In the past 5 years, every patient we have done has been orgasmic. Not to worry.

Best,

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

305-865-2000 Fax 305-865-2002

Thanks for visiting our web-site on female to male transgender
surgery http://srsmiami.com and for your beautiful letter.

We hope you like what you see http://srsmiami.com/photography-f2m.html

Be sure to join our adult Yahoo group with over 5133 members including
many FTM patients who will help you http://groups.yahoo.com/group/MTF-SRS-FTM/

This week alone 20 new members!

You’ll have to do about 10 key strokes to get there but once you are a member
logging in is easy.

Every so often we have a promotional week, in honor of a visiting urology professor, such as this past January when we hosted a colleague with the world’s largest collection of metoidioplasty patients. We did 3 metoidioplasties. Please understand visiting professors who are not licensed in Florida may not operate, but their advice is invaluable.

Yes, we do male chest reconstruction surgery.

While we will endeavor to utilize the smallest incisions possible,
and strive for reasons of concealment to make those incisions along anatomical
skin folds or planes if at all possible, a consultation would be required to best advise you.

Fees to include anesthesia and use of the facility range from $5,000 to $8,500. Scheduling
for surgery requires a 50% deposit which is non-refundable.

The balance is due no later than the day before surgery and must be presented in cashier’s check or currency at that time. Credit cards and personal checks are not accepted.

Consultation is $250 and there will be some out of pocket fees for a compressive chest
garment, laboratory tests (which could be done in your home town) and a letter of medical
clearance (if indicated). Consultation is usually initiated over the phone, so be sure to send us an envelope with your name, address, and phone number along with any pertinent records and we’ll get started.

We adhere to the Harry Benjamin standards of care. For below the waist FTM surgery you will need 2 letters of therapeutic clearance. One of which, should be written by a therapist with a doctoral degree (a psychologist, psychiatrist, sexologist, or sociologist) and one of the therapists must be following you for at least 6 months.

For construction of a penis, there are 2 approaches: metoidioplasty and (full-scale)
phalloplasty. Metoidioplasty is the simpler and least expensive of the two. Metoidioplasty taken from the Greek words, meta meaning toward oidion meaning male organs, and plasty to form. A metoidioplasty is based surgical release of a clitoris which has been primed on tetsosterone. You may reasonably anticipate the outcome based upon the length of the clitoral body and size of your glans clitoris pre-operatively. In other words, anticipate a juvenile sized phallus at best without ability to penetrate.

Metoidioplasty with a stand to void urethra has the advantage of being more economical $12,500 (in our practice) vs. $75,000 to $100,000 in the United States for complete phalloplasty.

In Europe a phalloplasty can be obtained for $15,000 to $30,000. A completed phalloplasty requires several stages and the likelihood that all stages will proceed without any complication or produce a perfect result without an occasional revisions is quite remote.

Anticipate revisions and discuss with your intended surgeon what you may reasonably expect as related to their unique technique. Please confer if you wish with Dr. Miroslav Djordjevic (djordjevic@uromiros.com) or Dr. Rados Djinovic, M.D. (perovics@eunet.rs) both in Belgrade, Serbia or Dr. Stanley Monstrey in Gent, Belgium. All are excellent surgeons and speak perfect English.. Dr. Monstrey does an excellent forearm flap. I have personally seen each do this surgery several times.

An ideal phalloplasty will produce a phallus that looks upon close inspection to be a penis
with good glans (head) formation and a corona (rim). The phallus must be completely sensate and beyond that orgasmically sensate. Within the phallus shall be a urinary channel of decent caliber so the patient can void urinating from the glans as with normal males.

Additionally there needs to be a mechanism for producing a penetrable erection. Alternatives include: an inflatable penile prosthesis carrying a 50% complication rate and in genetic males having an average survival of 6 to 8 years (less in transgendered patients); or a semi-rigid prosthesis (possibility of extrusion from continued
pressure); or a bacculum (silicone rod) which is inserted into a special channel just for sex.

Many dance steps to go through. Also there will be a noticeable deforming harvesting scar which represents the donor site, could be in the forearm, back, lower abdomen, or thigh.

