W
elco
me to TSSurgeryGuide.com
Your Guide to Transgender Surgeries


Sex Reassignment Surgery (SRS):


 Sex reassignment surgery (SRS) is also known as gender reassignment surgery (GRS), genital reassignment surgery, gender confirming surgery or simply a sex change operation. SRS is often the final stage in the physical transitioning for a male to female (MTF) or female to male (FTM) transsexual. SRS is a surgical procedure that entails removing the genitalia of one sex and constructing the genitals of the opposite sex.

 The procedure has very high rates of success when it is performed by responsible and experienced surgeons. However with current surgical technology male to female individuals usually are more satisfied with their results than female to male. Modern sex reassignment surgery has been performed for over 60 years. There are on average 50 SRS procedures performed each week in North America alone.

 Using modern techniques first pioneered by Dr. Georges Burou, M.D.
male to female individuals have been able to be orgasmic after surgery. However phalloplasty for female to males is unfortunately still usually limited by either appearance or function.

 There are primarily two groups of people that get surgery to alter the genital organs from one sex to another.

Newborns with intersex conditions are often forcibly assigned to one sex or the other. 

 Many men and women feel strongly they are physically a different sex than they are mentally and emotionally. They feel that they are a man or woman trapped in a body of the opposite gender. This dissonance, called gender dysphoria, is often so profound and uncomfortable that many individuals experiencing it desire to be surgically altered. In this way they can appear as and function as their correct sex.

 In either case, male to female surgeries are usually easier and more successful. Newborns with ambiguous organs will almost always be assigned to the female gender, unless the penis is at least an inch long. Whatever their chromosomes, they are much more likely to be socially well adjusted as females, even if they cannot have children. Gender identity is probably the most basic human characteristic and takes place very early in life. Since it can't be chosen, it is now recommended to wait and see the child's gender identity before performing surgery.

 Changing your physical sex as an adult may be the biggest change that a person could experience. It should only be done with people that can only happily function in the opposite gender role.

 Getting a sex change for a transgendered individual is a complex change, so experts recommend the support of a broad range of skilled professionals well experienced in gender identity issues. These professionals could include a general practitioner, surgeon, psychiatrist, psychologist, and an endocrinologist. They would work independently as well as cooperatively to provide the client and his or her family members with a well informed support network. The psychosocial as well as the physiological adaptation process could take several years, even after the successful completion of SRS.

 Most surgeons follow the WPATH standards of care. To be allowed to get SRS you will have to meet many requirements. Social reassignment is often highly recommended if not required before the individual commits to SRS. Also called "real life experience", it involves living and working for perhaps two years in the new gender role. This often gives some indication of the possible happiness after SRS.

 Hormonal reassignment usually takes place before SRS. For male to female transsexuals, estrogen therapy helps suppress the physical male characteristics and encourages physical female characteristics. Treatment of female to male transsexuals with testosterone lowers the pitch in voice, increases muscles and body hair.

 Surgeons who perform SRS have very strict requirements. Most surgeons require two letters of recommendation for surgery from either psychiatrists, therapists or psychologists recognized in the field of gender identity. These letters must state that the individual is an appropriate candidate for SRS.

Online gender therapists that can provide letters for surgery

 Once the surgeon is satisfied that the candidate is psychologically as well as physically ready, lab work and an HIV test is done. Some surgeons will refuse patients with HIV. If you are overweight, you might not be allowed to get sex reassignment surgery.

 Since you will lose blood, patients may be asked to donate two units of their own blood, just in case.

 An interview or consultation is given where you will be fully informed of the procedures involved in surgery and the implications of its irreversible nature. You will sign a written consent for sex reassignment surgery.



The Surgery:

 Some surgeons recommend the cessation of hormone therapy for three weeks prior to sex reassignment surgery. The male to female procedure can take anywhere from three to seven hours. For female to males, there are many variations of surgeries and techniques that it is impossible to give a general overview.

 Sex reassignment surgery for MTFs creates female sexual organs that look as natural as possible and that allow as much sexual arousal as possible. This involves removal of the penile muscle and tissue, the testicles, and reshaping the external genitalia to appear female and natural. It also involves creating a vagina deep enough to allow satisfactory intercourse.


