Susan's Place Transgender Resources

Hello everyone, I am new to this forum. I am on the process of starting HRT but I have some thoughts on SRS. Many women report that they lose their sex drive after the surgery. Also I have seen women after SRS who look neither male nor female. They look like they don't have gender. Many pre-op women look completely passable and you can never say they are transgender unless you see them nude. Even when we are on estrogen, our testicles produce some amount of T which is needed for every woman, also progesterone and other hormones. In my opinion the only benefit of having the surgery is psychological that you have the "right" genitals and you feel alright. But in terms of health issues I think it brings many disadvantages. Unless the science advance to the degree when ovaries can be transplanted, vagina to be formed by the human body itself, and the penis can be reverted and shrinked to the point of female clitoris, real SRS can not be done. These are just my thoughts of course. I have read a lot, but there is a lot more articles and projects I have to read. Can anyone who is more competent give his opinion.

I have researched SRS, and my observations and conclusions are a bit different. I do not believe that SRS influences passability, other than to eliminate the gonads which is the primary producer of testosterone (testosterone is also produced in the adrenal glands), which eliminates the need for high doses of estrogen, so that would be something that promotes female secondary characteristics. Physical passability is dependent on a number of variables, including, but not limited to the following; how masculine a face and body is when starting HRT, age (HRT efficacy is greatest the closer one is to their pubertal age, and diminishes over time), genetics, length of time on HRT, and whether one has face and body feminization surgeries, or not .

There is no "we". Some do, some don't.

It also nothing to do with how you look. I look like a man and I'm considering it. You'd never be able to guess I'm trans if you met me.

Quote from: jessicats on March 28, 2016, 11:15:08 AM
In my opinion the only benefit of having the surgery is psychological that you have the "right" genitals and you feel alright.

Well yes, but being trans is psychological so its a pretty massive benefit. Live saving for many.

Quote from: jessicats on March 28, 2016, 11:15:08 AM
But in terms of health issues I think it brings many disadvantages. Unless the science advance to the degree when ovaries can be transplanted, vagina to be formed by the human body itself, and the penis can be reverted and shrinked to the point of female clitoris, real SRS can not be done.

That's clearly not correct as so many transwomen are helped greatly by having SRS. Sure it would be even better if you could end up having a baby afterwards, but its vastly better than not doing it. I think the evidence speaks for itself on this.

Many of us have had the surgery knowing full well that we may never have a sexual encounter again. How powerful is that for motivation? It just shows how severe some of us feel about feeling completely female or male regardless of our future life. For some of us it is life or death. It really boils down to that. So, no, you may not need the surgery and I do hope you can manage without it. It does have health implications. There are no guarantees.

Well in my case I suffered from transsexualism.  Only one cure for that and it's SRS.  It worked!
Did not care if I was an ugly woman as long as I was a woman, body and soul.

Yes sex drive is in no way the same prior to SRS.  But honestly I have not missed it.  Often you are so distracted during intercourse with the 'WOW' feeling that you forget you too are supposed to finish.

One can argue many points over the merits of SRS but gaining the ability to experience vaginal intercourse with a man/person, is truly the biggest gift I have ever received.

Thank you,
Anne

EOM

Its a transgender spectrum.
There are hints to a biological connection of being transgender. There are differences in brains of women and men so there can be a mismatch, in different severities. So imo thats why there is a transgender spectrum.

There are people who are socially dysphoric, they like to be perceived as women.
And there are people who are physically dysphoric.

Well being penetrated is also a psychological thing.
Many people are orgasmic after SRS so they like it. The prostate is usually left in place, making for a pleasurable Gspot. This Gspot is connected via a secon neuronal pathway so seperate from the clit. So it should be there regardless of an outcome of the clit.

