Sex Reassignment Surgery Guide: Everything You Need to Know from Preparation to Recovery

Sex reassignment surgery (SRS) is a monumental step toward living authentically embraced by many. In the U.S. alone, around 9,000 transgender surgeries take place annually, with numbers soaring 3 times in just a few years. Yet, this transformation often comes with a mix of excitement and apprehension. Patients harbor understandable fears and concerns about the surgical procedures, outcomes, and the impact on their lives moving forward. Will the results reflect my identity? What is recovery like? Will I have any regrets? Questions like these can loom large in the minds of those considering such a significant life decision.

This article aims to demystify the process of sex reassignment surgery, covering everything from existing options and requirements to preparation and recovery. Whether you're considering embracing your true self or supporting someone on their journey, here’s your ultimate guide to navigating the complexities of gender-affirming care.

Table of Contents

1. What is Gender Confirmation Surgery?
2. Types of Sex Reassignment Surgery
3. Best Gender Reassignment Surgeons
4. Requirements for Gender Reassignment Surgery
5. Recovery from Gender Affirmation Surgery
6. FAQ
7. Interesting Facts
8. Takeaways

What is Gender Confirmation Surgery?

Gender confirmation surgery (or gender affirmation surgery) is an umbrella term for procedures that help align a person’s physical appearance with their gender identity.

Gender confirmation surgery enables transgender people to feel comfortable in their skin by giving them the physical appearance and functional abilities of their gender. These changes not only alleviate the distress associated with gender dysphoria but also empower individuals to navigate the world in a way that truly reflects their identity.

🏳️‍⚧️Gender Confirmation Surgery vs. Gender Reassignment. You might hear the terms "gender confirmation (affirming) surgery" and "gender (sex) reassignment surgery" used interchangeably. They both refer to the same medical procedures that help patients match their physical appearance and inner self. The only difference is that “gender confirmation surgery” (or “gender-affirming surgery”) is a more recent term. It emphasizes that the surgery confirms the individual's gender identity, which they have always known internally, rather than changing it.

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Types of Sex Reassignment Surgery

Sex reassignment surgeries focus on modifying both primary and secondary sex characteristics. They can facilitate:

• male-to-female (MTF) transition and a more feminine appearance for people assigned male at birth (AMAB);
• female-to-male (FTM) transition and a more masculine appearance for people assigned female at birth (AFAB);
• transition beyond traditional binary options for non-binary patients experiencing body dysphoria.

Sex reassignment surgeries can be broadly categorized into several types, outlined below.

Bottom Surgery

This category refers to genital reconstructive surgeries. The goal is to give the patient’s genitals the appearance and sometimes functionality that aligns with their identified gender. 

Having genitals that match one's inner sense of self can significantly ease gender dysphoria. Following genital reconstruction, transgender people report feeling more at ease with their sexual partners, in healthcare environments, and in public spaces.

For male-to-female (MTF) transition, genital surgery includes:

• penile inversion vaginoplasty — the primary procedure, creating a vaginal canal and vulva from penile and scrotal tissue;
• vulvoplasty (zero-depth vaginoplasty)— a less invasive procedure, constructing female external genitalia (the vulva) without a vaginal canal;
• orchiectomy — the removal of testicles to decrease testosterone production.

For female-to-male (FTM) transition, genital surgery usually involves two main options: 

• phalloplasty — constructs a penis using tissue from other parts of the body like arms or legs;
• metoidioplasty— a less complex procedure that creates a smaller penis from existing clitoral and vaginal tissue, enhanced through testosterone therapy. 

Both surgical options can include the construction of testicular implants (scrotoplasty) from the labia majora and the implantation of erectile prosthetics.

Top Surgery

This sex reassignment surgery alters the chest to match the patient's identity.

• Feminizing top surgery involves breast augmentation, typically using implants to create a fuller, more traditionally feminine chest.
• Masculinizing top surgery involves removing breast tissue (mastectomy) and chest contouring to achieve a flatter appearance.

Facial Reconstructive Surgery

Facial reconstructive surgery for gender affirmation sculpts the face to reflect a more feminine or masculine appearance, depending on the type of transition. This category encompasses a variety of procedures and often requires the expertise of multiple plastic surgery specialists. 

