Gender reassignment surgery is a radical surgical procedure and involves a set of procedures that take years. The process is irreversible in the sense that it is impossible to return lost body parts in their previous form. However, practice shows that there are transgender people, for example in the United States, who change their gender twice during their lives.

Indications for surgery

IN modern world Transsexualism or transgenderism are not considered diseases. Therefore, talking about “indications” in the matter of gender reassignment can only be conditional. The question of where the line is, crossing which a person begins to have such “indications” is debatable. In those countries in which such discussions are not subject to legislative, religious and other social prohibitions, this question is given to doctors of various specialties, who make their subjective decision about whether it is indicated to a specific person gender reassignment procedure.

Transsexualism is based on a violation of sexual self-identification in the form of a time-sustained identification of oneself with a gender opposite to one’s biological one. At the same time, life in the body given from birth causes a person psychological suffering, depression, does not provide opportunities for development, etc. Thus, the essence of gender identity disorder lies in the mismatch between the mental image and the physical body.

The causes of this disorder are unclear and exist in the form of assumptions about a combination of social and prenatal preconditions. One thing is obvious: the inability to find oneself in one’s body is a huge tragedy in a person’s life. The presence of such a tragedy in a person’s life is the main indication for sex reassignment surgery.

Gender correction can occur in two directions: from male to female (Male to Female – MtF) and from female to male (Female to Male – FtM). The final genital organs in both cases are imitations that do not have any physiological functions.

Most sex reassignment operations occur from male to female. In this case, the genitals are removed. The skin of the external genitalia forms the female genital organs, including the vagina.

Modern plastic surgeons are able to perform the external side of the operation so perfectly that even specialists cannot distinguish artificially formed female genitalia from real ones.

Naturally, the internal reproductive organs are not formed: a MtF transgender person cannot bear and give birth to children. To ensure that the artificially created vagina does not grow together, the operated transgender person needs to wear a special dildo inside.

Transformation of the FtM type is more complex and less popular. First, the internal reproductive organs and breasts are removed. Next comes the month rehabilitation period. After this, plastic surgery is performed to imitate the male genital organs, for which skin is taken from other parts of the body. This is an extremely technically complex operation.

Currently, complete reconstructive plastic surgery of the penis cannot be considered satisfactory from an aesthetic point of view. Naturally, the physiological erectile mechanism is not formed during the operation.

The cost of FtM transformation exceeds the cost of MtF by 2-7 times.

Contraindications

To undergo such a radical operation as gender reassignment, the patient must be in close to ideal health. Hormonal therapy significantly loads the internal organs, which leads to their rapid wear. In addition, the operation lasts several hours and is performed under general anesthesia. Therefore, a contraindication to surgery is the presence of diseases internal organs and disturbances in system processes that may be incompatible with the complex of gender reassignment procedures.

A transgender person must be over 21 years old to change gender. In some countries, such as Thailand, the age limit is 18 years.

How to change gender in Russia

If we talk about Russia, then the opportunity to change gender arises after making a diagnosis of transsexualism and obtaining a special certificate from a psychoneurological dispensary. Obtaining a certificate is preceded by a long period of psychological and psychiatric examination. In this case, the transgender person should not suffer from any concomitant mental illnesses. Doctors at the dispensary must see that the problem lies precisely in a person’s gender self-identification and is not a consequence, for example, of schizophrenia.

Making the necessary diagnosis can take years, and lasts until psychiatrists are completely convinced of the need for surgery. A transgender person will be told in detail about:

• Difficulties of the operation.
• Catastrophic consequences for the endocrine and hormonal systems.
• The need for lifelong medication.
• Significant reduction in life expectancy.

The transgender person will be given time to think thoroughly about such drastic changes in his life.

It is known that the heightened perception of the conflict between the internal and external world, like all other personal characteristics, smoothes out with age. This is absolutely true for the discrepancy between internal psychological identification and the requirements that stem from the transgender person’s existing biological sex. In the end, every person in this life has some motives and dreams that were not realized in real life. And this, of course, is not a reason to radically change your life. That is why doctors very carefully study the history of a transgender person and work with his behavior. At the same time, 75% of those who applied either refuse the operation themselves or do not receive permission for it. Middle age It takes 35 years for this operation to be carried out in the world.

How is the operation performed?

