gender reassignment surgery singapore price

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Gender Confirmation Surgery (GCS)

What is Gender Confirmation Surgery?

• Transfeminine Tr

Transmasculine Transition

• Traveling Abroad

Choosing a Surgeon

Gender confirmation surgery (GCS), known clinically as genitoplasty, are procedures that surgically confirm a person's gender by altering the genitalia and other physical features to align with their desired physical characteristics. Gender confirmation surgeries are also called gender affirmation procedures. These are both respectful terms.

Gender dysphoria , an experience of misalignment between gender and sex, is becoming more widely diagnosed.  People diagnosed with gender dysphoria are often referred to as "transgender," though one does not necessarily need to experience gender dysphoria to be a member of the transgender community. It is important to note there is controversy around the gender dysphoria diagnosis. Many disapprove of it, noting that the diagnosis suggests that being transgender is an illness.

Ellen Lindner / Verywell

Transfeminine Transition

Transfeminine is a term inclusive of trans women and non-binary trans people assigned male at birth.

Gender confirmation procedures that a transfeminine person may undergo include:

• Penectomy is the surgical removal of external male genitalia.
• Orchiectomy is the surgical removal of the testes.
• Vaginoplasty is the surgical creation of a vagina.
• Feminizing genitoplasty creates internal female genitalia.
• Breast implants create breasts.
• Gluteoplasty increases buttock volume.
• Chondrolaryngoplasty is a procedure on the throat that can minimize the appearance of Adam's apple .

Feminizing hormones are commonly used for at least 12 months prior to breast augmentation to maximize breast growth and achieve a better surgical outcome. They are also often used for approximately 12 months prior to feminizing genital surgeries.

Facial feminization surgery (FFS) is often done to soften the lines of the face. FFS can include softening the brow line, rhinoplasty (nose job), smoothing the jaw and forehead, and altering the cheekbones. Each person is unique and the procedures that are done are based on the individual's need and budget,

Transmasculine is a term inclusive of trans men and non-binary trans people assigned female at birth.

Gender confirmation procedures that a transmasculine person may undergo include:

• Masculinizing genitoplasty is the surgical creation of external genitalia. This procedure uses the tissue of the labia to create a penis.
• Phalloplasty is the surgical construction of a penis using a skin graft from the forearm, thigh, or upper back.
• Metoidioplasty is the creation of a penis from the hormonally enlarged clitoris.
• Scrotoplasty is the creation of a scrotum.

Procedures that change the genitalia are performed with other procedures, which may be extensive.

The change to a masculine appearance may also include hormone therapy with testosterone, a mastectomy (surgical removal of the breasts), hysterectomy (surgical removal of the uterus), and perhaps additional cosmetic procedures intended to masculinize the appearance.

Paying For Gender Confirmation Surgery

Medicare and some health insurance providers in the United States may cover a portion of the cost of gender confirmation surgery.

It is unlawful to discriminate or withhold healthcare based on sex or gender. However, many plans do have exclusions.

For most transgender individuals, the burden of financing the procedure(s) is the main difficulty in obtaining treatment. The cost of transitioning can often exceed $100,000 in the United States, depending upon the procedures needed.

A typical genitoplasty alone averages about $18,000. Rhinoplasty, or a nose job, averaged $5,409 in 2019.  

Traveling Abroad for GCS

Some patients seek gender confirmation surgery overseas, as the procedures can be less expensive in some other countries. It is important to remember that traveling to a foreign country for surgery, also known as surgery tourism, can be very risky.

Regardless of where the surgery will be performed, it is essential that your surgeon is skilled in the procedure being performed and that your surgery will be performed in a reputable facility that offers high-quality care.

When choosing a surgeon , it is important to do your research, whether the surgery is performed in the U.S. or elsewhere. Talk to people who have already had the procedure and ask about their experience and their surgeon.

Before and after photos don't tell the whole story, and can easily be altered, so consider asking for a patient reference with whom you can speak.

It is important to remember that surgeons have specialties and to stick with your surgeon's specialty. For example, you may choose to have one surgeon perform a genitoplasty, but another to perform facial surgeries. This may result in more expenses, but it can result in a better outcome.

A Word From Verywell

Gender confirmation surgery is very complex, and the procedures that one person needs to achieve their desired result can be very different from what another person wants.

Each individual's goals for their appearance will be different. For example, one individual may feel strongly that breast implants are essential to having a desirable and feminine appearance, while a different person may not feel that breast size is a concern. A personalized approach is essential to satisfaction because personal appearance is so highly individualized.

Davy Z, Toze M. What is gender dysphoria? A critical systematic narrative review . Transgend Health . 2018;3(1):159-169. doi:10.1089/trgh.2018.0014

Morrison SD, Vyas KS, Motakef S, et al. Facial Feminization: Systematic Review of the Literature . Plast Reconstr Surg. 2016;137(6):1759-70. doi:10.1097/PRS.0000000000002171

Hadj-moussa M, Agarwal S, Ohl DA, Kuzon WM. Masculinizing Genital Gender Confirmation Surgery . Sex Med Rev . 2019;7(1):141-155. doi:10.1016/j.sxmr.2018.06.004

Dowshen NL, Christensen J, Gruschow SM. Health Insurance Coverage of Recommended Gender-Affirming Health Care Services for Transgender Youth: Shopping Online for Coverage Information . Transgend Health . 2019;4(1):131-135. doi:10.1089/trgh.2018.0055

American Society of Plastic Surgeons. Rhinoplasty nose surgery .

Rights Group: More U.S. Companies Covering Cost of Gender Reassignment Surgery. CNS News. http://cnsnews.com/news/article/rights-group-more-us-companies-covering-cost-gender-reassignment-surgery

The Sex Change Capital of the US. CBS News. http://www.cbsnews.com/2100-3445_162-4423154.html

By Jennifer Whitlock, RN, MSN, FN Jennifer Whitlock, RN, MSN, FNP-C, is a board-certified family nurse practitioner. She has experience in primary care and hospital medicine.

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Entry #1945: Right to change legal gender in Singapore

Current version, revision history (2), edited by gerwynharry . copyedit, created by danlev.

• Status is not correct "In Islam, change of gender is prohibited. No surgery require unless that person born with 2 parts (male & female) on the body." Dec 13, 2021
• Status is not correct "illegal" Sep 13, 2018

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Gender Reassignment Surgery Cost (MTF & FTM)

Explore the rising demand for gender reassignment surgery worldwide. Learn about the various procedures and their detailed costs in this comprehensive article.

• Transgender Surgery

By Priyanka Dutta Deb

6th June '22

Gender reassignment surgery cost varies depending on the type of transition. 

• For male to female (MTF) transition, the cost ranges from $2438 to $6095 and  
• For female to male (FTM) transition, the cost falls between $4876 and $9752 .

When considering the cost of gender reassignment surgery, it's important to note that these figures encompass the surgical expenses alone. Additional costs, such as:

• pre-operative consultations
• post-operative care
• hospitalization may also be involved

For a precise cost estimate that aligns with your specific needs, it is highly recommended that you consult reliable healthcare providers or clinics.

Begin with clarity. Contact us for detailed cost insights now.

There are two broad types of gender reassignment surgery : top surgery and bottom surgery. The top surgery is performed for both people assigned female at birth (AFAB) and assigned male at birth (AMAB). 

• Male to female or non-binary (MTF/N): This procedure entails using saline or silicone implants to boost chest size and form for a more feminine or female appearance. Male-to-female top surgery is done under general anesthesia.
• Female to male or non-binary (FTM/N):  During FTM top surgery, breast tissue is removed and the chest is shaped to give the patient a flat, masculine, or male appearance. Following this, a nipple graft is planted to give a complete look .

Before we discuss each service's cost, let's take a quick look at overall transgender surgery costs in different countries.

You must be curious to know the gender change surgery cost of different surgical procedures. Let's read.

What is the Cost of Male-to-Female Top Surgery?

Breast augmentation or augmentation mammoplasty is another name for MTF and MTN top surgery. 

The MTF/N top surgery or breast augmentation surgery cost in India is around USD 1290 to USD 1940 . The surgeon's expertise and experience are two of the most critical aspects that affect the cost.

