What is Transgender Surgery?
There are a few differences between the names you will hear related to transgender surgeries.
Transgender surgery is a general colloquial term for all types of surgeries related to affirm one’s gender.
Gender affirming surgery (or gender confirmation surgery) is the medical term that doctors use to designate transgender surgeries. There are five main types, as you will read later.
Finally, sex reassignment surgery or gender reassignment surgery are outdated terms for transgender surgeries that are generally no longer in use by medical professionals. As, we are not reassigning a gender; you know what your gender is.
Types of Transgender Surgeries
Non-Surgical Options
Hormone replacement therapy and puberty blockers
Hormone replacement therapy is usually where transgender individuals start. It consists in taking hormones of the desired gender, whether it be through pills, injections, or gels. This leads to changes such as voice pitch, facial structure (to an extent), hair growth, and fat distribution.
Puberty blockers are the option given to transgender minors. They basically delay puberty, and avoid the changes in secondary sexual characters usually associated with it such as hair growth, voice pitch change, penile growth, menstruation, chest growth, etc.
Voice training
Voice training is the process of doing specific vocal exercises to change one’s voice pitch. It can be done by oneself with exercises found on the Internet, or with a speech therapist.
Laser hair removal
Laser hair removal, usually catered towards transfeminine people, is the process of removing one’s body and facial hair in longevity by burning the hair follicles.
Surgical Options
For transfeminine people
Facial feminization surgery
This surgery aims to feminize the face to look more like cisgender women, and includes steps such as a lower hairline, less prominent brow bone and chin, fuller cheeks, rounded jaw, and smaller Adam’s apple (tracheal shaving).
Breast augmentation
In this surgery, the breasts are made bigger (keeping in mind that a year to a year and a half of HRT will make your breasts look natural) with saline or silicone implants, or by redistributing fat from the body.
Orchiectomy
It consists of removing the testes, which will lead to less production of testosterone in the body. This usually happens at the same time as a scrotectomy.
Scrotectomy
It consists of removing the scrotum, or the pouch surrounding the testes. It rarely happens without an orchiectomy at the same time.
Penectomy
This is the ablation of the penis. It is not the most popular option, as it does not preserve the tissues to recreate a vulva, but it is the right option for some.
Vaginoplasty
This surgery uses the penile tissues and sometimes the scrotal tissues to create a vaginal opening. This often happens alongside a labiaplasty and / or clitoroplasty.
Labiaplasty
In this procedure, genital tissue is used to recreate labia (minora and / or majora). This is usually an additional step to a vaginoplasty.
Clitoroplasty
In this procedure, the glans retains its eroticism and is used to create a clitoris. This is usually an additional step to a vaginoplasty.
Vulvoplasty
This operation constructs the parts of a vulva (the mons, labia, and clitoris) but not a vaginal opening. This can be an option for asexual transfeminine people.
Body contouring
Body contouring is done to make the body resemble more that of a cisgender woman. There may be fat redistribution, injection, or implants to widen the hips, thighs and butt, thin the waist, and more depending on the desired result.
Vocal Cord Surgery
In this surgery, the vocal cords are thinned out, shortened, or tightened, in order to produce a higher pitch.
For transmasculine people
Masculinizing facial surgery
This surgery aims to masculinize the face to look more like cisgender man, and includes steps such as a wider forehead, more prominent brow bone and chin, more angular cheekbones and jaw, and making the Adam’s apple appear.
Mastectomy
This operation consists of the ablation of the mammary gland (most often) and the removal of fat in order to create a flatter chest. This is sometimes accompanied by a nipple graft by moving the existing nipple (sometimes after a reduction); sometimes the patient chooses to keep the nipple in its size and placements; sometimes they decide to have it removed completely.
Several methods exist depending on the size and droopiness of the chest: double incision, keyhole, periareolar, flying brevet.. Your doctor will advise you on the best method to provide satisfying results and minimal scarring.
Hysterectomy
This consists in the removal of the uterus. It may be accompanied by the removal of the ovaries (oophorectomy). This surgery is still popular within transmasculine people who have an increased fear of ovary cancer while on testosterone, although this is not backed up by modern studies.