We do not perform primary phalloplasty but will do revisions.

If you are considering metoidioplasty, you should be on testosterone for
2 years to maximize growth before surgery.

Our metoidioplasty fees are the best around (we believe) at $12,500 to include
anesthesia, surgery, use of the facility, and my aftercare.

During this procedure if you desire one stage urethral extension, a buccal
graft, small mucosal strip from the inside of your cheek, will also
be performed to assist in tubularization of the additional urethral length. Most
patients are able to eat the next day and are fairly comfortable with an ice pack
for 24 hours.

Soft testicular implants can be inserted at the same time and our fee inclusive of the implants and anesthesia time is $4000. “Add-ons” are less expensive. Augmentation with testicular implants and scrotalplasty as an independent procedure is $5,500.

Candidates who wish to secure their reservations with our facilities are required to have minimally letters of clearance and a phone consultation with a favorable response to questions of concern. Assuming this, you will be given the nod to send in a 50% deposit which is non-refundable.

Please understand in that metoidioplasty involves a fair amount of tissue transfer,
some degree of post-operative swelling is expected.

Complications may include but are not limited to less than anticipated length, torquing of the clitoris (usually amenable to release), loss of sensation, tissue necrosis, localized infection, persistent tenderness or hypersensitivity, transient or permanent narrowing of the vaginal opening which may render the vagina incapable of penile penetration, urethral narrowing, urethral obstruction.

Urethral fistula (leakage of urine anywhere along the pathway of urethral extension), and may close spontaneously or require a revision procedure (performed by Dr. Reed at no additional cost).

Additional length may be accomplished after wound healing with use of a vacuum erection device (furnished by Dr. Reed).

Additionally you may want to have your vagina removed (colpocleisis) and this
is done by others, but needs to follow metoidioplasty. Could be done
before or after phalloplasty, but perhaps desirable before. Hysterectomy and
oophorectomy can be done before or after metoidioplasty, but probably better
before phalloplasty. Please consider state of the art “total laparoscopic
hysterectomy and oophorectomy” and this is done by others.

If there is further interest, please call Anne, our amiable office manager
and set up an appointment for your initial visit. There are many illustrations
and products that need to be shown to you as well.

Having a neophallus constructed from a graft is more complicated and involves many steps including fulfillment of Harry Benjamin criteria, total laparoscopic salpingo-oophorectomy and hysterectomy, construction of a neo-phallus with internal urethra, and
creating a scrotum from labia majora
tissue and installing testicular prosthesis.

If you already have a neophallus, about 6 months later you can have an inflatable penile prosthesis installed.

Our fee for a semi rigid is $7000 and for an inflatable (recommended) is $13,500.

This includes surgery, facility fee, anesthesia, and of course the implant itself.

If you are over 40 and are on medications other than hormones, please call the office before scheduling surgery, as a letter of medical clearance will most likely be needed.

If you are a smoker, you must stop completely for 2 months before surgery and please never again. Smoking causes vaso-spasm, impairs wound healing, produces excessive scarring, tissue necrosis, irritates and inflames pulmonary membranes and
enhances anesthetic risk.

This goes also for any products containing nicotine or nicotine like agents including nicorette gum, nicotine patches, Nicotrol inhalers, and second hand smoke.
Again not for 8 weeks before and not for 8 weeks afterwards. Hopefully never again.

If you have a history of inflammatory bowel disease, such as Crohn’s or regional enteritis, please get clearance from your GI doctor, as rectal inflammation can be an inciting factor for the post-operative complication: rectal-vaginal fistula.

Obtain a pair of anti-embolism thigh high stockings. T.E.D. (by Futuro) or Jobst are common brand names. Yes, do try these on before you come here to be sure
they fit comfortably. If you wash or dry them in a hot cycle, they may never fit properly again. So best not to wash them at all until after surgery.

As a courtesy to the hotel, please obtain and bring with you a bundle of “chucks” or disposable superabsorbent pads with plastic liner on underside (typically 24 by 36 inches) to conserve hotel laundry and bedding.