For the duration of the surgery, you will be put under general anesthesia. Your surgeon may choose different breast augmentation methods depending on your desired chest size, implant kind, and incision site. The average time for MTF and MTN top surgery is 1 to 2 hours .

The insertion cost and the implant cost are the two components of the surgery cost.

Navigating your options?  Contact us today for more information on cost!

What is the cost of female-to-male top surgery?

An FTM or FTN top surgery procedure takes from   1.5 to 4 hours . Various treatments are performed to get a more flat, masculine, or male-looking chest. Double incision, periareolar, and keyhole are the most popular procedures used by surgeons. 

The FTM top surgery cost ranges around USD 3870 .

Now that we have already discussed top surgery costs, let's take a look at how much mtf bottom surgery costs.

AFAB and AMAB people can undergo bottom surgery as part of their gender confirmation process. Bottom surgery involves transforming or reconstructing the bottom or genitalia. This involves Vaginoplasty, penile transplant , phalloplasty, and metoidioplasty.

What is the cost of male-to-female bottom surgery?

Vaginoplasty surgery is the major procedure performed in bottom surgery . There are three main options under Vaginoplasty. Penile inversion, non-penile inversion Vaginoplasty, and recto-sigmoid or colon graft.

The clitoris is moulded from the head/tip of the penis in all three surgical approaches. The Vaginoplasty cost is around USD 3870 to USD 4520.

Now, let's look at female to male bottom surgery cost.

What is the Cost of Female-to-Male Bottom Surgery?

This procedure involves the removal of the female organs in the lower region and reassigning them to male sexual parts. It includes removing the uterus, vaginal remodeling, labia reconstruction, metoidioplasty, and phalloplasty.

The whole procedure may cost somewhere around USD 5160 to USD 10,335 . 

To get a clearer picture of gender reassignment surgery cost, connect with us now .

What is the Cost of Facial Feminization Surgery?

Facial feminization surgery is a technique that involves changing your facial characteristics to make them appear more feminine. FFS is concerned with bone structure and nose shape. FFS is distinct for each person and can affect any part of the face or neck.

The facial feminization surgery cost is USD 1350 . 

What is Hormonal Replacement Cost?

Hormonal replacement therapy is for both MTF/N and FTM/N transitioning.

MTF/N: The hormones for a male-to-female transition enhance the alignment of your gender identity. It helps induce physical changes in your body produced by female hormones during puberty (gender congruence). Male secondary sex traits can be avoided if feminizing hormone therapy like progesterone is initiated before male puberty. The hormonal replacement therapy cost for MTF/N is USD 12/month.

FTM/N: You'll be administered the male hormone testosterone during masculinizing hormone therapy. It suppresses your menstrual cycles and lowers oestrogen synthesis in your ovaries.  The hormonal replacement therapy cost FTM/N is USD 7/month.

To make a more informed decision, talk to us today.

Factors affecting the cost of gender reassignment surgery:

• Hospital charges:  It depends on the type of hospital you choose. Moreover, the cost also depends on whether you are admitted to a general ward or a private room.
• Psychiatrist : If you need a psychiatrist to deal with your physical changes, your cost will impact you. A psychiatrist is recommended to understand better the complex procedures and adjustments you will need before and after your surgery.
• Clinical Experts and Surgeons : You will discuss the specifics of your gender change surgery with your doctor. It includes an assessment of your medical health status, discussing your long-term gender confirmation goals, and evaluating which procedures may be most appropriate to assist you in your journey. You can ask for specific details such as risks, benefits, and what to expect from the surgery.
• Medical Insurance:  Your medical insurance will play an essential role in the procedure, saving you a lot of money.
• Accommodation Charges:  The accommodation charges are included for international patients.
• Medication charges : These charges include all the medication you will receive before and after the procedure ends.
• Pre- and Post-treatment charges:  The pre-treatment charges include doctor consultation fees, diagnosis charges, etc. The post-treatment charges may include medicine costs, doctor's revisit charges, etc.

Your health is too important to ignore –  schedule your appointment now.

Do Insurance Companies Cover Gender Reassignment Surgery?

Yes, insurance companies that cover gender reassignment surgery! There is no legal prohibition for that. Not all employers provide insurance coverage to unmarried or live-in partners of straight employees. But, several organizations nowadays provide medical insurance to their employees' same-sex partners, including coverage for gender-reassignment surgery.

Some independent companies have made it a goal to try and incorporate this coverage into their medical insurance for employees.  

Note: This article is on the cost of gender reassignment surgery, and data about it is only for your informational purposes and is subject to change.  

1. Side effects of gender reassignment surgery

• Infections.
• Side effects of anesthesia.
• Difficulty in urinating.
• Severe complications in intestines.
• Leakage of urine through openings.
• Closure of vaginal opening.

2. Who typically undergoes gender reassignment surgery?

Gender reassignment surgery is typically undergone by individuals who experience gender dysphoria, a condition where an individual's gender identity does not match their assigned sex at birth. It is usually recommended as a last resort after other treatments such as therapy, hormone therapy, and social transition have been tried.

3. What are the types of gender reassignment surgery?

The two main types of gender reassignment surgery are "top surgery," which refers to surgeries that alter the chest and breast area, and "bottom surgery," which refers to surgeries that alter the genital area. Top surgery may involve a mastectomy, breast augmentation, or breast reduction. Bottom surgery may involve genital reconstruction, orchiectomy, metoidioplasty, or phalloplasty. 4. Do the costs vary for different types of gender affirmation procedures? Yes, the cost can vary based on the specific surgeries involved, such as chest or breast augmentation, facial feminization, or genital reconstruction. References: 

https://my.clevelandclinic.org/

Dr. Josef Hadeed Plastic Surgery | Beverly Hills & Los Angeles (josefhadeedmd.com)

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Transgender surgery – Knowledge gap among physicians impacti... : Current Urology (lww.com)

https://jamanetwork.com/journals/jamasurgery/fullarticle/2779429  

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Question and Answers

I am 22 years male. I have gender identity issues. I feel like I don’t fit to this gender.

It is a common thing for lots of people­ to feel they do not be­long to the gender the­y were given at birth. This is calle­d gender dysphoria. The signs might include­ feeling weird about your body, clothe­s, or pronouns people use for you. This happe­ns because your gende­r identity does not match the se­x you were marked at birth. Spe­aking to a therapist who gets gende­r identity can help you in finding ways to feel good and supporte­d. 

Answered on 2nd May '24

Dr. Vinod Vij

Will those who are transgender have children?

Transgende­r individuals face challenges in naturally conce­iving due to medical aspects. Those­ assigned female at birth and on hormone­ therapy may have lower fe­rtility. Those assigned male at birth typically cannot ge­t pregnant. Preserving e­ggs or sperm before transitioning may he­lp those wanting biological kids later. Consulting fertility e­xperts can help transge­nder people de­siring parenthood.

Answered on 19th Apr '24

Dr. Pradeep Mahajan

Currently I am a woman. Born on 17-09-1989. I want to transition from girl to boy. Is it possible? How much will it cost? And whether there are any physical complications later?

Female | 35

Going from girl to boy occurs when pe­ople take hormones and have­ operations. The total cost depe­nds on what treatments are chose­n. After, problems could be infe­ctions, scars, and fertility changes. Talking to a transgende­r doctor regarding options and risks is crucial.

Can transgender women get pregnant?

Transgender women who have had hormonal treatment and/or surgery may notice a drop in sperm count and fertility as a side effect of the process. But this scenario, when became the case, is an exception. Effective relationships between transgender women who wish to have a baby and a reproductive endocrinologist or fertility specialist are of utmost importance as they will provide them with advice and the needed support.

Answered on 5th Apr '24

After sex change body Ex vometing

Female | 20

In case you are experiencing vomiting after a sex change surgery, please consider medical attention. This could be a symptom of the complication, like an infection or medication intolerance. It is advisable to see a gender reassignment surgeon or a doctor who has dealt with transgender patients in the past. Do not delay seeking medical care.  

