Female Doctor

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

Top surgery involves making surgical changes so that a person’s chest matches their gender identity. Top surgery includes 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.

Never Miss a Beat!

Get Healthy Tips Sent to Your Phone!

Message and data rates may apply. Text the word STOP to opt out and HELP for help. Click here to view the privacy and terms.

Bottom Surgery

bottom surgeries are the affirming surgeries that are related to the sex organs.

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.

Facial Surgery

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:

  • Bleeding.
  • Infection.
  • 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.

Editor's Note: This article was originally published on , and was last reviewed on .

Sources

Brian A Nuyen, Z Jason Qian, Ross D Campbell, Elizabeth Erickson-DiRenzo, James Thomas, C Kwang Sung. Feminization Laryngoplasty: 17-Year Review on Long-Term Outcomes, Safety, and Technique. Otolargyngology: Head and Neck Surgery. August 17, 2021. Link

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

About Pediatrics

From nutrition to illnesses, from athletics to school, children will face many challenges growing up. Parents often will make important health care decisions for them. We hope to help guide both of you in that journey. UPMC Children’s Hospital of Pittsburgh is a national leader in pediatric care, ranking consistently on U.S. News & World Report’s Best Children’s Hospitals Honor Roll. We provide expert treatment for pediatric diseases, along well-child visits, urgent care, and more. With locations across Pennsylvania, Maryland, and West Virginia, you can find world-class care close to home. We also work closely with UPMC Magee-Womens Hospital, a national leader in care for newborns and their mothers. Our goal is to provide the best care for your children, from birth to adulthood and beyond. Visit our website to find a doctor near you.