After SRS some hormones and transmitter substances fall away.
But after SRS people are not menopausal women, they should keep their hormone levels well in the female range.
With a normal hrt many endos strive for blood levels of 200 pg/ml or above. If after SRS hormone levels are greatly reduced levels may fall to menopausal levels. This can have an influence on mood and sex drive.
It can also have an influence on the neovagina. The neovagina reacts to estrogen like a cis vagina. So with too low levels there might even be some atrophy.

There are endos who also watch for a mix of estrogen, bioidentical progesterone and also testosterone in the female range.
If estrogen levels are high enough and there is still fatigue or low sex drive some endos give very low doses of testosterone.
There are studies showing in menopausal women it helps.
http://www.ncbi.nlm.nih.gov/pubmed/16014407
With levels still in the female range for testo, below 60 ng/dl.

This is simply what experenced endos do. Many endos and people after SRS do not know this so discussing it with an endo can be important. There are thanking letters to endos from people after SRS who had full vaginal function and much higher drive and less fatigue and they also looked younger after restoring female levels.

There are also studies showing with the presence of estrogen a neovagina can turn into a mucosa over time.
https://www.susans.org/forums/index.php/topic,149304.msg1682002.html#msg1682002


This all can take some getting used to.
I'd say take your time ... look up a few timelines ... look up a few descriptions of people who had SRS, and why ...
and try to get a feeling for what you would like ...

oh and hello and welcome  :)


*hugs*

Personally, I have a lot of physical issues 'down stairs' including one necessary surgery whose post-op recovery time mirrored how I've seen post-op SRS describes. And that problem never fully goes away as long as those particular organs exists, so losing them honestly sounds like it would be a blessing.

I also have other non-physical issues in regards to sex (a lot of them are dysphoria related) so the possibility of never having physical sex again doesn't sound like much of a loss. I can still be intimate without physicality and that's enough for me.

This is just my situation, if course. You'll have to weigh in on yout own to decide if it's worth it for you.

jessicats,

Interesting question. I am still pretty early in my journey. If I did not have other concerns(family, age), I would be looking for the same information but on the side of the aisle thinking we would want it.

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Welcome to Susan's. Look around, continue to ask questions and join in. Hope you find what you are looking for.

With warmth,

Joanna

Welcome to the forum!

I can't see how surgery would have any bearing on passability.

At any rate I look at GRS this way, if you need it you need it; if you don't need it you don't need it. Notwithstanding those who feel they need it and can't for any number of reasons, it is a personal choice.

I'd see how things go for your transition. You say you're about to start HRT. Give it a year or two before you start thinking about the GRS option and see where your need is then. :)

It is a really great question that have thought about also. Now I'm very new to the process (5 weeks HRT) so I don't know exactly what kind of woman I will become over time, just as with any girl going through puberty. But as of today I still feel I won't GRS. I am definitely getting an orchiectomy the second a doctor says I can. Now I believe that will alleviate my dysforia and I guess I base that on an absolute need to have the orchiectomy performed to the point where I would probably end up being one of those desperate women who tries it themselves. Like the need is that strong (I have a great healthcare team at the Fenway in Boston so don't worry I'm not going to do that. lol) but I don't really have that same NEED for full GRS. I think there are several factors, such as there is full transgender spectrum and it's okay no matter where you land or in what ways you would find your body aesthetically pleasing. Also for me age is a bit of a factor I guess. I am only 42 but it really does seem like such a physically traumatic surgery and quite frankly the recovery scares me. I think if I were younger maybe I would feel differently as there would be that chance to live my entire adult life as woman with the matching genitals. Having said all that I still think about it more and more each day. I just don't think I know for sure the answer to that question because I believe I will continue to grow and change and there may come a time when the surgery recovery seems that bad.

Sorry, super rambley response but it is definitely something I think about a lot. Thanks for the interesting discussion.

