Vulvoplasty (zero-depth vaginoplasty)

I never have really had a great need to look like a female, yet always have had great desire to be like a female sexually, have the ability to be penetrated by a man as females can be, as well as a great desire not to look male by having a penis myself and instead have at least a female looking vulva. I want men to have sex with me because I am a "Fem-male" (100% female acting/roled), not because I have a penis.

I don't want Gay men to be attracted to me, because they are suppose to be attracted to Gay Men, what Gay really means I don't know, it's complex. One reason I refer to myself as " Female-roled male ".


The vulva is the outside part of the vagina. A vulvoplasty is a type of surgery that uses skin and tissue from a penis to create all of the outside parts of a vagina (except for the vaginal canal). 

The steps of a vulvoplasty are the same as a vaginoplasty. During a vulvoplasty, your surgeon will:

  • create a clitoris out of the glans (or head) of the penis,

  • create an inner and outer labia from skin on the penis and scrotum,

  • create the opening of the urethra so you can urinate, and

  • create the introitus (opening of the vagina).

The only thing that’s different between a full vaginoplasty and a vulvoplasty is the internal part of the vaginal canal.

  • Vaginoplasty creates a vaginal canal.

  • Vulvoplasty creates all the parts of a vagina except for the vaginal canal.

After vulvoplasty, this means you won’t be able to have intercourse or insert a penis into your vagina.


How Do I Choose Between a Vulvoplasty vs. Vaginoplasty?

A vulvoplasty has a much easier recovery. For example, you won’t need to dilate (or stretch) your vagina.

Another reason to consider vulvoplasty instead of vaginoplasty is because of medical problems or complications. One serious complication after vaginoplasty is called rectal injury. In some cases, a rectal injury can create a hole between your rectum and vagina.

But your chances of developing a rectal injury are much lower if you have a vulvoplasty instead of a vaginoplasty.

Sex & Vaginal Intercourse

Some patients know that they’re not interested in having vaginal intercourse. For these patients, a vulvoplasty may be a better choice.

After a vulvoplasty, you can still have orgasms through clitoral stimulation, just like with vaginoplasty. During a vulvoplasty, your surgeon will create a clitoris from the glans or head of the penis. 


 A Must Read Website for any Male to Female type trans person seeking " GRS " surgery ;

                   Post-Op; life after Reassignment or Orchiectomy /

"Special Note to Those Thinking About a Sex Change,

                                                  by Danielle Berry

Don't do it! That's my advice. This is the most awful, most expensive, most painful, most disruptive thing you could ever do. Don't do it unless there is no other alternative. You may think your life is tough but unless it's a choice between suicide and a sex-change it will only get worse. And the costs keep coming. You lose control over most aspects of your life, become a second class citizen and all so you can wear women's clothes and feel cuter than you do now. Don't do it is all I've got to say.

That's advice I wish someone had given me. I had the sex change, I "pass" fine, my career is good but you can't imagine the number of times I've wished I could go back and see if there was another way. Despite following the rules and being as honest as I could with the medical folks at each stage, nobody stopped me and said "Are you honest to God absolutely sure this is the ONLY path for you?!" To the contrary, the voices were all cheerfully supportive of my decision. I was fortunate that the web didn't exist then - there are too damn many cheerleaders ready to reassure themselves of their own decision by parading their "successful" surgeries and encouraging others.

I can speak the transgender party line that I was a female trapped in a male body and I remember feeling this way since I was 4. But, it's never that easy if you look at it sincerely and without preconception. There's little question that a mid-life crisis, a divorce and a cancer scare were involved in at least the timing of my sex-change decision. To be completely honest at this point (3 yrs post-op) is not easy, however, I'm not sure I would do it again. I'm now concerned that much of what I took as a gender dysfunction might have been nothing more than a neurotic sexual obsession. I was a cross-dresser for all of my sexual life and had always fantasized going fem as an ultimate turn-on. Ironically, when I began hormone treatment my libido went away. However, I mistook that relief from sexual obsession for validation of my gender change. Then in the final bit of irony, after surgery my new genitals were non-orgasmic (like 80% of my TG sisters).

