Our gender affirming surgery evaluation process follows a multidisciplinary approach aligned with the World Professional Association for Transgender Health (WPATH) Standards of Care.
Common reasons people seek gender affirming surgeries are to:
- Increase physical and emotional comfort
- Reduce distress related to the body
- Feel more affirmed in their gender identity
- Feel a greater sense of ease and safety in public spaces
- Increase sexual function or fulfillment
Before deciding on a surgery, your Care Pathway Center team will discuss with you all your available options. Here are some things to think about in preparation:
- Which surgery option will help you to achieve your gender affirming goals*
- Timing for surgery based on your life priorities
- Caregiver support to help you while you recover from surgery
- Recovery time
- Physical and emotional health before, during, and after the healing process
- Fertility plans or goals for starting a family
* Some surgeries may not yet be covered under the insurance benefit. To learn which surgeries are covered, please contact Kaiser Permanente Hawaiʻi Member Services at (808) 432-2000.
Feminizing genital surgery
This information is for people thinking about or preparing for feminizing genital surgery, as well as their caregivers who plan to support someone before and after the surgical process.
These surgeries are all performed under general anesthesia.
The vaginoplasty and vulvoplasty surgeries are performed at our affiliated surgical site on the continental U.S. The orchiectomy can be performed locally on Oahu.
The surgery types below will not result in:
- An internal reproductive anatomy, including a uterus, ovaries, or fallopian tubes
- Menstruation, pregnancy, and childbirth
- Removal of the prostate, so patients will need future prostate evaluations when indicated
| Surgery Type | Involves | Why choose this procedure |
|---|---|---|
| Vaginoplasty (Full-depth) |
• Removing the phallus (penis) and testicles, if still present. • Creating a vagina, labia, and clitoris from existing genital tissue (penile and scrotal tissue) and constructing a vaginal canal using the penile inversion technique • Shortening and repositioning of the urethra to allow urinating while seated. For some patients, it is possible to create a clitoral hood and labia minora at this stage. For others, this may require a second surgery called a labioplasty. If a second surgery is necessary, it may take place 3-6 months after the initial surgery, depending on the recovery process |
• If the patient is willing and physically able to undergo a more complex surgery with a longer recovery time than other genital surgery options. • If the patient is prepared to perform lifetime vaginal dilation • If the patient has a desire for vaginal penetration |
| Vulvoplasty (Shallow-depth vaginoplasty) |
• Removing the phallus (penis) and testicles, if still present. • Creating a vagina, labia,and clitoris from existing genital tissue (penile and scrotal tissue) without construction of a vaginal canal • Shortening and repositioning of the urethra to allow urinating while seated. As with full-depth vaginoplasty, the goal is to preserve erotic and tactile genital sensation and urinary function, however penetrative sex with the vagina is not possible |
• Surgery is less complex than full-depth vaginoplasty, so risks are lower and surgical and recovery times are shorter • Lifetime vaginal dilation is not required, since there is no vaginal canal. • Vaginal penetration is not the desired outcome |
| Orchiectomy | • Removing the testicles | • Reduces the production of testosterone, which may allow patients to discontinue anti-androgen medications and reduce estrogen dose. • Less complex than vaginoplasty or vulvoplasty, so risks are lower and recovery times are shorter |
Surgery Risks & Complications
Understanding the benefits, risks, and possible complications will ensure you have a safe surgical outcome.
During your surgical consultation, the surgeon will discuss the risks associated with each procedure type and explain what may need to be done if a complication develops. Some complications heal on their own, but others may require multiple surgeries to address. Risks for all surgeries include:
- Infection
- Side effects from anesthesia
- Opening of the wound along incision lines
- Abnormal swelling or bleeding
- Poor blood flow to the area, leading to partial or full loss of vaginal canal
Post-surgery complications can be minimized by:
- Not using any nicotine products, including tobacco, vaping, patches, gum, or lozenges
- Following your surgeon’s discharge and aftercare instructions
- Keeping the surgical area clean and dry
- Responding to cues from one’s own body
- Dilating your vagina routinely, as advised by your surgeon
Keep in mind that even healthy people, who follow all instructions may develop complications.
Facial feminization surgery
This information is for people thinking about, or preparing for facial feminization surgery (FFS), as well as caregivers who plan to support someone before and after the surgical process. Individuals seek gender affirming facial surgery to:
- Increase physical and emotional comfort
- Reduce distress related to their body (or other symptoms, such as social anxiety)
- Feel more at ease and safer in public spaces
These surgeries are all performed under general anesthesia. All surgeries are performed at our affiliated surgical site on the continental U.S., except the chondrolaryngoplasty (“tracheal shave”), which can be performed locally on Oahu.
