surgery

Trans* Jersey

MtF surgery

All surgery is optional. You should not feel that you have to have surgery to validate your transition from M to F. You should have surgery because you want to have surgery and for no other reason.

Bottom surgery
This refers to genital reconstruction surgery (GRS), ie. a penectomy and orchidectomy to remove the male genitalia and plastic surgery (vaginoplasty, clitoroplasty, labioplasty and repositioning of the urethra) to provide you with a genital appearance that is virtually indistinguishable from natal born women. The phases of the operation are done in one procedure under general anaesthetic and takes about five hours. The Looking Glass Society has a great section on the variety of surgical methods and their advantages and disadvantages.

When considering bottom surgery, manage your expectations. Post-surgery interviews reveal that 98% of transwomen are satisfied with the physical results of their surgery. However, the surgery is irreversible so you need to consider the emotional implications carefully. You will not be able to have children after surgery (unless you make a deposit with a sperm bank first), you may find that your relationship with your partner changes dramatically post-surgery, with potential loss, and genital surgery won’t change how people behave towards you in public life.

There are no surgeons available on the island to undertake this procedure so you will need to go to the UK or abroad if you want GRS. If you are being treated through the NHS, you will be offered a list of approved surgeons to choose from. If you wish to go privately, you can choose from surgeons in private practice all over the world. However, you will need to research the best person for your needs and your budget.

Do your research. Look at the numerous blogs and YouTube videos uploaded by transwomen describing their experiences. Visit some of the forums for transwomen and post questions asking about their experiences. Don’t forget to ask about any emotional reactions to the surgery as well as the physical results. Most transwomen are happy to share this information.

surgeryOther surgery
This comes in several parts. The Looking Glass Society explains the range of surgical options available to transwomen. It is exceedingly rare for any of these procedures to be funded through the health service. If you wish to undergo one of these options, you should be prepared to fund it privately.

You will not be surprised to learn that there are no surgeons with the required skills to perform these operations in the island. You are therefore looking at travel costs again and, because of the complexity of some procedures, several trips to the UK or abroad may be needed.

Facial feminising surgery and rhinoplasty
This refers to plastic surgery to feminise the face and/or remodel the nose. Some transwomen find that, even after HRT, their facial features retain a heaviness that is masculine in appearance and does not allow them to pass as they would like to. Cosmetic surgery can help to alleviate this problem.

Thyroid chondroplasty (tracheal shave)
For transwoman who have a very prominent ‘Adam’s Apple’, this procedure can reduce it by making a small horizontal incision in a natural crease-line on the neck and removing part of the thyroid cartilage.

Augmentation mammoplasty (breast enlargement)
Even after one or two years on HRT, some transwomen are unhappy with the breast growth resulting naturally. They, therefore, consider having implants. There are a number of options available now that are alternatives to silicone so do your research to find out which would suit your requirements best.

Hair transplantation
HRT will thicken the existing hair but many transwomen who transition later in life find that they retain a male pattern hairline. Hair transplantation can be effective in “filling in” the gaps at the front of the hairline to produce a more feminine line.

The same advice applies to these surgeries as for GRS: manage your expectations and do your research thoroughly.

Video Trans* Jersey

Intersex and Identity

For the first part of the show, Dr Sharon Preves, sociologist and professor, discussed her research of intersex individuals. Sharon first defined terms, such as “intersex,” “hermaphrodite,” and “transgender,” then explained how and why she became involved in this research. Sharon next explained the cause for negative stigma against intersex individuals, including the religious views of people who do not fit easily into the male/female binary. Sharon noted the strong drive that society has to pigeonhole everyone – even fetuses – into one of two genders. She discussed the evolution of outlying conditions in Western civilization: from sin, to crime, to medicalisation. Sharon then explained the excessive intrusion of the medical world and its treatment of intersexuality as an emergency requiring “correction”.

During the second half of the show, Sharon Preves, professor at Hamline University, further detailed the medicalisation of conditions that do not, normally, require medical intervention, including intersex infants and childbirth itself. Sharon compared the unnecessary interventions into intersexed individuals bodies with circumcision, and she then discussed the emotional ramifications on the patients. Many felt guilt, shame, and even fear. Some grew up convinced they had been born with a disease so terrible that no one – not even their parents or doctors – would discuss it openly. Sharon next cited recent gains in the rights of those born intersexed, and listed off ways they have found healing, such as through support groups. Sharon also provided the example of an intersex teenager who was instructed to pray that she become fully female. Sharon concluded by offering several resources, including her own book, “Intersex and Identity”.

