So I’ve been questioning my gender identity pretty hard lately. I had a discussion with my friends. One of them mentioned how they talked to a receptionist at a doctor’s office who said more than half of the trans patients had complications. I’m not sure if this was in regards to HRT or surgery or some mixture of both. I started to research this rather heavily.
To get you guys started let’s look at MTF surgery options first, mainly with vaginoplasty:
https://www.healthline.com/health/transgender/vaginoplasty
This article covers two of the most popular methods: penile inversion and a colon procedure. Some surgeons have explored another option that uses some tissue from the stomach… It seems the results of the colon procedure as well as the stomach tissue or Peritoneal Pull Through Vaginoplasty method.
See also:
https://www.wired.com/story/a-patient-gets-the-new-transgender-surgery-she-helped-invent/,
https://www.mozaiccare.net/vaginoplasty-peritoneal, https://www.mtfsurgery.net/peritoneal-pull-through-vaginoplasty.htm,
http://www.trans-health.com/2019/peritoneal-pull-through-vaginoplasty-procedure/
Data size 1684, published in 2017. https://pubmed.ncbi.nlm.nih.gov/29057562/
Apparently 31.2% experienced complications post surgery. A large portion of these were due to not following neovaginal care procedures post surgery (namely dilation). This is concerning… I remember running into a figure that the study encompassed patients up to 2009 so there may have been improvements to the surgery between then and the time of publishing. I couldn’t find this figure again so I have to assume it was up to around 2017. A frustrating complication around the surgery is that every surgeon seems to have their own developed procedure so it remains difficult to make sense of the data and nuances in procedure as it correlates to complications post surgery. One major complication directly tied to the surgery is being able to properly void sometimes this requires corrective surgery. I think this means If I were to pursue surgery a question should be how to avoid having to go down this road. I hope to hear about refinements made to the surgical process to help avoid this or care taken to make sure recovery is underway before discharge (or similar recommendation around staying nearby for a couple weeks).
Conversing with my friend about surgery and hormone treatment he brought up ideas common for those outside of the trans community. I’m not saying he’s wrong to think this. But I think it should be acknowledged that these treatments do work for some. Those ideas being that one should just accept their body the way it is, that this is a mental issue, and what is next race or becoming inanimate objects? While there are often mental issues surrounding transgender I do not consider transgenderism to be merely mental. Parents of trans most influenced by the detrans community seem insistent on transgenderism as an ideology. While there are extremist and I believe the trans community is a bit too pro transition and surgery–too deeply pro choice with body autonomy with regards to having medical intervention performed at what seems to be a whim from the outsider, I believe most are reasonable.
I think it might be getting dressed up too nicely with terms like “tittie skittles” in reference to HRT. Clearly these people need support but should the support be so blind and embracing that they don’t stop and question? Of course most of the trans community in mtf for example, they do and are questioning, they are seeking professional help and promote this activity as well. The detrans community is an outcry right now for help–for change. They are crying out to make it more difficult to transition–to make sure the treatment is justified with the presentation of symptoms. It is difficult to balance–I think the social world transgender enter are not the most friendly. Most healthcare professionals are aware of this and become lenient when it comes to taking it to the pad and writing a script.
I think possible risk factors should be identified. These factors shouldn’t prevent you from care but it should be discussed. I think around the 6 month mark there should be a discussion between the therapist and patient to review red flags. Follow ups should be done after treatment starts 3,6,9,12 months, 18 months, 2 years, 3 years, 5 years, 10 years. Questions: Have you detransitioned? (What was it that caused you to transition? How do you know that detransitioning is right?) Do you have any regrets? What do you wish you knew going into it? If there was anything to do differently going into treatment what is it? What pronouns do you prefer? Sexual orientation? Have you had complications? What kind of intervention? Are you still in therapy? Not sure what else.
For those who detransition: We should document what we thought were indicators of being trans. Do we have any red flags? For those who don’t detransition especially for those that we had red flags for. Were there indicators we should have weighted more than others? Was there anything about the patient that indicated a higher likelihood of success?
Another important thing is expectations. That needs done from the beginning–what do you hope to achieve with transition?