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The GenderGP Podcast: Facial Feminisation Surgery Special

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.

In this three-part special, we explore all things FFS; from the theory, with Alexandra Hamer, to the practice with Dr Raul Bellinga and finally the impact, with radio and TV presenter, Stephanie Hirst and her surgeon, Dr Simon.

Part 1. Alexandra Hamer – The Principals of Facial Feminisation Surgery

Alexandra Hamer has been studying facial gender differences for 18 years. She specialises in understanding what makes a face look feminine or masculine. In this episode she talks to Dr Helen and Marianne about her work in facial feminisation simulation. Using photoshop, Alex helps individuals considering surgery to understand the impact which FFS might have and how to use the minimum number of surgical techniques, to achieve the maximum feminising results.

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
http://www.virtualffs.co.uk
Facebook: https://www.facebook.com/VirtualFFS
https://facialteam.eu/ffs-cost-consultations/virtual-ffs/

 

The GenderGP Podcast

What is Facial Feminisation Surgery? The GenderGP Podcast S5 E4

 

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:
Welcome, everybody, to this edition of our podcast. I am here with Marianne as usual, and we have a lovely guest today as well. I’d like to welcome Alex, who I think is very exciting because her specialty is virtual facial feminisation. I love the fact that it’s facial feminisation because this is going to help a lot of people, but also the fact that this virtual thing is very much what GenderGP is all about. So Alex, let me allow you to introduce yourself and tell us all that you do. Take the floor.

Alexandra Hamer:
Right. Do you know what I feel? It’s really difficult because I have one of those jobs that doesn’t have a proper name. People say what do you do? And depending on how much time I’ve got, the answer can be very long or very short. Anyway, I am Alexandra Hamer, and, so, essentially, I advise people on facial feminisation surgery. I am not a surgeon, I am not a doctor, so it’s not that I advise them on the surgery, but I explain what makes their face masculine, and what techniques there are available that can feminise it. And I also simulate the changes in photoshop so that they can get a sense of how those different procedures will look in real life. By doing that, they get a sense of what’s important and what isn’t important. The thing is, if you go to a surgeon, they will often give you a very long shopping list of procedures, and a lot of those often will make very little difference but will cost you thousands and thousands of pounds. And so I can show people, I can say, look, your forehead makes a huge difference, the cheek makes a very tiny difference, so if you are on a budget, you know. That is essentially what I do. I don’t know, does that explain it?

Dr Helen Webberley:
Yeah.

Marianne Oakes:
I think it does to me. I suppose the question in my mind is what are the key skills that are needed to do your job if it’s not too big a question.

Alexandra Hamer:
The key thing is that I have been studying facial gender differences since 2002, so for about 18 years. And that’s really the key. Skills aren’t the word here, knowledge if you like. And I’ve done some original research in this area. Pointed out a few things that people haven’t spotted before and things like that. So the key skill is being able to identify facial masculinities. And then with a little bit of background knowledge on the surgical techniques available.

Dr Helen Webberley:
It’s always, isn’t it? It’s the case with that we see time and time again, it’s such a minefield. People don’t know where to go to get information. Do you know? If you just go on and surf the internet, it’s impossible sometimes to put it all together. And like you say, there is that massive shopping list. And people don’t know what is going to suit them, do they? And what is going to actually be right for them? So it is really exciting to be able to do what you do. How does it work? So if someone came to you, what would you do? How does it go?

Alexandra Hamer:
Well, essentially, if they’re—cause I work with Facial Team, if they work with Facial Team it’s a different thing. But if they’re coming to me through my website, what happens is I have a lot of instructions on my website about how to take the pictures properly, because that is point number one. Just as a basic thing, you need the camera to be at least six feet away, cause otherwise, you get this thing called barrel distortion. Which makes your nose look big, makes your lip to nose distance look longer. So people who are taking pictures with their phones and thinking, oh this is a problem, this is a problem. You can’t see it properly unless you get six feet away. So there are instructions on taking the pictures. They email the pictures to me, they answer several questions, are they on hormones, have they been on hormones for a while, because that affects the facial features to some extent. Things like age. Weight is another issue, as well. Because we store a lot of weight around the jaw area, and sometimes it’s difficult to tell whether somebody is a little bit overweight or they have quite a heavy structure to the jaw. So there is a load of questions they fill in. And then I usually work on three pictures, a frontal, a three quarters, and a profile. And I start analysing, and I write them a full written assessment going through each feature one at a time, explaining what’s masculine and what can be done about it. And usually simulate the changes one at a time so that they will get several versions of each picture. So for example, they’ll get a picture with just showing the forehead changes, and one forehead and nose, then one showing forehead nose and chin. So on and so forth. But they also, it’s also a case of spotting what some surgeons are going to recommend even if you don’t need them. So I sometimes simulate that. Even if just to show that it’s not going to make any difference. So that is essentially the process, and then I email the pictures and the assessment back to them a few weeks later when I’ve done it.

