Hormones for gender reassignment of transsexuals

Have you ever had a nightmare when you look at yourself in the mirror and a complete stranger is reflected there? You may not fully understand the situation, you may not remember well what you look like in a dream, but your anxiety is growing. You know something is wrong and something is wrong with your reflection. But what to do? Tearing out your hair? Scratch your face? Try to run as far away from your own reflection as possible? But this, fortunately, is a dream, and after the ending, whatever it may be, you will wake up, laugh at your fright and say: “What nonsense I dreamed!” But there are people for whom reflection in the mirror is akin to this nightmare, only it will not end when you open your sleepy eyes. Their bodies do not match their sense of self, and at best they are haunted by feelings of wrongness, but more often than not, our society engages in a generous and unlimited campaign called “bullying” and “estrangement.” There are not many options, but the most direct one is sex reassignment surgery. It is worth noting that in Russia the first question people often ask is about price.

Execution technique i

The most common procedure is to sew the tissues of the penis into the vagina and labia. The labia majora are made from the skin of the scrotum, the clitoris is made from the sensitive skin of the head of the penis. The prostate gland is left in place where it can function as a large erogenous zone, similar to the G-spot.

Since surgeons need to create a vagina identical to the natural one, there is not always enough tissue to recreate the natural depth. Therefore, the skin of the upper half or inner side of the thigh and lower abdomen is taken. The location where additional material is taken is usually minimal and hidden.

Skin grafting from other areas of the body has always been the subject of heated debate among plastic surgeons. Some believe that the extra skin makes the genitals look better. Others believe it hurts functionality. After all, the skin from other parts of the body is not as tender and sensitive as the own tissue of the genitals.

Penile tissue inversion surgery is considered the gold standard for vaginoplasty. It is recommended by the Center of Excellence in Transgender Health.

Read more about who transgender people are and how they differ in our next article.

Sometimes ordinary hormonal pills can do a lot without surgery:

It really works miracles in the literal sense: after a short time, a man can become a girl, and a girl can turn into a man with a rough voice and a beard. But there is no way back after hormones: while a transgender man can still somehow return to the female gender, then trans girls cannot. Under no circumstances will the male body recover from hormonal therapy.

This is what will happen to a man after taking estrogen:

Breasts will enlarge: after a couple of years of taking hormonal drugs, men's breasts grow. Sometimes even up to size 2 or 3, which is why some transgender people don't even need breast augmentation surgery.
Body hair becomes softer and less noticeable, particularly on the face.
The skin takes on a more well-groomed and delicate appearance.
Muscle mass disappears - with prolonged use of estrogen, a man’s body begins to lose its “masculine” muscles, and the body acquires femininity.
The pattern of fat distribution changes: instead of the abdomen, it begins to be deposited in the thighs and buttocks.
The prostate gland and testicles decrease in size.
The ability to erect is lost, and there are almost no sperm left in the semen.

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What happens to a woman after taking androgens:

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Facial features become rougher.
The voice becomes hoarse.
Hair appears on the chest and face.
The size of the legs may increase, and the hands become thicker.

Testosterone (a type of androgen) is prescribed only by injection.

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Vagina from the colon2

There is another method of creating a vulva - using the large intestine. However, research on the outcomes of this procedure is limited. The advantage of the operation is that the intestinal tissue is capable of producing mucus (lubrication of the future vulva).

While the vaginal hydration from the penis tissue will be artificial. This is the only advantage of colon vulvaplasty so far. The operation is used when the first method fails or when penile plastic surgery is impossible.

Many patients need repeated cosmetic surgery after gender reassignment. This is labiaplasty. Repeated surgery gives doctors the opportunity to work with already healed tissue, giving the lips an aesthetic appearance and positioning the urethra in the right place. This surgery is less invasive and is intended to cosmetically correct the appearance of the vulva.

Now the surgeons are taking over

There are two types of operations, depending on the patient's original gender. The relieved sigh of men will be absolutely justified, because the operation from a man to a woman costs much less. A woman’s “oh damn” will be just as justified. Surgical interventions are more complex and require significantly larger investments. You should not rely on the operation for people under 21 years of age (in some countries 18 years are allowed) or the elderly; good health and the absence of bad habits are also necessary for a successful operation.