Answered on 21st Feb '24

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WORLD LEADER IN GENDER REASSIGNMENT SURGERY

The most advanced clinic in Europe

Gender reassignment surgery, what is gender reassignment surgery.

Gender reassignment surgery, confirmation surgery or sex reassignment surgery means a variety of procedures that allow people transition to their self-identified gender. These surgical treatments modify a physical person’s appearance and sexual characteristics to approach their identified gender.

The most common treatments are feminization surgeries are vaginoplasty, breast augmentation or facial aesthetic procedures. In the cases FTM, phalloplasty, breast reduction or facial masculinization operations are the most demanded surgeries.

Our gender affirming treatments and procedures

We offer a wide range of gender confirmation procedures to help our patients to achieve the results they are looking for, supporting and providing professional advice throughout the transformation process.

Feminisation surgery

MTF Vaginoplasty

Facial feminization

BREAST AUGMENTATION

MTF body surgery

FEMINIZING VOICE SURGERY

AESTHETIC MEDICINE

Masculinisation surgery.

Phalloplasty

Metoidioplasty

FTM top surgery

FTM Hysterectomy

Body Masculinization

OTHER MASCULINIZATION SURGERIES

Before and after gender-affirming surgery results.

Knowing the results of some sex reassignment surgeries could be helpful to make a decision and to have an idea about what to expect.

Dr. Ivan Mañero, a reference

Dr. Ivan Mañero, reconstructive and aesthetic plastic surgeon, is an international leader in gender affirmation surgery (ies) for trans people. He has been performing and perfecting gender reassignment surgeries for more than two decades, both inside and outside our borders.

His professionalism has led him to be internationally known and sought after, participating and moderating events in conferences. From the beginning of his professional career, he has always advocated for specialized and sensitive care for trans people. However, in the beginning, he had to deal with other peers who did not understand why a specialist like him cared about this matter.

A pioneer in unique surgical techniques for gender reassignment, Dr. Ivan Mañero has collaborated with various administrations to ensure that this type of a surgeries re included within the public health service in Spain. . In order to be able to offer greater and better care to trans people who require it.

The IM GENDER team, led by Dr Ivan Mañero, is a leading international reference in sex reassignment surgery and genital reassignment surgery.

World leader in gender reassignment surgery

The IM GENDER Gender Unit opened its doors over twenty years ago and has become an international benchmark in Gender Reassignment Surgery. IM GENDER has cared for more than 3,000 trans people who have decided to carry out some treatment or surgical procedure at the Unit, whether genital affirmation surgery – vaginoplasty, phalloplasty, metoidioplasty -, body surgery – mastectomy, breast augmentation, feminizing liposculpture, among others -, facial surgery – facial feminization, thyroplasty, masculinization of features, etc.- or other plastic surgery procedures.

IM GENDER offers all the advantages of IM CLINIC, a pioneering clinic for its concept of understanding healthcare in a global and personalized way. Our clinic confers differentiating characteristics that allow us to offer a high quality of care.

At IM GENDER you will find a clear commitment to the most cutting-edge and reliable technology, with technologically cutting-edge operating rooms and the most innovative equipment in the sector. All this, added to a medical team expert in gender surgery with more than two decades of experience led by Dr. Ivan Mañero, the most recognized plastic surgeon specialized in gender reassignment surgery in Europe and even internationally. In addition, Dr. Mañero was a pioneer in unique/specific surgical techniques for genital affirmation, such as vaginoplasty with graft.

The entire human team that makes up IM GENDER, from Patient Care to medical, health professionals, psychologists and physiotherapists, are trained in health care based on human rights, respect and privacy of all patients. Our goal is to offer all the necessary information before, during and after the surgery through close treatment and personalized attention.

YEARS OF EXPERIENCE

Im gender specialists.

THEIR EXPERIENCE COULD BE YOURS

Meet IM GENDER’s true stars and learn about their personal experiences, from preoperative consultations to postoperative follow-up care. Discover how our comprehensive approach to gender-affirming surgery, (ies) coupled with our psychological support and family guidance, has made a difference in their lives.

At IM GENDER, we understand that every patient’s journey is unique, and we are committed to providing personalised care that caters to individual needs. Our testimonials are a testament to our dedication to patient satisfaction, and we are proud to share the stories of our satisfied clients with you.

We invite you to explore our website and learn more about our services, team, and testimonials. Our team is available to answer any questions or concerns you may have and to help you start your journey towards gender affirmation.

REQUEST AN APPOINTMENT

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IM CLINIC  FACILITIES

IM GENDER is the Gender Unit at IM CLINIC, one of the most advanced sex reassignment surgery centers Internationally. A new concept of clinic born from our commitment to experience in the field. IM GENDER is a team of highly qualified professionals, who all believe in the same philosophy of exquisite patient care.

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Medindia » Articles » Procedure » Gender-Reassignment Surgery: Everything You Need to Know

Gender-Reassignment Surgery: Everything You Need to Know

• Indications

Non-Surgical Procedures

• Surgical Procedures

Risks in Non-Surgical and Surgical Procedures

• Whom to consult?
• Pre-Op Considerations
• Post-Op Considerations

Impact on Mental Health

• Cost of the Surgery

Gender reassignment surgery, also known as gender-affirming surgery, is a medical procedure or series of procedures aimed at altering an individual's physical appearance and sexual characteristics to align with their gender identity.

In Simple words, it can be defined as the alteration of a person's physical sex characteristics by surgery in order to match the person’s gender identity

This transformative process is often pursued by transgender individuals, as well as some cisgender and non-binary individuals. It involves various surgical interventions to modify primary and secondary sexual characteristics, thereby affirming an individual's gender identity( 1 ✔ ✔ Trusted Source Sex Reassignment Surgery in the Female-to-Male Transsexual Go to source ).

Alternative Names for Gender-Affirming Surgery

• Gender reassignment surgery (GRS)
• Gender-affirmation surgery
• Gender confirmation surgery
• Sex reassignment surgery

Who Can Get Gender Reassignment Surgery?

Transgender individuals.

Transgender individuals are those whose gender identity differs from the sex they were assigned at birth. Many transgender individuals experience gender dysphoria, a condition characterized by distress or discomfort caused by a misalignment between their gender identity and physical body. Gender reassignment surgery is often sought by transgender individuals as part of their transition journey to alleviate gender dysphoria and align their physical appearance with their gender identity.

Trans Women: Assigned male at birth but identify and live as women. Trans women may pursue feminizing surgeries such as vaginoplasty (creation of a vagina), breast augmentation, facial feminization surgery, and voice feminization surgery to affirm their gender identity.

Trans Men: Assigned female at birth but identify and live as men. Trans men may undergo masculinizing surgeries such as chest reconstruction (removal of breast tissue), hysterectomy (removal of the uterus), and phalloplasty or metoidioplasty (creation of a penis) to align their bodies with their gender identity.

Intersex Individuals

Intersex is a term used to describe individuals who are born with variations in their biological sex characteristics (chromosomes, gonads (testes/ovaries), reproductive organs (prostate/uterus) or external genitalia (penis/clitoris)) that do not fit typical definitions of male or female..

Intersex Individuals with Gender Dysphoria: While intersex individuals can be transgender if their gender identity does not match the sex they were raised or assigned as, some intersex individuals may experience distress or discomfort, known as gender dysphoria , due to a misalignment between their gender identity and assigned sex characteristics, and seek gender-affirming surgery to align their physical appearance with their gender identity( 2 ✔ ✔ Trusted Source Gender Affirmation Surgeries Go to source ).

Drag Performers

Drag performers are individuals who utilize clothing, makeup, and performance art to explore and celebrate gender expression. They are typically associated with a gender different from their own. These performers engage in drag for various reasons, including self-expression, artistic exploration, and entertainment purposes.

While some drag performers may identify as transgender or non-binary and use drag as a form of self-expression or exploration of their gender identity, others may identify as cisgender and engage in drag purely for entertainment or artistic expression.

Drag Queens and Drag Kings : Drag queens are typically male individuals who dress in feminine attire and adopt exaggerated female personas for performance. Drag kings, on the other hand, present as male or masculine while performing. While some drag performers may identify as transgender and may ultimately pursue gender-affirming surgeries, the act of performing drag does not inherently imply a desire for surgical intervention.

