When there is no more strength to endure: a sex change operation from a woman to a man as the only chance to live a full life. What hormones can be used to change sex

Sex change is a serious operation, shown not to everyone. With age, problems with gender identity tend to go away, but a certain percentage of people in adulthood continue to feel uncomfortable in their own body.

It all starts from childhood. The boy wears dresses and the girl plays football and wears pants. In order for the shell to reflect the inner essence of a transsexual, they take this risky step - a sex change. The average age of those who decided to undergo surgery was 35 years.

Don't confuse transsexualism with homosexuality. Homosexuals feel normal in their body and, as a rule, do not want to change sex.

How is gender reassignment done?

Sex reassignment always begins with getting a psychiatrist's opinion that the person is indeed transgender. It is necessary to be examined, assess the state of health. Such a long preparation is needed for the reason that nothing can be done if a person suddenly regrets it after the operation.

If sex change is really the only way, and this will be established by the medical commission, hormonal drugs are prescribed to the person. In women, menstruation immediately disappears, hair growth increases, and men acquire the features of women. The civilian sex has to be changed before the operation. This, of course, is rather humiliating; some look at the “applicants” with pity, and some openly despises.

It is always more difficult to make a woman a man, the percentage of successful operations in this case is lower. It is very difficult to replace female genitalia with male ones. Nevertheless, many who need an operation find mental balance only after it has been carried out.

In Israel, the waiting period for a decision has already been reduced to 9 months. Many countries are moving towards transsexuals. The resolution committee consists of several people: a plastic surgeon, a psychiatrist, an endocrinologist, a gynecologist (or a urologist for men). The operation lasts 7-9 hours. To create a vagina, doctors use part of the penis. From the skin of the scrotum create the labia. As a result, men have no external differences - even gynecologists take them for a woman. Of course, if the operation is successful.

After surgery, a liquid diet and plenty of sleep are indicated. The release takes place within 10 days. If the operation is done in a good clinic, the risk of bleeding and infection is minimal.

Sex-change operation

Some people feel very uncomfortable in their body. Such people are called transsexuals. Transsexualism is a behavioral disorder. But thanks to modern medicine, such people have a chance to change their lives. Sex change is a long and laborious process. And such patients require an ethical and careful approach. A lot of money is required for a sex change, permission from the authorities and a passage, it seems, through all the circles of hell, because those who want to change their sex are waiting not only for several painful operations, but also for a long paperwork. Life expectancy after the operation is reduced, until the end of days, a person who has gone through this drinks hormones, which strikes at the internal organs.

Thailand is the leader in the number of such operations. Thailand has the lowest cost of gender reassignment surgery. Officially, there are 15,000 transsexuals in the country.

Why do people decide to do this? Because gender defines personality. Before the operation, a person has to go through several stages of preparation. For a year, a person takes hormones and lives like a member of the opposite sex. Permission is given only if a person from an early age feels a sexual inadequacy that causes him suffering. At the same time, the “candidate” should not have other deviations in the psyche.

If the operation is successful, the person receives new documents. Family support is essential for adaptation.

Any operation is a risk of bleeding and infection, death from anesthesia. You need to weigh all the risks before you decide on this, because there will be no turning back.

Hormone therapy for sex change

Hormone therapy for transsexual women includes estrogens and antiandrogens. In some cases, progestogens are also prescribed. Basically, estrogens are taken in the form of tablets or a special patch containing them is glued to the skin. Suitable tablets for hormone replacement therapy: Diane 35, Logest. The dosage of these drugs is individual. Do not change the dose or stop taking.

Hormone therapy is started 9 months before surgery and stopped one month before.

The appointment of hormone therapy begins with a blood test to determine the initial amount of hormones. Examinations are carried out every 2 months. This frequency is minimal, if necessary, the analysis should be taken more often.

Of great importance for MtF transsexuals is a decrease in testosterone close to the lower limit of normal in women.

After and after 6 months after the start of therapy with female sex hormones, tests are taken for hemoglobin, lipid profile and liver enzymes.

After the operation, once a year, you need to check the level of hemoglobin and free testosterone (for men who have changed their sex to women).

Change male to female

Sex change from male to female is common. The surgeon is faced with the task of forming a vagina from the tissues of the scrotum. In addition, they do breast augmentation and give the face a more feminine look by changing the cheekbones and chin, rhinoplasty.

Before the operation, the patient passage is a long (about 3 years) period of preparation. It includes psychological adaptation to a new gender role and the use of hormones. The absence of a confirmed diagnosis of transsexuality, homosexuality and childhood (up to adulthood) are contraindications to changing the male to female gender.

After the operation, the patient stays in the hospital for 5-6 days.

The external genitalia are formed either by transplanting the skin of the penis and scrotum, or using tissue from the sigmoid colon.

Why are there so many cases of gender reassignment from male to female? In recent years, women have become more and more powerful, while men are turning from fearsome lions into cats. But it's not only that. Scientists have proven that the causes of transsexuality should be sought even in the period of intrauterine development. Sometimes a woman has a hormonal failure. This is what causes the “change of consciousness”.

Even after a person goes through these many sufferings, sometimes the problems do not end. For many representatives of the strong half of humanity, it is difficult to cope with the condemnation that society constantly expresses to them in connection with a sex change. Relatives and friends may simply be shocked.

The success of the operation depends on age and health. After the operation, the patient is under the supervision of a surgeon.

Over the years of practicing such interventions, medicine has developed special methods for managing transgender patients. The problem is that gender can be mental, genital and physical. The purpose of the operation is to eliminate the contradiction between the biological and mental sex.

Hormone therapy before surgery suppresses the secondary signs of the "original" sex - the one that the patient wants to change. Replacement hormone therapy is prescribed for life.

How is the vagina recreated? There are several methods:

Penal inversion method. The vagina is modeled from the skin of the penis in 5 hours. The method is the simplest and widely used. After the operation, a minimum of side effects and a quick recovery. The method is indicated if the length of the penis is more than 12 cm.
Method with skin grafting of the penis and scrotum. A lengthy operation creates a normal-sized vagina and labia. The operation is long - about 7 hours. The skin of the forearm may be used if there is insufficient material. The method is practiced with a small size of the penis.
The most complex method is modeling using a fragment of the sigmoid colon. After this operation, there is no danger of tightening the vagina. But nausea and subsequent complications of the bowel may be noted.