If a certificate with a diagnosis has been received, you can safely go to a clinic that performs such operations. There are several of them in Moscow and St. Petersburg. Before surgery, you are required to take hormonal medications for a year. Blood composition is monitored periodically.

Gender reassignment involves several operations.

• Plastic surgery of the external genitalia and removal of the internal reproductive organs.
• Breast surgery.
• Additional operations on the face and body depending on wishes and individual characteristics.

The most difficult is genital plastic surgery. This operation can take up to 10 hours. Inpatient stay after surgery is up to 10 days.

After the operation, hormonal therapy continues. After some time, deep psychophysiological transformations begin to occur, including changes in libido and sexual desire, speech, and gestures. The perception of the world and the behavior of a transgender person radically changes.

Gender reassignment surgery in Russia if diagnosed Russian citizens may risk going to some municipal clinics for free.

In private clinics, the operation will cost from 100 to 500 thousand rubles, including all stages of plastic surgery: genitals, breasts, face and body.

Operation in foreign countries and prices

In order to undergo gender reassignment abroad, you will also need to obtain permission. This procedure is much faster and easier than in Russia. The decision on the operation is made by a council of doctors of different specialties, which meets directly in the clinic where the operation will be performed.

The transgender person will be notified of everyone side effects gender reassignment and will even offer to sign a document stating that there are no claims against the clinic. The decision will be made within several months. As a rule, it is positive. Abroad, they are not very worried about the future of a person who wants to change their gender.

Foreign plastic doctors do not have any special surgical techniques. Gender change involves the same preparatory procedures as in Russia. A significant advantage of undergoing surgery abroad is the higher qualifications of foreign doctors due to the solid practice of conducting such operations.

The prices for gender reassignment surgery listed below only include the cost of the main MtF surgery, which involves genital plastic surgery:

• USA – $15,000.
• Germany – 10,000 euros.
• Austria – 12,000 euros.
• Thailand – $6,000.

The cost of a full course of gender transformation, including hormonal therapy, breast, face, and body plastic surgery, will be a two- or three-fold increase in the indicated amounts.

The cost of genital plastic surgery of the FtM type and surgery to remove internal reproductive organs will be, for example, about 50,000 thousand dollars in the USA. To this amount is added the cost of additional plastic and hormonal procedures.

Instructions

Take hormones for one and a half to two years and get tested for your body’s hormonal levels. See a psychologist. Register with an endocrinologist, sexologist and psychiatrist. Obtain from the latter the diagnosis F64.0 (“Transsexualism”) necessary for future surgery and change of documents.

Take care of your health, since hormones for transsexuals, especially feminizing ones, have serious side effects and are dangerous for the body. Partially compensate for these phenomena by taking vitamins and in a healthy way life, without alcohol and smoking.

Come for an interview with the head of the commission that issues paid permits for biological sex correction operations and has the necessary license. There are only two such commissions in the country, in Moscow and St. Petersburg. At his direction, take several paid psychiatric tests from a commission psychologist within two to three weeks. Receive a commission call. Its date depends on the results of the tests passed.

Visit the commission and receive a certificate of permission. Refusal will follow only if you have poor test results, and psychiatrists and psychologists have doubts about the correctness of the initial diagnosis of F64.0. Contraindications are psychiatric diseases, alcoholism, drug addiction, homosexuality, antisocial lifestyle, absence of visible signs of HRT.

Join transgender forums. Monitor plastic surgery clinics in Moscow and St. Petersburg and find out which doctor is better for surgery. If you have money, a foreign passport and, preferably, knowledge of English, then it is better to go to one of the clinics in Thailand. With a certificate from the commission, come to the selected surgeon or call him.

Agree on the type, date, time and cost of the unscheduled operation. Such operations are not carried out free of charge. They can only refuse you if you have some serious chronic illness. For example, HIV, hepatitis C, liver cirrhosis, diabetes mellitus in severe form. But usually they don’t refuse, but take additional precautions.

No earlier than two weeks before surgery, do a clinical and biochemical blood test, coagulogram, general analysis urine, as well as tests for HIV, syphilis, hepatitis B and C. If an operation is to be performed under general anesthesia, for example, vaginoplasty or mastectomy, removal of mammary glands in FtM (female-to-male transition), then a fresh electrocardiogram is also needed. A blood group test is taken if you do not have a note about it in your passport.

If the operation will be performed in the groin area, remove any possible hair with a razor. You can have a light dinner the day before, but eight hours before surgery you should avoid eating and drinking. Some doctors also recommend temporarily stopping hormones, but this is not a requirement.

