How a person transitions, should they decide to proceed, and what surgeries they undergo, is an individual choice. Some people believe that there is the “one” surgery that affirms a trans person in their identity. This is a misconception because it assumes that a trans person needs the surgery to be who they are, and that there aren’t other surgeries one can take to feel affirmed in their gender. Transitioning is a process, like growing up. There doesn’t necessarily need to be an end point for it to be a valid and enriching experience. Below are examples of surgeries people may have to affirm their genders and what those surgeries entail. Remember, again, it is about you, your gender, and what feels most comfortable. Keep in mind that multiple surgeries can be expensive and cannot always be covered by health care, so that may impact your decision of which ones you choose to have, if any. You can find photos of surgery results to help make an informed decision at www.transbucket.com.
A note on language: This guide uses terms doctors use to refer to trans people’s bodies, as this is how these surgeries are accessed. We recognize that not all trans people refer to their bodies with these terms and the importance of trans people labeling their bodies in ways that feel affirming.
Transfeminine surgeries funded through Alberta Health Services:
- Orchiectomy – Bilateral orchiectomy involves removal of both testicles, which eliminates the sources of androgen (testosterone) production.
- Vaginoplasty – A surgery that creates a vulva and vagina, usually by using the penis and scrotum as donor material.
Transfeminine surgeries not funded by Alberta Health Services:
- Breast augmentation/implants – Enlargement of breasts, by implanting silicone gel or saline solution implants. Usually typical growth on estrogen is one to two cup sizes below closely related non-trans women. Breast growth may be more limited in older transitioning individuals, and breast augmentation may be needed to achieve desirable results.
- Tracheal shave (reduction of the Adam’s apple).
- Voice modification surgery.
- Suction-assisted lipoplasty (contour modeling) of the waist.
- Rhinoplasty (nose correction).
- Facial Feminization Surgery (FFS) – A set of reconstructive surgical procedures that alter typically masculine facial features to bring them closer in shape and size to typically feminine facial features. FFS can include various bony and soft tissue procedures such as brow shave and brow lift, rhinoplasty, cheek implants, and lip lift and augmentation.
- Hair transplants – Mild cases of baldness may be addressed by means of hair transplants, in which healthy hair follicles from the back of the head are removed and implanted in those areas where hair loss has occurred. Local medical practitioners offering hair transplant services are provided in Appendix B.
Surgeries for transfeminine people that are not funded by AHS do not require referral from a psychologist or psychiatrist.
For more information on transfeminine surgeries, visit www.tsroadmap.com.
- Laser hair removal – Many individuals desire facial hair removal as part of their transition process. Laser hair removal involves pulses of laser light that conduct heat along the hair shaft in order to damage the follicles and prevent or reduce further hair growth. Multiple treatments (often ten or more) are typical. Laser hair removal is suitable only for darker hairs (i.e., black or brown), since light-coloured hairs do not absorb and conduct sufficient heat for the technique to be effective.
- Electrolysis – Electrolysis involves the use of electrical current to destroy the hair follicles and prevent further hair growth. Electrolysis is very time consuming, since each follicle must be treated individually. Depending on the individual, one or two hundred hours of treatments may be required. Electrolysis is effective on all hair colours, and is the only effective treatment for very light-coloured hair.
- Voice therapy – Transfeminine individuals are eligible for voice therapy at the Chinook Regional Hospital, on referral from the gender psychiatrist. Note that the voice clinic will only accept you for voice therapy once you are living full time in your desired gender.
Some local businesses offering laser and electrolysis hair removal services are provided in Appendix B.
- Hysterectomy – Removal of the uterus.
- Bilateral mastectomy – The removal of the breasts and the shaping of a male-contoured chest.
- Metoidioplasty – With the effects of testosterone, the clitoris enlarges over time, anywhere from one centimetre to 5 –7 centimetres (due to the clitoris and penis being developmentally homologous organs). In a metoidioplasty, the enlarged clitoral tissue is released from its position and moved forward to approximate the position of a penis.
- Phalloplasty – A surgery that uses skin removed from the inner forearm, as well as tissue from the vulva, to create a penis and testicles.
All the above surgeries are funded through Alberta Health Services.
For more information on transmasculine surgeries visit www.ftmguide.org.
Many of the criteria are the same for all trans-related surgeries governed by AHS (genital surgery for all trans people and top/chest surgery for transmasculine people). These include:
- Persistent, well-documented gender dysphoria;
- Capacity to make a fully informed decision and to consent for treatment;
- Age 18+ (if younger, a mastectomy can be accessed by following the standards of care for children and adolescents);
- If significant medical or mental health concerns are present, they must be reasonably well controlled.
There are additional criteria specific to certain surgeries, in addition to the above–mentioned criteria:
Mastectomy and creation of a male chest in transmasculine people:
- One referral from a doctor or therapist/psychologist/psychiatrist.
Hysterectomy and ovariectomy in transmasculine people and orchiectomy in transfeminine people:
- Twelve continuous months of hormone therapy as appropriate to the patient’s gender goals (unless the patient has a medical contraindication or is otherwise unable or unwilling to take hormones).
The aim of hormone therapy prior to gonadectomy is primarily to introduce a period of reversible estrogen or testosterone suppression, before a patient undergoes irreversible surgical intervention.
- Referrals from two different doctors/psychiatrists (criteria do not apply to patients who are having these surgical procedures for medical indications other than gender dysphoria).
Metoidioplasty or phalloplasty in transmasculine people and vaginoplasty in transfeminine people:
- Twelve continuous months of hormone therapy as appropriate to the patient’s gender goals (unless the patient has a medical contraindication or is otherwise unable or unwilling to take hormones).
- Twelve continuous months living in a gender role congruent with their gender identity.
- Referrals from two different psychiatrists.
Although not an explicit criterion, it is recommended that these patients also have regular visits with a mental health or other medical professional.
The criterion noted above for some types of genital surgeries, i.e., that patients engage in twelve continuous months of living in a gender role that is congruent with their gender identity, is based on expert clinical consensus that this experience provides ample opportunity for patients to experience and socially adjust in their desired gender role, before undergoing irreversible surgery (WPATH, 2012).