Sex reassignment surgery for a woman: how it is done, stages of the operation and scheme, how recovery occurs, hormonal drugs before and after

Gender reassignment surgery from male to female is the most dramatic change that is possible in a person. It is carried out when the patient considers his body to be someone else’s and wants to be like a woman not only in behavior, but also in appearance.

Modern medicine can turn a guy into a girl, but many examinations are required before a transgender transition can take place. Doctors must be sure that the decision to change gender to female is not hasty, but deliberate. It is possible to return a transgender person to their former appearance, but doctors do not give a chance for successful restoration. Moreover, death cannot be ruled out.

A little history about sex reassignment surgery

The first intervention for a transsexual was carried out in Denmark in 1931. But until the mid-60s, these operations remained unique. Everything has changed since the second half of the last century. The first specialized clinics that helped transsexuals arose in France. In 1978, an international association of surgeons specializing in sex reassignment operations was created in the United States. In the USSR, such an intervention was first carried out before 1991.

Singer Cher's daughter Chastity Bono becomes Chase

Indications for sex reassignment surgery in women

Surgical “transformation” from a woman to a man is much more difficult to do than to fashion a gentleman into a lady. Therefore, clear indications are needed for the operation. The main one is the patient’s transsexuality, confirmed by specialists. Lesbian sexual preferences are not grounds for plastic surgery.

Medical indications for gender reassignment

Before sex reassignment surgery, identification of medical indications is required:

confirmed diagnosis of transsexualism by a sexologist;
exclusion of similar forms of gender identification, including homosexual orientation, transvestism (inpatient diagnostics are desirable);
consultation with a psychiatrist to determine mental disorders (they are a contraindication for surgery).

Bruce Jenner changed gender at 65
After the initial examination and diagnosis, examination and observation by a psychiatrist is recommended in order to study:

developmental features, time of appearance of ideas about gender reassignment (for this, at the request of the patient, relatives are involved);
motives for surgery;
awareness of health risks, problems in contacts with the environment, family (it is especially important to take into account the psychological trauma of a child when a parent changes gender).

An andrologist and/or endocrinologist examines hormonal levels. To assess the condition of the female genital organs, you need to consult a gynecologist. Based on all this data, a medical consultation is appointed (sexologist, psychologist, psychiatrist), at which a conclusion is made about whether the person is really a transsexual and whether gender reassignment can help him.

If the answer is positive, a certificate is issued for the registry office. Based on it, changes are made to the passport data - the first name, last name and gender are changed. After a year of probation and taking male hormones, surgery is prescribed. Before this, a repeated examination and confirmation of the intention to change sex is necessary.

We recommend reading about cruroplasty of the legs. From the article you will learn about the advantages of this method of leg correction, indications and contraindications for it, types of implants and operations, recovery period, price. Read more about knee liposuction here.

Why do people change gender?

According to research, about 25 million people on the planet are transgender. This term refers to people whose real internal self-determination as a representative of the female or male gender does not coincide with the biological sex registered at birth. Often, such a discrepancy appears in early childhood and becomes more pronounced during puberty.

A transgender person who feels like a person of the other sex believes that he received the “outer shell” by mistake, therefore he cannot achieve inner harmony, experiences constant stress and faces misunderstanding from others. In this regard, such people turn to doctors to identify themselves and feel comfortable. The main thing is to understand that the desire to change gender is not a mental disorder. Gender reassignment is carried out if the following medical reasons exist:

discrepancy between physical appearance and mental self-perception, confirmed by a specialist;
transsexuality confirmed by a psychiatrist and sexologist.

What happens if you change gender from woman to man?

If a complete gender change has occurred from female to male, the following will be deleted as a result:

adipose tissue from the mammary glands so that they become flat, the size of the nipple decreases;
ovaries with fallopian tubes and uterus;
the vagina, or it is closed surgically;
excess fat on the buttocks and abdomen to give a masculine figure.

Implants for penile prosthetics
To recreate the genital organs, an operation is performed to form a penis from the tissues of the body or clitoris, or a scrotum from the labia.
It is also possible to inject silicone into the chin, calf muscles, and biceps. The scope of operations depends on the wishes and financial capabilities of the patient. All the time before and after the intervention you need to take male sex hormones, since without them complete transformation is impossible.

