Healthdirect Free Australian health advice you can count on.

Medical problem? Call 1800 022 222. If you need urgent medical help, call triple zero immediately

healthdirect Australia is a free service where you can talk to a nurse or doctor who can help you know what to do.

beginning of content

Gender affirming surgery

7-minute read

What is gender affirming surgery?

Gender affirming surgery refers to a variety of procedures that some trans or gender diverse people may use to affirm their gender.

Surgery is just one option for gender affirming care. All trans and gender diverse people are unique and will choose to affirm their gender in a way that feels right for them.

Gender affirming care might include:

  • Social affirmation, such as changing names, pronouns, hair or clothing.
  • Legal affirmation, such as changing legal name or gender.
  • Medical affirmation, with hormones or surgery.

Read more about gender incongruence, gender dysphoria, and gender affirming care here.

This article talks more about gender affirming surgery.

What happens during gender affirming surgery?

There are many different gender affirming surgeries and procedures. They may include making changes to your face, chest, genitals, or other body parts.

For people assumed male at birth, feminising surgeries may include:

  • Breast augmentation with insertion of breast implants.
  • Facial feminisation — changing the shape of any or all facial features.
  • Vocal surgery — shortening the vocal cords for a higher, more feminine voice.
  • Tracheal shave — reducing the size of the ‘Adam’s apple’.
  • Fillers or liposuction, to achieve a more typically feminine shape.
  • Orchiectomy, or removal of testicles.
  • Bottom surgery or ‘genital reconfiguration surgery’, involving changes to the genitals.

Bottom surgery is called ‘genital reconfiguration surgery’. This was previously known as ‘sex reassignment surgery’ or ‘gender confirmation surgery’. The name change shows that your genitals don’t define your sex or gender.

Feminising bottom surgery may involve a combination of the following procedures:

  • Removing the testicles (orchiectomy).
  • Removing and reshaping tissue from the penis to make a vulva. This includes external labia or lips, and a clitoris. This is known as vulvoplasty.
  • Shortening the urethra (tube that you urinate — wee — from).
  • Creation of a vaginal canal (vaginoplasty). This is a complicated step which some people choose to skip. After surgery, vaginal dilators will need to be used to maintain the shape of the vaginal canal.

For people assumed female at birth, masculinising surgeries may include:

  • Top surgery, with reduction or removal of breast tissue (mastectomy). This creates a flatter or more neutral chest. There are many different techniques used to achieve this.
  • Liposuction to achieve a more typically masculine shape.
  • Hysterectomy, or removal of the uterus (womb) and ovaries.
  • Bottom surgery or genital reconfiguration surgery. This involves changes to the genitals.

Masculinising bottom surgery may involve a combination of the following procedures:

  • Hysterectomy, if not already performed.
  • Vaginectomy, or removal of the vagina.
  • Creation of a penis, which may include metoidioplasty or phalloplasty.
  • Metoidioplasty involves making a penis shape wrapping tissue around the clitoris after it is enlarged by testosterone hormone therapy.
  • Phalloplasty involves making a larger penis with tissue from the arm, thigh, back, or abdomen. This involves lengthening the urethra to be able to urinate from the tip of the new penis. An inflatable penile implant may be inserted inside the penis to allow an erection.

Is gender affirming surgery right for me?

Choosing to undergo any surgery is a big decision. Everyone affirms their gender in different ways, and that may or may not include surgery.

Surgery is permanent so you need to make sure it’s the right choice for you. Surgery doesn’t make you more or less trans.

Before being able to access gender affirming surgery, you need to meet the criteria below:

  • A history of gender incongruence (for 6 months or more).
  • The ability to make a fully informed decision.
  • Be over the age of 16 for top surgery, or 18 for bottom surgery. Some surgeons will provide surgery to younger people in very specific situations.
  • Ensure that any physical or mental health conditions are well managed.

You will need letters of support from a mental health professional before having gender affirming surgery.

For top surgery, one letter is required. For bottom surgery two letters are required. For bottom surgery, you are also required to have ‘lived as your current gender’ for 12 months, meaning you have socially transitioned. The letter needs to state that surgery is appropriate for you and is likely to help affirm your gender and reduce any gender dysphoria that may be present.

If you are taking gender affirming hormones, or want to take hormones in the future, you should do this for 12 months before having surgery. This is to allow any significant body changes to occur before surgery.

Most people who have surgery are happy with their results and feel more comfortable in their bodies. But some people are disappointed with the results, or find that any gender dysphoria that was present is not fully resolved. Make sure you discuss any difficult feelings with your doctor or psychologist.

What questions should I ask before surgery?

It’s important to talk about the pros and cons of surgery in detail with your doctor. It’s a good idea to ask to see pictures of how other people look after surgery.

