Please...help me figure all of this out. I can't move forward without you.

[Azurefrost]

Over a year and a half ago, I started the process of transitioning by undergoing hormone replacement therapy. It was a horribly long and difficult journey, but everything has turned out so much better than I could have possibly imagined. I never thought it possible, but I'm now a gorgeous young woman with friends, a relationship, and a promising career. It's more than anyone could ask for, yet I'm falling apart... For the longest time, I thought I'd never need to undergo SRS to be happy, but now I can't keep it off my mind! I keep suffering intense emotional attacks when I think about it, my parts feel more incorrect than they ever have in my life, and even my dreams now have a different anatomy. I hate it! No matter how many excuses I make for why I shouldn't get it, the emotions DO NOT GO AWAY.

Look, I've -tried- to do research into it, but every time I do, I'm overcome with horrid feelings that make me want to throw up. I'm willing to accept that maybe I do need it after all, but I seriously need help to move forward. Please, I'm desperate over this and I'm praying at least one kind soul can help me get over this final hump! If someone can compile the information I need here, I may be able to handle the rest myself. I just need someone to make it easy for me right at this moment. Just spare the anecdotes and miracles, I JUST need the facts. Nothing more nothing less...

• I want to know who the best surgeons are. Money is no object as far as this surgery is concerned. This is way to important to not be willing to invest in my happiness.
• I want to see real examples...not those pictures of intersex reconstructive surgery that are often used to sell results that are unrealistic. I don't expect a porn star vagina, but I at least want people to be able to look and say, "yup, that looks like an ordinary vagina".
• I want to know what the limitations are. Don't sugar coat it for me. Is the tissue inside soft? Is it even remotely comparable to the real thing? Is the clit always oversized? Can they build up the proper tissue on the outside? Is scrotal tissue that close to labia tissue? Will I and others truly believe I have a vagina?

And thank you for anyone who is willing to help me. It truly means the world to me right now.

Edit: Because I know it's relevant, here is my biographical information...
-128 lbs
-Healthy and active
-Age 24
-No major health problems
-Circumcised
-White (since I heard something about Tai surgeons not being that great for westerners)

[karenpayneoregon]

I was in your shoes many years ago and simply search the web for a surgeon, looked at many, kept coming back to Marci Bowers. When I could not continue in (then) my body contacted Marci's office knowing around what it would cost.

I should mention, in my searching for a surgeon I was parcel to surgeons in the United States, did not want to travel to another country. I decided to pay in cash no matter the cost and did from funds I saved up over three years time.

I was told Marci was one year out, I said sign me up. Fast forward, went under the knife with Marci, surgery lasted five to six hours. Woke up several hours later with no pain. Marci came in about an hour later, examined me and had to put one stich in. The nurses and my close friend said my vagina looked like a normal female. Looking back to be honest it did not to me but a month down the road it did and was very happy with the results.
Spent one week in the hospital, great staff who are well versed with post-op patients. Spent the next week in a nice hotel (kitchen, huge bed room and living room) which Marci's staff recommended and for good reasons, the staff were educated with post-op's.

Some details, I forget exactly when I could orgasm, about six months' post-op but had sensations one month after surgery. At least for me I need some lubrication for intercourse but have done this without also.
Total cost was 30,000 for trachea shave, bottom surgery, hotel, airfare, going out with friends to dinner while in California (two flew down, one lived there).

In conclusion, Marci did a fantastic job, zero regrets.

[warlockmaker]

Hi Azurefrost, I will try and help you as much as possible. Please read my former post My Wonderful Surgeries at PAI and get some idea.

I will address your needs point by point.

1. Honestly the best place to have SRS is in Thailand' I have done a lot of research prior to my surgeries' I am exceptionally well off and could afford any surgeons and anywhere. Some points that I have noticed in this Forum is that any of us who had a good SRS will stand strongly by their surgeon. Some here receive commissions for referrals also.