Average prices

The main supplier of such services in the world is Thailand, and Iran is in second place. These countries have even created a special direction of medical tourism, in which the cost of the tour will also include hotel accommodation, a shopping tour, consultation with specialists, surgery and the postoperative period. In general, the cost varies on average from 7 to 10 thousand dollars. In other countries, the price may differ significantly, and usually upward:

In Russia, the operation alone will cost 500 thousand rubles, not counting work with specialists and other items;
In Germany, gender reassignment costs approximately $40,000;
In the USA it will be carried out for 40 thousand dollars (only the reconstruction of the genital organs without mastectomy and other nuances);
In Austria the price will be lower – 13-20 thousand dollars for the entire range of services.

You need to choose a clinic based not on price, but on the number of positive reviews, inspection of work and many other factors. The price is agreed upon in advance.

The video below will tell you why you should think twice before changing your gender:

https://youtube.com/watch?v=NB5XUk9FcHo

Stages of preparation for gender reassignment in women

Plastic surgery is performed through several surgical interventions, as it involves serious changes in the functions of the body. Therefore, the preliminary stage is also multi-stage.

Physical training

Before allowing a patient to undergo sex reassignment surgery to male, it is necessary:

Observe with a sex therapist for at least a year. It must reveal the impossibility of a woman to exist in the body given by nature, that is, the need for intervention.
The same amount of visits to a psychiatrist. The specialist must confirm the patient’s ability to make decisions, that is, the absence of pathologies.
Undergo a thorough examination. In addition to the tests that are required for any operation, hysteroscopy and salpingoscopy are needed. They must confirm the absence of genital tumors.
Long-term use of hormones. To make the new body aesthetically and functionally more consistent with a man’s, they take medications.

Before (Yvonne Buschbaum) and after (Balian Buschbaum)

Moral preparation of a woman

Before surgery, it is important to prepare yourself psychologically for future changes. You need to live as a man for at least a year to confirm that your feelings and decision to change your sex are correct. If such an existence turns out to be more natural and comfortable than in a female form, moral preparation can be considered successfully completed.

Is it worth radically deleting everything at once?

It is no secret that during surgery, the patient’s female genital organs are removed and the male genitals are reconstructed. But there are options here. If you preserve the uterus, ovaries, and fallopian tubes, there will be no external signs of their presence. That is, the patient will take on the appearance of a man. But subsequently, by stopping taking hormonal drugs, it is possible to restore the functions of the female organs.

And you can conceive, carry, give birth to your own child. Similar cases are known.

Thomas Beaty is the only pregnant man who did not immediately have all his female reproductive organs removed.

Other variations

In the understanding of most people, a transgender is a person who wants to change the gender of female to male or vice versa.

Based on this, such people are called:

transgender man – when a biologically born girl becomes a man;
transgender woman - when a biologically born man becomes a woman.

However, there is another option for gender identity. At the same time, a person feels outside the gender-binary system, that is, he does not associate himself with either a woman or a man. This identity is called non-binary.

Among its varieties, there are several variations.

Androgyny - a person exhibits both male and female characteristics. This concept covers psychosocial characteristics rather than anatomical ones. The appearance of such people, their clothing and habits, express both masculine and feminine traits. In the past, artists, supporters of surrealism, called this the third gender and considered it ideal.

Bigender is a bit like the concept of androgyne. He also exhibits qualities of both sexes, but does so alternately, depending on the situation. This concept should not be confused with split personality. This is one holistic personality, changing its gender-role behavior depending on the circumstances.

Genderqueer people do not associate themselves with any one gender. Moreover, he to some extent demonstratively shows his disdain for him. Such people insist on the theory that the concept of gender identity is not limited to a woman or a man, but includes other options.

Another form of non-binary identity is genderfluid. Unlike a bigender, his self-determination varies not only between male and female, but is also capable of taking on completely different forms.

Agenders are a completely different category of transgender people. They reject the concept of gender as such. In their appearance they try to hide signs that indicate their gender. They adhere to a neutral style in clothing.

