If you are one of about 700,000 Americans who do not identify with their biological gender, having a transgender operation is much easier — and safer — than it has ever been before. Patients begin with a course of hormone replacement therapy and counseling to help them decide whether gender reassignment is the choice they want to make, because of the significant changes the surgeries cause to the body. Many surgeons require that prospective transgender operation patients receive a letter of confirmation from two therapists, and a common requirement is for the prospective patient to live as a member of that gender for as long as a year.
The hormone replacement therapy (HRT) starts to make changes well ahead of the transgender operation, of course. Trans women (MTF changing from a man to a woman) experience growth in their breasts, generally up to a cup or two smaller than their female relatives. If the hormone therapy begins during puberty, the pelvis widens as well, but even if it starts later, the body stores a layer of fat under the skin around the hips and buttocks.
Once the patient has committed to a transgender operation, there are many different procedures from which to choose. These range from such “top” surgery options as a mastectomy and chest contouring (for trans men, FTM) — “top” referring to the top half of the body — to such “bottom” surgery options as converting the skin, blood supply and nerves in the penis to a clitoris and vagina.