Looking for opinions on GRS

[krone6]

Prefix
I'm currently going through my first letter for surgery and have been researching how to make my recovery the best and what to do to prepare for it, however at this point putting up a single thread and requesting opinions is best. I'm also juggling a decision between three different surgeons though am open to others. It's also worth reading on my situation so you have a better idea what I want and have come from. Smaller questions will be listed, though if you reply to a specific one it'd be helpful to know in your reply.

Background
I identify as a male with gender dysphoria/BIID (not officially diagnosed though therapist agrees) centered towards certain parts of my body; specifically body hair, adams apple, and genitals with the genitals being the focal point. I've already had my adams apple reduced and am getting electrolysis done per guidance of a transgender electrolysis who knows what hairs to take out and leave. Because of this I won't require estrogen, a name change, or to live as a female and will look the same on the outside to everyone. I'm going to be 24 soon and am 5'10" and stay around 125-130 pounds and am in the United States, employed and work from home. I've not banked sperm and have had no strong desire to find someone for a relationship as life has kept me busy enough. I'm also already socially satisfied though by 25 I'm sure I'll start looking, but we'll see. I'd rather just do whatever makes me happy which has worked very well in my life so far.

Outcome/goal
I place aesthetics as #1 followed by sensation and then depth. Since I am only romantically into women (just sexually into men) I don't expect to shove things other than dilators in me very often so somewhere around 5 inches is fine with me. For convenient reasons in the past my testicles have atrophied though are still in me due to no issues. I enjoy being on very low levels of testosterone and only take enough to counteract medical issues down the road, however I'm sure at some point I'll meet a girl who wants to have sex and am willing to raise my testosterone levels a bit for a weekend (if possible) so she's not left out which is why some sensation would be nice.

Questions
1: I hear having a foreskin helps with aesthetics and gives a more pink'ish look. Would regrowing one help in any way like I heard it does? My electrolysis says it would though am looking for opinions. I had a reference for the desired outcome and tagged it as NSFW though had it removed. You'll have to use your imagination on this part sadly.
2: I've had surgeons tell me if someone gets an orchiectomy or have atrophied testicles their scrotal skin will be less moist and pliable for surgery and manual stretching is recommended, however my electrolysis told me prothesis testicles would be enough to counteract these symptoms. What are everyone's thoughts on this? If I can automate something I will, though I'll only get prothesis if it'll help give my surgeon the best chance at making the recovery great.
3: For dumb reasons a long time ago I got a transcrotal and would love it reversed since hairs are in that hole, however doing so causes additional scarring. What's everyone's opinion on reversing this procedure? One idea I had is to get an orchiectomy with a single <5" incision down the midline of the scrotum, place prothesis in, and get the transcrotal fixed all in one surgery, though I'd like to make sure this is the best path long term and if all of this would even work.
4: This may be obvious, but I assume staying in shape will aid recovery, produce a better look, and heal faster? I read an ex-military at Suporn was up and about at 2 weeks whereas the rest at 3.
5: Is there anything else I may not be aware of that will give me the best chance of a good result? I already know no one really knows until after recovery, though there are things that assist in giving one a better shot such as not being overweight.
6: How do surgeons measure amount of skin; specifically the penis. Since the penis can atrophy due to no erections over time would I take my current length or old length? And would it be while erect or flaccid? This is to give me some comparison when people say "I only had 2 inches and got 6 inch depth" or "I had very little donor material and came out fine".
7: Some surgeons say electrolysis isn't needed while others recommend a small section. Even with these recommendations why do some people still get hair in the vagina such as some of Brassard's patients? since we're human getting every single hair on the first try with 100% accuracy seems very unlikely when we already know electrolysis can do that just fine as long as enough time's spent.
8: Since I'm not a typical case hormonal-wise how will this affect surgery? Many people that get GRS are transitioning from what I observe and resume taking estrogen after surgery. I, however, will not have extra estrogen in my body and just minimal testosterone.

Surgeons
1: What is everyone's opinion between Brassard and Suporn since I'm currently stuck between those two. Brassard is 4 hours flying from me and seems to have a great philosophy of only using what's needed and making things small and tidy with a smaller minora and larger majora and normal depth. Maybe it's the Thai culture, but Suporn seems obsessed with depth above all else I don't see why I' ever need more than 6 inches even if I were into men and they had huge penises. He also seems to focus on small majoras and large minors for the labia.
2: Dr. Chett is another one I might go with though what are the main advantages of him vs anyone else? I read there aren't many differences vs Suporn.
3: I've already had a consult with Marci Bowers and looked into some of the more wellknown American doctors though various things made me not to go with any such as waiting time. Besides being in the same country are there any main advantageous in terms of outcome for any of them vs anyone else that's well known?
4: Is Suporn's technique for the unique sensate organ really that good vs anyone else?
5: Do people normally require revisions for aesthetic reasons once things re healed? I read some things are not physically possible due to dilation breaking the skin like a fourchette.

