Medical treatment options for gender variant adults
The small number of people who experience extreme gender variance may find that they have no alternative but to transition full time to the opposite gender role, and have medication and surgery to overcome their severe discomfort.
The specific procedures that are appropriate vary from one individual to another. However, for most trans people, at least some of the surgeries set out below are essential. Waiting times for treatment within the NHS may be significant and funding policies vary from one PCT to another. Some treatments may have to be self funded. More information about NHS funding processes and waiting times is given in this booklet.
Hormone treatment impacts on the sex lives of trans people and their partners: trans women have greater difficulty in achieving erection and orgasm because of hormone blocking treatment (that lowers testosterone) and oestrogen administration, whereas trans men's libido is heightened once testosterone treatment starts.
| Surgery | Purpose |
|---|---|
| Orchidectomy | removal of testicles |
| Penectomy | removal of penis |
| Vaginoplasty | creation of vagina |
| Clitoroplasty | creation of clitoris |
| Labioplasty | creation of labia |
| Mammoplasty | breast enlargement |
| Thyroid chondroplasty | reduction of Adam's apple |
| Facial feminising | especially reshaping nose and chin |
| Body reshaping | |
| Crico-thyroid approximation | raising the pitch of the voice |
| Hair removal | donor site as well as facial and body |
| Hair transplant | to mitigate male pattern baldness |
| Surgery | Purpose |
|---|---|
| Mastectomy | chest reconstruction |
| Hysterectomy | removal of uterus |
| Salpingo-oophorectomy | removal of fallopian tubes |
| Vaginectomy | removal of vagina |
| Metoidioplasty | creation of micro-penis, using the clitoris |
| Phalloplasty | creation of penis, with or without urethra |
| Urethroplasty | creation of urethra within the penis |
| Scrotoplasty | creation of scrotum |
| Testicular prostheses | penile prosthesis implant---making erection possible |
| Hair removal | donor site |
Genital surgery is frequently regarded as a necessary step and an end-point to the journey from living as a man to living as a woman.
However, this surgery is irreversible and you should give yourself enough time to be sure that this is what you want. Although some level of reversal surgery is possible, you can never have your functioning male genital anatomy fully restored once it has been removed. Bear in mind that this surgery will not make a change to your everyday dressed appearance. In your public life, people will not behave differently towards you because you have undertaken this step. Successful social transition can be made without recourse to genital surgery, and there is no requirement to have any of the available surgical options in order to obtain full legal recognition by way of a Gender Recognition Certificate. So, genital surgery should not be regarded as inevitable.
Although living one's life as a woman with a penis is certainly possible, it does raise issues such as use of changing facilities, toilets and taking the kids swimming. These are all potentially public matters which can make for difficulties for those who have not had surgery to refashion the external genitalia. Clearly, and for some, more importantly, there is also an impact on intimate sexual relationships: what effect will surgery have on erotic possibilities; does this mark the end of your present relationship; will you be seeking new relationships; should you reveal your trans history to a new partner, if so, how and when? This booklet is available here.
Although chest reconstruction surgery is almost always undertaken by trans men, many do not undergo any ‘lower’ surgery at all. There is no requirement to have any of the available surgical options; full legal recognition by way of a Gender Recognition Certificate can be obtained without it. The desire to have a penis, and the decision to undergo complicated surgeries, are factors that are distinctly personal. Many trans men feel psychologically, as well as physically, incomplete without a phallus of masculine proportions. However, you are no less of a man if you decide against having this surgery, or are unable to for health reasons. Some may feel unable to undertake such major surgery, or may feel it is unnecessary to do so.
The context in which such decisions must be made, are not only personal but complex and social. In broad terms it is perfectly possible to live one's life as a man without a penis and to be recognised as a man, but issues such as use of men's locker rooms, use of urinals, and taking the kids swimming are all potentially public matters that make for difficulties for those who have not had phalloplasty. Clearly, and for some, more importantly, there is also an impact on intimate sexual relationships: what effect will surgery have on erotic possibilities; starting new relationships – how and when to you explain that you're not the same ‘down there’; adapting existing relationships – are you sexually attracted to men, or to women? All these considerations may impact on your decision about whether or not to have surgery at all, and if so, what outcome you will be hoping for. GIRES has prepared a booklet which advises on the different options and the issues connected with them. This booklet is available here.
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