Quote from: Briezy on March 28, 2016, 04:48:43 PM
It is a really great question that have thought about also. Now I'm very new to the process (5 weeks HRT) so I don't know exactly what kind of woman I will become over time, just as with any girl going through puberty. But as of today I still feel I won't GRS. I am definitely getting an orchiectomy the second a doctor says I can. Now I believe that will alleviate my dysforia and I guess I base that on an absolute need to have the orchiectomy performed to the point where I would probably end up being one of those desperate women who tries it themselves. Like the need is that strong (I have a great healthcare team at the Fenway in Boston so don't worry I'm not going to do that. lol) but I don't really have that same NEED for full GRS. I think there are several factors, such as there is full transgender spectrum and it's okay no matter where you land or in what ways you would find your body aesthetically pleasing. Also for me age is a bit of a factor I guess. I am only 42 but it really does seem like such a physically traumatic surgery and quite frankly the recovery scares me. I think if I were younger maybe I would feel differently as there would be that chance to live my entire adult life as woman with the matching genitals. Having said all that I still think about it more and more each day. I just don't think I know for sure the answer to that question because I believe I will continue to grow and change and there may come a time when the surgery recovery seems that bad.

Sorry, super rambley response but it is definitely something I think about a lot. Thanks for the interesting discussion.

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*

Well, that's a good question.
Situation varies for different people, and, for me, I would have SRS if I would have chance in the future. It's the best way to "be myself", I think.

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As each of our needs are individual, there is no 'need/no need' decision beyond what the individual desires.  I have taken the time to research GCS and will elect to have the procedure in a few years.  Not everyone does and I respect their decision to forgo.

My view of sex is take it or leave it really already.  HRT and the chemical changes it brings about have a bigger impact on libido than GCS by account of anyone I have spoken with that are post.  I have a couple of sisters that lost interest in sex post-op, but not because of the surgery itself.  They had minor complications that made intercourse...complicated and they opted to skip out on it while things were worked out.

ALL I can say is that I've thought about it all my life. I'm very envious of those who've accomplished it.

Hi Jessicats and welcome to Susan'


Transmedicine is an interesting and complicated field. It can be very confusing and there are a lot of 'armchair experts'. Most of us of course!

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.

Testosterone is produced in natal females and trans females by the adrenal glands and women do need testosterone for a healthy libido etc. Our endocrinologists also work with us to make sure we are hormonally safe. If need be we can get a shot of Testosterone to increase our levels to a normal female range, just as post menopausal women do if they need it.

I'm not sure what you mean by true SRS. Sure I cannot have ovaries, a uterus, or fallopian tubes etc, but I can have a very good replica of a vagina, and the good surgeons do a pretty awesome job on the clitoris.

Of course there is no reason to have GCS if you do not want it. Physical transformation has little to do with gender identification. The largest sex organ we have is between our ears and that is where gender is rooted.

No one can change our brains to match our bodies. But they can match our bodies to our brains. For most of us that is what we seek.

When we do align our bodies to our brain, and we deal with our social issues, we end up pretty damn happy.

I know I did!

Quote from: jessicats on March 28, 2016, 11:15:08 AM
Many women report that they lose their sex drive after the surgery.

If you are thinking of testosterone as the main hormone for sex drive, two things:

1) on HRT, you are taking estrogen and usually an anti-androgen. Both of these will reduce testosterone to castrate levels, similar to if you were post-SRS. So, why would sex drive be any different after SRS if before, you also reduced T levels to castrate levels. Chemical castration is the same as actual castration.
2) Estrogen affects libido, TRUST me! Many women in this board will also attest to this as enough of it will actually improve libido. It's not all about testosterone!

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

"estrogen deficiency results in a spectrum of symptoms. These include loss of fertility and libido in both males and females"

Hormones and Behavior
Volume 9, Issue 3, December 1977, Pages 228–248

"Treatment with DHTP had no influence on any aspect of proceptivity measured, in comparison to the NORX condition, whereas El or TP treatment augmented the frequencies of two of the proceptive behaviors and EB increased all three."

