Sex reassignment surgery (SRS) in Iran is known by a variety of names, including Gender reassignment surgery (GRS), s-e-x change surgery, s-e-x affirmation procedures, and genital reconstruction surgery. These procedures, which are known clinically as genitoplasty procedures, are done to surgically change the genitalia from one gender to another. That is, Sex reassignment surgery is performed to transition individuals with gender dysphoria to their desired gender.

For most patients undergoing SRS, the surgery is performed in order to match their physical gender with what they feel emotionally and intuitively is their true gender. This condition, known as gender dysphoria or gender identity disorder, is rare but becoming more widely diagnosed.

People with gender dysphoria often feel that they were born in the wrong gender. A biological male may identify more as a female and vice versa.

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Read more about Sex change procedure in iran( female to male )

Before Sex Reassignment Surgery

What to do Before a Sex Reassignment Surgery?

. Gender identification is the first, most essential part of the procedure. The transperson has to identify themselves as belonging to either of the 2 Sexes and hence undergo the procedure in order to become more like that Sex to maximum possibility. The identification can be done by themselves after reaching a certain mental maturity or should be done by the doctors even when the Trans babies are born.

. At the very start, when the Trans person first goes to consultation, he/she has to introspect within themselves and be doubtlessly sure that they want to undergo the procedure as a procedure like vaginoplasty is irreversible. A person entering into such a procedure without appropriate forethought, will be emotionally and psychologically overwhelmed after.

. Like all other major surgeries, this surgery too demands a decent medical history and the surgeons will be very sure to ask for it.

. The patient will have to quit smoking a few weeks prior to surgery as nicotine slows down the recovery. Patients needing nipple grafts should not consider smoking at all as nipple tissue is extremely sensitive to Nicotine and the graft might get rejected otherwise.

. Many healthcare providers require patients to be formally diagnosed with gender dysphoria and undergo counseling to determine if they are truly ready to surgically transition.

. Patients usually undergo hormone therapy first. Hormones can suppress the secondary Sex characteristics of the biological gender and make them appear more like their desired Sex. For instance, women take androgens and start developing facial hair. Men take estrogens and anti-androgens to look more feminine.

. Surgeons may also require that patients live as their desired gender for at least one year. A man might dress as a woman traditionally does in the culture. Many men change their names and refer to themselves with female pronouns. Women transitioning to men would do the reverse.

Not all people with gender dysphoria have surgery. Some feel comfortable living as the opposite gender without medical intervention. Others find that hormone therapy is sufficient for their personal needs.

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Read more about Gender Reassignment Surgery (Male To Female) In Iran

Read more about Gender Reassignment Surgery (Female To Male) In Iran

Important things to know about Sex Reassignment Surgery

. SRS is irreversible and thus patients must be entirely sure about its outcome before opting for the surgery.

. SRS is not simply a gender-change operation. The male and female anatomy is vastly different, beyond simply Sexual anatomy, such as size of pelvic bone, facial structure etc.  Choosing the right doctor(s) who is capable of handling every aspect of the surgery is imperative for good results.

. Psychiatric care may be required for many years after the reassignment surgery.

. The procedure is not recommended for individuals who have been diagnosed with HIV or Hepatitis C.

. Possible complications include infection, bruising, blood clots, scarring and necrosis.

What is Gender dysphoria?

Gender dysphoria is a condition where a person experiences discomfort or distress because there’s a mismatch between their biological Sex and gender identity. It’s sometimes known as gender incongruence.

Biological Sex is assigned at birth, depending on the appearance of the genitals. Gender identity is the gender that a person “identifies” with or feels themselves to be.

While biological Sex and gender identity are the same for most people, this isn’t the case for everyone. For example, some people may have the anatomy of a man, but identify themselves as a woman, while others may not feel they’re definitively either male or female.

This mismatch between Sex and gender identity can lead to distressing and uncomfortable feelings that are called gender dysphoria. Gender dysphoria is a recognised medical condition, for which treatment is sometimes appropriate. It’s not a mental illness.