So, needless to say, my life as a woman is not an ultimate turn-on. And what did it all cost? Over $30,000 and the loss of most of my relationships to family and friends. And the costs don't end. Every relationship I make now and in the future has to come to terms with the sex-change. And I'm not the only one who suffers. I hate the impact this will have on my kids and their future.

Anyway, I'm making it sound awful and it's not. There are some perks but the important things like being comfortable with myself and having a true love in my life don't seem like they were contingent on the change. Being my "real self" could have included having a penis and including more femininity in whatever forms made sense. I didn't know that until too late and now I have to make the best of the life I've stumbled into. I just wish I would have tried more options before I jumped off the precipice. I miss my easy access to my kids (unlike many TS's I didn't completely lose access to them though), I miss my family and old friends (I know they "shouldn't" have abandoned me but lots of folks aren't as open minded as they "should" be ... I still miss them) and finally, I hate the disconnect with my past (there's just no way to integrate the two unrelated lives). There's any number of ways to express your gender and sexuality and the only one I tried was the big one. I'll never know if I could have found a compromise that might have worked a lot better than the "one size fits all" sex-change. Please, check it out yourself before you do likewise."


- Danielle Berry -

Not to guess or discount the person's statement above, yet it seems they clearly state their reason for having the surgery done

        1.   " all so you can wear women's clothes and feel cuter than you do now."

        " I was a cross-dresser for all of my sexual life and had always fantasized going fem as an                     ultimate turn-on "

                                                       This person never mentions , being feminine for a male sexual partner

                                 Yet I'm thinking this person is not sexually-inverted / female sexually roled like myself.

                                  I am thinking the need to be in one's proper sexual role is a much more " real " pyschological

                                  motive for surgery.

        1. My motive is not to wear women clothes for the sake of looking cuter as a turn-on, it is to express my female role

           to a male sexual partner.

        2. My motive for wanting my penis removed, is due to fact that for whatever reason, I am sexually like a female mentally,

           or as I see it, " I have been pyscho-sexually fully emsculated since age 13 when I began very much wanting and                       having males sexually treat me like a girl, being female like for them, thus having them routinely penetrate me anally                 and ejaculate inside me. Thus for myself, to be sexually fulfilled, I have to attract a male then have him penetrate me,

           ideally " take his semen inside me "

        3. Both the zero-depth vagina/vulva , looking feminine are expressions of my emasculation, a way of showing a male                 that I am not male like sexually, and only want to perform for him like I am actually female. For example, even though 

          I truly love having a man's penis in my mouth, taking his semen by swallowing it, on my mind is always needing to get              his penis up inside me so I can take his semen up inside my body. So ideally I've always wished for a true functional                vagina, yet for medical reasons zero-depth vulva only practical, and fulfills my need of ;

                                                                   " Removing my penis " maleness

  For myself it's very important;

       A male sexual partner knows that I want to sexually be like a female,and if he is good          to me, I want to do all I can to sexually please him. I always have to explain to a man            that , I want sex alot, so I want a man whom has same type desire

  Thus compared to the person above - " always fantasized going fem as an                            ultimate turn-on "


   My ultimate turn-on is more like " having my man unzip his pants,pull out his hard cock, then tell me          to suck it , listen to him moan, knowing he is enjoying, then after a bit, he tells me to get on my hands and knees so              he can fuck me and ejaculate up in my bottom. I love listening to , feeling a man squirm,bucking                 about as he ejaculates inside me......OMG !, the ultimate way for me to feel feminine !



                           Transgender orchiectomy

Some people in our community choose bilateral orchiectomy prior to or instead of vaginoplasty. This medical procedure is also called orchidectomy or gonadectomy and is commonly known as castration or by the abbreviations “orch,” “orchi,” “orchy,” and “orchie.” Bilateral orchiectomy involves removal of both testicles, which eliminates the primary sources of androgen production.

