Working with the chief of Plastic and Reconstructive Surgery Division at OHSU, he began training in SRS surgical techniques. Meltzer researched and interviewed pediatric urologists with experience treating children born with ambiguous genitalia, and surgeons already performing vaginoplasty surgeries such as the late Stanley Biber. In 1993 he began performing vaginoplasty surgeries, which eventually became a large part of his practice. In 1996, he opened his own private practice in Portland, Oregon. In 2003, he relocated his practice to Scottsdale, Arizona, in 2003 becoming the first doctor in that state to specialize in gender reconstruction surgery.