The surgery over the recent years has developed into a vanilla surgery , meaning that its not rocket science. Thus, practice makes perfect. I would never consider a surgeon that has not done at least 500 SRS and that does more than 150 a year. Most that I know have done 3,000 or more. This amount of surgeries gives us an opportunity to see what negative comments have been made.

There will be arguments in this forum as who is the best and then a heavy heated discussion in the unique techniques for their surgeon of choice. My view is that the surgeons all opt for the best outcome and if there is some minor new technique that benefits their patients, they will copy it. The Thai surgeons are geared towards Western clients and most of their clients come from the west' It is not true that they have problems with western bodies. And of course the service and care is the best. Private nurses cost about 60USD for 24 hours and I highly recommend this.

I have personally seen the results from Dr Suporn, Dr Chettawut, Dr Kamoil an the Doctors at PAI - Dr Burin aand Dr Sutin. I have looked at pics of the USA surgeons and European. I can ask girls to discuss with you their experience with Dr Suporn, Dr Chettawut and the PAI surgeons. I will discard Dr Kamoil at this junction as I am aware of certain issues which I cannot accept.

1. The surgeons below have the best results aesthetically, great sensation and depth allows you to have sex fully and have orgasms as a cis female. The below is not in order of the best:

My concerns about each have been expressed in my other postings. Their techniques despite all the postings are similar.

Dr Suporn greatest drawback is that he has been too commercial and money minded. He has a long wait but you can jump to the wait with paying a premium. His surgeries take 7 hours, I'm not sure why but his hospital is not a 5 star hospital. You may wish to speak with Anony on his selection of Suporn. She is a fan of him.

Dr Chettawwut greatest drawback is that he does it in his clinic and has limited staff but his work and bedside manners are wonderful. His surgery takes 6 plus hours. I can refer a few girls for you to chat with.

Dr Burin and Dr Sutin do not have the issues above. I am a Sutin girl and I am thrilled with my results. I had 3 surgeries done at one time and only PAI had the Drs of quality as a team to do this. I can send you pics by e mail. The hospital is 5 star and the SRS took 3 hours.

2. Let me know who you would like to have a chat with. Remember each post SRS patients also did extensive research.

3. Limitations. Honestly there is none. Your aesthetics will look just like a cis female and you should have the most incredible orgasms when compared to orgasms as a male.

You may need to have corrective surgery a year later to make the aesthetic wonderful. A year is needed because you need to dilate. Some minor changes are done under local anesthetic. The common ones are, to balance the inner labia and clitoris hood which may have been unbalanced due to swelling after surgery. I will have the inner labia attach lower to the opening which no doctor will do immediately after surgery because of dilating.

All surgeon's will use penile skin and in the sensate areas. Depending on the skin available they can even give you options on the size of the inner labia.

Honestly, the dilation can become very inconvenient and tiresome. Thaat is the single biggest drawback in the first year.


You are young and not overweight and should have no problems with choosing one of the above. Like all surgeries we all have different reactions. Generally with great experience they measure out all the cuts so everything is balanced. But swelling can distort the outcome. So the less time under General Anesthetic the better. Its also is better for faster recovery.

[Ms Grace]

Hi there, I can't help directly with your questions. But what I would ask you is "what changed?" You said you were in a good place but now this has, by your own description, become a distressing obsession.

Can I presume that you moved from feeling that you didn't want/need surgery to now feeling that you do but feel that it will come at some kind of cost? All major surgery does of course - financial, physical and even emotional/psychological.

It may benefit you, while you are seeking the answers to those other questions, to consider what your fears are about "the op" vs not going through with "the op".

I'll be quite blunt...surgery can be a great positive but it is not a "cure" per se and if you are having concerns about who you are and your gender identity/presentation then surgery may not necessarily address those concerns. It might of course. The real variable is you.

It sounds like you are feeling a bit distressed at the moment, do talking to a counsellor about the issues, while not giving you hard facts, could help you sort out your perspective and feelings on things.

[2cherry]

I want to know who the best surgeons are. Money is no object as far as this surgery is concerned. This is way to important to not be willing to invest in my happiness.