Dr Helen Webberley:
Must be really exciting, I guess, to kind of have the before and after as a picture. I can imagine that’s really exciting.

Alexandra Hamer:
For me, it’s very stressful. Stressful for me because I know how important it is, and I know that there are people making decisions based on what I showed them. And what that means is that I have to get it right every single time. I always have to do my best work. I can’t ever just say oh that will do. So every single time I do a picture, it has to be my best work. That’s quite stressful. The impact on patients can be quite profound. And we see this when we do live consultations like when we were in London. You know, the surgeons are typically talking to the patients for 20 or 30 minutes whilst I am working on the pictures. And the conversation is very academic. Oh well, you would benefit from well, bossing reduction and so on and so forth and this will have—it’s a conversation about something, but when you actually see it that’s when people tend to get quite emotional and have some quite profound moments, really, during consultations. I mean, it’s the oldest cliché, isn’t it? That a picture speaks a thousand words. You know, it’s really important to be able to see. Because you are doing something to your face that people are going to see, and that you are going to see. It’s a visual thing. Explaining that brow bossing makes your face look masculine is different than seeing that it makes your face looks masculine. That can be very, very satisfying.

Marianne Oakes:
I think what you just said there about how it’s got to be, it’s very exciting what you do, isn’t it? One of the luxuries that we have with hormones, I suppose, is nobody really knows quite what they will and won’t do to an individual, so we can only explain the limitations, I suppose. And potential benefits. But where you’re talking, it’s quite an exacting outcome, or am I misunderstanding?

Alexandra Hamer:
What I say to people is that it’s not a prediction as such. It’s a bit like having an architect in to help you design a house. And it’s very, very useful. They can show you a picture, and immediately you say well no for starter I want the front door in the middle of the house. And I want, you know, this, this, and this. And I want this kind of roof. So then they sketch it again and you say yes that’s much more like it. And now can you do the door red, and can you do this kind of fence? And then eventually you get to a thing, yes, this is what I want. Now, the day you come to visit your finished house for the first time, it’s not exactly like the drawing. It’s like you might say things like, wow, it’s bigger than I imagined, it’s grander, or it’s smaller. But you have established the principles. Basically, it’s what you wanted, and by sketching it out beforehand, you could see what was important to you and what wasn’t important to you. What was going to make the difference? Does that make sense?

Marianne Oakes:
Yeah, perfectly, actually.

Alexandra Hamer:
So it’s more of it gives you a target. I mean, typically, for example. Let’s take a chin, for example. The difference between a masculine chin and a feminine chin is that a masculine chin essentially has a square shape, and a feminine chin has a rounded shape. So what I can simulate is the change form a square shape to a round shape. Now, in real life, it might come out a little more pointed, or a little more rounded, you know? Or it will be a tiny bit wider, or a tiny bit narrower. But what you establish with the pictures is that by removing the squareness, you get a sense of how feminising that is for your face or not, if you know what I mean. These things vary of course, according to what surgeon you go to and there is always a non-predictable element to surgery because people heal in different ways and there are certain things—when I am working with Facial Team, I get a CT scan as well so I can see the underlying structure which helps. You know, a lot of the time there are certain unpredictable elements.

