Gender reassignment surgery offers options to those who need them.
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You don’t have to be a penis doc to notice that more and more medical professionals are coming to understand that a person’s sexual characteristics don’t necessarily determine how they self-identify their gender.
In fact, The Williams Institute at the UCLA School of Law estimated in 2011 that 700,000 Americans are transgender. Often—although not always—this means the individual has undergone gender reassignment surgery. This kind of surgery is becoming more and more common: the Encyclopedia of Surgery says that there are an estimated 100-500 gender reassignment surgeries every year in the US. The worldwide total is estimated at 2-5 times larger.
Gender reassignment surgery happens based on a series of steps outlined by the World Professional Association for Transgender Health (WPATH):
- The individual meets with a mental healthcare professional to diagnose gender identity disorder, gender dysphoria, and/or other related mental health issues.
- The mental health professional provides a recommendation for the patient to begin hormone therapy. Hormones for female-to-male transitions include androgens to help change musculature, skin, and fat distribution, as well as increasing body hair. Hormones for male-to-female transitions include estrogen and anti-androgens, which support bodily changes and the reduction of body hair.
- While undergoing hormone therapy, the patient spends a set amount of time (often a year) living as their self-identified gender. This means going to work and school embodying their preferred gender, as well as changing their first name.
- The patient receives surgery to alter genitalia and other body parts.
For now, male-to-female genital surgery tends to be easier and less expensive than female-to-male surgery. The process involves removing the testicles and most of the penis, as well as cutting the urethra shorter. A “neoclitoris” can be created from parts of the penis. The prostate remains intact.
In female-to-male surgery, the breasts, uterus, and ovaries are removed (this involves two separate surgeries), and a “neophallus” is constructed, usually using tissue from the forearm. When possible, the urethra is extended to allow urination standing up.
Either way, it’s a costly process. Female-to-male transition can cost $75,000 or more, while male-to-female transition generally costs between $40,000 and $50,000. Some are able to get their insurance to help, but that’s a fairly new development.
Neither of these surgeries is particularly easy to recover from, either. The whole process tends to involve several different surgeries, each with a recovery time of at least several weeks to several months.
The key to success is to have a team of surgical specialists working together to support the patient and get the best results. For patients undergoing penile reconstruction, for example, the plastic surgeon and gynecologist are definitely central, but the urologist is also key—and I’m not just saying that because I am one! It’s the urologist who keeps an eye on the patient over time, making sure everything is working correctly and that no problems develop post-surgery. And it’s vital to make sure follow-up surgeries involving changes to the urethra and/or penile and testicular prostheses are handled well.
Although gender reassignment surgery is a significant time, emotional, and financial investment, it is allowing transsexual people the opportunity to match their gender identity with their bodies.