As I am getting repeated requests for this information, I've decided to include them here.
Please note that this is my opinion, not fact. Some information may be incorrect. This data is provided for informational use only. I make no claims of expertise.
The typical stages a FTM will medically go through:
1) Psychological therapy - to help the person understand their situation and to ensure that they make the right decisions. To also deal with social/emotional problems of being a FTM.
2) Hormone therapy
- testosterone, which is usually injected but can be applied on the skin
(expensive topical gel). This will create the following conditions on the body:
a) Period will stop (uterus and ovaries stop functioning normally)
b) Voice will deepen
c) Muscles will get a little bigger
d) Coarser hair will develop on face, chest, legs (depending on genetics/ethnicity ie Asians don't have much body hair to begin with)
e) Acne (for the first few months)
f) Enlarged clitoris
g) Ask doctor for further details (mood swings, headaches, vision change, etc.)
3) Surgery
Options for surgery
a) Mastectomy - removal of breast tissue. Notes: Most FTM's get this surgery if nothing else. Breasts are hard to hide and removing them really helps the person to pass as male.
b) Hystorectomy and Oophrectomy - removal of uterus and ovaries
Notes: These organs are forever altered once the person
starts taking hormones (testosterone). These structures produce most of the
estrogen (female hormone) for the body; they start to shut down once
testosterone (male hormone) is introduced. This surgery is recommended because
the testosterone causes the uterus and ovaries to atrophy which can lead to
medical problems later in life (my doctor stated that tumors and cancer can
develop through the years if not removed).
c) Vaginectomy - removal or closure of the vaginal canal. Usually performed with Metoidioplasty or Phalloplasty.
d) Creation of Phallus - there are a few options
a) Metoidioplasty - least invasive/least scarring.
This surgery serves to "release" the clitoris
so that is sits at a more "male" position in front of the body,
making it appear larger. It usually is not large enough to have penetrative
sex. (Dr. Toby
Meltzer of
b) Phalloplasty - creation of phallus from other areas on the body.
There are several techniques that can be used and just depends on the surgeon and his/her preference.
Techniques of Phalloplasty:
Forearm Free Flap Technique
This technique creates a phallus by removing tissue (blood vessels, nerve,
skin and tissue) from the non-dominant forearm (usually left). This tissue
is rolled into a tube (to look like a penis) and then grafted onto the groin
area where microsurgery is used to attach the blood vessels and nerves.
The following doctors use the forearm free flap technique:
a) Dr. Monstrey in Belgium- Uses the technique as described above but connects the nerves from the harvested tissue to a leg nerve (for protective sensation) and the clitoral nerve (for erotic sensation).
b) Dr. Daverio in Germany/Swtizerland – uses the same technique as Monstrey but does not attach the nerves of the clitoris to the new phallus. He leaves the clitoris intact.
c)
Drs.
Brassard and Mernard in
d)
Dr.
Greenwald in
Abdominal Pedicle Flap (aka
Suitcase Handle)
This technique has the surgeon creating the phallus by
cutting tissue on the abdomen or waist, rolling it into a tube and letting it get
used to being on its own (separated from the body). Basically, the patient has
a large roll of skin on the abdomen or waist for about a month or two – this
allows the tissue to establish its own blood supply. Later, when the surgeon is
sure that the phallus has a proper blood supply, it is
further cut to hang in the groin area and shaped to look more like a penis.
The following doctors use this
technique:
a) Dr. Foerster
in
b) Dr. Wilson in
c) Dr.Stephanides in
Notes on Phalloplasty:
The phallus created with either forearm tissue
or abdominal/waist tissue is basically a skin-covered tube of tissue that
has limited sensation depending on which nerves the surgeons connect to.
Additional tissue must be harvested to line the
inside of the tube that would allow urine to pass through. The inside of the
tube must have some kind of skin that can channel urine through and remain
relatively clean and resilient. This additional tissue can be taken from the
inner labia or the forearm since these areas are relatively hairless. This
is an additional surgery called urethroplasty and serves to elongate the existing
urethra into the new phallus to facilitate urination through the new phallus.
This way, you can urinate while standing. This procedure can also be done
in a modified way for metoidioplasties also.
A scrotum can be created by hollowing out the labia majora
(the two outer ‘lips’ of the vagina) and sewing the two sides together.
Silicone testicular implants are then put in to resemble the scrotal sac with
balls.
Intercourse with Phalloplasty
For intercourse, the technique these days is to
use an inflatable erection device originally created for biological men who
cannot achieve erection due to some physical impairment. This device is adapted
to be used in FTM phalloplasties. I don't know much
about the device, but it is an inflatable tube that is fitted along the shaft
of the phallus along with a fluid-filled sac (which is put into the makeshift
scrotum I think). When one wants to have an erection, you squeeze and pump
the sack so that the fluid fills the tube and stiffens the shaft. Voila! Erection.
