The operation to change the female to male. How to make a man out of a woman

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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. A month before sex reassignment surgery, hormones are canceled.

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

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.

Ovariectomy

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 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.

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.

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). After surgery, a urinary catheter must be used for two weeks.

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 with it 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 doctors 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.

Earlier this year, Denmark became the first country to de-classify transgenderness as a mental disorder. This was done so that transgenderness was not associated with the concepts of "problem" or "diagnosis". Scientists are inclined that the mental health of transgender people is more dependent on external factors (discrimination, lack of support), and not on the fact that gender identity does not match the biological sex. Perhaps this is the position of the WHO: a new version of the International Classification of Diseases, ICD-11, should be released next year. In the meantime, in many countries, legal gender recognition and sex-transforming operations only after a person who has decided to change sex is diagnosed with a gender identity disorder - transsexualism. Afisha Daily talked to doctors and a transgender woman about how sex reassignment is going on in Russia.

Susanna

At school, I was a black sheep. I was teased for my baggy clothes and a detached look, but no one knew about my transgender, so it was not. I began to have a severe rejection of my own body at the age of 12: I stopped looking in the mirror, I was very shy of myself and watched with horror the changes that took place during growing up. The older I got, the more clearly I understood that I could not accept myself the way nature made me.

I carefully hid all these thoughts from my parents: I think otherwise they would have sent me to a psychiatric hospital. For many years I portrayed a worthy son, studied well, graduated from the university and became a programmer. I must admit, it took me a long time to realize that my life was fake. And when it came, crises began to happen. I was saved by running and auto racing - with their help it was possible to drown out despair for a while. And yet during that period I had two suicide attempts.

Mom could not accept me: somehow she said in her hearts that it would be better if I were a killer

One day my cousin got suspicious and hinted to my parents that I didn't want to be a man. We had a conversation, I did not deny it. Mom could not accept me: somehow she said in her hearts that it would be better if I were a killer. My parents stopped communicating with me - I think it was a balanced decision. I was 25 years old, and I realized that I could sit back and wait for the next crisis or give myself a chance at another life. I decided to jump into nowhere: I packed my things and moved to Moscow. She rented an apartment in a residential area, got a job and ate doshirak for two years in order to save money for a full transition.

Transgender transition is not just plastic surgery and hormone therapy. On the one hand, you cannot live with this body, on the other hand, not only self-awareness is important, but also how society perceives you. The decision is difficult to make psychologically: the transition is associated with health risks, and you also constantly encounter bureaucracy. To obtain permission for surgical correction and drug therapy, a psychiatrist's certificate is required, and for this you need to pass a medical commission. In order to do this in a state institution, you must first be observed by a psychiatrist for about two years, so I decided to go through a commission in a private clinic. It cost about 30 thousand rubles. I was diagnosed with transsexualism.

My beloved and I met shortly before the vaginoplasty, and he knew about my transgender from the very beginning. It didn't interfere with our feelings.

I could not find a competent endocrinologist, so I still self-medicate. A prescription for preparations of female sex hormones is not needed, and I am looking for information on how to take them in English, because there are almost no quality materials in Russian. I started with drugs, and then I did breast augmentation. I started the transition while working for a large company. I confess that I was counting on a milder reaction from my colleagues. There was a hard ignore, jokes, ridicule. Many stopped saying hello. The girls staged a boycott - they could leave the toilet when I went there. The men openly expressed contempt. In addition, they began to talk with me about the dress code: they discussed what is possible and what is not, although I tried not to stand out. My mother has always been a model of style for me: I unconsciously learned from her, and now I was finally able to use these skills. I was then supported by two friends from work and a loved one. We met shortly before the vaginoplasty, and he knew about my transgender from the very beginning. This did not interfere with our feelings, but it prevented intimacy. He is an ordinary man, so he had a psychological barrier. The most he could afford was a hug. The operation lifted these restrictions.

My breast was operated on in Thailand, and I decided to do vaginoplasty in Moscow - it seemed that this should simplify the procedure for changing documents. The operation went well, but, unfortunately, I could not avoid complications. The inflammation led to an abscess and required surgical treatment. As a result, the rehabilitation period was very long, and I spent more than 300 thousand rubles on plastic surgery and treatment (in Thailand, plastic surgery would cost 700 thousand rubles). The doctor recommended to have vaginal sex six months after the operation, but even after two years this is a problem for me, because the pain has not gone away. I don't feel unhappy at all though - vaginal sex was not the goal of my transition.

