Home' South Florida Gay News : SFGN 070115 Contents 12 // 7.1.2015 // SFGN.com //
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The Fifth Annual
Some workshops at The Fifth Annual
Transgender Medical Symposium of Fort
Lauderdale focused on trans surgeries. The
words “top” and “bottom” have different
meanings in trans culture than in gay bi male
culture. They refer to types of surgeries. “Top”
refers to chest or breast surgery; “bottom”
refers to genitalia surgery.
Dr. Christopher Salgado of the University
of Miami reported on transsexual surgery.
The information below comes from his
workshop unless stated otherwise.
Male-to-female (MTF) and female-to-
male (FTM) surgeries take about 10-12 hours
each. People with serious diseases can have
trans surgery as long as those diseases are
controlled. For an HIV infected person,
“control” would mean a high CD4 count. Any
10-12 hour surgery counts as a major surgery,
requiring substantial post-surgery recovery
time. People should postpone trans surgery
until they have a good support system and
dedicated time for their recovery. They
should have enough funds to cover out-of-
pocket expenses and time out of work.
Trans man Surgery. In trans man (FTM) top
surgeries, surgeons will remove the breast
tissue. The surgeon then has to reattach the
nipples. This frequently results in a loss of
sensation in the nipples. As some trans men
do not choose bottom surgery, the surgeon
may also remove the ovaries during top
Taking male hormones has the following
effects in trans men: vaginal atrophy, clitoral
enlargement, and reports of an increased sex
drive. One type of bottom surgery transforms
the enlarged clitoris into a micro-penis. This
surgery extends the urethra through the
clitoris. While standing urination becomes
possible, a micro-penis may be too small for
In another type of bottom surgery, the
surgeon will construct a penis (a neo-penis)
from skin and other issue. Dr. Salgado mainly
uses the skin from the forearm, complete
with any tattoos. The surgeon will construct
a urethral extension. The surgeon will
construct the penile shaft around the clitoris.
It will take about one-year for the nerves to
attach to the head of the penis.
Trans man bottom surgeries have a high
risk of urinary tract infections. The “female”
bladder muscle has to push urine a much
shorter distance than the “male” bladder
muscle does. Either type of trans man bottom
surgery extends the urethra, increasing that
urethral distance. The “female” bladder
muscle may lack the strength to push urine
through the extended urethra. This results
in frequent urinary problems for those trans
men with extended urethras.
Trans women surgery. Female hormones
will cause breast growth in trans women.
Transwomen taking female hormones also
report a decreased sex drive.
The surgeon will construct a neo-vagina
from mucosal tissue and skin from the
scrotum and penis. Some doctors, other
than Dr. Salgado, use tissue from the colon
to construct the vagina. The surgeon will
construct the neo-clitoris from the glans of
the penis. A biologically constructed vagina
(a bio-vagina) will average about 7.5 inches
of depth. A surgically constructed vagina,
(a neo-vagina), however, will average about
4.5 inches of depth. The surgery will leave
the prostate intact, requiring transwomen to
have prostate exams.
A neo-vagina has a risk of closing. Regular
vaginal intercourse or the use of a vaginal
dilator, however, will prevent it from closing.
Dr. Salgado spoke about surgical facial
feminization, which trans women consider
critical for “passing.” This surgery reduces
the Adam’s apple and the brow ridge. A nose
job may also be required.
This concludes the reports from The Fifth
Annual Transgender Symposium, a very
Trans Surgeries Part III of III
For more information on transgenders, see the following resources.
Local – support groups, general information
Center for Excellence in Transgender Health ► transhealth.ucsf.edu
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