Change from female to male

Reassignment from female to male involves the removal of the mammary glands, the enlargement of the uterus and fallopian tubes, and the creation of a penis. The procedure for changing sex from both male to female and from female to male always takes place in several lengthy stages. The presence of transsexuality is confirmed by a psychiatrist. Then for a long time the patient drinks hormones. And only after that a series of operations is done.

First, the mammary glands are removed, then the ovaries and fallopian tubes, then the testicles and penis are formed. Rehabilitation after breast removal lasts about 3 weeks.

The operation of removal of the ovaries and fallopian tubes is performed laparoscopically or by abdominal means. Rehabilitation after it takes about a week.

A penis about 8 cm long can be formed surgically. Phalloplasty is a very complex operation. For transplantation, skin is taken from the thighs or abdomen.

Sex change in children

There is a growing number of teenagers who are being helped by doctors to change their gender. In such people, the structure of the brain is always closer to the other sex. Some children try to get rid of secondary sexual characteristics, mutilate themselves, are ridiculed. Therefore, from puberty until the age of 18, such adolescents take drugs to stop sexual development, and then, as adults, undergo sex reassignment surgery.

If the newborn's genitals are deformed, you must immediately choose the gender for him and operate. Usually hermaphrodites are turned into women. But, of course, such children become infertile in the future.

Forced sex change

History knows cases of forced sex change. Similar experiments were carried out in Nazi concentration camps. Josef Mengele is a doctor who used thousands of Auschwitz prisoners to conduct mocking experiments, cut off parts of the liver from children, infected people with typhus and performed forced sex change operations.

Unfortunately, such savagery in some countries is still flourishing. Due to the peculiarities of culture in India, it is better for the family when a boy is born. Therefore, some parents find doctors committing a crime - changing the sex of a child who was not born with signs of both sexes.

Sex reassignment clinics

Sex change is carried out in Moscow, St. Petersburg. In Moscow, the service is provided by the SM Clinic. Surgeons with many years of experience work here. The clinic has a modern operating room with high-tech equipment, and staying in the hospital will be comfortable for the patient. SM Clinic is a universal family clinic with a department of plastic surgery. In the clinic, before the operation, you can undergo body diagnostics using MRI, CT, endoscopy, you can pass all the necessary tests. People from all over the CIS operate here.

Also in Moscow, gender reassignment is done at the Medstyle Effect medical center. It is located in a picturesque corner of the city. In the center, doctors give everyone a very attentive reception and help to solve the most delicate problems. Sex reassignment surgery is carried out by candidates and doctors of sciences.

In St. Petersburg, sex change is done by the Rami clinic. This is a multidisciplinary clinic. Here, about 79% of patients are satisfied with the work of the surgeon as a result. Doctors will not undertake the operation if you do not have a certificate from a psychiatrist in your hands that you are a transgender. Also, for a year and a half before the operation, you must drink hormones. It is impossible to go back after sex reassignment surgery, weigh your decision.

Also, such operations are carried out by the City Hospital No. 9 of the city of St. Petersburg. Qualified surgeons work in the Department of Aesthetic and Plastic Surgery. Before the operation, you will need to register with a psychiatrist for a period of 1 year and obtain a certificate stating that the person has a diagnosis of transsexualism. First, the genitals are reconstructed, then both men and women need mammoplasty. If a woman wants to change her gender to a male, her uterus, fallopian tubes are removed, the vagina is closed, the scrotum, penis and testicles are created, subcutaneous fat is removed from the thighs using liposuction.

The operation is performed upon reaching adulthood - 21 years. You will have to undergo a comprehensive psychiatric and physical examination and 1 year of hormone therapy (sometimes more).

Sex change in Thailand

The leader in gender reassignment surgery is Thailand. Thai surgeons have a lot of experience in this area. In Thailand, sex reassignment surgery will cost three times less than in the US, and the quality will hardly suffer. In Thailand, gender reassignment surgery is performed on persons over 18 years of age. More often men want to change sex than women.

The patient spends a month in Thailand after the operation for rehabilitation.

Sex reassignment is successfully carried out by the doctors of the Bangkok Hospital Pattaya clinic.

The starting price of sex reassignment surgery in Thailand is $5,000. In recent decades, medical tourism in Thailand has become very popular. Here people combine leisure with useful activities.

Plastic surgeons in Thailand are professionals in their field. The low price is due to high competition. Many surgeons lecture at US universities. The hospitals have excellent service, clean rooms. The climate of Thailand speeds up recovery after the operation: it is warm here, the sea is nearby.

Sex change in Russia

Sex change in Russia is not carried out for everyone. First you need to be registered with a psychiatrist for up to 3 years. At the end of this period, the medical commission must issue him a certificate stating that he is indeed a transsexual. Only after that you can start hormone therapy and preparation for surgery. This takes about a year.

If a woman wants to become a man, she needs to undergo several operations: remove the breast, close the vagina, lengthen the clitoris, remove the ovaries, fallopian tubes and uterus, create a scrotum, testicles and penis. As a result, there are at least three stages.

In Russia, a patient under 21 years of age is not subject to gender reassignment. Elderly people, people with alcoholism and children are not subject to gender reassignment.

The sex change mindset is found in homosexuals and schizophrenic patients. Therefore, only one of the 4 requests is granted.

Sex change in Belarus

Sex change in Belarus is free for its citizens, and for foreigners the price is $3,000. To change sex, you need to see a psychiatrist for a long time, and then go through a commission of 15 people: it includes doctors and lawyers. Approximately 50% of applicants receive permission to change sex. In Minsk, sex change operations are performed by Ukrainians and Russians.

Sex change in Ukraine

Sex change in Ukraine is possible for persons over 18 years of age who do not have children and families after a psychiatric examination and undergoing hormone therapy. A person must have a job and housing, not abuse alcohol.

The number of people wishing to change their gender is growing. However, in no country in the world do they change the sex of everyone. Doctors first find out why a person needs it. In the presence of schizophrenia and other mental disorders, the operation is denied. A psychiatrist, a surgeon, a gynecologist, an endocrinologist, and a lawyer participate in the commission that decides whether or not to have an operation.

How much does a sex change cost?

Sex reassignment is carried out in many countries of the world and, of course, it depends on how much this operation will cost you. Operations are carried out in Iran, Thailand, Europe, Russia. In Russia, the operation will cost about 600,000 rubles. It is necessary to carry out several stages of reconstruction. 600,000 rubles is only an operation on the genitals. In Germany, the price can reach 30,000 Euros. You should also consider the rather high cost of mandatory hormone therapy.