These are not all types of non-binary identities. For example, there are astralgenders who associate their gender with cosmic beings.

An interesting example is the concept of color gender. At the same time, a transgender person associates his gender with colors, emotions, feelings, as well as objects associated with these categories. There are red color genders, blue, green, etc.

The concept of transgenderism combines a wide variety of bizarre features that seem unacceptable or unrealistic to the average person. Transgender people face misunderstanding, ridicule and cruelty in society.

In fact, it is difficult for an ordinary person to understand what kind of torment a transsexual endures while in a “strange” body. This is not just anatomical tolerance, but also a psychological conflict with oneself, leading to depression and suicide.

Considering the self-flagellation and self-hatred of such people, the world community, in honor of their support, asks to be more tolerant of them, to give them the opportunity for self-determination.

Whose organ is sewn into women during gender reassignment?

When women undergo sex reassignment, a sexual organ is sewn on, which is created from her own tissues . There are two options for the operation:

Formation of the penis from the clitoris and surrounding labia minora. It is carried out after the organ has grown while taking testosterone.
Creation of the penis from the muscle tissue of the back, forearm, thigh. As a result, it will be similar to a man's size, and an erection is possible. If it is not enough, then an additional prosthesis is inserted.

Scheme of surgery for gender reassignment from male to female

Schematically, the process of surgery for changing gender from male to female can be divided into stages:

Removal of glandular and excess fatty tissue of the mammary glands, formation of a small nipple.
Creation of a penis from the clitoris, muscle tissue and a new opening for urination.
Removal of the uterus, ovaries, fallopian tubes.
Stitching or complete excision of the vagina.
Changing the shape of the body, face, correction of the shape of the penis.
Penile prosthetics to maintain the desired erection.

Each of them includes preparation (blood and urine tests, consultation with an andrologist, surgeon), the surgical intervention itself and the recovery period. It is important to note that in each case the doctor can choose an individual sequence of stages, as well as surgical techniques. The duration of rehabilitation depends on the correction option and the general health of the patient.

Instant gender correction

A computer gender reassignment program called Faceapp was recently released. This application is used for entertainment by millions of people regardless of gender. By uploading a photo to the program, you can look at yourself from the outside under various circumstances: younger, older, and even... in the guise of the opposite sex. Faceapp allows you to change your facial expression: “draw” a smile or add facial shades. Having just appeared, the program has already gained wild popularity.

Gender transition is a complex and multifaceted path that requires considerable physical, psychological and financial costs. But, as a rule, those who experience acute rejection of their current image take it up. And such a transformation becomes for them not only a way to change their appearance, but also to establish harmony with themselves.

Drugs for gender reassignment from female to male

To change gender and transform from a woman to a man, testosterone-based drugs are prescribed Most often these are long-acting injectable forms - Sustanon and Omnadren. They will have the desired effect in about 4-6 months:

the body and its proportions begin to change;
the clitoris enlarges;
coarse hair appears on the face, along the white line of the abdomen, on the legs;
the volume of the mammary glands decreases;
menstruation gradually becomes smaller in volume and frequency, then disappears;
muscle strength increases.

It is important that the level of female hormones is not too high, as this will interfere with the functioning of testosterone. Therefore, you should visit an endocrinologist and get tested for estradiol, progesterone, prolactin and testosterone before starting replacement therapy. You may also need to take medications with an antiestrogenic effect or those that reduce prolactin levels.

How gender reassignment is performed for women, the course of the operation

Gender reassignment surgery, if you want to become a man, takes place in several stages:

the mammary glands are removed, the shape of the nipple is changed;
get rid of the uterus, ovaries, fallopian tubes;
the vagina is sutured or removed;
some time after the above manipulations, the penis is reconstructed.

To make their appearance more consistent with their gender, some patients need liposuction, facial surgery, and calf surgery.

During the cycle of gender reassignment operations, the following is performed in stages:

mammoplasty,
surgical castration,
plastic surgery of the penis,
creating the urethra for urination,
correction of body shapes.

Masculinizing mammoplasty

Surgery techniques vary depending on bust size, although all are performed under general anesthesia. If the breasts are small, an incision is made around the areola. Through peripheral access, medium-sized busts are removed.

