Near the end of March, Jessi Wangen returned to her Mayo Clinic finance job after a long-awaited surgery.
Six weeks earlier, Wangen, 28, had undergone one of Mayo Clinic’s gender confirmation surgeries.
Wangen moved to Rochester from Wisconsin in 2016. She reached out to the Transgender and Intersex Specialty Care Clinic (TISCC) to continue her hormone replacement therapy (HRT).
“It was a really easy transition — that’s a pun, I guess,” she said.
Near the end of 2016, she heard from doctors that the clinic planned to begin offering gender-confirmation surgery — also called bottom surgery. For trans women, that involves vaginoplasty, the construction of a vagina, and/or an orchiectomy, the surgical removal of one or both testicles.
“They hadn’t done anything yet, but it was on the horizon,” she said.
In 2017, Mayo Clinic became one of about 20 institutes to offer vaginoplasty for transgender women. TISCC’s first bottom surgery was in February 2017.
Since then, interest in and growth of the service has been explosive.
The clinic has completed about 40 gender-confirmation surgeries since early 2017, according to Oscar Manrique, a plastic surgeon who works in TISCC. He thinks they’ll do 120 in 2018. And the wait list is about one year long.
Wangen got on that list early. Wangen’s insurance needed to approve her surgery, and she had to request letters of approval from the psychologist and endocrinologist at Mayo to be eligible for surgery.
TISCC aligns with the standards of care developed by the World Professional Association for Transgender Health (WPATH), which requires two letters of approval from mental health professionals, a letter from the patient’s hormone provider and at least one year of real-life experience — that is, living as the gender with which patient identifies.
“They want you to kind of practice a little bit,” Wangen said.
Fast forward to February 2018. Wangen originally planned to undergo the procedure this summer but was moved up after a cancellation.
She estimates that the full cost for her bottom surgery would have been $79,000. But because Wangen has “top-tier” medical insurance through Mayo, her out-of-pocket costs were closer to $2,500.
Although it’s possible to get the surgery cheaper elsewhere, she said, the training and care in Rochester justified the cost.
She was in the hospital for six days to recover. Seven is considered the norm.
“A lot of surgeons across the country, they’re keeping people a couple days and then sending them home,” she said. “Mayo benefits from having really good hospitals. I feel like if I had been discharged earlier, it wouldn’t have been fun.”