Gender-affirming surgery patient guide

Most of the work for gender-affirming surgery happens before you travel, and some of it takes months. Start these steps when you first start considering an operation, not when you book it.

Know exactly which operation you are asking for

For trans women, genital surgery is usually a vaginoplasty, with or without a vaginal canal, or a smaller operation such as an orchiectomy. For trans men it is a metoidioplasty or a phalloplasty, and a phalloplasty is usually done in stages, often with repeat trips. Agree the operation, the technique, the stages and what happens if a revision is needed with your surgeon, in writing, before you book anything.

Start hair removal early if you are having a vaginoplasty

If skin is used to line the vaginal canal, that skin has to be permanently hair-free before surgery. Hair that is moved inside keeps growing there, and clearing it afterwards is difficult. Electrolysis or laser takes many sessions spread over months. At your first consultation, ask which area must be cleared, which method the surgeon accepts and by when it must be finished. If you are having a phalloplasty with urethral lengthening, ask whether the donor skin needs hair removal too. Hair removal is usually not included in the surgery price.

Settle the fertility question first

Operations that remove the testes or ovaries end the possibility of biological children permanently. If you might want children, sperm, egg or embryo freezing has to happen before surgery, and hormone therapy may already have reduced your fertility. Talk to the doctor who prescribes your hormones as early as you can, even if you are sure you do not want children.

Ask what to do with your hormone therapy

Do not stop or change your hormones on your own. Some surgeons ask you to pause or adjust hormone therapy around the operation and others do not. Ask your surgeon what they want, get the answer in writing, and share it with the doctor who prescribes your hormones.

Find out what the clinic needs from you

Requirements differ between surgeons, clinics and countries, and they change. Ask the clinic in writing what documentation it needs, from which professionals, in what language, and whether it has to be translated or notarised. Get the answer before you pay a deposit.

What your own country needs before it changes your legal documents is a separate question with its own rules. Having surgery abroad does not update anything at home automatically, so check before you travel.

Stop smoking

Smoking reduces blood flow to healing tissue and raises the risk that flaps and grafts fail. Stop well before surgery and stay stopped while you heal. Ask your surgeon when you need to stop, and whether that includes nicotine patches, gum and vaping.

Arrange your aftercare at home before you fly

Many problems after genital surgery appear in the weeks after you get home, when your surgeon is furthest away. Find a doctor at home who agrees, in advance, to see you afterwards. Agree with the clinic how you will reach them, how quickly they reply and who answers out of hours. Arrange somewhere to recover and someone to help you.

Before you travel

• Agree the operation, technique, stages and revision policy in writing.
• Finish hair removal, or have it well under way, if you are having a vaginoplasty.
• Complete any fertility preservation you want.
• Ask what to do with your hormone therapy, and do not change it until you have the answer.
• Tell your surgeon about every medicine and supplement you take, including anything that affects bleeding.
• Stop smoking and vaping.
• Send the clinic the documents it asked for, in the form it asked for.
• If you are having a vaginoplasty with a canal, ask for the dilation schedule in writing.
• Book time off that covers your whole recovery, not just the hospital stay.
• Find a doctor at home who will see you afterwards, and tell them what is being done.
• Arrange emotional support for afterwards as well as practical help.
• Do not book a tight return flight. Ask what happens, and who pays, if you are not fit to fly on the planned day.

Gender-affirming genital surgery is done under general anesthetic, and you stay in hospital rather than going straight to a hotel. Bowel preparation and stopping certain medicines are usually needed in the days before, and your surgeon will tell you exactly what to do. Expect a catheter, drains and dressings or packing at first, and limited movement for the first few days. It is normal to feel low for a while after an operation this size. It does not mean you made the wrong decision.

What to bring to the hospital

• Loose, comfortable clothes that are easy to put on without bending, and slip-on shoes.
• The underwear and pads your surgeon recommends for after the operation. Ask in advance.
• A list of every medicine you take, including hormone therapy, with doses.
• The documents the clinic asked for, and your surgeon's written plan.
• Your phone charger, and something to read or watch.
• Leave jewellery and valuables at home, and remove any piercings near the operation area.

The aftercare is what decides your result. For some operations it continues for the rest of your life, so know what it involves before you commit.

Dilation after a vaginoplasty

If you have a vaginoplasty with a canal, you will dilate for the rest of your life. It is frequent at first and becomes less frequent, but it never stops entirely. If you stop, the canal narrows and depth can be lost permanently. Ask for the schedule in writing before you travel, and be honest with yourself about whether it fits your life. A zero-depth vaginoplasty, without a canal, needs no dilation and is a reasonable choice in its own right.

Urinary care after phalloplasty or metoidioplasty

You go home with a catheter for a period, then learn how your new urethra works. A stream that weakens, sprays or becomes harder to start can be a sign of a narrowing called a stricture, so tell your surgeon early. Care of the donor site, and any later stages, continue over a long period.

Healing

• Follow the wound care and hygiene routine you are taught before discharge, and ask for it in writing too.
• Swelling and bruising take a long time to settle. What you see early on is not the result.
• Sensation returns slowly and unevenly over months. Numb patches early on are expected.
• Avoid heavy lifting, swimming, baths and sex until your surgeon clears you, and ask how and when you can sit.
• Ask before restarting hormone therapy if it was paused.
• Do not smoke while you heal.
• Low mood in the first weeks is common. Use the support you arranged before you went.

Going home

• Carry your operation note and discharge summary, in a language your own doctors read.
• Plan the journey: you will be sore, you should not lift luggage, and a long flight is harder than people expect. Ask your surgeon how to lower your risk of blood clots while you travel.
• Keep the clinic's contact details on paper as well as on your phone.
• See the doctor at home you arranged before you left, and tell the clinic early if something changes.

For what each operation involves, its risks and how to choose a surgeon, read our pages on gender-affirming genital surgery in Turkey and in Thailand.