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Long term implications of chest reconstructions are several. Important for the patient to remember that this is irreversible procedure. The patient will not be able to breastfeed in the future. And to the majority of the patients, they are going to lose completely the sensation in the nipples. Because we are disconnecting the nipple completely off and reducing the size and the thickness, we are placing them back in. Most of the times, their nerves do not grow in and therefore they will be completely numb or somewhat numb.

We're starting the process with Ting, who wants a vagina. The network of moms is supportive. Nicole is a junior in high school, planning surgery between junior and senior year. She's doing great.

If someone desires female anatomy but does not have it, there is a surgical option available. This procedure involves inverting the penis to create a vagina.

"Speaker 0: A phalloplasty is a procedure to basically create a penis or a phallus for an individual who was born biological female and who seeks transition to, a male, gender." "Speaker 0: The procedure is done with plastic surgeons and urologists." "Speaker 0: The urologists manipulate the tissues in the surrounding area to lengthen the urethra." "Speaker 0: A new scrotum is created and, some of the anatomical parts of, the female anatomy are removed." "Speaker 0: We typically utilize tissue from elsewhere." "Speaker 0: For example, the forearm or the thigh is used." "Speaker 0: The plastic surgeons are also responsible for, providing sensation by doing the nerve coaptation so that the new phallus will have sensation, and also responsible for reestablishing the blood supply, and also to shape it in a way that appears more physiologically and anatomically like a natural one."

- "Puberty blockers are a group of medications or hormones that we use in the transgender population to stop puberty from progressing." - "We call them in endocrinology gonadotropin releasing hormone analogs or agonists." - "Their job is to really interfere with the signaling from the brain to either the ovaries or the testicles that produce the hormones." - "When somebody starts puberty, we can use them to stop the puberty from progressing, thereby allowing somebody to really explore their gender without the pressure of having secondary sex characteristics that are often permanent." - "And the really nice thing about puberty blockers is that they are reversible, so it's a really nice way for an adolescent to be able to explore their gender." - "We like to use them in birth assigned males who have already even gone through a full male puberty because they are able to then use a lower dose of estrogen."

Speaker 1 had gynecomastia surgery because he was tired of worrying about what clothes to wear. During a follow-up appointment, he tells Dr. Duffer that one nipple seems to get more erect than the other and sticks out a little more. Dr. Duffer says that Speaker 1 looks really good and natural and that one side of his chest is firmer, possibly due to more scar tissue. Speaker 1 says he noticed tissue when he was 13 and it never went away with working out or dieting. He researched plastic surgeons and was nervous at first due to swelling, but the results were priceless. He doesn't have to obsess over what to wear anymore. Later, Speaker 1, who is Officer Sewell, offers the doctor and another person a ride to a gay bar. He then invites a cop to hang out with them later at the gay bar.

Chest reconstruction is a procedure that we perform to patients who identify as non binary or transmasculine or interested in, having their breast removed and to reconstruct a more masculine appearance of their chest. Most of the times it includes a mastectomy, which is the medical term to describe a removal of the breast tissue, but also, building a more masculine appearance to the chest, eliminating the inframammary fold and reconstructing the nipples in a more masculine position and appearance.

Max, who identifies as a boy, is visiting the doctor to discuss hormone blockers to prevent puberty. He has started experiencing some breast growth and feels uncomfortable. His parent expresses concern about medical interventions and their effects on bone health and psychosocial development. The doctor explains that hormone blockers can halt puberty progression and reassures that if Max changes his mind, he can still go through female puberty later. The procedure involves inserting a small implant in Max's arm, which will last about 14 to 18 months. The entire process is quick, taking only about 10 to 15 minutes.

Speaker 0: In the immediate recovery after chest reconstruction, the patients are going home the same day or the following day. In the majority of the cases, they go home with a drain in each breast pocket and they have some dressings. They also have a foam to cover their chest to help with reducing the swelling and the risk for bleeding and a surgical vest. The majority of the patients describe that their pain is between two to four out of 10, and most of them don't take any narcotics and need a few medications just to control the pain.

