Transvox - Ed Whelan and Gender Confirming Surgeries

[00:00:07] [SPEAKER_02]: Hi, hi, hi and welcome back to Transvox. And with this with me this week, a bright shiny face, not Jenny this week I'm afraid it's Edward Whelan.

[00:00:19] [SPEAKER_02]: Now, now I know you called Edward Whelan but I have rolled this fan station to call you Ed which is much easier.

[00:00:25] [SPEAKER_02]: That's fine, great.

[00:00:27] [SPEAKER_02]: Where in the world are you Ed?

[00:00:28] [SPEAKER_03]: I am currently based in London.

[00:00:31] [SPEAKER_02]: Wow, so I don't know about you but today we have a sort of a large arc floating down the high street and this is what passes for the British summers.

[00:00:40] [SPEAKER_02]: Is it the same for you down there?

[00:00:42] [SPEAKER_03]: Yeah absolutely, we've got sort of heat and rain at the same time so it's kind of muggy which is not very pleasant.

[00:00:49] [SPEAKER_02]: At least you've got one thing that's good, we just got rain.

[00:00:52] [SPEAKER_02]: Well look, I know for this Tom food only. Tell me a bit about yourself Ed if you would.

[00:00:58] [SPEAKER_03]: Sure, so I'm a trans guy. I started my transition way back in 2002 and so it's been a long old time.

[00:01:11] [SPEAKER_03]: Yeah, I started in Scotland and it was a, I found it like a strange time now looking back because there was no Facebook, no Twitter and I literally stumbled upon the fact that I was trans by just Googling certain things I wasn't looking.

[00:01:26] [SPEAKER_03]: And I came across what was then the Yahoo! FTM forum for trans guys, FTM being female to male.

[00:01:38] [SPEAKER_03]: And yeah it was like a bolt out of the blue for me to go from one day thinking, oh you know I feel like I should be wearing more men's clothes.

[00:01:48] [SPEAKER_03]: That feels like what should be right for me and I was just Googling around that and then I came across this forum and it said, oh this is a place for people who've always felt that they should have been born into a male body.

[00:02:00] [SPEAKER_03]: And like 48 hours later I was down the GP saying, I've solved it, I know what's wrong. I know what's wrong.

[00:02:06] [SPEAKER_03]: And then sent me a consultation to the gender clinic and yeah, and then just from there I kind of just clicked through the usual transition steps got referred to the clinic, then got referred for hormones, then got referred for surgery and just found my way through it.

[00:02:29] [SPEAKER_02]: Yeah. So before we get to surgery, which I know is your particular expertise, can you talk to because obviously as a trans woman and yeah, you know, we, I understand having spent quite a lot of my life as a guy,

[00:02:45] [SPEAKER_02]: I understand this idea that you know it's not right but you don't know what it is and then some day somebody points at that what it is and they think oh yes that's what it was.

[00:02:54] [SPEAKER_02]: But a lot of people don't understand that they think we sort of transgender by choice so we're just sort of, you know, come across it on a whim.

[00:03:02] [SPEAKER_02]: But I'm guessing this is something that you'd experience over the course of quite a lot of years yeah.

[00:03:07] [SPEAKER_03]: Yeah, definitely. It's some, it is a strange thing for it to have kind of all fitted into place very suddenly for me, certainly.

[00:03:17] [SPEAKER_03]: But looking back I could see lots of evidence of it as I went back and it made perfect sense to me once I had the right words for it.

[00:03:27] [SPEAKER_03]: So I think the way that the way that I come to describe it will sound I think strange to anybody who chooses not to believe that trans people genuinely exist.

[00:03:37] [SPEAKER_03]: But if you believe the trans people genuinely exist then it makes perfect sense.

[00:03:43] [SPEAKER_03]: So I had always, I'd always seen my interior character.

[00:03:48] [SPEAKER_03]: I suppose I can't think of a way to describe my real self as being male.

[00:03:54] [SPEAKER_03]: And so I the fact that I was looking like a girl and being raised you know as a girl. I thought maybe I was being a bad feminist you know that I was kind of maybe idealizing men as the right way to be and I needed to have more kind of a feminist approach to myself.

[00:04:13] [SPEAKER_03]: But then also there was, there were things about being female that I didn't mind.

[00:04:18] [SPEAKER_03]: So it was never a very clear harsh line the kind of the identity I had that was male and the identity that I had that was female thinking like as a child and then as a teenager.

[00:04:29] [SPEAKER_03]: It was, it was blurry and it was hard for me to pin down exactly what was exactly what was wrong.

[00:04:35] [SPEAKER_03]: And I had a lot of, a lot of struggles with my mental health starting as a child all through my adolescence and then I was into my twenties when I found out that I was trans.

[00:04:49] [SPEAKER_03]: I dropped out of uni. I didn't have a job.

[00:04:52] [SPEAKER_03]: My whole life was just sort of trying to hold myself together and really not understanding what the problem was.

[00:04:57] [SPEAKER_03]: I was just full of anxiety and my mood was all over the place.

[00:05:02] [SPEAKER_03]: And I had just, yeah, lots of trouble with my mental health and quite a very serious eating disorder at that time as well that I couldn't kind of grasp and deal with.

[00:05:13] [SPEAKER_03]: And then once I found out about being trans, I was like, oh, I think, I think that perfectly captures all the feelings that I had about who I was and my body and who I felt my real self was.

[00:05:27] [SPEAKER_03]: But I had never told anyone.

[00:05:29] [SPEAKER_03]: So to the rest of the world it must have come as a complete bolt out of the blue.

[00:05:34] [SPEAKER_03]: But for me, it just ticked all the boxes that I'd had inside but couldn't have didn't have a language for just didn't have any way of expressing.

[00:05:44] [SPEAKER_02]: And I think I think that's what's interesting isn't it because I've just been chatting to someone who's trans and I mean born this, born this century for a start which is a shock in my book.

[00:05:55] [SPEAKER_02]: And but also, you know, very, very young and they have no, they have the language and it never had a problem with the language. But, you know, it is interesting that you say this from the trans mask perspective isn't it that we often talk on the trans femme thing about being

[00:06:21] [SPEAKER_02]: I don't know if that's true given this. I guess I understand there is a more trans mask people and trans femme but all the fuss is about our side of the equation isn't it.

[00:06:31] [SPEAKER_02]: How do you do it?

[00:06:34] [SPEAKER_03]: Certainly when when I so yes like 20 years ago when I came out.

[00:06:39] [SPEAKER_03]: There was something like one in eight were one in eight trans people were trans mask and the vast majority were trans feminine. And I think at that time as well very few people that I knew were using words like non binary or gender queer to describe their identity.

[00:06:59] [SPEAKER_03]: So, yeah I think definitely as we have more as we have more words to kind of describe ourselves as we have more exposure of the different sorts of ways you can describe yourself the different ways you can use your identity.

[00:07:14] [SPEAKER_03]: You know you don't have to describe yourself as this and only wear those clothes you can do this and that.

[00:07:19] [SPEAKER_03]: It has really I think opened up doors for people to be like oh this is fine I can, I can say this and do this but also do that okay this is good. And I think that's I mean that's just been brilliant.

