Feelings about Top and bottom surgery. (27th Jan 2017)

DISCLAIMER!!! All medical information is right to best of my knowledge! Apologies if any turns out to be wrong

For a transgender male having ‘Top surgery’, breast removal, is almost a guarantee (for example I am part of a number of group contacting me with over 15,000 transgender males around the world and I have never spoken to a single one who didn’t want their breast removed. Like most Trans male I want top surgery and it is something I can’t wait to finally have, to have flat chest and not worry about it. There are a couple different ways to achieve this. The most common are; 


1) would Peri-areolar which is for guys with a chest size of B cup or smaller – in the UK. 
During this surgery the breast is removed through a small incision at the bottom of the areola, the nipple itself is left intact.

2) Double incision this procedure is ideal for medium to large chested men. During this procedure, the skin on the chest is opened along two horizontal incisions, at the top and bottom of the pectoral muscle. The skin is pulled back and the breast tissue is then removed, Nipples are removed, re-sized and grafted on the chest, this often leads to the person having little to no sensation of the nipple.

3) The Inverted-T Top Surgery procedure is ideal for medium to large chested men who wish to retain the most sensation possible in the nipple. The procedure is similar to Double Incision Top Surgery: skin on the chest is opened along two horizontal incisions, at the top and bottom of the pectoral muscle. (The muscle itself is not touched.) The skin is pulled back and the breast tissue is then removed.



Bottom surgery on the other hand is very different. I would guess that worldwide less in 50% of transmen get any form of bottom surgery. A big reason Trans men don’t get the surgery is the cost (roughly £50,000 for all stages), I would also guess that in countries, like the UK, where there is more funding and help to pay for such an expensive surgery the percentage of guys getting it would be much higher. There are two types of bottom surgery Metoidioplasty and Phalloplasty, they are both very different.

-Metoidioplasty (known as Meta for short) take advantage of the fact that testosterone causes a Trans males clitoris to grow longer. By cutting the ligament that holds the clitoris in place under the pubic bone, as well as cutting away some of the surrounding tissue, the surgeon is able to create a small phallus from the elongated clitoris. In order to further enhance the result, fat may be removed from the pubic mound and skin may be pulled upward to bring the phallus even farther forward. It also includes a urethral lengthening procedure to allow the patient to urinate through the penis while standing. Depending on the goals of the patient, the vaginal cavity may or may not be closed or removed, this is known as a vaginectomy. A phallus created by Meta would not be able to penetrate during sex.

-Phalloplasty (known as Phallo for short) come in a two different forms depending one where one the person’s body the skin comes from, it can come from the forearm or groin.
-Forearm Phalloplasty is the most common, this procedure is considered by many to produce a more realistic-looking,
 and the forearm skin is shaped into the new penis and grafted into place on the groin, where the nerves and blood vessels are connected. Some surgeons will connect the brachial nerve of the forearm to the pudendal nerve of the clitoris. A urethra is typically created using tissue from the labia shaped into an inverted tube. The clitoris is usually left intact near the base of the penis; the exact placement of the base of the penis with regard to the clitoris should be discussed with the surgeon. Usually, a flexible rod must be inserted into the penis or an implanted pump device used in order to achieve an erection. The vaginal cavity will be closed, in a vaginectomy. Phalloplasty is comprised of three stage, most men also have a hysterectomy during the second stage of Phalloplasty.

 

Here in the UK we have the National Health Service (NHS) paid for by taxes that means that treatment is free, something we are extremely lucky to have. So when I have top surgery it will be on the NHS and thus free for me, however it is still possible to going privately which is the same quality service but normally quicker but at a cost. The same will be true for bottom surgery, so for me the question of money is THANKFULLY not an issue. Things I need to consider are if I want to be able to pee standing up, penetrate during sex and generally have a penis. I discussed the topic at length with my wife, obliviously the final decision would have to be my own as my wife and I could separate and I would have to live with the decision I had made. At this point in time I have decided that bottom surgery, forearm Phalloplasty, is something I do want to have, there is the chance that, that could change but at the moment I don’t see that happening.

 

-Honest Trans Guy 

Testosterone – pros and cons of different forms (Jan 24th 2017)

Testosterone, in the UK, comes in several forms injections, gel/creams. There is also patches, oral and pellet forms however these don’t seem to be used in the UK.

When I first went on testosterone in March 2016 I was put on testogel, which is a gel form of testosterone. It comes in little packets, similar to sauce packets, testogel is applied daily; it is applied as a thin layer onto a person’s stomach, shoulders or thighs. It is applied and then the person has to leave to dry, normally 5-10 minutes before putting clothes on. Testogel should not come into skin contact with a cisgender female or with children.

