As a network partner of ATHB (Association of Transgender & Hijra in Bengal), we provide three basic services to Transgender for their well being:
Medical: our medical services include three basic steps in it, followed by The “World Professional Association for Transgender Health”. The overall goal of these services to provide guidance and assist transgender, and gender nonconforming people with safe and effective pathways to achieving lasting personal comfort with their gendered selves.
DIAGNOSTIC ASSESSMENT is the first approach where the psychiatrist of our panel refer the individuals for “Psychometric Evaluation Tests” the assess the psychosomatic situation of the Transgender Individual. This is a standard and scientific method used to measure individual’s (irrespective of gender and sexuality) mental capacities and behavioural style. They can identify the extent to which an individual’s personality and cognitive abilities match those required to perform the role. Implication of these tests to transgendered individuals is not to detect their Gender Dysphoria, but to identify if there is any co-associated life threatening mental illness which may lead to gross disorder.
REAL LIFE ASSISTANCE is the second stage on gender transition procedure. Depending on the positive (without any serious mental illness) psychometric report, psychiatrist refers the individual for the next step which we named Real Life Assistance. This stage involves consultation of Hormone Replacement Therapy,
[Hormone replacement therapy (HRT) of the male-to-female transgender is a form of hormone therapy that is used to change the secondary sexual characteristics of transgender and transsexual people from masculine (or androgynous) to feminine. It is one of two types of HRT for transgender and transsexual people (the other being female-to-male), and is predominantly used to treat transgender women. Some intersex people also receive this form of HRT.
The purpose of this form of HRT is to cause the development of the secondary sex characteristics of the desired sex, such as breasts and a feminine pattern of hair, fat, and muscle distribution. It cannot undo many of the changes produced by naturally occurring puberty, which may necessitate surgery and other treatments. The medications used in HRT of the MTF type include estrogens, anti androgens, and sometimes Progesterone.
While HRT cannot undo the effects of a person's first puberty, developing secondary sex characteristics associated with a different gender can relieve some or all of the distress and discomfort associated with gender dysphoria, and can help the person to "pass" or be seen as the gender they identify with.
Because of the same reason, Female-to-Male (FTM) hormone therapy is used to change the secondary sexual characteristics of transgender and transsexual people from feminine (or androgynous) to masculine. The purpose of this form of HRT is to cause the development of the secondary sex characteristics of the desired sex, such as voice deepening and a masculine pattern of hair, fat, and muscle distribution. It cannot undo many of the changes produced by naturally occurring puberty, which may necessitate surgery and other treatments. The medications used in HRT of the Female to Male type include, mainly, androgens (namely testosterone) and GnRH analogues.
While HRT cannot undo the effects of a person's first puberty, developing secondary sex characteristics associated with a different gender can relieve some or all of the distress and discomfort associated with gender dysphoria, and can help the person to "pass" or be seen as the gender they identify with. Introducing exogenous hormones into the body impacts it at every level and many patients report changes in energy levels, mood, appetite, etc. The goal of HRT, and indeed all somatic treatments, is to provide patients with a more satisfying body that is more congruent with their gender identity].
Almost one year after hormone therapy, again psychiatric Consultation is approached to get the psychiatric referral for surgical interventions. Depending on the psychometric outcome, surgeon decides which surgery should be carried out.
As the first part of Male to Female gender reassignment procedure, surgeon may prefer to choose BREAST AGUGMENTATION SURGERY. As because genital reconstruction is irreversible in nature and there is no way to come back to the previous stage. But, breast augmentation is almost reversible and the individual can have enough mental preparation to adjust the newly formed anatomical shape of the body.
Breast augmentation is a surgical procedure involving the placement of breast implants to increase the size and improve the shape of the breasts. Male to female transsexual/transgender individuals usually get a certain amount of breast development from long-term hormone therapy. Most of them usually develop an “A” cup size breast from this therapy, although occasionally the breasts can grow larger. Those who desire a larger breast than hormones produce should explore having breast augmentation surgery, in which a breast implant (prosthesis) is inserted under the existing breast through an incision.
Breast implants are placed through three kinds of incision.
A. Auxiliary (underarm) approach.
B. Areolar (The dark circular part around the Nipple) approach.
C. Infra-mammary (under the breast fold) approach.
Our surgeon mostly prefers the Infra-mammary approach. This approach tends to be more direct and to allow greater control of the implant positioning. Eighty to Ninety percent of breast augmentations are performed using this incision site. Since the incision is in the fold underneath the breast, the parts of the breast that make milk are less likely to be affected in case of genetic women. This option also allows the surgeon to place a little large sized implant and look directly where the implant will be placed and allows for better implant placement. In addition, if complications occur and additional surgeries are needed, the original incision can be used. Some of the other incision sites may not be ideal for treating complications.
This approach works well with individuals who have already had a long time female hormone therapy and are having a moderate size of breast development, since HRT creates a small amount of natural fat tissue in the breast. This size allows the incision to be well hidden in most transsexual woman.
Although for the genetic women who has yet to have children, and transgender/transsexual women who are thin, or who are younger, this surgical option may result in a more visible scar.
