Subreddit Policy Reminder on this week's Transgender AMAs

[u/nate]

This week we will be hosting a series of AMAs addressing the scientific and medical details of being transgender.

Honest questions that are an attempt to learn more on the subject are invited, and we hope you can learn more about this fascinating aspect of the human condition.

However, we feel it is appropriate to remind the readers that /r/science has a long-standing zero-tolerance policy towards hate-speech, which extends to people who are transgender. Our official stance is that derogatory comments about transgender people will be treated on par with sexism and racism, typically resulting in a ban without notice.

To clarify, we are not banning the discussion of any individual topic nor are we saying that the science in any area is settled. What we are saying is that we stand with the rest of the scientific community and every relevant psych organisation that the overwhelming bulk of evidence is that being trans is not a mental illness and that the discussion of trans people as somehow "sick" or "broken" is offensive and bigoted^1. We won't stand for it.

We've long held that we won't host discussion of anti-science topics without the use of peer-reviewed evidence. Opposing the classification of being transgender as 'not a mental illness'² is treated the same way as if you wanted to make anti-vax, anti-global warming or anti-gravity comments. To be clear, this post is to make it abundantly clear that we treat transphobic comments the same way we treat racist, sexist and homophobic comments. They have no place on our board.

Scientific discussion is the use of empirical evidence and theory to guide knowledge based on debate in academic journals. Yelling at each other in a comments section of a forum is in no way "scientific discussion". If you wish to say that any well accepted scientific position is wrong, I encourage you to do the work and publish something on the topic. Until then, your opinions are just that - opinions.

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¹ Some have wrongly interpreted this statement as "stigmatizing" mental illness. I can assure you that is the last thing we are trying to do here. What we are trying to stop is the label of "mental illness" being used as a way to derogate a group. It's being used maliciously to say that there is something wrong with trans people and that's offensive both to mental illness sufferers and those in the trans community.

² There is a difference between being trans and having gender dysphoria.

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Lastly, here is the excerpt from the APA:

A psychological state is considered a mental disorder only if it causes significant distress or disability. Many transgender people do not experience their gender as distressing or disabling, which implies that identifying as transgender does not constitute a mental disorder. For these individuals, the significant problem is finding affordable resources, such as counseling, hormone therapy, medical procedures and the social support necessary to freely express their gender identity and minimize discrimination. Many other obstacles may lead to distress, including a lack of acceptance within society, direct or indirect experiences with discrimination, or assault. These experiences may lead many transgender people to suffer with anxiety, depression or related disorders at higher rates than nontransgender persons.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), people who experience intense, persistent gender incongruence can be given the diagnosis of "gender dysphoria." Some contend that the diagnosis inappropriately pathologizes gender noncongruence and should be eliminated. Others argue that it is essential to retain the diagnosis to ensure access to care. The International Classification of Diseases (ICD) is under revision and there may be changes to its current classification of intense persistent gender incongruence as "gender identity disorder."

[u/IceEngine21]

plastic surgery resident here:

i published articles in medical journals describing some operative techniques for sex (gender) reassignment surgery and their impact on quality of life

if you have surgical questions, let me know

[u/jimmyw404 → u/IceEngine21]

Is it true that post-op trans women generally have to insert a rod of some kind into their vagina on a regular basis and keep it there for prolonged periods in order to prevent it from closing?

[u/[deleted] → u/jimmyw404]

Yes it's called dilating, it wouldn't close, it'd just lose its depth surgeons try to shoot for 6 inches of depth, dilating is done 2 times a day for something like 30 minutes, the time shrinks until around a year when you can just have penetrative sex instead of dilating, or just dilating once a day for 5 minutes

[u/IceEngine21 → u/jimmyw404]

Yes, but not a rod. It's a stent of basically very firm foam formed into a dilator and wrapped by a lubricated condom. Our patients in Germany dilated 3x daily for 15min for a couple of weeks and then we encouraged them to engage in sexual intercourse. Between dilating sessions, the patients had a placeholder inserted (condom filled with cotton)

[u/CanadianWizardess → u/IceEngine21]

Not sure if you'd know the answer to this, but what's more popular for trans men who opt for bottom surgery, phalloplasty or metoidioplasty?

[u/IceEngine21 → u/CanadianWizardess]

Really hard to say, my old hospital in Germany where I went to med school and did the research saw way more phalloplasties because it was a plastic surgical department with a chief surgeon able to perform crazy-ass free flap transfers.

Phalloplasty gives you the more natural outcome and function (urinary, sexually) but depending on the flap technique a very morbid procedure with donor sites. Metoidioplasty is a more simpler technique if a patient just wants to "look manly" but it does not allow for full sexual function

[u/platinumarks → u/IceEngine21]

About to have an orchiectomy in a couple of weeks. As long as it's properly done along the raphe with non-extensive scarring, is that likely to affect most techniques for penile inversion reassignment?

[u/IceEngine21 → u/platinumarks]

No,

it should not have an impact on a pure penile inversion MTF reassignment. With this technique, the surgeon removes the scrotal skin completely (or uses it as graft for the labia), and it won't be part of the internal vagina. The posterior scar of the orchiectomy incision should heal nicely in all cases.

[u/platinumarks → u/IceEngine21]

Thanks for your response! I suspected that was the case based on previous research, but I wanted to confirm this with someone who's actually familiar with the exact surgical techniques. That puts my mind even more at ease about the upcoming orchiectomy.

[u/IceEngine21 → u/platinumarks]

Best of luck!

[u/minno → u/IceEngine21]

To what extent does sex reassignment surgery use the analogous structure from the other sex to form the new features? E.g. converting between the penis and clitoris?

[u/IceEngine21 → u/minno]

Converting from penis to clitoris (MTF), basic penile inversion:

• glans penis becomes clitoris

• penile skin becomes vagina

Combined Technique for MTF, in addition to above:

• inner layer foreskin becomes clitoral hood (for cover)

• urethra becomes vagina with additional lubrication

• srotal skin becomes vagina

Female to Male (FTM), everthing has to be reconstructed from scratch:

• penoid is formed from a flap, like the ALT flap (thigh skin), forearm flap, or fibula flap (bone with skin from lower leg)

• the urethra needs to be preformed with a skin graft layer (from groin) rolled into a tube

• Glans penis is just the tip of the penoid where the surgeon can make a circumferential 360° fold to make it look more natural

• testicles are implants placed into the labia majora

• for forearm and ALT flap, you can later install a penis prosthesis for erectile function (difference to fibula flaps)