The discrepancy between the anatomical structure of the body and the psychological state of a person (transsexuality) is scientifically substantiated and accepted throughout the civilized world. Only gender reassignment surgery can correct the imbalance. The procedure is difficult not only physically.
Therefore, before making a final decision, you need to consult with a psychiatrist, sex therapist, and hear the opinions of different doctors. It is also important to find out how the procedure works and what the risks are.
Surgical gender reassignment: general concepts
Carrying out such a surgical intervention is a complex process that takes place in several stages, has contraindications and risks, and requires long-term moral and physical preparation.
Plastic surgery to change the sex of a woman into a man is more difficult than a man into a woman, but according to statistics it is required less often. There are many more people who psychologically consider themselves a woman, but are forced to be in a male “shell”.
Transgender people, after gender reassignment surgery, receive a new birth certificate and improve their everyday life, forming an environment that they had previously only dreamed of.
Indications and contraindications for gender reassignment surgery
Indications for surgical correction are:
- awareness of the inconsistency of one’s gender;
- the desire to be similar to the opposite sex not only in habits, but also in appearance;
- the danger of suicide due to a “mistake of nature.”
The operation is carried out only for a fee, but desire and money are not enough to make your dream come true. Transgender must be confirmed in writing by a psychiatrist.
In addition, there are a number of contraindications:
- minor age (with some exceptions);
- mental disorders;
- some chronic diseases for which any surgical intervention is contraindicated;
- old age (the doctor sets the upper limit individually depending on the performance of internal organs);
- homosexuality;
- addiction (alcohol, toxic, narcotic).
Rehabilitation (recovery period) for women who have changed sex
Rehabilitation after a woman is turned into a man is based on several points:
- Maintaining a calm, healthy lifestyle. Includes proper nutrition, minimal physical activity, and self-treatment of stitches
- Scheduled examinations with a specialist, strictly following his recommendations.
- Taking hormonal medications, broad-spectrum antibiotics, painkillers (as needed).
The recovery period lasts from six months or more, depending on the characteristics of the body.
How to prepare: physically and mentally
Gender reassignment surgery, called transgender transition, is the most dramatic change that can occur in a person. The operation is carried out only after successful completion of the preparatory period. The required document is a conclusion based on the results of a psychiatric consultation. Transsexuals, after consultation, must lead a lifestyle for a year and establish everyday life as representatives of the opposite sex, so that the decision does not turn out to be hasty. In addition, hormonal changes and social adaptation are necessary.
Before changing gender, you need to take hormonal medications to partially suppress the hormones of your real gender. In men, the growth of body hair slows down, facial features become more feminine, in women menstruation disappears, and the voice becomes rougher. The doctor selects the course individually after a preliminary examination. After all, hormones affect not only the expression of gender, but also a person’s well-being, and they must be taken before and after gender change.
Mandatory conditions for the operation are:
- exclusion of all contraindications;
- been observed by a sex therapist for at least a year;
- full examination in hospital;
- high level of social adaptation;
- a psychiatrist’s conclusion about a person’s belonging to transsexuals in full mental health.
Before surgery, you must take hormonal medications for at least 8 months, and stop taking them immediately a month before the procedure.
Alina Davis
According to his passport, he is a Russian man, Dmitry Kozhukhov. (Photo © Alina Davis / Instagram, VK)
But can one suspect this? Even despite the “artificial” doll-like face.
Note that this is without any surgery!
By the way, you are probably familiar with the beauty: in August 2014, all the media, including television, were making noise about the Moscow wedding of two androgynous brides, one of whom was Alina (pictured on the right; and on the left is a “natural” girl named Alisa).
Mitya-Alina has been taking hormonal medications for several years, but has no plans to radically change her gender yet. In response to a barrage of hateful criticism and insults on social media, she says she was deeply unhappy in “the skin of a bitch man with an ugly face.”
Would you be a nicer guy?
Since the wedding, the colorful married couple has only found themselves in scandalous chronicles, now of a criminal nature. Either they both beat up a neighbor, then the wife steals clothes from a store, then drugs are found on the husband. Moreover, in the latter case, the authorities could not decide which cell of the pre-trial detention center to place him in - male or female. As a result, he was released on his own recognizance.
How does gender change occur?
The operations are provided for men and women. The entire process of gender reassignment consists of many diverse procedures, the decision regarding the implementation of which is made jointly by the patient and the doctor.
The genitals remain sensitive after gender reassignment.
Change of gender from male to female
It is easier for plastic surgeons to transform male genitals into female ones due to the large amount of “working material”. The operation includes:
- removal of the body of the penis;
- removal of testicles;
- creating a vagina from a phallus, labia from a scrotum;
- breast enlargement and change in position.
