History of transsexualism and gender affirming surgery.
People wishing to alter their sexual identity is probably as old as humankind. Historical accounts mention the Roman emperor Elagabalus who is said to be called a lady and not a lord. Elagabalus supposedly offered vast sums to any physician who could provide him with a vagina by means of incision. In Indian mythology altered sexual states are also mentioned, for example Ardhanarishwara, an androgynous deity. The Ramayana text mentions a King called Ila who transforms from man to woman halfway his live. In the Mahabharata, Arjuna, a fierce warrior is in an intersex state for a year. The Egyptian Pharaoh Hatsepshut, assigned female at birth 1479 BC, invented a hybrid gender so that she was accepted as a ruler.
It was not until the 20th century with the advent of aseptic procedures and modern surgery that gender affirming surgery became possible. One of the first successful reports comes from the United States where in 1917, Alan L. Hart, an American tuberculosis specialist, became one of the first transgender men who had his womb and ovaries removed. In Germany in1922 Dora Richter was one of the first transgender females to undergo complete male-to-female genital surgery, first her testicles were removed, followed 10 years later with the removal of her penis and the creation of a vagina. Dora was in the care of the famous sexologist Magnus Hirschfeld at Berlin’s Institute for Sexual Research.
Current day transgender healthcare
The World Professional Association for Transgender Health (WPATH) is an international, multidisciplinary, professional association whose mission is to promote evidence-based care, education, research, public policy, and respect in transgender health. One of the main functions of WPATH is to promote the highest standards of health care for transgender diverse (TGD) people through the Standards of Care (SOC). The SOC was initially developed in 1979, and the previous version (SOC-7) was published in 2012. In view of the increasing scientific evidence, WPATH commissioned a new version of the Standards of Care, the SOC-8. Non-binary individuals are included for the first time in SOC-8. The guidelines recommend that medical treatment and social support be made available to non-binary people in individualized combinations, for example providing medical interventions without social transition or gender-affirming surgery without hormone therapy. The chapter additionally notes unique experiences of discrimination, minority stress, and difficulty accessing gender-affirming medical treatment among non- binary people, which healthcare providers should take into consideration.
Surgical procedures
Other names for gender-affirming surgery are sex reassignment surgery, gender reassignment surgery, and gender confirmation surgery. Top surgery and bottom surgery refer to surgeries on the chest and genitals respectively. Gender-affirming surgery is often sensationalized and misrepresented by anti-trans activists through terminology such as genital-mutilation surgery.
The most commonly known gender-affirming procedures are those that reshape the genitals, The meaning of "sex reassignment surgery" has been clarified by the medical organization, the World Professional Association for Transgender Health (WPATH), to include any of a larger number of surgical procedures performed as part of a medical treatment for gender dysphoria.
Gender affirming surgery is performed in intersex persons, or in transgender persons who desire medical assistance to transition from one sex to another. Trans women and others assigned male at birth may opt to undergo one or more feminizing procedures which result in anatomy that is typically gendered female. These include genital surgeries such as penectomy (removal of the penis), orchiectomy (removal of the testicles), vaginoplasty (construction of a vagina), vulvoplasty (construction of a vulva). Genital reconstruction usually involves the surgical construction of a vagina. The two most common techniques are penile inversion and rectosigmoid vaginoplasty. A third technique, the non-penile inversion technique, makes use of perforated scrotal tissue to construct the vaginal canal. Top surgery consists of breast augmentation. Lastly, other feminization procedures are, tracheal shave (reduction of the Adam's apple), facial feminization surgery, and voice feminization surgery.
Trans men and others assigned female at birth seeking surgery may opt to undergo one or more masculinizing procedures, which include chest reconstruction, breast reduction, hysterectomy (removal of the uterus), oophorectomy (removal of the ovaries). A penis constructed through phalloplasty, is a operation that produces a visual penis out of grafted tissue from the patient. Metoidioplasty works to create a penis out of the patient's genitals. This allows the patient to have a sensation-perceiving penis head. A scrotum is created through scrotoplasty.
As knowledge of non-binary genders expands in the medical community, more surgeons are willing to tailor operations to individual needs. Bi-genital operations allow individuals to construct a penis or vagina and retain their original internal sex organs. Gender nullification is the removal of all external genitalia except the urethral opening, typically pursued by people assigned male at birth. There are several different ways to get a satifying non-binary result with the help of top surgery, varying the amount of breast tissue left behind, areola size, nipple projection, or a complete removal of nipples.
Other surgeries
As underscored by WPATH, a medically transitioning may entail a variety of non-genital surgical procedures that change primary or secondary sex characteristics, any of which are considered "gender-affirming surgery" when undertaken to affirm a person's gender identity. For some trans women, facial feminization surgery, hair transplants, and breast augmentation are also aesthetic components of their surgical treatment. Voice feminizing surgery is a procedure in which the overall pitch range of the patient's voice is reduced. Adam's apple reduction surgery (chondrolaryngoplasty) or tracheal shaving is a procedure in which the most prominent part of the thyroid cartilage is reduced. There is also Adam's apple enhancement therapy, in which cartilage is used to bring out the Adam's apple in female to male patients. In addition, other non-surgical procedures are also considered medically necessary treatments by WPATH, including facial hair electrolysis.
Sources and references
Wikipedia lemma on Elagabalus: https://en.wikipedia.org/wiki/Elagabalus Accessed
October 3, 2024
Richie Gupta, Anil Murarka: Treating transsexuals in India: History, prerequisites for surgery and legal issues. Indian J Plast Surg 2009 Jul;42(2):226-33.
Wikipedia lemma on Gender affirming surgery: https://en.wikipedia.org/wiki/Gender-affirming_surgery#Surgical_procedures Accessed October 3, 2024
Coleman E, Radix AE, Bouman WP, Brown GR, de Vries AL, Deutsch MB, et al: Standards of Care for the Health of Transgender and Gender Diverse People, Version 8". International Journal of Transgender Health. 23(Suppl 1): S1 S259. doi:10.1080/26895269.2022.2100644.
