How is a transgender person made

Physical gender reassignment options

There are very different medical ways to adjust the body to the gender that is felt. But how exactly do sex reassignment surgeries work? And what do you have to consider?

Transition - as much as necessary, as little as possible

A goal of physical gender reassignment - too TransitionTransgender people describe the period in which they approach their perceived gender as transition. called - it is to feel more coherent, more comfortable and more satisfied in your own sexual body afterwards. Up until a few years ago, the notion of "converting" men into women or women into men was still prevalent in medicine.

Today there is an expanded understanding of the sex bodies and Gender identitiesGender identity describes a person's knowledge and feelings about their own gender. of the human. These show an infinite variety that is always individually nuanced. This realization is liberating for those who may only want partial physical changes. Nobody should put themselves under pressure to transition to the prototype male or female.

The challenge is rather to personally balance how much masculinization (masculinization) or feminization (feminization) is right and necessary for yourself and how much is not. It should be possible to feel more comfortable in your own body with as little physical treatment as possible.

Genital surgery affects one of the most sensitive areas of our body and this part deserves careful attention. In making a decision to have surgery, it should be made aware that all surgical procedures involve risks and complications.

With phalloplasty in particular, there is an increased risk of complications with, in some cases, multiple reoperations. Testimonials (positive, but also negative) from others transgenderTransgender people do not identify or only identify with the gender they were assigned at birth.People using different surgical techniques from different surgeons at home and abroad can be helpful. There are also alternative paths in life to operations that are still too little communicated today.

Think first, then decide

Most people take a long time to make the decision to transition. All steps of the transition and their course should be carefully considered, because most changes to the body, whether through medication or surgery, can no longer be reversed at a certain point. Few make this decision for themselves, most consult with family and / or friends.

For many, it is helpful to talk to other trans * people personally to share their treatment experiences. Many self-help groups offer this today. In some cities there are now trans * counseling centers that can help.

There is also the option of seeking psychotherapeutic help in making decisions. Since there are not yet that many psychotherapists who are familiar with the topic of trans *, a targeted search should be made for a person who has a trans * positive attitude and who can support the path of transition.

Find doctors you trust

It is advisable to take your time looking for the right doctors and to inform yourself carefully beforehand. The criteria for the selection are, on the one hand, that doctors already have experience in the treatment of trans * patients. On the other hand, it is important to feel a sense of trust in the practitioner. Experience reports from trans * groups are often helpful here, as they usually also provide the current addresses of recommended doctors.

As a rule, there is a preliminary talk with the doctor to provide clarification and information before the treatment. It's perfectly fine to have a second appointment with another doctor. Such an important step as a transition should not be taken hastily and prematurely.

The masculinization of the body

Visible masculine changes due to hormones

First of all, a physical and a laboratory examination must be carried out to determine whether treatment with hormones is harmless to health in the individual case. Medicine speaks of "pre-therapeutic risk screening". Ideally, these treatments should be carried out by doctors who specialize in endocrinology and accompanied in the further course.

"Male hormones" (testosterones) can be injected into a muscle by syringe or applied over the skin with a gel / plaster. When biologically given testosterone to females, the body changes over time to what is traditionally considered male. Changes to be expected are a lower pitch of the voice, increased body hair, beard growth, increase in muscles, a gradual cessation of menstruation, coarsening of the skin relief and sometimes acne can occur. Hair loss is also possible over the years.

At the beginning of treatment, some endocrinologists recommend adding "leuprorelin acetate" to testosterone, a drug that also weakens the effect of the body's own sex hormones.

Masculinizing surgery in the chest area

In masculinizing operations in the chest area, the chest body is first surgically removed and the nipples are moved to the anatomical position. With larger breasts, external scars remain, which fade over time. The aim is to operate on a flat breast that looks as analogous as possible to the anatomically male image.

Surgical removal of the uterus and ovaries

For some trans * people it is important to have the uterus and ovaries removed as part of a masculinization process, even though they are not visible from the outside. In addition, a "colpectomy" is performed, which involves the removal of the vaginal skin and the closure of the vagina.

Masculinizing operations in the genital area

Masculinizing genital operations include both "phalloplasty" and "clitoral penoid". The clitoral penoid is called "metaidoioplasty" in technical terms.

