SRS - do we really need it

[Carrie Liz]

Yes, because for a lot of us, it's not even about "looking the part" or about sexual function, it's about replacing a body part that causes us constant emotional distress with one that is at least reasonably congruent with how our brain is programmed to expect our body to feel.

Like, I feel like there's a huge divide in the trans community between those whose primary dysphoria is social, based on putward appearance and how other people see them, versus those whose primary dysphoria is bodily, and based around physical discomfort with how one is shaped and how the body feels on a fundamental level.

If your dysphoria is mostly social, then yes, obviously SRS is just a personal decision, one that's not inherently "necessary." For those of us with more severe body dysphoria, though, it is absolutely 100% medically necessary. Phantom sensations are common. Dissociation is common. Having no sex life at all because the very act of sex feels wrong with those pre-operative genitals is common. SRS, while yes, it's not perfect, fixes that mental map incongruity, and make you feel like you have actual genitals rather than what often feels like a mis-shapen tumor down there.

So, yeah, it depends on your individual experience of dysphoria. For me, it's not even about SRS somehow making me "female," or how I'm seen by anyone else, it's all about that physical dysphoria. I'd want a vagina and labia and clitoris even if I was completely "male" on the outside, because it was never about fitting into the "female" role so much for me as a physical sensation of discomfort with the very way that having "male" genitals works in the first place.

I mean, it's pretty hard to enjoy sexuality at all when the very act of getting an erection feels so wrong and gross on a fundamental level.

[Emileeeee]

I lost my sex drive with HRT alone. I don't even have so much as a consultation for SRS yet, although I do plan on getting it. So I probably won't be using it for its intended purpose, but it'll make me feel a heck of a lot better when I don't have to see that other thing down there. As an added bonus, it would be nice to not have to always worry about whether people can tell it's there.

[warlockmaker]

Ah.  The deep thoughts. . srs or not. I remember posting on the internet, under a pseudo name, on an open site, that I wanted srs and the negative responses from men and women were numerous. Kinda upset me but was an interesting exercise as I began this journey some 8 years ago.

It's very much a personal decision and is not right for everyone. There is no right or wrong...only some wrong logic that I observe from the posts.

First, health wise there are more benefits than negatives. The chance of prostate cancer and any other sex organ cancer is almost eliminated. In addition, a slower metabolism and less agressive mental approach encourages long life and less stress related heart attacks. Yes, we have a higher exposure to breast cancer, possible blood clots which can cause heart issues and should check our liver. We should take blood tests regularly. Other than that there is no increase in risk .

Sex drive, female sex drive is different than that of a T driven male. It's a long subject but it is suffice to say that under today's srs techniques from the top surgeons there in the clitoris type orgasmn and the prostate orgasmn.  The orgasmn is much more intense and even not having one is pleasurable. Most males need to orgasmn.

Then comes reasons many may opt not to have surgery because of the fear of surgery...the pain and the possible complications. This is a good reason not to have the surgery but be honest with yourself. Many cannot afford this surgery..for those I feel great empathy and I can only hope that government recognize the needs of certain tgs.

Each of us seeks to find peace and i hope that we all have a solution which we can live with..be it srs or not.

[Ange]

That GCS is helpful or not has been looked at in many studies and yes the suicide rate post GCS runs at about 20%; far too high. But that is directly attributable to lack of societal acceptance and not to the surgery itself.

20% ? Numbers of the biggest Paris hospital indicate a 0.5% suicide rate post-op over 25 years.

Other studies indicates a reduction from 30% to 5% after SRS. In all studies but one, a dramatic decrease of suicide rate has been observed after GCS.

To me that "high number of suicide post GCS" has always been some kind of transphobic propaganda. (and it even work on us, since access to these informations are hard to get.)

[Lucie]

The chance of prostate cancer and any other sex organ cancer is almost eliminated.

Are you sure that the risk of prostate cancer is lower after SRS than before ? How would you explain that ?

[Laura_7]

Are you sure that the risk of prostate cancer is lower after SRS than before ? How would you explain that ?