Dr Helen Webberley:
So it’s interesting though, the Facial Team in Marbella, we did a podcast with them in a different episode. And we have some more coming up. It’s going to be a really good kind of series to put together. But they are a group of surgeons in Marbella who specialise in nothing else but facial feminisation surgery. And so it’s interesting, isn’t it? The luxury of having this photograph for somebody from six feet away, and then the CT scan which shows the bone structure underneath the skin, so you take all the skin off and then have a look at the bone structure and then compare that with the actual photograph, and then you’ve got the photoshop which says I reckon only looking at this that you will probably need feminising your chin, for example, is going to look something like this. And basically, it’s going to cost you something like this. Do you think it’s worth it? I guess that’s kind of the thing. I’m feeling a little bit sorry for the surgeons. Actually, it’s a difficult job, isn’t it? I’ve worked with many many surgeons, and we always used to joke about there is a particular type of person who becomes a surgeon and a particular kind of person who becomes a physician or a GP. And as a doctor, you dive into a particular kind of job. And I think if I was—I’m not the kind of person who could ever have been a surgeon—but if I had been that kind of person, I’d have valued someone like you who could do, you mentioned the artistic thing. There is that kind of artistic, fluffy, nice soft bit which really explains things really well. It reminds me a bit like a specialist nurse who works very closely with a surgeon. The surgeon does the surgery, and that’s what they’re very good at, that’s what they’re trained at, and the nurse is the kind of complementary to that procedure. And this is what it’s reminding me of, really.

Alexandra Hamer:
Yeah, I suppose yeah. Surgeons are often of a type, do you know what I mean? Actually, I have to say, the guys at Facial Team are not that type, really. A lot of surgeons you find are quite, this is probably a wrong word, but a little bit psychopathic. Do you know what I say?

Dr Helen Webberley:
You said it for me.

Alexandra Hamer:
There’s a certain coldness there at it. One of the things I liked when I met the Faical Team guys was that they were kind of normal. Well, this is a refreshing change. But also, one of the key things, when they suggested it might be that we work together, was that I specified that it has to be that they don’t tell me what to do. That I am employed as a second opinion. Not as anything else. And what I liked about them is that they embraced that so that in a consultation. Now I cannot say anything about a surgical technique, you know. I can’t say what kind of suture to use or anything like that. I know nothing about that. But what I can say is I can mention something that I think might be useful that the surgeon, not necessarily hasn’t spotted, but maybe hasn’t considered. Or that they might suggest one thing and I might say, well, that would work, but then you have got to balance it with the width of the jaw and so let’s try some sketches here. So it’s kind of a conversation, and they’re very happy for me to give my input. And so that’s very important to me because then I know that there is no kind of coercing the patient and I am not just being told. That, you see, this is the other reason why I like working with them, is that they don’t do these long listed procedures. They start with the same principle that I do, which is what is the minimum amount that you can do that will achieve you the most feminine result. When I say minimum amount, I don’t mean that if you do a change to the forehead that you would do a minimum change. You do a maximum change to the forehead, but maybe you only need to do the forehead. You don’t need to do cheeks, nose, lips, chin, jaw, Adam’s apple, you know.

Dr Helen Webberley:
Marianne, you will be able to help me with this one. I’ve met some trans people in the past, and they kind of go through the stages they would like to achieve. And they’ve talked obviously about the social transition and the medical transition. You mentioned hormones a minute ago Marianne. And then they talk about, it kind of feels like alright my next step is surgery, and I want to have this done, and I want to have this done, and I want to have facial feminisation. And personally, I look at them and I am thinking, I don’t see why you need that. And I am just wondering, you know, for me, the steps that they have already taken, in my eyes, says feminine to me. You know what I mean? And I am thinking, are some people on that road because it’s the next step that has to be done if you know what I mean? And it goes a bit like your shopping list, Alex, you know, when you were talking about the brow and then the nose and the chin and the throat, you know. I feel a bit sad, really, that we need someone to step back and say hang on a minute, you know, you don’t have to have all of these things done. I don’t know, Marianne, whether you get to talk to people in that situation.

Marianne Oakes:
I think the hardest part of my job at times is talking to someone who thinks this surgery will make me female. That actually, I worry that we can do all the surgery, but there’s something about self-acceptance. However, I think, and I am sure Alex will know more than I do about this, I obsessed with facial surgery for a long, long time. And the first time I spoke to my GP was because I felt addicted to looking at outcomes. And the irony is, I’ve never had any so far. But I suppose the real point is that we can’t understand the depth of dysphoria that people are feeling around certain areas in their physique. And I think for some, certainly the men, people that were assigned male at birth, that have had real damage to them by testosterone, this is a real genuine need. I think sometimes there are some people who just believe that if they have this surgery, this is what’s needed to be seen for who I am. For some people it genuinely is a need.