It was very funny to me when someone at a previous job said: “You decided to become a woman so that you can live easier”

I haven't been able to change my documents yet. At first they refused to register, and now there are difficulties in court. The problem is that it is necessary to provide a certificate with the seal of a medical institution on the performance of an irreversible operation, and instead I have an extract (epicrisis), where there is a lot of unnecessary information: symptoms, body temperature - but the main thing is missing. There seems to be a real possibility that a forensic examination will be ordered. I look forward to this with trepidation.

After the transition, I got a new job in a large Russian company. I have documents in a man's name, so I had to dump - to sell myself to the employer cheaper because of the peculiarities of my candidacy. This state of affairs suits everyone. In this office, few people know about my past, but some women guess, so it’s difficult for me to fit into their company. With men, there is another point: many people think that since I'm a girl, it means I'm dumber. But I'm used to the fact that you need to break through, and I try to respond to sexist jokes with banter. It was very funny to me when someone at a previous job said: “You decided to become a woman so that you can live easier.” Life easier? No, it's the opposite of a challenge. Everything has become much more difficult. But I do not regret anything - the main thing is that now I can be myself and my life has finally settled down.

Olga Demicheva

Endocrinologist

Before the doctor on the scales there are two bowls: the benefits for the patient and the risks for the patient. Any medicine has undesirable effects, treatment is always associated with certain risks. But there is also a benefit, in this case it is associated with the request of the individual. Sex change is not a whim. People who have suffered for their decision, who fought for it, who have come a difficult path, turn to the doctor.

Let's remember how WHO is health. Experts cite a number of concepts, and the first place among them is the quality of life. Every day for an unsocialized, unsatisfied person is suffering, even if he is young and physically healthy. If we can get rid of this suffering, then we must do it. As a doctor, I think: everything that is given by nature and proceeds safely is good, I am sharpened to store, protect and support it. But when a person comes to me with the need to change sex, I must treat him as a patient and treat him, working on his quality of life and doing everything in my power to make life as long as possible.

You will have to receive drugs all your life so that the body does not realize itself according to its hormonal program.

I do not think, that the endocrinologist needs the preliminary conclusion of the psychiatrist. If, after talking with the patient, I consider that it is impossible to start therapy without consulting a psychiatrist, I will refer to a psychiatrist. If such a need does not arise, we will discuss with the patient the timing of the idea. I will suggest waiting and thinking for a while as when applying to the registry office. After all, these are serious changes in life, so the decision should mature and be not spontaneous, but conscious.

The genetic program dictates the order in which certain sex-related hormones are produced. In physically healthy people, the external signs of sex are a manifestation of the sexual genotype. If a woman is injected with male hormones, she will look like a man, but her genotype will remain female. And vice versa, a man will remain genetically a man, even if he outwardly turned into a woman due to the introduction of female sex hormones and the suppression of the action of male ones. You will have to receive drugs all your life so that the body does not realize itself according to its hormonal program.

The medical literature tells how and in what doses to prescribe replacement therapy for sex reassignment in order to obtain the desired effect. This is information for physicians, but patients also have access to it. There are foreign, mostly English-language websites with advice for transgender people. It is important to understand that these recommendations are not universal. Uncontrolled intake of hormonal drugs increases the risk of developing serious diseases and conditions (for example, osteoporosis, atherosclerosis, thrombosis, obesity). In addition, self-medication may not give the desired effect (for example, external signs of genetic sex will be observed due to incorrect dosage).

Andrey Istranov

Plastic surgeon, Doctor of Medical Sciences, Professor of the Department of Plastic Surgery of the First Moscow State Medical University named after I.I. I.M. Sechenov

When we talk about, we are referring to the standard by which the mammary glands are considered female secondary characteristics. Of course, we know that not all women have large mammary glands, it's just that often this is not evident in conjunction with everything else. When a person changes sex, he usually wants to emphasize secondary signs with the help of an operation. But besides this, there are certain facial features, features of female and male anatomy. Recently, the number of operations for feminization and masculinization of the face has increased: patients want to increase or decrease the nose and superciliary arches, change the cheekbones, and the shape of the chin. There are also operations that allow you to change the contours of the body - liposuction and lipofilling (introduction of fat). Surgically, you can reduce the Adam's apple. And more and more often combined operations are carried out, when several changes are made at once.

