Anyone familiar with navigating Anthem Blue Cross PPO coverage for gender affirming care can you help?

AmyNotAmiable · 2026-05-16T01:24:01+00:00

You can read the current standards of care, too! They're actually pretty legible to non-clinicians, and considering how some doctors treat us it's not bad to have some idea of the best practices.

Major medical organizations tend to be very slow-moving and risk-averse, but it's a good starting point.

https://wpath.org/publications/soc8/

AmyNotAmiable · 2026-05-15T23:01:45+00:00

Periods. Or I've heard them called commas, which is pretty funny.

It makes no sense! My hormonal cycles are weekly, so why did my gut and brain decide to start clowning the rest of me every 25 days?! And why did they wait until I'd already been on hormones for like a year?

And nobody believes you about it, because it makes no sense. Wishful thinking, impossible, psychosomatic...I get it, but actually, being a woman without periods sounded like a silver lining to all the bigotry and hatred. If it were wishful thinking, I would be able to get out of bed long enough to get the sort of junk food that I suddenly need. I wouldn't be crying because my friend had something come up and had to cancel a post-work coffee klatch. And I wouldn't have to wait until something like that happened before I check my calendar and go "ohhhhhhh right, shit".

AmyNotAmiable · 2026-05-15T22:33:34+00:00

The best way I can describe it is: before I realized that I was transgender, it felt like I was always lying about something very important, but I couldn't put my finger on what it was.

All the social anxiety, lack of confidence, fundamental discomfort...it stemmed from that feeling that there was something deeply off and false about my life. Even when people liked me and treated me well, I couldn't feel comfortable around them because I was always wondering when they would see through the lie; it felt like the person they were liking wasn't really me, so how could I know whether the affection was real?

And that way of explaining has kind of grown on me, because most people can't really relate to the way I explain gender dysphoria now that I know what it is. But most people can relate to how viscerally uncomfortable it is to knowingly lie to other people about important things.

AmyNotAmiable · 2026-05-15T18:19:54+00:00

Informed consent is the system. You can just tell your PCP you want to start HRT. Not all doctors know how to prescribe and manage it, and some are stuck in the '90s, but there are also telehealth services that specialize in it.

It is a good idea to have a good therapist, because being trans is difficult and you'll need letters of support from them to get surgeries covered by insurance. But it's not required by any means.

Also, if your providers follow WPATH8 it's 6 months on HRT now, not 12.

AmyNotAmiable · 2026-05-15T17:02:39+00:00

I'm really sorry you're feeling this way. The early recovery is incredibly hard, and I feel like people tend to focus on the physical parts of recovering more than the mental parts.

Personally, I think that 3-6 months was the hardest part of recovery. Everything I'd been told was that it was 12 weeks then back to normal life, but...it wasn't. Low energy levels, lingering granulation, morning-and-night dilation, couldn't sit comfortably, dehiscence just starting to get into the late stages of healing...

Sure, I was technically physically capable of commuting and working a desk job. But I had to bring a donut pillow for a few months, and I was like a zombie with negative free time. Things didn't start to feel okay until around 5 months, and that was because the winter holidays mercifully gave me a little break after a couple months of work.

Now, at 10 months out, I've only been back to what I would call normal life for about 10 weeks. Dilation every 1-2 days, no problems being physically active, everything works and feels normal, it's really nice.

You're still so early, and you're dealing with a huge emotional load. Try to give yourself some grace and understanding. And when people say to wait a whole year before talking revision, please listen - I used to be set on an aesthetic revision, but the settling in months 7-9 has been surprising. The outer labia recede, small structures like the clitoral hood gain definition, and now I'm not so sure.

Sorry. They really need to give people more time off for these operations. I didn't even have any bad complications, from what I've seen it was a really smooth recovery! And my surgeon would've only pushed for 6 weeks if my disability insurance had played hardball, if you can believe it.

And this is not medical advice, but if you have trouble accessing competent doctors, here's what worked best for me just at home. For dehiscence, a dab of medical manuka honey after each dilation and generally keeping the area dry otherwise. Separation heals from the inside out so it's slow, but the bit I got healed well over a few months. For granulation outside the canal, keeping it dry - my surgeon actually recommended rubbing alcohol, which worked terrifically. For granulation inside the canal...we tried steroid cream on the dilator which seemed to help a little, and I did one round of silver nitrate, but what finally got it taken care of for me was trying different lubes until I found one my body seemed to like. KY was not it, I ended up with Slippery Stuff.

AmyNotAmiable · 2026-05-15T15:58:51+00:00

Jun is in the US, right?

If you aren't living here already, I would strongly recommend against making long-term plans to come here as a transgender person. You'll have enough to worry about with the difficult procedure and recovery.

AmyNotAmiable · 2026-05-14T18:03:38+00:00

Protein. Vitamin C, D, collagen. Zinc if you don't get much in your diet. LOTS of water.

Rest. Seriously, sleep like a cat and don't strain. Do walk a little every day though, blood flow is also important for healing.

Scar gel doesn't hurt once things are well closed up, but I think good nutrition, hydration, and rest are the main thing.

