From the earliest times, human beings have decorated and modified their bodies– not only temporarily, with paint, cosmetics, jewelry, wigs, and clothing, but permanently, drawing upon locally available materials. The techniques used for permanent body modification were independently discovered and developed tens of thousands of years ago by tribal societies in widely separated locations on all six inhabited continents, and their use continues in contemporary society. Techniques used include piercing, tattooing, scarification, amputation and other surgical procedures; cutting, stretching, and binding to reshape body parts; and ingestion of plant and animal substances.
These body-modification techniques are often used to enhance sexual attractiveness — but they are frequently used in the pursuit of making male-born bodies look more feminine and female-born bodies look more masculine. Paleontologist Timothy Taylor, remarking on the frequency of skeletons at Paleolithic burial sites with secondary sex markers intermediate between male and female, has speculated that estrogenic herbs in the potent pharmacopeia of early humans were purposefully used to feminize certain — and probably, self-selected — natal males.
The last half of the nineteenth century and the first half of the twentieth saw advances in medical procedures that made it possible for men and women to more effectively alter their bodies toward that of the non-natal sex. While none of these technologies were developed with sex reassignment in mind, they were easily adapted and modified by medical professionals and by transsexuals themselves and have come into common use to create somatic changes.
Electrolysis
The first of these technologies to be developed was electrolysis, a process wherein electric current is passed via a metallic probe or needle through the root of a hair, killing the root. This allows individuals vectored toward female to permanently get rid of thick facial hair. The result of effective facial electrolysis is smooth skin with the same downy, nearly invisible vellus hairs that cover the faces of women and children; this provides a strong social signal of femaleness.
Despite a history of hair removal by “needleless” electrolysis, the application of chemicals that promised permanent depilation, and even irradiation, and despite the recent proliferation of laser and other light-based methods of hair removal, electrolysis is still the only method acknowledged by the Federal Food and Drug Administration to safely and permanently remove hair.
Since about 1996, male-to-female transsexuals have routinely visited electrologists for removal of hair from their genital area as part of their preparation for vaginoplasty.
Hormonal Therapy
All human beings produce both male and female hormones, but until the mid-twentieth century, the only ways to change the hormonal balance of an individual were surgical removal of the gonads (testes and ovaries) or ingestion of herbs with estrogenic (feminizing) or androgenic (masculinizing) properties. The development and marketing of human sex hormones in the second and third decades of the twentieth century not only enabled hypogonadal individuals in society’s mainstream to increase their hormonal levels; it allowed transgendered and transsexual individuals to approximate the hormonal state of the non-natal sex via ingestion, injection, or transdermal patch.
The effects of hormones are gradual and at first subtle, but over time can be profound and even astonishing. In a female-bodied individual, androgens will cause thickening of the vocal cords, resulting in a low-pitched voice; coarsening and increased oiliness of the skin; an increase in body hair; heavier musculature; significant growth of the clitoris; and suppression of the menstrual cycle. Male pattern baldness sometimes occurs. Behavioral effects include increased libido and, arguably, a lower trigger for aggressive behavior (some female-to-male transsexual report a lowering of aggression).
In natal males, a regimen of estrogens will eventually result in softer skin, decreased body hair, breast development, a subtle redistribution of subcutaneous fat which can change facial contours, shrinkage of the penis and testicles, and the suppression of the production of seminal fluid. Behavioral effects include a lowering of libido and, arguably, aggression.
Genital Surgery for Those Vectored Toward Female
Orchidectomy– removal of the testicles, or castration– has been practiced for thousands of years, and is a common procedure on the Indian subcontinent today. Although it’s difficult to find a surgeon to do the procedure, some North American transgendered persons vectored toward female opt to have this procedure instead of vaginoplasty. Removal of the testicles immediately removes the primary source of production of the male hormone.
Penectomy — removal of the penis — is rarely done in isolation as a part of the transgender process, but is sometimes attempted — and occasionally accomplished — by female-vectored transgendered and transsexual people who are either in great conflict about their gender identity or who, because of personal situations like incarceration, are unable to obtain hormones and vaginoplasty. Such self-emasculation may consist of castration, penectomy, or both.
Vaginoplasty consists of castration, penectomy, and surgical creation of a vaginal cavity and labia. Certain penile tissues and the scrotal tissue are generally retained and used to create a sensitive clitoris, line the vagina, and sculpt labia. Some surgeons favor use of a loop of intestine for the vaginal lining, and some surgeons use supplemental tissue taken by graft from the upper leg, thigh, or abdomen.
All of this is accomplished in a single operation that can take as little as three hours under general anesthesia. Patients have the option of additional visits to the surgeon for refinement of the labia or correction of cosmetic imperfections.
Surgery for Those Vectored Toward Male
The most common surgical procedure sought and obtained by female-to-male transsexuals is reduction of the breasts and the sculpting of a chest with male contours. The procedure is important to FtMs for several reasons: it removes a socially-visible, ego-dystonic symbol of femaleness; it facilitates social passing as male; it is relatively (so far as surgical procedures go, which means it still costs a lot of money) inexpensive; and, with modern techniques used by the proper surgeon, the result can be cosmetically and functionally pleasing and trouble-free.
