At home sexual reassignment surgery-Gender Reassignment Surgery |GRS Montreal

The quality and safety in our care and services; Your peace of mind. Excellence is a core value that drives the decisions and actions of every member of our staff. Regarded as the most experienced surgeons in the field of gender affirming surgery, performing over surgeries per year. Care is provided in the spirit of patient support and in consideration of the uniqueness of your own experience. From the preoperative period to your postoperative follow-ups, we will be right beside you.

At home sexual reassignment surgery

At home sexual reassignment surgery

At home sexual reassignment surgery

International Journal of Transgenderism. Georges Burou's pioneering technigue for male-to-female surgical sex reassignment". Pichet from Bangkok Plastic Surgery. The aim of hormone therapy is to make you more comfortable with yourself, both in terms of physical appearance and how you feel. Regular food can be resumed when you are back in your country. When it comes, I eat voraciously, impatient for her to return.

Busty glasses facial. Reader Interactions

If done properly, the post-operative patient can have powerful feelings of sexual arousal erection of the corpora stumps remaining inside her body and can easily be orgasmic the prostate is left intact, and can spasm during orgasm just as before SRS - while the nerve tissues throughout the corpora, the clitoris and the vulva spasm, throb and release at Hentai unisversity same time, just as in any other woman. Courage and decisiveness in seeking gender correction while still young Gay police sex dramatically improve her chances for a full and complete life. Why Choose Dr. Schrang in Novemberin order to bring her results up to modern standards. It is also important to try to get over hang-ups At home sexual reassignment surgery reassignmwnt "OK" and what's "naughty". However, anyone resssignment to Thailand for SRS should make very certain that they are going to one of the handful of reputable surgeons there who are doing high-quality SRS's using modern surgical At home sexual reassignment surgery in the best hospitals. Many healthcare providers require patients to be formally diagnosed with gender reassiggnment and undergo counseling to determine if they are truly ready to surgically transition. Health care and medicine. Families left, and Main Street, once a bustling collection of. Hartan American TB specialist, becomes one of the first female-to-male transsexuals to undergo hysterectomy and gonadectomy for the relief of gender dysphoria. Modern sex hormone therapy, vaginoplasty SRS surgery, facial feminization surgery and cosmetic surgeries can substantially modify an MtF transsexual's body to properly match her innate gender, especially if treatment is started early enough in life. Voice feminization lessons are available to train trans women to practice feminization of their speech. All of the nerves and skin tissue of the penis, for example, can be repositioned in the new vagina and function as a clitoris.

S ix weeks before sex reassignment surgery SRS , I am obliged to stop taking my hormones.

  • All Rights Reserved.
  • Gender reassignment surgery, sometimes called sex reassignment surgery, is performed to transition individuals with gender dysphoria to their desired gender.
  • Learn something new every day More Info

Sex reassignment surgery SRS , also known as gender reassignment surgery GRS and several other names, is a surgical procedure or procedures by which a transgender person's physical appearance and function of their existing sexual characteristics are altered to resemble that socially associated with their identified gender.

It is part of a treatment for gender dysphoria in transgender people. Professional medical organizations have established Standards of Care that apply before someone can apply for and receive reassignment surgery, including psychological evaluation, and a period of real-life experience living in the desired gender.

Feminization surgeries are surgeries that result in anatomy that is typically gendered female. These surgeries include vaginoplasty , feminizing augmentation mammoplasty , orchiectomy , facial feminization surgery , reduction thyrochondroplasty tracheal shave , and voice feminization surgery among others.

Masculinization surgeries are surgeries that result in anatomy that is typically gendered male. These surgeries include chest masculinization surgery top surgery , metoidioplasty , phalloplasty , scrotoplasty , and hysterectomy. In addition to SRS, patients may need to follow a lifelong course of masculinizing or feminizing hormone replacement therapy.

There are numerous other expressions that are used to refer to this type of surgery apart from sexual reassignment surgery and gender reassignment surgery. Some transgender people who desire medical assistance to transition from one sex to another identify as transsexual. A trans man assigned female at birth and seeking masculinizing surgery may undergo one or more procedures, which may include masculinizing genitoplasty , metoidioplasty or phalloplasty.

The result of early transition surgeries was the removal of hormone-producing organs such as the gonads and the uterus. Later, as surgical technique becomes more complex, the goal is to produce functional sex organs from sex organs that are already present in the patient. In the US in , Dr. Alan L. Hart , an American TB specialist, becomes one of the first female-to-male transsexuals to undergo hysterectomy and gonadectomy for the relief of gender dysphoria.

In Berlin in , Dora Richter , became the first known transgender woman to undergo the vaginoplasty [7] surgical approach. This was followed by Lili Elbe in Dresden during — She started with the removal of her original sex organs, the operation supervised by Dr.

Magnus Hirschfeld. Lili went on to have four more subsequent operations that included an orchiectomy , an ovary transplant, a penectomy , and ultimately an unsuccessful uterine transplant , the rejection of which resulted in death. An earlier known recipient of this was Magnus Hirschfeld's housekeeper , [8] but their identity is unclear at this time.