Reasons to get an orchiectomy:

  • Costs much less money than vaginoplasty

  • Shorter recovery time

  • Fewer possible complications

  • Patients don’t need antiandrogens after the surgery

  • Patients can take lower doses of feminizing hormones after the surgery

Problems that can happen:

  • It can shrink the amount of tissue available for vaginoplasty

  • It leaves small scars which may affect a later vaginoplasty result


In the photo above , I have my penis pulled back under me, with the orchiectomy, my testes would be completely removed, and they are what makes it difficult to pull back. My penis is easy to, I use a certain type balloon with a silicone egg  in it, attach the open end of balloon to tip of my penis, the egg aspect I slip up in my bottom, this pulls my penis tightly up under me securely.

      3/12/2020 - Talked to nurse at surgeon's office today about the  orchiectomy, as it is only surgery I can afford ( the vaginoplasty is 25000 ). Either way I must take testosterone replacement after surgery.  What to do now ??,   because I truly wish for the " Zero-Depth " vulvoplasty, get a loan ?

My main desire is to display that I am fully psychologically emasculated, and only desire to be in the role of a female sexually.

Not having a penis, is much ,much better for my identity as a person, as I am so psycho-sexually like a female.

My dilemma is, I know 100% that the "Zero Depth" is what I need to feel as fully feminine as I truly feel.

       Or it at least elimates the masculine/male symbolism from me ( view of penis), which contradicts my desire to only be in the female role sexually', and having a penis doesn't reflex my sexual role.

Thus, will call doctor Gallagher's office, to get another cost estimate.

I have never desired to look female, other then have a " vagina "or Not have a penis, sure I want to look "Feminine " for a Man, yet only to degree that reflexes my sexual orientation is 100% female roled.

I've dreamed, wished all my life to look like I do in photo above,

as a youth I was constantly tucking my penis up under me , so I could appear like a girl, some times use a magic maker to paint hair, then got found out cause used a marker that didn't wash  off so easily........:(

Even if I am unable to get surgery done, at least in my own mind , I can say I tired, explored as many options as possible.



For myself , I always felt as though not male nore female, though much more feminine then masculine, very much sexually inverted (psychological female like), thus I am only attracted to heterosexual males and not gay males
I am happy with just wearing padded bra, thus though dream of having breasts, nothing like my desire Not to have a penis.
Instead have a Female appearing " Vulva " the identify for self, and a male partner that I am completey female roled.
I inquiried last week about the cost of  male to female genital reassignment , I only desire a "zero-depth vaginoplasty " (just have female appearing vulva) they told me base cost was $ 25,000 dollars, thus not very attainable for myself, as have no insurance that covers such a surgery.
     Also the standard " rule " is one must take either male hormone or a female hormone. I wish to not do either, so a road block,
Yet, I am going over " idea " with surgeon, What if only a small pocket is created where the vagino-canal would normally be, thus one " testis " placed there, just under skin, (temp control) then no need for any hormones !, I am going to pursue this idea, til the there is no hope,  I did even explained I'd sign a waiver etc. be a " crash test dummy " of sorts, being in a teaching setting as it is a " teaching hospital "  if it don't work , remove the testis, then one would have to begin hormone replacement . I do see a lot of Stereotyping, assuming about the whole transgender dilemma, for example here is a excerpt from Wikipedia about "sexual inversion theory",    " The not people need the same thing "

" According to this theory, gay men and lesbians were sexual "inverts", people who appeared physically male or female on the outside, but felt internally that they were of the "opposite" anatomical sex (according to the binary view of gender). Therefore, same-sex desires and attraction were explained as "latent heterosexuality", and bisexual desire was known as psychosexual hermaphroditism – in other words, gay men and lesbians were really just heterosexuals who were "born in the wrong body", and "bisexuals" were what modern-day sexologists would call intersexuals (formerly hermaphrodites) by this theory (the bisexual person's "male" part supposedly has attractions towards females, and the "female" part have attractions towards males). I have never seen myself as " homosexual " , I see straight males as the opposite sex, and I've always felt psychologically female like, similar to.

My point I have no desire to pass as a female, my desire is to pass as a "Female roled male", and believe me I spent a life time trying to " Find what Fits ".." I feel so feminine don't to need that !, the vulva would be as much " Symbolic " psychologically, as " Affirming of my identity ".

