Gender-affirming surgery

Richard was supportive of his daughter’s wishes to have surgery in the future, even though he felt that any parent would prefer their children not to need an operation.

Whilst not all trans or gender diverse people want or choose to have surgery, some choose to have gender affirming surgery.
We spoke to parents whose now-adult children had undergone gender affirming surgery and others whose children were considering it in the future.
In this section, you can also find out what the parents and carers we spoke to said about:
  • their young person’s wishes for surgery in the future; and
  • their own thoughts about gender affirming surgery.
There are a range of gender affirming surgical interventions available to trans adults as explained on the NHS website. A person can be referred to a surgeon based on the recommendation from the adult Gender Identity Clinic. A person is expected to have socially transitioned at least a year before they can be referred for gender affirming surgery.
For trans men, surgery 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
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)
  • breast implants
Some interventions, such as facial feminisation surgery (surgery to make your face a more feminine shape) and hair transplants are not routinely available on the NHS.
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.’
Gender affirming surgery may involve several procedures during one operation or might take place over a period of time. As with all surgery there could also be unexpected complications to deal with.

Experiences of parents whose adult children had surgery

E and D talked about their son having top surgery, how it went and how they felt about it as parents.

Gender affirming surgery can be an important milestone for a trans or gender diverse person. In our interviews, four parents had children who had had gender affirming surgery as adults. Two parents were interviewed together about their son and both talked about their son’s top surgery. One mother’s daughter had experience of bottom surgery and another parent shared their daughter’s experience of facial feminisation surgery. In the interviews, these parents talked about their children’s reasons for wanting surgery (including body dysphoria), the process for being referred, the surgery itself and recovery.
While some types of gender affirming surgery are available on the NHS, others are not. For example, one parent’s daughter wanted facial feminisation surgery because she ‘felt so conscious, she had a very prominent masculine nose and, Adam’s apple.’ Jan shared that they, as a family, decided to pay for her daughter’s surgery privately, as this type of intervention is not offered on the NHS. To be cleared for the procedure, their daughter ‘had to have a very detailed session with a fully qualified psychotherapist.’ Jan felt that the surgery itself was a ‘big deal’ as it involved four different procedures, but also shared that their young person was happy with the result overall and needed the surgery to be able to ‘move forward.’

Jan talked about her daughter’s motivation to have facial feminisation surgery and how the surgery had gone.

Within the NHS, waiting times for surgery can be very long, but one mother felt her daughter did not have to wait long for bottom surgery. She said: ‘I thought it was remarkably quick. She probably didnt [think so] …she got told she was going for the operation in about October and I think she had the operation in March.’ However, it is important to note that this five-month wait followed two other waiting periods: an assessment process at the Gender Identity Clinic, and a waiting list for assessment. What this parent was disappointed about was the lack of care after her daughter’s surgery. She felt her and her daughter had ‘nobody to seek advice from’ when her daughter got unwell after leaving the hospital. She said that it was a ‘long recovery’ for her daughter, but that she was now on an ‘upward slope’ from the surgery. Bottom surgeries tend to be more invasive and more likely to involve more severe complications and long recoveries. For another person’s son, the recovery from his top surgery was much easier. His mother talked about how technically the surgery went very well. She said about her son: ‘He didn’t have any post op complications and recovered quite fast.’

VM’s daughter had bottom surgery on the NHS. She talked about how her daughter fell ill after the surgery and had to rely on local GP for help.

Parents sharing their children’s future surgery plans

For some parents we spoke to, future surgery was something that their children had discussed with them. In the interviews, parents stressed that their children were clear about what procedures they wanted. When one parent’s partner asked their daughter (age 16) what she wanted for Christmas she said she wanted a vagina. The parent shared: ‘That’s what she wants. She wants surgery. She wants to get sorted.’ Kate said she discussed surgery with her son ‘quite early on.’ She emphasised that her son wants top surgery and ‘to have his womb and his ovaries removed. But he doesn’t want, anything else done.’ She felt the interventions that her son wanted were done routinely regardless of a person’s trans status, so she was ‘less concerned about him having that part done.’
Parents also spoke about their children researching available procedures, where to go to start the treatment and the best surgeons available. Research could include looking for information online as well as talking (online or in person) to trans people who had had surgery.

Lesley talked about her and her son doing research on top surgery and said her son can’t wait for it to happen. She hoped he can have the surgery on the NHS.

Parents’ views about gender affirming surgery

In our interviews, parents were largely understanding of their children’s choices to have surgery and the importance of surgical intervention to their child’s wellbeing. For future surgery, most parents and carers supported their children in doing research with them, discussing their plans and providing emotional support. But not everyone felt the same. Elijah worried that being trans meant a life of medicalisation and unnecessary surgery for his child. He also talked about age threshold for deciding on surgery. It is important to note that not all trans people want or choose to have surgery. Parental support and acceptance are key to the wellbeing and mental health of young trans and gender diverse people and so is access to timely care. Denial and delaying of care causes harm.*

For Elijah deciding on surgery was a momentous’ decision for a 13 year old. He was against those under 18 choosing pills and surgery.

Even where parents didn’t like the idea of their children having surgery they often recognised the positive benefits it would have for their children, and emphasised the importance of respecting their children’s choices and autonomy to decide over their own bodies. E said that what she thought was ‘unnecessary surgery’ was a ‘horrible thing to see happening to your child’. However, she also said that her son was very adamant about having it and agreed with D that their son was ‘very pleased with the outcome’ of the surgery. For other parents, like Richard and Lesley, supporting their child’s decisions about future surgery was part of affirming and valuing their gender identity.

Lesley said she had no concerns about future top surgery for her son, because she recognised that he is trans.

* See for example:
Puckett, J. A., Matsuno, E., Dyar, C., Mustanski, B., & Newcomb, M. E. (2019). Mental health and resilience in transgender individuals: What type of support makes a difference? Journal of Family Psychology 33(8).
Simons, L., Schrager, S. M., Clark, L. F., Belzer, M., & Olson, J. (2013). Parental support and mental health among transgender adolescents. Journal of Adolescent Health, 53(6).
Priest, M. (2019) Transgender Children and the Right to Transition: Medical Ethics When Parents Mean Well but Cause Harm, The American Journal of Bioethics, 19(2).


Most of the parents we spoke to had children who were in school. They described a range of experiences related to how their child's gender...