% Surgery

**TODO: add information about intersex people.**

For facial feminization surgery, [we have a separate page](ffs.md).

Table of contents
=================

-   [We oppose penile inversion technique](#penile-inversion)
-   Recovery
-   [Stimulation](#stimulation)
-   [New Zealand](#nz)
-   [Trans women](#mtf)
-   [Trans men](#ftm)
-   [Non-binary trans people](#nonbinary)

We oppose penile inversion technique (MtF vaginoplasty) {#penile-inversion}
=======================================================

Transit recommends **not** having surgery done using the *penile
inversion* technique, for these reasons:

-   Requires expensive genital hair removal, which can damage the
    genital area (the skin is much more sensitive). This also makes
    penile inversion more cost prohibitive for trans people, who are
    more likely to be poor than other groups of people
-   Does not result in self-lubrication (you need to use lube when
    having sex)
-   Inferior in terms of depth, sensation, etc, and doesn't look as
    good in terms of cosmetic appearance

There are other, superior methods

Recovery
========

No matter where you get your surgery, make sure that you have decent
care after surgery, to help you recover. If you're doing it overseas,
you might need to stay in that foreign country for a few weeks before
returning home (in some cases, it could be just 1 week or a few days
before being able to continue recovery at home). After surgery (any
surgery) you need time for your body to heal, and you will be in pain
for a while.

Stimulation (assigned male at birth) {#stimulation}
====================================

Some people say that, prior to surgery, you should flex/stimulate your
penis regularly. This means making it become erect, and stretching it
when it's not erect. Some people believe that this is necessary,
otherwise the penis would eventually become not as flexible and would
make surgery less effective. Basically pull your penis and stretch it as
much as possible, and make it erect a few times each week at minimum.

If this is true, it's important to mention, because a lot of people
assigned male at birth (trans women and non-binary) don't like touching
or handling their penis. This is especially important while on HRT,
which makes it less easy to get erect (it's common for trans women on
HRT for even a few months, to stop getting spontaneous erections, where
they go days or even a whole week or more without becoming erect).

**We're not sure about this, it's just word of mouth. We need to
research this, to confirm.**

New Zealand {#nz}
===========

Read [this
article](https://www.theguardian.com/world/2016/apr/22/new-zealand-transgender-waitlist-surgery-30-years).
New Zealand has no surgeons at all at the moment, for MtF, FtM on
non-binary surgeries. If you live in New Zealand, you will have to
travel overseas and use a foreign surgeon. We're adding more surgeons
to this page, as and when we find good ones.

You \*can\* get surgery done in Australia or Thailand. These countries
are within easy travel distance to you. **TODO: add information about
surgery in Thailand and Australia. Thailand in particular has good
services, some of the best in the world.**

**New Zealand needs surgeons for transgender surgeries! It is
unacceptable that it does not have any qualified surgeons! If you are
studying to be a surgeon, you should definitely consider studying this
and becoming qualified. You will literally be saving lives.**

Surgery for trans women {#mtf}
=======================

List of surgeries available:

-   Bottom surgery (vaginoplasty. Construction of a vagina. Also
    labiaplasty and clitoroplasty)
-   Facial reconstruction surgery
-   Adams apple removal/trimming (trachea shave)
-   Breast augmentation (don't do this until after a few years HRT when
    your breasts are fully grown)
-   orchiectomy (removal of testicles. Done during GRS or can be done
    before)
-   Voice feminization surgery
-   TODO: research other surgeries, if they exist.
-   TODO: medical/scientific names of each surgery

List of surgeons
----------------

Note for trans women: none of these surgeons perform penile inversion
technique, for vaginoplasty. They use other, superior methods which
result in better depth, sensation and, most importantly, ability to
self-lubricate, without the need for external lubricant liquids. **You
also don't need genital hair removal, for the surgeries that these
surgeons perform.**

This is why we don't list any UK surgeons, or indeed most European
surgeons, because we are not currently aware of any that use non-penile
inversion techniques. See [\#penile-inversion](#penile-inversion) for an
explanation of why we are against the penile inversion technique.

### TSSurgeryGuide.com

[TSSurgeryGuide.com has their own lists of surgeons, including other
advice like how to afford surgery,
etc](http://www.tssurgeryguide.com/Welcome.html) - they might recommend
surgeons that perform penile inversion there, so do beware. **Integrate
info from that site, onto the Transit site**

### Brazil

-   [Marcio Littleton](http://www.marciolittleton.com/)

### Portugal

-   [Joao Decio
    Ferreira](http://www.joaodecioferreira.com/pt/transexualidade/cirurgia-m-para-f/57-cirurgia-m-f.html)
-   [Marcio Littleton](http://www.marciolittleton.com/)

### Thailand (Bangkok)

-   [The Suporn Clinic](http://supornclinic.com/) - one of the best
    surgeons on earth, basically. Highly recommended for Male to Female
    vaginoplasty surgery. Also provides decent aftercare, for recovery
    after surgery. Also offers other surgeries.
-   [Chettawut Plastic Surgery
    Center](http://www.chet-plasticsurgery.com/) - also very good

Trachea shave (adams apple size reduction)
------------------------------------------

Cis women also have adams apples, but they're usually not as large.
Some people AMAB who transition decide to have their trachea reduced in
size. Not all people need this.

**TODO: add more information about this, including information about
surgeons.**

Orchiectomy
-----------

The testicles are what product testosterone. People who are AMAB might
take *antiandrogens* before GRS. It's possible to have the testicles
removed, even before GRS. It's advisable to use a surgeon who will
remove the testicles themselves but leave the scrotum skin intact so
that it can be used for surgery.

With testicles removed, someone who is AMAB will stop taking
antiandrogens, since their body is no longer naturally producing high
levels of testosterone.

This type of surgery should be available at most hospitals, but do do
your research before having it done. **TODO: add information about
surgeons here.**

**You need to maintain a minimal level of estradiol after orchi, to
prevent oesteoporosis. Make sure to take estradiol (as HRT) but without
an antiandrogen (avoid spiro, cypro, GnRH, etc) after having an orchi.
Estradiol (as HRT) is also required for preventing menopause symptoms.**

Voice feminization surgery
--------------------------

The larynx (voice box) increases in size during male puberty and
vibrates at a much lower pitch (when your voice breaks during puberty).
Voice feminization surgery aims to increase natural voice pitch by
reversing some of this. **[Voice training is still required, even with
voice surgery, and voice surgery is optional. You can still get to a
high female pitch in every day conversations, without surgery. Some
people get surgery anyway, and it can benefit some people.](voice.md)**

Stories of trans women who have had bottom surgery
--------------------------------------------------

<https://laurakbuzz.com/2017/04/12/transition-vagina-ownership-and-post-lower-surgery-life/>

Surgery for trans men {#ftm}
=====================

List of surgeries available:

-   Top surgery (remove breasts)
-   Bottom surgery (construction of a penis)
-   TODO: research other surgeries, if they exist.
-   TODO: medical/scientific names of each surgery

Surgeons
--------

For construction of a penis.

-   [Joao Decio
    Ferreira](http://www.joaodecioferreira.com/pt/transexualidade/cirurgia-m-para-f/57-cirurgia-m-f.html)

TODO: add info about top surgeons, for removing breasts

Surgery for non-binary trans people {#nonbinary}
===================================

TODO: research

Some people have *gender nullification surgery* to make their genitals
genderless.