Less testo more estro. There are remedies for that based on high doses of estro.


*hugs*

[warlockmaker]

This has been covered by other posts in Susans.. plus look it up on the internet. Generally speaking the prostate shrinks and thus ...no prostate cancer.  Dr feel for a swollen prostate as a sign of cancer .

Hope this clarifies

[Beth Andrea]

If you have an Orchi you might tell the surgeon to use procedures which allow for an SRS later. There are less invasive procedures.
Its even possible to ask SRS Surgeons for advice, some are willing to instruct surgeons.

SRS is still labeled cosmetic surgery. Compared with other surgeries its not that invasive. Its healthy people going into an operation, and with very experienced surgeons really severe complications are rather rare.
There are SRS surgens who send their clients home after 10 days in a recovery facility.
Pain varies. Some need a lot of meds, some almost none after the procedure.

I'd say look up a few descriptions of people ...


*hugs*

SRS is medically necessary if the patient says it is needed, at least according to the most recent DSM.

To the OP: You're entitled to your opinion, and for you it is correct. But it is not correct to apply your thoughts to the entire population of trans*people, because we all have different needs and values, which create a wide variety of "cost to benefit ratios."

Btw, they have developed uterus+vaginal cloning, and have transplanted several cis-women with their own DNA-created organs. The potential is breathtaking to consider...

"Passing" has a lot to do with confidence in oneself. Having the right parts downstairs is, for some, a big boost in that department.

[Laura_7]

SRS is medically necessary if the patient says it is needed, at least according to the most recent DSM.

This was meant about invasiveness.
It start to get a bit more severe when it comes to transplanting of lab grown organs, which many hope for.

Of course its important if people feel they need it.


*hugs*

[jessicats]

Thank you all for the responses! I agree that having SRS or not is a personal decision and everyone knows for themseles. Personally I don't realy have such a big need to do the surgery. As long as I am physically passable and comfortable with my looks, some wrong part down there wouldn't bother me so much. Of course I would love to have a vagina, but not on every price. Some sources say that after removing the gonads you go through the menopause. Yes, with hormones you treat it, but you are already in menopause. It is like a cis woman to remove her gonads. This is what bothers me most. Of course, as long as you all feel comfortable there is nothing bad with having the surgery. Some people on this thread already said about the possibility to have a vagina, uterus etc. grown from your own genes and then transplanted to your body. That would be amazing and such a great success of science. Of course being able to have your own children and give birth would be something that most of us have dreamt of.

[Jenna Marie]

That is true - and I even tell medical professionals now that I'm in surgical menopause - but pre-op trans women are also taking a variety of medications to induce menopause, more or less. (That is, to suppress the native sex hormones and then supplement with estrogen instead.) The difference post-op is that it's permanent, which *is* a big change for anyone who wanted the ability to regain T production if she chose, but otherwise...

Personally, the pathology report stated that my testicles were permanently nonfunctional anyway after a couple years on HRT, so I guess for me it wasn't even that much of a change, except that they were finally gone.

[Lucie]

This has been covered by other posts in Susans.. plus look it up on the internet. Generally speaking the prostate shrinks and thus ...no prostate cancer.  Dr feel for a swollen prostate as a sign of cancer .

Prostate shrinking begins before SRS, as soon as HRT and AA action have started. So I don't see how the risk of prostate cancer could be higher before SRS than after (under HRT in both case).
Also some time ago KayXo posted this:

Andrologia. 2014 Dec;46(10):1156-60.
Prostate cancer incidence in orchidectomised male-to-female transsexual persons treated with oestrogens.
Gooren L1, Morgentaler A.

« When diagnosed in this population, there appears to be a tendency for PCa to behave aggressively. Prostate monitoring should be considered in these individuals beginning at age 50 years."

I agree that SRS is not orchidectomy, however I don't see why prostate cancer risk should be higher after orchidectomy than after SRS.
Am I missing something ?

[KayXo]

I also do not want to limit my sexual pleasure (need to do more research).

