Journal tomhudson's Journal: Gender Eduation: What's Involved in a Sex Change 10
I - Basic Info On Transexuality
II - Are You A Transexual?
III - Social and Moral Implications
IV - Questions by Posters
V - Politics And Gender Identity
VI - What's Involved In A Sex Change - this article
VII - Breaking the News
WHAT: This is the sixth of seven articles I'll be posting over the next little bit about sex, gender and identity.
WHY: Recent journal entries by several people have shown the need.
RULES: As always, any honest reply or question is welcome, and will be answered, and posted as a top-level JE so that others can read it. This is a sensitive topic, and the people who are most affected are in many cases extremely vulnerable. Please show the same compassion for them as you would want for yourself or a loved one if the situation were reversed. Private email addy is hudson AT groupehudson DOT com - plese note its "groupe" not "group", for those wishing to discuss individual circumstances.
What's Involved in a Sex Change - How Jack Becomes Jill
For those who have wondered about the actual steps, here's a concise list of the events and procedures that a male-to-female transexual undergoes.
For those wondering why I'm concentrating on the M2F (male-to-female) procedure, there are 2 reasons:
- Statistically, male-to-female procedures are much more frequent;
- The legal requirements are much more consistent across jurisdictions concerning post-op women (male-to-female transexuals) than for post-op men (female-to-male transexuals);
A Note About Writing Style For This Article
This article's target audience is three-fold:
- The transexual who is looking for information
- Friends, family, and associates
- The general public
Since the primary target is transexuals, I will be writing directly to them, rather than using the more impersonal 3rd-person style of the other articles. I will trust the reader will make the appropriate adjustments, depending on which of the three above groups he or she fits into.
The 4 Areas: Physical, Psychological, Social, and Legal
When people think of "sex change", they generally focus on the physical procedures - the surgeries and hormones required to make a person's physical sex match their target gender sex. This overlooks all the other issues that, if not handled properly, can spell the difference between success and suicide.
The Role of the Therapist
Early on, you will either find a therapist or be directed to one. Their role is three-fold:
- help you realistically evaluate your situation;
- help you to examine alternatives;
- recommend a course of action.
Yes, therapists do function as gatekeepers, but they are also facilitators. You're impatient - you've decided that its time to abandon all pretense, and you just wish the world would "get with the program already!" Remember, though, that there's still a lot of groundwork to be laid. Its not just a question of "give me the hormones and pick a date for surgery." First off, no responsible surgeon is going to operate without 2 letters of recommendation, so, while you might think you're ready, nobody else is.
Most therapists use the HBIGDA guidelines. These guidelines build on the work of Harry Benjamin, one of the pioneers in the field.
These guidelines are better known as the SOC (Standards of Care) pdf file of version 6
The SOC lays out in greater detail your therapists' functions (modified, personal pronouns added):
- To accurately diagnose your gender disorder;
- To accurately diagnose any co-morbind psychiatric conditions you may have and see to their appropriate treatment;
- To counsel you about the range of treatment options and their implications;
- To engage in psychotherapy with you;
- To ascertain your eligibility and readiness for hormone and surgical therapy;
- To make formal recommendations about your treatment to medical and surgical colleagues;
- To document your relevant history in a letter of recommendation;
- To be a colleague on a team of professionals with an interest in your gender identity disorder;
- To educate your family members, employers, and institutions about your gender identity disorder;
- To be available for follow-up for you.
It's a lot of responsibility, for both you and your therapist. As I wrote in a previous article, this is very personal, and if you don't feel comfortable with your current therapist, by all means ask for another. They won't take it personally. Choosing the right therapist is part of your responsibility, as is being honest with them, and understanding that they need time to get up to speed with your case, and ensure that they have met their professional obligations. You've had to live with it all your life, so you may think you know your case intimately. They don't, so you will need patience.
Now, did you notice that I didn't write "you know your case intimately", but that "you may think you know
Have you thought about how this will affect your family and friends? What are you going to do if someone rejects you?
