Overview:
What is gender affirming surgery?
A range of surgeries that includes the removal or addition of breast or chest tissue, creating a vagina and labia, creating penile tissue, or creating a penis. A gender affirming hysterectomy is also possible. Don’t forget facial surgeries!
The most common ones are chest and facial surgeries, but given the difficulty in accessing genital surgeries we talk about those a little more here
Pre-surgery:
Online forums are great! But buyers beware...bias. It's still an online review forum, so now that its biased in who chooses to participate in online forums or share pictures there
Surgeon’s website, realizing that they only choose the best photos, are also a good place
Look for folks with similar bodies and skin colors to hear their stories
Primary care providers will help navigate any possible changes in hormones post-op and be there to set you up with any resources for possible post-op stress or depression
In addition: surgery stresses your body! A PCP can find ways to get your medical care in a good place before surgery to make the recovery process as smooth as possible
E.g. having your blood pressure, cholesterol, and/or diabetes optimized
Also, quitting smoking. Many surgeons will do a lab test to see if someone is smoking. Called cotinine testing, it's a breakdown product of nicotine and tells the health care provider if someone recently smoked nicotine.
FYI: there is some data that says folks who had access to primary care prior to beginning or completing puberty, including hormone blockers, are less likely to get surgery because the tissues they want surgically modified never developed
For example, someone who took hormone blockers never developed breast tissue so never gets breast tissue removed surgically
Find a surgeon
Where to look?
For some folks, the internet is a great starting point
Others will be able to receive referrals from PCPs
Make sure they are board certified
Someone with experience providing these procedures to trans individuals.
Do they take your insurance?
Hair removal! If this is relevant to the surgery being planned.
Get a head start - it often requires upwards of 10 sessions and takes about a year
Look for folks who have experience in clients with your level of melanin
What kind of hair removal? Laser hair removal or electrolysis (more about this in our full show notes on our website).
Getting mental health providers to provide a letter for your insurance clearance
Let’s start out by saying: this is a controversial barrier to care that is often seen as a transphobic and discriminatory gate-keeping measure (almost no other surgery requires this step) ...but, if someone is making you see a mental health provider know that surgery is stressful and there are real resources a mental health provider can offer
Heads up: this can take a while. And double heads up: if you are having bottom surgery you will almost certainly need TWO different mental health provider letters
Submit your mental health letters to your surgeon, who submits them to insurance. Cue the hours of hold music.
Post-surgery
Post-op depression is common! It's not unusual that with big changes and the physical stress to experience changes in mood in unexpected ways
There is a healing process. It can take months, depending on which surgery you have
Your physical comfort and activity level will take time to return to baseline
Seek out caregivers before hand to help you afterwards
Dilation (this is relevant only to vaginoplasty)
Dilation is done to maintain depth and width in a newly constructed vagina
Expect to dilate weekly throughout your lifetime in order to have receptive vaginal intercourse
To that point - not everyone will share a goal of keeping an open vaginal canal. If that’s the case for you, we encourage you to check in with your healthcare provider about what this means re:dilation
Helps with healing, pain, urinary issues, dilation - a win!
Ask your surgeon for someone who has worked with people who have had your surgery before you, and who will be affirming!
Is totally defined by the person experiencing it, and different folks will have different goals for their own sexual satisfaction
Lubrication may or may not happen, and may or may not be enough to make penetrative sex comfortable
Orgasming - can take time, practice, and getting to know your new body. Again - ask your surgeon honest questions!
If you use the body part for sex, get it tested for STIs
Some final context:
To quote our community voice: having surgery is not everyone’s end goal. Everyone’s journey with any gender affirming medical care is their own!