[00:07:29] [SPEAKER_03]: And I just yeah a little bit jealous I think a little bit jealous of people coming growing up now and having have that that other fingertips.

[00:07:36] [SPEAKER_02]: Yes, hello there are different challenges, obviously.

[00:07:39] [SPEAKER_02]: Absolutely yes.

[00:07:40] [SPEAKER_02]: Okay so so before again before we get to surgery let's go through the hormones piece I mean, I'm always quite jealous of trans mask people because the testosterone just really really sort of has an immediate impact on in the sort of

[00:07:57] [SPEAKER_02]: realisation of a of a of any body doesn't it's quite horrendous sort of hormone.

[00:08:03] [SPEAKER_03]: It's powerful stuff definitely definitely it has big impact and for most people I'd say fairly quick impact. And when I say fairly quick within a within a year or two.

[00:08:17] [SPEAKER_03]: So I definitely started feeling the effects within the first three to four months.

[00:08:24] [SPEAKER_03]: And when I say feel it wasn't really a feeling I think the things I noticed was, I had, I had basically my sideburns were starting to grow. So my, my facial hair was coming in down the side of my face.

[00:08:38] [SPEAKER_03]: That was where it started. And my voice, I found I didn't notice it first but I found if I tried I could drop a little lower.

[00:08:47] [SPEAKER_03]: And that happened within the first five months or so and then it kept going for maybe a couple of years.

[00:08:55] [SPEAKER_03]: And then I was like oh no I think this is this is where I'm going to stop because this is probably what my voice is going to be.

[00:09:00] [SPEAKER_03]: And other people noticed that a little bit more than me. So yeah it came in, it came in fast.

[00:09:08] [SPEAKER_03]: But that is very varied you know like I don't want to give the impression that's the same for everybody. People do have different experiences of it.

[00:09:14] [SPEAKER_03]: But yeah and then also just all yeah so your hair will grow all over your body.

[00:09:20] [SPEAKER_03]: Lots of people experienced that my eyebrows got bigger. That was one of the things that I kind of definitely noticed within the first few months.

[00:09:27] [SPEAKER_03]: And yeah just hair like on your arms and on your back and just like appearing in little patches in awkward ways.

[00:09:35] [SPEAKER_03]: And then I lost hair on my head. That took much longer I'd say.

[00:09:41] [SPEAKER_03]: And again it doesn't happen for everyone but yeah when did I start losing my hair?

[00:09:47] [SPEAKER_03]: Probably like six or seven years in I'd say.

[00:09:50] [SPEAKER_03]: It started right at the back in the traditional sort of little ball patch.

[00:09:53] [SPEAKER_03]: Didn't know until somebody took a photo from me from a balcony and then I was like oh I'm losing my hair.

[00:09:59] [SPEAKER_03]: Okay I'm going to think about that.

[00:10:00] [SPEAKER_02]: So I remember someone saying to me that being a transmask is something about having three H's.

[00:10:07] [SPEAKER_02]: Hot, hairy and horny or something.

[00:10:10] [SPEAKER_02]: Are those things, is that what you recognise?

[00:10:13] [SPEAKER_02]: Was it like did you say hot, hairy and horny?

[00:10:15] [SPEAKER_02]: Yeah hot in terms of temperature I think.

[00:10:17] [SPEAKER_03]: Oh yeah yeah so I don't get the hot thing.

[00:10:22] [SPEAKER_03]: Testosterone for me sometimes gives me a common side effect I've heard.

[00:10:27] [SPEAKER_03]: It makes you feel kind of itchy just for like a week or so straight after the shot.

[00:10:32] [SPEAKER_03]: It might depend how you're applying it.

[00:10:35] [SPEAKER_03]: So I started on something called Sustenum which is the testosterone injection.

[00:10:40] [SPEAKER_03]: You have it every two to three weeks.

[00:10:43] [SPEAKER_03]: But I started to find after a few years I started to find it was just a real,

[00:10:47] [SPEAKER_03]: it was just a nuisance stuff to go back to a GP every three weeks.

[00:10:51] [SPEAKER_03]: And then sometimes it was like every two weeks if I needed to fit it in.

[00:10:54] [SPEAKER_03]: So I switched to a different injection called Nabeedo which is every three months.

[00:10:59] [SPEAKER_03]: And I prefer it because it's less.

[00:11:01] [SPEAKER_03]: Yeah like straight, I gather in the big muscle on your bum basically at the base of your spine,

[00:11:07] [SPEAKER_03]: top of your bum.

[00:11:07] [SPEAKER_03]: And it's more convenient because you don't have to go to the GP so often.

[00:11:12] [SPEAKER_03]: And I found it gives me a smoother hormone arc like it's slower to hit and slower to drop away.

[00:11:19] [SPEAKER_03]: And that was much more comfortable definitely.

[00:11:23] [SPEAKER_03]: In terms of horniness, I'd say it's changed over the years definitely.

[00:11:28] [SPEAKER_03]: I think and some of it might have been placebo as well it's hard to know.

[00:11:32] [SPEAKER_03]: I've spoken to lots of people who say they definitely felt a real

[00:11:35] [SPEAKER_03]: a whoosh up a real increase in their libido.

[00:11:39] [SPEAKER_03]: But then I spoke to other people who said they had a real drop.

[00:11:43] [SPEAKER_03]: So I don't know and I think I'm probably somewhere in the middle.

[00:11:45] [SPEAKER_03]: It changed over times a little bit.

[00:11:48] [SPEAKER_02]: So how do you find the social effects of being male now because I'm guess because a lot of people

[00:11:53] [SPEAKER_02]: transmask talk to me a lot about they really notice the male privilege.

[00:11:58] [SPEAKER_02]: So I wonder if that's something you've come across as well.

[00:12:02] [SPEAKER_03]: Yeah, I think so.

[00:12:05] [SPEAKER_03]: I think I have noticed that I noticed that people defer to me it made

[00:12:10] [SPEAKER_03]: I think I noticed it more as I got a little older and my male appearance

[00:12:16] [SPEAKER_03]: started to match my age because when I first when I was first being recognized as male

[00:12:21] [SPEAKER_03]: in the sort of testosterone really started to kick in.

[00:12:24] [SPEAKER_03]: I was being recognized as male but I was 25 at the time and I was being recognized

[00:12:31] [SPEAKER_03]: as about 15 years old.

[00:12:33] [SPEAKER_03]: So it like it like my male privilege was quite low in some ways maybe because I

[00:12:38] [SPEAKER_03]: was seen as such a young person in a space where people around me were in

[00:12:42] [SPEAKER_03]: their kind of late 20s maybe I'm guessing a bit.

[00:12:45] [SPEAKER_03]: And then as my appearance started to catch up with my age

[00:12:50] [SPEAKER_03]: I noticed little things like maybe people looked at me first for answers in

[00:12:55] [SPEAKER_03]: certain situations.

[00:12:58] [SPEAKER_03]: I'm not particularly tall but I'm not particularly short either.

[00:13:04] [SPEAKER_03]: It's hard to know it's hard to know what would have happened

[00:13:08] [SPEAKER_03]: if I hadn't been male in any given situation but I don't move in a very

[00:13:13] [SPEAKER_03]: I don't move in a very toxic male spaces.

