Surgical consultations

This page includes info on what to expect from a surgical consultation appointment, as well as top tips from trans people who have already accessed transition related surgery.

This is a first appointment with a surgeon to give you an opportunity to:

  • Explain your situation. Such as your medical conditions and medications
  • Explain what you want from your surgery.
  • Ask the surgeon questions. There are suggested questions further down this page.
  • Learn more about the surgery. This includes what options are available to you, recovery times, and any potential risks
  • Receive paperwork. This is likely to include documents to read over before your surgery
  • Agree to the surgery. This is called giving your consent, but you can still change your mind later

The surgeon will be assessing your physical and psychological readiness for surgery.

You should always have a surgical consultation before any gender surgery to make sure you are fully prepared for the surgery and that surgeon agrees you are ready to proceed.

Think about what you’ll say

It can be useful to prepare a list of questions before your surgical consultation. You might want to write them down. This is particularly useful if you have difficulties with communication.

You might want to also prepare a list of things you want the surgeon to know about you. This is particularly important if you have specific needs related to a disability, medical condition or because you’re neurodiverse.

You can find out more about communication with medical professionals on the Communicating about my needs page.

Some people find it useful to take a friend or family member to their consultation with them for support. They don’t have to come into the consultation room with you, but they can if you want.

Plan for self care

A surgical consultation might trigger dysphoria for some people and/or be emotionally tiring. Plan a nice activity for after your appointment.

Dress for the occasion

Think about your clothing choices – if your chest might be examined, it’s probably a bad idea to wear a dress or a jumpsuit.

Think about what you want

It’s useful to have researched different surgical techniques and identified what is important to you in relation to surgical outcomes.

It is useful to ask yourself the following questions:

  • What do I want to achieve by having surgery?
  • What do I want that area of my body to look like?
  • Am I worried about visible scarring and/or loss of physical sensation on that part of my body?
  • For lower surgery, what aspects of sexual function (if any) are important to me?
  • For phalloplasty and metoidioplasty, do I want to be able to wee standing up?
  • Does my disability or health condition mean that recovery will be more difficult or that surgery is riskier for me?

However, it’s ok if you don’t have an answer to all of these questions before your consultation. The surgeon will be able to give you the information you need to help you to decide.

There are a few things that it might be useful to take to a surgical consultation:

  • Dates of previous surgeries (if you’ve had any).
  • Details of any medical conditions.
  • Your GP’s name and address.
  • A list of questions you want to ask the surgeon and/or nurse.
  • A list of things you want the surgical team to know about you – this could relate to a disability or medical condition, to your access or communication needs, or to any relevant phobias (for example fear of needles).
  • Your communication passport if you would find it useful.

You will meet with a surgeon from the team. You might also meet nurse from the surgical team. Consultation appointments normally take place at the hospital or clinic where you’ll be having surgery, or at their office if they’re a private surgeon.

Sometimes it’s possible to have your consultation online if you would have a long way to travel.

You will have a conversation about the surgery with the surgeon where you can ask each other questions.

The surgeon and/or nurse are likely to ask you:

  • Why you want surgery and what you want it to achieve for you.
  • If you have a preference around techniques or scar placement. It’s ok not to know and to ask your surgeon for more information.
  • Your medical history and medical history of close family members – this is to identify any potential risks associated with the surgery for you. It’s ok to tell the surgeon if you don’t know about your family medical history.
  • About your mental health.
  • Your height and weight – they might weigh and measure you.
  • If you currently smoke, vape or use nicotine products. They ask it because it may affect your recovery.

Sometimes there may be students or trainees present in your appointments. If you’d prefer them not to be there, you are entitled to ask to have the appointment without them.

In this consultation, the surgeon may physically examine you and the team may take some tests. You’ll find more information on that further down this page.

Remember that if you would feel more comfortable with a friend, family member, or another person present, you are allowed to ask for this.

There are lots of things you might to ask a surgeon during a consultation. If you have any any other worries or concerns, this is the time to ask about them. It’s ok to ask questions and most surgeons welcome it.

In this section we’ve given some suggestions about the things you could ask.

Questions about the surgeon and surgery

  • What is your level of experience?
  • What experience have you got operating people with a similar skin colour and body type to me?
  • What experience have you got operating on people with a similar disability or chronic illness to mine?
  • Is your hospital able to meet my access needs?
  • Can I see examples of your results for people who look like me?
  • What different techniques do you offer?
  • What options are available to me? What options aren’t? These options could be around surgical technique, scar placement and aspects relating to size, appearance and function.
  • What will my sexual function be? How long will I need to wait before having sex?
  • What complications (problems after the surgery) may happen?
  • What are the risks of complications happening? What can be done if they happen?
  • How likely am I to lose sensation in the area you’re operating on? Is it likely to come back?
  • How long does the operation normally take?
  • How long is your waiting list?
  • For people having phalloplasty or metoidioplasty: how many stages do you do the procedures in? What is included in each stage? Is hysterectomy included or should I seek it separately?

