This summary contains details of surgical intervention. It is not intended to replace a consultation with an appropriately qualified medical practitioner. Always seek the advice of a healthcare professional.
Whilst not all trans or gender diverse people want surgery (see Diverse journeys and pathways) some choose to have gender affirming surgery (also known as gender or sex ‘reassignment’ surgery). Altering of the genital region is often referred to as ‘bottom surgery.’ Surgery that involves breast tissue removal and chest contouring, and/or breast implants is often referred to as ‘top surgery.’
We talked to trans and gender diverse people under the age of 18 about their thoughts and feelings about surgery. Many were weighing up future possibilities very carefully. Some participants over 18 talked about the decision-making process they went through if they opted to have surgery. On this page you can read what people said about:
- Finding information about surgery
- Decisions for trans men and transmasculine people
- Decisions for trans women and transfeminine people
There are a range of gender affirming surgical interventions available to trans and gender diverse adults that you can read about on the NHS website.
Finding information about surgery experiences
The trans and gender diverse young people we spoke to talked about how they found information to help make decisions about gender affirming surgeries.
Many found it difficult to find reliable detailed information on surgery. N said, ‘There’s very little information available at all for bottom surgery [available] for trans guys’. Begam shared how she had found ‘a little bit of information [about] the surgical procedures…I watched a documentary on TV about reassignment surgery and [what] it’s like for the individual.’ Begam wanted ‘more information about the surgical procedures [and] the whole impact it’s gonna place on the body’.
Rahul was given a pamphlet of information before top surgery but struggled to find answers to the following questions: ‘how long it would take me to recover? What I was able to do? When I would expect the scars to fade? How long I would be incapacitated for after the surgery? How much pain I would be in?’
Rahul talks about the little information there is available on surgeries for trans men.
Bay says it’s okay to have doubts’ about having surgery, it’s a big change to make to your body.
Due to a lack of information on patient experiences available through formal medical channels, those we spoke to found most of their information online and through social networks. Declan said a lot of his information about surgery is found online, ‘there’s a lot of videos online of people explaining their experiences with surgery.’ PJ said that he found information through a mix of Facebook groups and his own research, ‘I mostly just researched that and Googled it.’ Sally said, ‘I was on Discord, where there were other trans people and I ended up talking to somebody else that was having like surgery’.
Ezio talked about the YouTuber ‘Jammidodger’ ‘he had a metoidioplasty and he’s talked about that and there’s pictures of that which sort of is more like a smaller version of a penis and you can have a urethral lengthening but not everyone does and then you have like phalloplasty which is like the full sort of construction of a penis.’
Patrick describes the two main options for lower surgery’ Metoidioplasy and Phaloplasty.
Missing information led people to turn to informal and community support for information on surgery. Ari found most of their information about surgery through ‘UK FTM, Tumblr or…TMSA (Trans Masculine Support and Advice) on Facebook which is quite a large group of trans masculine individuals.’ They said having a ‘community resource has always been more helpful to me than more official things on surgeon’s websites… you can get a better idea of experiences that way.’ N said, ‘I’ve had these conversations in real time [with friends]…it was like, “Oh yeah this is another piece of information that you would want to know, that you’re not going to find on the internet.”
Bay found it difficult to find information about the different methods for top surgery and doesn’t feel they made a particularly informed decision.
Shash describes the information she has on Vaginoplasty and Orchidectomy surgeries and how she feels about them.
Those we spoke to with experiences of surgery talked about getting information before consultations with health professionals. They advised others to do as much research as possible before their appointments. M advised others to be ‘prepared for the consultations’. They said, ‘I’d done a lot of research into it, I don’t think there [were] any surprises’. Henry said, ‘I would definitely say do your research before you have surgery.’ He said, ‘the more I read into it, in terms of logistics, the more questions I asked, the more comfortable I felt.’
One participant mentioned how the information she was given on surgeries was not relevant for a diversity of trans bodies. Jaz said the health professionals ‘show you this like… big book of vulvas, in terms of cosmetic appearances after surgery…and they’re all like… white’.
Jaz talks about finding information about gender confirmation surgery saturated with whiteness’ and seeing no representation of poc bodies.
Tori’s advice to others was to ‘write lists, that’s a really good way to get all your questions answered, and don’t shy away. It’s more scary having to have a new body and not know what to do with it so ask as many questions as possible.’ M suggested ‘knowing what questions you wanna come with… take examples of how you want [your surgery] to look… just [be] as prepared for that process as possible then the rest really falls into place’.
Ari says being fully equipped with all the surgical options that are available to you before you go in is really helpful.
Decisions for trans men and transmasculine people
For trans men, surgeries may involve:
- a bilateral mastectomy (removal of both breasts)
- a hysterectomy (removal of the womb)
- a salpingo-oophorectomy (removal of the fallopian tubes and ovaries)
- phalloplasty or metoidioplasty (construction of a penis)
- scrotoplasty (construction of a scrotum) and testicular implants
- a penile implant
Young transmasculine participants talked about their thoughts on top and bottom surgery.
Top surgery was a consideration for many of our young people. For some it was essential in reaching a comfortable place in their bodies and gender identity. Jack said, ‘It’s not that I hate my body, it’s a very acceptable body, it’s a human body it does its job… but for me it doesn’t feel like mine so I guess it’s just taking steps to make it my body really.’ Jacob said, ‘Surgeries are very dependent on the person because of what that person wants in their life.’ He said, ‘I personally know that top surgery is a 100% must for me… to the point where I ended up reducing the amount I was binding just so I could have top surgery later in life.’
