gender reassignment surgery a

What to know about female-to-male surgery

gender reassignment surgery a

Female-to-male surgery is a type of sex reassignment surgery, which is also called gender affirmation surgery or gender-affirming surgery.

Trans male artist draws in his studio

This can take different forms, including the removal of breasts — a mastectomy — and the altering of the genital region, known as “bottom” surgery.

Examples of bottom surgery include:

In this article, we describe female-to-male gender-affirming surgeries. We also discuss recovery and what to expect from a transgender penis.

Before having female-to-male gender-affirming surgery, a person will receive testosterone replacement therapy.

They may then undergo one or more of the following types of procedure.

Chest restructuring

A person undergoing surgery to transition from female to male typically has a subcutaneous mastectomy to remove breast tissue. The surgeon will also make alterations to the appearance and position of the nipples.

Meanwhile, testosterone therapy will stimulate the growth of chest hair.

Removal of the uterus, ovaries, and fallopian tubes

A person may wish to undergo this type of surgery if they are uncomfortable having a uterus, ovaries, or fallopian tubes, or if hormone therapy does not stop menstruation.

In a partial hysterectomy, a surgeon will remove only the uterus.

In a total hysterectomy, they will also remove the cervix.

A bilateral salpingo-oophorectomy, or BSO, involves the removal of the right and left fallopian tubes and ovaries.

Metoidioplasty

A metoidioplasty is a method of constructing a new penis, or neopenis.

It involves changing the clitoris into a penis. A person will receive hormone therapy before the surgery to enlarge the clitoris for this purpose.

During the procedure, the surgeon also removes the vagina, in a vaginectomy.

In addition, they lengthen the urethra and position it through the neopenis. To achieve the lengthening, the surgeon uses tissues from the cheek, labia minora, or other parts of the vagina. The aim of this is to allow the person to urinate while standing.

Another option is a Centurion procedure, which involves repositioning round ligaments under the clitoris to increase the girth of the penis.

A metoidioplasty typically takes 2–5 hours . After the initial surgery, additional procedures may be necessary.

A Centurion procedure takes approximately 2.5 hours , and removing the female reproductive organs will add to this time.

An advantage of a metoidioplasty is that the neopenis may become erect, due to the erectile abilities of clitoral tissue.

However, a neopenis resulting from a metoidioplasty is often too small for penetrative sex.

Phalloplasty

A phalloplasty uses grafted skin — usually from the arm, thigh, back, or abdomen — to form a neopenis. Doctors consider taking skin from the forearm to be the best option in penile construction.

Compared with a metoidioplasty, a phalloplasty results in a larger penis. However, this neopenis cannot become erect on its own.

After a period of recovery, a person can have a penile implant. This can allow them to get and maintain erections and have penetrative sex.

During a phalloplasty, the surgeon performs a vaginectomy and lengthens the urethra to allow for urination through the penis.

Disadvantages of a phalloplasty include the number of surgical visits and revisions that may be necessary, as well as the cost, which is typically higher than that of a metoidioplasty.

Scrotoplasty

A person may decide to have a scrotoplasty — the creation of a scrotum — alongside a metoidioplasty or phalloplasty.

In a scrotoplasty, a surgeon hollows out and repositions the labia majora to form a scrotum and inserts silicone testicular implants.

The recovery time from female-to-male surgery varies, depending on the type of procedure and factors such as the person’s overall health and lifestyle choices.

For example, smoking slows down recovery and increases the risk of complications following surgery. If a person smokes, vapes, or uses any substance with nicotine, a medical team may consider them less eligible for this type of surgery.

Following gender-affirming surgery, most people need to stay in the hospital for at least a couple of days.

After leaving the hospital, the person needs to rest and only engage in very limited activities for about 6 weeks or longer.

Also, when a person has had a urethral extension, they need to use a catheter for 3–4 weeks.

Some complications of a metoidioplasty or phalloplasty include:

A person who has had a phalloplasty may experience:

Risks of a scrotoplasty include rejection of the testicular implants.

All gender-affirming surgeries carry a risk of:

What to expect

A person who undergoes a metoidioplasty may have erections and enjoy more sensation in their neopenis. However, the penis will be relatively small in size.

A neopenis that results from a phalloplasty is usually larger, though it may be less sensitive. To have erections, a person will need a penile implant.

If a person has urethral extension, the goal is to be able to urinate while standing after a full recovery from the procedure. Some studies report a high number of urological complications following phalloplasties. It is important to attend regular follow-ups with a urologist.

A 2005 study of 55 people who underwent gender-affirming surgery — including 23 female-to-male participants — notes that 80% of all participants reported “improvement of their sexuality” following surgery.

