I am 7 years on Testosterone. 5 years post-op top surgery. Legally male in the state of Ohio.
Specific Question: Do you perform testicular implants as a procedure by itself. I typically take a long time to heal and do not want to complicate my healing by having multiple procedures at once. I’m ideally looking to have the scrotoplasty/implants done first and then decide on whether meta or phalloplasty is a better option for myself.

Sincerely, Seth

Good afternoon Seth,

Yes, we can. The attached may be of some help.  Please see  http://srsmiami.com/photography-f2m.html and http://penisdoctor.com/photo6.htm for photographic examples of our work.

Harold M. Reed, M.D.
305-865-2000

my name is Roz and I had surgery performed in your office about two years ago and couldn’t have been more pleased with the outcome. Since then, I have been researching different techniques on making the hips and buttocks look fuller….There doesn’t seem to be much out there except for silicone injections and that is out of the question for me…I recently came across a site that described Artefill/Artecoll and how it is being used to give a more shapely and feminine figure….I was just wondering if you use this ineluctable filler and if it is safe? I am trying so hard to find a safe way to enhance my figure…..Thank you….

Hi Roz,

Thank you for your kind words.  If you could post them on our Yahoo group http://groups.yahoo.com/group/MTF-SRS-FTM/   I would be very appreciative.

I do not do tissue fillers except for Juvederm Ultra Plus which is not permanent.   A very good video on Artecoll/Artefill is done by Dr. Lam…
http://www.metacafe.com/watch/1040242/dallas_plastic_surgery_

why_i_dont_use_artefill_artecoll/

Please definitely do not have silicone injected to your buttocks as once in, it cannot be taken out and most of our patients have been done by less than skillful aestheticians.  The end result, pardon the pun, looks like a rear tire.  There is a doctor in Miami, Dr. Tiller who uses silicone implants versus liquid injection and seems to be well regarded, but I am detached from this area altogether.  We have done a few breast augs on pateints who had silicone injected into their breasts, and it’s like cement to open a tissue plane and the contours can be very cuboidal.

So hope I have been helpful, at least caring and best wishes,

Harold M. Reed, M.D.
305-865-2000

January 26, 2010

Hello I am trying to get an idea for the phalloplasty procedure early on and I have  a few questions about the FTM phalloplasty operation. How much could one expect to  pay for a full procedure? Is it required to consult with a therapist  before being aproved for the procedure?   Randy

Hi Randy,

We can consult without a therapist clearance, however, before you have irreversible surgery, you will need 2 letters of therapy clearance.  Phalloplasties have many variables including stand to void result, penile implant to provide penetration ability, orgasmic sensation versus somatic sensation (what you might feel on the abdominal wall).  So please confer with me and then we can provide a fee estimate.

All the best,

Harold M./ Reed, M.D.
305-865-2000

I am contacting your office because of my interest in undergoing the orchiectomy procedure, however, I did have a few questions for you.

1. I know there are several places for incision, but I am curious where Dr. Reed chooses?

2. I live in St. Louis, Missouri and because of that, flying to Miami is quite costly. Will a consultation prior to surgery be necessary? I would like the Doctor to know that I have currently had another consultation in St. Louis, though I choose not to go with that doctor due to her lack of experience with MTF patients.

3. What does the $2,500 cost exactly include? If there are additional costs, could you tell me how much those additional costs usually run?

4. How long does Dr. Reed recommend the patient stay in the Miami area before flying home?

5. One of the major reasons I want to have this procedure performed is to have my gender marker on my birth certificate and subsequently my driver’s license change. In the State of Missouri, what is required for this is receipt of a certified copy of an order of a court of competent jurisdiction indicating the sex of an individual born in this state has been changed by surgical procedure and that such individual’s name has been changed, the certificate of birth of such individual shall be amended. Will the notarized documentation that Dr. Reed provides to me after the surgery use the key language “the sex of [Chloe] has been changed by surgical procedure”? I ask this because that language is key to having it amended.

