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Facial Feminisation Surgery Special – Part 3 Stephanie Hirst and Dr David Simon

Radio and TV presenter Stephanie Hirst is joined by her surgeon, Dr Simon, co-founder of the FacialTeam in Marbella, Spain. In this third and final part of our Facial Feminisation Special, Stephanie shares her experiences of FFS and how it changed her life, while Dr Simon talks about the guidelines, research and best practice which have been instrumental in forcing the re-evaluation of FFS and the transformative role it can play in the lives of trans women.

Dr Daniel Simon from the Facial Team

Dr Daniel Simon talks to Stephanie Hirst for the GenderGP Podcast

As work continues on the updated WPATH Standards of Care, it is anticipated that the transformative role that Facial Feminisation Surgery can play in the lives of trans feminine individuals, will be given more prominence than ever before. This is largely thanks to the groundbreaking work being carried out by experts in the field, including the specialist surgeons at FacialTeam in Malaga, Spain.

If you have been affected by any of the topics discussed in our podcast, and would like to get in touch, please drop us a line at info@GenderGP.com. You can also contact us on social media where you will find us at @GenderGP on Twitter, Facebook and Instagram.

We are always happy to accept ideas for future shows, so if there is something in particular you would like us to discuss, or a specific guest you would love to hear from, let us know. Your feedback is really important to us. If you could take a minute or two to leave us a review and rating for the podcast on your favourite podcast app, it will help others to discover us.

Links
Twitter: @stephaniehirst
https://www.facebook.com/stephaniehirsty/
http://facialteam.eu/
https://facialteam.eu/facial-feminisation-surgeons/facial-feminization-surgeons/

 

The GenderGP Podcast

Stephanie Hirst – How Facial Feminisation Surgery Changed my Life: The GenderGP Podcast S5 E6

 

Hello, this is Dr Helen Webberley. Welcome to our GenderGP Podcast, where we will be discussing some of the issues affecting the trans and non-binary community in the world today, together with my co-host Marianne Oakes, a trans woman herself, and our head of therapy.

 

Dr Helen Webberley:
Okay, hi everybody, welcome to this edition of our podcast. I am not with Marianne today, but I have two other guests with me. I have Stephanie Hirst, who is a radio and TV presenter, who also has a trans history. We’re really excited to hear about all that she has to say about being trans, about her journey, about what it’s like to be such a celebrity, and making that journey. And then we have Dr Simon, who’s our third guest from the Facial Team, who I think has some input into how beautiful Stephanie looks today, and how feminine she looks. So, I am really excited to welcome both of you. Thank you for joining us. Stephanie, can I pass over to you first and let you introduce yourself in a much better way than I could ever do? Tell us all about you and over to you.

Stephanie Hirst:
I guess my story is quite classic because I think from a very early age, I knew that something wasn’t right. And when you are at school, especially like nursery school and they put the girls and the boys into different groups, I would always go and stick with the girls, because that was my natural state of comfortable. And they would go and put me back with the boys. Now you sit over there with the boys. And this happened several times, they raised it to my mum. Back then, there was no google or anything like that. There was nothing. You know, my mum couldn’t look this kind of stuff up. So, I think she just went with her gut instinct and just ignored it. And then as you grow up, you start to learn that this isn’t, in inverted commas, I guess, acceptable. Because anyone who I guess looks like a boy and I guess well is a boy, then you are slightly effeminate, well, you tend to get bullied. And that is what happened all through my school years. I got horrifically bullied for being short, spindly, rather effeminate, and talked about radio a bit too much. And the 1980s pop star Shakin’ Stevens, which again, probably didn’t do me any good whilst everyone else was into Duran Duran and Spandau Ballet.

Dr Helen Webberley:
Yeah, definitely. Dr Simon, is that a story—well, introduce yourself, Dr Simon—but I can’t wait to hear, is that a story that you have heard a lot? Is that the kind of classical story that you come across?

Dr David Simon:
Good afternoon to everyone. My name is Simon, and I am one of the cofounders of Facial Team in Spain. And I am sorry for the hair, but I have the same problems as you guys, I don’t have anywhere to go to cut my hair. I tried to do it myself, and it’s not easy. I am giving a lot of value to the hairdressers nowadays. So yeah, we have, of course, been working with patients of feminization surgery for the last almost thirteen years, and let’s say as Facial Team for around ten years now. And what Stephanie is telling, it’s, of course, a story that we hear many times. There are many things changing, I would say nowadays. When we started, we could say that our average patient was around 45 to 48 years old. This is changing a lot. In the last year, our average patient was 26 years old. So, this is showing that transition process, the patients are starting to have treatments, or to identify themselves is going to start much sooner because of information, because of family support. There are many reasons, of course, but the stories are changing. We are having stories of patients who are, let’s say, having a little bit less difficulties during their childhood, or at least more support during their adolescence.