Individuals with Klinefelter Syndrome

Klinefelter syndrome is a chromosomal condition in which individuals are born with an extra X chromosome (XXY), resulting in differences in sexual development and often leading to infertility and other physical characteristics such as tall stature, reduced muscle mass, and gynecomastia (enlarged breast tissue in males)( 4 ✔ ✔ Trusted Source Klinefelter syndrome Go to source ).

While not directly related to transgender identity, some individuals with Klinefelter syndrome may experience gender dysphoria and seek gender-affirming treatments, including surgery. These individuals may undergo procedures to modify their physical characteristics to better align with their gender identity and alleviate distress associated with gender dysphoria.

Non-Binary Individuals

"Non-binary" is a term used to describe individuals whose gender identity does not exclusively align with the categories of male or female. This is a deeply personal and internal sense of one's own gender. Non-binary individuals may identify as both, neither, a combination of both, or as a gender entirely different from male or female.

Bigenital Operation: Bigenital operations allow individuals to construct a penis or vagina and retain their original organs. Some non-binary individuals may opt for these surgeries to achieve a physical presentation that aligns with their gender identity while maintaining aspects of their original anatomy. These surgeries cater to the diverse spectrum of gender identities and expressions and provide options for individuals who do not fit within the traditional binary understanding of gender.

"Cisgender" is a term used to describe individuals whose gender identity aligns with the sex they were assigned at birth. In other words, someone who is cisgender identifies as the gender typically associated with the biological sex they were born with. For example, a person who was assigned female at birth and identifies as a woman is considered cisgender. The term "cisgender" is often used in contrast to "transgender," which describes individuals whose gender identity differs from the sex they were assigned at birth

While gender dysphoria is often associated with transgender individuals, cisgender people can also experience it. In some cases, cisgender individuals with severe gender dysphoria may seek gender-affirming surgeries to alleviate their distress and bring their physical appearance into alignment with their gender identity. These surgeries are typically pursued after extensive evaluation and therapy, and they can significantly improve the mental health and well-being of individuals experiencing gender dysphoria.

Is Gender Dysphoria the only Reason for Gender Reassignment Surgery?

No, not only gender dysphoric individuals seek gender reassignment surgery. While gender dysphoria is a common reason why individuals pursue gender-affirming surgeries, it's not the only factor. Some people may choose to undergo these surgeries for reasons beyond alleviating distress associated with gender dysphoria.

For example, individuals with intersex variations may seek gender-affirming surgeries to align their physical appearance with their gender identity, even if they do not experience gender dysphoria. Similarly, some non-binary individuals may opt for surgeries to achieve a physical presentation that better aligns with their gender identity, regardless of whether they experience gender dysphoria.

Furthermore, some cisgender individuals may also undergo gender-affirming surgeries for reasons related to body dysmorphia or dissatisfaction with their physical appearance, rather than gender dysphoria.

Ultimately, the decision to pursue gender reassignment surgery is deeply personal and can be influenced by a variety of factors beyond gender dysphoria alone.

Hormonal injections is the only available non-surgical procedure.It isa form of hormone replacement therapy (HRT) commonly used in transgender healthcare to induce and maintain desired physical changes consistent with an individual's gender identity.

These injections typically involve the administration of testosterone for transmasculine individuals (female-to-male, or FtM) and estrogen for transfeminine individuals (male-to-female, or MtF).

Testosterone Injections (for Transmasculine Individuals)

Purpose : Testosterone injections are administered to induce masculine changes, such as increased facial and body hair growth, deepening of the voice, muscle development, and redistribution of body fat.

Types of Testosterone : There are different formulations of testosterone available for injection, including testosterone cypionate, testosterone enanthate, and testosterone undecanoate.

Administration : Testosterone injections are typically administered intramuscularly (into the muscle) in either the gluteal (buttocks) or deltoid (upper arm) muscle.

Dosage and Frequency : The dosage and frequency of testosterone injections can vary depending on individual factors such as age, weight, hormone levels, and desired changes. Typically, injections are administered every one to two weeks to maintain stable testosterone levels in the body.

Monitoring : Regular monitoring of hormone levels, liver function, and other relevant markers is essential to ensure the safety and effectiveness of testosterone therapy. Blood tests may be conducted periodically to assess hormone levels and adjust the dosage as needed.

Estrogen Injections (for Transfeminine Individuals)

Purpose : Estrogen injections are administered to induce feminine changes, such as breastdevelopment, redistribution of body fat, softening of the skin, and reduction of muscle mass.

Types of Estrogen : The most common form of estrogen used in injections is estradiol valerate.

Administration : Estrogen injections are typically administered intramuscularly, similar to testosterone injections, in the gluteal or deltoid muscle.

Dosage and Frequency : The dosage and frequency of estrogen injections vary depending on individual factors and treatment goals. Typically, injections are administered every one to two weeks.

Monitoring : Regular monitoring of hormone levels, liver function, and other relevant parameters is crucial for ensuring the safety and effectiveness of estrogen therapy. Blood tests may be conducted periodically to assess hormone levels and adjust the dosage as needed.

Time Frame of Use of Hormonal Injections

Initiation : Hormonal injections are often initiated after a thorough evaluation by healthcare providers, including discussions about treatment goals, potential risks and benefits, and informed consent. The timing of initiation may vary depending on individual factors such as age, readiness for treatment, and presence of any underlying health conditions.

Duration : Hormonal injections are typically used as part of long-term hormone replacement therapy to maintain desired physical changes and support overall well-being. The duration of hormone therapy may vary from individual to individual and often continues indefinitely, especially for those who desire ongoing maintenance of gender-affirming changes.

Discontinuation : In some cases, individuals may choose to discontinue hormonal injections for various reasons, such as personal preference, changes in health status, or the achievement of desired physical changes. It's essential for individuals to discuss any plans to discontinue hormone therapy with their healthcare provider to ensure proper management of any potential effects or complications.

Surgical Procedures: Gender Affirming Surgery

These surgical procedures play vital roles in gender affirmation for transgender individuals, aligning their physical appearance with their gender identity( 3 ✔ ✔ Trusted Source Gender Confirmation Surgery Go to source ).

Male-to-Female (MtF) Transitions:

• Tracheal Shave: This procedure reduces the prominence of the Adam's apple, a typically male characteristic, to create a smoother, more feminine neck contour.
• Breast Augmentation: Transfeminine individuals undergo breast augmentation to develop fuller, more feminine breast contours. Breast implants are placed behind breast tissue or chest muscle to achieve the desired size and shape.
• Facial Feminization Surgery (FFS): FFS encompasses various surgical procedures aimed at feminizing facial features. Techniques may include forehead contouring, rhinoplasty , cheek augmentation, chin and jaw reshaping, tracheal shave, lip augmentation, and hairline lowering to achieve a more traditionally feminine appearance.
• Male-to-Female Genital Sex Reassignment (Vaginoplasty): This surgical procedure constructs female genitalia for transfeminine individuals seeking alignment with their gender identity. Techniques involve using penile and scrotal tissue to create the vaginal canal, labia, and clitoral hood. The procedure may also include the creation of a neurovascular neoclitoris, providing both aesthetic and functional female genitalia in one operation.

Female-to-Male (FtM) Transitions:

• Hysterectomy and Oophorectomy: This procedure involves the removal of the uterus and ovaries, reducing the production of female hormones (estrogen and progesterone).
• Vaginectomy: Vaginectomy is the surgical removal of the vaginal canal, aligning the physical anatomy with a masculine appearance.
• Chest Reconstruction (Top Surgery): FtM individuals undergo chest reconstruction surgery to remove breast tissue and reshape the chest to achieve a more masculine contour. Techniques include subcutaneous mastectomy or double mastectomy with or without nipple reconstruction.
• Female-to-Male Genital Sex Reassignment (Phalloplasty): Phalloplasty is a surgical procedure to construct a phallus for FtM individuals seeking male genitalia. The radial forearm flap method is commonly used, involving tissue grafting from the forearm to create the phallus and urethra for standing urination. This procedure can be performed concurrently with a hysterectomy/vaginectomy to complete the transition process. A scrotum with testicular implants may be constructed in a second stage.

