This is an essay Ginny wrote for one of her classes :) I'm proud to be the inspiration for her chosen topic. This essay, along with all her research actually helped me more than I imagined it would. I have even changed my mind on which surgery(s) I want/will be pursuing. I hope this is helpful for you all to understand just a little more of what my journey entails. :) Please feel free to let me know what you think about it, I LOVE it :)
Quest for Perfection: Unity Inside Out
A female to male transsexual (FTM), also known as a transman, is defined as a person who is born into a female body, but whose gender identity is male (Hudson, 2004-2010). According to a study conducted in 2005, there were only 321 self-identified transmen in the United States (Forshee, 2008). The majority of those identified in the study were under 35, employed, with at least some college education (Forshee, 2008). They are brothers, fathers, sons, neighbors, coworkers, doctors, lawyers, actors, waiters; they are everyday people. But they are people who often struggle to find their place in society. Surgery is not a requirement to live part- or even full-time as a male; however, for some it is a personal necessity. Some transmen use cosmetic surgery in their quest for perfection, to gain unity inside out, with chest reconstruction, a hysterectomy, and genital reconstruction.
Although many transmen want to finish the process immediately and move onward to live their lives as normal men, there are options to consider and steps to complete. The first requirement is for the in-depth psychological counseling that a transman must go through prior to any gender reassignment surgery (Encyclopedia of Surgery, 2007-2009). The World Professional Association for Transgender Health (WPATH) Standards of Care requires the individual to be diagnosed with Gender Identity Disorder (Hudson, 2004-2010). They must also obtain letters from at least two certified therapists, giving them the “go-ahead” for the surgeries (Hudson, 2004-2010). These surgeries are irreversible and the guidelines are in place to ensure that the transman is truly ready for the next steps in the process. The gender reassignment is not just one single sex-change operation, it is many. Along with the surgeries, many transmen choose to take testosterone as part of their transition. The testosterone must be taken for the remainder of their lives (Green, 1994).
A good amount of research must be done before embarking down the path to surgery. For each surgery different surgeons have different techniques, and each person's body is different to begin with; therefore, results will vary widely from one patient to the next. The transman must be realistic about what he wants versus what he can achieve with each of the surgeries (Green, 1994). These surgeries can be very costly and are rarely covered even partially by health insurance (Hudson, 2004-2010). As with any surgery, there are many risks: infection, post-operative pain, bleeding, dissatisfaction with results, and the need to return for repairs (Encyclopedia of Surgery, 2007-2009). However, one can minimize these risks by maintaining an overall higher level of health and fitness including weight management and not smoking prior to the surgery (Hudson, 2004-2010). With the research and pre-work done, a transman can choose to continue his quest with one or more surgical procedures.
The most commonly sought-after surgery in the female to male transition process is the chest reconstruction. This surgery is the only surgery for many transmen (Hudson, 2004-2010) because in most states this surgery alone is enough to change their gender to male legally (Green, 1994). Being legally male has many personal benefits to the transman and largely aids him in being seen as a male to the rest of society. The top surgery allows the transman to have a flat, contoured, male-looking chest without the need for binding, and provides the ability for him to even go shirtless in public. This surgery in particular is much easier for the surgeon to achieve the desired results if the patient has already been working out because he or she can better shape the new chest with the patient's existing pectoral muscles (Green, 1994).
Of the many techniques used for chest reconstruction, the two most common are the keyhole/peri-areola and the double incision. The keyhole/peri-areola technique, done only for small breasts, yields little scarring because the incision is done around the areola (Hudson, 2004-2010). Liposuction is most often used to remove the mammary tissue, and then the nipples are replaced in the original position to cover the scars (Hudson, 2004-2010). The double incision, done mainly for medium to large breasts, consists of two long incisions along the bottom of the breast, exposing all the mammary gland and fatty tissue, and allowing excess skin to be fully removed (Hudson, 2004-2010). Although the double incision results in more prominent scarring, the technique gives the surgeon better opportunity to achieve the desired results without the need for follow-up procedures.
Many doctors recommend, and sometimes require, for a transman to have a total hysterectomy and oophorectomy. In a few states the oophorectomy is the required surgery to change one's legal gender from female to male (Green, 1994). Also, doctors recommended that the hysterectomy and oophorectomy be done within five years of starting the testosterone therapy because of the potential increased risks of endometrial and ovarian cancer (Hudson, 2004-2010). Female organs, and the resulting menstrual cycles, often cause psychological confusion for transmen, especially in their younger years (Nick, 2007) making this surgery a personal necessity for them.