Free sex change

In Russia, women who want to become a man get phalloplasty for free. For men who turn into women, the vagina is formed free of charge. Only hospital stay, hormonal therapy, mammoplasty are paid. For foreign citizens, sex change is carried out for a fee. The cost of the operation is 600,000 rubles or so.

The same applies to the Republic of Belarus. Also, sex change operations are performed free of charge for citizens of Brazil. True, in this country, the period of observation by psychiatrists is very long - 3 years. Since 2000, 300 gender reassignment surgeries have been performed. The authorities believe that if transsexualism is a violation of sexual identity, the only possible treatment for which is often sex reassignment surgery, then not giving citizens the right to change sex for free is ignoring the Constitution. In these countries, health care for residents is free.

At the expense of the state, gender reassignment operations are carried out on native Israelis. As of 2014, 27 citizens are waiting for permission to perform a sex change operation.

The decision is yours - maybe, if you think carefully, you will understand that there are many other ways out of the situation, not only a sex change.

sex after sex change

Sex change, if it is carried out normally, has little effect on the quality of sex, it is close to normal. However, it still happens that such an experience ends in disappointment.

A transsexual girl is not a man. Gender identity always depends not on the genitals, but on the brain. Transgender women are not homosexuals. They are women in every sense of the word, born in a male body. We all fall in love not only with the body, but also with the soul. You can consider that nature mistakenly imprisoned the transsexual in the body of the opposite sex, and with the operation he only corrected this mistake, finding the way to harmony with himself and the world.

Problems can arise when the desires of partners do not match. Transsexual women's sexuality differs from men's in the same way as women's.

If a woman turns into a man, then the base of the penis is formed from the remnants of the genital organs and during the next operation a prosthesis is attached to it, or the penis is formed from its own tissues. The "grown" penis has only a slightly reduced sensitivity.

Orgasm after sex change

Sex change makes orgasm possible. This can happen immediately or after some time, sometimes several years. Most patients are satisfied with the results they can achieve.

Gender reassignment is a serious change, many people who go for it build illusions about their new body, hover in the clouds, do not understand what they will face after the operation. If you have such a desire, be prepared for hatred, aggression, rejection of others, even relatives and friends. Get ready for a job change. All the necessary tests and examinations will take one and a half to two years. It will cost you a tidy sum, about a thousand dollars. Hormone therapy begins 9 months before surgery and is prescribed for life. The operation costs $7,000-20,000, but some countries have made it free for their citizens. After the operation, you will have to change your passport, diploma, medical insurance, go through a huge number of bureaucratic procedures. It's still about a year old.

If you experience sexual satisfaction from wearing lingerie, this is fetishism, not transsexualism. You don't need to change gender in this case.

Your libido and even the direction of your sexual desire will change after surgery. As a result of taking hormones, your kidneys and heart will fail faster. Hormones in such quantities in any scenario harm the body, even if you have good health. Hormones are poison. They cannot be poison only when produced naturally. There is no need to get away from problems in life with the help of a sex change, because psychologists and psychiatrists will definitely notice this when they give you a “verdict” - whether or not to have an operation. And no problem can be solved by changing gender. If you are a man and want to become a woman, then we will answer you that you will never become a woman in the full sense because of infertility. The entire transformation takes 2-5 years. Sometimes a lot of facial surgery is needed, because hormones cannot make you a woman, they can only help you become a woman. Relatives and friends always react negatively to this, that is, by solving one problem, you can get many other psychological problems in addition. And again you will beat the thresholds of the offices of psychologists and psychotherapists.

It is important to know!

Gender identity disorder is a condition of strong identification with the opposite sex, in which people believe that they are victims of a biological error and are severely imprisoned in a body that is incompatible with their subjective perception of gender.

It is difficult to surprise anyone with a sex change operation in our time. Plastic surgery actively meets people who want to find their true "I" even with such radical methods.

Surgical change of female to male usually includes: removal of the mammary glands and correction of the shape of the nipple, removal of the uterus, ovaries and fallopian tubes, removal of the vagina or its surgical closure, creation of the penis.

Aesthetic correction methods such as liposuction excessive body fat, changes in the shape of the calf muscles and chin. Changing from female to male is considered more problematic than changing from male to female. This is due to the highest complexity of the operations for the reconstruction of the genital organs.

Sex reassignment surgery

Operation steps

The procedure for changing sex in all cases takes a very long time and is carried out in stages. The first two stages are preparatory. They can last over a year. Only then the surgeon proceeds to the final stage - the operation itself.

First stage- this is a confirmation of transsexuality (inconsistency of biological and social sex).

The second stage is long-term hormone therapy.

The role of hormones in the human body is extremely high, they regulate not only secondary sexual characteristics, homeostasis and body temperature, but also other functions. Before starting hormone therapy, it is necessary to make a complete examination, excluding infectious diseases, anemia and abnormalities in the liver.

And only after that third stage- gender reassignment surgery. On average, the passage of all three stages takes about two years.

It is known that an American human rights activist, actor and writer, as well as the son of the famous singer Cher - Chez Salvatore Bono (nee Chastite San Bono) underwent the operation to change the female gender to the male one.

Indications for surgical change of female to male

Contraindications to surgical reassignment of female to male

Contraindications to surgical sex change are the following factors:

lack of a confirmed diagnosis of transsexuality by specialists in the field of gender dysphoria;
severe mental and systemic diseases;
alcoholism;
homosexuality;
old or too young (under 18 years old) age.

The indication for gender reassignment surgery is transsexuality. The presence of transsexuality must be identified and confirmed by qualified professionals.

Surgical change of female to male

Sex change is carried out in several stages. Some operations can be performed simultaneously, some require a pause between repeated surgical interventions.

Surgery to remove the mammary glands

This surgical intervention is performed under general anesthesia, the postoperative period is an average of 14 days. The procedure is performed either through a periareolar incision (in cases where the breast is small), a peripheral incision (used in cases where the patient has medium-sized breasts), and a vertical incision (when large breasts need to be removed). After this operation, it is necessary to go through a long recovery period.

An oophorectomy is an operation to remove the ovaries and fallopian tubes. But before the appointment of an oophorectomy, it is necessary to carry out two diagnostic manipulations: hysteroscopy (examination of the uterus) and salpingoscopy (examination of the fallopian tubes). They are performed under general anesthesia. Only after the doctor is convinced that the woman does not have neoplasms, especially oncological ones, is an oophorectomy performed. The operation to remove the ovaries and fallopian tubes can be performed by laparoscopy (this is a less traumatic surgical intervention) or by conventional abdominal surgery. In both cases, the operation is performed under general anesthesia. The postoperative period after laparoscopic intervention takes an average of up to 6 days. After abdominal surgery, sutures are removed on the 7th day, and the duration of the rehabilitation period depends on the patient's health, but in any case, it will take at least a month.