After a successful gender reassignment, there are no scars or scars left. And even a gynecologist during an examination cannot determine that a person has undergone surgery.
Additionally, plastic surgery is recommended to change the cheekbones, nose, eyebrows, if necessary, to give the face a femininity.
Gender change from female to male
Transforming a body from female to male is much more difficult than vice versa. Stages of gender reassignment include:
- removal of part of the mammary glands, reduction of nipples;
- removal of the uterus, fallopian tubes, ovaries;
- creating a resemblance of male genital organs.
Phalloplasty is performed only a year after surgery to remove the female genital organs. The material is clitoral tissue, so the genitals do not look quite masculine. This means that psychological problems may appear after the operation.
The penis is no more than 9 cm and can subsequently cause a feeling of inferiority during intimate relations.
It is also recommended to enlarge the chin, calf muscles, and perform liposuction on the buttocks, hips, and waist area.
Gender reassignment in children
Problems with gender conformity occur in children from an early age and stem from the structure of the brain. Children express their desire to change themselves vividly; in severe cases, they try to get rid of “alien” genitals on their own and commit suicide.
After a conversation between a psychiatrist and the child and his conclusion about gender incongruity, the patient is prescribed hormone therapy until adulthood, then undergoes gender reassignment surgery.
There are cases when babies at birth do not have a clear gender expression. In most cases, such children undergo surgical correction in infancy to transform them into a girl. As a result of the operation, the patient will not be able to have her own children, but she will be able to live a full life.
Jazz Jennings
Just 14, she is a transgender activist who was named by Time magazine in 2014 as one of the five most influential teens in the world. (All photos © Jazz Jennings/Instagram)
No, she did not have any operations and did not take hormones yet, but, being born a boy, from a very early age she felt like a girl. Already at the age of 4, doctors confirmed her diagnosis of “gender dysphoria” - that is, the inability to accept belonging to one’s own gender (in her case, male).
The youngest child in the family, whom his parents named Jaron, refused to wear his brothers’ clothes, but loved to dress up in his sister’s clothes, and at the age of 2 he asked his mother when the fairy would fly in and make him a girl. “For as long as I can remember, I’ve always liked dolls, dresses, glitter, everything girly.”
It is unknown whether Jazz will decide to change her gender when she reaches adulthood, but she already knows for sure that she wants to become a mother in the future.
Pain and restrictions after sex reassignment surgery
After surgery and the end of the anesthesia, the condition of a transgender person or transsexual (as a person who has changed their gender is called) is not without pain. To improve his condition, he is prescribed anesthetics.
In the first 10 days after the procedure, those who have changed their sex can eat only liquid food, should get out of bed less, and sleep more.
You can return to sexual activity and physical activity only after all signs of gender reassignment have been eliminated, pain has completely disappeared, and stitches have been removed.
Vladimir Luxuria
If humanity recognized a third gender, then this Italian actress, TV presenter and gay activist would probably join it. She once stated that she considered herself neither a man nor a woman - maybe that’s why she left herself a man’s name? However, she lives exclusively as a woman, albeit in a male body.
Vladimir, or Vladi, became Europe's first transgender MP in 2006, but lost her seat in the Italian parliament in 2008.
© Reuters / Shutterstock
Luxuria also participated in attempts to hold gay pride parades in Moscow, and in 2014, during the Winter Olympics, she was detained in Sochi for holding a rainbow flag with the inscription in Russian “Gay - Okay!” and was soon expelled from Russia.
There are practically no photographs on the Internet where Vladimir would be in male form. There are only rare pictures without makeup.
And here are a few more transgender individuals who should be quite familiar to you.
Forecast
The prognosis for gender correction is positive in most cases. Physical condition depends on the patient's age, the presence or absence of chronic diseases and the experience of the surgeon. With a correctly performed procedure and constant use of hormones before and after sex reassignment surgery, transgender people live a full life. There is also no incompatibility between the biological and psychological sides, since gender reassignment surgery is performed after lengthy preparation and social adaptation.
Chelsea Manning
You wouldn’t wish the fate of this transgender woman on your enemy. Former US Army soldier Bradley Manning, accused of disclosing classified data to WikiLeaks and sentenced in 2013 to 35 years in prison, suddenly announced his desire to change his gender while behind bars. According to him, since childhood he felt like a girl, but tried to fight it, considering it abnormal. The authorities allowed him to change his name and even undergo hormone therapy. But Chelsea is banned from wearing a woman's hairstyle and clothing, and she remains in a men's prison.
