Sex reassignment surgery for a woman: how it is done, stages of the operation and scheme, how recovery occurs, hormonal drugs before and after

Transgender transition female - to - male, that is, when a woman becomes a man, is considered a classic, true form of transsexualism.
Gender reassignment from male to female is a more diffuse form in which false cases are more common. But, nevertheless, more often than not, sexual transformation occurs in the form male – to – female, that is, from male to female. The stages of both types of transitions are identical in principle. This includes a change of image according to psychological gender and social adaptation of a person in a new role, as well as physical transformation of the body under the influence of hormone therapy and plastic surgery.

A little history about sex reassignment surgery

The first intervention for a transsexual was carried out in Denmark in 1931. But until the mid-60s, these operations remained unique. Everything has changed since the second half of the last century. The first specialized clinics that helped transsexuals arose in France. In 1978, an international association of surgeons specializing in sex reassignment operations was created in the United States. In the USSR, such an intervention was first carried out before 1991.

Singer Cher's daughter Chastity Bono becomes Chase

Indications for sex reassignment surgery in women

Surgical “transformation” from a woman to a man is much more difficult to do than to fashion a gentleman into a lady. Therefore, clear indications are needed for the operation. The main one is the patient’s transsexuality, confirmed by specialists. Lesbian sexual preferences are not grounds for plastic surgery.

Medical indications for gender reassignment

Before sex reassignment surgery, identification of medical indications is required:

confirmed diagnosis of transsexualism by a sexologist;
exclusion of similar forms of gender identification, including homosexual orientation, transvestism (inpatient diagnostics are desirable);
consultation with a psychiatrist to determine mental disorders (they are a contraindication for surgery).

Bruce Jenner changed gender at 65
After the initial examination and diagnosis, examination and observation by a psychiatrist is recommended in order to study:

developmental features, time of appearance of ideas about gender reassignment (for this, at the request of the patient, relatives are involved);
motives for surgery;
awareness of health risks, problems in contacts with the environment, family (it is especially important to take into account the psychological trauma of a child when a parent changes gender).

An andrologist and/or endocrinologist examines hormonal levels. To assess the condition of the female genital organs, you need to consult a gynecologist. Based on all this data, a medical consultation is appointed (sexologist, psychologist, psychiatrist), at which a conclusion is made about whether the person is really a transsexual and whether gender reassignment can help him.

If the answer is positive, a certificate is issued for the registry office. Based on it, changes are made to the passport data - the first name, last name and gender are changed. After a year of probation and taking male hormones, surgery is prescribed. Before this, a repeated examination and confirmation of the intention to change sex is necessary.

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What happens if you change gender from woman to man?

If a complete gender change has occurred from female to male, the following will be deleted as a result:

adipose tissue from the mammary glands so that they become flat, the size of the nipple decreases;
ovaries with fallopian tubes and uterus;
the vagina, or it is closed surgically;
excess fat on the buttocks and abdomen to give a masculine figure.

Implants for penile prosthetics
To recreate the genital organs, an operation is performed to form a penis from the tissues of the body or clitoris, or a scrotum from the labia. It is also possible to inject silicone into the chin, calf muscles, and biceps. The scope of operations depends on the wishes and financial capabilities of the patient. All the time before and after the intervention you need to take male sex hormones, since without them complete transformation is impossible.

What do hormones do?

Men take the female hormone estrogen and antiandrogens. As a result, muscles decrease, the skin becomes smoother and softer, body fat is distributed “feminine-style,” and body hair decreases (but does not disappear). The appearance becomes more feminine.

Women, on the contrary, take androgens, thanks to which their voice breaks, the silhouette and structure of the body changes, the Adam's apple grows and hair begins to grow on the face and body. In principle, therapy alone can radically change the appearance of such a person, making him visually indistinguishable from an ordinary man. Take a look at New York musician Jamie Wilson before and after 2 years of testosterone therapy.

But the main task of hormones, as physician Fred Ettner explains, is to “rewire” the brain. If previously the patient suffered from a discrepancy between physical and mental gender, then after hormonal therapy he feels “right”.

Only after this long and public preparation is an operation to change the genitals scheduled. According to doctors, at most a third of patients pass through it. The reasons for indecision are different, but for many it is simply unaffordable.

Stages of preparation for gender reassignment in women

Plastic surgery is performed through several surgical interventions, as it involves serious changes in the functions of the body. Therefore, the preliminary stage is also multi-stage.

Physical training

Before allowing a patient to undergo sex reassignment surgery to male, it is necessary:

Observe with a sex therapist for at least a year. It must reveal the impossibility of a woman to exist in the body given by nature, that is, the need for intervention.
The same amount of visits to a psychiatrist. The specialist must confirm the patient’s ability to make decisions, that is, the absence of pathologies.
Undergo a thorough examination. In addition to the tests that are required for any operation, hysteroscopy and salpingoscopy are needed. They must confirm the absence of genital tumors.
Long-term use of hormones. To make the new body aesthetically and functionally more consistent with a man’s, they take medications.

Before (Yvonne Buschbaum) and after (Balian Buschbaum)

Moral preparation of a woman

Before surgery, it is important to prepare yourself psychologically for future changes. You need to live as a man for at least a year to confirm that your feelings and decision to change your sex are correct. If such an existence turns out to be more natural and comfortable than in a female form, moral preparation can be considered successfully completed.

Is it worth radically deleting everything at once?

It is no secret that during surgery, the patient’s female genital organs are removed and the male genitals are reconstructed. But there are options here. If you preserve the uterus, ovaries, and fallopian tubes, there will be no external signs of their presence. That is, the patient will take on the appearance of a man. But subsequently, by stopping taking hormonal drugs, it is possible to restore the functions of the female organs.

And you can conceive, carry, give birth to your own child. Similar cases are known.

Thomas Beaty is the only pregnant man who did not immediately have all his female reproductive organs removed.

“My wife and I were breaking ourselves trying to portray a heterosexual couple.”

Victoria (name changed), 32 years old

When I was two years old, I was in an accident and hit my head hard. Perhaps this somehow affected my body, because I began to develop physically early. Doctors have never established the exact cause. At the age of six, my breasts suddenly began to grow, and at eight I started getting my period. I was the youngest in the class and the tallest. I was mistaken for a second-year student, although I was an “excellent” student. By the age of 12, my height was 158 cm, and my breasts had grown to size four - oh, how I hated them! After that I didn't grow any more. Of course, I had a lot of complexes about my appearance and was ashamed of myself. I didn’t understand how to communicate with my peers, and I felt out of place everywhere.

