Meltzer, whose career goal had been to perform a wide variety of surgeries, accepted the challenge of learning.

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Meltzer pushed himself to improve the procedure, becoming the first in the U. to create a clitoris with sensation by rearranging nerves in the tip of the penis — offering patients real sexual function instead of what had essentially been an amputation.

It’s 80 percent plastic surgery, Meltzer says, and 20 percent complicated urology.

Administrators told Meltzer they were unable to recruit physicians because of the stigma attached to his work. but I wasn’t going to let my patients down.” The fact that Meltzer was driven out of one of America’s most liberal states seems hard to imagine now that he’s spent more than 13 years quietly practicing in Scottsdale without incident.

He wasn’t welcome there – nor was he welcome anywhere, he learned as he toured the state requesting hospital privileges. Meltzer considered shifting his focus back to the traditional plastic surgery he’d trained for years to perform. It’s even harder to imagine now that TIME magazine has trumpeted “the transgender tipping point” on its cover. Now that Meltzer, 58, has worked with more than 3,000 patients, inspiring demand for his services so great that he’s expanding his practice to include another surgeon.

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Genitals not only need to be reshaped, but they need to function – and surgery requires dangerous proximity to the bladder, urethra and rectum.

“It’s a challenge on almost everyone you do, and I’ve done over 3,000 of them,” he says.

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