m-to-i SRS - how soon is too soon?

[kellb]

Hi all,

   I imagine this is somewhat different to the norm, but I hope people might have some wisdom to share with me.

   I'm a non-binary person who's biologically male, but feels intersex - specifically that my body should be masculine (it is very hairy!), but that my bottom should be vaginal (which it unfortunately is not).  I've long thought about what it would be like, all through my childhood - I knew there was something missing, but never realised that was it!  In the past decade I've gotten in touch with my feminine side (my mental gender is about 30% masculine, 30% feminine by weighting - yes, I don't sum to a whole person), and last month I had the massive crystalising realisation of just what was wrong and what I could do about it.  It's been a scary ride, but now that I know how to fix what's been wrong with me, I've never felt so happy.  I've gone from hopeless to optimistic for the first time in my life!

   Ok, yay.  Go Kell!  But now that I know there is this option available to me, I'm faced with the possibility of taking true action.  I'm organising to go see a gender therapist, but I'm already quite certain this is what I want and need to feel whole.  I would really need them to tell me I'm crazy to talk me out of it.

   Because I'm genetically male and present as male, I don't believe I'll need lived experience (I pass as my cis-gender pretty well, I think).  I want to keep my testicles, up in the inguinal canal, so that I won't need HRT.  I want to freeze sperm because I've yet to have a family, but I was planning to do that anyway because partner is male and we're looking into surrogacy.  My partner is simply amazing and totally supportive (although he'll miss my cock, he'll gain a pussy to play with - good thing he's bi!). Money is not too much of a problem for me.  Assuming I somehow manage to get the two legal psyche evaluations, in theory I could get this done as soon as I can arrange a surgical team and time off work*.

   Terrific... except, how sure can I really be?

   I guess that's what the psyche evaluation is for, but mtf/ftm trans folks have a lot longer to think about it by necessity of lived experience and HRT timelines.  In my case,  it's hardly "gender reassignment", and no HRT unless I can't avoid the orchidectomy, and even then I already handle T just fine.

   It's got me to wondering - how soon is too soon to think about doing this?  What's minimal "Have you really thought long enough about this?" period?  Obviously, it's different for everyone.  I was always unhappy with my body but didn't know why; I didn't realise that I needed a vagina until I was an adult.  I feel like many folks are pretty decided on SRS well before the time they pass the cooling off period.

   I know I could just wait years, but I'm already 34 and I feel time slipping away - I'd love to do this while I'm still "young".  Is it too much to dream to do before I'm 35?  Seems fair that if I live to 70, I'll get half and half!

   Any thoughts?

   -Kell


*Obviously, there are delays, waiting lists and cooling off periods anyway... but I'm talking about the time needed just to find my own 'certainty'.

[JLT1]

Hi,

Good, honest questions.  I've actually seen this before...a MTF "detransitioned" and was totally happy being a man with a vagina.  It's unusual but does happen.

Start with the psychologist who has experience with gender issues and explore who you are with them.
Then, look at what is involved in SRS.  It is a surgery with risks and rewards.  There are surgeons who will do the operation so look around. Lastly, as a MTF who has kept a good relationship with a spouce, keep your partner involved in the process.  This also means not being obsessed with the process and result.

Hugs,

Jennifer

[Serenation]

Don't thing any of that could happen in my country (au) because wpath? not heard of that sort of surgery before either (maybe I'm sheltered)

[Dena]

You would need two things, a surgeon who would do the work and people who would write the letters for you. For sexual reassignment the requirement is a year of living in the opposite role. While you are living in the desired role, you may still need a year of therapy for the therapist to be sure of your intention.

I would expect there might be some exposure to female hormones because a Premarin cream is used externally to convert the skin to vaginal tissue and you will need to dilate until the surgery is able to withstand sex.

[Jenna Marie]

First of all, it can be harder for non-binary people to find sympathetic and knowledgeable medical professionals, so you may have to shop around a bit more for someone who understands. I'm not entirely sure that living as male will qualify for the "real life experience" either (don't get me wrong, I don't think we SHOULD have that requirement at all, and I'm 100% behind trans people being able to make whatever choices they need for their own happiness, but many therapists and surgeons are more conservative than I). Secondly, I think they do prefer to remove testicles for the same reason that undescended testes in children are corrected; there's some medical risks of leaving them "in place," and post-GRS they would presumably be permanently unable to descend.

So you'll need a) waivers or an "exception" on RLE and HRT and b) a surgeon willing to work on you. Both should be possible, but I doubt either is instantaneous in the current climate, so you probably (unfortunately) should expect to spend a few weeks to months lining everything up.

