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procedures |
The whole issue of body modification is both complex and relatively dangerous. You can minimize your risk by doing your research, finding doctors or other care professionals that you get along with, and being diligent about your aftercare. Still, things can and will go awry. Should you choose to embark on modification try to be realistic about your expected outcome and understand the levels of risk associated with each procedure. Also be wary of your motivations.
Sperm banking
Sperm banking (a.k.a. semen cryopreservation, cryobanking) is something I highly recommend that you look into if you plan to start hormone treatments and one day have children from your genetic material. It does cost a bit but the benefits are long-term. The costs are approximate and will probably vary for the bank you choose and what your abilities are.
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So what goes on exactly? First, you find a cryobank, make an appointment, and you go down to their clinic where you get bombarded with paperwork. They'll take a bit of a blood sample for testing (to confirm you don't have any transmittable disesases and whatnot) as well as to record other factors. When you begin doing deposits you'll sign in and be pointed to your own private room where you can do your magic into a small specimen cup. If you don't like the magazines or other stuff they have there you might want to bring your own. And some warm socks if they have cold floors. When you're done you'll give the sample to them and the staff will process the contents.
The first visit is potentially more expensive because of the lab work and processing. Subsequent visits may include the first year of storage fees. You might want to negotiate long-term storage fees for your entire collection---it can save your money! When you withdraw your samples there are other fees and if you rent their ice transport carriers there are fees for that too. One consideration when choosing a bank is to be sure that it looks to have longevity. I call my bank about once every year to make sure it's still in good operation.
My experience yielded:
Your results will vary. I probably have low sperm count. One friend went like 4 sessions and she banked well over 800 million. Go figure.
item cost / qty Approximate costs for first year $2,300 Yearly maintenance costs $900 Number of sessions 12 Approximate quantity stored 360.5 million Approximate quantity desired 400.0 million
Electrolysis
Electrolysis is the only proven method for permanent hair removal today. It has its roots (pun intended) dating back to the late 1800s when opthamologist Dr. Charles Michel was looking for a way to remove ingrown eyelashes. Thankfully today we use an array of machinery and the skill of trained operators to get rid of the beard, the monobrow, and much more. Even though technology has advanced to the point where laser technology is producing decent results, there still is quite a bit of pain involved. It may be an ordeal but it is a survivable one---don't take shortcuts.
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- Thermolysis. A lightning-fast application of heat at the end of the probe burns the follicle. Operators using thermolysis have a reputation for causing skin damage due to extreme temperatures. Patients often opt for thermolysis because of the rapid hair removal, but each follicle may require more treatments.
- Galvanic. Direct current generates a small amount of lye in the follicle which chemically kills the hair. Relatively safe but some people are allergic to lye.
- Blend. Both thermolysis and galvanic lye combine to deliver a hefty punch to the follicle.
There are merits and drawbacks to all the above and people with different hair types may find various methods more effective. The main thing you want to avoid is permanent skin damage. Your skin is extremely soft (and gets softer after being on HRT!) and can't take a lot of beating. A common sign of skin damage is scabbing.
Pain can be mitigated by having the operator adjust the amount of power being used. Local anesthetics may also be applied by injection (e.g. lidocaine) or topically (e.g. tetracaine, EMLA, DOTC Blue). Especially with topicals you need to allow enough time for the medicine to work its way through your skin. Being relaxed and well-rested really helps as well. When I'm being operated on I try to zone out or count numbers.
After treatment the areas of skin are typically very sensitive and sometimes swollen. Aloe vera, vitamin K creams, and vitamin E oils seem to help a little. Swelling usually goes down after a few hours to a couple of days. Be sure not to rub the affected areas and always wear sunscreen.
Electrolysis operators should have a current license from the board of cosmetology. The work area should be clean, sometimes paper (like from the doctor's office) covers the bed you lay on. Each needle should be new, never reused. Tweezers should always be sterilzed. Basically, a clean operation is what you're looking for.
Getting rid of all of your facial hair takes an amazingly long time usually on the order about about 1-2 years. Your results will vary. (I've had friends have less than 60 hours; one friend is over 500 and counting.) Plan well ahead if you think you're going full-time!!! Oh, and if you have SRS and your doctor recommends getting your genitals regions cleared of hair remember that will run about 20-40 hours as well. Working on your face doing 4 hours a week is a lot of stress on your body. When you do genital electryolsis most people get real doped up on anesthetics and and do 5+ hour sessions. Remember: your body needs healing time. Don't think that you can do 200 hours in 4 weeks.
Costs are quite expensive and may even be more than SRS or FFS! Consider that hourly rates are $60+ and anesthetics cost maybe $40 a small container/tube. Multiplied by the number of hours you require you are probably looking at $10,000 to $30,000---in 2004 figures. You can cut your costs by negotiating package deals with your operator or by going to electrolysis schools. Beware, electrolysis schools are typically doing thermolysis with inexperienced students. Your chances of skin damage are higher.
