High prices for gender reassignment and a shortage of high-quality surgeons have led to a decrease in the number of such operations in the country. State institutions have lost their monopoly on the treatment of transsexualism - this has ceased to be of interest to them due to the non-inclusion of the congenital disease in the compulsory health insurance (CHI) program. And private clinics that have entered this market cannot yet maintain the price-quality ratio. As a result, transhuman Russians go under the knife in Thailand and India, where the cost of surgical services is slightly more expensive, but the quality is higher. Details are in the NEWS.ru material.
Gender reassignment is not included in the compulsory medical insurance program
Over the past two years at the Russian Scientific Center for Surgery named after. Academician B. Petrovsky underwent only four gender reassignment operations, NEWS.ru was told at the medical institution. And this despite the fact that ex-employee of the center, Professor Ruben Adamyan, five years ago, announced several thousand T-junctions there from 1991 to 2010. At that time, the institution was the first place in the country where those wishing to change their biological sex tried to go. Also, tens and hundreds of operations for the treatment of transsexualism in 2010–2019 were performed on the basis of the Department of Oncology, Radiotherapy and Plastic Surgery of the Sechenov First Moscow State Medical University.
How many Russians today go under the knife with this problem is unknown. The Ministry of Health and First Honey were unable to provide any information about this.
Transsexualism is classified as a mental illness, but free diagnosis, treatment and gender correction for patients are not intended and are not included in the compulsory medical insurance program. These services are provided on a paid basis and are not cheap. To make a T-junction, a person must obtain permission from a specialized medical commission. At the same time, he is prescribed a course of hormonal therapy, which transforms his appearance. After the operation, you have to change your documents.
Transsexualism is a condition in which a person feels like a person of a different gender, opposite to the biological one. Without medical help, transgender people experience gender dysphoria (a form of low mood (the antonym of euphoria) characterized by gloomy irritability and a feeling of hostility towards others) and are at higher risk of suicide than ordinary people.
The quality of life of patients is reduced, they experience difficulties in various social aspects , says a plastic surgeon, an employee of the department of oncology, radiotherapy and plastic surgery at the University. Sechenov Vladimir Safronov.
The NEWS.ru interlocutor does not believe that the number of sex reassignment operations performed in Russia is decreasing. Interest in them, he says, is due to the prevalence of transsexualism. And this indicator is stable. According to research, the frequency of T-transition MtF (male to female) is 1:14706 and 1:38462 FtM (female to male).
The creators of the trans initiative group “T-Action” are confident that the situation in the market for services for transsexuals has changed in the last ten years. By 2022, government agencies have lost their monopoly on providing such assistance, giving way to private clinics. Therefore, today only a few turn to public organizations for gender reassignment, preferring a few reputable doctors from commercial structures.
Regarding masculinizing genital surgery, the situation in Russia is very deplorable. Most transmen are reluctant to go under the knife, not just because of the cost. This is a great deal of trauma, risks, and an insufficiently high result that modern medicine can, in principle, offer.
But again, a certain number of such operations are also done here ,” Fr.
It is especially difficult to find specialists in the field of masculinizing mastectomy and genital surgery, community representatives said. Easier - for feminization of the face, vocal cords, removal of the Adam's apple, feminizing mammoplasty, since the same operations are performed on cisgender women (cisgender is a term denoting people whose gender identity matches the sex assigned at birth).
Due to the shortage of professional surgeons, many who want to change their sex prefer to go under the knife in Thailand or India. The cost of correction in these countries is not much more expensive, but the quality of the result is higher than in Russia.
Liu Kun/XinHua/Global Look Press
Newly minted men who are happy in their new look
The world is rich in stories about the successful sexual transformation of a woman into a man. These people are incredibly happy and satisfied with their new life. They remember their existence in a biological body with a shudder.
Leith Ashley, born a girl, already felt discomfort from his body from the age of 5. At the age of 19, he made the transformation into a man. Leith worked a lot on his body: he took hormones and trained in the gym. Now he is a fairly successful model, he has worked with such famous designers as Calvin Klein, Versace.
Some transgender men even manage to carry and give birth to a child. Trystaine Reese became a man under the influence of hormone therapy. He did not resort to castration surgery, that is, removal of internal organs, which allowed him to become pregnant and subsequently give birth to a healthy boy.