If it is necessary to remove a large breast, a vertical incision is made. But in all cases, they get rid of the fatty and glandular components and excess skin. Sometimes there is a need to move the nipple and areola and make them smaller.

How is mammoplasty performed?

Involves excision of adipose and glandular tissue. If the breast is initially small, or significant reduction has been achieved when taking hormones, then the incision is made around the nipple. For large-sized glands, access passes under the breast or along its anterior surface.

The operation can be one-stage, but large mammary glands are often removed in two stages with an interval of 3-4 months. This is due to the fact that after the main correction of the shape, to give an aesthetic appearance, it is necessary to remove excess skin and reduce the diameter of the nipple.

Ovariectomy with hysterosalpingectomy, or female castration

If the patient does not plan to give birth in the future, it is necessary to remove the uterus, ovaries and fallopian tubes. Ovariectomy is performed laparoscopically or using abdominal surgery. Each of them requires general anesthesia.

If a hysterectomy or hysterosalpingectomy is planned at the same time, an incision is made above the pubic plexus.

The postoperative period, which lasts up to 7–10 days, ends with the removal of sutures. But he undergoes rehabilitation for at least 1 month.

How is surgical castration done?

This stage includes:

removal of ovaries, fallopian tubes;
isolation and cutting off the uterus.

When only the ovaries are partially removed, the operation is less traumatic, since it can be performed through a laparoscope. The incisions for inserting the device will be small (2-3 cm), recovery is quick - about 1 week.

If complete removal of all internal genital organs is prescribed, then the surgical approach is often through the vagina, since the anterior abdominal wall may be needed for further penile plastic surgery. But an incision is also possible in the suprapubic area. The duration of the operation is about 2.5-4 hours. The rehabilitation period after complete castration takes 8-12 weeks.

The need to remove the uterus and ovaries is dictated by the risks of hormone replacement therapy. With lifelong use of male hormones, the risk of tumors of these organs increases. Doctors often recommend this stage after penile plastic surgery, that is, at the final stage of gender correction, in order to have complete confidence in the patient’s intentions.

Watch this video about gender reassignment surgery:

Vaginectomy, or masculinizing vaginoplasty

Another stage in the transformation of a woman into a man is the correction or removal of the vagina. The organ can be removed along with the uterus during a hysterosalpingectomy. In other cases, a less traumatic masculinizing vaginoplasty is performed. During the operation, the anterior and posterior walls of the organ are sutured.

Features of vaginal removal

If the method of complete removal of the female organs is chosen, then the vagina may also be cut off. This is the most difficult option for recovery. Complete healing occurs within 3-4 months; there is a high risk of postoperative complications. Therefore, more often the surgeon recommends suturing the vaginal walls after the stage of removing the ovaries, tubes and uterus. The operation is less traumatic, recovery will take about 3-4 weeks.

Phalloplasty or metoidioplasty

After the removal or cessation of the functioning of the female genital organs, reconstruction of the male genital organs follows. This is possible in 2 ways:

Phalloplasty is a 3-stage creation of a penis using a prosthesis and transplantation of living tissue from the thigh, abdomen or forearm. First, the urethra is formed, then the penis, the head with the scrotum and artificial testicles.

Phalloplasty

Metoidioplasty is the reconstruction of the penis using only its own tissue. It is carried out provided that, as a result of taking hormones, the clitoris has increased by 6 cm or more. The urethra is formed from the vaginal mucosa, and the size of the penis as a result of the operation will be approximately 5 cm. The scrotum is created from the labia majora with the introduction of a prosthesis. This is a less traumatic operation, and it also makes the penis very sensitive.

But full sexual intercourse with insertion into the vagina is not always possible.

More details about creating a penis

It can take place in two stages. The first is called metoidioplasty and is sufficient for the clitoris and surrounding labia minora. This method makes it possible to obtain a penis from 6 to 8 cm, but only if it is already close to these sizes due to the use of male hormones. As a result, the penis will be quite sensitive, but its erection will usually be weak.

