How Gender Reassignment Surgery Works

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Bradley Manning, the U.S. Army private who was sentenced Aug. 21 to 35 years in a military prison for releasing highly sensitive U.S. military secrets, is seeking gender reassignment. Here’s how gender reassignment works:


Converting male anatomy to female anatomy requires removing the penis, reshaping genital tissue to appear more female and constructing a vagina. An incision is made into the scrotum, and the flap of skin is pulled back. The testes are removed. A shorter urethra is cut. The penis is removed, and the excess skin is used to create the labia and vagina. People who have male-to-female gender-reassignment surgery retain a prostate.

Following surgery, estrogen (a female hormone) will stimulate breast development, widen the hips, inhibit the growth of facial hair and slightly increase voice pitch. Female-to-male surgery has achieved lesser success due to the difficulty of creating a functioning penis from the much smaller clitoral tissue available in the female genitals. The uterus and the ovaries are removed. Genital reconstructive procedures (GRT) use either the clitoris, which is enlarged by hormones, or rely onfree tissue grafts from the arm, the thigh or belly and an erectile prosthetic (phalloplasty). Breasts need to be surgically altered if they are to look less feminine. This process involves removing breast tissue and excess skin, and reducing and properly positioning the nipples and areolae. Androgens (male hormones) will stimulate the development of facial and chest hair, and cause the voice to deepen. Reliable statistics are extremely difficult to obtain.

Many sexual-reassignment procedures are conducted in private facilities that are not subject to reporting requirements. The cost for female-to-male reassignment can be more than $50,000. The cost for male-to-female reassignment can be $7,000 to $24,000. Between 100 to 500 gender-reassignment procedures are conducted in the United States each year.

Written By: Ross Toro
continue to source article at livescience.com

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  1. For male to female you might also augment the breasts, reduce the jaw, move fat around.

    I once knew a M->F TS. He was over 6 feet tall and just about the homeliest guy I ever saw. I thought, oh hear, she will make the world’s ugliest female. I ran into her a bout a year later. I was gobsmacked at what surgeons (and his life savings) could do. She was as glamorous as a Las Vegas show girl.

  2. I have two transwomen friends and one transman acquaintance , none of whom has had the radical genital surgery but who insist that they ‘count’ as having transgendered. I support them in this, and consider them to be the sex they have chosen. But I mention this here because I sense that there are hundreds of thousands of people like them, possibly the majority of transgendered people, who cannot afford the cost in the US for genital re-assignment and who rely primarily on hormones.
    I have also observed that people who make the decision to transition early in life are the most successful, which is sad, because who has that much money and that much self-confidence at the age of 18?

  3. OK, I know this may seem very un-PC of me but I’m really skeptical of this kind of surgery. Since I’ve had some serious illness one thing I’ve noticed is that there are some doctors whose first response to everything is to do surgery. I can understand the emotion, when you get really good using a hammer you want the whole world to consist of things that need to be nailed together. I wonder if there are any studies on the long term effects here? Are there any controlled studies that show people who have the surgery really are happier that those who don’t? This seems to me like it could be drastic irreversible surgical solution to a problem that could at least party be psychological and often could be better addressed by therapy and possibly medication.

    • In reply to #4 by Red Dog:

      OK, I know this may seem very un-PC of me but I’m really skeptical of this kind of surgery.

      Think of it like this, lets say you woke up tomorrow in a female body (presuming you don’t already have one). Your top priority would be getting this embarrassing defect fixed even with stop gap measures.

      My ex had many TS friends. They were in their teens and early 20s. They tended to cook up goofy schemes to quickly raise the money. They were just too impatient to get on with some longer term scheme that would work.

      • In reply to #5 by Roedy:

        In reply to #4 by Red Dog:

        OK, I know this may seem very un-PC of me but I’m really skeptical of this kind of surgery.

        Think of it like this, lets say you woke up tomorrow in a female body (presuming you don’t already have one). Your top priority would be getting this embarrassing defect fixed ev…

        That example is hardly the same thing as these cases. I’ve lived all my life as a man so of course if I woke up tomorrow as a woman I would want my man parts back. The question is what about all these people who are born with man/woman parts but feel as if they are women/men? Just because we can do surgery and change their parts are we really so sure that is the proper response? Or even in the case where people are born with some lady and some man parts or with weird hormonal imbalances are we so sure that surgery is the best answer?

        This is one of those questions IMO where there is a lot of emotion on both sides rather than reasonable discussion. The conservatives are freaked out by the idea of someone having voluntary surgery to slice off mr winkie so they naturally oppose this and lots of liberals are so used to just giving a knee jerk response for anything conservatives are against that they think everyone who wants these kinds of surgeries should have them.

        And I’m sure that on the side of the doctors there are at least some who think its so cool that they can do this that they want to do it. Not because there is solid science that its the best option for their patients but because it will enhance their reputation, give them journal articles to write, etc. As a technical person I can kind of relate. As I went from programmer to manager one of the first things I learned I had to do was to recognize when the techies were proposing to build something because it was such a challenging thing to build and good techies like a challenge as opposed to because it really made business sense.

