News Page
DATE FOR GRS - JUNE 4TH
Series 2, 'Sex Change Uncut' !
Series 2 is 3 episodes each 1 hour in duration. The episode I was involved with is part 3.
The original 'Sex Change' series is still being repeated and, due to being so well received, will continue to be shown. Look out for the advert on this series - I'm on it!
- The 15 part documentary series called 'Sex Change', will be shown each weekday for three weeks on Discovery Home & Health Channel.
- Check www.discoveryhealth.co.uk for further details.
Gender Recognition Certificates
- For Gender Recognition Bill news visit www.pfc.org.uk
- For Gender Recognition Panel visit www.grp.gov.uk
Coming soon......
sarahspages new sister website, 'Sarahs Pictorial' .....to be launched September 2007!
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FAQ's ~ Voice Surgery ~ Rhinoplasty ~ Legal ~ Hormones ~ Lasers & Electrolysis ~ Links & Contacts
FAQ Page
What is Gender Dysphoria?
Gender Dysphoria is a medical term for anxiety and confusion about birth gender. The most intense form is called Transsexualism (a person, male or female, who has a lifelong feeling of being trapped in the wrong body). People who experience gender dysphoria are often afraid to express their feelings publicly, due to feelings of rejection or feelings of guilt or shame. They can develop an anxiety which deepens over time. This can lead to chronic depression; some even consider or attempt suicide.
What causes Gender Dysphoria?
Little is known about the causes of gender dysphoria. One theory is that changes in the brain prior to birth cause parts of the brain to develop in a pattern opposite to that of the physical gender.
Is gender dysphoria the same as being a homosexual or transvestite?
Gender identity is quite separate from a person's sexuality; people with gender dysphoria can be homosexual, bisexual or heterosexual. A male to female transsexual, for example, attracted to women, may consider themselves to be a lesbian. Others may be attracted to heterosexual men and would not identify as being homosexual since their adopted gender identity is female.
A transvestite, is a person, male or female, who cross-dresses as a member of the opposite sex. Transvestism is quite distinct from transsexualism. A transvestite has no feelings of belonging to the opposite gender, and doesn't experience alienation from their body/sexual organs.
Voice Surgery
Crico Thyroid Approximation
This procedure modifies the pitch of the voice by loosely suturing the cricoid and thyroid cartilages to each other, thus limiting the extent to which the vocal cords can be relaxed, and preventing the voice from dropping too low.
It will not give the patient access to any higher pitch than she is already capable of producing; it merely prevents her from lapsing into a lower range. Furthermore, much of the perceived femininity of the voice is due to factors other than pitch. Crico-thyroid approximation is in no way a substitute for speech therapy.
The operation is normally performed in conjunction with a thyroid chondroplasty, as the crico-thyroid approximation tends to make the thyroid cartilage more prominent.
As with any form of 'voice surgery' there is some risk of permanent damage, leading to disruption of the voice, even though the procedure is, in principle, reversible. Many practitioners are of the opinion that this operation would be ill-advised for all but a very small minority of trans women, and that speech therapy is the preferred approach.
This first close up clearly shows where the incision was made. During the first week after the operation I was resting my voice completely and on a liquid diet due to problems swallowing food. The stitch work was done with some old fishing line found by my surgeon.
The side view here shows the area is still very swollen. I will have to wait to see the end result of the Thyroid Chondroplasty.
The bruising had spread down my neck to my chest. Healing will take some time and my voice will need lots of work with my speech therapist and practice to perfect.
Speech Therapy
The majority of trans women will have male-sounding voices which have broken normally at puberty. Neither hormone treatment nor genital surgery will affect the voice, so the patient must learn to produce an acceptable female voice with the help of a qualified speech therapist. Some trans women are able to adapt their voices quite readily, many require professional help, some may help very little success even with speech therapy.
I have had speech therapy since 2002. My voice has only improved with practice and, with the help of the crico-thyroid approximation procedure, I hope to improve my voice further.
Thyroid Chondroplasty
Thyroid Chondroplasty or Tracheal Shave
This procedure reduces the prominence of the 'Adams Apple', by making a small horizontal incision in a natural crease-line on the neck, and removing part of the thyroid cartilage.
