Gender affirmation surgery, also known as gender confirmation surgery, helps people transition to their ‘self-identified’ gender, giving them the physical appearance and functional abilities of the gender they know themselves to be. This might include anything from facial surgery to bottom surgery and top surgery, usually used as a treatment to ease symptoms of gender dysphoria.
What this means will vary from person to person, and is different for children, young people and adults. According to the NHS, waiting times for referral and treatment are currently long and for children under 18, they'll usually be referred to the Gender Identity Development Service (GIDS) at the Tavistock and Portman NHS Foundation Trust first before a treatment plan is put in place with a team of experts including psychologists and adolescent psychiatrists.
What you need to know about this commonly-misunderstood condition.
For adults who have chosen to have surgery to permanently alter body parts associated with their biological sex, they are first referred to a Gender Dysphoria Clinic (GDC) and seen by a multidisciplinary team of healthcare professionals, who offer ongoing assessments, treatments, support and advice, including psychological support, cross-sex hormone therapy and speech and language therapy. Based on the recommendations of doctors at the gender dysphoria clinic, they will be referred to a specialist surgeon outside the clinic who is an expert in this type of surgery.
Here's everything you need to need to know about gender affirmation surgery.
Sex reassignment surgery refers to procedures that help people transition to their self-identified gender. Today, many people prefer to use the terms gender affirmation or confirmation surgery.
People may have surgery so that their physical body matches their gender identity. People who choose gender affirmation surgery do so because they experience gender dysphoria. Gender dysphoria is the distress that occurs when your sex assigned at birth does not match your gender identity.
Such a joyous photo!
“Gender-affirming surgical procedures can have a significant impact on a patient’s overall wellbeing and are often a critical step for many in their transition," says plastic surgeon Dr Paul Banwell.
Dr. Banwell adds: "With regards to available procedures, breast augmentation can add volume and shape for a more feminine appearance. By contrast, mastectomy involves the removal of breast tissue and therefore masculinises the chest.
“Body contouring can also align with both masculine and feminine ideals. We can look at liposuction and fat grafting to redistribute body fat to areas such as the hips and buttocks for a more feminine appearance whilst defining the torso may be necessary for masculinisation. Of course this is all based on the individual’s needs and carefully decided through a thorough consultation period.”
According to the NHS, there are various surgical procedures involved when it comes to sex reassignment.
Common chest procedures for trans men (trans-masculine people) include:
- removal of both breasts (bilateral mastectomy) and associated chest reconstruction
- nipple repositioning
- dermal implant and tattoo
Gender surgery (sometimes known as ‘bottom surgery’) for trans men includes:
- construction of a penis (phalloplasty or metoidioplasty)
- construction of a scrotum (scrotoplasty) and testicular implants
- a penile implant
Removal of the womb (hysterectomy) and the ovaries and fallopian tubes (salpingo-oophorectomy) may also be considered.
Gender surgery for trans women includes:
- removal of the testes (orchidectomy)
- removal of the penis (penectomy)
- construction of a vagina (vaginoplasty)
- construction of a vulva (vulvoplasty)
- construction of a clitoris (clitoroplasty)
Breast implants for trans women (trans-feminine people) are not routinely available on the NHS, nor are any surgical procedures for facial feminisation or hair transplants.
Surgery is just one option for those looking to transition gender. Not everyone who is transgender or nonbinary chooses to have surgery. Depending on your age and preferences, you may choose:
- Hormone therapy is used to increase masculine or feminine characteristics, such as the amount of body hair or vocal tone.
- Voice therapy to adjust your voice or tone or help with communication skills, such as introducing yourself with your pronouns.
- Fillers to create a softer appearance for those transitioning into females, or to make a more ‘masculine’ angular jawline.
Aesthetic surgeon Dr Glyn Estebanez of Prima Aesthetics treats many patients asking for gender-affirming cosmetic tweakments. He tells GLAMOUR he often turns to the use of fillers as a surgical alternative for those looking to alter their appearance.
“Everyone’s facial features are different, but we naturally associate certain traits with femininity. Female faces usually have softer, more delicate features, for example. For a more feminine appearance, we can lift the brow and create a more defined brow arch with filler applied to the temple area, softening the ridge above the brow bone and creating a more curved forehead.
“Fillers can also be carefully injected to the cheeks and to the lips. We can also use anti-wrinkle injections in the masseter to create a more delicate jawline. With regards to tech-based treatments, hair removal is incredibly popular.
“For masculinisation, on the other hand, we can apply fillers to the jawline and chin to make this more angular and longer, to balance the face in a more masculine way.”
As with all surgical procedures, there can be complications. Your surgeon should discuss the risks and limitations of surgery with you before you consent to the procedure. For example, individuals who have bottom surgery may have changes to their sexual sensation, or trouble with bladder emptying. In general, significant complications are rare, as long as an experienced surgeon is performing the procedure.
For more information visit nhs.uk/gender-dysphoria.
Healthcare models are still centred around cisgender white men, which should worry us all.
