Bradley Manning, the U.S. Army private who was sentenced Aug. 21 to 35 years in a military prison for releasing highly sensitive U.S. military secrets, is seeking gender reassignment. Here’s how gender reassignment works:
Converting male anatomy to female anatomy requires removing the penis, reshaping genital tissue to appear more female and constructing a vagina.
An incision is made into the scrotum, and the flap of skin is pulled back. The testes are removed.
A shorter urethra is cut. The penis is removed, and the excess skin is used to create the labia and vagina.
People who have male-to-female gender-reassignment surgery retain a prostate. Following surgery, estrogen (a female hormone) will stimulate breast development, widen the hips, inhibit the growth of facial hair and slightly increase voice pitch.
Female-to-male surgery has achieved lesser success due to the difficulty of creating a functioning penis from the much smaller clitoral tissue available in the female genitals.
The uterus and the ovaries are removed. Genital reconstructive procedures (GRT) use either the clitoris, which is enlarged by hormones, or rely on free tissue grafts from the arm, the thigh or belly and an erectile prosthetic (phalloplasty).
Breasts need to be surgically altered if they are to look less feminine. This process involves removing breast tissue and excess skin, and reducing and properly positioning the nipples and areolae. Androgens (male hormones) will stimulate the development of facial and chest hair, and cause the voice to deepen.
Reliable statistics are extremely difficult to obtain. Many sexual-reassignment procedures are conducted in private facilities that are not subject to reporting requirements.
The cost for female-to-male reassignment can be more than $50,000. The cost for male-to-female reassignment can be $7,000 to $24,000.
Between 100 to 500 gender-reassignment procedures are conducted in the United States each year.
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Recently, writer Brynn Tannehill produced a list of misconceptions that plague people's understanding of gender-confirmation surgeries (in particular, those of the genital variety). Perusing her inventory, I nodded in recognition at every barb; like her, I've heard all these and more hurled at me, my loved ones, or my comrades online. "It's not life-or-death," "It's cosmetic," "You need therapy, not surgery," and "It will burden taxpayers" are among the many toxic myths in need of exploding.
Inspired, I decided to build on this conversation by considering the specific fictions concerning trans-male procedures and embodiments -- and I hope to read a list generated about women's gender-specific experiences as well.
So -- with the caveats that this list is not exhaustive and I am no medical expert -- it's time to bust some myths!
1. Without genital reconstruction, trans men aren't "real" men.
I look forward to a day where this goes without saying: Being a man is so much more before and beyond what's in one's pants.
Rather, being a man is first and foremost about knowing oneself as a man, working toward being the kind of man one wants to be, and being acknowledged publicly and intimately as a man if that's necessary to one's self-actualization. The individual -- not the system -- knows best.
Cisgender and transgender men share these needs, and we also share feelings of hurt (and possibly threats) when our manhood goes unacknowledged or denied, particularly based on external factors like perceptions of our anatomy. This is the case whether one's genitals are exposed (which is irrelevant to 95 percent of interactions) or not.
2. There's only one kind of genital reconstruction.
Media portrays transgender people as seeking the surgery -- you know, that one, single "sex-change" operation?
The reality, however, is that trans people seek many gender-confirming surgeries, and the most popular among men -- chest reconstruction -- does not even have to do with the genitals. Concerning genital reconstruction, the go-to image is of a surgery that creates a penis (or whatever a man may refer to this organ as). For this goal, there are actually two different procedures men seek.
A metoidioplasty is the removal of the ligaments surrounding a testosterone-enlargened phallus/clitoris, allowing it to protrude further from the body.
A phalloplasty is a construction of a penis from tissue harvested from either the forearm, the side of the chest, the pubic area, or the thigh. Men sometimes first undergo a metoidioplasty and then later undergo a phalloplasty.
In addition, there is a host of other reconstructive surgeries that take existing tissues to construct or enhance parts: urethraplasty/urethral lengthening, scrotoplasty (constructing the scrotum), and glansoplasty (constructing the head of the penis).
Furthermore, there are surgeries that pertain to the removal of internal sex organs: hysterectomy (removal of the uterus), oophorectomy (removal of the ovaries), and vaginectomy/colpectomy (removal of the vagina). A mons resection removes external pubic fat so that the genitals protrude further.
All of these are among what trans men informally refer to as "bottom surgeries." Knowing a man is seeking bottom reconstruction doesn't necessarily clue a listener in to what surgery he seeks -- nor should it. A person's body parts are private knowledge, unless they choose to share that knowledge with others. Nobody has a right to know simply by virtue of being curious.
3. All trans men want genital reconstruction.
This misconception emerges in part from a cultural logic that says that no man would consider himself whole without genitals that most closely resemble those of the average cis male.
In reality, however, trans men vary in their need for specific embodiments (and cis men vary in their genital shapes!). Just as we should trust the individual to know their own gender, we should trust that they know their own body's needs best.
Two mitigating factors should also be acknowledged here: (a) economic constraints, and (b) identity shifting over time. Many men who need genital reconstruction simply cannot afford it. This adds to the perception that very few trans men are seeking surgery and is one of the reasons that health-insurance reform is so crucial.
Furthermore, men may live happily for many years without genital reconstruction and then come to know that they need it as part of their self-actualization journey. Shifts in self-perception should be respected even if they seem to contradict what one "knows" about an individual's history.
4. No trans men want genital reconstruction.
For decades a logic has circulated within and outside trans communities that male genital surgeries simply aren't "worth it." This could refer to the expense, the pain of recovery, the time investment, or satisfaction with results.