At the age of 15, I fell into a prolonged depression. I didn’t want to see anyone or go out anywhere. My cousin suggested that my parents send me to Israel, where my grandmother went many years ago, followed by my cousin, who also had communication problems as a child - but there he found his place. This is how I ended up in an Israeli religious school for girls. It was there that the persistent realization came to me that women are second class. For example, we were told in plain text that education is, of course, wonderful, but of secondary importance. The main thing is that we be good wives and mothers. One day my brother took me from school for the weekend and took me to visit his friends. I had to, as a matter of course, help an unfamiliar aunt bring food to the men. Women were given food after men, only because they were women. I was very indignant.

Three months later, without further explanation, I asked my parents to take me home, which they did: my mother says that I was a difficult child and she did not dare to argue with me at all.

At home I was left to my own devices. My parents were on the verge of divorce, my mother had already found herself another man. In general, my emotional state left much to be desired. I plunged headlong into the Internet, became interested in role-playing games: on forums, many girls pretended to be guys, and I always played exclusively male roles and felt much freer than in female ones.

On the forum I met a person with whom I began a long-distance relationship. Naturally, he thought I was a guy. I'm talking about him too. I don’t know if this is true - we haven’t met in person. It was then that the thought occurred to me that I didn’t just want to play for a guy, I wanted to be him, that everything was wrong in my life because I was a “woman.” I began to look for information about transgenderism; neither operations, nor possible health problems, nor the misunderstanding of others scared me.

I almost immediately told my mother about everything, and she, oddly enough, supported me and told my father about everything herself. He drank a glass of vodka and remained silent. He didn’t openly object, but he didn’t support me either.

My mother and I went to psychologists and psychiatrists together, but in the Baltic country where I lived at that time, there were no normal specialists. Some said that it was just my age and would go away, others explained my behavior as stress due to school. And one psychologist told me that I was suffering from garbage and was simply wasting my parents’ money. Then we went to St. Petersburg, and there they told me to wait until I came of age.

When my parents divorced, I went with my mother to my stepfather, who soon began to harass me. He undressed me under the pretext of a “therapeutic massage” - supposedly he was a good massage therapist, but asked not to tell anyone about it. At the same time, he also began to play “strict daddy” in front of his mother. Therefore, I soon packed my things and went to my father, telling my mother that I was fed up with this bastard and his control. I was ashamed to name the real reason for leaving.

At home, in the Baltics, I graduated from school as an external student, just so as not to “play a female role,” and at the university I asked to register me under a man’s name, promising to later bring a certificate of transgenderism and new documents. It was terribly offensive when an elderly teacher, reading my name in a magazine and looking at me, asked: “Are you a girl, or what?” With my height and figure, I was not at all attracted to a guy.

Immediately after my 18th birthday, I went to the commission to get a certificate of transgenderism. The commission lasted 10-15 minutes: “How long have you had this? Why do you think you need surgery? What are your plans for the future?". I successfully answered the questions, received a certificate and quickly changed my first and last name, rejoicing that I would finally live and not “wait for life.” I had a mastectomy in St. Petersburg. Six months later, a second operation was scheduled to remove the uterus. But shortly before it, I suddenly changed my mind and decided that I would have the operation sometime later. I still can’t explain this decision of mine.

I left the university, realizing that I had chosen the wrong specialty, and left the Baltic states to study in central Europe - I wanted to start a new life in a new country. Everything was fine with my studies, but I still had no friends. I was scared to approach guys: I was afraid that they would understand that I was not a “real” guy, that I was a fake, and they would make fun of me or punch me in the face. It didn't work out with girls for the same reason. At university, I was often addressed as “girl” at seminars. I felt terribly stupid.

Watching our wedding video, I saw myself, a dressed-up butch penguin with damaged skin and excess weight, and I became scared

Around the age of 20, I had periods when I stopped hormonal therapy because I was afraid of changes in my appearance: excess weight, acne, facial hair. But I quickly decided that all this was nonsense, and I was not a “woman.”

Once on a forum I met a girl from Moscow - my future wife. We started visiting each other. I constantly asked questions like: “What should a man do? How to behave so as not to lose face?” After a while, I told her that I was intersex, just to avoid saying the terrible “I’m a woman.” It's still embarrassing to remember this. She accepted me. Soon I proposed to her.

Watching our wedding video, I saw myself, a costumed butch penguin (a masculine-looking lesbian. - Kholoda’s note) with damaged skin and excess weight, and I became scared, because before I was a pretty pretty girl. I tried to push these thoughts aside, but at some point I realized that I was tired of wearing the “tough guy” mask. The role of the head of the family turned out to be alien and unnatural for me. Romance and understanding faded away, turning into quarrels and routine. I drove myself into a dead end, trying to hold on to the idea that transgender people make the decision to transition only once, and it is the only right one. And if my decision was wrong, then I really suck.

It took me over a year to accept the fact that I made a mistake. I rethought my life, decided to go into detransition and confessed everything to my wife. At first she was against it. But in essence, we were both breaking ourselves, trying to portray a heterosexual couple: before me, my wife had only met and lived with girls, but she had no luck with them, so she thought that with “this option” like me, it would be easier for her. Now we live peacefully as a same-sex couple.

In 2021, I went for a consultation with an LGBT-friendly psychologist. She tried to talk me out of transitioning back, telling me that I just needed to take more male hormones and have my ovaries removed. As a result, she redirected me to a consultation with a psychiatrist who gave me an opinion 10 years ago. I delayed going to him for several months, but in the end everything went quickly, just like the first time: the commission lasted a few minutes, they asked me what happened, how I lived after the transition and how my relationship with my wife was. I received a certificate that allowed me to change my documents to women's ones. But I still haven’t done this - I’m waiting for my wife to receive a residence permit: now we live in the Baltic states.

It was difficult for me to socialize as a woman after so many years in a male image. For a long time I convinced myself that everything feminine was bad, and this affected my manner of communication, habits, and tastes. Coming back, I sometimes felt like a “man in a skirt.” The first awkward attempts to be feminine sometimes looked “too much”: I suddenly suddenly started wearing feminine clothes and shoes, putting on makeup - doing everything that I had refused for a long time, as if trying to make up for lost time. Now I can put on makeup when I’m in the mood, I can wear heels, or I can go out in sweatpants without bothering. I still often talk about myself in the masculine gender: with my wife, parents, on the Internet, but at the same time I am well aware that I am not a man.

My parents and relatives took my “kickback” calmly. Mom said that she would accept any of my decisions, as long as I felt good. Dad doesn’t care, the main thing is that I communicate with him more often. My aunt and her family said “thank God” and immediately began calling me by my female name. My friends in Russia all know and accept me, but we haven’t seen each other for a long time and communicate only by correspondence, I don’t know how it will be in real life.

While still a “guy,” I got a job at a language school. Everything was going well: I led groups and taught students individually. But school is not the place to talk about detransition. Therefore, I completed my contract as a “man” and quit. I still receive offers to take a group or teach a course online. I have to refuse. I don’t do this because of transphobia or homophobia of others - I haven’t encountered it. I just don’t want to explain to people again what happened to me. Perhaps I will return to teaching when I change my documents.