Metoidioplasty

Therefore, patients often insist on creating a full-sized penis. For this purpose, an operation called reconstructive phalloplasty is prescribed. A flap is cut out in the area of the back, thigh or forearm. It includes skin, subcutaneous tissue, muscles with blood vessels and nerve fibers. It is then transferred to the pubic area and a tube-shaped penis is formed. An important stage for successful engraftment is the connection with the local vascular and nervous network.

After phalloplasty, the size of the penis reaches from 15 to 20 cm. In some patients, over time (after good innervation), an imitation of an erection appears. It cannot be completely identical, since in men it involves cavernous and spongy tissues filled with blood.

If the penis is not hard enough to be inserted into the vagina, then a prosthesis is installed to artificially pump fluid using a pump. They also use wrapping the muscles with thigh fascia (a dense sheath of connective tissue) to impart firmness.

Watch this video about what phalloplasty is:

Gender change from female to male: result and features of lower surgery

When changing gender to male from female, surgery is performed on the external genitalia (lower correction). It involves the creation of a penis. At the request of the patient, it can be formed from the clitoris and labia. In this case, it is necessary that after the administration of testosterone its length is at least 6 cm.

Metoidioplasty (as this method is called) will allow you to naturally feel arousal and a rush of blood to the penis due to the reaction of the clitoris. But the resulting erection will not be sufficient for sexual relations.

To obtain a penis equal to the natural size, phalloplasty is recommended. It will require part of your own tissue from the posterolateral region of the chest or forearm, thigh. A flap containing muscles, nerves and blood vessels is sewn into its anatomical area, and the body of the penis is formed.

In order to recreate a complete external resemblance to a man, a subsequent creation of a new opening for urine excretion, the head and scrotum with testicles is carried out.

When there is a gender change from a girl to a man, how does the genital organ work?

The functioning of the genital organ during a gender change from a girl to a man will depend on the amount of correction performed:

Taking hormones – the clitoris grows, sexual attraction to women increases.
Metoidioplasty – a penis is surgically formed from the labia and clitoris; it is small in size, retains sensitivity to stimulation, and an erection occurs.
This is usually enough for insertion into the vagina, but does not allow sexual intercourse.
Phalloplasty - a penis is created from one’s own tissues taken from the forearm, back, and thigh. Its length will be the same as that of men. After the nerves have fused, muscle contraction becomes possible. An erection appears, but not in all cases - the penis may be soft and rise weakly.
Penile prosthesis - after complete healing has occurred, a prosthesis is inserted into the penis. It consists of a tube, a fluid reservoir and a pump. If necessary, the pump (looks like an oval ball, is inserted into the created scrotum) is compressed and fluid fills the penis. This method ensures full erection and sexual activity.

Forming a hole for urine removal

Urethroplasty is considered one of the most difficult procedures. For it, they take a synthetic tube and wrap it with cloth from the forearm. A bed is formed in the penis, a new urethra is placed, and adjacent vessels are sutured. Connect the natural opening with new tissues. Then, after engraftment, the synthetic tube is removed.

In many cases, patients prefer to leave the opening under the new penis. This allows them to urinate while standing, but not through the penis.

Correction of external sexual characteristics

At the request of the patient, the following is carried out:

fat removal (liposuction) of the buttocks and abdomen;
implantation of testicular analogues, creation of a scrotum from the labia majora;
formation of the head of the penis;
injection of silicone into the chin, biceps muscle to simulate biceps muscles;
emphasizing the cheekbones (removing fatty lumps of Bisha from the cheeks).

Silicone implantation

In order for the patient’s appearance to be masculine, sometimes correction of different parts of the body and face with the help of endoprostheses is required. More often they are installed in the area of the testicles, chin or calves. First, access to tissue is provided through incisions in the appropriate area. A pocket for the implant is then formed in the area to be corrected. After installation, a suture is applied and a drain is placed, which is removed after a day.

Liposuction

Excess fat and the peculiarities of its distribution can hinder the final appearance of a man. Liposuction can help get rid of effeminacy. It is done wherever there is excess. The fat is removed through the incisions into which the cannula is inserted using a vacuum. A solution that thins the lipid tissue is first introduced.

