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Transgender Surgery Man To Woman

Changing Genders: How Its Done

Gender Affirmation Surgery Options for Female to Male Patients | UCLAMDChat

People who wish to live their lives as the opposite sex are known as transgender. A report from The Williams Institute at UCLA School of Law estimates that about 700,000 Americans identify this way. But itâs unclear exactly how large the transgender population might be.

We do know, though, that physically changing your sex is a complex process, and not everyone follows the same path. Some people choose hormone therapy alone. Others go further, getting major surgeries to make the transition. Here are the steps involved.

Before And After Surgery

Unlike other cosmetic or reconstructive surgery, one cannot just request it and have the operations to change sex. Most countries around the world require a series of psychological evaluations and eligibility assessments before a person is considered fit for sex change surgery.

In treating transsexual, transgender, and gender nonconforming people, medical professionals use the Standards of Care established by the World Professional Association for Transgender Health . These standards of care, based on the best available science and expert professional consensus, are updated from time to time. They provide clinical guidance for health professionals to assist transsexual, transgender and gender nonconforming people with safe and effective pathways to achieve lasting personal comfort with their gendered selves, in order to maximise their overall health, psychological well-being, and self-fulfillment.

According to, This assistance may include primary care, gynecologic and urologic care, reproductive options, voice and communication therapy, mental health services , and hormonal and surgical treatments.

Is Gender Affirming Surgery Right For Me

Choosing to undergo any surgery is a big decision. Everyone affirms their gender in different ways, and that may or may not include surgery.

Surgery is permanent so you need to make sure its the right choice for you. Surgery doesnt make you more or less trans.

Before being able to access gender affirming surgery, you need to meet the criteria below:

  • A history of gender incongruence .
  • The ability to make a fully informed decision.
  • Be over the age of 16 for top surgery, or 18 for bottom surgery. Some surgeons will provide surgery to younger people in very specific situations.
  • Ensure that any physical or mental health conditions are well managed.

You will need letters of support from a mental health professional before having gender affirming surgery.

For top surgery, one letter is required. For bottom surgery two letters are required. For bottom surgery, you are also required to have lived as your current gender for 12 months, meaning you have socially transitioned. The letter needs to state that surgery is appropriate for you and is likely to help affirm your gender and reduce any gender dysphoria that may be present.

If you are taking gender affirming hormones, or want to take hormones in the future, you should do this for 12 months before having surgery. This is to allow any significant body changes to occur before surgery.

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Reasons For Choosing To Have Male To Female Sex Reassignment Surgery

Male to female sex change operations are for people who are biologically male, but who identify as women and wish to live their lives as women.

Many transgender people say they are uncomfortable with their biological sex and its associated gender role. They feel trapped in a body they cannot identify with. According to the American Psychiatric Association, gender identity disorder can cause duress and impair an individual on both social and personal levels.

Transgender people also report experiencing some form of stigma and discrimination, verbal and physical abuse, threats of violence and actual physical violence proportionately more than others. According to the 2007 Australian Research Centre in Sex, Health & Society publication, Tranznation: A report on the health and well being of sex and gender diverse gender people in Australia and New Zealand:

  • A large majority had experienced at least one form of stigma or discrimination
  • Over half reported verbal abuse
  • One third had received threats of violence or intimidation
  • Nearly one in five had experienced a physical attack or other kind of violence

Transgender people are also likely to experience bullying in schools, workplaces and other social situations.

Gender role changing, hormone therapy and sex change surgery are treatments for this condition.

Subjects And Study Setup

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This is a retrospective cohort study of Brazilian transgender women who underwent penile inversion vaginoplasty between January of 2000 and March of 2020 at the Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil. The study was approved by our institutional medical and research ethics committee.

At our institution, gender-affirming surgery is indicated for transgender women who are under assistance by our program for transsexual individuals. All transsexual women included in this study had at least 2 years of experience as a woman and met WPATH standards for GAS . Patients were submitted to biweekly group meetings and monthly individual therapy.

Between January of 2000 and March of 2020, a total of 214 patients underwent penile inversion vaginoplasty. The surgical procedures were performed by two separate staff members, mostly assisted by residents. A retrospective chart review was conducted recording patient demographics, intraoperative and postoperative complications, reoperations, and secondary surgical procedures. Informed consent was obtained from all individual participants included in the study.

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What Happens Before Gender Affirmation Surgery

Before surgery, you should work with a trusted healthcare provider. A healthcare provider can help you understand the risks and benefits of all surgery options.

Many insurance companies require you to submit specific documentation before they will cover a gender-affirming surgery. This documentation includes:

  • Health records that show consistent gender dysphoria.
  • Letter of support from a mental health provider, such as a social worker or psychiatrist.