Whose organ is sewn into women during gender reassignment?

When women undergo sex reassignment, a sexual organ is sewn on, which is created from her own tissues . There are two options for the operation:

Formation of the penis from the clitoris and surrounding labia minora. It is carried out after the organ has grown while taking testosterone.
Creation of the penis from the muscle tissue of the back, forearm, thigh. As a result, it will be similar to a man's size, and an erection is possible. If it is not enough, then an additional prosthesis is inserted.

The phenomenon of transsexuality has nothing to do with homosexuality.

Transsexuality is a state of discrepancy between an individual's anatomical structure and his gender identity. And here gender identity is formed not only by psychological status, but also, with rare exceptions, by the different functioning of certain physiological systems of the body. That is why not only psychiatrists are included in the examination before gender reassignment. A lot of doctors from other specialties conduct tests and examinations to confirm the physiological component of transsexuality.

A homosexual desires individuals of his own gender, a transsexual desires individuals of the opposite gender identity, even if it does not coincide with his anatomical structure.

Scheme of surgery for gender reassignment from male to female

Schematically, the process of surgery for changing gender from male to female can be divided into stages:

Removal of glandular and excess fatty tissue of the mammary glands, formation of a small nipple.
Creation of a penis from the clitoris, muscle tissue and a new opening for urination.
Removal of the uterus, ovaries, fallopian tubes.
Stitching or complete excision of the vagina.
Changing the shape of the body, face, correction of the shape of the penis.
Penile prosthetics to maintain the desired erection.

Each of them includes preparation (blood and urine tests, consultation with an andrologist, surgeon), the surgical intervention itself and the recovery period. It is important to note that in each case the doctor can choose an individual sequence of stages, as well as surgical techniques. The duration of rehabilitation depends on the correction option and the general health of the patient.

Drugs for gender reassignment from female to male

To change gender and transform from a woman to a man, testosterone-based drugs are prescribed Most often these are long-acting injectable forms - Sustanon and Omnadren. They will have the desired effect in about 4-6 months:

the body and its proportions begin to change;
the clitoris enlarges;
coarse hair appears on the face, along the white line of the abdomen, on the legs;
the volume of the mammary glands decreases;
menstruation gradually becomes smaller in volume and frequency, then disappears;
muscle strength increases.

It is important that the level of female hormones is not too high, as this will interfere with the functioning of testosterone. Therefore, you should visit an endocrinologist and get tested for estradiol, progesterone, prolactin and testosterone before starting replacement therapy. You may also need to take medications with an antiestrogenic effect or those that reduce prolactin levels.

Hormone therapy

The concept of “gender reassignment” does not exist. There is a transgender transition - this is a set of actions that a person takes to bring his internal sense of gender closer to his external one. The transition may include a change of identity, taking hormone therapy, changes in appearance and clothing, or one or more breast or genital surgeries. Which set of these actions to perform is up to everyone to decide for themselves. Many people start taking hormone therapy: estrogen for trans women, testosterone for trans men. After therapy, their bodies change, and some changes persist even if they stop taking hormones

.
For example, trans men can become pregnant if they stop taking testosterone before their ovaries lose their function.
Stepan:

Testosterone causes hair to appear on the body and face, and menstruation disappears. The muscles grow, the voice becomes lower. Body fat is redistributed, shoulders and back become wider. The nose grows, the fat on the face is also redistributed. The complexion changes - it becomes redder. The pressure rises. Body odor changes. Many people lose hair on their heads, I do too, and I struggled with it in every possible way.

Kate:

On estrogen, on the contrary, you become weaker. Before the transition, I was involved in powerlifting, and after, of course, I couldn’t lift as much as before. The muscle definition disappeared, the body became smoother. Cellulite has appeared! The complexion became paler, greenish, like that of cisgender women. The veins in my arms have disappeared.

Stepan:

On the contrary, trans men develop veins. When I started the transition, more beard and body hair were just waiting for the veins on my arms. I went to the mirror and checked if they were visible enough, and got upset. And then by chance on the bus I compared my hand and the hand of the man next to me on the handrail and realized that our veins stuck out the same way, I was terribly happy. Here it is, happiness has arrived.

Maxim : When you start taking testosterone, a small penis grows. There is no universal word for this organ, which is why transgender men call it that. There are all sorts of slang names within the community like “mini-dick” and “nano-dick.”

Stepan:

The penis begins to grow almost immediately, right from the first or second injection. And he gets an erection. It grows for about a year and then stops. Many people use pumps and special testosterone creams for growth - they say it helps. Someone is actually pulling him back. I didn’t do all this, I’m fine as is.

Maksim:

On testosterone you become calmer. Before the transition, I was often tossed in all directions; something could easily piss me off or offend me. This upset me terribly; it seemed that my emotions were controlling me, and not I controlling them. And now I am aware of them all, but they do not seem to have the same intensity as before. And that's great.

Kate:

When I started transitioning, I learned to cry. Previously, I simply didn’t know how to do this, I lived in the concept of “men don’t cry” and felt two options: “normal” or “punch me in the face.” And then a brave new world of emotions opened up: joy, euphoria, delight, sadness, melancholy, melancholy, hysteria, tears. Now I’m already used to it, but at first I was absolutely delighted with it. True, this sometimes gets in the way. Previously, before the transition, I had to restrain myself a lot so as not to get into a fight and not explode, but with taking estrogen, on the contrary, I had to restrain myself so as not to cry at meetings, not to get offended, not to shake. I can now chat with my friends on the phone for an hour and a half and discuss everything. There is zero information, but what a thrill!

How gender reassignment is performed for women, the course of the operation

Gender reassignment surgery, if you want to become a man, takes place in several stages:

the mammary glands are removed, the shape of the nipple is changed;
get rid of the uterus, ovaries, fallopian tubes;
the vagina is sutured or removed;
some time after the above manipulations, the penis is reconstructed.

To make their appearance more consistent with their gender, some patients need liposuction, facial surgery, and calf surgery.

During the cycle of gender reassignment operations, the following is performed in stages:

mammoplasty,
surgical castration,
plastic surgery of the penis,
creating the urethra for urination,
correction of body shapes.

Masculinizing mammoplasty

Surgery techniques vary depending on bust size, although all are performed under general anesthesia. If the breasts are small, an incision is made around the areola. Through peripheral access, medium-sized busts are removed.

If it is necessary to remove a large breast, a vertical incision is made. But in all cases, they get rid of the fatty and glandular components and excess skin. Sometimes there is a need to move the nipple and areola and make them smaller.

How is mammoplasty performed?

Involves excision of adipose and glandular tissue. If the breast is initially small, or significant reduction has been achieved when taking hormones, then the incision is made around the nipple. For large-sized glands, access passes under the breast or along its anterior surface.