All surgeries that Lili Elbe underwent are techniques used today for male-to-female sexual reassignment , and have developed for greater success since the s. In , Dr. Harold Gillies , a plastic surgeon active in World War II, worked to develop the first technique for female-to-male SRS , producing a technique that has become a modern standard, called phalloplasty. Following phalloplasty, in , the procedure for metoidioplasty was developed for female-to-male surgical transition by Drs.

Lebovic and Laub. This allows the patient to have a sensation-perceiving penis head. As of , [update] some European countries require forced sterilization for the legal recognition of sex reassignment.

Many transgender persons present with health conditions including diabetes, asthma, and HIV, which can lead to complications with future therapy and pharmacologic management. Typically, a patient's treatment involves a healthcare team consisting of a variety of providers including endocrinologists, whom the surgeon may consult when determining if the patient is physically fit for surgery. People with HIV or hepatitis C may have difficulty finding a surgeon able to perform successful surgery.

Many surgeons operate in small private clinics that cannot treat potential complications in these populations. Some surgeons charge higher fees for HIV and hepatitis C-positive patients; other medical professionals assert that it is unethical to deny surgical or hormonal treatments to transgender people solely on the basis of their HIV or hepatitis status.

Other health conditions such as diabetes , abnormal blood clotting , ostomies , and obesity do not usually present a problem to experienced surgeons. The conditions do increase the anesthetic risk and the rate of post-operative complications. Surgeons may require overweight patients to reduce their weight before surgery, any patients to refrain from hormone replacement before surgery, and smoking patients to refrain from smoking before and after surgery.

Surgeons commonly stipulate the latter regardless of the type of operation. SRS does not refer to surgery performed on infants with differences in sex development intersex.

Sex reassignment surgery performed on unconsenting minors babies and children may result in catastrophic outcomes including PTSD and suicide—such as in the David Reimer case, following a botched circumcision when the individual's sexual identity determined by neuroanatomical brain wiring is discrepant with the surgical reassignment previously imposed. Burns School of Medicine, University of Hawaii recommended that physicians do not perform surgery on children until they are old enough to give informed consent and to assign such infants in the gender to which they will probably best adjust.

Diamond believed introducing children to others with differences of sex development could help remove shame and stigma. Diamond considered the intersex condition as a difference of sex development, not as a disorder. Sex reassignment surgery can be difficult to obtain due to financial barriers, insurance coverage, and lack of providers. An increasing number of surgeons are now training to perform such surgeries.

Some treatment may require a minimum duration of psychological evaluation and living as a member of the target gender full-time, sometimes called the real life experience RLE sometimes mistakenly referred to as the real life test RLT before sex reassignment surgeries are covered by insurance.

Standards of Care usually give certain very specific "minimum" requirements as guidelines for progressing with treatment, causing them to be highly controversial and often maligned documents among transgender patients seeking surgery. Alternative local standards of care exist, such as in the Netherlands, Germany, and Italy.

Many surgeons require two letters of recommendation for sex reassignment surgery. At least one of these letters must be from a mental health professional experienced in diagnosing gender identity disorder, who has known the patient for over a year.

Letters must state that sex reassignment surgery is the correct course of treatment for the patient. Many medical professionals and numerous professional associations have stated that surgical interventions should not be required in order for transsexual individuals to change sex designation on identity documents. In some jurisdictions legal gender change is prohibited in any circumstances, even after genital or other surgery or treatment.

In June , the American Medical Association AMA House of Delegates stated that the denial to patients with gender dysphoria or otherwise covered benefits represents discrimination, and that the AMA supports "public and private health insurance coverage for treatment for gender dysphoria as recommended by the patient's physician.

In , the United States Defense Health Agency for the first time approved payment for sex reassignment surgery for an active-duty U. The patient, an infantry soldier who identifies as a woman, had already begun a course of treatment for gender reassignment. The procedure, which the treating doctor deemed medically necessary, was performed on November 14 at a private hospital, since U. The array of medically indicated surgeries differs between trans women male to female and trans men female to male.

For trans women, genital reconstruction usually involves the surgical construction of a vagina , by means of penile inversion or the sigmoid colon neovagina technique; or, more recently, non-penile inversion techniques that make use of scrotal tissue to construct the vaginal canal. For trans men, genital reconstruction may involve construction of a penis through either phalloplasty or metoidioplasty. For both trans women and trans men, genital surgery may also involve other medically necessary ancillary procedures, such as orchiectomy , penectomy , mastectomy or vaginectomy.

These require additional surgery to correct and are often fixed by colorectal surgeons. As underscored by WPATH, a medically assisted transition from one sex to another may entail any of a variety of non-genital surgical procedures, any of which are considered "sex reassignment surgery" when performed as part of treatment for gender dysphoria. For trans men, these may include mastectomy removal of the breasts and chest reconstruction the shaping of a male-contoured chest , or hysterectomy and bilateral salpingo-oophorectomy removal of ovaries and Fallopian tubes.

For some trans women, facial feminization surgery , hair implants, and breast augmentation are also aesthetic components of their surgical treatment. The best known of these surgeries are those that reshape the genitals, which are also known as genital reassignment surgery or genital reconstruction surgery GRS - or bottom surgery the latter is named in contrast to top surgery , which is surgery to the breasts; bottom surgery does not refer to surgery on the buttocks in this context.

