At least since May 10th, 2014 everybody knows “her”: Conchita Wurst sang herself into people’s hearts with her ballade Rise like a Phoenix at the 59th Eurovision Song Contest in Copenhagen. A honorable performance – because up to now only the world-famous Udo Jürgens accomplished to get the title for Austria in the sixties with the popular song Merci Cherie.
Our landlocked country was thus represented successfully in one case by a man and in the other one by a woman… or actually by an androgyne, a transgender person, as it is called nowadays.
It is well known that Conchita was born as Thomas Neuwirth. To take a stand against discrimination of homosexuals Tom turned into the artificial character Conchita Wurst. The self-appointed drag queen of course did undergo several changes – the beard had to stay for the reason of being a distinctive mark of the brand “Conchita Wurst”. It is worth noting that “Conchita” (shell) means “vagina” in the Spanish colloquial.
Vast amounts of makeup, extensions and glittery gowns alone do not make up a transgender person alone. Depending on how far one wants to go, different additional interventions may be necessary. At the beginning of such metamorphosis of an androgyne “phoenix” there is often a hormonal change. Hormones are messenger substances which take effect within a complex control circuit and control numerous tasks both in male as in female bodies. Depending on the sex different hormones are released in varying amounts and show their impact on our body.
In female bodies larger amounts of the sexual hormone estrogen are produced than in men. Among other hormones estrogens are responsible for growth of the female breasts. These and other effects of estrogen are utilized by transgender people to make their body more female. After analysis of the hormonal status a hormone therapy that is tailored to the patient’s individual needs can be started. In our point of view the option which has proven to be the best is the one where bioidentical hormones are administered, which correspond to the body’s own hormones in chemical structure and thus – other than artificial hormone drugs – hardly cause any side effects when being administered in right dose.
A result can already be seen after a few weeks. Because of fat deposits and enlargement of the glands a female breast can be recognized and also the body composition changes: The body fat content increases and muscle mass decreases. These are signs that the body adapts to female conditions.
The breast is growing due to the intake of hormones, but rather equals a girlie breast than a female breast. Thus transgender people often express the wish for further measures for breast augmentation. Silicone implants are mostly unwanted in those cases because they seem anything but natural.
Breast augmentation with autologous fat or stem cells is an alternative to the foreign object silicone. However, even this breast augmentation technique requires further preparation in transgender people. After it has been clarified that enough body fat is available for the treatment, pre-stretching of the flat breasts using a suction bra or with frequent injections of saline solution is necessary. The latter you may already know from my blog posting about breast augmentation for one night.
Assuming continuous intake of female hormones it is usually possible to obtain the needed amount of fat also in transgender people. A breast augmentation with autologous fat (lipofilling) or stem cells (stem cell-assisted fat transfer) is a proper alternative to silicone for transgender persons in order to obtain natural female breasts.
What is now the résumé? Transgender people who want to accentuate the female aspects of their bodies have to make their bodies more female with the help of hormones. Of course, such a drastic intervention in the hormonal balance and the body should be considered carefully and is not easily possible from a legal point of view. If the decision has been made definitely, typical female body forms can be enhanced and emphasized by aesthetic procedures, for example using autologous fat and stem cells.
It will be interesting if our national drag-queen Conchita will approach with a female cleavage on parties or on stage in the foreseeable future. Indeed estrogens do not really go together with growth of a beard. Thus Conchita would have to decide either for a female body or for her distinctive mark.
DDr. Heinrich, MD