Circular (ring or donut) pillow. Yes, please bring a circular or donut pillow with you so you do not sit directly on your suture line or testicular prostheses for at least 3 weeks. Very important especially if traveling by car or plane. Your suture lines are not designed to withstand the pressure of your torso and your testicular implants may shift..

Please no aspirin or aspirin products, no anti-inflammatory drugs such as Motrin, Advil, Alleve, or Cox 2 inhibitors such as Celebrex or Vioxx for a week before surgery. No Vitamin E or excessive alcohol or spices for a week before surgery as this may promote bruising. Bruising can be reduced (many believe) with Bromelain 500 mg 1 twice
a day, Arnica montana (Boiron brand) dose 30C (take 4 small tablets sublingually,
4 times a day), vitamin C 500 mg (3 times a day) starting 1 week before surgery. Do take these medications unless there are specific reasons why you choose not to and let’s discuss this beforehand.

Boiron brand is available at Whole Foods and on the web at http://www.vitaminshoppe.com for “pennies” and we do notice a difference. You will need 2 vials.

FAQ: 1. Where to start?

In every major city in this country there are therapists and physicians
who will assist you. The best places to start the web-sites of Dr. Anne Lawrence
http://www.annelawrence.com/links.html,
Dr. Becky Allison http://www.drbecky.com/therapists.html ,
and Mrs. DaleLynn Sims http://www.kindredspiritlakeside.homestead.com/resources.html

FAQ: 2. How do I obtain hormones?

Hormones are helpful to assist in the real life test. If being passable is an important
consideration in your decision to undergo transition, then your first stop is to see a therapist.

Ethical and responsible medical practice would suggest that hormones should only
be prescribed by a knowledgeable doctor such as an endocrinologist, who will
request a letter of therapy clearance.

Hormone changes may be irreversible and some very adverse effects may occur
with improper use. Do-it-yourselfers, beware!

You will need to have a few baseline blood tests performed and be followed every so
often to be sure you are achieving safe and effective levels.

For those in the South Florida area, this service is provided by our office.

FAQ: 3. Will I be able to penetrate during sexual relations?

Our technology does not permit insertion of a prosthesis in metoidioplasty patients at
this time. For those patients who have a neo-phallus fashioned from a graft or flap,
this can be accomplished with either a stent (bacculum) that can be inserted into a linear
cavity within your phallus while having sex, or via an inflatable penile prosthesis.

FAQ: 4. Would I be able to produce sperm and let’s say in the future would I be able to impregnate a female and have kids?

Genetic research technology is not that far advanced. The muscles and accessory sex glands (prostate and seminal vesicles especially) needed for ejaculation are not created in today’s FTM surgical procedures. Let’s hope for and follow future developments.

FAQ: 5. Are any of your patients amenable to speaking with me?

As you may know the new HIPAA laws are very strict about patient confidentiality. However, photos are available both on our web-site and http://www.transster.com

FAQ: 6. Would it be of normal size and look and feel real?

To discerning people examining you in bright light, your neo-phallus will resemble a penis but subtle differences in skin pigmentation, texture, and the presence of some incisional areas although well healed and perhaps ever so fine, will be apparent.
Our goal will be to create a sensate phallus at least as long as a real penis, with glans formation, through which you can void and make erect for the purposes
of penetration.

Once you made your selections and accept continuous cross-dressing for
at least 1 year and have fulfilled the Harry Benjamin requirements (see our web-site),
you are all set for below the waist
surgery.

FAQ: 7. Do you perform male chest reconstruction?

Yes, we do male chest reconstruction surgery.

While we will endeavor to utilize the smallest incisions possible,
and strive for reasons of concealment to make those incisions along anatomical
skin folds or planes if at all possible, a consultation would be required to best advise you.

We cannot do breasts larger than a small C in the office unless you have pendulous
breasts with a narrow pedicle

Fees to include anesthesia and use of the facility range from $5,000 to $8,500. Scheduling for surgery requires a 50% deposit which is non-refundable.

The balance is due no later than the day before surgery and must be presented in cashier’s check
or currency at that time. Credit cards and personal checks are not accepted.

Consultation is $250 and there will be some out of pocket fees for a compressive chest garment, laboratory tests (which could be done in your home town) and a letter
of medical clearance (if indicated).

