The first objection people have to the whole concept of gender reassignment surgery (what people used to call "sex change" surgery) is, "What if that person is just going through a weird phase? What if they get all this done and then change their mind? What if it's just something they're doing on a wacky dare?"

Well, it's not like nobody has ever thought of that. Gender reassignment surgery is a massive, totally life-altering process that we'll cover in just ... so much gross detail shortly. It's such a serious procedure that the first step involves proving you really, really, really, really want it. The World Professional Association For Transgender Health advises patients to spend at least a year living and dressing as the gender they'd like to transition to. This is called real-life experience. Nora lives in the Netherlands, where gender reassignment is covered by government-mandated health insurance, and an extended period of RLE is mandatory there:

"I had to wait out a six-month list to see a psychiatrist for a minimum of three sessions before I could start hormone-replacement therapy, but only if I could show I was going to start living as my gender."

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"If you're not comfortable living as a woman, maybe labia aren't right for you."

Which is to say, the whole gender reassignment process takes a long-ass time, even for folks who, like Nora, already had plenty of RLE before they started the process. For those who were hoping to hop right on the hormone train and hit the secondary sex characteristics cart before they make their public debut, it can be devastating. At first, Nora felt extremely uncomfortable presenting herself as a woman when she still felt she looked like a man:

"At first I was thinking, 'Oh god, I'm in the bus wearing makeup and a dress'; after a month or two I'd switched to, 'Oh my god, cute guy in the bus and I'm not wearing makeup and why didn't I wear some nicer clothes?'"

And then, "The hospital clinic I went to required 18 months of HRT before I could have the reassignment surgery, which had, of course, another waiting list." That one was three months. Again -- plenty of time to change your mind if you're just a "confused" guy going through a phase.

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"And that's the last waiting list I have to be on?"
"Yup! Only delay indices from here on out."

She described the whole process as "both a thrill ride and a torturous test of patience." At one point she had to bring in her mom. "This is for the psychiatrist during the intake phase. We discussed my childhood, how I experienced my life, my gender. What my thoughts were on hormones and the surgery, and what I expected from them. But also whether my life was stable enough, did I have a support network in place? What were my hobbies, my goals and ambitions, professionally and personally?" Hell, how many of you could pass that interview?

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"Where do you see yourself in five years?"
"Still in the middle of this interview, apparently."

And then there's the litany of warnings about all the things that can go horribly wrong. If you have any lingering doubts, just see if they can withstand this news: "You may lose sensitivity and end up not being able to have physical pleasure from sex. Like I was having so much fun with it before and totally didn't want to cry after. But it's a major surgery in a very difficult area; complications like infections or fistulas aren't unheard of. For the hormones, there are different side effects. ... They increase the risk of developing deep-vein thrombosis and require careful monitoring. I met a woman once who had self-medded; she had a stroke that left half of her face paralyzed. She was only 30 years old. It broke my heart."

All of this, by the way, is why many transgender people never attempt surgery -- they just live their lives as the other gender and forever dread the moment they have to explain why they have the wrong genitals. Did we mention that close to half of all trans people will attempt suicide at some point?

Taking hormone therapy for male-to-female transitions involves testosterone blockers, which reduce signs of male physicality like body hair and a deep voice. The second part of the cocktail is estrogen pills, which shrink your penis and redistribute fat to the butt and hips. It all seems pretty straightforward -- you learned in school that hormones are what make men look like men and women look like women. What she was not ready for was how profoundly hormones affect behavior.

"They had warned me that after a period of five months or so I might experience a very emotional time. That was certainly true. Crying all the time; getting catty or simply furious. ... Now this is just the hormones affecting your moods, sort of like PMS for some women or menopause. You have to adjust to it, and after a month of this, it started evening out. It's different for everybody -- some have it sooner, some later, for some it's worse (I don't envy them; I had it pretty badly), and some hardly notice it at all.

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"This is going to adjust your emotional chemistry in unpredictable ways, so maybe
don't take these with alcohol."

"I'm still more emotional than before, but that feels good. I'm more patient, I'm calmer, I feel less driven than I did before I had testosterone blockers. My emotions may be stronger, but I'm more in touch with them as well."

Oh, and then there were the out-of-nowhere giggling fits, like the time she had a debilitating laughing fit when she noticed "how the Gorilla Munch corn puffs gorilla looks like it's pretending to give a b*****b and a handjob."

Nature's Path
OH GOD, SHE'S RIGHT

After 18 months on that hormone roller coaster, she was finally ready to start surgery. And if you were thinking it's just a matter of the doctor going in, sawing off a dick and tossing it over his shoulder into a little trash can full of them, you're not realizing how much cutting it takes to actually look how society says a woman should.

In other words, having the wrong genitals freaks out the public so much that you'd think they'd be thrilled when someone goes through surgery to fix it. "You can't marginalize and disrespect a group of people and at the same time start wagging fingers when they try to adjust. And, trust me, a fine pair of tits just screams female to most people."

Next comes a visit to the crotch-laserer. "I had to have laser hair removal in preparation for it. Some surgeons do a follicle scrape during the surgery. This is needed because part of the skin is inverted to line the vaginal wall. Imagine what would happen if they didn't. The laser sessions ... are anything but fun. If 'lasers firing at your groin' sounds painful, that's because they are, and you are of sound mind. Or maybe it sounds cool and you are into some really weird stuff, but I won't judge; good for you, hun. Personally, I was reminded of the torture scene in Goldfinger. But naked. Being a trans person with body issues doesn't help, either."

