Sex reassignment surgery (female-to-male)
Encyclopedia
Sex reassignment surgery
from female to male includes a variety of surgical procedures for transsexual men that alter female anatomical traits to provide physical traits more appropriate to the trans man's male identity and functioning.
Many trans men considering the surgical option do not opt for genital reassignment surgery; more frequent surgical options include bilateral mastectomy
(removal of the breasts) and chest contouring
(providing a more typically male chest shape), and hysterectomy
(the removal of internal sex organs).
Sex reassignment surgery is usually preceded by beginning hormone treatment
with testosterone
.
, also called "top surgery", the removal of the breasts and the shaping of a male contoured chest.
Trans men with moderate to large breasts usually require a formal bilateral mastectomy with grafting and reconstruction of the nipple-areola. This will result in two horizontal scars on the lower edge of the pectoralis muscle, but allows for easier resizing of the nipple and placement in a typically male position.
By some doctors, the surgery is done in two steps, first the contents of the breast are removed through either a cut inside the areola or around it, and then let the skin retract for about a year, where in a second surgery the excess skin is removed. This technique results in far less scarring, and the nipple-areola needs not to be removed and grafted. Completely removing and grafting often results in a loss of sensation of that area that may take months to over a year to return, or may never return at all; and in rare cases in the complete loss of this tissue. In these rare cases, a nipple can be reconstructed as it is for surgical candidates whose nipples are removed as part of treatment for breast cancer.
For trans men with smaller breasts, a peri-areolar or "keyhole" procedure may be done where the mastectomy is performed through an incision made around the areola. This avoids the larger scars of a traditional mastectomy, but the nipples may be larger and may not be in a perfectly male orientation on the chest wall. In addition, there is less denervation (damage to the nerves supplying the skin) of the chest wall with a peri-areolar mastectomy, and less time is required for sensation to return. See Male Chest Reconstruction
.
is the removal of the uterus
. Bilateral salpingo-oophorectomy (BSO) is the removal of both ovaries and fallopian tube
s. Hysterectomy without BSO in cisgender
women is sometimes erroneously referred to as a 'partial hysterectomy' and is done to treat uterine disease while maintaining the female hormonal milieu until natural menopause
occurs. A 'partial hysterectomy' is actually when the uterus is removed, but the cervix is left intact. If the cervix is removed, it is called a 'total hysterectomy.'
Some trans men desire to have a hysterectomy/BSO because of a discomfort with having internal female reproductive organs despite the fact that menses usually cease with hormonal therapy. Some undergo this as their only gender-identity confirming 'bottom surgery'. In other cases, sterilization may be required by the state in order for the sex marker on official documents to be corrected.
For many trans men however, hysterectomy/BSO is done to decrease the risk of developing cervical
, endometrial
, and ovarian cancer
. (Though like breast cancer
, the risk does not become zero, but is drastically decreased.) It is unknown whether the risk of ovarian cancer
is increased, decreased, or unchanged in transgender men compared to the general female population. The risk will probably never be known since the overall population of transgender men is very small; even within the population of transgender men on hormone therapy, many patients are at significantly decreased risk due to prior oophorectomy
(removal of the ovaries). While the rates of endometrial and cervical cancer are overall higher than ovarian cancer, and these malignancies occur in younger people, it is still highly unlikely that this question will ever be definitively answered.
Decreasing cancer risk is however, particularly important as trans men often feel uncomfortable seeking gynecologic care, and many do not have access to adequate and culturally sensitive treatment. Though ideally, even after hysterectomy/BSO, trans men should see a gynecologist for a check-up at least every three years. This is particularly the case for trans men who:
One important consideration is that any trans man who develops vaginal bleeding after successfully ceasing menses on testosterone, must be evaluated by a gynecologist. This is equivalent to post-menopausal bleeding in a cisgender
woman and may herald the development of a gynecologic cancer.
), or rely on free tissue grafts from the arm, the thigh or belly and an erectile prosthetic
(Phalloplasty
).
In either case, the urethra can be rerouted through the phallus to allow urination through the reconstructed penis. The labia majora (see vulva
) are united to form a scrotum
, where prosthetic
testicles can be inserted.
Sex reassignment surgery
Sex reassignment surgery is a term for the surgical procedures by which a person's physical appearance and function of their existing sexual characteristics are altered to resemble...
from female to male includes a variety of surgical procedures for transsexual men that alter female anatomical traits to provide physical traits more appropriate to the trans man's male identity and functioning.
Many trans men considering the surgical option do not opt for genital reassignment surgery; more frequent surgical options include bilateral mastectomy
Mastectomy
Mastectomy is the medical term for the surgical removal of one or both breasts, partially or completely. Mastectomy is usually done to treat breast cancer; in some cases, women and some men believed to be at high risk of breast cancer have the operation prophylactically, that is, to prevent cancer...
(removal of the breasts) and chest contouring
Male Chest Reconstruction
In men with female breast growth, caused either by gynecomastia or by status as a trans man, a male chest reconstruction is often done to give the chest a more masculine appearance...