When you no longer want an erection, there is some kind of area that you press
to allow the fluid back into the sack, deflating the device.
Another option for intercourse is to place a bendable shaft
into the phallus. When one wants to have intercourse, the shaft is
straightened. When done, the shaft is bent back into place.
Some
quesions recently asked.
During the hormonal therapy, It was said that the muscles increase. Is
that true and how big do your muscles grow ? Do the FtM bodies after the
surgery, by any chance, look abnormal ?
Your muscles will grow a little bit, nothing grotesquely huge. I work out and do not look even close to a body builder. You will notice that you are stronger but it is not a pronounced difference.
After surgery,
you will have lots of scars, depending on what type of surgery you’ve had.
The forearm free flap surgery I mentioned above will leave a huge scar on
your forearm. With the traditional forearm freeflap, you will also have a
scar on your thigh (usually left) for the skin graft taken to replace the
skin on the forearm. I have large scars on mychest from my chest surgery because
I had large breasts for my size. I will also have a couple of small scars
on my lower abdomen (from hysterectomy) and waist (from phalloplasty).
Have you gone through the "phallo" process? If so, do the implants and
penis look almost real? And what is the average size of the penis big?
small ? normal? what does it depend on..? I've seen a few pictures which
freaked me out coz it looks like an "egg" sewn under the belly...
No,
I haven’t had the phallo yet. The implants and penis
look somewhat real but not when you get up close. Why? Well, it doesn’t act
like a real penis – it doesn’t grow or ejaculate or get hard on its own. Keep
looking for pics, I have a lot of links to pics on
the site. The size will depend on the surgeon. Real penises can be between
1.5 inches to 6 inches (on average) when soft/flaccid and the same
when erect – it depends on the guy. I’ve watched a couple of pornos
to see what real dicks look like and probably would advise you to do the same
to familiarize yourself with what you're supposed to have been born with.
There’s also nobscan.com
to see what flaccid real dicks look like. I think the surgery pic where it
looked like an "egg" was the first stage of the abdominal pedicle
flap where a flap of tissue is cut from the abdomen and fashioned into a phallus.
During the first month, it sits on the abdomen (or to the side of it) to develop
its own blood supply before it is "relocated" to its new position
on the groin area.
Do you recommend any specific
surgeons that do the whole process of the
FtM surgery? including the
erection prothesis.
I
can’t recommend any surgeons, you have to research
and find who you’re most comfortable with. Geography, finances, etc., can
play a large role in determing the best surgeon for you. I personally am going
to have surgery with Dr. Stephanides in
Do you even recommend the surgery
at all ?! I'm in love with a woman, and
have been for 2 years and 8 months...
I plan on
having surgery myself but there are a lot of FTM’s
who never get the whole thing done. They just get the mastectomy and hysterectomy/oophrectomy.
It just depends on the person.
Are there any side effects that
occur after the surgery..? Any useful
info you could give me from your own experience would be fine.
I
think that some surgeons worry that the erectile prosthesis can bust through
the tissue during intercourse. I’ve never heard of that happening though.
Some surgeons are very picky about weight. Diabetes and smoking are problems
too because they can interfere with the healing process. Some surgeons will
not operate on people who have diabetes or who continue to smoke, or on people
who they think are too overweight. Long-term side effects? Haven't heard of
any but then again, I don't hear much from those that have already had it.
I don’t have much first-hand experience yet. I will be sure to post it all
once I get some.
Say you were with a woman who doesnt know you've done a FtM
surgery,
would she notice ? Is any of the procedures done to
the body noticeable ?
The
woman would know that you are somewhat “impaired” compared to a bio guy's sexual
functioning. You can’t achieve erection normally, you can’t ejaculate, and you
won’t be able to have children. And you will have scars. You could tell her you
had some kind of accident or something or just be honest.
Do you increase in height during hormonal
therapy?
Don’t know
about that one. Since you’re young (17 right?), maybe, but normally no.
where do i find
"endocrinologists" ? (people who do the
whole process of
hormonal therapy for you and watch you for a year)...And how long is the
process of hormonal therapy anyways ?
Endocrinologists
are doctors that specialize in the endocrine system of the body. They deal
with other people besides FTM’s too. Some regular
family doctors will prescribe hormones if he/she believes in you. Since the
biological female body does not produce enough testosterone on its own, you
will have to take testosterone for life. Testosterone keeps you looking male.
The dosage will go down once your female, estrogen-producing sex organs (uterus,
ovaries) are removed.
Last but not least, Is it easy to
get a passport and related documents
after you have changed your name ? You said you would
be glad to help
people, will you be willing to help me if i get stuck
somewhere through out
the whole process.. because i will be travelling from overseas...
Changing
documents like that depend on the country they are issued. In the