Feminizing Surgeries for Gender Affirmation

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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 feminizing surgery?

There are different types of surgery that can help you have a more feminine body. You may choose to have top surgery to create fuller breasts. You may choose to have bottom surgery to remove the penis and testicles. Bottom surgery may also include creating a vagina, labia, and a clitoris.

How is it done?

Top surgery

During breast augmentation, the surgeon makes small cuts (incisions) to place silicone or saline implants in the chest. The cuts may be under the breast, in the armpit, or around the nipple.

Bottom surgeries

  • Orchiectomy and penectomy are often done together.
    • Orchiectomy. The testicles are removed. The scrotal skin may or may not be removed and used to form the labia.
    • Penectomy. The penis is removed. If you're not having vaginoplasty, the surgeon creates a shallow vaginal dimple. This lets you urinate while sitting down.
  • Vaginoplasty, labioplasty, and clitoroplasty. These are often done together.
    • Most surgeons use the skin of the penis to form the vaginal wall. Sometimes extra skin is needed. It may come from the lower belly, intestine, or scrotum.
    • The scrotum is often used to form the labia.
    • The nerve-sensitive head of the penis is used to create a clitoris.
    • The urethra is shortened and repositioned.

What are the risks?

Top surgery

Risks include:

  • Scar tissue formation. This can become uncomfortable or change the shape of the breast.
  • Implants that leak or rupture. These have to be removed.
  • Changes in how the nipple feels.
  • Infection.
  • A need to redo surgery. This may be needed if the breasts are uneven or wrinkled.

Bottom surgeries

Risks include:

  • Infection.
  • A lot of bleeding.
  • An opening that forms between the rectum and the vagina.
  • A breakdown of the tissue used to create the vagina.
  • A narrowing or closure of the vagina or urethra.
  • A vagina that's too small or short for vaginal intercourse.
  • Bladder infections or other bladder problems.

What can you expect after surgery?

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

Top surgery

After breast augmentation:

  • Your breasts may look or feel different. They may be firmer and rounder.
  • You may lose feeling in your nipples. This may be short-term. But it may not.

Bottom surgeries

If you have surgery to remove the penis and testes:

  • Your body will no longer make testosterone. So you may be able to reduce the amount of estrogen that you take.
  • You'll sit down to urinate.

If you have surgery to create a vagina:

  • You'll need to use a dilator every day to maintain the depth and width of your vagina.
  • You'll need to use a lubricant if you have vaginal sex.

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.


Current as of: November 27, 2023

Author: Healthwise Staff
Clinical Review Board
All Healthwise education is reviewed by a team that includes physicians, nurses, advanced practitioners, registered dieticians, and other healthcare professionals.

The Health Encyclopedia contains general health information. Not all treatments or services described are covered benefits for Kaiser Permanente members or offered as services by Kaiser Permanente. For a list of covered benefits, please refer to your Evidence of Coverage or Summary Plan Description. For recommended treatments, please consult with your health care provider.