The Hormone Dilemma is the " Road Block " for any type of Affirmation Surgery


For myself, unless they can come up with a method of maintaining one of the testes in the body to produce testosterone, the " GRS" surgery is not fesible or realistic, as I am not going to be dependent on taking testosterone rest of life.

1 . Number One you become a Life time patient, dependent, A addict to the "Hormones"

I very much wish,(have since puberty)

I truly wish I had a female looking vagina, as well as functioning,with the ability to take a man's penis up inside me like a true female can,yet the hormone issue,prevents this.

  Clearly I am not alone,as the person below as well wishs to perform sexually as a female,thus had their penis replaced with a funtioning female like vagina


Transgender vaginoplasty involves creating a vagina, clitoris, labia majora, and labia minora using your existing genital tissue. Our surgeons use a penile inversion technique. This procedure is effective both for people who have and those who have not had orchiectomy in the past. Removal of the testes is required as a part of vaginoplasty.

We perform vaginoplasty under general anesthesia. Most people spend three full days in the hospital after surgery. Recovery from vaginoplasty can take up to three months, and requires intensive post-operative care. Most people spend the first seven to ten days after the procedure in bed, getting up only to go to the bathroom. It is important to have both someone who can help take care of you after surgery as well as the privacy you need to take care of yourself.

You will also need the privacy to dilate every day. Dilation involves inserting a medical dilator into the vagina to keep it from closing. The process can be painful and messy.

Creating a self-lubricating vagina has been a challenge. Our surgeons have pioneered an approach using the peritoneal lining. This tissue secretes moisture all of the time, but does not increase production with sexual arousal. The peritoneal lining is hairless and pink. While the peritoneal vaginoplasty does provide moisture, it is not self-lubricating. Patients will still need to use water based lubricant for intercourse and dilation. This is a new procedure, and we are still gathering data about the procedure's long-term safety and efficacy. This approach can work for patients who are not suited to a traditional penile inversion vaginoplasty.

I have always dreamed of being able to have the ability to tell a man that I don't have a penis, and that I can take his penis up inside me similar to the way a true female can.

I've never had desire to look like a female (pass as). My dilemma is being sexually "inverted", in that I only wish to perform as a female sexually.

Like photo to right shows - me with my penis pulled back and up behind , I like this look and still retain testes so no hormone intervention is  needed. 

 At least it shows I can't / don't perform like a male sexually because " I don't have a penis "

The above photo is what I think I could look like if kept testes, which I like, as it still shows that I am emasculated, and I desire only to be " Female-roled " sexually.

My main desire is to not have the " penis " aspect of my maleness, yet maintaining " testes " eliminates need for use of " Hormones " after surgery. I personally don't wish to take any kind of hormones. My main objective is to be fully " emasculated " thus expressing my desire to be only female-roled sexually.

A rendering of how maybe could look if retained testes and just had penis shaft completely removed, could still have orgasms like a normal male, yet expresses that I have choose to be emasculated. Helps express that I am fully committed to sexually performing in female sexual role.

Ideally though, I've always wished to have a truly functional vagina to offer to a boyfriend, so didn't have to always have to worry about getting my bottom clean every time he wished to " bone " me.

As much as I love sucking cock, my number one desire has always been to get a boyfriend's cock up inside me so I can take his semen in me.

Having men penetrate me, and ejaculate in my bottom has always been my number one desire,pleasure, one big reason I had to be very selective with whom I had sex with, yet keeping my bottom clean and ready for penetration was always a task in it's self. 

Thus the idea of having a vagina is very appealing in it's self for that reason.

I've always wanted to go to a nude beach and look as I do above, or model for life-drawing classes, at least others would know that sexually I am like a female.

I'm sure there are quite a few other males like myself out there whom feel having a vagina best fits their sexual orientation

A Question I've always had regarding "Shemale porn actors " ; "Do you wish you had a vagina and desire bottom surgery ? "

A interview with a shemale performer - 

     While on the red carpet at the AVN Awards back in January, I couldn’t help but notice a cute, petite girl in a mirrored dress coming down the carpet after me. Waiting in line to be interviewed by Showtime, I found out that that the tiny woman was Madison Montag, who was nominated as “Transsexual Performer of the Year.”


