As you were growing up, how did you know you were a girl or a boy? Was it because you had a female or male organ (vagina or a penis)? Or was it something other than what your body looked like? Some people feel that their minds and bodies don't match up. This feeling is commonly known as gender identity disorder or gender dysphoria. The medical community used to use the word "transsexuals" to describe this community. But today, "transgender" is used as a general, non-medical term to describe anyone whose gender identity is different from their physical sex at birth. Transgender people often wish to live as a different gender than the one they were assigned when they were born. They may transform their bodies through Sex Reassignment Surgery, also known as gender reassignment surgery or gender confirmation surgery or sex change surgery- term for the surgical procedures by which a person's physical appearance and function of their existing sexual characteristics are altered to resemble that of the other sex.
Gender identity struggles usually begin in early childhood but have been identified in people of all ages. A biologically born man who identifies as a woman is known as transwoman, or transgender woman. A biologically born woman who identifies as a man is known as transman, or transgender man. There are also people whose identity lies somewhere along a spectrum of gender that may refer to them as neither male nor female. Prospective candidates for gender reassignment surgery must work with a mental health professional for diagnosis. However, the mental health professional additionally provides counsel about treatment options and implications as well as therapy and education for the individual, his or her family and employers.
After a diagnosis, there are three phases left for patients undergoing surgery:
- Hormone Therapy
- Real life experience, also known as the Real Life Test
- Surgery to change genitalia and other sex characteristics
In addition to diagnosing patients and providing counsel, mental health professionals also assess a person's eligibility and readiness for hormone therapy and surgery. Not all transgender people need all three phases of therapy; each path to gender reassignment is tailored to the person. And, as we've noted before, not all transgender people undergo surgery. After a patient meets these criteria and undergoes a basic physical examination, a physician will then prescribe hormones.
Androgens are given to biological females transitioning to male. Estrogen, progesterone, and testosterone-blocking agents are given to biological males transitioning to female. Hormones are taken orally, by injection or transdermally (a patch).
The Real-Life Experience immerses the individual into life as his or her preferred gender. The candidate is required to maintain full or part-time employment (or attend school full or part-time), legally change his or her first name to one that is gender appropriate and prove that people other than the therapist and doctor know his or her desired gender.
After 12 months of continuous and successful hormone therapy and Real-Life Experience, the individual is eligible for genital surgery. Two letters of recommendation, usually one from the mental health professional and one from the hormone-prescribing physician, are required for surgery.
Male to female (Trans female)
The procedures involved systematic excision of penis & testicles, Creation of neo-vagina using penis skin, creation of labia majora & labia minora by scrotal skin and creation of clitoris by de-bulked sensate flap of glans penis. Breast implant (Silicone cohesive gel or expander implant) completes the procedure. Though the surgery can be performed in single or two stages, but few further stages may be required to fine-tune the result or to perform procedures like reduction thyroid chondroplasty, suction-assisted lipoplasty of the waist, rhinoplasty, facial bone reconstruction, hairline correction, forehead recontouring, brow lift, cheek implants, lip lift, lip filling, chin recontouring, jaw recontouring and blepharoplasty. Some patients have laser hair removal, vocal cord surgery or voice training.
Female to male (Trans male)
F to M is more complex and complicated procedure than M to F. Genital surgery for female-to-male patients may include excision of breast, hysterectomy, salpingo-oophorectomy, vaginectomy, metoidioplasty, scrotoplasty, placement of testicular prostheses and phalloplasty (the creation of a neophallus or surgically constructed penis). A transman may also undergo elective surgeries like liposuction to reduce fat in hips, thighs and buttocks, placement of penile implants for penile erection.
These all surgeries are performed in stages. A gap of 4-6 month is required in between each stage for proper healing of the areas. It's generally reported that transgender people who have undergone these surgeries are, in almost all cases, happy they did so. And while there may be a few, who regret their decision.