Understanding the Types, Costs, Benefits and Risks of Transgender Surgery Procedures

Medically reviewed by Paul Gonzales on March 25, 2024.

“Transgender surgery” is a commonly searched term that refers to gender-affirming procedures for trans, non-binary, and gender non-conforming patients. Specifically, these are procedures that alter a patient’s body to help them experience greater gender congruence and gender euphoria as a result. In this article, we discuss the different kinds of gender-affirming surgical procedures, their costs, benefits as well as risks. If you would like to undergo any of these procedures, you can schedule a free, virtual consultation with one of our board-certified surgeons today.

Types of “Transgender Surgery”

Research has demonstrated, per the World Professional Association for Transgender Health’s  (WPATH) Standards of Care (SOC) version 8, that gender-affirming surgical care is medically necessary for many trans, non-binary and gender non-conforming people. That is to say, not only binary trans people––those who identify as trans men or women–have and can benefit from the transformative effects of the surgeries outlined below.

Top Surgery: Chest Reconstruction

Chest reconstruction top surgery can utilize a variety of techniques through different incision types, liposuction, and nipple skin grafts to remove chest tissue and construct a flatter chest in alignment with the patient’s unique goals.

The double incision technique is the most commonly performed because of its ability to remove large ammounts of tissue and optimize chest flatness. The Gender Confirmation Center (GCC) offers the widest variety of top surgery insicion types of any gender-affirmative surgical center, such as, the keyhole, periareolar, buttonhole, fishmouth and more.

Additionally, patients can choose between having their nipples removed, positioned and resized through skin grafting, or preserved in their original form to decrease the risk of erotic sensation loss. 

Top Surgery: Aggressive Breast Reduction

For some patients interested in top surgery, achieving complete chest flatness is not their goal. For many non-binary and gender non-conforming patients, they would experience a greater sense of gender congruence with their bodies through a breast reduction. Generally speaking, the inverted-T incision technique can achieve this by allowing more volume and sensation to be maintained in the chest.

Top Surgery: Breast Augmentation

Breast augmentations in trans feminine and non-binary patients are most often accomplished through the use of silicone implants of varying sizes, depending on patient preference. Likewise, most trans patients have their breast implants placed through an inframammary incision, which conceals the scar at the bottom fold of the breast. You can learn about the other options available for breast augmentation surgery on this page.

Gender-Affirming Body Contouring

Body contouring encompasses a series of liposuction, fat grafting, skin excision and even implant procedures to align the shape of a patient’s body with their gender goals. Patients can undergo liposuction to remove “feminine” curves from their body, liposuction and/or fat grafting to give them the appearance of “feminine” curves or opt for silicone pectoral implants to enhance their top surgery results.

Facial Surgery

Facial Feminization Surgery (FFS) and Facial Masculinization Surgery (FMS) are umbrella terms for different kinds of surgical procedures that can be used to change the appearance of the face. Patients can choose to alter one or more of the following parts of the face:

  • The position of the hairline
  • The flatness or protrusion of the brow bone
  • The size and shape of the nose
  • The volume of the cheeks
  • The size and shape of the lips
  • The size and shape of the jaw
  • The size and shape of the chin
  • The size or appearance of the laryngeal prominence (“Adam’s Apple”)
  • …and more

Bottom Surgery

Bottom surgery refers to a series of procedures that reconstruct a patient’s genitals to achieve gender euphoria, enable urination while standing and/or allow for different sexual functions (i.e., penetrative intercourse). 

A vaginal canal, clitoris and/or labia can be constructed through the following procedures: vaginoplasty, vulvoplasty and labiaplasty. If a patient would like to undergo a vaginoplasty that conserves their penis, a penile-preserving vaginoplasty can be performed. If a patient would like a vaginal canal, lifelong dilation after surgery will be necessary to maintain its functionality.

The testicles and scrotum can be removed through an orchiectomy and scrotectomy procedure. It’s important to note that scrotal tissue can be used to construct the labia and lining of vaginal walls. So, patients who are planning to undergo a vaginoplasty or vulvoplasty should consider waiting to remove their scrotum and undergo permanent hair removal of the skin for reconstruction purposes.

