A person holds up a piece of paper with combined gender symbols.
A person holds up a piece of paper with combined gender symbols.
A person holds up a piece of paper with combined gender symbols.

Preparing for Gender Affirmation Surgery: Ask the Experts

Featured Experts:

Preparing for your gender affirmation surgery can be daunting. To help provide some guidance for those considering gender affirmation procedures, two of our experts from the Johns Hopkins Center for Transgender Health answered some questions about what to expect before and after your surgery. Paula Neira, M.S.N., J.D., R.N., C.E.N., is the Program Director of LGBTQ+ Equity and Education, Johns Hopkins Medicine Office of Diversity, Inclusion and Health Equity and Devin O’Brien-Coon, M.D., M.S.E., is the former medical director.

What kind of care should I expect as a transgender individual?

Before beginning the process, we recommend reading the World Professional Association for Transgender Health standards of care. The standards were created by international agreement using the latest scientific research on transgender health so that doctors can best meet the unique health care needs of transgender and gender-nonconforming people. It is usually a favorable sign if the hospital you choose for your gender affirmation surgery follows or references these standards in their transgender care practices.

Can I still have children after gender affirmation surgery?

Many transgender individuals choose to undergo fertility preservation before their gender affirmation surgery if having biological children is part of their long-term goals. Discuss all your options, such as sperm banking and egg freezing, with your doctor so that you can create the best plan for future family building.

Are there other ways I need to prepare?

It is very important to prepare mentally for your surgery. If you haven’t already done so, talk to people who have undergone gender affirmation surgeries or read first-hand accounts. These conversations and articles may be helpful; however, keep in mind that not everything you read will apply to your situation.

If you have questions about whether something applies to your individual care, it is always best to talk to your doctor.

You will also want to think about your recovery plan postsurgery. Do you have friends or family who can help care for you in the days after your surgery? Having a support system is vital to your continued health both right after surgery and long term. Most centers have specific discharge instructions that you will receive after surgery. Ask if you can receive a copy of these instructions in advance so you can familiarize yourself with the information.

What happens during my appointments?

The appointment process for your surgical procedure will likely include:

An initial intake interview via phone with a clinical specialist. This is your first point of contact with the clinical team, where you will review your medical history, discuss which procedures you’d like to learn more about and what is required, and develop a plan for next steps. Paula Neira lists the documentation below as potentially necessary depending on your specific surgery:

  • Pharmacy records and medical records documenting your hormone therapy.
  • Medical records from your primary physician (these will be requested by the clinical team).
  • Surgical readiness referral letters from mental health providers documenting their assessment and evaluation.
  • Information about which prescription and over-the-counter medications you are currently taking.
  • Insurance information.

An appointment with your surgeon. You will meet to discuss the specifics of your gender affirming surgery. Dr. O’Brien-Coon says these appointments typically include:

  • Assessment of your medical health status and readiness for major surgical procedures.
  • Discussion of your long-term gender affirmation goals and assessment of which procedures may be most appropriate to help you in your journey.
  • Specific details about the procedures you and your surgeon identify, including the risks, benefits and what to expect after surgery.

A preoperative anesthesia and medical evaluation. Two to four weeks before your surgery, you may be asked to complete these evaluations at the hospital, which ensure that you are healthy enough for surgery.

What can I expect after gender affirming surgery?

When you’ve finished the surgical aspects of your gender affirmation, we encourage you to follow up with your primary care physician to make sure that they have the latest information about your health. Your doctor can create a custom plan for long-term care that best fits your needs. Depending on your specific surgery and which organs you continue to have, you may need to follow up with a urologist or gynecologist for routine cancer screening.

Among other changes, you may consider updating your name and identification. This list of resources for transgender and gender-nonconforming individuals can help you in this process.

Paula Neira shared a final thought, “The gender affirming surgery part of your transition plan is a process in itself, and made successful by taking the time to research, plan ahead and find support. The health care team you choose should provide you with their best clinical judgment, skills and knowledge to help you achieve your health care goals — to be the best you, you can be.”

Johns Hopkins Building

The Center for Transgender Health Team at Johns Hopkins

Embracing diversity and inclusion, the Center for Transgender 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.

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