However, the meaning of "sex reassignment surgery" has been clarified by the medical subspecialty organization, the World Professional Association for Transgender Health WPATH , to include any of a larger number of surgical procedures performed as part of a medical treatment for "gender dysphoria" or "transsexualism". According to WPATH, medically necessary sex reassignment surgeries include "complete hysterectomy, bilateral mastectomy, chest reconstruction or augmentation Patients of sex reassignment surgery may experience changes in their physical health and quality of life, the side effects of sex steroid treatment.

Hence, transgender people should be well informed of these risks before choosing to undergo SRS. Several studies tried to measure the quality of life and self-perceive physical health using different scales. For instance, trans men obtained a higher self-perceived health score than women because they had a higher level of testosterone than them. Trans women who had undergone face feminization surgery have reported higher satisfaction in different aspects of their quality of life, including their general physical health.

After sex reassignment surgery, transsexuals people who underwent cross-sex hormone therapy and sex reassignment surgery tend to be less gender dysphoric. They also normally function well both socially and psychologically. Anxiety, depression and hostility levels were lower after sex reassignment surgery. In these studies, most of the patients have reported being very happy with the results and very few of the patients have expressed regret for undergoing sex reassignment surgery.

Although studies have suggested that the positive consequences of sex reassignment surgery outweigh the negative consequences, [48] it has been suggested that most studies investigating the outcomes of sex reassignment surgery are flawed as they have only included a small percentage of sex reassignment surgery patients in their studies. Persistent regret can occur after sex reassignment surgery.

Regret may be due to unresolved gender dysphoria, or a weak and fluctuating sense of identity, and may even lead to suicide. Many patients perceive the outcome of the surgery as not only medically but also psychologically important. Social support can help them to relate to their minority identity, ascertain their trans identity and reduce minority stress.

Looking specifically at transsexual people's genital sensitivities, trans men and trans women are capable of maintaining their genital sensitivities after SRS. However, these are counted upon the procedures and surgical tricks which are used to preserve the sensitivity. Considering the importance of genital sensitivity in helping transsexual individuals to avoid unnecessary harm or injuries to the genitals, allowing trans men to obtain an erection and perform the insertion of the erect penile prosthesis after phalloplasty , [56] the ability for transsexual to experience erogenous and tactile sensitivity in their reconstructed genitals is one of the essential objectives surgeons want to achieve in SRS.

Erogenous sensitivity is measured by the capabilities to reach orgasms in genital sexual activities, like masturbation and intercourse. The majority of the transsexual individuals have reported enjoying better sex lives and improved sexual satisfaction after sex reassignment surgery. Hence, they were frigid and not enthusiastic about engaging in sexual activity.

In consequence, transsexuals individuals who have undergone SRS are more satisfied with their bodies and experienced less stress when participating in sexual activity. Most of the individuals have reported that they have experienced sexual excitement during sexual activity, including masturbation.

The female-to-male transgender individuals reported that they had been experiencing intensified and stronger excitements while male-to-female individuals have been encountering longer and more gentle feelings. The rates of masturbation have also changed after sex reassignment surgery for both trans women and trans men. Moreover, trans men also had a lower sexual satisfaction with their sexual life than trans women. Georges Burou 's clinic for transgender women. Burou is considered one of the pioneers of SRS.

India: India is offering affordable sex reassignment surgery to a growing number of medical tourists [63] and to the general population. Iran: The Iranian government's response to homosexuality is to endorse, and fully pay for, sex reassignment surgery.

Thailand: Thailand is the country that performs the most sex reassignment surgeries, followed by Iran. France: Since , France no longer requires SRS as a condition for a gender change on legal documents.

Although Estratest is a somewhat controversial treatment, many natal women began taking it after it was featured in a story on Oprah Winfrey's hugely popular television show in the U. Andrea James SRS vaginoplasty page, which includes an international list of surgeons:. Sex reassignment surgery on infants is sometimes done if a child is born with sexual characteristics that are both male and female. During the late 50's and into the early 60's, a number of intensely transsexual girls in the U. These tablets contain either 1. Quora User , Top Writer People with HIV or hepatitis C may have difficulty finding a surgeon able to perform successful surgery.

At home sexual reassignment surgery

At home sexual reassignment surgery

At home sexual reassignment surgery

At home sexual reassignment surgery

At home sexual reassignment surgery

At home sexual reassignment surgery. Recommended

Looking specifically at transsexual people's genital sensitivities, trans men and trans women are capable of maintaining their genital sensitivities after SRS. However, these are counted upon the procedures and surgical tricks which are used to preserve the sensitivity. Considering the importance of genital sensitivity in helping transsexual individuals to avoid unnecessary harm or injuries to the genitals, allowing trans men to obtain an erection and perform the insertion of the erect penile prosthesis after phalloplasty , [56] the ability for transsexual to experience erogenous and tactile sensitivity in their reconstructed genitals is one of the essential objectives surgeons want to achieve in SRS.

Erogenous sensitivity is measured by the capabilities to reach orgasms in genital sexual activities, like masturbation and intercourse. The majority of the transsexual individuals have reported enjoying better sex lives and improved sexual satisfaction after sex reassignment surgery. Hence, they were frigid and not enthusiastic about engaging in sexual activity. In consequence, transsexuals individuals who have undergone SRS are more satisfied with their bodies and experienced less stress when participating in sexual activity.