These surgical interventions are integral to gender affirmation for transgender individuals, helping align their physical appearance with their gender identity and alleviating gender dysphoria. Each procedure is tailored to the individual's unique needs and goals, reflecting the diversity of experiences within the transgender community.

Risks in Hormone Therapies

• Cardiovascular Risks : Hormone replacement therapy (HRT) may increase the risk of cardiovascular events such as heart attacks and strokes, especially in older individuals or those with pre-existing cardiovascular conditions.
• Thromboembolic Events : Estrogen therapy, particularly in forms like oral contraceptives, may elevate the risk of blood clots, leading to thromboembolic events such as deep vein thrombosis (DVT) or pulmonary embolism (PE).
• Endocrine Disruption : Hormone therapies can disrupt the body's natural hormone balance, leading to potential complications such as metabolic disturbances, including insulin resistance and dyslipidemia.
• Breast Cancer Risk : Some studies suggest that long-term use of hormone replacement therapy, especially estrogen-only formulations, may increase the risk of breast cancer in transgender women.
• Liver Dysfunction : Hormone therapies, particularly oral estrogen formulations, may affect liver function and increase the risk of liver disease or dysfunction.

Risks in Gender Reassignment Surgeries

• Surgical Complications : As with any surgical procedure, gender reassignment surgeries carry risks such as infection, bleeding , anesthesia complications, and adverse reactions to medications.
• Scarring : Gender-affirming surgeries, especially those involving breast augmentation, chest reconstruction, or genital reconstruction, may result in visible scarring that could impact body image and self-esteem.
• Loss of Sensation : Surgeries involving genital reconstruction, such as vaginoplasty or phalloplasty, may result in loss of sensation or altered sensation in the genital region, affecting sexual function and satisfaction.
• Functional Complications : Some individuals may experience functional complications post-surgery, such as urinary incontinence , erectile dysfunction, or difficulties with sexual arousal or orgasm.
• Psychological Impact : Gender reassignment surgeries can have profound psychological effects, including adjustment difficulties, post-operative depression, and challenges related to body image and identity.

Guidance on Surgical Procedures: Whom to Consult?

When contemplating gender reassignment surgery, it's essential for individuals to consult with a team of experienced healthcare providers specializing in transgender care. Here's whom to consider consulting:

1. Gender-Affirming Surgeons

Gender-affirming surgeons specialize in performing gender reassignment surgeries and have expertise in various surgical techniques, including chest surgery (for both masculinization and feminization procedures), genital reconstruction, and facial feminization surgery. These surgeons can provide comprehensive information about the surgical options available, discuss the potential risks and benefits, and guide individuals through the decision-making process.

2. Endocrinologists

Endocrinologists play a crucial role in managing hormone therapy for transgender individuals. They can provide guidance on hormone replacement therapy (HRT), including the use of testosterone for transmasculine individuals and estrogen for transfeminine individuals. Endocrinologists can assess hormone levels, monitor any potential side effects, and adjust hormone regimens as needed to support the transition process.

3. Mental Health Professionals

Mental health professionals, such as psychologists, psychiatrists, or licensed therapists, offer invaluable support throughout the gender transition journey. They can assist individuals in exploring their gender identity, coping with gender dysphoria, and addressing any psychological concerns or challenges that may arise before, during, or after surgery. Mental health professionals also play a role in assessing readiness for surgery and providing pre- and post-operative counseling and support.

4. Primary Care Physicians

Primary care physicians are essential members of the healthcare team and can provide general medical care, coordinate referrals to specialists, and monitor overall health and well-being. They can also assist with managing any pre-existing medical conditions and ensuring that individuals are physically fit for surgery.

5. Support Groups and Advocacy Organizations

Support groups and advocacy organizations within the transgender community can offer valuable peer support, resources, and information about gender-affirming surgeries. These groups provide opportunities for individuals to connect with others who have undergone similar experiences, share insights, and seek guidance from those who have navigated the transition process.

Consulting with a multidisciplinary team of healthcare providers ensures that individuals receive comprehensive care tailored to their unique needs and goals. This collaborative approach helps individuals make informed decisions about gender reassignment surgery and supports their overall health and well-being throughout the transition process.

Pre-operative Considerations

1. Medical Considerations

Transgender individuals may have preexisting health conditions like diabetes , asthma , or HIV, which can impact their eligibility for surgery and postoperative care. Surgeons often consult with endocrinologists to assess the patient's physical fitness for surgery, especially considering the complex medication regimens involved in hormone therapy before and after surgery.

2. Fertility Concerns

Patients considering sex reassignment surgery (SRS) are informed about potential infertility, particularly if procedures like orchiectomy or oophorectomy are performed as part of the transition process. Preservation of fertility options may be discussed before surgery.

3. Age and Consent

SRS is generally not performed on children under 18, with rare exceptions made for adolescents based on healthcare provider assessments and potential benefits or risks. Consent from parents or legal guardians is required, along with long-term mental health counseling to confirm persistent gender dysphoria.

4. Intersex and Trauma Cases

Infants born with intersex traits may undergo surgical interventions at or near birth, raising ethical concerns about human rights implications. Trauma cases also require careful consideration, as surgically assigned gender may not align with the individual's gender identity, leading to negative outcomes later in life.

5. Standards of Care

Many regions follow Standards of Care for the Health of Transgender and Gender Diverse People (SOC), such as those published by the World Professional Association for Transgender Health (WPATH). These guidelines outline minimum requirements for treatment, including psychological evaluation and living as the desired gender before surgery.

6. Insurance Coverage

Obtaining insurance coverage for SRS may require documented assessments by mental health professionals, evidence of persistent gender dysphoria, and completion of physician-supervised hormone therapy for a specified duration.

Post-operative Considerations

1. Quality of Life and Physical Health

Studies assessing postoperative quality of life vary, with some reporting similar quality to control groups while others note lower quality in domains of health and limitations. Overall, many individuals report improvements in mental health, satisfaction with physical appearance, and overall well-being after surgery.

2. Psychological and Social Consequences

SRS has been shown to be effective in relieving gender dysphoria, though some studies highlight methodological limitations. Patients often report reduced anxiety, depression , and hostility levels post-surgery, with improvements in self-perceived physical and mental health.

3. Sexuality and Sexual Satisfaction

SRS can significantly impact individuals' sexual experiences and satisfaction. Most transsexual individuals report enjoying better sex lives and improved sexual satisfaction after surgery, with changes in orgasm frequency, intensity, and masturbation habits observed. However, satisfaction levels may vary between trans men and trans women, and expectations for sexual aspects of life may differ from cisgender individuals.

4. Continued Support

Comprehensive postoperative care involves ongoing psychological support, management of any complications, and assistance with adjustment to physical changes. Social support networks play a crucial role in helping individuals navigate their post-surgical experiences and integrate their gender identities into their daily lives.

The denial or limited access to gender-affirming surgeries can have severe consequences for the mental health and well-being of transgender individuals.

1. Persistent Gender Dysphoria

Without access to surgery, transgender individuals may continue to experience intense distress and discomfort due to the misalignment between their gender identity and physical characteristics. This persistent gender dysphoria can lead to heightened anxiety, depression, and a sense of hopelessness.

2. Heightened Anxiety

Living in a body that does not align with one's gender identity can contribute to persistent anxiety. The frustration of being unable to access necessary medical care and the ongoing struggle to navigate societal expectations can exacerbate feelings of stress and worry.

3. Increased Depression

Untreated gender dysphoria and the inability to undergo gender-affirming surgeries can lead to deepening feelings of depression and despair. Transgender individuals may struggle with low self-esteem, feelings of worthlessness, and a sense of isolation from not being able to live authentically.

4. Social Withdrawal

The distress caused by the incongruence between one's gender identity and physical appearance can result in social withdrawal and avoidance of social interactions. Transgender individuals may feel ashamed or uncomfortable in social settings, leading to further isolation and loneliness.

