Gender affirmation surgery provides individuals—particularly those who identify as transgender or nonbinary—the opportunity to alter physical characteristics that align with their gender identity. This procedure can help alleviate gender dysphoria, a condition where a person’s gender identity doesn’t match the sex they were assigned at birth. By undergoing gender affirmation surgery, individuals can experience increased comfort and a sense of alignment between their internal identity and external appearance.

This article explores the types of gender affirmation surgeries, including masculinizing, feminizing, and gender-nullifying surgeries, as well as the risks, complications, and considerations involved.

Why Is Gender Affirmation Surgery Performed?

People opt for gender affirmation surgery for various reasons, but the core motivation is typically to align their physical features with their gender identity. This alignment can significantly reduce the distress caused by gender dysphoria, a condition that affects many transgender and nonbinary individuals.

Studies show that between 2016 and 2020, over 48,000 people underwent gender affirmation surgeries. The procedures most commonly performed include breast and chest surgeries, genital reconstruction, and facial cosmetic surgeries. Notably, individuals who undergo these surgeries often experience significant improvements in their mental health, including decreased anxiety and depression, and reduced reliance on medications like antidepressants.

Importantly, gender affirmation surgery is only performed when deemed appropriate after consultation with healthcare providers and mental health professionals.

Transgender vs. Nonbinary

While both transgender and nonbinary individuals may seek gender affirmation surgery, there are key differences in their identities.

  • Transgender people have a gender identity that differs from the sex they were assigned at birth.

  • Nonbinary people, on the other hand, don’t exclusively identify as either male or female. They may see themselves as a mix of both genders, neither, or as a gender outside the traditional binary.

Both groups can seek surgery to affirm their gender identity, although the type of surgery might vary depending on individual preferences and needs.

Hormone Therapy

Hormone therapy is an essential part of gender affirmation. It uses sex hormones or hormone blockers to help align the individual’s physical traits with their gender identity. People assigned female at birth may take masculinizing hormones (such as testosterone) to develop male secondary sex characteristics, while people assigned male at birth may take feminizing hormones (such as estrogen) to develop female secondary sex characteristics.

There are also options for non-binary hormone therapy, which may include a mix of male and female hormones or hormone blockers tailored to individual needs.

Masculinizing Hormone Therapy helps individuals develop male characteristics like body and facial hair, deepened voice, and increased muscle mass.

Feminizing Hormone Therapy includes estrogen and testosterone blockers, which can promote breast development, reduce facial and body hair, and create a more feminine appearance.

Hormone therapy is often recommended before undergoing surgery, though not everyone chooses to pursue it. For those who do, it can lead to significant physical changes over time.

Masculinizing Surgeries

Masculinizing surgeries are often pursued by transgender men and nonbinary people seeking to align their physical appearance with their gender identity. These surgeries may include top surgery, bottom surgery, or both.

Chest Masculinization (Top Surgery)
Chest masculinization involves removing breast tissue and reshaping the chest to create a more masculine appearance. There are two primary approaches to chest masculinization:

  • Double-incision approach: Typically used for individuals with moderate to large breasts, this method involves making two horizontal incisions to remove breast tissue and reshape the chest.

  • Short scar top surgery: This method is used for individuals with smaller breasts and involves a smaller incision along the lower half of the areola.

Metoidioplasty
Metoidioplasty involves lengthening the clitoris to create a small penis. This procedure may also involve extending the urethra, so individuals can urinate while standing. Some individuals may choose to have scrotoplasty, which involves creating a scrotum from labia tissue.

Phalloplasty
Phalloplasty is a more complex procedure that involves creating a penis using tissue from another part of the body, such as the forearm or thigh. This surgery typically requires multiple stages and may involve additional procedures like urethral reconstruction, which can have a high risk of complications.

Hysterectomy and Oophorectomy
A hysterectomy, which involves removing the uterus, and an oophorectomy, which removes the ovaries, are common components of masculinizing surgeries. These surgeries help align the individual’s body with their gender identity and may be necessary for those pursuing bottom surgery.

Feminizing Surgeries

Feminizing surgeries are often sought by transgender women and nonbinary individuals to help align their bodies with their gender identity. These surgeries may include breast augmentation, facial feminization surgery, and genital reconstruction.

Breast Augmentation (Top Surgery)
Breast augmentation, or mammoplasty, involves the insertion of implants or the use of fat from other parts of the body to create a more feminine chest. Many individuals undergo breast augmentation after at least 12 months of feminizing hormone therapy.

Facial Feminization Surgery
Facial feminization surgery (FFS) reshapes the face to create more feminine features. This can include altering the forehead, jawline, nose, cheeks, and chin. Non-surgical treatments such as Botox or fillers may also be used to enhance feminine features.

Vaginoplasty
Vaginoplasty is a surgery to create a vulva and vaginal canal. The procedure typically uses tissue from the penis and scrotum to form the vaginal lining. This can be done in one or two stages, depending on the individual’s needs. Electrolysis or laser hair removal is often performed before the procedure to remove pubic hair.

Tracheal Shave (Chondrolaryngoplasty)
Tracheal shave surgery reduces the size of the Adam’s apple, creating a smoother, more feminine neck. This procedure is often done alongside other feminizing surgeries.

Other Surgical Options

Some individuals opt for additional surgeries based on their unique gender identity. These procedures may include gender nullification, which involves the removal of all sex organs, or surgeries that combine elements of both masculinizing and feminizing surgeries.

Gender Nullification
Gender nullification is the removal of all genitalia to create a gender-neutral appearance. This procedure is typically pursued by individuals who are agender or nonbinary.

Penile Preservation Vaginoplasty
Some people wish to preserve their penis while still undergoing bottom surgery. In this case, a penile preservation vaginoplasty may be performed to create a vagina while keeping the penis intact.

Recovery

The recovery time for gender affirmation surgeries varies depending on the type of surgery performed. Recovery from facial surgeries may take weeks, while bottom surgery recovery can take several months. Mental health support, pelvic floor physiotherapy, and follow-up care are essential parts of the recovery process.

Risks and Complications

As with any surgery, there are risks associated with gender affirmation surgeries. Common risks include:

  • Anesthesia complications

  • Bleeding and hematoma

  • Infection or sepsis

  • Urethral stricture or stenosis

  • Deep vein thrombosis (blood clots)

  • Pain and poor wound healing

Although these risks are present, many individuals find the benefits of gender affirmation surgery outweigh the potential complications.

What To Consider

It’s essential to understand that gender affirmation surgery is not a required part of transitioning. For some individuals, living as their identified gender is sufficient to alleviate gender dysphoria. However, those who do pursue surgery should be evaluated by mental health professionals and healthcare providers to ensure the procedure is appropriate for their needs.

Conclusion

Gender affirmation surgeries are transformative procedures that help individuals align their physical appearance with their gender identity. Whether pursuing masculinizing, feminizing, or gender-nullifying surgeries, the process is highly personalized and can significantly improve an individual’s mental health and quality of life. It’s important to approach these surgeries with a thorough understanding of the risks, benefits, and recovery process.