Insurance is just beginning to cover some of the costs.
Marci Bowers, a transgender obstetrician and gynecologist in Burlingame, Calif., who performs the surgeries, said in an interview that she does about 200 per year herself, about three quarters of them male to female.A "neoclitoris" that allows sensation can be created from parts of the penis. In female to male surgery, the breasts, uterus and ovaries are removed (in two separate procedures).A "neophallus" can be constructed using tissue from the forearm or other parts of the body that allows sexual sensation, an expensive procedure.That is usually followed by a period of living publicly as a member of the opposite sex and, finally, surgery to alter the genitalia and other body parts. Androgens are given to women to help them develop secondary male sex characteristics such as a beard and body hair.Estrogen and anti-androgens are given to men to help change their musculature, skin and fat distribution, all of which will make them appear more feminine. But Ettner said the hormones' most important contribution is to reduce the dysphoria transgender people have been struggling with all their lives. What is the Real-Life Experience (also known as the Real-Life Test) Surgeons who follow the WPATH standards of care (which some patients and experts consider too strict) usually require candidates for surgery to live for as long as a year in their preferred gender role.