While tucking gives a more desirable presentation for many trans women, it can be damaging to spermatogenesis, the process of sperm production in the testicles. Tucking can be done by moving the penis and scrotum between the buttocks, or by pushing the testicles up into the inguinal canals (where the testicles reside before “dropping” during infancy), and securing with tight underwear or tape. Some trans women who are pre-operative or have not chosen surgery practice tucking, a way to hide the penis and the testes. Not every trans woman will choose to have bottom surgery (or surgery at all). These surgeries involve different levels of complexity and recovery. This surgery is similar to vulvoplasty, except that in addition to the clitoris, urethra, and labia, the surgeon will create an internal vaginal canal between the rectum and the bladder. After vulvoplasty, a trans woman will not have a vaginal canal, but will have the outward appearance of female genitals. During vulvoplasty, a surgeon uses the tissue from the penis and scrotum to create a clitoris, urethra, and labia. Because the testicles produce testosterone, removing them may make gender-affirming hormone therapy simpler, allowing a transfeminine person to stop taking anti-androgens and take lower levels of estrogen. An orchiectomy is the removal of the testicles from the scrotum. “Bottom surgery” is surgery performed below the waist, typically to the genitals.īottom surgery may involve one or more of these three options: “Top surgery” refers to surgery performed above the waist for trans women, that’s sometimes breast augmentation (implants). There are many different directions a trans woman can take with surgical transition. Taking estrogen, and blocking the effect of testosterone in the body, allows a trans woman to develop more typically feminine features, such as breasts, wider hips, smaller arms, and finer, slower-growing facial and body hair.Īs gender-affirming hormone therapy can have a significant impact on a person’s ability to produce healthy sperm, fertility preservation, namely sperm freezing options, can be considered at this stage. Hormones like estrogen and testosterone affect secondary sex characteristics. Androgens, such as testosterone, are “male” hormones that are found in higher levels in sperm-producing people anti-androgens or “androgen blockers” are medications that prevent testosterone from affecting the body as it typically would. Many trans women also take anti-androgen medications. For assigned-male-at-birth people, this hormone therapy usually involves taking estrogen, often considered a “female” hormone (although all sexes produce some level of estrogen). At this step, a person may seek care from a medical provider to access gender-affirming hormone therapy.
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