it would save my leg, and would save my life; but I feared that I
would not be able to live
the normal active life of which I have grown so fond. I am still scared, very,
Today my own doctor, Dr. Richard Horowitz, came to evaluate my condition and relieve Dr. Barnett. He had already seen the results of the Doppler ultrasound and had spoken with the resident vascular expert, Dr. Richard Van Allen. Dr. Van Allen suggested that for me, another way to go would be a lysing procedure using the drug TPA, also a blood thinner. The successful result of this procedure would be that after just 24 hours of administering TPA, the DVT would be completely eradicated and would negate the need for any further procedure, including the filter placement. Of course, oral drug therapy using Coumadin would also be necessary, but perhaps only for 90 days.
This procedure is also dependent on the age of the DVT, which had not been accurately determined by the Doppler ultrasound. If older that 2 weeks, this procedure would be too risky, in which case we would have to revert to the heparin therapy and subsequent filter placement.
Sounds great; but, of course, this unique procedure is not without its own
unique danger, that being a
very high risk of hemorrhaging, from spot bleeding up to cerebral hemorrhaging
during the time that the
TPA would be administered. It was noted that probably I was at a lower risk for
this because of my age
and health and lack of a personal or family history of DVT. So, it was decided
today that tomorrow we
This morning, quite early, I was whisked to the awesomely ominous vascular
area for an angiogram.
After I awoke from what seemed like a 1960s experience, Dr. Van Allen showed me
the result he had
found on the monitor. It was a much clearer picture of the full extent of my
condition than could be seen
by the ultrasound. The clot was a monster, but luckily it was a relatively young
one, meaning that it was
most likely NOT caused by my surgery two months ago. I now knew myself what the
was; I just didnít want to admit it to myself. Dr. Van Allen began the TPA, and
I was sent to recovery
and then to ICU.
Just about 24 hours later, I am once again in the hands of the very handsome Dr. Van Allen and his delightful crew and those big, scary, ominous machines. Because I still had in my leg the catheter they put in my yesterday, they didnít put me as far under today, which was OK because I didnít really like the 60s anyway. So I was mostly awake for the seemingly short angiogram procedure. I was most certainly awake enough to see that there was no color in the vein depicted on the monitor. I already knew what that meantÖ the clot was gone! Not just dissipated, it had vanished! Would anyone doubt that I cried just then?
Back up to ICU to wait for a room on a lower floor, a room that is for
patients who are on their way to
recovery, and on their way home. I am OK and in a few days, I am going home!
I have been home now since Friday afternoon. There is pain in my leg when it is not elevated, mostly when I walk; but as Dr. Horowitz explained, this is just due to the fact that my vein was has been irritated, and now when the blood flows through the damaged area it hurts. But that will go away.
I want everyone who reads this to know what caused this to happen to me.
I did. Plain and simple, I did.
NOT because I decided on this path in life, but because I didnít follow one of the basic ruleÖ Let those that know make the recommendations -- listen to your doctors!
After my surgery on June 13th, I think I got sort of "cocky," a strange term for someone like me to use, but itís true. I had to discontinue hormone use for 30 days prior to my surgery and suddenly, after surgery, I was not particularly happy with what I had lost in terms of breast mass. Both Dr. Alter and Dr. Horowitz told me it would come back, but I was impatient.
So when Dr. Alter sent me home from my surgery and said that I could start my previous hormone therapy again, I guess that I decided to give the process a jump start and I cheated on my doses, ever so slightly mind you, but I took more than what I had been taking prior to surgery. I wanted my boobs back! The result was a swift, uninsured, kick in my pretty little ass -- a lesson, if you will, in what so many of us take for granted: our health.
When I first started on this journey, I self-medicated for 6 months. It seemed OK because, it seemed that so many people were doing it. And while it worked for me then, my arrogance made me think I was invincible, so I did it again.
I guess what I am saying is that if this can happen to me, a relatively young
and very healthy person,
who only slightly increased an already-prescribed dose, then it could
theoretically happen to anyone.
Please, I hope that anyone who considers taking hormones does so under a
physicianís care. I could
have died. I was lucky.
I am lying here with an aching leg and a huge acrylic rod in my groin, wondering if I have really gotten across my sentiment about Dr. Alters work. I think it represents the current state of the art in SRS surgery. My sexual sensitivity is fantastic, and the intensity of my orgasms is overwhelming. I also want to make clear that I don't feel that Dr. Alter was to blame in any way for my DVT. That responsibility lies solely with me.
With great love and respect for all of those who are on this path,
© 2000 by Anne A. Lawrence, M.D., Ph.D. All rights reserved.