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Since 2001 helping TRANS people web based at a distance
butterfly

First Action: the diagnostic in 4 steps

  • anamnesis Caption here

    FIRST STEP: The ANAMNESIS We always start diagnosis with an anamnesis consultation through directed questionnaires and emails.

    Anamnesis is a medical term which signifies the way we have to know your life story. In presential face-to-face consultation, the patient shows and tells the therapist his/her problems and the therapist observes the way the patient tells the self situations and the self story.

    Usually there are multiple sessions, periodic ones, for months, or even years.
    We do the same through emails.
    Not for months or years, but i would say some 3 to 4 weeks.

    We will not see you, your manners, that is the weakest part to develop a Web-anamnesis, but we have the best part of it when someone writes the own story, the own life and remember all moments and situations.

    Always when someone has the opportunity to revive something, something new may happen. That is an aspect of the Web-anamnesis, that is extremely important, mainly for gender variance analysis.

    The patient, most of times, opens the own heart, and remembers hided facts, live again old feelings.

    Some patients show a lost memory, mainly for the earlier years, and hard times. These are signals that are important to be considered, and mainly the gestation period, the time of the beginning of each one of us, when we have a special time of formation.

    The great French writer Marcel Proust, when he described the "magdaleines episode" inside his great work "A la Rechereche du Temps Perdu" he shows us how some moments may trigger memories, when we almost live again old memories.

    We seek to trigger the patient to write... to remember... to live again... to tell us... to live it again with us...

    To develop a good anamnesis, face-to-face or Web-based, the key words for us are... compassion and respect, always.

    So through these emails we may know all your feelings, your sufferings and your overall story... since your gestation, what you may know about your gestation... talking to your parents, your grand-parents sometimes, and later about your first infancy... and so on, up until nowadays.

    Are these emails secure?

    Nothing in the Web (and life) is 100% secure. But the lack of security increases with money subjects and email name exposure.

    You never pay nothing to Gendercare through emails; you never show your account numbers to us mainly through emails and our clinical communications with you are developed through Gendercare email processors.

    So our communication is sufficiently secure for what we intend to do.

    Would not be better face-to-face interviewing? Having some more "human contact"?

    I would say yes and no; surely NO considering the most important factors!

    Yes because it is always good to be near the other. To have among us two computers is not the best situation surely. Including, for any Psy therapy, Web-therapy would be impossible - not due to legal prescriptions, that could be wrong - but due to the impossibility to touch the other, using any technique as we like more, as Psychodrama for example.

    But gender variances are special situations, really very particular situations.

    The first important consideration to answer that important question, is personal interviewing gender variant people could disturb you and your reality. All therapist, as all human being, has its own religious, ideological, social and personal points of view! So, the contact, that is absolutely necessary for psychotherapy, is a problem for gender therapy.

    Most patients with gender problems, most of the time live or acts as autists. They like to be alone, they prefer to have not contact with "experts" or "therapists". Why?

    The contact is difficult.

    So, we have a rule number one: It is much more easy for someone with any gender problem, to open the heart to a strange, or to a mirror, or to an inanimate screen, as a paper sheet or a word processor, than to a therapist... that is an "outsider", even when he/she is a PhD and Emeritus Professor, but who never suffered a gender problem, or is only able to theorize about it.

    At one meeting in Brazil, some years ago, a psychologist and antropologist was telling a lot of theoretical things which people with gender problems never would consider... and after she stoped I asked her... dear friend, how many times did you live your life crossdressed as a man? At home, at work, in the streets?

    Astonished she answered me... never!

    Yes... so you are not prepared to understand what it is to live that reality.

    Someone could say: the good cancer expert need not to have a cancer. Yes, I agree.

    Why?

    Because a desiase, as a cancer is not you... it is something you HAVE... it is not someone you ARE.

    Gender problems never are related to what you have but always to who you are. Transsex (HBS), CD, transgender, intersex, intergender... these things are not things you have, but who you are.

    So, medicine is not a good place to see any analogy, but ethnology is a wonderful place for analogies as an example.

    You, as a "white American" you may not know really what it is TO BE a South American... as a South American may not easily know what it is to be an Australian Aborigine... and also to an Australian Aborigine it is not easy to understand what it is to me a British gentleman... and for the British gentleman it would be very difficult to understand what it is to be a Shivaite in India...

    I have two extraordinary examples to show you here:

    Alain Danielou, the great French musician and philosopher, to understand the Shivaism in India, he had only one way: to become a Shivaite in India!

    Another French, the ethnologist and artist Pierre Verger, who came to Brazil, to Bahia, to study Yoruba and Candomble culture. The only way would be to become a candomble initiate, and later he went to Africa, Nigeria, and came back to Bahia... and until today the Yoruba community respect Pierre Verger.

