Not so technical
February 20th, 2011 at 12:30:16 PM
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I meant to post about the whole transition process, which takes years and has many steps, but I need to read up on it first and refresh my mind. So I'll post about the sex reassignment surgery (SRS) itself, leaving out most details (it's easy since I don't know the details). I'll focus entirely on the male-to-female (MTF) kind, because it's the only one I know.
First, what cannot be done?
You cannot implant a full female reproductive system. The reasons for this are more ethical and practical than technical. Organ transplants are major surgery with huge risks. And postoperative there will be rejection, which needs to be managed by suppressing the immune system, which leaves the patient vulnerable to infections, which is a huge risk all its own. In addition transplants require highly skilled surgical teams and things such as an organ transport infrastructure (all too often the recipients are far away from the donors). This applies at both ends. removing a heart, say, is easier than implanting it on someone else, but it's not a simple matter of snipping at a few arteries and veins and packing it in ice.
For all that, transplants have been reserved for life or death conditions. Broadly speaking there are 4 organs which will kill you when they fail: heart, lungs, liver and kidneys. Most transplants concern these organs. At that, failing kidneys can be supplemented with dialysis, and people have been known to live with only one lung (albeit with severe restrictions on their activity).
But this has changed recently. In the past five years there have been a few hand and arm transplants, and at least one celebrated face transplant (details elsewhere, please). All these involve quality of life issues, not life or death ones. They're possible because there are more surgeons and better drugs to manage rejection. But they remain rare.
As medicine advances, it's possible we'll see ovarian and uterine transplants as treatments for infertility, perhaps. Then again perhaps not. There are other ways to deal with infertility. And perhaps in the future this can be an option for SRS, but then again it might not be. There are other issues beyond transplants to consider, namely hormonal ones.
And, no, you cannot change your genes. It would do you no good if you could anyway.
So what can be done?
The set of male genitals can be reshaped into a functional vagina. This is not as surprising as it seems at first sight, since 1) the male and female bodies are not as dissimilar as they appear, and 2) a vagina doesn't actually do anything; it's a rather passive limb.
How is this done? [WARNING! The more squeamish might want to turn away now]
The procedure is called vaginoplasty, which is medical talk for "forming a vagina." Rhinoplasty, a term you may be more familiar with, similarly means "forming a nose."
First you need a vaginal cavity. I don't know how this is done, exactly, but it is located between the bladder and rectum. results vary largely by anatomy, but the depth falls between 4 to 5 inches. This is within the normal dimensions for a natural vaginal cavity.
Next it really gets bad for the squeamish. Take note you've been warned twice now :)
Next tissue from the phallus is used for the labia and the clitoris. The latter is shaped mostly using the glans, which is the part of the phallus that's responsible for sexual response. This technique is called penile inversion. The erectile tissue is removed. The testes are removed (and good riddance), but the scrotum is used for the outer labia. Sometimes skin grafts are needed as well. Whether or not they're necessary depends on the patient's anatomy (size, if you know what I mean). They can be taken from the legs or buttocks, as they are for the treatment of burns, but mucous membranes can also be used (usually from the colon). I'd prefer skin, as the skin tone will be the same (yes, I'll need a graft should I get that far). The urethra is repositioned and shortened.
The result is a vagina that looks pretty much like a natural one. Functionally there are differences from a natural vagina, notably as regards lubrication, but it serves well enough for intercourse. Most patients will still experience orgasm after surgery (read where the glans goes and why), but not all of them. I don't have statistics about it. In any case there always remains sensation.
This operation is done mostly by plastic surgeons. A little known fact is that a similar procedure, involving grafts, is available to women as a means of vaginal rejuvenation.
Another important item to point out is that most surgeons won't perform SRS without referral letters from two psychotherapists. I'll address that as time permits elsewhere. I know of one who will, but I wouldn't trust that butcher with a hangnail.
