Coming out... to *you*

iVillage Member
Registered: 10-04-2004
Coming out... to *you*
25
Mon, 09-26-2005 - 6:45pm

I work in a small office of

iVillage Member
Registered: 02-15-2004
Wed, 09-28-2005 - 6:33pm

Hey Nelle, I've been following this post with a lot of interest. The pictures on the website were great. I had to read loerncameron's biography twice to make sure that I understood what I was reading. I'd like to thank your for sharing this. I will be looking forward in reading more about this.

Thanks for your time and sharing about this.

Hugs!

 


Hugs,


Sebastian


 


http://www.facebook.com/sebastianbruce

iVillage Member
Registered: 10-04-2004
Wed, 09-28-2005 - 6:46pm

You are most welcome! Loren is a renowned photographer, and has books out there you might find interesting...


of course, there is also Pat Calafia, but Pat isn't

iVillage Member
Registered: 02-15-2004
Wed, 09-28-2005 - 7:09pm

He would have had my complete and undivided attention, during the whole presentation.

Thanks again!

Hugs!

 


Hugs,


Sebastian


 


http://www.facebook.com/sebastianbruce

iVillage Member
Registered: 02-04-2005
Thu, 09-29-2005 - 10:00am
Thanks nelle for the info.
Hugs,
Laurie
Check out my new blog.
co-cl of Lesbian Life Message Board
Email- didoangst@comcast.net
http://didoangst.blogspot.com/
http://homepage.mac.com/lauriedav/PhotoAlbum1.html
Hugs, Laurie Check out my new blog. co-cl of Lesbian Life Message Board Email- didoangst@comcast.net http://didoangst.blogspot.com/ http://www.4-lesbianlife.com/
iVillage Member
Registered: 03-25-2003
Tue, 10-04-2005 - 7:26pm

Do you know if Loren was in a documentary? I think I remember her face in a series named “In the Life”. I think she (if it was her) was being interviewed while she was pumping iron. Am I correct in calling Loren she or is he the correct word to use now? Soo confusing! They were talking about transforming from m2f & f2m. It was a fascinating story. I think I was struck with their determination to live the way they want finally and no one going to stop them from being happy, not even the hostility they encounter in gay and straight communities.

Now, what you said about losing hair from male pattern baldness, which is surprising. I guess when you lose your femaleness; you lose it all the way! It’s like all or nothing, huh? Do you know why f2m surgery is not as good as the m2f? Did they explain this discrepancy? Is it because not many females are willing to change that drastically so there not many for the surgeons to work and perfect on? Sorry to be asking all this like I’m demanding answers. *L* I’m not looking for a change. Sometime curiosity hit my head. *grin*

iVillage Member
Registered: 10-04-2004
Tue, 10-04-2005 - 8:11pm

Loren may well have been... I'll check with Vicki (coworker) tomorrow, she was there as well. I seem to recall Loren talking about lifting. And how you feel is exactly how I did watching his presentation.


Surgery is not as good because of what is attempted.


>>>>warning<<<<


Lynn Conway has an excellent website with info on mtf surgery... it's graphic, but it's damn good...


http://ai.eecs.umich.edu/people/conway/TS/SRS.html


Now for various info on female to male surgery...


Here's one on the cost... notice it is 3 times my cost for mtf surgery.


http://www.ftmphallo.com/Home/ftmhome1.htm


And an excellent article by James Green...


http://www.gender.org/resources/getting_real.html


The bottom line with “bottom” surgery is no surgeon can give you the penis you should have been born with. So what’s the reason for having genital reconstruction at all? Well, some FTMs think there is no acceptable reason to have “bottom” surgery. And some FTMs want desperately to have their bodies altered so they can have “male” sex, or get their new birth certificate, get married, or be legally male. And some are just afraid of being caught with female genitalia, with nothing in their crotch, or caught sitting in a toilet stall, unable to urinate while standing. Some are afraid of being perceived as female, or discovered to be a woman “after all” (because everybody “knows” genitals are the final arbiter of identity). There are a lot of reasons to have lower surgery, not the least of which is the desire to have one’s entire body match one’s identity. But genital reconstruction is a lot more expensive and riskier than a bilateral mastectomy. There are far fewer surgeons who are willing to perform genital reconstruction, and fewer still who are truly good at it.


Genital reconstruction falls into two basic types: phalloplasty and metoidioplasty, (also written as metadoioplasty; see end note, p. 32). The term “genitoplasty” is also, erroneously, used to refer to this type of surgery: technically, genitoplasty is any genital surgery, not necessarily limited to the creation of male genitals out of female genitals, which is, technically, metoidioplasty.


