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by Internet Medical Society

It was back in 1952 when a 27 year old George Jorgensen described himself as woman trapped in man’s body. 2 years later, he underwent gender reassignment surgery which was considered as one of the first cases of transition from male to female gender.  

“I wanted to find my true self”, said George Jorgensen,  who later changed his name to Christine Jorgensen after the surgery.

In general, we are all in the pursuit of finding who we are and we all aspire to fully resonate with who we are as a person. While gender may seem quite insignificant to heterosexuals, it can prove to be quite a challenge for people whose gender does not align with their genitalia.

According to 2011 census, India has around 5 lakh people who identify as transgender and this number should be considerably higher now.

Diagnosing Gender Dysphoria

Men and women who suffer from gender dysphoria often describe the feeling of not belonging in their own body because their psychological being resonates with one sex but their body does not.  It can be traumatic and psychologically challenging for anyone to have to live with such a condition. Furthermore, society does not make it any easier for them in their search to find who they really are and who they want to be in terms of their sexual identity.

Individuals with gender dysphoria often describe being born in the wrong body and plastic surgery is an important step in aligning their bodies with whom they know themselves with” says Dr. Ankur Sood, one of the best plastic surgeon in India.

And in order to help people with gender dysphoria, the World Professional Association for Transgender Health (WPATH) has come up to provide the highest standard of care for these individuals.

 Gender reassignment surgery has proven to be one of the most efficient ways to provide such individuals their peace of mind by aligning their body with their mind with the help of advanced surgical procedures. It is not something to be taken lightly and requires intensive therapy and emotional preparation for years before actually opting for the surgery.

Steps Required Before Gender Reassignment Surgery

Doctors often require patients to live for a couple of years as their desired sex, for instance those who biologically identify as male but lean towards feminine character may dress the way a woman does, they may also change their names and refer to themselves using female pronouns. Females identifying as male do the reverse. Psychological evaluation is a primary requisite to the surgery and there is no loop hole surrounding it.

Patients are also required to undergo hormone therapy for a minimum period of 1 year. Hormone therapy suppresses the secondary sex characteristics of their biological gender and makes them look more like their preferred sex. Androgens are steroid hormones that regulate the development and maintenance of male characteristics. Estrogens are vital in regulating female characteristics and they are responsible for secondary sex characteristics in females. Men are required to ingest synthetic estrogens while women do the same with androgens, which will give them the appearance of their desired sex.

In addition to  understanding the procedures and risk involved in the operation, there are few necessary steps that need to be taken care of before the surgery, like:

 

Male to Female Transition

 

Male to Female Transition are intended to make the patient’s body align with female gender. It includes various options like “Top” which encompasses breast augmentation (increasing the size of the breasts) and “Bottom” surgery that includes orchiectomy (removal of the testicles) and vaginoplasty (creating a vagina).

These procedures in more detail are given below:

1.Breast augmentation

In Breast Augmentation, there is considerable enhancement of the patient’s breasts either by using fat from another part of the patient’s body or using breast implants. Breast implants are usually made of silicone shells which are either filled with saline (salt water solution) or silicone gel. They come in different shapes and sizes and are picked according to the patient’s preferences. These implants are completely safe and can be modified to whatever the patient’s needs are.

 2. Facial feminization surgery

The aim of facial feminization surgery is to restructure a male face to give a more feminine look as a product. Surgical manipulation of the soft tissue and bones makes it possible to achieve a female facial appearance.

 3. Body contouring

Procedures like Tummy tuck (abdominoplasty), Buttock lift (gluteal augmentation) and liposuction are used to give the body a more feminine shape. These procedures come under Body contouring surgery.

 4. Tracheal Shave

A Tracheal Shave procedure is aimed at decreasing the size of the thyroid cartilage or the Adam’s apple to ensure a feminine look.

 5. Feminization Laryngoplasty or Voice feminization surgery

Feminization Laryngoplasty is a surgical procedure to change the patient’s voice to a higher pitch to ensure a female-like voice. The procedure involves shrinking the voice box and shortening the vocal chords to raise the pitch of the voice. A Thyrohyoid elevation procedure which shrinks the pharynx is also used in certain cases to improve resonance in the pharynx. It is also used to correct complications that arise from the Tracheal Shave procedure.

6. Genital surgery

Genital surgery involves multiple procedures like Orchiectomy (to remove the testicles), Vaginoplasty (to create a vagina using penile or colon tissue), Vulvoplasty (to create a vulva), Labiaplasty (to create labia) and Clitoroplasty (to create a clitoris).

Orchiectomy in this case is a bilateral orchiectomy which involves removal of both testicles. This is done to stop the production of testosterone in the body which would make transitioning from male to female considerably an achievable task.

Vaginoplasty, Vulvoplasty, Labiaplasty and Clitoroplasty are all genitalia inversion procedures which are aimed at giving the patient their desired sexual genitalia as opposed to their biologically assigned sex.

 

Female to Male Transition

 

Female to Male Transition are intended to make the patient’s body align with male gender. It includes “Top” Surgeries to remove the breasts and structure a more male-like chest and “Bottom” Surgeries like Metoidioplasty (to increase the length of the clitoris), Phalloplasty (to create a penis) and Scrotoplasty (to create a scrotum).

 

These procedures are given below in detail:

 1. Mastectomy or Breast reduction surgery

Breast Reduction surgery involves the process of decreasing the size and shape of breasts. The most common type is “Bilateral mastectomy with free nipple grafts” and it allows for the removal of practically all breast tissue, including the milk ducts and to reduce and re-position the nipples in the appropriate place. Markings are made in pre-op and incisions are made on each side of the breast below the nipple areola complex which connects just above the nipple to a key-hole shaped incision.

 2. Pectoral Implants

Pectoral implants are used to give the patient’s chest a well-defined and structured appearance as no amount of exercise can give ample results in Female to Male (FTM) Transsexuals. Pectoral implants give balance and proportion to the body and have minimal rate of rupture because they are composed of solid silicone base, unlike traditional breast implants.

 3. Liposuction

Liposuction and fat grafting procedures are used to give the body a more male like appearance.

 4. Genital surgery

For a Female to Male transition, there are two main parts in genital surgery. There is the removal of the existing female organs and the rebuilding of new male sexual organs. 

It includes hysterectomy (removal of the uterus), vaginectomy (removal of the vagina) and salpingo-oophorectomy (removal of fallopian tubes and ovaries). Removing the ovaries results in no production of estrogen which makes the patient’s transitioning from female to male an achievable task.

The next part involves surgeries like Scrotoplasty (to create a scrotum), place a particular testicular prosthesis, Metoidioplasty (to increase the length of the clitoris) and Phalloplasty (to create a penis).

Conclusion

The above two primary transitions, that is, Female to Male (FTM) and Male to Female (MTF) transitions are very sensitive surgeries and require the patient to have a proper support system as well as the require patients to have great mental strength and efficient support system to get through such extensive surgeries.

A change in identity is not a simple transition but here at TIPS we ensure that you will get the right support and guidance as you make this life-changing decision. As we just finished the PRIDE month of June to support people from the LGBTQ community, we at TIPS seek to provide pristine health care to our patients irrespective of their gender. Above all, our patient’s comfort and emotional health are our top priorities and we wish to help them align their body with their mind.

 

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