Medical transitioning, a term that replaces “sex change” and constitutes the hormonal and/or surgical processes undertaken by a person to adapt their body to one they identify with, is a very visual process. Hormones produce changes slowly over months and years while surgeries often confer immediate changes. While it is a medical topic and one that lends itself well to visual representation, few medical illustrations exist related to transitioning. To remedy this, my work focuses on creating illustrations pertaining to transgender/trans, non-binary, and gender diverse health, from medical transitioning to daily health concerns for this patient population. I use these illustrated guides in my medical and health sciences lectures while others use my images (with permission) for a variety of patient, family, and physician education needs. As trans patients often, but not always, rely on medical interventions to align their physical body with their gender identity, it is essential that medical education prepare healthcare professionals to be both “culturally” and clinically competent. Furthermore, it is important for gender diverse people themselves to understand the changes that their bodies will undergo so they can make informed decisions and be advocates for their own health care needs.
Let’s get real: it’s not easy to give yourself (or another person) an injection. Some people get over it quickly, others may never get accustomed to doing it. And whether it’s someone’s first time giving/getting a hormone injection or their 100th, it’s always important to do it right. It is necessary that medical providers are sure their patient is confident in their injection technique.
Binding and Tucking
Many trans folks, whether instead of or before medically transitioning, alter their body to reduce or enhance gendered characteristics using temporary body modifications, such as binding or tucking. Both involve using constriction to change the silhouette of the body, which can cause minor to sometimes major problems from regular use. Those who tuck or bind and their healthcare providers should be aware of proper technique, possible outcomes, and harm reduction measures.
Padding involves adding curves to areas to make the illusion of rounder, fuller anatomy. Trans women and trans feminine people may use padding to accentuate the breasts, hips, thighs, and/or buttocks.
Trans Masculine Surgeries
Surgical videos and photographs of any kind are graphic for most audiences. They are not very helpful for most audiences either. For these reasons, medical illustrators translate the important stages of surgical procedures from bloody, scary photos to informative illustrations. However, because few images of gender-affirming surgeries exist, many folks and their families and friends are forced to rely on surgical videos and photographs taken immediately after surgery to learn more about specific procedures. This work seeks to address these issues by generalizing complex surgeries like these to show the before and after results as well as major milestones of the procedure.
Virtually all surgeries that transgender people undergo are used on cisgender people as well, but for different reasons. For example, top surgery on trans masculine people overlaps with bilateral mastectomies due to malignancies. Because there are many variations for surgery because of cancer, there can also be many versions that trans people have access to. Top surgery type is predominately determined by the following factors: chest size, degree to ptosis (skin sag), tissue elasticity, nipple reduction, nipple grafting, etc.
Bottom surgery generally refers to any gender-related procedure to the genitals and/or gonads. For trans masculine people who want and can access/afford, bottom surgery is more likely to be a simpler metoidioplasty procedure rather than a full-scale, multi-surgery phalloplasty. For either procedure, at least one year of testosterone hormone therapy is required in order for the erectile tissues to grow. A mon pubis resection is also a common procedure instead of or in addition to bottom surgery. With skin removal and liposuction, it positions the genitals higher and more prominently outward.
A metoidioplasty, also known as a “meto/meta,” procedure involves releasing suspensory ligaments and other compressing tissues to allow the glans and shaft of the erectile tissues to lower and lengthen; it can also involve wrapping and connecting the labia minora tissue around the body of the organ to provide more girth to the shaft, generate a larger erection, and move the urethral opening from the underside of the body to the tip, allowing someone to stand to urinate. It may also include a scrotoplasty procedure, or the creation of scrotum from labia majora filled with prosthetic testes.
A phalloplasty involves multiple surgeries and utilizes a substantial skin graft to create a penis with internal erection device; it is often accompanied by scrotoplasty. The “phallo” procedure involves creating a “tube within a tube” for the urine to exit the body from the end of the penis. Unlike what was common practice in previous years, it is now preferred to leave the sensory organ and all nerves and vasculature attached and instead build a penis from a graft on top. With the sensory organ underneath, the ability for sexual arousal and orgasm is generally unaffected, if not improved. After healing, a medical tattooist may colorize the genital tissues to appear more realistic.
Trans Feminine Surgeries
An orchiectomy is the removal of testes that some trans women and trans feminine people may undergo. Some people may only want this procedure while it is for others just a necessary first step for further procedures.
A vaginoplasty is the construction of a vagina through the use of either penile tissue, scrotal tissue, or a colon graft. The space for the vaginal canal is created between the bladder and the rectum; generally, the prostate remains intact. Inverted penile skin becomes the vaginal walls. Every effort is made to retain nerve function and sexual response.
A common version of the vaginoplasty is the penile inversion technique that involves the following steps in order: orchietomy, removal of erectile tissues, creation of neourethra, skin is inverted to create neovagina, fashioning a clitoris (clitoroplasty) and vaginal lips (labiaplasty.)
Another surgery that accompany the vaginoplasty to create a realistic vulva is by crafting a sensate clitoris and labia/vaginal lips.
The clitoroplasty procedure is done mid-vaginoplasty and involves rolling the glans into the shape of a clitoris and reattaching the erectile body, keeping vasculature and innervation intact. The purpose is to make a sensate clitoris.
The Labiaplasty procedure involves using the skin of the scrotum and base of penis to create internal and external lips (or labia minora and majora, respectively.)
- Effects of Estrogen Hormone Therapy
- Effects of Testosterone Hormone Therapy
- Subcutaneous Injection
- Chest Binding
- Genital Tucking
- Top Surgery
- Mons Pubis Resection
- Metoidioplasty Surgery
- Phalloplasty Surgery
- Orchiectomy Surgery
- Penile Inversion Vaginoplasty
- Clitoroplasty Surgery
- Labiaplasty Surgery