The below guide is designed to be a primer for individuals seeking information about Sex Reassignment Surgery (SRS). Undergoing SRS is a complex process, both for the individual seeking to transition and for their partners/loved ones. We have tried to be as objective as possible in presenting the most accurate information available, but it is the responsibility of each individual to conduct their own research beyond this guide. If there is information that we have missed or not yet discovered, please let us know by emailing contact@junomedical.com.

What is Sex Reassignment Surgery?

Sex Reassignment Surgery (also known as: Gender Confirmation Surgery, Sex Confirmation Surgery, Gender Reassignment Surgery, Gender Realignment Surgery, Sex Realignment Surgery) is the umbrella term for a number of procedures that transform the anatomical sex of an individual.

Sex Reassignment Surgery is usually pursued by individuals who identify with a gender different than the one assigned at birth, known to the medical community as gender dysphoria or Gender Identity Disorder (GID). Gender dysphoria is the distress that an individual experiences when the anatomical sex assigned at birth doesn’t correspond with the gender that the individual identifies with mentally, socially, and culturally. Although research has not yet determined causal factors in the development of gender dysphoria, it is believed to correlate to a combination of psychological, behavioral, genetic, and/or hormonal factors.

Sex Reassignment Surgery can be categorized into procedures applicable for:

  • Male-to-Female (MtF) Sex Reassignment
  • Female-to-Male (FtM) Sex Reassignment

What is the World Professional Association for Transgender Health?

The World Professional Association for Transgender Health (WPATH) is a professional organization dedicated to the understanding of gender dysphoria and uniting the community of health professionals providing care to these individuals.

WPATH has become somewhat of a global authority on best practices surrounding gender dysphoria, publishing the Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People (SOC), which provides clinical and ethical guidelines for health professionals. The overall goal of the SOC is to provide clinical guidance for health professionals to assist transsexual, and gender nonconforming people with safe and effective pathways to achieving lasting personal comfort with their gendered selves, in order to maximize their overall health, psychological well-being, and self- fulfillment.

Many medical boards, social institutions, and other regulatory bodies around the world recognize WPATH’s SOC as the benchmark for transsexual healthcare. The organization also sponsors scientific conferences, provides information for providers and consumers, offers trainings and certifications, and is involved in research. However, some members of the trans community have criticized WPATH’s overly scientific approach to transsexualism, which doesn’t sufficiently reflect the many social and psychological factors involved in a transition.

Who is eligible for Sex Reassignment Surgery?

According to the guidelines established by the WPATH, individuals wishing to transition must be living in an identity-congruent role for at least 12 months before undergoing sex reassignment surgery. These 12 months usually include hormonal therapies and psychiatric support as well.

Before taking on a patient for sex reassignment surgery, a surgeon will typically require 2 letters of recommendation that this surgery is the right option for the patient. One of these letters must come from a mental health professional with experience in gender dysphoria, who has known the patient for at least one year.

It is important to note that the guidelines and requirements for approval for an SRS procedure are constantly shifting and evolving, and vary from country to country. In recent years, many medical professionals in the field have moved towards a more patient-centered, informed consent model.

How is Male-to-Female Sex Reassignment Surgery performed?

The procedures related to Male-to-Female Sex Reassignment Surgery are detailed below, where the ultimate goal of most patients seeking a full transition is to re-shape the penis into a vagina (vaginoplasty). Patients may choose any, all, or none of these options, depending on the individual’s preferences and desired outcome.

  • Orchiectomy: surgical procedure to remove the testicles
  • Tracheal Shave: surgical procedure to reduce cartilage in the throat to make the appearance more feminine (also known as Adam’s Apple Removal)
  • Breast Augmentation: a set of surgical procedures using implants and/or fat grafting to create female breasts, optimizing for size, shape, and texture
  • Buttock Augmentation: a set of surgical procedures using implants and/or fat grafting to alter the size, shape, and texture of the buttocks
  • FFS: Facial Feminization Surgery is a set of surgical procedures that, in conjunction with hormone therapy, change the masculine features of a male face to be more feminine.
  • Body Sculpting: a set of surgical procedures that aim to enhance the appearance of the body, which includes evening fatty tissue deposits, reducing localized excess, and providing the desired feminization of the body
  • Hair Grafting: surgical procedure to augment female-pattern body hair developed with hormone therapy
  • Clitoroplasty: surgical procedure to create a clitoris
  • Labiaplasty: surgical procedure to create labia
  • Urethroplasty: surgical procedure to reconstruct the urethra
  • Vaginoplasty: surgical procedure to reconstruct the penis into a fully-sensitive vagina.

