Gender-Affirming Surgery

The first step is getting to know you. We want to really understand where you’re coming from and why you want surgery. We want to know your transition goals and how you feel gender-affirming surgery will make a difference in your life. We want to know all of these things because that’s how we can give you the very best recommendations and the very best care.

You’re always welcome to bring a loved one or friend to any of your appointments. Your comfort level is very important to us, and if having a support person by your side helps, then we’re all for it. For some surgeries, we ask that you have a support person with you right after your procedure. Bringing this person to your appointments is highly recommended. 

Gender-affirming surgeries we offer

An important part of our consultation will be finding out what procedures interest you. At Cleveland Clinic, we offer a variety of feminizing and masculinizing surgeries. 

Our experts will show you pictures of previous surgery results so you have a better idea of what to expect from your own surgery. We’ll explain the surgery process in great detail, and you’ll even meet with several members of your care team during your consultation visit. We’ll also go over timelines and what recovery might look like. Transitioning through surgery isn’t a quick process. There are lots of steps. And it can take many months from start to finish. But being thorough with each part of the journey is how we make sure you stay safe and get the results you want and expect. 

And throughout it all, we’ll take the time to listen to all of your concerns and answer any questions you have. We know this is a big decision, and we’ll give you the time you need. 

Feminizing surgeries include:

• Orchiectomy.
• Vaginoplasty.
• Vulvoplasty.
• Breast augmentation.
• Facial feminization.
• Voice feminization. 

Masculinizing surgeries include: 

• Metoidioplasty. 
• Phalloplasty.
• Hysterectomy. 
• Mastectomy. 

After we’ve talked about the procedures you’d like to have, we’ll go over the requirements for those surgeries. At Cleveland Clinic, we follow the World Professional Association for Transgender Health’s (WPATH) Standards of Care. Most insurance companies also require you to meet the WPATH guidelines. We understand that the WPATH Standards of Care 8 has changed. Our goal is to align our requirements with the WPATH Standards of Care 8, as well as your insurance provider in order to care for the greatest number of people in the most consistent way. While we work to stay in step with WPATH Standards, please note that our requirements may be adjusted in order to optimize approval for surgical procedures.

Also, surgeons are willing to complete consults once you have met the six-month requirement for gender affirming hormone therapy. But they’ll need to wait to schedule your date of surgery if your insurance requires 12 months of gender affirming hormone therapy.

At Cleveland Clinic, we also have our own pre-surgery requirements — in addition to the WPATH standards — for each procedure. Here are a few things we look for:

• Be 18 years old: Because gender-affirming surgeries are life-changing, we only offer these procedures for people who can provide their own consent for surgery.
• Body Mass Index (BMI): This is a measurement based on your height and weight. You can use this BMI calculator to get an estimate. Your BMI can help us decide if you’re healthy enough for a certain surgery. We use your BMI as a starting point for conversations about surgery, but we know it’s not perfect. Each person is unique. If your BMI doesn’t match the requirement for a certain surgery, your healthcare provider can talk about next steps.
• Don’t use tobacco: Being nicotine free is important for most of these surgeries. Plus, it’s just a great thing to be, period. If you’re having trouble quitting smoking, our Smoking Cessation Program may help. This comprehensive program can be tailored to fit your individual needs.
• Specialist consultation or provider referral: For some of the procedures, you’ll need to meet with a specialist first or get a letter of support for the surgery from your healthcare provider or mental health professional. This is a WPATH requirement for many of the surgeries we offer. We do this to make sure you fully understand and are ready for the procedure. We can help you coordinate these appointments.

Surgery-specific requirements at Cleveland Clinic

In addition to the WPATH standards, here’s a quick rundown of the requirements you’ll also need to meet to have each of these gender-affirming procedures at Cleveland Clinic:

Orchiectomy

• Be at least 18 years old.
• Have at least six months (or up to 12 months) of feminizing hormone therapy.
• Have a consult with a surgeon after six months of gender affirming hormone therapy treatment (you may need to wait to schedule your surgery date if your insurance requires 12 months of treatment)
• Have two letters of support from licensed mental health providers (this requirement may be impacted by insurance requirements or evaluation from your mental health provider).