A penis or neophallus can be constructed through a metoidioplasty or a phalloplasty procedure. A metoidioplasty or “meta” releases the ligaments around the erectile tissue (called a clitoris or penis) to extend it to about 2-4 inches in length. A phalloplasty uses donor skin (from the forearm, thigh or groin) to construct a penis of 4 inches in length or more. A urethral lengthening procedure can be performed with either procedure to facilitate urinating while standing up. To reduce complications associated with urethral lengthening, removal of the vaginal canal through a vaginectomy may be performed. You can read more about these and other related procedures, such as a hysterectomy and scrotoplasty, here.

Vocal Surgery

Another type of gender-affirming surgery mentioned in WPATH’s SOC 8 is vocal surgery. Voice modification can be achieved through voice training but some may undergo surgery to alter their vocal cord to change the pitch and tone of the voice. These surgeries are less commonly performed than the aforementioned procedures and are not currently offered by the GCC.

Is there transgender surgery for non-binary patients?

It is important to note that gender expression is fluid and there is no singular way to look like a woman, man, or non-binary person. Surgery can enable individuals to seek out ways to experience greater gender congruence that is unique to them. Historically, non-binary patients have faced difficulties in receiving individualized gender-affirming care. The GCC has made strides to work closely with non-binary patients to develop surgical techniques that meet the unique needs of this population. Not all non-binary individuals feel that surgery is a necessary part of their transition. Similarly, not all non-binary patients seek to alter their physical appearance to appear more masculine or feminine through surgery. That said, the following pages describe trends in what many non-binary patients have requested from our practice:

Cost and Insurance Coverage for Transgender Surgery

When not covered by insurance, gender surgeries can be expensive with costs quickly reaching tens of thousands of dollars. For example, top surgery can cost between $14,000-$17,000 for cash-pay patients. Thankfully, in states like California, many insurance plans cover the costs of gender-affirming care, reducing costs significantly. You can read more about this topic below. 

Below is a list of estimated costs for each procedure without other associated costs (i.e. facility fees). You can learn more about cost breakdowns for surgery here. If you would like to receive a quote for a procedure that can meet your specific needs, schedule a free, virtual consultation with one of our surgeons today.

Procedure Costs Price Range*
Chest reconstruction top surgery $8,500 – $11,500
Revision top surgery (scar revision, dog ears) $1,500 – $3,000
Breast augmentation (w/ implants) $8,500 – $10,000
Body masculinization (trunk, thigh, buttocks) $8,500 – $14,000
Body feminization (trunk, thigh, buttocks) $15,000 – $19,500
Facial surgery – upper third (hairline, frontal bone, brow) $10,000 – $50,000
Facial surgery – middle third (nose, cheeks) $6,000 – $18,000
Facial surgery – lower third (lip, jaw, chin, neck) $4,500 – $50,000
Metoidioplasty $19,000 – $42,000
Phalloplasty  $35,000 – $50,000
Vaginoplasty $23,000 – $24,500
Vulvoplasty $20,500 – $22,000
Labiaplasty $8,500 – $10,000

Insurance Coverage

Insurance coverage for transgender surgery may vary based on different insurance providers, state laws, or plan requirements. Some private insurers and Medicaid programs may exclude coverage for transition-related treatment. While self-funded plans are exempt from state regulations, some states prohibit exclusions and mandate coverage based on recent anti-discrimination laws. Some insurance companies have coverage for gender-affirming surgery, but may require hormone therapy before approval.

Currently, body contouring procedures like body masculinization surgery (BMS) and Body Feminization Surgery (BFS) have been experiencing significant reductions in insurance reimbursements. You can learn more about which plans cover the costs of surgery and what steps need to be taken to secure coverage here.

Affordability Concerns

We understand that high costs coupled with limited insurance coverage make gender-affirming surgery unaffordable for many members of our community. Some turn to crowd-funding campaigns or personal loans, while others seek out free or reduced-cost surgery by participating in transgender surgery clinical trials.

Non-profit groups like the Jim Collins Foundation and Transhealth Care also offer financial aid grants; however, resources are limited compared to the demand. Likewise, many of our patients turn to trusted medical creditors to finance their surgery. You can learn more about these financial assistance options here.

Greater insurance coverage and public funding assistance is needed to ensure equal access to medically necessary transgender surgery.

Benefits and Risks of Transgender Surgery

Gender-affirming surgery offers many potential physical and emotional benefits. As with all medical procedures, they can also carry certain risks.