Transgender men tended to report more frequent masturbation, sexual satisfaction, and sexual excitement than transgender women. They also reported reaching orgasms more easily than they had before surgery and a tendency toward “more powerful and shorter” orgasms.

Transgender men with penile implants for erections experienced pain more frequently during sex than those without implants. However, they also reported that their sexual expectations were more fully realized, compared with participants who had not received implants.

A 2018 study found that 94–100% of participants who had undergone gender-affirming surgery reported satisfaction with the surgical results, with the variance depending on the type of procedure.

The 6% of people who reported dissatisfaction or regret did so as a result of preoperative psychological symptoms or complications following the procedures.

The outlook for female-to-male surgery depends on the type of surgery, the person’s health, and other factors. Most people report satisfaction following the procedure.

However, the complication rate is relatively high , especially in relation to urinary health.

Therefore, it is important to work closely with a qualified plastic surgeon, urologist, gynecologist , and mental health professional to ensure the best outcome.

It is also essential to follow recovery guidelines and attend all follow-up appointments.

Last medically reviewed on October 8, 2019

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Masculinizing surgery, also called gender-affirming surgery or gender-confirmation surgery, involves procedures that help better align the body with a person's gender identity. Masculinizing surgery includes several options, such as top surgery to create a more male-contoured chest and bottom surgery that changes the genitals.

Not everybody chooses masculinizing surgery. These surgeries can be expensive, carry risks and complications, and involve follow-up medical care and procedures. Certain surgeries change fertility and sexual sensations. They also may change how you feel about your body.

Your health care team can talk with you about your options and help you weigh the risks and benefits.

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Why it's done

Many people seek masculinizing surgery as a step in the process of treating discomfort or distress because their gender identity differs from their sex assigned at birth. The medical term for this is gender dysphoria.

For some people, having masculinizing surgery feels like a natural step. It's important to their sense of self. Others choose not to have surgery. All people relate to their bodies differently and should make individual choices that best suit their needs.

Options for masculinizing surgery include:

Your health care provider might advise against these surgeries if you have:

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Like any major surgery, many types of masculinizing surgery pose a risk of bleeding, infection and a reaction to anesthesia. Other complications might include:

Certain types of masculinizing surgery may limit or end fertility. If you want to have biological children, and you're having surgery that involves your reproductive organs, talk to your health care provider about your options. You may choose to freeze eggs with a procedure called mature oocyte cryopreservation, or freeze embryos using embryo cryopreservation. Another option involves having ovarian tissue surgically removed, frozen, and later thawed and reimplanted. That procedure is called ovarian tissue cryopreservation.

Egg freezing involves multiple steps, including ovulation induction, egg retrieval and freezing. If you want to freeze embryos, an additional step of having the eggs fertilized before they are frozen also is required.

How you prepare

Before surgery, you meet with your surgeon. Work with a surgeon who is board certified and experienced in the procedures you want. Your surgeon talks with you about your options and the potential results. The surgeon also may provide information on details such as the type of anesthesia that will be used during surgery and the kind of follow-up care that you may need.

Follow your health care team's directions on preparing for your procedures. This may include guidelines on eating and drinking. You may need to make changes in the medicine you take and stop using nicotine, including vaping, smoking and chewing tobacco.

Because masculinizing surgery might cause physical changes that cannot be reversed, you must give informed consent after thoroughly discussing:

Evaluation for surgery

Before surgery, a health care provider evaluates your health to address any medical conditions that might prevent you from having surgery or that could affect the procedure. This evaluation may be done by a provider with expertise in transgender medicine. The evaluation might include:

You also may have a behavioral health evaluation by a health care provider with expertise in transgender health. That evaluation might assess:

Other considerations

Health insurance coverage for masculinizing surgery varies widely. Before you have surgery, check with your insurance provider to see what will be covered.

Before surgery, you might consider talking to others who have had masculinizing surgery. If you don't know someone, ask your health care provider about support groups in your area or online resources you can trust. People who have gone through the process may be able to help you set your expectations and offer a point of comparison for your own goals of the surgery.

What you can expect

Top surgery, also called masculinizing chest surgery, involves the removal of breast tissue — a procedure known as subcutaneous mastectomy. There are several approaches for this surgery, including:

After surgery, you may need to stay in the hospital overnight. You might not be able to bear weight on your upper body for six weeks. Talk to your health care provider about the specific activity restrictions you need to follow.

Some breast tissue remains after surgery regardless of the surgery you have. Because of that, ask your health care provider about breast cancer screening you may need after surgery.

Genital surgery

Metoidioplasty.