A simple change from male to female is a simple amputation of the testicles (orchiectomy). The cost of the operation for 2020 ranges from 5,000 to 250,000 rubles.

How does operation 3 work?

The morning before the procedure, the patient is examined by the operating surgeon and anesthesiologist. Doctors will briefly outline the course of Day X. The patient will be offered a sedative to calm and reduce anxiety. He will then be taken to the operating room.

The operation is performed under general anesthesia. The patient lies on his back with his legs spread up and to the sides. The operation is complex and involves working with thin skin, vasculature and nerve fibers. Here are the key steps of the entire procedure:

the testicles are isolated and discarded;
a hole is made in the space between the rectum and the bladder for the future vagina;
a prosthesis (surgical dildo) is inserted into the allocated cavity to maintain its shape;
the skin is separated from the penis, a pouch is formed from it, which is stitched and turned inside out;
a triangular segment from the foreskin and glans penis is released to form the future clitoris;
The urethra is separated, shortened and prepared for implantation in a new location before the remaining parts of the penis are amputated.

The formed vulva is sutured, bandages and bandages are applied. The entire procedure takes from 2 to 5 hours. The bandages and catheter are usually removed after 4 days. After which comes a period of postoperative rehabilitation.

How much does a radical gender reassignment surgery cost?

Today, you can change your sex in almost any country in the world, and the cost of the operation will depend on this. Quality operations are carried out in Iran, Europe, Thailand and Russia. In our country, this kind of surgical intervention will cost about 600,000 rubles. It is carried out in several stages. The indicated cost includes only genital surgery. German doctors perform it for 30,000 euros. This additionally takes into account the considerable price of hormonal therapy, which is mandatory.

How to prepare for surgery 5

Hair usually grows on the skin of the scrotum and other parts of the body where skin grafts are taken during surgery. It is worth asking your doctor where exactly he intends to extract additional skin material. And several weeks and even months before the appointed time, undergo a full course of laser or electrolysis in order to permanently get rid of hair in the areas of the future vulva.

It is necessary to strictly follow the doctor's instructions the day before and the morning before the operation. Usually you cannot eat anything in the evening, since the patient will have to be put into general medicated sleep.

And a few more tips:

It’s worth talking to people who have already walked this path, asking about their experiences, feelings and impressions.
Do not be afraid to consult with a doctor as much as necessary, ask all the questions you are interested in, no matter how stupid and inappropriate they may seem.
Write down a plan for your new future, in particular, reproductive. It may be worth talking to your doctors about freezing your sperm sample.
Enlist the support of family and friends. It will be very useful after surgery.

The operation costs, on average, about $20,000. This is only the first procedure. A second labiaplasty operation requires additional costs. In addition, some patients also undergo mammoplasty and other procedures for complete transformation. The total cost of a new life in a new body depends on the patient's financial well-being, insurance and region.

Before surgery

No matter how much you run away from reality, there are actually only two ways out: try to change your gender through surgery or try to pull yourself together and come to terms with the current situation. Let's face it, the latter is more difficult - it is a thorny path through self-digging, developing the skill of ignoring and depression. If you give up, the consequences can be the most catastrophic. But, unlike in previous centuries, surgery is relatively accessible to every person, and the main difficulty here is more financial than psychological. So how much does gender reassignment surgery cost?

First you need to know what is required for the operation itself. Prepare in advance for the fact that you won’t be able to take this difficult step quickly.

It is necessary to undergo a special psychiatric commission so that it confirms the diagnosis of “transsexualism” (in Russia it is generally considered a disease) and does not give verdicts such as “schizophrenia”. Sometimes people with schizophrenia suffer from an obsession with gender reassignment.
For some time, the future patient will have to live as a member of the opposite sex so that psychiatrists are convinced of the firmness of the decision. This can last up to several years.
She will have to undergo hormone therapy for about a year. The number of drugs is determined individually, but in any case, hormones are not cheap, and you can’t get men’s hormones without a prescription, for which you need to say “thank you” to unscrupulous athletes who abuse them. The price of hormonal drugs also varies; for example, let’s say that the cost of one standard box is about 1,000 rubles. In Russia, the diagnosis of “transsexualism” does not provide any benefits for hormonal products.

