Frequently Asked Questions

The usual disclaimer applies: This is medical talk, not medical advice. For medical advice, always consult your personal physician.

  1. I'm trying to decide which surgeon I should go to for SRS. What are your opinions?

  2. I'm considering facial feminization surgery. Can you recommend any surgeons?

  3. Can you recommend a good therapist (doctor, electrologist, support group) in my area?

  4. What are some typical hormone regimens -- usual medications and dosages?

  5. Are you currently prescribing hormones in your medical practice?

  6. What do you think about herbal estrogens (phytoestrogens, dong qwai, black cohosh, etc.)?

  7. In your opinion, should a one-year Real-Life Experience (RLE) in the preferred gender role be an eligibility requirement for SRS?

  8. How can I just develop breasts, without feminizing myself in other ways?

  9. Is there an operation that can make my hips wider or my buttocks larger?

  10. Will the hormones I am taking show up on the drug tests my employer requires me to undergo?

  11. What do you think of on-line gender tests, such as the COGIATI and the Moir-Jessel Brain Sex test?

1. I'm trying to decide which surgeon I should go to for SRS. What are your opinions?

I no longer follow developments in SRS as closely as in years past. Dr. Toby Meltzer, Dr. Pierre Brassard, Dr. Preecha Tiewtranon, Dr. Chettawut Tulayaphanich, and Dr. Suporn Watanyusakul enjoy excellent reputations and, in my experience, reliably produce satisfactory results in most cases. There are undoubtedly many other good surgeons as well.

I would advise anyone seeking SRS to interview as many surgeons and former patients as possible and to look at as many postop results as possible before making a decision. Personally, I would never undergo SRS with any surgeon unless I had seen actual examples of that surgeon's results.

One of the most disturbing trends I have observed in recent years is the widespread use of colon segment procedures for primary vaginoplasty. Although using a colon segment may sometimes be acceptable for reconstructive work after a failed penile inversion vaginoplasty, in my opinion, this technique should rarely, if ever, be used routinely for primary vaginoplasty. Situations that might justify the use of a colon segment in primary vaginoplasty are uncommon. An example might be if a person had undergone complete amputation of the penis and scrotum prior to SRS. Therefore, my opinion is that, if a surgeon suggests that you might be a good candidate for a primary colon segment vaginoplasty, you should strongly consider choosing a different surgeon.

2. I'm considering facial feminization sugery (FFS). Can you recommend any surgeons?

I no longer follow developments in FFS closely enough to make informed recommendations.

3. Can you recommend a good therapist (doctor, electrologist, support group) in my area?

Except for Washington State and a very few other areas, I do not have the personal experience necessary to make informed recommendations. For my recommendations for Washington State, please see Washington State Resources. For an archival listing of other US resources, please see Selected US Resources.

Local support groups or individuals in them can usually refer you to other local resources, such as therapists, prescribing physicians, and electrologists.

4. What are some typical feminizing hormone regimens -- usual medications and dosages?

I have posted a summary of the most commonly-used medications and their suggested dosages elsewhere at this site. The page is called Feminizing Hormone Regimens.

5. Are you currently prescribing hormones in your medical practice?

I am not currently prescribing hormone therapy in my private medical practice in Seattle. I do provide evaluations for hormone therapy and referrals to other prescribing physicians.

6. What do you think about herbal estrogens (phytoestrogens, dong qwai, black cohosh, etc.)?

I am unaware of any reliable published data about the beneficial effects or side effects of these substances. Reputedly these are weak estrogens. As such, they may result in limited feminization and may be ineffective at suppressing testosterone. I think most people would do better with regular pharmaceutical estrogens.

7. In your opinion, should a one-year Real-Life Experience (RLE) in the preferred gender role be an eligibility requirement for SRS?

The study I conducted with Dr. Toby Meltzer in 2001 demonstrated that regret among persons who had undergone SRS with a RLE of less than one year was no greater than among persons who had completed a year or more of RLE. No participants in either category expressed outright regret, and only about 6% overall were even occasionally regretful.

8. How can I just develop breasts, without feminizing myself in other ways?

One technique would be to take effective doses of estrogen for a long enough time to develop breast tissue and then simply stop taking estrogen. Most of the breast tissue that has developed will remain, but the other feminizing effects (i.e., on hair, skin, fat distribution, muscle mass, fertility, etc.) will dissipate, and previous male characteristics will return. Breast tissue that has developed might lose some of its tone and shapeliness when estrogen is removed, but it will not simply disappear.

There seems to be little published evidence about how long one can take fully feminizing doses of estrogen and still expect complete recovery of testicular function when estrogen is stopped. Anecdotally, periods of a year or less seem to be fairly safe.

9. Is there an operation that can make my hips wider or my buttocks larger?

At present there are no good surgical techniques to widen the hips or enlarge the buttocks. Implants are not advisable: Existing implant materials look and feel hard, lumpy, and unnatural when placed in the hip and buttocks areas. Free silicone is sometimes injected into the hips and buttocks by unscrupulous practitioners. This can cause severe disfigurement and is potentially fatal. People who care about their appearance or their health should NEVER undergo injection of free silicone.

10. Will the hormones I am taking show up on the urine tests my employer requires me to undergo?

No. They might if someone looked for them, but there is no reason an employer would do so. Estrogen and progesterone are not drugs of abuse and they are not tested for during routine urine screens for drugs. Typically, the most extensive screens only test for alcohol, amphetamines, barbiturates, benzodiazepines, cannabinoids, cocaine, opiates, methadone, methaqualone, phencyclidine, and propoxyphene.

In some situations, such as athletic competitions, urine might be tested for anabolic steroids. Estrogens and progesterone are not tested for and they do not create false positive results on tests for anabolic steroids.

11. What do you think of on-line gender tests, such as the COGIATI and the Moir-Jessel Brain Sex test?

I think that both the COGIATI and the Moir-Jessel tests are little more than pseudoscientific nonsense and that anyone trying to figure out his or her gender identity issues would be well advised to ignore both.

© 2011 by Anne A. Lawrence, M.D., Ph.D. All rights reserved.