Dr Helen Webberley:
Yeah, that’s really reassuring to hear, isn’t it, actually? Abd the words that you use, horrifically bullied—not just bullied—but when you take those two words to describe your life, that you were horrifically bullied, I mean, it makes me go shivery inside. What an awful thing to have to remember.

Stephanie Hirst:
Yeah, I grew up on a—and I wouldn’t have to change this for the world—I grew up on a working-class council estate in the north of England. And I must stress that I wouldn’t change that for the world because that made me who I am. That made me quite tough, I guess, in some respects. But because the school I went to wasn’t the greatest school, I didn’t have the greatest education, so I guess a lot of my education was self-taught. I mean, I did okay, don’t get me wrong. But I wish I had gone to a school which I guess was much better. But I probably had something to do with that as well, in the fact that I found a love of radio from a very early age. And I think now looking back, my obsession with radio was definitely to mask the gender issues that I was having because that was taking me away from that thought process. If I threw myself into the world of radio and the obsession about my favourite DJs, and my obsession about music, and learning about music and artists and all sorts about stuff like that, that took my brain away from thinking about my body’s wrong. So that was something that probably I may have obsessed about a little bit too much. But one of my ribcage—I must have had cracked ribs or something, so I was kicked viciously whilst on the floor, and I mean I didn’t leave the school gates, the front of our school, for gosh, eighteen months. I used to stay behind, and I had a wonderful library teacher called Ms Rose. And she’d been at school since it first opened in the 1950s. She didn’t leave until the late 90s or the early naughties. She went way past retirement age. And I think she lived until she was about a hundred and two. And she’s only recently passed away. And she obviously saw a vulnerability within me. And she would allow me, once school had finished, to go and sit in the library for half an hour, forty minutes, until all the bullies had left the front gates. And then I would kind of hop over a fence or leave. It was just a bit of a rough school that I saw, but I probably didn’t help because I was—I think kids and children, always, they see the vulnerability in other children, don’t they? And they see that as a target. So, I was very much a target. Yeah, let’s kick, my surname’s Hirst, let’s kick Hirst because we’ve got nothing else better to do today. And they’d move on to other people. So, I wasn’t saying I was the only victim in our school, but I was most certainly one of them. And also, as well, I had a bit of a gob on me as well, which helps as a broadcaster. So that didn’t help me. I am not saying it was entirely the bullies’ fault, but I had a bit of a rough time. But I guess that’s why I threw myself into the world of radio, I guess, really.

Dr Helen Webberley:
Yeah, well, I don’t know what to say—I can never make that go away. But thank you for sharing that. And I really hope that trans children and trans adolescents of the future don’t have to have this. And I think part of this, the work that we do, the generosity of your time coming to share this with us is about making trans normality a thing of the future, which I think is possible. So, thank you.

Stephanie Hirst:
Yeah and I think, also I think the schools these days very quickly—schools these days they take bullying seriously. I remember when we were in school in the 80s, it really wasn’t, they didn’t take it seriously. It was like, oh, hit them back. That’s what you got told to do. It wasn’t really a thing to take it seriously. Whereas now, they have guidelines to do with bullying and cyberbullying and all sorts of stuff like that.

Dr Helen Webberley:
So, fast-forwarding a little bit, from school to when you met with the Facial Team. I don’t want to skip anything that you want to share with us that is going to be important, but I wouldn’t like to end up talking about the help that you’ve had from the Facial Team and how that helps to shape your life in the way that you want it to. Without missing anything out.

Stephanie Hirst:
I had, and still have, a very, I shouldn’t say I’m lucky to have kept my career, but I guess growing up through the time that I did, and seeing how people who have transitioned were treated by the media, I would think radio studio, surrounded by daily newspapers every single day. So, I would see the press portrays people who had transitioned in a certain way. So, I would see, it’s always a really bad photo. From a really bad angle. Sex change Charlie, gender-bending freak. Or whatever. Or the icon that is Caroline Cossey, I distinctly remember she had been to the court of human rights in Strasbourg to fight to get her gender legally changed so she could change her birth certificate and then she could marry. And I remember her, she lost that, first case. And I remember the Daily Mirror, leading with a double-page spread of her looking fabulous, and it was double-paged, and the headline was this is a fella. And I remember seeing that. I was about fifteen when I saw that. But throughout the years of being in a radio studio, having the day’s newspapers, all of the red tops and looking through them, and just seeing how the press was portraying people transitioned or who had come out, for want of a better word. And that horrified me. And I knew that was possibly going to happen to me one day. But I got this amazing career. And I didn’t want to lose it because I absolutely adore radio more than anything. I love it. It’s the core of who I am. And music. But I knew that would happen to me. So, suicide obviously came into this. Because I couldn’t bear losing everything and then being dragged through the press and all that kind of stuff. And being hated by my friends. So that was at the front of my mind for quite some time, to just get off the planet. I used to drive home every single day from doing my radio show, and there was a particular part of the motorway where the carriageway going in the other direction is below, and I would think about turning the steering wheel into the central reservation and rolling the car onto the carriageway. And that was always there, for years. Every single day. Every single journey. And I knew that I couldn’t do it because that would have an effect on other people. And I didn’t want me taking my own life to have an effect on other people. There were several other avenues I was looking at taking my life. But then I got to a point where I was like, no, I can do this. And then I stumbled, in my early stages of looking and doing research, and knowing that I had to transition some point. I stumbled across the Facial Team’s website. And I was like, ahh! This could help. This could help make things easier for me. So, in the early stage, your first website and your first versions of the website, Dr Simon, early on, I saw some of the photos that you shared, and that really helped me. And then I pressed the button, of course. You do this big interview in the UK on BBC 5 live, and I come out. I leave my daily breakfast show. I come out—and I am doing a very abridged version here—and somehow successfully transitioned. And everything goes okay. And the first thing on the list, and actually, I was thinking about this before I did the interview this morning, hindsight, would (unclear 12:03) always say, I wish I had gone to the Facial Team first, then transitioned. I don’t know. Dr Simon, do you find people doing that now? Do you find people coming to see you before they do transition?

