It’s January, 2023. My son (FTM) sends me a text — just an aside in the middle of a conversation about movies or philosophy or something: “Also!! Top surgery on June 27.”
I open my calendar to start making plans. It’s something he’s been working on for more than a year. We tried going through my insurance, and while the insurance promised to cover the procedure, we were unable to find anyone willing to do the procedure under insurance. They all wanted no insurance, payment in full up front.
Most doctors were holding new patients to a six-month, one-year, or even two-year waitlist to even have an initial consultation. And then, it would cost approximately $16,000-$18,000. And, to be honest, the doctors he talked to in person were cold-shouldered, unfeeling and just chasing profit.
So, my son was researching medical tourism, which is traveling to another country to have surgery done cheaper and faster than what the United States could provide.
Some may not agree with us on this, but his mother and I put the burden of achieving this goal on our son. We had him in gender-affirming care, including hormone replacement, and were fully supportive of his pronouns and recognition of his gender. But we wanted this surgery to be something he owned, something he made happen for himself, not something we gifted him.
It is part of life’s journey that we struggle to accomplish the things most important to us, the experiences that define us. Gifts don’t do that; struggle does.
But that being said, we were not going to just abandon our son. We wanted to be supportive. So I helped with flights and told him I was willing to pay for my own accommodations to be there with him during his transformation.
I made sure that everything I did was my expense to be there with him, but he COULD have done this completely on his own. That was important.
So. I scheduled our flights, and then I began thinking:
I’m a native Texan, but in all my years, I’ve never been to Mexico. And as far as Texans go, my Spanish is terrible, good for little more than reading a restaurant menu. And I’ve been fed a media diet that looks down on Mexico as a third world country, rife with crime and danger and filthiness.
Let me just say that, as open-minded as I am and as much as I try to be non-prejudiced, our media in the U.S. is insidious and pervasive. I was worried about this trip because of everything I’d heard in our media.
Were we at risk of being kidnapped? Are the hospitals there terrible? Do the toilets work? Are we going to get sick if we inadvertently drink the water? Is my kid safe having surgery here?
But life is an adventure. So I booked our flights and he booked our AirBnB and the recovery house. And we prepared for our adventure.
His surgeon was located in Guadalajara, which has a strong medical tourism industry. It’s not as prevalent as in Mexico City or other cities in Mexico, but it is established. There are multiple surgeons and surgery centers and recovery houses available there.
It is a large city, with all of the modern aspects you would expect any large city to have. Uber and AirBnb are common and easy to use. We made extensive use of Google Translate and the translation functions of WhatsApp to communicate, and it made our lives much easier.
We arrived a day before my son was to have his initial consultation. He booked a cute little AirBnB for the first two nights, as it was much cheaper than the Recovery House. For these two nights, a one-bedroom AirBnb in a nice part of town was about $50 a night. It had an upstairs bedroom with an air conditioner, bathroom and shower, and a futon in a little living room and kitchen on the first floor. I’ve certainly stayed in worse places for more money.
The next morning, my son was scheduled for his blood draw and in-person consultation with the surgeon. I must say that one of the most striking differences in the health care practices in Mexico versus the United States is the simple practicality of Mexico’s process.
We arrived at the surgeon’s office for the blood draw and consultation. My son talked to the lady running the lab desk. She took his payment — $30 — and then sat him down right there and did the blood draw, giving him a receipt to take to the surgeon. Including the delays for translation of instructions and payment, we were there about 10 minutes.
Then we walked upstairs and told the desk he was there to see his surgeon. We waited about five minutes, and then were escorted back to meet with the surgeon in person.
Now, to be clear, this is a person that my son had been talking to over email and in messages for months, with electronic consultations. My son had sent him a wire transfer of $500 to secure the surgery date, and this day was the first time they had met in person.
The doctor was very supportive, spoke fluent English and answered all of our questions, multiple times. While my son was getting changed for the physical aspect of the consultation, the doctor addressed me, saying (paraphrased), “It is so nice when I see family come with my patients. It is love. It is love to support them.”
