Female to Male Surgery

Female to male surgery is also called gender confirmation/affirmation surgery. This surgery was formerly known as gender reassignment surgery. It helps individuals with gender dysphoria/discomfort/dissatisfaction change their body parts permanently. Also, physical appearance can be changed by taking hormones which make you look like the opposite gender. In the case of a female, she will take androgen that will help her grow hair on her face.

The surgery involves the removal of the breast, ovaries, and uterus. Removing a breast is known as a mastectomy, and removing the uterus and ovaries is known as hysterectomy. The vagina is closed, and the scrotum and penis are made from other body tissues such as the thigh, back, arm or the inside of the abdomen wall.

The benefit of this surgery is that you may feel long-term mental health benefits as you get the desired changes in your body. Other benefits of this surgery include:

1. Boosts self-esteem
2. Cosmetic appearance
3. Sexual functioning
4. Desired body image
5. Socioeconomic adjustment
6. Better social relationships
7. Good family life
8. Psychological status and satisfaction

Individuals who feel gender dysphoria need this surgery. Gender dysphoria is a discomfort/distress that occurs when your gender assigned at birth does not meet your sexual identity.

If the surgery is delayed, the sense of gender dysphoria may continue, eventually affecting the person, as gender dysphoria causes anxiety, distress, and emotional distress.

The surgery involves:

1. Mastectomy (breast reduction): Breast removal, refinement of the areola and nipple, and shaping to get a contoured male chest are known as bilateral (both sides) mastectomy. 
2. Oophorectomy and hysterectomy: Removal of the ovaries and uterus
3. Penis and scrotum construction (phalloplasty, metoidioplasty, and scrotoplasty): The vagina is removed by vaginectomy and reconstruction of the urethra and penis is done by using either tissue of the vagina or other body part to build the penis.
4. Facial gender surgeries may be done, such as nose and chin reshaping, augmentation of the thyroid cartilage to build Adam’s apple, cheek augmentation, forehead lengthening and augmentation, and jaw augmentation.

There are various options for surgery. Facial reconstructive surgery alters the facial features to make you appear more masculine or feminine. Chest or ‘top’ surgery involves the removal of breast tissue to give you a more masculine appearance or improves the size and shape of your breast to give you a more feminine appearance. Genital or ‘bottom’ surgery involves reconstructing and transforming the genital organs.

1. On the day of the surgery, you will be asked to sign the consent formalities.
2. The nursing staff will ask you to remove your clothes and put on a hospital gown. 
3. You will also need to remove all pieces of jewellery and non-permanent dentures. 
4. Someone from the team will trim or shave the hair at the surgical site. 
5. The doctor will record your last meal and monitor your vitals, including heart rate, breathing, and blood pressure.
6. Finally, the medical staff will shift you to the OT room.

1. In the OT, you will be made to relax on the operating table.
2. A nurse will start an IV line in your arm, hand, or wrist for giving fluids and medications during the surgery. 
3. He/she will give general anaesthesia to put you to sleep or a spinal block that numbs the lower half of the body. 
4. The nursing team will clean the surgical site with an antiseptic solution. 
5. The team will monitor your vitals throughout the procedure.
6. Finally, the surgeon will make an incision and perform the surgery. 
7. After the surgery, he/she will close the incision with stitches and put a small bandage on the wound. 

Recovery in Hospital:-

1. After the surgery, the healthcare team will shift you to the recovery room. 
2. The staff will monitor your heart rate, breathing, blood pressure, and the effect of anaesthesia. 
3. You will also be given pain medications to relieve pain. 
4. Once you are stable, the team will shift you to a hospital room. 
5. After a day of the surgery, a physical therapist will help you walk a few steps. 
6. Based on your condition, you will get discharged from the hospital within three to five days after the surgery. 

Recovery at Home:-

1. Continue physical therapy for weeks or months after the surgery
2. Place everyday items at waist level to avoid bending or reaching up
3. Avoid climbing stairs
4. Sit in a straight-back chair
5. Use an elevated toilet seat
6. Eat a well-balanced meal 
7. Avoid driving for approximately eight weeks following the surgery
8. Keep the incisions clean and dry

Follow-Up Appointment

The first follow-up appointment is usually recommended 4 to 6 weeks after the surgery. The doctor will conduct an X-ray and examine your wound and recovery during the visit. Post-operative visits help your surgeon to check if your hip is healing well. Therefore, ensure to visit your doctor regularly for routine checkups. 

Possible side effects that normally occur after any surgery:

1. Bleeding
2. Side effects of anaesthesia
3. Pain

Risk/complications that may occur after the surgery:

1. Pain that does not disappear after many weeks
2. Changes in sexual feelings (after bottom surgery)
3. Trouble emptying the bladder
4. Haemorrhage or bleeding for a longer period of time
5. Urethral stenosis (narrowing of the urethra through which the urine passes)
6. Urinary incontinence (loss of bladder control)
7. Vaginal stenosis (the vagina becomes narrow)
8. Rectal fistula
9. Dissatisfaction with the results
10. Reactions to anaesthesia
11. Sequelae of infection: The surgical site does not heal or change colour