Questions about your eligibility for surgery

  • What are your upper and lower limits for BMI?
  • Will I be required to quit smoking? How long for?
  • Would my medical conditions or medications affect my surgery or recovery?

Questions about preparation and recovery

  • What do I need to do before the day of surgery?
  • Will I need hair removal before surgery? If so, how long do I need to leave between the last session and my surgical date? What area needs hair removal and can you give me a guide to show the hair removal specialist?
  • Will I need to stop taking my hormones or any other medication in the lead up to surgery. How far in advance?
  • Will I need to remove my piercing(s) before surgery? If so, how long for?
  • What should I expect when I wake up from surgery? Will there be drains? Will there be a catheter? If so, will I go home with the drains and catheter or will they removed before discharge?
  • How long will I be in the hospital?
  • What will my pain management options be?
  • How does discharge (leaving hospital) work?
  • How long do I need to stay locally after surgery?
  • What do I need to do when I get back home?
  • What support might I need from friends and family when I’m recovering at home?
  • What support might I need from my GP practice when I’m recovering at home?
  • How will I be supported by the surgical team after discharge from hospital?
  • Will I need to come back to see the sugical team again? When?
  • What should I expect during my recovery?
  • How long will I need to take off work?
  • Are you able to provide a sick note?
  • What should I look out for after the surgery?
  • What do I do if an emergency happens at home?
  • How soon can I go back to work, exercising, having sex or playing sports?
  • What happens if I need surgical revisions? Will they be included in my care?

Extra questions to ask a private surgeon

  • Can payments be made in instalments or on a payment plan?
  • What additional costs might I need to pay in addition to the surgery fee?
  • If I need revision surgery, would this be at extra cost?

If you’re having surgery abroad, there are other questions that it will be useful to ask. You’ll find those on the Travelling Abroad for Surgery page.

Your surgical consultation gives you an opportunity to explain to your surgeon what you would like your results to be like. This is very important.

This page has things you can consider asking about, but if something in particular is important to you, ask the surgeon.

Surgeons may be open to unexpected requests, and it may be helpful to have at least explored ideas with the surgeon, so that you do not regret not asking later.

If you have seen pictures of surgical results or can provide a picture to your surgeon showing what you’d like your result to be, it may help you to communicate your preferences.

Chest surgery

If you are having a chest surgery, you might want to indicate if you have preferences whether:

  • nipple size is large or small
  • nipples are retained or not
  • to prioritise hiding scars, or instead to make as flat as possible
  • to prioritise nipple sensation, appearance, or reducing risks

Feminising genital surgery

If you are having a feminising genital surgery, you might want to indicate if you have preferences around:

  • whether to prioritise appearance, reducing risks, or maintaining sexual function
  • the depth of your vaginal canal
  • a more ‘natural’ looking appearance or something smooth is what you want

Masculinising genital surgery

If you are having a masculinising genital surgery, you might want to indicate if you have preferences around:

  • whether to prioritise appearance (of your penis and/or your scrotum), reducing risks, or maintaining sexual function
  • ability to have vaginal sex
  • ability to penetrate your partner with your genitalia
  • standing to wee
  • whether or not you want a scrotum and prosthetic testicles
  • whether you want to be able to have an erection.

Remember: it’s your body and you should not feel pressured into having a combination of surgeries that doesn’t feel right for you.

Procedures will be different from surgical team to surgical team and will also depend on your medical history and the procedure you’ll be having.

You might be asked to:

  • Provide a urine sample. This can be used to test you for particular medical conditions.
  • Use a test swab. This is a small stick covered in fabric which you may be asked to rub on a part of your body, which may be your genitalia or anus, and can also be used to test you for particular medical conditions.
  • Have a blood test. This is less common, as blood tests are typically taken at the pre-op appointment.

The surgeon is likely to need to examine the relevant parts of your body as part of the consultation. This examination is typically used to help them plan your operation, to identify which options will be available to you and what outcomes you might be able to expect.

The physical examination might involve:

  • Taking measurements with a ruler or measuring tape.
  • Touching the part of your body or by moving it so they can examine your body. They might ask you to move the part of the body for them instead.
  • Taking photos of the relevant part(s) of your body. This is for your medical records and may be used for surgical planning. You may be asked for your consent for the anonymised photos to be used for patient education, staff education, and potentially for publication. It is your choice whether to give this consent or not.
  • For radial forearm phalloplasty, the surgeon will check the blood flow in your non-dominant arm.
  • For some types of surgery, the surgeon may check your skin elasticity.