Dr David Simon:
Yes. With that, of course. The importance of facial surgery in someone who decided transition is a little bit underestimated. And even on the standards of care, on the main documents generated for the health professionals for treating transgender patients, facial feminization was considered something cosmetic. So, this doesn’t help, of course, as information to patients or potential patients that they understand that this is a crucial part of the transition. So, we had patients coming to us with SRS, so genital surgery performed, but still with a very masculine face. And this, of course, doesn’t help psychologically, doesn’t help with the transition. So yes, I believe that. If we are now helping the new standards of care, if you read them now, we are helping on the face part. And we believe that there should be a sequence. I am not telling that all patients need to follow that sequence, but there should be a sequence, a logical one, that is going to make the experience of the transition less traumatic, more comfortable. And I believe that if the face can be addressed at the right time, I cannot say if it is before transition or after because this is a very grey area. Where did the transition really start? Has it started already? But I believe the feminization surgery should not be left for last. I think it should be done as soon as possible. We normally ask our patients to be under hormone therapy for around a year before surgery. Because then, the hormone therapy will play an important role already on the face, giving a lot of difference on the skin, on the fat distribution. Even psychological patients are going to be feeling better. And then, we do the facial surgery. The ideal sequence, I cannot feel like the authority to tell what the ideal sequence. But from what I see, and we have seen many patients, doing the face at the beginning of the process helps a lot.

Stephanie Hirst:
Yeah, a friend of mine came to see you recently. My friend Jo. And before she actually came out to all of her friends, she came to see you guys at the Facial Team. And she said, it has completely changed her life. And I think for me, I think when did I go? I think it was about six to eight months after I had come out. And it’s always weird, it’s weird when you say coming out. What does that mean, when you kind of reveal, Hi, this is actually me? And I was doing, I was appearing a lot on a TV show here in the UK, an iTV called Lorraine. And I had originally gone on as a guest. And then they gave me a job where we were doing this thing called change one thing, which is, if there is one thing you could change about your life, what would that be? And because I had gone through quite a change, I was helping mental, some of the people who were changing one thing. And I was doing a lot of TV, and there was a particular side angle in one of the cameras, it was camera 3. Used to come round and used to get my side angle, so I would come home, sit in my living room, and everything is in HD these days. I would sit and watch the performance from that morning show, and pause it, and see that side profile. And I was spending a lot of time on trains backwards and forwards. And when someone sits next to you on a train, they see your side angle as they look out of the window. And this side angle, I hated. I didn’t particularly have a huge bossing of the forehead, but it was definitely there. And looking back on photos now, it’s like oh my gosh, yeah, it made a massive change. So, booking to see you guys, I can only say, and I’ve never really spoken publicly about it, so this is a first for me, speaking about my surgery and stuff. I have spoken about other surgeries, but I can only—you changed my life. You changed my life, and I can’t thank you all at the Facial Team from my first, speaking to Lilia straight away, and every way through every single process. It changed my life. And it was the most amazing experience ever. It was yeah, absolutely, thank you.

Dr Helen Webberley:
That deserves a round of applause, I have to say. That was lovely.

Dr David Simon:
Thank you so much.

Dr Helen Webberley:
Isn’t that lovely. Dr Simon, isn’t it amazing, as a doctor, to be able to help somebody so much? You know, those words are not words that you hear very often in the whole of medical practice, but you changed my life, you helped me so much—that is such an amazing thing for doctors to be able to do, isn’t it, really?