5. Suicidal Ideation

The lack of access to gender-affirming surgeries and the ongoing struggle with gender dysphoria can significantly increase the risk of suicidal thoughts and behaviors. Without the hope of being able to live authentically and alleviate their distress, transgender individuals may experience profound feelings of hopelessness and desperation.

Click here to know more about Mental health in transgender community

Affordable Surgery Options

Gender-affirming surgeries, including gender reassignment surgery (GRS), vary widely in cost globally. Affordable options exist in countries like Turkey, Brazil, Argentina, and Belgium. Turkey offers the most budget-friendly option, followed by Brazil, Argentina, and Belgium. While these countries provide competitive prices, individuals should consider factors beyond cost, such as healthcare quality and legal protections.

Click here for detailed information on the global cost of these surgeries and to find out which options are more affordable

In summary, gender reassignment surgery serves as a vital tool in validating the gender identities of transgender and intersex individuals, enabling them to harmonize their external appearance with their innate sense of self. Despite its transformative potential, many face obstacles in accessing this essential care, including financial constraints, inadequate insurance coverage, and legal hurdles.

As society progresses towards greater awareness and acceptance of transgender rights, it's imperative to prioritize equitable access to gender-affirming treatments and offer unwavering support to individuals throughout their transition journey. By dismantling these barriers and fostering inclusivity within healthcare systems, we can empower transgender individuals to live authentically and flourish in their gender identity.

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• Sex Reassignment Surgery in the Female-to-Male Transsexual - (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3312187/)
• Gender Affirmation Surgeries - (https://www.hopkinsmedicine.org/health/wellness-and-prevention/gender-affirmation-surgeries)
• Gender Confirmation Surgery - (https://www.uofmhealth.org/conditions-treatments/transgender-services/gender-confirmation-surgery)
• Klinefelter syndrome - (https://www.nhs.uk/conditions/klinefelters-syndrome/)

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Gender-affirming care encompasses a broad range of psychological, behavioral and medical treatments for transgender, nonbinary and gender-nonconforming people.

The care is designed to “support and affirm an individual’s gender identity” when it is at odds with the sex they were assigned at birth, as defined by the World Health Organization.

What is gender-affirming surgery?

Gender-affirming surgery refers to the surgical and cosmetic procedures that give transgender and nonbinary people “the physical appearance and functional abilities of the gender they know themselves to be,” according to the American Society of Plastic Surgeons. It is sometimes called gender reassignment surgery.

There are three main types of gender-affirming surgeries, per the Cleveland Clinic:

Top surgery , in which a surgeon either removes a person’s breast tissue for a more traditionally masculine appearance or shapes a person’s breast tissue for a more traditionally feminine appearance. 

Bottom surgery , or the reconstruction of the genitals to better align with a person’s gender identity.

Facial feminization or masculinization surgery , in which the bones and soft tissue of a person’s face are transformed for either a more traditionally masculine or feminine appearance.   

Some people who undergo gender-affirming surgeries also use specific hormone therapies. A trans woman or nonbinary person on feminizing hormone therapy, for example, takes estrogen that’s paired with a substance that blocks testosterone. And a trans man or nonbinary person on masculinizing hormone therapy takes testosterone.

Gender-affirming surgeries and treatments are the recommended course of treatment for gender dysphoria by the American Medical Association. Gender dysphoria is defined as “clinically significant distress or impairment related to gender incongruence, which may include desire to change primary and/or secondary sex characteristics,” according to the American Psychiatric Association.

Some LGBTQ+ advocates and medical professionals feel that gender dysphoria shouldn't be treated as a mental disorder, and worry that gender dysphoria’s inclusion in the DSM-5 — the authoritative source on recognized mental health disorders for the psychiatric industry — stigmatizes trans and nonbinary people.

How much does gender-affirming surgery cost?

Gender-affirming surgery can cost between $6,900 and $63,400 depending on the precise procedure, according to a 2022 study published in The Journal of Law, Medicine and Ethics.

Out-of-pocket costs can vary dramatically, though, depending on whether you have insurance and whether your insurance company covers gender-affirming surgeries.

There are also costs associated with the surgery that may not be represented in these estimates. Additional costs may include:

Surgeons fees

Hospital fees

Consultation fees

Insurance copays

The cost of psychiatric care or therapy, as most insurance companies and surgeons require at least one referral letter prior to the surgery. An hour of therapy can cost between $65 and $250, according to Good Therapy, an online platform for therapists and counselors. 

Time off work. After bottom surgery, you can expect to miss six weeks of work while recovering. Most people miss around two weeks of work after top surgery. 

Miscellaneous goods that’ll help you recover. For example, after bottom surgery, you might need to invest in a shower stool, waterproof bed sheets, cheap underwear and sanitary towels. Top surgery patients may need, depending on the procedure, a mastectomy pillow, chest binder and baggy clothes.

Is gender-affirming surgery covered by insurance?

It’s illegal for any federally funded health insurance program to deny coverage on the basis of gender identity, sexual orientation or sexual characteristics, per Section 1557, a section of the Affordable Care Act. Section 1557 doesn’t apply to private insurance companies, though, and several U.S. states have passed laws banning gender-affirming care.

The following states have banned gender-affirming surgery for people under 18 years old, according to the Human Rights Campaign: Alabama, Arkansas, Florida, Georgia, Idaho, Indiana, Iowa, Kentucky, Louisiana, Mississippi, Missouri, Montana, Nebraska, North Carolina, North Dakota, Oklahoma, South Dakota, Tennessee, Texas, Utah, West Virginia. In four of these states — Alabama, Arkansas, Florida and Indiana — court injunctions are currently ensuring access to care.

And these states have either passed laws — or have governors who issued executive orders — protecting access to gender-affirming surgery, according to the Movement Advancement Project, a public policy nonprofit: California, Colorado, Connecticut, Illinois, Maryland, Massachusetts, Minnesota, New Jersey, New Mexico, New York, Oregon, Vermont and Washington, D.C.

But even if your state has enshrined protections for gender-affirming care, some private insurance companies may consider surgeries “cosmetic” and therefore “not medically necessary,” according to the Transgender Legal Defense and Education Fund. If you have private insurance or are insured through your employer, contact your insurance company and see if they cover gender-affirming care. Also, ask about any documentation the insurance company requires for coverage.

The Williams Institute estimates that 14% of trans Americans currently enrolled in Medicaid live in states where such coverage is banned, while another 27% of trans Americans live in states where coverage is “uncertain,” because their state laws are “silent or unclear on coverage for gender-affirming care.”

Because of Section 1557, Medicaid is federally banned from denying coverage on the basis of sex or gender; among the roughly 1.3 million transgender Americans, around 276,000 have Medicaid coverage, according to a 2022 report from the Williams Institute.

How to pay for gender-affirming surgery

If your private insurance company won’t cover gender-affirming care, and you’re unable to obtain coverage through the federal marketplace, consider these sources:

Online personal loan.

Credit union personal loan.

Credit card.

CareCredit.

Home equity line of credit.

Family loan.

There are also several nonprofits that offer financial assistance for gender-affirmation surgeries. Those organizations include:

Point of Pride , which offers grants and scholarships to trans and nonbinary people seeking gender-affirming surgery and care.

The Jim Collins Foundation , which raises money to fund gender-affirming surgeries. 

Genderbands , which offers grants for gender-affirming surgeries and care. 

Black Transmen Inc. , which funds gender-affirming surgeries for Black trans men. 

On a similar note...

Gender-affirming care for minors

In Singapore, gender-affirming care for minors (under 21) requires the consent of both parents, even if those parents are separated.

Exceptions may be made for extraordinary circumstances (e.g. if one or both parents are dead or mentally incapacitated).

There is no minimum age to be evaluated by a psychiatrist for gender dysphoria (which is required for HRT), although parental consent will be required for those under 18.

After receiving a diagnosis of gender dysphoria, trans youths with both parents’ consent can access HRT through private healthcare if they are above 16, and through public healthcare if they are above 18.

Obtaining gender-affirming care for minors

The private healthcare route.

