Gender-affirming surgery (female-to-male)
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Gender-affirming surgery for female-to-male transgender people includes a variety of surgical procedures that alter anatomical traits to provide physical traits more comfortable to the trans man's male identity and functioning.
Often used to refer to phalloplasty, metoidoplasty, or vaginectomy, sex reassignment surgery can also more broadly refer to many procedures an individual may have, such as male chest reconstruction, hysterectomy, or oophorectomy.
Gender-affirming surgery is usually preceded by beginning hormone treatment with testosterone.
Chest reconstruction
If the breast size is small, surgery that spares the skin, nipple and areola (subcutaneous nipple-sparing mastectomy) may be performed. This procedure minimizes scarring, has a faster healing time and usually preserves sensation in the nipples. During this surgery, incisions are made around the borders of the areolae and the surrounding skin. Breast tissue is removed through the incisions and some skin also might be removed. Remaining skin is reattached at the border of the areola.[citation needed]
Research suggests that most transgender men are satisfied with their surgical results, with only 1% experiencing regret after the operation.[4]
Hysterectomy and bilateral salpingo-oophorectomy
According to the ACOG, symptomatic uterine leiomyomas are the most common indication for hysterectomy in the US, followed by abnormal uterine bleeding, endometriosis and prolapse.[5] Risk-reducing hysterectomy is also performed for patients with high-risk of endometrial cancer, including patients with germ-line BRCA1/2 mutations, Lynch Syndrome and family history. Hysterectomy can also be performed for male-identifying patients with uterus in conjunction with testosterone therapy.
Hysterectomy can be performed through three methods: abdominal, laparoscopic, vaginal.[6] Abdominal hysterectomy is performed with incision into the abdominal wall, whereas laparoscopic and vaginal hysterectomies are minimally invasive procedures.[7] Current ACOG guidelines recommend minimally invasive procedures, specifically vaginal hysterectomy, over surgical hysterectomy due to faster recovery time, shorter procedural time, shorter hospital stays and better quality of life.[7][8][9] Discharge from minimally invasive hysterectomy can occur as fast as one day post-operation, in contrast to five days post-operation for abdominal hysterectomies. Following discharge, patients often experience gastrointestinal symptoms such as constipation or urinary tract infections, as well as vaginal bleeding or discharge. These symptoms should be temporary and resolve within six weeks.[10] Follow-up visits with a gynecologist is recommended six-weeks following hysterectomy.
Follow-up care for male-identifying patients with uterus should still see a gynecologist for a check-up at least every three years. This is particularly the case for patients who:
- retain their vagina (whether before or after further genital reconstruction,)
- have a strong family history of cancers of the breast, ovary, or uterus (endometrium,)
- have a personal history of gynecological cancer or significant Pap smear.
- develop vaginal bleeding post-operation and hormone therapy
Complications of hysterectomy involve infection, venous thromboembolic events, genitourinary and gastrointestinal tract injury and nerve injury. The most common of these complications is infection, which occurs at a rate of 10.5% of abdominal hysterectomy, 13% of vaginal hysterectomy and 9% of laparoscopic hysterectomy.[11] There is also a low risk of long-term complications, which can include chronic pain, sexual dysfunction and bowel dysfunction.
Genital reassignment
Also known as genital reconstructive procedures (GRT).[12]
Phalloplasty
Phalloplasty is the process of constructing a neopenis using a flap (graft) from the patient's arm, thigh, abdomen, or back.[13] Compared to metoidioplasty, phalloplasty provides a larger penis which may more closely resemble a natal penis.[medical citation needed] A neopenis created through phalloplasty relies on penile implants to achieve erection.[13] Sexual sensation varies in location and intensity, but is usually preserved at least at base of the penis, where the original clitoris was.[medical citation needed]
Metoidioplasty
Metoidioplasty is done after enlarging the clitoris using hormone replacement therapy, where a neopenis is constructed from the enlarged clitoris, with or without extending the urethra to allow urination while standing up. The labia majora are united to form a scrotum, where prosthetic testicles can be inserted. The new neophallus ranges in size from 4–10 cm (with an average of 5.7 cm) and has the approximate girth of a human adult thumb.[15] Sexual sensation and erectile function are usually completely preserved. Specialized metoidioplasty penile implants may be an option in those who cannot achieve penetration during sex.[16]
Penile implants
Penile implants are usually used in phalloplasty surgery due to the inability of the neophallus to achieve proper
Facial masculinization
Facial masculinization also alters anatomical features to achieve an appearance that aligns more closely with gender identity. This can be achieved surgically, which might entail reconstruction of the forehead, nose, upper lip, or chin.[18] Non-surgical options include injections to alter the jawline and chin.[19] Non-surgical methods can be combined with surgery or used alone when subtle changes are desired. In addition to alteration of facial structure, hair transplantation can be used to achieve more permanent masculine hair growth patterns such as sideburns, mustaches, or beards.[19]
See also
- Facial masculinization
- List of transgender-related topics
- Penile implant
- Sex reassignment surgery (male-to-female)
Notes and references
Citations
- ^ a b c "What is Top Surgery? A Guide to the Reconstructive Chest Procedure for Transmasculine Individuals". Insider. October 14, 2020. Retrieved September 14, 2021.
- ^ "What is Gynecomastia?". NHS. 26 June 2018. Archived from the original on 14 August 2021. Retrieved September 14, 2021.
- PMID 31624695.
- S2CID 225704571.
- ^ "Choosing the Route of Hysterectomy for Benign Disease". The American College of Obstetricians and Gynecologists. June 2017. Archived from the original on September 13, 2021. Retrieved September 14, 2021.
- PMID 16275095.
- ^ PMID 37642285.
- ^ "Choosing the Route of Hysterectomy for Benign Disease". Archived from the original on 2021-09-13. Retrieved 2021-09-13.
- S2CID 36424081.
- ^ "Recovery - Hysterectomy". NHS. 14 May 2018. Archived from the original on 13 September 2021. Retrieved September 14, 2021.
- from the original on 2021-09-13. Retrieved 2021-09-13.
- PMID 28234856.
- ^ PMID 31380234.
- PMID 34721306.
- ^ Metoidioplasty as a Single Stage Sex Reassignment Surgery in Female Transsexuals: Belgrade Experience Djordjevic, Miroslav L. et al., Journal of Sexual Medicine, Volume 6, Issue 5, 1306 - 1313
- PMID 31004096.
- S2CID 207890601.
- S2CID 241880496, retrieved 2021-09-11
- ^ PMID 30383180.
General sources
- Factors Which Influence Individual's Decisions When Considering Female-To-Male Genital Reconstructive Surgery by Katherine Rachlin from the International Journal of Transgenderism. Female-To-Male Genital Reconstructive Surgery. Factors, Benefits and Risks by Preecha Tiewtranon This article also discusses some general issues of female-to-male GRT.
External links
- Everything you wanted to know about ... Total Abdominal Hysterectomy with Bilateral Salpingo Oophorectomy Archived 2014-11-16 at the Wayback Machine