The operation can be one-stage, but large mammary glands are often removed in two stages with an interval of 3-4 months. This is due to the fact that after the main correction of the shape, to give an aesthetic appearance, it is necessary to remove excess skin and reduce the diameter of the nipple.

Ovariectomy with hysterosalpingectomy, or female castration

If the patient does not plan to give birth in the future, it is necessary to remove the uterus, ovaries and fallopian tubes. Ovariectomy is performed laparoscopically or using abdominal surgery. Each of them requires general anesthesia.

If a hysterectomy or hysterosalpingectomy is planned at the same time, an incision is made above the pubic plexus.

The postoperative period, which lasts up to 7–10 days, ends with the removal of sutures. But he undergoes rehabilitation for at least 1 month.

How is surgical castration done?

This stage includes:

removal of ovaries, fallopian tubes;
isolation and cutting off the uterus.

When only the ovaries are partially removed, the operation is less traumatic, since it can be performed through a laparoscope. The incisions for inserting the device will be small (2-3 cm), recovery is quick - about 1 week.

If complete removal of all internal genital organs is prescribed, then the surgical approach is often through the vagina, since the anterior abdominal wall may be needed for further penile plastic surgery. But an incision is also possible in the suprapubic area. The duration of the operation is about 2.5-4 hours. The rehabilitation period after complete castration takes 8-12 weeks.

The need to remove the uterus and ovaries is dictated by the risks of hormone replacement therapy. With lifelong use of male hormones, the risk of tumors of these organs increases. Doctors often recommend this stage after penile plastic surgery, that is, at the final stage of gender correction, in order to have complete confidence in the patient’s intentions.

Watch this video about gender reassignment surgery:

Vaginectomy, or masculinizing vaginoplasty

Another stage in the transformation of a woman into a man is the correction or removal of the vagina. The organ can be removed along with the uterus during a hysterosalpingectomy. In other cases, a less traumatic masculinizing vaginoplasty is performed. During the operation, the anterior and posterior walls of the organ are sutured.

Features of vaginal removal

If the method of complete removal of the female organs is chosen, then the vagina may also be cut off. This is the most difficult option for recovery. Complete healing occurs within 3-4 months; there is a high risk of postoperative complications. Therefore, more often the surgeon recommends suturing the vaginal walls after the stage of removing the ovaries, tubes and uterus. The operation is less traumatic, recovery will take about 3-4 weeks.

Phalloplasty or metoidioplasty

After the removal or cessation of the functioning of the female genital organs, reconstruction of the male genital organs follows. This is possible in 2 ways:

Phalloplasty is a 3-stage creation of a penis using a prosthesis and transplantation of living tissue from the thigh, abdomen or forearm. First, the urethra is formed, then the penis, the head with the scrotum and artificial testicles.

Phalloplasty

Metoidioplasty is the reconstruction of the penis using only its own tissue. It is carried out provided that, as a result of taking hormones, the clitoris has increased by 6 cm or more. The urethra is formed from the vaginal mucosa, and the size of the penis as a result of the operation will be approximately 5 cm. The scrotum is created from the labia majora with the introduction of a prosthesis. This is a less traumatic operation, and it also makes the penis very sensitive.

But full sexual intercourse with insertion into the vagina is not always possible.

More details about creating a penis

It can take place in two stages. The first is called metoidioplasty and is sufficient for the clitoris and surrounding labia minora. This method makes it possible to obtain a penis from 6 to 8 cm, but only if it is already close to these sizes due to the use of male hormones. As a result, the penis will be quite sensitive, but its erection will usually be weak.

Metoidioplasty

Therefore, patients often insist on creating a full-sized penis. For this purpose, an operation called reconstructive phalloplasty is prescribed. A flap is cut out in the area of the back, thigh or forearm. It includes skin, subcutaneous tissue, muscles with blood vessels and nerve fibers. It is then transferred to the pubic area and a tube-shaped penis is formed. An important stage for successful engraftment is the connection with the local vascular and nervous network.

After phalloplasty, the size of the penis reaches from 15 to 20 cm. In some patients, over time (after good innervation), an imitation of an erection appears. It cannot be completely identical, since in men it involves cavernous and spongy tissues filled with blood.

If the penis is not hard enough to be inserted into the vagina, then a prosthesis is installed to artificially pump fluid using a pump. They also use wrapping the muscles with thigh fascia (a dense sheath of connective tissue) to impart firmness.

Watch this video about what phalloplasty is:

Gender change from female to male: result and features of lower surgery

When changing gender to male from female, surgery is performed on the external genitalia (lower correction). It involves the creation of a penis. At the request of the patient, it can be formed from the clitoris and labia. In this case, it is necessary that after the administration of testosterone its length is at least 6 cm.

Metoidioplasty (as this method is called) will allow you to naturally feel arousal and a rush of blood to the penis due to the reaction of the clitoris. But the resulting erection will not be sufficient for sexual relations.

To obtain a penis equal to the natural size, phalloplasty is recommended. It will require part of your own tissue from the posterolateral region of the chest or forearm, thigh. A flap containing muscles, nerves and blood vessels is sewn into its anatomical area, and the body of the penis is formed.

In order to recreate a complete external resemblance to a man, a subsequent creation of a new opening for urine excretion, the head and scrotum with testicles is carried out.

When there is a gender change from a girl to a man, how does the genital organ work?

The functioning of the genital organ during a gender change from a girl to a man will depend on the amount of correction performed:

Taking hormones – the clitoris grows, sexual attraction to women increases.
Metoidioplasty – a penis is surgically formed from the labia and clitoris; it is small in size, retains sensitivity to stimulation, and an erection occurs.
This is usually enough for insertion into the vagina, but does not allow sexual intercourse.
Phalloplasty - a penis is created from one’s own tissues taken from the forearm, back, and thigh. Its length will be the same as that of men. After the nerves have fused, muscle contraction becomes possible. An erection appears, but not in all cases - the penis may be soft and rise weakly.
Penile prosthesis - after complete healing has occurred, a prosthesis is inserted into the penis. It consists of a tube, a fluid reservoir and a pump. If necessary, the pump (looks like an oval ball, is inserted into the created scrotum) is compressed and fluid fills the penis. This method ensures full erection and sexual activity.

Forming a hole for urine removal

Urethroplasty is considered one of the most difficult procedures. For it, they take a synthetic tube and wrap it with cloth from the forearm. A bed is formed in the penis, a new urethra is placed, and adjacent vessels are sutured. Connect the natural opening with new tissues. Then, after engraftment, the synthetic tube is removed.

In many cases, patients prefer to leave the opening under the new penis. This allows them to urinate while standing, but not through the penis.

Correction of external sexual characteristics

At the request of the patient, the following is carried out:

fat removal (liposuction) of the buttocks and abdomen;
implantation of testicular analogues, creation of a scrotum from the labia majora;
formation of the head of the penis;
injection of silicone into the chin, biceps muscle to simulate biceps muscles;
emphasizing the cheekbones (removing fatty lumps of Bisha from the cheeks).

