This summary contains details of surgical intervention for people aged 18 and over. Some content and language may be sensitive for younger users and caution is advised. It is not intended to replace a consultation with an appropriately qualified medical practitioner. Always seek the advice of a healthcare professional
We spoke to some trans and gender diverse young people aged 18+ about having gender affirming surgery. Gender affirming surgery may involve several procedures during one operation or might take place over time. As with all surgery, there could also be unexpected complications to deal with. People talked about:
- Getting a referral
- Appointments with surgeons
- Accessing surgery privately
- Experiences of surgery and changes
- Recovery after surgery
- Aftercare and support
There are a range of gender affirming surgeries available to trans and gender diverse adults. You can read about these and the referral process, on the NHS website. You can find more information on gender affirming surgeries available and decision-making processes for young people here.
Getting a referral
Many people talked about the slow process of getting a referral for surgery and long waits in between appointments on the NHS. Sally said her surgery appointments ‘went from being in June of that year and then my next appointment was like May of the next year’. Jaz said it took her ‘two years of GIC appointments to get the referral’. When Noelle had her first appointment, ‘the guy there said… that the absolute earliest I would get my second appointment was…a year and a half [later]. And given that it took over two years just to get the first appointment it may very well be longer than that.’
People had to meet a number of conditions before getting referred to a surgeon. Patrick said, ‘I had a hard time being referred for top surgery because my BMI was too high’. He said ‘the gender clinic told me that I needed to lose weight… before they’d refer me which was really hard to hear because binding and having a large chest was stopping me from being able to exercise’. CJ talked about how ‘the doctor told me that although I was physically fit and healthy, and an ideal candidate for it, because my BMI is at a certain level, he would not perform surgery on me and that was that.’ Patrick said, ‘a lot of the surgeons look at risk factors in general so like if you smoke, if you drink excessively, if you do drugs’.
Declan talks about his experience of surgery appointments and the questions he was asked.
Some talked about their struggle getting a date for surgery. Rahul said, ‘It was a very stressful period and they couldn’t really give me an accurate date. I ended up not actually having my date for surgery until I think eleven days before my actual surgery, that’s when they told me the date because there was a cancellation. So, they called me up and offered me it. And obviously, I dropped everything and said, yes.’ Patrick was also on the cancellation list and had three days’ notice before his surgery. Noelle said, ‘I know that they won’t confirm the referral straight away. I will need to get approval from two different specialists.’
People had mixed experiences at their surgery appointments. Declan said, ‘The nurses actually were really good. They were the highlight of the whole experience. They made me feel really comfortable and at ease with the whole stripping thing. The doctors were very like curt and serious about it all. He didn’t really say much that wasn’t to do with the surgery. He was kind of to the point with everything.’ Jaz said, ‘I was not prepared for how patronising they would be. She talked about the advice practitioners gave about what she can and can’t do while recovering from surgery. [The practitioners said] “You know you can’t go horse-riding?” It’s like who goes horse-riding? Like, who are you? Who is this aimed at?’
One person raised racism as an l issue at their surgery appointments. M explained that their surgeon ‘said something weird about like my race and I was just like yeah you’re not the one’. N talked about the power imbalance in surgery appointments ‘power is difficult, and then… if you intersect that with like disability or mental health or race… then that becomes even harder in that situation because I haven’t yet met a non-white healthcare professional working on trans health’. Jaz felt that her experiences of surgery appointments were ‘saturated with whiteness’ and questioned, [what] does this say… about trans people of colour not getting the healthcare that we need?’
M talks about their experiences of a surgeon making unhelpful assumptions about the body based on race.
Accessing surgery privately
For some participants the wait for surgery via the NHS was too long and they made plans to access surgery privately. Reuben said, ‘I want top surgery so bad but it’s like eight or nine grand’. He added, ‘I’m not really that bothered about bottom surgery. At the moment I don’t feel like that’s something that I’ll need’. Freya wanted ‘all of them’. She said, ‘I will definitely, definitely have bottom surgery… I might even pay for that, ‘cos it’s looking at the moment like four to seven years [before] I get it free.’ At that point, the £20-£30,000 is worth it for me.’ Freya said that the money people save up for ‘mortgages and stuff in their 20s or 30s [she’d] be happy to spend on FFS (facial feminisation surgery).’
Anderson said, ‘I’ve chosen to go private… because I know that I will be sitting waiting for a long time and I know the things that I will have to compromise.’ They added, ‘I know the damage that it’ll do to my mental health to go through the way that I’ve seen so many people go through the NHS service.’
Anderson talks about deciding to crowd fund their surgeries to avoid the waiting list and the damaging impact on their mental health.
Getting surgery privately is expensive. M said, ‘All together it ended up costing about like ten grand and I was like ‘where do I get this money from?’’
Some young people tried raising funds through crowd-funding or similar means. M said, ‘I started a GoFundMe and thankfully a lot of people supported me through that and I was able to raise the money that I needed… that was a blessing’. However, CJ didn’t feel comfortable using crowdfunding, they said, ‘I’m just so aware of how in need so many people in our community are, that something doesn’t feel right to me about doing that.’
Henry talks about his surgery date getting pushed back further and further’ and choosing to seek surgery privately instead.
M talks about their experience of funding their surgery through crowd funding.
Experiences of surgery and the changes
People talked about preparing for going to hospital. M said when they had surgery they were accompanied by their mum and two friends. Patrick had ‘some family support, although they weren’t super into the idea of me having surgery’. Patrick said before top surgery, ‘my like main preparation was sort of logistical, working out how I was getting there and how I was getting home’. He said, ‘I made sure that when I came home there were like glasses on the side rather than in the tops of cupboards so that I could get myself a glass of water’.