What I know about surgery the other way, female-to-male (FTM), is what doctors faced with malformed genitalia in XY newborns have known for a long time: it's easier to make a vagina than a phallus (the original phrase is rather crude and offensive to transmen). As far as I know it's not possible to create a functioning set of male genitals the way you can make female ones. There are other ways in which we MTF TGs have it better than our FTM brothers. I may address this in another thread.
First, what cannot be done?
You cannot implant a full female reproductive system. The reasons for this are more ethical and practical than technical. Organ transplants are major surgery with huge risks. And postoperative there will be rejection, which needs to be managed by suppressing the immune system, which leaves the patient vulnerable to infections, which is a huge risk all its own. In addition transplants require highly skilled surgical teams and things such as an organ transport infrastructure (all too often the recipients are far away from the donors). This applies at both ends. removing a heart, say, is easier than implanting it on someone else, but it's not a simple matter of snipping at a few arteries and veins and packing it in ice.
For all that, transplants have been reserved for life or death conditions. Broadly speaking there are 4 organs which will kill you when they fail: heart, lungs, liver and kidneys. Most transplants concern these organs. At that, failing kidneys can be supplemented with dialysis, and people have been known to live with only one lung (albeit with severe restrictions on their activity).
But this has changed recently. In the past five years there have been a few hand and arm transplants, and at least one celebrated face transplant (details elsewhere, please). All these involve quality of life issues, not life or death ones. They're possible because there are more surgeons and better drugs to manage rejection. But they remain rare.
As medicine advances, it's possible we'll see ovarian and uterine transplants as treatments for infertility, perhaps. Then again perhaps not. There are other ways to deal with infertility. And perhaps in the future this can be an option for SRS, but then again it might not be. There are other issues beyond transplants to consider, namely hormonal ones.
And, no, you cannot change your genes. It would do you no good if you could anyway.
So what can be done?
The set of male genitals can be reshaped into a functional vagina. This is not as surprising as it seems at first sight, since 1) the male and female bodies are not as dissimilar as they appear, and 2) a vagina doesn't actually do anything; it's a rather passive limb.
How is this done? [WARNING! The more squeamish might want to turn away now]
The procedure is called vaginoplasty, which is medical talk for "forming a vagina." Rhinoplasty, a term you may be more familiar with, similarly means "forming a nose."
First you need a vaginal cavity. I don't know how this is done, exactly, but it is located between the bladder and rectum. results vary largely by anatomy, but the depth falls between 4 to 5 inches. This is within the normal dimensions for a natural vaginal cavity.
Next it really gets bad for the squeamish. Take note you've been warned twice now :)
Next tissue from the phallus is used for the labia and the clitoris. The latter is shaped mostly using the glans, which is the part of the phallus that's responsible for sexual response. This technique is called penile inversion. The erectile tissue is removed. The testes are removed (and good riddance), but the scrotum is used for the outer labia. Sometimes skin grafts are needed as well. Whether or not they're necessary depends on the patient's anatomy (size, if you know what I mean). They can be taken from the legs or buttocks, as they are for the treatment of burns, but mucous membranes can also be used (usually from the colon). I'd prefer skin, as the skin tone will be the same (yes, I'll need a graft should I get that far). The urethra is repositioned and shortened.
The result is a vagina that looks pretty much like a natural one. Functionally there are differences from a natural vagina, notably as regards lubrication, but it serves well enough for intercourse. Most patients will still experience orgasm after surgery (read where the glans goes and why), but not all of them. I don't have statistics about it. In any case there always remains sensation.
This operation is done mostly by plastic surgeons. A little known fact is that a similar procedure, involving grafts, is available to women as a means of vaginal rejuvenation.
Another important item to point out is that most surgeons won't perform SRS without referral letters from two psychotherapists. I'll address that as time permits elsewhere. I know of one who will, but I wouldn't trust that butcher with a hangnail.
