Gender reassignment surgery is known by a number of names including:
It is a surgical procedure to transition patients with gender dysphoria or transsexualism to their desired gender. Gender dysphoria, or Gender Identity Disorder (GID), is a condition where a person is born with the mental, psychological and emotional gender that is the opposite of their biological gender. In other words, the patient may feel conflicted between how they are physically perceived by others and how they see themselves emotionally. Gender reassignment is also known as sex reassignment surgery or a sex change operation. It can be performed to change the body to match how the patient mentally and emotionally feels. Besides genital reassignment, gender reassignment may also include chest reconstruction and a variety of facial feminization or masculinization procedures.
GOOD CANDIDATES for gender reassignment are:
The following are NOT GOOD CANDIDATES for gender reassignment surgery:
Gender reassignment may involve one, or several, surgical procedures to gain the desired outcome and may involve a 1 to 3 day hospital stay.
A male patient transitioning to female (MTF) will have the testicles, scrotum and most of the penis removed to form a labia, a vagina and a clitoris. The skin of the penis will be left attached to the body, reshaped, turned inside out and inserted into the body to form the vagina. This procedure is called a vaginoplasty. A portion of the head (glans) of the penis will be used to create a clitoris. Since there will still be adequate blood flow and nerve supply to this portion of the genitals, the area will preserve sexual sensation. The labia, AKA the tissue adjacent to the vaginal opening, can be created from penile or scrotal skin. The surgeon will also shorten the urethra which is the tube that transports urine from the bladder to outside the body.
Gender reassignment for female patients transitioning to male (FTM) is a little more complex. The breasts are removed via chest reassignment surgery (subcutaneous mastectomy) and the excess skin is reduced. The nipple and areola size is also reduced if necessary to resemble a male chest. A hysterectomy can also be performed to remove the uterus, tubes and ovaries and the vaginal canal may be partially or totally removed. The surgeon may use one of two methods to create a penis:
Patients who aren’t ready for surgical transition may be comfortable using hormone therapy. Hormone therapy will suppress the secondary sex characteristics of the biological gender and make them seem more like their chosen sex. Women who take androgens during hormone therapy will usually develop facial hair, a deeper voice, increased muscle mass and increased libido. Men who take estrogen and anti-androgens will begin to grow breasts while the testicles will shrink and produce less testosterone. Also, muscle mass will decrease and there will be an increase in subcutaneous body fat and a decrease in libido
An alternative for FTM transsexuals is an external prosthetic penis called a packer. A packer is glued, or strapped on, rather than going through surgery. MTF transsexuals may also choose to have facial feminization surgery to alter or soften their facial features and/or remove their Adam’s apple.
Both trans women and men may desire other surgical procedures in addition to their genital surgery to lose their initial sexual characteristics. These procedures may include orchiectomy, penectomy, mastectomy or vaginectomy. Other procedures that help patients find the characteristics of the opposite sex are body hair removal and hair transplant to transform a masculine hairline to a feminine one.
Gender reassignment costs depend on what the patient desires to have done and the type and number of procedures performed. Genital reassignment for female patients transitioning to male tends to be more complex and cost more money than male to female. The average cost of FTM GRS is approximately $40,000-$150,000 while an MTF GRS is $20,000 to $30,000 for the genital reassignment only. These costs do not include pre-qualification treatment for gender reassignment such as counseling and hormone therapy.
Facial feminization costs vary depending on which procedures are done including a forehead brow lift with scalp advance and bone flattering, rhinoplasty, upper lip lift, face and jaw contouring or an Adam's Apple reduction. Breast augmentation costs from $6000 to S9000. Chest masculinization procedures range from $9500 to $12,000 including the surgery, hospital and anesthesia costs.
After gender reassignment surgery, the patient may have some bruising, bleeding, swelling and pain in the treatment area. Pain medication will be provided during the RECOVERY period. Ice can be placed on the surgical sites to decrease swelling and bruising. Stool softeners may be recommended to help the patient stay regular since pain medications can cause constipation. For MTF patients, vaginal packing will be inserted into the vagina to keep it from shrinking or closing as it heals. The packing in the vagina can cause a patient to feel like they need to have a bowel movement but they should not strain the region. The packing will be removed in approximately 5-7 days and patients will then need to use vaginal dilators regularly to keep the vagina open. Dilators come in various sizes from the width of a tampon to the size of a large penis.
DOWNTIME involves bed rest on the back or lying on the side with pillows between the knees for the first 5-7 days. Patients will need to take a sponge bath during this time. After that, they may shower and can gradually increase activities but should do so with caution. Strenuous activities, lifting heavy objects and bending and using force on objects should be avoided for at least the first 2 weeks after gender reassignment surgery. Most patients can return to light duty work after 4 weeks but those who want to do strenuous exercises, or are required to do heavy work, may need to wait 6-8 weeks.
Due to all of the swelling and bruising, it may take several weeks or months for the results of gender reassignment to become functional and appear normal. Most patients are happy with their results. Complete healing takes up to one year and patients are usually no longer gender dysphoric and feel more comfortable with their bodies. Scarring can take up to a year to fade from red to pink before finally settling into flat white scars. The results of gender reassignment are permanent and usually irreversible.
Limitations for gender reassignment surgery include:
The risks involved with gender reassignment include:
Patients considering gender reassignment surgery should choose a board-certified plastic surgeon, urologist or GYN surgeon who performs sex-change procedures regularly. The surgeon should be highly trained and follow standards of care set by WPATH (World Professional Association for Transgender Health). The surgeon should work together with the patient’s counselors to ensure the patient is a viable candidate for gender reassignment since the procedure usually cannot be reversed once it is done. There is an approximately 1% incidence of regret from an individual wishing they had not done gender reassignment surgery. The majorities that have this surgery are extremely happy and enjoy a greatly improved quality of life.
Written by Cosmetic Town Editorial Team - MA
Based on an exclusive interview with Dr. Sherman Leis in Bala Cynwyd, PA