Gender Dysphoria Unit

Colloquially, we define gender dysphoria as a situation in which a person identifies with the sex opposite to that to which he or she biologically belongs. In other words, people who do not identify with their own biological sex.

Unidad de Genero del Instituto Jesús Lago

Since the existence of these situations was first observed in people who, for social reasons, found it difficult to tell their friends and families, there have been different medical trends to try to help these people. Surgery is the method that has proven to be the most effective.

How can we help transgender people ?

When we detect a situation of this type, the most important step, before taking any action, is to verify that we are facing a true case of transsexuality. There are other gender identity disorders that are not always transsexuality and therefore, before taking any false step, it is important to obtain a clear and precise diagnosis from a competent professional, namely, a transsexuality psychiatrist or psychologist.

Having defined the transsexual status, we can speak of male or female transsexuality. A transsexual woman is a person with male biological genitalia who feels like a woman. On the other hand, a transsexual male is a person with female biological genitalia who feels like a man.

What tests are needed before starting medical or surgical treatment for transsexualism ?

Before starting any hormone treatment and/or surgical action, the professional must perform different tests to rule out any other intersexual situation, and determine lipid profiles and liver function, as they may be altered by the hormone treatment.

What is the first step ?

We always recommend starting treatment with the hormone treatment. In every case, it is recommended that the patient experience the effect of hormones on the body before considering surgery.

When it comes to transgender men, the onset of chest hair helps to give a final shape to the male chest. On the other hand, when it comes to transsexual women, in order to modify the external genitalia, that is, perform a vaginoplasty, laser removal of the pubic hair is recommended, because the hair-bearing skin is used to create the vagina and if it is not removed prior to surgery, the hair could later grow in unwanted areas.

Is hormone therapy prior to surgery essential ?

No, it is not essential. In fact, there are people who cannot tolerate this treatment, or for whom the side effects are very harmful. We do not reject these people for surgery.

The transsexual man

Recall that is a person with female biological genitalia who feels like a man.

Normally, transsexual men are most concerned with their breasts, which look very feminine, and this is the first thing they want to treat. There are different techniques to give a masculine form and look to the female thorax. Do not forget that a transsexual person wants a body that physically corresponds to the sex with which they identify, and the goal of the surgery is to help them obtain this body.

It is not to reduce or remove the breasts as in the case of a disease; the goal is to masculinize the chest, giving the thorax a masculine appearance, so that after the surgery no one has any doubt, when they see the transsexual man, that he has the chest of a male.

According to recent, reliable scientific publications on surgery in transsexual people, it has been shown that the two most appropriate techniques for the treatment of the chest in male transsexuals are: subcutaneous mammaplasty and mammaplasty with free nipple grafting, both selected taking into account the previous breast.

mammoplasty in gender unit Institute Dr. Lago
mammoplasty in gender unit Institute Dr. Lago

What happens to the external genitalia in the transsexual man ?

Once hormone therapy has been started and the masculinization of the chest is complete, it is recommendable to remove the uterus and ovaries to prevent the risk of long-term malignant degeneration. Additionally, you can perform genital reconstruction surgery to give the genitalia a masculine appearance and in some cases even the capacity for erection and penetration. This surgery is performed with two different techniques depending on the existence or not of clitoral hypertrophy, an effect produced by the male hormones. If there is hypertrophy, we carry out a metoidioplasty, which achieves sensitivity and in some cases capacity for erection and penetration. If there is no hypertrophy, a phalloplasty is performed, which can achieve considerable penis length but not sensitivity.

clitoral hypertrophy gender unit in Spain

The transsexual woman

Recall that this is a person with male biological genitalia who feels like a woman.

Normally, as with transsexual men, the first thing transsexual women want to treat are their breasts; they want to look very feminine.

For some transsexual women, surgery is not needed since the hormone therapy alone sometimes makes the breasts develop enough to acquire a feminine size and form. Otherwise, we must resort to breast augmentation surgery, which is performed by implanting a prosthetic axillary for best results.

What happens when the appearance of the face is not feminine ?

There are fundamental differences in the bone structure of the male and female faces.

The woman has a more triangular face, a narrow jaw, higher eyebrows and a smaller nose. All these differences require various facial interventions to obtain a good result and a distinctly feminine facial appearance.

facial surgery gender unit in Spain

What happens to the external genitalia in the transsexual woman ?

The most important change is obtained with vaginoplasty, since the existence of male external genitalia traumatizes the transsexual woman to the point of preventing a normal intimate relationship. The vaginoplasty consists of surgery not only to give the external genitalia a female appearance, but also to enable vaginal sex and provide sensitivity and the ability to achieve orgasm during sex. This requires a precise surgical technique to obtain a vulva indistinguishable from that of a non-transsexual woman, with a clitoris, a vagina and a female urethra.

The depth of the vagina is also important. For this, we must properly assess the male external genitalia before surgery because the depth of the vagina and the surgical technique depend on the length of the penis and whether or not the patient has previously undergone an operation for phimosis. If penis size is insufficient to make a vagina, considering that the standard technique uses the skin of the penis to create the vagina, the surgeon must resort to a coloplasty, using part of the large intestine for the vagina.

vaginoplasty in gender unit in Spain
vaginoplasty in gender unit in Spain
Clínica Fuensanta
Miembro SECE
Centro autorizado por la Comunidad de Madrid
Miembro SECO
Miembro SEEDO
AE Cirujanos
World Professional Association for Transgender Health
European College of Aesthetic Medicine & Surgery

Madrid office

  • Clínica Fuensanta
  • Street Arturo Soria 17
  • C.P. 28027, Madrid
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Collado Villalba

  • Street La Venta, 4, 1º A
  • C.P. 28400, Collado Villalba
  • Phone 918 51 33 17
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