Nuances and indications before surgery
- The patient must be 21 years old.
- Psychiatric observation for 2 years is mandatory: psychocorrectional measures, somatic and instrumental examination.
- Obtaining a certificate of form F 64.0, which will indicate the diagnosis of “transsexualism”.
- A year of hormone therapy.
- A year of successful experience living as a person of the opposite sex. Such an indication may be prescribed by the supervising physician.
- Most importantly, the patient must be fully aware of the long postoperative hospitalization and rehabilitation.
Phalloplasty in solving aesthetic problems
The concept of phalloplasty sometimes includes operations to enlarge and thicken the penis in healthy patients, which are performed solely for aesthetic reasons. Most often these are 4 types of surgery:
Ligamentotomy . Lengthening the male organ by cutting the suspensory pubic ligament. The penis is pulled outward due to its internal part and is fixed with a special device - an extender (the best option is a stretcher). The operation using a modern technique with scrotal access does not take much time and is relatively safe.
Lipofilling . Autofat, the patient’s own purified fat, is injected into the corpora cavernosa using a device with several needles to increase the diameter of the phallus. The likelihood of rejection of such an implant is small, but the fat can gradually dissolve. If resorption occurs unevenly, there is a risk of tuberosity appearing on the surface.
Hyaluronic acid . Similar to the previous procedure, only instead of autologous fat, hyaluronic acid is introduced. The acid can also gradually dissolve unevenly, with the formation of hard encapsulated lumps that can be felt in the body of the penis.
Thickening with a muscle tissue flap . A piece of tissue is wrapped around the penis and covered with the skin of the penis. A complex type of surgery - in addition to tissue transplantation, it is necessary to create blood circulation in the muscle flap and innervate it. There is a high probability of rejection and other complications. The technique has become rarely used.
An alternative non-surgical solution to aesthetic problems is the PeniMaster Pro extender, which enlarges the penis in all directions, including the head. To wear the device, you don’t need to go to the hospital and don’t even have to give up sex. The Bathmate hydropump will help increase the thickness. Although each of the devices stimulates the penis in its own way, exercises increase libido, erection, and duration of sexual intercourse.
Modeling business and scandals
The first step towards worldwide fame was the Melbourne branch of the international modeling agency Chadwick Model Management, where Pejic sent his photographs. The head of the branch, Matthew Anderson, was struck by the guy’s resemblance to Jessica Hart, a model for the agency. Andrei signed a contract and for several years, until graduating from high school, he studied the intricacies of modeling: fashion shows, posing in front of the camera, the basics of makeup and other nuances. His high height (188 cm with a weight of 67-70 kg) allowed Pejic to break into the catwalk models.
Pejic's appearance as a woman at Sydney Fashion Week in 2009 created a real sensation. At the invitation of the Storm agency, Andrey flew to London in 2010 and signed a contract with him there. Immediately after this, the androgyne entered into agreements in Paris and Milan: in France, the New Madison agency began to represent his interests, and in Italy, I Love Models Management. The glossy publication Dazed&Confused invited the model to shoot. Thus, a year after the first fashion show, Pejic's career soared to the very heights of European fashion.
2011 began for Andrej Pejic with a triumphant march along the catwalks of Paris: he presented the women's clothing collection of Jean-Paul Gaultier and took part in the men's fashion show from Marc Jacobs.
Andrej Pejic and Jean-Paul Gaultier
The young man also managed to work with John Galliano, Raf Simons and Paul Smith.
Pejic rarely performed as a man, so such shows seemed paradoxically rebellious to the public and also aroused increased interest. The unusual nature of the model fascinated the audience, and the images he created delighted the audience. The presence of an androgyne in an advertisement for women's clothing shocked readers of the glossy, and the collections that Andrei presented became popular among fashionistas. The Queen of England herself became interested in Pejic’s personality. Andrei was invited to a tea party with Elizabeth II, where he came wearing a Paul Smith blazer and a Versace pencil skirt.
Andrea Pejic as a man
In the same year, Dossier magazine placed a topless photo of Pejic on the cover, which caused a scandal: the American bookstore chains Barnes & Noble and Borders refused to put the magazine up for sale because Andrei looked too much like a woman. Such a conscious provocation played into the hands of both the magazine and the model: Pejic’s popularity grew even more. Androgyne was included in the 50 most sought-after male top models according to the models website.
No sooner had the “Dossier” story died down than a new scandal broke out. According to the results of voting by readers of the FHM men's magazine, the androgynous Pejic was included in the hundred most beautiful women. That year, the list was topped by Rosie Huntington-Whiteley, Katy Perry, and Rihanna.