(Oh, and Premarin cream or female HRT was not required for my post-op care... female HRT or an exception *was* for qualifying for GRS, but post-op I could have chosen menopause if I'd really wanted to. Or, in your case, testosterone.)

[kellb]

Wow!  Thank you all so much for your really helpful replies!  Good stuff to know.

I'm in Australia, so I'm guessing we're under WPATH7 (at least the gender clinic I'm hoping to go to says that on their website).  Nothing under those standards that I've seen would prevent me from getting what I need... it's just a question of how long it will take.

But yes, I know I'm in for a wait until it can be made right.  If it's a year of psyche then... ok.  I think it's worth it.

As for the relocation to the inguinal canal, yes, it can be done.  Apparently it's rare but hardly unheard of (see Tess Cowen for an example).  In my case, I suffer from testicular cysts that occasionally fill, burst and drain on their own.  They're non-cancerous, but they hurt like heck and I like to keep an eye on them.  If I did relocate them I expect I would need regular ultrasounds to keep an eye on them.  The higher abdominal temperature would make me infertile, and I have also researched the increased cancer risk of cryptoorchidism and consider it acceptable.

I confess I'd not heard of the Premarin cream (damn - I thought my research had been quite extensive!), but it doesn't trouble me.  Given my mental gender, I would actually welcome a little estrogen and a little less testosterone, provided it didn't make me grow breasts.  Weird, right?  My body image is a guy with a vagina, but definitely not breasts.

-K

[LizMarie]

Any exposure to higher estrogen levels could trigger breast development. A lot depends on your specific genetics. You cannot guarantee breasts will not develop under any sort of estrogen therapy. No doctor can guarantee they will or won't. All they can do is provide the hormones then whatever happens happens, largely dictated by your own genetics.

[Dena]

I confess I'd not heard of the Premarin cream (damn - I thought my research had been quite extensive!), but it doesn't trouble me.  Given my mental gender, I would actually welcome a little estrogen and a little less testosterone, provided it didn't make me grow breasts.  Weird, right?  My body image is a guy with a vagina, but definitely not breasts.

The estrogen helps convert the tissue to be self lubricating and improve the elasticity. Normally the cream just speeds up the process but as you are not going to be on HRT and wish to be sexually active, there is a strong possibility you will need it. I don't know how much would be absorbed into your system but some might. What you are asking is something I have little knowledge of and I have to apply what I do know to your case.

Breast growth is slow so if you do start developing you would have plenty of time to stop the cream before much happened. You would just need to do a weekly inspection of yourself for changes.

[AnonyMs]

I'm in Australia, so I'm guessing we're under WPATH7 (at least the gender clinic I'm hoping to go to says that on their website).  Nothing under those standards that I've seen would prevent me from getting what I need... it's just a question of how long it will take.

I have some interest in non-standard paths myself and have done a fair bit of research into it. My situations a bit different in that I'm MTF, but need to keep presenting male for various reasons. The end result is much the same though.

If you're sane and have no other issues I don't think you'll have too much trouble doing this. It is very rare though. I believe the main issue is going to be finding a psych who'll sign off on it, which might take a bit of work. I think the amount of time you need will depend on how long it takes the psych to determine you're sane and know what you're doing. If they suggested a year or anything like it I'd be looking elsewhere. Perhaps if you say which city you're in someone can suggest a psych to start with.

I don't think you'll have much trouble finding a surgeon once you have the letter. The surgeon relies on the psych to evaluate your suitability, and unless he's got some kind of moral objection why would he refuse? It doesn't really matter if anyone in Australia will do it or not, that's what aeroplanes are for! In Thailand you only need one letter, not two - you get the other one there.

The psych evaluation is not exactly to help you be sure. You can see a therapist to discuss it and they will help you understand yourself, but the answer comes from within. They don't, or shouldn't, tell you. You won't fit any of the standard stereotypes either, so they really won't be able to tell you the answer. The psychiatrist may provide therapy (mine did), but at the end of the day he (or she) evaluates you to make sure you're sane and understand what you're in for, and only then do you get the prized letter.

WPATH is more of a best practices than any kind of strict rule. It's certainly not any kind of legal thing. I'd not worry about it too much.

I'm not sure you'd get to keep your testicles. Undescended testicles are a cancer risk, plus I'd imagine that would put the surgery into uncharted territory. Sex with testicles in the way sounds excruciatingly painful as well. However you can still get testosterone supplements if you need it.

https://en.wikipedia.org/wiki/Cryptorchidism

From what I've read of FTM's testosterone causes vaginal atrophy, i.e. thinning of the vaginal walls leading to pain and bleeding. I've no idea what that would mean in your case.