I’m sure there are some that will say this was just him keeping his paying clients happy, but I felt it was more than that. Yes, he is a plastic surgeon conducting cosmetic surgery. And mostly their center does breast enhancement. But this felt different. I genuinely feel that he wanted to help my son feel more confident and at home in his own body.
So my son consulted with the doctor. And, upon seeing my son in person, the surgeon changed his plan a bit before scheduling surgery for 8:30 a.m. the next day.
Our challenge then was to get from the AirBnb to the Recovery House, get set up and go straight from there to surgery. Fortunately the recovery house was very accommodating and were able to pick us up early in the morning with enough time to move our gear and get us to surgery — with time to spare.
A note on traffic: Traffic in Guadalajara is much like traffic in any larger city, except where, in the U.S., stop signs mean stop, in Guadalajara, stop signs are a mild suggestion. Stop lights are more serious — but not much more. It was common for our drivers to see a stop sign or a stop light and just check that the intersection was clear, and, if it was, just blow through it. So I do recommend using official taxis and Uber drivers to get around unless you are an adventurous driver.
I had heard about people trying scam tourists with bad or fake taxi services, but I think the Uber phenomenon has supplanted that. We used an official taxi service to get from the airport to the AirBnb, then we used Uber after that. We had no problems at all with any of these services.
On the day of surgery, we arrived at the surgery center. From what I could determine, we were the only patients there that morning, so we had the building and the staff to ourselves. The rooms were very plain and simple compared to surgery rooms in the U.S., and very practical: a bed, a seating area for supporting relatives, a bathroom and some basic medical equipment such as heart and blood pressure monitors. And that’s all.
Now I’m going to go into some differences in procedures and treatment.
In the U.S., top surgery — more officially, double mastectomy with chest sculpting — involves the patient being put fully under anesthesia — intubated and completely down. However, this anesthesiologist did not feel that was necessary, so her plan was to put my son in twilight with an epidural. The option was always there to take him fully under if necessary, but she didn’t feel it was needed.
This surgery required no cutting of muscles or bones; it’s just skin and fatty tissue work. This made my son a bit anxious but it worked out very well. Surgery took about four hours during which time I used the local Wi-Fi to work.
I took a picture, and I remember vividly that last moment, watching my son walk into the operating theater to his transformation, knowing that the person I would meet a few hours later would be fundamentally different.
It was a long wait. But finally they rolled him back from surgery, already awake and talking. He recovered quickly because of the lower anesthesia, and at about four in the afternoon, we called for our ride to take us back to the Recovery House.
During this time, we needed to make the final payments for the surgery, and here is how understanding and nice they are: My son had already paid half upon arrival, and the other half was due prior to surgery starting. However, their system glitched, and they were not able to process the payment before surgery started. But they went ahead with the surgery.
While he was in surgery, the system cleared, and I worked with them to complete payment. I can’t imagine that we would have had the same understanding in the U.S.
They were instructing me on the post-operative care my son would need in the recovery house — prescriptions, bandages, anti-septics, compression wraps, gauze, cotton — and the nurse, while my son was recovering post-surgery, literally walked with me down the street to a pharmacy, ordered the prescriptions and picked out all of the items we would need. I just paid drug store prices for all of it.
No stupid $300 for Tylenol markup, just go to the pharmacy and buy these things to use in recovery. Very practical. And you can get Tramadol over the counter for pain management.
After we left the surgery center and returned to the Recovery House, the same nurse that walked me to the pharmacy came there to help my son shower, clean and change his bandages and rewrap everything.
According to my son and his peers who have had top surgery in the U.S., this is very different. In the U.S., they have been told to stay in their bandages for a week, maybe two weeks before changing anything. Here, they wanted the bandages changed, the wounds inspected every day and pictures sent to the surgeon to monitor healing.
My son got to see the shape of his new chest the next morning, unlike his peers in the U.S. The nurse helped him shower, and even washed his hair, the very next morning after surgery. I can’t even express how good this was for my son’s morale.
