Hey, someone else like me!
I'm also an AMAB enby. My identity is androgyne, somewhere slightly fem-of-center on the male-female spectrum if that makes sense. "Hermaphrodite" does pretty succinctly describe my GCS goals as well, but it's not been an easy path. (Also, some people object to use of the term, since it has been used as an anti-intersex slur, so I tend not to use it.)
I'll share what I've been able to find out, which isn't much, sadly.
Starting on the most positive note, HRT is definitely possible. I started mine by informed consent, in the Bible Belt, so even if you can't get a doc to write a letter for you, you could try the same (although a parent would probably have to cosign if you are still a minor). In fact, I usually recommend doing so to newly-transitioning folks who are certain of their status as transgender, since gatekeeping is nonsense.
As for GCS...
Yeah, I want a vagina, and I want to keep my penis. Orchiectomy, I could go either way on. I don't have much dysphoria about the appearance/feeling, but hell if I want anything to do with testosterone ever again.
Actually, I'd probably at least
consider any result that wasn't exclusively male or exclusively female, but that's what it would look like ideally.
To forestall
some of the "But you can't!" responses that inevitably follow that:
- Yes, I know that most vaginoplasty techniques in use today use the penile inversion technique. Obviously, I am looking for something else.
- Yes, there are other procedures that, to a layperson like myself, are at least sound enough that I'd like to have a serious discussion about them with an actual surgeon before ruling them out. (I'll get into that below.)
- Yes, I know this is a big ask, and it might turn out that after an epic search that every option is infeasible, or that there might not be any surgeon willing to perform a procedure, or that there might be complications with the procedure, or that the results might not have the appearance and/or function that I want... etc. Basically, I am gathering information, and I am a lot more interested in collecting and looking into possibilities than I am in hearing why something is impossible, unlikely, difficult, risky, expensive, etc. It's very likely I've heard it before. After I feel I've learned everything I can, I'll weigh those things and figure out what's best for me, even if what's best is doing nothing.
- I can assure you I'm not rushing into anything. I'm very settled in my identity. I'm sure that this is what I'd want if it were feasible and "only" as hard to get as "traditional" GCS. I'm trying to do this "right". I've spoken with my doctors about this at length. Each of them is supportive of my goal, and I've gone through an altogether-too-lengthy evaluation process to get cleared for surgery. The only roadblock left is that they haven't been able to help me find any provider to consult with.
As for the procedures that
might be possible...
Some are techniques used to treat vaginal agenesis in cis women, such as the Vecchetti and McIndoe procedures.
Some are older or less popular forms of GCS, such as a colon graft.
And there's a fairly new technique for GCS that uses the peritoneum for material.
Unfortunately, the usual response I get from doctors is that they aren't sure how these could be applied, aren't interested in developing any such technique, aren't interested in talking about it, and that they don't know any doctor who might be interested, nor any patient who's had it done. My doctors and my insurance have also made inquiries on my behalf, to no avail.
The end result is I spent a couple years doing research on my own intermittently, and working with my insurance for the past year and a half or so, and I've still got no answers with any medical credibility behind them. More recently, I've been looking to hire a patient advocate to help with the search, since it's become a fairly stressful and disappointing process, but it's been slow going trying to find an advocate willing to so so.
So, that's about the size of it. So far, no surgeon's office wants to talk about it, even to give a detailed answer about why a particular technique might not be possible. Frustrating really doesn't cover it.
Sorry I can't give better news.
Good luck in your transition, whatever form it might take.
~D
(They/them)