Oophorectomy
This designates the removal of the ovaries, It is usually conducted alongside a hysterectomy.
Vaginectomy
This consists of the vagina and vaginal opening to be removed. People who do not want a penis can choose this option (often for asexual people). The procedure often involves using the vaginal tissue to recreate genitals.
Metoidioplasty
During the procedure, the clitoris is pulled out (which is helped by the lengthening of the clitoris caused by HRT) to create a glans and penis. This procedure usually happens alongside scrotoplasty.
Phalloplasty
The skin of another body part (such as the arm or the thigh) is used to create a penis. This will give longer and girthier results than a metoidioplasty. It usually happens alongside scrotoplasty.
Scrotoplasty
It uses the outer part of the vulva to create a scrotum. Sometimes, silicone or saline implants are also added afterwards to look more like a cisgender scrotum.
Body contouring
Body contouring is done to make the body resemble more that of a cisgender man. It usually involves fat redistribution to make the butt, hips and thighs thinner, and the waist wider. Implants may be used to make the shoulders wider, ankles bigger, and more depending on the desired results.
Vocal Cord Surgery
In this surgery, the vocal cords are thickened up or lengthened in order to produce a lower pitch.
Which Is The Right Surgery For Me?
Choosing a surgery depends on several factors, including the goal, the desired result, and the budget.
You must wonder about the goal. If it is due to gender dysphoria about certain body parts, or to better fit in with your gender, then go ahead. If it’s due to peer pressure or you are a newly discovered transgender person, then it might be best to hit the brakes. Just like any cosmetic surgery, it requires a lot of thought and research put into it first.
Then, desired results. It is important to check the gallery of the clinic you wish to do your surgery in. Know that a mastectomy will leave scars, that you may lose sensation in certain body parts, etc. The practice of transgender surgeries still has a long way to go, so the results may not be perfect, and you need to consider that.
Finally, there is the budget. Transgender surgeries are very costly, and not always covered by insurance, depending on the country. You need to choose a surgery that you can afford, while still getting a result that pleases you and does not put your life in danger.
Where Can I Get Transgender Surgery?
Types of Facilities Offering Transgender Surgery
Large hospitals and university hospitals
Large hospitals and university hospitals tend to provide a variety of surgeries, which can include transgender surgery. This is especially true in big cities. The care they provide might be on a shorter shortlist and slightly less expensive, but colder.
Specialized clinics
Because transgender surgeries are specialized care, it is also possible to find smaller clinics that do them. They may provide more personal care, but the waitlist might be longer and the cost higher.
Countries That Commonly Offer Transgender Surgery
Thailand
Thailand is known for being a pioneer in the field of gender affirming surgery. Thailand, known for its top-notch medical facilities and talented surgeons, provides a secure and welcoming setting for those looking for gender affirming surgery. The infrastructure for medical tourism in the nation is advanced, and Bangkok is a center for such surgeries.
Germany
One notable European location for gender affirming surgery is Germany. Modern technology, high medical standards, and skilled surgeons are all features of the nation. Patients travel from all over the world to Berlin, which is known for its superior gender affirming surgery.
USA
With its extensive healthcare system and cutting-edge medical facilities, the US continues to be a popular destination for gender reassignment surgery. Renowned gender clinics in major cities like New York, San Francisco, and Los Angeles provide comprehensive care and a variety of procedures.
Brazil
Brazil is a leader in gender affirming surgery. The nation is a popular choice for people looking for complete makeovers because of its skilled surgeons who are knowledgeable about gender affirming surgery procedures.
Japan
With its culture of service, Japan is also a good destination for gender affirming surgery. Skilled and passionate surgeons can help you reach your goals. As well, like South Korea, Japan is big on cosmetic surgeries, so it is a good choice for facial feminization surgery.
If you want to learn more about gender affirming surgeries in Japan, check out our article!
How to Prepare for Transgender Surgery?
Paperwork
Before any surgeries, you will be prompted by your physician to see a psychologist, in order to assess your gender incongruence and dysphoria. It is not an assessment of “whether you are trans or not”, but rather to check if you are of sound mind to make those changes to your body.