Most of the individuals have reported that they have experienced sexual excitement during sexual activity, including masturbation. The female-to-male transgender individuals reported that they had been experiencing intensified and stronger excitements while male-to-female individuals have been encountering longer and more gentle feelings.

The rates of masturbation have also changed after sex reassignment surgery for both trans women and trans men. Moreover, trans men also had a lower sexual satisfaction with their sexual life than trans women. Georges Burou 's clinic for transgender women. Burou is considered one of the pioneers of SRS. India: India is offering affordable sex reassignment surgery to a growing number of medical tourists [63] and to the general population. Iran: The Iranian government's response to homosexuality is to endorse, and fully pay for, sex reassignment surgery.

Thailand: Thailand is the country that performs the most sex reassignment surgeries, followed by Iran. France: Since , France no longer requires SRS as a condition for a gender change on legal documents. France was found in violation of the European Convention on Human Rights for requiring the forced sterilization of transgender people seeking to change their gender on legal documents.

Malta: As late as , transgender people that have undergone SRS can change their sex on legal documents. Spain: Despite a resolution from the European Parliament in suggesting advanced rights for all European Union citizens, as of only Andalucia's public health system covers sex reassignment surgery.

These included requirements of at least 2 years of psychotherapy before health insurance was obligated to cover the cost of SRS [74] [75] and inability to procreate. Ukraine: In , the Administrative District Court of Kiev ruled that forced sterilization was unlawful and no longer required for legal gender change. Canada: Laws regarding legal recognition of gender identity vary from province to province in Canada with most provinces requiring reassignment surgery for a sex change on legal identification.

The United States: Many of the surgeries mentioned in the History section of this article were developed in the United States. Before the legalization of same-sex marriage in the United States, there were several notable Supreme Court cases that did not legally recognize individuals who underwent SRS by invalidating marriages of trans people.

Mexico : As of a law, [79] Mexico City no longer requires SRS for changes of sex on birth certificates, and several states have followed suit. Argentina: In , Argentina began offering government subsidized total or partial SRS to all persons 18 years of age or older. At the same time, the Argentinian government repealed a law that banned SRS without authorization from a judge.

Chile: In , a bill was introduced that stated SRS was no longer a requirement for legal name and sex change. In , Chile's public health plan was required to cover sex reassignment surgery. From Wikipedia, the free encyclopedia. See also: Sex reassignment surgery male-to-female and Sex reassignment surgery female-to-male. Gender identities.

Health care and medicine. Rights issues. Society and culture. Theory and concepts. By country. See also. See also: Transgender rights. The examples and perspective in this section deal primarily with the United States and do not represent a worldwide view of the subject. You may improve this section , discuss the issue on the talk page , or create a new article , as appropriate.

October Learn how and when to remove this template message. Main articles: Sex reassignment surgery male-to-female and Sex reassignment surgery female-to-male. This section needs additional citations for verification. Please help improve this article by adding citations to reliable sources.

Unsourced material may be challenged and removed. Commissioner Reproductive health Sex reassignment surgery female-to-male Sex reassignment surgery male-to-female Yogyakarta Principles. American Society of Plastic Surgeons. Retrieved Traversing Gender: Understanding Transgender Realities. Mystic Productions Press. Retrieved 15 October The term transgender was coined by John Oliven and popularized by various transgender people who pioneered the concept and practice of transgenderism.

It is sometimes said that Virginia Prince popularized the term, but history shows that many transgender people advocated the use of this term much more than Prince. As aforementioned, many transsexual individuals prefer the term transgender, or simply trans, as it is more inclusive and carries fewer stigmas. There are some transsexual individuals, however, who reject the term transgender; these individuals view transsexualism as a treatable congenital condition.

Retrieved 1 November Retrieved 13 June The New York Times. The Economist. Retrieved 2 September December January Medicine, Science, and the Law.

BioMed Research International. Transgender Health. The scandal of genital mutilation surgery on infants pp. May Ed. Sydney: Harper Collins Publishers. Milton Diamond, Ph. Retrieved 1 August Keith October Guidelines for dealing with persons with ambiguous genitalia". Arch Pediatr Adolesc Med. Retrieved 24 April Archived from the original PDF on September 20, See www. NBC News. Charles; Murphy, Gregory P. The Journal of Urology.

Archived from the original PDF on Archives of Sexual Behavior. Quality of Life Research. Journal of Endocrinological Investigation. Fertility and Sterility. The Journal of Sexual Medicine.

International Journal of Transgenderism. Bibcode : PLoSO The Scientific World Journal. Sex Roles. Gender Dysphoria and Disorders of Sex Development. New York, NY, U. A: Springer. Annals of Plastic Surgery. Georges Burou's pioneering technigue for male-to-female surgical sex reassignment".

Current Opinion in Urology. The Hindu. May 7, The urethra is dissected from the shaft of the penis. Figure 6. The corpora cavernosa are separated to assure a minimal stump. Figure 7. The perineal dissection. Figure 8. The perineal dissection has been completed and the anterior flap perforated to position the urethral meatus. Figure 9. The skin flaps are sutured and placed in position in the vaginal cavity. Figure The preservation of the vaginal cavity is assured by use of a suitable vaginal form.

