“I have no idea what I’m doing,” he remembers thinking.“I’m going to stick to the things I know.” Meltzer knew nothing about transgender health in 1990, when he began working for Oregon Health & Science University in Portland.

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He was a year out of plastic surgery residency when two doctors at the Portland hospital approached him about taking over their practice.

A plastic surgeon and a urologist had been teaming up for gender-reassignment surgeries, but with both retiring, they wanted someone to continue their work.

Reliable statistical studies are notoriously elusive, but several European studies do seem to indicate generally positive satisfaction rates among patients, despite significant post-surgical mechanical issues.

(See sidebar.) Male-to-female surgery involves removing the testicles and tissue from the penis, inverting skin to form a vagina and turning scrotum skin into labia.

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