There are 3 different surgical methods which can be performed and are dependent on each patient.
Before the surgery, the patient will be administered with a general anesthetic. For patients with a long penis, the surgery is performed with penile skin inversion, which is a technique that inverting the penis and removing the erectile tissue and skin, which is then used to create a labia and inverted into the pelvic tissue. The urethra is shortened to fit into place with the female anatomy.
For patients with a medium sized penis, the penis is also inverted, however this is combined with a scrotal skin graft. The hair from the scrotum is removed using laser hair removal techniques. The skin graft is used to create the vagina.
For patients with a shorter penis, the surgery is performed with a penile skin inversion, in combination with a sigmoid colon graft. The surgery involves taking a section of the sigmoid colon and using it to construct the vaginal opening.
The Sex Reassignment Surgery (Male to Female) takes 2 to 3 hours.
Gender-confirmation surgeries—the name given to procedures that change the physical appearance and function of sexual characteristics—increased by 20 percent from 2015 to 2016 in the U.S., with more than 3,000 such operations performed last year. Rates are also increasing worldwide. Now, at least one surgeon is reporting a trend of regret.
Urologist Miroslav Djordjevic, who specializes in gender reassignment surgery, has seen an increase in “reversal” surgeries among transgender women who want their male genitalia back. In the past five years, Djordjevic performed seven reversals in his clinic in Belgrade, Serbia. The urologist explains to The Telegraph that those who want the reversal display high levels of depression, and in some instances, suicidal thoughts. Other researchers also report hearing about such regrets.
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“It can be a real disaster to hear these stories,” Djordjevic told The Telegraph.
Charles Kane, who identified as Sam Hashimi after male-to-female reassignment surgery, opted to become a man again after experiencing “hormonal regret.” In the BBC documentary One Life: Make Me a Man Again, Kane explained he originally wanted to become a woman after a nervous breakdown.
“When I was in the psychiatric hospital, there was a man on one side of me who thought he was King George and another guy on the other side who thought he was Jesus Christ. I decided I was Sam,” Kane said.
Postsurgery, Kane believed his female identity would never be liked or accepted as a real woman. He also blamed the influence of female hormones as responsible for making him seek the surgery. “I don’t think there’s anyone born transsexual. Areas of their human brain get altered by female hormones,” Kane told Nightline.
Kane’s insight may not be applicable to all transgender patients seeking reversal surgery. Djordjevic expresses concern about the psychiatric evaluation and counseling that take place prior to the gender reassignment surgery. He recalls patients telling him that when they inquired about the procedure at other clinics, they receive minimal information before being asked for proof that they could pay for the operation.
In Djordjevic’s practice, patients undergo a minimum of one to two years of psychiatric evaluation, accompanied by hormonal evaluation and therapy. Prior to the surgery, he asks patients for two professional letters of recommendation. After the procedure, he strives to remain in contact—he talks with 80 percent of his former patients, The Telegraph reports.
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A 2011 study found that after sex reassignment surgery, more than 300 Swedish transsexuals faced a higher risk for mortality, suicide ideation, and psychiatric issues compared to the rest of the population. The researchers concluded, “Our findings suggest that sex reassignment, although alleviating gender dysphoria, may not suffice as treatment for transsexualism, and should inspire improved psychiatric and somatic care after sex reassignment for this patient group.”
In male-to-female reassignment surgery, doctors will reshape the male genitals in the form of a vagina. The surgery also includes removing the testicles and an inversion of the penis. In female-to-male procedures, doctors remove the breasts, uterus and ovaries and extend the urethra so a transgender man can urinate standing up. Male-to-female reassignments are more common because they are considered less expensive and more successful.
Gender reassignment surgeries are expensive. Male-to-female procedures cost between $7,000 and $24,000, and the cost of female-to-male procedures can reach $50,000. The complications and the expense warrant extra care from doctors performing these reassignments. “Ethically, we have to help any person,” says Djordjevic, “in the best possible way.”