Gender-diverse patients face many challenges – within themselves, their families, romantic relationships, at work, and in communities around the world. However, society is becoming more accepting of diverse gender identities and expressions.
The decision to undergo gender affirmation surgery (formerly called sex change or gender reassignment surgery) is a complex emotional and physical journey. The series of treatments and procedures aligns the patient’s physical characteristics with their gender identity.
If you or a loved one are considering gender transitioning with medical and surgical intervention, you are likely to have many questions. You need a team of doctors to address your concerns and walk you through every step of the process with experience and sensitivity.
The University of Miami Health System’s Gender Affirmation Program unites numerous patient-care specialties: plastic surgeons, urologists, OB/GYNs, endocrinologists, voice therapists, social workers, and psychologists. Sara Danker, M.D. is an expert in microvascular and complex reconstructive surgery. Her microsurgical skills make her one of the few surgeons in Florida qualified to perform phalloplasties and other rigorous gender-affirming procedures.
Dr. Danker’s patients recognize the long road they have to travel to achieve full gender affirmation. But they are also living in bodies that feel completely alien to them. “These are the most grateful patients I have ever encountered,” she says. “I can see how happy they are, their sense of relief and self-actualization. It’s just the most rewarding thing I do as a surgeon.”
What should I expect during my first doctor visit?
You will undergo a basic medical checkup with a nurse or medical assistant, which will include taking your weight, blood pressure, pulse, and temperature. You will then meet with a physician to review your health history; address any specific concerns that you have; perform a physical exam, if appropriate; and discuss the options.
Which treatments or surgeries should I get?
Choosing which gender-affirming services or surgeries are right for you is ultimately a personal choice. However, working closely with a health care team that is experienced in gender-affirming services can help you make decisions based on your situation, health history, preferences, and goals.
At UHealth, we offer the following gender-affirming services and cosmetic procedures:
- counseling for those considering or undergoing gender-affirming services
- facial feminization including brow reduction
- brow lift
- forehead reduction/contouring
- hairline advancement
- rhinoplasty, jaw and chin contouring, lip lift
- phalloplasty (creation of a penis with tissue from the patient’s forearm or thigh)
- tracheal shave (Adam’s apple reduction)
- urethral lengthening (connects the urethra, making the new penis as functional as possible)
- voice surgery
Your care plan will be individualized to your needs. Every patient is different, and we will help you decide which procedures are appropriate for you. There is no prescribed order for surgeries, but oftentimes, patients will start their surgical journey with chest surgery and complete it with genital surgery. Some surgeries can be combined, for example, top surgery (mastectomy) and hysterectomy/oophorectomy.
Patients must often return for several surgeries, over a year or longer, before the journey is complete.
What will hormone therapy do?
The overall goal of hormone therapy is to help align your identified gender with your expressed or physical gender. Most types of hormone therapy involve taking an oral (by mouth) medication each day at home.
Transgender men may take testosterone to induce virilization (which can lead to the growth of facial hair and other male characteristics) and suppress feminizing characteristics.
Transgender women may take estrogen to help promote the development of more feminine characteristics. They can also take anti-androgens to help suppress masculine characteristics.
Changes caused by these hormones may be temporary or permanent. After undergoing gender-affirming surgery, your hormone doses may change. For example, if you underwent an orchiectomy (removal of testicles) as part of a male-to-female sex reassignment surgery, you will likely need a lower dose of estrogen post-surgery, since the testicles are no longer in place to produce testosterone. Your physician will create a customized post-surgical care plan for you, including current medication and hormone therapy instructions.
Will my treatment/surgery affect my fertility?
Taking hormones can interfere with your fertility and sexual function, so you should make sure to discuss all benefits and risks with your healthcare provider prior to starting hormone therapy.
If you decide to undergo hormone therapy or gender-affirming procedures, there are options to preserve your future fertility. The most common form of fertility preservation is having your eggs or sperm preserved prior to beginning these procedures. Speak with your physician about the options available to you.
What is the recovery like?
On average, you can expect to be fully recovered six to eight weeks after surgery. During the recovery period, you should rest and practice good hygiene to keep the surgical area clean and dry. Make sure you set and keep any follow-up appointments with your physician. Your care team will provide you with detailed recovery information specific to you and your procedure(s).
Why do you specialize in gender-affirmation plastic surgery?
This is an incredible way to help people realize their potential and feel whole. I am awed by the lengths that patients go to and the risks they are willing to face for some of these procedures. It is the most fulfilling and impactful work that exists in my field.
Dana Kantrowitz is a contributing writer for UMiami Health News. She compiled these answers, generously given and reviewed by Dr. Danker.
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