Male-to-Female Genital Reconstruction is typically performed as follows:

  • After the testicles are removed, the penile skin, glans, blood vessels, nerves and urethra are separated from the penile shaft, and the erectile tissue of the penis is removed as close to the body as possible.
  • The blood supply and nerves of the glans or head of the penis are kept intact and it is transformed into a functional clitoris, and the urethra is shortened and positioned like it would be in a female.
  • The penis skin is turned inside out so that the outer skin becomes the inner lining of the vagina, which is inserted into the space between the bladder and the rectum.
  • Incisions are then made to expose the urethra and the clitoris in their correct positions. Penile skin or scrotal tissue is used to form the labia.
  • The body will treat the new vagina as a wound, so after the surgery, in order to maintain the width and depth of the new vagina, it must be kept dilated using medical graduated dilators.
  • The recovery time varies, but most patients spend 3 to 7 days in the hospital. Sutures are usually removed within 7 to 10 days after the surgery. Physical activity can usually be resumed within 5 to 7 weeks.

How is Female-to-Male Sex Reassignment Surgery performed?

The procedures related to Female-to-Male Sex Reassignment Surgery are detailed below, where the ultimate goal of most patients seeking a full transition is to construct a penis (phalloplasty). Patients may choose any, all, or none of these options, depending on the individual’s preferences and desired outcome.

  • Mastectomy: surgical procedure to remove the breasts and reposition the nipples
  • Hysterectomy: surgical procedure to remove the uterus
  • Oophorectomy: surgical procedure to remove the ovaries
  • Salpingectomy: surgical procedure to remove the fallopian tubes
  • Vaginectomy: surgical procedure to remove all or part of the vagina
  • Hair Grafting: surgical procedure to augment male-pattern body hair developed with hormone therapy
  • FMS: Facial Masculinization Surgery is a set of surgical procedures that, in conjunction with hormone therapy, change the feminine features of a female face to be more masculine
  • Body Sculpting: a set of surgical procedures that aim to enhance the appearance of the body, which includes evening fatty tissue deposits, reducing localized excess, and providing the desired masculinization of the body
  • Scrotoplasty: surgical procedure to create a new scrotum
  • Glansplasty: surgical procedure to construct the glans penis, or the ‘head of the penis’, which is the sensitive and bulbous structure at the tip of the penis
  • Urethroplasty: surgical procedure to reconstruct the urethra
  • Penile Implant: surgical procedure to insert a prosthetic substance that will serve as a replacement for the spongy tissue inside a penis that normally fills with blood during an erection
  • Metoidioplasty: minimally-invasive surgical procedure to move the clitoris into the approximate position of where a penis would be (also known as ‘meto’ or ‘meta’)
  • Phalloplasty: surgical procedure to construct, enlarge, or repair the penis

Female-to-Male Genital Reconstruction is usually performed as follows:

  • 2 or more years of testosterone therapy is needed to grow the clitoris to up to 2 inches long.
  • After the clitoris is enlarged, the surgeon separates the clitoris from the labia minora and severs a suspensory ligament to move it forward to the approximate location of a natural penis.
  • Recovery time is about 12 weeks.
  • Once enough time has passed, donor skin will be harvested from another site on the body, such as the arm, chest, leg or pubic area.
  • The urethra is extended, nerves are connected to the pre-existing clitoris, and everything is enclosed in the donor skin.
  • There is usually also an erectile prosthesis implanted, though this is most often done in a separate surgery afterward.
  • The recovery time requires a minimum hospital stay of 2 weeks, and resumption of physical activity after 6 to 8 weeks.

What are the risks and post-operative issues of Sex Reassignment Surgery?

As with any surgical procedure, there are risks associated and potential side effects, which may include pain, urination problems, emotional difficulties, infection, inflammation, and a potential need for corrective surgeries. However, 20-year longitudinal studies conducted by the NHS (National Health Service, England’s publicly funded healthcare provider), have shown that over 96% of patients with genital reconstruction were satisfied with their results.