Dr David Simon:
There are so many things that we experience in our day by day that are not common in the medical field. It’s amazing. We travel, we sometimes travel to see patients abroad, and we have previous patients like Stephanie that want to come just to say hello, you know, and just to talk to us. And of course, it is not something that is common. It’s something that is special happens during the FFS. I remember Stephanie, her surgery was some time ago, some years ago. But I remember very well. The thing I think is interesting, and I think she can confirm, many patients believe that when they are going to do an FFS, they believe that there is going to be a crazy and a strong change on the face and we have to do a lot of stuff. And with her, we do what we normally do. We look at each face, and try to identify which area really makes a difference, which area is masculine. And many times, we do one or two procedures. So, small touch in some areas, key areas of the face you are able to achieve a very good and feminine result. And very importantly, without removing the core identity. So, people that knew Stephanie before surgery when they see her after and she herself seeing her after, she can identify completely with herself because the only thing we have eliminated is the masculine feature. And this is the key point in feminization surgery. At least, modern feminization surgery. We are not trying to make a face change completely. This has another name. This is called extreme makeover. This is not what we do. We only want to address the masculine features. And this is very nice also for the response of families and friends, because they are very afraid of losing their relative to another face and they are not going to identify it anymore, and it doesn’t happen like this. So, yeah, I am so happy that Stephanie is one other success patient not only in her personal life, she is so successful, but that also the surgery could also help her gain more confidence and go on with her career and be the amazing woman she is nowadays. And thank you so much for this. It is true, we have never talked about your surgery since you came, so I am very happy to know that you are doing well.

Stephanie Hirst:
Oh, thank you so much. I think there was one thing that really kind of stood out for me as well. And it’s only a really little thing, in the fact that when I had my first—I think it was in London, actually—I had my first kind of assessment, and I was booked in for a facelift. So apart from the forehead contouring and the rhinoplasty, there was lip lifting there as well. And I came back to Marbella, and you looked at me again, and you said. Actually, you don’t need a lip lift. And this for me, is like you could have taken that money.

Dr Helen Webberley:
Yeah, yeah.

Stephanie Hirst:
That could have been taken. Lip lift could have been done. But you didn’t do it. And I thought, and you gave me my money back. And I just thought, these people I am working with here, these people are working on me, these people I booked to see are true, genuine, people. And they only want the best. And they will only do what’s needed. And I thought that was just—and I remember thinking wow, they transferred the money back to me and I was like, wow, gosh. Whereas maybe there are some charlatans out there who would like, have this, even though you don’t need it, just to make a quick buck. Whereas you guys didn’t at all. And I thought that was—

Dr David Simon:
Yeah, it’s a very common thing. That’s why I was saying this, that you are now expressing that you are very happy, and you had maybe twenty per cent of the whole scope of procedures that exist in FFS. But you are very happy. And we get many patients that have, or believe that they need a lot, or they have been assessed by other surgeons that tell them that they need a lot of procedures. And this has not only one consequence, of course, first, if they do a lot of procedures, the cost is going to be much higher. And second, they believe that if they do not have all those procedures performed, they will not be feminine. So, the assessment can be a problem for the patient, because the patient absorbs that assessment and they are understanding that if I do not do all this, I will never be a hundred per cent feminine. So, this is the change that we see in FFS. When we have to do a very objective assessment where we only address the masculine features. Putting procedures over procedures that don’t have any sense or of course, I am not even going to mention the fact that a surgeon should never put a procedure on a patient just aiming financial advantage. Of course, this is how it should be done. This is how we work from the beginning. I believe this is one of the reasons why we have grown a lot in the last years, as you know. We didn’t change nothing about it. We like to give an assessment that is extremely clear for the patients. And of course, very objective so that the most potential result of femininity is obtained with the least amount of procedures.

Stephanie Hirst:
And I love the fact that you are contactable, as well. Whereas, some surgeons, the work is done, and you may never see them again or whatever. You are contactable, and I really like that. You speak to Lilia, but you will always get in contact with you. You will always get an answer back. And I loved the chain of communication. I loved the checkout procedure, as well. Everything from start to finish, I thought it was just, yeah. So, when I am fifty, I am going to book back in, and I am going to have some kind of facelift done.

Dr Helen Webberley:
We did a podcast with Alexandra Hamer, and she talked exactly a lot about this. About the importance of not just booking in every single procedure and not everybody needs everything. The other thing I just want to go back to, if you don’t mind, is the concept of dysphoria, which is absolutely different for every single person. And you, Stephanie, you were explaining really well about the side of your face, the side view. You know, even on every train, every TV show that you did, and it’s really interesting for me as a medic, that there are different types of dysphoria that people have, whether it might be the brow that you were talking about or the side of the face. For some people it’s their voice, for some people it’s their height, or what have you. And I think again, as a medic trying to help, it’s really important to understand what’s important for that person, and it can be completely different from what society might spot or notice, and very different from another patient.

