Surgery

A Guide For F.T.M.s Part 3

Sourced from Vancouver Coastal Health, Transgender Health Program

(The Gender Centre advise that this article may not be current and as such certain content, including but not limited to persons, contact details and dates may not apply. Where legal authority or medical related matters are cited, responsibility lies with the reader to obtain the most current relevant legal authority and/or medical publication.)

Making the Decision to Have S.R.S.

Part 1: Am I sure?

There is no one right way to make the decision to have surgery. As with any big life-changing decision, it is normal to have doubts, fears, and anxieties about S.R.S. But as part of the decision-making process, it is important that you are sure you want to go ahead with surgery.

We know from our own experiences and from listening to many other people that every person's situation is unique, that there is no one way to make a decision about S.R.S., and that it is not as simple as a one-time yes or no - it is often a long process that is shaped not only by internal feelings and beliefs but also by ever-changing external circumstances that are not necessarily in your control (health, money, family responsibilities, limited access to services, etc.).

It's been our experience that people tend to make decisions about S.R.S. the same way they make decisions about the rest of life. Some trans people look for a strong internal feeling that S.R.S. is right and don't want to be influenced by what other people think, while others want to get opinions from friends, family members, other trans people, counsellors, or other health professionals as part of making the decision.

Whatever way you think things through, some questions to consider are listed below. There aren't any right answers to these questions, they are just ways to think through various aspects of S.R.S. so you can better understand your feelings, values, and expectations.

• Do you have a clear mental picture of what you want to look like after S.R.S.? How do you think you might feel if the results don't match that mental picture?
• Are you hoping SRS will fix anything, and if so, what?
• What parts of your life might change after S.R.S.? What do you hope might change, and what do you fear might change?
• Do you think your hopes for S.R.S. are realistic? How can you tell if they are or not?
• How much do you know about the options for S.R.S.? What more do you need to know to be able to make a fully informed decision?
• Are the parts of your body that will be changed by S.R.S. part of your sexuality? What will happen if you lose that part of your sexuality?
• Who else in your life will be affected by your decision? How do you think they will feel about you having S.R.S.? How will their reactions impact you?
• What do you think is a "wrong reason" to have S.R.S.? What do you think are the "right reasons?"

What S.R.S. won't do for you

S.R.S. can be a great relief for trans people and allow us to live more comfortably. But there are some things S.R.S. won't do.

1. S.R.S. won't solve all body image problems. The point of S.R.S. is to feel more comfortable with your body by bringing physical characteristics closer to your internal sense of self. This relief can increase self-esteem and make you feel more confident and attractive. However, you will find that there are also attractiveness standards after S.R.S., and you may not fit them. Comfort with your body is made more complicated by the social pressures and gender stereotypes about appearance. Some F.T.M.s respond to this by obsessively working out or having endless surgical revisions, chasing an idealized stereotype of attractiveness. It can be hard to separate out gender dysphoria from body image problems. Professional and peer counselling can be helpful to sort out your expectations about your appearance, and to work towards greater self-acceptance after S.R.S..
2. S.R.S. won't solve all sexual problems. For some trans people, wanting to feel more comfortable about sex is an important reason for having S.R.S.. S.R.S. can help ease feelings of dysphoria that impact negatively on sexuality. However, not all sexual problems are due to dysphoria. Sexuality is complex and can be impacted by many things, including physical problems, stress, relationship dynamics, body image image problems, past sexual abuse or other kinds of trauma, and cultural and personal beliefs about sexuality. S.R.S. will not automatically fix all of these areas of your life If you are having sexual difficulties, consider peer or professional counselling to explore the reasons and to find out about sexual health treatment options. The Gender Centre can assist if you need help finding a trans-positive sexual health professional. S.R.S. often has a positive impact on sexuality. In numerous studies, the majority of trans people who participated reported increased sexual satisfaction after S.R.S. But S.R.S. can also have a negative impact. Change in sensation is very common after surgery. You may find that touch is not as intense, or that it is more intense (to the point of being uncomfortable or painful). Some F.T.M.s have difficulty reaching orgasm after surgery, or report that orgasm is less intense. Making the decision about surgery includes considering the possibility that S.R.S. may negatively impact your sexuality, and thinking about how you might cope with that possibility. Whether or not you decide to have S.R.S., some trans people find counselling useful in dealing with the impact of internalized transphobia on their sexuality. Living in a transphobic society, many trans people internalize negative messages about being trans. This can include shame about erotic cross-dressing or other transspecific sexual desires and fantasies, or shame about having a body that does not conform to societal norms. Peer or professional support can be helpful in working towards greater self-acceptance of your sexuality (with or without S.R.S.).
3. S.R.S. won't make you into someone else. Many people experience positive emotional changes with S.R.S. But you'll likely find, after the excitement wears off and you've incorporated the changes into your day-to-day life, that if you were shy you're still shy, if you didn't like your laugh you still don't, and you're still afraid of spiders. Whatever things you think of as your strengths and weaknesses will still be there. Hopefully, you will be happier, and that is good for anyone. S.R.S. may help you to be more accepting of yourself. But if you are expecting that all your problems will pass away, and that everything is going to be easy emotionally and socially from here on in, you're probably going to be disappointed. This extends to mental health concerns as well. Trans people who were depressed because of gender dysphoria may find that S.R.S. greatly alleviates their depression. However, if you have depression caused by biological factors, the stresses of transphobia, or unresolved personal issues, you may still be depressed after S.R.S. Likewise, if you are having problems with drugs or alcohol, S.R.S. will not necessarily get rid of those problems.
4. S.R.S. won't provide you with a perfect community. For some trans people, S.R.S. is a ritual affirming that they are who they say they are. Making physical changes is a way to bring who you are to the rest of the world so other people can see it. This process of self-emergence can be very liberating, but it does not guarantee that you will find acceptance or understanding. Some F.T.M.s hope that after they make physical changes they will be validated as "real" men, or feel more accepted by the trans community. But the idea that trans people aren't "real" unless they've changed their bodies is transphobic, and communities or groups that have this belief are not likely to be fully respectful in terms of trans people's identities and bodies. During the various stages of transition, it's common to dream about finding an ideal community of trans people. When undergoing S.R.S. there can be a particular drive to find other people who have gone through similar experiences. There are a lot of very cool trans people to talk with about S.R.S.. But having had S.R.S. doesn't automatically make trans people welcoming, approachable, or sensitive to the needs of others, and despite having some experiences in common you will likely find that no trans person will exactly mirror your personal experiences, identity, and beliefs. Being realistic about the likelihood that you will at times feel lonely and alone after you start taking hormones is part of emotionally preparing for S.R.S.