Genital surgeries for those vectored toward female can include metadoioplasty, penectomy, scrotoplasty, and implantation of testicular prostheses, and excision of the labia and vagina. Hysterectomy and oophorectomy (removal of the ovaries) are also performed, sometimes electively, and sometimes for medical reasons.
A relatively inexpensive procedure, metadoioplasty, increases the apparent size of the testosterone-enlarged clitoris, effectively producing a small, erectile, sensate phallus. Unlike phalloplasty– the surgical creation of a penis from tissues from the abdomen or arm– it is relatively trouble-free and requires but a single surgical visit. Phalloplasty is an expensive undertaking that requires multiple visits and the result, even at the hands of the most experienced plastic surgeon, will not pass as a penis upon close or even casual inspection. The phallus is not sensate, and it is non-erectile without the use of experimental prosthetic devices. Additional surgeries are required if the phallus is serve as a conduit for urine, and often necessary to address tissue rejection, leakage of urine, and other problems.
Other Surgeries
In natal males, a variety of vocal surgeries can serve to raise the pitch of the voice. It should be noted that even the most effective of these procedures will not alone produce a voice that sounds like that of a natal female. To achieve a passably female voice, most female-vectored transpeople will also require extensive speech therapy.
Female-vectored transgendered and transsexual people have long taken advance of facial plastic surgical procedures like rhinoplasty, blepharoplasty (eyelid surgery), and face lifts, but over the past decade, radical facial feminization surgery has become common. FFS includes cutting or scraping of the skull to approximate female contours and refashioning of the overlying skin. The results can be dramatic, allowing the individual to pass convincingly as female, but the procedure is expensive.
A variety of procedures exist to reverse male pattern baldness. The use of hair plugs is well-known, as is the corn row effect that can result. The recent development of micrograph techniques can leave a more cosmetically pleasing result.
Scalp reduction surgery consists of the removal of a bald area after the use of tissue expanders. Surrounding hair-bearing scalp is pulled over the area and sutured together. In flap surgery, a surgical wedge of hair, with blood supply and nerves intact, is swiveled and sutured to a bald area from which the skin has been cut away. Both scalp reduction and flap surgeries are supplemented with micrographs, which are used to create a natural hairline.
A Note on Silicone
Liquid silicone has a long and horrible history as a body-modifying substance. Its use and subsequent discontinuation in breast implants is well-known, but it has an even longer history as an injectable, especially in transgender populations. It has been used, initially by physicians and more recently by quasi-medical “practitioners” to change the contours of lips, brows, foreheads, chins, arms, legs, thighs, breasts, calves, and thighs. Industrial grade silicone purchased at Home Depot or auto parts stores is most often used, sometimes in quantities measured in liters. Once injected, silicone migrates into muscular and organ tissue and is almost impossible to remove.
The health dangers of injected silicone are legion and have long been known. Recently, because of a number of deaths that directly resulted from injections of silicone, the law enforcement community has become more aware of the problem and has begun to prosecute those who inject others with silicone, but the practice continues unabated, especially in drag, female impersonator, sex worker, and various minority communities.
Although insurance coverage of transgender-related procedures is improving, they are still are rarely covered by medical insurance; those who have the procedures must have or find the money necessary to pay for them. Many transgendered and transsexual people are unemployed or chronically underemployed, often as a result of discrimination. Consequently, they simply cannot find the financial resources for expensive body-modification procedures, and especially surgery. They sometimes turn to often-dangerous substitutes, like liquid silicone, or do without– and doing without can subject them to discrimination, harassment, and violence because they are detectible as transgendered. Thus, access to body-modifying technologies is a class issue as well as a medical issue.
References
Basson, R., & Prior, J.C. (1998). Hormonal therapy of gender dysphoria: The male-to-female transsexual. In D. Denny (Ed.), Current concepts in transgender identity, pp. 277-296. New York: Garland Publishing.
Denny, D., & Mishael, A. (1997, July). Electrolysis in transsexual women: A retrospective look at frequency of treatment in four cases. Journal of Electrology, 12(2), 2-16.
Hage, J.J. (1992). From peniplastica totalis to reassignment surgery of the external genitalia in female-to-male transsexuals. Amsterdam: Vrieji Universiteit Press.
Hage, J.J. (1996). Metaidoplasty: An alternative phalloplasty technique in transsexuals. Plastic & Reconstructive Surgery, 97, 161?167.
Hirsch, S., Mourdant, M., & Adler, R.K. (2006). Voice and communication therapy for the transgender/transsexual client: A comprehensive clinical guide. Plural Publishing.
Kotula, D., & Parker, W.E. (Eds.). (2002). The phallus palace. Boston: Alyson Books.
Prior, J.C., & Elliott, S. (1998). Hormonal therapy of gender dysphoria: The female-to-male transsexual. In D. Denny (Ed.), Current concepts in transgender identity, pp. 297-313. New York: Garland Publishing.
Taylor, T. (1996). The prehistory of sex: Four million years of human sexual culture. New York: Bantam Books.
Copyright 2011 by Dallas Denny
Tags: Facial Feminization Surgery, featured, Plastic Surgery
Category: Transgender Body & Soul, Transgender How To