Beyond aesthetic enhancement, these surgeries offer significant psychological benefits, including alleviating gender dysphoria and boosting self-confidence. Besides, the ability to "pass" can provide an added layer of safety for transgender people in a society where transphobia still exists.

Facial feminization surgery (FFS)softens masculine contours and can consist of:

• rhinoplasty;
• cheek augmentation;
• jaw reshaping;
• tracheal shave (thyroid cartilage reduction) — Adam's apple reduction.

Facial masculinization surgery (FMS) creates a more angular, traditionally masculine appearance through plastic surgery and may involve:

• jaw and chin;
• cheeks;
• forehead;
• nose;
• throat (to create an Adam’s apple).

This type of sex reassignment surgery is less common than FFS. Trans men often find that testosterone therapy promotes masculine appearance without the need for surgery.

Voice Surgery

This surgical procedure, along with voice therapy, helps patients modify their vocal pitch and resonance.

• Voice feminization surgeryraises the voice pitch of transgender women. It is often accompanied by voice therapy to achieve an authentic tone and feminine sound.
• Voice masculinization surgeryaims to lower the pitch of the voice. Similarly to facial masculinization surgery, this procedure is less popular since testosterone therapy deepens the voice naturally.

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Best Gender Reassignment Surgeons

Requirements for Gender Reassignment Surgery

The highest standards for transgender healthcare, including SRS, are set forth by the World Professional Association for Transgender Health (WPATH). Its guidelines are considered best practices in the field of transgender medicine. Many surgeons and insurance companies require transgender patients to submit evidence regarding WPATH guidelines before the surgical procedure. The criteria include:

1. Informed consent. Understanding the risks, benefits, and permanent changes associated with gender affirmation surgeries is crucial. Patients must provide informed consent, indicating they fully understand the scope of the surgery and its impact on their lives.
2. Letters of readiness. WPATH guidelines require letters of readiness from a mental health professional. These letters should outline your treatment progress and eligibility for surgery. One letter is required for breast/chest surgery and some facial surgeries, and two letters for genital surgeries. However, some medical practices deem the informed consent model sufficient and don’t require letters of readiness.
3. A history of gender dysphoria. You may need to provide health records supporting consistent identification with a gender different from the one assigned at birth.
4. Hormone therapy. For certain surgical procedures, preoperative hormone therapy may be necessary. The hormones induce physical changes that can enhance the outcomes. The duration of hormone therapy varies but is typically around 1 year.
5. Physical health. A general health assessment is necessary to ensure the individual is fit for surgical procedures. This includes evaluating any underlying conditions that could complicate surgery or recovery. Smokers, for example, may be asked to quit, as smoking can hinder healing.

Recovery from Gender Affirmation Surgery

Recovery from gender affirmation surgery is a period that demands careful self-care and support. This time is crucial for healing and adjusting to physical and emotional changes.

Recovery Timeframes

Recovery time will differ depending on the type of sex reassignment surgery:

• Facial surgeries. Swelling typically reduces in 2-4 weeks for cheek and nose procedures. Chin and jaw surgeries might see swelling subside within 2 weeks, but complete healing can take up to 4 months.
• Chest surgery. Expect swelling and soreness for 1-2 weeks. It is recommended to avoid vigorous activities for at least a month.
• Bottom surgery. Patients can resume their usual activities after at least 6 weeks, with weekly follow-up doctor visits for a few months. It’s crucial to abstain from sexual activities for 6 weeks after phalloplasty and for 12 weeks after vaginoplasty.
• Voice surgery. Complete recovery will take about 3 weeks, with absolute voice rest required for the first 7 days post-surgery.

Post-Surgery Care 

Immediately after the surgical procedure, patients receive detailed care instructions from their surgical team. Here’s what you should focus on during the post-surgery period:

• Wound care. To avoid infections, follow your doctor's guidance on wound care and handling catheters and drains. You may also need compression garments to reduce swelling and encourage quicker wound healing.
• Medication. Ensure you take all prescribed medications. Reach out to your healthcare provider for any issues regarding pain control.
• Avoiding strain. Prior to surgery, arrange your living space to minimize the need to reach for items and reduce the risk of post-operative injuries. You'll also need to make temporary changes to your daily activities, such as limiting physical exertion and sexual activities.
• Nutrition. Your doctor will help you establish a diet that promotes healing, providing your body with nutrients.
• Emotional support. It can come from support groups, mental health professionals, friends, and family. The transition period can evoke many emotions, and a strong support network helps navigate these changes.
• Long-term care. Beyond the immediate recovery period, long-term follow-up care may be necessary, including hormone therapy adjustments and attending to any surgical revisions if needed. Open communication with healthcare providers ensures ongoing health and satisfaction with surgery outcomes.