What I know about surgery the other way, female-to-male (FTM), is what doctors faced with malformed genitalia in XY newborns have known for a long time: it's easier to make a vagina than a phallus (the original phrase is rather crude and offensive to transmen). As far as I know it's not possible to create a functioning set of male genitals the way you can make female ones. There are other ways in which we MTF TGs have it better than our FTM brothers. I may address this in another thread.
Donald Trump is a fucking criminal
February 20th, 2011 at 2:32:07 PM
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I want to add a pre-operative step that's important t consider along with SRS: hormone replacement therapy (HRT).
It's been said that the base genetic blueprint for most mammals, including humans, is female. This isn't quite right. The base genetic blueprint is shared by both genders. How the body develops along gender depends largely on sex hormones. This includes things like bone structure and overall size, but also what's known as secondary sexual characteristics.
Men and women both have mammary glands, for example. Upon puberty, when production of sex hormones starts in earnest, women develop theirs but men don't. Yet if you add estrogen to a male body, it will develop breasts the same as a woman does. Likewise both sexes have body hair, including facial hair. Again upon puberty male hormones make body hair, especially facial hair, grow and thicken on men, while on women it remains thin even where it does grow (as o the legs and arms) and facial hair remains little more than barely noticeable fuzz which might as well not be there.
When transitioning the MTF route, HRT is an important part of the process. Therapy consists of taking estrogens, which can be by pills, injections or both, and, depending on the patient and the endocrinologist, androgen agonists or anti-androgens (drugs that block or interfere with the effects of male hormones on the body).
The effects are varied. More or less in order of importance this is what happens:
1) Breasts develop, as noted above. Only it's not so simple. While the mammary glands will develop fully, if HRT is followed long enough, and be functional (add prolactin and they will produce breast milk), they won't grow as large as those on a born female. The rule of thumb is they grow larger the earlier HRT is started. But size is also dependent on genetics; that is, if women on your family are small breasted, you'll probably be too. In many cases the breasts go through another spurt of growth after SRS or orchiectomy (removal of the testes), but the growth, if any, is unpredictable.
2) Body fat changes in distribution. more of it goes towards the hips and less to the abdomen, which gives one a more feminine figure. Again, the redistribution isn't as pronounced as in born women.
3) Body hair thins a little. Only a little. Enough that waxing, shaving and other non-permanent hair removal methods become more effective. Unfortunately there's little if any effect on facial hair. The reason is the qualitative difference between it and the rest of the hair on the body. Facial hair requires male hormones to develop, but not to maintain itself; most other body hair does need hormones to remain as it developed. Facial hair may grow more slowly, but that's about it. Electrolysis or laser treatments remain necessary.
These are the important effects. There may be some change in the pitch of one's voice, but then again there may not be. The testes may shrink a little bit, too.
Aside from breast growth, all changes are reversible. That is, if one stops HRT permanently, fat goes back to the abdomen and body hair thickens again.
Here I do know a bit of what happens in the FTM direction. Essentially there's a mirror image. An FTM TG will take androgens and drugs to block estrogens. But there are differences. Here's some of what happens:
1) Body hair, including facial hair, develops and/or thickens.
2) The voice does lower in pitch. Effects vary among individuals, but they do happen.
3) Fat migrates in the opposite direction, narrowing the hips somewhat, but only somewhat. The size and shape of the pelvis, which determines hip width more than fat tissue does, remains the same.
Again these are the important effects. Aside from fat redistribution, though, the effects are irreversible. Body hair will thin a bit, but won't vanish, neither will facial hair. The lower voice pitch stays. In addition the ovaries may shrink, but won't go away.
There are side effects in both cases, which is why therapy needs to be managed by a competent physician.
It's been said that the base genetic blueprint for most mammals, including humans, is female. This isn't quite right. The base genetic blueprint is shared by both genders. How the body develops along gender depends largely on sex hormones. This includes things like bone structure and overall size, but also what's known as secondary sexual characteristics.