Metoidioplasty is a procedure to increase the length of the clitoris without adding other tissue. During surgery, the clitoris is freed from its attachment against the body. The surgeon also can extend the urethra through the released clitoris using a graft typically taken from the lining of the mouth. This is called a urethral hookup. It makes standing urination possible.

This procedure usually results in a penis with an unstimulated length between 1 and 3 inches (3 and 8 centimeters). Typically after this surgery, you still have full sensation and the ability to have an orgasm.

It isn't necessary for the vagina to be closed or removed before metoidioplasty. But penetration and Pap tests might not be possible after it. As a result, your surgeon might suggest removing your uterus, cervix and ovaries during metoidioplasty.

After metoidioplasty, you have a tube temporarily placed in your urethra to collect urine. Recovery might take up to two weeks.

Phalloplasty

Phalloplasty, the surgical creation of a penis, involves several procedures. During phalloplasty, large amounts of skin are taken from other areas of the body. These may include the forearm, calf or lower abdomen. This can cause significant scarring. The skin is rolled into the shape of a penis and anchored into position above the clitoris. Phalloplasty also may include:

After phalloplasty, a tube is temporarily placed in the urethra to collect urine. You'll likely need to stay in the hospital for a few days. Phalloplasty carries a high rate of complications. It could require many follow-up surgeries. Depending on the procedure, recovery might take up to 12 weeks. The new penis will not become erect with sexual stimulation. A penile implant is needed to allow penetrative sex.

Scrotoplasty

Scrotoplasty is the surgical creation of a scrotum. During scrotoplasty, testicular implants are inserted into the labia. To prepare for the procedure, expanders are placed under the skin. The expanders are gradually filled with saline over several months. When the skin has been expanded enough, the implants are inserted. Some people find the implants uncomfortable. It is possible for the implants to wear through surrounding tissue or become infected.

Other masculinizing surgeries also are available, including surgery to place pectoral implants in the chest, as well as procedures to remove fat and fat grafting. Ask your health care provider about these options and the risks and benefits they involve.

Research has found that that gender-affirming surgery can have a positive impact on well-being and sexual function. It's important to follow your health care provider's advice for long-term care and follow-up after surgery. Continued care after surgery is associated with good outcomes for long-term health.

Before you have surgery, talk to members of your health care team about what to expect after surgery and the ongoing care you may need.

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How Gender Reassignment Surgery Works (Infographic)

Infographics: How surgery can change the sex of an individual.

Bradley Manning, the U.S. Army private who was sentenced Aug. 21 to 35 years in a military prison for releasing highly sensitive U.S. military secrets, is seeking gender reassignment. Here’s how gender reassignment works:

Converting male anatomy to female anatomy requires removing the penis, reshaping genital tissue to appear more female and constructing a vagina.

An incision is made into the scrotum, and the flap of skin is pulled back. The testes are removed.

A shorter urethra is cut. The penis is removed, and the excess skin is used to create the labia and vagina.

People who have male-to-female gender-reassignment surgery retain a prostate. Following surgery, estrogen (a female hormone) will stimulate breast development, widen the hips, inhibit the growth of facial hair and slightly increase voice pitch.

Female-to-male surgery has achieved lesser success due to the difficulty of creating a functioning penis from the much smaller clitoral tissue available in the female genitals.

The uterus and the ovaries are removed. Genital reconstructive procedures (GRT) use either the clitoris, which is enlarged by hormones, or rely on free tissue grafts from the arm, the thigh or belly and an erectile prosthetic (phalloplasty).

Breasts need to be surgically altered if they are to look less feminine. This process involves removing breast tissue and excess skin, and reducing and properly positioning the nipples and areolae. Androgens (male hormones) will stimulate the development of facial and chest hair, and cause the voice to deepen.

Reliable statistics are extremely difficult to obtain. Many sexual-reassignment procedures are conducted in private facilities that are not subject to reporting requirements.

The cost for female-to-male reassignment can be more than $50,000. The cost for male-to-female reassignment can be $7,000 to $24,000.

Between 100 to 500 gender-reassignment procedures are conducted in the United States each year.

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Before & After Photos

Breast Augmentations

Facial feminizations, mastectomies, vaginoplasty.

This procedure involves enlargement of the breasts with an implant. Various techniques may be used to perform this procedure, and they are surgeon and patient dependent. Breast augmentation is often performed as an outpatient procedure but some patients may require one night stay in the hospital.

This is a 56 year old who underwent Bilateral augmentation mammoplasty for gender dysphoria purposes. The patient is 1 month post surgery.

This is a 28 year old who underwent Breast augmentation for gender dysphoria purposes. The patient is 1 month post surgery.

This is a 31 year old who underwent Bilateral augmentation mammoplasty for gender dysphoria purposes. The patient is 1 month post surgery.

