gender confirmation surgery

Gender reassignment surgery, also known as gender confirmation surgery, is the medical term for a range of procedures that change the physical characteristics of a person’s body to make them more congruent with their gender identity. As the following article explains, gender reassignment surgery is not an exact science and the final appearance of a person’s new body will depend on a number of factors, such as their age and general health. It is also an expensive procedure and a political ‘hot potato' over who should foot the bill.

Gender reassignment surgery or sex reassignment surgery is an umbrella term given to a number of procedures that aim to realign a person’s physical characteristics with their internal sense of gender. It is often the end of a process of transition that begins with superficial changes, such as clothes, makeup and hair and continues with hormone therapy.

Someone who has always felt deep-down to be a woman, for example, but has the physical characteristics of a man, might opt for surgery to remove male biological features and have surgeries giving them more stereotypically feminine features, such as breasts and a vagina. A woman identifying as a man can also have surgery and treatment that will help them to look like a man.

It is important to note that for many trans people, surgery is not part of their journey, and surgery should not be undertaken lightly, not least because of the significant risks and side-effects, as with any surgical procedure. In the UK, for example, gender reassignment surgery is only an option for those who are over 18 and pre-surgery counselling is also a requirement. Other countries have slightly different rules but usually follow a clear principle

Candidates for gender confirmation surgery must always transition socially, and live as their preferred gender identity full-time. Often they will need to wear a wig or hair extension to add a feminine touch. They must have pre-surgery counselling, generally for at least two years, and usually receive hormone therapy for at least six months before surgery.  This is a crucial part of the whole debate.  Whether a patient is suffering from dysmorphia – a psychological issue – or simply feels that their gender was wrongly assigned at birth.  The fact that the LGBT lobby is so powerful has made this subject area very difficult to navigate without risking giving offence.

gender confirmation surgery

Gender confirmation surgery is only offered once the person and their care team are sure it is the right choice for them. It’s always good to remember that genitals don’t have genders, people do, and the patient is already the woman, man or non-binary person they’ve always been.

For those who do choose to transition through surgery, there is the whole issue of costs and who pays for the procedure.   This does, of course, vary tremendously by country and by the insurance company.  There are various surgical procedures that can be undertaken.

Once the surgical pathway is undertaken there are various optional stages.

Gender confirmation surgery for transgender men in the UK may involve:

  • removal of the breasts, known as a double mastectomy
  • removal of the womb, ovaries and fallopian tubes

Gender confirmation surgery on the chest is commonly referred to as top surgery, while gender confirmation surgery on the genitals is commonly referred to as bottom surgery.

Someone who has always felt like a woman, for example, but has the physical characteristics of a man, might opt for surgery to remove male biological features and have surgeries giving them more stereotypically feminine features, such as breasts and a vagina. A woman identifying as a man can also have surgery and treatment that will help them to look like a man. Other popular surgeries include:

  • Chondrolaryngoplasty – this is a shaving of the part of the trachea commonly known as the Adam’s apple, making it less pronounced and less visible.
  • Vocal Folds Shortening and Retrodisplacement of the Anterior Commissure’ ( VFSRAC) or voice feminisation surgery – this surgery alters the voice box resulting in a voice that is higher pitched than a man’s.
  • There are also many types of facial reconstruction surgeries that modify strongly masculine bone and cartilage structures. These are not usually available on the NHS.

The Cost of Gender Reassignment Surgery

how much is gender confirmation

In the USA for example, patients experience numerous roadblocks from insurance companies for gender-affirming procedures and are commonly denied coverage for additional “cosmetic” costs. Meanwhile, cisgender women are able to schedule and receive a breast reduction for their back pain, completely covered by insurance, despite being the same procedure that insurance companies deny members of the transgender community. Insurance companies say that gender-affirming surgery is “medically necessary” and therefore covered, but in the fine print, one finds that a single necessary component of such surgeries can add up to thousands of dollars out of pocket for the patient. These hidden costs are a way of stacking the deck against the transgender and non-binary community without doing so out in the open.

It wasn’t until 2019 that the World Health Organization (WHO) stopped labeling transgender as a gender identity disorder and instead reframed it around “gender incongruence” in a section under sexual health. Studies show how categorizing transgender people as “sick” has contributed to medical and human rights barriers that negatively impact quality of life. This was one of the reasons that WHO decided to amend their health guidelines and policies, hoping to make widespread changes in public perception. While this was a big step for the LGBTQ+ community in the USA and brought about promises of acceptance for transgender people, the institutions that uphold old policies and outdated perceptions inherently influence the rest of society, including the medical field, and it starts way before an insurance company can deny coverage for a nipple graft. Hopefully, the new Biden regime will make the path a little bit easier. Many hope that it will.

in the UK too, changing sex isn't cheap. The cost of gender reassignment is £19,236 per patient, including support as well as surgery. The total cost to the NHS in England lin 2016 was £17.13 million and this year the budget has been increased to £22.72 million.

