For many transgender people, sex reassignment surgery (SRS) is a big step toward living authentically. In the United States alone, the number of these operations nearly tripled in three years, from about 4,500 to over 13,000 a year. SRS is a group of operations that change the body to match a person's gender identity. It is also called gender confirmation surgery or gender-affirming surgery.

Key Takeaways

  • SRS: $5,600–$9,300 in Thailand, from $14,600 in Turkey, $32,000–$60,000 in the US.
  • Savings vs the US: 70%–90% in Thailand, 50%–75% in Turkey.
  • MTF bottom surgery: from $6,600 in Thailand vs $50,000–$80,000 in the US.
  • Phalloplasty: $15,000–$25,000 in Turkey vs $80,000–$160,000 in the US.
  • Top surgery: from $2,800 in Turkey and $3,200 in Thailand.
  • Bangkok package with a 16-night hotel stay: about $10,400.
  • Results: 93% satisfied, about 1% regret.

gender affirmation surgery overview

Table of Contents

  1. What Is Sex Reassignment Surgery (SRS)?
  2. Types of Sex Reassignment Surgery
  3. Requirements for Gender Reassignment Surgery
  4. How Much Does Sex Reassignment Surgery Cost?
  5. Best Gender Reassignment Surgeons
  6. Recovery from Sex Reassignment Surgery
  7. Interesting Facts About Sex Reassignment Surgery
  8. Bottom Line
  9. FAQ

What Is Sex Reassignment Surgery (SRS)?

Gender confirmation surgery (or gender affirmation surgery) is an umbrella term for procedures that change the body's appearance, and sometimes its function, to match a person's gender identity. Surgeons perform these operations to ease gender dysphoria.

Gender dysphoria refers to the psychological distress that arises from a mismatch between a person's experienced gender and their physical characteristics.

Surgery is usually one step of a wider transition that can also include hormone therapy and voice training. Each person decides which operations to have, so one patient may choose chest surgery alone while another also has genital surgery.

Gender confirmation surgery and gender reassignment surgery name the same operations. The newer term says that the surgery confirms a gender identity the person already has. The same operations are also known as a sex change operation or gender change surgery.

Types of Sex Reassignment Surgery

Sex reassignment surgery covers operations on the genitals, the chest, the face and the voice.

types of gender affirmation surgery

Depending on the person's goals, these surgeries can support:

  • 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);
  • a transition outside the male and female categories for non-binary patients with body dysphoria (distress about specific body features).

Bottom Surgery

Bottom surgery is genital reconstruction. It gives the genitals the appearance, and sometimes the function, that matches the patient's gender identity.

Genitals that match a person's sense of self can ease gender dysphoria. After genital reconstruction, transgender people report feeling more at ease with sexual partners, in health care settings and in public spaces.

For male-to-female (MTF) transition, genital surgery includes the procedures below.

MTF Genital Surgery Procedures

Male-to-female genital surgery is built around one main operation. The choice depends mainly on whether the patient wants a vaginal canal. Orchiectomy can be done on its own or as part of vaginoplasty.

  • Penile inversion vaginoplasty. It is the main procedure and creates a vaginal canal and vulva from penile and scrotal skin.
  • Vulvoplasty (zero-depth vaginoplasty). This less invasive operation creates the external female genitals (the vulva) without a vaginal canal.
  • Orchiectomy. The surgeon removes the testicles, which lowers testosterone production.

Surgeons can also line the vaginal canal with tissue other than skin. One option is tissue from the lining of the abdomen (peritoneal vaginoplasty), and another is a section of the bowel (colon vaginoplasty). Both linings produce some natural moisture. For example, Bookimed's partner Wansiri Hospital in Bangkok offers skin graft, peritoneal and colon vaginoplasty packages.

MTF gender affirmation surgery

For female-to-male (FTM) transition, genital surgery usually involves one of the two options below.

FTM Genital Surgery Options

The two options differ in the size of the result, the number of operations and the recovery time.

  • Phalloplasty. The surgeon creates a penis from tissue taken from another part of the body, such as the forearm or thigh.
  • Metoidioplasty. This less complex operation creates a smaller penis from the clitoris after testosterone therapy has enlarged it.

Either operation can include scrotoplasty (creating a scrotum from the labia majora, the outer folds of the vulva), into which testicular implants may be placed. A surgeon can also place an erectile implant to allow erections. Some FTM patients also have a hysterectomy (removal of the uterus) as a step of their transition.

metoidioplasty
Four major checkpoints in a metoidioplasty surgery. Picture by TailorCat, licensed under CC BY-SA 4.0.