[Isabelle]

Have I got this right....?
You want a
Vaginoplasty operation but you keep your testicles, you present as a man, live as a man, but just want a vulva, vaginal canal with testes instead of ovaries? It's the first time I've heard of a
Transgender wanting this but, I've certainly transgenders say they want things even more unusual than what you're talking about, so I don't think "the powers that be" would have a problem with it.. 
My advice is just get your surgery letters from Thai psych people.  It's literally a formality and takes all of 5 minutes to get a reccomendation. I don't know if there's much in the WAPATH guidelines about someone requesting what you're requesting. Im sure you'll find plenty of people that are happy to take your money.

[Dena]

Have I got this right....?
You want a
Vaginoplasty operation but you keep your testicles, you present as a man, live as a man, but just want a vulva, vaginal canal with testes instead of ovaries? It's the first time I've heard of a
Transgender wanting this but, I've certainly transgenders say they want things even more unusual than what you're talking about, so I don't think "the powers that be" would have a problem with it.. 
My advice is just get your surgery letters from Thai psych people.  It's literally a formality and takes all of 5 minutes to get a reccomendation. I don't know if there's much in the WAPATH guidelines about someone requesting what you're requesting. Im sure you'll find plenty of people that are happy to take your money.

It's the third case in as many months that I have see here. I may be spending far to much time online because just about everything that has been going through this web site has passed before my eyes at one time or another.

[kellb]

Thanks, everyone!  I confess I've been a bit scared about all of this, but non-critical feedback is really helping!

AnonyMS: Thank you so so much for the useful thoughts!  When I get my rep up I will def private message you - I would love to share notes about things.

Isabelle: Almost!  I present and live as a man, but I don't feel like a man.  I'm mentally gendered about 30% male, and 30% female - I describe it as having "two sets of circuits" in my brain (I'm an engineer... my tech metaphors drive my partner nuts).  Those numbers are constantly being revised on mood and as I learn more about myself.  Sometimes I feel totally zero (actually, most of the time and for most of my life), sometimes I wear flowers in my hair at home.  Even after finally figuring out and becoming comfortable with my gender, it took me a long time to realise that a big source of discontentment was my body itself.  I have absolutely nothing invested in my penis/testes aside from using them to make my partner happy and directing streams of urine.  The only reason I want to keep my testes is to avoid the need for HRT - turns out testicles are a great natural source of my daily recommended testosterone intake!

Dena: Interesting.  I agree it's a try and see sort of thing.  I'm not so pathological about having breasts that their formation would be a mentally life-threatening occurrence.  If a small dose to get things going down there had the desired effect but meant I'd need a mastectomy, I would be ok with that - alternatively, binding would be ok too.  Simply put, breasts aren't me but they aren't nearly as unwelcome and alien to me as my penis is.

As for my sanity... well, that's what I'm hoping to work out.  I can only tell you the wave of happiness and positivity I've had at simply even -knowing- what the problem was.  I don't expect life to suddenly get better from having SRS; it's already better.  I just want to make things 'right'.

-Kell

[Serenation]

Feeling intersex and being intersex are two different things, and the gender clinic (main one in australia) says being intersex makes no weight in their evaluations anyway.

I had to see the main psych for many many months and then have see their other psychiatrist, you will have to answer many questions on how you are managing living as the proposed gender. After both psychs are convinced you will be ok living as female and it's the best thing for you, you can see the surgeon (your actually able to see the surgeon any time but he wont do anything without your approval from the psychs from the gender clinic)

In an interview I believe was asked if someone can walk in off the street and ask for a vagina, and he said no because he abides by wpath.

Of course plenty of people bypass all this and just go to thailand but you get to pick the technique they offer, you don't get to make up your own operation and have them perform it.

it takes a year to properly recover from from srs.

To get what you want you'd probably have to pretend to be living as full time female, which means taking hrt and being monitored, do that for a few years, have srs then de transition, the government has closed down Australias services once before so they are pretty cautious for the sake of everyone.

[Isabelle]

Feeling intersex and being intersex are two different things, and the gender clinic (main one in australia) says being intersex makes no weight in their evaluations anyway.

^YYYYYYYEEESSSS^^^^

Transgenders colonising (and therefore imposing without consent, upon) interex people's lived experience is NOT cool. I see it online quite often.