What are you going to do if you're "clocked" in public (when the police capture you on radar, you're "clocked" as going at a certain speed. similarly, if someone "clocks" you in public - "sees through your presentation" - how are you going to react?).
Are you psychologically prepared to accept that your sexual preferences may change once you've begun transitioning? That what may have been unthinkable may, once you're comfortable in your target gender role, become your norm? And conversely, that feelings you once took for granted just "aren't there" any more? Are you also prepared that, in some cases, you will lose all capability of orgasm? Or that, instead of thinking about sex, you think about love?
Your therapist has training to help you in your evaluation of all these issues, and more. They won't tell you what to think - that's not their job. There is no "right answer" in that sense, just a question of "have you addressed these concerns, and are your expectations realistic or not?"
Social Functioning - The RLT/RLE (Real Life Test or Real Life Experience)
You have a lot to learn before you "go under the knife."
The RLE in 100 words or less:
Better safe than sorry - here's your chance to discover if living as a woman is right for you. Do you find it limiting; do you miss your former social perks; does living as a woman cause conflict with those around you; are you constantly "slipping back" into "being a man"? Or do you find it liberating not having to "play man" any more; has your social life improved; have friends reacted supportively; did you find it uncomfortable on those occasions when you needed to temporarily "change roles", and have you acted to put an end to it?
The SOC describes the RLE as follows:
The act of fully adopting a new or evolving gender role or gender presentation in everyday life is known as the real-life experience. The real-life experience is essential to the transition to the geder role that is congruent with the patient's gender identity. Since changing one's gender presentation has immediate profound personal and social consequences, the decision to do si should be preceded by an awareness of what the familial, vocational, interpersonal, educational, economic, and legal consequences are likely to be. Professionals have a responsibility to discuss these predictable consequences with their patients. Change of gender role and presentation can be an important factor in employment discrimination, divorce, marital problems, and the restriction or loss of visitation rights with children. These consequences may be quite different from what the patient imagined prior to undertaking the real-life experiences. However, not all changes are negative.
In other words, this is an essential step you must take. As noted, "not all changes are negative." There are few things more self-affirming than having your friends or family accept you.
What You Are Expected To Do
- Some combination of work, study, or volunteer work, as a woman
- Legal name change (though this may be delayed by agreement depending on the legal requirements of the state or province you are in. For example, some jurisdictions make it illegal to take a gender-appropriate name until after surgery is completed)
- Prove that people other than your therapist are aware that you are living as a woman. (It's not your therapists' job to "play detective." Have your friends and family available to confirm that you are living as a woman. A few pictures at get-togethers is always useful - no photoshops or gimping, please. These are considered legal documents, and, as such, forgery is a criminal act)
As the SOC points out, "When the patient is successful in the real-life experience, both the mental health professional and the patient gain confidence about undertaking further steps."
Voice Training
Hormones won't affect your vocal chords in the case of male-to-female transexuals. The damage is already done - the larynx has grown. However, there is hope. Here is one way. All it costs is a bit of practice. Buy a mini tape recorder (+/- $25.00), or a microphone for your computer (+/- $5.00) and practice, practice, practice. Eventually, you'll notice that even your "thinking", your internal narration, sounds female to you.
There are new techniques for voice surgery that involve either tightening the vocal chords and stapling them in place, or a laser to remove some tissue so that the vocal chords are lighter, and vibrate at a slightly higher pitch, but both are risky - if it doesn't work, you could end up sounding like a chain-smoking gravel-voiced trucker. Practicing is cheaper and safer, and you can do it today!
Electrolysis
Hormones don't get rid of facial hair, though they can have some effect on it over time, same as body hair. That beard is going to have to come off permanently one way or another. Don't bother with the laser - you're almost guaranteed to be disappointed.
BTW, there's no such thing as "laser electrolysis" except in marketing materials.
