Transsexualism, like other intersex conditions, is something that just happens in some sexually reproducing animals. We humans now have a more-or-less effective way of dealing with that.
But the notion of "becoming a woman" or "becoming a man" can, in various ways, lure individuals who are largely comfortable and happy with their assigned genders into transitioning. This usually pans out to be a Bad Thing for all involved.
To help prevent misguided people from doing irreversible damage to their lives and bodies via ill-advised gender transitions, there are now a number of safeguards in place. By far, the most commonly used system for safer transition is the Harry Benjamin Standards of Care. The HBSoC protocol provides guidelines for therapists and gender specialists in helping patients cope.
So the network of caretakers in gender therapy have mostly mutually agreed on these guidelines. As such, surgeons and endocrinologists require written recommendation "letters" from therapists and psychologists before they will provide hormones or surgery.
The guideline for beginning hormones is a minimum of three months therapy or full-time living. My therapist also required dressing as my true gender in group, and a couple of outings in public as myself. (Which were quite interesting, hee!) One letter is required.
For surgery, two letters (or signatures) are generally required. One year of living full-time as yourself, a significant, documented amount of volunteering, employment, or schooling, and a legal name change will probably be expected by your therapist. At minimum. This is collectively known as the Real Life Test. [Your Humble Narrator will have completed this by the end of the year. She has already been living full-time for exactly one year.]
The HBSoC is not by any means a legal requirement, but to help prevent fiascoes and lawsuits, the vast majority of the trans caretaker network mutually enforces it. This is very much a Good Thing, because otherwise, there'd be a much larger number of very unhappy, litigious men with neo-vaginas about.
(Warning: Genital surgery is a subject that squicks many, and this entry gets a bit graphic. Some readers may wish to skip it.)
"The wound healed and I was left / With a one inch mound of flesh
Where my penis used to be / Where my vagina never was
It was a one inch mound of flesh / With a scar running down it like a sideways grimace on an eyeless face
It was just a little bulge / It was an angry inch" - Hedwig and the Angry Inch, "Angry Inch"
Heh. With that choice quote out of the way, let's talk about surgery!
I haven't personally had any transition-related MtF surgery beyond a short period of facial electrolysis yet. So my ability to write about it is limited compared to some. But I do have a basic understanding, have read a lot about it, and have talked one-on-one to people who have had it.
First, let's quell the infamous myth straight off. Sexual Reassignment Surgery (SRS) does not mean removal of the penis or what have you. In fact, to my knowledge, the only things removed are the testes and the erectile tissue. The testes are sometimes removed in a separate operation called an orchiectomy.
Rather than being removed, the penis and scrotum are restructured and retrofitted to (re)construct the vagina. Depending on the surgeon, a sensate, orgasmic clitoris can be formed. In another operation called Penile Inversion, it's basically turned inside out. This mode of SRS is becoming deprecated. Often, even a general practitioner cannot distinguish between a "natal vagina" and a neo-vagina via cursory inspection, particularly with the newer techniques.
Once the vagina is constructed, it must be dilated to the desired width and maximum depth. This is done by inserting dildo-like surgical stents of increasing size and applying pressure. In the weeks following surgery, the vagina must be dilated about five times a day for a half hour at a time, which will decrease to once a week over about half a year. At this point, dilation continues indefinitely with current techniques. If dilation isn't done often or long enough, the vagina will become very shallow and probably even heal shut.
According to one web source, average cost for MtF SRS was a little over $10k in 2001. This likely covered only the surgery itself. Figures I've heard in group therapy run more like $15k unless you get Facial Feminization Surgery. Lots of that can run it up close to $50k. We'll cover FFS in Part II.
Facial Feminization Surgery (FFS) is another mixed blessing/necessary evil in the world of MtF transition. It does what female hormones can't do, namely giving certain facial structures (such as the nose, forehead, and jaw) a markedly feminine appearance, reversing certain effects of testosterone exposure that female HRT can only prevent. Very early transition often precludes the need for any FFS.