The Importance Of A Multidisciplinary Approach

Gender reassignment, particularly reassignment surgery, requires close cooperation between the different surgical specialties. In phalloplasty, the collaboration between the plastic surgeon, the urologist, and the gynecologist is essential.45 The actual penile reconstruction is typically performed by the plastic and reconstructive surgeon, and the contribution of the gynecologist, who performs a hysterectomy and a BSO , should not be underestimated.

However, in the long term, the urologist’s role may be the most important for patients who have undergone penile reconstruction, especially because the complication rate is rather high, particularly with regard to the number of urinary fistulas and urinary stenoses. The urologist also reconstructs the fixed part of the urethra. He or she is likely the best choice for implantation and follow-up of the penile and/or testicular prostheses. They must also address later sequelae, including stone formation. Moreover, the surgical complexity of adding an elongated conduit to a biological female bladder, and the long-term effects of evacuating urine through this skin tube, demand lifelong urological follow-up.

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What Happens During The Procedure

On the morning of your surgery you will meet with your surgeon and an anesthesiologist. They will give you an overview of how the day is going to play out. They will probably give you an antianxiety medication or another sedative to help you relax. Then they will bring you to the operating room.

During your penile inversion vaginoplasty, you will be under general anesthesia, lying on your back with your legs up in stirrups.

The procedure is complex, involving delicate tissue, vasculature, and nerve fibers. Here are some of the broad strokes:

  • The testicles are removed and discarded.
  • The new vaginal cavity is carved out in the space between the urethra and the rectum.
  • A penile prosthesis is inserted into the cavity to hold the shape.

Everything is sutured together and bandages are applied. The whole procedure takes two to five hours. The bandages and a catheter typically remain in place for four days, after which time postoperative steps should be taken.

There are always risks associated with surgery, but vaginoplasty complications are rare. Infections can usually be cleared up with antibiotics. Some immediate postsurgical risks include:

Criteria For Vaginoplasty Or Vulvoplasty

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  • Persistent, well documented gender dysphoria
  • Capacity to make a fully informed decision and to consent for treatment
  • be the age of majority in a given country
  • If significant medical or mental health concerns are present, they must be well controlled
  • Twelve continuous months of hormone therapy as appropriate to the patients gender goals
  • Twelve continuous months of living in a gender role that is congruent with their gender identity.
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    What Is The Difference Between Transgender And Nonbinary

    The term transgender describes someone whose gender identity is different than their sex assigned at birth. Gender nonbinary describes someone whose gender identity does not fit within traditional female or male categories. People in either of these categories may opt for gender affirmation medical treatment or surgery.

    What To Consider Before Transgender Surgery

    “What I always tell patients is if you don’t have dysphoria about a body part, don’t have surgery,” Christopher McClung, MD, a urologist with OhioHealth in Columbus, Ohio, told Health.

    Dysphoria refers to the distress that trans people may experience when their gender identity doesn’t match their sex assigned at birth. In some cases, surgery may be medically necessary to treat the dysphoria, according to the World Professional Association for Transgender Health , which publishes evidence-based standards for the care of transsexual, transgender, and gender non-conforming people.

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    Please Explain Bottom Surgery

    We would love to speak about your transfeminine bottom surgery options with you during a private one-on-one consultation at our Miami area practice. As advocates in the LGBTQ+ community, it is our passion to help each trans man or woman achieve their true selves through beautifully personalized results and board certified expertise. Please feel free to , or call us at .

    What Doctors Wish Their Patients Knew Before Surgery

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    All in all, the entire transition processliving as your preferred gender, obtaining mental health referrals, getting insurance approvals, taking hormones, going through hair removal, and having various surgeriescan take years, doctors explained.

    Yet it’s important to proceed with the utmost care. Dr. McClung said he wishes patients had a better idea of the potential risks. Complication rates related to vaginoplasties, phalloplasties, and other procedures can be as high as 25%, Dr. McClung said.

    “I always tell my patients, ‘Look, I want the same thing as you: I want a cosmetically and functionally perfect set of genitals that is going to make you happy,'” Dr. McClung said. But the procedures need to be done in the safest way possible to avoid complications.

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    What Happens During Transgender Surgery

    What happens during surgery varies depending on the procedure. You may choose facial surgery, top surgery, bottom surgery or a combination of these operations.

    Facial surgery may change your:

    • Cheekbones: Many transgender women have injections to enhance the cheekbones.
    • Chin: You may opt to soften or more prominently define your chins angles.
    • Jaw: A surgeon may shave down your jawbone or use fillers to enhance your jaw.
    • Nose: You may have a rhinoplasty, surgery to reshape the nose.

    If you are a transgender woman , other surgeries may include:

    • Adams apple reduction.
    • Placement of breast implants .

    If you are a transgender man , you may have surgeries that involve:

    • Removal of the ovaries and uterus .

    Treatment Caring For Transgender Patients

    Fearing discrimination and hostility, transgender people are often reluctant to seek care. Discover how Paula Neira, Program Director of LGBTQ+ Equity and Education, Johns Hopkins Medicine Office of Diversity, Inclusion and Health Equity, is working to ensure that all patients regardless of gender identity are treated with dignity and respect.