(providing a more typically male chest shape), and hysterectomy
Hysterectomy
A hysterectomy is the surgical removal of the uterus, usually performed by a gynecologist. Hysterectomy may be total or partial...
(the removal of internal sex organs).
Sex reassignment surgery is usually preceded by beginning hormone treatment
Hormone replacement therapy (female-to-male)
Hormone replacement therapy for transgender gender variant and transsexual introduces hormones associate with the gender that the patient identifies with...
with testosterone
Testosterone
Testosterone is a steroid hormone from the androgen group and is found in mammals, reptiles, birds, and other vertebrates. In mammals, testosterone is primarily secreted in the testes of males and the ovaries of females, although small amounts are also secreted by the adrenal glands...
.
Mastectomy
Many trans men seek bilateral mastectomyMastectomy
Mastectomy is the medical term for the surgical removal of one or both breasts, partially or completely. Mastectomy is usually done to treat breast cancer; in some cases, women and some men believed to be at high risk of breast cancer have the operation prophylactically, that is, to prevent cancer...
, also called "top surgery", the removal of the breasts and the shaping of a male contoured chest.
Trans men with moderate to large breasts usually require a formal bilateral mastectomy with grafting and reconstruction of the nipple-areola. This will result in two horizontal scars on the lower edge of the pectoralis muscle, but allows for easier resizing of the nipple and placement in a typically male position.
By some doctors, the surgery is done in two steps, first the contents of the breast are removed through either a cut inside the areola or around it, and then let the skin retract for about a year, where in a second surgery the excess skin is removed. This technique results in far less scarring, and the nipple-areola needs not to be removed and grafted. Completely removing and grafting often results in a loss of sensation of that area that may take months to over a year to return, or may never return at all; and in rare cases in the complete loss of this tissue. In these rare cases, a nipple can be reconstructed as it is for surgical candidates whose nipples are removed as part of treatment for breast cancer.
For trans men with smaller breasts, a peri-areolar or "keyhole" procedure may be done where the mastectomy is performed through an incision made around the areola. This avoids the larger scars of a traditional mastectomy, but the nipples may be larger and may not be in a perfectly male orientation on the chest wall. In addition, there is less denervation (damage to the nerves supplying the skin) of the chest wall with a peri-areolar mastectomy, and less time is required for sensation to return. See Male Chest Reconstruction
Male Chest Reconstruction
In men with female breast growth, caused either by gynecomastia or by status as a trans man, a male chest reconstruction is often done to give the chest a more masculine appearance...
.
Hysterectomy and bilateral salpingo-oophorectomy
HysterectomyHysterectomy
A hysterectomy is the surgical removal of the uterus, usually performed by a gynecologist. Hysterectomy may be total or partial...
is the removal of the uterus
Uterus
The uterus or womb is a major female hormone-responsive reproductive sex organ of most mammals including humans. One end, the cervix, opens into the vagina, while the other is connected to one or both fallopian tubes, depending on the species...
. Bilateral salpingo-oophorectomy (BSO) is the removal of both ovaries and fallopian tube
Fallopian tube
The Fallopian tubes, also known as oviducts, uterine tubes, and salpinges are two very fine tubes lined with ciliated epithelia, leading from the ovaries of female mammals into the uterus, via the utero-tubal junction...
s. Hysterectomy without BSO in cisgender
Cisgender
Cisgender is an adjective used in the context of gender issues and counselling to refer to a class of gender identities formed by a match between an individual's gender identity and the behavior or role considered appropriate for one's sex.Kristen Schilt and Laurel Westbrook defined "cisgender"...
women is sometimes erroneously referred to as a 'partial hysterectomy' and is done to treat uterine disease while maintaining the female hormonal milieu until natural menopause
Menopause
Menopause is a term used to describe the permanent cessation of the primary functions of the human ovaries: the ripening and release of ova and the release of hormones that cause both the creation of the uterine lining and the subsequent shedding of the uterine lining...
occurs. A 'partial hysterectomy' is actually when the uterus is removed, but the cervix is left intact. If the cervix is removed, it is called a 'total hysterectomy.'
Some trans men desire to have a hysterectomy/BSO because of a discomfort with having internal female reproductive organs despite the fact that menses usually cease with hormonal therapy. Some undergo this as their only gender-identity confirming 'bottom surgery'. In other cases, sterilization may be required by the state in order for the sex marker on official documents to be corrected.
For many trans men however, hysterectomy/BSO is done to decrease the risk of developing cervical
Cervical cancer
Cervical cancer is malignant neoplasm of the cervix uteri or cervical area. One of the most common symptoms is abnormal vaginal bleeding, but in some cases there may be no obvious symptoms until the cancer is in its advanced stages...
, endometrial
Endometrial cancer
Endometrial cancer refers to several types of malignancies that arise from the endometrium, or lining, of the uterus. Endometrial cancers are the most common gynecologic cancers in the United States, with over 35,000 women diagnosed each year. The incidence is on a slow rise secondary to the...