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FAQ

What kind of doctor does gender reassignment surgery?

Sex reassignment surgery involves a multidisciplinary team of medical professionals, ensuring comprehensive care before, during, and after the procedure. Your gender affirmation surgery team may include the following:

• urologist — specializes in the urinary tract and male reproductive organs, playing a pivotal role in female-to-male surgical procedures;
• gynecologist — focuses on female reproductive health, contributing expertise for patients transitioning from male to female;
• plastic surgeon — central to the team, plastic surgeons perform surgical procedures to modify physical appearance in line with gender identity;
• otolaryngologist — involved in procedures related to the throat, including voice modification surgeries;
• speech-language pathologist (SLP) — helps modify vocal patterns.

How long does gender reassignment surgery take?

The duration of sex reassignment surgery varies. Some procedures, like chest surgery, are completed in one day. Others, such as phalloplasty, require multiple surgical procedures over time. You might need additional surgical interventions later, depending on your satisfaction with the results.

What is the cost of transgender surgery?

Gender-affirming surgery can cost from $3,000 and reach up to $75,000, depending on the procedure. This table represents approximate prices for some types of sex reassignment surgeries:

Surgery Type	Price
MTF bottom surgery	$6,000-$30,000
FTM bottom surgery	$20,000-$50,000
MTF top surgery	$5,000-$10,000
FTM top surgery	$3,000-$10,000
Facial feminization surgery	$20,000-$50,000
Facial masculinization surgery	$1,000-$20,000
Voice feminization/masculinization surgery	$5,500-$9,000

Is gender-affirming surgery covered by insurance?

Whether gender-affirming surgery is covered by insurance depends on the policy and the provider. Many insurance plans, especially those in regions with inclusive health policies, do cover gender-affirming surgeries. However, insurance coverage varies widely and typically doesn’t extend to cosmetic procedures. Most insurers require documentation such as letters of readiness or evidence of persistent gender dysphoria.

How old do you have to be to get gender reassignment surgery?

In 2022, WPATH suggested lifting the age restrictions for youth seeking gender-affirming surgery. However, most regions still require individuals to be at least 18 years old to consent to surgery. In some instances, younger patients may access hormone therapy or even undergo surgery with parental consent and a comprehensive psychological evaluation. 

In the European Union, the age at which one can undergo sex reassignment surgery without parental or public authority consent is typically 18. However, in some countries, it can be as low as 15. 

In the United States, the legal landscape is mixed, with 22 states banning gender-affirming surgery for minors and 21 of those also restricting hormonal treatment.

What is transgender surgery regret rate?

Studies on transgender surgery regret rates have generally found them to be low — approximately 1%. The vast majority of individuals who undergo gender-affirming surgeries report satisfaction with the outcomes and a significant improvement in quality of life, mental health, and gender dysphoria.

What is non-binary surgery?

You can undergo gender-affirming surgery if you do not identify as transgender. Non-binary, genderqueer, gender-fluid, and gender-nonconforming people may also seek gender-affirming surgeries. In fact, a study found that 77.2% of non-binary participants were interested in sex hormones or surgery to alleviate gender dysphoria.

These procedures aim to align patients’ physical appearance with their gender expression, regardless of whether they identify within or outside the binary categories of male and female. The focus is on ensuring that each individual feels comfortable in their body and that their physical appearance reflects their true self.

Among the surgical options non-binary people might consider are:

• chest surgery;
• metoidioplasty/phalloplasty;
• orchiectomy;
• penectomy — the removal of the penis;
• genital nullification — removing all external genitalia;
• vulvoplasty — creates the labia and clitoris without constructing a vaginal canal;
• penile-preserving vaginoplasty — creating a functional vagina while preserving the penis.

What is transgender sex like after surgery?

Gender affirmation surgeries such as vaginoplasty and phalloplasty aim to create genitalia that are not only visually affirming but also capable of sensation and sexual function. As healing progresses, individuals often report increased sensitivity and the ability to experience pleasure.