Trans-Auxiliary incision is from the armpit. Fifteen to twenty percent of breast augmentations are done using this surgery. This incision site can be used for both sub-muscular and sub-glandular placement of the implant. One of the advantages to this site is placement of the scar in a less visible location. It also allows better access to place the implant in the sub-muscular position. Some surgeons will also use an endoscope, or a small fibber-optic camera, to help them in this surgery. This approach is often used for thin genetic women and trans-women where sub-muscular placement would allow more natural appearance to the breast. It is also used for women who are younger and have little to no breast sag, thus making an infra-mammary scar more visible.
A potential disadvantage to this approach is that proper implant positioning is somewhat more difficult, particularly if the procedure is performed without an endoscope. In addition, if the individual experiences scar thickening postoperatively, this scar may be visible when the patient wears a shirt or dress without sleeves. In addition, it may be visible when the person wears a bathing suit and raises her arms.
THE BREAST IMPLNTS WE USE:
In previous years we used to perform breast augmentations with two brands of Silicone Implants. The first choice was with the American brand ALLERGAN.
Unfortunately after GST (Goods and Services Tax ) has taken place, we stopped working with this brand. Because of the highly increased cost, our vendor stopped supplying the brand to us.
On the second it is EUROSILICONE, which is a French Brand and less costly than the American brands.
Another more popular FDA approved (Food and Drug Administration) Silicone brand that we have introduced recently is the British Silicone Implant “NAGOR”.
Usually after six months of breast augmentation our surgeon prefers to perform the genital reconstruction of male to female Transsexual individuals. This is the most crucial and important part in sex reassignment. This part is actually the gender reassignment in medico-legal term.
There are variety of surgical approaches exist for MTF Vaginoplasty, the two most widespread techniques are the Penile Inversion and Recto sigmoid methods. The most common and effective method of transsexual Vaginoplasty is called “Penile Inversion”. Penile Inversion Vaginoplasty is widely regarded as the “gold standard” method of male-to-female gender reassignment surgery. In this technique our surgeon performs the One-Stage Modified Penile Inversion Vaginoplasty which results in an authentic appearance with excellent depth, function and sensation. To create the vagina, the majority of skin from the shaft of the penis is inverted and used to line the vaginal cavity created in the perineum. If additional tissue is required to create a vagina of acceptable depth, skin grafts can be harvested from the scrotum. Erectile tissue is removed so that sexual arousal doesn't cause narrowing of the vaginal opening or protrusion of the urethral opening and clitoris.
The urethra is shortened and redirected to emerge at the normal point for a woman, i.e. just in front of the new vaginal opening. Excess erectile tissue around the urethra is eliminated to prevent it from increasing in size during sexual stimulation and thereby interfering with the proper opening of the vagina.
A small, sensate clitoris is created from a small portion of the glans which is left attached to its nerve and blood supply. the penis skin is moved to form the vaginal walls. The remaining parts of the penis, including the corpora cavernosa (whose function is erection) and part of the penile urethra are eliminated.
Where possible, our surgeon uses a large part of the urethra to form the internal walls of the vaginal vulva, thereby giving pink, mucous appearance similar to the female vulva.
Labia minora and majora are constructed from prepuce or penile skin and scrotal skin.
The prostate gland, which is typically well-atrophied from hormone replacement therapy, is not touched. The vagina is created behind the prostate. Any future required examination of the prostate would thus occur via the vagina, not the rectum.
The reconstructed vagina’s size will vary depending upon three characteristics of the transsexual patient: the size of their penis, the elasticity of their skin and their height (which determines the size of the cavity to house the new vagina).
POST SURGICAL CARE:
Post surgical care is very much important for a trans-woman to maintain the depth of the newly created vagina. You have to properly clean the surgical area until it heals properly. As per the surgeon’s advice, you have to start Vaginal Dilation every day. Any technique of Vaginoplasty performed will require vaginal dilation of the patient for the rest of her life with a set of vaginal stents. This is due to the surrounding tissues, including the pubococcygeus muscle, trying to move back to their original positions, forcing the neovagina closed.
Scar tissue will form at any place that two pieces of tissue (in the form of grafts) are joined together in this manner. Scar tissue has very different properties than the rest of the skin.
As if this wasn't enough, when the neovagina relaxes and contracts between dilations, it develops wrinkles. These wrinkles will actually start healing together, narrowing the diameter of the neovagina. This will continue until the tissue has enough time to heal, so adequate dilation must be maintained during the healing process.
After the initial healing process it is possible to regain lost vaginal depth and or width by using progressively larger dilators, but it is a slow and difficult process. Therefore it is necessary to encourage proper dilation technique during the early stages of healing.
Depending on the package, we provide a Dressing and Dilator Kit, packed with four different sizes of medical grade silicone dilator, lubrication gel, inside
OUR LEGAL SERVICES:
As the Medical services, accordingly we provide legal services too. We arrange the Affidavit of Name and Gender to amend or change the existing old documents. In case of gender related violence in family educational sector or in society, we provide legal support within our capacity.
OUR FUTURE AGENDA:
As per many requests from the Transgender individuals and their families from past few years, we have decided to get entry into sensitization programmes. In this curriculum, we have included family therapy and Gender sensitization workshops in various Educational institutes.