Give the surgeon a certificate of permission from the commission and a report from the clinic where you had your preoperative tests. Sign the contract, pay the money. The cost, for example, of a bilateral orchiectomy, castration in MtF (transition from male to female) is 30 thousand rubles. The cost of vaginoplasty is over 200 thousand.

If the operation is performed under local anesthesia, such as a bilateral orchiectomy, then carefully listen to the surgeon's instructions. Answer the questions asked to check your status. At FtM, all types of operations - mastectomy, hysterectomy (removal of the uterus and ovaries) and phalloplasty (creation of an artificial genital organ from one's own skin) - are performed under general anesthesia.

When leaving the table after completing the operation, be careful. If you are going home immediately, as is usually done after an orchiectomy, to save money, most MtF, then ask someone from your family or friends to help you in advance. Be sure to drink or eat something light after surgery - yogurt, kefir, banana. For the first two days, stay in bed.

An important condition for obtaining the commission’s conclusion is the so-called coming out. Translated from English - “opening”. This means that an MtF transsexual, born in a male biological sex and possessing only male documents, must live in society as a woman for at least a year. With an appropriate name and feminine appearance. And the FtM transsexual is obliged to live as a man with a masculine appearance.

Without transsexual surgery in Russia, it is almost impossible to change documents, find work and a means of livelihood.

Useful advice

Be sure to get a certificate from the surgeon about the operation and a copy of the clinic’s license. After recovery, you need to come to the registry office with them to change your birth certificate and full name. After which you will receive another certificate from the registry office - to change your passport and all other documents.

A little history...

Imagine that the very first sex change operation was performed back in the thirties! At that time, naturally, the possibilities of medicine and surgery were, to put it mildly, modest, and the risk of complications after surgery, on the contrary, was high! Einar Veginera (Danish artist) had a great desire to change his name to Lili Elbe, and accordingly, his body too. This man was so obsessed with the desire to turn into a woman that he allowed more and more experiments on his body. As a result, one of the operations - ovarian transplantation - ended unsuccessfully. But let’s not talk about sad things, no one is to blame for this, because he himself wanted to! M or F?

It's 2013. Today, sex reassignment surgery is a method of surgical intervention in the human reproductive system that has been refined over the years. Therefore, many can now fully get what they have dreamed of all their lives. But in order for surgeons to perform gender reassignment, you must have access to the transsexual program. What is needed for this?

Transsexual program

Legal aspect

In accordance with current legislation, the civil gender is changed even before the operation. By the way, this alone can have a strong psychological effect on the future transsexual, which often has a positive effect on him.

Gender reassignment surgery is an operation that tens of thousands of people around the world undergo every year. The first sex reassignment operation was performed at the beginning of the 20th century.

During the first sex reassignment surgery, doctors change the transsexual's body, particularly the primary and secondary sexual characteristics.

In Russia, before gender reassignment you must:

• It is necessary to register with a psychiatric hospital, undergo a thorough examination and be under the supervision of a psychiatrist for about 2 years (sometimes less).
• After this period, the patient undergoes a special commission, which includes at least three doctors. If the patient successfully passes this commission, then as a result he receives a certificate with a diagnosis of “transsexualism.”
• Also, before the operation, hormonal therapy is carried out under the supervision of a specialist. The course of hormone therapy is at least one year.

It makes sense to contact a surgeon already having a paper with a diagnosis in hand, otherwise the operation will not be performed.

Types of body modification surgery

1. Breast correction. Breast tissue and excess skin are removed; nipples move.
2. Reduction mammoplasty. Some breast tissue is removed to make the chest look like a man's.
3. Vaginectomy. The vagina is removed.
4. Colpocleisis. The vagina is closed surgically.
5. Metoidioplasty. The clitoris is lengthened to form a small penis.
6. Phalloplasty. The penis is created using tissue from other parts of the body.
7. Ovariectomy. The ovaries and fallopian tubes are removed.
8. Hysterectomy. The uterus is removed
9. Salpingo-oophorectomy. The uterus is removed along with the appendages.
10. Scrotoplasty. The scrotum and testicles are created.

Operations such as removal of subcutaneous fat (liposuction) and installation of calf implants are also possible, chest and chin to make these parts of the body look masculine.

