Doctor: Sex Change Treatments Could Start Early in Life

Loren Schechter’s surgical specialty would never be considered the easiest or most commonplace. Only three other surgeons in the United States and perhaps just 20 in the entire world are in the practice.

But, going forward, the Morton Grove-based doctor who handles the most difficult part of what he calls “gender-confirmation” surgery – once termed a “sex-change” operation – believes his job may get a bit easier and receive more social acceptance as medical research progresses in coming years.

That’s because the issues of the mind are probably more important than those of the body in determining the cause of gender identification – and whether both medical treatment and psychological counseling should begin in the pre-teen years when perplexed youths begin to wonder why they feel like one gender trapped in the body of the other.

“I think the ongoing areas of research are on the pediatric front — what age is it appropriate to begin treatment?” Highland Park resident Schechter said at his offices, headquartered for the past 11 years at 9000 Waukegan Road. “Get help as early as it (gender-identity issues are) manifested.”

Schechter said acceptance of the process has come via some insurance companies agreeing to pay for the surgery and more favorable portrayals in movies and TV shows. “There’s less discrimination,” he said. “Culturally, we’ve moved forward. In the European Union, they pay for much of the genitalia-related surgery.”

Surgeon among less than a handful in his specialty

While a bevy of plastic surgeons can handle facial, breast and other physical re-constructions necessary in the trans-gender process, Schechter and colleagues in Phoenix and San Francisco actually construct new genital organs for patients. But that is merely the end result of a long process involving hormonal treatments and intense psychological counseling. Schechter requires a team to handle patients. He works with Fred Ettner, a general practitioner, and wife Randi Ettner, a psychologist.

Gender-changing (or “re-assignment”) surgery has been done as far back as 1930. But the process has had to overcome a slew of social, legal and medical obstacles, with still more to come.

“Things like delaying puberty, medically or hormonally,” Schechter said of the ongoing research emphasis. “Preventing the development of secondary sexual characteristics – hair growth, bony prominence in the forehead region, which many people will try to undo through surgery at later stages. We’re medically able to do those things."

But he added that there are other issues – legal issues.

"The age of majority and the appropriateness to make some of these decisions, that’s the goals of research – what is the appropriate age? There are so many issues outside of the medical and psychological aspects: legal, religious, moral,” Schechter said.

Important in the issue is understanding if confusion over gender originates via genetics, whether an individual is “wired” as such, and then how much environment plays into the equation.

Nature vs. nurture?

“Emotionally, psychologically, chemically – probably all of the above,” Schechter said of the root causes. “There are many theories – whether it’s genetic and pre-wired, whether it is neural or hormonal, an influence in utero, whether there are anatomic or structural differences. So it’s probably some combination of biology and environment. Nature vs. nurture.”

Still, Schechter and associates have endured challenges in being able to perform surgery. Some religious-based hospitals have objected. Schechter performs his genital surgeries at Thorek Hospital on Chicago’s Near North Side, while his other plastic-surgery procedures are staged at Lutheran General Hospital in Park Ridge. The male-to-female surgery usually is a one-step major procedure. Due to the creation of entirely new physiology, female-to-male usually goes through three surgical steps.

“Our goals now are to have a cosmetically acceptable, functional genitalia,” Schechter said. “The techniques of male-to-female are not as involved as the technique of female-to-male. But we have reasonably good results of meeting our criteria, of meeting our requirements."

In order to achieve those results, a detailed and delicate process is needed, which varies for each gender. 

“Different techniques are used for female-to-male. One is simply designed to lengthen the urethra so they can urinate standing like a man in a men’s room. More sophisticated techniques create a neo-phallus. In order to achieve an erection, there’s an implant required, the same as the one for men experiencing impotence," he said. "It’s similar technology, but that’s part of problem – the implant was designed for a different group.”

While University Plastic Surgery has hundreds of patients overall, Schechter counts his gender-reassignment genital surgery patients “in the 50s.” With the scarcity of specialists, they come from all over the country. Part of Schechter’s schedule is flying to symposiums to exchange ideas with the select group of surgeons world-wide. He also will fly to Asia and Europe to observe their surgical techniques.

“You’re always drawing on the experiences of other individuals,” Schechter said.