Most surgeons you will read about have done hundreds of sex changes. This isn't the eighties.  It's pretty standard these days to perform one of three well known techniques: penile inversion, penile inversion plus grafts, colon. Usually the surgeon decides based upon how much material you have down there. Some surgeons have a personal technique, which are variations of the penile inversion and penile inversion with grafts/flaps. Some surgeons make a g-spot, others perfected the labia minor. You could make a list of what you want, and then look for a surgeon who can grant your wish. Is depth important? is sensitivity important? that kind of questions. Western surgeons are more conservative: they follow well known/tested techniques. In other countries, there are surgeon who can take risks because there isn't any regulation. So they can experiment, and develop different variations. Some Western surgeons frown upon techniques done in Thailand, especially the follicle scraping of the skin because they fear that the skin becomes too thin leading to more possible complications (fistula's, punctured holes).

I want to see real examples...not those pictures of intersex reconstructive surgery that are often used to sell results that are unrealistic. I don't expect a porn star vagina, but I at least want people to be able to look and say, "yup, that looks like an ordinary vagina".

There are websites like transbucket which hosts photographs of real V's from people like us.

Is the tissue inside soft?

Yes. Feels the same as a cis-vagina. Warm and soft.

Is it even remotely comparable to the real thing?

About 80-90% identical.

Is the clit always oversized?

I asked specifically to make it as small as possible.

Can they build up the proper tissue on the outside?

Yes. But ask examples of how the labia minor is constructed. Sometimes they close the labia minor, making it almond shape with the pee hole in the center. It still looks like a V, but upon close inspection and with some anatomy in mind, it doesn't look the same.

Is scrotal tissue that close to labia tissue?

Outer labia are identical. The inner/smaller labia and clit hood are best made from penile skin. (foreskin)

Will I and others truly believe I have a vagina?

Yes. A guy I dated, gave me head and he never noticed anything.

[SadieBlake]

I also didn't believe I'd need GCS, first for 20 years when I also felt I would get by without estrogen therapy. Well that worked well enough for a while and yet depression slowly crept back and by the time I stopped denying I was dealing with depression again, I was feeling suicidal fairly regularly.

Anyhow skip to a year ago I'd started HRT and because I was certain I might need to proceed to GCS I started putting the ducks in a row - making transition official at work, starting electrolysis etc.

What surprised me was how much hormones added to my genital dysphoria. I was absolutely happier with how my brain worked and equally less happy with my body.

My letters are written or being drafted, I'm supposed to have a surgery date email in the next few days and will have passed the last WPATH hurdle in 23 days. In 6 months I expect to be post op and mostly healed from surgery.

I commend you to proceed; talk with your partner, clarify your own thinking with a therapist and maybe just sit with the decision.

As to which doc, on the face of it I wouldn't personally split hairs between Bowers, Satterwhite and his newly trained surgeon Wittenberg. They're all doing essentially the same method and my understanding is the a acknowledge learning from each other. I would have gone with Marci but for the 3 year timing and exorbitant fee for a consultation. Satterwhite is now booked out nearly a year and so Wittenberg is my choice. I'm lucky to be well hung and therefore have adequate material for construction of 6-7" of depth using the pi technique, if that weren't so I'd be thinking about Thai surgeons using skin grafts for material however their longer recovery times are a concern and as US surgeons are covered by my insurance, cost is also a consideration; I'd have to sell my house to do it in Thailand or Canada.

[AnonyMs]

I don't think you're going to get the answer you're after. There's no consensus about who's best, even among people who you'd think would know.

I've seen a fair number of post-op results over the years of searching on Internet and there's a big mismatch between what I've seen and what people say about surgeons. I can't understand it.

You'll generally find positive and negative posts about all surgeons. You can't simply pick from that.

If you look at Warlockmaker's posts you'll see that she went to unusual and impressive lengths to select a surgeon. I've never heard of anyone else doing what she did. Here's the post she referenced, but its well worth looking at others.