 

James Zimmerman hosted.Two part interview, recorded 5/2/2013.

Minnesota Atheists practices positive, inclusive, active, friendly neighborhood atheism in order to:

– Provide a community for atheists
– Educate the public about atheism
– Promote separation of state and church

http://www.mnatheists.org/

Trans* Jersey

MtF finance

Even if you take the publicly funded healthcare route to manage your transition, the costs are higher for trans* islanders than for trans* individuals in the UK because we have to travel to see the specialists who can assist us to transition.

For those transwomen with island medical insurance policies, you will find that they specifically do not cover any treatment relating to gender reassignment.

Below are some of the costs that you will need to fund whichever transition route you follow:

Travel
Flights to the UK for consultations with your therapist. You will need to budget for more than one visit. Depending on how your therapy goes, you could be visiting regularly for a while. The cheapest flights from Jersey to the UK are on the Gatwick route so take this into consideration when you and your GP select your therapist. Your appointment should only be an hour so you should be able to get over and back in the day. Also, remember to budget for the Gatwick Express into London and transport in London.

GP visits
You will need to visit your GP more regularly than usual to keep them updated on progress, to ask for referrals, to have bloods taken to check your hormone levels and to ask their advice on a range of issues. Budget for about one every two months during your first two years of transition.

Change of name
The costs given below are approximate. They may change.

Deed poll prepared by Jersey advocate and sworn in Royal Court: £435
New driving licence: £40
New passport: £75
Passport photographs: £5

See the change of name page for more details.

Devices for passing
Some transwomen like to use breastforms and gaffs to assist them in passing. Breastforms start at about £30 and can go up as high as £750 for realistic skin tone, shape and nipples. Gaffs are around £35-£50. For more information about suppliers see the help page.

financeBelow are some of the costs that are optional depending on how you manage your transition. You may elect to go completely private, completely public through the States and NHS systems, or do a mixture of private and public:

Gender therapy
For those who wish to see a gender therapist privately in the UK, an hour’s consultation will cost about £200.

Hormone therapy
For those who wish to see an endocrinologist privately in Jersey, an hour’s consultation will cost about £280.

Surgery
Bottom surgery (GRS): costs vary depending on the surgical procedure being undertaken. Orchiectomy: £3,000 app. Cosmetic genital reconstruction surgery without vaginoplasty: £9,500 app. Vaginoplasty (penile inversion): £10,800 app. Colon vaginoplasty: £13,000 app.

If you go abroad for surgery, don’t forget to add in the travel, accommodation and food costs. For GRS, for example, you won’t be able to fly for a least a week afterwards, which means a hotel bill. Full recovery time is six to twelve weeks.

Top surgery: costs vary depending on the type of breast augmentation surgery being undertaken. There are two types of implant commonly used. However, you can expect to pay between £3,500 and £5,000.
Facial feminising surgery: costs vary depending on the surgery being undertaken, and there is a large range of procedures you can have done. You can pay anything from £1,000 for a minor procedure to £10,000 for a full facelift.

See the surgery page for more details of MtF surgery.

Funding
The truth is transitioning costs the trans* individual and, because it is still seen as a choice rather than a necessity, especially by insurers, there is little financial help available.

Try to put away £100 of your salary every month into a transition fund or hold a ‘transition fund’ event where friends and family show their support by donating as much or as little as they want without embarrassment.

Don’t fund your transition through credit cards or pay-day loans. These are the worst ways to borrow money as the interest rates are so high. If you need to borrow, talk to your bank about a loan. Trans* Jersey has contacted NatWest bank in Jersey and they have confirmed that they would do a personal loan for treatment or surgery and that anyone who approached them would be treated sensitively and with discretion. Criteria for the loan would be the standard requirements, ie. any person wanting a loan will need to bank with NatWest for 6 months, have a regular income mandated to the account and be able to afford the loan. Anyone seeking this sort of facility can contact Tanya Nerac, Assistant Relationship Manager, in the first instance who is one of our trans* allies.

Trans* Jersey

MtF timeline

For those who are still questioning their gender, take some time to read this site, to surf the Internet and watch video clips uploaded by transwomen, to read some of the excellent personal accounts of transitioning available as books from Amazon, and to feel comfortable with the idea that you are trans*. This is an important step and not one that should be hurried. It can take years to reach a point of ease with who you are.

