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I still have my male anatomy, but I embrace femininity on my own terms. I don't desire to have a vagina or be like other women. I simply want to express myself in a feminine way.

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.

- "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."

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.

A politician introduces a video clip of a surgeon who identifies as the "queer surgeon" and performs gender affirming surgeries. The politician expresses concern over experimental and irreversible procedures being performed on children. In the clip, the surgeon states that 80% of their practice is gender affirming surgery, with a focus on genital surgeries like vaginoplasty and phalloplasty. They acknowledge an increase in adolescents seeking surgical intervention, which presents unique challenges, especially for those who have undergone puberty suppression. The surgeon admits that there is a lack of published research on genital surgeries for pubertally suppressed adolescents and that they are "just kind of learning and figuring out what works." They explain that puberty suppression affects the amount of tissue available for vaginoplasty, requiring alternative techniques like using peritoneum to line the vaginal canal. The surgeon notes that they will know more about the outcomes in 5-10 years and that it will be fascinating to see how these kids turn out. The politician then condemns these procedures as "barbarism" and "mutilation of children" that should be illegal. They claim that children lack the capacity to make such life-altering decisions and that sex is an immutable characteristic.

The speaker underwent a 7-hour procedure with complications, leading to pain and internal scar tissue. Despite efforts, the new organ was rejected by the body. The speaker criticizes the surgeon for misleading advice and advocates against early gender surgeries. The speaker expresses sympathy for others who have experienced similar situations.

"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.

Speaker 0 explains that sex is not only functional for making babies; it can also be enjoyable. They have previously said that it’s fun to explore and to discover how their body works and how the other person’s body works. Speaker 1 asks questions about whether the other person has touched their penis, when they do it, and under what circumstances. They ask if it happens while eating or in class. Speaker 0 responds that touching in class is not appropriate and asks why that would happen. Speaker 1 reiterates that it shouldn’t happen in class and asks when someone can touch their penis. Speaker 0 clarifies that touching can happen at home. They state that it’s not only boys who are able to reach climax; girls can also climax. They note that girls do not have ejaculation, because they do not have semen. However, it is described as a pleasant sensation. Speaker 0 continues by describing female anatomy: a vagina, the labia majora, and the inner labia. They mention two openings: one for urination and one through which a baby comes during birth. Above these openings, there is a small knob. They ask if this has been seen or studied before. Speaker 1 says no, not really having studied it. Speaker 0 identifies the knob as the clitoris and explains that touching it can give a very pleasant sensation. They describe that you can feel pleasure by touching the clitoris, and give an example of rubbing it with a finger. In summary, the conversation covers: the idea that sex can be both functional and enjoyable; the normalcy of exploring one’s own body and understanding how bodies work; guidance on appropriate settings for exploring (home rather than in class); the fact that both boys and girls can experience sexual pleasure, with girls potentially experiencing climax though without ejaculation; a basic description of female genital anatomy (vagina, labia, two openings, clitoris); and the notion that stimulating the clitoris can produce pleasant sensations.

For bottom surgery, hair removal is extremely important. For hair removal for a vaginoplasty, you can use laser. And because we're usually using penile inversion vaginoplasty, we need that hair to be removed because that's going to be the inside of the new lining of the cavity. Not only do we not want hair in there, it also can cause a lot of complications. So we go through that with you before, and then we do many hair checks as well to make sure that you're on the right path.

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.

I prefer male pronouns and presenting as male. I want to either have no genitalia through nullification surgery or have female genitalia. Even if I don't have testicles, I would still take testosterone. My husband and I haven't decided on surgery, but I have started tucking and binding my genitals, which has been life-changing for me.

"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."

Gender affirming hysterectomy is similar to a regular hysterectomy, involving the removal of the uterus, cervix, and fallopian tubes. Sometimes, the ovaries are also removed in a separate procedure called bilateral oophorectomy, but this is not always necessary for gender affirming hysterectomies. People undergoing this surgery do not have to have their ovaries removed.

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.

A breakthrough in surgery is the ability to harvest the peritoneal lining. Jazz, a medical case, presents a challenge as her puberty was effectively blocked, preventing normal genital growth. This makes it difficult for surgeons to use a conventional approach. They are using the peritoneum tissue to create what can be described as a patchwork or Franken vagina.

The speaker states that circumcision results in the loss of about 80,000 to 100,000 Meissner corpuscles, which are described as the pleasure-centered nerves. What is gained back are the field nerves in the gland.

- "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."

Breast augmentation for transfeminine patients is augmenting or increasing the volume of the breast tissue. And when we do that, we're trying to reconstruct a more feminine appearance to the chest. We typically do that with silicone implants that can either sit under the muscle or under the breast tissue itself. To the majority of the patients, they have this surgery several years after being on estrogen because estrogen itself can cause a building of breast tissue. It's very typical that we will need to increase the distance between the nipple to the fold underneath the breast and we are able to do that in the same procedure as well.

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.

A doctor states that roughly 50% of the baby girls he delivers require an operation to remove and reshape a penis and testicles, adding that five of his seven daughters had the procedure. He claims Louise, one of the first babies he delivered, has dating problems. Another doctor accuses him of mutilating over 2,000 little boys by performing this surgery. The doctor responds that they weren't boys, but little girls trapped in little boys' bodies, and that boys are bad.