Lifelong hormone therapy

Taking medications is not limited to the preparatory period. The patient will have to take hormones throughout his life to maintain external masculinity and a deep voice. After all, the organs that produce these substances necessary for life cannot be recreated. The drugs must contain testosterone and other androgens.

Watch the video for the opinion of sex therapist Yuri Prokopenko about the beginning of the formation of transsexualism and the consequences of the decision to change sex:

What happens after transgender transition

Is it true that transgender people have a shorter life expectancy and a lower quality of life (tendency to mood swings, unstable psyche) due to the hormonal medications they take?

There is no such data. Taking hormone replacement therapy does not affect life expectancy and mental stability - on the contrary, many transmasculine people and transmen note that under the influence of testosterone they become calmer and more self-confident. But, of course, the life of trans people, especially in Russia, is associated with additional stress: transphobia, changing documents, problems with going to doctors, rejection from family and friends, surgical operations, problems with getting a job. Often all this leads people to anxiety disorders, depression and suicide, not to mention violence and physical risks during operations. There is even a Day of Remembrance for Transpeople (victims of transphobia and suicide) in the world - it is celebrated on November 20.

How does transition affect the psyche of a transgender person?

Everything is individual. But, as a rule, the transition brings the desired relief from dysphoria and the acquisition of harmony between internal sensations and external signs. However, the changes that occur to the body after starting hormone therapy and surgery are certainly stressful for the body. Not to mention the reaction of others to the transition, problems with work and socialization. After transition, many transwomen are surprised to discover all the disadvantages of female gender socialization - they face harassment, discrimination and violence from men.

If a trans man does not have his uterus and ovaries removed, will he be able to give birth? What about a trans woman?

Sometimes yes. Some transmen do this: if they do not start testosterone hormone therapy or stop it for a while, fertility can be restored and it is possible to become pregnant. But a trans woman cannot get pregnant and give birth.

So if I say “all pregnant women should get screened,” I’m not talking about all pregnant people?

Yes exactly. This is not very correct.

If a person has made a trans transition, can he then return everything back? Is it possible to restore the body's previous functions?

A small number of people who have made the transition do detransition (from the English detransition, that is, “transition back”). Research shows that the number of those who were disappointed in the transition ranges from approximately 2 to (while out of 8%, more than half interrupted the transition only temporarily). However, critics rightly note that the topic has been little studied and in fact we do not have accurate data.

Detransition occurs for various reasons. A person may realize that dissatisfaction with himself has not gone away after the transgender transition, may experience problems in the new gender role, or something else. Often, during or after transition, a trans person comes to the point that they do not want to fit into the binary gender system - in other words, they do not consider themselves to be either a man or a woman. Some people then stop taking hormone therapy or reduce it in order to look androgynous. There are cases when a person makes several transitions “back and forth.” However, he does not necessarily consider this a mistake - rather, it is his experience and his search.

If a person does not remove their reproductive organs during transition, their function may be restored after cessation of hormonal therapy.

How do transgender people (especially those who have not undergone surgery) go to the pool, fitness club, beach, or toilet?

If possible, the same as cisgender people. Transmen go to the men's restroom, transwomen go to the women's restroom. Everyone decides for themselves where and how much to expose themselves in locker rooms and on the beaches. Transmen often wear a packer, a special silicone imitation penis that is inserted into their briefs or swimming trunks. They come in varying degrees of realism, some can even be used to pee while standing - they are used by those who want to use urinals in toilets. Of course, some trans people continue to experience dysphoria and embarrassment and avoid places where they would be forced to undress in public.

Actresses Indya Moore and MJ Rodriguez in the TV series Pose

Michael Parmalee / FX / Everett Collection / Vida Press

Part four

Rehabilitation and recovery in women who have changed their sex

The recovery period after such an intervention consists of several important points:

taking antibiotics, painkillers and hormonal drugs;
exclusion of physical activity;
seam care;
quitting smoking and alcohol;
nutritious food without excesses;
monitoring the condition by a specialist;
refusing sex until the intimate area is completely healed.

How long rehabilitation will last depends on the individual characteristics of the patient and the amount of changes made.

