40 y/o MTF pre-op, 6 months into HRT (E and GnRH blockers), no desire to detransition. These appear to be my GCS options:

1. No surgery - keep taking E and GnRH blockers indefinitely. Long term (10+ years)
effects of GnRH blockers are unknown.

2. Orchiectomy:
2a. Replace original testicles with 'fake' ones to retain original appearance and prevent scrotal skin shrinkage.
2b. Remove testicles,  and retain empty scrotum.
2c. Remove testicles and scrotum.

3. Penectomy with 2c.

4a. Vulvaplasty
4b. Vulvaplasty & sigmoid vaginoplasty at a later date.

5. Vaginoplasty
5a. Penile inversion/graft type.
5b. Sigmoid colon type.

Have I missed any?


Some of these prevent future changes,  some keep certain options open. Option 5a is probably not an option for me because of currently available material. Option 3 does not appeal to me personally (just my own preference).
All the remaining options have their pros and cons for appearance, passability, risk,  recovery, maintenance and functionality.

I identify as pansexual, so my sexuality does not really point to any specific option.

How on earth do I decide!?

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Long nights lying awake, and digesting myself from the inside out over coffee was my decision making process.

After I decided to 2b, someone asked me why I would throw away a happy sex life as a functioning man, and my house of cards collapsed and I found myself starting the "Do I want to do this" process over again. I still came to the conclusion to 2b. Don't do anything until you know you're ready. You will find peace.

Hugs, Devlyn

You forgot option:
1b. No surgery - keep taking E indefinitely and weening off of anti-androgens as the T levels reduce and the testicles atrophy to a useless state. There are plenty of trans women on here that have transitioned without blockers. You will likely be taking estradiol for a long time no matter which of the above options you choose and that well be enough to keep your testicles shriveling up from inactivity. What was your baseline T level and your T level from your latest test?

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Quote from: Megan. on December 07, 2017, 11:24:35 AM
40 y/o MTF pre-op, 6 months into HRT (E and GnRH blockers), no desire to detransition. These appear to be my GCS options:

1. No surgery - keep taking E and GnRH blockers indefinitely. Long term (10+ years)
effects of GnRH blockers are unknown.

2. Orchiectomy:
2a. Replace original testicles with 'fake' ones to retain original appearance and prevent scrotal skin shrinkage.
2b. Remove testicles,  and retain empty scrotum.
2c. Remove testicles and scrotum.

3. Penectomy with 2c.

4a. Vulvaplasty
4b. Vulvaplasty & sigmoid vaginoplasty at a later date.

5. Vaginoplasty
5a. Penile inversion/graft type.
5b. Sigmoid colon type.

Have I missed any?

One that intrigues me would be
5c. Peritoneal graft type.

Blimey, I'm looking at my future options as well, I'm not sure. I'm currently married and my wife loves penetration but.. she doesn't want sex with a woman so I've been sexless for a while now even though I'm not presenting full time or even that close to. I'm a lesbian, funnily enough hrt has made that plainer to me, though I suppose that could change and as far as sex goes I want, no need to be in a loving relationship with me as me... so what to do with my equipment is a quandary, I don't particularly like it and would be opting for 5 if I was financially able when the time came around. I've plenty of time to think though and maybe down the track things will be clearer for myself. I'm worried about being on this level of hormones forever though and I'd be considering anything surgically that will make me feel as happy in myself as the hormones do.
Siobhan

  I am leaning toward option 6.

   6.

Megan have you had one or more srs surgeons tell you that 5a is not  possible for you, as many surgeons are very good at getting good results with little material to start out with?

Quote from: Laurie on December 07, 2017, 02:27:54 PM
  I am leaning toward option 6.

   6.

[emoji853]. If you don't put something sensible for that young lady, I reserve the right to put something silly [emoji16]

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Quote from: mm on December 07, 2017, 02:31:05 PM
Megan have you had one or more srs surgeons tell you that 5a is not  possible for you, as many surgeons are very good at getting good results with little material to start out with?

It's not ruled out,  but unlikely. I've contacted one clinic and gave them my particulars,  they responded that sigmoid would be best.
I've had several surgeries to that area previously (I was born intersex) and on-going (see my HRT thread), and have never even had to or been able to tuck.

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Megan, I had very little material. If I had the option at the time I would have jumped on the Peritoneal graft. Dr. Ting at Mt. Sinai hospital.

I am still dealing with my unique genitals and Dr. McGinn has been very supportive and is going above and beyond. I wish she did the peritoneal graph 11/15/2016.

I had GRS with Dr Bluebond-Langner at NYU in August.  I was on E , Spiro and Finastride for 17 years. 

I stuffed my testicles up inside over 10 years ago and my scrotal sack shrank down to nothing.  I was concerned she would not have enough to work with.  It was no problem.  She got me about 5 1/2" of depth with no extra grafts and I'm 66. Everything looks great and is healing up nicely.

One note. DON'T stuff testicles up inside and not allow them to come down occasionally.  Mine grew into place and had to be cut out.  The area was very painful after the surgery and it could have been avoided. . . .

Megan, Dr Meltzer has done great with little starting material, might want to check with him as well.

Quote from: mm on December 09, 2017, 02:00:46 PM
Megan, Dr Meltzer has done great with little starting material, might want to check with him as well.

One problem I have is no insurance coverage and no funds to self-pay. My choices will be limited to what the NHS can offer, but I think I'd rather go without if they're unable to offer the most suitable technique.

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Quote from: Megan. on December 09, 2017, 02:06:47 PM
One problem I have is no insurance coverage and no funds to self-pay. My choices will be limited to what the NHS can offer, but I think I'd rather go without if they're unable to offer the most suitable technique.

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If i were you I would do that colovaginaplsty ..That one doctor named Bellringer does it in the UK but i heard he also does not work under the NHS any longer