    A third example, a dearest example to me, personally, because we were far relatives were the Villas-Boas brothers. They were the better friends of Xingu indian nations in Brazil. I have tears in my eyes now, when I am writing. Orlando Villas-Boas lived a big part of his life among the Xingu indian nations in the center of Brazil. When Orlando died, the Xingu Nations performed a Kuarup - a special death ceremonial, to remember Orlando Villas-Boas, the white brother.They go to the forest and cut a big tree. That tree they put in the middle of the "aldeia" where they live, and perform a lot of ceremonies, and later they took the tree that signifies the dead friend, and put it in the river... a very beautiful ceremony, Brazilians saw last year.

    All that I write to you is trying to show you what is important and what is not so important, in face-to-face anamnesis or Web-based anamnesis.

    What is important is not the means we use, but the quality of the therapist. And we know the therapist not through the number of PhD's and academic titles, but if the therapist lives, and knows "from the inside" and not only "from the outside".

    Also, as in ethnology, the therapist need to act sometimes not only as a doctor or as a psychologist, but with compassion, as a priest.

    Gender therapy, as good ethnology, we may live only as priests, as Alain Danielou was the Indian priest among French people, and he worked also as a French priest among the Hindu people.

    The same piesthood did Pierre Verger amond the Youruba, and Orlando Villas-Boas in the Xingu.

    From the outside, all anamnesis is surely bad. Face-to-face or Web-based. From the inside, all therapy can surely be good, when there is compassion and respect.

    To treat a cancer, you need knowledge mainly. To treat THINGS PEOPLE HAVE you need knowledge, good instruments and some talent.
    To evaluate and treat gender problems is a question of life, so you need to live, to mediate life, and that mediation is what I name priesthood... knowledge is absolutely necessary... but it is not sufficient!!!

    Another aspect is face-to-face therapy stimulates we act through our own ideas and values, mainly some "old style" therapists who always try to change or interfere on the patient, and not to know the patient...

    We never intend to interfere but to know the way the patient feels and understands the self-reality.

    The importance, for gender variance best evaluation, to don't see the patient!

    Why?
    Because when the therapist sees the patient, what he/she sees arouse inner feelings and values... unconsciously. For example, a someone that feels female, but is very high, has a hairy body and beard... and some baldness, heavy and big as a truck driver...surely the uncouncious of the therapist will press to say it is not a woman, but a man.

    But what need to be evaluated is not hair, dresses, garments, skin... but identities! The therapist needs to learn to evaluate brains and hearts, memories and time-series and not garments, manners or baldness!

    So, the best evaluation possible, is developped without seeing the image of the patient!

    The image of the petient helps nothing, but increase "information noise", decreasing the quality of the evaluation!
    So, why not evaluate the anamnesis through the Web? The Web is the best place for it, considering all pros and cons!

    After the diagnosis and COMPLETE evaluation, if necessary, the patient will send us pictures/videos so we may know the face, hair and body condition, to help transition (when needed and desired), hormonetherapy and surgeries.But only AFTER the conclusion of the COMPLETE evaluation!

  • mfx y fmx Caption here

    SECOND STEP: THE GENDER IDENTITY DYNAMICS TEST. MFX and FMX Through the Web, the patient feels alone and we may not suggest answers so we may not disturb the test with our presence, which is an ideal condition to perform a test!

    At any moment, any question the patient may ask us, before or after the ending of the test ... and the patient in some special situations may repeat the test, due to disturbing situations and even in some special situations when the patient feels insecure mainly about the time schedule of our tests - as our tests intend to discover the dynamics of GI-gender identity formation, our questions considers remembering facts and desires from childhood and early ages - sometimes patients may have difficulties relating their own life development with the ages prescribed at the test. So some may have difficulties, not properly to answer the questions, when the patient needs to remember situations, but to consider the time at past ages.

    With the test answers, we may, with some software we developed, transform test scores and indices in time-series we call "trajectories" in Gender Space*g.

    We consider gender identity formation a time development defining a gender phase or state space - using very simple time-delay embedding techniquesin discrete space, when we may apply Taken's theorem - and from that time-series at phase space we may develop and study some measurements as the phase diagram, the return plot portrait and the recurrence plot (among other measurements). That way we may study the dynamic characteristics of the development of gender states as a whole for a population defining typical developments as signatures, and the development for each patient then comparying the patient with the signatures, objectively "measuring" at which group each patient may be considered.

    We consider not etiology and causes, but only dynamic characteristics, and considering these characteristics we may consider typical relations.

    Can someone fake the test? Surely yes, even Nasa may be faked, and Fort Knox too. But... to mislead a face-to-face therapist with maneurisms surely is much easier than to fake a phase space structure.

