The usual disclaimer applies: This is medical talk, not medical advice. For medical advice, always consult your personal physician.
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
I no longer follow developments in FFS closely enough to make
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
I have posted a
summary of the most commonly-used medications and their suggested
dosages elsewhere at this site. The page is called Feminizing
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.
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.
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.
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.
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.
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.
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.