Note 1: Figure 10 is quite misleading and does not correspond to the anatomy the should result from this procedure. In figure 10, the vaginal opening is way too far forward from the anal opening, and the vaginal entry is shown going first in horizontally and then turning upwards after passing a large web of skin in front of the anus.

Compare this sketch with the later photos of the details of modern SRS results, especially the one showing the entry of a vaginal stent into a postop's vagina. This very poorly conceived sketch has likely been the source of many botched surgeries in the early days, as surgeons copying the Hopkins procedure may have thought that a thick web of skin was needed in order to prevent tears into the rectum.

Note 2: Over the years, the techniques for doing SRS have been steadily refined. It has also became common for post-op MtF's to have additional genital surgery called "labiaplasty" that construct further details of the external female genitalia. The result of many years of research observations and clinical practice by Dr. Benjamin became the seminal text on transsexualism.

The book finally identified transsexualism as a distinct, major medical affliction in which patients have an innate gender identity opposite to the genital sex of their bodies. These theories and results obtained considerable attention within the U. Then, following interactions with Dr. Benjamin and some of his patients, physicians at the Stanford Medical Center started a exploratory gender clinic in , led by Norman Fisk, M.

SRS operations were undertaken on selected MtF patients, and the Stanford clinical and surgical results further validated the concept of SRS as treatment for those suffering from intense transsexualism. Acceptance of SRS as a serious and valid treatment for transsexualism began to slowly spread among thought leaders in the U. Hospitals around the country began gradually lifting their bans on transsexual surgeries, and surgeons at various locations began performing these surgeries on small numbers of selected patients in the U.

In Stanley Biber, M. The excellent successes of his surgeries became widely known, and patients streamed to him. For a detailed report from one of Dr. Biber's surgeries, see this Operative Report. For many years Dr. Sex-Change nickname makes Colo. Transformation via surgery has become common in community. There was Elise, a buxom brunette in a crop top and hip-huggers. Kate, a Harvard graduate writer in khakis, hand-knit sweater and pearl earrings.

Thea, a graphics designer sporting chic suede boots. And Jackie, a towering figure in trousers and blazer. In the lunchtime crowd of merchants, housewives and farmers at the Main Street Bakery and Cafe, the four stuck out like fashion models on a pig farm. Retreating to the kitchen, the waitress pulled her boss aside and stammered, "Those women I'm waiting on?

They're men! Hardly anyone else gave the foursome a second glance. Not in the so-called "Sex-Change Capital of the World. Repeat that phrase to, almost any of the town's 9, people and one would likely get a lecture on what the southern Colorado hamlet should be known for - its idyllic scenery, comfortable climate and friendly people. Most don't mind that more sex-change operations have been done in their town than anywhere else about 4, to date ; they just hate that nickname.

Although no formal statistics are kept on the number of sex reassignment surgeries, experts in the field agree that Trinidad's Stanley Biber - because of the year he began and his age - has performed more than anyone.

What makes Trinidad unique is not that it's the sex-change capital of the world, but the fact that this former mining town has come to accept its destiny, depend on it and even embrace it.

In , Trinidad was a town in transition. Coal had been king in these parts since the turn of the century, but after World War II, the mines began closing. By the late '60s, only a few remained. Families left, and Main Street, once a bustling collection of.

Yet Biber was thriving from his fourth-floor office inside the First National Bank building. As Trinidad's-s only general surgeon, Biber did it all - from delivering babies and removing appendixes to reconstructing the cleft palates of poor children.

In those first 15 years, Biber built a comfortable life around a practice he loved and a town he adored. In , he encountered the patient who would forever change both. A social Worker Biber had met asked him to perform her surgery. And Biber asked, "What is that? After consulting a New York physician who had done sex reassignment operations and obtaining hand-drawn sketches from Johns Hopkins University, Biber agreed to do the surgery.

With less than a handful of doctors performing the procedure, Trinidad became THE place to come for a sex-change operation, and Biber was THE man to do it. The town's sole hospital, Mt. San Rafael, was run by Catholic nuns, and Biber hid the charts of his first transsexual patients. But he knew he'd eventually need the approval of the hospital board and his neighbors.

Biber explained his Work to the sisters and local ministers. I went through the psychology of it all. They decided as long as we were doing a service and it was a good service, that there was no reason we couldn't continue doing them," he says.

Soon, Biber was lecturing to the hospital staff and the public. Not all agree. The Rev. Verlyn Hanson, pastor of the First Baptist Church for the past three years says the town turned a blind eye to Biber's work because of the economic boost it provided. At the height of his practice, Biber performed about transsexual operations a year. His patients brought families and friends who remained in town during their loved ones' eight-day hospital stay.

Whether or not people liked what Biber did, they liked the squat, balding doctor who wore jeans and flannel shirts to work and always said hello. At 77, Biber has scaled back his transsexual business to about surgeries a year. The majority of his practice remains tending to the ills of Trinidad's citizens.

He knows retirement may not be far off, and he's in search of a surgeon who will continue his work. Biber was one of the pioneering surgeons of the 20th century. Over a 35 year period beginning in , he performed over sex reassignment surgeries, almost single-handedly establishing SRS as an acknowledged and accepted treatment for transsexualism in the U.

Much beloved by the trans community, Dr. Biber passed away on Monday January, 16, at the age of In this configuration, the penis cannot usually get enough blood supply for full external penile erection.