Questions to ask your surgeon include:

  • What different surgical techniques are there?
  • What are the pros and cons of each technique for me?
  • What results can I expect?
  • What are the possible risks and complications?

For help in having the discussion, visit healthdirect’s Question Builder.

What should I expect after surgery?

Surgical recovery can be long and uncomfortable. Your surgeon will be able to give you more information on what can be expected before, during, and after surgery. This might include spending time in hospital afterwards, any special dressings, surgical garments, or follow up care.

Make sure you do everything your doctor tells you and go to all follow-up appointments. This will help you get the best results from your surgery.

Having surgery is a big deal. Even if you’ve been looking forward to it and are happy with the result, it can still be quite confronting. It might take some time to get used to your new body.

Talk to your doctor if you are feeling any distress following surgery.

How much will gender affirming surgery cost me?

Gender affirming surgery can be very expensive. It can cost between $20,000 to more than $100,000, depending on which procedures you need.

Your surgeon will be able to tell you how much surgery will cost. The cost may include specialist visits before and after surgery, surgeon and anaesthetist fees, hospital and theatre costs, and any other products or services necessary.

Some costs may be covered by Medicare, such as specialist consults if you have a referral from your doctor. Unfortunately, most gender affirming surgery in Australia is done privately, meaning there will be large out-of-pocket costs.

You should ask your surgeon what Medicare item numbers they use. You can check the Medicare rebate at MBS Online.

Some private health insurance will also help with gender affirming surgery. If you have health insurance, it’s important to check with your health fund first about your level of cover. There is a range of health insurance comparison sites available online, such as

Changing your gender on your passport, licence, Medicare card or birth certificate all require separate processes. These vary between states and territories. In some states and territories, you must have undergone specific types of gender affirmation surgery to change the gender marker on your birth certificate.

You can find out more about the specific processes at TransHub.

You are legally protected by the Sex Discrimination Act from discrimination on the grounds of sexual orientation, gender identity or intersex status. Visit the Australian Government Attorney-General’s Department for more details.

Where can I get more information on gender affirming surgery?

Learn more here about the development and quality assurance of healthdirect content.

Last reviewed: June 2022

Back To Top

Need more information?

These trusted information partners have more on this topic.

Top results

Everything you need to know about gender identity | Gender Identity

If you’ve ever wondered ‘what does gender mean?’, you’re not alone. Gender and identity exists on a diverse spectrum. Learn more about gender in this guide.

Read more on website

What Is Gender Identity | headspace

Gender identify and mental health is an issue that affects many young people. Learn more about the affects of gender identify and how you can get help from headspace.

Read more on headspace website

Understanding gender identity - for families | headspace

understanding sexuality and sexual identity - for family and friends The term sexuality refers to a person's sexual attractions, experiences of the attraction and sexual preferences

Read more on headspace website

Gender Identity Examples, Meaning & Definition | Kids Helpline

Gender identity is more than being male or female. Kids Helpline can help you understand what it is and how you can understand your own identity.

Read more on Kids Helpline website

Gender dysphoria & identity: kids & teens | Raising Children Network

Gender identity is feeling male, female, both or neither. Gender dysphoria is when your child is distressed by feeling different from their birth gender.

Read more on website

Gender dysphoria & identity: kids & teens | Raising Children Network

Gender identity is feeling male, female, both or neither. Gender dysphoria is when your child is distressed by feeling different from their birth gender.

Read more on website

How Emma learnt to accept herself and her gender identity | ReachOut Australia

Emma, a young transgender woman, shares how reaching out for support helped her to accept her gender identity.

Read more on website

Gender dysphoria & diversity: support | Raising Children Network

If your child is gender diverse or experiencing gender dysphoria, support means embracing their gender identity. Your support boosts your child’s wellbeing.

Read more on website

Supporting a transgender teenager - ReachOut Parents

Learn how best to support your teen as they embrace their gender identity, with ReachOut Australia and Ross Jacobs from QLife.

Read more on website

Your child’s gender diversity: your family | Raising Children Network

If your child is gender diverse, it’s OK if you and your child’s siblings have mixed feelings about your child’s gender identity. It’s good to seek support.

Read more on website

Healthdirect 24hr 7 days a week hotline

24 hour health advice you can count on

1800 022 222

Government Accredited with over 140 information partners

We are a government-funded service, providing quality, approved health information and advice

Australian Government, health department logo ACT Government logo New South Wales government, health department logo Northen Territory Government logo Queensland Government logo Government of South Australia, health department logo Tasmanian government logo Victorian government logo Government of Western Australia, health department logo

Healthdirect Australia acknowledges the Traditional Owners of Country throughout Australia and their continuing connection to land, sea and community. We pay our respects to the Traditional Owners and to Elders both past and present.