Some people with gender dysphoria have a strong and persistent desire to live according to their gender identity, rather than their biological Sex. These people are sometimes called transsexual or Trans people. Some Trans people have treatment to make their physical appearance more consistent with their gender identity.

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What causes gender dysphoria?

Gender development is complex and there are many possible variations that cause a mismatch between a person’s biological Sex and their gender identity, making the exact cause of gender dysphoria unclear.

Occasionally, the hormones that trigger the development of biological Sex may not work properly on the brain, reproductive organs and genitals, causing differences between them. This may be caused by:

. Additional hormones in the mother’s system – possibly as a result of taking medication

. The foetus’ insensitivity to the hormones, known as androgen insensitivity syndrome (AIS) – when this happens, gender dysphoria may be caused by hormones not working properly in the womb.

Gender dysphoria may also be the result of other rare conditions, such as:

. Congenital adrenal hyperplasia (CAH) – where a high level of male hormones are produced in a female foetus. This causes the genitals to become more male in appearance and, in some cases, the baby may be thought to be biologically male when she is born.

. Intersex conditions – which cause babies to be born with the genitalia of both sexes (or ambiguous genitalia). Parents are recommended to wait until the child can choose their own gender identity before any surgery is carried out.

Symptoms

Symptoms of Gender dysphoria

There are no physical symptoms of gender dysphoria, but people with the condition may experience and display a range of feelings and behaviours.

In many cases, a person with gender dysphoria begins to feel a mismatch between their biological Sex and gender identity during early childhood. For others, this may not happen until adulthood.

Children

Gender dysphoria behaviours in children can include:

. Insisting they’re of the opposite Sex

. Disliking or refusing to wear clothes that are typically worn by their Sex and wanting to wear clothes typically worn by the opposite s-e-x.

. Disliking or refusing to take part in activities and games that are typically associated with their Sex, and wanting to take part in activities and games typically associated with the opposite Sex.

. Preferring to play with children of the opposite biological Sex

. Disliking or refusing to pass urine as other members of their biological Sex usually do – for example, a boy may want to sit down to pass urine and a girl may want to stand up.

. Insisting or hoping their genitals will change – for example, a boy may say he wants to be rid of his penis, and a girl may want to grow a penis.

. Feeling extreme distress at the physical changes of puberty

Children with gender dysphoria may display some, or all, of these behaviours. However, in many cases, behaviours such as these are just a part of childhood and don’t necessarily mean your child has gender dysphoria.

For example, many girls behave in a way that can be described as “tomboyish”, which is often seen as part of normal female development. It’s also not uncommon for boys to roleplay as girls and to dress up in their mother’s or sister’s clothes. This is usually just a phase.

Most children who behave in these ways don’t have gender dysphoria and don’t become transsexuals. Only in rare cases does the behaviour persist into the teenage years and adulthood.

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Teenagers and adults

If the feelings of gender dysphoria are still present by the time your child is a teenager or adult, it’s likely that they’re not just going through a phase.

If you’re a teenager or an adult whose feelings of gender dysphoria begun in childhood, you may now have a much clearer sense of your gender identity and how you want to deal with it. Many people with strong feelings of gender dysphoria are fully transsexual during their teenage years.

The way gender dysphoria affects teenagers and adults is different to the way it affects children. If you’re a teenager or adult with gender dysphoria, you may feel:

. Without doubt that your gender identity is at odds with your biological sex

. Comfortable only when in the gender role of your preferred gender identity

. A strong desire to hide or be rid of the physical signs of your Sex, such as breasts, body hair or muscle definition.

. A strong dislike for – and a strong desire to change or be rid of – the genitalia of your biological Sex.

Without appropriate help and support, some people may try to suppress their feelings and attempt to live the life of their biological Sex. Ultimately, however, most people are unable to keep this up.

Having or suppressing these feelings is often very difficult to deal with and, as a result, many transsexuals and people with gender dysphoria experience depression, self-harm or suicidal thoughts.

