Questions to ask your potential surgeon before gender-confirming surgeries

Pencil and questionnaire

Genital and breast/chest surgical treatments for gender dysphoria are not merely another set of elective procedures. Typical elective procedures involve only a private mutually consenting contract between a patient and a surgeon. Genital and breast/chest surgeries as medically necessary treatments for gender dysphoria are to be undertaken only after assessment of the patient by qualified mental health professionals, as outlined in section VII of the WPATH Standards Of Care version 7:

Referral for surgery

Surgical treatments for gender dysphoria can be initiated by a referral (one or two, depending on the type of surgery) from a qualified mental health professional. The mental health professional provides documentation—in the chart and/or referral letter—of the patient’s personal and treatment history, progress, and eligibility. Mental health professionals who recommend surgery share the ethical and legal responsibility for that decision with the surgeon.

• One referral from a qualified mental health professional is needed for breast/chest surgery (e.g., mastectomy, chest reconstruction, or augmentation mammoplasty).

• Two referrals—from qualified mental health professionals who have independently assessed the patient—are needed for genital surgery (i.e., hysterectomy/salpingo-oophorectomy, orchiectomy, genital reconstructive surgeries). If the first referral is from the patient’s psychotherapist, the second referral should be from a person who has only had an evaluative role with the patient. Two separate letters, or one letter signed by both (e.g., if practicing within the same clinic) may be sent.

Training

More important than where your surgeon went to school is the type of training he or she received. Who the Surgeon trained under, the experience of that person, what procedures the surgeon specializes in, and how long has he or she been practicing. While a Surgeon may choose to concentrate on a limited number of procedures, this comprehensive background gives a solid foundation to his or her skills.

Experience

– Ask the surgeons on your list if they perform the procedure you need frequently or only occasionally, and when they last performed that procedure.

– Ask how many surgeries they have performed of the specific procedure you are interested in undertaking.

Requirements

Make sure that *you* understand the WPATH Standards of Care and especially the 2011 updates in Version 7.

Make sure the surgeon operates under the WPATH Standards of Care and that they are familiar with recommendations in version 7 of the standards.

Other requirements, blood tests etc. vary slightly from Surgeon to Surgeon, ask your preferred Surgeon what documents he or she requires from you.

Technique

Ask your Surgeon which technique he or she prefers to use and why. Ask them why they use a certain technique as opposed to other techniques, and ask them to explain the benefits and disadvantages of using the technique they prefer. Ask your Surgeon whether they use skin grafts, how often and under what specific circumstances skin grafts may be required, where they are taken from. Ask whether they insist on patients undergoing genital electrolysis before surgery, and ask them why.

Functionality

Ask your surgeon just how functional your results will be following surgery. In the case of genital surgeries, this can mean the depth of the vagina, the sensitivity of the clitoris, the ability to reach orgasm and the ability to urinate cleanly and without any difficulty.

Appearance

The appearance of your result is obviously an important part of any cosmetic procedure. Ask your surgeon to show you photographic examples of their work; the more the better. If your chosen Surgeon is overseas, interstate or not able to be reached easily for a consultation, ask him or her to send you photographs or direct you to Internet websites where they appear.

Cost

The cost of gender confirming surgeries varies between Surgeons, and is usually an important factor in choosing a Surgeon. Ask your Surgeon how much he or she charges, and what their charges include. Some include hospital, surgery fee, anesthetist, airport pick up and return (for overseas and interstate patients), a Surgery Care Kit including aftercare items, and post surgery consultations. Make sure you know what you’re paying for! If traveling overseas, check likely exchange rates, airline ticket prices, and possible accommodation and living expenses. Some Surgeons provide accommodation, most don’t.

Aftercare

Ask your Surgeon how long your hospital stay will be, and how long you should remain close to his or her practice for follow-up consultations. Ask what aftercare product you’ll need to buy, and which ones will be provided. Ask your Surgeon for his or her recommended post-operative dilation and aftercare you’ll be expected to uphold once you’ve returned home. Ask your Surgeon how long you’ll be required to rest before you return to work or other activities. Ask your Surgeon how long he or she recommends before having intercourse.

Testimonials

Ask your preferred Surgeon for names of previous patients you can contact. Ask them the same questions you asked the Surgeon. If you know someone who has seen your chosen Surgeon, ask them the same questions you’ve asked your Surgeon, compare their responses to those given by your Surgeon. Try and make contact with as many previous patients as possible, either in person or by email.

Other Relevant Information

If traveling on a plane for surgery, ask your Surgeon to write a letter to your airline requesting that a wheelchair be made available for you. You may not feel you need this, though you will be first on the plane and last off, avoiding unnecessary crowds. At your destination you’ll be assisted in collecting your luggage. This is extremely helpful.

Expect to be recovering and unable to work for a period recommended by the surgeon following surgery. Plan for this financially when considering your surgery costs.

It is your responsibility to uphold diligent related aftercare procedures to ensure a quick and safe recovery, so find out what procedures you will need to be responsible for such as wound care, etc.

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