Expert Doctor

Gender Reassignment

Gender Reassignment

Gender reassignment surgery is known by a number of names including:

  • Genital Reassignment Surgery (GRS)
  • Sex Reassignment Surgery (SRS)
  • Gender Confirmation Surgery
  • Genital Reconstruction
  • Sex Realignment Surgery
  • Gender Affirming Surgery

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.

Am I a Good Candidate for Gender Reassignment?

GOOD CANDIDATES for gender reassignment are:

  • People who have been cleared by mental health specialists trained in transgender issues
  • A male or female who wishes to alter their genitalia to match their desired gender
  • A male or female who wishes to alter their facial futures to match their desired gender
  • A person who feels they were born with the wrong gender or body
  • A biological female who wishes to have chest masculinization, i.e. bilateral mastectomy, or a biological male who wishes to have breast augmentation
  • Individuals who have already undergone a minimum of 1 year hormone therapy for gender transition
  • A male or female who has undergone a minimum 12-month trial period of living as his or her true gender
  • Individuals who were born with intersex deformities and were assigned a sex contrary to what they believe is their true gender
  • A patient who has been formally diagnosed with gender dysphoria and has undergone mental health evaluation and counseling to determine if they are emotionally stable, non-suicidal and ready for surgical transition

The following are NOT GOOD CANDIDATES for gender reassignment surgery:

  • A person who is not willing to undergo an extensive evaluation and transition period
  • Patients who do not want to go through surgical procedures
  • A person who is under severe mental stress, is mentally unstable or suicidal or is deemed incapable of making a properly informed decision
  • A person whose therapist does not recommend they undergo surgery

How is Gender Reassignment Performed?

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:

  1. Metoidioplasty (Clitoral release) – A small penis can be created from the clitoris by releasing its normal place of attachment to allow it to project outward. The natural blood flow allows the clitoris to become erect for aesthetics and sensation but it cannot function for intercourse because it's too small.  The newly created penis will enlarge with the use of testosterone but will never be the size of an adult penis.
  2. Phalloplasty – A phalloplasty uses flaps of tissue with nerves and blood vessels from another area of the body to create an adult-sized penis. The vagina can be removed or left in place. The urethra can be rerouted through the new penis or it can be extended with grafts of skin to allow the patient to stand while urinating. The labia’s fleshy tissue can be used to create a scrotum and testicular implants can be added for a more natural look. In some instances, a penile implant may be placed to help the penis become erect.  Unfortunately, there is a high incidence of complications associated with extending the urethra and so this option may not be chosen.  This means that the person will need to sit in order to urinate.  Also, penile implants can extrude (ejected from the body), so instead of implanting a penile prosthesis, external penile support techniques are recommended such as special thicker and firmer condoms, extenders, expanders, etc.

Hormone Therapy

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

Alternative Methods

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.

What is the Cost of Gender Reassignment? 

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.

Recovery and Downtime

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 of Gender Reassignment Surgery

Limitations for gender reassignment surgery include:

  • Patients who need to lose weight may be denied surgery until they are closer to their ideal weight
  • FTM patients will have a natural looking penis after a phalloplasty but will not be able to ejaculate, produce children or have a natural erection
  • FTM patients who had a metoidioplasty (clitoral release) procedure will not be able to use their penis for intercourse
  • People with significant medical problems such as heart disease, diabetes and hypertension will have to be cleared for surgery by their medical doctors
  • Patients who have not been formally diagnosed with gender dysphoria, undergone counseling, had hormone therapy for at least a year or lived a one year trial (full-time) in their desired gender may be denied gender reassignment surgery

Risks of Gender Reassignment Surgery

The risks involved with gender reassignment include:

  • Bleeding
  • Blood clots
  • Infection
  • Necrosis with partial or total loss of penis or labial, clitoral or vaginal tissues
  • Bad scarring (thick, wide, discolored or contracting scars)
  • Deep vein thrombosis
  • Inability to have a natural erection
  • Extrusion of penile or testicular implants
  • Urinary obstruction or inability to urinate efficiently
  • Vaginal narrowing or closure with a decrease in length and/or width of the vagina may require revisional surgery
  • Fistula formation which is the unwanted connection between anatomic structures such as urinary tract openings into the vagina resulting in constant leaking of urine into vagina or recto-vaginal fistula which results in having bowel movements through the vagina

Not a Decision to Be Made Lightly

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