        Finally there is also a “grass is always greener” syndrome. Humans, especially humans with serious emotional problems, tend to look for any drastic change and think “if only I did X everything would be better”. I’ve experienced this myself and seen it in plenty of friends. X can be changing jobs, getting/dumping significant other, etc. and seldom when X is accomplished do things magically all get better.

        I’m not saying no one should ever have this surgery only that I think there should be more rational discussion and not an assumption that just because someone doesn’t feel comfortable as a man or woman that the obvious solution is surgery.

        • In reply to #6 by Red Dog:

          In reply to #5 by Roedy:

          In reply to #4 by Red Dog:

          OK, I know this may seem very un-PC of me but I’m really skeptical of this kind of surgery.

          Think of it like this, lets say you woke up tomorrow in a female body (presuming you don’t already have one). Your top priority would be getting this em…

          I agree, but I think it can be extended to any kind of non-essential surgery such as plastic surgery. The distinction should be between essential and non-essential surgery because the more frivolous it is, the harder it is to defend. Personally, I think the main problem is that people don’t realize what the real risks and costs are when it comes to surgery, and both should be made clear. There should be reasons for and against it, not gut reactions, though.

          • In reply to #7 by Zeuglodon:

            In reply to #6 by Red Dog:

            In reply to #5 by Roedy:

            In reply to #4 by Red Dog:

            OK, I know this may seem very un-PC of me but I’m really skeptical of this kind of surgery.

            Think of it like this, lets say you woke up tomorrow in a female body (presuming you don’t already have one). Your top prior…

            Agree with all of that although I don’t see this as exactly the same as cosmetic surgery (not talking about burn victims but people who want larger breasts, etc.) In the case of cosmetic surgery I don’t think any national healthcare system should pay for it. Cosmetic surgery frankly just baffles me. I’ve seen older women who look like freaks and its all self inflicted. Where as older women (realize this applies to men as well but its more common with women) who just age naturally look so much better. And the huge breasts, I just can’t conceive why any woman would want them.

            This is a topic I’ve given a great deal of thought and empirical study to (I still collect data on a daily basis) and I like breasts just the way they are, small, medium, or big they all look beautiful as made by nature and they all look worse IMO after some surgeon starts mucking with them.

      • In reply to #5 by Roedy:

        In reply to #4 by Red Dog:

        OK, I know this may seem very un-PC of me but I’m really skeptical of this kind of surgery.

        Think of it like this, lets say you woke up tomorrow in a female body (presuming you don’t already have one). Your top priority would be getting this embarrassing defect fixed even with stop gap measures.

        I don’t think it’s right to regard it as a defect. That’s like saying waking up with another ethnicity’s skin colour would be a defect simply because it’s different. Ideally, society should be so unprejudiced about either sex that the only things that would change would be toilet and sex arrangements.

        • In reply to #8 by Zeuglodon:

          In reply to #5 by Roedy:

          In reply to #4 by Red Dog:
          I don’t think it’s right to regard it as a defect. That’s like saying waking up with another ethnicity’s skin colour would be a defect simply because it’s different. Ideally, society should be so unprejudiced about either sex that the only things that would change would be toilet and sex arrangements.

          Certainly being a female shouldn’t be considered a defect but I don’t think that is how Roedy meant it. The point is there are people who feel like one gender even though physically they are of another. For those people their gender is a defect because there is a mismatch between the physiology and their psychology. I think its possible that for some of those people the appropriate response may be surgery but (and I admit this is just an impression I haven’t really read up on this) my feeling is that many of the advocates for this don’t really evaluate all the options and jump to surgery too quickly.

          • In reply to #9 by Red Dog:

            Sorry, I should have said “cosmetic surgery”, not plastic surgery. :-(

            I do think a sex change should be considered cosmetic, though. My reasoning is that the reproductive system is non-essential to personal survival, not in the sense that it wouldn’t kill someone if it was hacked off or infected, but in the sense that the body strictly speaking doesn’t need it to survive. My reasoning’s a little hazy when it comes to sexual arrangements, since I’m not sure what impact genital change has to sexual health, but my impression would be that it, too, is non-essential. I’m probably wrong, though. Most likely, you know more than me here.

            In reply to #10 by Red Dog:

            I’m still not sure about it, though I can appreciate it from, say, an argument from pragmatism. In the current social and cultural climate, there isn’t enough equality between the sexes for us to expect a sex change to have few consequences. A guy with a “feminine” mind would be treated differently from a straight-up girl, which could be sizeable enough a difference to justify the surgery. It just feels like here, the problem is a more general one of how far you’d have to go to justify the difference: I mean, is a feminine mind in a male body really that severe that you’d risk complications for it? Also, I suspect the “defect” in this context comes from some essentialist notions of sex, to the point that “maleness” in a body but “femaleness” in a mind can be considered incompatible. It doesn’t seem to sit well with a more biologically informed notion of sexes (as merely roles in reproduction), nor does it seem particularly egalitarian to distinguish them without a rationale, and I wonder if the disparity comes from some cultural judgement rather than from any genuine biological difficulties.

            Have to admit, I’m getting a little out of my depth here. :-(

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