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  • Jaclyn Kotora

Gender-Affirming Surgeries

By: Jaclyn Kotora, Contributing Writer

Edited by: Olivia Storti, Editor; Eve Nevelos, Editor in Chief

Gender-affirming surgeries are procedures to help a patient surgically transition from male to female (MTF) or female to male (FTM). There are various gender-affirming interventions that an individual may seek, such as hormone therapy, facial hair removal, modification for speech, genital tucking or packing, or chest binding. Gender-affirming surgeries can have a substantial benefit on transgender and gender-diverse individuals’ mental health. However, not all transgender people may seek these interventions, nor desire them at all. It is up to each individual to take whatever steps they see fit to affirm their gender identity.

Gender-affirming surgeries for a transfeminine individual often involve ‘bottom surgery’, which includes vaginoplasty, vulvoplasty, and orchiectomy. Vaginoplasty surgery involves creating both an outer and inner vagina by using skin and tissue from a penis, while vulvoplasty is a type of surgery that uses skin and tissue from a penis to create all of the outside parts of a vagina, except for the vaginal canal (University of Utah Health). In general, a vulvoplasty has a much easier recovery and less risk of medical complications, like rectal injuries, which can create a hole between your rectum and vagina. However, most patients choose to begin with a smaller surgery, an orchiectomy, where the testicles are removed. Once removed, the amount of male hormone, testosterone, drops significantly, which may permit an individual to take less estrogen. Additional procedures like facial feminization and voice procedures are also available. It is essential to research and talk to your doctor about all options to find what will work best for you.

Gender-affirming surgeries for a transmasculine individual include “top surgery” and metoidioplasty or phalloplasty “bottom surgery”. Top surgery involves “the removal of the breasts and reconstructing the skin, nipples, and areolas to create a masculine-looking chest,” (University of Utah Health). There are various techniques used to accomplish this, which can be further discussed with your surgeon during consultation. Of the bottom surgery options, a metoidioplasty is a procedure used to form a small penis using existing genital tissue. A phalloplasty involves multiple procedures to create the penis, lengthening the urethra (allowing the individual to stand whilst peeing), creating the tip (glans) of the penis, creating the scrotum, etc. While both have their benefits and frequent side effects, metoidioplasty generally has a lower risk of medical complications, is more affordable, and has a faster recovery. Like MTF procedures, there are additional FTM surgeries to help affirm one’s gender identity.

When individuals undergo their desired surgeries to affirm their gender, research shows that they experience various beneficial mental outcomes. Kristen Monaco from MedPage Today reports, “TGD (transgender and gender-diverse) individuals who already underwent all of their desired surgeries saw a significantly lower odds of experienced psychological distress, substance abuse issues, and suicidality versus those who didn't receive any of their desired surgeries.” These gender-affirmation surgeries are sometimes inaccessible to some individuals due to health insurers denying coverage, partially because of the lack of evidence of the health benefits. However, many recent studies are being conducted to fill these gaps of evidence and ensure and expand care for the TGD population. Senior study author Dr. Alex Keuroghlian, director of the National LGBTQIA+ Health Education Center at The Fenway Institute and director of the Psychiatry Gender Identity Program at Massachusetts General Hospital, stated, "If we align people's bodies and gender expression with their gender identity, that is a way in which they can most authentically live their true lives and be their true selves, and also navigate society in a way where they are presenting as the gender they identify with. We think that that reduces distress significantly.”

Before going through these surgical interventions, make sure you have a clear pre- and post-surgery plan with your support team and clinical specialists. It’s also important to mentally prepare for this surgery, and you may find it helpful to talk to people who have gone through gender-affirming surgeries, but keep in mind that everything you hear or read may not apply to your situation. As more studies are being conducted, hopefully, more data and evidence to support these procedures will emerge to allow gender-affirming surgeries to become more accessible.


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