           1. How do you identify sexually?;

             I identify myself as a straight woman.

        2. Would you ever get bottom surgery? Why or                why not?;

                   That’s a very interesting question. A year ago I said I wouldn’t, but at this point in my life, I’m not sure. I’m still very young and have time to think about it. I’m still growing mentally and physically, but I’m leaning towards “yes.” Only time will tell. For a lot of trans people the goal is not to have all the surgeries but to get to a place where you are living as the gender you present as, and where you are happy with yourself. I have found that a lot of trans people cannot be comfortable with any leftover misgendered parts, and that the obvious “end game” becomes complete sexual reassignment surgery.

Like myself, my sexual identity has always been what I feel is like that of a heterosexual female -me

As The technology is slowly improves for bottom surgery, and the hormone issues involved, cost will as well hopefully come down to be much more affordable. I know if I was content with current technology and could afford it, I'd have the " Vaginoplasty surgery ", so then I would be able to be penetrated by a man like I were female.

A Patient Gets the New Transgender Surgery She Helped Invent -

"Hayley Anthony recently became one of the first people in the world to have tissue incised from the cavity of   her abdomen and turned into a vagina." -2017

And for myself the ultimate way to feel lady-like sexually is to have a vagina .

  I've alway asked men to " please treat me like a girl, told them I am a wanna be transsexual, in regards to ; I don't want to have a penis, because I feel like I should have a vagina because I only want to have sex as though I am female


Yet for myself, even if I couldn't have a functioning female like vagina, at least I could " Not have a penis ", thus appear alot better Feminized and emasculated for my female sexual role.


The following Statement shows that it has been Stereotyped ; to think a transsexuals wish to be the opposite sex, my gender is male, my sexuality is female, I don't desire to live as female,be female, yet I only wish to perform as a female does sexually and a big part of that is having a vagina.


Some surgeons who perform sex reassignment surgeries may require their patients to live as members of their target gender in as many ways as possible for a specified period of time, prior to any surgery. However, some surgeons recognize that this so-called real-life test for trans men, without breast removal and/or chest reconstruction, may be difficult. Therefore, many surgeons are willing to perform some or all elements of sex reassignment surgery without a real-life test. This is especially common amongst surgeons who practice in Asia. However, almost all surgeons practicing in North America and Europe who perform genital reassignment surgery require letters of approval from two psychotherapists; most Standards of Care recommend, and most therapists require, a one-year real-life test prior to genital reassignment surgery, though some therapists are willing to waive this requirement for certain patients.- Wikipedia ( Sex reassignment therapy )

Another way I can convey how I feel,

     I am so Feminized and emasculated psychologically I can't even imagine desiring to be sexually like a man.


The memory that is most vivid, and impacting on me is when at about age 7, I seen my new step-sisters vulva. After that I simply have wished to be like a girl in this regard, then after puberty I've always wished to be like a girl is sexually, have sex with men,in the female role.


My frustration is most of all of the mainstream male to female transsexual therapy involves using female hormones, blocking testosterone etc. which I have no interest in.

My idea of being totally feminized physically is the need             

       " not having a penis ",

as I am already psychologically very feminine, my sexual role is 100% female. I know for sure at least since puberty that I've wanted to be like a female sexually.


Thus for me, if I were to get a vulvoplasty my main concern is loss of testosterone production.

Thus Post-Op life is big concern, and I am always seeking imfo. like from the following site ;

Post-Op; life after Reassignment or Orchiectomy

Not all transgender patients undergo gender reassignment surgery (GRS) but for those who do so there are many challenges facing them.  GRS is a major crossroads in the trans journey involving two abrupt alterations, one structural, the other both structural & functional.

