For some, though not all, transgender people, surgery is an important and affirming part of the transition process. It can help alleviate feelings of dysphoria, help align your body with your internal sense of your gender, and make it easier to navigate the world in your gender.
Over the years, the names for these surgeries have evolved. Today, many transgender people prefer to use the term “gender confirmation surgery,” because when we say something like gender “reassignment” or “sex change,” it implies that a person’s gender changes when they have surgery.
As many trans folks have noted, surgery doesn’t change one’s gender — it changes the body in which one experiences that gender.
Here, we break down the different types of surgeries available to transgender people.
During puberty, most folks who were assigned female at birth (AFAB) will develop breast or chest tissue.
Top surgery is a procedure to remove the chest tissue and reconstruct the chest to have more of a masculine appearance.
There are three basic top surgery options for AFAB folks:
With this procedure, incisions are typically made at the top and bottom of the pectoral muscle and the chest tissue is removed.
The skin is pulled down and reconnected at the sight of the lower incision.
The nipples are also removed and used to create a graft that has the appearance of a nipple. This method generally results in decreased nipple sensation.
With the Inverted-T and Buttonhole methods, incisions are made around the nipples. This allows them to remain intact and retain sensation.
This procedure may work best for people with medium- to large-sized chests.
Periareolar and keyhole
With the periareolar procedure, one incision is made around the areola, and a larger circular incision is made around that.
The breast tissue is removed, as is the ring of skin between the two incisions.
The skin is then pulled in around the nipple — like a drawstring — and reattached. This leaves the nipple intact.
With the keyhole procedure, there’s only one incision. It goes underneath the nipple, allowing the chest tissue to be removed from there.
These procedures may work best for folks with smaller chests.
AFAB folks were, for the most part, born with a vagina and clitoris.
Although testosterone use increases the size of the clitoris, some transmasculine people may wish to have some form of bottom surgery in which the genitals are reconstructed to create a phallus.
Testicular implants may be added, the urethra may be rerouted into the new phallus, and the vagina and other reproductive organs may be removed.
Bottom surgery options for AFAB folks include the following:
The enlarged clitoris is released from the clitoral hood to create a new phallus.
Folks who get this surgery may have their urethra rerouted with a graft from their cheek or the inside of the vaginal wall so they can urinate through the new phallus.
The addition of testicular implants is also possible.
This surgery is only possible for folks who have been on testosterone. It’s a great option for people who want something less invasive than phalloplasty.
A graft is taken — typically from the forearm, thigh, or back — and used to create a penis.
Depending on the type of surgery, the urethra may be linked to allow urination through the new penis, and an implant may be installed to allow the penis to become erect.
This surgery is best for people who want a more realistic, average-size penis.
Hysterectomy, oophorectomy, and vaginectomy
AFAB trans people have a number of options when it comes to their reproductive organs. This includes removal of the uterus (hysterectomy), removal of one or both ovaries (oophorectomy), and removal of the vagina.
For transfeminine people and nonbinary folks who were assigned male at birth (AMAB), the absence of breast tissue can be a source of discomfort or dysphoria.
While hormone therapy can increase the size of the chest, some may wish to have top surgery to increase the size of the breasts, known as breast augmentation.
An incision is made along the areola, at the point where the chest and breast tissue meet or under the armpit.
The surgeon then inserts either a custom-sized silicone or saline implant and sutures the incision.
Silicone implants tend to be softer and more realistic. Saline implants are typically less expensive.
This surgery is great for anyone who wants to have a larger chest.
Most AMAB folks have a penis and testicles. For transfeminine and nonbinary AMAB folks, this may be a source of discomfort which bottom surgery can relieve.
There are three basic bottom surgery options for AMAB folks:
A functioning vagina is created out of existing tissue. The most common method is through penile inversion. The penis is inverted to create a vagina, the tip of the penis becomes a functioning clitoris, and the scrotal skin becomes the labia.
There are variations in which a graft from the intestine is used to create the vaginal wall (to supply more lubrication), or in which the scrotum is inverted to create a vaginal wall.
This surgery may be an option for anyone who wishes to have a functioning vagina.
Orchiectomy and scrotectomy
With these procedures, one or both testicles or the entire scrotum are removed.
Orchiectomy is a relatively inexpensive option in which the testes are removed. This allows your body to create less endogenous testosterone, which can be especially helpful for those on hormone replacement therapy.
Scrotectomy offers similar results, but it isn’t recommended for folks who wish to have a vaginoplasty. Scrotal skin is required for a vaginoplasty.
The increasing availability of gender confirmation surgeries is an incredible mark of progress for the transgender community. However, it’s important to note a few things about gender confirmation surgery and whether it’s the right choice for you.
Surgery isn’t the only aspect of medical transition
Representations of trans people tend to focus on the surgical aspects of transition, especially bottom surgery.
However, hormonal transition is also a valid medical option and can often produce results that alleviate dysphoria.
And, remember, medical transition isn’t necessary unless it’s something you truly want.
Surgery isn’t the same for everyone
One of the biggest things to remember is that not everyone wishes to have gender confirmation surgery, and the results — mental, physical, and emotional — will be different for everyone. Do your research and figure out what the right path is for you.
Surgery doesn’t define your experience or make you more valid
Surgery can be incredibly affirming for those who wish to have it.
But it’s important to remember that gender confirmation surgery simply changes the body in which you experience your gender, not your gender itself.
Your gender is valid, regardless of whether you want to have surgery.
Section 1557 of the Affordable Care Act (ACA) prohibits discrimination based on gender identity by any public insurance program or private insurance company receiving federal funding.
This means that if you have Medicare, Medicaid, public school insurance, or a private plan through the ACA marketplace, it’s illegal for you to be discriminated against for being transgender.
Your insurance may cover gender confirmation surgery in order to avoid breaching this non-discrimination clause. However, the law doesn’t require that an insurance company cover any specific procedures, leaving it somewhat open to interpretation.
Recent news from the White House makes it unclear how insurance companies will handle gender confirmation surgeries in the future. But as it currently stands, many people are able to get their surgeries covered by insurance.
If you don’t have insurance or if your insurance won’t cover your surgery, you may need to raise the funds yourself and pay out-of-pocket. Many trans people have used crowdfunding or medical loans to cover their surgeries.
Regardless, these are the prices you can expect to pay for the surgeries we’ve listed here.
- Transmasculine top surgery: Ranges from $3,000 to $11,000, depending on surgery type and surgeon.
- Transmasculine bottom surgery: Starts around $4,000 for metoidioplasty and goes up to $22,000 for phalloplasty.
- Transfeminine top surgery: Ranges from $3,000 to $11,000, depending on surgeon and location.
- Transfeminine bottom surgery: Starts around $4,000 for orchiectomy and goes up to $20,000 for vaginoplasty.
Depending on your insurance coverage, you may need to find someone in your network. You can check with your insurance company to see which surgeons are in your network.
If you don’t have insurance or your insurance won’t cover your surgery, you may be able to select a doctor you like based on their work and other factors.
These are a few great resources for finding a provider:
Gender confirmation surgery certainly isn’t the right choice for everyone.
But for the folks who want — and in fact need — confirmation surgery, it can be an incredible opportunity to help align your body with your internal sense of self.
If gender confirmation surgery is in your future, be sure to do your research to find the right surgeon for you.