• If you have your parents’ support and they can afford it, you can visit a private psychiatrist to be evaluated for gender dysphoria. This will likely require several sessions, with each costing a few hundred dollars. Some psychiatrists are also able to speak with your parents to explain what it means to be transgender and address concerns they may have.
• Once your psychiatrist has deemed you suitable to begin HRT, you can then visit a private endocrinologist. Note that private endocrinologists may have their own age requirements.
• If you are above 18, you can also bring the psychiatrist’s diagnosis to a public hospital endocrinologist (via a polyclinic referral if you are a Singapore Citizen or PR), but results may vary as they may not accept diagnoses from private psychiatrists.

Through the public healthcare route

• HRT approval for trans youths under 21 is much stricter, especially given the global climate with regards to transitioning for trans youths. You will be subject to a lot more evaluation than trans adults, and there are people who have been rejected for HRT despite having both parents’ consent.
• If you are under 18, you may receive a diagnosis but will need to wait until 18 before you can begin HRT even if both parents approve.
• If your parents do not consent to HRT, you can still use these appointments later on as supporting documentation to gain accommodations (e.g. for National Service)

Puberty blockers

A minority of transgender youth who desire medical transition and who have been assessed by doctors as suitable candidates for treatment may choose to undergo temporary puberty suppression with puberty blockers. This will solely halt the development of secondary sex characteristics, allowing them time to physically and mentally mature before making the irreversible decision to undergo either typical male or female puberty.

Subsequent HRT will then allow them to develop bodies that – genitalia aside – are phenotypically identical to others of their gender. Trans women will be able to retain high voices; trans men will not have to grow breasts. Both will develop the height, musculature and skeletal structure typical for their identified gender. This eliminates most sources of body dysphoria, increasing quality of life. It will also make it much easier for them to blend into society, significantly reducing their risk of discrimination, abuse and violence and give them the ability to live a normal life, should they so choose.

At this point, assessments are rigorous enough that roughly 98% of these youths persist in trans identification as adults, indicating that non-treatment is far more likely to do harm than good, and allaying common fears that many may cease to be trans in adulthood.

The remaining 2% include those who are still trans but have decided not to medically transition at that point, those who realise they are non-binary, and a few who no longer consider themselves trans. These youths can then go off the blockers and proceed with regular puberty, retaining their fertility, and will likewise look no different from others of their sex.

A large scale study of 20,619 transgender adults aged 18-36 found that past access to pubertal suppression, for the 16.9% who desired them (2.5% of that subset had access), was associated with reduced lifetime suicide ideation and improved mental health outcomes.

Prior long-term studies of transgender youth who undergo puberty blockers treatment have consistently produced extremely positive results. In one study , 55 transgender youth were monitored over a period of about 8 years from the administration of puberty blockers at an average age of 13 to hormone therapy at ~17 to surgery at ~21, after which they scored equal or better on assessments of mental health compared to their non-trans peers. This is especially significant in light of the astronomical rate of mental illness and suicide that has long been observed in transgender youth denied treatment until adulthood.

As with all medication, there is a risk of side effects. Each youth’s individual health profile, existing conditions and family medical history are thus also taken into consideration alongside the severity of dysphoria and other concerns. These risks may need to be separately monitored and managed as appropriate.

Side effects are more common with extended use of puberty blockers over many years, as is the case for children with precocious puberty, and it is not recommended to be on them for more than 2-3 years. Where a youth has been on puberty blockers for several years or experienced concerning side effects, had found relief from dysphoria through the blockers, and has expressed a strong and persistent gender identity across many years that shows no sign of changing, earlier access to HRT may be considered appropriate on a case-by-case basis.

Puberty blockers are not available in Singapore for transgender youths in the public health system. For information on how you can obtain puberty blockers through a private specialist, reach out to us at [email protected] .

Things to consider for trans youth

There is no single “right” way to transition.

Some trans people experience little or no body dysphoria and are content with social transition without medical intervention. This is especially common for those who are non-binary.

If this is the case for you, and you are happy with your body as it is, you should never feel pressured to pursue HRT out of the belief that it is what a trans person “should” do. The goal of transition is for you to be comfortable with your body and identity.

If you are happy with yourself as you are but feel that you need to look a certain way to be taken seriously as your gender, that is a valid concern, but should not be the basis for medical decisions. Consider speaking about this with a counsellor, or find other ways to influence how others see you – such as through make-up (for trans girls and other transfemmes) or working out (for trans boys and other transmascs), or even explicit indicators like pronoun pins. For trans youths, this – alongside clothing, hairstyles and mannerisms – may be sufficient for you to be perceived as your gender.

Socially, trans students in Singapore face immense challenges within the school system and are unlikely to be accommodated on issues of uniform and toilet access. If you are presently enrolled in a local public school, you may wish to consider options like withholding your transition until after graduation, living as your gender only among friends or outside of school, or going on HRT without full social transition if your dysphoria is too severe.

• This could look like a trans girl going on HRT to ease her dysphoria and coming out to friends and classmates, while continuing to wear the boys’ uniform at school. This is often harder for trans boys, who would stand out more in the girls’ uniform if they are on HRT, but some schools are willing to make accommodations to allow PE uniforms instead.

If you legally change your name, you can update your name in your school records and be addressed as such. Schools would otherwise continue to refer to you by your legal name, which would also be the name that appears in your transcripts and certificates.

International schools are known to be more accommodating and even strongly supportive of transgender students. This nonetheless differs from school to school.

Managing stress

Transitioning is often deeply stressful, especially in Singapore and especially for youths, all the more if you do not have a supportive environment. If you are already undergoing considerable stress in other areas of your life, do take that into account when considering when and how to transition.

• If you have severe gender dysphoria, the relief from transition may help you better cope with stresses in other areas of your life, even alongside the new challenges that will come from transitioning.
• If however your gender dysphoria is minimal, the relief you get from transitioning may not be enough to overcome those additional stresses and challenges. In that case, you may wish to wait until you are older, since transitioning as an adult over 21 is much easier in many ways and also gives you more control over your own transition. This is especially important if you desire a less typical transition, such going on low-dose HRT or pursuing surgeries without HRT.

What you can do in the meantime

It is difficult to access psychological care and support for gender dysphoria without parental approval. However, some services have a lower age limit – support and befriending services begin at 16 for TransBefrienders.

If your parents can afford it and are open to it, you can ask to go to a LGBTQ-affirming counselling or therapy service. Some provide family counselling sessions that you can attend together with your parents

Coming out to parents – I’ll Walk With You

I’ll Walk With You is a comprehensive resource guide for parents of transgender children and is available in all four of Singapore’s official languages – Malay, English, Chinese and Tamil.

It is available in PDF form here.

If your parents would like additional support, they can also reach out to us for information.

Due to the sensitivity of the information involved, feel free to contact us if you wish to find out more about pursuing transition via the public healthcare system. You can reach us by email at [email protected].

Disclaimer: Information on this site is for general information only. It does not constitute legal or medical advice and is not a substitute for obtaining advice from a qualified professional. We do not represent or warrant that this information is suitable, reliable, complete, accurate or up-to-date.