6. Lastly, how many orchiectomy procedures has Dr. Reed performed on MTF transsexuals?

I have done a lot of research on Dr. Reed, and find that she would be a wonderful surgeon for me. I hope to hear from you soon, and I thank you for your cooperation.   Carla

Good afternoon Carla,

Yes, for lack of a more appropriate term, we do have to gather information before surgery about your medical history, review therapy letters of clearance, review laboratory tests, examine you and answer many questions you may have and put out information to you.  This can be initiated over the phone and with the help of Email.

We will see you the day before your orchiectomy and give you instructions to help you prepare. We recommend you stay at the Baltic Hotel so I can follow you there for 2 days, and then you are good to return home.

We are equidistant between Ft. Lauderdale and Miami airports, so take the flight that is most economical.

At Miami, you can use SuperShuttle for ground transportation, and in Ft. Lauderdale.. Go-Transportation for a significant savings.

Carla,  I can write words to that effect when we say you have had irreversible gender altering surgery. That you have been living as a female for (—) years and are recognized as a female by your psychotherapists.  We have never had a notarized letter (signed by me) of this import rejected.

I have performed about 400 or more orchiectomies on MTF patients.  We use a small 1 inch vertical scrotal incision

Your surgical fee includes: surgery, use of the facility, local anesthesia with IV sedation, my followup visits with you and of course several confirming letters.

Have a restful evening,

Harold M. Reed, M.D.
305-865-2000

Good morning Kim,

Like the stewardesses say, “be careful accessing the overhead racks as articles tend to shift in flight.” I have never seen a class A result either from this office or from any other doctor, where after a few months something could be done to improve the appearance. May be a noticeable scar, or small separation that healed with a scar, or a urethral opening up too high or an elevated posterior lip, or a clitoris that is too prominent or could use more hooding, or labia majora that simply do not look youthful.

I strive to have all my patients be a visual “turn on.” Yes, I find the female genitalia very attractive and feel if someone is paying big bucks and entrusting their care to me, they deserve something really extraordinary.

We only want walking positive advertisements. For that reason, we do touch ups at no charge under local with IV sedation, with the understanding if the patient is overly anxious, or has a history of drug tolerance, or needs a fair amount of work to be done, they do have to pay for the services of anesthetist which never exceeds 600 and could be less. Everything else is on me and don’t forget to bring that ring pillow back again. Sitting on your incision line is not good for wound healing!

Sincerely,

Harold M. Reed, M.D.
305-865-2000

Dear Dr. Reed,

You have my photographs.  Hope you can make me as pretty as what I see on your web-site   srsMiami.com

April,     PS:  here is Camilla’s enthusiastic letter.

Dearest Dr. Reed, First of all, I will d?like to say THANK YOU VERY MUCH for your wonderful revision labiaplasty you did on me. I?M VERY HAPPY! Let me say hello and thanks to you secretary Anne, as well, such kindly and lovely. I had all of kind of attentions and care about the staff, and lots of care from you. I consider to advice all the folks need procedures about any kind of ?sexual gender problems? to go to Dr. Reed. He’s definetelly, is the best of surgeon and as good person. Thank you forever. Camilla

September 23, 2008

Good afternoon April,

Thank you for your excellent medical photographs.  Very helpful.

Yes, I agree the labia and clitoral hood are the most notable areas that need revision.  I do believe you will receive a result that will make you smile at last, no more double-take looks.