    Surely also, as the patient pays the test - that is important, to pay the test to be something that costs money - the patient will not misuse it, spending money for nothing.

    Our tests are very useful in thousands of situations... for a lot of clients from different countries and languages, from different cultures.

    Our free pre-evaluation MF9 and FM1 tests up until today were answered by more than a dozen thousand visitors - Brazilian and foreigners -, and the clinical ones (the only dynamic ones) were answered by some cents of clients - near one thousand ones - also Brazilians and foreigners from USA, United Kingdom, Ireland, Italy, Chile, Mexico... Japan, Singapore... Phillipines, South Africa... including Arabian countries, among much others.

    (Those tests were scientifically validated through more than one thousand answered tests through the web by Brazilians, in 2001/02. - but not through simple validity tests that are not adequate for it) - but now we have a special opportunity to show better mainly HBIGDA/WPATH members and other "experts" its quality.

    What do the MFX and FMX Gendercare tests evaluate?

    The patient's Gender Identity development dynamic characteristics.

    Gender is a typical non-linear dynamical process, as almost all genetic-triggered processes are. From the human egg starts a huge diversity as a chaotic and deterministic development. Each human being is one human being as the result of that potential - real and experimental - reality.

    From the human egg, since the start there may be small genetic differences that surely will develop systems diversity - deterministic and not stochastic diversity - a diversity determined by the start structure. XX or XY... or chimeras, or mosaicisms, or... a lot of possible diversity!

    But let's suppose we consider only male eggs... XY, XXY, XYY... etc... even with these big restrictions we have also a big diversity!

    What means diversity? UNPREDICTABILITY! When a system has high probability states and LOW PROBABILITY STATES, even EXTREME EVENTS, diversity surely means INDIVIDUAL LACK OF PREDICTABILITY!

    But suppose now we have only XY, very stable XY eggs! Much more restriction at the start! Due to AIS-androgen insensitivity syndromes we may have ... from XY eggs... CAIS women... and other possibilities! and the diversity continues!

    But let's suppose all eggs are XY with no Androgen Receptor insensitivity problems! All them follow a Typical Sexual Development-TSD... but in kindergarten some will show and also will say they feel girls and would like to be girls and not boys! So... XY with TSD means almost nothing about gender development! They are not simple causes, but causes among a complex of other causes!

    That is a real complex system! but as it is very sensible to the initial conditions, by definition that system surely is a non-linear deterministic system, or in other words, what we define nowadays as a "Chaotic System".
    Our conclusion? If we define a Gender Space, between two "pure" limits we call M and F, all gender identity will be necessarily inside that space and will show always a potential development diversity that is unpredictable for each individual - as the electrons in the double slit experience on Quantum Mechanics - but always following an underline pattern - or a "signature that may be recognized and measured"!

    dimension.
    We developed our tests to research that pattern of development for each human being that answer our 100 questions.

    To start the evaluation of GI inside a gender state space, we need a reference point, M or F.

    We use M as the reference point for people originally assigned as male, measuring from the pure M pole, the development of unexpected femininity. And vice versa for the other half of gender state space.

    Gendercare MFX test example curve for Unexpected Gender Phase Space

    Normal men Return Map typical portrait in Yellow
    TS/HBS family in Gray
    Patient X in Red

    That patient shows a TS/HBS typical pattern at MFX test!
    That Return Map shows the development of unexpected femininity from a M start. The family signatures (yellow and gray) are very different and may be perfectly recognized.


    We consider 4 main scales:

    Unexpected gender development scale, when we may recognize and measure your male or female inner tendencies, since first childhood;

    Gender Dysphoria scale that helps the differential diagnosis between TS/HBS, transgenderism and crossdressing, from where we may discover the deepness of the unexpected femininity or masculinity, and how it developed; that scale result need always to be considered in relation to the fist scale. For example let's say that for age 3 someone shows 80% tendency to transsexualism... but also for that age only 30% femininity... so that result means not necessarily a tendence to transsexualism, because the femininity baseline was very low.

    Sexual Orientation scale, where we discover what kind of people you love more, and how that tendency developed inside your "tastes";

    Sexual Action scale , where we consider what sexual action you prefer in bed: to play the active partner, the passive, both or neither? that way we try to understand your sexual action tendencies.

    We study these 4 scales, in a progressive way, following your age and life development, generating for each scale a "trajectory" as a time-series.

    The only scale we study in depth the development dynamics is the first scale, when we develop the time-series as the "trajectory", and also the phase space diagram and the return-plot portrait, comparing your result with typical results (signatures or patterns).
    As you may see, with those tests we may discover your Gender Identity and how it developed, but we discover almost nothing about why you may have an unexpected gender identity!
    How could we discover why you are a Gender Variant?