In other words, giving EB (estradiol benzoate) to female monkeys (our close relatives, of the same family of primates) increased female's courting behavior with males the MOST compared to testosterone, estrone (a weaker estrogen) or DHT that did nothing suggesting that T affects sexual awakening/interest by converting to E.

Also,
"The response of the male toward the female was influenced by the female's hormonal condition. Treatment with TP or DHTP did not increase the frequency of male contact or the mount rate in comparison to the NORX condition, whereas EB or El treatment did."

Which means males were more interested when females had E in their system.

3) progesterone in some women stimulates libido.

QuoteAlso I have seen women after SRS who look neither male nor female. They look like they don't have gender. Many pre-op women look completely passable and you can never say they are transgender unless you see them nude.

Nothing to with being post-op or pre-op but rather depends on the individual's circumstances.

QuoteEven when we are on estrogen, our testicles produce some amount of T which is needed for every woman, also progesterone and other hormones.

The amount of progesterone in males is VERY low, is negligible. Pre-op and post-op, some women take progesterone, getting much higher levels in the blood, which sometimes helps with mood, skin/hair, fat distribution, breasts. 

Estrogen reduces testicular production of sex hormones so the more E you have, the less testicles produce. If you take enough E and an anti-androgen, testicles will stop producing anything and it will be the same as post-op. No difference.

QuoteIn my opinion the only benefit of having the surgery is psychological that you have the "right" genitals and you feel alright.

This is a huge benefit! On so many levels. Going to the beach, feeling better in your body, complete (for some women), being able to have sex with men (for some women). If you choose to keep it, then that's fine too. But, hormonally, there is no difference. Unless you take lower doses of E and anti-androgens such that you allow testicles to keep producing some T but you can also take some T post-op. I believe if you have enough E (and sometimes P), you will be fine and feel ok.

QuoteBut in terms of health issues I think it brings many disadvantages.

What are the health issues? The operation is straightforward these days, surgeons have acquired an expertise, risk of complications is very small. Post-op, you take estrogen (and maybe progesterone), same as pre-op. Same level of T.

Quotereal SRS can not be done.

My vagina looks like a vagina, can't tell it apart from a woman's. Works great, I have orgasms, I lubricate, even ejaculate. I do have some hair inside but it's rare and can be easily addressed pre-op (I didn't, my fault). 

We don't need ovaries, we take hormones. Better hormones than ovaries as we are then increasing the risk of cancer of ovaries, we will go through highs and low of hormones (menstrual cycle) vs more constant levels of hormones with what we take. The fluctuations in women have also been linked to increased risk of breast cancer which is low in transwomen.

So what's the problem??

Quote from: kittenpower on March 28, 2016, 12:01:57 PM
eliminates the need for high doses of estrogen

This was important back in the time when ONLY estrogen was used (without an anti-androgen) and the estrogen was not bio-identical but now, things have changed such that bio-identical estrogens are much safer, don't need to be reduced post-op, especially if taken with an anti-androgen as the only difference now is you don't have gonads so you don't need the anti-androgen.

QuoteHRT efficacy is greatest the closer one is to their pubertal age, and diminishes over time

Beg to differ with this one as I've seen several times, older women develop better, larger breasts, more feminine traits, curves. But, if taken during puberty, there is an obvious advantage that is not debatable, of course.

Quote from: Laura_7 on March 28, 2016, 01:26:25 PM
If estrogen levels are high enough and there is still fatigue or low sex drive some endos give very low doses of testosterone.

Testosterone, even in low dose, can however, have undesirable effects such as acne, oily skin, body hair growth, scalp hair thinner, lowering of voice, more angular face, less feminine fat distribution. It's very tricky, you need to be careful as some effects may be irreversible. Estrogen gives energy and affects libido positively.

Quote from: Briezy on March 28, 2016, 04:48:43 PM
Also for me age is a bit of a factor I guess. I am only 42 but it really does seem like such a physically traumatic surgery and quite frankly the recovery scares me.