Facial feminization surgery (FFS) involves several surgeries that can be done to feminize the facial features. These procedures include but are not limited to: rhinoplasty, forehead contouring, jaw angle reduction, chin width reduction, lowering the hairline, hair transplantation, cheek augmentation, lip augmentation and upper lip shortening. Some procedures are performed as outpatient procedures while others require an inpatient stay.

This is a 30 year old who underwent facial feminization surgery including hairline brow lift, correction of frontal bossing and superior lateral orbital bossing, fat transfer to right malar region, anterior lipectomy and platysmaplasty, horizontal advancement and lengthening genioplasty. She is 2 months post surgery.

This procedure includes removal of breast tissue with masculinizing chest contouring and nipple grafting in some cases. Chest surgery is sometimes performed as an outpatient procedure but some patients may require one night stay in the hospital.

This is a 27 year old who underwent Subcutaneous mastectomies with periareolar mastopexy type incision for gender dysphoria purposes. The patient is 1.5 months post surgery.

This is a 24 year old who underwent Bilateral subcutaneous mastectomies with free nipple graft nipple reconstructions for gender dysphoria purposes. The patient is 4 months post surgery.

This is a 27 year old who underwent Bilateral subcutaneous mastectomies with free nipple grafting for nipple reconstruction for gender dyphoria purposes. The patient is 2 months post surgery.

This is a 20 year old who underwent Bilateral subcutaneous mastectomy with free nipple graft nipple reconstructions for gender dysphoria purposes. The patient is 1 month post surgery.

This is a 22 year old who underwent Bilateral subcutaneous mastectomy with pedicle nipple-areolar complex, nipple-areolar reconstruction for gender dysphoria. The patient is 1 month post surgery.

Vaginoplasty surgery involves creation of the vulva (outer female genital structures) with or without a vaginal canal. Patients may opt to have a “zero depth” vaginoplasty procedure which involves creation of the outer genitals (labia, clitoral hood, urethral opening) only without a vagina. The procedure requires an inpatient stay in the hospital and if a full-depth vaginoplasty is performed, there is a required stay at a nearby hotel. For zero-depth procedures patients should expect to be in Cleveland for 3-4 days after the surgery and for a full-depth procedure, 7-10 days after surgery.

IMAGES

Gender Transition Still Comes at a Staggeringly High Price in 2017
Federal judge orders Wisconsin to pay for gender reassignment surgeries -- Society's Child
FtM Gender Reassignment Surgery: FtM Phalloplasty Rescue
Gender Reassignment Surgery Results Male To Female
1 Month Post-Op
Sex reassignment surgery SRS

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Gender Reassignment Surgery Philippines
Post-Op Sex! 🍆🌮 I MTF Transgender experience
From Female to Male: The Transformation of Famous Women
SRS JOURNEY at KAMOL HOSPITAL
Gender ReAssignment Surgery

COMMENTS

Gender Affirmation (Confirmation) or Sex Reassignment Surgery
Gender-affirming surgery gives transgender people a body that aligns with their gender. It may involve procedures on the face, chest or genitalia. Common transgender surgery options include: Facial reconstructive surgery to make facial features more masculine or feminine.
Transgender penis: How does female-to-male surgery work?
A metoidioplasty is a method of constructing a new penis, or neopenis. It involves changing the clitoris into a penis. A person will receive hormone therapy before the surgery to enlarge the...
Feminizing surgery
Feminizing surgery includes several options, such as top surgery to increase the size of the breasts. That procedure also is called breast augmentation. Bottom surgery can involve removal of the testicles, or removal of the testicles and penis and the creation of a vagina, labia and clitoris.
Masculinizing surgery
Overview. Masculinizing surgery, also called gender-affirming surgery or gender-confirmation surgery, involves procedures that help better align the body with a person's gender identity. Masculinizing surgery includes several options, such as top surgery to create a more male-contoured chest and bottom surgery that changes the genitals.
Gender-affirming surgery
Gender-affirming surgery ( GAS) is a surgical procedure, or series of procedures, that alters a transgender or transsexual person's physical appearance and sexual characteristics to resemble those associated with their identified gender, and alleviate gender dysphoria.
How Gender Reassignment Surgery Works (Infographic)
Here’s how gender reassignment works: Converting male anatomy to female anatomy requires removing the penis, reshaping genital tissue to appear more female and constructing a vagina. An...
Gender Affirming Surgery: Before and After Photos
This procedure involves enlargement of the breasts with an implant. Various techniques may be used to perform this procedure, and they are surgeon and patient dependent. Breast augmentation is often performed as an outpatient procedure but some patients may require one night stay in the hospital. 1 of 7 About Cleveland Clinic Community Commitment