Contraindications
Contraindications can be absolute, in which phalloplasty is impossible, and relative, in which the operation can be performed under certain conditions.
Absolute contraindications:
- Diabetes
- Autoimmune diseases
- Blood clotting problems
- Chronic pathologies of the heart, kidneys, liver and other internal organs
Relative contraindications:
- Venereal diseases
- Inflammatory processes in the groin area
- Taking anticoagulants that reduce blood clotting
- Psychological problems
- In case of relative contraindications, phalloplasty is possible after excluding interfering factors.
Operation: from woman to man
Before changing the genitals, a separate operation is performed to remove the uterus and ovaries. The vaginal mucosa is also removed, with the exception of a small area, which will later be useful for urethroplasty (creating a new urethra). The vagina is sutured. And only then do they begin to create the “neophallus”.
Method 1. “Grow” your own penis
Oddly enough, this is possible due to the similar development of female and male genitalia during the embryonic stage. The procedure is called metoidioplasty. The penis (or, more precisely, its micro-similarity) is created from the clitoris, enlarged as a result of hormonal therapy (usually up to 4-5 cm, but occasionally up to 8-10 cm).
The surgeon separates the clitoris from the attachment site so that it retracts and secures the skin at the base so that it does not retract back. Using the remainder of the vaginal mucosa, as well as flaps of the outer wall of the vagina, the urethra is lengthened and its opening is brought to the head of the future neophallus.
The resulting organ is wrapped in a flap of skin from the labia minora. And from the labia majora a scrotum is created, into which prosthetic testicles are implanted.
A neophallus created in this way is capable of erection, since inside the female clitoris there are the same cavernous bodies as in the penis (although much smaller in size) - they ensure that the organ is filled with blood. However, the length of such a neophallus in an extended state is on average only 4.5-5 cm. This makes it incapable of penetration.
Chaz Bono, the only child of singer Cher, born a girl named Chastity, has been officially registered as a man since 2010. In 2012, he admitted to Rolling Stone magazine that he was considering metoidioplasty. However, he still remains transgender and has not decided to undergo surgery.
Cher and Chaz in 2021
Cher and Chastity in 1998
Despite the purely aesthetic disadvantage of the micro-phallus, many transsexuals choose this particular method because, firstly, it is simpler and much cheaper than the one we will discuss below, it is carried out in one stage and takes 3-5 hours. And secondly, “everything is different” here, so the operation has a much less traumatic effect and a low percentage of possible complications.
Projects in show business
Andrej Pejic already attracted the attention of entertainment content creators at the beginning of his career. The image of a fashion model, stunning social foundations, promised high ratings for projects with his participation.
In 2012, Pejic sat on the jury of the British version of the reality show Next Top Model. A year later, he starred in the Turkish television film “Fatih,” a serial drama from the creators of “The Magnificent Century.” The series, based on real events, told the story of Sultan Mehmet, who subjugated Istanbul. Pejic played the Slavic prince Radu, who was the lover of the Turkish conqueror.
The plot of “Fatiha” with homosexual motives caused mixed reviews from viewers, but the touch of scandal only fueled the public’s interest in the series.
Show business added participation in concerts and videos to Pejic’s projects. Andrey, along with his colleague Saskia de Brauw and actress Tilda Swinton, appeared in the David Bowie Stars music video. In 2013, Pejic appeared on stage in Taylor Swift’s show program as part of her “1987” tour.
The glory of the androgynous model
Great success came to Andrei Pejic after participating in women's clothing shows. His debut project was working with designer Jean-Paul Gaultier in 2011. Andrey completed his Haute Couture show as a bride. The sensational show was followed by an advertising campaign for the same brand. In the photo, Andrej Pejic posed with another model of Slavic origin, Karolina Kurkova.
Designers and editors of glossy publications appreciated the potential of the mannequin. Pejic was in line with the fashion trend towards erasing gender stereotypes. The industry was abandoning traditional ideas about male and female attractiveness. Individuality and professionalism were now required from models.
Pejic participated in filming for the Marc Jacobs brand and international glossy magazines. He advertised underwear with a push-up effect. Photos of a male model looking convincing in a padded bra were intended to highlight the outstanding capabilities of the bras.
In 2014, Pejic decided to draw public attention to the problem of sexual minorities. Andrey created a special collection of jewelry in collaboration with American jewelers. The jewelry designs embodied his essence as a man who lives between two genders. Proceeds from the sale of accessories went to a fund to help homeless children in New York.
