Surgery and Hormones for Trans People

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Described by the NHS as gender dysphoria’, there are a number of different options available for adults, children and young people to help them live in their preferred gender. As these preferences vary significantly from person to person, the treatment plan must be tailored to each individual’s personal needs.

The NHS system usually refers children and young people under the age of 18 to a specialist Gender Identity Clinic if they are thought to have gender dysphoria. NHS England currently runs 8 such clinics, of which only the Gender Identity Development Service (GIDS), based in north London, treats minors. Once referred, an assessment will then be carried out to determine the best form of support for the patient. This can include:

  • Family therapy
  • Individual therapy
  • Parental support or counselling
  • Group work for young people and their parents
  • Regular reviews to monitor gender identity development
  • Hormone therapy

Hormone therapy is available if the child has reached puberty, and they then could be treated with gonadotrophin-releasing hormone (GnRH) analogues. These synthetic hormones suppress the natural hormones produced by the body. The aim of this is to prevent or reduce some of the significant bodily changes that occur during puberty that may cause the child more distress, until they are old enough for the treatment options available to adults. This includes cross-sex hormone treatment, which involves taking the hormones of the gender to which you identify.

According to GIDS’ own figures, there has been a sharp increase in the number of children referred to their services. In 2009/10, only 97 children were referred to GIDS, which offers support to children experiencing ‘difficulties in the development of their gender identity’. By 2017/18, the corresponding figure had risen to 2,519 referrals. There is also now a significant split between genders in referrals, as over 70% (1,806) of referrals in 2017/18 were for girls. The rise in demand has led to the waiting time between referral to GIDS and appointment increase to 14-18 months, as of July 2018.

Hormone Therapy for Adults

For trans women (male to female gender transition), hormone therapy (which involves taking oestrogen) may result in physical changes including more fat on the hips, less facial and body hair, breasts becoming slightly larger, less muscle and reduction in size of the penis and testicles. The voice will not be affected so, to make the voice higher, voice therapy is an option as well as voice modifying surgery in some rare cases.

Trans men (female to male) will take testosterone. The resultant physical changes may include more muscle, more facial/body hair, periods stopping and enlargement of the clitoris. Libido may also increase, and the voice may become deeper, though often not as deep as other men’s voices.

Credit: Avila Diana Chidume.
Credit: Avila Diana Chidume.

The risks associated with long term use of masculinising and feminising hormone therapy are not fully understood. Some of the potential problems include blood clots, gallstones, weight gain, acne, hair loss from the scalp and sleep apnoea. The hormones will also result in reduced fertility and will eventually result in loss of fertility. There is also no guarantee that fertility will return to normal if the hormones are stopped. Some of the other changes that take place are known to be irreversible even if the hormones are stopped. This includes deepening of the voice in trans men and breast growth in trans women.

The results of hormone therapy vary from person to person. Due to the great number of changes, the potential associated risks and to check if the treatment is working, it’s important to be properly monitored by healthcare professionals throughout the process.

Surgery for Adults

Prior to having genital reconstructive surgery, trans men and women must have lived in the gender to which they want to physically transition to for at least a year. This is known as “social gender role transition”. This is important to ensure that it is the right option because the surgeries are not only very invasive, they are also permanent. Support is made available throughout this process.

Surgeries for trans men include:

  • A bilateral mastectomy (removal of both breasts)
  • A hysterectomy (removal of the womb)
  • A salpingo-oophorectomy (removal of the fallopian tubes and ovaries)
  • Phalloplasty or metoidioplasty (construction of a penis from the clitoris, which has been enlarged during hormone therapy, as well as existing vaginal tissue and skin grafts)
  • Scrotoplasty (construction of a scrotum) and testicular implants
  • A penile implant

Surgeries for trans women include:

  • An orchidectomy (removal of the testes)
  • A penectomy (removal of the penis)
  • Vaginoplasty (construction of a vagina using skin from the penis as the lining and skin from the scrotum to make the labia)
  • Vulvoplasty (construction of the vulva)
  • Clitoroplasty (construction of a clitoris with sensation)
  • Breast implants
  • Surgery (surgery to make the face a more feminine shape)

Surgeries for trans men tend to involve more complicated construction techniques and as a result, are usually more expensive to seek private treatment for. According to the NHS, one review of a number of studies carried out over a 20-year period found that 96% were satisfied after genital reconstructive surgery.

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