The first type of phalloplasty, developed in the first half of this century, was the Gillies abdominal tube, in which a flap of abdominal skin is rolled into a tube and left hanging like a flaccid organ. Early phalloplasty techniques were originally pioneered to treat men whose penises were lost by traumatic amputation in war or industrial accidents, and were first applied to FTMs (as far as we know) in 1948. Some FTMs have postulated that there is a conspiracy against us by the surgeons, that they aren’t trying hard enough to give us a good penis because they don’t care about us, but the truth is that the same problems in creating a penis apply to us as to any other penisless man.


Dr. Gillies worked later with Dr. Maltz to develop the “tube-within-a-tube” phalloplasty to provide for a urinary canal, which has proven not terribly effective due to the frequent complications of fistulae (leaks) or strictures (blockages) in the urinary passage. Maltz also developed the “suitcase handle” technique, in which the rolled tube of skin is left attached top and bottom on the abdomen for six weeks to ensure adequate blood supply to the neo-phallus, then the upper attachment is severed and the “handle” swung down over the clitoral base. This improvement resulted in better retention of the neophallus, which otherwise was prone to wither and fall off!


These early-style phalloplasties (which many surgeons still perform) require the use of a stent (silicone rod stiffener) inserted in the shaft to achieve erection. The neophallus has no feeling and usually does not have a very natural appearance. Some surgeons leave the female genitalia completely intact, and some will attempt the formation of the scrotum using a pouch of abdominal tissue beneath the neophallus, still leaving the male genitalia perched on the lower belly above the female genitalia. Still, other surgeons may be more adept using these techniques than the examples I have seen in real life.


The more contemporary phalloplasty technique is called the free tissue flap transfer (FTFT). This technique has been made possible by the advent of microsurgery, and the development of the fine art of connecting dissimilar nerves. Using a flap of skin and muscle tissue from the forearm, groin, or thigh, this flap is transferred with its existing nerves and blood vessels to the groin area, and the nerves and blood vessels are connected microsurgically to the nerves and blood vessels of the groin, e.g., the brachial nerve of the forearm is connected to the pudendal nerve (see fig. 3). Note that the head of the clitoris is removed to provide access to the pudendal nerve (the nerve providing erotic sensation). This results in a penis that may have feeling, but is not capable of achieving or sustaining an erection. Although implants are available to achieve erection, they have so far proven to be problematic due to infections, rejection by the body, and extrusion and intrusion. Without an implant, a stent is required to erect the shaft of the neophallus. This penis still may not have a natural appearance; in fact, with all phalloplasties, the sculpting of the glans leaves much to be desired, and it is usually this feature that exposes the organ as one that has been artificially constructed (see fig. 4).


The advantages of FTFT are that new microsurgical techniques can provide a phallus with erotic sensation, and one that is closer in size to that of the average genetic male penis, as well as providing for urinary extension. The risks, though, are many: damage to the remaining nerves of the donor site, damage to the pudendal nerve of the groin resulting in a numb organ, death of the graft, loss of function in the donor site, and the frequent development of fistulae or strictures in the urinary passage. And there are disadvantages, too: the inability to achieve or sustain an erection without a stent or an implant; excessive donor site scarring; the fact that these procedures usually require multiple revisions, and may be aesthetically inferior; and there is severe pain and discomfort associated with the donor sites as well as the groin area. Also, for most FTMs, FTFT is cost prohibitive, rang0ing from $50,000 to $150,000, plus months—or even years—spent in recovery and/or revisions.


An FTM’s natural advantage over a penisless man is the clitoris. Dr. Bouman in The Netherlands and Dr. Laub in the U.S. recognized this in the 1970s and independently (and virtually simultaneously) developed the metoidioplasty technique, which is the only type of genital reconstruction that actually transforms the female genitalia into male-appearing organs (see fig. 5). Providing there has been sufficient clitoral growth induced by testosterone, the closest approximation to a typically-sized adult male penis is achieved with a clitoral release (the severing of the suspensory ligaments that hold the clitoris in a position where it is tucked under the pubic bone). The clitoral release effectively gives the FTM a micropenis, a naturally occurring condition among roughly 5% of male-bodied individuals. More length can be obtained once the suspensory ligaments are cut by the surgeon proceeding beneath the pubic bone and advancing the crura (or “legs” of the clitoris—or penis) out). These “legs” can be repositioned forward with respect to the pubic bone and a flap of abdominal skin can be used to cover the newly exposed tissue on the clitpenoid shaft. This procedure is being practiced more and more often in cases of male-bodied persons born with micropenis. For FTMs, the scrotum is formed by joining the labia majora and using silicone testicular implants, sometimes preceded by tissue expanders. The primary risk with metoidioplasty is that when the surgeon advances the crura out, it is possible that the pudendal nerve may be damaged and the organ rendered numb. The advantages are that the penis, though small, is otherwise normal in appearance, with a natural glans and foreskin, and the scrotum can be sized appropriately for the patient’s body. Another advantage is that sexual function is not lost; the FTM can have natural erections and orgasm (unless the pudendal nerve is damaged). Note that intravaginal penetration is possible for some individuals with this type of penis, but this ability cannot be expected in all cases.