FFS is a series of procedures that modifies the craniofacial features to create a more feminine appearance. The surgeon will discuss and customize a FFS surgical plan based on your goals and physical exam findings. FFS procedures may involve:
- Forehead contouring (frontal sinus setback)
- Eyebrow elevation (brow lift)
- Hairline lowering (scalp advancement)
- Jawline contouring (mandibuloplasty)
- Chin contouring (genioplasty)
- Nose reshaping (rhinoplasty)
- Tracheal shave (chondrolaryngoplasty)
FFS Risks & Complications
Any surgery involves risks. Facial surgery has specific risks that are important to consider including:
- Bleeding
- Infection
- Blood clots (hematoma)
- Fluid collection (seroma)
- Delayed wound healing
- Scarring
- Hair loss
- Difficulty breathing through your nose
- Loss of sensation in specific areas
- Weakness of facial muscles
- Future sinus infections or complications
- Hardware infections or complications
- Dental loss, infections, or complications
- Possible need for surgical revisions
Post-surgery complications can be minimized by:
- Not using any nicotine products, including tobacco, vaping, patches, gum, or lozenges
- Following your surgeon’s discharge and aftercare instructions
- Keeping the surgical area clean and dry
- Responding to cues from one’s own body
Keep in mind that even healthy people, who follow all instructions may develop complications.
Masculinizing genital surgery
This information is for people thinking about or preparing for masculinizing genital surgery, as well as caregivers who plan to support someone before and after the surgical process.
These surgeries are all performed under general anesthesia.
The metoidioplasty and phalloplasty surgeries are performed at our affiliated surgical site in the continental U.S. The hysterectomy/oophorectomy surgeries can be performed locally on Oahu.
The surgery types below will not result in biological male reproductive ability (generating sperm for conception).
| Surgery Type | Involves | Why choose this procedure |
|---|---|---|
| Metoidioplasty | • Creation of a neophallus (penis) from existing tissue through a procedure called suspensory ligament release • Vaginectomy, which is the closure of the vagina • May include urethral lengthening using labial tissue to extend the urethra to the tip of the neophallus (penis) • Use of a suprapubic catheter (tube to drain urine) for at least 4-6 weeks until urethra heals • May include scrotoplasty or the creation of a scrotum with the option of testicular implants later |
• May provide ability to stand up and urinate • Maintenance of erogenous sensations • Lower rate of complications • Shorter recovery time • May be converted to a phalloplasty later. • Can be done in combination with hysterectomy with or without salpingo-oophorectomy (removal of fallopian tubes and ovaries) |
| Phalloplasty (2 or more stages) |
• Creation of a neophallus (penis) from a tube of skin from a donor site from the forearm or upper thigh. • Skin graft usually taken from the thigh to cover the donor site. • Use of a suprapubic catheter (tube to drain urine) for at least 4-6 weeks until urethra heals • Stage 2 performed after Stage 1 has healed (at least 6 months) |
• Ability to stand up and urinate. • Satisfying aesthetics. • Maintenance of erogenous sensation/sexual function. • Ability to receive penile implant later for penetrative intercourse. |
Surgery Risks & Complications
Understanding the benefits, risks, and possible complications will ensure you have a safe surgical outcome. During your surgical consultation, the surgeon will discuss the risks associated with each procedure type and explain what may need to be done if a complication develops.
Some complications heal on their own, but others may require multiple surgeries to address. Risks for all surgeries include:
- Infection
- Side effects from anesthesia
- Opening of the wound along incision lines
- Abnormal swelling or bleeding
- Urinary problems, including inability to urinate due to stenosis
- Formation of a fistula, an unplanned opening that can cause leakage of urine.
- Poor blood flow to the area, leading to partial or full loss of the phallus
Post-surgery complications can be minimized by:
- Not using any nicotine products, including tobacco, vaping, patches, gum, or lozenges
- Following your surgeon’s discharge and aftercare instructions
- Keeping the surgical area clean and dry
- Responding to cues from one’s own body
Keep in mind that even healthy people, who follow all instructions may develop complications.
Penile & Testicular Implants
Some individuals may choose to have penile and/or testicular implants placed after undergoing metoidioplasty or phalloplasty. This procedure can typically be performed at least six months after surgery. Reasons to choose to have implants placed:
- Ability to have penetrative intercourse
- Supports gender affirmation
Facial masculinization surgery
This information is for people thinking about, or preparing for facial masculinizing surgery (FMS), as well as caregivers who plan to support someone before and after the surgical process. Individuals seek gender-affirming facial surgery to:
- Increase physical and emotional comfort
- Reduce distress related to their body (or other symptoms, such as social anxiety)
- Feel more at ease and safer in public spaces
FMS is a series of procedures that modifies the craniofacial features to create a more masculine appearance. The surgeon will discuss and customize a FMS surgical plan based on the patient’s goals and physical exam findings. FMS procedures may involve:
- Forehead contouring
- Jawline contouring (mandibuloplasty)
- Chin contouring (genioplasty)
- Nose reshaping (rhinoplasty)
All surgeries are performed at our affiliated surgical site on the continental U.S. under general anesthesia.
FMS Risks & Complications
Any surgery involves risks. Facial surgery has specific risks that are important to consider including:
- Bleeding
- Infection
- Blood clots (hematoma)
- Fluid collection (seroma)
- Delayed wound healing
- Scarring
- Hair loss
- Difficulty breathing through your nose
- Loss of sensation in specific areas
- Weakness of facial muscles
- Future sinus infections or complications
- Hardware infections or complications
- Dental loss, infections, or complications
- Possible need for surgical revisions
Post-surgery complications can be minimized by:
- Not using any nicotine products, including tobacco, vaping, patches, gum, or lozenges
- Following your surgeon’s discharge and aftercare instructions
- Keeping the surgical area clean and dry
- Responding to cues from one’s own body
Keep in mind that even healthy people, who follow all instructions may develop complications.