Alexandra Hamer:
This is something that varies. There are as many different cases as there are patients. I mean, you know, nobody needs facial feminisation surgery to be valid. Nobody even needs to transition to be valid. Any medical interventions. I am a strong believer that a trans woman is not a man who wants to be a woman. It’s a woman who was assigned male at birth. There’s nothing that you have to do in order to be valid. However, there are two elements, if we are thinking about passing. I know that’s quite a loaded word as well. The thing is, there is how you are perceived by other people, okay? so if you are perceived by other people as a man even though you are a woman, that can be very distressing. It is very upsetting. And sometimes, the perception people have is based on the structure of your face. And in that case, FFS can sometimes help. Although it’s limited. And if your passability problems are with other things, then it may not make a huge difference. But there is also our relationship with our own reflection. So how we pass to ourselves. And that’s when things start to get a little bit more complicated. Because I see many people who have no problem passing when they are out in the general public. They have the option of living in stealth, nobody knows. But they know that little dump here above their eyebrows is something that happens because of testosterone. And every time they see it, it makes them feel sad. And so you know, either they can come to terms with that, and say, well, it doesn’t really make a difference in the end, it’s just one of a few lingering things about the puberty I went through. Or they can say, oh well look, I can get rid of that, and you know, feel better about myself. It’s difficult, because this is where you get into the world of body dysmorphic disorder. Which is hugely common in trans women. And I’ve been through it myself. I still fight against it. because it’s, you have to work out the difference between recognising a masculinity that happened because of testosterone, and seeing what the logical options are to dealing with that, either accepting it or surgically removing it or an irrational hatred of that masculinity that far exceeds the effect that it actually has in any objective sense. You know, I tried to explain it on my website, I was using, quite unfairly, Jennifer Anniston, who is an extremely beautiful actress, but she has quite a square chin. Now, this has no effect on her—nobody mistakes her for a man. But the reason I use her as an example is that if she came to me and said, do you know what, is my chin masculine? I could say well, technically, it’s a little more towards the masculine range than the feminine range, on average. And she said, could I feminise it? and I’d say yes, you could round it off if you wanted to. So that’s kind of a reasonable approach. Maybe she just doesn’t like it. People should be able to do what they like with themselves. However, if she came to me and said I can’t go out, I can’t leave the house cause of my chin. I always talk with my hand over my chin so people can’t see it. I won’t let anybody take a photograph of me because I hate it so much. Well then, when you look at her reaction and set it against how she actually looks, that’s why you start to see there’s such a disparity between those two things. There’s probably a psychological problem here. And the problem with that is that you can’t fix that surgically because you are looking at—because the problem’s in your brain, you’re looking at your face through that brain so that even when you round that chin, you’re still looking at your face with that same brain that is going I hate it, I hate it, I hate it. and you can get into that. It’s always a terrible example used, but the Michael Jackson thing. You know, if you looked at him when he was a young man, he has—okay, he’s black. He’s got a broader nose than a European. But he had quite a broad nose for a black man. And he was bullied about it. and so he could come to you and say, could I get my nose narrowed a little bit, and you would say, sure, why not, go for it. And if you look a some of the earlier pictures after he first did it, it looks fine. But then, if he thinks that his nose is still too wide, I want it narrower. So the surgeon narrows it again, and he says no, it’s still too wide. And narrows it again, it’s still too wide. So he narrows it again, and it keeps getting smaller and smaller, and it’s because he can only see it as a wide nose. This is a psychological issue. And sometimes it is a difficult area. You don’t want to be recommending surgery to people for whom it’s not going to make the key difference.

Marianne Oakes:
Managing expectations, I think, is probably key. Why do they want it? It’s a bit like the architect. Why do you want a red door? Just working through it with them. I suppose ultimately, and I don’t—this might be probably one of the challenging parts of my job is when somebody comes to you that is obviously beautiful or feminine already, and they’re going to want to make changes that would be potentially I won’t say not making them beautiful, but it’s not going to add any value to their appearance or life or well-being, I suppose.