Stephanie Hirst:
The things that society and other people and friends spot are completely different to what you spot about yourself. Every one of us hates something about themselves, whether it’s our arms, our legs, do you know? My hair, I’ve got loads of it, I’m very lucky. But it’s fine, and it’s always been fine and fairly nuclear since I was a child. It was like I could stop my fingers in a plug socket. So that’s one thing. But I just count myself lucky that I’ve got my hair. And I’m very black and white about some things. I go, right, what can I change, what can’t I change? And I guess the dysphoria side of my face was I just didn’t like the side angle. There was actually looking at some old photos of the front of the face. I probably could have gotten away with that, maybe. There was still some bossing of the brow, actually, when I look back at frontal photos. But I think as soon as I had it done, and this is definitely a psychological thing, and I didn’t suffer a lot of bruises. There was some swelling, of course, but it wasn’t bad, it wasn’t painful. I wasn’t in any pain in any way, shape, or form. But as soon as I had it done, it was almost like someone had reprogrammed my brain almost. I don’t have to worry about that anymore. That’s gone. That side profile, what I was worried about, has now gone. They’ve taken it away. And I never worried about it again. So, it’s interesting how the brain puts things into certain compartments, isn’t it? In the brain, that’s now just being put away or thrown away, we don’t even think about it. So, it’s a little thing, but it’s massive at the same time. I would say out of all of my surgeries, the facial stuff was the life-changing one. Absolutely, without doubt.

Dr Helen Webberley:
You look very beautiful and very feminine as I said at the beginning.

Stephanie Hirst:
I’ve been very lucky as well in the fact that I am five foot seven. And I’ve always been a bit—I was never masculine. I never had big shoulders. But also, after GRS, your body changes again. And I had several friends say to me as soon as you have your lower surgery done, which is some years ago now, your body will change. And one of my friends said, oh, your back muscles will change. And I was like, really? I think it’s changed enough. I mean, I am quite happy with it as it is. And then, slowly after surgery, the rest of my body changed again. I think it’s done now. I think I’m just going to get old and things will start dropping. But yeah, that was—

Dr Helen Webberley:
Switching the hormones is a massive thing for your body as well, isn’t it? That takes time, and it’s interesting, because, Dr Simon, you were talking about this, the psychological effects, as well, of changing the hormones. It is a very important part of us, isn’t it, the hormone profile kind of thing? And those changes go on. When I watch my sons go through puberty, and in their late teens, they’re still spindly little lads, but through their twenties, it’s still developing and changing into a big kind of masculine thing that they are quite happy to be. It’s funny, Stephanie, you should say that the thing you were horrifically bullied for, being a spindly little lad, at school, actually now makes you five foot seven, narrow, you know, lady. So, it’s interesting, isn’t it?

Stephanie Hirst:
It’s funny for me as well. Because I don’t do the whole—it’s rare for me to speak about it as well, this kind of stuff. Not that I’ve walked away from any community or anything like that. But, for me, transitioning is a process. It’s transitory. It’s moving from A to B. Transport. And I’ve moved, I’ve done it. I didn’t want this to start to define me, because I’d seen other friends. And all of their working day and everything and tweeting about it constantly and Facebooking and sharing, it starts to consume you. And I was like, I flew the flag for a good few years. And I went, I just don’t want this to start to define me. I just don’t want to be known for this. I am a broadcaster. I am a human being. I am a daughter. I am a friend. I’m all of these. But yeah, I’ve got transistory. So, I decided to just go, do you know what, I’ll speak about it when it feels right to speak about it. And this opportunity feels absolutely right to speak about it and to speak with yourselves and the amazing Facial Team and Dr Simon. But I think it’s healthy to not let it define you. I think it really is. Because I was racked up in this from three years old. And do I want to spend the rest of my life in my seventies still being angry at society because we’re not accepted? Or certainly, a small percentage of society doesn’t accept it. Only because they are afraid. So, I thought, if I can educate in an invisible way, and I am just doing my job, just being a broadcaster. I’m on the radio every single day on the BBC, and I never talk about it, it never comes up, I just get on with that. And I have had several of my listeners who have listened to me for years go, I’ve actually forgotten you were anything else. And I was like, yes, fist bump, because that’s what you want. You want people to almost forget that there was anything else. You’re just you. I’m just Steph, who happens to muddle away through radio shows every single day. So, for me, it was just, I see if I can educate in a way of not being that person who is going, you must accept me, you must accept me, look at me, I’m female. Accept me. If I can just do my job and go she’s not weird, is she? She’s just that woman off the radio. And that’s it, and we move on. So that’s it. That’s the tact that I am going with, and that feels right for me. But for everyone else, if flying the flag and banging the drum is right for you, do it. I am not saying it’s wrong. But we’ve all got to do things that are right for us, I guess, really. Does that make sense?

Dr Helen Webberley:
Yeah, absolutely. We’ve talked to lots and lots of people, and I think it’s really important. For me, it reminds me of the dysphoria, which is different for everybody, about the path that you want to follow. And that can change, you know, the path you took at the beginning was different to the one— actually you know what, I’m done there now, I’m just going to be female Steph, presenter, and just get with my career kind of thing. Whereas some people want to carry on flying that flag forever.

Stephanie Hirst:
Absolutely. And so, they should if that feels right for them. I applaud them, and I can’t thank them enough for everything they are doing for future generations. But I am still, even though you don’t see me on twitter, tweeting about it. I am flying the flag, daily, on the air, publicly, showing people that you can make a success of your life, showing people that you can just be you.