Urethral extension in metoidioplasty poses the same problems it always has with phalloplasties: some surgeons are more willing to attempt it than others, and 100% success is still rare. But several surgeons are working on new techniques to eliminate strictures and fistulae.


Metoidioplasty can be performed on an outpatient basis and also costs less than phalloplasty, usually running $4,000 to $10,000. If tissue expanders are used for the scrotum, expect a second procedure to remove them and replace them with the actual implants; this procedure costs approximately $2000. Each procedure requires about 10 days of absolute rest, and the initial reconstruction requires some further healing period of one to three weeks when it may be necessary to limit activity.


What else can be done for FTMs to increase penis size? Generally speaking, the extent of the possible enlargement of the adult clitoris is limited; that is, it will grow only to a certain degree because of the limited number of cells in its specific composition. Enlargement of the clitoris is a matter of the enlargement of the internal structures, also known as the spongy bodies, the corpora cavernosa and the corpora spongiosum (the tissue responsible for erections). Most of this growth is obtained during the first year of testosterone therapy. Other possibilities for clitoral enlargement are the use of testosterone propionate ointment 0.2% applied directly to the clitoris (this is still an experimental treatment), or the use of a vacuum pump to stimulate the repeated rush of blood into the area that enlarges the tissue, much as a bodybuilder increases muscle size through repeated blood engorgement. The penis is not a muscle, however, and too much pumping can actually tear the fibrous tissue of the organ.


When you are searching the medical literature for ideas about how to improve phalloplasty, don’t be misled by descriptions of penis reconstruction techniques used for loss of erectile function caused by other diseases. These methods presume the presence of an organ which is not easily mimicked by tissue from other parts of the body. Instead, look for Kallmann’s Syndrome (one of many conditions that results in micropenis) or hypospadius repair; these conditions are far more analogous to our physical situation. Also, watch out for promises made out of fat transfers: packing your penis with your own fat can make it difficult to erect and less sensate. The fat can also clump or even die!


There is one further type of surgery of which FTMs will usually avail themselves: hysterectomy, oophorectomy, and sometimes vaginectomy. These procedures may be performed through an abdominal incision, through a vaginal entry, or using laparoscopy. Some U.S. states require that oophorectomy be performed to render the FTM sterile before he may be granted legal recognition as a male. Some FTMs feel they need to be rid of these “female” organs for psychological reasons, and some need to have them removed because the testosterone therapy may aggravate existing precancerous conditions in that tissue. And some FTMs feel this is unnecessary surgery and will avoid it.


When deciding whether or not to have the uterus and ovaries removed, there are a few things to be aware of. First, because the FTM population is not well studied, we don’t know the long term impact of testosterone therapy on internal female organs. If one is in a high risk group for cancers of female organs, is prone to ovarian cysts, or has a history of problems in these organs, these are good indicators for considering removal. Also, people who live in small towns may run into problems obtaining medical treatment for “female” problems while presenting a male appearance. Sometimes big cities aren’t any easier on the physically incongruent, either.


Considering the three different approaches, the advantages and disadvantages are these: The abdominal approach is the least desirable because it induces more trauma, leaves a noticeable scar, and may interfere with a later phalloplasty via abdominal tube; however, in cases where the organs are difficult to remove or there are large fibroids or other growths, this method may be necessary. The laparoscopic approach can only remove the ovaries and fallopian tubes; it is more expensive than the abdominal method, and not all gynecologists are skilled in the technique; it leaves some scarring. The vaginal approach leaves no external scar, causes less trauma, allows for more rapid healing, and is convenient if the surgeon is also performing a vaginectomy and/or anterior vaginal flap urethroplasty (the most effective technique to date for urethral extensions); one prerequisite is that the vaginal opening must be large enough to accommodate the surgical instruments.