[00:13:19] [SPEAKER_03]: So I don't feel like the men around me are always being particularly dominant.

[00:13:27] [SPEAKER_03]: Most of my friends are female.

[00:13:30] [SPEAKER_03]: The way I work is mostly women.

[00:13:34] [SPEAKER_03]: So yeah it's hard to say.

[00:13:36] [SPEAKER_03]: I'm sure it has had an effect because I wouldn't I would want to in any

[00:13:40] [SPEAKER_03]: way suggest that like are you know that kind of male privilege thing

[00:13:45] [SPEAKER_03]: doesn't exist.

[00:13:46] [SPEAKER_03]: I'm sure it's happening around me but I'm not always noticing it which is my fault.

[00:13:52] [SPEAKER_02]: Yeah it's interesting isn't it.

[00:13:54] [SPEAKER_02]: Okay so what line of work are you in before we move on to the

[00:13:58] [SPEAKER_03]: I have an ordinary office job I work for mental health charity

[00:14:04] [SPEAKER_03]: by work just like in the office doing communication type work.

[00:14:10] [SPEAKER_03]: Oh lovely okay fantastic and you decided to write a book.

[00:14:14] [SPEAKER_03]: I did yes yes so after after my transition was was done and dusted

[00:14:22] [SPEAKER_03]: and I kind of felt like I'd been through the whole I've been through as much as I wanted to get done.

[00:14:28] [SPEAKER_03]: And it had been a long old journey so from start to finish maybe about 15 years

[00:14:35] [SPEAKER_03]: then I was like I just I need to kind of take a breather and then I was reflecting was like

[00:14:41] [SPEAKER_03]: I there was so many things that I found very difficult about navigating surgery in particular

[00:14:46] [SPEAKER_03]: that I felt that was they needed to be a resource out there that just helped people

[00:14:52] [SPEAKER_03]: when they're just starting to think about surgery could be in their future

[00:14:56] [SPEAKER_03]: and they want to just have a clear overview of the options and the pros and cons to get them started.

[00:15:04] [SPEAKER_03]: And so that's how I came to write the book she's called gender confirmation surgery

[00:15:09] [SPEAKER_03]: guide for trans and non binary people and it's an introduction to the main confirmation surgeries

[00:15:16] [SPEAKER_03]: and just yeah the pros and cons it's a starter it's a place to start it's a not

[00:15:21] [SPEAKER_03]: thorough kind of everything you need to know under the sun because really I was finding when I was starting to look at surgery

[00:15:28] [SPEAKER_03]: I could find resources like that online and they were overwhelming to me there was just too much information coming at me

[00:15:35] [SPEAKER_03]: too much for me to take in and so that's what I kind of thought there needs to be something that is reliable

[00:15:41] [SPEAKER_03]: but also just stage one to thinking about it.

[00:15:46] [SPEAKER_03]: So who's it for would you say?

[00:15:49] [SPEAKER_03]: Well definitely for anyone who thinks surgery might be in their future

[00:15:54] [SPEAKER_03]: it doesn't have to be something that you're sure about yet the book is definitely not

[00:16:01] [SPEAKER_03]: in not implying that surgery is what all trans and non binary people do

[00:16:05] [SPEAKER_03]: and it starts with a chapter which is just thinking about surgery so if you're unsure

[00:16:11] [SPEAKER_03]: if you're thinking one of the surgeries might be right for you but you don't feel 100% yet

[00:16:16] [SPEAKER_03]: there's an exercise in there for just teasing out for yourself to help you kind of sift through your thoughts

[00:16:23] [SPEAKER_03]: what do I want? What am I hoping for?

[00:16:26] [SPEAKER_03]: What do I find difficult about this part of my body or that part of my body and can surgery actually give me the thing that I want

[00:16:34] [SPEAKER_03]: because it's very easy maybe to think as we are certainly as I sort of dived into my transition

[00:16:42] [SPEAKER_03]: and just sort of head down and just plowed forward and it was right for me

[00:16:47] [SPEAKER_03]: but I wasn't stopping very long to sort of really think about what I needed and wanted all the time

[00:16:55] [SPEAKER_03]: and I've certainly met other people who maybe rushed a little bit too fast and didn't have the time and space to think about what they wanted

[00:17:02] [SPEAKER_03]: and so surgeries has a lot of options it's not always clear what those options are

[00:17:10] [SPEAKER_03]: but it can't solve everything either it can't get necessarily solve everything that you find difficult about your body

[00:17:18] [SPEAKER_02]: so it can't make you taller

[00:17:20] [SPEAKER_02]: it can't make you taller

[00:17:21] [SPEAKER_02]: no so I like the fact that you've got a sort of thoughtful thing around whether surgery is right for you because I think there is a risk with surgery

[00:17:31] [SPEAKER_02]: and I've seen it on many programmes and as a therapist myself people get easily addicted to things

[00:17:37] [SPEAKER_02]: and people can get addicted to surgeries can't they?

[00:17:40] [SPEAKER_02]: there's a sort of pursuit of something which can be I guess a risk which has to be mitigated in a way?

[00:17:49] [SPEAKER_03]: yeah and I would hope that any surgeon that somebody goes for a consultation with would spend time talking to the prospective patient about what their hopes are for the surgery

[00:18:03] [SPEAKER_03]: and whether that surgery itself can deliver that but you don't get very long in a consultation

[00:18:11] [SPEAKER_03]: maybe 45 minutes an hour

[00:18:12] [SPEAKER_03]: wow that's a long one

[00:18:14] [SPEAKER_03]: yeah maybe that but maybe much less

[00:18:16] [SPEAKER_03]: and then maybe also you've been on the waiting list for several years to get to that point to have a consultation

[00:18:22] [SPEAKER_03]: and you might have a lot of questions

[00:18:25] [SPEAKER_03]: you might also feel a lot of pressure on yourself to like I've got to convince this surgeon that this is right for me because I'm never going to go back on the waiting list

[00:18:34] [SPEAKER_03]: so that's where like I would always advocate just spend time with yourself thinking about what you really need

[00:18:41] [SPEAKER_03]: what this surgery is going to give you

[00:18:44] [SPEAKER_03]: what it's going to affect in your social life what it might affect in your sex life

[00:18:47] [SPEAKER_03]: what it's going to affect how you visualise your body

[00:18:50] [SPEAKER_03]: and also really think about what it's not going to give you

[00:18:53] [SPEAKER_03]: and then just yeah if you can go in with those kind of realistic expectations of like yeah this surgery is right for me but I also recognise it's not going to solve everything

[00:19:03] [SPEAKER_03]: then that can that's a better chance that you're happy with the results

[00:19:07] [SPEAKER_02]: so so I'm guessing and I don't know how the book is ordered and maybe I should ask you that

[00:19:11] [SPEAKER_02]: how was the book ordered so can you start with like major surgeries minor surgeries where is the sort of access point

[00:19:18] [SPEAKER_03]: it starts with it starts with a kind of general intro to you know what being transgender is and the different identities

[00:19:27] [SPEAKER_03]: because I think it could be useful for anybody working in healthcare as well