I provided two studies. I can attest to having as much, if not MORE sexual pleasure now than ever before because my body feels right to ME. Sexual pleasure, I think, is also very much influenced by our minds, regardless of hormones, if we are actually doing what we want, have no religious hang-ups, repression, etc.

For me, it's not even about SRS somehow making me "female," or how I'm seen by anyone else, it's all about that physical dysphoria. I'd want a vagina and labia and clitoris even if I was completely "male" on the outside

Yes! +1

The chance of prostate cancer and any other sex organ cancer is almost eliminated.

The prostate is not removed during SRS and either way, pre or post-op, our androgen levels are very low so it shouldn't make a difference in that respect. Of the 5 (out of overall 6) cases reported in transsexual women in the literature, I have noted 4 being post-op. So, cancer can indeed occur.

Andrologia. 2014 Dec;46(10):1156-60.
Prostate cancer incidence in orchidectomised male-to-female transsexual persons treated with oestrogens.
Gooren L1, Morgentaler A.

« When diagnosed in this population, there appears to be a tendency for PCa to behave aggressively. Prostate monitoring should be considered in these individuals beginning at age 50 years."

In addition, a slower metabolism and less agressive mental approach encourages long life and less stress related heart attacks.

The same can be said of pre-ops as they have little T. Cardiovascular risks are lessened due to positive effects of estrogen on the cardiovascular system if bio-identical E is taken, preferably non-orally.

Yes, we have a higher exposure to breast cancer

Not quite.

Journal of Clinical & Translational Endocrinology 2 (2015) 55-60

"There is no increase in cancer prevalence or mortality due to transgender HT."

"While some guidelines for transgender medical care express concerns for elevated cancer risk with certain hormone regimes, current data suggest that the risk of cancer may not rise."

"Although studies are small, overall cancer incidence in transgender men and transgender women to-date has not been found to be different than their respective male and female controls [5]. There are no reports of change in breast cancer specific risk among transgender individuals on estrogen compared to secular trends of male breast cancer incidence. Rates are lower relative to secular trends of female breast cancer rates."

Breast Cancer Res Treat. 2015 Jan;149(1):191-8.

3 cases out of 3,556 transsexual women as is indicated in the full article. An incidence rate of 0.08%.

J Sex Med.2013Dec;10(12):3129-34.

"We researched the occurrence of breast cancer among transsexual persons 18-80 years with an exposure to cross-sex hormones between 5 to >30 years. Our study included 2,307 male-to-female (MtF) transsexual persons undergoing androgen deprivation and estrogen administration (52,370 person-years of exposure)"

"Among MtF individuals one case was encountered, as well as a probable but not proven second case."

"The number of people studied and duration of hormone exposure are limited but it would appear that cross-sex hormone administration does not increase the risk of breast cancer development, in either MtF or FtM transsexual individuals.Breast carcinoma incidences in both groups are comparable to male breast cancers. Cross-sex hormone treatment of transsexual subjects does not seem to be associated with an increased risk of malignant breast development."

"The incidence rate of breast cancer in our MtF cohort was thereby 4.1 per 100,000 person-years (i.e., two cases divided by the total amount of 49,370 person-years of follow-up). The 95% confidence interval of the incidence ranged from 0.8 to 13.0 per 100,000 patient-years. For comparison, the calculated expected incidence of breast cancer in biologic women would be 170.0 per 100,000 person-years of follow-up. In our sample, the one or possibly two incident cases of breast cancer in MtF subjects more closely approximate the expected incidence of breast cancer of 1.2 per 100,000 patient-years that would occur in biologic men."

possible blood clots which can cause heart issues

Only observed with the use of non bio-identical estrogen and progestogens (as for instance, in the 2003 WHI study).

Journal of Clinical & Translational Endocrinology 2 (2015) 55-60

"Other compelling data suggest that
the incidence of venous thromboembolism (VTE) among transgender
women appears associated with the presence of a hypercoaguable
risk factor, including the use of an especially
thrombogenic estrogen (ethinyl estradiol) which is no longer used
[3]. Gooren et al. (2008), reported no increase in VTE among 2236
male-to-female (MTF) transgender individuals on HT from 1975 to
2006 compared with controls, with the exception of those who used
ethinyl estradiol, for which there was a 6-8% incidence [4]."