Dr Helen Webberley:
I mean we talked about it earlier, wasn’t it? That trans normalcy it doesn’t matter, so what? Do you know what I mean? It’s me, hi, hi, I’m me I’ll be talking in the radio today, that kind of thing. Dr Simon, you mentioned the WPath Standards of Care. For those people who are not quite sure what that is, I am going to explain it. So, the World Professional Association of Transgender Health, they issue a big booklet which comes to transgender issues from all kinds of angles. And they are rewriting the guidelines at the moment. So, the medics amongst us and the community amongst us is very, very excited about what they’re going to say, and hoping—because it’s been some time since they last developed the guidelines—so it’s really, we are really hoping that this time lots has changed in the last few years. So, Dr Simon, what is the situation, when are they coming out? When can we read, and what’s happening? We’re all so excited to get on with it.

Dr David Simon:
The WPath, just to clarify is the World Professional Association for Transgender Health, and they have written the standards of care, the last one, which is this guideline about the transition process for professionals treating transgender patients. The last one is from I believe 2011, I think. And they have been now evolving this document for a new edition. And we believe it’s going to be out, of course, we now have the moment of the crisis of the virus that is delaying everything. But it should be out this year or next year. And we have been invited to contribute with the feminization of the face. So, we have been contributed to a talk about the importance of the face inside the transition process. And the feedback we got to now it’s a very positive one. Because we see that the way we see the feminization of the face inside the transition process was really well-translated in the document. And we believe that it’s going to be very helpful for patients all around the world who will need these types of guidelines, to justify, for example, for medical insurance, for even public services, that this is one of the important processes inside transition.

Dr Helen Webberley:
It’s interesting that you should say that. Our National Health Service, although it has a list of things that you are allowed to have funded for you, and you’re not allowed. Genital reconstructive surgery is on the list of allowed things, but facial feminization surgery isn’t. And again, it goes back to that kind of lists of dysphoria. What if that person doesn’t have any dysphoria about their genitals, and it’s just not a problem, you know? But for example, the side angle of their face is very important. So, I think this will really help be able to shape guidance in lots of countries around the world, which is really good. And we were talking before with your team, I think I just want to congratulate you from the medical point of view on the research and the guidance that you’ve managed to produce in all the years that you’ve been working because nothing can go forward without research. I don’t want to talk about the lack of research that everyone is talking about because there is plenty of good research. And I think that your team has contributed greatly to that, haven’t you?

Dr David Simon:
Yeah, we have been trying to put out the experience we have with our patients, not only regarding surgery but regarding the type of evaluation, the type of exams necessary, the type of instruments that we use. We try to put this out through different ways, from research that goes to scientific articles that we can write, that are published of course in medical journals, to many, many medical conferences that we attend where we are able to talk about what we do. And this is information that has gained much more importance by the medical field. But yeah, the importance of research, at the end of the day, is that this is a surgery as most surgeries that exist that should be performed with a certain amount of protocol. There’s a saying that if you have many ways to treat one thing, it’s because probably there is not one of those ways that is very good. So, it’s always good that you try to establish some way, at least some guidelines that a way of the surgery to be performed. And FFS is not different. And when we started, we found that this was a very sparse field, where you had surgeons doing things from a completely different way than the other. Completely different materials, even the diagnostics, it is still very difficult. Some surgeons who make diagnostics, it is completely different than diagnostics of other surgeons. So, research is mandatory here. We have now published a recently last month, an article that it’s where we expose after round ten years our protocol of evaluation. So, we are just explaining how we evaluate a patient, how we make diagnostics which are the step-by-step before doing surgery. Because doing articles about surgery are good as well. But we see also the need for complimenting these steps before surgery, which is also still very weak in literature. So yes, research is very important. I know it affects sometimes less the patients directly because not all patients they have accessed this medical literature. But it is very important when it affects the surgeons who want to start in this field. If you see what is the current situation of FFS in the world now, and ten years before, there are so much more surgeons nowadays who want to perform these procedures, starting to do it, and this is because of course of constant improvement in research.

Dr Helen Webberley:
That’s right. And going back to that point where the patients will be using this guidance. What we do is actually kind of translating medical language into everyday language. Which I think it’s really, really important, the standards of care is going to be such an important document. So, we will be kind of translating it into readable sections so don’t worry, if you’re too technical in there, don’t worry, we’ll make it readable.

Dr David Simon:
It is technical. It is a little bit technical because we are publishing in medical journals, but this work that you do, it’s amazing. Because let me tell you, again, from the conversation when I was saying there are so many things that are completely different from medical life. We have our patients that are almost every time asking to send our scientific articles. So, this is often not common. When you remember you went to a surgeon, for any other problem, and you said, I would like to read some scientific articles about it? So the patients, they are so interested about this, and they are so conscious about making their decisions, not only about the team they are choosing, but also what is the current literature about the surgery? Because I have to make a decision. They understand this is a surgery you do once in your life if you want to do it very well. So let’s make the decision with some base, with some solid information.

