Gender Confirmation Surgery

Male to Female

What is Gender Confirmation Surgery?

Gender confirmation surgery, also known as sex reassignment surgery (SRS), is a surgical procedure that alters a transgender person’s physical appearance and function of their existing sexual characteristics in order to resemble that which is socially associated with their identified gender. It is part of a treatment for gender dysphoria in transgender people.

What procedures are involved in transitioning from male to female (MTF)?

When a patient is considering MTF gender confirmation surgery, there are a number of procedures involved. The procedures are usually broken down into top surgery (above the belt) and bottom surgery (below the belt).

There are five facets to the overall procedure involved in bottom surgery for MTF confirmation surgery. They surgery takes around four hours to perform. The patient is under general anesthesia during this surgery:

a. Penectomy: A surgical procedure to remove the penis.
b. Orchiectomy: A surgical procedure in which the testicles are removed.
c. Urethroplasty: The reconstruction of the urethra to allow urination and a pink entrance to the vagina.
d. Clitoroplasty: A portion of the penis will be used to make a clitoris with part of the head of the penis, leaving artery vein and nerve intact.
e. Vaginoplasty: A pouch is created that will accept a skin graft and the penile shaft skin to function as a vagina.

Top surgery involves a variety of procedures intended to make the patient’s overall appearance more feminine. Versus the “bottom surgeries” these are considered to be cosmetic surgeries. These are the procedures that may be considered:

  • Breast augmentation
  • Facial feminization surgery, including forehead surgery
  • Buttock enhancement
  • Nose surgery to narrow and refine the tip
  • Jaw surgery to shave down the jaw bone
  • Chin reduction
  • Cheek implantation
  • Lip augmentation
  • Hairline transplantation to create a female hairline
  • Male pattern hair removal
  • Reduction of the Adam’s apple
  • Voice change surgery
  • Buccal fat-pad removal
  • Eyelid surgery
  • Eyebrow lift
  • Facelift
  • Neck lift

Who is an ideal candidate for MTF gender confirmation surgery?

A person born a man who feels he actually should be a woman is a good candidate for this surgery, but this cannot be a rushed decision. That’s why the WPATH has set standards of care to follow before even being considered for surgery. After candidates have completed the three-step WPATH process, they can move on to surgery. Ideal candidates need to understand the limitations of the surgeries involved in this process. These are not minor surgeries, and recovery will involve pain and the need to miss work for extended periods.

What are the steps to be taken before having MTF gender confirmation surgery?

There are standards of care adopted by the World Professional Association for Transgender Health (WPATH). Prior to surgery, there are three phases the patient needs to accomplish before moving to surgery.

  • Diagnosis – In the first step, the patient meets with a mental health professional to receive a diagnosis and participate in a series of psychotherapy sessions. Based on these sessions, the doctor will provide a diagnosis of gender identity disorder or gender dysphoria.
  • Hormone Therapy – With this diagnosis the patient can then begin hormone therapy, usually with an endocrinologist. The purpose of hormone therapy is to cause the development of all the secondary sex characteristics of the desired sex of the patient. While hormone therapy cannot undo many of the changes produced by the body during puberty, it can help the patient develop breasts (in male to female change), different hair patterns, muscle development and distribution, skin changes, fat changes, even bone/skeletal changes. The most important contribution of hormone therapy, however, is to reduce the dysphoria transgender people have felt most of their lives.
  • Real-life Experience – The next step of the WPATH standards is for the patient to live for as long as one year in their preferred gender role. This involves going to work or school and generally living successfully as the opposite sex. Part of this experience will involve changing of the first name. This phase is meant to help the patient develop the confidence that he or she can successfully live as the opposite sex.

    How Do I Prepare For The Procedure?

    • Candidates should have an affiliation with a provider that follows WPATH criteria
    • Obtain the appropriate letters
    • Laser or electrolysis hair removal

    What Will The Procedure Change/Correct/Accomplish?

    Male-to-Female gender confirmation surgery will:

    • Provide a functional vagina
    • Allow urination in the seated position
    • Allow orgasm to be maintained
    • Create a working vagina that accepts a penis
    • with a clitoris that allows for orgasm

    What Has The Success Rate Been For The Procedure?

    95 % of patients maintain the ability to experience full orgasm.

    What Are The Potential Risks/Complications/Side Effects?

    Following the procedure, the following are common:

    • Bleeding
    • Infection
    • Scar tissue
    • Delayed wound healing
    • Narrowed vagina
    • Fistula formation
    • Transfusion
    • Pain
    • Blood clot

    Will I Go Home The Same Day, Or Will I Need To Spend The Night At The Hospital?

    Patients typically stay in the hospital for 2-4 days.

    How Long Is The Recovery?

    Recovery is typically 2 weeks initially, but it can take up to 3 months to fully recover.

    The following are common in a patient’s recovery:

    • 1-2 weeks with vaginal packing and urethral catheter
    • Pain
    • Swelling
    • Discoloration
    • Ability to start dilating 1-2 weeks after surgery
    • Intercourse at 3 months.

    When Will I Be Able To Resume Normal Activities?

    Patients typically are able to resume routine daily activities in 2-4 weeks, and
    have sex at 3 months.

    What issues could prevent me from undergoing MTF gender confirmation surgery?

    Cost can be an obstacle to having all of the surgeries the patient may seek. Insurance is getting better at covering gender confirmation surgeries, but different companies can be variable. Others potential candidates do not want to go through the series of surgeries and recoveries necessary. The process isn’t easy. Some men simply don’t want to have surgery to remove/transform the penis. These are complicated issues and are even more reason to take your time with every decision necessary.

    What is the timeframe for the entire MTF transition process?

    Surgery is delayed until at least one year after the start of hormone therapy and at least two years after the first mental health evaluation. Once the surgical procedures begin, the timeframe varies widely based on the procedures chosen, the individual’s recovery times, and numerous other variables. We will discuss your individual timeframe during your consultation process.

    What are the risks of undergoing MTF confirming surgery?

    These are major surgeries and they carry the same risks as with any surgery: excessive bleeding, poor wound healing, infection, reaction to anesthesia, and others.

    Does insurance cover gender confirmation surgery?

    Cost has been an obstacle for patients seeking gender confirmation surgery, as insurance has historically not covered these procedures. That is changing. A number of public and private insurance companies cover some, or all, of gender confirmation surgeries, but these vary wildly. The team at Avalon will work with your insurer to seek the highest level of coverage possible.

    The Avalon Gender Affirmation Program proudly provides patients from Los Angeles and Glendale, CA and surrounding areas with gender confirmation surgery.
    Contact us at (818) 643-2333 or fill out our online Contact Form here.


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Avalon Gender Affirmation Program

716 West Broadway
Glendale, CA 91204

Tel: 818-643-2333


Office Hours

Monday-Friday 8am-5pm