Physical Changes of Transsexual Transition

Types of Medical Steps

The medical steps of transsexual transition fall into three general types as described below: Transition Basics, Cosmetic and SRS (Sex Reassignment Surgery). Setting aside the thorny question of whether or not a non-op (short for "non-operative" and means that SRS is not wanted) transgender person is actually a transsexual, these types are often taken in the order presented, though not always. (I didn't.)

With very few exceptions, the most fundamental medical steps for male-to-female (MTF) transsexual people are taking female sex hormones (estrogens) and having facial and body hair permanently removed, usually via electrolysis. Between the two steps, a dramatically visible amount of feminization is possible.

However, sex hormones are very powerful and can cause serious health problems if they are wrongly used, especially if they are used without the supervision of a licensed doctor. Please see the warning about hormones and unsupervised use on my main page.

A huge variety of cosmetic procedures may be done to transsexual women, many of which genetic women routinely have done. I will focus only on what I had done. The most visible change (to the public) was my breast implants, but I have also have other work done on my face as well. The most drastic and recent (October, 2005) was FFS (Facial Feminization Surgery).

FFS encompases a very specific and specialized cosmetic surgery involving maxillofacial and other skull bone work. Several very specific procedures reduce and recontour various facial features to make them more typically feminine. Only a handful of doctors perform this surgery on transsexual women. Mine was done by the same surgeon who did my SRS, Dr. Toby Meltzer.

Sex Reassignment Surgery is also known as "sex change" surgery. For transsexual women it may be performed in up to three steps, not counting revision work, or may be performed all at once, depending on both the surgeon's style and the patient's needs. An Orchiectomy removes the testicles, thus the main source of testosterone. A Vaginoplasty transforms the penis into a vagina. A Labiaplasty creates labia and a clitoral hood. Sexual sensation and even orgasm are possible, depending on the surgeon's skill and the patient's condition.

Transition Basics

Feb '89                   May '91
The first year was a combination of intramusclar shots and 2.5 mg oral Premarin daily. I gave myself a weekly shot of Depo-Provera except for the fourth week when another doctor gave me a shot of Delestrogen and Delalutin. Then, until May '91 I was on oral hormones only, a combination Estinyl, Provera and Premarin. After the orchiectomy I was on a low dose for about six months, but then I discontinued hormones until I resumed Delestrogen in 2005.

touchup electro w/galvanic
There are three main forms of electrolysis, other than laser, which are proven to permanently remove hair: thermolysis, blend, and multiple needle galvanic. I found the first two methods very painful, and my facial skin was actually damaged badly enough by thermolysis to require a chemical peel. I'm not claiming that galvanic is not uncomfortable because it is, but the only area where I ever needed numbing injections are around my mouth, especially under the nose. Even the pre-SRS clearing of my genital tissue was very bearable. I wholeheartly recommend galvanic to anyone for any part of their body, especially pre-SRS work. (Note: these dots were gone in a week.)

Cosmetic Procedures

20 months of hormones                 3 months after implants
Breast Implants
I got these silicone implants in June of 1990. The trans-axiallary method was used, placing the implants underneath the chest wall muscle via an incision in my armpit where the scar is almost invisible. They are still soft and don't sag after all this time.

July of 1990                                   3 months later
Cheek Implants
I wanted a little more cheekbone definition, so I had some very subtle solid silicone implants put in at the same time as the breast implants. They were placed in through incisions in the gumline inside my mouth.

Early March, 1991

Late April, 1991
Chemical Peel
In 1991 I opted for a chemical peel to fix the damage from thermolysis. I had the harshest method, a phenol peel, causing severe scabbing that had to be kept coated with Polysporin to prevent infection. After two weeks the scabbing fell I was bright red for almost a month and had to wear heavy sunblock until late summer. With some Pan-Stik the red was easily covered, showing off some very smooth skin.

one day after FFS
Facial Feminization Surgery
This photo was shot one day after Dr. Toby Meltzer recountered my forehead, jaw, and nose. He also brought my scalp line forward to give me a shorter forehead in addition to being more rounded. The entire surgery took over nine hours. When it turned out the rhinoplasty (nose) work took less time than he'd estimated he actually refunded nearly $3000 to me. Click on the photo for more photos and info on my FFS.

