Gender Affirmation (Confirmation) or Sex Reassignment Surgery

What is sex reassignment surgery?

Sex reassignment surgery refers to procedures that help people transition to their self-identified gender. Today, many people prefer to use the terms gender affirmation or confirmation surgery.

Why is gender affirmation surgery done?

People may have surgery so that their physical body matches their gender identity. People who choose gender affirmation surgery do so because they experience gender dysphoria. Gender dysphoria is the distress that occurs when your sex assigned at birth does not match your gender identity.

What is the difference between transgender and nonbinary?

The term transgender describes someone whose gender identity is different than their sex assigned at birth. Gender nonbinary describes someone whose gender identity does not fit within traditional female or male categories. People in either of these categories may opt for gender affirmation medical treatment or surgery.

What are the types of transgender surgery?

Gender-affirming surgery gives transgender people a body that aligns with their gender. It may involve procedures on the face, chest or genitalia. Common transgender surgery options include:

• Facial reconstructive surgery to make facial features more masculine or feminine.
• Chest or “Top” surgery to remove breast tissue for a more masculine appearance or enhance breast size and shape for a more feminine appearance.
• Genital or “Bottom” surgery to transform and reconstruct the genitalia.

Is gender affirmation surgery the only treatment for gender dysphoria?

No. Surgery is just one option. Not everyone who is transgender or nonbinary chooses to have surgery. Depending on your age and preferences, you may choose:

• Hormone therapy to increase masculine or feminine characteristics, such as your amount of body hair or vocal tone.
• Puberty blockers to prevent you from going through puberty.
• Voice therapyto adjust your voice or tone or help with communication skills, such as introducing yourself with your pronouns.

People may also socially transition to their true gender with or without surgery. As part of social transitioning, you might:

• Adopt a new name.

• Choose different pronouns.
• Present as your gender identity by wearing different clothing or changing your hairstyle.

How common is gender affirmation surgery?

Surveys report that around 1 in 4 transgender and nonbinary people choose gender affirmation surgery.

What happens before gender affirmation surgery?

Before surgery, you should work with a trusted healthcare provider. A healthcare provider can help you understand the risks and benefits of all surgery options.

Many insurance companies require you to submit specific documentation before they will cover a gender-affirming surgery. This documentation includes:

• Health records that show consistent gender dysphoria.
• Letter of support from a mental health provider, such as a social worker or psychiatrist.

What happens during transgender surgery?

What happens during surgery varies depending on the procedure. You may choose facial surgery, top surgery, bottom surgery or a combination of these operations.

Facial surgery may change your:

• Cheekbones: Many transgender women have injections to enhance the cheekbones.
• Chin: You may opt to soften or more prominently define your chin’s angles.
• Jaw: A surgeon may shave down your jawbone or use fillers to enhance your jaw.
• Nose: You may have a rhinoplasty, surgery to reshape the nose.

If you are a transgender woman (assigned male at birth or AMAB), other surgeries may include:

• Adam’s apple reduction.
• Placement of breast implants (breast augmentation).
• Removal of the penis and scrotum (penectomy and orchiectomy).
• Construction of a vagina and labia (feminizing genitoplasty).

If you are a transgender man (assigned female at birth or AFAB), you may have surgeries that involve:

• Breast reduction or mastectomy.
• Removal of the ovaries and uterus (oophorectomy and hysterectomy).
• Construction of a penis and scrotum (metoidioplasty, phalloplasty and scrotoplasty).

What happens after gender affirmation surgery?

Recovery times vary based on what procedures or combination of procedures you have:

• Cheek and nose surgery: Swelling lasts for around two to four weeks.
• Chin and jaw surgery: Most swelling fades within two weeks. It may take up to four months for swelling to disappear.
• Chest surgery: Swelling and soreness last for one to two weeks. You will need to avoid vigorous activity for at least one month.
• Bottom surgery: Most people don’t resume usual activities until at least six weeks after surgery. You will need weekly follow-up with your healthcare provider for a few months. These visits ensure you are healing well.

It’s important to understand that, for most people, surgery is only one part of the transitioning process. After surgery, you should continue to work with a therapist or counselor. This professional can support you with social transitioning and your mental health.

What are the benefits of gender affirmation surgery?

Research has shown that transgender individuals who choose gender-affirming surgery experience long-term mental health benefits. In one study, a person’s odds of needing mental health treatment declined by 8% each year after the gender-affirming procedure.

What are the risks or complications of gender affirmation surgery?

Different procedures carry different risks. For example, individuals who have bottom surgery may have changes to their sexual sensation, or trouble with bladder emptying. In general, significant complications are rare, as long as an experienced surgeon is performing the procedure.

With any surgery, there is a small risk of complications, including:

• Bleeding.
• Infection.
• Side effects of anesthesia.

What is the outlook for people who have gender affirmation surgery?

Most people who choose these surgeries experience an improvement in their quality of life. Depending on the procedure, 94% to 100% of people report being satisfied with their surgery results. In general, people who work with a mental health provider before surgery tend to experience more satisfaction with their treatment results.

When should I see my healthcare provider?

After surgery, you should see your healthcare provider if you experience:

• Bleeding for more than a few days after surgery.
• Pain that doesn’t go away after several weeks.
• Signs of infection, such as a wound that changes color or doesn’t heal.

A note from Cleveland Clinic

Gender affirmation procedures help people transition to their self-identified gender. Gender affirmation surgery may involve operations to change the face, chest or genitalia. You may choose to have one type of surgery or a combination of procedures. Before and after surgery, it’s important to work with a mental health provider. Research shows that having a trusted therapist makes you more likely to be satisfied with your surgery results.