What are the risks of gender affirming surgeries?

Written By Bel H

All surgeries come with risks, but many gender affirming surgeries - especially surgery conducted on reproductive organs - are experimental, costly, risky and have high rates of complications and likelihood of revision surgery.[6][8][9][13][16][17][19][20]

The general risks of gender affirming surgeries include:

Specific Risks for Males (Transfeminine Surgeries)

CREATION OF AN ARTIFICIAL VAGINA

(Also referred to as vaginoplasty/vulvoplasty/neo vagina/bottom surgery). 
Risks include:
  • Dilation,  a crucial post-operative procedure following vaginoplasty, involves inserting a lubricated dilator into an artificial vagina to maintain depth, width and prevent contraction of the skin graft inside. [1][2] Patients may need to dilate three times a day for at least 20 minutes[5]. While the frequency of dilation may decrease over time, it is a lifelong process [4] that can be painful [1] emotionally taxing, and lead to further medical complications [1][3].
  • A study found that patients who underwent this surgery often reported pain (53.8%), dilation concerns (46.3%), bleeding (42.5%). Sexual function was also a common concern (33.8%), including concerns about anorgasmia (11.3%) and dyspareunia (painful intercourse)(11.3%). [6]
  • A review found that surgeries to create artificial vaginas have a high overall complication rate (32.5%). [7] Some complications have been lethal. [18]
  • Loss of fertility or impaired sexual function. [9]

REMOVAL OF THE PENIS (PENECTOMY)

(Will often occur alongside surgery to create an artificial vagina / or removal of the testicles)
Risks include:
  • Loss of fertility and impaired sexual function. [9][3][6][24]
  • Chronic pain [3][5][6][24]
  • Narrowing of the urethra and difficulties urinating [3][5][6][24]

REMOVAL OF THE TESTICLES (ORCHIDECTOMY)

(Will often occur alongside surgery to create an artificial vagina / removal of the penis)
Risks include:
  • Depression [22][23]
  • Fatigue [22][23]
  • Hot flashes [22][23]
  • Low muscle mass [22][23]
  • Osteoporosis [22][23]
  • Low sex drive, loss of fertility or impaired sexual function. [9][22][23]

BREAST AUGMENTATION

(Also referred to as top surgery / mammoplasty). 
Risks include:
  • As with other breast surgeries, there is a risk of scar tissue, implant rupture, and changes in nipple sensation [8].

VOCAL SURGERY — SHORTENING THE VOCAL CORDS (CHONDROLARYNGOPLASTY)

Risks include:    
  • Vocal cord dysfunction or paralysis [25][26]
  • Dysphagia (discomfort when swallowing) [25][27]
  • Fluid buildup in vocal cords (edema) [27]
Granulation tissue formation [28]
Infection and scarring (both internal and external) [26][28]

TRACHEAL SHAVE — REDUCING THE SIZE OF THE ‘ADAM’S APPLE’.

FACIAL FEMINISATION — CHANGING THE SHAPE OF ANY OR ALL FACIAL FEATURES.

FILLERS OR LIPOSUCTION, TO ACHIEVE A MORE TYPICALLY FEMININE SHAPE.

Other gender affirming surgeries, like those above, surgeries carry many of the same risks as other cosmetic surgeries including pain, infection, scarring, bleeding and hematoma, blood clots, nerve damage and regret.

Specific Risks for Females (Transmasculine Surgeries)

CREATION OF AN ARTIFICIAL PENIS (PHALLOPLASTY)

(Also referred to as bottom surgery / neo penis/neophallus).
Risks include:
  • This complex procedure involves harvesting skin, fat, nerves, arteries, and veins from the patient's wrist to about halfway up the forearm. The harvested tissue is shaped and contoured to form an artificial penis (also called skin flap or phallus). [10] Complication rates are high, with some surgeons reporting up to 100% chance of at least minor complications. [13]
  • Urethral complications are particularly common, include urethral fistulas: openings causing urine leakage [11][12] and urethral strictures. [13]. 
  • Incontinence or 'dribbling' has been reported in over 70% of patients). [13]
  • Partial or total phallus loss can occur. [12]
  • Other risks include wound breakdown, hematoma formation, decreased sensation, excessive scarring or wound contracture, badder injury (rare), urinary tract infections, infection, bleeding, pain and rectal injury (rare but serious). [13] [14] [15] 
  • Loss of fertility or impaired sexual function. [9]

CONSTRUCTION OF AN IMITATION SCROTUM

(Also can referred to as scrotoplasty. Can occur alongside phalloplasty and removal of female sex organs.)
Risks include:
  • Testicular implant complications including discomfort from oversized implants, erosion of surrounding tissue, infection, or fistula, device extrusion, erosion, migration or malposition, inadequate rigidity, loss of sensation, device failure. [32][33]
  • Injury to the urethra. [33]

REDUCTION OR REMOVAL OF BREAST TISSUE (MASTECTOMY)

(Also referred to as top surgery). Risks include:
  • Seroma, fluid accumulation in the breast area. [29][31]
  • Lymphedema, chronic swelling in the arm or breast area. [29] [31]
  • Persistent pain and sensory disturbances. [30]
  • Inability to breastfeed. In one case study, a detransition describes her distress over her inability to breast feed after a double mastectomy:  “...it was really hard knowing that he wanted to breastfeed, and I couldn't give him that", and,  “I'll never be able to forgive myself for whatever potential effects of testosterone that I took might have had on my eggs and affected my son including, epigenetic changes… who knows what that did?” [16]
  • Other female destransitioners have decribed not being adequately questioned about their true motivations before receiving mastectomies: Detransitioners abandoned by medical and trans communities

 

REMOVAL OF THE UTERUS (HYSTERECTOMY)

(Can occur alongside removal of ovaries/fallopian tubes or the removal of the vagina)
Risks include:
  • Damage to surrounding tissues such as bowels, bladder, ureter, rectum, or other internal organs. [35][36]
  • Menopause that starts at a younger age, even if the ovaries aren't taken out. [36]

REMOVAL OF OVARIES/FALLOPIAN TUBES (SALPINGO-OOPHORECOMY)

(Can occur alongside removal of the uterus or the removal of the vagina) 
Risks include:
  • Hormonal complications / reduced estrogen production if cross-sex hormones (testosterone) are stopped [34][35][36]
  • Higher risk for osteoporosis or low bone density [34][35]
  • Infertility, cessation of ovum production [35][37]

LIPOSUCTION TO ACHIEVE A MORE TYPICALLY MASCULINE SHAPE.

FACIAL MASCULINISATION — CHANGING THE SHAPE OF ANY OR ALL FACIAL FEATURES.

Other gender affirming surgeries, like those above, surgeries carry many of the same risks as other cosmetic surgeries including pain, infection, scarring, bleeding and hematoma, blood clots, nerve damage and regret.
Bel H
Previous

The risks of puberty blockers
Next

Myth Busting: Are gender affirming surgeries performed on minors?