Vaginoplasty

• Be at least 18 years old.
• Have a BMI of less than or equal to 35.
• Have completed electrolysis, laser genital hair removal or a combination of both and have no hair regrowth. For your convenience, our dermatology department offers laser hair removal. Please feel free to reach out to them to discuss and to schedule an appointment.
• Be nicotine-free.
• Be able to follow Cleveland Clinic guidelines for hospital stay after surgery and commit to follow-up visits.
• Have 12 months of feminizing hormone therapy.
• Live for 12 months full-time in the gender role that matches your gender identity.
• Have two letters of support from licensed mental health providers.

View before and after photos.

Vulvoplasty

• Be at least 18 years old.
• Have a BMI of less than or equal to 35.
• Be nicotine-free.
• Able to follow Cleveland Clinic guidelines for hospital stay after surgery and commit to follow-up visits.
• Have 12 months of feminizing hormone therapy.
• Live for 12 months full-time in the gender role that matches your gender identity.
• Have two letters of support from licensed mental health providers.

Breast augmentation

• Be at least 18 years old.
• Have a BMI of less than or equal to 35.
• Be nicotine-free.
• For the best results, we recommend that you do at least six months (or up to 12 months) of feminizing hormone therapy before breast augmentation surgery (this could be impacted by insurance requirements).

View before and after photos.

Facial feminization

• Be at least 18 years old.
• Be nicotine-free.
• Have 12 months of feminizing hormone therapy.
• Have one letter of support from a licensed mental health provider.

View before and after photos.

Voice feminization

• Be at least 18 years old.
• Be nicotine-free.
• Consult with a Cleveland Clinic speech-language pathologist, or SLP (we can help you coordinate this appointment).
• Have 12 months of feminizing hormone therapy.
• Have one letter of support from a licensed mental health provider.

Metoidioplasty and phalloplasty

• Be at least 18 years old.
• Have a BMI of less than or equal to 32.
• Be nicotine-free.
• Be able to follow Cleveland Clinic guidelines for hospital stay after surgery and commit to follow-up visits.
• Have 12 months of masculinizing hormone therapy.
• Live for 12 months full-time in the gender role that matches your gender identity.
• Have two letters of support from licensed mental health providers.

Hysterectomy

• Be at least 18 years old.
• Have a BMI of less than or equal to 40.
• Have at least six months (or up to 12 months) of masculinizing hormone therapy.
• Have a consult with a surgeon after six months of gender affirming hormone therapy treatment (you may need to wait to schedule your surgery date if your insurance requires 12 months of treatment).
• Have two letters of support from licensed mental health providers (this requirement may be affected by insurance requirements or an evaluation from your mental health provider).

Mastectomy

• Be at least 18 years old.
• Have a BMI of less than or equal to 35.
• Be nicotine-free.
• Have 12 months of masculinizing hormone therapy.
• Have one letter of support from a licensed mental health provider.

View before and after photos.

Please note that letters of support need to be written by a psychologist, nurse practitioner, psychotherapist or mental health provider with a doctoral level degree. This is typically a requirement from your insurance provider.

What To Expect After Gender-Affirming Surgery at Cleveland Clinic

Recovery times will vary depending on the type of surgery or surgeries you have. Your provider will let you know what to expect after each procedure. It’s important to know that surgery is just one part of your transition. You’ll need to keep up with your primary care providers and any specialists you have as you get used to the changes in your body. Ongoing care with a mental health provider might help you with some of the stressors of having surgery.  We can refer you to Cleveland Clinic providers in all areas who understand transgender health and can support you in every way. 

Taking the Next Step

Having gender-affirming surgery is a big decision. You need to fully understand the process and the requirements for each procedure. Once you’re ready, you’ll meet with the surgery team. At Cleveland Clinic, our surgeons are compassionate and highly skilled at gender-affirming surgeries. They can help make this part of your transition journey safe and successful.