Like for any surgery, you will also have to sign a document of informed consent regarding the life-altering nature of the surgeries and the knowledge of the medical risks associated with it (more about this later).
Finally, it is often necessary to have been on hormone replacement therapy before certain surgeries. This leads to better results, first of all, but also, if you remove the glands that produce the hormone of your sex assigned at birth, this can lead to medical issues.
Physical Preparation
Of course, your physician will first assess if you are healthy enough to undergo the surgery. Depending on the procedure, you may need to physically prepare for it. Before bottom surgery, transfeminine women receive electrolysis of the penile and scrotal skin to create hair-free tissue. As well, for a drastic breast augmentation, spacers may be placed inside the chest for a few days or weeks before the surgery.
Note that, depending on the procedure, you might need to stop your hormone replacement therapy before and after the surgery for some time (much like any medicine).
Mental Preparation
Changing a part of your body is a drastic, life-altering choice to make electively. A lot of transgender feel shock and sometimes regret upon seeing the results of the operation straight away (this usually passes afterwards). Therefore, you need to mentally prepare yourself. Your mental health professional can help you with this.
Post-Transgender Surgery Recovery
General advice
You will need to follow your doctor’s advice and care for the wounds properly. Wear the catheters, drains, and compression garments as needed, and be on the lookout for anything abnormal. Do not under- or over-take medicine, as this can hinder your healing and put you in danger.
Generally, your routine will have to change. You may need to bathe with a sponge for a while, and have a special diet. Avoid any strenuous task (over-extending your limbs, exercising, sexual activities) so that the wounds heal properly.
Facial reconstruction surgery
Swelling lasts for around two weeks to four months, depending on the procedure and your healing abilities.
Chest surgery
Swelling and soreness last for one to two weeks. Be mindful of your drains!
Bottom surgeries
Usually, healing lasts for about six weeks until you can return to your daily activities. Weekly follow-up visits are necessary for a few months.
For transfeminine people, packing or spacers are placed inside of the vagina for about a week to ensure that it does not close down. You will then need to use vagina dilators to increase the width of the vagina.
What Are The Risks to Be Aware in Transgender Surgery?
For transfeminine people
Breast augmentation
In addition to typical surgery complications (bleeding, infection, anesthesia complications), there are risks of allergy and rejection. Note that breast implants make it difficult to breastfeed.
Bottom surgeries
In addition to typical surgery complications (bleeding, infection, anesthesia complications), there is a risk of necrosis if the blood supply is cut off. There is also a risk of bladder and bowel fistulas. Finally, as the urethra is shortened, there is an increased risk of UTI, just like for cisgender women.
Body contouring
In addition to typical surgery complications (bleeding, infection, anesthesia complications), there is the risk of complications if you go the silicone-free injections way (cheaper). Indeed, this is not an FDA-approved use of silicone, and there are possibilities of infection, necrosis, migration of silicone, allergic reaction, silicone pulmonary embolism, and other organ damage. As well, you must always keep in mind to visit an accredited physician, as injections are one of those procedures that non-physicians do practice at even smaller costs.
For transmasculine people
Mastectomy
Complications are similar to other types of mastectomy, like bleeding, infection, drain blockage, or dehiscence (partial or total separation of the wound).
Metoidioplasty
If a person only gets a metoidioplasty and the vaginal opening remains, then penetration, pap smears, and vaginal exams may be impossible afterwards as it is usually much smaller.
Phalloplasty, Scrotoplasty
Complications of this surgery include urinary tract stenosis (obstruction or closing), necrosis, infection, and wound breakdown. There is often a loss of erotic sensation.
Conclusion
Transgender surgeries are extensive, but life-saving procedures. They require a lot of thought, and to do your research well in choosing the right surgery(ies) and physician(s).
At the end of the day, those surgeries will finally make you the person you want to be. You will look like, feel like, and engage in sexual activities like the gender you are.
It is wonderful to see how modern medicine has improved in practice and mindset to give transgender people the best life they can ever have.