Last week we did a similar case, perhaps not as exaggerated as yours, and she was very pleased.  Here is a “thank you post” from our http://srsmiami.com/blog/

Thanks for Vaginoplasty Revision

September 21st, 2008

1. Camilla F. | pinko@pallino.it | srsmiami.com | IP: 87.18.47.195 Dearest Dr. Reed, First of all, I will d?like to say THANK YOU VERY MUCH for your wonderful revision labiaplasty you did on me. I?M VERY HAPPY! Let me say hello and thanks to you secretary Anne, as well, such kindly and lovely. I had all of kind of attentions and care about the staff, and lots of care from you. I consider to advice all the folks need procedures about any kind of ?sexual gender problems? to go to Dr. Reed. He?s definetelly, is the best of surgeon and as good person. Thank you forever. Camilla

Dear Dr. Reed I recently emailed you advising that I had SRS MTF sutgery. I asked about vaginal deepening procedures and labiaplasty. You wanted me to come in to your office. I will be in the Miami SOuth Beach area 02-28-2010 until 03-04-2010 iwanted to know if i can come into your office on a friday or monday .  Please email me back or call to verify appt dt and time !!!!!!
How you heard about us: annelawrence.com

January 24, 2010

Dear Nicole,

What a pleasant surprise to hear from you.

Preesently on retreat in the Carolinas followed by 2 fully booked weeks in Miami. But do call the office on Monday February 1, 2010 and schedule in.

Anne our amiable office manager should be very helpful.

With every best wish,

Harold M. Reed, M.D.,
305-865-2000

Re: When will a scrotal graft be necessary, Nessie

Hi Nessie,

The use of a scrotal graft is really necessary for any one who is seeking adequate depth for penetrating sex. For the past year we counsel the patient pre-op and do it at no extra charge, because we want you to be a happy. You never know when Mr. Right comes along.

Very rarely when a patient says do not do it, if they are confirmed asexual or lot older, and it is desirable to save 45 minutes of operating time, that step will be eliminated in the interest of patient safety. Unless someone has a stretched penile shaft skin length of 7 inches, we heartily recommend that
scrotal graft extension be done.

In conjunction with this we also recommend electrolysis starting 3 months before. We have seen hair grow back on patients who have last moment epilation in the operating room. Even if successful the trauma to the scrotal tissue may reduce ideal graft take.

The scrotum will stretch almost like a latex glove, so once the graft is above the level of the pelvic floor, you can build upon our depth to suit, providing you embark upon early and dedicated stent usage, until again Mr. Right comes along.

If dilation is painful initially, this is quite normal. Then consider EMLA cream or lidocaine jelly 2%. Please do not procrastinate. Your doctor will show you, using the palm of your hand, how hard you can push safely. Even if you just gain an 1/8″ every week, it adds up.

Harold M. Reed, M.D.
305-865-200

Dear Laurie,

Read the letter and this is the classic example of how a letter of endorsement should not be written. This type of letter is in fact seen when a therapist feels a certain obligation to say something but in fact has deep seated reservations about making any written commitment. This is akin to a “letter of recommendation”  for an employee.   Miss so and so worked in my office from June 1st 1999 to September 5, 2001. (Start, period, end of letter).

This is a more a letter of detachment.

The standards for how a letter should be written if the Dr. is interested are posted on WPATH.   To wit:

The Mental Health Professional’s Documentation Letter for Hormone Therapy or Surgery

Should Succinctly Specify:

1. The patient’s general identifying characteristics;

2. The initial and evolving gender, sexual, and other psychiatric diagnoses;

3. The duration of their professional relationship including the type of psychotherapy or

evaluation that the patient underwent;

4. The eligibility criteria that have been met and the mental health professional’s rationale

for hormone therapy or surgery;

5. The degree to which the patient has followed the Standards of Care to date and the

likelihood of future compliance;

6. Whether the author of the report is part of a gender team;

7. That the sender welcomes a phone call to verify the fact that the mental health professional actually wrote the letter as described in this document.  

The organization and completeness of these letters provide the hormone-prescribing physician and the surgeon an important degree of assurance that mental health professional is knowledgeable and competent concerning gender identity disorders.

More or less in the first paragraph the therapist should introduce him/herself by virtue of their background and training and societal memberships. Next the therapist should endorse the client for transgender surgery (”I recommend, I endorse, or Miss so and so would be a good candidate for transgender surgery, etc”).

Next suicidal ideation or attempts (yes or no) should be mentioned, as well as any drug abuse history or ethanol dependency (yes or no).