Things to remember:

  • For any physical examination, you are entitled to ask for a chaperone.
  • If something doesn’t feel right, it’s ok to ask the surgeon to stop and to ask them to explain what the purpose of the examination is.
  • The surgeon will have seen bodies of many shapes and sizes before.
  • If your surgeon specialises in transition related surgery, then you can expect them to treat you sensitively in relation to dysphoria.
  • If you’re struggling with dysphoria during the examination or finding it overwhelming, it’s ok to tell the surgeon that you need to take a break.
  • You’re unlikely to be asked to undress fully, normally you’ll only have to remove the clothing covering the relevant part of the body and you’ll be allowed to put it straight back on after the examination.
  • Your privacy will be respected and the surgeon will be as quick as possible.
  • Whilst physical examinations can induce dysphoria or feel embarrassing, it’s better to have had a thorough consultation than.

If you’re planning to have surgery overseas, the surgeon may ask you to send photos of the relevant parts of your body before you have a consultation via video call. In these circumstances, you can expect them to physically examine you before surgery.

Some people kindly share photos of their surgical results. Helpful starting points may be:

Your surgeon will tell you whether or not you need hair removal (also known as epilation) before surgery.

You can expect your surgical team to:

  • Tell you whether they think electrolysis or laser hair removal will be most effective for your skin and hair colour.
  • Provide guidance with your hair removal provider on what area hair needs to be removed from – they often provide a template that you can take with you.
  • Work with your hair removal provider to identify when you’re ready for surgery.

Hair removal on the NHS

The NHS will fund clinically necessary hair removal for NHS patients. This means that if your surgeon says there isn’t a medical reason for you to have hair removal, the NHS won’t pay for it. In this case, you do have the option of private hair removal if it is important to you.

If your surgeon recommends hair removal, the relevant funding papers will be sent to your local Integrated Care Board (England and Northern Ireland) or Health Board (Scotland and Wales). This will be overseen by GDNRSS.

You’ll find more information about pre-vaginoplasty hair removal in the GDNRSS booklet. GDNRSS will be able to tell you which hair removal providers are closest to you.

Private hair removal

If you choose to access hair removal privately or need to access private hair removal because you’re going private for surgery, it’s important to choose your hair removal provider carefully.

It’s important to check:

  • That the provider offers medical hair removal.
  • That the hair removal practitioner is qualified to offer the type of hair removal you need.
  • That any laser practitioners are registered with the Care Quality Commission or British Medical Laser Association.
  • That any electrolysis practitioners are registered with the British Institute and Association of Electrolysis (BIAE). They have a search tool which will help you find a local provider.
  • What the provider’s policies are around trans inclusion and whether they’ve provided hair removal for trans people before.

BIAE have a search tool which allows you to filter that lets people look specifically for electro techs that do gender work

You’re unlikely to be rejected completely at this stage – the surgeon had already accepted your referral.

For things that can be addressed, the surgeon might not reject you entirely but instead ask you to update them with your progress. Some teams may even hold your place on their waiting list. Ask the surgeon if there are any time limits attached to these types of arrangement.

Either way, you can expect to be given a reason for your surgeon’s decision. If they don’t tell you, make sure you ask. If it is something that can be addressed – for example, quitting smoking – then ask the surgeon if they can signpost you to any support or offer any guidance.

It is important to know that even if the referral is rejected, you can seek re-referral at a later date.

If you aren’t happy with the refusal, you can seek a second opinion or ask your gender clinic to refer you to a different surgical team.

It’s ok if you’re not sure what you want or if you change your mind. You can ask for a second consultation and this can take place at your own pace.

After your consultation you are still free to change your mind and decide not to have surgery, or to switch to a different surgeon or surgery team.

You might think of more things you want to know after your surgical consultation has finished. You can email your surgery team to ask these questions, or if you would like, you can ask for another surgical consultation to ask further questions so that you are sure before you make the final decision.

If there are specific things relating to your communication or access needs, you can send an email to the surgeon or specialist nurse and ask them to communicate your needs to the wider team.

You might also want to start preparing for your surgery. Take a look at the Preparing for surgery page.

If you decide that you would prefer to use a different surgeon, you can contact NHS Gender Dysphoria National Referral Support Services (GDNRSS) to arrange this (call 01522 85 77 99 or email, though you may find that you have to spend additional time waiting to access the new surgeon.

There are more ideas for questions you might ask in your consultation on this article on the Dillon Marshall Cowell website.

You can also speak to NHS Gender Dysphoria National Referral Support Services (GDNRSS) to discuss how to make best use of an NHS surgical consultation. You can contact the service by calling 01522 85 77 99 or by email. The service is open Monday to Friday from 9am until 5pm. Find out more about the service.

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