Hormones
Various options are available, which you can discuss with the physician your therapist refers you to. The SOC outlines them, without going into too much detail. You can find more detail about procuring hormones, various regimens, etc., here.
It may be helpful to print up the various regimens so that you can discuss the pros and cons of each with your doctor, and more fully understand the reason they are prescribing a particualr regimen.
A word about ethics: Premarin production is not pretty. However, rather than providing specific links, I'll leave it to you to search the web for the relevent facts and make your own decision based on your own research. There are alternative regimens, as outlined above, that you may want to investigate.
Tracheal Shave
Female hormones not only won't affect your voice - they also don't get rid of the "Adams' Apple". If it is too prominent, it will present an obstacle to you living in your target gender, though in fact most people don't really notice, and you're probably more self-conscious about it than is warranted.
Nevertheless, its possible to "plane down" the cartilege, and is something to be considered, either as a procedure to be done during SRS/GRS, or as a separate operation.
The "Boob Job"
Hormones will usually result in breasts 1 or 2 cup sizes smaller than your mother or sisters. Most transexuals end up getting breast implants at the same time they're getting their GRS, if they haven't done it prior (the waiting list for GRS is 2 or more years for many practitioners, so some women choose to get their implants sooner; this can be done with the help of a letter of recommendation from their therapist. Whether the therapists agrees or not is another matter. As with everything else, your case is special)
On the question of size: many genetic women who have had breast enhancement surgery say that if they had to do it over again, (here) or (here) they would have gotten larger implants.
A recent survey of 1350 breast augmentation patients showed that, while satisfaction with surgery was extremely high, nevertheless 34 percent of those who underwent re-operation did so simply to change the size of their implants. In most cases, women who change implant size switch to larger implants, says James Baker, Jr., MD, co-chair of the ASAPS Breast Surgery Committee and author of an article on choosing breast implant size that appears in the current issue of ASAPS' peer-reviewed Aesthetic Surgery Journal
As a male-to-female transexual, there is a good chance that your ribcage is proportionately larger than a genetic woman of your height. What this means is that you should give consideration to a larger breast implant than you normally would.
He warns, however, that implants that are too large can leave a patient looking "proportionally disfigured." "If a patient demands a size unsuited to her body type, I cannot in good conscience perform the surgery," he says.
In your case, the reverse situation is just as possible - breasts that are too small end up looking like they were "tacked on" as an afterthought. The key - don't be shy.
One thing you should do is experiment with the weight you will be carrying. It doesn't matter what form of prosthesis you are using now - you need to find out if you can support the additional weight without strain on your back muscles. Silicone breast forms don't necessarily have the necessary weight. A simple test - find some large (2-3 foot) latex balloons, and fill them with water to fill your bra to the desired size (you may want to use a measuring cup to record just how much water you use - the surgeon can then order implants with the proper displacement), stuff them in some pantyhose, and see if, over the course of a few weeks, you run into additional strain or back pain.
Use an extra-large balloon, and making sure it has lots of "give" (don't tie it off so that its round - you want it to be relatively slack so it can conform to your body). The advantage of this is that, even if you've begun hormonal treatment and have some breast growth, you can still get an accurate idea of how much "more" you'll need to be "in proportion".
On a final note - don't go overboard. There is such a thing as "too much of a good thing" - both from the health and social points of view. You want to be in proportion so that people accept you - too big, and other women may see you as a threat, and everyone will see you as "just a pair of boobs" (and not just the men). The goal is to be acceptable and accepted, not a walking ad for "Nip and Tuck".
breast implant procedure, possible complications explained, as well as before and after pictures
SRS/GRS - The Sex Change
Finally, the big day has arrived. Your therapist and another professional have signed off on your surgery, you've saved up the funds to pay for it, and you're ready for that next step. You'll have a dual orchidectomy (removal of the testes), and much of the tissue from the penis will be excised. What's left will be inverted into a neo-vagina, complete with a sensate clitoris and labia (some surgeons perfer to do the labia later, in a second procedure).