Surgical reconstruction of female genital organs into male

Metoidioplasty is carried out in those patients who, with the help of hormone therapy, have received an increase in the clitoris over 6 centimeters. The new urethra is created from the mucous membrane of the vaginal tissue, and the average length of the penis after surgery is 5 centimeters. In the postoperative period, it is necessary to use a urinary catheter for two weeks.

After metoidioplasty, there is a very low number of postoperative complications, and the erogenous zones retain their sensitivity. Moreover, it is a one-step operation. But the penis after the operation does not have a penetrating ability.

Allows you to create a full-fledged penis from an aesthetic point of view, which has adequate dimensions. At the same time, he will have high sensitivity and the ability to perform penetrative sexual intercourse, which is achieved by placing an erectile prosthesis in the vagina.

It should be noted that phalloplasty is a long and complex operation that requires tissue grafting (as a rule, skin tissue is taken for transplantation either from the thigh, or forearms, or abdominal cavity).

Instruction

Within one and a half to two years, take hormones, take tests for the hormonal background of the body. Visit a psychologist. Get registered with an endocrinologist, sexologist and psychiatrist. Obtain from the latter the diagnosis F64.0 (“Transsexualism”) necessary for the future operation and change of documents.

Watch your health, because hormones for transsexuals, especially feminizing ones, have serious side effects and are dangerous for the body. Partially compensate for these phenomena by taking vitamins and a healthy lifestyle, without alcohol and smoking.

Come for an interview with the head of the commission that issues paid permits for biological sex correction operations and has the necessary license. There are only two such commissions in the country, in Moscow and St. Petersburg. Submit several paid psychiatric tests in his direction within two to three weeks from the psychologist of the commission. Get a commission call. Its date depends on the results of the passed tests.

Visit the commission and get a certificate-permission. A refusal will follow only if you have poor test results, and psychiatrists and a psychologist have doubts about the correctness of the initial diagnosis of F64.0. Contraindications are psychiatric diseases, alcoholism, drug addiction, homosexuality, antisocial lifestyle, the absence of visible signs of HRT.

Register on transgender forums. Monitor plastic surgery clinics in Moscow and St. Petersburg and find out if it is better to operate. If you have money, a passport and, preferably, knowledge of English, then it is better to go to one of the clinics in Thailand. With a certificate from the commission to the selected surgeon or call him.

Agree on the type, date, time and cost of an unscheduled operation. Such operations are not free of charge. You can be denied only in case of some serious chronic illness. For example, HIV, hepatitis C, liver cirrhosis, severe diabetes. But usually they do not refuse, but take additional precautions.

Not earlier than two weeks before the operation, do a clinical and biochemical blood test, a coagulogram, a general urinalysis, as well as tests for HIV, syphilis, hepatitis B and C. If you have an operation under general anesthesia, for example, or a mastectomy, removal of milk glands in FtM (transition from a woman to a man), then a fresh electrocardiogram is also needed. An analysis for a blood type is given if you do not have a mark about it in your passport.

If the operation will be performed in the groin area, then remove the possible hair with a razor. You can have a light dinner the night before, but you should avoid food and water eight hours before the operation. Some doctors also recommend temporarily stopping hormones, but this is not a prerequisite.

Give the surgeon a certificate-permission of the commission and the conclusion of the clinic where you took preoperative tests. Sign the contract, pay the money. The cost, for example, of bilateral orchiectomy, castration at MtF (transition from a man to a woman) is 30 thousand rubles. The cost of vaginoplasty is over 200 thousand.

If the operation is performed under local anesthesia, like a bilateral orchiectomy, then carefully listen to the instructions of the surgeon. Answer the questions asked to check your condition. In FtM, everything - mastectomy, hysterectomy (removal of the uterus and ovaries) and phalloplasty (creation of an artificial penis from one's own skin) - are done under general anesthesia.

When getting up from the table after the operation is completed, be careful. If you go straight home, as is usually done after an orchiectomy, to save money, most MtFs, then ask a relative or acquaintance to help you in advance. Be sure to drink or eat something light after the operation - yogurt, kefir, banana. Stay in bed for the first two days.

If the operation is more complicated, then try to stay in a paid hospital for a few days. It will not be possible to go to the general free ward due to the lack of a new passport and the legal recognition of the gender reassignment. Learn and write down all the surgeon's recommendations for the treatment of the operated site. For example, as bougienage in vaginoplasty.

note

Transsexuality appears in a person by nature, and subsequently is not eliminated or treated. Hormonal and surgical therapy partially removes only its main symptom - dysphoria. This is a discrepancy between a person's appearance (biological or passport sex) and his gender (mental) content - towards the second.

An important condition for obtaining a commission opinion is the so-called coming out. Translated from English - "opening". This means that a transsexual MtF, who was born in a male biological field and has only a man's documents, must live in society as a woman for at least a year. With an appropriate name and feminine appearance. And the transsexual FtM is obliged to live as a man with a masculine appearance.

Without a transgender operation in Russia, it is almost impossible to change documents, find work and livelihood.

Helpful advice

Be sure to take a certificate from the surgeon about the operation and a copy of the license of the clinic. After recovery, you need to come with them to the registry office to change the birth certificate and full name. After that, you will receive another certificate from the registry office - to change your passport and all other documents.

A bit of history about gender reassignment surgery

The first intervention on a transsexual was carried out in Denmark in 1931. But until the mid-60s, these operations remained unique. Everything has changed since the second half of the last century. The first specialized clinics where transsexuals were helped arose in France. In 1978, the International Association of Surgeons Specializing in Sex Reassignment Surgery was established in the United States. In the USSR, for the first time such an intervention was carried out before 1991.

How does sex change happen?

The first stage of preparation for surgery is a visit to a psychiatrist, who, through the necessary research, will make sure that surgery is really a necessity. If this is indeed the case, the person will be given a certificate stating that he is a transgender and is absolutely mentally healthy.

If the operation is necessary for a full life, a person who decides to change sex is prescribed a course of hormonal drugs. In women, after such hormone therapy, menstruation completely stops, hair growth increases, and the voice becomes low. In men, facial features become more feminine.