My experience was that I had a moderate amount of hair and to get rid of most of my facial hair:
I've also been tracking the stats for genital electrolysis and while it takes less time to clear it is in some ways much more gruelling.
item cost / qty Approximate total $11,250 Number of hours 175.00 Number of sessions 101
Your results will almost certainly vary. But keep this in mind: the amount of hair is finite.
item cost / qty Approximate total $1,400 Number of hours 16.00 Number of sessions 4
Facial surgery
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For many the answer is "yes". Your face is probably the most gender-identifying thing about you along with your voice. While FTMs on testosterone rapidly become undetectable as their beards grow and voices deepen, the same is not true with MTFs. Years of testosterone damage are irreversible and so surgery is often the only viable solution. So, FFS gives you a chance at passing.
There are a myriad of doctors out there willing to do almost anything for you for a price. Ask to see the doctor's credentials and their portfolio. Check message boards and see what real patients have to say. Do not believe that you have to have everything done the doctor suggests---voice and hair take you a long long way, and they're free! Be comfortable with your doctor's bedside manner.
FFS is an art at best and your results will likely vary. Don't expect to look like a supermodel and don't expect quick results. What you can usually expect is that the surgery will make your face more feminine such that you have a much better chance at passing. And if that's worth it to you then go for it.
If you would like to read my personal experiences with FFS (tracheal shave, mandibular contouring) please visit the FFS Special Section.
Voice surgery
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- Cricothyroid approximation (CTA). Using a clamp to partially close the anterior part of the folds. The problems with this are that over time the folds may stretch anyways thus making the clamp useless. However, this approach is technically reversible.
- Anterior commissure advancement. Pulls the front part of the folds forward thus creating more taut chords hence the higher pitch. Usually permanent.
- Injections of steroids or use of a laser can be used to cause part of the vocal folds to atrophy such that the overall mass of the folds is reduced.
- Laser Assisted Voice Adjustment (LAVA). Using a laser to scar the upper layers of the folds so that they become more taut which in turn relates to a higher pitch produced. Unfortuately scarring is scarring.
Genital surgery
Sex Reassignment Surgery (SRS) or Gender Reassignment Surgery (GRS) for the MTF typically involves construction of the labia, clitoris, and vaginal cavity from the existing genitals of the patient. Rather than "cutting it off" think of it more like flipping a sock inside out. While surgeons vary in their technique there are similarities with the current methods.
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In preparation for penile inversion surgery the patient may be requested to have electrolysis performed on penis, scrotum, and general area surrounding both. (This is to prevent hair growth inside the vaginal cavity.) This electrolysis should complete weeks ahead of time. As well, the patient needs to be completely off hormones for about 1 month and abstain from taking certain other medication, herbs, dietary supplements, vitamins, and certain drugs (including aspirin). Sometimes the patient donates a couple units of their own blood.
At the time of the actual surgery the patient is placed under general anesthesia. Incisions are made to remove the erectile tissue of the penis and the testes---these parts are usually discarded. The glans, the urethra, and the nerve bundles are preserved as much as possible. The remaining scrotal skin, the penile skin, and possibly additional grafts are used to create the neo-vagina while preserving proper blood supply. Incisions are made to the abdominal muscle wall below the public bone and the neo-vagina is inverted and inserted through this. The back of the neo-vagina will rest in the new thin cavity near the colon. The urethra is shortened and also relocated through the abdominal wall. The glans and associated nerve bundles are fashioned into the clitoris and placed through the wall. Finally, the remaining skin around the vagina, clitoris, and urethral opening are brought together to create the labia.
In a two-step procedure the labia may not be created at the time of SRS. Instead several months are allowed to pass while the surgery site heals. A short outpatient procedure is then performed to bring the folds of skin over the clitoris and urethra ("hooding the clitoris").
A variation of this technique, sigmoid colon resection, is to use part of the colon as part of the neovaginal wall. This creates a custom "depth" but some people report problems with the durability of colon tissue used in the neo-vagina as well as constant moisture secretions from the same tissue.
Aftercare requires diligent cleanliness (daily washing and periodic douching), dilation with stents (to enlargen and maintain the neo-vagina cavity), regular check-ups with an OBGYN. Pap smears are standard. Prostate examinations may still be required as the prostate has been untouched in the surgery and tends to develop cancer in later years. In short, it is a lifetime of proper maintenance for optimal results.
While this is becoming a fairly routine surgery, complications are common and range from minor cosmetic issues to necrosis to loss of feeling to extensive bleeding and death. One of the more serious problems is a rectal-vaginal fistula. This is when there is a breach of the rear of the neo-vagina into the colon allowing gas and feces to pass into the neo-vagina. Most complications can be solved with revisional surgery, though you may experience loss of depth or other cosmetic degradation. In general, however, the surgery is considered safe for healthy individuals who are mindful of their physical health.
The number of people who have encountered complications from SRS is significant and they have been all ages, all ethnic backgrounds, and have gone to different doctors around the world. It would seem the best thing you can do is to be sure you have a doctor in your home area that is familiar with treating transgender patients and/or is an experienced physician. That way when the complications occur you have someone you can speak to and corrections can be performed immediately instead of allowing to fester.
Individuals who have completed SRS will not get pregnant however they are still completely susceptible to all the nasty venereal diseases and vaginal infections. Proper precautions should be taken with having intercourse and, as said before, regular cleansing is essential.
If you would like to read my personal experiences with SRS (vaginoplasty, labiaplasty) please visit the SRS Special Section.
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