It's important to note that such assumptions aren't merely rooted in practicality. There is a tendency among trans men to dismiss their need for a penis (should they feel this way) because they know they are already men before taking physical measures to manifest this socially, and they are perhaps acutely aware of how damaging gender stereotypes like "size matters" can be.
Furthermore, as Shannon Minter points out in the introduction to Hung Jury: Testimonies of Genital Surgery by Transsexual Men (Transgress Press, 2012), many trans men have internalized and perpetuate negative "blanket pronouncements" about surgeries as a coping mechanism for being unable to access them:
When faced with financial and other barriers that seem to place genital surgeries out of reach, we [trans men] may seek to protect ourselves by devaluing what we cannot have. In addition, because many transgender men have been conditioned to deny our deepest needs, we may believe that we do not deserve genital surgery, or even unconsciously fear that we will be punished if we dare seek it out.
In reality, many trans men do need genital reconstruction to feel somatically whole, so it's important to discuss, openly and without shame or dismissal, the desire and realities of becoming men with penises. Awareness that satisfying surgical options are available is essential to trans men's well-being.
5. Genital reconstructions are excessively risky.
Every surgery involves risk, and genital procedures are no exceptions. Risks vary for common procedures like metoidioplasty, phalloplasty, hysterectomy, and scrotoplasty. Certain procedures also have multiple steps and techniques that affect risk. A final mitigating factor is an individual's body and health history.
But philosophically speaking, what makes one consider risk excessive or prohibitive? As long as a doctor feels safe performing a procedure, perception of risk largely lies with the patient. And this perception often does not emerge from weighing statistics.
The idea that trans men's genital reconstructions are too risky is intimately tied up with that previous question of whether surgery is worth it, and with the following question: "Can he do _____ with his body afterwards?" And the responses are as varied as the bodies being considered.
If we forego the expectation that any particular appearance constitutes a real penis, or that possessing certain functions is all that makes a penis valuable, the question of risk becomes too complex to boil down to "it's too much," and it becomes clearer how risk assessments partly emerge from limiting gender norms -- which is often not a great place from which to make self-affirming decisions anyway.
6. If you can't _____ afterwards, there's no point in having genital reconstruction.
It's undeniable: Penises hold a reverential place in patriarchal societies. Being born with or without a specific kind of penis (i.e., one of classifiable appearance and functions) is an automatic shorthand for "male" or "non-male" in Western societies. Because of this, having a medico-legally official penis doesn't simply confer a biological sex; it also confers social status and privilege.
So in response to this misconception, I'd first have to ask: Why should "penis = man"? That one-shot deal doesn't leave enough room for the beautiful diversity of lived gender. No one, trans or cisgender, should have to "prove" that they have any specific body parts to have their gender respected. And indeed, a trans man can understand himself as having a penis without any surgical intervention.
Still, if we try to fill in the blank, it's easy enough to come up with preconceived answers: "urinate while standing," "no longer be able to become pregnant," "have a X-inch-long penis," "have penetrative sex," "have testicles," "ejaculate sperm," "non-manually produce an erection," "no longer have a vagina," "have a certain genital shape," "feel certain sensations," "be able to impregnate someone," etc., etc.
But the realities of why men seek surgery are again more complex than normative expectations. Every individual certainly does not desire all these things. Furthermore, if there are desires men have for their genitals that are not quite achievable through surgery, this does not mean that the reconstructions they do receive are a wholly unnecessary step on their journey. In fact, the "ideal" male genitalia these ideas evoke isn't achievable for many cisgender men either.
7. Little progress has been/will be made in available procedures.
Genital reconstructions, like most surgeries, continue improving as surgeons practice them. As scholar Dr. Trystan Cotten points out in Hung Jury:
New developments and breakthroughs in medical knowledge, surgical techniques, and technology are occurring every year. Surgical outcomes depend on a variety of factors ... [that] combine in ways that are unique and specific to each person, affecting everyone's healing and surgical outcomes differently. Thus it is difficult (and perhaps impossible) to make objective generalizations....
Misconceptions about a lack of progress emerge mostly around phalloplasty. However, it's clear from the array of techniques available that this procedure has improved greatly over the past several decades and will continue to do so. There are multiple options for skin donor sites, length and appearance; achieving and maintaining rigidity; and the construction of the scrotum (if needed).
Considering surgeons' websites and portfolios, consulting with them directly, talking with former patients, and reading research are some of the quickest ways to bust this myth.
8. Trans men cannot obtain correct legal gender documentation without genital reconstruction.
My answer to this myth is admittedly U.S.-centric, as that's where my personal experience lies, but I imagine and hope its applicability ranges to many countries.
Historically, proof of "sex-change" surgery was required for a transgender person to be able to change their gender on legal documents in the U.S. However, according to the National Center for Transgender Equality, about half of U.S. states have nixed that requirement, and more are expected to do so. A recent major policy change saw the Social Security Administration implicitly acknowledging that not all trans people need surgery, nor are they all able to access it if needed.
There are many identifying documents whose use varies from situation to situation: state IDs, passports, birth certificates, marriage certificates, death certificates, Social Security cards, and more. The polices on these shift across state lines or over time, making it impossible to say whether surgery will be required (and what kind of surgery, since chest reconstruction can often count).
One thing is for certain, however: A trans man is a man whether he has a legal "M" on all his documents or on none of them, or has a mix of gender markers; whether or not he needs or obtains surgery; and, finally, whether or not he has enough socioeconomic privilege to access health care.
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