See your GP as soon as possible if you’ve been feeling depressed or suicidal.

What are the Advantages and Disadvantages S-e–x Reassignment Surgery?

Advantages:

. A patient who undergoes a sex reassignment procedure is able to enjoy her sexual life in the future as s/he does not have to deal with the mental stress of being in the wrong body.

. Finding the right doctor and getting the desired treatment can lead to psychological happiness for the patient.

. With medical tourism rising, the treatment is cheap in a few noted destinations.

. After the Sex reassignment surgery, the patients are usually found to be less gender dysphoric. There have less anxiety levels, depression levels etc.  Than before.

Disadvantages:

. The patient who has undergone the surgery from male to female or vice versa, will be unable to reproduce.

. The patient will not only have to face physical changes but also psychological changes which may be hard to deal with. With the help of counselling and post-operative care provided by the hospitals the patient are able to recover better and faster.

. Postoperative complications can include hematoma. Small hematoma can be cured through puncture and the larger one needs the patient to undergo surgical treatment.

. Complication such as nipple necrosis may arise. The patient can undergo aesthetic procedures which can reconstruct the nipples.

Who are the ideal Candidates for Sex Reassignment Surgery?

. The patient must have good Body Mass Index. Their weight divided by the square of their height should give a value between 20 and 25. Being overweight won’t necessarily exclude a person from surgery, but a stable weight category definitely helps as the excess fat tissue in and around the operating area of the patient’s body only adds to the surgeon’s troubles.

. The patient must not have any sort of a bleeding disorder, high cholesterol, high BP, obesity, arthritis, diabetes, severe allergies, coronary and pulmonary diseases and severe depression.

. The patient needs to have a positive outlook and realistic expectations as no surgery is perfect. For example, many people who undergo Surgeries involving the Breast tissue start regretting it a few weeks after the surgery seeing the red, swollen area but they must understand that all this will eventually pass.

Who should avoid a Sex Reassignment Surgery?

Gender reassignment surgery is not ideal for you, if:

. You’re under 18 or above 60 year of age

. You’re under mental stress and are deemed incapable of making the right decision by a doctor

. Your therapist does not recommend you to undergo the surgery

. Your gender identity is too strong to change as can be determined by your therapist/doctor.

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Risks and Complications

A Sex reassignment surgery is a major procedure that comes with significant risks. All patients are informed of these risks prior to the surgery. Apart from medical risks, the surgery also has some limitations, which should also be explained in detail to the patient before he or she provides consent for the surgery and all preceding treatments involved.

Some of the risks of the Sex reassignment procedure are due to the hormone therapy itself. These include:

. High blood pressure

. Sleep apnea

. Heart disease

. Tumors affecting the pituitary gland

. Infertility

. Uncontrolled weight gain

. High levels of liver enzymes

. Blood clots

. Anxiety

. Feelings of uncertainty and confusion

Thus, people undergoing hormone therapy need to be constantly supervised by a medical professional, especially during the first months of the process, so that the effects of the hormones can be properly monitored.

Also, patients undergoing either hormone therapy or Sex change surgery will benefit from ongoing counseling or continuous visits to their endocrinologist, a medical specialist focusing on the body’s hormones.

Also, it is important for patients to understand that the decision to pursue Sex change surgery is a major and, in many cases, irreversible, so it should not be made lightly. The decision of the patient should be backed by the surgeon or psychologist handling his or her case. This is the reason why patients are required to undergo at least 12 months of hormone therapy before they are allowed to undergo a s-e-x change surgery.

The surgery itself comes with the following risks, which depend on whether the patient is a male transitioning to female, or vice versa.

For men who are changing into women, the risks involve:

. Death of the tissue that is used to create the vagina and vulva; this tissue is usually taken from the scrotum and penis

. Fistulas, which are abnormal connections between the vagina and the bladder or the bowels

. Narrowing of the urethra, which, in severe cases, can obstruct urine flow and increase a person’s risk of kidney damage. There’s no guarantee that fertility will return to normal if hormones are stopped.