SRS is no longer such a risky endeavor as surgeons are experienced in this matter, lots has been written about it, there are protocols, etc. Tens of thousands, if not more, of women have had it. Even in their 60's and their 70's, sometimes along with implants and other interventions, all at the same time! It's normal to worry and there are risks, as with any surgery but they are quite small and I think you are overworrying. :)

Quote from: Laura_7 on March 28, 2016, 05:26:42 PM
SRS is still labeled cosmetic surgery.

Not in some countries like mine where it is 100% covered by insurance. If it were cosmetic, it wouldn't be covered. For some women, it's a question of life or death and also improves quality of life, easier to function in society, pass, not be harassed, etc.

Quote from: Cindy on March 29, 2016, 02:27:24 AM
Testosterone is produced in natal females and trans females by the adrenal glands

Also produced by ovaries in natal females so premenopausal women have more T than post-op transwomen, typically.

Quotewomen do need testosterone for a healthy libido etc.

How do women with XY chromosome who are completely insensitive to androgens fare, in terms of libido? I wonder. I know with my T levels at undetectable levels but with enough E and P, I have plenty of libido. I personally question the importance of T. There is also the mind that is very important. I was always a sexual person. :)

I think if someone doesn't want any step in transition, perhaps especially surgery, they shouldn't do it. We're all individuals, and we're the experts on ourselves.

With that said, I had a slightly increased sex drive after GRS (well, to be honest, I had more willingness to have sex just b/c I didn't have that thing to interfere). I'm not sure what health issues you mean, but I didn't have any problems besides the initial healing phase that comes with any surgery.  I don't even think GRS worsens appearance, since it removes testosterone; my T level is not zero, incidentally, as my adrenal glands still produce a bit just as they do for cis women. My genitals now look and function indistinguishably from a cis woman's, and that's all I wanted. And I don't want kids, so that probably helps me see this as "good enough."

In other words, I think everyone gets to decide for themselves, but that also means not telling people that they *don't* need GRS. ;)

The following quote helped me move forward with SRS.  Worked like a charm with therapist.  :P

'It's so hard to explain all this to those who haven't experienced physical mis-gendering. Without reassignment, such a person isn't able to experience their full humanity, including their sexuality. It just doesn't work. Sex reassignment is NOT A CHOICE for such people. It is a life-enabling transformation that makes their physical sex consistent with their innate gender feelings. Without a consistent gender, one really doesn't have a life, much less liberty and a chance to pursue happiness.  - Lynn Conway (She underwent SRS in 1968)

Yes, in my case. Not everyone needs genital alignment surgeries however.


     Hugs,
- Katie
Sent from my iPhone using Tapatalk

I do not need it. If I did the surgery, it wouldnt be because I want it but to fit in a heterosexual society. Which therefore it is not worth it in my opinion at this point. It wouldnt make me feel less of a woman either way. I am woman enough if I never decide to do anything.

If I had limitless cash, it still wouldnt be on my "need" list.

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

I am sure others have a different opinion.

My opinion could change one day too. I might need it one day.

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.

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.

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.

Quote from: Cindy on March 29, 2016, 02:27:24 AMThat 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.)

Quote from: warlockmaker on March 29, 2016, 11:46:47 PM
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 ?

Quote from: Lucie on March 30, 2016, 07:01:44 AM
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*

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

Quote from: Laura_7 on March 28, 2016, 05:26:42 PM
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.

Quote from: Beth Andrea on March 30, 2016, 09:08:54 AM
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*

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.

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.

Quote from: warlockmaker on March 30, 2016, 09:03:52 AM
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 ?

Quote from: Wild Flower on March 29, 2016, 06:01:44 PM
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.

Quote from: Carrie Liz on March 29, 2016, 07:41:41 PM
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

Quote from: warlockmaker on March 29, 2016, 11:46:47 PM
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."