Even though the external part of the penis cannot erect when tucked tightly, the girl nevetheless experiences the familiar female "glow" and warmth throughout her interior genital region when she is aroused, for example, by a man's warm attentions.

In addition, the corpora cavernosa shafts inside her body can become erect once the girl is sexually aroused, and that arousal feels really wonderful - even though the external part of the penis is flaccid. Sexual stimulation by rubbing and caressing the genital area and the breasts can then lead to orgasm for a girl who is sufficiently aroused.

From experiences like this, preop women can visualize that after undergoing SRS the remaining internal stumps of her corpora will still engorge and become erect, and that she can experience similar feelings of sexual arousal when she is postop.

In addition, the postop woman can now also experience wonderful sensations from caressing her clitoris, which, in contrast to the previously hidden penis, can now be openly played with without her experiencing angst about her body-image. After surgery, some women find that their adrenal glands the other source of testosterone do not produce enough to provide adequate libido or orgasm.

You may require a small amount of supplemental testosterone to regain functioning. The amount required is typically far below the amount that will cause any other unwanted side effects, such as hair growth. Not everyone requires this, but keep in mind that some do. Many natal women who are having difficulty in feeling turned-on and in achieving orgasms especially post-menopausal women are now taking Estratest tablets, which contain a combination of estrogen and small amounts of testosterone.

Although Estratest is a somewhat controversial treatment, many natal women began taking it after it was featured in a story on Oprah Winfrey's hugely popular television show in the U.

As a result of this news, and of advice like that on the Zen page, some post-op women who were experiencing difficulty in arousals and orgasms began using Estratest too, and some report that the therapy helps them.

These tablets contain either 1. There may be some kind of threshold effect involved here, whereby some women need a small amount of testosterone to maintain orgasmic capability. On the other hand, many other postop and post-menopausal women enjoy strong orgasms even in the complete absence of testosterone.

In any event, once a postop woman begins experiencing arousals, the nerves in the clitoris and vulvar surfaces become highly sensitized, and sensual and sexy feeling permeate her body. Then, just as during pubertal sexual awakening, she will automatically feel urges to play with her body and to masturbate. The arousals will gradually intensify as her genital area fully heals from the SRS. Masturbation and sexual activity can likely play a role in helping neural regeneration and sensitivity during this period.

There are many ways to masturbate, but one favorite way for girls to do it is to "rub on a pillow". The girl does this by lying face down on her bed, with a firm pillow between her legs. This way she can rub her vulva and clitoris on the pillow while squeezing it, putting pressure on her clit and also being able to thrust and thrash around. At the same time she can play with her breasts and body with her hands. Alternatively, she can rub her clitoris with the fingers of one hand while squeezing her legs and thrashing around to stimulate her body.

And there are many other ways to stimulate arousals and produce orgasms, including using vibrators and other women's sex toys. Girls discover these ways just as automatically as boys discover "jerking off", even though girls have been more secretive about it our society in the past. While masturbating, the pubertal girl will suddenly begin to experience her first orgasms, and she is then on her way to developing her full sexuality as a woman.

In just the same way, the postop woman needs to explore her new sexual anatomy and masturbate, and learn her new sexual responses and experience her first orgasms as a woman - learning what most girls do in their teens during puberty.

This ongoing pubertal aspect of immediate postop life can be very thrilling and exciting, but also very confusing and scary for the woman, much in the same way that the onset of sexual maturity is for any teenager. Monica's site stresses the need to gain experience with your new sexual responses prior to having intercourse.

It is also important to try to get over hang-ups about what's "OK" and what's "naughty". Then too, many woman enjoy experiencing playful anal stimulation, including using sex toys to overcome inhibitions and enhance arousals.

Most women also learn to use fantasies to trigger and enhance arousals and orgasms. Those fantasies can be used during masturbation, and then later used to help heighten one's experiences during intercourse with a lover. Thus we see that transition and SRS are just the very beginning: They enable the girl enter her new puberty. What she will make of herself as a woman is yet to be determined! The most prominent SRS surgeons in the U. These surgeons are in their prime, are performing hundreds of SRS each year, and are achieving outstanding results in appearance, function and sensitivity.

Marci Bowers, M. Biber, has recently taken over his practice in Trinidad, Colorado and is reported to be doing excellent SRS surgeries there Dr. Biber is now retired.

Suporn" in Chornburi, Thailand. Toby Meltzer, M. Eugene Schrang, M. For information on many surgeons performing excellent vaginoplasty SRS operations both here and abroad, see Andrea's Vaginoplasty page and follow the many links there. There are also a number of surgeons in Thailand who are now performing good quality SRS's, and the costs of surgery there are much lower than for comparable work elsewhere in the world.

This compounded the tragedy of being TS for the small minority of women who had been forced to live "on the streets" and had contracted this dread disease. However, surgical techniques have improved to where SRS can now be done without risk to expert surgical teams, although extra procedures are required that may raise costs.

Christine herself survived life on the streets, and went on to become a successful postop woman. Another link contains a detailed sequence of photos of a labiaplasty performed by Dr. Spanish actress Carla Antonelli's website also contains a very detailed "still-frame-video" sequence of SRS.

