Sex Reassignment Surgery
Sex reassignment surgery (SRS) is known by a variety of names, including gender reassignment surgery (GRS), sex change surgery, sex affirmation procedures, and genital reconstruction surgery.
For most patients undergoing SRS, the surgery is performed in order to match their physical gender with what they feel emotionally and intuitively is their true gender. This condition, known as gender dysphoria or gender identity disorder, is rare but becoming more widely diagnosed.1 You may also hear these people being referred to as “transgender.”
Male to Female Transition
The procedures that change male genitalia to female genitalia include a penectomy (removal of penis) and orchiectomy (removal of the testes), which are typically followed by a vaginoplasty (creation of the vagina) or a feminizing genitoplasty (creation of female genitalia).
For those born male and transitioning to female, there may also be procedures that include breast implants, gluteoplasty to increase buttock volume, a procedure to minimize the appearance of the Adam’s apple, and possibly, feminizing hormones.
Facial feminization surgery (FFS) is often done to soften the more masculine lines of the face.2 Each patient is unique and the procedures that are done are based on the individual need and budget, but facial feminization often includes softening the brow line, rhinoplasty (nose job), smoothing the jaw and forehead, and altering the cheekbones. For some, a chondrolaryngoplasty, commonly known as a “tracheal shave,” can help reduce the prominence of the Adam’s apple.
Female to Male Transition
The procedure that changes female genitalia to male genitalia is a masculinizing genitoplasty (creation of male genitalia). This procedure uses the tissue of the labia to create a penis.
The procedures that change the genitalia are rarely performed without other procedures, which may be extensive. For those born female, the change to a masculine appearance may also include hormone therapy with testosterone, a mastectomy, a hysterectomy procedure, and perhaps additional cosmetic procedures intended to masculinize the appearance.
Questions? We got Answers!
- SRS is irreversible and thus patients must be entirely sure about its outcome before opting for the surgery.
- SRS is not simply a gender-change operation. The male and female anatomy is vastly different, beyond simply sexual anatomy, such as size of pelvic bone, facial structure etc. Choosing the right doctor(s) who is capable of handling every aspect of the surgery is imperative for good results.
- Psychiatric care may be required for many years after the reassignment surgery.
- The procedure is not recommended for individuals who have been diagnosed with HIV or Hepatitis C.
- Possible complications include infection, bruising, blood clots, scarring and necrosis.
The feminizing effects of estrogen and the masculinizing effects of testosterone may appear after the first couple of doses, although it may be several years before a person is satisfactorily transitioned. This is especially true of breast development.
Surgery is delayed until at least one year after the start of hormone therapy and at least two years after the first mental health evaluation. Once the surgical procedures begin, the amount of time until completion is variable depending on the number of procedures desired, recovery time, and more.
Quality of life appears to improve after gender-affirming surgery both for people who transition from female to male and those who transition from male to female. One 2017 study found that surgical satisfaction ranged from 94% to 100%.
Since there are many steps and sometimes uncomfortable surgeries involved, this number supports the benefits of surgery for those who feel it is their best choice.
Surgery is not without potential risks and complications. Estrogen therapy has been associated with an elevated risk of blood clots (deep vein thrombosis and pulmonary emboli) for transgender women. There is also the potentially increased risk of breast cancer, and even without hormones we know that males can also develop breast cancer. Testosterone use in transgender men has been associated with an increase in blood pressure, insulin resistance, and lipid abnormalities, though it’s not certain exactly what role these changes play in the development of heart disease.
With surgery, there are surgical risks such as bleeding and infection, as well as side effects of anesthesia. Those who are considering these treatments should have a careful discussion with their doctor about potential risks related to hormone therapy as well as the surgeries.
