Overview
Why Choose Cleveland Clinic for Gender Affirmation Surgery?
Comprehensive care for transgender patients involves a wide spectrum of services, ranging from routine medical visits to the physical transition process. Few hospitals are equipped to provide such care. Even fewer hospitals offer surgical care for patients wishing to undergo gender affirmation surgery. Over the last several years, we have been actively expanding the surgical services Cleveland Clinic offers to gender and sex-minority patients.
Our team follows the World Professional Association for Transgender Health (WPATH) guidelines to ensure patients are appropriate surgical candidates. We require that patients live full time as their self-affirmed gender for more than one year, that they have undergone cross-sex hormone therapy for at least one year, and that they have letters of support for surgical transition from two mental health professionals who are well-versed in transgender patient care. Patients who have met these criteria are deemed appropriate surgical candidates. They cannot be smokers or be excessively overweight, and they must be medically optimized for surgery if they have medical comorbidities.
Our volume of patients increases each month, and with this growth, we continue to expand our caregiver team to be able to accommodate our patients’ needs.
Treatments & Procedures
Male Gender-Affirming Surgeries
Hysterectomy
This procedure includes removal of the uterus and cervix as well as the fallopian tubes and ovaries in those patients who do not desire future fertility. The procedure is often performed laparoscopically using three 5mm incisions on the lower abdomen. Hysterectomy is often performed as an outpatient procedure, but some patients may require one night stay in the hospital.
Requirements for surgery:
- WPATH guidelines must be met.
- Patients must have a support person to bring them home from the hospital.
Insurance coverage: This procedure is covered by many insurance plans when criteria has been met. Please check with your insurance provider to make sure that it is covered. If it is not, you will receive information about payment plans at the time of your consultation.
Phalloplasty/Metoidioplasty
Phalloplasty creates a working penis for transgender men. A metoidioplasty uses testosterone-enlarged clitoris to form a penis. Recovery after surgery will take between six and eight weeks. While you recover, you'll need to stay locally (within one hour of Cleveland Clinic Main Campus) for four to six weeks. Our team can share options for where to stay, including the new Medley-Fairfax Apartments from Barsala.
Requirements for surgery:
To qualify for gender-affirming surgery, you must:
- Meet WPATH criteria.
- Have a BMI of 32 or less.
- Be nicotine/tobacco-free.
- Have a support person to stay with you during your hospital stay.
- Provide your most recent primary care medical records.
- Remove all pubic hair before surgery
Insurance coverage: Many insurance plans will cover this procedure. But only if you’ve met the requirements for surgery. It’s important to check with your insurance provider to be sure you’re covered.
Masculinizing/Defeminizing Chest Reconstructive Surgery (Mastectomy)
This procedure includes removal of breast tissue with masculinizing chest contouring and nipple grafting in some cases. Chest surgery is sometimes performed as an outpatient procedure but some patients may require one night stay in the hospital.
Requirements for surgery:
To qualify for gender-affirming surgery, you must:
- WPATH criteria must be met.
- BMI requirements are determined by your surgeon.
- Patient must be nicotine/tobacco-free.
- Patients must have a support person to bring them home from the hospital.
Insurance coverage: This procedure is sometimes covered by insurance plans when criteria has been met. Please check with your insurance provider to make sure that it is covered. If it is not, you will receive information about payment plans at the time of your consultation.
Female Gender-Affirming Procedures
Breast Augmentation
This procedure involves enlargement of the breasts with an implant. Various techniques may be used to perform this procedure, and they are surgeon and patient dependent. Breast augmentation is often performed as an outpatient procedure but some patients may require one night stay in the hospital.
Requirements for surgery:
- WPATH criteria must be met.
- BMI requirements are determined by your surgeon
- Patient must be nicotine/tobacco-free.
- Patients must have a support person to bring them home from the hospital.
Insurance coverage: This procedure is covered by many insurance plans when criteria has been met. Please check with your insurance provider to make sure that it is covered.
Orchiectomy (Surgical Removal of the Testes)
Orchiectomy is a procedure done to remove the testes which alleviates genital dysphoria in some patients and eliminates the need for androgen (testosterone) suppression and optimize the effects of estrogen. The procedure is done through a 3cm incision along the scrotum. Undergoing this procedure will not interfere with the possibility of having future vaginoplasty. Orchiectomy is performed as an outpatient procedure.
Requirements for surgery:
- WPATH guidelines must be met.
- Patients must have a support person to bring them home from the hospital.
Insurance coverage: This procedure is covered by many insurance plans when criteria has been met. Please check with your insurance provider to make sure that it is covered. If it is not, you will receive information about payment plans at the time of your consultation.
Vaginoplasty (Female Genital Reconstructive Surgery)
Vaginoplasty surgery makes the vulva (outer female genitals). This may or may not include a vagina. You may choose to have what's called a zero-depth vaginoplasty. It only creates the outer genitals (labia, clitoral hood, urethral opening) without a vagina. The procedure requires an inpatient stay in the hospital and if a full-depth vaginoplasty is performed, there is a required stay at a nearby hotel. For zero-depth procedures patients should expect to be in Cleveland for three to four days after the surgery and for a full-depth procedure, seven to 10 days after surgery. Your recovery after surgery will take about six to eight weeks. This can vary with each person. We're happy to complete FLMA and short-term disability (STD) paperwork if needed.
Requirements for surgery:
To qualify for gender-affirming surgery, you must:
- Meet WPATH criteria.
- Have a BMI of 35 or less.
- Be nicotine/tobacco-free.
- Have a support person to stay with you during your hospital stay.
- Provide your most recent primary care medical records.