If everything went well, and you have enough money for an armful of hormonal supplements, you can move on to the most important thing: gender reassignment surgery. Until this moment, you will definitely have to understand whether you want to continue or not. And if your wallet is now significantly thinner after a year of drugs, it looks like your answer will be in the affirmative.

Rehabilitation 6

The long-term outcome of the operation largely depends on rehabilitation. You must strictly follow the doctors' instructions. After surgery, patients are given a vaginal dilator, which should be used as soon as possible after the bandages are removed. It should be used daily for a year to give the desired depth and circumference to the vagina.

The doctor will also provide a schedule for this procedure. Typically, the dilator needs to be inserted into the vagina for 10 minutes 3 times a day for the first 3 months and 1 time a day for the next 3 months. Then the time of use is reduced to 2-3 times a week for a year. The diameter of the device also needs to be increased every month.

Finally, a list of restrictions during the rehabilitation period:

Avoid swimming or getting your genitals wet for 8 weeks. After the first visit to the doctor after surgery, the issue of the ability to shower is decided.
Do not expose yourself to physical stress.
Do not swim or ride a bike for 3 months.
Buy a donut-shaped seat (with a hole in the middle) and sit only on it.
No sexual intercourse for the first 3 months.
Apply ice for 20 minutes throughout the day for the first week.
There will be swelling and swelling - this is normal.
Vaginal bleeding in the first 4-8 weeks is also normal;
Avoid smoking at least for the first month.
Do not rely on painkillers. Take them only if absolutely necessary.

We read about the intricacies of intimate plastic surgery, which is used not only for gender reassignment, in our article further on the link.

Currently, in Stockholm alone, 390 cases of teenagers wishing to change their gender are pending.

But worried doctors - as well as parents of children who regretted what they did - warn that permission for such a procedure is handed out too frivolously.

“I know of cases where people later regretted having the operation and committed suicide,” says Jovanna Dahlgren, a professor at Sahlgrenska University Hospital.

Meanwhile, the government introduced a bill that would lower the age limit for genital surgery from 18 to 15 years.

“I’m afraid that in just a few years we will have a scandal on the scale of the Macchiarini case,” says Christopher Gillberg, a professor of child and adolescent psychology.

The number of Swedish children seeking treatment for gender dysphoria is growing rapidly. From 2013 to 2020, the number of such cases in Stockholm increased from 24 to 239.

Shortly before the elections, the government introduced a bill on transgender people. It, for example, proposed lowering the age limit for surgical interventions on the genitals from 18 to 15 years. Members of the government motivated this by saying that they want to support young people in a difficult situation: “The government wants to make this process easier for those who early realized that their body does not correspond to their gender identity.”

But in November 2020, the State Department of Social Protection received a letter signed by doctors, scientists and loved ones of patients.

The letter expressed "serious concerns" about the activities of investigative teams conducting such cases in clinics across the country.

Doctors and parents write that cases of children and adolescents with gender dysphoria are processed too quickly and not thoroughly enough, and cases of “repentant” ones are denied or ignored.

SVT 04/08/2019 American Thinker 02/27/2019 Dagens Nyheter 04/25/2019

The Associated Press 09/23/2015 Foreign Media 05/27/2014 “It cannot be ruled out that gender dysphoria may be “contagious,” as is the case with eating disorders and self-harm. It is a good thing that awareness of transgender people and access to treatment are improving. However, we must be clearly aware of the risk that among the “real” transgender people there may be young people whose problems in the long term will not correspond to such a solution.”

“Therefore, the risks associated with rapid medical intervention for young people who suddenly develop gender dysphoria cannot be considered acceptable. (...) It is dangerous to be uncritical of the sharp increase in the number of people wishing to correct their gender, attributing this to the fact that people simply began to talk more boldly about their characteristics,” says the letter to the State Administration for Social Protection of the Population.

In addition to doctors and scientists, a total of 11 Swedish and Norwegian parents signed the letter.

Many of them have children who had sex reassignment surgery and then regretted it, says professor and chief medical officer Christopher Gillberg. He is also among those who signed the appeal.

