Gender Identity
Research and
Education Society

Medical treatment options for gender variant adults

Surgeries for Trans Women

Lower Surgery – Trans women

Genital surgery is frequently regarded as a necessary step and an end-point to the journey from living as a man to living as a woman.

However, this surgery is irreversible and you should give yourself enough time to be sure that this is what you want. Although some level of reversal surgery is possible, you can never have your functioning male genital anatomy fully restored once it has been removed. Bear in mind that this surgery will not make a change to your everyday dressed appearance. In your public life, people will not behave differently towards you because you have undertaken this step. Successful social transition can be made without recourse to genital surgery, and there is no requirement to have any of the available surgical options in order to obtain full legal recognition by way of a Gender Recognition Certificate. So, genital surgery should not be regarded as inevitable.

Although living one's life as a woman with a penis is certainly possible, it does raise issues such as use of changing facilities, toilets and taking the kids swimming. These are all potentially public matters which can make for difficulties for those who have not had surgery to refashion the external genitalia. Clearly, and for some, more importantly, there is also an impact on intimate sexual relationships: what effect will surgery have on erotic possibilities; does this mark the end of your present relationship; will you be seeking new relationships; should you reveal your trans history to a new partner, if so, how and when? This booklet is available here.

Surgeries for Trans Men

Lower Surgery – Trans men

Although chest reconstruction surgery is almost always undertaken by trans men, many do not undergo any ‘lower’ surgery at all. There is no requirement to have any of the available surgical options; full legal recognition by way of a Gender Recognition Certificate can be obtained without it. The desire to have a penis, and the decision to undergo complicated surgeries, are factors that are distinctly personal. Many trans men feel psychologically, as well as physically, incomplete without a phallus of masculine proportions. However, you are no less of a man if you decide against having this surgery, or are unable to for health reasons. Some may feel unable to undertake such major surgery, or may feel it is unnecessary to do so.

The context in which such decisions must be made, are not only personal but complex and social. In broad terms it is perfectly possible to live one's life as a man without a penis and to be recognised as a man, but issues such as use of men's locker rooms, use of urinals, and taking the kids swimming are all potentially public matters that make for difficulties for those who have not had phalloplasty. Clearly, and for some, more importantly, there is also an impact on intimate sexual relationships: what effect will surgery have on erotic possibilities; starting new relationships – how and when to you explain that you're not the same ‘down there’; adapting existing relationships – are you sexually attracted to men, or to women? All these considerations may impact on your decision about whether or not to have surgery at all, and if so, what outcome you will be hoping for. GIRES has prepared a booklet which advises on the different options and the issues connected with them. This booklet is available here.

Hysterectomy?

There is little written advice available for trans men considering having hysterectomy and limited objective research.

Having a hysterectomy/oöphorectomy involves an operation with attendant risks. Although it is a frequently performed procedure, it should not be underestimated in terms of the potential adverse consequences, and it has a significant effect on the workings of the body. Dr Richard Curtis considers the implication for trans men here.