And here is a link to a photo of an early surgery done by Dr. Biber in Trinidad, Colorado in Biber became justifiably famous among T-girls in the U. The early surgical technique and results are very similar to Lynn's sex reassignment surgery, which was performed by the famous Mexican plastic surgeon J.

Barbosa, M. Lynn had follow-up surgery for vaginal deepening and labiaplasty performed by Dr. Schrang in November , in order to bring her results up to modern standards. Schrang also has extensive experience in successfully correcting SRS complications surgeries done elsewhere.

Because of their gender condition, many younger transsexuals are unable to obtain good enough employment to save money fast enough to achieve a timely transition. Meantime, they are often doomed to watch as their bodies continue to masculinize even if taking estrogen which makes a successful and complete transition seem further and further out of reach. Recent developments, including easier and earlier access to female hormones and antiandrogens ordered from overseas pharmacy sites via the web.

Easier access to hormones and surgery have made it much easier for young transsexual girls to feminize themselves while young and to achieve complete gender transition while in their twenties. The Thai surgeons do not insist on the full HBIGDA protocol and instead make their own informed decision whether a patient is suitable for SRS , thus greatly reducing the financial burden and logistical complexities of having to go to two counselors or psychiatrists for several years in order to get the letters of approval for SRS required here in the U.

See also Dr. Suporn Watanyusakul's website and photos of recent SRS at his clinic. For another recent example of Dr. Photos of recent vaginoplasty SRS results by Dr. Sanguan Kunaporn. However, anyone going to Thailand for SRS should make very certain that they are going to one of the handful of reputable surgeons there who are doing high-quality SRS's using modern surgical techniques in the best hospitals.

There has long been a tradition in Thailand of doing what superficial "Hijra-style" SRS's which do not create a full vagina. Many Katheoy "working girls" undergo these surgeries, not being able to afford the full SRS surgeries if someone does not need a full SRS, a Kathoey-type surgery might be an option to consider.

Bottom line is that anyone going to Thailand should carefully research the latest information on Thai surgeons, and avoid going to the "lowest bidder" for such an important and life-changing surgery. As an even less expensive alternative, transsexuals in the U. After orchiectomy castration a T-girl's body will not be further maimed by testosterone, and the feminizing effect of female sex hormones is much more rapid and more pronounced especially in younger girls.

This option can enable younger T-girls to rapidly become feminized and passable, and to buy some time to save money for SRS without feeling such desperate urgency. For more information on this type of surgery, see this Orchiectomy page. In the past, many T-girls went to Dr.

Although Dr. Barham required that you had transgender counseling for one year and been on hormone replacement therapy for one year and had passed a recent HIV status test. His protocol involved seeing you at least one day before the procedure to discuss the procedure, the implications and the risks. The procedure was then generally done on the following day in his office. He used bilateral spermatic cord blocks for anesthesia. The procedure itself took approximately one hour. Following the procedure it was best if you can remained in bed with ice packs for 12 to 24 hours.

He also asked that you stay in town for 48 hours, to take care of any problems that might arise, and also to give you a chance to begin healing before returning home. For more detailed information about orchiectomy, see Sherry's website. Sherry is a transgender girl who underwent orchiectomy in as part of her preparation for gender transition. In her website she describes her own experiences and provides a lot of up to date information about orchiectomy, including a list of surgeons.

See also Andrea James' new Orchiectomy page. Anne Lawrence's site contains photos of recent breast augmentation surgery on transsexual women, and Lynn's FFS site contains information on facial feminization.

What is gender reassignment surgery? | ISSM

Back to Gender dysphoria. Treatment for gender dysphoria aims to help people with the condition live the way they want to, in their preferred gender identity. What this means will vary from person to person, and is different for children, young people and adults. Read about how to find an NHS gender identity clinic. Staff at these clinics can carry out a detailed assessment of your child, to help them determine what support they need. Depending on the results of this assessment, the options for children and young people with suspected gender dysphoria can include:.

Most treatments offered at this stage are psychological, rather than medical or surgical. This is because the majority of children with suspected gender dysphoria don't have the condition once they reach puberty. These are synthetic man-made hormones that suppress the hormones naturally produced by the body. Some of the changes that take place during puberty are driven by hormones.

For example, the hormone testosterone, which is produced by the testes in boys, helps stimulate penis growth. They also suppress puberty and can help delay potentially distressing physical changes caused by their body becoming even more like that of their biological sex, until they're old enough for the treatment options discussed below.

The effects of treatment with GnRH analogues are considered to be fully reversible, so treatment can usually be stopped at any time after a discussion between you, your child and your MDT. Teenagers who are 17 years of age or older may be seen in an adult gender clinic. They are entitled to consent to their own treatment and follow the standard adult protocols. Adults with gender dysphoria should be referred to a specialist adult GIC. Others will need more extensive treatment, such as a full transition to the opposite sex.

The amount of treatment you have is completely up to you. The aim of hormone therapy is to make you more comfortable with yourself, both in terms of physical appearance and how you feel.

These hormones start the process of changing your body into one that is more female or more male, depending on your gender identity. They usually need to be taken indefinitely, even if you have genital reconstructive surgery. Hormone therapy may be all the treatment you need to enable you to live with your gender dysphoria. The hormones may improve how you feel and mean that you don't need to start living in your preferred gender or have surgery.

