Definition & Overview

Sex change surgery, also known as gender reassignment or genital reconstruction surgery, is a surgical procedure that changes a person’s sexual structure, in terms of both appearance and function, from that of a man to a woman, or vice versa. It is also medically known as feminizing or masculinizing, genitoplasty, penectomy or vaginoplasty, orchiectomy, metoidioplasty, or phalloplasty, depending on the original and intended gender. It is taken advantage by transgender individuals to shift from their biological gender to their identified sex as a treatment for a condition known as gender dysphoria.

Who Should Undergo & Expected Results

Sex change surgery is performed on people who are identified as transgenders, which are referred to as transsexuals after the surgery. The surgery should only be performed on people who are mentally healthy, a state that will be determined by a mental health evaluation that is conducted prior to the surgery. It is also reserved for patients who are proven to have gender dysphoria, a medical condition that is formerly known as gender identity disorder. People with this condition feel that they should be of the opposite gender, and this feeling causes distress in their lives.

A sex change surgery is expected to reduce a person’s feelings of distress due to having a gender he or she does not identify or feel comfortable with. In some people, hormone therapy alone can achieve this, whereas in some people, minor gender-related surgeries suffice. If less major treatments do not relieve a person’s feelings of displacement due to gender, then sex reassignment surgery is considered.

How Does the Procedure Work?

The road to getting a sex change surgery begins with an evaluation of the patient’s mental health. This is conducted by a psychologist or a mental health specialist who has experience in dealing with gender issues. This medical professional will be the one to determine whether the person needs to be treated for gender dysphoria.

Also, prior to undergoing the actual procedure, the patient will be required to undergo hormone therapy. This is important because the gender of a person is not only determined by the appearance of his or her sexual structure. In fact, several factors that characterize a person based on his or her gender are controlled by hormones; these include the size of the breasts, hair growth in various parts of the body, and total muscle mass. Thus, before a person can change genders, the entire body has to be brought through a complete transition process that takes into consideration all the sexual characteristics of a person.

Women who wish to transition to becoming men need to take supplements of the male hormone, also called androgens. These hormones can gradually make their bodies look more masculine by enhancing muscle mass (and therefore strength), encouraging more hair growth in the body and also on the face, and deepening the voice. Androgen supplements can also cause an enlargement of the clitoris. On the other hand, supplementation of the female hormone will make a male patient more feminine by decreasing total muscle mass and strength, increasing breast size, slowing down the growth of facial and body hair, and altering the distribution of body fat. Changes brought about by hormone therapy usually begin to show after a month, but full effects can only be expected after 5 years.

The reason why hormone therapy has to be done prior to a sex change surgery is that, in some cases, it is usually adequate to ease a person’s feelings of gender confusion and thus relieve the distressing symptoms caused by gender dysphoria. Due to this, studies show that up to 75% of people suffering from gender dysphoria choose not to pursue the surgery itself as the hormone therapy has made them feel more balanced and less distressed regarding their gender.

Surgery, however, is the only remaining option if hormone therapy is deemed ineffective. Once all preparatory procedures such as mental health evaluation and hormone therapy are completed, the procedure is done by using the penis and the scrotum to reconstruct a vagina and vulva, or forming a new penis.

Possible Complications and Risks

A sex reassignment surgery is a major procedure that comes with significant risks. All patients are informed of these risks prior to the surgery. Apart from medical risks, the surgery also has some limitations, which should also be explained in detail to the patient before he or she provides consent for the surgery and all preceding treatments involved.

Some of the risks of the sex change procedure are due to the hormone therapy itself. These include:

  • High blood pressure
  • Sleep apnea
  • Heart disease
  • Tumors affecting the pituitary gland
  • Infertility
  • Uncontrolled weight gain
  • High levels of liver enzymes
  • Blood clots
  • Anxiety
  • Feelings of uncertainty and confusion

Thus, people undergoing hormone therapy need to be constantly supervised by a medical professional, especially during the first months of the process, so that the effects of the hormones can be properly monitored.

Also, patients undergoing either hormone therapy or sex change surgery will benefit from ongoing counseling or continuous visits to their endocrinologist, a medical specialist focusing on the body’s hormones.

Also, it is important for patients to understand that the decision to pursue sex change surgery is a major and, in many cases, irreversible, so it should not be made lightly. The decision of the patient should be backed by the surgeon or psychologist handling his or her case. This is the reason why patients are required to undergo at least 12 months of hormone therapy before they are allowed to undergo a sex change surgery.

The surgery itself comes with the following risks, which depend on whether the patient is a male transitioning to female, or vice versa. For men who are changing into women, the risks involve:

  • Death of the tissue that is used to create the vagina and vulva; this tissue is usually taken from the scrotum and penis
  • Fistulas, which are abnormal connections between the vagina and the bladder or the bowels
  • Narrowing of the urethra, which, in severe cases, can obstruct urine flow and increase a person’s risk of kidney damage

On the other hand, women transitioning into men are exposed to the following risks:

  • Narrowing of the urinary tract with the same increased risk to the kidneys
  • Death of the tissue in the newly formed penis

The risks are heightened in the case of women changing into men by having a new penis reconstructed. The increased risk is due to the many different stages of the surgery as well as the high rate of technical difficulties encountered so far in such surgeries. Due to this, some women only opt for the removal of their uterus and ovaries, and choose to forego phalloplasty.

Complications and risks can also be avoided by choosing minor sex change procedures, such as mastectomies for women who want to get rid of their breasts or breast augmentation for men who want to increase their breast size. Most patients feel that these procedures are enough and thus don’t feel the need to have their sexual genitals reconstructed. This is because breast augmentations and mastectomies can be reversed in case they change their mind after the procedures are done.

References:

  • Jamison Green, Ph.D., president, World Professional Association for Transgender Health.
  • Sherman Leis, DO, surgeon, Philadelphia Center for Transgender Surgery.
  • WPATH Standards of Care (SOC) for the Health of Transsexual, Transgender, and Gender- Nonconforming People, Volume 7.
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