Lastly the therapist should invite the recipient to call their office for further discussion should questions arise.

Look at Dr. Mora’s letter hopefully and you will see the difference.

Sincerely,

Harold M. Reed, M.D.
305-865-2000

(courtesy of Carl C, our superman)

Tissue Engineering Advance: Implications For FtM Phalloplasty

SciMed – Hormones, Meds & Surgery
TS-Si News Service
Thursday, 07 May 2009 02:00
Linköping, Sweden. Scientists can now create cartilage, bones and the internal walls of blood vessels by using common connective tissue cells from human skin. Researchers in reconstructive plastic surgery at Linköping Universitet successfully manipulated these tissue cells to take on different shapes depending on the medium used for cultivation.

This is a practical example of an autologous biological process, where cells, tissues or even proteins can be reimplanted in the same individual who donated the materials in the first place. Candidate materials for autografts ordinarily include a variety of natural donor sites, including bone, bone marrow, cartilage, and skin biopsy.

There are obvious implications for generating new and improved techniques for Sex Reassignment Surgery (SRS), including phalloplasty, a continuing issue for F2M patients (cf. sidebar).

Phalloplasty is the construction or repair of a penis. In natal males, it can involve modification of an existing penis to correct the effects of an injury or to achieve cosmetic goals. Dr. Harold Gillies performed the first phalloplasty for FtM sex reassignment on Michael Dillon in 1946, a story documented in The First Man-Made Man by Pagan Kennedy.

In general, the sex organs of natal males and females evolve from the same human tissue. For instance, the glans penis is made of the same basic material as the clitoral glans (i.e., they are homologous). Likewise, the male corpora cavernosa are homologous to the clitoral body. Among other examples are the pairings of corpus spongiosum/vestibular bulbs (beneath the labia minora) and the foreskin/clitoral hood. The scrotum is homologous to the labia minora/majora.

Because of these homologous relationships, the combination of hormone therapy and surgical intervention offers opportunities for effective transformation. Over the long term, natural tissue replacement in the body (under hormonal supervision) enhances the outcome.

Basic surgical procedures are similar ro those used on natal males (except in extreme cases). The labia are united to form a scrotum capable of housing prosthetic testicles. However, the urethra must be lengthened since it ends near the vaginal opening, a source of many (if not most) surgical complications.

Sexual penetration is possible following the replacement of the erectile tissue with an erectile prosthesis. Ordinarily, this is done as a separate surgery to reduce risks and promote healing.

Historically, phalloplasty techniques included grafts from the arm, leg, abdomen or musculocutaneous latissimus dorsi, replanting abdominal muscle, or relocating fatty tissue from the abdomen.Another important technique has been the insertion of living bone (long-term follow-up studies in Germany and Turkey show that stiffness is maintained without late complications.

A more contemporary option is metoidioplasty involves enlarging the preexistent clitoris by hormone replacement therapy and fashioning a small penis that can be enlarged using other techniques.

Surgical techniques for FtM patients have advanced since the first phalloplasty, but much remains to be done. This situation is changing with new research efforts and the arrival of practical techniques derived from bioengineered tissue cultures.
Bone, cartilage and blood vessels are important components in reconstructive surgery, when damaged or missing tissue needs to be recreated. Minor fractures can heal spontaneously but for major bone damage and cartilage injuries there is the need to transplant tissue from other parts of the patient’s body.

The studies are the first in the world with results that show connective tissue cells from human skin transformed into other so called phenotypes and creating other types of tissue. Previously, researcher have attempted to grow autologous tissue from stem cells, such as those present in bone marrow. These cells, however, can be difficult to harvest, cultivate and store.

Connective tissue cells from human skin have great comparative advantages. A small biopsy is often sufficient to collect a useful number of cells.

