Beauty Industry Bulletins

Gender Identification Surgery: Common Questions and Answers

If you or a loved one is considering sex determination surgery, you are probably wondering what steps you need to go through before the surgery can be performed. Let’s look at what it takes to be a candidate for these surgeries, the potential positive effects and side effects of hormone therapy, and the types of surgeries that are available.

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Sex confirmation surgery, also known as sex confirmation surgery, is done to align or convict people with gender dysphoria to their true gender.

A transgender woman, transgender man, or a non-binary person may opt for sex confirmation surgery.

The term “transgender” was previously used by the medical community to describe people undergoing sex determination surgery. The term is no longer accepted by many members of the trans community as it is often used as an insult. While some transsexuals identify as “transgender” it is best to use the term “transgender” to describe members of this community.


The transition can include:

  • Social transition: use different pronouns, change your style, adopt a new name, etc. to confirm your gender
  • Medical conversion: Ingestion of hormones and / or surgical removal or alteration of genitals and reproductive organs

Transgender individuals do not need to undergo medical intervention to have a valid identity.

Reasons for an operation

Many transgender people experience a marked mismatch between their gender and the gender assigned to them at birth.The American Psychiatric Association (APA) has identified this as gender dysphoria.

Gender dysphoria is the distress some transsexuals experience when their looks don’t reflect their gender. Dysphoria can cause poor mental health or cause mental illness in transgender people.

In these individuals, social transition, hormone therapy, and gender-based affirmation surgery enable their physical appearance to match their true gender.

Steps to take before surgery

In addition to a thorough understanding of the procedures, hormones, and other risks associated with gender-specific surgery, additional steps must be taken prior to surgery. These steps are one way the medical community and insurance companies are restricting access to gender-based procedures.

Steps can be:

  • Mental health assessment: A mental health assessment is needed to look for any mental health problems that may affect a person’s mental state and to assess a person’s willingness to endure the physical and emotional stresses of transition.
  • Clear and consistent documentation of gender dysphoria
  • A “real life” test: The person must take on the role of their gender in everyday activities, both socially and professionally (so-called “real-life experience” or “real-life test”).

First, not all transgender people experience physical dysphoria. The “real life” test is also very dangerous, as trans people must make themselves vulnerable in public in order to be considered for positive trials. If a trans person fails (easily identifiable as their gender), they can be branded (identified as transgender), putting them at risk of violence and discrimination.

It is extremely dangerous to require transgender people to take a “real life” test despite the ongoing violence transgender people face, especially because some transgender people only want surgery to reduce their risk of experiencing transphobic violence.

Hormone Therapy & Conversion

Hormone therapy involves taking progesterone, estrogen, or testosterone. A person must have had hormone therapy for a year before sex confirmation surgery can be performed.

The purpose of hormone therapy is to change physical appearance to reflect gender identity.

Effects of testosterone

When a trans person starts taking testosterone, the changes include both a decrease in the associated female sexual characteristics and an increase in the associated male sexual characteristics.

Physical changes can be:

  • Beard and mustache growth
  • Deepening of the voice
  • Enlargement of the clitoris
  • Increased body hair growth
  • Increased muscle mass and strength
  • Increase in the number of red blood cells
  • Redistribution of fat from the breasts, hips and thighs to the abdominal area
  • Development of acne, similar to male puberty
  • Baldness or localized hair loss, especially on the temples and the top of the head
  • Atrophy of the uterus and ovaries, resulting in the inability to have children

Changes in behavior include:

  • aggression
  • Increased sex drive

Effects of Estrogen

When a trans person begins taking estrogen, the changes include both a decrease in the associated male sexual characteristics and an increase in the associated female characteristics.

Physical changes can be:

  • Breast development
  • Loss of erection
  • Shrinkage of the testicles
  • Decreased acne
  • Less facial and body hair
  • Decreased muscle mass and strength
  • Softer and smoother skin
  • Slowing down of balding
  • Redistribution of fat from the abdomen to the hips, thighs and buttocks

Changes in behavior include:

  • Decreased sex drive
  • Mood swings

When will the effects of hormone therapy be noticed?

