My understanding of the medical aspects of female to male (FTM) transsexualism is split into three categories. Hormone therapy, top surgery, and bottom surgery. These things are around to alleviate the gender dysphoria that comes with being a transgendered individual. I believe that each person has different primary... triggers for their dysphoria, and thus a different way of ranking the medical options in order of preference.
Hormone Therapy:
Injecting testosterone into one's meaty bits (thighs or arse) which then causes most of the subtle changes. Facial and body hair growth, vocal change, fat moving from hips and thighs to stomach, growth of erectile tissue (clitoral growth, basically), growth of Adam's apple and other such manly attributes.
Top Surgery:
Getting rid of the boobies. There are two main variations on this, called 'keyhole/peri-areolar' and 'double-incision/bilateral mastectomy'. The first, suitable for the smaller chested, involves the nipples and pulling the breast tissue out through small incisions in the areolae. The other option is to remove the tissue through large incisions beneath the breasts, which is then usually (but not always) followed by nipple grafts or nipple reconstruction, to get them in the right place. These processes are performed by reconstructive surgeons.
Bottom Surgery:
There's LOTS of options here. Basically, there are techniques that use what you've got down there, techniques that use extra donor flesh, techniques with machinery inside, etc. Basically, there's 'metoidioplasty' and 'phalloplasty'. Metoidioplasty is the construction of a small penis from the hormonally enlarged clitoris and skin from the labia. Phalloplasty involves using skin from the abdomen, thigh, or forearm to construct a tube of flesh that when finished, resembles the average male penis. There are about a billion different ways to do either of these, and they can be combined with hysterectomies and other procedures that reduce the female aspects of the bits.
Personally, I'm all for getting rid of the boobs and starting testosterone therapy. Sign me up. I'm a little more skeptical about the bottom surgery. I feel like... if I'm going to have the ability to enjoy the sexxins, that beats having a big visually obvious penis. I can get a prosthetic if it's a problem. There are some amazing prosthetics out there, which I'm sure I'll discuss in a future article.
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