• Vaginoplasty. Nerve regeneration, crucial for sensation, may start around 3 weeks post-surgery but can take a year or more for full sensation to return.
• Metoidioplasty. This surgery usually doesn't create a penis large enough for penetrative sex. However, sexual arousal and orgasm are still achievable, with many even reporting heightened sexual satisfaction post-surgery. 
• Phalloplasty. For those prioritizing penetrative sex and the ability to maintain an erection, an erectile prosthetic can be implanted during one of the stages of phalloplasty. Orgasm post-phalloplasty remains possible.

Interesting Facts

Who invented transgender surgery?

Transgender surgery, as we know it today, evolved through the contributions of many pioneering doctors over the years. Figures like Magnus Hirschfeld (Germany) laid the groundwork in sexology in the early 20th century. Surgeons like Georges Burou (Morocco) and Elmer Belt (USA) further developed surgical techniques in the mid-20th century. Interestingly, Harold Gillies, the father of plastic surgery, performed the first female-to-male bottom surgery (phalloplasty) in the 1940s.

When was the first transgender surgery performed?

The journey of transgender surgery began over a century ago. These trailblazers remind us that the desire to align one's physical body with one's true identity has always been part of the human experience:

🏳‍⚧Alan L. Hart (1917). One of the earliest recorded transgender surgical procedures was performed on Alan L. Hart, an American who underwent a hysterectomy in 1917 as part of his transition.

🏳‍⚧Dora Richter (1922-1931). Under the care of Dr. Magnus Hirschfeld in Berlin, Richter became the first known trans woman to complete male-to-female gender affirmation surgery.

What transgender celebrities have affirmed their identity through surgery?

Several transgender celebrities have publicly shared their journeys of gender affirmation through surgery, raising awareness and understanding of transgender experiences. Here are some notable examples:

🌟Caitlyn Jenner. Former Olympic athlete and reality TV star, Jenner became one of the most famous trans women after her very public transition in 2015.

🌟Laverne Cox. An acclaimed actress and LGBTQ+ advocate, Cox became the first openly transgender person to be nominated for a Primetime Emmy Award.

🌟Wachowski Sisters. Lana and Lilly Wachowski, directors of the groundbreaking Matrix trilogy, transitioned publicly in 2010 and 2016, respectively, becoming two of the most prominent figures in the film industry to do so.

🌟Hari Nef. An actress and model, Nef made headlines for her role in the highly anticipated movie Barbie, marking a milestone for transgender visibility and representation in mainstream media.

🌟Elliot Page. Known for his roles in Inception, Juno, and The Umbrella Academy, Page announced his transition in 2020 and became one of the most prominent trans men in Hollywood.

🌟Kim Petras. A German singer-songwriter, Petras made history as one of the youngest individuals to undergo gender confirmation surgery at age 16. She has since become a pop sensation known for her catchy tunes.

Takeaways

• Gender confirmation surgery is a set of procedures that help align a person’s physical appearance with their gender identity. This step empowers transgender people to feel comfortable in their skin and live as their true selves.
• Gender-affirming surgeries can be broadly categorized into bottom surgery (genital reconstruction), top surgery (chest alteration), facial surgery, and voice surgery.
• Accessing sex reassignment surgeries involves criteria like informed consent, mental health evaluations, and sometimes hormone therapy, guided by standards set by the World Professional Association for Transgender Health (WPATH).
• While letters from mental health professionals are widely requested to demonstrate readiness for surgery, many practices are moving towards an informed consent model. This model emphasizes patient autonomy by allowing individuals to proceed based on their informed understanding of the surgery's risks and benefits.
• Depending on the procedure, the recovery period may range between 1 and 12 weeks. 
• Gender-affirming surgery costs vary significantly depending on the procedure, generally ranging from $3,000 to $50,000.
• Many insurance plans cover gender-affirming surgeries, though the extent of coverage varies widely. Insurers often require evidence of persistent gender dysphoria.
• Although WPATH suggests lifting age restrictions for youth seeking gender-affirming surgery, most places require transgender patients to be at least 18 years old, with some exceptions for minors.
• The practice of transgender surgery is not new but has evolved over a century, reflecting a longstanding quest for authenticity and recognition within the transgender community.