Nuances and indications before surgery

1. The patient must be 21 years old.
2. Psychiatric observation for 2 years is mandatory: psychocorrectional measures, somatic and instrumental examination.
3. Obtaining a certificate of form F 64.0, which will indicate the diagnosis of “transsexualism”.
4. A year of hormone therapy.
5. A year of successful experience living as a person of the opposite sex. Such an indication may be prescribed by the supervising physician.
6. Most importantly, the patient must be fully aware of the long postoperative hospitalization and rehabilitation.

Types of gender reassignment surgeries

There are two types of surgical gender reassignment:

• sex reassignment surgery from male to female - MtF(Male to Female),
• gender reassignment surgery from female to male - FtM(Female to Male).

The second type is much less common, as more complex surgical interventions are required. In addition, gender reassignment of the second type (FtM) is a more expensive procedure.

Making a man out of a woman is a more expensive procedure.

The first operation is always correction of the genital organs. More than one operation may be required, but several, so be prepared for long-term treatment.

There are a number of contraindications, in addition to the lack of diagnosis:

• old age,
• homosexuality,
• the presence of severe systemic diseases (including mental ones),
• alcoholism,
• age up to 18 years.

VIDEO - Gender reassignment surgery from female to male and vice versa

Watch an online video of the results of the most famous gender reassignment operations from female to male and vice versa:

PHOTO - sex reassignment surgery Before and After

London resident John changed his gender and turned into Jane:

1987: Sam, after spending $200,000, becomes Samantha. But seven years later, Samantha changed her mind and, for $50,000, undergoes an operation to restore her former gender.
2001: Samantha becomes a man again - Charles.

Cost of gender reassignment surgery

The main leaders in plastic surgery are Thailand and Iran.

Plastic surgery for gender reassignment in Thailand

In Thailand plastic surgery for gender reassignment are very popular, so local doctors have already, so to speak, “cut their teeth” on their compatriots.

In addition, significant funds are now being invested in the development of plastic surgery for gender reassignment and government support is provided. Most items are purchased modern equipment, new clinics are constantly being built and excellent specialists are attracted from all over the world.

The fact is that the Thai Ministry of Health drew attention to the popularity of gender reassignment surgeries and calculated that they could make very good money in this industry. Statisticians estimate that the profit could amount to 200 billion baht per year, which translates to about 184 billion in Russian rubles!

Sex reassignment tours are a new direction of medical tourism in Thailand.

In connection with this state of affairs, the Thai authorities decided to open a new branch of tourism in their country. The special tourist medical package will include accommodation in a luxury hotel, a shopping tour, consultation with all the necessary specialists, the operation itself and post-operative treatment.

Now the price of sex reassignment surgery in Thailand ranges from 7 to 10 thousand dollars. So the priorities are obvious. Therefore, gender correction in Thailand is a good solution.

Sex reassignment surgery in Russia

The cost of consultations with a psychiatrist in Russia averages about 15 thousand rubles. The operation itself in domestic clinics will cost 550 thousand rubles. However, few people decide to undergo such a serious operation in Russia; foreign surgeons seem more reliable.

There are many good Russian doctors who live and work abroad. Naturally, they work better not because they are not in Russia, but because in foreign clinics the equipment and specialized training are much better and more serious.

The cost of sex reassignment surgery in Russia is relatively small, but few people want to risk their health for the sake of dubious savings. After all, changing gender is a colossal change in life.

Cost of gender reassignment surgery abroad

Many people do not dare to undergo such a serious operation in Russia, so they begin to look for information about foreign clinics and services.

And yet, if we talk about the quality and high class of service, it is impossible not to recall European and American medicine. Here the prices are completely different.

• Germany. It has long been famous for its plastic surgery clinics, because the popularity of this type of surgical intervention is growing every year. People's interest in plastic surgery is increasing, and accordingly the demand for the services of plastic surgeons is increasing.
• USA. The cost of the main operation is about 40,000 US dollars. Breast removal surgery will cost about $4,000; Closing the vagina and lengthening the urethra will cost you about the same amount. Creating a penis costs about 7,000 US dollars.
• Austria. By the way, a not very expensive operation can be performed in Austria. The service will cost you from 13,000 to 20,000 US dollars, and this is the total cost of the entire complex.

It is worth remembering that it is best to choose a clinic that guarantees proper post-operative care, because hospitalization on average takes up to 14 days.