Possible complications in women after gender reassignment

Problems due to interference may arise:

General surgical. These are infections, seromas, hematomas, poor tissue healing, and implant rejection. Bleeding, insensitivity of some parts of the body, and negative consequences of anesthesia are possible.
Psychological. It happens that the patient is uncomfortable being a man. And he wants to get his old body back.

Long-term consequences of sex reassignment surgery

Changing gender with the help of an operation, even if it is completely successful, has long-term consequences - the need to primarily hide the truth, due to hormones, interruptions in the cardiovascular system, liver damage, and diabetes can occur.

Psychological ones are most often caused by the fact that a person believes that all problems with gender identification and role in society will disappear. In reality, this is not always the case. Throughout the transformation, one has to deal with the negative attitude of others, rejection due to homophobic sentiments, and psychological trauma in the family. Therefore, purely biological changes caused by hormones unusual for the body are superimposed with psychological discomfort.

Since this is a conscious decision for which we had to fight for a long time, patients prefer to fight depression and melancholy on their own. Alcoholism and abuse of psychotropic drugs occur. However, the majority still feel relief if the diagnosis was made correctly and surgery was the only option.

Side effects of long-term testosterone use include:

an increase in the level of estradiol in case of overdose or uncontrolled administration, excess testosterone is converted into them;
heart and vascular diseases - lack of female hormones increases the risk of atherosclerosis, hypertension, myocardial infarction, stroke, especially with obesity, smoking, hereditary predisposition;
damage to the liver, which processes hormones;
increase in hemoglobin, blood thickening, increased formation of blood clots and blockage of blood vessels;
increased blood glucose, development of diabetes mellitus with a tendency to impaired carbohydrate metabolism, cases of illness in the family;
headache.

Therefore, it is important to be under the supervision of a doctor throughout the entire period of hormone replacement therapy.

Does a woman become a man as a result of sex reassignment surgery?

As a result of gender reassignment surgery, a woman becomes a man only by external signs . This means that she will have:

flat mammary glands;
internal genital organs (ovaries, uterus, tubes) were removed;
no vagina (sutured or completely removed);
the penis, urethra (urethra), an analogue of the scrotum with testicles, have been formed.

The operation will not allow you to make changes to:

chromosome set, all genetic material will be female;
hormonal background - testosterone will be independently produced by the adrenal glands in minute quantities, which requires lifelong use of male hormones;
psychology and behavior - a period of adaptation to the new body, socialization (changes in contacts with the environment), development of new behavioral reactions are required, for which psychological help is recommended.

Hormone replacement therapy

To begin with, even before surgery, the patient undergoes hormone therapy for a year.

For men, these hormones are estrogens and antiandrogens. As a result of this therapy, the male appearance changes significantly. Thick hair disappears, muscle mass decreases. Body fat accumulates according to the female pattern.

Women undergo a course of androgens, in particular testosterone. On the contrary, they increase the thickness of the hairline and change their voice. The figure acquires masculine features, menstruation stops.

The use of hormone therapy allows you to radically change your appearance. But it affects not only external signs, but also reprograms the brain to adequately perceive a new personality. It becomes morally easier for a person to perceive his reincarnation.

But hormones alone are not enough. During this year, a transgender person is obliged to behave in society as a representative of the other sex. He must not hide his intentions from anyone. Moreover, immediately before the operation itself, the person must provide the doctor with evidence that other people know about his transformation.

What else does a woman need to know after becoming a man?

Before surgery, a patient wishing to change gender should know:

about possible difficulties with the preparation of new documents;
about the likely hostility of others who learn about the operation, the difficulties of communicating with loved ones;
that it is possible to acquire purely male diseases;
about problems with the liver and kidneys that develop over the years due to taking hormones;
about the impossibility of fully returning the functions of a lost female body if one wants to;
that postoperative adaptation should occur with the help of a psychologist.

On the left is an ex-girlfriend

Frequently asked questions by future men

When changing gender to male, the uterus is removed, and what is it replaced with?

When sexual characteristics change from female to male, the uterus is removed; it is not replaced with anything. This operation is performed based on the wishes of the patient, but if the decision is clear, it is also recommended for medical reasons. Since you will need to constantly drink male hormones in the future, the risk of tumors in the female genital organs increases.

