Surgical Transition

 Focusing on Hysterectomy, Oophorectomy, and Phalloplasty

For individuals diagnosed with Gender Dysphoria or identifying as transgender, the path to aligning their physical bodies with their gender identity involves a series of surgical procedures, notably hysterectomy, oophorectomy, and the construction of male genitalia through phalloplasty.

These surgeries represent pivotal steps in the transition from female to male, each carrying its own set of considerations, preparation requirements, and potential outcomes.

Hysterectomy and Oophorectomy: Surgical Considerations

Following initial surgeries such as mastectomy, individuals may opt for the removal of ovaries and uterus (oophorectomy and hysterectomy) as a further step towards gender transition.

This decision necessitates careful evaluation by healthcare professionals to assess the patient’s physical and psychological readiness for such irreversible procedures.

Post-operatively, individuals must navigate the onset of menopause due to the cessation of natural female hormone production, typically managed through continued hormone therapy.

Preparation for Genital Construction Surgery

The creation of male genitalia, a process known as phalloplasty, is a highly intricate and challenging aspect of gender transition surgeries.

Candidates for this surgery are usually required to have undergone continuous hormone therapy for a minimum of one year, allowing for the manifestation of secondary male sexual characteristics.

This preparatory phase also serves as a period for patients to thoroughly consider the irreversible nature of genital construction and its implications on their future lives.

Phalloplasty: Techniques and Outcomes

Various surgical techniques have been developed for phalloplasty, each with distinct advantages and challenges.

Common methods include the use of tissue from the forearm (forearm flap), anterolateral thigh flap (ALT), and fibula osteocutaneous flap, among others.

These techniques aim to create a functional and aesthetically pleasing male genitalia that allows for urination in the standing position, tactile and sexual sensation, and, in some cases, the capacity for an erection sufficient for sexual intercourse.

Comparative Analysis of Phalloplasty Techniques

Each phalloplasty technique offers different outcomes regarding the size, appearance, and functionality of the constructed genitalia.

The forearm flap method, for instance, is often preferred for its natural appearance and the potential for tactile sensation, albeit with visible scarring at the donor site.

Conversely, the ALT flap method may result in larger genitalia with less visible scarring but can have uncertain sexual sensation. The choice of technique depends on the patient’s preferences, physical condition, and the surgeon’s expertise.

Post-Surgical Adjustments and Considerations

The journey through gender transition surgery requires patients to adjust to significant physical and psychological changes.

Post-surgical care is critical for monitoring healing, managing potential complications, and ensuring the functionality of the constructed genitalia.

Patients must also prepare for the social implications of their transition, including potential challenges in personal and professional environments.


The surgical path from female to male transition for transgender individuals encompasses a complex array of procedures, each with profound implications for the patient’s identity, well-being, and quality of life.

Through informed decision-making, comprehensive preparation, and support from a multidisciplinary healthcare team, patients can navigate this journey towards achieving congruence between their physical appearance and gender identity.

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The Essential First Step

Psychiatry’s Role in the Gender Transition Journey

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