Some therapists, mine included, often discourage even their older girls from getting FFS, not only because of the inherent risks of any invasive surgery, but because it's not always necessary or even advisable.
FFS is a drastic measure. For those with heavy brows, it can involve things like getting your browbone removed, sanded down, and replaced, a Forehead Bone Contouring. Or one's entire jawbone made sharper and smaller. Being transgendered, I can still easily imagine how people would be willing to undergo such extreme procedures for many thousands of dollars, and may even have some done myself.
For more information on specific procedures, see here. Also, some amazing before/after photos featuring specific procedures performed by Dr. Suporn in Thailand (who I plan to see for SRS at the least) can be found here.
A larger portion of girls (a little over half) are satisfied with the breast development induced by female HRT, but sometimes with larger frames and/or a smaller genetic disposition, the chest doesn't develop to a size that is proportional or satisfactory. The MtF generally grows boobs about one cup size below her mother or sister. So of course, it's everyone's favorite procedure, Augmentation Mammoplasty to the rescue! (Note: Uncovered boobs on linked page.)
I finally got rid of an unwanted part of my anatomy a couple days ago!
I have pretty nice teeth overall, but one of them, a molar, had broken in the summer sometime and had gotten really painful at times during my holiday visit home.
Today, at the Tri-County Dental Clinic in Appleton, I finally managed to get the bugger removed. Ten bucks! Huge thanks to all the donors and volunteers; it's a great service to the local community.
It ended up being a complicated surgical extraction, and the most difficult thing I've been through, including a root canal, a tendon re-attachment, and intensive facial electrolysis right below the nose. Nasty. Twelve shots total of Novocaine. I was numbed, literally, up to my right eyeball.
So over that evening, and all day yesterday and today, I've been doing Pretty Okay with a tab of Vicodin every few hours and chocolate ice cream as needed.
And while I'm writing a personal entry: my early probation discharge was officially recognized on January 17th. So the legal mess is behind me, and I'm a free girl. Woo!
Transsexualism, like other intersex conditions, is something that just happens in some sexually reproducing animals. We humans now have a more-or-less effective way of dealing with that.
But the notion of "becoming a woman" or "becoming a man" can, in various ways, lure individuals who are largely comfortable and happy with their assigned genders into transitioning. This usually pans out to be a Bad Thing for all involved.
To help prevent misguided people from doing irreversible damage to their lives and bodies via ill-advised gender transitions, there are now a number of safeguards in place. By far, the most commonly used system for safer transition is the Harry Benjamin Standards of Care. The HBSoC protocol provides guidelines for therapists and gender specialists in helping patients cope.
So the network of caretakers in gender therapy have mostly mutually agreed on these guidelines. As such, surgeons and endocrinologists require written recommendation "letters" from therapists and psychologists before they will provide hormones or surgery.
The guideline for beginning hormones is a minimum of three months therapy or full-time living. My therapist also required dressing as my true gender in group, and a couple of outings in public as myself. (Which were quite interesting, hee!) One letter is required.
For surgery, two letters (or signatures) are generally required. One year of living full-time as yourself, a significant, documented amount of volunteering, employment, or schooling, and a legal name change will probably be expected by your therapist. At minimum. This is collectively known as the Real Life Test. [Your Humble Narrator will have completed this by the end of the year. She has already been living full-time for exactly one year.]
The HBSoC is not by any means a legal requirement, but to help prevent fiascoes and lawsuits, the vast majority of the trans caretaker network mutually enforces it. This is very much a Good Thing, because otherwise, there'd be a much larger number of very unhappy, litigious men with neo-vaginas about.
Posted in hormones, surgery, transition by Milla | Post a Comment?
(Warning: Genital surgery is a subject that squicks many, and this entry gets a bit graphic. Some readers may wish to skip it.)
Heh. With that choice quote out of the way, let's talk about surgery!