    To try to answer that question, we will need to answer first two other questions:

    1st:Have you a gender dysphoria? Or even with an Intergender or Gender Variance are you happy with your body condition?

    2nd:Perhaps, could you have some mental problems?

    May your Gender Dysphoria & Gender Variance be caused by any kind of mental problem?

  • mfx or fmx test Caption here

    THIRD STEP: THE MENTAL SCREENING

    After the first two stages of our assessment / diagnostic, we know whether or not you have a gender problem and if it is confirmed we already identified what kind of problem you have.

    But we can not know the origin of the problem. Especially it is necessary to investigate if the problem may have a MENTAL origin, or if on the other hand, even without having mental origin, the problem may be triggering some mental disorder as a consequence.

    The way that we have to make that determination, is applying the old version of the some inventory scales as published in Brazil, as a pre-assessment.

    If we recognize problems, or trends for problems, the results must be considered in the final evaluation of the patient.

    For example, when the assessment tests MFX or FMX indicate a possible situation of GID / GIDNOS (a possible genuine gender identity disorder), caution should be considered for the mental health of the patient.

    The integration of tests MFX & FMX and evaluation with the Mental Screening


    If our test MFX or FMX shows that you are a typical transsexual (HBS-Harry Benjamin Syndrome), and you do not show signs of mental problems (through psy scales assessment) , you probably developed what Dr.Torres, MSc, PhD set in 1998, with Dr.Dorina Epps Quaglia, MD, PhD; Dr.Jalma Jurado, MD, PhD and Dr. Julio Cezar Meirelles Gomes, MD as a "gender neurodiscord" when your neural baseline "reptilian" cirsuits of the brain and the organization of your genital organs are in disharmony of gender, which can occur during the last two-thirds of your gestation (considering extensive work from D�rner from the 70's and 80's).

    We cannot change your basal brain, but we can enforce your brain - which is the main part that creates a very complex self-perception inside you - correcting your body (genitals and other aspects related).

    That is, we may help you to promote the harmony of your body and genitals with your brain and your interior self-perception.

    Thus harmonized, you should have a broad and unfettered chance of being included in society as a normal and decent person with ample possibilities and opportunities for success, depending on your individual skills and your professional capacity.

    If our test MFX or FMX shows that you are a transgender (TG), and you do not show signs of mental problems (through psy scales asessment) , probably you suffered during early childhood (and not during gestation), from very strong traumas, especially related to mother rejection or baed on other deep family relationships, or other factor rather drastic in early childhood may have caused a break.

    Not always breaks are perceived in psy scales, unfortunately.

    We already deeply investigated your history, to try to find out what-trauma or any other root of possible problem-may have generated this break, and perhaps nothing could be found. This type of injuries or causes are so deep that most of the time we can not change the consequences, and what we can do to help you is to help your body to adjust to your inner established reality, so you may have a chance to survive with that reality, even in an unjust society with so little respect and understanding as ours.


    If our tests MFX or FMX shows that you are a crossdresser/drag (CD), and you do not have mental problems, the rise probably can be another type of trauma, not as deep, not so early in life, possibly a sexual abuse, or problems with the parental figures. We have already investigated your history, we must have already formed an idea of what may have generated that unexpected state, and perhaps we may see how we can help you, and show you your wise limits. Often these cases are accompanied by OCD - possible obsessions and compulsions, which should be detected by the MMPI.

    Each CD lives a very personal, and very specific but mild condition, and due to this, CD's can sometimes require only what we call a simplified evaluation, when we do not need to have the MMPI, when the first 2 steps of a full evaluation shows a situation very CD typical.

    And if you, through our tests do not show a typical situation, or an orderly development, but a pattern we call GID / GIDNOS?

    If your history shows traces of possible mental problems that go beyond a problem of gender?

    The MMPI is essential, and generally it shows a special condition. In such complex cases, first of all, the MMPI sees if a mental problem may have broken out the GID / GIDNOS or not, and then, if this condition of GID / GIDNOS may have broken out mental consequences (morbidity or co-morbidity).

    In such cases, even when you can begin a transition - very monitored, very slow, moderate, limited and controlled, you should need local face-to-face psychotherapeutic support.

    Such cases of real situations of GID / GIDNOS exist, we have some exemples, but are very, very rare - and sometimes devastating.

    If on the other hand you live a situation of intersex, and live an intergender (IG) reality, and are referred to one of the tests MFX or FMX, and this was recognized, we should decide on the need or otherwise of a psy screening. Usually it is not necessary, even if it is always appropriate to eliminate any doubts.

    If you are satisfied with your body, we have nothing more to help, if you are well.