Top Surgery

Top surgery changes the chest to match the patient's gender identity. Bookimed's partner top surgery clinics perform the following operations:

  • Feminizing top surgery. The surgeon enlarges the breasts, usually with implants, to create a fuller chest.
  • Masculinizing top surgery. The surgeon removes breast tissue (mastectomy) and contours the chest to make it flatter.
feminizing top surgery
Feminizing top surgery
masculinizing top surgery
Masculinizing top surgery

Facial Surgery

Facial surgery for gender affirmation reshapes the face to look more feminine or more masculine, depending on the transition. It covers several procedures and often involves more than one plastic surgery specialist. These operations can ease gender dysphoria and improve self-confidence.

Facial feminization surgery (FFS) softens masculine features. FFS procedures can include:

  • rhinoplasty (nose reshaping);
  • cheek augmentation;
  • jaw reshaping;
  • tracheal shave (thyroid cartilage reduction), which makes the Adam's apple smaller.

Facial masculinization surgery (FMS) creates a more angular, masculine look. FMS procedures may change these areas:

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

Facial masculinization surgery is less common than FFS, because testosterone therapy can make the face look more masculine without surgery.

Voice Surgery

Voice surgery changes the pitch of the voice and is usually combined with voice therapy, which is training with a speech specialist. The options are:

  • Voice feminization surgery. It raises the pitch of the voice for trans women, and voice therapy afterward helps create a feminine tone.
  • Voice masculinization surgery. It lowers the pitch of the voice and is less common, because testosterone therapy deepens the voice on its own.

Requirements for Gender Reassignment Surgery

Gender surgeons base their requirements on the Standards of Care that WPATH (the World Professional Association for Transgender Health) publishes. Before approving an operation, the surgeon checks the following:

  • Informed consent. You confirm in writing that you understand the risks, benefits and permanent changes of the surgery.
  • Assessment letter. This letter of readiness describes your treatment so far and confirms that you are eligible for surgery. Earlier WPATH standards asked for one letter before chest surgery and two before genital surgery. Under the current WPATH standards, one written opinion is enough for genital, chest and facial surgery. It comes from a health professional qualified to assess and diagnose gender incongruence. Some clinics still ask for two letters before genital surgery, so ask your clinic how many it needs.
  • History of gender dysphoria. You may need health records that show persistent gender incongruence, a lasting sense that your gender differs from the sex assigned at birth.
  • Hormone therapy. For adult genital surgery, WPATH advises at least 6 months of hormone therapy, or longer if the surgeon requires it for the result. This does not apply if you do not want hormones or they are medically unsuitable for you. Adults do not need a set period of hormone therapy before top (chest) surgery.
  • Physical health. Stop smoking before surgery – smoking slows wound healing. A general health check also looks for conditions that could affect surgery or recovery.

The informed consent model lets you go ahead with surgery once you show that you understand its possible results, without a separate psychological evaluation. Ask your clinic whether it accepts this model in place of an assessment letter.

Before skin graft vaginoplasty, most surgeons require hair removal on the penis and scrotum, because this skin lines the new vaginal canal. Hair removal can take several months, so start it well before your travel date.

Each clinic sets its own list of documents, so confirm it in writing before you buy flights. A Bookimed coordinator can explain which documents the clinic asks for.

How Much Does Sex Reassignment Surgery Cost?

Sex reassignment surgery costs $5,600–$9,300 in Thailand and starts at $14,600 in Turkey, based on Bookimed data. That is roughly 70%–90% less in Thailand and 50%–75% less in Turkey than in the United States, where it costs $32,000–$60,000.

Prices differ by type of operation. They range from $2,800–$4,200 for breast augmentation in Turkey to $80,000–$160,000 for phalloplasty in the United States. The transgender surgery cost guide covers each type in more detail.

Type of surgeryThailand (USD)Turkey (USD)United States (USD)
MTF bottom surgeryfrom $6,600from $14,000$50,000–$80,000
FTM phalloplastyfrom $27,500$15,000–$25,000$80,000–$160,000
Metoidioplastyfrom $17,000$6,000–$9,000$18,000–$34,000
MTF top surgery (breast augmentation)$3,200–$4,000$2,800–$4,200from $6,000
FTM top surgeryfrom $3,800from $4,400$10,000–$20,000
Facial feminization surgery$9,300–$12,000$5,000–$8,200from $20,000
Facial masculinization surgeryfrom $5,800$8,000–$16,000$30,000–$60,000
Voice feminization surgery$4,500–$8,500from $3,700$15,000–$25,000
Voice masculinization surgery$3,000–$5,000from $9,200$11,000–$19,000

For every operation in the table, even the lowest US price is higher than the starting price in Thailand and in Turkey. Flights and a hotel stay during recovery add to the total cost abroad.

