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Gender Reassignment Surgery

Gender reassignment surgery (GRS) is a procedure that changes genital organs from one gender to another. Some transsexual people opt for reassignment surgery to better align their physical sexual characteristics with their gender identity, but it may also be performed on intersex people, often in infancy. GRS includes feminizing genitoplasty or penectomy, orchiectomy/orchidectomy, and vaginoplasty for trans women (male to female). In the case of trans men, genital reconstruction may involve either construction of a penis (phalloplasty) or metoidioplasty (an alternative to phalloplasty). To be more precise, penectomy is the complete (or sometimes partial) removal of the penis. Orchiectomy is the surgical removal of one or both testicles, or testes, in the human male. It is also called an orchidectomy, particularly in British publications.

Vaginoplasty is the surgical construction of a vagina through skin inversion. It involves removing the organs and erectile tissue of the penis. The skin and tissue is used to create a vaginal opening, clitoris, clitoral hood, and labia (lips).

Phalloplasty involves the construction of a penis using donor skin from other areas of the body. Depending on the type of phalloplasty procedure, skin is typically taken from the abdomen, groin/leg, and/or forearm and grafted onto the pubic area. Phalloplasty often involves a urethral lengthening procedure so that the patient can urinate through the penis. Erections are usually achieved with either a malleable rod implanted permanently or inserted temporarily in the penis, or with an implanted pump device.

Metoidioplasty-a surgical procedure developed in the 1970s-takes advantage of the fact that ongoing testosterone treatment in a trans man typically causes his clitoris to grow longer. The amount of clitoral growth varies with each individual, but it is not uncommon to see an increase in size to about the length of one's thumb. By cutting the ligament that holds the clitoris in place under the pubic bone, as well as cutting away some of the surrounding tissue, the surgeon is able to create a small phallus from the elongated clitoris.

Cost and Expectations

While for the man-woman conversion, the aesthetic-functional results may be described as satisfactory, the woman-man transformation continues to remain a true surgical challenge, whose results rarely fully satisfy the patient's expectations. In particular, penis reconstruction surgery today remains one of the most controversial surgical fields due to the difficulty of reaching optimal results from both an aesthetic and functional point of view. There currently does not exist a standard technique and frequent complications may arise, especially in the case when the reconstruction of the urinary tract is requested. Consequently, a calm assessment of the pros and cons becomes indispensable. An honest, transparent relationship between physician and patient plays a considerably important role.

Reassignment surgery in the United States can cost between $10,000 and $20,000, not including the additional cost of pre and post therapy. The therapies that may accompany the GRS are in fact numerous, costly, and lengthy, from hormonal therapy to the (many) forms of aesthetic surgery.

First, the transition must necessarily be accompanied by a hormonal treatment. The authorization of hormone replacement therapy (estrogens and anti-androgens for male to female (MtF) patients and androgens for female to male patients (FtM)) generally calls for a psychotherapeutic course, according to approaches that may vary significantly. The Harry Benjamin International Gender Dysphoria Association provides the following eligibility and readiness criteria for transgender adults seeking hormone therapy: legal age of majority (age 18 in the United States); demonstrable knowledge of what hormones can and cannot medically do and hormone benefits and risks; either real-life experience (RLE) of at least three months or a period of psychotherapy (usually at least three months) specified by a mental health professional.

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