Gender affirming surgery

Gender affirmation is a way to help you live and be recognised as the gender with which you identify.

Gender affirmation might include:

• social affirmation — such as changing your name, pronouns, hair or clothing
• legal affirmation — such as changing your legal name or gender
• medical affirmation — which can include puberty blockers, hormones or surgery

You can read more about gender incongruence and gender affirming care.

Surgery is just one option for gender affirming care.

Gender affirming surgery refers to a variety of procedures that some people may use to affirm their gender and feel more comfortable in their body. This can include making changes to:

• your chest — top surgery
• your genitals — bottom surgery
• your face — this includes facial feminisation surgery
• other body parts — such as in vocal surgery

All trans and gender diverse people are unique. Not everyone with gender incongruence has surgery. You can choose to affirm your gender in a way that feels right for you.

Gender affirming surgery is usually done in adulthood.

For people assigned male at birth, feminising surgeries may include:

• breast/chest surgery — insertion of breast implants
• facial feminisation — changing the shape of the lips, eyes or nose
• voice surgery — shortening the vocal cords for a higher, more feminine voice
• tracheal shave — to reduce the size of the 'Adam's apple'
• lipofillers or liposuction — to achieve a more feminine shape

Bottom surgery (genital reconfiguration surgery) involves changes to the genitals. This was previously known as 'sex reassignment surgery' or 'gender confirmation surgery'.

Feminising bottom surgery can involve a mixture of procedures such as:

• orchiectomy and scrotectomy — removing the testicles and scrotum
• penectomy — removing and reshaping tissue from the penis to make a vulva
• vulvoplasty — creating external labia or lips, and a clitoris
• vaginoplasty — creating a vaginal canal

After vaginoplasty surgery, you'll need to use vaginal dilators to maintain the shape of your vaginal canal.

For people assigned female at birth, masculinising surgeries may include:

• breast or chest surgery — to create a male chest
• pectoral implants
• lipofillers and liposuction — to achieve a more masculine shape
• facial surgery — to create an Adam's apple

Masculinising bottom surgery may involve a mixture of procedures such as:

• hysterectomy and ovariectomy — removal of your uterus (womb) and ovaries.
• vaginectomy — removal of the vagina
• metoidioplasty or phalloplasty — creation of a penis

Metoidioplasty involves making a small penis from the clitoris after it is enlarged by testosterone hormone therapy. The final stage of surgery involves testicle implants and a device that may help you to have an erection.

Phalloplasty uses tissue from your body to make a penis. This tissue usually comes from your:

• arm
• thigh
• back

For both metoidioplasty and phalloplasty, you may choose to have urethral lengthening. This should allow you to urinate from the tip of your new penis.

Choosing to undergo any surgery is a big decision. Everyone affirms their gender in different ways. For you, affirmation may or may not include surgery.

Surgery is permanent. So, you need to make sure it's the right choice for you.

If you are considering gender affirming surgery, speak with your doctor. They can:

• give you information about your options
• help you navigate the process
• recommend services that can support you
• refer you to other health professionals for further help
• help you decide what's best for you

Remember, surgery is your choice. Having surgery doesn't make you more or less trans.

You can read general information about preparing for surgery.

Before you can get gender affirming surgery, you need to meet certain criteria. You need to:

• have a history of gender dysphoria (for 6 months or more)
• have the ability to make a fully informed decision and give consent
• be over the age of 18 years
• ensure that any physical or mental health conditions you have are well managed

Some surgeons will only provide surgery to people under the age of 18 in specific situations.

You may also need letters of support from a mental health professional before having gender affirming surgery. The letter should describe:

• your desire to transition
• any gender dysphoria that you have
• your mental wellbeing
• your ability to provide informed consent

To have gender affirming surgery in Australia, you need to have 'lived as your current gender' for 12 months. This means that you have socially transitioned.

If you are taking gender affirming hormones, you should do this for at least 6 months before having surgery. This is to allow any significant body changes to occur before surgery.

It's important to talk about the benefits and risks of any surgery with your doctor.

It's a good idea to ask to see pictures of how other people look before and after surgery.

Questions to ask your surgeon include:

• Am I a good candidate for the procedure?
• What surgical techniques are recommended for me?
• How long will the recovery period be?
• What are the possible risks and complications?
• Where will you perform the surgery?

Surgical recovery can be long and uncomfortable. Your recovery will look different depending on the type of surgery you have.

Your surgeon will give you more information on what you can expect after each surgery and steps for recovery.

You may want to ask some questions:

• How long will I spend in hospital?
• How should I maintain personal hygiene?
• How much physical exercise can I do?
• Do I need to change my diet while I am recovering?
• When can I resume sexual activity?
• Will I need any special dressings or surgical garments?
• When do I need to return for follow-up care?

Make sure you follow your doctor's care instructions and go to all follow-up appointments. This will help you get the best results from your surgery. Some people may need another surgery to get the best results.

How can gender affirming surgery impact my emotions?

Having surgery is a big deal. Even after having gender affirming surgery, it might take some time to get used to your new body.

Most people who have surgery are happy with their results and feel more comfortable in their bodies.

Some people are disappointed with the results. They may find that their gender dysphoria is not fully resolved.

Even if you've been looking forward to it and are happy with the result, having surgery can still be quite confronting.

Talk to your doctor or psychologist if you are feeling any distress after surgery.

Complications can happen after any surgery, including gender affirming surgery. These may include:

• infection
• bleeding
• scarring
• difficulty urinating (peeing)

Talk to your doctor or surgeon about how to help prevent complications.

Gender affirming surgery can be very expensive. It can cost between $20,000 to more than $100,000, depending on which procedures you need.

Your surgeon will be able to tell you how much surgery will cost. There may be extra costs for:

• specialist visits before and after surgery
• surgeon and anaesthetist fees
• hospital and theatre costs
• any other products or services you need

The costs of some procedures may be covered by Medicare. You should ask your surgeon what Medicare item numbers they use. You can check the Medicare rebate at MBS Online (Opens in new tab).

Most gender affirming surgery in Australia is done privately. If you have private health insurance, it's important to check with your health fund about what they cover. You can also check what your out-of-pocket costs will be.

There are separate processes needed to change your gender on your:

• passport
• driving licence
• Medicare card
• birth certificate

These processes can vary between states and territories.

In some states and territories, you must have gender affirmation surgery to change the gender marker on your birth certificate.

You are legally protected from discrimination on the grounds of sexual orientation, gender identity or intersex status by the Sex Discrimination Act (Opens in new tab). Visit the Australian Government Attorney-General's Department for more details on the Recognition of Sex and Gender (Opens in new tab).

• You can find more information about genital reconfiguration surgery (Opens in new tab) or search for a surgeon (Opens in new tab) on the Australian Society of Plastic Surgeons website.
• You can visit The Australian Professional Association for Trans Health (AusPATH) (Opens in new tab) for a list of healthcare professionals (Opens in new tab) who are committed to strengthening the health, rights and wellbeing of all trans people.
• You can visit the QLife (Opens in new tab) website for resources (Opens in new tab), webchat or call 1800 184 527 (Opens in new tab).
• You can visit the Gender Centre (NSW) (Opens in new tab) website for resources (Opens in new tab) and support.
• In NSW, Twenty10 (Opens in new tab) works with young people in gender-affirming ways to support their rights, agency and wellbeing. They have resources (Opens in new tab) and services available.

You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with you 24 hours a day, 7 days a week.