However, it is worth reaching that point before you more forward with your transition, especially in Jersey. We all know how quickly news travels in small communities, more so than in a big city. You are unlikely to be able to keep your transition a secret in the island. You need to be prepared to ‘out’ yourself to all sorts of people in order to get their help and you can only do that if you are proud and confident about who you are.

Having reached a place where you know that you are transgender, your first point of contact is your doctor/GP in Jersey. Explain to them that you are unhappy with the gender assigned to you at birth and that you would like to start the process of transitioning. Ask your GP to write a letter of referral to a gender therapist (if going the privately funded route) or to a psychiatrist within the health services in Jersey (if going the publicly funded route).

There are no gender therapists in Jersey so you will have to go to the UK for counselling. Your GP can either refer you privately to a gender clinic of your choice or your Jersey psychiatrist can refer you through the NHS to the Charing Cross Gender Identity Clinic. The advantages of going private are that you control the timetable and can get things moving as quickly as you need to. The disadvantage is that you pay for private consultations (see the finance page). The NHS route is free but you are stuck with their timescale.

Remember that your therapist is not there to ‘judge’ you. They are there to help you make sure that transitioning is what you want to do. Therapy is a time for you to ask questions about transitioning, to be honest with yourself and answer the therapist’s questions as openly as you can, to think about alternatives to transitioning and to understand why they are not an option for you, and to double-check your feelings with an impartial and skilled observer.

Depending on how you and your therapist feel about your readiness to transition, the next step is either to change your name by deed poll to the name by which you want to be known going forward or to commence hormone therapy.

For more information about changing your name and all your documents, see the change of name page.

evolution-womanJersey has the necessary skills on the island to administer your hormone therapy, which will be a lifelong commitment to taking estrogen, progestogen and antiandrogen in some form. Your therapist will need to provide a letter to your GP or psychiatrist recommending that you commence hormone therapy, the appropriate delivery method of the hormones and the doses that you require. Your GP or psychiatrist can then refer you to the island’s endocrinologist. This can be done privately, for which you will pay, or you can be referred through the States system, which is free.

For more information about hormone therapy, see the hormones page.

This may be as far as you wish to go in your transition. You may consider the changes made by the hormone therapy sufficient to allow you to pass as a woman. However, you may elect to undergo one or more surgical procedures to further feminise your body. If so, you will need to leave the island again for your operation(s). Jersey has no surgeons who can perform this specialist surgery. You will need to decide whether you wish to pay for surgery privately or whether you are prepared to wait for surgery in the UK through the NHS.

If you elect to have surgery through the NHS, you need to ask your NHS therapist to place you on the NHS waiting list.

If you elect to have private surgery there are two advantages: you can choose your surgeon, so you can choose to see anyone in the world who takes private patients, and the timing of your surgery is your choice. You should research your surgeon carefully, taking time to read testimonials from transwomen who have had surgery with them. If you are unsure about your choice, ask your GP for their opinion.

Once you have selected your surgeon, contact them directly. You do not need to go back to your GP for a referral. However, the surgeon will undoubtedly want a letter from your therapist or GP referring you after you have made the initial contact.

For more information about surgery, see the surgery page.

Finally, take ownership of your transition. If you are not getting the answers you require from your health professional, keep asking until you do. Research as much as you can and prepare the questions you want answered before every consultation. Your Jersey GP may never have taken a patient through a transition process so you may need to guide them on what they need to do next for you.

Trans* Jersey

NHS leaflets

This is the range of NHS leaflets available for trans* patients explaining the various aspects of the NHS service –

An introduction to trans* issues
A guide for NHS practitioners treating trans* patients
GIRES guide to your rights to care and treatment under the NHS
A guide to NHS funding and waiting times
A guide to hormone therapy
A guide to lower surgery options and procedures for transwomen
A guide to lower surgery options and procedures for transmen
A guide for families with trans* children or teenagers
nhs

Trans* Jersey

FtM surgery

All surgery is optional. You should not feel that you have to have surgery to validate your transition from F to M. You should have surgery because you want to have surgery and for no other reason.

Top surgery
This refers to a double mastectomy to remove the female breasts and plastic surgery to build a male chest. The two phases of the operation are done in one procedure under general anaesthetic. Hudson’s Guide has a great section on chest surgery methods and their advantages and disadvantages.

When considering top surgery, manage your expectations. You will have scarring, whichever method you choose, you may need revisions post-surgery, and your final chest is unlikely to look like a natural male chest close up. However, with gym work to improve the tone of your pecs, most post-op transmen would pass on the beach at St Ouen’s.

