How should I prepare for gender affirmation surgery?
You’ll work with healthcare providers to ensure you meet the criteria for gender-affirming surgery, according to the World Professional Association for Transgender Health (WPATH) standards of care. This organization promotes evidence-based care for transgender and gender-diverse people.
Many insurance companies require you to submit documentation related to WPATH criteria before they cover surgery costs.
Criteria include:
- Providing informed consent. You’ll need to demonstrate that you understand what’s involved. This includes what happens during surgery and how it’ll affect your life. These effects extend to your desire to have biological children. Many surgeries cause temporary or permanent infertility. Your provider will explain fertility preservation options, like freezing your eggs or sperm.
- A history of gender incongruence. You may need to produce health records demonstrating a history of gender incongruence (usually a year or more).
- A mental health evaluation. You may need a letter of support from a qualified mental health provider (therapist, psychiatrist or social worker). They’ll work with you to determine the safest and healthiest options for embodying your gender. If you have gender dysphoria, they can help diagnose and treat related conditions, like anxiety and depression.
- Hormone therapy. In some cases, you may need to be on hormone therapy before surgery. Depending on the procedure and desired outcomes, hormones can cause changes in your body that make surgery more effective.
To prepare for the procedure, your provider will review your medical history to ensure you’re in good physical health. They may perform various tests, including:
- A physical exam.
- Blood tests.
- Imaging tests.
What happens during gender affirmation surgery?
Your healthcare provider will walk you through what’ll happen during surgery. For many people, gender affirmation surgery is a combination of procedures. For example, you may have both an orchiectomy and a vaginoplasty, a hysterectomy and a phalloplasty, etc.
Regardless of the procedure, your surgeon will administer anesthesia so you don’t feel any pain. Depending on the surgery, your surgeon will:
- Remove or restructure organs or tissue.
- Construct new structures out of existing tissue.
- Insert implants or tissue grafts.
They may also place drains to remove fluid from wounds or a Foley catheter to help you pee.
Reach out to your provider if you have any questions about the specifics.
How long does gender-affirming surgery take?
Some procedures take place in a single day, while others require several surgeries spread out over time. For example, top surgery usually takes one day. But a phalloplasty is usually spread out over several surgeries.
Even if surgery only takes a day, you may need to return to your provider for additional changes (revision surgery) depending on how satisfied you are with the results. Choosing a healthcare provider with extensive experience performing a particular surgery will reduce the likelihood you’ll need a revision.
It’s essential to talk to your healthcare provider beforehand so you understand:
- How many surgeries you’ll need.
- How long (approximately) each surgery will last.
- When you should expect to see full results.
What types of healthcare providers make up a gender affirmation surgery team?
The following healthcare providers may make up your gender affirmation surgery team:
- Urologist.
- Gynecologist.
- Plastic surgeon.
- Otolaryngologist.
- Anesthesiologist.
- Speech-language pathologist (SLP).
- Physical/occupational therapists.
- Nurses, nurse practitioners, physician assistants.
- Trainees (residents and fellows).
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What happens after gender affirmation surgery?
You’ll need to take extra care of yourself as you heal. This may mean asking friends or family to help during recovery. After surgery, you’ll need to:
- Care for wounds, catheters and drains. Follow your healthcare provider’s guidance on how to wash your wounds and monitor for infection. Make sure you understand how to care for catheters and drains if you have them.
- Wear compression garments. You may need to wear compression bandages or garments to reduce swelling, so wounds heal faster.
- Take medicines as prescribed. This includes reaching out to your healthcare provider if you need help managing pain.
- Avoid reaching or straining. Before surgery, rearrange your living space so you don’t have to strain to reach objects you need. This can prevent injuries once you return home.
- Monitor your eating patterns. Discuss nutritious food options that will facilitate healing with your healthcare provider.
- Adjust your routine. For example, you may need to stick with sponge baths for a while and limit exercise. You may need to avoid certain sexual activities until you’ve healed completely. Follow your provider’s instructions.