United Artists
"No, miss, I expect you to cry."

Finally, it was time for a vaginoplasty. "The thing that surprised me the most about the surgery itself was that it was pretty much painless. People had told me it would be, but I didn't believe them. Genital surgery sounds horribly painful, and I thought they were just trying to put me at ease. But they were right. It wasn't medication that made it painless; it just isn't a very painful procedure."

You can find all the pictures you'd ever want of post-operative vaginoplastied vaginas here. They look ... like vaginas. Because they are. It's a lot easier to create a new vagina using surgery than it is to create a penis, mainly because all the parts of a vagina have been right there in your penis all along. They just need a surgeon who believes in them before they can achieve their full potential. "Male and female genitalia are just the same basic things that have grown differently. The tip of the penis is a clitoris, the testicles are ovaries, the blood vessels that fill up are the same in a woman's labia. It's all there, they just need to be adjusted."

But next comes the recovery, and that's when things get weirder ...

There was a little bit of pain in the recovery, as you'd expect. "The worst of it all was dealing with the catheter. It's not painful, but it sure feels icky having a tube sticking up your urethra. You need one, though. They rearrange your urethra -- anyone with some basic knowledge of biology will understand why, but for those without: Women pee from a place lower than men do. Men pee from what is basically their clitoris."

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Which really goes a long way toward explaining men's terrible aim.

After a week of bed rest, Nora was ready to begin leading her new be-vagina'd life. But that new vagina wasn't quite ready for the full range of traditional vagina activities.

"See, your brain expects the new parts you get, which means you expect the new parts you get. But your body doesn't. It doesn't know there should be a cavity there because there's never been one before, and nobody told it there would be one. Or so it claims. I did try to tell it; since I was little I was trying to tell it, but it refused to listen.

"But now there is one, and you have to keep it that way, so you need to dilate. This involves a set of medical dilottes, which is doctor-speak for boring dildos. You need to use these twice a day at first, for half a year, then you can start using them less and less. It takes about half an hour, so that really adds up, and it's surprisingly tedious and dull. Thank god for laptops and YouTube. In slang, the dilottes are often called Thai boyfriends since so many people go to Bangkok for surgery and come back home with them."

If you'd like more information on "post-operative dilation," you can watch this extremely thorough video by a woman with terrifying eyes.

Via YouTube
"Wait, is she talking about her eyebrows?"

And, of course, having a new f**k-zone makes that whole aspect of your life quite different. "But after being over the 'new' part of it, it feels natural in a way it never did before. I wasn't joking earlier about wanting to cry after sex; it never felt right, and it created a wall between me and anyone I was intimate with." And note that there are a few differences between a surgery-built vagina and one that just grows in the traditional way. Namely, lubrication. "What male bodies obviously don't grow are lubricating ducts for the vaginal wall. After surgery, you'll always need lube for sex, and with the aftercare being what it is I feel I should get a sponsorship from Durex."

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Or at least a "sixth one free" punch card.

Nora didn't view her surgery as just transitioning from a penis to a vagina. "I went from nothing to something, from not having a vagina to having one. I never felt like I had genitalia of my own before; the thing was just there, it didn't belong to me. It was a cruel joke. I couldn't even talk about it in terms like 'my penis'; it was 'that thing.' Now I do have private parts, and it's liberating and empowering. It's not been all that long and already I can hardly remember what it felt like, physically, to have that other thing."

This actually hits on a major misconception people have about transgender people, viewing them as men who want to be women. Nora says, "I wasn't a boy who wanted to be a girl. I was an unhappy girl who wanted to be a happy one. Without understanding that, having an understanding of transsexuality is not possible. I have ambitions now, motivations; I enjoy life, and I enjoy people. The surgery didn't magically make me happy, but it took away a lot of barriers and allowed me to work towards the life I want for myself, just like anyone else."

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Surgery below the belt; results above the shoulders.

Now, we're not trying to publish an advertisement for gender reassignment surgery here. There is very little long-term data on the effects. The best evidence we have suggests it does have a positive mental health impact on most patients (weirdly enough, results tend to be better for people who transition from female to male than male to female -- nobody knows why), but gender reassignment patients do still have an elevated suicide risk compared to the general population. Not just because patients still face a stigma (again, you're having to explain this to every single person in your life) but because gender identity issues have so dominated their lives that they're not sure how to move on.

"Many -- too many -- people get post-operative depression. Not because they regret it but because they've spent so much time and effort into working towards it that when it's over they have little left going on." That, by the way, was why the counselors kept prodding her about her career and life goals. "The clinic wants to know there is more to your life than transition, because when it's all your life is about it can be a red flag." You spend your youth wishing you could live your life as a woman, but once you accomplish that goal, you then have to actually go out and live your life as a woman. That's not the end of a story -- it's the beginning of one.

Knowledge is power, so get you some. Be sure to check out 5 Shocking Realities oF Being Transgender The Media Ignores and 6 Awful Lessons I Learned Transitioning From Female To Male.

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