Some doctors recommend removing the vagina (like the other unnecessary female organs) to avoid infections and cancer. But FTMs might consider retaining the vagina when no urethroplasty is being done because it reserves this important tissue in the event a urethroplasty is elected in the future. And some people who are accustomed to vaginal response during orgasm may want to retain the tissue to avoid loss of that sexual response.


Getting real about FTM surgery means accepting the fact that we are altering our bodies; we will never have the bodies we should have been born with. Getting real means accepting the limitations that our bodies have before we get on the operating table, and accepting that we will not come out of this scarless, without wounds, without compromises. That’s not to say that we can’t keep working and hoping for improvements; we can and we do. But we have to live in our bodies one way or another: where do we get the ideas of perfection that we try to live up to? How much imperfection can you handle? Identifying as transsexual means you have signed up to consider these questions. Not to do so is to invite disaster—which may occur anyway under the knife. I’ve had a bilateral mastectomy via double incision, hysterectomy and oopohrectomy via abdominal incision, and metoidioplasty without urethral extension. My last procedure was in 1991, and I’ve been really pleased with the results. I’ve made some compromises in order to live legally as a man, and I feel I’ve been fortunate in both my decisions and in their consequences. Things could have easily turned out otherwise. For me, getting real means taking responsibility for my decisions about my body and living with myself

We fell asleep and began to dream when something broke the night
Memories stirred inside of us - the struggle and the fight
And we could feel the heat of a thousand voices
Telling us which way to go
And we cried out "Is there no escape from the words that plague me so?"

And we were drawn to the rhythm
Drawn into the rhythm of the sea
Yes, we were drawn to the rhythm
Drawn into the rhythm of the sea


Drawn to the Rhythm ~ Sarah McLachlan

iVillage Member
Registered: 03-25-2003
Tue, 10-04-2005 - 8:31pm

oh girl...you just provide more materials for more questions. *L*

how do you get your mind and body prepare for this surgery?
does insurance pay for this or is it all out of pocket for everyone electing this procedure?
how did the doctors get into this field? Is it the case of the demand producing on occupation?
how about donors? is it possible for outside donors to contribute an organ or tissue for these tubes? or is rejection rate is so high they don't consider that? (this question must sound silly). :-p

iVillage Member
Registered: 10-04-2004
Tue, 10-04-2005 - 8:53pm

how do you get your mind and body prepare for this surgery?


Hmmmm... return with me now to a time not so long ago, but most assuredly in a land far, far away... a whole other life. Surgery was scheduled for 6 December, 2004. I'd have been temporarily married, and that person would have seen to my spiritual healing, as well as had legal say over anything unanticipated happening. I could care less... surgery could involved cutting me in two, and indeed... I would have cared less... still could care less... get this done! I've had to live with a birth defect for 50 years... I'll take the risk, and smiel the whole damn way. If it kills me, well... it will be smieling.



does insurance pay for this or is it all out of pocket for everyone electing this procedure?


Very few are fortunate to have it covered. The city of San Francisco covers the procedure, but most health policies exclude it, the theory being it is 'elective surgery.' Yeah, right. If they covered it, it would add like 20 cents to the average health premium.

iVillage Member
Registered: 03-25-2003
Thu, 10-06-2005 - 12:58pm
You are really brave.
All that time and energy to be who you want to be.
Bravo. *Smile*
iVillage Member
Registered: 08-01-2004
Thu, 10-06-2005 - 9:38pm

"how do you get your mind and body prepare for this surgery?"

I spent the morning of my srs listening to Cris Williamson's The Changer and The Changed.

In terms of the surgery itself, it just seems like a normal step. By the time you get to that point, you've been putting things into place for a very long time. It's a transition, like getting married or having a child. I did a lot of introspection about how my life had led me to that point. I would find myself looking at photos of myself as a child or googling people I hadn't seen since high school.

"how did the doctors get into this field? Is it the case of the demand producing on occupation?"

I don't know how my SRS surgeon got into it, but I know that Thailand had a policy of encouraging hospital development for cosmetic surgery for foreign patients. And the Thais have a tradition of transgendered women (katoey) that goes back for centuries. Dr. Ousterhout my facial surgeon was a cranial-facial surgeon who was doing reconstructions for accident victims, victims of violence, and children with birth defects. A colleague ran him up and asked him if he could "feminize a skull." He'd never thought about the issue, so he went and measured skulls at the local medical school's collection and came up with where the measurements differed on average. He applied the math and did the operation. And the results were, to say the least, stunning. Word of mouth carried from there and 20 years later he's booked months in advance and has clients from around the world coming to have surgery with him. Not to mention spawning an entire field that didn't exist before.