Transitioning to a different gender through surgical alteration is called gender reassignment surgery (GRS) or Sex reassignment surgery (SRS). This surgery is either males transitioning to females (MTF) or females transitioning to males (FTM). There are various stages of gender reassignment surgery for both FTM and MTF.
Female to Male (FTM) Reassignment Surgery:
Females generally begin their transitioning by undergoing an elective bilateral mastectomy.This is sometimes referred to as ‘top surgery’ and consists of the removal or radical reduction of both breasts. This procedure involves making a small incision in the breast near the nipple and removing fat and breast tissue from under the skin. The shape of the chest is made to look more masculine. Sometimes, the individual chooses to have a more masculine-looking nipple grafted from the skin of the existing nipple.
There are few complications to this surgery and often this is all the surgery a FTM needs to feel comfortably transformed and able to pass as a male in society.
Sometimes, in FTM reassignment surgery, the individual wants to also have a penis created. This surgery is much more complex and more complications can be involved.
The first step to creating a penis is a surgical procedure called Metoidioplasty or a slightly more advanced surgical procedure called Phalloplasty. Both these surgeries are done to create a penis from the existing clitoris and a scrotum from the existing vaginal lips. Testicle implants are later placed in the newly-created scrotum. The more advanced Plalloplasty procedurecan create a typically-functioning organ (with adaptations) but the surgery also has increased risks involved, mainly involving possible tissue death and urinary tract issues.
Male to Female (MTF) Reassignment Surgery:
In MTF reassignment surgery several issues must be surgically addressed. The first surgical procedure usually undertaken is anElective Bilateral Orchiectomy. This procedure involves removal of both testicles. The importance of having this procedure first is because it significantly lowers the production of testosterone and allows the individual with a male body to transition to a woman and take lower doses of estrogen. This procedure typically is done on an outpatient basis.
The next procedure performed is aTracheal Shave. This is an outpatient surgery also, and involves surgically reducing the tracheal cartilage or ‘Adam’s apple’. The front of the throat cartilage is shaved flat to create a more feminine appearance. This procedure does not affect the voice unless too much cartilage is shaved and the vocal chords are damaged during surgery.
Vaginoplasty is the most complicated MTF Reassignment Surgery. The surgery consists of constructing a vagina and removing the organs and erectile tissue of the penis. The skin and tissue of the penis is then used to create a vaginal opening, clitoris, clitoral hood and labial lips. There is risk for several complications with a vagioplasty, but about 80% of sex reassignment clients are satisfied with their results.
For a client to be eligible to progress to Gender Reassignment Surgery, the following criteria is usually required:
Legal age of majority (age 18 in the United States)
12 months of prior continuous hormone therapy (HT), unless medically contraindicated
12 months of successful, continuous, full-time, real-life experience
Regular, responsible participation in psychotherapy, if required by the mental health professional
Demonstrable knowledge about surgical cost, length of hospitalization, complications, and rehabilitation
Knowledge of different competent surgeons
Patient has made demonstrable progress in consolidating gender identity.
Patient has made progress in improving or continuing stable mental health (implies control of sociopathy, substance abuse, psychosis, and suicidal tendencies).
(Adapted from Standards of Care for Gender Identity Disorders. 2001. The Harry Benjamin International Gender Dysphoria Association).