Feeling Complete After Transformative Surgery

Lucas Wilhite can't quite explain it, but he has always known he was different.

"It's been a knowledge I've always had," he says. "I wasn't born with the right body."

Assigned female at birth, Lucas is now 36 and finally completing his physical transition. His gender-affirming surgery is clinically known as metoidioplasty. The procedure involves a team of specialists working together to create a penis in a single surgery. It is the final surgical step for Lucas and the first such procedure to be performed at The University of Kansas Health System.

"The staff have been amazing," Lucas says. "Every doctor I've met with and everyone else through the health system were equally supportive. I couldn’t have asked for better care."

Lucas began his long-sought physical transition on April 23, 2016, when he started testosterone therapy. "I think every transgender person taking hormone replacement remembers their first time," he says. "It's a significant anniversary. It may sound cheesy, but some transgender men call it a 'maniversary,'" he says.

Like all new patients in the health system's transgender medicine program, Lucas first met with Judy Gay, RN, nurse coordinator. "Judy really is like a second mother to me," he says. "I met her right after I had started taking testosterone. I wanted to talk about the next steps, which would involve surgery. I could tell she understood my challenges."

Gay says that each patient she consults with is unique and requires personalized attention. For instance, Lucas wanted to completely transition, having all surgical intervention possible to remove his female anatomy and create male anatomy. However, not every patient wants every available procedure. Gay's first question always focuses on the individual's needs and goals. A care plan is developed based on that.

Lucas met early on with Meredith Gray, MD, a board-certified gynecologist who specializes in transgender surgery and serves as medical director in this area. "There's no 'right' way to transition," she says. "The goal is to alleviate each person’s gender dysphoria."

Gender dysphoria is the psychological designation describing the feeling that one's emotional and psychological identity as male or female does not match one’s biological sex.

Dr. Gray adds that choosing a specific procedure or planning a series of surgeries is a complicated equation. There may be multiple ways to approach specific surgical procedures, and Dr. Gray works with an interdisciplinary team, including specialists in urology, plastic surgery and gynecology. She also refers patients to mental health professionals, if needed, who provide pre-surgical letters of recommendation required by the World Professional Association for Transgender Health standards of care.

"It's actually rare for someone to come to us at the very beginning of the process," she says. "Some of our patients have been involved in transitioning for years before we see them. They may be just experimenting at home with changing their wardrobe or changing their identity among friends and family. Some have been seeing therapists for a long time. And some are talking to us about the medical aspects of gender reassignment for the first time."

Lucas asked Dr. Gray about a specific surgical approach he had learned about during his own research. She sought additional information and even traveled to study the procedure with its originator.

"We're one of only a handful of academic medical centers in the nation to provide these services," Dr. Gray adds. "The demand has always been there, but the transgender community has struggled with access to care. Now they have an option right here in the Midwest."

The patient base has been growing steadily and an increasing number of patients from outside Kansas and Missouri are finding their way to the health system.

"The bottom line is we want to perform the safest, most functional, most aesthetically accurate surgical solution possible for each patient," says Dr. Gray. "Our team's approach will continue to advance as we gain experience and continue to consult with experts around the world."

With the testosterone changing his voice and appearance, Lucas publicly changed his outward identity. "I had always been pretty androgynous," he says. "But the testosterone caused physical changes that made it easier for me to present myself as a man. It was easier for people to relate to me as a man because they could see the changes." He notes that most people who meet him now have no idea he was assigned female at birth.

Fortunately, Lucas is surrounded by supportive family and friends. "But I was my own worst enemy, judging myself more than other people judged me," he says. "With my clothes on, I feel confident, but seeing myself in the mirror was tough."

In September 2016, Lucas had a hysterectomy, and in June 2018 he underwent a double mastectomy, removing the breasts he’d been trying to hide for so many years. Before his metoidioplasty, Lucas met with all three physicians who were involved in the procedure. In addition to Dr. Gray, Satish Ponnuru, MD, a board-certified plastic surgeon, and Joshua Broghammer, MD, a board-certified urologist, participated.

"All three surgeons were passionate about making sure I meet my goals," Lucas says. "They wanted this to be perfect for me, and they were willing to put in time and commit to research to make sure the surgery was right for me."

Gender reassignment surgery sometimes requires multiple stages and procedures before the desired result is achieved. "Team Lucas" collaborated to complete the entire procedure in a single surgery. The result was a scrotum and penis with an elongated urethra, allowing for natural urination.

"I know not every transgender man feels the need to have gender reassignment surgery, but this is what I needed to do to feel complete as a man," Lucas says. "I think it's important to be open to all the possibilities, whether that means a full surgical transition or not. And that’s why I want to share my experiences with the community."