Gender Affirmation Surgery
Also known as gender confirmation surgery, gender affirmation surgeries refer to procedures that help individuals transition to their identified gender. These surgeries can include facial surgeries, bottom surgeries, or top surgeries.
These procedures help the body align more closely with gender identity, as opposed to the gender assigned at birth. They are chosen when the gender assigned at birth differs from the individual's gender identity. This helps alleviate psychological distress caused by gender incongruence, also known as gender dysphoria.
What is Gender Affirmation?
Gender affirmation surgeries can be used to change or reduce the physical characteristics of individuals assigned male at birth, as well as for those assigned female at birth. These surgeries can also involve changing the appearance of the sexual organs.
Non-Surgical Gender Affirmation Options
There are also non-surgical gender affirmation options. These include:
Feminizing Hormone Therapy
This therapy increases feminine characteristics, such as larger breasts, rounder hips, and a higher-pitched voice.
Masculinizing Hormone Therapy
This therapy increases masculine characteristics, such as facial hair, muscle mass, and a deeper voice.
Puberty Blockers
These delay the development of secondary sex characteristics during puberty. Examples include changes in facial structure, breast development, and facial hair growth.
Voice Therapy
This helps individuals learn speech and communication skills that allow them to express their gender identity.
Laser Hair Removal
This is used to remove facial or body hair.
Not every transgender or gender-diverse person requires medical transition to express their gender identity. Other options for expressing gender identity include:
- Changing style
- Choosing a new name
- Using different pronouns
Gender Affirmation and Psychological Assessment
Psychotherapy accompanies the individual's social transition process, while comprehensive gender psychological assessment provides additional information on issues that may not be addressed in psychological therapy. The psychological assessment helps to understand the full picture comprehensively and in-depth.
It provides an overview of both current and past aspects of gender development, as well as important areas in the individual's life. Additionally, a targeted assessment of any potential co-occurring psychological concerns is conducted. Individuals whose gender identity does not align with their assigned gender at birth may need medical interventions in addition to social transition.
Before undergoing what is known as gender affirmation surgery, a thorough assessment is required to determine if the individual meets the criteria set by the World Professional Association for Transgender Health (WPATH). In many countries, a recommendation letter from a mental health professional specializing in this field is mandatory for gender affirmation surgeries.
What Procedures Are Performed for Gender Affirmation?
Types of gender affirmation surgeries include:
- Facial reconstructive surgery to make facial features more masculine or feminine
- Vocal surgery to change the pitch of the voice
- Chest or top surgery to remove breast tissue or enhance breast shape
- Genital surgery to transform or reconstruct sexual organs
Male to Female Gender Affirmation
Surgeries performed on individuals assigned male at birth, such as transgender women and transfeminine non-binary individuals, include:
Facial Feminization Surgery
This involves reshaping the bones and tissues of the face to achieve a more feminine appearance. Changes include a lower hairline, fuller cheeks, a rounded chin, and a smaller Adam's apple.
Feminizing Top Surgery
This surgery involves adding saline or silicone implants beneath the breast tissue to create fuller breasts. Some individuals may choose fat grafting from another part of the body instead.
Orchiectomy
This surgery involves the removal of the testicles. The absence of testicles reduces the body's testosterone production, which may reduce the need for feminizing hormone therapy. It can be performed in conjunction with scrotal removal surgery.
Penectomy
This surgery involves the removal of the penis. It is performed to preserve tissue for feminization surgeries such as vaginoplasty or vulvoplasty.
Vaginoplasty
Vaginoplasty involves the creation of a vaginal canal using penile tissue and other genital organs. This surgery may be performed along with labioplasty and clitoroplasty.
Vulvoplasty
This surgery involves the creation of the external vulva without creating a vaginal canal.
Female to Male Gender Affirmation
Examples of gender affirmation surgeries performed on individuals assigned female at birth, such as transgender men and transmasculine non-binary individuals, include:
Facial Masculinization Surgery
This surgery involves altering the bones and tissues of the face to create a more masculine appearance, including a broader forehead, more pronounced cheekbones and jawline, and an Adam's apple.
Masculine Top Surgery
This surgery involves the removal of breast tissue to achieve a natural male chest appearance.
Hysterectomy
This surgery involves the removal of the uterus and can be performed along with oophorectomy, which is the removal of the ovaries.
Metoidioplasty
This surgery involves creating a penis using the clitoris. Testosterone therapy is typically required before surgery to enlarge the clitoris to a microphallus size.
Phalloplasty
This surgery involves creating an average-sized penis using a graft of skin from another part of the body. It is often performed along with scrotoplasty.
Scrotoplasty
This surgery involves reshaping part of the external labia into a scrotum. After healing, silicone gel or saline implants, known as testicular implants, may be chosen to create the appearance and feel of testicles.
How to Prepare for Gender Affirmation Surgery?
