Living as a man and suddenly realizing one is a woman, or vice versa; such cases are not uncommon in Vietnam. Gender affirmation surgery can help them return to their true gender identity.
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(Photo: gay.blogs) |
Many individuals who appear male are actually female, and vice versa; this is known as male pseudomorphism (or female pseudomorphism). Professor Tran Quan Anh, Director of the Andrology Center at Viet Duc Hospital (Hanoi), explains that male pseudomorphism is characterized by external genitalia resembling a penis, yet the individual has a chromosomal makeup of 46XX.
Many of them were registered as male at birth, lived through childhood as boys, and only upon reaching puberty or adulthood do they realize something is missing that prevents them from feeling like a true man. Upon examination, these “boys” are shocked to discover they possess both a uterus and ovaries; the penis is essentially an enlarged clitoris. The reason they do not experience menstruation like normal women is due to the absence of a vagina. Naturally, they also lose hope of becoming husbands or fathers.
Conversely, female pseudomorphism refers to men who have female-like appearances and are often mistaken for women. The labia majora in their genitalia are actually scrotal sacs; testicles are often concealed, rendering them invisible, and the penis may be short or “hidden”, necessitating the individual to urinate while sitting. As these “young women” reach puberty, many notice the growth of facial hair and a deepening voice; while their friends begin menstruating, serving as a “certificate” of womanhood, they do not experience this at all. It is only after medical consultation that these girls learn they are biologically male, with a chromosomal makeup of 46XY.
Professor Quan Anh states that to confirm cases of pseudomorphism, testing for sex hormones is essential. Male pseudomorphs will exhibit high levels of female hormones and vice versa.
Surgery can help these patients return to their true gender with genitalia that aligns with their chromosomal makeup. For male pseudomorphs, doctors will remove the “penis” and create a vagina using a segment of intestine or skin graft extending from the cervix. This allows the woman to menstruate (if the ovaries are functioning well) and engage in sexual intercourse normally. For female pseudomorphs, doctors will reconstruct the scrotum from the labia majora to reposition the testicles correctly and expose the penis. These surgical procedures are referred to as gender affirmation surgery.
Gender affirmation surgery can also be applied to cases of intersex individuals, meaning those with both male and female reproductive organs (uterus, ovaries, testicles). In such cases, Professor Quan Anh notes that two criteria are used to “select” a patient’s gender: the dominant sex characteristics and the patient’s preferences.
Typically, doctors determine which sex is more dominant. If the ovaries are functioning better, then the testicles will be removed to eliminate the source of male hormones before reconstructive surgery. Conversely, if the testicles are “stronger”, the ovaries and uterus (usually underdeveloped) will need to be removed to eliminate the source of female hormones, thereby ending any menstruation. However, these interventions require the patient’s consent. In some cases, gender affirmation surgery is performed according to the patient’s wishes, regardless of which sex is dominant in their body.
Professor Quan Anh states that the law allows for gender affirmation surgery (meaning returning individuals to their true gender), and Viet Duc Hospital is fully capable of performing this surgery from a technical standpoint. However, current facilities do not ensure safety for these surgeries, as microsurgery demands absolute sterility. Once conditions for gender affirmation surgery are met, the hospital will provide thorough explanations and require patients and their families to sign agreements before the procedure to avoid legal issues, as has occurred in other facilities. According to Professor Anh, a previous hospital director lost his position due to a lawsuit filed by a patient’s family, claiming, “Our child is a boy; why did the doctor turn him into a girl, causing our family to lose our heir?”
Additionally, Professor Anh emphasizes the need to differentiate between gender affirmation surgery and gender reassignment surgery—a procedure not permitted by law. Individuals seeking gender reassignment are those who are biologically perfect men or women, meaning their internal and external reproductive organs align completely with their chromosomal makeup. However, due to homosexual tendencies or feelings of not belonging to the gender their bodies exhibit, they desire to change.
To undergo gender reassignment, patients take hormones from the opposite sex and eliminate the source of their original hormones by surgically removing their reproductive organs (testicles for men and ovaries for women), then reconstructing new genitalia. For men transitioning to women, after removing the penis, doctors create a neovagina that allows for sexual intercourse. For women transitioning to men, they construct a penis, with an internal urethra and an outer layer augmented with rib cartilage for rigidity, facilitating successful intercourse. All individuals undergoing gender reassignment must take hormones of their new gender for life.
Professor Quan Anh notes that Viet Duc Hospital is capable of performing gender reassignment surgeries and has received many requests from patients. However, Viet Duc does not conduct these surgeries, not only due to legal prohibitions but also because these procedures can be devastating, requiring the complete removal of healthy reproductive organs inappropriately. Furthermore, this surgery only satisfies physiological needs (allowing for intercourse) while completely eliminating their reproductive capabilities, leaving them unable to fully embody their chosen gender. Lifelong hormone treatment not only serves as a reminder of their incompleteness but poses health risks, potentially leading to cancer.
Thanh Nhan