Part 2: Am I ready?

It's not enough to be sure that S.R.S. is right for you: you should also be sure it is the right time in your life to have S.R.S. This depends both on your readiness for the physical stress and mental adjustment involved in S.R.S., and also your readiness to deal with the reactions of others.

For any kind of surgery the patient needs to be both physically and psychologically ready.

Physical readiness means you are in reasonable health overall, and you have completed any of your surgeon's physical requirements (e.g., electrolysis before phalloplasty, quitting smoking).

Physical readiness also includes arrangements for the physical care you will need after surgery - having a safe place where you can recover after surgery, understanding what is involved in aftercare, and having friends, family, or health professionals who can help look after you.

Mental readiness doesn't mean you have no mental health problems or life stresses, it means you have:

1. A solid sense of your gender identity. S.R.S. is not for people who are just starting to question, explore, and think through issues around gender identity. If you are thinking about S.R.S. as part of your initial process of exploring gender issues, give yourself some time to get a clear sense of how you identify and how surgery will contribute to this sense self before making a decision.
2. Enough mental stability to make an informed decision about your medical care. Times of chaos and crisis are not the best times to make big decisions. Being in crisis can make it hard to think clearly and make fully informed decisions. If you are finding it hard to make general life decisions because you're overwhelmed by anxiety, depression, drug or alcohol problems, family stresses, work problems, or other issues, you're not in a good place to make a big decision like whether to have surgery and what kind of surgery to have. Get peer or professional support to work on whatever is making it hard to think things through, and then come back to the question of whether to have S.R.S. when your mind is clearer.
3. Enough coping skills and supports to withstand the typical stresses of S.R.S. Trans people often feel exhilarated and liberated after S.R.S., but it is also common to have emotional ups and downs after surgery. It can be difficult to adjust to changes to how your body looks and feels, to cope with pain or other physical complications, and to deal with other people's reactions. For some loved ones, S.R.S. is the first time it really sinks in that gender issues are not going to go away and that you really are trans. This can be a hard emotional process for them and can affect the support they can offer. If you don't feel you have the emotional resilience to deal with these possibilities, now is not the right time for S.R.S. If you are sure that S.R.S. is right for you but you are not sure that you are ready at this point in your life, you don't have to abandon S.R.S. altogether. You can still work towards S.R.S. by thinking about what might help you get to the point where you are ready - counselling, advocacy, peer support, etc. - and slowly but steadily making life changes to move closer to readiness.

What Happens if I Regret Having Surgery?

Surgery is an extremely powerful experience. Dissatisfaction, disappointment, and doubt are relatively common after any surgery, and (for trans and non-trans people) typically relate to post-operative pain, surgical complications, discrepancy between hoped-for results and actual results, a sense of "now what?", and the reactions of other people. These are all normal parts of adjustment and usually resolve within the first year after surgery. Studies have consistently found that less than 1% of F.T.M. who go through S.R.S. have deep and long-lasting regrets.

If you are having trouble coping with surgical ups and downs, peer and professional counselling can be helpful. It is important that the counsellor have strong experience with trans issues and understand issues relating to surgery. The Gender Centre can help you find mental health professionals with this experience.

Many people who experience persistent regret come to peace with their decision to have had surgery - even if they wouldn't do it again, they feel that at the time it was the right decision. Some people decide that surgery and transition was wrong for them, and want to transition back. This is a big decision and should not be made without professional counselling.

This is the final section of Surgery: A Guide for F.T.M.s. The Gender Centre is grateful to the Vancouver Health, Transcend Transgender Support and Education Society and the Canadian Rainbow Health Coalition who produced the original booklet.

The text has been lightly edited to bring it into line with Australian conditions (the substitution of the Emergency Phone Number 000, for instance, in place of the North American 911).

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