Before the operation, it is important to fully decide on the choice, since the loss of this organ will be irreversible.

What is used to replace men's penises in women's areas?

To replace the male penis in female areas, the following are used:

Clitoris and labia minora after hormonal therapy (metoidioplasty surgery). The penis will have a male appearance, you can urinate while standing, its erection will allow penetration, but full sexual contact will be difficult.
Muscle and skin tissue from the posterolateral surface of the chest, forearms, thighs, lateral areas of the abdomen (phalloplasty) - with its help it is possible to achieve sufficient hardness of the penis, but most often only after installing an implant (mechanical pump).

How is a penis sewn on?

During gender reassignment surgery, a penis formed from its own tissues is sewn onto a male one in this way:

a selected musculocutaneous flap from the arm, abdomen, thigh or back is connected into a tube;
the surgeon uses a microscope to connect arteries, venous vessels and nerve fibers;
after complete healing or simultaneously the urethra is formed.

Is a prostate transplant possible after gender reassignment?

Prostate transplantation is not performed for gender reassignment. This surgery is not used on men or women who have undergone hormone therapy or penile reconstruction. This is due to the fact that the work of the gland is regulated by several organs: the pituitary gland, adrenal glands, testicles. The relationship between them is formed during the period of intrauterine development. Therefore, the transplanted organ does not function.

Such interventions are not yet technically feasible. As a result, when changing gender, the artificially formed penis cannot independently achieve the same erection as a natural one and release sperm.

Is it possible to change gender at 40?

Changing gender from female to male is possible even after 40 years, but it is very important to take into account that with true transsexualism this desire arises in adolescence.

At a more mature age, hasty decisions caused by life situations are possible. A person goes through a crisis of forty years and often feels that he is not living his own life. Moving to another social category seems like a good option for solving problems.

Dangers that lie in wait when changing sex after 40 years:

rethinking, the desire to return everything back;
difficulties in adapting to the family, negative reactions of children, even suicidal decisions;
destruction of professional career;
the need to change place of residence;
difficulty in recovery after multi-stage operations caused by concomitant diseases.

The daughter of singer Cher Chastity, who became Chase.
In order to eliminate most of the negative consequences, a long preparatory period before the operation is recommended - at least 3-4 years. All this time should be devoted to examination and work with a psychologist or sexologist.

When changing gender, is sex very different from the sensations and functions of the genitals of an ordinary man?

According to reviews from those who have completely changed their gender to a man, the sensations and functions of the genital organs allow them to have a sexual life with women. In terms of differences from an ordinary man, it is difficult to draw a conclusion, since there is no data on comparison of these two options by the same person. Most people admit that they get maximum satisfaction from bringing their psychological state into line.

Nevertheless, there are also cases when a person, having gone through the entire path of difficult operations and recovery, regrets his decision.

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Methods of surgical change from male to female

Currently, there are several main methods of surgery to change the male to female sex. It should be noted that before surgery aimed at gender reassignment, the patient must undergo a long course of hormone therapy.

Penal skin inversion method

This method is used to create a vagina using the skin of the penis. This is considered to be a fairly simple operation. Its average duration is about four hours.

Due to its relative simplicity, the penile skin inversion method is widespread in different countries.

However, this operation is not advisable in all cases. If the length of the patient's penis does not reach ten centimeters, there will not be enough skin tissue to form a vagina and labia minora of normal size. After all, the depth of the vagina is equal to the length of the penis minus two to three centimeters, which are necessary for the formation of the labia minora. The length of hospital stay for surgery performed using this method averages four days.

Surgery without complete inversion of the skin tissue of the penis with scrotal tissue transplantation

This method involves partial skin grafting of the penis and scrotum. This is a fairly complex surgical procedure that lasts about six hours. This operation allows you to create a normal-sized vagina, as well as the labia minora.

In rare cases, skin tissue from the upper limbs or abdominal area can also be used for transplantation. Compared to the previous method, surgery with scrotal tissue transplantation makes it possible to create a vagina that corresponds to the physiological norms of the female body. In this case, the length of the penis does not matter. The length of hospital stay after such an operation can be up to six days.