Hormone therapy won't affect the voice of a trans woman. To make the voice higher, trans women will need voice therapy and, rarely, voice modifying surgery. There's some uncertainty about the possible risks of long-term masculinising and feminising hormone treatment.

You should be made aware of the potential risks and the importance of regular monitoring before treatment begins. Hormone therapy will also make both trans men and trans women less fertile and, eventually, completely infertile.

Your specialist should discuss the implications for fertility before starting treatment, and they may talk to you about the option of storing eggs or sperm known as gamete storage in case you want to have children in the future. While you're taking these hormones, you'll need to have regular check-ups, either at your GIC or your local GP surgery.

You'll be assessed, to check for any signs of possible health problems and to find out if the hormone treatment is working. If you don't think that hormone treatment is working, talk to the healthcare professionals who are treating you. If necessary, you can stop taking the hormones although some changes are irreversible, such as a deeper voice in trans men and breast growth in trans women.

Hormones can't change the shape of your skeleton, such as how wide your shoulders or your hips are. It also can't change your height. Hormones for gender dysphoria are also available from other sources, such as the internet, and it may be tempting to get them from here instead of through your clinic. However, hormones from other sources may not be licensed and safe. If you decide to use these hormones, let your doctors know so they can monitor you.

If you want to have genital reconstructive surgery, you'll usually first need to live in your preferred gender identity full time for at least a year. This is known as "social gender role transition" previously known as "real life experience" or "RLE" and it will help in confirming whether permanent surgery is the right option.

You can start your social gender role transition as soon as you're ready, after discussing it with your care team, who can offer support throughout the process. The length of the transition period recommended can vary, but it's usually one to two years. This will allow enough time for you to have a range of experiences in your preferred gender role, such as work, holidays and family events.

For some types of surgery, such as a bilateral mastectomy removal of both breasts in trans men, you may not need to complete the entire transition period before having the operation. Once you've completed your social gender role transition and you and your care team feels you're ready, you may decide to have surgery to permanently alter your sex. The most common options are discussed below, but you can talk to members of your team and the surgeon at your consultation about the full range available.

A phalloplasty uses the existing vaginal tissue and skin taken from the inner forearm or lower abdominal wall to create a penis. A metoidioplasty involves creating a penis from the clitoris, which has been enlarged through hormone therapy. The aim of this type of surgery is to create a functioning penis, which allows you to pass urine standing up and to retain sexual sensation. You'll usually need to have more than one operation to achieve this.

The vagina is usually created and lined with skin from the penis, with tissue from the scrotum the sack that holds the testes used to create the labia. The urethra urine tube is shortened and repositioned.

In some cases, a piece of bowel may be used during a vaginoplasty if hormone therapy has caused the penis and scrotum to shrink a significant amount. The aim of this type of surgery is to create a functioning vagina with an acceptable appearance and retained sexual sensation. Some trans women can't have a full vaginoplasty for medical reasons, or they may not want to have a functioning vagina. In such cases, a cosmetic vulvoplasty and clitoroplasty is an option, as well as removing the testes and penis.

After surgery, most trans women and men are happy with their new sex and feel comfortable with their gender identity. Despite high levels of personal satisfaction, people who have had genital reconstructive surgery may face prejudice or discrimination because of their condition.

Treatment can sometimes leave people feeling:. There are legal safeguards to protect against discrimination see guidelines for gender dysphoria , but other types of prejudice may be harder to deal with. If you're feeling anxious or depressed since having your treatment, speak to your GP or a healthcare professional at your clinic. Once transition has been completed, it's possible for a trans man or woman to experience a change of sexual orientation.

If you're a trans man or woman going through the process of transition, you may not know what your sexual preference will be until it's complete. However, try not to let this worry you. For many people, the issue of sexual orientation is secondary to the process of transition itself. Page last reviewed: 12 April Next review due: 1 April Transition to adult services Teenagers who are 17 years of age or older may be seen in an adult gender clinic.

Treatment for adults Adults with gender dysphoria should be referred to a specialist adult GIC. Changes in trans women If you're a trans woman, changes that you may notice from hormone therapy include: your penis and testicles getting smaller less muscle more fat on your hips your breasts becoming lumpy and increasing in size slightly less facial and body hair Hormone therapy won't affect the voice of a trans woman.

Risks There's some uncertainty about the possible risks of long-term masculinising and feminising hormone treatment. There's no guarantee that fertility will return to normal if hormones are stopped. Monitoring While you're taking these hormones, you'll need to have regular check-ups, either at your GIC or your local GP surgery.

Social gender role transition If you want to have genital reconstructive surgery, you'll usually first need to live in your preferred gender identity full time for at least a year.

Surgery Once you've completed your social gender role transition and you and your care team feels you're ready, you may decide to have surgery to permanently alter your sex.

Life after surgery After surgery, most trans women and men are happy with their new sex and feel comfortable with their gender identity.

Treatment can sometimes leave people feeling: isolated, if they're not with people who understand what they're going through stressed about or afraid of not being accepted socially discriminated against at work There are legal safeguards to protect against discrimination see guidelines for gender dysphoria , but other types of prejudice may be harder to deal with.

Media last reviewed: 20 July Media review due: 20 July

At home sexual reassignment surgery