Gender Affirmation Surgery and Compassionate Care for Individuals with Gender Dysphoria

Gender dysphoria is a medical term used to describe a condition in which a person’s gender identity – an internal and innate sense of oneself as being male or female – is incompatible with the external sexual characteristics present at birth. For example, a person born with female genitals who feels essentially male in every other way and identifies with that gender; or a person born with male genitals, yet feels essentially female in every other way and identifies with that gender. Both may be said to have gender dysphoria – a state of mind that can lead to depression, social anxiety, social isolation and a general state of emotional distress.

In recent years, recognition and acceptance of gender dysphoria as a legitimate diagnosis has spurred efforts in the medical community to offer compassionate support along with medical and surgical options to help people reconcile their outward appearance and sexual functioning with their internal self-perceptions.

A diagnosis of gender dysphoria is made by a healthcare provider after a thorough and careful evaluation has been done by a team of medical and psychological professionals. The next steps will depend on the individual’s goals and expectations.

What Is Gender Affirmation Surgery?

Any surgical procedure designed to align a person’s internal sense of self with their external physical and sexual characteristics is known as gender affirmation surgery. This is sometimes called gender confirmation surgery as well. Older terms such as gender reassignment or sex reassignment surgery have fallen out of favor.

While some may opt for hormone therapy only, for some transgender, transsexual or gender non-conforming patients it is medically and psychologically necessary to change their physical body to reduce gender dysphoria and improve their quality of life.

Some individuals may choose to undergo “top surgery” to alter their anatomy to be more in-line with their gender identity – male to female transgender individuals (transfemales or transwomen) may take female hormones to promote breast development with or without breast implants. Furthermore, some transwomen undergo facial feminization, Adam’s Apple reduction, or vocal cord surgery as well. Female to male transgender individuals (transmen or transmales) may have their breasts surgically removed (bilateral mastectomy) in addition to taking male hormones to increase muscle mass, lower their tone of voice and promote the growth of body and facial hair.

Genital Gender Affirmation Surgeries

Some people will choose to complete their transition with genital gender affirmation surgery or “bottom surgery” – a surgical procedure (or procedures) by which the genital organs are altered to physically resemble and function like those that are associated with their identified gender. Prior to genital gender affirmation surgery, patients must have been on hormones for at least a year while living consistently as the gender to which they are transitioning.

UH reconstructive urologist, Shubham Gupta, MD, FACS offers male to female and female to male genital reconstruction surgeries, including:

• Vaginoplasty (male to female)
• Phalloplasty and metoidioplasty (female to male)

Eligibility Requirements for Gender Affirmation Surgery

All gender transition surgeries result in permanent, physical transformation so patients must meet certain eligibility requirements before proceeding. To be eligible, patients must:

• Be of legal age (age 18 in the United States)
• Complete 12 months of continuous hormone therapy (HT)
• Successfully complete 12 months of living full-time as the gender with which they identify
• Undergo a mental health assessment and participate in psychotherapy
• Demonstrate knowledge and understanding of the surgeries (including cost), potential complications, recovery and rehabilitation.