The safety of the procedure is generally good, and it should not affect the quality of the voice, provided a surgeon is experienced in treating trans patients is chosen, but there have been a few notable disasters in which excessive cartilage has been removed, leading to collapse of the vocal cords.
I had this procedure in October 2003 and again October 2005 together with the Crico Thyroid Approximation procedure.
Rhinoplasty
What is a Rhinoplasty?
A Rhinoplasty is an operation to change the shape of the nose.
The operation is usually done under a general anaesthetic, which means that you will be asleep throughout the procedure and will feel no pain. Alternatively, you can have a sedative and a local anaesthetic that numbs the area around the nose.
My Rhinoplasty on 13th April 2005
I was admitted on 12th April and the operation was performed under general anaesthetic on 13th April at 12 midday. The operation lasted just over 2 hours and was performed by Mr Saleh at London's Charing Cross Hospital.
The objective of the operation was to reduce the bump on the bridge of the nose, raise the tip and slightly widen the nostrils to make the nose appear more feminine and shorter.
The pictures below were taken post op and the procedure will be shown in August on Discovery Health channel.
The first picture was taken on 14th April (the day after the operation), the bruising around the eyes is already very clear and the plaster cast is held in position with adhesive tape. I had nose bleeds the night before and today from my nostrils and also from the top corner near my right eye.
At home on Friday 15th April. The bruising worsens and the cast can be seen more clearly in this close up. I am still getting nose bleeds and head aches and feeling very blocked up. Just when I thought it couldn't get any worse, I developed a cold. Discovered it was best to open my mouth and cross legs when sneezing, this protects the nose and stops it falling off.
Saturday 16th April. My eyes are at their worse here and my cold is making breathing very uncomfortable. Taking Paracetemol and Ibroprofen (for bruising).
In desperate need of make-up....... infact, in need of a lot of make-up.
Plaster cast removed on 25th April. My nose is red and swollen. It will take at least 3 months to see the result, healing may take 6-12 months.
Do not intend to go clubbing tonight.
Charing Cross Hospital.
This is a picture of the main entrance. Below the clock is the swimming pool, top left is the balcony over looking the pool and a view of the beautiful Fulham Palace Road.
Legal
What documents can be changed?
Everything. Bank details, driving licence, passport, work records, medical records and anything else which has my name on it.
The change of name deed is obtained from any solicitor costing between £40-£60.
Can you change your birth certificate?
The Gender Recognition Bill (Gerbil) was passed to the House Of Lords on 10/02/04.
The bill completed its last parliamentary stages on 8th June, and received the Royal Assent on 1st July. It offers transsexual people full legal recognition of change of gender.
Changes relating to marriage became neccessary when the government lost two cases at the European Court Of Human Rights.
Surgery will not be a condition of registration. Those wishing to register will have to show they have lived in new gender role for at least two years.
(see www.pfc.org.uk)
Can passports be changed?
Yes.
A copy of my change of name deed and a letter from The Gender Identity Clinic at Charing Cross hospital to say the change will be permanent must be sent to the passport office.
My new name and picture appears on my new passport and sex reads 'F'.
Hormones
What effect will hormones have on your body?
I began Ethinyloestradiol (Oestrogen) in July 2003 and started with one a day for first 3 months then 2, then building up to 3 a day. The effects were slow to begin with but now I have soft skin, 'A' cup breasts, thicker head hair, reduction in body hair and I'm putting weight on my hips. My sex drive has dissipated, I am more emotional, have mood swings and chocolate addiction !
My Oestrogen was changed in August 2005 to Estradiol Valerate (Progynova) 6mg. This is taken along with an Anti-Androgen, Goserelin Acetate (slow release injection just underneath the skin near stomach.
The Oestrogen will not affect my voice (a voice cannot be unbroken) and my facial hair will slightly soften but will still continue to grow and require electrolysis to remove permanently. Oestrogen will be taken for life, anti-androgen will cease following GRS.
What different types of hormones are there?