The hysterectomy, removal of the uterus and cervix, and the oophorectomy, removal of the ovaries and fallopian tubes, can be done through an incision in the abdominal wall just above the pubic hairline, or through the vaginal canal (Hudson, 2004-2010). The vaginal canal leaves no visible scarring; unfortunately, if the vaginal canal is too narrow for the surgical instruments then the abdominal incision must be used (Hudson, 2004-2010). The completion of these surgeries can often result in the need for a lower dose of testosterone because the body is no longer producing estrogen to counteract the testosterone (Hudson, 2004-2010).
For some transmen, even with the chest reconstruction and hysterectomy, possessing male genitalia is a requirement for them ultimately to view themselves as a complete male. Mainly two different techniques are used to achieve the goal of a penis: metoidioplasty and phalloplasty. With the ongoing use of testosterone, the clitoris often grows longer (Hudson, 2004-2010). Metoidioplasty, also known as clitoral free-up, uses the elongated clitoris as the new penis (Hudson, 2004-2010). The process includes cutting the ligaments that hold the clitoris in place, and removal or changing of the surrounding tissue to achieve the correct placement and look of a normal penis (Hudson, 2004-2010). Phalloplasty is the construction of a penis using donor skin and tissue from the patients abdomen, groin/leg, or forearm; most often the forearm (Hudson, 2004-2010). Phalloplasty is very uncommon not only because of the high price, but also because the surgeries are done by very few surgeons throughout the world and the results most often do not produce “normal” looking male genitalia (Hudson, 2004-2010).
For some, the significant cost of $50,000 or more is well worth it to ensure that no one ever sees that they are a woman “after-all” (Green, 1994). Which surgery to get, if any, is a very personal choice and the reasons behind the decision are different from person to person. Metoidioplasty gives the transman a small, but normal appearing penis with minimal scarring; although, the final size depends on how long the clitoris grew with the testosterone therapy and even the largest is generally not enough for penetration during intercourse (Hudson, 2004-2010). On the other hand, Phalloplasty can give the transman an average sized penis capable of penetration during intercourse, standing urination, and a more acceptable appearance in places such as locker rooms; however the high price paid for this procedure includes multiple surgeries and revisions, very painful and significant recovery time, and large visible scarring (Hudson, 2004-2010).
When a person starts on a mission to change his or her sexual identity, he or she is embarking on one of the most significant changes a person can experience (Encyclopedia of Surgery, 2007-2009). Although some transmen do seek out the hormonal therapy and gender reassignment surgeries, the majority of transmen will never surgically alter their appearance (Encyclopedia of Surgery, 2007-2009). And even of those who do follow through with any portion of the process, many will “go stealth” by fitting themselves into society with no mention of their past (Forshee, 2008). It is a long and hard road, this quest for perfection. For some it is worth that ultimate goal of gaining unity in themselves. For them the feeling that they are the same person inside and out, is worth every penny, every pain, every price they pay in the end.
Reference List
Encyclopedia of Surgery.(2007-2009). Sex Reassignment Surgery. Retrieved March 27, 2010 from http://www.surgeryencyclopedia.com/pa-st/sex-reassignment-surgery.html
Forshee, A. S. (April 2008). Transgender Men: A Demographic Snapshot. Journal of Gay & Lesbian Social Services, 20(3), 221-236. Retrieved April 10, 2010 from http://search.ebscohost.com/
Green, J. (1994). Getting Real about FTM Surgery. Gender.Org. Retrieved March 27, 2010 from http://www.gender.org/resources/getting_real.html
Hudson. (2004-2010). FTM Resource Guide. Retrieved March 15, 2010 from http://www.ftmguide.org/
Nick. (October 2007). The Hysterectomy Hierarchy. Retrieved March 27, 2010 from http://www.thetransitionalmale.com/hysthyst.html
Schilt, K., & Waszkiewicz, E. (2006). I Feel So Much More in My Body: Challenging the Significance of the Penis in Transsexual Men's Bodies. Conference Papers – American Sociological Association; 2006 Annual Meeting, Montreal, p1, 25p. Retrieved March 16, 2010, from http://search.ebscohost.com/
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