[00:19:31] [SPEAKER_03]: who is interacting with trans and non-binary patients or maybe going through surgery so it gives a bit of an intro

[00:19:37] [SPEAKER_03]: then there's a chapter on thinking about surgery

[00:19:39] [SPEAKER_03]: and just those sort of things that I was just saying about you know kind of like teasing out for yourself what you want

[00:19:45] [SPEAKER_03]: and then it goes through each of the major surgeries starting sort of top to bottom really so it has

[00:19:53] [SPEAKER_03]: top surgery for transmasked people non-binary people their breast augmentation then hysterectomy

[00:20:01] [SPEAKER_03]: facial feminisation and facial masculinisation surgery and then moving into lower surgery for trans feminine people

[00:20:10] [SPEAKER_03]: and then lower surgery for transmasked people and then also vocal surgery

[00:20:16] [SPEAKER_03]: and then there's chapters on like thinking if you've got a surgery coming up like how are you going to prepare for it

[00:20:22] [SPEAKER_03]: thinking about taking the time off work taking time off study saving money

[00:20:28] [SPEAKER_03]: preparing your home preparing yourself for going into hospital which can be a very challenging time

[00:20:33] [SPEAKER_03]: if you've never been in hospital before it could be very daunting to be in hospital for a few nights

[00:20:38] [SPEAKER_03]: it's quite an overwhelming experience so just kind of like giving people space to think about that

[00:20:44] [SPEAKER_03]: and then there's chapters at the end about checkups so like things that might have changed for your first sexual health checkups or cancer checkups

[00:20:53] [SPEAKER_03]: if you've had surgery sexual health thinking about sexual behaviour and sexuality pre-transition and post-transition

[00:21:00] [SPEAKER_03]: and then dotted throughout as well there's stories from people who've had surgery or not had surgery

[00:21:05] [SPEAKER_03]: just given their perspective on their thinking process what made them decide to have it or not have it

[00:21:11] [SPEAKER_03]: and how they found it how they dealt with it

[00:21:14] [SPEAKER_02]: so I've got a thousand questions as you can possibly tell and they're all trying to get at my mouth at the same time

[00:21:22] [SPEAKER_02]: let me just restrict myself to one before we go

[00:21:24] [SPEAKER_02]: what's interesting about transmasked people and I get all the sort of masculinisation if that's a word

[00:21:32] [SPEAKER_02]: they're there surgeries to get at but you must have a biological issue around things like eggs, wombs

[00:21:39] [SPEAKER_02]: and such like which if you're masculinising you still have the opportunity to conceive

[00:21:45] [SPEAKER_02]: you have the risk of pregnancy you have a menopause and that's slightly different for trans women

[00:21:51] [SPEAKER_02]: so you've got things to minimise the

[00:21:55] [SPEAKER_02]: so is that part of your process as well because I mean those decisions for a cis female to have hysterectomians

[00:22:03] [SPEAKER_02]: and use eggs and wombs and such like I mean that could be a massive traumatic experience

[00:22:08] [SPEAKER_03]: yes yes so so testosterone taking testosterone itself will for most people stop having a period

[00:22:19] [SPEAKER_03]: it doesn't do any damage to your internal reproductive organs and it doesn't act as a contraception

[00:22:28] [SPEAKER_03]: so even if you have stopped having a period but you're still having sex that might get you pregnant

[00:22:36] [SPEAKER_03]: you are still at risk is still use condoms or another form of contraception

[00:22:41] [SPEAKER_03]: and if you wanted to get pregnant you still do you still can do that even if you have had top surgery is still possible to get pregnant

[00:22:55] [SPEAKER_03]: usually involves coming off testosterone for a few months to kind of start up the internal processes again

[00:23:03] [SPEAKER_03]: but as far as I understand it and I'm definitely not an expert on this but as far as I understand it

[00:23:08] [SPEAKER_03]: the process would be come off testosterone wait a few months and then if you haven't had a hysterectomy everything inside is still working fine

[00:23:18] [SPEAKER_03]: then you can get pregnant and if you've had sorry what are you going to say?

[00:23:23] [SPEAKER_02]: no I was going to say I interrupted your call on if you've had

[00:23:25] [SPEAKER_03]: oh I was just going to say if you've had lower surgery and if you've had a phalloplasty which is the surgery to create a penis

[00:23:34] [SPEAKER_03]: I don't think it's possible to get pregnant because of the tissue that they use to make the penis

[00:23:44] [SPEAKER_03]: if you've had a metoidioplasty which is a different type of lower surgery

[00:23:50] [SPEAKER_03]: it's it is possible to get pregnant but you probably wouldn't have a vaginal birth you would have a caesarean section

[00:23:59] [SPEAKER_03]: because of what happens to the exterior organs

[00:24:03] [SPEAKER_02]: and I'm guessing one of the choices trans mass people have to deal with is what am I doing with eggs

[00:24:11] [SPEAKER_02]: and such like because that's something you probably need to deal with to be safe first before you actually start the testosterone in the first place

[00:24:19] [SPEAKER_03]: yeah testosterone should have no decreasing effect on your eggs or should not damage eggs in any way

[00:24:26] [SPEAKER_03]: so if you just take testosterone and you haven't had any surgery interior or exterior and then you want to get pregnant

[00:24:33] [SPEAKER_03]: those eggs are still sitting inside you you can still use them

[00:24:37] [SPEAKER_03]: but if you did want to have lower surgery and maybe use a surrogate to get pregnant later but with your own eggs

[00:24:45] [SPEAKER_03]: then the usual the usual ways that you would kind of like preserve your fertility fertility would be open to you

[00:24:52] [SPEAKER_03]: you can freeze eggs and you can freeze embryos as well so it'd be a case of speaking to a clinic and seeing your options

[00:25:02] [SPEAKER_03]: but yeah it should be all open to you as much as as much as they would be to anyone

[00:25:07] [SPEAKER_02]: let's get started then so let's start so I imagine being trans mass one of the things you're dealing with first of all is binding and then the the decision

[00:25:15] [SPEAKER_02]: I mean I'm sure there's no order to this but I'm just working my way up and down both sets

[00:25:20] [SPEAKER_02]: I suppose you start with top surgery is that is that a regular starting place for trans men

[00:25:27] [SPEAKER_03]: it definitely is I think the the current guidelines don't actually restrict people from having surgery in any particular order

[00:25:36] [SPEAKER_03]: and it wouldn't stop you from having lower surgery without top surgery if that was your option

[00:25:43] [SPEAKER_03]: but it'd be a conversation with your it would be a conversation with the clinic to kind of see if they would refer you for that

[00:25:49] [SPEAKER_03]: but I don't think it would be against the rules

[00:25:52] [SPEAKER_03]: but yeah certainly the way I did it and the way that most people I know do it is they start with testosterone

[00:25:58] [SPEAKER_03]: then they get referred for top surgery and so you're binding for as long as you know you need to

[00:26:06] [SPEAKER_03]: and then yeah and then having top surgery and then having lower surgery if you want it and looking at those options yeah

[00:26:12] [SPEAKER_02]: so I'm quite interested in the sort of I mean how long is the operation how long does it how long is the recovery time from that