Gunnar Kratz is a Professor of Experimental Plastic Surgery and team leader for the research group. “This means that it will be much easier to produce autologous tissue, which is tissue created from the patient’s own body”, he says. The results of the group’s research are now published in three simultaneous scientific articles. [C1-3]

According to Kratz, connective tissue cells “… are the `weed’ cells of the body, very easy to collect and cultivate into the cell type required. They are also very suitable to use to create a personal cell bank.”

Working with colleagues, Kratz has developed a technique to grow bone-like, cartilage-like and endothelial-like cells from connective tissue cells. Endothelial cells are the building blocks for the inner walls of blood vessels and line the entire circulatory system, reducing the turbulence of blood flow and allowing further pumping of blood fluids.

The new technique has been used to create whole tissue in gelatine scaffolds. Currently, preparations are underway to transplant these complete tissue pieces into laboratory animals.

In the their studies, the researchers collected connective tissue cells from healthy skin left over from breast and stomach plastic surgery and used fat stem cells to provide a comparison. To ensure that the transformation was not a result of the fusion of different cells, connective tissue cells from one cloned cell were also used.

The cell cultures were cultivated in four different environments optimised for
bone,

cartilage,

fat and

endothelium.
After two to four weeks the connective tissue cells had produced cartilage and bone mass to a greater extent than the fat stem cells had. The cells showed
several functions normally only present in the genuine (or conventionally ocurring) cell type.

capabilities as building material for three dimensional tissues, to create capillary networks, and other functions important to regenerative medicine.
“The dream is to be able to manipulate connective tissue cells in the human body to develop into specific cell types, for example to create bone cells for broken bones”, says Kratz. And much more.

Citation[C1] Engineering three-dimensional cartilage- and bone-like tissues using human dermal fibroblasts and macroporous gelatine microcarriers. Pehr Sommar, Sofia Pettersson, Charlotte Ness, Hans Johnson, Gunnar Kratz, Johan P.E. Junker. Journal of Plastic Reconstructive & Aesthetic Surgery. Feburary 2009. doi: 10.1016/j.bjps.2009.02.072

Summary

The creation of tissue-engineered cartilage and bone, using cells from an easily available source seeded on a suitable biomaterial, may have a vast impact on regenerative medicine. While various types of adult stem cells have shown promising results, their use is accompanied by difficulties associated with harvest and culture. The proposed inherent plasticity of dermally derived human fibroblasts may render them useful in tissue-engineering applications. In the present study, human dermal fibroblasts cultured on macroporous gelatine microcarriers encapsulated in platelet-rich plasma into three-dimensional constructs were differentiated towards chondrogenic and osteogenic phenotypes using specific induction media. The effect of flow-induced shear stress on osteogenic differentiation of fibroblasts was also evaluated. The generated tissue constructs were analysed after 4, 8 and 12 weeks using routine and immunohistochemical stainings as well as an enzyme activity assay. The chondrogenic-induced tissue constructs were composed of glycosaminoglycan-rich extracellular matrix, which stained positive for aggrecan. The osteogenic-induced tissue constructs were composed of mineralised extracellular matrix containing osteocalcin and osteonectin, with cells showing an increased alkaline phosphatase activity. Increased osteogenic differentiation was seen when applying flow-induced shear stress to the culture. Un-induced fibroblast controls did not form cartilage- or bone-like tissues. Our findings suggest that primary human dermal fibroblasts can be used to form cartilage- and bone-like tissues in vitro when cultured in specific induction media.

Keywords: Dermal fibroblast, Chondrogenesis, Osteogenesis, Microcarrier, Tissue engineering, Regenerative medicine.

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[C2] Adipogenic, chondrogenic and osteogenic differentiation of clonally derived human dermal fibroblasts. Johan P E Junker, Pehr Sommar, Mårten Skog, Hans Johnson, Gunnar Kratz. Cells, Tissues, Organs. In press.

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[C3] Human Dermal Fibroblasts: a Potential Cell Source for Endothelialization of Vascular Grafts. Lisa K Karlsson, Johan PE Junker, Magnus Grenegård, Gunnar Kratz. Annals of Vascular Surgery. Accepted.