More than a month later, the Social Security Administration responded that it was not going to look into the matter and advised parents to contact the Health and Social Affairs Inspectorate if they wanted to complain about specific organizations.

Christopher Gillberg is very critical of performing irreversible gender reassignment surgery on minors. In his opinion, permits are issued too frivolously. He already wrote about this, for example, in Svenska Dagbladet.

“We know from other studies that the human brain at the age of 18 is not yet fully formed; this happens only at the age of 22-25. When you are 13 or 18 years old, you cannot fully understand how such a decision will affect your entire future life,” Christopher Gillberg told Expressen newspaper.

“I think that even real transgender people who can truly say that their gender transition has been a joy for them will be harmed by this development.”

There is evidence that there are significantly more people who regretted gender reassignment than official statistics indicate, adds Christopher Gillberg.

“Although studies have shown that only 9-10% of patients have regrets, there are other unpublished data that suggest there are many, many more such patients.”

Expressen: What is this unpublished data that shows many people regret having surgery?

Christopher Gillberg: If we look at the lists and talk to those who are personally involved in this, we see a different picture. Usually you can get acquainted with it at lectures and in other situations when we are talking about numbers that prove that there are many more people who regret it.

— This is what Swedish doctors say?

- Yes. It is for this reason, for fear of mistakes, that many doctors stop treating gender dysphoria. They can no longer tolerate a situation where children undergo such treatment until adulthood. At the same time, they remain silent because they are afraid of the consequences.

Swedish Association for LGBTQ Rights: "Nothing is done too hastily"

Children and teenagers seeking help for gender dysphoria are accepted at the Astrid Lindgren Children's Hospital in Stockholm. First, they need to contact the child and youth psychiatry department.

Susanna Terling is the Chief Medical Officer of the Gender Identity Unit in the Department of Child and Adolescent Psychiatry. She has been working here for more than a year and a half and notes that the number of applications from patients has increased significantly.

However, according to her, it is difficult to say what this is connected with.

“This is the million dollar question that everyone is asking now. There is simply no scientific answer to this. But many believe several interrelated factors are likely at play. Issues related to sex and gender identity are now receiving more attention, we have made some progress in terms of destigmatizing transgender people, they are starting to talk about it on social networks,” says Susanna Turling.

According to her, it is difficult to determine an average period allotted for making a decision.

In Stockholm there are no specific regulations on how quickly treatment for such a problem can be started.

“But it almost always takes more than a year,” says Dr. Susanna Terling.

The Swedish Association for LGBTQ Rights certainly does not believe that the time frame for investigating children and adolescents is too short.

“In the medical field related to gender reassignment, nothing is done too hastily. People who apply for help first receive a referral, then wait in line (usually for more than a year), and then their case becomes the subject of a long and detailed review,” says Sandra Ehne, chairman of the Association.

Post-traumatic treatment offered in Western Sweden

Lennart Fällberg is the head of the department at the Lundström Psychiatric Clinic in Alingsås. Children and teenagers from the west of Sweden come here to understand and receive treatment for gender dysphoria.

He states that the number of applications began to increase both nationally and internationally around 2014, and the explanation for this is difficult to find.

“I believe this is due to the fact that society’s attitude towards the problem has gradually changed. This means that now people with such a problem are not afraid to ask for help - they feel that this is normal. If so, then the trend is positive. But in general, everything is not so simple.”

Lennart Fällberg continues:

“The question is how large is the number of those who are, so to speak, truly transsexual. Naturally, such people can be among young people. But whether there really are as many of them as we can now judge from the number of requests is unknown. And therefore, everyone who comes to us should have the opportunity to reflect on their life situation and gender identity. We strive to ensure that over time they do not change their minds.”

The Spectator 07/05/2019 Svenska Dagbladet 06/11/2019 American Thinker 02/27/2019 Those who have already undergone gender reassignment surgery, but later regretted it, also come to the clinic in Alingsås. According to Lennart Fällberg, in general we are talking about 5 to 10% of patients.

“We accept everyone who regrets their decision. After all, they are experiencing a crisis. And we are trying to help as much as possible."

The clinic offers, for example, post-traumatic treatment for those who regret the operation.

