Surgery: An intro – TransActual

There are several things to consider when you’re deciding whether or not to have transition related surgery. On this page, we’ll give you some more information to help you decide.

Some of the things you should think about are:

What you want your body to look like.
What you want your body to be able to do (for example, do you want to stand to wee? Do you want to have penetrative vaginal sex? Do you want your body to still produce oestrogen or testosterone?).
Whether it is available on the NHS (and if not, how you would fund private care).
Potential complications of different surgery types.
What recovery is like and how it relates to your circumstances, your mental health, your body and any disabilities or medical conditions that you have.

If you’re over 18 and have a formal gender diagnosis, the NHS will fund:

Mastectomy and chest reconstruction

Double incision technique
Peri-areolar technique
Liposuction as part of chest masculinising surgery
Nipple re-positioning, grafting or modification
Dermal implants and nipple tattooing

The options available to you will depend on your chest size and your nipple size. The peri-areolar technique is typically only offered for people with smaller chests.

Read the GDNRSS leaflet about top surgery

Surgeries to create a penis

Phalloplasty. This can include hysterectomy, bilateral Salpingo-oophorectomy, vaginectomy, placement of penile prosthesis, scrotoplasty with placement of testicular prosthesis, and glans sculpting. Read the GDNRSS booklet about phalloplasty and about hair removal in preparation to phalloplasty.
Metoidioplasty. This can include hysterectomy, bilateral Salpingo-oophorectomy, vaginectomy, and scrotoplasty with placement of testicular prosthesis. Read the GDNRSS booklet about metoidioplasty.

For an update on ongoing issues with access to NHS phalloplasty and metoidioplasty, visit our What’s Happening with NHS Phallo and Meta? page.

Hysterectomy

If you are having phalloplasty or metoidioplasty, you’ll be offered either a stand-alone hysterectomy or a hysterectomy as part of one of your genital surgeries.

If you’d like a hysterectomy without genital surgery, you can ask your gender clinic to write to your GP. The doctor at the gender clinic will ask your GP to refer you for a hysterectomy. Your hysterectomy will be funded by your local Integrated Care Board (in England and Northern Ireland) or Health Board (in Scotland and Wales). Remember that if they initially refuse, you have the right to appeal their decision.

Surgeries to create a vulva and vagina

Penectomy – typically in conjunction with vaginoplasty
Bilateral Orchidectomy – often in conjunction with vaginoplasty
Vaginoplasty – read more about vaginoplasty in the GDNRSS booklet. There’s also a GDNRSS leaflet about hair removal prior to vaginoplasty. Note that the NHS only funds intestinal vaginoplasty if other vaginoplasty techniques are not possible.
Clitoroplasty – typically in conjunction with vaginoplasty
Vulvoplasty – typically in conjunction with vaginoplasty, but can be a stand-alone procedure. Read more about vulvoplasty in the GDNRSS booklet.

Orchidectomy

If you are having vaginoplasty or vulvoplasty, orchidectomy will form part of that.

If you want an orchidectomy but not a vaginoplasty or vulvoplasty, tell your clinician at the gender clinic. They will either make the referral for you, or write to your GP asking them to do it.

Remember that if they initially refuse, you have the right to appeal their decision.

There is a considerable wait to access medical support from the NHS. If you have a formal diagnosis, you can pay for these surgeries yourself, which can mean a shorter wait.

In addition to accessing the surgeries available via the NHS, a number of transition related procedures are available via private providers:

Phonosurgery (voice feminisation surgery)
Augmentation Mammoplasty (breast enlargement)
Breast reduction (including non-flat top surgery)
Facial Feminisation Surgery
Facial Masculinisation Surgery
Lipoplasty or body contouring (“feminising”, “masculinising” or “affirming”)
Hair transplant
Tracheal shave

Approval for funding for these surgeries is very occasionally given on an individual basis. Please note that these requests are rarely granted.

The application for this funding has different names in different places. Follow the link most relevant to you if you’re interested.

England – Individual Funding Request.
Northern Ireland – Individual Funding Request
Scotland – Peer Approved Clinical System (PACS) Tier Two process.
Wales – Individual Patient Funding Request (IPFR)

GDNRSS have produced detailed guides about gender surgeries, which you’ll find in the relevant sections of this page.

Other sources of information include:

Next: Choosing a surgeon

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Errors or omissions

Is there something missing from this page? Have you spotted something that isn’t correct? E-mail info@transactual.org.uk to let us know.

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This page is based on information originally posted on genderkit.org.uk with permission.

Visit genderkit.org.uk

A disclaimer: TransActual do not provide medical, health, or legal advice. The content of this page is intended for information purposes only. It is not a substitute for medical advice, diagnosis or treatment from a medical professional. It is not a substitute for advice from a legal professional. We strongly suggest you consult a healthcare professional or legal professional for specific advice about your situation. TransActual do not advocate or recommend the purchase of any specific product and we do not endorse or guarantee the credentials or appropriateness of any health care provider, any product or any provider of insurance and legal services.

Page last updated:

5 April 2024