On the other hand, women transitioning into men are exposed to the following risks:

. Narrowing of the urinary tract with the same increased risk to the kidneys

. Death of the tissue in the newly formed penis

The risks are heightened in the case of women changing into men by having a new penis reconstructed. The increased risk is due to the many different stages of the surgery as well as the high rate of technical difficulties encountered so far in such surgeries. Due to this, some women only opt for the removal of their uterus and ovaries, and choose to forego phalloplasty.

Complications and risks can also be avoided by choosing minor Sex change procedures, such as mastectomies for women who want to get rid of their breasts or breast augmentation for men who want to increase their breast size. Most patients feel that these procedures are enough and thus don’t feel the need to have their sexual genitals reconstructed. This is because breast augmentations and mastectomies can be reversed in case they change their mind after the procedures are done.

. Undergoing Sex change surgery is easy. But to completely fit into the role of a different gender takes a longer span of time, generally, a few years.

. You will need to undergo therapy before and after the surgery to help you change your Sex mentally, and to adjust to other’s opinion of you based on your Sex.

. The surgery changes your genitalia. However, the hormones that determine secondary sexual characteristics such as your voice and hair growth are not affected by the surgery.

During Sex Reassignment Surgery

Types of Gender Reassignment Surgery in Iran

1. Male to Female Transition

The procedures that change male genitalia to female genitalia include a penectomy (removal of penis) and orchiectomy (removal of the testes), which are typically followed by a vaginoplasty (creation of the vagina) or a feminizing genitoplasty (creation of female genitalia).

For those born male and transitioning to female, there may also be procedures that include breast implants, gluteoplasty to increase buttock volume,

A procedure to minimize the appearance of the Adam’s apple, and possibly, feminizing hormones. Facial feminization surgery (FFS) is often done to soften the more masculine lines of the face. Each patient is unique and the procedures that are done are based on the individual need and budget, but facial feminization often includes softening the brow line, rhinoplasty (nose job), smoothing the jaw and forehead, and altering the cheek bones. For some, a chondrolaryngoplasty, commonly known as a “tracheal shave,” can help reduce the prominence of the Adam’s apple.

2. Female to Male Transition

The procedure that changes female genitalia to male genitalia is a masculinizing genitoplasty (creation of male genitalia). This procedure uses the tissue of the labia to create a penis.

The procedures that change the genitalia are rarely performed without other procedures, which may be extensive. For those born female, the change to a masculine appearance may also include hormone therapy with testosterone, a mastectomy, a hysterectomy procedure, and perhaps additional cosmetic procedures intended to masculinize the appearance.

For female to male Sex change, the surgery involves two main types of procedures- phalloplasty and metoidioplasty. A hysterectomy is performed in addition to the aforementioned options. Phalloplasty involves a tissue graft from the arm and abdomen to construct a penis. In this surgery, the labia majora is joined to make the scrotal sac and the urethra is connected to the penis. Metoidioplasty involves consumption of hormones to increase the size of the clitoris and thus construct a penis. This procedure, although less complicated, creates a significantly smaller sized penis.

Treatment

Adults with gender dysphoria should be referred to a specialist adult GIC. As with specialist children and young people GICs, these clinics can offer ongoing assessments, treatments, support and advice, including:

. Mental health support, such as counselling

. Cross-Sex hormone treatment (see below)

. Speech and language therapy – to help alter your voice, to sound more typical of your gender identity.

. Hair removal treatments, particularly facial hair

. Peer support groups, to meet other people with gender dysphoria

. Relatives’ support groups, for your family

For some people, support and advice from a clinic are all they need to feel comfortable in their gender identity. Others will need more extensive treatment, such as a full transition to the opposite Sex. The amount of treatment you have is completely up to you.