QuoteIn 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.

QuoteYes, 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."

Quotepossible 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"

Quoteand 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.

QuoteThe 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!

QuoteThen 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.

QuoteMany cannot afford this surgery

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

Quote from: Ange on March 30, 2016, 03:16:24 AM
20% ?

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

Quote from: Lucie on March 30, 2016, 07:01:44 AM
Are you sure that the risk of prostate cancer is lower after SRS than before ? How would you explain that ?

Quote from: Laura_7 on March 30, 2016, 08:59:07 AM
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.

Quote from: jessicats on March 30, 2016, 10:55:45 AM
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.

QuoteOf 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. ;)

Quote from: Jenna Marie on March 30, 2016, 11:18:55 AM
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.

Quote from: Lucie on March 30, 2016, 12:24:59 PM
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.

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.)

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.

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.

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?

Quote from: jessicats on April 29, 2016, 05:42:00 AM
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

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."

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

For me at least, the expense and recovery time for SRS is the main deal breaker.

As far as sex drive goes I've never really had one and I've always had quite a "disconnect" from the boy parts anyway making having sex often being an embarrassing futile attempt.

  Mother Nature at least made up for those things by giving me some natural girly physical attributes and a nice happy, female state of mind.

Quote from: Michelle G on April 29, 2016, 10:38:51 AM
For me at least, the expense and recovery time for SRS is the main deal breaker.

You could have a look here:

https://www.susans.org/forums/index.php/topic,204651.msg1830163.html#msg1830163


hugs

Quote from: Briezy on March 28, 2016, 04:48:43 PM(I have a great healthcare team at the Fenway in Boston so don't worry I'm not going to do that. lol)

What made you choose to go there? I have been off HRT for a number of years (I'm over 17 years post-op) and am looking to restart. I really did not want to have to deal with driving into the city with the traffic and parking so I ruled out the Fenway... There is an endo at Lahey in Burlington who handles  TS HRT so I plan to go there. Did you know about her, and if so why did you not chose her?

Quote
Also for me age is a bit of a factor I guess. I am only 42 but it really does seem like such a physically traumatic surgery and quite frankly the recovery scares me.

I had SRS at 43 (one week after my birthday) and not very fit... For me it was not a difficult sugary. I had BA at the same time and THAT hurt worst!

If you don't feel you need SRS that is fine... but if you are in good health you should not fear the surgery being physically traumatic with a good surgeon.

- Karen

Bottom surgery has always been off the table for I'm a lesbian with the perfect strapon,besides I wanted children and a marriage. Been married 28yrs so must be doing something right and my wife and her sis are my biggest supporters.

Since I haven't seen it mentioned, one thing about having a surgery to remove the gonads, T production continues with the adrenal glands...  Since androgen blockers are discontinued, the testosterone is freely able to bind to t receptors.  So theoretically while you may have lower T levels, more is effectively used.  That is my understanding at least.

You only need SRS if it's what you want. Don't let anyone tell you that you have to do things the way that worked for them.

That said I feel it's very necessary for me. Other than the desirable functional sexual aspects and the beneficial psychological ones, there is a physical benefit of me no longer needing to take spironolactone, which can be harsh on the kidneys, causes me constipation, and made me put my seven year long vegetarianism on hiatus in order to control my potassium levels 

You can debate whether or not SRS is a cure for transsexualism but the only thing I can say with definite proof is that it sure cured me. I wouldn't trade my lady parts for all the tea in China.

Quote from: Karen_A on May 03, 2016, 06:27:50 PM
What made you choose to go there? I have been off HRT for a number of years (I'm over 17 years post-op) and am looking to restart. I really did not want to have to deal with driving into the city with the traffic and parking so I ruled out the Fenway... There is an endo at Lahey in Burlington who handles  TS HRT so I plan to go there. Did you know about her, and if so why did you not chose her?