According to doctors, changing the sex from female to male is much more difficult than from male to female, and the number of successful operations is several times lower. This fact is due to the fact that the male genital organs are much easier to transform into female ones - for this, a semblance of a vagina is recreated from the penis, and the labia from the scrotum. If such an operation is done with high quality, and at the same time it is successful, even gynecologists will not be able to guess about the sex change during the examination.

hormone therapy is one of the most important stages of preparation for surgery. To reduce the level of sex hormones, transsexual women are prescribed antiandrogens and estrogens, in some cases additional intake of other female hormones is required. For men who decide to change sex, it is very important to reduce testosterone levels to a minimum.

Hormone therapy must have been given to the person at least nine months prior to the procedure. One month before sex reassignment surgery, hormones are discontinued.

Indications and contraindications for surgical reassignment of female to male

The indication for gender reassignment surgery is transsexuality. The presence of transsexuality must be identified and confirmed by qualified professionals.

Contraindications to surgical sex change are the following factors:

lack of a confirmed diagnosis of transsexuality by specialists in the field of gender dysphoria;
severe mental and systemic diseases;
alcoholism;
homosexuality;
old or too young (under 18 years old) age.

How to prepare: physically and mentally

And yet, despite the prevalence of this practice around the world, do not forget: gender is the most important trait that defines individuality. Sex change is the most serious change that can happen to a person, so you need to change sex with great care.

Before an operation, a person undergoes a long preparation in several stages. To establish the diagnosis, a psychiatric examination is carried out. Social adaptation and hormonal adjustment are also required. Sex reassignment surgery is not performed if the psychiatric examination shows that the person is unsure of his decision. After the diagnosis of transsexualism is made, the patient has to undergo a year-long test: he must live as a member of the opposite sex - only in this way can one be sure of the correctness of the decision.

Hormonal preparation includes taking hormonal drugs. This is necessary, because the transformed person will be forced to accept them all his life.

Permission to correct the floor is given under the following conditions:

awareness of the discrepancy of one's gender at an early age and a constant feeling of sexual discrepancy;
periodic observation by a sexologist for at least a year;
examination for a month in a stationary clinic;
the risk of suicide due to a mismatch between internal self-perception and real gender;
lack of homosexuality and mental illness;
the presence of a sufficient level of social adaptation in the new conditions of life.

Upon successful completion of the training, a person receives permission for sex reassignment surgery, and all he has to do is find a suitable clinic.

Surgical change of female to male

Sex change is carried out in several stages. Some operations can be performed simultaneously, some require a pause between repeated surgical interventions.

Surgery to remove the mammary glands

Ovariectomy

The operation to remove the ovaries and fallopian tubes can be performed by laparoscopy (this is a less traumatic surgical intervention) or by conventional abdominal surgery. In both cases, the operation is performed under general anesthesia. The postoperative period after laparoscopic intervention takes an average of up to 6 days. After abdominal surgery, sutures are removed on the 7th day, and the duration of the rehabilitation period depends on the patient's health, but in any case, it will take at least a month.

Surgical reconstruction of female genital organs into male

Phalloplasty allows you to create a full-fledged penis from an aesthetic point of view, which has adequate dimensions. At the same time, he will have high sensitivity and the ability to perform penetrative sexual intercourse, which is achieved by placing an erectile prosthesis in the vagina.

The operation is carried out in three stages:

First step- creation of the urethra
second phase- creating a penis
third stage– the design of the glans penis and the creation of a scrotum with artificial testicles.

The passage of three stages usually takes the patient at least a year.

After female to male reassignment surgery

In the postoperative period, physical activity should be limited. Sex life until the surgical area is completely healed is not recommended. The patient should visit the attending physician to monitor the progress of healing.

Sex change from male to female

Preparation

The period of preparation for the operation includes a comprehensive examination of the body and a psychological examination. It is important that a person understands how difficult the operation is ahead of him, how many procedures he will have to go through. If the patient expresses strong consent, hormone therapy is prescribed to him. Before undergoing surgery, it is important to make sure that the body tolerates all prescribed drugs well, because after the operation, a person will have to take them for life.

Hormonal drugs

It is known that not only the genitals change after a sex change operation, but also the hormonal background of a person. Few people know, but it is hormone therapy that makes it possible to transform as much as possible, and not the surgical manipulations on the body themselves. Taking estrogens gives femininity: the face and its features are softened, rounded, hair growth on the body decreases, the voice becomes higher and more melodic.

Taking androgens, on the contrary, makes facial features coarser, voice - low, provokes the growth of hair on the face and body. Reception of hormones should be lifelong. Officially, this is called hormone replacement therapy, it should be selected by the doctor individually for each patient. However, in Russia there are difficulties with prescribing drugs for people who have experienced a sex change, so many patients choose drugs for themselves, significantly risking their health.

How is the operation going?

Sex reassignment surgery is a procedure in which the external genitalia are replaced by surgical procedures with organs of the opposite sex. It is important to understand that even if the manipulations performed by the doctor create visually aesthetic and correct genitals, the person will forever lose his reproductive ability. And getting sensual pleasure will also be a big question.

Sex change from male to female is carried out faster in time. During the operation, the doctor removes the penis, and from its flaps and fragments of the intestine forms the female vagina. But the transformation from a woman to a man lasts at least one year. First of all, the surgeon removes the organs of the female reproductive system. And only after 10-12 months the male penis is formed from the clitoris.

Other procedures

After hormone therapy and surgery, the process of gender transformation can already be considered complete. But many people prefer to go all the way, improving their body.

The list of procedures includes:

laser hair removal;
breast augmentation with implants;
correction of facial areas with fillers.

Rehabilitation

The rehabilitation period after a sex change from a man to a woman or vice versa is aggravated by a period of physical recovery after surgical interventions and psychological adaptation to a new gender role. If the preparation for the operation was correct, and the person admitted to the operation does not have somatic pathologies that can interfere with the recovery period, there will be a minimum number of contraindications.

Physiological risks

The risks that a transgender transition carries can be divided into psychological and physiological. Physiological includes any complications that can occur after surgery.

Namely:

blood poisoning;
hematomas;
tissue infection;
scars
loss of tissue sensitivity;
swelling;
bleeding.

Almost all of these complications are reversible. That is, for some time a person will have to face physical discomfort and postoperative difficulties, but after a period of rehabilitation, a person’s well-being is completely normal. As a rule, the surgeon gives the patient recommendations, following which, you can minimize all the undesirable consequences of the operation. If complications nevertheless arise, it is necessary to report them to the doctor or medical personnel as soon as possible.

