Ever Wondered About Hormone Therapy & Gender Affirmation Surgery?

Yaaay, it’s Pride Month! And maybe we could learn about Gender Affirmation Surgery on this occasion. Well, I didn’t know much about this until recently when I read a lot about it. For the layman, this is the surgery that transgender people undergo to ‘change genders.’ Unfortunately, due to the underrepresentation of the trans community by the media, most of us are ignorant about this process. I personally had many questions, and after extensive research, I am to answer all your queries about Gender Affirmation Surgery.

Gender Affirmation surgery is for people that don’t associate with the sex assigned to them at birth/ transgender people undergo to confirm their gender. It is also addressed as Gender Confirmation. There was a discussion about this with the team. After talking to someone belonging to the trans community, we decided upon sticking to the term Gender Affirmation since they were comfortable with the same. Also, changing Genders is another term used to refer to the same, and this implies that one’s gender changes after the surgery have been performed (which isn’t true). Many are unaware of the process, and your questions concerning Gender Affirmation shall be answered in this article.

Firstly, Why do people undergo Gender Affirmation Surgery?

Gender Dysphoria is the reason behind people opting for gender affirmation surgeries. According to Mayo Clinic, Gender dysphoria is the feeling of discomfort or distress that might occur in people whose gender identity differs from their assigned sex at birth or sex-related physical characteristics. It is often described as a feeling trapped in the body of the wrong sex. Although every trans person does not experience this, some people might be at ease with their bodies.

On that note, it can also be overcome through medical intervention (Gender Affirmation Surgery). The surgery helps trans people by improving their mental health, boosting self-image and self-esteem, paving the way for a better quality of life, and the ability to ‘blend with society.’

What exactly is Transition?

According to Trans EqualityTransitioning is the time period during which a person begins to live according to their gender identity, rather than the gender they were thought to be at birth. This can look different for different people. This may (or may not) include things like changing names, pronouns, appearance, etc. Some get their name and gender changed on official documents (passport, license, bank accounts, credit cards, birth certificate, medical records, etc.). This is because they might be subjected to harassment if their appearance and gender don’t match with the one mentioned in the documents. Some others opt for hormone therapy, while others also go for gender affirmation surgery. However, not every transgender person necessarily needs to transition, but most do. 

What exactly is Hormone Therapy?

Hormone therapy helps trans folx deal with gender dysphoria that has been haunting them for years. In this, individuals that have been Assigned Female at Birth (AFAB) are administered Androgens to develop ‘secondary male sexual characteristics’ such as beard and chest hair. Those individuals that have been Assigned Male at Birth (AMAB) are given Estrogen and anti-Androgen hormones to make their bodies look more ‘feminine’ with a decrease in body hair. Hormone therapy helps trans people feel better about themselves since their physical features align with their gender.

How is the surgery performed for people assigned female at birth?

A person first receives testosterone replacement/hormone therapy. After this, they can undergo the following procedures based on how they want their body to be:

1. Hysterectomy (partial/total)

  • Performed when having a uterus and fallopian tubes causes discomfort.
  • Also, hormone therapy doesn’t help stop menstruation, but a hysterectomy is performed.
  • In partial hysterectomy, only the uterus is removed, while in the case of total hysterectomy, the cervix is also removed.

2. Vaginectomy-

  • The vaginal mucosa is removed during this procedure.

3. Mastectomy- 

  • The breast tissues are removed.
  • Nipples’ position and appearance are changed.
  • There will be the growth of chest hair due to hormone therapy.

4. Metoidioplasty-

  • Makes the clitoris penis-like.
  • This is the process of constructing a new penis (neopenis/neophallus) out of the clitoris.
  • Urethra is lengthened to position it through the neopenis.
  • Tissues from other parts of the vagina are used to lengthen the neopenis.
  • Neopenis, constructed through this process, is not usually long enough for penetrative sex, though it can become erect.

5. Phalloplasty-

  • Skin from the abdomen, arm, back, forearm, or thighs is used in penile construction.
  • This neopenis can’t become erect on its own but is long enough for penetrative sex.
  • For erections, there should be a penile implant after recovery.
  • The cost of this procedure is quite high and also demands a lot of visits to the doc.

6. Scrotoplasty-

  • A scrotum is created through this procedure.
  • The labia majora is hollowed out and repositioned to form a scrotum.
  • Silicone testicular implants are placed.

How is the surgery performed in the case of people assigned male at birth?

The procedure begins with the individual undergoing estrogen/hormone therapy alongside supportive counseling. Later, they sit for other surgeries (the first three in the following list are quite easy).