[00:26:23] [SPEAKER_03]: so top surgery there's quite a few different options

[00:26:27] [SPEAKER_03]: and I don't know if all of them are currently available in the UK because different surgeons have different styles and techniques

[00:26:35] [SPEAKER_03]: and there's quite a few different top surgeons available across the UK so what's available can change

[00:26:43] [SPEAKER_03]: but a lot of people have the double mastectomy which creates the very typical curved scar sort of along the line of your pectoral muscle

[00:26:55] [SPEAKER_03]: that's the most common because it's suitable for all sizes of chest whereas the other techniques are really only suitable for quite small chests

[00:27:06] [SPEAKER_03]: which is rarer so most people have the double mastectomy the surgery itself I think maybe takes about two hours approximately

[00:27:15] [SPEAKER_03]: if nothing goes wrong and then recovery probably around four weeks I would say I think that's still about the average

[00:27:28] [SPEAKER_03]: you want to avoid heavy lifting or moving your arms around too much just kind of really protect your incision sites

[00:27:36] [SPEAKER_03]: and yeah it's it was a really interesting process for me because I had never been in hospital before

[00:27:48] [SPEAKER_03]: I had no real sort of concept of what hospitals were like and to wake up in the disorientating environment of a hospital

[00:27:57] [SPEAKER_03]: and then just be able to kind of like sort of tap your fingers across your torso and be like what I've created a new body

[00:28:04] [SPEAKER_03]: it was yeah it was just extraordinary yes I have very fond memories of it because it was both very strange

[00:28:13] [SPEAKER_03]: but also just such relief of like oh I'm just never going to have to bind again which is a huge painful awkward in the arse to do

[00:28:22] [SPEAKER_02]: yeah I can have what does sounds correct it's like binding your feet isn't it

[00:28:27] [SPEAKER_02]: it must be painful as well I know people break their ribs and have all sorts of problems breathing and all sorts of disaster especially with poor binders

[00:28:36] [SPEAKER_02]: but on the other side of the fence then so we get into breast augmentation on the other side

[00:28:41] [SPEAKER_02]: now I've discovered some quite interesting stuff there which is I mean again it's a massively complex subject

[00:28:48] [SPEAKER_02]: we're just really outlining bits and pieces but there are practitioners who deal specifically trans women

[00:28:54] [SPEAKER_02]: and they and there were people who deal with cis women and this effectively it's the same operation isn't it as far as I understand

[00:29:00] [SPEAKER_03]: as far as I know yeah your options around breast augmentation are obviously it's an implant

[00:29:08] [SPEAKER_03]: and obviously it's made of the same material whether you're a trans woman or cis woman

[00:29:13] [SPEAKER_03]: it's you've got some different materials to choose from different shapes and sizes

[00:29:19] [SPEAKER_03]: and again just different placements of the scar so depending on how large a breast you're going for you might go for

[00:29:25] [SPEAKER_03]: you might have a smaller scar or larger scar depends where it can be placed in the body

[00:29:29] [SPEAKER_02]: but the same process as far as I understand yeah yeah so that's good

[00:29:33] [SPEAKER_02]: and of course what's interesting in terms of health and equality is that the same surgeons of breast augmentation to trans women and cis women

[00:29:41] [SPEAKER_02]: exactly the same operation and it's more expensive for trans women

[00:29:45] [SPEAKER_02]: is it really I did not know that

[00:29:47] [SPEAKER_02]: it is if you shop around it is it is quite interesting so that's the first thing so the second thing is

[00:29:53] [SPEAKER_02]: so we have FFS which is facial feminization surgery is there an FMS I mean do many

[00:30:01] [SPEAKER_02]: so there is oh I didn't know that so tell me more about facial masculinization

[00:30:04] [SPEAKER_03]: there is facial masculinization surgery I do not know if there's currently any practitioners in the UK that do it

[00:30:16] [SPEAKER_03]: shop around and see who's available

[00:30:18] [SPEAKER_03]: I don't think it's particularly common but that's not to say there's anything wrong with it

[00:30:25] [SPEAKER_03]: and I think though this is an area now that my expertise is running for me

[00:30:32] [SPEAKER_03]: and so to to to feminize a face

[00:30:38] [SPEAKER_03]: and I'm using language that is that is very binary in its kind of understanding of gender

[00:30:44] [SPEAKER_03]: so really we're talking about surgery that will adjust small features around the face to make it be seen as female

[00:30:51] [SPEAKER_03]: like it's not that it isn't female it's that it's how the rest of the world is perceiving it

[00:30:55] [SPEAKER_03]: and that's usually about making features a little bit smaller adjusting things around the brow around the eyes the nose the jawline

[00:31:03] [SPEAKER_03]: so to masculinize the face you're making little things a little bit bigger

[00:31:07] [SPEAKER_03]: so you're usually putting I think implants in just a couple of places to maybe just give a bit more of that bone structure

[00:31:16] [SPEAKER_03]: that kind of like heavy bone structure look to the face but you know facial surgery is a big step

[00:31:23] [SPEAKER_03]: and it can be quite a daunting psychological one so not to be taken lightly

[00:31:28] [SPEAKER_02]: and it's something you know one looks at it and it is it is you know really it's very expensive

[00:31:34] [SPEAKER_02]: and it can be and if you see what's going on with facial feminization surgery I mean lots of people who tell that

[00:31:41] [SPEAKER_02]: they have great results and all sorts of stuff but you should go into that with your literally eyes wide open

[00:31:46] [SPEAKER_02]: because it is very traumatic on the body in some ways it's for a trans woman it's one of the most traumatic

[00:31:53] [SPEAKER_02]: surgeries in a way it's actually possibly more traumatic than GRS is it?

[00:31:59] [SPEAKER_02]: Well depends what you mean by traumatic I mean physiologically traumatic in terms of the cutting and bits and pieces

[00:32:07] [SPEAKER_03]: It is to your face so I think in some ways it can be psychologically quite daunting

[00:32:16] [SPEAKER_03]: but in terms of risks and recovery time it's not particularly extreme

[00:32:24] [SPEAKER_03]: you go to a good surgeon you shop around you spend time with that surgeon at consultation

[00:32:30] [SPEAKER_03]: you can have as many consultations as you want they will charge you

[00:32:34] [SPEAKER_03]: but it's more important that you feel comfortable if you're thinking about this surgery

[00:32:38] [SPEAKER_03]: that you feel comfortable that the surgeon is understanding what you want

[00:32:42] [SPEAKER_03]: and that you feel comfortable about his or her skills, experience and that they are hearing you clearly

[00:32:50] [SPEAKER_03]: you speak to other people who have had similar surgeries with that surgeon

[00:32:54] [SPEAKER_03]: it's always a good idea I think to speak to people who have had the same surgery as what you're thinking about

[00:32:58] [SPEAKER_03]: more than one person ideally and just give yourself time

[00:33:02] [SPEAKER_03]: and one thing I think which is very important though it's hard to do

[00:33:08] [SPEAKER_03]: I totally recognise that it's hard to do but there can be and I had this myself