Psychological risks

Despite the fact that a change of sex from a man to a woman or the reverse transformation is a welcome event in the life of a person who has decided to take this step, often the period of adaptation to a new gender role leads a person to an emotional crisis. There are cases when a person went to the doctor again with a request to return his former gender. Suicide has also been reported.

Sex change trends in the world

Sex reassignment surgery is a fairly common practice these days. For example, in Britain between 2000 and 2010, 853 men went under the surgeon's knife to become women. However, only 12 women underwent surgery to become men. In 2000, only 54 gender reassignment surgeries were performed, and in the past this figure had risen to 143.

The average age of a person undergoing sex reassignment surgery is 42 years. For comparison: in the United States, from 100 to 500 sex change operations are performed annually. However, Thailand and Iran remain the leaders in the number of surgical interventions.

The Islamic Republic of Iran lives according to Sharia law, but since 1979, by decree of Ayatollah Khomeini, the spiritual leader of the Islamic Revolution, gender reassignment operations have been allowed there. Basically, the operation is decided by men who have discovered homosexual inclinations in themselves. Cohabitation with a person of the same sex is a crime in Iran and is punishable by death, so local gays agree to turn into women.

The operation is considered a valid alternative and way of life in this country. “Islam can cure those who want to change their gender,” says Khoyatol Islam Muhammad Mahdi Karminia, an Iranian clergyman responsible for addressing gender issues. In his opinion, such an operation is as insignificant a “sin” as turning wheat into flour, and flour into bread.

In order to get a referral to a clinic, an Iranian citizen needs to be diagnosed as transgender, after which he receives permission to wear women's clothes. In Iran, sex reassignment surgery costs about $5,000, but if the patient does not have the specified amount, the state pays up to 50% of the cost.

After the operation, the woman is given a new birth certificate, and since transgender women often experience problems with employment, the state provides them with a loan to develop their own business.

As a result of this policy, Iranian surgeons perform more gender reassignment surgeries than physicians in any other country (with the exception of Thailand), and the number of transgender people in Iran is estimated to be about 20,000.

Thailand is the leader in the number of gender reassignment surgeries. According to Buddhist beliefs, katoi and ladyboys (as they call transsexuals or transvestites who have partially changed sex) are just unfortunate souls punished for their deeds in a past life in such an extravagant way. By the way, there they belong to individuals of the third sex. The cost of sex reassignment surgery is one of the lowest in the world, with a very high level of medical care.

The high popularity of gender reassignment among young Thais has seriously worried the government about a possible demographic crisis. Officially, about ten thousand transsexuals live in the country, but in fact there are several times more of them. Basically, these people are engaged in the field of sex tourism and bring good profits to the state in the form of an inexhaustible flow of tourists.

Many families deliberately send boys to the panel for earnings, remaking them into girls: their figures are most suitable for European standards of a woman - thin, long-legged, etc. Thais, on the other hand, have a different physique and cannot “earn” much.

Despite this, Parliament has recently introduced a number of restrictions on the conduct of operations. Now all citizens wishing to change their gender must reach the age of 18, undergo a mandatory psychiatric commission and wait more than a year for a decision on admission to the operation. All this time, candidates are required to wear clothes of the opposite sex.

Famous people who changed gender

Andreas Krieger - athlete from the GDR
The Wachowski sisters are film directors
Dana International - Israeli singer
Balian Buschbaum - German athlete, transgender man
Brandon Tina is a victim of a hate crime
Chaz Bono - Cher's son, LGBT rights activist, writer, actor and musician
Billy Tipton - American pianist, saxophonist and jazz musician
Thomas Beaty - the first "pregnant man"
Kim Petras - German singer
Andrea Pejic is an Australian model.
Elliot Fletcher - actor, musician, LGBT rights activist

Sex change and religion

In 1989, the Islamic Law Academy of the World Islamic League ruled that it is haram (forbidden) to change the sex of a man who has reached full puberty, as well as a woman who has reached full puberty. These actions belong to major sins. The person who committed such an act should be punished, because it is equivalent to changing the creations of the Almighty.

Birth of children

Women who have changed their gender to male can become pregnant under certain circumstances. To do this, a person must save the uterus and stop taking hormonal drugs. Several similar cases of pregnancy are known. So, for example, in Austria, a woman who changed her sex gave birth to a child. She retained her uterus during sex reassignment surgery. The child was conceived naturally.

Changing gender, male and female, is a serious act, making which, it is important to understand that there may be no turning back. Of course, you can do a second operation and return the genitals to their former appearance and stop taking hormonal drugs. But any interventions affect human health, so a second operation may cause contraindications. In addition, when returning to the previous sex, reproductive functions and sensitivity of the genital organs will not be returned.

The diagnosis of "transsexualism" is still interpreted by many as something "non-medical" and condemned by society. But people who have experienced this disease, like any patient, most of all want to be cured. And often only surgery can help them. About how gender identity disorders are treated, what stages patients have to go through, we will talk with PhD, plastic surgeon Igor Valerievich Gulyaev.

- Igor Valeryevich, how long have you been doing gender reassignment surgery?

I have been doing gender reassignment surgery since 2003, since graduation from the institute. In the very first year of residency, when I got to the Russian Scientific Center for Surgery (RNCC named after academician B.V. Petrovsky of the Russian Academy of Medical Sciences), the very first operation that I saw in this department was a sex change operation. It was a phalloplasty (penis reconstruction) in a patient with a non-standard situation. A variant when the gender is erroneously determined. In the maternity hospital, he was identified as female, and phenotypically it was a man. The operation was carried out by Professor Ruben Tatevos Adamyan, my teacher and mentor. After distribution to the residency, all young residents are assigned curators. I was very lucky that Professor Adamyan became my curator.

- How could it happen that the child was given the wrong gender at birth?

The patient had false hermaphroditism, one of the symptoms of which was an underdeveloped and split scrotum, which looked like a large labia. In cases of true hermaphroditism, the sex is determined by the parents. And when there are phenotypic signs of sex, it is necessary to determine the karyotype, i.e. set of chromosomes in cells.

Hermaphroditism and transsexualism are two different things.

Is hermaphroditism also a variant of transsexuality?

Hermaphroditism and transsexualism are two different things. Hermaphroditism refers to genetic pathologies. Transsexualism - to pathologies of a psychiatric profile. There is a big difference here.