  • mental screening Caption here

    FOURTH STEP: THE DIAGNODIS REPORT . The printed and signed Report will have as attachments, printed and signed reports for the Gender Identity test (MFX or FMX) Report and the Mental Screening Report. You will receive our printed and signed report, at your address, we will send it by regular registed post office, priority service.

    The language of all reports depend on the patient but also and mainly, the desited by yhe payient surgeon for SRS, bevause yhe complrte fiagnosis report will be an attachment of the SRS REFERRAL LETTER.

    It is important the patient keep the original, and bring for the surgeries, copies to show and give to the surgeons.

Second Action: THE TRANSITION, MtF or FtM. The TRANSPACK

  • about-me Caption here

    TRANSPACK: full 3 months of follow up We accept for TransPack only patients evaluated by us, so we know you a little since the start. So the TransPack is not something new, but the continuity of our help and care for your gender dysphoria condition.

    As soon as you take and pay that service the first step will be to prepare a consultation to send us as soon as possible telling us:
    At which stage you are in transition.
    Height, weight and general remarks about your body.
    Any disease, or special condition.
    Tell us about your heart and family heart history, circulation and liver history. Did you had hormones already? Which, when, how much dose and time? Surgeries? Any natural signs in your body, as gynecomastia for MtF's and beard for FtM's? Tell us all in your first transition consultation. We may already know a lot, but we need to know or to confirm what we know.

    We will send you our comments, instructions and orientations in English as we did during your evaluation.

    As soon as you can, prepare for us:

    4 pictures of your whole body (front, profile and rear) in swiming clothes; 4 more pictures of your face (front, profile and rear) for hair & face evaluations. No artificialities please! We will need to know your reality!

    If you will need a HRT referral letter for your local doctor (surely if you are outside Brazil you will need it), ask us, and send us your directions so we may send a signed copy of it through mail. It is important to have a local clinician, mainly patients older than age 40.

    That local clinician or endocrinologist will be very important for the follow up of your general health and for local prescriptions (we may not send you prescriptions through the web). During transition, we and your local doctor surely will need to monitor your liver and circulation, among other body functions, through blood tests.

    It will be great if we could cooperate to help you: Gendercare and your local clinician! We may be in touch through emails, exchanging opinions and data to help you mre completely.

    From MtF's or FtM's in transition with Gendercare supervision through TransPack, WE NEED EACH 15 DAYS AT LEAST A REPORT OF YOUR PROGRESS - how you feel - how your transition is progressing - what possible problems you are living - because the transition promotes changes in the body and also some mental changes. These reports are extremely important, because that will be the way we may detect any problem and the way we may reconsider the best ways for HRT and transition.

    Later, if you need our help, or your clinician need our help, we will say you what to do:

    For MtF's:


    1. We will follow up all your HRT, and we will give you a complete orientation about what to take, or what you may not take. We will discuss with you or your local doctor what you need to take, and the best way for you to stop your male hormones influences, and to take female ones in the proper way.

    2. We will follow up your beard and body hair and show you how to erase them. Laser or electrolysis? Electric epilator for body hair elimination?

    3. Have you hair problems? Are you loosing your hair? perceptible baldness? How we may recover it? And stop it?

    4. How you will increase your breasts formation and volume? Hormones for breast development, and bust enhancers? Silicon prosthesis? What will be the best way for you?

    5. How you will manage your social life? Would you show your transition at school, to your family, friends or at the office? What will be the best strategy for you? RLE- real life exposition or our Butterfly strategy?

    6. What could you do about your voice? And your face? FFS - face feminization surgery is necessary or not?

    7. Are you properly feminine? And your garments? Are they good for your age and social status?

    8. Will you need to loose weight?

    9. What will be the best SRS- sex reassignment surgery for you? Where and when? Have you enough skin for the surgery?

    10. Are you prepared to live as a woman? Have you a way to survive as a woman? Would you need to prepare a new professional career?

    Important note: After the first 6 to 12 months of transition MtF we have a special program included in that service to teach girls to learn to masturbate and have pleasure as women.

    This teaching and preparation are essential to learn to have pleasure with dilation after SRS.

    We do not know anyone else in the world that provides this possibility and that detail in this type of service.


    What is includded in that service:

    1.All email consultations during 3 months (feel free to write us, at any moment, due to any reason, through emails), and we will answer you any question or doubt you may have about all your transition possible problems and difficulties.

    2. We may show you (if possible in agreement with your LOCAL DOCTOR), what will be the best hormones for you for a good and secure transition. To suggest hormones, we will ask you locally provide a blood test, and scan the result and send us.