- Remove all pubic hair before surgery
Insurance coverage: Many insurance plans will cover this procedure. But only if you’ve met the requirements for surgery. It’s important to check with your insurance provider to be sure you’re covered.
Tracheal Shaving Surgery (Chondrolaryngoplasty)
A tracheal shaving procedure involves reduction of the thyroid cartilage to reduce the size of the Adam’s apple. It is performed as an outpatient procedure.
Requirements for surgery:
- There is no WPATH criteria.
- Patients must have a support person to bring them home from the hospital.
Insurance coverage: This procedure is covered by many insurance plans when criteria has been met. Please check with your insurance provider to make sure that it is covered. If it is not, you will receive information about payment plans at the time of your consultation.
Facial Feminization Procedures
Facial feminization surgery (FFS) involves several surgeries that can be done to feminize the facial features. These procedures include but are not limited to: rhinoplasty, forehead contouring, jaw angle reduction, chin width reduction, lowering the hairline, hair transplantation, cheek augmentation, lip augmentation and upper lip shortening. Some procedures are performed as outpatient procedures while others require an inpatient stay.
Requirements for surgery:
- There is no WPATH criteria.
- Patient must be nicotine/tobacco-free.
- Patients must have a support person to bring them home from the hospital.
Insurance coverage: This procedure is very specialized and often not covered by insurance plans. Please contact our office with any questions.
Meet Our Team
Transgender Surgery Program Leadership
Bahar Bassiri Gharb, MD, PhD
Surgical Co-Director
Michele (Mike) Fascelli, MD
Surgical Co-Director
Urogenital Gender Affirming Surgery
Michele (Mike) Fascelli, MD
Director, Urogenital Reconstruction
Evelina Flanagan, PA-C- Laser Hair Removal
Amanda George, PT, DPT, OCS- Pelvic Floor Rehabilitation
Erika Lyndon, PT, DPT- Pelvic Floor Rehabilitation
Cameron Pikula, PT, DPT, COMT- Pelvic Floor Rehabilitation
Chest Gender Affirming Surgery (Top Surgery)
Raymond Isakov, MD
Director, Chest Gender Affirming Surgery
Facial Feminization and Masculinization Surgery
Bahar Bassiri Gharb, MD, PhD
Director, Facial Gender Affirming Surgery
Voice Gender Affirming Surgery
Paul C. Bryson, MD, MBA
Director, Voice Gender Affirming Surgery
Michelle Adessa, BM, MS, CCC-SLP, Speech/Language Pathology
Bethany Beckham, BA, MA, CCC-SLP, Speech/Language Pathology
Ellen Swain, M.A., CCC-SLP, Speech/Language Pathology
What to Expect
Before & after photos
Do you want to see examples of gender-affirming surgery? Our before-and-after pictures can help. You'll see what real people look like before and after their surgeries.
Special Considerations for Vaginoplasty Surgery & Phalloplasty/Metoidioplasty
Out-of-state residents
Traveling from a distance? You might want to make hotel reservations for you and your support person for the entire time you'll be in Cleveland. This will give you a safe place to get ready for your surgery and be close by for any follow-up visits. We have information about nearby hotels if needed.
Leaving the hospital
When it’s time to leave the hospital, you must have a family member, friend or caregiver be there to drive you. You won’t be able to leave with a medical transportation service, public transportation or a ride-share like Uber or Lyft.
Follow-up visits
You will have multiple appointments with your care team after you leave the hospital. For the first two to four weeks, your support person will have to take you to these appointments as you won't be able to drive.
Checklist for vaginoplasty & phalloplasty/metoidioplasty
Ready to move forward? Here’s a checklist to make sure you’re ready to take the next step. You must:
- Stop using nicotine/nicotine-related products for at least three months before surgery.
- Stop using all nonprescription substances, including marijuana, for at least three months.
- Complete hair removal process and have no regrowth.
- Establish a relationship with a mental health provider who can see you within four to six weeks after surgery.
- Provide two letters of support from qualified mental health providers dated within the past 12 months.
- Ensure you have available funds to cover your postoperative stay.
- Have a support companion able to stay with you during your postoperative stay.
Need referrals? Just ask. Our team can share a list of qualified hair removal and/or mental health providers upon request.
WPATH Guidelines
The World Professional Association for Transgender Health (WPATH) promotes the highest standards of healthcare for people through clear and understandable Standards of Care (SOC) for the Health of Transsexual, Transgender and Gender Nonconforming People. The SOC are based on the best available science and expert professional consensus.
The overall goal of the SOC is to provide clinical guidance for health professionals. This helps them offer safe and effective pathways for transsexual, transgender and gender nonconforming people to achieve lasting personal comfort with their gendered selves — maximizing their overall health, psychological well-being and self-fulfillment.
Cleveland Clinic requires that all people seeking the following gender affirming surgical services, must get a letter from a licensed mental health professional (counselor, social worker, etc.) that meets WPATH Guidelines:
- Chest surgery (breast augmentation, masculinizing mastectomy) - One letter must be obtained.
- Male hysterectomy/vaginectomy - Two letters must be obtained.
- Orchiectomy (surgical removal of the testes) - Two letters must be obtained.
- Vaginoplasty (female genital reconstructive surgery) - Two letters must be obtained.
- Phalloplasty/metoidioplasty - Two letters must be obtained.
Appointments & Location
For more information about the program or to make an appointment, please contact the Transgender Surgery Program at 216.445.6308.
The Cleveland Clinic Transgender Surgery Program has also partnered with several community mental health practices and program in our area and our coordinator will be happy to provide you with a provider or practice referral should you need one outside of Cleveland Clinic.
Location
Cleveland Clinic Main Campus
9500 Euclid Ave.
Cleveland, Ohio 44195