Silicone implantation

In order for the patient’s appearance to be masculine, sometimes correction of different parts of the body and face with the help of endoprostheses is required. More often they are installed in the area of the testicles, chin or calves. First, access to tissue is provided through incisions in the appropriate area. A pocket for the implant is then formed in the area to be corrected. After installation, a suture is applied and a drain is placed, which is removed after a day.

Liposuction

Excess fat and the peculiarities of its distribution can hinder the final appearance of a man. Liposuction can help get rid of effeminacy. It is done wherever there is excess. The fat is removed through the incisions into which the cannula is inserted using a vacuum. A solution that thins the lipid tissue is first introduced.

Lifelong hormone therapy

Taking medications is not limited to the preparatory period. The patient will have to take hormones throughout his life to maintain external masculinity and a deep voice. After all, the organs that produce these substances necessary for life cannot be recreated. The drugs must contain testosterone and other androgens.

Watch the video for the opinion of sex therapist Yuri Prokopenko about the beginning of the formation of transsexualism and the consequences of the decision to change sex:

“With a beard to the gynecologist”: how and why they change gender in Russia

Doctors, psychologists and transpeople themselves told what was happening to them Photo: pexels.com

The topic of transgender people today is one of the most popular in Russian society. And this is not only an interest in something incomprehensible and exotic - it is dictated by life itself: in large cities, trans communities already number tens of thousands of people. There are not only more of them: trans activists unite, learn to defend their rights, and some decide to “come out of the shadows” and open up to the world. However, transgender people still remain a mystery to the average person. What pushes them to change their appearance? What kind of surgery do they do and how much does it cost? Everything about gender change in modern Russia - in the stories of doctors, psychologists and transpeople themselves - on "URA.RU".

Transgender people are among us

According to doctors, every year in every major city in Russia from several to several dozen people make a transgender transition. However, there is no data on how many transgender people there are in Russia. There are none in the world. “The most famous study was conducted in America: people were asked: “Are you a transgender person?” Anton Mackintosh, coordinator of the transgender initiative group “T-Action” (St. Petersburg), told URA.RU. “The result varied from state to state: in San Francisco and Washington it reached 2 percent, in the southern states (Alabama, Texas, etc.) - 0.2 - 0.3 percent.”

If you take the population of Moscow (11.9 million people) and calculate these 0.2 - 0.3 percent, you get 20-30 thousand transgender people.

St. Petersburg is the transgender capital of Russia

Photo: Vladimir Zhabrikov © URA.RU

“There is also migration, because it is impossible for transgender people to live in the outback, and they move to the capitals,” says McIntosh. “St. Petersburg is considered the trans capital of Russia - it is clear that the percentage of transgender people is higher here.” There is also evidence that there are more transwomen (mail-to-female - people with a male gender at birth who feel like women) in the world than transmen (on the contrary: female at birth who feel like men). And only in Russia it’s the other way around: there are more people making the transition to the male side.

The most difficult question is who is considered transgender. “Not every transgender person experiences discomfort from their body,” explains Svetlana Bondarenko, social work specialist at the Russian LGBT project “PULSAR” (Omsk). —

Someone had their breasts removed, started taking hormonal therapy - and that’s enough for him. And in general, transsexuality (when a person changes his appearance - editor's note) is only one of the options for transgenderism.

There are bigenders who feel both masculine and feminine in themselves, and there are genderfluids whose gender identity changes (at one time he feels feminine in himself, at another time he feels masculine). Everything about this topic is complicated.”

How do you become transgender?

No way. Stories that a person lived his whole life as a man, and then suddenly decided to become a woman (or vice versa) are myths. It is impossible to become transgender - you can only be born. According to transgender people themselves, since childhood they have felt like a being of a different gender. True, awareness of one’s identity can occur at different ages.

Article on the topic

Transgender people have infiltrated Russian ministries and security forces

“When I was just born, I had a lot of questions for my parents: why do they dress me like a girl, call me like a girl? — says transgender Alexander from Murmansk. “From early childhood I understood that I was a man, not a woman. And I thought that it was they, my parents, who were strange for behaving this way. Later, when I saw the physiological differences between boys and girls, I began to think. I didn’t know what to do or who to contact.”

It happens that a person realizes that he belongs to the other sex during adolescence, when teenagers begin to fall in love for the first time. If a boy in the guise of a girl suddenly realizes that she likes girls, not boys, questions arise and an urgent need to understand herself. And also problems - many transgender people who have realized their identity are met with rejection from their loved ones.

“Among my acquaintances there is not a single person who has not encountered negativity, misunderstanding, violence: everyone is beaten, offended, some are kicked out of the house by their parents,” says Alexander. — One of my friends (he’s a trans man) is not wanted by his parents to see or hear. There are many such cases. Fortunately, my parents understood and accepted everything.

Mom was even happy when I made the transition. And she said that she should have done this earlier: “You wouldn’t have suffered so much!”

How does trans transition happen?

There are cases when people decide to make a transgender transition (changing their appearance and passport data) already in adulthood, having a family and children. Several years ago, the story of former paratrooper and sports commentator Yuri Ovodov from Yekaterinburg, who became Yulia Solovyova, thundered throughout the country: neither her elderly parents nor her children could accept her choice. Therefore, it is believed that the earlier the transgender transition occurs, the better.

The story of former paratrooper and sports columnist Yuri Ovodov from Yekaterinburg, who became Yulia Solovyova, spread throughout the media. Yulia even went to “Let Them Talk”

Collage: URA.RU, photo from the pages of Yulia Solovyova and Yuri Ovodov on social networks

Until last year there were big problems with changing my passport; I had to go through the courts. “The registry offices did not take it upon themselves to make such a decision, because they did not understand what exactly was considered a gender change,” explains Anton McIntosh. “With the advent of the order of the Ministry of Health in October 2021 and the introduction of uniform certificates, it became easier” (the transgender community, by the way, actively participated in the preparation of this order during public discussions, and many recommendations of trans activists were taken into account in it).

“According to this order, a person who experiences such experiences turns to a local psychiatrist and becomes under his supervision,” Mikhail Pertsel, head of the Neurosis Clinic (Ekaterinburg), told URA.RU. — Next, the psychiatrist refers the patient to a medical commission, which finally makes a diagnosis. It includes a psychiatrist, psychologist, and sexologist.”

In Yekaterinburg, there are such commissions in the Neurosis Clinic and in the Sverdlovsk Regional Psychiatric Hospital. According to doctors, all these services (observation by a psychiatrist and the conclusion of a commission) are free - within the framework of mental health care programs.

At the antenatal clinic they say: “Pervert, what are you doing here?”