By the way, before this Tristain had a miscarriage. Currently, in addition to his own son, he and his boyfriend are raising two more adopted children. In the future, the transgender is determined to complete his transformation by adjusting his genitals.
Change your gender for several million rubles
In domestic private clinics, a “full package” of procedures for the T-transition from a man to a woman at minimal prices today will cost an average of more than two million rubles. “Transformation” into a man is cheaper - 500–600 thousand rubles. As a rule, before the operation, the patient is introduced to his future appearance using a 3D image. Surgeons perform feminization of the face and body for men, and masculinization for women.
On the other hand, not all patients undergo the full scope of correction, stopping at the stage that is sufficient for them to achieve psychosocial adaptation, Vladimir Safronov from the University named after Vladimir Safronov told NEWS.ru. Sechenov. He explained that, depending on the stages, the cost of correction can be more than a million rubles, but all interventions are not performed at once. The doctor is convinced that the inclusion of surgical gender reassignment in the lists of compulsory medical insurance and high-tech medical care will significantly simplify patients’ access to medical care and improve its quality.
On Internet forums dedicated to this problem, they often discuss whether it is worth making a “transition,” as the T-transition is called there. Many are deterred from taking such a step by the high cost of a surgeon’s services, the low aesthetic effect, and some by religious considerations. A regular forum participant with the nickname Chukchi, an Orthodox Christian, responds to the opponent of the operation:
We had a mastectomy (surgery to remove the breast). I was on HRT (hormone replacement therapy) for eight years. And you consider yourself a “non-op” (Non-operative transsexual person, unoperated transsexual. - NEWS.ru) . In fact, many TS are limited to mastectomy and HRT. And this is called “post-op”. To finally move into this category, all you have to do is change your passport. As for the negative impact of HRT on your health, this is individual. In your case, many people have been on HRT for twenty years without having a hystero (a method of examining the uterine cavity) - and everything is fine with their health and weight.
A forum participant with the nickname Maxim161 is sure that he will remain dissatisfied with the result of the “transition”.
My appearance allows me to adapt, using tightening and the right clothes. Maybe I'll live to see better technology. Basically, I want changes that medicine, art modification or sports cannot provide. They partially go beyond the FTM transition.
Financially, I can’t afford all this either; at best, it might be enough for amateur HRT (hormone replacement therapy), and then after a while. Again, this circumstance comes from a state of health - all sorts of congenital nastiness with bones and other physiological surprises that reduce ability to work and reserve strength, but formally “are not serious for everyone.” All I have been able to do so far is to achieve my own private space (housing) and not slide from apathy into depression. I got very burnt out along the way.
Forum member None writes:
I don’t do surgeries because I have a very feminine body type - narrow shoulders, narrow ribs (60 cm girth), wide hips, thin bones (wrist girth - 13 cm). I understand that even after starting hormone therapy and having breast removal surgery and all this, I still won’t look like a man, but rather like a very strange unhealthy woman. Do I need it? Definitely not necessary. A complete dead end. I’m trying to socialize according to my physical gender, but my personal life is very bad. I don’t know what to do, because the available options are not options at all.
Features of hormone therapy during the FtM transition
The task of hormone therapy during the transition of a woman to a man is the process of masculinization, that is, the acquisition of masculine traits: a change in voice, the acquisition of masculine body shapes, including the redistribution of fat, hair growth according to the male pattern, the disappearance of menstruation.
This goal is achieved by artificially introducing the main male hormone - testosterone, mainly by injection, but gels and transdermal patches are also used. If menstruation persists, oral forms are used - tablets, capsules.
Testosterone hormone therapy begins with short-acting drugs. This is necessary in order to observe the body’s reaction to the influence of a new substance. Such a drug, for example, is Androgel, which creates a daily concentration of the hormone in the body with a single use.
After four weeks, long-acting testosterone is added. A drug such as Nebido, when administered intramuscularly, retains its effect for 3 months.
During therapy with hormonal drugs, not only the formation of secondary sexual characteristics of the desired gender occurs. Atrophy of the own gonads is observed. Sclerotic cysts form in the ovaries, due to which their activity gradually fades away. They do not fully produce female sex hormones and do not participate in the generation of eggs.
Not every woman who decides to transform can resort to HRT. There are contraindications that strictly prohibit its use. These include malignant tumors of the breast and uterus, and coronary insufficiency. But the very first contraindication to HRT is pregnancy and breastfeeding.
