Transitioning to another gender is a deeply personal process that may take years to accomplish. After psychotherapy, hormone replacement therapy, and living as a member of the preferred gender, some trans women and men may opt for a more significant change through genital reassignment transgender surgery.Gender reassignment surgery can transform the life of a transsexual person. Not long ago, Medicare lifted a 33-year ban on coverage for this type of surgery. Fortunately, many U.S. companies are now providing transgender health benefits for their employees, making life-changing transgender surgical procedures available to more trans men and women than ever nationwide. At Beverly Hills Transgender Surgery, Dr. Alexander Sinclair has focused his practice on gender reassignment and transgender surgery. Dr. Sinclair is a general plastic surgeon with a compassionate approach and several decades of experience in all types of complex plastic surgery. The doctor and his staff are committed to surgical excellence and a comfortable treatment experience for their transgender patients.
WPATH Standards for Sex Change SurgeryThe World Professional Association for Transgender Health (WPATH) has adopted certain standards of care for gender reassignment. Seeing a mental health professional for diagnosis and psychotherapy is the first step under those standards. A patient with a gender identity disorder or gender dysphoria diagnosis and a letter of recommendation from a mental health therapist may see a doctor to begin hormone replacement therapy. A period of living publicly as a trans man or woman is required before gender reassignment surgery is performed.
Hormone Replacement Therapy and Gender Reassignment SurgeryIn transgender hormone replacement therapy, androgens (male sex hormones, primarily testosterone) are given to trans men to promote the development of male sex characteristics, such as body and facial hair and upper-body muscle mass. Estrogen and anti-androgens (drugs that block the action of male sex hormones) are administered to trans women to produce changes in body hair, skin, fat distribution, and musculature to make them appear more feminine.
Real-Life TestAfter hormone therapy is begun, Dr. Sinclair and other plastic surgeons who follow WPATH guidelines may require candidates for gender confirmation surgery to live for up to a year in the preferred gender role before the surgery is performed. In this real-life experience (or real-life test), patients must change their first names, work, go to school, or volunteer, and generally prove to the surgeon that people other than their psychotherapists know that they are living successfully as a trans man or woman.
Male to Female Gender Reassignment SurgeryMale-to-female (MTF) sexual reassignment surgery (SRS), also known as gender reassignment surgery (GRS), is less costly, easier to perform, and less complex than female-to-male GRS. Also known as “MTF bottom surgery,” this procedure changes the form and function of the primary sex organs. The surgery involves a penectomy (removal of penis), orchiectomy (removal of testicles), reconstruction of the urethra, and creation of a clitoris. The goals of the surgery are to provide a vagina with a depth of at least 12.5 centimeters, a width of 3 centimeters, a moist, elastic, hairless neovagina, a urinary stream that is directed down in the sitting position, and the ability to climax during sexual activity. Dr. Sinclair makes the vagina using an inverted penile flap augmented with full thickness scrotal skin grafts. The clitoris is fashioned from the glans and gets its blood supply and sensation from the dorsal artery, vein, and nerve of the penis.
What to Expect with MTF Gender Reassignment SurgeryDr. Sinclair follows the World Professional Association of Transgender Health (WPATH) guidelines. You will need two letters of recommendation from mental health professionals. You will arrive in Los Angeles 48 hours before the surgery and undergo a bowel prep the day before the surgery. The surgery is done in a hospital under general anesthesia with a 3 night stay. You will stay in Los Angeles for a week after your hospital stay. The office will assist you in making arrangements. Prior to leaving Los Angeles you will began dilating your vagina. Patients can return to work two to three weeks after surgery and can begin sexual intercourse three months after surgery.
Male-to-Female SRS FAQWhat do I need to do before surgery? Dr. Sinclair is a member of, and adheres to the World Professional Association of Transgender Health guidelines. You will need two letters from competent mental health caregivers recommending SRS. You will need medical clearance from your family doctor before coming to Los Angeles. What technique does Dr. Sinclair use? Dr. Sinclair uses a penile inversion technique. The vagina will be a sensate flap from the penile shaft; length will be augmented with a graft from the scrotal skin. A portion of the urethra will be used as mucosal lining from the vagina to the clitoris. The clitoris is created from the dorsal glans penis and will have sensation from the dorsal sensory nerve. Every effort will be made to give the clitoris orgasmic potential. Surgical time is about 3.5 hours. Anesthesia is done with an endotracheal technique. The usual hospital stay is 3 nights. Packing and urine catheter are left in place for several days. Dilation begins after packing is removed. How long do I need to be in Los Angeles? A 10-day stay is recommended. When can I return to work? Most patients return to work in 3 weeks. When can I begin vaginal intercourse? Most patients can begin vaginal intercourse 3 months after surgery. Does Dr. Sinclair accept insurance? Yes, Anita will work with you to get coverage.
Female to Male Gender Reassignment SurgeryFemale-to-male (FTM) genital reassignment surgery is more expensive and less commonly performed with a lower success rate than male-to-female SRS. The breasts and the uterus and ovaries are removed in two separate surgical procedures. A neo-phallus may be constructed using tissue from the forearm, thigh, or stomach, or the clitoris, which has been enlarged with male hormone therapy. The urethra may be extended to allow for standing urination, which is the most difficult part of the procedure. This surgery is less successful than MTF genital reassignment for two basic reasons:
- It is not feasible to construct the penis less than a year after hysterectomy (surgery to remove the uterus and ovaries).
- There is limited clitoral tissue from which to construct a functioning penis.
- Cessation of menstruation
- Increased sex drive
- Chest and facial hair
- Coarser hair on the arms and legs
- Deeper voice
- Decreased breast fat
- Increased upper-body muscle mass and strength
- Redistribution of body fat for a more masculine physique
- Clitoris up to 5 cm in size