According to the standards of the World Professional Association for Transgender Health (WPATH), individuals should work with healthcare professionals to ensure they meet the criteria for gender affirmation surgery. This organization promotes evidence-based care for transgender and gender-diverse individuals.
Many insurance companies require documentation related to the organization's criteria before covering the costs. These criteria include:
Informed Consent
It is essential to understand what gender affirmation surgery involves. This includes understanding what will happen during surgery and how life may be affected afterward.
This information covers various areas, including the desire to have biological children. Many surgeries can lead to temporary or permanent infertility, so individuals should explore options such as sperm or egg freezing.
History of Gender Dysphoria
There should be medical records showing a history of gender dysphoria. Typically, these records must demonstrate that this condition has been experienced for one year or longer.
Mental Health Evaluation
A support letter from a qualified mental health professional is required. Mental health professionals work with individuals to determine the safest and healthiest option for embodying their gender. They also address concerns such as gender dysphoria, anxiety, and depression.
Hormone Therapy
In some cases, hormone therapy is required before gender affirmation surgeries. Depending on the procedure and desired outcomes, hormones help the body transition more effectively during surgery.
To prepare for the procedure, specialists will assess whether individuals are physically healthy enough for surgery. This includes conducting the following tests:
- Physical examination
- Blood tests
- Imaging tests
What Happens During Gender Affirmation Surgery?
The specialist will inform individuals about what will occur during the surgery. Regardless of the procedure, anesthesia is used during surgery to prevent any pain or discomfort. Depending on the procedure, the surgery may involve:
- Removing or reconstructing organs or tissue
- Creating new structures from existing tissue
- Inserting implants or grafts
Additionally, drains for fluid removal or a Foley catheter for urine output may be inserted.
Duration of Gender Affirmation Surgery
The duration of gender affirmation surgeries varies depending on the procedures performed. Some surgeries can be completed in one day, while others may require multiple days. Even if the surgery is completed in one day, revision surgeries may be necessary depending on the desired outcomes.
Specialists Involved in Gender Affirmation Surgery
Gender affirmation surgeries are comprehensive procedures that can significantly impact an individual's life. Therefore, it is crucial to work with a team of specialists both during the decision-making and execution stages. This team may include specialists in the following fields:
- Urology
- Gynecology
- Plastic Surgery
- Otolaryngology (ENT)
- Anesthesiology
- Speech and Language Therapy
- Physical Therapy
- Nursing
- General Practice
- Physician Assistants
Recovery Process After Gender Affirmation Surgery
After gender affirmation surgeries, individuals need to be cautious during the recovery process. Assistance from friends and family may be required. Post-surgery care includes:
Care of Wounds and Catheters
Detailed instructions should be obtained from the doctor regarding wound care and infection monitoring. If a catheter or drain was used, care for these should also be learned.
Use of Compression Garments
Compression bandages and garments can be used to promote faster healing of wounds and reduce swelling.
Medication Adherence
It is crucial to use the prescribed medications as directed after surgery.
Avoiding Strain and Stretching
It is recommended to place items that may be needed after surgery within easy reach. This helps prevent injuries after discharge.
Monitoring Diet
It is advisable to consult with a specialist before surgery to ensure a faster recovery process.
Adjusting Routines
Sponge baths may be necessary for a while after surgery. Additionally, physical exercise and sexual activity should be avoided. It is important to follow the doctor's recommendations during this time.
The recovery time after surgery varies depending on the area and the procedure performed. The average recovery times are as follows:
- Swelling from cheek and nose surgeries typically lasts about 2-4 weeks.
- Swelling from chin surgeries takes about 2 weeks to subside, with complete healing taking up to 4 months.
- Swelling and pain from chest surgeries can last 1-2 weeks. Strenuous activities should be avoided for at least 1 month.
- For bottom surgeries, activities should be avoided for at least 6 weeks, with weekly follow-up visits required for several months.
After gender affirmation surgeries, it is advisable to consult with a mental health professional who specializes in transgender issues. This can help individuals better adapt to life after surgery.
Life After Gender Affirmation Surgery
Many studies have been conducted on the psychological changes experienced after gender affirmation surgeries. Common findings from these studies include:
- Decreased rates of mental health issues
- Reduced substance abuse
- Decreased suicidal thoughts
- Reduced depression and antidepressant use
- Reduced alcohol dependency
- Reduced smoking rates
Benefits of Gender Affirmation Surgery
Gender affirmation surgeries help address areas where gender feels incongruent with the body. The benefits of these surgeries include:
- Changes in the appearance of the face, chest, and sexual organs
- Achieving the desired appearance, voice tone, and routine activities
- Engaging in gender-appropriate sexual activities
Risks of Gender Affirmation Surgery
Different procedures involved in gender affirmation surgery come with different risks. For example, individuals who undergo bottom surgery may experience issues with bladder emptying or changes in sexual sensations. It is important to understand the specific risks associated with each procedure. However, there are common risks across all procedures, which include:
- Bleeding
- Infection
- Side effects of anesthesia