If doctors are ready to observe you not only before, but also after sex reassignment surgery, then they are not indifferent to your fate.

You can find additional information on this topic in the section.

Sex reassignment surgery is recognized as the only treatment method for transsexuality today. This intervention is designed to eliminate the dissonance between a person’s psychological and physical gender. In many countries, medical intervention is required before changes can be made to documents. Surgical correction is not a complete gender change.

The cost of the operation depends on the desired gender and the country in which the procedure will be performed. Changing the male to female gender is more common and has a lower cost. European countries guarantee high quality of work. Germany ranks first in the cost of such operations, since new body parts are actually grown from the body's own cells.

The initial stage of gender reassignment is confirmation of transsexuality (discrepancy between biological and social sex). This includes numerous studies, psychiatric commissions, examinations of doctors (gynecologist, urologist, endocrinologist). The second stage is long-term hormonal therapy.

Woman-Man. This includes plastic surgery to remove breasts, create a new masculine nipple shape, create breast relief, remove female genital organs, and create a penis in their place; hair transplant. Each intervention is a separate type of operation, and therefore is paid differently.

Man-Woman. This includes: breast augmentation, hip augmentation, lower leg augmentation, removal of lower ribs, testicle removal, vaginoplasty, Adam's apple removal, chin reduction, lip and facial surgery.

Related procedures: blood tests, anesthesia, hospital, psychiatry, diagnostic examination, testing.

Average cost varies from 200 thousand to several million rubles. This does not include the amount of expensive hormonal drugs that are used for a long time after the operation.

Consequences of sex reassignment surgery

Like any operation, gender reassignment negatively affects a person’s health; after it, one has to go through a rather long recovery period. It’s good if the patient is satisfied with the external result, because everything should look natural. Many expect a miracle from doctors, hoping that they will wake up healthy, but later they realize that nothing has changed inside, and the body cut up after surgery can cause inconvenience for a long time.

There are rare cases when it is possible to achieve external ideal proportions; in general, others can see that there is “something wrong” with the person and the psychological pressure on the transsexual increases even more.

Separately, it is worth mentioning the extensive hormonal disturbances in the body after such operations. The functioning of organs is completely disrupted; after surgical changes are made to the reproductive system, a favorable environment for the development of cancer arises; the consequences can be the most terrible.

A sex reassignment operation in financial terms is significantly less than the price a person subsequently pays with his health, so it is better to carefully weigh all the arguments before undergoing surgery.

The price of plastic surgery consists of several points. The first is the doctor's remuneration. This figure will fluctuate depending on the status of the surgeon and the complexity of the manipulations performed. On average, remuneration starts at 40,000 rubles.

The second component of the cost is payment for postoperative rehabilitation in the clinic. Some operations do not have this item - after them the patient can immediately go home (for example, if general anesthesia was not used). However, most interventions require hospital follow-up.

Here the cost varies depending on the service you choose: room, availability of amenities, location, etc. Please note: some highly professional doctors operate at the bases of different clinics, the cost of hospitalization in which may vary up or down. This will allow you to either reduce costs or choose more high level comfort.

The third important cost item is anesthesia. In this case, you pay both the cost of the drugs and the work of the anesthesiologist. The successful outcome of your operation depends on this person (as well as on the surgeon). That is why famous clinics work exclusively with proven professionals.

The fourth position in the price list is postoperative observation and medications. This item is not always present. For example, you may be asked to pay as you go for subsequent inspections. In some cases, additional items are specified separately: compression garments, consumables. You can purchase them yourself or leave this action to the clinic.

Why the cost of the operation can be changed

Plastic surgery is always associated with high risks. Before performing it, the surgeon must ensure the health of his patient. Therefore, you will be scheduled for a preliminary examination. In some clinics you can have it done “on the spot” and the cost will be included in the future price list.

Please note: the examination must be complete and not limited to taking tests. Best option– do it yourself in an independent clinic.

During the operation, you may need immediate resuscitation or the presence of other specialists. These points will also subsequently be included in the price. Various emergency situations may arise, due to which the level of complexity of the operation will become higher.

Please note that prices often do not include transactions necessary materials. For example, special implants are used to enlarge the breasts or buttocks. Their cost is calculated separately.

“Additional options” can also contribute to an increase in price. For example, if you decide on reduction mammoplasty, you may be offered nipple correction, halos, and additional lifting. Each item increases the final cost.

Sources:

• gender change like