These are all of the current questions I have though am expecting more once replies come in and I research more. If anyone is confused on any part please let me know and I'll answer as best I can.

[Jenna Marie]

My understanding is that it's the mucosal tissue of the foreskin that has that moist and "pink" look, and I do not think that can be recovered, even if the skin is stretched until there is the appearance of a foreskin again. In the pre-op picture, btw, the person did not appear circumcised, so that result was likely because of Brassard's urethral technique rather than foreskin.

I went to Brassard, and I am happy to answer any questions you have; my priorities were sensation and then aesthetics and then depth, and I was very happy. I was orgasmic 3 weeks post-op, and the aesthetics are good enough that a gynecologist testified for insurance purposes that I was cis (...then I had to get that straightened out!). Also, Brassard is used to working with circumcised people - he used the leftover mucosal tissue from the urethra to give me a pink and moist clitoral hood and inside portion of the inner labia, which is accurate in terms of what cis vulvas look like. My results look like that picture you've linked to in terms of pinkish color and approximate outcome, but I have a much smaller clit that is fully hooded (it's only barely visible if the hood is pulled back as far as possible) and I did not have the issue with inner labia fusing. Oh, and I had no electro and no issues with hair where there shouldn't be.

I was in very good shape at the time of surgery, and I do think it helped me bounce back faster, although I still tired easily for months afterward. I was also overweight, but because I was very fit, there were no issues.

Brassard measured the skin by stretching my penis to the fullest extent, so I assume it is the erect length at the time of surgery; it is worth noting, however, that when I went off HRT in preparation, my penis rebounded to its original size, so for me "original size" and "size at surgery" were the same.

[krone6]

My understanding is that it's the mucosal tissue of the foreskin that has that moist and "pink" look, and I do not think that can be recovered, even if the skin is stretched until there is the appearance of a foreskin again. In the pre-op picture, btw, the person did not appear circumcised, so that result was likely because of Brassard's urethral technique rather than foreskin.

[paragraph cut out]

Brassard measured the skin by stretching my penis to the fullest extent, so I assume it is the erect length at the time of surgery; it is worth noting, however, that when I went off HRT in preparation, my penis rebounded to its original size, so for me "original size" and "size at surgery" were the same.

EDIT: I just thought of this but do you think the outcome of the surgery will matter in any way if I'm not on high levels of estrogen like many would be? I've yet to find another person like me even though I shouldn't be that different.

Thank you for the reply and am glad you gained a similar result from Brassard. Since I'm still waiting for a reply from him do you think there'll be any benefit to regrowing the foreskin? As for the length at surgery do you have opinions if I should remain close to my old penile length at all? Of course these are questions I'll ask Brassard but am waiting on the first reply so things stay organized.

So far Brassard's looking like my choice and am hoping he doesn't require someone to live full time as a women or go on hormones considering my type of gender dysphoria. To everyone else if you have any information on the testicle prothesis please let me know.

[SorchaC]

Hi Krone,

One thing I'd start with saying is the more work you put into preparing the penis with surgery the more potential you have for something to go wrong before you ever get to SRS.

I had an orchi and was circumcised so really didn't help myself I suppose.    I was advised by one surgeon to stretch things manually and by another that he would insert an inflatable balloon to stretch the scrotum 3 months prior to SRS and that would help me. The concern both had was depth but you're not overly concerned by that so maybe you don't need to worry about what scars you have? Dr Chett decided the only good skin I had was the graft skin he was going to take but unlike you I'd been on estrogen for 7 years by this point and that clearly had an effect. I was also older and heavier than you.

One of the first questions Chett will ask you is what do you consider the most important in terms of outcome?

Maybe its the Thai culture, but Suporn seems obsessed with depth above all else I don't see why I' ever need more than 6 inches even if I were into men and they had huge penises. He also seems to focus on small majoras and large minors for the labia.

You've no doubt read here and other places the posts from people who are unhappy when they don't have what they consider to be proper depth. By nature Thais want to satisfy you when they perform a service or do work for you and I think this has led to them believing that what western patients value most is the right depth. I deal with them a fair bit in my work and tell people to be very clear in what you want. At the time I had my op Chett said I was the most difficult case he's had because of the lack of skin and I likely didn't help myself by telling him to just do the best he can. I got depth but maybe could have had a better aesthetic outcome but by his own admission he ran out of skin.

You're right that being fit and the right weight will help speed up your recovery but what will also help is the right attitude. I was unfit and overweight but I was ready to return to my hotel the next morning after my surgery although Chett likely would have shot me if I'd tried 

The technique used will also make a big difference. Suporn and Chett have a similar technique but that is non penile inversion where as Brassard and most other surgeons use penile inversion which gives a much quicker recovery time and a shorter surgery as well.