[00:33:14] [SPEAKER_03]: you know I kind of feeling like I want to get everything done really soon

[00:33:17] [SPEAKER_03]: like I've waited too long or I've been thinking about this for so long

[00:33:21] [SPEAKER_03]: and now I've got my referrals and I just want to get through it

[00:33:25] [SPEAKER_03]: and actually I think what I needed when I was in the early stages of my transition

[00:33:30] [SPEAKER_03]: was a bit more time to chat to people about the options and what was available

[00:33:37] [SPEAKER_03]: so that I could really digest it and think about what was right for me

[00:33:40] [SPEAKER_03]: and so in a way I was lucky because what I chose was right for me

[00:33:44] [SPEAKER_03]: there wasn't a huge amount of options, I chose the ones I wanted

[00:33:48] [SPEAKER_03]: but I put myself a little bit of risk there because I wasn't spending enough time

[00:33:52] [SPEAKER_03]: weighing up the different options that I had

[00:33:54] [SPEAKER_02]: I think you make a good point and I think one of the things that you often see in Facebook groups

[00:33:58] [SPEAKER_02]: which is other groups and Reddit posts and such like

[00:34:01] [SPEAKER_02]: is people say has anyone heard of this surgeon what do they think

[00:34:04] [SPEAKER_02]: and what you get is they're great, they're terrible, they're great, they're terrible

[00:34:06] [SPEAKER_02]: and I think what you actually have to do is to talk to someone

[00:34:09] [SPEAKER_02]: because I think you're right it's that thing about well tell me why they're great

[00:34:12] [SPEAKER_02]: tell me why they're terrible and a lot of it comes down to the trust you build between

[00:34:16] [SPEAKER_02]: it's like therapy isn't it the major benefit of therapy comes from the relationship you have

[00:34:22] [SPEAKER_02]: and I think that must be that I mean obviously there's different skills that he

[00:34:25] [SPEAKER_02]: can do but you have to be able to trust the person who's literally who's going to put their hands underneath your skin

[00:34:31] [SPEAKER_02]: and change everything so I think you're right I think you know the old idea just talking to one or two people

[00:34:36] [SPEAKER_02]: or saying it's cheaper in Turkey let me go there I think there are all sorts of risks

[00:34:41] [SPEAKER_02]: and some of it is something you alluded to earlier because there's more than one dimension

[00:34:44] [SPEAKER_02]: there's the prep, there's the having the surgery but also the recuperation phase

[00:34:49] [SPEAKER_02]: and you often see a lot of people who had operations abroad coming back

[00:34:54] [SPEAKER_02]: and then the recuperation phase goes wrong and then they're finding themselves in the NHS

[00:34:59] [SPEAKER_02]: and I think that's and I think it's important to look at all those aspects.

[00:35:03] [SPEAKER_03]: 100% yeah I think I think the recovery period for any surgery

[00:35:10] [SPEAKER_03]: it should never be underestimated and I would I'd recommend to anybody who was thinking about surgery

[00:35:15] [SPEAKER_03]: in the next let's say two to three years to think about building themselves a timeline

[00:35:20] [SPEAKER_03]: so that they can plot in okay I need this much time to you know get things ready

[00:35:27] [SPEAKER_03]: I need to like finish a project at work I need to pass an exam then I've got that out the way

[00:35:31] [SPEAKER_03]: then I'm going to have my surgery then I need to think about the four weeks or eight weeks

[00:35:36] [SPEAKER_03]: that I'm going to have off afterwards or longer lots of surgeries well all surgery comes with a risk of complication

[00:35:43] [SPEAKER_03]: that is just taken for granted and you should never go into a surgery expecting that it's all just going to be absolutely perfect

[00:35:50] [SPEAKER_03]: and you know you'll just shut your eyes and hope for the best there's always a risk of complication

[00:35:55] [SPEAKER_03]: it could be minor it could be a little bit more serious then you maybe need to go back for a second surgery

[00:36:00] [SPEAKER_03]: so when you're building your timeline think about I need to recover I need to not do any exercise

[00:36:06] [SPEAKER_03]: I need to have people around me to help with shopping walking the dog looking after things

[00:36:11] [SPEAKER_03]: then I need to maybe factor in I might have a complication so I need another four weeks or eight weeks

[00:36:16] [SPEAKER_03]: and make sure that you don't rush through that whole period because it's only eight weeks or twelve weeks

[00:36:23] [SPEAKER_03]: and then you've got the rest of your life but if you rush then your healing might be a little bit interrupted

[00:36:27] [SPEAKER_03]: it could be just a little bit extra strain on your body that you don't need

[00:36:31] [SPEAKER_02]: and that's quite fascinating talking about that sort of run up to it because I've got a someone I know who's trans

[00:36:39] [SPEAKER_02]: and gone through the process very fast everything in three years I mean that's extraordinary

[00:36:43] [SPEAKER_02]: but it's like being it's overnight success apparently she said she spent five years preparing so she had lots lots of wake up

[00:36:50] [SPEAKER_02]: it very fit you know really sort of invested in their mental health now and a physical health and she was she was really fit

[00:36:58] [SPEAKER_02]: and she was really and she you know she had all this sort of stuff going on

[00:37:02] [SPEAKER_02]: and so she went in actually really aware of her body and how it works and how to recuperate

[00:37:07] [SPEAKER_02]: and like you had said you know the stuff that you know which you got a sort of half price cancellation would you like this sort of tomorrow

[00:37:15] [SPEAKER_02]: so she said no you know I've got this I've got this curve I'm on this curve I know where I'm going

[00:37:20] [SPEAKER_02]: and I think you're right there's a sort of we begin to rush to the end don't we rather than forgetting that the end is not the end

[00:37:27] [SPEAKER_02]: the end is just another bit in there it's just another part of actually normalising life

[00:37:31] [SPEAKER_03]: and it's a bit of a move yeah yeah yeah and it's I find like transition is often for people not always often it's quite a long process

[00:37:40] [SPEAKER_03]: there's obviously the waiting list go on and on life gets in the way and maybe you know you have to wait a bit for you go to the next stage that you're going through

[00:37:48] [SPEAKER_03]: and if all you're thinking about that whole time is getting through surgery I think it psychologically will wear you down

[00:37:55] [SPEAKER_03]: so I tried to just think about the next thing that's going to happen and then once it was done I'd have to just switch off for a bit

[00:38:02] [SPEAKER_03]: and not think about being trans and not think about surgery and just go on with other things and sort of build up my resources again

[00:38:09] [SPEAKER_03]: and be like right okay I need to go back to the doctors and back and sort of put myself through it again

[00:38:14] [SPEAKER_02]: well a general anaesthetic is catastrophic on your body I mean it can take well over a week just the effects of the anaesthetic itself

[00:38:21] [SPEAKER_02]: of your body can't it and yeah it having keyhole surgery I mean it takes quite a lot of time to you know resume in almost shape doesn't it

[00:38:30] [SPEAKER_03]: yeah yeah and keyhole surgery so I had a hysterectomy in preparation for my lower surgery and I didn't know much about hysterectomy

[00:38:39] [SPEAKER_03]: but it was done through keyhole so my my actual scars were tiny they were like the tips of a pencil