Life after surgery

The first change involves the external genitalia, shifting from penis to vagina which people focus upon almost exclusively, while ignoring the deeper changes.  This procedure doesn’t influence the rest of the body in terms of its functions, its state of general health or its metabolism.  It is purely local & structural.  In contrast the second procedure involves removal of the primary sex organs or gonads; a process which people frequently forget or choose to ignore, despite its life-changing influences.  
The gonads are the sources of our sexual hormones and include the ovaries in women & the testes in men.  The sexual hormones they elaborate in turn influence the fetal development, before we are even born, of our sexual characteristics, including either the penis or the vagina, thus determining what shows up at birth.  Now when it comes to the consequences of GRS the focus is far too often placed on these external genitalia because they are the outward, visible declarations of our sexuality and sexual identities, but removal of the gonads is far more important, being as it is both irreversible & potentially cataclysmic in terms of our physical & mental health.

What exactly is being lost here, functionally? 

In the male to female transsexual, removal of the testes translates hormonally into the loss of adult male levels of testosterone.  Male levels of testosterone are both defeminizing and masculinizing, keeping in mind that defeminization and masculinization are two separate issues even though they may operate synergistically, like the two engines of a twin-engine airoplane. Slow down one engine and/or speed up the other & the plane will turn in a certain direction.  
To clarify, let’s look at this scenario in terms of the breast, an obvious, sexually-defining hormonal target.  Because well-developed breasts are a hallmark characteristic of the female condition, people tend to think of them as targets solely for the feminizing hormones, in other words for estradiol and progesterone, but the fact is that androgens such as testosterone also have a significant impact on the breast, although in a defeminizing way that opposes the feminizing influences of estrogen and progesterone. Breast size and development depend on the net balance between feminizing & androgenizing hormones, the hormonal balance-sheet.  Why does this matter?  
Consider the case of a 40-year-old woman who has had both of her ovaries surgically removed for valid health reasons. Does this surgery cause her to become dramatically masculine, overnight?  The answer is that despite a dramatic loss of feminizing hormonal influences, there is no reason for her breasts to become masculinized, because she simply does not possess a male-typic level of testosterone capable of masculinizing her. Now in contrast consider a trans-woman who’s been taking effective doses of feminizing hormones for three full years, at a dosage sufficient enough to chemically castrate her. What will happen when she suddenly discontinues feminizing hormone therapy? The answer is that while it may take some months, depending on her dose of feminizing hormones and how long-acting they happen to be, sooner or later her testes will come back online. Sometime after that her breasts will begin to shrink back in the male direction, as a result of the masculinizing effects of her reemerging androgens, in contrast to the genetic female where there isn’t sufficient androgen present to effectively masculinize her.


So orchiectomy, the process of having one’s testicles removed surgically, is the most important of the processes involved with GRS as well as being permanant.  Some patients however will have an orchiectomy without GRS, in an effort to accelerate feminization while reducing the need for higher hormonal doses.  Either way, the patient in question is being castrated.  The hormonal consequences will be just the same, involving severe, abrupt deprivation from testosterone. 


Removal of the testes in the genetic male and of the ovaries in the genetic female leads to a sudden, severe hormonal drop off with testosterone depletion in both cases. Testosterone levels nosedive down to levels below those even characteristic of the genetic female norm.  Female castration occurs following an operation known as a TAH-BSO, which is applied in young women for a variety of health reasons including endometriosis and cancer. The bodies of these young women have been accustomed, up until the moment when their ovaries were removed, to the presence of generous levels of the sexual hormones even including testosterone, lying within the normal female range.  Hormonal withdrawal in these women, not only from estradiol & progesterone but also from testosterone is abrupt & drastic & the consequences can be seismic, both physically & mentally.  And the same set of problems that genetic women experience when surgically castrated tend also to crop up in trans-women following orchiectomy, unless some form of adequate hormone therapy is maintained so as to prevent hormonal deprivation.  Unfortunately, replacement hormone therapy is rarely either administered or sought after in the post-operative trans-woman. 

Hormone deprivation

The two kinds of patients for whom precision hormone therapy is most critically needed include the genetic woman who has undergone a premature menopause consequent to surgical removal of the ovaries and the post-operative trans-woman.  Their problems are just about identical as are their symptoms & the forces that drive them.  Treatment in both groups requires considerable professional expertise as well as an awareness on the part of both types of patient that even when hot flashes fade away, the body still suffers from the consequences of hormonal depletion.  So the optimal post-surgical life for both the trans-woman & the young genetic woman who has lost her ovaries, mentally, emotionally, intellectually, sexually & in a broadly physical sense involves optimal, expertly administered precision HRT. 