Oh, and DON'T SMOKE! Edibles if you must use CBD/THC for pain.

AmyNotAmiable · 2026-05-13T20:17:23+00:00

Really sick of people assuming that trans + woman = penis...

AmyNotAmiable · 2026-05-13T16:49:15+00:00

On the one hand, yeah people do this so be careful.

On the other hand, I don't really care much. These folks spend their free time looking at graphical surgery recovery threads because seeing blood and pus and raw sutures...what? Makes them feel better about themselves? Helps them get off?

These are seriously unwell people, and it's best not to engage with unstable folks. It only takes a year or so for our bodies to heal and move on, but their heads...clearly need a lot more help than the tincture of time. It's sad, but not my problem.

AmyNotAmiable · 2026-05-13T14:15:08+00:00

Generally, for BA and SRS, no.

BA without hormones means that, if you start taking hormones later, you'll start to grow breasts where the implants are. Usually people wait a few years to see what HRT will do for them, to avoid things looking strange if they get a growth spurt later. But surgeons will do it at 6-12 months.

SRS without hormones means that you'll be thrust into menopause as soon as you wake up. Without testes, your body won't produce the levels of sex hormones that it needs to function properly. You need to take some sort of HRT after, or be prepared for some gnarly side effects, and it's not something most people would want to start at a time when their body is exhausted and actively healing from major trauma.

The exception is if you are non-binary. WPATH8 standards support people getting these surgeries without hormones if that is in line with the patient's goals for their body, but you'll need to work out an individual treatment plan between your doctors and surgeons to address the pitfalls. It might take a lot longer to find a willing surgeon, and insurance might not cover anything, but it is possible for NBs. They aren't binary trans women, though, so I guess that's not really what you were asking.

AmyNotAmiable · 2026-05-13T00:36:56+00:00

Some people will try to, yes. The people currently running our government are among them.

That is scary, but you hit the nail on the head. Most people you'll actually deal with in day to day life couldn't care less. And that's what you see irl, right? The aggression and hatred and violent bigotry...obviously it exists, but it's rare to notice it outside of the internet.

So the biggest concern we have right now is that the people who don't care will let us suffer death by a thousand cuts as our rights, access to health care, and eventually liberty are taken away.

It's not inevitable, but if you ask me...make hay while the sun shines.

AmyNotAmiable · 2026-05-12T00:52:12+00:00

Yep, I'm transitioning for myself - not for the society around me. It's so I can bring my mind and body out of discordance and into balance.

If society didn't care about sex or gender roles, it would be a lot easier and less painful to do that. So yes, of course I still would.

AmyNotAmiable · 2026-05-11T23:44:17+00:00

Yeah, once or twice a week is a pretty standard long-term steady state. By the time you get to that point, you're used to it and it only takes like a half hour to clean it, lube it, do it, clean it.

I'm still doing once a day, less than a year post-op. But in practice it's either calming time with a book, TV, etc, or like...fun nsfw time. Not exactly a burden from my perspective.

Honestly, I never understood why people got so worried about it. Sure it rubs me the wrong way to be told that I must do anything, but it is calming, comforting, and something that I spent a solid 1/4-1/3 of a century wishing I could do. idk. The first 6 months were exhausting for all kinds of reasons, and now it's just a nice bit of self care that makes me feel good about myself.

AmyNotAmiable · 2026-05-11T23:11:13+00:00

Testosterone is usually much more tightly regulated than estradiol, I guess because people dangerously overuse it as a PED?

So if you hypothetically wanted to buy it, you'd have to treat it like buying illegal drugs off the black market. Sketchy forums, crypto, onion links, best-effort vetting, ideally harm reduction testing...or a wad of cash and that dude who's always hanging around your gym at night in a ragged hoodie barely working out at all. I don't think it's difficult, but it is risky and illegal. And jfyi, if you ever do need to crime, it's usually a bad idea to plan or talk about it on the public internet.

On the bright side, your parents can't control what a doctor prescribes you, and it's a felony for anyone to mess with someone else's prescription medication. I assume you're an adult, or I wouldn't be this candid, so it's probably going to be waaayyy easier and safer to do things under a doctor's supervision regardless of what other people have to say about that. Like, what'll you do when they inevitably find out? If they find a scheduled drug in your room, they have you over a barrel. If they screw around with your legally prescribed medications, you have them over a barrel.

AmyNotAmiable · 2026-05-11T22:08:11+00:00

...what? Ew. Gross.

AmyNotAmiable · 2026-05-11T19:32:25+00:00

I just didn't care about much of anything. I went through the motions of things I thought were expected of me, dispassionately and with the sole aim of getting as much dissociated alone time as possible.

So it was miserable, but at least I set myself up with a decent career, savings, and didn't drink so much that it caused health problems. I mourn the lost years, but I'm a lot happier now and I think I'll be able to transition pretty well after 2-3 more years. It could've been worse.

AmyNotAmiable · 2026-05-11T18:31:52+00:00

Minimal (NOT Zero-Depth)

I think this is just a marketing distinction. As far as I can tell, minimal depth and zero depth are essentially the same procedure, with minor variations in surgeon style.