"For someone who is assigned male at birth and if they've already been through puberty, they could produce a semen specimen and have it frozen." "If someone is assigned female at birth and they are also all the way through puberty, you can do egg banking, which entails a little bit more." "Typically, you have to take some additional hormone injections and it's a procedure to go in and retrieve the eggs." "We think someone has to be probably in mid male puberty to produce semen." "There have been some case reports of transgender men who were assigned female at birth who weren't completely through puberty and have been able to do fertility preservation, but we don't know if that applies to everybody." "We definitely counsel all of our patients about fertility preservation." "Usually from their first visit, we're starting to talk about it."

Penile inversion vaginoplasty is the full name of vaginoplasty. In this procedure, the surgical team is creating the outer and the inner vagina. The reason it's called penile inversion vaginoplasty because we use the penile skin and the scrotal skin in order to reconstruct the vagina. By doing so, we break it down to all of its components and we use some of the tissue to reconstruct things the way they were supposed to be for that patient.

There is not one surgery that every transgender person wants. Many transgender people have no interest in having surgery. For other people, they undergo medical transition involving use of gender affirming hormone treatments. And for others, they may have one or more surgeries. They may have top surgery, which is surgery on the chest or breasts. They may have bottom surgery, surgery on the genitals. They may have facial feminization. Trans women may have a tracheal shave to reduce their Adam's apple. No two trans people have the same needs to resolve their gender dysphoria. So you can never make an assumption that any trans person wants any particular surgery or any surgery at all.

In this video, the speaker shares their top surgery results, which they had three years ago with Dr. Katharine Gast. They show their faded scars and mention that they don't do much scar care because they like how they look. The speaker emphasizes the importance of their decision to have top surgery at 16, which involved removing excess chest tissue and masculinizing the shape.

A gender affirming hysterectomy is very similar to most hysterectomies that occur. Hysterectomy itself is the removal of the uterus, the cervix, which is the opening of the uterus, and the fallopian tubes, which are attached to the sides of the uterus. Some gender affirming hysterectomies will also include the removal of the ovaries, but that's technically a separate procedure called a bilateral oophorectomy. And not every gender affirming hysterectomy includes that, and people who are getting gender affirming hysterectomies do not have to have their ovaries removed.

"The eligibility for getting gender affirming surgeries at Boston Children's Hospital is basically the same as it would be for most other hospitals or surgeons in The United States." "And that's the case because we all follow the World Professional Association for Transgender Health or WPATH standards of care." "For top surgery, you are requested, but not required to have been on gender affirming hormones for at least a year." "If you're a trans woman, it's really encouraged that you be on estrogen for at least a year because you want to maximize your natural breast growth." "Many surgical centers require you to be 18." "At Boston Children's Hospital for top surgeries, we'll see people as young as age 15 if they've been affirmed in their gender for a long period of time and don't really have any other life complications that make surgery inappropriate."

Binding is essentially when someone who's assigned female wears something on their chest to make it appear flatter. And a lot of my patients who identify as transgender male or non binary or male leaning like to do that. The top three tips I have for safe binding are to first make sure you're measuring correctly. And sometimes it might take the assistance of like a parent or a trusted friend to do it right. Second, making sure that you're buying not only the correct size for your chest measurements, but for your shoulder measurements too. Cause a lot of people make mistakes there. And then the third tip is definitely not wearing it for more than ten hours a day.

Penile inversion vaginoplasty, also known as vaginoplasty, involves creating both the outer and inner vagina using penile and scrotal skin. This procedure reconstructs the vagina by utilizing the patient's own tissue.

"Puberty blockers work at the level of the pituitary gland and they actually suppress the release of the LH and the FSH so that the sex organs are no longer stimulated." "The main benefit is that they prevent the unwanted permanent effects of puberty, and thus future surgeries can be avoided as an adult." "They are also reversible, and thus if the patient decides to stop using pubertal blockers, their endogenous puberty will resume as previous." "Using pubertal blockers can alleviate the depression or worsening gender dysphoria that is often associated with progressing pubertal changes." "Lastly, the use of puberty suppression is recommended by the Pediatric Endocrine Society in their clinical guidelines for the treatment of transgender and gender diverse youth." "The practice of using puberty suppressors in transgender youth is new." "Since the first clinical guidelines were only published in 02/2009."

