What are the general steps of prepping a patient for surgery?

"We do the initial intake, we get the list of medicines they're on, we find out their medical history, their surgical history, and we delve in if there's certain things that don’t sound right. With a young healthy person, it can go as fast as 20 minutes and it’s easy to do over the phone. A person with a complicated medical history, they have to come in and see us. They may have tests that are ordered that we need to do.

"And we have this entire surgical infection deterrent. We have a whole protocol in place where they do washes the night before and the morning of and we give them antimicrobial mouthwash to swish around. We just don’t want that bacteria in the OR. We want to decrease any risk of surgical site infection. So we go over that with them. There's a lot of education that goes on even before they enter the hospital, so that they're prepared."

Tell me about the steps specific to sex-reassignment surgery.

"When the patients come in to see us, they have been totally evaluated emotionally, psychologically, physically, where they go through intense evaluation to make sure that this is what they really want. They’ve seen their surgeon multiple times. They are given hormone therapy to start the gender reassignment even before they have surgery — estrogen or testosterone.

"And they are actually some of the happiest people we deal with. They come in pretty upbeat because they're finally getting something they’ve wanted, for a lot of these people, their whole life, because they’ve had gender dysphoria from as far back as they can remember... They [knew] something [was] not right as far back as they can remember."