Phalloplasty

In phalloplasty, the penis is surgically constructed from a flap of skin, which is usually taken from the skin of the forearm, sometimes also the thigh, and implanted in an anatomically correct location. The wound on the arm or thigh is covered with a skin graft. At the same time, a functioning urethra is constructed so that it is possible to urinate while standing. The skin of the labia becomes the scrotum and is filled with silicone testicular prostheses. To stiffen the penis, the implantation of a stiffening implant, a so-called erectile prosthesis, is necessary. If the operation is successful, the ability to orgasm is retained.

Metaidoioplasty

If the complex phalloplasty is not desired, the metaidoioplasty is an alternative. The clitoris, which has usually grown larger during treatment with androgens, is exposed from the surrounding skin, detached from the retaining straps and moved upwards into a "male" position, which gives it additional length. A urethra is formed from the inner labia and possibly from the vaginal skin, which extends from the existing urethral opening to the tip of the clitoris, which is moved upwards, so that it is possible to urinate while standing. The ability to orgasm is retained if the operation proceeds properly.

The feminization of the body

Visible feminine changes through hormones

Treatment with feminizing drugs is also carried out by doctors specializing in endocrinology. First of all, a pre-therapeutic risk screening is necessary. Female hormones (estrogens) can be given as tablets or via gels / patches. Some endocrinologists recommend so-called antiandrogens in addition to estrogens. These are drugs that still block effective endogenous testosterone.

The effects of these treatments are manifested in a gradual feminization of the body: the skin becomes softer, the breast begins to enlarge, the testicles and genitals shrink, the ability to erect and ejaculate decreases, the body fat is distributed differently, and the body hair goes slowly back. However, beard growth is not stopped under the influence of estrogens and antiandrogens, and the pitch of the voice does not change either. In addition, the desire for sexuality can be weakened.

Feminizing operations in the genital area

The feminizing operation is performed in two sessions. In the first, the more complex operation, the erectile tissue and testicles are first removed, then a space is opened between the urinary bladder and rectum, into which the skin of the penis to the neovagina is turned inside. The clitoris is made from the glans and the labia are made from the skin of the scrotum. After several months, cosmetic and functional corrections are made in a second procedure. The ability to orgasm is usually retained.

Feminizing surgery in the breast area

This operation is only necessary if a female breast has not developed sufficiently while taking estrogens. As a rule, silicone prostheses are surgically implanted, which are available in various shapes and designs. It is important to get good and detailed medical advice beforehand.

Feminization of the voice

Increasing the pitch of the voice can be practiced through speech therapy. Trans * people rarely want an operation on the vocal cords if speech therapy does not lead to success.

Correction of the Adam's apple

To shrink the Adam's apple, various surgical methods are available that are considered safe and uncomplicated.

Trans * people can also have children

In the course of time, the ingestion of hormones affects one's own ability to reproduce. Operations on the reproductive organs with removal of the gonads even lead to an inability to reproduce. What if you still want to have children of your own?

In any case, it is advisable to deal with this question before the transition in order not to miss the right time to preserve your own germ cells. It is best to get advice on individual options at the endocrinology department at the latest during the consultation and to be referred to doctors who are familiar with fertility treatments.

In a nutshell: there is the possibility of "cryopreservation", especially for biologically male people. For this purpose, germ cells (semen / egg cells) are frozen using liquid nitrogen, they can be stored for a long time and used for fertilization at a later point in time. This works very well with sperm cells, but the success rate is lower with egg cells.

Biologically female people face the question of whether they want to be able to have children of their own in the course of masculinization, at the latest in connection with the surgical removal of the uterus and ovaries. If this operation is not carried out, it is possible to carry your own children to term at a later time, despite taking hormones. To do this, however, the male hormones must be discontinued over a certain period of time until the original fertility is restored. By the way, do not worry, the externally visible masculinization is not affected.

Author: Annette Güldenring

Short biography:Annette Güldenring is a specialist in psychiatry and psychotherapy and head of the transgender outpatient clinic at the West Coast Clinic in Heide. She has been active in the transgender movement since 1979, and was editor of the magazine "EZKU - magazine of transsexuals for all Terrans" in the early 1980s. Numerous lectures, workshops and publications on trans identity and transgender health care. Employee in the department for sexual orientation of the DGPPN, mandate holder of the S3 guideline "Gender incongruence, gender dysphoria and trans * health" according to the specifications of the Working Group of Scientific Medical Societies in Germany since July 2017 on the executive board of BVT *. Latest publication: Güldenring, A., Sauer, A. (2017): "Trans *… inclusive? Gender identities in medicine, law and society". In: Diehl, E. (Hg): Participation for all - realities of life between discrimination and participation, series volume 10155. Federal Agency for Civic Education. Bonn, 2017