[kellb]

To get what you want you'd probably have to pretend to be living as full time female, which means taking hrt and being monitored, do that for a few years, have srs then de transition

Unfortunately, that's simply not an option for me.  I'm not a woman and have no wish to be one; I'm a big stocky hirsute "male" and it's pretty obvious that I'm hardly about to change that.  I teach at a university, which makes me something of a semi-public figure - a public transition to and then fro would be career suicide.  That said, I've read through WPATH7, and nothing in it suggested to me that I'm asking for the impossible.  My biggest fear is that they will say "Meh, you can live with out it - make do."

Why were Australia's services closed down?  I would be interested in spinning off a new thread to discuss the State of the Union so far as SRS in Oz works.

[AnonyMs]

Feeling intersex and being intersex are two different things, and the gender clinic (main one in australia) says being intersex makes no weight in their evaluations anyway.

I don't think that's according to WPATH. This is a small extract from WPATH, where DSD is the term they use for intersex.

"However, certain criteria for treatment (e.g., age, duration of experience with living in the desired gender role) are usually not routinely applied to people with a DSD; rather, the criteria are interpreted in light of a patient's specific situation (Meyer-Bahlburg, 2011)."

There's more than that, but it suffice to say according to WPATH it does make a difference. I believe its quite common for doctors to say they follow it without actually doing so. I wonder if some of them have even read it.

I don't think there's a main clinic in Australia. The states are all quite different, and much to my surprise Sydney's great.

I had to see the main psych for many many months and then have see their other psychiatrist, you will have to answer many questions on how you are managing living as the proposed gender. After both psychs are convinced you will be ok living as female and it's the best thing for you, you can see the surgeon (your actually able to see the surgeon any time but he wont do anything without your approval from the psychs from the gender clinic)

That's the common view on how it works, but its not the only way. I know of other cases, but I saw a YouTube video last week of a Sydney girl who had 1 psych interview and got her surgery letter for Thailand. She was obviously ready, and it would have be pointless to drag it out of the sake of following some paperwork. Perhaps she's even here?

it takes a year to properly recover from from srs.

Yes, but you can go back to work way before then, and if you're trying to hide it from anyone you could think of it being be anywhere from 4 weeks to a few months.

To get what you want you'd probably have to pretend to be living as full time female, which means taking hrt and being monitored, do that for a few years, have srs then de transition, the government has closed down Australias services once before so they are pretty cautious for the sake of everyone.

While that's the usual path I don't think its the full story. Socially transitioning right now would likely be  be a disaster for me, and if/when I get SRS I'm not going to socially transition before or after. I'm quite certain I can get what I want; I have the money and ability to choose my own path.

[kellb]

AnonyMs:  Given the LGBT population of Sydney, I'd be astonished if it wasn't a good place for it.  Since you asked, I'm in Brisbane, btw.  I do get to travel often, though.

[kellb]

Socially transitioning right now would likely be  be a disaster for me, and if/when I get SRS I'm not going to socially transition before or after. I'm quite certain I can get what I want; I have the money and ability to choose my own path.

Oh yes, do I feel ya!  My plan is to use my testicular cysts as a 'cover story'.  If/when I get it done, I will simply tell people "Things went bad and they had to come out.  There were complications and nothing could be done."  Most people will be too respectful to pry.

[AnonyMs]

Oh yes, do I feel ya!  My plan is to use my testicular cysts as a 'cover story'.  If/when I get it done, I will simply tell people "Things went bad and they had to come out.  There were complications and nothing could be done."  Most people will be too respectful to pry.

Personally I feel the less said the better. I'd not mention the testicles, but cancer is "good". Just so long as it doesn't affect your job prospects if people don't think you have a long term future there...

[Isabelle]

Going by what you've said, I don't think any western surgeon will perform SRS on you. Because you think SRS  an elective procedure someone can just choose to have when, it is in fact it can only be performed by trained professionals and only when found to be  medically indicated by meeting certain diagnostic criteria.
For you, This means thailand, and finding the type of surgeon that works outside the ethical consensus of their profession. For example there's surgeons that castrate local kathoeys at 13 years old for a few hundred. Or "Drs" in India that perform full penectomy on Hidjra's for very little. Basically, go east, take cash, talk to locals, follow leads, make offers.

If/when I get it done, I will simply tell people "Things went bad and they had to come out.  There were complications and nothing could be done."  Most people will be too respectful to pry.

I don't really understand why you'd have to tell anyone anything at all, as youre not transitioning socially are you? Nobody would ever know/need to know.