It is a great joy to receive SMS from a patient: “Hurrah! Today I experienced an orgasm for the first time after the operation.

One of the principles of sex-transforming operations is the principle of minimum sufficiency. There is no limit to perfection, so it is worth stopping when changes are enough for social adaptation. Someone needs vaginoplasty for this, someone needs vaginoplasty and breast plastic surgery. Everything is individual. Over the past 10-15 years, the requirements for the result have greatly increased, and sometimes the modern possibilities of surgery do not meet them. There is a lot of low-quality information around, unverified data. A person reads an article that magic pills save from all diseases or that a patient was operated on almost yesterday, and today she is already experiencing an orgasm. It’s hard to believe in all this, but I really want to, and some have internal expectations that medicine is not yet able to fulfill.

During the formation of the penis or vagina, it is possible to preserve erogenous sensitivity, but its recovery after surgery takes two to eight months. There are different methods. In women, we can keep elements of the clitoris or camouflage it under the skin at the base of the penis. In men, we take tissue elements that are located on the head of the penis and the inner surface of the foreskin, place them inside the vagina or form the clitoris from them. It is a great joy to receive SMS from a patient: “Hurrah! Today I experienced an orgasm for the first time since the operation.” But first, the pain syndrome must go away - it is important to correctly conduct the postoperative and rehabilitation period. Also, a person needs time to re-find points of irritation and ways to stimulate them. It's like learning to walk all over again.

In the clinic where I operate, vaginoplasty costs an average of 150-200 thousand rubles. To change documents in our country, you need a certificate stating that the patient has undergone an irreversible operation, and usually medical institutions issue it. However, difficulties can still arise. Registry offices often refuse if they have not had such a precedent in the past. In this case, you need to go to court, which, in my experience, always makes a positive decision in favor of the patient.

Artem Gilev

Psychiatrist

We can only speak of gender identity disorder as a disorder if it causes significant discomfort to the patient, unrelated to the desire to make the transition. This desire in itself is not a problem. Of course, this position has opponents, but after all, homosexuality used to be classified as a mental disorder.

To make the transition, you need to have a very strong nervous system

The problems of people with transgenderism largely arise from the reaction of society. A person is being bullied, he cannot find support anywhere. He goes to a psychiatrist, and he tells him that he is a fool or a schizophrenic. The thought of going transgender, like any other, can be caused by a thought disorder in schizophrenia, but this is a very rare case. For someone, the doctor not only makes a wrong diagnosis, but also says: “We will not change the sex, we will treat you.” Very often, all this leads to a neurotic disorder, the risk of depression and suicide increases. Our whole system makes it so that a person begins to have real mental health problems. Initially, there was no need for treatment. To make the transition, you need to have a very strong nervous system. There is a huge pressure, rejection from relatives, friends and colleagues. If everything was normal in society, a psychiatrist would be needed only to get a certificate. The same formality as when obtaining a license or applying for a job.

I know that now a long-term observation by a psychiatrist is necessary to obtain a certificate. This is wrong, because our task is to diagnose, and usually this can be done in one hour of a good conversation. It does not take two years to suspect schizophrenia and make a diagnosis. If doubts arise - which happens infrequently - you can involve a psychotherapist, get the opinion of fellow psychiatrists by collecting a commission. If a person has a depressive or anxiety disorder, a doctor may prescribe medications and psychotherapy, but not to cure the desire for gender reassignment. The same psychotherapy in this case teaches useful skills that allow you to improve the quality of life, while remaining yourself.

In the last decade, gender reassignment surgery has become a common phenomenon. Although modern society is still biased towards transsexuals, many still decide to embark on this difficult path of transformation from a man to a woman and vice versa. What will a person who wants to change their gender have to face? How is the operation of changing gender from male to female? What are the risks? "Popular about health" will help to understand these issues.

Where to start a man who wants to become a woman?

