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Gender Affirming Surgery: Everything You Need to Know

According to those who have undergone the gender affirming surgeries, the quality of life seems to change gradually. A 2017 study shows that surgical satisfaction stood at 94% to 100%.

Gender Affirming Surgery: Everything You Need to Know

Gender affirming surgery may be necessary for trans people experiencing gender dysphoria (discomfort experienced when one’s gender does not align with the gender assigned at birth). Many types of gender-affirming surgery can help trans people feel safe and comfortable. 

Gender-affirming surgery is categorized in masculinization (female to male) and feminization (male to female.) However, gender-nonconforming folks may also undergo these surgeries.

Here are the top things you should keep in mind before undergoing gender-affirming surgery.

Reasons for Gender Affirming Surgery

Why do you need to undergo surgery? Are you experiencing gender dysphoria? Most people who experience gender dysphoria opt to have the surgery to feel right with their bodies. The distress caused by this condition can lead to anxiety, depression, or suicide attempts.

According to some doctors, if you are not struggling with gender dysphoria, it’s advisable not to undergo gender-affirming surgery. There are lots of trans people that do not undergo surgeries but instead choose to have hormone therapy.

Related: What Is Gender Transitioning?


It is essential to prepare emotionally and mentally. Apart from understanding the process, hormones, and risk factors involved in gender-affirming surgery, there are a few things that may be done to prepare you for the surgery. They include:

  • Mental health evaluation: This will determine if you have any mental health concerns that can influence your thinking. The doctors will use the result to assess your readiness for the physical and emotional stress post-surgery.
  • A “real-life” test: You will be required to play the role of your gender in daily activities, socially and professionally.
  • Clear and consistent evidence of gender dysphoria.

Note that not all trans people experience physical gender dysphoria. To determine whether you qualify for gender-affirming surgery, you may need to have the “real-life” test. The test is dangerous since the individual has to make themselves vulnerable in public for the surgery.

Suppose the trans individual is easily identified as their current gender. In that case, they are blocked from having the surgery, increasing their chances of being discriminated against since they have already revealed to people who they really are.

Transitioning and Hormone Therapy

Hormone therapy includes taking estrogen, progesterone, or testosterone. A trans person should undergo hormone therapy for a year before gender-affirming surgery.

Hormone therapy aims to change the individual’s physical appearance to align with gender identity.

Effects of Estrogen

The effects of estrogen include reducing assigned male sexual characteristics to an increase in assigned female sexual characteristics. Physical changes may include:

  • Slow building
  • Breast development
  • Softer skin
  • Decreased acne
  • Redistribution of fat from the abdominal area to the hips, buttocks, and thighs
  • Decreased in facial and body hair
  • Shrinkage of testicles
  • Loss of erection

Behavioral change may include mood swings and decreased sex drive.

Effects of Testosterone

After taking testosterone, the individual may experience a reduction in assigned female sexual characters and an increase in assigned male sexual characters.

Body changes may include;

  • Deepening voice
  • Clitoris enlargement
  • Beard growth
  • Increased growth of body hair
  • Increased in muscle mass and strength
  • Baldness
  • Reduction of fat from hips, breasts, and thighs to abdominal area
  • Development of acne

Behavioral changes may include aggression and increased sex drive.

When Does the Hormone Therapy Effects Begin to Show?

The effect of estrogen and testosterone may start to show after the first couple of doses. However, it can take several years before the transition is satisfying, especially in breast development.

How Long is the Surgical Process?

Gender affirming surgery is done at least a year after the beginning of hormone therapy and at least two years after mental health evaluation.

After the beginning of the surgery, the completion time depends on the number of the preferred procedures and recovery time.

Types of Gender Affirming Surgeries

There are two types of gender-affirming surgeries: Transfeminine surgeries and transmasculine surgeries.

Transmasculine Surgeries

Transmasculine surgeries include top surgery (surgeries performed above the belt) and bottom surgery (surgeries performed under the belt.)

  • Top surgery includes subcutaneous mastectomy or breast reduction surgery.
  • Bottom surgery includes uterus and ovaries removal and the creation of the penis and scrotum.

Transfeminine Surgeries

As transmasculine surgeries, transfeminine surgeries also include top surgery and bottom surgeries. Procedures considered for transfeminine are as follows.

Top surgeries:

  • Facial feminization
  • Breast augmentation
  • Jaw surgery
  • Narrowing and refining the nose
  • Lifting of the eyebrows
  • Chin reduction
  • Lips surgery
  • Removal of Adam’s apple
  • Vocal change surgery
  • Alteration of hairline

Bottom surgery

  • Penis and scrotum removal
  • Vagina and labia creation

Complications of Gender Affirming Surgery

As with other types of surgeries, gender-affirming surgery comes with its fair share of complications. Estrogen therapy is associated with high risks of blood clots in transfeminine persons. There is also a probability of breast cancer for a person using estrogen.

Testosterone in transmasculine people has been linked with high blood pressure, insulin resistance, and lipid abnormalities

There are also surgical risks such as infections, excessive bleeding, and also side effects of anesthesia. Before the commence of gender-affirming surgery, the patient should discuss the probabilities and side effects of hormone therapy and surgery.

Cost of Gender Affirming Surgery

This kind of surgery can be costly for most trans people. From counseling to hormones to the surgery itself, the amount can add up very quickly. Transfeminine surgeries are more expensive compared to transmasculine ones. Luckily, health insurance can cater to some expenses.

Life After Surgery

According to those who have undergone the procedures, the quality of life seems to change gradually. A 2017 study shows that surgical satisfaction stood at 94% to 100%. Although the surgical procedure may involve some uncomfortable steps, most of its beneficiaries recommend it for people who feel like undergoing it.

Gender-affirming surgery is a medical option in treating gender dysphoria. If you have gender dysphoria and view gender-affirming surgery as your treatment option, you should first consult your doctor to have a clear understanding of the process.

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