Trans Surgeries Part III of III

Some workshops at The Fifth Annual Transgender Medical Symposium of Fort Lauderdale focused on trans surgeries. The words “top” and “bottom” have different meanings in trans culture than in gay bi male culture. They refer to types of surgeries. “Top” refers to chest or breast surgery; “bottom” refers to genitalia surgery.

Dr. Christopher Salgado of the University of Miami reported on transsexual surgery. The information below comes from his workshop unless stated otherwise.

Male-to-female (MTF) and female-to-male (FTM) surgeries take about 10-12 hours each. People with serious diseases can have trans surgery as long as those diseases are controlled. For an HIV infected person, “control” would mean a high CD4 count. Any 10-12 hour surgery counts as a major surgery, requiring substantial post-surgery recovery time. People should postpone trans surgery until they have a good support system and dedicated time for their recovery. They should have enough funds to cover out-of-pocket expenses and time out of work.

Trans man surgery:

In trans man (FTM) top surgeries, surgeons will remove the breast tissue. The surgeon then has to reattach the nipples. This frequently results in a loss of sensation in the nipples. As some trans man do not choose bottom surgery, the surgeon may also remove the ovaries during top surgery.

Taking male hormones has the following effects in trans men: vaginal atrophy, clitoral enlargement, and reports of an increased sex drive. One type of bottom surgery transforms the enlarged clitoris into a micro-penis. This surgery extends the urethra through the clitoris. While standing urination becomes possible, a micro-penis may be too small for intercourse.

In another type of bottom surgery, the surgeon will construct a penis (a neo-penis) from skin and other issue. Dr. Salgado mainly uses the skin from the forearm, complete with any tattoos. The surgeon will construct a urethral extension. The surgeon will construct the penile shaft around the clitoris. It will take about one-year for the nerves to attach to the head of the penis.

Trans man bottom surgeries have a high risk of urinary tract infections. The “female” bladder muscle has to push urine a much shorter distance than the “male” bladder muscle does. Either type of trans man bottom surgery extends the urethra, increasing that urethral distance. The “female” bladder muscle may lack the strength to push urine through the extended urethra. This results in frequent urinary problems for those trans men with extended urethras.

Trans woman surgery:

Female hormones will cause breast growth in trans women. Trans women taking female hormones also report a decreased sex drive.

The surgeon will construct a neo-vagina from mucosal tissue and skin from the scrotum and penis. Some doctors, other than Dr. Salgado, use tissue from the colon to construct the vagina. The surgeon will construct the neo-clitoris from the glans of the penis. A biologically constructed vagina (a bio-vagina) will average about 7.5 inches of depth. A surgically constructed vagina, (a neo-vagina), however, will average about 4.5 inches of depth. The surgery will leave the prostate intact, requiring trans women to have prostate exams.

A neo-vagina has a risk of closing. Regular vaginal intercourse or the use of a vaginal dilator, however, will prevent it from closing.

Dr. Salgado spoke about surgical facial feminization, which trans women consider critical for “passing.” This surgery reduces the Adam’s apple and the brow ridge. A nose job may also be required.

This concludes the reports from The Fifth Annual Transgender Symposium, a very worthwhile event.

For more information on transgenders, see the following resources.
Local – support groups, general information

Center for Excellence in Transgender Health