The gender transition process is quite complicated. It is necessary to go through, as they say, all the circles of hell. It all starts, of course, with making a conscious decision. If a guy has been experiencing discomfort in his body since childhood and suffers because of his gender, then he has a chance to change everything. However, the decision should not be made on emotions, because of resentment towards the partner or other circumstances. The next stage of reincarnation is a visit to a psychiatrist.

A man needs to register with this doctor and be observed by him for at least a year. The psychiatrist conducts many conversations with the patient, prescribes the necessary tests to find out if there really are no other ways to solve the patient's problem. If the medical commission establishes the fact that the guy is really a transsexual, then he will eventually be issued an appropriate certificate. It also states that no other mental abnormalities were found in the patient. This means that the decision was made consciously. The next step is hormone therapy.

Taking hormones as part of the transformation of a man into a woman

After receiving the conclusion of a psychiatrist, a man must be tested for hormones. Based on their results, it will be seen what dosage of hormones should be prescribed to the patient. Hormone therapy is a long process, taking pills before surgery is carried out for 9 months. It is impossible to skip or change the dosage, the doctor should adjust the doses, based on the results of the tests (they are taken every one and a half to two months).

What changes occur to a man as a result of taking female hormones? The features of his face gradually soften, acquiring femininity, the body also changes - the hair on the face, legs, arms disappears, the figure is slightly rounded. What hormones should a man take? Most often it is estrogen. Sometimes the doctor considers it necessary to include progestogens in the course of hormone therapy. Hormone intake is stopped at least one month before the planned date of the operation. After surgery, it is necessary to take female hormones for life. And how the operation itself proceeds, you will learn further.

operation from man to woman

From the point of view of anatomy and surgery, it is easier to turn from a guy into a girl. The operation is performed in a hospital and lasts from 5 to 8 hours (depending on the complexity). What exactly does a surgeon do? First, he removes the male testicles. The future vagina and clitoris are formed from the tissue of the penis, the scrotum is used to form the labia.

If this tissue is not enough, then a section of the sigmoid colon or skin taken from the man's forearm is used.

In parallel, the surgeon will have to perform other plastic surgeries - mammoplasty (breast augmentation) and face correction. The surgeon must work with the patient's cheekbones, nose, if necessary. Such operations are successfully performed in Russia and other countries. Most of these transformations are done in Thailand. In this country, they are loyal to transsexuals. There are about 15 thousand of them. The cost of a sex change operation from a man to a woman in sunny Thailand is almost three times lower than in other countries.

Who should not undergo gender reassignment surgery??

The following factors serve as grounds for refusing to carry out such an operation:

1. Age up to 18 years.

2. Absence of a psychiatrist's report or detected mental abnormalities.

3. Homosexuality.

4. HIV, AIDS, hepatitis.

5. Diseases of the liver, heart.

6. Other possible health problems for which surgery is contraindicated.

What are the predictions for a successful outcome of sex reassignment surgery??

Any operation is associated with the risk of infection, this must be understood from the outset. Heart problems may arise during the introduction of anesthesia, and it should not be ruled out that the transplanted tissues may not take root well. It is also important to mention the nuance that after the operation, the patient's life expectancy is reduced. Hormone intake plays an important role in this regard. However, in almost 80 percent of cases, the outcome is favorable.

In addition to the risks of harming health, the patient will face many psychological problems. He will certainly face misunderstanding among his entourage, relatives, it is also worth mentally preparing for this. After changing gender, a man who has turned into a woman needs to go through many procedures with identity documents.

Sex change from male to female is a long and difficult process which requires patience, awareness, willingness to make sacrifices for the sake of your well-being. It is very important to weigh everything many times before making a decision, because there will be no turning back.

Transsexuals are people who do not feel like a person of their biological sex. Often this manifests itself in childhood: in habits, behavior, interests, the desire to wear clothes of one's real gender, and not given from birth. It is important to distinguish transsexuals from transvestites. Transvestites are cisgenders (people whose gender is the same as their biological sex) who wear women's or men's clothing as entertainment, a fetish, or as a stage persona. Transvestites have no desire to change sex.