Hormone therapy

Hormone therapy for adults means taking the hormones of your preferred gender:

. A Trans man (female to male) will take testosterone (masculinising hormones)

. A Trans woman (male to female) will take oestrogen (feminising hormones)

The aim of hormone therapy is to make you more comfortable with yourself, both in terms of physical appearance and how you feel. These hormones start the process of changing your body into one that is more female or more male, depending on your gender identity. They usually need to be taken indefinitely, even if you have genital reconstructive surgery.

Hormone therapy may be all the treatment you need to enable you to live with your gender dysphoria. The hormones may improve how you feel and mean that you don’t need to start living in your preferred gender or have surgery.

Changes in Trans women

If you’re a Trans woman, changes that you may notice from hormone therapy include:

. Your penis and testicles getting smaller

. Less muscle

. More fat on your hips

. Your breasts becoming lumpy and increasing in size slightly

. Less facial and body hair

Hormone therapy won’t affect the voice of a Trans woman. To make the voice higher, Trans women will need voice therapy and, rarely, voice modifying surgery.

Changes in Trans men

If you’re a Trans man, changes you may notice from hormone therapy include:

. More body and facial hair

. More muscle

. Your clitoris (a small, sensitive part of the female genitals) getting bigger

. Your periods stopping

. An increased Sex drive (libido)

Your voice may also get slightly deeper, but it may not be as deep as other men’s voices.

Surgery

Once you’ve completed your social gender role transition and you and your care team feels you’re ready, you may decide to have surgery to permanently alter your Sex.

The most common options are discussed below, but you can talk to members of your team and the surgeon at your consultation about the full range available.

Trans man surgery

For trans men, surgery may involve:

. A bilateral mastectomy (removal of both breasts)

. A hysterectomy (removal of the womb)

. A salpingo-oophorectomy (removal of the fallopian tubes and ovaries)

. Phalloplasty or metoidioplasty (construction of a penis)

. Scrotoplasty (construction of a scrotum) and testicular implants

. A penile implant

A phalloplasty uses the existing vaginal tissue and skin taken from the inner forearm or lower abdominal wall to create a penis. A metoidioplasty involves creating a penis from the clitoris, which has been enlarged through hormone therapy.

The aim of this type of surgery is to create a functioning penis, which allows you to pass urine standing up and to retain sexual sensation. You’ll usually need to have more than one operation to achieve this.

Trans woman surgery

For trans women, surgery may involve:

. An orchidectomy (removal of the testes)

. A penectomy (removal of the penis)

. Vaginoplasty (construction of a vagina)

. Vulvoplasty (construction of the vulva)

. Clitoroplasty (construction of a clitoris with sensation)

. Breast implants

. Facial feminisation surgery (surgery to make your face a more feminine shape)

The vagina is usually created and lined with skin from the penis, with tissue from the scrotum (the sack that holds the testes) used to create the labia. The urethra (urine tube) is shortened and repositioned. In some cases, a piece of bowel may be used during a vaginoplasty if hormone therapy has caused the penis and scrotum to shrink a significant amount.

The aim of this type of surgery is to create a functioning vagina with an acceptable appearance and retained sexual sensation.

Some trans women can’t have a full vaginoplasty for medical reasons, or they may not want to have a functioning vagina. In such cases, a cosmetic vulvoplasty and clitoroplasty is an option, as well as removing the testes and penis.

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After Sex Reassignment Surgery

What is the Post-Operative Care for Sex Reassignment Surgery?

Male to Female Surgery Care:

. After 3 days in the hospital for the surgery, for the recovery time, the patient has to stay in the area for 10 to 12 days.

. The patient can perform light work in 4 to 6 weeks. Strenuous work and exercise can begin by 6 to 8 weeks.

. Dilation (stretching the vagina walls periodically) should be done as per the surgeon’s after care instructions, with a frequency of twice a week till 13 weeks.

. A good dilator that is large and comfortably fits inside the vagina should be used.

. The vagina should be douched (cleaned in a particular way) as per surgeon’s instructions.