For some, wearing a binder long term wasn’t an option. One of the key elements of dysphoria for Erion was around his chest but he had ‘health issues that inhibit [me] wearing a binder all the time.’ Loges felt top surgery would help him to ’just be happy with myself,’ and ‘could be comfortable in the summer taking my T-shirt off’.
Jack hoped top surgery would give him ‘a flatter more masculine chest… so I can feel happier with the way clothes fit, the way I look at myself in the mirror and feel like it’s actually me looking back at me rather than someone else’. Cas thought, ‘it would probably be the most relieving thing I will ever do with my life’.
Alistair talks about his decision to only have top surgery.
Others didn’t have strong feelings about having top surgery or were unsure if top surgery was the right decision for them. June was happy to ‘have a very cis [gender]-passing chest for an AFAB [assigned female at birth] trans person so I almost feel it’s not priority for me.’ Beth said, ‘I have been going back and forth on whether I would benefit from top surgery’. They said, ‘there is a bit of me that really likes the idea… I quite like gender fuckery as a thing.’ They said, ‘I’d be like comfortable with having no boobs, but still embracing the femininity from the clothes that I wear.’
Some of the young people who were in the early stages of their transition were happy just to receive hormone therapy and weren’t in a rush to make a decision about surgery. Although Jay would like to have top surgery in the future, ‘I feel a lot better about [surgery] now that I am self-medicating because before that I felt very hopeless. Self-medicating has ‘been me reclaiming my own transition.’
For some participants the importance of surgery changed over the course of their transition, Alistair no longer thought bottom surgery was important like he did at the start of his transition. For H, top surgery had become more important.
H describes why after taking hormones he would now like to have top surgery.
Our transmasculine young people had mixed feelings about current bottom surgery options.
PJ said, ‘I’ve always known I wanted top surgery because I don’t want to wear a binder for the rest of my life, it hurts.’ However, for lower surgery, ‘there’s pros and cons of it, and I don’t really know if the pros outweigh the cons’.
Patrick was considering bottom surgery because they wanted ‘to be able to stand to pee’ and ‘just a general feeling of sort of discomfort with my physical appearance at the moment.’ However, he understood ‘it’s a possibility that I might end up with like results that …don’t make me any happier than I currently am.’ Finn said he had ‘not seen a single like bottom surgery story or video or discussion where it’s gone perfectly okay and what’s supposed to happen has happened’.
Bailey wanted top surgery ‘but I’m not 100% sure about bottom’. He feared ‘there’s so many things that could go wrong, it’s so long, painful. I’m not sure if that’s appealing to me yet. I’ve got time to wait for that.’ Some hoped health technology would develop and they would wait to see if there were any better bottom surgery options in the future.
Declan talks about the difference top surgery will make in terms of playing sports.
Decisions for trans women and transfeminine people
For trans women, surgery may involve:
- an orchidectomy (removal of the testes)
- a penectomy (removal of the penis)
- vaginoplasty (construction of a vagina)
- vulvoplasty (construction of the vulva)
- clitoroplasty (construction of a clitoris with sensation)
Interventions such as breast implants, facial feminisation surgery (surgery to make your face a more feminine shape) and hair transplants are not routinely available on the NHS. The trans women and transfeminine young people talked about the possibility of having gender affirming surgeries and how they came to this decision.
For some young people bottom surgery was an important consideration. Freya felt that her life ‘won’t properly’ begin ‘until I have like a vagina’. Sally said, ‘I wanted surgery mainly because I was sick of tucking my genitalia away… and that gets uncomfortable really quickly.’ For Tori ‘there was no real decision… as soon as I found out that you could have… full reassignment surgery’ she wanted it. Sophie wanted gender affirming surgery ‘to be able to physically look female as well as feel female.’ She hoped it would ‘help in terms of being in a relationship and allowing me to feel myself and be myself.’
For some young people it was a more difficult decision. Kat said, ‘I’d be willing to wait a few extra years… if it looked like there was going to be some kind of breakthrough which would mean the surgery would be better… or there would be a quicker recovery, or you’d get better results’. Cassie said she was ‘open minded for [bottom surgery] as a possibility’.
Summer describes her decision making process around feminising surgeries.
Facial feminising surgeries are not routinely available through the NHS Gender Identity Clinic, though this can be an important consideration for some transfeminine people. Summer wanted facial feminising surgeries ‘because I feel like it might give me the option of going outside without make-up and being less likely to get misgendered’. She added, ‘it’s ridiculously expensive and… my life is geared towards saving money for it. Noelle said, ‘some days I’m quite happy with the way I look and I think I’m quite lucky in that department. And then other days, there’s like things I hate about my face and I want to change them.’
Some participants were happy to wait to observe the physical impact of hormone therapy before making a decision about surgery. Rosa wanted to wait until ‘after I’ve been on hormones for a while’. She said ‘I might feel comfortable after hormones and might not feel any need to have any other medical treatment after that.’ A said ‘I’m waiting for the hormones to reach that stable stage where things stop changing and then once I get there then I’ll think about if I want facial feminisation surgery’.