After the commission, the person is given two certificates: one for changing documents, the other for permission to perform surgical operations and take hormonal medications. “In theory, an endocrinologist should develop a medication regimen, you need to take tests, including tumor markers, but many don’t give a damn about all this and start taking hormones earlier, at their own peril and risk,” says Alexander. “People want to see themselves in the mirror closer to the desired image,” explain trans activists.

Australian model Andrea Pejic is one of the most famous transsexuals in the world (the model was previously a man)

Photo: Instagram andrejapejic

The drugs are not cheap: an ampoule of testosterone costs about a thousand rubles (the frequency of injections is on average once every 14 days), plus you need to undergo tests periodically. It is easier for trans women to start hormone therapy: drugs with female hormones are sold in pharmacies (unlike male hormones, which have to be obtained on the “black market”, since testosterone is prohibited for free sale). Female hormones, when used for a long time, lead to chemical castration.

It is during this transitional period that transmen face enormous difficulties in the outside world: hormones are already affecting their voice and appearance (for example, transmen begin to grow a beard). “Until you have a hysterectomy (removal of the uterus), you need to see a gynecologist. Of course, in the antenatal clinic.

You come there with a knee-length beard and ask for a ticket - not everyone understands this,” says Alexander. — You sit in line with women who look at you askance, start discussing, giggling or insulting you.

They may react aggressively - there have been cases when they chased away: “You pervert, what are you doing here!” It happened that the doctors themselves drove them away. Fortunately, there are doctors who treat it adequately.”

They save for years for surgery

There are different methods for “transforming a man into a woman,” one of the most common is the formation of a neovagina from a man’s penis (watch the video). Many people prefer to have this operation done in Thailand, where doctors have become skilled at such manipulations. “Recently, an acquaintance went to Thailand, to a world-famous clinic in Bangkok, where two such operations are performed a day and where everything has been worked out for years (you can even choose the appearance of the future organ),” said one of the transgender people. “The operation itself cost about 600 thousand rubles plus flights, accommodation, medications - a total of about a million rubles.”

Transformation towards a male appearance is more expensive: three surgical operations are performed successively: mastectomy (breast removal), hysterectomy (removal of the uterus - this is necessary, as it produces female hormones) and phalloplasty (falloprosthetics). All this is quite expensive. For example, in one of the Moscow clinics, a URA.RU correspondent was told that a hysterectomy would cost 147 thousand rubles (103 thousand for the operation itself plus anesthesia, hospitalization and tests), and phallourethroplasty - 407 thousand rubles. The cost of all three operations in Russia is from 1.5 million rubles.

Rehabilitation and recovery in women who have changed their sex

The recovery period after such an intervention consists of several important points:

taking antibiotics, painkillers and hormonal drugs;
exclusion of physical activity;
seam care;
quitting smoking and alcohol;
nutritious food without excesses;
monitoring the condition by a specialist;
refusing sex until the intimate area is completely healed.

How long rehabilitation will last depends on the individual characteristics of the patient and the amount of changes made.

Possible complications in women after gender reassignment

Problems due to interference may arise:

General surgical. These are infections, seromas, hematomas, poor tissue healing, and implant rejection. Bleeding, insensitivity of some parts of the body, and negative consequences of anesthesia are possible.
Psychological. It happens that the patient is uncomfortable being a man. And he wants to get his old body back.

Long-term consequences of sex reassignment surgery

Changing gender with the help of an operation, even if it is completely successful, has long-term consequences - the need to primarily hide the truth, due to hormones, interruptions in the cardiovascular system, liver damage, and diabetes can occur.

Psychological ones are most often caused by the fact that a person believes that all problems with gender identification and role in society will disappear. In reality, this is not always the case. Throughout the transformation, one has to deal with the negative attitude of others, rejection due to homophobic sentiments, and psychological trauma in the family. Therefore, purely biological changes caused by hormones unusual for the body are superimposed with psychological discomfort.

Since this is a conscious decision for which we had to fight for a long time, patients prefer to fight depression and melancholy on their own. Alcoholism and abuse of psychotropic drugs occur. However, the majority still feel relief if the diagnosis was made correctly and surgery was the only option.

Side effects of long-term testosterone use include:

an increase in the level of estradiol in case of overdose or uncontrolled administration, excess testosterone is converted into them;
heart and vascular diseases - lack of female hormones increases the risk of atherosclerosis, hypertension, myocardial infarction, stroke, especially with obesity, smoking, hereditary predisposition;
damage to the liver, which processes hormones;
increase in hemoglobin, blood thickening, increased formation of blood clots and blockage of blood vessels;
increased blood glucose, development of diabetes mellitus with a tendency to impaired carbohydrate metabolism, cases of illness in the family;
headache.

Therefore, it is important to be under the supervision of a doctor throughout the entire period of hormone replacement therapy.

First prove that you are of the “other gender”

According to the standards of the World Professional Association for Transgender Health (WPATH), first of all, the patient must be examined by a psychiatrist and undergo a special commission. If a diagnosis of gender identity disorder or gender dysphoria is made, hormone replacement therapy can be started under the supervision of a doctor.

Moreover, while a person noticeably changes in appearance, he should not hide from anyone. Moreover, WPATH requires that a transgender person live openly as a member of the opposite sex for at least a year and even provide evidence to the surgeon that not only his doctors, but also other people know him as such.

For example, Kelly Maloney, the former boxing promoter and manager of Lennox Lewis, formerly known as Frank Maloney, lived as a transgender woman for a year and a half before surgery.

This is what Frank Maloney was like before his transformation

Does a woman become a man as a result of sex reassignment surgery?

As a result of gender reassignment surgery, a woman becomes a man only by external signs . This means that she will have:

flat mammary glands;
internal genital organs (ovaries, uterus, tubes) were removed;
no vagina (sutured or completely removed);
the penis, urethra (urethra), an analogue of the scrotum with testicles, have been formed.

The operation will not allow you to make changes to:

chromosome set, all genetic material will be female;
hormonal background - testosterone will be independently produced by the adrenal glands in minute quantities, which requires lifelong use of male hormones;
psychology and behavior - a period of adaptation to the new body, socialization (changes in contacts with the environment), development of new behavioral reactions are required, for which psychological help is recommended.

Case 3. Oriental tales

Israeli singer Dana International, real name Sharon Cohen, born Yaron Cohen.

Transsexuality is a universal phenomenon, and its representatives are evenly found among all nationalities. The fiery brunette Anwar (for example), who introduced herself as Amina, was a native of one of our southern republics. Some time ago, she fell passionately in love with another also eastern youth, and he reciprocated. The chosen one had no idea about the not entirely female structure of individual parts of Anwar-Amina’s body. Things were heading towards the wedding and the wedding night, so that at the most inopportune moment the blood would not boil up in a hot falcon, it was decided to urgently go to the capital of our Motherland and secretly solve this problem.