Michigan Medicine strives to be a safe, welcoming place for transgender individuals and to provide excellent health care regardless of gender. The goal of this video is to improve the comfort and competency of frontline staff in caring for transgender individuals. We will start by talking about gender identity, challenges the transgender community has faced in the health care system, and Michigan's policies regarding gender non-discrimination. The second half of this training is job specific. To discuss gender identity, it is important to understand the difference between sex and gender. Sex refers to one's reproductive organs, native hormones, and chromosomes, while gender identity refers to one's internal sense of gender, a person's basic sense of being a man or boy, a woman or girl, or another gender. Gender identity can be expressed by how individuals present themselves socially, including clothing, physical characteristics, speech, and mannerisms. All people, whether they are transgender or cisgender, meaning not transgender, have a gender identity and expression. Transgender is a term for individuals whose gender identity differs from the gender identity typically associated with their sex assigned at birth. There are many identities that fall under the umbrella of transgender. Transgender men, trans men, or trans masculine refer to people who are assigned female sex at birth but identify as men or masculine. Transgender women, trans women, or trans feminine refer to people who were assigned male sex at birth but identify as women or feminine. Other individuals may identify as genderqueer, agender, genderfluid, two spirited, bigender, or another identity that does not fit neatly into the categories of men or women. All major American medical societies, including the American Medical Association and American Psychological Association, endorse gender affirming care as the standard of care for transgender individuals. This means caring for people in a way that supports their gender transition and gender identity. Transgender people may undergo any one of a number of gender affirming medical interventions, including hormonal therapies like estrogen, testosterone, or hormone blockers, and surgical treatment to change body contours or genitalia. However, it is important to note that one does not have to undergo any medical or surgical treatment to be transgender. Some people are easily read as the gender they affirm while others are visibly gender non conforming or androgynous appearing.

Speaker 0 confirms that the person is currently taking 6 milligrams of estrogen per day. Speaker 1 clarifies that they take it twice a day. Speaker 0 reviews the person's history and asks about the surgery they are seeking. They discuss the irreversible effects of estrogen therapy, such as breast development and shrinkage of the testicles. Speaker 0 mentions that hair growth and redistribution may be affected by estrogen. Speaker 1 mentions that they are not complaining about taking daily pills, but rather wondering if it accelerates the process. The conversation ends.

- "Vaginoplasty is a relatively big procedure." - "It takes about between four to six hours in the Operating Room and therefore there is some swelling involved, there's some pain involved." - "But most of the times we actually administer epidural anesthesia as well, which helps a lot with the pain management for the patient." - "A very big component of the vaginoplasty procedure is the post op care." - "Seven to ten days after the procedure, the patient is required to start doing dilations." - "In the dilations, they are using different sizes of dilators gradually, and they need to do that several times a day for minutes a day." - "The reason for that is because otherwise the cavity will not be maintained and the old reconstruction can be lost."

Karen Selva, pediatric endocrinologist and medical director of Randall Children's Hospital T Clinic, discusses puberty blockers for transgender and gender expansive youth. Puberty blockers work at the level of the pituitary gland and they actually suppress the release of the LH and the FSH so that the sex organs are no longer stimulated; The signs are blocked and don't progress. The main benefit is that they prevent the unwanted permanent effects of puberty, and thus future surgeries can be avoided as an adult. We can prevent chest reconstruction in affirm trans males or facial feminization surgery in transfemales. They are reversible; if stopped, endogenous puberty resumes. They can alleviate depression or worsening gender dysphoria. The Pediatric Endocrine Society recommends puberty suppression in clinical guidelines for transgender and gender diverse youth. The practice is new; first guidelines were published in 02/2009, and long-term data are not yet available.