Hormones
After a period of assessment, and by mutual agreement, some routine blood tests will be done to determine health and suitability. Hormone treatment may be offered in the form of the male hormone testosterone. This is usually administered by intra muscular injections once every two or three weeks, for the whole of your life.

The effects you can expect from taking testosterone include deepening of the voice, increased sex-drive, cessation of menstruation, re-distribution of body-fat to a more male pattern, increased muscle tone and male pattern body hair and facial hair growth. The possible side effects of taking testosterone can be a slightly increased risk of liver complications, acne and male pattern baldness, depending on your hereditary factors. Regular exercise will increase muscle bulk and give maximum impact to the masculinising effects of testosterone.

The Sandyford Gender Identity Clinic requires you to have changed your name and to be living as a man before starting to take testosterone, because permanent changes such as your voice breaking can occur quickly after starting testosterone. Depending on your genetics, significant masculine body hair and facial hair development may become obvious within the first few months of your hormone treatment, or it may take up to a few years.
The masculising effects of testosterone are irreversible and hormones have to be taken for the duration of one’s life.

Please Note: - Hormones should never be taken without your doctor’s involvement.

It is advisable to reduce or stop smoking before commencing hormone treatment. Taking testosterone can slightly increase the risk of heart disease. Smoking while taking hormones will greatly increase this risk.

Testosterone causes the clitoris to grow slightly, and this with surgery can make it look like a very small penis, while still retaining its sensitivity. Problems with urinating can be a risk of surgery, and the penis is usually too small to use for penetrative sex.

Surgery
Some transsexual men decide to have surgery. This usually involves bi-lateral mastectomy (removal of the breasts and reduction in the size of the nipples). This can be arranged depending on funding from your local health authority. Some also decide to have a hysterectomy (removal of the womb, cervix and ovaries). A smaller number of transsexual men choose to get surgery to change the appearance of their genitals:

• Phalloplasty is a technique that involves creating a penis using skin from the forearm or abdomen. This surgery can also involve the extension of the Urethra, giving the ability to stand up and urinate. The penis can also be inserted with an erectile implant. Problems with urinating and loss of sensation are risks of surgery. Some transsexual men feel this surgery is necessary for them.

However, many decide not to go through this process, as techniques are still being developed and it can involve several operations, long stays in hospital, extensive scarring and, in some cases, unsatisfactory results.

• Metoidoplasty is a technique which involves releasing the clitoral hood and extending the urethra.

• Scrotoplasty involves the creation of a scrotum from the labia by using testicular implants.

Many transsexual men decide not to have any genital surgery at all and some prefer to wear a prosthetic to give the appearance of male genitalia.

All Gender Confirmation Surgery is performed in England, and Surgeons Mr. David Ralph and Mr. Nim Christopher hold clinics 3-4 monthly at Sandyford.