The good news is that gender reassignment is available on the NHS but the bad news is that there are often long waiting lists, depending on the demand in your area. The average waiting time for sex-change therapy for an adult is approximately 9 months -and this is just the start of the process. In the UK, it is considered good practice for individuals to receive counselling for at least two years before any surgery. Receiving hormone therapy for at least six months is also usually a given. However, this is not set in stone and there are exceptions to every rule. If a trans man, for example, is suffering health issues caused by breast binding, surgery may be offered as an alternative to hormone treatment.

So how can you fund your surgery without going to war with the big insurance companies or institutions such as the NHS?

raising money

Get help paying for gender confirmation surgery

Given how expensive gender confirmation surgery can be, paying for it can be tough. So how can you pay to cover top or bottom surgery costs privately?

Take out a loan

Taking out a loan is quick to do, but be wary as high-interest rates could lead to financial problems down the line.

Reach out to a charity 

Charitable organisations may be able to provide you with some financial assistance in the form of a medical grant.

Organise a rainbow dress-up day

One of LGBTQ+ charity Stonewall’s top fundraising ideas is to organise a rainbow dress-up day at your workplace. Talk to your employer about your plans for gender confirmation surgery and rally support from your colleagues. The idea is that everybody swaps their boring office attire for an outfit in all the colours of the rainbow, in a nod to the well-known LGBTQ+ flag, in exchange for a donation to your cause.

Host an LGBTQ+ movie night

Encourage friends to donate by hosting a big night in complete with movies, popcorn and a floor full of duvets.

Throw a fundraising party

Your local LGBTQ+ nightclub could make the ideal venue for a fundraising party, especially if you offer them a cut of your proceeds. Consider asking any LGBTQ+ groups you’re involved with whether members could spare some time to help you sell tickets, book some entertainment and/or organise a raffle.

Try your hand as a quizmaster

Fundraising over a drink or two is hard to beat. Get in touch with your local pub about hosting a quiz there one night. Explain why you’re fundraising and see if they’d be willing to donate a prize for the winner in exchange for you promoting the event and bringing people their bar.

Raise funds by asking people to donate as much as they can in place of the usual quiz entry fee. Throw in a few questions about trans issues, language and equality – your quizzers will learn and have fun at the same time.


Thousands of transgender people have successfully set up crowdfunding campaigns on sites such as GoFundMe to help raise funds for treatment.

In 2019, a transgender man called Jude smashed his £1,200 crowdfunding target, allowing him to travel to Poland for top surgery. “My whole life, I’ve detested the body I live in,” he wrote on his GoFundMe. “It feels like a cage. It feels monstrous. Jude isn’t the only one who had success crowdfunding. Laura met her £550 goal to raise funds to cover her initial appointment fee and travel costs, while Mia raised nearly £5,700 for facial feminisation surgery.

Many clinics around the world specialise in GRS but with the travel constraints of COVID-19 many of these options have vanished for the moment.  Our list of specialist surgeries may no longer be up to date but it should provide a start for you if you are exploring the treatment options.

How well this clinic med your expectations?
    • Chettawut Plastic Surgery Center, Bangkok Thailand (approved)
    How well this clinic med your expectations?
      • Sava Perovic Foundation Surgery Belgrade Serbia (approved)
      How well this clinic med your expectations?
        • Cosmetic Surgery Partners (approved)
        How well this clinic med your expectations?
          • Phuket International Aesthetic Centre (PIAC) Thailand (approved)
          How well this clinic med your expectations?
            • Rumer Cosmetic Surgery. Ardmore USA (approved)
            How well this clinic med your expectations?
              • Center for Transgender Medicine & Surgery New York USA (approved)
              How well this clinic med your expectations?
                • Preecha Aesthetic Institute (PAI Clinic) Bangkok Thailand (approved)
                How well this clinic med your expectations?
                  • Kamol Hospital (approved)
                  How well this clinic med your expectations?
                    • Elysian Plastic Surgery Texas USA (approved)
                    How well this clinic med your expectations?
                      • 2Pass Clinic Antwerp Belgium (approved)