    3. We will follow up your progress through pictures you will send us through the web.

    4. We will give you all necessary instructions about hair, body hair, beard, FFS, SRS, RLE or Butterfly Strategy, etc..

    5. We will discuss with you and suggest you the best social strategy to show or hide your transition condition.

    6. A HRT referral letter is includded in that service, signed by us. At any moment you may ask that referral letter.

    What IS NOT includded in that service:

    1. Any clinical analysis, as blood tests; any hormones and other kind of needed products.

    2. Any services as laser or electrolysis epilation, etc..

    3. Any surgery or silicon implants.

    4. SRS or FFS, or any surgery referral letters ARE NOT INCLUDDED in that service. When they are necessary we will prepare special referral letters, when asked by the patient, considering Gendercare conditions and prices.

    For FtM's:

    1. We will follow up all your HRT, and we will give you a complete orientation about what to take, or what you may not take. We will discuss with you and/or your local doctor what you need to take, and the best way for you to stop your female hormones influences, and to take male ones in the proper way, for your condition and age.

    2. We will follow up your beard and body hair and show you how to increase them.

    3. How you will erase your breasts? Hormones alone will be sufficient to erase your breasts and to develop a male chest? What will be the best process for your mastectomy?

    4. How and when will be the best way and moment to develop muscles, through exercises?

    5. How you will manage your social life? Would you show your transition at school, to your family, friends or at the office? What will be the best strategy for you?

    6. What could you do about your voice? And your face?

    7. Are you properly masculine? And your garments? Are they good for your age and social status?

    8. Will you need to loose weight?

    9. At what moment will you need a hysterectomy and total ovariectomy?

    10. And vaginectomy?

    11. What will be the best surgery for you, a metaioidioplasty, a Centurion or a phalloplasty? Where and when? What you could expect from each possibility?

    What is includded in that service:

    1.All email consultations during these 3 months (feel free to email us at any moment), and we will answer you any question or doubt you may have about all your transition possible problems and difficulties.

    2. If necessary, we may show you, if possible in agreement with your LOCAL DOCTOR, what will be the best hormones for you for a good and secure transition.

    3. We will follow up your progress through pictures you will send us through the web.

    4. We will give you all necessary instructions about beard, muscles, mastectomy, etc... all about "low" surgery will be discussed...

    5. We will discuss with you and suggest you the best social strategy to show or hide your transition condition.

    6. A HRT referral letter is includded in that service, signed by us. At any moment you may ask that referral letter.

    What IS NOT includded in that service:

    1. Any clinical analysis, as blood tests; any hormones and other kind of needed products.

    3. Any surgeries or surgery referral letters.

    4. Mastectomy, histerectomy, metaioidioplasty or any surgery referral letters ARE NOT INCLUDDED in that service. When they are necessary we will prepare special referral letters, when asked by the patient, considering Gendercare conditions and prices.

Third Action: SRS SURGERIES, MtF or FtM. The REFERRAL LETTERS

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    OUR REFERRAL LETTERS .

    SRS MtF surgeries:


    The main aspects we need to consider to prepare and decide for a SRS MtF surgery are:

    The amount of penile skin;
    Untouched testicle purse skin;
    Integral nerves and vessels to preserve sensitivity and orgasmic capacity;
    The SRS technique;
    Depth and width possible for the neovagina;
    No kidney stones to close the future new urethra;
    The dilation needs after surgery;
    We discuss with the patient all the details of each of these aspects BEFORE we are able to write any letter:

    There is enough penile skin? Which is the size of the erected penis? The lenght and circunference of the original penis?
    The size of the testicle purse? Untouched skin?
    Did the patient had circuncision with loose of precious skin?
    Any attempt of penis elimination in childhood or youth? Any manipulation to try to erase or to hide the penis in a way that the vessels and nerves were put in danger? Or are they untouched?
    The patient's age?
    Is she married or has a boyfriend? Sex will be something frequent with a partner, or rare or eventual?
    Masturbation will be important? With a dildo and without it?
    How important will be the cunnilingus performed by a partner?
  • To stay with no sex - no masturbation or intercourse for months - could happen as a normal reality?
    How the patient feels about being necessary forever a dilation every week, even with a mature age and alone?
    One day a MANDATORY dilation could be a problem?
    All these aspects are important and need to be considered BEFORE we decide about the technique and the surgeon.

    Dilation is more important - absolutely important for some surgeries and not so important for others!
    So some not so dilation demanding techniques may be better for more mature women! The possibility of a neovagina collapse (stenosis) recovery is more real for some surgeries than for others!
    The possibility of orgasm with easy masturbation without a dildo is different for each technique!
    The perfection of the esthetics may be important for the patient considering the partner. For example, cunnilingus shows for the partner the sensitivity and vulva anatomy. Some surgeries are perfect for cunnilingus (oral sex), but others are absolutely catastrophic considering that aspect, that may be an important aspect for everyday life.
    More vaginal depth is important for most women - to have a normal life with the sexual partner! Before we prepare the SRS referral letter, we consider all details with the patient - and we suggest always only renewed surgeons, as Dr.Suporn, Dr.Preecha, Dr.Kamol, Dr.Kunaporn in Thailand; Dr.Jurado in Brazil; among others.

