Au­gusta trans man in­spires oth­ers to live their truths

Urog­y­ne­col­o­gist weighs in on surgery op­tions, risks

GA Voice - - Georgianews -


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Rowan Eli­jah Feld­haus, 25, passed away May 16 fol­low­ing com­pli­ca­tions from gen­der con­fir­ma­tion surgery. The Au­gusta res­i­dent made head­lines in June 2016 af­ter a lo­cal judge de­nied his name change re­quest, a de­ci­sion over­turned ear­lier this year by the Court of Ap­peals of Ge­or­gia. But that was just the start of his legacy.

In life, Feld­haus was known for his “grace, quiet dig­nity, strength and self-as­sur­ance,” Lambda Le­gal Coun­sel Beth Lit­trell said in a state­ment. Now, af­ter a Harry Pot­ter-in­spired wand cer­e­mony to cel­e­brate his time on Earth, Feld­haus lives on as both an or­gan donor and an in­spi­ra­tion to all who want to live their truths.

Ac­cord­ing to the Amer­i­can So­ci­ety of Plas­tic Sur­geons, there was a nearly 20 per­cent in­crease in gen­der con­fir­ma­tion surg­eries in just the first year of re­port­ing. In 2016, more than 3,200 surg­eries were per­formed to help trans­gen­der in­di­vid­u­als.

What’s right for me?

Trans­gen­der in­di­vid­u­als don’t al­ways elect to un­dergo surgery as part of their tran­si­tion, but if they do, there are a number of pro­ce­dures avail­able to them. Some are more cos­metic, such as body or fa­cial con­tour­ing, but oth­ers in­volve cre­at­ing func­tional gen­i­talia.

“It’s a grab-bag term, but it in­volves mul­ti­ple types of pro­ce­dures de­pend­ing on where an in­di­vid­ual is in terms of their tran­si­tion and what they feel helps af­firm them and their ex­pres­sion of the gen­der,” said Dr. Bernard Tay­lor, a urog­y­ne­col­o­gist with the Caroli­nas Health­care Sys­tem De­part­ment of Ob­stet­rics and Gy­ne­col­ogy in Char­lotte, North Carolina.

He spe­cial­izes in “bot­tom surgery,” which in­volves surg­eries that af­firm gen­der be­low the belt.

“The women who un­dergo trans­gen­der fe­male surg­eries gen­er­ally have to have their tes­ti­cles re­moved, pe­nis re­moved and then we cre­ate a vagi­nal canal,” Tay­lor said.

This pro­ce­dure in­verts the skin of the pe- Gen­der con­fir­ma­tion surgery in­cludes a number of dif­fer­ent pro­ce­dures, in­clud­ing chest aug­men­ta­tion and gen­i­tal con­struc­tion. More than 3,200 such surg­eries were per­formed in 2016. (Photo via iStock) nis and scro­tum. It’s a bit of the op­po­site for trans men, how­ever.

“Many times they’re go­ing to start with a hys­terec­tomy and the re­moval of the ovaries. Then that may be all that they want; they want to have their men­strual pe­riod stopped. They want their uterus and ovaries re­moved,” Tay­lor said. “If they want to fur­ther tran­si­tion to more mas­cu­line gen­i­talia, many times we’ll close off or re­move the internal vagina and then re­con­struct a small pe­nis they can use to uri­nate while stand­ing.”

For trans­gen­der men who plan to have sex, Tay­lor said it’s pos­si­ble to un­dergo a pro­ce­dure called a phal­lo­plasty, which con­structs a pe­nis that, if de­sired, can have a pros­the­sis that al­lows it to be­come erect.

Tay­lor said these surg­eries are only per­formed for in­di­vid­u­als with a med­i­cal condi- tion called gen­der dys­pho­ria, mean­ing they feel their gen­i­talia must be changed in or­der to live as their true gen­der.

“Those in­di­vid­u­als who have dys­pho­ria are those who phys­i­cally look at them­selves in the mir­ror and are re­ally dis­tressed about their bod­ies not be­ing the gen­der they were born to be,” Tay­lor said.

Re­gard­less of what pro­ce­dures, if any, a trans­gen­der in­di­vid­ual chooses, there’s lots of prepa­ra­tion and coun­sel­ing in­volved.

“The bot­tom surg­eries are per­ma­nent. They’re not re­versible. So the pa­tient has to un­dergo much more thor­ough coun­sel­ing and we have to make sure they’re pre­pared, and their fam­i­lies and their so­cial life,” Tay­lor said. “We have a con­sul­ta­tion about the var­i­ous types of surgery.”

Age of tran­si­tion is also a hot topic in the med­i­cal com­mu­nity. Tay­lor said the stan­dard of care is that surgery is ac­cept­able at 18 years old, though some in­di­vid­u­als may choose to be­gin hor­mone ther­apy or other non-sur­gi­cal forms of tran­si­tion much ear­lier.

Be risk-aware

Like any pro­ce­dure, bot­tom surg­eries are surgery, and with them come risks — even some that may seem far-fetched.

“Any surgery, there’s an im­me­di­ate risk of bleed­ing, anes­the­sia, risk of in­jur­ing body or­gans, in­fec­tion,” Tay­lor said. “The long-term po­ten­tial risks or com­pli­ca­tions that can arise can be chronic prob­lems with blad­der dys­func­tion. If we’re cre­at­ing a ure­thra or pe­nis, you can have a fis­tula, which is a nar­row­ing of the ure­thra. For a pa­tient un­der­go­ing vagino­plasty, they re­quire di­la­tion, and if they don’t di­late reg­u­larly, then they could ac­tu­ally have nar­row­ing, tight­en­ing or short­en­ing of the vagi­nal canal in­ter­nally and it won’t be func­tional.”

Even a reg­u­larly per­formed surgery can have po­ten­tial com­pli­ca­tions. Ac­cord­ing to the Cen­ters for Dis­ease Con­trol and Pre­ven­tion, there are ap­prox­i­mately 600,000 hys­terec­tomies per­formed each year in the US. How­ever, it was com­pli­ca­tions re­lated to this pro­ce­dure that led to Feld­haus’ death.

“Sep­sis is an over­whelm­ing in­fec­tion in the body where bac­te­ria and some of the tox­ins can be re­leased and they cause or­gan dam­age, par­tic­u­larly kid­neys, liver, heart and lungs. That’s what could oc­cur with any surgery, and it has to be iden­ti­fied very early and treated in the hospi­tal,” Tay­lor said. “Typ­i­cally it’s pretty rare to have it hap­pen af­ter an elec­tive surgery, but it can oc­cur af­ter any pro­ce­dure.”

He ad­vised trans­gen­der in­di­vid­u­als con­sid­er­ing surgery to en­sure their pro­ce­dures are done by a board-cer­ti­fied physi­cian who has hospi­tal priv­i­leges in case a com­pli­ca­tion does arise.

“We don’t plan them, but they hap­pen. When it does hap­pen, you want to make sure your sur­geon has priv­i­leges and re­sources so you can be taken care of,” Tay­lor said.

Un­for­tu­nately, there’s not a great re­source avail­able list­ing doc­tors who per­form gen­der con­fir­ma­tion surg­eries. Tay­lor said pa­tients should ask their doc­tors how many such pro­ce­dures they’ve done in the past year to en­sure they’re pair­ing with some­one pre­pared to of­fer them the best treat­ment avail­able.

May 26, 2017

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