Once this is complete, you can expect a few weeks of recovery, after which you can resume work. Your hormone regimen will be changed to reflect that you no longer need anti-androgens, and you should have the necessary paperwork to apply for a change of designation of sex in most jurisdictions.
The Law Doesn't Cover Everything
There are a lot of laws that come into play - one of the most oft-discussed being one of the most mundane - "Which bathroom do I use?" Only a few places have laws on the books that accomodate the needs of transexuals.
Obviously, if you are living as a woman, taking hormones, doing the whole RLE, going into the Mens Room could be very dangerous, and not just from "breaking character." The risk of physical assault in such situations is high. At the same time, any genetic woman who "knows" about your situation may feel uncomfortable about you using the Ladies Room. You don't need the hassle of police hauling you into court for "deviancy."
The first way to deal with this is to avoid the situation entirely. Before going out, empty your bladder, and don't drink too many fluids. When that's not possible, see If you can find an unused single-stall handicapped washroom.
Another technique is to explain to a female friend (if they are unaware of the situation) that you have some medicine that requires an injection, which requires you use the counter instead of a stall, and you don't want your bare fanny exposed to the whole world, so could they please guard the Lady's Room door for a minute or two?
Of course, if you are at the point where you have no problem passing, there shouldn't be an issue with washrooms. Just go in like any other woman and do your business. Just don't stand when peeing, even if the equipment is still semi-functional
Change of Designation Of Sex
So, once you have all the paperwork, you can apply to have your old birth certificate sealed, and a new one issued with your new name and gender. In the eyes of the law in most places, you are a woman. You can get your drivers' license, passport, medical cards, employee's id, social security id, and all other pieces of identification updated. This includes professional credentials, such as degrees and certifications.
It's not over (it never is - life is a process), but hopefully the best is yet to come.
some further reading on recent medical thinking on transexualism
Thanks (Score:1)
Good writing, information is always nice.
Re:Thanks (Score:2)
Sorry about that. After writing the first 5 articles, I felt I needed a break. It turns out I needed a bigger break than I thought.
My writing method is a bit unusual, at least for this topic. I don't sit down with an outline of what I want to say, how I'm going to say it, or anything else. I sit down with a purpose. In this case, it is to communicate useful information to both the community at large, and to people asking questions about themselves. So I can't just sit down with a bunch of notes, links, r
Re:Thanks (Score:2)
I work with several gay people (some openly gay, others not) but they appear to be comfortable in their genetically assigned genders. We do have a few transgendered people working in different areas, although I professionaly have only worked with one person who did go through GRS. That was two decades ago. He was a short but heavy young man, neve
Re:Thanks (Score:2)
<shameless plug>
</shameless plug>
I guess it shows that by the time I got to college, I had discovered a fascination for sociology and psychology I hadn't known I had ... (I always thought I was going to stay in the hard sciences. Of course, programming is even mor
Re:Thanks (Score:2)
Re:Thanks (Score:1)
I am pretty much the same way (although most of my journal entries do not show it since I typically write them late at night when my written language skills are greatly diminished), but my one foray into publishing (I had a contract and everything!) ended in disa
Re:Thanks (Score:2)
ThaI'll take that as a compliment :-) Or an endorsement.
It's also why I also included the non-gmail addy in the articles - hudson AT groupehudson DOT com (just remember to put the "e" on group - its french :-) Obviously not everyone wishes to discuss their own details publicly, or has other questions
Re:One more bit. (Score:2)
Thanks for the linky. Yep, I overlooked it. My bad :-( Keep lurking!
Most transsexuals who go that route have to wait because of the expense, but you're right - it can make an ENORMOUS difference. Seeing is believing - and any skeptic following the link isn't going to believe their eyes.
To see the difference it can make, just fire up a copy of the GIMP (or Photoshop), and remove the brow ridges on your own face. The difference can be astounding. Of course there's more ... changing the hairline, a nose j