The outcome of sex reassignment surgery in Belgrade: This is commonly performed on the ulnar aspect of the skin island. Heterosexual and homosexual gender dysphoria. The combination of emasculation as teenagers combined with use of estrogen enables some Hijra now to become very beautiful - even though, sadly, they do not have female genitalia vaginas and are not socially accepted as women. In efforts to ease their suffering, he began prescribing estrogen to selected patients in response their profound pleas for medical feminization. With smoking being a significant risk factor, under our current policy, we no longer operate on patients who fail to quit smoking one year prior to their surgery.