For the first month I had to put on half a packet a day, then from month 2 till month 4 I put on a full packet as day. After this time I had a return appointment with my gender clinic my doctor felt my testosterone level was slightly too high so I was put onto a routine of full packet one day then half packet the next day and repeated – this went on until Dec 2016 when I swapped from gel form to injections.

As with all forms of testosterone there are pros and cons.

-Injections (commonly in the UK Nebido and Sustanon) are the most common way of getting testosterone. Nebido is injected by a nurse, as it is a thick needle, into the top of the buttocks every three months. Sustanon is normally injected every 2-3 week into the thigh and can be done at home.

-Gel/cream (commonly in the UK Testogel and Testim). As described above tesogel comes in packets and is normally one full packet as day. Testim comes in a pump, like soap, and is normally one or two pumps a day. Daily applications can help give a steady level rather than the up and down that comes with injections.

All of these are available through the NHS or privately. Through NHS each cost the same as a normal prescription (£8.40 per item) that would make testogel and testim a cost of roughly £8.40 per month. Sustanon a cost of roughly £16.80 and Nebido a cost of £8.40 every 12 weeks.

I have found that whilst gel could have been better for regulating my mood, applying it daily was difficult and a three monthly injection is a better fit with my life.

-Honest Trans Guy

Sexuality and Being Perceive as gay. (Jan 13th 2017)

Coming out as transgender at 21 meant that I had already lived all that time as a cisgender female, being raised as a female and following stereotypes that the world puts on females. That means that I have many of the mannerisms associated with females, I use my hands when I talk, I find little animals cute etc. This means since coming out and starting to pass more and be seen as a cisgender male by most strangers now, those mannerisms mean people perceive me as gay. This Perception doesn’t bother me, I don’t see being gay as a negative thing and I am happy enough for people to assume whatever they want.
I have been told multiple times that I come across as gay, or that I should act differently because I could be perceived as gay. That to me is stupid, is isn’t an insult to be assumed as gay so why should I go out of my way to make sure everyone knows I’m not, it’s ridiculous. I am secure in my sexuality, I make no secret of the fact that I am happily married and that is enough for me.
I consider myself a Queer person, I am a man married to a woman however I would be open to a relationship with people of any gender in the future should my married not work out (however unlikely I feel that idea maybe. It isn’t important for me for everyone to know my sexuality as I think it is a very small part of who I am and as long as the people that matter know, it is no-one else’s business.
-Honest Trans Guy
Queer defined; 1) an umbrella term used to define the entire LGBT+ community. 2) An alternative word some use to in place of labels such as lesbian, gay etc.
—It is important to remember that some people find the word offensive.

Feminine transgender guys. –Unpopular opinion within (Jan 12th 2017)

Here’s the thing, with this blog I want to express my opinions honestly. I want to open about how difficult and painful transitioning it. It’s not all before and after shots showing super masculine, cis passing men. I wish it was, but is just isn’t, there is a lot more to it all. There are different types of transgender male, and there is a lot of hate within the ‘walls’ of my community towards each other. In this blog I am going to talk about the hate feminine transgender males get from more masculine transgender guys. I may also talk about non binary people. I will almost defiantly say thing that not everyone will agree, say the kinds of things that lead femme guys to call masc guys transphobic. But this is my ‘Honest Trans Guy’ views, so I will do my best to be as honest as possible.

 

 

It is common misconception that all Trans men are very masculine, this simply isn’t true of course you get some Trans men who are ultra-masculine but there are many that aren’t either because they are more androgynous or even feminine. Personally I would say I was I am masculine, sure there are some feminine things about me, but as I was raised female I don’t think that’s uncommon. There is a small number of ultra-masculine Trans males who think that feminine Trans guy shouldn’t be wearing makeup and dresses etc. I have seen masc trans guys tell femme trans guys, that they aren’t really trans, that they are how can you say you are a male and then present purely female and even just plain call them females.

 

Here is the thing, I completely see the masc guys point and on a general level I agree, I do think if you put on makeup and wear a dress people are going to assume you are female, and if you are a transgender male and do those things, you can’t bitch about being misgendered as female. Most doctors that work with transgender people will use how you dress and present as part of their assessment for hormones and surgery. Also there are a large portion of cisgender people who think that ALL transgender people are just looking for attention, and transgender male who only present as female, by wearing makeup and dress etc. aren’t helping the community in anyway.

 

There is also a rising argument of there being no right way to be transgender, which again I disagree with transgender is defined as “a person whose sense of personal identity and gender does not correspond with their birth sex.” Well that is kind of the only way to be transgender, sure that doesn’t mean you have to be ultra-masculine but it doesn’t mean to be transgender you have to transition from one gender to the other.

