How do transgender surgeries work?
Gender-affirming care can be lifesaving for transgender people, as it provides a way for trans people to align with their gender identity by medically transitioning. That is why it can be a source of hope to know of the different options available in terms of surgeries. This article will present the procedures in general, and we encourage you further look up any that you find interesting. Let’s get into it!
Disclaimer/TW: medical terms for bodily anatomy will be used for common understanding and education. The use of body terminology and sex characteristics are not synonymous with an associated gender.
Why get gender affirming surgeries?
Medical procedures take a high toll on finances, as well as physical and mental health. Why would someone undertake gender confirmation surgery when it is so demanding? The decision to undergo gender affirming surgeries is personal, and usually is tied with the deep hope of a positive sense of self as an outcome.
When access to hormonal treatment is either not enough, or inaccessible, surgical procedures can also support a gender transition. It may help alleviate feelings of gender dysphoria, by matching how the person imagines themselves looking with how they actually look. This relief, for many, is a necessity; it isn’t a simple cosmetic difference.
General tips for all surgeries
All mentioned surgeries will have some aspects in common, the necessity to find a competent, trust-worthy team of surgeons for the best standards of care. It is highly encouraged to look up the staff beforehand and gauge their reputation in the transgender community, by looking for testimonies of other patients. This is because any surgery, when seeking a positive outcome, requires an open and honest communication between what the patient wants and what the surgeon can provide. Feeling uncomfortable to advocate for yourself because the vibe sucks makes things more complicated.
Meeting the team is an opportunity to discuss the recommended choice in technique for the surgery, common risks and complications, postoperative care, a recovery timeline as well as possibilities for surgery revisions (in case you’re not totally satisfied). Asking for photos of previous surgeries is also pretty frequent, just to get a better idea of the surgeon’s work.
Be honest about your medical history and drug consumption. These specialists want to help you, but can only operate based on what you share with them. Being transparent can avoid many complications in the future.
With that out of the way, let’s look at these surgery options.
Types of masculinizing surgeries
Masculinizing surgeries are a category of gender affirming procedures aiming to align closer to generally male sex characteristics.
Top surgery,or a bilateral/double mastectomy refers to a removal of breasts in order to construct a flat, stereotypical male chest. Several techniques exist, that depend on the chest size, amount of scarring and nerve sensation. These factors are pretty decisive in narrowing down how a surgeon can perform the surgery. Talk with the medical team about the best option for you.
A hysterectomy is a surgery to remove the uterus, but may also involve the removal of the cervix, ovaries and Fallopian tubes. This procedure presents several attractive features that maybe desirable: it completely removes the possibility for menstrual periods, prevents the possibility of pregnancy, and can be life-saving from illness. There are different types of hysterectomies based on the organs removed and the technique. Choices depend on how invasive it is, size and the selection of removed organs as assessed by the surgeon.
A vaginectomy is the surgical removal of the vaginal lining and the closing of the vagina. The removal itself of this body part may reduce feelings of dysphoria, as well as eliminates the hygienic upkeep. But it is also considered necessary by some surgeons who perform bottom surgery, as it reduces complications. A vaginectomy is often paired with a hysterectomy, metoidiosplasty or phalloplasty, which tends to dictate the technique used.
Masculinizing bottom surgery, or procedures to construct a penis and/or a scrotum, has two options: Metoidioplasty and Phalloplasty. Metoidioplasty is the enhancement of a penis based on the existing genital tissue from hormone replacement therapy. When taking testosterone, a very apparent effect is the enlargement of the clitoris commonly called a T-dick. Metoidioplasty cuts the labial tissue in order to free the T-dick, into a more protruding position. This option is less invasive and more affordable than its counterpart. Phalloplasty is the construction of a penis with larger length than metoidioplasty, with the ability to pee standing up and, with an implant, allows for penetrative sex. Several techniques exist, but all require a skin graft from a donor site to create the shaft; their differences are based in preferences for length, girth, donor site availability, sensation, aesthetic and functionality, as well as the surgeon’s technique. Research for these is crucial in order to find a good match.