What an SRS Package in Thailand Includes

Bookimed packages for MTF vaginoplasty in Bangkok combine the operation with a recovery stay. For example, at Wansiri Hospital, the skin graft vaginoplasty package costs about $10,400 and includes a 16-night hotel stay. Colon and peritoneal vaginoplasty packages there include a 21-night stay and cost from about $13,400 up to $20,900, depending on the technique.

Package prices are higher than the surgery price because they also cover accommodation, meals and aftercare. At Asia Cosmetic Hospital in Bangkok, which holds Joint Commission International (JCI) accreditation, the MTF package costs $12,000 and does not include accommodation.

The Wansiri skin graft vaginoplasty package includes:

  • general anesthesia;
  • pre-operative tests and blood tests;
  • medications during and after the hospital stay;
  • follow-up examination;
  • hospital stay, then a hotel stay with all meals;
  • airport, hotel and clinic transfers;
  • language assistance.

The split between hospital nights and hotel nights differs by package, so check with the clinic where you will recover after discharge.

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Best Gender Reassignment Surgeons

Bookimed's partner clinics in Thailand and Turkey work with surgeons who perform gender-affirming operations. Two of them are described below.

Dr. Saran WannachamrasDr. Saran Wannachamras, Thailand

Dr. Saran Wannachamras is a plastic surgeon with 31 years of experience. He heads the rhinoplasty and sex change department at Wansiri Hospital in Bangkok and performs male-to-female and female-to-male surgery, including colon vaginoplasty. He is a member of the Society of Plastic Aesthetic Surgeons of Thailand and a fellow of the International College of Surgeons.

Dr. Bugra CetinDr. Bugra Cetin, Turkey

Dr. Bugra Cetin is a board-certified urological surgeon with 13 years of experience at Uroaesthetic Clinic in Istanbul. He specializes in genital reconstruction, penile prosthesis surgery and male sexual health. He is a member of the International Society for Sexual Medicine (ISSM), the European Society for Sexual Medicine (ESSM) and the European Association of Urology (EAU).

How to Choose a Gender Reassignment Surgeon

Gender reassignment surgery is a specialist field. To check a surgeon's training and experience with your exact operation, ask the clinic about the following:

  • Specialty. Ask whether the surgeon trained in plastic surgery or urology and how many operations of your type they perform each year. A surgeon who cannot give a yearly figure for your operation may have limited experience with it.
  • Techniques. Ask which techniques the surgeon offers, for example skin graft, peritoneal or colon vaginoplasty. If the surgeon offers only one technique, ask whether it is suitable for your anatomy.
  • Follow-up. Ask how follow-up works after you fly home, including video consultations and who answers your questions. If the clinic has no plan for contact after discharge, arrange follow-up with a local doctor before you travel.

Written answers to these questions let you compare surgeons on the same points before you book.

Recovery from Sex Reassignment Surgery

Recovery from sex reassignment surgery takes from about 1 week to 4 months, depending on the operation. It includes healing as well as adjusting to physical and emotional changes.

Recovery Timeframes

Each type of sex reassignment surgery has its own healing time:

  • Facial surgery. Swelling usually goes down in 2–4 weeks after cheek and nose procedures. After chin and jaw surgery, swelling can go down within 2 weeks, but complete healing can take up to 4 months.
  • Chest surgery. Expect swelling and soreness for 1–2 weeks, and avoid strenuous activity for at least a month.
  • Bottom surgery. You can return to usual activities after at least 6 weeks, with weekly follow-up visits for a few months. Avoid sexual activity for 6 weeks after phalloplasty and for 12 weeks after vaginoplasty.
  • Voice surgery. Complete recovery takes about 3 weeks, and you will need complete voice rest for the first 7 days.

If you are having more than one operation, plan your time off work around the longest of these periods.

Possible Risks of Sex Reassignment Surgery

Most people are satisfied with the results of sex reassignment surgery. In a review of 46 studies covering 3,716 male-to-female vaginoplasty cases, 93% of patients were satisfied with the overall result, 87% with how the genitals work and 90% with how they look. About 1% regretted the operation. Knowing the possible risks in advance helps you prepare for them and spot problems early.