Alexandra Hamer:
The very key thing is to differentiate between beauty and femininity. Beaty is subjective. It is always subjective. And it really is entirely subjective. Changes throughout time and according to culture. So, for example, I like very old movies. I like watching twenties and thirties movies. I was watching a Jean Harlow movie the other day. I don’t know if you know who Jean Harlow is, but she was a huge sex symbol in the early 1930s. But by today’s standards, nobody would really consider her beautiful at all. But she was an absolute pin-up then. All you can look at, you can start looking back at paintings of people who were considered very beautiful, and you think, really, it’s kind of a surprise. And of course, different people’s taste varies. Personally, I like faces with a little bit of character. If somebody has something odd on their face, I am not automatically finding it more attractive than somebody who has a perfect face, which can be quite dull. You know, quite bland. But femininity is objective. You can measure it. It’s a biological fact. There are objective differences between male faces on average and female faces on average. So you can essentially measure that. You can’t measure—it’s difficult to measure in millimetres and things like that. But you can say that there are these differences and they are objective. So it’s very important to differentiate between the two of them because they are constantly conflated. There are a lot of surgeons out there who sell beautification procedures as feminisation procedures. And that’s not what they are. So that’s another one of the ways they start totting up things on the list. So yeah, I’m always at great pains to explain the difference. If the example you gave, which is somebody who is very beautiful and you can be very beautiful and have some facial masculinities. Or you can have an entirely feminine face but not be particularly attractive. These are quite different things. So one interesting thing is that I found time and time again it’s one of the most reliable rules in FFS. It’s that the more beautiful and the more feminine the person is that you speak to, the more insecure they will be about their face. And the most problematic conversations, the most difficult conversations are usually with the people who others would say need surgery the least. So I do meet those people who perhaps transition in their teens, maybe even with puberty blockers, so they have very little observable masculinity, but who literally will not leave the house and constantly have their hair right over their faces and wear sunglasses and try and hide all the time. And there is that just lovely face behind it. It’s a very difficult area.

Dr Helen Webberley:
There are so many aspects to a human person. This is not about gender alone. That human person has a gender. They have a brain, a very powerful brain, and what that image gives to them in the mirror, as you say. And then they have their body and their structure as well as their brain and their gender. And their hopes and their expectations. It’s very difficult, isn’t it? For many people, whatever gender. Help me educate myself, and hopefully, that will help other people also have their education. You know, what is it that testosterone does to a face if it’s allowed unimpeded during puberty? And actually, as I’ve learned more recently not just during puberty, that carries on, doesn’t it? In the twenties and thirties, that masculinising effect of testosterone, which is what it was designed to do, I guess but, but yes what exactly, at a basic level—what does testosterone do to someone’s face? To their body?

Alexandra Hamer:
When an archaeologist digs up children’s skeletons, they usually struggle to tell whether they are male or female. There’s nothing obvious in the skeleton to give that away. You can sometimes work things out, but most of the time, it’s they’re every indeterminate. What happens at puberty is that the female skull essentially stays the same. You get bigger, but the overall structure stays the same. The male skull changes a great deal. So, how do we start? If we go from top to bottom, okay? Let’s go with hairline height. Now it’s a common misconception that men have higher hairlines in the middle than women do. In fact, it’s the opposite, men have slightly lower hairlines in the middle.

Dr Helen Webberley:
I can see what you’re doing. But just for the listeners, what do you mean by hairline height?