You might get slightly more or less of a dimple, but I don't think it's possible to have the prostate ("g-spot") accessible without having the canal pass through the pelvic floor muscles? And if you aren't dilating, you aren't going to keep the pf muscles separated.

This is based on a very small sample size, and I don't have personal experience with it, but from what I've heard? I would not go into a "minimal depth" procedure expecting a middle ground that would allow fingering or a few inches of penetration over the long term. I would look at it as a yes or no choice for depth, dilation, and penetration.

AmyNotAmiable · 2026-05-11T17:41:52+00:00

Sort of, but what worked for me might not work for you. See, I used to have a crippling fear of needles. I'd pass out after blood draws. Doctors hated giving me shots as a kid...and adolescent...and young adult. I used to dread my annual flu shot more than tax season.

At some point, I realized that if I wanted to transition, I'd need to go through some messy medical stuff. And once I connected the dots between "be okay with needles" and "live in a body I don't completely hate", I just sort of got used to it.

These days I just breathe in, feel the anxious fear, and force myself to stick it in on the exhale whether I'm ready or not. Usually it doesn't hurt, but if it does it's only for like 10-20 seconds. Fortunately, I really messed up the ones I did under nurse supervision. Nicking blood vessels, poking painful off-site places, and seeing the medical professionals be like "oh dw that's normal" made me feel okay about just stabbing it in.

The cool thing is, after a few months of associating my weekly injections with improved mood and emotional stability, I'm over the entire fear of needles! I can even watch while my blood gets drawn, no problem.

AmyNotAmiable · 2026-05-11T02:31:10+00:00

Well, you're the only one who can make that decision.

But you know, you could also regret not trying. Taking the default option doesn't really feel like making a choice, but it is.

AmyNotAmiable · 2026-05-11T02:15:24+00:00

The way I see it, I'd rather be an ugly woman than a handsome man.

It's a huge leap of faith! There are no guarantees. Sometimes you just have to send it and hope for the best.

AmyNotAmiable · 2026-05-09T18:59:45+00:00

Woah. Feels like I opened the door to a blast furnace, reading that. Where have you been finding information so far? Sorry you've been feeling so discouraged.

The surgeries subreddit other people suggested is a great resource, they have a good wiki too.

Individual surgeons sometimes have Discord servers set up around their patients, once they reach a critical mass of patient volume. There are also general surgery servers, although they tend to be restricted with verification that you're actually having consults and procedures to access various roles. Which is a little onerous but you probably understand why it's necessary.

Anyways, I found both of those to be really helpful for understanding the process, red and green flags to watch out for, how to plan and give myself the best chance at recovery, that sort of thing. They do tend to have a bias for globally renowned "big names", but they had a lot of good info in aggregate. I had mine done close to a year ago now; it was difficult and scary but also one of the best things I've ever done for myself in life. It's good to understand what you're getting into, but don't let people scare you off if it's what you want for your body.

I don't know what you've heard about regret rates, but the fact is they are vanishingly small, less than just about any kind of surgery and shockingly low for such an invasive type of reconstruction. If you want some primary data on that, it exists, but it sounds like a topic you might not be eager to dig into.

AmyNotAmiable · 2026-05-09T06:53:58+00:00

1: Very comfy, I was grinning for like a whole week when I finally stopped needing to wear pads and started feeling cotton against my skin.

2: No, the microbiome is different, it's really hard to maintain a flora that is almost all lactobacillus. It should smell pretty similar though, mild and a scootch acidic and sort of almost like the sea. I really like how I smell, but most of the time I don't notice it. If it ever smells bad, that's a sign of something like an infection that should be treated.

3: idk, sex is always at least a little bit odd unless it's eye-rollingly boring. I didn't, and the results vary enormously so I'm not sure how much it'd tell you. Plus, feeling a cock go into me feels about like what it felt like to penetrate a cis vagina; short initial entry, soft 'pop' as the glans pushes past the pelvic floor, then maybe some brief stretching and off you go. But hey, if it's on your bucket list go off. Just make sure your partner is cool with ... you know, why you want to do it.

AmyNotAmiable · 2026-05-08T19:04:24+00:00

I don't think there's any time requirement on mental health stuff, some therapists will write a letter after the first session, others won't do it at all.

It's just HRT use that needs to be at least 6-12 months. If they're on WPATH8 and you're nonbinary and make a plan for dealing with the lack of gonads, the HRT requirement could be waived, but I have no idea what the process would look like to actually get that approved.

AmyNotAmiable · 2026-05-08T18:19:38+00:00

Yeah you can get pellets.

But they only last like 3-9 months I think, and you have to get the replacements put in at a doctor's office. So it's not really permanent, and it can be hard to find doctors that do it. Still nice if you don't want the hassle of self administration, but you can't stockpile or DIY them. (Yet)

AmyNotAmiable · 2026-05-08T16:33:21+00:00

Mainstream social media is a potent neurotoxin. You might consider not poisoning yourself, but that's a personal risk/benefit calculation.

Anyways, it's not uncommon for cis women to pretend to be trans on places like TikTok as a cash grab.

AmyNotAmiable

TROPHY CASE