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    Average Cost Of Transgender Surgery

    Transgender surgery is comprised of several surgical procedures that you can avail individually or as a package. The average transgender surgery cost for each procedure typically ranges from $1,500 to $26,000 but the total for all could be as high as $200,000 to $300,000.

    Replacing the core reproductive organ completes the entire sexual reassignment. The male-to-female vaginoplasty is estimated to be somewhere between $20,000 and $50,000 or even higher. For the female-to-male phalloplasty and complete testicular implantation, the total cost could climb up to $25,000 to $35,000.

    How Will It Affect Libido

    Transgender woman tells story of transitioning from male to female

    Transgender women may experience a decrease in sex drive after gender-affirming surgery.

    According to a 2020 article, people can stop taking anti-testosterone medication and may experience a decreased sex drive following an orchidectomy.

    Hormone replacement therapy may help maintain a regular sex drive.

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    The Center For Transgender Health Team At Johns Hopkins

    Embracing diversity and inclusion, the Center for Transgender Health provides affirming, objective, person-centered care to improve health and enhance wellness educates interdisciplinary health care professionals to provide culturally competent, evidence-based care informs the public on transgender health issues and advances medical knowledge by conducting biomedical research.

    What Questions Should I Ask Before Surgery

    Its important to talk about the pros and cons of surgery in detail with your doctor. Its a good idea to ask to see pictures of how other people look after surgery.

    • What different surgical techniques are there?
    • What are the pros and cons of each technique for me?
    • What results can I expect?
    • What are the possible risks and complications?

    For help in having the discussion, visit healthdirects Question Builder.

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    Uh Experts Offers A Wide Variety Of Surgical Options For Male To Female Transition

    Choosing to surgically alter your body to align with your inner perception of self is a big decision and a permanent one. Although some transgender individuals may be comfortable simply living as their affirmed gender, others feel that surgery is an essential step to allow them to live the life they want as the person they know they are.

    Once a decision has been made and the eligibility requirements for surgical transition have been met, it is essential to choose a care team with experience and expertise to achieve the best possible functional and cosmetic outcomes. The multidisciplinary team of surgeons at University Hospitals have the advanced training and experience to provide our transgender patients with a full range of procedures from which to choose, and the compassion to support patients throughout this unique journey.

    Call our dedicated gender care patient navigator at to schedule a consultation with a UH plastic surgeon or reconstructive urologist, Shubham Gupta, MD.

    How Much Does It Cost

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    The average cost for a penile inversion vaginoplasty is around $20,000 without insurance. This includes a few days in the hospital, plus anesthesia. However, this is only for one surgery. If you want a secondary labiaplasty, the costs increase.

    Many people who get vaginoplasties also undergo breast augmentation and facial feminization surgeries, which are very expensive. You should also keep in mind the cost of electrolysis, which can add up to thousands of dollars.

    Costs will vary depending on your insurance coverage, where you live, and where you get your surgery done.

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    Gender Affirmation: Do I Need Surgery

    There is no one-size-fits-all approach for the gender affirmation process. Perhaps you dont want to undergo surgery right now because its too expensive or your family is not on board. Maybe you dont see surgery as being a part of your transition process at all.

    Gender affirmation is an individualized journey. Doing your own research and talking to experts will help you decide which options are best for you.

    Dr. Fan Liang, the current medical director of Johns Hopkins Center for Transgender Health, stresses that while surgery can be a part of the transition process for many, its not for everyone. “Each patient needs to consider their personal goals and decide whether surgical options will improve their quality of life and lessen their gender dysphoria,” she adds.

    Dr. Liang shares insights into the many choices available to patients who wish to use nonsurgical options to express their gender identity. Its very possible that surgery is not in the transition plan for someone in the gender affirmation process. There are several nonsurgical services that may help transgender patients achieve their transition goals.

    Possible Risks And Complications

    As with any surgical procedure there are risks involved in a male to female sex change procedure. You should be fully aware of potential risks and complications involved in any surgical procedure before you elect to have the surgery. It is always better to err on the side of caution.

    Specific complications that could occur during or after a vaginoplasty procedure include:

    • Rupture of multiple stitches that open up the wound.
    • Narrowing or closure of the restructured urethra, causing difficulty in urinating, painful urination or a significant reduction in the amount of urine excreted. If you experience any of this, or find that you need increased time and effort to urinate, tell the surgeon without delay.

    Some of the above are long-terms risks of genital surgery. Other complications, such as bleeding, swelling, minor infections or rupture of stitches can be handled by nursing staff.

    After discharge from hospital, you need to move around as much as is comfortable. Staying hydrated can help prevent blood clots, so be vigilant about drinking lots of water. You should seek emergency care if you suddenly experience shortness of breath, dizziness, chest pain or tender, warm swollen legs. All these can be signs of a blood clot.

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