Oestrogens
Oestradiol Valerate
Ethinyloestradiol
Conjugated Natural Oestrogens (Premarin)
Other Oestrogens
Progestogens
Medroxyprogesterone Acetate
Dydrogesterone
Natural Progesterone USP
Synthetic Progestogens
Anti-androgens
Antiandrogen Drugs
Cyproterone Acetate
Flutamide
Spironolactone
Finasteride
GnRH Agonists
Nafarelin Acetate
Goserelin Acetate
Leunrorelin Acetate
Orchidectomy (Removal of testes)
When are hormones authorised?
I am attending Charing Cross hospital GIC (Gender Identity Clinic) where I am assessed by a specialist gender identity psychiatrist. The GIC oversee the whole reassignment program. I have had to see at least two different psychiatrists and begin the real life test before hormones are authorised. I have had regular blood tests for Prolactin and liver profile. It is common for prolactin levels to flutuate during the treatment.
More information on types of hormones.......
Progynova (Estadiol Valerate)
This drug is equivalent to natural 17 beta-oestradiol. It is generally well-tolerated, and clinical data from postmenopausal women suggest it is safer than ethinyloestradiol for long-term use, with less risk of breast cancer, thromboembolic events, or liver problems. It is not certain whether this improved safety applies in the high doses necessary for pre-op transsexuals. This is widely regarded as the oestrogen of choice for long-term maintenance in post-op TS patients due to its good safety record; typical post-op dose would be 1-2mg daily, ideally divided into two doses. Oestradiol Velerate appears to be less effective at inducing feminisation in pre-op subjects than ethinyloestradiol, probably due to it`s short serum half life-particularly, as it appears tp fare poorly when "in competition" with endogenous male hormones; adequate results have been obtained with oestradiol valerate combined with an effective anti androgen. Typical pre-op dose would be 4-6mg daily in divided doses (1 or 2mg per dose); if menopause-type symptoms appear (hot flushes, night sweats, etc) this can often be a sign that the dose is not sufficent to overcome the endogenous male hormones and a switch to ethinyloestradiol would probably be advisable.
Ethinyloestradiol
This drug is a synthetically-produced modification of natural 17 beta-oestradiol. The modified molecule is eliminated only slowly by the liver, giving it a far greater potency and much longer half life than other oestrogens. It is generally well-tolerated, but appears to be less safe in very long-term use than oestradiol valerate. Ethinyloestradiol is widely regarded as the oestrogen of choice in pre-operative subjects. A dose of 100 ug daily (in two doses) is typical; this can be increased to 150ug if necessary. Its long half life and high potency give it excellent feminising effects. In post-op patients, this drug may still be used, especially for patients whose feminisation has not completed by the time they have GRS. For short-term post-op use, the full pre-op dose of 100 ug may be used, this is normally reduced to 50 ug after 6-12 months. For long-term post-op use, oestradiol valerate is probably preferable. It should be noted here that oestrogen overdosage may paradoxically cause vasomotor symptoms similar to those produced by insufficient oestrogen dosage. This is sometimes seen in post-op patients who are still on pre-op dosage, and if this effect is suspected then the oestrogen dosage should immediately be reduced to a typical post-op level. This effect is more likely with ethinyloestradiol than with other oestrogens due to its high potency, and consideration may be given to an early switch to oestradiol valerate if the problem persists.
Conjugated Natural Oestrogens (Premarin)
This drug is a mixture of various oestrogenic substances extracted from the urine of pregnant mares. It lacks the potency of ethinyloestradiol, and there is no evidence that it has any advantages over oestradiol valerate. Many patients dislike this drug because of ethical concerns over the manner in which it is produced. It is increasingly regarded as an outmoded treatment for TS patients. It is also more expensive than the synthetically-manufactured drugs. A typical pre-op dose would be 5-7.5mg daily in divided doses, reducing to 1-2.5mg daily post- up.
Other Oestrogens
A number of other oestrogenic drugs exist, many of which have been tried in the past in TS patients. It has already been mentioned that metabolites such as oestrone and oestriol are not suitable for use in TS patients; other oestrogen derivatives exist but have no advantages over the three oestrogens listed above. Diethylstilboestrol has been used in the past, and while it certainty produces worthwhile feminising effects, its safety record contraindicates its use in TS subjects: many serious problems, including fatalities, have been reported.