 

I will also say that whilst I do think that transgender men shouldn’t present female, wear makeup and dresses etc. do NOT give anyone the right to degrade them, there is the right way to communicate an opinion and it isn’t being by name calling or pure aggression, all that does is make you seem like a giant asshole. However equally a transgender masculine male is NOT transphobic for telling a feminine transgender male not to wear makeup or dresses. Transphobia is defined as “prejudice against transgender people,” I would say that most of the disagreement with feminine trans guy come from a place of frustration, frustration that their behaviour and presentation just fuels the cisgender argument that ALL transgender people just want attention. Being transgender is extremely hard and when masculine people fight daily to be seen as male by all cisgender people and then they see, normally young transgender guys who don’t try to present female and making the problem harder for masculine guys. This doesn’t make the behaviour of some right but it does give it a reason.

 

Another argument I see happening a lot at the moment is about if non-binary people belong in the transgender community, and in a few cases doubting if non-binary is even a thing. In more recent terms transgender is being used as an umbrella term for anyone who doesn’t identify with their birth sex. This is a much harder thing to have an opinion on, I haven’t spoken to many people who identifies as non-binary before so I’ve not had the opportunity to hear a wide range of explanations of what being non-binary means. I do think that maybe non-binary people deserve their own community with people who understand what each other are going through, because their need, experiences and expression differs vastly from that of a transitioning transgender people.

 

I have also seen piece of information saying there should be a third gender that I strongly disagree with. There is male (cisgender and transgender) and female (cisgender and transgender), anyone who is non-binary doesn’t fall into the ‘gender binary’. Creating a third gender inside the binary would surely go against the idea of being non-binary?

Relationship compromises. Part two -children (Jan 6th 2017)

My wife and I have talked a lot about children, we both would love a child, but we both want to travel and live our lives without being tied down – no matter how harsh that may sounds. In the 10 years we have been together we have gone back and forth with if we want to have children or not. We have considered adoption, fostering, birth child and not having any at all.

In recent times our biggest problem has, when it comes to having a child, has been me. I don’t want to have a child at all until my sex has been legally changed, something I am hoping will happen till year. There is also my many surgeries to consider, several of which will take 6+ weeks for me to recover and during that time I will be stuck in bed for 2-3 of those weeks. All of these things cause a problem with having a newborn baby or even a toddler.

Something I have been struggling with for a several month now is the idea that I can’t get my wife pregnant, even though I am not bothered about our child having my DNA, as I don’t feel that makes a person a parent. But as a male, who one day will be assumed cisgender by strangers it is assumed that you will make a child, I guess it must be similar to have cisgender people feel when they find out they can’t create a baby, naturally. I have been trying to get over this feeling and I know that I won’t love my future child any less just because I couldn’t create them naturally, so isn’t that all that matters. With that in mind, my wife and I have decided to try for a baby, with the knowledge that that doesn’t mean it will actually work.

With our decision in mind, we know have to make several other decisions. Making it a long, stressful progress. It’s nice to pretend everything will be nice and simple, but it isn’t. There is a lot to consider when you can’t just have sex and make a baby. We have to think about what we want our sperm donor to look like, we have to be sure that the sperm has been tested for sexual infections, genetic disorders. We have to decide if we want to use IVF (In Vitro Fertilisation – a process by which an egg is fertilised by sperm outside of the body) or IUI (Intrauterine Insemination – a process by which sperm is inserted directly into a female’s womb in hopes it will fertilise an egg itself) or even home insemination (where a person/couple use sperm and insert it into the female’s vagina close to cervix and allow the sperm to work the same way as it would during natural conception). Each come with their own pros and cons. For example, IVF has the highest success rate but cost upwards of £5000 per cycle (and it can take a lot of cycle to fall pregnant); IUI has a success rate of about 15% for women under 35 years old but cost around £2000; Home insemination is by far the cheapest option as it cost very little, this is because it is illegal to pay for sperm however the success rate is hard to measure but if you take the success rate of natural conception as a guide it would be around 20%, raising to almost 80% over the space of a year. Home insemination does seem like the best option, calm, familiar surroundings is said to help, and the problem with home insemination is finding a sperm donor. In the UK all donors, sperm or egg, have to be known (they cannot be anonymous) this change in the law years ago has led to a dip in donors coming forward. In other countries, Denmark for example has a high donor rate as they can still remain anonymous. So even if we used a clinic, stayed at home, go sperm from a sperm bank outside the UK the donor will need to be traceable, so that at 18 any child could be able to find this person.

There is still a lot to think about, to decide upon, but I do hope that we will make the best decisions for both us and our future child.

-Honest Trans Guy