Facial Masculinization Surgery and Body Masculinization Surgery are, as the name indicates, a set of cosmetic surgeries with the intention of emphasizing stereotypical features, such as jaw contouring, Adam’s apple surgery, liposuction and more. These options are available for those who have not seen the benefits of masculinization they hoped from hormonal changes. Surgeries under this category are quite varied, so it’s best to research them based on the desired outcome.
Types of feminizing surgeries
Feminizing surgeries are gender-affirming care with the intention of aligning closer to generally female sex characteristics.
A breast augmentation is a procedure using breasts implants in order to create a set of stereotypical female breasts. The implants have a silicone outer shell, filled with either saline(rounder and more fluid-feeling, but bigger risk of rippling) or silicone gel(firmer and smooth, natural look). The type of implant and technique depend on the desired shape and placement, as well as cost and size of incisions.
Orchiectomy is the surgical removal of testicles. This procedure not only has a gender-affirming effect, but carries hormonal changes that reduce bodily changes resulting from testosterone production, like body hair growth, beard growth, etc. The techniques for orchiectomy depend on the desire for vaginoplasty, which can use the remaining scrotum tissue for the construction of the vagina. As always, this is best discussed with the surgeon!
Feminizing bottom surgery is a set of procedures grouping vaginoplasty and vulvoplasty with the same goal of relieving genital dysphoria. Vaginoplasty involves the construction of an outer and inner vagina and labia, a new urethra opening to urinate and a vaginal opening, while removing the scrotum and penis. This procedure is quite expensive and can be demanding in recovery. It also requires some aftercare: the vagina needs a dilating regiment. The differences in techniques offered depend on the donor site’s available tissue and the ease for penetrative sex. Vulvoplasty is a cheaper gender-affirming bottom surgery that uses a donor site to create a vulva, clitoris, inner and outer labia, new urethra opening and the opening of a vagina. However, vulvoplasty cannot create a vaginal canal unlike vaginoplasty. In this procedure, the goal is for the clitoris, which is reconstructed from the penis head, may still provide erotic sensation.
Facial Feminization Surgery and Body Feminization surgery, like its masculine counterpart, are a set of cosmetic surgeries in order to emphasize feminine features that may cause dysphoria. This includes hairline correction, chin and jaw recontouring, lip augmentation, Brazilian butt lift… and many more. Again, all of these are quite varied in their specifics, so it is best to research based on the body part causing dissatisfaction.
Is gender affirming surgery for me?
Now that we’ve taken a look at all the different options for gender affirming surgery, it may be difficult to gauge which ones suit you best, if any. Medical procedures regarding your well-being are deeply personal, and none of them are inherently necessary to live a fulfilling life, if you don’t believe them to be! There is no such thing as a set of surgeries to “fully transition” or legitimize your gender identity.Finding community support can be useful, as well as seeking out a mental health professional to talk through your considerations.
No medical surgery is walk in the park.They all have good and bad sides, require a trusting and competent medical team and some operations are more or less irreversible. Those are all good reason to take your time finding out what may suit you best and research as much as possible to make an informed decision.
For those currently struggling with their dysphoric thoughts and are seeking for hope, know that real relief is possible.In the shallow amount of research on transgender patient satisfaction, there is an overwhelming sense of satisfaction post-operation 1,2. Though a medical transition demands much patience, the outcome can be very positive.
1https://pubmed.ncbi.nlm.nih.gov/30450345/
2https://transgenderinfo.be/wp-content/uploads/2013/01/QOL_Motmans.pdf
-- transgender surgery -- 76%
-- gender reassignment surgery -- 72%(vert, fairly optimized)
-- gender affirming surgery -- 72%
image credit goes to Paul Trombley