A hermaphrodite is a person who has both of these phenotypic traits. A transsexual is a patient who has the phenotypic characteristics of one sex, and he has self-awareness as a representative of the other sex.

- Are there any other cases when it manifests itself at the phenotype level?

There is an adrenogenital syndrome, when there is an underdevelopment of external sexual characteristics, to the extent that the sex can be determined incorrectly. Girls have atresia (underdevelopment) of the vagina.

- Do you treat all pathologies of this profile?

We only deal with transsexualism. All other options are the profile of either urologists, or gynecologists, or related specialists. They solve issues that need to be addressed at a very early age. We work with people over 18 years old, or from 15 years old with the permission of their parents.

- I.e. Are your main patients transsexual?

Yes, we take people with a diagnosis "Nuclear form of transsexualism". There are 2 forms of this disease: subclinical, and nuclear, which is characterized by extreme rejection of one's appearance and the desire to change sex to the opposite. We work with the second group of patients. Previously, it was believed that they could be cured with the help of psychiatry. Various methods were used, in particular, insulin coma, electroshock therapy. But we realized that it doesn't work. You can suppress or break a person, but you cannot solve the problem.

- Are there any bureaucratic obstacles?

We (surgeons) are the final link. First, the patient comes to the psychiatrist. There he is observed, diagnosed, determined how to help. The patient comes to the surgeon with a conclusion signed by a commission of doctors and a psychiatric diagnosis. A psychiatrist may recommend different options for changing sex:

only passport,
passport sex change with hormonal therapy,
sex reassignment surgery.

There is a standard requirement for such operations. The psychiatrist should write in the conclusion: “surgical sex reassignment is indicated” or “surgical sex reassignment is not contraindicated” or “social adaptation can occur only after surgical sex reassignment”.

- According to your statistics, what type of sex change is more in demand: from a man to a woman or vice versa?

According to our (Russian) statistics, for every four or five patients who want to turn from a woman into a man, there is one patient who wants to become a woman. But according to world statistics, the situation is slightly different. In Europe it is 2:3. In Southeast Asia, 9:1, that is, a significant advantage in favor of those who want to become a woman.

- Do Muslim countries have such problems?

In Muslim countries, this is viewed extremely negatively. As far as I know, such operations are prohibited in official medicine in Muslim countries. I had several patients from Muslim countries and the North Caucasus, and these were always extremely closed people who almost always had to completely cut off relations with their relatives and friends. By the way, this is not only found in Muslim regions.

However, the rejection of others is not the biggest problem. The main problem of such patients is the lack of financial ability to perform an operation on themselves. It is difficult for them to get a job - after all, their appearance is very different from passport data. Where personal presence is required, it is impossible to work. For them, the way out is remote work, which does not require facial identification.

It turns out a vicious circle: a person cannot earn money to have an operation that will allow him to have an appearance corresponding to the sex, which will allow him to work at a normal job and earn money ...

- What operations are included in the complex of sex reassignment operations?

Since most of the time we make a man out of a woman, The first operation is the removal of the mammary glands. Mastectomy for transsexualism is inexpensive here, we get practically nothing from this operation, but this operation gives the patient the opportunity to receive new documents, rehabilitate himself socially, and find a job. Sometimes that's all there is to it.

- On the basis of what it is possible to change the passport, where the other gender will be indicated?

The only legal way is on the basis of a certificate that we issue, stating that an organ-removing operation was performed, which led to an irreversible sex change from such and such to such and such. For the registry office, this is a document that is legally the basis for performing registration actions. If the registry office for some reason refuses patients at this stage, the documents can be changed through the court, which most often takes the side of the patient.

- What other operations are included in the complex of operations to change the sex from a woman to a man?

The phasing of the gender reassignment process is key. The patient can stop at any stage if he feels that this is enough for social rehabilitation. For some, hormone therapy alone is sufficient.

Usually the minimum set: removal of the uterus with appendages and removal of the mammary glands. Next step: perineal plasty so that the patient can urinate standing up. This is also a certain sign of belonging to the male sex. The operation allows you to lengthen the female urethra, bring it to the base of the clitoris. Further operations: phalloplasty (formation of the penis), urethroplasty (the ability to urinate through the penis).

Phalloplasty is performed with reinnervation- using a musculocutaneous flap on a vascular pedicle from a fragment of the latissimus dorsi muscle. Such a muscle retains the ability to contract. This can be considered an imitation of an erection. The same operations are performed on patients who have undergone amputation of the penis. Moreover, the resulting penis is quite functional, and this is the second fundamental principle of these operations: not just aesthetics, but also function. A few years ago we had a patient who lost his penis as a result of Fournier's gangrene. We performed an operation on him using the same technology as in the treatment of transsexualism. He started a family and even recently had a baby!

There is another version of phalloplasty based on clitoral plastic surgery. This option avoids a voluminous and expensive microsurgical operation with a flap taken from the back. On hormones, the clitoris hypertrophies. From this hypertrophied clitoris, we can make a small penis using local plastic techniques. Outwardly, it no longer looks like a female crotch, but like a man's microfallia. For those patients for whom function is not as important as social belonging is important, such an operation is enough.

- Now let's talk about those patients who, on the contrary, want to become a woman from a man ...

The first stage is neovaginoplasty. We create primary sexual characteristics - neovagina. There are two options: the use of penile tissues and the use of a fragment of the intestine. When the plastic is due to the tissues of the penis, we use all its components and tissues of the scrotum. The modeled perineum has a high aesthetic similarity to the phenotypically female, and through the delicate preservation of structures, we can achieve erogenous sensitivity.

It happens that it is possible to achieve a very good result, so that the partner of a woman (who has become her from a man) may not notice anything. Let me give you a funny case from our practice. We had a patient who, after a transgender operation, married a very wealthy person in Europe. She always flew to Russia for any illnesses to be treated by doctors she knew. But one day, in Germany, she was hospitalized with renal colic. She had an MRI, and the doctor saw the prostate in the pictures (the prostate is not removed during transgender surgery). He was extremely surprised, since outwardly there were no signs that the patient could suspect the operations performed.

Plastic surgery due to the sigmoid colon is an abdominal operation that requires lengthy preparation. For us, it is the operation of choice when it is impossible to perform plastic surgery using the tissues of the penis (for example, with a very small penis), because if a vaginoplasty has already been performed, but unsuccessfully.