Progestogens
Progestogens administered alone do not produce feminisation in a phenotypic male. However, progestogens are generally quite antiandrogenic and will often promote a useful degree of testosterone suppression in a pre-op patient, and more importantly when administered in conjunction with oestrogen, improve the feminisation attained compared to oestrogen-only therapy, particularly in terms of breast weight and texture. One U K endocrinologist has claimed that progestogens have no effect in transsexual patients, however numerous studies both in the UK and elsewhere have demonstrated that this claim is false. Progestogens are now very widely used in conjunction with oestrogens in the treatment of male-to-female transsexualism. Progestogens may also lessen the risk of cancer associated with long-term oestrogen treatment, according to some studies in natural-born females. In addition, some patients report that progestogens affect them psychologically, particularly in terms of maintaining the libido.
For all these reasons, it may well be desirable to continue with a low dose of progestogen post- operatively, even though there is no absolute need for it. No reliable data exists regarding the incidence of breast cancer in transsexuals. Many are lost to follow-up and conceal their transsexual past after completing their treatment, and any instances of breast cancer in this group are likely to be recorded as occurring in normal women rather than transsexuals. One researcher has claimed to find a significant excess of breast cancers among certain chromosomally-intersexed patients who have been reassigned to female. A few patients experience androgenic effects from some progestogens, possibly including an increase in body hair. If this occurs, a different progestogen should be tried. Similarly, if fluid retention occurs, a switch to an alternative drug will probably resolve it.
Anti-androgens
Hormone treatment in pre-operative male-to-female subjects is normally supplemented by some form of antiandrogen treatment. While oestrogens and progestogens are to some extent antiandrogenic in themselves, a number of other methods exists to suppress the effects of androgens and make the feminising hormones more effective without having to administer the latter in unreasonably high doses.
These treatments also, of course, cause a significant reduction in male sex drive (and indeed sexual function), which is generally considered highly desirable by transsexual subjects.
There are three approaches to antiandrogen treatment:
- Antiandrogen drugs.
- GnRH (Gonadotropin-releasing-hormone) agonists.
- Bilateral orchidectomy (castration).
These treatments are not applicable to patients who are post-operative, as their bodies will, by definition, be incapable of producing gonadal androgens. Adrenal androgens are produced in small amounts by both sexes, and no attempt should be made to suppress them unless a serum androgen test has indicated significant overproduction, as in cases of adrenal hyperplasia. In general it is considered unwise to administer antiandrogens to post-operative subjects (and indeed to severely hypogonadal subjects such as certain intersexed patients), as the small amount of adrenal androgens remaining in such subjects are necessary for normal functioning.
These drugs either inhibit gonadal androgen production, interfere with androgen receptor sites, or both. Most are likely to produce some side effects in effective doses; some patients cannot tolerate some or all antiandrogen drugs, in which case bilateral orchidectomy is likely to be a preferable treatment.
The effect of these drugs on fertility and male sexual function is reversible to an extent, however (like feminising hormones) irreversible infertility may ensue after some months of treatment.
All antiandrogen drugs, like feminising hormones, must be withdrawn prior to major surgery. This may lead to a degree of reversion towards masculinity, which may be pronounced and disturbing in some patients.
Goserelin Acetate
Administered as a depot (i.e. time release) injection (typically 3.6 mg monthly). Reported adverse effects include heart failure, obstructive pulmonary disease and severe allergic reactions as well as more minor side effects such as lethargy and nausea. In view of the fact that it is a depot injection, this drug should be treated with caution as it cannot be rapidly withdrawn should problems occur.
Lasers & Electrolysis
Hair Growth
The growth and shedding cycle of the hair follicle is divided into three phases: anagen (growing 
stage), catagen (changing stage), telogen (resting stage).
In the growing stage (anagen) the cells at the base of the hair follicle divide and form the new hair which is pushed upward and appears on the skin surface. Once the formation of the hair is complete the cells at the base of the follicle stop dividing and the follicle then moves into the next stage (catogen). The follicle continues to nourish the hair, which is still firmly attached. The final stage (telogen) occurs where the follicle no longer nourishes the hair, which in turn is shed. After a dormant period the hair follicle will spring back to life and the process is then renewed. The length of each of these stages varies in different body sites for example the follicles of the scalp remain in the anagen stage much longer than any other body site which is why our head hair grows long.