Alexandra Hamer:
So imagine drawing a line from the top of your nose straight up to where your hairline starts, okay? That distance is typically longer in females than it is in males. But most surgeons and most patients think it’s the opposite. Problem with that is because they think it’s the opposite, surgeons typically do a procedure that is called a scalp advance, where they cut all along the hairline, and move the whole scalp forwards. Now the problem with that is it leaves you with a visible scar all along your hairline. And it brings your hair further into the masculine ranges than the feminine ranges. So for the vast majority of the people I work with, they actually don’t need to lower the hairline at all, right? But the key difference between male and a female hairline is the corners of the hairline. So if you think of it this way, a male hairline is typically m-shaped. Like a capital M, where a female hairline is typically u-shaped, like an upside-down U. You have these corners to the hairlines, and these are one of the things that develop at puberty. So one of the things that I discovered through my research is that when you add corners to a hairline, it makes a whole hairline look higher. And I think that is one of the reasons that make people think masculine hairlines are higher in the middle. So it’s kind of an optical illusion caused by the corners of the hairline. Typically in FFS, what you do is you fill in the corners to give the hairline a more rounded shape. It’s best done with transplants. Then you avoid any of these scarring issues. So that’s the hairline. Then you get to the brow bossing. Now, this is the most important area in facial gender recognition. Brow bossing refers to a kind of ridge of bone that stretches right across the forehead at about eyebrow level. And in males this is typically much more strongly developed than in females. And because when we talk to people, we look at their eyes, the eyes are the single most important thing in a person’s face, and this is the frame of the eyes. It’s one of the reasons why it’s so important. So yeah, you get this much heavier bone above the eye in males. So removing that is probably the key procedure in FFS. There are also other things called frontal eminences. Bumps in the middle of the forehead. There are things called temporal ridges, which are kind of ridges which go up the sides of the forehead, and these all tend to be more strongly developed in males than females. But these can all be smoothed out as part of the FFS. And then you get to the noses. And there’s less difference between male and female noses on average than people realise, and the key differences are if you look at the nose from the side, the angle at the base of the nose is more upwards in a female face, and more kind of coming out at a right angle in a male face. Typically, the male nose tends to be a bit bigger, and often have a bit more of a hump to the bridge. And then you get to the cheeks. This is another area where people are making an awful lot of mistakes because there is this idea that men have stronger cheekbones than women do. Now, when you look at skulls, you can make the argument that cheekbones are stronger in males. When you look at the face on the outside, you can’t see that. this is all hidden underneath the soft tissues. The key difference between male and female cheeks is that female cheeks have an awful lot of fat in them. This is something that is hormones–generally, oestrogen will fill the cheeks with fat. The younger you start hormones, the greater the effect. But there’s a lot of variation from person to person. So yes, the cheeks get fatter. And then you’ve got the distance between the top lip and the nose, it typically grows longer at puberty in males. So usually, when a woman’s mouth is relaxed, you can see the top of the teeth. But when a man’s mouth is open and relaxed, you can’t see his upper teeth. There’s a procedure to shorten that distance. And then as I mentioned going at the chin, the male chin tends to be vertically taller, wider, and has more of a square shape, whereas a female chin is shorter, narrower, and has more of a rounded shape. And then the jaw, people often think that men have wider jaws than females. Actually, in proportion to the faces, this is not really true. What they tend to have are vertically taller jaws. So a lot of people want their jaws narrowed when what they need is just the height of them reduced. And then you get down to the Adam’s apple of course. Everybody has an Adam’s apple. It’s a vital structure. But what males typically have is a sort of a bump on top of it made of cartilage. So all these things tend to happen at puberty. There is this concept called neotony, which is when a childish characteristic is retained in adulthood. And this is essentially a typical female face, an adult female face, is like. It’s like they had that when they were young. It didn’t really change at puberty. So there’s this fundamental principle in FFS which few surgeons follow, but which I think is absolutely key. Which I called puberty reset. And it’s the idea that the purpose of FFS is not to give you a new face to make you look like somebody else or some idea of femininity but to take your face back closer to its original construction before puberty happened. Giving you your own face back before the effects of testosterone happened. That should be the fundamental principle of FFS. Sometimes people misunderstand, and they look for pictures of beautiful women they particularly find attractive, and they say can you make me look like this? Can I be made to look like this? Can I have a nose like Beyonce? Can I have eyebrows like so and so? And trying to do that to your face, it typically leads to disaster. You just can’t do it. but what you can often do is reverse at least to some extent these effects of testosterone at puberty. This it still is your face. You look like you. And you being you is the very purpose of transition at all.

Dr Helen Webberley:
Yes, that’s the difference, isn’t it? Between feminisation and beautification. And you know, we have to be very clear, you know, that they are very different. Marianne, you looked like you were going to ask something.

Marianne Oakes:
What’s been going through my mind is the education I am getting listening to you. I struggle with sometimes, and we talk about it at gender GP a lot, the language around what we are doing, and what the point of the exercise is. (unclear 38:05). And it’s ever-evolving. Sometimes, we have a meeting. And one of us will say, well, we’ve just got to stop saying that. it doesn’t feel right. And just listening to you talk now, some of the stuff you said now to us today, just makes me realise that in the therapy room or whatever, people come to GenderGP for whatever help, it’s reminding them, or not reminding them, but using the right language so they can better understand of what they’re really saying. Does that make sense? The not falling into a narrative of what other people are saying that this is about them and like you say going back to the original face. Going back to Jennifer Aniston’s face or Beyonce’s face.

Alexandra Hamer:
Yeah, that makes sense. The language is always difficult. It’s one of the things that is making me quite nervous right now. I know I am talking very fast, which is a little bit of an ADHD thing, but I know I will listen back to it and I’ll be thinking to myself, you shouldn’t have said male there you should’ve said masculine. You shouldn’t have said that. And of course, there has been no mention of non-binary people in this whole conversation of facial feminisation. But of course, they are absolutely key and entirely as valid as anybody else.