Before this post becomes a book I will end it here but I'll private message you with some more answers.

Hope that has helped.

Hugs

Sorcha 

[Jenna Marie]

I don't really know about estrogen levels; I was on very low doses of estrogen myself, but it was very effective for me, so I don't know whether that is helpful, either.

Sorry, I thought I was clear: I don't think regrowing the foreskin will be worthwhile, because the portion that is necessary is permanently removed by circumcision. There is no way to regain that original mucosal tissue.

As for the length, it is generally ideal to have the maximum amount of skin available, but I don't think you need to worry too much about length at surgery. The only woman I saw there who needed a skin graft to supplement her existing penile and scrotal skin said she was "less than 1" erect." Everyone who was larger/longer than that had very good results with no graft. Brassard's focus on adequate but not excessive depth probably plays into that; most people have plenty of donor skin for what he needs to use it for.

[krone6]

I don't really know about estrogen levels; I was on very low doses of estrogen myself, but it was very effective for me, so I don't know whether that is helpful, either.

Sorry, I thought I was clear: I don't think regrowing the foreskin will be worthwhile, because the portion that is necessary is permanently removed by circumcision. There is no way to regain that original mucosal tissue.

As for the length, it is generally ideal to have the maximum amount of skin available, but I don't think you need to worry too much about length at surgery. The only woman I saw there who needed a skin graft to supplement her existing penile and scrotal skin said she was "less than 1" erect." Everyone who was larger/longer than that had very good results with no graft. Brassard's focus on adequate but not excessive depth probably plays into that; most people have plenty of donor skin for what he needs to use it for.

Thank you for the follow-up. To make sure I understand, the amount of skin matters on the day of SRS so if someone's penis atrophies a couple inches then that'd mean a couple inches less of material?

To everyone else: I'm very curious on the orchiectomy/prothesis part. I'm not 100% sided that having prothesis testicles will take care of preventing my scrotal skin from drying up and becoming less pliable, though if it's true it seems like a worthwhile thing to do long term so I don't have to automate that myself. Overall I want to give the surgeon a good shot of things going smoothly since I get one shot.

[Jenna Marie]

Yes, it is the amount of skin you have on the day of GRS. However, that may be more than it seems, since the surgeon can stretch it quite a bit more than would be possible while it was still attached to a person who was able to complain! In other words, even the erect size does not translate directly into depth, much less anything else. It's not as straightforward as 6" erect = 6" depth or even 6" precisely of skin to use. Generally speaking, if you do go with Brassard, you would only need to be over about 2" erect to be sufficient for his purposes (and even that's rounding up to be generous). Plus he does have the option of a minimal skin graft if absolutely necessary. (He also uses the patch of skin that is removed where the vagina will be placed as a skin graft.)

Essentially, some of that atrophy, if it happens, is simply the skin tightening up in ways that are reversible once it's removed. I don't know of anyone who ended up under 2" on HRT who was of reasonable/average size to start with; that woman I referred to had just missed having a micropenis pre-HRT. So while there are no guarantees, if you are not tiny in that regard now, you would likely not have a shortage should you go on HRT and then choose Brassard.

[AnonyMs]

Hi Krone,

I'd recommend you read this thread

Orchiectomy or Vaginoplasty for non-transitioning people
https://www.susans.org/forums/index.php/topic,214355.msg1906385.html

It may be difficult to find a psych to write you letters for surgery, and then it might be difficult to find a surgeon anyway. I've seen a post elsewhere that indicates Brassard would do it, and there's a few other surgeons.

For Suporn scrotal skin is very important due to the way he uses it, and since you've done something there I think you'd need to ask them about that. I'd not do any further surgery there without asking them first as you may make it worse. Suporn gets a lot of depth but the main reason he developed his technique was aesthetics. Suporn's recovery time is double what you'd get from surgeons doing penile inversion - he says it himself.

This is about Suporn.
https://www.the-ress.net/files/SRS-With-Dr-Suporn-2015.pdf

It sounds like you know about the risk of osteoporosis if you do this and don't take some kind of HRT?

If you don't take estrogen you may get vaginal atrophy, which FTM's get when they take testosterone.

[krone6]

Hi Krone,

I'd recommend you read this thread

Orchiectomy or Vaginoplasty for non-transitioning people
https://www.susans.org/forums/index.php/topic,214355.msg1906385.html

It may be difficult to find a psych to write you letters for surgery, and then it might be difficult to find a surgeon anyway. I've seen a post elsewhere that indicates Brassard would do it, and there's a few other surgeons.

