Gender Affirming Surgery

Gender affirming surgeries can be performed to better align the bodies of transgender and gender non-binary people with their gender identities. Not all gender diverse people need gender affirming surgeries.

Criteria for Surgery

Facial feminization surgery, chest surgery, and breast augmentation require 1 letter of support from a mental health provider competent in transgender health who determines that the patient meets the World Professional Association of Transgender Health (WPATH) Standards of Care criteria for surgeries. Genital surgery requires referrals and letters of support from two mental health providers competent in transgender health who determine that the patient meets the WPATH criteria. 

Types of Surgery

Masculinizing procedures

Chest-wall contouring (“top surgery”). This procedure removes most of the breast tissue; however breast cancer surveillance still needs to continue when indicated.

Hysterectomy includes removal of the uterus

Bilateral salpingo-oophorectomy includes removal of both fallopian tubes and ovaries.

Metoidioplasty lengthens the hormonally enlarged clitoris. Can also include formation of a scrotum and closure of the vaginal canal. Urethral diversion may enable standing with urination. Penetrative sex may not be possible.

Phalloplasty is a surgical procedure to construct a penis. A penile prosthesis is needed for sexual intercourse.

Feminizing procedures

Breast Augmentation (“top surgery”). This procedure increases breast size with fat grafting or implants.

Orchiectomy removes one or both testicles, and can be done in conjunction with other surgeries, such as vaginoplasty.

Vaginoplasty creates a vaginal vault and the vaginal lining is created from penile skin. An orchiectomy is performed, the labia majora are created using scrotal skin, and the clitoris is created from a portion of the glans penis. The prostate is left in place.

Facial Feminization Surgery (FFS) is when masculine facial structures are changed into a more feminine appearance. Examples include hairline advancement, brow lift, forehead contouring, rhinoplasty, and chin and jaw modification.

Tracheal Shave is a procedure that reduces the size of the “Adam’s apple.”

Other Procedures to Consider
Electrolysis and laser are procedures that remove hair from the body.

Potential Complications of Surgical Procedures

  • Bleeding
  • Infection
  • Wound healing concerns
  • Fistulas
  • Persistent pain or loss of sensation
  • Loss of sexual pleasure and functioning
  • Blood clots
  • Urinary concerns (e.g., incontinence)
  • Pelvic floor dysfunction

Insurance overage

Some insurance companies do not cover all recommended services, even though they are medically necessary. Patients should determine what coverage is provided by their health insurance.

An endocrinologist will play an important role in your care team, find one today!

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