As for transsexuals, from an early age they strive to show their difference from their peers of "their" sex. This is expressed in appearance, behavior, hobbies, etc. Often they tend to copy the social roles of the gender in which they feel themselves. Often they meet with aggression and misunderstanding on the part of peers, and sometimes parents. Constant pressure can cause serious psychological trauma, the suicide rate among transsexuals is very high.

According to the latest research by scientists, statistics have been derived that show that transgender men (male to female) are one third more than women (female to male). This may be due to the fact that for women, the operation is much more difficult and dangerous.

It is also important to understand that transsexuals and homosexuals are not the same as many believe. People who show same-sex attraction most often do not experience problems with self-identification. Homosexuals rarely go for gender reassignment surgery.

These days, transgender people can change sex through hormone therapy and surgery to change the shape of their genitals. However, the full transition process takes a very long time, the operations are complicated, and the hormones that a person is forced to take all his life shorten its period.

Reasons for transsexualism

Genetics is, changes in the psyche or something else, is still not clear. It is thoroughly known that 100% does not lead to transsexuality:

• upbringing;
• environment;
• culture;
• stress;
• hobbies;
• sexual orientation;
• TV and books;
• radiation, etc.

In some cases, a number of mental disorders are mistaken for transsexuality, which are treated with the help of psychotherapists or psychiatrists. It is for this reason that before changing sex, a transsexual must undergo an examination by a psychiatrist in order to exclude possible diseases.

Preparing for gender reassignment surgery

The practice of gender reassignment is global, although public attitudes towards it in different countries can vary from acceptance to discrimination. Gender is the basic component that allows you to identify yourself. Changing gender from male to female and vice versa is a serious decision that should not be made on a momentary basis. There is no way back, this decision must be approached with all seriousness.

Some people give up the decision to change sex already at the stage of communication with a psychologist, having carefully weighed their decision. A referral for sex reassignment surgery cannot be obtained if, after a psychiatric examination, it is clear that the person is hesitant in his decision. After the diagnosis of transsexualism is made, the patient must be observed by doctors for a whole year and show that his decision is final.

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

• the patient has been aware of his belonging to the opposite sex since childhood or most of his conscious life;
• biological sex brings strong psychological discomfort;
• a transsexual has been seen by a sex therapist for 1 year or more;
• all necessary examinations were carried out in the hospital;
• no urge to commit suicide;
• no mental abnormalities;
• the patient is fully socially adapted to his new gender.

If the long preparation is successful, the transsexual gets permission for corrective surgery and hormone therapy. It remains only to choose a doctor and clinic.

How are gender reassignment surgeries performed?

This is a long process that begins long before the operation itself. A transsexual must undergo a long course of hormone therapy so that the body naturally begins to change according to the male or female principle. It takes months, and only after a course of hormonal drugs can the final plastic surgery be performed.

You will have to take hormonal preparations with male or female hormones for the rest of your life, since they are not produced naturally in the body.

In the process of gender reassignment, the reproductive function will be completely lost, so if the patient wants to have a child, this should be thought about in advance. Changing sex will not work back, the hormonal background and the reproductive system will be irrevocably disrupted. If the decision is really right, then a new life will bring joy and satisfaction with oneself. After a biological sex change, a transsexual will only have to change documents.

The hardest thing will be for women who want to change their gender to male. It will take many operations to create at least a semblance of a male member. This is not always successful and if unsuccessful, the patient will be forced to constantly wear a catheter to divert urine. The danger and complexity of operations is perhaps the only reason why many women limit themselves to hormone therapy and breast removal.

Male to female change operation

To create a vagina, a man's penis and testicles are completely removed. The female genital organs are formed from the remnants of the skin and scrotum, and a fragment of the intestine is taken to simulate the vagina.

Important! The testicles are removed only after hormonal therapy, which allows to reduce the level of androgens as much as possible.

When the testicles are removed, male hormones in the body are practically not synthesized, which allows you to reduce the dose of drugs. After the operation, now the patient will have to drink estrogens. It is possible to give the body female forms not only with hormonal therapy, some agree to plastic surgery to increase the breasts and buttocks. But only a few agree on the removal of ribs for a thin waist.

The operation to change the female to male gender:

As for women who want to become men, operations are not so effective. It is almost impossible to form a full-fledged penis - there is too little "source material". The size of the clitoris is clearly not enough to surgically make a penis out of it. The clitoris may enlarge during hormone therapy, but not too much.

