Sexual Health Q&A

What is gender reassignment surgery?

Gender reassignment surgery, sometimes called sex reassignment surgery, is performed to transition individuals with gender dysphoria to their desired gender.

People with gender dysphoria often feel that they were born in the wrong gender. A biological male may identify more as a female and vice versa.

Surgery is typically the last step in the physical transition process, but it is not a decision to be made lightly.

Many healthcare providers require patients to be formally diagnosed with gender dysphoria and undergo counseling to determine if they are truly ready to surgically transition.

Patients usually undergo hormone therapy first. Hormones can suppress the secondary sex characteristics of the biological gender and make them appear more like their desired sex. For instance, women take androgens and start developing facial hair. Men take estrogens and anti-androgens to look more feminine.

Surgeons may also require that patients live as their desired gender for at least one year. A man might dress as a woman traditionally does in the culture. Many men change their names and refer to themselves with female pronouns. Women transitioning to men would do the reverse.

Surgical transition may include several procedures. Males transitioning to females have their testicles and penis removed. The prostate gland may or may not be removed as well. Tissue from the penis is used to construct a vagina and clitoris. Labia – the “lips” surrounding the vagina - can be made from scrotal skin. The urethra (the tube from which urine leaves the body) is shortened.

Many biological men also have facial feminization surgery to change the appearance of their lips, eyes, nose, or Adam’s apple.

After surgery, patients use vaginal dilators to keep the new vagina open and flexible.

Surgery for females transitioning to males is more complicated and expensive. The breasts, ovaries, and uterus are removed and the vagina is closed. A penis and scrotum may be made from other tissue. In some cases, a penile implant is used. The urethra is extended so that the patient can urinate while standing.

Continued psychotherapy is recommended for most patients as they adjust to their new bodies and lifestyles.

Not all people with gender dysphoria have surgery. Some feel comfortable living as the opposite gender without medical intervention. Others find that hormone therapy is sufficient for their personal needs.