What is gender affirmation?

Gender affirmation is the process you go through when you start to live as the gender with which you identify.

Gender affirmation might include:

• social affirmation — such as changing your name, pronouns, hair or clothing
• legal affirmation — such as changing your legal name or gender
• medical affirmation — which can include puberty blockers, hormones or surgery

Read more about gender incongruence and gender affirming care.

What is gender affirming surgery?

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

Surgery is just one option for gender affirming care. This includes top and bottom surgeries, as well as other surgeries like facial feminisation surgery.

All trans and gender diverse people are unique. You can choose to affirm your gender in a way that feels right for you.

This article talks more about gender affirming surgery.

What happens during gender affirming surgery?

Gender affirming surgery is usually done in adulthood.

There are many different gender affirming surgeries and procedures. They may include making changes to your:

• face
• chest
• genitals
• other body parts

Not everyone with gender incongruence has surgery.

Male to female surgeries

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

• Breast/chest surgery — augmentation with insertion of breast implants.
• Facial feminisation — changing the shape of the lips, eyes or nose.
• Voice surgery — shortening the vocal cords for a higher, more feminine voice.
• Tracheal shave — reducing the size of the 'Adam's apple'.
• Lipofillers or liposuction, to achieve a more feminine shape.

Bottom surgery (genital reconfiguration surgery) involves changes to the genitals. 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 mixture of the following procedures:

• Removing the testicles (orchiectomy).
• Removing and reshaping tissue from the penis to make a vulva (penectomy) — this includes creating external labia or lips, and a clitoris (vulvoplasty).
• Shortening the urethra (tube that you urinate from).
• Creating a vaginal canal (vaginoplasty) — some people choose to skip this.

After vaginoplasty surgery, you need to use vaginal dilators to maintain the shape of your vaginal canal.

Female to male surgeries

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

• Breast/chest surgery to create a male chest.
• Lipofillers and liposuction to achieve a more masculine shape.
• Pectoral implants.

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

• Hysterectomy and ovariectomy — removal of your uterus (womb) and ovaries.
• Removal of the vagina (vaginectomy).
• Creation of a penis, which may include metoidioplasty or phalloplasty.

Metoidioplasty involves making a small penis using tissue from the clitoris after it is enlarged by testosterone hormone therapy.

Phalloplasty uses tissue from your body to make a penis. This tissue usually comes from your arm, thigh or back. Phalloplasty is a multi-stage process.

You may choose to have urethral lengthening, so that you can urinate from the tip of your new penis. This can happen about 6 months after your first surgery.

The final stage of surgery involves testicle implants and a device that may help you to have 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. Doing your own research and talking with experts will help you decide what's best for you. Surgery doesn't make you more or less trans.

When can I have gender affirming surgery?

Before you can get gender affirming surgery, you need to meet certain criteria. You need to:

• have a history of gender dysphoria (for 6 months or more)
• have the ability to make a fully informed decision
• be over the age of 16 years for top surgery, or 18 years for bottom surgery (some surgeons will provide surgery to younger people in specific situations)
• ensure that any physical or mental health conditions you have are well managed

You will also need letters of support from a mental health professional before having gender affirming surgery. The letter needs to state that surgery is:

• appropriate for you
• likely to help affirm your gender
• likely to reduce any gender dysphoria that you have

For top surgery, one letter is needed. For bottom surgery, 2 letters are needed.

For bottom surgery, you are also required to have 'lived as your current gender' for 12 months. This means that you have socially transitioned.

If you are taking gender affirming hormones, you should do this for at least 12 months before having surgery. This is to allow any significant body changes to occur before surgery.

What questions should I ask my doctor before surgery?

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

Questions to ask your surgeon include:

• Am I a good candidate for the procedure?
• What different surgical techniques are recommended for me?
• How long will the recovery period be?
• What are the possible risks and complications?
• Where will you perform the surgery?

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 you can expect after each surgery.

You may want to ask:

• How long will I spend in hospital?
• When can I shower?
• Will I need any special dressings or surgical garments?
• When do I need to return for 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. Some people may need another surgery to get the best results.

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 their gender dysphoria is not fully resolved.

Make sure you discuss any difficult feelings with your doctor or psychologist.

Complications from gender affirming 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.

However, research suggests that very few people who have gender affirming surgery regret their decision.

Talk to your doctor or psychologist if you are feeling any distress after surgery.

How much will gender affirming surgery cost?

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. There may be extra costs for:

• specialist visits before and after surgery
• surgeon and anaesthetist fees
• hospital and theatre costs
• any other products or services you need

The costs of some procedures may be covered by Medicare. You should ask your surgeon what Medicare item numbers they use. You can check the Medicare rebate at MBS Online.

Unfortunately, most gender affirming surgery in Australia is done privately. If you have private health insurance, it's important to check with your health fund about:

• what is covered
• what your out-of-pocket costs will be

Legal affirmation

Changing your gender on your passport, licence, Medicare card or birth certificate all require separate processes. These processes can vary between states and territories.

In some states and territories, you must have gender affirmation surgery to change the gender marker on your birth certificate.

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

Resources and support

The Australian Professional Association for Trans Health (AusPATH) lists healthcare professionals who are committed to strengthening the health, rights and wellbeing of all trans people.

TransHub has information about gender affirming surgery and updating your gender marker on identity documents

The Gender Centre (NSW) offers resources and support.

You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with 24 hours a day, 7 days a week.