medicine through time

Supervisor: Worker 72094. You failed to meet your quota for 3 weeks in a row now.

Worker 72094: I can explain!

Supervisor: You're clearly burned out. I heard you moved recently. Take a mandatory two weeks paid vacation to readjust and report to me then.

Worker 11335: Is it because I badmouthed the company during lunch?

Shadowy Board Member: That is correct. We are very displeased, Worker 11335...

Worker 100100: What's with the mask?

Of course. All Hopeless Inc. employees are due-paying members of Mindless Drones United.

Eridians' perception of the world relies on something that is completely absent in space — sound. They haven't been looking at the stars their entire existence the way we have. Their concept of aliens might only be as old as their discovery of astrophage. They made a bad ship, because it was their first one ever! Rocky himself says they rushed it, and that multiple (vital) things broke. Their mission was just as much of a Hail Mary pass as ours was — they had no idea what they were doing, if they could even travel in space safely. And, as it turns out, they couldn't.

Humans are the ones who have been doing it over multiple lifetimes. Mary is state of the art. We've been space farers longer than most humans have been alive. We can actually see through space. We are more likely to survive exposure to the void. We can encase our lighter, more flexible, more mobile bodies in a material that lets us walk outside of our ship, and, to a degree, we can get our bearings out there in a way Eridians just can't.

Facial Masculinization (FMS) . Which includes:

Tracheal Augmentation: Creating an Adam's Apple.

Rhinoplasty: AKA a "nose-job" , while many people get these to make there nose smaller, transmasc people can also get them to make ther bridge and the overall structure larger, wider, and more prominent.

Brow Bone Augmentation & Hairline Repositioning (this usually involves adding an implant)

Jaw and Chin Augmentation (this usually involves adding an implant)

Buccal Fat Removal: Removes fat from the cheeks, to make the face less round.

Dermal Fillers: Temporarily builds volume in the chin, cheeks, or jawline without major surgery.

Beard implant: Moves hair follicles from a donor area (usually the back of the scalp or under the chin) onto the face to create a thicker or fuller beard

Vocal masculinization. Which includes:

Type III thyroplasty: lowers the pitch of someone's voice by relaxing the vocal chords.

Injection laryngoplasty: adding volume to the vocal folds using derma fillers or autologous fat. Derma fillers are temporary and fat grafting is significantly more long lasting.

Direct vocal fold testosterone injections: Exactly what it says in the tin, they inject testerone directly into your vocal chords and it lowers the pitch. This is a new procedure and we're unsure if it's temporary or permanent.

Body Masculinization. Which includes:

Body Sculpting Liposuction: Removes fat from the hips, flanks, thighs, and lower back to straighten the waistline and square the torso.

Top Surgery or chest masculization. Which includes:

Double Incision mastectomy: This is the one most people know. Two long horizontal cuts across the chest; used for medium to large chests or extra skin; nipples are typically resized and grafted back on. You can leave the nipples off if you want. There is a small chance of loosing nipple sensation.

Inverted-T (Anchor): Uses a horizontal cut plus a vertical drop down to the nipple; keeps the nipple attached to its blood supply/nerves; good for larger chests wanting to save nipple sensation.

Buttonhole: Similar to the inverted-T but without a major vertical skin removal; keeps the nipple attached on a stalk to preserve sensation.

Peri-Areolar (Circumareolar): A circular cut around the outer edge of the areola to remove tissue and extra skin rings; best for small chests with good skin snap-back.

Keyhole: A tiny cut along the bottom edge of the areola; used for very small chests (A-cup or small B-cup) with no loose skin; leaves minimal scarring.

Bottom Surgery or FTM/FTX SRS:

Phalloplasty: Builds a full-sized penis using a skin and tissue graft from the forearm or thigh, done in multiple stages and often including urethral lengthening and erectile implants (see more on erectile implants in the next section). The natal neo phallus is typically buried at the root of the phalloplasty shaft. There is unfortunately a lot of fear mongering and misinformation about Phalloplasty. Most Phalloplasty images you see shared are either mid stage (not completed) and/or haven't healed yet.

Glansplasty: This surgical procedure creates the look of a circumcised penis. A crown is added after phalloplasty for a more aesthetically typical phallus.

Glans Implant: silicone ridge added to Glansplasty to prevent flattening. To my knowledge currently only Dr. Curtis Cane performs this.

Metoidioplasty: AKA "Meta". Uses the natal neo phallus growth that develops from being on testosterone therapy to create a small (2-3 inches typically) penis, preserving full sensation, the ability to have erection without an implant or external device, and has a shorter recovery time.

Scrotoplasty: Shapes labial tissue into a scrotum and places silicone testicular implants. Avaliable with both phalloplasty and metodioplastly.

Urethroplasty: lengthen and reroute the urethra, which allows you to stand and pee. Possible with Phalloplasty, metodioplastly, and non phallus constructive vaginectomy.

Vaginectomy: Removal of the vaginal canal and labia and the the vaginal opening is sutured shut. This is not required to have Phalloplasty or metodioplastly. It is also possible to get a vaginectomy without constructing a phallus, resulting in a smooth transition from the abdomen to the groin, without any genitals. A hysterectomy is required to get a vaginectomy.

Erectile Implants for Phalloplasty. Which include:

Inflatable Implants: Fluid-filled systems (available in 2-piece or 3-piece configurations) that use a scrotal pump to inflate cylinders for an erection and a release valve to return to a flaccid state.

Malleable Implants: Aka "semi-rigid rods". Bendable silicone or wire rods laced inside the phallus that can be manually moved up for use and down for concealment.

The ZSI-475 FTM: This is the only implant designed specifically with transgender men in mind. It is an inflatable implant and has a single piece configuration. It provides an incorporated anchorage plate, in the proximal part of the cylinder, composed of stainless steel and silicone to be sealed with four non-absorbable stitches to the pubic periosteum. The pump is testicle-shaped to improve aesthetical appearance of the scrotum. It is a relatively new implant and less data on it is avaliable in comparison to other erectile implants.

Non Surgical Erectile Devices for trans men post bottom surgery:

The Elator: Consists of two silicone or expandable bands connected by plastic-coated rigid or flexible metal support rods, which hold the phalloplasty in an erect position.