Sex Reassignment Surgery

By May of 1991 the megadoses of female hormones and other factors were causing liver toxicity and my doctor suggested I stop all medication. Unwilling to allow testosterone to ravage my body unchecked, I arranged for an orchiectomy the first place I could, Tijuana. I went through heavy mood swings, mostly depression and tears for about a month following the abrupt cutoff of all sex hormones in my body. The changes in my face, skin and musculature over the next two years were amazing. When Dr. Meltzer examined me ten months before the surgery, he remarked what a great job the surgeon did in leaving only a minor scar. It is a myth that an orchiectomy too far in advance of SRS will cause the scrotal skin to atrophy and necessitate a skin graft. Over eleven years elapsed between my orch and SRS, and I have good depth (6") and no graft was needed.

Passageway to New Womanhood, 10/31/02
Surgery, Eastmoreland Hospital
This was the last thing I saw before I was wheeled into the operating room, the surgical area hallway. There I was, swaddled in these warm blankets, thanking the Goddess that this moment had finally arrived, not even a tiny bit nervous. When they were prepping me for surgery, the anesthesiologist had asked if I wanted a shot for my anxiety, to which I replied "what anxiety?" The coolest thing was when they actually rolled me into the O.R. someone on the surgical staff had Rock music playing. I wish I'd asked who it was. Then they plugged a syringe into my IV line and the next thing I remember is the recovery room, woozy and tired, but at peace.

The 15,620 Dollar Woman
Day After SRS
I woke up tired and dizzy, but not in too much pain. Even without the Demerol drip (the gray box under the IV bag) the pain of the actual surgery site was not bad, mostly a dull ache. An small icebag placed over the maxipad helped keep the swelling down. The sore spot was my abdomen; it hurt to move my hips very much. Even rolling onto my side was tough for the first two days. What made it all better was my mother, who sat just to my left for all three days, from 10 AM until bedtime. We bonded as mother and daughter more than we ever had before.

One Way to Lose Weight: Surgery
Later That First Day
I can tell it was the first day after SRS because of the Jello, part of the clear liquid diet (broth, juice, etc.). The next day I got oatmeal, milk, actual soup! The third day I was back on solid food, and the IV was out of my arm. I was off the Demerol as quickly as possible and taking the least heavy painkiller, Percocet. But on this first day I still had the IV line, plus the compression leggings were annoying the hell out of me. To prevent a DVT (deep vein thrombosis) which can cause an embolism, your calves are placed in leggings that alternately inflate every minute, causing equal pressure all the way around. In the beginning it feels like a massage, but after two days it's very annoying. Couldn't wait until they removed them.

Catheter (yellow), drains (red)
Day Two After SRS
So let's concentrate on the surgical site, since that's what this is all about. The new vagina in still sutured closed at this point to hold the cloth packing inside. Three tubes are coming out, the Foley catheter (held in the bladder with a tiny balloon) plus two drains through which blood and fluids can ooze from inside. The drains terminate into peach-sized plastic containers that are squeezed to create a mild suction. Every 6-8 hours a nurse would empty and resqueeze them. On this day the IV line was pulled, the leggings removed (yay!) and I was able to get out of bed. Several times I walked the length of the ward, more ambulatory than anyone expected me to be. I'd say the hiking and aerobics and all the healthy living I did the month before surgery really paid off.