Archives of Sexual Behavior, Vol. 27, No. 5, 1998

"The incidence of thromboembolic events during cross-
gender hormone treatment in our patients was zero."

Despite VERY high doses of parenteral bio-identical estradiol and moderate to high doses of oral bio-identical E.

Exp Clin Endocrinol Diabetes. 2005 Dec;113(10):586-92.

"Sixty male-to-female transsexuals were treated with monthly injections of gonadotropin-releasing hormone agonist (GnRHa) and oral oestradiol-17beta valerate for 2 years to achieve feminisation until SRS."

"Two side effects were documented. One, venous thrombosis, occurred in a patient with a homozygous MTHFR mutation."

Only 1 case with a GENETIC PREDISPOSITION.

J Clin Endocrinol Metab. 2003 Dec;88(12):5723-9.
Venous thrombosis and changes of hemostatic variables during cross-sex hormone treatment in transsexual people

"In conclusion, we have shown that treatment of MtF transsexuals with sex steroid hormones (CPA combined with E2 or EE) affects the hemostatic balance with a very pronounced difference in the effects of oral EE compared with the effects of both td E2 or oral E2. Oral EE induces a clinically relevant prothrombotic state."

J Clin Endocrinol Metab. 2012 Dec;97(12):4422-8.

"Historically, high-dose estrogen in the form
of ethinyloestradiol or conjugated equine estrogen (CEE) was
used to suppress testicular function and induce feminization.In
view of the procoagulant nature of these older estrogens and the
inability to use plasma estradiol levels to guide treatment, this
protocol was changed in 2004 to oral estradiol valerate"

BMJ 2012;345

After 10 yrs of HRT on bio-identical estradiol:

"Stroke rates did not differ between the groups (14 in control group v 11 in treated group; 0.77, 0.35 to 1.70; P=0.70). The rate of venous thromboembolism was low and did not differ significantly between groups. Three women had confirmed deep vein thrombosis (1 in control group v 2 in treated group; 2.01, 0.18 to 22.16) and only one woman (control group) was admitted to hospital with pulmonary embolism."

After 16 yrs follow-up:

"Stroke rates did not differ between groups, with 21 cases in the control group and 19 in the treated group (0.89, 0.48 to 1.65; P=0.71). The rate of venous thromboembolism and pulmonary embolism was low and there was no significant difference between groups (fig 6⇓). Nine women had confirmed deep vein thrombosis (5 in control group v 4 in treated group; 0.80, 0.22 to 2.99; P=0.74), and only four women were admitted to hospital with pulmonary embolism (3 in control group v 1 in treated group; 0.33, 0.04 to 3.21; P=0.34)."

"This may be due to the differences in the administered hormones; 17-β-estradiol has been reported to be less thrombogenic than conjugated equine oestrogen.21 22 In human aortic endothelial cells 17-β-estradiol is superior to conjugated equine oestrogen in increasing the production of nitric oxide, partially because of a higher ability to activate the production of endothelial nitric oxide synthase.23"

"The type of progestogen used may be important, as natural progesterone seems to have more beneficial effects on the cardiovascular system than does medroxyprogesterone acetate.30 31"

and should check our liver

Liver problems have been associated with a certain anti-androgen (cyproterone acetate) and NON bio-identical estrogens such as ethinyl estradiol and conjugated estrogens.

Exp Clin Endocrinol Diabetes. 2005 Dec;113(10):586-92.

" Sixty male-to-female transsexuals were treated with monthly injections of gonadotropin-releasing hormone agonist (GnRHa) and oral oestradiol-17beta valerate for 2 years to achieve feminisation until SRS."

"Liver enzymes, lipids, and prolactin levels were unchanged."

J Clin Endocrinol Metab. 2008 May;93(5):1702-10.