Like any major surgery, feminizing and masculinizing surgery carry a risk of bleeding, infection and a reaction to anesthesia, according to the Mayo Clinic.

Depending on the operation, other possible risks include:

  • slower wound healing;
  • fluid or blood collecting under the skin (seroma or hematoma);
  • changes in skin sensation, such as numbness or tingling;
  • urinary problems, such as leaking urine (incontinence);
  • an abnormal opening between two body parts, such as the bladder and the vagina (fistula);
  • permanent scarring.

Phalloplasty may require several follow-up operations. Some operations, such as orchiectomy and hysterectomy, may limit or end fertility, so ask your doctor about freezing sperm or eggs before surgery.

Wound care, prescribed medication and follow-up visits reduce the risk of infection and bleeding. If you notice bleeding or signs of infection after you return home, see a doctor promptly.

Post-Surgery Care

Your surgical team will give you detailed care instructions after the operation. Focus on these steps during recovery:

  • Wound care. Follow your doctor's instructions for wound care, catheters and drains to prevent infection. You may also need compression garments to reduce swelling and help wounds heal faster.
  • Medication. Take all prescribed medications, and contact your care team if your pain is not under control.
  • Avoiding strain. Arrange your home before surgery so that everyday items are within easy reach. Limit physical exertion and sexual activity for as long as your surgeon advises.
  • Nutrition. Follow the diet your doctor recommends to give your body the nutrients it requires for healing.
  • Emotional support. Join a support group, see a mental health professional, or ask friends and family for support during the transition.
  • Long-term care. Keep attending follow-up visits after recovery, including hormone therapy adjustments and any revision surgery (a smaller operation to refine the result) your surgeon recommends.

Flying Home After Surgery Abroad

Stay near the clinic until the surgeon confirms in writing that you are fit to fly, and buy the return ticket only after that.

Deep vein thrombosis (DVT) is a blood clot in a vein, usually in the leg. To lower the chance of DVT on journeys of 4 hours or more, the NHS advises:

  • wearing loose clothing;
  • drinking plenty of water;
  • avoiding alcohol;
  • walking around when possible.

Ask your surgeon whether you also need compression stockings or blood-thinning injections for the flight home after surgery.

Interesting Facts About Sex Reassignment Surgery

Surgeons have performed sex reassignment operations for more than a century.

Who invented transgender surgery?

Transgender surgery developed through the work of several doctors over the 20th century. Magnus Hirschfeld in Germany laid the groundwork in sexology in the early 1900s. In the mid-20th century, Georges Burou in Morocco and Elmer Belt in the United States developed the surgical techniques further. Harold Gillies, known as 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 first recorded transgender operations took place in 1917 and 1931:

  • Alan L. Hart (1917). He had a hysterectomy (removal of the uterus) as part of his transition, one of the earliest recorded transgender operations.
  • Dora Richter (1931). Under the care of Magnus Hirschfeld in Berlin, she became the first known trans woman to complete male-to-female genital surgery.

Which transgender public figures have spoken about their transition?

Several well-known transgender people have spoken publicly about their transition:

  • Caitlyn Jenner. The former Olympic athlete and TV personality transitioned publicly.
  • Laverne Cox. The actress became the first openly transgender person nominated for a Primetime Emmy Award.
  • Lana and Lilly Wachowski. The directors of The Matrix films both transitioned publicly.
  • Hari Nef. The actress and model played a role in the film Barbie.
  • Elliot Page. The actor, known for Juno, Inception and The Umbrella Academy, announced his transition publicly.

Bottom Line

Sex reassignment surgery covers bottom, top, facial and voice operations, and most patients are satisfied with the result. Abroad, the same operations cost 70%–90% less in Thailand and 50%–75% less in Turkey: from $5,600 in Thailand and $14,600 in Turkey, compared with $32,000–$60,000 in the US. Before you book, plan for the WPATH requirements, at least 6 months of hormone therapy before genital surgery and a recovery stay of 2–3 weeks near the clinic.

FAQ

gender affirmation surgeries faq

What kind of doctor does gender reassignment surgery?

Gender reassignment surgery is performed by a team, usually led by a plastic surgeon or a urologist. Other specialists join for specific steps before, during and after the operation.