Attempts to create a penis in FtM can be made only after the removal of the ovaries, at least a year must pass from the moment of the operation. According to statistics, about 50% of patients decide on the operation, being content only with the removal of the mammary glands.

What are the dangers of gender reassignment

The main danger of the operation is its irreversibility. Removed genitals cannot be returned, so if the decision is made too hastily, this is a real tragedy. Other risks differ little from other operations:

• long recovery period due to the large number of operations;
• poor-quality work of surgeons can lead to inflammation, divergence of sutures, etc.

If the uterus is not removed from FtM, the possibility of becoming pregnant, enduring and giving birth to a child remains.

Postoperative rehabilitation

The last step is to change documents. After that, the person changes sex physically and socially. The support of the environment is very important, especially when it comes to the family. Many transsexuals may attempt suicide in the post-operative period due to pressure or harassment from the people they care about the most.

Unfortunately, rejection by family and society is not the only reason for suicide attempts among transsexuals who have successfully changed their sex. A hasty decision to have an operation and the inability to return to the previous state is a serious trauma for the psyche.

Gender reassignment is a serious decision that starts from childhood. At an early age, manifestations of transsexualism do not look threatening: girls wear trousers and like to play football, boys wear dresses and play with dolls. With age, problems of self-identification often disappear, but remain a large percentage people who feel uncomfortable in their own body. This is what transsexuals are.

In order to change the physical state to the opposite sex, one should undergo a long course of treatment, perform an operation, and then take hormones to change the sex of transsexuals. Hormone therapy (feminization or masculinization) after surgery continues throughout life.

What is transsexualism?

Transsexualism is a psychiatric disease characterized by a mismatch between gender identity and physical condition. This diagnosis should not be confused with homosexuality. As well as men's love for women's attire and underwear, this is fetishism. That is why it is very important to undergo an examination by a psychiatrist before changing sex, who will make an accurate and correct diagnosis.

Sex reassignment therapy is a treatment for transsexualism, and if the diagnosis is correct, then it is mandatory. Modern medicine offers a large number of procedures that allow you to favorably turn a man into a woman, or a woman into a man. But such a decision should be considered, because there is no turning back.

Changing the sex of a man or woman begins with a medical examination and obtaining permission. Without fail, a transsexual is examined by an endocrinologist, gynecologist or urologist, plastic surgeon and psychiatrist. It is the psychiatrist who gives the final conclusion, which allows or forbids the patient to undergo sex reassignment surgery. If the transgender is approved, hormone replacement therapy is given before the operation.

Hormone replacement therapy before sex reassignment surgery

Hormone replacement therapy is an aggressive method of influencing the body, which helps to bring the patient's appearance in line with the desired sex. Due to the influence of male or female hormones, the gonadal synthesis of hormones decreases. The result of synthetic saturation with hormones is a decrease in the production of luteinizing and follicle-stimulating hormones of the pituitary gland, which are responsible for stimulating the sex glands.

Thus, taking a synthetic sex hormone of the opposite sex, the body stops the natural production of hormones, which inhibits the natural signs of belonging and provokes the development of secondary sexual characteristics. Hormone therapy does not have the ability to influence the development of the genitals of the opposite sex. This will require an operation.

The appointment of hormone therapy begins with a blood test to determine the initial amount of hormones. Such studies are cyclical every 2 months. This frequency is minimal, most often the analysis is taken once a month. The duration of taking hormones is 8 months. Then a monthly break is made and surgical intervention is performed.

After the sex reassignment surgery, the transsexual is prescribed lifelong hormone therapy. The use of hormones after the removal of hormone-producing organs is mandatory. Otherwise, the body begins to die. All organs, skeletal system, muscle tissues, etc. suffer.

With favorable hormone therapy, transsexuals come into full external conformity with the chosen sex. Transsexuals are no different from normal men and women.

Hormonal feminization

If a biological man wants to become a woman, estrogen and progesterone are selected. If necessary, the course includes antiandrogenic drugs. There is a large number medicines based on estrogen hormones. They are used in the form of gels and patches. The most popular form are tablets. The dosage of drugs is determined strictly by the attending physician.