“Most often this is various types of psychotherapy. The methods may differ depending on the person,” says Lennart Fällberg.

He continues.

“We also work with those who feel unwell, although they have not regretted gender reassignment. There are many of those. We provide support to help them feel a little better. It’s good that we have the opportunity to participate in their lives at this stage.”

It's not just in Sweden that the number of people under 18 seeking help for gender dysphoria has risen. In other countries, for example, in Finland, this trend is also observed.

Riittakerttu Kalpialo-Heino works as a doctor and conducts research in Tampere. She believes the rise in children identifying as transgender in their early teens may have something to do with fashion.

“To a certain extent, it may be that fear of growing up results in uncertainty about one’s gender identity. This is in the spirit of our times. But I also think that some children really need hormonal treatment before they grow up.”

20% have autism

Another challenge that those treating children with gender dysphoria face is whether the child has multiple comorbid diagnoses, says Riittakerttu Kalpialo-Heino.

“In our first publication, we said that children seeking treatment for gender dysphoria are also very often diagnosed as being on the autism spectrum. Approximately 1% of the population has such diagnoses, and among children who come to us with gender dysphoria, more than 20% suffer from them. That is, among people with gender dysphoria, autism is 20 times more common. So yes, this is a problem."

Doctors at the Stockholm clinic are also familiar with the problem of multiple diagnoses in patients with gender dysphoria.

According to Susanna Terling, they are well aware of this complication.

“We take this into account when considering cases. The speed of analyzing the case depends on this; if necessary, we extend the period and conduct more conversations,” she says.

She continues:

“Because there are no objective methods of diagnosis in this field, such as blood tests or brain scans, those involved in the case have a great responsibility: they must be able to distinguish gender dysphoria from other conditions.”

Suicides among those who regretted gender reassignment

Susanna Terling knows of cases when a patient interrupted treatment or regretted having decided to take it. But, according to her, this happens very rarely.

“In our opinion, this is very unusual,” says Susanna Terling.

Truth, then adds:

“Research on this issue also shows that few people regret their decision. But they are based on old data, and we don’t know what will happen next.”

It happens that treatment has tragic consequences. According to Christopher Gillberg and his colleague Juvanna Dahlgren, who also serves as chairwoman of the Association of Christian Physicians and Medical Students, some of those who regretted gender reassignment have decided to commit suicide.

“Yes, there were such cases. This started happening two or three years ago. So this is a relatively new phenomenon,” says Christopher Gillberg.

— Does this happen often?

- As far as I know, no.

Pediatrician Juvanna Dahlgren also knows of cases where people who regretted gender reassignment surgery committed suicide.

“Yes, later, as adults. In a couple of such cases, I spoke to their loved ones,” she says.

“If this is so, then this is a big tragedy, but I have not encountered such cases,” says Susanna Törling from the Stockholm clinic.

Christopher Gillberg is concerned about how things will go if doctors continue to work under the current rules.

— What do you think will happen if the government bill is adopted, including lowering the age limit?

“I’m afraid that in just a few years we will get a new scandal on the scale of the Macchiarini case (surgeon Paolo Macchiarini, an employee of the Swedish Karolinska Institute, used untested treatment methods, which resulted in the death of several patients. He also worked in Russia,” editor’s note. ). We must come to our senses; we cannot make such a decision without having information.

InoSMI materials contain assessments exclusively of foreign media and do not reflect the position of the InoSMI editorial staff.

Complications

General surgical. These include: infection, hematomas, seromas, poor healing, implant rejection, bleeding, lack of sensitivity of a particular anatomical zone, complicated reaction to anesthesia.
Psychological. There are cases when the patient becomes uncomfortable in a male body. That is why preliminary consultations with specialists and the stage of psychological preparation are so important.

What problem situations are possible? After a gender change, problems may arise with the preparation of new personal documents. In addition, the hostility of others who learn about surgical gender reassignment cannot be ruled out. Sometimes difficulties arise when communicating with loved ones.

As a result of lifelong prescription of hormone therapy, complications on the liver and kidneys are common. It is not always possible to take everything into account, so postoperative adaptation with the help of a psychologist is extremely important.