Physical and Emotional Benefits

Gender-affirming surgery can significantly improve the physical and mental well-being of transgender individuals by helping them feel more comfortable and confident in their own bodies. While most of the physical changes affect how the body appears, it can also enable physical functions (i.e., standing urination, penetrative intercourse, etc). In addition to physical changes, surgery can provide significant mental and emotional benefits. Countless clinical studies have shown how gender-affirming surgical care reduces gender dysphoria and related anxiety, depression, and distress.

Many transgender people report improved social and personal relationships after surgery. They feel more comfortable interacting with friends, family, and romantic partners. Surgery can improve the quality of life for most transgender individuals.

Weighing the Risks

Some studies show that regret and dissatisfaction rates are lower in transgender patients compared to cisgender patients who undergo the same surgical procedures (i.e. breast augmentation, facial surgery, etc)

Like any surgical procedure, there is always a risk of complications. These can be mitigated by maintaining optimal health, following your surgeon’s pre-operative tips, and being transparent with your health. Schedule a free, virtual consultation with our surgeons and inform them of any medical conditions you may have.

One of the most common concerns we get from patients is about the risk of sensation loss after surgery. While some patients who undergo chest reconstruction or breast augmentation procedures can experience a loss of heightened, erotic sensation in their nipples, they still report greater feelings of sexual satisfaction after surgery due to feelings of gender euphoria.

Frequently Asked Questions About Gender-Affirming Surgery

  • What is the difference between sex and gender?
    • Sex refers to individual biological characteristics like chromosomes or reproductive anatomy. Gender refers to the social and cultural roles, behaviors, and identities often associated with the sex individuals are assigned at birth (i.e., male or female)
  • Who can get transgender surgery?

  • Most adults can get surgery with many gender-affirming surgical practices, like the GCC, using the informed-consent model. Depending on the procedure, most surgeons follow guidelines set by the World Professional Association for Transgender Health (WPATH) which may require clearance by a mental health professional and/or 1-2 years of hormone therapy. Transgender surgery for adolescents requires a multi-disciplinary approach that involves parents/guardians and gender-competent health care professionals to ensure their wellbeing.

  • What does the recovery process involve?
    • Recovery times vary based on the type of surgery. Most require anywhere from 2-6 weeks off work or school. Restrictions on exercise and movement are typical for at least the first 6 weeks. You can find the specific recovery instructions for each procedure on our website.
  • Do I need to legally change my gender before getting surgery?
    • There is no legal requirement to change your name and/or gender marker prior to getting surgery. Some surgical practices may ask patients to process their name/gender change on their  legal ID if their experience indicates it can help secure insurance coverage.
  • How do I choose a qualified surgeon?
    • WPATH SOC 8 recommends that surgeons who practice gender-affirming care have the following qualifications:
      • Training and documented supervision in gender-affirming procedures, 
      • The maintenance of an active practice in gender-affirming surgical procedures
      • Knowledge about gender diverse identiies and expressions
      • Continuing education in the field of gender-affirmation surgery
      • Tracking of surgical outcomes.
    • You can find WPATH’s Provider Directory here. 
  • Should I get every transgender surgery?
    • Each person should thoughtfully consider which procedures are truly necessary for them. There is no single way to undergo medical transition. It’s important to take time to consider important decisions about permanent surgical changes. We recommend consulting with gender-competent mental health professionals and gender-affirming surgeons if you have questions about which procedure(s) would be right for you.
  • Can I still have biological children after surgery?
  • Does getting surgery help with passing?
    • “Passing” is a loaded concept that describes when a trans person can “pass” or be perceived by others as cisgender. While surgery can change an individual’s appearance, surgery cannot change other people’s perceptions since these perceptions are based on their own experiences/beliefs. Therefore, motivations to pursue surgery should not be a decision based on external reasons to “pass” but rather a decision to improve internal alignment with your body to achieve gender congruence.
  • How do I tell friends and family about my surgery plans?
    • Every patient’s journey is unique. Generally speaking, it can be a good idea to gradually share the news starting with those who seem the most supportive. It may be difficult to manage mixed or negative reactions from others, especially for those who may need time to assimilate, accept, or support this decision. Reaching out to community and mental health professionals for support can be of great assistance in this process.