If you aren’t aware, having this surgery often requires having drains present to siphon off bodily fluid that is generated by the surgery. This means plastic tubes coming out of the chest to drain into a container. In the U.S., doctors often just let the patient heal for a week with these drains in, no changing of bandages or other care. For my son’s doctor this was different. It still took a little more than a week before the drains were removed, but in that time my son was able to shower every day, view the progress of his healing every day and feel better every day.
There were some issues with pain. Even though this surgery did not involve cutting any muscle or bone, it did involve removal of breast tissue and lactation glands, liposuction and nipple replacement, with long cuts across the chest to sculpt the skin. My son is generally opposed to opioids, but on the second night, the pain was rough. Fortunately tramadol is available over-the-counter, as I noted, and I was able to walk to a nearby pharmacy and get some serious pain relief for him. This got him through the next couple of nights until the healing crested and the pain began to subside.
The Recovery House provided for everything he needed. All meals were covered and included protein, fresh fruits and vegetables and, usually, fruit or vegetable juice. They had direct access to his doctor’s office for any questions.
They did not provide items such as soap, shampoo or toothpaste or any of the materials needed for recovery. You provide those yourself. But they did clean the rooms and laundry every day, including our personal laundry.
There was a nice sitting area, Wi-Fi, a patio and comfortable places to just be and listen to the birds or enjoy the weather. The house was gated and protected by electric wire, and the gates were always closed. I never had a sense of being unsafe.
Because Guadalajara is not “zoned” the way many neighborhoods in the U.S. are, there were many options for food and supplies within easy walking distance. Less than five minutes’ walk in three directions there were convenience stores and pharmacies as well as cafes, restaurants and other shops. It was easy to simply walk out the gate down to the 7-11 or the pharmacy, pick up some gauze or tape or prescriptions and return.
Two weeks of watching your kid recover is a long time, so I read a lot of books on my computer and worked with my teams in the U.S. We watched Netflix at night until he was tired.
After about eight days, the doctor felt the fluid drainage had subsided enough to remove the drains. So we went into the office where he snipped the ends of the sutures holding the drains in and smoothly removed them. My son said it felt weird but was not painful.
It’s important to know that this surgery requires compression to make sure the skin reattaches to the underlying body fascia. So this whole time, my son was wearing a layer of gauze over the wounds, a layer of cotton over the gauze, and an elastic bandage wrapped multiple times around his torso to provide compression. With the drains in, this was uncomfortable for him. Once the drains were removed, a lot of that discomfort went away, and a day later he felt ready to go out and see something other than the inside of the recovery room.
Fortunately, there were a lot of options nearby. Just a 10-minute walk away was a nice shopping area with a casino, several restaurants and some shops. You only need to be 18 to gamble, so we spent a few hours on the slots until he got tired, and we walked back and had a nice dinner to celebrate.
It was not lost on me, by the way, that my son had his transformative surgery during Pride Month.
He continued to heal over the next week and, finally, on the day before we were to return the U.S. he saw his surgeon for a final check-up. All this time, the surgeon had been getting daily photos of my son’s healing process, and now it was time to snip the sutures. This was painful, but it also marked the final step.
This is where the full reality of transformation really hit home. My son was crying with happiness. And his surgeon showed so much compassion and care; he spent easily a half an hour with us, even as he had other patients to care for, to make sure that my son was okay.
As has always happened anytime I travel, I completely re-evaluated my expectations, threw away prejudices I was not aware I had (mostly due to U.S. media) and came to a greater understanding of our shared humanity. I was privileged to watch a person I love become more of who they want to be, and I was privileged to meet people who gladly helped him make this transformation. From the surgeon to the housekeepers, everyone was supportive, smiling and friendly.
I went to Mexico to support my son and found I was only one of many people willing to be his support.
Editor’s Note: This is Part II of Sean Hamilton’s story about his experience supporting his transgender son. Read Part 1, in which Hamilton discusses details of planning a medical tourism trip to Mexico for the surgery. All monetary sums are in U.S. dollars.
Dallas Voice courtesy of the National LGBTQ Media Association.