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I need everyone's help to expand the surgical options and lower the costs for the transsexual community!! Here's what you can do ...
I urge anyone reading this page, TS or not, to write letter to local plastic/orthapedic surgeons informing them 1. of the high need and high profit of FFS and 2. that new surgical developments are needed for hand, foot, arm and shoulder osteotomies (bone reductions), and larnyx feminization (ie implants to thin the voice box shape). Countless TSes simply cannot pass, no matter how they desire, because of their hand/foot sizes, (foot being related to arm size), and shoulders. And we all know what problems the voice can create. We can transplant hearts, clone sheep and pigs, make a deaf person hear and a blind man see, but we can't feminize a voice?! They can LENGTHEN a midgets legs a good 5 inches, but they cant shorten a lousy shoulder?? Something's terribly wrong here - we're not being addressed and its up to us to make ourselves heard. We are a very small community, so its only natural that we are rarely considered for new techniques. Indeed, many TS surgeries were discovered by accident or while working on something unrelated, IE cartilage reduction voice surgery, and SRS. They're just not thinking about us. So start writing! (/calling/going to doctors' consultations)
  Points to Include 1. There is no more universal application of medicine than the human desire to feel beautiful. This is why plastic surgery has grown as much as it has in the past 50 years, and why it is the highest paying field of medicine. Well theres no greater feeling of ugliness than any sort of trait of the wrong gender. Thus the needs of the TS community run deeper than most seeking PS. The disgust with a large nose or love handles cannot possibly compare to the feeling of self hatred arising from a transsexual woman's large, boxy stature. Not only that, but a TS' body can ruin her life. Many TSes choose not to transition as their hands/feet are way too big, or voices are way too masculine. For those who transition in spite of such traits, the harrassment and alienation are unbearable. For these reasons, it is only logical that any TS surgeries the doctor chooses to undertake would be in very high demand, giving the doctor the ability to charge a lot, (See below for why this won't be a problem for us in the long run), and help people GREATLY while making a LOT of money in the process. With doctor Ousterhout charging almost $ 30 000 for FFS and SRS in the same range, the profit margin is obviously quite high. You should convey the point that transsexual surgeries are without a doubt among THE MOST profitable.
2. Let him know up front that you KNOW these procedures don't exist right now (except FFS), and that he doesn't do them currently. This way he cannot say "I don't do such a procedure" as a terse response to your letter. Explain that the procedures are not especially challenging.
3. Be specific about incision locations and bone names, so that it looks like you know what you're talking about. Like you've thought it all out for him.
4. Let him know that you have plenty of TS friends who would be interested in the same procedure, if he does a good job! Give a specific number, again, to make it seem real.
5. If you pass well except for the area you need surgery on, send him a photo of yourself. Or try to get him on the phone if your voice passes well. Present yourself as a normal woman with one problem area that need surgery (hands, shoulders whatever). Don't mention you're TS at all, if you can pass, and if you can't, leave it til the very end. If you seem like a real woman, he will be more likely to want to help you. The damsel in distress always gets help. Passable or not, make sure you present yourself as a normal woman who lives full-time and just has this little problem that is holding her back from an otherwise very normal, productive woman's life. A normal woman is much more approachable than a man living as a woman. So get him to see you as one. In fact, if you can, maybe get a genetic woman to make the initial contact with the doctor. She can go in for a consultation even, and see him in person. If she has large hands or feet or shoulders, she can make up a story about the surgery being for her. She can mention her friend "____" (insert your name) and that you are interested in the exact same procedure. Then when the doctor agrees that the procedure is possible and that he himself CAN do the procedure, she can say she will get back to him, and you can step in and schedule the surgery, armed now with the fact that your friend Pam (or whoever) said he agreed he could and would do it.
6. Be positive in your approach. A cheerful attitude rallies people around you. If you seem depressed or despondent about passing, unconfident, or very very needy of this surgery in order to go on with your life, the doctor will dismiss you as someone who has "issues" that are too big for him to help at all. But again, present yourself as a happy, carefree woman with no weight on her shoulders, and the situation will become much lighter for him, and he might jump right on the bandwagon.
7. Please use the word transsexual, not transgendered. The latter sounds WEIRD, like some alien species. Whats more, transsexual is a term people are more familiar with. And using the term transgendered makes it seem like we're a group that takes offense easy (thus we changed our title), alluding that we're not comfortable with ourselves. Avoid these things.

  Also Drive home the point that research undeniably points to transsexualism as being a birth condition. Feminine men, gay AND TS, have been shown in countless autopsies to have brains identical to those of females, not males. It has long been known that fetal brains, like genitalia, start out as female, but undergo a testosterone interaction which changes their routing and make them into male brains. Is it so unlikely that this step doesn't happen 100% of the time? No. Why might it not happen? Well in rats, scientists have shown that stressing the mother rat anywhere from 18 - 21 days into the pregnancy will invariably cause the baby, if male, to be born with female behavior and sexuality. Could the same thing be the cause in humans? Almost definitely. Let them know that we're not basket cases, but biological errors, as the doctor might have his own prejudice toward TSes based on ignorance. I will have urls to sites discussing the specifics of the studies at a later date.

In the long run, as doctors begin seeing how profitable TS surgeries are, doctors will flood the market causing the supply to increase, and the price to fall. So informing them of the high demand might drive up the price at first, but will ultimately bring it way down.
But TS surgery has to be a visible market first, which it isn't right now. EVERY single doctor you get to offer their services helps a little. Thats why your individual action in this matter is greatly needed. (This is not like the 2000 election - your vote DOES COUNT!) Especially considering how few plastic/orthopedic surgeons there are in this country. Each doctor you write to counts a lot.
  For the TS who REALLY wants to help Become a doctor yourself - what better TS surgeon than a TS herself? You KNOW what we need because chances are you need it yourself! Make it your goal to develop the needed procedures. For those without $ 150 000, do it the illegal way - buy a few text books at your local universitys medical book store, obtain the needed supplies, and go into practice. Be a nurse or doctor's assistant in a surgeon's staff for a while if you want to get a feel of what its like first, or watch a few surgical instruction tapes. To practice without a license all you need is a consent form signed by the patient, saying that he/she is aware and doesn't care. Sure a lot of TSes would rather have a doctor from an accredited med school, but A LOT are WAY too poor to afford transition surgeries at licensed doctors fees. Other types of medicine have kitchen doctors - we need one too. BADLY. Anyone whos good with your hands and wants to help us out, PLEASE DO.
In the old days, when America was great and the do-it-yourself philosophy abounded, communities had their OWN doctors. Unlicensed, untrained, and DAMN GOOD! The TS community is very much like those communities - close-knit, isolated and on the frontier. We need to do the same thing.
I know TSes that have bought electrology machines together and done each other's faces. Then they sold the machines, so they basically paid $ 0 for full electrology treatment. Time to take things like this a step further and do very simple surgeries by ourselves, such as orchectemy (teste removal) , jaw osteotomy (not chin, because that risks nerve damage. the incision can be made behind the ear), elbow/knee thinning, alar base reductions, scalp advancement, arm/shoulder reduction.