, and ovarian cancer
Ovarian cancer
Ovarian cancer is a cancerous growth arising from the ovary. Symptoms are frequently very subtle early on and may include: bloating, pelvic pain, difficulty eating and frequent urination, and are easily confused with other illnesses....
. (Though like breast cancer
Breast cancer
Breast cancer is cancer originating from breast tissue, most commonly from the inner lining of milk ducts or the lobules that supply the ducts with milk. Cancers originating from ducts are known as ductal carcinomas; those originating from lobules are known as lobular carcinomas...
, the risk does not become zero, but is drastically decreased.) It is unknown whether the risk of ovarian cancer
Ovarian cancer
Ovarian cancer is a cancerous growth arising from the ovary. Symptoms are frequently very subtle early on and may include: bloating, pelvic pain, difficulty eating and frequent urination, and are easily confused with other illnesses....
is increased, decreased, or unchanged in transgender men compared to the general female population. The risk will probably never be known since the overall population of transgender men is very small; even within the population of transgender men on hormone therapy, many patients are at significantly decreased risk due to prior oophorectomy
Oophorectomy
Oophorectomy is the surgical removal of an ovary or ovaries. The surgery is also called ovariectomy, but this term has been traditionally used in basic science research describing the surgical removal of ovaries in laboratory animals...
(removal of the ovaries). While the rates of endometrial and cervical cancer are overall higher than ovarian cancer, and these malignancies occur in younger people, it is still highly unlikely that this question will ever be definitively answered.
Decreasing cancer risk is however, particularly important as trans men often feel uncomfortable seeking gynecologic care, and many do not have access to adequate and culturally sensitive treatment. Though ideally, even after hysterectomy/BSO, trans men should see a gynecologist for a check-up at least every three years. This is particularly the case for trans men who:
- retain their vagina (whether before or after further genital reconstruction,)
- have a strong family history or cancers of the breast, ovary, or uterus (endometrium,)
- have a personal history of gynecological cancer or significant dysplasia on a Pap smearPap smearThe Papanicolaou test is a screening test used in to detect pre-cancerous and cancerous processes in the endocervical canal of the female reproductive system. Changes can be treated, thus preventing cervical cancer...
.
One important consideration is that any trans man who develops vaginal bleeding after successfully ceasing menses on testosterone, must be evaluated by a gynecologist. This is equivalent to post-menopausal bleeding in a cisgender
Cisgender
Cisgender is an adjective used in the context of gender issues and counselling to refer to a class of gender identities formed by a match between an individual's gender identity and the behavior or role considered appropriate for one's sex.Kristen Schilt and Laurel Westbrook defined "cisgender"...
woman and may herald the development of a gynecologic cancer.
Genital reassignment
Genital reconstructive procedures (GRT) use either the clitoris, which is enlarged by androgenic hormones (MetoidioplastyMetoidioplasty
Metoidioplasty, sometimes referred to as a meto or meta or spelled "metaoidioplasty", is an alternative to phalloplasty for trans men...
), or rely on free tissue grafts from the arm, the thigh or belly and an erectile prosthetic
Penile prosthesis
A penile prosthesis is a medical device implanted in the penis requiring a surgical procedure. The device is often used for men with organic or treatment-resistant psychogenic impotence who suffer from erectile dysfunction...
(Phalloplasty
Phalloplasty
Phalloplasty refers to the construction of a penis or, sometimes, artificial modification of the penis by surgery, often for cosmetic purposes. It is also occasionally used to refer to penis enlargement....
).
In either case, the urethra can be rerouted through the phallus to allow urination through the reconstructed penis. The labia majora (see vulva
Vulva
The vulva consists of the external genital organs of the female mammal. This article deals with the vulva of the human being, although the structures are similar for other mammals....
) are united to form a scrotum
Scrotum
In some male mammals the scrotum is a dual-chambered protuberance of skin and muscle containing the testicles and divided by a septum. It is an extension of the perineum, and is located between the penis and anus. In humans and some other mammals, the base of the scrotum becomes covered with curly...
, where prosthetic
Prosthesis
In medicine, a prosthesis, prosthetic, or prosthetic limb is an artificial device extension that replaces a missing body part. It is part of the field of biomechatronics, the science of using mechanical devices with human muscle, skeleton, and nervous systems to assist or enhance motor control...
testicles can be inserted.
See also
- ScrotoplastyScrotoplastyScrotoplasty, also known as oscheoplasty, is reparative or plastic surgery of the scrotum.As part of the surgical options for trans men, scrotoplasty is one of several operations performed to transform/reform the external genitalia into a penis and a scrotum.In this procedure, the labia majora are...
- List of transgender-related topics
- Sex reassignment surgery male-to-femaleSex reassignment surgery male-to-femaleSex reassignment surgery from male to female involves reshaping the male genitals into a form with the appearance of and, as far as possible, the function of female genitalia. Prior to any surgeries, trans women usually undergo hormone replacement therapy and facial hair removal...
- ClitoridectomyClitoridectomyClitoridectomy is the surgical removal of the clitoris. It is rarely needed as a therapeutic medical procedure, such as when cancer has developed in or spread to the clitoris...