. Painkillers according to the surgeon’s prescription should be administered in the different stages of healing after the gender reassignment.

Female to Male Surgery Care:

. After 2 days in the hospital, the patient will have to stay in the area for about 5 to 6 days.

. Small work can be resumed in 2 weeks. More strenuous exercise can only be started after 4 to 6 weeks.

. A compression binder might have to be worn during the recovery stages for 6 weeks. It primarily depends on the surgeon’s advice.

. There will be less than moderate pain after surgery for a few weeks depending on how the surgery was done.  This will be taken care of by the surgeon who will prescribe necessary painkillers.

. Sutures in the top surgery will be removed in about a week.

. Activities

You are expected to stay only in your hotel room for sufficient rest and proper healing during the first 2 weeks of recovery after Sex reassignment surgery.

Our affiliated hotels routinely offer room service for your breakfast without extra charge throughout your entire stay and we also recommend you use room service for your lunch & dinner during the first 2 weeks of recovery after SRS.

Some light activities inside the hotel, for example taking food at the dining room or chatting at the hotel lobby is possible after 2 week recovery from SRS, however you should ask our nurses if you are already fit enough to do such activities.

. Medication

We offer all necessary medications throughout your recovery in Iran and also home medications taken while recovering in your country without additional charge.

It is necessary to strictly follow our medication instruction and complete the prescribed course of your prophylactic antibiotic therapy.

Potent pain reliever (Narcotic like medication- for example tramadol) is routinely provided to ensure that you are feeling comfortable.

You are not allowed to take Estrogen Hormones during your recovery in Iran because it may put you at risk for DVT (development of blood clots on deep veins of the legs) while taking your flight back home.

You can resume your HRT (Hormonal replacement therapy) as soon as you arrive home. Later on, you can probably reduce your estrogen dose and completely discontinue androgen suppressors, however this delicate adjustment should be taken care of by your hormone specialist.

. Scars never disappear.  It takes about one year for scars to heal completely and during the first few months they are usually pink or reddish and sometimes tender and raised, but between six months and a year they usually become flat, white and soft and are barely visible by 8-12 months after surgery.

Post-operative Diet

. The morning right after surgery liquid diet is recommended.

. A balanced diet that is high in fruits, vegetables and fibre is recommended for the first few weeks after surgery.

. Meat is alright. Cheese should be avoided.

. Smoking should be avoided to speed recovery up.

. Low Sodium Diet should be undergone, as sodium causes water retention.

. Alcohol intake should be kept to a bare minimum the first few weeks. It’s good if the patient doesn’t drink at all.

Life after surgery

After surgery, most Trans women and men are happy with their new Sex and feel comfortable with their gender identity. One review of a number of studies that were carried out over a 20-year period found that 96% of people who had genital reconstructive surgery were satisfied.

Despite high levels of personal satisfaction, people who have had genital reconstructive surgery may face prejudice or discrimination because of their condition. Treatment can sometimes leave people feeling:

. Isolated, if they’re not with people who understand what they’re going through

. Stressed about or afraid of not being accepted socially

. Discriminated against at work

There are legal safeguards to protect against discrimination, but other types of prejudice may be harder to deal with. If you’re feeling anxious or depressed since having your treatment, speak to your GP or a healthcare professional at your clinic.

Sex reassignment surgeons

How can I find the best Sex reassignment surgeon in Iran?

Sex reassignment surgeons in Iran can help you in making your final decision about sex reassignment Surgery.

It is important that you seek the assistance of experienced and skilled Sex reassignment surgeons in Iran who have provided a suitable condition for people with limited budgets to undergo s-e-x change in Iran easily. It is worth explaining that the quality provided by Iranian surgeons is far higher than other countries including Turkey, Thailand and India.

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Sex reassignment surgery cost

How much does Sex Reassignment Surgery cost in Iran?

The cost for Sex reassignment surgery can be more than $25,000 in many countries while the cost of female-to-male reassignment surgery in Iran is between $11000-13000.