There are no surgeons available on the island to undertake this procedure so you will need to go to the UK or abroad if you want chest surgery. If you are being treated through the NHS, you will be offered a list of approved surgeons to choose from. If you wish to go privately, you can choose from surgeons in private practice all over the world. However, you will need to research the best person for your needs and your budget.

Do your research. Look at the numerous YouTube videos uploaded by transmen showing pre and post-surgery photos. Compare the pre-op photos with your own body shape. It is no good admiring the chest of a transman who started off as a B cup if you are a D cup! If the post-op results look good to you, send a comment to the transman who posted the video asking who his surgeon was. Most transmen are happy (and flattered) to share this information.

surgeryBottom surgery
This comes in two parts.

Hysterectomy and oophorectomy
This refers to the removal of the uterus and ovaries respectively. After taking testosterone for a while, some transmen may find that they have to have one or both of these procedures for medical reasons. Hudson’s Guide explains the reasons for this surgery and the surgical options available.

Jersey has the necessary surgeons capable of performing a this surgery through the health service. If you have island health insurance, you may also find that this is the only part of your transition it will cover, especially if you have to have the operation for medical reasons, such as the development of cysts. However, you may wish to go privately in order to choose the surgical method used by your surgeon.

Genital reconstruction surgery (GRS)
The surgery to contruct a penis and testes is the surgery that majority of transmen elect to do without. The results still ask transmen to trade-off sexual function and visual appearance, there can be complications, it is by far the most costly and time-consuming of trans surgeries, and can involve numerous surgical procedures. Details of the various options currently available to transmen can be found on Hudson’s Guide or can be downloaded here (warning: this download contains graphic photographs of operation progress and results).

You will not be surprised to learn that there are no surgeons with the required skills to perform GRS in the island. You are therefore looking at travel costs again and, because of the complexity of the surgery, several trips to the UK or abroad may be needed.

The same advice applies to GRS as for top surgery: manage your expectations and do your research thoroughly.

Trans* Jersey

FtM Finance

Even if you take the publicly funded healthcare route to manage your transition, the costs are higher for trans* islanders than for trans* individuals in the UK because we have to travel to see the specialists who can assist us to transition.

For those transmen with island medical insurance policies, you will find that they specifically do not cover any treatment relating to gender reassignment.

Below are some of the costs that you will need to fund whichever transition route you follow:

Travel
Flights to the UK for consultations with your therapist. You will need to budget for more than one visit. Depending on how your therapy goes, you could be visiting regularly for a while. The cheapest flights from Jersey to the UK are on the Gatwick route so take this into consideration when you and your GP select your therapist. Your appointment should only be an hour so you should be able to get over and back in the day. Also, remember to budget for the Gatwick Express into London and transport in London.

GP visits
You will need to visit your GP more regularly than usual to keep them updated on progress, to ask for referrals, to have bloods taken to check your hormone levels and to ask their advice on a range of issues. Budget for about one every two months during your first two years of transition.

Change of name
The costs given below are approximate. They may change.

Deed poll prepared by Jersey advocate and sworn in Royal Court: £435
New driving licence: £40
New passport: £75
Passport photographs: £5

See the change of name page for more details.

Devices for passing
Some transmen like to use packers and binders to assist them in passing. Packers start at about £12 and can go up as high as £500 for realistic peeing and playing packers. Chest binders are around £35-£50. For more information about suppliers see the help page.

financeBelow are some of the costs that are optional depending on how you manage your transition. You may elect to go completely private, completely public through the States and NHS systems, or do a mixture of private and public:

Gender therapy
For those who wish to see a gender therapist privately in the UK, an hour’s consultation will cost about £200.

Hormone therapy
For those who wish to see an endocrinologist privately in Jersey, an hour’s consultation will cost about £280.

Surgery
Top surgery: costs vary depending on the type of chest surgery being undertaken. There are two methods commonly used. However, you can expect to pay between £5,000 and £10,000.

Bottom surgery: Hysterectomy: £7,500-£12,500. Costs vary depending on the type of penile construction surgery being undertaken. Metoidioplasty: £10,000-£15,000. Phalloplasty: this is complex requiring numerous procedures so you are looking at anything from £25,000 upwards.

If you go abroad for surgery, don’t forget to add in the travel, accommodation and food costs. For chest surgery, for example, you won’t be able to fly for a least a week afterwards which means a hotel bill.

See the surgery page for more details on FtM surgery.

Funding
The truth is transitioning costs the trans* individual and, because it is still seen as a choice rather than a necessity, especially by insurers, there is little financial help available.