For Suporn scrotal skin is very important due to the way he uses it, and since you've done something there I think you'd need to ask them about that. I'd not do any further surgery there without asking them first as you may make it worse. Suporn gets a lot of depth but the main reason he developed his technique was aesthetics. Suporn's recovery time is double what you'd get from surgeons doing penile inversion - he says it himself.

This is about Suporn.
https://www.the-ress.net/files/SRS-With-Dr-Suporn-2015.pdf

It sounds like you know about the risk of osteoporosis if you do this and don't take some kind of HRT?

If you don't take estrogen you may get vaginal atrophy, which FTM's get when they take testosterone.

EDIT: No idea why there's so much space in the quote.

Thank you for the reply. I looked at the first link and very little related to my situation since it talks about people living as a female post op. Regarding psychologists/therapists for letters it isn't going to be an issue as I'm in the middle of obtaining my first one and will be referred by him to someone else to get a second. Until then all I can do is prepare and learn as much as I can so I don't make a hasty decision.

I already got a reply from Sophie regarding Suporn and am skeptical on what she says based on how she's treated people in the past. I doubt she actually talked to Suporn, however from what I read he seems to focus on depths over aesthetics and in many cases use every single piece of skin even if it's too much and require followups (plane tickets are EXPENSIVE to Thailand). Is it just what I've observed, or is he known for doing this? There's just something that seems to give me a bad taste when I think of Suporn even though I read he's quality and I have no idea what it is yet. I've also already read that entire PDF earlier this week and has helped a lot. Too bad there's nothing similar and as long on other major surgeons recently.

As for your last part I'll have to ask some surgeons about this since my therapist or family doctor would know. Until now everything else was at worst a set back and nothing more. I didn't find much researching similar people with GRS so do you think it's possible to be on enough estrogen to counteract it without feminization features? I'm open to go on higher amounts of testosterone if I must, though I really, really don't want to go back to my old self. Just imagining me being at the level I was makes me want to cry in some cases since all I thought about was sex and porn. I feel much more free now.

[AnonyMs]

Thank you for the reply. I looked at the first link and very little related to my situation since it talks about people living as a female post op.

Not sure we're talking about the same link, as it's about people who have surgery and living as men post-op, and one poster is non-binary. Doesn't really matter if you're about to get letters.

As for your last part I'll have to ask some surgeons about this since my therapist or family doctor would know. Until now everything else was at worst a set back and nothing more. I didn't find much researching similar people with GRS so do you think it's possible to be on enough estrogen to counteract it without feminization features? I'm open to go on higher amounts of testosterone if I must, though I really, really don't want to go back to my old self. Just imagining me being at the level I was makes me want to cry in some cases since all I thought about was sex and porn. I feel much more free now.

I'm not clear on what you're saying here. You can search on vaginal atrophy for FTM, its well known - I believe it makes sex difficult and leads to bleeding. I don't know too much about it as its not my situation. I doubt you'll find any posts on having SRS and taking testosterone instead of estrogen, or low levels of estrogen. There's almost no posts about doing that at all, let alone the details. There's an often quoted scientific study that shows the skin of the post-op vagina changes to be like cis-female, but that may well be because of the influence of estrogen.

I'll pm you something about Suporn.

[krone6]

[Post redacted per user request] - Seems I'll just have to get my 15 posts to be able to reply to my PMs. To anyone that has helped me so far I thank you for the assistance while some of these questions are answered. It will take time and luckily I'm still young enough it doesn't matter too much, though any reply will definitely help as there are still so many questions I don't have answers to and emails from the three surgeons on my list take time to come in.

[krone6]

Hey all, just letting everyone know I have had all of the original post's questions answered since I last posted and have chosen Suporn as my surgeon. At this point I'm working on my letter and finances before making an appointment with Suporn.

Thank you again for the help.

EDIT: Is it not possible to edit the original post? I was going to put [solved] before it to let people know.

[karenpayneoregon]

My surgery was done by Marci Bowers, had to wait 12 months and was well worth the wait. Marci is a fantastic surgeon and human being.

From performing so many surgeries her and the team make the entire process smooth and relatively painless from zero pain from the time I woke up after surgery until returning home two weeks later. Her team has arrangements with a local hotel were the staff have experience with post-op patients and will bend over backwards for you as they did for me.

My reasons for using Marci were, she works in the United States, has great resources in the event anything goes wrong at the hospital and even after leaving the hospital while still in town (and she provides her personal cell too).

Can't say she is the best because one can only go off their one time surgery but can say I never had problems, have expected sensations below and the trac shave was done perfectly. After two years I can honestly say there are no telltale signs of scares on both surgery sites.   

Of course with the wait time the other downside is her cost, I paid in cash as my insurance did not cover the surgeries. Just under 30,000 for both surgeries, airfare and hotel fees is not easy for many to come up with. It took me two years to save money up for this.