Dr Helen Webberley:
I think you’re right. I think that’s what we’re saying, isn’t it? Is that this isn’t about making you into a woman or making you into a different gender or an in-between gender or neither gender. This is just about taking your face back to what it would have been if you hadn’t had testosterone on board through this really important years. So this isn’t making you. This isn’t validating your gender. This isn’t making you a woman. This isn’t making you more non-binary than a man. This is just about feminising your appearance as it would have been if you had had access to estrogen when you were going through puberty and your 20s and 30s instead of having testosterone in your body. And you know, language, don’t worry—we all are slipping up with language. And we understand that it’s very important language when we are so passionate about something, sometimes the wrong words come up. I have a question though, I am interested. Because testosterone, of course, works below the neck as well, and so you know, traditionally the male skeleton is broader, taller, which is right down to hands and feet. So is there sometimes a mismatch? Because it seems to me that we can feminise, or do feminisation of the face, does that then cause a mismatch with the skeleton below that face? Is that something that we see or not?

Alexandra Hamer:
I don’t think so, because one of the interesting things is that—I have a concept on my website, I call it the gender scale, it’s like a scale which goes from F5, which is the most feminine you could possibly be. To M5, which is as masculine as you could be, structurally, and GN in the middle, which is gender-neutral. So there are all these stages. The thing is, one of the things I discovered many years ago is trying to find an M5 and an F5 face, a face that is 100 per cent masculine extremely in every aspect, and the same for a feminine face. And if they just don’t exist, they just don’t exist. I mean, even things like, you could look at a hyperfeminine face like Marilyn Monroe, and she still has an m-shaped hairline, which is a masculinity. Technically it’s a masculinity. And again, if she came to me, I would say you don’t need to fix it. Sorry, you were saying about the mismatch, you have a very feminine face on a very, let’s say masculine body shape, no I don’t think that happens, because I think that happens in real life. I see people—cause obviously I am obsessed with faces, and I examine people’s faces all the time, I see people who are built like rugby players, who have massive, who are big blokes. You know what, your nose, forehead, and chin are entirely within feminine ranges. You don’t notice it, you know? Because—there was some huge boxer, I can’t remember who it was, and somebody was saying, now that’s a masculine face, and I said well actually, and I had to explain several things that they’re actually quite feminine. So it seems like it’s a very good question, but I don’t see that happening in real life. What you do see is things like, for instance, if somebody wants a tiny little turned-up nose, but they have quite an underlying facial structure, some of which you can’t fix, for example, if you have quite a long face. It’s a common problem for trans women. There’s a limited amount that you can do about that. But they want this sort of hyperfeminine nose like this tiny little turned-up nose. And if you impose a nose like that on a face like that, that can look kind of strange sometimes. Basically, it can look like a rhinoplasty, rather than the nose they would naturally have. So that’s an area where a juxtaposition can be a little bit jarring. But even then you can sometimes have somebody with a long face, and a little turned-up nose.

Dr Helen Webberley:
It’s that what you’re saying, isn’t it? That it’s really what we should be concentrating on is giving you your face shape back, kind of pre-testosterone, rather than choosing from a selection of noses which one would look better for you. It’s making you—feminising you, isn’t it, but not changing you. I think it’s absolutely fascinating. Once again, I’ve learned so much from you. I don’t know about you, Marianne, but I learn so much every time we talk to new people. It’s really fascinating. We’re going to put your website below the podcast so that people can have a look at what you do because I think it’s really—I think what you do really helps people and it also must be a huge help to surgeons and the doctors who are going to actually carry out the procedure that that person is thinking about and that you’re actually simulating with your photoshop.

Alexandra Hamer:
That depends a little bit on which surgeon you ask. I’ve made quite a few enemies because—one of the key things about what I do is people often come to me, and they’ve already spoken to several surgeons who may have several very long shopping lists. And I show them that you don’t need, this, this, this, or this. So there are quite a few surgeons who have said some fairly unpleasant things about me in the past.

Dr Helen Webberley:
Well, I think we all have our role to play in healthcare, in giving people the information so that they can make their own informed voices. That is what it’s all about. It’s been fascinating talking to you today. Thank you so much for sharing your knowledge with us and our listeners. It’s been really, really great. Thank you so much.

Alexandra Hamer:
You’re very welcome. Thanks for having me.

Marianne Oakes:
Bye.

Alexandra Hamer:
Bye.

 

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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