    The surgeon, the patient defines and the choice is the patient's. We suggest which we believe may be the better, for eah situation.

    With our SRS referral letter the patient gains also our follow up, through emails, during the stay at the hospital, before and after the surgery. We talk to the clinic, we discuss specificialities of the subject, and later we follow up the post op at the hospital, at a hotel near the hospital, to see if the urethra is fine, if the dilation is going well, checking sensitivity and so on, until the patient leaves the hospital/hotel to come back home.

    All financial contact and arrengements about surgeries and hospital are directly defined between the patient and the surgeon. We know both, so we make suggestions and we facilitate the knowledge between them. We have no financial relation with no surgeon.

    Metaioidioplasty FtM surgeries:


    The main aspects we need to consider for "low" FtM surgeries are:

    Which is more important, size or functioning?
    Size or sensitivity and orgasm possibilities?
    Which is the importance to piss in a stand up position?
    Which is the importance to be able to penetrate in a sexual relation?
    We discuss with the patient all the details of each of these aspects BEFORE we are able to decide for a Metaioidioplasty and not a Neophalloplasty.
    After we decide for the Metaioidioplasty, we have some important aspects to consider:

    The hormone therapy developed the clitoris in which way?
    Is it possible, with more HRT time to develop the clitoris a little bit more?
    If it will show necessary, would you accept to have a micropenis, considering the use of any device to try to extend it for penetration and sex?

    The surgery may be developed in steps. Are you aware of it? Which steps would be better for you?
    The patient's age?

    All these aspects are important and need to be considered BEFORE we decide about the technique and the surgeon.

    Before we prepare the Metaioidioplasty referral letter, we consider all details with the patient - and we suggest always only renewed surgeons, as Dr.Bowers, Dr.Meltzer, in US; Dr.Menard, Dr.Brassard in Canada; Dr.Preecha in Thailand; among others.

    The surgeon, the patient defines and the choice is the patient's. We suggest which we believe may be the better, for eah situation.

    With our referral letter the patient gains also our follow up, through emails, during the stay at the hospital, before and after the surgery. We talk to the clinic, we discuss specificialities of the subject, and later we follow up the post op at the hospital, at a hotel near the hospital, to see if all is going well, checking sensitivity and so on, until the patient leaves the hospital/hotel to come back home.


    A good metaioidio result.



    All financial contact and arrangements about surgeries and hospital are directly defined between the patient and the surgeon. We know both, so we make suggestions and we facilitate the knowledge between them. We have no financial relation with no surgeon.

SPECIAL SERVICES & SERVICE PACKS: CHILDREN, POSTOP PACK and SRSPACK

  • about-me Caption here

    CHILDREN The SOC6 of WPATH suggests for children that may show any sign of unexpected gender development, no evaluation.
    Any diagnosis and evaluation is suggested only after 18 years old.

    That is the "official" position of WPATH but, in Chicago last September 2007, the evaluation of children and youths with possible unexpected gender developments was the main subject of the symposium.



    A lot of parents are living the anguish situation when they see their child showing possible signs of an unexpected gender development as small children and youths. We need to help them, the children and their parents.

    What we may do to help them?

    We may follow the signs of any unexpected development.

    How?

    Through a continuous follow up of the situation, provided by continuous consultations through emails from parents and Gendercare about the child.

    Also we developed the resource of game-tests for children. Those games are free, and the parents may send the results for our evaluation, as a continuous flow of information and follow up.

    REMARK: Gendercare.com still hope it will be possible to develop more professional game-tests in a way all the results will go directly to Gendercare.com servers for analysis - so the parents will need not to interfere.

    What the parents need to do?

    Continuously OBSERVE, OBSERVE AND OBSERVE.... and SEND US the OBSERVATIONS following our instructions.

    Following our orientations, for example about games, about gifts for the child, about garments, about aggressivity against the child. Never being aggressive against the child, but giving the child free chance for choices, the parents reporting us the free choices of the child, about plays, toys, garments, etc..

    The ChildPack Program

    We know, that time of evaluation is extremely difficult and full of possible traumatic situations, for the parents and mainly for the children in schools and at home.

    1

    All start with a consultation about the child.

    Access the Start-Anamnesis and we may start now.

