Home' LOTL : February 2006 Contents 51
By Dr Ann
GENDER AND MEDICINE
Back in the bad old days sex reassignment surgery was performed
under a veil of secrecy at private hospitals. Even then patients would
often meet with intrusive questions and hostile behaviour from staff and
other patients. Now FtM (Female-to-Male) transsexuals are having their
surgery at major public hospitals, and staff are educated in providing
supportive care – although due to the ignorance and prejudice of some
individuals, transsexual patients do not always find that their hospital stay
Those considering their gender may fall into different categories or adopt
the label they feel describes their situation best. “FtM” is a woman who
has had medical and legal steps taken in order to transition to status as
a man. By contrast “F2M” refers to women who have male or masculine
identities or appearance (e.g. tomboys, butches, drag kings, gender
benders, transsexuals, transgenderists, intersexuals). As The Gender
Centre in Sydney notes, however, these groups are often referred to
under the umbrella term “transgendered”.
The experience for women transitioning to men (FtMs) can be quite
different from that of men transitioning to women (MtFs). According to
The Gender Centre, “Many MtFs define themselves in the separation
of pre-op and post-op and the distinction between cross-dresser and
transsexual, subscribing to the premise that one is “real” and the other a
mere pretense or dalliance. These clear strata do not exist for the FtM.
Many (FtM) “blur,” or exist within two or more categories. The concept of
going through phalloplasty surgeries and becoming a “finished” man is
losing currency within the FtM community.”
From a medical point of view, patients having surgery or hormonal
therapy in order to transition to another gender are treated as though they
already are their desired gender. FtMs are addressed as “Mr” by staff.
Surgical or hormonal treatment is performed in the context of removing
any barriers to the patient’s male identity.
Reaching the point of contact with the medical world is, however,
a lengthy process which many transgender patients approach with
trepidation. Hormonal therapy appears to be less invasive than surgery,
but the stories of side effects can often deter patients from taking that
Hormonal therapy for FtM patients involves intramuscular injections
every 2-3 weeks. These consist of testosterone which prompts the
development of “secondary male sex characteristics” such as facial
and body hair, deepening of the voice etc. Another option is to have
testosterone implants every 4-5 months. The insertion of these can be
done as day surgery under local anaesthetic. Patients report various side
effects from hormonal treatment, the most common being headache,
acne, rash and itch at the injection site, and in some cases, balding.
Surgery is not something patients enter into lightly, as the financial
and emotional costs make this one of the more daunting aspects of
treatment. According to European studies, one in 100,000 women will
seek sex-reassignment surgery. The most common surgery to be chosen
by patients is the mastectomy, where both breasts are removed. In
addition patients may have a hysterectomy (where the uterus is removed)
and/or an oophorectomy (the removal of both ovaries). Another aspect
of surgical treatment is the metaoidioplasty, where the clitoris is freed
to more resemble a penis, and a scrotal sac constructed with testicular
implants. Phalloplasty, where a penis is constructed from abdominal/groin
or forearm tissue, is a complex series of operations which many patients
choose to forgo due to the discomfort and complication rate.
Whatever the chosen method of transition, FtM patients’ medical
experiences can be improved with pre- and post-treatment counselling.
This, combined with access to supportive groups through organisations
like The Gender Centre, can make all the difference.
For more information see: www.gendercentre.org.au, www.ftmi.org,
www.annelawrence.com and www.hbigda.org
Dr Ann is a doctor at a Sydney metropolitan area hospital. The opinions
expressed in this column are those of the author and are not intended as
a substitute for medical advice. If you have concerns about your health
please consult your health practitioner.
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