My wonderful surgeries SRS, BA and FFS at PAI Bangkok
https://www.susans.org/forums/index.php?topic=204651.0

The difficulty for me is there's so few other posts about PAI that its difficult to get any impression of their work apart from what Warlockmaker posted.

Personally I'd choose Suporn. There's not much I could say about him that hasn't been said before. You can find heaps of posts about him, and a number of post-op photo's. There's a pdf about SRS with him here.

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

[Sophia Sage]

• I want to know who the best surgeons are. Money is no object as far as this surgery is concerned. This is way to important to not be willing to invest in my happiness.
• I want to see real examples...not those pictures of intersex reconstructive surgery that are often used to sell results that are unrealistic. I don't expect a porn star vagina, but I at least want people to be able to look and say, "yup, that looks like an ordinary vagina".
• I want to know what the limitations are. Don't sugar coat it for me. Is the tissue inside soft? Is it even remotely comparable to the real thing? Is the clit always oversized? Can they build up the proper tissue on the outside? Is scrotal tissue that close to labia tissue? Will I and others truly believe I have a vagina?

As far as due diligence goes, you will want to consult with Suporn, Chettawut, and Meltzer at the very least.  They are all at the top of their game, and their work (after all stages, revisions, and healing is complete) will typically pass with a gynecologist if you don't say otherwise (and assuming you also pass otherwise with your face and voice and social skills). They will think you've had a total hysterectomy.   Yes, find pictures... but also ask some electrologists, those who work in the T community and have to tidy up hair down there after the fact, they probably see more results than most people. 

Now, limitations -- I was shocked at how smooth I felt inside upon my first dilation, and how soft everything has become.  It's just amazing how my vagina feels like, well, a vagina.  I've had post-op sex without disclosing my narrative with a dozen-some partners, and no questions asked.  Great sex, great orgasms, yadda yadda.

That said, I know there are anatomical differences.  First, you won't have a cervix, hence the assumption of a hysterectomy (and if you ever have a tummy tuck you'll finally have the right scar for that, too.).  Second, it's very difficult to make a clitoral hood that's distinguished from the inner labia, the latter of which are supposed to extend out from the clitoral frenulum, the most difficult structure to create imo, aesthetically speaking.  Third, you probably won't be able to stretch enough to be fisted, if you're into that sort of thing. 

The other major difference is typically how wet you won't get without exogenous lube (though this isn't always the case, ymmv), but again this is also a problem other women also have to deal with, and can be dealt with in the same way that other dry women deal with it -- either apply ahead of time (get something flavorless), insist on cunnilingus, or both (hence the flavorless, with salt added to taste). 

On the other hand, there's an incredible amount of variation in female anatomy -- google "the Great Wall of Vagina," which is an art installation of hundreds of different vaginas.  Some women have "porn" vaginas, some have almost no labia minora at all and others have great big folds, some have no visible clits and others have fat ones, some have short vaginas and some have long vaginas.  (A lot of women are self-conscious about theirs not looking "right" btw, so this is normal.) 

As always, results can vary. It certainly helps to be in good fit shape, as this helps keeps swelling at bay, though again bodies vary.  And finally, the more material you have to work with, the better, so even if it makes you dysphoric, do what it takes to avoid permanent shrinkage. 

No one is going to question your vagina if you don't, and again assuming that everything else in your presentation aligns with expectations for female gendering, which in this day and age also takes (usually) narrative discretion.

All my best,
Sophie

[Dena]

My surgery is a very old version 1.0 and I had some questions about it. I was communicating with another member about it and she suggested two surgeons. One was in the UK and she used him for a Version 2.0 upgrade. The other was Meltzer who is within 30 miles from me. Through an internet search I was able to answer my questions but for other reasons I was able to meet Meltzer and he would be very high on my list to see for any of the surgeries that he preforms. He has had years of experience and is very easy to get along with.

As money isn't a limitation, you should visit with each surgeon you are considering. That will tell you what each can do with what you have and get to know the surgeons. This was an advantage I didn't have but anyone considering more than one surgeon should interview each surgeon under consideration.