Sex reassignment surgery (female-to-male)
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Sex reassignment 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. Non-binary people assigned female at birth may also have these surgeries.
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,
Male chest reconstruction
Also called "top surgery", male chest reconstruction is any of a variety of surgeries to remove breast tissue, and provide shaping of a male contoured chest. Surgeries for female-to-male transgender patients have similarities to both gynecomastia surgeries for cisgender men, breast reduction surgery for gigantomastia, and the separate mastectomies done for breast cancer.
Moderate to large breasts usually require a double incision procedure, with grafting and reconstruction of the nipple-areola. This procedure makes it easier to contour the chest and place the nipples in a more natural position but results in more visible scarring.
For smaller breasts, a peri-areolar, or keyhole procedure may be done where the breast tissue is removed through an incision made around the areola. This results in less visible scarring but may result in lower than average nipple placement, and a less natural contour.
There is less denervation of the chest wall with a peri-areolar mastectomy, and less time is required for sensation to return. Loss of sensation to varying degrees is a risk with any chest reconstruction procedure.
Hysterectomy and bilateral salpingo-oophorectomy
Hysterectomy is the removal of the uterus. Bilateral salpingo-oophorectomy (BSO) is the removal of both ovaries and fallopian tubes. A 'partial hysterectomy' is when the uterus is removed, but the cervix is left intact. If the cervix is also removed, it is called a 'total hysterectomy.'
Some trans men desire to have a hysterectomy/BSO because of a discomfort with having them, or when menses fail to fully stop with testosterone replacement therapy.
Hysterectomy/BSO is also done to decrease the risk of developing cervical, endometrial, and ovarian cancer, although it is unknown whether the risk of ovarian cancer is increased, decreased, or unchanged in the transgender male population.
After hysterectomy/BSO, trans men should still see a gynecologist for a check-up at least every three years. This is particularly the case for trans men 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 dysplasia on a Pap smear.
One important consideration is that any trans man who develops vaginal bleeding after successfully ceasing menses on testosterone must be evaluated by a gynecologist. This is equivalent to postmenopausal bleeding in a woman and may herald the development of gynecologic cancer.
Genital reconstructive procedures (GRT) use either solely the clitoris, which is enlarged by androgenic hormones (metoidioplasty), or also use free tissue grafts from either the arm, the thigh, the abdomen, or the back (phalloplasty), most of which further use an erectile implant. In either case, the urethra can be rerouted through the phallus to allow urination through the newly constructed penis. The labia majora are united to form a scrotum, where prosthetic testicles can be inserted.
Notes and references
- 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 Dr Preecha Tiewtranon This article also discusses some general issues of female-to-male GRT.