As soon as I reveal to someone that I'm involved with a female-to-male (FTM) person, I inevitably get the same questions. Has he had the surgery? Has he gone all the way—the dick and everything? It's not enough to simply say my lover was born female and now lives his life as a male: He prefers male pronouns, uses the men's room, and looks like a guy. No, this explanation doesn't seem to satisfy most people. They need to know what his body looks like, how it works, what physically makes him a dude.
This response is linked to our society's deeply entrenched beliefs about biological sex and gender: In other words, genitals determine gender. I suspect that it's also based on some people's awareness of male-to-female (MTF) people, for whom sex reassignment surgery (SRS) is common. When folks ask about "the surgery" of FTMs, most don't know that there isn't one option, but many (see ftm-intl.org for more information). In fact, the most popular method of body modification is non-surgical—testosterone hormone therapy can broaden shoulders, narrow hips, enlarge the clitoris, and cause facial and body hair growth. When it comes to what's often referred to as "top surgery," some transmen opt for a double mastectomy followed by chest reconstruction. FTMs with small breasts may opt for the "keyhole" procedure, in which a small incision is made just below the areola, and breast tissue is removed through liposuction with little scarring and a better chance of retaining nipple sensitivity.
"Bottom surgery" options are more complicated. The most common are hysterectomies and metoidioplasties, in which skin around the clitoris is removed, freeing the clit from the pubis. Some trannies get silicone implants for balls and a scrotal sac crafted from the labia. Phalloplasty is the most complex, least successful, and least common option. Surgeons can create a cock out of skin taken from the forearm, the abdomen, or the upper thigh, but a urethral extension is needed for peeing out of it and the sexual sensitivity varies (many leave the clitoris at the base of the new dick). Erections are also tricky: Surgeons can leave a hole to insert a rod or a built-in inflatable pump. These phallic devices may resemble high-tech Sharper Image toys on paper, but most of them don't seem to look (or work) as good as they sound.
And how do I know what they look like? Photographer and transman Loren Cameron has documented the bodies and narratives of 12 FTMs in his new e-book Man Tool: The Nuts and Bolts of Female-to-Male Surgery(www.lorencameron.com/mantool/index.html). Building on his first book of transsexual portraits, Body Alchemy, this interactive collection closely captures transmale bodies, making the hidden visible. While the owners of these new man tools are content and upbeat about the results, you can't help but see big differences between SRS for transmen and transwomen.
For MTFs, surgical options are more advanced, performed by more physicians, and potentially a lot less expensive than their FTM counterparts ($5000 to $25,000 for vaginoplasty and $15,000 to $150,000 for phalloplasty). I saw an extremely explicit slide presentation by Beverly Hills physician Gary Alter (one of only three doctors in the world who is board certified in both plastic surgery and urology), who proclaimed that every one of his MTF patients were orgasmic post-op. I don't know how he gauged that, but I do know that they had pretty good-looking coochies. And I wouldn't be able to tell the XX from the XY in a pussy lineup. But while Dr. Alter has been trained to perform FTM sex reassignment surgery, and has even done a few, he won't do it anymore. He's a perfectionist—a great quality for someone modifying bodies for a living—who says he can't achieve anything close to perfection with the available operations.
In her comprehensive research study, Anne Lawrence, a Seattle physician specializing in transgender medicine, found that the happiness, satisfaction, and quality of life of one group of MTFs depended greatly on the physical success of their sex reassignment surgery. "Buying a vagina these days is like buying a Toyota Camry. The technology has largely been worked out, and consumer satisfaction is very high. You can even shop around for the particular model you want," says Lawrence. "On the other hand, buying a penis is more like buying a Wright brothers airplane. Can it fly? Yes, sometimes. But how high, and for how long? Is it something you'd really want to fly in? In female-to-male surgery the engineering challenges are far greater, and the technology is still being worked out."
When you dig into the medical issues of building a cunt versus a cock, you see why it's much easier to make an aesthetically pleasing, sexually sensitive, and functional vagina than a comparable dick. But politically, the imbalance is still glaring. There are far fewer well-reputed, experienced physicians performing FTM surgeries. There is less research on FTM body modification and the relationship between transmen and their bodies. One can't help but hear the male-centered medical industry whispering, "We'll move you down the patriarchal hierarchy, but we won't move you up."