I haven't personally had any transition-related MtF surgery beyond a short period of facial electrolysis yet. So my ability to write about it is limited compared to some. But I do have a basic understanding, have read a lot about it, and have talked one-on-one to people who have had it.
First, let's quell the infamous myth straight off. Sexual Reassignment Surgery (SRS) does not mean removal of the penis or what have you. In fact, to my knowledge, the only things removed are the testes and the erectile tissue. The testes are sometimes removed in a separate operation called an orchiectomy.
Rather than being removed, the penis and scrotum are restructured and retrofitted to (re)construct the vagina. Depending on the surgeon, a sensate, orgasmic clitoris can be formed. In another operation called Penile Inversion, it's basically turned inside out. This mode of SRS is becoming deprecated. Often, even a general practitioner cannot distinguish between a "natal vagina" and a neo-vagina via cursory inspection, particularly with the newer techniques.
Once the vagina is constructed, it must be dilated to the desired width and maximum depth. This is done by inserting dildo-like surgical stents of increasing size and applying pressure. In the weeks following surgery, the vagina must be dilated about five times a day for a half hour at a time, which will decrease to once a week over about half a year. At this point, dilation continues indefinitely with current techniques. If dilation isn't done often or long enough, the vagina will become very shallow and probably even heal shut.
According to one web source, average cost for MtF SRS was a little over $10k in 2001. This likely covered only the surgery itself. Figures I've heard in group therapy run more like $15k unless you get Facial Feminization Surgery. Lots of that can run it up close to $50k. We'll cover FFS in Part II.
Posted in surgery by Milla | Comments (4)
Facial Feminization Surgery (FFS) is another mixed blessing/necessary evil in the world of MtF transition. It does what female hormones can't do, namely giving certain facial structures (such as the nose, forehead, and jaw) a markedly feminine appearance, reversing certain effects of testosterone exposure that female HRT can only prevent. Very early transition often precludes the need for any FFS.
Some therapists, mine included, often discourage even their older girls from getting FFS, not only because of the inherent risks of any invasive surgery, but because it's not always necessary or even advisable.
FFS is a drastic measure. For those with heavy brows, it can involve things like getting your browbone removed, sanded down, and replaced, a Forehead Bone Contouring. Or one's entire jawbone made sharper and smaller. Being transgendered, I can still easily imagine how people would be willing to undergo such extreme procedures for many thousands of dollars, and may even have some done myself.
For more information on specific procedures, see here. Also, some amazing before/after photos featuring specific procedures performed by Dr. Suporn in Thailand (who I plan to see for SRS at the least) can be found here.
A larger portion of girls (a little over half) are satisfied with the breast development induced by female HRT, but sometimes with larger frames and/or a smaller genetic disposition, the chest doesn't develop to a size that is proportional or satisfactory. The MtF generally grows boobs about one cup size below her mother or sister. So of course, it's everyone's favorite procedure, Augmentation Mammoplasty to the rescue! (Note: Uncovered boobs on linked page.)
Posted in surgery by Milla | Comments (4)
I finally got rid of an unwanted part of my anatomy a couple days ago!
I have pretty nice teeth overall, but one of them, a molar, had broken in the summer sometime and had gotten really painful at times during my holiday visit home.
Today, at the Tri-County Dental Clinic in Appleton, I finally managed to get the bugger removed. Ten bucks! Huge thanks to all the donors and volunteers; it's a great service to the local community.
It ended up being a complicated surgical extraction, and the most difficult thing I've been through, including a root canal, a tendon re-attachment, and intensive facial electrolysis right below the nose. Nasty. Twelve shots total of Novocaine. I was numbed, literally, up to my right eyeball.
So over that evening, and all day yesterday and today, I've been doing Pretty Okay with a tab of Vicodin every few hours and chocolate ice cream as needed.
And while I'm writing a personal entry: my early probation discharge was officially recognized on January 17th. So the legal mess is behind me, and I'm a free girl. Woo!
Posted in misc, surgery by Milla | Comments (2)