[00:38:44] [SPEAKER_03]: but inside had obviously been chipped and chopped away and kind of great big pieces taken out so it was disorientating I think

[00:38:54] [SPEAKER_03]: but I felt so run down and tired and sore when I had you know virtually in the fairly visible little tiny scars

[00:39:04] [SPEAKER_03]: and so it would have been so easy if I had been somebody who was just much more restless than I am

[00:39:09] [SPEAKER_03]: to kind of rush back into my regular life because you know look at the outside of me there's only a tiny little scar on the plaster on it

[00:39:16] [SPEAKER_02]: but I needed what was the best. I mean only 20 only 10 years to 15 years ago you know doctors used to advise that you have to take six weeks off after a hysterectomy

[00:39:26] [SPEAKER_02]: and now people seem to as you say sort of rush back pretty quickly it doesn't make a lot of sense

[00:39:33] [SPEAKER_03]: no no I mean I I don't know if you need I do not know this I don't know what I should say I don't know if you need less time off

[00:39:42] [SPEAKER_03]: as well I was going to say if you had the open incision for hysterectomy where they do the wide cut

[00:39:50] [SPEAKER_03]: maybe because it's a much larger incision but you know even if you have the keyhole surgery you've had a lot of slipping inside

[00:39:58] [SPEAKER_03]: and your body's been put through a big traumatic thing so just let it rest let it sit still catch up on telly you know give yourself some space

[00:40:07] [SPEAKER_02]: and look after yourself it's really important so we're beginning the process of talking about bottom surgery for trans men

[00:40:13] [SPEAKER_02]: so maybe should we carry on with that because there are so many different options aren't there

[00:40:19] [SPEAKER_03]: there's there's a lot to think about when it comes to lower surgery for trans men

[00:40:25] [SPEAKER_03]: timeline again is important so okay let's let's think about this you've got two main options for lower surgery for trans men

[00:40:34] [SPEAKER_03]: one is called metoidiaplasty and one is called phalloplasty and metoidiaplasty to just sort of describe what it is for anyone who doesn't know

[00:40:46] [SPEAKER_03]: what that involves is is releasing so the clitoris gets quite a bit larger from taking testosterone after two to three years or so

[00:41:00] [SPEAKER_03]: like that's probably going to be gets bigger after a couple of years it's probably the size it's going to stay

[00:41:05] [SPEAKER_03]: and a clitoris is very similar in structure to a penis just smaller

[00:41:11] [SPEAKER_03]: and so a metoidiaplasty just snips away a little bit of skin that holds the clitoris back against the body

[00:41:22] [SPEAKER_03]: so it falls forward and it sort of full size is visible

[00:41:28] [SPEAKER_03]: and so it looks like a small penis even more so than it did just from taking testosterone in terms of size you're still talking very small

[00:41:38] [SPEAKER_03]: maybe an inch and a half you know like the size will vary quite a lot from person to person but really on average you know you're looking inch and a half maybe a little bit bigger

[00:41:50] [SPEAKER_03]: maybe a bit smaller depending on what you've got and so it gives you something that looks and functions a bit like a small penis

[00:41:59] [SPEAKER_03]: they can then shape the skin around it to look like testicle sacs and you can then have testicle implants to give you that kind of full masculine look

[00:42:11] [SPEAKER_03]: and you can have the choice of having the urethra which is a little tube that you pee through having that moved and extended through your new little penis

[00:42:23] [SPEAKER_03]: so you can pee through it so it has the look of a penis with testicles and you can pee through it

[00:42:33] [SPEAKER_03]: and its big advantage I suppose is that the sensation is still very high for you know your penis is still very eroticised

[00:42:43] [SPEAKER_03]: because they haven't changed any of the nerves or anything around there

[00:42:47] [SPEAKER_03]: the disadvantage may be it will be small you know and so if what you're thinking really what you want of your new penis is I really want to have penetrative sex in some way

[00:43:00] [SPEAKER_03]: or I want to have a real realistic look of an adult man it's not quite that because of its size

[00:43:07] [SPEAKER_03]: I guess you can't pee standing up can you?

[00:43:09] [SPEAKER_03]: you might be able to pee standing up depending on the size that you've got

[00:43:15] [SPEAKER_03]: I think it's technically possible but often a bit tricky because the penis might not be quite large enough to clear your clothes

[00:43:24] [SPEAKER_03]: so if you're standing at your right or you think you need to be large enough to kind of poke through underwear and trousers

[00:43:30] [SPEAKER_03]: and it might not be quite big enough to get past it and not get on your clothes

[00:43:33] [SPEAKER_03]: so yeah but yeah and then the other option is phalloplasty and that is when they take a piece of flesh from another part of your body

[00:43:48] [SPEAKER_03]: maybe the arm or the thigh the two typical ones and they roll it into a tube so it looks like a penis

[00:43:57] [SPEAKER_03]: it's usually about four and a half to five and a half inches long so more kind of the size of a typical adult penis

[00:44:08] [SPEAKER_03]: they roll it into a tube they attach it to your body roughly where a penis would sit

[00:44:14] [SPEAKER_03]: they then take one of the large nerves that runs to the clitoris you've got two big large nerves that run through the clitoris

[00:44:23] [SPEAKER_03]: they take one of them and attach it into the nerve from that flesh that they've taken from another part of the body

[00:44:30] [SPEAKER_03]: so that the length of the penis will start to have some erotic sensation as the nerve starts to kind of attach and grow back

[00:44:38] [SPEAKER_03]: and then around it they do a similar thing with them to a matured plasty they take the skin from your body

[00:44:44] [SPEAKER_03]: in your genitals they fashion testicle sacs put in testicle implants and then again you have the option to pee through it if you want or not

[00:44:57] [SPEAKER_03]: and you have the option to have it become erect so that you could have penetrative sex with it or not

[00:45:05] [SPEAKER_03]: and I would say of all those things that kind of rattle through all the options

[00:45:08] [SPEAKER_03]: your first main choice really is how big a deal it is to pee through it

[00:45:13] [SPEAKER_03]: because well that seems like a kind of like it seems like a silly thing in a way like to pee through it or not

[00:45:19] [SPEAKER_03]: it's the stage that causes the most complications so if it's something you're not fussed about

[00:45:26] [SPEAKER_03]: and if for any reason you're thinking you don't want to put your body through unnecessary surgery

[00:45:31] [SPEAKER_03]: or you know surgery that might cause more complications for extra surgery

[00:45:36] [SPEAKER_03]: it's one of the biggest decisions I would say to be thinking about if you're thinking lower surgery

[00:45:41] [SPEAKER_02]: and again lower surgery for trans women

[00:45:46] [SPEAKER_02]: it's sort of the same process but in reservists it's about removing things

[00:45:49] [SPEAKER_02]: yeah you can do a halfway house which is like an orchidectomy remove the testicles

[00:45:55] [SPEAKER_02]: or you can have a full gender reassignment surgery

[00:45:59] [SPEAKER_02]: and I guess that comes down to how much you want to have penetrative sex again I guess

[00:46:04] [SPEAKER_03]: you've got three main options around for trans women

[00:46:10] [SPEAKER_03]: you've got orchectomy which yeah like you say it just takes away the testicles