Drains out, bruising developed    11/03/02
Three Days After SRS
Here is a good view of how the major labia are sutured together to hold the packing in place. By now the drains are gone since the exudation had slowed to the barest trickle. Day Three indicates how bad it was going to look. The bruising around the mons (below the tape securing the catheter) began to progress down my thighs, and three days later it looked like I was wearing black and blue shorts. Still, as bad as it looks, the pain was relatively minor. The only true agony of the entire experience were gas pains on Day Two, the result of breaking my fast and hospital food. A day later I was fine. I walked a couple hundred yards around the hospital on Day Three; the only problem was I had to take short strides because all of the sutures down there pinched if I didn't go slow. That afternoon I transfered to the TLC unit at Meridian Park Hospital, healing very well.

Packing Out,
Dilator In
Five Days After SRS
On Tuesday the 5th, the nurse Susan came by with a big package and a pair of surgical scissors. Suture by suture she removed the stiches holding together my labia, then pulled out the packing, an inchwide strip of woven cotton about a meter long. It was a slight, surgary pain as it came out; it seemed to take forever. Then she presented me with my new friends: five, graduated lucite dilators, a reusable douche kit, a bottle of antibacterial soap, a tube of Bacitacin ointment and a tube of SurgiLube. She then talked me through my very first dilation, the first of 120 I would do over the next month. It wasn't bad at all. Over the next month I would begin to like it. (That's when I began to realize I might be more heterosexually oriented than I believed I was.) My last five days at TLC blended into a rhythm of dilating, walking to the cafeteria, reading, television and working on my laptop. Soon it was time to fly back to Los Angeles.

Due to the repressive, socially conservative agenda advanced over the last seven years, I had removed the following post-surgical photos because I could be prosecuted for showing "obscene" photos. With those specific laws currently in limbo, I have reinstated the photos until the judical system finally determines what our rights are. I hope I never again need to remove these educational photos.

October, 2002
Two Weeks Post-Op
By this point the bruising is mostly gone, but there is still a lot of swelling in both the mons and the labia. By New Year's Day, 2003, my vagina will have reached its final appearance, though I'm planning a labiaplasty in spring to create minor labia and a clitoral hood. Expect a new photo.

As you can see, Dr. Toby Meltzer is a miracle worker. What can't be seen is how it feels. I have good sensation, and I expect I'll be orgasmic when I'm fully healed. I used to be very bitter about being denied surgery ten years before, but given the result that I have, I am no longer sorry I had to wait that long. This was fully worth the wait. And I learned a valuable lesson in patience.

December, 2002
Two Months Post-Op
The bruising is all gone now, and most of the swelling in the mons and labia has gone way down. When I first posted this (January, 2003) dilating with the #3 stent was easy, but #4 was a bit of a stretch . . . literally! By February I was well into #4 and working up to #5. I had my labiaplasty in mid-March (see below) and that pretty much finishes my "down there" work, save for some cosmetic electrolysis to sculpt some pretty pubes and get rid of some yucky stray hairs. Sometime I look in the mirror and have trouble believing that really is me. I am so grateful that my body looks the way I want and fully reflects who I am inside. Goddess bless Toby Meltzer!

click to view bigger photo
March 20, 2003
Labiaplasty, First Week Post-op
This was the final step in my Sex Reassignment Surgery, creating minor labia and a clitoral hood, giving me the external genitalia of a woman. The swelling and discoloration are normal for the first two weeks. I got by with Tylenol and a low dose of Percocet to help me sleep.

The dark tissue is due to dead blood, which is not abnormal after the operation. For a week a bit of the tissue became necrotic (dead) but it soon sloughed off and the rest of it healed beautifully.

click to view bigger photo
white patch is necrosis

October, 2006
Final Result
Here I am four years later. I've had urethral and labial revision to remove excess skin I later decided I didn't like, but my vulva and vagina have looked this good since 2003. I have nearly six inches of depth, and sex feels exquisitely good!

You might be amazed at how good this looks. Were I so inclined I could pose for explicit photos in Hustler, and you would not be able tell the difference. If you read adult publications it is very possible that you have seen a transsexual woman's vagina and didn't even know it. You might have even had sex with one of us. Hope you loved it!

November, 2006

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