Lack of HRT

For many but not all trans-women, gender reassignment is the ultimate goal, the moment when one crosses the gender river.  But this moment, far from being an end, a culmination, is actually only the beginning.  Once the testes have been removed, the only significant source of sex hormones is hormonal therapy arriving from the outside.  Despite this, many if not most post-operative trans-women, believing they have now reached their ultimate feminine goal, back off from receiving feminizing hormone therapy or quit it completely, believing as they do that having a vagina is all they need.  This is a terrible mistake. 

Problems assailing the post-op trans-woman

Far too many post-operative trans-women receive little or no ongoing hormone therapy, focused medical follow-up or problem-oriented health monitoring.  This might have been a vaguely acceptable approach in the past, when we believed that sex hormones were only sexual in their influences, but now we know better.  Now finally appreciating the true scope of sex hormone influence, not only slow but rapid & not only sexual but broadly physical & critically mental, it behooves us to show more insight & more medical responsibility.  We need to become more aware of the importance of the body’s hormonal milieu. 

The symptoms

It shouldn’t be so surprising therefore to discover that many post-operative trans-women, having achieved their life’s desire, are surprisingly tired, haggard & disappointed, lacking physical energy & assailed by frequent episodes of anxiety, panic attacks, mood swings, depression & even suicidal urgings, not because of who they are as many judgmentally assume, looking with jaundiced eye at the trans-woman & her life choices, but because of hormonal deficiency & lack of adequate, precisely metered hormonal care.  And they lack both sexual interest & orgasmic function as well.   
Other more easily overlooked problems include changes in personality, either overt or subtle, cognitive dysfunction including glitches in memory & concentration, generalized aches & pains resembling so called fibromyalgia, frequent headaches, insomnia & irritable bowel symptoms.  And these are just the obvious, overt problems.  At the same time, unbeknownst to the patient, sex hormone depletion is inexorably fueling the silent development of early heart disease, osteoporosis, dementia, insulin resistance & weight gain, cholesterol problems & accelerated cosmetic aging. 

How can we be so negligent?

Considering these dire consequences of chronic hormone depletion, how can this standard of care, this deplorable deficiency continue?  Because modern medicine is still far too symptoms-oriented in its approach, depending on the use of addictive sedatives and analgesics such as opiates, as well as mind-numbing, sex-destroying anti-depressants & marijuana, drugs that, despite frequently being ineffective, may be not only dangerous but riddled with side-effects that further compound the complications of castration, such as brain-fog, worsening sexual dysfunction, weight gain, even diabetes.  Better treatments are available that happen to be user-friendly, even sex-friendly, methods that actually work based on a precision form of hormone therapy.  These methods won’t be found in rigid protocols, medical cookbooks, so called standards of care or the frozen bibles of managed care. 

Total care

Perhaps people don’t care what happens to a group of people whom they sometimes find embarrassing or discomforting such as the transgendered.  Whatever the reason, it is urgently needed that we change the current approach, not only for trans-women but for those genetic women who are crossing the threshold of menopause as well.  Ultimately only the trans-woman herself can force the issue of improved post-operative health care, & that is why we at O’Dea Medical have placed a particular emphasis on post-operative trans-care, not only vaginal care but care for the brain, the mind, the bones, the heart, the metabolism, the life!  
Crossing the gender river & achieving ones goal should make the trans-woman feel her verybest ever.  Unfortunately the lack of ambient feminizing hormones even in the absence of testicles or of male levels of testosterone may cause the gender dysphoria that for so long has bothered the trans-woman emotionally to continue unabated.  More than ever before trans-hormone therapy needs to be precise & accurate after GRS since it has now become the only significant source of sexual hormones in her body.  Dips & depletions in the presence of hormones at this point have a far greater negative impact than in the pre-operative transsexual, who may dislike her continued production of male hormones but who at least isn’t hormonally running on empty. 