Rahul shares all the important things they took away from their experience of top surgery.
N talks about the associated costs with top surgery that people don’t think about.
Tori describes going for bottom surgery and her immediate experiences after.
For some young people getting to the hospital was difficult. Jaz talked about young people and adults in Scotland having no choice but to travel long distances to England to receive surgery, ‘it’s the only referral pathway’. Patrick said, ‘Because it was so far away from where I was living, I was… completely on my own [and] no-one had been able to come with me.’
M shares their experience of being misgendered by a nurse at hospital at the time of their surgery.
Interview 28 talks about her bottom surgery results and her feelings about future sexual experiences.
The young people talked about their positive feelings after surgery. M said, ‘one of the weirdest things about it? is that it just feels so normal… this is how I deserve to feel, I feel so much more connected to my body’. Jaz said, ‘after having gender confirmation surgery, I realised that my physical relationship to my body was so much better, on a level that I hadn’t foreseen.’
Henry said that since having top surgery, ‘I haven’t looked back.’ He described it as ‘an absolute weight, a literal and metaphorical weight off my shoulders’. Patrick said, ‘All of the like staff at the hospital were super lovely and they knew how important it was for me as a trans person’ ‘I just remember like seeing [the nurses], crying and being so relieved that it had finally been done after years of waiting’. He said, ‘I just remember feeling so relieved and just sort of sitting there and just crying’.
Rahul talks about what his priorities were for top surgery and choosing between the different options.
Patrick describes his experience of double incision top surgery’ and being a lot more comfortable in his body.
Recovery after surgery
Everyone we spoke to who had received gender confirming surgeries talked about the process of recovery and the aftercare that was important following the experience. Henry had top surgery and said, ‘I would urge people to make sure that they do that research about caring for themselves afterwards.’ One of the key messages people had for others was the time it took to heal. M had top surgery, ‘I started doing things again [after] about three or four weeks, I tried to take as long as I could, yeah about four weeks, five weeks’.
They talked about how drained they felt and the importance of rest. Sally said she ‘recovered fairly quickly’ after bottom surgery but it ‘took a lot out of me’. She added ‘It’s huge surgery …pain wise it was very easy to manage but it just made me so tired’. Patrick had ‘a really unusual recovery because I did just recover really quickly’ from top surgery and was back at work after two weeks but acknowledges ‘that’s not a typical experience of recovery.’
Patrick talks about their experience of recovery after top surgery including drains for fluid and dressings.
Jaz who had bottom surgery and was signed off work for three months, said, ‘the actual arc of recovery is really long, and your priority is patience’. She said, ‘you might not want to get out of bed for like a year, and that’s like fine because that’s your body [needing] recovery time still.’
Some young people talked about the concerns they had about their body following surgery. Interview 28, who had bottom surgery, said, ‘I had some problems with where my scars meet, and so in the following weeks I did have to get in contact with the nurse and she was really good, she talked to me and she was really good about the process.’ M said about their top surgery, it was important for them to recognise that ‘the aesthetics of it aren’t everything and that the scars will in time like fade’. They said, ‘my body will heal however my body heals’ and it was about ‘honouring… the process that it’s gonna go through.’ They added, ‘I’m happy with them, they’re my scars’.
N highlights some of the most helpful things they learned through having top surgery and their recovery.
People shared quite different experiences of managing pain during their recovery. Patrick said once he got home, he took ‘paracetamol and ibuprofen… every four hours for a week’ and then after that just taking it as needed. Rahul said he felt like he was recovering faster than he was. He said, ‘because you are still on codeine painkillers… you are not feeling the pain… you feel you are almost back to fully functioning level. But you have to be careful with that as well, because you can rip up your stitches again.’
For trans masculine participants certain items, such as, a standing armchair pillow were helpful to recovery. Henry said it was also important to have ‘somebody around me to support me because no matter how much will I had, if I attempted to start doing things too quickly after the surgery, there was a chance that I would damage things and make the whole thing pointless’.
Tori talks about how she dealt with fears about her recovery and aftercare and how she appreciated rapid reassuring responses from her clinician.
Aftercare and support
Many talked about how grateful they were to have support from friends and family during the recovery period. They talked about the importance of having somebody to help them with chores and look after them during recovery. Jaz’s key message after bottom surgery was ‘make sure you’ve got support’ because ‘it can be a big deal to organise.’
She spoke about how she had ‘a team of seven friends’ who were there to support her and provide aftercare. This included chores like cleaning her bathroom ‘that made so much of a difference, it just took all the pressure off me, I just focussed on healing’. Rahul said after top surgery, ‘I genuinely needed two people. One person to carry all my things and another person to carry me. You are so much more drained than what you think. You are like ready to fall asleep anywhere.’
Ari talks about the key things to be aware of when it comes to transmasculine surgery aftercare.
An important stage of chest reduction surgery or top surgery for transmasculine young people was the process of having drains removed followed by dressings covering the chest and nipple area. Patrick said having all of his dressings taken off and being able to see his chest ‘completely bare for the first time’ was ‘incredible’.
Young people also talked about being grateful to have the support of work and university when needing long periods of time to recover. Patrick said, ‘it helped that I had a really supportive work team and also like my lecturers at college were super supportive and they were like take as much time off as you need’. M said their recovery ‘was really peaceful…I read a lot, I started watching a TV series and just like rested, I gave myself the space to do that’. They also took themselves ‘completely off the internet and just taking my time and it was lovely’.
Rahul talks about the process of having his drains taken out and when his dressings came off.
Tori talks about the process of dilating for trans women who have had bottom surgery.