Sex Reassignment Surgery is not reversible, and it may take more than one surgery to achieve each individual’s desired result. Genital reconstruction is not recommended for individuals who have been diagnosed with HIV or Hepatitis C, but WPATH guidelines do not recognize these conditions as a barrier. Individuals who smoke or suffer from obesity are at higher risk during any of these procedures.

To minimize any postoperative complications, patients are advised to select a surgeon experienced in sex reassignment surgery, and to follow all recommended care. Most surgeons will highly encourage that patients continue to seek psychiatric support in the weeks and months following the procedure to ensure that any dissatisfaction with outcomes or expectations can be addressed effectively.

How much does Sex Reassignment Surgery cost?

As with any surgical procedure, the cost of sex reassignment surgery varies based on the complexity of the procedures selected, the expertise of the surgeon, the amount of post-operative care required, as well as what country the procedure is performed in. A comparison of average prices for SRS around the world can be found below.

It is important to note that for high-quality results, the cost of surgery will be substantially higher than the averages indicated above, but price differentials across countries are usually due to differences in costs of labor and living rather than quality.

Since SRS is a highly specialized and relatively young branch of medicine, there are much fewer highly qualified surgeons available. Junomedical only partners with the most experienced surgeons who can also offer the procedures at up to 80% less than the average cost in the U.S., Germany, and the U.K.

In some countries, there is also the option for individuals undergoing SRS to have their medical costs covered by insurance. Although policies vary depending on the insurance provider, usually if an individual can provide letters of referral from health professionals indicating the medical necessity of the procedure, the costs can be covered or reimbursed in full as any other medically necessary procedure. These policies are typically applied to major SRS procedures like genital reconstruction, but are usually not applicable for minor procedures that can be deemed ‘medically unnecessary,’ such as collagen injections.

Where can SRS be performed?

Please see below for our short list of surgeons specializing in SRS around the world.

Europe

Dr. Alberto Musolas (Barcelona, Spain)
Dr. Beat Hammer (Aarau, Switzerland)
Dr. Cvetan Taskov (Erding, Germany)
Dr. Caroline Mills (London, United Kingdom)
Dr. David Ralph (London, United Kingdom)
Dr. F.G. Bouman (Amsterdam, Netherlands)
Dr. Ivan Manero (Barcelona, Spain)
Dr. James Bellinger (London, United Kingdom)
Dr. João Décio Ferreira (Lisbon, Portugal)
Dr. Juergen Schaff (Munich, Germany)
Dr. M.E. Buncamper (Amsterdam, Netherlands)
Dr. Nicolas Morel-Journel (Pierre-Benite, France)
Dr. Olivier Bauquis (Lausanne, Switzerland)
Dr. Paul Daverio (Potsdam, Germany)
Dr. Robert C.J. Kanhai (Rotterdam, Netherlands)

United States

Dr. Christine McGinn (New Hope, Pennsylvania)
Dr. Curtis Crane (Greenbrae, California)
Dr. Daniel A. Medalie (Cleveland, Ohio)
Dr. Kathy Rumer (Ardmore, Pennsylvania)
Dr. Marci L. Bowers (San Mateo, California)
Dr. Paul M. Steinwald (Denver, Colorado)
Dr. Scott Mosser (San Francisco, California)
Dr. Toby R. Meltzer (Scottsdale, Arizona)

Canada

Dr. Lisa Korus (Edmonton)
Dr. Lorne Brown (Vancouver)
Dr. Maud Belanger (Montreal)
Dr. Pierre Brassard (Montreal)

Mexico

Dr. Benjamin Villarán (Guadalajara)
Dr. Carlos Alejandro Molina Villa (Leon)
Dr. Ivan Aguilar (Culiacan)

Thailand

Dr. Chettawut Tulayapanich (Bangkok)
Dr. Greechart Pornsinsirirak (Bangkok)
Dr. Preecha Tiewtranon (Bangkok)
Dr. Sanguan Kunaporn (Phuket)
Dr. Suporn Watanyusakul (Chonburi Province)
Dr. Sutin Khobunsongserm (Bangkok)

Australia

Dr. Andrew Ives (Melbourne)
Dr. David J. David (Adelaide)
Dr. Megan Hassall (Sydney)
Dr. Peter Haertsch (Sydney)