When transplanting the intestine, a fragment of the sigmoid colon is used, which is rotated towards the small pelvis on a vascular pedicle. We perform the operation together with a coloproctologist. The intestine is taken laparoscopically by a coloproctologist, then it is inserted into the neo-vagina. We are required to form the vestibule of the vagina.

After vaginoplasty, and sometimes even before it, patients who have changed their gender to female undergo endoprosthesis replacement of the mammary glands, face feminization operations, and reduce the Adam's apple. In addition, you can turn to phoniators - they work with the timbre of the voice.

So, the stages of surgical treatment for gender reassignment F-M:

Mastectomy
Removal of the uterus and appendages
Perineal plasty (perineal urethroplasty)
phalloplasty
Stem urethroplasty
Aesthetic operations

Stages of surgical treatment for gender reassignment M-F:

Vaginoplasty
Mammoplasty
Aesthetic operations.

- Which transition is technically more difficult to perform - from a woman to a man or from a man to a woman?

It is more difficult from a woman to a man. This operation requires two major microsurgical interventions: skin grafting for penile reconstruction and urethroplasty.

Each stage involves a long hospitalization (5-7 days the patient is in the hospital, does not get out of bed. Such restrictions are necessary. If the patient stands up, there is a difference in vascular pressure. This can lead to vasospasm, thrombosis of the vascular pedicle. Therefore, until the wall of the vessels is primarily afflicted, the patient must lie down.

- And what is the rehabilitation during the transition from a man to a woman?

I also need strict bed rest for about 5 days. The skin sheath made of the tissues of the penis, which we invert into the position of the vagina, is fixed with a special stent. During this time, the tissues begin to “grow” to the walls of the tunnel we have formed. The patient must lie down all this time, otherwise the neovagina may simply “turn out” out.

Let's talk a little about hormone therapy. Do these people have to take hormones for the rest of their lives?

Yes. They are taken even before the operation. Moreover, some patients themselves begin to take hormones long before they decide on surgical treatment. It is especially easy to find female hormones - these are pills sold without a prescription in any pharmacy.

There is a very famous endocrinologist with whom we cooperate - Svetlana Yurievna Kalinchenko. Specialist specifically in endocrinology of the genital area, hormone replacement therapy. Many of our transgender patients come to her.

- And how did this area of surgery originate - sex reassignment surgery?

The pioneer in the surgical sex change was the Soviet surgeon Viktor Konstantinovich Kalnberz. He began to do such operations back in the 60s of the last century. At that time, the well-known surgeon Boris Vasilyevich Petrovsky was the Minister of Health. He was categorically against such operations and, to put it mildly, did not approve of Kalnberz's work, he even wanted to send him to compulsory psychiatric treatment! So gender reassignment surgery was a gamble for both doctor and patient. Indeed, in the USSR there were strict laws - for homosexuality they were imprisoned. And transsexuals were counted among them.

- Which of the foreign specialists can you name the most significant figures in the surgical sex change?

Harry Benjamin. He was the first in the world to describe transsexualism as a mental illness, and was a pioneer researcher in the field of gender identity disorders. He clearly distinguished transsexualism from transvestism.

- Do repeated surgeries happen in this area, when the result was not satisfactory for the patient for the first time?

They happen, but rarely. Operations of this profile are not a profitable direction. From the point of view of a plastic surgeon, it is easier to make money on a conventional augmentation mammoplasty. And in our case, this means several years of work and management of the patient, complex microsurgical operations. Very few surgeons take on such things.

- Do gender reassignment operations involve a large operating team?

Yes, as usual, 2 surgeons, assistants, an anesthesiologist and nurses. Phalloplasty takes 3-4 hours. Urethroplasty - 5-6 hours. These are complex operations. Theoretically, you can do them alone. But it is much easier if they are carried out in a team.

- After all these operations and hormone therapy - how long do such patients live?

Of course, any operation and hormone replacement therapy leave an imprint. There are statistics from the International Association for the Study and Treatment of Gender Dysphoria named after Harry Benjamin, which brought together specialists around the world in the treatment of transsexualism (surgeons, endocrinologists, psychologists, psychiatrists). According to their statistics, such patients live 5-7 years less than ordinary people.

In Russia, there are no statistics yet, since these operations began to be done en masse not so long ago.

- In our country, general military service. How to deal with it? If a woman becomes a man, is she (he) drafted into the army?

There were comical cases when such people received a summons. But this is quickly resolved. A person comes to the medical commission - where the doctors understand everything.
And if a man has become a woman, then everything is simpler - he is already a woman.

How long does such treatment take?

We recommend that there be at least six months between stages. If with FtM transformation 4-5 stages - this is 2.5 years. Further aesthetic operations can still be performed: phalloprosthetics, scrotoplasty, etc. With MtF transformation, the time is shorter.

- Describe the most suitable type of patient for such operations.

In our practice, the most successful case was when a 12-year-old girl applied. The parents realized what problems their child had, and the girl began to take hormones. As a result, by the time of puberty, the contours of the body were formed according to the female type. We, as surgeons, by the time of puberty (16 years old) have very little left to add to our appearance.

- It is impossible to bypass the issue of the cost of operations, since for many this is a decisive factor. How much do such operations cost, and are there quotas and opportunities for free treatment?

In Russia, the vast majority of such operations are commercial. There are no official quotas. Sometimes it turns out to get them through urological quotas, but it's difficult.

For our part, we try to carry them out at the lowest possible cost, since these are not wealthy patients. Our goal is to help.

In the process of changing a woman into a man, the first stage, mastectomy, is quite inexpensive - 95-100 thousand rubles, including anesthesia, hospital and everything else. And subsequent complex operations - phalloprosthesis, urethroplasty - can cost up to 500 thousand rubles and more.In the case of a change from a man to a woman, the first stage, vaginoplasty, costs 230-250 thousand rubles. Plastic surgery of the sigmoid colon costs from 350-400 thousand rubles.

- And what is the situation with prices for transgender operations abroad?

Their prices are much higher. But, for example, in Germany, some of these operations can be done at the expense of public funding. As a German citizen, you can expect to pay for the main stages.

- Do people from other countries come to us for treatment? How do such patients resolve issues with documents?

Basically, they come from the CIS countries. We draw up the entire sequence of changing documents according to Russian rules. But there are legal agreements between the CIS countries, when documents made here are accepted there and do not require an apostille.

Igor Valerievich, thank you for such a detailed story! Of course, there are still many nuances in transgender operations that we have not discussed, but this material is already enough to understand the scope of the problem and the main stages of its solution.

drgulyaev.ru