Thursday, June 4, 2015

Answering The Question Of Transgender Surgeries

I’m going to stick my neck out and attempt to give basic information on the question of transgender surgeries…


People are trying to figure out what being transgender means and how it relates (or doesn’t relate) to them. Many of us put information through the filters we currently have. The idea of someone’s assigned sex at birth not matching gender identity might make sense so people move down their list with their filters and at some point they hit questions that aren’t necessarily comfortable for everyone to answer. The question of surgery is one of those question... 

We're going to generalize the information so we can understand and move on. Please don’t get angry if I get something wrong… contact me so I can correct it because my goal is to increase acceptance through knowledge.  I TRULY believe sharing this will lead to acceptance and acceptance equates to a happier SAFER society for everyone. 

Okay Pretty Ones: Here we go.

I know my Pretties wouldn’t purposely piss someone off/upset someone by asking a question in an inappropriate way. But just so we are all on the same page: Unless you are planning on sleeping with the person or having a relationship with them that might lead toward the bedroom you don’t need to know specifically what is in a certain person’s pants/skirt. It’s that simple.

Education & Understanding = Acceptance.

In that vein we’re going peek beneath the shroud around transgender surgery. But first allow me to show you some statistics to help sensitize you as to why surgeries aren’t what we should be focusing on…

41% of people who are transgender & gender non-conforming have attempted suicide (over 9x higher than the national average)
78% of survey respondents have suffered physical or sexual violence at school
65% of respondents experienced violence at work
57% of those reported that their family chose not to speak/spend time with them
69% have experienced homelessness
60% reported a doctor or healthcare provider refused to treat them
57-61% of those disrespected or harassed by law enforcement officers

These are the issues we need to focus on. But I respect you need a framework so let’s address the surgery issue so we can move on.

Not every person who is transgender wants gender affirmation surgery.
Huh? Isn’t that what transgender means?

Nope. Not everyone who is transgender has body dysmorphia. They don’t feel the need to have surgery. They are comfortable or have found ways to be comfort living within their current body.

Surgery can be expensive therefore out of the reach.

There are risks that for some people may not outweigh the benefits.

An individual may not be healthy enough to have surgery.

Having/wanting surgery or not does not determine whether someone is transgender.

I’m not a doctor. I have done research (some of which I’ve listed the sources) and I have talked with a number of women in Bangkok who had surgeries. I’ve never spoken to any transmen about the surgery only about testorone.

Again having surgeries is a very personal decision and procedures need to be very individualized. I’m hoping to give you enough information to give you a foundation so if someone says something goofy you can correct them.

Surgeries Available for Transmen

1. Hormones: (Not surgical but it is a powerful agent of change so I’ve included it)  Testorone or “T” shots, patches, creams.

Results: Allows masculine secondary sex characteristics to develop as well as blocking female related functions.
Potential Risks: Side effects of testorone but those are usually the desired results. There can be mood swings.

2. Chest reconstruction surgeries: (or "top" surgery): 

Breasts are removed and the torso is contoured into a more masculine shape.

Results: No longer need to bind breasts. Can take your shirt off. More masculine in appearance.
Potential Risks: As with all surgeries there is a risk of bleeding, infection, problems from anesthesia, blood clots or death (rare). There might be scarring, need for additional surgeries or loss of sensitivity.

3. Removal of the uterus and ovaries

Results: No longer needing to deal with female processes.
Potential Risks: Hysterectomy side effects (mood swings, night sweats, vaginal dryness, etc.) Any surgery poses risks such as bleeding, infection, problems from anesthesia, blood clots, or death.

4. Genital reconstruction surgeries (or "lower"/"bottom" surgery) 

I’m going to skim the procedures to give you some idea and a general direction if you wish to go deeper into the subject.

Testosterone treatment causes the clitoris to grow longer (usually to the size of a thumb). The surgeon cuts the ligament holding the clitoris in place and some of the surrounding tissue to create a small phallus from the elongated clitoris.
To create scrotum there are two steps. First tissue expanders are put in then after the stretching permanent testicular implants are inserted.
Metoidioplasty may also lengthen the urethral. Tissue from the vaginal area or from inside the mouth/cheeks are used to create a urethral extension, which would allow the person to pee standing up.
The vaginal cavity may or may not be closed or removed.
Results:  A natural looking (albeit small), erotically sensate penis. The patient can achieve erections when aroused. The procedure takes advantage of existing genital tissue, and doesn't leave visible scars on other parts of the body. The penis maybe too small for penetration.
Potential Issues: The implants could cause an abnormal blockage. There could be leakage of the urethral passage, which could cause infection and tissue death. As with all surgeries there is a risk of bleeding, infection, problems from anesthesia, blood clots, or death (rare). 