There were no fewer of Anwar-Amina’s fellow countrymen in Moscow than in his native republic, so problems could arise with the “secret” one. This is how our meeting took place in Yekaterinburg. Regarding future family life and joint children, which even in theory cannot exist, Anwar-Amina said that problems need to be solved as they arise. He was sure that in the future this problem would somehow be solved. Otherwise, no mental abnormalities were identified, so the go-ahead was given for the operation. I don’t know whether she will pretend to be heavily pregnant (and how?), whether she will get a certificate of infertility, or come up with something else, but with all our hearts we wish the new unit of society good luck. Amina's resourcefulness, and her (probably current) husband's, if something happens, tolerance.

What else does a woman need to know after becoming a man?

Before surgery, a patient wishing to change gender should know:

about possible difficulties with the preparation of new documents;
about the likely hostility of others who learn about the operation, the difficulties of communicating with loved ones;
that it is possible to acquire purely male diseases;
about problems with the liver and kidneys that develop over the years due to taking hormones;
about the impossibility of fully returning the functions of a lost female body if one wants to;
that postoperative adaptation should occur with the help of a psychologist.

On the left is an ex-girlfriend

Sex

There are no common or universal sexual practices among trans people. Like cisgender people (people who have the same sex assigned at birth, body and self-perception - TD), they have sex with people of different genders and in different ways. Transgender people can be of any sexual orientation. It may remain the same as before the transition, or it may change over the course of life.

Kate:

After the operation, sex became awesome. I actually got my first orgasm on the tenth day after the operation, during bougienage. Absolutely by chance, in the treatment room. The nurse came in, I was all crimson and breathing quickly, she thought that something was wrong with me, she barely convinced her that everything was fine.

After my transition, I felt like a lesbian and was attracted to women. Now I don’t call myself anything at all. For me, sex is primarily about the soul, about an emotional connection; I’m not interested in one-night stands. It turns out that before I was a “normal man”, and now I have become a double “pervert”: firstly, a trans woman, and secondly, a lesbian. Despite the fact that I liked women and continue to like them.

Maksim:

When you start hormonal therapy, it’s like a second transitional age. It seems that you are already a thirty-year-old adult, with experience and intelligence, but you are starting to behave like a teenager. For example, I was in a storm all the time, I wanted to have sex with everyone, which is basically what I did. After the transition, I began to look quite masculine (manly - TD's note) and presented myself as gay, that is, I met and slept with men.

Stepan:

And I spent the entire “new puberty” in one place, without leaving the room, and this saved me from many spontaneous decisions. At first I thought I was heterosexual: I liked girls, the more feminine the better. And then, probably in the second year of hormonal therapy, something began to change, and Maxim appeared in my life.

Frequently asked questions by future men

When changing gender to male, the uterus is removed, and what is it replaced with?

When sexual characteristics change from female to male, the uterus is removed; it is not replaced with anything. This operation is performed based on the wishes of the patient, but if the decision is clear, it is also recommended for medical reasons. Since you will need to constantly drink male hormones in the future, the risk of tumors in the female genital organs increases.

Before the operation, it is important to fully decide on the choice, since the loss of this organ will be irreversible.

What is used to replace men's penises in women's areas?

To replace the male penis in female areas, the following are used:

Clitoris and labia minora after hormonal therapy (metoidioplasty surgery). The penis will have a male appearance, you can urinate while standing, its erection will allow penetration, but full sexual contact will be difficult.
Muscle and skin tissue from the posterolateral surface of the chest, forearms, thighs, lateral areas of the abdomen (phalloplasty) - with its help it is possible to achieve sufficient hardness of the penis, but most often only after installing an implant (mechanical pump).

How is a penis sewn on?

During gender reassignment surgery, a penis formed from its own tissues is sewn onto a male one in this way:

a selected musculocutaneous flap from the arm, abdomen, thigh or back is connected into a tube;
the surgeon uses a microscope to connect arteries, venous vessels and nerve fibers;
after complete healing or simultaneously the urethra is formed.

Is a prostate transplant possible after gender reassignment?

Prostate transplantation is not performed for gender reassignment. This surgery is not used on men or women who have undergone hormone therapy or penile reconstruction. This is due to the fact that the work of the gland is regulated by several organs: the pituitary gland, adrenal glands, testicles. The relationship between them is formed during the period of intrauterine development. Therefore, the transplanted organ does not function.

Such interventions are not yet technically feasible. As a result, when changing gender, the artificially formed penis cannot independently achieve the same erection as a natural one and release sperm.

Is it possible to change gender at 40?

Changing gender from female to male is possible even after 40 years, but it is very important to take into account that with true transsexualism this desire arises in adolescence.

At a more mature age, hasty decisions caused by life situations are possible. A person goes through a crisis of forty years and often feels that he is not living his own life. Moving to another social category seems like a good option for solving problems.

Dangers that lie in wait when changing sex after 40 years:

rethinking, the desire to return everything back;
difficulties in adapting to the family, negative reactions of children, even suicidal decisions;
destruction of professional career;
the need to change place of residence;
difficulty in recovery after multi-stage operations caused by concomitant diseases.

The daughter of singer Cher Chastity, who became Chase.
In order to eliminate most of the negative consequences, a long preparatory period before the operation is recommended - at least 3-4 years. All this time should be devoted to examination and work with a psychologist or sexologist.

When changing gender, is sex very different from the sensations and functions of the genitals of an ordinary man?

According to reviews from those who have completely changed their gender to a man, the sensations and functions of the genital organs allow them to have a sexual life with women. In terms of differences from an ordinary man, it is difficult to draw a conclusion, since there is no data on comparison of these two options by the same person. Most people admit that they get maximum satisfaction from bringing their psychological state into line.

Nevertheless, there are also cases when a person, having gone through the entire path of difficult operations and recovery, regrets his decision.

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“I thought that when I became a brutal “man,” they would take me more seriously.”

Sony, 22 years old

Biologically, I am a woman, but I lived for five years as a transgender guy and for two of those years I was on male hormone therapy.

As a child, I was friends with boys, I was not interested in dresses and dolls. From peers or adults not close to me, I often heard addressed to me: “Girls don’t behave like that.” This made me angry. When I was eight years old, I told my mother that I would no longer wear skirts. Mom didn't like it, but she didn't mind. It seemed to me that I looked ridiculous in skirts, but I think that subconsciously I simply felt weaker in women's clothing, which means that I could be offended and I would have to defend myself, which I did not know how to do.

At the age of five, I first fell in love with a girl, of course, unconsciously: it was a very pleasant feeling, but I was ashamed and scared that someone would find out about it. Subconsciously I understood that this was “wrong”. In the future, I called my attraction to girls “dependence”, “attachment”, but never “falling in love”.

At the age of eight, my breasts began to grow. I was very upset, I wanted it to always remain flat, but I understood that with age my breasts would be “bigger and scarier,” and I was terribly jealous of the boys who did not have to hide them. I started slouching to somehow hide my curves, and when I was older I wore tie-downs.

