Trans woman contemplates.
Trans woman contemplates.
Trans woman contemplates.

Gender Affirmation: Do I Need Surgery?

Featured Expert:

There is no one-size-fits-all approach for the gender affirmation process. Perhaps you don’t want to undergo surgery right now because it’s too expensive or your family is not on board. Maybe you don’t see surgery as being a part of your transition process at all.

Gender affirmation is an individualized journey. Doing your own research and talking to experts will help you decide which options are best for you.

Dr. Fan Liang, the current medical director of Johns Hopkins Center for Transgender and Gender Expansive Health, stresses that while surgery can be a part of the transition process for many, it’s not for everyone. "Each patient needs to consider their personal goals and decide whether surgical options will improve their quality of life and lessen their gender dysphoria," she adds.

Dr. Liang shares insights into the many choices available to patients who wish to use nonsurgical options to express their gender identity. “It’s very possible that surgery is not in the transition plan for someone in the gender affirmation process. There are several nonsurgical services that may help transgender patients achieve their transition goals.

Hormone Treatment

Hormone therapy can help you achieve more masculine or feminine characteristics. Commonly prescribed by a primary care provider or endocrinologist, hormone treatments can be part of a presurgical plan or a stand-alone service.

These medications work to more closely align outward secondary sexual characteristics, such as enlarged breasts, body fat distribution or facial hair, with someone’s gender identity.

For transgender women or transfeminine nonbinary individuals, the hormones administered include estrogens and antiandrogens. For transgender men or transmasculine nonbinary individuals, hormones administered include androgens such as testosterone. Always talk to your doctor about your options and any possible side effects before beginning hormone treatment.


As part of the gender affirmation process, you can choose to undergo permanent hair removal for both aesthetic reasons and as preparation for some surgeries. Laser and electrolysis are the recommended methods.

  • During electrolysis, your dermatologist may use chemical or heat energy to destroy hair follicles and tweezers to remove the hair. Possible side effects of the treatment are pain, swelling or redness.
  • Laser hair removal uses infrared light to destroy hair follicles. Laser hair removal can cover a larger area more quickly than electrolysis. Possible side effects include skin irritation and redness. Some hair could be resistant to the laser treatment or grow back, although it is usually finer and lighter. Laser is not an option for every skin and hair type (for example, gray hair and/or fair hair).

Voice Therapy

Voice therapy with a laryngologist may help you achieve a way of speaking that more closely matches your gender identity. During an initial consultation, you will be comprehensively evaluated, including screening for the presence of any physical problems with your voice, such as vocal cord nodules. Depending on your desired outcome, a voice therapist who specializes in gender affirmation can help you with the following:

  • Habitual speaking pitch
  • Resonance (the way sound is shaped to produce a vocal quality)
  • Inflection/prosody (the melodic ups and downs of the voice)
  • Rate of speech
  • Volume/intensity
  • Articulation (how speech sounds are produced)
  • Pragmatics (social rules of communication)
  • Nonverbal communication

“As you consider your options, remember that the journey is your own,” says Liang. Knowing what is available, talking to other people who have transitioned and meeting with transgender health care experts can help you make an informed decision on which procedures, if any, are right for you.

The Center for Transgender and Gender Expansive Health Team at Johns Hopkins

Embracing diversity and inclusion, the Center for Transgender and Gender Expansive Health provides affirming, objective, person-centered care to improve health and enhance wellness; educates interdisciplinary health care professionals to provide culturally competent, evidence-based care; informs the public on transgender health issues; and advances medical knowledge by conducting biomedical research.

Request an Appointment

Find a Doctor
Find a Doctor