There is also a list of pathologies in which the doctor makes a decision on the possibility of carrying out hormonal replacement therapy based on the individual characteristics of the patient:
Here is an example of the dynamics of the development of male sexual characteristics in a girl who decided to become a man and began hormone therapy at the age of 20. She felt the first changes already on the second day: sexual sensitivity changed. The breasts gradually decreased and the clitoris increased. For several months the changes were quite painful.
Next, the fat layer disappeared from the chest and thighs. The contours of the face changed and, naturally, hair began to grow.
The female reproductive system itself is more resilient than the male. That is, if a man takes female hormones and his testicles atrophy, then when it stops, it is quite difficult to restore the former sexual characteristics.
If a woman decides to stop her transformation and stops taking male hormones, she should be prepared for the fact that certain changes are irreversible. These include hair growth, voice timbre, and an increase in the size of the clitoris. And in case of long-term therapy, it is impossible to get pregnant.
Reversible consequences include an increase in muscle volume and a change in body shape, a change in sexual behavior, an increase in body odor, an increase in appetite and an increase in body weight. After cessation of androgen therapy, the menstrual cycle resumes and the vagina returns to its original shape.
The state makes money on the treatment of transsexualism
Nevertheless, plastic reconstructive and aesthetic surgery has made a big leap in Russia since the 1990s. Even 15 years ago, domestic specialists developed various methods for treating transsexualism, diagnosing gender identity disorders, technologies for forming a neophallus and vagina during operations, etc. And in 2022, the Center for Commercialization of Technologies of the University named after. Sechenov received a patent for “a method for correcting the contour of the soft tissues of the anterior chest wall in the nuclear form of female transsexualism” (masculinizing mammoplasty). After the operation, the differences between the breasts of a man and a transman are practically invisible, as follows from the description of the development.
The authors of the new correction method - Olesya Startseva, Ruben Adamyan and Vladimir Safronov - present clinical cases, comparing photographs of the patient before surgery and two years after it. According to the doctors, the predicted aesthetic effect of the operation was confirmed by the high assessment of the client, and no re-operation was required.
In the period from August 2012 to February 2018, at the bases of the Department of Oncology, Radiotherapy and Plastic Surgery of the University. Sechenov, 57 operations were performed in accordance with the proposed method, and the patients had breast sizes from B to F. The vast majority of patients (98.2%) rated the result of the operation as good and very good, achieving maximum aesthetic effect.
Transformation of a man into a woman
A transformation of this kind involves the following corrections:
To modify the penis, it is removed, leaving only part of the head to form the clitoris, as well as nerve fibers and blood vessels. The skin of the penis and scrotum, part of the intestine goes to the formation of the labia and vagina. The empty “skin sac” of the genital organ is turned out, as it were, and an incision is made. A cavity is formed corresponding to the vagina. Usually its depth reaches about 15 cm. But this figure is inaccurate: it all depends on the size of the manhood.
The new vagina does not have sufficient sensitivity and does not produce the required amount of lubricant. During the year after plastic surgery, vaginal dilators should be used to prevent the hole from becoming closed. In the future, with a stable sex life, this will no longer be necessary.
What's next
Most transsexuals stop at coming out and hormones. And this turns out to be quite enough for them. A very small percentage decide to undergo surgery. There are several reasons for this. One of them is finance. Thus, genital correction costs approximately 500,000 rubles. A complete surgical transformation will cost the trance about 2 million rubles. The amounts are considerable, and not everyone can afford them.
Some decide to modify the breasts and remove the internal genital organs: the uterus, its appendages, and testicles. Fortunately, there are no such strict restrictions for this as for changing genitals.
Having gone through the first two stages of transformation, quite a large number of transsexuals feel great.
Thus, the American girl Susan Angel did not like her body since childhood. And when her breasts began to grow, it completely threw her into confusion. She became addicted to alcohol and drugs and even tried to commit suicide. And all because she didn’t understand what was happening to her.
Fears and doubts stopped when Susan decided to change her gender. She managed without surgery. And now her (or his) name is Buck.
Life after the transformation became different. Buck is a porn actor who also produces similar films. In addition, he is on the Board of Directors of the Foundation for Human Sexual Freedoms.
After a gender change, you must document your new identity. To do this, you should contact the relevant authorities to change documents. The basis for this is hormone therapy, as well as surgery, but not even necessarily to correct the external genitalia - this could be, for example, amputation of the mammary gland.