In computer games, I always chose male characters because I thought that I would definitely win with them. At the age of 10, I corresponded on the Internet with girls on behalf of a boy and uploaded photos of myself with a boy’s hairstyle with bangs in half the face to my profile. At the same time, I didn’t have any clear thoughts that I wanted to be a guy. At 12, I decided that I would run after girls for another two years, and then I would need to fall in love with boys - that’s more correct. But nothing worked out for me. I could admire the boys as very beautiful exhibits, even kiss them - but nothing more. I did not feel sexual attraction to them. Besides, I didn’t like that the guys didn’t perceive me as a friend, but only as a sex object.

Before hormone therapy. Photo: Ekaterina Golodko

Over the years, my dissatisfaction with my own appearance grew. I envied the guys: they grew taller, their voices broke, their muscles appeared. I also really wanted to grow up and become a muscleman. From 9 to 16 years old I played basketball. I was the shortest on the team and had a lot of complexes about this. Even at 21, with a height of 171 centimeters, I considered myself very short compared to men.

When I was a teenager, many people said I was beautiful, but before I started hormone therapy, I felt like I was ugly. I had a short haircut and was very sensitive to comments like “this is unfeminine”, “you looked better with long ones”. I think people didn’t want to offend me, but said that because I looked unusual. But it was very unpleasant for me.

On my basketball team, many people openly disapproved of LGBT people. And I myself believed that being part of the LGBT community was disgusting and immoral. Even when I realized that I only fell in love with girls, I did not consider myself a lesbian - this definition seemed shameful and offensive to me, I did not apply it to myself. I looked down on lesbians, but I myself fell in love with heterosexual girls, who often rejected me.

At the age of 16, I went to college to become a restoration artist and met several LGBT-friendly people there. My attitude towards people with non-traditional sexual orientation changed, but I still didn’t consider myself a lesbian.

At the age of 17, the realization came to me that I was not a girl: I came across a video of a transgender guy and realized that everything he was saying was about me. I started reading trans publics and became convinced that everything was fine with me, I was just a guy on whom nature had played a cruel joke. And if I had been born with XY chromosomes, then there would be no envy of men, and no problems with communication either. During this period, I experienced terrible discomfort when people addressed me in the feminine gender.

For the next three years, I studied all the available information on the topic, talked with transgender people, learned about their path, together we dreamed that we would have operations, change documents, start all over again, and were angry at the injustice of life. No one understood and supported me more than the trans community. And it became easier for me, because I thought that I had finally figured myself out. Almost immediately I came out to my family. My family, of course, were shocked, but they said that they love and accept me in any case. Some people disappeared from my social circle. For example, when I told my best friend about everything, he asked: “What about the children?” I laughed it off. His girlfriend couldn’t stand me: lesbians were second-class women for her, and transgender people were generally something abnormal, out of the ordinary. The friend took her side, and we stopped communicating.

Even before starting hormone therapy, it dawned on me that a guy can be feminine, and a girl can be masculine - and this is normal, that “female” and “male” interests are sexist nonsense, that toxic masculinity is bad. Despite this, I still felt like a 100% guy and dreamed of surgery.

I decided to hold off on hormone therapy until after graduation. All this time I languished in painful anticipation, I had hysterics (any topic where gender was mentioned was painful for me - tears immediately began to flow) and an acute feeling that I was on the verge of a nervous breakdown due to gender dysphoria (strong discomfort from the discrepancy between gender self-identification and the sex that a person was assigned at birth. - Note from “Cold”). I didn’t even think about a psychotherapist: why do I need him if I know what to do and am 100 percent sure that I’m a guy? And I didn’t have money for it - I saved for therapy and operations.

On hormone therapy. Photo: Polina-Elizabeth Schiffer

At age 20, I finally started taking male hormones. Life began to get better: my voice became rougher, the hysterics gradually subsided, and I came to life. A year after starting hormone therapy, I finally had my breasts removed.

But I also had fears. I was afraid of ending up in a hospital, prison, or the men's locker room at the pool; I was worried that if someone saw the size of my legs or hands, they would think I was a woman. So when I started getting stubble on my face, I felt a lot more relaxed. Sometimes in trans publics I came across stories about detransition and tried them on myself. I was afraid that this could happen to a transgender person. At that moment, I would have made the reverse transition only forcibly, due to severe health problems or some external insurmountable circumstances such as war. I was sure that this was definitely not about me, and I thought: how terrible it is to make such a mistake.

In the summer of 2021, I fell in love with a yoga trainer. She also turned out to be a psychotherapist. We didn't meet - we were just friends. I told her everything about myself. She never said it was wrong or that she didn't believe me. I admired her awareness, awareness, understanding of feelings and ability to analyze them. She helped me recognize and live my emotions and pain, set personal boundaries, and not depend on social attitudes and the opinions of others. This was a huge step for me towards accepting myself and my body.

For the last nine months of two years of hormone therapy, I did not date anyone, but completely immersed myself in studying myself. I had to re-embrace myself as transgender. I accepted my thin hands, short stature - my whole body. I began to treat myself more carefully. After much self-reflection, I decided that, most likely, I was a non-binary person, and gave up on the masculine image. Then I began to understand that there was something feminine in me, and the percentage of this feminine only grew over time. I began to position myself as an androgyne, a person without gender. At some point, after consulting with an endocrinologist, I stopped hormonal therapy and three months after that I admitted to myself that I was a girl - and it sounds proud. New feminist friends helped me a lot with this.

Eight months after detransition. Photo: Alexander Milovidov

I began to take the first timid steps towards female socialization. I sold things on Avito from an old account with a man’s name, and explained to buyers that I was a girl, and the name was for conspiracy. It was scary, but I met with buyers and talked about myself as a woman. I didn’t notice any sidelong glances in my direction.

Now I talk about myself in the feminine gender, but if someone addresses me in the masculine gender, it doesn’t bother me.

I don't think hormone therapy is a mistake. I needed male socialization. All my life until I was 21, I competed with guys. Now I don't need it. Transgender transition helped me understand and accept myself. I was lucky that I stopped in time and my reproductive system is normal. Do I regret having a mastectomy? Don't know. Now I look at old photos and I like my breasts. But I also like the way I look now. It seems to me that if I get my breasts done again, it won’t be about self-acceptance, but about fitting into stereotypical social standards. Moreover, in the modeling business, where I want to find work, people with androgynous appearance are in great demand. I still have documents in a man’s name, when I change them, I’ll seriously start looking for a job.

Now I’m dating a girl, but I consider myself pansexual (a sexual orientation in which biological sex and gender do not play a role in choosing a partner. - Note from “Cold”). Sex and gender are not important, what matters is what’s inside a person.

I used to think that when I became a brutal “man,” they would take me more seriously. Now I understand that it doesn’t matter who you are - a guy or a girl - sexists will always find something to complain about.