 |
 |
GRS / SRS |
||||||||||||||
|
Where Can I Find a Therapist? We're slowly building a list of therapists and counselors familiar with transgender issues that our patients have worked with and recommend. You can find it online here Do you recommend using Arnica Montana or other supplements prior to or after surgery? Arnica Montana is fantastic for reducing swelling, although the current technique has been responsible for reduced swelling lately. You can start Arnica Montana after the surgery while still in the hospital. Dr. Bowers does not recommend using Arnica Montana, or any other supplements prior to the surgery. (MTF) Does Dr. Bowers remove the prostate? If this is not a normal procedure what are the reasons for leaving the prostate in? The prostate shrinks so remarkably on Estrogen that, in my opinion, it does not deserve worry after surgery, with the exception of one PSA (prostate Specific Antigen) performed one year after surgery. During surgery, we go THROUGH the prostate but do not and cannot remove it. There are many recommendations for post-ops to have their prostates examined (just as some recommend pap smears for MTF's). I believe, both recommendations are odd/alarmist and do not fully account for the physiology of the cancers they are trying to detect. So long a post-op remains on estrogen, there is virtually no worry about prostate cancer. The PSA is about as cautious as one needs to be, in my opinion. (MTF) How safe is long term HRT for transsexual women? There are great controversies regarding HRT. I, for one, am not fearful of the stuff, not in the least. The studies done so far really do not test the 'best' HRT, that of a plant-based estradiol type formulation. Most all of the testing (and fear) is regarding Premarin, the HRT gold standard for many years which is conjugated equine estrogen extracted from the urine of chained pregnant mare's urine. I have always considered this stuff karmically unhealthy (I am also a vegetarian) and have never preferentially prescribed this stuff during my 20+ year career. Because there is no pharmaceutical backing, plant-based estradiol is not studied and is most certainly NOT the same as Premarin. Furthermore the studies that ARE out there still show benefit for Premarin alone but have concerns more when Premarin is combined with Medroxyprogesterone (Provera). Again, natural plant-based Progesterone (Prometrium) is not studied....go figure. As for the length of time that a post-operative woman should take HRT, that is not known but, I would think, at least into a person's early 70's (which is completely arbitrary at this point). I would suggest the lowest comfortable dose until further data does come in. Furthermore, consider animal fat intake as the primary etiology in breast cancer causation. (4Sept05) (MTF) Do I really need to do hair removal in the genital area prior to GRS? Technically no as we do a follicle scraping and intra-operative electrolysis at the time of surgery. However, no matter how we try, this is likely to be incomplete and hair is likely to grow within the vagina if it is not cleared ahead of time (hair grows in cycles, as you know!). The areas of concentration should be (see website diagram) the shaft down to the base and the inner two-thirds of the central scrotum (ie. leave the outer third as it forms the labia major and hair is an excellent camouflage for surgical scarring!). The clearing can extend all the way back to the anal area although it tapers down to a point in this area in terms of what is used during surgery. (06June05) (MTF) Will I need a labiaplasty following my GRS? Normally no. The so-called 'one-stage' appraoch was a primary goal of mine when taking over the surgery details from Dr. Biber in 2003. From both a cosmetic and hassle-related standpoint, the one-stage procedure offers great improvement over previous 'two-stage' techniques, in my opinion as a gynecologist. As a result, it also lowers the total cost for GRS by requiring only one procedure. That said, the primary GRS procedure is enormously difficult to perform, particularly given the differences in individual anatomy. Thus, I have seen a patient here and there that would benefit from relatively minor revisional 'labiaplasty' although we have had only one patient request this in well over one year of performing the 'one-stage' approach. (06June05) (MTF) How many GRS/SRS procedures has Dr. Bowers actually performed? Dr. Bowers began to work with Dr. Biber in Jan 2003. She has been performing these surgeries exclusively, since July 2003. All told, she has performed more than 500 solo, primary GRS/SRS surgeries (as of Feb 2008) - along with 10 years of experience with labiaplasties and FTM surgeries. Tracheal shaving and breast augmentation are also related surgeries that Dr. Bowers does well. Most importantly, she brings her 20+ years of pelvic surgery experience to GRS/SRS, having already made significant modifications to Dr. Biber's technique since taking over. (Feb 2008) Help! I've lost my Surgical Declaration Letter We want you to leave Trinidad with this essential document in hand. For additional copies, or if yours gets lost, destroyed, or tied up in the legal system, we’re happy to notarize additional documents for a nominal fee of $20 per copy. (29Jan05) (MTF) I am considering having an orchiectomy for androgen supression but I really don't want to complicate my SRS surgery. What kinds of issues could having an orchiectomy before SRS, and are there ways to minimize the possible complications?This is my most Frequently Asked Question these days, so I hope to answer it once and for all. I counsel against orchiectomy, as it drains money which could go towards SRS, unless this is your final destination (as it is for some individuals who, for health or personal reasons, never plan on SRS). We've found spironolactone online for 0.50 cents / 100mG dose. At a typical pre-op dosage of 200mG/day, that is $30 per month. Even at a bargain basement $1000 for an outpatient orchiectomy (not recommended), the breakeven point is 3 YEARS. So unless you have some serious health issues that preclude taking testosterone blockers or are planning to have surgery 4-5 years down the road, an orchiectomy is going to cost you more money than simply taking the meds and saving your money. (27Jan04) Can I bring my laptop with me to Trinidad? Yes! Wireless high-speed Internet is available in your room, as well as a phone line at your bedside (dial 8 for an outside line). (Nov. 2006) (MTF) Do I need to go off my hormones before surgery? No, not really. I do like people to get down to a dose no greater than estradiol 2 mg daily about 2 weeks before surgery (that will be your ongoing dose following surgery anyhow). This is a time-honored torture that no one has ever questioned (let alone, asked a gynecologist about). The effects on blood-clotting are minimal; the avoidance of blood clots is handled in ways completely unrelated to hormones. However, we do request that you stop other medications (i.e. - progesterone, spironolactone, etc. ) two weeks before your surgery. (10Aug03) (MTF) Will my clitoris be sensory? Although Dr. Biber did not use the dorsal nerve complex and glans to create a sensate clitoris, Dr. Bowers has made this important modification to ensure sensation. (04Aug03) (MTF) Will I be able to orgasm after surgery? Patients report a greater than 90% rate of orgasm, much of which depends upon good sexual health prior to surgery. (04Aug03) (MTF) What sort of breast augmentation technique(s) do you prefer? We do saline implants, using a retroarealar or inframmary (below the breast) incision but place them in front of the muscle. Natal breast tissue does not lie beneath the muscle, it lies in front. The chief advantage in placing behind the muscle is that it requires less precision to keep the implant from shifting before a capsule (scar tissue) can hold it in place. If placement is accurate from the start, the implant will look good and stay where it ought to. We do place breast implants occasionally beneath the muscle (retro-pectoral) but generally only when insufficient breast development has taken place with hormones. In general, the retro pectoral location is considerably more painful and does not enhance the visual results when there is sufficient pre-operative breast tissue. (27June03) If you have a question for Dr. Bowers that you would like to see answered here, please drop her an email. |
||||||||||||||||
| GRS Home | TG Links | TG Site Map | FAQ | OB/GYN |
| History | Procedures | Outcomes | Our Patients | Your Surgery |
©2006 Marci L. Bowers, MD
|
||||