Learning About Masculinizing Surgeries for Gender Affirmation

What is gender-affirming surgery?

Gender-affirming surgery is a procedure that changes the look and function of your body. There are many kinds of gender-affirming surgery. They make your body more closely match your gender identity. Some people choose surgery. Some don't. It's up to you to decide if it will be part of your gender affirmation.

What are the types of surgery?

There are different types of surgery that can help you have a more masculine body. You may choose top surgery to flatten your chest. You may also have bottom surgery. This can be done to remove the uterus, ovaries, and vagina. It may also include creating a penis and scrotum.

How is it done?

Top surgery

Top surgery can be done in a few different ways. You might have one or two cuts (incisions). The breast tissue is removed. And your nipples might be reshaped.

Bottom surgeries

These may include:

• Hysterectomy. The uterus (and sometimes ovaries) are removed through a small cut in the belly or through the vagina.
• Vaginectomy. The surgeon removes the vagina. Then the surgeon closes the vaginal opening.
• Creation of a penis. Options include:
  • Metoidioplasty. The clitoris is used to form a small penis. Sometimes tissue from another part of the body is also used (skin graft).
  • Phalloplasty. A skin graft (often from the forearm, belly, or thigh) is used to form an average-sized penis. This often involves more than one surgery, especially if you want a penile implant.

Bottom surgery may or may not include the creation of a scrotum or the use of testicular implants.

What are the risks?

Top surgery

Risks include:

• Pockets of swelling under the skin.
• Breakdown of nipple tissue.
• Sagging or puckering of skin.
• Scarring.
• Infection.
• A need to redo surgery.

Bottom surgeries

Risks include:

• Infection.
• A need to redo surgery.
• Urinary problems. Examples are a narrowed urethra and leaking.
• A breakdown of the tissue used to create the penis.
• Scarring.

Risks of a penile implant include:

• An implant that stops working.
• A thinning or breakdown of the skin that surrounds the implant.

What can you expect after surgery?

Your recovery will depend on the type of surgery you had.

Top surgery

After chest reconstruction surgery:

• You may have some scarring. This can improve with time.
• Your nipples may be less sensitive than before.

Bottom surgeries

If you have surgery to remove the uterus, you'll no longer have periods. And you won't be able to get pregnant.

If you have surgery to remove the uterus and the ovaries, your body will no longer make estrogen. So you may be able to reduce the amount of the male hormone (testosterone) you take.

If you have surgery to create a penis, you may:

• Lose feeling in the places where they used tissue to create the penis.
• See a scar where they took the tissue to create the penis.
• Need several months to heal.

What do you need to know before deciding about surgery?

There's no right or wrong way to affirm your gender. Some people choose surgery. Some don't. It's different for everyone. Here are some things to think about.

Know your reasons for having surgery

Take the time to understand who you are and why you want surgery. Think about the long-term impact on your social, family, and work lives.

Your decision to have surgery may be based on:

• Your goals, your needs, and what you expect.
• Your health and body type.
• Cost and insurance coverage.
• Recovery time.
• Your feelings about the risks.

Get the facts about surgery

Here are some things to keep in mind:

• Surgery may only be possible after you've had hormone therapy.
• Bottom surgery can affect your ability to have a biological child. Talk with your doctor about your reproductive goals.
• Surgeons use different techniques. Ask to see pictures of people after their surgery.
• You may be able to combine surgeries. But it may also be too much stress on the body to combine certain ones.
• Going through surgery can be challenging for both your body and your emotions. But it's rare that people regret doing it.

Build a support network

Try to connect with people online or in person who've been through surgery.

Try to surround yourself with as much love and support as you can.