Surgical Options for Male to Female Sex Changes

For people wanting to make the gender transition from male to female — known as transgender women — surgical options generally come into play after at least a couple years of hormone therapy (including a year or more of living as a woman) and at least one (and often two) letters from psychotherapists or physicians attesting to the diagnosis of gender dysphoria. While these procedures have generally not been covered by insurers in the past, as they were able to get away with classifying gender dysphoria as a pre-existing condition — and deny coverage. Thanks to the Affordable Care Act and federal laws prohibiting discrimination against transgender persons, though, that problem has largely gone away, and more and more carriers are finding it fiscally wiser to cover the procedures than pay for litigation.

The cost of gender reassignment is still significant because of the need to satisfy deductibles, as well as the fact that many of the procedures are cosmetic in nature. Depending on what a person’s needs and desires are, 2014 costs have tended to range between $7,000 and $50,000, with the differences coming from the number and type of male to female procedures chosen as well as the facility.

The suite of procedures that make up a male to female transformation is chosen on the basis of patient desire and takes place through consultation with a team of health professionals, including an endocrinologist, urologist, gynecologist, reconstructive cosmetic surgeon and a mental health professional.

One of the most common male to female surgeries that patients choose is breast augmentation. Hormone replacement therapy (HRT) often causes the growth of breasts to within a cup size or so of the transgender person’s female relatives. However, some patients want to have larger breasts as part of their female identification, and so they go with augmentation. When the surgery involves a biological male transitioning to a female identity, some restructuring of the chest bone area is often necessary as the male body is somewhat differently set up than that of women.

Another male to female surgical option has to do with changing the genitalia out for a more feminine set. Orchiectomy (testicular removal), clitoroplasty (building a clit from the penis glans), penile inversion vaginoplasty (using the penis to build a vagina) and labiaplasty (building labia from the scrotal skin) are all possible options. Basically, the doctor removes the testicle and inner penile tissue and then shortens the urethra. After that, he turns the skin of the penis inside out and builds the vagina and external labia from the tissue. Some of the more sensitive erectile tissue goes into the creation of the clitoris. Since the glans ends up at the other end of the vagina, this means that male to female transgender patients can often experience orgasm after the reassignment and recovery are complete. The genital reconstructive surgery usually takes between four and five hours. Patients do have to follow a regimen of regular dilation of the new vagina to keep it from closing.

Many transgender women also elect to have cosmetic procedures done to increase the femininity of their appearance. Such operations as cheek and chin augmentation, forehead and brow lift (along with reduction of the brow bone and advance of the hair line at times), blepharoplasty (eyelid surgery), rhinoplasty, liposuction, and a tracheal shave (to cut down on the appearance of the Adam’s apple) are all common procedures. While any plastic surgeon can perform these operations, has listings for plastic surgeons who are familiar with the specific challenges that go along with gender transitions and have more of a history with male to female patients. Another option is voice modification surgery, which alters the vocal pitch. Voice training and speech therapy are also ways to practice talking in a more feminine way, and over time the patient can train herself to leave her masculine voice behind. has helped many patients find the right male to female surgeon for their personal needs — and for their insurance carrier. Check out reviews of all of the listed surgeons on the website as you move toward beginning your own male to female journey. Take the stress out of the situation by learning as much as possible from our site before your first appointment.

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