Try to put away £100 of your salary every month into a transition fund or hold a ‘transition fund’ event where friends and family show their support by donating as much or as little as they want without embarrassment.

Don’t fund your transition through credit cards or pay-day loans. These are the worst ways to borrow money as the interest rates are so high. If you need to borrow, talk to your bank about a loan. Trans* Jersey has contacted NatWest bank in Jersey and they have confirmed that they would do a personal loan for treatment or surgery and that anyone who approached them would be treated sensitively and with discretion. Criteria for the loan would be the standard requirements, ie. any person wanting a loan will need to bank with NatWest for 6 months, have a regular income mandated to the account and be able to afford the loan. Anyone seeking this sort of facility can contact Tanya Nerac, Assistant Relationship Manager, in the first instance who is one of our trans* allies.

Trans* Jersey

FtM timeline

For those who are still questioning their gender, take some time to read this site, to surf the Internet and watch video clips uploaded by transmen, to read some of the excellent personal accounts of transitioning available as books from Amazon, and to feel comfortable with the idea that you are trans*. This is an important step and not one that should be hurried. It can take years to reach a point of ease with who you are.

However, it is worth reaching that point before you more forward with your transition, especially in Jersey. We all know how quickly news travels in small communities, more so than in a big city. You are unlikely to be able to keep your transition a secret in the island. You need to be prepared to ‘out’ yourself to all sorts of people in order to get their help and you can only do that if you are proud and confident about who you are.

Having reached a place where you know that you are transgender, your first point of contact is your doctor/GP in Jersey. Explain to them that you are unhappy with the gender assigned to you at birth and that you would like to start the process of transitioning. Ask your GP to write a letter of referral to a gender therapist (if going the privately funded route) or to a psychiatrist within the health services in Jersey (if going the publicly funded route).

There are no gender therapists in Jersey so you will have to go to the UK for counselling. Your GP can either refer you privately to a gender clinic of your choice or your Jersey psychiatrist can refer you through the NHS to the Charing Cross Gender Identity Clinic. The advantages of going private are that you control the timetable and can get things moving as quickly as you need to. The disadvantage is that you pay for private consultations (see the finance page). The NHS route is free but you are stuck with their timescale.

Remember that your therapist is not there to ‘judge’ you. They are there to help you make sure that transitioning is what you want to do. Therapy is a time for you to ask questions about transitioning, to be honest with yourself and answer the therapist’s questions as openly as you can, to think about alternatives to transitioning and to understand why they are not an option for you, and to double-check your feelings with an impartial and skilled observer.

Depending on how you and your therapist feel about your readiness to transition, the next step is either to change your name by deed poll to the name by which you want to be known going forward or to commence hormone therapy.

For more information about changing your name and all your documents, see the change of name page.

timelineJersey has the necessary skills on the island to administer your hormone therapy, which will be a lifelong commitment to taking testosterone. Your therapist will need to provide a letter to your GP or psychiatrist recommending that you commence hormone therapy, the appropriate delivery method of the testosterone and the dose that you require. Your GP or psychiatrist can then refer you to the island’s endocrinologist. This can be done privately, for which you will pay, or you can be referred through the States system, which is free.

For more information about hormone therapy, see the hormones page.

This may be as far as you wish to go in your transition. You may consider the changes made by the hormone therapy sufficient to allow you to pass as a man. However, you may elect to undergo one or more surgical procedures to further masculinise your body. If so, you will need to leave the island again for your operation(s). Jersey has no surgeons who can perform this specialist surgery. You will need to decide whether you wish to pay for surgery privately or whether you are prepared to wait for surgery in the UK through the NHS.

If you elect to have surgery through the NHS, you need to ask your NHS therapist to place you on the NHS waiting list.

If you elect to have private surgery there are two advantages: you can choose your surgeon, so you can choose to see anyone in the world who takes private patients, and the timing of your surgery is your choice. You should research your surgeon carefully, taking time to read testimonials from transmen who have had surgery with them. If you are unsure about your choice, ask your GP for their opinion.

Once you have selected your surgeon, contact them directly. You do not need to go back to your GP for a referral. However, the surgeon will undoubtedly want a letter from your therapist or GP referring you after you have made the initial contact.

For more information about surgery, see the surgery page.

Finally, take ownership of your transition. If you are not getting the answers you require from your health professional, keep asking until you do. Research as much as you can and prepare the questions you want answered before every consultation. Your Jersey GP may never have taken a patient through a transition process so you may need to guide them on what they need to do next for you.