Men and women both have mammary glands, for example. Upon puberty, when production of sex hormones starts in earnest, women develop theirs but men don't. Yet if you add estrogen to a male body, it will develop breasts the same as a woman does. Likewise both sexes have body hair, including facial hair. Again upon puberty male hormones make body hair, especially facial hair, grow and thicken on men, while on women it remains thin even where it does grow (as o the legs and arms) and facial hair remains little more than barely noticeable fuzz which might as well not be there.
When transitioning the MTF route, HRT is an important part of the process. Therapy consists of taking estrogens, which can be by pills, injections or both, and, depending on the patient and the endocrinologist, androgen agonists or anti-androgens (drugs that block or interfere with the effects of male hormones on the body).
The effects are varied. More or less in order of importance this is what happens:
1) Breasts develop, as noted above. Only it's not so simple. While the mammary glands will develop fully, if HRT is followed long enough, and be functional (add prolactin and they will produce breast milk), they won't grow as large as those on a born female. The rule of thumb is they grow larger the earlier HRT is started. But size is also dependent on genetics; that is, if women on your family are small breasted, you'll probably be too. In many cases the breasts go through another spurt of growth after SRS or orchiectomy (removal of the testes), but the growth, if any, is unpredictable.
2) Body fat changes in distribution. more of it goes towards the hips and less to the abdomen, which gives one a more feminine figure. Again, the redistribution isn't as pronounced as in born women.
3) Body hair thins a little. Only a little. Enough that waxing, shaving and other non-permanent hair removal methods become more effective. Unfortunately there's little if any effect on facial hair. The reason is the qualitative difference between it and the rest of the hair on the body. Facial hair requires male hormones to develop, but not to maintain itself; most other body hair does need hormones to remain as it developed. Facial hair may grow more slowly, but that's about it. Electrolysis or laser treatments remain necessary.
These are the important effects. There may be some change in the pitch of one's voice, but then again there may not be. The testes may shrink a little bit, too.
Aside from breast growth, all changes are reversible. That is, if one stops HRT permanently, fat goes back to the abdomen and body hair thickens again.
Here I do know a bit of what happens in the FTM direction. Essentially there's a mirror image. An FTM TG will take androgens and drugs to block estrogens. But there are differences. Here's some of what happens:
1) Body hair, including facial hair, develops and/or thickens.
2) The voice does lower in pitch. Effects vary among individuals, but they do happen.
3) Fat migrates in the opposite direction, narrowing the hips somewhat, but only somewhat. The size and shape of the pelvis, which determines hip width more than fat tissue does, remains the same.
Again these are the important effects. Aside from fat redistribution, though, the effects are irreversible. Body hair will thin a bit, but won't vanish, neither will facial hair. The lower voice pitch stays. In addition the ovaries may shrink, but won't go away.
There are side effects in both cases, which is why therapy needs to be managed by a competent physician.
Donald Trump is a fucking criminal
February 20th, 2011 at 4:31:41 PM
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Quote: NareedNext it really gets bad for the squeamish. Take note you've been warned twice now :)
It wasn't nearly as bad as I thought it might be.
Quote: NareedAnother important item to point out is that most surgeons won't perform SRS without referral letters from two psychotherapists. I'll address that as time permits elsewhere.
If you mean the reasons for such a thing, I think it's kinda obvious. If you mean your personal experience thru that part of the process, then cool.
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February 20th, 2011 at 4:42:32 PM
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Quote: DJTeddyBearIt wasn't nearly as bad as I thought it might be.
I did leave out some details and didn't link to any pictures.
Quote:If you mean the reasons for such a thing, I think it's kinda obvious. If you mean your personal experience thru that part of the process, then cool.
I expect I'll post about my experiences as they happen. They're still in the future, so I've been planning ahead.
Donald Trump is a fucking criminal
