Gender-affirming surgery is any type of surgical procedure that helps affirm a person’s gender. People may seek gender-affirming surgery when their gender identity doesn’t match their sex assigned at birth.
Gender-affirming surgery is one of the many treatments a person might seek while going through their transition. Transitioning is the process of making changes so that a person’s physical appearance and behavior match their gender identity.
Most people think of gender-affirming surgery as only related to the sex organs (bottom surgery). But trans people have other surgical options to affirm their gender identity besides surgery on their sex organs.
Top surgery involves making surgical changes so that a person’s chest matches their gender identity. The two types of top surgery are trans feminine top surgery and trans masculine top surgery.
Trans feminine top surgery is similar to other breast enhancement and augmentation procedures. The surgery increases the size of the breasts and enhances their shape so they appear more feminine.
Trans masculine top surgery involves removing the breast tissue and making the chest appear more masculine. The removal of feminine breasts is called a mastectomy.
Like top surgery, the two main types of bottom surgery are trans feminine and trans masculine.
Trans feminine bottom surgery involves transforming the genitals of someone assigned male at birth into ones more feminine. This usually involves removing the penis and the testicles. Sometimes, the surgeon uses penile and scrotal tissue in the process of reconstructing a feminine vulva and vagina.
Trans masculine bottom surgery transforms the genitals of someone assigned female at birth into something more masculine. This means reconstructing a penis and testicles instead of a vagina. This surgery usually takes multiple steps, and these steps will vary based on a discussion with your doctor about your needs and goals.
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Plastic surgery on the face can “feminize” or “masculinize” the face. A person assigned female at birth may undergo masculinization facial surgery to make his features appear more like a man’s. Typical masculine features include more square-shaped jaws, wider foreheads, and wider noses and mouths.
Facial feminization surgery involves making surgical changes to make a person’s features more typically feminine. Feminine faces tend to have heart-shaped jaws, shorter foreheads, arched eyebrows, smaller noses, prominent cheekbones, and fuller lips.
These procedures usually involve substantial changes to the bone and soft tissue of the face. Either of these procedures may occur during one surgical procedure or may occur in stages. It depends on the person’s goals and needs and a discussion with their doctor.
Vocal Cord Surgery
For many transgender, non-binary, or otherwise gender-diverse people, voice therapy is sufficient to help them affirm their gender identity.
However, some may consider surgery that makes changes to the vocal cords to adjust the pitch, tone, and sound of the voice. The vocal cords are two smooth muscles in the voice box, called the larynx. This surgery is often called a laryngoplasty.
Feminizing vocal cord surgery increases the pitch of the speaking vocal range. Research has found high levels of satisfaction and self-esteem in people who underwent this surgery. The rate of complications is very low, around 1.2%.
Vocal cord surgery to masculinize the voice lowers its pitch to sound more masculine. This procedure is called thyroplasty.
Risks of Gender-Affirming Surgery
All medical procedures, including surgeries, carry risks in addition to benefits. The most common risks are infection or excessive bleeding, but these are still rare in gender-affirming surgeries.
Trans feminine bottom surgery risks
The risks of trans feminine bottom surgery are similar to the risks of many surgical procedures. Those include:
- Incision cuts that do not heal well.
- A collection of blood called a hematoma, similar to a large bruise.
- Injury to the nerves.
- Injury to the urinary tract.
Some possible post-surgical complications could include painful sexual intercourse and insufficient depth or width of the vagina. If these complications arise, you can work with your surgeon to address them.
Not every person undergoing transition chooses to have surgical or even medical procedures. There is no wrong way to transition. If you opt for surgery, the surgeries you choose will depend on your needs and goals during discussions with your doctor.
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Charlotte Bultynck, Marjan Cosyns, Guy T'Sjoen, John Van Borsel, Katrien Bonte. Thyroplasty Type III to Lower the Vocal Pitch in Trans Men. Otolargyngology: Head and Neck Surgery. January 2021. Link
Darshan P Patel, Isak A Goodwin, Omer Acar, Ervin Kocjancic, James M Hotaling. Masculinizing gender-affirming surgery for trans-males and non-binary individuals: what you should know. Fertility and Sterility. August 14, 2021. Link
Farah Sayegh, David C Ludwig, Mona Ascha, Krishna Vyas, et al. The Journal of Craniofacial Surgery. Facial Masculinization Surgery and its Role in the Treatment of Gender Dysphoria. July 2019. Link
Gender Confirmation Surgeries. Reconstructive Procedures. American Society of Plastic Surgeons. Link
Jordan Deschamps-Braly. Facial feminization for cisgender women with masculine-looking faces. American Society of Plastic Surgeons. August 21, 2018. Link
Nicolette V Siringo, Zoe P Berman, Daniel Boczar, Bachar F Chaya, Gustave K Diep, Jorge Trilles, Sara Mazzei, Ricardo Rodriguez Colon, Eduardo D Rodriguez. Techniques and Trends of Facial Feminization Surgery: A Systematic Review and Representative Case Report. Annals of Plastic Surgery. July 13, 2021. Link
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