When taking estrogen in men, secondary sexual characteristics appear more expressively. Changes in the amount of hair on the body and their localization, breast size, skin quality, musculature and fat distribution, the size of the prostate and genitals (in the preoperative period).

• Breast. Hormone replacement therapy promotes the development of full-fledged mammary glands. Breast size under the influence of hormones grows up to 2-3 sizes in a few years. Nipples and halos change in accordance with the growth of the mammary glands. This result contributes to the rejection of surgical breast implantation.
• Hair cover. Hair growth on the face and body is significantly reduced due to long-term use of hormones. The hairs are not completely eliminated, their structure weakens, the hairs become thinner. Initial softening occurs on the limbs, then in the chest, shoulders, abdomen, around the areola, in the armpit and on the pubis.
• Leather. While taking hormonal drugs, the skin becomes softer and silky. With proper skin care and sun protection, the look of a transgender girl will be feminine and attractive.

• Muscle mass. A large role in the formation of broad shoulders, arms and chest is played not by the skeleton, but by the muscle mass of a person. Under the influence of estrogens and antiandrogens during feminization, most of the muscle mass disappears. A transsexual woman's body will appear in 2-3 years.
• Distribution of fat. At the beginning of hormonal feminizing therapy, significant changes occur in the body regarding the subcutaneous tissue. Fat deposits will accumulate in the thighs and buttocks, and the male tendency to accumulate fat in the abdomen will weaken. Thanks to this distribution of fat, the figure of a transsexual will become more refined and feminine.
• Prostate. Under the influence of female sex hormones, the prostate gland gradually decreases in size. Often, female hormones are used in the treatment of benign prostatic hyperplasia, which is accompanied by painful urination and incontinence. In transsexuals, the risk of development and course of this pathology disappears, since estrogens have a therapeutic effect.
• Genitals. Hormone replacement therapy before surgery helps to reduce the size of the testicles. This process occurs due to blocking the production and activity of testosterone, which is responsible for the function of the testicles. The patient has a decrease in sexual desire and erection. There is also a decrease in ejaculate. The discharge becomes scanty and colorless.

After the operation and removal of the testicles, estrogens continue to be taken, and the need for the use of antiandrogens disappears.

It is very important not to self-medicate when treating transsexualism. Some, guided by the thoughts "there is no limit to perfection", begin to use more estrogen. This can lead to negative consequences, including increased blood clotting, thrombosis, embolism, etc. High doses of estrogen cause hormonal imbalance, which leads to disruption in the work of all systems and organs.

What effects should not be expected from feminization?

Among all the positive factors and physical changes that occur during hormone replacement therapy, there are those male characteristics that do not change under the influence of female sex hormones.

Facial hair is the most undesirable factor for transgender women. With the help of hormones, the hairs on the face become softer, lose their density, thickness and dark shade, but hormone replacement therapy cannot ensure the complete disappearance of the beard and mustache. In order to get rid of facial hair, transsexual women should resort to the help of cosmetologists. To date, there are a large number of cosmetic procedures that provide a long-term slowdown in hair growth on the body and face.

Under the influence of female sex hormones, the timbre and pitch of the voice does not change. To get the desired result, many doctors recommend vocals, as this helps them hone the femininity of the voice. The second option for eliminating the male voice is surgery, which is a surgical correction of the tone and resonance of the voice.

But also transgender people should deal with manners. Work on oneself is an important component in sexual transformation, which requires long-term work and patience, as well as increased perseverance and determination.

Hormonal masculinization

If a biological woman wants to become a man, male sex hormones androgens, in particular testosterone, are prescribed. The intake of male hormones stimulates the growth of hair on the face and chest, coarsens facial features and voice timbre. Very often, the action of hormones affects the size of the legs and hands, they increase significantly.

Reception of testosterone is carried out only by injection. Doses are determined by the attending physician.

Removal of a hormone-producing organ (ovaries) is not an indication to stop taking hormonal drugs. After the operation, only the dosage changes.

How is gender reassignment surgery performed?

Before the operation, the patient undergoes a long preparation, which can be up to 3 years. The preparatory course includes psychological adaptation to a new gender role and hormone replacement therapy.