A letter of therapy clearance written by a consultant with a doctoral degree (could be a psychiatrist, psychologist, or sociologist) is also required. You may already have such a letter. If written in the past year this is acceptable, or simply have it updated.

You may wish to log in with a very stimulating discussion group with posted topics that could be of interest http://groups.yahoo.com/group/MTF-SRS-FTM/
We hope you’ll join us.

With kindest regards and best wishes for fulfillment of your goals,

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

musculocuaneous latissimus dorsi phalloplasty.pdf

The Reed Centre for Ambulatory Surgery
1111 Kane Concourse, Suite # 311
Bay Harbor Islands, Florida 33154-2041

Re: Female to Male Transgender Surgery (as requested by an attorney
representing a client to explain the involved process)

May 2, 2007

Good afternoon,

This will confirm I am a transsexual surgeon, an active member of the World Professional Association
for Transgender Health (formerly the Harry Benjamin International Gender Dysphoria Association),
a urologist board certified in 1975, and a senior member of the American Urological Association.

Reviewing the steps a female may take to be legally accepted and present as a male, the following
information is provided.

The patient should enter into a therapeutic relationship with a licensed therapist who has attained at least a masters degree and ideally a doctoral degree and who has received sufficient education in gender dysphoria to understand the evaluation process, to manage adjustment problems, and
to know when it is appropriate to make recommendations for advancement in transition.

Typically after a few months, clearance is given for initiation of the Real
Life Test (RLT) which means living in the role of a male 24/7 (at work and play)
for a minimum of one year..

Testosterone is frequently provided to produce secondary male sex characteristics such as
enhanced muscle mass, beard, and a lower voice. Voice changes are considered to be irreversible. There should be monitoring of blood levels every 3 months to pick up subclinical adverse reactions such as liver dysfunction and elevated blood viscosity secondary to unduly high levels of red blood cell mass.

Once the patient has lived in this mode for a year or more and feels comfortable undertaking an irreversible surgical procedure, an additional letter of concurrence provided by an independent therapist is required (one of the two must have a doctoral degree). A subcutaneous mastectomy may be performed in lieu of breast binding. This is accomplished via one of three incisions: a periareolar (so called key hole incision) in which the incision line lies at the boundary of the pigmented shield or areola and breast skin and at which time the nipple-areola complex is reduced; or via a transverse incision made at the inferior mammary line; or thirdly by this incision augmented with a vertical incision to help remove excessive skin, so called “anchor incision.” The incidence of mastectomy revisions either wished for by the patient or suggested and performed by the surgeon is about 50%.

Liposuction may be needed to remove feminine fatty deposits in the hip and buttocks
area. A chin implant may be placed to provide a more masculine outline.

Below the waist genital surgery may include removal of the uterus and ovaries now via
state of the art total laparoscopic hysterectomy and bilateral salipingo-oophorectomy.
The vaginal lining can also be removed by a procedure called colpocleisis.
Following that the vaginal vault contracts from an open space into a central fibrous mass.

To create a phallus, the patient has two choices, one is clitoral release and the
other is full phalloplasty. The latter can be performed with procedures such as
a sensate radial forearm graft, or a lower abdominal flap, or a latissimus dorsi
(muscle and skin) graft. All leave disfiguring harvesting scars. A follow-up procedure
called a Muniwar glans plasty is used to create a rim or corona.

Urethroplasty, insertion of a tube within the phallus permits extension of the
urethra for standup voiding. Capability to penetrate can be provided with a
bacculum stent which is inserted into a grooved space within the phallus only
during intromission, or via penile prosthesis affording the patient a controllable
erection or a permanent semi rigid (malleable) erection. With phalloplasty, the
necessity for staged procedures is predictable and the revision rate is often quite high.

Testicular prostheses can also be inserted into the labia which may be joined from
side to side to create the semblance of a scrotum.

Sincerely yours,

Harold M. Reed, M.D. FICS
Senior Member of the American Urological Association
Society of Genito-Urinary Reconstructive Surgeons
Founding Member of Sexual Society of North America
Founding Member and Treasurer of American Academy of Phalloplasty Surgeons