    2

    Then we will suggest the parents download the game-test Ways & Dreams 1.0 version, and suggest the child try it. The parents, NOT DIRECTLY INTERFERING WITH THE CHILD, observe what are the ways and the results of the child, and send us those results. Observe attentivelly the child reactions to the game, playing the game. Observe if NATURALLY, without any stimulation, after the child knows the game, if the child love the game.

    Free download of Ways & Dreams 1.0 version

    If the results show a probable unexpected gender development condition, than we may start our follow up program - the ChildPack.

    3

    Then, only after we ask to, the parents may take a ChildPack for the child and we will start the follow up.
    For 4 full months we will continuously help you with your child, through your informations and game results, until the child has 7-8 years old and may start answering online questions.

    From then on, we will be in touch too with the child through emails, and we will be able to start online gender identity tests.

    The evaluation will end only after 10-11 years old, and surely it will be very well established as a real GD (gender dysphoria - someone with an unexpected gender development that intends to correct the body to triggers harmony inside the self-reality) or not (perhaps the child will show only some homosexual tendencies, or nothing), and what kind of GD it could be.

    At the end of that evaluation we will perform other tests (the mental screening), and finally we will be able to sign a final report about your child evaluation (before puberty - at 11-12).

    Only then we may discuss what will be the best way for your child.

  • about-me Caption here

    POST-OP PACK We will follow your MtF SRS results for 3 months. 1. We will follow up your dilation and cleaning procedures, and we will give you a complete orientation about what to take, or what you may not take. We will discuss with you and/or your SRS surgeon, what you need to do, and the best way for you to do it.

    2. We will follow up your clitorial sensations... your orgasmic capacity and limitations

    3. What are your limits? Depth & width? Flexibility?

    4. Hormones? Hormones to prepare the vagina? When you may start them?

    5. How you will manage your social and sexual life? What will be the best strategy for you? Can you have good oral sex? and how to make penetrations more easy?

    6. May dilation interfere with your intestines? May you continue or start having also anal sex?

    7. Are you properly feminine? Odors and vagina juices? When may you start having sex with a partner?

    8. Will you need to loose weight?

    9. Will you need to dilate forever? And if you stop some days it may...collapse?

    10. Some surgeons suggest after SRS MtF minimum dilation procedures. They consider small dildoes, in width and lenght, dildoes that have not the normal size of a normal penis. Later, the patient will have enormous problems to have normal sex with normal male partners and will live a very bad post op SRS result. We suggest progressively for our patients, correct size dildoes, for realistic dilations, to have not difficulties to have sex later.

    11. Some surgeons also precribe the possibility of sexual relations soon; some 1 month after SRS, some prescribe 2 months. We if necessary change that too, for more realistic delays after SRS.

    What is includded in that service:

    1.All consultations during these 3 months, and we will answer you any question or doubt you may have about all your SRS MtF post op possible problems and difficulties.

    2. If necessary, we may show you OR YOUR LOCAL DOCTOR, what will be the best hormones for you for a good and secure post op condition.

    3. We will follow up your progress through pictures (when necessary and possible) you will send us through the web, and mainly based on what you say to us.

    4. We will give you all necessary instructions about dilation and related problems.

    5. We will discuss with you, if you have big problems, as closing of the neovagina, for example, what you will need to do, and your possible limitations.

    What IS NOT includded in that service:

    1. Any clinical analysis, as blood tests; any hormones and other kind of needed products.

    2. Any eventually nessary SRS surgery revision referral letters ARE NOT INCLUDDED in that service.

    When they are necessary we will prepare special referral letters, when asked by the patient, considering Gendercare shop conditions and prices.

    3. No Gendercare dilator's kit is includded.

  • about-me about-me Caption here

    SRS PACK If you are ready for SRS MtF or FtM,
    that SRSPack is all you need to schedule the best SRS with the best of the best SRS surgeons in the world. The same for FtM metoidioplasties.


    That SRS Pack includes:

    • Your complete diagnosis, web based, by Gendercare staff
    • The verification consultation, if you are ready for SRS, through pictures, voice files and emails
    • If you are ready, your SRS MtF referral letter, printed and signed, will be sent to your home adress, or your FtM metoidio letter.
    If perhaps you are not ready, we will suggest you which way to follow to prepare for SRS - and our referral letter we will send you as soon as you are ready.

    With which surgeons you will be able to have SRS?
    Any SRS MtF surgeon of your choice, but we suggest in Thailand:

    Dr.Suporn
    Dr.Kamol
    Dr.Chettawut
    Dr.Preecha
    Dr.Kunaporn

    Specially these, but you may have SRS with others.

    For FtM Metoidio SRS we suggest:

    Dr.Djordjevic in Serbia
    Dr.Meltzer in US
    Dr.Marci Bowers in US

    Among others

    Would you like to start it now?
    CONTACT US FOR DETAILS

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