Change male to female

The change of male to female is a common phenomenon. The surgeon faces a difficult task - to change the male genital organs to female ones (a vagina is formed from the tissues of the scrotum), to enlarge the chest and make the face more feminine (by changing the cheekbones and chin, rhinoplasty).

The external genitalia are formed by several methods:

• The penal inversion method is the simplest. Within 5 hours, the vagina is formed from the skin of the penis. This method is possible if the length of the penis is more than 12 cm.
• The method of skin grafting from the penis and scrotum is longer. The operation takes about 7 hours. In the course, a vagina and labia of normal size are created. If there is not enough material, additional skin is taken from the forearm. This operation is indicated for small penis size.
• The most difficult method is the modeling of the genital organs using the sigmoid colon. Side effects (nausea, vomiting, and other bowel complications) may occur after surgery.

After the operation, the patient stays in the hospital for 5-6 days under the supervision of the attending physician. After discharge, the transsexual is advised to limit physical and sexual activity.

Sex reassignment surgery is not the end. The patient is prescribed lifelong hormone therapy, which promotes the development of secondary sexual characteristics.

Change from female to male

Changing a woman's sex to a man's includes removing the breasts, uterus, fallopian tubes, and creating a penis. Operational procedures are carried out in several stages.

• The mammary glands are removed first. Rehabilitation after this operation lasts 3 weeks.
• Next, the ovaries and fallopian tubes are removed by laparoscopy or by abdominal cavity. Recovery takes a week.
• The last to form are the testicles and the penis. Skin for the penis is taken from the thighs or abdomen. The formed penis is 8 cm long.

Phalloplasty is a difficult operation that requires maximum care and skill. After the operation, the patient is under the supervision of doctors for a long time and undergoes a course of psychological rehabilitation. But even a favorable operation does not guarantee the transsexual from the occurrence of undesirable consequences.

Inevitable consequences of gender reassignment

The use of hormonal drugs throughout life will not be able to remain invisible to the physiological state of the body. In any case, transsexuals are at risk of developing severe pathologies of organs and systems. The kidneys and heart receive the main blow from taking hormones.

In addition to the development of cardiovascular pathologies and kidney disease, the use of hormones for sex change negatively affects the reproductive function of both men and women. In both sexes, sexual desire is reduced, which inhibits the ability to achieve and maintain an erection. It affects spermatogenesis and fertility. In other words, long-term use of hormones suppresses the functions of follicle-stimulating and luteinizing hormones, which are responsible for the formation of the fetus. Therefore, transsexuals are subject to infertility.

Transsexual offspring should be taken care of in advance. There are a large number of reproductive centers that provide the service of sperm freezing for further use. This procedure will help people who have changed sex to have children in the future.

And also transsexuals are subject to psycho-emotional failures. Since the fact of a sex change causes an ambiguous reaction among others. Some look at these people with pity, others with disgust. Often close people and relatives who do not understand the decision of a transgender have a strong blow. Therefore, before taking the final step, you should think carefully about your own decision.

Sexual satisfaction after sex change

With the favorable performance of the sex change operation, the quality of sex does not change. But even a normally performed operation does not give 100% guarantees. There are times when transsexuals are disappointed. Gender identity does not depend on certain sexual organs, but on the brain. Therefore, sexual attraction directly depends on the internal state.

Achieving orgasm is also possible for people who have changed sex. But full recovery takes time. For some, this period lasts a month, for others several years, but the results obtained fully justify the hopes of transsexuals.

In any case, when you change sex, both libido and the direction of sexual desire change. For a normal perception of one's desires, it takes time to get used to this turn of events, not only morally, but also physically.

Transsexualism is a psychiatric pathology, which is characterized by a discrepancy between the patient's inner world and his external signs. Treatment of pathology is aimed at correcting inconsistencies, namely, changing the sex of the patient. Only after lengthy procedures, analyzes and studies, a transsexual is prescribed hormonal therapy, which develops secondary sexual characteristics and inhibits the action of natural sex hormones.

The external genitalia are modified with the help of surgical correction. After 2–3 years, the transsexual is no different from the chosen sex. But such a result should be maintained throughout life with the help of hormone replacement therapy. Therefore, before taking such a step, you should think about everything very well.