Don't know how many of you may have caught the Paula Zahn Now show last night, but it featured Marci Bowers at the end. The stories before Bowers were very heartwarming and handled pretty well, I thought.  The only thing I can say about Bowers is she put the nail in the coffin for me. I think she's a publicity hound. She made claims on that show that are totally and completely false. One was the claim that she does more SRS surgeries than anyone in the world. W-R-O-N-G! [Bowers] is advertising the two-step (SRS followed by Labiaplasty) procedure on her website. I know she has "experimented" with the one-step process, but obviously hasn't perfected it. A check of legal actions against her shows that there are some very unhappy customers of hers.  I think one reason Bowers gets so much play time on TV is because she's trans herself; it's the sensationalism factor. Reporters get to conclude that only she knows what SRS candidates are going through because she went through it herself because Bowers is a transsexual. I'm not saying other surgeons are not publicity hounds. Schrang sure was. But his technique is thought to be very good. Brassard hasn't shrugged at publicity either, but doesn't seem to seek it out. He is well regarded, like Schrang, in the medical community. Meltzer, another US SRS surgeon, is also very well regarded and doesn't seek any publicity out. He just goes about his business and is very low-key. 

Many people choose to go to Thailand for financial reasons. It's a known fact that the doctors in North America have higher fees for SRS. Some of that is due to hospitalization costs in this country, some due to high doctor's fees. Medical costs in Thailand are lower across the board. These economic considerations are the main reason the Thai surgeons offer a one-step process. In an interview on television a few years back Suporn (a plastic surgeon by training) stated that his preference was the two-step process, but he worked on offering a one-step process because he understood the economic considerations involved. I think there is one other note to be made here:  with the exception of Brassard in Canada, the foreign SRS surgeons do not follow the generally accepted standards of care for GID as closely as US doctors do. In other words, a person can go to Thailand, get SRS, and never have to demonstrate or provide letter of proof of therapy and diagnosis, or full-time status. And, BTW, there are two doctors here in the US (Schrang and Meltzer) who practice and who are thought to be quite good. Both are plastic surgeons, not gynecologists like most of the others (Bowers is a gynecologist by training). Schrang is retired. I don't know if he still does surgery at all anymore. Other doctors in the US do not have a track record that begins to approach those of Meltzer and Schrang. These two have been at it for years and years, and have perfected their techniques  over time.

Which brings me to one point I want to make. Much has been debated about the one-step SRS versus the two-step SRS. Which is better?  [My spouse] and I did a lot of research on this before her surgery. [My Spouse] is a PhD scientist, so she had resources at her disposal that  others may not have. We looked at the statistics of each of the known  SRS surgeons in the US. [She] elected not to go outside the country.  She had concerns over what might happen if there were complications.  She also decided to opt for a plastic surgeon and not a gynecologist  because she was most concerned with sensation and esthetics. I decided to honor those decisions of hers. One of the things we found  out is that the one-step process is medically contraindicated for one  main reason: the SRS itself (at least for M2Fs) is traumatic to the tissues involved. Before a labia can be fashioned from the left-over  tissues from the scrotum and the penis, the tissue, nerves, and vessels need to heal and blood flow needs to normalize to those areas  in order for the tissue and nerves to heal. That's why most SRS doctors who are plastic surgeons usually opt for the two-step  process. Most plastic surgeries are not one step processes anyway, so why should SRS be limited to one step? Suporn does the one-step, but  he will do labiaplasty separately if the patient returns 3 months  later. Few want to do that because of the time and expense, so Suporn  does it all in one step. But if you look at some of the pictures of one-step procedures, it's pretty obvious that a separate labiaplasty has it's benefits.

Which brings me to my second point. What do M2Fs want from SRS?  Depth? Esthetics? Sensation? Well, a plastic surgeon will tell you that the last two are more important. Labiaplasty goes a long way to  having an esthetically pleasing external look. To get sensation the surgeon has to do one heck of a job with all the nerves in the glans  and the penis shaft in order to give the neo-vagina and clitoris  sensation (enough for an orgasm). But, many post-op M2Fs will tell you privately that the sensation they have post-op is nowhere near that which they had before surgery. They might have clitoral sensation, but many don't have much in the neo-vagina. Schrang used  to tote along some of his patients when he did the rounds at various trans conferences. He used to have them talk about how great they felt about the surgery and how happy they were with the results. But when asked specific questions about sensation and ability to orgasm (usually by SOs, believe it or not) the answers focused on the fact  that many had limited or no sensation. But they were ecstatic about having a vagina. As to depth, well that depends in large part on the  length of the penis and the amount of scrotal tissue available. But, remember that the average penis size doesn't exactly match what the porn movies depict! It seems men often think their size is more than it really is. Why do you think jock straps don't come in "small" as a  size!  :-)  So, as a few of the more realistic SRS surgeons will tell you, you don't need much more than 5-7 inches of depth for function.  Most genetic women will tell you that more than that is painful anyway!

One last thing my spouse and I learned in our research. There are quite  a few physicians who are trans and who have had SRS. We met several  (five that I can recall off the bat) ourselves and became friends  with a couple of them. Without exception, every one of them had  Meltzer or Schrang do their surgery. When I asked a couple of them  why, the reasons included the fact that they thought those surgeons'  techniques were better and that they like those surgeons' results  better. The biggest reason was that these surgeons were plastic surgeons. I will add that these surgeons charge about $17K-$17K for  part one and about $4K for part two, so they aren't inexpensive. But,  as on of the trans doctors told me, "I only had one crack at this. I didn't want any mistakes."

So, this is my long winded way of saying that this is not an easy or inexpensive decision to make.... not for anyone. There are many considerations, expenses, and risks. If you go out of the country, especially Thailand, you have lower costs, but face an arduous trip back, especially if you don't stay at least three weeks for the healing process to take hold. If you elect a US doctor your costs are often higher. There's just no easy way to make the SRS decision. It never ceases to amaze me how many people go into this process so uninformed. And the sad thing is that there are few places where you can get all the information you really need. Talking about SRS is often taboo or shunned. Resources that give explicit and much needed information are few or non-existent. And many post-ops simply disappear into the woodwork after SRS and don't want to talk about the process or life before anymore. So we all go through similar processes, repeating the same experiences, learning the same things, over and over, and over. This SRS stuff is something that is never discussed as much as I think it should be. We have a local retailer here in Washington, DC, whose tag line is about being a "better educated consumer." Well, if undergoing the SRS process isn't about being a better educated consumer, I don't know what is!

Last update : 28-06-2007 00:39