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.

I also wanted to add some links we send new members. If you have not had a chance to look through them please take a few minutes and do so:

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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. 

'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.