Dr Helen Webberley:
Yeah, the other point you made is about the evaluation. And I’ve been shocked while I’ve been in this field, about if you’re not transgender, the evaluation is really about what procedure to do and how best to do it and what time frame to do it. If you are transgender, there’s a whole great big piece of work to be done to make sure you’re transgender in the first place. And it’s almost like why ever would they come to you and say I am transgender and my face is masculine, can you help me please, if they weren’t transgender in the first place? You know? And so, we at GenderGP have a big philosophy about informed consent, autonomy, the patient is the expert in their gender, and you know, then our medical team will just help them with their hormones, you know? So, it’s really important that the evaluation is about the medical procedure not about their transgender identity.

Dr David Simon:
Yeah, I completely agree. We have many patients that come to us in a moment maybe regarding their face that it is so early, and they are sometimes scared to come because they think they’re going to be, maybe it’s ridiculous to come at this point because I’m still presenting myself as masculine, why should I come now I should be more feminine to come. But actually, it is not true. We encourage our patients that are starting their process, already identifying themselves, that being in a transition that they come to us early because we can save them a lot of thoughts that are not very useful to them. We have patients that come to us, and we can say, like with Stephanie, that you need that procedure. And with that, we’ll be fine. But in their minds they are thinking they need so many things. Just sitting with us and having a clarification of when they have their surgery what is it going to be like, is a very relaxing moment. Because they have something to look at, and they understand, okay, when the moment of my feminization comes, I know I just have to do that. And all that movie that was in your head, it is going down. You are much more relaxed.

Stephanie Hirst:
The skull scans that you get, as well as the CT scans afterwards. And when you see the befores and afters, it’s fascinating. The amount of friends, at the time, when I first had it done, I think I still have them on my phone now, actually. I still look at this, and it’s seven minutes to take the forehead off. It takes about seven minutes?

Dr David Simon:
Yes, the CT scans that we use, as you say, these are all 3D scans. And they are not only because they are amazing, because they indeed look amazing, anyone can understand it. The 3D scan. You can see your skull, perfectly, in HD. It is almost like your BBC programs where you can see HD, the skull. But they have a very important role nowadays that not all patients already know, that we use the 3D scans to 3D print things, okay? So, when we are doing, for example, a jaw and chin surgery nowadays, we do it all with 3D printing. It means we are able to take that scan, we put it in our planning software. We have a software that can move the skull in the screen. And we can design the cuts we are going to make on the jaw and chin. And then, this image is going to be 3D printed. So, what we have in the end is a cutting guide that we can use in the surgery, so it fits only your jaw, because it is done over your scan and it shows us what we are going to cut. So, the 3D scans, they are not only for us to see and make diagnostics, they are now already have evaded completely the treatment of the surgery. It’s not only pre-op or post-op, it’s trans-op, or intra-op, okay? So it’s very good. We do the forehead surgery, we have to get to the forehead. So, we need to get to the bone area here. We have to do a detachment. So, we have to separate the skin and muscles of the forehead to see the bone. We do it with an incision inside the hair, completely hidden. And with that incision, we are able to expose all this area. Many patients, when they hear this, they are like dizzy, you know, they are scared. But at the end of the day, the incision, and the amount of detachment that we make is not larger or more broader than a facelift. When you do a facelift, which is a much more accepted procedure, everyone knows what a facelift is, you have some cuts and incisions done from here to here, even to the back. And you do it in both sides. If you put them together, they are larger than the incision we do for the forehead. And the detachment for a facelift is also aggressive, where you are going to have a lot of the soft tissues of the face here completely detached. So, I understand completely, it’s much more wow. It’s much more powerful to imagine that we are detaching this area, but the surgery itself, it’s less aggressive regarding the soft tissue.

Stephanie Hirst:
The one thing I did love is the fact that the scar is hidden, where I had seen in my early research, people were cutting across the top of the hairline. And you can see that, can you? It’s visible. Even though the scar will fade. It is still visible. But the fact that I never even think about the fact that I’ve got a scar running across the top of my head.

Dr David Simon:
This is one of the typical points of research that you have. Some surgeons say I do from here, and others say I do from here. I mean there is a limit where preference can play a role. A surgeon can tell I like to use this type of scalpel and that type of instrument, and the others like that. But there are big differences between making a cut on the hairline and inside, and I don’t—I think that research plays a role here. You have to do what’s best for the patient. One of our main articles, it’s talking about this, when we are discussing the differences between the approaches. Because for the surgeon it’s just a moment. I am going to see you during the surgery, do that procedure, maybe going to make a cut on the hairline or here, but the patient is going to leave with that incision for the rest of her life. So, it’s a very important moment the decision where to make your incision. And there are some guidelines. And the guidelines aren’t very well-exposed in this article. And I tell you that right now we are doing so rarely an incision on the hairline. I think it’s less than one per cent of our patients nowadays that we do an incision here. Most of these incisions are hidden because we are trying to keep one of the pillars we always talk about, that we can make a nice change but without visible scars. And the scars on the hairline, even when they heal very well and you don’t see a scar, you will sometimes see the artificial aspect of the hairline itself because when it heals, it’s not going to have that nice irregularity that hairline normally has. But it’s much more problematic than that. If you do a hairline approach, you are not able to change the hairline shape to a round one. And this is the goal. You can only get the hairline down with the same square shape that we see in most of our patients, or m-shaped. I could talk about hairlines here for two hours, really. But it’s just another example as to how research is important in this field, and that we should start to establish some protocols.