1. Facial Feminization Surgery (FFS)-

  • The face usually depicts the gender of a person, and changes in the same can be very comforting to many people.
  • Based on the requirements of the person, surgeons customize the plan.
  • FFS involves brow lift, nose reshaping, tracheal shave, lip lift, cheek implants, face/ neck lift, cheek softening, and blepharoplasty (makes eyelids look more aesthetic).
  • Adam’s Apple is also shaved down so that it is less prominent.

2. Breast Augmentation-

  • Hormone therapy helps in the growth of breasts in trans womxn, but some opt for breast augmentation surgery.
  • Based on one’s preferences, the process is carried out.

3. Body Feminization Surgery-

  • Includes buttocks augmentation and trunk liposuction.
  • Fat is removed from the abdomen, lower back, and waist regions (Trunk liposuction).
  • This fat is used to make the buttocks look more ‘feminine’ (Buttocks augmentation).

4. Gender Affirmation Surgery-

  • Penile inversion is performed to turn the penis inside out to form the walls of the vagina.
  • The clitoris (neoclitoris) is created from the head of the penis.
  • Urethra is made shorter and repositioned.
  • These changes help in urination, penetrative sex as well as in experiencing orgasms.

What are the risks involved in Gender Affirmation Surgery

  • Bleeding
  • Infections
  • Reaction to anesthesia
  • Spouses, friends, and family might not be welcoming this, unfortunately

Also, according to a study by Karolinska Institute, people have a risk of suicidal tendencies, deaths, and psychiatric morbidity. Besides this, one might not be pleased with the results after the surgery has been performed (though this is not the case with most people).

What about recovery?

  • The person needs to stay at the hospital for a few days.
  • Recovery time varies from person to person based on one’s lifestyle.
  • In the case of a person who smokes or uses nicotine in any other form, recovery takes quite a long time. As a result, such people are usually considered ineligible to get the procedure done.
  • For about 6 weeks post-surgery, one needs to take maximum rest.
  • Trans womxn must use a catheter for approximately a month post-surgery.

How beneficial is a gender affirmation surgery for one’s mental health?

According to a Yale School of Public Health survey, trans people who undergo this procedure are less likely to seek therapy for mental well-being. According to WebMD, trans people are more likely to seek care to overcome anxiety and anti-anxiety medication about 6 times and 3 times, respectively (before surgery). Though gender affirmation isn’t the panacea, the study found out that people who underwent surgery were 8% less likely to seek help for mental well-being. Undergoing the procedure isn’t an easy thing, and it is important to analyze if it would be beneficial because the physical appearance of an individual doesn’t define their gender!

How much does the surgery cost?

The surgery is expensive, and this discourages many from opting for it. A ‘male to female’ transition can cost anywhere between Rs. 2-5 lakhs and a ‘female to male’ transition ranges from Rs. 4-8 lakhs in case of a private hospital. The one year of compulsory therapy costs around Rs. 50,000 to 70,000. In the case of government hospitals, the procedure is performed for free, but the staff there are reportedly highly insensitive. Also, this procedure is not encompassed by Ayushman Bharat. As a result, people wishing to undergo surgery are forced to approach private hospitals only. Another reason people prefer going to private hospitals because there is this taboo surrounding transgender people that makes them choose privacy. Many also get this done in Thailand since the costs are way less there.

A few pointers to remember:

  • A gender confirmation surgery can be reaffirming, but it just helps change your body the way you experience your gender.
  • Your gender isn’t defined by your body but by your experience.
  • The way you experience your gender is completely valid!

Some good news this Pride Month!

The Madras High Court, on 7th June 2021, issued an order (do give it a read) which is expected to pave the way for mainstreaming the people belonging to the LGBTQIA+ community. It aims to prohibit ‘Gender Affirmation Surgeries’ by educating parents as well as students about sexuality. Every single individual is entitled to the ‘right to privacy’ and the ‘right to lead a dignified existence,’ and that these rights have been protected through the Constitution.

Justice N Anand Venkatesh, who gave this judgment, said, “I have no hesitation in accepting that I too belong to the majority of commoners who are yet to comprehend homosexuality completely. However, ignorance is no justification for normalizing any form of discrimination.” Also, in any cases involving two consenting adults from the LGBTQIA+ community, the police must close the case without harassing them. 


“I would have never guessed” is a common phrase that trans people often get to hear. This is because there’s this notion that trans people look ‘visibly trans.’ The truth is that trans people are everywhere- even if you don’t think you know of one, you will most probably do! On this note, a small reminder to everyone who doesn’t identify themselves as trans people – IT’S NOT A SIN FOR ONE TO BE THEMSELVES! Also, never ask a trans person about their surgical status (or genitalia) or birth name. Let them bring these up if they wish to. Please let others define themselves. Be a safe space for them. This is how you will become a better ally to the community as well.



Graphic design by: Ruta Shelke


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