What about oral hormone therapy in the post GRS trans-woman?

Of those few women who do continue on hormone therapy after GRS, the majority are taking oral estrogen from their family doctors, without accompanying progesterone or testosterone treatment.  This can be a problem.  First of all many trans-women at the time of gender reassignment simply haven’t received adequate feminizing therapy so far, and although they are now demasculinized, they have still been far from adequately feminized.  Some of these women, when now introduced to truly effective forms of feminizing HRT for the very first time, will continue to progressively feminize for another 5 or so more years as they play catch up.   Oral hormone therapy is thoroughly inadequate for these women since oral estradiol is mainly converted into estrone and is very short acting, leaving the body totally depleted for more than half the day.  And finally testosterone therapy in very subtle dosages may also be necessary. 

The bottom line

To sum up, many post-GRS or post-orchiectomy women feel that with their testes removed & a functional vagina surgically created, they are now fully transitioned & have all the femininity they will ever need, particularly if they have already obtained breast implants, silicone injections & other measures of faux femininity.  The problem with this kind of thinking is that while surgery may have removed their source of masculinizing hormones, it does nothing to create a source of feminizing hormones.   This is a dangerous road to travel since it carries with it a host of physical & mental problems, problems too easily blamed on the marginalized trans-woman herself instead of her lack of hormones.  The hard fact is that once the trans-woman recovers from surgery, she is on her own, often medically abandoned, isolated & thoroughly undertreated.     
The good news is that precision hormone therapy can restore this woman, emotionally, intellectually, sexually and physically to a state of good health while often dispensing with the need for symptomatic care, but that requires good judgment & hormonal expertise.  -

A person, shown below that has under gone the male to female vulvoplasty surgery (zero-depth vagina).

 This type surgery being the only type that seems realistic for me.



    As much as I truly wish I had a vulva and not a penis

          It doesn't seem rational or feasible with todays methods

My concept of being a transsexual/ female-roled male / berdache type person

I simply love how I look not having a penis , fits me so much better, as my desire is to feel feminine,and female sexually roled.

Ever Since I can remember I've dreamed of having a vulva/vagina, even prior to actually starting to have post-puberty sex with other males


I know for myself, the only thing that keeps me from actually prevents me from undergoing or stops my pursuit of having the vaginoplasty surgery ,whether it be zero-depth or a functioning vagina is loss of testosterone due to removal of testes.

    Yet if sudden if the surgery came available, which retained testes internal, in order to Not disrupt normal hormone production.I would very much try to make it a reality.

    Thus any new technologies pertaining to this type surgery ,I've always kept ear out  for.

Excerpt from ;  " Manatees Cool the Jewels with an Inguinal Venous Plexus " , 

  " Elephants comprise one group of truly testicond mammals; with a core body temperature above 36C, and no identified cooling mechanism for the intra-abdominal testicles, these proboscideans appear to violate the temperature hypothesis for evolution of the scrotum and testicular descent (Werdelin and Nilsonne, 1999). Other mammals that are truly testicond, such as tenrecs, golden moles, and monotremes, have relatively low core body temperatures. The exceptional elephants have close relatives that regulate testicular temperature in two different manners. Hyraxes (Hyracoidea) have poor internal thermoregulation, and thus control core temperature behaviorally; also, reproduction is seasonal in these animals, such that continuous production of sperm is not required.

The Sirenia (dugongs and manatees) are also close relatives of elephants, and the reproductive organs of the Florida Manatee (Trichechus manatus latirostris) would seem to be at risk, due to insulating fat, proximity to heat-generating swimming muscles, and a core body temperature of 36C. Therefore, Rommel and colleages (2001) examined the vascular anatomy of structures surrounding the reproductive organs in both male and female manatees, obtained as carcasses necropsied by the Florida Fish and Wildlife Conservation Commission. After removing ventral skin, fat and abdominal muscle to expose the organs, the researchers focused their attention on the anatomy of a region called the hypogastric fossa, where body wall thickness is reduced. Veins and arteries in this region were injected with colored latex, through the caudal vena cava, and the aorta, respectively. "