Your gender affirmation surgery team may include:

  • Plastic surgeon. This surgeon performs the operations that change the genitals, chest and face to match your gender identity.
  • Urologist. This specialist treats the urinary tract and male reproductive organs and takes part in female-to-male genital surgery.
  • Gynecologist. This specialist focuses on female reproductive health and contributes to male-to-female surgery.
  • Otolaryngologist. This ear, nose and throat surgeon operates on the throat, including voice surgery.
  • Speech-language pathologist. This voice therapist helps you change the pitch and patterns of your voice.

The clinic can tell you which of these specialists will take part in your operation and in your follow-up care.

How long does gender reassignment surgery take?

Gender reassignment surgery takes from one day for chest surgery to several stages over time for phalloplasty.

In a staged phalloplasty, the surgeon creates the penis first and can place an erectile implant in a later operation. Vaginoplasty and metoidioplasty can be done in one main operation, followed by a hospital stay and recovery near the clinic. Facial feminization procedures can be combined in one session or split across several.

You may also need a further, smaller operation later to refine the result, depending on how satisfied you are with it. Ask the surgeon how many stages your plan includes and how long to wait between them. This helps you schedule trips and time off work.

Is gender-affirming surgery covered by insurance?

Whether insurance covers gender-affirming surgery depends on your policy and your insurer.

Health insurance may cover surgery that a doctor documents as medically necessary to treat gender dysphoria. Plans may exclude procedures they class as cosmetic, which can include some facial or chest operations. Insurers may also ask for documents before they approve coverage. These can include an assessment letter from a qualified health professional or records of persistent gender dysphoria.

If you plan surgery abroad, check whether your policy pays for treatment outside your country. Get the insurer's answer in writing before you pay for surgery. Keep copies of your medical records and the clinic's treatment plan, because an insurer may request them when you file a claim. Ask the clinic for an itemized invoice that lists each procedure separately.

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

You usually have to be at least 18 years old to consent to gender reassignment surgery on your own.

In the European Union, the age at which a person can have sex reassignment surgery without parental or public authority consent is typically 18. In some EU countries, it can be as low as 15.

For adolescents, the WPATH Standards of Care recommend an individual assessment by a team of health professionals instead of a fixed minimum age. In some cases, younger patients can access hormone therapy, or even surgery, with parental consent and a full psychological evaluation.

If you are under 18, ask the clinic about the legal age for surgery in the country where you plan to have it. Also ask which documents your parents or guardians will need to sign.

What is transgender surgery regret rate?

About 1% of patients regret gender-affirming surgery and about 99% do not, according to a review of 27 studies that pooled nearly 8,000 transgender patients.

The review covered every type of gender-affirming surgery, including genital, chest and facial operations.

The assessment before surgery gives you time to discuss the permanent changes with a health professional and to check that the plan matches your goals. Talk through the expected results with your surgeon as well, including what the operation can and cannot change, before you sign the consent form.

If you have doubts at any stage, tell your surgeon, because the operation can be postponed until you feel ready. Ask the clinic whether you can speak with a mental health professional before and after surgery.

What is non-binary surgery?

Non-binary surgery is gender-affirming surgery for people who do not identify only as male or female, chosen to match how they express their gender.

Non-binary, genderqueer, gender-fluid and gender-nonconforming people may all seek these operations. The aim is a body that matches each person's gender expression, whether that expression falls within or outside the male and female categories.

Surgical options for non-binary people include:

  • chest surgery;
  • metoidioplasty or phalloplasty;
  • removal of the testicles (orchiectomy);
  • removal of the penis (penectomy);
  • removal of all external genitals (genital nullification);
  • creating the labia and clitoris without a vaginal canal (vulvoplasty);
  • creating a vagina while keeping the penis (penile-preserving vaginoplasty).

Each of these is a separate operation, so discuss with your surgeon which combination matches your goals.

What is sex like after transgender surgery?

Sexual sensation and orgasm remain possible after vaginoplasty, metoidioplasty and phalloplasty, and sensation returns gradually as the tissue heals.

These operations aim to create genitals that look affirming and also have sensation and sexual function:

  • Vaginoplasty. Feeling may start to return around 3 weeks after surgery, and full sensation can take a year or more as the nerves recover.
  • Metoidioplasty. The penis is usually too small for penetrative sex, but arousal, erections and orgasm remain possible. After metoidioplasty, 80% of patients were satisfied with sexual function and 77% with how the result looks.
  • Phalloplasty. A surgeon can place an erectile implant during one stage of phalloplasty to allow penetrative sex, and orgasm remains possible.

Wait for your surgeon's approval before sexual activity, which is usually about 6 weeks after phalloplasty and 12 weeks after vaginoplasty.