First sex reassignment surgery

Singapore infopedia.

by Chan, Meng Choo

The first sex reassignment surgery in Singapore was successfully performed on 30 July 1971 at the Kandang Kerbau Hospital (now known as the  KK Women’s and Children’s Hospital ). The operation involved a 24-year-old man and was the first procedure of its kind carried out in Singapore. There had been similar operations done in Singapore, but these mostly involved patients who had both male and female genitalia (hermaphrodites) and the removal of one set of genitalia. 1  The 1971 operation was regarded as the first because it involved a surgical conversion aimed at functionally changing a person’s sex and appearance. 2 Patient and diagnosis The patient was a 24-year-old Chinese Singaporean. Her name was kept secret, but her background was later made public in a book. Born the eldest son in a family of five with two younger sisters, her father was a dentist who was often physically violent with his wife, which caused the patient psychological trauma. As a child, the patient was raised by her grandmother, who dressed her as a female. In her teenage years, she associated with other cross-dressers before frequenting the transgender scene on  Bugis Street  as an adult. 3 From the age of 16, she worked as a sales assistant, a housemaid, in a bank and as a public relations officer in a hotel. She later won second prize in a beauty contest and became a model. While working as a part-time model, she joined a cabaret in 1968 and was known as “Mama Chan”. She also ran a social escort service. 4 Having lived as a woman for some time, in 1969 she first consulted Professor  S. S. Ratnam , a senior lecturer in the  University of Singapore ’s Department of Obstetrics and Gynaecology. She had been suffering from sexual and emotional problems, which led to two suicide attempts. Ratnam explained to her that he had no experience in sex reassignment surgery, but she continued to visit his clinic weekly. After researching the subject of transsexualism and sex reassignment surgeries, Ratnam familiarised himself with the surgical techniques by practising on cadavers. 5 The patient then underwent a psychological analysis by a team of psychiatrists who confirmed that the patient was a transgender who required surgery. 6  The diagnosis required the patient to possess a continual sense of inappropriateness about his or her anatomic sex, a desire to discard his or her genitalia and live as a member of the opposite sex, and the absence of physical intersex symptoms or genetic abnormalities. In addition, the gender confusion (gender dysphoria) must not be caused by other disorders such as schizophrenia. 7  The patient was also cautioned that the surgery would be irreversible, potentially involved a number of complications and required a prolonged follow-up period. 8  A total of six to nine months of medical and psychiatric tests had to be carried out before the patient could take the operation. 9 Legal clearance for the operation was then sought from the Ministry of Health and granted. After consideration of the patient’s psychological profile and the medical expertise involved, with the approval of the ministry, it was decided to proceed with the operation. 10  Operation and impact The operation was performed by Ratnam and two other surgeons from the University of Singapore’s Department of Obstetrics and Gynaecology, Associate Professor Khew Khoon Shin and plastic surgeon R. Sundarason. 11  Photography of the operation was not permitted. Ratnam later described the three-hour operation as a success, with an uneventful post-surgery recovery. 12    After her successful operation, the patient went on hormone treatments 13  and was functionally a woman, though she could not conceive or menstruate. 14  She later married a French man and owned a travel agency in Paris, before moving to England. 15 The July 1971 operation paved the way for sex reassignment surgeries in Singapore and the region. Singapore’s first sex reassignment operation on a woman took place three years later. It was carried out in three stages between August 1974 and October 1977. 16  Female-to-male conversions are more complex and involve several surgical stages. 17  In the 1970s and ’80s, hospitals in Singapore accepted numerous sex change patients from abroad, with foreigners making up around half of all surgeries performed, while the rest were locals and Malaysians. 18   In the years following the operation, a number of legal issues arose for transsexuals – those who had undergone a sex change. The Registry of Marriages implicitly recognised marriages involving a transsexual, as it required only an identity card to prove the different genders of the couple. 19  In 1991, however, a marriage between a transsexual man and a woman was declared void by the  High Court , officially making such marriages illegal in Singapore. 20  It was only in 1996 that the government amended the Women’s Charter to allow transsexuals to marry legally. 21 Author Chan Meng Choo References 1. Yeo, J. (1971, July 31).  First sex change surgery in S’pore .  The Straits Times , p. 17; Tan, W. L. (1971, August 25).  Sex change patient has marriage plans .  The Straits Times , p. 8. Retrieved from NewspaperSG. 2. Tan, W. L. (1971, November 11).  They’re still ‘misters’ despite sex change .  The Straits Times , p. 8. Retrieved from NewspaperSG. 3. Ratnam, S. S., Goh, V. H. H., & Tsoi, W. F. (1991).  Cries from within: Transsexualism, gender confusion & sex change . Singapore: Longman Singapore, pp. 25–26. (Call no.: RSING 616.8583 RAT) 4. Ratnam, S. S., Goh, V. H. H., & Tsoi, W. F. (1991).  Cries from within: Transsexualism, gender confusion & sex change . Singapore: Longman Singapore, pp. 25–26. (Call no.: RSING 616.8583 RAT) 5. Ratnam, S. S., Goh, V. H. H., & Tsoi, W. F. (1991).  Cries from within: Transsexualism, gender confusion & sex change . Singapore: Longman Singapore, pp. 25–26. (Call no.: RSING 616.8583 RAT) 6. Yeo, J. (1971, July 31).  First sex change surgery in S’pore .  The Straits Times , p. 17; Tan, W. L. (1971, August 25).  Sex change patient has marriage plans .  The Straits Times , p. 8. Retrieved from NewspaperSG. 7. Ratnam, S. S., Goh, V. H. H., & Tsoi, W. F. (1991).  Cries from within: Transsexualism, gender confusion & sex change . Singapore: Longman Singapore, p. 4. (Call no.: RSING 616.8583 RAT) 8. Chua, M. (1974, November 7).  Who really needs a sex-change?   The Straits Times , p. 10. Retrieved from NewspaperSG. 9. Lim, S. (1990, May 20).  Legal poser over sex-change transsexuals who get hitched .  The Straits Times , p. 21. Retrieved from NewspaperSG. 10. Tan, W. L. (1971, November 11).  They’re still ‘misters’ despite sex change .  The Straits Times , p. 8. Retrieved from NewspaperSG. 11. Tan, W. L. (1971, August 25).  Sex change patient has marriage plans .  The Straits Times , p. 8. Retrieved from NewspaperSG. 12. Yeo, J. (1971, July 31).  First sex change surgery in S’pore .  The Straits Times , p. 17. Retrieved from NewspaperSG. 13.  Second sex change operation in S’pore . (1971, November 5).  The Straits Times , p. 15. Retrieved from NewspaperSG. 14.  Why sex-change patients set up homes overseas . (1975, August 10).  The Straits Times , p. 5. Retrieved from NewspaperSG. 15. Ratnam, S. S., Goh, V. H. H., & Tsoi, W. F. (1991).  Cries from within: Transsexualism, gender confusion & sex change . Singapore: Longman Singapore, p. 26. (Call no.: RSING 616.8583 RAT);  She tried to commit suicide.  (1992, January 18).  The New Paper , p. 20. Retrieved from NewspaperSG. 16. Kwee, M. (1974, October 20).  S’pore’s first sex change woman .  The Straits Times , p. 1. Retrieved from NewspaperSG. 17.  Why sex-change patients set up homes overseas . (1975, August 10).  The Straits Times , p. 5. Retrieved from NewspaperSG. 18. Chong, G. P. (1986, November 3).  Sex-change cases can get new ICs.   The Straits Times , p. 13. Retrieved from NewspaperSG. 19. Lim, S. (1990, May 20).  Legal poser over sex-change transsexuals who get hitched .  The Straits Times , p. 21. Retrieved from NewspaperSG. 20.  Sex-change pairs can’t marry . (1991, September 26).  The New Paper , p. 11. Retrieved from NewspaperSG. 21. Goh. T. T. (1996, January 26).  They were allowed to wed before.   The New Paper , p. 9; Gwee, E. (1996, August 30).  ‘I do’ – and no need to state gender at birth .  The Straits Times , p. 6. Retrieved from NewspaperSG. Further resources Cheow, X. Y., & Fung, E. (2007, March 7).  Born in the wrong body .  The Straits Times , p. 114. Retrieved from NewspaperSG. Chong, G.P. (1986, November 3).  Sex-change cases can get new ICs.   The Straits Times , p. 13. Retrieved from NewspaperSG. Fifth sex-change operation a success . (1972, September 11).  The Straits Times,   p. 6. Retrieved from NewspaperSG. Sex change man signs statutory declaration affirming that he is now a woman . (1972, April 16).  The Straits Times , p. 6. Retrieved from NewspaperSG. Tan, K. H., & Tay, E. H. (Eds.). (2003).  The History of Obstetrics and Gynaecology in Singapore . Singapore: Obstetrical & Gynaecological Society of Singapore: National Heritage Board. (Call no.: RSING q618.095957 HIS) Tan, W. L. (1971, August 31).  Man-made woman may not get marriage licence .  The Straits Times , p. 6. Retrieved from NewspaperSG. The information in this article is valid as at  2016  and correct as far as we are able to ascertain from our sources. It is not intended to be an exhaustive or complete history of the subject. Please contact the Library for further reading materials on the topic.

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