It is only in the anagen stage that enough thermal damage can be done to the hair follicle thus destroying its capacity for re-growth. This coupled with fact that all of our hair follicles are not active at the same time explains why laser hair removal requires more than one treatment
What types of hair removal are available?
Nd Yag
The removal of unwanted hair using the Nd YAG Laser is based on the long accepted and proven principle of Selective Photo-Thermolysis. The laser beam, emitted via the handpiece is selectively absorbed by the melanin within the hair shaft, causing a heat reaction, which in turn causes damage to the germative cells. The resulting damage will reduce the hair growth by up to 40% per treatment. The laser works both with single or repeated pulses, and the intensity of each pulse can be finely regulated. The combination of all these parameters, controlled by a microcomputer, allows the calibration of the laser according to the hair characteristics: colour, thickness and density. It can be used on wide areas, so that the process is extremely quick and accurate. Nd Yag is totally ineffective on blonde or red hair.
Plasmalite
Plasmalite is the third generation of light based hair removal systems. Incorporating all the benefits of both Laser and Intense Pulse Light in a single system and using unique fluorescence technology.
Epilite
Epilight uses pulsed light to remove hair and impair hair regrowth. First, a cool gel and a hand held treatment unit are gently applied to the skin. Then in a flash, pulses of light safely penetrate the skin and disable hundreds of hair follicles simultaneously. When the gel is removed, much of the hair is wiped off with it. The remaining hair in the treated area falls out within a week or two.
The system's unique design offers you customised treatment, according to your hair and skin colour, texture and location on the body including the chin, upper lip, cheeks, legs, arms, under arms, and back - as well as sensitive areas like the nose, chest, breasts and bikini. Blonde, grey and white hair cannot be treated. All skin colours can safely be treated.
You can return to work the same day and resume all regular activities. No cosmetics or cleansing for 24 hours. No exposure of the treated area to UV sunlight or sunbeds during your treatment.
How does Epilight compare with commonly used hair removal methods?
Electrolysis is a tedious, invasive and painful process which involves inserting needles into each hair follicle and delivering an electrical charge to destroy them one at a time. Electrolysis often requires years of treatment at regular intervals.
There are no current types of laser that work effectively on blonde or red hair.
Electrolysis
Almost invariably, male-to-female transsexuals require electrolysis treatment to remove facial hair, prior to or shortly after their change of gender role. In rare cases this has been obtained on the NHS, but at the present time it is hard to obtain any treatment on the NHS for transsexualism and most clients will pay for electrolysis privately.
Genital Electrolysis
The precise method of surgery used depends upon the surgeon performing the procedure; but all methods of GRS place potentially hair-bearing tissue from the penis and/or scrotum in locations where hair would be undesirable and problematical (inside the vagina, under the clitoral hood, and perhaps inside the labia). For this reason, patients are well advised to seek the advice of their chosen surgeon as to which parts must be depilated, and then to obtain the necessary electrolysis well in advance of surgery (to allow the skin to recover).
Linx & Numbers
Contact me! - sarahspages@hotmail.com
Websites
For medical overview;
www.looking-glass.greenend.org.uk/medical.htm
For Gender Recognition Bill latest news;
For Employers;
www.gendertrust.org.uk/emplgude.htm
Some of my friends;
www.louise.h.wilson.btinternet.co.uk
Useful numbers
Gentrust helpline - 01305 269222
The Beaumont Trust - 07000 287878
Transliving (ex New Transessex) - every weekday and evening until 9pm
01268 583761
Beaumont Society Information Line -Pre-recorded information about The Beaumont Society.
01582 412220
The Gender Trust Transsexual Helpline - Calls before 10.00pm.
07000 790347
Helplines For Wives and Partners run by WOBS. This line is to enable women to talk to other women about concerns they have with their husbands or partners cross dressing. Operating between 7.30pm and 10.30pm.
01223 441246
01684 578281
01389 380389
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