Stephanie Hirst:
Yeah, and an immediate hair transplant as well. I wasn’t receding much, but you gave me an option of taking some of the hair follicles and then planting them back in, which I’m so glad you did, thank you.

Dr Helen Webberley:
I think it’s a progression as well, isn’t it? There are some people listening who may have had the hairline approach because that was all that was available to them at the time. And this is about progression as you say moving forward and making sure that what we do is important safely for medical reasons. And then of course what the patient wants as well. I could also talk for hours, but I think we’ve kind of come to the end of our time. It’s been really, really nice. Thanks so much, Stephanie, for sharing your journey with us. I am sorry your journey started with the bullying—

Stephanie Hirst:
Oh, it’s fine. I don’t even think about it. The good thing was that actually, I got a job on the radio in the area where I went to school. Actually, the bullies ended up buying me drinks on a Friday night in town. Every cloud.

Dr Helen Webberley:
Every cloud, absolutely. Thank you for being candid and for sharing that story. And for always flying that flag, even though it’s not your today’s mission, kind of every day we know—

Stephanie Hirst:
Yeah, I’m flying it this afternoon. I’m not talking about it. A DJ actually here in my kitchen on a Saturday night, and I think the view is a hundred thousand people watching the DJ in my kitchen. And yeah, I am always doing things on TV, bits and pieces there. So yeah, I guess I am flying the flag invisibly.

Dr Helen Webberley:
And I think for me, for normalcy. And whatever we’ll see.

Stephanie Hirst:
Whatever that is.

Dr Helen Webberley:
And showing that trans people are completely and utterly normal and ordinary, acceptable, successful, and this is the future.

Stephanie Hirst:
Thing is, we are all different. Every single human on earth, on this planet, comes in all shapes and sizes. And every single one of us should be accepted for who we are. What we are. Our values, the way people like to be treated. Be nice, be kind, and that’s all we ask for, every human being on the planet, isn’t it, really. It’s not much to ask. Be kind.

Dr Helen Webberley:
And you said at the beginning, you knew, but you didn’t know what the words were. You didn’t know how to verbalize it. We didn’t have the search engine to help you, but these days we do. And to anybody out there who is doing that bit just before you come out as we talked about earlier. There’s lots of information out there. Lots of people willing to share their stories.

Stephanie Hirst:
I’ll get messages on my Facebook page, online, and through my website, and I will always reply back always. I will always point people in the right direction. I’ve pointed people in the direction of the Facial Team, and several other avenues. And I will always, always help see if anybody wants to email me they can do, just pop to my website. And absolutely, I’ll always answer any questions anyone’s ever got.

Dr Helen Webberley:
Brilliant. And to the Facial Team, thank you so much for the third in our series with you. And it’s been really informative. As I said on the last two, I’ve learned ever such a lot, and thank you. And I hope that people listening will have learned a lot, as well. And again, I want to thank you for the great work that you do for your patients because we’ve seen so many happy people. And also, the great work that you’re doing for the medical progression in this field, which is equally important to me. Thank you so much for joining us.

Dr David Simon:
Thank you so much for inviting us. Thank you so much for inviting Stephanie. It’s amazing to be able to see you here after so many years. And yes, these are the types of initiatives that are growing more and more to spread information, to make patients more aware. The goal of Facial Team is and will always be to improve the life of transgender women around the planet. This is our main mission. And if we can do this, through research, through improvement of our surgical techniques, or through improving the way that we believe the medical field should treat these patients, this is what we are going to keep doing. And the feedback we get, like this, it just confirms the importance that it has. And I’m so happy to hear that we are making a difference in so many people’s lives.

Dr Helen Webberley:
Good. Let’s carry on flying that flag for the trans community. So, we’ll do it from the medical side, and you do it from the facial side. Thanks ever so much, guys. I really, really enjoyed talking to you.

Stephanie Hirst:
Thank you so much. Thank you.

Dr Helen Webberley:
Bye now.

 

Thank you. We hope you enjoyed our program. Do go ahead and subscribe if you haven’t done so already. If you or anyone else is affected by any of the topics discussed on our podcast and would like to contact us, please drop us a line at doctor@gendergp.co.uk. We’re very happy to accept ideas for future episodes and guests, or if there is something specific you would like us to cover. You can also visit our website, www.gendergp.co.uk. You can follow us on social media @gendergp, and you can sign up to our monthly newsletter. Full details can be found in our show notes on the podcast page. Thanks for listening.

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