"transdermal E2 exerts minimal effects on CRP and the other inflammation and hepatic parameters."

Am J Obstet Gynecol. 1987 May;156(5):1326-31.

"None of the doses of transdermal estradiol exerted any measurable action on hepatic markers of estrogen action"

J Clin Endocrinol Metab. 1991 Aug;73(2):275-80.

"despite the relatively high doses necessary to mimic a hormonally normal cycle, the transdermal route did not significantly alter the hepatic parameters studied"

Hepatol Res. 2007 Apr;37(4):239-47.

"Our previous studies showed that estradiol suppressed hepatic fibrosis in animal models"

Int J Endocrinol. 2015;2015:294278.

"In females, estradiol regulates liver metabolism via estrogen receptors by decreasing lipogenesis, gluconeogenesis, and fatty acid uptake, while enhancing lipolysis, cholesterol secretion, and glucose catabolism."

"These recent integrated concepts suggest that sex hormone receptors could be potential promising targets for the prevention of hepatic steatosis."

Am J Physiol Endocrinol Metab. 2014 Aug 1;307(3):E345-54.

"Diet-induced hepatic steatosis was attenuated by E₂"

Scand J Clin Lab Invest Suppl. 2014;244:90-4.

"Although not a classical target for estrogens, the liver is a target for their action and is sensitive to their deprivation. The occurrence of menopause is accompanied by a chain of events depending on the progressive estrogen deprivation that eventually leads to a shift from a low inflammatory to a high inflammatory state. This has a series of well-known consequences in many different organs and tissues (bone, heart, brain, body fat etc.) among which the liver is particularly interesting. The consequences are extremely evident in HCV-positive women in whom HCV infection and menopause cooperate to induce higher necro-inflammatory features, increased hepatic steatosis and eventually faster progression of fibrosis."

Ernst Schering Found Symp Proc. 2006;(1):45-67.

"These mutations, both natural and experimental, have revealed that estrogen deficiency results in a spectrum of symptoms. These include loss of fertility and libido in both males and females; loss of bone in both males and females; a cardiovascular and cerebrovascular phenotype; development of a metabolic syndrome in both males and females, with truncal adiposity and male-specific hepatic steatosis. Most of these symptoms can be reversed or attenuated by estradiol therapy."

Gynecol Endocrinol. 1993 Jun;7(2):111-4.

"Serum concentrations of sex hormone-binding globulin (SHBG), corticosteroid binding globulin (CBG), ceruloplasmin, lipoprotein A and liver enzymes were measured in 30 postmenopausal women treated with (...) micronized 17 beta-estradiol daily and micronized progesterone (...), as progestogen supplementation. The treatment lasted for 4 months. The serum levels of SHBG and CBG increased during treatment and a weak association between progesterone dosage and CBG was observed. Levels of lipoprotein A and liver enzymes did not change. It is concluded that micronized natural progesterone is an attractive means of progesterone supplementation in postmenopausal hormone replacement therapy without any liver-related side-effects."

Gynecol Endocrinol. 1996 Feb;10(1):41-7.
Clinical evaluation of near-continuous oral micronized progesterone therapy in estrogenized postmenopausal women

"No significant changes were observed in blood glucose or liver enzymes."

Estrogen and progesterone supplementation provide many benefits to the body and mind, regardless if pre or post-op.

The orgasmn is much more intense and even not having one is pleasurable.

I have plenty of orgasms post-op, even when I sleep at night, when I dream!

Then comes reasons many may opt not to have surgery because of the fear of surgery...the pain and the possible complications.

But then, one must weigh this risk which today is quite low vs. the benefits of having the surgery. This will depend on the individual.

Many cannot afford this surgery

In some countries, it is paid for by the government or insured/covered with certain plans.

20% ?

It would be nice to see the supporting evidence. For this finding, for the suicide rate post-op.

Are you sure that the risk of prostate cancer is lower after SRS than before ? How would you explain that ?

Less testo more estro. There are remedies for that based on high doses of estro.

