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“It’s a challenge on almost everyone you do, and I’ve done over 3,000 of them,” he says. Toby Meltzer was capable of performing the most complex of plastic and microsurgery procedures: on hands, on nerves and blood vessels, on faces damaged by cancer or car accidents. Meltzer had already moved his growing practice away from one hospital in Portland, which at times had denied his patients a bed the day they arrived for surgery. And because of that fact, he couldn’t find a place to operate in the entire state of Oregon.“I have no idea what I’m doing,” he remembers thinking.“I’m going to stick to the things I know.” Meltzer knew nothing about transgender health in 1990, when he began working for Oregon Health & Science University in Portland.