That's a good question. I went to a free information night there that I think they have once a week or something and they were nice and set up an appointment. While I was waiting I started talking with Doctor Forcier in Rhode Island (I'm on the Southcoast and a lot closer to providence than Boston.) There were a lot more hoops to jump through in RI though and while I was trying to get in there I had my appointment at the Fenway and they were just so great and knowing is get hrt on my next appointment I just stayed with them. I don't regret it. Sure there is traffic but there is always metered parking near the one on Boyleston.

And thank you for sharing your srs story. Just in the time that I posted that I have already started to believe that I will be getting the surgery. It just feels right. Thanks.

Quote from: Briezy on May 04, 2016, 02:33:26 PM
There were a lot more hoops to jump through in RI though and while I was trying to get in there I had my appointment at the Fenway and they were just so great and knowing is get hrt on my next appointment I just stayed with them. I don't regret it.

The reason I asked is that I would like to know the HRT philosophy of both places... i REALLY don't want to go to the Fenway but I also worry that given my age and that I am long post-op I could wind up with an endo that prescribes too conservatively.

As to SRS., if you do go that route, make sure you go to someone with a good reputation that has done a LOT of surgeries... I know I did not someone just learning or trying to refine their skills on me. Make sure you contact a lot of their patients ... Back in the day I ran into a lot of former patients of a then well known surgeon (now retired ) that had a lot of issues.

Obviously the need for SRS is an individual thing and I respect whatever decision someone makes for themselves...

While I can rationally come up with reasons,  I have to admit I don't really understand emotionally why someone would want to transition and not want to have SRS (understanding all that want it may not be able to get it).

For myself if I did not feel the need for SRS, I would not have transitioned.

- karen

Quote from: HeatherR on May 04, 2016, 02:11:14 AM
Since I haven't seen it mentioned, one thing about having a surgery to remove the gonads, T production continues with the adrenal glands...  Since androgen blockers are discontinued, the testosterone is freely able to bind to t receptors.  So theoretically while you may have lower T levels, more is effectively used.  That is my understanding at least.

Dr Suporn has something to say about this. I'll just link to someone else quoting it.

https://www.susans.org/forums/index.php/topic,163131.msg1529919.html#msg1529919

There are other references to such things if you're interested.

Going back to the original question, most trans folks do not have surgery.  It's personal choice.  As several other girls alluded to, it depends on how much dysphoria your male bits cause you.  I am overall pretty happy to be me except when dealing with that so yea, I'm totally SRS bound. 

The Washington Post did a writeup on the general topic https://www.washingtonpost.com/news/to-your-health/wp/2015/02/09/heres-how-sex-reassignment-surgery-works/ (https://www.washingtonpost.com/news/to-your-health/wp/2015/02/09/heres-how-sex-reassignment-surgery-works/) and they cite Dr Bowers as saying "two of the 1,300 people she has operated on have wanted to go back to their old bodies" 

With respect to suicide rates, surgeries help align body with mind but there is still a lot of stress due to being trans and going through this.  The strain on family, friends, etc is huge.  Many are also sadly stressed if they do not pass in their own eyes.  Thus said, the suicide rate is understandably higher than the national norm. http://www.transadvocate.com/fact-check-study-shows-transition-makes-trans-people-suicidal_n_15483.htm
(http://www.transadvocate.com/fact-check-study-shows-transition-makes-trans-people-suicidal_n_15483.htm)

There was a recent writeup that living where you are forced to use the bathroom that matches the birth assigned gender raises the suicide rate from ~42% to near 60%.  I got lazy and didn't look it up.  It's recent though if you want to see it.

Long story short, if you need to do SRS then you need it.  Most don't get it for one reason or another.  It isn't a panacea for all ills but for many it is a huge weight off of their backs.  For me, it's a matter of being and living where I should be.  I do not identify as trans.  I identify as woman.  For me, this is needed.