Pre- or post-op, T is low, there is no difference. Same with E. So risks should be similar.

Some sources say that after removing the gonads you go through the menopause. Yes, with hormones you treat it, but you are already in menopause.

Taking hormones will take you OUT of menopause and you will be no different than a ciswoman who is pre-menopausal except that you have no uterus, fallopian tubes, or ovaries. For me, that is no biggie. I'm ok with that.

Of course being able to have your own children and give birth would be something that most of us have dreamt of.

Not me. To each their own.

The difference post-op is that it's permanent, which *is* a big change for anyone who wanted the ability to regain T production if she chose

Then simply take T. It's pretty simple.

I agree that SRS is not orchidectomy, however I don't see why prostate cancer risk should be higher after orchidectomy than after SRS.
Am I missing something ?

You're perfectly right. It's the same thing. Orchiectomy is removing testicles, thus testicular production of T, same as SRS, except you also get a vagina and the penis removed. From a hormonal standpoint, pre-op and post-op (whether orchiectomy or SRS) are the same.

[Jenna Marie]

Kay : Fair enough, but it's probably also fair to note that cis women who take HRT because of menopause do not typically feel that it's "the same" as having their own body produce it - so I wanted to address the concern of someone who specifically did want *her own body* to produce T again. (I personally had a horror of that happening, but since the whole point of the thread was to acknowledge different viewpoints, I wanted to be as inclusive as possible.)

[Karlie Ann]

I'm going to answer this for myself only.  For many years the only escape I had to fantasize about being a woman was to look at certain forms of p---ography.  Seeing so many of the women with the same equipment as me only with a woman's face and body has made it so I don't really have a problem with seeing it down there.  My dysphoria is more my face and lack of breasts.

That said, I used to say that I would leave it there, and now I'm not so sure.

[liz]

About the sex drive it really depend on individual. If it is a concern just take a look at the percentage of post op trans woman going on a sex frenzy (am i in this number?  Haha)

Well if you dont feel like you need it then you should avoid it for now. It's a lot of aftercare and time consuming. There are risks associated with it and many had bad experiences. None of this will discourage someone who need it, but if it does then maybe it's not for you or you're just not there yet.

[jessicats]

The main thing I am worried about when I eventually go post op is my T levels. Would I still be able to have T within the maximum in the female range? Because every woman needs T in order to have an active lifestle, sexual life etc. How about you girls, what are your T levels after you go post op - it's closer to the minimum or to the maximum for a woman?

[Laura_7]

The main thing I am worried about when I eventually go post op is my T levels. Would I still be able to have T within the maximum in the female range? Because every woman needs T in order to have an active lifestle, sexual life etc. How about you girls, what are your T levels after you go post op - it's closer to the minimum or to the maximum for a woman?

You might talk about it with your endo.
Its not only t its the mix.
A neovagina reacts to estrogen like a vagina.
So having estrogen levels in the menopausal range could lead to dryness and even some atrophy...

many endos strive for levels of estro of 200 pg/ml or above, and levels of testo below 60 ng/dl.
So its possible to raise estro levels to levels well in the female range, and see how people feel.
A small amount of testo is still produced by some glands.
Many people have sufficient levels for a good libido and an active lifestyle.
If levels of t are still too low its possible to add t for example via implants of gels.
There are low dose treatments specifically for menopausal woman for example, low dose implants.
Testo can help with libido in menopausal women, there are studies.
http://www.ncbi.nlm.nih.gov/pubmed/16014407
But it might be a good idea to raise estrogen levels first well into the female range, some people have menopausal estro levels, and see how people feel then.

Talk about all of it with an endo.

hugs

[Jenna Marie]

I don't know why you need T levels at the maximum end of the range to get those benefits? After all, the *whole* range was defined for cis women in terms of what is typical and necessary.

Mine is right in the middle of the range for cis women, and I have no problems with energy, sex drive/capability, or an "active lifestyle."

[Serenation]

Balanced hormones keep you healthy, you certainly don't need high testosterone to wake up have sex and go ride a bike.