[00:46:16] [SPEAKER_03]: advantages of that is you sometimes get a more, for some people that feels like a more neutral look

[00:46:21] [SPEAKER_03]: for them like you know it's not quite male it's not quite female it's just sort of something that feels more comfortable

[00:46:27] [SPEAKER_03]: it reduces the amount of anti androgens if you're taking anti androgens with the testicles removed

[00:46:33] [SPEAKER_03]: you might need to take less of those so you might be feeling more of the effect of taking any estrogen

[00:46:39] [SPEAKER_03]: and it can affect a sex drive in a positive or negative way like it can affect your sex drive in a big way

[00:46:47] [SPEAKER_03]: not for everybody some people find that they enjoy the slightly lower sex drive

[00:46:53] [SPEAKER_03]: it can also change how you orgasm it can change how you feel when you're touching gendals

[00:47:00] [SPEAKER_03]: so yeah it's not just simply an aesthetic thing it will have a knock on effect on different elements

[00:47:08] [SPEAKER_03]: and then you've got the next stage might be a vulvaplasty where you have the exterior look of a vulva

[00:47:18] [SPEAKER_03]: but no depth so the penis is removed the testicles are removed the flesh is kind of refashioned into a vulva

[00:47:27] [SPEAKER_03]: with the outer and inner labia clitoris is fashioned from the head of the penis kind of pulled back

[00:47:34] [SPEAKER_03]: and turned into something that looks like clitoris but you won't have any depth so you couldn't have penetrative sex

[00:47:42] [SPEAKER_03]: if that was something that was important to you the main advantage of vulvaplasty is

[00:47:49] [SPEAKER_03]: and this is kind of an advantage it sort of depends how you're feeling about it

[00:47:52] [SPEAKER_03]: but the main difference I'd say between a vulvaplasty and a vaginaplasty is you wouldn't have to do the word has slipped my mind

[00:48:02] [SPEAKER_03]: but using the insertion tool the dilation tool yeah there you go you wouldn't have to dilate and dilating is essential with vaginaplasty

[00:48:12] [SPEAKER_03]: and a lifelong commitment so if that would be something that people would find daunting or difficult for any reason

[00:48:19] [SPEAKER_03]: and they're not interested in penetrative sex then vulvaplasty could be an option

[00:48:25] [SPEAKER_03]: and then yeah vaginaplasty you get the exterior look and you get the depth as well

[00:48:34] [SPEAKER_03]: but yeah you would also need to dilate lifelong

[00:48:38] [SPEAKER_02]: and I know we haven't covered everything and I'm just being respectful of your time because I could chat you all night

[00:48:43] [SPEAKER_02]: so there's two things strike me what some think of intersex people and non-binary people so might non-binary people simply

[00:48:50] [SPEAKER_02]: I mean might they go well what might non-binary people tackle or think about in terms of surgeries some of it all of it nothing of it

[00:49:00] [SPEAKER_03]: I think entirely up to them in my experience like I do not identify as non-binary myself

[00:49:06] [SPEAKER_03]: my experience of talking to non-binary people and I used to run we used to co-run a support group

[00:49:14] [SPEAKER_03]: for trans men and non-binary people so like had a fair few chats with different people

[00:49:19] [SPEAKER_03]: their choices are as varied as anybody else's

[00:49:23] [SPEAKER_03]: and so all the options are just as open to them as it would be to anybody else if you want to if you identified as non-binary

[00:49:30] [SPEAKER_03]: and you wanted to have top surgery and a phalloplasty like that is absolutely fine there's no reason you couldn't do that

[00:49:35] [SPEAKER_03]: it's entirely your choice about making your body feel like what it feels should be right for you and what you want to do with it

[00:49:42] [SPEAKER_02]: and of course the challenge is how it's paid for so if it's an NHS it may well be that you have all sorts of desires but doesn't mean that they come true

[00:49:50] [SPEAKER_02]: so one has to factor that into the normal equation and of course I'm guessing with things like intersex people there are all sorts of reasons why people are intersex but there are again there are a range of operations

[00:50:03] [SPEAKER_03]: as I understand it I like I do not have a huge amount I would don't really have any experience of talking to intersex people or understanding the things that they're going through

[00:50:12] [SPEAKER_03]: the things that they want and I as I understand it the options are available to them

[00:50:20] [SPEAKER_03]: but beyond that I don't I'm afraid I just don't I don't know I don't know what I don't if there's any barriers particularly that they're coming up against

[00:50:27] [SPEAKER_03]: I'd say yeah have to speak to them

[00:50:30] [SPEAKER_02]: I can talk all night I shouldn't is been absolutely brilliant so how can people get hold of the book

[00:50:37] [SPEAKER_03]: so the book is called gender confirmation surgery it's available well good bookshops you can order it from I mean like look up your local queer bookshop or independent bookshop

[00:50:47] [SPEAKER_03]: and you can order it from there you can order it from anywhere online it's published by Jessica Kingsley if the bookshop needs to know who the publisher is

[00:50:55] [SPEAKER_02]: and yeah it's available now and it's on Amazon so I'm looking on the news on Amazon yes five-star reviews and that's very good it's it's it's on Kindle yet

[00:51:08] [SPEAKER_02]: there is an e-book version it should be available as e-book yeah just having a look it's not on Kindle yet but that oh yeah there it is yeah

[00:51:16] [SPEAKER_02]: oh good oh Blanche it's the same price Kindle as this paperback I shall have the paper

[00:51:21] [SPEAKER_02]: fantastic good well look thank you so much for your time it's been absolutely fascinating and sorry for making you stay longer than we originally thought because it's been an absolute joy to talk

[00:51:33] [SPEAKER_02]: and perhaps another time you come back to us and maybe you could drill into some of these things in a bit more depth I would love that if you wouldn't mind

[00:51:40] [SPEAKER_02]: I'd be very happy very happy to absolutely thank you so much you take care you too

[00:51:50] [SPEAKER_02]: thanks for listening to this episode of Transvox it's been a joy to have you with us if you want to make contact with us you can contact us at gillianarttransvox.com.uk

[00:52:03] [SPEAKER_02]: and if you'd like to support the work we do please go to Patreon and go to Page Transvox and all of our money goes to our nominated charity

[00:52:12] [SPEAKER_02]: and Jen you've chosen the charity for the next number of episodes which one have you chosen

[00:52:17] [SPEAKER_00]: our charity is called Beyond Reflections which is a charity that provides support and counselling to trans people non-binary people and their friends and their families across the UK

[00:52:28] [SPEAKER_00]: an amazing charity doing some amazing work really important so please if you can give

[00:52:34] [SPEAKER_02]: great and if you want to go and have a look at Beyond Reflections it's beyond-reflections.org.uk

[00:52:40] [SPEAKER_02]: but as I say if you'd like to make a contribution to what we're doing because we love to help the people who help us

[00:52:45] [SPEAKER_02]: again if you've got ideas for the show things you'd like to ask us questions comments applause or brick baths feel free to send it all in to gillianarttransvox.com.uk

[00:52:58] [SPEAKER_02]: until the next time goodbye bye bye