FTM Reassignment Surgery Possible in One Stage

[NEW YORK] - Italian researchers have successfully performed a procedure that changes a woman into a man in one operation, a process that normally takes multiple surgeries to achieve.

While the idea of one operation to achieve sex-reassignment is likely attractive to many, some argue that the benefits of the procedure are often outweighed by its costs, both literal and figurative.

In the recent issue of the journal BJU International, Dr. C. Trombetta and colleagues from the University of Trieste in Italy describe operations during which they removed the breasts, ovaries and uterus of three women, then used tissue from their abdomens to fashion a penis. All of the steps in the complicated process of sex-reassignment were completed during one operation.

The operations required two surgical teams, one to remove the patients' breasts, the other to remove their female sexual organs and to manipulate the skin to form a penis. The entire procedure lasted 6 hours, and patients returned home after 12 days in the hospital, with no major complications. The patients were apparently satisfied with the appearance of their new bodies--something not all patients who undergo sex-reassignment surgery report.

The authors also describe a new procedure that fashions a penis out of the skin of a patient's abdomen, a variation on current techniques that take skin from other parts of the body.

In an interview with Reuters Health, Denise Leclair, executive director of the International Foundation for Gender Education, who reviewed the article, said that there are many reasons why some people opting to go from female to male might want it all taken care of during one procedure. Often, she said, women are not permitted to receive the procedure until after they have dressed and acted--in short, lived--as a man for one year, during which they are often subject to prejudice and harassment.

"It's nice to be able to get through this stuff as quickly as possible," she said.

However, Leclair added that sex reassignment surgeries are often prohibitively expensive, and are not covered by insurance in the US. For instance, removing a patient's breasts costs approximately $6,000, while the procedure to fashion a penis out of the patient's own skin can run upwards of $100,000. And for some patients, that is too much money to put up all at once, Leclair said.

Dean Kotula, the author of the new book "Phallus Palace" about the procedures used to change a woman's body into a man's, said that he believed taking skin from the forearm might suit patients better than taking it from the abdomen and other body regions. Parts of the forearm are more sensitive to touch than skin from other areas, he noted, and the forearm skin also bears a strong resemblance to that of a penis.

Kotula added that in Europe, sex reassignment surgeries are much more common than in the US. As a result, he said, many European doctors are becoming experts at the technique while, in the US, only a few know the procedure. Consequently, a procedure like the one described in the current study is possible in the US, but assembling a team of American doctors to perform all parts of the surgery at once would be very difficult, Kotula said.

"There's plenty of doctors that will do the mastectomy," Kotula said, referring to the breast removal portion of the surgery. "There's less than a handful that will perform the lower part of the surgery."

He added that the entire female-to-male procedure can take a large psychological toll on the people who go through it, and those who can wait to change their bodies, emotionally speaking, may prefer to space out the procedures. People who wait may also benefit from new, as yet undiscovered technologies, which might give them a penis that would look and feel better than the procedures used now, Kotula said.

SOURCE: BJU International 2002;90:754-757.