This is a variation of metoidioplasty. The ligaments are joined around the clitoris, which adds girth. The procedure adds a pocket for silicone scrotal implants to be place. A urethral extension is made by putting the skin flaps around a catheter that is at the underside of the clitoris. The catheter is removed after urethral heals. The Centurion can be performed at the same time of a vaginectomy (closing/removing the vagina) and hysterectomy/oophorectomy (removal of ovaries).
Results:  similar to Metoidioplasty.
Potential Issues: similar to Metoidioplasty 

Phalloplasty constructs a penis using skin from other parts of the body and grafted onto the pubic area. The urethral is lengthened to allow patient to urinate through the penis. Erections can be achieved by inserting a rod (permanently or temporarily).
**There are many different techniques to accomplish phalloplasty and I won’t go into them all.**
Result: An average-sized penis that conforms to societal norms and can engage in penetrative sex.
Potential Issues: Possible tissue death could result in loss of part or the entire penis. Sometimes multiple surgeries are necessary as well and as a possible need for revision of the penis. Significant recovery time is needed. Phalloplasty can leave scarring in the areas of donated skin and possible nerve damage or numbness. Complications of testicular or penile implants, blockages, leakage of the urethral passage. Erotic sensation may be changed or diminished. As well as all the usual risks when having surgery.

Surgeries Available for Transwomen

1) Hormones: while not formally a surgery these chemicals change and affect the body dramatically. Hormones will encourage the development of secondary female sex characteristics.

2) Breast Augmentation: (or “top” surgery) increasing the size of breasts with implant. Hormones can usually increase breasts to an A-cup.

3) Vaginoplasty: (or “bottom” surgery) The testicles are removed and the penis is inverted to form a fully sensitive vagina. A clitoris is made from the glans of the penis. The scrotal tissue is reformed to make labia. Sometimes if there isn’t enough skin (or if Vaginoplasty fails) skin grafts from hips, thighs or a section of the colon is used.

Use of stints to dilate the vagina is necessary to prevent it from closing.

Definitions of success for gender affirmation surgery vary based on the individual and are subjective. I’m going to use two of the categories that come up on the various forums for people who have gone through the surgery use assessing the success of the procedure.

Orgasms: I’ve read & heard 25%+ of the woman who’ve had gender affirmation surgery can no longer have orgasms but to counterbalance that I’ve seen articles claiming higher rate of orgasm than cis-gender women at 90%+.  The brain is our largest sex organ so much will depend on how the individual is feeling. (Though please don’t discount the importance of a great nerve sparring surgeon).  

Remember not every person considers orgasm as part of their success equation.

On a forum there was a woman whose goal was post-operative orgasms. Pre-surgery she practiced orgasming as quickly as possible. After surgery she worked on having erotic sensations and feelings while she was doing her dilations. It took about a year and half until she was able to have an orgasm. She said her body needed to relearn how to build the sensations into pleasure. She also found working at it and anal stimulation assisted her.

Look & Feel: Many transgender women are concerned that they look and feel similar to cis-gender women. Only subjective data can be obtained but usually most are pleased with the results.

Potential Issues:  As with all surgeries there is a risk of bleeding, infection, problems from anesthesia, blood clots, or death. There are concerns for infection, numbness, loss of ability to orgasm, need for additional surgeries also vary.non-functioning vagina, etc.

Gender isn’t defined in what’s in our pants/skirts.

Now if you wish to seek further information YouTube has an array of people who are transgender sharing their journey. (I’ve spent hours watching videos and hearing so wonderfully uplifting stories as well as some heartbreaking ones.) 

But now you’ve peeked beyond the veil of affirmation surgery I expect your energy can be directed in helping to protect of the rights of individuals who are transgender.

Did you know:

In 32 of America’s states it is legal to fire someone for being transgender.

People who are transgender are fighting for the right to use the bathroom that fits their gender not their assigned sex at birth.

Transgender people are dying due to lack of acceptance. Please learn as much as you can and be ally.

Promote rights and equality for all people.

If you ever have any questions please ask. I’ll not be insulted, upset or put off by. If I don’t know the answer I’ll help you find it. (( I believe asking is caring…  

Understanding = Acceptance

Many Hugs,
Z. Allora


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