Techniques:

 There are several techniques that can be used to create the vagina. The most common and least invasive technique is using the inverted skin of the penis to line the newly created vaginal cavity. An incision is made from the base to the head of the penis, and the skin is peeled away from the shaft.

 In most techniques, a portion of the head of the penis is formed into a clitoris. This technique allows sexual stimulation and enjoyment. If the penis is long enough, no additional skin grafts will be necessary. If the penis isn't long enough then a scrotal, abdominal or thigh skin graft is often used. Unfortunately, this might leave scarring. Scrotal skin must have had all of the pubic hair removed before sex reassignment surgery.


 Another technique is to create the vagina using "full thickness" skin grafts. These grafts are obtained from hairless portions of the sides and the penile skin is then used to create the labia minora and the scrotum skin to create the labia majora. The width and dept of the vagina are usually greater than with the inverted penile skin, and so the new vagina will be less likely to shrink over time.

 Rectosigmoid vaginoplasty utilizes a piece of the rectosigmoid colon instead of skin grafts or inverted penile tissue. This technique allows for the creation of a deep and lubricated vagina, but is a more invasive, dangerous and expensive surgery.


Aftercare:

 To prevent the new vagina from closing, a vaginal stent is inserted and stays in place for the length of the hospital stay. This usually averages around a week. Demerol or morphine are commonly given intravenously to ease the pain. Ice is placed on the surgical area to prevent and decrease bleeding and swelling. The surgical area is kept packed with ice to decrease swelling and bleeding.

Many patients choose to come back and have cosmetic revisions after sex reassignment surgery.

 The most common complication for MTFs is that the vagina will try to shrink as it heals. Surgery to correct this is more difficult and extensive than the initial procedure. It involves making incisions in the inverted penile skin and inserting full thickness skin grafts. For this reason it is recommended to use a vaginal dilator for the rest of your life. It is similar to wearing retainers after getting braces.

 Patients should see their surgeon at scheduled intervals to make sure that the healing is progressing fine. Also after surgery, you will need to take estrogen for the rest of your life to prevent health problems such as osteoporosis.


Female to Male (FTM):

 Female to male sex reassignment surgery has had less success, because of the difficulty of building a functioning penis from the much smaller clitoral tissue. For some, removing the breasts with top surgery is enough. Some FTMs use a prosthetic penis called a packer that is either glued or strapped on.

 For the FTMs that those options aren't enough, they can undergo a phalloplasty to surgically create a penis. Penis construction can be done a year after the preliminary surgery, in which the uterus and ovaries were removed. The procedure combines several surgeries during which a penis shaped structure is constructed by peeling and rolling skin from the abdomen or upper thigh and attaching it over the clitoris to preserve as much sexual stimulation as possible.

 This procedure often creates unsatisfactory urination ability and, while the penis can be used for intercourse, it is less than perfect. Men that get this surgery are very happy to have the presence of a penis. One study in Singapore found that a third of individuals who underwent female to male SRS would not choose to do so again, but they were all happy with the reassignment of their gender.


Irreversible:

 Sex reassignment surgery is irreversible. It is for this reason that you must be sure before getting operated on.


Sex Reassignment Surgeons:

Male to Female (MtF):

Dr. Toby Meltzer (Arizona)
Dr. Gary Alter (California)
Dr. Peter Davis (California)
Dr. Marci Bowers (California)
Dr. Harold Reed (Florida)
Dr. Tuan Nguyen (Oregon)
Dr. Sherman Leis (Pennsylvania)
Dr. Christine McGinn (Pennsylvania)
Dr. Kathy Rumer (Pennsylvania)

Dr. Brassard (Montreal, Canada)


Female to Male (FtM)

Dr. Toby Meltzer (Arizona) 
Dr. Gary Alter (California) 
Dr. Marci Bowers (California) 
Dr. Harold Reed (Florida) 
Dr. Daniel Medalie (Ohio)
Dr. Sherman Leis (Pennsylvania) 
Dr. Christine McGinn (Pennsylvania) 
Dr. Kathy Rumer (Pennsylvania) 

Dr. Brassard (Montreal, Canada)