Chaz Bono, formerly Chastity, is one of the few public figures that has brought the topic of ‘sex change’ up for discussion. While this topic breeds controversy, there are also many facts people don’t know about the life changing transformation. Read more below about the facts of gender reassignment, and view the before and after photos of the transformations below.
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A few years back I read “The Testosterone Files: My Hormonal and Social Transformation from Female to Male” by Max Valerio. Valerio tells his story in three parts: the height of his transition, where he witnesses increased energy and sex drive while struggling with gaining confidence in his male self; life before testosterone, as Anita, a lesbian out for fourteen years; and life after testosterone, experiencing life as a man. The book gave me a whole new perspective on an issue I couldn’t quite understand. On top of being educational “The Testosterone Files” was an emotional and honest journey through the eyes of a man, born in a woman’s body.
(Max Wolf Valerio Before and After)
When a biological woman is going through the process of becoming a man, taking hormones, and psychological therapy is the most common way to start. With time comes a double mastectomy, usually after flattening or taping their breasts down for some time. The final steps are where it becomes more complicated. There is more than one way to change the vagina into a penis, and a working one at that. One way is through phalloplasty, another is metoidioplasty.
Metoidioplasty, sometimes referred to as a meto or meta or spelled “metaoidioplasty”, is an alternative to phalloplasty for trans men. With the effects of testosterone treatment, the clitoris enlarges, over time, to an average of 4–5 cm (due to the clitoris and penis being developmentally homologous organs). In a metoidioplasty the enlarged clitoral tissue is released from its position and moved forward to more closely approximate the position of a penis.
(GRAPHIC) photos of metoidioplasty:
Metoidioplasty is technically simpler than a phalloplasty, and has fewer complications. The surgery itself is also considerably shorter (2–3 hours vs. 8–10 hours overall) and it is much less risky. Unlike a phalloplasty, an erectile prosthesis is not needed to achieve erection. Because metoidioplasty can not achieve penile dimensions comparable to a cisgender penis, the neopenis is usually not capable of penetrative sexual intercourse. Genital orgasm is almost always retained after surgery (unlike phalloplasty which carries significant risk of loss of erogenous sensation).
- After patient prep, the skin surrounding the enlarged clitoris is incised on the underside and the lateral crura which suspends the tissue in place is cut, freeing the clitoral tissue from the pubic bone.
- If the urethra is to be extended, the process starts now using mucosal tissues from either the vaginal area or from inside the mouth/cheeks. An experimental option is a graft from the intestines. The labia minora can be used to protect the graft, as well as provide greater girth. A catheter is placed in the extension to facilitate healing for two to three weeks.
- The neopenis is then provided with skin by cutting the labia minora and wrapping around the tissue and secured with stitches. A step usually done at the same time during metoidioplasty surgery, is scrotoplasty. Vaginectomy, hysterectomy and/or oophorectomy can also be performed at this time if they have not been done already.
Phalloplasty, refers to the construction (or reconstruction) of a penis. It is also occasionally used to refer to penis enlargement. There are four different techniques for phalloplasty. All of the techniques involve taking a graft of tissue from a donor site and extending the urethra. A penis of up to 7 inches (14–18cm) long with a circumference up to 5.9 inches (11–15cm) can be created with each of the methods.
With all types of phalloplasty in trans men, scrotoplasty can be performed using the labia majora (vulva) to form a scrotum where prosthetic testicles can be inserted. If vaginectomy,hysterectomy and/or oophorectomy have not been performed, they can be done at the same time.
(GRAPHIC) Photos of phalloplasty:
Unlike metoidioplasty, phalloplasty requires an implanted erectile prosthesis to achieve an erection (and enable sexual penetration). This is usually done in a separate surgery to allow time for healing. There are several types of erectile prostheses, including malleable rod-like medical devices that allow the neo-penis to either stand up or hang down. Penile implants require a neophallus of appropriate length and volume in order to be a safe option. The long term success rates of implants in constructed penises are less than the success rates of reconstruction in cisgender men. Good sensation in the reconstructed penis can help reduce the risk of the implant eventually eroding through the skin.
Earlier techniques used a bone graft as part of reconstruction. Long-term follow-up studies from Germany and Turkey of more than 10 years proved that these reconstructions maintain their stiffness without late complications. Unfortunately, it results in a penis that has no ability to become flaccid again without breaking the internal bone graft.
(Chase, after his transformation)
Before any of these intense and life changing surgeries are done, they must be approved. It’s not as easy as you may think. Going through with the whole sex change procedure is a time consuming process, and expensive too. Years of therapy with a doctor and taking hormones must be documented before anything is even considered.
(David Harrison before and after)
Many are quick to judge something they do not understand. A little education on something you may not understand can go along way, and maybe even change your mind on the subject. If not, that’s fine too, everyone is entitled to their own opinion.
(Loren Cameron after his transformation)
(Chaz Bono transforming from Chastity)