The feminizing effects of estrogen and the masculinizing effects of testosterone can appear after the first few doses, although it can take several years for a person to be satisfied with their transition.This is especially true for breast development.

Surgical process timeline

The operation is postponed for at least one year after starting hormone therapy and at least two years after a psychological examination. Once the surgical procedures begin, the length of time to complete is variable depending on the number of procedures desired, recovery time, and more.

Transfeminine Operations

Transfeminine is an umbrella term for trans women and non-binary trans people who were assigned a man at birth.

Most commonly, surgeries involved in gender-specific confirmation surgery are broken down into those that take place above the belt (upper operation) and below the belt (lower operation). Not everyone undergoes all of these surgeries, but procedures that may be considered for transfeminine individuals are listed below.

The top surgeries include:

  • Breast augmentation
  • Facial feminization
  • Nasal surgery: A rhinoplasty can be done to narrow the nose and refine the tip.
  • Eyebrows: A brow lift can be performed to feminize the curvature and position of the eyebrows.
  • Jaw surgery: the jawbone can be shaved off.
  • Chin reduction: Chin reduction can be done to soften the angles of the chin.
  • Cheekbones: Cheekbones can be enhanced, often with collagen injections, as well as other plastic surgery techniques.
  • Lips: A lip lift can be performed.
  • Change in the hairline
  • Hair removal in men
  • Reduction of Adam’s apple
  • Voice change surgery

Lower surgery includes:

  • Removal of the penis (penectomy) and scrotum (orchiectomy)
  • Creation of a vagina and labia

Transmasculine operations

Transmasculine is an umbrella term for trans men and non-binary trans people who were assigned female at birth.

The surgery for this group also includes upper surgery and lower surgery.

The top surgeries include:

  • Subcutaneous mastectomy / breast reduction.

Lower surgery includes:

Complications and side effects

Surgery is not without its potential risks and complications. Estrogen therapy has been associated with an increased risk of blood clots (deep vein thrombosis and pulmonary embolism) in transfeminine individuals.There is also a possibility of an increased risk of breast cancer (breast cancer can develop even without hormones).

Testosterone use in transmasculine people has been linked to increases in blood pressure, insulin resistance, and lipid abnormalities, although it is not known exactly what role these changes play in the development of heart disease.

During an operation there are operational risks such as bleeding and infection as well as side effects of the anesthesia. Those considering these treatments should speak carefully with their doctor about possible risks associated with hormone therapy as well as surgeries.

Sex confirmation surgery cost

Surgery can be prohibitively expensive for many transgender people. The cost including counseling, hormones, electrolysis, and surgery can be well in excess of $ 100,000. Transfeminine procedures are usually more expensive than transmasculine procedures. Sometimes health insurance pays part of the cost.

Quality of life after the operation

The quality of life appears to improve after gender-affirming surgery for all trans people undergoing a medical transition. A 2017 study found that surgical satisfaction ranged from 94% to 100%.

Since it takes many steps and sometimes uncomfortable surgery, this number supports the benefits of having surgery for those who think they are the best choice.

A word from Verywell

Sex confirmation surgery is a lengthy process that begins with a consultation and mental health assessment to determine whether a person can be diagnosed with gender dysphoria.

After this is complete, hormone treatment will begin with testosterone for transmasculine individuals and estrogen for transfeminine individuals. Some of the physical and behavioral changes associated with hormone treatment are listed above.

After continuing hormone therapy for at least a year, a number of surgical procedures may be considered. These are divided into “top” methods and “bottom” methods.

Surgery is costly, but there are many variables that make accurate estimates difficult. It is beneficial to find a surgeon who is solely focused on the sex confirmation surgery and who has performed many of these procedures.Conversations with previous patients of a surgeon can be helpful in gaining insight into the doctor’s office as well.

For those undergoing these prep, hormonal treatments, and surgeries, studies show that quality of life appears to improve. Many people who undergo these procedures are satisfied with their results.

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