How you prepare

Before feminizing surgery, you'll meet with your surgeon. Consult a surgeon who is board certified and experienced in the procedures you desire. Your surgeon will describe your options and potential results. The surgeon will provide information on the anesthesia, the location of the operation and the kind of follow-up procedures that you might need. Follow your doctor's specific instructions on preparing for your procedures, including guidelines on eating and drinking, adjusting current medications, and quitting smoking.

Although giving your informed consent after discussing the procedure’s risks and benefits is an acceptable standard of care, most surgeons will require you to meet certain criteria before having a feminizing surgery. To start, your surgeon will evaluate your health to rule out or address any medical conditions that might affect or contraindicate treatment. The evaluation might include:

• A review of your personal and family medical history
• A physical exam, including an assessment of your internal reproductive organs
• Lab tests measuring your lipids, blood sugar, blood count, liver enzymes, electrolytes and the hormone prolactin
• A review of your immunizations
• Age- and sex-appropriate screenings
• Identification and management of tobacco use, drug abuse, alcohol abuse, HIV and other sexually transmitted infections
• Discussion about sperm freezing (sperm cryopreservation)

A behavioral health evaluation by a provider with expertise in transgender health is also required. The evaluation might assess:

• Your gender identity and gender dysphoria
• The impact of your gender identity at work, school, home and social environments, including issues related to discrimination, relationship abuse and minority stress
• Mood or other mental health concerns
• Sexual health concerns
• Risk-taking behaviors, including substance use and use of nonmedical-grade silicone injections or unapproved hormone therapy or supplements
• Protective factors such as social support from family, friends and peers
• Your goals, risks and expectations of treatment and your future care plans

In addition, before having non-genital feminizing surgery, you’ll be required to have one letter of support from a behavioral health provider with expertise in transgender health. The letter must confirm that you meet the World Professional Association of Transgender Health (WPATH) standards of care criteria for surgery, including:

• Having the ability to make fully informed decisions and to consent to treatment
• Be managing any major medical or mental health problems

Before having genital surgery, you'll be required to obtain two letters of support, each from a behavioral health provider with expertise in transgender health. The letters must confirm that you meet the WPATH standards of care criteria, including:

• Undergoing hormone therapy as appropriate to your gender goals for at least 12 months, unless you have a medical contraindication or you're otherwise unable or unwilling to take hormones
• Living in a gender role that matches your gender identity for at least 12 continuous months

Consent

Since feminizing surgery might cause irreversible physical changes, you must give informed consent after thoroughly discussing:

• Risks and benefits
• Cost
• Alternatives to surgery
• Expectations and goals
• Social and legal implications
• Potential complications
• Impact on sexual function and fertility

Health insurance coverage for feminizing surgical procedures is variable.

You also might consider talking to others who've had feminizing surgery. They can help you shape your expectations of what can be achieved and help prepare you for the recovery process, scarring and possible changes in sexual sensations. They might also have insight on what personal and social problems you might experience during treatment.